Wobbling Mass Influence on Impact Ground Reaction Forces: A Simulation Model Sensitivity Analysis

This article was published in the serial, Journal of Applied Biomechanics [© Human Kinetics]. The definitive version is available at: http://journals.humankinetics.com/JABTo gain insight into joint loadings during impacts, wobbling mass models have been used. The aim of this study was to investigate the sensitivity of a wobbling mass model, of landing from a drop, to the model's parameters. A two-dimensional wobbling mass model was developed. Three rigid linked segments designed to represent the skeleton each had a second mass attached to them, via two translational non-linear spring dampers, representing the soft tissue. Model parameters were systematically varied one at a time and the effect this had on the peak vertical ground reaction force and segment kinematics was examined. Model output showed low sensitivity to most model parameters but was sensitive to the timing of joint torque initiation. Varying the heel pad stiffness in the range of stiffness values reported in the literature had the largest influence on the peak vertical ground reaction force. The analysis indicated that the more proximal body segments had a lower influence on peak vertical ground reaction force per unit mass than the segments nearer the contact point, 340 N/kg, 157 N/kg and 24 N/kg for the shank, thigh and trunk respectively. Model simulations were relatively insensitive to variations in the properties of the connection between the wobbling masses and the skeleton. Given the proviso that estimates for the other model parameters and joint torque activation timings lie in a realistic range, then if the goal is to examine the effects of the wobbling mass on the system this insensitivity is an advantage. If precise knowledge about the motion of the wobbling mass is of interest, however, more experimental work is required to determine precisely these model parameters

Metal-free restorations: Esthetic considerations, treatment planning, preparation, manufacturing, luting, and followup

PubMedID: 26793716[No abstract available

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)