Changes In Performance Scores Research Articles

Which Occupations Did People Engage in during Lockdown? A European Cross-Sectional Descriptive Survey by Generation.

The primary objective was to describe the occupations people engaged in more frequently during lockdown than before the coronavirus disease 2019 pandemic as a function of generation. The secondary objectives were to (i) describe the levels of importance, performance, and satisfaction for these occupations and (ii) identify factors affecting the levels of importance, performance, and satisfaction. We conducted an online, cross-sectional survey of young adults (YAs, aged 18-39), middle-aged adults (MAs, aged 40-59), and older adults (OAs, aged 60 or over). 2534 participants (YAs: 47%, MAs: 33%, and OAs: 20%) cited 4500 occupations. The occupations in which people most engaged were leisure occupations (67%), followed by productive occupations (31%) and then self-care (2%) occupations. YAs gave a median (interquartile range) importance score of 8 (6; 9) to leisure, 8 (7; 10) to productivity, and 8 (7; 10) to self-care. MAs gave a median importance score of 8 (6; 10) to leisure, 8 (7; 10) to productivity, and 8 (7; 10) to self-care. OAs gave a median importance score of 8 (7; 10) to leisure, 8 (7; 9) to productivity, and 9 (8; 10) to self-care. In a pre-/postlockdown comparison, the changes in performance scores among YAs were +5 (3; 6) for leisure, +4 (2; 5) for productivity, and +4 (3; 6) for self-care. Among MAs, these changes were, respectively, +4 (3; 6), +3 (2; 5), and +4.5 (3; 6). Among OAs, these changes were, respectively, +3 (1; 5) for leisure, +3 (2; 5) for productivity, and +2 (0; 4) for self-care. The changes in satisfaction scores among YAs were +3 (0; 5) for leisure, +3 (0; 5) for productivity, and +3 (1; 6) for self-care. Among MAs, these changes were, respectively, +3 (0; 5), +2 (0; 4), and +5 (0; 6). Among OAs, these changes were, respectively, +2 (0; 4), +2 (0; 4), and +2 (0; 4). Lockdown led to stronger engagements in quiet leisure and alternative forms of socialization. Occupational therapists may have a role in helping community-dwelling people to balance and structure their new daily routine.

Ranking Universities of Medical Sciences as Public Health Services Provider Institutions in Iran: A Result-Chain Analysis.

Universities of medical sciences (UMSs) in Iran have geographic catchment areas (normally a province) in which they are responsible for public health services as well as provision of care by public providers. The present study strived to analyze and rank the performance of the medical sciences universities in improving the public health and primary healthcare. Data on 41 indicators on the output (16 indicators), outcome (16 indicators), and impact (9 indicators) levels were extracted from various data sources. Principal component analysis (PCA) was used to calculate the weight for each of the indicators. The score range for each level of performance is between 0 and 1. A score of 1 indicates the highest and a score of 0 indicates the lowest level of performance. Finally, the UMSs were ranked by their scores. The national mean performance scores of the UMSs on the output, outcome, impact, and the composite indicator levels were 0.756, 0.641, 0.561, and 0.563, respectively. The results show that the changes in performance scores at different levels of the results chain are remarkable. The national mean performance of the UMSs of Iran is not satisfactory. However, there is considerable dispersion in their performance. Designing effective interventions in proportion to the conditions of universities on different levels of the results chain, developing a robust information system, conducting continuous monitoring and evaluation of public health are recommended for balanced improvements in public health and primary healthcare indicators in the country.

Functional results and survivorship after medial unicompartmental knee arthroplasty: a single center experience from Saudi Arabia.

BACKGROUND: Isolated involvement of the medial compartment of the knee in degenerative disease is encountered in about 25% of patients with gonarthrosis. We aim to show that in a well-selected group of such patients, medial unicompartmental knee arthroplasty (UKA) is a good option.OBJECTIVES: Review the functional outcomes of patients undergoing UKA and determine the long-term survivorship of the implants and complications of the procedure.DESIGN: Analytical retrospective chart review.SETTING: Academic tertiary care medical center and tertiary care private hospital in the western region of Saudi Arabia.PATIENTS AND METHODS: We selected patients who underwent medial UKAs by the same surgeon between December 1988 and December 2009. The life table approach and the Kaplan-Meier statistical method were used to estimate the survival rate (5–30 years) with revision as the endpoint. Functional outcome scores were determined according to the Knee Society Clinical Rating System.MAIN OUTCOME MEASURES: Change in performance scores for pain, walking, and range of movement. Survivorship of the implants with removal of the implant as the endpoint; post-operative complications.SAMPLE SIZE: 218 implants on 142 patients.RESULTS: The survival rate for UKA was 94.7% at 10 years (95% CI 0.906–0.970), 80.9% at 20 years (95%CI 0.724–0.871), and at 30 years it was 77.8% (95%CI 0.669–0.855) of the total knee arthropathies. The average grand total functional score increased from 61 (maximum 200) at 0 months to above 150 at ≥6 months.CONCLUSION: UKA is a good option for isolated medial compartment gonarthrosis with excellent functional outcome and good survivorship in selected patients.LIMITATION: Single center experience, retrospective. We lost 6.0% of patients during follow-up.CONFLICT OF INTEREST: None.

Seasonal Variation of Physical Performance and Inter-limb Asymmetry in Professional Cricket Athletes.

Bishop, C, Weldon, A, Hughes, J, Brazier, J, Loturco, I, Turner, A, and Read, P. Seasonal variation of physical performance and interlimb asymmetry in professional cricket athletes. J Strength Cond Res 35(4): 941-948, 2021-The aims of this study were to: (a) determine the seasonal variation of physical performance in professional cricket players and (b) determine the seasonal variation of interlimb asymmetries in the same cohort of professional players. Fifteen male professional cricket players (age: 20.60 ± 1.59 years; height: 1.82 ± 0.08 m; and body mass: 78.70 ± 11.23 kg) performed unilateral countermovement jumps (CMJs), unilateral drop jumps, 10 m sprints and 505 change of direction (COD) speed tests at pre (March), mid (June), and end (September) of the 2018 season. Interlimb asymmetry was quantified in the unilateral CMJ (jump height and concentric impulse), unilateral drop jump (jump height and reactive strength index [RSI]), and 505 (total time and COD deficit). Significant changes (p < 0.05) were evident for the following tests: unilateral CMJ (effect size [ES] range = 0.67-1.00), 505 on the right leg (ES = 0.70), 10 m (ES range = -1.39 to 0.70), and COD deficit (ES range = 0.70-0.80), with the largest changes evident for 10-m sprint. No significant differences were evident in drop jump performance throughout the season. For the magnitude of asymmetry, significant changes in jump height asymmetry from the unilateral CMJ were evident from mid to end of season (ES = 0.72). For the direction of asymmetry, levels of agreement ranged from poor to substantial in the unilateral CMJ (kappa = -0.21 to 0.72), fair to substantial in the unilateral drop jump (kappa range = 0.33 to 0.74), and slight to moderate during the 505 test (kappa range = 0.06 to 0.44), with RSI showing noticeably better results than other tests or metrics. These data show that the largest changes in performance scores throughout the season came from the 10-m test, which practitioners may wish to consider implementing if not doing so already. Furthermore, both unilateral jump tests showed their use for asymmetry interpretation, which practitioners may wish to consider implementing in to their test batteries. Specifically, jump height asymmetry during the unilateral CMJ was the only metric to exhibit meaningful changes between time points, whereas RSI was the metric that exhibited more consistent limb dominance characteristics for the direction of asymmetry.

Efficacy and cost-feasibility of the Timely Chest Compression Training (T-CCT): a contextualized cardiopulmonary resuscitation training for personal support workers participating during in-hospital cardiac arrests.

The Timely Chest Compression Training (T-CCT) was created to promote more frequent training in chest compressions for personal support workers. This study aims to assess the efficacy of the T-CCT on the chest compression performance and to examine costs related to this intervention. A prospective single group, before-after study was conducted at a university-affiliated hospital. The T-CCT is adapted for support workers and lasts 20min during working hours. Guided by peer trainers, live feedback devices and mannikins, the T-CCT targets chest compression training. Using an algorithm, chest compression performance scores were gathered before and after the intervention. Of 875 employed support workers, 573 were trained in 5days. Prior to the intervention, the median performance score was 72%. Participants significantly improved after the intervention (p < 0.001) and the median of the differences was 32% (95% CI 28.5-36.0). Support workers in critical care units and those with an active basic life support (BLS) certification performed better at baseline and were less inclined to have large changes in performance scores after the intervention. When compared to basic life support training, the T-CCT is over three times less expensive. The T-CCT was an effective and low-cost initiative that allowed to train a large group of support workers in a short amount of time. Since they are actively involved in resuscitation efforts in Quebec (Canada), it may promote the delivery of high-quality compressions during in-hospital cardiac arrests. Our inquiry can incite and guide other organizations in the implementation of similar interventions.

Sensor-based indicators of performance changes between sessions during robotic surgery training

Training of surgeons is essential for safe and effective use of robotic surgery, yet current assessment tools for learning progression are limited. The objective of this study was to measure changes in trainees’ cognitive and behavioral states as they progressed in a robotic surgeon training curriculum at a medical institution. Seven surgical trainees in urology who had no formal robotic training experience participated in the simulation curriculum. They performed 12 robotic skills exercises with varying levels of difficulty repetitively in separate sessions. EEG (electroencephalogram) activity and eye movements were measured throughout to calculate three metrics: engagement index (indicator of task engagement), pupil diameter (indicator of mental workload) and gaze entropy (indicator of randomness in gaze pattern). Performance scores (completion of task goals) and mental workload ratings (NASA-Task Load Index) were collected after each exercise. Changes in performance scores between training sessions were calculated. Analysis of variance, repeated measures correlation, and machine learning classification were used to diagnose how cognitive and behavioral states associate with performance increases or decreases between sessions. The changes in performance were correlated with changes in engagement index (rrm=−.25,p<.001) and gaze entropy (rrm=−.37,p<.001). Changes in cognitive and behavioral states were able to predict training outcomes with 72.5% accuracy. Findings suggest that cognitive and behavioral metrics correlate with changes in performance between sessions. These measures can complement current feedback tools used by medical educators and learners for skills assessment in robotic surgery training.

Beyond Pay‐for‐Performance: Can Different Feedback and Payment Distribution Methods Affect Team Performance?

Research ObjectiveThis study examines how, under team‐based pay‐for‐performance (P4P), managers incentivize physicians for teamwork through internal feedback and payment distribution methods. We evaluate whether these incentive methods affect team performance, drawing on theory of management and behavioral economics in interpreting why some feedback methods may be superior to others in specific contexts.Study DesignThe present research was conducted against the backdrop of Taiwan’s Family Doctor Plan (FDP), a program resembling US patient‐centered medical home initiatives in terms of team‐based care and value‐based purchasing. FDP created primary care teams, each consisting of 5‐10 physician practices, and rewarded the entire team if it achieved certain quality metrics. We developed an instrument and conducted a national survey of managers of 450 teams (response rate 46.9%). In the survey, managers assessed the extents to which their teams: (a) provided continuous, coordinated and comprehensive (3C) care, and (b) improved patient health as compared with the previous year. We then examined whether changes in performance scores could be materially explained by changes in feedback and payment distribution methods between and within groups. Because the choice of internal incentive methods may be correlated with unobserved, group‐specific factors such as team cohesion, we applied multilevel mixed‐effects linear regressions that accommodate endogenous time‐varying covariates. Furthermore, to tackle manager‐related bias, we included manager characteristics in the model and applied the Hausman‐Taylor approach to further accommodate endogenous time‐constant covariates.Population StudiedAfter deleting missing data, 138 primary care teams were included in the final study sample, forming a balanced panel with 276 group‐year observations.Principal FindingsAfter controlling for manager characteristics and other variables, all models tested showed that within teams, when physicians knew their own performances and anonymous peer performances, the team performed better than when physicians knew only their own performances, only team performances, or their own performances plus performances of named peers. Moreover, the results showed that varying methods for distributing performance pay had little effect on team performances.ConclusionsThe results suggest that nonfinancial incentives embedded in feedback are critical in improving team performance especially when financial incentives fail to motivate physicians. However, caution should be taken when applying principles of social comparisons, where public disclosure of identifiable peer performance may have a demotivating effect on lower‐rated physicians when they work in small teams and do not have full control over delivery of 3C care and patient outcomes. In this context, allowing physicians to compare their own performance with anonymous peer performance may be more effective as it appears to trigger low performers’ sense of competitiveness without making them less respected by team members.Implications for Policy or PracticeAdvocacy of P4P or feedback as quality improvement interventions does not typically seem to explicitly address their applications to team‐based models. This paper identifies a cost‐effective and easy‐to‐implement feedback method that is instrumental to health care managers and policy makers for improving team‐based care.Primary Funding SourceMinistry of Science and Technology.

Interdisciplinary Patient Tracers: Routine, Systematic Safety Surveillance.

Patient tracers and leadership WalkRounds proactively identify quality and safety issues. However, these programs have been inconsistent in application, results, and sustainability. The goal was to identify a more consistent and efficient approach to survey health care facilities. The authors developed a Peer-to-Peer Interdisciplinary Patient Tracer program to assess compliance with National Patient Safety Goals and to proactively identify areas of inpatient, ambulatory, and procedural risk. The program has been operational for more than 5 years, with continued expansion annually. In all, 96% of frontline leadership reported satisfaction; 100% reported that they would recommend the program to others (Kirkpatrick level 1 results). Mean absolute change in performance scores from 2014 to 2018 was 15%. All survey findings triggered the development of an improvement project. This novel integrated program advanced institutional improvement by strengthening internal peer-to-peer surveillance, engaging leadership, and creating an accountability structure for internal improvement efforts.

The transfer of group practice strategy instruction to beginning instrumentalists’ individual practice

This quasi-experimental study investigated the transfer of learning for effective practice strategies from large ensemble to individual rehearsal. Five middle school bands were randomly assigned to one of three conditions. Two treatment conditions had teachers use an iterative, explicit instruction protocol to teach a targeted practice strategy during a sight-reading activity on a novel piece of music over a series of six lessons. The control condition included non-specific sight-reading activities. A sample of students from each band (N=66) participated in a cycle of pre-test/post-test/delay-test observations that involved a ten- minute practice session followed by a performance on a new piece of music similar to those used in the treatment sessions. Student practice sessions were analyzed for frequency of usage of the targeted strategies, and performances were rated for pitch and rhythmic accuracy. A 3x2x3 ANOVA identified a significant effect for strategy used within groups (F(1,63)=122.388, p&lt;.001, η2=.660), but no significant effect or interactions were found between groups. The results of a 3x3 ANOVA identified a moderate-sized main effect for test cycle on performance scores (F(2,63)=2.192, p&lt;.001, η2=.414), leading to a series of repeated measures t-tests that demonstrated significant changes in performance scores from pre- to post-test in both treatment conditions

Sustainable efficiency assessment of private diagnostic laboratories under uncertainty

PurposeAssessing the performance of medical laboratories plays an important role in the quality of health services. However, because of imprecise data, reliable results from laboratory performance cannot be obtained easily. The purpose of this paper is to illustrate the use of interval network data envelopment analysis (INDEA) based on sustainable development indicators under uncertainty.Design/methodology/approachIn this study, each medical diagnostic laboratory is considered as a decision-making unit (DMU) and an INDEA model is used for calculating the efficiency of each medical diagnostic laboratory under imprecise inputs and outputs. The proposed model helps provide managers with effective performance scores for deficiencies and business improvements. The proposed model with realistic efficiency scores can help administrators manage their deficiencies and ultimately improve their business.FindingsThe results indicate that uncertainty can lead to changes in performance scores, rankings and performance classifications. Therefore, the use of DEA models under certainty can be potentially misleading.Originality/valueThe contribution of this study provides useful insights into the use of INDEA as a modeling tool to aid managerial decision-making in assessing efficiency of medical diagnostic laboratories based on sustainable development indicators under uncertainty.

Exploring the relationship between homework task difficulty, student engagement and performance

This article considers the relationship between differential homework task difficulty, student engagement and performance across four Irish post-primary school sites. A total of 236 participants completed all elements of this study. All participants were junior cycle students, aged between 12 and 16 years. The study employed a standardised test–retest approach, with a one week interval between tests. Between testing, participants were randomly subdivided into three cohorts. Each cohort received homework questions of different difficulty levels to complete for one week. The results of this study found that Cohort A, who received the least difficult homework tasks, completed the most non-compulsory questions. Although Cohort A demonstrated higher levels of engagement, no statistically significant difference was found in the change in performance scores of the three cohorts. The results highlight the negative impact of increased task difficulty on student engagement with independent homework tasks. The findings suggest that in order to support student engagement it is important that teachers afford ample opportunity for student success when designing self-directed tasks such as homework.

Relationship Between Linear Running and Change of Direction Performances of Male Soccer Players

It is known that there is a strong correlation between performance and match performance in terms of soccer players. Furthermore, it is expressed that the agility and the linear sprint have different performance skills. Therefore, the purpose of this study was to analyze the relationship between linear sprint and change in performance scores and determine the most appropriate agility test for soccer players. 16 male soccer players (age: 21.93 ± 3.62 years, height: 175.06 ± 3.06 cm, body mass: 69.51 ± 7.40 kg, body mass index: 22.67 ± 2.16 kg / m 2, body fat ratio: 7.52 ± 2.64% linear sprint and agility tests. All participants completed a test battery involving linear sprinting (10, 20, 30 m), agility tests (T test, 505, Pro-agility, illinois). The 10, 20, and 30 m sprint performance were positively correlated with the illinois agility test (p <0.05). Furthermore, the 20-m sprint performance was positively correlated (r = .571, p = .042) with performance on pro-agility test. (R = .329, p = .272; r = .370, p = .214; r = .338, p = .259 respectively) with performance on T test but this correlation levels were not significance. Given these meaningless relationships, it may state that the most appropriate agility tests are T test for soccer players.

The Applicability of Standard Error of Measurement and Minimal Detectable Change to Motor Learning Research-A Behavioral Study.

Motor learning studies face the challenge of differentiating between real changes in performance and random measurement error. While the traditional p-value-based analyses of difference (e.g., t-tests, ANOVAs) provide information on the statistical significance of a reported change in performance scores, they do not inform as to the likely cause or origin of that change, that is, the contribution of both real modifications in performance and random measurement error to the reported change. One way of differentiating between real change and random measurement error is through the utilization of the statistics of standard error of measurement (SEM) and minimal detectable change (MDC). SEM is estimated from the standard deviation of a sample of scores at baseline and a test–retest reliability index of the measurement instrument or test employed. MDC, in turn, is estimated from SEM and a degree of confidence, usually 95%. The MDC value might be regarded as the minimum amount of change that needs to be observed for it to be considered a real change, or a change to which the contribution of real modifications in performance is likely to be greater than that of random measurement error. A computer-based motor task was designed to illustrate the applicability of SEM and MDC to motor learning research. Two studies were conducted with healthy participants. Study 1 assessed the test–retest reliability of the task and Study 2 consisted in a typical motor learning study, where participants practiced the task for five consecutive days. In Study 2, the data were analyzed with a traditional p-value-based analysis of difference (ANOVA) and also with SEM and MDC. The findings showed good test–retest reliability for the task and that the p-value-based analysis alone identified statistically significant improvements in performance over time even when the observed changes could in fact have been smaller than the MDC and thereby caused mostly by random measurement error, as opposed to by learning. We suggest therefore that motor learning studies could complement their p-value-based analyses of difference with statistics such as SEM and MDC in order to inform as to the likely cause or origin of any reported changes in performance.

Dental Fluorosis Treatment Can Improve the Individuals’ OHRQoL? Results from a Randomized Clinical Trial

This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Personalized Video Feedback and Repeated Task Practice Improve Laparoscopic Knot-Tying Skills: Two Controlled Trials.

Compare the effect of personalized feedback (PF) vs. task demonstration (TD), both delivered via video, on laparoscopic knot-tying skills and perceived workload; and evaluate the effect of repeated practice. General surgery interns and research fellows completed four repetitions of a simulated laparoscopic knot-tying task at one-month intervals. Midway between repetitions, participants received via e-mail either a TD video (demonstration by an expert) or a PF video (video of their own performance with voiceover from a blinded senior surgeon). Each participant received at least one video per format, with sequence randomly assigned. Outcomes included performance scores and NASA Task Load Index (NASA-TLX) scores. To evaluate the effectiveness of repeated practice, scores from these trainees on a separate delayed retention test were compared against historical controls who did not have scheduled repetitions. Twenty-one trainees completed the randomized study. Mean change in performance scores was significantly greater for those receiving PF (difference = 23.1 of 150 [95% confidence interval (CI): 0, 46.2], P = .05). Perceived workload was also significantly reduced (difference = -3.0 of 20 [95% CI: -5.8, -0.3], P = .04). Compared with historical controls (N = 93), the 21 with scheduled repeated practice had higher scores on the laparoscopic knot-tying assessment two weeks after the final repetition (difference = 1.5 of 10 [95% CI: 0.2, 2.8], P = .02). Personalized video feedback improves trainees' procedural performance and perceived workload compared with a task demonstration video. Brief monthly practice sessions support skill acquisition and retention.

Quantitative measures with WREX usage.

This paper presents the results of two surveys conducted with users of a functional upper extremity orthosis called the Wilmington Robotic EXoskeleton (WREX). The WREX is a passive anti-gravity arm orthosis that allows people with neuromuscular disabilities to move their arms in three dimensions. An online user survey with 55 patients was conducted to determine the benefits of the WREX. The survey asked 10 questions related to upper extremity function with and without the WREX as well as subjective impressions of the device. A second survey used a phone interview based on the Canadian Occupational Performance Measure (COPM). Parents rated their child's performance and satisfaction while partaking in important activities both with and without the exoskeleton device. Scores were assessed for change between the two conditions. Twenty-five families responded to this survey. Twenty-four out of 25 subjects reported greater levels of performance and satisfaction when they were wearing the WREX. The mean change in performance score was 3.61 points, and the mean change in satisfaction score was 4.44 points. Results show a statistically significant improvement in arm function for everyday tasks with the WREX.

Performance-based Outcomes among American Professional Athletes Following Microfracture of the Knee: A Cross-sport Analysis

Objectives:Damage to the articular cartilage of the knee is a common and potentially career-threatening injury among professional athletes. Microfracture is a technique frequently used to treat chondral defects, but the potential benefits of this procedure in the elite athlete population remain unclear. This study sought to assess outcomes after microfracture of the knee among American professional athletes in different sports.Methods:Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL) athletes who underwent primary unilateral microfracture of the knee while on the active roster of a professional team and had a definitive date of surgery were identified through a well-established algorithmic approach based on public sources. Demographic information, as well as both pre- and post-surgery regular season player statistics, was compiled for each player. Successful return-to-play (RTP) was defined as returning for at least one professional regular season game after surgery. RTP time was defined as the number of days elapsed between date of surgery and date of first professional game back. Performance scores were calculated for each sport using previously established scoring systems. Players across different sports were compared by adjusting for season and career length differences between sports and by calculating percent change in performance.Results:A total of 131 professional athletes treated with microfracture from 1991 to 2015 met the inclusion criteria. Of these athletes, 103 (78.6%) successfully returned to play (Figure 1). Average time to RTP was 293±146 days. A player’s total career games started-to-games played ratio (GS:GP) before surgery was a significant positive independent predictor of RTP (p=0.039). NBA athletes who returned showed a significant reduction in adjusted games played during their first season post-surgery (61) compared to baseline (100) (p<0.0001). NBA and MLB athletes demonstrated significantly decreased performance one season after surgery (p=0.029 and p=0.002, respectively), and NBA athletes also demonstrated significantly decreased performance during post-operative seasons 2-3 (p=0.024) (Figure 2). BMI, age, career experience (years), games played during index season and total pre-operative career, and GS:GP during index season and total pre-operative career were not found to be predictors of RTP time, career length after surgery (years and games played), or change in performance score.Conclusion:Microfracture of the knee is a serious procedure that has the potential to negatively impact a professional athlete’s career. NFL athletes demonstrated the lowest probability of returning after surgery (71.1%), but for those who returned, performance was recoverable to baseline. NBA athletes had a higher-than-average probability of returning to play (82.4%), but those who returned showed a significant decline in performance one season after surgery that was sustained 2-3 seasons post-surgery, and a reduction in games played one season after surgery that was recoverable to baseline by seasons 2-3 post-surgery. Given the small sample size for NHL, microfracture of the knee may be uncommon in these athletes and definitive conclusions cannot be made. The findings of this study demonstrate that outcomes following microfracture vary significantly depending on sport, which is likely due in part to differences in sport-specific tasks. Figure 1:Return-to-play rates following primary unilateral microfracture of the knee for American professional athletes. *MLB athletes returned to play at a significantly higher rate than athletes of all other sports (p=0.013). **NFL athletes returned to play at a significantly lower rate than athletes of all other sports (p=0.017). Figure 2:Performance-based outcomes among American professional athletes following primary unilateral knee microfracture surgery. “Denotes significant difference (p<0.135) compared with pre-surgery season (baseline) for each athlete in cohort. NHL excluded due to small sample size.

Improving Pediatric Rapid Response Team Performance Through Crew Resource Management Training of Team Leaders.

Rapid response teams (RRTs) improve the detection of and response to deteriorating patients. Professional hierarchies and the multidisciplinary nature of RRTs hinder team performance. This study assessed whether an intervention involving crew resource management training of team leaders could improve team performance. In situ observations of RRT activations were performed pre- and post-training intervention. Team performance and dynamics were measured by observed adherence to an ideal task list and by the Team Emergency Assessment Measure tool, respectively. Multiple quartile (median) and logistic regression models were developed to evaluate change in performance scores or completion of specific tasks. Team leader and team introductions (40% to 90%, P = .004; 7% to 45%, P = .03), floor team presentations in Situation Background Assessment Recommendation format (20% to 65%, P = .01), and confirmation of the plan (7% to 70%, P = .002) improved after training in patients transferred to the ICU (n = 35). The Team Emergency Assessment Measure metric was improved in all 4 categories: leadership (2.5 to 3.5, P < .001), teamwork (2.7 to 3.7, P < .001), task management (2.9 to 3.8, P < .001), and global scores (6.0 to 9.0, P < .001) for teams caring for patients who required transfer to the ICU. Targeted crew resource management training of the team leader resulted in improved team performance and dynamics for patients requiring transfer to the ICU. The intervention demonstrated that training the team leader improved behavior in RRT members who were not trained.

Acute Exercise and Motor Memory Consolidation: The Role of Exercise Intensity.

A single bout of high intensity aerobic exercise (~90% VO2peak) was previously demonstrated to amplify off-line gains in skill level during the consolidation phase of procedural memory. High intensity exercise is not always a viable option for many patient groups or in a rehabilitation setting where low to moderate intensities may be more suitable. The aim of this study was to investigate the role of intensity in mediating the effects of acute cardiovascular exercise on motor skill learning. We investigated the effects of different exercise intensities on the retention (performance score) of a visuomotor accuracy tracking task. Thirty six healthy male subjects were randomly assigned to one of three groups that performed either a single bout of aerobic exercise at 20 min post motor skill learning at 45% (EX45), 90% (EX90) maximal power output (Wmax) or rested (CON). Randomization was stratified to ensure that the groups were matched for relative peak oxygen consumption (ml O2/min/kg) and baseline score in the tracking task. Retention tests were carried out at 1 (R1) and 7 days (R7) post motor skill learning. At R1, changes in performance scores were greater for EX90 compared to CON (p<0.001) and EX45 (p = 0.011). The EX45 and EX90 groups demonstrated a greater change in performance score at R7 compared to the CON group (p = 0.003 and p<0.001, respectively). The change in performance score for EX90 at R7 was also greater than EX45 (p = 0.049). We suggest that exercise intensity plays an important role in modulating the effects that a single bout of cardiovascular exercise has on the consolidation phase following motor skill learning. There appears to be a dose-response relationship in favour of higher intensity exercise in order to augment off-line effects and strengthen procedural memory.

Acute Exercise and Motor Memory Consolidation: The Role of Exercise Timing.

High intensity aerobic exercise amplifies offline gains in procedural memory acquired during motor practice. This effect seems to be evident when exercise is placed immediately after acquisition, during the first stages of memory consolidation, but the importance of temporal proximity of the exercise bout used to stimulate improvements in procedural memory is unknown. The effects of three different temporal placements of high intensity exercise were investigated following visuomotor skill acquisition on the retention of motor memory in 48 young (24.0 ± 2.5 yrs), healthy male subjects randomly assigned to one of four groups either performing a high intensity (90% Maximal Power Output) exercise bout at 20 min (EX90), 1 h (EX90+1), 2 h (EX90+2) after acquisition or rested (CON). Retention tests were performed at 1 d (R1) and 7 d (R7). At R1 changes in performance scores after acquisition were greater for EX90 than CON (p < 0.001) and EX90+2 (p = 0.001). At R7 changes in performance scores for EX90, EX90+1, and EX90+2 were higher than CON (p < 0.001, p = 0.008, and p = 0.008, resp.). Changes for EX90 at R7 were greater than EX90+2 (p = 0.049). Exercise-induced improvements in procedural memory diminish as the temporal proximity of exercise from acquisition is increased. Timing of exercise following motor practice is important for motor memory consolidation.