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BACKGROUND Although the COVID-19 pandemic resulted in a rapid implementation and scale-up of telehealth for patients in need of rehabilitation, an overall slower scaling up to telerehabilitation has been documented. OBJECTIVE The purpose of this study was to understand experiences of implementing telerehabilitation during the COVID-19 pandemic as well as using the Toronto Rehab Telerehab Toolkit from the perspective of rehabilitation professionals across Canada and internationally. METHODS The study adopted a qualitative descriptive approach that consisted of telephone- or videoconference-supported interviews and focus groups. Participants included rehabilitation providers as well as health care leaders who had used the Toronto Rehab Telerehab Toolkit. Each participant took part in a semi-structured interview or focus group, lasting approximately 30-40 minutes. Thematic analysis was used to understand the barriers and enablers of providing telerehabilitation and implementing the Toronto Rehab Telerehab Toolkit. Three members of the research team independently analyzed a set of the same transcripts and met after each set to discuss their analysis. RESULTS A total of 22 participants participated, and 7 interviews and 4 focus groups were included. The data of participants were collected from both Canadian (Alberta, New Brunswick, and Ontario) and international sites (Australia, Greece, and South Korea). A total of 11 sites were represented, 5 of which focused on neurological rehabilitation. Participants included health care providers (ie, physicians, occupational therapists, physical therapists, speech language pathologists, and social workers), managers and system leaders, as well as research and education professionals. Overall, 4 themes were identified including (1) implementation considerations for telerehabilitation, encompassing 2 subthemes of “infrastructure, equipment, and space” and “leadership and organizational support”; (2) innovations developed as a result of telerehabilitation; (3) the toolkit as a catalyst for implementing telerehabilitation; and (4) recommendations for improving the toolkit. CONCLUSIONS Findings from this qualitative study confirm some of the previously identified experiences with implementing telerehabilitation, but from the perspective of Canadian and international rehabilitation providers and leaders. These findings include the importance of adequate infrastructure, equipment, and space; the key role of organizational or leadership support in adopting telerehabilitation; and availing resources to implement it. Importantly, participants in our study described the toolkit as an important resource to broker networking opportunities and highlighted the need to pivot to telerehabilitation, especially early in the pandemic. Findings from this study will be used to improve the next iteration of the toolkit (Toolkit 2.0) to promote safe, accessible, and effective telerehabilitation to those patients in need in the future.

Introduction Patient safety is important in all healthcare settings. Few studies have examined the state of patient safety in rehabilitation and none have examined patient safety in the setting of acquired brain injury (ABI) rehabilitation. Objectives To determine the incidence, most common types, and severities of adverse events among inpatients undergoing ABI rehabilitation. Design Retrospective case series descriptive study. Setting The inpatient ABI rehabilitation program at an academic, tertiary rehabilitation hospital in Canada. Participants 108 consecutive inpatients with acquired brain injuries. Interventions Not applicable. Main outcome measure(s) Patient charts and incident reports from the hospital's voluntary reporting system were reviewed by three board-certified physiatrists to determine the incidence, type, severity and preventability of adverse events. Adverse events were identified and classified for severity and type using the WHO International Classification for Patient Safety. Preventability was rated on a 6-point Likert scale. Results During the study period, the incidence of adverse events was 17.42 ± 3.86 per 1000 patient days. Adverse events affected 52.8% of patients. Most adverse events identified were mild in severity (98.51%) and the rest were of moderate severity. The two most common types of adverse events were 1) patient incidents (56.72%) such as falls, pressure ulcers and skin tears, and 2) patient behaviors such as missing patient, assault, or sexual behaviors (16.42%). Of the 80 adverse events identified in the study, 44.78% were preventable. The hospital's voluntary reporting system did not capture 57.9% of the adverse events identified. Conclusions Future efforts to improve patient safety in ABI rehab should focus on reducing falls, skin injuries and behaviors, and removing barriers to voluntary incident reporting. Detecting adverse events through chart reviews provide a more complete understanding of patient safety risks in ABI rehab than relying on incident reporting alone. This article is protected by copyright. All rights reserved.

Objective The objective of this study was to investigate the impact and prevalence of sleep-wake disturbances among adult patients admitted for inpatient acquired brain injury rehabilitation. Method This was a retrospective cohort study involving all adults admitted for inpatient ABI neurocognitive rehabilitation at UHN-Toronto Rehabilitation Institute over a 12-month period (n = 165). The primary endpoint of the study was the comparison of functional independent measure efficiency and hospital length of stay between patients reporting sleep disturbance (e.g. increased sleep latency, obstructive sleep apnea [OSA], sleep maintenance insomnia) versus those with normal sleep. Results We found that more than half (58.2%) of patients experienced sleep disturbance based on a combination of self-report and clinical documentation. The most common sleep disturbance was increased sleep onset latency (28.5%), followed by mixed sleep onset/maintenance insomnia (14.5%) and obstructive sleep apnea (8.5%). Notably, OSA was associated with longer length of hospital stay and reduced functional independence measure (FIM) efficiency in the cognitive domain after accounting for age and number of medical comorbidities. Implications The results of this investigation underscore the importance of screening patients with brain injury for sleep disturbances due to its high prevalence and impact on rehabilitation efficiency.

The operating frequency of the networked control system (NCS) determines both its control performance and heat flux density. Considering the significant effect of thermal stress on the reliability of electronics, a quantitative reliability analysis framework is proposed for NCSs with the consideration of its operating frequency. It includes 5 main steps: 1) compute the power consumption of all its electronic components using circuit simulation; 2) obtain the thermal stress of these components by thermal simulation; 3) apply the thermal stress results to assess the reliability of components using the part stress analysis method; 4) calculate the reliability of the modules using reliability block diagrams; and 5) quantify the reliability of the NCS by combining the graph reduction method and other network reliability algorithms together. A double loop networked control system is used as an example to verify the effectiveness of our method.

Chouioia cunea (Yang) is an endoparasitic wasp which parasitizes pupae and thus plays an important role in the biological control of the fall webworm (Hyphantria cunea Drury), an important quarantine pest in the entire world and a major invasive pest in China. For the purposes of investigating which proteins are involved in the response of C. cunea to 1-Docecene, one of the chemical compounds of pupae of H. cunea with a significant attracting action to mated female C. cunea, 11.5 Gb transcriptome data was sequenced on the PacBio RS II platform from 1-day old C. cunea adults to generate a reference assembly. Afterwards, 46.88 Gb of clean RNA-Seq data were obtained to assess the transcriptional response of these insects before and after the stimulation with 1-Docecene. After removing redundancy using CD-HIT, a sequence structure analysis predicted 29,105 complete coding sequence (CDS) regions, 51,458 single-sequence repeats (SSRs), and 2,375 long non-coding RNAs. Based on the early transcriptome sequencing in our laboratory, we revealed some new sequences corresponding to chemosensory genes such as odorant binding proteins (OBPs), odorant receptor (OR), gustatory receptors(GRs). Results of quantitative real-time PCR experiments revealed that CcOBP7, CcOBP18, CcCSP4, CcOR2, and CcGR18 were up-regulated after 1-Dodecene stimulation. In addition, the expression of 31 genes, including 1 gene related to phospholipid biosynthesis and 2 genes related to transmembrane transport were up-regulated after 1-Dodecene stimulation; meanwhile, the expression of 22 genes, including 5 genes related to protein phosphorylation and protein serine/threonine kinase activity were significantly down-regulated after 1-Dodecene stimulation. These results suggest that the attraction of adult C. cunea to 1-dodecane is associated with the transmembrane signal transduction and dephosphorylation of some proteins. Our findings will provide useful targets for further studies on the molecular mechanism of host recognition in C. cunea.

Physician engagement is an important factor in improving care quality and patient safety, but engaging physicians is not easy. Winston Churchill's famous assertion about never wasting a crisis has defined the approach taken by many leaders during the COVID-19 pandemic. This paper describes three case studies of successful physician engagement across the continuum of acute care, chronic care and primary care settings during the pandemic. These examples offer insights on physician engagement within unique settings by leveraging intrinsic motivators and Spurgeon's model of medical engagement.

We investigate the impact of political ideology biases in training data. Through a set of comparison studies, we examine the propagation of biases in several widely-used NLP models and its effect on the overall retrieval accuracy. Our work highlights the susceptibility of large, complex models to propagating the biases from human-selected input, which may lead to a deterioration of retrieval accuracy, and the importance of controlling for these biases. Finally, as a way to mitigate the bias, we propose to learn a text representation that is invariant to political ideology while still judging topic relevance., Comment: To appear in The Proceedings of The 28th International Conference on Computational Linguistics (COLING-2020)

Objective To describe the implementation process, outcomes, and lessons learned in the implementation of medical safety huddles, a novel patient safety monitoring strategy that promotes physician engagement with patient safety. Design Single-center observational study. Setting Brain and spinal cord injury rehabilitation program at an urban, academic adult rehabilitation hospital. Participants Physicians associated with the program (N=18). Interventions Weekly physicians' safety huddles were implemented to review, anticipate, and address patient safety issues. Main Outcome Measures Main outcome measures were the number and nature of identified and anticipated patient safety incidents, actions taken, and physician attendance during huddles. The number of adverse events in the program before and after huddle implementation were secondary measures. Results Over a 7-month period, average physician attendance at medical huddles was 76.0%. There were 1.0±0.8 patient safety incidents and 3.2±2.1 anticipated patient safety issues identified in each weekly huddle. Most patient safety incidents identified were clinical administrative and clinical process related, which differed from information gathered from the organization's preexisting patient safety monitoring strategies. A total of 79 actions, or 3.3±1.8 actions per huddle, were taken in response to improve patient safety for the program. Adverse events decreased from 31.2 (95% confidence interval [CI], 27.0–35.3) to 22.9 per month (95% CI, 19.3–26.5) after implementation. Conclusions Medical safety huddles are a novel strategy to engage physicians in patient safety and organizational quality improvement. They have the potential to enhance organizational anticipation of safety risks by supplementing existing methods. Other rehabilitation settings may wish to consider implementing and evaluating similar huddles into their existing patient safety and quality improvement frameworks.

Medication reconciliation in ambulatory care settings helps prevent adverse drug events. Patient involvement in the process is crucial, as clinicians must verify the reported medication history with other sources such as home medication lists or brown-bagged home medications provided by patients. However, only 47.8% of brain injury and stroke adult outpatients at Toronto Rehabilitation Institute, an academic rehabilitation hospital, bring their medications/medication lists to clinic visits. In turn, missing medication information impacts the clinic by causing delays in treatment and interrupted clinic flow. This project aimed to increase the percentage of patients who bring their medications/medication lists to 80% and decrease the impact on clinic visits caused by missing medication information to 10%. This was a controlled before-after study, with the outpatient rehabilitation assessment (OPRA) clinic as the intervention and the spasticity clinic as the control. The model for improvement was used as the project framework. Process mapping, Ishikawa diagrams, driver diagrams and patient surveys generated the change ideas. Verbal reminders during confirmation phone calls, written reminders and medication list templates were implemented. Data were collected on a biweekly basis and analysed using statistical control charts. After six Plan-Do-Study-Act cycles conducted over 49 weeks, both project aims were achieved. The percentage of OPRA clinic patients who brought medications/medication lists was 81.8% and the impact on clinic visits caused by missing medication information was 9.1% of clinic visits. Special cause variation was detected on the statistical control charts. Conversely, there was no special cause variation for the spasticity clinic (the control) for either aim. Lessons learnt include the importance of prolonged data collection when implementing interventions with long lag time, and that verbal reminders may not be effective for patients with cognitive impairments. Future efforts may focus on implementing the bundle of project interventions for the spasticity clinic.

Characteristics of HfOx-based resistive switching memory (RRAM) in Al/HfOx/Al and Al/AlOx/HfOx/Al structures were studied using a dynamic conductance method. Step-like RESET behaviors as well as pre- and post-RESET regions of operation were characterized. The results indicated that defects at the oxide interface caused cycling issues in the Al/AlOx/HfOx/Al structure. No such RESET behavior was observed for the Al/HfOx/Al structure. Current induced over-heating, which caused an early RESET event, could be avoided using current-sweep technique that caused less electrical and thermal stress in localized regions. The experimental results not only provided insights into potential reliability issues and power management in HfOx-based RRAM, but also helped clarifying the resistive switching mechanisms.

The time devoted to musculoskeletal (MSK) clinical skills in medical school curricula is often limited, with several studies reporting gaps in MSK clinical examination skills among medical students. Furthermore, there is a limited number of Physical Medicine and Rehabilitation (PM&R) specialists in Canada which leads to infrequent exposure to PM&R during medical school and lower interest in PM&R as a career choice. With the goal of improving MSK clinical skills and awareness of PM&R, an annual, extra-curricular MSK clinical skill workshop was developed for second-year medical students. The purpose of this study was to evaluate the effect of the workshops on the following: (1) MSK clinical skills, (2) understanding of PM&R as a medical specialty, and (3) career interest in PM&R. Consenting students completed three surveys before, after, and at 9 months post-workshop, and their composite score on the MSK portion of the year-end objective structured clinical examination (OSCE) was compared to the class average. Participants’ (n = 60) confidence levels in their MSK clinical skills were significantly higher (p

Oxide based resistive switching memory are the promising candidates for future non-volatile memory according to fast programing, low power operation, scalability and compatibility to the current CMOS process. Among, SiOx single layer resistive switching devices have been widely studied and characterized. The SiOx single layer resistive memory has good compatibility to CMOS fabrication process. However, it can only be programmed under the vacuum or non-oxidized ambient. Also, the previous results reported on SiOx-based memristors indicate that the electroforming and programming voltage is relatively higher than the other dielectric materials and obstructed for low-power applications. In this work, by using SiOx/HfOx stacking engineering, we have developed a low-voltage operation (< 2V) for SiOx-based ReRAM. The results show that with HfOx (3nm) on bottom, the metal-insulator-semiconductor (MIS) structures exhibit resistive switching at low voltage (x-based MIS devices which exhibit bipolar-type resistive switching behaviors with small memory window.Clearly, SiOx/HfOx stacking optimization not only maintains the RS behaviors even in air environment without any programming window degradation, but also further reduces the switching voltage below 2V. Figure 1 shows the results of three different structures, including SiOx single layer memristor, SiOx/HfOx bilayer memristor and HfOx single layer memristor. In terms of operation environment condition, inserting the HfOx layer would help the SiOx memristor to be able to programmed either under a pressure of 1E-4 torr or in the atmosphere. The HfOx single layer memristor has the lowest electroforming voltage of 2.3 V, and which in SiOx/HfOx stacks has been reduced significantly to 5 V comparing which of 14 V for SiOx single layer. For the SiOx/HfOx bilayer, a memory window of 4 decades is achieved and comparable to that of SiOx single layer, and larger than that of single layer HfOx by 2 decades. In terms of operation voltage, the set voltage is reduced from 4V to 2 V and the reset voltage is also suppressed significantly from 10 V to 0.3 V by inserting the 3 nm HfOx layer. Figure 2 shows the TEM images of both SiOx single layer memristor and SiOx/HfOx bilayer memristor. The 3 nm HfOx was deposited on N+ Si wafer at 250 oC by atomic layer deposition followed by 30 nm SiO2 deposition using e-beam evaporator and 160 nm TaN depositing by sputtering. Figure 3. The single layer HfOx-based MIS devices resistive switching behaviors. (a) The electroforming process, resistive switching behaviors in 20 times cycling. (b) The switching voltage (SET/RESET) and states (HRS/LRS) distribution. Figure 1

Physiatrists in all practice settings can improve the care of rehabilitation patients through the rigorous application of quality improvement (QI) methodology. This primer provides a step-by-step guide to QI in rehabilitation settings for academic and community physiatrists, using the Model for Improvement. Key concepts discussed include Plan-Do-Study-Act cycles, setting optimal aim statements and measures, involving the rehabilitation team, diagnostic tools to understand root causes of quality problems, selection of change concepts and ideas, and utilizing run charts for data analysis. A QI project focused on the secondary prevention of vascular complications in amputees with diabetes admitted to inpatient rehabilitation is used as an illustrative example throughout the primer.

Adhesive bonding technology is widely applied in the assembly and repair processes of composite laminates. However, the debond flaws existing in the adhesive layer weakens the load-carrying capacity of adhesively bonded structures. This article presents an analytical model to investigate the adhesive shear behaviour of double-lap joints containing a debond flaw. Differential element method is employed to simulate the stress and strain distribution of adhesive layer, which considers anisotropy of each ply in the composite laminates and elastic-perfectly plastic behaviour of the adhesive. This model can compute the stress and stiffness of adhesive double-lap joints with different debond flaw conditions, covering fully debond ones as well as non-fully ones. Finite element model of double-lap joints is built in this paper to validate the accuracy of proposed analytical model. We also compared the debond flaw joints and non-flaw ones in terms of their adhesive strain and stress distribution.

For the first time, a comprehensive study of Vanadium oxide-based selector characteristics with a universal model observed by thermal and electrical induced threshold switching (TS) phenomena at interface is presented in this work. The model can explain that the resistance evolution by thermal temperature in TS behaviors, as well as the resistance gradually increases with cycling (“seasoning effect”). Compatible current density (107∼109 A/cm2) and selectivity (∼100) with physical understanding of evolution in energy barrier and MIT metallic state modulation are studied. The results show a promising design guideline for future storage-class memory (SCM) applications.

Aiming at the problem of limited insulation time of vacuum insulating cup, the modification and design of new photovoltaic vacuum insulating cup are completed, including selection of heating material, selection of power supply of photovoltaic insulating cup, power transmission and overall structure design. Compared with similar research, this paper focuses on the selection of heating materials and the use of wireless transmission devices to solve the problem of thermal insulation. In this paper, the structure of photovoltaic insulating cup is studied, and the optimum heating material is discussed. Combined with photovoltaic power supply and wireless power transmission technology, the design of insulation Cup is completed, and the insulation performance of this design is verified for more than ten hours.

Recently, resistive random access memory (RRAM) using various metal oxides (i.e., SiO 2 [1], HfO 2 , NiO[2], Al 2 O 3 , NbO) have attracted a lot of attentions since the current nonvolatile memory (NVM) approaching the scaling limits. Meanwhile, the selector devices are essential to address the sneak path issue which causing the reading errors in high-packing-density cross-bar RRAM array. Several types of selector devices with threshold switching (TS) behavior has been investigated, such as rectifying diode[3], varistors[4], ovonic TS (OTS)[5], metal-insulator transition (MIT)[6] etc. In this work, the characteristics of electrically driven MIT (E-MIT) in both Nb-doped SrTiO 3 and HfO 2 -based selector devices has been investigated.

We report ferroelectricity and self-polarization in the (001) oriented ultrathin relaxor ferroelectric PMN-PT films grown on Nb-SrTiO3, SrRuO3 and La0.7Sr0.3MnO3, respectively. Resistance-voltage measurements and AC impedance analysis suggest that at high temperatures Schottky depletion width in a 4 nm thick PMN-PT film deposited on Nb-SrTiO3 is smaller than the film thickness. We propose that Schottky interfacial dipoles make the dipoles of the nanometer-sized polar nanoregions (PNRs) in PMN-PT films grown on Nb-SrTiO3 point downward at high temperatures and lead to the self-polarization at room temperature with the assistance of in-plane compressive strain. This work sheds light on the understanding of epitaxial strain effects on relaxor ferroelectric films and self-polarization mechanism.

A voltage-induced unidirectional threshold resistive switching has been reported for Au/NiO/Nb:SrTiO3 devices fabricated by pulsed laser deposition. The devices show the threshold resistive switching behavior only for the positive voltages, determined by the forming process. The current-voltage (I-V) and capacitance-voltage (C-V) characteristics of the as-grown samples with different thicknesses suggest that the I-V and C-V properties are dominated by the Schottky junction at the NiO/Nb:SrTiO3 interface and NiO film, respectively, indicating the formation of conductive filaments in NiO film. Furthermore, the effect of NiO-film thickness on the resistive switching, as well as the I-V and C-V characteristics, indicates that the unidirectional threshold resistive switching originates from the combined contributions of the interfacial Schottky junction modulation and the bipolar threshold switching related to the unstable conductive filament in NiO film. Our research results provide additional insights into t...

Intrinsically rectifying-resistive switching (IR-RS) has been regarded as an effective way to address the crosstalk issue, due to the Schottky diodes formed at the metal/oxide interfaces in the ON states to suppress the sneak current at reverse biases. In this paper, the authors report for the first time another type of IR-RS that is related to the built-in homojunction. The IR-RS study is usually limited to macroscopic samples with micrometer-order pad-type electrodes, while this work is on NiO nanodots fabricated with ultrathin anodic-aluminum-oxide templates and acting as nanoscaled analogs of real devices. The NiO nanodots show high storage density and high uniformity, and the IR-RS behaviors are of good device performances in terms of retention, endurance, switching ratio, and rectification ratio. The feasibility of the IR-RS for selection device-free memory application is demonstrated by calculating the maximum crossbar array size under the worst-case scenario to be 3 Mbit.

Sexual health contributes greatly to quality of life. Research shows that stroke survivors want to learn and talk about sexual health, but are not given information. In keeping with the Canadian Best Practice Recommendations for Stroke Care, this project aimed to provide all stroke rehabilitation inpatients with the opportunity to discuss sexual health concerns with healthcare providers at West Park Healthcare Centre, a rehabilitation and complex continuing care centre in Toronto. Gap analysis conducted via staff member interviews and retrospective chart reviews showed that close to no patients were given the opportunity to discuss sexual health concerns at baseline. Plan-Do-Study-Act (PDSA) methodology was used as the project framework. The changes implemented included a reminder system, standardization of care processes for sexual health, patient-centred time points for the delivery of sexual health discussions, and the development of a sexual health supported conversation tool for patients with aphasia. By the end of the ten month project period and after three PDSA cycles, the percentage of patients provided with the opportunity to discuss sexual health during inpatient rehabilitation increased to 80%. This quality improvement project successfully implemented the Canadian Best Practice Recommendations for Stroke Care with respect to sexual health. Lessons learned included the importance of early baseline data collection and advance planning for tools used in QI projects. Future projects may focus on improving the discussion of sexual health concerns during outpatient stroke rehabilitation.