Search

Abstract In many populations like wheelchair and prosthetic users, the soft tissue is subject to excessive or repetitive loading, making it prone to Deep Tissue Injury (DTI). To study the skeletal muscle response to physical stress, numerous in vitro and in vivo models exist. Yet, accuracy, variability, and ethical considerations pose significant trade-offs. Here, we present an ex vivo approach to address these limitations and offer additional quantitative information on cellular damage. In this study, skeletal muscle tissue from Sprague Dawley rats was isolated and transversely loaded. Histological analysis and fluorescence staining demonstrated that the setup was suitable to keep the tissue alive throughout the experimental procedure. Mechanically induced cell damage was readily distinguishable through morphological changes and uptake of a membrane impermeable dye. Our comparably simple experimental setup can be adapted to different loading conditions and tissues to assess the cell response to mechanical loading in future studies.

Uncovering lead-free materials with an exceptionally high recoverable energy density is vital for the creation of future pulse power capacitors. This study determined that introducing Tungsten (W) and Tantalum (Ta) into the Nb-site of AgNbO3 lead-free antiferroelectric ceramics, while offsetting this with vacancies at the Ag-site, can effectively maintain the electrical homogeneity. Additionally, employing this co-doping approach can secure the antiferroelectric phases by lowering the necessary temperatures for M1-M2 and M2-M3 phase transitions. This may prove advantageous in the creation of novel AgNbO3-based energy storage ceramics. The use of in-situ high-resolution synchrotron powder x-ray diffraction (SPXD) at varying temperatures revealed for the first time that in 10 at% W doped AgNbO3, the M1 and M2 phases in the temperature range of −193 to ∼150 °C are more appropriately fitted as the non-polar Pbcm space group, whereas the M3 phase aligns with the mixed of non-polar Pbcm and polar Pmc21 space groups.

Background Voluntary medical male circumcision (MC) is a biomedical HIV prevention method that requires post-operative follow-up for healing confirmation. Recent research found that a two-way texting (2wT) app providing SMS-based telehealth for MC patients was safe and reduced provider workload. We evaluated 2wT usability among MC clients in South Africa assigned the 2wT intervention within a larger randomized controlled trial (RCT) of 2wT safety and workload. Methods This quantitative usability study is within an RCT where 547 men used 2wT to interact with an MC provider via SMS. The sub-study involved the first 100 men assigned to 2wT who completed a usability survey 14 days after surgery. Acceptability was assessed through 2wT response rates of the 547 men. Regression models analyzed associations between age, wage, location, potential adverse events (AEs), and 2wT responses. Results Men assigned to 2wT found it safe, comfortable, and convenient, reporting time and cost savings. High response rates (88%) to daily messages indicated acceptability. Age, wage, and location didn't affect text responses or potential AEs. Conclusion 2wT for post-MC follow-up was highly usable and acceptable, suggesting its viability as an alternative to in-person visits. It enhanced confidence in wound self-management. This SMS-based telehealth can enhance MC care quality and be adapted to similar contexts for independent healing support, particularly for men.

BackgroundThere is a dearth of high-quality evidence from digital health interventions in routine program settings in low- and middle-income countries. We previously conducted a randomized controlled trial (RCT) in Zimbabwe, demonstrating that 2-way texting (2wT) was safe and effective for follow-up after adult voluntary medical male circumcision (VMMC). ObjectiveTo demonstrate the replicability of 2wT, we conducted a larger RCT in both urban and rural VMMC settings in South Africa to determine whether 2wT improves adverse event (AE) ascertainment and, therefore, the quality of follow-up after VMMC while reducing health care workers’ workload. MethodsA prospective, unblinded, noninferiority RCT was conducted among adult participants who underwent VMMC with cell phones randomized in a 1:1 ratio between 2wT and control (routine care) in North West and Gauteng provinces. The 2wT participants responded to a daily SMS text message with in-person follow-up only if desired or an AE was suspected. The control group was requested to make in-person visits on postoperative days 2 and 7 as per national VMMC guidelines. All participants were asked to return on postoperative day 14 for study-specific review. Safety (cumulative AEs ≤day 14 visit) and workload (number of in-person follow-up visits) were compared. Differences in cumulative AEs were calculated between groups. Noninferiority was prespecified with a margin of −0.25%. The Manning score method was used to calculate 95% CIs. ResultsThe study was conducted between June 7, 2021, and February 21, 2022. In total, 1084 men were enrolled (2wT: n=547, 50.5%, control: n=537, 49.5%), with near-equal proportions of rural and urban participants. Cumulative AEs were identified in 2.3% (95% CI 1.3-4.1) of 2wT participants and 1.0% (95% CI 0.4-2.3) of control participants, demonstrating noninferiority (1-sided 95% CI −0.09 to ∞). Among the 2wT participants, 11 AEs (9 moderate and 2 severe) were identified, compared with 5 AEs (all moderate) among the control participants—a nonsignificant difference in AE rates (P=.13). The 2wT participants attended 0.22 visits, and the control participants attended 1.34 visits—a significant reduction in follow-up visit workload (P

Abstract The field of mathematical morphology offers well-studied techniques for image processing and is applicable for studies ranging from materials science to ecological pattern formation. In this work, we view morphological operations through the lens of persistent homology, a tool at the heart of the field of topological data analysis. We demonstrate that morphological operations naturally form a multiparameter filtration and that persistent homology can then be used to extract information about both topology and geometry in the images as well as to automate methods for optimizing the study and rendering of structure in images. For illustration, we develop an automated approach that utilizes this framework to denoise binary, grayscale, and color images with salt and pepper and larger spatial scale noise. We measure our example unsupervised denoising approach to state-of-the-art supervised, deep learning methods to show that our results are comparable.

BackgroundVoluntary medical male circumcision (VMMC) is a safe and effective HIV prevention strategy. However, adherence to recommended in-person, postoperative follow-up is inefficient for procedures with few adverse events. Two-way texting (2wT)–based follow-up appears to be a safe and an efficient alternative to scheduled clinic visits for low-risk patients who underwent VMMC. To ensure that 2wT responds to the needs of health care workers (HCWs) and patients, HCWs were closely involved in app design using a human-centered design (HCD) approach. ObjectiveEmbedded within an ongoing randomized controlled trial of 2wT in South Africa and complementary HCD processes of 2wT app optimization, this qualitative study aimed to use key informant interviews (KIIs) to explore the thoughts, suggestions, and opinions on and perceptions of 2wT’s usability and acceptability among HCWs involved in 2wT implementation in both urban and rural South Africa. MethodsA total of 7 HCWs using 2wT in Gauteng and the North West province participated in KIIs regarding the usability and acceptability of 2wT. HCWs were asked for their opinions on 2wT as a viable, useful, appropriate, and accessible method of postoperative VMMC care. They were also asked about 2wT-related working, exploring areas where 2wT could add to or reduce their daily tasks. The KII data were explored, coded, and analyzed by 3 qualitative researchers using thematic content analysis and the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software. ResultsMost HCWs felt confident, comfortable, satisfied, and well supported using a 2wT-based follow-up as an alternative to in-person clinical reviews. They felt that 2wT was easy to use and required little technical support after initial mentoring on how to use the 2wT system. Few noted safety concerns, as men can receive clinical guidance, reassurance, and referral via 2wT. Although fewer in-person visits reduced the in-person review workload and eased clinical flow, HCWs noted the added burden of having to interact with clients via SMS text messages on evenings or weekends. HCWs reinforced the need for enhanced postoperative counseling to ensure that 2wT patients could recognize and understood how to respond to early signs of complications. HCWs suggested a rotation to spread the evening and weekend workload and ensure swift patient responses. ConclusionsIn this formative qualitative study focused on HCWs, 2wT was a highly usable alternative to in-person postoperative reviews for patients who underwent VMMC in South Africa. The HCD processes likely improved the usability and acceptability of 2wT for HCWs. HCWs supported the scale-up of 2wT given the distance from the clinic to the men’s homes and the potential for reducing workload. To ensure success, providers urged sensitizing patients to the fact that 2wT augments, but does not replace, the existing after-hours and emergency care services.

IntroductionVoluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings.MethodsActivity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings.ResultsVMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively.ConclusionQuality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

BACKGROUND: The human hand is critical in assisting with activities of daily living (ADL). Amputation of the hand can affect a person physically, socially and psychologically. Knowledge of outcome measures used to assess upper limb activity of intact and amputee populations may aid in guiding research to develop applicable measurement tools specific to the amputee population. Tools could aid developments in prosthetic design and prescription, which benefit both users and healthcare researchers. OBJECTIVE(S): This literature review examined outcome measurement tools used with non-amputee and amputee populations to assess hand activity. The objectives were to identify which characteristics of hand activity are captured by currently available measurement tools. METHODOLOGY: Searches were conducted using PubMed, Cochrane and ProQuest for studies investigating hand activity for amputee and non-amputee populations. A total of 15 studies were included. PRISMA guidelines were used to assist with study selection. Data extraction and narrative synthesis were carried out. FINDINGS: A total of 32 outcome measures were found. Frequently used tools were: Box and Block Test, Swedish Disabilities of the Arm Shoulder and Hand Questionnaire, and range of motion. Studies employed a combination of 2 to 12 tools. Themes extracted were: importance of function and quality of life, the need for realistic tasks, and the need for outcome measures specific of the population. CONCLUSION: There is a gap in research surrounding outcome measurement tools used to assess hand activity in the amputee population. A combination of outcome measures are required to obtain insight into the hand activities of intact and amputee populations. Function and quality of life are important aspects to consider when describing hand activity. Layman's Abstract The human hand provides important functionality to help us live our daily lives. Hands enable us to perform tasks such as turn a key, cook food, use a phone and get dressed. Amputation of the hand not only affects activities of daily living (ADL), but also mental health. Hands are often assessed by healthcare professionals but there are few measurement tools available to assess artificial hands, commonly known as prosthetic hands. Developing new measurement tools would help us learn more about how people perform tasks if they are missing a hand, or using a prosthetic hand, will benefit society. The goal of this review was to examine measurement tools that assess hand activity. The first objective was to identify which types of hand activities are captured by currently available measurement tools. This review included 15 studies and compared to find common themes. Frequently used measurement tools were: Box and Block Test, Swedish Disabilities of the Arm Shoulder and Hand Questionnaire, and range of motion. All studies used a combination of measurement tools. The key themes commonly found were: importance of function and quality of life to be assessed, the need for realistic tasks and the need for tools designed specifically for the population of amputees or prosthesis users. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/39023/30502 How To Cite: Carlyle K, Day S. Outcome measures used to assess hand activity in amputee and intact populations: A literature review. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 2, No.4. https://doi.org/10.33137/cpoj.v5i2.39023 Corresponding Author: Kirsty Carlyle, MEng Department of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, United Kingdom. E-Mail:kirsty.carlyle@strath.ac.uk ORCID ID: https://orcid.org/0000-0002-0291-4717

Abstract Background Mobile HIV testing approaches are a key to reaching the global targets of halting the HIV epidemic by 2030. Importantly, the number of clients reached through mobile HIV testing approaches, need to remain high to maintain the cost-effectiveness of these approaches. Advances in rapid in-vitro tests such as INSTI® HIV-1/HIV-2 (INSTI) which uses flow-through technologies, offer opportunities to reduce the HIV testing time to about one minute. Using data from a routine mobile HTS programme which piloted the use of the INSTI point-of-care (POC) test, we sought to estimate the effect of using a faster test on client testing volumes and the number of people identified to be living with HIV, in comparison with standard of care HIV rapid tests. Methods In November 2019, one out of four mobile HTS teams operating in Ekurhuleni District (South Africa) was randomly selected to pilot the field use of INSTI-POC test as an HIV screening test (i.e., the intervention team). We compared the median number of clients tested for HIV and the number of HIV-positive clients by the intervention team with another mobile HTS team (matched on performance and area of operation) which used the standard of care (SOC) HIV screening test (i.e., SOC team). Results From 19 to 20 December 2019, the intervention team tested 7,403 clients, and the SOC team tested 2,426 clients. The intervention team tested a median of 442 (IQR: 288–522) clients/day; SOC team tested a median of 97 (IQR: 40–187) clients/day (p

People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, hereafter called users, are yet to benefit from the fast-paced growth in academic knowledge within the field of upper limb prosthetics. Crucially over the past decade, research has acknowledged the limitations of conducting laboratory-based studies for clinical translation. This has led to an increase, albeit rather small, in trials that gather real-world user data. Multi-stakeholder collaboration is critical within such trials, especially between researchers, users, and clinicians, as well as policy makers, charity representatives, and industry specialists. This paper presents a co-creation model that enables researchers to collaborate with multiple stakeholders, including users, throughout the duration of a study. This approach can lead to a transition in defining the roles of stakeholders, such as users, from participants to co-researchers. This presents a scenario whereby the boundaries between research and participation become blurred and ethical considerations may become complex. However, the time and resources that are required to conduct co-creation within academia can lead to greater impact and benefit the people that the research aims to serve.

BACKGROUND: Existing trans-radial prosthetic socket designs are not optimised to facilitate reliable myoelectric control. Many socket designs pre-date the introduction of myoelectric devices. However, socket designs featuring improved biomechanical stability, notably longitudinal compression sockets, have emerged in more recent years. Neither the subsequent effects, if any, of stabilising the limb on myoelectric control nor in which arrangement to apply the compression have been reported. METHODOLOGY: Twelve able-bodied participants completed two tasks whilst wearing a longitudinal compression socket simulator in three different configurations: 1) compressed, where the compression strut was placed on top of the muscle of interest, 2) relief, where the compression struts were placed either side of the muscle being recorded and 3) uncompressed, with no external compression. The tasks were 1) a single-channel myoelectric target tracking exercise, followed by 2), a high-intensity grasping task. The wearers’ accuracy during the tracking task, the pressure at opposing sides of the simulator during contractions and the rate at which the limb fatigued were observed. FINDINGS: No significant difference between the tracking-task accuracy scores or rate of fatigue was observed for the different compression configurations. Pressure recordings from the compressed configuration showed that pressure was maintained at opposing sides of the simulator during muscle contractions. CONCLUSION: Longitudinal compression does not inhibit single-channel EMG control, nor improve fatigue performance. Longitudinal compression sockets have the potential to improve the reliability of multi-channel EMG control due to the maintenance of pressure during muscle contractions. Layman's Abstract Most prosthetic limbs are attached to the body using a rigid, cup-like socket shaped to each individual limb. Prosthetic arms attached to a residual forearm are called trans-radial prostheses, and bionic hands and grippers, formally referred to as myoelectric devices, are types of attachments which can be affixed to trans-radial prostheses. The sockets used in conjunction with myoelectric devices today pre-date the clinical introduction of myoelectric devices, and therefore are not optimised to facilitate signal transmission. Newer socket styles have emerged, with the aim of improving comfort and stability, notably those featuring areas of longitudinal compression running parallel to the underlying bone structures. However, longitudinal compression sockets have not been researched for their effects on critical aspects influencing the reliability of myoelectric control. Hence, this study investigates the effect of longitudinal compression on key factors influencing a wearers’ ability to control their myoelectric device. In twelve able-bodied participants, the following three factors were observed: 1) a wearers’ ability to complete a simple on-screen target tracking task whilst wearing a longitudinal compression socket simulator, 2) whether pressure at opposing sides of the socket simulator is maintained during muscle contractions, and 3) whether the longitudinal compression affects the rate at which the forearm fatigues during a short duration, high intensity gripping task. The results from the study showed longitudinal compression of the forearm does not significantly impact a wearers’ ability to complete a simple target-tracking task, or the rate at which the forearm fatigues. However, some benefit to myoelectric control may be achieved due to the maintenance of pressure using this type of socket. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37963/29734 How To Cite: Olsen J, Day S, Dupan S, Nazarpour K, Dyson M. Does trans-radial longitudinal compression influence myoelectric control? Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 2, No.2.https://doi.org/10.33137/cpoj.v5i2.37963 Corresponding Author: Jennifer Olsen, Intelligent Sensing Laboratory, School of Engineering, Newcastle University, UK. E-Mail: j.olsen@newcastle.ac.uk ORCID ID: https://orcid.org/0000-0001-9076-3092

We develop a novel statistical approach to estimate topological information from large, noisy images. Our main motivation is to measure pore microstructure in 2-dimensional X-ray micro-computed tomography (micro-CT) images of ice cores at different depths. The pore space in these samples is where gas can move and get trapped within the ice column and is of interest to climate scientists. While the field of topological data analysis offers tools (e.g. lifespan cutoff and PD Thresholding) for estimating topological information in noisy images, direct application of these techniques to large images often leads to inaccuracies and proves infeasible as image size and noise levels grow. Our approach uses image subsampling to estimate the number of holes of a prescribed size range in a computationally feasible manner. In applications where holes naturally have a known size range on a smaller scale than the full image, this approach offers a means of estimating Betti numbers, or global counts of holes of various dimensions, via subsampling of the image.

Nitrogen-doped TiO2 exhibits improved photocatalytic water-splitting activity partially due to enhanced oxygen vacancy formation. Here, authors demonstrate the temperature-dependent lattice distortion of oxygen vacancies, and identify the presence of a titanium oxynitride phase in high activity catalysts.

The majority of limb prostheses are socket mounted. For these devices, the socket is essential for adequate prosthetic suspension, comfort, and control. The socket is unique among prosthetic components as it is not usually mass-produced and must instead be custom-made for individual residual limbs by a prosthetist. The knowledge of what constitutes “good” socket fit is gained by expert prosthetists and technicians over years of experience, and rarely documented. The reliance on tacit knowledge makes it difficult to standardize the criteria for a well-fitting socket, leading to difficulties understanding the impact of socket fit. Despite its importance, the workflow for socket fitting is often overlooked in literature. Due to the customized nature of sockets, if information is provided in literature, generally only the type of socket and suspension mechanism is noted, with information regarding the fitting and manufacturing processes omitted. In this article, the concerns, issues and consequences arising from lack of upper and lower limb socket documentation are discussed from a researcher perspective, supported by healthcare professionals and socket fabrication specialists. Key changes are proposed to the way socket manufacturing and evaluation are documented to assist future research.

Abstract Background The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Although not intended to tolerate high loads and deformation, it becomes a weight-bearing structure within the residuum-prosthesis-complex. Consequently, deep soft tissue layers may be damaged, resulting in Deep Tissue Injury (DTI). Whilst considerable effort has gone into DTI research on immobilised individuals, only little is known about the aetiology and population-specific risk factors in amputees. This scoping review maps out and critically appraises existing research on DTI in lower-limb prosthetic users according to (1) the population-specific aetiology, (2) risk factors, and (3) methodologies to investigate both. Results A systematic search within the databases Pubmed, Ovid Excerpta Medica, and Scopus identified 16 English-language studies. The results indicate that prosthetic users may be at risk for DTI during various loading scenarios. This is influenced by individual surgical, morphological, and physiological determinants, as well as the choice of prosthetic componentry. However, methodological limitations, high inter-patient variability, and small sample sizes complicate the interpretation of outcome measures. Additionally, fundamental research on cell and tissue reactions to dynamic loading and on prosthesis-induced alterations of the vascular and lymphatic supply is missing. Conclusion We therefore recommend increased interdisciplinary research endeavours with a focus on prosthesis-related experimental design to widen our understanding of DTI. The results have the potential to initiate much-needed clinical advances in surgical and prosthetic practice and inform future pressure ulcer classifications and guidelines.

Despite the extensive efforts to stabilize Au catalysts for industrial hydrochlorination of acetylene to vinyl chloride the deactivation is not overcome yet. Here, the authors demonstrate that the ceria promotion to Au catalysts affords enhanced activity and stability via formation of Au(0)/Au(I) as new active pairs.

People who either use an upper limb prosthesis and/or have used services provided by a prosthetic rehabilitation centre, experience limitations of currently available prosthetic devices. Collaboration between academia and a broad range of stakeholders, can lead to the development of solutions that address peoples' needs. By doing so, the rate of prosthetic device abandonment can decrease. Co-creation is an approach that can enable collaboration of this nature to occur throughout the research process. We present findings of a co-creation project that gained user perspectives from a user survey, and a subsequent workshop involving: people who use an upper limb prosthesis and/or have experienced care services (users), academics, industry experts, charity executives, and clinicians. The survey invited users to prioritise six themes, which academia, clinicians, and industry should focus on over the next decade. The prioritisation of the themes concluded in the following order, with the first as the most important: function, psychology, aesthetics, clinical service, collaboration, and media. Within five multi-stakeholder groups, the workshop participants discussed challenges and collaborative opportunities for each theme. Workshop groups prioritised the themes based on their discussions, to highlight opportunities for further development. Two groups chose function, one group chose clinical service, one group chose collaboration, and another group chose media. The identified opportunities are presented within the context of the prioritised themes, including the importance of transparent information flow between all stakeholders; user involvement throughout research studies; and routes to informing healthcare policy through collaboration. As the field of upper limb prosthetics moves toward in-home research, we present co-creation as an approach that can facilitate user involvement throughout the duration of such studies.