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Context: Instrument-assisted soft tissue mobilization (IASTM) continues to increase in popularity and utilization among manual therapists. Despite its popularity, little is known about the consistency in peak or average forces that clinicians apply when performing IASTM treatments with a 2-handed grip. The purpose of this study was to examine intraclinician consistency in peak and average forces when applying a 2-handed IASTM grip. Design: Randomized crossover study conducted in a university biomechanics laboratory. Methods: Five (5) licensed athletic trainers with prior IASTM training used 5 different IASTM instruments to apply simulated treatment. Average peak forces (Fpeak) and average mean forces (Fmean) were collected via force plate for all 5 IASTM instruments with a skin simulant attached. Descriptive statistics, coefficients of variation (CVs), box and density plots, and Bland–Altman plots were assessed. Results: The clinicians' average Fpeak ranged from 3.0 N to 11.6 N and average Fmean from 1.9 N to 8.1 N. Fpeak CVs for all instruments ranged from 14% to 31%, and Fmean CVs ranged from 15% to 35%. Bland–Altman plots indicated that for both Fpeak and Fmean, 97% of the data points fell within the limits of agreement across instruments and clinicians. Mean differences across instruments ranged from 0.9 N (91.8 g) to 4.1 N (418.1 g) for Fpeak and from 1.0 N (102.0 g) to 2.8 N (285.5 g) for Fmean. Thus, CVs, box and density plots, and Bland–Altman plots supported general force application consistency. Conclusion: Trained IASTM clinicians produced consistent treatment application forces (ie, Fpeak and Fmean) within treatment sessions during 2-handed simulated application. [ABSTRACT FROM AUTHOR]

Pronghorn (Antilocapra americana) are considered a keystone species of North American grasslands and an important economic source for many landowners in Texas. Pronghorn restoration projects routinely capture and translocate individuals from surplus populations to restoration areas. The objective of this study was to generate normal hematological and biochemical reference intervals (RI) for free-ranging pronghorn populations in Texas as a health monitoring tool for pronghorn restoration efforts. Blood samples were collected by jugular venipuncture and divided among an EDTA tube, serum separator tube, and a single blood smear on site. Complete blood counts and biochemical profiles were completed at the Texas Veterinary Medical Diagnostic Laboratory. In total, 417 individuals (41 males, 376 females) were included in the analysis. RI were determined by robust methods (R Studio) and mixed models' analysis of variance (SPSS 28) to examine differences in blood parameters due to fever, sex, age (adult versus yearling [<1 yr of age]), cell abnormalities, and pathogen exposure reported by the testing laboratory. Sex, age, and pathogen exposure affected mean blood values, but did not warrant development of separate RI by class. Bluetongue virus was identified in 46.8% (195/417) of pronghorns and epizootic hemorrhagic disease in 89.4% (194/217) of pronghorns; 84.8% (184/217) of the pronghorns tested positive for both diseases. This information provides baseline hematology and biochemical parameters to assess the health of free-ranging pronghorn and guide wildlife managers in decision-making for future translocations and restoration objectives. [ABSTRACT FROM AUTHOR]

Context: Mental health is an important component of holistic care in athletic settings. Burnout is one of many factors associated with poor mental health, and clinicians should assess for these symptoms. The Athlete Burnout Questionnaire (ABQ) has been proposed as a measure of burnout in athletes; however, design concerns are prevalent within the scale, and psychometric analyses have resulted in inconsistent measurement properties, limiting the usefulness of the scale for accurate assessment of burnout in athletes. The objective of our study was to assess the factor structure of the Alternate Modified ABQ-15v2 using confirmatory factor analysis. If model fit was inadequate, a secondary purpose was to identify a psychometrically sound alternate ABQ model. Design: Observational study. Methods: Intercollegiate athletes and dancers pursuing a degree in dance (n = 614) were recruited from programs across the United States. Individuals had varied health statuses (eg, healthy, injured), scholarship support, and participated in a variety of intercollegiate sports. A confirmatory factor analysis was conducted on the modified 15-item ABQ (Alternate Modified ABQ-15v2). Exploratory factor analysis and covariance modeling of a proposed alternate 9-item scale (ABQ-9) was conducted and multigroup invariance analysis was assessed across athlete category, class standing, and student-athlete scholarship status to assess consistency of item interpretation across subgroups. Results: The Modified ABQ did not meet recommended model fit criteria. The ABQ-9 met all recommended model fit indices but was not invariant across athlete category. Conclusions: The ABQ-9 may be a viable and efficient option for assessing burnout in the collegiate athletics setting. However, further research is needed to validate the ABQ-9 in a cross-validation study. [ABSTRACT FROM AUTHOR]

Context: Among numerous knee-related patient-reported outcome measures, the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) has been used across a wide variety of knee pathologies. However, traditional validation procedures (classical test theory) and existing studies (estimating item parameters) have limitations in establishing the measurement properties of the IKDC-SKF. Rasch analysis reveals a strong validation approach to improve IKDC-SKF clinical interpretation with larger samples. Objective: To assess psychometric properties, including differential item functioning, of the IKDC-SKF as a patient-reported measure of knee function. Design: Cross-sectional study. Setting: Secondary data. Data were extracted from the cloud-based orthopedic and sports medicine global registry Surgical Outcome System (Arthrex). Patients: A total of 1725 individuals who underwent an arthroscopic knee procedure and completed all items on the IKDC-SKF. Main Outcome Measure(s): Rasch analysis including model-data fit, rating scale's function, item-person map (distribution of item difficulty and person ability), and differential item functioning (sex and age groups) was used to evaluate the psychometric properties of the IKDC-SKF. Results: Ten misfit items were found and removed. The 5-point Likert scale of the 9-item IKDC-SKF worked well. Item difficulty ranged from 0.58 to 0.81 logits, and person's knee function had ranged from –5.56 to 4.86 logits, with a wide distribution. The IKDC-SKF was found to function similarly for sex (male vs female) and age. Conclusions: Rasch analysis identified a unidimensional structure retaining 9 of the original IKDC-SKF items; however, a more comprehensive inventory is necessary to assess a wider range of knee function and improve measurement validity. [ABSTRACT FROM AUTHOR]

Clinicians utilize instrument-assisted soft tissue mobilization (IASTM) to identify and treat myofascial dysfunction or pathology. Currently, little is known regarding the ability of clinicians to provide similar IASTM forces across treatment sessions. The authors’ purpose was to quantify clinician reliability of force application during a simulated IASTM treatment scenario. Five licensed athletic trainers with previous IASTM training (mean credential experience = 5.2 [4.3] y; median = 5 y) performed 15 one-handed unidirectional sweeping strokes with each of the 3 instruments on 2 consecutive days for a total of 90 data points each. The IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke across 2 sessions. The authors’ findings indicate IASTM trained clinicians demonstrated sufficient Fpeak and Fmean reliability across a treatment range during a one-handed IASTM treatment. Future research should examine if IASTM applied at different force ranges influences patient outcomes. [ABSTRACT FROM AUTHOR]

Context: Instrument-assisted Soft Tissue Mobilization (IASTM) is a therapeutic intervention used by clinicians to identify and treat myofascial dysfunction or pathology. However, little is known about the amount of force used by clinicians during an IASTM treatment and how it compares to reports of force in the current literature. Objective: To quantify the range of force applied by trained clinicians during a simulated IASTM treatment scenario. Design: Experimental. Setting: University research laboratory. Participants: Eleven licensed clinicians (physical therapist = 2, chiropractor = 2, and athletic trainer = 7) with professional IASTM training participated in the study. The participants reported a range of credentialed experience from 1 to 15 years (mean = 7 [4.7] y; median = 6 y). Intervention: Participants performed 15 one-handed unidirectional sweeping strokes with each of the 5 instruments for a total of 75 data points each. Force data were collected from a force plate with an attached skin simulant during a hypothetical treatment scenario. Main Outcome Measures: Peak force and average forces for individual strokes across all instruments were identified. Averages for these forces were calculated for all participants combined, as well as for individual participants. Results: The average of peak forces produced by our sample of trained clinicians was 6.7 N and the average mean forces was 4.5 N. Across individual clinicians, average peak forces ranged from 2.6 to 14.0 N, and average mean forces ranged from 1.6 to 10.0 N. Conclusions: The clinicians in our study produced a broad range of IASTM forces. The observed forces in our study were similar to those reported in prior research examining an IASTM treatment to the gastrocnemius of healthy individuals and greater than what has been reported as effective in treating delayed onset muscle soreness. Our data can be used by researchers examining clinically relevant IASTM treatment force on patient outcomes. [ABSTRACT FROM AUTHOR]

Context: Total Motion Release® (TMR®) is a novel treatment paradigm used to restore asymmetries in the body (eg, pain, tightness, limited range of motion). Six primary movements, known as the Fab 6, are performed by the patient and scored using a 0 to 100 scale. Clinicians currently utilize the TMR® scale to modify treatment, assess patient progress, and measure treatment effectiveness; however, the reliability of the TMR® scale has not been determined. It is imperative to assess scale reliability and establish minimal detectable change (MDC) values to guide clinical practice. Objective: To assess the reliability of the TMR® scale and establish MDC values for each motion in healthy individuals in a group setting. Design: Retrospective analysis of group TMR® assessments. Setting: University classroom. Participants: A convenience sample of 61 students (23 males and 38 females; 25.48 [5.73] y), with (n = 31) and without (n = 30) previous exposure to TMR®. Intervention: The TMR® Fab 6 movements were tested at 2 time points, 2 hours apart. A clinician with previous training in TMR® led participant groups through both sessions while participants recorded individual motion scores using the 0 to 100 TMR® scale. Test–retest reliability was calculated using an intraclass correlation coefficient (2,1) for inexperienced, experienced, and combined student groups. Standard error of measurement and MDC values were also assessed for each intraclass correlation coefficient. Outcome Measure: Self-reported scores on the TMR® scale. Results: Test–retest reliability ranged from 0.57 to 0.95 across the Fab 6 movements, standard error of measurement values ranged from 4.85 to 11.77, and MDC values ranged from 13.45 to 32.62. Conclusion: The results indicate moderate to excellent reliability across the Fab 6 movements and a range of MDC values. Although this study is the first step in assessing the reliability of the TMR® scale for clinical practice, caution is warranted until further research is completed to establish reliability and MDC values of the TMR® scale in various settings to better guide patient care. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the reliability and validity of the Clinometer™ smartphone application. Intrarater and interrater reliability were calculated for devices (i.e., goniometer, Clinometer™, bubble inclinometer) using intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Interinstrument reliability and Clinometer™ validity were also assessed. Intrarater reliability was good (intraclass correlation coefficients =.70 −.83) and interrater reliability was moderate (intraclass correlation coefficient =.63 −.72) across devices. Interinstrument reliability and Clinometer™ validity were supported across analyses. The Clinometer™ is comparable to a goniometer or bubble inclinometer for measuring prone knee flexion. [ABSTRACT FROM AUTHOR]

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite its popularity, little is known about the forces applied by the clinician using the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM–trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (physical therapists = 2, chiropractors = 2, athletic trainers = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across 5 IASTM instruments on a skin simulant attached to a force plate. Instrument-assisted soft tissue mobilization stroke application was analyzed for peak normal forces and mean normal forces by stroke. We observed an average peak normal force of 8.9 N and mean normal force of 6.0 N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as reference for the application of IASTM in practice and research. [ABSTRACT FROM AUTHOR]

Background The impact of timing of genetic testing on surgical decision making in women with breast cancer and BRCA mutation is not well known. Methods Women who were found to carry a deleterious BRCA mutation and had been diagnosed with breast cancer were identified from a database at Beaumont Health. Women who had received BRCA positive results at least a day prior to their index surgery were considered to be aware of their mutation status prior to surgery. Baseline characteristics and surgical choices were compared between women who were aware of their mutation status prior to surgery and those who were not. Fischer's exact test was used for categorical variables and Mann-Whitney U-Test was used for continuous variables. Results A total of 220 patients were included in the final analysis, 208 (94.5%) with unilateral breast cancer and 12 (5.5%) with bilateral breast cancer. Out of the 208 patients with unilateral breast cancer, 106 (51.0%) patients were aware of their mutation status prior to index surgery while 102 (49%) were not. A significantly (p < 0.05) higher proportion of women underwent contralateral prophylactic mastectomy in the group that was aware of their mutation status prior to index surgery compared to the group that was not (76.4% vs 14.7%). Conclusions Our study demonstrates that knowledge of BRCA mutation status impacts surgical decision making in favor of bilateral mastectomy in patients who are aware of their results prior to index surgery. This finding supports the practice of preoperative genetic testing in patients with newly diagnosed breast cancer. Keywords: BRCA, Mastectomy, Surgical decision, Surgery, Timing, Author(s): Siddhartha Yadav[sup.1,2] , Ashley Reeves[sup.2] , Sarah Campian[sup.2] , Amy Sufka[sup.2] and Dana Zakalik[sup.2,3] Background Breast cancer is a leading cause of mortality and morbidity in women. The American [...]

As GIPS® verifiers, we have seen literally hundreds of GIPS Policies & Procedures. In the course of this time, you might say that we've seen "the good, the bad, and the ugly." In addition, a couple of us have written policies and procedures for multiple asset managers. This experience has resulted in an awareness of what is needed, as well as the best ways to present it. We hope that you find this paper of value as you prepare, develop, and/or maintain such documents for your firm or organization. [ABSTRACT FROM AUTHOR]

The utility and benefit of integrating germ-line genetic testing into the management of newly diagnosed breast cancer is not fully understood. This study evaluates the impact of preoperative genetic testing on surgical decision making in patients with newly diagnosed breast cancer. Women with newly diagnosed breast cancer were classified into preoperative or postoperative genetic testing group, depending on whether they received their genetic testing results prior to or after their first surgery. Demographics, tumor characteristics, surgical treatment, and results of genetic testing were retrospectively collected. A total of 997 patients were evaluated, 531 (53.3%) in the preoperative genetic testing group and 466 (46.7%) in the postoperative group. Majority (87.2%) of BRCA-positive women in the preoperative group underwent bilateral mastectomy as first surgery. Majority (70.6%) of BRCA-positive women in postoperative group underwent partial mastectomy as first surgery prior to receiving their genetic testing result. Nearly half (41.2%) of these women in the postoperative group with partial mastectomy underwent bilateral mastectomy after receiving their BRCA-positive result. Time from diagnosis to first surgery was longer in the preoperative genetic testing group. Younger age, bilateral cancer, BRCA1/2- positive results, and preoperative genetic testing were significant predictors of bilateral mastectomy at first surgery. Preoperative genetic testing impacts initial surgical treatment in BRCA1/2-positive patients and reduces the need for additional surgeries. [ABSTRACT FROM AUTHOR]

This white paper provides background information on the GIPS guidance for asset owner compliance with the Standards, along with a detailed "road map" to help institutions move toward compliance. [ABSTRACT FROM AUTHOR]

Your firm has worked hard to obtain and maintain compliance with the Global Investment Performance Standards (GIPS®), and you have done everything you thought you needed to do to be compliant. Perhaps your firm has even engaged an independent verification firm to provide you and your prospective clients additional confidence in your firm's claim of GIPS compliance. Perhaps your firm has been verified for several years running. So of course you feel confident in your firm's claim. But are you sure your firm is really compliant? Or, do you suffer from GIPS compliance overconfidence? [ABSTRACT FROM AUTHOR]

The 20th Annual GIPS standards Conference was held in Boston, MA on September 22nd and 23rd, 2016 and was attended by more than 400people from 2 7 countries. The conference brings together performance and compliance professionals from around the world to hear subject matter experts discuss best practices and developments in the performance measurement field, with focus on the Global Investment Performance (GIPS) standards. Here are some highlights from the conference. [ABSTRACT FROM AUTHOR]

The rapid identification and management of air leak syndrome in the neonatal intensive care unit is critical to prevent and/or minimize short- and long-term complications. Traditionally, chest X-ray is used to diagnose pneumothorax or pneumomediastinum. However, point-of-care ultrasound is increasingly being used for procedural and diagnostic purposes. Current ultrasound guidelines recommend specific criteria to diagnose pneumothorax in newborns including sharp A-lines, absence of B-lines, lack of shimmering of the pleural line, and the presence of a lung point. Pneumomediastinum may have similar ultrasound characteristics. In this case report, we present two cases of pneumomediastinum in newborns, describe the associated ultrasound findings, and review some of the criteria to differentiate from pneumothorax, including the presence of a still lung point. A high index of suspicion for pneumomediastinum should be maintained when using ultrasound to diagnose air leak given the overlapping sonographic features with pneumothorax. This distinction is of particular importance if evacuation of air by needle thoracentesis or the placement of a chest tube is under consideration., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)