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Peak tibial accelerations are used to monitor impact severity during distance running and as input for bio-feedback. Here, peak tibial accelerations were compared between rearfoot and forefoot strikes. Two different studies were undertaken by independent research centres. Tibial acceleration and optical motion capture were collected in 14 rearfoot strikers who changed to a forefoot strike in the first centre. In the second centre, tibial acceleration of 14 other rearfoot strikers and nine forefoot strikers were collected and processed. In over-ground level running at a submaximal speed, the resultant peak tibial acceleration was greater in the instructed forefoot strike condition (Δ X  = 7.6 ± 1.3 g, mean ± standard error difference) and in the habitual forefoot strikers (Δ X -  = 3.7 ± 1.1 g) than in the rearfoot strikers. The shank kinematics revealed a greater decrease in antero-posterior velocity following touchdown in the forefoot strike condition. The forefoot strikes experienced greater posterior tibial acceleration, which resulted in an increased resultant peak tibial acceleration that also occurred earlier than in the rearfoot strikes. No significant difference in axial peak tibial acceleration was found between these foot strike patterns. In conclusion, the foot strike pattern differently affects peak tibial accelerations in level running, which can have implications for monitoring and biofeedback applications.

This study explored how mental fatigue affects brain activity during a low-intensity bike task utilising a continuous wavelet transformation in electroencephalography (EEG) analysis. The aim was to examine changes in brain activity potentially linked to central motor commands and to investigate their relationship with ratings of perceived exertion (RPE). In this study, sixteen participants (age: 21 ± 6 y, 7 females, 9 males) underwent one familiarization and two experimental trials in a randomised, blinded, cross-over study design. Participants executed a low-intensity bike task (9 min; 45 rpm; intensity (W): 10 % below aerobic threshold) after performing a mentally fatiguing (individualized 60-min Stroop task) or a control (documentary) task. Physiological (heart rate, EEG) and subjective measures (self-reported feeling of mental fatigue, RPE, cognitive load, motivation) were assessed prior, during and after the bike task. Post-Stroop, self-reported feeling of mental fatigue was higher in the intervention group (EXP) (74 ± 16) than in the control group (CON) (37 ± 17; p < 0.001). No significant differences in RPE during the bike task were observed between conditions. EEG analysis revealed significant differences (p < 0.05) in beta frequency (13-30 Hz) during the bike task, with EXP exhibiting more desynchronization during the pedal push phase and synchronization during the pedal release phase. These results suggest that mental fatigue, confirmed by both subjective and neurophysiological markers, did not significantly impact RPE during the bike task, possibly due to the use of the CR100 scale or absence of a performance outcome. However, EEG data did reveal significant beta band alterations during the task, indicating increased neural effort under mental fatigue. These findings reveal, for the first time, how motor-related brain activity at the motor cortex is impacted during a low-intensity bike task when mentally fatigued., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflict of interest is declared by the authors. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Mental fatigue (MF) and hypoxia impair cognitive performance through changes in brain hemodynamics. We want to elucidate the role of prefrontal cortex (PFC)-oxygenation in MF. Twelve participants (22.9 ± 3.5 years) completed four experimental trials, (1) MF in (normobaric) hypoxia (MF&#95;HYP) (3.800 m; 13.5%O 2 ), (2) MF in normoxia (MF&#95;NOR) (98 m; 21.0%O 2 ), (3) Control task in HYP (CON&#95;HYP), (4) Control in NOR (CON&#95;NOR). Participants performed a 2-back task, Digit Symbol Substitution test and Psychomotor Vigilance task before and after a 60-min Stroop task or an emotionally neutral documentary. Brain oxygenation was measured through functional Near Infrared Spectroscopy. Subjective feelings of MF and physiological measures (heart rate, oxygen saturation, blood glucose and hemoglobin) were recorded. The Stroop task resulted in increased subjective feelings of MF compared to watching the documentary. 2-back accuracy was lower post task compared to pre task in MF&#95;NOR and CON&#95;NOR, while no differences were found in the other cognitive tasks. The fraction of inspired oxygen did not impact feelings of MF. Although performing the Stroop resulted in higher subjective feelings of MF, hypoxia had no effect on the severity of self-reported MF. Additionally, this study could not provide evidence for a role of oxygenation of the PFC in the build-up of MF., (© 2024. The Author(s).)

Due to differences in actuation and design, active and passive industrial back exoskeletons could influence functional performance, i.e., work performance, perceived task difficulty, and discomfort, differently. Therefore, this study investigated and compared the impact of the active CrayX (7 kg) and passive Paexo Back (4.5 kg) on functional performance. Eighteen participants performed twelve work-related tasks with both types of exoskeletons and without (NoExo). The CrayX hindered work performance up to 22% in multiple tasks, compared to the Paexo Back and NoExo, while work performance between NoExo and the Paexo Back condition was more comparable, except for stair climbing (13% hindrance). Perceived task difficulty and discomfort seldomly varied between both exoskeletons. Although the CrayX shows promise to benefit workers, limitations in hindrance and comfort should first be addressed. The Paexo Back has demonstrated an advantage in certain static tasks. However, increasing its potential across a broader range of tasks seems warranted. Practitioner Summary: Differences between industrial back exoskeletons with regard to functional performance, i.e. work performance, discomfort and perceived task difficulty, were investigated by evaluating the active CrayX and passive Paexo Back back exoskeletons. The CrayX significantly hindered functional performance, while the Paexo Back seldomly affected functional performance. Abbreviations : WMSD: Work-related musculoskeletal disorder; NoExo: No Exoskeleton; GD: General discomfort; PTD: Perceived task difficulty; BMI: Body Mass Index.

Purpose: Several mechanisms have been proposed to explain how mental fatigue degrades sport performance. In terms of endurance performance, a role for an increased perceived exertion has been demonstrated. Using electroencephalography and, more specifically, the movement-related cortical potential (MRCP), the present study explored the neural mechanisms that could underlie the mental fatigue-associated increase in perceived exertion., Methods: Fourteen participants (age, 23 ± 2 yr; 5 women, 9 men) performed one familiarization and two experimental trials in a randomized, blinded, crossover study design. Participants had to complete a submaximal leg extension task after a mentally fatiguing task (EXP; individualized 60-min Stroop task) or control task (CON; documentary). The leg extension task consisted of performing 100 extensions at 35% of 1 repetition maximum, during which multiple physiological (heart rate, electroencephalography) and subjective measures (self-reported feeling of mental fatigue, cognitive load, behand motivation, ratings of perceived exertion) were assessed., Results: Self-reported feeling of mental fatigue was higher in EXP (72 ± 18) compared with CON (37 ± 17; P < 0.001). A significant decrease in flanker accuracy was detected only in EXP (from 0.96 ± 0.03% to 0.03%; P < 0.05). No significant differences between conditions were found in MRCP characteristics and perceived exertion. Specifically in EXP, alpha wave power increased during the leg extension task ( P < 0.01)., Conclusions: Mental fatigue did not impact the perceived exertion or MRCP characteristics during the leg extension task. This could be related to low perceived exertion and/or the absence of a performance outcome during the leg extension task. The increase in alpha power during the leg extension task in EXP suggests that participants may engage a focused internal attention mechanism to maintain performance and mitigate feelings of fatigue., (Copyright © 2023 by the American College of Sports Medicine.)

Background: The introduction of assisted reproductive technology and the trend of increasing maternal age at conception have contributed to a significant rise in the incidence of multiple pregnancies. Multiple pregnancies bear several inherent risks for both mother and child. These risks increase with plurality and type of chorionicity. Multifetal pregnancy reduction is the selective abortion of ≥1 fetuses to improve the outcome of the remaining fetus(es) by decreasing the risk of premature birth and other complications., Objective: This study aimed to compare birth outcomes of trichorionic triplets reduced to twins with those of trichorionic triplets and primary dichorionic twins. The added value of this study is the comparison with an additional control group, namely primary dichorionic twins., Study Design: This was a retrospective cohort study. Data from January 1990 to November 2016 were collected from the East Flanders Prospective Twin Survey, one of the largest European multiple birth registries. A total of 85 trichorionic triplet pregnancies (170 neonates) undergoing multifetal pregnancy reduction to twins were compared with 5093 primary dichorionic twin pregnancies (10,186 neonates) and 104 expectantly managed trichorionic triplet pregnancies (309 neonates). The assessed outcomes were gestational age at delivery, birthweight, and small for gestational age., Results: Pregnancy reduction from triplets to twins was associated with higher birthweight (+365.44 g; 95% confidence interval, 222.75-508.14 g; P<.0001) and higher gestational age (1.7 weeks; 95% confidence interval, 0.93-2.46; P<.0001) compared with ongoing trichorionic triplets after adjustment for sex, parity, method of conception, birth year, and maternal age. A trend toward lower risk of small for gestational age was observed. Reduced triplets had, on average, lower birthweight (-263.12 g; 95% confidence interval, -371.80 to -154.44 g; P<.0001) and lower gestational age (-1.13 weeks; 95% confidence interval, -1.70 to -0.56; P=.0001) compared with primary twins. No statistically significant difference was observed between primary twins and reduced triplets that reached 32 weeks of gestation., Conclusion: Multifetal pregnancy reduction from trichorionic triplets to twins significantly improved birth outcomes. This suggests that multifetal pregnancy reduction of trichorionic triplets to twins is medically justifiable. However, the birth outcomes of primary twins before 32 weeks of gestation are still better than those of reduced triplets. The process of multifetal pregnancy reduction includes at least 1 fetal death by definition, and thus prevention of higher-order pregnancies is preferable., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Occupational back-support exoskeletons, categorized as active or passive, hold promise for mitigating work-related musculoskeletal disorders. However, their impact on combined physical and cognitive aspects of industrial work performance remains inadequately understood, especially regarding potential differences between exoskeleton categories. A randomized, counterbalanced cross-over study was conducted, comparing the active CrayX, passive Paexo Back, and a no exoskeleton condition. A 15-min dual task was used to simulate both cognitive and physical aspects of industrial work performance. Cognitive workload parameters included reaction time, accuracy, and subjective measures. Physical workload included movement duration, segmented in three phases: (1) walking to and grabbing the box, (2) picking up, carrying, and putting down the box, and (3) returning to the starting point. Comfort of both devices was also surveyed. The Paexo significantly increased movement duration in the first segment compared to NoExo (Paexo = 1.55 ± 0.19 s; NoExo = 1.32 ± 0.17 s; p  < .01). Moreover, both the Paexo and CrayX increased movement duration for the third segment compared to NoExo (CrayX = 1.70 ± 0.27 s; Paexo = 1.74 ± 0.27 s, NoExo = 1.54 ± 0.23 s; p  < .01). No significant impact on cognitive outcomes was observed. Movement Time 2 was not significantly affected by both exoskeletons. Results of the first movement segment suggest the Paexo may hinder trunk bending, favoring the active device for dynamic movements. Both devices may have contributed to a higher workload as the movement duration in the third segment increased compared to NoExo., Competing Interests: The authors declare no competing interests exist., (© The Author(s) 2023.)

Background: The synanthropic house fly (Musca domestica) can potentially contribute to the mechanical spread of eggs of Taenia and Ascaris spp. in the environment and between hosts. However, the absence of validated protocols to recover eggs hampers an in-depth analysis of the house fly's role in parasite egg transmission., Methods: The gastrointestinal tract and exoskeleton of euthanized house flies were spiked with Taenia saginata eggs. The performance of several recovery protocols, in terms of both the recovery rate and ease-of-use, was (microscopically) evaluated and compared. These protocols employed steps such as washing, maceration, filtration, flotation and both passive and centrifugal sedimentation. The final validated protocols were subsequently evaluated for the recovery of Ascaris suum eggs., Results: The final protocol validated for the recovery of T. saginata eggs from the house fly's gastrointestinal tract involved homogenization in phosphate-buffered saline and centrifugation at 2000 g for 2 min, yielding a recovery rate of 79.7%. This protocol required 6.5 min to perform (which included 1.5 min of hands-on time) and removed large debris particles that could hinder the differentiation of eggs from debris. Similarly, the final protocol validated for the recovery of T. saginata eggs from the fly's exoskeleton involved washing by vortexing for 2 min in Tween 80 (0.05%), 15 min of passive sedimentation and centrifugation at 2000 g for 2 min, yielding a recovery rate of 77.4%. This protocol required 20.5 min to perform (which included 3.5 min of hands-on time) and successfully removed debris. The same protocols yielded recovery rates of 74.2% and 91.5% for the recovery of A. suum eggs from the fly's gastrointestinal tract and exoskeleton, respectively., Conclusions: Effective, simple and easy-to-use protocols were developed and validated for the recovery of T. saginata and A. suum eggs from the house fly's gastrointestinal tract and exoskeleton. These protocols can be applied to investigate the importance of flies as parasite egg transmitters in laboratory and field settings., (© 2023. The Author(s).)

Various barriers prevent the adoption of occupational exoskeletons. It is therefore important to understand why some people are willing to use occupational exoskeletons, while others are not. To identify why people use or do not use exoskeletons, we created a typology describing different types of users and non-users. These types were created based on existing literature on internet adoption and social robots. Next, literature and empirical data were used to identify reasons why some people use exoskeletons and others do not use them (yet). The typology includes users with pain and users without work-related musculoskeletal disorders, but also non-users: resisters, rejecters, discontinuers, excluded or expelled non-users. It can be used by companies interested in implementing exoskeletons to identify possible early adopters. For exoskeleton designers, it can be used as a tool to identify non-users and focus on design strategies to enable non-users to become users (such as making exoskeletons that would fit people with a wide range of body shapes). Future research can use these types to identify users and non-users in field trials or pilot projects.

Back support soft exosuits are promising solutions to reduce risk of musculoskeletal injuries at workplaces resulting from physically demanding and repetitive lifting tasks. Design of novel active exosuits address the impact on the muscle activity and metabolic costs but do not consider other critical aspects such as comfort and user perception during the intended tasks. Thus, in this study, we describe a novel soft active exosuit in line with its impact on physiological and subjective measures during lifting. We tested four healthy participants who performed repetitive lifting tasks with and without this exosuit. The exosuit provided assistance proportional to the lumbar flexion angle measured using an inertial measurement unit. We measured the participant's multimodal physiological measures including surface electromyography, metabolic cost, heart rate, and skin temperature. We also measured subjective scores on user exertion, task load, and device acceptability. All participants perceived a reduction in task load when using the exosuit. Three participants showed reduction of muscle activity for the erector spinae muscles. The metabolic costs and heart rate reserve reduced for two participants, with similar trends for skin temperature. For future development of workplace exosuits, we recommend incorporating assessments of both physiological and subjective measures, considering the user-dependent response to the exosuit.

Advancements in wearable robots aim to improve the users' motion, performance, and comfort by optimizing, mainly, energetic cost (EC). However, EC is a noisy measurement with a physiological delayed response that requires long evaluation periods and wearing an uncomfortable mask. This study aims to estimate and minimize an EMG-based objective function that describes the natural energetic expenditure of individuals walking. This objective is assessed by combining multiple electromyography (EMG) variables from the EMG intensity and muscle synergies. To evaluate this objective function simply and repeatedly, we prescribed step frequency (SF) via a metronome and optimized this frequency to minimize muscle activity demands. Further, a linear mixed-effects model was fitted for EC, with the EMG variables as fixed-effects and a random intercept that varies by participant. After the model was fitted to the data, a cubic polynomial was used to identify the optimal SF that reduces the overall EMG-based objective function. Our analysis outlines that the proposed objective function is comparable to the EC during walking, the primary objective function used in human-in-the-loop optimization. Thus, this EMG-based objective function could be potentially used to optimize wearable robots and improve human-robot interaction.

Mental fatigue (MF) is likely to occur in the industrial working population. However, the link between MF and industrial work performance has not been investigated, nor how this interacts with a passive lower back exoskeleton used during industrial work. Therefore, to elucidate its potential effect(s), this study investigated the accuracy of work performance and movement duration through a dual task paradigm and compared results between mentally fatigued volunteers and controls, with and without the exoskeleton. No main effects of MF and the exoskeleton were found. However, when mentally fatigued and wearing the exoskeleton, movement duration significantly increased compared to the baseline condition (β MF:Exo  = 0.17, p = .02, ω 2  = .03), suggesting an important interaction between the exoskeleton and one's psychobiological state. Importantly, presented data indicate a negative effect on production efficiency through increased performance time. Further research into the cognitive aspects of industrial work performance and human-exoskeleton interaction is therefore warranted., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Analgesia after robot assisted radical cystectomy aims to reduce postoperative pain and opioid consumption, while facilitating early mobilization and enteral nutrition and minimizing complications. Epidural analgesia is currently recommended for an open radical cystectomy, but it is unclear if intrathecal morphine is a suiting, less-invasive alternative for a robot-assisted radical cystectomy., Methods: The analgesic method of choice changed from epidural anesthesia to intrathecal anesthesia for patients undergoing a robot-assisted radical cystectomy. This single-center retrospective study aims to investigate if there is a difference between epidural and intrathecal analgesia in postoperative pain scores, opioid consumption, length of hospital stays and postoperative complications. An Propensity Matched Analysis was added to conventional analysis to consolidate the findings., Results: The study population consisted of 153 patients of whom 114 received an epidural catheter with bupivacaine/sufentanil and 39 received a single shot of intrathecal bupivacaine/morphine. Mean pain scores on the first two postoperative days (POD) were slightly higher in the intrathecal analgesia group (epidural versus intrathecal analgesia, NRS POD0: 0(0-2)[0-8] versus 1(0-3)[0-5], p = 0.050; POD1: 2(1-3)[0-8] versus 3(1-4)[0-7], p = 0.058; POD2: 2(0-3)[0-8] versus 3(2-4)[0-7], p = 0.010). Total postoperative morphine consumption was similar over the first seven days: 15 mg (5-35)[0-148] in the epidural group versus 11 mg (0-35)[0-148] in the intrathecal morphine group, p = 0.167. Length of hospital stay and time until fit for discharge where slightly higher in the epidural group (respectively 7 days (5-9)[4-42] versus 6 days (5-7)[4-38], p = 0.006, and 5 days (4-8)[3-30]) versus 5 days (4-6)[3-34], p = 0.018). There was no further difference in postoperative course., Conclusions: This study showed that the effects of epidural analgesia and intrathecal morphine are comparable and that intrathecal morphine may be a suiting alternative for epidural analgesia., (© 2023. The Author(s).)

Purpose: To evaluate the clinical characteristics of petrous apex cholesterol granulomas (PACG) and assess outcomes after different treatment strategies. Method: A consecutive case series of 34 patients with a PACG. Main outcomes were PACG growth, symptoms, and the outcomes of different treatment strategies: wait-and-scan (WS) and surgical drainage. Results: Thirty-four patients were analyzed; mean follow-up time was 7.1 years. Twenty-one patients (61.7%) showed symptoms, mostly more than one. Most symptoms reported were cranial nerve palsy (58.8%) and headache (35.3%). Twenty-one patients (61.8%) received solely wait-and-scan (WS), and thirteen patients (38.2%) underwent surgery, five of whom (38.5%) after an initial WS period. In the solely WS group, one (4.8%) developed new symptoms, and two (9.5%) reported symptom progression despite a stable granuloma size. Two (9.5%) showed granuloma growth on follow-up scans without symptom progression. Surgery consisted of drainage. Eleven (84.6%) of these thirteen patients reported partial recovery; one (7.7%) reported no recovery; and one (7.7%) reported full recovery of reported symptoms related to PACG. Among the patients with cranial nerve involvement, 7.7% showed full recovery after surgery; 84.6% showed partial recovery; and 7.7% did not recover. Adverse events occurred in five out of 13 patients who underwent surgery, all with full recovery. Conclusions: This study confirms that PACG are slow-growing lesions with a low risk of adverse events. Solely using wait-and-scan strategy is a safe option for patients without symptoms, with acceptable symptoms without symptom progression, and with asymptomatic growth. Surgical treatment can be considered in patients with symptom progression or symptomatic growth.

Background: Despite the potential of occupational passive shoulder exoskeletons (PSEs) to relieve overhead work, limited insights in overhead work precision performance impedes large-scale adoption in industry., Objective: To investigate the effect of PSE support on the reduction in task performance caused by physical fatigue., Methods: This experiment consisted of a randomized, counterbalanced cross-over design comparing Exo4Work PSE support and no support, in a physically fatigued state and a control condition. Precision performance was determined using execution speed and drilling errors. Muscle activity and shoulder joint kinematics were recorded., Results: Fatigue altered task performance, shoulder joint kinematics, muscle activity and subjective experience during overhead work. The PSE support mitigated the fatigue-induced changes in shoulder kinematics. Additionally, a part of the fatigue-induced co-activation of shoulder stabilizing muscles was avoided when working with the PSE. The PSE support also reduced the activity of the anterior and medial deltoid., Conclusion: Physical fatigue provokes compensatory movements and increased co-contraction of muscles when executing overhead work. These fatigue-induced alterations are generally believed to increase the overall musculoskeletal load. The support provided by the PSE reduced muscle activity of muscles working to elevate the arm, but also partially mitigated those fatigue-induced effects., Significance: This study shows that the effect of PSE support on precision performance is limited, and suggested that, apart from the known effects of PSE support during overhead work, wearing the exoskeleton in a physically fatigued state may provide additional advantages., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sander De Bock, Marco Rossini, Dirk Lefeber, Carlos Rodriguez-Guerrero, Joost Geeroms, Romain Meeusen and Kevin De Pauw were involved in the Exo4Work project of the Research Foundation - Flanders (FWO)(S000118N SBO), where the Exo4Work exoskeleton was developed., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This paper assesses the effect of a passive shoulder exoskeleton prototype, Exo4Work, on muscle activity, muscle fatigue and subjective experience during simulated occupational overhead and non-overhead work., Methods: Twenty-two healthy males performed six simulated industrial tasks with and without Exo4Work exoskeleton in a randomized counterbalanced cross-over design. During these tasks electromyography, heart rate, metabolic cost, subjective parameters and performance parameters were acquired. The effect of the exoskeleton and the body side on these parameters was investigated., Results: Anterior deltoid activity and fatigue reduced up to 16% and 41%, respectively, during isometric overhead work, and minimized hindrance of the device during non-overhead tasks. Wearing the exoskeleton increased feelings of frustration and increased discomfort in the areas where the exoskeleton and the body interfaced. The assistive effect of the exoskeleton was less prominent during dynamic tasks., Conclusion: This exoskeleton may reduce muscle activity and delay development of muscle fatigue in an overhead working scenario. For dynamic applications, the exoskeleton's assistive profile, which mimics the gravitational torque of the arm, is potentially sub-optimal., Significance: This evaluation paper is the first to report reduced muscle fatigue and activity when working with an occupational shoulder exoskeleton providing one third of the gravitational torque of the arm during overhead work. These results stress the potential of occupational shoulder exoskeletons in overhead working situations and may direct towards longitudinal field experiments. Additionally, this experiment may stimulate future work to further investigate the effect of different assistive profiles.

An improved understanding of the environmental transmission of Taenia spp. is key to control of the parasite. Methods to detect and quantify Taenia eggs in different environmental matrices, including sludge and water, currently lack performance validation with regard to the recovery efficiency and process ease of use. Therefore, this study aimed to assess the recovery efficiency and process duration of commonly used methods for the detection of Taenia eggs in sludge and water samples. Ten detection methods for Taenia spp. eggs were selected from a systematic review. Sludge and water samples were spiked with a high dose of Taenia saginata eggs, i.e., around 200 eggs/g sludge and 50 eggs/ml water, and were tested using five methods each. The two methods with the highest egg recovery efficiencies were selected per matrix for assessment with a lower spiking dose, i.e., 4 eggs/g sludge and 1 egg/ml water. Each time five replicates were used. Recovery efficiency was defined as the proportion of the number of eggs recovered to the total number of eggs spiked. Using the high spiking dose, all samples tested positive for all the methods. The mean egg recovery efficiency varied from 4% to 69% for sludge samples and from 3% to 68% for water samples. Using the lower spiking dose, one of the methods performed on sludge samples was able to detect all replicates, whereas only one replicate was positive using the other method. For water, all low dose samples tested positive using both methods. In conclusion, most methods performed inadequately in recovering Taenia eggs from sludge and water, with half of the methods performed on the high dose samples having a mean egg recovery efficiency of approximately 10% or less. The assessed recovery methods were generally time-consuming and labourious. A more thorough validation of existing recovery methods and improvement of method protocols to increase recovery efficiency is thus urgently needed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Objectives: To provide an overview of protocols assessing the effect of occupational exoskeletons on users and to formulate recommendations towards a literature-based assessment framework to benchmark the effect of occupational exoskeletons on the user., Methods: PubMed (MEDLINE), Web of Science database and Scopus were searched (March 2, 2021). Studies were included if they investigated the effect of one or more occupational exoskeletons on the user., Results: In total, 139 eligible studies were identified, encompassing 33, 25 and 18 unique back, shoulder and other exoskeletons, respectively. Device validation was most frequently conducted using controlled tasks while collecting muscle activity and biomechanical data. As the exoskeleton concept matures, tasks became more applied and the experimental design more representative. With that change towards realistic testing environments came a trade-off with experimental control, and user experience data became more valuable., Discussion: This evidence mapping systematic review reveals that the assessment of occupational exoskeletons is a dynamic process, and provides literature-based assessment recommendations. The homogeneity and repeatability of future exoskeleton assessment experiments will increase following these recommendations. The current review recognises the value of variability in evaluation protocols in order to obtain an overall overview of the effect of exoskeletons on the users, but the presented framework strives to facilitate benchmarking the effect of occupational exoskeletons on the users across this variety of assessment protocols., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The CYBERLEGs-gamma (CLs-ɣ) prosthesis has been developed to investigate the possibilities of powerful active prosthetics in restoring human gait capabilities after lower limb amputation., Objective: The objective of this study was to determine the performance of the CLs-ɣ prosthesis during simulated daily activities., Methods: Eight participants with a transfemoral amputation (age: 55 ± 15 years, K -level 3, registered under: NCT03376919) performed a familiarization session, an experimental session with their current prosthesis, three training sessions with the CLs-ɣ prosthesis and another experimental session with the CLs-ɣ prosthesis. Participants completed a stair-climbing-test, a timed-up-and-go-test, a sit-to stand-test, a 2-min dual-task and a 6-min treadmill walk test., Results: Comparisons between the two experimental sessions showed that stride length significantly increased during walking with the CLs-ɣ prosthesis ( p  = .012) due to a greater step length of the amputated leg ( p  = .035). Although a training period with the prototype was included, preferred walking speed was significantly slower ( p  = .018), the metabolic cost of transport was significantly higher ( p  = .028) and reaction times significantly worsened ( p  = .012) when walking with the CLs-ɣ compared to the current prosthesis., Conclusions: It can be stated that a higher physical and cognitive effort were required when wearing the CLs-ɣ prosthesis. Positive outcomes were observed regarding stride length and stair ambulation. Future prosthetics development should minimize the weight of the device and integrate customized control systems. A recommendation for future research is to include several shorter training periods or a prolonged adaptation period., Competing Interests: The authors declare no competing interests exist., (© The Author(s) 2021.)

Objectives: This study aims to evaluate the medium to long-term (1-12 years) effectiveness of two-duct ligation (2-DL) in patients with nonprogressive neurodisabilities., Methods: Main outcomes included a Visual Analogue Scale (VAS), Drooling Severity (DS) and Drooling Frequency (DF), collected at baseline, 32 weeks postintervention and 1-12 years postintervention. Secondary outcomes were adverse events (AEs), and satisfaction., Results: Forty-two patients were analyzed (mean age 17 years, mean baseline VAS 82). VAS decreased significantly from baseline to long-term (n = 30. Mean difference -36.5, CI -47.0 to -26.0, p ≤ 0.001; -26.1, CI -36.2 to -15.9, p ≤ 0.001). However, long-term VAS significantly increased compared to VAS at 32 weeks (+10.4, CI 1.0-19.8, p = 0.031). Out of 42 patients, 64% would recommend 2-DL to peers., Conclusion: There is a significant subjective 2-DL effect on drooling severity in the medium to long-term as reported by patients and caregivers, but there is also a certain degree of recurrence in this time span, and 33% of the patients required subsequent treatment. However, the majority of patients and/or caregivers would recommend 2-DL to peers., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Over the course of the twenty-first century, work-related musculoskeletal disorders are still persisting among blue collar workers. At present, no epidemiological overview exists. Therefore, a systematic review and meta-analysis was performed on the epidemiology of work-related musculoskeletal disorders (WMSD) within Europe's secondary industries., Methods: Five databases were screened, yielding 34 studies for the qualitative analysis and 17 for the quantitative analysis. Twelve subgroups of WMSDs were obtained for the meta-analysis by means of predefined inclusion criteria: back (overall), upper back, lower back, neck, shoulder, neck/shoulder, elbow, wrist/hand, leg (overall), hip, knee, and ankle/feet., Results: The most prevalent WMSDs were located at the back (overall), shoulder/neck, neck, shoulder, lower back and wrist WMSDs with mean 12-month prevalence values of 60, 54, 51, 50, 47, and 42%, respectively. The food industry was in the majority of subgroups the most prominent researched sector and was frequently associated with high prevalence values of WMSDs. Incidence ratios of upper limb WMSDs ranged between 0.04 and 0.26. Incidence ratios could not be calculated for other anatomical regions due to the lack of sufficient articles., Conclusion: WMSDs are still highly present among blue collar workers. Relatively high prevalence values and low incidence ratios indicate a limited onset of WMSDs with however long-term complaints., (© 2021. The Author(s).)

Introduction: Acute apnea evokes bradycardia and peripheral vasoconstriction in order to conserve oxygen, which is more pronounced with face immersion. This response is contrary to the tachycardia and increased blood flow to muscle tissue related to the higher oxygen consumption during exercise. The aim of this study was to investigate cardiovascular and metabolic responses of dynamic dry apnea (DRA) and face immersed apnea (FIA). Methods: Ten female volunteers (17.1 ± 0.6 years old) naive to breath-hold-related sports, performed a series of seven dynamic 30 s breath-holds while cycling at 25% of their peak power output. This was performed in two separate conditions in a randomized order: FIA (15°C) and DRA. Heart rate and muscle tissue oxygenation through near-infrared spectroscopy were continuously measured to determine oxygenated (m[O 2 Hb]) and deoxygenated hemoglobin concentration (m[HHb]) and tissue oxygenation index (mTOI). Capillary blood lactate was measured 1 min after the first, third, fifth, and seventh breath-hold. Results: Average duration of the seven breath-holds did not differ between conditions (25.3 s ± 1.4 s, p = 0.231). The apnea-induced bradycardia was stronger with FIA (from 134 ± 4 to 85 ± 3 bpm) than DRA (from 134 ± 4 to 100 ± 5 bpm, p < 0.001). mTOI decreased significantly from 69.9 ± 0.9% to 63.0 ± 1.3% ( p < 0.001) which is reflected in a steady decrease in m[O 2 Hb] ( p < 0.001) and concomitant increase in m[HHb] ( p = 0.001). However, this was similar in both conditions (0.121 < p < 0.542). Lactate was lower after the first apnea with FIA compared to DRA ( p = 0.038), while no differences were observed in the other breath-holds. Conclusion: Our data show strong decreases in heart rate and muscle tissue oxygenation during dynamic apneas. A stronger bradycardia was observed in FIA, while muscle oxygenation was not different, suggesting that FIA did not influence muscle oxygenation. An order of mechanisms was observed in which, after an initial tachycardia, heart rate starts to decrease after muscle tissue deoxygenation occurs, suggesting a role of peripheral vasoconstriction in the apnea-induced bradycardia. The apnea-induced increase in lactate was lower in FIA during the first apnea, probably caused by the stronger bradycardia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bouten, De Bock, Bourgois, de Jager, Dumortier, Boone and Bourgois.)

Shoulder exoskeletons potentially reduce overuse injuries in industrial settings including overhead work or lifting tasks. Previous studies evaluated these devices primarily in laboratory setting, but evidence of their effectiveness outside the lab is lacking. The present study aimed to evaluate the effectiveness of two passive shoulder exoskeletons and explore the transfer of laboratory-based results to the field. Four industrial workers performed controlled and in-field evaluations without and with two exoskeletons, ShoulderX and Skelex in a randomized order. The exoskeletons decreased upper trapezius activity (up to 46%) and heart rate in isolated tasks. In the field, the effects of both exoskeletons were less prominent (up to 26% upper trapezius activity reduction) while lifting windscreens weighing 13.1 and 17.0 kg. ShoulderX received high discomfort scores in the shoulder region and usability of both exoskeletons was moderate. Overall, both exoskeletons positively affected the isolated tasks, but in the field the support of both exoskeletons was limited. Skelex, which performed worse in the isolated tasks compared to ShoulderX, seemed to provide the most support during the in-field situations. Exoskeleton interface improvements are required to improve comfort and usability. Laboratory-based evaluations of exoskeletons should be interpreted with caution, since the effect of an exoskeleton is task specific and not all in-field situations with high-level lifting will equally benefit from the use of an exoskeleton. Before considering passive exoskeleton implementation, we recommend analyzing joint angles in the field, because the support is inherently dependent on these angles, and to perform in-field pilot tests. This paper is the first thorough evaluation of two shoulder exoskeletons in a controlled and in-field situation.

The aim of this study was to determine the effect of Thiel embalming on the biomechanical properties of nerve tissue, to validate the use of Thiel embalmed bodies as a reliable model system for obtaining biomechanical data to supplement neurodynamic models, for anesthesiological and neurosurgical training and for future preclinical test set-ups involving nerve tissue. Upon the arrival of a body at the anatomy department, a fresh median nerve was harvested, the harvest site was sutured and following the Thiel embalming procedure the Thiel embalmed median nerve of the opposing wrist was harvested. Micro CT was performed to establish the cross-sectional area and biomechanical tensile testing was performed to compare the Young's modulus/elasticity of fresh frozen and Thiel embalmed nerves. Thiel embalming did not cause a significant difference in elasticity when comparing Thiel embalmed and fresh frozen specimens. A correlation was found between the cross-sectional area of Thiel embalmed nerve specimens and their Young's modulus. Thiel embalming does not significantly alter the elasticity of nerve tissue compared to fresh frozen nerve tissue. Similar shapes were observed when comparing the stress/strain curves of both specimen types. This indicates that Thiel embalmed nerve tissue is a viable alternative for using fresh frozen specimens when investigating biomechanical principles/mechanisms. Some specimens showed a reversed trend in Young's modulus that could be related to slight differences in embalming outcome, so caution is advised when Thiel embalmed specimens are used to obtain raw numerical data for direct application in the clinic.

Objective: The aim of this study is to test the unified theory of acceptance and use of technology (UTAUT) model for explaining the intention to use exoskeletons among industrial workers., Background: Exoskeletons could help reduce physical workload and risk for injuries among industrial workers. Therefore, it is crucial to understand which factors play a role in workers' intention to use such exoskeletons., Method: Industrial workers ( N = 124) completed a survey on their attitudes regarding the use of exoskeletons at their workplace. Using partial least squares (PLS) path modeling, the UTAUT model and a revised version of the UTAUT model were fitted to these data., Results: The adapted UTAUT model of Dwivedi et al. (2017) was able to explain up to 75.6% of the variance in intention to use exoskeletons, suggesting a reasonable model fit., Conclusion: The model fit suggests that effort expectancy (how easy it seems to use an exoskeleton) plays an important role in predicting the intention to use exoskeletons. Social influence (whether others think workers should use exoskeletons) and performance expectancy (how useful exoskeletons seem to be for work) play a smaller role in predicting the intention to use., Applications: This research informs companies about the optimal implementation of exoskeletons by improving the determinants of acceptance among their workers.