Evaluation of surgical skill using machine learning with optimal wearable sensor locations.

Evaluation of surgical skills during minimally invasive surgeries is needed when recruiting new surgeons. Although surgeons' differentiation by skill level is highly complex, performance in specific clinical tasks such as pegboard transfer and knot tying could be determined using wearable EMG and accelerometer sensors. A wireless wearable platform has made it feasible to collect movement and muscle activation signals for quick skill evaluation during surgical tasks. However, it is challenging since the placement of multiple wireless wearable sensors may interfere with their performance in the assessment. This study utilizes machine learning techniques to identify optimal muscles and features critical for accurate skill evaluation. This study enrolled a total of twenty-six surgeons of different skill levels: novice (n = 11), intermediaries (n = 12), and experts (n = 3). Twelve wireless wearable sensors consisting of surface EMGs and accelerometers were placed bilaterally on bicep brachii, tricep brachii, anterior deltoid, flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), and thenar eminence (TE) muscles to assess muscle activations and movement variability profiles. We found features related to movement complexity such as approximate entropy, sample entropy, and multiscale entropy played a critical role in skill level identification. We found that skill level was classified with highest accuracy by i) ECU for Random Forest Classifier (RFC), ii) deltoid for Support Vector Machines (SVM) and iii) biceps for Naïve Bayes Classifier with classification accuracies 61%, 57% and 47%. We found RFC classifier performed best with highest classification accuracy when muscles are combined i) ECU and deltoid (58%), ii) ECU and biceps (53%), and iii) ECU, biceps and deltoid (52%). Our findings suggest that quick surgical skill evaluation is possible using wearables sensors, and features from ECU, deltoid, and biceps muscles contribute an important role in surgical skill evaluation.

Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles.

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020-January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure-e.g., inequitable access to public benefits-may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.

Occupational therapy and physiotherapy education and workforce in Anglophone sub-Saharan Africa countries.

BACKGROUND: Sub-Saharan Africa (SSA) countries are faced with the challenge of educating a critical mass of occupational therapists (OTs) and physiotherapists (PTs) to meet the growing demand for health and rehabilitation services. The World Federation of Occupational Therapy (WFOT) and World Confederation of Physical Therapy (WCPT) have argued for the need of graduate-level training for OTs and PTs for decades. However, very few studies have been conducted to determine the availability of OT and PT training programs and practitioners in SSA countries. METHODS: Initial data were collected and compiled from an extensive literature search conducted using MEDLINE and PubMed to examine the availability of OT and PT education and training programs in SSA countries. Additional data were collected, compiled, and collated from academic institutions, ministries of health, health professions associations, and licensing authorities in SSA countries. Secondary data were also collected from the websites of organizations such as the World Bank, World Health Organization (WHO), WFOT, and WCPT. RESULTS: This investigation revealed that there are limited number of OT and PT training programs and that these training programs in Anglophone SSA countries are offered at or below the bachelor's level. More than half of the countries do not have OT or PT training programs. The number of qualified OTs and PTs appears to be insufficient to meet the demand for rehabilitation services. Nigeria and South Africa are the only countries offering post-entry-level masters and doctoral-level training programs in physiotherapy and occupational therapy. CONCLUSIONS: Higher learning institutions in SSA countries need to collaborate and partner with other regional and foreign universities to elevate the educational training and increase the supply of PTs and OTs in the region.

A case report of shoulder fatigue imbalance in wheelchair rugby: implications to pain and injury.

The purpose of this case-control study was to examine potential agonist-antagonist fatigue imbalance during wheelchair rugby activity. A 16-channel NORAXON electromyography (EMG) system 1400A with telemetry was used to assess EMG activity in a 39-year-old male with a C6 complete spinal cord injury (American Spinal Injury Association Impairment Scale (AIS) A), 17.5 years post injury. Mean amplitude and median frequency were determined for push-phase agonists (anterior deltoid and pectoralis major) and antagonist (posterior deltoid) across four training sessions at a community fitness and Paralympic training facility. Unlike continuous wheelchair pushing, acute muscle imbalances between agonists and antagonists (that is, push and recovery muscles) were not demonstrated. Wheelchair sports such as rugby may reduce risk of shoulder pain and overuse injury due to intermittent activity rather than continuous pushing. The current study is one of the first to document sport fatigue through electromyography during intermittent, live play rather than clinical conditions (that is, continuous pushing).

Reliability of Doppler and stethoscope methods of determining systolic blood pressures: considerations for calculating an ankle-brachial index.

PURPOSE: The purposes of this study were to: (1) identify the interrater and intrarater reliability of systolic blood pressures using a stethoscope and Doppler to determine an ankle-brachial index (ABI), and (2) to determine the correlation between the 2 methods. BACKGROUND: Peripheral arterial disease (PAD) affects approximately 8 to 12 million people in the United States, and nearly half of those with this disease are asymptomatic. Early detection and prompt treatment of PAD will improve health outcomes. It is important that clinicians perform tests that determine the presence of PAD. METHOD: Two individual raters trained in ABI procedure measured the systolic blood pressures of 20 individuals' upper and lower extremities. Standard ABI measurement protocols were observed. Raters individually recorded the systolic blood pressures of each extremity using a stethoscope and a Doppler, for a total of 640 independent measures. RESULTS: Interrater reliability of Doppler measurements to determine SBP at the ankle was very strong (intraclass correlation coefficient [ICC], 0.93-0.99) compared to moderate to strong reliability using a stethoscope (ICC, 0.64-0.87). Agreement between the 2 devices to determine SBP was moderate to very weak (ICC, 0.13-0.61). Comparisons of the use of Doppler and stethoscope to determine ABI showed weak to very weak intrarater correlation (ICC, 0.17-0.35). Linear regression analysis of the 2 methods to determine ABI showed positive but weak to very weak correlations (r2 = .013, P = .184). CONCLUSIONS: A Doppler ultrasound is recommended over a stethoscope for accuracy in systolic pressure readings for ABI measurements.

Biomechanics of muscular effort: age-related changes.

PURPOSE: The ability of older adults to perform activities of daily living (ADL) declines with age. One possible reason could be that older adults require substantially greater effort than younger adults to perform similar ADL. This study examined the effects of age on the biomechanics of muscular effort in healthy adults during isometric torque production tasks. METHODS: Thirty healthy adults [15 younger (8 males, 7 females, aged 29.3 +/- 5.53 yr) and 15 older (8 males, 7 females, aged 70.8 +/- 3.6 yr)] participated in this study. After the determination of maximal voluntary contraction (MVC) strength for both isometric elbow flexion and extension tasks using a dynamometer, the participants then produced isometric elbow flexion and extension joint torques that corresponded to effort levels of 1, 3, 5, 7, and 9 on a modified Borg-CR10 scale. The 10 conditions (2 tasks x 5 effort levels) were presented in random order. A three-way repeated-measures ANOVA was used to assess the effects of age, task, and effort level on absolute (N.m) and relative (% MVC) elbow joint torques. RESULTS: Older adults required significantly greater muscular effort to accomplish equivalent motor task performance as compared with younger adults for effort levels of 3, 5, 7, and 9 (P < 0.001). In addition, older adults demonstrated significantly greater muscular effort scaling error than younger subjects across all effort levels (P < 0.0001). CONCLUSION: There was an age-related increase in muscular effort during isometric elbow flexion and extension torque production tasks in healthy adults. Errors in muscular effort scaling exist, which increased as a function of both intensity (effort level) of motor task and age.