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Objective: Measuring the severity of the lateral spinal curvature, or Cobb angle, is critical for monitoring and making treatment decisions for children with adolescent idiopathic scoliosis (AIS). However, manual measurement is time-consuming and subject to human error. Therefore, clinicians seek an automated measurement method to streamline workflow and improve accuracy. This paper reports on a novel machine learning algorithm of cascaded convolutional neural networks (CNN) to measure the Cobb angle on spinal radiographs automatically. Methods: The developed method consisted of spinal column segmentation using a CNN, vertebra localization and segmentation using iterative vertebra body location coupled with another CNN, point-set registration to correct vertebra segmentations, and Cobb angle measurement using the final segmentations. Measurement performance was evaluated with the circular mean absolute error (CMAE) and percentage within clinical acceptance ( $\le 5^{\circ }$ ) between automatic and manual measurements. Analysis was separated by curve severity to identify any potential systematic biases using independent samples Student’s t-tests. Results: The method detected 346 of the 352 manually measured Cobb angles (98%), with a CMAE of 2.8° and 91% of measurements within the 5° clinical acceptance. No statistically significant differences were found between the CMAEs of mild ( $ < 25^{\circ }$ ), moderate (25°-45°), and severe ( $\ge 45^{\circ }$ ) groups. The average measurement time per radiograph was 17.7±10.2s, improving upon the estimated average of 30s it takes an experienced rater to measure. Additionally, the algorithm outputs segmentations with the measurement, allowing clinicians to interpret measurement results. Discussion/Conclusion: The developed method measured Cobb angles on radiographs automatically with high accuracy, quick measurement time, and interpretability, suggesting clinical feasibility.

Spinal bracing is a proven effective treatment for children with adolescent idiopathic scoliosis (AIS). Four factors have been reported to affect brace treatment outcome including (1) growth or curve-based risk, (2) the in-brace correction, (3) the brace wear quantity, and (4) the brace wear quality. The in-brace correction is impacted by spinal flexibility. The quality of brace design also affects the in-brace correction and comfort which indirectly affects the brace wear quantity and quality. A traditional polypropylene spinal brace is bulky and uncomfortable, and its manufacturing process is labor intensive. As 3D printing technology becomes more common and advanced, there is a potential to manufacture spinal braces using 3D printing technology. The objectives of this paper were to report the immediate effectiveness and benefits in using 3D printed brace to treat children with AIS. Six children with AIS (5F, 1M; 12.9 ± 1.4 years old; Cobb angle: 26° ± 7°), who were new to brace treatment, were recruited. Spinal flexibility and pressure pad locations were acquired using ultrasound assisted method to ensure braces were designed properly. To manufacture the braces, all participants were scanned by a handheld 3D scanner to obtain their body shapes. The 3D braces were then printed with Nylon 12 material. The average in-brace Cobb angle correction was 10 ± 4° (41 ± 18% correction). The 3D brace was 33% thinner, 26% lighter, 37% lower cost and required 3.7 h less labor time to manufacture when compared with the standard polypropylene brace. As a conclusion, the 3D printed brace had good immediate treatment effectiveness, but the long-time effect is still required time to explore.

ABSTRACT: Identifying daily oviposition events for individual broiler breeders is important for bird management. Identifying non-laying birds in a flock that might be caused by improper nutrition or diseases can guide diet changes or disease treatments for these individuals. Oviposition depends on follicle maturation and egg formation, and follicle maturation can be variable. As such, the day and time of oviposition events of individual birds in a free-run flock can be hard to predict. Based on a precision feeding (PF) system that can record the feeding activity of individual birds, a recent study reported a machine learning model to predict daily egg-laying events of broiler breeders. However, there were 2 limitations in that study: 1) It could only be used to identify daily egg-laying events on a subsequent day; 2) The prediction outputs that were binary labels were unable to indicate more details among the outputs with the same label. To improve the previous approach, the current study aimed to predict and output the probability of daily oviposition events occurring using a specific time point in 1 day. In the current study, 706 egg-laying events recorded by nest boxes with radio frequency identification of hens and 706 randomly selected no-egg-laying events were used. The anchor point was newly defined in the current study as a specific time point in 1 day, and 26 features around the anchor point were created for all events (706 egg-laying events and 706 no-egg-laying events). A feed-forward artificial neural network (ANN) model was built for prediction. The area under the receiver operating characteristic (ROC) curve was 0.9409, indicating that the model had an outstanding classification performance. The ANN model could predict oviposition events on the current day, and the output was a probability that could be informative to indicate the likelihood of an oviposition event for an individual breeder. In situations where total egg production was known for a group, the ANN model could predict the probability of daily oviposition events occurring of all individual birds and then rank them to choose those most likely to have laid an egg.

This paper presents the methodology and challenges experienced in the microfabrication, packaging, and integration of a fixed-fixed folded spring piezoelectric energy harvester. A variety of challenges were overcome in the fabrication of the energy harvesters, such as the diagnosis and rectification of sol-gel PZT film quality and adhesion issues. A packaging and integration methodology was developed to allow for the characterizing the harvesters under a base vibration. The conditioning circuitry developed allowed for a complete energy harvesting system, consisting a harvester, a voltage doubler, a voltage regulator and a NiMH battery. A feasibility study was undertaken with the designed conditioning circuitry to determine the effect of the input parameters on the overall performance of the circuit. It was found that the maximum efficiency does not correlate to the maximum charging current supplied to the battery. The efficiency and charging current must be balanced to achieve a high output and a reasonable output current. The development of the complete energy harvesting system allows for the direct integration of the energy harvesting technology into existing power management schemes for wireless sensing.

The measurements of spinal curvatures using the ultrasound (US) imaging method on children with scoliosis have been comparable with radiography. However, factors influencing the reliability and accuracy of US measurement have not been studied. The purpose of this study is to investigate the effects of curve features and patients' demographics on US measurements and to determine which factors influence the reliability and accuracy. Two hundred children with scoliosis were recruited and scanned with US by one experienced operator and three trainees. One experienced rater measured the proxy Cobb angles from US images twice one week apart and compared the results with clinical radiographic records. The correlation and accuracy between the US and radiographic measurements were subdivided by different curve severities, curve types, subjects' weight status and US acquisition experiences. A total of 326 and 313 curves were recognized from radiographs and US images, respectively. The mean Cobb angles of the 13 missing curves were 17.4±7.4° and 11 at the thoracic region. Among the 16 curves showing large discrepancy (≥6°) between US and radiographic measurements, 7 were main thoracic and 6 were lumbar curves. Twelve had axial vertebral rotation (AVR) greater than 8°. The US scans performed by the experienced operator showed fewer large discrepancy curves, smaller difference and higher correlation than the scans from the trainees (3%, 1.7±1.5°, 0.95 vs 6%, 2.4±1.8°, 0.90). Only 4% missing and 5% large discrepancy curves were demonstrated for US measurements in comparison to radiography. The missing curves were mainly caused by small severity and in the upper spinal region. There was a higher chance of the large discrepancy curves in the main thoracic and lumbar regions with AVR>8°. A skilled operator acquired better US images and led to more accurate measurements especially for those subjects with larger curvatures, AVR and body mass index (BMI).

Prosthetic elevated vacuum is a suspension method used to reduce daily volume changes of the residual limb. Evaluation of the effectiveness of these systems is limited due to a lack of correlation to actual socket air pressure, particularly during unconstrained movements. This may explain some of the variability in functional outcomes reported in the literature. Our objective was to develop a light-weight portable socket measurement system to quantify internal socket air pressure, temperature, and acceleration; and to present preliminary results from implementation with three transtibial prosthesis users with mechanical elevated vacuum pumps. Participants completed five functional tasks with and without the vacuum pumps actively connected, including the 2-Minute Walk test, 5-Times Sit-to-Stand test, 4-Square Step test, L-Test, and Figure-8 test. Results demonstrated different gait profiles and pressure ranges for each user. Two of the participants demonstrated substantially lower air pressure (higher vacuum) over time while the pump was active compared to inactive. The minimum air pressure measured for all participants was -34.6 ± 7.7 kPa. One participant did not show substantial changes in pressure over time for either pump condition. Functional task performance was not significantly different between pump conditions. Correlation with accelerometer readings indicated peak positive pressures occurred just following initial contact of the foot in early stance, and the most negative pressures (highest vacuum) were observed throughout swing. This study has demonstrated the use of a portable data logging tool that may serve the clinical and research communities to quantify the operation of elevated vacuum systems, and better understand the variability of mechanical pump operation and overall system performance.

Spinal alignment can be assessed without radiation using three-dimensional ultrasound imaging (3DUS). Reliable measurements could inform the ideal arm position for scoliosis radiographs. This study determined the inter-evaluator reliability of axial vertebral rotation (AVR) measurements and sagittal curve angles in healthy females from 3DUS spinal images in standing with two common radiograph arm positions: Chin and abduction (Abd). Three novice evaluators (R1, R2, and R3) measured images once. The Bland-Altman bias and limits of agreement (LOA) were calculated. T5-T12 kyphosis measurements met our bias and LOA error threshold only for R1 vs R2 in the Chin position [-0.53° (-10.7,9.7)]. The distance between the bias and the LOA also met our acceptable threshold of 5° for all mean AVRTwist, and all but one AVRTwist measurements (R1-R2_Chin = 5.9°). Three lordosis measurements did not meet our acceptable threshold (R1-R2_Chin, R1-R3_Chin, and R2-R3_Abd). The inter-evaluator reliability of novice evaluators was adequate and did not differ significantly between positions.

This paper presents the experimental evaluation of a new piezoresistive MEMS strain sensor. Geometric characteristics of the sensor silicon carrier have been employed to improve the sensor sensitivity. Surface features or trenches have been introduced in the vicinity of the sensing elements. These features create stress concentration regions (SCRs) and as a result, the strain/stress field was altered. The improved sensing sensitivity compensated for the signal loss. The feasibility of this methodology was proved in a previous work using Finite Element Analysis (FEA). This paper provides the experimental part of the previous study. The experiments covered a temperature range from −50 °C to +50 °C. The MEMS sensors are fabricated using five different doping concentrations. FEA is also utilized to investigate the effect of material properties and layer thickness of the bonding adhesive on the sensor response. The experimental findings are compared to the simulation results to guide selection of bonding adhesive and installation procedure. Finally, FEA was used to analyze the effect of rotational/alignment errors.

In this article, we report on the new design of a miniaturized strain microsensor. The proposed sensor utilizes the piezoresistive properties of doped single crystal silicon. Employing the Micro Electro Mechanical Systems (MEMS) technology, high sensor sensitivities and resolutions have been achieved. The current sensor design employs different levels of signal amplifications. These amplifications include geometric, material and electronic levels. The sensor and the electronic circuits can be integrated on a single chip, and packaged as a small functional unit. The sensor converts input strain to resistance change, which can be transformed to bridge imbalance voltage. An analog output that demonstrates high sensitivity (0.03mV/me), high absolute resolution (1μe) and low power consumption (100μA) with a maximum range of ±4000μe has been reported. These performance characteristics have been achieved with high signal stability over a wide temperature range (±50oC), which introduces the proposed MEMS strain sensor as a strong candidate for wireless strain sensing applications under harsh environmental conditions. Moreover, this sensor has been designed, verified and can be easily modified to measure other values such as force, torque…etc. In this work, the sensor design is achieved using Finite Element Method (FEM) with the application of the piezoresistivity theory. This design process and the microfabrication process flow to prototype the design have been presented.

The North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis.To determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS.Fifty patients with AIS aged 10-18 years, with curves of 10°-45° and Risser grade 0-5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30-45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported.In the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and [Formula: see text] (95% CI -0.8 to 0.2, p = 0.006).Schroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS.NCT01610908.