A Pilot Study to Assess the Reliability of Sensing Joint Acoustic Emissions of the Wrist.

Joint acoustic emission (JAE) sensing has recently proven to be a viable technique for non-invasive quantification indicating knee joint health. In this work, we adapt the acoustic emission sensing method to measure the JAEs of the wrist-another joint commonly affected by injury and degenerative disease. JAEs of seven healthy volunteers were recorded during wrist flexion-extension and rotation with sensitive uniaxial accelerometers placed at eight locations around the wrist. The acoustic data were bandpass filtered (150 Hz-20 kHz). The signal-to-noise ratio (SNR) was used to quantify the strength of the JAE signals in each recording. Then, nine audio features were extracted, and the intraclass correlation coefficient (ICC) (model 3,k), coefficients of variability (CVs), and Jensen-Shannon (JS) divergence were calculated to evaluate the interrater repeatability of the signals. We found that SNR ranged from 4.1 to 9.8 dB, intrasession and intersession ICC values ranged from 0.629 to 0.886, CVs ranged from 0.099 to 0.241, and JS divergence ranged from 0.18 to 0.20, demonstrating high JAE repeatability and signal strength at three locations. The volunteer sample size is not large enough to represent JAE analysis of a larger population, but this work will lay a foundation for future work in using wrist JAEs to aid in diagnosis and treatment tracking of musculoskeletal pathologies and injury in wearable systems.

An office-based approach to emotional and behavioral risk factor reduction for cardiovascular disease.

There are many psychological risk factors for cardiovascular disease, and the ability to reduce mortality depends on an ability to integrate care of these risk factors with traditional Framingham cardiovascular risk and use them both in routine practice. The aim of this article is to provide an update of all the major emotional and behavioral cardiovascular risk factors along with a practical treatment model for implementation. First, we provide a review of major emotional and behavioral cardiovascular risk factors, the associated primary effect, and proposed mechanism of action. Second, we provide an office-based approach to cardiovascular risk factor reduction and methods of reducing barriers to implementation, called Prevention Oriented Primary Care-Abridged. The approach integrates several forms of detection, assessment using the 3As (ask, assess, assist), and Stages of Change approaches, and subsequent efficient and targeted treatment with either Motivational Interviewing or further office intervention. A case example is provided to help illustrate this process.