Multivariate Techniques in Biomechanical Analysis

This work outlines the theoretical advantages of multivariate methods in biomechanical data, validates the proposed methods and outlines new clinical findings relating to knee osteoarthritis that were made possible by this approach. New techniques were based on existing multivariate approaches, Partial Least Squares (PLS) and Non-negative Matrix Factorization (NMF) and validated using existing data sets. The new techniques developed, PCA-PLS-LDA (Principal Component Analysis – Partial Least Squares – Linear Discriminant Analysis), PCA-PLS-MLR (Principal Component Analysis – Partial Least Squares –Multiple Linear Regression) and Waveform Similarity (based on NMF) were developed to address the challenging characteristics of biomechanical data, variability and correlation. As a result, these new structure-seeking technique revealed new clinical findings. The first new clinical finding relates to the relationship between pain, radiographic severity and mechanics. Simultaneous analysis of pain and radiographic severity outcomes, a first in biomechanics, revealed that the knee adduction moment’s relationship to radiographic features is mediated by pain in subjects with moderate osteoarthritis. The second clinical finding was quantifying the importance of neuromuscular patterns in brace effectiveness for patients with knee osteoarthritis. I found that brace effectiveness was more related to the patient’s unbraced neuromuscular patterns than it was to mechanics, and that these neuromuscular patterns were more complicated than simply increased overall muscle activity, as previously thought.

The Relationship between Hospital Infection Surveillance and Control Activities and Antibiotic Resistant Pathogen Rates

Objective: The purpose of the study was to examine the relationship of surveillance and control activities in Canadian hospitals with rates of nosocomial methicillin-resistant S. aureus (MRSA), C. difficile associated diarrhea (CDAD), and vancomycin-resistant Enterococcus (VRE). Methods: Surveys were sent to Infection Control programs in hospitals that participated in an earlier survey of infection control practices in Canadian acute care hospitals. Results: One hundred and twenty of 145 (82.8%) hospitals responded to the survey. The mean MRSA rate was 2.0 (SD 2.9) per 1,000 admissions, the mean CDAD rate was 3.8 (SD 4.3), and the mean VRE rate was 0.4 (SD 1.5). Multiple stepwise regression analysis found hospitals that reported infection rates by specific risk groups (r = - 0.27, p < 0.01) and that kept attendance records of infection control teaching activities (r = - 0.23, p < 0.01) were associated with lower MRSA rates. Multiple stepwise regression analysis found larger hospitals (r = 0.25, p < 0.01) and hospitals where infection control committees or staff had the direct authority to close a ward or unit to further admissions due to outbreaks (r = 0.22, p < 0.05) were associated with higher CDAD rates. Multiple logistic regression analysis found larger hospitals (OR = 1.6, CI 1.2 - 2.0, p = 0.003) and teaching hospitals (OR = 3.7, CI 1.2 - 11.8, p = 0.02) were associated with the presence of VRE. Hospitals were less likely to have VRE when infection control staff frequently contacted physicians and nurses for reports of new infections (OR = 0.5, CI 0.3 - 0.7, p = 0.02) and there were in-service programs for updating nursing and ancillary staff on current infection control practices (OR = 0.2, CI 0.1 - 0.7, p = 0.01). Conclusions: Surveillance and control activities were associated with MRSA and CDAD rates and the presence of VRE. Surveillance and control activities might be especially beneficial in large and teaching hospitals.