The potential role of sensors, wearables and telehealth in the remote management of diabetes-related foot disease

Diabetes-related foot disease (DFD), which includes foot ulcers, infection and gangrene,is a leading cause of the global disability burden. About half of people who develop DFD experience a recurrence within one year. Long-term medical management to reduce the risk of recurrence is therefore important to reduce the global DFD burden. This review describes research assessing the value of sensors, wearables and telehealth in preventing DFD. Sensors and wearables have been developed to monitor foot temperature, plantar pressures, glucose, blood pressure and lipids. The monitoring of these risk factors along with telehealth consultations has promise as a method for remotely managing people who are at risk of DFD. This approach can potentially avoid or reduce the need for face-to-face consultations. Home foot temperature monitoring, continuous glucose monitoring and telehealth consultations are the approaches for which the most highly developed and user-friendly technology has been developed. A number of clinical studies in people at risk of DFD have demonstrated benefits when using one of these remote monitoring methods. Further development and evidence are needed for some of the other approaches, such as home plantar pressure and footwear adherence monitoring. As yet, no composite remote management program incorporating remote monitoring and the management of all the key risk factors for DFD has been developed and implemented. Further research assessing the feasibility and value of combining these remote monitoring approaches as a holistic way of preventing DFD is needed

Injuries, accidents and falls in adults with learning disabilities and their carers: a prospective cohort study

Injuries are among the leading causes of death and disability in the world and a major public health concern. Young persons with learning disabilities have a higher rate and different pattern of injuries when compared with young persons without learning disabilities, but little is known regarding adults. The aim of this study was to determine the incidence and types of injuries experienced by a community-based cohort of adults with learning disabilities (n = 511). Face-to-face interviews were conducted with participants and their carers two years after they had first been recruited into a longitudinal study. The measures were based on those previously used with a large population-based sample (n = 6,104) in the Scottish Health Survey (2003). Results were compared between the adults with learning disabilities and the general population. Incidence of at least one injury that required medical or nursing attention or treatment in a 12-month period was 20.5% (105), of which 12.1% (62) was due to falls. The standardised incident injury ratio for adults with learning disabilities aged 18 - 64 years, compared with the regional general population aged 18 – 64 years, is 1.63 (95% confidence interval (CI) = 1.55 – 1.71). The types and causes of injuries experienced differed from those found in the general population. Incident injury was predicted by having epilepsy (odds ratio (OR) 1.809), and not having autism (OR 0.153). Incident fall injury was predicted by urinary incontinence (OR 1.976), whilst Down syndrome reduced risk (OR 0.416). Carers of adults with learning disabilities (n = 446) were less likely to experience at least one injury in a 12-month period overall, but they were significantly more likely to experience harmful injury from another person (p = 0.048), and less likely to experience injury through the use of a tool, implement or equipment (p = 0.045), when compared with the regional general population. These findings are first steps towards understanding the considerable burden of injuries, accidents and falls in the learning disabilities population, and towards informing interventions to prevent injuries and falls in adults with learning disabilities in the future. The types and causes of injury experienced by carers of adults with learning disabilities are also reported for the first time

Proceedings of the ECCOMAS Thematic Conference on Multibody Dynamics 2015

This volume contains the full papers accepted for presentation at the ECCOMAS Thematic Conference on Multibody Dynamics 2015 held in the Barcelona School of Industrial Engineering, Universitat Politècnica de Catalunya, on June 29 - July 2, 2015. The ECCOMAS Thematic Conference on Multibody Dynamics is an international meeting held once every two years in a European country. Continuing the very successful series of past conferences that have been organized in Lisbon (2003), Madrid (2005), Milan (2007), Warsaw (2009), Brussels (2011) and Zagreb (2013); this edition will once again serve as a meeting point for the international researchers, scientists and experts from academia, research laboratories and industry working in the area of multibody dynamics. Applications are related to many fields of contemporary engineering, such as vehicle and railway systems, aeronautical and space vehicles, robotic manipulators, mechatronic and autonomous systems, smart structures, biomechanical systems and nanotechnologies. The topics of the conference include, but are not restricted to: ● Formulations and Numerical Methods ● Efficient Methods and Real-Time Applications ● Flexible Multibody Dynamics ● Contact Dynamics and Constraints ● Multiphysics and Coupled Problems ● Control and Optimization ● Software Development and Computer Technology ● Aerospace and Maritime Applications ● Biomechanics ● Railroad Vehicle Dynamics ● Road Vehicle Dynamics ● Robotics ● Benchmark ProblemsPostprint (published version

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients

A critical appraisal of research in arts, health and wellbeing

In interviews study participants stated the importance of the arts, its value, and the contribution to improve their ... This review considered wellbeing as reported in the included studies at the individual and community levels