Effects of global postural alignment on posture-stabilizing synergy and intermuscular coherence in bipedal standing.

Clinicians frequently assess and intervene on postural alignment; however, notions of what constitutes good postural alignment are variable. Furthermore, the majority of current evidence appeals either to population norms or defines good postural alignment as the negation of what has been observed to correlate with pathology. The purpose of this study was to identify affirmative indicators of good postural alignment in reference to motor control theory. Electromyography (anterior leg, posterior leg, and trunk muscles) and motion capture data were acquired from 13 participants during 4 min bipedal standing trials in 4 conditions: control, - 10%, + 30%, and + 60% of subject-specific anterior limits of stability. Synergistic kinematic coordination was quantified via the uncontrolled manifold framework, and correlated neural drive was quantified in posture-relevant muscle groups (anterior, posterior, and trunk) via intermuscular coherence. Multilevel models assessed the effects of sagittal plane alignment on both outcomes. We observed a within-subjects fixed effect in which kinematic synergistic coordination decreased as subjects became more misaligned. We also observed within-subjects fixed effects for middle- and high-frequency intermuscular coherence in the posterior group (increased coherence with increased misalignment) and for trunk intermuscular coherence across all frequency bands (decreased coherence with increased misalignment). Our findings indicate that it may be possible to describe healthy postural alignment in light of referent control theory. Greater misalignment with respect to vertical is associated with compromises in synergistic control of posture and increased corticospinal drive to specific muscle groups. These results suggest that postural alignment may not simply be an empirical phenomenon.

Effects of an aerobic fitness test on short- and long-term memory in elementary-aged children.

Meta-analytic evidence supports that exercise has benefits for short-term memory (STM) and long-term memory (LTM). However, only three studies with children have tested the differential effects of exercise on STM and LTM. The purpose of this study was to examine the effects of an aerobic fitness test on STM and LTM and to consider the moderating effects of grade level. Children (7-13 years of age) were randomly assigned to either perform an aerobic fitness test before (exercise prior) or after (exercise post) performing the Rey Auditory Verbal Learning Test (RAVLT) to assess memory. Memory was tested again after approximately 24 hours. There were significant differences in memory performance as a function of grade with 4th and 6th graders consistently outperforming 2nd graders. For learning, Day 1 Retention, 24-hr recall, and Day 2 Retention, the exercise prior group performed better than the exercise post group. It is concluded that an aerobic fitness test performed prior to a declarative memory test benefits LTM as compared to when the aerobic fitness test is performed after the memory test.

Effectiveness of a 2-Week Strength Training Learning Intervention on Self-selected Weight-Training Intensity.

Glass, SC, Ahmad, S, and Gabler, T. Effectiveness of a 2-week strength training learning intervention on self-selected weight-training intensity. J Strength Cond Res 34(9): 2443-2448, 2020-The purpose of this study was to determine the effectiveness of an imposed (IM) vs. self-selected (SS) 2-week strength training intervention on SS resistance training intensity. Subjects 18-40 years (SS n = 10 and IM n = 10) were provided resistance training orientation (chest press, leg press, triceps extension, bicep curl, and shoulder press). On 6 different training days, subjects completed 2 sets on each machine while blinded to the load. The SS group SS loads without any intensity or effort feedback. Load, repetitions, and ratings of perceived exertion (RPE) were recorded. The IM group was encouraged to lift to fatigue, and if they exceeded 12 repetitions, subsequent load was increased (goal-attain 70% one repetition maximum [1RM]). After training, SS and IM SS loads and repetitions for all lifts, plus 3 novel lifts (pec fly, leg extension, and shoulder raise). One repetition maximum was assessed last. Comparisons between groups were made using 2-way analysis of variance. There were significant main effects for % 1RM for the condition and day (day 1 IM = 57.2 ± 12.0%, SS = 47.2 ± 13.7% and day 6 IM = 74.7 ± 10.8%, SS = 66.2 ± 13.4%). There were significant effects across days for reps (day 1 IM = 10.8 ± 4.8, SS = 12.3 ± 4.0 and day 6 IM = 9.3 ± 3.6, SS = 10.0 ± 3.0) and RPE (day 1 = 15.4 ± 2.0 and day 6 = 16.5 ± 1.9). For both SS and IM post-training SS loads exceeded 60% 1RM. However, among the novel lifts, only the pec fly was greater than 60% 1RM (pec fly 63.0 ± 11.0%, leg extension 39.8 ± 12.5%, and shoulder raise 53.1 ± 12.8%). Two weeks of supervised resistance training resulted in both IM and SS self-selecting loads greater than 60% 1RM. There were no differences after 2-weeks of training between IM load and SS load groups.

Validity of Postural Sway Assessment on the Biodex BioSway™ Compared With the NeuroCom Smart Equitest.

CONTEXT: Current tools for sideline assessment of balance following a concussion may not be sufficiently sensitive to identify impairments, which may place athletes at risk for future injury. Quantitative field-expedient balance assessments are becoming increasingly accessible in sports medicine and may improve sensitivity to enable clinicians to more readily detect these subtle deficits. OBJECTIVE: To determine the validity of the postural sway assessment on the Biodex BioSway™ compared with the gold standard NeuroCom Smart Equitest System. DESIGN: Cross-sectional cohort study. SETTING: Clinical research laboratory. PARTICIPANTS: Forty-nine healthy adults (29 females: 24.34 [2.45] y, height 163.65 [7.57] cm, mass 63.64 [7.94] kg; 20 males: 26.00 [3.70] y, height 180.11 [7.16] cm, mass 82.97 [12.78] kg). INTERVENTION(S): The participants completed the modified clinical test of sensory interaction in balance on the Biodex BioSway™ with 2 additional conditions (head shake and firm surface; head shake and foam surface) and the Sensory Organization Test and Head Shake Sensory Organization Test on the NeuroCom Smart Equitest. MAIN OUTCOME MEASURES: Interclass correlation coefficient and Bland-Altman limits of agreement for Sway Index, equilibrium ratio, and area of 95% confidence ellipse. RESULTS: Fair-good reliability (interclass correlation coefficient = .48-.65) was demonstrated for the stance conditions with eyes open on a firm surface. The Head Shake Sensory Interaction and Balance Test condition on a firm surface resulted in fair reliability (interclass correlation coefficient = .50-.59). The authors observed large ranges for limits of agreement across outcome measures, indicating that the systems should not be used interchangeably. CONCLUSIONS: The authors observed fair reliability between BioSway™ and NeuroCom, with better agreement between systems with the assessment of postural sway on firm/static surfaces. However, the agreement of these systems may improve by incorporating methods that mitigate the floor effect in an athletic population (eg, including a head shake condition). BioSway™ may provide a surrogate field-expedient measurement tool.

Sex-Specific Dependence of Linear and Nonlinear Postural Control Metrics on Anthropometrics During Clinical Balance Tests in Healthy Young Adults.

CONTEXT: Previous work suggests that balance behavior is a sex-dependent, complex process that can be characterized by linear and nonlinear metrics. Although a certain degree of center of pressure variability may be expected based on sexual dimorphism, there is evidence to suggest that these effects are obscured by potential interactions between sex and anthropometric factors. To date, no study has accounted for such interactive effects using both linear and nonlinear measures. OBJECTIVE: This investigation sought to analyze interactive models featuring sex, height, and weight as predictors of linear and nonlinear aspects of postural control. DESIGN: Cross-sectional study. SETTING: Controlled laboratory. PARTICIPANTS: A total of 26 males (23.80 [3.44] y, 177.87 [6.44] cm, 81.70 [10.80] kg) and 28 females (21.14 [2.03] y, 169.57 [8.80] cm, 64.48 [8.86] kg) were sampled from a healthy university population. MAIN OUTCOME MEASURES: Linear (range [RNG], velocity [VEL], and SD) and nonlinear (detrended fluctuation analysis scaling exponent, multivariate multiscale sample entropy [MMSECI]) summary metrics of center of pressure time series. PROCEDURE: Participants stood on a force plate for 20 seconds in 3 conditions: double (D), single (S), and tandem (T) stance. Data for each stance condition were analyzed using regression models with interaction terms for sex × height and sex × weight. In D, weight had a positive, significant main effect on VELy, MMSECId, and MMSECIv. In men, height was observed to have a positive effect on SDy (S), RNGy (S), and RNGx (T) and a negative effect on MMSECIv (T). In women, weight was observed to have a positive effect on SDy and VELx (both T). CONCLUSIONS: Our findings suggest that men and women differ with respect to certain linear and nonlinear aspects of balance behavior, and that these differences may reflect sex-specific behavioral patterns in addition to effects related to sexual dimorphism.

Effectiveness of an antifungal stewardship programme at a London teaching hospital 2010-16.

Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes. Patients and methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist. Demographics, diagnosis by European Organization for Research and Treatment of Cancer (EORTC) criteria, drug, indication, advice, acceptance and in-hospital mortality were recorded. Antifungal consumption and expenditure, and candidaemia species and susceptibility data were extracted from pharmacy and microbiology databases. Results: A total of 432 patients were reviewed, most commonly receiving AmBisome® (35%) or intravenous fluconazole (29%). Empirical treatment was often unnecessary, with 82% having no evidence of IFI. Advice was given in 64% of reviews (most commonly de-escalating or stopping treatment) and was followed in 84%. Annual antifungal expenditure initially reduced by 30% (£0.98 million to £0.73 million), then increased to 20% above baseline over a 5 year period; this was a significantly lower rise compared with national figures, which showed a doubling of expenditure over the same period. Inpatient mortality, Candida species distribution and rates of resistance were not adversely affected by the intervention. Conclusions: Provision of specialist input to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes. Our model is readily implementable by hospitals with high numbers of at-risk patients and antifungal expenditure.

Validity of an Automated Balance Error Scoring System.

The Balance Error Scoring System (BESS) is a human-scored, field-based balance test used in cases of suspected concussion. Recently developed instrumented alternatives to human scoring carry substantial advantages over traditional testing, but thus far report relatively abstract outcomes which may not be useful to clinicians or coaches. In contrast, the Automated Assessment of Postural Stability (AAPS) is a computerized system that tabulates error events in accordance with the original description of the BESS. This study compared AAPS and human-based BESS scores. Twenty-five healthy adults performed the modified BESS. Tests were scored twice each by human raters (3) and the computerized system. Interrater (between-human) and inter-method (AAPS vs. human) agreement (ICC(2,1)) were calculated alongside Bland-Altman limits of agreement (LOA). Interrater analyses were significant (p<0.005) and demonstrated good to excellent agreement. Inter-method agreement analyses were significant (p<0.005), with agreement ranging from poor to excellent. Computerized scores were equivalent across rating occasions. LOA ranges for AAPS vs. the Human Average exceeded the average LOA ranges between human raters. Coaches and clinicians may consider a system such as AAPS to automate balance testing while maintaining the familiarity of human-based scoring, although scores should not yet be considered interchangeable with those of a human rater.

Compensatory Muscle Activation During Unstable Overhead Squat Using a Water-filled Training Tube.

Glass, SC, and Albert, RW. Compensatory muscle activation during unstable overhead squat using a water-filled training tube. J Strength Cond Res 32(5): 1230-1237, 2018-The purpose of this study was to assess compensatory muscle activation of core and support muscle during an overhead squat using a water-filled training tube. Eleven experienced weightlifting (age = 20.10 ± 0.99, mass 89.17 ± 6.88 kg) men completed 3, 30-second trials of an overhead squat using an 11.4 kg tube that was partially filled with water. A central valve allowed 3 conditions of water movement: 50% open, 100% open, and a stable(S), closed valve condition. Subjects completed 8-10 repetitions within each condition. Electromyographic (EMG) electrodes were placed over the belly of the vastus lateralis, deltoid, rectus abdominus, and paraspinal muscles and recorded during concentric and eccentric (ECC) phases. Integrated EMG were computed and converted to percent maximal voluntary contraction (%MVC). Compensatory activation was assessed using the natural log of the coefficient of variation of %MVC across repetitions. A 1-way repeated-measures analysis of variance across (phase, condition) was used. Significant compensatory muscle activation was seen in the deltoid muscle during ECC (100% open = 3.60 ± 0.50 > stable LogCV = 3.06 ± 0.45). In addition, paraspinal muscle activity was also more variable during the ECC phase (50% open LogCv = 3.28 ± 0.26 > stable = 2.77 ± 0.67). We conclude that the water-filled training tube induces compensatory muscle activation in the deltoid and paraspinal muscles during the ECC phase of the overhead squat.

Changes in Posture Following a Single Session of Long-Duration Water Immersion.

Transitioning between different sensory environments is known to affect sensorimotor function and postural control. Water immersion presents a novel environmental stimulus common to many professional and recreational pursuits, but is not well-studied with regard to its sensorimotor effects upon transitioning back to land. The authors investigated the effects of long-duration water immersion on terrestrial postural control outcomes in veteran divers. Eleven healthy men completed a 6-hour thermoneutral pool dive (4.57 m) breathing diver air. Center of pressure was observed before and 15 minutes after the dive under 4 conditions: (1) eyes open/stable surface (Open-Stable); (2) eyes open/foam surface (Open-Foam); (3) eyes closed/stable surface (Closed-Stable); and (4) eyes closed/foam surface (Closed-Foam). Postdive decreases in postural sway were observed in all testing conditions except for Open-Stable. The specific pattern of center of pressure changes in the postdive window is consistent with (1) a stiffening/overregulation of the ankle strategy during Open-Foam, Closed-Stable, and Closed-Foam or (2) acute upweighting of vestibular input along with downweighting of somatosensory, proprioceptive, and visual inputs. Thus, our findings suggest that postimmersion decreases in postural sway may have been driven by changes in weighting of sensory inputs and associated changes in balance strategy following adaptation to the aquatic environment.

Multiplex PCR point of care testing versus routine, laboratory-based testing in the treatment of adults with respiratory tract infections: a quasi-randomised study assessing impact on length of stay and antimicrobial use.

BACKGROUND: Laboratory-based respiratory pathogen (RP) results are often available too late to influence clinical decisions such as hospitalisation or antibiotic treatment due to time delay in transport of specimens and testing schedules. Ward-based i.e. point of care (POC) testing providing rapid results may alter the clinical management pathway. METHODS: FilmArray® RP polymerase chain reaction (PCR) systems were placed in three in-patient and out-patient medical areas. Patients presenting with influenza-like illness /upper respiratory tract infection +/- lower RTI were recruited between January-July 2015. FilmArray® POC testing occurred on even days of the month (intervention) or routine, laboratory-based RP PCR testing +/- atypical serology on odd days (control). The primary outcome was length of hospital stay. The secondary outcomes were impact on the use of antimicrobials, readmissions, all-cause mortality, length of ward stay and turn-around time (TAT) (time to result from admission). RESULTS: Of 606 eligible patients, 545 (89.9%) were included; 211 in the control arm and 334 in the intervention arm. 20% of control arm patients and 24% of intervention arm patients had an RP detected. POC testing was not associated with the primary outcome measure, length of stay, but reduced the TAT from 39.5 h to 19.0 h, p < 0.001. Only the prescribing decision differed between study arms, p < 0.001. When antivirals were given, the intervention was associated with a reduction in the median time to the first dose of 36 h and allowed appropriate treatment of mycoplasma infection. CONCLUSIONS: We found no association between respiratory PCR POC testing and length of stay or most of the secondary outcomes except the antimicrobial prescribing decision. This was probably due to a delay in initiating FilmArray® testing. Despite this, POC testing allowed time-critical antivirals to be given significantly faster, appropriate mycoplasma treatment and results were available considerably faster than routine, laboratory-based testing. Ward-staff of all grades performed POC testing without difficulty suggesting potential use across many divergent healthcare settings. Further studies evaluating the implementation of rapid respiratory PCR POC testing and the effect on length of stay and antimicrobial use are required. TRIAL REGISTRATION: ISRCTN10470967 , Retrospectively Registered, 30/6/2015.

Core Muscle Activation During Unstable Bicep Curl Using a Water-Filled Instability Training Tube.

Glass, SC, Blanchette, TW, Karwan, LA, Pearson, SS, O'Neil, AP, and Karlik, DA. Core muscle activation during unstable bicep curl using a water-filled instability training tube. J Strength Cond Res 30(11): 3212-3219, 2016-The purpose of this study was to assess compensatory muscle activation created during a bicep curl using a water-filled, unstable lifting tube. Ten men (age = 21 ± 1.6 years, height = 180.0 ± 3.3 cm, mass = 87.4 ± 15.0 kg) and 10 women (age = 19.6 ± 1.3 years, height = 161.4 ± 12.0 cm, mass = 61.2 ± 7.4 kg) completed bicep curls using an 11.4-kg tube partially filled with water during a 50% open-valve, 100% open, and control setting. Subjects completed 8 repetitions within each condition with integrated electromyographic signal (converted to percent maximal voluntary contraction) of the bicep, deltoid, rectus abdominus, and paraspinal muscles measured. Compensatory activation was determined using the natural log of coefficient of variation across concentric (CON) and eccentric (ECC) contractions. There were no differences between gender for any condition. Significant variability was seen across treatments for paraspinal muscles for CON and ECC at 50% (CON LnCV = 3.13 ± 0.56%, ECC LnCV = 3.34 ± 0.58%) and 100% (CON = 3.24 ± 0.34%, ECC = 3.46 ± 0.35%) compared with control (CON = 2.59 ± 0.47%, ECC = 2.80 ± 0.61%). Deltoid variability was greater at the 100% open setting (CON = 3.51 ± 0.53%, ECC = 3.56 ± 0.36%) compared with control (CON = 2.98 ± 0.35%, ECC = 2.97 ± 0.45%). The abdominal CON 100% showed variability (3.02 ± 0.47%) compared with control (2.65 ± 0.43%). Bicep activation remained unvaried. Compensatory activation of postural muscles contribute to postural stability. This device may be a useful tool for neuromuscular training leading to improved stability and control.

Acute responses of postural alignment and intermuscular coherence to anti-gravitational muscle engagement-A randomized crossover trial.

INTRODUCTION: Posture is a facet of clinical assessment in several rehabilitative disciplines. Despite extensive clinical focus, the precision with which posture can be evaluated and intervened upon is limited by the very general terms used to describe it. The purpose of this crossover trial was to quantify the effects of targeted postural intervention motivated by theoretical sagittal gravitational collapsing (SGC) tendencies on: 1) distance from SGC, 2) intermuscular coherence (iCOH), and 3) kinematic chain connectivity. METHODS: Ten healthy adults (24.50 ± 1.18 years, 172.72 ± 10.19 cm, 76.47 ± 14.60 kg) completed pre- and post-intervention testing on two occasions involving contrasting interventions: promote postural muscle (PPM) vs. reduce compensatory muscle (RCM) engagement. Distance from SGC, iCOH, and kinematic chain connectivity were quantified from electromyography and/or kinematic data acquired during tests administered before and after interventions. Effects of Treatment [PPM, RCM] and Time [Pre, Post] were tested with linear mixed models. RESULTS: A Treatment*Time interaction was observed for distance from SGC. Post-intervention distance from SGC was greater following PPM only (p < 0.01). A Treatment*Time interaction was observed for hi-frequency trunk muscle iCOH, with a post-intervention increase corresponding to the RCM intervention (p < 0.007). Additional iCOH effects did not differ by intervention. CONCLUSION: Distance from SGC is acutely modifiable and increases following exercises to facilitate anti-SGC muscles. Convergent findings related to kinematic chain connectivity and prescriptive neural binding were not observed. These observations suggest that it may be possible to describe, evaluate, and intervene upon posture in reference to a specific, mechanistic theory regarding the function of postural alignment.

Effect of Instability Training on Compensatory Muscle Activation during Perturbation Challenge in Young Adults.

Balance requires constant adjustments in muscle activation to attain force steadiness. Creating appropriate training can be challenging. The purpose of this study was to examine the effects of 2 weeks of front squat instability training using a water-filled training tube on force steadiness during an instability challenge. Control (CON, n = 13) and experimental (EXP, n = 17) subjects completed pre- and post-testing for EMG variability by completing one set of 10 repetitions with a stable and unstable training tube. Electrodes were placed bilaterally on the anterior deltoid, paraspinal, and vastus lateralis muscles. CON subjects completed 2 weeks of training using a stable training tube, while EXP subjects trained with a water-filled instability tube. EMG data were integrated for each contraction, and force steadiness was computed using the natural log of coefficient of variation. CON results showed no changes in force steadiness for any condition. EXP showed significant reductions in EMG activation variability across all muscles. These results indicate a significant training effect in reducing muscle activation variability in subjects training with a water-filled instability training device. Improvements seen in these healthy subjects support the development of training implements for a more clinical population to help improve force steadiness.

Antibiotic review kit for hospitals (ARK-Hospital): a stepped-wedge cluster-randomised controlled trial.

BACKGROUND: Strategies to reduce antibiotic overuse in hospitals depend on prescribers taking decisions to stop unnecessary antibiotic use. There is scarce evidence for how to support these decisions. We evaluated a multifaceted behaviour change intervention (ie, the antibiotic review kit) designed to reduce antibiotic use among adult acute general medical inpatients by increasing appropriate decisions to stop antibiotics at clinical review. METHODS: We performed a stepped-wedge, cluster (hospital)-randomised controlled trial using computer-generated sequence randomisation of eligible hospitals in seven calendar-time blocks in the UK. Hospitals were eligible for inclusion if they admitted adult non-elective general or medical inpatients, had a local representative to champion the intervention, and could provide the required study data. Hospital clusters were randomised to an implementation date occurring at 1-2 week intervals, and the date was concealed until 12 weeks before implementation, when local preparations were designed to start. The intervention effect was assessed using data from pseudonymised routine electronic health records, ward-level antibiotic dispensing, Clostridioides difficile tests, prescription audits, and an implementation process evaluation. Co-primary outcomes were monthly antibiotic defined daily doses per adult acute general medical admission (hospital-level, superiority) and all-cause mortality within 30 days of admission (patient level, non-inferiority margin of 5%). Outcomes were assessed in the modified intention-to-treat population (ie, excluding sites that withdrew before implementation). Intervention effects were assessed by use of interrupted time series analyses within each site, estimating overall effects through random-effects meta-analysis, with heterogeneity across prespecified potential modifiers assessed by use of meta-regression. This trial is completed and is registered with ISRCTN, ISRCTN12674243. FINDINGS: 58 hospital organisations expressed an interest in participating. Three pilot sites implemented the intervention between Sept 25 and Nov 20, 2017. 43 further sites were randomised to implement the intervention between Feb 12, 2018, and July 1, 2019, and seven sites withdrew before implementation. 39 sites were followed up for at least 14 months. Adjusted estimates showed reductions in total antibiotic defined daily doses per acute general medical admission (-4·8% per year, 95% CI -9·1 to -0·2) following the intervention. Among 7 160 421 acute general medical admissions, the ARK intervention was associated with an immediate change of -2·7% (95% CI -5·7 to 0·3) and sustained change of 3·0% (-0·1 to 6·2) in adjusted 30-day mortality. INTERPRETATION: The antibiotic review kit intervention resulted in sustained reductions in antibiotic use among adult acute general medical inpatients. The weak, inconsistent intervention effects on mortality are probably explained by the onset of the COVID-19 pandemic. Hospitals should use the antibiotic review kit to reduce antibiotic overuse. FUNDING: UK National Institute for Health and Care Research.

Evaluation of the effectiveness of skin preparation methods for the reduction of Cutibacterium acnes (formerly Propionibacterium acnes) in shoulder surgery: a systematic review.

Background: Cutibacterium acnes (C. acnes) is the most common pathogen responsible for post-operative shoulder infections. The purpose of this study was to evaluate the effectiveness of skin preparation methods against C. acnes in shoulder surgery. Methods: A systematic review was conducted evaluating the effectiveness of skin preparation methods in the reduction of C. acnes in patients undergoing shoulder surgery. Outcomes were assessed based on the effectiveness of the method used; side effects and cost were also analysed. Results: Of the 19 included studies, 9 evaluated pre-surgical home treatments: 8 assessed benzoyl peroxide (BPO) and 6 concluded it is effective in reducing C. acnes. Nine studies assessed surgical skin preparation and concluded that Chlorhexidine gluconate (CHG) was not effective; in contrast hydrogen peroxide reduced C. acnes. Finally, one study evaluated an aseptic protocol using CHG and concluded that it was not effective. Conclusions: It was demonstrated that BPO as home treatment is effective in reducing C. acnes load on skin; it rarely causes side effects and is also cost-effective. This study highlights non-effectiveness of CHG. There was some evidence that the addition of hydrogen peroxide could have a positive effect in the reduction of C. acnes skin load; however, more studies are required.

Test-Retest Reliability of Postural Control Assessment on Biodex BioSway™.

Background: Recent protocols for posturographic assessment of postural control and balance have included head shake test conditions to challenge the vestibular contributions of postural control in an effort to increase the diagnostic accuracy of identifying individuals with impaired balance. However, evidence is limited regarding the test-retest reliability of such assessment protocols. Purpose: The purpose of this study was twofold: to determine the test-retest reliability of postural control assessment on the Biodex Biosway™, an accessible and field expedient tool for posturographic assessment, and to determine the test-retest reliability of the Head Shake Sensory Interaction and Balance Test (HS-SIB), an adaptation of the modified Clinical Test of Sensory Interaction and Balance (mCTSIB) which adds two head shake conditions to challenge the vestibular contributions to postural control. Study Design. This was a correlational time series cohort study completed in a biomechanics laboratory. Methods: The sample consisted of nineteen healthy adults (10 females, 9 males). Sway Index, Equilibrium Score, and the area of the ellipse enclosing 95% of the anterior-posterior (AP) and medial-lateral (ML) center of gravity (COG) displacement (AREA95) are the 3 summary variables. Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) are also reported. Results: Test-retest reliability was generally poor with limited exceptions. Moderate to good reliability was observed for the more challenging stance conditions (ICC range 0.58-0.81), including those with head shake. Conclusions: Field-expedient systems, such as the Biodex BioSway™, may offer reliable posturographic testing where gold-standard methods are not available. Clinicians should be aware that less demanding test conditions have limited reliability; however, test-retest reliability of this assessment tool is improved with more challenged stance conditions and the inclusion of a head shake task.

Direction-Specific Signatures of Sport Participation in Center of Pressure Profiles of Division I Athletes.

BACKGROUND: Descriptive and comparative studies of human postural control generally report effects for component or resultant dimensions of a measured signal, which may obscure potentially important information related to off-cardinal directionality. Recent work has demonstrated highly specific balance behavior that is often not easily reconciled with conventional theories of postural control. PURPOSE: The purpose of this study was to quantify the effects of sport-specific training history on directional profiles of center of pressure (COP) displacement and velocity among collegiate athletes. STUDY DESIGN: Cross-Sectional Study. METHODS: One-hundred sixty-seven NCAA Division-I varsity athletes (80 female: 19.12±1.08 years, 169.79±7.03 cm, 65.69±10.43 kg; 87 male: 19.59±1.33 years, 181.25±9.06 cm, 76.40±12.73 kg) representing four sports (basketball, soccer, tennis, and cross county) participated in this study. Participants balanced barefoot with eyes closed on a force plate for 10-s. in double leg and single leg stance. Effects of sport on mean COP velocity and total displacement were assessed within eight non-overlapping directions (i.e. heading bins). RESULTS: Greater double leg COP displacement and velocity were observed within specific heading bins in cross country athletes when compared to soccer athletes. Greater double leg COP velocity was also observed in multiple heading bins in basketball athletes when compared to soccer athletes. Greater single leg (non-dominant limb) COP displacement was observed in the 135° heading bin in basketball athletes when compared to soccer athletes. CONCLUSIONS: The observed effects are likely attributable to sport-specific sensorimotor adaptations, including lower extremity strength/power, proprioceptive acuity, and efficiency of integrating vestibular information. Other potential mechanism-namely the involvement of cutaneous feedback and/or muscle synergies-deserve consideration. Directional profiling of spontaneous COP motion may improve understanding of sport-related balance behavior, enhancing its application in therapeutic and performance monitoring contexts. LEVEL OF EVIDENCE: 3b.

Item-level and Composite-level Interrater Reliability of Functional Movement Screen™ Scores Following Condensed Training in Novice Raters.

BACKGROUND: The Functional Movement Screen™ (FMS™) is a clinical instrument designed to use movement behaviors to screen individuals for injury risk. Current rater certification programs focus on extensive, individualized training, which may not be appropriate in all screening contexts. PURPOSE: The purpose of this research was to examine the effect of a two-hour FMSTM training seminar on measures of reliability between previously untrained scorers. STUDY DESIGN: Repeated measures, descriptive cohort study. METHODS: Four novice raters completed a two-hour training course administered by an FMS™-certified, licensed physical therapist. The novices and the instructor then scored a group of 16 individuals on the seven FMS™ component tests on two separate occasions. Interrater reliability was assessed for FMS™ component scores using Fleiss' kappa and Krippendorff's α. Interrater reliability for the FMS™ composite score was assessed using a two-way ICC for agreement (a priori significance level=0.05). RESULTS: Reliability ranged from fair to almost perfect (kappa) for Deep Squat (0.61 Day 1, 0.79 Day 2), Shoulder Mobility (0.90 Day 1, 1.00 Day 2), Active Straight Leg Raise (0.53 Day 1, 0.69 Day 2), and Trunk Stability Push Up (0.48 Day 1, 0.49 Day 2) on both testing occurrences (p<0.05). Reliability (kappa) was fair for Inline Lunge (0.24 Day 1, 0.39 Day 2), and poor for Hurdle Step (Day 1 -0.01, Day 2 no result) and Rotary Stability (Day 1 -0.03, Day 2 -0.01). Results for Krippendorff's α were similar, with unacceptable interrater reliability for Hurdle Step (Day 1 -0.01, Day 2 1.00), Inline Lunge (Day 1 0.31, Day 2 0.39), and Rotary Stability (Day 1 -0.02, Day 2 -0.01). Interrater composite score reliability (ICC) was good (0.79 Day 1, 0.84 Day 2; both p<0.05). CONCLUSIONS: Findings suggest that a brief training seminar may be sufficient to ensure acceptable reliability in many, but not all, of the FMS™ component tests and composite score. LEVELS OF EVIDENCE: Level 2b.

Lemierre's syndrome involving milleri group streptococci: further insight into age and aetiology.

Lemierre's syndrome (LS) is a suppurative thrombophlebitis of the internal jugular vein secondary to otorhinolaryngologic infection. It is classically associated with the Gram-negative anaerobe Fusobacterium necrophorum (FN) and is thought to be a disease of young people. Here, we describe the case of a 56-year-old woman with LS involving milleri group streptococci (MGS), which has been reported only 13 times since it was first observed in 2003. Subgroup analysis of all published cases of LS involving MGS demonstrated these patients were significantly older than those involving FN (median age 49 years versus 18 years, p = 0.007, IQR 36-58 years), although this finding is limited by publication bias. This report clarifies a 2014 hypothesis regarding the relationship between age and aetiology in this rare disease. While FN remains the most common cause of LS overall, empiric antibiotic therapy should also cover oral streptococci such as MGS, even in younger adults.

Potential Mediators of Load-Related Changes in Movement Complexity in Young, Healthy Adults.

CONTEXT: Movement screening has become increasingly popular among tactical professionals. This popularity has motivated the design of interventions that cater to improving outcomes on the screens themselves, which are often scored in reference to an objective norm. In contrast to the assumptions underlying this approach, dynamical systems theory suggests that movements arise as a function of continuously evolving constraints and that optimal movement strategies may not exist. To date, few data address behavioral complexity in the fundamental movement tasks commonly used in clinical screenings. OBJECTIVE: To provide evidence of complex variability during movement screens and test the role of modifiable-that is, trainable-constraints in mediating loss of complexity during experimental-task manipulations. DESIGN: Crossover study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-five male (age = 23.96 ± 3.74 years, height = 178.82 ± 7.51 cm, mass = 79.66 ± 12.66 kg) and 25 female (age = 22.00 ± 2.02 years, height = 165.40 ± 10.24 cm, mass = 63.98 ± 11.07 kg) recreationally active adults. INTERVENTION(S): Participants performed tests of balance, range of motion, and strength. Additionally, they performed cyclical movement tasks under a control (C) condition and while wearing an 18.10-kg weight vest (W). MAIN OUTCOME MEASURE(S): Ground reaction forces were sampled at 1000 Hz and used to calculate center of pressure during cyclical movement tests. Multivariate multiscale entropy (MMSE) for the center-of-pressure signal was then calculated. Condition effects (C versus W) were analyzed using paired t tests, and penalized varying-coefficients regression was used to identify models predicting entropy outcomes from balance, range of motion, and strength. RESULTS: The MMSE decreased during the W condition (MMSEC > MMSEW; t49 range = 3.17-5.21; all P values < .01). CONCLUSIONS: Moderate evidence supported an association between modifiable constraints and behavioral complexity, but a role in mediating load-related loss of complexity was not demonstrated.