Evaluation of Isokinetic Single-Leg Cycling as a Rehabilitation Exercise Following Anterior Cruciate Ligament Reconstruction Surgery

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments, with over 250,000 injuries per year in the United States. Its primary function is to limit anterior tibial translation when the quadriceps muscle group contracts to extend the knee. Previous studies have found that ACL-deficient individuals avoid use of the quadriceps in the injured limb as a means of limiting anterior movement of the tibia in the absence of a functioning ACL. This altered gait pattern has been found to persist in the period following ACL reconstruction surgery, and inhibits the ability of patients to return to full quadriceps strength during physical therapy. A study by Hunt et al. investigated the existence of quadriceps avoidance in stationary, isokinetic cycling, a common rehabilitation exercise, and found that the injured individuals not only practiced avoidance of the quadriceps, but avoidance of the entire limb as well. This is possible because a large increase in output from one limb can effectively maintain the necessary cadence required in isokinetic cycling. From these results, a study was designed to investigate the effectiveness of isokinetic single-leg cycling in increasing quadriceps strength. Ten control and seven ACL-reconstructed subjects participated in an IRB approved study that consisted of a series of 15 second cycling trails in isokinetic mode at 75 rpm, while kinematic, kinetic, and electromyographic data of the lower limbs were collected, with the trials including both double-leg cycling and single-leg cycling. It was hypothesized that there would be an increase in quadriceps muscle activity, peak knee extensor moment, and knee joint power in single-leg cycling when compared to double-leg cycling. Results of the study, although not statistically significant (p\u3c0.05), hinted at the possible effectiveness of isokinetic single-leg cycling in increasing quadriceps use. A trend in data demonstrated that given a specific limb power, more quadriceps muscle force would be generated in the single-leg task when compared to the double-leg task. Future studies should investigate the muscle activation patterns associated with single-leg cycling, and should involve a testing protocol that assesses the performance of ACL reconstructed individuals at multiple time points in physical therapy

Music Generation with Deep Neural Networks Using Flattened Multi-Channel Skip-3 Softmax and Cross-Entropy

This paper presents an investigation of convolutional neural networks as a means of generating human-plausible, goal-oriented music, specifically pop melodies. Deep neural networks were chosen as a focus because their training seems to mimic the way in which a person passively learns music throughout life. The raw dataset of MIDI files was acquired from 17,216 song clips by 4825 artists from Hooktheory\u27s TheoryTab Database. A custom dataset was created by encoding the MIDI files into sparse matrices and sliding a fixed window over each song to generate sequences. A novel approach within the domain of music generation was employed using a custom ‘skip-3’ softmax activation function, as well as a ‘skip-3’ cross-entropy loss function. The current results of generating music, given a seed, using a fully-connected network, a convolutional network, and a dilated convolutional network show some evidence of rhythmic and harmonic patterns, but lack melodic elements

Universal, Person-Centered Interior Design Recommendations for Sunnybrook Assisted Living

This redesign of a current assisted living facility incorporates principles and theories from Person-Centered Design and the Eden Alternative. Multipurpose spaces and nontraditional additions create an environment that is interesting, functional, and creates added revenue

Isolation of Legionella Pneumophila From Well-Maintained Emergency Showers and Eyewash Stations

Legionella pneumophila is a gram-negative bacterium responsible for Legionnaire\u27s disease, and is commonly transmitted via aerosolized water. Legionella colonization of emergency eyewash and shower stations may pose an exposure hazard to users of these stations. There is little information about the role of these stations as significant reservoirs for Legionella. Samples were collected from 67 stations in an industrial facility. At the time of this study, the stations within this facility were under a routine maintenance program that included at least monthly flushing. This study also included the analysis for other bacterial organisms to determine an association between the presence and concentration of other bacteria and Legionella. All samples resulted in no detection of Legionella, yet 12 of the samples contained large counts of other bacteria. Thus, this study supports that properly maintained emergency eyewash and shower stations do not appear to be a significant source for aerosol transmission of Legionella

REGRESSION ADJUSTMENT AND STRATIFICATION BY PROPENSTY SCORE IN TREATMENT EFFECT ESTIMATION

Propensity score adjustment of effect estimates in observational studies of treatment is a common technique used to control for bias in treatment assignment. In situations where matching on propensity score is not possible or desirable, regression adjustment and stratification are two options. Regression adjustment is used most often and can be highly efficient, but it can lead to biased results when model assumptions are violated. Validity of the stratification approach depends on fewer model assumptions, but is less efficient than regression adjustment when the regression assumptions hold. To investigate these issues, by simulation we compare stratification and regression adjustments. We consider two stratification approaches; equal frequency classes and an approach the attempts to minimize the mean squared error (MSE) of the treatment effect estimate. The regression approach we consider is a Generalized Additive Model (GAM), that flexibly estimates the relations among propensity score, treatment assignment, and outcome. We find that, under a wide range of plausible data generating distributions, the GAM approach outperforms stratification in treatment effect estimation with respect to bias, variance, and thereby MSE. We illustrate approaches via analysis of data on insurance plan choice and its relation to satisfaction with asthma care

OPTIMAL PROPENSITY SCORE STRATIFICATION

Stratifying on propensity score in observational studies of treatment is a common technique used to control for bias in treatment assignment; however, there have been few studies of the relative efficiency of the various ways of forming those strata. The standard method is to use the quintiles of propensity score to create subclasses, but this choice is not based on any measure of performance either observed or theoretical. In this paper, we investigate the optimal subclassification of propensity scores for estimating treatment effect with respect to mean squared error of the estimate. We consider the optimal formation of subclasses within formation schemes that require either equal frequency of observations within each subclass or equal variance of the effect estimate within each subclass. Under these restrictions, choosing the partition is reduced to choosing the number of subclasses. We also consider an overalll optimal partition that produces an effect estimate with minimum MSE among all partitions considered. To create this stratification, the investigator must choose both the number of subclasses and their placement. Finally, we present a stratified propensity score analysis of data concerning insurance plan choice and its relation to satisfaction with asthma care

LEARNING FROM NEAR MISSES IN MEDICATION ERRORS: A BAYESIAN APPROACH

Medical errors originating in health care facilities are a significant source of preventable morbidity, mortality, and healthcare costs. Voluntary error report systems that collect information on the causes and contributing factors of medi- cal errors regardless of the resulting harm may be useful for developing effective harm prevention strategies. Some patient safety experts question the utility of data from errors that did not lead to harm to the patient, also called near misses. A near miss (a.k.a. close call) is an unplanned event that did not result in injury to the patient. Only a fortunate break in the chain of events prevented injury. We use data from a large voluntary reporting system of 836,174 medication errors from 1999 to 2005 to provide evidence that the causes and contributing factors of errors that result in harm are similar to the causes and contributing factors of near misses. We develop Bayesian hierarchical models for estimating the log odds of selecting a given cause (or contributing factor) of error given harm has occurred and the log odds of selecting the same cause given that harm did not occur. The posterior distribution of the correlation between these two vectors of log-odds is used as a measure of the evidence supporting the use of data from near misses and their causes and contributing factors to prevent medical errors. In addition, we identify the causes and contributing factors that have the highest or lowest log-odds ratio of harm versus no harm. These causes and contributing factors should also be a focus in the design of prevention strategies. This paper provides important evidence on the utility of data from near misses, which constitute the vast majority of errors in our data

INTEGRATION OF TECHNOLOGY ROADMAPPING INFORMATION INTO DMSMS-DRIVEN DESIGN REFRESH PLANNING OF THE V-22 ADVANCED MISSION COMPUTER

As the pace of technological progress increases, technology obsolescence problems will have a greater effect on traditionally sustainment-dominated industries. Many organizations rely solely on reactive approaches to manage obsolescence events as they occur, often employing lifetime buys, aftermarket sources and other mitigation approaches to ensure that they have enough parts to last through the system's lifecycle. Strategically planned design refreshes coupled with various mitigation approaches can, in many cases, lead to greater cost avoidance than reactive mitigation alone. Design refresh planning is performed by organizations that wish to avoid the high costs of purely reactive obsolescence solutions. Planning to phase-out specific parts at certain times lessens the reliance on reactive solutions (and the resulting quest for obsolete parts) and, in turn, lessens the total cost of sustaining a system. However, design refreshing solely to manage obsolescence is not practical for many systems, and therefore, obsolescence management refresh activities need to be coordinated with the technology insertion roadmap. Technology insertion roadmaps are developed to dictate how the system's functionality and performance must be changed over time. Technology roadmaps reflect an organization's internal technology goals and budget cycles, and give insight into the organization's inherent modus operandi. The MOCA (Mitigation of Obsolescence Cost Analysis) software tool has been designed to generate and select an optimum design refresh plan for a system. This thesis describes an extension to MOCA that allows information from technology roadmaps to be used as constraints in MOCA. The integration of technology roadmap information into MOCA's decision analysis ensures that selected refresh plans meet roadmap imposed timing constraints, and that the costs of roadmap specified actions are included within relevant refreshes. These new developments in MOCA are discussed in the context of the V-22 Advanced Mission Computer (AMC) system. The mechanics of the MOCA tool's optimization analysis with roadmapping considerations are described and the cost avoidance resulting from the optimum refresh plan is articulated in business case terms

Harvest of the Month Kits for Early Care and Education Settings

Research tells us that a young child’s food preferences develop within the first few years of life as an infant transitions from eating one food to a multitude of foods with varying flavor profiles.1 With the understanding of a young child’s influential years, early care facilities have the ability to target these young years and help influence dietary preferences in a healthy, engaging, and positive way. For my capstone project, four Harvest of the Month (HOTM) Kits will be created to be used in Early Care and Education settings with three-to-five-year-olds. These HOTM Kits will be correlated with Georgia’s Department of Education’s kindergarten through twelfth grade Harvest of the Month resources. Each kit will combine a locally grown Georgia fruit or vegetable, recipe to prepare the seasonal produce, nutritional activity to tie in learning, children’s literature connection, handout to send home, and a local procurement handout. The goal of these kits are to provide a hands-on learning experience to enhance children’s knowledge of fruits and vegetables through activities and literature connections, allow them an opportunity to try new fruits and vegetables through taste testing, and empower them in the kitchen through recipe creations