Effects of Dancer-Specific Biomechanics on Adolescent Ballet Dancers' Posture En Pointe and Factors Related to Pointe Readiness: A Cross-Sectional Study.

OBJECTIVE: There are no universally accepted requirements or uniform protocols to determine when dancers can safely commence dancing en pointe (shod relevé). The purpose of this study was to examine dancer-specific biomechanics of adolescent pointe dancers and explore factors that may help determine pointe readiness. METHODS: Dancers (n=26; median age 14 yrs [IQR=13-16]) were stratified into two groups based on the ability to stand on the pointe shoe box as per a plumb line (Group 1: on the box; Group 2: not on the box) during parallel, shod relevé. Measurements included unshod weight-bearing range of motion (ROM) of ankle plantarflexion (PF) and first metatarsophalangeal (MTP) extension and shod posture assessment during first position elevé (rising into relevé with turned out, straight legs). Qualisys 3D motion capture and AMTITM force plates recorded dancers performing 10-15 repetitions of first position elevé. Comparison of three kinematic and three kinetic variables aimed to describe group differences during unshod and shod conditions. Wilcoxon signed-rank test assumed no difference between groups with a Bonferroni correction (p<0.0083). RESULTS: During unshod parallel relevé, ROM was different between groups for first MTP extension (deg; MedGroup1: 90°, IQR 80°-90°; MedGroup 2: 70°, IQR: 70°-80°, p<0.0001) but no statistical difference in ankle PF (deg; p=0.0098). There were no differences in C7 displacement (m; p=0.5055), ankle PF moment (p=0.1484), or hip mediolateral and anteroposterior moments (p=0.8785 and 0.8785, respectively) during shod first position relevé, indicating that both groups tend to engage the same dominant muscle groups (trunk extensors, ankle dorsiflexors, hip flexors, and hip abductors) during elevé. CONCLUSION: Dancers in Group 1 demonstrated greater first MTP extension during unshod relevé compared to dancers in Group 2. Weight-bearing ROM could be a valuable tool in predicting pointe readiness of adolescent ballet dancers.

The Impact of Amplification on Cognitive Screening Test Scores.

Hearing loss is associated with cognitive decline in older adults. Research has shown that hearing loss negatively affects cognitive screening test measures as patients may mishear verbally administered questions. The purpose of the current study was to investigate the impact of amplification on performance on a commonly used cognitive screening test. Thirty older adults with hearing loss underwent testing with the Mini-Mental State Examination (MMSE) in three conditions: without hearing aids, with hearing aids, and with a personal listening device (PLD). Performance on the MMSE significantly improved with the use of hearing aids or a PLD. Amplification and the use of communication strategies should be considered when administering cognitive screening measures to older adults. Failure to account for hearing status may lead to invalid results and can increase the likelihood of over-referral for further assessment. [Journal of Gerontological Nursing, 48(7), 31-37.].

Home food access and children's heart healthy dietary intake at home and child care.

Background: About 12 million children under 5 years of age attend early care and education centers (ECEs). Child intake at home can be impacted by food insecurity, which is higher among low income, rural, and racially diverse families. Aim: Determine whether greater access to fruits, vegetables, and snacks at home was associated with heart-healthy diet score at home and at ECEs in preschool-age children, and to determine whether there is a difference in heart-healthy diet score between home and ECEs. Methods: Cross-sectional study involving children (3-to-5-year-old, n = 88) who attended 16 licensed ECEs across Oklahoma. Caregivers completed the Healthy Home Survey and 3-Dinner Dietary recall to report children's home food access and home dinner dietary intake, respectively. Researchers recorded children's ECE lunch consumption using the Dietary Observation for Child Care. Heart-healthy diet score was derived from composite scores for six variables: consumption of fish, fruits, vegetables, sodium, fiber, and sugary drinks. Results: Home access to total fruits and vegetables (16.2 ± 6.3) outnumbered snacks (5.5 ± 3.0). No difference in composite heart-healthy diet score between ECEs (1.50 ± 0.8) and home (1.27 ± 0.9, P = 0.0851). Children within neither environment met recommendations for most variables (vegetables [18-24%], fruit [6-10%], fish [5-10%], fiber [1%], sodium [22-39%]). No relationship between home food access variables and the heart-healthy diet scores at home or ECEs. Conclusion: Dietary intake of children at home and ECEs does not meet heart-healthy diet score recommendations. Interventions should support preschool aged children from families that are located rurally, low-income, racial minorities, and whose primary caregivers work outside the home.

The effectiveness of post-professional physical therapist training in the treatment of chronic low back pain using a propensity score approach with machine learning.

RATIONALE: Low back pain (LBP) is a leading cause of disability in the United States creating substantial hardships through negative social, financial, and health effects. Chronic low back pain (CLBP) accounted for above half of patients treated in physical therapy (PT) clinics for LBP. However, research shows small benefit from PT in CLBP treatment. Preliminary evidence suggests clinician-level training variables may affect outcomes, but requires further investigation to determine whether patients with CLBP benefit from treatment by providers with post-professional training. This study examined the relationship between clinician training levels and patient-reported outcomes in CLBP treatment. METHODS: Physical therapies were surveyed using a large patient outcome assessment system to determine and categorise them by level of post-professional education. To account for the possibility that clinicians with higher levels of training are referred more-complex patients, a machine learning approach was used to identify predictive variables for clinician group, then to construct propensity scores to account for differences between groups. Differences in functional status score change among pooled data were analysed using linear models adjusted for propensity scores. RESULTS: There were no clinically meaningful differences in patient outcomes when comparing clinician post-professional training level. The propensity score method proved to be a valuable way to account for differences at baseline between groups. CONCLUSION: Post-professional training does not appear to contribute to improved patient outcomes in the treatment of CLBP. This study demonstrates that propensity score analysis can be used to ensure that differences observed are true and not due to differences at baseline.

90Y-Labeled Resin Microsphere Spills: A Pilot Study to Determine Efficient Cleanup Practices.

90Y-labeled resin microspheres (RMs) are selective internal radiation therapy agents encased in microscopic resin spheres and then suspended in water for injection. The 90Y-RM package insert includes a recommended cleanup procedure for contamination spills. However, after a local hospital recently experienced a clinical incident, we explored the efficiency of the recommended cleanup procedure. The aim of this investigation was to demonstrate the effectiveness of different cleaning procedures and compare these with the recommended procedure. Methods: Controlled spills of 90Y-RMs were placed in the middle of 10 independent 0.09 m2 (1 ft2) tile sections of an existing vinyl tile floor. Each 0.09 m2 (1 ft2) area was surrounded by absorbent pads and was further contained within 0.28 m2 (3 ft2) 1.9-cm (¾ in)-thick plywood box enclosures. Three cleaning methods were implemented: damp paper towels (recommended procedure), adhesive paper, and a Swiffer wet mop (SWM). A calibrated Geiger counter was used to determine the maximum precleaning and maximum postcleaning exposure within the tile sections. Percentage exposure reduction was calculated for each cleaning trial, and because of the low sample size, nonparametric exact Kruskal-Wallis tests were used to determine differences in percentage exposure reduction among cleaning types. All statistical tests were conducted assuming a 5% chance of a type 1 error. Results: Both damp paper towels and the SWM were superior to adhesive paper (P = 0.0006 and P = 0.0005, respectively). There was no difference between damp paper towels and the SWM, nor did the variability of the cleanup methods differ (P = 0.6826 and P = 0.2501, respectively). Conclusion: Damp paper towels and the SWM decontaminated the controlled spills equally. This finding indicates that the SWM can effectively clean up 90Y contamination.

Perceptions of Visible Body Art Among Radiographers.

PURPOSE: To determine the perceptions among radiographers of visible tattoos and nontraditional body piercings (piercings other than traditional pierced earlobes) in the clinical setting. METHODS: An institutional review board-approved survey was delivered electronically to radiography clinical preceptors working at hospitals affiliated with a radiography program in the South Central part of the United States. Discussion board forum posts about the survey were created in the American Society of Radiologic Technologists Communities, targeting radiographers throughout the United States. Responses were collected for 4 weeks and compared quantitatively using linear regression, logistic regression, and chi-square analysis. Qualitative results were examined for themes, and proportions among themes were reported. RESULTS: A total of 943 valid responses were received from radiographers working in the United States. Acceptance of body art was lower among individuals without tattoos compared with those who have tattoos (P < .001). Individuals without piercings had a lower acceptance of piercings compared with those who have piercings (P < .001). Acceptance was lower for those who have tattoos but cover them at work compared with those who have visible tattoos at work (P < .001). Acceptance was not statistically significant among those who have piercings who cover them compared with those who have visible nontraditional piercings at work (P = .073). Respondents believed it was more acceptable for members of the public to display a tattoo than for radiographers to display a tattoo at work (P < .001). However, acceptability was higher (P < .001) when the radiographer's tattoo was medically related. DISCUSSION: Research links visible body art with negative perceptions of professionalism and skill set ability in other professions, but no studies have addressed radiography. This study reflects findings similar to those professions. A negative perception exists among radiographers regarding the display of body art while working, even among those who have body art. However, the subject of a tattoo might matter more than the location of a tattoo in terms of acceptability. These results have implications for the credibility and appropriateness of radiographers who display body art in the clinical setting because it might adversely affect the perceptions of co-workers and the perceptions of patient care provided during imaging services, and might affect hospital policy management. CONCLUSION: Among radiographers working in the United States, a negative perception exists regarding visible body art such as tattoos and nontraditional piercings in the health care setting. Implications include negative perceptions of radiographers displaying body art while working. Future research might influence policy implementation as hospitals work to continually improve satisfaction scores and perceptions of care received.

Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study.

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred "initial" and 200 "reply" Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

Description of School-Based Physical Therapy Services and Outcomes for Students with Down Syndrome.

Students with Down syndrome (DS) receive school-based physical therapy (SBPT), however little data exists regarding services and outcomes. Using a prospective observational cohort study our aim was to explore SBPT activities and interventions, and students' goal achievement of 46 students with DS, tracked by 17 physical therapists (PTs). PTs provided on average 24.0 min/week direct service and 11.6 min/week services on behalf of the student. The most frequent activities employed were physical education/recreation, mobility, and sitting/standing/transitions. The most frequent interventions implemented were neuromuscular, mobility, and musculoskeletal. Although students individually met 69.5% of their primary outcome goals, their achievement could not be explained by total minutes of either direct and minutes on behalf of SBPT, nor minutes spent in most frequent activity.

Effect of Reduced Audibility on Mini-Mental State Examination Scores.

BACKGROUND: The interaction of audition and cognition has been of interest to researchers and clinicians, especially as the prevalence of hearing loss and cognitive decline increases with advancing age. Cognitive screening tests are commonly used to assess cognitive status in individuals reporting changes in memory or function or to monitor cognitive status over time. These assessments are administered verbally, so performance may be adversely affected by hearing loss. Previous research on the impact of reduced audibility on cognitive screening test scores has been limited to older adults with sensorineural hearing loss (SNHL) or young adults with normal hearing and simulated audibility loss. No comparisons have been conducted to determine whether age-related SNHL and its impact on cognitive screening tests is successfully modeled by audibility reduction. PURPOSE: The purpose of this study was to examine the effects of reduced audibility on the Mini-Mental State Examination (MMSE), a common bedside cognitive screening instrument, by comparing performance of cognitively normal older adults with SNHL and young adults with normal hearing. DESIGN: A 1:1 gender-matched case-control design was used for this study. STUDY SAMPLE: Thirty older adults (60-80 years old) with mild to moderately severe SNHL (cases) and 30 young adults (18-35 years old) with normal hearing (controls) served as participants for this study. Participants in both groups were selected for inclusion if their cognitive status was within normal limits on the Montreal Cognitive Assessment. DATA COLLECTION AND ANALYSIS: Case participants were administered a recorded version of the MMSE in background noise at a signal-to-noise ratio of +25-dB SNR. Control participants were administered a digitally filtered version of the MMSE that reflected the loss of audibility (i.e., threshold elevation) of the matched case participant at a signal-to-noise ratio of +25-dB SNR. Performance on the MMSE was scored using standard criteria. RESULTS: Between-group analyses revealed no significant difference in the MMSE score. However, within-group analyses showed that education was a significant effect modifier for the case participants. CONCLUSIONS: Reduced audibility has a negative effect on MMSE score in cognitively intact participants, which contributes to and confirms the findings of earlier studies. The findings suggest that observed reductions in score on the MMSE were primarily due to loss of audibility of the test item. The negative effects of audibility loss may be greater in individuals who have lower levels of educational attainment. Higher levels of educational attainment may offset decreased performance on the MMSE because of reduced audibility. Failure to consider audibility and optimize communication when administering these assessments can lead to invalid results (e.g., false positives or missed information), misdiagnosis, and inappropriate recommendations for medication or intervention.

Effects of Continuing Education Incentives on Clinical Instructors.

PURPOSE: To research whether the ability to earn continuing education (CE) credit for time spent teaching motivates radiologic science professionals to teach students in clinic and to assess whether sonographers, who earn CE credit for time teaching, have more positive attitudes toward teaching than those in modalities who do not earn CE credit for time spent teaching. METHODS: Researchers developed a 2-track digital survey and delivered it electronically and on paper to clinical instructors working at hospitals affiliated with Department of Medical Imaging and Radiation Sciences programs at the University of Oklahoma Health Sciences Center. Responses were collected for 2 weeks and then compared quantitatively using chi-square tests and logistic regression models. Qualitative results were examined for themes, and proportions among themes were reported. RESULTS: A total of 239 people responded, with 166 responses coming from individuals working in radiography, radiation therapy, nuclear medicine, and medical dosimetry, and 73 responses from sonography. Receiving CE credit did not result in a difference in teaching attitudes (x2 5 0.0004, DF 5 1, P 5 .985). However, the non-CE credit-earning population showed a 12% increase in positive attitudes if allowed to earn CE credit in the future (95% CI; 0.08, 0.17). DISCUSSION: Student learning and performance in clinic directly are related to experiencing a positive learning environment. Factors other than CE credit appear to motivate instructors to teach students. Although the results of this study did not support the hypotheses, this study furthers the need to discuss whether offering CE credit for clinic instruction is something the profession should consider. CONCLUSION: Clinical instructors who are willing to teach are the most desirable to students. Further evaluation of CE credit as an extrinsic motivating factor for clinical instructorship is important for providing the best positive learning environment for students.

Feasibility of Ideal Cardiovascular Health Evaluation in a Pediatric Clinic Setting.

The feasibility of "point-of-care" screening for ideal cardiovascular health was explored in a pediatric specialty clinic setting. Children and adolescents aged 9-18 years (n=91) with treated and stabilized diseases were recruited at a pediatric endocrinology clinic. A table-top device was used to assay fingerstick samples for non-HDL cholesterol (non-HDL-C), which was used to divide participants into two groups based on the non-HDL-C threshold for comparison of the remaining metrics between groups. A significant number of children had low scores, and score frequency distribution was similar to larger retrospective studies, with few participants achieving none or all of the health metrics. Healthy diet was the metric least often achieved. Those with a non-HDL-C above the ideal threshold of 3.1 mmol/L (120 mg/dl) had a higher BMI percentile (p<0.01) and diastolic blood pressure percentile (p<0.05). We conclude that pediatric risk factor screening and scoring can be performed in a specialty clinic with meaningful cardiovascular health scores for patients and providers. Association of abnormal "point-of care" non-HDL-C levels with elevated BMI and blood pressure supports evidence for risk factor clustering and use of the ideal health construct in pediatric clinic settings.

The associations between diet and physical activity with body composition and walking a timed distance in adults with Prader-Willi syndrome.

BACKGROUND: Research on aging in Prader-Willi syndrome (PWS) is limited, although people with PWS are living longer. Individuals with PWS present with high fat mass, low lean mass, and low levels of physical activity (PA). Previous reports in children and young adults with PWS show inadequate nutrient intake and body fat percentage indicating obesity. Previous studies in PWS rarely included individuals beyond young adulthood, especially studies conducted in the United States. This study includes adults from 18 to 62 years of age, and includes 19 of the estimated 60 adult individuals with PWS in Oklahoma. Because individuals with PWS are living longer, information must be provided on aging with PWS. This study is a report of the initial data for a planned longitudinal study on aging with PWS. OBJECTIVE: Determine associations between body composition, diet, PA, and a timed walk for adults with PWS, and to assess adequacy of dietary intake for those individuals aging with PWS. DESIGN: This cross-sectional investigation determined dietary habits, PA, and body composition of adults with PWS, and tested associations between these variables. RESULTS: Participants ranged in age from 18 to 62 years. They had healthier body composition, at 26.8% body fat, than previously reported. Mean body mass index (BMI) was in the overweight range at 26.7. Those who consumed higher amounts of fat (as a percent of total kilocalories) had statistically significant lower body fat percentage, but this may simply reflect that individuals with lower body fat percentages felt freer to consume fat. Mean steps taken per day was 7631.7 steps but only 16% of participants met healthy PA recommendations despite participating in daily structured exercise. All participants' diets met Dietary Guidelines for macronutrient distribution, but 80% were deficient in calcium, 100% were deficient in dietary vitamin D, and 87% were deficient in fiber. Sample size was small, so it was difficult to reach statistical significance, despite seeing clinical significance. CONCLUSIONS: Recommend working toward healthy PA recommendations for all age groups by decreasing time in sedentary activity. Recommend increasing vitamin A and D fortified dairy products and high-fiber foods, and consider dietary supplementation, especially for calcium, vitamin D, and fiber.

Effects of Including Information about Hidden Hearing Loss in an Adopt-A-Band Program on College Band Members' Attitudes toward Healthy Hearing Behaviors.

Young musicians may be at risk for developing cochlear synaptopathy (CS), or hidden hearing loss (HHL), that could lead to permanent music-induced hearing loss (MIHL). Patients with CS often complain of tinnitus and/or difficulty understanding speech in noisy situations, even though traditional audiometric testing indicates normal hearing. The aim of this article was to determine the effects of including information about HHL on an Adopt-A-Band program involving college band members' concern about and self-efficacy toward the prevention of MIHL. We conducted a single-blinded, randomized clinical trial. Forty-eight band members participated in this study. Band members were randomly assigned to two Adopt-A-Band presentations, one with and one without information on HHL. Including information about HHL had no effect on these band members' concerns about and self-efficacy toward the prevention of MIHL. However, the Adopt-A-Band program resulted in significantly increased concern for MIHL by 39.5% ( p < 0.0001, 95% confidence interval [CI]: 25-54.2), self-efficacy in its prevention by 79.1% ( p < 0.0001, 95% CI: 66.9-91.2), and plans to use musicians' earplugs while playing by 67.4% ( p < 0.0001, 95% CI: 53.4-81.45). Although inclusion of information about HHL did not have a significant effect, the Adopt-A-Band program, in general, significantly increased the immediate intent of these students to practice healthy hearing behaviors. Future research is needed to determine the long-term effects of using the Adopt-A-Band program with university marching bands' use of healthy hearing behaviors.

Prevalence and Mortality of Melanoma in Oklahoma Among Racial Groups, 2000-2008.

INTRODUCTION: This study assessed the period prevalence (2000-2008) and mortality rates of melanoma, in Oklahoma, among different racial/ethnic strata. METHODS: We analyzed incident cases of melanoma from 2000-2008 from the Oklahoma Central Cancer Registry and determined disease duration using Kaplan-Meier survival analysis to calculate period prevalence of melanoma in Oklahoma. Using a series of Chi-Square tests, we compared period prevalence and mortality rates among the racial groups and compared mortality between Oklahoma and the US. RESULTS: White non-Hispanics in Oklahoma have the highest period prevalence (p<0.0001) among the racial strata. American Indian or Alaska Native (AI/AN) individuals have the second highest period prevalence in Oklahoma (p<0.0001). Furthermore, white non-Hispanics (p<0.0001) and AI/AN individuals (p=0.0003) in Oklahoma had higher mortality rates compared to the US. CONCLUSIONS: There are disparities in the prevalence and mortality of melanoma among the AI/AN population in Oklahoma, and prevention and education programs should focus on this population.

Radiation Hormesis: Historical and Current Perspectives.

The purpose of this article is to provide the reader with a better understanding of radiation hormesis, the investigational research that supports or does not support the theory, and the relationship between the theory and current radiation safety guidelines and practices. The concept of radiation hormesis is known to nuclear medicine technologists, but understanding its complexities and the historical development of the theory may bring about a better understanding of radiation safety and regulations.

Gynecologic oncologists' perceptions of fellowship training.

OBJECTIVE: To determine fellowship satisfaction through a survey of practicing gynecologic oncologists. STUDY DESIGN: A survey was sent to all candidate members of the Society of Gynecologic Oncologists listed in the 2000 directory. Surveys were returned anonymously and confidentially. Questions focused on demographics, research, clinical opportunity and educational experience, satisfaction with fellowship training and career choice. Associations between variables were studied using chi2 and two-tailed t tests. RESULTS: Of the surveys sent, 47.1% (71/156) were returned. Average time out of fellowship was 3.6 years, 94.6% were currently performing research, and 47.3% did not publish their basic science research as a fellow, with 20.3% citing lack of mentorship as the main reason. Clinically, hands-on experience and faculty involvement were the top areas influencing surgical training during fellowship. Surgical, chemotherapy and radiation therapy training was adequate according to 90.5%, 94.6%, and 98.6%, respectively. Of those surveyed, 86.5% recommended a statistics course, and 81.5% recommended didactics specific to fellows; however, only 59.5% had received such teaching. Of the respondents, 44.6% and 40.8% had an opportunity to evaluate their fellowship and attending staff, respectively, as compared to 70.8% receiving routine performance evaluations (p = 0.001 and 0.0003, respectively); 98.6% and 89.2% were satisfied and recommended their fellowships. The areas of greatest satisfaction were surgical training and clinical experience. The areas of least satisfaction were didactics, basic science and clinical research. In all, 95.9% were satisfied with their career choice. CONCLUSION: Areas in which fellowship satisfaction could improve are formal didactics and improved mentoring in research. Fellowship and faculty evaluations could provide a forum to continue to improve training programs. Respondents thought that they were sufficiently trained and were satisfied with their career choice.