Scapulothoracic kinematic pattern in the shoulder pain and scapular dyskinesis: A principal component analysis approach

The relationship between shoulder pain and scapular dyskinesis (SDK) is unclear. Differences between groups with and without SDK have been demonstrated, focusing on the amount of scapular motion at specific degrees of humeral elevation. However, this approach does not consider the temporal information and shape of the scapular motion temporal series. Principal Component Analysis (PCA) may clarify this variability and advance current understanding of ‘abnormal’ movement patterns. This study aimed to evaluate the scapular kinematics in patients with shoulder pain and in asymptomatic participants with and without SDK using PCA. Data were collected in 98 participants separated in four groups: Pain + SDK (n = 24), Pain (n = 25), No Pain + SDK (n = 24), and No Pain (n = 25). Scapulothoracic kinematic data were measured with an electromagnetic tracking device during arm elevation and lowering phases. PCA and analysis of variance were used to compare the groups. The No Pain + SDK group had a progressive increasing in anterior tilt over the elevation phase compared to the Pain (effect size = 0.79) and No Pain (effect size = 0.80) groups. During the arm-lowering, the Pain + SDK group had a progressive increasing in anterior tilt over this phase in comparison to the No Pain + SDK group (effect size = 0.68). Therefore, PCA demonstrated differences in the scapular anterior tilt related to SDK and shoulder pain. The presence of SDK revealed a scapular pattern with progressive increasing in anterior tilt over the elevation phase. However, during the arm-lowering phase, asymptomatic participants with SDK changed their motion pattern, unlike the symptomatic group, reinforcing the suggested association between scapular modifications and shoulder symptoms.     

Using n-alkanes to estimate diet composition of herbivores: a novel mathematical approach

N-alkanes are long-chain saturated hydrocarbons occurring in plant cuticles that can be used as chemical markers for estimating the diet composition of herbivores. An important constraint of using n-alkanes to estimate diet composition with currently employed mathematical procedures is that the number of markers must be equal or larger than the number of diet components. This is a considerable limitation when dealing with free-ranging herbivores feeding on complex plant communities. We present a novel approach for the estimation of diet composition using n-alkanes which applies equally to cases where the number of markers is lower, equal or greater than the number of plant species in the diet. The model uses linear programming to estimate the minimum and maximum proportions of each plant in the diet, and avoids the need for grouping species in order to reduce the number of estimated dietary components. We illustrate the model with two data sets of n-alkane content of plants and faeces obtained from a sheep grazing experiment conducted in Australia and a red deer study in Portugal. Our results are consistent with previous studies on those data sets and provide additional information on the proportions of individual species in the diet. Results show that sheep included in the diet high proportions of white clover (from 0.25 to 0.37), and relatively high proportions of grasses (e.g. brome from 0.14 to 0.26) but tended to avoid Lotus spp. (always less than 0.04 of the diet). For red deer we found high proportions of legumes (e.g. Trifolium angustifolium and Vicia sativa reaching maximum proportions of 0.42 and 0.30 of the diet, respectively) with grasses being less important and Cistus ladanifer, a browse, also having relevance (from 0.21 to 0.42 of the diet).     

Three-dimensional comparison of static and dynamic scapular motion tracking techniques

The shoulder is complex and comprised of many moving parts. Accurately measuring shoulder rhythm is difficult. To classify shoulder rhythm and identify pathological movement, static measures have been the preferred method. However, dynamic measures are also used and can be less burdensome to obtain. The purpose of this paper was to determine how closely dynamic measures represent static measures using the same acromion marker cluster scapular tracking technique. Five shoulder angles were assessed for 24 participants using dynamic and static tracking techniques during humeral elevation in three planes (frontal, scapular, sagittal). ANOVAs were used to identify where significant differences existed for the factors of plane, elevation angle, and tracking technique (static, dynamic raising, dynamic lowering). All factors were significantly different for all shoulder angles (p < 0.001), except for elevation plane in scapulothoracic protraction/retraction (p = 0.955). Tracking techniques were influential (p < 0.001), but the grouped mean differences fell below a clinically relevant 5° benchmark. There was large variation in mean differences of the techniques across individuals. While population averages are similar, individual static and dynamic shoulder assessments may be different. Caution should be taken when dynamic shoulder assessments are performed on individuals, as they may not reflect those obtained in static scapular motion tracking.     

A comparison of two non-invasive methods for measuring scapular orientation in functional positions

Identification of scapular dyskinesis and evaluation of interventions depend on the ability to properly measure scapulothoracic (ST) motion. The most widely used measurement approach is the acromion marker cluster (AMC), which can yield large errors in extreme humeral elevation and can be inaccurate in children and patient populations. Recently, an individualized regression approach has been proposed as an alternative to the AMC. This technique utilizes the relationship between ST orientation, humerothoracic orientation and acromion process position derived from calibration positions to predict dynamic ST orientations from humerothoracic and acromion process measures during motion. These individualized regressions demonstrated promising results for healthy adults; however, this method had not yet been compared to the more conventional AMC. This study compared ST orientation estimates by the AMC and regression approaches to static ST angles determined by surface markers placed on palpated landmarks in typically developing adolescents performing functional tasks. Both approaches produced errors within the range reported in the literature for skin-based scapular measurement techniques. The performance of the regression approach suffered when applied to positions outside of the range of motion in the set of calibration positions. The AMC significantly underestimated ST internal rotation across all positions and overestimated posterior tilt in some positions. Overall, root mean square errors for the regression approach were smaller than the AMC for every position across all axes of ST motion. Accordingly, we recommend the regression approach as a suitable technique for measuring ST kinematics in functional motion.     

Validation of a video-based motion analysis technique in 3-D dynamic scapular kinematic measurements

BackgroundCurrent non-invasive 3-D scapular kinematic measurement techniques such as electromagnetic tracking are subjected to restrictions of wired sensors and limited capture space. Video-based motion analysis provides greater freedom with relatively less movement restriction. However, video-based motion analysis was rarely used in and not validated for scapular kinematics.MethodsScapular kinematics of five subjects performing abduction, scaption, and internal/external rotation was captured simultaneously with video-based motion analysis and dynamic stereo X-ray, a gold standard for tracking scapular movements. The data from video-based motion analysis was correlated with the data from dynamic stereo X-ray for validity evaluation.FindingsStrong and significant correlations were identified in scapular protraction/retraction and medial/lateral rotation during abduction and scaption, and scapular medial/lateral rotation and anterior/posterior tilt during internal/external rotation.InterpretationVideo-based motion analysis is valid for evaluating a single subject's scapular movement pattern in protraction/retraction during abduction and scaption, and medial/lateral-rotation during internal/external rotation. Anterior/posterior-tilt during abduction and scaption should be investigated with caution. Video motion analysis is also valid for evaluating group average of scapular kinematics except for protraction/retraction during internal/external rotation. While acknowledging the inherent limitations, video-based motion analysis is an appropriate technique for tracking scapular kinematics.     

Competitive coexistence in a dynamic landscape

This paper investigates the effect of a dynamic landscape on the persistence of many interacting species. We develop a multi-species community model with an evolving landscape in which the creation and destruction of habitat are dynamic and local in space. Species interactions are also local involving hierarchical competitive trade-offs. We show that dynamic landscapes can reverse the trend of increasing species richness with higher fragmentation observed in static landscapes. The increase in the species-area exponent from a homogeneous to a fragmented landscape does not occur when dynamics are turned on. Thus, temporal aspects of the processes that generate and destroy habitat appear dominant relative to spatial characteristics. We also demonstrate, however, that temporal and spatial aspects interact to influence the persistence time of individual species, and therefore, rank-abundance curves. Specifically, persistence in the model increases in habitats with faster local turnover because of the presence of dynamic corridors.     

Validation of radiostereometric analysis in six degrees of freedom for use with reverse total shoulder arthroplasty

A phantom study was conducted to determine bias in motion and bias at zero motion of radiostereometric analysis (RSA) for evaluating implant relative displacement in reverse total shoulder arthroplasty (RTSA). A Sawbones shoulder phantom was fitted with a RTSA implant set and 13 tantalum markers. The model was fixed to a manual micrometer, providing controlled movements though fifteen known increments in translation and twelve increments in rotation (0.02–5.00 mm and 0.1–6.0°), along each translation and rotation axis. Movement between the glenoid and humerus was assessed using beads vs. beads (B/B), model vs. beads (M/B), and model vs. model (M/M) measurement methods in a model-based RSA environment. Bias in motion and bias at zero motion were defined as the difference between measured and accepted reference values, and the difference between double examinations with a theoretical displacement of zero, respectively. Bias in motion ranged from 0.054 ± 0.010 to 0.129 ± 0.014 mm and 0.076 ± 0.025 to 0.126 ± 0.025° (B/B), 0.023 ± 0.009 to 0.126 ± 0.016 mm and 0.111 ± 0.033 to 0.794 ± 0.251° (M/B), and 0.029 ± 0.010 to 0.135 ± 0.030 mm and 0.243 ± 0.088 to 0.384 ± 0.153° (M/M). Bias at zero motion ranged from 0.120 to 0.156 mm and 0.075 to 0.206° (B/B), 0.074 to 0.149 mm and 0.067 to 1.953° (M/B), and 0.069 to 0.259 mm and 0.284 to 1.273° (M/M). This is the first RSA for RTSA study, with results comparable to those validating the use of RSA for hip and knee arthroplasties (accepted as 0.05–0.50 mm and 0.15–1.15°), justifying the potential use of RSA as a tool for measuring implant displacement in the shoulder.     

Outline of a mathematical approach to history

A mathematical model for the development of human society, beginning with the earliest stages of urban cultures, is outlined. In the early stages of history, behavior was characterized largely by adherence to a number of beliefs and prejudices of diffeirent kinds, which were accepted on faith and not subject to critical rational analysis. Due to psychobiological variability a very small number of individuals spontaneously appear at all times who challenge the accepted beliefs and prejudices and do not follow the accepted patterns of social behavior. The effect of these individuals upon the rest of the society, especially upon the younger generation, depends on the facilities with which information spreads in society. In earliest societies, when modern methods of mass communication were unknown, the channels of communication were practically identical with the channels of economic transport. The latter in its turn depended on the nature of the roads, and especially on the presence of waterway, which facilitated transportation. The sizes of the earliest cities and the distances between them were largely determined by relative ease of transporation. Expressions are derived for the average size of the earliest cities and for the average distance between them. The calculated average populations of the earliest cities are of the order of 10³; the distance of the order of 10² km. Both are in agreement with some archaeological findings. An expression for the time spaon required for the development from the earliest stages of urban cultures to the present time is derived and shown to depend on the specific shoreline of the country, that is, the length of the shorline divided by the area of the country. It is pointed out that western Europe's specific shoreline, including land bordering both seas and rivers, is ten times as large as the shoreline area of other parts of the world. It is shown that this greater specific shoreline may account quantitatively for the faster social and technological development of western Europe in the last few centuries. The calculated total span of time of development from earliest urban cultures to our days is found to be of the order of magnitude of ten thousand years. It is shown that the model accounts for the existence at the present time of primitive cultures. A number of suggestions is made in regard to other possible applications of mathematics to history.     

Using biofeedback to optimize scapular muscle activation ratios during a seated resisted scaption exercise

Impairments in muscle activation have been linked to increased risk of developing shoulder pathologies such as subacromial impingement syndrome (SIS) and associated rotator cuff injuries. Individuals with SIS have demonstrated increased upper trapezius (UT) muscle activation and reduced serratus anterior (SA) and lower trapezius (LT) muscle activation, which can be collectively represented as ratios (UT/SA and UT/LT). Targeted exercise is an important component of shoulder rehabilitation programs to re-establish optimal muscle activation and ratios. Electromyography (EMG) biofeedback during exercise has been shown to reduce UT activation and favorably alter scapular muscle activation ratios, however, a literature gap exists regarding the efficacy of other types of biofeedback. Therefore, we compared the effects of three types of biofeedback (visual EMG, auditory, verbal cues) on UT/SA and UT/LT ratios during a seated resisted scaption exercise in fifteen subjects without shoulder pain. Baseline muscle activation was recorded and compared to real-time muscle activation during each randomized biofeedback trial. All biofeedback types showed improvements in the UT/SA and UT/LT ratios, with visual EMG demonstrating a significant change in UT/LT ratio (p < 0.05). These results suggest that biofeedback could be utilized as a component of rehabilitation programs to prevent or treat shoulder pain.     

异质种群动态模型:破碎化景观动态模拟的新途径

景观破碎化导致物种以异质种群方式存活,使得基于异质种群动态模拟破碎化景观动态成为可能。异质种群动态模型的发展为景观动态模拟奠定了良好基础。根据空间处理方式的不同,异质种群模型可分为三大类,可不同程度地用于描述破碎化景观动态。(1)空间不确定异质种群模型,假定所有局域种群间均等互联,模型中不包含空间信息,仅能用于景观斑块动态描述;(2)空间确定异质种群模型,假设局域种群在二维空间上以规则格子形式排列,是一种准现实的空间处理方式,可用于景观动态的简单描述;(3)空间现实异质种群模型,包含了破碎化景观中局域种群的几何特征,可直接用于真实景观动态的模拟研究。空间现实的和基于个体的异质种群模型不但是未来异质种群模型发展的主流,也将成为未来破碎化景观动态研究的重要工具。为了更加准确完整地描述破碎化景观动态,不但应该综合运用已有的各种异质种群模型方法,更要引进新模型来刎画多物种、多变量、高维度、复杂连接的破碎化景观格局与过程。     

Validation of a non-invasive fluoroscopic imaging technique for the measurement of dynamic knee joint motion

The accurate measurement of the in vivo knee joint kinematics in six degrees-of-freedom (6DOF) remains a challenge in biomedical engineering. We have adapted a dual fluoroscopic imaging system (DFIS) to investigate the various in vivo dynamic knee joint motions. This paper presents a thorough validation of the accuracy and repeatability of the DFIS system when used to measure 6DOF dynamic knee kinematics. First, the validation utilized standard geometric spheres made from different materials to demonstrate the capability of the DFIS technique to determine the object positions under changing speeds. The translational pose of the spheres could be recreated to less than 0.15±0.09 mm for velocities below 300 mm/s. Next, tantalum beads were inserted into the femur and tibia of two fresh frozen cadaver knees to compare the dynamic kinematics measured by matching knee models to the kinematics from the tantalum bead matching—a technique similar to Roentgen stereophotogrammetric analysis (RSA). Each cadaveric knee was attached to the crosshead of a tensile testing machine and vertically translated at a rate of 16.66 mm/s while images were captured with the DFIS. Subsequently, the tibia was held fixed and the femur manually flexed from full extension to 90° of flexion, as the DFIS acquired images. In vitro translation of the cadaver knee using the tensile testing machine deviated from predicted values by 0.08±0.14 mm for the matched knee models. The difference between matching the knee and tantalum bead models during the dynamic flexion–extension motion of the knee was 0.1±0.65°/s in flexion speed; 0.24±0.16 mm in posterior femoral translation; and 0.16±0.61° in internal–external tibial rotation. Finally, we applied the method to investigate the knee kinematics of a living subject during a step ascent and treadmill gait. High repeatability was demonstrated for the in vivo application. Thus, the DFIS provides an easy and powerful tool for accurately determining 6DOF positions of the knee when performing daily functional activities.     

Validation of imaging-based quantification of glenohumeral joint kinematics using an unmodified clinical biplane fluoroscopy system

Model-based tracking, using CT and biplane fluoroscopy, allows highly accurate quantification of glenohumeral motion and changes in the subacromial space. Previous investigators have used custom-built biplane fluoroscopes designed specifically for kinematic applications, which are available at few institutions and require FDA approval prior to clinical use. The aim of this study was to demonstrate the utility of an off-the-shelf clinical biplane fluoroscope for kinematic applications by validating model-based tracking for measurement of glenohumeral motion using an unmodified clinical system. Biplane images of each shoulder of a cadaver torso were acquired at various joint positions and during simulated movements along anatomical planes of motion. The pose of each humerus and scapula was determined using model-based tracking and compared to a bead-based gold standard. Error due to a temporal-offset between corresponding biplane images, characteristic of clinical biplane systems, was determined by comparison of measured and known relative position of 2 bead clusters of a phantom that was imaged while moved throughout the fluoroscopy image volume. Model-based tracking had global kinematic mean absolute errors of 0.27 mm and 0.29° (static), and 0.22–0.32 mm and 0.12–0.45° (dynamic). Glenohumeral mean absolute errors were 0.39 mm and 0.45° (static), and 0.36–0.42 mm and 0.41–0.48° (dynamic). The temporal-offset was predicted to add errors of 0.06–0.85 mm and 0.05–0.28° for cadaveric trials for the speeds examined. For defined speeds, sub-millimeter and sub-degree kinematic accuracy and precision were achieved using an unmodified clinical biplane fluoroscope for quantification of glenohumeral motion.     

Validation of a posturographic approach to monitor sleepiness

Sleepiness is a major risk factor in traffic- and occupational accidents. While sleepiness is a persistent concern, there is no convenient test to monitor impending levels of sleepiness. We show that force platform posturographic balance testing addresses this need because it estimates time awake (TA) accurately and precisely. Testing the TA is appropriate because TA drives the sleep homeostatic process, a component in sleepiness. With 12 subjects we evaluated the accuracy and precision of repeated estimates of TA. Our extended study design that allows evaluating the accuracy and precision of posturographic TA-estimates is new. First, we tested the subjects’ balance every 2 h during 36 h of sustained wakefulness. This comprised the subjects’ reference curves (balance as a function of known and increasing TA). Then, we tested the subjects’ balance once a day over one week. We also tested the subjects’ balance once a week over one month. Finally, to estimate the subjects’ TA, we equated the balance scores with the scores in their reference curves. The accuracy of the estimates was 86%, and the precision was 97%. The high accuracy and precision of the estimates obtained with this one-month protocol validates the method of posturographic monitoring of sleepiness. So far, force platform posturographic balance testing has generally been used for clinical purposes, to quantify balance control and musculoskeletal performance. Our main result is that we now validated that balance testing provides accurate and precise estimates of TA, and hence, also provides an approach towards an automated monitor of sleepiness.     

DFBAlab: a fast and reliable MATLAB code for dynamic flux balance analysis

Background

Dynamic Flux Balance Analysis (DFBA) is a dynamic simulation framework for biochemical processes. DFBA can be performed using different approaches such as static optimization (SOA), dynamic optimization (DOA), and direct approaches (DA). Few existing simulators address the theoretical and practical challenges of nonunique exchange fluxes or infeasible linear programs (LPs). Both are common sources of failure and inefficiencies for these simulators.

Results

DFBAlab, a MATLAB-based simulator that uses the LP feasibility problem to obtain an extended system and lexicographic optimization to yield unique exchange fluxes, is presented. DFBAlab is able to simulate complex dynamic cultures with multiple species rapidly and reliably, including differential-algebraic equation (DAE) systems. In addition, DFBAlab’s running time scales linearly with the number of species models. Three examples are presented where the performance of COBRA, DyMMM and DFBAlab are compared.

Conclusions

Lexicographic optimization is used to determine unique exchange fluxes which are necessary for a well-defined dynamic system. DFBAlab does not fail during numerical integration due to infeasible LPs. The extended system obtained through the LP feasibility problem in DFBAlab provides a penalty function that can be used in optimization algorithms.

Electronic supplementary material

The online version of this article (doi:10.1186/s12859-014-0409-8) contains supplementary material, which is available to authorized users.     

Multienergetic verification of dynamic wedge angles in medical accelerators using multichannel linear array

Background

The aim of the modern radiotherapy is to get a homogenous dose distribution in PTV, which is obtained by using for example physical or dynamic wedges. The using of a physical wedge has provided such isodose distributions but their use resulted in detrimental dosimetric consequences, for example beam hardening effects and practical consequences of filter handling or possible misalignment. Linear accelerators are now equipped with collimator jaws systems and controlled by modern computers and it is possible to generate wedge shaped isodose distributions dynamically. Because of a more comfortable use of a dynamic wedge, there are alternatives to the standard physical wedge. During the treatment, different segments of the treatment field can be exposed to the primary beam at different intervals of time. This process of shrinking the field while modulating the collimator jaw velocity and dose rate creates the desired wedge-shaped isodose gradient across the treatment field. Dynamic wedges can replace physical wedges but they need more precise dosimetry and quality control procedures.

Aim

The aim of this study was to perform a multienergetic verification of dynamic wedge angles using the multichannel detector PTW LA48 linear array.

Material and methods

The measurements of angle value of dynamic wedges were performed for Clinac 2300 C/D accelerators (Varian). The accelerator was equipped with the EDW option for 6 MV and 15 MV photon beams. In this case, 7 wedge angle values were used: 10°, 15°, 20°, 25°, 30°, 45° and 60°. The dynamic wedges are realized by continuous movement of one collimator jaw. The field size is gradually reduced until the collimator is almost completely closed or the field increases, while the beam is on. The measurements were divided in two steps: in the first step, the dynamic wedges were verified with the recommended values and in the second step there the planned and measured angles of dynamic wedges were compared. Measurements were made by means of LA48 linear array of ionization chambers (PTW). The results of the measurements were compared with the reference profile produced by the treatment planning system ECLIPSE 8.5 (Varian).

Results

The results showed differences between measured and calculated angle of dynamic wedges. The differences were observed for both energies in the case of a small angle value. For energies 6 MV and 15 MV, almost all percentage difference between the measured and calculated profile was lower than 5%. The biggest difference was observed in the first step of measurements when the angle of Dynamic Wedge was verified. The comparison between the planned and measured angle value of Dynamic Wedge showed the difference between 0.1% and 4.5%.The difference for 6 MV for the angle value of 10° in orientation IN was 1.1% and for energy 15 MV in the same case the difference was 3.8%. Thinner wedges exhibit less difference.

Conclusion

It is necessary to provide comprehensive quality control procedure for enhanced dynamic wedges. Verification measurements should be an obligatory procedure in the recommendation for the testing of medical accelerators. These results are the preliminary results to provide measurements in other Polish Cancer Centres.     

Outline of a mathematical approach to the cancer problem

The fact that the growth of every organism, as it develops through cell multiplication from the ovum, eventually ceases, makes plausible the hypothesis that each cell of an organism exerts some kind of inhibitory influence upon the growth and multiplication of every other cell through the medium of some factorj. Each cell, however, is considered to possess an amount of a “growth factor”g, the activity of which is inhibited byj. In the course of development, most cells differentiate. A number of them remains relatively undifferentiated, and those are used for repairs of natural tear and wear as well as for healing of wounds. With age either the number of those cells or their “potency” decreases, which accounts for a general decrease in the speed of wound healing. Due to statistical fluctuations, the amount of theg is not uniformly distributed amongst the cells. Some of them have accidentally a greater amount than others. As the number or potency of the undifferentiated cells decreases with age, so does their inhibitory influence upon other cells. Therefore, those cells which do have an accidental dental excess ofg-factor will begin to grow and multiply, producing neoplasms. Putting the above assumptions into mathematical form, it is possible to derive a relation which gives theprobability of cancer incidence as a function of age. The theoretical relation is compared to the rather inadequate empirical data and found in agreement with them. A relation for the speed of wound healing as a function of age is also derived, and also found in general agreement with the rather scant data. Several other conclusions are discussed and possibilities of their practical applications pointed out.     

A novel approach to estimate trabecular bone anisotropy using a database approach

Continuum finite element (FE) models of bones have become a standard pre-clinical tool to estimate bone strength. These models are usually based on clinical CT scans and material properties assigned are chosen as isotropic based only on the density distribution. It has been shown, however, that trabecular bone elastic behavior is best described as orthotropic. Unfortunately, the use of orthotropic models in FE analysis derived from CT scans is hampered by the fact that the measurement of a trabecular orientation (fabric) is not possible from clinical CT images due to the low resolution of such images. In this study, we explore the concept of using a database (DB) of high-resolution bone models to derive the fabric information that is missing in clinical images. The goal of this study was to investigate if models with fabric derived from a relatively small database can already produce more accurate results than isotropic models.