Analysis of obstetricians' decision making on CTG recordings.

Interpretation of cardiotocogram (CTG) is a difficult task since its evaluation is complicated by a great inter- and intra-individual variability. Previous studies have predominantly analyzed clinicians' agreement on CTG evaluation based on quantitative measures (e.g. kappa coefficient) that do not offer any insight into clinical decision making. In this paper we aim to examine the agreement on evaluation in detail and provide data-driven analysis of clinical evaluation. For this study, nine obstetricians provided clinical evaluation of 634 CTG recordings (each ca. 60min long). We studied the agreement on evaluation and its dependence on the increasing number of clinicians involved in the final decision. We showed that despite of large number of clinicians the agreement on CTG evaluations is difficult to reach. The main reason is inherent inter- and intra-observer variability of CTG evaluation. Latent class model provides better and more natural way to aggregate the CTG evaluation than the majority voting especially for larger number of clinicians. Significant improvement was reached in particular for the pathological evaluation - giving a new insight into the process of CTG evaluation. Further, the analysis of latent class model revealed that clinicians unconsciously use four classes when evaluating CTG recordings, despite the fact that the clinical evaluation was based on FIGO guidelines where three classes are defined.

Design, analysis and verification of a knee joint oncological prosthesis finite element model.

BACKGROUND: The aim of this paper was to design a finite element model for a hinged PROSPON oncological knee endoprosthesis and to verify the model by comparison with ankle flexion angle using knee-bending experimental data obtained previously. METHOD: Visible Human Project CT scans were used to create a general lower extremity bones model and to compose a 3D CAD knee joint model to which muscles and ligaments were added. Into the assembly the designed finite element PROSPON prosthesis model was integrated and an analysis focused on the PEEK-OPTIMA hinge pin bushing stress state was carried out. To confirm the stress state analysis results, contact pressure was investigated. The analysis was performed in the knee-bending position within 15.4-69.4° hip joint flexion range. RESULTS: The results showed that the maximum stress achieved during the analysis (46.6 MPa) did not exceed the yield strength of the material (90 MPa); the condition of plastic stability was therefore met. The stress state analysis results were confirmed by the distribution of contact pressure during knee-bending. CONCLUSION: The applicability of our designed finite element model for the real implant behaviour prediction was proven on the basis of good correlation of the analytical and experimental ankle flexion angle data.

Knee joint endoprosthesis loading in full extension.

This paper deals with a knee joint endoprosthesis finite element analysis. Based on a three dimensional geometric model of a lower extremity, a mechanical axis of the limb was designed. This axis is important for several reasons. Firstly, the endoprosthesis was positioned due to its direction, secondly, boundary conditions was defined on its proximal and distal end and finally, the axis enabled reasonable simplification of the model which led to the time saving analysis while preserving principal features of the model like the natural boundary conditions or knee joint's degrees of freedom . Having this, one leg stance was simulated. Results of the analysis were encouraging for future models. Especially the choice of the mechanical axis was suitable and enabled a better distribution of contact pressures and stress on both femoral and tibial component compared to our former models. Also their magnitudes correspond better the manufacturer's experience and our findings. The stresses did not exceeded 30MPa for the UHMWPE tibial plateau and 100MPa for the femoral component. The contact pressures were lower than 40MPa.