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BackgroundThe number of older adults living with lower limb amputation (LLA) who require rehabilitation for improving their walking capacity and mobility is growing. Existing rehabilitation practices frequently fail to meet this demand. Nintendo Wii Fit may be a valuable tool to enable rehabilitation interventions. Based on pilot studies, we have developed “Wii.n.Walk”, an in-home telehealth Wii Fit intervention targeted to improve walking capacity in older adults with LLA. ObjectiveThe objective of this study is to determine whether the Wii.n.Walk intervention enhances walking capacity compared to an attention control group. MethodsThis project is a multi-site (Vancouver BC, London ON), parallel, evaluator-blind randomized controlled trial. Participants include community-dwelling older adults over the age of 50 years with unilateral transtibial or transfemoral amputation. Participants will be stratified by site and block randomized in triplets to either the Wii.n.Walk intervention or an attention control group employing the Wii Big Brain cognitive software. This trial will include both supervised and unsupervised phases. During the supervised phase, both groups will receive 40-minute sessions of supervised group training three times per week for a duration of 4 weeks. Participants will complete the first week of the intervention in groups of three at their local rehabilitation center with a trainer. The remaining 3 weeks will take place at participants’ homes using remote supervision by the trainer using Apple iPad technology. At the end of 4 weeks, the supervised period will end and the unsupervised period will begin. Participants will retain the Wii console and be encouraged to continue using the program for an additional 4 weeks’ duration. The primary outcome measure will be the “Two-Minute Walk Test” to measure walking capacity. Outcome measures will be evaluated for all participants at baseline, after the end of both the supervised and unsupervised phases, and after 1-year follow up. ResultsStudy staff have been hired and trained at both sites and recruitment is currently underway. No participants have been enrolled yet. ConclusionsWii.n.Walk is a promising in-home telehealth intervention that may have useful applications for older adults with LLA who are discharged from rehabilitation or live in remote areas having limited or no access to existing rehabilitation programs. Trial RegistrationClinicaltrial.gov NCT01942798; http://clinicaltrials.gov/ct2/show/NCT01942798 (Archived by WebCite at http://www.webcitation.org/6V0w8baKP).

Introduction: Although depression is a major contributor to the global burden of disease, services remain scarce in many low- and middle-income countries. In Vietnam, depression services are limited, and the government has recently prioritized primary care and community-based service integration. We conducted a pilot study in 2 districts of Hanoi to test the feasibility of (a) introducing a supported self-management (SSM) intervention for adult depression in primary care in Vietnam, and (b) conducting a randomized controlled trial (RCT) to test the effectiveness of the intervention. Method: We conducted focus groups with providers (n = 16) and community members (n = 32) to assess the appropriateness of an Antidepressant Skills Workbook for use in Vietnam. We trained providers (n = 23) to screen patients using the Self-Reporting Questionnaire-20 (SRQ-20) depression scale and to deliver SSM for a 2-month period. A total of 71 patients were eligible to participate in the study, with depression (SRQ-20) and disability (World Health Organization Disability Assessment Schedule 2.0) scores assessed at baseline and 1 and 2 months. Results: Study results demonstrate the feasibility of conducting a full RCT in Vietnam and suggest that SSM is an appropriate care model for the Vietnamese context. There was a statistically significant decrease in depression symptoms on the SRQ-20 and in functional disability in all domains for the World Health Organization Disability Assessment Schedule 2.). Conclusion: Feasibility study results suggested that a full RCT was warranted. An unanticipated outcome of the study was the uptake of the model by the Ministry of Labor, Invalids, and Social Affairs in 2 additional provinces. Keywords: depression, primary health care, supported self-management, Vietnam, mental health services, Although depressive disorders contribute considerably to the global burden of disease, services for depression are limited, particularly in low- and middle-income countries (LMICs). To address this gap, integrating depression services [...]

Rehabilitation increasingly addresses the International Classification of Functioning, Disability and Health's (ICF) concepts of activity and participation, but little is known about associations between changes in body functions and structures, activity, and participation. We conducted a before-and-after study of 35 ambulatory children with spastic diplegia or hemiplegic cerebral palsy, mean age 5 years 6 months (SD 2y 2mo). Children were in Gross Motor Function Classification System (GMFCS) Levels I (n=11), II (n=12), or III (n=12). We assessed body functions and structures, activity, and participation at baseline and at 2 months and 6 months post-botulinum toxin type A (BoNT-A) injection. Repeated-measures analysis of variance evaluated change, and linear regression assessed relationships. Baseline score relationships were moderate to strong but, despite similar directions of change at 2 months, change score relationships between measures of body functions and structures (spasticity and timed walk), activity (Gross Motor Function Measure and Pediatric Evaluation of Disability Inventory), and participation (Pediatric Outcomes Data Collection Instrument) at 2 months and 6 months were poor to fair (r less than 0.40). Predictor combinations accounted for less than 69% of variation in activity and participation change scores. Predictors often pertained to baseline score, GMFCS level, or age. Relationships between changes at different ICF levels are complex, and activity and participation gains post-BoNT-A are likely to be influenced by the child and environment factors.

Background: The Quality Initiative in Rectal Cancer (QIRC) trial targeted surgeon intraoperative technique and not radiation therapy (RT) use. We performed a post hoc analysis of RT use among patients in the QIRC trial, not by arm of trial but rather for the entire group. We wished to identify associations between local recurrence risk and use of preoperative, postoperative or no RT Methods: We compared demographic, tumour and process of care measures among patients receiving preoperative, postoperative or no RT. A multivariable Cox regression model assessed local recurrence risk. Results: The QIRC trial enrolled 1015 patients at 16 hospitals between 2002 and 2004. Radiation therapy use did not differ between trial arms, and median follow-up was 3.6 years. For the preoperative, postoperative and no RT groups, respectively, the percentage of patients was 12.8%, 19.3% and 67.9%; the percentage of stage II/III tumours was 57.0%, 88.7% and 48.1%; and the local recurrence rate was 5.3%, 10.2% and 5.5% (p = 0.05). After controlling for patient and tumour characteristics, including tumour stage, the hazard ratio (HR) for local recurrence was increased in the postoperative RT versus the no RT group (HR 1.64, 95% confidence interval 1.04-2.58, p = 0.027). Conclusion: Use of preoperative RT was low; most patients with stage II/III disease did not receive RT and, as expected, the postoperative RT group had the highest risk of local recurrence. Our results suggest opportunities to improve rectal cancer RT use in Ontario. Contexte: L'essai QIRC (Quality Initiative in Rectal Cancer) portait sur la technique peroperatoire des chirurgiens et non sur l'utilisation de la radiotherapie (RT). Nous avons effectue une analyse retrospective de l'utilisation de la RT chez les patients inclus dans l'essai QIRC, non pas en fonction des differents groupes de l'essai, mais en fonction de sa population entiere. Nous avons voulu verifier les liens entre le risque de recurrences locales et l'utilisation preoperatoire ou postoperatoire de la RT ou l'abstention de toute RT. Methodes: Nous avons compare les parametres demographiques, les caracteristiques de la tumeur et le processus de soins chez les patients soumis a une RT preoperatoire ou postoperatoire, ou non traites par RT. Un modele de regression multivariee de Cox a permis d'evaluer le risque de recurrences locales. Resultats: L'essai QIRC a regroupe 1015 patients de 16 hopitaux entre 2002 et 2004. Le recours a la radiotherapie n'a pas differe entre les groupes de l'essai, et le suivi median a ete de 3,6 ans. Pour ce qui est des groupes soumis a une RT preoperatoire ou postoperatoire, ou non soumis a la RT, respectivement, le pourcentage de patients etait de 12,8 %, 19,3 % et 67,9 %; le pourcentage de tumeurs de stade II/III etait de 57,0 %, 88,7 % et 48,1 %, et le taux de recurrences locales, de 5,3 %, 10,2 % et 5,5 % (p = 0,05). Apres ajustement pour tenir compte des caracteristiques des patients et des tumeurs, y compris le stade de la tumeur, le risque relatif (RR) de recurrences locales a augmente dans le groupe soumis a une RT postoperatoire par rapport au groupe non soumis a la RT (RR 1,64; intervalle de confiance de 95 %, 1,04-2,58, p = 0,027). Conclusion: Le recours a la RT preoperatoire a ete faible; la plupart des patients atteints d'une maladie de stade II/III n'ont pas recu de RT et comme prevu, le groupe soumis a une RT postoperatoire a presente le risque le plus eleve de recurrences locales. Nos resultats indiquent qu'il serait possible d'ameliorer l'utilisation de la RT pour le cancer rectal en Ontario., A negative outcome following rectal cancer surgery is local tumour recurrence in the pelvis. Prospective randomized trials have demonstrated that pelvic radiation can reduce postsurgical rates of local recurrence and [...]

Background: Theory suggests the uptake of a medical innovation is influenced by how potential adopters perceive innovation characteristics and by characteristics of potential adopters. Innovation adoption is slow among the first 20% of individuals in a target group and then accelerates. The Quality Initiative in Rectal Cancer (QIRC) trial assessed if rectal cancer surgery outcomes could be improved through surgeon participation in the QIRC strategy. We tested if traditional uptake of innovation concepts applied to surgeons in the experimental arm of the trial. Methods: The QIRC strategy included workshops, access to opinion leaders, intraoperative demonstrations, postoperative questionnaires, and audit and feedback. For intraoperative demonstrations, a participating surgeon invited an outside surgeon to demonstrate optimal rectal surgery techniques. We used surgeon timing in a demonstration to differentiate early and late adopters of the QIRC strategy. Surgeons completed surveys on perceptions of the strategy and personal characteristics. Results: Nineteen of 56 surgeons (34%) requested an operative demonstration on their first case of rectal surgery. Early and late adopters had similar perceptions of the QIRC strategy and similar characteristics. Late adopters were less likely than early adopters to perceive an advantage for the surgical techniques promoted by the trial (p = 0.023). Conclusion: Most traditional diffusion of innovation concepts did not apply to surgeons in the QIRC trial, with the exception of the importance of perceptions of comparative advantage. Contexte: Selon une theorie, 2 facteurs influencent l'adoption de nouvelles pratiques en medecine, soit la facon dont les adeptes potentiels percoivent les caracteristiques novatrices et les caracteristiques propres aux adeptes potentiels eux-memes. L'adoption des nouvelles pratiques se fait lentement chez les premiers 20 % des individus d'un groupe cible, puis va en s'accelerant. L'etude QIRC (Quality Initiative in Rectal Cancer) a voulu verifier si la participation des chirurgiens a la strategie QIRC pouvait ameliorer l'issue de la chirurgie pour cancer du rectum. Nous avons verifie si les modes habituels d'adoption des nouvelles pratiques s'appliquaient aux chirurgiens dans le groupe experimental de l'etude. Methodes: La strategie QIRC incluait des ateliers, l'acces a des meneurs d'opinion, des demonstrations peroperatoires et des questionnaires postoperatoires, suivis de verifications et de commentaires. Pour les demonstrations peroperatoires, un chirurgien participant invitait un chirurgien de l'exterieur a faire une demonstration de techniques chirurgicales rectales optimales. Nous avons utilise les delais d'adoption des nouvelles pratiques par les chirurgiens pour faire ressortir la distinction entre les adeptes precoces et tardifs de la strategie QIRC. Les chirurgiens ont repondu a des questionnaires sur leurs perceptions a l'endroit de la strategie et sur leurs caracteristiques personnelles. Resultats: Dix-neuf chirurgiens sur 56 (34 %) ont demande une demonstration operatoire lors de leur premier cas de chirurgie rectale. Les adeptes precoces et tardifs avaient des perceptions similaires de la strategie QIRC et des caracteristiques personnelles similaires. Les adeptes tardifs etaient moins susceptibles que les adeptes precoces de percevoir l'avantage des techniques chirurgicales preconisees dans le cadre de l'etude (p= 0,023). Conclusion: La plupart des modes habituels de diffusion des nouvelles pratiques ne s'appliquaient pas aux chirurgiens de l'essai QIRC, a l'exception de l'importance des perceptions a l'endroit des avantages comparatifs., Researchers suggest that the uptake of a medical innovation depends on how potential adopters perceive the characteristics of the innovation, the characteristics of the potential adopters and contextual factors that [...]

A compact model is proposed to facilitate the design and simulation of the control waveform of RF microelectromechanical systems (MEMS) capacitive switches with electrostatically actuated membranes. Following conventional approaches, the pull-in motion of a membrane is simulated by an L--R--C network. However, the present model deviates from conventional approaches by adding another capacitor and a diode to simulate the gradual contact of the membrane with the stationary electrode. After contact, variable mass, spring constant, and damping factor are used to simulate the release process of the membrane. By smoothly bridging the model between pull-in, contact, and release processes, the model can efficiently simulate static and transient S-parameters of the switches up to 50 GHz. The model can be readily installed in popular computer-aided circuit design environments to analyze in the time domain the behavior of the switches and the operation of MEMS-based circuits. Index Terms--Capacitance measurement, electromechanicai effects, microelectromechanical devices, microwave devices, microwave measurements, microwave switches.

To determine the effectiveness of ultrasound/phonophoresis as an adjuvant to exercise or manual therapy for the improvement of patient-centred outcomes in adults with non-specific neck pain (NSNP). Seven electronic databases were systematically searched up to September 2020. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to judge the Quality of Evidence (QoE). Six studies involving 249 participants were included. The QoE was very low GRADE. Phonophoresis with capsaicin plus exercise improved pain at immediate post-treatment (MD: −3.30 [−4.05, −2.55]) but not with diclofenac sodium plus exercise as compared to exercise. Continuous ultrasound (CUS) plus exercise improved pain and pressure pain threshold (PPT) at immediate post-treatment (pain: MD: −3.42 [−4.08, −2.7]); (PPT: MD: 0.91 [0.68, 1.14]) and at intermediate-term as compared to exercise. CUS or high power pain threshold (HPPT) ultrasound plus manual therapy and exercise showed no benefit for pain reduction (MD: −0.75 [−2.08, 0.58]) did not improve function/disability (MD: −1.05 [−4.27, 2.17]) at immediate or short-term as compared to manual therapy and exercise. Due to high risk of bias, inconsistency, and indirectness the QoE is very low in support of benefit of ultrasound/phonophoresis as an adjuvant treatment for NSNP. Due to high risk of bias, inconsistency, and indirectness the quality of evidence (QoE) is very low in support of benefit of adding ultrasound or phonophoresis to exercise or manual therapy for pain reduction or improvement in function/disability for those with sub-acute and chronic myofascial associated neck pain. However, our confidence in the findings is very low and conclusions are likely to change as more evidences emerges. Clinicians using ultrasound therapy as an adjuvant intervention for management of chronic myofascial associated neck pain should carefully consider the available evidence on ultrasound, including the benefits and costs involved. [ABSTRACT FROM AUTHOR]

A common difficulty encountered by surgeons is the broad range of treatment choices available for a surgical condition. Observational studies and small randomized trials account for a large proportion of [...]

Bipolar control-voltage waveforms, under which the control voltage alternates between positive and negative after each cycle, have been proposed to mitigate dielectric charging in electrostatically actuated RF microelectromechanical system capacitive switches. In this study, dielectric charging under bipolar waveforms is modeled and characterized quantitatively. In general, the experimental results agree with predictions based on the superposition of unipolar charging models that are extracted under positive and negative voltages, respectively. The basic assumptions for such a superposition model are examined in detail and validated experimentally. The current analysis indicates that, while bipolar waveforms can reduce charging, it is difficult to fine tune the waveforms to completely eliminate charging. Index Terms--Charge injection, dielectric films, dielectric materials, microelectromechanical devices, switches.