Customised design of a patient specific 3D printed whole mandible implant

In this study we investigate the design methodology for the creation of a patient specific, whole mandible implant based on a patient’s medical imaging data. We tailor the implant as a treatment option for a patient who will undergo a mandibulectomy due to cancer infiltration of the jaw. We create a 3D representative model of the patient’s skeletal structure from CT scan data, and us this to generate the implant from the patient’s corrupt mandible. In this particular case study the cancer is restricted to the right region of the mandible, and so the left side is used in a symmetry matching approach to create the final model for manufacturing. The final design was 3D printed in medical grade titanium and finished using a mechanical polishing technique, the yield a near mirror finish. We found the final implant to be highly robust, and an excellent fit to a representative model of the patient’s skeletal anatomy. We believe this approach to hold considerable potential for implementation as a treatment option for mandibular complications.

Governing the soil: Natural farming and bionationalism in India

This article examines India’s response to the global soil health crisis. A longstanding centre of agricultural production and innovation, India has recently launched an ambitious soil health programme. The country’s Soil Health Card (SHC) Scheme intervenes in farm-scale decisions about efficient fertiliser use, envisioning farmers as managers and soil as a substrate for production. India is also home to one of the world’s largest alternative agriculture movements: natural farming. This puts farmer expertise at the centre of soil fertility and attends to the wider ecological health of soils. Despite emerging as a mode of resistance to dominant agricultural systems, natural farming is now being delivered in increasingly bureaucratic ways by India’s state governments. This article offers Himachal Pradesh as a case study in how the soil is governed, drawing on 38 semi-structured interviews with scientists, agricultural officers, non-governmental organisation leaders, and activists. Rather than assess approaches to soil health according to their ecological bottom line, we examine the differing forms of knowledge, expertise and ‘truth’ in the SHC and Natural Farming approaches. Our analysis reveals discontinuities in how farmers are imagined, as well as continuities in how quasi-spiritual language combines in a bionationalist project, positing assumptions about the correct arrangement of life in nationalist terms. We point to a shift toward hybrid and pick-and-mix approaches to soil health, as farmers and their organisers are increasingly invested with the capacities to combine multiple options. We see a fracturing of expertise and the opening up of epistemic pluralism in responses to the soil fertility crisis

Stylistic analysis of stone arrangements supports regional cultural interactions along the northern Great Barrier Reef, Queensland

Stone arrangements are frequently encountered on the Australian mainland and islands. They have high significance values to Indigenous Australians and are usually associated with the material expression and emplacement of socio-religious beliefs and associated ceremonial/ritual activities. Despite their ubiquity, stone arrangements are an understudied site type with their distribution and morphological variability remaining poorly documented and their functional variability poorly understood. Although in most parts of Australia the authorship of stone arrangements is unambiguously Aboriginal, for far north Queensland this is less clear for places where Aboriginal people and Torres Strait Islanders, and more recently South Sea Islanders, all with documented traditions of stone arrangement construction and use, are known to have operated. A comparative stylistic analysis of stone arrangements constructed by Aboriginal people, Torres Strait Islanders and Island Melanesians of the southwest Pacific reveals that although Lizard Island Group stone arrangements are predominately of Aboriginal authorship, some arrangements exhibit cultural influences from neighbouring areas. In this respect, Lizard Island Group stone arrangements appear to be a further material expression of the Torres Strait Cultural Complex and Coral Sea Cultural Interaction Sphere

Monitoring Training Load Using the Acute: Chronic Workload Ratio in Non-Elite Intercollegiate Female Athletes

Monitoring training load and its progression in athletes is important to optimise adaptations to training while simultaneously preventing injury. A recent development in this field is the acute: chronic workload ratio (ACWR), which track s average acute training load against average chronic training load to describe training load progression. Furthermore, a new method of calculating the ACWR has been developed using exponentially weighted moving averages (EWMA) which accounts for the decay of fitness and fatigue. This study sought to investigate the relationship between the EWMA and ACWR (based upon session rating of perceived exertion (sRPE)), and injury risk in intercollegiate female athletes (N=4). Participants performed adductor squeeze tests (ASTs) once a week for 8 week s, while their training and wel lness were monitored with sRPE and a daily questionnaire respectively. A hierarchical regression demonstrated that monitoring of average sleep length, average stress, sRPE work loads and an EWMA provided the best model for predicting injury risk in athletes (R2 = 0.47). The findings indicate that the EWMA may be a effective training load monitoring tool than the ACWR model

Design of a Patient Specific, 3D printed Arm Cast

3D printing is a manufacturing technique by which the material is added layer by layer to create a physical three-dimensional object. This manufacturing technique had primarily found uses in academic and commercial sectors for prototyping and product realization purposes. However, more recently the home consumer market has seen a surge in low cost printers bringing this capability to the masses. More recently 3D printing has seen considerable interest from the clinical sector, where alongside the synergistic use with medical imaging data, a whole generation of patient specific implantable technologies, splints/casts and resection guides can be created. Predominantly, clinical applications have focused on the use of 3D printing for bone replacement, however with the advent of more sophisticated multi-material printers, interest has now begun to move to applications in orthotics and orthopedic casting.This study is to review and evaluate the feasibility of designing and realizing a more patient specific orthopedic cast to surpass current limitation with traditional fiberglass/plaster casts, through the use of advanced 3D modelling and printing techniques. To directly compare the efficacy of the traditional and 3D printed casts, we shall investigate critical parameters such as the time for manufacture, the overall weight of the final product, the accuracy off the cast relative to the patient’s unique anatomy and additional user-centric metrics (comfort, aesthetics, etc.). The design examined made use of advanced mesh structures throughout the bulk of the cast, such that the device would require less material (by weight) during fabrication, could allow for tunable weight and mechanical properties and allow for air penetration to the person skin, thereby reducing discomfort due to prolonged moisture exposure (chaffing, bad smells, etc.). As the primary focus of this study is the design and product realization phases and we shall not assess metrics relating to patient recover time or experience.Overall it was found that the 3D printed cast was significantly lighter, with improved water repellent and air circulation properties, as compared to a traditional cast. Through the use of high precision design/manufacturing techniques, the final device could be accurately reproduced to match the test patient’s unique anatomy, thereby optimizing the orientation of the patient’s bones during post fracture recovery. It was however found that the manufacturing time for the 3D printed cast was slower than traditional casting methods owing to the additional time during the design phase. In future work we aim to address this limitation and to devise a streamlined methodology such that a generic cast design can be adapted to patient specific anatomical data through parametric design algorithms.Ultimately, it was found that through the use of advanced design techniques, patient specific data and 3D printing, a custom orthopedic cast could be realized and with significant potential to augment current use of this technology for surgical intervention and improve patient outcomes. The use of advanced manufacturing in the medical field will likely enable more patient specific/user-centric treatment in the near future

“It’s About Walking Alongside a Family”: Practitioner Perspectives on Caregiver Coaching With Families of Children Who Are Deaf or Hard of Hearing

Practitioners utilize caregiver coaching in early intervention services, but coaching principles and practices are not well understood in the context of listening and spoken language (LSL) services with families of children who are deaf or hard of hearing. The purpose of this study was to examine practitioners’ experiences with coaching, including definitions, training, and practices they utilize in their work with families. Using semi-structured, qualitative interviews and video observation discussions, this study examined the perspectives of 14 practitioners providing LSL services to families at three intervention sites in the US and Canada. Results indicate that practitioners’ underlying beliefs about their coaching proficiency and caregivers’ capacity impact their coaching practices and how they engage with caregivers. Results highlight practices such as mentoring and accountability that supported practitioners’ coaching skills. This study contributes to the understanding of caregiver coaching in LSL practice and has implications for practitioners working to improve their coaching skills, which may improve LSL services and optimize child outcomes

Design optimisation of a thermoplastic splint

Following partial hand amputation, a post-surgery orthosis is required to hold the remaining ligaments and appendages of the patient in a fixed position to aid recovery. This type of orthosis is traditionally handmade and fabricated using laborious and qualitative techniques, which would benefit from the enhancements offered by modern 3D technologies. This study investigated the use of optical laser scanning, Computer Aided Design (CAD) and Material Extrusion (ME) additive manufacturing to manufacture a polymeric splint for use in post-surgical hand amputation. To examine the efficacy of our techniques, we take an existing splint from a patient and use this as the template data for production. We found this approach to be a highly effective means of rapidly reproducing the major surface contours of the orthosis while allowing for the introduction of advanced design features for improved aesthetics, alongside reduced material consumption. Our demonstrated techniques resulted in a more lightweight and lower cost device, while the design and manufacturing elements afford greater flexibility for orthosis customisation. Ultimately, this approach provides an optimized and complete methodology for orthosis production

“It gives me confidence”: Caregiver Coaching From the Perspective of Families of Children Who Are Deaf or Hard of Hearing

Caregiver coaching is utilized in early intervention services with families of children who are deaf or hard of hearing to increase caregivers’ skills and confidence in supporting their child’s language development, but few studies have examined coaching from the perspective of the caregivers. The purpose of this study was to increase understanding of caregivers’ experiences of coaching in the context of listening and spoken language intervention services. Using semi-structured, qualitative interviews, this study examined 13 caregivers’ perspectives at three intervention sites in the US and Canada. Results indicate that caregivers perceive that practitioner characteristics, expectations, and the evolution of the coaching relationship over time contribute to a positive caregiver coaching relationship. This study contributes to the understanding of the caregiver coaching experience and has implications for new and experienced practitioners working to improve their practice by establishing and strengthening collaborative caregiver coaching relationships with the families they serve