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Objective: To describe implementation of myTIPreport for milestone feedback and to initiate construct validity testing of myTIPreport for milestones., Design: myTIPreport was used to provide workplace feedback on Accreditation Council for Graduate Medical Education required milestone sets. Performance of senior learners (postgraduate year [PGY]-4s) was compared to that of junior learners (PGY-1s) to begin the process of construct validity testing for myTIPreport., Setting: A convenience-based site selection of Obstetrics and Gynecology (OBGYN) residency programs., Participants: OBGYN residents and faculty., Results: Amongst the 12 participating OBGYN residency programs, there were 444 unique learners and 343 unique faculty teachers. A total of 5293 milestone feedback encounters were recorded. Mean PGY-4 performance was rated higher than mean PGY-1 performance on all 25 of the compared milestone sets, with statistically significant differences seen for 19 (76%) of these 25 milestone sets and nonsignificant differences in the predicted direction observed for the other 6 milestone sets., Conclusions: myTIPreport detected differences between senior and junior learners for the majority of compared feedback encounters for OBGYN residents. Findings support the emerging construct validity of myTIPreport for milestone feedback., Competing Interests: Conflict of interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Context: Increased frontal-plane knee motion during functional tasks, or medial knee displacement, is a predictor of noncontact anterior cruciate ligament injury and patellofemoral pain. Intervention studies that resulted in a reduced risk of knee injury included some form of feedback to address aberrant lower extremity movement patterns. Research on integrating feedback into single-legged tasks and the ability to train 1 task and test another is limited., Objective: To determine if adding real-time visual biofeedback to common lower extremity exercises would improve single-legged landing mechanics in females with medial knee displacement., Design: Cohort study., Setting: University laboratory., Patients or Other Participants: Twenty-four recreationally active females with medial knee displacement were randomized to a visual-biofeedback group (n = 12; age = 19.75 ± 0.87 years, height = 165.32 ± 8.69 cm, mass = 62.41 ± 8.91 kg) or a control group (n = 12; age = 19.75 ± 0.97 years, height = 166.98 ± 6.89 cm, mass = 59.98 ± 6.24 kg)., Intervention(s): Individuals in the feedback group viewed a real-time digital model of their body segments generated by Microsoft Kinect. The skeletal model changed color according to the knee-abduction angle of the test limb during the exercise tasks., Main Outcome Measure(s): Participants completed 3 trials of the single-legged drop vertical jump (SL-DVJ) while triplanar kinematics at the trunk, hip, knee, and ankle were collected via 3-dimensional motion capture. The feedback and control groups completed lower extremity exercises with or without real-time visual biofeedback, respectively. After the intervention, participants completed 3 additional trials of the SL-DVJ., Results: At baseline, the feedback group had 3.83° more ankle eversion than the control group after initial contact. After the intervention, the feedback group exhibited 13.03° more knee flexion during the flight phase of the SL-DVJ and 6.16° less knee abduction after initial contact than the control group. The feedback group also demonstrated a 3.02° decrease in peak knee-abduction excursion compared with the baseline values ( P = .008)., Conclusions: Real-time visual biofeedback immediately improved faulty lower extremity kinematics related to knee-injury risk. Individuals with medial knee displacement adjusted their movement patterns after a single training session and reduced their medial knee motion during a dynamic task.

Aim: The aim of the study was two-fold: first, to assess the efficacy of an electronic real-time feedback system; second, to examine patient satisfaction. Methods: This was a mixed-method study. Data were collected from two psychiatric outpatient clinics using electronic patient feedback devices. The efficacy of the real-time feedback system was assessed by calculating the overall response rate, and the response rate to each individual five-point Likert scale statement and open-ended question by using descriptive statistics. Patient satisfaction was examined by analyzing the response rate to each statement. Open-ended feedback was analyzed by using inductive qualitative content analysis. Results: The overall response rate was 21.0% ( n  = 1658) and response rates varied by statements. Most of the patients saw that they received the appointment to the outpatient clinic quickly enough ( n  = 1404, 85%), the personnel treated them well ( n  = 1126, 95%), the information about the care was understandable ( n  = 1066, 94%), and decisions regarding their care were made together with them ( n  = 1051, 94%). Of the patients, 94% ( n  = 1052) would recommend the service. Positive open-ended feedback highlighted good service, skilled staff, perceived benefits and help from care. Critique and development areas dealt with the large number of forms that required filling out beforehand, subjective experience of long waiting times, and having too many collaborative professionals present during treatment. Conclusions: The real-time feedback system proved to be an efficient method of gathering patient feedback. Patient satisfaction seemed to be high with received care in all fields.

See related Article See related Article [ABSTRACT FROM AUTHOR]

The article discusses the use of Inertial Measurement Units (IMU) for real-time feedback for gesture sport performance monitoring particularly on swimming technique. The most common performance criterion for swimming is stroke length, stroke count and lap count and the tested device is a Swimbot. Topic includes methods for measurements which includes manual video analysis (VIRB cameras, Garmin, Schaffhausen) and motion capture system OptiTrack (NaturalPoint, Corvallis).

The objective of this study is to develop improved methods for renal blood oxygenation level dependent (BOLD) imaging. T2* mapping of the kidneys, or renal BOLD imaging, may depict renal oxygen levels and may be valuable as a noninvasive means of following the progression of renal disease. Current renal BOLD data is limited by imaging in a single breath hold, which results in low resolution and low signal‐to‐noise ratio (SNR). We compare a new free‐breathing renal BOLD method with conventional breath‐hold BOLD (BH‐BOLD). A multi‐echo GRE sequence with continuous prospective respiratory navigation and real‐time feedback was developed that allows high resolution and high SNR renal BOLD imaging with constant sequence repetition time (TR) during free‐breathing BOLD (FB‐BOLD). The sequence was evaluated in 10 normal volunteers and compared with conventional BH‐BOLD. Scan time for the FB‐BOLD sequence was approximately three minutes, compared with 15 seconds for the BH‐BOLD sequence. SNR of source images and residual error of T2* fitting were compared between the two methods. The FB‐BOLD sequence produced motion‐free T2* maps of the kidneys with SNR 1.9 times higher than BH‐BOLD images. Residual error of T2* fitting was consistently lower in the right kidney with FB‐BOLD (30% less than BH‐BOLD) but higher in the left kidney (80% more than BH‐BOLD), likely related to placement of the navigator on the right hemidiaphragm. A free‐breathing prospectively navigated renal BOLD sequence allows flexible tradeoff between scan time, resolution, and SNR. [ABSTRACT FROM AUTHOR]

Context: Existing anterior cruciate ligament (ACL) injury prevention programs have failed to reverse the high rate of ACL injuries in adolescent female athletes., Objective: This investigation attempts to overcome factors that limit efficacy with existing injury prevention programs through the use of a novel, objective, and real-time interactive visual feedback system designed to reduce the biomechanical risk factors associated with ACL injuries., Design: Cross-over study., Setting: Medical center laboratory., Participants: A total of 20 females (age = 19.7 [1.34] y; height = 1.74 [0.09] m; weight = 72.16 [12.45] kg) participated in this study., Methods: Participants performed sets of 10 bodyweight squats in each of 8 training blocks (ie, 4 real-time and 4 control blocks) and 3 testing blocks for a total of 110 squats. Feedback conditions were blocked and counterbalanced with half of participants randomly assigned to receive the real-time feedback block first and half receiving the control (sham) feedback first., Results: Heat map analysis revealed that during interaction with the real-time feedback, squat performance measured in terms of key biomechanical parameters was improved compared with performance when participants squatted with the sham stimulus., Conclusions: This study demonstrates that the interactive feedback system guided participants to significantly improve movement biomechanics during performance of a body weight squat, which is a fundamental exercise for a longer term ACL injury risk reduction intervention. A longer training and testing period is necessary to investigate the efficacy of this feedback approach to effect long-term adaptations in the biomechanical risk profile of athletes.

Control of shear ground reaction forces (sGRF) is important in performing running and cutting tasks as poor sGRF control has implications for those with knee injuries, such as anterior cruciate ligament (ACL) ruptures. The goal of this study was to develop a novel and safe task to evaluate control or accurate modulation of shear ground reaction forces related to those generated during cutting. Our approach utilized a force control task using real-time visual feedback of a subject’s force production and evaluated control capabilities through accuracy and divergence measurements. Ten healthy recreational athletes completed the force control task while force control via accuracy measures and divergence calculations was investigated. Participants were able to accurately control sGRF in multiple directions based on error measurements. Forces generated during the task were equal to or greater than those measured during a number of functional activities. We found no significant difference in the divergence of the force profiles using the Lyapunov Exponent of the sGRF trajectories. Participants using our approach produced high accuracy and low divergence force profiles and functional force magnitudes. Moving forward, we will utilize this task in at-risk populations who are unable to complete a cutting maneuver in early stages of rehabilitation, such as ACL deficient and newly reconstructed individuals, allowing insight into force control not obtainable otherwise. [ABSTRACT FROM AUTHOR]

Background: The knee adduction moment (KAM) is often elevated in medial knee osteoarthritis (KOA). The aim of this study was to evaluate effects on KAM and patient-reported outcomes of a six-week gait training program., Methods: Twenty-one patients (61 ± 6 years) with KOA participated in a six-week biofeedback training program to encourage increased toe-in (all patients) and increased step-width (five patients). Patients received real-time visual feedback while walking on an instrumented treadmill. We analysed the effect of the gait modification(s) on peak KAM in week six and three and six months post-training. We also evaluated the effect on pain and functional ability., Results: Of 21 patients starting the program, 16 completed it with high attendance (15 and 16 respectively) at the three and six month follow-ups. First peak KAM was significantly reduced by up to 14.0% in week six with non-significant reductions of 8.2% and 5.5% at the follow-ups. Functional ability (assessed using the WOMAC questionnaire) improved significantly after the training (eight point reduction, p = 0.04 in week six and nine point reduction, p = 0.04 at six-month follow-up). There was also a trend towards reduction in WOMAC pain (p = 0.06) at follow-up., Conclusions: Biofeedback training to encourage gait modifications is feasible and leads to short-term benefits. However, at follow-up, reductions in KAM were less pronounced in some participants suggesting that to influence progression of KOA in the longer term, a permanent regime to reinforce the effects of the training program is needed. Trial number: ISRCTN14687588., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: The Relational Aspects of Care Questionnaire (RAC-Q) is an electronic instrument which has been developed to assess staff's interactions with patients when delivering relational care to inpatients and those accessing accident and emergency (A&E) services. The aim of this study was to reduce the number of questionnaire items and explore scoring methods for "not applicable" response options., Patients and Methods: Participants (n=3928) were inpatients or A&E attendees across six participating hospital trusts in England during 2015-2016. The instrument, consisting of 20 questionnaire items, was administered by trained hospital volunteers over a period of 10 months. Items were subjected to exploratory factor analysis to confirm unidimensionality, and the number of items was reduced using a range of a priori psychometric criteria. Two alternative approaches to scoring were undertaken, one treated "not applicable" responses as missing data, while the second adopted a problem score approach where "not applicable" was considered "no problem with care.", Results: Two short-form RAC-Qs with alternative scoring options were identified. The first (the RAC-Q-12) contained 12 items, while the second scoring option (the RAC-Q-14) contained 14 items. Scores from both short forms correlated highly with the full 20-item parent form score (RAC-Q-12, r =0.93 and RAC-Q-14, f =0.92), displayed high internal consistency (Cronbach's α: RAC-Q-12=0.92 and RAC-Q-14=0.89) and had high levels of agreement (intraclass correlation coefficient [ICC]=0.97 for both scales)., Conclusion: The RAC-Q is designed to offer near-real-time feedback on staff's interactions with patients when delivering relational care. The new short-form RAC-Qs and their respective method of scoring are reflective of scores derived using the full 20-item parent form. The new short-form RAC-Qs may be incorporated into inpatient surveys to enable the comparison of ward or hospital performance. Using either the RAC-Q-12 or the RAC-Q-14 offers a method to reduce missing data and response fatigue., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. However, the specific benefits of diaphragmatic breathing on mental health remain largely unknown. The present study aimed to investigate the effect of diaphragmatic breathing on cognition, affect, and cortisol responses to stress. Forty participants were randomly assigned to either a breathing intervention group (BIG) or a control group (CG). The BIG received intensive training for 20 sessions, implemented over 8 weeks, employing a real-time feedback device, and an average respiratory rate of 4 breaths/min, while the CG did not receive this treatment. All participants completed pre- and post-tests of sustained attention and affect. Additionally, pre-test and post-test salivary cortisol concentrations were determined in both groups. The findings suggested that the BIG showed a significant decrease in negative affect after intervention, compared to baseline. In the diaphragmatic breathing condition, there was a significant interaction effect of group by time on sustained attention, whereby the BIG showed significantly increased sustained attention after training, compared to baseline. There was a significant interaction effect of group and time in the diaphragmatic breathing condition on cortisol levels, whereby the BIG had a significantly lower cortisol level after training, while the CG showed no significant change in cortisol levels. In conclusion, diaphragmatic breathing could improve sustained attention, affect, and cortisol levels. This study provided evidence demonstrating the effect of diaphragmatic breathing, a mind-body practice, on mental function, from a health psychology approach, which has important implications for health promotion in healthy individuals.

Background and Objectives: Irreversible Electroporation (IRE) is a focal ablation technique highly attractive to surgical oncologists due to its non-thermal nature that allows for eradication of unresectable tumors in a minimally invasive procedure. In this study, our group sought to address the challenge of predicting the ablation volume with IRE for pancreatic procedures., Methods: In compliance with HIPAA and hospital IRB approval, we established a pre-treatment planning methodology for IRE procedures in pancreas, which optimized treatment protocols for individual cases of locally advanced pancreatic cancer (LAPC). A new method for confirming treatment plans through intraoperative monitoring of tissue resistance was also proved feasible in three patients., Results: Results from computational models showed good correlation with experimental data available in the literature. By implementing the proposed resistance measurement system 210 ± 26.1 (mean ± standard deviation) fewer pulses were delivered per electrode-pair., Conclusion: The proposed physics-based pre-treatment plan through finite element analysis and system for actively monitoring resistance changes can be paired to significantly reduce ablation times and risk of thermal effects during IRE procedures for LAPC., (© 2017 Wiley Periodicals, Inc.)

An electrotactile display is a tactile interface composed of skin surface electrodes. The use of such a device is limited by the variability of the elicited sensation. One possible solution to this problem is to monitor skin electrical impedance. Previous studies revealed a correlation between impedance and threshold, but did not construct real-time feedback loops. In this study, an electrotactile display was constructed using a 1.45 \mus feedback loop. Real-time pulse width modulation was proposed, and the relationship between skin resistance and absolute threshold was measured to find a function for determining a suitable pulse width from skin resistance. An evaluation experiment revealed that the proposed algorithm suppressed spatial variation and reduced temporal change. [ABSTRACT FROM PUBLISHER]

There is an increasing demand in veterinary education to engage students, teach and reinforce clinical reasoning, and provide access anytime/anywhere to quality learning opportunities. In addition, accrediting bodies are asking for more concrete documentation of essential clinical-skills outcomes. Unfortunately, during the clinical year in a referral hospital setting, students are at the mercy of chance regarding the types of cases they will encounter and the opportunities they will have to participate. Patient- and case-simulation technology is becoming more popular as a way to achieve these objectives in human and veterinary medical education. Many of the current options available to the veterinary medical education community to develop virtual-patient cases are too time-consuming, cost prohibitive, or difficult for the instructor or learner to use. In response, we developed a learning tool, Case Manager, which is low-cost and user-friendly. Case Manager was designed to meet the demands of veterinary education by providing students with an opportunity to cultivate clinical reasoning skills and allowing for real-time student feedback. We launched a pilot test with 37 senior veterinary medical students as part of their Small Animal Internal Medicine clinical rotation. Students reported that Case Manager increased their engagement with the material, improved diagnostic and problem-solving skills, and broadened their exposure to a variety of cases. In addition, students felt that Case Manager was superior to a more traditional, less interactive case presentation format.

Real-time sensing and computing technologies are increasingly used in the delivery of real-time health behavior interventions. Auditory signals play a critical role in many of these interventions, impacting not only behavioral response but also treatment adherence and participant retention. Yet, few behavioral interventions that employ auditory feedback report the characteristics of sounds used and even fewer design signals specifically for their intervention. This paper describes a four-step process used in developing and selecting auditory warnings for a behavioral trial designed to reduce indoor secondhand smoke exposure. In step one, relevant information was gathered from ergonomic and behavioral science literature to assist a panel of research assistants in developing criteria for intervention-specific auditory feedback. In step two, multiple sounds were identified through internet searches and modified in accordance with the developed criteria, and two sounds were selected that best met those criteria. In step three, a survey was conducted among 64 persons from the primary sampling frame of the larger behavioral trial to compare the relative aversiveness of sounds, determine respondents' reported behavioral reactions to those signals, and assess participant's preference between sounds. In the final step, survey results were used to select the appropriate sound for auditory warnings. Ultimately, a single-tone pulse, 500 milliseconds (ms) in length that repeats every 270 ms for 3 cycles was chosen for the behavioral trial. The methods described herein represent one example of steps that can be followed to develop and select auditory feedback tailored for a given behavioral intervention.

Diabetes is the seventh leading cause of death in the United States, but careful symptom monitoring can prevent adverse events. A real-time patient monitoring and feedback system is one of the solutions to help patients with diabetes and their healthcare professionals monitor health-related measurements and provide dynamic feedback. However, data-driven methods to dynamically prioritize and generate tasks are not well investigated in the domain of remote health monitoring. This paper presents a wireless health project (WANDA) that leverages sensor technology and wireless communication to monitor the health status of patients with diabetes. The WANDA dynamic task management function applies data analytics in real-time to discretize continuous features, applying data clustering and association rule mining techniques to manage a sliding window size dynamically and to prioritize required user tasks. The developed algorithm minimizes the number of daily action items required by patients with diabetes using association rules that satisfy a minimum support, confidence and conditional probability thresholds. Each of these tasks maximizes information gain, thereby improving the overall level of patient adherence and satisfaction. Experimental results from applying EM-based clustering and Apriori algorithms show that the developed algorithm can predict further events with higher confidence levels and reduce the number of user tasks by up to 76.19 %.