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In immersive VR, a self-avatar that replicates the user’s movements and is viewed from a first-person perspective can substitute the real body. If the avatar’s movements are sufficiently synchronized with the user’s actual movements, the user can experience a sense of embodiment over the avatar. Recent studies have shown that discrepancies between the movements of the avatar and those of the user can be well tolerated while maintaining high levels of embodiment. The point at which a distortion is perceived (detection threshold) and its impact on the level of embodiment has not been studied in lower limb tasks such as gait. This study aimed to identify a detection threshold of gait asymmetry by unilaterally manipulating the step length of a self-avatar, and the effect of this detection on perceived embodiment. A real-time step length distortion model was developed, and a detection threshold between actual and avatar’s gait movement was assessed on thirty healthy participants. The step length was manipulated to introduce gait asymmetry (ascending condition) or start from a large asymmetry that was gradually decreased (descending). The results showed that, on average, the avatar’s step length could be increased by up to 12% before the participants detected the distortion. Furthermore, in the descending condition, they detected increases that were above 9%. The point of detection had no effect on the sense of embodiment as participants still reported being embodied in their avatars, even when they consciously detected the step length distortion. The sense of embodiment was closely correlated with the level of distortion; as distortion increased, embodiment decreased, and vice versa. For a given distortion level, embodiment was similar whether in the ascending or descending condition. This suggests that embodiment can be achieved even when the avatar’s spatial alignment initially differs from the participants’, provided that alignment is gradually restored. These results provide valuable insights into participants’ ability to tolerate movement discrepancies in embodied avatar experiences during gait in virtual environments, with potential applications in motor training and gait rehabilitation.

The integration of cutting-edge technologies, such as wearables, in complex systems is crucial for enhancing collaboration between humans and machines in the era of Industry 5.0. However, this increased interaction also introduces new challenges and risks, including the potential for human errors. A thorough analysis of the literature reveals an absence of studies that have quantified these risks, underscoring the utmost importance of this research. To address the above gap, the present study introduces the STPA-PSO methodology, which aims to quantify the risks associated with the use of smart glasses in complex systems, with a specific focus on human error risks. The proposed methodology leverages the Systems-Theoretic Process Analysis (STPA) approach to proactively identify hazards, while harnessing the power of the Particle Swarm Optimization (PSO) algorithm to accurately calculate and optimize risks, including those related to human errors. To validate the effectiveness of the methodology, a case study involving the assembly of a refrigerator was conducted, encompassing various critical aspects, such as the Industrial, Financial, and Occupational Health and Safety (OHS) aspects. The results provide evidence of the efficacy of the STPA-PSO approach in assessing, quantifying, and managing risks during the design stage. By proposing a robust and comprehensive risk quantification framework, this study makes a significant contribution to the advancement of system safety analysis in complex environments, providing invaluable insights for the seamless integration of wearables and ensuring safer interactions between humans and machines.

Recent research suggests that museum visits can benefit psychological well-being by reducing symptoms of stress and anxiety. However, these reported relaxing effects remain inconsistent between studies. Shedding light on the underlying cerebral mechanisms of museum visits might support a better understanding of how it affects psychological well-being. This study aimed to investigate the prefrontal engagement evoked by artwork analysis during a museum visit and to determine if these prefrontal substrates are associated with the museum’s effect on psychological well-being in older adults. Nineteen adults aged between 65 and 79, toured a Baroque-style exhibit at the Montreal Museum of Fine Arts for approximately 20 minutes while equipped with a near-infrared spectroscopy system measuring the prefrontal cortex’s hemodynamic activity. For each painting, participants received the instruction to either (1): analyze the painting and produce a personal interpretation of its signification (analytic condition) or (2) visualize the painting without any specific thoughts (visualization condition). Questionnaires measuring stress, anxiety, and well-being were administered before and after the visit. Sixteen older women (71.5 ± 4 years) were included in the analyses. Results showed that, at the group level, the analytic condition was associated with an increased activation pattern in the left ventrolateral prefrontal region, typically related to attentional processes (not observed in the visualization condition). The activation associated with the analytic condition predicted pre-/post-visit reductions in self-reported anxiety and stress in the sample of older women. These observations suggest that the level of engagement of attentional processes during artwork analysis may play a major role in the effect of a museum’s visit on self-reported symptoms of anxiety.

Building information modelling (BIM) and product lifecycle management (PLM) technologies provide automatic model checking (AMC) tools that can be used for the prevention of occupational health and safety (OHS) risks through design (PtD). Considering that the risks related to energy sources during the operation stage of industrial facilities can be major, our objective is to propose a PtD approach for this type of risk that uses AMC tools. For this purpose, our methodology is based on the information systems design-science paradigm. Considering that both BIM and PLM mock-ups can be used to design industrial facilities and that Catia V5 is one of the main software programs used to design industrial equipment and facilities, our methodology specifically includes a comparative literature review of the uses of AMC tools to check BIM and PLM mock-ups and a comparative study of the OHS risk prevention capabilities of the AMC tools available in Catia V5. Therefore, the PtD approach that we propose is specific to Catia V5. It consists of: 1) extracting rules related to hazardous energy control from regulatory requirements and classifying them according to their automation potential, 2) expressing the rules in a form that is compatible with the RASE method, 3) interpreting the rules using the RASE method, and 4) using a macro script to automatically check the compliance of the digital mock-ups. The proposed approach's contribution is that it makes it possible to support facility designers in automatically identifying hazardous energy sources in systems. In future studies, we intend to couple this PtD approach with methods that integrate dynamic system behavior to assess the level of risk corresponding to the hazardous sources identified.

BackgroundRapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI). ObjectiveThis study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative. MethodsA cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI. ResultsThe biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022. ConclusionsThe program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community. International Registered Report Identifier (IRRID)PRR1-10.2196/12506

BackgroundLiving labs in the health and well-being domain have become increasingly common over the past decade but vary in available infrastructure, implemented study designs, and outcome measures. The Horizon 2020 Project Virtual Health and Wellbeing Living Lab Infrastructure aims to harmonize living lab procedures and open living lab infrastructures to facilitate and promote research activities in the health and well-being domain in Europe and beyond. This protocol will describe the design of a joint research activity, focusing on the use of innovative technology for both rehabilitation interventions and data collection in a rehabilitation context. ObjectiveWith this joint research activity, this study primarily aims to gain insight into each living lab’s infrastructure and procedures to harmonize health and well-being living lab procedures and infrastructures in Europe and beyond, particularly in the context of rehabilitation. Secondarily, this study aims to investigate the potential of innovative technologies for rehabilitation through living lab methodologies. MethodsThis study has a mixed methods design comprising multiple phases. There are two main phases of data collection: cocreation (phase 1) and small-scale pilot studies (phase 2), which are preceded by a preliminary harmonization of procedures among the different international living labs. An intermediate phase further allows the implementation of minor adjustments to the intervention or protocol depending on the input that was obtained in the cocreation phase. A total of 6 small-scale pilot studies using innovative technologies for intervention or data collection will be performed across 4 countries. The target study sample comprises patients with stroke and older adults with mild cognitive impairment. The third and final phases involve Delphi procedures to reach a consensus on harmonized procedures and protocols. ResultsPhase 1 data collection will begin in March 2022, and phase 2 data collection will begin in June 2022. Results will include the output of the cocreation sessions, small-scale pilot studies, and advice on harmonizing procedures and protocols for health and well-being living labs focusing on rehabilitation. ConclusionsThe knowledge gained by the execution of this research will lead to harmonized procedures and protocols in a rehabilitation context for health and well-being living labs in Europe and beyond. In addition to the harmonized procedures and protocols in rehabilitation, we will also be able to provide new insights for improving the implementation of innovative technologies in rehabilitation. International Registered Report Identifier (IRRID)PRR1-10.2196/34537

BackgroundLiving Labs are user-centered, open innovation ecosystems based on a systematic user cocreation approach, which integrates research and innovation processes in real-life communities and settings. The Horizon 2020 Project VITALISE (Virtual Health and Wellbeing Living Lab Infrastructure) unites 19 partners across 11 countries. The project aims to harmonize Living Lab procedures and enable effective and convenient transnational and virtual access to key European health and well-being research infrastructures, which are governed by Living Labs. The VITALISE consortium will conduct joint research activities in the fields included in the care pathway of patients: rehabilitation, transitional care, and everyday living environments for older adults. This protocol focuses on health and well-being research in everyday living environments. ObjectiveThe main aim of this study is to cocreate and test a harmonized research protocol for developing big data–driven hybrid persona, which are hypothetical user archetypes created to represent a user community. In addition, the use and applicability of innovative technologies will be investigated in the context of various everyday living and Living Lab environments. MethodsIn phase 1, surveys and structured interviews will be used to identify the most suitable Living Lab methods, tools, and instruments for health-related research among VITALISE project Living Labs (N=10). A series of web-based cocreation workshops and iterative cowriting processes will be applied to define the initial protocols. In phase 2, five small-scale case studies will be conducted to test the cocreated research protocols in various real-life everyday living settings and Living Lab infrastructures. In phase 3, a cross-case analysis grounded on semistructured interviews will be conducted to identify the challenges and benefits of using the proposed research protocols. Furthermore, a series of cocreation workshops and the consensus seeking Delphi study process will be conducted in parallel to cocreate and validate the acceptance of the defined harmonized research protocols among wider Living Lab communities. ResultsAs of September 30, 2021, project deliverables Ethics and safety manual and Living lab standard version 1 have been submitted to the European Commission review process. The study will be finished by March 2024. ConclusionsThe outcome of this research will lead to harmonized procedures and protocols in the context of big data–driven hybrid persona development among health and well-being Living Labs in Europe and beyond. Harmonized protocols enable Living Labs to exploit similar research protocols, devices, hardware, and software for interventions and complex data collection purposes. Economies of scale and improved use of resources will speed up and improve research quality and offer novel possibilities for open data sharing, multidisciplinary research, and comparative studies beyond current practices. Case studies will also provide novel insights for implementing innovative technologies in the context of everyday Living Lab research. International Registered Report Identifier (IRRID)DERR1-10.2196/34567

When immersed in virtual reality, users who view their body as a co-located virtual avatar that reflects their movements, generally develop a sense of embodiment whereby they perceive the virtual body to be their own. One aspect of the sense of embodiment is the feeling of agency over the avatar, i.e., the feeling that one is producing the movements of the avatar. In contexts such as physical rehabilitation, telepresence and gaming, it may be useful to induce a strong sense of agency in users who cannot produce movements or for whom it is not practical to do so. Being able to feel agency over a walking avatar without having to produce walking movements could be especially valuable. Muscle vibrations have been shown to produce the proprioceptive perception of movements, without any movement on the part of the user. The objectives of the current study were to: 1-determine if the addition of lower-limb muscle-vibrations with gait-like patterns to a walking avatar can increase the illusory perception of walking in healthy individuals who are standing still; 2-compare the effects of the complexity of the vibration patterns and of their synchronicity on the sense of agency and on the illusory perception of walking. Thirty participants viewed a walking avatar from a first-person perspective, either without muscle vibrations or with one of four different patterns of vibrations. These five conditions were presented pairwise in a two-alternative forced choice paradigm and individually presented, after which participants answered an embodiment questionnaire. The displacement of center of pressure of the participants was measured throughout the experiment. The results show that all patterns of proprioceptive stimulation increased the sense of agency to a similar degree. However, the condition in which the proprioceptive feedback was realistic and temporally aligned with the avatar’s leg movements led to significantly larger anteroposterior sway of the center of pressure. The frequency of this sway matched the cadence of the avatar’s gait. Thus, congruent and realistic proprioceptive stimulation increases the feeling of agency, the illusory perception of walking and the motor responses of the participants when viewing a walking avatar from a first-person perspective.

We present the cases of 2 expansive juvenile psammomatoid ossifying fibromas from sinonasal origin. Our first patient presented with a fronto-ethmoidal mass invading the orbit and the cranial base and had a bicoronal approach for tumor removal. The second patient also had orbital involvement and underwent an endoscopic surgery. Complete resection of juvenile psammomatoid ossifying fibromas is paramount to avoid recurrence, thus preoperative recognition of their characteristic thick outer mantle and radiolucent core on imaging is key, but can be challenging. We herein discuss and propose a novel algorithm of differential diagnoses of facial bone lesions based on radiologic appearance. Keywords: Bone neoplasms, Paranasal sinuses, Facial bones

Abstract Background Post-stroke physical inactivity is explained by several factors related to the stroke, which have been suggested as the causes and consequences of functional declines and health problems. Therefore, it is important to increase physical activity levels and reduce the time spent in low-energy expenditure activities after a stroke. Since the maintenance of cardiorespiratory fitness is a significant predictor of physical activity levels post-stroke, it may be important to investigate whether aerobic training is effective in increasing physical activity levels and reducing the time spent in low-energy expenditure activities in this population. The efficacy of aerobic training on these variables is not well known. The primary objective of this trial will be to investigate the effects of aerobic treadmill training on physical activity levels and on time spent in low-energy expenditure activities in people with stroke. The secondary aim will be to evaluate the effects of the training on cardiorespiratory fitness, endurance, depression, mobility, quality of life, and participation. Methods/design A randomized controlled trial, with blinded assessments, will be performed in a community-based setting. Altogether, 22 adults with a diagnosis of stroke (>6 months) who are sedentary or insufficiently active will be included. Participants will be randomly assigned to either: (1) aerobic treadmill training (experimental group, at 60–80% of their heart rate reserve) or (2) walking outside (control group, below 40% of heart rate reserve). Both groups will attend 40-min training sessions, three times per week over 12 weeks, in groups of two to four participants, with a trained physiotherapist. Primary outcomes are physical activity levels and time spent in low-energy expenditure activities (Multi-sensor SenseWear Mini® and Human Activity Profile). Secondary outcomes are cardiorespiratory fitness (peak oxygen uptake VO2peak and ventilatory threshold), endurance, depression, mobility, quality of life, and participation. The effects of the training will be analyzed from the collected data using intention to treat. Between-group differences will be measured by two-way repeated measures ANOVA, considering the baseline, post-training, and 4-week follow-up. Discussion The results of this trial will likely provide valuable new information on the effects of aerobic treadmill training on physical activity levels and on time spent in low-energy expenditure activities of individuals with stroke, through changes in cardiorespiratory fitness. Trial registration ClinicalTrials.gov, NCT02798237. Registered on 13 June 2016.

Manual assembly operations are sensitive to human errors that can diminish the quality of final products. The paper shows an application of human reliability analysis in a realistic manufacturing context to identify where and why manual assembly errors occur. The techniques SHERPA and HEART were used to perform the analysis of human reliability. Three critical tasks were selected for analysis based on quality records: (1) installation of three types of brackets using fasteners, (2) fixation of a data cable to the assembly structure using cushioned loop clamps and (3) installation of cap covers to protect inlets. The identified error modes with SHERPA were: 36 action errors, nine selection errors, eight information retrieval errors and six checking errors. According to HEART, the highest human error probabilities were associated with assembly parts sensitive to geometry-related errors (brackets and cushioned loop clamps). The study showed that perceptually engaging assembly instructions seem to offer the highest potential for error reduction and performance improvement. Other identified areas of action were the improvement of the inspection process and workers’ provision with better tracking and better feedback. Implementation of assembly guidance systems could potentially benefit worker’s performance and decrease assembly errors.

In recent years, the focus in safety management has shifted from failure-based analysis towards a more systemic perspective, redefining a successful or failed performance as a complex and emergent event rather than as a conclusion of singular errors or root causes. This paradigm shift has also necessitated the introduction of innovative tools capable of capturing the complex and dynamic nature of modern sociotechnical systems. In our research, we argued at previous stages for adopting a more systemic and human-centric perspective to evaluate the context of aircraft de-icing operations. The Functional Resonance Analysis Method (FRAM) was applied in the first stage for this purpose. Consequently, fuzzy logic was combined with FRAM in the second stage to provide a quantified representation of performance variability. Fuzzy logic was used as a quantification tool suitable for computing with natural language. Several limitations were found in the data collection and rule generation process for the first prototype. In the third phase, the model was further improved by integrating rough sets as a data-mining tool to generate and reduce the size of the rule base and classify outcomes. In this paper, we reflect on the three stages of the project and discuss in a qualitative manner the challenges and limitations faced in the development and application of the models. A summary of the advantages and disadvantages of the three models as experienced in our case are presented at the end. The objective is to present an outlook for future studies to address methodological limitations in the study of complex sociotechnical systems.

Understanding the intervertebral disc response to mechanical loads is important to prevent back injuries. The experimental and the finite element methods are widely used for that purpose but methodological triangulation is deficient due to lack of a complementary method. This study aims at choosing theories and assumptions that could be used to develop an analytical model for stress analysis of intervertebral discs. Thin-shell and beam-on-elastic-foundation theories are used in conjunction with an iterative method to account for large deformation of the disc. The model simulates an axial compression load acting on a simplified axisymmetric disc composed of a multi-shell linear and isotropic structure surrounding a pressurized cavity. The highly deformable lamellae are idealized by either circular or parabolic arches in the sagittal plane, and their effect on stress and strain response are compared. The circumferential and longitudinal stresses are compared to those of a simplified finite element model. The comparison shows that the analytical approach is promising and allows to identify improvements for future studies. The use of a parabolic profile is advantageous and allows to account for the interactive support of the lamellae near the endplates. The method should be adapted to improve bulge deformation obtained across the thickness of anulus fibrosus, and the model should include material anisotropy and hyperelasticity.

Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.

Solitary fibrous tumors (SFTs) were first described as spindle-cell tumors originating from the pleura. Until recently, there was some debate with regards to the name and origin of these tumors and the distinctions with the term haemangiopericytomas (HPCs), a rare type of vascular tumor . Morphological, immunohistochemical and clinical features of HPCs were not specific for one entity. With the exception of myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract showing myoid differentiation, all other HPC-like lesions are best considered as subtypes of SFT. Due to their mesenchymal origin, we are now aware that SFTs may involve several extrapleural sites including soft tissues or meninges. When SFTs involve the skull base and show malignant histological characteristics, they can be an important challenge for the surgical team. We report a case of a 54-year-old man complaining of poor vision and facial pain that had worsened over the last year. Computed tomography and magnetic resonance imaging indicated a large mass, involving the right infratemporal and pterygomaxillary fossa. A biopsy proved positive for a solitary fibrous tumor with malignant features. Surgery was performed using a combined approach of frontotemporal craniotomy and nasal endoscopy. The subtotal resection, conducted due to nodularity on the dura mater, was a success and was complemented by postoperative radiation therapy. Follow-up MRIs showed no recurrence of the tumor. To the authors’ knowledge, this is the first reported case of a massive SFT involving this region, treated with minimal invasive surgery without any facial osteotomies.