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Background: With the increasingly serious energy and environmental crises and shortages of conventional energy such as coal and oil, humans have been focusing on new energy sources, especially the abundant wave energy resource. Previous researchers have made great contributions to the design of wave energy converters and have also applied for many patents. However, advanced comprehensive wave energy evaluation and application systems are still scarce, which results in the primitive state of wave energy evaluation. Methods: The goal of this work is to overview the status and prospects of the evaluation of global wave energy to find an effective method to evaluate wave energy resources. This study divides the wave energy evaluation into 4 historical periods according to the data source. The future focus for wave energy resource evaluation is also presented in this study. Results: The wave energy evaluation includes 4 periods: the observational wave data period, the satellite-derived wave data period, the hindcast (simulation wave data from a wave model) wave data period and the reanalysis wave data period. In future research, the focus of wave energy evaluation should include the swell energy, the climatic characteristics of the wave energy resource, the characteristics of marine environments, the mid-to-long-term prediction of wave energy, the short-term forecasting of wave energy, and the evaluation of resources at a particular site. Conclusion: A scientific evaluation framework and application system (software) is urgently needed to provide a basis for decisions for the development of wave power generation, desalination and other developments of wave energy and to promote the sustainable development of human society.

Background and Purpose Telehealth is defined as the delivery of health-related services and information via telecommunication technologies. The purposes of this case report are: (1) to describe the development, implementation, and evaluation of a telehealth approach for meeting physical therapist supervision requirements in a skilled nursing facility (SNF) in Washington and (2) to explore clinical and human factors of physical therapist practice in an SNF delivered via telehealth. Case Description In 2009, Infinity Rehab conducted a pilot program to determine whether telehealth could be used to meet physical therapist supervision requirements in an SNF. In 2011, language allowing telehealth physical therapy was approved by the Washington Board of Physical Therapy (Board). In 2014–2015, telehealth outcomes were evaluated in a 51-person sample at an Infinity Rehab SNF. Cost savings of telehealth implementation from 2011 to 2015 were estimated. Outcomes The Board deemed the telehealth pilot program a success and subsequently established telehealth practice language for physical therapy. Both human factors and clinical outcomes were required to implement a successful telehealth practice. Clinical outcomes and user satisfaction in telehealth and nontelehealth groups were equivalent. Cost savings were identified. Discussion Human factors, such as the need for provider education in appropriate bedside manner with a telehealth session, were identified. Since 2011, more than 1,000 telehealth physical therapy sessions were conducted at Infinity Rehab SNFs in Washington State. In the future, alternative payment models focused on valued-based clinical outcomes may facilitate wider telehealth adoption in physical therapy. Future research on efficacy and cost-effectiveness is needed to promote broader adoption of telehealth physical therapy in SNFs. This experience demonstrates that telehealth implementation in an SNF for the purpose of physical therapy re-evaluation is a feasible alternative to in-person encounters.

BACKGROUND AND PURPOSEMultimedia innovations including audio and video instructions are used in physical therapy education.1 Classroom technology in physical therapist (PT) educational programs has included multimedia use of CD ROM, student response systems, web 2.0 applications, and flipped class applications in PT educational programs.2'5 In addition, educational leaders in physical therapy emphasize the importance of delivering multimedia innovations into the modern classroom to effectively engage millennial learners.6,7 However, multimedia innovations come with inherent barriers and costs.5 Faculty in PT educational programs are challenged by lack of resources and time necessary to implement multimedia innovations in the classroom.8 Faculty may also be uncomfortable with new multimedia innovations and perceive its usage in the classroom as more disruptive than beneficial for learners. Most importantly, despite growing up with expansive technology, some student learners are not comfortable with use of new multimedia innovations in the classroom.5,9 Beyond the actual costs associated with physical hardware, software, and equipment, new multimedia innovations may require administrative fees and/or institutional licenses for users.5 One strategy to alleviate the potential costs and implementation barriers is to use free online media player 3 (mp3) media in order to reinforce classroom learning.Online mp3 media are audio files downloaded from the Internet ideally available to the general public for free and used in physical therapy.10 To date, online mp3 media to promote learning in PT education, including medical screening for patient referral content, have not been described.The literature provides examples of teaching strategies related to differential diagnosis and medical screening for patient referral in PT educational programs. Various educational programs have incorporated case vignettes and student/faculty role-playing to enhance classroom activities.11,12 These teaching methods improved students' written exam outcomes and student self-confidence in skills necessary for initiating a medical referral to a physician.11 Furthermore, learning experiences including actual callers with aches, pains, sprains, and strains may be advantageous to reinforce student medical screening for patient referral abilities in a written assignment. Jette et al,13 using a survey made up of 12 hypothetical case scenarios, noted that PTs with orthopedic specialty are better at making appropriate decisions for medical referrals. In fact, PTs with an orthopedic specialization were almost twice as likely to make correct decisions for critical medical and musculoskeletal conditions compared to PTs without orthopedic specialty. In a followup study using the same hypothetical case vignettes, PT students in their final year of curriculum demonstrated lower abilities to make the correct decisions regarding medical referral compared to practicing PTs with orthopedic specialization.12 This suggests that the experience gained from clinical practice is an important aspect of the reasoning process. For example, except orthopedists, PTs in the uniformed services demonstrated higher scores than medical students, physician interns, residents, active duty military physicians and specialists in management of musculoskeletal conditions.14 Physical therapists have been shown to have the requisite knowledge to provide direct access for patients with musculoskeletal conditions in the military and cost-effective care in orthopedic outpatient departments in the United Kingdom.14,15 In light of this evidence, it could be advantageous to connect PT students with experienced PTs in a "real world setting" to reinforce medical screening abilities and to aid in the reasoning process. The use of multimedia innovations, including online mp3 media, may provide this opportunity in the classroom. The purpose of this case report is to describe educational multimedia innovations used in the "Medical Screening for Patient Referral" course at the Mount Saint Mary's University (MSMU), Los Argeles Doctor of Physical Therapy (DPT) program. …

Background and Purpose: Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-Analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy. Summary of Key Points: We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, "LifeCIT," is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained. Recommendations for Clinical Practice: We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.

Background: Advances in molecular genetic technologies have improved our understanding of genetic causes of rare neurological disorders with features of myoclonus. Case Report: A family with two affected siblings, presenting with multifocal polymyoclonus and neurodevelopmental delay, was recruited for whole-exome sequencing following unyielding diagnostic neurometabolic investigations. Compound heterozygous mutations in TBC1D24, a gene previously associated with various epilepsy phenotypes and hearing loss, were identified in both siblings. The mutations included a missense change c.457G>A (p.Glu157Lys), and a novel frameshift mutation c.545del (p.Thr182Serfs*6). Discussion: We propose that TBC1D24-related diseases should be in the differential diagnosis for children with polymyoclonus., Tremor and Other Hyperkinetic Movements, Tremor and Other Hyperkinetic Movements

Noroviruses account for over 90% of all viral gastroenteritis cases and ~50% of all outbreaks worldwide. Each year in Australia, there are an estimated 1.8 million cases. Casesmaybe sporadic or part of outbreaks, occurring in either the community or healthcare setting. Outbreaks are associated with significant morbidity and some mortality. They incur substantial costs and can be difficult to control in healthcare institutions or other closed settings. Multiple factors (related to virus biological properties, human immune responses or inadequate management modalities) make it a challenging pathogen to control. They include: multiple transmission routes, low infectious dose, environmental survival, spread and persistence, diagnostic difficulty, hand hygiene controversies, imperfect immunity and immune evasion, asymptomatic and prolonged shedding, lack of vaccine and lack of antiviral treatment. The purpose of this article is to promote a better understanding of these factors in order that health professionals may be better equipped to manage the problems posed by noroviruses. Until large-scale effective vaccination and specific treatments become available, the safeguarding of food and water supplies and the rigorous and timely application of outbreak management and infection control measures will remain the key to norovirus disease prevention and control.

Aims To describe long-term survival (beyond 200 days) following Staphylococcus aureus bacteraemia (SAB) and to determine if certain patient subgroups had poorer long-term survival outcomes. Methods A single-centre, retrospective, cohort study of all SAB cases at The Canberra Hospital, a tertiary referral centre, from January 1998 to December 2007 was performed. Clinical and demographic data were obtained from a pre-existing prospectively collected database. Patients were followed-up for a minimum of 9 months. Subsets within the cohort were analysed for differences in long-term survival. The main outcome measure was death from any cause. Results During the 3889-day study observation period, 439 patients had SAB and were followed for a total of 546 360 person-days. The overall median survival was 3169 days. The mortality rates were 9.6%, 17%, 24%, 29% and 32% at 7, 30, 90, 180 and 365 days respectively. Atotal of 188 (43%) patients died. Of the 188 deaths, 22%, 40%, 55%, 67% and 75% occurred within the first 7, 30, 90, 180 and 365 days respectively after their SAB episode. Initial analysis showed poorer long-term survival in those patients with older age, MRSA, with an unknown focus of infection, and who were not admitted under the Infectious Diseases team. However, on multivariate analysis, the only independent risk factors for poorer survival were older age, unknown focus of infection and not being admitted under the Infectious Diseases team. MRSA, sex, surgical vs non-surgical admitting team and an association with an intravascular device were not associated with poorer long-term survival. Conclusions High rates of death continue for many months after patients have an episode of SAB. Short-term follow-up studies (30 days or less) may miss large numbers of SAB-associated deaths. If accurate data on SAB associated mortality is needed, then follow-up of these patients will be needed for at least 90 days, ideally performed prospectively with a matched control group consisting of hospitalised patients without SAB.

Common birthmarks can be an indicator of underlying genetic disease but are often overlooked. Mongolian blue spots (dermal melanocytosis) are usually localized and transient, but they can be extensive, permanent, and associated with extracutaneous abnormalities. Co-occurrence with vascular birthmarks defines a subtype of phakomatosis pigmentovascularis, a group of syndromes associated with neurovascular, ophthalmological, overgrowth, and malignant complications. Here, we discover that extensive dermal melanocytosis and phakomatosis pigmentovascularis are associated with activating mutations in GNA11 and GNAQ, genes that encode Gα subunits of heterotrimeric G proteins. The mutations were detected at very low levels in affected tissues but were undetectable in the blood, indicating that these conditions are postzygotic mosaic disorders. In vitro expression of mutant GNA11R183C and GNA11Q209L in human cell lines demonstrated activation of the downstream p38 MAPK signaling pathway and the p38, JNK, and ERK pathways, respectively. Transgenic mosaic zebrafish models expressing mutant GNA11R183C under promoter mitfa developed extensive dermal melanocytosis recapitulating the human phenotype. Phakomatosis pigmentovascularis and extensive dermal melanocytosis are therefore diagnoses in the group of mosaic heterotrimeric G-protein disorders, joining McCune-Albright and Sturge-Weber syndromes. These findings will allow accurate clinical and molecular diagnosis of this subset of common birthmarks, thereby identifying infants at risk for serious complications, and provide novel therapeutic opportunities.

Telehealth is defined as the delivery of health-related services and information via telecommunications technologies. According to the American Telemedicine Association (ATA), “telehealth” is a broad term used to describe the use of electronic communications to deliver clinical services as well as other types of health information.1 In rehabilitation, telehealth is defined by the American Physical Therapy Association (APTA) as the use of electronic communications to provide and deliver a host of health-related information and health care services, including, but not limited to, physical therapy–related information and services, over large and small distances.2 Telehealth may be used to provide health education and advice, communicate patient reminders, monitor clinical status, or deliver interventions. Other rehabilitation disciplines, such as occupational therapy and speech therapy, utilize the terms “telerehabilitation”3 and “telepractice”4 as terms to define telehealth in their respective disciplines. The Patient Protection and Affordable Care Act (Public Law 111–148) (PPACA),5 signed into law on March 23, 2010, addresses the use of telehealth as a means of delivering efficient and effective health care in the United States. The national health care reform6 presents a unique opportunity for physical therapists to become identified as clinicians eligible to provide telehealth physical therapy services. However, there are several barriers to overcome if telehealth as a means of health care delivery for physical therapist practice is to become a reality. The objectives of this health policy perspective article are: (1) to describe the development of the telehealth field from a rehabilitation perspective, thereby highlighting some of the potential applications by physical therapists; (2) to discuss current barriers to adoption of telehealth technology by physical therapists; and (3) to identify an overall strategy to achieve long-term adoption of telehealth practices for physical therapists. The earliest applications of telehealth used technology to monitor cardiac …