How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

Comparison of Panel D-15 Tests in a Large Older Population

PurposeTo determine the frequency and type of color vision defects in a large group of randomly selected older people using two versions of the D-15 and to examine the agreement between the two tests.MethodsThe Adams desaturated D-15 test was administered under Illuminant C (MacBeth lamp, ∼ 100 lux) to a group of 865 individuals aged 58 to 102 years (mean, 75.2 ± 9.1 years). No exclusion criteria, other than the reported presence of a congenital color defect, were applied. Testing was binocular with habitual near correction. If any error was made on this test, the Farnsworth D-15 was administered under identical conditions. On both tests, a color confusion score of 30 or higher was considered failing, and for those failing the test, color defect type (blue-yellow, red-green, or nonselective) was determined using the method of Vingrys and King-Smith (1988).ResultsThe majority (60.8%) of the people tested passed both tests. For the sample as a whole, the failure rates of the Adams desaturated D-15 and the Farnsworth D-15 were 36.2% and 20.76%, respectively. As expected, for both tests, failure rate increased markedly with age. Among those who failed both tests, 17.5% of the population, the proportion of specific agreement for red-green and blue-yellow defects was high, 88%. The vast majority of those failing either or both tests had blue-yellow defects, in agreement with previous studies.ConclusionsBlue-yellow defects were quite common among the aged, becoming increasingly prevalent with increasing age. More people failed the Adams desaturated D-15 than the Farnsworth D-15, but among those who failed, the proportion of blue-yellow defects was similar for the two tests, approximately 75%. The agreement between the two tests in identifying acquired red-green and blue-yellow errors was high

Urban land expansion in Indonesia 1992-2012: evidence from satellite-detected luminosity

Land conversion to urban use typically accompanies economic development but raises concerns about food security. Debates of these issues often rely on incomplete and incompatible evidence. This study uses satellite-detected luminosity, from 1992 to 2012, to examine the urban land expansion of 41 major urban areas in Indonesia. The trend annual expansion rate is 2.0 per cent, which is comparable to the rate for India and just one-third of the rate for China, as estimated with the same data and methods. Prior to the Asian Financial Crisis in 1997/98, the rate of urban expansion was faster, and the income elasticity of urban expansion was much higher. About 85 per cent of the area of urban expansion had formerly been grassland, shrub or woodland, and just 7.0 per cent was former cropland so food security concerns about urban expansion may be overstated

Longitudinal Increase in Anisometropia in Older Adults

PurposeAnisometropia shows an exponential increase in prevalence with increasing age based on cross-sectional studies. The purpose of this study was to evaluate longitudinal changes in anisometropia in all refractive components in older observers and to assess the influence of early cataract development.MethodsRefractive error was assessed at two time points separated by approximately 12 years in 118 older observers (aged 67.1 and 79.3 years at the two test times). Anisometropia defined as greater than or equal to 1.00 D was calculated for all refractive components. The subjects had intact ocular lenses in both eyes throughout the study. Lens evaluations were performed at the second test using the Lens Opacities Classification System III.ResultsAll refractive components approximately doubled in prevalence of anisometropia. Spherical equivalent anisometropia changed from 16.1 to 32.2%. Similar changes were found for spherical error (17 to 38.1%), primary astigmatism (7.6 to 17.8%), and oblique astigmatism (14.4 to 29.7%). Many who did not have anisometropia at the first visit subsequently developed anisometropia (e.g., 26.3% for spherical error and 22.9% for oblique cylinder). The onset of anisometropia occurred at all ages within the studied age range, with no particular preference for any one age. A small number lost anisometropia over time. Individual comparisons of refractive error changes in the two eyes in combination with nuclear lens changes showed that early changes in nuclear sclerosis in the two eyes could account for a large proportion of anisometropia (~40%), but unequal hyperopic shift in the spherical component in the two eyes was the primary cause of the anisometropia.ConclusionsAnisometropia is at least 10 times more common in the elderly than in children, and anisometropia develops in all refractive components in the oldest observers. Clinicians need to be aware of this common condition that could lead to binocular vision problems and potentially cause falls in the elderly