Touching on elements for a non-invasive sensory feedback system for use in a prosthetic hand

Hand amputation results in the loss of motor and sensory functions, impacting activities of daily life and quality of life. Commercially available prosthetic hands restore the motor function but lack sensory feedback, which is crucial to receive information about the prosthesis state in real-time when interacting with the external environment. As a supplement to the missing sensory feedback, the amputee needs to rely on visual and audio cues to operate the prosthetic hand, which can be mentally demanding. This thesis revolves around finding potential solutions to contribute to an intuitive non-invasive sensory feedback system that could be cognitively less burdensome and enhance the sense of embodiment (the feeling that an artificial limb belongs to one’s own body), increasing acceptance of wearing a prosthesis.A sensory feedback system contains sensors to detect signals applied to the prosthetics. The signals are encoded via signal processing to resemble the detected sensation delivered by actuators on the skin. There is a challenge in implementing commercial sensors in a prosthetic finger. Due to the prosthetic finger’s curvature and the fact that some prosthetic hands use a covering rubber glove, the sensor response would be inaccurate. This thesis shows that a pneumatic touch sensor integrated into a rubber glove eliminates these errors. This sensor provides a consistent reading independent of the incident angle of stimulus, has a sensitivity of 0.82 kPa/N, a hysteresis error of 2.39±0.17%, and a linearity error of 2.95±0.40%.For intuitive tactile stimulation, it has been suggested that the feedback stimulus should be modality-matched with the intention to provide a sensation that can be easily associated with the real touch on the prosthetic hand, e.g., pressure on the prosthetic finger should provide pressure on the residual limb. A stimulus should also be spatially matched (e.g., position, size, and shape). Electrotactile stimulation has the ability to provide various sensations due to it having several adjustable parameters. Therefore, this type of stimulus is a good candidate for discrimination of textures. A microphone can detect texture-elicited vibrations to be processed, and by varying, e.g., the median frequency of the electrical stimulation, the signal can be presented on the skin. Participants in a study using electrotactile feedback showed a median accuracy of 85% in differentiating between four textures.During active exploration, electrotactile and vibrotactile feedback provide spatially matched modality stimulations, providing continuous feedback and providing a displaced sensation or a sensation dispatched on a larger area. Evaluating commonly used stimulation modalities using the Rubber Hand Illusion, modalities which resemble the intended sensation provide a more vivid illusion of ownership for the rubber hand.For a potentially more intuitive sensory feedback, the stimulation can be somatotopically matched, where the stimulus is experienced as being applied on a site corresponding to their missing hand. This is possible for amputees who experience referred sensation on their residual stump. However, not all amputees experience referred sensations. Nonetheless, after a structured training period, it is possible to learn to associate touch with specific fingers, and the effect persisted after two weeks. This effect was evaluated on participants with intact limbs, so it remains to evaluate this effect for amputees.In conclusion, this thesis proposes suggestions on sensory feedback systems that could be helpful in future prosthetic hands to (1) reduce their complexity and (2) enhance the sense of body ownership to enhance the overall sense of embodiment as an addition to an intuitive control system

Multi-modality Sensory Feedback: a pilot study

The aim of this study is to test the hypotheses that a multi-modality sensory feedback device, incorporating mechanotactile and vibrotactile feedback can increase the subjects’ performance in localization and intensity discrimination.To the best of our knowledge, this is the first attempt combining mechanotactile and vibrotactile into a single sebsory feedback device. For persons without maps of referred sensation, the localization of the stimulation has to be memorized and predicted from previous stimulation. The outcome of this study shows that the hybrid stimulation relieves the mental load, but in future work activating both modalities simultaneously could increase haptic vocabulary. Hybrid stimulation also improves the performance for subjects with maps of referred sensation,

The rubber hand illusion evaluated using different stimulation modalities

Tactile feedback plays a vital role in inducing ownership and improving motor control of prosthetic hands. However, commercially available prosthetic hands typically do not provide tactile feedback and because of that the prosthetic user must rely on visual input to adjust the grip. The classical rubber hand illusion (RHI) where a brush is stroking the rubber hand, and the user’s hidden hand synchronously can induce ownership of a rubber hand. In the classic RHI the stimulation is modality-matched, meaning that the stimulus on the real hand matches the stimulus on the rubber hand. The RHI has also been used in previous studies with a prosthetic hand as the “rubber hand,” suggesting that a hand prosthesis can be incorporated within the amputee’s body scheme. Interestingly, previous studies have shown that stimulation with a mismatched modality, where the rubber hand was brushed, and vibrations were felt on the hidden hand also induced the RHI. The aim of this study was to compare how well mechanotactile, vibrotactile, and electrotactile feedback induced the RHI in able-bodied participants and forearm amputees. 27 participants with intact hands and three transradial amputees took part in a modified RHI experiment. The rubber hand was stroked with a brush, and the participant’s hidden hand/residual limb received stimulation with either brush stroking, electricity, pressure, or vibration. The three latter stimulations were modality mismatched with regard to the brushstroke. Participants were tested for ten different combinations (stimulation blocks) where the stimulations were applied on the volar (glabrous skin), and dorsal (hairy skin) sides of the hand. Outcome was assessed using two standard tests (questionnaire and proprioceptive drift). All types of stimulation induced RHI but electrical and vibration stimulation induced a stronger RHI than pressure. After completing more stimulation blocks, the proprioceptive drift test showed that the difference between pre- and post-test was reduced. This indicates that the illusion was drifting toward the rubber hand further into the session

Incidence and Sequelae of Prosthesis-Patient Mismatch in Transcatheter Versus Surgical Valve Replacement in High-Risk Patients With Severe Aortic Stenosis A PARTNER Trial Cohort-A Analysis

AbstractBackgroundLittle is known about the incidence of prosthesis-patient mismatch (PPM) and its impact on outcomes after transcatheter aortic valve replacement (TAVR).ObjectivesThe objectives of this study were: 1) to compare the incidence of PPM in the TAVR and surgical aortic valve replacement (SAVR) randomized control trial (RCT) arms of the PARTNER (Placement of AoRTic TraNscathetER Valves) I Trial cohort A; and 2) to assess the impact of PPM on regression of left ventricular (LV) hypertrophy and mortality in these 2 arms and in the TAVR nonrandomized continued access (NRCA) registry cohort.MethodsThe PARTNER Trial cohort A randomized patients 1:1 to TAVR or bioprosthetic SAVR. Postoperative PPM was defined as absent if the indexed effective orifice area (EOA) was >0.85 cm2/m2, moderate if the indexed EOA was ≥0.65 but ≤0.85 cm2/m2, or severe if the indexed EOA was <0.65 cm2/m2. LV mass regression and mortality were analyzed using the SAVR-RCT (n = 270), TAVR-RCT (n = 304), and TAVR-NRCA (n = 1,637) cohorts.ResultsThe incidence of PPM was 60.0% (severe: 28.1%) in the SAVR-RCT cohort versus 46.4% (severe: 19.7%) in the TAVR-RCT cohort (p < 0.001) and 43.8% (severe: 13.6%) in the TAVR-NRCA cohort. In patients with an aortic annulus diameter <20 mm, severe PPM developed in 33.7% undergoing SAVR compared with 19.0% undergoing TAVR (p = 0.002). PPM was an independent predictor of less LV mass regression at 1 year in the SAVR-RCT (p = 0.017) and TAVR-NRCA (p = 0.012) cohorts but not in the TAVR-RCT cohort (p = 0.35). Severe PPM was an independent predictor of 2-year mortality in the SAVR-RCT cohort (hazard ratio [HR]: 1.78; p = 0.041) but not in the TAVR-RCT cohort (HR: 0.58; p = 0.11). In the TAVR-NRCA cohort, severe PPM was not a predictor of 1-year mortality in all patients (HR: 1.05; p = 0.60) but did independently predict mortality in the subset of patients with no post-procedural aortic regurgitation (HR: 1.88; p = 0.02).ConclusionsIn patients with severe aortic stenosis and high surgical risk, PPM is more frequent and more often severe after SAVR than TAVR. Patients with PPM after SAVR have worse survival and less LV mass regression than those without PPM. Severe PPM also has a significant impact on survival after TAVR in the subset of patients with no post-procedural aortic regurgitation. TAVR may be preferable to SAVR in patients with a small aortic annulus who are susceptible to PPM to avoid its adverse impact on LV mass regression and survival. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894

Two-year outcomes after transcatheter or surgical aortic-valve replacement.

BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits. METHODS: At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation. RESULTS: The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P<0.001), and even mild paravalvular regurgitation was associated with increased late mortality (P<0.001). CONCLUSIONS: A 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.)

Understanding watershed hydrogeochemistry: 2. Synchronized hydrological and geochemical processes drive stream chemostatic behavior

This article is a companion to Bao et al. [2017], doi: 10.1002/2016WR018934.Why do solute concentrations in streams remain largely constant while discharge varies by orders of magnitude? We used a new hydrological land surface and reactive transport code, RT‐Flux‐PIHM, to understand this long‐standing puzzle. We focus on the nonreactive chloride (Cl) and reactive magnesium (Mg) in the Susquehanna Shale Hills Critical Zone Observatory (SSHCZO). Simulation results show that stream discharge comes from surface runoff (Qs), soil lateral flow (QL), and deeper groundwater (QG), with QL contributing >70%. In the summer, when high evapotranspiration dries up and disconnects most of the watershed from the stream, Cl is trapped along planar hillslopes. Successive rainfalls connect the watershed and mobilize trapped Cl, which counteracts dilution effects brought about by high water storage (Vw) and maintains chemostasis. Similarly, the synchronous response of clay dissolution rates (Mg source) to hydrological conditions, maintained largely by a relatively constant ratio between “wetted” mineral surface area Aw and Vw, controls Mg chemostatic behavior. Sensitivity analysis indicates that cation exchange plays a secondary role in determining chemostasis compared to clay dissolution, although it does store an order‐of‐magnitude more Mg on exchange sites than soil water. Model simulations indicate that dilution (concentration decrease with increasing discharge) occurs only when mass influxes from soil lateral flow are negligible (e.g., via having low clay surface area) so that stream discharge is dominated by relatively constant mass fluxes from deep groundwater that are unresponsive to surface hydrological conditions.EAR 07‐25019EAR 12‐39285EAR 13‐3172

Road infrastructure and primate conservation : introducing the Global primate roadkill database

As road infrastructure networks rapidly expand globally, especially in the tropics, previously continuous habitats are being fragmented, resulting in more frequent wildlife–vehicle collisions (WVC). Primates are widespread throughout many sub-/tropical countries, and as their habitats are fragmented, they are increasingly at risk of WVC. We created the Global Primate Roadkill Database (GPRD), the largest available standardized database of primate roadkill incidents. We obtained data from published papers, un-published and citizen science databases, anecdotal reports, news reports, and social media posts. Here, we describe the collection methods for the GPRD and present the most up-to-date version of the database in full. For each primate roadkill incident, we recorded the species killed, the exact location, and the year and month the roadkill was observed. At the time of publication, the GPRD includes 2862 individual primate roadkill records from 41 countries. As primates range in more than twice as many countries, the absence of data from these countries is not necessarily indicative of a lack of primate vehicular collisions. Given the value of these data for addressing both local and global research questions, we encourage conservationists and citizen scientists to contribute to the GPRD so that, together, we can better understand the impact road infrastructure has on primates and evaluate measures which may help mitigate risk-prone areas or species

Ecology and Transmission of Buruli Ulcer Disease: A Systematic Review

Buruli ulcer is a neglected emerging disease that has recently been reported in some countries as the second most frequent mycobacterial disease in humans after tuberculosis. Cases have been reported from at least 32 countries in Africa (mainly west), Australia, Southeast Asia, China, Central and South America, and the Western Pacific. Large lesions often result in scarring, contractual deformities, amputations, and disabilities, and in Africa, most cases of the disease occur in children between the ages of 4–15 years. This environmental mycobacterium, Mycobacterium ulcerans, is found in communities associated with rivers, swamps, wetlands, and human-linked changes in the aquatic environment, particularly those created as a result of environmental disturbance such as deforestation, dam construction, and agriculture. Buruli ulcer disease is often referred to as the “mysterious disease” because the mode of transmission remains unclear, although several hypotheses have been proposed. The above review reveals that various routes of transmission may occur, varying amongst epidemiological setting and geographic region, and that there may be some role for living agents as reservoirs and as vectors of M. ulcerans, in particular aquatic insects, adult mosquitoes or other biting arthropods. We discuss traditional and non-traditional methods for indicting the roles of living agents as biologically significant reservoirs and/or vectors of pathogens, and suggest an intellectual framework for establishing criteria for transmission. The application of these criteria to the transmission of M. ulcerans presents a significant challenge

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR