Rasch analysis of the Patient Rated Elbow Evaluation questionnaire

© 2015 Vincent et al. Background: The Patient Rated Elbow Evaluation (PREE) was developed as an elbow joint specific measure of pain and disability and validated with classical psychometric methods. More recently, Rasch analysis has contributed new methods for analyzing the clinical measurement properties of self-report outcome measures. The objective of the study was to determine aspects of validity of the PREE using the Rasch model to assess the overall fit of the PREE data, the response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality and person separation index (PSI). Methods: A convenience sample of 236 patients (Age range 21-79 years; M: F- 97:139) with elbow disorders were recruited from the Roth|McFarlane Hand and Upper Limb Centre, London, Ontario, Canada. The baseline scores of the PREE were used. Rasch analysis was conducted using RUMM 2030 software on the 3 sub scales of the PREE separately. Results: The 3 sub scales showed misfit initially with disordered thresholds on17 out of 20 items), uniform DIF was observed for two items ( Carrying a 10lbs object from specific activities subscale for age group; and household work from the usual activities subscale for gender); multidimensionality and local dependency. The Pain subscale satisfied Rasch expectations when item 2 Pain - At rest was split for age group, while the usual activities subscale readily stood up to Rasch requirements when the item 2 household work was split for gender. The specific activities subscale demonstrated fit to the Rasch model when sub test analysis accounted for local dependency. All three subscales of the PREE were well targeted and had high reliability (PSI \u3e0.80). Conclusion: The three subscales of the PREE appear to be robust when tested against the Rasch model when subject to a few alterations. The value of changing the 0-10 format is questionable given its widespread use; further Rasch-based analysis of whether these findings are stable in other samples is warranted

End Effector Development for Automated Sandwich Assembly

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An In Vitro Study of the Role of Implant Positioning on Ulnohumeral Articular Contact in Distal Humeral Hemiarthroplasty

© 2017 American Society for Surgery of the Hand Purpose To investigate the effect of implant positioning on ulnohumeral contact using patient-specific distal humeral (DH) implants. Methods Seven reverse-engineered DH implants were manufactured based on computed tomography scans of their osseous geometry. Native ulnae were paired with corresponding native humeri and custom DH implants in a loading apparatus. The ulna was set at 90° of flexion and the humeral component (either native bone or reverse-engineered implant) was positioned from 5° varus to 5° valgus in 2.5° increments under a 100-N compressive load. Contact with the ulna was measured with both the native distal humerus and the reverse-engineered DH implant at all varus-valgus (VV) angles, using a joint casting method. Contact patches were digitized and analyzed in 4 ulnar quadrants. Output variables were contact area and contact pattern. Results Mean contact area of the native articulation was significantly greater than with the distal humeral hemiarthroplasty (DHH) implants across all VV positions. Within the native condition, contact area did not significantly change owing to VV angulation. Within the DHH condition, contact area also did not significantly change owing to VV angulation. Conversely, in the DHH condition, contact pattern did significantly change. Medial ulnar contact pattern was significantly affected by VV angulation. Lateral ulnar contact was variably affected, but generally decreased as well. Conclusions Ulnar contact patterns were changed as a result of VV implant positioning using reverse-engineered DH implants, most notably on the medial aspect of the joint. Implant positioning plays a crucial role in producing contact patterns more like those observed in the native joint. Clinical relevance Recent clinical evidence reports nonsymmetrical ulnar wear after DHH. This work suggests that implant positioning is likely a contributing factor and that more exact implant positioning may lead to better clinical outcomes

The Effect of Radial Head Hemiarthroplasty Stem Fit on Radiocapitellar Contact Mechanics: Is Loose Fit better than Rigidly Fixed?

Background/Methods: Radial head hemiarthroplasty is commonly employed to manage comminuted displaced fractures. With regards to implant fixation, current designs vary with some prostheses aiming to achieve a tight \u27fixed\u27 fit, and others utilizing a smooth stem with an over reamed \u27loose\u27 fit. The purpose of the present study was to evaluate the effect of radial head hemiarthroplasty stem fit on radiocapitellar contact using a finite element model which simulated both fixed (size-for-size) and loose (1, 2 & 3mm over reamed) stem fits. Hypothesis: It was hypothesized that a loose stem fit would improve radiocapitellar contact mechanics, with increased contact area and decreased contact stress, by allowing the implant to find its \u27optimal\u27 position with respect to the capitellum. Results/Discussion: This data suggests that the loose smooth stem radial head implant may be functioning like a bipolar implant in optimizing radiocapitellar contact. The \u27loose\u27 over reamed stem provided optimal contact mechanics of the metallic axisymmetric radial head implant compared to the \u27fixed\u27 stem. The 1mm over reamed stem reduced maximum contact stress without affecting contact area. Over reaming of 2mm provided the greatest decrease in maximum contact stress, albeit with a significant reduction in contact area. Over reaming of 3mm produced a larger amount of stress concentrations on the capitellum suggesting there may be a limit to how loose a smooth stem implant should be implanted

Invasion genetics of the Pacific oyster Crassostrea gigas in the British Isles inferred from microsatellite and mitochondrial markers

The Pacific oyster, Crassostrea gigas, native to northeast Asia, is one of the most important cultured shellfish species. In Europe, Pacific oysters first settled along the Atlantic coasts of France at the end of the 1960s but rapidly spread and are now widely established. Twenty-two sites in the United Kingdom (UK), Ireland, Denmark, France and Spain were sampled to assess genetic diversity and differentiation. Hatchery-propagated stocks from two hatcheries located in the UK also were included. Two main genetic clusters were identified from pairwise genetic differentiation indexes, Bayesian clustering methods or neighbour-joining analysis, based on 7 microsatellite loci: (1) a Northeast cluster (including feral samples from East England, Ireland and Denmark as well as UK hatchery stocks) and (2) a Southwest cluster (including samples from South Wales, South West England, France and Spain). The Southwest cluster had significantly higher allelic richness (A) and expected heterozygosity (He) (A: 45.68, He: 0.928) than in the Northeast (A: 26.58, He: 0.883); the two diverging by a small but significant FST value (FST=0.017, 95% CI: 0.014-0.021). A 739-bp fragment of the major noncoding region of the mitochondrial genome was sequenced in 248 oysters from 12 of the studied samples in Europe and in 25 oysters from Miyagi prefecture (Japan). A total of 81 haplotypes were found. Haplotype frequency analyses identified the same two clusters observed using microsatellites. This study highlights how the number and size of introduction events, aquaculture practices, genetic bottlenecks followed by genetic drift and natural dispersal can act concurrently to shape the genetic diversity and structure of introduced populations

Evaluation of a computational model to predict elbow range of motion

© 2014 The Author(s). Computer models capable of predicting elbow flexion and extension range of motion (ROM) limits would be useful for assisting surgeons in improving the outcomes of surgical treatment of patients with elbow contractures. A simple and robust computer-based model was developed that predicts elbow joint ROM using bone geometries calculated from computed tomography image data. The model assumes a hinge-like flexion-extension axis, and that elbow passive ROM limits can be based on terminal bony impingement. The model was validated against experimental results with a cadaveric specimen, and was able to predict the flexion and extension limits of the intact joint to 0° and 3°, respectively. The model was also able to predict the flexion and extension limits to 1° and 2°, respectively, when simulated osteophytes were inserted into the joint. Future studies based on this approach will be used for the prediction of elbow flexion-extension ROM in patients with primary osteoarthritis to help identify motion-limiting hypertrophic osteophytes, and will eventually permit real-time computer-assisted navigated excisions

Owl and Lizard: Patterns of Head Pose and Eye Pose in Driver Gaze Classification

Accurate, robust, inexpensive gaze tracking in the car can help keep a driver safe by facilitating the more effective study of how to improve (1) vehicle interfaces and (2) the design of future Advanced Driver Assistance Systems. In this paper, we estimate head pose and eye pose from monocular video using methods developed extensively in prior work and ask two new interesting questions. First, how much better can we classify driver gaze using head and eye pose versus just using head pose? Second, are there individual-specific gaze strategies that strongly correlate with how much gaze classification improves with the addition of eye pose information? We answer these questions by evaluating data drawn from an on-road study of 40 drivers. The main insight of the paper is conveyed through the analogy of an "owl" and "lizard" which describes the degree to which the eyes and the head move when shifting gaze. When the head moves a lot ("owl"), not much classification improvement is attained by estimating eye pose on top of head pose. On the other hand, when the head stays still and only the eyes move ("lizard"), classification accuracy increases significantly from adding in eye pose. We characterize how that accuracy varies between people, gaze strategies, and gaze regions.Comment: Accepted for Publication in IET Computer Vision. arXiv admin note: text overlap with arXiv:1507.0476

The effect of implant linking and ligament integrity on humeral loading of a convertible total elbow arthroplasty

© 2017 The British Elbow & Shoulder Society. Background: Both unlinked and linked total elbow arthroplasty (TEA) implants have been employed with no consensus as to the optimal design. The present study aimed to evaluate the effect of collateral ligament integrity and implant linkage on wear-inducing loads in a convertible TEA. Methods: Eight fresh frozen upper extremities were tested in an elbow motion simulator. A convertible TEA with an instrumented humeral stem was inserted using computer navigation. Elbow kinematics and humeral loading were recorded with the TEA both linked and unlinked. The collateral ligaments were then sectioned and testing was repeated. Results: In the dependent position, there was no effect of implant linkage or ligament sectioning on humeral loading. Humeral loading was significantly greater following sectioning of the collateral ligaments but not after linking the TEA with the arm in the valgus position. Humeral loading was significantly greater after linking the TEA but not after sectioning of the collateral ligaments and with the arm in the varus position. Conclusions: Collateral ligament integrity reduces wear-inducing loads for both an unlinked and linked TEA. Linkage of a convertible TEA increases humeral loading, which may have detrimental effects on implant longevity