The human ankle produces a large burst of 'push-off' mechanical power late in the stance phase of walking, reduction of which leads to considerably poorer energy economy. It is, however, uncertain ...whether the energetic penalty results from poorer efficiency when the other leg joints substitute for the ankle's push-off work, or from a higher overall demand for work due to some fundamental feature of push-off. Here, we show that greater metabolic energy expenditure is indeed explained by a greater demand for work. This is predicted by a simple model of walking on pendulum-like legs, because proper push-off reduces collision losses from the leading leg. We tested this by experimentally restricting ankle push-off bilaterally in healthy adults (N=8) walking on a treadmill at 1.4 m s(-1), using ankle-foot orthoses with steel cables limiting motion. These produced up to ∼50% reduction in ankle push-off power and work, resulting in up to ∼50% greater net metabolic power expenditure to walk at the same speed. For each 1 J reduction in ankle work, we observed 0.6 J more dissipative collision work by the other leg, 1.3 J more positive work from the leg joints overall, and 3.94 J more metabolic energy expended. Loss of ankle push-off required more positive work elsewhere to maintain walking speed; this additional work was performed by the knee, apparently at reasonably high efficiency. Ankle push-off may contribute to walking economy by reducing dissipative collision losses and thus overall work demand.
Background:
Routine testing of hemodialysis patients for COVID-19 (outside of those identified as “at risk” based on regional practice) is not universally recommended. However, there is variability ...in the clinical presentation of COVID-19; patients may experience symptoms that do not meet regional criteria for testing and some patients with active infection may be asymptomatic. To avoid missing individuals who are infected, consideration could be made for regular screening, particularly among those residing in areas with evidence of community spread.
Objective:
To describe the clinical characteristics, symptom burden, and COVID-19 status in a cross-section of hemodialysis patients residing in areas with evidence of community spread.
Design:
Cross-sectional study.
Setting:
Three hemodialysis units in a large tertiary care facility in Nova Scotia, Canada.
Patients:
In-center hemodialysis patients who resided in areas with evidence of community transmission at the time of the study.
Methods:
All dialysis patients (irrespective of whether or not they resided in areas with community spread) completed a standard “at-risk” questionnaire for COVID-19 based on (1) 2 or more of new or worsening cough, fever greater than 38°C, sore throat, headache, runny nose/new or acute respiratory illness consistent with infection or (2) any one of close contact with a known/suspected case, travel outside of the province or residence in a facility with an outbreak prior to entry into the dialysis unit at each treatment. Patients residing in areas with evidence of community spread were swabbed for SARS-CoV-2 over a 1-week period (May 1-7, 2020) using a combined oropharyngeal/nares swab irrespective of whether or not they were identified as “at-risk.”
Measurements:
Baseline characteristics of patients were acquired using electronic records. In addition to the “at-risk” questionnaire, patients answered “yes” or “no” to any of the following symptoms at the time of the swab (sneeze, fatigue, myalgia, nausea/vomiting, diarrhea, malaise, abdominal pain, loss of taste, and loss of smell).
Results:
Of the 334 patients receiving dialysis at the time of the study, 133 resided in areas with evidence of community transmission and 104 consented for the study. No patients met our regional criteria for being “at-risk” and no patients reported cough, sore throat or fever at the time of swab. Many other symptoms were noted, including sneezing (24%), fatigue (16%), myalgias (11%), nausea/vomiting (11%), loss of taste (4%), and loss of smell (4%). Overall, 100% of swabs performed for this study were negative for SARS-CoV-2.
Limitations:
Single-center study, and the daily new case rate was exceedingly low (4-14) at the time of the study, emphasizing that the findings are not generalizable to areas of higher prevalence of SARS-CoV-2.
Conclusions:
In this study of hemodialysis patients residing in areas with community spread who otherwise did not meet symptom criteria for being “at-risk,” we did not identify any individual who tested positive for SARS-CoV-2. Future studies are needed to examine the utility of routine testing for COVID-19 (outside of those who are “at-risk”) in areas of higher disease prevalence.
Trial Registration:
Not applicable as this is not a clinical trial.
Buoyant balaenids: the ups and downs of buoyancy in right whales Nowacek, Douglas P.; Johnson, Mark P.; Tyack, Peter L. ...
Proceedings - Royal Society. Biological sciences/Proceedings - Royal Society. Biological Sciences,
09/2001, Letnik:
268, Številka:
1478
Journal Article
Recenzirano
Odprti dostop
A variety of marine mammal species have been shown to conserve energy by using negative buoyancy to power prolonged descent glides during dives. A new non-invasive tag attached to North Atlantic ...right whales recorded swim stroke from changes in pitch angle derived from a three-axis accelerometer. These results show that right whales are positively buoyant near the surface, a finding that has significant implications for both energetics and management. Some of the most powerful fluke strokes observed in tagged right whales occur as they counteract this buoyancy as they start a dive. By contrast, right whales use positive buoyancy to power glides during ascent. Right whales appear to use their positive buoyancy for more efficient swimming and diving. However, this buoyancy may pose added risks of vessel collision. Such collisions are the primary source of anthropogenic mortality for North Atlantic right whales, whose population is critically endangered and declining. Buoyancy may impede diving responses to oncoming vessels and right whales may have a reduced ability to manoeuvre during free ascents. These risk factors can inform efforts to avoid collisions.
The human ankle produces a large burst of “push-off” mechanical power late in the stance phase of walking, reduction of which leads to considerably poorer energy economy. It is, however, uncertain ...whether the energetic penalty results from poorer efficiency when the other leg joints substitute for the ankle's push-off work, or from a higher overall demand for work due to some fundamental feature of push-off. Here we show that greater metabolic energy expenditure is indeed explained by a greater demand for work. This is predicted by a simple model of walking on pendulum-like legs, because proper push-off reduces collision losses from the leading leg. We tested this by experimentally restricting ankle push-off bilaterally in healthy adults (N=8) walking on a treadmill at 1.4 m⋅s−1, using ankle-foot orthoses with steel cables limiting motion. These produced up to about 50% reduction in ankle push-off power and work, resulting in up to about 50% greater net metabolic power expenditure to walk at the same speed. For each 1 J reduction in ankle work, we observed about 0.6 J more dissipative collision work by the other leg, 1.3 J more positive work from the leg joints overall, and 3.94 J more metabolic energy expended. Loss of ankle push-off required more positive work elsewhere to maintain walking speed. That additional work was performed by the knee, apparently at reasonably high efficiency. Ankle push-off may contribute to walking economy by reducing dissipative collision losses and thus overall work demand.
Experimental evaluation of a portable powered ankle-foot orthosis Shorter, Kenneth A.; Li, Yifan; Morris, Emily A. ...
2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society,
01/2011, Letnik:
2011
Conference Proceeding, Journal Article
Ankle-foot orthoses (AFOs) ameliorate the impact of impairments to the lower limb neuromuscular motor system that affect gait. Emerging technologies provide a vision for fully powered, untethered ...AFOs. The portable powered AFO (PPAFO) provides both plantarflexor and dorsiflexor torque assistance via a bi-directional pneumatic rotary actuator. The system uses a portable pneumatic power source (bottle of compressed CO 2 ) and embedded electronics to control foot motion during level walking. Experimental data were collected to demonstrate functionality from two subjects with bilateral impairments to the lower legs. These data demonstrated the PPAFO's ability to provide functional assistance during gait. The stringent design requirements of light weight, small size, high efficiency and low noise make the creation of daily wear assist devices challenging; but once such devices appear, they will present new opportunities for clinical treatment of gait abnormalities.
Crohn's disease and cancer Weedon, D D; Shorter, R G; Ilstrup, D M ...
The New England journal of medicine,
11/1973, Letnik:
289, Številka:
21
Journal Article
A common problem for healthcare providers is accurately tracking patients' adherence to medication and providing real-time feedback on the management of their medication regimen. This is a particular ...problem for eye drop medications, as the current commercially available monitors focus on measuring adherence to pills, and not to eye drops. This work presents an intelligent bottle sleeve that slides onto a prescription eye drop medication bottle. The intelligent sleeve is capable of detecting eye drop use, measuring fluid level, and sending use information to a healthcare team to facilitate intervention. The electronics embedded into the sleeve measure fluid level, dropper orientation, the state of the dropper top (on/off), and rates of angular motion during an application. The sleeve was tested with ten patients (age ≥65) and successfully identified and timestamped 94% of use events. On-board processing enabled event detection and the measurement of fluid levels at a 0.4 mL resolution. These data were communicated to the healthcare team using Bluetooth and Wi-Fi in real-time, enabling rapid feedback to the subject. The healthcare team can therefore monitor a log of medication use behavior to make informed decisions on treatment or support for the patient.
Intermittent locomotion composed of periods of active flapping/stroking followed by inactive gliding has been observed with species that inhabit both aerial and marine environments. However, studies ...on the energetic benefits of a fluke-and-glide (FG) gait during horizontal locomotion are limited for dolphins. This work presents a physics-based model of FG gait and an analysis of the associated cost of transport for bottlenose dolphins (Tursiops truncatus). New gliding drag coefficients for the model were estimated using measured data from free-swimming bottlenose dolphins. The data-driven approach used kinematic measurement from 84 h of biologging tag data collected from three animals to estimate the coefficients. A set of 532 qualifying gliding events were automatically extracted for estimation of the gliding drag coefficient. Next, data from 783 FG bouts were parameterized and used with the model-based dynamic analysis to investigate the cost benefits of FG gait. Experimental results indicate that FG gait was preferred at speeds of ∼2.2-2.7 m s-1. Observed FG bouts had an average duty factor of 0.45 and a gliding duration of 5 s. The average associated metabolic cost of transport (COT) and mechanical cost of transport (MECOT) of FG gait are 2.53 and 0.35 J m-1 kg-1, respectively, at the preferred speeds. This corresponded to a respective 18.9% and 27.1% reduction in cost when compared with model predictions of continuous fluking gait at the same average bout speed. Average thrust was positively correlated with fluking frequency and amplitude as animals accelerated during the FG bouts, whereas fluking frequency and amplitude were negatively correlated for a given thrust range. These results suggest that FG gait enhances the horizontal swimming efficiency of bottlenose dolphins and provides new insights into the gait dynamics of these animals.
Ankle-foot orthoses (AFOs) can be used to ameliorate the impact of impairments to the lower limb neuromuscular motor system that affect gait. Existing AFO technologies include passive devices with ...fixed and articulated joints, semiactive devices that modulate damping at the joint, and active devices that make use of a variety of technologies to produce power to move the foot. Emerging technologies provide a vision for fully powered, untethered AFOs. However, the stringent design requirements of light weight, small size, high efficiency, and low noise present significant engineering challenges before such devices will be realized. Once such devices appear, they will present new opportunities for clinical treatment of gait abnormalities.
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