Initial Adjustment Research Articles

Factors associated with the frequency of antihypertensive drug adjustments in chronic kidney disease patients: a multicentre, 2-year retrospective study.

Background Optimum antihypertensive drug effect in chronic kidney disease is important to mitigate disease progression. As frequent adjustments to antihypertensive drugs might lead to problems that may affect their effectiveness, the modifiable factors leading to frequent adjustments of antihypertensive drugs should be identified and addressed. Objective This study aims to identify the factors associated with frequent adjustments to antihypertensive drugs among chronic kidney disease patients receiving routine nephrology care. Setting Nephrology clinics at two Malaysian tertiary hospitals. Method This multi-centre, retrospective cohort study included adult patients under chronic kidney disease clinic follow-up. Demographic data, clinical information, laboratory data and medication characteristics from 2018 to 2020 were collected. Multiple logistic regression was used to identify the factors associated with frequent adjustments to antihypertensive drugs (≥ 1 per year). Main outcome measure Frequent adjustments to antihypertensive drugs. Results From 671 patients included in the study, 219 (32.6%) had frequent adjustments to antihypertensive drugs. Frequent adjustment to antihypertensive drugs was more likely to occur with follow-ups in multiple institutions (adjusted Odds Ratio [aOR] 1.244, 95% confidence interval [CI] 1.012, 1.530), use of traditional/complementary medicine (aOR 2.058, 95% CI 1.058, 4.001), poor medication adherence (aOR 1.563, 95% CI 1.037, 2.357), change in estimated glomerular filtration rate (aOR 0.970, 95% CI 0.951, 0.990), and albuminuria categories A2 (aOR 2.173, 95% CI 1.311, 3.603) and A3 (aOR 2.117, 95% CI 1.349, 3.322), after controlling for confounding factors. Conclusion This work highlights the importance of close monitoring of patients requiring initial adjustments to antihypertensive drugs. Antihypertensive drug adjustments may indicate events that could contribute to poorer outcomes in the future.

Iterative automatic global registration algorithm for multi-view point cloud of underground tunnel space

Aiming at the narrow and long tunnel structure, few internal features, and a large amount of point cloud data, the existing registration algorithms and commercial software registration results are not ideal, an iterative global registration algorithm is proposed for massive underground tunnel point cloud registration, which is composed of local initial pose acquisition and global adjustment. Firstly, the feature point coordinates in the point cloud are extracted, and then the station-by-station registration is performed according to the Rodrigues matrix. Finally, the registration result is considered as the initial value of the parameter, and the global adjustment of all observations is carried out. The observation values are weighted by the selection weight iteration method and the weights are constantly modified in the iteration process until the threshold conditions are met and the iteration stops. In this paper, the experimental data, made up of 85 stations of point cloud data, are from the Xiamen subway tunnel, which is about 1300 m long. When the accumulated error of station-to-station registration is too large, several stations are regarded as partial wholes, and the optimal registration is achieved through multiple global adjustments, and the registration accuracy is within 5 mm. Experimental results confirm the feasibility and effectiveness of the algorithm, which provides a new method for point cloud registration of underground space tunnel.

Adapting an In-person Transdiagnostic Social Skills Program to Online Delivery: Technology to the Rescue

Social skills intervention programs have demonstrated treatment efficacy in session but putting that knowledge into practice is a critically important component. It requires simultaneous development of related essential skills, like emotion regulation and resilience. Additionally, transdiagnostic treatment methodologies, which are more cost-effective and increase accessibility, have become increasingly popular. However, accessibility remains a problem for in-person programs. LUNCH Groups® (www. lunchgroups.com), an in-person transdiagnostic program, incorporated various technology-based assessment and intervention elements as part of the original program design. These included a customized online assessment tool, home generalization app, computer animation projects, and online parent webinars. Their inclusion paved the way for a quick pivot to telehealth-based services while maintaining HIPAA compliance. The original in-person program is described along with the steps taken in the switch to telehealth, outlining the benefits and challenges that resulted. Attendance and attrition data indicated no problems after an initial adjustment period that coincided with the onset of the pandemic. Survey data indicated general satisfaction with the revised program structure and curriculum, with significant gains approximating those seen in the in-person version.

Spontaneous eye blink activity during slitlamp-based assessments

ABSTRACT Clinical relevance Slitlamp‐type assessments of eye blink activity with head and chin support need to consider time‐related differences that can occur. Background Previous studies have not assessed the predictability of changes in spontaneous eye blink rate occurring during slitlamp observations. Methods Video recordings were made of eye blink activity of 85 young adults who were either emmetropic or spectacle wearers for refractive errors between −8.25 D and +8.25 D. After an initial adjustment period of one to two minutes positioned at the slitlamp (including the time after removing spectacles), participants had a five minutes recording made in silence while seated with forehead and chin support and directing their gaze to a high‐contrast target on a distant whiteboard under ambient luminance of 35 cd per square metre. Results The mean spontaneous eye blink rate values over five minutes were 13.4 ± 3.1 blinks/minute (± SD), ranging from 7.4 to 20.8 blinks/minute. Overall, incomplete eye blink events were noted 39 times in the total of 5,704 recorded (that is, 0.68 per cent of all eye blinks). There was a progressive decline in averaged spontaneous eye blink rate values (r = 0.897, p < 0.05), with 70.6 per cent of the participants exhibiting a higher spontaneous eye blink rate value in the first minute compared to the fifth minute. The inter‐participant variability in spontaneous eye blink rate also progressively declined over time, but there was no detectable difference in either averaged values or the variability in spontaneous eye blink rate in relation to refractive error. Conclusions In slitlamp‐based assessments of eye blink activity, a small progressive time‐related reduction appears likely but is not obviously related to visual blur in ametropic individuals.

Trunk kinematic variability as a function of time during the early phase of a repetitive lifting task

AbstractLift‐to‐lift variability occurs in repetitive lifting tasks due to alterations in the lifting techniques used by the lifter, resulting in variability in lower back tissue loading. Understanding how trunk variability changes with time in the initial phases of a lifting bout may provide insights into the risk of injury during work startup. The purpose of this study was to quantify the variation of lifting kinematics and kinetics during the initial phase of a lifting bout. Twenty participants performed a repetitive lifting task continuously for 30 min. The load was equivalent to 10% of each participant's body weight and lifting was done at a rate of six lifts/min. Kinematic variables (three‐dimensional range of motion, angular velocity, and angular acceleration) of the trunk were measured using the Lumbar Motion Monitor and a dynamic biomechanical model estimated peak L5/S1 moment and spine compression. The variances of these variables were compared across 10‐min intervals: 0–10 min, 10–20 min, and 20–30 min. Results indicate a significant reduction in the variance of the peak sagittal acceleration, the sagittal range of motion, the transverse range of motion, peak sagittal moment, and peak spine compression between the first and second time intervals, followed by no significant change in variance between the second and third intervals. The downward trend in variation of these kinematic and kinetic variables suggests an initial adjustment period as the lifters reach a steady state of their lifting technique. The reduced variance of spinal loading may reduce the probability that a tissue tolerance is exceeded.

How To Prescribe And Troubleshoot Continuous Renal Replacement Therapy: A Case-Based Review.

Continuous RRT (CRRT) is the preferred dialysis modality for solute management, acid-base stability, and volume control in patients who are critically ill with AKI in the intensive care unit (ICU). CRRT offers multiple advantages over conventional hemodialysis in the critically ill population, such as greater hemodynamic stability, better fluid management, greater solute control, lower bleeding risk, and a more continuous (physiologic) approach of kidney support. Despite its frequent use, several aspects of CRRT delivery are still not fully standardized, or do not have solid evidence-based foundations. In this study, we provide a case-based review and recommendations of common scenarios and interventions encountered during the provision of CRRT to patients who are critically ill. Specific focus is on initial prescription, CRRT dosing, and adjustments related to severe hyponatremia management, concomitant extracorporeal membrane oxygenation support, dialysis catheter placement, use of regional citrate anticoagulation, and antibiotic dosing. This case-driven simulation is made as the clinical status of the patient evolves, and is on the basis of step-wise decisions made during the care of this patient, according to the specific patient's needs and the logistics available at the corresponding institution.

Pediatric Acquired Disability: Child and Parental Adjustment

Pediatric acquired disability challenges children and their parents as they adjust to a new reality of physical impairment. This longitudinal study explored the association between severity of children’s acquired disability and children and parents’ adjustment six weeks after diagnosis (T1) and three-four months later (T2), particularly focusing on parental perception of illness and of parent–child interactions. The participants were 140 parents of children with acquired disability who were hospitalized in pediatric or rehabilitation departments at three major medical centers in Israel. Parents completed questionnaires on background information, parental illness perception, perception of parent–child interactions, and child and parents’ adjustment. Physicians and nurses completed a questionnaire on disability severity indexes. The results revealed that severity of child’s disability correlated positively with parental illness perception and adjustment, but not with parental perception of parent–child interactions. At both time points, parents’ adjustment correlated negatively with illness perceptions and positively with perception of parent–child interactions. Parents’ adjustment was partially associated with children’s adjustment. Children and parents’ adjustment improved over time, as the severity of the child’s disability decreased and parental illness perception eased. Parental perception of parent–child interactions did not change significantly. Parents’ initial adjustment at T1 correlated with their children’s subsequent adjustment, but not vice versa. The study showed that parental adjustment affects children’s adjustment to the acquired disability, and demonstrated the role of parental perception. Early identification of parents at risk might facilitate appropriate professional intervention.

Psychological distress in North America during COVID-19: The role of pandemic-related stressors.

The COVID-19 pandemic has wreaked havoc on lives around the globe. In addition to the primary threat of infection, widespread secondary stressors associated with the pandemic have included social isolation, financial insecurity, resource scarcity, and occupational difficulties. The current study examined the impact of these disruptions on psychological distress during the initial adjustment phase to the pandemic in North America. A sample of 2463 residents of the US and Canada completed both baseline and follow-up surveys across several weeks between March and May 2020. Those participants perceiving stress related to higher levels of personal threat to health and to the well-being of family members at baseline reported higher levels of depressive symptoms at follow-up, even after controlling for baseline depressive symptoms. In addition, pandemic-related secondary stressors (social isolation, financial insecurity, occupational difficulty, and resource scarcity) were all independently associated with depressive symptoms at follow-up, controlling for both baseline depression and perceived health threats. The results were robust and held up after controlling for demographic factors. Women, young adults, and those who reported lower income were all at higher risk for subsequent depressive symptoms. Findings from the present study can help to identify key groups at risk for mental health problems during the pandemic, and indicate actionable areas for targeted intervention.

Evaluation of the critical points of the most adequate nonlinear model in adjusting growth data of ‘green dwarf’ coconut fruits

Abstract ‘Green Dwarf’ coconut is a fruit of great economic interest, since all its components are used, in addition to water, its main component. It is a culture of humid tropics, widely produced in northeastern Brazil, being an important income source for the region. The phenology study of this type of fruit is extremely important, but there are few studies in literature. Regression models, especially nonlinear growth models, can be of great value to understand how fruit growth behaves. The scarcity of works of this nature may be linked to some difficulties in estimating parameters of nonlinear models, such as assigning initial values to the itterative process. Overcoming this difficulty, for regression analysis, linear or not, several steps need to be respected to ensure the validity of information. Much information can be extracted from nonlinear growth models, such as the asynotic value, growth rate and critical points (maximum acceleration point, inflection point, maximum deceleration point and asynotic deceleration point). The aim of this work was to describe the stages of nonlinear regression analysis and to estimate the critical points of ‘Green Dwarf ’ coconut growth curves. After initial adjustments, the only unmet assumption was independence, adding a first order autoregressive term. Again, models were adjusted and all parameters were significant, with both models, Gompertz and Logistic, adjusting well to data, with slight advantage for the Logistic model with better adjustment quality criteria values, with maximum expected LED and LEDKP values of 21.4037 cm and 21.5478 cm, respectively. The x and y axis of critical points were estimated, with values that can help producers to make more objective decisions about the appropriate time to harvest coconut fruits, considering the most diverse uses of this type of fruit.

Peculiarities of Intersystemic Correlation Relationships of M-Response and F-Wave Characteristics in the Forearms Symmetric Muscles Which Participate in the Implementation of Multiple Coordinated Bimanual Movements

The organization of combined voluntary goal directed movements of hands has remained a serious scientific problem with a pronounced applicable nature. Insufficiency of a procedural framework and clear quantitative and qualitative criteria causes gaps and difficulties in professional selection, the effectiveness diagnosis of work-out session in sports and rehabilitation within remedial treatment. The aim of the investigation is to study the adjustment and co-adjustment of the effector apparatus elements, which are the basis of bimanual coordination, in the groups of male and female trial subjects. In the following study, based on informed consent in accordance with the ethics committee requirements, 75 subjects (39 men and 36 women) at the age of 18-20 took part. F-wave and M-response parameters registration was carried out by means of NMA-4-01 “NEUROMIAN” neuromyoanalyzer (Taganrog, Russia) according to the standard method. It has been established that the nerve centers responsible for the work of homonymous muscles in the right and left forearms, innervating synergists and antagonists, are to a certain extent in the initial adjustment and co-adjustment according to the level of activity, which determines not only the moment of the excitement onset, but also the speed of its irradiation. The revealed manifestations of adjustment and co-adjustment have pronounced sex differences. Proceeding from the fact that female trial subjects have a lower level of bimanual movements if compared with men, it can be assumed that the revealed features of correlational relationships determine, to a certain extent, coordination abilities of men and women.

Anaerobic digestion of dissolved air floatation slurries: Effect of substrate concentration and pH

Dissolved air floatation (DAF) slurries are an unconventional substrate for anaerobic digestion owing to their high COD concentrations, mainly consisting of lipids. Batch anaerobic digestion of DAF slurry was conducted to investigate the methane production through dilution of the slurry (with mineral salt medium, MSM) and by adjusting the initial pH (to 6.0, 5.5, 5.0 and 4.5) The performance of two different inocula, namely waste activated sludge (WAS) treating domestic wastewater and anaerobic granular sludge (AGS) treating dairy wastewater, was compared. The DAF slurry had a pH of 7.03 ( ± 0.07), conductivity of 6.69 ( ± 0.54) mS/cm, and a COD and ammonium concentration of 85.96 ( ± 8.32) g/L and 168.49 ( ± 1.79) mg N/L, respectively. DAF slurry without dilution produced a maximum methane yield of 58.60 ( ± 1.97) mL/g COD after 30 days of incubation. Dilution with MSM up to three folds, improved the methane yield by about 67%–105% and 67%–177% with WAS and AGS as the inoculum, respectively. Higher methane productivity was achieved at an inoculum to substrate ratio of at least 1.5 for WAS and 2.0 for AGS, respectively. AGS was more effective with a 20% increase in methane production from 3-fold diluted DAF slurry when compared with WAS. Adjustment of the initial pH of the DAF slurry to 6.0 resulted in a methane yield of 359.71 ( ± 32.72) mL/g COD, which was 23% higher than the control without pH adjustment. This study demonstrated that the methane yield from DAF slurries can be enhanced through substrate dilution and initial pH adjustment. • Methane yield enhanced by 23% upon adjustment of initial pH of the DAF slurry to 6.0. • 3-fold dilution increased methane production rate by 275% with granular sludge. • Anaerobic granular sludge is an efficient inoculum for methanogenesis of DAF slurry. • Lag phase duration was not shortened by dilution or pH adjustment of the DAF slurry. • Optimal inoculum to substrate ratio at least 1.5 and 2.0 for WAS and AGS, respectively.

Development and Validation of a Method for Ionic Dyes Determination in Guava Fibrous Matrix Using Reverse Phase Chromatography

In this work, a method for food dyes determination in fibrous fruit pulps was developed. The analytes Tartrazine, Twilight Yellow FCF, Erythrosine, Orange G and Allura Red were analyzed by reverse phase chromatography with diode array (DAD) detection. The sample preparation consisted of a simple procedure, based on initial pH adjustment of the sample (pH = 10.0), followed by an extraction with acetonitrile (5.0 mL and agitation for 30 s), ultrasonic (5 min) and centrifugation (4000 rpm, 20 ºC, for 20 min). The supernatant had its pH adjusted to 3.0, followed by filtration. The method was validated, with the analytical curves prepared in a matrix, in the range of 50 to 150 mg kg-1 for all the analytes studied (determination coefficients (R2) &gt; 0.99). The method veracity was evaluated in terms of recovery, obtaining recoveries of 93-110%. The repeatability was less than 13.7%, while the intermediate precision was less than 19.0%. The limits of detection and quantification were determined, being 15 and 30 mg kg-1, respectively. The combined relative uncertainties were less than 13.8%. Therefore, it can be concluded that a simple method was developed, suitable for monitoring the presence of dyes in fruit pulps in routine analyzes.

Simulation of a low-voltage distribution network when arranging voltage stabilizers

A computer algorithm for optimal voltage regulation using voltage stabilizers is presented. The applied voltage stabilizers are suitable for operation with radial distribution networks, taking into account various load models. The proposed algorithm makes the initial selection, installation, and adjustment of voltage stabilizers, which provide smooth voltage regulation throughout the network, using the existing algorithms, which are appropriately modified and optimized. The algorithm is fast, efficient, and reliable, which is confirmed by its practical application in distribution networks.

1329. Vancomycin Therapeutic Drug Monitoring: How to hit the Curve

BackgroundFor the management of serious S. aureus infections, area-under-the curve to minimum inhibitory concentration (AUC/MIC) applied dosing is recommended as the preferred method to goal trough-based monitoring. This pharmacodynamic dosing demonstrates efficacy with optimized exposure and decreased nephrotoxicity. While two levels are ideal for estimating AUC/MIC mathematically, the logistics and costs may outweigh the benefits of this approach. This study will compare AUC/MIC estimates using two single-level pharmacokinetic calculators (C2 and C3) and a Bayesian dosing calculator (C1) versus steady-state troughs.MethodsA retrospective cohort study using a data repository to identify patients from 2019 included patients on intravenous vancomycin for greater than 48 hours with a steady state trough. Patients on dialysis or with unstable renal function were excluded. Vancomycin AUC/MIC and peak levels were estimated using C1, C2, and C3. The objective was to assess correlation of trough levels of 10-20mcg/ml to an AUC/MIC of 400-600 mg∙h/L. Secondary outcomes included examining the difference in R-squared values of the three calculators, and the percentage of patients with dose adjustments.Results55 patients met inclusion criteria. Of 55 troughs, 78% were 10-20mcg/ml and 5% were >20mcg/ml. On average, the three calculators found 85% of all initial troughs and 93% of therapeutic troughs correlated to an AUC >400. However, less than half of therapeutic troughs corresponded to an AUC of 400-600 mg∙h/L. Nearly 70% of patients had one or more dose adjustments often for unclear reasons as the AUC/MIC target of 400-600 mg∙h/L was met in 29-63% of initial adjustments. The three different calculators showed noticeable variability in calculating AUC/MIC.Figure 1 Figure 2 Figure 3 ConclusionA weak relationship between AUC/MIC and steady state troughs was found. Excess vancomycin exposure was demonstrated in 39% of therapeutic troughs. Over 25% of dose adjustments were deemed unnecessary. Utilizing AUC/MIC estimates for vancomycin may limit excess exposure while reducing the overall number of drug levels. Selecting a single-level calculator is problematic with the high degree of variation between calculators.Figure 4 Disclosures All Authors: No reported disclosures

Laboratory Scale Production of Lithium Manganese Oxide as Active Material of Lithum-Ion Batteries in Sol-Gel Method Assisted by Local Biomass

Experimental and theoretical studies of the production of lithium manganese oxide (LiMn2O4) using sol-gel method have been carried out on a larger scale than previous studies. The purpose of this investigation was to observe sample behavior along the synthesis process to be considered in further scale-up production of lithium manganese oxide, based on the sol-gel method. Calcination products were analyzed by TGA and crystalline phase formation analyzed by XRD. LiMn2O4 spinel phase was formed at 600oC. SEM showed some interesting morphology. Xerogel swelling was observed overwhelmingly during drying at 250oC to 300oC. Exothermic occurrence as a source of irregular and unpredictable auto combustion in the calcination process. Both phenomenon were not observed in a xerogel made with a small amount precursor. Therefore, initial mixture adjustment and additional steps were considered for production.

The impact of sea-level rise and basin area reduction on the cyclic behavior of tidal inlet systems

Ebb-tidal deltas filter incoming wave energy and mitigate erosion of basins and coasts by temporarily providing sediment. In many systems, these coastal safety functions are under threat from human activities. Here we use Delft3D/SWAN to assess the effects of relative sea-level rise and changes in basin area on the long-term dynamics of ebb-tidal deltas. The results show that the time scales of the cyclic channel-shoal dynamics of ebb-tidal deltas are affected. An instantaneous decrease in basin area slows down the cyclic behavior during the initial adjustment period. The duration of the adjustment period increases with larger basin area reduction. After the adjustment, smaller basins have shorter time scales of cyclic channel-shoal dynamics. This is linked to a decrease in tidal prism and ebb-tidal delta volume. Moreover, we find that the effects of relative sea-level rise depend on the rate of rising water levels. For relatively low rates, the period of the cycles eventually shortens, whereas higher rates can cause longer periods. The volume of ebb-tidal deltas appears to be unaffected by relative sea-level rise; but because the average water depth increases, more energetic waves reach the basin. By showing how ebb-tidal deltas adjust to relative sea-level rise and basin area reduction and by unraveling the underlying mechanisms, this study contributes to our understanding of the long-term evolution of tidal inlets.

Rationality research of the adjustment law for the blade pitch angle of H-type vertical-axis wind turbines

Pitch angle greatly affects the performance of VAWT. Aiming at the maximum value of CT, this study first obtains the theoretical optimal angles of attack, i.e., 17.7° and −18.4° in upwind and downwind zones. A 2.5D model is simulated using Fluent to determine the magnitude and direction of induced velocity, and an initial pitch angle adjustment law is obtained combining the proposed local TSR. Compared with a prototype wind turbine, CP is increased by 2.69% after applying the initial adjustment law. The fitting curve angle δ at the abrupt part of pitch angle is analyzed. The smaller the angle δ is, the more evident the performance improvement of VAWT becomes. CP is increased by 11.68% when the angle is δ = 0°. On this basis, the adjustment law corresponding to δ = 0° of 100°<azimuth angle θ < 250°, where CT is low, is modified locally. At this time, CP is improved by 14.56%. Lastly, the change of the shaft’s synthetic force is analyzed. Compared with no various pitch, that with the adjustment law shows an increased average value of synthetic force and a decreased fluctuation. Moreover, the fluctuation of the shaft’s synthetic force under the action of the local adjustment law is the smallest.

More than moving online: Implications of the COVID-19 pandemic on curriculum development.

With the dust settled, but not yet cleared, on initial adjustments to education during COVID‐19, 10 author groups offer reflections on next steps for 10 areas of practice.

Embodiment of Wearable Technology: Qualitative Longitudinal Study.

BackgroundCurrent technology innovations, such as wearables, have caused surprising reactions and feelings of deep connection to devices. Some researchers are calling mobile and wearable technologies cognitive prostheses, which are intrinsically connected to individuals as if they are part of the body, similar to a physical prosthesis. Additionally, while several studies have been performed on the phenomenology of receiving and wearing a physical prosthesis, it is unknown whether similar subjective experiences arise with technology.ObjectiveIn one of the first qualitative studies to track wearables in a longitudinal investigation, we explore whether a wearable can be embodied similar to a physical prosthesis. We hoped to gain insights and compare the phases of embodiment (ie, initial adjustment to the prosthesis) and the psychological responses (ie, accept the prosthesis as part of their body) between wearables and limb prostheses. This approach allowed us to find out whether this pattern was part of a cyclical (ie, period of different usage intensity) or asymptotic (ie, abandonment of the technology) pattern.MethodsWe adapted a limb prosthesis methodological framework to be applied to wearables and conducted semistructured interviews over a span of several months to assess if, how, and to what extent individuals come to embody wearables similar to prosthetic devices. Twelve individuals wore fitness trackers for 9 months, during which time interviews were conducted in the following three phases: after 3 months, after 6 months, and at the end of the study after 9 months. A deductive thematic analysis based on Murray’s work was combined with an inductive approach in which new themes were discovered.ResultsOverall, the individuals experienced technology embodiment similar to limb embodiment in terms of adjustment, wearability, awareness, and body extension. Furthermore, we discovered two additional themes of engagement/reengagement and comparison to another device or person. Interestingly, many participants experienced a rarely reported phenomenon in longitudinal studies where the feedback from the device was counterintuitive to their own beliefs. This created a blurring of self-perception and a dilemma of “whom” to believe, the machine or one’s self.ConclusionsThere are many similarities between the embodiment of a limb prosthesis and a wearable. The large overlap between limb and wearable embodiment would suggest that insights from physical prostheses can be applied to wearables and vice versa. This is especially interesting as we are seeing the traditionally “dumb” body prosthesis becoming smarter and thus a natural merging of technology and body. Future longitudinal studies could focus on the dilemma people might experience of whether to believe the information of the device over their own thoughts and feelings. These studies might take into account constructs, such as technology reliance, autonomy, and levels of self-awareness.

Understanding Human Neural Control of Short-term Gait Adaptation to the Split-belt Treadmill

Many studies of split-belt treadmill adaptation have been focused on the biomechanical changes that occur in response to walking on belts at different speeds. This process of adaptation, and the ensuing aftereffects that are present when participants return to typical treadmill walking, have inspired the potential use of the split-belt treadmill as a rehabilitation tool. However, a full systematic review of the current split-belt treadmill literature has not yet been published to consolidate what is known about how the human central nervous system (CNS) controls adaptation to this type of symmetry perturbation. A systematic literature search identified 55 studies that investigated the neural control of human gait adaptation to a split-belt treadmill. Studies of infants and manipulated sensory feedback in healthy adults suggest that the initial gait adjustments to split-belt walking are reliant on proprioceptive feedback to inform central pattern generators to modify lower limb muscle activation patterns appropriately. Simultaneously, this literature suggested that proprioceptive and visual feedback inform supraspinal centres for motor planning and motor output to adapt and store a new and efficient gait pattern to walk on belts at different speeds. However, evidence from participants with brain injury (post-stroke, cerebellar lesions) suggest that injury impedes, but does not completely take away, the ability to adjust and adapt aspects of the gait pattern to split-belts. The model proposed from this review provides the overarching roles of the CNS in the adaptation process, specifically in short-term, and potential sites of focus within the human CNS for future rehabilitation-based work.