Placement Settings Research Articles

Adaptive Rank-Based Selection of Geological Realizations for Optimum Field Development Planning

SummaryUncertainties are present in many decision-making processes. In field development planning, these uncertainties, typically represented by a set of geological realizations, need to be propagated in response to any proposed alternative (solution). Incorporation of the full set of realizations results in the oil and gas field development optimization problem—where either an algorithm iteratively tries to find the best solution from all the possible alternatives or the best solution must be selected from a set of predefined engineering judgment-driven development scenarios (i.e., set of either well control or well placement settings)—becoming computationally demanding. As such, realization subset selection techniques are required to reduce the computational overhead. We first introduce a reformulation of the subset selection problem to one that aims at ensuring consistent ranking of alternatives between those obtained by the full set and the selected subset. We argue that this should be the ultimate goal of any subset selection technique in such problems. In addition, we also propose a technique which selects a subset that minimizes the difference between the rankings obtained by the full set and subset, for a small batch of alternatives. The key idea, which we investigate thoroughly, is that there is a positive association between the goodness (in terms of ranking alternatives) of the subset selected using a small batch of alternatives and its fidelity in ranking other alternatives. Unlike previous methods, this technique does not depend on selecting subjective (static) properties to perform the subset selection nor does it rely only on flow-response vectors of a base-case scenario. In this work, the proposed technique is assessed using well placement and well control development alternatives to determine the applicability within field development planning. Additionally, the proposed subset selection technique is implemented in an adaptive scheme to solve a well placement optimization problem. The results are promising as the proposed technique consistently selects subsets that are able to rank development alternatives in a similar manner to the full set regardless of the type of development strategy (well control settings or well placement). Furthermore, the implementation of the proposed technique in an adaptive scheme is able to reduce the computational costs, on average, by a factor close to 9 without compromising the solution found for well placement optimization.

An Exploratory Study of Allied Health Students' Experiences of Electronic Medical Records During Placements.

Allowing students to access and document in electronic medical records (eMRs) during clinical placements is viewed as critical for ensuring that graduates have a high level of digital proficiency prior to entering the workforce. Limited studies have explored student access to eMRs in health disciplines outside of medicine and nursing. Our main objective was to examine allied health students' experiences and perceptions of the opportunity to develop eMR competencies during their placement, across a range of allied health disciplines and placement settings. An explanatory sequential design was used, comprising a quantitative survey (n = 102) followed by qualitative semi-structured interviews (n = 6) with senior allied health students to explore their experiences and perceptions of eMR access during placements. Of the 93 students who responded to the question about their placement eMR, nine (10%) reported their placement site did not use an eMR and four students reported that they were not allowed to access the eMR during their placement. Most students (64%, 54 out of 84) accessed the system using their own credentials, but 31% (26 out of 84) used someone else's log-in and password. Students were satisfied with the eMR training and support received while on placement, but there was significant variability across sites on the level of training and support provided. All students believed that eMR access was beneficial for learning and preparation for work, improved delivery of care, taking ownership of work, and feeling responsible for patient care. Providing students with access to eMRs during placements is fundamental to the development of a student's professional identity and to recognizing their role in the delivery of interprofessional patient care. For graduates to be equipped to effectively contribute to multi-disciplinary care in a digital health environment, universities need to work with practice partners to standardize and formalize eMR access, registration, training, and support, and to provide students with early exposure and training on eMRs in university courses.

What sociodemographic and work characteristics are associated with musculoskeletal complaints in nursing students? A cross-sectional analysis of repeated measurements

Musculoskeletal complaints (MSCs) arise during nursing education. We examined cross-sectional associations between self-reported MSCs and both sociodemographic and workplace characteristics in different clinical placement settings. We included two observations among three cohorts of third-year Dutch nursing students (total N = 711) of the undergraduate nursing program of Rotterdam University of Applied Sciences. Questionnaire data on sociodemographic, physical and psychosocial work characteristics, and MSCs were used. Generalized estimating equation analysis for repeated measurements with backward elimination was used to examine associations with MSCs.In total, 79% of students experienced MSCs. Female sex (OR 0.37, 95% CI 0.22–0.62), lifting and bending (OR 1.01, 95% CI 1.00–1.03), physical job demands (OR 2.33, 95% CI 1.68–3.22) and need for recovery (OR 1.02, 95% CI 1.01–1.03), were statistically significantly associated with overall MSCs. Models for regional complaints are also presented in this article. Nursing school and clinical placement staff should consider these factors when dealing with nursing students with MSCs.

Peripheral IV Administration of Hypertonic Saline: Single-Center Retrospective PICU Study.

To determine the frequency and characteristics of complications of peripherally administered hypertonic saline (HTS) through assessment of infiltration and extravasation. Retrospective cross-sectional study. Freestanding tertiary care pediatric hospital. Children who received HTS through a peripheral IV catheter (PIVC). None. We conducted a single-center retrospective review from January 2012 to 2019. A total of 526 patients with 1,020 unique administrations of HTS through a PIVC met inclusion criteria. The primary endpoint was PIVC failure due to infiltration or extravasation. The indication for the administration of HTS infusion was collected. Catheter data was captured, including the setting of catheter placement, anatomical location on the patient, gauge size, length of time from catheter insertion to HTS infusion, in situ duration of catheter lifespan, and removal rationale. The administration data for HTS was reviewed and included volume of administration, bolus versus continuous infusion, infusion rate, infusion duration, and vesicant medications administered through the PIVC. There were 843 bolus infusions of HTS and 172 continuous infusions. Of the bolus administrations, there were eight infiltrations (0.9%). The continuous infusion group had 13 infiltrations (7.6%). There were no extravasations in either group, and no patients required medical therapy or intervention by the wound care or plastic surgery teams. There was no significant morbidity attributed to HTS administration in either group. HTS administered through a PIVC infrequently infiltrates in critically ill pediatric patients. The infiltration rate was low when HTS is administered as a bolus but higher when given as a continuous infusion. However, no patient suffered an extravasation injury or long-term morbidity from any infiltration.

Evaluation of the ideal length of the Seldinger needle for internal jugular vein catheter placement

Placement of central venous catheters (CVC) into the internal jugular vein represents a routine clinical intervention. The periprocedural complication rate ranges from 5 to 20% and can be reduced by ultrasound guidance, training of residents and other measures. We aimed to proof that the average Seldinger needle is too long, increasing the risk of periprocedural injury, best epitomized in the stellate ganglion injury/irritation. The first part of the study was an online market analysis to investigate the standard needle length currently offered as part of the CVC placement sets. The second part of the study involved 35 hospitalized patients (14 female; median age 74.5 years). In those the distance between the skin and the internal jugular vein as well as the diameter of the internal jugular vein was measured by ultrasound in both, supine position as well as 45° semi-sitting position. In the third part of the study 80 body donors (45 female; median age 83.0 years) preserved by the ethanol/formaldehyde method were studied. In those the distance and angle between the typical landmark for insertion of the Seldinger needle for internal jugular vein catheter placement to the stellate ganglion was measured. The median [interquartile range] Seldinger needle length was 7 [4.0–10.0] cm. In the examined patients the maximum distance between the skin and the internal jugular vein was 1.87 cm. The minimum distance was 0.46 cm and the median distance averaging supine and 45° position was 1.14 [0.94–1.31] cm. Regarding the body donors the median distance from the insertion point of the internal jugular vein to the stellate ganglion was longer in men 5.5 [4.95–6.35] cm than in women 5.2 [4.7–5.9] (p = 0.031 unpaired t-test). With 7 cm average length the Seldinger needle currently sold as part of CVC sets is long enough to physically reach the stellate ganglion, not to mention more proximal structures. A shorter needle length would be sufficient to reach the internal jugular vein even in obese patients and with a small insertion angle while minimizing the possibility to cause severe injury as structures like the pleura and the stellate ganglion could not be reached by shorter needles.

Preservice Teachers’ Pedagogical Mobility: A Case Study about Classroom Preparedness and Flexibility in a Disrupted Professional Placement Context

The COVID-19 pandemic has shifted the contextual matters of education at all levels, for example, geographic location, community engagement in education and socioeconomic factors, to mention some contextual matters. Awareness of these matters stimulates critical reflections on the depth of preservice teachers’ pedagogical content and pedagogical knowledge. This paper examines preservice teachers’ pedagogical mobility in periods that rely on disruptive innovation. Preservice teachers’ placement settings changed rapidly because of COVID-19 regulations which impacted face-to-face and online teaching and learning environments. This investigation focused on professional learning under the ambit of teacher education, which up to now has been focused on face-to-face teaching pedagogies. The rapidly changing context has made the classroom the pedagogical anchor of education theory and practice. Using a reflective case study approach, we investigated (a) preservice teachers’ pedagogical challenges, (b) the meaning of pedagogical flexibility and innovative pedagogical mobility, and (c) the application of teacher performance and teaching standards in a teaching and learning environment affected by COVID-19. The critical self-reflective narratives offer insight into lived experiences and multiple contextual challenges that raise questions about well-prepared preservice teachers.

Experiences of Physiotherapy Students, Health Care Providers, and Patients with a Role-Emerging Student Clinical Placement in an Emergency Department: A Qualitative Study.

Purpose: To understand the experiences and perspectives of physiotherapy (PT) students, their clinical instructor, nurses, physicians, and patients with a role-emerging student clinical placement in an emergency department (ED) and to identify barriers and facilitators in implementing this placement model. Method: We conducted qualitative semi-structured interviews with 6 PT students, 1 PT clinical instructor, 15 nurses, 12 physicians, and 17 patients. Five researchers independently coded the transcribed interviews and performed thematic analysis in an interpretive description tradition with frequent peer debriefing and reflexive discussions. Results: Students and their clinical instructor reported that the placement setting provided a unique learning opportunity. Patients and ED staff noted that involving the PT students in patient care delivery improved the musculoskeletal assessments and self-management advice provided to patients. Identified barriers included students' inability to chart in the electronic medical record, lack of bed space, and lack of clarity about students' scope and abilities. Reported facilitators included positive perceptions of the students' supervision and a perceived positive impact on patient care and the health care team. Conclusions: Participants reported positive experiences with the student ED placement and recommended similar placements in the future. Understanding barriers and facilitators in implementing PT student clinical placements in an ED can inform future placements.

Propofol-an alternative to sevoflurane for laryngeal mask airway insertion in children

Supraglottic devices like laryngeal mask airway (LMA) is used in children for anesthesia as it induces least hemodynamic stress response. We have carried out this trial to measure the potency of induction agents like propofol with sevoflurane for conditions of LMA placement in pediatric surgery. 60 children were included in our study and were split into two groups. Children in group S were induced with sevoflurane 8vol%. Children in group P were induced with propofol at 3 mg/kg IV. Proper size of LMA was inserted. Induction time, insertion time, LMA placement conditions and hemodynamic abnormalities were assessed. Induction time was shorter with group P contrary to S group. (p<0>0.05) There was no remarkable difference in various LMA insertion conditions and LMA insertion score in both groups. Hemodynamic changes were comparable in group S and P. Propofol and sevoflurane revealed equivalent and suitable LMA placement settings. So propofol may be a good substitute to sevoflurane for placement of LMA in children in a recourse limited setting. Keywords: Sevoflurane, Propofol, Laryngeal mask airway, Children.

Evaluating the Clinical Reasoning of Student Health Professionals in Placement and Simulation Settings: A Systematic Review.

(1) Background: Clinical reasoning is essential to the effective practice of autonomous health professionals and is, therefore, an essential capability to develop as students. This review aimed to systematically identify the tools available to health professional educators to evaluate students’ attainment of clinical reasoning capabilities in clinical placement and simulation settings. (2) Methods: A systemic review of seven databases was undertaken. Peer-reviewed, English-language publications reporting studies that developed or tested relevant tools were included. Searches included multiple terms related to clinical reasoning and health disciplines. Data regarding each tool’s conceptual basis and evaluated constructs were systematically extracted and analysed. (3) Results: Most of the 61 included papers evaluated students in medical and nursing disciplines, and over half reported on the Script Concordance Test or Lasater Clinical Judgement Rubric. A number of conceptual frameworks were referenced, though many papers did not reference any framework. (4) Conclusions: Overall, key outcomes highlighted an emphasis on diagnostic reasoning, as opposed to management reasoning. Tools were predominantly aligned with individual health disciplines and with limited cross-referencing within the field. Future research into clinical reasoning evaluation tools should build on and refer to existing approaches and consider contributions across professional disciplinary divides.

Influence of User Mobility and Antenna Placement on System Loss in B2B Networks

In this paper, the influence of user mobility and on-body antenna placement on system loss in body-to-body communications in indoor and outdoor environments and different mobility scenarios is studied, based on system loss measurements at 2.45 GHz. The novelty of this work lies on the proposal of a classification model to characterise the effect of user mobility and path visibility on system loss, allowing to identify the best set of on-body antenna placements. To quantify the influence of visibility and mobility on the average system loss, a combined score is proposed, allowing to map system loss onto the degree of visibility and mobility that depends on the scenario being considered and on on-body antenna placements. Overall, a good agreement is observed between the proposed classification model and the average measured values of system loss, with the higher values of combined scores being associated with lower values of systems loss. For the cases under study, the average values of system loss are 61.6 dB for the cases of the antennas being positioned only on the front of the body and/or the head, and 64.5 dB if at least one of the antennas is placed on an arm.

Supporting student nurses to develop healthy conversation skills.

As advocates for health, nurses are ideally situated to deliver effective health promotion in their daily interactions with people. This work evaluates the integration of healthy conversation training, making every contact count (MECC), into a health promotion module in an undergraduate nursing degree at a higher education institute (HEI). In all, 108 students completed the online questionnaire I year after receiving healthy conversation training. 67% of students reported the regular or occasional use of healthy conversation skills and identified a wide range of scenarios where they had used the skills. 65% of students used health action planning framework in their own personal self-care. Student nurses acknowledged barriers and enablers to their use of healthy conversation skills. Having knowledgeable mentors who role modelled healthy conversations skills in their consultations was the most frequently raised factor, in addition to lack of knowledge of local resources, time and confidence. All placement settings should ensure that registered nurses, especially those undertaking mentorship responsibilities have access to healthy conversation training.

S2208 Primary Squamous Cell Carcinoma as a Long-Term Complication of Percutaneous Endoscopic Gastrostomy Placement

Introduction: Common complications associated with percutaneous endoscopic gastrostomy (PEG) placement include aspiration, bleeding, leakage, irritation, abdominal pain, and infection. Previous case reports have described the PEG site as a location for metastatic malignancy, especially in the setting of head and neck cancers (often an indication for PEG placement). We present a rare case of primary squamous cell carcinoma (SCC) which developed in the setting of long-term PEG placement. Case Description/Methods: Patient is a 51-year-old woman with developmental delay and dystonia secondary to DYT1 gene mutation. Given her developmental delay, a PEG was placed for nutritional support and had been in place for thirty-two years. She presented with a 2-cm abscess at her PEG site and was discharged with oral antibiotics following incision and drainage (I+D). She noted persistent leakage of bloody and foul-smelling drainage from her PEG tube (figure 1). She returned with worsening irritation surrounding the PEG site and was noted to have a 5x7 cm area of erythema with overlying fluctuant abscess. Again, she underwent I+D and was started on IV antibiotics. Cross sectional imaging demonstrated irregular soft tissue thickening involving the greater curvature of the stomach, adjacent to the PEG site, extending into the gastrostomy tube tract. A biopsy of the skin surrounding the PEG tube was performed and demonstrated well-differentiated and invasive SCC. A subsequent PET scan showed locally invasive disease with PEG site involvement extending into the abdominal wall. There were no additional areas concerning for malignancy (no indications of an alternative primary site). Given the burden of locally invasive disease, surgical resection was deferred and she was offered palliative radiation. Discussion: The development of SCC at the PEG site is an uncommon occurrence and previous case reports typically describe these events as metastasis from a head/neck primary site. There has been at least one additional documented case of primary SCC at the PEG site but this occurred in an immunosuppressed patient. Chronic irritation of the skin, which is a known complication of PEG placement, possibly contributed to the development of SCC in this patient. Aggressive wound care and close monitoring for suspicious mucosal changes should be considered in patients with long-term PEG placement.Figure 1.: Squamous Cell Carcinoma along the PEG site.

UAV Swarm Position Optimization for High Capacity MIMO Backhaul

A swarm of cooperating UAVs communicating with a distant multiantenna ground station can leverage MIMO spatial multiplexing to scale the capacity. Due to the line-of-sight propagation between the swarm and the ground station, the MIMO channel is highly correlated, leading to limited multiplexing gains. In this paper, we optimize the UAV positions to attain the maximum MIMO capacity given by the single user bound. An infinite set of UAV placements that attains the capacity bound is first derived. Given an initial swarm placement, we formulate the problem of minimizing the distance traveled by the UAVs to reach a placement within the capacity maximizing set of positions. An offline centralized solution to the problem using block coordinate descent is developed assuming known initial positions of UAVs. We also propose an online distributed algorithm, where the UAVs iteratively adjust their positions to maximize the capacity. Our proposed approaches are shown to significantly increase the capacity at the expense of a bounded translation from the initial UAV placements. This capacity increase persists when using a massive MIMO ground station. Using numerical simulations, we show the robustness of our approaches in a Rician channel under UAV motion disturbances.

Interrupting White Supremacy in Field Education

As social work’s signature pedagogy, field education socializes students into their professional roles as practitioners. However, for students and field instructors of color, racial microaggressions add another dimension to the practice experience. Utilizing findings from a qualitative study exploring the experiences of Black, Indigenous, and People of Color (BIPOC) social work students and agency-based field instructors, this paper highlights experiences of microaggressions in field placement settings. Specifically, BIPOC students and field instructors described being tokenized in agencies, feeling invisible in placement settings, experiencing microaggressions from service users or students, and witnessing microaggressions. Experiences of microaggressions had emotional impacts, and affected participants’ sense of professional identity and confidence. Based on findings, we share recommendations for addressing racial microaggressions within social work field education in order to promote racial equity, including: grounding microaggressions in an ecological approach, unpacking the concept of professionalism, and building capacity of field instructors and agencies to respond to racism and microaggressions. Addressing microaggressions in field education is necessary to support BIPOC students in field placements, honor the work and well-being of racialized social workers who serve as field instructors, disrupt white supremacy, and move the social work field forward in regard to anti-racist practice.

Revisiting Diary Entries from Care: An Exposition of the Challenges of Unregulated Placement Settings

In September 2020, the Children’s Commissioner for England published a report entitled ‘Unregulated: Children in care living in semi-independent accommodation’, which concluded that some of the country’s most vulnerable looked after children were living in accommodation unfit for human habitation. This observation encapsulates my experience of residing in such a placement between 2009 and 2011. In this article, I refer to diary entries I made during this period, which are photographed and categorised into three areas — challenges I encountered at a micro, meso, and macro level. Following each section, I provide reflection, contextual information, and propose what may have ameliorated these issues. The photographed diary extracts are personal; they were never intended to be published. However, given that the future of England’s care system hangs in the balance in the context of the Independent Care Review, they are offered as insights into the impact of unregulated placements on the physical and mental wellbeing of children. The article proposes that such settings are unsuitable for children and young people who have not yet reached adulthood and should be abandoned in favour of nurturing homes which enable them not just to barely survive, but truly thrive.

MARS: mmWave-based Assistive Rehabilitation System for Smart Healthcare

Rehabilitation is a crucial process for patients suffering from motor disorders. The current practice is performing rehabilitation exercises under clinical expert supervision. New approaches are needed to allow patients to perform prescribed exercises at their homes and alleviate commuting requirements, expert shortages, and healthcare costs. Human joint estimation is a substantial component of these programs since it offers valuable visualization and feedback based on body movements. Camera-based systems have been popular for capturing joint motion. However, they have high-cost, raise serious privacy concerns, and require strict lighting and placement settings. We propose a millimeter-wave (mmWave)-based assistive rehabilitation system (MARS) for motor disorders to address these challenges. MARS provides a low-cost solution with a competitive object localization and detection accuracy. It first maps the 5D time-series point cloud from mmWave to a lower dimension. Then, it uses a convolution neural network (CNN) to estimate the accurate location of human joints. MARS can reconstruct 19 human joints and their skeleton from the point cloud generated by mmWave radar. We evaluate MARS using ten specific rehabilitation movements performed by four human subjects involving all body parts and obtain an average mean absolute error of 5.87 cm for all joint positions. To the best of our knowledge, this is the first rehabilitation movements dataset using mmWave point cloud. MARS is evaluated on the Nvidia Jetson Xavier-NX board. Model inference takes only 64 s and consumes 442 J energy. These results demonstrate the practicality of MARS on low-power edge devices.

Optimization of Phasor Measurement Unit Placement Using Several Proposed Case Factors for Power Network Monitoring

Recent developments in electrical power systems are concerned not only with static power flow control but also with their control during dynamic processes. Smart Grids came into being when it was noticed that the traditional electrical power system structure was lacking in reliability, power flow control, and consistency in the monitoring of phasor quantities. The Phasor Measurement Unit (PMU) is one of the main critical factors for Smart Grid (SG) operation. It has the ability to provide real-time synchronized measurement of phasor quantities with the help of a Global Positioning System (GPS). However, when considering the installation costs of a PMU device, it is far too expensive to equip on every busbar in all grid stations. Therefore, this paper proposes a new approach for the Optimum Placement of the PMU problem (OPP problem) to minimize the installed number of PMUs and maximize the measurement redundancy of the network. Exclusion of the unwanted nodes technique is used in the proposed approach, in which only the most desirable buses consisting of generator bus and load bus are selected, without considering Pure Transit Nodes (PTNs) in the optimum PMU placement sets. The focal point of the proposed work considers, most importantly, the case factor of the exclusion technique of PTNs from the optimum PMU locations, as prior approaches concerning almost every algorithm have taken PTNs as their optimal PMU placement sets. Furthermore, other case factors of the proposed approach, namely, PMU channel limits, radial bus, and single PMU outage, are also considered for the OPP problem. The proposed work is tested on standard Institute of Electrical and Electronics Engineering (IEEE)-case studies from MATPOWER on the MATLAB software. To show the success of the proposed work, the outputs are compared with the existing techniques.

Nursing students\u2019 experience with clinical placement in nursing homes: a focus group study

BackgroundA renewed interest in nursing homes as clinical placement settings for nursing students has been prompted by the growing healthcare needs of an ageing population. However, if future nurses are to be enthusiastic about working in this healthcare context, it is essential that higher education institutions that educate nurses and nursing homes that provide placement experiences to students do so with a supportive, positive, and enriched approach.MethodsTo explore first-year nursing students’ placement experience in nursing homes, we conducted an exploratory qualitative study in three city-based nursing homes in western Norway. Thirteen first-year nursing students participated in the study. Three focus group interviews were conducted to explore the students’ placement experiences. Data were analysed using thematic analysis. The findings were reported using the Standards for Reporting Qualitative Research (SRQR).ResultsThe analysis describes five themes relating to first-year students’ placement experience in nursing homes; (1) variations in utility of pre-placement orientation and welcome at placement site; (2) a challenging learning environment; (3) spending considerable placement time with non-registered nurses; (4) considerable variability in supervision practices; and (5) a vulnerable and demanding student role.ConclusionsThe research provides insight into the contextual characteristics encountered by first-year students that influence the quality of their placement experiences. Consequently, these characteristics impede access to important role models who lend support to a student’s growth and professional development, preventing full utilisation of the learning potential offered in nursing homes. Hence, we propose that targeted efforts are warranted to foster positive placement experiences and enhance students’ clinical education in nursing homes.

Learning to become evidence based social workers: student views on research education and implementation in practice

ABSTRACT Professional guidelines for social workers in relation to research use in practice, present social workers as consumers, rather than producers of research evidence. This approach aligns with a growing emphasis on the use of evidence-based practice within social work. This paper reports on a small mixed methods study with a cohort of BA social work students (N = 38) with two aims: 1) to understand the experiences of students learning research at undergraduate level and 2) to explore how their learning and placement experiences interact and influence their development as ‘research-minded’ practitioners of the future. Descriptive statistics of the quantitative data and thematic analysis of focus groups are presented. Our findings support the existing literature relating to social work students attitudes to research, including feelings of anxiety and perceptions of difficulty, while also viewing it as important to their careers. We also found that within placement settings, students encounter negative, often dismissive views of research and experience little in the way of role-modelling of evidence-based practice. We consider these findings in light of the promotion of EBP in UK social work, and how this may influence our teaching of research and evidence use to future student cohorts.

Habituation After Deep Brain Stimulation in Tremor Syndromes: Prevalence, Risk Factors and Long-Term Outcomes.

Deep brain stimulation (DBS) of the thalamus is an effective treatment for medically refractory essential, dystonic and Parkinson's tremor. It may also provide benefit in less common tremor syndromes including, post-traumatic, cerebellar, Holmes, neuropathic and orthostatic tremor. The long-term benefit of DBS in essential and dystonic tremor (ET/DT) often wanes over time, a phenomena referred to as stimulation “tolerance” or “habituation”. While habituation is generally accepted to exist, it remains controversial. Attempts to quantify habituation have revealed conflicting reports. Placebo effects, loss of micro-lesional effect, disease related progression, suboptimal stimulation and stimulation related side-effects may all contribute to the loss of sustained long-term therapeutic effect. Habituation often presents as substantial loss of initial DBS benefit occurring as early as a few months after initial stimulation; a complex and feared issue when faced in the setting of optimal electrode placement. Simply increasing stimulation current tends only to propagate tremor severity and induce stimulation related side effects. The report by Paschen and colleagues of worsening tremor scores in the “On” vs. “Off” stimulation state over time, even after accounting for “rebound” tremor, supports the concept of habituation. However, these findings have not been consistent across all studies. Chronic high intensity stimulation has been hypothesized to induce detrimental plastic effects on tremor networks, with some lines of evidence that DT and ET may be more susceptible than Parkinson's tremor to habituation. However, Tsuboi and colleague's recent longitudinal follow-up in dystonic and “pure” essential tremor suggests otherwise. Alternatively, post-mortem findings support a biological adaption to stimulation. The prevalence and etiology of habituation is still not fully understood and management remains difficult. A recent study reported that alternating thalamic stimulation parameters at weekly intervals provided improved stability of tremor control consistent with reduced habituation. In this article the available evidence for habituation after DBS for tremor syndromes is reviewed; including its prevalence, time-course, possible mechanisms; along with expected long-term outcomes for tremor and factors that may assist in predicting, preventing and managing habituation.