Relationship between heat loss indexes and physiological indicators of turnout-related heat strain in mild and hot environments.

A validated physiological manikin method was used to qualify environmentally dependent correlations between firefighter turnout total heat loss (THL) and intrinsic evaporative resistance (Ref) heat strain indexes and core temperature rise in stressful work conducted in mild (25 °C, 65% relative humidity [RH]) and hot (35 °C, 40% RH; 40 °C, 28% RH) conditions. Five turnout suit constructions representing a wide range of breathability were selected. The observed correlations between measured material heat loss and core temperature showed that the THL heat strain index accurately forecast thermal burden in mild environments (<25 °C); while the Ref index provided accurate prediction in hot environments (>35 °C). They showed that the THL index did not predict heat strain in hot work environments. The findings of this study support incorporating both the Ref and THL heat strain indexes as dual metrics for characterizing the heat strain performance of turnout clothing fabrics.

Chip-scale blue light phased array.

Compact beam steering in the visible spectral range is required for a wide range of emerging applications, such as augmented and virtual reality displays, optical traps for quantum information processing, biological sensing, and stimulation. Optical phased arrays (OPAs) can shape and steer light to enable these applications with no moving parts on a compact chip. However, OPA demonstrations have been mainly limited to the near-infrared spectral range due to the fabrication and material challenges imposed by the shorter wavelengths. Here, we demonstrate the first chip-scale phased array operating at blue wavelengths (488 nm) using a high-confinement silicon nitride platform. We use a sparse aperiodic emitter layout to mitigate fabrication constraints at this short wavelength and achieve wide-angle beam steering over a 50° field of view with a full width at half-maximum beam size of 0.17°. Large-scale integration of this platform paves the way for fully reconfigurable chip-scale three-dimensional volumetric light projection across the entire visible range.

Effectiveness of Using a Thermal Sweating Manikin Coupled with a Thermoregulation Model to Predict Human Physiological Response to Different Firefighter Turnout Suits.

Manikins have been used for almost 100 years to help understand the properties of clothing materials and garments. Data from sweating manikins also have been used within thermoregulation computer models to estimate the physiological responses of humans. In recent years, the development of the ManikinPC system has incorporated a thermoregulation model into a thermal sweating manikin system to provide a real-time analysis of predicted physiological response. This paper describes an experimental study that demonstrates the utility of this manikin-model system to predict the effects of three composite materials used in firefighter suits on human physiological response. This study addresses this question: Can ManikinPC emulate the physiological response of a controlled wear trial using three different sets of firefighter turnout gear in one environmental condition? The average core temperature, skin temperature, and sweat loss from human subjects are compared with the predicted values generated from the manikin coupled with the model. Results indicate similar trends and ranking of the three suits. The data revealed slightly higher predictive responses from the manikin-model system compared with the collected human data.

Syntheses and Biological Evaluations of Highly Functionalized Hydroxamate Containing and N-Methylthio Monobactams as Anti-Tuberculosis and ß-Lactamase Inhibitory Agents.

Both the resurgence of tuberculosis (TB) and antibiotic resistance continue to threaten modern healthcare and new means of combating pathogenic bacterial infections are needed. The syntheses of monobactams possessing hydroxamate and N-methylthio functionality are described, as well as their anti-TB, in vitro ß-lactamase inhibitory, and general antimicrobial evaluations. A number of compounds exhibited significant anti-TB and ß-lactamase inhibitory activity, with MIC values in the range of 25 to < 0.19 µM against Mycobacteria tuberculosis (M.tb), and Ki values in the range of 25-0.03 µM against purified NDM-1 and VIM-1 lystate metallo ß-lactamases. This work suggests that these scaffolds may serve as promising leads in developing new antibiotics and/or ß-lactamase inhibitors.

New and concise syntheses of the bicyclic oxamazin core using an intramolecular nitroso Diels-Alder reaction and ring-closing olefin metathesis.

Herein two new and concise synthetic approaches for making an unsaturated bicyclic oxamazin core are reported. The first involves the use of an intramolecular Diels-Alder reaction to form both of the fused rings in one step. The second approach incorporates ring-closing olefin metathesis in the final step to form the second fused ring of the core. The scope of the second approach was also expanded further to afford larger ringed bicyclic systems.

Effects of a supported speed treadmill training exercise program on impairment and function for children with cerebral palsy.

AIM: To compare the effects of a supported speed treadmill training exercise program (SSTTEP) with exercise on spasticity, strength, motor control, gait spatiotemporal parameters, gross motor skills, and physical function. METHOD: Twenty-six children (14 males, 12 females; mean age 9y 6mo, SD 2y 2mo) with spastic cerebral palsy (CP; diplegia, n=12; triplegia, n=2; quadriplegia n=12; Gross Motor Function Classification System levels II-IV) were randomly assigned to the SSTTEP or exercise (strengthening) group. After a twice daily, 2-week induction, children continued the intervention at home 5 days a week for 10 weeks. Data collected at baseline, after 12-weeks' intervention, and 4 weeks after the intervention stopped included spasticity, motor control, and strength; gait spatiotemporal parameters; Gross Motor Function Measure (GMFM); and Pediatric Outcomes Data Collection Instrument (PODCI). RESULTS: Gait speed, cadence, and PODCI global scores improved, with no difference between groups. No significant changes were seen in spasticity, strength, motor control, GMFM scores, or PODCI transfers and mobility. Post-hoc testing showed that gains in gait speed and PODCI global scores were maintained in the SSTTEP group after withdrawal of the intervention. INTERPRETATION: Although our hypothesis that the SSTTEP group would have better outcomes was not supported, results are encouraging as children in both groups showed changes in function and gait. Only the SSTTEP group maintained gains after withdrawal of intervention.

Precision and content range of a parent-reported item bank assessing lower extremity and mobility skills in children with cerebral palsy.

AIM: The aim of this study was to determine the psychometric properties, content range, and measurement precision of a lower extremity physical functioning and mobility skills item bank (LE85) in children with cerebral palsy (CP). METHOD: Lower extremity functioning and mobility skill items were administered to 308 parents of children (169 males, 139 females; mean age 10y 8mo, SD 4y) with spastic CP (145 diplegia, 73 hemiplegia, 89 quadriplegia; [for one person type of CP was unknown]) classified using the Gross Motor Function Classification System (75 level I, 91 level II, 79 level III, 37 level IV, 26 level V). Additional legacy measures were administered to assess concurrent validity. Psychometric characteristics, differential item functioning, content range, and score precision were examined. RESULTS: The LE85 had acceptable psychometric properties. Content range matched the ability range of the sample population and exceeded legacy measures with minimal differential item functioning. The LE85 had good correlation with the Paediatric Outcomes Data Collection Instrument, Functional Independence Measure for Children, Gillette Functional Assessment Questionnaire, and Paediatric Quality of Life Inventory-CP module (range r=0.63-0.86). Precision of the LE85 and 10-item simulated computer adaptive test scores outperformed legacy measures. INTERPRETATION: The LE85 appears to be suitable to administer as a computer adaptive test to measure lower extremity physical functioning and mobility in children with CP.

Validity and reliability of physical functioning computer-adaptive tests for children with cerebral palsy.

BACKGROUND: The purpose of this study was to assess the concurrent validity and reliability of scores from 4 new parent-report computer-adapted testing (CAT) programs developed to measure the physical functioning of children with cerebral palsy (CP). The Shriners Hospitals for Children CP-CAT battery includes upper-extremity skills, lower-extremity and mobility skills, activity, and global physical health. METHODS: This was a prospective study of 91 children with CP who were tested cross-sectionally and 27 children with CP who were administered the CP-CAT programs twice within approximately a 1-month interval. We examined the concurrent validity of the 4 Shriners Hospitals for Children CP-CAT programs by Pearson correlations with comparative parent-report instruments. The scale reliability was tested by developing estimates of marginal reliability; test-retest reliability was assessed by intraclass correlations. RESULTS: Pearson correlations were moderate to high in matching content domains of the CATs with the comparison measures. Marginal reliability estimates were always better for the CAT program than the comparative instruments. Average test-retest reliability using Intraclass correlations across the 4 CATs was ICC3,1=0.91 with a range of 0.88 to 0.94. CONCLUSIONS: We found the CAT scores to be related to expected domains from external instruments, to have good scale reliability, and to have stable scores as determined by test-retest reliability. These results support the use of parent-report CATs in the assessment of physical functioning in children with CP.

Development of a parent-report computer-adaptive test to assess physical functioning in children with cerebral palsy I: lower-extremity and mobility skills.

The objective of this project was to develop computer-adaptive tests (CATs) using parent reports of physical function in children and adolescents with cerebral palsy (CP). The specific aims of this study were to (1) examine the psychometric properties of an item bank of lower-extremity and mobility skills for children with CP; (2) evaluate a CAT using this item bank; (3) examine the concurrent validity of the CAT with the Pediatric Outcomes Data Collection Instrument (PODCI) and the Functional Assessment Questionnaire (FAQ); and (4) establish the discriminant validity of simulated CATs with Gross Motor Function Classification System (GMFCS) levels and CP type (diplegia, hemiplegia, or quadriplegia). Parents (n=190) of children and adolescents with spastic diplegic (48%), hemiplegic (22%), or quadriplegic (30%) CP consisting of 108 males and 82 females with a mean age of 10 years 7 months (SD 4y 1mo, range 2-21y) and in GMFCS levels I to V participated in item pool calibration and completed the PODCI and FAQ. Confirmatory factor analyses supported a unidimensional model for the 45 basic lower-extremity and mobility items. Simulated CATs of 5, 10, and 15 items demonstrated excellent accuracy (intraclass correlation coefficients [ICCs] >0.91) with the full item bank and had high correlations with PODCI transfers and mobility (ICC = 0.86) and FAQ scores (ICC = 0.77). All CATs discriminated among GMFCS levels and CP type. The lower-extremity and mobility skills item bank and simulated CATs demonstrated excellent performance over a wide span of ages and severity levels.

Evaluation of an item bank for a computerized adaptive test of activity in children with cerebral palsy.

BACKGROUND: Contemporary clinical assessments of activity are needed across the age span for children with cerebral palsy (CP). Computerized adaptive testing (CAT) has the potential to efficiently administer items for children across wide age spans and functional levels. OBJECTIVE: The objective of this study was to examine the psychometric properties of a new item bank and simulated computerized adaptive test to assess activity level abilities in children with CP. DESIGN: This was a cross-sectional item calibration study. METHODS: The convenience sample consisted of 308 children and youth with CP, aged 2 to 20 years (X=10.7, SD=4.0), recruited from 4 pediatric hospitals. We collected parent-report data on an initial set of 45 activity items. Using an Item Response Theory (IRT) approach, we compared estimated scores from the activity item bank with concurrent instruments, examined discriminate validity, and developed computer simulations of a CAT algorithm with multiple stop rules to evaluate scale coverage, score agreement with CAT algorithms, and discriminant and concurrent validity. RESULTS: Confirmatory factor analysis supported scale unidimensionality, local item dependence, and invariance. Scores from the computer simulations of the prototype CATs with varying stop rules were consistent with scores from the full item bank (r=.93-.98). The activity summary scores discriminated across levels of upper-extremity and gross motor severity and were correlated with the Pediatric OUTCOMES: Data Collection Instrument (PODCI) physical function and sports subscale (r=.86), the Functional Independence Measure for Children (Wee-FIM) (r=.79), and the Pediatric Quality of Life Inventory-Cerebral Palsy version (r=.74). LIMITATIONS: The sample size was small for such IRT item banks and CAT development studies. Another limitation was oversampling of children with CP at higher functioning levels. CONCLUSIONS: The new activity item bank appears to have promise for use in a CAT application for the assessment of activity abilities in children with CP across a wide age range and different levels of motor severity.

Development of a parent-report computer-adaptive test to assess physical functioning in children with cerebral palsy II: upper-extremity skills.

The specific aims of this study were to (1) examine the psychometric properties (unidimensionality, differential item functioning, scale coverage) of an item bank of upper-extremity skills for children and adolescents with cerebral palsy (CP); (2) evaluate a simulated computer-adaptive test (CAT) using this item bank; (3) examine the concurrent validity of the CAT with the Pediatric Outcomes Data Collection Instrument (PODCI) upper-extremity core scale; and (4) determine the discriminant validity of the simulated CAT with Manual Ability Classification System (MACS) levels and CP type (i.e. diplegia, hemiplegia, or quadriplegia). Parents (n=180) of children and adolescents with CP (spastic diplegia 49%, hemiplegia 22%, or quadriplegia 28%) consisting of 102 males and 78 females with a mean age of 10 years 6 months (SD 4y 1mo, range 2-21y), and MACS levels I through V participated in calibration of an item pool and completed the PODCI. Confirmatory factor analyses supported a unidimensional model using 49 of the 53 upper-extremity items. Simulated CATs of 5, 10, and 15 items demonstrated excellent accuracy (intraclass correlation coefficient [ICCs] >0.93) with the full item bank, had high correlations with the PODCI upper-extremity core scale score (ICC 0.79), and discriminated among MACS levels. The simulated CATs demonstrated excellent overall content coverage over a wide age span and severity of upper-extremity involvement. The future development and refinement of CATs for parent report of physical function in children and adolescents with CP is supported by our work.

Measuring global physical health in children with cerebral palsy: illustration of a multidimensional bi-factor model and computerized adaptive testing.

PURPOSE: The purposes of this study were to apply a bi-factor model for the determination of test dimensionality and a multidimensional CAT using computer simulations of real data for the assessment of a new global physical health measure for children with cerebral palsy (CP). METHODS: Parent respondents of 306 children with cerebral palsy were recruited from four pediatric rehabilitation hospitals and outpatient clinics. We compared confirmatory factor analysis results across four models: (1) one-factor unidimensional; (2) two-factor multidimensional (MIRT); (3) bi-factor MIRT with fixed slopes; and (4) bi-factor MIRT with varied slopes. We tested whether the general and content (fatigue and pain) person score estimates could discriminate across severity and types of CP, and whether score estimates from a simulated CAT were similar to estimates based on the total item bank, and whether they correlated as expected with external measures. RESULTS: Confirmatory factor analysis suggested separate pain and fatigue sub-factors; all 37 items were retained in the analyses. From the bi-factor MIRT model with fixed slopes, the full item bank scores discriminated across levels of severity and types of CP, and compared favorably to external instruments. CAT scores based on 10- and 15-item versions accurately captured the global physical health scores. CONCLUSIONS: The bi-factor MIRT CAT application, especially the 10- and 15-item versions, yielded accurate global physical health scores that discriminated across known severity groups and types of CP, and correlated as expected with concurrent measures. The CATs have potential for collecting complex data on the physical health of children with CP in an efficient manner.

Using cognitive interviewing for test items to assess physical function in children with cerebral palsy.

PURPOSE: The purpose of this study was to assess the content, format, and comprehension of test items and responses developed for use in a computer adaptive test (CAT) of physical function for children with cerebral palsy (CP). METHODS: After training in cognitive interviewing techniques, investigators defined item intent and developed questions for each item. Parents of children with CP (n = 27) participated in interviews probing item meaning, item wording, and response choice adequacy and appropriateness. RESULTS: Qualitative analysis identified 3 themes: item clarity; relevance, context, and attribution; and problems with wording or tone. Parents reported the importance of delineating task components, assistance amount, and environmental context. CONCLUSION: Cognitive interviewing provided valuable information about the validity of new items and insight to improve relevance and context. We believe that the development of CATs in pediatric rehabilitation may ultimately reduce the impact of the issues identified.

Physical function for children and youth with cerebral palsy: Item bank development for computer adaptive testing.

The purposes of this paper are to: 1) present a conceptual framework that supports development of a computer adaptive test (CAT) outcome measure of physical functioning for children with cerebral palsy; 2) illustrate the development and refinement of an item bank for use in the CAT; and 3) describe the intended application of these newly developed items in a CAT platform. Improvement in physical functioning is one of the most important developmental and rehabilitative outcomes for children with cerebral palsy (CP). Computer adaptive testing technology provides means to improve outcome measures. We adopted a conceptual framework appropriate to support a CAT of physical functioning consisting of 4 sub-domains: lower extremity skills, upper extremity skills, physical activity, and global physical health. Review of existing tests and measures of physical function, expert clinician review, and cognitive testing were used to identify, develop and refine sets of items (item banks) that reflect the breadth of each sub-domain. These item banks will be used to develop contemporary parent-report instruments by application of Item Response Theory (IRT) analyses, leading to a CAT outcome measure. Such CAT approaches can efficiently assess broad areas of physical functioning across a wide age-range and levels of severity of children with CP.