bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of water content in a power transformer using moisture dynamic measurement of its oil
Authors: Sarfi Vahid , Mohajeryami Saeed , Majzoobi Alireza
Published: February 2017

Careful monitoring of high voltage equipments and diagnosing the critical conditions before they lead to a disaster are prerequisites of condition‐based maintenance. Moisture content in a transformer is regarded as one of the major factors in diagnosing its conditions. It causes many problems for a power transformer including electrical breakdown between either its windings or one winding with neutral, increase in the amount of partial discharge and sundry minor problems. Since paper insulation of a power transformer carries large portion of water content, determining moisture content in this part of the transformer is essential. However, the problem is that the direct measurement of moisture in paper is impossible. Therefore, various methods have been proposed to measure the moisture content in a transformer but each one has its limitations. In this study, an approach is introduced to measure water content in a transformer by analysing the moisture dynamics in oil, tracking its variations and analysis of parameters such as temperature, without necessity of disconnecting the transformer from the power grid.
Workforce insights on how health promotion is practised in an Aboriginal Community Controlled Health Service
Authors: McFarlane Kathryn , Devine Sue , Judd Jenni , Nichols Nina , Watt Kerrianne
Published: February 2017

Aboriginal Community Controlled Health Services deliver holistic and culturally appropriate primary health care to over 150 communities in Australia. Health promotion is a core function of comprehensive primary health care; however, little has been published on what enables or challenges health promotion practice in an Aboriginal Community Controlled Health Service. Apunipima Cape York Health Council (Apunipima) delivers primary health care to 11 remote north Queensland communities. The workforce includes medical, allied health, Aboriginal and Torres Strait Islander health workers and health practitioners and corporate support staff. This study aimed to identify current health promotion practices at Apunipima, and the enablers and challenges identified by the workforce, which support or hinder health promotion practice. Sixty-three staff from across this workforce completed an online survey in February 2015 (42% response rate). Key findings were: (1) health promotion is delivered across a continuum of one-on-one approaches through to population advocacy and policy change efforts; (2) the attitude towards health promotion was very positive; and (3) health promotion capacity can be enhanced at both individual and organisational levels. Workforce insights have identified areas for continued support and areas that, now identified, can be targeted to strengthen the health promotion capacity of Apunipima.
Prevalence of HIV among Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis
Authors: Graham Simon , O'Connor Catherine C. , Morgan Stephen , Chamberlain Catherine , Hocking Jane
Published: February 2017

Background
Aboriginal and Torres Strait Islanders (Aboriginal) are Australia’s first peoples. Between 2006 and 2015, HIV notifications increased among Aboriginal people; however, among non-Aboriginal people, notifications remained relatively stable. This systematic review and meta-analysis aims to examine the prevalence of HIV among Aboriginal people overall and by subgroups. Methods: In November 2015, a search of PubMed and Web of Science, grey literature and abstracts from conferences was conducted. A study was included if it reported the number of Aboriginal people tested and those who tested positive for HIV. The following variables were extracted: gender; Aboriginal status; population group (men who have sex with men, people who inject drugs, adults, youth in detention and pregnant females) and geographical location. An assessment of between study heterogeneity (I2 test) and within study bias (selection, measurement and sample size) was also conducted. Results: Seven studies were included; all were cross-sectional study designs. The overall sample size was 3772 and the prevalence of HIV was 0.1% (I2 = 38.3%, P = 0.136). Five studies included convenient samples of people attending Australian Needle and Syringe Program Centres, clinics, hospitals and a youth detention centre, increasing the potential of selection bias. Four studies had a sample size, thus decreasing the ability to report pooled estimates. Conclusions: The prevalence of HIV among Aboriginal people in Australia is low. Community-based programs that include both prevention messages for those at risk of infection and culturally appropriate clinical management and support for Aboriginal people living with HIV are needed to prevent HIV increasing among Aboriginal people.
Undiagnosed hepatitis B and C infection is rare in Sydney gay and bisexual men attending a community HIV testing site
Authors: Lockwood John , Gray James , Selvey Christine
Published: February 2017

This letter reports on an enhanced surveillance snapshot of hepatitis B and C at a men who have sex with men community testing site in inner Sydney. The finding show undiagnosed hepatitis B and C infection is rare in this population of gay and bisexual men. Evidence of immunity to hepatitis B through vaccination is high, however client knowledge of vaccination status is poor. Current targeted hepatitis screening practices were sufficient to detect all undiagnosed cases of hepatitis B and C in this population.
Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments
Authors: Keuroghlian Alex S. , Ard Kevin L. , Makadon Harvey J.
Published: February 2017

Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Adequate LGBT sexual health education for emerging health professionals is currently lacking. Clinical training programs and healthcare organisations are well poised to start addressing these disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Health education programs can emphasise mastery of basic LGBT concepts and terminology, as well as openness towards and acceptance of LGBT people. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for the health needs of LGBT patients also involves the creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.
Comparative optical genome analysis of two pangolin species: Manis pentadactyla and Manis javanica
Authors: Zhihai Huang , Jiang Xu , Shuiming Xiao , Baosheng Liao , Yuan Gao , Chaochao Zhai , Xiaohui Qiu , Wen Xu , Shilin Chen
Published: February 2017

Background: The pangolin is a Pholidota mammal with large keratin scales protecting its skin. Two pangolin species (Manis pentadactyla and Manis javanica) have been recorded as critically endangered on the International Union for Conservation of Nature Red List of Threatened Species. Optical mapping constructs high-resolution restriction maps from single DNA molecules for genome analysis at the megabase scale and to assist genome assembly. Here, we constructed restriction maps of M. pentadactyla and M. javanica using optical mapping to assist with genome assembly and analysis of these species.

Findings: Genomic DNA was nicked with Nt.BspQI and then labeled using fluorescently labeled bases that were detected by the Irys optical mapping system. In total, 3,313,734 DNA molecules (517.847 Gb) for M. pentadactyla and 3,439,885 DNA molecules (504.743 Gb) for M. javanica were obtained, which corresponded to approximately 178X and 177X genome coverage, respectively. Qualified molecules (≥150 kb with a label density of >6 sites per 100 kb) were analyzed using the de novo assembly program embedded in the IrysView pipeline. We obtained two maps that were 2.91 Gb and 2.85 Gb in size with N50s of 1.88 Mb and 1.97 Mb, respectively.

Conclusions: Optical mapping reveals large-scale structural information that is especially important for non-model genomes that lack a good reference. The approach has the potential to guide de novo assembly of genomes sequenced using next-generation sequencing. Our data provide a resource for Manidae genome analysis and references for de novo assembly. This note also provides new insights into Manidae evolutionary analysis at the genome structure level.
A History of the Council of State Neurosurgical Societies
Authors: Zaidi Hasan A. , Tumialán Luis M. , Rosenow Joshua M. , Colen Chaim B. , Stroink Ann R. , Linskey Mark , Schirmer Clemens M. , Watridge Clarence
Published: February 2017

As neurological surgery evolved into its own subspecialty early in the 20th century, a need arose to create an environment for communication and education among those surgeons working in this burgeoning surgical discipline. As the socioeconomic climate in health care began to change in the United States, an unforeseen need arose that was outside the scope of the American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Society of Neurological Surgeons. The capacity to understand and address the evolving socioeconomic landscape and to offer a platform for advocacy required a new entity. Grassroots efforts of neurosurgeons at the state level ultimately yielded a formal organization of state neurosurgical societies to fill this void by recognizing, understanding, and addressing socioeconomic factors affecting the practice of neurological surgery. This formal organization became the Council of State Neurosurgical Societies (CSNS). The CSNS provides a forum in which state societies can meet to identify, understand, and advocate for policies on behalf of organized neurosurgery. The purpose of this paper is to detail the history of the formation of the CSNS. By understanding this history and the need for the development of the CSNS, it is hoped that its evolving role as a voice for neurological surgeons in the modern era of health care will be made clear.
Multiloculated Pyogenic Brain Abscess: Experience in 25 Patients
Authors: Su Thung-Ming , Lan Chu-Mei , Tsai Yu-Duan , Lee Tao-Chen , Lu Cheng-Hsien , Chang Wen-Neng
Published: February 2017

OBJECTIVE

To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses.

METHODS

We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess.

RESULTS

The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragiliswas the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess.

CONCLUSION

Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.
Stimulation of the Posterior Hypothalamus for Treatment of Chronic Intractable Cluster Headaches: First Reported Series
Authors: Franzini Angelo , Ferroli Paolo , Leone Massimo , Broggi Giovanni
Published: February 2017

OBJECTIVE

To describe the results of deep brain stimulation of the ipsilateral posterior hypothalamus for the treatment of drug-resistant chronic cluster headaches (CHs). A technique for electrode placement is reported.

METHODS

Because recent functional studies suggested hypothalamic dysfunction as the cause of CH bouts, we explored the therapeutic effectiveness of posterior hypothalamic stimulation for the treatment of CHs. Five patients with intractable chronic CHs were treated with long-term, high-frequency, electrical stimulation of the posterior hypothalamus. Electrodes were stereotactically implanted in the following position: 3 mm behind the midcommissural point, 5 mm below the midcommissural point, and 2 mm lateral to the midline.

RESULTS

Since this treatment, all five patients continue to be pain-free after 2 to 22 months of follow-up monitoring. Two of the five patients have remained pain-free without any medication, whereas three of the five required low doses of methysergide (two patients) or verapamil (one patient). No adverse side effects of chronic, high-frequency, hypothalamic stimulation have been observed, and we have not encountered any acute complications resulting from the implant procedure. There have been no tolerance phenomena.

CONCLUSION

These preliminary results indicate a role for posterior hypothalamic stimulation, which was demonstrated to be safe and effective, in the treatment of drug-resistant chronic CHs. These data point to a central pathogenesis for chronic CHs.
Distinction between Paraclinoid and Cavernous Sinus Aneurysms with Computed Tomographic Angiography
Authors: Gonzalez L. Fernando , Walker Matthew T. , Zabramski Joseph M. , Partovi Shahram , Wallace Robert C. , Spetzler Robert F.
Published: February 2017

OBJECTIVE

To examine the reliability of using the optic strut as a landmark in computed tomographic (CT) angiography, to differentiate between intradural and extradural (cavernous sinus) aneurysms involving the paraclinoid segment of the internal carotid artery (ICA).

METHODS

Microanatomic dissections were performed with five cadaveric heads (10 sides), to establish the relationships of the optic strut to the cavernous sinus and the ICA. Results from these anatomic studies were compared with intraoperative and CT angiographic findings for four patients with nine intracranial aneurysms involving the paraclinoid segment of the ICA.

RESULTS

The inferior boundary of the optic strut accurately localized the point at which the ICA pierced the oculomotor membrane (proximal dural ring) and exited the cavernous sinus. The optic strut and its relationship to the ICA could be well observed on CT angiograms. During surgery, six of six aneurysms that arose distal to the optic strut were identified intradurally and were successfully clipped. Conversely, all aneurysms that arose proximal to the optic strut were observed to lie within the cavernous sinus. An aneurysm at the optic strut was within the clinoid segment or interdural, between the proximal and distal rings.

CONCLUSION

The optic strut, as identified with CT angiography, provided a reliable anatomic landmark for accurate discrimination between intradural and extradural (cavernous sinus) aneurysms.
Trigeminal Neuralgia Associated with a Primitive Trigeminal Artery Variant: Case Report
Authors: Tamura Yoji , Shimano Hiroshi , Kuroiwa Toshihiko , Miki Yoshihito
Published: February 2017

OBJECTIVE AND IMPORTANCE

A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel.

CLINICAL PRESENTATION

A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis.

INTERVENTION

Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively.

CONCLUSION

Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.
Simulation-Based Neurosurgical Training for the Presigmoid Approach With a Physical Model
Authors: Jabbour Pascal , Chalouhi Nohra
Published: February 2017

BACKGROUND:

In recent years, there has been growing interest in the use of simulation to supplement conventional surgical training. Simulation remains, however, in its infancy in neurosurgery.

OBJECTIVE:

To report on and assess the utility of a simulation physical model for the presigmoid approach.

METHODS:

The Congress of Neurological Surgeons created a Simulation Committee to explore and develop simulation-based models. The current model involves drilling of the presigmoid cranial base under image guidance. Each time the drill touches the dura, facial nerve, or sigmoid sinus, a beeping and a warning sound are emitted.

RESULTS:

Nine neurosurgery residents participated in and completed the presigmoid approach simulation module. All residents successfully completed the simulation procedure within the allocated time period (20 minutes). The mean number of hits to the dura, facial nerve, and sigmoid sinus decreased from 4.2 in the first test to 3.1 in the second test (P < .05). The facial nerve was the most likely structure to be injured, followed by the sigmoid sinus and finally the dura. All 9 participants had an improvement in their technical scores.

CONCLUSION:

The presigmoid approach simulation model is a useful tool in resident education that may improve surgical proficiency while minimizing risk to patients. More studies with standardized end points for technical proficiency and clinical outcomes are needed.
Reliability of Scores on the Stroke Rehabilitation Assessment of Movement (STREAM) Measure
Authors: Daley Kathy , Mayo Nancy , Wood-Dauphinée Sharon
Published: February 2017

Background and Purpose. The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores.Subjects and Methods. A “direct-observation reliability study” was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A “videotaped assessments reliability study” was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability.Results. The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall.Conclusion and Discussion. These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress.
Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain
Authors: Levangie Pamela K
Published: February 2017

Background and Purpose. The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and the Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. Subjects. A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. Methods. The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive values. Results. Individual test sensitivities were low (8%-44%), as were negative predictive values (28%-38%), for identifying the presence of innominate torsion. Combining tests and controlling for sex, age group, leg-length difference, or iliac crest level did not improve performance characteristics. The associations of test results with low back pain were weak, with the exception of the Gillet test (odds ratio=4.57). Conclusion and Discussion. The data do not support the value of these tests in identifying innominate torsion, although the use of these tests for identifying other phenomena (eg, sacroiliac joint hypomobility) cannot be ruled out. Further exploration of the association of Gillet test results with low back pain is warranted.
Postural Synergies Associated With a Stepping Task
Authors: Mercer Vicki Stemmons , Sahrmann Shirley A
Published: February 2017

Background and Purpose. Synergistic relationships among multiple muscle components are thought to exist to simplify control of posture and movement. The purpose of this study was to examine the extent to which children, young adults, and older adults exhibit consistent sequences of postural muscle activation when lifting the right foot onto a step from a standing position. Subjects. Twenty subjects without known impairments of the neuromuscular system (10 male, 10 female) in each of 3 age groups—children (8–12 years), young adults (25–35 years), and older adults (65–73 years)—participated. Methods. A pressure switch taped to the subject's right foot was used to determine movement onset and offset. Latencies of muscle activation were determined using surface electromyography. A preferred postural synergy was defined as the sequence of postural muscle activation observed during the majority of trials for each subject. Results. Mean movement times did not differ among age groups. Although the left tibialis anterior (TA) muscle was the first of the postural muscles activated in 93% of the trials, subjects displayed considerable variability in the subsequent order of postural muscle activation. Across subjects, a total of 14 different preferred postural synergies were observed. Age groups did not differ in the number of different synergies. Conclusion and Discussion. Early TA activation may reflect biomechanical constraints of the stepping task, producing forward displacement of the center of mass over the changing base of support. The fact that subjects of all ages were quite variable in the specific sequences of muscles activated subsequent to the TA suggests that, for this type of task, therapists should not focus their interventions on facilitating execution of particular synergy patterns.
The Sock Test for Evaluating Activity Limitation in Patients With Musculoskeletal Pain
Authors: Strand Liv I , Wie Solveig L
Published: February 2017

Background and Purpose. Assessment within rehabilitation often must reflect patients' perceived functional problems and provide information on whether these problems are caused by impairments of the musculoskeletal system. Such capabilities were examined in a new functional test, the Sock Test, simulating the activity of putting on a sock. Subjects and Methods. Intertester reliability was examined in 21 patients. Concurrent validity, responsiveness, and predictive validity were examined in a sample of 337 patients and in subgroups of this sample. Results. Intertester reliability was acceptable. Sock Test scores were related to concurrent reports of activity limitation in dressing activities. Scores also reflected questionnaire–derived reports of problems in a broad range of activities of daily living and pain and were responsive to change over time. Increases in age and body mass index increased the likelihood of Sock Test scores indicating activity limitation. Pretest scores were predictive of perceived difficulties in dressing activities after 1 year. Conclusion and Discussion. Sock Test scores reflect perceived activity limitations and restrictions of the musculoskeletal system.
Energy Cost of Propulsion in Standard and Ultralight Wheelchairs in People With Spinal Cord Injuries
Authors: Beekman Claire E , Miller-Porter Leslie , Schoneberger Marion
Published: February 2017

Background and Purpose. Wheelchair- and subject-related factors influence the efficiency of wheelchair propulsion. The purpose of this study was to compare wheelchair propulsion in ultralight and standard wheelchairs in people with different levels of spinal cord injury. Subjects. Seventy-four subjects (mean age=26.2 years, SD=7.14, range=17-50) with spinal cord injury resulting in motor loss (30 with tetraplegia and 44 with paraplegia) were studied. Method. Each subject propelled standard and ultralight wheelchairs around an outdoor track at self-selected speeds, while data were collected at 4 predetermined intervals. Speed, distance traveled, and oxygen cost (V̇o2 mL/kg/m) were compared by wheelchair, group, and over time, using a Bonferroni correction. Results. In the ultralight wheelchair, speed and distance traveled were greater for both subjects with paraplegia and subjects with tetraplegia, whereas V̇o2 was less only for subjects with paraplegia. Subjects with paraplegia propelled faster and farther than did subjects with tetraplegia. Conclusion and Discussion. The ultralight wheelchair improved the efficiency of propulsion in the tested subjects. Subjects with tetraplegia, especially at the C6 level, are limited in their ability to propel a wheelchair.
The Prevalence of Low Back Pain in Adults: A Methodological Review of the Literature
Authors: Loney Patricia L , Stratford Paul W
Published: February 2017

The prevalence of low back pain (LBP) has been reported in the literature for different populations. Methodological differences among studies and lack of methodological rigor have made it difficult to draw conclusions from these studies. A systematic review was done for adult community prevalence studies of LBP published from 1981 to 1998. The technique of capture-recapture was performed to estimate the completeness of the search strategy used. Established guidelines and a methodological scoring system were used to critically appraise the studies. Thirteen studies were deemed methodologically acceptable. Differences in the duration of LBP used in the studies appeared to affect the prevalence rates reported and explain much of the variation seen. It was estimated that the point prevalence rate in North America is 5.6%. Further studies using superior methods are needed, however, before this estimate can be used with confidence to make health care policies and decisions relating to physical therapy.
Physical Therapy for Facial Paralysis: A Tailored Treatment Approach
Authors: Brach Jennifer S , VanSwearingen Jessie M
Published: February 2017

Background and Purpose. Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. Case Description. The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. Outcomes. In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score=17/100, final FGS score=68/100) and no reported functional limitations. Discussion. Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.
Effects of Repetitive Handgrip Training on Endurance, Specificity, and Cross–Education
Authors: Shields Richard K , Leo Ken C , Messaros Andrew J , Somers Virend K
Published: February 2017

Background and Purpose. Exercise programs are more likely to be successful when they are based on research that predicts the outcomes of such training. This study determined the effect of submaximal rhythmic handgrip training on rhythmic handgrip endurance or work (RHW), isometric handgrip endurance time (IHE), and maximal voluntary isometric contraction for the handgrip force (MVIC) (in newtons). Subjects. Twenty–four male subjects (mean age=26.2 years) with right–hand dominance were randomly assigned to a regular training group (n=8), a low–level training group (n=8), or a control group (n=8). Methods. Rhythmic handgrip work, IHE, and MVIC were determined bilaterally before and after 6 weeks of a rhythmic right handgrip training program using 30% of MVIC. The low-level training group performed daily training with a near–zero load (<0.005% of MVIC). Results. There was a 1,232% increase in RHW and an 8% decrease in IHE after the training program using 30% of MVIC for the right hand. The left hand showed a 43% increase in RHW after training, whereas the low–level training group showed a 35% increase in RHW. No differences were found between the change in the left=hand RHW of the regular training group and the change in the right–hand RHW of the low–level training group, but both measurements were greater than the change in the control group (6.4%). Conclusion and Discussion. Submaximal handgrip endurance training at 30% of MVIC had a minimal effect on submaximal IHE and MVIC of the handgrip, but it had a large effect on RHW of the trained extremity. The regular training group and the low–level training group showed similar increases in cross–education, suggesting that cross–education during endurance training is not intensity–dependent.
The Clinical Doctorate: A Framework for Analysis in Physical Therapist Education
Authors: Threlkeld A Joseph , Jensen Gail M , Royeen Charlotte Brasic
Published: February 2017

This article explores major considerations for analysis and discussion of the role of the clinical doctorate as the first professional degree in physical therapist education (DPT). A process for this analysis is posed based on a conceptual framework developed by Stark, Lowther, Hagerty, and Orczyk through grounded theory research on professional education. External influences from society and the profession, institutional and programmatic influences, and articulation of critical dimensions of professional competence and professional attitudes as major categories are discussed in relation to the DPT. A series of questions generated from the application of the model are put forth for continued discussion and deliberation concerning the DPT. We conclude that the DPT provides the best pathway to serve society, the patient, and the profession.
Effect of Positioning on Recorded Lung Sound Intensities in Subjects Without Pulmonary Dysfunction
Authors: Jones Alice , Jones R Douglas , Kwong Kevin , Burns Yvonne
Published: February 2017

Background and Purpose. Physical therapists often use positioning to assist in the reexpansion of collapsed lung segments. An increase in lung sound intensity on auscultation is considered indicative of lung expansion. This study was designed to examine whether clinical interpretation of auscultatory findings is warranted. Subjects. The subjects (5 male, 6 female) were young physical therapist students without pulmonary dysfunction (mean age=20.4 years, mean height=166.3 cm, mean weight=57.5 kg). Subjects with lung disease were excluded because pulmonary pathology is difficult to standardize. Methods. Lung sounds electronically recorded over the posterior chest wall of subjects in sitting and side-lying positions were compared. Measures included peak intensity, frequency at maximum power, and median frequency. Results. In the sitting position, inspiratory sounds recorded over the left posterior chest wall were louder than those recorded on the right side. In the side-lying positions, the sound intensity recorded from the dependent chest wall was louder than that recorded from the nondependent chest wall. In side-lying positions, the upper hemithorax is “nondependent,” and the side in contact with the bed is “dependent.” Sound intensities recorded over both posterior chest walls in the sitting position were louder than those recorded over the same lung area in the nondependent side-lying position. There was no difference in the sound intensity recorded between the sitting and dependent side-lying postures. Conclusion and Discussion. When comparative auscultation of the chest wall is used by physical therapists to assess the adequacy of pulmonary ventilation, patient posture and regional differences in breath sound intensity can influence clinical interpretation.
Effects of Length on the Catchlike Property of Human Quadriceps Femoris Muscle
Authors: Lee Samuel CK , Gerdom Michelle L , Binder-Macleod Stuart A
Published: February 2017

Background and Purpose. Recent reports have suggested that electrical stimulation trains that take advantage of the catchlike property of skeletal muscle can produce higher forces from skeletal muscle than traditionally used constant-frequency trains. This study investigated the effects of catchlike-inducing trains on human quadriceps femoris muscles while the knee joint was held at 15 degrees of flexion. Subjects and Methods. Subjects (N=12) were tested with constant-frequency trains that had interpulse intervals ranging from 10 to 160 milliseconds and comparable catchlike-inducing trains. Data were collected during the control condition (1 train every 10 seconds) and during repetitive contractions (1 train per second). Results. During control and repetitive activation conditions, catchlike-inducing trains produced approximately 5% to 110% greater peak forces than comparable constant-frequency trains, depending on the frequencies being compared. Total forces produced (ie, force-time integrals) were increased up to 59% and 49% during the control and repetitive activation conditions, respectively. Conclusion and Discussion. These results support earlier findings that catchlike-inducing trains may be advantageous in functional electrical stimulation applications.
Expert Practice in Physical Therapy
Authors: Jensen Gail M , Gwyer Jan , Shepard Katherine F , Hack Laurita M
Published: February 2017

Background and Purpose. The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Methods. Guided by a grounded theory approach, a multiple case study research design was used, with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. Results. A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. Conclusion and Discussion. These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.
Circulatory Responses to Voluntary and Electrically Induced Muscle Contractions in Humans
Authors: Miller Benjamin F , Gruben Kreg G , Morgan Barbara J
Published: February 2017

Background and Purpose. Transcutaneous electrical nerve stimulation (TENS) increases regional blood flow when applied at intensities sufficient to cause skeletal muscle contraction. It is not known whether increases in blood flow elicited by TENS differ from those caused by voluntary muscle contraction. The purpose of this study, therefore, was to compare the hemodynamic effects of these 2 types of muscle contraction. Subjects and Methods. Fourteen people with no known pathology, aged 18 to 49 years (X̄=28, SD=8), served as subjects. Calf blood flow (venous occlusion plethysmography), heart rate (electrocardiogram), blood pressure (automated sphygmomanometry), and force (footplate transducer) were measured during electrically induced and voluntary contractions. Results. Both modes of exercise caused rapid, but short-lived vasodilation (calf vascular resistance [X̄±SEM]: −53%±3% for voluntary contractions versus −57%±4% for electrically induced contractions). The vasodilation caused by electrically induced contractions persisted for at least 15 seconds in the postexercise period, whereas the vasodilation elicited by voluntary contractions had resolved by this time point. Conclusion and Discussion. The hemodynamic changes elicited by voluntary and electrically induced muscle contractions are similar in magnitude but different in duration.
Reliability and Responsiveness of Two Physical Performance Measures Examined in the Context of a Functional Training Intervention
Authors: King Mary B , Judge James O , Whipple Robert , Wolfson Leslie
Published: February 2017

Background and Purpose. The reliability and responsiveness of 2 physical performance measures were assessed in this nonrandomized, controlled pilot exercise intervention. Subjects. Forty-five older individuals with mobility impairment (mean age=77.9 years, SD=5.9, range=70–92) were sequentially assigned to participate in an exercise program (intervention group) or to a control group. Methods. The intervention group performed exercise 3 times a week for 12 weeks that targeted muscle force, endurance, balance, and flexibility. Outcome measures were the 8-item Physical Performance Test (PPT-8) and the 6-minute walk test. Test-retest reliability and responsiveness indexes were determined for both tests; interrater reliability was measured for the PPT-8. Results. The intraclass correlation coefficient for interrater reliability for the PPT-8 was .96. Intraclass correlation coefficients for test-retest reliability were .88 for the PPT-8 and .93 for the 6-minute walk test. The intervention group improved 2.4 points and the control group improved 0.7 point on the PPT-8, as compared with baseline measurements. There was no change in 6-minute walk test distance in the intervention group when compared with the control group. The responsiveness index was .8 for the PPT-8 and .6 for the 6-minute walk test. Conclusion and Discussion. Measurements for both the PPT-8 and the 6-minute walk test appeared to be highly reliable. The PPT-8 was more responsive than the 6-minute walk test to change in performance expected with this functional training intervention.
Patellar Kinematics, Part I: The Influence of Vastus Muscle Activity in Subjects With and Without Patellofemoral Pain
Authors: Powers Christopher M
Published: February 2017

Background and Purpose. Reduced motor unit activity of the vastus medialis muscle relative to the vastus lateralis muscle has been implicated as a cause of lateral patellar subluxation. The purpose of this study was to assess the influence of vastus muscle motor unit activity on patellar kinematics. Subjects. Twenty-three women (mean age=26.8 years, SD=8.5, range=14–46) with a diagnosis of patellofemoral pain and 12 women (mean age=29.1 years, SD=5.0, range=24–38) without patellofemoral pain participated. Only female subjects were studied because of potential biomechanical differences between sexes. Methods. Patellar kinematics (kinematic magnetic resonance imaging) and vastus muscle electromyographic (EMG) activity using indwelling electrodes were measured during resisted knee extension. Measurements of medial and lateral patellar displacement and tilt obtained from magnetic resonance images were correlated with normalized vastus lateralis:vastus medialis oblique muscle and vastus lateralis:vastus medialis longus muscle EMG ratios at 45, 36, 27, 18, 9, and 0 degrees of knee flexion using a stepwise regression procedure. Results. The vastus lateralis:vastus medialis longus muscle EMG ratio contributed to the prediction of lateral patellar displacement at 27 degrees of knee flexion (r=−.48), with increased vastus medialis longus muscle activity being associated with greater lateral patellar displacement. A similar inverse relationship was evident with lateral patellar tilt at 36, 27, 18, and 9 degrees of knee flexion. Conclusion and Discussion. These results suggest that increased motor unit activity of the vastus medialis muscle appears to be associated with abnormal patellar kinematics in women, but it is not necessarily a cause of abnormal patellar kinematics.
Validation of a Model of Gross Motor Function for Children With Cerebral Palsy
Authors: Palisano Robert J , Hanna Steven E , Rosenbaum Peter L , Russell Dianne J , Walter Stephen D , Wood Ellen P , Raina Parminder S , Galuppi Barbara E
Published: February 2017

Background and Purpose. Development of gross motor function in children with cerebral palsy (CP) has not been documented. The purposes of this study were to examine a model of gross motor function in children with CP and to apply the model to construct gross motor function curves for each of the 5 levels of the Gross Motor Function Classification System (GMFCS). Subjects. A stratified sample of 586 children with CP, 1 to 12 years of age, who reside in Ontario, Canada, and are known to rehabilitation centers participated. Methods. Subjects were classified using the GMFCS, and gross motor function was measured with the Gross Motor Function Measure (GMFM). Four models were examined to construct curves that described the nonlinear relationship between age and gross motor function. Results. The model in which both the limit parameter (maximum GMFM score) and the rate parameter (rate at which the maximum GMFM score is approached) vary for each GMFCS level explained 83% of the variation in GMFM scores. The predicted maximum GMFM scores differed among the 5 curves (level I=96.8, level II=89.3, level III=61.3, level IV=36.1, and level V=12.9). The rate at which children at level II approached their maximum GMFM score was slower than the rates for levels I and III. The correlation between GMFCS levels and GMFM scores was −.91. Logistic regression, used to estimate the probability that children with CP are able to achieve gross motor milestones based on their GMFM total scores, suggests that distinctions between GMFCS levels are clinically meaningful. Conclusion and Discussion. Classification of children with CP based on functional abilities and limitations is predictive of gross motor function, whereas age alone is a poor predictor. Evaluation of gross motor function of children with CP by comparison with children of the same age and GMFCS level has implications for decision making and interpretation of intervention outcomes.
The Effects of Intense Physical Exercise on Secondary Antibody Response in Young and Old Mice
Authors: Kapasi Zoher F , Catlin Pamela A , Joyner Dexter R , Lewis Michelle L , Schwartz Ann L , Townsend Elise L
Published: February 2017

Background and Purpose. Based largely on data from young subjects, intense physical exercise is believed to suppress immune function. In addition, immune function, including secondary antibody response, declines with advancing age. Therefore, intense exercise in old subjects may further suppress the secondary antibody response. The purpose of this in vivo study was to investigate the effects of intense physical exercise on secondary antibody response in young (6–8 weeks) and old (22–24 months) C57BL/6 mice. Subjects and Methods. Data were obtained from 22 young and 18 old C57BL/6 mice that were immunized to human serum albumin (HSA) and randomly divided into 3 groups. Two groups were exposed to a single bout of intense exercise to exhaustion and immediately boosted with an injection of HSA. The first group did not exercise further, but the second group continued with daily bouts of intense exercise to exhaustion for 9 days. The third group (control group) did not undergo intense exercise, but received the booster injection of HSA at the same time as the other groups. Ten days after the HSA booster injection, when high level of antibodies are produced in secondary antibody response, serum anti-HSA antibodies were measured by enzyme-linked immunosorbent assay. Results. Young mice did not show suppression of secondary antibody response following intense exercise. However, old mice, exposed to a single bout of intense exercise, had an enhanced response similar to the response seen in young control mice. Conclusion and Discussion. The widely accepted hypothesis of immunosuppression resulting from intense exercise may not be true for old mice.