Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Load compliance

Osseointegration has been introduced in the orthopaedic surgery in the 1990’s in Gothenburg (Sweden). To date, there are two frequently used commercially available human implants: the OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany) systems. The rehabilitation program with both systems include some form of static load bearing exercises. These latter involved following a load progression that is monitored by the bathroom scale, providing only the load applied on the vertical axis. The loading data could be analysed through different biomechanical variables. For instance, the load compliance, corresponding to the difference between the load recommended (LR) and the load actually applied on the implant, will be presented here.

Description of body posture during Static load bearing exercises for individuals with transfemoral amputation fitted with bone-anchored prosthesis

The rehabilitation programs of bone-anchorage prostheses relying either on the OPRA (Integrum, Sweden) or the ILP (Orthodynamics, Germany) fixation involve some forms of static load bearing exercises (LBE). So far, most of biomechanical studies of these static LBEs focused on the direct measurements of the actual forces and moments applied on the OPRA fixation of individuals with transfemoral amputation (TFA). To date, the proof-of-concept of an apparatus to conduct these kinetic measurements has been presented, along with some preliminary data. The understanding of the kinetic data is essential to improve rehabilitation programs as well as the design of upcoming loading frames. However, kinetic information alone is difficult to interpret without concomitant kinematic data. The purpose of this preliminary study was to introduce a qualitative analysis describing the different body postures during LBE for a group of TFAs.

Load bearing exercises and functional outcome of individuals with transfemoral amputation fitted with OPRA fixation

Individuals with lower limb amputation fitted with an OPRA osseointegrated fixation are facing an extensive rehabilitation program including static load bearing exercises (LBE). The application of a suitable amount of stress stimulates osseointegration and prepares the bone to tolerate the forces and moments that will be incurred during activities of daily living (ADL. At present, the monitoring is typically carried out using a normal bathroom weighing scale. This scale provides information only on the magnitude of the vertical component of the applied force. The moment around the long axis of the fixation when the femur is perpendicular to the ground is not assessed and neither are the components of force and moment generated on the other two axes.

Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Kinetic analysis

The desire to solve problems caused by socket prostheses in transfemoral amputees and the acquired success of osseointegration in the dental application has led to the introduction of osseointegration in the orthopedic surgery. Since its first introduction in 1990 in Gothenburg Sweden the osseointegrated (OI) orthopedic fixation has proven several benefits[1]. The surgery consists of two surgical procedures followed by a lengthy rehabilitation program. The rehabilitation program after an OI implant includes a specific training period with a short training prosthesis. Since mechanical loading is considered to be one of the key factors that influence bone mass and the osseointegration of bone-anchored implants, the rehabilitation program will also need to include some form of load bearing exercises (LBE). To date there are two frequently used commercially available human implants. We can find proof in the literature that load bearing exercises are performed by patients with both types of OI implants. We refer to two articles, a first one written by Dr. Aschoff and all and published in 2010 in the Journal of Bone and Joint Surgery.[2] The second one presented by Hagberg et al in 2009 gives a very thorough description of the rehabilitation program of TFA fitted with an OPRA implant. The progression of the load however is determined individually according to the residual skeleton’s quality, pain level and body weight of the participant.[1] Patients are using a classical bathroom weighing scale to control the load on the implant during the course of their rehabilitation. The bathroom scale is an affordable and easy-to-use device but it has some important shortcomings. The scale provides instantaneous feedback to the patient only on the magnitude of the vertical component of the applied force. The forces and moments applied along and around the three axes of the implant are unknown. Although there are different ways to assess the load on the implant for instance through inverse dynamics in a motion analysis laboratory [3-6] this assessment is challenging. A recent proof- of-concept study by Frossard et al (2009) showed that the shortcomings of the weighing scale can be overcome by a portable kinetic system based on a commercial transducer[7].

Dynamic input to determine hip joint moments, power and work on the prosthetic limb of transfemoral amputees: ground reactions vs knee reactions

Study Design: Comparative analysis Background: Calculations of lower limbs kinetics are limited by floor-mounted force-plates. Objectives: Comparison of hip joint moments, power and mechanical work on the prosthetic limb of a transfemoral amputee calculated by inverse dynamics using either the ground reactions (force-plates) or knee reactions (transducer). Methods: Kinematics, ground reactions and knee reactions were collected using a motion analysis system, two force-plates and a multi-axial transducer mounted below the socket, respectively. Results: The inverse dynamics using ground reactions under-estimated the peaks of hip energy generation and absorption occurring at 63 % and 76 % of the gait cycle (GC) by 28 % and 54 %, respectively. This method over-estimated a phase of negative work at the hip (from 37 %GC to 56 %GC) by 24%. It under-estimated the phases of positive (from 57 %GC to 72 %GC) and negative (from 73 %GC to 98 %GC) work at the hip by 11 % and 58%, respectively. Conclusions: A transducer mounted within the prosthesis has the capacity to provide more realistic kinetics of the prosthetic limb because it enables assessment of multiple consecutive steps and a wide range of activities without issues of foot placement on force-plates. CLINICAL RELEVANCE The hip is the only joint that an amputee controls directly to set in motion the prosthesis. Hip joint kinetics are associated with joint degeneration, low back pain, risks of fall, etc. Therefore, realistic assessment of hip kinetics over multiple gait cycles and a wide range of activities is essential.

Regressive measures won’t help youth into work or training

The 2014 federal budget implemented a so-called crackdown on what Minister for Social Services Kevin Andrews calls young people who are content to “sit on the couch at home and pick up a welfare cheque”. The crackdown will change access to income support for people under 30 years of age. From January 1 2015, all young people seeking Newstart Allowance and Youth Allowance for the first time will be required to “demonstrate appropriate job search and participation in employment services support for six months before receiving payments”. Upon qualifying, recipients must then spend 25 hours per week in Work for the Dole in order to receive income support for a six-month period. What happens beyond this six months is unclear. What is clear is that these policy changes, together with the Minister’s accompanying statements, are informed by a deficit view of disadvantaged youth. It is a view that demonstrates how little politicians know or understand about these young peoples’ past circumstances.

Issues in autonomous navigation of underground vehicles

This paper describes current research at the Australian Centre for Field Robotics (ACFR) in collaboration with the Commonwealth Scientific and Industrial Research Organisation (CSIRO) within the Cooperative Research Centre (CRC) for Mining Technology and Equipment (CMTE) towards achieving autonomous navigation of underground vehicles, like a Load-Haul-Dump (LHD) truck. This work is being sponsored by the mining industry through the Australian Mineral Industries Research Association Limited (AMIRA). Robust and reliable autonomous navigation can only be realised by achieving high level tasks such as path-planning and obstacle avoidance. This requires determining the pose (position and orientation) of the vehicle at all times. A minimal infrastructure localisation algorithm that has been developed for this purpose is outlined and the corresponding results are presented. Further research issues that are under investigation are also outlined briefly.

Emotional anguish at work: The mediating role of perceived rejection on workgroup mistreatment and affective outcomes

In this study, the authors pay particular attention to mistreatment directed toward an organizational member from fellow workgroup members. The study contributes to the growing body of literature that examines the mistreatment of employees in the workplace. The authors propose that mistreatment by the workgroup would contribute to feelings of rejection, over and above mistreatment by the supervisor. In addition, the authors tested the mediating role of perceived rejection between workgroup mistreatment and affective outcomes such as depression and organization-based self-esteem. Part-time working participants (N = 142) took part in the study, which required them to complete a questionnaire on workplace behaviors. Results indicated that workgroup mistreatment contributed additional variance to perceived rejection over and above supervisory mistreatment when predicting depression and organization-based self-esteem. The results also indicated that perceived rejection mediates the relationship between mistreatment and affective outcomes. Results are discussed and implications for research and practice are considered.

One step closer into the design of fall protective device for individuals fitted with a bone-anchored prosthesis

The consequences of falls are often dreadful for individuals with lower limb amputation using bone-anchored prosthesis.[1-5] Typically, the impact on the fixation is responsible for bending the intercutaneous piece that could lead to a complete breakage over time. .[3, 5-8] The surgical replacement of this piece is possible but complex and expensive. Clearly, there is a need for solid data enabling an evidence-based design of protective devices limiting impact forces and torsion applied during a fall. The impact on the fixation during an actual fall is obviously difficult to record during a scientific experiment.[6, 8-13] Consequently, Schwartze and colleagues opted for one of the next best options science has to offer: simulation with an able-bodied participant. They recorded body movements and knee impacts on the floor while mimicking several plausible falling scenarios. Then, they calculated the forces and moments that would be applied at four levels along the femur corresponding to amputation heights.[6, 8-11, 14-25] The overall forces applied during the falls were similar regardless of the amputation height indicating that the impact forces were simply translated along the femur. As expected, they showed that overall moments generally increased with amputation height due to changes in lever arm. This work demonstrates that devices preventing only against force overload do not require considering amputation height while those protecting against bending moments should. Another significant contribution is to provide, for the time, the magnitude of the impact load during different falls. This loading range is crucial to the overall design and, more precisely, the triggering threshold of protective devices. Unfortunately, the analysis of only a single able-bodied participant replicating falls limits greatly the generalisation of the findings. Nonetheless, this case study is an important milestone contributing to a better understanding of load impact during a fall. This new knowledge will improve the treatment, the safe ambulation and, ultimately, the quality of life of individuals fitted with bone-anchored prosthesis.

Resilience and work-life balance in first-line nurse manager

Purpose The aim of this study was to explore how first-line nurse managers constructed the meaning of resilience and its relationship to work-life balance for nurses in Korea. Methods Participants were 20 first-line nurse managers working in six university hospitals. Data were collected through in-depth interviews from December 2011 to August 2012, and analyzed using Strauss and Corbin's grounded theory method. Results Analysis revealed that participants perceived work-life balance and resilience to be shaped by dynamic, reflective processes. The features consisting resilience included "positive thinking", "flexibility", "assuming responsibility", and "separating work and life". This perception of resilience has the potential to facilitate a shift in focus from negative to positive experiences, from rigidity to flexibility, from task-centered to person-centered thinking, and from the organization to life. Conclusions Recognizing the importance of work-life balance in producing and sustaining resilience in first-line nurse managers could increase retention in the Korean nursing workforce.

An efficient DSE using conditional multivariate complex Gaussian distribution

This paper presents an efficient noniterative method for distribution state estimation using conditional multivariate complex Gaussian distribution (CMCGD). In the proposed method, the mean and standard deviation (SD) of the state variables is obtained in one step considering load uncertainties, measurement errors, and load correlations. In this method, first the bus voltages, branch currents, and injection currents are represented by MCGD using direct load flow and a linear transformation. Then, the mean and SD of bus voltages, or other states, are calculated using CMCGD and estimation of variance method. The mean and SD of pseudo measurements, as well as spatial correlations between pseudo measurements, are modeled based on the historical data for different levels of load duration curve. The proposed method can handle load uncertainties without using time-consuming approaches such as Monte Carlo. Simulation results of two case studies, six-bus, and a realistic 747-bus distribution network show the effectiveness of the proposed method in terms of speed, accuracy, and quality against the conventional approach.

Using a free online questionnaire to determine the skills, competencies and knowledge required to work in a digital library environment in Australia

This paper discusses the data collection technique used to determine the skills and knowledge required of academic librarians working in a digital library environment in Australia. The research was undertaken as part of the researcher’s master’s thesis conducted at Tallinn University. The data collection instrument used was a freely available online survey tool, and its advantages and disadvantages are discussed in terms of the desired outcomes and circumstances surrounding the thesis project. Decisions regarding the design of the questionnaire are also discussed.

Exploring how adults who work with young children conceptualise sustainability and describe their practice initiatives

The development of early Childhood Education for Sustainability (ECEfS) practices with young children from birth to eight years is an emerging area in academic and professional literature. ECEfS practices reflect growing awareness of the imperative for twenty-first century societies to respond to the pressures of unsustainable patterns of living. This article contributes to the growing area of ECEfS research by exploring sustainability conceptualisations and practice initiatives as reported by early childhood teachers, educators, pre-service educators and parents in Tasmania. We do this by analysing data collected from participants who attended ECEfS professional learning workshops, entitled Living and learning about sustainability in the early years. Findings show that environmental (nature/natural) aspects of sustainability dominate these adults' practice initiatives and understandings. While many of the reported educational initiatives are to be celebrated, the authors contend that there is much work to be done to extend thinking and practice beyond the natural/environmental dimension in order to embrace holistic notions of sustainability incorporating social, economic and political dimensions.

Web crippling tests of cold-formed steel channels under two flange load cases

Cold-formed steel members have many advantages over hot-rolled steel members. However, they are susceptible to various buckling modes at stresses below the yield stress of the member because of their relatively high width-to-thickness ratio. Web crippling is a form of localized failure mode that can occur when the members are subjected to transverse high concentrated loadings and/or reactions. The four common loading conditions are the end-one-flange (EOF), interior-one-flange (IOF), end-two-flange (ETF) and interior-two-flange (ITF) loadings. Recently a test method has been proposed by AISI to obtain the web crippling capacities under these four loading conditions. Using this test method 42 tests were conducted in this research to investigate the web crippling behaviour and strengths of unlipped channels with stocky webs under ETF and ITF cases. DuraGal sections having a nominal yield stress of 450 MPa were tested with different web slenderness and bearing lengths. The flanges of these channel sections were not fastened to the supports. In this research the suitability of the currently available design rules for unlipped channels subject to web crippling was investigated, and suitable modifications were proposed where necessary. In addition to this, a new design rule was proposed based on the direct strength method to predict the web crippling capacities of tested beams. This paper presents the details of this experimental study and the results.

Local buckling studies of cold-formed steel compression members at elevated temperatures

Cold-formed steel members have been widely used in residential and commercial buildings as primary load bearing structural elements. They are often made of thin steel sheets and hence they are more susceptible to local buckling. The buckling behaviour of cold-formed steel compression members under fire conditions is not fully investigated yet and hence there is a lack of knowledge on the fire performance of cold-formed steel compression members. Current cold-formed steel design standards do not provide adequate design guidelines for the fire design of cold-formed steel compression members. Therefore a research project based on extensive experimental and numerical studies was undertaken to investigate the local buckling behaviour of light gauge cold-formed steel compression members under simulated fire conditions. First a series of 91 local buckling tests was conducted at ambient and uniform elevated temperatures up to 700oC on cold-formed lipped and unlipped channels. Suitable finite element models were then developed to simulate the behaviour of tested columns and were validated using test results. All the ultimate load capacity results for local buckling were compared with the predictions from the available design rules based on AS/NZS 4600, BS 5950 Part 5, Eurocode 3 Parts 1.2 and 1.3 and the direct strength method (DSM), based on which suitable recommendations have been made for the fire design of cold-formed steel compression members subject to local buckling at uniform elevated temperatures.