The influence of the mechanical properties of trans-tibial prostheses on amputee performance

Achieving the required functionality of a trans-tibial prosthesis during the stance phase of gait (e.g., shock absorption, close to normal roll-over characteristics, and smooth transition into swing) depends on the "Amputee Independent Prosthesis Properties" (AIPP), defined here as the mechanical properties of the prosthetic components distal to the socket that directly influence the performance of the amputee. Accordingly, if research studies are to inform the design of better prostheses, AIPP must be a primary consideration. Therefore, the objectives of this PhD study were: 1) develop a standardised method of AIPP characterisation, and 2) investigate the effects of AIPP on amputee performance through human performance testing. For the first objective, a modified version of the roll-over shape model, referred to as the Salford AIPP model, was developed in order to characterise the mechanical properties of a trans-tibial prosthesis (i.e., foot and pylon). A custom-built test-rig was built in order to measure the parameters of this model. For the second objective, a series of human performance studies were conducted which measured the biomechanical, physiological, and subjective performance of five amputees during four walking conditions: self-selected walking speed (SSWS) on the level, fast walking speed on the level, SSWS on a 5% grade incline, and SSWS on a 5% grade decline. A custombuilt foot-ankle mechanism allowed for independent modulation of the prosthetic plantar and dorsiflexion stiffness. Four combinations of plantar and dorsiflexion stiffness were tested during each of the four walking conditions. Results indicated that dorsiflexion stiffness is a dominant factor in trans-tibial amputee gait performance and decreased stiffness improved performance (e.g., increased gait symmetry and reduced metabolic energy expenditure). However, future work on identifying effective AIPP for improved gait performance must involve amputee gait simulation, in which results from this study may serve as a means of validation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Amputee perception of prosthetic ankle stiffness during locomotion

Abstract Background Prosthetic feet are spring-like, and their stiffness critically affects the wearer’s stability, comfort, and energetic cost of walking. Despite the importance of stiffness in ambulation, the prescription process often entails testing a limited number of prostheses, which may result in patients receiving a foot with suboptimal mechanics. To understand the resolution with which prostheses should be individually optimized, we sought to characterize below-knee prosthesis users’ psychophysical sensitivity to prosthesis stiffness. Methods We used a novel variable-stiffness ankle prosthesis to measure the repeatability of user-selected preferred stiffness, and implemented a psychophysical experiment to characterize the just noticeable difference of stiffness during locomotion. Results All eight subjects with below-knee amputation exhibited high repeatability in selecting their Preferred Stiffness (mean coefficient of variation: 14.2 ± 1.7%) and were able to correctly identify a 7.7 ± 1.3% change in ankle stiffness (with 75% accuracy). Conclusions This high sensitivity suggests prosthetic foot stiffness should be tuned with a high degree of precision on an individual basis. These results also highlight the need for a pairing of new robotic prescription tools and mechanical characterizations of prosthetic feet.https://deepblue.lib.umich.edu/bitstream/2027.42/146187/1/12984_2018_Article_432.pd

Natural history of malignant bone disease in breast cancer and the use of cumulative mean functions to measure skeletal morbidity

BACKGROUND: Bone metastases are a common cause of skeletal morbidity in patients with advanced cancer. The pattern of skeletal morbidity is complex, and the number of skeletal complications is influenced by the duration of survival. Because many patients with cancer die before trial completion, there is a need for survival-adjusted methods to accurately assess the effects of treatment on skeletal morbidity. METHODS: Recently, a survival-adjusted cumulative mean function model has been generated that can provide an intuitive graphic representation of skeletal morbidity throughout a study. This model was applied to the placebo-control arm of a pamidronate study in patients with malignant bone disease from breast cancer. RESULTS: Analysis by bone lesion location showed that spinal metastases were associated with the highest cumulative mean incidence of skeletal-related events (SREs), followed by chest and pelvic metastases. Metastases located in the extremities were associated with an intermediate incidence of SREs, and those in the skull were associated with the lowest incidence of SREs. CONCLUSION: Application of this model to data from the placebo arm of this trial revealed important insight into the natural history of skeletal morbidity in patients with bone metastases. Based on these observations, treatment for the prevention of SREs is warranted regardless of lesion location except for metastases on the skull

Community Participation for Community Benefits From Natural Capital Projects : A Review for the Facility for Investment Ready Nature in Scotland Programme

Despite the growing volume and scale of natural capital investments, it remains unclear if, and how, these projects to maintain and restore the ecosystem will empower and enrich communities. This report is a core output from the project, Community Benefits Standard for the UK Nature Investment Market, developed in Scotland, which is funded by the Facility for Investment Ready Nature in Scotland (FIRNS). The FIRNS programme is delivered by NatureScot, in collaboration with the Scottish Government and in partnership with the National Lottery Heritage Fund. It provides a review of academic and practitioner literature to explore best practice approaches for facilitating community inclusion and participation in order to generate lasting community benefit from nature-based projects. Such approaches can build and sustain two-way relationships between developers and community groups; helping developers to both understand and act upon the needs or issues that communities experience in relation to natural capital investments and to align with community priorities. These approaches can also contribute towards broader community wealth building and justice objectives. However, such co-benefits are not guaranteed. We offer a number of lessons, grounded in robust academic evidence, about how best to approach participation for community benefit creation

Modular Design of a Passive, Low-Cost Prosthetic Knee Mechanism to Enable Able-Bodied Kinematics for Users With Transfemoral Amputation

There is a significant need for low-cost, high-performance prosthetic knee technology for transfemoral amputees in India. Replicating able-bodied gait in amputees is biomechanically necessary to reduce the metabolic cost, and it is equally important to mitigate the socio-economic discrimination faced by amputees in developing countries due to their conspicuous gait deviations. This paper improves upon a previous study of a fully passive knee mechanism, addressing the issues identified in its user testing in India. This paper presents the design, analysis and bench-level testing of the three major functional modules of the new prosthetic knee architecture: (i) a four-bar latch mechanism for achieving stability during stance phase of walking, (ii) an early stance flexion module designed by implementing a fully adjustable mechanism, and (iii) a hydraulic rotary damping system for achieving smooth and reliable swing-phase control

Deglutarylation of glutaryl-CoA dehydrogenase by deacylating enzyme SIRT5 promotes lysine oxidation in mice

A wide range of protein acyl modifications has been identified on enzymes across various metabolic processes; however, the impact of these modifications remains poorly understood. Protein glutarylation is a recently identified modification that can be nonenzymatically driven by glutaryl-CoA. In mammalian systems, this unique metabolite is only produced in the lysine and tryptophan oxidative pathways. To better understand the biology of protein glutarylation, we studied the relationship between enzymes within the lysine/tryptophan catabolic pathways, protein glutarylation, and regulation by the deglutarylating enzyme sirtuin 5 (SIRT5). Here, we identify glutarylation on the lysine oxidation pathway enzyme glutaryl-CoA dehydrogenase (GCDH) and show increased GCDH glutarylation when glutaryl-CoA production is stimulated by lysine catabolism. Our data reveal that glutarylation of GCDH impacts its function, ultimately decreasing lysine oxidation. We also demonstrate the ability of SIRT5 to deglutarylate GCDH, restoring its enzymatic activity. Finally, metabolomic and bioinformatic analyses indicate an expanded role for SIRT5 in regulating amino acid metabolism. Together, these data support a feedback loop model within the lysine/tryptophan oxidation pathway in which glutaryl-CoA is produced, in turn inhibiting GCDH function via glutaryl modification of GCDH lysine residues and can be relieved by SIRT5 deacylation activity

Identification and Evaluation of Epidemic Prediction and Forecasting Reporting Guidelines: A Systematic Review and a Call for Action

INTRODUCTION: High quality epidemic forecasting and prediction are critical to support response to local, regional and global infectious disease threats. Other fields of biomedical research use consensus reporting guidelines to ensure standardization and quality of research practice among researchers, and to provide a framework for end-users to interpret the validity of study results. The purpose of this study was to determine whether guidelines exist specifically for epidemic forecast and prediction publications. METHODS: We undertook a formal systematic review to identify and evaluate any published infectious disease epidemic forecasting and prediction reporting guidelines. This review leveraged a team of 18 investigators from US Government and academic sectors. RESULTS: A literature database search through May 26, 2019, identified 1467 publications (MEDLINE n = 584, EMBASE n = 883), and a grey-literature review identified a further 407 publications, yielding a total 1777 unique publications. A paired-reviewer system screened in 25 potentially eligible publications, of which two were ultimately deemed eligible. A qualitative review of these two published reporting guidelines indicated that neither were specific for epidemic forecasting and prediction, although they described reporting items which may be relevant to epidemic forecasting and prediction studies. CONCLUSIONS: This systematic review confirms that no specific guidelines have been published to standardize the reporting of epidemic forecasting and prediction studies. These findings underscore the need to develop such reporting guidelines in order to improve the transparency, quality and implementation of epidemic forecasting and prediction research in operational public health