Development of a diarrhoea severity scoring scale in a passive health facility-based surveillance system

Background Diarrhoeal disease remains a leading cause of death among children mostly in low and middle- income countries. Factors contributing to disease severity are complex and there is currently no consensus on a scoring tool for use in community-based studies. Methods Data were collected during a passive surveillance system in an outpatient health facility in Lusaka, Zambia from March 2019 to July 2019. Diarrhea episodes were assessed for severity using an in-house severity scoring tool (CIDRZ) and previously published scores (Vesikari, Clark, CODA, and DHAKA). The CIDRZ score was constructed using fieldworker-reported clinical signs and exploratory factor analysis. We used precision-recall curves measuring severe diarrhoea (i.e., requiring intravenous rehydration or referred for hospital admission) to determine the best performing scores. Then, we used Cronbach's alpha to assess the scale's internal consistency. Finally, we used Cohen's kappa to assess agreement between the scores. Results Of 110 diarrhea episodes, 3 (3%) required intravenous rehydration or were referred for hospital admission. The precision-recall area under the curve of each score as a predictor of severe diarrhoea requiring intravenous rehydration or hospital admission was 0.26 for Vesikari, 0.18 for CODA, 0.24 for Clark, 0.59 for DHAKA, and 0.59 for CIDRZ. The CIDRZ scale had substantial reliability and performed similarly to the DHAKA score. Conclusions Diarrhoea severity scores focused on characteristics specific to dehydration status may better predict severe diarrhea among children in Lusaka. Aetiology-specific scoring tools may not be appropriate for use in community healthcare settings. Validation studies for the CIDRZ score in diverse settings and with larger sample sizes are warranted

Changes in functional movement patterns over a competitive season in intercollegiate soccer and volleyball players

Changes in many aspects of physical capacity and athletic performance have been documented through the course of a competitive season in collegiate athletes. Movement pattern quality as measured by the functional movement screen (FMS) has recently been linked to performance and injury risk. The purpose of this study was to document the changes in functional movement patterns over a competitive season. Fifty-seven National Collegiate Athletic Association Division II athletes were screened using the FMS as part of the pre and post participation examination for their competitive seasons in 2012. Composite and individual FMS test scores for the preseason and postseason were compared with identified significant changes. The scores were also analyzed for changes in the number of asymmetries present and the frequency of a score of 1 in any of the tests. There were no significant interactions in the main effects for time or sport in the composite FMS scores. However, 4 individual tests did show significant change. The deep squat (Z = -3.260, p = 0.001) and in-line lunge scores (Z = -3.498, p \u3c 0.001) improved across all athletes, and the active straight leg raise (Z = -2.496, p = 0.013) and rotary stability scores (Z = -2.530, p = 0.011) worsened across all athletes. A reduction in the number of asymmetries (χ = 4.258, p = 0.039) and scores of 1 (χ = 26.148, p \u3c 0.001) were also found. Changes in individual fundamental movement patterns occur through the course of a competitive season

The relationship between glenohumeral joint total range of motion and the functional movement screenTM shoulder mobility test

PURPOSE/BACKGROUND: Side to side asymmetry in glenohumeral joint rotation correlates with injury risk in overhead athletes. The purpose of the current study was to identify the relationship between side-to-side asymmetries in glenohumeral joint total rotational range of motion and shoulder mobility test scores from the Functional Movement Screen™ in collegiate overhead athletes. The authors hypothesized that asymmetries of \u3e 10° in glenohumeral total rotation would not be associated with asymmetrical findings in the Functional Movement Screen™ (FMS) shoulder mobility test. METHODS: Passive glenohumeral total rotational range of motion and the shoulder mobility test of the FMS were measured during pre-participation examinations in 121 NCAA male and female Division II collegiate overhead athletes from varied sports. Passive shoulder range of motion was measured in supine at 90° of abduction, with the humerus in the scapular plane using two measurers and a bubble goniometer. A Pearson Chi-square analysis, p RESULTS: 40/114 (35.1%) athletes demonstrated asymmetries in total glenohumeral rotation. 45/114 (39.5%) athletes demonstrated asymmetries in the shoulder mobility test. Only 17 of the 45 subjects who demonstrated asymmetry on the shoulder mobility test also demonstrated glenohumeral joint rotation differences of \u3e 10°. Athletes with asymmetries in rotation of \u3e 10° were not any more likely to have asymmetries identified in the shoulder mobility test (95% CI=.555-2.658, P=.627). CONCLUSIONS: Glenohumeral joint range of motion is one of multiple contributors to performance on the FMS shoulder mobility test, and alone, did not appear to influence results. The FMS shoulder mobility test should not be used alone as a means of identifying clinically meaningful differences of shoulder mobility in the overhead athlete. Clinicians working with overhead athletes may consider using both assessments as a complete screening tool for injury prevention measures

Restoring capability of friction pendulum seismic isolation systems

The restoring (or re-centring) capability is an important feature of any isolation system and a fundamental requirement of current standards and guideline specifications for the design of seismically isolated structures. In this paper, the restoring capability of spherical sliding isolation systems, often referred to as friction pendulum systems (FPSs), is investigated through an extensive parametric study involving thousands of non-linear response history analyses of SDOF systems. The dynamic behavior of the isolation system is described with the visco-plastic model of Constantinou et al. (J Struct Eng 116(2):455–474, 1990), considering the variability of the friction coefficient with sliding velocity and contact pressure. Numerical analyses have been carried out using a set of approximately three hundred natural seismic ground motions recorded during different earthquakes and differing in seismic intensity, frequency content characteristics, magnitude, epicentral distance and soil characteristics. Regression analysis has been performed to derive the dependency of the residual displacement from the parameters governing the dynamic response of FPS. The influence of near-fault earthquakes and the accumulation of residual displacements due to real sequences of seismic ground motions have been also investigated. Finally, the restoring compliance criteria proposed in this study are compared to the lateral restoring force requirements of current seismic codes. Based on the results of this study, useful recommendations for a (more) rational design of FPSs are outlined