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In healthcare, disablement model frameworks aim to improve the delivery of patient-centered care through the recognition of patient factors beyond impairments, restrictions, and limitations, which include personal, environmental, and societal factors. Such benefits translate directly to athletic healthcare providing a mechanism for athletic trainers (ATs), as well as other healthcare professionals, to ensure that all aspects of the patient are managed prior to returning to work or sport. The purpose of this study was to investigate ATs recognition and use of disablement frameworks in current clinical practice. We used criterion sampling to identify ATs who were currently practicing from a random sample of ATs that participated in a related cross-sectional survey. A total of 13 participants engaged in an online, audio-only, semi-structured interview that was audio-recorded and transcribed verbatim. A consensual qualitative research (CQR) approach was used to analyze the data. A coding team of three individuals used a multi-phase process to construct a consensus codebook that identified common domains and categories among the participants’ responses. Four domains emerged regarding ATs’ experiences and recognition of disablement model frameworks. The first three domains were related to the application of disablement model frameworks: (1) patient-centered care, (2) limitations and impairments, and (3) environment and support. Participants described varying degrees of competence and consciousness regarding these domains. The fourth domain related to participants’ exposure to disablement model frameworks through formal or informal experiences. Findings suggest that ATs largely demonstrate unconscious incompetence regarding the use of disablement frameworks in clinical practice.

In 2021, the Supreme Court denied certiorari in Care Alternatives v. United States, leaving open a circuit split regarding the intersection of expert testimony and the falsity element of the False Claims Act. This uncertainty could lead to significant civil liability not only for Medicare/Medicaid service providers, but also for any private parties that receive money from the federal government. This Note outlines three potential solutions that can resolve this circuit split to balance between the interests of the federal government in countering fraud from the contracting process, and the interests of private sector firms in facilitating ease of doing business with the public sector.

The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.

Purpose: Although gender disparities and workplace vitality for women has been studied in athletic training, gender discrimination has not been widely studied. The purpose of this study was to describe gender-based aggressions experienced by women athletic trainers (ATs) within their educational and workplace environments. Methods: We used a cross-sectional design, and the web-based survey was comprised of demographic questions, the Schedule of Sexism Events (SSE), and questions on incident reporting. The SSE asks participant to rank items on a Likert Scale (1 = the event never happened to 6 = the event happens almost all the time). Items within the SSE are contextualized to either events in the past year or events in their entire life. The survey was distributed to 5,667 women ATs through the National Athletic Training Association (NATA). Five hundred thirty-nine (539) participants accessed the survey (9.5%). Four hundred seventy-eight (478) participants (age=34.2±8.6y [range=23–66y], experience=11.0±8.2y [range=0-40y]) completed the entire instrument (88.6%). We used descriptive statistics to analyze demographic variables, gender-based education- and work- related items of the SSE and incident reporting. Results: When asked about unfair treatment while interacting with teachers, professors, or engaging in academics in their lifetime, 89% (n=425) of participants indicated they had experienced unfair treatment. Comparatively, 53% (n=252) of participants experienced unfair treatment from teachers, or professors, or while engaging in academics in the last year. When asked about unfair treatment by an employer, boss, or supervisor, 88% (n=421) of participants experienced unfair treatment in their lifetime, where 55% (n=267) have experienced unfair treatment in the past year. Ninety percent (90%, n=430) indicated they experienced unfair treatment by co-workers, fellow students, or colleagues, in their lifetime compared to 61% (n=292) in the past year. When asked if they had experienced gender-based macroaggressions and microaggressions in the workplace, 41% (n=198) experienced both types of aggressions; 5% (n=22) experienced macroaggressions and 29% (n=137) experienced microaggressions. Only 25% (n=119) of participants have reported aggressions in the workplace. Conclusion: Women ATs experience gender-based aggressions in the workplace but they do not typically report these aggressions. All ATs have the responsibility to work towards an inclusive, equitable, and welcoming workplace that directly addresses aggressions.

Purpose: Typically, athletic trainers (ATs) have relied on external support networks to debrief after a critical incident (CI). ATs report focusing on improving work-related processes after a CI rather than their emotional response to the CI. The purpose of this study was to identify both the short-term emotional impacts of CIs and what coping strategies ATs use to address their emotional response to CIs. Methods: We used a cross-sectional, web-based survey, distributed to a random sample of NATA members to explore the perceived effects of CIs on ATs. Participants (n=73, 36±11y) were primarily women (n=53, 72.6%), working in the college/university practice setting (n = 40, 54.8%), with 7±3y of experience. All participants experienced a CI within the previous 12 months. The data were analyzed using descriptive statistics for demographic variables and multi-analyst inductive coding for the open-ended items amongst a 4-person team. We used a modified consensual qualitative research (CQR) process to review and analyze the open-ended questions and identify domains and core ideas. Trustworthiness was established with multi-analyst triangulation and auditing. Results: Participants most commonly reported feelings of thinking too much (71%, n=52), anxiety (63%, n=46), sadness (60%, n=44), fatigue (53%, n=39), and sleep disturbance (49%, n=36) resulting from CIs. Common coping strategies used were exercise (63%, n=46), humor (44%, n=32), interacting with pets (41%, n=30), expressing oneself through crying (40%, n=29), and peer support (34%, n=25). Sixty-two participants (86%) responded to open-ended questions related to the outcomes of CIs. Four domains were identified from the open-ended responses. Those domains included 1) dissociation, 2) deteriorated emotional state, 3) disruption of daily activities, and 4) improved event or post-event processes. Conclusion: Various strategies are used by ATs to cope with CIs; however, the only ways in which ATs expressed that coping helped was with care delivery, not the emotional impact of the CI. The lack of responses relative to coping strategies that improve quality of life is potentially alarming. To build resilience and persistence, organizations should consider requiring support beyond process improvement that addresses the emotional impact of CIs.

ObjectiveTo determine the association between PTSD symptoms due to prior trauma and prior trauma type with PTSD symptoms after suspected acute coronary syndrome (ACS).MethodA consecutive sample of patients presenting to the emergency department (ED) for suspected ACS were surveyed. Logistic regression was used to estimate the odds of elevated ACS-related PTSD symptoms [PCL-S≥33] at 1-month associated with PTSD symptoms due to prior trauma and prior trauma type at the time of suspected ACS, adjusting for demographics, comorbidities, depression, and etiology of ACS symptoms.ResultsOf 984 patients, 81.6% reported ≥1 prior trauma type and 22.5% reported PTSD symptoms due to prior trauma at the time of suspected ACS. One month later, 18.0% had ACS-related PTSD symptoms. Patients with versus without PTSD symptoms due to prior trauma at the time of the suspected ACS had increased odds of ACS-related PTSD symptoms one month later (42.1% vs 9.9%; aOR 4.49, 95% CI:3.05-6.60; p&nbsp

Introduction Controlling pain in burn patients is one of the most important components of patient satisfaction. At our institution, pain specific HCAHPS scores indicate that burn patients consistently rate pain control less than the 25th percentile in the nation. Research shows that patients who felt that their pain was well managed reported more trust in their health care team and that pain management directly affects length of stay for burn patients. This project aims to increase HCAHPS pain scores to greater than the 75th percentile, encourage improved communication, and optimize patient education regarding pain management. Methods A multimodal approach to pain management was identified as the best way to intervene. The multidisciplinary team met to assess the problem and completed a fishbone diagram and A3 to better understand the drivers of poor pain control. It is understood that patient satisfaction data is a lagging indicator and more real-time actionable data was needed. A focus was placed on improved communication, managing expectations, and education about types of burn pain and pain management. The self-reporting pain tool was developed as a daily assessment of pain satisfaction and a facilitator of communication between nurses and patients about pain. The self-reporting pain tool was implemented as a task for night shift nurses to be completed with their initial shift assessment. Results After implementation of the pain tool, daily compliance was documented and displayed on a visual management board on the unit. As a result of daily and intentional communication with patients about their pain using the pain tool, the pain HCAHPS indicators have sustained above the 75th percentile for quarter four of FY17. Conclusions Both the patient and the nurse is more satisfied when they are effectively communicating about pain. Efficiency is improved because interventions such as physical therapy, occupational therapy, and wound care are able to be more successfully completed when patients’ pain management is optimized. Daily indicators and visual management are key components of successful implementation to ensure accountability and that nurses are seeing the progress of the project. The results of this project identify a need for standardized education about burn pain and pain management. Applicability of Research to Practice

Higher levels of mental skill use and knowledge have been consistently associated with enhanced performances in athletic settings (e.g., Greenleaf, Gould & Dieffenbach, 2001; Hatzigeorgiadis, Zourbanos, Galanis, & Theodorakis, 2011; Weinberg, 2008). More specifically, exceptional athletic performances have been linked to the practice and application of mental skills such as goal-setting, imagery, self-talk, emotion control, activation, relaxation, automaticity, and positive thinking (Thomas, Murphy, & Hardy, 1999). Mental skills have also been shown to enhance psychological resilience, stress hardiness, and performance among members of the U.S. military (Adler et al., 2015).

Background: Prior studies have assessed the short-term reproducibility of the masked hypertension (MHT) phenotype. Less is known about the stability of MHT over time or its responsiveness to BP medication. Methods: We assessed BP phenotypes in 441 untreated subjects with a screening BP Results: Of subjects with MHT at baseline, 41%(24/59) continued to have MHT at 6 years, 44%(26/59) developed sustained hypertension, and 15%(9/59) became normotensive ( Table ). Of subjects with baseline office SBP 120-139mmHg, there was a trend toward a greater increase in LVM over 6 years in those with versus without MHT (change in LVM +25.2±37.5g vs +15.7±27.8g, p=0.25). Of subjects with MHT at baseline, those on BP treatment at 6 years had a decrease in ambulatory awake SBP compared to baseline whereas untreated subjects had an increase in ambulatory awake SBP (-5.4±7.2mmHg vs +7.2±8.0mmHg; p Conclusion: Approximately half of MHT subjects progressed to sustained hypertension over 6 years, supporting the hypothesis that MHT is an intermediary phenotype on the way to sustained hypertension. Treatment with BP medication was associated with lower ambulatory BP, though randomized trials are needed to confirm efficacy and safety.

Current bioelectric impedance analysis (BIA) systems are often large, cumbersome devices which require strict electrode placement on the user, thus inhibiting mobile capabilities. In this work, we developed a handheld BIA device that measures impedance from multiple frequencies (5 kHz~200 kHz) with four contact electrodes and evaluated the BIA device against standard body composition analysis systems: a dual-energy X-ray absorptiometry (DXA) system (GE Lunar Prodigy, GE Healthcare, Buckinghamshire, UK) and a whole-body BIA system (InBody S10, InBody, Co. Ltd, Seoul, Korea). In the study, 568 healthy participants, varying widely in body mass index, age, and gender, were recruited at two research centers: the Samsung Medical Center (SMC) in South Korea and the Pennington Biomedical Research Center (PBRC) in the United States. From the measured impedance data, we analyzed individual body fat and skeletal muscle mass by applying linear regression analysis against target reference data. Results indicated strong correlations of impedance measurements between the prototype pathways and corresponding InBody S10 electrical pathways (R = 0.93, p &lt, 0.0001). Additionally, body fat estimates from DXA did not yield significant differences (p &gt, 0.728 (paired t-test), DXA mean body fat 29.45 ± 10.77 kg, estimated body fat 29.52 ± 12.53 kg). Thus, this portable BIA system shows a promising ability to estimate an individual’s body composition that is comparable to large stationary BIA systems.

This article provides a description of the administrative model that enabled a city-wide integration effort between Greater Toronto Area hospitals and Toronto Emergency Medical Services in the care of patients within the city of Toronto with ST elevation myocardial infarction (STEMI). This administrative structure, known as the Toronto Heart Attack Collaborative (THAC), enabled universal 24/7 access to primary percutaneous coronary intervention within Toronto, improving patient efficacy and outcomes. The lessons and administrative enablers from this experience may be useful for regions that are embarking on multi-centre integration efforts. This article presents a five-year perspective on the THAC integration effort.

SummaryReciprocal triangular numbers have appeared in series since the very first infinite series were summed. Here we attack a number of subseries of the reciprocal triangular numbers by methodically expressing them as integrals.

Summary: We assessed the efficacy of a pilot questionnaire designed to elicit information about external risk factors for breast cancer in sub-Saharan African women. Preliminary analysis identified areas of the questionnaire and interviewing process that required modification, as well as socioeconomic factors that contribute to reduced participation among these understudied populations.

When asked about our weight, most of us can name a figure based on prior knowledge. And while stepping on a scale gives us the ability to know that exact number and track it routinely, it does not provide insights into our body?s composition. This, at the basic level, refers to proportions of fat and lean or fat-free mass (FFM) that comprise the human body. Conventionally, the body mass index (BMI), which is the ratio of body weight in kilograms to the square of its height in meters, and anthropometric parameters like waist circumference, waist-to-hip ratio, and skinfold thickness have been used to estimate the level of fatness. In fact, BMI is the de facto marker for stratifying individuals into underweight (18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (30 kg/m2) categories. Nonetheless, these metrics are limited in precisely characterizing individuals by percentages of body fat and muscle mass, particularly in epidemiological studies where these proportions vary across age, sex, and ethnic groups. Of note is also how, solely on the basis of BMI, a physically fit individual may be classified as overweight due to having a higher proportion of lean body mass, which outweighs fat. This highlights the importance of body composition in weight tracking and management.

Body fat and skeletal muscle mass measurement is of increasing interest in the clinical setting and the general public. The study aim was to evaluate the feasibility of developing small portable wi...

There is a wide variety of objects that find their way into the human gastrointestinal tract, either accidentally or deliberately. In this case a crack pipe was ingested in its entirety. Despite the seemingly rare and random nature that this scenario presents, this patient's care serves to reinforce what should be done to successfully manage a patient with an ingested foreign body, as well as the important issues related to crack cocaine abuse.

Our poster is an exploration of the effects of quantifying physical experiences and refashioning them into new, interactive, live experiences through data visualization; the poster explores how data visualizations are designed to teach and effect change. Specifically, the authors explore two topics: athletic training and teacher training. Both of these fields have been inundated by data analysis tactics; sports data visualizations are highly developed and hypermediate while teacher training data are still largely immediate and static Through an analysis of these two topics in relation to theories of phenomenography and remediation, the poster discusses how the use of real-time data analysis and data visualization common in sports training might inform how that we effect change in other fields, such as teaching.

We developed the first MEMS cantilever resonator actuated by piezoelectric Parylene-C, which is a new piezoelectric material for its integration into/with MEMS because it can be deposited at room temperature and electrically poled at 200°C with 400V of DC bias. After our first report on Parylene-C as a new piezoelectric material, we demonstrated here the first MEMS cantilever resonator actuated by piezoelectric PA-C.

This work reports the first study of preparing Parylene-C (i.e., PA-C) as a piezoelectric material. The poling of the Parylene-C film was performed with an electric field up to 40 MV/m up to 250°C. This work also applied a charge integration method to measure the longitudinal piezoelectric coefficient (i.e., d33) using step-wise pneumatic pressure changes over the piezoelectric PA-C film samples in a sealed chamber. The (d33) is measured to be −0.01 to −2.00pC/N depending on poling conditions.

The balanced scorecard (BSC) has become increasing popular in healthcare organizations. A recent study conducted at the University Health Network in Toronto explored the extent to which the BSC has focused and aligned various organizational units and departments around shared goals and objectives. The evaluation also assessed the BSC's impact on front-line staff and how the development and rollout of the BSC should be modified in the next planning iteration.