Golf swing generates power through coordinated rotations of the pelvis and upper torso, which are highly consistent among professionals. Currently, golf performance is graded on handicap, ...length-of-shot, and clubhead-speed-at-impact. No performance indices are grading the technique of pelvic and torso rotations. As an initial step toward developing a performance index, we collected kinematic metrics of swing rotational biomechanics and hypothesized that a set of these metrics could differentiate between amateur and pro players. The aim of this study was to develop a single-score index of rotational biomechanics based on metrics that are consistent among pros and could be derived in the future using inertial measurement units (IMU).
Golf swing rotational biomechanics was analyzed using 3D kinematics on eleven professional (age 31.0 ± 5.9 years) and five amateur (age 28.4 ± 6.9 years) golfers. Nine kinematic metrics known to be consistent among professionals and could be obtained using IMUs were selected as candidate variables. Oversampling was used to account for dataset imbalances. All combinations, up to three metrics, were tested for suitability for factor analysis using Kaiser-Meyer-Olkin tests. Principal component analysis was performed, and the logarithm of Euclidean distance of principal components between golf swings and the average pro vector was used to classify pro vs. amateur golf swings employing logistic regression and leave-one-out cross-validation. The area under the receiver operating characteristic curve was used to determine the optimal set of kinematic metrics.
A single-score index calculated using peak pelvic rotational velocity pre-impact, pelvic rotational velocity at impact, and peak upper torso rotational velocity post-impact demonstrated strong predictive performance to differentiate pro (mean ± SD:100 ± 10) vs. amateur (mean ± SD:82 ± 4) golfers with an AUC of 0.97 and a standardized mean difference of 2.12.
In this initial analysis, an index derived from peak pelvic rotational velocity pre-impact, pelvic rotational velocity at impact, and peak upper torso rotational velocity post-impact demonstrated strong predictive performance to differentiate pro from amateur golfers. Swing Performance Index was developed using a limited sample size; future research is needed to confirm results. The Swing Performance Index aims to provide quantified feedback on swing technique to improve performance, expedite training, and prevent injuries.
BACKGROUND:The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 in the United States to address “patient dumping,” or refusing to provide emergency care to patients and ...instead transferring them to other hospitals. Under EMTALA, the “reverse-dumping” provision prevents hospitals from refusing patients who require specialized capabilities or facilities if the hospital has the capacity to treat them. Despite this provision, patients continue to be transferred to distant tertiary care centers.
METHODS:We reviewed the literature on EMTALA in the context of a critically ill woman with an infection associated with an orthopaedic implant who was rejected from 2 geographically closer tertiary care centers and was ultimately transferred by helicopter ambulance to an academic teaching hospital that was 169 miles away from her home.
RESULTS:After transfer to our tertiary care, level-I trauma center, the patient spent 61 days in the intensive care unit; she required 9 operative procedures, which totaled 1,520 minutes of operative time. Eighteen medical specialties and 8 ancillary medical consulting teams were involved in her care. She underwent 1,436 laboratory and 83 radiographic studies. The total reimbursement from Medi-Cal (California’s Medicaid program) for her care in our tertiary care center was $463,753; the hospital charges were more than tenfold higher.
CONCLUSIONS:Dumping and reverse dumping continue despite compromise of patient care and the high financial burden of the accepting institutions. This may be due to ineffective monitoring and enforcement, lack of uniformity among the courts, and lack of incentive to receive uninsured or poorly funded patients. Under EMTALA, it is difficult for tertiary care centers to argue lack of specialized capabilities or capacity to accept patients, and neither hospitals nor physicians are compensated for the charges of providing care to uninsured or underinsured patients. Moving forward, efforts to better align financial incentives through cost-sharing between community hospitals and tertiary care centers, increased clinician literacy regarding the provisions of EMTALA, and increased transparency with hospital transfers may help improve EMTALA compliance and patient care.
Aim
To develop an easily‐administered metric to quantify gait impairment in children and to assess its use in children with cerebral palsy (CP).
Method
The Pediatric Temporal‐spatial Deviation Index ...(TDI) was developed from gait data collected from 75 typically developing children (37 males, 38 females; mean age 9y 4mo; interquartile range IQR 8–10y) and 17 children diagnosed with spastic CP (nine males, eight females; mean age 9y 9mo; IQR 9–11y), in Gross Motor Function Classification System (GMFCS) levels I to III, aged 7 to 11 years. Children walked on a pressure‐sensitive mat. Children with CP also completed 3D gait analysis. The Kaiser‐Meyer‐Olkin test of sampling adequacy was used for temporal‐spatial feature selection. Principal components obtained from temporal‐spatial gait parameters quantified deviation from typically developing gait. Deviation was normalized to a Pediatric TDI score mean (standard deviation SD) of 100 (10). The Pediatric TDI for children with CP was compared to 3D motion capture‐based Gait Deviation Index (GDI).
Results
The Pediatric TDI was significantly lower for children with CP compared to typically developing children (p<0.001), correlated with average GDI (r=0.610, p=0.009), and demonstrated sensitivity (0.78) and specificity (0.88) to gait function, assessed with GDI.
Interpretation
The Pediatric TDI is an easily administered, revealing gait metric that can be used in children with CP in pediatric clinics and for research. Detection of gait abnormalities in the clinic can expedite diagnosis and treatment.
What this paper adds
The Pediatric Temporal‐spatial Deviation Index (TDI) is a single‐score index of gait deviation, based on nine parameters.
The Pediatric TDI was more revealing than single temporal‐spatial gait parameters.
The Pediatric TDI is quick and simple to administer in the clinic.
What this paper adds
The Pediatric Temporal‐spatial Deviation Index (TDI) is a single‐score index of gait deviation, based on nine parameters.
The Pediatric TDI was more revealing than single temporal‐spatial gait parameters.
The Pediatric TDI is quick and simple to administer in the clinic.
Scapholunate Ligament Injuries Zhou, Joanne Y.; Jodah, Riasoya; Joseph, Lauren P. ...
Journal of hand surgery global online,
05/2024, Letnik:
6, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic ...impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.
Ulnar shortening osteotomy can be used to treat ulnar impaction syndrome and other causes of ulnar wrist pain. Distal metaphyseal ulnar shortening osteotomy (DMUSO) is one technique that has been ...proposed to reduce the complications seen with a diaphyseal USO or a wafer resection. However, to our knowledge, the optimal fixation construct for DMUSO has not been studied. We sought to characterize the biomechanical stiffness and rotational stability of different DMUSO constructs.
A DMUSO was performed on 40 human cadaveric ulnas using 4 different fixation constructs (10 specimens per group): one 3.0 mm antegrade screw; two 2.2 mm antegrade screws; one 3.0 mm retrograde screw; and two 2.2 mm retrograde screws. Biaxial testing using axial load and cyclical axial torque was performed until failure, defined as 10° of rotation or 2 mm displacement. Specimens were assessed for stiffness at failure. Bone density was assessed using the second metacarpal cortical percentage.
Bone density was similar between all 4 testing groups. Of the 4 groups, the 2 antegrade screw group exhibited the highest rotational stiffness of 232 ± 102 Nm/deg. In paired analysis, this was significantly greater than 1 retrograde screw constructs. In multivariable analysis, 2-screw constructs were significantly stiffer than 1 screw and antegrade constructs were significantly stiffer than retrograde. Maximum failure torque did not differ with orientation, but 2 screws failed at significantly higher torques.
Using 2 screws for DMUSO fixation constructs may provide higher stiffness and maximum failure torque, and antegrade screw constructs may provide more stiffness than retrograde constructs.
Antegrade screw fixation using 2 screws may provide the strongest construct for DMUSO. Antegrade fixation may be preferred because it avoids violating the distal radioulnar joint capsule and articular surface of the ulna.
Approximately 20% of patients after resection arthroplasty and antibiotic spacer placement for prosthetic joint infection develop repeat infections, requiring an additional antibiotic spacer before ...definitive reimplantation. The host and bacterial characteristics associated with the development of recurrent infection is poorly understood. A case‐control study was conducted for 106 patients with intention to treat by two‐stage revision arthroplasty for prosthetic joint infection at a single institution between 2009 and 2020. Infection was defined according to the 2018 Musculoskeletal Infection Society criteria. Thirty‐nine cases (“recurrent‐periprosthetic joint infection PJI”) received at least two antibiotic spacers before clinical resolution of their infection, and 67 controls (“single‐PJI”) received a single antibiotic cement spacer before infection‐free prosthesis reimplantation. Patient demographics, McPherson host grade, and culture results including antibiotic susceptibilities were compared. Fifty‐two (78%) single‐PJI and 32 (82%) recurrent‐PJI patients had positive intraoperative cultures at the time of their initial spacer procedure. The odds of polymicrobial infections were 11‐fold higher among recurrent‐PJI patients, and the odds of significant systemic compromise (McPherson host‐grade C) were more than double. Recurrent‐PJI patients were significantly more likely to harbor Staphylococcus aureus. We found no differences between cases and controls in pathogen resistance to the six most tested antibiotics. Among recurrent‐PJI patients, erythromycin‐resistant infections were more prevalent at the final than initial spacer, despite no erythromycin exposure. Our findings suggest that McPherson host grade, polymicrobial infection, and S. aureus infection are key indicators of secondary or persistent joint infection following resection arthroplasty and antibiotic spacer placement, while bacterial resistance does not predict infection‐related arthroplasty failure.
Coronoid fractures are associated with elbow fracture-dislocations. Fractures involving the anteromedial facet of the coronoid often are associated with a posteromedial rotational instability pattern ...which requires careful management to avoid persistent and often subtle instability. Although some anteromedial coronoid fractures may be treated nonoperatively, internal fixation through a medial approach is indicated in most cases. Without a universally accepted treatment algorithm, surgeons should consider the risk of persistent instability when approaching this injury pattern. Fracture morphology, fragment size, and joint congruity, as determined by computed tomography imaging and physical examination, inform clinical decision making.
The ulnar shortening osteotomy (USO) is a common procedure used to treat ulnar impaction syndrome secondary to static or dynamic ulnar-positive variance. There are many described techniques for the ...USO. The distal metaphyseal ulnar shortening osteotomy (DMUSO) with retrograde cannulated screw fixation was described to reduce complications seen with other techniques. Biomechanical analysis of fixation constructs demonstrates 2-screw constructs are significantly stiffer than 1 screw and antegrade constructs have similar or greater stiffness when compared with retrograde constructs. Here, we describe a technique of antegrade cannulated screw fixation for DMUSO that obviates the need for the disruption of the distal radioulnar joint for intra-articular exposure of the ulnar head. Similar to the traditional retrograde DMUSO technique, this construct may also decrease the risk of delayed union, symptomatic implants associated with diaphyseal osteotomies, and disruption of triangular fibrocartilaginous complex in wafer procedures.
Introduction: Oncologic proximal femoral resection and reconstruction in skeletally immature children remains a formidable task due to the risk of developing hip instability with patient growth or ...interval leg lengthening through the prosthesis. Shelf pelvic osteotomy increases femoral head coverage and containment, and favorable long-term results have been reported in the setting of developmental dysplasia of the hip and Perthes disease. We present a technique of combining shelf osteotomy with expandable proximal femoral endoprosthesis reconstruction in pediatric limb-sparing surgery. Materials and Methods: Four surgeons at 2 centers from 2012 to 2020 performed proximal femoral reconstruction with shelf osteotomy. Data were collected retrospectively on operative technique, radiographic measurements, and complications including dislocation, subluxation, implant loosening, pain, function, and radiographic outcomes. Results: Five patients were included in the study. The mean follow-up was 49 months (range: 17 to 104 mo). The mean lateral center edge angle status postproximal femoral resection and reconstruction shelf osteotomy was 56.1 degrees (±30.5). There were no reported incidences of subluxations, dislocations, periprosthetic fractures, or soft tissue complications. The 3 patients with the longest follow-up at 3, 5, and 8 years tolerated serial lengthening of the endoprosthesis totaling 1 cm, 7.25 cm, and 9 cm, respectively, and demonstrated earlier triradiate cartilage closure in the operative side compared with the nonoperative side. All patients have returned to independent ambulation. Discussion: Combining proximal femoral reconstruction with shelf osteotomy in limb salvage pediatric orthopedic oncology may help to improve hip stability with serial lengthening and patient growth.
The demand for more creative and innovative nurses and together with the rapid expansion of nurse education in Mainland China have called for new approaches to student learning. Challenge Based ...Learning, an active student-directed approach was incorporated into an elective course in an undergraduate nursing programme. Initially, the students were given some big ideas about the real world. They worked together in small groups to identify the most challenging problems from these ideas, develop some innovative solutions, formulate an action plan for a selected solution, carry out the actions and evaluate the outcome.
To evaluate the effectiveness of Challenge Based Learning on students' creativity and innovativeness.
Quasi-experimental.
A medical university in Guangzhou, China.
A convenience sample of 48 undergraduate nursing students from the bilingual class, who enrolled in the elective course, Innovation and Creative Thinking was invited to participate in the evaluative study. They completed the Creativity and Innovation Effectiveness Profile before and after the course.
Apart from descriptive statistics, the mean scores of the Creativity and Innovation Effectiveness Profile between the pretest and posttest assessments were analyzed using the Wilcoxon signed ranks test. The results showed that the mean scores of all 7 domains (i.e. creative consciousness, levels of curiosity, pattern breaking skills, idea nurturing ability, willingness to experiment and take risks, courage and resilience and energetic persistence) of Creativity and Innovation Effectiveness were significantly higher in the posttest.
Students can enhance their ability to innovate and create through learning. The successful practical experience of using CBL in the study provides a good reference for nurse teachers who want their students to be self-directed, creative and innovative.
•The ever changing health service demands for more creative and innovative nurses.•Challenge Based Learning was adopted to help the nursing students identify and solve health problems.•The students showed marked improvement in their ability to develop and implement innovative solutions.•Challenge Based Learning strengthens self-directed learning and student’s creativity and innovativeness.
