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PubMed1997

Contact patterns at the tarsal joints.

OBJECTIVE: To determine the contact patterns at the tarsal joints under two levels of loading (150 and 600 N) with the foot in the neutral position, plantarflexion, dorsiflexion, inversion and eversion. DESIGN: In vitro measurements quantifying the size, location and patterns of contact. BACKGROUND: Several methods have been employed to study contact areas and patterns in joints such as the hip and knee; in contrast there is limited data on the joints of the foot. METHODS: Contact areas and patterns were determined by injecting coloured dyes, one for each level of loading, into the joint spaces in 23 pairs of feet: three pairs in the neutral position, five pairs in each of plantarflexion and dorsiflexion, and ten pairs in inversion (right foot) and eversion (left foot). RESULTS: Contact area maps were constructed for the ankle, subtalar, talonavicular, calcaneocuboid, cuneonavicular and the intercuneiform joints. Quantification of the surface areas was performed using a digitizer. The extent of the changes in contact area appeared to be related to the mobility of the joints under consideration, with the greatest changes in contact pattern and area being associated with the most mobile joints. CONCLUSION: The small change in absolute contact area with increased loading reflects the role of the foot, in providing a stable support for the body during gait.

Journal Article↗
PubMed2003

Inverse treatment planning by physically constrained minimization of a biological objective function.

In the current state-of-the art of clinical inverse planning, the design of clinically acceptable IMRT plans is predominantly based on the optimization of physical rather than biological objective functions. A major impetus for this trend is the unproven predictive power of radiobiological models, which is largely due to the scarcity of data sets for an accurate evaluation of the model parameters. On the other hand, these models do capture the currently known dose-volume effects in tissue dose-response, which should be accounted for in the process of optimization. In order to incorporate radiobiological information in clinical treatment planning optimization, we propose a hybrid physico-biological approach to inverse treatment planning based on the application of a continuous penalty function method to the constrained minimization of a biological objective. The objective is defined as the weighted sum of normal tissue complication probabilities evaluated with the Lyman normal-tissue complication probability model. Physical constraints specify the admissible minimum and maximum target dose. The continuous penalty function method is then used to find an approximate solution of the resulting large-scale constrained minimization problem. Plans generated by our approach are compared to ones produced by a commercial planning system incorporating physical optimization. The comparisons show clinically negligible differences, with the advantage that the hybrid technique does not require specifications of any dose-volume constraints to the normal tissues. This indicates that the proposed hybrid physico-biological method can be used for the generation of clinically acceptable plans.

Algorithms↗
PubMed1994

Comparison of functional knee braces for control of anterior tibial displacement.

Using a surrogate knee model, the ten custom functional knee braces that previous studies had shown to be most effective were tested for restraint to anterior tibial displacement. Testing was performed at 20 degrees knee flexion with applied forces ranging from 50 to 400 N. All braces reduced anterior tibial displacement. Resistance to anterior tibial displacement depends directly on the brace design and is inversely related to the applied force. Post-bilateral hinge shell braces exhibited the most resistance to anterior tibial displacement. Few braces were effective in controlling anterior tibial displacement comparable with a normal knee at low forces. Most of the braces were less effective at controlling anterior tibial displacement at high forces.

Adult↗
PubMed2005

An adjustable adiabatic pulse for selective population inversion.

A new adiabatic inversion pulse and its design principles are presented. An analytical expression in the pulse length, inversion bandwidth, inversion efficiency, peak RF amplitude, and width of the transition region is derived and validated. Accordingly, the pulse shape can be adapted to achieve a specified inversion performance. Adjusted for broadband application, population can be inverted band selectively, rather independently of spatial RF field inhomogeneities, and with significantly reduced peak RF amplitude in comparison with the well-known hyperbolic secant adiabatic pulse.

Head↗
PubMed2004

Who cares in England and Wales? The Positive Care Law: cross-sectional study.

BACKGROUND: The inverse care law proposing that medical services are distributed inversely to population health needs, and that this law operates more completely where medical care is most exposed to market forces, was first suggested by Tudor Hart in 1971. This paper considers whether an inverse care law can be observed for the provision of informal care as well as for medical care. AIM: Using data from the 2001 census we sought to investigate the contemporary relevance of the inverse care law. DESIGN OF STUDY: Cross-sectional study. SETTING: England and Wales. METHOD: Data from the 2001 census for the population of England and Wales were analysed at the county, unitary, or former metropolitan authority level. The prevalence of the conjunction of general health status and limiting long-term illness was correlated with the percentage of the local population who were working as qualified healthcare workers (nurses, qualified medical practitioners, dentists, and other health professionals and therapists) and with the percentage of the population providing 50 or more hours of unpaid care per week. RESULTS: In 2001, 7.6% of people reported that their health was not good and that they had a limiting long-term illness (the need for care). Over one million people reported providing 50 or more hours of unpaid care per week. An inverse care law was found at the ecological level between the need for care and the proportion of the population who were working as qualified medical practitioners, dentists, and other health professionals. Informal care was almost perfectly positively correlated with the need for care (r = 0.97). These relationships were more marked for areas in the north of the country compared with the south. In the north more people provide unpaid care as more people need that care and because there are fewer working qualified medical professionals, other than nurses, providing such care per head. CONCLUSIONS: Medical care is distributed inversely to need, whereas the provision of informal care is positively related to need--where care is most needed, informal care is most likely to be provided. The greater the market forces that are allowed to intervene in the relationships between the need for care and its provision, the more likely the inverse care law is to be found to apply. Where no market forces apply, where people give up their time for free to provide care, an almost perfectly positive care law is found to apply.

Adolescent↗
PubMed1997

Serum erythropoietin levels in children with leukemia.

OBJECTIVE: Our aim was to test the hypothesis that, in leukemic children, serum erythropoietin (EPO) levels vary inversely with hemoglobin. DESIGN: Twenty-four children (15 males, nine females) with an age range of 1-16 years (mean, 7.7 years) diagnosed with acute leukemia (22 acute lymphocytic, two acute myeloid) were studied over 4 months. Serum EPO and hemoglobin were measured simultaneously at multiple time points in the course of their disease, and a multiple regression analysis was performed to describe the EPO-hemoglobin relationship. RESULTS: In a model adjusted for individual subject, there was a significant correlation between hemoglobin and logEPO in these leukemic children (r = -0.55, P < .01, n = 100). When measurements at hemoglobins less than 10.0 were analyzed the correlation increased significantly (r = -0.88, P < .01, n = 21). However, approximately 20% of the observations fell into one of two groups: an inappropriately low EPO for hemoglobin or an inappropriately elevated EPO for hemoglobin. The clinical characteristics of the children at each of these determinations were not different in any manner from the determinations which fell within the 95% confidence intervals for predicted mean EPO value: each of the outlying points came from a patient who at other times had an appropriate EPO for hemoglobin. CONCLUSIONS: There existed a significant inverse relationship between hemoglobin and EPO, suggesting that the feedback mechanism for EPO is intact. Reasons for inappropriately high or low EPO, for level of hemoglobin, are not clear and may be reflective of other aspects of bone marrow or EPO metabolism.

Acute Disease↗
PubMedDate not supplied

Rational combinatorial library design. 2. Rational design of targeted combinatorial peptide libraries using chemical similarity probe and the inverse QSAR approaches.

We have developed a novel strategy for rational design of targeted peptide libraries. The goal of this method is to select a subset of natural amino acids that are most likely to be present in active peptides for the synthesis of library. Two different protocols are employed where chemical structures of peptides are described either by topological indices or by a combination of physicochemical descriptors for individual amino acids. The selection of a peptide as a candidate for the targeted library is based either on its chemical similarity to a biologically active probe or on its biological activity predicted from a preconstructed quantitative structure-activity (QSAR) equation. The optimization of the library is achieved by means of genetic algorithms (GA). This method was tested by rational design of the library with bradykinin-potentiating activity. Twenty-eight bradykinin-potentiating pentapeptides were used as a training set for the development of a QSAR equation, and, alternatively, two active pentapeptides, VEWAK and VKWAP, were used as probe molecules. In each case, the frequency distribution of amino acids in the top 100 peptides suggested by the method resembles the frequency distribution of amino acids found in the active peptides. The results obtained after GA optimization also compared favorably with those obtained by the exhaustive analysis of all possible 3.2 million pentapeptides.

Algorithms↗
PubMed1987

Shufflon: multi-inversion of four contiguous DNA segments of plasmid R64 creates seven different open reading frames.

The IncI alpha plasmid R64 was found to bear a highly mobile DNA segment which was designated as a clustered inversion region (J. Bacteriol. 165, 94-100, 1986). The clustered inversion region consists of four DNA segments designated respectively as A, B, C and D which differ in molecular size and restriction sites. The four DNA segments invert independently or in groups resulting in a complex DNA rearrangement. We now show the nucleotide sequence of the clustered inversion region of R64. The present results suggest that the clustered inversion region is a biological switch to select one of seven open reading frames whose primary structures at the region proximal to N-termini are constant while those at the C-terminal region are variable. A name, "Shufflon" was proposed to call this kind of the clustered inversion region.

Base Sequence↗
PubMed2004

Multi-criteria decision making in micellar liquid chromatographic separation of chlorophenols.

Simultaneous optimization of separation quality and analysis time of the micellar liquid chromatography of nine chlorophenol isomers was investigated. The effect on retention of three experimental parameters was studied using multivariate analysis. The factors studied were the concentration of sodium dodecyl sulfate, propanol content, and pH of the mobile phase. The experiments were performed according to the face-centered cube central composite design and the inverse form of the experimental retention times of analytes was fitted to polynomial models. The results of the analysis of variance showed that the models obtained explain over 99% of the variance observed in the chromatograms. The good predictive ability of the models was verified by high correlation coefficient (R2 > 0.99) and F ratio values for the plots of predicted cross-validated versus experimental retention times. The study showed that the use of the Pareto-Optimality method, an approach from multi-criteria decision making, allows selection of the best possible combinations of separation quality and analysis time in micellar liquid chromatography of chlorophenols.

Journal Article↗
PubMed1994

A strategy for sampling on a sphere applied to 3D selective RF pulse design.

Conventional constant angular velocity sampling of the surface of a sphere results in a higher sampling density near the two poles relative to the equatorial region. More samples, and hence longer sampling time, are required to achieve a given sampling density in the equatorial region when compared with uniform sampling. This paper presents a simple expression for a continuous sample path through a nearly uniform distribution of points on the surface of a sphere. Sampling of concentric spherical shells in k-space with the new strategy is used to design 3D selective inversion and spin-echo pulses. These new 3D selective pulses have been implemented and verified experimentally.

Humans↗
PubMed1981

Imaging of the brain by nuclear magnetic resonance.

A nuclear magnetic resonance (NMR) machine constructed by Thorn-EMI Ltd was used to produce tomographic images of the brain in eight volunteers and fourteen patients. The use of an inversion recovery technique designed to emphasise variations in the spin-lattice time constant (T1) resulted in remarkable differentiation between grey and white matter in all subjects examined. White matter was seen both centrally and peripherally to subcortical level and the basal ganglia were clearly demarcated by the surrounding white matter and ventricular system. The posterior fossa was visualised with substantially less artefact than with X-ray computed tomography (CT) and both the brainstem and middle cerebellar peduncle were clearly shown. Pathological appearances in patients with glioblastoma multiforme, cerebral infarction, and cerebral aneurysm were demonstrated and compared with those seen with CT. The technique will require thorough clinical evaluation but appears to have considerable potential in the diagnosis of neurological disease.

Brain↗
PubMed2001

Treatment planning and delivery of intensity-modulated radiation therapy for primary nasopharynx cancer.

PURPOSE: To implement intensity-modulated radiation therapy (IMRT) for primary nasopharynx cancer and to compare this technique with conventional treatment methods. METHODS AND MATERIALS: Between May 1998 and June 2000, 23 patients with primary nasopharynx cancer were treated with IMRT delivered with dynamic multileaf collimation. Treatments were designed using an inverse planning algorithm, which accepts dose and dose-volume constraints for targets and normal structures. The IMRT plan was compared with a traditional plan consisting of phased lateral fields and a three-dimensional (3D) plan consisting of a combination of lateral fields and a 3D conformal plan. RESULTS: Mean planning target volume (PTV) dose increased from 67.9 Gy with the traditional plan, to 74.6 Gy and 77.3 Gy with the 3D and IMRT plans, respectively. PTV coverage improved in the parapharyngeal region, the skull base, and the medial aspects of the nodal volumes using IMRT and doses to all normal structures decreased compared to the other treatment approaches. Average maximum cord dose decreased from 49 Gy with the traditional plan, to 44 Gy with the 3D plan and 34.5 Gy with IMRT. With the IMRT plan, the volume of mandible and temporal lobes receiving more than 60 Gy decreased by 10-15% compared to the traditional and 3D plans. The mean parotid gland dose decreased with IMRT, although it was not low enough to preserve salivary function. CONCLUSION: Lower normal tissue doses and improved target coverage, primarily in the retropharynx, skull base, and nodal regions, were achieved using IMRT. IMRT could potentially improve locoregional control and toxicity at current dose levels or facilitate dose escalation to further enhance locoregional control.

Algorithms↗
PubMed1993

A technique for arthroscopic mattress suture placement.

Many techniques and instrument systems have been developed for performing arthroscopic Bankart repair and arthroscopic rotator cuff repair. These procedures often use multiple simple sutures placed in the repaired tissue. The use of a mattress suture design allows for inversion or eversion of the repaired tissue, greater repair strength, and provides a greater area of soft tissue apposition to bone. Described is a technique for arthroscopic mattress suture placement. We have used this technique primarily for arthroscopic Bankart repair and arthroscopic rotator cuff repair. Suture material of any type may be used with this technique.

Arthroscopes↗
PubMed2002

Development of respiratory rhythms in perinatal chick embryos.

In chick embryos, gas exchange takes place via the chorioallantoic membrane (CAM) and the lungs at approximately 1 day prior to hatching. The present study was designed to elucidate the development of respiratory rhythms in the chick embryo during the whole pipping (perinatal) period with a condenser-microphone measuring system. The microphone was hermetically attached on the eggshell over the air cell on day 18 of incubation. It first detected a cardiogenic signal (i.e. acoustocardiogram), and then beak clapping and breathing signals (acoustorespirogram, ARG). The first signals of lung ventilation appeared intermittently and irregularly approximately once per 5 s among the clapping signals after the embryo penetrated its beak into the air cell (internal pipping, IP). The respiratory rhythm then developed irregularly, with a subsequent more regular rate. The envelope pattern of breathing from the onset of IP through external pipping (EP) to hatching was constructed by a specially devised procedure, which eliminated external and internal noises. The envelope patterns indicated that the IP, EP and whole perinatal periods of 10 embryos were 14.1+/-6.4 (S.D.), 13.6+/-4.0 and 27.6+/-5.4 h, respectively. In addition, they also indicated the period of embryonic hatching activity (i.e. climax) which was 48+/-19 min. The development of respiratory rhythm was also shown by the instantaneous respiratory rate (IRR) which was designated as an inverse value of two adjacent ARG waves.

Animals↗
PubMedDate not supplied

High signal regions in normal white matter shown by heavily T2-weighted CSF nulled IR sequences.

Inversion recovery (IR) sequences with an inversion time (TI) designed to markedly reduce or null the signal from CSF (TI of approximately 2,100 ms at 1.0 T) and a very long echo time (TE) of 240 ms were used to image the brain of two normal adult volunteers, one 34-year-old man with an intrinsic tumor, and one 3-month-old infant with an infarct. Using these very heavily T2-weighted pulse sequences, adult gray and white matter showed similar signal intensity in many areas of the brain, but normal white matter in regions of the centrum semiovale, posterior internal capsule, parietopontile tract, occipitothalamic radiation, and brain stem showed a much higher signal intensity than surrounding gray or white matter. The infant displayed a low signal intensity in myelinated regions in the internal capsule and occipitothalamic radiation and a high signal in unmyelinated white matter. In many of the images there were strong similarities to the distribution of high signal within white matter seen with pulsed gradient spin echo sequences (TE 130 ms) designed to demonstrate effects due to anisotropic diffusion. Arguments are advanced to support the view that the high signal intensity in white matter tracts is due to one or more long T2 components that may be associated with unmyelinated or sparsely myelinated fibres within white matter. The resemblance to diffusion weighted images may reflect the fact that both employ long TEs and both produce a low signal from CSF. If myelin possessed a different susceptibility from axoplasm so that magnetic field gradients were generated around nerve fibres when their orientation was not parallel to B0, diffusion of water might then produce the observed dependence on fibre direction. The high signal regions in white matter are a potential source of confusion in image interpretation, and measurements of T2 in white matter need to be made with these regional variations in mind. The concept of normal appearing white matter also needs to be applied with a knowledge of these differences. The IR sequences used in this study provide a very high T2 dependence with a low signal from CSF and may be useful for detecting disease in the CNS of adults and children.

Adult↗
PubMed2006

Error mapping controller: a closed loop neuroprosthesis controlled by artificial neural networks.

BACKGROUND: The design of an optimal neuroprostheses controller and its clinical use presents several challenges. First, the physiological system is characterized by highly inter-subjects varying properties and also by non stationary behaviour with time, due to conditioning level and fatigue. Secondly, the easiness to use in routine clinical practice requires experienced operators. Therefore, feedback controllers, avoiding long setting procedures, are required. METHODS: The error mapping controller (EMC) here proposed uses artificial neural networks (ANNs) both for the design of an inverse model and of a feedback controller. A neuromuscular model is used to validate the performance of the controllers in simulations. The EMC performance is compared to a Proportional Integral Derivative (PID) included in an anti wind-up scheme (called PIDAW) and to a controller with an ANN as inverse model and a PID in the feedback loop (NEUROPID). In addition tests on the EMC robustness in response to variations of the Plant parameters and to mechanical disturbances are carried out. RESULTS: The EMC shows improvements with respect to the other controllers in tracking accuracy, capability to prolong exercise managing fatigue, robustness to parameter variations and resistance to mechanical disturbances. CONCLUSION: Different from the other controllers, the EMC is capable of balancing between tracking accuracy and mapping of fatigue during the exercise. In this way, it avoids overstressing muscles and allows a considerable prolongation of the movement. The collection of the training sets does not require any particular experimental setting and can be introduced in routine clinical practice.

Journal Article↗
PubMed1999

Eversion strength analysis of uninjured and functionally unstable ankles.

OBJECTIVE: Functional ankle instability (FAI) afflicts many athletes. Several causes of FAI have been implicated, including peroneal muscle weakness. Traditional musculoskeletal rehabilitation programs have focused on concentric muscle strength. The purpose of our study was to compare concentric and eccentric isokinetic and isometric eversion ankle strength measurements between subjects identified as having unilateral FAI and subjects having no history of inversion ankle sprain. DESIGN AND SETTING: Employing a matched-pairs technique, subjects with no history of ankle injury were compared with subjects with unilateral FAI using isokinetic and isometric measures of eversion ankle strength. Strength testing was performed in a sports medicine clinic setting. SUBJECTS: Forty-two subjects volunteered for this study: 21 subjects suffered from unilateral FAI (age = 19.3 +/- 1.1 years, wt = 84.0 +/- 9.5 kg, ht = 181.5 +/- 9.2 cm), while 21 subjects served as matched-paired controls (age = 19.5 +/- 1.2 years, wt = 82.5 +/- 10.9 kg, ht = 179.5 +/- 7.9 cm). MEASUREMENTS: Ankle eversion concentric and eccentric strength (peak torque) was assessed at 0 degrees /s, 30 degrees /s, 60 degrees /s, 90 degrees /s, 120 degrees /s, 150 degrees /s, and 180 degrees /s using an isokinetic dynamometer. RESULTS: We found no significant differences in concentric, eccentric, or isometric eversion ankle strength between the 2 groups of subjects. CONCLUSIONS: The exact cause of FAI remains elusive. Based on our results, those who suffer from unilateral FAI do not appear to have eversion strength deficits. Unless clear evidence of weakness exists, clinicians may find that eversion strength training exercises are unnecessary. Future research should examine other causes of FAI, including reciprocal muscle group strength ratios and proprioception deficits.

Journal Article↗
PubMedDate not supplied

Public health performance related to selected health status and risk measures.

Many public health interventions are targeted for high-risk locales. For this reason, health status and public health effort may appear inversely related. We designed a study to relate public health performance to health status or risk measures. This study hypothesized that differences in local need might prompt divergent levels of public health response and that the resultant diversity might imply disarray. From a group of 62 local health departments that have been the subject of intensive study, 34 were chosen serving jurisdictions with populations in excess of 100,000. Data were collected on selected health status as well as socioeconomic and budget measures. The data were then examined in a four-cell format, aggregating levels of public health performance with health status or risk levels according to each measure. The analysis of public health performance, when related to selected measures, suggests that public health endeavors may differ appropriately in different jurisdictions.

Health Status Indicators↗