In vivo measurement of shoulder joint loads during walking with crutches.

BACKGROUND: Following surgery or injury of the lower limbs, the use of walking aids like crutches can cause high loads on the shoulder joint. These loads have been calculated so far with computer models but with strongly varying results. METHODS: Shoulder joint forces and moments were measured during crutch-assisted walking with complete and partial unloading of the lower limbs. Using telemeterized implants in 6 subjects axillary crutches and forearm crutches were compared. A force direction was more in the direction of the long humeral axis, and slightly lower forces were assumed using axillary crutches. Similar force magnitudes as those experienced during previously measured wheelchair weight relief tasks were expected for complete unloading. The friction-induced moment was hypothesized to act mainly around the medio-lateral axis during the swing phase of the body. FINDINGS: Maximum loads of up 170% of the bodyweight and 0.8% of the bodyweight times meter were measured with large variations among the patients. Higher forces were found in most of the patients using forearm crutches. The hypothesized predominant moment around the medio-lateral axis was only found in some patients. More often, the other two moments had larger magnitudes with the highest values in female patients. The assumed different load direction could only be found during partial unloading. INTERPRETATION: In general the force magnitudes were in the range of activities of daily living. However, the number of repetitions during long-lasting crutch use could lead to shoulder problems as a long-term consequence. The slightly lower forces with axillary crutches could be caused by loads acting directly from the crutch on the scapula, thus bypassing the glenohumeral joint. The higher bending moments in the female patients could be a sign of lacking muscle strength for centring the humeral head on the glenoid.

An EMG-driven musculoskeletal model of the shoulder.

This paper aims to develop an EMG-driven model of the shoulder that can consider possible muscle co-contractions. A musculoskeletal shoulder model (the original model) is modified such that measured EMGs can be used as model-inputs (the EMG-driven model). The model is validated by using the in-vivo measured glenohumeral-joint reaction forces (GH-JRFs). Three patients carrying instrumented hemi-arthroplasty were asked to perform arm abduction and forward-flexion up to maximum possible elevation, during which motion data, EMG, and in-vivo GH-JRF were measured. The measured EMGs were normalized and together with analyzed motions served as model inputs to estimate the GH-JRF. All possible combinations of input EMGs ranging from a single signal to all EMG signals together were tested. The 'best solution' was defined as the combination of EMGs which yielded the closest match between the model and the experiments. Two types of inconsistencies between the original model and the measurements were observed including a general GH-JRF underestimation and a GH-JRF drop above 90° elevation. Both inconsistencies appeared to be related to co-contraction since inclusion of EMGs could significantly (p<.05) improve the predicted GH-JRF (up to 45%). The developed model has shown the potential to successfully take the existent muscle co-contractions of patients into account.

Functionalized nanoparticle interactions with polymeric membranes.

A series of experiments was performed to measure the retention of a class of functionalized nanoparticles (NPs) on porous (microfiltration and ultrafiltration) membranes. The findings impact engineered water and wastewater treatment using membrane technology, characterization and analytical schemes for NP detection, and the use of NPs in waste treatment scenarios. The NPs studied were composed of silver, titanium dioxide, and gold; had organic coatings to yield either positive or negative surface charge; and were between 2 and 10nm in diameter. NP solutions were applied to polymeric membranes composed of different materials and pore sizes (ranging from ≈ 2 nm [3 kDa molecular weight cutoff] to 0.2 µm). Greater than 99% rejection was observed of positively charged NPs by negatively charged membranes even though pore diameters were up to 20 times the NP diameter; thus, sorption caused rejection. Negatively charged NPs were less well rejected, but behavior was dependent not only on surface functionality but on NP core material (Ag, TiO(2), or Au). NP rejection depended more upon NP properties than membrane properties; all of the negatively charged polymeric membranes behaved similarly. The NP-membrane interaction behavior fell into four categories, which are defined and described here.

Measurement of shoulder joint loads during wheelchair propulsion measured in vivo.

BACKGROUND: Recent in vivo measurements show that the loads acting in the glenohumeral joint are high even during activities of daily living. Wheelchair users are frequently affected by shoulder problems. With previous musculoskeletal shoulder models, shoulder joint loading was mostly calculated during well-defined activities like forward flexion or abduction. For complex movements of everyday living or wheelchair propulsion, the reported loads vary considerably. METHODS: Shoulder joint forces and moments were measured with telemeterized implants in 6 subjects. Data were captured on a treadmill at defined speeds and inclinations. Additional measurements were taken in 1 subject when lifting the body from the wheelchair, using his arms only, and in 2 subjects when rapidly accelerating and stopping the wheelchair. The influence of the floor material on shoulder joint loading was accessed in 2 subjects. In general, the maximum shoulder loads did not exceed those during daily living but the time courses and magnitudes of the loads intra-individually varied much. FINDINGS: The highest forces acted during maximum acceleration and lifting from the wheelchair (128% and 188% of body weight). Grass was the only surface which led to a general load increase, compared to a smooth floor. INTERPRETATION: The increased incidence of overuse injuries in wheelchair users are probably not caused by excessive load magnitudes during regular propulsion. The high number of repetitions is assumed to be more decisive.

In vivo gleno-humeral joint loads during forward flexion and abduction.

To improve design and preclinical test scenarios of shoulder joint implants as well as computer-based musculoskeletal models, a precise knowledge of realistic loads acting in vivo is necessary. Such data are also helpful to optimize physiotherapy after joint replacement and fractures. This is the first study that presents forces and moments measured in vivo in the gleno-humeral joint of 6 patients during forward flexion and abduction of the straight arm. The peak forces and, even more, the maximum moments varied inter-individually to a considerable extent. Forces of up to 238%BW (percent of body weight) and moments up to 1.74%BWm were determined. For elevation angles of less than 90° the forces agreed with many previous model-based calculations. At higher elevation angles, however, the measured loads still rose in contrast to the analytical results. When the exercises were performed at a higher speed, the peak forces decreased. The force directions relative to the humerus remained quite constant throughout the whole motion. Large moments in the joint indicate that friction in shoulder implants is high if the glenoid is not replaced. A friction coefficient of 0.1-0.2 seems to be realistic in these cases.

Validation of the Delft Shoulder and Elbow Model using in-vivo glenohumeral joint contact forces.

The Delft Shoulder and Elbow Model (DSEM), a large-scale musculoskeletal model, is used for the estimation of muscle and joint reaction forces in the shoulder and elbow complex. Although the model has been qualitatively verified using EMG-signals, quantitative validation has until recently not been feasible. The development of an instrumented shoulder endoprosthesis has now made this possible. To this end, motion data, EMG-signals, external forces, and in-vivo glenohumeral joint reaction forces (GH-JRF) were recorded for two patients with an instrumented shoulder hemi-arthroplasty, during dynamic tasks (including abduction and anteflexion) and force tasks with the arm held in a static position. Motions and external forces served as the model inputs to estimate the GH-JRF. In the modeling process, the effect of two different (stress and energy) optimization cost functions and uniform size and mass scaling were evaluated. The model-estimated GH-JRF followed the in-vivo measured force for dynamic tasks up to about 90° arm elevations, but generally underestimates the peak forces up to 31%; whereas a different behavior (ascending measured but descending estimated force) was found for angles above 90°. For the force tasks the model generally overestimated the peak GH-JRF for most directions (on average up to 34%). Applying the energy cost function improved model predictions for the dynamic anteflexion task (up to 9%) and for the force task (on average up to 23%). Scaling also led to improvement of the model predictions during the dynamic tasks (up to 26%), but had a negligible effect (<2%) on the force task results. Although results indicated a reasonable compatibility between model and measured data, adjustments will be necessary to individualize the generic model with the patient-specific characteristics.

Titanium nanomaterial removal and release from wastewater treatment plants.

Titanium (Ti) occurs naturally in soils and as highly purified titanium dioxide (Ti5O2) in many commercial products that have been used for decades. We report for the first time the occurrence, characterization, and removal of nano- and larger-sized Ti at wastewater treatment plants (WWTPs). At one WWTP studied in detail, raw sewage contained 100 to nearly 3000 microg TVL Ti larger than 0.7 microm accounted for the majority of the Ti in raw sewage, and this fraction was well removed by WWTP processes. Ti concentrations in effluents from this and several other WWTPs ranged from <5 to 15 microg/L and were nearly all present in the < 0.7 microm size fraction. As Ti was removed, it accumulated in settled solids at concentrations ranging from 1 to 6 microg Ti/mg. Ti-containing solids were imaged in sewage, biosolids, and liquid effluent as well as in commercial products containing engineered TiO2. Single nanoparticles plus spherical aggregates (50 nm to a few hundred nanometer in size) composed of sub-50 nm spheres of Ti and oxygen only (presumably TiO2) were observed in all samples. Significantly larger silicate particles containing a mixture of Ti and other metal atoms were also observed in the samples. To support the field work, laboratory adsorption batch and sequencing batch reactor experiments using TiO2 and activated sludge bacteria verified that adsorption of TiO2 onto activated sludge biomass occurs. Monitoring for TiO2 in the environment where WWTP liquid effluent is discharged (rivers, lakes, oceans) or biomass disposed (landfills, agriculture and soil amendments, incinerator off-gas or residuals) will increase our knowledge on the fate and transport of other nanomaterials in the environment

In vivo measurement of shoulder joint loads during activities of daily living.

Until recently the contact loads acting in the glenohumeral joint have been calculated using musculoskeletal models or measured in vitro. Now, contact forces and moments are measured in vivo using telemeterized shoulder implants. Mean total contact forces from four patients during eight activities of daily living are reported here. Lifting a coffee pot (1.5kg) with straight arm caused an average force of 105.0%BW (%body weight) (range: 90-124.6%BW), while setting down the coffee pot in the same position led to higher forces of 122.9%BW on the average (105.3-153.4%BW). The highest joint contact forces were measured when the straight arm was abducted or elevated by 90 degrees or more, with a weight in the hand. Lifting up 2kg from a board up to head height caused a contact force of 98.3%BW (93-103.6%BW); again, setting it down on the board led to higher forces of 131.5%BW (118.8-144.1%BW). In contrast to previously calculated high loads, the contact force during passive holding of a 10kg weight laterally was only 12.3%BW (9.2-17.9%BW), but when lifting it up to belt height it increased to 91.5%BW (87-95%BW). The moments transferred inside the joint at our patients varied much more than did the forces both inter and intra-individually. Our data suggest that patients with shoulder problems or during the first post-operative weeks after shoulder fractures or joint replacements should avoid certain activities encountered during daily living e.g. lifting or holding a weight with an outstretched arm. Some energy-related optimization criteria used in the literature for analytical musculoskeletal shoulder models must now be reconsidered.

Nitrogen enriched dissolved organic matter (DOM) isolates and their affinity to form emerging disinfection by-products.

Increased contributions from wastewater discharges and algal activity in drinking water supplies can lead to elevated levels of dissolved organic nitrogen (DON), which can increase the likelihood for the formation of emerging nitrogenous disinfection by-products (N-DBPs) of health concern. Dissolved organic matter (DOM) isolated from five waters, using a newly developed DOM isolation method specific to DON fractionation, produced thirty-four isolates of suitable mass. Each isolate was treated with free chlorine or chloramines under formation potential conditions. The DBP yields were determined for three halogenated DBPs (trichloromethane, dichloroacetonitrile, and trichloronitromethane) and one non-halogenated DBP (N-nitrosodimethylamine [NDMA]). Halogenated DBP yields were greater during the application of free chlorine, however chloramination produced significant levels of halogenated N-DBPs for some isolates. NDMA was only observed to form from selected nitrogen-enriched isolates (DOC/DON ratio < 20 mg/mg), especially those isolated from treated wastewater. Other results indicated that nitrogen-enriched DOM resulted in increased yields of the other N-DBPs studied.

An instrumented implant for in vivo measurement of contact forces and contact moments in the shoulder joint.

To improve implant design, fixation and preclinical testing, implant manufacturers depend on realistic data of loads acting on the shoulder joint. Furthermore, these data can help to optimize physiotherapeutic treatment and to advise patients in their everyday living conditions. Calculated shoulder joint loads vary extremely among different authors [Anglin C, Wyss UP, Pichora DR. Glenohumeral contact forces. Proc Inst Mech Eng [H] 2000;214:637-44]. Additionally the moments acting in the joint caused by friction or incongruent articular surfaces, for example, are not implemented in most models. An instrumented shoulder joint implant was developed to measure the contact forces and the contact moments acting in the glenohumeral joint. This article provides a detailed description of the implant, containing a nine-channel telemetry unit, six load sensors and an inductive power supply, all hermetically sealed inside the implant. The instrumented implant is based on a clinically proven BIOMET Biomodular shoulder replacement and was calibrated before implantation by using complex mathematical calculation routines in order to achieve an average measuring precision of approximately 2%.

Design and calibration of load sensing orthopaedic implants.

Contact forces and moments act on orthopaedic implants such as joint replacements. The three forces and three moment components can be measured by six internal strain gauges and wireless telemetric data transmission. The accuracy of instrumented implants is restricted by their small size, varying modes of load transfer, and the accuracy of calibration. Aims of this study were to test with finite element studies design features to improve the accuracy, to develop simple but accurate calibration arrangements, and to select the best mathematical method for calculating the calibration constants. Several instrumented implants, and commercial and test transducers were calibrated using different loading setups and mathematical methods. It was found that the arrangement of flexible elements such as bellows or notches between the areas of load transfer and the central sensor locations is most effective to improve the accuracy. Increasing the rigidity of the implant areas, which are fixed in bones or articulate against joint surfaces, is less effective. Simple but accurate calibration of the six force and moment components can be achieved by applying eccentric forces instead of central forces and pure moments. Three different methods for calculating the measuring constants proved to be equally well suited. Employing these improvements makes it possible to keep the average measuring errors of many instrumented implants below 1-2% of the calibration ranges, including cross talk. Additional errors caused by noise of the transmitted signals can be reduced by filtering if this is permitted by the sampling rate and the required frequency content of the loads.

[Loads acting on orthopaedic implants. Measurements and practical applications]. / Die Belastung orthopädischer Implantate. Messungen und praktische Anwendungen.

The loads measured at instrumented joint replacements and other orthopaedic implants allow the optimization of their stability, wear properties, fixation stability and kinematic properties prior to clinical applications. The data obtained also indicate which activities cause very high loads and should be avoided by the patients in order not to endanger the long-term success of the implant. In addition, physiotherapy after joint arthroplasty and fractures can be further improved on the basis of these data. The technical principles for such measurements are summarized and examples for the design of load measuring instrumented implants are presented. The most important results are presented based on the measurements taken at the hip and shoulder joints, internal spinal fixation devices, vertebral body replacements and knee joints. Using this data, many practical conclusions are drawn. Due to the huge amount of data obtained from the hip, most practical advise can be provided to patients with replacement or disorders involving this joint.

Vanadium removal by metal (hydr)oxide adsorbents.

Vanadium is listed on the United States Environment Protection Agency (USEPA) candidate contaminant list # 2 (CCL2), and regulatory guidelines for vanadium exist in some US states. The USEPA requires treatability studies before making regulatory decisions on CCL2 contaminants. Previous studies have examined vanadium adsorption onto some metal hydroxides but not onto commercially available adsorbents. This paper briefly summarizes known vanadium occurrence in North American groundwater and assesses vanadium removal by three commercially available metal oxide adsorbents with different mineralogies. GTO (Dow) is TiO2 based and E-33 (Seven Trents) and GFH (US Filter) are iron based. Preliminary vanadate adsorption kinetics onto GFH, E-33 and GTO has been studied and the homogenous surface diffusion model (HSDM) is used to describe the adsorption kinetics data. The effects of pH, vanadium concentration, and volume/mass ratio are assessed. Vanadium adsorption decreases with increasing pH, with maximum adsorption capacities achieved in at pH 3-4. Results indicate that all adsorbents remove vanadium; GFH has the highest adsorption capacity, followed by GTO and E-33. Data are best fit with the Langmuir model rather than Freundlich isotherms. Both the sorption maxima (Xm) and binding energy constant (b) follow the trend GFH>GTO>E-33. Naturally occurring vanadium is also removed from Arizona ground water in rapid small-scale column tests (RSSCTs). Metal oxide adsorption technologies currently used for arsenic removal may also remove vanadium but not always with the same effectiveness.

In vivo glenohumeral contact forces--measurements in the first patient 7 months postoperatively.

Knowledge of forces in the glenohumeral joint is essential for understanding normal and pathologic shoulder function. It forms the basis for performing fracture treatment or joint replacement surgery, for optimizing implant design and fixation and for improving and verifying analytical biomechanical models of the shoulder. An instrumented shoulder implant with telemetric data transmission was developed to measure six components of joint contact forces and moments. A patient with humeral head arthrosis achieved good joint function after its implantation. During the first 7 postoperative months, the contact force remained below 100% BW (percent body weight) for most activities of daily living. It ranged up to 130% BW for arm positions close to the limits of motion or when acting against external resistance. When the patient tried to turn a blocked steering wheel with maximum effort, the force rose to about 150% BW, the highest level observed thus far. Of great interest were the force directions relative to the humerus, especially those in the sagittal plane, which were not greatly influenced by the type of exercise, the arm position or the external resistance. The moments due to friction in the joint reached 5.2 Nm. The friction-induced shift of contact forces relative to the implant head centre ranged up to 6.3mm. These first worldwide in vivo measurements of glenohumeral contact forces are being continued in more patients and for longer postoperative times.

Reactivity of natural organic matter with aqueous chlorine and bromine.

While both aqueous bromine (HOBr/OBr(-)) and chlorine (HOCl/OCl(-)) react with natural organic matter (NOM) during water treatment, limited direct parallel comparison of bromine versus chlorine has been conducted. Experiments with model compounds and natural waters indicated more efficient substitution reactions with bromine than chlorine. Kinetic experiments with NOM isolates with and without pre-ozonation were conducted to obtain second-order rate constants (k) with bromine and chlorine. Two-stage reaction kinetics (rapid initial and slower consumption stages) were observed. Bromine reacted about 10 times faster than chlorine with NOM isolates during both stages. The rapid initial stage reactions were too fast to quantify k values, but qualitative estimates ranged between 500 and 5000 M(-1)s(-1). For the slower second stage k values for bromine were 15 to 167 M(-1)s(-1) over the pH range of 5-11, and lower for chlorine (k = 0.7-5M(-1)s(-1)). Values of k correlated with initial SUVA values of NOM (UVA measured at 254 nm divided by DOC). Based upon UV/VIS and solid-state (13)C-NMR spectroscopy, chlorine addition to a NOM isolate resulted in significant oxidation of aromatic and ketone groups while bromine had significantly less change in spectra. Overall, the improved knowledge that bromine reacts faster and substitutes more efficiently than chlorine will be useful in developing strategies to control disinfection by-product formation during water treatment.

Fluorescence spectroscopy and molecular weight distribution of extracellular polymers from full-scale activated sludge biomass.

Two fractions of extracellular polymer substances (EPSs), soluble and readily extractable (RE), were characterised in terms of their molecular weight distributions (MWD) and 3-D excitation-emission-matrix (EEM) fluorescence spectroscopy signatures. The EPS fractions were different: the soluble EPSs were composed mainly of high molecular weight compounds, while the RE EPSs were composed of small molecular weight compounds. Contrary to previous thought, EPS may not be considered only as macromolecular because most organic matter present in both fractions had low molecular weight. Three different fluorophore peaks were identified in the EEM fluorescence spectra. Two peaks were attributed to protein-like fluorophores, and the third to a humic-like fluorophore. Fluorescence signatures were different from other previously published signatures for marine and riverine environments. EEM spectroscopy proved to be a suitable method that may be used to characterise and trace organic matter of bacterial origin in wastewater treatment operations.

Fluorescence analysis of a standard fulvic acid and tertiary treated wastewater.

Fluorescence measurements (emission scan, synchronous scan, and excitation-emission matrix [EEM] scan) were used to compare characteristics of two sources of dissolved organic carbon (DOC) from distinctly different origins: (i) a standard fulvic acid from the Suwannee River (SRF sample) and (ii) an unfractionated DOC sample from a tertiary wastewater treatment plant (MWW sample). Two methods were demonstrated that quantitatively differentiated allochthonous DOC (e.g., SRF) from autochthonous DOC (e.g., MWW). The MWW sample exhibited fluorescence peaks undetected in the SRF sample, at shorter wavelength pairs (e.g., 220 nm:300 to 350 nm) than the dominant peaks in the SRF sample (e.g., 220 nm:450 nm). These peaks may be associated with base or neutral fractions, potentially enriched in organic nitrogen. Effects of DOC concentration and solution pH were discussed. A simple procedure was recommended (pH = 3; DOC = 1 mg/L; dilution with 0.01 M KCl) that minimizes the need to correct spectra for inner-filter absorbance effects. A method, using synchronous fluorescence, to estimate the percentage of DOC from different sources when mixed together was also presented. Further work to understand the structural properties of DOC that fluoresce in wastewater samples, especially at shorter EEM wavelength pairs, will enable water managers to better understand the influence of wastewater on DOC in receiving waters (e.g., rivers, lakes).

Removal of nitrate from groundwater by cyanobacteria: quantitative assessment of factors influencing nitrate uptake.

The feasibility of biologically removing nitrate from groundwater was tested by using cyanobacterial cultures in batch mode under laboratory conditions. Results demonstrated that nitrate-contaminated groundwater, when supplemented with phosphate and some trace elements, can be used as growth medium supporting vigorous growth of several strains of cyanobacteria. As cyanobacteria grew, nitrate was removed from the water. Of three species tested, Synechococcus sp. strain PCC 7942 displayed the highest nitrate uptake rate, but all species showed rapid removal of nitrate from groundwater. The nitrate uptake rate increased proportionally with increasing light intensity up to 100 micromol of photons m(-2) s(-1), which parallels photosynthetic activity. The nitrate uptake rate was affected by inoculum size (i.e., cell density), fixed-nitrogen level in the cells in the inoculum, and aeration rate, with vigorously aerated, nitrate-sufficient cells in mid-logarithmic phase having the highest long-term nitrate uptake rate. Average nitrate uptake rates up to 0.05 mM NO(3-) h(-1) could be achieved at a culture optical density at 730 nm of 0.5 to 1. 0 over a 2-day culture period. This result compares favorably with those reported for nitrate removal by other cyanobacteria and algae, and therefore effective nitrate removal from groundwater using this organism could be anticipated on large-scale operations.