Rate of Performance Change in American Female Weightlifters Over Ten Years of Competition.

The purpose of this study was to evaluate the rates of performance change for American female weightlifters over 10 years of competition. Athlete performance results were gathered from the United States Weightlifting open access, results archive, database. Data was delimited to athletes (N ≥ 750) that competed in Youth or Junior Nationals to ensure athletes were <21yrs old at the first recorded competition. Competition results were converted to strength to mass (SM) ratios to control for the effect of bodyweight on performance. Starting with the first competition date, the highest SM for the snatch (SNT), clean and jerk (CJ) and combined total (T), in three month segments for three years, and six month segments over 10 years, were recorded. Observed percentage change in SM and Cohen's d effect size (ES) between each 3-and 6-month segment and the first competition (baseline), for the SNT, CJ and T, was determined. Positive change in rate of performance peaked between time segments baseline-6mo and 7mo-12mo for the SNT (+8.7%, SM 0.68±0.19 to 0.74±0.19, ES=0.34), CJ (+7.7%, SM 0.90±0.24 to 0.97±0.24, ES=0.31) and T (+8.2%, SM 1.57±0.41 to 1.71±0.42 ES=0.34). Total performance increase over 10yrs for the SNT was 27.7% (Year 1 SM 0.68±0.18, year 10 SM 1.13±0.24, ES=0.96), the CJ 22.2% (Year 1 SM 0.90±0.23, year 10 SM 1.40±0.30, ES=0.84), and T 25.0% (Year 1 SM 1.56±0.41, year 10 SM 2.53±0.53, ES=0.91). Observed rates in performance change could be useful for weightlifting coaches as a barometer for evaluating training program outcomes over time.

Decision support tool use in colorectal surgery: what is the role?

BACKGROUND: Decision support tools prioritizing transitional care can help decrease medical readmissions but little evidence exists within surgical specialties. MATERIALS AND METHODS: This study evaluated the use of early screen for discharge planning and discharge decision support system screening tools or selective multidisciplinary clinical evaluation for targeting post-acute care interventions among higher risk colorectal surgery patients based on 30-d readmission status. Patients with positive screening tool scores underwent standard discharge planning education and evaluation during index operation hospitalization and were referred for targeted post-acute interventions; patients with negative screening tool scores were further clinically evaluated for selective referral for post-acute interventions. RESULTS: We identified 300 colorectal surgery patients; 30.3% (n = 91) of patients had a positive screening score (early screen for discharge planning and/or discharge decision support system). Positive screening scores did not correlate with hospital readmission (35% of readmitted patients versus 29% of non-readmitted had a positive screen; P = 0.424). After negative screening scores, selective referral based on clinical assessment for postdischarge interventions helped to concentrate resources in patients who were later readmitted. Index hospitalization complications were significantly associated with positive screening tool scores whereas postdischarge complications were most predictive of readmission. CONCLUSIONS: Among colorectal surgery patients, selective clinical referrals appeared to be the best method for targeting post-acute interventions in patients at higher risk for readmission. Future research should focus on improving existing processes of care to reduce postoperative complications and constructing better tools to assess individual patients' needs for targeted interventions in the post-acute setting.

Myoelectric walking mode classification for transtibial amputees.

Myoelectric control algorithms have the potential to detect an amputee's motion intent and allow the prosthetic to adapt to changes in walking mode. The development of a myoelectric walking mode classifier for transtibial amputees is outlined. Myoelectric signals from four muscles (tibialis anterior, medial gastrocnemius (MG), vastus lateralis, and biceps femoris) were recorded for five nonamputee subjects and five transtibial amputees over a variety of walking modes: level ground at three speeds, ramp ascent/descent, and stair ascent/descent. These signals were decomposed into relevant features (mean absolute value, variance, wavelength, number of slope sign changes, number of zero crossings) over three subwindows from the gait cycle and used to test the ability of classification algorithms for transtibial amputees using linear discriminant analysis (LDA) and support vector machine (SVM) classifiers. Detection of all seven walking modes had an accuracy of 97.9% for the amputee group and 94.7% for the nonamputee group. Misclassifications occurred most frequently between different walking speeds due to the similar nature of the gait pattern. Stair ascent/descent had the best classification accuracy with 99.8% for the amputee group and 100.0% for the nonamputee group. Stability of the developed classifier was explored using an electrode shift disturbance for each muscle. Shifting the electrode placement of the MG had the most pronounced effect on the classification accuracy for both samples. No increase in classification accuracy was observed when using SVM compared to LDA for the current dataset.

Association of self-reported hospital discharge handoffs with 30-day readmissions.

IMPORTANCE: Poor health care provider communication across health care settings may lead to adverse outcomes. OBJECTIVE: To determine the frequency with which inpatient providers report communicating directly with outpatient providers and whether direct communication was associated with 30-day readmissions. DESIGN: We conducted a single-center prospective study of self-reported communication patterns by discharging health care providers on inpatient medical services from September 2010 to December 2011 at The Johns Hopkins Hospital. SETTING: A 1000-bed urban, academic center. PARTICIPANTS: There were 13 954 hospitalizations in this time period. Of those, 9719 were for initial visits. After additional exclusions, including patients whose outpatient health care provider was the inpatient attending physician, those who had planned or routine admissions, those without outpatient health care providers, those who died in the hospital, and those discharged to other healthcare facilities, we were left with 6635 hospitalizations for analysis. INTERVENTIONS: Self-reported communication was captured from a mandatory electronic discharge worksheet field. Thirty-day readmissions, length of stay (LOS), and demographics were obtained from administrative databases. DATA EXTRACTION: We used multivariable logistic regression models to examine, first, the association between direct communication and patient age, sex, LOS, race, payer, expected 30-day readmission rate based on diagnosis and illness severity, and physician type and, second, the association between 30-day readmission and direct communication, adjusting for patient and physician-level factors. RESULTS: Of 6635 included hospitalizations, successful direct communication occurred in 2438 (36.7%). The most frequently reported reason for lack of direct communication was the health care provider's perception that the discharge summary was adequate. Predictors of direct communication, adjusting for all other variables, included patients cared for by hospitalists without house staff (odds ratio [OR], 1.81 [95% CI, 1.59-2.08]), high expected 30-day readmission rate (OR, 1.18 [95% CI, 1.10-1.28] per 10%), and insurance by Medicare (OR, 1.35 [95% CI, 1.16-1.56]) and private insurance companies (OR, 1.35 [95% CI, 1.18-1.56]) compared with Medicaid. Direct communication with the outpatient health care provider was not associated with readmissions (OR, 1.08 [95% CI, 0.92-1.26]) in adjusted analysis. CONCLUSIONS AND RELEVANCE: Self-reported direct communication between inpatient and outpatient providers occurred at a low rate but was not associated with readmissions. This suggests that enhancing interprovider communication at hospital discharge may not, in isolation, prevent readmissions.

Total care requirements of burn patients: implications for a disaster management plan.

The purpose of this study was to determine the operative and ward-based requirements of burn patients as a first step in the development of a National Health Emergency Multiple Complex Burn Action Plan. A retrospective review of 1043 patients admitted to the National Burn Centre at Middlemore Hospital, Auckland, New Zealand, from June 2006 to June 2009 was undertaken. Outcome measures included the number of operative procedures, operative time, length of inpatient stay, nursing hours, and allied health hours. A mean of 0.3 operating theater visits and 22.8 minutes of operating time was needed per percentage total body surface area (TBSA) burn. Length of inpatient stay equated to 1.1 days per percentage TBSA burn. There was an exponential relationship between operative requirements and burn surface area. Total operating theater time could be predicted from a formula based on burn surface area, mean depth, and type of burn. Operative time required was greatest in the first week and roughly halved each week after this, whereas nursing and allied health hours remained relatively constant. On the basis of operative requirements in the first week, patients with acute burn injuries totaling up to 129% TBSA could be treated at one time at the authors' institution. This study provides an objective trigger point for the activation of a disaster plan and enables us to predict operative and staffing requirements on a week by week basis, taking into account the existing workload. This information can be used to plan both the acute and protracted phase of a national response to a burn disaster.