Implications of material selection on the design of packaging machinery.

Material selection has significant implications on the design and cost of horizontal-form-fill-seal packaging machinery. To avoid excessive costs, machine redesigns and project delays, material selection must be reconciled early in the project and revisited throughout the construction of the machine.

The challenges of diabetes and older adults.

Diabetes is a chronic illness that affects a disproportionate number of older adults and members of ethnic minorities. It is an illness that requires long-term active patient participation to maintain metabolic control and challenges both the patient and health care provider. The need for the patient to carry out daily self-care behaviors is no less important simply because the person is older. Older adults, however, experience unique challenges because of the physical and functional changes that may be imposed by the aging process and the prevalence of multiple chronic illnesses and complications. Because diabetes self-care is carried out within the context of all aspects of a person's life, it is important, then, for the health professional to recognize these social, functional, and psychological challenges. All aspects of physical, functional, and psychosocial status need to be taken into account, and diabetes education needs to be provided based on jointly identified goals, interests, abilities, and needs.

Energy expenditure in patients with low-, mid-, or high-thoracic paraplegia using Scott-Craig knee-ankle-foot orthoses.

Renewed interest in ambulation in patients with paraplegia prompted us to measure the energy expenditure (kcal/kg per min) during standing and ambulating with the Scott-Craig orthosis in nine patients who had low-, mid-, or high-thoracic paraplegia. Energy expenditure during standing and during ambulation with a walker was similar for patients with all levels of paraplegia. In patients with high-thoracic paraplegia, energy efficiency was significantly less (P less than 0.05) than that for patients with mid- or low-thoracic paraplegia, whose efficiency levels were similar. In patients with low-thoracic paraplegia, the only patients who could perform swing-through gait patterns, energy efficiency was increased because of increased velocity. Our data do not support the concept of denying, on the basis of the level of the lesion alone, young, otherwise healthy, well-motivated patients with thoracic paraplegia the opportunity of using Scott-Craig orthoses to supplement wheelchair mobility and activities of daily living.

Paraplegic energy expenditure during negotiation of architectural barriers.

Long-leg braces are often used by persons with paraplegia to negotiate architectural barriers, and thereby increase their wheelchair mobility. Such barriers include ramps, stairways, and narrow corridors requiring multiple turns. This study was designed to measure the energy expenditure during such activities for two long-leg orthoses: standard braces without a dorsiflexion stop and Scott-Craig braces. Energy expenditure was measured in eight subjects by indirect spirometry using Douglas bag collection and Haldane analysis. Data obtained were used to calculate oxygen consumption per minute, volume of oxygen per turn, step, or meter, and calories per minute during each activity. Using Scott-Craig braces on one day and standard braces on another day, each subject negotiated five 90 degrees turns and two 180 degree turns, ten 15.24 cm steps, both up and down, and an 11.9 m ramp inclined 12 degrees, both up and down. Milliliters of oxygen consumed per kilogram of body weight per turn, step, or meter were recorded for Scott-Craig braces, standard braces, and normal walking. All of these activities required a high expenditure of energy. No significant difference was apparent between the standard and the Scott-Craig braces for any activity.

Energy expenditure of paraplegic patients standing and walking with two knee-ankle-foot orthoses.

To determine which kind of knee-ankle-foot orthosis (KAFO) is more efficient, we measured energy expenditure in standing, walking with a walker, and walking with crutches by eight subjects using the Scott-Craig KAFO and a single-stopped long-leg KAFO. All subjects had complete motor paralysis below the level of their lesion and had been fully trained to use KAFOs. Every subject used both types of KAFO, and energy expenditure--per minute and per meter traveled--was measured by oxygen consumption. No significant difference in energy expenditure appeared during standing. During ambulation, however, mean energy expenditure was less with the Scott-Craig KAFO than with the single-stopped type: 31% less kcal/m with a walker and 25% less kcal/min with crutches. These results suggest that the Scott-Craig KAFO is more energy-efficient than the single-stopped long-leg KAFO.