Academia’s Role to Drive Change in the Orthotics and Prosthetics Profession

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education - an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals\u27 clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive

Academia’s Role to Drive Change in the Orthotics and Prosthetics Profession

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education - an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals\u27 clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive

Selective orthotic constraint of lower limb movement during walking reveals new insights into neuromuscular adaptation

IntroductionA concern expressed by the clinical community is that the constraint of motion provided by an ankle foot orthosis (AFO) may lead the user to become dependent on its stiffness, leading to learned non-use. To examine this, we hypothesized that using an experimental AFO-footwear combination (exAFO-FC) that constrains ankle motion during walking would result in reduced soleus and tibialis anterior EMG compared to free (exAFO-FC) and control (no AFO, footwear only) conditions.MethodA total of 14 healthy subjects walked at their preferred speed (1.34 ± 0.09 m·s-1) for 15 min, in three conditions, namely, control, free, and stop.ResultsDuring the stance phase of walking in the stop condition, ipsilateral soleus integrated EMG (iEMG) declined linearly, culminating in a 32.1% reduction compared to the control condition in the final 5 min interval of the protocol. In contrast, ipsilateral tibialis anterior iEMG declined in a variable fashion culminating in an 11.2% reduction compared to control in the final 5 min interval. During the swing phase, the tibialis anterior iEMG increased by 6.6% compared to the control condition during the final 5 min interval. The contralateral soleus and tibialis anterior exhibited increased iEMG in the stop condition.DiscussionAn AFO-FC functions as a biomechanical motion control device that influences the neural control system and alters the output of muscles experiencing constraints of motion

Giant and reversible extrinsic magnetocaloric effects in La0.7Ca0.3MnO3 films due to strain

Large thermal changes driven by a magnetic field have been proposed for environmentally friendly energy efficient refrigeration, but only a few materials which suffer hysteresis show these giant magnetocaloric effects. Here we create giant and reversible extrinsic magnetocaloric effects in epitaxial films of the ferromagnetic manganite La0.7Ca0.3MnO3 using strain mediated feedback from BaTiO3 substrates near a first-order structural phase transition. Our findings should inspire the discovery of giant magnetocaloric effects in a wide range of magnetic materials, and the parallel development of nanostructured bulk samples for practical applications.Comment: 32 pages, 1 Table, 5 figures, supplementary informatio

Characterization of Facies and Permeability Patterns in Carbonate Reservoirs Based in Outcrop Analogs

More than 13 billion barrels (Bbbl) of mobile oil and 17 Bbbl of residual oil will remain in San Andres and Grayburg reservoirs at abandonment under current development practices. Through the development and application of new recovery technology, a large part of this resource can be recovered. This report focuses on research for the development and testing of new techniques for improving the recovery of this resource. Outcrop and subsurface geologic and engineering data are utilized to develop new methodologies through the integration of geologic observations and engineering data for improving numerical models that predict reservoir performance more accurately. Extensive regional mapping of the 14-mile by 1,200-foot San Andres outcrop, located on the Algerita Escarpment, Guadalupe Mountains, New Mexico, demonstrates that the San Andres carbonate-ramp complex is composed of multiple depositional sequences that have significant basinward shifts in reservoir-quality facies tracts occurring across sequence boundaries. Detailed geologic and petrophysical mapping of three reservoir-quality facies tracts demonstrates that the fundamental scale of geologic description for reservoir characterization is the parasequence and its component rock-fabric-based facies. Descriptions of cores from the Seminole San Andres Unit illustrate that the parasequence is also the fundamental geologic scale for reservoir mapping in the subsurface.Bureau of Economic Geolog

Characterization of Reservoir Heterogenity in Carbonate-Ramp Systems, San Andres/Grayburg Permian Basin

This report summarizes research carried out by the Bureau of Economic Geology's San Andres/Grayburg Reservoir Characterization Research Laboratory (RCRL) from September 1988 through September 1990. The goal of the RCRL program was to develop advanced approaches to reservoir characterization for improved recovery of the substantial remaining mobile oil in San Andres and Grayburg reservoirs. Emphasis was placed on developing an outcrop analog for San Andres strata that could be used as (1) a guide to interpreting the regional and local geologic framework of the subsurface reservoirs and (2) a data source illustrating the scales and patterns of variability of rock-fabric facies and petrophysical properties, particularly in lateral dimensions, and on scales that cannot be studied during subsurface reservoir characterization. Areas selected for study were the San Andres exposures of the Algerita Escarpment in the northern Guadalupe Mountains and the Seminole San Andres Unit on the northern margin of the Central Basin Platform. The outcrop-analog research was emphasized because it had received little attention before this study by either industry or academe. Reports in this summary involve (1) outcrop and subsurface geological characterization of the Algerita Escarpment San Andres and the Seminole San Andres Unit (Kerans), (2) correlation of detailed outcrop mapping in order to research cored wells at Lawyer Canyon, Algerita Escarpment (Nance), (3) diagenetic/petrographic analysis of selected upper San Andres facies focusing on the origin of moldic porosity (Hovorka), (4) geologic engineering description of the upper San Andres carbonates at Lawyer Canyon and the upper producing interval at Seminole (Lucia), (5) geostatistical analysis of permeability patterns and stochastic-based finite-difference modeling of the upper San Andres parasequence window (Senger and Fogg), and (6) deterministic finite element modeling of the upper San Andres parasequence window (Kasap). Availability of basic data for these studies is summarized in the appendix.Bureau of Economic Geolog

Modelling and optimal control of blood glucose levels in the human body

Regulating the blood glucose level is a challenging control problem for the human body. Abnormal blood glucose levels can cause serious health problems over time, including diabetes. Although several mathematical models have been proposed to describe the dynamics of glucose-insulin interaction, none of them have been universally adopted by the research community. In this paper, we consider a dynamic model of the blood glucose regulatory system originally proposed by Liu and Tang in 2008. This model consists of eight state variables naturally divided into three subsystems: the glucagon and insulin transition subsystem, the receptor binding subsystem and the glucosesubsystem. The model contains 36 model parameters, many of which are unknown and difficult to determine accurately. We formulate an optimal parameter selection problem in which optimal values for the model parameters must be selected so that the resulting model best its given experimental data.We demonstrate that this optimal parameter selection problem can be solved readily using the optimal control software MISER 3.3. Using this approach, significant improvements can be made in matching the model to the experimental data. We also investigate the sensitivity of the resulting optimizedmodel with respect to the insulin release rate. Finally, we use MISER 3.3 to determine optimal open loop controls for the optimized model

Impact of liver fat on the differential partitioning of hepatic triacylglycerol into VLDL subclasses on high and low sugar diets.

Dietary sugars are linked to the development of non-alcoholic fatty liver disease (NAFLD) and dyslipidaemia, but it is unknown if NAFLD itself influences the effects of sugars on plasma lipoproteins. To study this further, men with NAFLD (n=11) and low liver fat 'controls' (n= 14) were fed two iso-energetic diets, high or low in sugars (26% or 6% total energy) for 12 weeks, in a randomised, cross-over design. Fasting plasma lipid and lipoprotein kinetics were measured after each diet by stable isotope trace-labelling. There were significant differences in the production and catabolic rates of VLDL subclasses between men with NAFLD and controls, in response to the high and low sugar diets. Men with NAFLD had higher plasma concentrations of VLDL1-triacylglycerol (TAG) after the high ( P <0.02) and low sugar ( P <0.0002) diets, a lower VLDL1-TAG fractional catabolic rate after the high sugar diet ( P <0.01), and a higher VLDL1-TAG production rate after the low sugar diet ( P <0.01), relative to controls. An effect of the high sugar diet, was to channel hepatic TAG into a higher production of VLDL1-TAG ( P <0.02) in the controls, but in contrast, a higher production of VLDL2-TAG ( P <0.05) in NAFLD. These dietary effects on VLDL subclass kinetics could be explained, in part, by differences in the contribution of fatty acids from intra-hepatic stores, and de novo lipogenesis. This study provides new evidence that liver fat accumulation leads to a differential partitioning of hepatic TAG into large and small VLDL subclasses, in response to high and low intakes of sugars.The work was supported by a UK government grant from the Biological Biotechnology Scientific Research Council (Grant no. BB/G009899/1); University of Surrey PhD scholarship for AM; Medical Research Council (body composition measurements) and infrastructure support from the National Institute of Health Research at the Cambridge Biomedical Research Centre