Causes and Solutions for High Direct Care Staff Turnover

This quantitative research project explores the reasons and solutions for the high rates of direct care staff turnover. Emails were sent out to social service agency supervisors asking for their approval to allow their employees to participate in an online survey about direct care staff turnover. Agencies that agreed to participate were then emailed a script and a consent form with instructions to email both the script and the consent form to their employees. The ten question online survey explored the direct care staff\u27s opinions on topics such as compensation, support and training. Additionally, there was a qualitative question at the end of the survey asking for direct care staff\u27s input as to possible solutions to reduce direct care staff turnover. Twenty-six individuals participated in the survey. Answers were analyzed and entered into SPSS in order to find correlations in the data. Themes were identified amongst the responses to the qualitative question. A majority of the respondents did not feel they received adequate support from their supervisor or adequate compensation for the work that they do. Answers showed that direct care staff who participated in the survey attributed inadequate compensation as the largest contributor to the high rates of direct care staff turnover. The answers revealed no statistically significant data however, some correlations approached statistical significance. Results from this quantitative research project were consistent with pre-existing literature

In vivo kinematics of knee replacement during daily living activities: Condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses

In total knee replacement, the investigation on the exact contact patterns at the post-cam in implanted patients from real in vivo data during daily living activities is fundamental for validating implant design concepts and assessing relevant performances. This study is aimed at verifying the restoration of natural tibio-femoral condylar kinematics by investigating the post-cam engagement at different motor tasks. An innovative validated technique, combining three-dimensional fluoroscopic and finite element analyses, was applied to measure joint kinematics during daily living activities in 15 patients implanted with guided motion posterior-stabilized total knee replacement. Motion results showed physiological antero-posterior translations of the tibio-femoral condyles for every motor task. However, high variability was observed in the position of the calculated pivot point among different patients and different motor tasks, as well as in the range of post-cam engagement. Physiological tibio-femoral joint rotations and contacts at the condyles were found restored in the present knee replacement. Articular contact patterns experienced at the post-cam were found compatible with this original prosthesis design. The present study reports replaced knee kinematics also in terms of articular surface contacts, both at the condyles and, for the first time, at the post-cam

marker tracking for local strain measurement in mechanical testing of biomedical materials

Local strain measurement is one of the key aspects in tensile tests of biomedical materials and biological tissues, especially if aimed at developing appropriate constitutive formulations to describe mechanical behavior. The measurement of strain as the ratio between the current and the initial length of the sample can be coupled with markers recognition via non-contact video extensometer for characterizing the local mechanical behavior. A crucial point in video extensometer measurement is the selection of the most appropriate markers and technique of their application on the sample surface. This work promotes understanding the effect of markers on material mechanical response. Different solutions were taken into account, as paint markers, namely a commercial lacquer and an acrylic paint, or physical markers attached with the use of adhesives, i.e. cyanoacrylate or medical spray band. Tensile tests revealed that markers can modify the mechanical response of the tested materials, inducing a local stiffening of the samples. The use of cyanoacrylate, as marker adhesive, affects not only the local but also the overall mechanical response, at least for the sample size considered in this work. These effects are more pronounced with higher material compliance. Based on these results, caution is recommended with the use of cyanoacrylate for attaching markers on biomedical polymers

Which data sources may be used to efficiently generate subject-specific knee models to meet clinical questions?

Knee joint kinematics is the result of a complex roto-translation movementcharacteristic of the tibio-femoral (TF) and patello-femoral (PF) articulations.This movement depends on the shape of the femur, the tibial plateau andthe patella. Moreover, it depends also on the morphological and mechanicalproperties of the soft tissues of the knee joint. In fact, the knee is characterizedby an extrinsic stability due to the active constraints (muscles and tendons)and passive soft tissues (menisci, retinaculum and ligaments) that surround it.As a result, knee kinematics and kinetics are different in each human being, andsometimes, even in the same person, with the right knee behaving differentlycompared to the left one.The ideal total knee arthroplasty TKA, used to correct pathologies that couldaffect the knee joint, should enable the restoration of the patient’s functionalknee kinematics and kinetics, so that the patient does not normally notice theTKA implant.Nowadays, TKA surgery is a well-established procedure and surgeons maychoose from among the broad range of TKA solutions available on the marketto meet the patient’s request. Prostheses may differ because of shape, materials,and mechanical constraints of their components. Consequently, the restorationof the knee joint biomechanics is limited by the degrees of freedom guaranteedby the adopted design solution.Despite the success of TKAs, pain and limited motor skills are reportedto still affect the clinical outcomes and not all patients are shown to be happyafter a TKA.Current complaints regarding post-TKA surgery might be related to the absenceof a proven tool that enables predicting patient-specific outcomes based ondifferent TKA solutions and providing guidelines to surgeons. In fact, surgicalpre-planning is usually based on a patient’s evaluation that the clinician canmake also based on medical images, and clinical experience. Data reported inthe literature can help in guiding the surgeon to a final decision regarding thebest subject-specific solution.Numerical methods, able to simulate knee biomechanics for various configurations,can be fundamental for the development of the appropriate reliableand effective tools to support clinically-tailored responses to a question.In particular, they can be used for subject-specific analyses on the intact kneeand for supporting the surgical pre-planning phase by comparing the effect ofdifferent solutions.When developing a subject-specific knee model, different kinds of datainputsare needed, such as the knee shapes and alignment information, softtissuesbehavior and boundary conditions describing the investigated motortasks. Often, most of this requested data are unlikely to be available (e.g.subject-specific soft-tissues material properties). Consequently, it is a commonoperating procedure to integrate literature data with subject-specific informationin order to develop knee models for collecting personalized outputsthat could be used to address research and clinical questions.However, up to now, the resulting effect of different generalized sources, asa mix of subject-specific and literature data, still needs to be evaluated for itsimpact on personalized outputs concerning knee behaviour.Furthermore, clinical questions are often focused on specific requests thatpartially use features of more complex knee models that could require too muchtime to be efficiently incorporated into daily clinical evaluations.For these reasons, the principal aims of this research have been to assess,first, the impact of differently derived generalized sources on the developmentof an intact subject-specific knee model or after a TKA; second,to provide guidelines to identify efficient clinically-tailored data sourcesused in and for knee modeling.To accomplish these tasks, a numerical knee model of an intact knee wasdeveloped based on both subject-specific and literature data sources. Theinfluence of different approaches to deal with a subject’s information, such asthe reconstruction of the knee geometries from different imaging sources, hasiiibeen evaluated. Moreover, a sensitivity analysis was performed to understandthe potential changes on kinetics and kinematics outcomes due to differentlyderived literature inputs, such as models and the properties that characterizethe joint materials and ligaments description. The outputs collected after finiteelement analyses were analyzed and compared with already published experimentaloutcomes for the same analyzed specimen and replicated boundaryconditions.Additionally, the effects on knee joint contact forces and kinematics afterTKA surgery and due to the mis-alignment of implant components or misidentificationsof ligament insertions were evaluated in another sensitivityanalysis performed with a rigid body analysis for four different TKA designsimplanted in a subject-specific knee model. As for the intact knee model, theanalyzed configurations were compared against already published experimentaloutputs or literature data replicating similar boundary conditions.Moreover, several dedicated knee models were developed to address specificclinical questions, such as the lack of biomechanical explanations for certainbehaviours of TKA designs.Once compared to already published experimental or literature data, the resultsof the developed models agree.The main results from the numerical simulations performed show that, changingthe values of some of the parameters used as inputs, the knee model kinematicsis less influenced than the contact forces and stresses outputs.In particular, in developing an intact knee model, the main effecting parameteris the material properties selection for the knee cartilage layers. Among theconfigurations analyzed using subject-specific knee models with TKAs, theposition of the tibial component and the height of the patellar buttonare the most effecting inputs.Exploring the different chapters of this research thesis, several specific resultsare shown regarding each main step followed in developing a knee numericalmodel. For example, new approaches based on MRIs have been suggested andtested proving that they are suitable for collecting subject-specific informationregarding geometrical shapes and landmark definitions. Moreover, a newgraphical method was proposed resulting more effective and immediate thanconventional representations in reporting huge amount of data. In particular,the method is the favourite to show complex biomechanical analyses especiallyfor the clinical audience that replied to a survey. Furthermore, the differentmodels tailored to address specific clinical questions collected useful biomechanicalresults, to provide clinical advice or industrial guidelines, and can beconsidered as examples of what should be included in a knee model for similarscenarios.The results of this thesis offer several contributions. Generally, these findingscould provide useful guidelines for knee-model developers to achievea more balanced approach to subject-specific intact knee models based upongeneral sources in order to improve the understanding of personalized kneebiomechanics.To address a general comment to the title of this thesis, there is no singleanswer. In fact, the selection of data sources is case-dependent using, forexample, the subject’s or literature available data to describe material’s behavioror the boundary conditions of a specific motor task. Moreover, differentclinical questions can be addressed with different numerical approaches, e.g.finite element analysis is necessary especially in the case that stress outputs arerequested, but can be too time-consuming for addressing complex sensitivityanalyses.Once the knee model developer has identified the necessary data sources andthe approaches to be implemented, the question-tailored knee models can thusbe used for several applications such as predicting subject-specific abnormalknee kinematics and kinetics for different TKA designs, polyethylene wear,patellofemoral dislocation and bone remodeling, choosing the best fitting TKAdesign for a specific patient, and developing a procedure to optimize TKAimplant designs.Doctorat en Sciences de l'ingénieur et technologieinfo:eu-repo/semantics/nonPublishe

The use of finite element modeling to improve biomechanical research on knee prosthesis

Biomechanical numerical models in orthopedic research are currently becoming more and more frequent, complex and comprehensive. In this context, finite element analysis of biomechanical models has consistently increased in the last decades. The growing trend in the use of such numerical technique is indeed strongly correlated with the increasing and the easiest access to computational resources and, parallel to this, with the development of more sophisticated data handling algorithms. In fact, looking to the past, the use of finite element analysis in the field of biomechanics was mainly limited to simplistic approaches, such as bi-dimensional models, considering mainly linear analyses, and investigation of single structures or tissue types only. Nowadays, fully three-dimensional, nonlinear, multi-structures and tissues, and even multi-joint systems, can be also easily implemented in the simulation. More specifically, for a knee with an implant (e.g. total knee arthroplasty (TKA), unicondilar knee arthroplasty (UKA) or patello-femoral joint), the model aims to replicate the behavior of three-dimensional biological structures, like bones, cartilage and ligaments, coupled with non-biological knee components made of different synthetic materials. An additional complexity in knee modeling is provided by the huge variability inherent to the field. This variability is due to the vast range of different kinematics and contact forces that could be induced by the variety of prosthesis designs, in different patients, and under specific motor tasks. Due to the multiplicity of these aspects, the use of finite element modeling is of foremost importance; in fact, it allows to obtain qualitative guesses and qualitative data that cannot be provided by any other method (such as in-vitro experimental tests or gait analysis) such as the stresses distribution for bone and prosthesis components under different conditions, and contact forces interactions, both for generic and patient-specific solutions. These outputs, coupled with clinical outputs, allow to relate, for example, stress changes, from the physiological to a knee with a prosthesis and to a bone mineral density changes in the patients, allowing to formulate possible answers to common unsolved clinical questions. An added value derived by the use of finite element analysis is the possibility to characterize performances of prosthesis designs in restoring knee functions and maintaining long-term mechanical integrity for different patients and in agreement with different surgeon requests. In more general terms, the use of finite element modeling in the understanding of knee prosthesis biomechanics is fundamental to answer clinical questions, to improve and predict clinical outputs, to provide more surgeon-friendly guidelines and, last but not least, to improve TKA. success and avoid critical situations. This modeling procedure can help bridging the gap between surgeons and engineers, aiming in the improving of the biomechanical research on knee prosthesis.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Contact forces in several TKA designs during squatting: A numerical sensitivity analysis

<p>Maximum contact patellofemoral contact forces for different TKA designs under mal-alignment configurations under a squat task.</p

Contact forces in several TKA designs during squatting: A numerical sensitivity analysis

<p>Maximum contact tibio-femoral contact forces for different TKA designs under mal-alignment configurations under a squat task.</p

Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty

Augments are a common solution for treating bone loss in revision total knee arthroplasty (TKA) and industry is providing to surgeons several options, in terms of material, thickness, and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modeling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10, and 15 mm), and material (bone cement, porous metal, and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus, it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

An Anthropometric-Based Subject-Specific Finite Element Model of the Human Breast for Predicting Large Deformations.

The large deformation of the human breast threatens proper nodules tracking when the subject mammograms are used as pre-planning data for biopsy. However, techniques capable of accurately supporting the surgeons during biopsy are missing. Finite element (FE) models are at the basis of currently investigated methodologies to track nodules displacement. Nonetheless, the impact of breast material modeling on the mechanical response of its tissues (e.g. tumors) is not clear. This study proposes a subject-specific FE model of the breast, obtained by anthropometric measurements, to predict breast large deformation. A healthy breast subject-specific FE parametric model was developed and validated by Cranio-caudal (CC) and Medio-Lateral Oblique (MLO) mammograms. The model was successively modified, including nodules, and utilized to investigate the effect of nodules size, typology, and material modeling on nodules shift under the effect of CC, MLO, and gravity loads. Results show that a Mooney-Rivlin material model can estimate healthy breast large deformation. For a pathological breast, under CC compression, the nodules displacement is very close to zero when a linear elastic material model is used. Finally, when nodules are modeled, including tumor material properties, under CC, or MLO or gravity loads, nodules shift shows ~15% average relative difference.info:eu-repo/semantics/publishe