Examination of the prediction of the planar piecewise continuous lumped muscle parameter model for walking gait with ankle-foot orthosis.

GOAL: This work examines the use of a previously described piecewise continuous lumped muscle parameter (PPCLMP) model for predicting selected gait parameters for walking without and with ankle-foot orthoses (AFOs) of varying stiffnesses. METHODS: Two AFOs with low (3.4 Nm/deg) and high (6.9 Nm/deg) stiffnesses were tested on the left leg of six healthy subjects to examine the model prediction on the influence of different AFO stiffnesses on gait. RESULTS: The model prediction errors ranged from 0 % to 70 % for step lengths with root mean square error (RMSE) of 0.15 m and ranged from 0 % to 67 % for swing time with RMSE of 0.07 s. The prediction precision of step length was more consistent among subjects than of swing time. DISCUSSIONS AND CONCLUSIONS: The model predicts the observed shortened step lengths and swing times, but there were significant differences between predicted and observed swing times and step lengths. The causes of these differences might be differences in the lumped muscle parameters taken from the literature and those of the subjects tested. Also, the model assumption that muscle stiffness is proportional to joint angle may not be corrected.

Selected movement and force pattern differences in rail- and rung-climbing of fire apparatus aerial ladders at 52.5° slope.

This study compares human climbing performance, including climbing speed and movement and force patterns, between rail- and rung-climbing styles for a moderate aerial ladder slope (52.5°). Hand and foot movements and forces were recorded for 9 male and 10 female firefighters as they ascended and descended a 3.4-m ladder using elevated handrails (rail-climbing) or rungs (rung-climbing) for hand support. The results indicated that climbers used three or more points of contact 54% of the time for rung-climbing and 100% of the time for rail-climbing. Furthermore, rail-climbing was 10% faster than rung-climbing. In rail-climbing, the lateral hand forces were mostly directed away from the body; while during rung-climbing, they were alternated in lateral and medial directions. Overall, the results suggested that rail-climbing provides better control over body positioning and faster climbing speed. Furthermore, the continuous contact of both hands in rail-climbing may reduce the fall risk by facilitating the recovery from a slip or perturbation.

Field Observation of Hospital Food Service Workers and the Relationship between Customer Demand and Biomechanical Stress: A Case Study.

OCCUPATIONAL APPLICATIONSMotion analysis of three workers at a large hospital kitchen was conducted using video recordings as part of this case study. Workers were observed during both a high-demand period and a low-demand period to evaluate their exposure to physical risk factors for work-related musculoskeletal disorders. On average, workers' reaching posture did not change significantly with customer demand. However, recovery time decreased by 18% and hand activity level (HAL) increased by 27% when customer demand increased. On an individual basis, the only worker whose work pace was constrained by processing (cooking) time and the availability of materials to complete the tasks had the most recovery time and did not show an increase in HAL even with an increase in demand. These results suggest the importance of designing tasks that are paced externally (e.g., cooking time) in a self-paced operation to limit the reduction in recovery time and increase in HAL as demand increases.

A planar piecewise continuous lumped muscle parameter model for prediction of walking gait.

GOAL: This work aims to develop a planar piecewise continuous lumped muscle parameter (PPCLMP) model that can utilize inputs that can be obtained in a clinical or home setting using simple tools (e.g. video cameras and inertial sensors) to predict human walking gait. METHODS: The model characterizes the sagittal-plane movement of the lower limbs during the single stance phase as an inverted pendulum, the double stance phase as a kinematic chain, and the swing phase as a double pendulum. The joint angles and angular velocities at the end of one phase are used as the initial conditions of the next phase. The model predicts the gait cycle based on the initial joint angles and angular velocities via forward dynamics. The errors between the initial and end conditions are minimized by changing the input initial joint angles and angular velocities of the gait cycle. RESULTS: Sensitivity analysis showed that the errors between the initial and end conditions of a gait cycle were sensitive to the initial joint angles. The step length was sensitive to subject stature. The model only works for a certain range of initial conditions. CONCLUSIONS: The model can predict gait cycles based on forward dynamics and selects initial conditions that minimize the errors between the initial and end conditions of the gait cycle. The model utilizes 2-D representations of lower limbs and simplified representations of joint torques to reduce the required inputs for gait prediction and builds the foundation of gait assessment tools.

Frequent template switching in postreplication gaps: suppression of deleterious consequences by the Escherichia coli Uup and RadD proteins.

When replication forks encounter template DNA lesions, the lesion is simply skipped in some cases. The resulting lesion-containing gap must be converted to duplex DNA to permit repair. Some gap filling occurs via template switching, a process that generates recombination-like branched DNA intermediates. The Escherichia coli Uup and RadD proteins function in different pathways to process the branched intermediates. Uup is a UvrA-like ABC family ATPase. RadD is a RecQ-like SF2 family ATPase. Loss of both functions uncovers frequent and RecA-independent deletion events in a plasmid-based assay. Elevated levels of crossing over and repeat expansions accompany these deletion events, indicating that many, if not most, of these events are associated with template switching in postreplication gaps as opposed to simple replication slippage. The deletion data underpin simulations indicating that multiple postreplication gaps may be generated per replication cycle. Both Uup and RadD bind to branched DNAs in vitro. RadD protein suppresses crossovers and Uup prevents nucleoid mis-segregation. Loss of Uup and RadD function increases sensitivity to ciprofloxacin. We present Uup and RadD as genomic guardians. These proteins govern two pathways for resolution of branched DNA intermediates such that potentially deleterious genome rearrangements arising from frequent template switching are averted.

Role of RNase H enzymes in maintaining genome stability in Escherichia coli expressing a steric-gate mutant of pol VICE391.

pol VICE391 (RumA'2B) is a low-fidelity polymerase that promotes considerably higher levels of spontaneous "SOS-induced" mutagenesis than the related E. coli pol V (UmuD'2C). The molecular basis for the enhanced mutagenesis was previously unknown. Using single molecule fluorescence microscopy to visualize pol V enzymes, we discovered that the elevated levels of mutagenesis are likely due, in part, to prolonged binding of RumB to genomic DNA leading to increased levels of DNA synthesis compared to UmuC. We have generated a steric gate pol VICE391 variant (pol VICE391_Y13A) that readily misincorporates ribonucleotides into the E. coli genome and have used the enzyme to investigate the molecular mechanisms of Ribonucleotide Excision Repair (RER) under conditions of increased ribonucleotide-induced stress. To do so, we compared the extent of spontaneous mutagenesis promoted by pol V and pol VICE391 to that of their respective steric gate variants. Levels of mutagenesis promoted by the steric gate variants that are lower than that of the wild-type enzyme are indicative of active RER that removes misincorporated ribonucleotides, but also misincorporated deoxyribonucleotides from the genome. Using such an approach, we confirmed that RNase HII plays a pivotal role in RER. In the absence of RNase HII, Nucleotide Excision Repair (NER) proteins help remove misincorporated ribonucleotides. However, significant RER occurs in the absence of RNase HII and NER. Most of the RNase HII and NER-independent RER occurs on the lagging strand during genome duplication. We suggest that this is most likely due to efficient RNase HI-dependent RER which recognizes the polyribonucleotide tracts generated by pol VICE391_Y13A. These activities are critical for the maintenance of genomic integrity when RNase HII is overwhelmed, or inactivated, as ΔrnhB or ΔrnhB ΔuvrA strains expressing pol VICE391_Y13A exhibit genome and plasmid instability in the absence of RNase HI.

Carpal tunnel syndrome and manual work: the OCTOPUS cohort, results of a ten-year longitudinal study.

OBJECTIVE: The American Conference of Governmental Industrial Hygienists (ACGIH) proposed a method to assess the hand, wrist and forearm biomechanical overload based on exertions frequency (hand-activity level) and force use (normalized peak force). We applied the ACGIH threshold limit value (TLV)® method to a large occupational cohort to assess its ability to predict carpal tunnel syndrome (CTS) onset. METHODS: A cohort of industrial and service workers was followed-up between 2000 and 2011. We investigated the incidence of CTS symptoms and CTS confirmed by nerve conduction studies (NCS). We then classified exposure with respect to action limit (AL) and TLV. Cox regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate hazard ratios (HR) of CTS and population attributable fractions. RESULTS: We analyzed data from 3131 workers [females, N=2032 (65%); mean age at baseline 39.3, standard deviation (SD) 9.4 years]. We observed 431 incident cases of CTS symptoms in 8000 person-years and 126 cases of CTS confirmed by NCS in 8883 person-years. The ACGIH TLV® method predicted both CTS symptoms [HR between AL and TLV 2.18, 95% confidence interval (95% CI) 1.86-2.56; above TLV 2.07, 95% CI 1.52-2.81] and CTS confirmed by NCS (HR between AL and TLV 1.93, 95% CI 1.38-2.71; above TLV 1.95, 95% CI 1.27-3.00). About one third of CTS cases were attributable to exposure levels above the AL. CONCLUSIONS: The ACGIH TLV® method predicted the risk of CTS, but the dose-response was flat above the AL; a fine-tuning of the proposed thresholds should be considered.

Effect of alternative video displays on postures, perceived effort, and performance during microsurgery skill tasks.

Physical work demands and posture constraint from operating microscopes may adversely affect microsurgeon health and performance. Alternative video displays were developed to reduce posture constraints. Their effects on postures, perceived efforts, and performance were compared with the microscope. Sixteen participants performed microsurgery skill tasks using both stereo and non-stereoscopic microscopes and video displays. Results showed that neck angles were 9-13° more neutral and shoulder flexion were 9-10° more elevated on the video display than the microscope. Time observed in neck extension was higher (30% vs. 17%) and neck movements were 3x more frequent on the video display than microscopes. Ratings of perceived efforts did not differ among displays, but usability ratings were better on the microscope than the video display. Performance times on the video displays were 66-110% slower than microscopes. Although postures improved, further research is needed to improve task performance on video displays.

A hand speed-duty cycle equation for estimating the ACGIH hand activity level rating.

An equation was developed for estimating hand activity level (HAL) directly from tracked root mean square (RMS) hand speed (S) and duty cycle (D). Table lookup, equation or marker-less video tracking can estimate HAL from motion/exertion frequency (F) and D. Since automatically estimating F is sometimes complex, HAL may be more readily assessed using S. Hands from 33 videos originally used for the HAL rating were tracked to estimate S, scaled relative to hand breadth (HB), and single-frame analysis was used to measure D. Since HBs were unknown, a Monte Carlo method was employed for iteratively estimating the regression coefficients from US Army anthropometry survey data. The equation: HAL = 10[e(-15:87+0:02D+2:25 ln S)/(1+e(-15:87+0:02D+2:25 ln S)], R(2) = 0.97, had a residual range ± 0.5 HAL. The S equation superiorly fits the Latko et al. ( 1997 ) data and predicted independently observed HAL values (Harris 2011) better (MSE = 0.16) than the F equation (MSE = 1.28).

A frequency-duty cycle equation for the ACGIH hand activity level.

A new equation for predicting the hand activity level (HAL) used in the American Conference for Government Industrial Hygienists threshold limit value®(TLV®) was based on exertion frequency (F) and percentage duty cycle (D). The TLV® includes a table for estimating HAL from F and D originating from data in Latko et al. (Latko WA, Armstrong TJ, Foulke JA, Herrin GD, Rabourn RA, Ulin SS, Development and evaluation of an observational method for assessing repetition in hand tasks. American Industrial Hygiene Association Journal, 58(4):278-285, 1997) and post hoc adjustments that include extrapolations outside of the data range. Multimedia video task analysis determined D for two additional jobs from Latko's study not in the original data-set, and a new nonlinear regression equation was developed to better fit the data and create a more accurate table. The equation, HAL = 6:56 ln D[F(1:31) /1+3:18 F(1:31), generally matches the TLV® HAL lookup table, and is a substantial improvement over the linear model, particularly for F>1.25 Hz and D>60% jobs. The equation more closely fits the data and applies the TLV® using a continuous function.

Identification of technique variations among microvascular surgeons and cases using hierarchical task analysis.

A hierarchical taxonomy was developed for identifying differences among microvascular surgeons and cases and for investigating the impact of those differences on case outcome. Hierarchical task analysis was performed on eight microvascular anastomosis cases. The analysis was simplified by redefining subtasks and elements to only describe actions and adding attributes to describe the work object, method, tool, material, conditions and ergonomics factors. The resulting taxonomy was applied to 64 cases. Differences were found among cases for the frequency and duration of subtask, elements, attributes and element sequences. Observed variations were used to formulate hypotheses about the relationship between different methods and outcomes that can be tested in future studies. The taxonomy provides a framework for comparing alternative methods, determining the best methods for given conditions and for surgical training and retraining. PRACTITIONER SUMMARY: A hierarchical taxonomy, created from a hierarchical task analysis and work attributes, was applied to describe technique variations among microsurgery cases. Variations in time, frequency and sequence were used to form hypotheses on best methods for standardising procedures.

Maximum hand-rung coupling forces in children: the effects of handhold diameter.

OBJECTIVE: To quantify the effect of handhold size (diameter) on the maximum breakaway strength between a hand and handhold for children. BACKGROUND: Falls from playground equipment are a major cause of childhood injury and death. It is unclear if recommendations for handholds on playground equipment are too broad. METHODS: Breakaway strength was defined as the maximum quasistatic force that can be exerted on a grasped object before the object is forcibly pulled from the grasp. Hand anthropometry, grip, and breakaway strengths were measured for 397 children between the ages of 6 and 11 years. Three cylindrical handhold diameters were tested. RESULTS: Breakaway strength was significantly affected by handhold size, gender, and hand dominance. Significant covariate predictors for breakaway strength included grip strength, age, and hand breadth. Breakaway strength was reduced for the largest diameter (3.81 cm) for children of all ages. CONCLUSION: Handhold design factors significantly affect the breakaway strength of children. APPLICATION: The results can be used as a basis for design recommendations for hand rungs used by children to reliably support their bodyweight.

Feasibility and safety of a novel in vivo model to assess playground falls in children.

BACKGROUND: Falls are the leading cause of nonfatal unintentional injuries among hospitalized children with playground equipment accounting for more than 50%. National standards for playground rung and rail design exist, but there a lack of in vivo models available to test these standards. We developed a novel in vivo model to test rung and rail design. We report the feasibility and safety of the model. METHODS: A device was built to simulate children hanging onto a playground bar until their hand slips off. This was defined as breakaway strength. The handle unit was mounted on a vertical cable that was mechanically raised and lowered using a linear actuator controlled by the experimenter. The unit was padded and contained a video camera that recorded the posture of the hand during each trial. Breakaway force and torque were recorded as they held onto the handle by LabView software. In addition, standard anthropometrics and grip strength were recorded. RESULTS: Biomedical engineering approved the device. There were 425 eligible students aged 5 years to 11 years. Of these, 93% (397) participated (212 males and 185 females). Ninety-nine percent (396 of 397) completed all three experimental stations, one declined because of fear. There were no injuries and no falls. Average time to complete the study was 22 ± 0.5 minutes. Ninety-one percent of participants were right handed; the ethnicity was representative of the local area with 79% being white. Mean ± SD height, weight, and body mass index for the 397 participants were 1.28 ± 0.11 m, 28.0 ± 8.12 kg, and 16.31 ± 2.59 kg/m², respectively. Hand size, grip strength, and maximum breakaway force increased with age. CONCLUSION: This model is safe and feasible and maybe a viable method to assess rung and rail design for playgrounds.

Validation of the ACGIH TLV for hand activity level in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome.

OBJECTIVES: This study aimed to evaluate the risk of musculoskeletal disorders to the hand-wrist system. The American Conference of Governmental Industrial Hygienists (ACGIH) proposed threshold limit values (TLV©) based on hand activity level (HAL) and normalized peak force (PF). We validated ACGIH TLV© in OCTOPUS, a large cohort study on carpal tunnel syndrome (CTS). METHODS: Industrial and service workers were followed from 2000-2003. We classified subjects with respect to action limit (AL) and TLV. Case definitions were: (i) self-reported symptoms; and (ii) combination of symptoms and positive nerve conduction studies. Poisson regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate incidence rate ratios (IRR) of CTS. RESULTS: There were 4097 eligible workers. Of these, 236 (5.8%) were non-responders, 2194 (53.6%) had a complete follow-up, 728 (17.8%) were lost after intermediate assessment, and 939 (22.9%) were lost after baseline. Among the 3860 subjects with complete information at baseline, 2599 (67.3%) were women [mean age 38.1 [standard deviation (SD) 9.5] years; mean body mass index (BMI) 23.8 (SD 3.9) kg/m2]. ACGIH TLV© classification predicted both CTS symptoms [IRR between AL and TLV 2.43 [95% confidence interval (95% CI) 1.77-3.33]; above TLV 3.32 (95% CI 2.34-4.72)] and CTS confirmed by nerve conduction studies [IRR between AL and TLV 1.95 (95% CI 1.21-3.16); above TLV 2.70 (95% CI 1.48-4.91)]. CONCLUSIONS: We found a dose-response relationship between ACGIH TLV© classification and risk of CTS. The increased risk observed for workers exposed between AL and TLV suggests that the current AL and TLV might not be sufficiently protective.

The objective assessment of experts' and novices' suturing skills using an image analysis program.

PURPOSE: To objectively assess suturing performance using an image analysis program and to provide validity evidence for this assessment method by comparing experts' and novices' performance. METHOD: In 2009, the authors used an image analysis program to extract objective variables from digital images of suturing end products obtained during a previous study involving third-year medical students (novices) and surgical faculty and residents (experts). Variables included number of stitches, stitch length, total bite size, travel, stitch orientation, total bite-size-to-travel ratio, and symmetry across the incision ratio. The authors compared all variables between groups to detect significant differences and two variables (total bite-size-to-travel ratio and symmetry across the incision ratio) to ideal values. RESULTS: Five experts and 15 novices participated. Experts' and novices' performances differed significantly (P < .05) with large effect sizes attributable to experience (Cohen d > 0.8) for total bite size (P = .009, d = 1.5), travel (P = .045, d = 1.1), total bite-size-to-travel ratio (P < .0001, d = 2.6), stitch orientation (P = .014,d = 1.4), and symmetry across the incision ratio (P = .022, d = 1.3). CONCLUSIONS: The authors found that a simple computer algorithm can extract variables from digital images of a running suture and rapidly provide quantitative summative assessment feedback. The significant differences found between groups confirm that this system can discriminate between skill levels. This image analysis program represents a viable training tool for objectively assessing trainees' suturing, a foundational skill for many medical specialties.

The effect of handhold orientation, size, and wearing gloves on hand-handhold breakaway strength.

OBJECTIVE: The aim of this study was to quantify the effect of handhold orientation, size (diameter), and wearing a glove on the maximum breakaway strength between a hand and handhold. BACKGROUND: Manual breakaway strength is known to be greatly reduced for vertical compared with horizontal handholds, but oblique orientations have yet to be studied. METHOD: For this study, 12 young adults (6 female) attempted to hold on to fixed overhead cylindrical handholds with one hand in low-speed simulated falls as forces on the handhold were recorded in two experimental designs. Breakaway strength was measured for (a) three different-sized cylinders in four orientations while the participants were using the dominant hand and (b) a single-sized cylinder in four orientations while the participants were bare-handed or wearing a glove on the nondominant hand. RESULTS: Handhold orientation (p < .001), handhold diameter (p < .001), and wearing gloves (p < .001) significantly affected breakaway strength. Breakaway strength increased 75% to 94% as the orientation of the handhold was moved from vertical to horizontal. Breakaway strength decreased 8% to 13% for large-diameter (51-mm) handholds as compared with smaller diameters (22 mm to 32 mm), depending on orientation. Gloves may increase or decrease the ability to hang on depending on interface friction; greater friction increased breakaway force. CONCLUSION: Handles oriented perpendicular to the pull direction and high-friction gloves provide the greatest breakaway strength. Smaller handhold diameters than predicted by grip strength afford greater capability in these orientations. APPLICATION: These insights can be used to design handholds that increase the ability to support one's body weight and reduce the effort needed to pull or lift heavy items.

The effects of functional limitations on soldier common tasks.

This paper describes the findings associated with the ability of an individual to perform the United States Army's Common Soldier Tasks of: "Maintaining an M16-Series Rifle" , "Protect Yourself from Chemical, Biological, Radiological, and Nuclear (CBRN) Injury or Contamination with Mission-Oriented Protective Posture (MOPP) Gear", and "Protect Yourself from Chemical and Biological (CB) Contamination Using Your Assigned Protective Mask." The analysis was conducted using data compiled from videos of a Soldier performing the given tasks at Walter Reed Army Medical Center. The findings reflect the opinions of researchers in identifying potential elements, which impose abnormal, irregular, and/or extraneous effort when performing the tasks as outlined in STP-21-1-SMCT - Soldier's Manual of Common Tasks: Skill Level I.

Quantification of hand grasp force using a pressure mapping system.

The goal of this study was to use a pressure sensor to measure the force distribution and contact area of the hand when gripping, pushing, and pulling a cylinder. Data was collected from 10 subjects with no hand impairments and from 1 subject with rheumatoid arthritis (RA). Subjects grasped an aluminum cylinder wrapped with a Tekscan pressure sensor and performed each trial at 25%, 50%, and 100% maximum voluntary exertion. A relationship was found between increasing exertion and increasing hand area with increasing hand contact area. The force distribution maps showed the thenar region of the hand exerts the most force during pushing while the metacarpal joint line exerts the highest force during pulling. The third and fourth phalange were found to exert the highest phalange force during gripping. The force distribution maps from the RA subject showed higher thumb forces and distal phalange forces, relative to the entire phalange, compared to the non-impaired subjects. This suggests that the RA subject compensates for the lack of phalange function with the regions of the hand that still function. Future studies should sample individuals with a larger hand area range and sample more individuals with RA.

The effect of visualization method on the performance of simulated microsurgery tasks.

The operating microscopes may be a significant cause of fatigue and discomfort in surgeons. The need for the microscope to be placed over the operating field forces surgeons to remain at the microscope's eyepieces at an uncomfortable posture for the entirety of the surgery. This study compared the effects on microsurgical task performance for four visualization methods: a monocular microscope, a binocular microscope, a three-dimensional (3D) flat-panel television display and a two-dimensional (2D) flat-panel television display. Eleven subjects each performed two microsurgical tasks and their performance was documented by video camera. The statistical analysis performed indicated utilization of the microscope as a visualization method increased subject performance. No significant difference in performance between the 2D and stereoscopic visualization methods.