Tuning and Control of Human Locomotion

Mathematical modeling and analysis have been an integral part of legged locomotion research for many years. While models from the very simple inverted pendulum model of walking and the spring-mass model of running to multi-segmental models with numerous muscles across each joint have been used to explore the process of legged locomotion, they are not always sufficient to explain how human locomotion adapts to a changing environment. Using techniques from dynamical and control systems, I : 1) identify the time scales involved in metabolic minimization in running, 2) explore how stability differs between walking and running, 3) develop an algorithm for optimal control in discrete physical systems, and 4) examine the changes in leg mechanics involved in uphill and downhill running. For the first project, I use ideas from control systems to identify the processes involved in metabolic minimization in running. For the second project, I use ideas of orbital and local stability, measured using Floquet multipliers and finite time Lyapunov exponents, to try to quantify dynamic stability in walking and running at preferred and transition speeds. For the third project, I define a new method for the constrained optimization problem underlying Discrete Mechanics in Optimal Control. For the fourth project, I use a control systems approach to examine the changes in leg dynamics from level to uphill and downhill running. By exploring the adaptations that occur with changing environment, I hope to reveal the mechanisms, and possibly some of the strategies, that lead to stable locomotion

Higher Quality at Lower Cost: Community Health Worker Interventions in the Health Care Innovation Awards

Background: Published evidence regarding cost savings, reduced utilization, and improved quality associated with employing community health workers (CHWs) is largely lacking. This paper presents findings from the Centers for Medicare & Medicaid Services Health Care Innovation Awards (HCIA), with a focus on six diverse programs that employ CHWs. We examine outcomes associated with programs incorporating CHWs into care teams for a broad age range of patients with various health issues such as cancer, asthma, and complex conditions. Methods: This mixed-methods study used data from claims and site visits to assess the effectiveness of CHW programs. In difference-in-differences analyses of Medicare fee-for-service and Medicaid claims, we compared utilization and spending for beneficiaries participating in each CHW program with propensity score matched non-participant beneficiaries for baseline (2010 – 2012) and post-intervention (2013 – 2016). We adjusted for geographic area, prior utilization, and clinical and sociodemographic characteristics. We assessed changes in care quality through beneficiary focus groups and interviews with program leadership and staff. Results: Five of the six programs saw a significant reduction in utilization and/or spending relative to a comparison group, and all programs had positive qualitative findings regarding quality of care. In three of the six programs, the adjusted total cost of care was significantly reduced (-$143 to -$2,044 per beneficiary quarter). We hypothesize that some reductions in spending can be attributed to CHWs’ provision of enhanced access outside of regular clinic hours, which facilitated patient adherence to evidence-based treatment pathways and averted unnecessary ED visits and hospitalizations. Culturally competent CHW encounters engaged patients in health care decisions, generated confidence in their decisions, encouraged adherence to treatment pathways, and mitigated social barriers to care. Conclusions: Programs were associated with improved quality and reductions in health care utilization and spending up to $20,000 per patient over the three-year period. Findings suggest a strong business case for the use of CHWs as part of interdisciplinary teams as CHW programs can provide a significant return on investment for payers. Reimbursement policies that do not account for the services of non-clinical staff such as CHWs impede the sustainability and spread of these interventions, despite mounting evidence of CHWs’ effectiveness. Organizations looking to integrate CHWs into care delivery may conduct feasibility assessments of available workforce and the capacity for clinical oversight, physician buy-in, and funding sustainability. Established programs could be leveraged for mentorship

Bacteria and Competing Herbivores Weaken Top–Down and Bottom–Up Aphid Suppression

Herbivore suppression is mediated by both plant defenses and predators. In turn, plant defenses are impacted by soil fertility and interactions with soil bacteria. Measuring the relative importance of nutritional and microbial drivers of herbivore resistance has proven problematic, in part because it is difficult to manipulate soil-bacterial community composition. Here, we exploit variation in soil fertility and microbial biodiversity across 20 farms to untangle suppression of aphids (Brevicoryne brassicae) through bottom–up and top–down channels. We planted Brassica oleracea plants in soil from each farm, manipulated single and dual infestations of aphids alone or with caterpillars (Pieris rapae), and exposed aphids to parasitoid wasps (Diaeretiella rapae) in the open field. We then used multi-model inference to identify the strongest soil-based predictors of herbivore growth and parasitism. We found that densities of Bacillus spp., a genus known to include plant-growth-promoting rhizobacteria, negatively correlated with aphid suppression by specialist parasitoids. Aphid parasitism also was disrupted on plants that had caterpillar damage, compared to plants attacked only by aphids. Relative abundance of Pseudomonas spp. bacteria correlated with higher aphid growth, although this appeared to be a direct effect, as aphid parasitism was not associated with this group of bacteria. Non-pathogenic soil bacteria are often shown to deliver benefits to plants, improving plant nutrition and the deployment of anti-herbivore defenses. However, our results suggest that these plant growth-promoting bacteria may also indirectly weaken top–down aphid suppression by parasitoids and directly improve aphid performance. Against a background of varying soil fertility, microbial biodiversity, competing herbivores, and natural enemies, we found that effects of non-pathogenic soil microbes on aphid growth outweighed those of nutritional factors. Therefore, predictions about the strength of plant defenses along resource gradients must be expanded to include microbial associates

Lessons from the Health Care Innovation Awards: Productively Engaging Vulnerable Populations to Address Social Determinants of Health

Objectives: This paper examines productive interactions—a cornerstone of the Chronic Care Model—between health care providers and vulnerable populations with chronic illnesses and/or disabilities. Methods: We conducted qualitative analysis of 16 focus groups and 29 interviews with patients and/or caregivers and 195 interviews with program leadership and providers across 15 Health Care Innovation Awards that targeted vulnerable populations. We analyzed how awardees addressed health concerns and social determinants of health (SDOH), and identified key components of productive interactions. Results: Providers achieved productive interactions through four primary strategies: establishing trust and showing respect; solving problems; building accuracy in health information exchange; and sharing accountability and responsibility. While providers sought cooperation from patients and caregivers for medical goals, they often addressed SDOH priorities. Discussion: Strategies tailored to vulnerable populations can enable shared decision-making and effective self-care. A nonjudgmental engagement style, accurate information, and consistent communication are important for patient engagement

The gut microbiome: a key player in the complexity of amyotrophic lateral sclerosis (ALS)

Background Much progress has been made in mapping genetic abnormalities linked to amyotrophic lateral sclerosis (ALS), but the majority of cases still present with no known underlying cause. Furthermore, even in families with a shared genetic abnormality there is significant phenotypic variability, suggesting that non-genetic elements may modify pathogenesis. Identification of such disease-modifiers is important as they might represent new therapeutic targets. A growing body of research has begun to shed light on the role played by the gut microbiome in health and disease with a number of studies linking abnormalities to ALS. Main body The microbiome refers to the genes belonging to the myriad different microorganisms that live within and upon us, collectively known as the microbiota. Most of these microbes are found in the intestines, where they play important roles in digestion and the generation of key metabolites including neurotransmitters. The gut microbiota is an important aspect of the environment in which our bodies operate and inter-individual differences may be key to explaining the different disease outcomes seen in ALS. Work has begun to investigate animal models of the disease, and the gut microbiomes of people living with ALS, revealing changes in the microbial communities of these groups. The current body of knowledge will be summarised in this review. Advances in microbiome sequencing methods will be highlighted, as their improved resolution now enables researchers to further explore differences at a functional level. Proposed mechanisms connecting the gut microbiome to neurodegeneration will also be considered, including direct effects via metabolites released into the host circulation and indirect effects on bioavailability of nutrients and even medications. Conclusion Profiling of the gut microbiome has the potential to add an environmental component to rapidly advancing studies of ALS genetics and move research a step further towards personalised medicine for this disease. Moreover, should compelling evidence of upstream neurotoxicity or neuroprotection initiated by gut microbiota emerge, modification of the microbiome will represent a potential new avenue for disease modifying therapies. For an intractable condition with few current therapeutic options, further research into the ALS microbiome is of crucial importance

Circulating 25-Hydroxyvitamin D and the Risk of Rarer Cancers: Design and Methods of the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers

The Cohort Consortium Vitamin D Pooling Project of Rarer Cancers (VDPP), a consortium of 10 prospective cohort studies from the United States, Finland, and China, was formed to examine the associations between circulating 25-hydroxyvitamin D (25(OH)D) concentrations and the risk of rarer cancers. Cases (total n = 5,491) included incident primary endometrial (n = 830), kidney (n = 775), ovarian (n = 516), pancreatic (n = 952), and upper gastrointestinal tract (n = 1,065) cancers and non-Hodgkin lymphoma (n = 1,353) diagnosed in the participating cohorts. At least 1 control was matched to each case on age, date of blood collection (1974–2006), sex, and race/ethnicity (n = 6,714). Covariate data were obtained from each cohort in a standardized manner. The majority of the serum or plasma samples were assayed in a central laboratory using a direct, competitive chemiluminescence immunoassay on the DiaSorin LIAISON platform (DiaSorin, Inc., Stillwater, Minnesota). Masked quality control samples included serum standards from the US National Institute of Standards and Technology. Conditional logistic regression analyses were conducted using clinically defined cutpoints, with 50–<75 nmol/L as the reference category. Meta-analyses were also conducted using inverse-variance weights in random-effects models. This consortium approach permits estimation of the association between 25(OH)D and several rarer cancers with high accuracy and precision across a wide range of 25(OH)D concentrations

Endocytic regulation of alkali metal transport proteins in mammals, yeast and plants

The relative concentrations of ions and solutes inside cells are actively maintained by several classes of transport proteins, in many cases against their concentration gradient. These transport processes, which consume a large portion of cellular energy, must be constantly regulated. Many structurally distinct families of channels, carriers, and pumps have been characterized in considerable detail during the past decades and defects in the function of some of these proteins have been linked to a growing list of human diseases. The dynamic regulation of the transport proteins present at the cell surface is vital for both normal cellular function and for the successful adaptation to changing environments. The composition of proteins present at the cell surface is controlled on both the transcriptional and post-translational level. Post-translational regulation involves highly conserved mechanisms of phosphorylation- and ubiquitylation-dependent signal transduction routes used to modify the cohort of receptors and transport proteins present under any given circumstances. In this review, we will summarize what is currently known about one facet of this regulatory process: the endocytic regulation of alkali metal transport proteins. The physiological relevance, major contributors, parallels and missing pieces of the puzzle in mammals, yeast and plants will be discussed.This work was supported by grant BFU2011-30197-C03-03 from the Ministerio de Ciencia e Innovacion (Spain). V.L.-T. is supported by a fellowship from the Universidad Politecnica de Valencia. C. P. is supported by a fellowship from the Consejo Superior de Investigaciones Cientificas (Spain).Mulet Salort, JM.; Llopis Torregrosa, V.; Primo Planta, C.; Marques Romero, MC.; Yenush, L. (2013). 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The death-dealing smog over Donora, Pennsylvania : Industrial air pollution, public health, and federal policy, 1915-1963

An air pollution disaster over the two southwestern Pennsylvania towns of Donora and Webster in October 1948 took dozens of lives, left thousands literally gasping for breath, and motivated the United States Public Health Service (PHS) to enter the arena of air pollution policy. This dissertation explores how investigations of Donora\u27s smog reflected and contributed to the power of manufacturing interests over environmental and public health conditions and to the emergence of federal environmental health policy after World War Two. Outside of the Donora region, the episode symbolized the excesses of post-1945 economic growth which were already visible in southern California\u27s eye-stinging haze. For public health professionals, government officials, and industrial managers, the smog focused attention on the freshly perceived threat that air pollution posed to public health. Near Donora, smog explanations were shaped by controversy regarding the role of a zinc smelter in contributing to the disaster. Decades of litigation over damages attributed to the mill, and preparation for suits anticipated after the smog, transformed PHS activities in Donora into an illuminating case study of the science and politics of interpreting a disaster and assigning responsibility. Following a narrative overview of the disaster itself, chapters are arranged chronologically from the first years of the smelter\u27s operations (1915) to the passage of the 1963 Clean Air Act, which established a permanent federal air pollution program under the aegis of the PHS. Industrial manufacturers used the production of expertise about Donora to frame public discussion about air pollution. This strategy benefitted from a shift in federal policy that would direct public health resources toward the subsidy of scientific research rather than support for public health programs. Donora\u27s legacy became that of a freak of Nature, an instance where weather and topography concentrated air pollution to hazardous levels, rather than of a warning sign about the threat that industrial deterioration posed to working-class communities like Donora and Webster

Shameless Magazine: Making It To 10 Years And Beyond, Revenue Strategies For Small Magazines

Shameless magazine is a Canadian magazine for teen girls and transgender (“trans”) youth. Its first issue was published in June 2004 with the aim to be an alternative to what was offered in the mainstream media for young women, to fill a perceived gap in the magazine racks. Shameless is entering its tenth year of publishing in June 2014. It hangs by a thread financially, and even though its editorial voice has grown and flourished over the years, the mechanics of funding and financing the publication have not. This report summarizes the history of Shameless magazine, and is the only account on paper to date. It identifies the need for more revenue as a major and immediate need, and surveys four main sources of revenue for magazines: circulation, advertising, grants, and donations, with discussion on how each of these applies, or does not yet apply, to Shameless magazine. The result of this analysis and reflection on the history of the magazine is a set of nine recommendations to guide the magazine in building and maintaining financial stability. Shameless contributes an important voice to Canadian media, and with careful focus on the most suitable revenue streams it will continue to publish for years to come

The death-dealing smog over Donora, Pennsylvania : Industrial air pollution, public health, and federal policy, 1915-1963

An air pollution disaster over the two southwestern Pennsylvania towns of Donora and Webster in October 1948 took dozens of lives, left thousands literally gasping for breath, and motivated the United States Public Health Service (PHS) to enter the arena of air pollution policy. This dissertation explores how investigations of Donora\u27s smog reflected and contributed to the power of manufacturing interests over environmental and public health conditions and to the emergence of federal environmental health policy after World War Two. Outside of the Donora region, the episode symbolized the excesses of post-1945 economic growth which were already visible in southern California\u27s eye-stinging haze. For public health professionals, government officials, and industrial managers, the smog focused attention on the freshly perceived threat that air pollution posed to public health. Near Donora, smog explanations were shaped by controversy regarding the role of a zinc smelter in contributing to the disaster. Decades of litigation over damages attributed to the mill, and preparation for suits anticipated after the smog, transformed PHS activities in Donora into an illuminating case study of the science and politics of interpreting a disaster and assigning responsibility. Following a narrative overview of the disaster itself, chapters are arranged chronologically from the first years of the smelter\u27s operations (1915) to the passage of the 1963 Clean Air Act, which established a permanent federal air pollution program under the aegis of the PHS. Industrial manufacturers used the production of expertise about Donora to frame public discussion about air pollution. This strategy benefitted from a shift in federal policy that would direct public health resources toward the subsidy of scientific research rather than support for public health programs. Donora\u27s legacy became that of a freak of Nature, an instance where weather and topography concentrated air pollution to hazardous levels, rather than of a warning sign about the threat that industrial deterioration posed to working-class communities like Donora and Webster