Search

Medical school education should foster creativity by enabling students to become "makers" who prototype and design. Healthcare professionals and students experience pain points on a daily basis, but are not given the tools, training, or opportunity to help solve them in new, potentially better ways. The student physician of the future will learn these skills through collaborative workshops and having dedicated "innovation time." This pre-clinical curriculum would incorporate skills centered on (1) Digital Technology and Small Electronics (DTSE), (2) Textiles and Medical Materials (TMM), and (3) Rapid Prototyping Technologies (RPT). Complemented by an on-campus makerspace, students will be able to prototype and iterate on their ideas in a fun and accessible space. Designing and making among and between patients and healthcare professionals would change the current dynamic of medical education, empowering students to solve problems in healthcare even at an early stage in their career. By doing so, they will gain empathy, problem-solving abilities, and communication skills that will extend into clinical practice. Our proposed curriculum will equip medical students with the skills, passion, and curiosity to impact the future of healthcare.

This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person's stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person's goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care., (©Timothy Bober, Bruce L Rollman, Steven Handler, Andrew Watson, Lyndsay A Nelson, Julie Faieta, Ann-Marie Rosland. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 09.10.2024.)

Background: Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020., Methods: In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt., Results: Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not., Conclusions: Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Typical hospital lighting is rich in blue-wavelength emission, which can create unwanted circadian disruption in patients when exposed at night. Despite a growing body of evidence regarding the effects of poor sleep on health outcomes, physiologically neutral technologies have not been widely implemented in the US healthcare system., Objective: The authors sought to determine if rechargeable, proximity-sensing, blue-depleted lighting pods that provide wireless task lighting can make overnight hospital care more efficient for providers and less disruptive to patients., Design: Non-randomised, controlled interventional trial in an intermediate-acuity unit at a large urban medical centre., Methods: Night-time healthcare providers abstained from turning on overhead patient room lighting in favour of a physiologically neutral lighting device. 33 nurses caring for patients on that unit were surveyed after each shift. 21 patients were evaluated after two nights with standard-of-care light and after two nights with lighting intervention., Results: Providers reported a satisfaction score of 8 out of 10, with 82% responding that the lighting pods provided adequate lighting for overnight care tasks. Among patients, a median 2-point improvement on the Hospital Anxiety and Depression Scale was reported., Conclusion and Relevance: The authors noted improved caregiver satisfaction and decreased patient anxiety by using a blue-depleted automated task-lighting alternative to overhead room lights. Larger studies are needed to determine the impact of these lighting devices on sleep measures and patient health outcomes like delirium. With the shift to patient-centred financial incentives and emphasis on patient experience, this study points to the feasibility of a physiologically targeted solution for overnight task lighting in healthcare environments., Competing Interests: Competing interests: Thomas Jefferson University (Jefferson) and Circalux Inc. (Circalux) have a license agreement whereas Jefferson has intellectual property pending and is licensing to Circalux. Some of the authors (TB, LA and GH) hold equity in Circalux, and are inventors of the intellectual property, and as such did not participate in data collection or analysis. These same individuals were enrolled as students at Jefferson during the study duration. There was no financial exchange between any of the authors, Circalux and Jefferson for the purposes of this study. YL and JH are employees of Jefferson., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: An increase in the value of the hamstring-to-quadriceps (H/Q) ratio with an increase in angular velocity may effectively prevent injuries of the back of the thigh. Previous studies have found that the conventional H/Q ratio was unaltered along with an increasing angular velocity in females. Therefore, this study aimed to investigate the relationships between the conventional H/Q ratio and angular velocity in a group of female soccer players., Methods: The study was carried out on a group of 16 female soccer players (age: 20.7 ± 3.9 years, body height: 166.1 ± 5.8 cm, body mass: 58.4 ± 6.2 kg, training experience: 8.8 ± 4.1 years). Measurements of peak torque of extensors and flexors of the knee joint under static conditions and under isokinetic conditions (at angular velocities of 30°/s, 60°/s, 90°/s and 120°/s) were carried out using a Biodex dynamometer., Results: There was a statistically significant increase in the conventional H/Q ratio with an increase in angular velocity. These differences occurred between measurements at angular velocities of 0°/s and 30°/s, and 30°/s and 60°/s., Conclusions: As previously found for males, an increase in conventional H/Q ratio with increased angular velocity was also present in this group of female players. This phenomenon should reduce the number of injuries of the muscles of back of the thigh. Coaches should pay attention to increasing the level of strength in the group of knee joint flexor muscles so as to make the value of the H/Q ratio appropriately high and increasing with increasing angular velocity.

Purpose: Lower extremity power is an important physical capacity of a soccer athlete. Power represents, and can be modified by, the training of strength and speed. Pre-season and in-season training differs in the relative emphasis on these two quantities. It is nevertheless desirable that the mechanical power remain the same or become higher during the in-season period. The purpose of this study was to identify changes in quantities related to "explosive strength" and to check whether, in collegiate female soccer players, pre- and inseason lower extremity power will remain unaltered., Methods: Twenty collegiate female soccer players, representing all field positions, participated. Lower extremity power was assessed by a series of drop jumps executed from four different heights (15, 30, 45, and 60 cm). Mechanical power was calculated using subject's mass, jump height, and acceleration due to gravity. This value was further normalized by body mass of each athlete to obtain the relative (or normalized) mechanical power., Results: The normalized lower extremity mechanical power was highest when landing from the 30 cm height for both pre- and inseason periods. However, contrary to expectations, it turned out lower during the in-season than during the pre-season test, even though no significant differences were found between the corresponding jump heights., Conclusions: It is concluded that altered, perhaps inadequate, training strategies were employed during the in-season period. Besides, advantages of adding the relative mechanical power as a season readiness indicator are underlined compared with relying on the jump height alone.

Gait analysis is an objective tool for the clinical assessment of locomotor activity in children with cerebral palsy (CP). Correct diagnosis and properly planned rehabilitation are necessary for enhanced motor functions in persons suffering from cerebral palsy. Orthoses, orthopedic operations, medications and physiotherapy are the most common treatments. However, there is still a lack of objective methods for assessing motor behavior and monitoring the progress of recovery. The aim of the study was to use the ground reaction force patterns generated during walking to create the Integral Method (IM), which could become an objective tool that could supplement the functional classification of CP children based on the Gross Motor Function Classification System (GMFCS). A total of 15 healthy children and 34 children with CP who walk independently participated in the study. A Kistler force plate and GRFintegral software were used. Of the 34 measurements based on the IM for CP children, 17 matched the level assigned by the GMFCS, 2 children were assigned a higher level, and 15 were assigned a lower level. Pearson's correlation coefficient between the IM and the GMFCS was moderate (r = 0.61, p ≤ 0.01). Asymmetry was found in 11 cases. The IM supplements the GMFCS and is an objective and quantitative assessment of motor abilities. The method allows for the detection of asymmetry, diagnosis of the improvement of gait pattern and assessment of foot support technique. With the appropriate software, the IM provides pediatricians, neurologists, orthopedists, surgeons and physiotherapists with a simple and fast way to assess gait.

Chlamydiae are microorganisms exhibiting characteristics intermediate between bacteria and viruses. Chlamydia is widespread in the natural world, intracellular parasites of people and animals. They are capable of independent reproduction, because they do not synthesize ATP, in its development cycle using the host cell metabolic pathways. The life cycle of these microorganisms is original, unique among bacteria and lasts from 24 to 48 hours. Chlamydia antigens consist of 4 groups: group-specific, species-specific, type-specific and subspecies-specific. The group of species-specific antigens consists of MOMP and heat shock proteins. C. trachomatis is a potent immunogen, stimulating the immune processes of microorganisms. In the course of C. trachomatis infection, the response mechanisms involved are: non-specific, specific, humoral and cellular. Chronic infection is characterized by maintenance of microorganisms in the host cell. Inflammation is formed in less time and with increased intensity and has a rapid immune response on the part of previously sensitized lymphocytes. C. trachomatis infections are the most common bacterial sexually-transmitted infections. It represents an important clinical problem for doctors in many areas of medicine such as dermatology, venereology, ophthalmology, gynecology and obstetrics, rheumatology and others. Chlamydial infections are important pathogens in medical practice, not only because they cause disease in various fields of medicine, but also because of the large proportion of the population suffering and exposed to these microbial infections. Chlamydial infections are characterized by multifocality and polymorphism changes. Chlamydia causes inflammation in the adult urethra and cervix with the possibility of serious complications, and can cause perinatal infections in infants.

The aim of this study was to present kinematics of trunk and upper extremities in tennis players who perform one-handed and two-handed backhand strokes. The study aimed to address the question of whether one of those techniques has some important advantage over the other. If so, what makes it superior? The study included 10 tennis coaches with average coaching experience of 9 years. The coaches were asked to hit 15 one-handed and two-handed backhands. The tests were carried out in a laboratory. A sponge ball was used in order to protect the measurement equipment. Video motion analysis was carried out using BTS SMART system; images were recorded with 6 cameras with a rate of 120 frames per second. The analysis of both backhand strokes focused on the second phase of the stroke (acceleration). The use of an eight-element model of human body for description of upper body motion in both techniques revealed kinematic differences in how both backhands are performed. The two-handed backhand was performed in closed kinetic chain with 8 degrees of freedom, whereas the one-handed backhand involved an open kinetic chain with 7 degrees of freedom. Higher rigidity of upper extremities which are connected with trunk in the two-handed backhand, contributes to an elevated trunk effect in this stroke. This is confirmed by higher component velocities for racket handle, which result from trunk rotation in the two-handed backhand and a negative separation angle in the two-handed backhand at the moment of contact of the racket with the ball. The study does not provide a clear-cut answer to the question of advantages of one technique over the other; however, it reveals dissimilar patterns of driving the racket in both techniques, which suggests the need for extending the analysis of techniques of both backhands with additional kinematics of tennis racket in consideration of measurements of ball velocities.

Background: The aim of this paper is to present the physiotherapeutic program employed at the Rehabilitation Centre for the College of Physiotherapy in Wrocław, Poland and its effectiveness by demonstrating the increase in strength of knee joint extensor and flexor muscles of patients after anterior cruciate ligament (ACL) reconstruction., Material/methods: Thirty-seven males participated in the physiotherapeutic program from the first week up to 8 months postoperatively. Each patient underwent an individual therapeutic program. Endoscopic reconstruction of a completely ruptured ACL was performed using Mitek's method (graft harvesting from flexor muscles). All patients previously underwent orthopedic and functional examinations, including measurements of the range of movement, knee and thigh circumference and strength of flexor and extensor muscles of the involved and uninvolved leg using a Biodex 3 System in both static and isokinetic modes., Results: The outcome of the physiotherapeutic procedure, which is detailed in the paper, revealed a favorable effect of physiotherapy 6 months after ACL reconstruction. The observed 9% deficit in extensor muscle strength measured under isokinetic conditions of the involved knees compared with the uninvolved knees led us to conclude that the period of physiotherapy should be extended beyond 6 months for some patients., Conclusions: 1. Six months of physiotherapy following ACL reconstruction in males favorably affected muscle strength values of the involved and uninvolved knees under static and isokinetic conditions. 2. The application of individual loads during the sixth month of physiotherapy resulted in similar values of extensor and flexor muscle strength measured under static conditions, and flexor muscle strength measured under isokinetic conditions in involved and uninvolved knees.

Isokinetic dynamometers are frequently used as training devices. They are also regularly employed to measure the characteristics of skeletal muscles under dynamic conditions. The combination of published data of such measurements and the authors' own experience led to the present investigation of the validity of measurements performed using the Biodex System 3 dynamometer. Two individual dynamometers of the same type were used. A calibration technique was used to test the validity of measured torque and the angular coordinate of the position of the lever arm of the dynamometer under static conditions. The results of measurements performed under dynamic (isokinetic) conditions were verified by comparing numerical values of tests provided in the Biodex report and raw data collected directly from the measuring computer of the same isokinetic machine. The shapes of experimentally determined characteristics of torque Mmax(ω) and power P(ω) were also analysed, taking into consideration their conformity with the laws of thermodynamics and known properties of skeletal muscles. The static tests showed that the indications of the Biodex System 3 dynamometer lay within the error range specified by the manufacturer. Therefore, the results of static measurements can be considered accurate. According to the isokinetic tests, the values of angular velocity were also accurate. However, indications of torque and power were much less accurate, justifying the uncertainty over whether they can be considered true results of measurement.

The purpose of this study was to develop a statistical model to describe the electromyography (EMG) signal frequency changes during a submaximal isometric contraction. Thirty subjects performed a 30-second isometric contraction of the biceps brachii muscle at 80% of the maximal voluntary isometric force. Surface EMG electrodes recorded electrical activity of the biceps brachii. Zero-Crossing-Rate was calculated to identify EMG frequency shifts. The mean frequencies for every one-second period were used to calculate a linear relationship between frequency and time. A significant relationship (p<0.05) between slope and initial frequency value was identified. The model described EMG frequency changes during submaximal effort of biceps brachii up to 15 seconds. The prediction error was 9.8%. Modifying this equation to initial values of frequency of each participant decreased prediction error to 7.2%. These results demonstrate that despite individual differences between subjects it is possible to derive single equation that describes EMG alterations during submaximal, isometric contractions across a homogeneous group of people.

The action of three functional rockers, namely the heel, ankle and forefoot rocker, assist the progression of the leg over the supporting foot. The purpose of this case series was to analyze the occurrence of foot rockers during gait in three children with cerebral palsy (CP) who had undergone the tendo-Achilles lengthening (TAL), procedure followed by a clinic- or home-based intervention and in one child with CP without history of surgery. Self-selected gait was video-recorded in a laboratory during six testing sessions at half-year intervals rendering a 3 year period of observation. One child had pre- and post-surgical gait data and the other two had post surgical data only. Sagittal plane knee angular velocity, as well as foot to ground positions, and foot rocker occurrence were analyzed. In a child with history of CP, and without history of surgery, mean angular velocities of the 1st, 2nd and 3rd foot rocker were 3.7, 0.57 and 6.67 rad/s, respectively, and the step length and cadence were normal. In children who underwent TAL the 1st and 2nd rocker was absent, as the initial contact of the foot with the ground was either with foot-flat or forefoot. The mean velocity of the 3rd rocker in children who underwent TAL was lower by approximately 50-80% than that of the nonsurgical case. Furthermore, the characteristic pattern of the knee joint to foot-floor position during gait was not observed in these cases. Foot rocker analysis identified children with abnormal gait characteristics. Following surgery these gait characteristics remained abnormal.

The angular velocity of a knee extension performed after flexion with different range and velocity, i.e. the kicking movement with stabilized thigh, was investigated and described. In addition, the maximum velocity of extension reached after prestretch was compared to that obtained in trials without prestretch. The maximum velocity of extension varied from 213 to 1087 degrees s-1 depending on the range and velocity of prestretch. In trials without prestretch the velocity of extension was worse up to 43% when small range of movement was involved. In trials with full range of movement the velocity of extension was similar in the tasks with and without prestretch. In this context the possible role of elastic energy is discussed. The method used was electrogoniometry.

The activity of muscles of the human arm can produce force against an external system which may be interpreted as a directional force and a stabilizing force. This paper investigated the relationship between muscle activity in the human arm during both maximal and submaximal external force development against a handle. Three different handle arrangements were studied; fixed, free to move in the horizontal direction and free to move in the vertical direction. Ten subjects were utilized. Analyses of angle, force and electromyographic data revealed that the increased muscle activity at the wrist when compared with action against the movable external system was a function of the stabilizing force and not of directional force production. It is suggested that the extensor muscles of the wrist are the initiators of the stabilizing force as well as the major stabilizers of the wrist joint during the resultant force production against the handle.