Exploring interventions to increase primary care providers’ use of self-management goals

Accreditors, such as the Joint Commission, consider evidence of patient engagement strategies for awarding Primary Care/Patient-Centered Medical Home (PCMH) accreditation. This project explored the use of brief Motivational Interviewing (MI) training at a local county health center and evaluated the impact on the documented use of self-management goals (SMGs) for patients with diabetes and hypertension. Methods included a professional development program, including an online module, presentation, and educational materials. The goal was to increase providers’ MI knowledge and skills to better construct and document SMGs. The program impact was evaluated by chart review to determine the use of SMGs by providers in patients with diabetes and hypertension. The presentation evaluation included participant scoring of statements based on learning objectives. Results of the presentation objectives included \u3e than 3.88/4 means of each item and indicated satisfaction with the presentation. Pre implementation (N=120) chart review demonstrated that only 7% of the charts contained SMG documentation. One month after the program completion, no change (6%) was noted in providers’ (N= 86) SMG documentation. Informal interviews with providers indicated favorable attitudes toward increasing patient engagement with MI and formation of SMGs but challenges were identified such as too little time with patients, health literacy, and lack of resources. Conclusions indicate that innovative options should be developed to support providers in the development and documentation of SMGs

Method and apparatus for automatic control of a humanoid robot

A robotic system includes a humanoid robot having a plurality of joints adapted for force control with respect to an object acted upon by the robot, a graphical user interface (GUI) for receiving an input signal from a user, and a controller. The GUI provides the user with intuitive programming access to the controller. The controller controls the joints using an impedance-based control framework, which provides object level, end-effector level, and/or joint space-level control of the robot in response to the input signal. A method for controlling the robotic system includes receiving the input signal via the GUI, e.g., a desired force, and then processing the input signal using a host machine to control the joints via an impedance-based control framework. The framework provides object level, end-effector level, and/or joint space-level control of the robot, and allows for functional-based GUI to simplify implementation of a myriad of operating modes

Interactive robot control system and method of use

A robotic system includes a robot having joints, actuators, and sensors, and a distributed controller. The controller includes command-level controller, embedded joint-level controllers each controlling a respective joint, and a joint coordination-level controller coordinating motion of the joints. A central data library (CDL) centralizes all control and feedback data, and a user interface displays a status of each joint, actuator, and sensor using the CDL. A parameterized action sequence has a hierarchy of linked events, and allows the control data to be modified in real time. A method of controlling the robot includes transmitting control data through the various levels of the controller, routing all control and feedback data to the CDL, and displaying status and operation of the robot using the CDL. The parameterized action sequences are generated for execution by the robot, and a hierarchy of linked events is created within the sequence

Torque Control of Underactuated Tendon-driven Robotic Fingers

A robotic system includes a robot having a total number of degrees of freedom (DOF) equal to at least n, an underactuated tendon-driven finger driven by n tendons and n DOF, the finger having at least two joints, being characterized by an asymmetrical joint radius in one embodiment. A controller is in communication with the robot, and controls actuation of the tendon-driven finger using force control. Operating the finger with force control on the tendons, rather than position control, eliminates the unconstrained slack-space that would have otherwise existed. The controller may utilize the asymmetrical joint radii to independently command joint torques. A method of controlling the finger includes commanding either independent or parameterized joint torques to the controller to actuate the fingers via force control on the tendons

Robust Operation of Tendon-Driven Robot Fingers Using Force and Position-Based Control Laws

A robotic system includes a tendon-driven finger and a control system. The system controls the finger via a force-based control law when a tension sensor is available, and via a position-based control law when a sensor is not available. Multiple tendons may each have a corresponding sensor. The system selectively injects a compliance value into the position-based control law when only some sensors are available. A control system includes a host machine and a non-transitory computer-readable medium having a control process, which is executed by the host machine to control the finger via the force- or position-based control law. A method for controlling the finger includes determining the availability of a tension sensor(s), and selectively controlling the finger, using the control system, via the force or position-based control law. The position control law allows the control system to resist disturbances while nominally maintaining the initial state of internal tendon tensions

Adapting detection sensitivity based on evidence of irregular sinus arrhythmia to improve atrial fibrillation detection in insertable cardiac monitors

Intermittent change in p-wave discernibility during periods of ectopy and sinus arrhythmia is a cause of inappropriate atrial fibrillation (AF) detection in insertable cardiac monitors (ICM). To address this, we developed and validated an enhanced AF detection algorithm.Atrial fibrillation detection in Reveal LINQ ICM uses patterns of incoherence in RR intervals and absence of P-wave evidence over a 2-min period. The enhanced algorithm includes P-wave evidence during RR irregularity as evidence of sinus arrhythmia or ectopy to adaptively optimize sensitivity for AF detection. The algorithm was developed and validated using Holter data from the XPECT and LINQ Usability studies which collected surface electrocardiogram (ECG) and continuous ICM ECG over a 24-48 h period. The algorithm detections were compared with Holter annotations, performed by multiple reviewers, to compute episode and duration detection performance. The validation dataset comprised of 3187 h of valid Holter and LINQ recordings from 138 patients, with true AF in 37 patients yielding 108 true AF episodes ≥2-min and 449 h of AF. The enhanced algorithm reduced inappropriately detected episodes by 49% and duration by 66% with <1% loss in true episodes or duration. The algorithm correctly identified 98.9% of total AF duration and 99.8% of total sinus or non-AF rhythm duration. The algorithm detected 97.2% (99.7% per-patient average) of all AF episodes ≥2-min, and 84.9% (95.3% per-patient average) of detected episodes involved AF.An enhancement that adapts sensitivity for AF detection reduced inappropriately detected episodes and duration with minimal reduction in sensitivity.Helmut Pürerfellner, Prashanthan Sanders, Shantanu Sarkar, Erin Reisfeld, Jerry Reiland, Jodi Koehler, Evgeny Pokushalov, Ľuboš Urban, Lukas R C Dekke

A VLBI receiving system for the South Pole Telescope

The Event Horizon Telescope (EHT) is a very-long-baseline interferometry (VLBI) experiment that aims to observe supermassive black holes with an angular resolution that is comparable to the event horizon scale. The South Pole occupies an important position in the array, greatly increasing its north-south extent and therefore its resolution. The South Pole Telescope (SPT) is a 10-meter diameter, millimeter-wavelength telescope equipped for bolometric observations of the cosmic microwave background. To enable VLBI observations with the SPT we have constructed a coherent signal chain suitable for the South Pole environment. The dual-frequency receiver incorporates state-of-the-art SIS mixers and is installed in the SPT receiver cabin. The VLBI signal chain also includes a recording system and reference frequency generator tied to a hydrogen maser. Here we describe the SPT VLBI system design in detail and present both the lab measurements and on-sky results.Comment: 14 pages, 11 figures, to appear in the Proceedings of the SPIE (SPIE Astronomical Telescopes + Instrumentation 2018; Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy IX

Humanoid Robot

A humanoid robot includes a torso, a pair of arms, two hands, a neck, and a head. The torso extends along a primary axis and presents a pair of shoulders. The pair of arms movably extend from a respective one of the pair of shoulders. Each of the arms has a plurality of arm joints. The neck movably extends from the torso along the primary axis. The neck has at least one neck joint. The head movably extends from the neck along the primary axis. The head has at least one head joint. The shoulders are canted toward one another at a shrug angle that is defined between each of the shoulders such that a workspace is defined between the shoulders

Differential Phosphorylation of Ribosomal Proteins in Arabidopsis thaliana Plants during Day and Night

Protein synthesis in plants is characterized by increase in the translation rates for numerous proteins and central metabolic enzymes during the day phase of the photoperiod. The detailed molecular mechanisms of this diurnal regulation are unknown, while eukaryotic protein translation is mainly controlled at the level of ribosomal initiation complexes, which also involves multiple events of protein phosphorylation. We characterized the extent of protein phosphorylation in cytosolic ribosomes isolated from leaves of the model plant Arabidopsis thaliana harvested during day or night. Proteomic analyses of preparations corresponding to both phases of the photoperiod detected phosphorylation at eight serine residues in the C-termini of six ribosomal proteins: S2-3, S6-1, S6-2, P0-2, P1 and L29-1. This included previously unknown phosphorylation of the 40S ribosomal protein S6 at Ser-231. Relative quantification of the phosphorylated peptides using stable isotope labeling and mass spectrometry revealed a 2.2 times increase in the day/night phosphorylation ratio at this site. Phosphorylation of the S6-1 and S6-2 variants of the same protein at Ser-240 increased by the factors of 4.2 and 1.8, respectively. The 1.6 increase in phosphorylation during the day was also found at Ser-58 of the 60S ribosomal protein L29-1. It is suggested that differential phosphorylation of the ribosomal proteins S6-1, S6-2 and L29-1 may contribute to modulation of the diurnal protein synthesis in plants

High Light Induced Disassembly of Photosystem II Supercomplexes in Arabidopsis Requires STN7-Dependent Phosphorylation of CP29

Photosynthetic oxidation of water and production of oxygen by photosystem II (PSII) in thylakoid membranes of plant chloroplasts is highly affected by changes in light intensities. To minimize damage imposed by excessive sunlight and sustain the photosynthetic activity PSII, organized in supercomplexes with its light harvesting antenna, undergoes conformational changes, disassembly and repair via not clearly understood mechanisms. We characterized the phosphoproteome of the thylakoid membranes from Arabidopsis thaliana wild type, stn7, stn8 and stn7stn8 mutant plants exposed to high light. The high light treatment of the wild type and stn8 caused specific increase in phosphorylation of Lhcb4.1 and Lhcb4.2 isoforms of the PSII linker protein CP29 at five different threonine residues. Phosphorylation of CP29 at four of these residues was not found in stn7 and stn7stn8 plants lacking the STN7 protein kinase. Blue native gel electrophoresis followed by immunological and mass spectrometric analyses of the membrane protein complexes revealed that the high light treatment of the wild type caused redistribution of CP29 from PSII supercomplexes to PSII dimers and monomers. A similar high-light-induced disassembly of the PSII supercomplexes occurred in stn8, but not in stn7 and stn7stn8. Transfer of the high-light-treated wild type plants to normal light relocated CP29 back to PSII supercomplexes. We postulate that disassembly of PSII supercomplexes in plants exposed to high light involves STN7-kinase-dependent phosphorylation of the linker protein CP29. Disruption of this adaptive mechanism can explain dramatically retarded growth of the stn7 and stn7stn8 mutants under fluctuating normal/high light conditions, as previously reported