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Recently, many industrial exoskeletons for supporting workers in heavy physical tasks have been developed. However, the efficiency of exoskeletons with regard to physical strain reduction has not been fully proved, yet. Several laboratory and field studies have been conducted, but still more data, that cannot be obtained solely by behavioral experiments, are needed to investigate effects on the human body.
This paper presents an approach to extend laboratory and field research with biomechanical simulations using the AnyBody Modeling System. Based on a dataset recorded in a laboratory experiment with 12 participants using the exoskeleton Paexo Shoulder in an overhead task, the same situation was reproduced in a virtual environment and analyzed with biomechanical simulation.
Simulation results indicate that the exoskeleton substantially reduces muscle activity and joint reaction forces in relevant body areas. Deltoid muscle activity and glenohumeral joint forces in the shoulder were decreased between 54 and 87%. Simultanously, no increases of muscle activity and forces in other body areas were observed.
This study demonstrates how a simulation framework could be used to evaluate changes in internal body loads as a result of wearing exoskeletons. Biomechanical simulation results widely agree with experimental measurements in the previous laboratory experiment and supplement such by providing an insight into effects on the human musculoskeletal system. They confirm that Paexo Shoulder is an effective device to reduce physical strain in overhead tasks. The framework can be extended with further parameters, allowing investigations for product design and evaluation.
Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms – namely reality distortion, disorganization, negative symptoms, depression, and mania – remains unclear. Moreover, the differential effects of negative v. positive LEs are poorly understood.
The present study utilizes an epidemiologic cohort of patients (N = 428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48-, and 120-month follow-ups.
We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in reality distortion (β = 0.07), disorganized (β = 0.07), manic (β = 0.08), and depressive symptoms (β = 0.06), and a decrease in negative symptoms (β = −0.08). Conversely, positive LEs predicted fewer reality distortion (β = −0.04), disorganized (β = −0.04), and negative (β = −0.13) symptoms, and were unrelated to mood symptoms. A between-person approach to the same hypotheses confirmed that negative LEs predicted change in all symptoms, while positive LEs predicted change only in negative symptoms. In contrast, symptoms rarely predicted future LEs.
These findings confirm that LEs have an effect on symptoms, and thus contribute to the burden of psychotic disorders. That LEs increase positive symptoms and decrease negative symptoms suggest at least two different mechanisms underlying the relationship between LEs and symptoms. Our findings underscore the need for increased symptom monitoring following negative LEs, as symptoms may worsen during that time.
Combining additive manufacturing (AM) with carbon fiber reinforced polymer patched composites unlocks potentials in the design of individualized, lightweight biomedical structures. Arising design opportunities are geometrical individualization of structures using the design freedom of AM and the patient-individual design of the load-bearing components employing carbon fiber patch placement. To date, however, full exploitation of these opportunities is a complex recurring task, which requires a high amount of knowledge and engineering effort for design, optimization, and manufacturing. The goal of this study is to make this complexity manageable by introducing a suitable manufacturing strategy for individualized lightweight structures and by developing a digitized end-to-end design process chain, which provides a high degree of task automation. The approach to achieve full individualization uses a parametric model of the structure which is adapted to patients’ 3D scans. Moreover, patient data is used to define individual load cases and perform structural optimization. The potentials of the approach are demonstrated on an exoskeleton hip structure. A significant reduction of weight compared to a standard design suggests that the design and manufacturing chain is promising for the realization of individualized high-performance structures.
The rate of deforestation in the Amazon is increasing. Predictive models estimate that as a result of agricultural expansion 40% of these forests will be lost by 2050. As a consequence the habitat of forest-dwelling species such as the Endangered black-faced black spider monkey Ateles chamek is being lost, particularly along the arc of deforestation in the Brazilian Amazon. We used species distribution modelling to (1) define the distribution of this spider monkey, using environmental predictors, (2) calculate the area of this distribution covered by the protected area network, and (3) calculate the expected loss of the species’ habitat under future scenarios of deforestation. We found that the species occupies only c. 28% of its extent of occurrence. Only 32% of the species’ area of occupancy is legally protected, and the modelling suggests that 31–40% of the species’ habitat will be lost by 2050. We highlight three unprotected regions with extensive forest cover that are predicted to become severely deforested by 2050 as priority regions for expanding the protected area network. We also propose landscape management and restoration in three human-modified regions. Our study provides an example of how species distribution modelling can be applied to assess threats to species and support decision makers in implementing conservation actions.
An outbreak of invasive Mycobacterium chimaera infections associated with heater-cooler devices (HCDs) has now affected patients in several countries on different continents. Clinical infections are characterized by delayed diagnosis, inadequate treatment response to antimicrobial agents, and poor prognosis. Outbreak investigators found M. chimaera in HCD water circuits and air samples while HCDs were running, suggesting that transmission from the HCD to the surgical site occurs via the airborne route. New HCDs at the manufacturing site were also contaminated with M. chimaera, and recent whole-genome sequencing data suggest a point source. Some guidance on screening for M. chimaera colonization in HCD water and exhaust air is available. In contrast, reliable disinfection procedures are not well described, and it is not yet known whether eradication of M. chimaera from a contaminated HCD can be achieved. Meanwhile, strict separation of the HCD from operating room air is necessary to ensure patient safety, and these efforts may require engineering solutions. While our understanding of the causes and the extent of the M. chimaera outbreak is growing, several aspects of patient management, device handling, and risk mitigation still require clarification.
Between December 2007 and March 2009, small mammals were captured in 6 Atlantic Forest patches in Brazil. We assessed tick-host associations and whether they differ among forest strata, sites, seasons, and host age classes or between sexes. Moreover, we assessed the exposure of animals to Rickettsia spp. In total, 432 animals were captured and 808 ticks were found on 32·9% of them. Significant differences were found among host species, collection sites, and forest strata; microhabitat preference was a strong risk factor for tick infestation. The highest tick density rates were recorded in forest fragments settled in rural areas; 91·3% of the ticks were collected from animals trapped in these forest fragments. A high prevalence (68·8%) of antibodies to Rickettsia spp. was detected among animals. This study suggests that disturbed Atlantic Forest fragments provide an environment for ticks and small mammals, which are highly exposed to rickettsiae. It also indicates that forest patches settled in rural areas are usually associated with higher small mammal diversity as well as with higher tick density rates.
We derive the full chemical enrichment histories for 3800 early-type galaxies, including both star forming and passively evolving systems. For this purpose we have developed a method to simultaneously derive the element abundance ratios [C/Fe], [N/Fe], [Mg/Fe], [Ca/Fe] and [Ti/Fe] for unresolved stellar populations. The method is based on up-to-date stellar population models with varying element abundance ratios. A novelty of the models is that they are flux-calibrated, removing the dependence on the Lick/IDS system. Trends with velocity dispersion are investigated where [Mg/Fe] and [C/Fe] are found to show very similar trends, while [N/Fe] show overall lower abundances ratios. [Ca/Fe] ratios are close to solar values over the velocity dispersion range covered. Tentative, due to large scatter, result for [Ti/Fe] implies that Ti follow the trends of Ca.
Declining soil fertility is a major cause of low per capita food production on smallholder farms of sub-Saharan Africa. This study attempted to provide an empirical explanation of the factors associated with farmers' decisions to adopt or not to adopt newly introduced integrated soil fertility management (ISFM) technologies consisting of combinations of organics and mineral fertilizer in Meru South district of the central highlands of Kenya. Out of 106 households interviewed, 46% were ‘adopters’ while 54% were ‘non-adopters’. A logistic regression model showed that the factors that significantly influenced adoption positively were farm management, ability to hire labour and months in a year households bought food for their families, while age of household head and number of mature cattle negatively influenced adoption. The implication of these results is that the adoption of ISFM practices could be enhanced through targeting of younger families where both spouses work on the farm full-time and food insecure households. It is also important to target farmers that lack access to other sources of soil fertility improvement. Examples include farmers that do not own cattle or those owning few and who, therefore, have limited access to animal manure.
To evaluate the assumption that resistance rates in intensive care units (ICUs) are markedly influenced by cross-transmission events in addition to high rates of antimicrobial usage.
This was a prospective ICU- and laboratory-based surveillance study involving 35 German ICUs from 1999 through 2004. A total of 585 ciprofloxacin- or imipenem-resistant isolates of Pseudomonas aeruginosa were investigated together with resistance rate and unit-based antimicrobial usage density. Antimicrobial use was reported in terms of defined daily doses per 1,000 patient-days. All the strains were assigned to ICU-based genotypes. Genodiversity was calculated as the numbers of indistinguishable ICU-based genotypes found per isolates tested. Reduced ICU-based genodiversity was taken as an indirect measure of frequently occurring cross-transmission events.
The genodiversity of ciprofloxacin- and imipenem-resistant P. aeruginosa isolates was significantly lower (P ≤ .05, by Fisher exact test) in ICUs with high resistance rate and low antimicrobial usage density (genodiversity, 0.50 and 0.50, respectively) than in ICUs that featured low resistance rate in the presence of high antimicrobial usage density (genodiversity, 0.90 and 0.95, respectively). In ICUs with low genodiversity, there was a greater rise in resistance rate with increasing antimicrobial usage density, compared with that in ICUs with high diversity.
This study on resistant P. aeruginosa isolates supports the assumption that high resistance rate in the presence of low antimicrobial usage density results from more-frequent cross-transmission events. A greater rise in resistance rate with increasing antimicrobial usage density in ICUs with low genodiversity indicates that resistance rate in ICUs might be markedly determined by cross-transmission events other than antimicrobial usage.
Leentje Van Lommel, Gene Expression Unit, Department of Molecular Cell Biology, K. U. Leuven, Belgium,
Yves Moreau, Department of Electrical Engineering, ESAT–SCD, K. U. Leuven, Belgium,
Daniel Pipeleers, Diabetes Research Center, Vrije Universiteit Brussel, Belgium,
Jean-Christophe Jonas, Unit of Endocrinology and Metabolism, Faculty of Medicine, Université Catholique de Louvain, Brussels, Belgium,
Frans Schuit, Gene Expression Unit, Department of Molecular Cell Biology, K. U. Leuven, Belgium
Diabetes is one of the most common health problems of our age, affecting more than 150 million patients worldwide today and perhaps will affect twice as many a few decades on from now . In the vast majority of patients, the exact cause of their disease state is unknown. Diabetes can be caused by autoimmune destruction of insulin-producing beta-cells in the pancreas (type 1 diabetes) or by a failure of the beta-cells to produce/release insulin in sufficient amounts to meet the metabolic demand (type 2 diabetes). The latter group represents about 90% of all diabetic patients and today is one of the most prevalent existing health problems. The high prevalence, chronic nature, and unknown cause of diabetes are strong arguments for studying the beta-cell in order to identify mechanisms by which beta-cells are destroyed or made dysfunctional.
Identification of key aspects of beta-cell dysfunction at the molecular detail requires that the molecules in the normal beta-cell, as well as their mode of action, are known. The rationale to build up such knowledge in a biomedical context is dual. First, it is expected that such insight will assist in the process of finding new ways of drug treatment for type 2 patients, so that beta-cell dysfunction can be corrected in a more efficient way than is possible today. Second, this type of knowledge will define the endpoint of investigations that aim to generate new beta-cells from pancreatic or extra-pancreatic precursor cells.
The objective of this study was to analyze methicillin-resistant Staphylococcus aureus (MRSA) percentages (defined as the percentage of S. aureus isolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003).
This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days.
From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552 S. aureus isolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use (P<.05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%]). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage (P<.05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days.
The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.
With improved control of cancer above the clavicles, distant metastases (DM) are frequently more seen and are becoming a more common cause of morbidity and mortality. The present study defined the incidence of distant metastases in a cohort of terminal head and neck cancer patients (HNCP) and compared it to current reported data. The incidence of distant metastases in relation to the primary tumour was evaluated and their impact on survival was assessed. A retrospective survey of patient charts was made, based on the hospice database and original referring hospital charts. Data of 59 patients admitted to the hospice were evaluated. The incidence and location of locoregional and distant disease were studied and effects on survival analyzed.
The overall survival from diagnosis to demise was 42.7 months. Thyroid cancer was seen in 20.3 per cent of cases and squamous cell cancer was seen in 59.3 per cent. Distant metastases were found in 83 per cent and 48.6 per cent of patients respectively. Laryngeal cancer patients had a 54.5 per cent incidence of distant metastases. Locoregional disease was seen in 47 per cent of cases and 35.7 per cent of them had distant metastases while a 64.3 per cent incidence of distant metastases was found in cases without locoregional disease. Mean survival was 47.3 months with distant metastases vs 36.5 months without metastases. The difference was not statistically significant.
The incidence of distant metastases in squamous cell cancer in terminalHNCP was 48.6 per cent. This is the highest reported incidence of metastases in a clinical series. Patients without locoregional disease had almost a two-fold incidence of metastases. Survival was not affected by metastases in this series.
The fourth order orientation distribution function (ODF) coefficients of textured low carbon steel sheets were determined nondestructively from the anisotropy of the velocity of Lamb (So) and SHO plate waves measured using electromagnetic acoustic transducers (EMATs). The three coefficients (C411, C412, C413) are calculated from five velocity measurements made in three directions in the rolling plane of the sheet using the Hill approximation by an iterative numerical method. The coefficients were also determined from Young's modulus measurements based on a resonance technique and are compared to those obtained ultrasonically. The comparison with coefficients determined from X-ray diffraction pole figures permits adjustment of the C411 coefficient and then very good agreement is obtained. The plastic strain ratios (R-values) of the steel samples are predicted from the adjusted coefficients using a series expansion method based on the Taylor theory of crystal plasticity. These are compared with experimental measurements and again good agreement is displayed.
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