Accessibility and Ease of Use in Neuromodulation Devices

BACKGROUND

The utilization of neuromodulation therapy continues to grow as therapeutic indications expand. These conditions often present with comorbid physical, visual, and auditory impairments. Patients with disabilities in these categories may have difficulty operating their devices. Thus, reviewing the accessibility and inclusive design of neuromodulation devices is imperative to ensure equal access for patients of all ability levels. To date, the literature provides little insight into this topic.

MATERIALS AND METHODS

Manufacturers of Food and Drug Administration-approved neuromodulation devices in the United States completed our electronic survey to assess neuromodulation device features, universal/inclusive design guidelines, and methods used to make the device accessible to patients with disabilities.

RESULTS

We assessed 11 devices from seven manufacturers. Of those, there were six spinal cord, two peripheral nerve, and three deep brain stimulators. Of all respondents, 91% used universal inclusive design guidelines. Of the studied devices, 91% have an interface that uses visual feedback, and 82% have an interface that uses auditory feedback. All surveyed devices were reported to have an interface that requires physical handling.

DISCUSSION

Our study found that most devices incorporate auditory signals, buttons with raised indentations, speech commands, or other useful features to assist those with visual disabilities. Visual interfaces may be sufficient for a patient with hearing impairment to use all the surveyed devices. However, dual sensory impairment presents a significant limitation in all devices surveyed. Furthermore, the biggest barrier to using neuromodulation devices was physical impairment because all surveyed devices require physical handling.

CONCLUSIONS

Manufacturers have awareness of universal inclusive design principles. However, our study was unable to find a device that is accessible to all users regardless of ability. As such, it is critical to involve universal design principles to ensure that inclusive devices are available to improve patient adherence, treatment efficacy, and outcomes.

Improve service coordination and delivery in community hubs serving homeless and at-risk populations

Background

Two community hubs are currently located in Durham Region, Ontario, Canada, to provide a single point of access to a wide range of support services for individuals experiencing homelessness and other at-risk populations. The community hub in Oshawa is formally known as the Back Door Mission for the Relief of Poverty and the community hub in Ajax is formally known as the Ajax Hygiene Hub. It is unclear if these two community hubs are effective in addressing the needs of individuals experiencing homelessness and how the COVID-19 pandemic continues to impact these services amongst this population. This study was conducted to identify gaps and barriers within the community hub models as well as provide recommendations to improve the coordination and delivery of services serving individuals experiencing homelessness and other at-risk populations.

Methods

A mixed methods approach was utilized in this study, which included surveys for individuals experiencing homelessness, through open-ended and close-ended questions to assess their experiences at either one of the two community hubs. A total of 75 surveys were completed by the study participants (40 surveys in Oshawa and 35 in Ajax). Thematic analysis was performed for all the open-ended survey responses. A literature review was also conducted to evaluate the community hub models as well as best practices for the implementation locally, nationally, and internationally.

Results

Data analysis for the open-ended survey responses revealed the need for housing support, increased resources for medical services, and the expansion of programs provided by the community hubs.

Conclusions

Homelessness is a major public health issue however community hubs play a pivotal role in addressing this concern in Durham Region. The equitable access to a diverse range of services that are co-located in a community hub is imperative for individuals experiencing homelessness, especially during the COVID-19 pandemic.

Key messages

A review of the bioelectronic implications of stimulation of the peripheral nervous system for chronic pain conditions

Background

Peripheral Nerve Stimulation has been used to treat human disease including pain for several decades. Innovation has made it a more viable option for treatment of common chronic pain processes, and interest in the therapy is increasing.

Main body

While clinical data is forthcoming, understanding factors that influence successful outcomes in the use of PNS still needs to be delineated. This article reviews the evolution and bioelectronic principles of peripheral nerve stimulation including patient selection, nerve targets, techniques and guidance of target delivery. We collate the current evidence for outcomes and provide recommendations for salient topics in PNS.

Conclusion

Peripheral nerve stimulation has evolved from a surgically invasive procedure to a minimally invasive technique that can be used early in the treatment of peripheral nerve pain. This review identifies and addresses many of the variables which influence the success of PNS in the clinical setting.

Bioaccessibility of Cd and Pb in tailings from a zinc smelting in Brazil: implications for human health

Soils and wastes enriched with heavy metals may present ecological and human health risks. A considerable number of mining areas exist in Brazil, where high levels of metals have been found. However, studies of bioaccessibility of metals in soils/tailings from these areas are scarce, despite their potential informational contribution concerning exposure risks of residents near these areas. This study evaluated tailings collected from four sites of a zinc smelting area located in Brazil with aims to: (1) evaluate the presence of metals of potential concern; (2) investigate Cd and Pb bioaccessibility; and (3) determine the desorption kinetics of Cd and Pb. High concentrations of total Cd and Pb (up to 1743 mg Cd kg(-1) and 8675 mg Pb kg(-1)) and great variability were found in the tailings, indicating the importance of adequate planning for their final disposal, in order to avoid contamination in the surrounding environment. Cadmium and Pb bioaccessibility percentages in the intestinal phase were less than 47 and 4 %, respectively, which represents significant fractions not available for absorption in the intestinal tract. However, this material has to be monitored since its bioaccessibility may increase with eventual physicochemical changes, releasing Cd and Pb. Desorption kinetics experiments revealed that Pb in the samples remained in less labile fractions, whereas Cd was found in more labile fractions, which is in accordance with the bioaccessibility results.

Investigation of arsenic species in tailings and windblown dust from a gold mining area

Research has shown the presence of high levels of arsenic (up to 2666 mg As kg(-1)) in tailings from a gold mining area of Brazil. This is an important point of attention, generating concerns about impacts on human health. Yet, a recent study showed that As bioaccessibility in the same area was very low (<4.4%). Thus, determination of the direct solid-phase speciation of As in the mine tailings and windblown dust is needed to explain this low bioaccessibility. Mine samples were collected from four subareas and windblown dust from eight sites. Synchrotron-based bulk-X-ray absorption near-edge structure (bulk-XANES) spectroscopy, micro-X-ray absorption near-edge structure (μ-XANES), and μ-X-ray fluorescence (μ-SXRF) spectroscopy were applied to determine As speciation. Bulk-XANES spectra indicated that As occurs as the As(V) oxidation state. Micro-XANES and μ-SXRF analyses revealed that As was also present as arsenopyrite (FeAsS) and its weathering products, but mostly it was As(V) as poorly crystalline ferric arsenate. This supports the findings of low bioaccessible As and highlights the importance of Fe oxides in immobilizing As in the terrestrial environment. All air particulate samples exhibited As-rich particles (up to 313 mg As kg(-1)). The air particulates exhibited solid-phase As species very similar to those found in the mine samples, which indicates that As in the windblown dust is not easily available.

Dietary shifts affect the gastrointestinal microflora of the giant panda (Ailuropoda melanoleuca)

Giant pandas exhibit seasonal changes in bamboo plant part preference. The influences on the gastrointestinal tracts (GIT) microbial populations were evaluated during a 14-month period for a pair of adult male and female giant pandas housed at the Memphis Zoo using traditional culturing methods to enumerate eight bacterial groups (total anaerobes, total aerobes (TAR), streptococci (STR), total enterics, Escherichia coli, Bacteroides spp., lactobacilli and Clostridium spp.). Both the male and female pandas altered bamboo consumption behaviours, with a sharp decrease in leaf preference in April 2010 and returning to high levels of leaf preference from June to October, corresponding to significant shifts in the densities of TAR, STR, and lactobacilli and Bacteroides spp. These findings indicate seasonal changes in food preference affect the assemblages of microbial populations within the GIT of the giant panda and contribute to a better understanding of the importance of bamboo in this species' foraging strategy.

Field performance of maize grown from Fusarium verticillioides-inoculated seed

Fusarium verticillioides is an important fungus occupying dual roles in the maize plant. The fungus functions as an endophyte, a fungal/host interaction beneficial to the growth of some plants. At other times, the fungus may function as a mycotoxin producing pathogen. The advantages and/or disadvantages of the endophytic relationship must be established in order to target appropriate sites for controlling diseases and mycotoxins in maize. One possibility could be to ensure seed maize is fungal free prior to planting. Reciprocal inoculations were made with two fungal isolates on seed of two maize genotypes. Yield was measured at harvest by ear and seed characters and vegetative growth at one-month intervals for plant survival, height, weight and stem diameter. Yield and vegetative growth differed among mature plants only once based on seed inoculation status. In 1998, plant weight was reduced and seed weight per ear was increased for the dent maize, GT-MAS: gk, grown from F. verticillioides RRC 374-inoculated seed compared to other seed treatments. Most vegetative characters were reduced at the first collection for Silver Queen plants grown from F. verticillioides-inoculated seed in 1997 and 1999, but not in 1998. However, no significant differences occurred among mature Silver Queen plants during any of the three growing seasons. In conclusion, yield and vegetative growth of mature maize plants grown from F. verticillioides-inoculated seed were equal to or greater than plants grown from non-inoculated seed under south Georgia field conditions during 1997, 1998, and 1999.

Measurement of density and chemical concentration using a microfluidic chip

A new microfluidic product for measuring fluid density, specific gravity and chemical concentration has been developed. At the core of this lab-on-a-chip sensor is a vacuum-sealed resonating silicon microtube. Measurements can be made with under a microliter of sample fluid, which is over 1000x less than is conventionally required. Since the product is MEMS-based the overall system size is a fraction of conventional density meters and it weighs much less than the traditional desk-top, temperature controlled, density meters. The syringe or pipette loaded system includes a dynamic temperature control system that operates between 0 degree C and 90 degree C with an accuracy of less than 0.01 degree C. Density measurement accuracies of 4 to 5 digits have been observed with aqueous solutions. Measurement examples and applications will be discussed.

The role of the superior colliculus in saccade initiation: a study of express saccades and the gap effect

Neural mechanisms underlying the initiation of saccadic eye movements were studied by recording the activity of neurons in the superior colliculus of rhesus monkeys that had extensive experience on the gap task using targets restricted to one visual field. The superposition of visual activation upon the increased excitability occurring on gap trials facilitates the occurrence of a motor burst with extremely short latency; the motor burst is tightly coupled to saccade onset for the full range of saccadic reactions times, both regular and express. We found no evidence that express saccades are a special class of saccades triggered directly by visual responses. The low frequency activity, necessary for the occurrence of express saccades, neither initiates express saccades nor serves as an accurate predictor of the direction or latency of saccades. Based upon these findings, the hypothesis that the motor burst of collicular neurons serves as a signal for triggering saccade onset can now be extended to express saccades.

Methods of antigen recovery vary in their usefulness in unmasking specific antigens in immunohistochemistry

Microwave heating of histologic sections in citrate buffer (MAR) is a widely used method of antigen recovery but often results in loss of tissue sections. Low-temperature antigen retrieval (LTAR), incubation at 80 degrees C in citrate buffer for 2 hours with trypsin pretreatment is an alternative method reported to result in better antigen recovery for specific antigens as well as decreased loss of tissue sections. To optimize our immunohistochemical evaluation of breast carcinomas, we compared the efficacy of these methods of antigen recovery for several important antigens. Ten breast carcinomas were immunostained for estrogen and progesterone receptors (ER and PR), Ki-67/ MIB 1, p27/Kip-1, and Bcl-2 after MAR, LTAR with enzymatic pretreatment, or no antigen recovery. The immunohistochemical staining was scored and compared for each antibody and antigen recovery combination. The proportion of tissue lost from each slide after staining also was assessed. More and stronger positive staining was achieved with antibodies to Ki67/MIB 1 and ER when LTAR was used compared with the other two methods; in contrast, optimal staining with antibodies to Bcl-2 was achieved when MAR was used. Staining with anti-p27/Kip- was nearly equal with either LTAR or MAR. Staining with anti-PR was slightly better with MAR than with LTAR. Tissue loss was greatest for MAR compared with LTAR or with no antigen recovery. For selected cases, LTAR caused focal tissue damage, and either the immunostaining with LTAR had to be repeated or only a portion of some tissue sections would be used for examination. LTAR was the most effective for ER and Ki-67/MIB 1. MAR provided the most intense staining for Bcl-2 and PR, but this enhanced staining must be weighed against the greater tissue section loss from MAR. This study demonstrated that AR methods are not equally applicable to all antibodies.

Fecal impaction: a review

TOPIC

Fecal impaction, a review of the literature.

PURPOSE

To review the definition, diagnosis, causes, signs and symptoms, and treatment of fecal impaction.

SOURCES

Published literature.

CONCLUSIONS

While a great deal has been published on fecal impaction, there is limited research. Clarification of when constipation changes to impaction is ambiguous. Causes of fecal impaction are multiple, and people can be affected at all ages. Signs and symptoms of and problems associated with fecal impaction are varied. Research-based treatment of fecal impaction is very limited, and nonresearch based treatment varies. There is a need for additional research to clarify terminology, diagnosis, and interventions.

Rigidity phase transition in granular packings

We numerically model two-dimensional systems of granular aggregates confined between two rough walls and demonstrate that at a critical grain volume fraction nu(c) an abrupt rigidity transition occurs. The transition has first-order characteristics, although the elastic constants undergo a second-order transition. Densely packed grains, with a volume fraction nu>nu(c), display an elastic-plastic rheology. Loose packings, with nu<nu(c), display gas-like characteristics. It is shown that when the volume fraction is allowed to change freely (applying a constant normal stress to the walls), it evolves spontaneously to nu(c) under a wide range of boundary stress values, demonstrating that the phase boundary is an attractive critical state.

Familial hypoalphalipoproteinemias

The familial hypoalphalipoproteinemias are a heterogeneous group of rare lipoprotein disorders characterized by extremely low levels of plasma high density lipoproteins (HDL) and, in most cases, autosomal recessive inheritance. Most of these conditions present distinctive and diagnostic clinical and laboratory abnormalities. In spite of the marked reductions in HDL, however, many of these conditions are not associated with premature atherosclerosis. This is true of Tangier disease, Fish Eye disease, lecithin: cholesterol acyltransferase deficiency, and of some variants of apo Al. Another condition, defined as a primary and familial decrease in HDL-cholesterol levels in the absence of other lipoprotein abnormalities. that is associated with premature atherosclerosis was originally called Familial Hypoalphalipoproteinemia but is better referred as to Familial Isolated Hypoalphalipoproteinemia. At present, the prevalence, inheritance, and the underlying defect(s) in this disorder are unknown. Decreased or absent synthesis of apo A-I due to a gene defect is the cause of apo A-I/C-III and apo A-I/C-III/A-IV deficiency. However, the etiology of the low levels of HDL is unclear for most of the remaining familial hypoalphalipoproteinemias. Increased catabolism, decreased synthesis and altered equilibration of HDL between intra- and extravascular spaces have all been suggested as underlying causes of low plasma HDL. Whatever their causes, these disorders are associated with altered HDL composition and altered equilibration of cholesterol amongst the various lipoprotein classes. The absence of consistent correlation with premature atherosclerosis in many of these conditions suggests that the protective effect of HDL may reside in a quantitatively small, but metabolically active subfraction of HDL particles.

Enzyme Immunoassay for Detection of Salmonella in Foods: Collaborative Study

A collaborative study was performed in 25 laboratories to validate an enzyme immunoassay (EIA) procedure utilizing 2 specific monoclonal antibodies for rapid detection of Salmonella in foods. The EIA was compared with the standard culture procedure for detection of Salmonella in 6 food types: ground black pepper, soy isolate, dried whole eggs, milk chocolate, nonfat dry milk, and raw deboned turkey, Uninoculated and inoculated samples were included in each food group analyzed, with the exception of poultry which was naturally contaminated. There was no significant difference in the productivity of the EIA and culture procedures at the 5% level for any of the 6 foods. The enzyme immunoassay screening method has been adopted official first action.

Assessment of a solid-phase reagent for urinary specific gravity determination

We have compared the specific gravity (S.G.) determined by the N-Multistix method with that obtained from the Total Solids (TS) meter. Overall, 88.7% of the specific gravity results obtained with the reagent strip method were within 0.005 of those obtained with the TS meter. There was a good correlation between the methods and there was no bias for the group means obtained by either method. A good correlation was also found between the S.G. on the strip and osmolality (correlation coefficient of 0.955). The results obtained with the reagent strip for urinary specific gravity therefore appear acceptable for routine laboratory purposes.

Alteration of urinary levels of the carcinogen, N-hydroxy-2-naphthylamine, and its N-glucuronide in the rat by control of urinary pH, inhibition of metabolic sulfation, and changes in biliary excretion

The hepatic metabolism of arylamine bladder carcinogens to N-hydroxy arylamine N-glucuronides, their excretion in the urine, and their subsequent acidic hydrolysis to highly carcinogenic and reactive N-hydroxy arylamines have been proposed as essential steps in arylamine-induced urinary bladder carcinogenesis. In this study, alteration of urinary pH, inhibition of metabolic sulfation, and blockage of biliary disposition were shown to profoundly affect the urinary excretion of the probable ultimate bladder carcinogen, N-hydroxy-2-naphthylamine (N-HO-2-NA) and its N-glucuronide conjugate. The normal pH of rat urine (6.7) was altered to 5.7 or 7.7 by administration of NH4Cl or NaHCO3 in the drinking water. Subsequent treatment with either 2-naphthylamine (2-NA) or 2-nitronaphthalene (2-NN) resulted in increased urinary levels of free N-HO-2-NA (relative to its N-glucuronide) in acidic urines and decreased relative amounts of free N-HO-2-NA in alkaline urines. In addition, 2-NN yielded 5--10-fold greater levels of urinary N-HO-2-NA and its N-glucuronide than rats given 2-NA; and 2-NA was not detected as a urinary metabolite of 2-NN. Some 12 additional metabolites of 2-NA and 2-NN were also found. Of these, 2-amino-1-naphthol and its sulfate and glucuronide conjugates were quantitated. From these data, 2-NA and 2-NN appear to share common metabolic pathways which yield free N-HO-2-NA as a putative ultimate urinary bladder carcinogen. Pentachlorophenol, a known inhibitor of hepatic sulfotransferases, was shown to cause a 2--3-fold increase in the urinary levels of N-HO-2-NA N-glucuronide and N-HO-2-NA from 2-NA-treated rats. Similarly, inhibition of the biliary excretion of 2-NA by bile duct ligation resulted in a 6-fold increase in total urinary N-HO-2-NfA. Furthermore, analyses of bile revealed that substantial amounts of N-HO-2-NA N-glucuronide, but not free N-HO-2-NA, were present. The role of urinary versus biliary excretion of N-hydroxy arylamines in relation to bladder and colon carcinogenesis is discussed.