Attenuation of centre-of-pressure trajectory fluctuations under the prosthetic foot when using an articulating hydraulic ankle attachment compared to fixed attachment.

yesBackground Disruptions to the progress of the centre-of-pressure trajectory beneath prosthetic feet have been reported previously. These disruptions reflect how body weight is transferred over the prosthetic limb and are governed by the compliance of the prosthetic foot device and its ability to simulate ankle function. This study investigated whether using an articulating hydraulic ankle attachment attenuates centre-of-pressure trajectory fluctuations under the prosthetic foot compared to a fixed attachment. Methods Twenty active unilateral trans-tibial amputees completed walking trials at their freely-selected, comfortable walking speed using both their habitual foot with either a rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment. Centre-of-pressure displacement and velocity fluctuations beneath the prosthetic foot, prosthetic shank angular velocity during stance, and walking speed were compared between foot conditions. Findings Use of the hydraulic device eliminated or reduced the magnitude of posteriorly directed centre-of-pressure displacements, reduced centre-of-pressure velocity variability across single-support, increased mean forward angular velocity of the shank during early stance, and increased freely chosen comfortable walking speed (P ≤ 0.002). Interpretation The attenuation of centre-of-pressure trajectory fluctuations when using the hydraulic device indicated bodyweight was transferred onto the prosthetic limb in a smoother, less faltering manner which allowed the centre of mass to translate more quickly over the foot

Toe clearance when walking in people with unilateral transtibial amputation: Effects of passive hydraulic ankle

YesMost clinically available prosthetic feet have a rigid attachment or incorporate an “ankle” device allowing elastic articulation during stance, with the foot returning to a “neutral” position at toe-off. We investigated whether using a foot with a hydraulically controlled articulating ankle that allows the foot to be relatively dorsiflexed at toe-off and throughout swing would increase minimum toe clearance (MTC). Twenty-one people with unilateral transtibial amputation completed overground walking trials using their habitual prosthetic foot with rigid or elastic articulating attachment and a foot with a hydraulic ankle attachment (hyA-F). MTC and other kinematic variables were assessed across multiple trials. When using the hyA-F, mean MTC increased on both limbs (p= 0.03). On the prosthetic limb this was partly due to the device being in its fully dorsiflexed position at toe-off, which reduced the “toes down” foot angle throughout swing (p = 0.01). Walking speed also increased when using the hyA-F (p = 0.001) and was associated with greater swing-limb hip flexion on the prosthetic side (p = 0.04), which may have contributed to the increase in mean MTC. Variability in MTC increased on the prosthetic side when using the hyA-F (p = 0.03), but this did not increase risk of tripping

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

A retrospective review of psychosocial outcomes after microprocessor knee prescription

Abstract Study Design: Retrospective Analysis Introduction: Microprocessor knees have been shown to improve gait biomechanics and to reduce the frequency of falls but evidence of their influence on psychosocial health is limited. Objective: To evaluate the change in psychosocial outcome measures when prosthetic users change from a Non-Microprocessor controlled Prosthetic Knee (NMPK) to a Microprocessor-controlled Prosthetic Knee (MPK). Methods: Using validated outcome measures, physical and psychological attributes of 26 MPK users were analysed using data collected at routine appointments. Baseline data were collected using NMPK limbs first then compared to data collected four weeks and six months following initial MPK fitting. Results: A significant improvement of 13.7% in Reintegration to Normal Living Index (RNLI) scores was observed after six months (p=0.001). The PHQ-9 demonstrated a 64.6% significant reduction in the presence of depression-like symptoms after six months of MPK use (p<0.001), including four participants who previously scored highly enough to be diagnosed with major depressive disorder. Frequency of falls reduced significantly as well (p<0.001). Increases in self-selected walking speed were seen in both the 2 Minute Walk and 6 Minute Walk Tests. Conclusions: Significant improvements were seen in all psychosocial outcome measures, indicating participants' psychosocial health improved with the prescription of an MPK despite a lack of clinically important improvements in parallel performance-based outcome measures

A retrospective review of psychosocial outcomes following microprocessor knee prescription

Abstract Study Design: Retrospective Analysis Introduction: Microprocessor knees have been shown to improve gait biomechanics and to reduce the frequency of falls but evidence of their influence on psychosocial health is limited. Objective: To evaluate the change in psychosocial outcome measures when prosthetic users change from a Non-Microprocessor controlled Prosthetic Knee (NMPK) to a Microprocessor-controlled Prosthetic Knee (MPK). Methods: Using validated outcome measures, physical and psychological attributes of 26 MPK users were analysed using data collected at routine appointments. Baseline data were collected using NMPK limbs first then compared to data collected four weeks and six months following initial MPK fitting. Results: A significant improvement of 13.7% in Reintegration to Normal Living Index (RNLI) scores was observed after six months (p=0.001). The PHQ-9 demonstrated a 64.6% significant reduction in the presence of depression-like symptoms after six months of MPK use (p<0.001), including four participants who previously scored highly enough to be diagnosed with major depressive disorder. Frequency of falls reduced significantly as well (p<0.001). Increases in self-selected walking speed were seen in both the 2 Minute Walk and 6 Minute Walk Tests. Conclusions: Significant improvements were seen in all psychosocial outcome measures, indicating participants' psychosocial health improved with the prescription of an MPK despite a lack of clinically important improvements in parallel performance-based outcome measures

Evaluation of the safety, immunogenicity and efficacy of a new live-attenuated lumpy skin disease vaccine in India

ABSTRACTLumpy skin disease (LSD) was reported for the first time in India in 2019 and since then, it has become endemic. Since a homologous (LSD-virus based) vaccine was not available in the country, goatpox virus (GPV)-based heterologous vaccine was authorized for mass immunization to induce protection against LSD in cattle. This study describes the evaluation of safety, immunogenicity and efficacy of a new live-attenuated LSD vaccine developed by using an Indian field strain, isolated in 2019 from cattle. The virus was attenuated by continuous passage (P = 50) in Vero cells. The vaccine (50th LSDV passage in Vero cells, named as Lumpi-ProVacInd) did not induce any local or systemic reaction upon its experimental inoculation in calves (n = 10). At day 30 post-vaccination (pv), the vaccinated animals were shown to develop antibody- and cell-mediated immune responses and exhibited complete protection upon virulent LSDV challenge. A minimum Neethling response (0.018% animals; 5 out of 26,940 animals) of the vaccine was observed in the field trials conducted in 26,940 animals. There was no significant reduction in the milk yield in lactating animals (n = 10108), besides there was no abortion or any other reproductive disorder in the pregnant animals (n = 2889). Sero-conversion was observed in 85.18% animals in the field by day 30 pv