Direct and indirect orthotic management of medial compartment osteoarthritis of the knee

Osteoarthritis (OA) is a painful condition and affects approximately 80% of individuals by the age of 55 [1], with knee OA occurring two times more frequently than OA of the hand or hip [2].The condition is more prevalent in the medial compartment and restricts the daily lives of individuals due to pain and a lack of functional independence. Patients with medial compartment osteoarthritis often have a varus alignment, with the mechanical axis and load bearing passing through this compartment with a greater adduction moment leading to greater pain and progression of osteoarthritis [3]. Surgery for the condition is possible although in some cases, particularly younger patients or those not yet requiring surgery, clinical management remains a challenge. Before surgery is considered, however, conservative management is advocated, though no one treatment has been shown to be most effective, and there are few quality biomechanical or clinical studies. Of the conservative approaches the principal orthotic treatments are valgus knee braces and laterally wedged foot inlays. Studies of knee valgus bracing have consistently demonstrated an associated decreased pain and improved function [4], and greater confidence [5]. A laterally wedged foot inlay has a thicker lateral border and applies a valgus moment to the heel. It is theorised that by changing the position of the ankle and subtalar joints during weight-bearing [6] the lateral wedges may apply a valgus moment across the knee as well as the rearfoot, with the assumed reduction on load in the medial knee compartment [7]. However, there has been no study to directly compare these orthotic treatments in the same study. The aim of this research is to investigate the efficacy of valgus knee braces and laterally wedged foot inlays in reducing the varus knee moment

Avoiding degenerate coframes in an affine gauge approach to quantum gravity

In quantum models of gravity, it is surmized that configurations with degenerate coframes could occur during topology change of the underlying spacetime structure. However, the coframe is not the true Yang--Mills type gauge field of the translations, since it lacks the inhomogeneous gradient term in the gauge transformations. By explicitly restoring this ``hidden" piece within the framework of the affine gauge approach to gravity, one can avoid the metric or coframe degeneracy which would otherwise interfere with the integrations within the path integral. This is an important advantage for quantization.Comment: 14 pages, Preprint Cologne-thp-1993-H

Effect of rocker shoe design features on forefoot plantar pressures in people with and without diabetes

Background: There is no consensus on the precise rocker shoe outsole design that will optimally reduce plantar pressure in people with diabetes. This study aimed to understand how peak plantar pressure is influenced by systematically varying three design features which characterise a curved rocker shoe: apex angle, apex position and rocker angle. Methods: A total of 12 different rocker shoe designs, spanning a range of each of the three design features, were tested in 24 people with diabetes and 24 healthy participants. Each subject also wore a flexible control shoe. Peak plantar pressure, in four anatomical regions, was recorded for each of the 13 shoes during walking at a controlled speed. Findings: There were a number of significant main effects for each of the three design features, however, the precise effect of each feature varied between the different regions. The results demonstrated maximum pressure reduction in the 2nd-4th metatarsal regions (39%) but that lower rocker angles ( 60% shoe length) should be avoided for this region. The effect of apex angle was most pronounced in the 1st metatarsophalangeal region with a clear decrease in pressure as the apex angle was increased to 100°. Interpretation: We suggest that an outsole design with a 95° apex angle, apex position at 60% of shoe length and 20° rocker angle may achieve an optimal balance for offloading different regions of the forefoot. However, future studies incorporating additional design feature combinations, on high risk patients, are required to make definitive recommendations

In vivo quantification of the functional characterisitics of the rearfoot complex

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN029143 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Participatory Exploration of the Heterogeneity in Household Socioeconomic, Food, and Nutrition Security Status for the Identification of Nutrition-Sensitive Interventions in the Rwandan Highlands

Food insecurity and malnutrition are challenges in rural Rwanda that are presumed to be affected by differential household socioeconomic status, but the relationship between food and nutrition security and socioeconomic status is not well-understood. We used a participatory and multidisciplinary study comprising nutrition survey, focus group discussion (FGD), detailed household/farm characterization, and interviews to construct a participatory household typology and to determine differences in the socioeconomic, food, and nutrition security status of 17 households representing the identified household types in Nyabihu District of Western Province. Strategies to improve household food and nutrition security were identified by the case study households themselves. During the FGDs, it was hypothesized that financial, physical, and natural capitals varied, resulting in high, medium, and low resource endowed households, abbreviated as HRE, MRE, and LRE, respectively. The HRE households had the most educated household heads, largest landholdings (~1 ha), and highest agricultural biodiversity and total farm income per annum. This probably resulted in better diets for women, children higher household food consumption relative to the other households. In contrast, the LRE households were the least food-secure, with poor household food consumption and low dietary diversity across seasons, probably due to limited physical and economic access to food. However, anthropometry of women and children did not differ with household type. Half of the children were stunted, including some from the more food-secure HRE households. Undiversified, nutritionally inadequate diets and bouts of illness likely contributed to chronic malnutrition in children. Making agricultural programs more nutrition-sensitive, creating diverse employment opportunities, and sensitizing communities to nutrition and adequate feeding practices of children could complement the interventions identified by households to improve their food and nutrition security.</p

Integrated systems research in nutrition-sensitive landscapes : A theoretical methodological framework

South Asia and sub-Saharan Africa are two regions of the world with the highest concentration of nutritionally vulnerable populations that depend to a large extent on agriculture as an important source of livelihood (Gillespie et al., 2015). The vast majority of farmers in these regions have small landholdings due to land fragmentation (Jayne et al., 2014; Valbuena et al., 2015) and are often constrained in their access to resources and agricultural inputs (Herrero et al., 2010), especially women (e.g., Cole et al., 2015). As a consequence, productivity levels are low, and because income sources are also limited, dependence on surrounding landscapes and ecosystem services is high in terms of safeguarding supplies of clean water, human and animal foods, construction materials and fuel wood. People shape their physical landscapes (Ellis, 2015), influenced by cultures, values and livelihood opportunities (Horlings, 2015). People’s utilization of their physical landscapes is shaped by various conditions such as soil properties, topography, climate and flooding patterns. People’s dependence on their physical landscapes is strong and expected to increase due to climate change, resulting in gradual but persistent changes including adjustments in frequency, timing and severity of anomalies such as droughts and floods (Naylor et al., 2007; Gornall et al., 2010)

Integrated systems research in nutrition-sensitive landscapes : A theoretical methodological framework

South Asia and sub-Saharan Africa are two regions of the world with the highest concentration of nutritionally vulnerable populations that depend to a large extent on agriculture as an important source of livelihood (Gillespie et al., 2015). The vast majority of farmers in these regions have small landholdings due to land fragmentation (Jayne et al., 2014; Valbuena et al., 2015) and are often constrained in their access to resources and agricultural inputs (Herrero et al., 2010), especially women (e.g., Cole et al., 2015). As a consequence, productivity levels are low, and because income sources are also limited, dependence on surrounding landscapes and ecosystem services is high in terms of safeguarding supplies of clean water, human and animal foods, construction materials and fuel wood. People shape their physical landscapes (Ellis, 2015), influenced by cultures, values and livelihood opportunities (Horlings, 2015). People’s utilization of their physical landscapes is shaped by various conditions such as soil properties, topography, climate and flooding patterns. People’s dependence on their physical landscapes is strong and expected to increase due to climate change, resulting in gradual but persistent changes including adjustments in frequency, timing and severity of anomalies such as droughts and floods (Naylor et al., 2007; Gornall et al., 2010)

Exploring solution spaces for nutrition-sensitive agriculture in Kenya and Vietnam

Smallholder agriculture is an important source of livelihoods in South Asia and sub-Saharan Africa. In these regions the highest concentrations of nutritionally vulnerable populations are found. Agricultural development needs to be nutrition-sensitive, and contribute simultaneously to improving household nutrition, farm productivity and environmental performance. We explored the windows of opportunities for farm development and the potential of crop diversification options for meeting household dietary requirements, whilst concurrently improving household economic performance in contrasting smallholder farm systems in Kenya and Vietnam. Farm and household features and farmer perspectives and priorities were integrated into a farm-household model that allowed quantification of a diverse set of nutritional, labour and productive indicators. Using a multi-objective optimization algorithm, we generated ‘solution spaces’ comprising crop compositions and management configurations that would satisfy household dietary needs and allowed income gains. Results indicated site-specific synergies between income and nutritional system yield for vitamin A. Diversification with novel vegetables could cover vitamin A requirements of 10 to 31 extra people per hectare and lead to greater income (25 to 185% increase) for some households, but reduced leisure time. Although the Vietnamese sites exhibited greater nutrient system yields than those in Kenya, the household diets in Kenya had greater nutrient adequacy due to the fact that the Vietnamese farmers sold greater proportions of their on-farm produced foods. We conclude that nutrition-sensitive, multi-method approaches have potential to identify solutions to simultaneously improve household income, nutrition and resource management in vulnerable smallholder farming systems.</p

Clinical Outcomes of Patients with C3G or IC-MPGN Treated with the Factor D Inhibitor Danicopan: Final Results from Two Phase 2 Studies

Introduction: C3 glomerulopathy (C3G) is an ultrarare, chronic and progressive nephropathy mediated by dysregulation of the alternative pathway of complement (AP), with poor prognosis and limited treatment options. Targeted inhibition of proximal AP through factor D (FD) blockade represents a rational treatment approach. We present two phase 2 proof-of-concept clinical studies of the orally active FD inhibitor danicopan in patients with C3G and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN) (NCT03369236 and NCT03459443). Methods: A double-blind, placebo-controlled study in patients with C3G and a single-arm, open-label study in patients with C3G or IC-MPGN treated with danicopan are reported. The studies evaluated pharmacokinetic/pharmacodynamic (PK/PD), efficacy, and safety outcomes. The co-primary endpoints were change from baseline in composite biopsy score and the proportion of patients with a 30% reduction in proteinuria relative to baseline at 6 or 12 months. Results: Optimal systemic concentrations of danicopan were not achieved for complete and sustained inhibition of AP, although there was evidence that blockade of FD reduced AP activity shortly after drug administration. Consequently, limited clinical response was observed in key efficacy endpoints. While stable disease or improvement from baseline was seen in some patients, response was not consistent. The data confirmed the favorable safety profile of danicopan. Conclusion: While demonstrating a favorable safety profile, danicopan resulted in incomplete and inadequately sustained inhibition of AP, probably due to limitations in its PK/PD profile in C3G, leading to lack of efficacy. Complete and sustained AP inhibition is required for a clinical response in patients with C3G.Nephrolog