Multimodal Assessment of Cognitive Workload Using Neural, Subjective and Behavioural Measures in Smart Factory Settings.

Collaborative robots (cobots) have largely replaced conventional industrial robots in today's workplaces, particularly in manufacturing setups, due to their improved performance and intelligent design. In the framework of Industry 5.0, humans are working alongside cobots to accomplish the required level of automation. However, human-robot interaction has brought up concerns regarding human factors (HF) and ergonomics. A human worker may experience cognitive stress as a result of cobots' irresponsive nature in unpredictably occurring situations, which adversely affects productivity. Therefore, there is a necessity to measure stress to enhance a human worker's performance in a human-robot collaborative environment. In this study, factory workers' mental workload was assessed using physiological, behavioural, and subjective measures. Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) signals were collected to acquire brain signals and track hemodynamic activity, respectively. The effect of task complexity, cobot movement speed, and cobot payload capacity on the mental stress of a human worker were observed for a task designed in the context of a smart factory. Task complexity and cobot speed proved to be more impactful. As physiological measures are unbiased and more authentic means to estimate stress, eventually they may replace the other conventional measures if they prove to correlate with the results of traditional ones. Here, regression and artificial neural networks (ANN) were utilised to determine the correlation between physiological data and subjective and behavioural measures. Regression performed better for most of the targets and the best correlation (rsq-adj = 0.654146) was achieved for predicting missed beeps, a behavioural measure, using a combination of multiple EEG and fNIRS predictors. The k-nearest neighbours (KNN) algorithm was used to evaluate the accuracy of correlation between traditional measures and physiological variables, with the highest accuracy of 77.8% achieved for missed beeps as the target. Results show that physiological measures can be more insightful and have the tendency to replace other biased parameters.

Developing a prototype digital risk mitigation pathway for children and young people admitted to acute paediatric NHS care in mental health crisis: Protocol of the Safety Assessment in Paediatric healthcare Environments (SAPhE) pathway study.

Background: Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis. Objective: To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway. Methods: This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops. Ethics and Dissemination: The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches.

Patient-maintained versus anaesthetist-controlled propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia: a randomised controlled trial.

BACKGROUND: Patient-maintained propofol TCI sedation (PMPS) allows patients to titrate their own target-controlled infusion (TCI) delivery of propofol sedation using a handheld button. The aim of this RCT was to compare PMPS with anaesthetist-controlled propofol TCI sedation (ACPS) in patients undergoing elective primary lower-limb arthroplasty surgery under spinal anaesthesia. METHODS: In this single-centre open-label investigator-led study, adult patients were randomly assigned to either PMPS or ACPS during their surgery. Both sedation regimes used Schnider effect-site TCI modelling. The primary outcome measure was infusion rate adjusted for weight (expressed as mg kg-1 h-1). Secondary outcomes measures included depth of sedation, occurrence of sedation-related adverse events and time to medical readiness for discharge from the postanaesthsia care unit (PACU). RESULTS: Eighty patients (48 female) were randomised. Subjects using PMPS used 39.3% less propofol during the sedation period compared with subjects in group ACPS (1.56 [0.57] vs 2.57 [1.33] mg kg-1 h-1; P<0.001), experienced fewer discrete episodes of deep sedation (0 vs 6; P=0.0256), fewer airway/breathing adverse events (odds ratio [95% confidence interval]: 2.94 [1.31-6.64]; P=0.009) and were ready for discharge from PACU more quickly (8.94 [5.5] vs 13.51 [7.2] min; P=0.0027). CONCLUSIONS: Patient-maintained propofol sedation during lower-limb arthroplasty under spinal anaesthesia results in reduced drug exposure and fewer episodes of sedation-related adverse events compared with anaesthetist-controlled propofol TCI sedation. To facilitate further investigation of this procedural sedation technique, PMPS-capable TCI infusion devices should be submitted for regulatory approval for clinical use. CLINICAL TRIAL REGISTRATION: ISRCTN29129799.

Comparison between menstrual cups: first step to categorization and improved safety.

OBJECTIVES: Menstrual cups come in a range of shapes, sizes, and firmnesses, but unlike tampons are not categorized in any way. With these factors having an impact on product leaks and comfort, as well as being linked to illness and injury, women need the same level of transparency when purchasing a menstrual cup. The comparison of physical and mechanical properties of menstrual cups will be the first step to achieve this. METHODS: In October 2020, 14 popular and highly rated menstrual cups underwent quantitative comparison in laboratory settings (the United Kingdom), and they were compared in terms of their dimensions, volume, and compressive strength (firmness) using the Instron Universal Testing System. The overall designs were compared including shape, material, and features. RESULTS: Although all the products in this comparison were marketed to women below 30 years of age having never given birth, total volume varied from 18.88 mL to 38.14 mL, and compressive load to compress the menstrual cup 50% (±0.5%) maximum diameter varied from 3.39 N to 13.92 N. CONCLUSIONS: Women are not sufficiently informed when choosing a menstrual cup. With no correlation between menstrual cup size, shape, and its volume, or material, shape, and its firmness, consumers cannot estimate which menstrual cup might be most suitable, and incorrect choice could cause injury. Transparency is needed across menstrual cup brands. With this and further regulation, women will make an informed decision to choose the correct menstrual cup and minimize injury. This work recommends firmness categories, ranging from 'very soft' to 'very firm' as a first step.

Task-Oriented Intelligent Solution to Measure Parkinson's Disease Tremor Severity.

Tremor is a common symptom of Parkinson's disease (PD). Currently, tremor is evaluated clinically based on MDS-UPDRS Rating Scale, which is inaccurate, subjective, and unreliable. Precise assessment of tremor severity is the key to effective treatment to alleviate the symptom. Therefore, several objective methods have been proposed for measuring and quantifying PD tremor from data collected while patients performing scripted and unscripted tasks. However, up to now, the literature appears to focus on suggesting tremor severity classification methods without discrimination tasks effect on classification and tremor severity measurement. In this study, a novel approach to identify a recommended system is used to measure tremor severity, including the influence of tasks performed during data collection on classification performance. The recommended system comprises recommended tasks, classifier, classifier hyperparameters, and resampling technique. The proposed approach is based on the above-average rule of five advanced metrics results of four subdatasets, six resampling techniques, six classifiers besides signal processing, and features extraction techniques. The results of this study indicate that tasks that do not involve direct wrist movements are better than tasks that involve direct wrist movements for tremor severity measurements. Furthermore, resampling techniques improve classification performance significantly. The findings of this study suggest that a recommended system consists of support vector machine (SVM) classifier combined with BorderlineSMOTE oversampling technique and data collection while performing set of recommended tasks, which are sitting, stairs up and down, walking straight, walking while counting, and standing.

Polymer-Based Additive Manufacturing: Process Optimisation for Low-Cost Industrial Robotics Manufacture.

The robotics design process can be complex with potentially multiple design iterations. The use of 3D printing is ideal for rapid prototyping and has conventionally been utilised in concept development and for exploring different design parameters that are ultimately used to meet an intended application or routine. During the initial stage of a robot development, exploiting 3D printing can provide design freedom, customisation and sustainability and ultimately lead to direct cost benefits. Traditionally, robot specifications are selected on the basis of being able to deliver a specific task. However, a robot that can be specified by design parameters linked to a distinctive task can be developed quickly, inexpensively, and with little overall risk utilising a 3D printing process. Numerous factors are inevitably important for the design of industrial robots using polymer-based additive manufacturing. However, with an extensive range of new polymer-based additive manufacturing techniques and materials, these could provide significant benefits for future robotics design and development.

Parkinson's disease: current assessment methods and wearable devices for evaluation of movement disorder motor symptoms - a patient and healthcare professional perspective.

BACKGROUND: Parkinson's disease is the second most common long-term chronic, progressive, neurodegenerative disease, affecting more than 10 million people worldwide. There has been a rising interest in wearable devices for evaluation of movement disorder diseases such as Parkinson's disease due to the limitations in current clinic assessment methods such as Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr (HY) scale. However, there are only a few commercial wearable devices available, which, in addition, have had very limited adoption and implementation. This inconsistency may be due to a lack of users' perspectives in terms of device design and implementation. This study aims to identify the perspectives of healthcare professionals and patients linked to current assessment methods and to identify preferences, and requirements of wearable devices. METHODS: This was a qualitative study using semi-structured interviews followed by focus groups. Transcripts from sessions were analysed using an inductive thematic approach. RESULTS: It was noted that the well-known assessment process such as Unified Parkinson's Disease Rating Scale (UPDRS) was not used routinely in clinics since it is time consuming, subjective, inaccurate, infrequent and dependent on patients' memories. Participants suggested that objective assessment methods are needed to increase the chance of effective treatment. The participants' perspectives were positive toward using wearable devices, particularly if they were involved in early design stages. Patients emphasized that the devices should be comfortable, but they did not have any concerns regarding device visibility or data privacy transmitted over the internet when it comes to their health. In terms of wearing a monitor, the preferable part of the body for all participants was the wrist. Healthcare professionals stated a need for an economical solution that is easy to interpret. Some design aspects identified by patients included clasps, material choice, and form factor. CONCLUSION: The study concluded that current assessment methods are limited. Patients' and healthcare professionals' involvement in wearable devices design process has a pivotal role in terms of ultimate user acceptance. This includes the provision of additional functions to the wearable device, such as fall detection and medication reminders, which could be attractive features for patients.

Proof-of-Concept Study: a Mobile Application to Derive Clinical Outcome Measures from Expression and Speech for Mental Health Status Evaluation.

This proof-of-concept study aimed to assess the ability of a mobile application and cloud analytics software solution to extract facial expression information from participant selfie videos. This is one component of a solution aimed at extracting possible health outcome measures based on expression, voice acoustics and speech sentiment from video diary data provided by patients. Forty healthy volunteers viewed 21 validated images from the International Affective Picture System database through a mobile app which simultaneously captured video footage of their face using the selfie camera. Images were intended to be associated with the following emotional responses: anger, disgust, sadness, contempt, fear, surprise and happiness. Both valence and arousal scores estimated from the video footage associated with each image were adequate predictors of the IAPS image scores (p < 0.001 and p = 0.04 respectively). 12.2% of images were categorised as containing a positive expression response in line with the target expression; with happiness and sadness responses providing the greatest frequency of responders: 41.0% and 21.4% respectively. 71.2% of images were associated with no change in expression. This proof-of-concept study provides early encouraging findings that changes in facial expression can be detected when they exist. Combined with voice acoustical measures and speech sentiment analysis, this may lead to novel measures of health status in patients using a video diary in indications including depression, schizophrenia, autism spectrum disorder and PTSD amongst other conditions.

Mechanical behaviour of 3D printed vs thermoformed clear dental aligner materials under non-linear compressive loading using FEM.

Clear dental aligners are commonly manufactured using thermoplastic materials such as Duran and Durasoft. Using conventional thermoforming methods there are inherent disadvantages including time consumption and poor geometrical accuracies that often occur. The use of digital technologies and 3D printing techniques for producing dental aligners is often preferred where possible. Innovation in 3D printing has resulted in bio-compatible materials becoming more readily available, including Formlabs Dental LT Clear resin, which is a 3D printable and Class IIa bio-compatible material. In this paper, we investigate the difference between thermoplastic materials such as Scheu-Dental Duran and Durasoft and 3D printed Dental LT using Finite Element Analysis (FEA)/Finite Element Modelling (FEM) in a dental aligner case based on an analysis of von Mises stress distribution at molars, incisors and canines for a total of 33161 nodes using Finite Element Analysis (FEA). Maximum von Mises stress distribution at all of the sections under the action of non-linear compressive forces equivalent to human biting force (up to 600 N) were discovered to vary within a range of 0.2-7.7% for Dental LT resin. The Duran and Durasoft cases were comparable, thereby widening the scope for the use of Dental LT in various dentistry applications, including clear aligners.

Mechanical and geometric properties of thermoformed and 3D printed clear dental aligners.

INTRODUCTION: The aim of this research was to compare compressive mechanical properties and geometric inaccuracies between conventionally manufactured thermoformed Duran clear dental aligners and 3D printed Dental Long Term (LT) resin-based clear aligners using 3D modeling and printing techniques. METHODS: Impressions of the patient's dentition were scanned and using 3D modeling software, dental models were designed and 3D printed. These printed models then underwent vacuum thermoforming to thermoform a clear Duran thermoplastic sheet of 0.75-mm thickness into clear dental aligners of the same thickness of 0.75 mm. For the same dental model, aligners were also designed and 3D printed to 0.75-mm thickness creating biocompatible clear dental aligners using Dental LT resin utilizing a Formlabs 3D printing machine for direct usage by the patients. Five observers calculated teeth height for both types of aligners for evaluation of geometric deviations. Both types of aligners were subjected to compression loading of 1000 N to evaluate their load vs displacement behavior. RESULTS: 3D printed cured clear dental aligners were found to be geometrically more accurate with an average relative difference in tooth height of 2.55% in comparison with thermoformed aligners (4.41%). Low standard deviations (0.03-0.09 mm) were observed for tooth height measurements taken by all the observers for both types of aligners. 3D printed aligners could resist a maximum load of nearly 662 N for a low displacement of 2.93 mm; whereas, thermoformed aligners could resist a load on only 105 N for 2.93-mm displacement. Thermoformed aligners deformed plastically and irreversibly for large displacements; whereas, 3D printed aligners deformed elastically with reversibility for lower displacements. CONCLUSIONS: 3D printed and suitably cured Dental LT resin-based clear dental aligners are suggested to be more suitable for patient use as they are geometrically more accurate; this presents an opportunity to make processing time savings while ensuring an aligner is mechanically stronger and elastic in comparison with the conventionally produced thermoplastic-based thermoformed clear dental aligners.

Menstrual Blood-Derived Mesenchymal Stem Cells: Women's Attitudes, Willingness, and Barriers to Donation of Menstrual Blood.

Background: Menstrual blood contains mesenchymal stem cells (MenSC), considered a potential "off-the-shelf" treatment for a range of diseases and medical conditions. Samples of menstrual blood can be collected painlessly, inexpensively, and as frequently as every month for cell therapy. While there has been considerable previous research into the clinical advantages of MenSC, there is currently little understanding of potential donors' attitudes regarding menstrual blood donation and MenSC. Methods: One hundred women 18 years of age or over were surveyed to understand attitudes and potential barriers to menstrual blood donation. The questionnaire assessed participant age and brief medical history (giving birth, donating blood, donating stem cells), menstrual experience (period rating, preferred menstrual hygiene products), and whether participants would donate MenSC or accept MenSC therapy. Results: MenSC was met with a generally positive response, with 78% of menstruating women willing to donate menstrual blood. No significant relationship was recognized between willingness to donate menstrual blood with age, history of childbirth or blood donation, menstruation perception, and preferred menstrual hygiene product. Women rated their period experience better after being made aware of the ability to donate menstrual blood, meaning MenSC therapy can be beneficial for donors as well as patients. Conclusions: Considering women's attitudes to MenSC and donation of menstrual blood, the future of MenSC therapy is positive; women are generally willing to donate menstrual blood, independent of age, perception of periods, and history of childbirth and blood donation.

A Prototype Patient-Maintained Propofol Sedation System Using Target Controlled Infusion for Primary Lower-Limb Arthroplasty.

Each year, many operations in the UK are performed with the patient awake, without the use of general anaesthesia. These include joint replacement procedures, and in order to reduce patient anxiety, the supervising anaesthetist delivers the sedative propofol intravenously using a target-controlled infusion (TCI) device. However, it is clinically challenging to judge the required effect-site concentration of sedative for an individual patient, resulting in patient care issues related to over or under-sedation. To improve the process, patient-maintained propofol sedation (PMPS), where the patient can request an increase in concentration through a hand-held button, has been considered as an alternative. However, due to the proprietary nature of modern TCI pumps, the majority of PMPS research has been conducted using prototypes in research studies. In this work, a PMPS system is presented that effectively converts a standard infusion pump into a TCI device using a laptop with TCI software. Functionally, the system delivers sedation analogous to a modern TCI pump, with the differences in propofol consumption and dosage within the tolerance of clinically approved devices. Therefore, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved the system as a safe alternative to anaesthetist-controlled TCI procedures. It represents a step forward in the consideration of PMPS as a sedation method as viable alternative, allowing further assessment in clinical trials.

Anaesthetist-controlled versus patient-maintained effect-site targeted propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia (ACCEPTS): study protocol for a parallel-group randomised comparison trial.

BACKGROUND: The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation. METHODS: The trial is an open-label, randomised, controlled superiority trial recruiting adults who are undergoing elective primary lower-limb arthroplasty with sedation by propofol infusion by effect-site targeting into two equal-sized parallel arms: PMPS and ACPS. The primary research objective is to compare the body-weight-normalised rate of propofol consumption when sedation for surgery on adults undergoing elective primary lower-limb arthroplasty under spinal anaesthesia is patient-maintained versus when it is anaesthetist-controlled. The study primary null hypothesis is that there is no difference in the rate of propofol consumption when sedation is patient-maintained versus anaesthetist-controlled. DISCUSSION: This is the first trial to test the superiority of effect-site-targeted patient-maintained propofol sedation versus anaesthetist-controlled propofol sedation in terms of total propofol consumption during the sedation period. The results of this trial will help inform clinicians and device manufacturers of the clinical efficacy and safety of patient-maintained propofol sedation applied to a common operative setting. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Registry, ISRCTN29129799 . Prospectively registered on 12 June 2018.

Efficiency of nanoparticle reinforcement using finite element analysis of titanium alloy mandible plate.

Nanoparticles in the form nanotubes and nanoplatelets have been compared for von Mises stresses by using them as low-composition reinforcements in titanium alloy-based mandible plate for different compositions and orientations. A finite element model has been designed to reconstruct a fractured human mandible with a titanium alloy mandible plate. A 500 N compressive force was applied on the mandible, and stress distribution across the plate sections was analysed for aligned two-dimensional random and three-dimensional random orientations for both tubes and platelets. Carbon material as graphene has been used for tube and platelet in the form of nanotubes and nanoplatelets, respectively. Using properties of graphene as the filler in titanium alloy plate, for both nanoplatelets and nanotubes, the stresses reduced between 5% and 25% for nanoplatelets and nanotubes graphene-titanium composite plates in comparison to non-reinforced plates, at critically stressed sections. Nanotubes exhibited stress reduction of nearly 23.4% for aligned configurations, while nanoplatelets exhibited stress reduction up to 21.2% for two-dimensional and three-dinemsional random configurations in comparison to non-reinforced titanium plates. Hence, it has been suggested that nanotubes exhibited superior mechanical reinforcement potential beyond that of aligned nanoplatelets, while nanoplatelets provided enhanced mechanical reinforcements for random configurations. Therefore, for biomedical implant applications nanocomposite materials can be designed with the same dimensional form but with lower compositions of filler materials by simply manipulating the appropriate orientations.

Finite element analysis of titanium alloy-graphene based mandible plate.

Titanium alloy based maxillofacial plates and implants are widely used in fracture treatment and reconstructions. Filler materials Graphene Nanoplatlets(GNPs) were used in a Titanium alloy maxillofacial plate and a Finite Element Model (FEM) was designed to reconstruct a fractured human mandible. Both 50N and 500N bite forces were applied on the mandible and stress distribution using Von mises failure theory across the plate sections was analyzed. A pure plate was critically stressed at a section near the mandible fracture region for a Von mises stress of nearly 27.5GPa while this stress reduced by nearly 10-22% with the presence of minor composition of GNPs in the plate. GNPs orientation in parallel (21.1 GPa) to the plate axis were more effective in comparison to other orientations(90°, 45° and 135°) and the location variation of these GNPs along the plate had no significant effect on the stress distribution. The fatigue analyses showed that, under these stresses and forces the plate with GNP was able to endure for nearly 7000 days, while the pure Titanium plate could fail by fatigue in approximately 70 days. Hence, presence of minor compositions of GNPs could enhance endurance life of the Titanium plate by reducing stress concentrations at critical sections of the plate.

Utilising the Intel RealSense Camera for Measuring Health Outcomes in Clinical Research.

Applications utilising 3D Camera technologies for the measurement of health outcomes in the health and wellness sector continues to expand. The Intel® RealSense™ is one of the leading 3D depth sensing cameras currently available on the market and aligns itself for use in many applications, including robotics, automation, and medical systems. One of the most prominent areas is the production of interactive solutions for rehabilitation which includes gait analysis and facial tracking. Advancements in depth camera technology has resulted in a noticeable increase in the integration of these technologies into portable platforms, suggesting significant future potential for pervasive in-clinic and field based health assessment solutions. This paper reviews the Intel RealSense technology's technical capabilities and discusses its application to clinical research and includes examples where the Intel RealSense camera range has been used for the measurement of health outcomes. This review supports the use of the technology to develop robust, objective movement and mobility-based endpoints to enable accurate tracking of the effects of treatment interventions in clinical trials.

Dynamic facial prosthetics for sufferers of facial paralysis.

BACKGROUND: This paper discusses the various methods and the materials for the fabrication of active artificial facial muscles. The primary use for these will be the reanimation of paralysed or atrophied muscles in sufferers of non-recoverable unilateral facial paralysis. METHOD: The prosthetic solution described in this paper is based on sensing muscle motion of the contralateral healthy muscles and replicating that motion across a patient's paralysed side of the face, via solid state and thin film actuators. The development of this facial prosthetic device focused on recreating a varying intensity smile, with emphasis on timing, displacement and the appearance of the wrinkles and folds that commonly appear around the nose and eyes during the expression. An animatronic face was constructed with actuations being made to a silicone representation musculature, using multiple shape-memory alloy cascades. Alongside the artificial muscle physical prototype, a facial expression recognition software system was constructed. This forms the basis of an automated calibration and reconfiguration system for the artificial muscles following implantation, so as to suit the implantee's unique physiognomy. RESULTS: An animatronic model face with silicone musculature was designed and built to evaluate the performance of Shape Memory Alloy artificial muscles, their power control circuitry and software control systems. A dual facial motion sensing system was designed to allow real time control over model - a piezoresistive flex sensor to measure physical motion, and a computer vision system to evaluate real to artificial muscle performance. Analysis of various facial expressions in real subjects was made, which give useful data upon which to base the systems parameter limits. CONCLUSION: The system performed well, and the various strengths and shortcomings of the materials and methods are reviewed and considered for the next research phase, when new polymer based artificial muscles are constructed and evaluated.