Differences in gait patterns of children with Duchenne muscular dystrophy (DMD) and typically developing (TD) peers are visible to the eye, but quantifications of those differences outside of the ...gait laboratory have been elusive. In this work, we measured vertical, mediolateral, and anteroposterior acceleration using a waist-worn iPhone accelerometer during ambulation across a typical range of velocities. Fifteen TD and fifteen DMD children from 3 to 16 years of age underwent eight walking/running activities, including five 25 m walk/run speed-calibration tests at a slow walk to running speeds (SC-L1 to SC-L5), a 6-min walk test (6MWT), a 100 m fast walk/jog/run (100MRW), and a free walk (FW). For clinical anchoring purposes, participants completed a Northstar Ambulatory Assessment (NSAA). We extracted temporospatial gait clinical features (CFs) and applied multiple machine learning (ML) approaches to differentiate between DMD and TD children using extracted temporospatial gait CFs and raw data. Extracted temporospatial gait CFs showed reduced step length and a greater mediolateral component of total power (TP) consistent with shorter strides and Trendelenberg-like gait commonly observed in DMD. ML approaches using temporospatial gait CFs and raw data varied in effectiveness at differentiating between DMD and TD controls at different speeds, with an accuracy of up to 100%. We demonstrate that by using ML with accelerometer data from a consumer-grade smartphone, we can capture DMD-associated gait characteristics in toddlers to teens.
Estimation of temporospatial clinical features of gait (CFs), such as step count and length, step duration, step frequency, gait speed, and distance traveled, is an important component of ...community-based mobility evaluation using wearable accelerometers. However, accurate unsupervised computerized measurement of CFs of individuals with Duchenne muscular dystrophy (DMD) who have progressive loss of ambulatory mobility is difficult due to differences in patterns and magnitudes of acceleration across their range of attainable gait velocities. This paper proposes a novel calibration method. It aims to detect steps, estimate stride lengths, and determine travel distance. The approach involves a combination of clinical observation, machine-learning-based step detection, and regression-based stride length prediction. The method demonstrates high accuracy in children with DMD and typically developing controls (TDs) regardless of the participant's level of ability. Fifteen children with DMD and fifteen TDs underwent supervised clinical testing across a range of gait speeds using 10 m or 25 m run/walk (10 MRW, 25 MRW), 100 m run/walk (100 MRW), 6-min walk (6 MWT), and free-walk (FW) evaluations while wearing a mobile-phone-based accelerometer at the waist near the body's center of mass. Following calibration by a trained clinical evaluator, CFs were extracted from the accelerometer data using a multi-step machine-learning-based process and the results were compared to ground-truth observation data. Model predictions vs. observed values for step counts, distance traveled, and step length showed a strong correlation (Pearson's r = -0.9929 to 0.9986,
< 0.0001). The estimates demonstrated a mean (SD) percentage error of 1.49% (7.04%) for step counts, 1.18% (9.91%) for distance traveled, and 0.37% (7.52%) for step length compared to ground-truth observations for the combined 6 MWT, 100 MRW, and FW tasks. Our study findings indicate that a single waist-worn accelerometer calibrated to an individual's stride characteristics using our methods accurately measures CFs and estimates travel distances across a common range of gait speeds in both DMD and TD peers.
In the southwestern United States, redberry (Juniperus pinchotii Sudw.) and ashe (Juniperus ashei Buchholz) juniper are two invasive species that dominate some rangelands. Goats will consume up to ...30% of their diet in juniper, but it is unknown if sheep will accept juniper to the same extent. The objectives of this study were to determine if sheep can be conditioned to consume juniper and to compare intake among different breeds. Rambouillet (n = 10), Suffolk (n = 10), and Dorper-cross (n = 10) lambs were randomly placed in individual pens for 31 d. A basal diet of alfalfa pellets (2.5% body weight BW) and juniper were fed. Juniper was fed each morning from 0800 to 0830 hours. The basal diet was fed for the remainder of the day. Intake of each was measured daily. Following the first 17 d, the basal diet was reduced to 2% BW for 7 d and then reduced to 1.5% BW for the final 7 d. Serum aspartate transaminase (AST), gamma glutamyltransferase (GGT), blood urea nitrogen (BUN), creatinine, and bilirubin levels, and live body weight were measured to assess any adverse physiological effects from juniper consumption. In a second trial, lambs were again fed alfalfa (2.5% BW) and juniper. One half of the lambs were also fed a 36% protein supplement to determine if supplementation with protein sources that escape rumen degradation would improve juniper consumption. Lambs received alfalfa, juniper, and protein supplement for 22 d with intake of each recorded daily. Intake of juniper was similar (P > 0.05) among breeds of sheep. Lambs readily consumed juniper and increased (P < 0.05) intake of juniper as the amount of alfalfa fed was reduced. Weight change was also similar among treatments. Protein supplementation did not improve juniper consumption. We contend that sheep will consume a diet consisting of 24% juniper without experiencing any adverse effects.
Redberry juniper (Juniperus pinchotii Sudw.) is a common invasive plant species in west-central Texas. Goats will consume redberry juniper, but intake is limited by monoterpenoids found in the plant. ...Previous research has shown that goats will increase juniper intake through 1) conditioning and 2) protein supplementation. This study compared intake of juniper when goats received different protein supplements either with or without protein sources that are high in amino acids that escape digestion in the rumen. Recently weaned Boer-cross goats (n = 47) were randomly placed into five treatments. Treatments 1, 2, 3, and 4 received a protein supplement and juniper for 1 h daily for 14 d, along with a basal diet of alfalfa pellets (2% body weight). Treatment 5 received only a basal diet of alfalfa pellets and juniper. All supplements were formulated to be isonitrogenous (37% crude protein CP). Treatment 1 contained cottonseed meal (high CP escape value), treatment 2 contained cottonseed meal and distiller's dried grain (higher CP escape value), treatment 3 contained soybean meal (low CP escape value), and treatment 4 contained soybean meal and distiller's dried grain (moderate CP escape value). Refusals of juniper, supplements, and alfalfa were weighed daily to determine intake. Supplementation with 1) cottonseed meal, 2) soybean meal, or 3) soybean meal and distillers dried grain did not influence (P > 0.05) juniper intake. Conversely, goats supplemented with cottonseed meal and distiller's dried grain ate more (P < 0.05) juniper than goats receiving only alfalfa, possibly because of increased escape of glucogenic amino acids. We contend that supplementation with feeds high in protein escape values should increase juniper intake on rangelands.
Goat browsing can be used as an alternative brush management option for redberry (Juniperus pinchotii Sudw.) and ashe (Juniperus asheii Buch) juniper instead of more expensive and invasive brush ...control methods, assuming consumption of juniper does not adversely affect the marketability of offspring. Some wildlife species reportedly retain juniper flavor when consumed. We determined if juniper consumption affected meat quality or flavoring of Boer-cross kid carcasses. Twenty recently weaned, Boer-cross wethers were randomly assigned to one of four treatments with treatments fed different amounts of juniper (0%, 10%, 20%, 30% juniper in the diet). All goats were fed juniper for 28 d at the Angelo State University (ASU) Management, Instruction, and Research Center. All goats were also fed a feedlot ration to meet maintenance requirements (2% body weight). Juniper intake varied (P < 0.05) between all treatments (0%, 10%, 20%, 30%) primarily because treatments were fed different amounts of juniper. Following a 28-d trial, goats were harvested at the ASU Food Safety and Product Development Laboratory. Carcass characteristics including live weight, hot carcass weight, dressing percentage, loineye area, body wall fat thickness, and leg circumference were similar (P > 0.05) among treatments. Sensory characteristics including tenderness, juiciness, flavor intensity, off-flavor, and overall acceptability were also similar (P > 0.05) among treatments. Landowners can utilize goats as a biological management tool without adversely affecting goat meat quality or flavoring.
Redberry (Juniperus pinchotii Sudw.) and ashe (Juniperus ashei Buchh.) juniper dominate rangelands throughout central Texas. Our objective was to attempt to improve the efficacy of goats as a ...biological control mechanism for juniper through behavioral training. Conditioning sheep and goats to increase the palatability of chemically defended plants can be a useful tool in brush control. Previous research illustrated that goats can be conditioned to consume more juniper while in individual pens when foraging choices are limited. To test whether this creates a longer-lasting increase in juniper preference, we determined if goats would continue to consume juniper on pasture for one year after being fed juniper in individual pens for 14 d. Female Boer-cross goats (n = 40) were randomly divided into two treatments: conditioned and naive to juniper. At approximately 12 mo of age, conditioned goats were placed in individual pens and fed redberry juniper 1 h daily for 14 d, while naive goats received only alfalfa pellets to meet maintenance requirements. After the pen-feeding phase of the study, goats were placed in one of four pastures (10 goats · pasture−1) for 12 mo. Two pastures housed conditioned goats, and two pastures housed naive goats at a moderate stocking rate (1 animal unit · yr−1 · 8 ha−1). Bite count surveys were conducted twice per month, while herbaceous standing crop and monoterpene levels were measured once per month. Juniper preference varied monthly; however, conditioned goats consistently ate more (P < 0.05) juniper than naive goats except for April, when the study began, and March, when the study ended. When selection of herbaceous forages decreased, conditioned goats increased selection of juniper, while naive goats increased selection of other palatable shrubs. Seasonal changes of monoterpene levels in juniper had no apparent effect on juniper preference. We contend that feeding juniper at weaning will increase use of the plant in grazing situations.
American rural hospitals are in the midst of an unprecedented closure crisis. Historically low-volume, remote hospitals have survived on tax revenue and government programs; however, recent cuts in ...government funding and declining local property values are forcing many organizations to close. In remote communities located an hour or more away from the nearest clinic or trauma center, hospital closures leave residents with limited, and in some cases, no access to healthcare. Rankin County Hospital District (RCHD) is located in Rankin, TX, a town of 800 residents in rural West Texas. Three years ago, RCHD was on the verge of falling victim to the rural hospital crisis. A closure would have devastated the community. Not only would residents lose access to medical care, but as one of the town’s leading employers, over 100 people would lose their job. To increase revenue, RCHD began offering new services. As intended, these new services increased profitability; however, staffing these new positions has become a problem. One group of employees has taken on most of the new responsibilities, while the other group is content in their current roles. As the organization continues to grow, the likelihood of sustaining current momentum is low without contributions from the entire staff. To ensure continued progress and meet employee needs, this study examined which factors contribute to employee motivation at RCHD. Existing research provides a strong base for understanding employee motivation at RCHD. However, current healthcare employee motivation studies take place in large health systems with thousands of employees. While motivating factors among healthcare employees may be similar across regions regardless of organization size, no rural healthcare employee motivation research exists. Following a phenomenological case study design, RCHD employees representing all twelve departments completed a paper-based survey and participated in one-on-one interviews. Motivation trends surfaced in the areas of leadership, local economy, employee age, job satisfaction, and training requirements. Existing motivation theories, including Maslow’s Needs Hierarchy, Herzberg’s Two-Factor Theory, and Vroom’s Expectancy Theory, provided a solid foundation in examining the findings, exploring implications, and developing a clearer understanding of rural healthcare employee motivation.
The purpose of this qualitative case study was to explore how the communication styles of a NCAA Division II collegiate football coaching staff and players influence motivational attributes and the ...workplace environment. The theoretical framework for this study included Barnlund’s transactional communication model and Deci and Ryan’s self-determination theory. The two research questions connected to this study were (1) how does the communication style of a collegiate head football coach, assistant coaches and team players influence motivational attributes and (2) how does the communication style of a collegiate head football coach, assistant coaches and team players influence the workplace environment. Five football coaches and six football players participated in this study. Data collected in this study came from the transcripts of semi-structured interviews and a focus group session and supportive data from the DISC behavioral instrument. Three themes emerged from the data about motivational attributes and answer research question #1: (1) positive motivational attributes are built on honesty, (2) negative motivational attributes are built on poor communication structure and (3) improvements can be made in the area of personal connection between coaches and players. In addition, three themes emerged from the data about the workplace environment and answer research question #2: (1) the team is learning about change, (2) teaching through role modeling by leaders, and (3) it is a positive environment. Collegiate head football coaches may find the results of this study in adopting their communication style to assistant coaches and players to improve motivational attributes and the workplace environment.
There is an urgent need for meaningful clinical trial outcome measurements for boys with Duchenne muscular dystrophy (DMD). New genetically targeted therapies have raised the hope of patients and ...caregivers for an improved quality and length of life, but currently, there is a lack of clinically significant methods for measuring the efficacy of new therapies in the youngest of patients who are most likely to benefit the most from early intervention. Commonly used clinical evaluation tools like the 6-minute walk test (6MWT) and North Star Ambulatory Assessment (NSAA) are not feasible in patients under 4 years of age. However, monitoring of community-based ambulation using accelerometers has previously been validated in patients as young as 2 years of age. Defining and then validating a methodology for capturing and reporting community based activity levels is one possible avenue for rapidly developing a clinical outcome measurement that will include younger boys with DMD and can be used by ambulatory patients across the spectrum of the disease. This document will explore the development of a possible methodology for displaying community based activity levels in boys with DMD that is based on a formula for height-adjusted distance at a given stride-rate.
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