ENABLING HARDWARE TECHNOLOGIES FOR AUTONOMY IN TINY ROBOTS: CONTROL, INTEGRATION, ACTUATION

The last two decades have seen many exciting examples of tiny robots from a few cm3 to less than one cm3. Although individually limited, a large group of these robots has the potential to work cooperatively and accomplish complex tasks. Two examples from nature that exhibit this type of cooperation are ant and bee colonies. They have the potential to assist in applications like search and rescue, military scouting, infrastructure and equipment monitoring, nano-manufacture, and possibly medicine. Most of these applications require the high level of autonomy that has been demonstrated by large robotic platforms, such as the iRobot and Honda ASIMO. However, when robot size shrinks down, current approaches to achieve the necessary functions are no longer valid. This work focused on challenges associated with the electronics and fabrication. We addressed three major technical hurdles inherent to current approaches: 1) difficulty of compact integration; 2) need for real-time and power-efficient computations; 3) unavailability of commercial tiny actuators and motion mechanisms. The aim of this work was to provide enabling hardware technologies to achieve autonomy in tiny robots. We proposed a decentralized application-specific integrated circuit (ASIC) where each component is responsible for its own operation and autonomy to the greatest extent possible. The ASIC consists of electronics modules for the fundamental functions required to fulfill the desired autonomy: actuation, control, power supply, and sensing. The actuators and mechanisms could potentially be post-fabricated on the ASIC directly. This design makes for a modular architecture. The following components were shown to work in physical implementations or simulations: 1) a tunable motion controller for ultralow frequency actuation; 2) a nonvolatile memory and programming circuit to achieve automatic and one-time programming; 3) a high-voltage circuit with the highest reported breakdown voltage in standard 0.5 μm CMOS; 4) thermal actuators fabricated using CMOS compatible process; 5) a low-power mixed-signal computational architecture for robotic dynamics simulator; 6) a frequency-boost technique to achieve low jitter in ring oscillators. These contributions will be generally enabling for other systems with strict size and power constraints such as wireless sensor nodes.

THE TERMINATION PHASE: THERAPISTS’ PERSPECTIVE ON THE THERAPEUTIC RELATIONSHIP AND OUTCOME

The termination phase of treatment is recognized as a significant aspect of the therapy process and yet remains vastly understudied in psychotherapy literature. In the present study, therapists’ perspectives were used to examine how three elements of the therapy relationship (working alliance, real relationship and transference) during the termination phase relate to perceived client sensitivity to loss, termination phase evaluation and overall treatment outcome. Self-report data was gathered from 233 therapists, recruited from two Divisions of the American Psychological Association. Therapists completed measures for their work with a client with whom they could identify a termination phase of treatment. Results revealed that the working alliance and real relationship during the termination phase related positively to termination phase evaluation and overall treatment outcome, whereas negative transference during the termination phase related negatively to overall treatment outcome. Therapists’ perceptions of client sensitivity to loss related positively to both negative and positive transference during the termination phase. Post-hoc analyses revealed only the working alliance during the termination phase uniquely predicted overall treatment outcome in a model with the three therapy relationship elements examined together. On the other hand, all three therapy relationship variables during the termination phase uniquely predicted termination phase evaluation, when examined together. Limitations and implications of these findings are discussed, and recommendations for future study are suggested.

Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.