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Background Degenerative disease of the lumbar spine is one of the most prevalent pathologies worldwide, and MRI is the gold standard imaging modality that helps to assess soft tissue and bony abnormalities and elicit causes of neural compression. It is not uncommon in the daily practice to have patients presenting with neurological symptoms during standing or walking while MRI fails to detect lesion that explains their clinical picture. The aim of this study was to detect changes that appear on dynamic weight-bearing MRI of the lumbar spine that was hidden on conventional supine MRI and to correlate them with the clinical situation. Methodology Ninety patients with back pain were enrolled in the study, they did conventional and dynamic MRI of the lumbar spine. We compared findings in both modalities as regard alignment, ligamentum flavum buckling, foraminal narrowing and neural compression. Results Dynamic MRI showed neural compression in 87% of patients in comparison to supine MRI, ligamentum flavum buckling was reported in 80%, neural foraminal narrowing was seen in 24%, exaggeration of the lumbar lordoisis in 10% and exaggeration of the already existing disc protrusion was documented in 60% of the included patients. Conclusions Upright dynamic MRI has added to supine MRI in problem solving cases with clinical radiological mismatch. The results indicated changes in the spine alignment, neural compression and spinal canal stenosis. Since the examination is non-invasive, it could be used in the preoperative planning of patients with degenerative lumbar spine disease.

Background Therapeutic head positioning plays a role in the management of patients with acute brain injury. Although intracranial pressure (ICP) is typically lower in an upright posture than in a flat position, limited data exist concerning the effect of upright positioning on brain oxygenation and circulation. We sought to determine the impact of supine (0°) and semirecumbent (15° and 30°) postures on ICP, brain oxygenation, and brain circulation. Methods An observational cohort study was conducted between February 2012 and September 2015. Twenty-three patients with severe acute brain injury were successively observed at head elevations of 30°, 15°, and 0°. Postural-induced changes in ICP, cerebral perfusion pressure, brain tissue oxygenation pressure, and transcranial Doppler findings were simultaneously measured during three repeated experiments: 24 h after admission to the intensive care unit (exp1), 24 h later (exp2), and 96 h later (exp3). Cerebral perfusion pressure, arterial blood gases, hemoglobin content, and body temperature remained unchanged during the three experiments. Results Using linear random-slope mixed models, we found that during the early phase of acute brain injury (exp1), lowering the head posture from 30° to 15°, and then to 0°, was associated with a gradual mean ICP increase of 2.6 mm Hg (1.4–3.7 mm Hg; P

Background: The purpose of this study was to determine the inter-and intra-observer reliability of the patellotrochlear index (PTI) on magnetic resonance images (MRI) in patients with patellofemoral pain. The correlation between the PTI measured on MRI and the modified Insall-Salvati (MIS) ratio measured on radiographs was also assessed. Methods: The PTI was assessed on MRI images and the MIS ratio on radiographs of 66 knees of 62 patients. Assessment was performed by two orthopaedic surgeons, one orthopaedic surgery registrar, two radiologists and one radiology registrar. Correlation coefficients, standard errors of measurement and limits of agreement were calculated for the PTI. To assess the association between the PTI and the MIS ratio, the Pearson's correlation coefficient was calculated. Results: The PTI showed good interobserver reliability (intraclass correlation coefficient (ICC) 0.79; 95% confidence interval (CI) 0.73-0.85) and excellent intra-observer reliability (ICC 0.90; 95% CI 0.89-0.91). The standard error of measurement was 0.05 and limits of agreement with the mean +/- 0.09. A very weak and not significant correlation was found between the PTI and the MIS (r = 0.02; P = 0.77). Conclusions: The PTI showed good interobserver reliability and excellent intra-observer reliability. In order to conclude which measurement method of assessing patellar height is truly the most reliable, future studies should investigate agreement parameters (standard error of measurement, limits of agreement) besides solely correlation coefficients. We found a very weak correlation between the PTI and the MIS which suggests that at least one index has poor validity. Future validity studies on indices to assess patellar height are necessary. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

This study evaluates an innovative reinforcement method for cold-formed steel (CFS) upright sections through finite element assessment as well as prediction of the normalized ultimate load and deflection of the profiles by artificial intelligence (AI) and machine learning (ML) techniques. Following the previous experimental studies, several CFS upright profiles with different lengths, thicknesses and reinforcement spacings are modeled and analyzed under flexural loading. The finite element method (FEM) is employed to evaluate the proposed reinforcement method in different upright sections and to provide a valid database for the analytical study. To detect the most influential factor on flexural strength, the “feature selection” method is performed on the FEM results. Then, by using the feature selection method, a hybrid neural network (a combination of multi-layer perceptron algorithm and particle swarm optimization method) is developed for the prediction of normalized ultimate load. The correlation coefficient (R), root mean square error (RMSE), Nash–Sutcliffe efficiency (NSE), mean absolute error (MAE) and Wilmot’s index of agreement (WI) are used as the measure of precision. The results show that the geometrical parameters have almost the same contribution in the flexural capacity and deflection of the specimens. According to the performance evaluation indexes, the best model is detected and optimized by tuning other algorithm parameters. The results indicate that the hybrid neural network can successfully predict the normalized ultimate load and deflection.

Perforated cold-formed steel (CFS) beams subjected to different bending scenarios should be able to deal with different buckling modes. There is almost no simple way to address this significant concern. This paper investigates the bending capacity and flexural behavior of a novel-designed system using bolt and nut reinforcing system through both experimental and numerical approaches. For the experiential program, a total of eighteen specimens of three types were manufactured: a non-reinforced section, and two sections reinforced along the upright length at 200 mm and 300 mm pitches. Then, monotonic loading was applied to both the minor and major axes of the specimens. The finite element models were also generated and proved the accuracy of the test results. Using the proposed reinforcing system the flexural capacity of the upright sections was improved around either the major axis or minor axis. The 200 mm reinforcement type provided the best performance of the three types. The proposed reinforcing pattern enhanced flexural behavior and constrained irregular buckling and deformation. Thus, the proposed reinforcements can be a very useful and cost-effective method for strengthening all open CFS sections under flexural loading, considering the trade-off between flexural performance and the cost of using the method.

Since the early days of megavoltage Radiation Therapy (RT), the potential of delivering treatment to a sub group of patients in an upright position has been recognized. Compared to lying horizontally, treating patients in an upright position offers potential benefits in terms of patient comfort especially for patients experiencing dyspnoea and saliva accumulation when lying down. Dosimetric benefits can also be gained from changes in the volume and location of lungs and heart in an upright position, which are potentially advantageous for clinical situations including Hodgkin's disease, lung and breast malignancies. Since the 1950's, upright stabilization mechanisms have ranged from standalone chair based apparatus to couch-top attachments with increasingly customizable solutions. The introduction of Computed-Tomography (CT) based three-dimensional (3D) dosimetry in the 1980's−90's necessitated image acquisition in a horizontal position (supine or prone), significantly reducing options for alternative patient positioning and upright techniques. Despite this, upright techniques have still been utilized where clinically indicated for palliative and novel approaches often involving non-standard treatment scenarios. More recently, a small number of centers have reported on specialized equipment capable of acquiring planning data with the patient in a vertical position. The possibility of acquiring planning quality Cone Beam CT (CBCT) on linear accelerators has recently reinvigorated the potential to deliver highly accurate and targeted treatments to patients in an upright position. This paper reflects on the historical applications of upright RT and explores new possibilities for this technology in modern RT departments.

This paper deals with the design of an upright using a topological optimization. This type of optimization is a relatively young and rapidly evolving area of computational mechanics that seeks to make multiple material savings that cannot be achieved by conventional methods. The optimized upright was utilized in a fully functional prototype of the student formula within the Formula Student competition. The main objective of the optimization was to meet the requirements of the physical properties, weight, stiffness, and strength of the upright. The initial model of the upright was iteratively optimized using topological optimization and a finite element static analysis to obtain the final model. Using the finite element analysis, its behavior in operation within individual load cases was predicted. Symmetry was used to mirror the finished model to obtain the opposite upright of the other side of the car. Finally, the topologically optimized upright was compared with an upright made by conventional methods. Web of Science 12 6 art. no. 1020

Background Compare Goldmann applanation tonometer (GAT) prism and correcting applanation tonometry surface (CATS) prism to intracameral intraocular pressure (IOP), in vivo and in vitro. Methods Pressure transducer intracameral IOP was measured on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically to 10, 20, and 40 mmHg. Simultaneously, IOP was measured using a Perkins tonometer with a standard GAT prism and a CATS prism at each of the intracameral pressures. Statistical comparison was made between true intracameral pressures and the two prism measurements. Differences between the two prism measurements were correlated to central corneal thickness (CCT) and corneal resistance factor (CRF). Human cadaver eyes were used to assess measurement repeatability. Results The CATS tonometer prism measured closer to true intracameral IOP than the GAT prism by 1.7+/−2.7 mmHg across all pressures and corneal properties. The difference in CATS and GAT measurements was greater in thin CCT corneas (2.7+/−1.9 mmHg) and low resistance (CRF) corneas (2.8+/−2.1 mmHg). The difference in prisms was negligible at high CCT and CRF values. No difference was seen in measurement repeatability between the two prisms. Conclusion A CATS prism in Goldmann tonometer armatures significantly improve the accuracy of IOP measurement compared to true intracameral pressure across a physiologic range of IOP values. The CATS prism is significantly more accurate compared to the GAT prism in thin and less rigid corneas. The in vivo intracameral study validates mathematical models and clinical findings in IOP measurement between the GAT and CATS prisms.

Formula SAE (FSAE) is a competition where university students are challenged to design, fabricate and race small open-wheeled vehicles. This work outlines the development and analysis of a wheel assembly for a race car which carried out by the James Cook University Motorsports. A number of strategies are utilized throughout the paper including load calculations, modelling by SolidWorks and finite element analysis via Ansys for each part of the system including the upright, braking system and hub shaft.

Background Goldmann applanation tonometry (GAT) error relative to intracameral intraocular pressure (IOP) has not been examined comparatively in both human cadaver eyes and in live human eyes. Futhermore, correlations to biomechanical corneal properties and positional changes have not been examined directly to intracameral IOP and GAT IOP. Methods Intracameral IOP was measured via pressure transducer on fifty-eight (58) eyes undergoing cataract surgery and the IOP was modulated manometrically on each patient alternately to 10, 20, and 40 mmHg. IOP was measured using a Perkins tonometer in the supine position on 58 eyes and upright on a subset of 8 eyes. Twenty one (21) fresh human cadaver globes were Intracamerally IOP adjusted and measured via pressure transducer. Intracameral IOP ranged between 5 and 60 mmHg. IOP was measured in the upright position with a Goldmann Applanation Tonometer (GAT) and supine position with a Perkins tonometer. Central corneal thickness (CCT) was also measured. Results The Goldmann-type tonometer error measured on live human eyes was 5.2 +/−1.6 mmHg lower than intracameral IOP in the upright position and 7.9 +/− 2.3 mmHg lower in the supine position (p

Cold-formed steel (CFS) storage rack structures are extensively used in various industries to store products in safe and secure warehouses before distribution to the market. Thin-walled open profiles that are typically used in storage rack structures are prone to loss of stability due to different buckling modes such as local, distortional, torsional and flexural, or any interaction between these modes. In this paper, an efficient way of increasing ultimate capacity of upright frames under compression load is proposed using bolts and spacers which are added externally to the section with certain pitches along the height. Hereinto, experimental tests on 81 upright frames with different thicknesses and different heights were conducted, and the effect of employing reinforcement strategies was examined through the failure mode and ultimate load results. Non-linear finite element analyses were also performed to investigate the effect of different reinforcement spacing on the upright performance. The results showed that the reinforcement method could restrain upright flange and consequently increase the distortional strength of the upright profiles. This method can also be effective for any other light gauged steel open section with perforation. It was also observed that the reinforcement approach is much more useful for short length upright frames compared to the taller frames.

Background Sitting too much has been associated with negative health outcomes. ‘The End of Sitting’ is a newly developed office landscape that moves away from the traditional chair-desk setup. The landscape aims to reduce sitting time by offering a variety of (supported) standing positions. The aim of this study was to determine the usage of the landscape after being placed in the main entrance hall of the VU University in Amsterdam. Methods We observed the number of spontaneous visitors as well as the duration of visits, changes to another location within the landscape, and adopted postures. Using questionnaires reasons (not) to visit the landscape, perceived affordances of the landscape and associations with long-term use were determined. Results Observed numbers of visitors were relatively low and duration of visits were short, which seemed to indicate visitors were trying out the landscape. The majority of visitors were in an upright position, reflecting the designers’ intentions. Visitors indicated that long-term use would be pleasant to them. Conclusion ‘The End of Sitting’ landscape received positive reactions but number of visits were limited in the few months that it was placed in the university main entrance hall. The landscape might be better suited for designated working or study spaces, for which it was originally intended. It might also be worth to explore the landscapes suitability for short stay environments, such as waiting rooms. Electronic supplementary material The online version of this article (10.1186/s12889-017-4971-7) contains supplementary material, which is available to authorized users.

Background: Little is known about soft tissue attenuation artifacts when an upright patient-position SPECTmyocardial perfusion imaging (MPI) system is used. In this investigation we sought to describe the patterns and frequency of attenuation artifacts associated with this type of instruments and we explored the impact of gender and body habitus on these artifacts. Methods: In a cross-sectional study, we described the prevalence of various soft-tissue attenuation patterns in 212 normal SPECT-MPI studies acquired with an upright patient-position imaging system. Results: In these 212 normal, clinically-indicated, upright-acquisition SPECT-MPIs the attenuation patterns observed were: anterior (6.1%), inferior (63.7%) and lateral (24.1%). Though uncommon, anterior attenuation trended to being more prevalent among women [9.5% vs. 3.4%, P=0.07] and was independently associated with chest circumference. Lateral attenuation was more common among women [34.7% vs. 15.4%, p=0.001] and was strongly associated with obesity (p Conclusions: Soft-tissue attenuation artifacts are common in upright-acquisition SPECT-MPI. Recognizing the frequency of these attenuation patterns and their interaction with gender and body habitus is critical for the accurate interpretation of SPECT-MPI.

Contains fulltext : 73300.pdf (Publisher’s version ) (Closed access) Aim. This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour. Background. Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives' views on women's positions have rarely been explored. Method. Six focus groups were conducted in 2006–2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk's models of informed consent and informed choice. Findings. The models were useful in distinguishing between two different approaches of midwives to women's positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman's consent for what they themselves prefer. When offering informed choice, a woman's preference is the starting point, but midwives will suggest other options if this is in the woman's interest. Obstetric factors and working conditions are reasons to deviate from women's preferences. Conclusions. To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions. 10 p.

(Semi) supine exercise testing has an established role in the evaluation of patients with valvular heart disease and can help clinical decision making. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. However, exercise-induced changes in valve hemodynamics, left ventricular outflow obstruction and pulmonary artery pressure depended on load variation. Changing position from supine to upright rapidly decreases load conditions for the ventricles. Therefore several cardiac centers have proposed exercise stress echocardiography in the upright position with gradient monitoring sometimes also in post-exercise recovery. Doppler measurement of subaortic gradient has been a very helpful and informative examination in several heart diseases (especially in hypertrophic cardiomyopathy, valve heart diseases, prosthesis dysfunction).

Background The aim of this study was to compare maternal labour and birth outcomes between women who gave birth on a birth seat or in any other position for vaginal birth and further, to study the relationship between synthetic oxytocin augmentation and maternal blood loss, in a stratified sample. Methods A re-analysis of a randomized controlled trial in Sweden. An on-treatment analysis was used to study obstetrical outcomes for nulliparous women who gave birth on a birth seat (birth seat group) compared to birth in any other position for vaginal birth (control group). Data were collected between November 2006 and July 2009. The outcome measurements included perineal outcome, post partum blood loss, epidural analgesia, synthetic oxytocin augmentation and duration of labour. Results The major findings of this paper were that women giving birth on the birth seat had shorter duration of labour and were significantly less likely to receive synthetic oxytocin for augmentation in the second stage of labour. Significantly more women had an increased blood loss when giving birth on the birth seat, but had no difference in perineal outcomes. Blood loss was increased regardless of birth position if women had been exposed to synthetic oxytocin augmentation during the first stage of labour. Conclusions The results of this analysis imply that women with a straightforward birth process may well benefit from giving birth on a birth seat without risk for any adverse obstetrical outcomes. However it is important to bear in mind that, women who received synthetic oxytocin during the first stage of labour may have an increased risk for greater blood loss when giving birth on a birth seat. Finally it is of vital importance to scrutinize the influence of synthetic oxytocin administered during the first stage of labour on blood loss postpartum, since excessive blood loss is a well-documented cause of maternal mortality worldwide and may cause severe maternal morbidity in high-income countries. Trial registration Unique Protocol ID: NCT01182038 (http://register.clinicaltrials.gov)

It was recently shown that expert face perception relies on the extraction of horizontally oriented visual cues. Picture-plane inversion was found to eliminate horizontal, suggesting that this tuning contributes to the specificity of face processing. The present experiments sought to determine the spatial frequency (SF) scales supporting the horizontal tuning of face perception. Participants were instructed to match upright and inverted faces that were filtered both in the frequency and orientation domains. Faces in a pair contained horizontal or vertical ranges of information in low, middle, or high SF (LSF, MSF, or HSF). Our findings confirm that upright (but not inverted) face perception is tuned to horizontal orientation. Horizontal tuning was the most robust in the MSF range, next in the HSF range, and absent in the LSF range. Moreover, face inversion selectively disrupted the ability to process horizontal information in MSF and HSF ranges. This finding was replicated even when task difficulty was equated across orientation and SF at upright orientation. Our findings suggest that upright face perception is tuned to horizontally oriented face information carried by intermediate and high SF bands. They further indicate that inversion alters the sampling of face information both in the orientation and SF domains.

Hirohiko Kakizaki1, Igal Leibovitch2, Yasuhiro Takahashi3, Dinesh Selva41Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan; 2Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel; 3Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; 4South Australian Institute of Ophthalmology and Discipline of Ophthalmology and Visual Sciences, University of Adelaide, AustraliaPurpose: To evaluate the effect of redundant lower eyelid skin on the eyelash direction in epiblepharon.Materials and methods: Asian patients with epiblepharon participated in this study. The lower eyelid skin was pulled downward in the upright position with the extent just to detach from eyelash roots, and the direction of the eyelashes was examined. These evaluations were repeated before surgery while the patients were lying supine under general anesthesia. Results: The study included 41 lower eyelids of 25 patients (17 females, 8 males, average age; 5.6 years, 16 cases bilateral, 9 unilateral). In the upright position, without downward traction of the skin, the eyelashes were vertically positioned and touching the cornea. The redundant skin touched only the eyelash roots and had minimal contribution to eyelash inversion. With downward skin traction, there was no significant change in the eyelash direction. In the supine position, the eyelashes were touching the cornea, and there was marked redundant skin that was pushing the eyelashes inward. With downward skin traction, there was no significant change.Conclusions: The direction of lower eyelashes in patients with epiblepharon was less influenced by lower eyelid skin redundancy than previously considered. The redundant skin is only a possible aggravating factor to epiblepharon.Keywords: epiblepharon, skin redundancy, upright, eyelash