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The objective of this study was to evaluate three passive upper-extremity exoskeletons relative to a control condition. Twelve subjects performed an hour-long, simulated occupational task in a laboratory setting. Independent measures of exoskeleton, exertion height (overhead, head height), time, and their interactions were assessed. Dependent measures included changes in tissue oxygenation (ΔTSI) in the anterior deltoid and middle trapezius, peak resultant lumbar spine loading, and subjective discomfort in various body regions. A statistically significant reduction in ΔTSI between exoskeleton and control was only observed in one instance. Additionally, neither increases in spinal loading nor increases in subjective discomfort ratings were observed for any of the exoskeletons. Ultimately, the exoskeletons offered little to no physiological benefit for the conditions tested. However, the experimental task was not highly fatiguing to the subjects, denoted by low ΔTSI values across conditions. Results may vary for tasks requiring constant arm elevation or higher force demands. Practitioner summary This study quantified the benefits of upper-extremity exoskeletons using NIRS, complementary to prior studies using EMG. The exoskeletons offered little to no physiological benefit for the conditions tested. However, the experimental task was not highly fatiguing, and results may vary for an experimental task with greater demand on the shoulders. Abbreviations: WMSD: work-related musculoskeletal disorder; EMG: electromyography; NIRS: near-infrared spectroscopy; NIR: near-infrared; Hb: haemoglobin; Mb: myoglobin; TSI: tissue saturation index; ATT: adipose tissue thickness.

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BACKGROUND: In spite of the prevalence of occupational neck disorders as a result of work force fluctuating from industry to sedentary office work, most cervical spine computational models are not capable of simulating occupational and daily living activities whereas majority of cervical spine models specialized to simulate crash and impact scenarios. Therefore, estimating spine tissue loads accurately to quantify the risk of neck disorders in occupational environments within those models is not possible due to the lack of muscle models, dynamic simulation and passive spine structures. METHODS: In this effort the structure, logic, and validation process of an electromyography-assisted cervical biomechanical model that is capable of estimating neck loading under three-dimensional complex motions is described. The developed model was designed to simulate complex dynamic motions similar to work place exposure. Curved muscle geometry, personalized muscle force parameters, and separate passive and (electromyography-driven) active muscle force components are implemented in this model. FINDINGS: Calibration algorithms were able to reverse-engineer personalized muscle properties to calculate active and passive muscle forces of each individual. INTERPRETATION: This electromyography-assisted cervical spine model with curved muscle model is capable to accurately predict spinal tissue loads during isometric and dynamic head and neck activities. Personalized active and passive muscle force algorithms will help to more robustly investigate person-specific muscle forces and spinal tissue loads.

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BACKGROUND: As the work load has been shifting from heavy manufacturing to office work, neck disorders are increasing. However, most of the current cervical spine biomechanical models were created to simulate crash situations. Therefore, the biomechanics of cervical spine during daily living and occupational activities remain unknown. In this effort, cervical spine biomechanical models were systematically reviewed based upon different features including approach, biomechanical properties, and validation methods. METHODS: The objective of this review was to systematically categorize cervical spine models and compare the underlying logic in order to identify voids in the literature. FINDINGS: Twenty-two models met our selection criteria and revealed several trends: 1) The multi-body dynamics modeling approach, equipped for simulating impact situations were the most common technique; 2) Straight muscle lines of action, inverse dynamic/optimization muscle force calculation, Hill-type muscle model with only active component were typically used in the majority of neck models; and 3) Several models have attempted to validate their results by comparing their approach with previous studies, but mostly were unable to provide task-specific validation. INTERPRETATION: EMG-driven dynamic model for simulating occupational activities, with accurate muscle geometry and force representation, and person- or task-specific validation of the model would be necessary to improve model fidelity.

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The importance of surface-EMG placement for development and interpretation of EMG-assisted biomechanical models is well established. Since MR has become a reliable noninvasive cervical spine musculoskeletal diagnostic tool, this investigation attempted to illustrate the anatomical relationships of individual cervical spine muscles with their paired surface-EMG electrodes. The secondary purpose of this investigation was to provide an MR cross-sectional pictorial and descriptive guideline of the cervical spine musculature. MR scans were performed on a healthy adult male subject from skull to manubrium of the sternum. Prior to scanning, MR safe markers were placed over neck muscles following surface EMG placement recommendations. Twenty-three neck muscles were traced manually in each of 267 scan slices. 3-D models of the neck musculoskeletal structure were constructed to aid with understanding the complex anatomy of the region as well as to identify correct EMG electrode locations and to identify muscles' curved lines-of-action. 3D models of the MR-safe markers were constructed relative to the target muscles. Based on the findings of this study, muscle palpation and bony landmarks can be used to effectively identify appropriate surface EMG electrode locations to record upper trapezius, middle trapezius, semispinalis capitis, splenius capitis, levator scapulae, scalenus, sternocleidomastoid and hyoid muscles activities.

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The objective of this study was to investigate biomechanical loading to the low back as a result of wearing an exoskeletal intervention designed to assist in occupational work. Twelve subjects simulated the use of two powered hand tools with and without the use of a Steadicam vest with an articulation tool support arm in a laboratory environment. Dependent measures of peak and mean muscle forces in ten trunk muscles and peak and mean spinal loads were examined utilizing a dynamic electromyography-assisted spine model. The exoskeletal device increased both peak and mean muscle forces in the torso extensor muscles (p < 0.001). Peak and mean compressive spinal loads were also increased up to 52.5% and 56.8%, respectively, for the exoskeleton condition relative to the control condition (p < 0.001). The results of this study highlight the need to design exoskeletal interventions while anticipating how mechanical loads might be shifted or transferred with their use.

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Background: The number of studies available on the performance of on-site medical waste treatment facilities is rare, to date. The aim of this study was to evaluate the performance of onsite medical waste treatment equipment in hospitals of Tabriz, Iran. Methods: A various range of the on-site medical waste disinfection equipment (autoclave, chemical disinfection, hydroclave, and dry thermal treatment) was considered to select 10 out of 22 hospitals in Tabriz to be included in the survey. The apparatus were monitored mechanically, chemically, and biologically for a six months period in all of the selected hospitals. Results: The results of the chemical monitoring (Bowie-Dick tests) indicated that 38.9% of the inspected autoclaves had operational problems in pre-vacuum, air leaks, inadequate steam penetration into the waste, and/or vacuum pump. The biological indicators revealed that about 55.55% of the samples were positive. The most of applied devices were not suitable for treating anatomical, pharmaceutical, cytotoxic, and chemical waste. Conclusion: Although on-site medical waste treating facilities have been installed in all the hospitals, the most of infectious-hazardous medical waste generated in the hospitals were deposited into a municipal solid waste landfill, without enough disinfection. The responsible authorities should stringently inspect and evaluate the operation of on-site medical waste treating equipment. An advanced off-site central facility with multi-treatment and disinfection equipment and enough capacity is recommended as an alternative.

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Freeze-drying is extensively used for fabrication of porous materials in tissue engineering and biomedical applications, due to its versatility and use of no toxic solvent. However, it has some significant drawbacks. Conventional freeze-drying technique leads to the production of heterogeneous porous structures with side orientated columnar pores. As the top and bottom surfaces of the sample are not in contact with similar environments, different rates of heat transfer in the surfaces and the temperature gradient across the sample establish the preferential direction of heat transfer. To achieve a scaffold with a desirable microstructure for skin tissue engineering, freeze-drying method was modified by controlling the rate of cooling and regulation of heat transfer across the sample during the freezing step. It could create a homogeneous porous structure with more equiaxed non-oriented pores. Freezing the polymeric solution in the aluminum mold enhanced pore interconnectivity relative to the polystyrene mold. Recrystallization process was discussed how to influence the mean pore size of the scaffold when the final freezing temperature varied. Higher final freezing temperature can easily provide the energy required for the recrystallization process, which lead to enlarged ice crystals and resulting pores.

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PURPOSE: Reproducing the femoral rollback through specially designed mechanism in knee implants is required to achieve full knee function in total knee arthroplasty. Most contemporary implants use cam/post mechanism to replace the function of Posterior Cruciate Ligament. This study was aimed to determine the most appropriate cam and post designs to produce normal femoral rollback of the knee. METHODS: Three different cams (triangle, ellipse, and circle) and three different posts (straight, convex, concave) geometries were considered in this study and were analysed using kinematic analyses. Femoral rollback did not occur until reaching 50° of knee flexion. Beyond this angle, two of the nine combinations demonstrate poor knee flexion and were eliminated from the study. RESULTS: The combination of circle cam with concave post, straight post and convex post showed 15.6, 15.9 and 16.1 mm posterior translation of the femur, respectively. The use of ellipse cam with convex post and straight post demonstrated a 15.3 and 14.9 mm femoral rollback, whilst the combination of triangle cam with convex post and straight post showed 16.1 and 15.8 mm femoral rollback, respectively. CONCLUSION: The present study demonstrates that the use of circle cam and convex post created the best femoral rollback effect which in turn produces the highest amount of knee flexion. The findings of the study suggest that if the design is applied for knee implants, superior knee flexion may be possible for future patients. LEVEL OF EVIDENCE: IV.

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Posterior instrumentation is a common fixation method used to treat thoracolumbar burst fractures. However, the role of different cross-link configurations in improving fixation stability in these fractures has not been established. A 3D finite element model of T11-L3 was used to investigate the biomechanical behavior of short (2 level) and long (4 level) segmental spine pedicle screw fixation with various cross-links to treat a hypothetical L1 vertebra burst fracture. Three types of cross-link configurations with an applied moment of 7.5 Nm and 200 N axial force were evaluated. The long construct was stiffer than the short construct irrespective of whether the cross-links were used (p < 0.05). The short constructs showed no significant differences between the cross-link configurations. The XL cross-link provided the highest stiffness and was 14.9% stiffer than the one without a cross-link. The long construct resulted in reduced stress to the adjacent vertebral bodies and screw necks, with 66.7% reduction in bending stress on L2 when the XL cross-link was used. Thus, the stability for L1 burst fracture fixation was best achieved by using long segmental posterior instrumentation constructs and an XL cross-link configuration. Cross-links did not improved stability when a short structure was used.

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