Evaluation of a new assistive technology: the StandBar.

PURPOSE: Evaluate the potential of a wheelchair assistive technology (StandBar) to promote power wheelchair users' ability to safely stand independently from their power wheelchair and determine the impact of the device use on psychological well-being for both power wheelchair users and their caregivers. MATERIALS AND METHODS: A convenience sample of 11 power wheelchair users and caregiver dyads provided study data. Participants included power wheelchair users who were existing StandBar users or currently in training with the StandBar as part of their rehabilitation. Assessments were conducted at baseline and at six-month follow-up and included physiological assessments and functional testing with and without the StandBar. Monthly follow-up phone calls were completed to collect information on adverse events (e.g., falls, hospitalizations, and skin breakdown). A qualitative interview assessed StandBar users' and caregivers' perception at six-month follow-up. RESULTS AND CONCLUSIONS: StandBar use provided power wheelchair users a higher level of independence, confidence, and safety. All participants highly recommended StandBar use to others with similar levels of functional impairment. StandBar use allowed many participants the ability to complete functional tasks that were otherwise not possible without assistance. Qualitative interviews reported improved independence and psychological well-being for StandBar users as well as reduced levels of anxiety and burden of care by caregivers. The StandBar is a cost-effective assistive technology that promotes independence and functionality for power wheelchair users and improves the psychological well-being of users and their caregivers. Implications for RehabilitationStandBar allows power wheelchair users to:Minimize negative effects of immobilization.Increase independence for activities of daily living (grooming, hygiene, toileting, transfers) and instrumental activities of daily living (social experiences).Improve their quality of life through increasing independence and confidence.Reduce need for assistance and corresponding caregiver burden.

Evaluation of Protective Properties of Commercially Available Medical Helmets: Are Medical Helmets Protective?

OBJECTIVES: The aims of the study were to evaluate and to compare protective properties of commercially available medical helmets for a set of standardized head injury risk measures. METHODS: Eleven helmet types were evaluated to represent the variety of commercially available medical helmet designs and manufacturers. A test mannequin and sensor apparatus were used to simulate a backward-standing fall. The head/neck size, mass, and "standing" height of the mannequin (5'9″) were representative of a 50th percentile male. A triaxial array was placed at the head center of mass to position 3 linear accelerometers and 3 angular rate sensors. Data were collected for 5 single trials for each helmet, as well as 5 repeated trials. Five trials were also collected with no helmet scenarios. Three head injury risk measures were examined (linear acceleration, angular acceleration, and head injury criterion). Data were analyzed by clinical cutoff thresholds and continuous values. RESULTS: Helmets varied in their performance across head injury risk measures. All helmets provided higher levels of protection compared with no helmet scenarios. No helmets were protective for subdural hematoma (measured by angular acceleration). All helmets lost protective properties with repeated falls. Results for skull fracture risk were inconsistent between linear acceleration and head injury criterion injury risk measures. CONCLUSIONS: No helmets were protective across all head injury risk measures. Medical helmets may reduce some fall injury severity but may not prevent all types of head injury. All helmets exhibited worsening of protective properties with repeated falls. We recommend medical helmets be replaced after each fall incident where the helmet impacts another surface.

EMG Pattern Recognition Control of the DEKA Arm: Impact on User Ratings of Satisfaction and Usability.

The DEKA Arm has multiple degrees of freedom which historically have been operated primarily by inertial measurement units (IMUs). However, the IMUs are not appropriate for all potential users; new control methods are needed. The purposes of this study were: 1) to describe usability and satisfaction of two controls methods-IMU and myoelectric pattern recognition (EMG-PR) controls-and 2) to compare ratings by control and amputation level. A total of 36 subjects with transradial (TR) or transhumeral (TH) amputation participated in the study. The subjects included 11 EMG-PR users (82% TR) and 25 IMU users (68% TR). The study consisted of in-laboratory training (Part A) and home use (Part B). The subjects were administered the Trinity Amputation and Prosthesis Experience satisfaction scale and other usability and satisfaction measures. Wilcoxon rank-sum tests compared the differences by control type. The differences were compared for those who did and did not want a DEKA Arm. The preferences for features of the DEKA Arm were compared by control type. The comparisons revealed poorer ratings of skill, comfort, and weight among EMG-PR users. The TR amputees using IMUs rated usability more favorably. TH amputees rated usability similarly. The TR amputees using EMG-PR were less satisfied with weight, pinch grip, and wrist display, whereas the TH amputees were less satisfied with the full system, wires/cables, and battery. Usability and satisfaction declined after Part B for EMG-PR users. Overall, we found that the IMU users rated the DEKA Arm and the controls more favorably than the EMG-PR users. The findings indicate that the EMG-PR system we tested was less well accepted than the IMUs for control of the DEKA Arm.

Neisseria gonorrhoeae DNA bacterial load in men with symptomatic and asymptomatic gonococcal urethritis.

OBJECTIVE: Previous studies have quantified bacterial loads of Neisseria gonorrhoeae in the pharynx and rectum of men but not the urethra. We quantified the bacterial load of N. gonorrhoeae in men with symptomatic and asymptomatic urethral gonorrhoea infections. METHODS: Consecutive men diagnosed with urethral gonorrhoea by Aptima Combo 2 testing of urine at the Melbourne Sexual Health Centre between March and July 2016 were eligible for the study: symptomatic men with purulent urethral discharge and asymptomatic men with no urethral symptoms. The gonococcal bacterial load in both groups was measured by urethral swab using a standardised collection method and real-time quantitative PCR targeting the opa gene. RESULTS: Twenty men were recruited into the study: 16 had purulent urethral discharge and 4 had asymptomatic urethral gonorrhoea. The median gonococcal bacterial load was significantly higher among symptomatic men (3.7×106 copies per swab, IQR 2.5×106-4.7×106) compared with asymptomatic men (2.0×105 copies per swab, IQR 2.7×104-4.5×105) (p=0.002). CONCLUSIONS: Gonococcal loads in men with urethral discharge were higher than loads seen with asymptomatic urethral gonorrhoea and loads seen in asymptomatic pharyngeal and rectal gonorrhoea infections in previous studies.

Assessment and feasibility of the four landmarks of the aortic root in a cohort of very preterm infants.

BACKGROUND: The diameter of the aortic root is used as a parameter to calculate blood flow in very preterm infants. There are considerable differences in diameter of the four anatomical landmarks of the aortic root in children and adults, but limited data are available for the very preterm population. The aim of this study was to obtain reference and reliability data on two-dimensional measurements of the aortic root in very preterm infants <30 weeks gestation. MATERIALS AND METHODS: Fifty long axis echocardiograms were reviewed and re-analyzed for measurements at the four anatomical landmarks of the aortic root; the aortic annulus, sinus of Valsalva (SV), sinotubular junction, and the proximal ascending aorta (PAA). A subjective visual scoring system was developed to quantify image quality. A random sample of images was blindly re-measured to assess intra- and inter-observer reliability. RESULTS: Significant differences in diameter were found between the four landmarks, except between SV and PAA. Inter-observer coefficients showed marginal variation ranging from 5.0% to 8.2%, with slightly lower intra-observer variability. Overall image quality score was poorest for PAA on standard long axis images but improved when the probe was adjusted along the outflow tract. CONCLUSION: We present reliability and reference values for all four anatomic landmarks of the aortic root in very preterm infants and demonstrated the importance of standardizing and reporting cardiac output measurements in preterm infants.

Impacts of logging on density-dependent predation of dipterocarp seeds in a South East Asian rainforest.

Much of the forest remaining in South East Asia has been selectively logged. The processes promoting species coexistence may be the key to the recovery and maintenance of diversity in these forests. One such process is the Janzen-Connell mechanism, where specialized natural enemies such as seed predators maintain diversity by inhibiting regeneration near conspecifics. In Neotropical forests, anthropogenic disturbance can disrupt the Janzen-Connell mechanism, but similar data are unavailable for South East Asia. We investigated the effects of conspecific density (two spatial scales) and distance from fruiting trees on seed and seedling survival of the canopy tree Parashorea malaanonan in unlogged and logged forests in Sabah, Malaysia. The production of mature seeds was higher in unlogged forest, perhaps because high adult densities facilitate pollination or satiate pre-dispersal predators. In both forest types, post-dispersal survival was reduced by small-scale (1 m(2)) conspecific density, but not by proximity to the nearest fruiting tree. Large-scale conspecific density (seeds per fruiting tree) reduced predation, probably by satiating predators. Higher seed production in unlogged forest, in combination with slightly higher survival, meant that recruitment was almost entirely limited to unlogged forest. Thus, while logging might not affect the Janzen-Connell mechanism at this site, it may influence the recruitment of particular species.

Comparison of the Pentax AWS videolaryngoscope with the Macintosh laryngoscope in simulated difficult airway intubations by emergency physicians.

OBJECTIVES: The aim of this study was to evaluate the Pentax AWS videolaryngoscope (PAV) in intubation of simulated difficult airways by emergency medical staff. METHODS: Emergency medical staff and students attempted to intubate a manikin using 3 difficult airways settings with both the PAV and a Macintosh (MAC) laryngoscope in a randomized order. The success of tracheal intubation, time required, number of attempts, airway adjunct use, grade of view obtained, and participant comments were recorded. RESULTS: Significantly higher success rates of intubation occurred with the PAV compared with the MAC, irrespective of the level of training or number of previous intubations. With the highest difficulty setting, success occurred in 76.4% with the PAV versus 8.8% with the MAC. The PAV also significantly improved the Cormack and Lehane grading and reduced airway adjunct use, number of intubation attempts, and damage during intubation. CONCLUSIONS: The PAV may be a useful adjunct in difficult intubations by emergency medical staff.