The Effectiveness, Economic Cost and Adoption of Robotic Rehabilitation for Mobility and Functional Ability in Adult Stroke Patients

Robotic rehabilitation devices have been developed to assist therapists to rehabilitate stroke patients based on intensive, high repetitions of task specific exercises to train the impaired limbs of patients. In contrast, conventional therapy is labour intensive and places physical strain on therapists when sustaining intense exercises. Hence it is hoped that with robotic assistive devices, better rehabilitation progress can be achieved for patients, together with alleviation of time and physical demands on therapists. However, there are still uncertainties regarding the use of robotic devices. Studies on the clinical effectiveness of robotic devices have presented a mixed picture. Robotic devices are high capital cost items and its economic cost effectiveness is unclear. The adoption of robotic devices into clinical settings is also an area lacking clarity, as these devices do not work alone but are part of a wider spectrum of clinical care that involves clinicians, patients, hospital administrators and device manufacturers. Inadequate, or incomplete interconnection across these domains of clinical care could affect adoption into clinical settings. Given these uncertainties, the aim of this thesis was to examine and investigate the clinical effectiveness, economic cost, and clinical adoption of robotic rehabilitation. The specific research questions were: Can robotic devices help adult stroke patients to regain motor movement of their upper and lower limbs? Can robotic devices rehabilitate adult stroke patients cost economically? What are the clinical views and experiences of utilizing robotic rehabilitation? What are the factors to consider when introducing robotic devices into the clinical care environment? How can findings from the effectiveness, economic cost and adoption studies be aggregated to create a conceptual framework of providing robotic rehabilitation? To determine the effectiveness and cost effectiveness of robotic rehabilitation, two systematic reviews were conducted according to the JBI review methodology. To seek insights regarding its clinical adoption, qualitative descriptive interviews were conducted with therapists to understand their experiences working with robotic devices. The findings of our research show that robotic rehabilitation is not only clinically effective but also economically cost effective, and especially for severely impaired lower limb patients robotic therapy provides better outcomes. The adoption study, which bridges the gap between the effectiveness and economic evidence from systematic reviews and translation into clinical practice, has uncovered a multitude of factors that need to be taken into consideration when introducing robotic rehabilitation into practice. These factors involve not just simply user training for these devices, but also aspects such as workflow processes, interfacing systems, communication strategies to influence adoption, perceived benefits, and attitudes and motivations of users. From the understandings gained from these various streams of research, a conceptual framework on implementing robotic rehabilitation was developed in order to facilitate translation of the research evidence into practice. This thesis contributes new evidence on effectiveness, cost-effectiveness and clinical integration to the global knowledge base about the use of robotic rehabilitation, and ultimately will lead to stroke patients benefiting from robotic rehabilitation and gaining better health outcomes.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 201

Ventricular arrhythmias in cardiac amyloidosis : a review of current literature

Cardiac Amyloidosis is an infiltrative cardiomyopathy which occurs secondary to deposition of mis-folded protein in the myocardium, with the two most common subtypes being AL amyloidosis and TTR amyloidosis. The pathogenesis of the disease is multifaceted and involves a variety of mechanisms including an inflammatory response cascade, oxidative stress and subsequent separation of myocyte fibrils. Cardiac Amyloidosis frequently results in congestive cardiac failure and arrhythmias, from a disruption in cardiac substrate with subsequent electro-mechanical remodelling. Disease progression is usually demonstrated by development of progressive pump failure, which may be seen with a high arrhythmic burden, usually portending a poor prognosis. There is a paucity of literature on the clinical implications of ventricular arrhythmias in the context of cardiac amyloidosis. The important diagnostic investigations for these patients include transthoracic echocardiography, cardiac magnetic resonance imaging and an electrophysiology study. Whilst there are no robust management guidelines, studies have indicated benefits from contemporary pharmacological therapy and case-by-case catheter ablation. There are novel directed therapies available for TTR amyloidosis that have shown to improve overall survival. The role of ICD therapy in cardiac amyloidosis is controversial, with benefits seen predominantly in early phases of the disease process. The only definitive surgical therapy includes heart transplantation, but is largely indicated for progressive decompensated heart failure (Figure 1). Further large-scale studies are required to better outline management paradigms for treating ventricular arrhythmias in cardiac amyloidosis

Questionnaire survey on point‐of‐care ultrasound utilization during cardiac arrest among emergency physicians in Hong Kong

Introduction: Although point‐of‐care ultrasound (POCUS) is recognized as a useful diagnostic and prognostic tool during the management of out‐of‐hospital cardiac arrest (OHCA), opposing viewpoints exist. The objectives of this study are to investigate the knowledge, attitude, and practice (KAP) in POCUS utilization during OHCA among emergency medicine (EM) physicians in Hong Kong and to identify their barriers. Methods: A cross‐sectional questionnaire was conducted among EM physicians in 9 accident and emergency departments in Hong Kong. The questionnaire assessed participants' demographics, knowledge, attitude, practices, and barriers on this issue. Composite scores for KAP were calculated. Subgroup analysis and multiple regression analysis were used to explore the correlation between KAP and participants' demographics. Participants' barriers were evaluated by binary and open‐ended questions. Results: A total of 224 questionnaires were distributed and 150 questionnaires were returned (response rate: 67.0%). Statistically significant associations of knowledge and attitude with practice were demonstrated (both p < 0.001). Independent predictors of more frequent POCUS use in OHCA included EM fellowship status (p = 0.005), receiving training on this issue (p < 0.001), and working in large hospitals (p = 0.007). The top‐ranked barriers were chaotic environment (74%), no structural education on this practice (63%), and the lack of staff (61%). Conclusions: The knowledge and attitude of performing POCUS during OHCA were demonstrated to enhance EM physicians' practice. By improving physicians' knowledge and removing the possible barriers they are facing, POCUS can be optimally utilized during OHCA to improve patient care

Growth processes of snow

Thesis (Sc.D.)--Massachusetts Institute of Technology, Dept. of Meteorology and Physical Oceanography, 1983.Microfiche copy available in Archives and Science.Vita.Bibliography: leaves 189-192.by Kwok-Wai Kenneth Lo.Sc.D

The Generation of 3D Surface Meshes for NURBS-Enhanced FEM

This work presents the first method for generating triangular surface meshes in three dimensions for the NURBS-enhanced finite element method. The generated meshes may contain triangular elements that span across multiple NURBS surfaces, whilst maintaining the exact representation of the CAD geometry. This strategy completely eliminates the need for de-featuring complex watertight CAD models and, at the same time, eliminates any uncertainty associated with the simplification of CAD models. In addition, the ability to create elements that span across multiple surfaces ensures that the generated meshes are highly compliant with the requirements of the user-specified spacing function, even if the CAD model contains very small geometric features. To demonstrate the capability, the proposed strategy is applied to a variety of CAD geometries, taken from areas such as solid/structural mechanics, fluid dynamics and wave propagation

The mesolithic occupation at Isolidda (San Vito Lo Capo), Sicily

‘Gruppo dell’Isolidda’ is a complex of five caves along a rocky cliff on the eastern side of the promontory of San Vito Lo Capo (Trapani) in NW Sicily. In 2004 archaeological excavations in the slope below the caves revealed a stratified deposit, partially in secondary position, containing levels with Late Epigravettian and Mesolithic stone tool assemblages. Early Mesolithic stone tool industries, characterized by backed microlithic tools, were distributed in two contiguous layers (SU 21 and SU 25), the lowest of which (SU 21) also contained Epigravettian tools, probably due to sediment reworking. Three AMS dates on Phorcus turbinatus shells (~9520-8990 cal. BP) are chronologically compatible with the Early Mesolithic materials and suggest that the bulk of the deposit accumulated then. A third level, lying above the previous ones, contained material culture associated to the Late Mesolithic or Early Neolithic. Faunal remains from the site represent mainly food refuse and included abundant shells of intertidal molluscs (e.g. Phorcus turbinatus and Patella sp.), along with few fragmented bones of terrestrial herbivores (e.g. Cervus elaphus and Sus scrofa). Oxygen isotope analyses on shell carbonates of Phorcus turbinatus show that, around 9520-9000 cal. BP, marine molluscs were exploited year-round, albeit more often in autumn and winter

WARNING: Physics Envy May Be Hazardous To Your Wealth!

The quantitative aspirations of economists and financial analysts have for many years been based on the belief that it should be possible to build models of economic systems - and financial markets in particular - that are as predictive as those in physics. While this perspective has led to a number of important breakthroughs in economics, "physics envy" has also created a false sense of mathematical precision in some cases. We speculate on the origins of physics envy, and then describe an alternate perspective of economic behavior based on a new taxonomy of uncertainty. We illustrate the relevance of this taxonomy with two concrete examples: the classical harmonic oscillator with some new twists that make physics look more like economics, and a quantitative equity market-neutral strategy. We conclude by offering a new interpretation of tail events, proposing an "uncertainty checklist" with which our taxonomy can be implemented, and considering the role that quants played in the current financial crisis.Comment: v3 adds 2 reference

Design and implementation of mlearning for calculus in tertiary education

Using IT in education has become prevalent worldwide. It is believed that IT not only motivates students to learn in class, but also encourages students to take the initiative to explore and inquire subject matters outside classroom by themselves (i.e. independent learning). The Hong Kong Education Bureau offered a series of professional development programmes to principals, vice principals, middle managers as well as teachers who have joined the "Support Scheme for e-Learning in Schools" since April 2014 to 2016/17 school year to further equip schools to implement e-learning. In primary and secondary education, for example, the HKSAR Government (2004) has been giving support to schools for using e-textbooks and e-learning resources during lessons. At tertiary level, other e-learning platforms such as MOODLE and BLACKBOARD have been widely used in different institutions. In recent years, the rapid development of mobile apps has been provided learners with ample opportunities to learn independently. There are various learning apps such as Math Tricks, Complete Mathematics, Mathematics Dictionary, IXL Maths Practice, etc on the market for primary and secondary education; nonetheless, the use of mobile apps in students’ learning of disciplinary subject seems to be new in tertiary level, and its effectiveness in students’ learning is worth investigation. Through this study, the project team hopes to a) explore whether a disciplinary-specific mobile app can help learners to acquire and apply disciplinary knowledge in and beyond classroom, b) identify elements to be included in a mobile app to helps students to learn outside classroom