Mapping lines of non-extension in persons with lower limb amputation to aid comfort-driven prosthetic socket design.

OBJECTIVE: This study aimed to develop a new technique to map the strain field for persons with lower-limb amputations to use for the design of comfortable prostheses. METHODS: Using a DSLR camera with stenciled 2D markers, we demonstrated a technique to measure skin strain around the residual limb of persons with lower limb amputations. We used open-source software programs to reconstruct a series of cloud points derived from the pictures of the marked residual limb into 3D models, then calculated the minimum, maximum, and non-extension lines from directional strain fields. RESULTS: A DSLR camera was successful in capturing 2D markers. The maximum mean principal strain was 68% ± 14%, observed around the patella. The minimum compressive mean principal strain of -31% ± 4% was observed posteriorly in the popliteal region of the knee. Although lines of non-extension (LoNE) appear separate in different participants, they are anatomically located in regions that could be generalized for the design of prostheses. CONCLUSIONS: Marker locations extracted from the video of different poses can be compared to calculate strains from which the position of LoNE can be generated. The use of LoNE could be valuable in reducing discomfort at the socket interface and informing future socket design.

Experiences from the international frontlines: An exploration of the perceptions of airport employees during the COVID-19 pandemic.

The aviation industry is one of the sectors that has been heavily impacted by the pandemic. While the major body of literature has focused on passenger experience and behaviour, this study focuses on airport employees instead-their experiences, perceptions, and preferences following the emergence of COVID-19. More than 1000 participants from 4 major airports-Amsterdam Airport Schiphol, Singapore Changi Airport, Taipei Taoyuan Airport, and Zurich Airport-representing over 10 different occupations, have provided a variety of sentiments about the airport as an employment ecosystem in the wake of COVID-19. Quantitatively and qualitatively surveying four different airports enabled a cross-border analysis of the results to identify interesting geographic contrasts, as well as global themes, among the responses. Regional differences regarding, the feeling of preparedness, confidence in measures, and optimism are presented. A significant difference in confidence in non-pharmaceutical measures between employees from Asian and European airports is shown. Wants and needs such as better physical/IT workplace infrastructure and more flexibility regarding job scope and hours are pointed out. The results of this research provide insights for future airport employee experience research by outlining areas to study in greater detail. Furthermore, practical implications for airport stakeholders and companies arising from the challenges experienced by the workforce are laid out to provide guidance to prepare for similar circumstances in the future and navigate the aftermath of and recovery from the pandemic.

Measuring discomfort-An objective method for quantifying peak pressure discomfort and improved fit in adults with transtibial amputation.

BACKGROUND: Prosthetic socket coupling with the residual limb should be comfortable without causing skin breakdown or excessive pressure. However, users report socket discomfort, and there is a scarcity of objective measurements available to assess this feeling of discomfort. Quantifying the specific pressure may enable clinicians and users to determine and improve comfort levels objectively. OBJECTIVES: (1) To evaluate if a peak pressure reduction assists in resolving wounds, redness, and pain inside prosthetic sockets in people with transtibial amputation. (2) To determine if peak pressures measured inside the prosthetic socket due to external forces could be used to quantify the level of improvement in socket discomfort. DESIGN: In this cohort study, we used a pressure sensor to quantify and facilitate adjustments to the prosthetic socket, correlating this information to the user's socket comfort. SETTING: Outpatient clinic in a tertiary hospital in Singapore. PARTICIPANTS: People (N = 16) with unilateral transtibial lower limb amputation using a prosthesis. INTERVENTIONS: NA. MAIN OUTCOME MEASURES: Peak pressure and socket comfort score (SCS). RESULTS: The peak pressure value showed a statistically significant reduction across all participants following adjustments at a 50% delta change in pressure (p = .001). This was achieved with a mean number of 2.6 ± 1.4 adjustments per participant. Following the adjustments, the paired t-test results showed a mean increase between the first SCS and final SCS was 2.6 (p = .001). CONCLUSION: The wound, redness, and pain resolved in 15 of 16 participants regardless of diabetic status following socket adjustments. Although the peak pressures values did not correlate to the SCS score, the reduction in peak pressure saw significant improvement to the SCS. The use of a portable sensor is a fast and efficient means to quantify adjustments inside the prosthetic socket and could potentially be considered as part of future care delivery.

Airport pandemic response: An assessment of impacts and strategies after one year with COVID-19.

The COVID-19 pandemic has caused an unprecedented crisis for the air transportation industry, affecting millions of aviation users and stakeholders. As the aviation sector has faced disease outbreaks and extreme events before-albeit not at the same scale-and will, in all likelihood, face them again, we provide an assessment in this study that a) gives an overview of the effects of the pandemic, b) categorizes the response mechanisms that were observed, and c) proposes a framework for a coordinated global response to future disease outbreaks. We highlight that of the many lessons, recommendations, and suggestions that emerged during previous outbreaks, few were introduced effectively into civil aviation practices and operations. Based on multiple data sources for passengers, cargo, and flight schedules, we assess the impact of COVID-19 on the global aviation industry and compare the data of some prominent airports to highlight the need for a coordinated response to effectively deal with future disruptions. As global aviation navigates its ongoing recovery, we discuss different responses during the pandemic including guidelines issued by bodies such as the International Civil Aviation Organization (ICAO), operational decisions such as closing terminals, increased cleaning frequencies, and mask mandates etc. We emphasize the need for resilience to accommodate disease outbreaks in future planning, design, and preparedness strategies for airports and airlines. We further argue that the existing civil aviation system needs a coordinated global response mechanism to combat future outbreaks and propose a framework with a threat response matrix to keep aviation safe and operational during future pandemics and mitigate socioeconomic fallout.

Leveraging Digital Technology to Overcome Barriers in the Prosthetic and Orthotic Industry: Evaluation of its Applicability and Use During the COVID-19 Pandemic.

BACKGROUND: The prosthetic and orthotic industry typically provides an artisan "hands-on" approach to the assessment and fitting of orthopedic devices. Despite growing interest in digital technology for prosthetic and orthotic service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. OBJECTIVE: This study's aim is to assess the use of digital technology in prosthetics and orthotics, and whether its use can help overcome challenges posed by the current COVID-19 pandemic. METHODS: A web-based survey of working prosthetists, orthotists, and lower limb patients was conducted between June and July 2020 and divided into three sections: lower limb amputees, prosthetist and orthotist (P&O) currently using digital technologies in their practice, and P&O not using any digital technology. Input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. RESULTS: In total, 113 individuals responded to the web-based survey. There were 83 surveys included in the analysis (patients: n=13, 15%; prosthetists and orthotists: n=70, 85%). There were 30 surveys excluded because less than 10% of the questions were answered. Out of 70 P&Os, 31 (44%) used digital technologies. Three dimensional scanning and digital imaging were the leading technologies being used (27/31, 88%), primarily for footwear (18/31, 58%), ankle-foot orthoses, and transtibial and transfemoral sockets (14/31, 45%). Digital technology enables safer care during COVID-19 with 24 out of 31 (77%) respondents stating it improves patient outcomes. Singapore was significantly less certain that the industry's future is digital (P=.04). The use of virtual care was reported by the P&O to be beneficial for consultations, education, patient monitoring, or triaging purposes. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. CONCLUSIONS: Digital technology is transforming health care. The current pandemic highlights its usefulness in providing safer care, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements using virtual platforms, digitalization methods, and improved connectivity will continue to change the future of health care delivery. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation, even if the world returns to pre-COVID-19 days.

Airport user experience unpacked: Conceptualizing its potential in the face of COVID-19.

Given the unprecedented challenges imposed on the aviation industry by the COVID-19 pandemic, this paper proposes a new perspective on airport user experience as a field of study to unlock its potential as a basis for strategic roadmapping. Through an integrative literature review, this study points out a dominant focus, in practice and research, on customer experience and service quality, as opposed to user experience, to help airports gain a competitive edge in an increasingly commoditized industry. The review highlights several issues with this understanding of experience, as users other than passengers, such as employees, working for the airport and its myriad stakeholders, as well as visitors, are largely omitted from study. Given the complexity of the system, operationally, passengers are generally reduced to smooth flows of a passive mass, which this study argues is both a missed opportunity and a vulnerability exacerbated by the COVID-19 pandemic. Major events apart from COVID-19 are used to show the negative effects this simplification of user experience has had. Based on solutions and models proposed in previous studies, a conceptual model has been developed to illustrate the postulated potential of a deeper and more holistic study of airport user experience to make airport systems generally more agile, flexible and future-proof. As such, the paper advocates to utilize the user experience as a basis for strategic planning to equip airports with the know-how to manage not just daily operations more effectively but also the aftermath of and recovery from major events like the COVID-19 pandemic. Moreover, with the user experience at the center of the strategic roadmap, airports can plan ahead to mitigate the impact of future scenarios. The importance of future research and the use of existing research are discussed.

A multiparallel bioreactor for the cultivation of mammalian cells in a 3D-ceramic matrix.

For adherently growing cells, cultivation is limited by the provided growth surface. Excellent surface-to-volume ratios are found in highly porous matrices, which have to face the challenge of nutrient supply inside the matrices' caverns. Therefore, perfusion strategies are recommended which often have to deal with the need of developing an encompassing bioreactor periphery. We present a modular bioreactor system based on a porous ceramic matrix that enables the supply of cells with oxygen and nutrients by perfusion. The present version of the reactor system focuses on simple testing of various inoculation and operation modes. Moreover, it can be used to efficiently test different foam structures. Protocols are given to set-up the system together with handling procedures for long-time cultivation of a CHO cell line. Experimental results confirm vital growth of cells inside the matrices' caverns.