Search

Background : Blind/low vision (BLV) severely limits information about our three-dimensional world, leading to poor spatial cognition and impaired navigation. BLV engenders mobility losses, debility, illness, and premature mortality. These mobility losses have been associated with unemployment and severe compromises in quality of life. VI not only eviscerates mobility and safety but also, creates barriers to inclusive higher education. Although true in almost every high-income country, these startling facts are even more severe in low- and middle-income countries, such as Thailand. We aim to use VIS4ION (Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation), an advanced wearable technology, to enable real-time access to microservices, providing a potential solution to close this gap and deliver consistent and reliable access to critical spatial information needed for mobility and orientation during navigation. Methods: We are leveraging 3D reconstruction and semantic segmentation techniques to create a digital twin of the campus that houses Mahidol University's disability college. We will do cross-over randomization, and two groups of randomized VI students will deploy this augmented platform in two phases: a passive phase, during which the wearable will only record location, and an active phase, in which end users receive orientation cueing during location recording. A group will perform the active phase first, then the passive, and the other group will experiment reciprocally. We will assess for acceptability, appropriateness, and feasibility, focusing on experiences with VIS4ION. In addition, we will test another cohort of students for navigational, health, and well-being improvements, comparing weeks 1 to 4. We will also conduct a process evaluation according to the Saunders Framework. Finally, we will extend our computer vision and digital twinning technique to a 12-block spatial grid in Bangkok, providing aid in a more complex environment. Discussion: Although electronic navigation aids seem like an attractive solution, there are several barriers to their use; chief among them is their dependence on either environmental (sensor-based) infrastructure or WiFi/cell "connectivity" infrastructure or both. These barriers limit their widespread adoption, particularly in low-and-middle-income countries. Here we propose a navigation solution that operates independently of both environmental and Wi-Fi/cell infrastructure. We predict the proposed platform supports spatial cognition in BLV populations, augmenting personal freedom and agency, and promoting health and well-being. Trial registration: ClinicalTrials.gov under the identifier: NCT03174314, Registered 2017.06.02. [ABSTRACT FROM AUTHOR]

The article addresses concerns about the adequacy of current pain medicine fellowship education and suggests reforms for comprehensive training. It highlights the need for an expanded curriculum to encompass diverse specialties, the changing landscape of fellowship applicants, and proposed solutions for enhanced pain medicine education, including options like extended fellowship lengths and advanced tracks within residency programs.

Background: Neuromodulation is a standard and well-accepted treatment for chronic refractory neuropathic pain. There has been progressive innovation in the field over the last decade, particularly in areas of spinal cord stimulation (SCS) and dorsal root ganglion stimulation. Improved outcomes using proprietary waveforms have become customary in the field, leading to an unprecedented expansion of these products and a plethora of options for the management of pain. Although advances in waveform technology have improved our fundamental understanding of neuromodulation, a scoping review describing new energy platforms and their associated clinical effects and outcomes is needed. The authors submit that understanding electrophysiological neuromodulation may be important for clinical decision-making and programming selection for personalized patient care., Objective: This review aims to characterize ways differences in mechanism of action and clinical outcomes of current spinal neuromodulation products may affect contemporary clinical decision-making while outlining a possible path for the future SCS., Study Design: The study is a scoping review of the literature about newer generation SCS waveforms., Materials and Methods: A literature report was performed on PubMed and chapters to include articles on spine neuromodulation mechanism of action and efficacy., Results: A total of 8469 studies were identified, 75 of which were included for the scoping review after keywords defining recent waveform technology were added., Conclusions: Clinical data suggest that neuromodulation remains a promising tool in the treatment of chronic pain. The evidence for SCS for treating chronic pain seems compelling; however, more long-term and comparative data are needed for a comparison of waveforms when it comes to the etiology of pain. In addition, an exploration into combination waveform therapy and waveform cycling may be paramount for future clinical studies and the development of new technologies., Competing Interests: Conflict of Interest Sayed E. Wahezi is a consultant for Boston Scientific and receives research funding from Vertos, Boston Scientific, and Abbott. Dr. Wahezi has filed for a neuromodulation patent during the production of this manuscript. Corey W. Hunter is a consultant for Abbott, Averitas, Biotronik, Boston Scientific, Mainstay, Nalu, PainTEQ, Saluda, SKK, and Vivex and holds stock and/or stock options with Mainstay, Nalu, PainTEQ, Spine Biopharma, and Vivex. Magdalena Anitescu reports consulting fees from Boston Scientific and Medtronic. Lynn Kohan reports consulting fees from Avanos. The remaining authors have no conflict of interest to report., (Copyright © 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Background: Radiofrequency ablation (RFA) is a common treatment in which radiofrequency (RF) is used to heat neural tissue and reduce pain. The impact of adipose content in tissue on the lesion size may impact efficacy, and to date, there is little, if any, data comparing its influence on RFA., Objectives: We evaluated the influence of adipose tissue on RF lesion size., Study Design: Controlled, ex vivo study., Setting: Academic institution in a procedural setting., Methods: RF lesions were created using 20-G 10-mm protruding electrode (PE) needles inserted into unbrined chicken breasts and thighs at 21°C. RF current was applied for 90 seconds at 80°C. Chicken breasts were used as the control group and chicken thighs were used as the high adipose variant. Four different groups were examined: 1- Standard 20 g RFA needle, 2- 20 g RFA PE needle, 3- Standard RFA needle with lidocaine 2% injectate, and 4- Standard RFA needle with iohexol 240 mg injectate. There were 12 lesions performed in each group; length, width, and depth were measured., Results: The control group had significantly deeper lesions in all 4 cohorts. Lesions' lengths were smaller in the fat-rich group. The control and PE cohorts showed a significant difference in width between the 2 fat-rich and nonfatty groups., Limitations: Radiofrequency ablation was performed at room temperature and not heated to physiological temperature. This was an ex vivo study, thus factors of human anatomy and physiology could not be evaluated., Conclusions: Adipose tissue content was inversely related to lesion size in all samples. This factor should be considered when assessing methods of enhancing lesion size in human models.