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Association between movement speed and instability catch kinematics and the differences between individuals with and without chronic low back pain
Get PDFStudies reported the existence of instability catch (IC) during trunk flexion in patients with chronic low back pain (CLBP). However, different movement speeds can cause different neuromuscular demands resulting in altered kinematic patterns. In addition, kinematic characterization corresponding to clinical observation of IC is still limited. Therefore, this study aimed to determine 1) the association between movement speed and kinematic parameters representing IC during trunk flexion, and 2) the differences in kinematic parameters between individuals with and without CLBP. Fifteen no low back pain (NoLBP) and 15 CLBP individuals were recruited. Inertial measurement units (IMU) were attached to T3, L1, and S2 spinous processes. Participants performed active trunk flexion, while IMU data were simultaneously collected. Total trunk, lumbar, and pelvic mean angular velocity (T_MV, L_MV, and P_MV), as well as number, peak-to-peak, and area of sudden deceleration and acceleration (Num, P2P, and Area), were derived. Pearson’s correlation was used to determine the association between movement speed (T_MV) and other kinematic parameters (L_MV, P_MV, Num, P2P, and Area). An ANCOVA was performed to determine the difference in kinematic parameters between groups using movement speed as a covariate. Significant associations (P<0.05) were found between movement speed and other kinematic parameters, except for Area. Results showed the L_MV significantly differed from the P_MV (P=0.002) in the CLBP group, while a significant between-group difference (P=0.037) was found in the P_MV. Additionally, significant between-group differences (P<0.05) in P2P and Area were observed. The associations between movement speed and kinematic parameters suggest that movement speed changes can alter kinematic patterns. Therefore, clinicians may challenge lumbopelvic neuromuscular control by modifying movement speed to elicit greater change in kinematic patterns. In addition, the NoLBP group used shared lumbar and pelvic contributions, while the CLBP group used less pelvic contribution. Finally, P2P and Area appeared to offer the greatest sensitivity to differentiate between the groups. Overall, these findings may enhance the understanding of the mechanism underlying IC in CLBP
Tooth Loss in Periodontitis Patients—A Risk Factor for Mild Cognitive Impairment: A Systematic Review and Meta—Analysis
Get PDFBackground: Periodontal disease and tooth loss have been long suggested as risk factors of mild cognitive impairment. The underlying mechanisms could be systemic chronic inflammatory mediators, direct pathologic challenge to the nervous system, malnutrition and/or loss of neurosensory stimulation input causing brain atrophy. This review aimed to examine the existing literature studies linking the effect of periodontal disease and tooth loss on the development of mild cognitive impairment. Methods: A systematic review using PEO was conducted. Three electronic databases, namely Embase, Medline and DOSS (UCLan), were searched for relevant articles published up to April 2023. Google Scholar and a hand search were also conducted to ensure no relevant studies had been missed. The Newcastle–Ottawa scale was used to assess the quality of studies. Results: The findings showed that chronic periodontitis and tooth loss, both individually and in combination, led to an increased risk of mild cognitive decline in adults over 50 years. Within the limitations of this review, periodontitis and tooth loss both contribute to an increased risk of mild cognitive impairment and dementia, but the evidence so far is not strong. Conclusions: In future, more robustly designed studies investigating periodontal disease and tooth losslink with cognitive health decline are required with a longer follow-up duration
Ensemble of physics-informed neural networks for solving plane elasticity problems with examples
Get PDFTwo-dimensional (plane) elasticity equations in solid mechanics are solved numerically with the use of an ensemble of physics-informed neural networks (PINNs). The system of equations consists of the kinematic definitions, i.e. the strain–displacement relations, the equilibrium equations connecting a stress tensor with external loading forces and the isotropic constitutive relations for stress and strain tensors. Different boundary conditions for the strain tensor and displacements are considered. The proposed computational approach is based on principles of artificial intelligence and uses a developed open-source machine learning platform, scientific software Tensorflow, written in Python and Keras library, an application programming interface, intended for a deep learning. A deep learning is performed through training the physics-informed neural network model in order to fit the plain elasticity equations and given boundary conditions at collocation points. The numerical technique is tested on an example, where the exact solution is given. Two examples with plane stress problems are calculated with the proposed multi-PINN model. The numerical solution is compared with results obtained after using commercial finite element software. The numerical results have shown that an application of a multi-network approach is more beneficial in comparison with using a single PINN with many outputs. The derived results confirmed the efficiency of the introduced methodology. The proposed technique can be extended and applied to the structures with nonlinear material properties
THE STUDY OF HEURISTIC BIAS WITHIN DECISION-MAKING RELATING TO OBSERVATION AND ANALYSIS STRATEGIES OF HIGH-PERFORMANCE COACHES
Get PDFIn an applied real-world coaching settings observation of athlete movement patterns has traditionally been utilised as an extensive assessment procedure and evaluation tool, that allows the coach to gather, monitor and evaluate performance. The effectiveness of the observer’s perceptual sensitivity to the athlete’s movement pattern and identification of performance errors are critical in providing feedback and directly impacting the coaching efficacy. However, observation of technique in this context is often characterised by subjective judgements on the observer within the sporting context is complex and criticised due to the inability of the observer to account for invisible factors such as cognition, intention or perception of the athlete. Critically, observation within sports coaching while it is universally utilised, it is rarely defined or agreed upon within the literature. In guiding coaching efficacy, observation within the sport is an area with a relative paucity of research and lacks a clear definition, with even less applied knowledge available to guide and educate the coach at the coal face.
In addressing these shortcomings this thesis sequentially examined the observational process of a holistic group of adventure, performance, and Paralympic high-level coaches to
examine the development of naturalistic observational [of athlete performance] strategies, associated mental models of performance and associated decisions of high-level coaches in Olympic, Paralympic and Adventure Sports. The research process has used a pragmatist approach of enquiry influenced by real-world naturalistic philosophies to examine the research questions in ‘real life’ settings, as is the nature of a Professional Doctorate. The examination of coaching decision-making related to observation from such a naturalistic stance, has resulted in the utilisation of an innovative research design, which uniquely blended methods of Applied Cognitive Task Analysis with the approach of Interpretive Phenomenological Analysis and Thematic Analysis.
In meeting the research aim this thesis makes a unique contribution to both professional practice and knowledge. The thesis contributes and extends the body of research, in the area of technical Shared Mental Models (SMM) for individual sports, variance within Olympic and Paralympic athlete individualisation and the use of expertise in generating bespoke knowledge.
The results of the studies found. 1) The SMM can be developed and utilised as an observational tool, at an individual athlete level to identify technical psycho-motor – psychosocial needs. 2) Understanding how the level of cognitive challenge related to observation is reduced. Coaches utilise naturalistic decision-making processes to manage the complexity of coaching and that these processes are linked to experience. 3) Coaches manage observational complexity through experience and the support of experts to develop, augment and create knowledge. 4) Understanding how to reduce this challenge extends the literature in how more effective decisions can be made by the coach, through an enhanced understanding of the SMM. 5) Insights gained within this thesis help to understand observation within the sporting context by making SMMs explicit and understanding associated decision-making.
Accordingly, the thesis offers original insights to support formal para-sport coach education and mentoring regarding the SMM. Through this knowledge exchange process,
coaches are able to modify and individualise their practice to the needs of the athlete. The findings add and evidence that these SMMs cannot be transferred from Olympic to
Paralympic Sport. The overlay of a generic template derived from coach education based on Olympic SMMs is ineffective due to variance of Paralympic athlete needs.
At an applied level there have been a number of key insights that have provided Great Britain athletes a performance advantage at the Tokyo Games. This work is unique in that it
is the first time that the researcher has held a dual lens of being a Head Coach within the same sport of both an Olympic and Paralympic team in considering the SMM and the
technical models of observation they utilise
EP241 - Managing Cervical Spine fracture in a district general hospital
No full textIntroduction
Cervical spinal injury affects 2–3% of trauma patients and accounts for 8.2% of all trauma-related deaths. Respiratory complications are cited as the primary cause of mortality with a 14 - >27 % rate in patients aged more than 65 years old.
Aim
Produce a clear set of guidelines in an aim to reduce mortality in patients > 65 years presenting with cervical spine fracture.
Method
Data was retrospectively collected for patients aged >65 between September 2021 and August 2022 in a district general hospital. Patients with confirmed cervical spine injury were included in the study. Data was collated and analysed using Excel.
Results
36 patients presented to ED with acute cervical spine fracture. 22 (61%) were female and 14 (39%) male with an age range of 66-98 years old. 31 (84%) patients were discussed with a tertiary centre. Complications ranged from constipation, delirium, DVT/PE, chest infections (n=5, 36%) to spinal shock (n= 3, 27%). 11 (30.6%) patients presenting with a c-spine fracture died within 30 days of admission.9 (25%) patients had an outpatient appointment booked in a tertiary centre and 13 (36%) were seen locally in the fracture clinic. 14 (39%) patients did not have any follow ups planned.
Conclusions
To mitigate in-hospital complications and improve outcomes, shared care with orthopaedics, geriatrics, and physiotherapy is being proposed for this group of patients. It would be beneficial to compare the data from the local network and aim at publishing an up-to-date set of robust guidelines
Inclusive Programmatic Assessment of Professional Body Outcomes in a New Optometry Master’s Programme
Get PDFBackground
Outcome based education dictates the behaviours that learners must display at the end of their training, but how do we get them there and how do we track their progress across a programme? The General Optical Council (GOC) revised the educational requirements for new optometry programmes starting in 2023, with 7 overarching categories of behaviour to be demonstrated across all four levels of Miller’s pyramid; Knows, knows how, shows how and does. This work gives an overview of how this can be achieved using a layered online tracking system which allows evidence to be collected in a multitude of ways including summative and formative assessment, patient examination, portfolio, discussion, and situational judgement at different levels. This inclusive, transparent approach gives the learner alternative ways of demonstrating they have met outcomes and was developed in conduction with a medical education developer.
Summary of Work
The aim of this work was to create a robust, transparent, and inclusive system of tracking the GOC outcomes across the four levels of Millers pyramid. Mapping both teaching and assessments to constructively align with learning outcomes is embedded in education; this is a relatively easy task for an individual session, topic or even module, but when it comes to mapping across a whole programme, it becomes more complex, especially in programmes linking academic experience, clinical experience and professional practice in a cohesive and spiral curriculum. A new strategy was needed to map the new GOC outcomes covering Person centred care, communication, clinical practice, ethics and standards, leadership and management and finally lifelong learning. Many of the outcomes are new to the optometry curriculum and require a holistic approach. It was also important that both academic staff, learners and practice-based educators could view and monitor the learner’s progress in real time. In creating a transparent tracking system, the aim was also for the learner to take ownership and develop experiential learning experiences and self-direction.
Summary of Results
To deliver a robust system of programmatic tracking of GOC outcomes, an online medical education platform ‘Meditrek’ was used. In consultation with the developer, a system of layered outcome tracking pages was developed, pulling information from different assessments into one space at the different levels of Millers pyramid. Outcomes are tracked both when achieved and not achieved, allowing areas of weakness to be identified both by the learner and the teacher. 3 pieces of evidence can be linked for each outcome and each level, building an evidence base for each learner across different contexts. The student portfolio was also embedded, allowing learners to map their own experiences and reflections against the outcomes which then flag to academics to review, confirm, or decline. This has the added benefit of familiarising learners with the outcomes from the start of the programme and actively seeking out experiences to meet them. Clinical patient examinations in the eye clinic are also linked, allowing clinical skill-based outcomes to be tracked. Both summative and formative assessments are mapped to the outcomes at the appropriate level and can be signed off both individually or as a group. This system allows a student who has not achieved an outcome in an assessment to achieve it in an alternative way. Additionally, due to the variability of patient exposure in the clinic, there is also flexibility for students to meet outcomes using simulations and situational judgement. Tracking outcomes throughout the programme ensures the learners meet the required outcomes at the appropriate stage of their training before they start their clinical placements and ultimately at the exit point as fully qualified registrants.
Discussion and Conclusion
Layering the different assessment strategies allowed a bespoke tracking system to be developed with the functionality for analysis, monitoring and export of required data including when and how each outcome has been achieved. The system is currently in use for the first cohort of students from September 2023.
In addition to providing a robust system of tracking the GOC outcomes, it is already providing real insights into the student’s practice-based learning, learners are reflecting on their experiences when mapping outcomes and seeking out experiences to meet them. This approach aligns with Kaufmann’s 7 principles of teaching in medicine, including self-directed learning, reflection, problem solving and the learner as an active contributor (Kaufmann. 2003).
Take home message
An inclusive approach to outcome tracking allows learners to demonstrate they have met outcomes in different ways but must be supported by a robust online tracking system across all 4 levels of Milers pyramid which integrates different assessment strategies. Programmatic outcome tracking allows learners progress to be monitored throughout their journey, it identifies strengths and weaknesses whilst embedding professional body outcomes at an early stage of the programme
Impossible Conversations Across Radically Different Frameworks. A critical rationalist approach to deep disagreements
Get PDFI will briefly restate the case for a Critical Rationalist approach to the way we view argumentation practice. I will then focus on a particular deep disagreement, involving two radically different conceptions of sex and gender, drawing on Karl Popper’s essay “The Myth of the Framework” and his optimism about the possibility having “fruitful conversations” across very different belief systems and eventually resolving deep disagreements
Exploring Similarities and Differences in a set of Linked Multiple-site Design Sessions with Children
No full textIn this paper, we present a multiple-site case study to illustrate the similarities and differences in design with children in situated research contexts. The aim is to provide the reader with an insight into the planning, execution and evaluation of a set of linked, yet individual, studies from several different contexts and countries. The cases provide a platform to think about how design studies might be collectively reported and evaluated even when they are carried out in different ways. We illustrate the inherent complexity of this process by considering six case studies from five countries on three continents. The contribution is an illustration of differentiated replication in multiple distributed participatory design case studies with children in different countries. We share our thoughts on replication and differentiation, on the value of the design activities, and on how to carry out a larger project
The Application and Effectiveness of Interdisciplinary Integration Education in Teaching Interior Design and Environmental Design
Get PDFThe innovative interdisciplinary integration teaching of interior design and environmental design courses results from the interaction between the development of disciplines and the needs of the times, individual aesthetic needs, and the optimization of the human habitat. Based on the STEAM teaching theory, the article analyzes the advantages of interdisciplinary integration teaching and establishes the teaching mode for interior design and environmental design courses. Students of interior design at a university were selected as the research object, and a system for evaluating teaching quality was established. The weights of evaluation indexes were solved using the rough set method, and the fuzzy comprehensive evaluation method was combined with it to conduct a thorough evaluation of the interdisciplinary, integrated teaching mode. A comparison experiment was conducted to analyze the effectiveness of the multidisciplinary integration teaching mode. After conducting the teaching comparison experiment, the mean value of the posttest scores for core literacy students in class A is 27.22 points higher than that of class B. The difference in occupational physical, mental, and behavioral literacy weighting is only 0.13%, and the overall evaluation score for the quality of interdisciplinary integrated teaching is 8.183. Introducing multidisciplinary integration teaching can improve students’ interior design abilities and help improve the quality of training in interior design and environmental design talents in colleges and universities