A user-friendly system for identifying the optimal insertion direction and to choose the best pedicle screws for patient-specific spine surgery

Background and objective

Many diseases of the spine require surgical treatments that are currently performed based on the experience of the surgeon. The basis of this study is to deliver an automatic and patient-specific algorithm able to come to the aid of the surgeons in pedicle arthrodesis operations, by finding the optimal direction of the screw insertion, the maximum screw diameter and the maximum screw length.

Results

The paper introduce an algorithm based on the reconstructed geometry of a vertebra by 3D-scan that is able to identify the best introduction direction for screw and to select, from commercial and/or personalised databases, the best screws in order to maximize the occupation of the bone while not intersecting each other and not going through the walls of the pedicle and the bounds of the vertebral body. In fact, for pedicle arthrodesis surgery, the incorrect positioning of the screws may cause operating failures, an increase in the overall duration of surgery and, therefore, more harmful, real-time X-ray checks. In case of not availability on market, the algorithm also suggests parameters for designing and manufacturing an 'ad hoc' solution. The algorithm has been tested on 6 vertebras extracted by a medical database. Furthermore, the algorithm is based on a procedure through which the surgeon can freely choose the entering point of the screw (based on his/her own experience and will). A real patient vertebra has been processed with almost 400 different entering point, always giving a feedback on the possibility to use the entering point (in case of unavailability of a good trajectory) and on the individuation of the right trajectory and the choose of the better screws.

Conclusions

In very recent bibliography, several papers deal with procedure to screw' trajectory planning in arthrodesis surgery by using Computer Aided surgery systems, and some of them used also modern methodologies (KBE, AI, Deep learning, etc.) methods for planning the surgery as better as possible. Nevertheless, no methodologies or algorithm have been still realized to plan the trajectory and choose the perfect fitting screws on the basis of the patient-specific vertebra. This paper represents a wind of novelty in this field and allow surgeons to use the proposed algorithm for planning their surgeries. Finally, it allows also the easy creation of a customized surgical template, characterized by two cylindrical guides that follow a correct trajectory previously calculated by means of that automatic algorithm generated on the basis of a vertebra CAD model for a specific patient. The surgeon will be able to set the template (drilling guides) on the patient's vertebra and safely apply the screws.

A body-shaped lumbar-sacral support for improving car-seat comfort

BACKGROUND

Nowadays, the ergonomic study of the driving position is a critical aspect of automotive design. Indeed, due to the rising needs on the market, one focus for car industries is to improve the perceived comfort related to the cars' interior. Driving a car for a prolonged time could cause complaints in some body-regions, especially in the lumbar-sacral area. Thus, special lumbar-sacral supports for driver seat has been proposed for reducing this kind of complaints.

OBJECTIVE

Development of two virtual and physical models of lumbar-sacral support for improving both the lumbar/sacral and overall perceived comfort while driving.

METHODS

Two prototypes of lumbar/sacral support have been realized: the first one was integrated into the seat, and the second one was shaped as a removable pillow (removable support). Fifty participants were asked to rate the perceived comfort in lab tests performed on a seating-buck by comparing three configurations (5 min each): a standard seat, seat with the removable support, seat with integrated support. Subjective data (by questionnaires) and objective data (interface pressure between backrest and driver) have been acquired and statistically processed. In addition, real driving tests have been performed to test the actual performance of the removable support in term of perceived comfort comparing it with the standard seat.

RESULTS

Statistical correlations between subjective and objective data showed interesting results in comfort improvement through the adopted solutions. Real driving tests showed an improvement in comfort perception with the lumbar-sacral support towards the standard seat.

CONCLUSIONS

Thanks to the virtual prototyping and the application of previous knowledge, coming from literature and experience, a solution for improving the overall comfort and reduce the lumbar/sacral pain while driving has been developed, tested, and assessed.

Identifying factors that influenced wellbeing and learning effectiveness during the sudden transition into eLearning due to the COVID-19 lockdown

BACKGROUND

The sanitary emergency due to COVID-19 virus obliged people to face up several changes in their everyday life becauseWorld Health Organisation (WHO) guidelines and countries' Health Systems imposed lockdown of activities and social distancing to flatten the infection curve. One of these rapid changes involved students and professors that had to turn the traditional "in presence" classes into online courses facing several problems for educational delivery.

OBJECTIVES

This work aimed to investigate the factors that affected both teaching/learning effectiveness and general human comfort and wellbeing after the sudden transition from classrooms to eLearning platforms due to COVID-19 in Italy.

METHODS

A workshop, involving students and experts of Human Factors and Ergonomics, has been performed to identify aspects/factors that could influence online learning. Then, from workshop output and literature studies, a survey composed of two questionnaires (one for students and one for teachers) has been developed and spread out among Italian universities students and professors.

RESULTS

700 people answered the questionnaires. Data have been analysed and discussed to define the most important changes due to the new eLearning approach. Absence of interactions with colleagues and the necessity to use several devices were some of the aspects coming out from questionnaires.

CONCLUSIONS

The study shows an overview of factors influencing both teaching/learning effectiveness and general human comfort and wellbeing. Results could be considered as a basis for future investigation and optimization about the dependencies and correlations among identified factors and the characteristics of the products/interaction/environment during eLearning courses.

Introduction to the special issue on comfort: A review of 26 papers from the International Comfort Congress 2019

Various aspects related to comfort are described in this special issue. Some papers are focused on the environment, like smell, temperature, light, acoustics, space and some on an artefact touching the human, like the floor angle, the seat, a bed and light. However, in this special issue also topics like modelling and behavior get more attention.

A method for postural critical factors checking: The case of library chairs

BACKGROUND

According to ergonomic researches regarding a good sitting posture, it is essential to ensure a natural back-curve in order to prevent musculoskeletal disorders. A brief observation among the Scientific Technology Library inside the University of Salerno showed that students used to complain about neck and lumbar pain, especially after a study day.

OBJECTIVE

On the light of this background, a sitting posture comfort analysis had been performed on chairs inside the library to check the critical factors that influence the postural comfort and, consequently, the learning.

METHODS

A prolonged sitting posture, that is common during the daily study activity, had been simulated with fifteen volunteer students performing 1-hour tests (divided into four 15-minutes tasks). Subjective perceptions had been gathered through questionnaires rating on a 5-point Comfort scale, both the expected comfort at the beginning of the experiment and the Localized Postural Comfort at the end of each task have been investigated. Then, postural angles had been gathered through photographic acquisition and Kinovea®. CaMAN software had been used to calculate the objective (dis)comfort indexes. Finally, subjective and objective data had been statistically processed and compared.

RESULTS

Lumbar area scored the lowest perceived comfort while the perceived comfort was independent of participants and tasks, but dependent on time.

CONCLUSIONS

After this comfort-driven analysis, critical factors of the chair-design were checked, and a proposal for a future re-design was hypothesized.

PCQ: Preferred Comfort Questionnaires for product design

BACKGROUND:

Selecting the most suitable questionnaire(s) in comfort research for product design is always a challenge, even for experienced researchers.

OBJECTIVE:

The objective of this research is to create a list of Preferred Comfort Questionnaires (PCQ) for product design to help researchers in the selection of questionnaires for comfort research.

METHODS:

Fifteen questionnaires that are often used in comfort research for product design were selected as candidate questionnaires. During the Second International Comfort Congress (ICC 2019), 55 researchers and practitioners working in the field of comfort joined together in a workshop to rate these questionnaires individually as well as rank them in groups based on their experience. The criteria of rating and ranking included easiness to answer, easiness for data interpretation, time needed to complete, the need for prior training, as well as mapping the applicable design phases and field of application.

RESULTS:

The elicited responses related to each questionnaire were analyzed. For comfort research in five proposed application fields and four design phases, the preferred questionnaires were highlighted and categorized into four categories: preferred questionnaire, suitable for less prior training, suitable for fast completion and generally applicable, which led to a list of PCQ for product design.

CONCLUSION:

We expect that the PCQ list can be used as a useful instrument to help researchers in selecting questionnaires for comfort research in product design.

Comfort driven design of innovative products: A personalized mattress case study

BACKGROUND

Human-centred design asks for wellbeing and comfort of the customer/worker when interacting with a product. Having a good perception-model and an objective method to evaluate the experienced (dis)comfort by the product user is needed for performing a preventive comfort evaluation as early as possible in the product development plan. The mattress of a bed is a typical product whose relevance in everyday life of people is under-evaluated. Fortunately, this behaviour is quickly changing, and the customer wants to understand the product he/she buys and asks for more comfortable and for scientifically assessed products. No guidelines for designing a personalized mattress are available in the literature.

OBJECTIVES

This study deals with the experience of designing an innovative product whose product-development-plan is focused on the customer perceived comfort: a personalized mattress. The research question is: which method can be used to innovate or create a comfort-driven human-centred product?

METHODS

Virtual prototyping was used to develop a correlated numerical model of the mattress. A comfort model for preventively assessing the perceived comfort was proposed and experimentally tested. Mattress testing sessions with subjects were organized, and collected data were compared with already tested mattresses. Brainstorming and multi-expert methods were used to propose, realize, and test an archetype of a new mattress for final comfort assessment.

RESULTS

A new reconfigurable mattress was developed, resulting in two patents. The mattress design shows that personalized products can be tuned according to the anthropometric data of the customer in order to improve the comfort experience during sleep.

CONCLUSIONS

A "comfort-driven design guideline" was proposed; this method has been based on the use of virtual prototyping, virtual optimization and physical prototyping and testing. It allowed to improve an existing product in a better way and to bring innovation in it.

School combo-desk comfort assessment: A method for weighing postural factors that affect the overall perceived comfort

BACKGROUND

In recent years, a growing interest in ergonomics and comfort perception in secondary schools and universities can be detected, to go beyond the UNI-EN regulations and understanding how practically improve students' perceived comfort during lessons.

OBJECTIVE

This study aimed to analyse the (dis)comfort perceived by students while sitting in a combo-desk during lessons; it proposed a method for understanding and weighing the influence of postural factors on overall (dis)comfort.

METHODS

Twenty healthy students performed a random combination of three different tasks in two sessions - listening, reading on a tablet and writing. Subjective perceptions were investigated through questionnaires, in which the expected and the overall comfort were evaluated; postural angles were gathered by processing photos through Kinovea® software and were used for the virtual-postural analysis, using a DHM (Digital Human Modelling) software; statistical analysis was used to investigate the influence of subjective comfort of each body part on the overall perceived comfort.

RESULTS

The statistical correlations were used to perform an optimization problem in order to create a general law to formulate the overall comfort function, for each task, as a weighted sum of the comfort perceived in each body part. The test procedure, additionally, evaluated the influence on comfort over time. The results showed how the upper back and the task-related upper limb are the most influencing factors in the overall comfort perception.

CONCLUSIONS

The paper revealed a precise and straightforward analysis method that can be easily repeated for other design applications. Obtained results can suggest to designers easy solution to re-design the combo-desk.

Integrating and applying models of comfort

This paper gives an overview of the relevance of the comfort concept, its definitions, boundary conditions, and stakeholders. Current comfort theories are presented and reflected on, both in their applicability and testing methodology. Questionnaires commonly used to study comfort and discomfort are also reviewed. An example of a comfort lab is introduced in its functionality and tools, which can be useful as a benchmark for others studying comfort.

Future vehicles: the effect of seat configuration on posture and quality of conversation

The percentage of passengers that prefer travelling in groups is increasing. In most vehicles, passengers sit side by side and need to turn their body to be engaged in the conversation with their fellow travellers. However, rotating the body could lead to discomfort which influences conversation quality. The aim of this research is to study the effect of seat configuration on the (dis)comfort experience, conversation quality and posture. Experiments in which participants were asked to talk to each other while sitting at the same distance (1 m) were conducted in four seating arrangements (with seat-belts on), where the angle between the forward directions of two seats were positioned at 0° (side by side), 22.5°, 90° and 120° (almost opposite each other), respectively. Optical tracking has been deployed and the collected data were processed with MatLab^® to acquire postural angles over time. Questionnaires were also used to evaluate the perceived (dis)comfort and the quality of the conversation. Experiment results indicate that the 120° configuration scored the best in the overall comfort and the quality of conversation, but only slightly better than the 90° configuration. Practitioner summary: Seating side by side is not optimal to have a comfortable conversation with your seatmate. To improve comfort and quality of conversation in future vehicles, we tested four seating arrangements analysing the effect of seat layout on (dis)comfort experience. Statistical analysis of objective and subjective data shows the optimal configuration for a comfortable conversation. Abbreviation: LPD: localized postural discomfort; PDF: probability density function; OCRA: occupational repetitive action.

Neck posture and muscle activity in a reclined business class aircraft seat watching IFE with and without head support

The purpose of this study is to research if a headrest benefits the comfort of the passenger and lowers muscle activity in the neck when sitting in a reclined (slouched) posture while watching in flight entertainment (IFE) in an aircraft business class seat. No significant differences in muscle activity in the musculus sternocleidomastoid and musculus trapezius pars descendant were found between the conditions with headrest and without headrest. A significant difference in expected comfort rating was found. Subjects indicated they expect to experience more comfort with a headrest when watching IFE for a duration of two movies during a long-haul flight. This study also found a significant difference in posture. In the condition without headrest the head was more upright compared to the condition with headrest. The lack of significant difference in muscle activity and the significant difference in posture may indicate that humans tend to look for a head position that is neutral, in the sense of minimal muscle effort. This study shows that the use of a headrest may benefit the comfort experience of the passenger during flight. However, further research is necessary on the design of the headrest and the long-term effects of head support on comfort, discomfort, muscle activity and fatigue for watching IFE in a slouched posture.

Towards comfortable communication in future vehicles

This research aims to study the effect of seat and/or backrest rotation on comfort and quality of conversation. Different sitting arrangements were tested to study the effect of the seat layout on: 1) (dis)comfort experience; 2) conversation quality and 3) postures. Two seats were arranged in different angles (0°, 45°, 90°, and 180°) at the same distance (1 m) and participants were asked to talk to each other. The participants' postures were acquired by using cameras and markers on the participants' body. Questionnaires were used to rate the perceived (dis)comfort and quality of conversation. Results show that 90° configuration scored the best both in overall comfort and quality of conversation; while the 0° configuration scored the lowest in both ratings. A strong correlation was established between high comfort and good quality of conversation.

Assessment of ranges of rest postures of human lower limbs

BACKGROUND

Several comfort perception models have proposed an objective method to evaluate "effects in the internal body" and "perceived comfort". Postural comfort is one aspect of comfort/discomfort perception, and this current work adds to existing knowledge toward a more objectified posture evaluation for comfort.

OBJECTIVE

The authors have used the concept of Range of Rest Posture (RRP), as proposed by Apostolico et al. The study focused on the identification of RRP within the Comfort Range of Motion (CROM) for lower limbs.

METHODS

The proposed method is based on extensive experimental work involving 114 healthy individuals (59 males and 55 females) ranging from 20 to 40 years old. The age range was narrowed to avoid an age-clustering of results due to inhomogeneity of the statistical sample. Data were processed using statistical methods for identifying the RRP in the experimental CROM. Several Maximum Level of Comfort (MLC) positions were found within the RRP.

RESULTS

RRPs for lower limbs of men and women have been identified and can be used for virtual comfort assessment.

CONCLUSIONS

This paper shows a method to evaluate in a more objective way the subjective postural comfort perception and results allow researchers to improve models for the virtual preventive comfort assessment.

The effect of spine discomfort on the overall postural (dis)comfort

Currently, the word 'comfort' is often used in relation to the marketing of products such as chairs, cars interiors, clothing, hand tools and even airplane tickets. In this field of research, the aim of this study is to investigate the influence of spinal posture on postural (dis)comfort perception; the test case is the analysis of the interaction between humans and vending machines for purchasing food or beverages. A statistical sample of 20 healthy students (subjects) performed the required tests, with each participant asked to take a product from three different vending machines (snacks, drinks and coffee). The subjects' postures were acquired non-invasively using cameras; software and instruments for virtual prototyping were used for posture analysis and interaction modelling, both questionnaires (subjective) and comfort-analysis software (objective) were used to rate the perceived (dis)comfort. The results obtained from simulations and questionnaires were compared, and a method to weigh the effect of the perceived spinal discomfort on overall postural (dis)comfort was proposed. These results reveal a good correlation between subjective perception and objective evaluation obtained through simulations, confirming the validity of the proposed method.

A study of classroom seat (dis)comfort: Relationships between body movements, center of pressure on the seat, and lower limbs' sensations

The aim of this work is to define a new method that helps researchers to analyze perceptions of (dis)comfort in dynamic conditions. Recent studies pay considerable attention to body movements, mobility, and stability to measure comfort or discomfort when seated. Most of these discuss the relations between subjective comfort/discomfort and objective measurements (e.g. body pressure distribution, body movement and EMG) for short- and medium-term sitting. The present analysis took place in a classroom of the Industrial Engineering Department at the University of Salerno. The participants included 25 students (12 females and 13 males), who were observed during classroom hours. The students were invited to sit at a combo-desk and were free to perform different combinations of movements while writing and listening. These activities required that they adapt their body movements, as the combo-desk was fixed to the floor. A pressure pad was used to detect pressure at interface and center of pressure's changes, allowing for the bodies' motion data to be recorded. The aim was to identify the correct threshold to be used for movement detection and to investigate correlations between the number of movements and the perceived (dis)comfort. The study also identifies those body parts that have the greatest effect on (dis)comfort perception.

Effect of in-seat exercising on comfort perception of airplane passengers

Sitting still for extended periods of time can lead to physical discomfort and even serious health risks. Due to safety regulations, reducing passenger' sitting time in aircrafts is not feasible. This paper presents the results of a laboratory study, in where an interactive airplane seat was compared with a current economy class seat. Participants used both seats for 3.5 h, and performed significantly more in-seat movements when using the interactive seating system. Furthermore, this interactive seat predominantly lead to significantly better comfort experiences and reduced discomfort experiences, however no significant differences have been found in self-reported localized musculoskeletal discomfort. Passengers indicated that they would prefer this interactive seat over a standard aircraft seat.

The effect of human-mattress interface's temperature on perceived thermal comfort

In recent years, methods that allow for an objective evaluation of perceived comfort, in terms of postural, physiological, cognitive and environmental comfort, have received a great deal of attention from researchers. This paper focuses on one of the factors that influences physiological comfort perception: the temperature difference between users and the objects with which they interact. The first aim is to create a measuring system that does not affect the perceived comfort during the temperatures' acquisition. The main aim is to evaluate how the temperature at the human-mattress interface can affect the level of perceived comfort. A foam mattress has been used for testing in order to take into account the entire back part of the human body. The temperature at the interface was registered by fourteen 100 Ohm Platinum RTDs (Resistance Temperature Detectors) placed on the mattress under the trunk, the shoulders, the buttocks, the legs, the thighs, the arms and the forearms of the test subject. 29 subjects participated in a comfort test in a humidity controlled environment. The test protocol involved: dress-code, anthropometric-based positioning on mattress, environment temperature measuring and an acclimatization time before the test. At the end of each test, each of the test subject's thermal sensations and the level of comfort perception were evaluated using the ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers) scale. The data analyses concerned, in the first instance, correlations between the temperature at the interface and comfort levels of the different parts of the body. Then the same analyses were performed independently of the body parts being considered. The results demonstrated that there was no strong correlation among the studied variables and that the total increase of temperature at interface is associated with a reduction in comfort.

FEM modeling of the reinforcement mechanism of Hydroxyapatite in PLLA scaffolds produced by supercritical drying, for Tissue Engineering applications

Scaffolds have been produced by supercritical CO2 drying of Poly-L-Lactid Acid (PLLA) gels loaded with micrometric fructose particles used as porogens. These structures show a microporous architecture generated by the voids left in the solid material by porogen leaching, while they maintain the nanostructure of the gel, consisting of a network of nanofilaments. These scaffolds have also been loaded with Hydroxyapatite (HA) nanoparticles, from 10 to 50% w/w with respect to the polymer, to improve the mechanical properties of the PLLA structure. Based on miscroscopic and mechanical considerations, we propose a parametric Finite Element Method (FEM) model of PLLA-HA composites that describes the microporous structure as a close-packing of equal spheres and the nanoscale structure as a space frame of isotropic curved fibers. The effect of HA on the mechanical properties of the scaffolds has been modeled on the basis of SEM images and by taking into consideration the formation of concentric cylinders of HA nanoparticles around PLLA nanofibers. Modeling analysis confirms that mechanical properties of these scaffolds depend on nanofibrous network connections and that bending is the major factor causing deformation of the network. The FEM model also takes into account the formation of HA multi-layer coating on some areas in the nanofiber network and its increase in thickness with HA percentage. The Young modulus tends to a plateau for HA percentages larger than 30% w/w and when the coverage of the nanofibers produced by HA nanoparticles reaches a loaded surface index of 0.14 in the FEM model.