Virtual patients design and its effect on clinical reasoning and student experience : a protocol for a randomised factorial multi-centre study

Background Virtual Patients (VPs) are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent) and structured clinical reasoning feedback (present or absent). Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent), and structured clinical reasoning feedback (present or absent).The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for both primary outcomes

The impact of tool selection on back and wrist injury risk in tying steel reinforcement bars: a single case experiment

The paper explores the risk of work-related musculoskeletal injury in tying steel reinforcement bars. Three tools are compared to determine the extent to which ergonomic tools can reduce the risk of injury to the back and wrist in steel-tying. A whole body system of wearable sensors was used to measure biomechanical risk in tying. Three tools were assessed to determine their impact on the risk of work-related musculoskeletal injury when used at different heights. These were: a conventional pincer-cutting tool; a power-driven tying tool, and a long handled stapler tool. No tool was found to work best in all situations. The long handled stapler tool significantly reduced trunk inclination when used from ground to shoulder height, but produced higher trunk extension (backward bending) when used above shoulder height. The power tying tool did not reduce the need to bend when working at lower work heights. The power-tying tool produced significantly lower peak wrist flexion values compared to the conventional pincer-cutter tool at all work heights except overhead. The power tying tool involved significantly lower levels of wrist rotation than the conventional pincer-cutter tool at all work heights above knee level. Many assessments of ergonomic risk factors in construction rely on observational methods. The use of small, lightweight wearable sensors permits the objective measurement of biomechanical risk factors for work-related musculoskeletal injury, as well as providing objective performance data that can be used in the design and selection of task-specific tools. Our analysis of work by height also provides insight into the way in which risk factors and reduction opportunities afforded by different tools vary depending on the height at which work is to be performed

Comfort-Centered Design of a Lightweight and Backdrivable Knee Exoskeleton

This paper presents design principles for comfort-centered wearable robots and their application in a lightweight and backdrivable knee exoskeleton. The mitigation of discomfort is treated as mechanical design and control issues and three solutions are proposed in this paper: 1) a new wearable structure optimizes the strap attachment configuration and suit layout to ameliorate excessive shear forces of conventional wearable structure design; 2) rolling knee joint and double-hinge mechanisms reduce the misalignment in the sagittal and frontal plane, without increasing the mechanical complexity and inertia, respectively; 3) a low impedance mechanical transmission reduces the reflected inertia and damping of the actuator to human, thus the exoskeleton is highly-backdrivable. Kinematic simulations demonstrate that misalignment between the robot joint and knee joint can be reduced by 74% at maximum knee flexion. In experiments, the exoskeleton in the unpowered mode exhibits 1.03 Nm root mean square (RMS) low resistive torque. The torque control experiments demonstrate 0.31 Nm RMS torque tracking error in three human subjects.Comment: 8 pages, 16figures, Journa

The impact of tool selection on back and wrist injury risk in tying steel reinforcement bars: a single case experiment

The paper explores the risk of work-related musculoskeletal injury in tying steel reinforcement bars. Three tools are compared to determine the extent to which ergonomic tools can reduce the risk of injury to the back and wrist in steel-tying. A whole body system of wearable sensors was used to measure biomechanical risk in tying. Three tools were assessed to determine their impact on the risk of work-related musculoskeletal injury when used at different heights. These were: a conventional pincer-cutting tool; a power-driven tying tool, and a long handled stapler tool. No tool was found to work best in all situations. The long handled stapler tool significantly reduced trunk inclination when used from ground to shoulder height, but produced higher trunk extension (backward bending) when used above shoulder height. The power tying tool did not reduce the need to bend when working at lower work heights. The power-tying tool produced significantly lower peak wrist flexion values compared to the conventional pincer-cutter tool at all work heights except overhead. The power tying tool involved significantly lower levels of wrist rotation than the conventional pincer-cutter tool at all work heights above knee level. Many assessments of ergonomic risk factors in construction rely on observational methods. The use of small, lightweight wearable sensors permits the objective measurement of biomechanical risk factors for work-related musculoskeletal injury, as well as providing objective performance data that can be used in the design and selection of task-specific tools. Our analysis of work by height also provides insight into the way in which risk factors and reduction opportunities afforded by different tools vary depending on the height at which work is to be performed

A Portable, Low-Cost Wheelchair Ergometer Design Based on a Mathematical Model of Pediatric Wheelchair Dynamics

Evaluation and training of wheelchair propulsion improves efficiency and prevents orthopaedic injury in pediatric manual wheelchair users. Ergometers allow static propulsion and emulate typical conditions. Currently available ergometers have deficiencies that limit their use in motion analysis. A new ergometer is developed and evaluated based on a model of wheelchair inertial dynamics that eliminates these deficiencies. This makes integrated motion analysis of wheelchair propulsion in current community, home, and international outreach efforts possible

Applying Design for Assembly Principles in Computer Aided Design to Make Small Changes that Improve the Efficiency of Manual Aircraft Systems Installations

The installation of essential systems into aircraft wings involves numerous labour-intensive processes. Many human operators are required to perform complex manual tasks over long periods of time in very challenging physical positions due to the limited access and confined space. This level of human activity in poor ergonomic conditions directly impacts on speed and quality of production but also, in the longer term, can cause costly human resource problems from operators' cumulative development of musculoskeletal injuries. These problems are exacerbated in areas of the wing which house multiple systems components because the volume of manual work and number of operators is higher but the available space is reduced.To improve the efficiency of manual work processes which cannot yet be automated we therefore need to consider how we might redesign systems installations in the enclosed wing environment to better enable operator access and reduce production time.This paper describes a recent study that applied design for assembly and maintainability principles and CATIA v5 computer aided design software to identify small design changes for wing systems installation tasks. Results show positive impacts for ergonomics, production time and cost, and maintainability, whilst accounting for aircraft performance and machining capabilities

Can virtual reality predict body part discomfort and performance of people in realistic world for assembling tasks?

This paper presents our work on relationship of evaluation results between virtual environment (VE) and realistic environment (RE) for assembling tasks. Evaluation results consist of subjective results (BPD and RPE) and objective results (posture and physical performance). Same tasks were performed with same experimental configurations and evaluation results were measured in RE and VE respectively. Then these evaluation results were compared. Slight difference of posture between VE and RE was found but not great difference of effect on people according to conventional ergonomics posture assessment method. Correlation of BPD and performance results between VE and RE are found by linear regression method. Moreover, results of BPD, physical performance, and RPE in VE are higher than that in RE with significant difference. Furthermore, these results indicates that subjects feel more discomfort and fatigue in VE than RE because of additional effort required in VE

Robotic design and modelling of medical lower extremity exoskeletons

This study aims to explain the development of the robotic Lower Extremity Exoskeleton (LEE) systems between 1960 and 2019 in chronological order. The scans performed in the exoskeleton system’s design have shown that a modeling program, such as AnyBody, and OpenSim, should be used first to observe the design and software animation, followed by the mechanical development of the system using sensors and motors. Also, the use of OpenSim and AnyBody musculoskeletal system software has been proven to play an essential role in designing the human-exoskeleton by eliminating the high costs and risks of the mechanical designs. Furthermore, these modeling systems can enable rapid optimization of the LEE design by detecting the forces and torques falling on the human muscles