Developing a method for quantifying hip joint angles and moments during walking using neural networks and wearables

Quantifying hip angles/moments during gait is critical for improving hip pathology diagnostic and treatment methods. Recent work has validated approaches combining wearables with artificial neural networks (ANNs) for cheaper, portable hip joint angle/moment computation. This study developed a Wearable-ANN approach for calculating hip joint angles/moments during walking in the sagittal/frontal planes with data from 17 healthy subjects, leveraging one shin-mounted inertial measurement unit (IMU) and a force-measuring insole for data capture. Compared to the benchmark approach, a two hidden layer ANN (n = 5 nodes per layer) achieved an average rRMSE = 15% and R2=0.85 across outputs, subjects and training rounds

Hip Joint Angles and Moments during Stair Ascent Using Neural Networks and Wearable Sensors

End-stage hip joint osteoarthritis treatment, known as total hip arthroplasty (THA), improves satisfaction, life quality, and activities of daily living (ADL) function. Postoperatively, evaluating how patients move (i.e., their kinematics/kinetics) during ADL often requires visits to clinics or specialized biomechanics laboratories. Prior work in our lab and others have leveraged wearables and machine learning approaches such as artificial neural networks (ANNs) to quantify hip angles/moments during simple ADL such as walking. Although level-ground ambulation is necessary for patient satisfaction and post-THA function, other tasks such as stair ascent may be more critical for improvement. This study utilized wearable sensors/ANNs to quantify sagittal/frontal plane angles and moments of the hip joint during stair ascent from 17 healthy subjects. Shin/thigh-mounted inertial measurement units and force insole data were inputted to an ANN (2 hidden layers, 10 total nodes). These results were compared to gold-standard optical motion capture and force-measuring insoles. The wearable-ANN approach performed well, achieving rRMSE = 17.7% and R2 = 0.77 (sagittal angle/moment: rRMSE = 17.7 ± 1.2%/14.1 ± 0.80%, R2 = 0.80 ± 0.02/0.77 ± 0.02; frontal angle/moment: rRMSE = 26.4 ± 1.4%/12.7 ± 1.1%, R2 = 0.59 ± 0.02/0.93 ± 0.01). While we only evaluated healthy subjects herein, this approach is simple and human-centered and could provide portable technology for quantifying patient hip biomechanics in future investigations

SORCE Daylight-Only Operations

The recent experience of the SORCE flight operations team offers an excellent example of innovative engineering using limited resources. The goal of this paper is to extend to the space operations community the lessons learned during this critical redesign in order to aid other missions facing equally daunting challenges. The end result is a mission extended well beyond its designed life continuing to return important data to the science community to extend the climate record

Participating in Research: Experiences of People Presenting to the Emergency Department With Self-Harm or Suicidality

Research on sensitive topics with vulnerable populations is challenging in terms of ensuring safety and obtaining ethical approval. We explored the experiences of people with self-harm/suicidality who had taken part in research that included being video-recorded. Twenty-two semi-structured interviews took place within 2 weeks of attending the Emergency Department and were thematically analysed. Participating in research when in distress and in a challenging environment was found to be overwhelmingly positive. Participants valued contributing their time and insight, particularly when research was conducted in a skilled and kind manner. They identified personal (e.g., talking as part of the healing process) and wider benefits (e.g., helping to improve services) of participation, which for most, negated the difficulty of discussing highly sensitive topics when in crisis. Despite the potential ‘intrusiveness’ of video-recording, it was found to be acceptable by those who participated in the follow up interviews, a better method for learning and capturing interactions than e.g., questionnaires, and did not impede communication and the disclosure of distress

Psychosocial Assessment in the Emergency Department.

Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the "person" and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the "risk" and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living

LiveOcean: a daily forecast model of biogeochemistry in Washington marine waters

LiveOcean is a daily forecast model of ocean conditions for the coastal waters of Washington, Oregon, and Vancouver Island, as well as the Salish Sea. It is forced with realistic tides, winds, rivers, and ocean conditions. The model simulates biogeochemical properties including phytoplankton, nitrate, dissolved oxygen, dissolved inorganic carbon, and alkalinity, up to 3 days in the future. It is used for the prediction of ocean acidification events in coastal estuaries, and for harmful algal bloom events on coastal beaches. I will describe the model construction, comparisons with observations, uses, and future developments

Experiences of care for self-harm in the Emergency Department: a comparison of the perspectives of patients, carers and practitioners

Background: Each year, 220,000 episodes of self-harm are managed by Emergency Departments (EDs) in England, providing support to people at risk of suicide. Aims: To explore treatment of self-harm in EDs, comparing perspectives of patients, carers and practitioners. Method: Focus groups and semi-structured interviews with 79 people explored experiences of receiving/delivering care. Participants were patients (7 young people, 12 adults), 8 carers, 15 generalist ED practitioners and 37 liaison psychiatry practitioners. Data were analysed using framework analysis. Results: We identified four themes. One was common across stakeholder groups: (1) The wider system is failing people who self-harm: They often only access crisis support as they are frequently excluded from services, leading to unhelpful cycles of attending the ED. Carers felt over-relied upon and ill-equipped to keep the person safe. Three themes reflected different perspectives across stakeholders: (2) Practitioners feel powerless and become hardened towards patients, with patients feeling judged for seeking help which exacerbates their distress; (3) Patients need a human connection to offer hope when life feels hopeless, yet practitioners underestimate the therapeutic potential of interactions; (4) Practitioners are fearful of blame if someone takes their life: formulaic question-and-answer risk assessments help make staff feel safer but patients feel this is not a valid way of assessing risk or addressing their needs. Conclusions: ED practitioners should seek to build a human connection and validate patients’ distress, which offers hope when life feels hopeless. Patients consider this a therapeutic intervention in its own right. Investment self-harm treatment is indicated

Asking about self-harm during risk assessment in psychosocial assessments in the emergency department: questions that facilitate and deter disclosure of self-harm

BACKGROUND: Emergency departments are key settings for suicide prevention. Most people are deemed to be at no or low risk in final contacts before death. AIM: To micro-analyse how clinicians ask about suicidal ideation and/or self-harm in emergency department psychosocial assessments and how patients respond. METHOD: Forty-six psychosocial assessments between mental health clinicians and people with suicidal ideation and/or self-harm were video-recorded. Verbal and non-verbal features of 55 question-answer sequences about self-harm thoughts and/or actions were micro-analysed using conversation analysis. Fisher's exact test was used to test the hypothesis that question type was associated with patient disclosure. RESULTS: (a) Eighty-four per cent of initial questions (N = 46/55) were closed yes/no questions about self-harm thoughts and/or feelings, plans to self-harm, potential for future self-harm, predicting risk of future self-harm and being okay or keeping safe. Patients disclosed minimal information in response to closed questions, whereas open questions elicited ambivalent and information rich responses. (b) All closed questions were leading, with 54% inviting no and 46% inviting yes. When patients were asked no-inviting questions, the disclosure rate was 8%, compared to 65% when asked yes-inviting questions (P < 0.05 Fisher's exact test). (c) Patients struggled to respond when asked to predict future self-harm or guarantee safety. (d) Half of closed questions had a narrow timeframe (e.g. at the moment, overnight) or were tied to possible discharge. CONCLUSION: Across assessments, there is a bias towards not uncovering thoughts and plans of self-harm through the cumulative effect of leading questions that invite a no response, their narrow timeframe and tying questions to possible discharge. Open questions, yes-inviting questions and asking how people feel about the future facilitate disclosure

Features of portal hypertension are associated with major adverse events in Fontan patients: The VAST study

BACKGROUND: Chronic congestive hepatopathy is known to cause hepatic fibrosis and portal hypertension in patients post-Fontan operation for single ventricle palliation. The clinical significance of these findings is not clear. We hypothesized that features of portal hypertension would be significantly related to major adverse events. METHODS: A retrospective review of 73 adult and pediatric post-Fontan patients referred for a liver evaluation from 2001-2011 was performed. The relationship between features of portal hypertension (VAST score ≥2, 1 point each for Varices, Ascites, Splenomegaly or Thrombocytopenia) and a major adverse event (death, need for transplant, or hepatocellular carcinoma) was examined using logistic regression. RESULTS: 73 post-Fontan patients (30% female, 73% Caucasian, 66% systemic left ventricle (SLV), mean age 24 ±11 years, mean interval from Fontan 17 ±6 years) were included in analysis. Features of portal hypertension (VAST score ≥2) were present in 26 (36%), and there were 19 major adverse events: death (n=12), transplant (n=6), HCC (n=1). A significant relationship was found between VAST score ≥2 and major adverse events (OR=9.8, 95% CI [2.9-32.7]). After adjusting for time since Fontan, SLV, age, hemoglobin and type of failure, VAST score ≥2 remained significant (OR=9.1, 95% CI [1.4-57.6]). CONCLUSION: Fontan patients with features of portal hypertension have a 9-fold increased risk for a major adverse event. Therapies targeted to manage clinical manifestations of portal hypertension, and early referral to heart transplant may help delay major adverse events. Future prospective studies are needed to confirm these findings

Association of treatment satisfaction and psychopathological sub-syndromes among involuntary patients with psychotic disorders

Publisher's version: http://www.springerlink.com/content/rx24036274667t10