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Reinforcement Learning-Driven Path Generation for Ankle Rehabilitation Robot Using Musculoskeletal-Informed Energy Optimization
Get PDFIn rehabilitation robotics, optimizing energy consumption and high interaction forces is essential to prevent unnecessary muscle fatigue and excessive joint loading as they often cause an inefficient trajectory planning and disrupt natural movement patterns. Stroke patients frequently exhibit asymmetrical muscle activation and impaired neuromuscular coordination, making it necessary to design a system that adapts to their specific motor limitations with energy-efficient and excessive torque control. This study presents a reinforcement learning-based trajectory optimization framework for a 3-DOF ankle rehabilitation robot, integrating musculoskeletal modeling, transactive energy and real-time physiological feedback to generate adaptive rehabilitation trajectories. The methodology utilizes electromyography (EMG) signals from key ankle muscles and joint reaction forces to refine movement patterns to ensure biomechanical efficiency. The methodology is validated using data from ten stroke patients, demonstrating its potential to enhance rehabilitation effectiveness by promoting more natural, efficient, and physiologically accurate movement trajectories
Indonesian–Australian media during an infodemic:fostering trust and social resilience through translation as care
No full textThe World Health Organisation (WHO) calls the proliferation of conflicting information during the COVID-19 pandemic an ‘infodemic’. To counter the infodemic experienced by diaspora communities, ethnic and multilingual media producers filled vital health communication gaps. This article focuses on the experiences of Indonesian–Australian media producers during this infodemic in Australia. Following semi-structured interviews with 10 Indonesian–Australian media producers, who recounted their experiences and practices supporting the information needs of Indonesian diaspora communities, we found that their translation of public health information extended beyond providing linguistically accessible and accurate information to the diasporic community. We propose the concept of ‘translation as care’. We suggest that translation practice can become an act of communal care during crises enabled by shared diaspora community identification and affective labour by Indonesian–Australian media producers. Translation as care addressed the gaps that Australian authorities could not adequately fill, fostering community trust and social resilience
Magnitudes of Various Forms of Undernutrition Among Children from the Composite Index of Anthropometric Failure in Sub-Saharan Africa:A Systematic Review and Meta-Analysis
No full text Background: Nearly half of under-five deaths are linked to undernutrition. Most evidence on undernutrition relies on conventional anthropometric measures. Conventional anthropometric measures fail to capture its overlapping forms and are limited in providing the true burden and distinct disaggregated patterns of undernutrition. Using the Composite Index of Anthropometric Failure (CIAF), this study aims to provide updated regional and country-level pooled prevalence estimates of the overall burden and various single and coexisting patterns of undernutrition among children in Sub-Saharan Africa (SSA). Methods: We systematically searched Medline, CINAHL, Web of Science, Scopus, and Google Scholar for studies published between January 2006 and October 2023. Studies reporting the prevalence of aggregated CIAF or any of the disaggregated forms of CIAF (stunting only, wasting only, underweight only, stunting-underweight, wasting-underweight, and stunting-wasting-underweight) based on the 2006 World Health Organisation (WHO) growth standard were included. Data extraction was performed by two reviewers, and discrepancies were resolved by consensus. Pooled prevalences of various categories of undernutrition were estimated using a random effect model meta-analysis. Subgroup analysis and meta-regression were performed to identify possible sources of heterogeneity among the included studies. Publication bias was checked using the Asymmetry funnel plot and Egger's test. The protocol was registered on PROSPERO (CRD42023458796). Result: This systematic review and meta-analysis identified 3898 published studies from the database search, of which 26 were included. In SSA, the overall pooled prevalence of undernutrition among children was 37.45% (95% Confidence Interval (CI): 31.97, 42.92). Of these, 10% (95% CI: 8.02, 11.98) of children experienced at least one coexisting form, and 25.5% (95% CI: 16.78, 33.72) experienced at least one single form of undernutrition. Stunting only [22.32% (95% CI: 18.26, 26.39)] was the most prevalent disaggregated pattern of undernutrition, followed by the coexistence of stunting with underweight [10.15% (95% CI: 8.17, 12.13)]. Conclusions: Over one in three children in SSA experienced at least one form of undernutrition. Nearly one-third of these undernourished children were affected by multiple forms of undernutrition. The high prevalence of coexisting undernutrition indicates the need to develop multi-indicator nutrition strategies that could simultaneously address the various dimensions of undernutrition in children. </p
Estimated carbon emissions for PBS-subsidised prescription respiratory inhalers, Australia, 2019-2023 a descriptive analysis
No full textThe Australian National Health and Climate Strategy1 identifies reducing the use of pressurised, metered dose inhalers as a high priority for decarbonising health care. These high emissions inhalers contain potent greenhouse gases as propellants, producing ten to thirty times as much in carbon dioxide equivalent (CO2e) emissions as low emissions inhalers (dry powder and soft mist inhalers), which are often clinically equivalent
Breastfeeding Support and Protection During Natural Disaster and Climate-Related Emergencies in Indonesia:Policy Audit
No full textBackground: Indonesia is a middle-income country in Southeast Asia in which 2,394 disasters were recorded in 2022 alone, with a total loss of 178,367 lives. In 2018 governments at the World Health Assembly resolved to improve emergency planning using Operational Guidance on Infant and Young Child Feeding in Emergencies (OG IFE). Little is known about whether Indonesian policies protect the health and lives of women, infants, and young children in line with OG IFE through planning for breastfeeding support and protection during emergencies. Research Aim: To identify and audit Indonesian policy regulations regarding infant and young child feeding support and protection during emergencies. Method: A search of the grey literature was conducted in 2023 through Google Basic and Advanced Search, official websites, and consultation with the Indonesian Breastfeeding Mothers Association (Asosiasi Ibu Menyusui Indonesia/AIMI) network. Keywords used included the Indonesian words for “regulation,” “disaster,” and the name of a province, city, or region, or the name of appropriate government organizations. Data was analyzed using a qualitative content analysis approach, and based on the Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Program Managers (OG-IFE) framework. Results: A total of 513 regulations were found online; however, only four were included for audit. The 509 excluded regulations did not specifically mention infant and young child feeding in emergencies. Those Indonesian policies that did mention infant and young child feeding in emergencies lacked attention to, and comprehensive planning for, breastfeeding protection and support during emergencies. Conclusion: Mothers and infants may be exposed to unnecessary risk and avoidable morbidity and mortality during emergencies. Indonesia could enhance its disaster relief policies to align with international standards supporting breastfeeding in emergencies. This could involve more comprehensive and integrated regional planning and preparation before disasters, including regular assessment of local infant and young child feeding practices, communication measures to raise emergency workers' awareness of breastfeeding, and resourcing of training so as to translate policies into practice.</p
Risk assessment processes within healthcare simulation centers:A scoping review
No full textObjectives: All healthcare workplace activities contain inherent safety threats; however, these may be potentially unique within the context of a simulation center. Simulation prioritises safety yet introduces risks. This scoping review aims to map the existing literature on risk assessment in healthcare simulation centers and identify how risk is assessed, measured and mitigated in these spaces. Design: The review adhered to the Joanna Briggs Population, Concept and Context (PCC) mnemonic, was reported using the Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for Scoping reviews (PRISMA-ScR) guidelines and registered with Open Science Framework. Results: A total of 490 articles were found, however only 8 studies met the inclusion criteria. The review highlights a lack of literature regarding the proactive assessment of risks in simulation learning. Conclusion: There is a need for the development and implementation of standardized risk assessment frameworks to ensure the safety of nursing faculty and students during simulation-based learning activities.</p
How remuneration committees incentivise executive compensation in Australia
No full textAlthough Australian regulators recommend that remuneration committees (RC) comprise directors who are independent, we argue that independence is not sufficient to avoid agency problems and counter managerial power. We evaluate a range of RC characteristics associated with executive compensation packages. We show that when independent directors, an independent chair or other firms’ CEOs sit on the RC, excess pay is likely to be lower. Furthermore, pay-performance sensitivity is higher when there are more senior directors on the RC. However, when directors are busy or the RC is diverse, executives are more likely to be overpaid. Overpayment and lower pay-performance sensitivity are also associated with the RC being influenced by the CEO, such as when the CEO sits on the RC or has appointed a high proportion of directors. Our results indicate that RC independence alone is insufficient for effective executive remuneration and we recommend appointing senior, experienced and less busy directors to increase RC effectiveness
Does a lack of juveniles indicate a threat?:Understanding body size distributions in a group of long-lived vertebrates
No full textTurtles are declining globally, and absences of juveniles during surveys are often interpreted as evidence of threats to early life stages. In Australia, for example, it is widely argued that a low number of juveniles is likely due to nest predation by introduced red foxes (Vulpes vulpes). However, small sample sizes within populations, low detectability of juveniles and turtles' long lifespans often confound the conclusion that a paucity of juveniles indicates a declining population. Because turtles have long reproductive lifespans, we might intuitively expect most turtle populations to be heavily weighted towards large individuals, but a 'typical' or 'healthy' size distribution for turtle populations has not been well established. Therefore, we collated data on 41,021 freshwater turtles from 38 species and 428 populations located in parts of Australia both with and without introduced foxes, as well as populations in the United States of America, which naturally have raccoons (Procyon lotor), foxes and other nest predators. We examined population-level body size distributions to establish a baseline for 'typical' turtle populations and test whether populations that are exposed to introduced foxes have proportionately fewer juveniles compared to both AU populations that lack introduced foxes and USA populations that are naturally exposed to nest predators. We found that most turtle populations in AU and the United States were heavily skewed towards adults and had few juveniles, regardless of the presence of foxes or other nest predators. There were, however, clear differences among population survey methods: those that target shallow areas (e.g. crawfish traps) tended to capture proportionately more juveniles, and small sample sizes (∼<50) often produced inaccurate representations of size distributions. Additionally, we used a simulation to demonstrate that, given common turtle life history parameters, even stable populations should generally have low proportions of juveniles. Based on our results, we encourage caution when interpreting turtle size distributions. A small number of juveniles does not inherently suggest that a population is declining due to high egg and/or juvenile mortality, and researchers should pay careful attention to the biases in their methods and strive to capture a minimum of 50-100 turtles before drawing inferences.</p
Knee joint moment changes and the relationship to radiological severity and body weight following a structured education and exercise therapy intervention for knee osteoarthritis
No full textBackground: Evidence links knee joint loads to knee osteoarthritis progression, making load reduction a target for non-surgical interventions. Exercise therapy does not appear to reduce knee joint moments, but studies focus on the medial compartment, overlook severity in other compartments and the influence of body weight, and do not assess more demanding tasks. This study evaluated whether knee adduction and knee flexion moments decrease following exercise therapy. We examined the extent to which knee joint moments change during a more demanding task, chair-rise, and the influence of body weight and osteoarthritis compartment severity. Methods: Thirty-one participants with knee osteoarthritis underwent three-dimensional biomechanical analysis during walking and chair rises at baseline and week-8 after the Good Life with OsteoArthritis in Denmark intervention. Multilevel models estimated knee adduction and knee flexion moments and their relationships with osteoarthritis compartment severity and body weight. Findings: Both knee adduction and knee flexion moments reduced during chair-rise after the intervention. The first peak knee adduction moment increased slightly by 3 % from 41.7 Nm (90 % CrI 37.0, 46.5) to 43.0 Nm (38.5, 47.5) during walking, regardless of osteoarthritis compartment severity. Greater lateral and patellofemoral compartment severity was related to larger knee flexion moment reductions during walking and chair-rises. Weak relationships were found between body weight and knee adduction and knee flexion moments for both tasks. Following the intervention, heavier people had larger increases during walking, but this was uncertain. Interpretation: Intervention had minimal impact on the knee adduction moment during walking, regardless of compartment severity. Reductions in knee joint moments were observed during chair-rises. Changes in joint load following exercise therapy may be more apparent during demanding tasks. The relationship between knee flexion moment and joint load during demanding tasks warrants further investigation.</p
Applications of schema therapy in young people:a systematic review
No full textAdolescents and young adults are increasingly susceptible to developing mental health conditions, but many young people do not respond well to the current evidence-based treatments. Schema therapy has been effective in adults with mental health conditions, and research suggests it holds promise in adolescents with chronic or treatment-resistant mental health conditions. Our systematic review searched for articles that applied schema therapy in people aged between 12 and 30. Databases searched using the EBSCOHost platform included PubMed MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioural Sciences Collection and American Psychological Association PsychInfo. Web of Science and the Cochrane Library was also searched. The quality of each article was assessed using the Mixed Method Appraisal Tool. Twelve studies including 180 participants were found meeting these criteria. These results provided preliminary support for the use of schema therapy in adolescents and young adults experiencing a wide range of mental health conditions including personality, conduct, anxiety, depressive or eating disorders. Our systematic review supports previous research on schema therapy, finding that it could be a promising treatment for young people. The present systematic review identifies directions for future research and provides guidance for clinicians providing schema therapy in this population.</p