Design and Development of a Powered Myoelectric Elbow Orthosis for Neuromuscular Injuries.

INTRODUCTION: Recovering from neuromuscular injuries or conditions can be a challenging journey that involves complex surgeries and extensive physical rehabilitation. During this process, individuals often rely on orthotic devices to support and enable movement of the affected limb. However, users have criticized current commercially available powered orthotic devices for their bulky and heavy design. To address these limitations, we developed a novel powered myoelectric elbow orthosis. MATERIALS AND METHODS: The orthosis incorporates 3 mechanisms: a solenoid brake, a Bowden cable-powered constant torque elbow mechanism, and an extension limiter. The device controller and battery are in a backpack to reduce the weight on the affected arm. We performed extensive calculations and testing to ensure that the orthosis could withstand at least 15 Nm of elbow torque. We developed a custom software effectively control the orthosis, enhancing its usability and functionality. A certified orthotist fitted a subject who had undergone a gracilis free functioning muscle transfer surgery with the device. We studied the subject under Mayo clinic IRB no. 20-006849 and obtained objective measurements to assess the orthosis's impact on upper extremity functionality during daily activities. RESULTS: The results are promising since the orthosis significantly improved elbow flexion range of motion by 40° and reduced compensatory movements at the shoulder (humerothoracic joint) by 50°. Additionally, the subject was able to perform tasks which were not possible before, such as carrying a basket with weights, highlighting the enhanced functionality provided by the orthosis. CONCLUSION: In brief, by addressing the limitations of existing devices, this novel powered myoelectric elbow orthosis offers individuals with neuromuscular injuries/conditions improved quality of life. Further research will expand the patient population and control mechanisms.

Investigating New Zealand radiation therapy student perceptions about their degree curriculum.

BACKGROUND: Radiation Therapists (RTs) are a key professional grouping in the delivery of health services for cancer patients. The education of RTs in New Zealand has evolved in response to regulatory and clinical workforce requirements. To date, it has lacked a fundamental underpinning of educational theory. Stakeholders, including students, were canvassed for their perspectives on the drivers behind the current curriculum with a view to developing theory which could shape future curricular development. METHODS: A focus group was conducted with eight student RTs enrolled at the time of the study. A process driven by Constructivist Grounded Theory principles was adopted for the analysis of the resulting data. RESULTS: Four themes were established to represent the data: "Being" is prized over "doing", Change is inevitable, A framework for Professional Identity formation and Modelling is key to learning. CONCLUSIONS: There is utility in exploring the student perspective around curriculum. The data suggest that students on this programme are engaged with the process of preparing for practice and the connected learning experiences. There is a focus on the patient and the personal values and qualities which result from that focus. While specialist knowledge and technical skills are required for delivering patient care, it is fully expected those aspects of the clinical role will significantly change over time. Even at this early stage in their careers, students recognise the development and need for professional identity formation. Role models are perceived to be a vital part of student learning, be they positive or negative. Scrutiny of the study findings provides reason to question some assumptions which are sometimes made about student practitioners based on factors such as age and gender and the assumed universal ability of practitioners to teach the next generation. The perspectives gained inform the next stage of data collection from this group and theory building that will be reported outside the confines of this article.

Simulation-based education: A narrative review of the use of VERT in radiation therapy education.

Simulation has a long history in medical and health science training and education. The literature describing this history is extensive. The role simulation plays in many health disciplines has evolved, as has the focus of the literature around it. The Virtual Environment for Radiotherapy Training (VERT) system is a relative newcomer to radiation therapy education and, similar to the literature around radiation therapy (RT) education, is still in its infancy. This narrative review sets the scene of simulation-based education within the health sciences and considers the lessons learned from published work on VERT to date. The evidence suggests that future inquiry involving VERT should explore different ways in which VERT can be used to contribute to the skillset required by the radiation therapist of tomorrow.

VERT, a virtual clinical environment, enhances understanding of radiation therapy planning concepts.

INTRODUCTION: The ability to understand treatment plan dosimetry and apply this understanding clinically is fundamental to the role of the radiation therapist. This study evaluates whether or not the Virtual Environment for Radiotherapy Training (VERT) contributes to teaching treatment planning concepts to a cohort of first-year radiation therapy students. METHODS: We directly compared a custom-developed VERT teaching module with a standard teaching module with respect to the understanding of treatment planning concepts using a cross-over design. Students self-reported their understanding of specific concepts before and after delivery of the VERT and standard teaching modules and evaluated aspects of VERT as a learning experience. In addition, teaching staff participated in a semi-structured interview discussing the modules from an educational perspective. RESULTS: Both the standard teaching module and VERT teaching module enhanced conceptual understanding and level of confidence in the student cohort after both teaching periods. The proportion of students reporting a perceived increase in knowledge/confidence was similar for the VERT teaching module for all but two scenarios. We propose that an integrated approach, providing a strong theoretical conceptual framework, followed by VERT to situate this framework in the (simulated) clinical environment combines the best of both teaching approaches. CONCLUSION: This study has established for the first time a clear role for a tailored VERT teaching module in teaching RT planning concepts because of its ability to visualise conceptual information within a simulated clinical environment.

Continuity of cancer patient care in New Zealand; the general practitioner perspective.

AIM: As cancer treatments become more effective, increasing numbers of cancer patients seek long-term support from general practice. This study aimed to canvass the perspective of GPs on issues around continuity of care for these patients. METHODS: In this qualitative study purposive sampling was used to invite a range of New Zealand GPs from urban and rural communities in the Greater Wellington and Otago/Southland areas to participate. A total of 34 GPs took part in three semi-structured individual interviews and six focus groups. RESULTS: Six main themes emerged; the participating GPs noted they wanted more involvement in their patients' cancer journeys but were not always clear of their place in relation to cancer specialists and other health care providers. They saw cancer as a chronic condition to be managed long term. They mentioned the breast cancer and palliative care models as examples to be followed. Poor communication and barriers for patients in accessing GP care were seen as areas for improvement. CONCLUSION: Participating GPs felt that the current cancer care pathway could be improved with a better understanding of their own role and through improved communication with patients, cancer specialists and other health professionals.

Protocol for a systematic review of screening tools for fear of recurrent illness in common life-threatening diseases.

BACKGROUND: A myocardial infarction (MI) ('heart attack') can be intensely stressful, and the impact of this event can leave patients with clinically significant post-MI stress symptoms. Untreated stress can make heart disease worse. Few tools are available that screen for specific thoughts or beliefs that can trigger post-MI stress responses. In other life-threatening illnesses, fear of recurrence (FoR) of illness has been identified as a key stressor, and screening tools have been developed to identify this. The aim of this review is to identify FoR screening tools used in other common life-threatening diseases that report on the development of the tool, to assess if there are any that can be adapted for use in MI survivors so that those with high levels of FoR can be identified and helped. METHODS/DESIGN: The review will evaluate full FoR screening tools and methods of measurement used in common life-threatening disease clinical populations. The Campbell and Cochrane Libraries, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE, Embase, Applied Social Sciences Index and Abstracts (ASSIA), Published International Literature on Traumatic Stress (PILOTS), Social Services Abstracts, Sociological Abstracts, Web of Knowledge, Health and Psychosocial Instruments and SCOPUS databases will be searched for relevant studies published from database inception. Reference lists and published reviews/meta-analyses will also be searched. All titles and abstracts will be screened and relevant full-text versions retrieved by two reviewers, who will then extract all the data. Each will independently review all data extracted by the other. Selected studies will also be assessed by two independent researchers using the COnsensus-based standards for the Selection of health status measurement INstruments (COSMIN) checklist and other quality criteria. This will be done to evaluate the degree to which their measurement properties meet the standards for good methodological quality. Disagreement will be resolved through consensus. DISCUSSION: Untreated post-MI stress has a considerable psychological and physical impact on MI survivors. Therefore, there is a critical need to develop a screening tool to identify fear of recurrent MI so that those affected can be identified and directed to appropriate support interventions. This proposed research will enable a tool to be developed and adapted for use in the MI survivor patient population. PROSPERO: CRD42014010500.

Letter in response to correspondence on 'Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions'.

There is ongoing debate on the position of research as an attribute of advanced practice. This letter highlights some issues to be considered in light of recent correspondence published in the JMRS.

Caution required when using an intraoperative knee balancer in total knee arthroplasty.

Various knee balancers have been developed to assist surgeons in balancing the flexion and extension spaces during total knee arthroplasty. Devices typically are designed to measure the distance between spaces during total knee arthroplasty at a given force level. We analyzed the accuracy of one type of these devices. We found that the devices accurately measure distances, but are quite inaccurate at demonstrating reproducible forces.

The role of free-living daily walking in human weight gain and obesity.

OBJECTIVE: Diminished daily physical activity explains, in part, why obesity and diabetes have become worldwide epidemics. In particular, chair use has replaced ambulation, so that obese individuals tend to sit for approximately 2.5 h/day more than lean counterparts. Here, we address the hypotheses that free-living daily walking distance is decreased in obesity compared with lean subjects and that experimental weight gain precipitates decreased daily walking. RESEARCH DESIGN AND METHODS: During weight-maintenance feeding, we measured free-living walking using a validated system that captures locomotion and body movement for 10 days in 22 healthy lean and obese sedentary individuals. These measurements were then repeated after the lean and obese subjects were overfed by 1,000 kcal/day for 8 weeks. RESULTS: We found that free-living walking comprises many (approximately 47) short-duration (<15 min), low-velocity ( approximately 1 mph) walking bouts. Lean subjects walked 3.5 miles/day more than obese subjects (n = 10, 10.3 +/- 2.5 vs. n = 12, 6.7 +/- 1.8 miles/day; P = 0.0009). With overfeeding, walking distance decreased by 1.5 miles/day compared with baseline values (-1.5 +/- 1.7 miles/day; P = 0.0005). The decrease in walking that accompanied overfeeding occurred to a similar degree in the lean (-1.4 +/- 1.9 miles/day; P = 0.04) and obese (-1.6 +/- 1.7 miles/day; P = 0.008) subjects. CONCLUSIONS: Walking is decreased in obesity and declines with weight gain. This may represent a continuum whereby progressive increases in weight are associated with progressive decreases in walking distance. By identifying walking as pivotal in weight gain and obesity, we hope to add credence to an argument for an ambulatory future.

Design of posture and activity detector (PAD).

In recent years, there has been much research and development of wearable devices using accelerometers for studying physical activity. Previously, we have described the development of the Posture and Activity Detector (PAD). After demonstrating success with PAD, we were motivated to improve the design by taking the device one step further and implementing all of these components on a single printed circuit board, adding a few additional features to make the system more flexible, and custom-designing an outer case. We have continued our efforts in improving PAD with respect to software development as well as making PAD more physically robust and mass producible. In this paper, the specifications for PAD will be outlined including its hardware and software components, and clinical research applications.

Interindividual variation in posture allocation: possible role in human obesity.

Obesity occurs when energy intake exceeds energy expenditure. Humans expend energy through purposeful exercise and through changes in posture and movement that are associated with the routines of daily life [called nonexercise activity thermogenesis (NEAT)]. To examine NEAT's role in obesity, we recruited 10 lean and 10 mildly obese sedentary volunteers and measured their body postures and movements every half-second for 10 days. Obese individuals were seated, on average, 2 hours longer per day than lean individuals. Posture allocation did not change when the obese individuals lost weight or when lean individuals gained weight, suggesting that it is biologically determined. If obese individuals adopted the NEAT-enhanced behaviors of their lean counterparts, they might expend an additional 350 calories (kcal) per day.

Hepatitis in aviation personnel.

BACKGROUND: This study examines the specific etiologies and aeromedical outcomes of naval aviation personnel with hepatitis. METHODS: We searched the Biomedical Database of the Naval Aerospace Medical Institute for waiver requests for hepatitis. We reviewed the records for specific etiologies, possible risk factors, and the aeromedical outcomes of aviators who received waivers for chronic hepatitis. RESULTS: We examined 48 initial and 95 follow-up waiver requests for hepatitis for naval aviation personnel from July 1988 to May 2001. Initial waiver requests were for chronic hepatitis C (HCV) in 23 (47.9%), chronic hepatitis B in 17 (35.4%), and other etiologies in 8 (16.7%). Asian Americans, who comprise 2% of the aviator population in the Biomedical Database, accounted for a disproportionate number of waiver requests for hepatitis: 7 (14.6%) of the total and 6 (35.3%) of the aviators with HBV. Of the 48 aviators with hepatitis, waivers were granted in 32 (66.7%) cases, all of whom were asymptomatic. Waivers were denied to 16 (33.3%) aviators. One aviator with Hodgkin's disease in remission and one aviator with chronic HCV who became asymptomatic after treatment with interferon later received waivers for a total of 34 (70.8%) waivers. Two waivers were later revoked because of symptomatic HCV requiring interferon in one and incomplete physical exam in another. CONCLUSIONS: Aviation personnel who receive waivers for asymptomatic hepatitis occasionally present with symptomatic hepatitis, but most waiver recipients remain asymptomatic during their aviation careers.

Clinical outcomes of naval aviation personnel with cholelithiasis.

BACKGROUND: This study examines the aeromedical outcomes of aviation personnel with asymptomatic cholelithiasis or those treated successfully with conventional (open) cholecystectomy (CC), laparoscopic cholecystectomy (LC), or extracorporeal shock wave lithotripsy (ESWL) for previous symptomatic cholecystitis. METHODS: The Biomedical Database of the Naval Aerospace Medical Institute was searched for waiver requests for asymptomatic gallstones, acute cholecystitis, and cholecystectomy. Microfiche records were then reviewed. The rates of development of symptomatic disease and need for cholecystectomy or ESWL were noted in aircrew granted waivers for asymptomatic cholelithiasis. The aeromedical outcomes of aircrew who underwent treatment for symptomatic disease by cholecystectomy (CC or LC) or ESWL were reviewed. RESULTS: A search of the Biomedical Database revealed waiver requests for cholelithiasis for 79 naval aviation personnel from April 1988 to August 2000. Waiver requests were for previous cholecystectomy in 56 (70.9%) and cholelithiasis in 23 (29.1%). No aviators had undergone ESWL. Of the 56 aviators with previous cholecystectomy, waivers were granted in 51 (91.1%) cases. Waivers were denied to five individuals, primarily for other medical problems. Of the 23 aviators with cholelithiasis, 11 (47.8%) were granted waivers. Waivers were denied in 12 aviators because of symptomatic cholelithiasis (5), asymptomatic cholelithiasis (1), common bile duct stone (1), other medical problems (3), or no explanation (2). The aviator with asymptomatic cholelithiasis and two of the aviators with symptomatic cholelithiasis were subsequently granted waivers after cholecystectomy (LC). The aviator with a symptomatic common bile duct stone received a waiver after cholecystectomy (CC). A total of 66 (83.5%) aviators received waivers. None were revoked during the study period because of symptomatic cholelithiasis or retained common bile duct stones. CONCLUSIONS: Aviation personnel who receive waivers for asymptomatic cholelithiasis or cholecystectomy rarely present with symptomatic biliary disease.