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It is common for biomechanics data sets to contain numerous dependent variables recorded over time, for many subjects, groups, and/or conditions. These data often require standard sorting, processing, and analysis operations to be performed in order to answer research questions. Visualization of these data is also crucial. This manuscript presents biomechZoo, an open-source toolbox that provides tools and graphical user interfaces to help users achieve these goals. The aims of this manuscript are to (1) introduce the main features of the toolbox, including a virtual three-dimensional environment to animate motion data (Director), a data plotting suite (Ensembler), and functions for the computation of three-dimensional lower-limb joint angles, moments, and power and (2) compare these computations to those of an existing validated system. To these ends, the steps required to process and analyze a sample data set via the toolbox are outlined. The data set comprises three-dimensional marker, ground reaction force (GRF), joint kinematic, and joint kinetic data of subjects performing straight walking and 90° turning manoeuvres. Joint kinematics and kinetics processed within the toolbox were found to be similar to outputs from a commercial system. The biomechZoo toolbox represents the work of several years and multiple contributors to provide a flexible platform to examine time-series data sets typical in the movement sciences. The toolbox has previously been used to process and analyse walking, running, and ice hockey data sets, and can integrate existing routines, such as the KineMat toolbox, for additional analyses. The toolbox can help researchers and clinicians new to programming or biomechanics to process and analyze their data through a customizable workflow, while advanced users are encouraged to contribute additional functionality to the project. Students may benefit from using biomechZoo as a learning and research tool. It is hoped that the toolbox can play a role in advancing research in the movement sciences. The biomechZoo m-files, sample data, and help repositories are available online (http://www.biomechzoo.com) under the Apache 2.0 License. The toolbox is supported for Matlab (r2014b or newer, The Mathworks Inc., Natick, USA) for Windows (Microsoft Corp., Redmond, USA) and Mac OS (Apple Inc., Cupertino, USA)., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: The Patient Protection and Affordable Care Act supports the establishment of accountable care organizations (ACOs) as care delivery models designed to save costs. The potential for these cost savings has been demonstrated in the primary care and inpatient populations, but not for patients with emergency conditions or traumatic injuries., Methods: Our study evaluated adult trauma patients transferred to the tertiary care hospitals of a pioneer ACO, comparing those who were transferred from within the ACO to those from outside the ACO in terms of overall cost of hospitalization. Hospital length of stay and number of imaging studies were predetermined secondary outcomes., Results: The study population included 7696 hospitalizations for traumatic injuries over a 5-year period, 85.1% of which were for patients transferred from outside the ACO. Patients transferred from within the ACO had a 7.2% lower overall cost of hospitalization (P = .032). Mean injury severity scores were not significantly different between groups. Differences in mortality, intensive care unit length of stay, and overall hospital length of stay were not significant. However, analysis of radiology studies performed during the hospitalization revealed that patients transferred from within the ACO had, on average, 0.47 fewer advanced imaging studies per hospitalization than did those transferred from outside the ACO (3.55 vs 4.02 studies per hospitalization, P = .003)., Conclusions: Adult trauma patients transferred from within an ACO have significantly lower total costs of hospitalization than do those transferred from outside the system, without significant differences in disease burden, hospital length of stay, or mortality., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions., Background: Multiple casualty incidents from natural or man-made incidents remain a constant global threat. Adequate preparation and the appropriate alignment of resources with immediate needs remain the key to optimal outcomes., Methods: A collaborative effort among Boston's trauma centers (2 level I adult, 3 combined level I adult/pediatric, 1 freestanding level I pediatric) examined the details and outcomes of the initial response. Each center entered its respective data into a central database (REDCap), and the data were analyzed to determine various prehospital and early in-hospital clinical and logistical parameters that collectively define the citywide medical response to the terrorist attack., Results: A total of 281 people were injured, and 127 patients received care at the participating trauma centers on that day. There were 3 (1%) immediate fatalities at the scene and no in-hospital mortality. A majority of the patients admitted (66.6%) suffered lower extremity soft tissue and bony injuries, and 31 had evidence for exsanguinating hemorrhage, with field tourniquets in place in 26 patients. Of the 75 patients admitted, 54 underwent urgent surgical intervention and 12 (22%) underwent amputation of a lower extremity., Conclusions: Adequate preparation, rapid logistical response, short transport times, immediate access to operating rooms, methodical multidisciplinary care delivery, and good fortune contributed to excellent outcomes.

Peptidoglycan O-acetylesterase (Ape1), which is required for host survival in Neisseria sp., belongs to the diverse SGNH hydrolase superfamily, which includes important viral and bacterial virulence factors. Here, multi-domain crystal structures of Ape1 with an SGNH catalytic domain and a newly identified putative peptidoglycan-detection module are reported. Enzyme catalysis was performed in Ape1 crystals and key catalytic intermediates along the SGNH esterase hydrolysis reaction pathway were visualized, revealing a substrate-induced productive conformation of the catalytic triad, a mechanistic detail that has not previously been observed. This substrate-induced productive conformation of the catalytic triad shifts the established dogma on these enzymes, generating valuable insight into the structure-based design of drugs targeting the SGNH esterase superfamily.

Introduction: The Boston Marathon terrorist bombing that occurred on April 15, 2013 illustrates the importance of a cohesive, efficient management for the operating room and perioperative services. Conceptually, emotional intelligence (EI) is a form of social intelligence used by individuals in leadership positions to monitor the feelings and emotions of their team while implementing a strategic plan., Objective: To describe the experience of caring for victims of the bombing at a large tertiary care center and provide examples demonstrating the importance of EI and its role in the management of patient flow and overall care., Methods: A retrospective review of trauma data was performed. Data regarding patient flow, treatment types, treatment times, and outcomes were gathered from the hospital's electronic tracking system and subsequently analyzed. Analyses were performed to aggregate the data, identify trends, and describe the medical care., Results: Immediately following the bombing, a total of 35 patients were brought to the emergency department (ED) with injuries requiring immediate medical attention. 10 of these patients went directly to the operating room on arrival to the hospital. The first victim was in an operating room within 21 minutes after arrival to the ED., Conclusion: The application of EI in managerial decisions helped to ensure smooth transitions for victims throughout all stages of their perioperative care. EI provided the fundamental groundwork that allowed the operating room manager and nurse leaders to establish the calm and coordinated leadership that facilitated patient care and teamwork.

Importance: Severe renal injuries after blunt trauma cause diagnostic and therapeutic challenges for the treating clinicians. The need for an operative vs a nonoperative approach is debated., Objective: To determine the rate, causes, predictors, and consequences of failure of nonoperative management (NOM) in grade IV and grade V blunt renal injuries (BRIs)., Design: Retrospective case series., Setting: Twelve level I and II trauma centers in New England., Participants: A total of 206 adult patients with a grade IV or V BRI who were admitted between January 1, 2000, and December 31, 2011., Main Outcomes and Measures: Failure of NOM, defined as the need for a delayed operation or death due to renal-related complications during NOM., Results: Of 206 patients, 52 (25.2%) were operated on immediately, and 154 (74.8%) were managed nonoperatively (with the assistance of angiographic embolization for 25 patients). Nonoperative management failed for 12 of the 154 patients (7.8%) and was related to kidney injury in 10 (6.5%). None of these 10 patients had complications because of the delay in BRI management. The mean (SD) time from admission to failure was 17.6 (27.4) hours (median time, 7.5 hours; range, 4.5-102 hours), and the cause was hemodynamic instability in 10 of the 12 patients (83.3%). Multivariate analysis identified 2 independent predictors of NOM failure: older than 55 years of age and a road traffic crash as the mechanism of injury. When both risk factors were present, NOM failure occurred for 27.3% of the patients; when both were absent, there were no NOM failures. Of the 142 patients successfully managed nonoperatively, 46 (32.4%) developed renal-related complications, including hematuria (24 patients), urinoma (15 patients), urinary tract infection (8 patients), renal failure (7 patients), and abscess (2 patients). These patients were managed successfully with no loss of renal units (ie, kidneys). The renal salvage rate was 76.2% for the entire population and 90.3% among patients selected for NOM., Conclusions and Relevance: Hemodynamically stable patients with a grade IV or V BRI were safely managed nonoperatively. Nonoperative management failed for only 6.5% of patients owing to renal-related injuries, and three-fourths of the entire population retained their kidneys.

The purpose of this study was to identify joint angular kinematics that corresponds to shooting accuracy in the stationary ice hockey wrist shot. Twenty-four subjects participated in this study, each performing 10 successful shots on four shooting targets. An eight-camera infra-red motion capture system (240 Hz), along with passive reflective markers, was used to record motion of the joints, hockey stick, and puck throughout the performance of the wrist shot. A multiple regression analysis was carried out to examine whole-body kinematic variables with accuracy scores as the dependent variable. Significant accuracy predictors were identified in the lower limbs, torso and upper limbs. Interpretation of the kinematics suggests that characteristics such as a better stability of the base of support, momentum cancellation, proper trunk orientation and a more dynamic control of the lead arm throughout the wrist shot movement are presented as predictors for the accuracy outcome. These findings are substantial as they not only provide a framework for further analysis of motor control strategies using tools for accurate projection of objects, but more tangibly they may provide a comprehensive evidence-based guide to coaches and athletes for planned training to improve performance.

Human activities, whether agricultural, industrial, commercial, or domestic, can contribute to ground water quality deterioration. In order to protect the ground water exploited by a production well, it is essential to develop a good knowledge of the flow system and to adequately delineate the area surrounding the well within which potential contamination sources should be managed. Many methods have been developed to delineate such a wellhead protection area (WHPA). The integration of more information on the geologic and hydrogeologic characteristics of the study area increases the precision of any given WHPA delineation method. From a practical point of view, the WHPA delineation methods allowing the simplest and least expensive integration of the available information should be favored. This paper presents a comparative study in which nine different WHPA delineation methods were applied to a well and a spring in an unconfined granular aquifer and to a well in a confined highly fractured rock aquifer. These methods range from simple approaches to complex computer models. Hydrogeological mapping and numerical modeling with MODFLOW-MODPATH were used as reference methods to respectively compare the delineation of the zone of contribution and the zone of travel obtained from the various WHPA methods. Although applied to simple ground water flow systems, these methods provided a relatively wide range of results. To allow a realistic delineation of the WHPA in aquifers of variable geometry, a WHPA delineation method should ensure a water balance and include observed or calculated regional flow characteristics.

Purpose of the Study: We wanted to check whether the differences in joint kinematics between the normal and prosthesis knee, with or without preservation of the posterior cruciate ligament, have an effect on knee flexion-extension during gait and on gait performance., Material and Methods: A control group of nine subjects was compared with two groups of subjects with total knee prostheses, with (n = 10 patients) or without (n = 6 patients) preservation of the posterior cruciate ligament. Gait was studied on flat ground at three different walking speeds. We measured the principal temporospatial gait parameters as well as knee flexion and extension angles using continuous electrogoniometry. Non-parametric statistical tests were used to analyze data due to the small number of subjects in each group., Results: The flexion-extension cycles were different between the control group and the prostheses groups, but there was no difference between the two prostheses groups. Measurements made during gait confirmed this result, demonstrating a modification of the temporospatial parameters and a decrease in knee flexion during weight bearing in the prostheses groups compared with the control group. The statistical analysis demonstrated a correlation between these two results., Discussion: The individual nature of gait parameters hindered data analysis. Indeed, there are many different ways to walk "normally". We were however able to demonstrate the following points. The theoretical differences in joint kinematics between prostheses with or without preservation of the posterior cruciate ligament did not have any effect on gait. There were however significant differences between the control group and the prostheses groups, and these differences depended on walking speed. The most interesting results concerned the changes in the weight-bearing phase. Flexion during this phase was related to walking speed and was decreased in amplitude in both prostheses groups. This lesser amplitude in knee flexion probably affected the quality of gait because it was correlated with decreased temporospatial parameters related to gait performance., Conclusion: This decreased amplitude of flexion during gait, which cannot be expected from motion measurements without weight bearing, can be explained by an interaction between joint kinematics, the musculoligamentary system and the locomotor schema.

Purpose of the Study: We wanted to develop a gait evaluation protocol using an electrogoniometric device allowing simpler measurements than optoelectronic recordings., Material and Methods: Gait was studied in a group of nine healthy subjects, mean age 58 years, walking on flat ground at three different speeds. We recorded the knee flexion and extension angles and the main temporospatial gait parameters. The principal conditions required for considering gait to be normal were taken from the literature., Results: The subjects exhibited gait cycles which were normal in 83% of the cases for both knees at all three walking speeds. In 17% of the cases, the subjects walked with a flexed knee or without flexion during the weight-bearing phase. Knee motion was symmetrical between the right and left knee in all subjects. Increased walking speed was associated with increases temporospatial parameters and greater flexion and extension angles, particularly during the weight-bearing phase. There was a correlation between the weight-bearing flexion phase and stride length., Discussion: The walking distance was moderate but sufficient to avoid the influence of the start and stop cycles. The electrogoniometers were small and did not perturb walking. Certain temporospatial parameters could not be measured directly but could be estimated. We checked that the results corresponded with data in the literature. Lateralization (right, left dominance) did not influence knee movement. Flexion during weight-bearing could influence gait quality by affecting the balance between gravity and quadriceps muscle force, particularly when considering forces used to progress forward. Knee motion varies with walking speed and depends not only on overall knee motion measured without weight bearing, but probably also on the interaction between joint kinematics, the musculoligamentary system, and the locomotor schema.

The functional relationships between areas 17 and 18 are still incompletely understood; many experiments indicate that cells sharing like properties are linked together, whereas other studies suggest a deviation from this principle. Here we report the effect of using GABA to block circumscribed area 17 neuronal populations with known orientation preferences. We studied the interaction of this treatment on the responses of simple and complex neurons in area 18. The data suggest that these interactions follow different rules for simple and complex cells: specifically, an iso-orientation linkage appears to hold for simple cells while a cross-orientation linkage appears to hold for complex cells.

We have investigated the effects of inactivation of localized sites in area 17 on the visual responses of cells in visuotopically corresponding regions of area 18. Experiments were performed on adult normal cats. The striate cortex was inactivated by the injection of nanoliters of lidocaine hydrochloride or of gamma-aminobutyric acid (GABA) dissolved in a staining solution. Responses of the simple and complex cells of area 18 to optimally oriented light and dark bars moving in the two directions of motion were recorded before, during, and after the drug injection. Two main effects are described. First, for a substantial number of cells, the drug injection provoked an overall reduction of the cell's visual responses. This nonspecific effect largely predominated in the complex cell family (76% of the units affected). This effect is consistent with the presence of long-range excitatory connections in the visual cortex. Second, the inactivation of area 17 could affect specific receptive-field properties of cells in area 18. The main specific effect was a loss of direction selectivity of a number of cells in area 18, mainly in the simple family (more than 53% of the units affected). The change in direction selectivity comes either from a disinhibitory effect in the nonpreferred direction or from a reduction of response in the preferred direction. It is proposed that the disinhibitory effects were mediated by inhibitory interneurones within area 18. In a very few cases, the change of directional preference was associated with a modification of the cell's response profile. These results showed that the signals from area 17 are necessary to drive a number of units in area 18, and that area 17 can contribute to, or at least modulate, the receptive-field properties of a large number of cells in the parastriate area.