Amount Of Movement Research Articles

High quality rehabilitation to optimize return to sport following lateral meniscus surgery in football players.

There is a paucity of studies in the literature pertaining about how to guide rehabilitation and return to sport (RTS) progression for football players that have sustained a lateral meniscus injury and subsequent surgery. These patients are clinically challenging. If they return to sport too soon, before the rehabilitation process is completed and RTS criteria have been met, functional outcomes could be non-optimal and/or associated with higher reinjury risk. The aims of this paper are (I) to provide a brief overview of the current trends in acute lateral meniscus tears surgery in football players and (II) to suggest a framework for clinicians on how to progress the player following lateral meniscus surgery. Post-operative rehabilitation approaches are different for meniscus repair and for the other surgical techniques. The main goal of all involved practitioners should be to balance the "short term success" with the "long term protection" of the athlete's health. Specific key goals and interventions in early-, mid-, and late-stage rehabilitation are provided. The most important principle is to manage the progressive increase in loading through multiple measurements including frequent medical control consultations and functional tests detailing movement quantity and quality. RTS monitoring needs to be comprehensive and interdisciplinary, incorporating state of the art tests, to achieve recovery of sport-specific fitness, optimal movement quality and on-field rehabilitation progression.

Effect of epidural spinal cord stimulation after chronic spinal cord injury on volitional movement and cardiovascular function: study protocol for the phase II open label controlled E-STAND trial

IntroductionSpinal cord injury (SCI) leads to significant changes in morbidity, mortality and quality of life (QOL). Currently, there are no effective therapies to restore function after chronic SCI. Preliminary studies...

Effects of Intensive Vibratory Treatment with a Robotic System on the Recovery of Sensation and Function in Patients with Subacute and Chronic Stroke: A Non-Randomized Clinical Trial.

Background: Sensory–motor deficits are frequent and affect the functionality after stroke. The use of robotic systems to improve functionality and motor performance is advisable; therefore, the aim of the present study was to evaluate the effects of intensive, high-frequency vibration treatment administered with a robotic system in subacute and chronic stroke patients in terms of upper limb sensitivity, motor function, quantity and quality of movement, and quality of life. Methods: A simple-blind, non-randomized controlled trial was conducted. The control group received conventional rehabilitation treatment and the experimental group received robotic treatment with an Amadeo® robot in addition to their conventional rehabilitation sessions. Results: Intragroup analysis identified significant improvements in the experimental group in hand (p = 0.012), arm (p = 0.018), and shoulder (p = 0.027) sensitivity, as well as in motor function (FMA-UEmotor function, p = 0.028), integration of the affected limb (MAL-14amount scale, p = 0.011; MAL-14How well scale, p = 0.008), and perceived quality of life (SIS-16, p = 0.008). The measures between the control and experimental groups showed statistically significant differences in motor performance and spontaneous use of the affected limb (MAL-14amount scale, p = 0.021; MAL-14How well scale, p = 0.037). Conclusions: Intensive, high-frequency vibration with a robotic system, in combination with conventional intervention, improves the recovery of upper limb function in terms of quantity and quality of movement in patients with subacute and chronic stroke.

Movement quantity and quality: How do they relate to pain and disability in dancers?

This field-based study aimed to determine the association between pre-professional student dancers' movement quantity and quality with (i) pain severity and (ii) pain related disability. Pre-professional female ballet and contemporary dance students (n = 52) participated in 4 time points of data collection over a 12-week university semester. At each time point dancers provided self-reported pain outcomes (Numerical Rating Scale as a measure of pain severity and Patient Specific Functional Scale as a measure of pain related disability) and wore a wearable sensor system. This system combined wearable sensors with previously developed machine learning models capable of capturing movement quantity and quality outcomes. A series of linear mixed models were applied to determine if there was an association between dancers' movement quantity and quality over the 4 time points with pain severity and pain related disability. Almost all dancers (n = 50) experienced pain, and half of the dancers experienced disabling pain (n = 26). Significant associations were evident for pain related disability and movement quantity and quality variables. Specifically, greater pain related disability was associated with more light activity, fewer leg lifts to the front, a shorter average duration of leg lifts to the front and fewer total leg lifts. Greater pain related disability was also associated with higher thigh elevation angles to the side. There was no evidence for associations between movement quantity and quality variables and pain severity. Despite a high prevalence of musculoskeletal pain, dancers' levels of pain severity and disability were generally low. Between-person level associations were identified between dancers' movement quantity and quality, and pain related disability. These findings may reflect dancers' adaptations to pain related disability, while they continue to dance. This proof-of-concept research provides a compelling model for future work exploring dancers' pain using field-based, serial data collection.

KELEMBABAN UDARA DENGAN ALAT HUMYDIMETER PADA LAHAN SAWAH DI KELURAHAN TANAH MERAH

Humidity is the concentration of water vapor in the air. In agriculture, air humidity is associated with increased productivity and development of cultivated plants, humidity in the environment where it grows can determine the selection of appropriate plant species, the purpose of this study was to determine air humidity in paddy fields between April, May , and June, changes in air humidity at any time describe the water vapor content in the air can be expressed as absolute humidity, relative or vapor pressure deficit, relative humidity compares the actual water vapor content/pressure with its saturation state or the air's capacity to accommodate water vapor. The relationship between air humidity in paddy fields in Tanah Merah Village is relatively low, this is the impact of changes in temperature, quantity and quality of radiation, wind movement, air pressure, vegetation, and availability of water and productivity of irrigated ricefields

Random and Short-Term Excessive Eye Movement in Children with Autism During Face-to-Face Conversation

This study investigated the oculomotor performance in children with autism spectrum disorder (ASD) during a face-to-face conversation. A head mounted eye tracker recorded the eye movements in 20 children with ASD and 23 children with typical development (TD). Group comparisons were conducted on the randomness and the quantity of eye movement. The amount of time needed to reveal group difference was also examined. Results showed that the randomness of eye movement was significantly higher at all examined time durations, and the amount of eye movement was significantly greater within 3s in the ASD group. These findings demonstrated an atypical pattern of oculomotor dynamics in children ASD, which might facilitate the objective identification of ASD during daily social interaction.

Physiotherapy and related management for childhood obesity: A systematic scoping review.

IntroductionDespite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.MethodA scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via “file:pdf”. A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.ResultsFrom the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.ConclusionWhen managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

Total Face Approach (TFA) 3D Cephalometry and Superimposition in Orthognathic Surgery: Evaluation of the Vertical Dimensions in a Consecutive Series.

Background: Cephalometry is fundamental in diagnosis, analysis, and planning of orthodontic-surgical treatment as it reveals skeletal relationship between the upper and lower jaw as well as facial aesthetic parameters. Nevertheless, 3D cephalometry has still not become the exam of choice in orthognathic treatment even though today CBCT (Cone Beam Computed Tomography) is routinely used in other branches of dentistry. Methods: In a sample of 13 patients undergoing bimaxillary orthognathic surgery a chin-vertex CBCT exam was prescribed prior to orthodontic treatment (OT) and 12 months after surgery (T1). The DICOM files uploaded to MaterialiseSimplant Ortho software pro 2.1 (Materialise Co., Leuven, Belgium) were analyzed following the multiplane 3D Total Face cephalometry protocol (TFA). Results: Results comparing pre-op and post-op TFA 3D cephalometry, were then evaluated considering reference values reported in literature. The CBCT, carried out pre- and post-surgery, were subsequently analyzed employing the superimposition method using cranial base as reference. The aim of this study is to evaluate the advantages and disadvantages of the two methods in orthognathic surgery. Conclusions: Multiplane 3D TFA allows the clinician to locate where major or minor skeletal discrepancies are found with respect to ideal parameters and is also useful in classifying skeletal intermaxillary relation. The superimposition method is highly intuitive but does not provide information on the quantity and location of osteotomic movement.

The effects of active and non-active virtual reality games on experimentally induced pain in young, healthy adults

Separately, both physical activity and virtual reality (VR) have the ability to attenuate pain sensitivity in healthy adults. What is not known is whether VR combined with physical activity could have a greater pain reducing effect compared to non-active VR distraction. The purpose of this study was to determine whether playing active VR games would have a greater hypoalgesic effect than non-active VR games. Participants (n=36) played three different active VR games (Beat Saber, Holopoint, and Hot Squat) and one non-active VR game (Relax Walk VR) for 15 minutes on four different visits. During gameplay, participants wore accelerometers on the thigh, wrist, and waist to measure the intensity and quantity of movement. Pressure pain thresholds (PPTs) were measured on the forearm and thigh toward the beginning of the session (familiarization PPT's), immediately prior to gameplay (pretest), and immediately following each gaming bout (posttest). Results showed no significant changes in PPT's from the familiarization PPT trials to the pretest PPT trials. However, the repeated measures ANOVA revealed an overall hypoalgesic effect of the VR games on the forearm, regardless of game type. Results also showed a significant hypoalgesic effect on the thigh following VR gameplay for Hot Squat, Holopoint, and Relax Walk VR. The magnitude of pain reduction was significantly greater during Hot Squat compared to the other games. Analysis of the accelerometer data indicated that Hot Squat elicited greater whole-body and lower body moderate to vigorous physical activity compared to the other games. In conclusion, VR gameplay exerted a hypoalgesic effect on experimental pressure pain. Additionally, the data provided evidence of a potential additive hypoalgesic effect of VR and whole-body physical activity on pressure pain sensitivity. Separately, both physical activity and virtual reality (VR) have the ability to attenuate pain sensitivity in healthy adults. What is not known is whether VR combined with physical activity could have a greater pain reducing effect compared to non-active VR distraction. The purpose of this study was to determine whether playing active VR games would have a greater hypoalgesic effect than non-active VR games. Participants (n=36) played three different active VR games (Beat Saber, Holopoint, and Hot Squat) and one non-active VR game (Relax Walk VR) for 15 minutes on four different visits. During gameplay, participants wore accelerometers on the thigh, wrist, and waist to measure the intensity and quantity of movement. Pressure pain thresholds (PPTs) were measured on the forearm and thigh toward the beginning of the session (familiarization PPT's), immediately prior to gameplay (pretest), and immediately following each gaming bout (posttest). Results showed no significant changes in PPT's from the familiarization PPT trials to the pretest PPT trials. However, the repeated measures ANOVA revealed an overall hypoalgesic effect of the VR games on the forearm, regardless of game type. Results also showed a significant hypoalgesic effect on the thigh following VR gameplay for Hot Squat, Holopoint, and Relax Walk VR. The magnitude of pain reduction was significantly greater during Hot Squat compared to the other games. Analysis of the accelerometer data indicated that Hot Squat elicited greater whole-body and lower body moderate to vigorous physical activity compared to the other games. In conclusion, VR gameplay exerted a hypoalgesic effect on experimental pressure pain. Additionally, the data provided evidence of a potential additive hypoalgesic effect of VR and whole-body physical activity on pressure pain sensitivity.

The United States of Europe: A Gravity Model Evaluation of the Four Freedoms

One of the pillars of the 1957 Treaty of Rome that ultimately led to the European Union is the commitment to the four freedoms of movement (goods, services, persons, and capital). Over the following decades, as the members expanded in numbers, they also sought to deepen the integration amongst themselves in all four dimensions. This paper estimates the success of these policies based primarily on a gravity framework. Distinct from past evaluations, we augment the traditional equation for international flows with the corresponding intra-national flows, permitting us to distinguish welfare-improving reductions in frictions from Fortress-Europe effects. We complement the gravity approach by measuring the extent of price convergence. We compare both quantity and price assessments of free movement with corresponding estimates for the 50 American states.

A Study and Analysis of Improved Binary Pattern Technique in Dynamic Images

A dynamic image has a distinct quantity of object movement from one to another. It can be any object such as a car, person, an object moving from one point X to another point Y. Image consists of a sense of movement. Applications of object tracking are biometrics tracking, AR uses, video surveillance, passage monitoring, vehicle navigation, etc. Challenges in tracking multifaceted objects are fast movement, geometric conversion, blurring, messy background, artifacts, etc. To resolve this problem by merge all small features with nearby texture features. Texture feature describes the plane space and configuration of an area. A mixture of color and texture feature improves the object details and to increase the strength of the object's illustration. In Existing methods such as binary pattern method all object features are removed, so it is difficult to predict the exact pixel movement. The proposed method of improved binary pattern is also tracking the small changes in the pixel difference in one frame to other. Compared with the existing algorithms, IBP method measures the spatial arrangement of local image texture which reduces the overall processing cost and improves the strength of objective image. To track the similarities and difference of the object in each and every frame efficiently and effectively Improved Local Binary Pattern tracking algorithm was proposed. This proposed technique is an effective way to analysis complicated real time situations compared with other methods.

Meeting movement quantity or quality return to sport criteria is associated with reduced second ACL injury rate.

The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.

Different Eye Movement Behaviors Related to Artificial Visual Field Defects–A Pilot Study of Video-Based Perimetry

Visual field defects (VFDs) can be caused by numerous diseases, some of which (e.g., glaucoma) are the main causes of blindness in humans. The present perimetry, which is defined as the measurement of visual field function, has high requirements for patients such as long-term fixation and reliable interaction with the system. In this pilot study, we combined the videos and eye-tracking techniques in a free-watching task and explored the different eye movement behaviors of people with several types of artificial VFDs, such as hemianopia, altitudinal VFDs, and tunnel vision. We carried out the task in a gaze-contingent modality where 38 participants with normal vision were recruited to watch a group of videos monocularly. The eye gaze data were recorded by the tracker during the task. We hypothesized that people with simulated VFDs will produce a more active eye movement coping mechanism to compensate for their visual field disadvantage. A new measurement called eye movement amount (MA) was proposed to describe the amount of eye movement toward a specific direction. Statistically significant differences caused by artificial VFDs were observed by comparing the MA values between the VFD groups and the control group. In addition, we found artificial hemianopia and inferior VFDs lead participants to produced increased MA in the horizontal and vertical directions respectively. Artificial tunnel vision, on the contrary, induces a decreased MAs in both horizontal and vertical directions. The proposed metrics can be used as potential biomarkers for distinguishing VFDs in a free-watching task.

Relationships between accelerometry and general compensatory movements of the upper limb after stroke

BackgroundStandardized assessments are used in rehabilitation clinics after stroke to measure restoration versus compensatory movements of the upper limb. Accelerometry is an emerging tool that can bridge the gap between in- and out-of-clinic assessments of the upper limb, but is limited in that it currently does not capture the quality of a person’s movement, an important concept to assess compensation versus restoration. The purpose of this analysis was to characterize how accelerometer variables may reflect upper limb compensatory movement patterns after stroke.MethodsThis study was a secondary analysis of an existing data set from a Phase II, single-blind, randomized, parallel dose–response trial (NCT0114369). Sources of data utilized were: (1) a compensatory movement score derived from video analysis of the Action Research Arm Test (ARAT), and (2) calculated accelerometer variables quantifying time, magnitude and variability of upper limb movement from the same time point during study participation for both in-clinic and out-of-clinic recording periods.ResultsParticipants had chronic upper limb paresis of mild to moderate severity. Compensatory movement scores varied across the sample, with a mean of 73.7 ± 33.6 and range from 11.5 to 188. Moderate correlations were observed between the compensatory movement score and each accelerometer variable. Accelerometer variables measured out-of-clinic had stronger relationships with compensatory movements, compared with accelerometer variables in-clinic. Variables quantifying time, magnitude, and variability of upper limb movement out-of-clinic had relationships to the compensatory movement score.ConclusionsAccelerometry is a tool that, while measuring movement quantity, can also reflect the use of general compensatory movement patterns of the upper limb in persons with chronic stroke. Individuals who move their limbs more in daily life with respect to time and variability tend to move with less movement compensations and more typical movement patterns. Likewise, individuals who move their paretic limbs less and their non-paretic limb more in daily life tend to move with more movement compensations at all joints in the paretic limb and less typical movement patterns.

Verification of a classification prediction method for the development of musical expression in early childhood using a machine learning method based on 3D motion capture data

It is widely acknowledged that children take developmental steps in performing musical expression through body movement dynamics. The author presents an approach to verify the method of classification prediction by machine learning using multiple classifiers to evaluate and classify the developmental degree of musical expressions in early childhood. The author addresses this potential solution by showing statistical analysis of full-body 3D motion captured data using such statistical analysis, and applies machine learning measures to predict developmental degrees of musical expression.
 In 2016, the author extracted the feature quantities of movement based on the results of the movement analysis of the musical expressions in the MEB program regarding 3-year-old, 4-year-old, and 5-year-old children (n=76). The developmental degree of musical expression was classified into three stages based on video analysis of the musical expression of each child. The 2016 training data as the feature quantity of movement (factors) and the three-stage evaluation (categorical dependent variables) were used as the model training for machine learning. Based on the results in 2017 with 2018, the classification model training results were applied to the acquired data (n=87) in 2019.
 The result of sensitivity analysis showed that the moving average acceleration of pelvis, the moving distance of right foot and the moving distance of right hand had a strong influence on the development of musical expression in early childhood. From those analysis results, the appropriateness of the machine learning method using decision trees for classifying the developmental degree of musical expression in early childhood was verified.

Characterizing upper extremity motor behavior in the first week after stroke.

BackgroundAnimal models of brain recovery identify the first days after lesioning as a time of great flux in sensorimotor function and physiology. After rodent motor system lesioning, daily skill training in the less affected forelimb reduces skill acquisition in the more affected forelimb. We asked whether spontaneous human motor behaviors of the less affected upper extremity (UE) early after stroke resemble the animal training model, with the potential to suppress clinical recovery.MethodsThis prospective observational study used a convenience sample of patients (n = 25, mean 4.5 ±1.8) days after stroke with a wide severity range; Controls were hospitalized for non-neurological conditions (n = 12). Outcome measures were Accelerometry, Upper-Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), Shoulder Abduction/ Finger Extension Test (SAFE), NIH Stroke Scale (NIHSS).ResultsAccelerometry indicated total paretic UE movement was reduced compared to controls, primarily due to a 44% reduction of bilateral UE use. Unilateral paretic movement was unchanged. Thus, movement shifted early after stroke; bilateral use was reduced and unilateral use of the non-paretic UE was increased by 77%. Low correlations between movement time and motor performance prompted an exploratory factor analysis (EFA) revealing a 2-component solution; motor performance tests load on one component (motor performance) whereas accelerometry-derived variables load on a second orthogonal component (quantity of movement).ConclusionsEarly after stroke, spontaneous overall UE movement is reduced, and movement shifts to unilateral use of the non-paretic UE. Two mechanisms that could influence motor recovery may already be in place 4.5 ± 1.8 days post stroke: (1) the overuse of the less affected UE, which could set the stage for learned non-use and (2) skill acquisition in the non-paretic limb that could impede recovery. Accurate UE motor assessment requires two independent constructs: motor performance and quantity of movement. These findings provide opportunities and measurement methods for studies to develop new behaviorally-based stroke recovery treatments that begin early after onset.

Influence of Purposeful Activities on Upper Extremity Motor Performance: A Systematic Review.

Following upper extremity injury, exercise-approaches are commonly used to address motor impairments. Occupation-based approaches are also used but less widely promoted and their mechanisms of action not well-understood. Movement performed during purposeful activities and occupations may yield better motor performance than during nonpurposeful tasks. This review investigated the influence of engagement in purposeful activities and occupations on upper extremity motor performance in healthy and musculoskeletal populations. Databases were searched for studies in healthy or upper extremity musculoskeletal-injured adults that compared motor performance during purposeful activities against nonpurposeful movements. Twenty-one studies of moderate quality, conducted predominantly in healthy populations, were included. Upper extremity movement quantity and quality were enhanced when performed during purposeful conditions. Purposeful activities have potential to be used following injury to enhance movement and address motor impairments to a greater extent than is currently promoted. Research in musculoskeletal populations is required.

DETERMINATION OF THE POWER INTERACTION OF THE HYDRO TURBINE GRID WITH A FLUID FLOW FOR A DOUBLE-ROTOR MICRO HYDRO POWER PLANT

The problem in given article consists in definition of power interaction of a lattice of the turbine witha liquid stream. The moment on the driving wheel is equal to change of the moment of quantity of movement of aproceeding liquid. To find the moment and capacity on a driving wheel shaft, it is necessary to define kinematicparameters of the stream which is flowing round a lattice of a wheel. At calculation new the blade systems the returnproblem of the theory of lattices is used. The return problem consists in definition of the form of a profile under theset law of distribution of speed (pressure) on a profile contour, and as in definition of power interaction of a streamand a lattice profile. For durability calculations of water-wheels it is necessary to know the hydrodynamic forcesoperating on the blade of the driving wheel. Analysis and study of the peculiarities of electromagnetic calculationdisk generator in static mode does not allow to evaluate the work make full disk generator. This regard, studies havebeen conducted dynamic mode disk generator. Studies and calculations were carried out by computer simulationusing the program «Ansoft Maxwell».Us essentially new design of micro hydroelectric power station with doublerotorthe hydro generator is offered.

An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments

ABSTRACT Background: Most literature on decision processes within physiotherapy relates to “reasoning that results in action” – decisions based on information including assessments that are gathered prior to treatment decisions. A process of “reasoning in interaction” that is often used, particularly by expert clinicians, has received less attention. Objective: To provide a theoretical and practical approach to applying reasoning in interaction in a musculoskeletal setting. Methods: The theory is: If an impairment that can be directly targeted by treatment (i.e. pain or limitation of passive movement) is related to patient’s active impairments and functional limitations, then moment-to-moment changes in the targeted impairment can be used as feedback to guide real-time treatment modification before formal reassessment of functional limitations and other impairments. Results: Applying the theory to manual therapy results in parameters of techniques such as force, speed, direction and duration no longer being pre-determined, but rather being continually adjusted in real-time according to feedback from the patient through both therapist perception (changes in movement quantity or quality) and patient verbal responses. Conclusion: A process of continuous decision-making is described that the authors believe is used by many experienced clinicians but has not previously been adequately described in the literature. .

Methods and tools for automated production of origin-destination flow maps

Abstract. Origin-destination flow maps represent movement between locations using lines of optionally varying width connecting points or areas. When flow lines intersect or overlap, legibility can be improved by curving flows to avoid each other, which is a time-consuming process to do by hand when there are many flows.We present a tool for ArcGIS Pro that implements a force-directed method developed by Jenny et al. (2017) for curving flows. This method reduces overlaps and intersections by curving flows away from nodes, other flows, and arrowheads, taking flow map design principles into account (Jenny et al., 2018). Users provide node coordinates and ids, and a table describing the volume of movement between the nodes. The tool produces two map layers, one containing curved flow lines, and another containing points that includes data about the total quantity of movement to and from each point. The new line and point layers are then added to a map in ArcGIS Pro. The width of each line represents the relative quantity of movement represented, and the diameter of each node represents the total movement in and out of that location. Users can opt to produce either net flows (the difference in movement between points) or total flows (the sum of movement between points in both directions). In the case of net flows, arrowheads are added to flows to indicate flow direction, and the ends of flows are clipped to prevent arrowheads from overlapping destination points. Arrowheads of smaller flows are made slightly larger to improve visibility. Users have several options to help reduce map clutter, including modifying the maximum width of flows and nodes, creating additional space between flows and their endpoints, and displaying only a selected number of the largest flows.We also introduce more advanced experimental features that we implemented in standalone prototype software. Our prototype can create parallel flow lines for bidirectional flows. This avoids inconsistently spaced opposing flow lines between a pair of origin and destination nodes. The prototype can shorten flow lines to reduce overlaps with other flows, nodes and arrowheads, and keep a minimum distance between flow lines. We will also discuss placing flow lines between areas instead of nodes and demonstrate an algorithmic implementation for creating flows between areas. Our prototype provides an easy-to-use graphical user interface and will be released as free and open-source software.