Extension for Community Healthcare Outcomes (ECHO) Telementoring in the Military: Where We Are Now, Opportunities and Challenges.

Introduction: In collaboration with the ECHO (Extension for Community Healthcare Outcomes) Institute since 2012, the Army, Navy, and Air Force have developed medical teleECHO programs to address various health and safety issues affecting military personnel. This article describes and compares the current state of military teleECHOs as well as the growth and change over time.

Materials And Methods: This study evaluated continuing education units (CEUs) offered, average session attendance, and number of spoke sites for current military teleECHO programs across the service branches.

Modal-Based Kinematics and Contact Detection of Soft Robots.

Soft robots offer an alternative approach to manipulate within a constrained space while maintaining a safe interaction with the external environment. Owing to its adaptable compliance characteristic, external contact force can easily deform the robot shapes and lead to undesired robot kinematic and dynamic properties. Accurate contact detection and contact location estimation are of critical importance for soft robot modeling, control, trajectory planning, and eventually affect the success of task completion.

Beacon-referenced pursuit for collective motions in three dimensions.

Motivated by real-world applications of unmanned aerial vehicles, this paper introduces a decentralized control mechanism to guide steering control of autonomous agents manoeuvring in the vicinity of multiple moving entities (e.g. other autonomous agents) and stationary entities (e.

Fiber Optic Shape Sensing for Soft Robotics.

While soft material actuators can undergo large deformations to execute very complex motions, what is critically lacking in soft material robotic systems is the ability to collect high-resolution shape information for sophisticated functions such as environmental mapping, collision detection, and full state feedback control. This work explores the potential of a nearly commercial fiber optic shape sensor (FOSS) and presents the first demonstrations of a monolithic, multicore FOSS integrated into the structure of a fiber-reinforced soft actuator. In this pilot study, we report an open loop sensorized soft actuator capable of submillimeter position feedback that can detect the soft actuator's shape, environmental shapes, collision locations, and material stiffness properties.

A Dexterous, Glove-Based Teleoperable Low-Power Soft Robotic Arm for Delicate Deep-Sea Biological Exploration.

Modern marine biologists seeking to study or interact with deep-sea organisms are confronted with few options beyond industrial robotic arms, claws, and suction samplers. This limits biological interactions to a subset of "rugged" and mostly immotile fauna. As the deep sea is one of the most biologically diverse and least studied ecosystems on the planet, there is much room for innovation in facilitating delicate interactions with a multitude of organisms.

Exploiting Textile Mechanical Anisotropy for Fabric-Based Pneumatic Actuators.

Knit, woven, and nonwoven fabrics offer a diverse range of stretch and strain limiting mechanical properties that can be leveraged to produce tailored, whole-body deformation mechanics of soft robotic systems. This work presents new insights and methods for combining heterogeneous fabric material layers to create soft fabric-based actuators. This work demonstrates that a range of multi-degree-of-freedom motions can be generated by varying fabrics and their layered arrangements when a thin airtight bladder is inserted between them and inflated.

Assisting hand function after spinal cord injury with a fabric-based soft robotic glove.

Background: Spinal cord injury is a devastating condition that can dramatically impact hand motor function. Passive and active assistive devices are becoming more commonly used to enhance lost hand strength and dexterity. Soft robotics is an emerging discipline that combines the classical principles of robotics with soft materials and could provide a new class of active assistive devices.

A Modular Soft Robotic Wrist for Underwater Manipulation.

This article presents the development of modular soft robotic wrist joint mechanisms for delicate and precise manipulation in the harsh deep-sea environment. The wrist consists of a rotary module and bending module, which can be combined with other actuators as part of a complete manipulator system. These mechanisms are part of a suite of soft robotic actuators being developed for deep-sea manipulation via submersibles and remotely operated vehicles, and are designed to be powered hydraulically with seawater.

Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project.

Introduction: Complementary and integrative medicine (CIM) use in the USA continues to expand, including within the Military Health System (MHS) and Veterans Health Administration (VHA). To mitigate the opioid crisis and provide additional non-pharmacological pain management options, a large cross-agency collaborative project sought to develop and implement a systems-wide curriculum, entitled Acupuncture Training Across Clinical Settings (ATACS).

Materials And Methods: ATACS curriculum content and structure were created and refined over the course of the project in response to consultations with Subject Matter Experts and provider feedback.

Use of the Pain Assessment Screening Tool and Outcomes Registry in an Army Interdisciplinary Pain Management Center, Lessons Learned and Future Implications of a 10-Month Beta Test.

Introduction: The U.S. Army Comprehensive Pain Management Campaign Plan was launched in 2010 to improve pain outcomes in military populations.

Symmetry and reduction in collectives: low-dimensional cyclic pursuit.

We investigate low-dimensional examples of cyclic pursuit in a collective, wherein each agent employs a constant bearing (CB) steering law relative to exactly one other agent. For the case of three agents in the plane, we characterize relative equilibria and pure shape equilibria of associated closed-loop dynamics. Re-scaling time yields a reduction of phase space to two dimensions and effective tools for stability analysis.

Soft Robotic Grippers for Biological Sampling on Deep Reefs.

This article presents the development of an underwater gripper that utilizes soft robotics technology to delicately manipulate and sample fragile species on the deep reef. Existing solutions for deep sea robotic manipulation have historically been driven by the oil industry, resulting in destructive interactions with undersea life. Soft material robotics relies on compliant materials that are inherently impedance matched to natural environments and to soft or fragile organisms.

Pain as a Barrier to Human Performance: A Focus on Function for Self-Reporting Pain With the Defense Veterans Pain Rating Scale.

The intense physical demands and dangerous operational environments common to Special Operations Forces (SOF) result in a variety of painful conditions, including musculoskeletal pain, headaches, and acute and chronic pain from combat injuries. Pain is a wellaccepted barrier to human performance. The Pain Management Task Force and the development of the Defense Veterans Pain Rating Scale (DVPRS) are discussed to provide a framework for changing the culture of pain management away from intensity of pain to interference with function and performance.

Psychometric Testing of the Defense and Veterans Pain Rating Scale (DVPRS): A New Pain Scale for Military Population.

Objective: The Defense and Veterans Pain Rating Scale (DVPRS 2.0) is a pain assessment tool that utilizes a numerical rating scale enhanced by functional word descriptors, color coding, and pictorial facial expressions matched to pain levels. Four supplemental questions measure how much pain interferes with usual activity and sleep, and affects mood and contributes to stress.

Expanding Health Care Access Through Education: Dissemination and Implementation of the ECHO Model.

Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based model that provides high-quality medical education for common and complex diseases through telementoring and comanagement of patients with primary care clinicians. In a one to many knowledge network, the ECHO model helps to bridge the gap between primary care clinicians and specialists by enhancing the knowledge, skills, confidence, and practice of primary care clinicians in their local communities. As a result, patients in rural and urban underserved areas are able to receive best practice care without long waits or having to travel long distances.

Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population.

Background: The Army Surgeon General released the Pain Management Task Force final report in May 2010. Among military providers, concerns were raised that the standard numeric rating scale (NRS) for pain was inconsistently administered and of questionable clinical value. In response, the Defense and Veterans Pain Rating Scale (DVPRS) was developed.

First controlled vertical flight of a biologically inspired microrobot.

In this paper, we present experimental results on altitude control of a flying microrobot. The problem is approached in two stages. In the first stage, system identification of two relevant subsystems composing the microrobot is performed, using a static flapping experimental setup.