Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update.

Purpose: This updated report on image guided radiation therapy (IGRT) is part of a series of consensus-based white papers previously published by the American Society for Radiation Oncology addressing patient safety. Since the first white papers were published, IGRT technology and procedures have progressed significantly such that these procedures are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites.

Factors Influencing Older Persons' Transitions to Facility-Based Care Settings: A Scoping Review.

Background And Objectives: Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living.

Research Design And Methods: Through a scoping review of 7 databases, we considered all academic literature examining factors influencing transitions from home living to FBC.

Development and deployment of cyclical focal muscle vibration system to improve walking performance in multiple sclerosis.

Vibration, a potent mechanical stimulus for activating muscle spindle primary afferents, may improve gait performance in persons with multiple sclerosis (MS), but has yet to be developed and deployed for multiple leg muscles with application during walking training. This study explored the development of a cyclic focal muscle vibration (FMV) system, and the deployment feasibility to correct MS walking swing phase deficits in order to determine whether this intervention warrants comprehensive study. The system was deployed during twelve, two-hour sessions of walking with cyclic FMV over six weeks.

The Association of Service Use and Other Client Factors with the Time to Transition from Home Care to Facility-Based Care.

Objectives: People are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons' (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities.

Design: Retrospective cohort study.

An introduction to new robust linear and monotonic correlation coefficients.

Background: The most common measure of association between two continuous variables is the Pearson correlation (Maronna et al. in Safari an OMC. Robust statistics, 2019.

Effect of Context-Dependent Modulation of Trunk Muscle Activity on Manual Wheelchair Propulsion.

Objective: The aims of the study were to reliably determine the two main phases of manual wheelchair propulsion via a simple wearable sensor and to evaluate the effects of modulated trunk and hip stimulation on manual wheelchair propulsion during the challenging tasks of ramp assent and level sprint.

Design: An offline tool was created to identify common features between wrist acceleration signals for all subjects who corresponded to the transitions between the contact and recovery phases of manual wheelchair propulsion. For one individual, the acceleration rules and thresholds were implemented for real-time phase-change event detection and modulation of stimulation.

A Comprehensive Analysis of the Effect of Histological Subtypes on the Survival Probability of Kidney Carcinoma Patients: A Hypertabastic Survival Analysis.

The purpose of this study is two-fold. First, to find out whether the histological subtypes can serve as an independent prognostic factor for kidney carcinoma; and second, whether it's role can be maintained when we control for confounders. Using National Cancer Institute data from 1975-2016, we have modeled the impact of histological subtypes on the survival probability of kidney carcinoma patients.

Does dispatcher-assisted bystander CPR improve outcomes from adult out-of-hospital cardiac arrest?

This short review addresses the evidence behind dispatcher-assisted CPR (DA-CPR) and whether it contributes to overall survival of out-of-hospital cardiac arrest (OHCA). Six papers directly addressed the review question and were selected for appraisal, including one systematic review. The outcomes of these studies demonstrate variable results from the implementation of DA-CPR strategies.

Implementing parallel spreadsheet models for health policy decisions: The impact of unintentional errors on model projections.

Background: Spreadsheet software is increasingly used to implement systems science models informing health policy decisions, both in academia and in practice where technical capacity may be limited. However, spreadsheet models are prone to unintentional errors that may not always be identified using standard error-checking techniques. Our objective was to illustrate, through a methodologic case study analysis, the impact of unintentional errors on model projections by implementing parallel model versions.

Long-Term Performance and User Satisfaction With Implanted Neuroprostheses for Upright Mobility After Paraplegia: 2- to 14-Year Follow-Up.

Objective: To quantify the long-term (>2y) effects of lower extremity (LE) neuroprostheses (NPs) for standing, transfers, stepping, and seated stability after spinal cord injury.

Design: Single-subject design case series with participants acting as their own concurrent controls, including retrospective data review.

Setting: Hospital-based clinical biomechanics laboratory with experienced (>20y in the field) research biomedical engineers, a physical therapist, and medical monitoring review.

Impact of an implanted neuroprosthesis on community ambulation in incomplete SCI.

Objective: Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI).

Design: Single subject research design with repeated measures.

Setting: Hospital-based biomechanics laboratory and user assessment of community use.

Ultrasound-Guided Diagnosis of Femoral Osteomyelitis and Abscess.

Skin and soft tissue infections are common disease presentations to the pediatric emergency department, and rapid and accurate identification of potentially serious skin and soft tissue infections is critical. In cases of atraumatic musculoskeletal pain with systemic complaints, a bacterial etiology must be ruled out. Point-of-care ultrasonography is increasingly common in the pediatric emergency department and assists in rapid and accurate identification of a variety of disease processes.

Surface peroneal nerve stimulation in lower limb hemiparesis: effect on quantitative gait parameters.

Objective: The objective of this study was to evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation vs. usual care via quantitative gait analysis.

Design: This study is a randomized controlled clinical trial.

Pulmonary embolism in the pediatric emergency department: a case demonstrating the application of point-of-care cardiac ultrasound in a pediatric patient with pulmonary embolism.

Although pulmonary embolism in children is rare, it is important for the pediatric emergency medicine provider to be aware of its presentation and emergent management. We present a case of bilateral pulmonary embolisms in an adolescent patient to illustrate the benefits from the timely diagnosis of right ventricular dysfunction by point-of-care echocardiography performed by emergency medicine physicians. Ultrasonographic techniques and the emergent management of pulmonary embolism are reviewed.

A preliminary comparison of myoelectric and cyclic control of an implanted neuroprosthesis to modulate gait speed in incomplete SCI.

Objective: Explore whether electromyography (EMG) control of electrical stimulation for walking after incomplete spinal cord injury (SCI) can affect ability to modulate speed and alter gait spatial-temporal parameters compared to cyclic repetition of pre-programmed stimulation.

Design: Single case study with subject acting as own concurrent control. Setting Hospital-based biomechanics laboratory.

Patient perspectives on information needs for amputation secondary to vascular surgery: what, when, why, and how much?

In patients undergoing an amputation secondary to vascular disease, little is known about the timing, mode of delivery, or amount of information needed. The purpose of this study was to explore the perspectives of patients who have undergone a major lower limb amputation as a result of vascular disease, regarding the information healthcare professionals should provide to them during their acute hospital stay. A qualitative study using descriptive methodology was used.

Ciguatera poisoning in the Cook Islands.

This case report presents two British medical students who contracted ciguatera poisoning while on elective in the Cook Islands. Thirty-six hours after consuming two reef fish they developed paraesthesia of the mouth, hands and feet, myalgia, pruritis and cold allodynia. Neurological examination was normal.

Effect of body mass index on hemiparetic gait.

Objective: To evaluate the relationship between body mass index (BMI) and spatiotemporal, kinematic, and kinetic gait parameters in chronic hemiparetic stroke survivors.

Design: Secondary analysis of data collected in a randomized controlled trial comparing two 12-week ambulation training treatments.

Setting: Academic medical center.

Factors influencing breast cancer screening in low-income African Americans in Tennessee.

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 334) were selected from the Meharry CNP community survey database.

Contralaterally controlled neuromuscular electrical stimulation for recovery of ankle dorsiflexion: a pilot randomized controlled trial in patients with chronic post-stroke hemiplegia.

Objective: The aim of this study was to compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) vs. cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics.

Design: Twenty-six survivors of stroke with chronic (≥6 mos) foot drop during ambulation were randomly assigned to 6 wks of CCNMES or cyclic NMES.