A force sensor improves trainee technique for rigid endoscopy.

OBJECTIVE: Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback. METHODS: A force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure. RESULTS: There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators. CONCLUSION: This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique.

Participatory Action Design and Engineering of Powered Personal Transfer System for Wheelchair Users: Initial Design and Assessment.

Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users' perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.

Classification of wheelchair pressure relief maneuvers using changes in center of pressure and weight on the seat.

BACKGROUND: Pressure injuries from prolonged sitting are a significant problem for wheelchair users incurring high costs in healthcare expenditures and reducing quality-of-life. There is a need to improve pressure relief training and adherence in a variety of settings. OBJECTIVE: To identify effective common wheelchair pressure relief (PR) manoeuvres based on changes to users' seated centre of pressure (CoP) and seated weight. PARTICIPANTS: 20 individuals who use manual wheelchairs as their primary means of mobility. METHODS: Participants performed 5 types of PR including seated push-ups, leftward, rightward, forward, and backward leans-while sitting in a wheelchair equipped with a custom instrumented seat pan support. Data were analysed using both clustering and decision tree approaches to identify types of PR. RESULTS: Both clustering and decision tree approaches were able to identify and classify PR though neither could accurately distinguish between forward and backward PR. CONCLUSION: Changes in the centre of pressure and the total weight on the wheelchair's seat can be used to automatically characterise type, amplitude and duration of pressure relief manoeuvres. Building such a classification and quality assessment scheme into an algorithm could enable a virtual coaching system to track users' pressure relief behaviour and make suggestions to improve adherence with clinical recommendations.IMPLICATIONS FOR REHABILITATIONMultiple bending beam load cells can be used to measure wheelchair users' seated centre of pressure independent of type of cushion used.Both cluster analysis and decision tree algorithms can classify commonly practiced pressure reliefs by measuring changes to the centre of pressure and total weight on the wheelchair's seat.The combination of force sensing for centre of pressure determination and either algorithm could serve as the basis for an application to coach wheelchair users to do effective pressure reliefs.

"I Felt Better When I Moved Into My Own Place": Needs and Experiences of Intimate Partner Violence Survivors in Rapid Rehousing.

Accessing stable housing is a basic need for intimate partner violence (IPV) survivors, and rapid rehousing programs are a critical way to address homelessness. However, little is known about survivor experiences, needs, and outcomes in rapid rehousing services within IPV agencies. This study uses an exploratory approach to understand the needs and experiences of 31 survivors using vouchers facilitated by an IPV program in the U.S. Southwest. Thematic analysis of structured interviews resulted in four summary themes: getting to housing, managing multiple needs, accessing support, and facing barriers. Practice and evaluation implications are discussed.

Elucidating Two Distinct Pathways for Electrocatalytic Hydrogen Production Using CoII Pincer Complexes.

Hydrogen gas is a sustainable energy source with water as the sole combustion product. As a result, efforts to catalyze H2 production are pertinent and widespread. The electrocatalytic H2 generating capabilities of two CoII complexes, [Co(κ3 -2,6-{Ph2 PNR}2 (NC5 H3 ))Br2 ] with R=H (I) or R=Me (II), were presented for a variety of proton sources including trifluoroacetic acid (TFA), acetic acid (AA), and trifluoroethanol (TFE). Cyclic voltammetry and controlled potential coulometry demonstrated that electrocatalysis from I and II occurred at two different potentials and are associated with different reduction processes. Density functional theory analysis provided insight into the identities of the catalyst and supported two distinct reaction pathways for electrocatalytic proton reduction. Specifically, stronger acids (e. g., AA, TFA) proceeded at -1.31 to -1.45 V through a MI /MIII pathway while sources with higher pKa values (e. g., TFE, H2 O) generated hydrogen at -2.4 V via M0 /MII ligand-assisted metal-centered reduction.

Nickel-cysteine binding supported by phosphine chelates.

The effect of chelating phosphines was tested on the structure and pH-dependent stability of nickel-cysteine binding. (1,2-Bis(diphenylphosphino)ethane (dppe) and 1,1,1-tris[(diphenylphosphino)methyl]ethane (triphos) were used with three different cysteine derivatives (L-cysteine, Cys; L-cysteine ethyl ester, CysEt; cystamine, CysAm) to prepare complexes of the form (dppe)NiCysR(n+) and (triphos)NiCysR(n+) (n = 0 for Cys; n = 1 for CysEt and CysAm). Similar 31P {1H} NMR spectra for all (dppe)NiCysRn+ confirmed their square-planar P2NiSN coordination spheres. The structure of [(dppe)NiCysAm]PF6 was also confirmed by single-crystal X-ray diffraction methods. The (triphos)NiCysAm+ and (triphos)NiCysEt+ complexes were fluxional at room temperature by 31P NMR. Upon cooling to -80 degrees C, all gave spectra consistent with a P2NiSN coordination sphere with the third phosphorus uncoordinated. Temperature-dependent 31P NMR spectra showed that a trans P-Ni-S pi interaction controlled the scrambling of the coordinated triphos. In aqueous media, (dppe)NiCys was protonated at pH approximately 4-5, leading to possible formation of a nickel-cysteinethiol and eventual cysteine loss at pH < 3. The importance of N-terminus cysteine in such complexes was demonstrated by preparing (dppe)NiCys-bead and trigonal-bipyramidal Tp*NiCys-bead complexes, where Cys-bead represents cysteine anchored to polystyrene synthesis beads and Tp*- = hydrotris(3,5-dimethylpyrazolyl)borate. Importantly, results with these heterogeneous systems demonstrated the selectivity of these nickel centers for cysteine over methionine and serine and most specifically for N-terminus cysteine. The role of Ni-S pi bonding in nickel-cysteine geometries will be discussed, including how these results suggest a mechanism for the movement of electron density from nickel onto the backbone of coordinated cysteine.