Maximum trunk tip force assessment related to trunk position and prehensile 'fingers' implication in African savannah elephants.

African elephants have a wide range of abilities using their trunk. As a muscular hydrostat, and thanks to the two finger-like processes at its tip, this proboscis can both precisely grasp and exert considerable force by wrapping. Yet few studies have attempted to quantify its distal grasping force. Thus, using a device equipped with force sensors and an automatic reward system, the trunk tip pinch force has been quantified in five captive female African savanna elephants. Results showed that the maximum pinch force of the trunk was 86.4 N, which may suggest that this part of the trunk is mainly dedicated to precision grasping. We also highlighted for the first time a difference in force between the two fingers of the trunk, with the dorsal finger predominantly stronger than the ventral finger. Finally, we showed that the position of the trunk, particularly the torsion, influences its force and distribution between the two trunk fingers. All these results are discussed in the light of the trunk's anatomy, and open up new avenues for evolutionary reflection and soft robot grippers.

Assessment of Isokinetic Trunk Muscle Strength and Fatigue Rate in Individuals after Bariatric Surgery.

Background and Objectives: Lean body mass loss after bariatric surgery (BS) is remarkable, despite an effective long-term mass reduction and significant declines in comorbidities. A person's functional capacity is adversely affected when their skeletal muscle strength declines by up to 30%. This study aimed to assess the isokinetic trunk muscle strength and fatigue rate in individuals after BS. Materials and Methods: This study included fifty-eight patients, both male and female, ranging in age from 19 to 45. Twenty-seven individuals had BS and twenty-seven healthy people served as the control group. The primary outcomes were the measurement of the concentric and eccentric isokinetic muscle strength of the trunk flexor and extensor muscles. An isokinetic dynamometer (Biodex Rehabilitation and Testing System 3) was used for the assessment of the isokinetic muscle strength. Noraxon EMG was used to determine a secondary outcome, which was the median frequency slop (MF/time) and root mean square slop (RMS/time) of the lumbar erector spinea muscle at 50% of the Maximum Voluntary Isometric Contraction (MVIC). Outcome measures were assessed for both groups. Results: Compared to the control group, the bariatric group showed a lower mean value of both concentric and eccentric isokinetic muscle strength for the flexor and extensor trunk muscles (p < 0.05). In terms of the EMG fatigue rate, the RMS slope increased significantly more than that of the control group, while the MF slope decreased (p > 0.05). Conclusions: The current study found that, in comparison to the healthy subjects, the BS group showed reduced levels of fatigue and isokinetic strength in the trunk muscles. Based on these results, it is recommended that individuals who underwent BS take part in tailored rehabilitation programs to avoid potential musculoskeletal issues in the future.

High Community-Level Social Vulnerability is Associated with Worse Recurrence-Free Survival (RFS) After Resection of Extremity and Truncal Soft Tissue Sarcoma.

BACKGROUND: Although social vulnerability has been associated with worse postoperative and oncologic outcomes in other cancer types, these effects have not been characterized in patients with soft tissue sarcoma. This study evaluated the association of social vulnerability and oncologic outcomes. METHODS: The authors conducted a single-institution cohort study of adult patients with primary and locally recurrent extremity or truncal soft tissue sarcoma undergoing resection between January 2016 and December 2021. The social vulnerability index (SVI) was measured on a low (SVI 1-39%, least vulnerable) to high (60-100%, most vulnerable) SVI scale. The association of SVI with overall survival (OS) and recurrence-free survival (RFS) was evaluated by Kaplan-Meier analysis and Cox proportional hazard regression. RESULTS: The study identified 577 patients. The median SVI was 44 (interquartile range [IQR], 19-67), with 195 patients categorized as high SVI and 265 patients as low SVI. The median age, tumor size, histologic subtype, grade, comorbidities, stage, follow-up time, and perioperative chemotherapy and radiation utilization were similar between the high and low SVI cohorts. The patients with high SVI had worse OS (p = 0.07) and RFS (p = 0.016) than the patients with low SVI. High SVI was independently associated with shorter RFS in the multivariate analysis (hazard ratio, 1.64; 95% confidence interval, 1.06-2.54) but not with OS (HR, 1.47; 95% CI 0.84-2.56). CONCLUSION: High community-level social vulnerability appears to be independently associated with worse RFS for patients undergoing resection of extremity and truncal soft tissue sarcoma. The effect of patient and community-level social risk factors should be considered in the treatment of patients with extremity sarcoma.

Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas.

In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.

Physics-Guided Deep Scatter Estimation by Weak Supervision for Quantitative SPECT.

Accurate scatter estimation is important in quantitative SPECT for improving image contrast and accuracy. With a large number of photon histories, Monte-Carlo (MC) simulation can yield accurate scatter estimation, but is computationally expensive. Recent deep learning-based approaches can yield accurate scatter estimates quickly, yet full MC simulation is still required to generate scatter estimates as ground truth labels for all training data. Here we propose a physics-guided weakly supervised training framework for fast and accurate scatter estimation in quantitative SPECT by using a 100× shorter MC simulation as weak labels and enhancing them with deep neural networks. Our weakly supervised approach also allows quick fine-tuning of the trained network to any new test data for further improved performance with an additional short MC simulation (weak label) for patient-specific scatter modelling. Our method was trained with 18 XCAT phantoms with diverse anatomies / activities and then was evaluated on 6 XCAT phantoms, 4 realistic virtual patient phantoms, 1 torso phantom and 3 clinical scans from 2 patients for 177Lu SPECT with single / dual photopeaks (113, 208 keV). Our proposed weakly supervised method yielded comparable performance to the supervised counterpart in phantom experiments, but with significantly reduced computation in labeling. Our proposed method with patient-specific fine-tuning achieved more accurate scatter estimates than the supervised method in clinical scans. Our method with physics-guided weak supervision enables accurate deep scatter estimation in quantitative SPECT, while requiring much lower computation in labeling, enabling patient-specific fine-tuning capability in testing.

A non-invasive method for scoliosis assessment-A new mathematical concept using polar angle.

Scoliosis is one of the most common pediatric spinal diseases that leads to a three-dimensional deformity of the spine and has a high risk of progression during growth. Regular clinical monitoring and follow-up X-rays are needed to providing proper treatment at that time. Repetitive X-rays can results in an increased risk of radiation related health problems. We present a non-invasive, ionizing radiation-free method for assessing scoliosis and its progression from the 3D images of the body torso, captured by a body scanner. A new concept is introduced based on a mathematical method in polar coordinate system to quantify and characterize the deformities in the torso from 2D transverse cross-sections of the 3D torso images at example cases for a healthy individual and for two patients with scoliosis. To capture quantitatively the characteristics of scoliosis, and to verify them at the example cases two asymmetry parameters and a linear fitting parameter are calculated: a) back side area asymmetry, b) left right area asymmetry, and c) coefficient of determination (R2). Within the analyzed patients, both the area asymmetries are maximum at the apex of scoliosis, and increase with the severity of scoliosis. R2 values are smaller in the case of patients compared with the healthy. Furthermore, the parameters show a trend when compared with the Cobb angle from the X-ray and the findings match with clinical examination. Therefore, the quantities are able to capture, certain characteristics associated with scoliosis. These quantities can be compared as a measure of deformities of torso, during the follow-up examinations in the future, without ionizing radiations.

Usefulness of gait parameters obtained from inertial sensors attached to the lower trunk and foot for assessment of gait performance in the early postoperative period after total knee arthroplasty.

BACKGROUND: This study was performed to (i) compare gait parameters obtained from inertial sensors attached to the lower trunk and foot between patients in the early postoperative period after total knee arthroplasty (TKA) and healthy age- and sex-matched controls and (ii) elucidate the association between the gait parameters and patient-reported outcome measures (PROMs). METHOD: The gait performance of 19 patients who had undergone TKA was assessed using inertial sensors and PROMs obtained from the Knee Injury and Osteoarthritis Outcome Score (KOOS) 1 week before hospital discharge. The patients walked along a 15-m walkway and we calculated the following gait parameters: walking speed, coefficient of variation (CV) of stride time, unbiased autocorrelation coefficient (AC), harmonic ratio (HR), and symmetry index (SI). The same gait parameter data from 19 age- and sex-matched healthy adults (controls) were obtained from our past study. RESULTS: The TKA group demonstrated slower walking speed, larger CV of stride time, lower HR in all three directions, lower AC in the vertical direction, and higher SI in the vertical direction than the healthy control group (all p < 0.05). Correlation analysis revealed that the SI in the anteroposterior direction was significantly correlated with the KOOS symptoms subscore and ADL subscore (p < 0.05). CONCLUSIONS: Patients in the early postoperative period after TKA exhibited worse gait performance as assessed by inertial sensors compared with healthy controls. Gait symmetry was correlated with PROMs. These results indicate the usefulness of assessing gait parameters after TKA.

The effectiveness and cost-effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma patients with uncontrolled torso haemorrhage: study protocol for a randomised clinical trial (the UK-REBOA trial).

BACKGROUND: Haemorrhage is the most common cause of preventable death after injury. REBOA is a novel technique whereby a percutaneously inserted balloon is deployed in the aorta, providing a relatively quick means of temporarily controlling haemorrhage and augmenting cerebral and coronary perfusion, until definitive control of haemorrhage can be attained. The aim of the UK-REBOA trial is to establish the clinical and cost-effectiveness of a policy of standard major trauma centre treatment plus REBOA, as compared with standard major trauma centre treatment alone, for the management of uncontrolled torso haemorrhage caused by injury. METHODS: Pragmatic, Bayesian, group-sequential, randomised controlled trial, performed in 16 major trauma centres in England. We aim to randomise 120 injured patients with suspected exsanguinating haemorrhage to either standard major trauma centre care plus REBOA or standard major trauma centre care alone. The primary clinical outcome is 90-day mortality. Secondary clinical outcomes include 3-h, 6-h, and 24-h mortality; in-hospital mortality; 6-month mortality; length of stay (in hospital and intensive care unit); 24-h blood product use; need for haemorrhage control procedure (operation or angioembolisation); and time to commencement of haemorrhage control procedure (REBOA, operation, or angioembolisation). The primary economic outcome is lifetime incremental cost per QALY gained, from a health and personal social services perspective. DISCUSSION: This study, which is the first to randomly allocate patients to treatment with REBOA or standard care, will contribute high-level evidence on the clinical and cost-effectiveness of REBOA in the management of trauma patients with exsanguinating haemorrhage and will provide important data on the feasibility of implementation of REBOA into mainstream clinical practice. TRIAL REGISTRATION: ISRCTN16184981.

Reliability and minimal detectable change of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and the trunk control test for individuals with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate the reliability and calculate the measurement error of the Trunk Assessment Scale for Spinal Cord Injury (TASS) and trunk control test (TCT-SCI) in individuals with spinal cord injury (SCI). SETTING: Rehabilitation Hospital in Japan. METHODS: The evaluations of TASS and TCT-SCI for individuals with SCI were video-recorded. The inter-rater reliability (two physiotherapists) was confirmed using the videos. ICC (2,1), kappa coefficient (κ) were used to determine the reliability of the total score and each item. Each minimal detectable change (MDC) was calculated. RESULTS: The TASS and TCT-SCI total scores showed excellent inter-rater reliability (ICC = 0.99, and 1.00). The kappa coefficients of TASS were acceptable to excellent for 8 items (κ = 0.76-1.00), below acceptable for 1 item (κ = 0.62). The kappa coefficients of TCT-SCI were excellent for 12 items (κ = 0.83-1.00), below acceptable for 1 item (κ = 0.68). The inter-rater MDC of the TASS total score was 4.07 points, and the MDC of the TCT-SCI total score was 1.13 points. The intra-rater MDC of the TASS total score was 3.86 points. CONCLUSION: Both TASS and TCT-SCI showed high reliability. Differences of less than four points in TASS and one point in TCT-SCI were interpreted as measurement errors between the two raters.

Trunk Dynamic Stability Assessment for Individuals With and Without Nonspecific Low Back Pain During Repetitive Movement.

OBJECTIVE: This study aimed to employ nonlinear dynamic approaches to assess trunk dynamic stability with speed, symmetry, and load during repetitive flexion-extension (FE) movements for individuals with and without nonspecific low back pain (NSLBP). BACKGROUND: Repetitive trunk FE movement is a typical work-related LBP risk factor contingent on speed, symmetry, and load. Improper settings/adjustments of these control parameters could undermine the dynamic stability of the trunk, hence leading to low back injuries. The underlying stability mechanisms and associated control impairments during such dynamic movements remain elusive. METHOD: Thirty-eight male volunteers (19 healthy, 19 NSLBP) enrolled in the current study. All participants performed repetitive trunk FE movements at high/low speeds, in symmetric/asymmetric directions, with/without a wearable loaded vest. Trunk instantaneous rotation angle was computed for each trial to be assessed in terms of local and orbital stability, using maximum finite-time Lyapunov exponents (LyEs) and Floquet multipliers (FMs), respectively. RESULTS: Both groups demonstrated equivalent competency in terms of trunk control and stability, suggesting functional adaptation strategies may be used by the NSLBP group. Wearing the loaded vest magnified the effects of trunk control impairment for the NSLBP group. The combined presence of high-speed and symmetrical FE movements was associated with least trunk local stability. CONCLUSION: Nonlinear dynamic techniques, particularly LyE, are potentially effective for assessing trunk dynamic stability dysfunction for individuals with NSLBP during various activities. APPLICATION: This work can be applied toward the development of quantitative personalized spinal evaluation tools with a wide range of potential occupational and clinical applications.

Isometric Trunk Strength Assessment of Athletes: Effects of Sex, Sport, and Low Back Pain History.

CONTEXT: The importance of isometric trunk strength (ITS) among sport science professionals is higher than its actual reported effect size on either performance or low back pain (LBP) occurrence. OBJECTIVE: To provide normative values of ITS and strength ratios, and to evaluate the effect of sex, sports discipline, and LBP status. DESIGN: Crossover study. SETTING: University research laboratory. PARTICIPANTS: Five hundred and sixty-seven elite athletes (186 females) with and without a history of LBP from different sports. MAIN OUTCOME MEASURE: Participants underwent ITS testing for trunk flexors, extensors, and lateral flexors. Normalized maximal strength (in newton meter per kilogram) and strength ratios were calculated. Differences between sex, LBP, and sport disciplines were assessed with 3-way analysis of variance (sex × LBP status × 7 sport categories) and partial eta-squared (ηp2) effect size. The predictive validity of ITS for LBP was checked with receiver operating characteristics (area under the curve). RESULTS: The authors found significant differences in extensor and flexor ITS in favor of male athletes (medium ηp2, P < .05), while sex differences in lateral flexion ITS had a low size effect (P < .05). A low size effect was also observed for the differences in strength ratios extensors/flexors (mean 1.47; 95% confidence interval, 1.45-1.50) and left flexors/right flexors (mean 0.99; 95% confidence interval, 0.98-1.01) among sexes. The sport discipline-related differences generally had a low size effect. No significant differences in ITS were found between LBP and LBP-free athletes. Only 50% to 58% of athletes (area under the curve, 0.501-0.582) were correctly classified as LBP or LBP-free using different ITS and strength ratio variables. CONCLUSIONS: ITS and strength ratios have low predictive validity for LBP history but may discriminate between sex and sport disciplines. Our data are a useful reference point for meaningful individual results interpretation when athletes are evaluated during training or rehabilitation.

MRI-guided attenuation correction in torso PET/MRI: Assessment of segmentation-, atlas-, and deep learning-based approaches in the presence of outliers.

PURPOSE: We compare the performance of three commonly used MRI-guided attenuation correction approaches in torso PET/MRI, namely segmentation-, atlas-, and deep learning-based algorithms. METHODS: Twenty-five co-registered torso 18 F-FDG PET/CT and PET/MR images were enrolled. PET attenuation maps were generated from in-phase Dixon MRI using a three-tissue class segmentation-based approach (soft-tissue, lung, and background air), voxel-wise weighting atlas-based approach, and a residual convolutional neural network. The bias in standardized uptake value (SUV) was calculated for each approach considering CT-based attenuation corrected PET images as reference. In addition to the overall performance assessment of these approaches, the primary focus of this work was on recognizing the origins of potential outliers, notably body truncation, metal-artifacts, abnormal anatomy, and small malignant lesions in the lungs. RESULTS: The deep learning approach outperformed both atlas- and segmentation-based methods resulting in less than 4% SUV bias across 25 patients compared to the segmentation-based method with up to 20% SUV bias in bony structures and the atlas-based method with 9% bias in the lung. The deep learning-based method exhibited superior performance. Yet, in case of sever truncation and metallic-artifacts in the input MRI, this approach was outperformed by the atlas-based method, exhibiting suboptimal performance in the affected regions. Conversely, for abnormal anatomies, such as a patient presenting with one lung or small malignant lesion in the lung, the deep learning algorithm exhibited promising performance compared to other methods. CONCLUSION: The deep learning-based method provides promising outcome for synthetic CT generation from MRI. However, metal-artifact and body truncation should be specifically addressed.

Assessment of a widely applicable torso ECG in acute coronary syndrome.

INTRODUCTION: The time from symptom onset to arrival at healthcare facility, and door to reperfusion time in treatment of acute coronary syndrome (ACS) can be improved significantly if the patient or the relatives can record a 12-lead ECG at home and transmit it to the physician for prompt interpretation. To make this widely applicable, the 12-lead ECG recording device has to be simple and user friendly. In this regard, torso ECG (T-ECG) electrode positions that are less cumbersome than the conventional ECG (C-ECG) electrode positions are an alternative worthy of consideration. OBJECTIVE: and setting: To study the utility of T-ECG versus C-ECG in ACS patients. DESIGN: and intervention: We proposed torso electrode positions in which upper limb electrodes were placed in the respective deltopectoral grooves below the lateral end of the clavicle; the right lower limb electrode was placed 2 finger breadths above the umbilicus and the left lower limb electrode, 2 finger breadths to the left of the umbilicus. We then studied the ECGs recorded, to ascertain whether T-ECGs miss or over-diagnose ACS changes. Twelve lead ECGs were recorded by both techniques (C-ECG & T-ECG) in 1361 patientsfrom the coronary care unit & out-patient department of a tertiary care hospital. A total of 1526 sets of ECGs (each set consisting of one C-ECG and one T -ECG) were read by two trained cardiologists independently and in a blinded fashion. There were 457 ECG sets from 342 patients with ACS. Of these, 116 ECG sets from 112 patients of anterior infarction who had changes restricted to precordial leads were excluded. Finally, 341 ECG sets from 230 patients with ACS and 324 sets of patients diagnosed to be normal on C-ECG were considered for the purpose of this study. MAIN RESULTS: All 341 ECG sets from the 230 patients of ACS diagnosed by C-ECG were correctly diagnosed by T-ECG (100% sensitivity) and all 324 normal ECGs on C-ECG were also identified as normal on T-ECG (100% specificity). Of the ACS ECGs, ST elevation was seen in 234 ECGs and ST depressions 154 ECGs. The localizations of ST elevation and ST depression were also accurately diagnosed by the T-ECG. CONCLUSION: The ECG recorded by our novel proposed torso electrode positions is comparable to a conventional ECG for the diagnosis of ACS.

Correlation between the Korean Version of the Trunk Control Measurement Scale and the Selective Control Assessment of the Lower Extremity Scores in Children with Cerebral Palsy.

Background and Objectives: The purpose of this study was to investigate the correlation between the Korean version of the trunk control measurement scale (K-TCMS) and the selective control assessment of the lower extremity (SCALE). Through this, we tried to find out the effect of proximal stabilization on distal motor development. Materials and Methods: Fifty-one children with gross motor function classification system level I-III, diagnosed with cerebral palsy (CP), were studied. The K-TCMS was used to evaluate the body control ability of the children. SCALE was used to quantify selective voluntary motor control (SVMC). Results: Analysis of SCALE and K-TCMS showed a significant positive correlation in all items. Multiple regression analysis showed that the SCALE score decreased as age increased, and that it increased as the static sitting balance ability score and the dynamic sitting balance ability score of the K-TCMS increased significantly (p < 0.05). Conclusions: In children with cerebral palsy, there was a close correlation between trunk control and selective voluntary motor control of the lower extremities. Therefore, when trying to improve the lower extremity function of a child with cerebral palsy, a trunk control intervention should be considered.

Balance effort, Cone of Economy, and dynamic compensatory mechanisms in common degenerative spinal pathologies.

BACKGROUND: Changes in balance are common in individuals with spinal disorders and may cause falls. Balance efficiency, is the ability of a person to maintain their center of gravity with minimal neuromuscular energy expenditure, oftentimes referred to as Cone of Economy (CoE). CoE balance is defined by two sets of measures taken from the center of mass (CoM) and head: 1) the range-of-sway (RoS) in the coronal and sagittal planes, and 2) the overall sway distance. This allows spine caregivers to assess the severity of a patient's balance, balance pattern, and dynamic posture and record the changes following surgical intervention. Maintenance of balance requires coordination between the central nervous and musculoskeletal systems. RESEARCH QUESTION: To discern differences in balance effort values between common degenerative spinal pathologies and a healthy control group. METHODS: Three-hundred and forty patients with degenerative spinal pathologies: cervical spondylotic myelopathy (CSM), adult degenerative scoliosis (ADS), sacroiliac dysfunction (SIJD), degenerative lumbar spondylolisthesis (DLS), single-level lumbar degeneration (LD), and failed back syndrome (FBS), and 40 healthy controls were recruited. A functional balance test was performed approximately one week before surgery recorded by 3D video motion capture. RESULTS: Balance effort and compensatory mechanisms were found to be significantly greater in degenerative spinal pathologies patients compared to controls. Head and Center of Mass (CoM) overall sway ranged from 65.22 to 92.78 cm (p < 0.004) and 35.77-53.31 cm (p < 0.001), respectively in degenerative spinal pathologies patients and in comparison to controls (Head: 44.52 cm, CoM: 22.24 cm). Patients with degenerative spinal pathologies presented with greater trunk (1.61-2.98°, p < 0.038), hip (4.25-5.87°, p < 0.049), and knee (4.55-6.09°, p < 0.036) excursion when compared to controls (trunk: 0.95°, hip: 2.97°, and knee: 2.43°). SIGNIFICANCE: The results of this study indicate that patients from a wide variety of degenerative spinal pathologies similarly exhibit markedly diminished balance (and compensatory mechanisms) as indicated by increased sway on a Romberg test and a larger Cone of Economy (CoE) as compared to healthy controls. Balance effort, as measured by overall sway, was found to be approximately double in patients with degenerative spinal pathologies compared to healthy matched controls. Clinicians can compare CoE parameters among symptomatic patients from the different cohorts using the Haddas' CoE classification system to guide their postoperative prognosis.

Evaluation of psychometric properties of the segmental assessment of trunk control (SATCo) in children with spastic quadriplegic cerebral palsy.

BACKGROUND: Segmental Assessment of Trunk Control (SATCo) is a scientific evaluation measure used to assess trunk control in subjects with cerebral palsy (CP). AIMS: The present study aimed at assessing the psychometric properties of SATCo in children with spastic quadriplegic CP. METHODOLOGY: This was an observational study in which we validated a test instrument in 31 children (aged 1-5 years) with spastic quadriplegic CP. Children were assessed for trunk control by principal rater (R1) using SATCo. Each assessment was video recorded, scored retrospectively, and independently by principal rater (R2) and secondary rater (R3) for intra-rater and inter-rater reliability, respectively. Concurrent validity was assessed by comparing the SATCo scores with sitting component scores of Gross Motor Functional Measure -88. RESULTS: Intra-class correlation coefficient values for intra-rater and inter-rater reliability for various components of the scale ranged from 0.82 to 0.98. The concurrent validity was calculated for various components of the scale using the Pearson correlation coefficient and they ranged from 0.72 to 0.77. CONCLUSION/RECOMMENDATION: SATCo is a reliable and valid scale that can be used for examining trunk control in children with spastic quadriplegic CP aged 1-5 years.

Establishing the reliability of instrumented trunk impairment assessment methods to enable evidence-based classification in Para swimming.

This study examined the reliability of instrumented trunk assessment methods across two experiments to develop and improve evidence-based classification in Para swimming. Trunk coordination, range of motion (ROM), and strength were assessed in 38 non-disabled participants. Each test battery was completed on two occasions to determine inter-session reliability. Intra-session reliability was also determined in Experiment Two. Absolute agreement of two-way mixed intraclass correlation coefficients (ICC 3,1) was calculated to assess reliability. Standard errors of measurement (SEMs) were also reported to facilitate comparisons between different outcomes. Trunk coordination measures had low-to-moderate reliability (inter-session ICCs = 0.00-0.60; intra-session ICCs = 0.14-0.65) and variable SEMs (5-60%). Trunk ROM demonstrated moderate-to-excellent reliability (inter-session ICCs = 0.61-0.93; intra-session ICCs = 0.87-0.95) and good SEMs (<10%). Trunk strength measures demonstrated good-to-excellent reliability (ICCs = 0.87-0.98) and good SEMs (<10%). The strength values obtained for the load cell and hand-held dynamometer (HHD) were significantly different from each other with the HHD underestimating strength. Modifications provided in Experiment Two improved the reliability of strength and ROM assessments but did not improve coordination measures. Further research involving para swimmers is required to establish the validity of the methods.

Sociodemographic Factors and Outcomes by Intent of Firearm Injury.

BACKGROUND AND OBJECTIVES: Firearm injuries are a leading and preventable cause of morbidity and mortality among youth. We sought to explore differences in sociodemographic factors and youth firearm injury outcomes by injury intent (unintentional, assault, and self-harm). METHODS: We conducted a repeated cross-sectional analysis of emergency department (ED) visits among youth aged 21 and younger presenting to an ED with a firearm injury between 2009 and 2016 using the Nationwide Emergency Department Sample. We performed multivariable logistic regression to measure the strength of association between (1) patient-level factors, (2) visit-level characteristics, and (3) clinical outcomes and intent of firearm injury. RESULTS: We identified 178 299 weighted visits for firearm injuries. The mean age was 17.9 (95% confidence interval 17.8-18.0) years; 89.0% of patients were male, 43.0% were publicly insured, 28.8% were admitted, and 6.0% died. Approximately one-third of the injuries were categorized as unintentional (39.4%), another third as assault (37.7%), and a small proportion as self-harm (1.7%). Unintentional firearm injuries were associated with younger age, rural hospital location, Southern region, ED discharge, and extremity injury. Self-harm firearm injuries were associated with older age, higher socioeconomic status, rural hospital location, transfer or death, and brain, back, or spinal cord injury. Firearm injuries by assault were associated with lower socioeconomic status, urban hospital location, and requiring admission. CONCLUSIONS: We identified distinct risk profiles for youth with unintentional, self-harm-, and assault-related firearm injuries. Sociodemographic factors related to intent may be useful in guiding policy and informing tailored interventions for the prevention of firearm injuries in at-risk youth.

Radiation Dose Reduction for Computed Tomography Localizer Radiography Using an Ag Additional Filter.

OBJECTIVE: This study aimed to assess the potential of an Ag additional filter attached to the bow tie filter of a computed tomography (CT) scanner to reduce the radiation dose in CT localizer radiography. METHODS: Radiation doses in CT localizer radiography with Cu and Ag additional filters were evaluated based on dose measurements and Monte Carlo simulations. Image quality evaluations of an adult torso phantom were performed, and the automatic exposure control performance was evaluated in terms of the water-equivalent thickness estimated from CT localizer radiographs. RESULTS: With the Ag additional filter, effective doses were approximately 72% to 75% lower than those with the Cu additional filter. The image quality and water-equivalent thickness with the Ag additional filter were similar to those with the Cu additional filter. CONCLUSIONS: The Ag additional filter helped significantly reduce radiation doses in CT localizer radiography while maintaining image quality and performance.

The functional assessment for control of trunk (FACT): An assessment tool for trunk function in stroke patients.

BACKGROUND: The Functional Assessment for Control of Trunk (FACT) was developed to evaluate trunk function after stroke. However, only a few studies used FACT to show functional outcome. OBJECTIVE: This study aimed to validate the FACT predictive ability for functional outcome following stroke and create an English version of the FACT. METHODS: This retrospective, observational study was conducted with patients aged≥65 years with stroke. Patients were divided into two groups according to the median FACT score at admission: trunk impairment or high trunk function group. Multiple regression analysis was performed for Functional Independence Measure (FIM) gain and FIM efficiency to examine the relationship between trunk function assessed by FACT at admission and functional prognosis. RESULTS: 105 participants (mean age, 80.2±7.6, 57.1%were men) were included. Of these, 48 (45.7%) and 57 (54.3%) were categorized to the trunk impairment group and high trunk function group, respectively. FACT score at admission was associated with FIM gain (coefficient = 0.875, P = 0.001) and FIM efficiency (coefficient = 0.015, P = 0.016) after adjusting for confounders. CONCLUSIONS: Trunk impairment at admission assessed by FACT could predict functional prognosis. The English version of FACT was created and further demonstrated the validity of FACT.