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Wrist-worn accelerometers are often applied to measure arm use after stroke. They measure arm movements during all activities, including whole-body movements, such as walking. Whole-body movements may influence clinimetric properties of arm use measurements—however, this has not yet been examined. This study investigates to what extent arm use measurements with wrist-worn accelerometers are affected by whole-body movements. Assuming that arm movements during whole-body movements are non-functional, we quantify the effect of whole-body movements by comparing two methods: Arm use measured with wrist-worn accelerometers during all whole-body postures and movements (P&M method), and during sitting/standing only (sit/stand method). We have performed a longitudinal observational cohort study with measurements in 33 stroke patients during weeks 3, 12, and 26 poststroke. The P&M method shows higher daily paretic arm use outcomes than the sit/stand method (p < 0.001), the mean difference increased from 31% at week three to 41% at week 26 (p < 0.001). Differences in daily paretic arm use between methods are strongly related to daily walking time (r = 0.83–0.92). Changes in the difference between methods are strongly related to changes in daily walking time (r = 0.89). We show that not correcting arm use measurements for whole-body movements substantially increases arm use outcomes, thereby threatening the validity of arm use outcomes and measured arm use changes.

Background: Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities. Methods: Qualitative study. Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data analysis. Results: Six participants 5–18 years post stroke with moderate to severe UE impairment. Three domains were identified: Person, Context, and Task. Themes for the Person domain included mental (cognitive effort, lack of acceptance), behavioral (routines/habits, self-evaluation), and physical (stiffness/fatigue). Themes for the Context domain included social environment (being in public, presence, and actions of others) and time constraints (being in a hurry). Themes for the task domain included necessity to complete bilateral and unilateral tasks, and safety (increased risk of accidents). Conclusion: Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Facilitators included cognitive effort, routines/habits, self-evaluation, and the perceived necessity. Barriers included in lack of acceptance, stiffness/fatigue, being in public, being in a hurry, and risk of ac-cidents. Social support was both a facilitator and a barrier. Our results support the growing call to adopt a broader biopsychosocial framework into rehabilitation delivery.

Background Upper limb impairment post-stroke often leads to a predominant use of the less affected arm and consequent learned disuse of the affected side, hindering upper limb outcome. Wearable sensors such as accelerometers, combined with smart reminders (i.e., based on the amount of arm activity), offer a potential approach to promote increased use of the affected arm to improve upper limb use during daily life. This study aimed to evaluate the efficacy of wrist vibratory reminders during a six-week home-based intervention in chronic stroke survivors. Methods We evaluated the impact of the home-based intervention on the primary outcome, the Motor Activity Log-14 Item Version scores Amount of Use (MAL-14 AOU), and the secondary outcomes MAL-14 Quality of Movement (QOM) and sensor-derived activity metrics from the affected arm. A randomized controlled trial design was used for the study: the intervention group received personalized reminders based on individualized arm activity goals, while the control group did not receive any feedback. Mixed linear models assessed the influence of the group, week of the intervention period, and initial impairment level on MAL-14 and arm activity metrics. Results Forty-two participants were enrolled in the study. Overall, participants exhibited modest but not clinically relevant increases in MAL-14 AOU (+ 0.2 points) and QOM (+ 0.2 points) after the intervention period, with no statistically significant differences between the intervention and control group. Feasibility challenges were noted, such as adherence to wearing the trackers and sensor data quality. However, in participants with sufficiently available sensor data ( n  = 23), the affected arm use extracted from the sensor data was significantly higher in the intervention group ( p  < 0.05). The initial impairment level strongly influenced affected arm use and both MAL-14 AOU and QOM ( p  < 0.01). Conclusions The study investigated the effectiveness of incorporating activity trackers with smart reminders to increase affected arm activity among stroke survivors during daily life. While the results regarding the increased arm use at home are promising, patient-reported outcomes remained below clinically meaningful thresholds and showed no group differences. Further, it is essential to acknowledge feasibility issues such as adherence to wearing the trackers during the intervention and missing sensor data. Trial registration NCT03294187.

BACKGROUND:A critical concept in brachial plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after brachial plexus surgery. OBJECTIVE:To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for brachial plexus injury, through a pilot study. METHODS:Five male patients who underwent nerve transfer after brachial plexus injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys. RESULTS:The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction0.97 (P = .008) and 0.99 (P = .002), respectively. CONCLUSION:Accelerometry-based activity monitors can successfully assess real-world functional outcomes after brachial plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.

Anatomical abnormalities in octopuses, whose behavior is facilitated by flexible, neuron-rich arms, offer insights into life histories and the neurological implications of understudied conditions such as bifurcation. Although documentation is scarce, here we present in situ videos of nine-armed O. vulgaris with a functional bifurcated R1 arm. Analysis using RDAs and GLMs investigated the impact of the bifurcated arm on behavior and examined changes during growth. Analysis revealed a differential usage of between the bifurcated arms in addition to an initial specialization of the bifurcated arms for actions below the body, decreasing over time for only one of the arms as grew. Further, bifurcated and regrown arms were utilized more in safe behaviors than risky ones, with more severely injured arms showing a higher frequency of use in safe behaviors. These findings contribute to the growing knowledge of arm usage in octopuses, suggesting that arm bifurcation may lead to branchial neural differentiation and potentially indicate post-traumatic associated in O. vulgaris.

Objectives We reconstruct the networks of officers co-involved in force incidents to test whether interactions with weapon-prone peers impact firearm use. Methods We draw from a statewide dataset of force incidents across law enforcement agencies in New Jersey, and employ conditional likelihood models to estimate whether exposure to peers with histories of firearm use is associated with an officer’s own likelihood of firearm use net of other contextual confounders. Results We find preliminary evidence that officer firearm behaviors, including drawing, pointing, and discharging a firearm, is influenced by an officer’s peers. Greater exposure to colleagues with histories of firearm use is associated with a lower risk of using a firearm. We also find that officer features, including experience and race/ethnicity, are associated with the risk of firearm use. Conclusions Our study suggests officers’ peers structure the risk of firearm use. Our data allow us to look at time order and rule out situational confounders pertaining to firearm use; however, do not allow us to infer causality. We discuss the study’s implications for understanding firearm behaviors and the role of network science in moving policing research forward.

Background Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. Methods This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. Discussion This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. Trial registration ClinicalTrials.gov NCT04232163. January 18, 2020.

Objectives Use of lethal force by police officers has incited riots, inspired social movements, and engendered socio-political debate. Police officers also assume a high level of risk during police–citizen encounters. Yet, existing studies tend to center on these two phenomena independently. Additionally, the under-utilization of multilevel research in these areas of inquiry has hampered attempts to empirically disentangle the individual, agency, and contextual correlates of fatal police–citizen encounters. This study integrates the predominantly distinct research bases on these phenomena to examine the contexts in which police use lethal force, relative to the contexts in which officers are killed in the line of duty. Methods Data were compiled on 6416 citizen fatalities and 709 officer fatalities distributed across 1735 agencies and 1506 U.S. places from 2000 to 2016. A series of three-level logistic regression models examined the civilian and officer characteristics, organizational factors, and contextual features that impacted the odds of citizen fatalities by the police relative to police lethal victimization. Results Findings indicated that structural disadvantage increased the odds of police lethal victimization relative to citizen fatalities by the police. Moreover, this contextual effect was, in part, a product of increased firearm usage by citizens who killed police in more disadvantaged areas. Conclusions A more complete understanding of fatal police–citizen encounters requires considering police use of lethal force and police lethal victimization concurrently in their broader social contexts.

This study employs a mixed methods approach, using quantitative analysis to discuss significant patterns, and qualitative analysis to provide descriptive accounts of homicide incidents. Seven hundred and five homicides that occurred in a northeastern city between January 1999 and December 2007 are examined to answer the following research question: Do the situated transactions of firearm homicides differ from those involving other weapons? The quantitative analyses found distinct patterns in offender intent, criminogenic tendencies, and situational attributes between firearm and other weapon homicides. The qualitative analysis revealed that firearms are most often utilized in homicides that can be understood as “doing crime,” where offenders and victims are engaged in a criminal lifestyle and firearms are an extension of this activity. Other weapons are associated with homicides concerned with “establishing moral order,” or defending values and ideals, between individuals who are intimate. The methodological and policy implication of these findings are discussed.

Background After a stroke, during seated reaching with their paretic upper limb, many patients spontaneously replace the use of their arm by trunk compensation movements, even though they are able to use their arm when forced to do so. We previously quantified this proximal arm non-use (PANU) with a motion capture system (Zebris, CMS20s). The aim of this study was to validate a low-cost Microsoft Kinect-based system against the CMS20s reference system to diagnose PANU. Methods In 19 hemiparetic stroke individuals, the PANU score, reach length, trunk length, and proximal arm use (PAU) were measured during seated reaching simultaneously by the Kinect (v2) and the CMS20s over two testing sessions separated by two hours. Results Intraclass correlation coefficients (ICC) and linear regression analysis showed that the PANU score (ICC = 0.96, r 2  = 0.92), reach length (ICC = 0.81, r 2  = 0.68), trunk length (ICC = 0.97, r 2  = 0.94) and PAU (ICC = 0.97, r 2  = 0.94) measured using the Kinect were strongly related to those measured using the CMS20s. The PANU scores showed good test-retest reliability for both the Kinect (ICC = 0.76) and CMS20s (ICC = 0.72). Bland and Altman plots showed slightly reduced PANU scores in the re-test session for both systems (Kinect: − 4.25 ± 6.76; CMS20s: − 4.71 ± 7.88), which suggests a practice effect. Conclusion We showed that the Kinect could accurately and reliably assess PANU, reach length, trunk length and PAU during seated reaching in post stroke individuals. We conclude that the Kinect can offer a low-cost and widely available solution to clinically assess PANU for individualised rehabilitation and to monitor the progress of paretic arm recovery. Trial registration The study was approved by The Ethics Committee of Montpellier, France (N°ID-RCB: 2014-A00395–42) and registered in Clinical Trial (N° NCT02326688, Registered on 15 December 2014, https://clinicaltrials.gov/ct2/show/results/NCT02326688 ).