text:
Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke
Yanhuan Huang1,
Will Poyan Lai2,
Qiuyang Qian1,
Xiaoling Hu1,
Eric W. C. Tam1,2 &
Yongping Zheng1
BioMedical Engineering OnLine volume 17, Article number: 91 (2018) Cite this article
Rehabilitation robots can provide intensive physical training after stroke. However, variations of the rehabilitation effects in translation from well-controlled research studies to clinical services have not been well evaluated yet. This study aims to compare the rehabilitation effects of the upper limb training by an electromyography (EMG)-driven robotic hand achieved in a well-controlled research environment and in a practical clinical service.
It was a non-randomized controlled trial, and thirty-two participants with chronic stroke were recruited either in the clinical service (n = 16, clinic group), or in the research setting (n = 16, lab group). Each participant received 20-session EMG-driven robotic hand assisted upper limb training. The training frequency (4 sessions/week) and the pace in a session were fixed for the lab group, while they were flexible (1–3 sessions/week) and adaptive for the clinic group. The training effects were evaluated before and after the treatment with clinical scores of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS).
Significant improvements in the FMA full score, shoulder/elbow and wrist/hand (P < 0.001), ARAT (P < 0.001), and MAS elbow (P < 0.05) were observed after the training for both groups. Significant improvements in the FIM (P < 0.05), MAS wrist (P < 0.001) and MAS hand (P < 0.05) were only obtained after the training in the clinic group. Compared with the lab group, higher FIM improvement in the clinic group was observed (P < 0.05).
The functional improvements after the robotic hand training in the clinical service were comparable to the effectiveness achieved in the research setting, through flexible training schedules even with a lower training frequency every week. Higher independence in the daily living and a more effective release in muscle tones were achieved in the clinic group than the lab group.
Stroke is a major cause of permanent disability in adults [1]. By 2014, the number of stroke survivors in Hong Kong was approximately 300,000, and more than 7 million in Mainland China, with an average of 2 million new cases per year and an annual increase of 8% from 2009 to 2014 in Mainland China [2, 3]. Approximately 80% of stroke survivors experience upper extremity impairment and disability in activities of daily living (ADLs) [4, 5]. However, fewer than 25% of these can regain limited recovery on their paretic arms even after post-stroke rehabilitation [6]. Physical treatment can result in more significant recovery of arm function during the subacute period (i.e., before 6 months after stroke onset) than in the chronic stage (i.e., more than 6 months after the stroke onset) [7]. In current clinical practice, the professional manpower of post-stroke rehabilitation is much more concentrated on the in-patient period in the subacute stage, compared with that in the long-term service for chronic stroke. However, recent studies have demonstrated that with intensive training, significant motor improvements could also be achieved during the chronic period after stroke [8, 9]. The challenge, however, is that rehabilitation manpower is insufficient, even in developed countries with the fast-expanding stroke populations. Hence, effective techniques and services for long-term rehabilitation after stroke are in urgent need.
Rehabilitation robots have been valuable for human therapists in delivering the labor-demanding physical training with the advantages of higher repetition and lower cost than professional manpower [10]. Various robots have been proposed for the upper limb rehabilitation after stroke, and the robots' effectiveness has been evaluated by clinical trials [11,12,13]. Among them, robot-assisted rehabilitation controlled by the voluntary inputs of the user exhibited more significant efficacy than that with continuous passive motions, i.e., no voluntary input was required from a user and the robots dominated the motion of a paralyzed limb [14]. In a voluntary intention driven robot designed by Song et al. [15], electromyography (EMG) from the residual muscle of the upper limb was used as the indicator of the voluntary motor intention from a stroke survivor. In the related randomized clinical trial, it was found that patients with chronic stroke obtained more significant motor gain when assisted with the EMG-driven robot than with passive motion assistance alone [16]. Another representative study was the large randomized multi-center trial by Lo et al. which compared the MIT-Manus robotic system for upper limb training with the conventional physical treatments by a human therapist [17]. The results suggested that the robot could achieve the equivalent motor improvements to those of the conventional treatment [17]. Thus, according to the findings, robot-assisted post-stroke training could be a cost-effective alternative to the conventional rehabilitation service when human manpower is insufficient.
However, almost all positive reports on robot-assisted rehabilitation were obtained through research-oriented clinical trial studies and not in a real clinical service configuration, with the assumption that the positive improvements reported in the trial studies would be naturally carried on into the real services after commercialization. Differences, or even discounts, in the rehabilitation effectiveness during the translation from well-controlled research studies to more flexible services have not yet been intensely evaluated. Actually, the feasibility and effectiveness of rehabilitation robots in the clinical service setting have been questioned when trial-quality management was difficult to achieve in a real long-term service [18,19,20,21,22]. There are several factors that increase the difficulty of head-to-head comparison on the training effectiveness in robot-assisted rehabilitation services with the clinical trials. For instance: (1) In a real service setting, the rehabilitation schedule is relatively flexible with payment from a client. In contrast, trial studies have restricted training schedules (are usually free of charge, or in some cases, participants are even paid for their involvement in the trial); (2) Participant (client) variability is large in the service. In the trials, participant inclusion criteria are usually targeted, and therefore, are difficult to replicate and implement exactly in the service management (particularly in the private sectors) due to the financial sustainability required; (3) In a clinical trial, the participants would usually not be allowed to receive other treatments that might interfere with the prescribed physical program under investigation. However, in a service setting, it is impossible to restrict a client and stop him/her from receiving other physical treatments he/she considers useful. An EMG-driven robotic hand was designed in our previous work, and its rehabilitation effectiveness on the upper limb functions in chronic stroke has been reported by a single group clinical trial [23]. From 2011, the EMG-driven robotic hand service open to local communities has been available in a self-financed university clinic in a private sector. The purpose of this work was to quantitatively evaluate the difference between the rehabilitation effects of an EMG-driven robot hand-assisted upper limb training program conducted as a research trial in a laboratory configuration and as real clinical practice in a private clinic, with minimum disturbance to the routine clinical management and service provided to the clients.
EMG-driven robotic hand
The EMG-driven robotic hand system used in this study is shown in Fig. 1. The system can aid with finger extension and flexion of the paretic limb in stroke patients. The robotic hand consisted of five linear actuators (Firgelli L12, Firgelli Technologies Inc.), and provided individual mechanical assistance to the five fingers [23]. The proximal and distal section of the index, middle, ring and little fingers were rotated around the virtual centers located at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP). The thumb was rotated around the virtual center of its MCP joint. The finger assembly provided two degrees of freedom (DOF) for each finger and offered a range of motion (ROM) of 55° and 65° for the MCP and PIP joints, respectively. The angular rotation speeds of the two joints were set as 22° and 26°/s at the MCP and PIP joints, respectively, during hand open/close.
The electromyography (EMG)-driven robotic hand system: A The wearable system consisting of a mechanical exoskeleton of the robotic hand and EMG electrodes; B, C the illustration of the configuration of the EMG electrodes attached to the extensor digitorum (ED) and abductor pollicis brevis (APB) muscles. The reference electrode was attached on the olecranon
To facilitate performance of phasic and sequential limb tasks (i.e. hand closing and hand opening), the abductor pollicis brevis (APB) and extensor digitorum (ED) muscles were used as voluntary neuromuscular drives. The APB was selected as the driving muscle in the "hand closing" phase, since the EMG signals from the APB of the paretic limb after stroke are less affected by spasticity and are relatively easier to be controlled than the flexor digitorum (FD) muscle for finger movements in chronic stroke [24]. EMG-triggered control was used in this study. During the training, the threshold level in each motion phase was set at three times the standard deviation (SD) above the EMG baseline in the resting state. In the "hand closing" phase, as soon as the EMG activation level of the APB muscle reached a preset threshold (3 SD above the baseline), the robotic hand would close with a constant speed (22 and 26°/s at the MCP and PIP joints, respectively) and provide mechanical assistance for finger flexion motions. In the "hand opening" phase, once the EMG activation level of the ED muscle reached a preset threshold (3 SD above the baseline), the robotic hand would open with a constant speed (22 and 26°/s at the MCP and PIP joints, respectively). Once the system's assistance has been initiated, voluntary effort from the patient is not required, and the robot's assistance will be continuously provided during the entire hand closing and opening phase in the defined ROM.
The EMG signals from the driving muscles captured using EMG electrodes were first amplified 1000 times (preamplifier: INA 333; Texas Instruments Inc., Dallas, TX), sampled at 1000 Hz by using a data acquisition card (DAQ, 6218 NI DAQ card; National Instruments Corp), and filtered by using a band-pass filter in the range 10–500 Hz. After digitization, the EMG signals from the APB and ED muscles were rectified and low-pass filtered (fourth-order, zero-phase forward and reverse Butterworth filter; cut-off frequency, 10 Hz) to obtain an envelope of EMG signals (i.e., the EMG activation level) in the real-time control.
Clinic versus laboratory
This research concerns a non-randomized, controlled trial comparing two different settings: the clinical service setting under a business environment and the laboratory setting (Table 1). The clinical service was hosted at the University's Jockey Club Rehabilitation Engineering Clinic (JCREClinic). The JCREClinic provides holistic clinical services, including prostheses, orthoses and robotic rehabilitation training to clients mainly from the local communities. Figure 2 presents the interior configuration of the JCREClinic consisting of a main entrance, reception counter, corridor, waiting area for guests, and treatment rooms. All of the JCREClinic's consultations and treatments can be arranged by walk-in or scheduled appointments via phone, email or WhatsApp message. The procedure for the robotic hand training service is as follows. First, the client makes an appointment. Then, the client would be invited to a consultation with the physical therapist responsible for the service. In this consultation session, the physical therapist serves the client by reviewing the medical and rehabilitation histories, and then evaluating the motor functions of the upper limb by clinical scores, which would be illustrated in detail later. Following this, the physical therapist helps the client to perform a trial of robotic hand training, including gauging the fit, size, and the possibility of using the target muscles to control the system for the potential treatment. During this stage of the process, the physiotherapist also explains to the client the possible rehabilitation effects, according to the previous results from the trial [23]. Once the client has accepted the robot hand assisted upper limb treatment after the consultation session, a training schedule consisting of 20 sessions (90 min/session) would be arranged by the clinic according to the availabilities of both the physiotherapist and the client with a suggested training frequency of 3–5 sessions/week. In the management of the service, a maximum four sessions/week could be provided to a client. However, the client might re-arrange the schedule later due to other commitments. Each session had a service charge rate of 400 Hong Kong Dollars to be paid after the completion of a session. A client could also quit at any point during the duration of the service without incurring a penalty.
Table 1 Clinic versus laboratory
The interior configuration and training setup of the robotic hand training in Jockey Club Rehabilitation Engineering Clinic: A Entrance, B corridor, C waiting area for guests and reception counter, D treatment room with estimated area presented by square meter, and E, F the training setup of the robotic hand rehabilitation system assisted by a physical therapist
For the laboratory setting, the EMG-driven robot hand assisted upper limb training was conducted in a neurorehabilitation lab (Fig. 3) in Hong Kong Polytechnic University. The neurorehabilitation lab consists of a physical training area, a cognitive training area, and an office area, and the robotic hand training was performed in the physical training area. The participants who attended the EMG-driven robot hand treatment in the laboratory were not charged for the treatment.
The interior configuration and training setup of the robotic hand training in a neurorehabilitation laboratory: A Lab planar graph with estimated area presented by square meter, B physical training area, and C the training setup of the robotic hand rehabilitation system assisted by a research staff
Participants recruitment
This work was approved by the Human Participants Ethics Sub-Committee of the Hong Kong Polytechnic University. The participants who received their training in the laboratory setting were regarded as the "lab group", while those in the clinical trial setting were the "clinic group", and the participants in the two groups were recruited by different approaches. Lab group participants were recruited from the local districts based on the following inclusion criteria [23]: (1) The participants were at least 6 months after the onset of a singular and unilateral brain lesion due to stroke; (2) Both the MCP and PIP joints could be extended to 180° passively; (3) The spasticity during extension at the finger joints and the wrist joint was lower than or equal to 3 as measured by the Modified Ashworth Scale (MAS) [25]; (4) There should be detectable voluntary EMG signals (i.e. the signal amplitude should exceed 3 SD above the mean of the baseline) from the target muscles in the paretic side of the participants; (5) The participants also had sufficient cognition to follow the experimental instructions as assessed by the Mini-Mental State Examination (MMSE > 21). In addition to these factors, lab group participants were also told that they could not attend other upper limb physical treatments during the robotic hand training, otherwise they would be dropped from the study. Before initiating treatment, all recruited participants had to submit their written consent.
Participants in the clinic group were recruited from a pool of clients scheduled for robotic hand rehabilitation in the JCREClinic. Clients were screened in the JCREClinic and potential participants were those who possessed the upper limb motor deficits that satisfied the same inclusion criteria as for the lab group. Then, the clients who showed the interest in participation and agreed not to receive other upper limb treatment during the training period were recruited in the study. Figure 4 illustrates the Consolidated Standards of Reporting Trials flowchart of the training program.
The consolidated standards of reporting trials flowchart of the experimental design
Training protocols
In this study, all participants attended the 20-session robotic hand assisted upper limb training. In each session, a participant was instructed to conduct the repetitive upper limb motions including hand grasp and release motions, and lateral task training and vertical task training. In the lateral task, each participant was instructed to grasp a sponge (thickness 5 cm, weight 30 g) that was placed on one side of a table near the paretic side of the participant, transport the sponge 50 cm horizontally, release it, grasp it again, and return it to the starting point. In the vertical task, each participant was instructed to grasp the sponge on the midline of the lower layer of a shelf, lift it through a vertical distance of 17 cm, place it on the midline of the upper layer of the shelf, grasp it again, and place it back on the starting point. The procedures have been fully detailed in our previous study [23].
The key training program differences between the clinic and the laboratory groups were the training pace and frequency per week, and the interaction between the treatment operator and the participant. In the clinic group, the recruited participants (clients) received the robotic hand training in a treatment room of the JCREClinic by a physiotherapist in a one-to-one manner, with a duration of 90 min for each session. The training frequency for those in the clinic group was negotiable with a maximum of four sessions/week. However, the final averaged training frequency in the clinic group was 2.25 sessions/week, with a range of 1–3 sessions/week, due to the re-arrangements raised in the middle in this study. In each session, a participant in the clinic group had a relatively flexible training pace, i.e., the participant could stop the practice for a rest of 5 min whenever needed to avoid significant fatigue. During the rest, verbal communication between physiotherapist and the participant, and encouragement from the therapist were delivered. In a 90-min training session, it was observed that the participants in the clinic group could gradually increase the accumulated practicing time from less than 45 min to more than 60 min (on average) throughout the treatment process.
By comparison, each participant in the lab group was invited to attend the robotic hand training in the laboratory by a research assistant in the project with a training frequency of four sessions/week, over a 5-week (consecutive) period. One 10-min break was given for every 20 min of training to reduce the muscle fatigue. The accumulated practicing time in a session was 60 min, as in our previous trial [23].
Outcome evaluations
The motor functional improvements in the upper limb of the participants were reviewed using a series of clinical scores by an assessor who was blinded to the protocol of the study. In this study, the applied assessments included the Fugl-Meyer Assessment [26] [FMA with the full score of 66 for the upper limb assessment was further divided into shoulder/elbow (42/66) and wrist/hand (24/66)], MAS [25] on the flexors related to the fingers, wrist and elbow, Action Research Arm Test (ARAT) [27], and Functional Independence Measure (FIM) [28]. The FMA evaluates the motor function impairment in voluntary limb movements. The MAS measures the resistance during passive muscle stretching and indicates the muscular spasticity, mainly in the flexors. The ARAT assesses the upper limb voluntary functions with a focus on the finger activities. The FIM was used to rate the basic quality of daily living activities (ADLs) for patients with stroke.
The varying demographic characteristics of the participants between the two groups were assessed by the independent t test or the Fisher exact test. The baselines of the clinical scores for the two groups were compared by independent t-test with an insignificant statistical difference (P > 0.05) on the primary clinical assessments (i.e., pre-assessments on FMA). One-way analysis of covariance (ANCOVA) was then used to evaluate the group differences of the post-training clinical assessments by taking the pre-assessment as a covariate. Following this, paired t-test was conducted to investigate the intragroup difference of the two groups at different time points both before and after the training. Furthermore, the changes of each clinical assessment after the treatments were also compared between the groups by independent t-test. The levels of statistical significance were indicated at 0.05, 0.01, 0.001 in this study.
For the lab group, 20 stroke patients were screened, and from these, 16 participants were recruited. For the clinic group, 150 stroke clients were screened in the JCREClinic; 19 participants fulfilled the inclusion criteria and were therefore, recruited into the clinic group. In total, three participants dropped out in the clinic group: two, because they attended other additional upper limb physical treatment during the training, and one, who decided to quit in the middle of the training. Therefore, a total of 32 participates completed the EMG-driven robotic hand assisted upper limb training, either in a clinical trial study (n = 16) or in a clinical service (n = 16). The recruited participants' demographic data are presented in Table 2. No statistical differences were observed between the groups in terms of age, gender, side of stroke, type of stroke, employment, and onset time. Twenty-eight participants quit their employment, and four participants in the clinic group were still working during the period of the study. Higher training sessions per week (P < 0.001, independent t-test, Table 2) can be observed in the lab group compared with the clinic group.
Table 2 Demographic characteristics of the participants
Table 3 details the comparisons between the two groups on the clinical scores before the training. Significant inter-group differences on pre-clinical assessment were found in the MAS elbow (P = 0.044, EF = 0.75, independent t-test, Table 3) and ARAT (P = 0.041, EF = 0.76, independent t-test, Table 3). There was no significant difference on the pre-clinical assessment between the two groups in the MAS finger, MAS wrist, FMA, and FIM (P > 0.05, independent t-test, Table 3).
Table 3 The pre-clinical assessments of each group
Figure 5 compares the two groups' clinical scores of the FMA, ARAT, FIM, and MAS evaluated before the first training session (pre-training assessment) and after the last training session (post-training assessment). The values of each clinical assessment of the two groups have been summarized in Table 4. In the clinic group, significant increases were observed in the clinical scores of the FMA full score (P < 0.001, EF = − 1.45, paired t-test, Table 4), FMA shoulder/elbow (P < 0.001, EF = − 1.35, paired t-test, Table 4), FMA wrist/hand (P < 0.001, EF = − 1.36, paired t-test, Table 4), ARAT (P < 0.001, EF = − 1.22, paired t-test, Table 4), and FIM (P = 0.004, EF = − 0.86, paired t-test, Table 4); while significant decreases were obtained in the MAS finger (P < 0.001, EF = 1.12, paired t-test, Table 4), MAS wrist (P = 0.001, EF = 0.97, paired t-test, Table 4) and MAS elbow (P = 0.001, EF = 1.08, paired t-test, Table 4). For the lab group, significant increases were observed in the scores of the FMA full score (P < 0.001, EF = − 1.46, paired t-test, Table 4), FMA shoulder/elbow (P < 0.001, EF = − 1.18, paired t-test, Table 4), FMA wrist/hand (P < 0.001, EF = − 1.35, paired t-test, Table 4) and ARAT (P < 0.001, EF = − 1.44, paired t-test, Table 4). Significant decreases were only obtained in the MAS elbow (P = 0.013, EF = 0.71, paired t-test, Table 4). However, no significant group differences were observed on scores in the post-assessments (P > 0.05, one-way ANCOVA, Table 4). As the interaction between the pre-clinical scores and group factor of the FIM score was significant (P < 0.05), one-way ANCOVA could not be used to evaluate the post-clinical scores of FIM between the two groups. Therefore, the variations of the clinical scores were further used to evaluate the intergroup comparison particularly on the FIM scores.
The clinical scores (evaluated before the first and after the 20th training session) of the participants in both clinic group and lab group: a Fugl-Meyer Assessment (FMA) full scores, b FMA shoulder/elbow scores, c FMA wrist/hand scores, d Action Research Arm Test (ARAT) scores, e Functional Independence Measure (FIM), and f Modified Ashworth Scale (MAS) scores at the fingers, the wrist and the elbow, presented as mean value with 2-time SE (error bar) in each evaluation session. The solid lines are for the clinic group, and the dashed lines are for the lab group. The significant intragroup difference is indicated by "*" (p < 0.05, paired t-test), and "#" is used to indicate the significant intergroup difference (p < 0.05, independent t-test)
Table 4 The clinical assessments of each group
Figure 6 lists the changes of each clinical assessment for the two groups following their respective treatments. The detailed values and the statistical results of the comparison have been summarized in Table 5. Compared with the lab group, significant higher variations in the clinic group were observed on the FIM scores (P = 0.043, EF = 0.75, independent t-test, Table 5). No significant variations of the clinical scores between the two groups were achieved in the MAS, FMA and ARAT (P > 0.05, independent t-test, Table 5).
The changes of each clinical assessment after the treatments in both clinic and lab groups: Fugl-Meyer Assessment (FMA) full scores, FMA shoulder/elbow, FMA wrist/hand, Action Research Arm Test (ARAT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) scores at the fingers, the wrist and the elbow, presented as mean value with 2-time SE (error bar) in each evaluation session. The significant difference is indicated by "*" (P < 0.05, independent t-test)
Table 5 The changes of each clinical assessment of each group
After 20 sessions of upper limb training assisted by EMG-driven robotic hand, improved clinical scores denoting enhanced motor function were observed in all participants, and were recorded in the shoulder, elbow and finger after the treatments.
The significant increase in the FMA shoulder/elbow score after the training in both groups indicated that robotic hand training could improve the motor control at the joints of the shoulder and elbow with equivalent training effectiveness. Although no specific robotic system was applied to the joints of the elbow and shoulder in this study, the increase in the FMA shoulder/elbow scores after robotic hand training can still be observed. Possible reasons for this are as follow: (1) The involvement of other joints in the training tasks might be beneficial to the whole upper limb [29]; in this study, the participants' shoulder-related and elbow-related muscles were practiced during the training process via the lateral task training and the vertical task training; and (2) the adjacent proximal joint would be simultaneously improved when the muscle around the joint was trained, as indicated by our previous studies [30, 31]. Hence, the wrist training might lead to elbow improvement [31], and the elbow training might lead to improved shoulder function [30]. As proximal to distal gradient of motor deficit being absent [32], this result suggests that task-oriented whole upper limb training is a more beneficial method than joint-per-joint rehabilitation, which is consistent with research by Susanto et al. [29] and Oujamaa et al. [33]. Both groups' significant increase in the FMA hand/wrist scores also demonstrated that this study's EMG-driven robotic hand could assist stroke patients with improving motor function in their wrists and hands, with a comparable achievement between the clinic group and the lab group. The ARAT score is mainly to evaluate the finger movements as well as grasping, gripping, and pinching movements. The significant increased score in the ARAT scores in both group after the training suggested the improved finger coordination for fine precision grasping and joint stability of the fingers, which was consistent with the increased FMA wrist/hand score.
When comparing the functional improvements between the two groups, the effectiveness of the robotic hand applied in the private clinic is statistically equivalent to that found in the research laboratory, where the clinic service group improved more with the lower training frequency compared with the lab group. Furthermore, the improvement on the ADLs indicated by the FIM scores in the clinic group was significantly better than the improvement on the ADLs achieved in the lab group. The FIM score is mainly used to rate the basic quality of daily living activities for patients with stroke. The significantly increased FIM scores in the clinic group reveal that the EMG-driven robotic hand was effective in improving the independence of ADLs for chronic stroke patients in the clinic group. However, there was no significant improvement in the FIM scores obtained in the lab group after the robotic hand training. In addition, the notable decrease in the MAS score at elbow, wrist and fingers for participants in the clinic group indicated that robotic hand training could improve the muscle coordination and joint stability of the proximal and distal joints not only during hand grasp and release motions, but also during arm reaching motions. For participants in the lab group, however, the significant decrease in the MAS scores was only observed on the elbow joint, and no noteworthy decrease in the MAS scores on the fingers and wrist were recorded for the lab group following the robotic hand training.
Thus, the question is why the clinic group achieved better ADLs and released muscle tone on hand despite the lower training frequency per week. One possible explanation for this is that the participants in the clinic group performed daily practice by themselves besides the treatment in the clinic. In the clinical service, the physical therapist always suggested and encouraged stroke patients to practice the hand grasp and release motion and arm reaching motions every day with the purpose to generalize the learnt motor skill in the daily functions. Those stroke patients actively followed the professional suggestions and performed daily living activities, such as self-feeding, dressing and bathing using their affected limb. In contrast, however, the research staff did not expressly suggest that the stroke patients in the laboratory practice by themselves in daily activities. In this study, the significant decrease in the MAS wrist in the clinic group after the robotic hand training suggested the release of spasticity in the wrist joint for these participants; no similar results were observed in the lab group. However, the joints of wrist were fixed on the palm-wrist module (shown in Fig. 1), and no specific tasks were assigned to the wrist joints in this study; therefore, the decreased spasticity in the wrist joint noted for participants in the clinic group may not be directly attributed to the robotic hand training, but instead may be due to the stroke patients' own self-practice. In addition, compared with the lab group, the significantly improved FIM scores in the clinic group may also be a result of the participants' additional self-practice with daily living activities.
Another unique aspect of the clinical service is the flexible training pace (also called voluntary exercise). During the robotic training, the participant could voluntarily control the training pace by deciding to rest whenever they needed, or by continuing to perform the robotic training without a rest. The average accumulated practicing time per session ranged from less than 45 min to more than 60 min throughout the whole training program. For example, in the first few training sessions, participants in the clinic group usually frequently asked for a rest after every 5 min of training. When the participants were familiar with the training program, they could gradually increase their practicing time to around 60 min per session. For those participants who could perform well with the robotic hand training, their total practicing time per session might even exceed 60 min, and they also claimed that they could practice more if there was no time limited. However, in the lab group, the participants took a 10-min break for every 20 min of training, with a 60-min accumulated practice time per session. Although little research has been conducted on the effect of voluntary exercise in stroke rehabilitation for human beings, some studies based on the post-stroke mice model have demonstrated that better results are achieved through voluntary exercise than through forced exercise. For instance, Ke et al. [34] used three approaches involving the voluntary exercise of wheel running (V-Ex), forced exercise of treadmill running (F-Ex), and involuntary exercise of FES (I-Ex) to train post-stroke rats. The V-Ex rats were housed individually in a cage with a running wheel assembled and left to freely run of their own accord, similar to the flexible training in our clinic group. However, F-Ex rats were forced to run on the motor-driven treadmill for a total of 30 min every day, which was like the fixed training in our lab group. The results revealed that the voluntary exercise was the most effective training style in facilitating motor recovery, while the forced exercise group achieved the least motor recovery, consistent with the findings of Lin et al. [35]. Thus, this may be the reason for the larger improvements achieved by the clinic group in this study, and is therefore, one potential avenue for further study on post-stroke rehabilitation for human beings.
Motivation has been regarded as the key to stroke rehabilitation and plays an important role in determining recovery outcomes [36]. It is widely believed that patients with high motivation can achieve better outcome compared with those patients with less enthusiastic for treatment [37, 38]. In this study, we observed that the stroke patients in the clinical service had higher motivation than those who were in the laboratory. It has been found that motivation is a multi-determined phenomenon involving various aspects, such as patient characteristics (including personality traits, anxiety, age, socio-economic status), social factors (including the qualities of the practitioner and patient-practitioner interaction) and rehabilitation environment [39, 40]. Thus, the higher socio-economic status in the clinic group compared with that of the lab group may have influenced the patients' motivations. For example, there were four stroke patients in the clinic group who were still employed and therefore, were strongly motivated to regain functional recovery; however, in the lab group, the participants had all quit their jobs, might not have confidence in their own abilities to perform everyday activities, and had low motivation to achieve functional recovery. The qualities of the practitioner and patient-practitioner interaction are also linked with the formation of patient motivation [41]. A practitioner exhibiting strong confidence in the treatment with good communication skills can improve patients' positive motivation, while a neutral or uncertain attitude may have little or even a negative impact on the patients [42, 43]. Therefore, a professional physical therapist who wears a doctor's overall and can provide professional rehabilitation guidelines in a clinic setting may subconsciously enhance the positive motivation of the patients in the clinic group. Furthermore, the treatments delivered in different rehabilitation environments may affect a patient's belief or faith in the treatment they receive. According to a qualitative analysis of stroke professionals' attitudes [40], it was pointed out that a stimulating rehabilitation environment with a well-maintained treatment room is a positive determinant of motivation. Hence, positive patients' motivation requires an encouraging environment and good interaction between the therapists and the patients. Some other studies also suggested that training devices which can provide rewarding schemes in a gaming environment had the ability to enhance the motivation of patients [44, 45]. However, how to optimally apply motivational therapy into the rehabilitation to achieve better training outcomes is still unclear and need to be further investigated [46].
It was noticed that the ARAT and MAS Elbow scores for the clinic group were significantly lower than the lab group. However, there was no significant difference between the groups in the pre-assessment for the other clinical scores. It might imply that the upper limb motor function of the clinic group could be lower than the lab group during the admission. In the post-assessment, the rehabilitation outcomes of the clinic group were comparable or even better (e.g., FIM) than the lab group. It might imply that the robotic hand training was more effective for those severely injured patients. The main limitation of this study was the small sample size. Large scale clinical trial with stratified randomization in multi-centers will be conducted in our future work to further validate the rehabilitation effectiveness of the device assisted post-stroke rehabilitation.
The improvements of the EMG-driven robotic hand training obtained in a clinical service were similar to the effectiveness of the same robotic training carried out in a research environment. A higher independence in the daily living activities and more effective release in muscle tones was achieved in the clinic group than the lab group. The potential better outcomes in the clinic group may due to the flexible training, self-exercise, and higher motivation. This study provides additional support for the role of robotics training in the clinic service for post-stroke patients after translation from the research laboratory. It has further demonstrated the feasibility and efficacy of robotic hand-assisted upper limb therapy with a flexible service in improving the distal function, which further translates to improvements in the elbow and shoulder.
Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008;371(9624):1612–23.
National Health and Family Planning Commission of the People's Republic of China. China health and family planning yearbook (2014–2015). Beijing: Peking Union Medical College Press; 2014.
Hospital Authority Statistical Report. Hospital Authority (2014–2015), Hong Kong. 2015. http://www.ha.org.hk/haho/ho/stat/HASR1415_3.pdf. Accessed 30 Jan 2018.
Masiero S, Armani M, Ferlini G, Rosati G, Rossi A. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2014. https://doi.org/10.1177/1545968313513073.
Rong W, Li W, Pang M, Hu J, Wei X, Yang B, Wai H, Zheng X, Hu X. A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke. J Neuroeng Rehabilitation. 2017. https://doi.org/10.1186/s12984-017-0245-y.
Dobkin BH. Rehabilitation after stroke. N Engl J Med. 2005. https://doi.org/10.1056/NEJMcp043511.
Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016. https://doi.org/10.1177/1747493016643553.
Good DC, Bettermann K, Reichwein RK. Stroke rehabilitation. continuum: lifelong learning. Neurology. 2011;17(3):545–67.
Page SJ, Gater DR, Bach-y-Rita P. Reconsidering the motor recovery plateau in stroke rehabilitation. Arch Phys Med Rehabil. 2004;85(8):1377–81.
Maciejasz P, Eschweiler J, Gerlach-Hahn K, et al. A survey on robotic devices for upper limb rehabilitation. J Neuroeng Rehabil. 2014. https://doi.org/10.1186/1743-0003-11-3.
Takahashi K, Domen K, Sakamoto T, et al. Efficacy of upper extremity robotic therapy in subacute poststroke hemiplegia an exploratory randomized trial. Stroke. 2016. https://doi.org/10.1161/STROKEAHA.115.012520.
Gert K, Boudewijn JK, Hermano IK. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair. 2008;22(2):111–21.
Norouzi-Gheidari N, Archambault PS, Fung J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature. J Rehabil Res Dev. 2012. https://doi.org/10.1682/JRRD.2010.10.0210.
Volpe BT, Ferraro M, Lynch D, et al. Robotics and other devices in the treatment of patients recovering from stroke. Curr Atheroscler Rep. 2004. https://doi.org/10.1007/s11910-005-0035-y.
Song R, Tong KY, Hu X, Li L. Assistive control system using continuous myoelectric signal in robot-aided arm training for patients after stroke. IEEE Trans Neural Syst Rehabil Eng. 2008;16(4):371–9.
Hu XL, K-y Tong, Song R, et al. A comparison between electromyography-driven robot and passive motion device on wrist rehabilitation for chronic stroke. Neurorehabil Neural Repair. 2009. https://doi.org/10.1177/1545968309338191.
Lo AC, Guarino PD, Richards LG, et al. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010. https://doi.org/10.1056/NEJMoa0911341.
Patton J, Small SL, Zev Rymer W. Functional restoration for the stroke survivor: informing the efforts of engineers. Top Stroke Rehabil. 2008. https://doi.org/10.1310/tsr1506-521.
Bishop L, Stein J. Three upper limb robotic devices for stroke rehabilitation: a review and clinical perspective. NeuroRehabilitation. 2013;33(1):3–11.
Demain S, Burridge J, Ellis-Hill C, et al. Assistive technologies after stroke: self-management or fending for yourself? A focus group study. BMC Health Serv Res. 2013. https://doi.org/10.1186/1472-6963-13-334.
Turchetti G, Vitiello N, Trieste L, Romiti S, Geisler E, Micera S. Why effectiveness of robot-mediated neurorehabilitation does not necessarily influence its adoption. IEEE Rev Biomed Eng. 2014;7:143–53.
Sukal-Moulton T, Clancy T, Zhang L-Q, et al. Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice? Arch Phys Med Rehabil. 2014. https://doi.org/10.1016/j.apmr.2014.04.010.
Hu X, Tong K, Wei X, et al. The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot. J Electromyogr Kinesiol. 2013. https://doi.org/10.1016/j.jelekin.2013.07.007.
Towles JD, Kamper DG, Rymer WZ. Lack of hypertonia in thumb muscles after stroke. J Neurophysiol. 2010. https://doi.org/10.1152/jn.00423.2009.
Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987. https://doi.org/10.1093/ptj/67.2.206.
Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13–31.
Carroll D. A quantitative test of upper extremity function. J Chronic Dis. 1965. https://doi.org/10.1016/0021-9681(65)90030-5.
Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (FIM). Scand J Rehabil Med. 1994;26(3):115–9.
Susanto EA, Tong RK, Ockenfeld C, et al. Efficacy of robot-assisted fingers training in chronic stroke survivors: a pilot randomized-controlled trial. J Neuroeng Rehabil. 2015. https://doi.org/10.1186/s12984-015-0033-5.
Qian Q, Hu X, Lai Q, Ng SC, Zheng Y, Poon W. Early stroke rehabilitation of the upper limb assisted with an electromyography-driven neuromuscular electrical stimulation-robotic arm. Front Neurol. 2017;8:447.
Hu XL, Tong RKY, Ho NS, et al. Wrist rehabilitation assisted by an electromyography-driven neuromuscular electrical stimulation robot after stroke. Neurorehabil Neural Repair. 2015. https://doi.org/10.1177/1545968314565510.
Beebe JA, Lang CE. Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke. Clin Neurophysiol. 2008. https://doi.org/10.1016/j.clinph.2008.04.293.
Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009;52(3):269–93.
Ke Z, Yip SP, Li L, et al. The effects of voluntary, involuntary, and forced exercises on brain-derived neurotrophic factor and motor function recovery: a rat brain ischemia model. PLoS ONE. 2011. https://doi.org/10.1371/journal.pone.0016643.
Lin Y, Dong J, Yan T, et al. Involuntary, forced and voluntary exercises are equally capable of inducing hippocampal plasticity and the recovery of cognitive function after stroke. Neurol Res. 2015. https://doi.org/10.1179/1743132815Y.0000000074.
Rowe JB, Chan V, Ingemanson ML, et al. Robotic assistance for training finger movement using a hebbian model: a randomized controlled trial. Neurorehabil Neural Repair. 2017. https://doi.org/10.1177/1545968317721975.
Colombo R, Pisano F, Mazzone A, et al. Design strategies to improve patient motivation during robot-aided rehabilitation. J Neuroeng Rehabil. 2007. https://doi.org/10.1186/1743-0003-11-64.
Maclean N, Pound P, Wolfe C, et al. Qualitative analysis of stroke patients' motivation for rehabilitation. BMJ. 2000. https://doi.org/10.1136/bmj.321.7268.1051.
Maclean N, Pound P. A critical review of the concept of patient motivation in the literature on physical rehabilitation. Soc Sci Med. 2000;50(4):495–506.
Maclean N, Pound P, Wolfe C, Rudd A. The concept of patient motivation: a qualitative analysis of stroke professionals' attitudes. Stroke. 2002;33(2):444–8.
Ong LM, De Haes JC, Hoos AM, et al. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995. https://doi.org/10.1016/0277-9536(94)00155-M.
Chan DK, Lonsdale C, Ho PY, et al. Patient Motivation and adherence to postsurgery rehabilitation exercise recommendations: the influence of physiotherapists' autonomy-supportive behaviors. Arch Phys Med Rehabil. 2009. https://doi.org/10.1016/j.apmr.2009.05.024.
Finkler K, Correa M. Factors influencing patient perceived recovery in Mexico. Soc Sci Med. 1996. https://doi.org/10.1016/0277-9536(95)00086-0.
Popović MD, Kostić MD, Rodić SZ, et al. Feedback-mediated upper extremities exercise: increasing patient motivation in poststroke rehabilitation. Biomed Res Int. 2014;2014:11.
Widmer M, Held JP, Wittmann F, et al. Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial. Trials. 2017. https://doi.org/10.1186/s13063-017-2328-2.
Luft AR. Rehabilitation and plasticity. In: Naritomi H, Krieger DW, editors. Clinical recovery from cns damage. 32nd ed. Basel: Karger Publishers; 2013. p. 88–94.
YHH contributed in the EMG-robotic hand assisted training experiment, data collection and analysis, and manuscript drafting. PYL and WCT contributed in the clinical service design and subject management. QYQ contributed in the clinical assessment. XLH conceived of the study and coordinated the whole project, including the clinical trial design, human subject experiments and manuscript drafting. YPZ contributed in the data analysis and manuscript drafting. All authors read and approved the final manuscript.
The authors would like to thank the subjects who participated in this study and Mr. Ziqi Guo, Miss. Chingyi Nam, Mr. Kekao Long who provided technical support and comments.
Please contact author for data requests.
This study was carried out in accordance with the human ethic guidelines of the Human Subjects Ethics Subcommittee of Hong Kong Polytechnic University. All subjects recruited in the study gave written informed consent in accordance with the Declaration of Helsinki before the start of the training.
The study was supported in part by PolyU Central Fund (1-ZE4R and G-YBRS).
Department of Biomedical Engineering, Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
Yanhuan Huang
, Qiuyang Qian
, Xiaoling Hu
, Eric W. C. Tam
& Yongping Zheng
Jockey Club Rehabilitation Engineering Clinic, Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
Will Poyan Lai
& Eric W. C. Tam
Search for Yanhuan Huang in:
Search for Will Poyan Lai in:
Search for Qiuyang Qian in:
Search for Xiaoling Hu in:
Search for Eric W. C. Tam in:
Search for Yongping Zheng in:
Correspondence to Xiaoling Hu.
Huang, Y., Lai, W.P., Qian, Q. et al. Translation of robot-assisted rehabilitation to clinical service: a comparison of the rehabilitation effectiveness of EMG-driven robot hand assisted upper limb training in practical clinical service and in clinical trial with laboratory configuration for chronic stroke. BioMed Eng OnLine 17, 91 (2018) doi:10.1186/s12938-018-0516-2
Advanced Signal Processing and Modeling for Neuroengineering


To be a hero can be interpreted many ways by different people. Frida Kahlo can be considered heroic for several reasons. Frida Kahlo was a Mexican painter who was born in 1907. She inspired people of many different backgrounds and challenges. She faced extreme physical and mental obstacles herself. Some people may argue that, as an artist, Frida Kahlo was only painting for the money, especially because a lot of her work has been put on display. Even though some believe this, Frida Kahlo should be considered a hero because she demonstrates the qualities of caring, courage and patience.
Caring, courage, and patience all support the statement that Frida Kahlo is a hero. Caring was especially important in her life. Kahlo felt bad for poorer people living in poverty and terrible conditions. The sight of wealthy men around the room aggravated her. "In a later letter she told the doctor, 'High society here turns me off and I feel a bit of rage against all these rich guys here, since I have seen thousands of people in the most terrible misery'…"(Frazier 47). Kahlo felt sympathy for the misfortunate events that others have gone through, and was somewhat empathetic because of her own misfortune, which show her as caring. She also stayed politically active and continued painting while in hospitals. "She continued to paint and support political causes despite having limited mobility" (Frida Kahlo Biography 1). Kahlo, even with her recent injuries, continued supporting political causes and expressing her inspirational life stories in art. Kahlo was sympathetic and empathetic towards the misfortunate people she saw and continued practicing her political beliefs as well as painting her thoughts. This depicts a sense of caring within her and further states why she is heroic.
While Frida Kahlo was caring, she was also very courageous. Kahlo's paintings shared the stories of her life, giving others who have gone through similar experiences the opportunity to feel empathetic. "Kahlo shared her physical challenges through her art…" (Frida Kahlo Biography 1). She showed her paintings, the life obstacles that she put into pictures, to the world, and demonstrated courage in that process. Kahlo's troubles included a devastating miscarriage caused by her injuries, but she worked hard to get happier by painting. Frida had a miscarriage because of her previous injuries and fell into depression, but she pulled herself out of it by painting (Frazier 49). She had the courage to go on with the pregnancy, knowing her previous injuries might prevent that, and when it didn't work out, she gained the courage to paint about that personal moment. Kahlo's miscarriage and paintings revealing her personal life represent her courage and willingness to spread the awareness that the things she went through really happen.
To add onto Frida Kahlo's demonstration of caring and courage, she also conveys a great amount of patience. Kahlo faced a lot of physical challenges throughout her life and it caused a great sadness within her, which would always be temporarily cured when she started to paint. "For the rest of her life, Frida would suffer the pain of her injuries and of more than 30 operations" (Frazier 36). Kahlo had to spend a big fraction of her life laying in a hospital bed, patiently waiting to heal and continue painting. The origin of Frida's paintings projecting her life stories came from a bus accident that changed her life. Frida Kahlo originally started painting after her severe injuries from a bus accident that changed her life (Frida Kahlo Biography 1). Kahlo's severe injuries resulted in a really long time for healing and staying in a hospital, painting while she waited. The remarkable patience Kahlo showed over the course of her whole life really extended her heroism.
Frida Kahlo is a hero who represents the qualities of caring, courage, and patience. She cared for poor and misfortunate people and for her political activity and paintings while in her hospital bed. Her courage shown was also impressive when she shared her life stories through art and her experiences that some average people can relate to. Kahlo's patience was outstanding while staying in hospitals for a lot of her life. In conclusion, Frida Kahlo has earned her right to be called a hero and demonstrates that right through effort and sacrifice.


Jessica Dubé FAQs 2019- Facts, Rumors and the latest Gossip.
Jessica Dubé FAQs: Facts, Rumors, Birthdate, Net Worth, Sexual Orientation and much more!
Who is Jessica Dubé? Biography, gossip, facts?
Jessica Dubé is a Canadian figure skater who is best known for her pairs career with Bryce Davison. They are the three-time (2007 2009 2010) Canadian national champion the 2008 World bronze medalist and the 2009 Four Continents silver medalist. They represented Canada at the 2006 and 2010 Winter Olympics. With later partner Sébastien Wolfe Dubé is the 2012 Canadian national silver medalist.
Is Jessica Dubé still alive? Are there any death rumors?
Yes, as far as we know, Jessica Dubé is still alive. We don't have any current information about Jessica Dubé's health. However, being younger than 50, we hope that everything is ok.
When did Jessica Dubé retire? When did Jessica Dubé end the active career?
Jessica Dubé retired in 2013, which is more than 6 years ago.
Are there any books, DVDs or other memorabilia of Jessica Dubé? Is there a Jessica Dubé action figure?
We would think so. You can find a collection of items related to Jessica Dubé right here.
Who are similar figure skaters to Jessica Dubé?
Beata Handra, Guillaume Gfeller, Ivana Dlhopoleková, Marcus Nikkanen and Massimo Scali are figure skaters that are similar to Jessica Dubé. Click on their names to check out their FAQs.
What is Jessica Dubé doing now?
Supposedly, 2019 has been a busy year for Jessica Dubé. However, we do not have any detailed information on what Jessica Dubé is doing these days. Maybe you know more. Feel free to add the latest news, gossip, official contact information such as mangement phone number, cell phone number or email address, and your questions below.
Is Jessica Dubé hot or not?
Well, that is up to you to decide! Click the "HOT"-Button if you think that Jessica Dubé is hot, or click "NOT" if you don't think so.
50% of all voters think that Jessica Dubé is hot, 50% voted for "Not Hot".
Does Jessica Dubé do drugs? Does Jessica Dubé smoke cigarettes or weed?
It is no secret that many celebrities have been caught with illegal drugs in the past. Some even openly admit their drug usuage. Do you think that Jessica Dubé does smoke cigarettes, weed or marijuhana? Or does Jessica Dubé do steroids, coke or even stronger drugs such as heroin? Tell us your opinion below.
0% of the voters think that Jessica Dubé does do drugs regularly, 0% assume that Jessica Dubé does take drugs recreationally and 0% are convinced that Jessica Dubé has never tried drugs before.
Is Jessica Dubé gay or straight?
Many people enjoy sharing rumors about the sexuality and sexual orientation of celebrities. We don't know for a fact whether Jessica Dubé is gay, bisexual or straight. However, feel free to tell us what you think! Vote by clicking below.
0% of all voters think that Jessica Dubé is gay (homosexual), 0% voted for straight (heterosexual), and 100% like to think that Jessica Dubé is actually bisexual.
Are there any photos of Jessica Dubé's hairstyle or shirtless?
What is Jessica Dubé's net worth in 2019? How much does Jessica Dubé earn?
According to various sources, Jessica Dubé's net worth has grown significantly in 2019. However, the numbers vary depending on the source. If you have current knowledge about Jessica Dubé's net worth, please feel free to share the information below.
As of today, we do not have any current numbers about Jessica Dubé's net worth in 2019 in our database. If you know more or want to take an educated guess, please feel free to do so above.


text:
Useful Tips For Choosing Between Acoustic And Electric Guitar
in You May Also Like
For people who play the guitar or enjoy the sounds that it makes, this is more than just an instrument. It has been marketed as a lifestyle and as a form of expression so unique that it seems like an extension of the musician's body itself. In nearly every genre of music in the modern age, the guitar has played a pivotal role. Similarly, string instruments are among the oldest kinds of instruments that are played all over the world. Every culture has some kind of string instrument that uses the same mechanics as the guitar's but creates a slightly different sound and has its own playing style. For people who are just getting into learning guitar, the most important question is what kind of guitar they should choose? Broadly speaking, the choice is between an acoustic guitar and an electric guitar. At this point, it is important to ask yourself a couple of questions. What kind of guitar interests you more? And, what kind of music are you aiming to create or replicate with this instrument? These two questions should be enough to give you some direction as to which instrument will be right for you. For a more in-depth understanding, let's look at a few differences between the two choices.
1. Costs
Unless you have somehow inherited a guitar, in which case you are stuck with what you have, you will have to buy one of these instruments. At a very basic level, the cost of an acoustic guitar will be lower than even an entry-level electric guitar. On the expensive side, there is no end to the price range. Extremely high-end acoustic guitars can out-price electric counterparts. However, just buying the guitar isn't the problem, it's the cost of the accessories that can really start to pile up. For starters, if you are getting a regular electric guitar, you will need a neck strap. Some guitars such as the electric steel guitar can be played on your lap like an acoustic but that's pretty much the only one that can be played without a strap. Then you'll need an amp, some pedals, wires and the list goes on and on. For acoustic guitars, all you need is the guitar and you're good to play.
8 Useful Tips for Hiring Professional Movers in Ottawa
Why You Should Compare Medical Alert Systems Before Buying One
How Safe Is Incognito Mode While Internet Browsing In Canada
2. Playing Style
What kind of genre do you enjoy listening to? What sort of music do you think you will want to play the most? Are you looking for those snappy Lenny Kravitz-style solos? Are you interested in being able to play the Moonlight Sonata? While they are both guitars, the kind of music they can create is completely different. There is a gray area in which both guitars can be used to achieve the desired results; however, for the more extreme ends of the spectrum, you will need a dedicated instrument. If you are looking to play genres like metal, you'll most likely require certain accessories; a distortion pedal is of the most basic, it is used to further modify signals from the electric guitar, creating even more diverse sounds. Effects like the wWah-wah sound, delay, reverb, and many other electronically generated effects can be created on an acoustic guitar. Also, if you are looking to play at high volumes, maybe even perform in front of a crowd, electric guitars allow amplification, which helps volume levels. You can only get so loud with an acoustic.
3. Skill
When you are just starting learning the guitar, it all seems quite similar. The main chords, the frets, the string tuning, and even the movement is very much alike in both the electric guitar and the acoustic. However, these similarities start to fade away as you progress. Eventually, you come to a point where certain styles are simply not possible on an instrument that they are not intended for. For instance, if you are interested in playing something that has more of a blues feel to it and you want to do metal slides, it's close to impossible on an acoustic. Not because of the difficulty but because the hardware is incapable of producing that sound. Similarly, fingerpicking on an electric is just making your life harder when it can be done so effortlessly on an acoustic.
While we all start at the same point, where we end up can be very different. Most of it has to do with the particular kind of music you listen to and enjoy playing. If you look at your favorite guitarists or even bands, you will notice that they have a few selected instruments that they use. In fact, many professional guitarists use the same instrument for all their serious work, while the other guitars are just for fun and general performances. Even two acoustic guitars made by the same manufacturer can sound different.
Allen Brown
5 Best Inspirational Wellness Documentaries to Watch on Netflix!

redpajama_set_name: RedPajamaCommonCrawl


This vehicle offers performance and capability combined with jaw-dropping style! Turbocharger technology provides forced air induction, enhancing performance while preserving fuel economy. Top features include rain sensing wipers, leather upholstery, front dual-zone air conditioning, and remote keyless entry.


text:
More on saw stop
By SetBuilder,
August 10, 2017 in Power Tools
SetBuilder
First Name: BillyJoeBob
http://www.npr.org/2017/08/10/542474093/despite-proven-technology-attempts-to-make-table-saws-safer-drag-on
Stercorarius
Location: Eastern Washington U.S.A
Occupation: Full time Neurotic
Fuck Gass. Fuck the guy who wrote that article.
First Name: Will
Location: Southeast
2 hours ago, Stercorarius said:
I don't feel quite as strongly as you do, and honestly know nothing more about SawStop than what I've read here and on various blogs, but the article does seem to be a blatant and self-righteous ad for that company. The title alone gives that away, and links to related articles indicate that NPR is a big fan of the technology, if not the company itself.
I don't own a table saw. Frankly, if and when I do I'll use every safety feature and accessory I can, but I would be highly unlikely to pay a premium for this technology. Grinders, circular saws, routers, and especially stationary tools like lathes are all inherently dangerous if taken for granted. A little caution and prudence all but negates the need to pay more for an invention by someone as contentious as Gass.
Besides, we recently had a Private Gass who got chaptered out of the Army. I have no use for any Gass besides that which comes from the pump.
It's just ridiculous to me to be creating a legal monopoly like that. If they require it on every saw, and simultaneously won't let anyone but sawstop sell it in the US. The writer of the article makes it sounds like cutting fingers off is an inevitability. Like every time we turn on a saw we're all in tears knowing that we can't just cut wood we have to cut fingers off too but we just keep cutting wood and appendages because big bad capitalist pigs running the evil collusion of table saw manufacturers are getting off by not giving us access to the one and only thing that will ever let us cut something safely. Accidents do happen, but in the same crowd that's buying table saw there's all of us that are pinning guards back on skilsaws. That's like the stupidest thing that a guy can do, but we do it anyway to save us a second even though we know we're probably going to lose something doing it sooner or later. What's next are they going to legally require flesh sensing tech in any and every cutting tool? I know that this wouldn't be the only instance of a safety device that can legally only be made or licensed from one company being required by law, but I still feel it's bullshit.
[/Rant]
I agree wholeheartedly. That article and other sources I've read make Gass seem like a blowhard who is putting personal interests before people's safety. It's great that he designed such a safe saw, and completely understandable that he wants some form of compensation, but as someone who long ago put his country ahead of personal gain (admittedly, though, the Army has helped me out tremendously) I cannot understand why he insists on pushing for this technology to become mandatory, thereby establishing that monopoly you speak of.
Maybe this is why I'll never earn a large salary, but I'd rather make a decent living and be known for helping keep others safe than trying to ensure legislation fattens my pockets under the guise of helping a few people (many of whom are improperly trained or lack/disable safety features) keep their fingers.
First Name: Kurt
Occupation: Land Surveyor
12 hours ago, Stercorarius said:
It's NPR, dude. They don't really like capitalism or the free market. Someone might not think the correct socialist thoughts.
Conductor562
Location: West "By God" Virginia
Occupation: Railroad Conductor, Tool Junkie, Stud Muffin (lol)
I'll never own a Sawstop saw. I think the technology is great, but Gass is a piece of shit. He's been trying to get any government entity he can to require his patented technology. He started in California a couple years back and he's been at it ever since.
When his patent runs out I may embrace the technology, but until that happens, he. An kiss my ass.
Grumpy MSG
If it truly was all about encouraging safety, he would have licensed his technology to all manufacturers for a low cost that would allow him to recover his investment quickly and then turn a profit after that. His lawsuit against Bosch showed his true colors.
First Name: Chris
Location: The Granite State!!!!
On 8/11/2017 at 2:10 PM, BK13 said:
JakeDewalt
First Name: Jake
Location: West Palm Beach FL
Occupation: Siding Contractor
On 8/25/2017 at 7:51 AM, Grumpy MSG said:
This 💯
He could have made a fortune licensing the technology. As I understand it he tried, but wanted a king's ransom to get rich quick and when manufacturers balked at his price, he set about his current path of trying to secure legislation to force everyone to buy technology they could only get from him and sue everyone who tried to compete. He's a lawyer by trade, so I guess shit like this is to be expected.
It's general principle that turns me off from the guy. I'll buy a "rest of my life" saw next year before any mandates come to pass, but if I did care about this technology, I'd wait until his patent died because I know there are superior systems that will come.
Gnomish Delight
Meh. I'm buying a 3hp Sawstop next month.
There's a lot of talk about creating a monopoly but that's not what the guy is doing. Any company can step up to the plate and create a safety device equal to the sawstop and compete with them. None of them have. Personally that just seems lazy, because this guy has already proven that there's a huge market for the stuff. Sawstop is the top seller in the U.S., and it isn't just because they make great table saws
Accidents happen, and they're often stupid accidents. I'm not fond of my own stupidity costing me flesh and appendages. I try to idiot-proof my work as much as possible, and a Sawstop saw makes that really easy which appeals to my second strongest motivation - laziness.
Thirdly, Sawstop knows how to appeal to my miserly habits and make me feel like I'm saving money. I'm going to end up getting my little hobby shop LLC'd and insured, because if I'm going to be out banging off in the toolshed every other night I'm probably going to be making too much money to hide from the Tax-man. When the assessor comes out to look at my shop I will be pulling him off to the side to have a moment about my new table saw, and show him the famous hot-dog video, and drop a hint that I've already had another insurance company tell me that they offer deep discounts for people who put safety equipment on their more dangerous tools.
I get to avoid potentially embarrassing myself with a stupid injury and stick it to the man, without sacrificing the quality of my work? I'm in.
2 hours ago, Gnomish Delight said:
The massive hole in your argument is that Bosch did exactly that, created a safety device equal to or better than the SawStop with 2 shots to a cartridge and doesn't lock up and ruin a blade. SawStop sued and instead of a license settlement/agreement went for the cease and desist order. So now if you purchased one of the Bosch jobsite table saws (SawStop did not even offer a comparable model at the time), you cannot purchase replacement cartridges. That is why a lot of folks think they had a great idea, but don't agree with the Company's policy and therefore won't do business with them.
6 hours ago, Grumpy MSG said:
That's called protecting your patent. Bosch's design wasn't dissimilar enough to keep it from infringing on the patent.
I don't care who you are, if you have a patent, you better sic your lawyer on anyone who puts one toe over the line in your protected intellectual property, otherwise when your patent goes up for review or renewal, you lose it.
That's how it works, and if you don't like it, go hire a team of lawyers and spend the rest of your life trying to get patent laws changed.
You still think it's a dick move? What would you have done? We all dream of having that Eureka moment and coming up with a brilliant idea, turning around and patenting it, then riding that patent to an early and comfortable retirement from the confines of our own garages.
What would you do if you were on the easy side of that slope and someone snicked your idea, reverse engineered it real quick, and put it on the market in direct competition with you?
If you didn't sue them, you'd be back to square one, letting the cogs and wheels turn again hoping lightning will strike twice while you fix the leg on your dining room chair a few years later, because the larger company (Bosch) came out of left field and steamrolled you with their marketing, production, customer support and entire teams of engineers devoted to product development, barely noticing the bump in the road (Sawstop) as they grind ever onward to that annual 4% GPR.
Everybody loves to act like they're behind the underdog, until the underdog wins, and then he's just as evil as the despot he de-throned.
On 8/26/2017 at 8:30 AM, Conductor562 said:
I'll buy a "rest of my life" saw next year before any mandates come to pass, but if I did care about this technology, I'd wait until his patent died because I know there are superior systems that will come.
What'cha thinking about getting, C-man? I am thinking about tricking out my grandfather's old Craftsman saw but after I buy an Incra fence system and miter, I'm getting, cost wise, to be into an old saw for a big chunk of a new one.
The "dick move" is to try to use the court system to require all manufacturers to license and use your technology. Doctor Jonas Salk, the University of Pittsburgh and the National Foundation For Infantile Paralysis (Now known as the March of Dimes) did not fight anybody to prevent them from using the vaccine his team created. And from Wikipedia's Post on Jonas Salk:
Salk campaigned for mandatory vaccination, claiming that public health should be considered a "moral commitment."[7] His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When asked who owned the patent to it, Salk said, "Well, the people I would say. There is no patent. Could you patent the sun?"[8]
I left the footnotes/links for Wikipedia so you could see where they got their info.
There sir, is an example of how not to do a "dick move". Like I said in an earlier post, he could have licensed his technology at a cost to recover his investment relatively quickly and start profiting after that while making woodworking and carpentry safer along the way. I am not telling you not to buy his products, I just don't like how he went about trying to force others to use it using the court system.
As for having great idea, I am no Izzy Swan, but I have had a few reasonably good ones I think and I have sent them to a company or two, hoping something might come from them. I am not looking for a patent or payment, and if a company made one of my ideas, I just hope they would send me one of the prototypes to try out and one of the first production ones made.
HiltiWpg
The Patent system is a joke in the US.
Apple sued Samsung over a "gesture", moving ones finger across a piece of glass. How ridiculous is that?
All you need is a generic description of an idea and you can sue anyone.
Never mind that someone figures out a better way, if the end result is the same, you sue.
Competition breeds innovation, that's why the US hasn't been an innovator for years. The patent system needs an overhaul.
http://fortune.com/2015/08/10/patent-system-economist/
Well regardless, I love my Sawstop. It's a quality built machine with exact tolerances and it might save my hand from some bonehead mistake.
Our legal and patent system is a joke through civil litigation. Bosch never should have been thrown out of the USA. It's an entirely different operating system and shame on our system for failing to see this.
estley
First Name: Esteban
Location: yardley, PA
yup, i'm fuzzy on the history, but didn't he in the beginning actually try to license the tech to the tool manufacturers, and was laughed at?
As you said, we all like to root for the little guy, and cry injustice and oppression when he/she losses, but we're appalled when he/she grows fangs and fights back in the only way that has a sliver of hope of winning against the armies of lawyers the big boys have...
Sent from my iPad using Tapatalk Pro
Ya know, I'm really high on the Delta Unisaw, but the Grizzly saws are pretty hard to beat for the money. It'll probably come down to how much my tax return is 😆
On 8/29/2017 at 6:07 PM, Gnomish Delight said:
You cried when the Death Star blew up didn't you?
You're missing the real issue. I don't think the patent protection issue is why everyone hates the guy. If I recall correctly (and I do), where he lost most of us was when he started lobbying to force us to buy his saw and take everyone else out of the game unless they paid him for his use of his technology, wanted or not. Estimates when he was trying to pull his shit in California were that the price of a contractor style saw could double. The Reaxx lawsuit just reaffirmed to all of us that the guy was a dick, but most of us disliked the bastard long before that.
Oh I'm sure it'd be great for him if I had no choice but to buy a saw with his technology in it, that when triggered requires a replacement cartridge that I can only get from him, and blades that I can only purchase from him, etc, but as a consumer, that's not my concern. I don't need his technology and I'd rather cut off my finger than give that bastard a nickel. When his efforts at world domination failed, he ended up creating a good quality saw and establishing his brand through marketing and product necessity. If he'd have done that to start with we wouldn't be having this conversation.
13 hours ago, Conductor562 said:
What the Death Star Blew up Fake News 2017!!!
khariV
Occupation: Enterprise Architect
On 8/31/2017 at 10:11 AM, Conductor562 said:
Perhaps, but there's always the contingent of people that want freedom above all else and bristle at anyone (especially the government) telling them that they can't do something. Whether it's riding a motorcycle without a helmet, building whatever you want to where ever you feel like building it or screwing a circular saw underneath a board and calling it a table saw, there's someone who wants to do it. Sometimes these people get away with it for a long time and then think that there are no consequences, but other times they end up with massive TBI from hitting their head on a curb, missing fingers from their "invention" or entire cities that are under 4 ft. of water because they paved over all of the prairies and wetlands that would absorb excessive rain.
I'm not going to pass judgement on whether we should or shouldn't have mandated active protection tech on table saws, but there are lots of people opposed to it on a fundamental and personal level and just as many that are in favor of it because the rest of society eventually pays the price for some people's "freedom."
To be fair any 10" 5/8" arbor (and several stacked dados) work with the Sawstop (including Forrest and Tenyru). Everything else....c'est la vie, the guy is a typical money sponge. Which I am ALL for capitalism, it's what founded this great country, you know, after we took it from its rightful owners. But....using the law to make companies submit to your business is b.s.
5 hours ago, khariV said:
That is an awesome point of view and really hits the nail on the head while acknowledging the repercussions of failure to take precautions.
A couple of years ago, this chowder head from Mass walks up to me, while I'm involved in a conversation as asks me...
"hey, troopah. I don't got to wear a seatbelt in New Hampshuh right"
In typical Chris fashion I retorted "no sir. If you want to smash your face all over your windshield and make me help you pay for your medical recovery....knock yourself out"
What a putz. At least he didn't file a complaint.
Joined 1 hour ago


text:
A Project of the Center for Advanced Study in the Visual Arts, National Gallery of Art
History of Early American Landscape Design
Digital Approach
Digital Approach and Vision
Semantic HEALD
Recent Upgrade
Benjamin Henry Latrobe
[http://www.nga.gov/content/ngaweb/research/casva/research-projects.html A Project of the National Gallery of Art, Center for Advanced Study in the Visual Arts ]
Revision as of 21:03, July 19, 2012 by Emily Pugh (talk | contribs) (→Associated Images)
Jump to:navigation, Quick search
File:507px-Benjamin latrobe by peale.jpg
Charles Willson Peale, Portrait of Benjamin Henry Latrobe (1804)
(May 1, 1764 – September 3, 1820)
Wikipedia: http://en.wikipedia.org/wiki/Benjamin_Latrobe
Architect of the Capitol website: http://www.aoc.gov/aoc/architects/latrobe.cfm/
University of Pennsylvania archives: http://www.archives.upenn.edu/people/1700s/latrobe_benj.html
Library of Congress: http://www.loc.gov/pictures/item/95858242/
Associated Sites: Harper's Estate, Oakland, Place D'Armes (renamed Jackson Square), Sedgeley, United States Capitol, United States Navy Hospital and Asylum
Associated Terms: Ancient style, Basin, Canal, Clump, Column/Pillar, Flower Garden, French style, Gate/Gateway, Grove, Ha-Ha/Sunk fence, Landscape Gardening, Lawn, Mall, Obelisk, Parterre, Piazza/Veranda/Porch/Portico, Picturesque, Pleasure ground/Pleasure garden, Quarter, Square, Statue, Temple, Wood/Woods
Associated Texts:
Carter II, Edward C., John C. Van Horne, and Charles E. Brownell. Latrobe's View of America, 1795-1820: Selections from the Watercolors and Sketches. New Haven and London: Yale University Press for the Maryland Historical Society, 1985. view on Zotero
Hamlin, Talbot. Benjamin Henry Latrobe. New York: Oxford University Press, 1955. view on Zotero
Latrobe, Benjamin Henry. Impressions Respecting New Orleans: Diaries and Sketches, 1818-1820. Edited by Samuel Wilson. New York: Columbia University Press, 1951. view on Zotero
———. The Journals of Benjamin Henry Latrobe, 1799-1820: From Philadelphia to New Orleans. Edited by Edward C. Carter II, John C. Van Horne, and Lee W. Formwalt. New Haven, Conn.: Yale University Press, 1980. view on Zotero
———. The Virginia Journals of Benjamin Henry Latrobe, 1795-1798. Edited by Edward C. Carter II. 2 vols. New Haven, Conn.: Yale University Press, 1977. view on Zotero
Latrobe, Green Spring. Maryland Historical Society, Baltimore, MD.
Latrobe, "View of Mount Vernon to the North" (July 17, 1796). Maryland Historical Society, Baltimore, MD.
Latrobe, "View to the North from the Lawn at Mount Vernon" (1796). Maryland Historical Society, Baltimore, MD.
Latrobe, "View of Mount Vernon looking towards the South West" (1796). Maryland Historical Society, Baltimore, MD.
Latrobe, "Sketch of Airy Plain, Estate" (1797). Maryland Historical Society, Baltimore, MD.
Latrobe, York River, looking N.W. up to West Point" (1797). Maryland Historical Society, Baltimore, MD.
Latrobe, House Plan With Gardens (c. 1798). Library of Congress, Washington, DC.
Latrobe, Garden temple/milkhouse: plan and elevation (1798-99). Library of Congress, Washington, DC.
Latrobe, Studies of Trees (1798-99). The Virginia State Library, Richmond, VA.
Latrobe, "Taste. Anno 1620" (1799). The Virginia State Library, Richmond, VA.
Latrobe, Studies of Trees (1799). The Virginia State Library, Richmond, VA.
Latrobe, Sedgeley (1799). Fairmount Park Commission, Philadelphia Museum of Art, Philadelphia, PA.
Latrobe, "Principal Story of a Military School," 1800. Library of Congress, Washington, DC.
Latrobe, Military academy. North elevation, rendered (1800). Library of Congress, Washington, DC.
Latrobe, Plan of the grounds of the White House (c. 1807). Library of Congress, Washington, DC.
Latrobe, United States Capitol (c. 1814-20). Library of Congress, Washington, DC.
Latrobe, Plan of the Capitol Ground (1815). Library of Congress, Washington, DC.
Latrobe, "Elevation of the South front of the President's house, copied from the design as proposed to be altered in 1807" (January 1817). Library of Congress, Washington, DC.
Latrobe, "Plan of the public Square in the city of New Orleans, as proposed to be improved . . ." [detail] (March 20, 1819). Department of Public Works, New Orleans, LA.
Retrieved from "https://heald.nga.gov/mediawiki/index.php?title=Benjamin_Henry_Latrobe&oldid=1789"
History of Early American Landscape Design contributors, "Benjamin Henry Latrobe," History of Early American Landscape Design, , https://heald.nga.gov/mediawiki/index.php?title=Benjamin_Henry_Latrobe&oldid=1789 (accessed January 27, 2023).
This page was last edited on September 16, 2021, at 18:08.
A Project of the Center for Advanced Study in the Visual Arts


text:
Search results for "set" in Definitions [Change Search Options] [Hide Search Options]
bracket to enclose or set apart with brackets. [1/5 definitions]
buckle to set oneself with will and a sense of purpose (usually followed by "down"). [1/5 definitions]
burn to cause to be set on fire. [1/8 definitions]
camp1 an outdoor area where tents or rough shelters are set up to live in or sleep in for a time. [2/5 definitions]
cannon a large gun that is set on wheels or some other base. Cannons fire heavy shells.
chime (usually plural) a set of tuned bells or other hollow objects that produce musical sounds when struck. [1/3 definitions]
class a set of lessons for a group of students in a particular subject, or one lesson of such a set. [1/8 definitions]
cock1 to set the hammer of so as to be ready to fire. [1/3 definitions]
code a set of rules or laws. [1/3 definitions]
console2 a cabinet for a television set, CD player, or radio.
constitution the set of basic laws by which a nation, state, or other organization is governed. [1/3 definitions]
contain to hold back; set limits on. [1/3 definitions]
course an area of land or water set aside for sport. [1/7 definitions]
cradle a baby's bed set on rockers. [1/4 definitions]
creed a set of beliefs held by a person or group.
dance a set pattern of steps or movements usually done to music. [1/7 definitions]
deacon a member of certain Christian churches who has a set of church duties but is not a member of the clergy. [1/2 definitions]
debate a kind of competition between two people or two teams who disagree on particular issue or set of issues. Each side is given certain amounts of time in which they can talk and present their argument. When one side talks, the other side must be quiet. A debate like this is done in front of an audience. [1/4 definitions]
dedicate to set apart for a special use or purpose. [1/5 definitions]
defense in sports, the set of players on a team who are responsible for defense. [1/5 definitions]
deliver to set free or save. [1/5 definitions]


MIL-STD-810G describes the standard series of tests utilized by the U.S. military to determine equipment limits and capabilities in various conditions based on the environments in which they are expected to be used. There is a large array of test situations and conditions. Tests include shock, humidity, extreme temperature and salt fog tolerance.
Zebra's durable, shock-resistant tablets have gone through rigorous MIL-STD-810G crash shock tests to ensure you and your teams have a high quality and reliable rugged mobile computer online at all times while on the move.
Investing in one of Zebra's shock-resistant tablet PCs is like investing in car insurance. You hope you never have an experience that requires the level of protection it provides, but knowing you're safeguarded against accidents allows you to conduct business as usual, without limitations. With our rigorous MIL-STD-810G crash shock testing methods and our hold tight, shock-resistant docking systems, you can be confident that Zebra shock-resistant rugged tablets will protect your device investment and your data, during crashes.
When your rugged mobile PC is supporting transportation, manufacturing, warehousing or even military workflows day in and day out, it is likely to be exposed to impacts that can result in shock and vibration at some point. But there's no need to panic from a single shock occurrence. Zebra's tough shock-resistant tablets keep your applications processing, your connections strong and your data intact even after the most powerful impacts.
That's because Zebra's impact-resistant tablets undergo multiple accident, drop and bump simulations during its MIL-STD-810G crash shock tests to ensure high performance. In fact, Zebra shock-resistant tablets are built to withstand up to 40G shock during a crash. That's a pretty significant shock resistance level considering that a fire truck sitting on a solid axle would experience a 20G shock when hitting a pothole.
Contact Zebra today to learn more about the MIL STD-810G crash shock-tested devices available for your team.


Baudis, L; Galloway, M; Kish, A; Marentini, C; Wulf, J (2018). Characterisation of Silicon Photomultipliers for liquid xenon detectors. Journal of Instrumentation, 13(10):P10022.
XENON Collaboration; et al; Baudis, Laura; Brown, Adam; Capelli, Chiara; Galloway, Michelle; Kazama, Shingo; Kish, A; Reichard, Shayne; Wulf, J (2018). Dark Matter Search Results from a One Ton-Year Exposure of XENON1T. Physical Review Letters, 121(11):111302.
This list was generated on Fri Apr 19 02:40:55 2019 CEST.


text:
Kelen Coleman Has A Boyfriend! Majority Of Fans Did Not Take The Dating Affair Well
Last Updated on: Aug 29, 2019 @ 09:56 AM
Birth Place Nashville, Tennessee, United States
Profession Actress
Birth Name Kelen Sadie Coleman
Religion N/A
Ethnicity/Race White
Father T. Michael Coleman
Mother Robin Coleman
Brother/s Jose Coleman
Career 2008–present
High School Winston Churchill High School
College University of North Carolina at Chapel Hill
Height/ How Tall? 5'9" (1.78 m)
Weight 64 kg (142 Lbs)
Hair Long
Body Measurements 37-26-37 inches
Lesbian No
Beautiful American actress Kelen Coleman has won many hearts with her acting skills. Many men are trying to date her and chances are there that women too might have their eyes set on this gorgeous actress.
But while she has been gushing about her being single on social medias, she has shocked the fans by revealing that she has a boyfriend in life. But how are the fans dealing with the surprise? Let us find out!
Kelen Coleman Is Dating: Who Is Her Boyfriend: How Did The Fans Take This?
Beautiful Kelen Coleman had said that she was single and even shared that she was enjoying her single life without any partner.
If I had a bf right now, He'd probably get as a present. If he wore it...Bonus points. If he knew what it was...marriage http://t.co/jNvEjBK
— Kelen Coleman (@Kelencoleman) July 28, 2011
But now, all of that has changed as she is in a relationship by the looks of the Instagram post on June 12, 2017. In the post, she gave a sweet smooch on the cheek, to her possible boyfriend, and that is enough to know that there is a special man in her life.
But sadly the post has been deleted now, that suggests that Kelen wants to keep thing private regarding her romantic life.
When the photo was posted, it grabbed the attention of her fans and followers. The fans and followers showed mixed reactions, but what we cannot ignore is, how they expressed their disappointment knowing that Kelen is now off the market.
Fans' reaction after knowing Kelen has a boyfriend.
Photo Credit: Kelen's Official Instagram Account.
Regardless of the fans reactions, the lady seems to be totally in love with her man, despite not disclosing any details about him.
Let us hope she reveals about her boyfriend shortly.
Who knows? She may even surprise everyone by getting married to her husband.
However, she was engaged on-screen and also gushed about her on-screen engagement via an Instagram post.
A post shared by Kelen Coleman (@kelencoleman) on Mar 17, 2016 at 4:56pm PDT
More About Kelen Coleman:
Born on April 19, 1984, Nashville, Tennessee, United States, Kelen Coleman is an American actress who grew up in Potomac, Maryland. She attended the University of North Carolina located in Chapel Hill. Her father is T. Michael Coleman, who is a multiple Grammy Award-winning bluegrass musician.
She is known for her roles in successful projects like "The Office," "The Mindy Project," "Men at Work" and "Californication." The success she has earned via these and other projects have helped her finances a good deal. However, she is yet to reveal any official statement on the actual figure of her net worth.
#American Actress #The McCarthys


This News Bulletin describes drug issues and local armed groups' response in Hpa-an and Dooplaya districts between February and December 2015.
In Dooplaya District, elderly women who have family members in armed groups, living in the villages near Kawkareik Town, are secretly selling drugs while their husbands are on military duty.
A villager who was over 50 years old was killed in a motorcycle accident. The person who crashed into him, Saw A---, was under the influence of the yaba drug. He was ordered to pay compensation to the deceased man's family.
A group of BGF soldiers went into O--- village in Paingkyon Township on February 12th 2015 to arrest a woman, Naw B---, and her two daughters, as they have been selling yaba in the village. Naw B--- escaped during the raid on her house and is currently hiding with the KNU/KNLA Peace Council (KNU/KNLA-PC) Htaw Meh Pa Battalion, which is led by Commander Kyaw Kyaw. Her two daughters were arrested and brought to a BGF base in the area.
As can be seen in previously published KHRG reports, armed groups such as the Karen National Union (KNU), Democratic Karen Benevolent Army (DKBA), Border Guard Force (BGF) and the Tatmadaw have previously attempted to cooperate to address the drug issues affecting communities in Karen State and take serious action in cases related to drugs. However, the production, sale and use of drugs are ongoing and have become a point of great concern in Karen State, especially in Hpa-an and Dooplaya districts.
According to a KHRG community member from Dooplaya District, the sale of yaba (methamphetamine) drugs in the villages near Kawkareik Town increased in 2015 and continues to increase in 2016. He reported that usually, it is the older women, those who are married to armed group members, who secretly sell yaba when their husbands are not home. The sale of drugs also occurs in many other places near the Thai-Burma/Myanmar border, such as Waw Lay village, Thay Baw Boh village and Hpa Lu village.
The widespread use of methamphetamines has been negatively affecting not only users, but also innocent community members. A stark example is the death of a villager named Kyaw Bleh from Mi Gan Kyar Ma Nai village, Kawkareik Township, Dooplaya District, who was over 50 years old. He was killed in a drug-induced motorcycle accident in Kaw Hser village while he was on his way to Kawkareik Town. Saw A---, the driver who crashed into Kyaw Bleh's motorcycle, was taken to the hospital after the accident. He mentioned that he had used yaba before driving and as a result, he accidently collided with Kyaw Bleh's motorcycle.
Given the negative consequences of the use of yaba, some armed groups have been taking action against known yaba dealers. In one case, on February 12th 2015, BGF soldiers came into O--- village, Paingkyon Township, Hpa-an District, to arrest Naw B--- and her two daughters, as the BGF were informed that they sell yaba in the village. However, they were not able to arrest Naw B---, as she escaped to evade arrest. During the raid on her house, they found 20,000 pills of yaba and a 32 mm pistol, as well as some of the money that she and her daughters earned from selling the drug. Naw B--- is currently hiding with Karen Peace Council's (KPC) Operation Command #3 Htaw Meh Pa Battalion, which is led by Commander Kyaw Kyaw.
 This News Bulletin was written by KHRG office staff and is based on information from community members from Dooplaya and Hpa-an districts who have been trained by KHRG to monitor local human rights conditions. It summarises information from three photo notes and one situation update received by KHRG between February 2015 and January 2016. In order to increase the transparency of KHRG methodology and more directly communicate the experiences and perspectives of villagers in southeast Burma/Myanmar, KHRG aims to make all field information received available on the KHRG website once it has been processed and translated, subject only to security considerations. For additional reports categorised by Type, Issue, Location and Year, please see the Related Readings component following each report on KHRG's website.
 See for example, "Hpa-an Situation Update: Paingkyon Township, June to October 2014," KHRG, August 2015, as well as, "Hpa-an Situation Update: Hlaingbwe, Nabu, Paingkyon and Hti Lon townships, May to July 2014," KHRG, November 2014.
 This information was included in unpublished Photo Notes received by KHRG in January 2016.
 It is not clear which BGF battalion conducted the operation; Battalion #1015 has traditionally operated in this area.
 This information was included in unpublished Photo Notes received by KHRG in 2015.
 This information was included in an unpublished Situation Update received by KHRG in January 2016.