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The latter condition is used to obtain expressions for R0 in age-structured models in sections 5 and 6 antibiotic xidox order sumycin now. This unrealistically short average lifetime has been chosen so that the endemic equilibrium is clearly above the horizontal axis and the spiraling into the endemic equilibrium can be seen infection 8 weeks after miscarriage cheap sumycin online master card. They unrealistically assume that the population is uniform and homogeneously mixing antibiotic used to treat chlamydia best order for sumycin, whereas it is known that mixing depends on many factors including age (children usually have more adequate contacts per day than adults) infection urinaire symptmes discount sumycin 500mg with visa. Moreover virus y antivirus buy sumycin with mastercard, difierent geographic and social-economic groups have difierent contact rates antibiotics vs surgery appendicitis discount 500mg sumycin with mastercard. By using data on the susceptible fractions so and sfi at the beginning and end of epidemics, this formula can be used to estimate contact numbers for specific diseases [100]. Using blood samples from freshmen at Yale University [75], the fractions susceptible to rubella at the beginning and end of the freshman year were found to be 0. This approach is somewhat naive, because the average seropositivity in a population decreases to zero as the initial passive immunity declines and then increases as people age and are exposed to infectives. Data on average ages of infection and average lifetimes in developed countries have been used to estimate basic reproduction numbers R0 for some viral diseases. These estimates of R0 are about 16 for measles, 11 for varicella (chickenpox), 12 for mumps, 7 for rubella, and 5 for poliomyelitis and smallpox [12, p. Because disease-acquired immunity is only temporary for bacterial diseases such as pertussis (whooping cough) and diphtheria, the formula R0 = fi =1+L/A cannot be used to estimate R0 for these diseases (see section 8 for estimates of R0 and fi for pertussis). Herd immunity occurs for a disease if enough people have disease-acquired or vaccination-acquired immunity, so that the introduction of one infective into the population does not cause an invasion of the disease. Intuitively, if the contact number is fi, so that the typical infective has adequate contacts with fi people during the infectious period, then the replacement number fis must be less than 1 so that the disease does not spread. This means that s must be less than 1/fi, so the immune fraction r must satisfy r>1 fi 1/fi =1fi 1/R0. Using the estimates above for R0, the minimum immune fractions for herd immunity are 0. Although these values give only crude, ballpark estimates for the vaccination-acquired immunity level in a community required for herd immunity, they are useful for comparing diseases. For example, these numbers suggest that it should be easier to achieve herd immunity for poliomyelitis and smallpox than for measles, mumps, and rubella. This conclusion is justified by the actual efiectiveness of vaccination programs in reducing, locally eliminating, and eradicating these diseases (eradication means elimination throughout the world). The information in the next section verifies that smallpox has been eradicated worldwide and polio should be eradicated worldwide within a few years, while the diseases of rubella and measles still persist at low levels in the United States and at higher levels in many other countries. For centuries the process of variolation with material from smallpox pustules was used in Africa, China, and India before arriving in Europe and the Americas in the 18th century. Edward Jenner, an English country doctor, observed over 25 years that milkmaids who had been infected with cowpox did not get smallpox. In 1796 he started vaccinating people with cowpox to protect them against smallpox [168]. Two years later, the findings of the first vaccine trials were published, and by the early 1800s, the smallpox vaccine was widely available. Smallpox vaccination was used in many countries in the 19th century, but smallpox remained endemic. Smallpox was slowly eliminated from many countries, with the last case in the Americas in 1971. The last case worldwide was in Somalia in 1977, so smallpox has been eradicated throughout the world [23, 77, 168]. Most cases of poliomyelitis are asymptomatic, but a small fraction of cases result in paralysis. In the 1950s in the United States, there were about 60,000 paralytic polio cases per year. In 1955 Jonas Salk developed an injectable polio vaccine from an inactivated polio virus. This vaccine provides protection for the person, but the person can still harbor live viruses in their intestines and can pass them to others. In 1961 Albert Sabin developed an oral polio vaccine from weakened strains of the polio virus. The Salk vaccine interrupted polio transmission and the Sabin vaccine eliminated polio epidemics in the United States, so there have been no indigenous cases of naturally occurring polio since 1979. In order to eliminate the few cases of vaccine-related paralytic polio each year, the United States now recommends the Salk injectable vaccine for the first four polio vaccinations, even though it is more expensive [50]. In the Americas, the last case of paralytic polio caused by the wild virus was in Peru in 1991. Most countries are using the live-attenuated Sabin vaccine, because it is inexpensive (8 cents per dose) and can be easily administered into a mouth by an untrained volunteer. Polio has disappeared from many countries in the past 10 years, so that by 1999 it was concentrated in the Eastern Mediterranean region, South Asia, West Africa, and Central Africa. Measles is a serious disease of childhood that can lead to complications and death. For example, measles caused about 7,500 deaths in the United States in 1920 and still causes about 1 million deaths worldwide each year [47, 48]. Measles vaccinations are given to children between 6 and 18 months of age, but the optimal age of vaccination for measles seems to vary geographically [99]. But the replacement number R remained above 1, so that smallpox persisted in most areas until the mid-20th century. In 1966 smallpox was still endemic in South America, Africa, India, and Indonesia. Because the goal of a rubella vaccination program is to prevent rubella infections in pregnant women, special vaccination strategies such as vaccination of 12 to 14-year-old girls are sometimes used [98, 101]. This 1976 photograph shows schoolchildren in Highland Park, Illinois, lining up for measles vaccinations. The replacement number R now appears to be below 1 throughout the United States, so that measles is no longer considered to be an indigenous disease there. Thus to reach the levels necessary to achieve herd immunity, the vaccinated fractions would have to be at least 0. These fractions suggest that achieving herd immunity would be much harder for measles than for rubella, because the percentages not vaccinated would have to be below 1% for measles and below 9% for rubella. Because vaccinating all but 1% against measles would be dificult to achieve, a two-dose program for measles is an attractive alternative in some countries [50, 98, 99]. In the prevaccine era, every child had measles, so the incidences were approximately equal to the sizes of the birth cohorts. After the measles vaccine was licensed in 1963 in the United States, the reported measles incidence dropped in a few years to around 50,000 cases per year. In 1978 the United States adopted a goal of eliminating measles, and vaccination coverage increased, so that there were fewer than 5,000 reported cases per year between 1981 and 1988. Pediatric epidemiologists at meetings at the Centers for Disease Control in Atlanta in November 1985 and February 1988 decided to continue the one-dose program for measles vaccinations instead of changing to a more expensive two-dose program. But there were about 16,000, 28,000, and 17,000 reported measles cases in the United States in 1989, 1990, and 1991, respectively; there were also measles outbreaks in Mexico and Canada during these years [117]. Reported measles cases declined after 1991 until there were only 137, 100, and 86 reported cases in 1997, 1998, and 1999, respectively. Each year some of the reported cases are imported cases and these imported cases can trigger small outbreaks. The proportion of cases not associated with importation has declined from 85% in 1995, 72% in 1996, 41% in 1997, to 29% in 1998. Analysis of the epidemiologic data for 1998 suggests that measles is no longer an indigenous disease in the United States [47]. Measles vaccination coverage in 19 to 35-month-old children was only 92% in 1998, but over 99% of children had at least one dose of measles-containing vaccine by age 6 years. Because measles is so easily transmitted and the worldwide measles vaccination coverage was only 72% in 1998 [48, 168], this author does not believe that it is feasible to eradicate measles worldwide using the currently available measles vaccines. In recent rubella outbreaks in the United States, most cases occurred among unvaccinated persons aged at least 20 years and among persons who were foreign born, primarily Hispanics (63% of reported cases in 1997) [46]. Worldwide eradication of rubella is not feasible, because over two-thirds of the population in the world is not yet routinely vaccinated for rubella. Indeed, the policies in China and India of not vaccinating against rubella may be the best policies for those countries, because most women of childbearing age in these countries already have disease-acquired immunity. Chickenpox is usually a mild disease in children that lasts about four to seven days with a body rash of several hundred lesions. Shingles is a painful vesicular rash along one or more sensory root nerves that usually occurs when the immune system is less efiective due to illness or aging [23]. But the vaccine-immunity wanes, so that vaccinated children can get chickenpox as adults. Two possible dangers of this new varicella vaccination program are more chickenpox cases in adults, when the complication rates are higher, and an increase in cases of shingles. An age-structured epidemiologic-demographic model has been used with parameters estimated from epidemiological data to evaluate the efiects of varicella vaccination programs [179]. Although the age distribution of varicella cases does shift in the computer simulations, this shift does not seem to be a problem since many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. In the computer simulations, shingles incidence increases in the first 30 years after initiation of a varicella vaccination program, because people are more likely to get shingles as adults when their immunity is not boosted by frequent exposures, but after 30 years the shingles incidence starts to decrease as the population includes more previously vaccinated people, who are less likely to get shingles. Thus the simulations validate the second danger that the new vaccination program could lead to more cases of shingles in the first several decades [179]. Type A infiuenza has three subtypes in humans (H1N1, H2N2, and H3N2) that are associated with widespread epidemics and pandemics. Infiuenza subtypes are classified by antigenic properties of the H and N surface glycoproteins, whose mutations lead to new variants every few years [23]. An infection or vaccination for one variant may give only partial immunity to another variant of the same subtype, so that fiu vaccines must be reformulated almost every year. If an infiuenza virus subtype did not change, then it should be easy to eradicate, because the contact number for fiu has been estimated above to be only about 1. But the frequent drift of the A subtypes to new variants implies that fiu vaccination programs cannot eradicate them because the target is constantly moving. Completely new A subtypes (antigenic shift) emerge occasionally from unpredictable recombinations of human with swine or avian infiuenza antigens. Pandemics also occurred in 1957 from the Asian Flu (an H2N2 subtype) and in 1968 from the Hong Kong fiu (an H3N2 subtype) [134]. When 18 confirmed human cases with 6 deaths from an H5N1 chicken fiu occurred in Hong Kong in 1997, there was great concern that this might lead to another antigenic shift and pandemic. Fortunately, the H5N1 virus did not evolve into a form that is readily transmitted from person to person [185, 198]. The two classic infectious disease models in section 2 assume that the total population size remains constant. However, constant population size models are not suitable when the natural births and deaths are not balanced or when the disease-related deaths are significant. Infectious diseases have often had a big impact on population sizes and historical events [158, 168, 202]. For example, the black plague caused 25% population decreases and led to social, economic, and religious changes in Europe in the 14th century. Diseases such as smallpox, diphtheria, and measles brought by Europeans devastated native populations in the Americas. Infectious diseases such as measles combined with low nutritional status still cause significant early mortality in developing countries. Indeed, the longer life spans in developed countries seem to be primarily a result of the decline of mortality due to communicable diseases [44]. Models with a variable total population size are often more dificult to analyze mathematically because the population size is an additional variable which is governed by a difierential equation [7, 8, 29, 30, 35, 37, 83, 88, 153, 159, 171, 201]. Let the birth rate constant be b and the death rate constant be d, so the population size N(t) satisfies N =(b fi d)N. Thus the population is growing, constant, or decaying if the net change rate q = b fi d is positive, zero, or negative, respectively. Since the population size can have exponential growth or decay, it is appropriate to separate the dynamics of the epidemiological process from the dynamics of the population size. The numbers of people in the epidemiological classes are denoted by M(t), S(t), E(t), I(t), and R(t), where t is time, and the fractions of the population in these classes are m(t), s(t), e(t), i(t), and r(t). We are interested in finding conditions that determine whether the disease dies out. Note that the number of infectives I could go to infinity even though the fraction i goes to zero if the population size N grows faster than I. Similarly, I could go to zero even when i remains bounded away from zero, if the population size is decaying to zero [83, 159]. To avoid any ambiguities, we focus on the behavior of the fractions in the epidemiological classes. The birth rate bS into the susceptible class of size S corresponds to newborns whose mothers are susceptible, and the other newborns b(N fi S) enter the passively immune class of size M, since their mothers were infected or had some type of immunity.

We established a collaboration with United Therapeutics antibiotic resistance animation ks4 cheap sumycin, and intend to engage with well-established companies whose distribution networks are deeply entrenched virus x-terminator cheap 250mg sumycin free shipping. We expect our commercial efforts will be comprised of the distribution networks of our collaboration partners antibiotic jaundice purchase sumycin paypal, particularly in the United States and Europe antibiotics linked to type 2 diabetes buy cheap sumycin 250 mg. We cultivate the tobacco plants used in the production of our rhCollagen in a network of farms in Israel antibiotic you can't drink alcohol order discount sumycin on-line, and we extract the raw materials used to manufacture our rhCollagen from these tobacco plants antibiotics dogs can take buy sumycin with mastercard. We have a manufacturing facility in Israel that is supporting our current commercial needs to manufacture commercial and clinical quantities of our rhCollagen and our BioInk in a cost-competitive manner for application in both premium and commodity markets. We intend to continue to develop additional products, both independently and with strategic collaborators, initially in 3D bioprinting of tissues and organs, and medical aesthetics markets and subsequently in other high value markets, based on our rhCollagen. Recently, we initiated development of injectable and 3D bioprinted breast implants. Our product pipeline and our research and development program are expected to yield new products in the coming years. We continually seek to expand our knowledge of plant-based protein production systems and introduce improvements into our process. We are shifting production to an enhanced line of tobacco plants with higher collagen yield, along with improvements in the growing and cultivation process as well as collagen extraction and purification. As tissue engineering and regenerative medicine continue to evolve and expand, we expect that the demand for high-quality biomaterials will grow. We have developed rhCollagen-based BioInks that are optimized and provides an ideal building block for the three-dimensional bioprinting of tissues and organs. The unique viscosity and shear thinning properties of the modified rhCollagen enable the formulation of BioInks that are suitable for different printing technologies including extrusion, ink-jet, Laser Induced Forward Transfer and Stereolithography. The control of chemical modification in combination with illumination energy allows tight control of the physical properties of the resulting scaffolds to match natural tissue properties, from stiff cartilage to soft adipose. BioInks formulated from rhCollagen were evaluated with all major currently available printing technologies and exhibited the required physical properties and excellent support for cells including a series of primary and differentiated human cells. These collaborations include development of technology for 3D bioprinting of life-saving organs and different tissues, such as cornea, using our BioInk formulations. Our collaborations are generally structured such that our partners provide research funding and purchasing of our BioInk to cover the scope of work, in part or in full. This funding is typically reflected as collaboration revenues in our financial statements. Upon entering into a collaboration, we disclose the financial details only to the extent that they are material to our business and not subject to confidentiality agreements with our partners. Research collaborations with academic or research institutions typically involve both us and the academic partner contributing resources directly to projects, but also may involve sponsored research agreements where we fund specific research programs. Other than under the United License Agreement, CollPlant has agreed not to conduct, enable or fund any research, development or commercialization, or grant any license, with respect to the Covered Products during the term of the United License Agreement, unless with respect to any Option Product, the option is not exercised and the right of first refusal period expires. The United License Agreement provides for the payment of an upfront cash payment of $5 million to CollPlant, which was paid to us in November 2018 following effectiveness of the United License Agreement. In addition, the United License Agreement provides for a one-time non-refundable option payment of $3 million per Option Product ($9 million in the aggregate), and up to $30 million of milestone payments payable as follows: (i) $5 million upon completion of the U. Unless earlier terminated, the United License Agreement will continue in effect on a Covered Product-by-Covered Product and country-by-country basis until the later of (i) the expiration, invalidation or abandonment of the last CollPlant patent covering a Covered Product in a particular country, and (ii) 12 years from the first commercial sale of such Covered Product in such country. The United License Agreement may be terminated early by either party for material breach or bankruptcy. On January 13, 2020, we announced a Joint Development Agreement with 3D Systems Corporation, pursuant to which we and 3D Systems agreed to jointly develop tissue and scaffold bioprinting processes for third party collaborators. Skin rejuvenation procedures are increasing in popularity, especially nonsurgical treatments such as dermal filler injections. Hyaluronic acid is a water-retaining molecule widely used for dermal filling, but on its own, lacks the ability to promote cell proliferation and tissue regeneration. The combination of hyaluronic acid with a photocurable version of our tissue regenerating rhCollagen, serves as the basis for a new dermal filler product line now in development. We are developing a photocurable regenerative filler comprised of rhCollagen and hyaluronic acid which is intended to provide several revolutionary effects: lifting, sculpturing ability, retention to the host tissue, and tissue regeneration. The photocurable regenerative dermal filler is intended for injection in a semiliquid phase and hardened in-situ post injection by light illumination through the skin. Utilization of photocuring technology is expected to ease the injection process, particularly in subcutaneous and supraperiosteal applications. As the hyaluronic acid and rhCollagen degrade, a newly formed tissue is expected to regenerate and take their place. Patent and Trademark Office for photocurable dermal fillers comprised of rhCollagen and hyaluronic acid, for the aesthetics market. In February 2019, we supplied the first material order of our rhCollagen to a leading company in the aesthetics market, and since then we have been selling rhCollagen for development of medical aesthetics products to that company. We believe that rising awareness and acceptance regarding several cosmetic procedures in developed and developing regions, coupled with increasing disposable income, is expected to drive forward the dermal filler market size. We believe that an expanding geriatric population across the globe seeking anti-aging and wrinkle treatment is expected to have a significant impact on segmental growth, and that an accelerating demand for numerous beauty enhancement procedures is expected to further support facial line correction segment growth. Breast implants Current breast reconstruction is based on synthetic breast implantation and free flap surgery/autologous fat tissue transfer, all of which replace tissue rather than regenerate it. Breast augmentation and reconstruction through silicone implants, which are among the most popular surgical procedures, are associated with high risk for adverse events. Another procedure increasing in popularity for relatively small volume breast augmentation is an injectable scaffold composed of autologous fat tissue injected into the desired location for volume fill (fat transfer). The clinical outcome of this procedure is however quite limited due to a significant volume loss after a relatively short period. We are advancing the development of injectable and 3D bioprinted breast implants for regeneration of breast tissue, aimed to overcome these challenges and provide a revolutionary alternative to the current practices. Injectable implants Injectable implants composed of rhCollagen, additional materials and fat cells taken from the patient are intended to promote breast tissue regeneration. The specific compositions are designed to support the viability and function of the autologous fat cells, and to attract cells to promote tissue regeneration. The scaffold is designed to gradually degrade and be replaced by newly grown natural breast tissue that is free of any foreign material. These implants are intended to promote tissue regeneration and degrade in synchronization with the development of a natural breast tissue. In August 2019, our proprietary rhCollagen-based regenerative breast implants program accelerated and we launched an animal study during the first quarter of 2020. Platelets contain growth factors that are responsible for stimulating tissue generation and repair, including soft tissue repair, bone regeneration, development of new blood vessels, and stimulation of the wound healing process. Globally, the aging population is playing a major role in increasing the incidence of sports injuries as the reduced flexibility and mobility associated with aging can make the body more prone to injury. Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The trial, which commenced in January 2015, initially enrolled 20 patients and was expanded to enroll an additional 20 patients. In November 2016, we entered into an exclusive distribution agreement with Arthrex GmbH in Munich, Germany, an affiliate of Arthrex, Inc. The indications included injuries in rotator cuff, Achilles tendon, peroneal tendon, tibialis tendon and common extensor tendon. In all treatment groups, patientrecorded-pain decreased after 2 weeks and continued along this trend up to the last follow-up at 6 months. Specifically for rotator cuff and common extensor tendon groups, the functionality was increased over the study period, almost achieving pre-symptom levels after 6 months. Other flowable gel products are available on the market, but they are based on tissue-derived collagen. MedTech Europe has reported there are an estimated 4 million individuals with wounds in the European Union per year. Product performance was examined according to several measures, the main one being the percentage of wound closure achieved. The results were published in February 2019 in Wounds, a peer-reviewed journal focusing on wound care and wound research. Four weeks following treatment, nine wounds closed completely, fifteen wounds exhibited a greater than 70% closure, and the median wound area reduction was 94%. Further, no significant device-related adverse events were reported throughout the study. Technology Our rhCollagen is based upon research conducted by our founder and Chief Scientist, Prof. We believe our technology is the only viable technology available for the production of recombinant type I human collagen, the most abundant collagen in the human body. The production of our rhCollagen begins with the creation of genetically engineered cultures that are transferred to selected greenhouses across Israel and continues with the harvesting of tobacco leaves and the processing of such leaves to an extract which then undergoes purification until the completion of the rhCollagen. Five human genes encoding heterotrimeric type I collagen are introduced into tobacco plants. These enzymes are responsible for key post-translational modifications of collagen, and plants co-expressing all five of these vacuole-targeted genes generate intact procollagen. The plants are grown in a greenhouse under strict growing protocols and mature leaves are transported to a protein extraction facility. Upon extraction, procollagen is enzymatically converted to atelocollagen using a plant-derived protease. Binding of integrins (transmembrane receptors) presented by the cells to a specific 3D structure on type I collagen fibrils requires a perfect triple helix. This binding is essential for binding and proliferation of cells on tissue repair scaffolds. In a study published in the Journal of Biomedical Materials Research Part B: Applied Biomaterials, rhCollagen was compared with acid-solubilized collagen from bovine dermis and pepsin-solubilized collagen from human fibroblast cell culture. Tested samples of the tissue-derived collagens had random fibrillar organization, whereas rhCollagen membranes showed far greater regional fibril alignment and transparency. RhCollagen membranes also showed better thermal stability compared with the tissue-derived collagens. The authors concluded that cross-linked rhCollagen membranes had a superior combination of desirable properties, namely higher transparency, higher thermal and tensile strengths, and adequate hydration. We have developed a large portfolio of configurations and composites based on our rhCollagen that are used to create high-quality products, including our three products, as follows: Our Development Activities Development History Our rhCollagen was first developed as a collaboration among several commercial partners and the Hebrew University of Jerusalem, a major academic institution in Israel, under the direction of Professor Oded Shoseyov. Shoseyov is a faculty member at the Robert Smith Institute of Plant Science and Genetics at the Hebrew University of Jerusalem. The intellectual property was transferred to our wholly owned subsidiary, CollPlant. Between 2013 and 2017, we developed with Bioventus a surgical matrix, a novel resorbable carrier designed to help accelerate bone healing and formation. The surgical matrix is a novel resorbable carrier composed of rhCollagen and synthetic minerals which is intended to be charged with a bone morphogenetic protein for use as a bone graft substitute in bone repair indications such as spinal fusion and trauma. In May 2018, we filed a provisional patent application for photocurable dermal fillers comprising rhCollagen and hyaluronic acid, for the aesthetics market. This application represents an integral part of our strategy to expand the uses for rhCollagen into new, high value markets. The combination of hyaluronic acid, a naturally-occurring, moisture-binding compound, with our plant-based, tissue regenerating rhCollagen is intended to form the basis for a new dermal filler product line aimed at addressing the need for innovative aesthetic products to treat wrinkles. In August 2019, we announced that we are developing 3D bioprinted implants for regeneration of breast tissue and that we successfully produced first prototypes. Loaded with fat cells taken from the patient, these implants are intended to promote breast tissue regeneration. Eventually, the scaffold is designed to degrade and be replaced by newly grown natural breast tissue, that is free of any foreign material. Future Development To facilitate efficient development, our management holds regular research and development meetings where they prioritize development projects and determine future products. The prioritization process is based on several factors, including our business plan, commercial potential of the products, time to market, cost of development, feasibility of the project, and our established strategic objectives. We periodically examine the continued development of other collagen-based products that we have conceived. Each one of our current products offers a platform to product derivatives that can address other indications and contribute to our pipeline and revenues. Through ongoing research we are also pursuing other platforms for our rhCollagen, such as biomaterial coatings in order to reduce foreign body response and tissue adhesion. We intend to contribute our expertise to advance the entire science and industry of bioengineering and manufacturing. Manufacturing, Supply, and Production the majority of our product research and development work is carried out at our offices and research laboratories center in Weizmann Science Park in Rehovot, Israel. We work with subcontractors with greenhouses for growing the tobacco plant containing human collagen. This tobacco growth occurs year-round and is optimized to the climate conditions in order to achieve the maximum amount of the protein in the leaves. Each grower has the infrastructure that can be scaled-up to accommodate future demand without additional capital expenditures. We believe that we currently have the ability to produce sufficient quantities of quality recombinant type I human collagen to support our product development activities and sales until 2022.

This provides stability to the nated if the anterior surface of the sacrum faces to the right joint and is the close-packed position for the sacroiliac and left rotation if the anterior surface faces to the left human antibiotics for dogs ear infection discount sumycin 250mg online. In females infection 3 weeks after abortion purchase generic sumycin on line, the center of gravity is in the same this sacral torsion is produced by the piriformis muscle in plane as the sacrum antibiotic quotes order discount sumycin, but in males antibiotic young living essential oils sumycin 250mg cheap, the center of gravity a side-bending exercise of the trunk (129) antibiotic kinetics order 500 mg sumycin amex. Thus bacteria urine hpf cheap sumycin 500 mg with mastercard, in males, a greater load is placed in the case of asymmetrical movement such as standing on on the sacroiliac joint, which in turn creates a tighter and one leg, there can be asymmetrical movement at the sacromore stable joint (164). The sacrum also rotates to the right or left with lateral flexion of the trunk (not shown). Both anterior tilt and posterior tilt in an open-chain movement Right Right can substitute for hip extension and hip flexion, respectively. Left (C) and right (D) lateral tilt accompany weight the pelvis can also tilt laterally and naturally tries to bearing on the right and left limbs, respectively, or lateral movements move through a right lateral tilt when weight is supported of the thigh or trunk. In the closed-chain weight-bearing posiright rotation of the trunk, respectively, or unilateral leg movement. This movement is controlled by muscles, parand the ilium, there is movement of the pelvic girdle as a ticularly the gluteus medius, so that it is not pronounced whole. These movements, shown in Figure 6-5, accomunless the controlling muscles are weak. Thus, right and pany trunk and thigh movements to facilitate positionleft lateral tilts occur with weight bearing and any lateral ing of the hip joint and the lumbar vertebrae. One Giant Step for Humankind Movements of the pelvis are described by monitoring the ilium, specifically, the anterior superior, and anterior have a partner start with their left foot forward and inferior iliac spines on the front of the ilium. Does the chain weight-bearing movement, the pelvis moves about pelvis have any lateral tiltfi Why a fixed femur, and anterior tilt of the pelvis occurs when does it tilt in this directionfi As shown on the left, the hip abduction movement in the open chain occurs as the thigh moves up toward the pelvis. In the closed-chain movement shown on the right, abduction occurs as the pelvis lowers on the weight-bearing side. Finally, the pelvic girdle rotates to the left and right the acetabulum is the concave surface of the ball as unilateral leg movements take place. As the right limb and socket, facing anteriorly, laterally, and inferiorly swings forward in a walk, run, and kick, the pelvis rotates (118,132). The hip, which has 3 degrees of freedom (df), is a ballthe spherical head of the femur fits snugly into the and-socket joint consisting of the articulation between acetabular cavity, giving the joint both congruency and a the acetabulum on the pelvis and the head of the femur. Both the femoral head and the the structure of the hip joint and femur is illustrated in acetabulum have large amounts of spongy trabecular bone Figure 6-8. It is formed by the concave surface of the acetabulum on the pelvis and the Patellar surface Medial Medial large head of the femur. The head is also lined with articular the cortical layer is reinforced on the lower surface of cartilage that is thicker in the middle central portions the neck, where greater strength is required in response of the head, where most of the load is supported. Also, the medial femoral neck is cartilage on the head thins out at the edges, where the the portion responsible for withstanding ground reaction acetabular cartilage is thick (118). The lateral portion of the neck resists compression of the head of the femur articulates with the acetabulum forces created by the muscles (118). The shaft is very Surrounding the whole hip joint is a loose but strong narrow in the middle, where it is reinforced with the thickcapsule that is reinforced by ligaments and the tendon of est layer of cortical bone. Also, the shaft bows anteriorly to the psoas muscle and encapsulates the entire femoral head offer the optimal structure for sustaining and supporting and a good portion of the femoral neck. The iliofemoof the femoral neck with respect to the shaft of the femur ral ligament, or Y-ligament, is strong and supports the in the frontal plane. This angle is larger at birth by almost sion, external rotation, and some adduction (151). The angle of inclination is important the second ligament on the front of the hip joint, the because it determines the effectiveness of the hip abducpubofemoral ligament, primarily resists abduction, with tors, the length of the limb, and the forces imposed on the some resistance to external rotation and extension. This increase in the angle of moral ligament, on the posterior capsule, where it resists inclination lengthens the limb, reduces the effectiveness of extension, adduction, and internal rotation (151). None the hip abductors, increases the load on the femoral head, of the ligaments surrounding the hip joint resist during and decreases the stress on the femoral neck (151). The neck is formed by cancellous gives the hip abductors a mechanical advantage needed trabecular bone with a thin cortical layer for strength. When the angle is reduced in coxa vara, the limb is shortened and the abductors are more effective because of a longer moment arm resulting in less load on the femoral head but more load on the femoral neck. The coxa valgus position lengthens the limb, reduces the effectiveness of the abductors because of a shorter moment arm, increases the load on the femoral head, and decreases the load on the neck. Anteversion in the hip increases the toeing-in accompanying excessive femoral anteversion mechanical advantage of the gluteus maximus, making it is illustrated in Figure 6-12. If the angle of anteversion is reversed so the femoral neck moves posteriorly, it is termed retroversion. A position of instability for the hip joint is in flexion and adduction, as when the legs are crossed (74). Movement Characteristics the hip joint allows the thigh to move through a wide range of motion in three directions. These measurements are made with respect to a fixed axis and vary considerably if measured with respect to the pelvis (7). Also, if thigh extension is limited or impaired, compensatory joint actions at the knee or in the lumbar vertebrae accommodate the lack of hip extension. There is also usually an adaptation in the tibia that develops external tibial torsion to reorient the foot straight ahead. Excessive anteversion has also been associated with increased hip joint contact forces and higher bending moments (62) as well as higher patellofemoral joint contact pressures (121). If the angle of anteversion is reversed so that it moves posteriorly, it is termed retroversion. Retroversion creates an externally rotated gait, a supinated foot, and a decrease in the Q-angle (142). The hip is one of the most stable joints in the body because of powerful muscles, the shape of the bones, the labrum, and the strong capsule and ligaments (122). The hip is a stable joint even though the acetabulum is not deep enough to cover all of the femoral head. The acetabular labrum deepens the socket to increase stability, and the joint is in a close-packed position in full extension when the lower body is stabilized on the pelvis. In hip flexion movements in an freely with the knees flexed but is severely limited by the open chain (leg raise), the pelvis rotates posteriorly in hamstrings if the flexion occurs with knee extension (74). In a leg raise with the knees Extension is limited by the anterior capsule, the strong flexed or extended, 26% to 39% of the hip flexion motion hip flexors, and the iliofemoral ligament. Abduction is limited by the adductor muscles, age anterior tilt of the swing limb has been shown to be and adduction is limited by the tensor fascia latae muscle. The range of motion for In a closed-chain, weight-bearing, standing position, rotation at the hip can be enhanced by the position of the pelvis moves anteriorly on the femur, and pelvic the thigh. Both internal and external rotation ranges of motion during hip flexion has been shown to contribute motion can be increased by flexing the thigh (74). Posterior pelinternal and external rotations are limited by their antagovic motion in weight bearing contributes to hip extension. In the frontal plane, pelvic orientation is maintained or Range of motion in the hip joint is usually lower in older adjusted in response to single-limb weight bearing seen in age groups, but the difference is not that substantial and walking or running. The pelvis and the thigh commonly move together unless In the transverse plane during weight bearing, a rotathe trunk restrains pelvic activity. The coordinated movetion forward of the pelvis on one side creates lateral rotament between the pelvis and the hip joint is termed the tion on the front hip and medial rotation on the back hip. In sit-ups with the hips flexed and the feet held in Thigh flexion is used in walking and running to bring the place, the hip flexors are more active. It is also an important movement in climbing lifts result in much higher activity in the iliopsoas than stairs and walking uphill and is forcefully used in kicking. Little emphasis is placed on training the hip joint for flexthe rectus femoris is another hip flexor whose conion movements because most consider flexion at the hip tribution depends on knee joint positioning. However, hip flexion is a two-joint muscle because it acts as an extensor of the very important for sprinters, hurdlers, high jumpers, and knee joint as well. Elite athletes it is in maximal position for output at the hip during the in these activities usually have proportionally stronger hip preparatory phase of the kick, when the thigh is drawn flexors and abdominal muscles than do less skilled athletes. During the kicking action, the rectus femoris is very the strongest hip flexor is the iliopsoas muscle, which susceptible to injury and avulsion at its insertion site, the consists of the psoas major, psoas minor, and iliacus (142). Loss of function of the the iliopsoas is a two-joint muscle that acts on both the rectus femoris diminishes thigh flexion strength as much lumbar spine of the trunk and the thigh. If the thigh is fixed, the iliopsoas prothe sartorius is a two-joint muscle originating at the duces hyperextension of the lumbar vertebrae and flexion anterior superior iliac spine and crossing the knee joint to of the trunk. A combination of knee and hip joint muscles comprise the anterior thigh region (E, F). It is accompanied femoris, which is considered the workhorse of extension by the tensor fascia latae, which is generally an internal at the hip. During walking, however, the tensor fascia latae Because all of the hamstrings cross the knee joint, aids thigh flexion. The tensor fascia latae is considered a producing both flexion and rotation of the lower tibia, two-joint muscle because it attaches to the fibrous band of their effectiveness as hip extensors depends on positionfascia, the iliotibial band, running down the lateral thigh ing at the knee joint. With the knee joint extended, the and attaching across the knee joint on the lateral aspect of hamstrings are put on stretch for optimal action at the the proximal tibia. The iliopsoas muscle and tensor fascia latae pull the hamstrings also control the pelvis by pulling down the pelvis anteriorly. If either of these muscles is tight, on the ischial tuberosity, creating a posterior tilt of the pelvic torsion, pelvic instability, or a functional short leg pelvis. The extensors attach tributed to the extension movement in the weight-bearing to the pelvis and consequently play a major role in stabipositions. Loss of function in the hamstrings produces lizing the pelvis in the anterior and posterior directions. A 50% reducvigorous hip extension is needed, the gluteus maximus is tion in the function of the abductors results in a slight to recruited as a major contributor (151). If the ning up hills, climbing stairs, rising out of a deep squat, abductors are weak, there will be an excessive tilt in the sprinting, and rising from a chair. Additionally, the shear forces the gluteus maximus appears to dominate the pelvis across the sacroiliac joint will greatly increase, and the during gait rather than contribute significantly to the individual will walk with greater side-to-side sway. Because the thigh is almost the adductor muscle group works to bring the thigh extended during the walking cycle, the function of the across the body, as seen commonly in dance, soccer, gluteus maximus is more trunk extension and posterior gymnastics, and swimming. At foot strike when the trunk flexes, the abductors, also work to maintain the pelvic position durgluteus maximus prevents the trunk from pitching foring gait. Because the gluteus maximus also externally rotates cle mass, with all of the muscles originating on the pubic the thigh, internal rotation places the muscle on stretch. Although the Loss of function of the gluteus maximus muscle does not adductors are important in specific activities, it has been significantly impair the extension strength of the thigh shown that a 70% reduction in the function of the thigh because the hamstrings dominate the production of extenadductors results in only a slight or moderate impairment sion strength (95). Finally, because the flexors and extensors control the the adductor muscles include the gracilis, on the pelvis anteroposteriorly, it is important that they are balmedial side of the thigh; the adductor longus, on the anteanced in both strength and flexibility so that the pelvis is rior side of the thigh; the adductor brevis, in the middle not drawn forward or backward as a result of one group of the thigh; and the adductor magnus, on the posterior being stronger or less flexible. High in the groin is the pectineus, Abduction of the thigh is an important movement in previously discussed briefly in its role as hip flexor. During gait, the abducadductors are active during the swing phase of gait as they tion muscles are more important in their role as stabilizwork to swing the limb through (151), and if they are ers of the pelvis and thigh. The abductors can raise the tight, a scissors gait can result, leading to a crossover plant. When abduction occurs, such as in doing splits with the adductors on the opposite side to maintain pelon the ground, both hip joints displace the same number vic positioning and prevent tilting. As shown earlier, the of degrees in abduction, even though only one limb may abductors and adductors must be balanced in strength have moved. The relative angle between the thigh and the and flexibility so that the pelvis can be balanced side to trunk is the same in both hip joints in abduction because side. Figure 6-15 illustrates how imbalances in abduction of the pelvic shift in response to abduction initiated in one and adduction can tilt the pelvis.

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Archives of Physical Medicine and the Marathon: Physiological, Medical, Epidemiological, and Rehabilitation, 75:85-93. Muscle soreness during running: analysis of muscle forces in the shoulder mechanism during Biomechanical and physiological considerations. Effects of shoe type on cardiorespiraefficiency: movement pattern adaptations to speed changes. Journal of Electromyography & propulsion as a function of seat position and user-to-chair Kinesiology, 1:270-280. Kinematics was defined as the description of measurement, the unit for force is the newton (N), of motion with no regard to the cause of the motion. Forces are vector quantities that have both magnitude the point of application of a force is the specific point and direction. As presented in the discussion of kinematic at which the force is applied to an object. This is very vectors in Chapter 8, a single force vector may be resolved important because the point of application most often into perpendicular components, or several forces can be determines whether the resulting motion is linear or resolved into one vector. In many instances, a force is represented be calculated or composed to represent the net effect of all by a point of application at a specific point, although of the forces in the system. For example, force, the resultant force can be resolved into its horizonthe point of application of a muscular force is the center tal and vertical components. In many cases, the muscle is not attached Several types of force systems must be defined to comto a single point on the bone but is attached to many pose or resolve systems of multiple forces. Any system of points, such as in the case of the fan-shaped deltoid forces acting in a single plane is referred to as coplanar, muscle. In solving mechanical problems, however, it is and if they act at a single point, they are called concurrent. Other points Any set of concurrent coplanar forces may be substituted of application are the contact point between the foot and by a single force, or the resultant, producing the same the ground for activities such as jumping, walking, and effect as the multiple forces. The process of finding this running; hand contact with the ball for a baseball throw; single force is called composition of force vectors. In this case, vector addition is the line of action of a force is a straight line of infiused to compose the forces. Consider the force system in nite length in the direction in which the force is acting. The force vectors a, b, and c all act in the A force can be assumed to produce the same accelerasame direction and can be replaced by a single force, d, tion of the object if it acts anywhere along this line of which is the sum of a, b, and c. In Figure 10-2B, however, two of the line of action to this system is given as an angular the force vectors, a and b, are acting in one direction, but the position and is referred to as the angle of application. The force vector d still represents the net effect of these x 10 cos 45 force vectors. Graphically, this can be done in exactly the same y 6 sin 0 manner as described in Chapter 8 in the section on adding 6 0. The force vectors a and 0 b are not collinear, but they may be composed or added x 6 cos 0 to determine their net effect. The greater the mass function tangent is used: of an object, the greater its inertia and thus the greater the difficulty in moving it or changing its current motion. Therefore, the inertia of these objects would compel them to maintain their status at a constant velocity. Overcoming the inertia of such objects requires a net external force greater than the inertia of the object. If an object is subjected to an external force that can overthe publication of the Principia Mathematica in 1687 by come the inertia, the object will be accelerated. To get an Sir Isaac Newton (1642 to 1727) astounded the scientific object moving, the external force must positively accelercommunity of the day (14). On the other hand, to stop the object from his three laws of motion that we use to explain a number moving, the external force must negatively accelerate the of phenomena. His work has prothe change of motion is proportional to the force vided the link between cause and effect. To fully underimpressed and is made in the direction of the straight line stand the underlying nature of motion, it is necessary to in which that force is impressed (14). This relationship is or, the mutual actions of two bodies upon each other are expressed as: always equal and directed to contrary parts. When two objects interact, the force this equation can also be used to define the unit of exerted by object A on object B is counteracted by a force force, the newton. By substituting the units for mass and equal and opposite exerted by object B on object A. These acceleration in the right-hand side, it can be seen that: forces are equal in magnitude but opposite in direction. The is the net force acting on the object in question, that is, result is that these two forces cannot cancel each other the sum of all of the forces involved. For example, a person landing from a jump sary to take the direction of the forces into account. If exerts a force on the earth, and the earth exerts an equal the forces exactly counteract each other, the net force is and opposite force on the person. If the sum of the forces is zero, the acceleration will more massive than the individual, the effect on the indialso be zero. If the net force produces acceleration, the accelerated illustrates that although the force and the counterforce are object will travel in a straight line along the line of action equal, they may not necessarily have comparable results. Acceleration was previously the jumper makes contact with the ground and generates defined as the time rate of change of velocity, or a large downward force because of the acceleration of the dv/dt. Substituting this expression into the equation of body combined with forces generated by body segments the second law: at contact, and a resulting reaction force upward controls dv the landing. F m dt or types of Forces mdv F dt the forces that exist in nature and affect the way humans the product of mass and velocity in the numerator move may be classified in a number of ways. The most of the right-hand side of this equation is known as the common classification scheme is to describe forces as conmomentum of an object. It is generally represented by the letter p and has units of kilogram-meters per second. To change the momentum of an object, an external force must be applied to the object. The momentum may increase or decrease, but in either case, an external force is required. As implied Because weight is a force, it has the attributes of a by the name, these are forces that are exerted by objects force. As a vector, it has a line of action and a point of that are not in direct contact with one another and may application. In the investigation of human movement, the most the point of origin of the weight vector is called the familiar and important noncontact force is gravity. They differ in that the center of gravidentified gravity as the force that causes objects to fall to ity refers only to the vertical direction because that is the the earth, the moon to orbit the earth, and the planets to direction in which gravity acts, but the center of mass does revolve about the sun. The computation of ity is inversely proportional to the square of the distance both the center of mass and the center of gravity is prebetween attracting objects and proportional to the prodsented in Chapter 11. Thus, the points 1 one object, m is mass of the other object, and r is the on the earth are not all equidistant from its center, and 2 distance between the mass centers of the objects. Another factor influencing the value of small size to another object of similar size is extremely g is altitude. The higher the altitude, the lower the value small and therefore can be neglected. If one were weighing oneself and a minimal weight the objects of most concern are the earth, the human were desired, the optimum place for the weigh-in would body, and projectiles. This is stated as: Because contact forces are those resulting from a direct Gmobject Mearth interaction of two objects, the number of such forces W Fg 2 r is considerably greater than the single noncontact force the force of gravity causes an object to accelerate discussed. W = ma where m is the mass of the individual and a is the acceleraGround Reaction Force tion due to gravity. This is the reaction W = mg force provided by the surface upon which one is moving. All surfaces on which an individual interacts chapter 10 Linear Kinetics 353 provide a reaction force. These components are orthogonal to each other along a three-dimensional coordinate system. In the reporting of three-dimensional data, however, some researchers label the axes as Fy (vertical), Fx (anteroposterior), and Fz (mediolateral). The former surface flush with the surface of the ground, on which the convention is used in this book because it is the most individual performs. This device measures the forces of the foot Regardless of the convention used, the anteroposterior and on the performing surface or the force of an individual mediolateral components are referred to as shear compojust standing on the platform. Force platforms have been nents because they act parallel to the surface of the ground. Locate the maximum vertical (Fz), anteroposterior (Fy), and mediolateral (Fx) forces (n). Most studies, however, have dealt with the load or impact on the body during landings, either from jumps or during support phase of gait. The origin of the force platform phase of running (17,19), walking (36), and landings coordinate system is at the center of the platform. Only the vertical component is presented component to the function of the foot during landings. Generally, the second peak is In many instances in biomechanical analyses, segments are greater than the first peak. Some individuals, however, examined, either singly or one at a time in a logical order. In most analyses, the magnitude of all masses of the segments times the acceleration due to of this force is unknown, but it can be calculated given gravity. That is, the sum of the product of the masses and the appropriate kinematic and kinetic data, in addition to accelerations of each segment. Dividing force is the force of the distal bony surface of one segment a force by the mass, the result would be acceleration. The actual fiF = ma bone-on-bone force is the sum of the actively contracting muscle forces pulling the joint together and the joint Dividing both sides of the equation by body mass (m): reaction force. At some point, however, the force is sufficiently large and the static fricFriction tion force cannot prevent the movement of the block. This Friction is a force that acts parallel to the interface of two relationship simply means that if a block weighing 750 N surfaces that are in contact during the motion or impendis standing on a surface with ms of 0.

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