Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: a systematic review

Abstract Background: Robotic exoskeletons have been developed to assist locomotion and address gait abnormalities in children with cerebral palsy (CP). These wearable assistive devices provide powered assistance to the lower-extremity joints, as well as support and stability. Research Question: Does exoskeleton-assisted walking improve gait in children with CP? Methods: The PRISMA guidelines were used to conduct this systematic review. Articles were obtained in a search of the following electronic databases: Embase, CINAHL Complete, PubMed, Web of Science and MEDLINE. Studies investigating spatiotemporal, kinematic, kinetic, muscle activity and/or physiological parameters during exoskeleton-assisted walking in children with CP were included. All articles were assessed for methodological quality using an adapted version of the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group, provided by NIH. Results: Thirteen studies were included. They involved the use of the following exoskeletons: tethered knee exoskeleton, pediatric knee exoskeleton (P.REX), untethered ankle exoskeleton, WAKE-Up ankle module, WAKE-Up ankle & knee module and unilateral ankle exosuit. Methodological quality varied, with key limitations in sample size and allocated time to adapt to the exoskeleton. There was a consensus that robotic exoskeletons improve gait given careful optimisation of exoskeleton torque and sufficient exoskeleton practice time for each participant. Improvements in gait included reduced metabolic cost of walking, increased walking speed, and increased knee and hip extension during stance. Furthermore, exoskeletons with an actuated ankle module were shown to promote normal ankle rocker function. Significance: Robotic exoskeletons have the potential to improve the mobility of CP children and may therefore increase community participation and improve quality of life. Future work should involve larger controlled intervention studies utilising robotic exoskeletons to improve gait in children with CP. These studies should ensure sufficient exoskeleton practice time for each participant

Relative contribution of multiple stressors on copepod density and diversity dynamics in the Belgian part of the North Sea

The effect of multiple stressors on marine ecosystems is poorly understood. To partially bridge this knowledge gap we investigated the relative contribution of environmental variables to density and diversity dynamics of the zooplankton community in the Belgian part of the North Sea. We applied multimodel inference on generalized additive models to quantify the relative contribution of chlorophyll a, temperature, nutrients, salinity and anthropogenic chemicals (i.e. polychlorinated biphenyls and polycyclic aromatic hydrocarbons) to the dynamics of calanoid copepod species in the Belgian part of the North Sea. Temperature was the only predictor consistently showing a high importance in all models predicting the abundances of the selected copepod species. The relative contribution of other predictors was species-dependent. Anthropogenic chemicals were important predictors for three out of six species indicating that chemical mixtures at low concentrations should not be left unattended when performing risk assessments in a natural environment

Sex-biased mortality of common terns in wind farm collisions

We studied sex differences in collision mortality in adult Common Terns (Sterna hirundo) at a wind farm in the direct vicinity of a breeding site in Zeebrugge, Belgium in 2005-2007. In total, 64 fatalities were collected and sexed, of which 64% were males. Uneven sex ratio among these birds was most pronounced during the period of incubation and early chick feeding (15 May-15 June), when 78% of the 28mortalities were male. During prelaying and feeding of young, the sex ratio of mortalities did not differ from equality. We argue that sex-biased collision mortality in Common Terns does not result from morphological differences between the sexes, but rather reflects differences in foraging frequency between males and females during egg-laying and incubation

Breed differences in the pharmacokinetics of ivermectin administered subcutaneously to Holstein and Belgian Blue calves

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Latent profiles of telehealth care satisfaction during the COVID-19 pandemic among patients with cardiac conditions in an outpatient setting

BackgroundDuring the COVID-19 pandemic, telemedicine was advocated and rapidly scaled up worldwide. However, little is known about for whom this type of care is acceptable.ObjectiveTo examine which patient characteristics (demographic, medical, psychosocial) are associated with telehealth care satisfaction, attitude toward telehealth, and preference regarding telehealth over time in a cardiac patient population.MethodsIn total, 317 patients were recruited at the Elisabeth-TweeSteden Hospital in The Netherlands. All patients who had received telehealth care (telephone and video) in the previous 2 months were approached for participation. Baseline, 3-month, and 6-month questionnaires were administered online. A 3-step latent class analysis was conducted to identify trajectories of telehealth use over time and the possible association of the found trajectories with external variables.ResultsFive trajectories (classes) were identified for satisfaction with telehealth and 4 for attitude toward telehealth. Patients with higher distress, lower physical and mental health, higher scores on pessimism, and negative affectivity were more likely to be less satisfied. Patients with no partner, more comorbidities, higher distress, lower physical and mental health, and higher scores on pessimism were more likely to hold a negative attitude toward telehealth. For the future application of telehealth, marital status, comorbidities, digital health literacy, and pessimism were significantly related.ConclusionResults show that patients’ profiles should be considered when offering telehealth care and that the “one size fits all” approach does not apply. Results can inform clinical practice on how to better implement remote health care in the future while considering a personalized approach.<br/

Modeling effects of rumination on free recall using ACT-R

Ruminative thinking, characterized by a recurrent focus on negative and self-related thought, is a key cognitive vulnerability marker of depression and, therefore, a key individual difference variable. This study aimed to develop a computational cognitive model of rumination focusing on the organization and retrieval of information in memory, and how these mechanisms differ in individuals prone to rumination and individuals less prone to rumination. Adaptive Control of Thought-Rational (ACT-R) was used to develop a rumination model by adding memory chunks with negative valence to the declarative memory. In addition, their strength of association was increased to simulate recurrent negative focus, thereby making it harder to disengage from. The ACT-R models were validated by comparing them against two empirical datasets containing data from control and depressed participants. Our general and ruminative models were able to recreate the benchmarks of free recall while matching the behavior exhibited by the control and the depressed participants, respectively. Our study shows that it is possible to build a computational theory of rumination that can accurately simulate the differences in free recall dynamics between control and depressed individuals. Such a model could enable a more fine-tuned investigation of underlying cognitive mechanisms of depression and potentially help to improve interventions by allowing them to more specifically target key mechanisms that instigate and maintain depression

Multimodel inference to quantify the relative importance of abiotic factors in the population dynamics of marine zooplankton

The effect of multiple stressors on marine ecosystems remains poorly understood and most of the knowledge available is related to phytoplankton. To partly address this knowledge gap, we tested if combining multimodel inference with generalized additive modelling could quantify the relative contribution of environmental variables on the population dynamics of a zooplankton species in the Belgian part of the North Sea. Hence, we have quantified the relative contribution of oceanographic variables (e.g. water temperature, salinity, nutrient concentrations, and chlorophyll a concentrations) and anthropogenic chemicals (i.e. polychlorinated biphenyls) to the density of Acartia clausi. We found that models with water temperature and chlorophyll a concentration explained ca. 73% of the population density of the marine copepod. Multimodel inference in combination with regression-based models are a generic way to disentangle and quantify multiple stressor-induced changes in marine ecosystems. Future–oriented simulations of copepod densities suggested increased copepod densities under predicted environmental changes

Seasonal and spatial fatty acid profiling of the calanoid copepods <i>Temora longicornis</i> and <i>Acartia clausi</i> linked to environmental stressors in the North Sea

The Belgian part of the North Sea (BPNS) is subjected to multiple environmental stressors. The impact of these stressors includes the modulation of fatty acid (FA) composition of the zooplankton. This study recorded temporal and spatial patterns of the FA profiles of two dominant calanoid copepods within the BPNS: Temora longicornis (Müller, 1785) and Acartia clausi (Giesbrecht, 1889). By means of distance-based linear modelling and by applying multi model inference to generalized additive models, environmental stressors were linked to patterns of the FA profiles of these species. The FA profiles of A. clausi and T. longicornis showed distinct intraspecific, spatial and temporal differences within the BPNS. Temperature and algal food quality (marked by the ratio of silicate concentration to dissolved inorganic nitrogen concentration, SiO4/DIN) were the most important drivers of seasonal fluctuations in the DHA/EPA ratio of both species. DHA/EPA ratio can be used as marker for stress in copepods in the BPNS in order to have a quick indication of food quality changes at the basis of the food web