The exoskeleton for gait rehabilitation ALICE: dynamic analysis and control system evaluation using Hamilton quaternions

[EN] A robotic exoskeleton is an electromechanical device that can be worn by a person to increase its physical capacity, to assist locomotion or for gait rehabilitation processes. In the case of rehabilitation exoskeletons, the control system is required to be smooth and capable to match accurately with the patients’ evolution in order to optimize the eciency of their recovery, this implies the design of robust and precise controllers. In this paper, kinematic analysis, dynamic analysis and control system evaluation for ALICE rehabilitation exoskeleton is presented. Among the control techniques used are: the PD controller, adaptive PD, and the sliding mode controller. In addition, a stability analysis using the Lyapunov criterion is performed. To test the performance of the controllers, gait data obtained by the ONCE School of  Physiotherapy in Madrid, which correspond to healthy people and people with multiple sclerosis, are used. MATLAB as simulation software and programming language is used.[ES] Un exoesqueleto robótico es un dispositivo electromecánico utilizado para aumentar la capacidad física de una persona, como ayuda a la locomoción o para procesos de rehabilitación de la marcha. En el caso de los exoesqueletos de rehabilitación se requiere que el sistema de control sea capaz de adaptarse adecuadamente a la evolución del paciente con el fin de optimizar su recuperación, esto implica el diseño de controladores robustos y precisos. En este trabajo se presenta el análisis cinemático, análisis dinámico y evaluación del sistema de control del exoesqueleto de rehabilitación ALICE. Dentro de las técnicas de control presentadas se encuentran: el controlador PD, PD adaptativo, y el controlador en modo deslizante. Además, se realiza un análisis de estabilidad utilizando el criterio de Lyapunov. Para probar el rendimiento de los reguladores, se utiliza un conjunto de datos de la Escuela de Fisioterapia de la ONCE de Madrid, correspondiente a personas sanas y personas con esclerosis múltiple. Se utiliza MATLAB como software de simulación y lenguaje de programación.Manuel Cardona agradece a la Fundación Carolina y a la Universidad Politécnica de Madrid, España, por el apoyo para la realización de esta investigación gracias a la beca de Doctorado otorgada en el marco del convenio con la Universidad Don Bosco, El Salvador.Cardona, M.; Serrano, F.; Martín, JA.; Rausell, E.; Saltaren, R.; García-Cena, C. (2020). El exoesqueleto de rehabilitación de la marcha ALICE: análisis dinámico y evaluación del sistema de control utilizando cuaternios de Hamilton. Revista Iberoamericana de Automática e Informática industrial. 18(1):48-57. https://doi.org/10.4995/riai.2020.12558OJS4857181Abolvafaei, M., Ganjefar, S., 2019. 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Editorial Panamericana, France.Maciejasz, P., Eschweiler, J., Gerlach-Hahn, K., et.al., 2014. "A survey on robotic devices for upper limb rehabilitation". https://doi.org/10.1186/1743-0003-11-3Proietti, T., Jarrasse, N., Roby-Brami, A., Morel, G., April 2015. Adaptive control of a robotic exoskeleton for neurorehabilitation. In: 2015 7th International IEEE/EMBS Conference on Neural Engineering (NER). pp. 803-806. https://doi.org/10.1109/NER.2015.7146745Reinkensmeyer, D. J., 2003. How to retrain movement after neurologic injury: a computational rationale for incorporating robot (or therapist) assistance. In: Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (IEEE Cat. No.03CH37439). Vol. 2. pp. 1479-1482 Vol.2.Reinkensmeyer, D. J., Aoyagi, D., Emken, J., Galvez, J., Ichinose W, W., etal, Aug-Sep 2006. Tools for understanding and optimizing robotic gait training. J Rehabil Res Dev 43 (5), 657-70. https://doi.org/10.1682/JRRD.2005.04.0073Riener, R., Guidali, M., Keller, U., Duschau-Wicke, A., et.al., 2014. "a survey on robotic devices for upper limb rehabilitation".Serrano, F. E., Rossell, J. M., 2015. Complete kinematic analysis of the stewartgough platform by unit quaternions. Mechanics and Control (Vol, 34, no. 4), 59-69.Spong, M., Hutchinson, S., Vidyasagar, M., 2006. Robot Modeling and Control. John Wiley and Sons.Wang, J.-Y., Liang, H.-Z., Sun, Z.-W., Wu, S.-N., Zhang, S.-J., 2013. Relative motion coupled control based on dual quaternion. Aerospace Science and Technology 25 (1), 102 - 113. https://doi.org/10.1016/j.ast.2011.12.013Wu, Q., Chen, B., Wu, H., 2019. Rbfn-based adaptive backstepping sliding mode control of an upper-limb exoskeleton with dynamic uncertainties. IEEE Access 7, 134635-134646. https://doi.org/10.1109/ACCESS.2019.2941973Yakub, F., Khudzari, A., Mori, Y., March 2014. "recent trends for practical rehabilitation robotics, current challenges and the future". https://doi.org/10.1097/MRR.0000000000000035Yang, Z., Zhu, Y., Yang, X., Zhang, Y., Aug 2009. Impedance control of exoskeleton suit based on adaptive rbf neural network. In: 2009 International Conference on Intelligent Human-Machine Systems and Cybernetics. Vol. 1. pp. 182-187. https://doi.org/10.1109/IHMSC.2009.54Zhou, W., Chen, W., Liu, H., Li, X., 2015. A new forward kinematic algorithm for a general stewart platform. Mechanism and Machine Theory 87, 177 - 190. https://doi.org/10.1016/j.mechmachtheory.2015.01.002Özgur, E., Mezouar, Y., 2016. Kinematic modeling and control of a robot arm ¨ using unit dual quaternions. Robotics and Autonomous Systems 77, 66 - 73. https://doi.org/10.1016/j.robot.2015.12.005Ilyas Eker, 2010. Second-order sliding mode control with experimental application. ISA Transactions 49 (3), 394 - 405. https://doi.org/10.1016/j.isatra.2010.03.01

Social Models for Dealing with Inequalities

Production of INCASI Project H2020-MSCA-RISE-2015 GA 691004This chapter compares social models in Europe and Latin America. The goal is to study the interaction between two institutions: on the one hand, pre-distributive (ex ante) institutions, such as the structure and coverage of collective bargaining and, on the other hand, post-distributive (ex post) institutions, such as unemployment protection and social policy. Pre-distributive institutions are important for correcting inequalities in the labour market, because they introduce guidelines for egalitarian wage structures. Post-distributive institutions help to mitigate inequalities generated in the labour market. The methodology is based on statistical analysis of a series of indicators related to pre and post-distributive policies. The results present three types of model: (1) coordinated economies, typical of neo-corporatist Scandinavian countries; (2) mixed economies, typical of Mediterranean systems, and (3) uncoordinated economies, which equate to liberalism and the Latin American 'structural heterogeneity' model. It is neo-corporatist coordinated economies that generate the most pre and post-distributive equality. In turn, uncoordinated economies, and Latin American ones in particular, generate more inequalities due to highly informal employment and the weakness of their post-distributive institutions

Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services

Background Despite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care. Methods We carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method. Results We identified three groups in relation to pre-pregnancy health and care: 1) The “prepared” group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The “poor knowledge” group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The “absent pre-pregnancy period” group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups. Conclusion Different pre-pregnancy care approaches are likely to be needed for each of the groups. Among the “prepared” group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the “poor knowledge” group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the “absent pre-pregnancy period” group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.This report is independent research commissioned and funded by the Department of Health Policy Research Programme Pre-Pregnancy Health and Care in England: Exploring Implementation and Public Health Impact, 006/0068

Mitsui-7, heat-treated, and nitrogen-doped multi-walled carbon nanotubes elicit genotoxicity in human lung epithelial cells

Background: The unique physicochemical properties of multi-walled carbon nanotubes (MWCNT) have led to many industrial applications. Due to their low density and small size, MWCNT are easily aerosolized in the workplace making respiratory exposures likely in workers. The International Agency for Research on Cancer designated the pristine Mitsui-7 MWCNT (MWCNT-7) as a Group 2B carcinogen, but there was insufficient data to classify all other MWCNT. Previously, MWCNT exposed to high temperature (MWCNT-HT) or synthesized with nitrogen (MWCNT-ND) have been found to elicit attenuated toxicity; however, their genotoxic and carcinogenic potential are not known. Our aim was to measure the genotoxicity of MWCNT-7 compared to these two physicochemically-altered MWCNTs in human lung epithelial cells (BEAS-2B & SAEC). Results: Dose-dependent partitioning of individual nanotubes in the cell nuclei was observed for each MWCNT material and was greatest for MWCNT-7. Exposure to each MWCNT led to significantly increased mitotic aberrations with multi- and monopolar spindle morphologies and fragmented centrosomes. Quantitative analysis of the spindle pole demonstrated significantly increased centrosome fragmentation from 0.024–2.4 μg/mL of each MWCNT. Significant aneuploidy was measured in a dose-response from each MWCNT-7, HT, and ND; the highest dose of 24 μg/mL produced 67, 61, and 55%, respectively. Chromosome analysis demonstrated significantly increased centromere fragmentation and translocations from each MWCNT at each dose. Following 24 h of exposure to MWCNT-7, ND and/or HT in BEAS-2B a significant arrest in the G1/S phase in the cell cycle occurred, whereas the MWCNT-ND also induced a G2 arrest. Primary SAEC exposed for 24 h to each MWCNT elicited a significantly greater arrest in the G1 and G2 phases. However, SAEC arrested in the G1/S phase after 72 h of exposure. Lastly, a significant increase in clonal growth was observed one month after exposure to 0.024 μg/mL MWCNT-HT & ND. Conclusions: Although MWCNT-HT & ND cause a lower incidence of genotoxicity, all three MWCNTs cause the same type of mitotic and chromosomal disruptions. Chromosomal fragmentation and translocations have not been observed with other nanomaterials. Because in vitro genotoxicity is correlated with in vivo genotoxic response, these studies in primary human lung cells may predict the genotoxic potency in exposed human populations

Diabetes mellitus, maternal adiposity, and insulin-dependent gestational diabetes are associated with COVID-19 in pregnancy: the INTERCOVID study

BACKGROUND: Among nonpregnant individuals, diabetes mellitus and high body mass index increase the risk of COVID-19 and its severity.OBJECTIVE: This study aimed to determine whether diabetes mellitus and high body mass index are risk factors for COVID-19 in pregnancy and whether gestational diabetes mellitus is associated with COVID-19 diagnosis.STUDY DESIGN: INTERCOVID was a multinational study conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women aged >= 18 years; a total of 2071 women were included in the analyses. For each woman diagnosed with COVID-19, 2 nondiagnosed women delivering or initiating antenatal care at the same institution were also enrolled. The main exposures were preexisting diabetes mellitus, high body mass index (overweight or obesity was defined as a body mass index >= 25 kg/m(2)), and gestational diabetes mellitus in pregnancy. The main outcome was a confirmed diagnosis of COVID-19 based on a real-time polymerase chain reaction test, antigen test, antibody test, radiological pulmonary findings, or >= 2 predefined COVID-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and COVID-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. Furthermore, we conducted sensitivity analyses: (1) restricted to those with a real-time polymerase chain reaction test or an antigen test in the last week of pregnancy, (2) restricted to those with a real-time polymerase chain reaction test or an antigen test during the entire pregnancy, (3) generating values for missing data using multiple imputation, and (4) analyses controlling for month of enrollment. In addition, among women who were diagnosed with COVID-19, we examined whether having gestational diabetes mellitus, diabetes mellitus, or high body mass index increased the risk of having symptomatic vs asymptomatic COVID-19.RESULTS: COVID-19 was associated with preexisting diabetes mellitus (risk ratio, 1.94; 95% confidence interval, 1.55-2.42), overweight or obesity (risk ratio, 1.20; 95% confidence interval, 1.06-1.37), and gestational diabetes mellitus (risk ratio, 1.21; 95% confidence interval, 0.99-1.46). The gestational diabetes mellitus association was specifically among women requiring insulin, whether they were of normal weight (risk ratio, 1.79; 95% confidence interval, 1.06-3.01) or overweight or obese (risk ratio, 1.77; 95% confidence interval, 1.28-2.45). A somewhat stronger association with COVID-19 diagnosis was observed among women with preexisting diabetes mellitus, whether they were of normal weight (risk ratio, 1.93; 95% confidence interval, 1.18-3.17) or overweight or obese (risk ratio, 2.32; 95% confidence interval, 1.82-2.97). When the sample was restricted to those with a real-time polymerase chain reaction test or an antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation or controlling for month of enrollment, the observed associations were comparable.CONCLUSION: Diabetes mellitus and overweight or obesity were risk factors for COVID-19 diagnosis in pregnancy, and insulin-dependent gestational diabetes mellitus was associated with the disease. Therefore, it is essential that women with these comorbidities are vaccinated

Adiponectin circulating levels and 10-year (2002–2012) cardiovascular disease incidence:the ATTICA Study

Purpose: Adiponectin is an adipokine with anti-inflammatory and cardiovascular-protective properties. Existing epidemiological evidence is conflicting on the exact relationship between adiponectin and long-term cardiovascular disease (CVD) risk. Our aim was to prospectively assess whether circulating adiponectin is associated with long-term incident CVD. Methods: A population-based, prospective study in adults (>18 years) without previous CVD history (ATTICA study). Circulating total adiponectin levels were measured at baseline (2001–2002) in a sub-sample (n = 531; women/men: 222/309; age: 40 ± 11 years) of the ATTICA cohort and complete 10-year follow-up data were available in 366 of these participants (women/men: 154/212; age: 40 ± 12 years). Results: After adjusting for multiple factors, including age, sex, body mass index, waist circumference, smoking, physical activity, Mediterranean diet adherence, hypertension, diabetes, and hypercholesterolemia, our logistic regression analysis indicates that an increase in circulating total adiponectin levels by 1 unit was associated with 36% lower CVD risk (relative risk [RR]: 0.64, 95% confidence interval [CI] 0.42–0.96; p = 0.03). Further adjusting for interleukin-6 plasma levels had no significant impact (RR: 0.60, 95% CI 0.38–0.94; p = 0.03), while additional adjustment for circulating C-reactive protein (CRP) modestly attenuated this association (RR: 0.63, 95% CI 0.40–0.99; p = 0.046). Conclusions: In our study, elevated circulating total adiponectin levels were associated with lower 10-year CVD risk in adults without previous CVD, independently of other established CVD risk factors. This association appeared to be modestly attenuated by CRP, yet was not mediated by interleukin-6 which is the main endocrine/circulating pro-inflammatory cytokine

Wogonin Improves Histological and Functional Outcomes, and Reduces Activation of TLR4/NF-κB Signaling after Experimental Traumatic Brain Injury

Traumatic brain injury (TBI) initiates a neuroinflammatory cascade that contributes to neuronal damage and behavioral impairment. This study was undertaken to investigate the effects of wogonin, a flavonoid with potent anti-inflammatory properties, on functional and histological outcomes, brain edema, and toll-like receptor 4 (TLR4)- and nuclear factor kappa B (NF-κB)-related signaling pathways in mice following TBI.Mice subjected to controlled cortical impact injury were injected with wogonin (20, 40, or 50 mg·kg(-1)) or vehicle 10 min after injury. Behavioral studies, histology analysis, and measurement of blood-brain barrier (BBB) permeability and brain water content were carried out to assess the effects of wogonin. Levels of TLR4/NF-κB-related inflammatory mediators were also examined. Treatment with 40 mg·kg(-1) wogonin significantly improved functional recovery and reduced contusion volumes up to post-injury day 28. Wogonin also significantly reduced neuronal death, BBB permeability, and brain edema beginning at day 1. These changes were associated with a marked reduction in leukocyte infiltration, microglial activation, TLR4 expression, NF-κB translocation to nucleus and its DNA binding activity, matrix metalloproteinase-9 activity, and expression of inflammatory mediators, including interleukin-1β, interleukin-6, macrophage inflammatory protein-2, and cyclooxygenase-2.Our results show that post-injury wogonin treatment improved long-term functional and histological outcomes, reduced brain edema, and attenuated the TLR4/NF-κB-mediated inflammatory response in mouse TBI. The neuroprotective effects of wogonin may be related to modulation of the TLR4/NF-κB signaling pathway