Steps toward the validation of the Trendelenburg Test : the effect of experimentally reduced hip abductor muscle function on frontal plane mechanics

Objective: To investigate the validity of the Trendelenburg test (TT) using an ultrasound-guided nerve block (UNB) of the superior gluteal nerve and determine whether the reduction in hip abductor muscle (HABD) strength would result in the theorized mechanical compensatory strategies measured during the TT. Design: Quasi-experimental. Setting: Hospital. Participants: Convenience sample of 9 healthy men. Only participants with no current or previous injury to the lumbar spine, pelvis, or lower extremities, and no previous surgeries were included. Interventions: Ultrasound-guided nerve block. Main Outcome Measures: Hip abductor muscle strength (percent body weight [%BW]), contralateral pelvic drop (cPD), change in contralateral pelvic drop (Delta cPD), ipsilateral hip adduction, and ipsilateral trunk sway (TRUNK) measured in degrees. Results: The median age and weight of the participants were 31 years (interquartile range [IQR], 22-32 years) and 73 kg (IQR, 67-81 kg), respectively. An average 52% reduction of HABD strength (z = 2.36, P = 0.02) resulted after the UNB. No differences were found in cPD or Delta cPD (z = 0.01, P = 0.99, z = 20.67, P = 0.49, respectively). Individual changes in biomechanics showed no consistency between participants and nonsystematic changes across the group. One participant demonstrated the mechanical compensations described by Trendelenburg. Conclusions: The TT should not be used as a screening measure for HABD strength in populations demonstrating strength greater than 30% BW but should be reserved for use with populations with marked HABD weakness. Clinical Relevance: This study presents data regarding a critical level of HABD strength required to support the pelvis during the TT.

Creative city index 2012 - Data sources, calculation methods and tools [Report spreadsheet]

Spreadsheet for Creative City Index 2012

The big data upgrade : new dimensions in data analysis - risks and opportunities [das big data upgrade : neue dimensionen der datennutzung – chancen und risiken]

Summary: More than ever before contemporary societies are characterised by the huge amounts of data being transferred. Authorities, companies, academia and other stakeholders refer to Big Data when discussing the importance of large and complex datasets and developing possible solutions for their use. Big Data promises to be the next frontier of innovation for institutions and individuals, yet it also offers possibilities to predict and influence human behaviour with ever-greater precision

Suspected mechanisms in the cause of overuse running injuries : A clinical review

Context: Various epidemiological studies have estimated that up to 70% of runners sustain an overuse running injury each year. Although few overuse running injuries have an established cause, more than 80% of running-related injuries occur at or below the knee, which suggests that some common mechanisms may be at work. The question then becomes, are there common mechanisms related to overuse running injuries? Evidence Acquisition: Research studies were identified via the following electronic databases: MEDLINE, EMBASE PsycInfo, and CINAHL (1980–July 2008). Inclusion was based on evaluation of risk factors for overuse running injuries. Results: A majority of the risk factors that have been researched over the past few years can be generally categorized into 2 groups: atypical foot pronation mechanics and inadequate hip muscle stabilization. Conclusion: Based on the review of literature, there is no definitive link between atypical foot mechanics and running injury mechanisms. The lack of normative data and a definition of typical foot structure has hampered progress. In contrast, a large and growing body of literature suggests that weakness of hip-stabilizing muscles leads to atypical lower extremity mechanics and increased forces within the lower extremity while running.

Steps towards the validation of the Trendelenburg test : The effect of experimentally reduced hip abductor muscle function on frontal plane mechanics

Introduction: The Trendelenburg Test (TT) is used to assess the functional strength of the hip abductor muscles (HABD), their ability to control frontal plane motion of the pelvis, and the ability of the lumbopelvic complex to transfer load into single leg stance. Rationale: Although a standard method to perform the test has been described for use within clinical populations, no study has directly investigated Trendelenburg’s hypotheses. Purpose: To investigate the validity of the TT using an ultrasound guided nerve block (UNB) of the superior gluteal nerve and determine whether the reduction in HABD strength would result in the theorized mechanical compensatory strategies measured during the TT. Methods: Quasi-experimental design using a convenience sample of nine healthy males. Only subjects with no current or previous injury to the lumbar spine, pelvis, or lower extremities, and no previous surgeries were included. Force dynamometry was used to evaluation HABD strength (%BW). 2D mechanics were used to evaluate contralateral pelvic drop (cMPD), change in contralateral pelvic drop (∆cMPD), ipsilateral hip adduction (iHADD) and ipsilateral trunk sway (TRUNK) measured in degrees (°). All measures were collected prior to and following a UNB on the superior gluteal nerve performed by an interventional radiologist. Results: Subjects’ age was median 31yrs (IQR:22-32yrs); and weight was median 73kg (IQR:67-81kg). An average 52% reduction of HABD strength (z=2.36,p=0.02) resulted following the UNB. No differences were found in cMPD or ∆cMPD (z=0.01,p= 0.99, z=-0.67,p=0.49). Individual changes in biomechanics show no consistency between subjects and non-systematic changes across the group. One subject demonstrated the mechanical compensations described by Trendelenburg. Discussion: The TT should not be used as screening measure for HABD strength in populations demonstrating strength greater than 30%BW but reserved for use with populations with marked HABD weakness. Importance: This study presents data regarding a critical level of HABD strength required to support the pelvis during the TT.

Comparison of moped, scooter and motorcycle crash risk and crash severity

The increased popularity of mopeds and motor scooters in Australia and elsewhere in the last decade has contributed substantially to the greater use of powered two-wheelers (PTWs) as a whole. As the exposure of mopeds and scooters has increased, so too has the number of reported crashes involving those PTW types, but there is currently little research comparing the safety of mopeds and, particularly, larger scooters with motorcycles. This study compared the crash risk and crash severity of motorcycles, mopeds and larger scooters in Queensland, Australia. Comprehensive data cleansing was undertaken to separate motorcycles, mopeds and larger scooters in police-reported crash data covering the five years to 30 June 2008. The crash rates of motorcycles (including larger scooters) and mopeds in terms of registered vehicles were similar over this period, although the moped crash rate showed a stronger downward trend. However, the crash rates in terms of distance travelled were nearly four times higher for mopeds than for motorcycles (including larger scooters). More comprehensive distance travelled data is needed to confirm these findings. The overall severity of moped and scooter crashes was significantly lower than motorcycle crashes but an ordered probit regression model showed that crash severity outcomes related to differences in crash characteristics and circumstances, rather than differences between PTW types per se. Greater motorcycle crash severity was associated with higher (>80 km/h) speed zones, horizontal curves, weekend, single vehicle and nighttime crashes. Moped crashes were more severe at night and in speed zones of 90 km/h or more. Larger scooter crashes were more severe in 70 km/h zones (than 60 km/h zones) but not in higher speed zones, and less severe on weekends than on weekdays. The findings can be used to inform potential crash and injury countermeasures tailored to users of different PTW types.

School-based first aid training and the implications for traffic injury prevention : a randomised controlled trial

Adolescent injury remains a significant public health concern and is often the result of at-risk transport related behaviours. When a person is injured actions taken by bystanders are of crucial importance and timely first aid appears to reduce the severity of some injuries (Hussain & Redmond, 1994). Accordingly, researchers have suggested that first aid training should be more widely available as a potential strategy to reduce injury (Lynch et al., 2006). Further research has identified schools as an ideal setting for learning first aid skills as a means of injury prevention (Maitra, 1997). The current research examines the implications of school based first aid training for young adolescents on injury prevention, particularly relating to transport injuries. First aid training was integrated with peer protection and school connectedness within the Skills for Preventing Injury in Youth (SPIY) program (Buckley & Sheehan, 2009) and evaluated to determine if there was a reduction in the likelihood of transport related injuries at six months post-intervention. In Queensland, Australia, 35 high schools were recruited and randomly assigned to intervention and control conditions in early April 2012. A total of 2,000 Year nine students (mean age 13.5 years, 39% male) completed surveys six months post-intervention in November 2012. Analyses will compare the intervention students with control group students who self-reported i) first aid training with a teacher, professional or other adult and ii) no first aid in the preceding six months. Using the Extended Adolescent Injury Checklist (E-AIC) (Chapman, Buckley & Sheehan, 2011) the transport related injury experiences included being injured while “riding as a passenger in a car”, “driving a car off road” and “riding a bicycle”. It is expected that students taught first aid within SPIY will report significantly fewer transport related injuries in the previous three months, compared to the control groups described above. Analyses will be conducted separately for sex and socio-economic class of schools. Findings from this study will provide insight into the value of first aid in adolescent injury prevention and provide evidence as to whether teaching first aid skills within a school based health education curriculum has traffic safety implications.

Measuring mechanical properties of tendon in vivo

Introduction: Understanding the mechanical properties of tendon is an important step to guiding the process of improving athletic performance, predicting injury and treating tendinopathies. The speed of sound in a medium is governed by the bulk modulus and density for fluids and isotropic materials. However, for tendon,which is a structural composite of fluid and collagen, there is some anisotropy requiring an adjustment for Poisson’s ratio. In this paper, these relationships are explored and modelled using data collected, in vivo, on human Achilles tendon. Estimates for elastic modulus and hysteresis based on speed of sound data are then compared against published values from in vitro mechanical tests. Methods: Measurements using clinical ultrasound imaging, inverse dynamics and acoustic transmission techniques were used to determine dimensions, loading conditions and longitudinal speed of sound for the Achilles tendon during a series of isometric plantar flexion exercises against body weight. Upper and lower bounds for speed of sound versus tensile stress in the tendon were then modelled and estimates derived for elastic modulus and hysteresis. Results: Axial speed of sound varied between 1850 to 2090 m.s−1 with a non-linear, asymptotic dependency on the level of tensile stress in the tendon 5–35 MPa. Estimates derived for the elastic modulus ranged between 1–2 GPa. Hysteresis derived from models of the stress-strain relationship, ranged from 3–11%. These values agree closely with those previously reported from direct measurements obtained via in vitro mechanical tensile tests on major weight bearing tendons. Discussion: There is sufficiently good agreement between these indirect (speed of sound derived) and direct (mechanical tensile test derived) measures of tendon mechanical properties to validate the use of this non-invasive acoustic transmission technique. This non-invasive method is suitable for monitoring changes in tendon properties as predictors of athletic performance, injury or therapeutic progression.

Discrete loading of the foot during hurdle drills: A pilot investigation

Introduction: Lower limb function in hurdling is patently asymmetrical. The lead limb undertakes the preparatory and landing steps while the trail limb contends with the hurdle and recovery steps. Discrete loading profiles of these steps will reflect the asymmetrical function and may provide useful insight into injury mechanisms. A pilot study was undertaken to determine the loading profiles of the hurdle, landing and recovery steps of elite male hurdlers. Equivalent data for steps between hurdles, where the running action is more symmetrical, were used for the purpose of comparison, simultaneously minimising the confounding effect of speed. Methodology: In-shoe pressures were recorded (FScan, 200 Hz) for four elite male hurdlers while they completed a routine hurdle drill at a self-selected fast but sub-race speed. The drill comprised of three consecutive hurdles. Data for the hurdle, landing and recovery steps of the first and second hurdles, along with data for the running steps between hurdles 1 and 2, and 2 and 3, were used for the purpose of analysis. Peak pressures within 1cm2 masks were determined for the hallux, first, central and fifth metatarsals (T1, M1, M2–4 and M5 respectively). Peak pressure (kPa) and loading duration (ms) for the hurdle, landing and recovery steps are reported as a percentage of the respective limb-matched values for between-hurdle steps. Results/discussion: For between-hurdle steps, T1, M1 and M2–4 peak pressures were 312/357, 356/306 and 362/368 kPa, lead/trail limbs respectively. For the hurdle, landing and recovery steps, pressures at T1 and M1 increased. For T1 the increases were in the order of 17%, 36% and 8% (hurdle, landing and recovery steps, respectively) while the corresponding increases at M1 were 7%, 54% and 20%. Pressures at M2–4 were similar for all steps, while M5 loaded erratically. For the between-hurdle steps, the loading durations at T1, M1 and M2–4, were 160/162, 170/142 and 190/191 ms, respectively. For the landing step, loading duration decreased for T1, M1and M2–4 (−8%, −19% and −18%, respectively). In the hurdle step, loading duration decreased for the metatarsals but not for T1. Conclusions: The hurdling action leads to regional pressure increases that act for shorter durations in comparison to the between-hurdle running steps. These changes are most notable at the first metatarsal, a common site of foot injury.

Clinical data integration approach using SAS clinical data integration server (CDI) tools

The decisions people make about medical treatments have a great impact on their lives. Health care practitioners, providers and patients often make decisions about medical treatments without complete understanding of the circumstances. The main reason for this is that medical data are available in fragmented, disparate and heterogeneous data silos. Without a centralised data warehouse structure to integrate these data silos, it is highly unlikely and impractical for the users to get all the information required on time to make a correct decision. In this research paper, a clinical data integration approach using SAS Clinical Data Integration Server tools is presented.

Under-reporting of road crashes in Pakistan and the role of fate

Objective: Comprehensive, accurate information about road crashes and related trauma is a prerequisite for identification and control of risk factors as well as for identifying faults within the broader road safety system. Quality data and appropriate crash investigation are critical in reducing the road toll that is rapidly growing in much of the developing world, including Pakistan. This qualitative research explored the involvement of social and cultural factors (in particular, fatalism) in risky road use in Pakistan. The findings highlight a significant issue, previously unreported in the road safety literature, namely, the link between fatalistic beliefs and inaccurate reporting of road crashes. Method: Thirty interviews (one-to one) were conducted by the first author with police officers, drivers, policy makers and religious orators in three Pakistani cities. Findings: Evidence emerged of a strong link between fatalism and the under-reporting of road crashes. In many cases, crashes and related road trauma appear to go unreported because a crash is considered to be one’s fate and, therefore, beyond personal control. Fate was also implicated in the practice of reconciliation between parties after a crash without police involvement and the seeking and granting of pardon for a road death. Conclusions: These issues represent additional factors that can contribute to under-reporting of crashes and associated trauma. Together, they highlight complications involved in establishing the true cost of road trauma in a country such as Pakistan and the difficulties faced when attempting to promote scientifically-based road safety information to counteract faith-based beliefs.

How to Improve Cardiac Surgery Decision Making? In Data Warehousing Perspective

The health system is one sector dealing with very large amount of complex data. Many healthcare organisations struggle to utilise these volumes of health data effectively and efficiently. Therefore, there is a need for very effective system to capture, collate and distribute this health data. There are number of technologies have been identified to integrate data from different sources. Data warehousing is one technology can be used to manage clinical data in the healthcare. This paper addresses how data warehousing assist to improve cardiac surgery decision making. This research used the cardiac surgery unit at the Prince Charles Hospital (TPCH) as the case study. In order to deal with other units efficiently, it is important to integrate disparate data to a single point interrogation. We propose implementing a data warehouse for the cardiac surgery unit at TPCH. The data warehouse prototype developed using SAS enterprise data integration studio 4.2 and data was analysed using SAS enterprise edition 4.3. This improves access to integrated clinical and financial data with, improved framing of data to the clinical context, giving potentially better informed decision making for both improved management and patient care.

Over time assessment data analysis tracking a school's on-going performance

In Australia, as in some other western nations, governments impose accountability measures on educational institutions (Earl, 2005). One such accountability measure is the National Assessment Program - Literacy and Numeracy (NAPLAN) from which high-stakes assessment data is generated. In this article, a practical method of data analysis known as the Over Time Assessment Data Analysis (OTADA) is offered as an analytical process by which schools can monitor their current and over time performances. This analysis developed by the author, is currently used extensively in schools throughout Queensland. By Analysing in this way, teachers, and in particular principals, can obtain a quick and insightful performance overview. For those seeking to track the achievements and progress of year level cohorts, the OTADA should be considered.

Pro-inflammatory growth factors reduce secondary degeneration after traumatic spinal cord injury

The role of inflammatory response after spinal cord injury remains unclear. This thesis was a step forward in studying how promoting the inflammation, by delivery pro-inflammatory growth factors, affects the outcomes of spinal cord injury. A significant functional improvement was observed after treatment and these results suggest an interesting avenue for future clinical treatments and may provide a platform to improve the efficacy of other treatments.

Data warehousing model for integrating fragmented electronic health records from disparate and heterogeneous clinical data stores

This research was a step forward in developing a data integration framework for Electronic Health Records. The outcome of the research is a conceptual and logical Data Warehousing model for integrating Cardiac Surgery electronic data records. This thesis investigated the main obstacles for the healthcare data integration and proposes a data warehousing model suitable for integrating fragmented data in a Cardiac Surgery Unit.