Does enforcing glenohumeral joint stability matter? A new rapid muscle redundancy solver highlights the importance of non-superficial shoulder muscles.

The complexity of the human shoulder girdle enables the large mobility of the upper extremity, but also introduces instability of the glenohumeral (GH) joint. Shoulder movements are generated by coordinating large superficial and deeper stabilizing muscles spanning numerous degrees-of-freedom. How shoulder muscles are coordinated to stabilize the movement of the GH joint remains widely unknown. Musculoskeletal simulations are powerful tools to gain insights into the actions of individual muscles and particularly of those that are difficult to measure. In this study, we analyze how enforcement of GH joint stability in a musculoskeletal model affects the estimates of individual muscle activity during shoulder movements. To estimate both muscle activity and GH stability from recorded shoulder movements, we developed a Rapid Muscle Redundancy (RMR) solver to include constraints on joint reaction forces (JRFs) from a musculoskeletal model. The RMR solver yields muscle activations and joint forces by minimizing the weighted sum of squared-activations, while matching experimental motion. We implemented three new features: first, computed muscle forces include active and passive fiber contributions; second, muscle activation rates are enforced to be physiological, and third, JRFs are efficiently formulated as linear functions of activations. Muscle activity from the RMR solver without GH stability was not different from the computed muscle control (CMC) algorithm and electromyography of superficial muscles. The efficiency of the solver enabled us to test over 3600 trials sampled within the uncertainty of the experimental movements to test the differences in muscle activity with and without GH joint stability enforced. We found that enforcing GH stability significantly increases the estimated activity of the rotator cuff muscles but not of most superficial muscles. Therefore, a comparison of shoulder model muscle activity to EMG measurements of superficial muscles alone is insufficient to validate the activity of rotator cuff muscles estimated from musculoskeletal models.

Longitudinal transcriptome analysis of cattle infected with Theileria parva.

The apicomplexan cattle parasite Theileria parva is a major barrier to improving the livelihoods of smallholder farmers in Africa, killing over one million cattle on the continent each year. Although exotic breeds not native to Africa are highly susceptible to the disease, previous studies have illustrated that such breeds often show innate tolerance to infection by the parasite. The mechanisms underlying this tolerance remain largely unclear. To better understand the host response to T. parva infection we characterised the transcriptional response over 15 days in tolerant and susceptible cattle (n = 29) naturally exposed to the parasite. We identify key genes and pathways activated in response to infection as well as, importantly, several genes differentially expressed between the animals that ultimately survived or succumbed to infection. These include genes linked to key cell proliferation and infection pathways. Furthermore, we identify response expression quantitative trait loci containing genetic variants whose impact on the expression level of nearby genes changes in response to the infection. These therefore provide an indication of the genetic basis of differential host responses. Together these results provide a comprehensive analysis of the host transcriptional response to this under-studied pathogen, providing clues as to the mechanisms underlying natural tolerance to the disease.

Optical mapping compendium of structural variants across global cattle breeds.

Structural variants (SV) have been linked to important bovine disease phenotypes, but due to the difficulty of their accurate detection with standard sequencing approaches, their role in shaping important traits across cattle breeds is largely unexplored. Optical mapping is an alternative approach for mapping SVs that has been shown to have higher sensitivity than DNA sequencing approaches. The aim of this project was to use optical mapping to develop a high-quality database of structural variation across cattle breeds from different geographical regions, to enable further study of SVs in cattle. To do this we generated 100X Bionano optical mapping data for 18 cattle of nine different ancestries, three continents and both cattle sub-species. In total we identified 13,457 SVs, of which 1,200 putatively overlap coding regions. This resource provides a high-quality set of optical mapping-based SV calls that can be used across studies, from validating DNA sequencing-based SV calls to prioritising candidate functional variants in genetic association studies and expanding our understanding of the role of SVs in cattle evolution.

A cattle graph genome incorporating global breed diversity.

Despite only 8% of cattle being found in Europe, European breeds dominate current genetic resources. This adversely impacts cattle research in other important global cattle breeds, especially those from Africa for which genomic resources are particularly limited, despite their disproportionate importance to the continent's economies. To mitigate this issue, we have generated assemblies of African breeds, which have been integrated with genomic data for 294 diverse cattle into a graph genome that incorporates global cattle diversity. We illustrate how this more representative reference assembly contains an extra 116.1 Mb (4.2%) of sequence absent from the current Hereford sequence and consequently inaccessible to current studies. We further demonstrate how using this graph genome increases read mapping rates, reduces allelic biases and improves the agreement of structural variant calling with independent optical mapping data. Consequently, we present an improved, more representative, reference assembly that will improve global cattle research.

Enabling Autonomous Colonoscopy Intervention Using a Robotic Endoscope Platform.

OBJECTIVE: Robotic endoscopes have the potential to dramatically improve endoscopy procedures, however current attempts remain limited due to mobility and sensing challenges and have yet to offer the full capabilities of traditional tools. Endoscopic intervention (e.g., biopsy) for robotic systems remains an understudied problem and must be addressed prior to clinical adoption. This paper presents an autonomous intervention technique onboard a Robotic Endoscope Platform (REP) using endoscopy forceps, an auto-feeding mechanism, and positional feedback. METHODS: A workspace model is established for estimating tool position while a Structure from Motion (SfM) approach is used for target-polyp position estimation with the onboard camera and positional sensor. Utilizing this data, a visual system for controlling the REP position and forceps extension is developed and tested within multiple anatomical environments. RESULTS: The workspace model demonstrates accuracy of 5.5% while the target-polyp estimates are within 5 mm of absolute error. This successful experiment requires only 15 seconds once the polyp has been located, with a success rate of 43% using a 1 cm polyp, 67% for a 2 cm polyp, and 81% for a 3 cm polyp. CONCLUSION: Workspace modeling and visual sensing techniques allow for autonomous endoscopic intervention and demonstrate the potential for similar strategies to be used onboard mobile robotic endoscopic devices. SIGNIFICANCE: To the authors' knowledge this is the first attempt at automating the task of colonoscopy intervention onboard a mobile robot. While the REP is not sized for actual procedures, these techniques are translatable to devices suitable for in vivo application.

Using regulatory variants to detect gene-gene interactions identifies networks of genes linked to cell immortalisation.

The extent to which the impact of regulatory genetic variants may depend on other factors, such as the expression levels of upstream transcription factors, remains poorly understood. Here we report a framework in which regulatory variants are first aggregated into sets, and using these as estimates of the total cis-genetic effects on a gene we model their non-additive interactions with the expression of other genes in the genome. Using 1220 lymphoblastoid cell lines across platforms and independent datasets we identify 74 genes where the impact of their regulatory variant-set is linked to the expression levels of networks of distal genes. We show that these networks are predominantly associated with tumourigenesis pathways, through which immortalised cells are able to rapidly proliferate. We consequently present an approach to define gene interaction networks underlying important cellular pathways such as cell immortalisation.

Exercise Rehabilitation Services Provided by Physiotherapy Departments in Cancer Care in Ireland

Aims This study aimed to identify the physiotherapy exercise rehabilitation services available to patients with cancer in Ireland and to identify barriers to the provision of services. Methods Physiotherapy department managers in specialised cancer centres, public and private hospitals and palliative care settings were surveyed to establish the availability of exercise rehabilitation services for patients with cancer. Results Of 40 managers contacted, 24 responded providing information about 26 services. Ten services employed a dedicated oncology physiotherapist. Exercise classes were offered to patients with cancer by five services, primarily within the palliative care setting. In the 17 hospitals which provided surgery, ten provided oncology specific post-operative exercise rehabilitation and one offered a prehabilitation programme. Limited human and physical resources and absence of established physiotherapy pathways were cited barriers to service provision. Conclusion Exercise rehabilitation is not an element of standard care for patients with cancer in Ireland.

Positioning Performance of Power and Manual Drivers in Posterior Spinal Fusion Procedures.

This work presents an analysis and comparison of the efficacy of two methods for pedicle screw placement during posterior spinal fusion surgery. A total of 100 screws (64 manual and 36 power driven), all placed utilizing a surgical navigation system, were analyzed and compared. Final screw placement was compared to initial surgical plans using the navigation system, and the final screw locations were analyzed on the basis of angular deviation from these planned trajectories as well as screw translation within a critical reference plane. The power driver was found to insignificantly decrease the resulting angular deviation of these pedicle screws with a mean deviation of 3.35 degrees compared to 3.44 degrees with the manual driver (p = 0.853). Conversely, the power driver was found to increase the translational distance in the critical region, with mean deviations of 2.45 mm for the power driver compared to 1.54 mm with the manual driver. The increase in translational deviation was significant (p = 0.002) indicating that there may be some loss in performance from the adoption of the power driver.

Towards autonomous motion control in minimally invasive robotic surgery.

INTRODUCTION: While autonomous surgical robotic systems exist primarily at the research level, recently these systems have made a strong push into clinical settings. The autonomous or semi-autonomous control of surgical robotic platforms may offer significant improvements to a diverse field of surgical procedures, allowing for high precision, intelligent manipulation of these systems and opening the door to advanced minimally invasive surgical procedures not currently possible. AREAS COVERED: This review highlights those experimental systems currently under development with a focus on in vivo modeling and control strategies designed specifically for the complex and dynamic surgical environment. Expert review: Novel methods for state estimation, system modeling and disturbance rejection, as applied to these devices, continues to improve the performance of these important surgical tools. Procedures such as Natural Orifice Transluminal Endoscopic Surgery and Laparo-Endoscopic Single Site surgery, as well as more conventional procedures such as Colonoscopy, serve to benefit tremendously from the development of these automated robotic systems, enabling surgeons to minimize tissue damage and shorten procedure times while avoiding the consequences of laparotomy.

Education on physical restraint reduction in dementia care: a review of the literature.

Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.

New direction for enhancing quality in diabetes care: utilizing telecommunications and paraprofessional outreach workers backed by an expert medical team.

Abstract This article assesses the value of using telecommunications with Promatoras (paraprofessional outreach workers) and an expert medical team of registered nurses (RNs) and endocrinologists in an at-risk type 2 diabetic Hispanic population recruited for a telemedicine feasibility project from a free clinic. Nineteen patients agreed to enter the program and 16 completed the program in 3.5 years of study. A Promatoras is the primary educator and the point of communication to patient or medical personnel overseeing each patient's home glucose monitoring, medical records, and medications, regularly communicating by telephone and e-mail with patients and diabetes specialists. Between clinic visits, all routine care, including body weight, blood glucose, and blood pressure monitoring, was shared over the Internet, and each patient was interviewed by audio and camera. The endocrinologist was in his office, while the primary care physician, patient, and Promotora volunteers were at the free clinic. Four variables were considered in this longitudinal study: weight, systolic blood pressure, diastolic blood pressure, and HbA1c. Estimates of means, correlations, t-tests, and slopes of the repeated measures were obtained, and comparisons were made between first and last values. The most important sign of improvement in the patients' situation was the significant decrease in HbA1c to 7.2% from 9.6% (p = 0.001).

Self-management and peer support among people with arthritis on a hospital joint replacement waiting list: a randomised controlled trial.

INTRODUCTION: To evaluate the efficacy of a self-management support program including a 6 week self-management course, individualised phone support and goal setting in osteoarthritis patients on a waiting list for arthroplasty surgery. METHOD: Randomised controlled trial of 152 public hospital outpatients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery. Participants were randomised to a self-management program or to usual care. The primary outcome was change in the Health Education Intervention Questionnaire (HeiQ) from randomisation to 6 month follow-up. Quality of life and depressive symptoms were also measured. Changes in pain and function were assessed using the Western Ontario and McMaster Universities (WOMAC) Arthritis Index. RESULTS: At 6 month follow-up, health-directed behaviour was significantly greater in the intervention [mean 4.29, 95% confidence interval (CI) 3.99-4.58] than the control (mean 3.81, 95% CI 3.52-4.09; P=0.017). There was also a significant effect on skill and technique acquisition for the intervention (mean 4.37, 95% CI 4.19-4.55) in comparison to control (mean 4.11, 95% CI 3.93-4.29; P=0.036). There was no significant effect of the intervention on the remaining HeiQ subscales, WOMAC pain or disability, quality of life or depressive symptoms. DISCUSSION: The arthritis self-management program improved health-directed behaviours, skill acquisition and stiffness in patients on a joint replacement waiting list, although the observed effects were of modest size (Cohen's d between 0.36 and 0.42). There was no significant effect on pain, function or quality of life in the short term. Self-management programs can assist in maintaining health behaviours (particularly walking) in this patient group. Further research is needed to assess their impact on quality of life and over longer periods.

Nitrification in a vertically moving biofilm system.

A laboratory continuous feed biofilm reactor, comprising a bulk fluid reactor, a biofilm plastic module, a feed tank, and pneumatic devices and controls, was operated for a total period of 257 days, including seeding time, to treat domestic-strength synthetic wastewater under increasing ammonium nitrogen (NH(4)(+)--N) loading rates, ranging from 0.17+/-0.01 (0.71+/-0.06 gm(-2)d(-1)) to 0.70+/-0.02 kgm(-3)d(-1) (2.9+/-0.1 gm(-2)d(-1)). The biofilm plastic module was moved vertically in and out of the wastewater in continuous cycles. The maximum NH(4)(+)-N removal rate was reached during the maximum loading phase, when a NH(4)(+)--N loading rate of 0.70+/-0.02 kgm(-3)d(-1) (2.9+/-0.1 gm(-2)d(-1)) was applied to the system. During this loading period, the average NH(4)(+)--N removal rate was 0.30+/-0.10 kgm(-3)d(-1) (1.30+/-0.40 gm(-2)d(-1)).

The efficiency of a sequencing batch biofilm reactor in organic carbon and phosphorus removal.

A laboratory sequencing batch biofilm reactor (SBBR), operated for a period of 158 days, was used to treat domestic-strength synthetic effluent. The biofilm reactor comprised a bulk fluid reactor, a biofilm plastic module, a synthetic wastewater feed tank, and pneumatic devices with pneumatic controls. The reactor cycle time was 8 h, and its operation consisted of five phases: feeding (59 min), mixing (1 min), anoxic/anaerobic (3 h), aerobic (3 h), and settling (1 h). At total chemical oxygen demand (CODT) loading rates of 8.8 g CODT m(-2) d(-1) and 1.2 kg CODT m(-3) d(-1), expressed in terms of the plastic module surface area and reactor volume, respectively, the SBBR had average removal rates of 8.3 g CODT m(-2) d(-1) and 1.1 kg CODT m(-3) d(-1), or 94%. Total orthophosphorus (PO4-PT) and filtered orthophosphorus (PO4-PF) removals were 44% and 50%, respectively.

Improvement of sensory impairment in patients with peripheral neuropathy.

OBJECTIVE: To report the findings in 27 patients with peripheral neuropathy (21 with lower extremity sensory impairment associated with diabetic peripheral neuropathy and 6 with other causes), who received treatment with monochromatic near-infrared photoenergy (890 nm) delivered by the Anodyne Therapy System (ATS). METHODS: All enrolled patients exhibited abnormal sensory perception (either hyperesthesia or hypoesthesia) based on a qualifying examination with the Neurometer CPT (current perception threshold) (baseline CPT). The patients received 10 ATS treatments (each lasting 40 minutes) during a 2-week period and then underwent CPT retesting to determine the extent of improvement of sensory impairment in myelinated and unmyelinated sensory fibers of the peroneal nerve. RESULTS: All patients obtained improvement in sensory impairment in comparison with baseline CPT measures, and 16 of the 27 patients achieved normal sensory responses in all nerve fiber subpopulations. Ten patients had been tested previously (initial CPT) and did not exhibit spontaneous improvement in sensory impairment during a mean period of 27 months before baseline CPT. After receiving the ATS treatments, however, this group of patients showed improvement in comparison with both initial CPT results and baseline CPT. CONCLUSION: On the basis of the data from this study, the ATS seems to be a safe and effective treatment to improve sensory impairment associated with peripheral neuropathy due to diabetes and other causes.

A one-quarter reduction in the salt content of bread can be made without detection.

OBJECTIVE: To determine if it is possible to deliver a one-quarter reduction in the sodium content of bread without detection. DESIGN: Single-blind, randomized, controlled trial. SETTING: The Royal North Shore Hospital in Sydney, Australia. PARTICIPANTS: One-hundred and ten volunteers from the hospital staff that completed 94% of scheduled assessments. INTERVENTION: Six consecutive weeks of bread with usual sodium content or six consecutive weeks of bread with cumulating 5% reductions in sodium content each week. MAIN OUTCOME MEASURE: The proportion of participants reporting a difference in the salt content of the study bread from week to week. RESULTS: The intervention group were no more likely than the control group to report a difference in the salt content of the bread from week to week (P=0.8). Similarly, there were no differences between randomized groups in the scores for flavour (P=0.08) or liking of the bread (P=0.95) over the study follow-up period. However, the saltiness scores recorded on a visual analogue scale did decline in the intervention group compared with the control group (P=0.01) CONCLUSIONS: A one-quarter reduction in the sodium content of white bread can be delivered over a short time period, while maintaining consumer acceptance. Over the long term, and particularly if achieved for multiple foods, a decrease in sodium content of this magnitude would be expected to reduce population levels of blood pressure and the risks of stroke and heart attack.

A randomized trial of exercise programs among older individuals living in two long-term care facilities: the FallsFREE program.

OBJECTIVE: To use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities. DESIGN: Randomized, controlled trial. SETTING: The study took place at two long-term care facilities with services ranging from independent living to skilled nursing. PARTICIPANTS: One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions. INTERVENTION: Participants were randomized to one of two exercise groups (resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming) or to a control group (basic enhanced programming only). Exercise classes were held three times per week throughout the study. MEASUREMENTS: Participants were evaluated for cognitive and physical functioning at baseline and 6, 12, and 24 months. Falls were determined from incident reports filed by the nursing staffs at the facilities. RESULTS: Time to first fall, time to death, number of days hospitalized, and incidence of falls did not differ among the treatment and control groups (P>.05). Among all participants, those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program. CONCLUSION: There were no significant differences in falls among the two exercise groups and the control group. Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs.

Comparison of flow rates of holes versus cross-cut teats for bottle-fed babies.

Under laboratory conditions the flow rates of two types of teat were compared. The openings of Group A teats were in the form of a cross-cut measuring 1.5 mm in radius plus a small central hole. Group B teats were pierced with a single hole of 0.5 mm in diameter. Five teats from each group were tested under atmospheric pressure conditions simulating the effect of a baby's sucking. The results of this trial confirms the hypothesis that the style of teat affects the flow rate and that faster flow rates can be obtained with a cross-cut teat rather than a single-hole teat. Babies using cross-cut teats may also learn to control flow rates by changing their sucking style.