The IndieTrainer system: a small-scale trial exploring a new approach to support powered mobility skill acquisition in children.

The IndieTrainer system, consisting of a mobility device and video-based gamified training modules, was developed to assist children in attaining power wheelchair (PWC) skills. The purposes of this small-scale trial were to explore the use of the IndieTrainer system to provide PWC skills training and document parental satisfaction with the IndieTrainer system. We hypothesized that PWC skills training provided using the IndieTrainer system would result in improvements in both children's understanding of how to use a PWC and their PWC skill execution, and that parental satisfaction would be high. An open-label, single-arm trial was conduct as follows: (a) Baseline testing (T0); (b) A 3-week intervention consisting of two, 60-min-PWC skills training sessions per week; (c) Post-intervention testing (T1); and (d) A single session retention trial held 4 weeks after completion of the intervention (T2). Outcome measures included the Assessment of Learning Powered mobility use (ALP), Wheelchair Skills Checklist (WSC), Canadian Occupational Performance Measure (COPM), and Client Satisfaction Questionnaire-8 (CSQ-8). 25 child/parent dyads participated. Between T0 and T1, statistically significant differences (p-value <.0001) with large effect sizes in mean ALP and WSC scores (ALP: d = 3.14; WSC: d = 3.25) and COPM performance and satisfaction scores (Performance: d = 4.66; Satisfaction: d = 3.24) were achieved. Mean T1 total CSQ-8 score was 31.52/32. At T2, all children maintained or improved their T1 ALP and WSC scores. This study provides initial support for the usability and feasibility of the IndieTrainer system. Futhermore, larger scaled studies using more rigorous research designs are indicated.

The IndieTrainer system allows clinicians to tailor power wheelchair skills (PWC) skills training based on an individual child's specific goals and level of understanding.Selectively combining the use of progressive video-based gamified modules and real-world power mobility experiences may support children who are learning PWC skills.When provided with progressive PWC skills training, children with severe disabilities may improve their understanding of how to use a PWC and their PWC skills.

Avulsion of the Lesser Trochanter Following a Shot Put Sport Session.

Avulsion of the lesser trochanter is an uncommon injury. In children and adolescents it usually occurs as a sports injury via traumatic avulsion of the psoas major tendon. In adults, isolated fractures of the lesser trochanter are most commonly pathological due to metastatic tumor invasion of the proximal femur. This case report documents how a 14-year-old boy, who presented with an avulsion of the lesser trochanter of the proximal femur following a seemingly atraumatic shot put session at a track and field event, was diagnosed and successfully treated with a conservative approach.

Curcumin Sensitizes Silymarin to Exert Synergistic Anticancer Activity in Colon Cancer Cells.

We studied combinatorial interactions of two phytochemicals, curcumin and silymarin, in their action against cancer cell proliferation. Curcumin is the major component of the spice turmeric. Silymarin is a bioactive component of milk thistle used as a protective supplement against liver disease. We studied antiproliferative effects of curcumin alone, silymarin alone and combinations of curcumin and silymarin using colon cancer cell lines (DLD-1, HCT116, LoVo). Curcumin inhibited colon cancer cell proliferation in a concentration-dependent manner, whereas silymarin showed significant inhibition only at the highest concentrations assessed. We found synergistic effects when colon cancer cells were treated with curcumin and silymarin together. The combination treatment led to inhibition of colon cancer cell proliferation and increased apoptosis compared to single compound treated cells. Combination treated cells exhibited marked cell rounding and membrane blebbing of apoptotic cells. Curcumin treated cells showed 3-fold more caspase3/7 activity whereas combination treated cells showed 5-fold more activity compared to control and silymarin treated cells. When DLD-1 cells were pre-exposed to curcumin, followed by treatment with silymarin, the cells underwent a high amount of cell death. The pre-exposure studies indicated curcumin sensitization of silymarin effect. Our results indicate that combinatorial treatments using phytochemicals are effective against colorectal cancer.

Hypothermia is a significant medical risk of mass participation long-distance open water swimming.

OBJECTIVE: To document the prevalence of hypothermia in a mass participation endurance open water swimming event and to determine demographic and individual factors that may predict failure to finish the race and hypothermia. METHODS: A prospective observational study in competitors in a 19.2-km open water swimming race in Perth, Western Australia. Pre-race information collected included age, sex, training and race experience, medical history, and body mass index (BMI). Body temperatures at 5 minutes postrace were measured using an equilibrated oral- or rectal-reading low-range glass mercury thermometer. Logistic regression was used to develop models predicting hypothermia (defined as a temperature of <35 degrees C) and failure to finish the race. RESULTS: One hundred and nine competitors (70 male, 39 female) with a combined mean age of 38.4 +/- 12.1 years were studied. Hypothermia was the most common race-related illness, identified in 26 of 35 swimmers screened as requiring temperature measurement, including 5 who required short-stay hospital care and 2 who required critical care transfer. Longer race duration (odds ratio [OR] 1.77, 95% CI 1.10-2.84, P = .018) was associated with an increased risk of hypothermia, and higher BMI (OR 0.57, 95% CI 0.41-0.79, P = .001) was associated with a decreased risk of hypothermia. Weak predictors of failure to finish were age (OR 1.06, 95% CI 1.01-1.11, P = .012) and hours spent training (OR 1.08, 95% CI 1.01-1.16, P = .025). CONCLUSIONS: Hypothermia is a common condition affecting mass participation long-distance open water swimmers. Increased BMI appears to be protective against hypothermia, while prolonged duration of the swim predicts an increased risk of hypothermia. The weak predictors of failing to finish are of questionable clinical significance.

Tympanic thermometry is unsuitable as a screening tool for hypothermia after open water swimming.

OBJECTIVE: Mass participation in competitive open water swimming is becoming increasingly popular. The purpose of this study was to determine whether infrared emission detection (IRED) tympanic temperature measurement taken in participants approximately 1 minute following a long-distance open water swimming event is a suitable screening tool for hypothermia. METHODS: We studied 15 males and 7 females who completed the 20-km Rottnest Channel Swim off the coast of Perth, Western Australia. Following the swim, each athlete was clinically assessed for hypothermia through the observation of gait, cognitive processing, and demeanor. Approximately 1 minute following the swim, participants underwent temperature measurement using one of two IVAC Core Check 2090 IRED tympanic thermometers set to core equivalent mode. Further tympanic readings and an oral temperature reading were taken at 5 minutes post swim in subjects triaged to the medical tent after the initial clinical screen. RESULTS: At 1 minute post event, the average tympanic temperature measurement was 28.9 degrees C (95% CI, 28.3-29.7), while at 5 minutes postevent it was 31.6 degrees C (95% CI, 31.1-32.2). The average oral temperature at 5 minutes post event was 34.3 degrees C (95% CI, 33.7-34.7). The difference between the screening tympanic and oral temperatures was statistically significant (P = 0.000). CONCLUSIONS: Infrared emission detection tympanic thermometry is unsuitable as a screening tool for hypothermia following a prolonged open water swim because it substantially overestimates the incidence and severity of hypothermia in participants.