Systematic Assessment of Prosthesis Stiffness on User Biomechanics Using the Lower Leg Trajectory Error Framework and Its Implication for the Design and Evaluation of Ankle-Foot Prostheses.

Advances in understanding the effects the mechanical characteristics of prosthetic feet on user biomechanics have enabled passive prostheses to improve the walking pattern of people with lower limb amputation. However, there is no consensus on the design methodology and criteria required to maximize specific user outcomes and fully restore their mobility. The Lower Leg Trajectory Error (LLTE) framework is a novel design methodology based on the replication of lower leg dynamics. The LLTE value evaluates how closely a prosthetic foot replicates a target walking pattern. Designing a prosthesis that minimizes the LLTE value, optimizes its mechanical function to enable users to best replicate the target lower leg trajectory. Here, we conducted a systematic sensitivity investigation of LLTE-optimized prostheses. Five people with unilateral transtibial amputation walked overground at self-selected speeds using five prototype energy storage and return feet with varying LLTE values. The prototypes' LLTE values were varied by changing the stiffness of the participant's LLTE-optimized design by 60%, 80%, 120%, and 167%. Users most closely replicated the target able-bodied walking pattern with the LLTE-optimized stiffness, experimentally demonstrating that the predicted optimum was a true optimum. Additionally, the predicted LLTE values were correlated to the user's ability to replicate the target walking pattern, user preferences, and clinical outcomes including roll-over geometries, trunk sway, prosthetic energy return, and peak push-off power. This study further validates the use of the LLTE framework as a predictive and quantitative tool for designing and evaluating prosthetic feet.

Experimental Demonstration of the Lower Leg Trajectory Error Framework Using Physiological Data as Inputs.

While many studies have attempted to characterize the mechanical behavior of passive prosthetic feet to understand their influence on amputee gait, the relationship between mechanical design and biomechanical performance has not yet been fully articulated from a fundamental physics perspective. A novel framework, called lower leg trajectory error (LLTE) framework, presents a means of quantitatively optimizing the constitutive model of prosthetic feet to match a reference kinematic and kinetic dataset. This framework can be used to predict the required stiffness and geometry of a prosthesis to yield a desired biomechanical response. A passive prototype foot with adjustable ankle stiffness was tested by a unilateral transtibial amputee to evaluate this framework. The foot condition with LLTE-optimal ankle stiffness enabled the user to replicate the physiological target dataset within 16% root-mean-square (RMS) error. Specifically, the measured kinematic variables matched the target kinematics within 4% RMS error. Testing a range of ankle stiffness conditions from 1.5 to 24.4 N·m/deg with the same user indicated that conditions with lower LLTE values deviated the least from the target kinematic data. Across all conditions, the framework predicted the horizontal/vertical position, and angular orientation of the lower leg during midstance within 1.0 cm, 0.3 cm, and 1.5 deg, respectively. This initial testing suggests that prosthetic feet designed with low LLTE values could offer benefits to users. The LLTE framework is agnostic to specific foot designs and kinematic/kinetic user targets, and could be used to design and customize prosthetic feet.

The Effects of the Inertial Properties of Above-Knee Prostheses on Optimal Stiffness, Damping, and Engagement Parameters of Passive Prosthetic Knees.

Our research aims to design low-cost, high-performance, passive prosthetic knees for developing countries. In this study, we determine optimal stiffness, damping, and engagement parameters for a low-cost, passive prosthetic knee that consists of simple mechanical elements and may enable users to walk with the normative kinematics of able-bodied humans. Knee joint power was analyzed to divide gait into energy-based phases and select mechanical components for each phase. The behavior of each component was described with a polynomial function, and the coefficients and polynomial order of each function were optimized to reproduce the knee moments required for normative kinematics of able-bodied humans. Sensitivity of coefficients to prosthesis mass was also investigated. The knee moments required for prosthesis users to walk with able-bodied normative kinematics were accurately reproduced with a mechanical system consisting of a linear spring, two constant-friction dampers, and three clutches (R2=0.90 for a typical prosthetic leg). Alterations in upper leg, lower leg, and foot mass had a large influence on optimal coefficients, changing damping coefficients by up to 180%. Critical results are reported through parametric illustrations that can be used by designers of prostheses to select optimal components for a prosthetic knee based on the inertial properties of the amputee and his or her prosthetic leg.

Low Atlantic hurricane activity in the 1970s and 1980s compared to the past 270 years.

Hurricane activity in the North Atlantic Ocean has increased significantly since 1995 (refs 1, 2). This trend has been attributed to both anthropogenically induced climate change and natural variability, but the primary cause remains uncertain. Changes in the frequency and intensity of hurricanes in the past can provide insights into the factors that influence hurricane activity, but reliable observations of hurricane activity in the North Atlantic only cover the past few decades. Here we construct a record of the frequency of major Atlantic hurricanes over the past 270 years using proxy records of vertical wind shear and sea surface temperature (the main controls on the formation of major hurricanes in this region) from corals and a marine sediment core. The record indicates that the average frequency of major hurricanes decreased gradually from the 1760s until the early 1990s, reaching anomalously low values during the 1970s and 1980s. Furthermore, the phase of enhanced hurricane activity since 1995 is not unusual compared to other periods of high hurricane activity in the record and thus appears to represent a recovery to normal hurricane activity, rather than a direct response to increasing sea surface temperature. Comparison of the record with a reconstruction of vertical wind shear indicates that variability in this parameter primarily controlled the frequency of major hurricanes in the Atlantic over the past 270 years, suggesting that changes in the magnitude of vertical wind shear will have a significant influence on future hurricane activity.

Taxonomy and morphology of Calciopappus curvus sp. nov. (Syracosphaeraceae, Prymnesiophyceae), a novel appendage-bearing coccolithophore.

Based on scanning electron microscopy observations, a new species of the coccolithophore genus Calciopappus (Syracosphaeraceae, Prymnesiophyceae) is described from the surface waters off Bergen and from the lower photic zone of sub-tropical and tropical waters. Morphological, coccolith rim structure and biometric analyses strongly support separation of this morphotype from the two described Calciopappus species, but inclusion of it within the genus. The new form differs from the other species in being noticeably smaller and in morpho-structural details of each of the three coccolith types that form the coccosphere: (1) the body coccoliths have an open central area; (2) the whorl coccoliths have a wide central opening and two thumb-like protrusions; and (3) the appendage coccoliths are curved. On this basis, the species is formally described as Calciopappus curvus sp. nov., its systematic affinity is discussed and compared with other extant coccolithophores.

Localized fluidization burrowing mechanics of Ensis directus.

Muscle measurements of Ensis directus, the Atlantic razor clam, indicate that the organism only has sufficient strength to burrow a few centimeters into the soil, yet razor clams burrow to over 70 cm. In this paper, we show that the animal uses the motions of its valves to locally fluidize the surrounding soil and reduce burrowing drag. Substrate deformations were measured using particle image velocimetry (PIV) in a novel visualization system that enabled us to see through the soil and watch E. directus burrow in situ. PIV data, supported by soil and fluid mechanics theory, show that contraction of the valves of E. directus locally fluidizes the surrounding soil. Particle and fluid mixtures can be modeled as a Newtonian fluid with an effective viscosity based on the local void fraction. Using these models, we demonstrate that E. directus is strong enough to reach full burrow depth in fluidized soil, but not in static soil. Furthermore, we show that the method of localized fluidization reduces the amount of energy required to reach burrow depth by an order of magnitude compared with penetrating static soil, and leads to a burrowing energy that scales linearly with depth rather than with depth squared.

Biomechanical evaluation over level ground walking of user-specific prosthetic feet designed using the lower leg trajectory error framework.

The walking pattern and comfort of a person with lower limb amputation are determined by the prosthetic foot's diverse set of mechanical characteristics. However, most design methodologies are iterative and focus on individual parameters, preventing a holistic design of prosthetic feet for a user's body size and walking preferences. Here we refined and evaluated the lower leg trajectory error (LLTE) framework, a novel quantitative and predictive design methodology that optimizes the mechanical function of a user's prosthesis to encourage gait dynamics that match their body size and desired walking pattern. Five people with unilateral below-knee amputation walked over-ground at self-selected speeds using an LLTE-optimized foot made of Nylon 6/6, their daily-use foot, and a standardized commercial energy storage and return (ESR) foot. Using the LLTE feet, target able-bodied kinematics and kinetics were replicated to within 5.2% and 13.9%, respectively, 13.5% closer than with the commercial ESR foot. Additionally, energy return and center of mass propulsion work were 46% and 34% greater compared to the other two prostheses, which could lead to reduced walking effort. Similarly, peak limb loading and flexion moment on the intact leg were reduced by an average of 13.1%, lowering risk of long-term injuries. LLTE-feet were preferred over the commercial ESR foot across all users and preferred over the daily-use feet by two participants. These results suggest that the LLTE framework could be used to design customized, high performance ESR prostheses using low-cost Nylon 6/6 material. More studies with large sample size are warranted for further verification.

Knee Swing Phase Flexion Resistance Affects Several Key Features of Leg Swing Important to Safe Transfemoral Prosthetic Gait.

We systematically investigate in-vivo the effect of increasing prosthetic knee flexion damping on key features of the swing phase of individuals with transfemoral amputation during walking. Five experienced prosthesis users walked using a prototype device in a motion capture laboratory. A range of interchangeable hydraulic rotary dampers was used to progressively modify swing phase flexion resistance in isolation. Toe clearance (TC; vertical distance toe to floor), effective leg length (ELL; distance hip to toe), and knee flexion angle during swing phase were computed, alongside the sensitivities of vertical toe position to angular displacements at the hip, knee and ankle. Key features of these profiles were compared across 5 damping conditions. With higher damping, knee extension occurred earlier in swing phase, promoting greater symmetry. However, with implications for toe catch, minimum TC reduced, and minimum TC and maximum ELL occurred earlier; temporally closer to mid-swing, when the limb must pass the stance limb. Further, TC became less sensitive to changes in hip flexion, suggesting a lesser ability to control toe clearance without employing proximal or contralateral compensations. There is a trade-off between key features related to gait safety when selecting an appropriate resistance for a mechanical prosthetic knee. In addition to highlighting broader implications surrounding swing phase damping selection for the optimization of mechanical knees, this work reveals design considerations that may be of utility in the formulation of control strategies for computerized devices.

Initiation of a stable convective hydroclimatic regime in Central America circa 9000 years BP.

Many Holocene hydroclimate records show rainfall changes that vary with local orbital insolation. However, some tropical regions display rainfall evolution that differs from gradual precessional pacing, suggesting that direct rainfall forcing effects were predominantly driven by sea-surface temperature thresholds or inter-ocean temperature gradients. Here we present a 12,000 yr continuous U/Th-dated precipitation record from a Guatemalan speleothem showing that Central American rainfall increased within a 2000 yr period from a persistently dry state to an active convective regime at 9000 yr BP and has remained strong thereafter. Our data suggest that the Holocene evolution of Central American rainfall was driven by exceeding a temperature threshold in the nearby tropical oceans. The sensitivity of this region to slow changes in radiative forcing is thus strongly mediated by internal dynamics acting on much faster time scales.

A novel, efficient 3D-printing based manufacturing process for custom ocular prostheses.

Ocular prostheses are part of a substantial global market for ocular implants. However, demand for custom ocular prostheses (COPs) can outpace supply at clinics due to the slow pace of prosthesis manufacturing and limited supply of ocularists, particularly in emerging markets such as India. Existing manufacturing methods for COPs involve multiple stages of casting and molds with limited quality control, resulting in time-intensive trial and error with patients to achieve a comfortable fit. Through collaboration with the LV Prasad Eye Institute (LVPEI) in India, the authors improved manufacturing process efficiency for COPs and without significantly increasing cost or decreasing customizability. A time study of the current process showed that no single step was a dominant contributor to process time, necessitating a holistic change to the manufacturing process. The modified process uses dip coating of a 3D printed internal body made from a scanned impression. Based on a timed experimental trial, the modified process has a projected daily COP production rate increase of 100% compared to the existing process. A study of produced COP quality showed accumulated error of critical dimensions within reasonable limits, with the greatest error being less than 65% of maximum acceptable error.Note: no experiments on human or animal subjects were carried out in the writing of this paper.

A Novel Framework for Quantitatively Connecting the Mechanical Design of Passive Prosthetic Feet to Lower Leg Trajectory.

This paper presents a novel framework that quantitatively connects the mechanical design of a prosthetic foot to its anticipated biomechanical performance. The framework uses kinetic inputs (ground reaction forces and center of pressure) to predict kinematic outputs of the lower leg segment by knowing the geometry and stiffness of the foot. The error between the predicted and target kinematics is evaluated using a root-mean-square error function called the Lower Leg Trajectory Error (LLTE). Using physiological kinetic inputs and kinematic targets, three model foot architectures were optimized to minimize the LLTE. The resulting predicted lower leg kinematics were compared to those of the same foot architectures optimized for physiological roll-over geometry. The feet with minimized LLTE had lower leg kinematics closer to physiological than those optimized for roll-over geometry. A prosthetic foot that exactly mimics physiological roll-over geometry may result in gait kinematics that differ greatly from physiological, as roll-over geometry omits information about the foot-ground contact constraint, lower leg orientation, and temporal progression of a step. The LLTE-based framework is agnostic to specific foot designs provided their constitutive behavior can be characterized, and it can accept alternate inputs and targets depending on what performance and clinical objectives are desired.

Digital Magnifying Glasses for Low-Vision Learners: Bringing Assistive Technologies to the Developing World.

A student squinting to see the board or holding a textbook inches from his or her nose often provides the first indication of a visual impairment. For most, the cause is a refractive error, readily correctible with eyeglasses. However, for an estimated 40-65 million people globally with functional low vision, the fuzzy words pose a lifelong challenge.

The Effects of Prosthesis Inertial Properties on Prosthetic Knee Moment and Hip Energetics Required to Achieve Able-Bodied Kinematics.

There is a major need in the developing world for a low-cost prosthetic knee that enables users to walk with able-bodied kinematics and low energy expenditure. To efficiently design such a knee, the relationship between the inertial properties of a prosthetic leg and joint kinetics and energetics must be determined. In this paper, using inverse dynamics, the theoretical effects of varying the inertial properties of an above-knee prosthesis on the prosthetic knee moment, hip power, and absolute hip work required for walking with able-bodied kinematics were quantified. The effects of independently varying mass and moment of inertia of the prosthesis, as well as independently varying the masses of each prosthesis segment, were also compared. Decreasing prosthesis mass to 25% of physiological leg mass increased peak late-stance knee moment by 43% and decreased peak swing knee moment by 76%. In addition, it reduced peak stance hip power by 26%, average swing hip power by 76%, and absolute hip work by 22%. Decreasing upper leg mass to 25% of its physiological value reduced absolute hip work by just 2%, whereas decreasing lower leg and foot mass reduced work by up to 22%, with foot mass having the greater effect. Results are reported in the form of parametric illustrations that can be utilized by researchers, designers, and prosthetists. The methods and outcomes presented have the potential to improve prosthetic knee component selection, facilitate able-bodied kinematics, and reduce energy expenditure for users of low-cost, passive knees in developing countries, as well as for users of advanced active knees in developed countries.

Wearable optical-digital assistive device for low vision students.

People with low vision have limited residual vision that can be greatly enhanced through high levels of magnification. Current assistive technologies are tailored for far field or near field magnification but not both. In collaboration with L.V. Prasad Eye Institute (LVPEI), a wearable, optical-digital assistive device was developed to meet the near and far field magnification needs of students. The critical requirements, system architecture and design decisions for each module were analyzed and quantified. A proof-of-concept prototype was fabricated that can achieve magnification up to 8x and a battery life of up to 8 hours. Potential user evaluation with a Snellen chart showed identification of characters not previously discernible. Further feedback suggested that the system could be used as a general accessibility aid.

Low vision system for rapid near- and far-field magnification switching.

People suffering from low vision, a condition caused by a variety of eye-related diseases and/or disorders, find their ability to read greatly improved when text is magnified between 2 and 6 times. Assistive devices currently on the market are either geared towards reading text far away (~20 ft.) or very near (~2 ft.). This is a problem especially for students suffering from low vision, as they struggle to flip their focus between the chalkboard (far-field) and their notes (near- field). A solution to this problem is of high interest to eye care facilities in the developing world - no devices currently exist that have the aforementioned capabilities at an accessible price point. Through consultation with specialists at L.V. Prasad Eye Institute in India, the authors propose, design and demonstrate a device that fills this need, directed primarily at the Indian market. The device utilizes available hardware technologies to electronically capture video ahead of the user and zoom and display the image in real-time on LCD screens mounted in front of the user's eyes. This design is integrated as a wearable system in a glasses form-factor.

Persistent drying in the tropics linked to natural forcing.

Approximately half of the world's population lives in the tropics, and future changes in the hydrological cycle will impact not just the freshwater supplies but also energy production in areas dependent upon hydroelectric power. It is vital that we understand the mechanisms/processes that affect tropical precipitation and the eventual surface hydrological response to better assess projected future regional precipitation trends and variability. Paleo-climate proxies are well suited for this purpose as they provide long time series that pre-date and complement the present, often short instrumental observations. Here we present paleo-precipitation data from a speleothem located in Mesoamerica that reveal large multi-decadal declines in regional precipitation, whose onset coincides with clusters of large volcanic eruptions during the nineteenth and twentieth centuries. This reconstruction provides new independent evidence of long-lasting volcanic effects on climate and elucidates key aspects of the causal chain of physical processes determining the tropical climate response to global radiative forcing.

Achieving appropriate design for developing world heath care: the case of a low-cost autoclave for primary health clinics.

In developing world health clinics, incidence of surgical site infection is 2 to 10 times higher than in developed world hospitals. This paper identifies lack of availability of appropriately designed, low-cost autoclaves in developing world health clinics as a major contributing factor to the dramatic gap in surgical site infection rates. The paper describes the process of developing a low-cost autoclave that addresses the unique challenges faced by developing world primary health clinics and discusses how appropriateness of design was determined. The resulting pressure cooker-based autoclave design was fabricated and tested against the CDC specifications. Twelve partnering clinics in Nepal trialed these autoclaves from July until December 2012.

Identification and evaluation of the Atlantic razor clam (Ensis directus) for biologically inspired subsea burrowing systems.

In this article, we identify and analyze a subsea organism to serve as a model for biologically inspired burrowing technology to be used in applications such as anchoring, installation of cables, and recovery of oil. After inspecting myriad forms of life that live on or within ocean substrates, the Atlantic razor clam, Ensis directis, stood out as an attractive basis for new burrowing technology because of its low-energy requirements associated with digging (0.21 J/cm), its speed and depth of burrrowing (∼1 cm/s and 70 cm, respectively), and its size and simplicity relative to man-made machines. As anchoring is a prime application for the technology resulting from this work, the performance of an Ensis directus-based anchoring system was compared to existing technologies. In anchoring force per embedment energy, the E. directus-based anchor beats existing technology by at least an order of magnitude. In anchoring force per weight of device, the biologically inspired system weighs less than half that of current anchors. The article concludes with a review of E. directus's digging strategy, which involves motions of its valves to locally fluidize the substrate to reduce burrowing drag and energy, and the successful adaptation of E. directus's burrowing mechanisms into an engineering system: the RoboClam burrowing robot, which, like the animal, uses localized fluidization to achieve digging energy that scales linearly with depth, rather than depth squared, for moving through static soil.