Evaluation of Using 3D Printing to Design and Build OMM Spinal Models for Teaching and Education

INTRODUCTION: Understanding spinal mechanics is the foundation for osteopathic manipulative medicine (OMM) training. With such knowledge, osteopathic physicians may confidently diagnose and treat spinal somatic dysfunctions. However, a dynamic and objective teaching tool to educate students on spinal mechanics has not been established. While 3D printing is gaining utility in academia, it is only just beginning to be employed within osteopathic educational settings. A literature review found a single study exploring the use of 3D printing to educate students on rib mechanics. Our study makes use of 3D printing to develop a functional model to teach and test students on spinal mechanics. OBJECTIVE: The primary objective of this study is to develop a working OMM model of the spine for educational and testing purposes. DESIGN/METHODOLOGY: This was a design-and-build project consisting of three phases. The primary endpoint was to have a model that could emulate rotational and sidebending motions of the human spine. The secondary endpoint included modifying the model to artificially create constraints on the system representing somatic dysfunction. The initial model was made from sponges and Lego blocks. It replicated sidebending and rotational motion while lacking a realistic human endfeel. The second model maintained the Lego base but incorporated 3D printing to manufacture manipulatable vertebrae. This corrected for the lack of human end-feel, but lacked sidebending capabilities. The final model incorporated both 3D printing and an adjustable cradle to create reproducible somatic dysfunctions. The natural feel of the spine was created by applying springs to recreate the natural recoil of paraspinal muscles and ligaments. Synthetic skin was also placed over the mechanism to generate a more realistic feel. RESULTS/FINDINGS: The final constructed model served to accurately demonstrate sidebending and rotational components of Fryette’s Laws of spinal motion. The ability to maneuver the cradle base into various positions enabled more thorough testing of somatic dysfunctions. For example, to demonstrate a Type I somatic dysfunction which is sidebent right and rotated left, the cradle base is translated to the left and the left cradle screw is lowered. FUTURE DIRECTION: The future directions of this project are multifaceted. In terms of the model itself, a comparison of the spring constant between paraspinal connective tissue and the springs used could gain extra palpatory realism. Additionally, while Type II somatic dysfunction can be inferred by sidebending and rotating the vertebral model to the same side, flexion and extension are unable to be tested with the current design. Future studies will also assess the subjective experience and diagnostic accuracy of osteopathic clinical faculty to determine the validity of the tool. The model can then be integrated as an educational tool during the first two years of OMM training, and subjective and objective student feedback will be collected. Eventually, the goal is for the model to be used as a means to standardize testing of students’ diagnostic skills across osteopathic medical schools

UNCITRAL Model Law: Reforming Electronic Procurement, Reverse Auctions, and Framework Contracts

A Working Group of the United Nations Commission on International Trade Law (UNCITRAL) is working on potential reforms to UNCITRAL\u27s Model Procurement Law and its Guide to Enactment. This article, written by several advisors to the U.S. delegation to the UNCITRAL Working Group, reviews the Working Group\u27s progress on several important fronts. The Working Group has reached initial consensus on a number of difficult procurement issues, including electronic commerce, reverse auctions and framework contracts, and significant progress has been made in a number or other areas, including the procurement of services, the strengthening of procurement remedies (known in the United States as bid protests), and the utilization of socioeconomic policy tools

UNCITRAL Model Law: Reforming Electronic Procurement, Reverse Auctions, and Framework Contracts

A Working Group of the United Nations Commission on International Trade Law (UNCITRAL) is working on potential reforms to UNCITRAL\u27s Model Procurement Law and its Guide to Enactment. This article, written by several advisors to the U.S. delegation to the UNCITRAL Working Group, reviews the Working Group\u27s progress on several important fronts. The Working Group has reached initial consensus on a number of difficult procurement issues, including electronic commerce, reverse auctions and framework contracts, and significant progress has been made in a number or other areas, including the procurement of services, the strengthening of procurement remedies (known in the United States as bid protests), and the utilization of socioeconomic policy tools

Role of Hedgehog signalling at the transition from double-positive to single-positive thymocyte

In the thymus, developing T cells receive signals that determine lineage choice, specificity, MHC restriction and tolerance to self-antigen. One way in which thymocytes receive instruction is by secretion of Sonic hedgehog (Shh) from thymic epithelial cells. We have previously shown that Hedgehog (Hh) signalling in the thymus decreases the CD4:CD8 single-positive (SP) thymocyte ratio. Here, we present data indicating that double-positive (DP) thymocytes are Hh-responsive and that thymocyte-intrinsic Hh signalling plays a role in modulating the production of CD4+ (SP4), CD8+ (SP8) and unconventional T-cell subsets. Repression of physiological Hh signalling in thymocytes altered the proportions of DP and SP4 cells. Thymocyte-intrinsic Hh-dependent transcription also attenuated both the production of mature SP4 and SP8 cells, and the establishment of peripheral T-cell compartments in TCR-transgenic mice. Additionally, stimulation or withdrawal of Hh signals in the WT foetal thymus impaired or enhanced upregulation of the CD4 lineage-specific transcription factor Gata3 respectively. These data together suggest that Hh signalling may play a role in influencing the later stages of thymocyte development