Biomechanical Characteristics of Lumbar Manipulation Performed by Expert, Resident, and Student Physical Therapists

Background Lumbar manipulation is a commonly used treatment for low back pain, but little research evidence exists regarding practitioner biomechanics during manipulation. Most existing evidence describes rate of force production through the hands into instrumented manikins and it is unclear how the practitioner moves their body and legs to generate this force. Objectives To identify and characterize important kinetic and kinematic factors in practitioners of varying experience performing lumbar manipulation in order to identify which factors distinguish experts from less experienced practitioners. Study design This was a cohort observational laboratory study. Methods 43 male physical therapists (PT) and PT students (4 experts, 11 residents, 13 third year, and 15 first year students) performed 4 manipulations each on asymptomatic patient models. Angular and linear kinematics of the pelvis were measured using motion capture, and ground reaction forces were measured with force plates under the practitioner\u27s feet. Results Peak pelvic angular velocity was greater and in the opposite direction in experts compared to other groups in the frontal plane (p = 0.020) and transverse plane (p = 0.000). Experts had greater downward pelvic linear velocity than third year students and first year students (p = 0.000). Experts also demonstrated faster rate of vertical ground reaction force unloading during the manipulation (p = 0.002). Conclusions Expert performance of manipulation was characterized by increased speed of linear and angular pelvic motion, and increased modulation of vertical ground reaction force. These results help to inform educators and practitioners that teach and use this complex manual skill

State of Nonprofits Annual Report: 2016

The 2016 State of Nonprofits and Philanthropy report analyzes the health of San Diego’s nonprofit sector, identifies important trends, and reports on leadership perspectives. In addition to an annual summary of the Caster Center’s State of Nonprofits Quarterly Index (SONP Index) this report draws on the most recently available data about nonprofits from the Internal Revenue Service (IRS) and the California Employment Development Department (EDD). These data are synthesized with feedback from Trend Reporters1 along with the 2016 Nonprofit Leader Survey sent to executive level management in San Diego County to provide the most comprehensive picture of San Diego’s nonprofit and philanthropic sector available (See Appendix A for more information about data sources).https://digital.sandiego.edu/npi-stateofnp/1003/thumbnail.jp

Progress in biomass gasification technique – with focus on Malaysian palm biomass for syngas production

Synthesis gas, also known as syngas, produced from biomass materials has been identified as a potential source of renewable energy. Syngas is mainly consists of CO and H2, which can be used directly as fuel source for power generation and transport fuel, as well as feedstock for chemical production. Syngas is produced through biomass gasification process that converts solids to gas phase via thermochemical conversion reactions. This paper critically reviews the type of gasifiers that have been used for biomass gasification, including fixed bed, fluidized bed, entrained flow and transport reactor types. The advantages and limitations of these gasifiers are compared, followed by discussion on the key parameters that are critical for the optimum production of syngas. Depending on the biomass feedstock, the properties and characteristics of syngas produced can be varied. It is thus essential to thoroughly characterise the properties of biomass to understand the limitations in order to identify the suitable methods for gasification. This paper later focuses on a specific biomass – oil palm-based for syngas production in the context of Malaysia, where palm biomass is readily available in abundance. The properties and suitability for gasification of the major palm biomass, including empty fruit bunch, oil palm fronds and palm kernel shells are reviewed. Optimization of the gasification process can significantly improve the prospect of commercial syngas production

Lower Extremity Kinetics and Muscle Activation During Gait Are Significantly Different During and After Pregnancy Compared to Nulliparous Females

Background Low back, pelvic, and lower extremity pain are common during and after pregnancy. Understanding differences in mechanics between pregnant and non-pregnant females is a first step toward identifying potential pathological mechanisms. The primary purpose of this study was to compare joint kinetics and muscle activation during gait between females during and after pregnancy to nulliparous females. Methods Twenty pregnant females completed testing on three occasions (second trimester, third trimester, and post-partum), while 20 matched, nulliparous controls were tested once. Motion capture, force data, and surface electromyography were averaged across seven trials during gait. Lower extremity kinematics, lower extremity moments and work normalized to pre-pregnancy body mass, work distribution, and peak and average muscle activation amplitude were calculated. Independent t-tests were conducted between pregnant and nulliparous females at each time point. Results Compared to controls, peak hip abductor moments were greater throughout and after pregnancy. Females in second trimester also demonstrated greater sagittal negative ankle work and greater percent contribution of the ankle and smaller percent contribution of the hip to negative work. Compared to controls, during third trimester there were greater knee abductor, ankle plantarflexor, and ankle dorsiflexor moments and greater work at the ankle and total work. Several moment and work variables continued to be elevated post-partum compared to controls. Gluteus maximus muscle activation amplitude was smaller in second trimester and post-partum compared to controls. Significance While overall joint demands were greater during and after pregnancy, there was a smaller relative sagittal utilization of the hip early in pregnancy and smaller gluteus maximus muscle amplitude during second trimester and post-partum. Because the gluteus maximus muscle contributes to force closure and dynamic stability of the low back and pelvis, relative gluteus maximus disuse, concurrent with increased joint loads, could potentially contribute to pain during and after pregnancy

An analysis on the convergence of equal-time commutators and the closure of the BRST algebra in Yang-Mills theories

In renormalizable theories, we define equal-time commutators (ETC'S) in terms of the equal-time limit and investigate its convergence in perturbation theory. We find that the equal-time limit vanishes for amplitudes with the effective dimension d_{\em eff} \leq -2 and is finite for those with d_{\em eff} =-1 but without nontrivial discontinuity. Otherwise we expect divergent equal-time limits. We also find that, if the ETC's involved in verifying an Jacobi identity exist, the identity is satisfied. Under these circumstances, we show in the Yang-Mills theory that the ETC of the $0$ component of the BRST current with each other vanishes to all orders in perturbation theory if the theory is free from the chiral anomaly, from which we conclude that $[\, Q\,,\,Q\,]=0$, where $Q$ is the BRST charge. For the case that the chiral anomaly is not canceled, we use various broken Ward identities to show that $[\, Q\,,\,Q\,]$ is finite and $[\,Q\,,\,[\, Q\,,\,Q]\,]$ vanishes at the one-loop level and that they start to diverge at the two-loop level unless there is some unexpected cancellation mechanism that improves the degree of convergence.Comment: 35 page

Current challenges of behavior change talk for medical professionals and trainees.

ObjectiveTo explore medical professionals' and trainees' experiences and views of behavior change talk in various health care settings to develop current understanding of the challenges that underlie this phenomenon.MethodsQualitative, semi-structured interviews were conducted with medical professionals and trainees (n=29). Grounded theory principles informed sampling, data collection and analysis. To achieve maximum variance, participants with different levels of experience were purposively sampled from a range of primary and secondary care settings. Analysis was iterative, involving a constant comparative approach allowing emergent ideas to be tested in subsequent interviews until thematic saturation was reached.ResultsThree emergent themes described reasons for not engaging in behavior change talk with patients: (1) 'personal challenges'; (2) 'somebody else's responsibility' and (3) 'prioritizing the doctor-patient relationship'.ConclusionDespite increasingly being recognized as a core aspect of medical practice and education, medical professionals and trainees remain unprepared to discuss health-related behavior change with patients and unclear of their roles within contemporary health care.Practice implicationsFormal training in theory-based behavior change techniques is likely to help empower doctors and mitigate many of the barriers found, particularly in relation to socially and emotionally uncomfortable topics that are perceived to threaten the doctor-patient relationship

Improving public services through open data: public toilets

Bichard’s work for the TACT3 project (Bichard REF Output 3) found that UK toilet provision is not centrally collated and no national map or database of toilets exists. In contrast, the UK government’s white paper Open Public Services (2011) emphasised its commitment to incorporating the use of Open Data in public services provision that could be tailored to community preferences, and therefore be more sustainable. Incorporating Open Data on public toilet provision, Bichard and Knight (RCA) developed The Great British Public Toilet Map (GBPTM). Whilst a number of other websites and applications map toilets by ‘crowd surfing’, GBPTM is entirely populated by Open Data, and not only uses the data as information for users, but informs members of the public that such information is available and accessible for their use. This paper presents the development of the GBPTM, including inclusive design research and studies that compare accuracy of information directly provided by users with Open Data collected by local authorities. It suggests that, to meet the health and well-being of an ageing population, a sustainable and cost-effective solution must be found for ‘publicly accessible’ toilet provision, including opening up provision beyond that ‘for customers only’ and providing accurate information on current public provision. The paper highlights the barriers encountered in the production of Open Data by local authorities. A review of the paper in the journal Civil Engineering (May 2013) described the design of the GBPTM as a ‘simple and elegant solution’. The development of a digital output and an understanding of digitally based research led to Bichard’s successful submission to an EPSRC Digital Economy sandpit, in which she developed an interdisciplinary project with the Universities of Newcastle, Bournemouth and the West of England. The project, Family Rituals 2.0, secured £750,000 in research funding with Bichard as co-investigator (2013–15)