bluuebunny/crossref_metadata_2025 huggingface dataset:
Strength Profiles of Shoulder Rotators in Healthy Sport Climbers and Nonclimbers
Authors: Wong Emmy K. L. , Ng Gabriel Y. F.
Published: December 2009

Objective:

To establish the isokinetic strength profiles and work ratios of the shoulder internal and external rotators in sport climbers and to compare them with these profiles and ratios in nonclimbers. We hypothesized that the strength profiles of the shoulder rotators were different between sport climbers and nonclimbers.

Design:

Cross-sectional study.

Setting:

Exercise science laboratory.

Patients or Other Participants:

Thirty-one experienced sport climbers and 27 nonclimbers.

Main Outcome Measure(s):

We tested all participants by measuring the isokinetic concentric and eccentric work output of their shoulder rotators in the middle 110° of shoulder rotation. We measured mean conventional work ratios of concentric external rotation (ER) to internal rotation (IR) (con ER:IR) and eccentric ER to IR (ecc ER:IR), and we measured mean functional work ratios of eccentric ER to concentric IR (ecc ER:con IR) and eccentric IR to concentric ER (ecc IR:con ER).

Results:

All work ratios were different between the 2 groups (P < .001). In the climbers, the conventional work ratios were smaller than 1 for con ER:IR (0.79) and ecc ER:IR (0.88), whereas for the nonclimbers, the ratios were 1.03 and 1.13, respectively. The functional work ratio of ecc ER:con IR was smaller for the climbers (1.05) than for the nonclimbers (1.30), but the functional work ratio of ecc IR:con ER was larger for the climbers (1.58) than for the nonclimbers (1.17).

Conclusions:

The difference in work ratios of the shoulder rotators between participant groups might be due to training-induced changes in the shoulder rotation muscles of sport climbers. The clinical implication of this strength difference in shoulder IR and ER in climbers has yet to be examined.
Cheerleading-Related Injuries in the United States: A Prospective Surveillance Study
Authors: Shields Brenda J. , Smith Gary A.
Published: December 2009

Context:

Cheerleading injuries are on the rise and are a significant source of injury to females. No published studies have described the epidemiology of cheerleading injuries by type of cheerleading team and event.

Objective:

To describe the epidemiology of cheerleading injuries and to calculate injury rates by type of cheerleading team and event.

Design:

Prospective injury surveillance study.

Setting:

Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) online surveillance tool.

Patients or Other Participants:

Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions.

Main Outcome Measure(s):

The numbers and rates of cheerleading injuries during a 1-year period (2006–2007) are reported by team type and event type.

Results:

A cohort of 9022 cheerleaders on 412 US cheerleading teams participated in the study. During the 1-year period, 567 cheerleading injuries were reported; 83% (467/565) occurred during practice, 52% (296/565) occurred while the cheerleader was attempting a stunt, and 24% (132/563) occurred while the cheerleader was basing or spotting 1 or more cheerleaders. Lower extremity injuries (30%, 168/565) and strains and sprains (53%, 302/565) were most common. Collegiate cheerleaders were more likely to sustain a concussion (P  =  .01, rate ratio [RR]  =  2.98, 95% confidence interval [CI]  =  1.34, 6.59), and All Star cheerleaders were more likely to sustain a fracture or dislocation (P  =  .01, RR  =  1.76, 95% CI  =  1.16, 2.66) than were cheerleaders on other types of teams. Overall injury rates for practices, pep rallies, athletic events, and cheerleading competitions were 1.0, 0.6, 0.6, and 1.4 injuries per 1000 athlete-exposures, respectively.

Conclusions:

We are the first to report cheerleading injury rates based on actual exposure data by type of team and event. These injury rates are lower than those reported for other high school and collegiate sports; however, many cheerleading injuries are preventable.
The Potential for Brain Injury on Selected Surfaces Used by Cheerleaders
Authors: Shields Brenda J. , Smith Gary A.
Published: December 2009

Context:

Although playground surfaces have been investigated for fall impact attenuation, the surfaces that cheerleaders use have received little attention.

Objective:

To determine (1) the critical height for selected surfaces used by cheerleaders at or below which a serious head impact injury from a fall is unlikely to occur, (2) the critical heights for non–impact-absorbing surfaces for comparison purposes, and (3) the effect of soil moisture and grass height on gmax (which is defined as the multiple of g [acceleration due to gravity at the earth's surface at sea level: ie, 32.2 feet·s−1·s−1] that represents the maximum deceleration experienced during an impact) and the Head Injury Criterion (HIC) at the critical height for a dry grass surface.

Design:

Observational study.

Settings:

A local cheerleading gym, indoor locations within the authors' institution, and various outdoor locations.

Main Outcome Measure(s):

g max, HIC, and critical height.

Results:

Critical heights for the surfaces tested ranged from 0.5 ft (0.15 m) for concrete and vinyl tile installed over concrete to more than 11 ft (3.35 m) for a spring floor. Increases in grass height and soil moisture resulted in an increase in the critical height for grass surfaces. Only spring floors and 4-in (0.10-m)–thick landing mats placed on traditional foam floors had critical heights greater than 10.5 ft (3.20 m), thus providing enough impact-absorbing capacity for performance of 2-level stunts.

Conclusions:

The potential for serious head impact injuries can be minimized by increasing the shock-absorbing capacity of the surface, decreasing the height from which the person falls, or both. Cheerleaders and cheerleading coaches should use the critical heights reported in this study to compare the relative impact-absorbing capacities of the various surfaces tested, with critical height as an indicator of the impact-absorption capacity of the surface. The findings of this study can be used to select the most appropriate surface for the type of maneuver to be performed, based on the maximum height expected to be achieved by the cheerleader(s) during execution of the maneuver. Cheerleaders should not perform maneuvers at heights that exceed the critical height for the surface on which they are performing.
Recent Injury and Health-Related Quality of Life in Adolescent Athletes
Authors: Valovich McLeod Tamara C. , Bay R. Curtis , Parsons John T. , Sauers Eric L. , Snyder Alison R.
Published: December 2009

Context:

Health-related quality of life (HRQOL) is a global concept that takes into account the physical, psychological, and social domains of health. Determining the extent to which injury affects HRQOL is an important aspect of rehabilitation practice, enabling comparisons of clinical outcomes across different conditions in diverse patient groups.

Objective:

To examine the extent to which a self-reported recent injury affected HRQOL in adolescent athletes using 2 generic patient self-report scales.

Design:

Cross-sectional study.

Setting:

High school classrooms and athletic training facilities.

Patients or Other Participants:

A convenience sample of uninjured (n  =  160) and injured (n  =  45) adolescent athletes.

Intervention(s):

The independent variable was injury status: uninjured versus injured. All participants completed a self-administered brief health status questionnaire and the Short Form–36 Health Survey Questionnaire (SF-36) and Pediatric Outcomes Data Collection Instrument (PODCI) in a counterbalanced manner.

Main Outcome Measure(s):

Dependent variables included 8 subscale and 2 composite scores of the SF-36 and 5 subscale scores and 1 global score of the PODCI. Group differences were assessed with the Mann-Whitney U test (P ≤ .05) and reported as median and interquartile range.

Results:

On the SF-36, the injured group demonstrated lower scores (P < .008) for physical functioning, limitations due to physical health problems, bodily pain, social functioning, and the physical composite. On the PODCI, the injured group reported lower scores (P < .01) on the pain and comfort subscale and the global score.

Conclusions:

Adolescent athletes with self-reported injuries demonstrated lower HRQOL than their uninjured peers. As expected, recent injury affected physical functioning and pain. Social functioning (on the SF-36) and global HRQOL (on the PODCI) also decreased, suggesting that injuries affected areas beyond the expected physical component of health. Clinicians need to recognize the full spectrum of negative influences that injuries may have on HRQOL in adolescent athletes.
Glenohumeral Rotational Range of Motion in Collegiate Overhead-Throwing Athletes During an Athletic Season
Authors: Dwelly Priscilla M. , Tripp Brady L. , Tripp Patricia A. , Eberman Lindsey E. , Gorin Steven
Published: December 2009

Context:

Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder.

Objective:

To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD.

Design:

Observational, repeated-measures study.

Setting:

Collegiate athletic training room.

Patients or Other Participants:

Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age  =  19 ± 1 years, height  =  174 ± 14 cm, mass  =  77.8 ± 18.1 kg; 19 softball, 29 baseball players).

Main Outcome Measure(s):

We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc.

Results:

In the dominant shoulder, ER increased during the season (F2,96  =  17.433, P < .001), but IR remained the same (F2,96  =  1.839, P  =  .17). The total arc in the dominant shoulder increased between time intervals (F2,96  =  14.030, P < .001); the mean difference between prefall and postspring measurements was 9.694° (P < .001), and the mean difference between prefall and postspring measurements was 10.990° (P < .001). In the nondominant shoulder, ER increased over the season (F2,96  =  23.395, P < .001), but IR did not change over the season (F2,96  =  0.087, P  =  .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F2,96  =  18.552, P < .001). No changes were noted in GIRD over time. However, more athletes with GIRD were identified with the GIRD (IR difference) calculation in prefall (n  =  6) than in prespring (n  =  1) and postspring (n  =  4) (Cochran Q  =  5.2, P  =  .07). In addition, more athletes with GIRD were identified with the GIRD (% total arc) calculation in postspring (n  =  6) than in prefall (n  =  5) or prespring (n  =  4) (Cochran Q  =  2.6, P  =  .27).

Conclusions:

Healthy NCAA Division I and Division II athletes did not display changes in glenohumeral IR over an athletic season. However, they gained in ER and total arc during the season in both shoulders. Future researchers should investigate changes over multiple seasons. The 2 methods of calculating GIRD identified different athletes as having GIRD, indicating that additional investigation is warranted to determine the clinical benefits of each method.
Elbow Joint Position Sense After Neuromuscular Training With Handheld Vibration
Authors: Tripp Brady L. , Faust Donald , Jacobs Patrick
Published: December 2009

Context:

Clinicians use neuromuscular control exercises to enhance joint position sense (JPS); however, because standardizing such exercises is difficult, validations of their use are limited.

Objective:

To evaluate the acute effects of a neuromuscular training exercise with a handheld vibrating dumbbell on elbow JPS acuity.

Design:

Crossover study.

Setting:

University athletic training research laboratory.

Patients or Other Participants:

Thirty-one healthy, college-aged volunteers (16 men, 15 women, age  =  23 ± 3 years, height  =  173 ± 8 cm, mass  =  76 ± 14 kg).

Intervention(s):

We measured and trained elbow JPS using an electromagnetic tracking device that provided auditory and visual biofeedback. For JPS testing, participants held a dumbbell and actively identified the target elbow flexion angle (90°) using the software-generated biofeedback, followed by 3 repositioning trials without feedback. Each neuromuscular training protocol included 3 exercises during which participants held a 2.55-kg dumbbell vibrating at 15, 5, or 0 Hz and used software-generated biofeedback to locate and maintain the target elbow flexion angle for 15 seconds.

Main Outcome Measure(s):

We calculated absolute (accuracy) and variable (variability) errors using the differences between target and reproduced angles.

Results:

Training protocols using 15-Hz vibration enhanced accuracy and decreased variability of elbow JPS (P ≤ .005), whereas 5-Hz vibration did not affect accuracy (F1,61  =  2.625, P  =  .100) but did decrease variability (F1,61  =  7.250, P  =  .009). The control condition and 0-Hz training protocol had no effect on accuracy or variability (P ≥ .200).

Conclusions:

Our results suggest these neuromuscular control exercises, which included low-magnitude, low-frequency handheld vibration, may enhance elbow JPS. Future researchers should examine vibration of various durations and frequencies, should include injured participants and functional multijoint and multiplanar measures, and should examine long-term effects of training protocols on JPS and injury.
Estimation of Prepractice Hydration Status of National Collegiate Athletic Association Division I Athletes
Authors: Volpe Stella L. , Poule Kristen A. , Bland Erica G.
Published: December 2009

Context:

To our knowledge, no one has compared the prepractice hydration status of male and female National Collegiate Athletic Association (NCAA) Division I athletes or has studied the effects of the menstrual cycle phase on women's prepractice hydration status.

Objective:

To report prepractice hydration status of collegiate athletes and determine the factors that might influence that status.

Design:

Cross-sectional, descriptive study.

Setting:

University sports team practices.

Patients or Other Participants:

Participants included 138 male and 125 female athletes (age  =  19.9 ± 1.3 years, height  =  165.8 ± 42.9 cm, mass  =  77.4 ± 17.5 kg) from an NCAA Division I New England university.

Intervention(s):

One spontaneously voided (spot) urine sample was collected from each participant before his or her team practice and was measured 2 times.

Main Outcome Measure(s):

A refractometer was used to analyze the amount of light that passed through a small drop of urine and assess urine specific gravity. Fluid intake and menstrual history for women were also collected. Three hydration-status groups were defined based on the American College of Sports Medicine and National Athletic Trainers' Association criteria: (1) euhydrated, which was urine specific gravity less than 1.020; (2) hypohydrated, from 1.020 to 1.029; and (3) significantly hypohydrated, equal to or more than 1.030.

Results:

Thirteen percent of student-athletes appeared significantly hypohydrated, with a mean urine specific gravity of 1.031 ± 0.002 (χ2  =  12.12, P < .05); 53% appeared hypohydrated, with a mean urine specific gravity of 1.024 ± 0.003 (χ2  =  12.12, P < .05); and 34% appeared euhydrated, with a mean urine specific gravity of 1.012 ± 0.005 (χ2  =  0.03, P > .05). A greater percentage of men (47%) than women (28%) were hypohydrated (χ2  =  8.33, P < .05). In women, no difference was evident between the luteal and follicular phases of their menstrual cycles (χ2  =  0.02, P > .05).

Conclusions:

Before activity, athletes were hypohydrated at different levels. A greater percentage of men than women were hypohydrated. Menstrual cycle phase did not appear to affect hydration in women.
Athletic Training Approved Clinical Instructors' Reports of Real-Time Opportunities for Evaluating Clinical Proficiencies
Authors: Armstrong Kirk J. , Weidner Thomas G. , Walker Stacy E.
Published: December 2009

Context:

Appropriate methods for evaluating clinical proficiencies are essential to ensuring entry-level competence in athletic training.

Objective:

To identify the methods Approved Clinical Instructors (ACIs) use to evaluate student performance of clinical proficiencies.

Design:

Cross-sectional design.

Setting:

Public and private institutions in National Athletic Trainers' Association (NATA) District 4.

Patients or Other Participants:

Approved Clinical Instructors from accredited athletic training education programs in the Great Lakes Athletic Trainers' Association, which is NATA District 4 (N  =  135).

Data Collection and Analysis:

Participants completed a previously validated survey instrument, Methods of Clinical Proficiency Evaluation in Athletic Training, that consisted of 15 items, including demographic characteristics of the respondents and Likert-scale items (1  =  strongly disagree to 5  =  strongly agree) regarding methods of clinical proficiency evaluation, barriers, educational content areas, and clinical experience settings. We used analyses of variance and 2-tailed, independent-samples t tests to assess differences among ACI demographic characteristics and the methods, barriers, educational content areas, settings, and opportunities for feedback regarding clinical proficiency evaluation. Qualitative analysis of respondents' comments was completed.

Results:

The ACIs (n  =  106 of 133 respondents, 79.7%) most often used simulations to evaluate clinical proficiencies. Only 59 (55.1%) of the 107 ACIs responding to a follow-up question reported that they feel students engage in a sufficient number of real-time evaluations to prepare them for entry-level practice. An independent-samples t test revealed that no particular clinical experience setting provided more opportunities than another for real-time evaluations (t119 range, −0.909 to 1.796, P ≥ .05). The occurrence of injuries not coinciding with the clinical proficiency evaluation timetable (4.00 ± 0.832) was a barrier to real-time evaluations. Respondents' comments indicated much interest in opportunities and barriers regarding real-time clinical proficiency evaluations.

Conclusions:

Most clinical proficiencies are evaluated via simulations. The ACIs should maximize real-time situations to evaluate students' clinical proficiencies whenever feasible. Athletic training education program administrators should develop alternative methods of clinical proficiency evaluations.
Computing Noncommutative Deformations of Presheaves and Sheaves of Modules
Authors: Eriksen Eivind
Published: December 2009

We describe a noncommutative deformation theory for presheaves and sheaves of modules that generalizes the commutative deformation theory of these global algebraic structures and the noncommutative deformation theory of modules over algebras due to Laudal.

In the first part of the paper, we describe a noncommutative deformation functor for presheaves of modules on a small category and an obstruction theory for this functor in terms of global Hochschild cohomology. An important feature of this obstruction theory is that it can be computed in concrete terms in many interesting cases.

In the last part of the paper, we describe a noncommutative deformation functor for quasi-coherent sheaves of modules on a ringed space (X,𝒜). We show that for any good A-affine open cover U of X, the forgetful functor QCoh𝒜 → PreSh(U,𝒜) induces an isomorphism of noncommutative deformation functors.

Applications. We consider noncommutative deformations of quasi-coherent 𝒜-modules on X when (X,𝒜) = (X,𝒪X) is a scheme or (X,𝒜) = (X,𝒟) is a D-scheme in the sense of Beilinson and Bernstein. In these cases, we may use any open affine cover of X closed under finite intersections to compute noncommutative deformations in concrete terms using presheaf methods. We compute the noncommutative deformations of the left 𝒟X-module 𝒟X when X is an elliptic curve as an example.
On the Spectrum of the Equivariant Cohomology Ring
Authors: Goresky Mark , MacPherson Robert
Published: December 2009

If an algebraic torusTacts on a complex projective algebraic varietyX, then the affine scheme SpecH*T(X; ℂ) associated with the equivariant cohomology is often an arrangement of linear subspaces of the vector spaceHT2(X; ℂ). In many situations the ordinary cohomology ring ofXcan be described in terms of this arrangement.
Classification of Reducing Subspaces of a Class of Multiplication Operators on the Bergman Space via the Hardy Space of the Bidisk
Authors: Sun Shunhua , Dechao Zheng  , Zhong Changyong
Published: December 2009

In this paper we obtain a complete description of nontrivial minimal reducing subspaces of the multiplication operator by a Blaschke product with four zeros on the Bergman space of the unit disk via the Hardy space of the bidisk.
On the Oscillation of a Second Order Strictly Sublinear Differential Equation
Authors: Agarwal Ravi P. , Avramescu Cezar , Mustafa Octavian G.
Published: December 2009

We establish a flexible oscillation criterion based on an averaging technique that improves upon a result due to C. G. Philos.
Semi-Slant Submanifolds of an Almost Paracontact Metric Manifold
Authors: Atc̣eken Mehmet
Published: December 2009

In this paper, we define and study the geometry of semi-slant submanifolds of an almost paracontact metric manifold. We give some characterizations for a submanifold to be semi-slant submanifold to be semi-slant product and obtain integrability conditions for the distributions involved in the definition of a semi-slant submanifold.
Boundedness From Below of Multiplication Operators Between α-Bloch Spaces
Authors: Chen Huaihui , Zhang Minzhu
Published: December 2009

In this paper, the boundedness from below of multiplication operators between α-Bloch spaces , α > 0, on the unit disk D is studied completely. For a bounded multiplication operator , defined by Muƒ = u ƒ for f ∈ , we prove the following result:

(i) If 0 < β < α, or 0 < α ≤ 1 and α < β, Mu is not bounded below;

(ii) if 0 < α = β ≤ 1, Mu is bounded below if and only if lim infz→∂D |u(z)| > 0;

(iii) if 1 < α ≤ β,Mu is bounded below if and only if there exist a δ > 0 and a positive r < 1 such that for every point z ∈ D there is a point z′ ∈ D with the property d(z′, z) < r and (1–|z′|2)β–α|u(z′)| ≥ δ, where d( · , · ) denotes the pseudo-distance on D.
Ranks in Families of Jacobian Varieties of Twisted Fermat Curves
Authors: Dąbrowski Andrzej , Jędrzejak Tomasz
Published: December 2009

In this paper, we prove that the unboundedness of ranks in families of Jacobian varieties of twisted Fermat curves is equivalent to the divergence of certain infinite series.
On Antichains of Spreading Models of Banach Spaces
Authors: Dodos Pandelis
Published: December 2009

We show that for every separable Banach spaceX, either SPw(X) (the set of all spreading models ofXgenerated by weakly-null sequences inX, modulo equivalence) is countable, or SPw(X) contains an antichain of the size of the continuum. This answers a question of S. J. Dilworth, E. Odell, and B. Sari.
Modules with Unique Closure Relative to a Torsion Theory
Authors: Doğruöz S. , Harmanci A. , Smith P. F.
Published: December 2009

We consider when a single submodule and also when every submodule of a module M over a general ring R has a unique closure with respect to a hereditary torsion theory on Mod-R.
Root Extensions and Factorization in Affine Domains
Authors: Etingof P. , Malcolmson P. , Okoh F.
Published: December 2009

An integral domain R is IDPF (Irreducible Divisors of Powers Finite) if, for every non-zero element a in R, the ascending chain of non-associate irreducible divisors in R of an stabilizes on a finite set as n ranges over the positive integers, while R is atomic if every non-zero element that is not a unit is a product of a finite number of irreducible elements (atoms). A ring extension S of R is a root extension or radical extension if for each s in S, there exists a natural number n(s) with sn(s) in R. In this paper it is shown that the ascent and descent of the IDPF property and atomicity for the pair of integral domains (R, S) is governed by the relative sizes of the unit groups U(R) and U(S) and whether S is a root extension of R. The following results are deduced from these considerations: An atomic IDPF domain containing a field of characteristic zero is completely integrally closed. An affine domain over a field of characteristic zero is IDPF if and only if it is completely integrally closed. Let R be a Noetherian domain with integral closure S. Suppose the conductor of S into R is non-zero. Then R is IDPF if and only if S is a root extension of R and U(S)/U(R) is finite.
Regular Points of a Subcartesian Space
Authors: Lusala Tsasa , Śniatycki Jędrzej , Watts Jordan
Published: December 2009

We discuss properties of the regular part Sreg of a subcartesian space S. We show that Sreg is open and dense in S and the restriction to Sreg of the tangent bundle space of S is locally trivial.
A Class of Finsler Metrics with Bounded Cartan Torsion
Authors: Mo Xiaohuan , Zhou Linfeng
Published: December 2009

In this paper, we find a class of (α,β) metrics which have a bounded Cartan torsion. This class contains all Randers metrics. Furthermore, we give some applications and obtain two corollaries about curvature of this metrics.
Multiple Nontrivial Solutions for Doubly Resonant Periodic Problems
Authors: Papageorgiou Nikolaos S. , Staicu Vasile
Published: December 2009

We consider semilinear periodic problems with the right-hand side nonlinearity satisfying a double resonance condition between two successive eigenvalues. Using a combination of variational and degree theoretic methods, we prove the existence of at least two nontrivial solutions.
Multiplicity-Free Schubert Calculus
Authors: Thomas Hugh , Yong Alexander
Published: December 2009

Multiplicity-free algebraic geometry is the study of subvarieties Y ⊆ X with the “smallest invariants” as witnessed by a multiplicity-free Chow ring decomposition of [Y] ∈ A*(X) into a predetermined linear basis.

This paper concerns the case of Richardson subvarieties of the Grassmannian in terms of the Schubert basis. We give a nonrecursive combinatorial classification of multiplicity-free Richardson varieties, i.e., we classify multiplicity-free products of Schubert classes. This answers a question of W. Fulton.
On the Local Unipotent Fundamental Group Scheme
Authors: Ünver Sinan
Published: December 2009

We prove a local, unipotent, analog of Kedlaya's theorem for the pro-ppart of the fundamental group of integral affine schemes in characteristicp.
A New Sufficient Condition for a Graph To Be (g, f, n)-Critical
Authors: Zhou Sizhong
Published: December 2009

Let G be a graph of order p, let a, b, and n be nonnegative integers with 1 ≤ a < b, and let g and f be two integer-valued functions defined on V(G) such that a ≤ g(x) < f (x) ≤ b for all x ∈ V(G). A (g, f )-factor of graph G is a spanning subgraph F of G such that g(x) ≤ dF(x) ≤ f (x) for each x ∈ V(F). Then a graph G is called (g, f, n)-critical if after deleting any n vertices of G the remaining graph of G has a (g, f )-factor. The binding number bind(G) of G is the minimum value of |NG(X)|/|X| taken over all non-empty subsets X of V(G) such that NG(X) ≠ V(G). In this paper, it is proved that G is a (g, f, n)-critical graph if

Furthermore, it is shown that this result is best possible in some sense.
A Culturally Relevant Agricultural and Environmental Course for K–12 Teachers in Hawaii
Authors: Sylva Traci , Chinn Pauline , Kinoshita Charles
Published: January 2010

A Hawaiian cultural‐based agricultural and environmental science professional development course was transformed based on the precepts of situated learning in communities of practice, and offered to K–12 teachers. In this article we describe the format and content of the transformed course based on lessons learned from previous years offered to K–12 teachers. We also describe the teachers’ responses to the course and students’ response to curricula implemented by teachers. Hawaiian ways of learning are experience‐based, embedded in real‐life purpose and context, highly interpersonal, and location specific. Our goal in transforming this course was to help teachers to incorporate important topics related to the environmental and agriculture science fields into their curricula, and to make that content relevant to their students’ lives and backgrounds, especially those of native Hawaiian decent. Based on observations, written and oral evaluations from teachers, student assessments, and student involvement in community projects, we feel that we have attained that goal. Some of the important factors for effective learning and implementation of this new culture–science curriculum by teachers are: (1) culturally relevant course format that provides meaningful, effective social interactions among instructors and teachers/students; (2) development of a “community of practice”; (3) a team of instructors, each knowledgeable in different areas, such as science, agriculture, Hawaiian culture, all experienced in problem‐based teaching; (4) excellent models of problem‐based and culturally based projects/curricula; and (5) continued support from peers and instructional team throughout the academic year.
Enhancing Undergraduate Agro‐Ecological Laboratory Employment through Experiential Learning
Authors: Grossman J. M. , Patel M. , Drinkwater L. E.
Published: January 2010

We piloted an educational model, the Sustainable Agriculture Scholars Program, linking research in organic agriculture to experiential learning activities for summer undergraduate employees in 2007 and 2008. Our objectives were to: (1) further student understanding of sustainable agriculture research, (2) increase student interest in sustainable agriculture careers, and (3) use community service as a vehicle for learning. The three learning environments were on‐farm and laboratory research settings, weekly meetings and field trips to discuss research and observe farming practices, and a service‐learning project. We collected feedback from participants through a post‐program focus‐group style evaluation in Year 1 and pre/post individual evaluations with participants and a non‐participant comparison group in Year 2. Students learned about linkages between research and practice within all environments. Farm visits were the primary learning site, specifically through observations of sustainable agriculture practices related to lab work and interactions with farmers. Students described how farm visits made lab work relevant; however, there were few instances describing how lab work was relevant to farming communities. Our preliminary findings from this pilot study suggest that participation in the program led to increased interest in sustainable agriculture careers and increased desire to pursue research in some students.
Residents' Perceptions of Their Own Professionalism and the Professionalism of Their Learning Environment
Authors: Gillespie Colleen , Paik Steve , Ark Tavinder , Zabar Sondra , Kalet Adina
Published: December 2009

Background

The competency of professionalism encompasses a range of behaviors in multiple domains. Residency programs are struggling to integrate and effectively assess professionalism. We report results from a survey assessing residents’ perceptions of their professional competence and the professionalism of their learning environment.

Methods

A survey was developed to assess specific behaviors reflecting professionalism based on the conceptualizations of key accrediting bodies. Residents rated their ability to perform the behaviors and reported the frequency with which they observed their fellow residents failing to perform the behaviors. Eighty-five senior residents in emergency medicine, internal medicine, pediatrics, psychiatry, and surgery specialties completed the survey (response rate = 77%). Differences among domains (and among items within domains) were assessed. Correlations between perceived professionalism and the professionalism of the learning environment were described.

Results

Cronbach alpha for professionalism competence was .93 and for professionalism in the learning environment it was .86. Residents reported feeling most competent in being accountable (mean score = 51.4%; F = 10.3, p<.001) and in demonstrating respect. Some residents reported having trouble being sensitive to patients (n = 5 to 23). Disrespectful behaviors were the most frequently witnessed professionalism lapse in the learning environment (mean = 41.1%; F = 8.1, p<.001). While serious lapses in professionalism were not witnessed with great frequency in the learning environment, instances of over-representing qualifications were reported. Problems in accountability in the learning environment were negatively associated with residents’ perceived competence.

Conclusions

Residents reported being able to perform professionally most of the time, especially in terms of accountability and respect. However, disrespect was a feature of the learning environment for many residents and several serious lapses were witnessed by a small number of residents. Accountability in the learning environment may be an important indicator of or influence on residents’ professionalism.
Mapping Cognitive Overlaps Between Practice-Based Learning and Improvement and Evidence-Based Medicine: An Operational Definition for Assessing Resident Physician Competence
Authors: Chatterji Madhabi , Graham Mark J. , Wyer Peter C.
Published: December 2009

Purpose

The complex competency labeled practice-based learning and improvement (PBLI) by the Accreditation Council for Graduate Medical Education (ACGME) incorporates core knowledge in evidence-based medicine (EBM). The purpose of this study was to operationally define a “PBLI-EBM” domain for assessing resident physician competence.

Method

The authors used an iterative design process to first content analyze and map correspondences between ACGME and EBM literature sources. The project team, including content and measurement experts and residents/fellows, parsed, classified, and hierarchically organized embedded learning outcomes using a literature-supported cognitive taxonomy. A pool of 141 items was produced from the domain and assessment specifications. The PBLI-EBM domain and resulting items were content validated through formal reviews by a national panel of experts.

Results

The final domain represents overlapping PBLI and EBM cognitive dimensions measurable through written, multiple-choice assessments. It is organized as 4 subdomains of clinical action: Therapy, Prognosis, Diagnosis, and Harm. Four broad cognitive skill branches (Ask, Acquire, Appraise, and Apply) are subsumed under each subdomain. Each skill branch is defined by enabling skills that specify the cognitive processes, content, and conditions pertinent to demonstrable competence. Most items passed content validity screening criteria and were prepared for test form assembly and administration.

Conclusions

The operational definition of PBLI-EBM competence is based on a rigorously developed and validated domain and item pool, and substantially expands conventional understandings of EBM. The domain, assessment specifications, and procedures outlined may be used to design written assessments to tap important cognitive dimensions of the overall PBLI competency, as given by ACGME. For more comprehensive coverage of the PBLI competency, such instruments need to be complemented with performance assessments.
Institute of Medicine Committee Report on Resident Duty Hours: A View From a Trench
Authors: Cedfeldt Andrea S. , English Clea , El Youssef Raphael , Gilhooly Joseph , Girard Donald E.
Published: December 2009

Background

In late 2008, the Institute of Medicine (IOM) published a report recommending more restrictive limits on resident work hours to promote patient safety. Reaction from the graduate medical education community has focused on concerns about a lack of evidence supporting the IOM’s recommendations. We highlight 3 concerns with the report: 1) a disproportionate attention to resident fatigue when changes in other areas may have a larger impact on patient safety. Data supporting a causal link between resident fatigue and medical errors that harm patients are not robust. Two areas where data support a stronger impact on patient safety include resident supervision and transitions of care; 2) a “one size fits all” model when specialty-specific recommendations may be more appropriate. For example, 16 hours on task is not at all similar for residents in different specialties (ie, surgery and primary care); and 3) the absence of a process to evaluate the impact of current or potential duty hour requirements on outcomes. Because these potential impacts have not been sufficiently researched, it is premature to support additional changes at this time.

Recommendations

To move forward in a comprehensive manner, we recommend the following: 1) support more research to evaluate the effects of duty hours in conjunction with other interrelated factors on patient safety, 2) encourage individual Accreditation Council for Graduate Medical Education (ACGME) Review committees to develop specialty specific duty hour limitations, and 3) develop partnerships between the IOM, ACGME, and the institutions directly involved with medical education to study how to maximize patient safety while maintaining quality educational outcomes.
Components of Critical Decision Making and ABSITE Assessment: Toward a More Comprehensive Evaluation
Authors: Krishnamurthy Satish , Satish Usha , Foster Tina , Streufert Siegfried , Dewan Mantosh , Krummel Thomas
Published: December 2009

Rationale

Accurate assessment of resident competency is a fundamental requisite to assure the training of physicians is adequate. In surgical disciplines, structured tests as well as ongoing evaluation by faculty are used for evaluating resident competency. Although structured tests evaluate content knowledge, faculty ratings are a better measure of how that knowledge is applied to real-world problems. In this study, we sought to explore the performance of surgical residents in a simulation exercise (strategic management simulations [SMS]) as an objective surrogate of real-world performance.

Methods

Forty surgical residents participated in the SMS simulation that entailed decision making in a real-world−oriented task situation. The task requirements enable the assessment of decision making along several parameters of thinking under both crisis and noncrisis situations. Performance attributes include “simpler” measures of competency (activity level), intermediate categories (information management and emergency responses) to complex measures (breadth of approach and strategy). Scores obtained in the SMS were compared with the scores obtained on the American Board of Surgery In-Training Examination (ABSITE).

Results

The data were intercorrelated and subjected to a multiple regression analysis with ABSITE as the dependent variable and simulation scores as independent variables. Using a 1-tail test analysis, only 3 simulation variables correlated with performance on ABSITE at the .01 level (ie, basic activity, focused activity, task orientation). Other simulation variables showed no meaningful relationships to ABSITE scores at all.

Conclusions

The more complex real-world−oriented decision-making parameters on SMS did not correlate with ABSITE scores. We believe that techniques such as the SMS, which focus on critical thinking, complement assessment of medical knowledge using ABSITE. The SMS technique provides an accurate measure of real-world performance and provides objective validation of faculty ratings.
Utilizing Quality Improvement Methods to Improve Patient Care Outcomes in a Pediatric Residency Program
Authors: Akins Ralitsa B. , Handal Gilbert A.
Published: December 2009

Objective

Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches.

Methods

A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios.

Results

Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic.

Conclusion

Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs.
Burnout, Psychological Skills, and Empathy: Balint Training in Obstetrics and Gynecology Residents
Authors: Ghetti Chiara , Chang Judy , Gosman Gabriella
Published: December 2009

Objectives

To assess burnout, behavioral-medicine skills, and empathy among obstetrics and gynecology residents before and after implementation of Balint training.

Methods

This was a prospective educational study. Balint training was introduced into the obstetrics and gynecology residency curriculum in July 2005. All 36 residents were approached for this study. The Psychological Medicine Inventory, the Maslach Burnout Inventory, and the Jefferson Scale of Physician Empathy were administered prior to initiating training and at 12 months. Baseline and 12-month scores were compared by Wilcoxon signed rank test.

Results

Seventeen residents completed baseline and 12-month questionnaires: 6 were postgraduate year (PGY) 1, 3 were PGY-2, 6 were PGY-3, and 2 were PGY-4. At baseline, 70% of participating residents reported high burnout scores. Burnout and empathy remained unchanged at 12 months. Psychological medicine skills improved at 12 months.

Conclusions

This study showed that obstetrics and gynecology residents are at high risk for burnout. Interest and confidence in handling psychological aspects of patient care improved at 12 months after the introduction of Balint training.
Toward a New Paradigm in Graduate Medical Education in the United States: Elimination of the 24-Hour Call
Authors: Mautone Susan G.
Published: December 2009

Background

Sleep deprivation negatively affects resident performance, education, and safety. Concerns over these effects have prompted efforts to reduce resident hours. This article describes the design and implementation of a scheduling system with no continuous 24-hour calls. Aims included meeting Accreditation Council for Graduate Medical Education work hour requirements without increasing resident complement, maximizing continuity of learning and patient care, maintaining patient care quality, and acceptance by residents, faculty, and administration.

Methods

Various coverage options were formulated and discussed. The final schedule was the product of consensus. After re-engineering the master rotation schedule, service-specific conversion of on-call schedules was initiated in July 2003 and completed in July 2004. Annual in-training and certifying examination performance, length of stay, patient mortalities, resident motor vehicle accidents/near misses, and resident satisfaction with the new scheduling system were tracked.

Results

Continuous 24-hour call has been eliminated from the program since July 2004, with the longest assigned shift being 14 hours. Residents have at least 1 free weekend per month, a 10-hour break between consecutive assigned duty hours, and a mandatory 4-hour “nap” break if assigned a night shift immediately following a day shift. Program-wide, duty hours average 66 hours per week for first-year residents, 63 hours per week for second-year residents, and 60 hours per week for third-year residents. Self-reported motor vehicle accidents and/or near misses of accidents significantly decreased (P < .001) and resident satisfaction increased (P  =  .42). The change was accomplished at no additional cost to the institution and with no adverse patient care or educational outcomes.

Conclusions

Pediatric residency training with restriction to 14 consecutive duty hours is effective and well accepted by stakeholders. Five years later, the re-engineered schedule has become the new “normal” for our program.
Reliability, validity, and responsiveness of five at‐work productivity measures in patients with rheumatoid arthritis or osteoarthritis
Authors: Beaton Dorcas E. , Tang Kenneth , Gignac Monique A. M. , Lacaille Diane , Badley Elizabeth M. , Anis Aslam H. , Bombardier Claire
Published: December 2009

Objective

Arthritis often impacts a worker's ability to be productive while at work. However, the ideal approach to measuring arthritis‐attributable at‐work productivity loss remains unclear. Our objective was to evaluate the relative strengths and weaknesses of 5 measures aimed at quantifying health‐related at‐work productivity loss and to determine the best available instrument for this population.

Methods

In a 12‐month longitudinal design, the psychometric properties (reliability, validity, and responsiveness) of 5 self‐reported measures of at‐work productivity were compared in workers with either rheumatoid arthritis (RA) or osteoarthritis (OA). We tested the Workplace Activity Limitations Scale (WALS), 6‐item Stanford Presenteeism Scale (SPS‐6), Endicott Work Productivity Scale (EWPS), RA Work Instability Scale (WIS), and Work Limitations Questionnaire (WLQ).

Results

Across all measures, participants (n = 250, 120 with RA and 130 with OA) consistently reported mild losses of at‐work productivity. The Cronbach's alpha of the scales ranged from 0.71 (for SPS‐6) to 0.94 (for EWPS), indicating some concerns over the internal consistency of the SPS‐6. The RA WIS demonstrated the strongest construct validity (|r| = 0.54–0.74), whereas the WALS was most responsive to perceived changes in work ability. Despite its increasing popularity and potential application for costing analysis, the WLQ did not compare favorably with the other scales, possibly due to psychometric concerns with its physical demands subscale.

Conclusion

Measures revealed unique conceptualization of at‐work disability, but no single scale emerged as clearly superior. However, current results slightly favor the WALS and RA WIS as superior instruments for measuring at‐work productivity loss in workers with arthritis.