Self-Attention Based Vision Processing for Prosthetic Vision.

We investigate Self-Attention (SA) networks for directly learning visual representations for prosthetic vision. Specifically, we explore how the SA mechanism can be leveraged to produce task-specific scene representations for prosthetic vision, overcoming the need for explicit hand-selection of learnt features and post-processing. Further, we demonstrate how the mapping of importance to image regions can serve as an explainability tool to analyse the learnt vision processing behaviour, providing enhanced validation and interpretation capability than current learning-based methods for prosthetic vision. We investigate our approach in the context of an orientation and mobility (OM) task, and demonstrate its feasibility for learning vision processing pipelines for prosthetic vision.

Video See-Through Pipelines for Virtual Reality Headsets and their Impact on Gait.

This study investigated the impact of different video see-through pipelines in virtual reality on gait. A mobility task was conducted with healthy participants to evaluate the gait adaptions using different video see-through pipelines. The gait parameters observed for this study were stride length, maximum toe clearance and walking speed. The results showed an impact on gait where the gait parameters were reduced when participants used a high latency and restricted field of view pipeline. However, when participants used a pipeline with low latency and a field of view closer to normal vision, less impact on gait was achieved. As virtual reality poses a promising future for gait rehabilitation in patients with Parkinson's disease, this result highlights the need to carefully consider the video see-through pipeline and display characteristics when considering its use for gait rehabilitation or mobility studies in general.Clinical relevance- This study demonstrates the impact of virtual reality systems on gait using different video see- through pipelines during a mobility task. This may be useful for clinicians who use virtual reality in gait rehabilitation and aid them in choosing the most suitable virtual reality system for therapy.

Self-reported use of technology by orientation and mobility clients in Australia and Malaysia before the COVID-19 pandemic.

Since the 1960s, many electronic travel aids have been developed for people with low vision or blindness to improve their independent travel skills, but uptake of these specialist devices has been limited. This study investigated what technologies orientation and mobility (O&M) clients in Australia and Malaysia have, use, like, and want to support their travel, to inform technology research and development. This two-phase mixed-methods study surveyed O&M clients face-to-face in Malaysia (n = 9), and online in Australia (n = 50). Participants managed safe walking using a human guide, long cane, or guide dog when their vision was insufficient to see hazards, but a smartphone is now a standard travel aid in both Australia and Malaysia. Participants relied on smartphone accessibility features and identified 108 apps they used for travel: for planning (e.g., public transport timetables), sourcing information in transit (e.g., GPS location and directions, finding a taxi), sensory conversion (e.g., camera-to-voice, voice-to-text, video-to-live description), social connections (e.g., phone, email, Facebook), food (e.g., finding eateries, ordering online), and entertainment (e.g., music, games). They wanted to 'carry less junk', and sought better accessibility features, consistency across platforms, and fast, reliable, real-time information that supports confident, non-visual travel, especially into unfamiliar places.

Use of technology by orientation and mobility professionals in Australia and Malaysia before COVID-19.

PURPOSE: Orientation and Mobility (O&M) professionals teach people with low vision or blindness to use specialist assistive technologies to support confident travel, but many O&M clients now prefer a smartphone. This study aimed to investigate what technology O&M professionals in Australia and Malaysia have, use, like, and want to support their client work, to inform the development of O&M technologies and build capacity in the international O&M profession. MATERIALS AND METHODS: A technology survey was completed by professionals (n = 36) attending O&M workshops in Malaysia. A revised survey was completed online by O&M specialists (n = 31) primarily in Australia. Qualitative data about technology use came from conferences, workshops and interviews with O&M professionals. Descriptive statistics were analysed together with free-text data. RESULTS: Limited awareness of apps used by clients, unaffordability of devices, and inadequate technology training discouraged many O&M professionals from employing existing technologies in client programmes or for broader professional purposes. Professionals needed to learn smartphone accessibility features and travel-related apps, and ways to use technology during O&M client programmes, initial professional training, ongoing professional development and research. CONCLUSIONS: Smartphones are now integral to travel with low vision or blindness and early-adopter O&M clients are the travel tech-experts. O&M professionals need better initial training and then regular upskilling in mainstream O&M technologies to expand clients' travel choices. COVID-19 has created an imperative for technology laggards to upskill for O&M tele-practice. O&M technology could support comprehensive O&M specialist training and practice in Malaysia, to better serve O&M clients with complex needs.Implications for rehabilitationMost orientation and mobility (O&M) clients are travelling with a smartphone, so O&M specialists need to be abreast of mainstream technologies, accessibility features and apps used by clients for orientation, mobility, visual efficiency and social engagement.O&M specialists who are technology laggards need human-guided support to develop confidence in using travel technologies, and O&M clients are the experts. COVID-19 has created an imperative to learn skills for O&M tele-practice.Affordability is a significant barrier to O&M professionals and clients accessing specialist travel technologies in Malaysia, and to O&M professionals upgrading technology in Australia.Comprehensive training for O&M specialists is needed in Malaysia to meet the travel needs of clients with low vision or blindness who also have physical, cognitive, sensory or mental health complications.

Exercise for affect and enjoyment in overweight or obese males: a comparison of high-intensity interval training and moderate-intensity continuous training.

High-intensity interval training (HIIT) is effective for generating positive cardiovascular health and fitness benefits. This study compared HIIT and moderate-intensity continuous training (MICT) for affective state and enjoyment in sedentary males with overweight or obesity.Twenty-eight participants performed stationary cycling for 6 weeks × 3 sessions/week. Participants were randomly allocated to HIIT (N=16) (10 × 1-minute intervals at ~90% peak heart rate) or MICT (N=12) (30 minutes at 65-75% peak heart rate). Affective state changes were assessed after 6-weeks training. Enjoyment and acute change in affect were assessed after individual training sessions.HIIT participants reported improved positive affect following 6 weeks training (∆ 3.6 ± 4.6, p = 0.007, effect size d = 0.70), without corresponding improvement in negative affect (p = 0.48, d = -0.19). MICT did not induce any improvement in positive affect (p = 0.56, d = 0.16) or negative affect (p = 0.23, d = -0.41). Enjoyment ratings were comparable for both exercise formats (HIIT: 4.4 ± 0.4 on a 7-point scale; MICT: 4.3 ± 0.3; p = 0.70, d = 0.15).Six weeks of HIIT induced improvement in positive affect in sedentary participants with overweight or obesity. Enjoyment of training was only slightly above neutral levels for both training formats.What's already known about this topic? Exercise training can improve general affect however the optimal exercise characteristics for improving affect are unclear.Studies assessing the relative enjoyment of HIIT in comparison to MICT have largely been equivocal to date.What does this study add? HIIT can improve affective state in males with overweight or obesity.Six weeks of stationary cycling HIIT were rated as only mildly enjoyable, comparable to ratings for MICT.

Chronic Reproductive Toxicity Thresholds for Northern Bobwhite Quail (Colinus virginianus) Exposed to Perfluorohexanoic Acid (PFHxA) and a Mixture of Perfluorooctane Sulfonic Acid (PFOS) and PFHxA.

Terrestrial toxicology data are limited for comprehensive ecotoxicological risk assessment of ecosystems contaminated by per- and polyfluoroalkyl substances (PFAS) partly because of their existence as mixtures in the environment. This complicates logistical dose-response modeling and establishment of a threshold value characterizing the chronic toxicity of PFAS to ecological receptors. We examined reproduction, growth, and survival endpoints using a combination of hypothesis testing and logistical dose-response modeling of northern bobwhite quail (Colinus virginianus) exposed to perfluorohexanoic acid (PFHxA) alone and to PFHxA in a binary mixture with perfluorooctane sulfonic acid (PFOS) via the drinking water. The exposure concentration chronic toxicity value (CTV) representative of the lowest-observable-adverse effect level (LOAEL) threshold for chronic oral PFAS toxicity (based on reduced offspring weight and growth rate) was 0.10 ng/mL for PFHxA and 0.06 ng/mL for a PFOS:PFHxA (2.7:1) mixture. These estimates corresponded to an adult LOAEL average daily intake CTV of 0.0149 and 0.0082 µg × kg body weight-1 × d-1 , respectively. Neither no-observable-adverse effect level threshold and representative CTVs nor dose-response and predicted effective concentration values could be established for these 2 response variables. The findings indicate that a reaction(s) occurs among the individual PFAS components present in the mixture to alter the potential toxicity, demonstrating that mixture affects avian PFAS toxicity. Thus, chronic oral PFAS toxicity to avian receptors represented as the sum of the individual compound toxicities may not necessarily be the best method for assessing chronic mixture exposure risk at PFAS-contaminated sites. Environ Toxicol Chem 2021;40:2601-2614. © 2021 SETAC.

Assessing the Ecological Risks of Per- and Polyfluoroalkyl Substances: Current State-of-the Science and a Proposed Path Forward.

Per- and poly-fluoroalkyl substances (PFAS) encompass a large, heterogenous group of chemicals of potential concern to human health and the environment. Based on information for a few relatively well-understood PFAS such as perfluorooctane sulfonate and perfluorooctanoate, there is ample basis to suspect that at least a subset can be considered persistent, bioaccumulative, and/or toxic. However, data suitable for determining risks in either prospective or retrospective assessments are lacking for the majority of PFAS. In August 2019, the Society of Environmental Toxicology and Chemistry sponsored a workshop that focused on the state-of-the-science supporting risk assessment of PFAS. The present review summarizes discussions concerning the ecotoxicology and ecological risks of PFAS. First, we summarize currently available information relevant to problem formulation/prioritization, exposure, and hazard/effects of PFAS in the context of regulatory and ecological risk assessment activities from around the world. We then describe critical gaps and uncertainties relative to ecological risk assessments for PFAS and propose approaches to address these needs. Recommendations include the development of more comprehensive monitoring programs to support exposure assessment, an emphasis on research to support the formulation of predictive models for bioaccumulation, and the development of in silico, in vitro, and in vivo methods to efficiently assess biological effects for potentially sensitive species/endpoints. Addressing needs associated with assessing the ecological risk of PFAS will require cross-disciplinary approaches that employ both conventional and new methods in an integrated, resource-effective manner. Environ Toxicol Chem 2021;40:564-605. © 2020 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Child and parent perceptions of acceptability and therapeutic value of a socially assistive robot used during pediatric rehabilitation.

Purpose: Socially assistive robots are emerging as a method of supporting the rehabilitation of children with physical disabilities. To date there has been no in-depth analysis of parent and child perspectives regarding the use of socially assistive robots for pediatric rehabilitation. The purpose of this study was to capture the experiences of parents and children who participated in a rehabilitation session with a socially assistive rehabilitation robot.Methods: An interpretivist qualitative design was used. Semi-structured interviews of five parent-child pairs were undertaken to examine their experiences during a rehabilitation session with the NAO robot. Interviews were analyzed using inductive thematic analysis.Results: Five themes were identified: 1) affective influence, 2) independence, 3) preference for human interaction, 4) accessibility of therapy and 5) familiarity with technology.Conclusion: Based on parent and child perspectives, the NAO robot is an acceptable complement to rehabilitation therapies. Children and parents perceived the NAO robot to have therapeutic value through its potential to enhance engagement, promote child independence during rehabilitation exercises and its potential support a rehabilitation program when a human therapist is not accessible.Implications for rehabilitationSocially assistive robots are an acceptable tool to support the delivery of exercise programs in pediatric rehabilitation.Therapists need to consider how to provide a positive affective experience during rehabilitation sessions, the use of socially assistive robots may be one method of doing this.When using socially assistive robots to support rehabilitation the individual needs and preferences of the child and family should be considered.Socially assistive robots may have a role in supporting home exercises programs; future work is needed to determine the feasibility of this.

Species- and Tissue-Specific Avian Chronic Toxicity Values for Perfluorooctane Sulfonate (PFOS) and a Binary Mixture of PFOS and Perfluorohexane Sulfonate.

To further characterize avian toxicity to environmental levels of select per- and poly-fluoroalkyl substances (PFAS), we established species- and tissue-specific PFAS chronic toxicity values (CTVs) associated with a lowest-observable-adverse effect level (LOAEL) threshold previously established for northern bobwhite quail (Colinus virginianus) chronically orally exposed via drinking water to either perfluorooctane sulfonate (PFOS) or a simple PFAS mixture. Aided by advances in analytical techniques, the novel avian oral PFAS CTVs reported in the present study are lower than the previously reported toxicity reference values (TRVs) estimated for birds chronically exposed via feed. Thus, current avian PFOS TRVs may not be fully protective of wild avian populations at PFAS-impacted sites. Also, likely due to differences in bioavailability, bioaccessibility, and toxicokinetics among individual PFAS between oral exposure types, we found higher bioaccumulation factors in all assessed tissues from birds exposed via water versus feed. Thus, we propose that future characterization of chemical toxicity due to ingestion exposure initially include a full examination of all probable sources of oral exposure for the most accurate derivation of TRVs and a more complete picture of ecological risk. The avian PFAS LOAEL CTVs established in the present study can be modified with the use of uncertainty factors to derive site-specific avian TRVs for ecological risk assessment at PFAS-impacted sites. From differences observed in the behavior of PFOS when administered as either a single chemical or part of a binary mixture with perfluorohexane sulfonate (PFHxS), we verified that PFOS was absorbed and distributed differently when coadministered with PFHxS and that PFOS likely interacted with PFHxS differently among tissues, helping to explain the differences observed in avian toxicity between exposures. Environ Toxicol Chem 2021;40:899-909. © 2020 SETAC.

VibroSleeve: A wearable vibro-tactile feedback device for arm guidance.

Vibro-tactile feedback offers a complementary augmentation cue for motor guidance and training. Motivated by the needs of prosthetic vision rehabilitation, we explore the use of the cylindrical forearm surface to deliver arm guidance cues via vibro-tactile stimulation. We present 'VibroSleeve', a novel wearable arm motion guidance aid made up of 4x4 arrangement of vibration coin motors embedded within an elastic sleeve for delivering vibro-tactile patterns to the forearm. In this paper, we present the concept and design of VibroSleeve, along with results of preliminary evaluation. We outline key insights gained into the perceptual aspects of calibration and usable intensity bandwidth critical for reliable interpretation of encoded information. Our results demonstrate feasibility of the approach, and provide foundations for future work on developing the sleeve as a rehabilitation aid for guiding the arm towards visually perceived targets.

Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials: Recommendations from the International HOVER Taskforce.

Translational research in vision prosthetics, gene therapy, optogenetics, stem cell and other forms of transplantation, and sensory substitution is creating new therapeutic options for patients with neural forms of blindness. The technical challenges faced by each of these disciplines differ considerably, but they all face the same challenge of how to assess vision in patients with ultra-low vision (ULV), who will be the earliest subjects to receive new therapies. Historically, there were few tests to assess vision in ULV patients. In the 1990s, the field of visual prosthetics expanded rapidly, and this activity led to a heightened need to develop better tests to quantify end points for clinical studies. Each group tended to develop novel tests, which made it difficult to compare outcomes across groups. The common lack of validation of the tests and the variable use of controls added to the challenge of interpreting the outcomes of these clinical studies. In 2014, at the bi-annual International "Eye and the Chip" meeting of experts in the field of visual prosthetics, a group of interested leaders agreed to work cooperatively to develop the International Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials (HOVER) Taskforce. Under this banner, more than 80 specialists across seven topic areas joined an effort to formulate guidelines for performing and reporting psychophysical tests in humans who participate in clinical trials for visual restoration. This document provides the complete version of the consensus opinions from the HOVER taskforce, which, together with its rules of governance, will be posted on the website of the Henry Ford Department of Ophthalmology (www.artificialvision.org). Research groups or companies that choose to follow these guidelines are encouraged to include a specific statement to that effect in their communications to the public. The Executive Committee of the HOVER Taskforce will maintain a list of all human psychophysical research in the relevant fields of research on the same website to provide an overview of methods and outcomes of all clinical work being performed in an attempt to restore vision to the blind. This website will also specify which scientific publications contain the statement of certification. The website will be updated every 2 years and continue to exist as a living document of worldwide efforts to restore vision to the blind. The HOVER consensus document has been written by over 80 of the world's experts in vision restoration and low vision and provides recommendations on the measurement and reporting of patient outcomes in vision restoration trials.

Sensory augmentation to aid training with retinal prostheses.

OBJECTIVE: Retinal prosthesis recipients require rehabilitative training to learn the non-intuitive nature of prosthetic 'phosphene vision'. This study investigated whether the addition of auditory cues, using The vOICe sensory substitution device (SSD), could improve functional performance with simulated phosphene vision. APPROACH: Forty normally sighted subjects completed two visual tasks under three conditions. The phosphene condition converted the image to simulated phosphenes displayed on a virtual reality headset. The SSD condition provided auditory information via stereo headphones, translating the image into sound. Horizontal information was encoded as stereo timing differences between ears, vertical information as pitch, and pixel intensity as audio intensity. The third condition combined phosphenes and SSD. Tasks comprised light localisation from the Basic Assessment of Light and Motion (BaLM) and the Tumbling-E from the Freiburg Acuity and Contrast Test (FrACT). To examine learning effects, twenty of the forty subjects received SSD training prior to assessment. MAIN RESULTS: Combining phosphenes with auditory SSD provided better light localisation accuracy than either phosphenes or SSD alone, suggesting a compound benefit of integrating modalities. Although response times for SSD-only were significantly longer than all other conditions, combined condition response times were as fast as phosphene-only, highlighting that audio-visual integration provided both response time and accuracy benefits. Prior SSD training provided a benefit to localisation accuracy and speed in SSD-only (as expected) and Combined conditions compared to untrained SSD-only. Integration of the two modalities did not improve spatial resolution task performance, with resolution limited to that of the higher resolution modality (SSD). SIGNIFICANCE: Combining phosphene (visual) and SSD (auditory) modalities was effective even without SSD training and led to an improvement in light localisation accuracy and response times. Spatial resolution performance was dominated by auditory SSD. The results suggest there may be a benefit to including auditory cues when training vision prosthesis recipients.

Chronic Reproductive Toxicity of Perfluorooctane Sulfonic Acid and a Simple Mixture of Perfluorooctane Sulfonic Acid and Perfluorohexane Sulfonic Acid to Northern Bobwhite Quail (Colinus virginianus).

Per- and poly-fluoroalkyl substances (PFAS) are a broad class of environmentally persistent chemicals that include thousands of potentially toxic synthetic organic molecules. Some PFAS have been shown to cause adverse health effects including decreased total cholesterol, birth weight, and reproductive success in laboratory animals; however, a lack of chronic toxicity data exists for PFAS in avian ecological receptors. The present study reports on the chronic toxicity of perfluorooctane sulfonic acid (PFOS) and a mixture of PFOS and perfluorohexane sulfonic acid (PFHxS) to northern bobwhite quail (Colinus virginianus) via oral exposure from drinking water. Female weight gain was adversely affected at an average daily intake (ADI) of 3.10 × 10-3 ± 0.15 × 10-3 mg PFOS:PFHxS (1.2:1) mixture × kg-1 body weight × d-1 . Successful liberation from the shell once pipped was adversely affected at an ADI of 2.45 × 10-3 ± 0.01 × 10-3 mg PFOS x kg-1 body weight × d-1 . These values are comparatively much lower than the current dietary avian toxicity reference value (TRV) derived from birds that were exposed via feed, suggesting the need for updated avian TRVs. Relationships between test chemical (PFOS) and test substance (PFOS:PFHxS) showed that PFOS and PFHxS have possible interacting effects in avian receptors and likely differing mechanisms of toxicity depending on chemical co-occurrence and dose. Both the single-chemical and mixture exposures produced similar and possibly additive toxicity values. Environ Toxicol Chem 2020;39:1101-1111. © 2020 SETAC.

High-intensity interval training for reducing blood pressure: a randomized trial vs. moderate-intensity continuous training in males with overweight or obesity.

The optimal exercise-training characteristics for reducing blood pressure (BP) are unclear. We investigated the effects of 6-weeks of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) on BP and aortic stiffness in males with overweight or obesity. Twenty-eight participants (18-45 years; BMI: 25-35 kg/m2) performed stationary cycling three times per week for 6 weeks. Participants were randomly allocated (unblinded) to work-matched HIIT (N = 16; 10 × 1-min intervals at 90-100% peak workload) or MICT (N = 12; 30 min at 65-75% peak heart rate). Central (aortic) and peripheral (brachial) BP and aortic stiffness was assessed before and after training. There were no significant group × time interactions for any BP measure (all p > 0.21). HIIT induced moderate reductions in central (systolic/diastolic ∆: -4.6/-3.5 mmHg, effect size d = -0.51/-0.40) and peripheral BP (-5.2/-4 mmHg, d = -0.45/-0.47). MICT induced moderate reductions in diastolic BP only (peripheral: -3.4 mmHg, d = -0.57; central: -3 mmHg, d = -0.50). The magnitude of improvement in BP was strongly negatively correlated with baseline BP (r = -0.66 to -0.78), with stronger correlations observed for HIIT (r = -0.73 to -0.88) compared with MICT (r = -0.43 to -0.61). HIIT was effective for reducing BP (~3-5 mmHg) in the overweight to obese cohort. Exercise training induced positive changes in central (aortic) BP. The BP-lowering effects of exercise training are more prominent in those with higher baseline BP, with stronger correlation in HIIT than MICT.

Combining Eye-tracking Data with an Analysis of Video Content from Free-viewing a Video of a Walk in an Urban Park Environment.

As individuals increasingly live in cities, methods to study their everyday movements and the data that can be collected becomes important and valuable. Eye-tracking informatics are known to connect to a range of feelings, health conditions, mental states and actions. But because vision is the result of constant eye-movements, teasing out what is important from what is noise is complex and data intensive. Furthermore, a significant challenge is controlling for what people look at compared to what is presented to them. The following presents a methodology for combining and analyzing eye-tracking on a video of a natural and complex scene with a machine learning technique for analyzing the content of the video. In the protocol we focus on analyzing data from filmed videos, how a video can be best used to record participants' eye-tracking data, and importantly how the content of the video can be analyzed and combined with the eye-tracking data. We present a brief summary of the results and a discussion of the potential of the method for further studies in complex environments.

Communication changes with laryngectomy and impact on quality of life: a review.

PURPOSE: Patients with throat cancer at later stages often undergo total laryngectomy, a procedure that removes the larynx (voice box) and directly impacts the patient's ability to produce natural voice and communication. This narrative review aimed to explore how changes to communication following laryngectomy may impact quality of life (QoL) for patients. METHODS: Literature searches were conducted using CINAHL, MEDLINE and PsychInfo databases for studies published between 2007 and 2018. The search terms (and derivatives) of laryngectomy AND communication AND quality of life were used. A synthesis and appraisal of the studies was conducted. RESULTS: Twelve studies met the inclusion criteria and were included in this review. The two main themes identified relating to changes in communication and impact on QoL were changes in communication competency (immediate changes and communication option used) and adaptation to change (e.g. self-related factors and relationships with others). Regardless of the type of communication option used, participants in all studies reported negative changes in their communication competency and QoL post-laryngectomy. Voice-related factors and aesthetics of the communication option used were noted to influence self-ratings of QoL for the participants, rather than how well others understood them. Participants using tracheoesophageal speech (TES) consistently showed the highest self-reported QoL across the majority of studies. A model incorporating the findings from this review has been proposed which outlines how changes in communication post-laryngectomy may lead to an impact on QoL. Here, the factors of changes in communication competency, self-perception and social engagement impact each other and are also influenced by adaptation to change. CONCLUSION: This review has highlighted the complex nature of changes faced by patients following laryngectomy in relation to communication and QoL. The model linking communication changes to QoL may become a useful tool for researchers and clinicians in supporting the management of patients post-laryngectomy.

Deep reinforcement learning for task-based feature learning in prosthetic vision.

Developing hand-crafted visual features to enhance perception with prosthetic vision devices can often miss important aspects of a given task. Retinal implants suffer from the need to create low-dimensional features for elaborate tasks such as navigation in complex environments. Using Deep Reinforcement Learning (DRL), visual features are learnt through task-based simulations that remove the ambiguity of inferring the visual information most crucial to a specific activity. Learning task-based features ensures that the visual information is salient to the tasks an implant recipient may be undertaking and eliminates potentially redundant features. In this paper, we focus specifically on basic orientation and mobility, and the methods for feature learning and visualisation in structured 3D environments. We propose a new model for learning visual features through task-based simulations and show that learnt features can be transferred directly to real RGB-D images. We demonstrate this new scalable approach for feature learning in simulation and open the possibility for more complex simulations of more complex tasks in the future.

Accelerating Innovation Through Coopetition: The Innovation Learning Network Experience.

Coopetition, the simultaneous pursuit of cooperation and competition, is a growing force in the innovation landscape. For some organizations, the primary mode of innovation continues to be deeply secretive and highly competitive, but for others, a new style of shared challenges, shared purpose, and shared development has become a superior, more efficient way of working to accelerate innovation capabilities and capacity. Over the last 2 decades, the literature base devoted to coopetition has gradually expanded. However, the field is still in its infancy. The majority of coopetition research is qualitative, primarily consisting of case studies. Few studies have addressed the nonprofit sector or service industries such as health care. The authors believe that this article may offer a unique perspective on coopetition in the context of a US-based national health care learning alliance designed to accelerate innovation, the Innovation Learning Network or ILN. The mission of the ILN is to "Share the joy and pain of innovation," accelerating innovation by sharing solutions, teaching techniques, and cultivating friendships. These 3 pillars (sharing, teaching, and cultivating) form the foundation for coopetition within the ILN. Through the lens of coopetition, we examine the experience of the ILN over the last 10 years and provide case examples that illustrate the benefits and challenges of coopetition in accelerating innovation in health care.

Optimising technology to measure functional vision, mobility and service outcomes for people with low vision or blindness: protocol for a prospective cohort study in Australia and Malaysia.

INTRODUCTION: Orientation and mobility (O&M) specialists assess the functional vision and O&M skills of people with mobility problems, usually relating to low vision or blindness. There are numerous O&M assessment checklists but no measures that reduce qualitative assessment data to a single comparable score suitable for assessing any O&M client, of any age or ability, in any location. Functional measures are needed internationally to align O&M assessment practices, guide referrals, profile O&M clients, plan appropriate services and evaluate outcomes from O&M programmes (eg, long cane training), assistive technology (eg, hazard sensors) and medical interventions (eg, retinal implants). This study aims to validate two new measures of functional performance vision-related outcomes in orientation and mobility (VROOM) and orientation and mobility outcomes (OMO) in the context of ordinary O&M assessments in Australia, with cultural comparisons in Malaysia, also developing phone apps and online training to streamline professional assessment practices. METHODS AND ANALYSIS: This multiphase observational study will employ embedded mixed methods with a qualitative/quantitative priority: corating functional vision and O&M during social inquiry. Australian O&M agencies (n=15) provide the sampling frame. O&M specialists will use quota sampling to generate cross-sectional assessment data (n=400) before investigating selected cohorts in outcome studies. Cultural relevance of the VROOM and OMO tools will be investigated in Malaysia, where the tools will inform the design of assistive devices and evaluate prototypes. Exploratory and confirmatory factor analysis, Rasch modelling, cluster analysis and analysis of variance will be undertaken along with descriptive analysis of measurement data. Qualitative findings will be used to interpret VROOM and OMO scores, filter statistically significant results, warrant their generalisability and identify additional relevant constructs that could also be measured. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Human Research Ethics Committee at Swinburne University (SHR Project 2016/316). Dissemination of results will be via agency reports, journal articles and conference presentations.

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol.

INTRODUCTION: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. METHODS AND ANALYSIS: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. ETHICS AND DISSEMINATION: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO REGISTRATION NUMBER: CRD42017054049.