Determinants of patients' expectations about total knee arthroplasty outcomes

Knee osteoarthritis (OA) is the most prevalent form of arthritis in the US, affecting approximately 37% of adults. Approximately 300,000 total knee arthroplasty (TKA) procedures take place in the United States each year. Total knee arthroplasty is an elective procedure available to patients as an irreversible treatment after failure of previous medical treatments. Some patients sacrifice quality of life and endure many years of pain before making the decision to undergo total knee replacement. In making their decision, it is therefore imperative for patients to understand the procedure, risks and surgical outcomes to create realistic expectations and increase outcome satisfaction. ^ From 2004-2007, 236 OA patients who underwent TKA participated in the PEAKS (Patient Expectations About Knee Surgery) study, an observational longitudinal cohort study, completed baseline and 6 month follow-up questionnaires after the surgery. We performed a secondary data analysis of the PEAKS study to: (1) determine the specific presurgical patient characteristics associated with patients’ presurgical expectations of time to functional recovery; and (2) determine the association between presurgical expectations of time to functional recovery and postsurgical patient capabilities (6 months after TKA). We utilized the WOMAC to measure knee pain and function, the SF-36 to measure health-related quality of life, and the DASS and MOS-SSS to measure psychosocial quality of life variables. Expectation and capability measures were generated from panel of experts. A list of 10 activities was used for this analysis to measure functional expectations and postoperative functional capabilities. ^ The final cohort consisted of 236 individuals, was predominately White with 154 women and 82 men. The mean age was 65 years. Patients were optimistic about their time to functional recovery. Expectation time of being able to perform the list activities per patient had a median of less than 3 months. Patients who expected to be able to perform the functional activities by 3 months had better knee function, less pain and better overall health-related quality of life. Despite expectation differences, all patients showed significant improvement 6 months after surgery. Participant expectation of time to functional recovery was not an independent predictor of capability to perform functional activities at 6 months. Better presurgical patient characteristics were, however, associated with a higher likelihood of being able to perform all activities at 6 months. ^ This study gave us initial insight on the relationship between presurgical patient characteristics and their expectations of functional recovery after total knee replacement. Future studies clarifying the relationship between patient presurgical characteristics and postsurgical functional capabilities are needed.^

Inverse kinematics of a 6 DoF human upper limb using ANFIS and ANN for anticipatory actuation in ADL-based physical Neurorehabilitation

Objective: This research is focused in the creation and validation of a solution to the inverse kinematics problem for a 6 degrees of freedom human upper limb. This system is intended to work within a realtime dysfunctional motion prediction system that allows anticipatory actuation in physical Neurorehabilitation under the assisted-as-needed paradigm. For this purpose, a multilayer perceptron-based and an ANFIS-based solution to the inverse kinematics problem are evaluated. Materials and methods: Both the multilayer perceptron-based and the ANFIS-based inverse kinematics methods have been trained with three-dimensional Cartesian positions corresponding to the end-effector of healthy human upper limbs that execute two different activities of the daily life: "serving water from a jar" and "picking up a bottle". Validation of the proposed methodologies has been performed by a 10 fold cross-validation procedure. Results: Once trained, the systems are able to map 3D positions of the end-effector to the corresponding healthy biomechanical configurations. A high mean correlation coefficient and a low root mean squared error have been found for both the multilayer perceptron and ANFIS-based methods. Conclusions: The obtained results indicate that both systems effectively solve the inverse kinematics problem, but, due to its low computational load, crucial in real-time applications, along with its high performance, a multilayer perceptron-based solution, consisting in 3 input neurons, 1 hidden layer with 3 neurons and 6 output neurons has been considered the most appropriated for the target application.

Inverse kinematics of a humanoid robot with non-spherical hip: a hybrid algorithm approach

This paper describes an approach to solve the inverse kinematics problem of humanoid robots whose construction shows a small but non negligible offset at the hip which prevents any purely analytical solution to be developed. Knowing that a purely numerical solution is not feasible due to variable efficiency problems, the proposed one first neglects the offset presence in order to obtain an approximate “solution” by means of an analytical algorithm based on screw theory, and then uses it as the initial condition of a numerical refining procedure based on the Levenberg‐Marquardt algorithm. In this way, few iterations are needed for any specified attitude, making it possible to implement the algorithm for real‐time applications. As a way to show the algorithm’s implementation, one case of study is considered throughout the paper, represented by the SILO2 humanoid robot.

Use of Headed Reinforcement Bars in Contruction. A Theoretical Approach to Determine the Dimensions of Anchorage Plates and Experimental Tests on Knee Joints Subjected to a Closing Moment

In order to reduce costs and time while improving quality, durability and sustainability in structural concrete constructions, a widely used material nowadays, special care must be taken in some crucial phases of the project and execution, including the structure design and calculation, the dosage, dumping and curing of concrete: another important aspect is the proper design and execution of assembly plans and construction details. The framework, a name designating the whole reinforcement bars cage already assembled as shown in the drawings, can be made up of several components and implies higher or lower industrialization degree. The framework costs constitute about one third of the price per cubic meter placed in concrete works. The best solutions from all points of view are clearly those involving an easier processing to achieve the same goal, and consequently carrying a high degree of industrialization, meaning quality and safety in the work. This thesis aims to provide an indepth analysis of a relatively new type of anchoring by plate known as headed reinforcement bars, which can potentially replace standard or L-shaped hooks, improving the cleaning of construction details and enabling a faster, more flexible, and therefore a more economical assembly. A literature review on the topic and an overview of typical applications is provided, followed by some examples of specific applications in real projects. Since a strict theoretical formulation used to provide the design plate dimensions has not yet been put forward, an equation is proposed for the side-face blowout strength of the anchorage, based on the capacity of concrete to carry concentrated loads in cases in which no transverse reinforcement is provided. The correlation of the calculated ultimate load with experimental results available in the literature is given. Besides, the proposed formulation can be expanded to cases in which a certain development length is available: using a software for nonlinear finite element analysis oriented to the study of reinforced concrete, numerical tests on the bond-bearing interaction are performed. The thesis ends with a testing of eight corner joints subjected to a closing moment, held in the Structures Laboratory of the Polytechnic University of Madrid, aiming to check whether the design of such plates as stated is adequate for these elements and whether an element with plate-anchored reinforcement is equivalent to one with a traditional construction detail.

Nuclease-resistant ribozymes decrease stromelysin mRNA levels in rabbit synovium following exogenous delivery to the knee joint.

Catalytic RNA molecules, or ribozymes, have generated significant interest as potential therapeutic agents for controlling gene expression. Although ribozymes have been shown to work in vitro and in cellular assays, there are no reports that demonstrate the efficacy of synthetic, stabilized ribozymes delivered in vivo. We are currently utilizing the rabbit model of interleukin 1-induced arthritis to assess the localization, stability, and efficacy of exogenous antistromelysin hammerhead ribozymes. The matrix metalloproteinase stromelysin is believed to be a key mediator in arthritic diseases. It seems likely therefore that inhibiting stromelysin would be a valid therapeutic approach for arthritis. We found that following intraarticular administration ribozymes were taken up by cells in the synovial lining, were stable in the synovium, and reduced synovial interleukin 1 alpha-induced stromelysin mRNA. This effect was demonstrated with ribozymes containing various chemical modifications that impart nuclease resistance and that recognize several distinct sites on the message. Catalytically inactive ribozymes were ineffective, thus suggesting a cleavage-mediated mechanism of action. These results suggest that ribozymes may be useful in the treatment of arthritic diseases characterized by dysregulation of metalloproteinase expression.

Kinematics of eyelid movement and eye retraction in the blinking

Resumen del póster expuesto en el 6th EOS Topical Meeting on Visual and Physiological Optics (EMVPO 2012), Dublín, 20-22 Agosto 2012.

Kinematics of eyelid movement and eye retraction in the blinking [Poster]

Póster presentado en el 6th EOS Meeting on Visual and Physiological Optics (EMVPO 2012), Dublín, 20-22 Agosto 2012.

Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people

Aim: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss. Background: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective. Design: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman. Findings: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as “obese” and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories. Conclusion: Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.

MRI Registration for Human Hip Kinematics

Measurement of joint kinematics can provide knowledge to help improve joint prosthesis design, as well as identify joint motion patterns that may lead to joint degeneration or injury. More investigation into how the hip translates in live human subjects during high amplitude motions is needed. This work presents a design of a non-invasive method using the registration between images from conventional Magnetic Resonance Imaging (MRI) and open MRI to calculate three dimensional hip joint kinematics. The method was tested on a single healthy subject in three different poses. MRI protocols for the conventional gantry, high-resolution MRI and the open gantry, lowresolution MRI were developed. The scan time for the low-resolution protocol was just under 6 minutes. High-resolution meshes and low resolution contours were derived from segmentation of the high-resolution and low-resolution images, respectively. Low-resolution contours described the poses as scanned, whereas the meshes described the bones’ geometries. The meshes and contours were registered to each other, and joint kinematics were calculated. The segmentation and registration were performed for both cortical and sub-cortical bone surfaces. A repeatability study was performed by comparing the kinematic results derived from three users’ segmentations of the sub-cortical bone surfaces from a low-resolution scan. The root mean squared error of all registrations was below 1.92mm. The maximum range between segmenters in translation magnitude was 0.95mm, and the maximum deviation from the average of all orientations was 1.27◦. This work demonstrated that this method for non-invasive measurement of hip kinematics is promising for measuring high-range-of-motion hip motions in vivo.

Transformation of Nine-Accelerometer-Package (NAP) data for replicating headpart kinematics and dynamic loading. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

A comparison of the automatic shoulder belt/knee bolster restraint system with the lap and shoulder belt system in VW Rabbits. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Combined medical-engineering study of injury and damage to the knee joint in impact. Final report.

National Highway Safety Bureau, Washington, D.C.

Directional irregular wave kinematics /

Includes bibliographical references: (p. 157-165).

An account of a new method of treating diseases of the joints of the knee and elbow : : in a letter to Mr. Percival Pott /

Mode of access: Internet.

The applications of the complex variable to kinematics /

Thesis (M.S.)--University of California, Berkeley, 1894.