LAY SUMMARY Female Veterans and female athletes with disabilities express concerns with mobility devices that are male-centric and do not address their unique needs. It is important that the needs of women are given the same attention as those of men. The following study asked groups of women who use wheelchairs or scooters, including Veterans and athletes, about their experiences. Twenty-four women, recruited from two sporting events for Veterans with disabilities, were asked to fill out a survey and participate in a focus group where they would discuss their views on mobility aids and related services. There were four major themes women often mentioned when they talked about using their mobility aids: usability (how they like using it), service delivery (how they get help with it), well-being (how they feel), and design (how it looks and works). Participants were concerned about the ability to adjust their device to their needs, how people obtained a device, and how they felt about using the device. Female wheelchair and scooter users recommended several changes to mobility aids that would improve the devices and improve the lives of women who use them.
Document the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport.A transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤30 weeks gestation.Forty-four newborns were studied in 2008-2015; of them, 21 were transported by road, 19, by helicopter and four, by fixed wing: median birthweight, 1130 g (680-1960 g) and median gestation, 27 weeks (23-30); 30 of 44 were male babies. Antenatal steroid course was complete in two babies. Ultrasound in the referring hospital was at a mean of two hours: 47 minutes (00:15-7:00) of age. Low systemic blood flow was common: 50% had right ventricular output <150mL/kg/min and 23%, a superior vena cava flow <50mL/kg/min. at stabilisation. Cranial US: 10 Grade I IVH, 2 Grade II IVH, 1 Grade IV IVH and 32 normal scans pretransport. After transport, three further Grade I IVH were reported. Mortality was higher in the babies with low systemic blood flow: 4 of 12 (33%) died vs 1 of 31 (6%) in the normal flow group (OR = 7.2, 95% CI: 1.1 to 47, p = 0.022).Point-of-care ultrasound during the retrieval of preterm infants confirms a high incidence of haemodynamic pathology. The use of ultrasound during transport may provide an opportunity for earlier targeted circulatory support.
ABSTRACT Background There has been little decline in neonatal mortality rates over recent decades, and this is now further challenged by the rising prevalence of antimicrobial resistance (AMR). In Australia, the incidence of neonatal sepsis is low on a global scale, yet there are increasingly frequent outbreaks of multidrug-resistant (MDR) infections in neonatal intensive care units, alongside rising rates of colonisation with MDR bacteria. Methods We analysed positive blood and cerebrospinal fluid (CSF) cultures collected from infants (aged 0 to ≤180 days) across five clinical sites in Australia between 2010 and 2019, to determine evolving antimicrobial susceptibility profiles. Results After excluding presumed contaminants, we analysed 743 pathogenic bacterial isolates cultured from 624 neonates and infants with early- (≤72 hours), late- (>72 hours to ≤28 days), and very late-onset (>28 days to ≤180 days) infections. Escherichia coli (37%) and Streptococcus agalactiae (31%) were the primary pathogens responsible for early-onset bloodstream infections, whilst coagulase-negative staphylococci, E. coli and Staphylococcus aureus were responsible for most infections in older neonates and infants. Antimicrobial susceptibility to currently-recommended empiric regimens remains high; however, gram-negative bacteria – including MDR bacteria – were responsible for an increasing proportion of very late-onset infections over the study period (22% in 2010-2014 versus 34% in 2015-2019; p=0.07). Conclusions Although empiric antimicrobial regimens remain adequate for most pathogens causing infections in neonates and infants in Australia, there is an increasing burden of invasive infections caused by gram-negative bacteria. Ongoing surveillance is necessary to ensure empiric antimicrobial guidelines remain efficacious and appropriate.
AbstractObjective: The purpose of this study was to compare trunk mechanics, distance covered, and average instantaneous velocity and acceleration recorded with caregivers performing transfer tasks using a research mannequin with both a prototype robotic assisted transfer device (RATD) and a mobile floor lift.Design: Cross-Sectional.Setting: Biomechanics Lab and Human Engineering Research Laboratories.Participants: Caregivers (N = 21).Intervention: Robotic Assisted Transfer Device.Outcome Measures: Range of flexion-extension, lateral bend, and axial rotation; distance covered; average instantaneous velocity and acceleration.Results: Caregivers performing transfers using the RATD as compared to when using the moble floor lift reported significantly smaller range of trunk flexion-extension, lateral bending, and axial rotation, and reported lower pelvic based distance covered and slower average instantaneous velocity and acceleration (P < 0.001).Conclusion: The design and usability of a RATD indicates design driven mobility advantages over clinical standard mobile floor lifts due to its ability to expand the workspace while further reducing risk factors for low back pain. While the concept is promising, further testing is required to address limitations and confirm the concept for clinical applications.Keywords: Healthcare personnelHandling and movingClinical biomechanicsRoboticsAssistive technology AcknowledgementsThe contents of this paper do not represent the views of the U.S Department of Veterans Affairs or the United States Government. Two of the authors, Dr. Rory Cooper and Dr. Garrett Grindle are co-inventors on the patent, united states patent 9,254,234, for the human engineering research laboratories robotic assisted transfer device (Strong Arm).Disclaimer statementsContributors None.Conflicts of interest No potential conflict of interest was reported by the author(s).Additional informationFundingThis work was funded by the VA Merit Review [grant number F1454R], Veterans Affairs Center of Excellence for Wheelchairs and Assistive Rehabilitation Engineering [grant numbers B9250-C and B9269-L], Integrative Graduate Education and Research Traineeship [grant number DGE1144584], and Paralyzed Veterans of America. Dr. Rory Cooper is a Senior Career Scientist at the U.S. Department of Veterans Affairs [grant number B9269-L].
Clinical and engineering advancements from rehabilitation sciences, medicine, psychology, and bioengineering are becoming more appealing, as they provide those with neurological disabilities, and the people that care for them, the confidence and assistance to live independently (Kirby et al., Arch Phys Med Rehabil 99: 1295–1302, 2018; Dicianno et al., Mil Med 183: e518–e525, 2018). The purpose of this chapter is to provide an overview and examples of emerging clinical technologies assisting people with disabilities as they increasingly become independent, participating members of society. In completing the chapter, the reader should understand (1) technology design and research; (2) clinical applications for neuroengineering; and (3) translation for activities of daily living. Examples discussed will include neurostimulation as well as assisted robots, adaptable aids, mobile health (mhealth), internet of things, and telehealth. The reader will then be provided with a discussion recapping each section while providing additional detail on their long-term benefits and potential future research.
The RATD represents a novel methodology to reduce strain, manoeuvring, and cognitive load a caregiver experiences when conducting transfers on a mannequin. However, caregivers who used this new technology report suggested adjustments regarding the robot's human machine interface and shape as to improve transfer efficiency and comfort for care recipients. The purpose of this study was to test a redesigned RATD and compare its ergonomics during a transfer to those of a mechanical floor lift.This was cross sectional protocol. As opposed to prior research which used a mannequin, caregivers in this study (N = 28) partnered with, and transferred, a mobility device user (N = 28) at three unique surfaces. Information about task demand and usability was collected from surveys after use of each device at each surface.Results indicated reduced physical demand (p = .004) and discomfort frequency (p = .01) in caregivers conducting the transfers with the RATD compared to the mechanical floor lift. Care recipients reported no significant differences between both transfer devices. Critiques with the interface, the harness and sling, and the robot's rigidity indicated more work is needed before introducing this technology to a larger market. Conclusions: The RATD represents a promising new intervention for transferring and handling care recipients who use wheelchairs. However, while caregivers report reduced physical demand and discomfort, more work is required to advance the ease of the human machine interface, the amount of space allowed for the robot to operate, and the ability of the care recipient to operate the technology independently.IMPLICATIONS FOR REHABILITATIONCaregivers report significant physical and mental stress while transferring clients in and out of a wheelchair.Clinical standard transfer equipment is limited in the space which it can be used.Robots, particularly those portable and powered, have the ability to not only make the transfer experience safer, but also expand the applications this equipment can provide.
The robotic assisted transfer device was developed as an updated lift technology to reduce adjustments in posture while increasing capabilities offered by transfer devices. The purpose of this study was to compare the trunk biomechanics of a robotic assisted transfer device and a mechanical floor lift in the transfer of a care recipient by a caregiver during essential transfer tasks.
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