Adjustable prosthetic sockets: a systematic review of industrial and research design characteristics and their justifications.

BACKGROUND: The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure. METHODS: Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices. RESULTS: 50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket. DISCUSSION: There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys.

BACKGROUND: Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana. METHODS: In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics. RESULTS: Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 - 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 - 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 - 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 - 3.243), richer (RRR = 1.908, 95 % CI 1.145 - 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 - 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 - 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 - 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 - 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 - 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 - 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 - 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions. CONCLUSIONS: Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

Assessing the Current Integration of Multiple Personalised Wearable Sensors for Environment and Health Monitoring.

The ever-growing development of sensor technology brings new opportunities to investigate impacts of the outdoor environment on human health at the individual level. However, there is limited literature on the use of multiple personalized sensors in urban environments. This review paper focuses on examining how multiple personalized sensors have been integrated to enhance the monitoring of co-exposures and health effects in the city. Following PRISMA guidelines, two reviewers screened 4898 studies from Scopus, Web of Science, ProQuest, Embase, and PubMed databases published from January 2010 to April 2021. In this case, 39 articles met the eligibility criteria. The review begins by examining the characteristics of the reviewed papers to assess the current situation of integrating multiple sensors for health and environment monitoring. Two main challenges were identified from the quality assessment: choosing sensors and integrating data. Lastly, we propose a checklist with feasible measures to improve the integration of multiple sensors for future studies.

A pin-array method for capturing tissue deformation under defined pressure distributions and its application to prosthetic socket design.

The Fit4Purpose project aims to develop upper limb prosthetic devices which are suitable for deployment in lower- and middle-income countries (LMIC's). Open-frame trans-radial socket designs are being considered, formed of several, linked components, including pads which interface directly with the skin surface. A mechanical tool has been developed to aid the design of pad shapes, using an array of square brass bars of varying lengths (i.e. a pin-array) to apply a chosen normal pressure distribution to an area of tissue. The shape to which the tissue is displaced can then be captured by clamping the bars together to fix their relative positions. The device is described, then three short studies are used to demonstrate its use on the forearm of a single, anatomically intact subject. The first investigates the effect of array size on the measured surface stiffness, finding an inverse relationship with a similar characteristic to previous published results. The second tests the hypothesis that a pad with a shape which duplicates that captured by the device will generate a similar overall load to the original pins if applied to the same region of tissue. The results support the hypothesis, but also highlight the sensitivity of the interface loading to the underlying muscle activation. Finally, the tool is used to demonstrate that different tissue displacements are observed when the same pressure distribution is applied to different areas of the forearm. Whilst the tool itself is a simple device, and the techniques used are not sophisticated, the studies suggest that the approach could be useful in pad design. Although it is clearly not appropriate for clinical application in its current form, there may be potential to develop the concept into a more practical device. Other applications could include the design of other devices which interface with the skin, the generation of data for validation of finite element models, including the application of known pressure distributions and tissue deformations during Magnetic Resonance Imaging, and the assessment of matrix pressure sensing devices on compliant materials with complex geometries.

Strategies to mitigate student resistance to active learning.

BACKGROUND: Research has shown that active learning promotes student learning and increases retention rates of STEM undergraduates. Yet, instructors are reluctant to change their teaching approaches for several reasons, including a fear of student resistance to active learning. This paper addresses this issue by building on our prior work which demonstrates that certain instructor strategies can positively influence student responses to active learning. We present an analysis of interview data from 17 engineering professors across the USA about the ways they use strategies to reduce student resistance to active learning in their undergraduate engineering courses. RESULTS: Our data reveal that instructor strategies for reducing student resistance generally fall within two broad types: explanation and facilitation strategies. Explanation strategies consist of the following: (a) explain the purpose, (b) explain course expectations, and (c) explain activity expectations. Facilitation strategies include the following: (a) approach non-participants, (b) assume an encouraging demeanor, (c) grade on participation, (d) walk around the room, (e) invite questions, (f) develop a routine, (g) design activities for participation, and (h) use incremental steps. Four of the strategies emerged from our analysis and were previously unstudied in the context of student resistance. CONCLUSIONS: The findings of this study have practical implications for instructors wishing to implement active learning. There is a variety of strategies to reduce student resistance to active learning, and there are multiple successful ways to implement the strategies. Importantly, effective use of strategies requires some degree of intentional course planning. These strategies should be considered as a starting point for instructors seeking to better incorporate the use of active learning strategies into their undergraduate engineering classrooms.

What about a Disability Rights Act for Canada?: Practices and lessons from America, Australia, and the United Kingdom.

The Harper government and most national political parties are committed to a federal act for dealing with accessibility rights for persons with disabilities. The purpose of this article is to identify progressive lessons from countries with similar legislation for consideration by Canadian authorities. Countries surveyed are the United States, Australia, and the United Kingdom. While disability rights legislation is widely accepted to be a necessary policy initiative in light of ongoing barriers and exclusion, experience suggests that such laws are far from a sufficient response to promote access. Other policy instruments required include supportive employment programs, tax incentives, and the direct provision of basic supports.

Organizing healthcare delivery systems for persons with ongoing care needs and their families: a best practices framework.

How systems of care delivery are structured can have a major impact on their relative efficiency and on the quality of care provided to individuals. As the population continues to age, as more people are able to continue to live with disabilities or chronic conditions, and as demands continue from consumers and lobby groups to allow individuals to be more fully integrated into customary Canadian life, pressures to deal with the needs of persons with ongoing care requirements will only continue to mount.

Providing care and support for an aging population: briefing notes on key policy issues.

The Canadian Initiative on Frailty and Aging was initiated with the overall goals of furthering understanding of the causes, trajectory and implications of frailty and improving the lives of older persons at risk of frailty. This paper presents the current research on key policy issues related to the frail elderly.