Combining inertial-based ergonomic assessment with biofeedback for posture correction: a narrative review

Work-related musculoskeletal disorders (WRMSDs) are the most reported work-related health problem in the European Union, representing an economic burden equivalent to 2% of its gross domestic product. Awkward postures are one of the main risk factors. Several postural assessment tools try to identify ergonomic exposure factors for evaluating WRMSD risk, yet these are commonly based on observation. Replacing observations with objective measurements can bring more accuracy and reproducibility to this analysis; hence, a direct measurement approach for the assessment is desired. This review looks for two-fold solutions, able to not only monitor workers’ posture using inertial sensors but also to return that information to the user, in a biofeedback loop. It presents systems for posture risk assessment, regarding ergonomic methods, sensors’ and actuators’ characteristics, and validation protocols. In particular, this review advances previous manuscripts by exploring the literature regarding different biofeedback strategies and ways to encode meaningful information in the cues, i.e., able to deliver intuitive ergonomic guidance so that the user becomes aware and changes into a more neutral posture. The combination of inertial sensors and vibrotactile motors stood out, due to its effectiveness in reducing postural risk. Directional feedback to guide users’ segments individually was found to be a promising strategy, although its validation is still limited. The results of the reviewed manuscripts pointed out the relevant practices, potentialities, and limitations of the existing solutions, allowing the identification of future challenges.This work was supported in part by the Fundação para a Ciência e Tecnologia (FCT) under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, and the INTEGRATOR project under Grant 2022.15668.MIT. Sara Cerqueira was supported by the doctoral Grant FRH/BD/151382/2021, financed by FCT, under MIT Portugal Program

Brain zinc chelation by diethyldithiocarbamate increased the behavioral and mitochondrial damages in zebrafish subjected to hypoxia

The increase in brain levels of chelatable zinc (Zn) in dysfunctions involving oxygen deprivation has stimulated the treatment with Zn chelators, such as diethyldithiocarbamate (DEDTC). However, DEDTC is a redox-active compound and it should be better evaluated during hypoxia. We use the hypoxia model in zebrafish to evaluate DEDTC effects. The exploratory behavior, chelatable Zn content, activities of mitochondrial dehydrogenases, reactive species levels (nitric oxide, superoxide anion, hydroxyl radical scavenger capacity) and cellular antioxidants (sulfhydryl, superoxide dismutase) of zebrafish brain were assessed after recovery, with or without 0.2mM DEDTC. The increased brain levels of chelatable Zn induced by hypoxia were mitigated by DEDTC. However, the novel tank task indicated that DEDTC did further enhance the exploratory deficit caused by hypoxia. Furthermore, these behavioral impairments caused by DEDTC were more associated with a negative action on mitochondrial activity and brain oxidative balance. Thus, due to apparent pro-oxidant action of DEDTC, our data do not support its use for neuroprotection in neuropathologies involving oxygen deprivation

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Burden of non-communicable diseases among adolescents aged 10–24 years in the EU, 1990–2019: a systematic analysis of the Global Burden of Diseases Study 2019

Background Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU. Methods Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10–14 years, 15–19 years, and 20–24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State. Findings In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5–88·8) of all YLDs and 38·8% (37·4–39·8) of total deaths in adolescents aged 10–24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62–4·25] per 100 000 population) and YLLs (281·78 [254·25–298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56–2773·47] per 100 000 population) and DALYs (2040·59 [1433·96–2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10–24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04–12·28] vs 7·89 [7·53–8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78–10 701·59] vs 6083·91 [4576·63–7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10–24 years substantially decreased (–40·41% [–43·00 to –37·61), and also the YLL rate considerably decreased (–40·56% [–43·16 to –37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=–0·46, p=0·015), neoplasms (rs=–0·57, p=0·0015), and sense organ diseases (rs=–0·61, p=0·0005)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Reconhecimento de posturas baseado em deep learning para uma framework de avaliação ergonómica holística

Dissertação de mestrado em Biomedical Engineering Medical ElectronicsWork-related musculoskeletal disorders (WRMSDs) are the most reported work-related health problem in the European Union, representing an economic burden equivalent to 2% of its gross domestic product. Several postural assessment tools try to identify ergonomic exposure factors for evaluating WRMSD risk, however, these are commonly based on observation. Thus, in an attempt to prevent WRMSD, it becomes crucial to quantify, automatise, but also complement posture risk assessment. This dissertation aims to develop a framework for a holistic and intuitive ergonomic assessment, able to, through inertial data, not only qualitatively identify posture but also to quantify the ergonomic risk, generating a report where the ergonomic score is associated with the postures adopted. This empowers the workers to comprehend which are the hazardous postures, and the ergonomists and line managers to possibly redesign the work tasks. The working postures of the two activity sectors most affected by WRMSDs were addressed as use cases, with the acquisition of an inertial dataset during the simulation of their typical tasks in circuit. The recognition of the postures performed was carried out by Deep Learning models. Different archi tectures were adapted and studied. The best results were achieved with a hybrid model that combines convolutional and recurrent layers, which attained an F1-score of 94.31% in the test. To better understand the models’ decisions, the explainability method Gradient-weighted Class Activation Mapping (Grad-CAM) was applied on the Convolutional Neural Network outputs. The continuous posture assessment, primarily based on a standard ergonomic method, also consid ered the previous postures’ impact on joint stress, by means of a kinematic wear index that can be used to define a safety threshold for how long joint angles can be maintained. As future work, the use of low-cost sensors in a self-developed smart garment and the integration of outlined haptic biofeedback strategies for the delivery of ergonomic haptic guidance are pointed out.As Lesões Musculoesqueléticas Relacionadas com o Trabalho (LMERT) são o problema de saúde relacionado com o trabalho mais reportado na União Europeia, com um encargo económico de 2% do produto interno bruto. Diversas ferramentas de avaliação postural tentam identificar fatores de exposição ergonómica para avaliar o risco de LMERT, mas são geralmente baseadas na observação. Assim, torna-se vital, para prevenir LMERT, quantificar, automatizar e também complementar a avaliação do risco postural. Esta dissertação visa desenvolver uma framework para avaliação ergonómica e intuitiva, que, a partir de dados inerciais, identifique qualitativamente a postura e quantifique o risco ergonómico, gerando um relatório onde o resultado ergonómico é associado às posturas adotadas. Isto habilita os trabalhadores a compreender quais as posturas prejudiciais e os ergonomistas e gestores de linha a possivelmente redesenhar as tarefas de trabalho. As posturas de trabalho dos dois setores de atividade mais afetados por LMERT foram endereçadas, adquirindo um dataset inercial durante tarefas típicas destes em circuito. O reconhecimento das posturas executadas foi realizado por modelos de Deep Learning. Diversas arquiteturas foram adaptadas e estudadas. Os melhores resultados foram alcançados com um modelo híbrido que combina camadas convolucionais e recorrentes, que chegou a um F1-score de 94,31% no teste. Para entender melhor as decisões dos modelos, o método de explicabilidade Gradient-weighted Class Activation Mapping (Grad-CAM) foi aplicado nos outputs de uma rede neuronal convolucional (CNN). A avaliação postural contínua, baseada, em primeiro lugar, num método ergonómico padrão, também considerou o impacto das posturas prévias no stress articular, com um índice de desgaste cinemático, que pode definir um limite de segurança para o tempo que os ângulos das articulações podem ser mantidos. Como trabalho futuro, apontam-se o uso de sensores de baixo custo num vestível inteligente e a integração das estratégias de biofeedback háptico delineadas para ajudar a conduzir para a postura neutra

Towards a user-specific ergonomics-based approach for an activity assessment tool

Work-related musculoskeletal disorders (WRMSDs) are the most reported work-related health problem in European Union. These are multifactorial disorders, influenced not only by sustained or repeated awkward postures but also by each worker’s individual and psychosocial context. Thus, it becomes crucial to quantify and automatize risk assessment, in an attempt to prevent and reduce WRMSD. This work presents the design of a solution for a user-specific assessment based on ergonomics for posture correction through an intuitive haptic feedback strategy to increase posture self-awareness and guide the user into a more neutral posture. The user’s angular configurations are continuously evaluated with a risk score, based on an ergonomic method, and then associated with the postures where those risks occurred. Posture is intended to be predicted by a deep learning model. Moreover, a joint kinematic wear index is used to carry out a cumulative assessment, taking into account the past postures’ scores. Inertial data from three individuals was collected and analyzed to perform movement analysis and define the ground truth of the recognition model. The resulting kinematic parameters’ ranges are presented. An offline risk assessment was also conducted, showing the potential of the cumulative approach for a more complete and meaningful evaluation.This work was supported in part by the Fundação para a Ciência e Tecnologia (FCT) under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, and by the FEDER Funds through the COMPETE 2020—Programa Operacional Competitividade e Internacionalização (POCI) and P2020 with the Reference Project SmartOs Grant POCI-01-0247-FEDER-039868. Sara Cerqueira was supported by the doctoral Grant SFRH/BD/151382/2021, financed by the Portuguese Foundation for Science and Technology (FCT), under MIT Portugal Program

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved