Initial Adjustment Research Articles

Trajectory evolution and changes in the structure of movement amplitude time series.

With increases in the index of difficulty [ID=log2(2A/W)], the time-series structure of movement amplitude values shift from pink to white noise. The appearance of pink noise at low-ID levels may be attributed to the dominance of feedforward control processes, while the appearance of white noise at high-ID levels may be attributed to increased reliance on visuomotor feedback processes needed to guide movement into the target region. Such within-movement corrections may disrupt the pink-noise time-series correlations that exist in the absence of feedback processing. In our prior work, movement amplitude was defined as the distance moved from movement start until its end. In contrast, in the current study we examined the time-series structure of movement amplitude values at each of 10 different percentages of time into the movement trajectory-ranging between 10 and 100% of the movement time (%MT)-at a low (2 bits) and a high (5 bits) ID level. We hypothesized that at both ID levels a pink-noise time-series structure would be seen during the early portions of the movement trajectory when feedforward control should dominate, but during later portions of the trajectory, increased whitening of time-series structure would emerge only under ID5 as there would be an increased need to engage visuomotor feedback processes. Under ID2, the same level of pink noise should be maintained across all %MT levels as movement should be under the same level of feedforward control throughout the trajectory. The only unpredicted result occurred at ID2 where the pink-noise level increased with increases in %MT. We hypothesize that such strengthening of pink noise as a function of %MT reflects the engagement of early trajectory corrections superimposed on the initial feedforward signal, but, once such initial adjustments were made, feedforward processes increasingly took over as the trajectory neared its goal.

The Dynamics of Property Rights and Consent in Autocracies

This paper studies the dynamics of property ownership, appropriation, and in autocratic political systems. An autocrat representing the interests of an in-group chooses whether and how much to appropriate from public and private assets at each date. To maintain the appearance of the rule of law, the autocrat proposes an assignment that would not be rejected if the citizens could actually vote. Despite this consent constraint the autocrat systematically appropriates property and wealth from the out-group and from public assets by exploiting gaps in property enforcement in the absence of consent. Under some initial conditions, the autocrat initially implements popular land reform only to take it back down the road. More generally, the wealth shares of both public property and private property of the out-group decline monotonically after an initial adjustment period. The model rationalizes the connection between increasing wealth inequality and privatization occurring in many autocracies. Calibrating parameters to Russian and Chinese wealth data, simulations of these countries' wealth distributions to mid 21st century display widening gaps in wealth between elites and the rest of the populace. Finally, we show that the ruling group under anocracy, an autocratic system that admits opposition and civil society groups, will generally be better off than under a traditional autocracy. The dilemma is that the anocratic system might enable the growth of an opposition party that eventually displaces the ruling group.

Critical Study of a Residual Viscosity Correlation of JOSSI: Pure Hydrocarbons Case

The most common residual viscosity correlation used in the petroleum models is JOSSI et al [1] where the residual viscosity is represented by a polynomial function of 4th degree involving the reduced density ρr ([(η-η*)ξ+10-4]1/4=Σ41=0(aiρri)). Based on this formula, it is possible to predict various uncertainties that can be accumulated and thus alter the performance of viscosity restitution which depends on several factors:The quality of the initial adjustment of the coefficients ai;The precision on the density;The accuracy with which are known the characteristics of the constituents of bases;The validity of the rule of the mixtures selected for the determination of the pseudo-critical coordinates Tcm and Pcm and the equivalent molar mass of the mixture.As far as the results are concerned, we reveal that with the new set of coefficients it is possible to obtain a more preciserepresentation compared to that of JOSSI. The method of JOSSI seems to be especially interesting for the viscosities restitution of systems containing light and close paraffins. However, for some pure substances, the opposite situation could be true. Among the four equations-of-state used, it has been found that the cubic equation-of-stateof PENG and ROBINSON should not be used since we would like to generate the density. Finally, we are not expecting a perfect systematic representation. As demonstrated in our model, if for light alkanes one can expect an average deviation ofless than 10%, for certain pure substances the deviation exceeds 20%.

Using infrared depth-sensing technology to improve the brachytherapy operating room experience

PurposeThe purpose of this study was to discuss the merits of using depth-sensing infrared camera technology in the brachytherapy operating room during interstitial brachytherapy for gynecologic malignancies. Materials and MethodsThe infrared depth-sensing camera from a Microsoft Kinect that had been adapted for surgical use was introduced into a high-volume interstitial brachytherapy operating room. Brachytherapists then used the touchless, gestural interface to review preoperative MRI in real time to guide needle insertion. ResultsThe interface was used for 10 consecutive procedures by 4 separate brachytherapists. The initial training and adjustment to the technology was variable among brachytherapists. All brachytherapists found the controls intuitive and were able to successfully navigate MRI on the system after 1, 30, 30, and 45 min. Qualitatively, brachytherapists found the system helpful for interpretation of intraoperative ultrasound imaging. Furthermore, it ensured adequate needle positioning and deposition was maintained for large tumors. Surgeons involved in its use agreed on potential for considerable benefit when performing interstitial brachytherapy. ConclusionsAdapting this technology for use in the brachytherapy suite provided a higher level of comfort with interstitial catheter placement. This novel tool or similar technology might be considered within other brachytherapy suites.

Parallelizable and robust image segmentation model based on the shape prior information

Image segmentation is an important task in many fields, and there are plentiful models based on region or edges. Nowadays, the speed of calculation and the universal applicability of the model attract much attention. To some extent, the traditional energy model can segment images suffering from intensity inhomogeneity while it relies on initialization seriously. In this paper, we present a new model that consists of an arbitrary active contour model and proposed shape priori information term, which can segment various images accurately and provide an opportunity to carry on parallelizable calculation. The shape priori information term plays a key role in our energy functional and the shape priori information can be chosen diversely. This term also improves the robustness of our model including initial conditions and parameter adjustment. Besides, the split Bregman method is then applied to minimize the energy functional. Multiple experimental results and comparisons are shown to demonstrate the superiority of the proposed model. Firstly, fuzzy clustering, threshold and manual operation are used to be the shape priori information. Secondly, it is illustrated that our model is not sensitive to parameters and initial contours. Computation time and accuracy are also obviously improved when using the parallel algorithm.

Effect of long-term feeding of the Obudu natural honey and table sugar-sweetened diets on obesity and pro-inflammatory biomarkers in rats

BackgroundThis study investigated long-term effect of the Obudu honey on selected biomarkers of energy storage regulation, compared to table sugar.MethodsFifty Wistar rats assigned to 5 groups of 10 rats each, were fed rat chow only (NC), 8% table sugar (S8%), 16% table sugar (S16%), 10% honey (H10%) and 20% honey (H20%) diets respectively, for 29 weeks. On dry weight basis, the percentages of table sugar and honey for each level of incorporation were equivalent. Diet intake, body weights and fasting blood glucose (FBG) were measured fortnightly. At the end of the study, serum glucose, insulin, leptin and tissue necrosis factor – α (TNF-α), wet weight of white adipose tissues (WAT) were measured.ResultsAfter an initial adjustment to the diets, there was no significant difference in diet consumed by female and male subgroups, except the female group fed H20% which was consistently lower than the NC and the corresponding S16% fed group (P < 0.05). Both honey and sugar incorporated diets caused significant body weight gain in the female animals compared to NC; an effect which was higher with the honey than sugar, and depended on the level of each sweetener used as well as feeding duration (P < 0.05). Furthermore, S8% and S16% diets increased leptin concentration in the female rats, by 35.8 and 45.3% respectively compared with NC and by 63.8 and 40.5% compared to H10% and H20% respectively (P < 0.05). Also, the S8% and S16% diets significantly increased serum insulin in the female subgroups compared to the corresponding honey-sweetened diets; and in both male and female rats when compared to NC (P < 0.05). Lastly, the S8% and S16% diets also caused a dose-dependent increase of TNF-α in both female and male rats compared to the H10% and H20% diets and the control (P < 0.05).ConclusionData obtained from the study associated table sugar with obesigenic and inflammatory mechanisms more than the Obudu honey, particularly in the females. However, the data did not exempt the honey from obesigenic effect. The effects were subtle and may require a longer time to precipitate obesity.

Investigation of Vocal Fatigue Using a Dose-Based Vocal Loading Task.

Vocal loading tasks are often used to investigate the relationship between voice use and vocal fatigue in laboratory settings. The present study investigated the concept of a novel quantitative dose-based vocal loading task for vocal fatigue evaluation. Ten female subjects participated in the study. Voice use was monitored and quantified using an online vocal distance dose calculator during six consecutive 30-min long sessions. Voice quality was evaluated subjectively using the CAPE-V and SAVRa before, between, and after each vocal loading task session. Fatigue-indicative symptoms, such as cough, swallowing, and voice clearance, were recorded. Statistical analysis of the results showed that the overall severity, the roughness, and the strain ratings obtained from CAPE-V obeyed similar trends as the three ratings from the SAVRa. These metrics increased over the first two thirds of the sessions to reach a maximum, and then decreased slightly near the session end. Quantitative metrics obtained from surface neck accelerometer signals were found to obey similar trends. The results consistently showed that an initial adjustment of voice quality was followed by vocal saturation, supporting the effectiveness of the proposed loading task.

Short communication: Increasing temperature and pH can facilitate reductions of cephapirin and antibiotic resistance genes in dairy manure slurries

Quantifying antibiotics and antibiotic resistance genes (ARG) in manure exposed to various temperature and pH treatments could guide the development of cost-effective manure handling methods to minimize the spread of antibiotic resistance following land application of manure. This study aimed to investigate the effect of various temperatures and initial pH shocks on the persistence of a cephalosporin antibiotic and ARG in dairy manure slurries. Feces and urine were collected from 5 healthy dairy cows administered with cephapirin (cephalosporin antibiotic) at dry-off via intramammary infusion and were mixed with sterile water to generate manure slurries. In a 28-d incubation study, dairy manure slurries either were continuously exposed to 1 of 3 temperatures (10, 35, and 55°C) or received various initial pH (5, 7, 9, and 12) shocks. Cephapirin was detected in the initial samples and on d 1 following all treatments, but it was undetectable thereafter. This indicates that cephapirin can be rapidly degraded irrespective of temperature and pH treatments. However, degradation was greater on d 1 with the mesophilic (35°C) and thermophilic (55°C) environments compared with the psychrophilic environment (10°C). Increasing pH beyond neutral also accelerated degradation as cephapirin concentrations were lower on d 1 after initial alkaline adjustments (pH 9 and 12) than after neutral and acidic adjustments (pH 7 and 5). No significant effect of temperature or initial pH was observed on abundances of a β-lactam ARG, cfxA, and a tetracycline ARG, tet(W), implying that bacteria that encoded cfxA or tet(W) genes were not sensitive to temperature or pH in dairy manure slurries. However, abundances of a macrolide ARG, mefA, were decreased in the psychrophilic and thermophilic environments and also following exposure to a strong alkaline shock (pH 12). Our results suggest that increasing temperature or pH during storage of dairy manure slurries could be used together with other on-farm practices that are tailored to reduce the transfer of ARG from manure to the environment following land application.

Optimization of an electrocoagulation-flotation system for domestic wastewater treatment and reuse

ABSTRACT The risks inherent to the inadequate domestic wastewater disposal, allied to the water growing demand, scarcity, and pollution problems, have highlighted the importance of adopting treatment techniques that not only target the sewage discharge, but also its reuse. For this reason, the objective of this study was to evaluate the best conditions of an electrocoagulation-flotation system for domestic wastewater treatment and urban reuse. To achieve this, an effects study followed by two rotatable central composite experimental designs 2² was performed, considering: agitation, electrical current, electrolysis time, inter-electrodes distance, and initial pH. The electrocoagulation-flotation system was composed of a cylindrical acrylic reactor with a working volume of 1 L, with two aluminium electrodes connected to a direct-current power supply. Results showed that electrical current and electrolysis time were the most influent operational parameters on domestic wastewater treatment in the electrocoagulation-flotation system. The initial pH adjustment was also important due the pH increase tendency observed in the results. The best conditions of agitation, inter-electrodes distance, electrolysis time, electrical current, and initial pH for domestic wastewater treatment and urban reuse were 262.5 rpm, 1 cm, 25 min, 1.65 A, and 6, respectively. Under these conditions, turbidity and colour removals higher than 98% and 92% were reached respectively, as well as residual turbidity lower than 6 NTU and final pH of 8 were achieved, following the Brazilian standards and guidelines for urban reuse. Thus, the electrocoagulation-flotation system studied was effective for domestic wastewater treatment and reuse for urban supply purposes.

Wpływ cofki zbiornika zaporowego na koryto rzeki górskiej – perspektywy badań = The impact of dam-reservoir backwater on mountain river channel – research perspectives

Dam reservoir construction is one of the most important factors shaping river-valley morphology in the Anthropocene. While a large number (&gt;58,000) of these constructions are in operation all over the world, we remain quite ignorant of what happens upstream of them (in so called backwater zone), especially for the case of gravel-bed rivers. Existing studies have shown that adjustments of the gravel-bed river in the backwater zone differ between the initial and long-term adjustments. The initial adjustments (occurring ≈ &lt;20 years following dam construction) are controlled by large floods and in-channel deposition which trigger bi-directional bar↔bank interactions (bank erosion causing bar growth and vice versa) resulting in channel-widening. The long-term adjustments (≈ &gt;20 years following dam construction) are characterized by river sinuosity increa sing and channel planform stabilization resulted from deposition of fine sediment and associated vegetation expansion. The long-term adjustments are controlled by the initial river morphology, which creates accommodation space for the deposition of fine sediment and for the associated expansion of vegetation on channel bars. The multi-thread river in backwater zone is significantly narrowed, its sinuosity increase (phase 1) and the planform is stabilized (phase 2). Whereas, in the case of initially single-thread river only planform stabilization occur (phase 2). This article summarizes recent findings on the backwater effects on gravel-bed channel morphodynamics, suggesting that backwater zones may be treated as hot-spots of human-induced changes in river geomorphology and biogeomorphology.

Analysis of Sensor-Based Real-Time Balancing of Humanoid Robots on Inclined Surfaces

An experimental and theoretical study of real-time robot balancing on inclined surfaces with electrical feedback circuitry is presented. Force sensors are experimentally shown to extend the sustainability of a stable robot posture beyond a critical surface inclination. For this purpose, the inclination feedback from the force sensors is used to adjust the robot's ankle-pitch-motor angle above the critical inclination, thus enabling the maintenance of a stable robot posture. Further, the Inverted Pendulum Model (IPM) (Hemami and Golliday, 1977, Hemami et al., 1973, and McGhee and Kuhner, 1969) is extended to the case of inclined surfaces. Through application of this extended IPM it is demonstrated, that simultaneous use of gyro-sensor data can minimize the necessary initial adjustment of the motor angle for controlled robot-body rotation, which additionally has the positive effect of reducing possible overshoots of the motor's rotation angle during feedback. Consequently, the reported feedback control improves the robot-body stability on inclined surfaces. Efficient implementation of the developed control scheme into an existing robot's electrical system is proposed.

영아의 어린이집 초기적응 척도개발 및 타당화

본 연구에서는 영아의 어린이집 초기적응을 측정하기 위한 척도를 개발하고 타당화 연구를 실시하였다. 문헌고찰 및 개방형 설문조사에 기초하여 정서상태, 분리불안, 사회적 관계, 관심과 탐색활동, 일상생활 등 어린이집 초기적응의 핵심적인 구성요인을 선정하고 관련 문항을 추출하였다. 902명의 영아를 대상으로 어린이집 초기적응 자료를 수집하여 척도의 타당화 검증을 실시한 결과는 다음과 같다. 첫째, 요인별 문항 양호도는 적절하였다. 어린이집 초기적응의 상·하위 집단의 점수 차는 통계적으로 유의하였으며 효과 크기는 높은 수준(.62～2.81)으로 나타났다. 둘째, 내적 합치도는 .67～.94이며, 검사-재검사 신뢰도는 .54～.80으로 적절하였다. 셋째, 확인적 요인 분석결과, 5요인 모형이 적절한 것으로 나타났으며, 기존의 ‘교사용 영아 어린이집 적응척도’와 전반적으로 높은 상관을 보여 초기적응이 기관적응과 밀접한 관련이 있었다. 그러나 초기적응 척도의 분리불안 요인은 기관적응과 관련이 없었으며 이는 기관적응을 측정하는 기존의 척도와 달리 본 척도가 만 0～2세 영아의 어린이집 초기적응을 측정하는데 유용한 도구임을 잘 나타내 준다.

A two-step approach for the correction of rolling shutter distortion in UAV photogrammetry

The use of consumer grade unmanned aerial vehicles (UAV) is becoming more and more ubiquitous in photogrammetric applications. A large proportion of consumer grade UAVs are equipped with CMOS image sensor and rolling shutter. When imaging with a rolling shutter camera, the image sensor is exposed line by line, which can introduce additional distortions in image space since the UAV navigates at a relatively high speed during aerial acquisitions. In this paper, we propose (1) an approach to calibrate the readout time of rolling shutter camera, (2) a two-step method to correct the image distortion introduced by this effect. The two-step method makes assumption that during exposure, the change of camera orientation is negligible with respect to the change of camera position, which is often the case when camera is fixed on a stabilized mount. Firstly, the camera velocity is estimated from the results of an initial bundle block adjustment; then, one camera pose per scan-line of the image sensor is recovered and image observations are corrected. To evaluate the performance of the proposed method, four datasets of block and corridor configurations are acquired with the DJI Mavic 2 Pro and its original Hasselbald L1D-20c camera. The proposed method is implemented in MicMac, a free, open-source photogrammetric software; comparisons are carried out with other two mainstream software, AgiSoft MetaShape and Pix4D, which also have the functionality of rolling shutter effect correction. For block configuration datasets, the three software give comparable results. AgiSoft Metashape and Pix4D are sensitive to the flight configuration and encounter difficulties when processing datasets in corridor configurations. The proposed method shows good robustness both in block and corridor configurations, and is the only method that works in corridor configuration. After the application of the rolling shutter effect correction, the 3D accuracy is improved by 30–60% in block configuration and 15–25% in corridor configuration. A further improvement can be expected if a precise dating of image is available or if the camera positions can be directly extracted from GNSS data.

Initial testing of a computer-integrated weight compensation system for rehabilitation of horses

Management of severely injured or neurologic horses is challenging, with ambulatory support limited to static lifts and rescue slings. The aim of this study was initial testing and adjustment of a novel computer-integrated dynamic lift system, including measuring effects of increasing weight compensation (i.e. load reduction) and time attached to the lift. This automated system was developed to improve outcomes and reduce complications in horses with ambulatory difficulties, allowing for controlled mobility and varying load carried by the horse with independent front and hind limb support. Two healthy Thoroughbred horses were studied using the Anderson rescue sling. The lift was programmed to respond to weight and movement of horses. Weight compensation (% bodyweight) was incrementally increased, for front and hind limbs, to maximum percent tolerated, based on heart/respiratory rates and behavioural scoring. The time attached to the lift was then incrementally increased at maximum tolerated weight compensation previously determined. Measures included heart/respiratory rates, behavioural scoring, muscle enzyme activity and blood flow to distal limbs. Results were analysed descriptively. Avoidance behaviour was observed at front and hind end weight compensation of 18 and 4%, respectively. Average maximum time attached to the lift was 2.25 hours. After 60 minutes, respiratory rate increased &gt;20 breaths (b)/minute, reaching 60 b/minute in one horse and 36 b/minute in the other, with shallow breathing. Other measures remained normal. In conclusion, lift programming was successful for weight compensation and mobility during lift support. Complications included avoidance behaviour and respiratory distress at &gt;20% weight compensation, likely caused by the Anderson rescue sling. To address these limitations, a new rehabilitation harness better suited for long-term use is under development.

Spring Model - Chromatin Modeling Tool Based on OpenMM.

Chromatin structure modeling is a rapidly developing field. Parallel to the enormous growth of available experimental data, there is a growing need of building and visualizing 3D structures of nuclei, chromosomes, chromatin domains, and single loops associated with particular gene loci. Here, we present a tool for chromatin domain modeling; it is available as a webservice and standalone python script. Our tool is based on molecular mechanics and utilizes the OpenMM engine for model generation. In this method the user provides contacts between chromatin regions and obtains a 3D structure that satisfies them. Additional parameters allow for the control of fibre stiffness, initial structure adjustments and simulation resolution, there are also options for structure refinement and modeling in a spherical container. The user may provide contacts in the form of bead indices, or insert interactions in genome coordinates sourced from BEDPE files. After the simulation is complete, the user is able to download the structure in the Protein Data Bank (PDB) format for further analysis. We dedicate this tool to all who are interested in chromatin structures. It is suitable for quick visualization of datasets, studying the impact of structural variants (SVs), inspecting the effects of adding and removing particular contacts, and measuring features such as maximum distances between sites (e.g.promoter-enhancer), or local chromatin density.

Analisis Risiko Proyek KPBU SPAM Regional Wosusokas Provinsi Jawa Tengah - Perspektif Pemerintah

During the dry season there was a scarcity of the availability of clean water in several Central Java province (Wonogiri, Sukoharjo, Karanganyar Disrict and Surakarta City), including Wosusokas Regional Region, so the government often drops clean water. So, the Government conducted the Wosusokas Regional Water Supply System Program. Public-Private Partnership (PPP) scheme is an option to overcome investment cost. This study aims to identify and analyze the risks of Wosusokas regional water supply system project eith government perspective. This research adopted a case study and literature analyze. Selected respondents from PDAB Tirta Utama, Dinas Bina Marga dan Cipta Karya Central Java, BPPW Central Java, District/ City Governments (Regional Water Supply Company, Bappeda and DPU) from Wonogiri, Sukoharjo, Karanganyar and Surakarta. The result found 35 risk factors that could potentially project failure or delay, the majority of these are considered high (11,43%), moderate (54,29%) and low (34,29). Risk factors with high probability are delay and increase cost of land acquisition, failure to complete the contract by the contractor / sub-contractor, failure initial tariff and delay periodic tariff adjustments. The results are useful for Government as a reference in managing the risks of PPP Spam Regional especially in Central Java.

Evaluating the Effect of Initial Adjustment Support Programs for Immigrants

본 연구의 목적은 이민자 대상의 조기적응프로그램에 대한 순수 효과를 실증적으로 평가하여 문제점과 개선방안을 도출하는 것이다. 이를 위해 “이민자 맞춤형 사회통합교육 및 사회정착지원을 위한 연구”의 원자료를 활용하여 역확률가중치(Inverse-probability weighted) 분석을 시행하였다. 본 연구에서 조기적응프로그램의 효과를 생활만족도, 한국생활에서의 어려움, 필수 생활 정보 교육, 기초 법질서와 문화 교육, 출입국 및 체류 관련 제도 교육 도움 정도로 간주하였다. 분석결과로써, 한국생활에서의 어려움을 제외한 효과 지표들은 참여자가 비참여자에 비해 높은 수준의 효과를 도출하지 못했으며, 통계적으로 유의미하지 않았다. 또한, 한국생활에서의 어려움은 통계적으로 유의미하였지만, 참여자가 비참여자에 비해 어려움을 더 많이 경험하고 있었다. 이러한 결과는 5가지 효과 지표 모두 비효과적이라고 설명할 수 있다. 즉, 조기적응프로그램이 이민자의 초기정착 단계에서 적응을 증진하지 못하고 있다고 볼 수 있다. 본 연구는 조기적응프로그램의 비효과적인 측면을 상쇄할 수 있는 정책적 대안을 모색하였다. 정책적 대안으로 조기적응프로그램을 사회통합프로그램의 0단계로 통합 운영되어야 함을 제시하였다. 또한, 통합적 운영과 동시에 사례관리 기법을 적용한 맞춤형 서비스 제공을 정책 방안으로 제시하였다.The purpose of this study is to empirically evaluate the net effect of Initial Adjustment Support Program for immigrants (IASP). To achieve the purpose, this study performed Inverse-probability weighted analysis using secondary data, Survey on the Experience of Immigrant Integration Education and Korean Society. In this study, the net effect of IASP was evaluated with five outcomes; (1) psychological adaptation (i.e. life satisfaction), (2) sociocultural adaptation (i.e. difficulty in Korean life), (3) the education of basic life information, (4) the education of basic law and culture, and (5) the education of basic immigration and sojourn. The findings showed that the levels of life satisfaction, the education of basic life information, the education of basic law and culture, and the education of basic immigration and sojourn are not significantly different between participants and non-participants. In addition, participants significantly scored higher on the extent of difficult in Korean daily life than non-participants. This indicates that IASP may be failing to improve immigrants’ adaptation in Korea. As an alternative policy to enhance its effect, this research suggests that IASP is delivered by integrating into the 0 level class of Korea Immigration & Integration Program and then, case management is conducted at the same time.

CAREGIVER RESPONSES TO REMOTE ACTIVITY MONITOR ALERTS OF PERSONS WITH DEMENTIA

The benefits of technology to alert family caregivers to the needs of persons with Alzheimer’s disease or related dementias (ADRD) are unclear. Previous research indicates that remote activity monitoring (RAM) system alerts can be alternately reassuring and highly stressful for caregivers. We conducted a parallel convergent mixed-methods analysis of 62 primary caregivers of persons with ADRD to evaluate the association between the number of alerts and caregiver outcomes after 6 months. We assessed caregiver-reported usability of the system as well as self-efficacy, sense of competence, and distress as primary outcomes. Linear regression models tested the association between the number of alerts and caregiver-reported usability and primary outcomes. The number of alerts declined over the first 6 months of system use and was not associated with a change in system usability or primary outcomes. Thematic analysis of caregiver-reported perceptions of RAM use simultaneously probed for more in-depth understanding of caregiver experiences of and feelings towards RAM. Preliminary analyses reveal that 28% of caregivers comments were positive, noting benefits such as early warning of health concerns and peace of mind. 34% of comments were neutral or mixed, and 38% were negative. Concerns included false alarms and accidental triggers, losing sleep due to alarms, and difficulties using the system. These findings help characterize the adjustment period to use RAM technology. The mixed-method results inform future research studies and applications of RAM systems so that researchers and caregivers can better understand the initial adjustment period, address concerns, and avoid discontinuing RAM use prematurely.

Tele-Rheumatology to Regional Hospital Outpatient Clinics: Patient Perspectives on a New Model of Care

Background: Telehealth has the potential to improve access to specialist rheumatology services. The timely and appropriate delivery of care to those living with rheumatological diseases is crucial to ensuring excellent long-term outcomes. Introduction: The outcomes of a tele-rheumatology service delivered to regional hospital outpatient clinics were evaluated with patient perspectives and acceptability analyzed. Materials and Methods: A tele-rheumatology clinic was commenced in Australia from a metropolitan hospital to five regional clinics. The model of care included a trained nurse at the spoke site linked to a rheumatologist from the hospital hub site for follow-up consultations of stable review patients using videoconferencing. Surveys assessing perspectives on the tele-rheumatology encounter were completed and a subsample participated in focus groups to further explore acceptability. Results: Forty-eight patients with a diverse range of conditions participated. Patient travel was reduced on average by 95 km and 42% avoided time off work. Eighty-eight to 100% of participants agreed/strongly agreed with statements relating to acceptability, quality of physician-patient interaction, and nurse involvement. Twenty-nine percent expressed the need for a physical examination by a specialist rheumatologist and 25% felt that an in-person consultation would establish better patient-physician rapport. Qualitatively, participants viewed tele-rheumatology as equivalent to in-person care after an initial adjustment period. Discussion: Tele-rheumatology through videoconferencing for follow-up of patients with established disease is acceptable to patients and demonstrates the potential to improve time, travel, and cost burdens placed on patients who live remotely compared with traditional, face-to-face rheumatology care. Conclusions: Implementation of sustainable and patient acceptable models of tele-rheumatology care may allow timely access to all patients living with rheumatological conditions.

Safe Zones for Anterior Acetabular Retractor Placement in Direct Anterior Total Hip Arthroplasty: A Cadaveric Study.

There is paucity of literature evaluating anterior acetabular retractor proximity to the femoral nerve and external iliac vessels during total hip arthroplasty through the direct anterior approach. In this cadaveric study, we evaluated three retractor locations to identify optimal positioning of anterior retractors. A direct anterior approach was performed in 22 hips of 15 cadavers. Anterior acetabular retractors were placed over the anterior acetabular wall in-line with the femoral neck (12-o'clock or middle position). The anterior neurovascular structures were identified through the ilioinguinal approach. Retractors were reinserted at 10-o'clock (right hip; superior) and 2-o'clock (right hip; inferior) locations marked using K-wires. Horizontal and vertical distances from retractor tip positions to neurovascular structures were measured with a digital caliper. Retractor tips moved significantly from lateral to the femoral nerve when placed in the superior position (mean, 2.8 mm) to medial to the femoral nerve in the middle (mean, -2.3 mm) and inferior (mean, -4.8 mm) locations. Retractor tips moved significantly medial toward the external iliac artery when retractors were moved from superior (mean, 15.3 mm) to inferior (mean, 6.6 mm) positions placing the retractor tip closer to the vessels. As retractor placements moved inferior, retractor tips moved medial to neurovascular structures. Inferior retractor positioning placed the femoral nerve and external iliac artery at the risk of injury during the initial retractor placement or adjustment. Retractors should be placed in a relative safe zone superior to the 12-o'clock position to avoid damage to neurovascular structures. IV.