Repeatability of an Integrative Method to Assess Knee Joint Mechanics and Cartilage Health under Load

An integrative and repeatable method that assesses quantitative magnetic resonance imaging (qMRI), mechanical measures by MRI (mechMRI) and gait (kinetics and kinematics) parameters is needed to better understand the mechanics of ACL-injury which is an early model of post-traumatic osteoarthritis. In developing a method that can be used, this research sought to answer three major questions: 1) What is the repeatability of the qMRI, mechMRI and gait analysis measures in healthy individuals? 2) What is the repeatability of the kinematic and kinetic outcomes using a MRI-based anatomical system and a standard gait coordinate system? 3) Is there a link between contact area and qMRI T2 relaxation times in cartilage? Addressing the above research questions involved primarily assessing the repeatability of each measure, expressed as the root-mean squared standard deviation (SDrms), as well as evaluating novel measures to determine the link between the different metrics. A MRI-safe loading rig was designed to simulate loading at the knee joint during MRI scanning as well as MRI-lucent gait markers to create a common coordinate system between the MRI and gait systems. Data was collected three times within a week for five healthy participants for this repeatability study. At the gait lab, participants carried out five motion tasks including walking, stair ascent, descent and chair rise and sit. With the MRI-lucent gait markers still at the same position, qMRI T2 relaxation time and anatomical MRI scans were carried out. The scans were acquired while the knee was unloaded and fully extended as well as loaded in two flexed positions. The repeatability results showed a link between qMRI T2 relaxation times and contact areas with low-SDrms measures in some qMRI-contact integration metrics and coordinate methods of processing dynamic data. qMRI-contact integration metrics were found to have smaller SDrms values for loaded cartilage in the lateral region (Average SDrms: 2.2 ms). Walk peak abduction angle had the smallest SDrms value for kinematics (0.8 degrees) and walk peak flexion moment for the kinetic measures (0.04 N.m/kg). Between dynamic data processed with MRI-based anatomical coordinates and standard gait coordinates systems, functional-based was generally found to have the smaller SDrms values. MRI-based processed data showed smaller SDrms values in kinetic outcome measures compared to that acquired from the standard gait coordinate system. In conclusion, there are indeed measures across the three different metrics that have smaller SDrms values and therefore may be better suited for use in the study of the ACL-injured population. From the findings of this study, we recommend particular attention be paid to lateral and loaded cartilage conditions for contact mechanics and qMRI T2 evaluation, and that knee kinematics and kinetics be evaluated with standard gait coordinate system, for the study of healthy and ACL-injured individuals

Developing digital literacy in construction management education: a design thinking led approach

Alongside the digital innovations in AEC (Architectural, Engineering and Construction) practice, are calls for a new type of digital literacy, including a new information-based literacy informed by creativity, critical analysis and the theoretical and practical knowledge of the construction profession. This paper explores the role of design thinking and the promotion of abductive problem situations when developing digital literacies in construction education. The impacts of advanced digital modelling technologies on construction management practices and education are investigated before an examination of design thinking, the role of abductive reasoning and the rise of normative models of design thinking workflows. The paper then explores the role that design thinking can play in the development of new digital literacies in contemporary construction studies. A three-part framework for the implementation of a design thinking approach to construction is presented. The paper closes with a discussion of the importance of models of design thinking for learning and knowledge production, emphasising how construction management education can benefit from them

The Social Constructs of Natural World Heritage: An Ethnographic Investigation into the Conflicts of a Danish UNESCO Destination

This paper will investigate the conflicts that can arise during destination development following a World Heritage inscription. Previous literature mentions that conflicts arise, but focuses on a more managerial perspective, and fails to account for the characteristics of those conflicts. The aim of the paper is to account for the characteristics of the conflicts that arise, by trying to grasp how various stakeholders in the destination development process have different understandings of the destination, and how these understandings are undergoing negotiation after the destination has received the World Heritage inscription. The paper is thus focusing on Consumer Culture Theory and Cultural Geography, thereby adding a sociocultural perspective to the strongly managerial perspective on destination development. The paper is based on an ethnographic field study of the Nature World Heritage destination Stevns Klint, Denmark. After interviews with various stakeholders about the development processes that the area had undergone since being inscribed the UNESCO World Heritage label, it became clear the locals of Stevns embedded meaning into the landscape, thus the term appropriating space becomes relevant. According to this result, conflict arises in Stevns from differentiating meaning embeddings, but mainly because certain development initiatives contradict the commonly accepted identities of various areas along the cliff. Which leads us into the second conflict, which is based on the power structures that arise in commodification processes. Only those in charge of destination development get to manifest the aforementioned appropriations of space, creating politics of representation. From these results, it becomes clear that there is a need for a sociocultural perspective on destination development in order to understand why conflicts happen in recently inscribed World Heritage destinations

Influence of Patient Satisfaction of Total Knee Replacement Patients on Stair Negotiation and Walking Biomechanics, Strength, and Balance

Total knee replacement (TKR) patients have shown alterations in lower extremity biomechanics during level ground walking and stair negotiation, strength levels, and balance abilities, however, it is unknown how dissatisfied TKR patients compare to satisfied TKR patients in these activities. Study One examined the lower extremity biomechanics of dissatisfied and satisfied TKR patients during level ground walking. Study Two investigated knee biomechanics during stair ascent and descent activities. Study Three compared isokinetic strength, balance abilities, deep knee flexion abilities, and functional abilities of the dissatisfied patients to the satisfied patients. Study Four performed a logistic regression as a means of examining significant variables in models designed to predict patient satisfaction. Study One found reduced 1st and 2nd peak VGRF, knee flexion ROM, and peak loadingresponse knee extension and abduction moments in the dissatisfied patients compared to healthy controls. First and 2nd peak VGRFs and flexion ROM were reduced in the replaced limb of the dissatisfied patients compared to their non-replaced limb. Study Two showed reduced 2nd peak VGRF and loading-response knee extension moments in the replaced limb of the dissatisfied group compared to their non-replaced limb and to satisfied and healthy groups during stair ascent. 1st peak VGRF and both loading-response and push-off abduction moments showed reduced values in replaced limbs compared to non-replaced limbs for all groups. During stair descent, the dissatisfied group showed reduced loading-response and push-off knee extension moments in their replaced limb compared to their non-replaced limb and the healthy group. The loading-response knee extension and abduction moments were also reduced in the dissatisfied group compared to the satisfied group. Study Three showed reduced peak extension (180°/s) and flexion (60°/s) torque in dissatisfied patients compared to satisfied patients. No balance differences were evident, although an increased percentage of dissatisfied patients were unable to complete the unilateral balance tests. Study Four produced models via the logistic regression analysis which often included peak VGRFs and knee extension moments. Future research should examine the effects of attempting to alter the physical differences between patient satisfaction groups and whether it improves patient satisfaction rates

LONGITUDINAL ADAPTATIONS IN MUSCLE STRENGTH, FUNCTIONAL PERFORMANCE, GAIT BIOMECHANICS, AND PATIENT-REPORTED FUNCTION AFTER UNILATERAL TOTAL KNEE ARTHROPLASTY

Objective: The aims of this research were to identify gaps in the literature related to impairments after total knee arthroplasty (TKA) (Aim 1) and define recovery between 3 and 6 months after TKA across four domains: 1) hip and knee muscle performance, 2) functional performance, 3) patient-reported function, and 4) biomechanics of walking and stair descent (Aim 2). Additionally, this project sought to explore the relationships between each domain (Aim 3) and establish predictive models to allow clinicians to use clinical measures to predict future gait biomechanics in patients after TKA (Aim 4). Ultimately, the results of this research would quantify post-rehabilitative recovery after TKA and identify potential targets for objective criteria needed for discharge from outpatient rehabilitation. Participants: Thirty-nine individuals completed the study protocol, 21 in the TKA group (7 male, 14 female, height: 1.68 ± 0.08 m, mass: 90.95 ± 21.04 kg, BMI: 32.27 ± 7.4 kg/m2, Age: 60.6 ± 8.1 years) and 18 matched control subjects (7 male, 11 female, height: 1.69 ± 0.10 m, mass: 83.69 ± 20.2 kg, BMI: 29.2 ± 5.5 kg/m2, Age: 61.2 ± 8.8 years). Methods: For Aim 1, a systematic review of the literature related to the four previously stated domains was conducted. In Aims 2-4, a longitudinal design with 3 and 6 months post-surgery assessment time points was used for the TKA group. At both assessment time points, participants underwent maximal voluntary isometric strength testing of bilateral hip abduction, hip external rotation, and knee extension to determine peak strength and rate of torque development (RTD). Participants also performed the five-time sit-to-stand test (FTSTS) and underwent three-dimensional motion analysis while walking at a self-selected speed and during a stair descent task. Patient-reported function was measured using the Knee Injury & Osteoarthritis Outcome Score (KOOS). The control subjects completed the same testing procedures at a single time point. Main Outcome Measures: Outcomes were assessed across four domains. The first domain included peak isometric muscle strength and RTD of hip abduction, hip external rotation, and knee extension. The second and third domains represented functional performance as assessed by the FTSTS and patient-reported function as measured by the KOOS, respectively. The final domain included hip and knee joint kinematics and kinetics during walking and stair descent as measured using three-dimensional motion analysis and inverse dynamics. Statistical Analysis: Aim 1: no formal statistics were utilized in the systematic review. Aim 2 utilized paired sample t-tests for between-limb (operative vs non-operative) and within-limb (3 months vs 6 months post-surgery) comparisons across all four domains. Additionally, independent two-sample t-tests were used to compare the operative and non-operative limbs of the TKA group to the matched control group. In Aim 3, Pearson product-moment correlations were performed to assess the relationships between muscle performance, FTSTS performance, and KOOS scores in the TKA group at 1) 3 months post-surgery, 2) 6 months post-surgery, and 3) between the improvements in these outcomes from 3 to 6 months post-surgery. Lastly, Aim 4 utilized Pearson product-moment correlations and stepwise multiple linear regressions to develop a predictive model using clinical measures assessed at 3 months post-operatively to predict knee flexion excursion during walking at 6 months post-surgery. Results: Aim 1: Improvements in KOOS scores, deficits in peak quadriceps strength, and altered knee joint biomechanics during walking are present during the first 6 months following TKA. Limited evidence exists regarding hip muscle strength deficits, FTSTS performance, and stair descent biomechanics after TKA. Aim 2: Quadriceps and hip external rotation peak strength and RTD, FTSTS performance, gait and stair descent biomechanics, and KOOS scores all demonstrated significant, but modest, improvement between 3 and 6 months post-surgery. However, persistent deficits in quadriceps and hip external rotation peak strength and RTD, FTSTS, movement biomechanics, and KOOS scores compared to control subjects indicate incomplete recovery after TKA both immediately after rehabilitation and following the early post-rehabilitative period. Aim 3: Peak hip muscle strength and FTSTS performance are significantly correlated with KOOS Pain, activities of daily living, and Sport subscales at 3 months post-surgery. Fewer relationships were observed at 6 months post-surgery and between improvements from 3 to 6 months. Aim 4: Quadriceps RTD, hip external rotation RTD, and FTSTS performance were predictive of knee flexion excursion during walking, with quadriceps RTD the strongest of the three predictors. Faster quadriceps RTD, slower hip external rotation RTD, and faster FTSTS performance are predicted to lead to greater knee flexion excursion. Conclusions: Modest improvement in muscle strength and RTD, FTSTS performance, patient-reported function, and biomechanics occur during the post-rehabilitative period after TKA, but all domains remain impaired compared to matched control subjects. Furthermore, muscle strength and RTD and FTSTS performance contribute to greater patient-perceived function and future knee flexion excursion during walking. In order to improve outcomes across domains after TKA, emphasizing improvement in muscle strength, RTD, and FTSTS ability during the first 3 months after surgery is critical as persistent deficits do not resolve by 6 months post-surgery. Lastly, maximizing quadriceps RTD by 3 months post-surgery is likely to lead to improved walking biomechanics at 6 months post-surgery

Kidnapping and Rise of Insecurity in Nigeria: A Case of Kaduna State

In recent years, Kaduna state is experiencing an upsurge of kidnapping activities for ransom. The frequent occurrences of this new insecurity in the last few years of 2016 and 2017, has put the country and Kaduna state in danger, and have become a source of worried and concern with tenths of people from different socio-economic category are being kidnapped for ransom on daily bases. The study is to critically look at this growing criminal act, possible motives and to streamline the complexities in its control. Motives such as economic hardship, political and moral decay have led to its upsurge. Hence, proactive economic and political policies and programs are measures to address the situation

Abe’s Diplomacy toward East Asia: Pursuit of Power Politics

departmental bulletin pape