Augmented reality for computer assisted orthopaedic surgery

In recent years, computer-assistance and robotics have established their presence in operating theatres and found success in orthopaedic procedures. Benefits of computer assisted orthopaedic surgery (CAOS) have been thoroughly explored in research, finding improvements in clinical outcomes, through increased control and precision over surgical actions. However, human-computer interaction in CAOS remains an evolving field, through emerging display technologies including augmented reality (AR) – a fused view of the real environment with virtual, computer-generated holograms. Interactions between clinicians and patient-specific data generated during CAOS are limited to basic 2D interactions on touchscreen monitors, potentially creating clutter and cognitive challenges in surgery. Work described in this thesis sought to explore the benefits of AR in CAOS through: an integration between commercially available AR and CAOS systems, creating a novel AR-centric surgical workflow to support various tasks of computer-assisted knee arthroplasty, and three pre–clinical studies exploring the impact of the new AR workflow on both existing and newly proposed quantitative and qualitative performance metrics. Early research focused on cloning the (2D) user-interface of an existing CAOS system onto a virtual AR screen and investigating any resulting impacts on usability and performance. An infrared-based registration system is also presented, describing a protocol for calibrating commercial AR headsets with optical trackers, calculating a spatial transformation between surgical and holographic coordinate frames. The main contribution of this thesis is a novel AR workflow designed to support computer-assisted patellofemoral arthroplasty. The reported workflow provided 3D in-situ holographic guidance for CAOS tasks including patient registration, pre-operative planning, and assisted-cutting. Pre-clinical experimental validation on a commercial system (NAVIO®, Smith & Nephew) for these contributions demonstrates encouraging early-stage results showing successful deployment of AR to CAOS systems, and promising indications that AR can enhance the clinician’s interactions in the future. The thesis concludes with a summary of achievements, corresponding limitations and future research opportunities.Open Acces

Benefits of a good posture in Cello playing the relation between posture and quality of performance / Mohd Iqbal Mohd Hisham

This study was carried out to addressed the benefits of posture in cello playing in relations between posture and quality of performance A total of five (5) respondents was selected to be interviewed during the period given of the study. A set of interview was designed and conducted to gain primary data from the respondents. A non-participant observation was also selected to be one of the data collection method in this study. From the overall findings, the study showed that there was two benefits gained by an appropriates posture in cello playing related towards the posture and the quality of performance. The study also carried out the causes that prevent cellists from executing the right posture while playing and the effects when cellists neglecting the right posture‘ In conclusion, the study the benefits towards posture in cello playing was addressed. Hence, recommendation for further research is included in this study

Trade liberalization and ready-made garments industry in Bangladesh

The study aims at examining the effect of trade liberalization on ready-made garments (RMG) industry in Bangladesh.It employs Johansen-Juselius Cointegration test and Vector Error Correction Modeling (VECM) on yearly data from January 1990 through September 2011. The results reveal a significant long-term relationship between RMG export of Bangladesh and the three tested explanatory variables (merchandise export of China and India plus domestic inflation in Bangladesh). The Granger Causality test shows the presence of dynamic relationship between the performance of RMG export of Bangladesh and the value of merchandise export from China and India. However, this dynamic relation is non-existent in relation to the inflation factor

Malaysian identity in design education: furniture and jewellery products / Marzuki Ibrahim ...[et al.]

Abstract –Incorporating issues of Malaysian identity in design education has become an important goal for educators in Malaysia recently. From theperspectiveofdesign students, many of them are constantly facing the dilemma of how to integrate identity in their design works.This paper reviews the literature that focuses on Malaysian identity. It begins with the development of education design in Malaysia followed by a review of furniture and jewellery design in Malaysia. This paper highlights a number of selected design works of furniture and jewellery design taken from the most recent winnersof design competitions and students’ project designswhichcarry the Malaysian identity in their designs.This paper concludes that design students as well as manufacturers have the responsibility of ensuring that furniture and jewellery products from Malaysia have the inherent look that is Malaysian by using local raw materials, applying Malaysian symbols and incorporating the cultural activities of Malaysians into the products. Besides bringing awareness in matters related to the Malaysian identity, this paper is also useful for design students, designers and manufacturers as a guideline to incorporate national identity into their design

Management of diabetes and arthritis –A systematic review

Purpose: Diabetes is a metabolic syndrome with reported musculoskeletal  effects. This systemic review aimed to identify a relationship between  diabetes and arthritis; disease-related risk factors, the effect of diet in disease management and the effect of anti-arthritic drugs on diabetes  treatment.Methods: This study analysed 20 articles identified and selected according to the study criteria. PRISMA guidelines were used for identification and screening of literature. Data search covered several primary databases, including Pubmed, Wiley library, Scopus, Clinical Trial Registry, etc.Results: The study findings suggest a significant correlation between  diabetes and arthritis. Obesity, impaired glucose tolerance (MS  components), vascular cell adhesion molecule 1 (VCAM-1) hypertension and dyslipidemia are the most common risk factors leading to disease progression. Omega -3-fatty acid showed no protective effect on disease condition.Conclusion: The findings indicate that anti-tumor necrosis factor (Tnf)-α, disease modifying antirheumatic drugs, and Interleukin receptors  antagonist improved the efficacy of diabetic medication and maintained blood sugar levels. However, Tnf-α reduced glucose intolerance, and therefore, its therapeutic use in conjunction with diabetic medications should be limited.Keywords: Diabetes, Arthritis, Risk factors, Diet, Pathogenesis, Disease progression, Medicatio

Assessment of hospital pharmacists' clinical knowledge and practical skill levels for pharmaceutical care in Madinah, Saudi Arabia

Purpose: To evaluate hospital pharmacists’ clinical knowledge and practical skill levels for pharmaceutical care.Methods: A quasi-experimental prospective longitudinal study design was used to evaluate the level of clinical skills with problem-based learning (PBL) sessions. Pharmacists’ in three different government hospitals in Madinah, Saudi Arabia recorded their responses or assessments in their work manuals for preparing reports. Instructors encouraged interactive learning by presenting case studies, in which pharmacists had to interpret medical history and clinical assessments of various body systems. Course learning design also focused on drug use evaluation, monitoring plans, and reaching clinical evidencebased decision-making.Results: A total of two hundred and fifty-five (255) hospital pharmacists participated in the study. The study sample was comprised of 128 (50.9 %) males and 127 (49.1 %) females. A significant (p < 0.01) difference was noticed between genders (male: 47.91 ± 7.15, female: 50.31 ± 4.88) for total mean scores of clinical skills. Cronbach’s alpha reliability coefficient for case data recitation was 0.91, while clinical assessment skills coefficient was 0.89. Overall, pharmacists reported that they “agree” (4.01 ± 0.67) that they acquired the ability to use case data recitation taught in the PBL; they also reported a positive evaluation (4.48 ± 0.58) of their ability to perform clinical data assessment.Conclusion: The findings indicate that pharmacist’s self-confidence to perform clinical assessment activities is low. Lack of confidence remains a critical education issue among pharmacists in the study setting.Keywords: Clinical pharmacy, Problem-based learning, Clinical skills, Pharmacist focus group, Therapeutics, Pharmaceutical car

Examining relationship between Palestine stock exchange and Amman stock exchange-cointegration approach

This paper aims at examining the probable equilibrium and dynamic relations between Palestine Stock Exchange (PEX) and Amman Stock Exchange (ASE). Within the framework of international trade theories, this study employs Engle-Granger Cointegration procedure (1987) as an estimation model involving monthly time series data from 1997 through 2011. The empirical results show that there is a significant equilibrium relationship between PEX and ASE, but fail to establish empirical evidence on dynamic relations between the two stock markets using Granger Causality tests. However, analysis of dynamic interactions during the post-sample period via Impulse-Response Functions and Variance Decomposition suggest that changes in ASE index do influence the performance of PEX

Burung Sebagai Subjek Reka Corak Ukkil Motif Senjata Tradisional Bajau Sama: Satu Pemerhatian Umum Bird As A Design Subject In The Ukkil Motif Of Bajau Sama Traditional Weaponry: A General Note

The value of wood carving motifs design created by the Bajau Sama craftsmens in Kota Belud is one of the uniqueness inherited by the Bajau ethnic groups in Sabah. This study discusses the uniqueness of Bajau wood carving motifs design with a bird as its source of inspiration. The subject of birds is appreciated in the design of Bajau traditional weapons. Birds that are used include burung Pimping, roasters (manuk) and dragons (naga). This study interpretes the value of Bajau woodcarvers in the design of bird-based motifs and their relationship to the cultural value of the Bajau Sama community in Kota Belud. This study has applied the process of collecting primary and secondary data. The primary data involved interviews with Bajau woodcarvers and observation of the carved motifs. Meanwhile, secondary data were collected from rjournals and books related to the art of wood carving in Malay world. The authors apply the principles of traditional Malay art and craft and the Semantic Differential method in analyzing the wood carving motifs. This observation is expected to provide a general understanding in the effort to fill in the literature gap of documentation and interpretation of the Bajau Sama motifs design especially on the subject of bird

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer

BACKGROUND: Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks’ presurgical AI treatment in ER+/HER2+ BCs. METHODS: All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS: HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14–5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION: Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse