Estimating body segment parameters from three-dimensional human body scans.

Body segment parameters are inputs for a range of applications. Participant-specific estimates of body segment parameters are desirable as this requires fewer prior assumptions and can reduce outcome measurement errors. Commonly used methods for estimating participant-specific body segment parameters are either expensive and out of reach (medical imaging), have many underlying assumptions (geometrical modelling) or are based on a specific subset of a population (regression models). Our objective was to develop a participant-specific 3D scanning and body segmentation method that estimates body segment parameters without any assumptions about the geometry of the body, ethnic background, and gender, is low-cost, fast, and can be readily available. Using a Microsoft Kinect Version 2 camera, we developed a 3D surface scanning protocol that enabled the estimation of participant-specific body segment parameters. To evaluate our system, we performed repeated 3D scans of 21 healthy participants (10 male, 11 female). We used open source tools to segment each body scan into 16 segments (head, torso, abdomen, pelvis, left and right hand, forearm, upper arm, foot, shank and thigh) and wrote custom software to estimate each segment's mass, mass moment of inertia in the three principal orthogonal axes relevant to the center of the segment, longitudinal length, and center of mass. We compared our body segment parameter estimates to those obtained using two comparison methods and found that our system was consistent in estimating total body volume between repeated scans (male p = 0.1194, female p = 0.2240), estimated total body mass without significant differences when compared to our comparison method and a medical scale (male p = 0.8529, female p = 0.6339), and generated consistent and comparable estimates across a range of the body segment parameters of interest. Our work here outlines and provides the code for an inexpensive 3D surface scanning method for estimating a range of participant-specific body segment parameters.

Measurement of pubic symphysis width in different birthing positions using ultrasound.

Studies have shown that some vertical birthing positions, such as squatting and standing, may influence labour and childbirth. However, a rigorous biomechanical understanding of how different positions affect a woman's pelvis during labour is currently lacking. It was hypothesized that the position of pubic bones is affected in different positions, and thus the pubic symphysis width changes. Therefore, we measured pubic symphysis width on eleven women in their seventh to ninth months of pregnancy in different positions through three-dimensional (3D) reconstruction of pubic symphysis ultrasound images. Positions studies included those used in clinics like supine and lithotomy positions, in addition to squatting and standing, which are recommended by midwives. The results showed that the average superior and inferior pubic symphysis widths in lithotomy, squatting and standing positions were approximately 1 mm larger than those in the supine position. However, no significant difference between lithotomy, squatting and standing positions was found. The results were consistent with those of two comparable studies. A significant difference was only found between standing and squatting, standing and lithotomy in the rotation angle about the medio-lateral axis. The results suggest that positions with thigh hyperflexion and gravity effect make a difference in pubic symphysis width and might have a positive effect in childbirth. However, due to the small sample size, no definite conclusion can be drawn.

Adapting Fitness Age Calculations to Suit a Modern North American Female Population, Regardless of Age, Race, or Ability Level.

Objectives: Fitness Age (FA) has been reported in Japan and South Korea as one way to assess an individual's overall health. To date, this method has not been used in North America. The objective of the current study was to assess the applicability of existing Fitness Age calculations for North American women. Methods: Thirty-seven North American working women aged 18 to 67 years completed a fitness test battery, as described by previous studies. The fitness test results were used with published regression equations to estimate each woman's FA which was subsequently adjusted to correct for biases in the data. Results: The data from the fitness tests were similar to those presented in the previously published literature with the exception of grip strength, trunk flexion, and body fat percentage which differed significantly compared to the populations assessed previously. These population differences appear to have impacted the applicability of the published methods for this population. Discussion: Because the FA estimates must be corrected according to a theoretical "ideal" to address population biases before they can be used, the authors propose using the deviation from this theoretical ideal rather than raw FA in future aging studies, as this is where the interesting inter-personal differences lay.

The effects of squatting while pregnant on pelvic dimensions: A computational simulation to understand childbirth.

Biomechanical complications of childbirth, such as obstructed labor, are a major cause of maternal and newborn morbidity and mortality. The impact of birthing position and mobility on pelvic alignment during labor has not been adequately explored. Our objective was to use a previously developed computational model of the female pelvis to determine the effects of maternal positioning and pregnancy on pelvic alignment. We hypothesized that loading conditions during squatting and increased ligament laxity during pregnancy would expand the pelvis. We simulated dynamic joint moments experienced during a squat movement under pregnant and non-pregnant conditions while tracking relevant anatomical landmarks on the innominate bones, sacrum, and coccyx; anteroposterior and transverse diameters, pubic symphysis width and angle, pelvic areas at the inlet, mid-plane, and outlet, were calculated. Pregnant simulation conditions resulted in greater increases in most pelvic measurements - and predominantly at the outlet - than for the non-pregnant simulation. Pelvic outlet diameters in anterior-posterior and transverse directions in the final squat posture increased by 6.1 mm and 11.0 mm, respectively, for the pregnant simulation compared with only 4.1 mm and 2.6 mm for the non-pregnant; these differences were considered to be clinically meaningful. Peak increases in diameter were demonstrated during the dynamic portion of the movement, rather than the final resting position. Outcomes from our computational simulation suggest that maternal joint loading in an upright birthing position, such as squatting, could open the outlet of the birth canal and dynamic activities may generate greater pelvic mobility than the comparable static posture.

Development and validation of a computational model for understanding the effects of an upright birthing position on the female pelvis.

Upright, natural birthing positions, such as squatting, are associated with several clinical benefits, yet recumbent positions are still most common during delivery in most health centres. The biomechanics of birth positioning are not yet fully understood; therefore, our objectives were to develop and validate a computational model that could determine pelvic kinematics under loading conditions resulting from an upright birthing position. A three-dimensional model of the pelvic region was created from MRI scans of a non-pregnant subject. Bones were designated rigid segments with sacroiliac and pubic symphysis joint motion constrained only by contact surfaces and ligaments modeled as non-linear spring elements. Actuating torques at the lumbosacral and hip joints were defined based on motion analyses of squatting. The model was validated by comparing simulation results with data from the literature and in vivo MRI data from three subjects in a kneel-squat position. Good agreement was found between clinical pelvimetry measurements from the squat simulation and MRI data. Differences between simulation predictions were within one standard deviation of mean MRI kneel-squat results for all clinical measurements except one: the predicted increase in bispinous diameter was approximately 1.5 standard deviations less than that of the mean MRI results and still well within physiologic limits according to data in the literature. This model can, therefore, be used to provide further insight into the biomechanics of certain upright birthing positions, such as squatting.

Determining loads acting on the pelvis in upright and recumbent birthing positions: A case study.

BACKGROUND: The biomechanics of mothers' birthing positions and their impact on maternal and newborn health outcomes are poorly understood. Our objectives were to determine the loads applied to the female pelvis during dynamic movement that may occur during childbirth; findings are intended to inform clinical understanding and further research on birth positioning mechanics. METHODS: An optical motion capture system and force platforms were used to collect upright and supine movement data from two pregnant and three non-pregnant participants. Using an inverse dynamics approach, normalized three-dimensional hip and sagittal plane lumbosacral joint moments were estimated during squatting, all-fours, and supine activities. FINDINGS: During squatting, peak hip abduction moments were greater for our pregnant (compared with non-pregnant) participants and lumbosacral extension moments substantially exceeded those during walking. The all-fours activity, conversely, generated flexion moments at the L5/S1 joint throughout most of the cycle. In supine, the magnitude of the ground reaction force reached 100% body weight with legs and upper body raised (McRoberts' position); the centre of pressure remained cranial to the sacrum. INTERPRETATION: Squatting generated appreciable moments at the hip and lumbosacral joints that could potentially affect pelvic motion during childbirth.

A new geometric-based model to accurately estimate arm and leg inertial estimates.

Segment estimates of mass, center of mass and moment of inertia are required input parameters to analyze the forces and moments acting across the joints. The objectives of this study were to propose a new geometric model for limb segments, to evaluate it against criterion values obtained from DXA, and to compare its performance to five other popular models. Twenty five female and 24 male college students participated in the study. For the criterion measures, the participants underwent a whole body DXA scan, and estimates for segment mass, center of mass location, and moment of inertia (frontal plane) were directly computed from the DXA mass units. For the new model, the volume was determined from two standing frontal and sagittal photographs. Each segment was modeled as a stack of slices, the sections of which were ellipses if they are not adjoining another segment and sectioned ellipses if they were adjoining another segment (e.g. upper arm and trunk). Length of axes of the ellipses was obtained from the photographs. In addition, a sex-specific, non-uniform density function was developed for each segment. A series of anthropometric measurements were also taken by directly following the definitions provided of the different body segment models tested, and the same parameters determined for each model. Comparison of models showed that estimates from the new model were consistently closer to the DXA criterion than those from the other models, with an error of less than 5% for mass and moment of inertia and less than about 6% for center of mass location.

Wrist postures and forces in tree planters during three tree unloading conditions.

The aims of this study were to investigate wrist postures and forces while operating the shovel during tree planting and to determine if different tree unloading techniques result in variations in wrist postures and forces. Experienced tree planters performed the planting task in a laboratory environment for three conditions: (1) symmetric tree unloading, and asymmetric unloading resulting in (2) right-loaded planting bags and (3) left-loaded planting bags. An optoelectric system and a shovel instrumented with strain gauges captured wrist posture and forces at the wrist, respectively. Wrist extension of up to 45° was observed, and this posture, in combination with varying degrees of wrist deviation, may be a primary risk factor for musculoskeletal pain. Average resultant forces at the wrist were moderately high (>30 N) for each unloading condition, indicating increased risk for the development of repetitive strain injuries such as carpal tunnel syndrome. No significant differences in wrist posture or forces existed between unloading conditions. PRACTITIONER SUMMARY: Wrist pain is a major musculoskeletal complaint among tree planters. This study measured wrist postures and forces at the wrist while operating the shovel during tree planting. The wrist extension observed, in combination with deviation, may be a key risk factor for musculoskeletal pain. Forces at the wrist indicate increased risk for repetitive strain injuries.

CD40 pathway activation reveals dual function for macrophages in human endometrial cancer cell survival and invasion.

Reproductive malignancies are a major cause of cancer death in women worldwide. CD40 is a TNF receptor family member, which upon activation may mediate tumor regression. However, despite the great potential of CD40 agonists, their use as a therapeutic option for reproductive cancers has never been investigated. Because CD40 ligation is a potent pathway of macrophage activation, an in vitro model of pro-inflammatory type-1 (Mϕ-1) and anti-inflammatory type-2 (Mϕ-2) macrophages was developed to determine whether and how macrophage CD40 pathway activation might influence endometrial tumor cell behavior. Analysis of tumor growth kinetic in the endometrial cancer xenograft model indicates that, when injected once into the growing tumors, CD40-activated Mϕ-1 greatly reduced, while CD40-activated Mϕ-2 increased tumor size when compared to control isotype-activated Mϕ-1 and Mϕ-2, respectively. In vitro assays indicated that CD40-activated Mϕ-2 increased cell viability but failed to promote cell invasion. CD40-activated Mϕ-1, in contrast, decreased cell survival but greatly increased cell invasion in tumor cells less susceptible to cell death by apoptosis; they also induced the expression of some pro-inflammatory genes, such as IL-6, LIF, and TNF-α, known to be involved in tumor promotion and metastasis. The presence of IFN-γ is minimally required for CD40-activated Mϕ-1 to promote tumor cell invasion, a process that is mediated in part through the activation of the PI3K/Akt2 signaling pathway in tumor cells. From these results, we speculate that some functions of CD40 in tumor-associated Mϕs might limit the therapeutic development of CD40 agonists in endometrial cancer malignancies.

[Medical translations and practical compilations: a necessary coincidence?]. / Traductions et compilations médicales: une coïncidence obligée?

Fourteenth- and fifteenth-century medicine is characterised by a trickle-down effect which led to an increasing dissemination of knowledge in the vernacular. In this context, translations and compilations appear to be two similar endeavours aiming to provide access to contents pertaining to the particulars of medical practice. Nowhere is this phenomenon seen more clearly than in vernacular manuscripts on surgery. Our study proposes to compare for the first time two corpora of manuscripts of surgical compilations, in Middle French and Middle English respectively, in order to discuss form and matter in this type of book production.

Trunk postural demands of occupational activities of some merchant pregnant women in Benin, West Africa.

Strenuous physical work puts expectant mothers at risk of experiencing back pain during the gestational months. Pregnant women in Benin perform physically demanding occupational tasks that include the lifting and carriage of heavy loads on their heads for commercial activities. A large percentage of pregnant subjects (58%) reported having back pain episodes since the start of their pregnancy. However, the mean Oswestry score of the affected participants was relatively low with a mean score of 0.2 (SD: 0.12), on a scale form 0 to 1. An evaluation of the postural demands of the occupational activities of these women revealed that they performed on average 328 trunk flexions at angles exceeding 60°, with 66 of these flexions sustained for more than 4 s, during the average 7.9 h where trunk postures were recorded. They also spent on average 36% of the recording time at trunk flexion angles larger than 20°. These results show that the merchant pregnant women in the Porto-Novo area in Benin are at great risk for developing back disorders during pregnancy. PRACTITIONER SUMMARY: Results will make a first contribution to the literature by identifying the stressful postures adopted during a typical day. The findings of this study can help in the development of preventative concepts and postural modification techniques to decrease the occurrence of back pain during pregnancy for women in Benin.

Head load carriage and pregnancy in West Africa.

BACKGROUND: The postures of the trunk and of the head relative to the trunk adopted during the specific task of head load carriage were measured for a group of pregnant women and a control group of non-pregnant women because this activity was identified as a risk factor for back pain during pregnancy. METHODS: The postural data of the trunk and of the head relative to the trunk were collected using two inclinometer devices and an electrogoniometer, respectively. FINDINGS: During walking, the load on the head caused significantly larger upper trunk extension and smaller flexion of the head relative to the trunk. The amplitude of motion of the upper trunk and of the head relative to the trunk, as measured by the standard deviation of walking angles, was found to decrease as a result of carrying a load on the head and compensated by increased motion at the sacrum. Pregnant women showed larger upper trunk movements than their counterpart in the frontal and sagittal planes during the unloaded walking trials. INTERPRETATION: These posture modifications were believed to be adopted by the subjects to provide better stability for the load during walking. These prolonged postural strains caused by the trunk being displaced from its normal position can lead to muscle fatigue and ultimately to musculoskeletal injuries. The larger movements of the upper trunk for the pregnant women were hypothesized to be due to the enlarged abdomen of pregnant women as it creates a larger moment about L5/S1 and increases instability.

Pro-inflammatory type-1 and anti-inflammatory type-2 macrophages differentially modulate cell survival and invasion of human bladder carcinoma T24 cells.

Findings from numerous studies suggest that inflammation is likely to have an important role in bladder carcinogenesis and cancer disease progression. While macrophages (Mϕs) constitute a major inflammatory component of the stroma of human bladder carcinoma, the regulatory role of such inflammatory leukocytes in tumor cell survival and invasion remains elusive. Human urothelial bladder cancer (UBC) T24 cells and monocyte-derived macrophages were used to study the relative contribution of pro-inflammatory type-1 (Mϕ-1) and anti-inflammatory type-2 (Mϕ-2) macrophages in the regulation of UBC cell behaviour. Cell-to-cell studies indicated that the number of viable cells were considerable higher in T24 cell/Mϕ-2 cocultures but lower in T24 cell/Mϕ-1 cocultures when compared to cultures of T24 cells alone. Mϕ-1-derived factors inhibit T24 cell growth but fail to induce caspase-3-mediated apoptosis. Mϕ-2-derived factors have the ability to suppress the inhibitory effect of Mϕ-1-derived factors on T24 cell growth. Exogenous interleukin (IL)-10 reverse Mϕ-1-mediated arrest growth in T24 cell/Mϕ-1 cell cocultures. Further analyses showed that Mϕ-1-derived factors induced tumor necrosis factor (TNF)-α gene expression, promoted cellular invasiveness and increased phosphoinositide 3-kinase (PI 3-K)/Akt signaling pathway activity in T24 cells. Inhibition of PI 3-K activation in T24 cells or blockade of TNFα receptor in T24 cell/Mϕ-1 cell cocultures decreased cellular invasiveness but did not affect T24 cell viability. Based on these observations, we propose that similar functional interactions between UBC cells and infiltrating macrophages can take place in vivo and influence tumor cell survival and invasion during bladder cancer progression.

Musculoskeletal symptoms in tree planters in Ontario, Canada.

UNLABELLED: Tree planting is extremely physical, seasonal, repetitive work with high risk for musculoskeletal injuries. OBJECTIVES: (1) To assess musculoskeletal symptoms in tree planters as they develop over the course of the planting season. (2) To investigate the effect of pre-season level of physical activity on development of musculoskeletal symptoms. PARTICIPANTS: 132 tree planters from two reforestation camps participated in the study. METHODS: Three questionnaires were completed prior to the first work day of the planting season. Questionnaires included the International Physical Activity Questionnaire, a body map to report areas of musculoskeletal symptoms (MSS questionnaire), and a series of questions about planter demographics. A subset of study participants (n=14) also completed the MSS questionnaire each work shift during the planting season. Musculoskeletal symptoms in each area of the body were compared pre-and-post season using a paired t-test on data from the MSS questionnaire. RESULTS AND CONCLUSIONS: Areas of the body with the greatest amount of musculoskeletal pain and discomfort were the feet, wrists and back, whereas areas with the highest frequency of reported pain were the upper, middle and lower back. Musculoskeletal symptoms worsened significantly over the course of the work season. Pre-season level of physical activity could not be correlated with development of musculoskeletal symptoms.

Influence of the volume and density functions within geometric models for estimating trunk inertial parameters.

The geometric method combines a volume and a density function to estimate body segment parameters and has the best opportunity for developing the most accurate models. In the trunk, there are many different tissues that greatly differ in density (e.g., bone versus lung). Thus, the density function for the trunk must be particularly sensitive to capture this diversity, such that accurate inertial estimates are possible. Three different models were used to test this hypothesis by estimating trunk inertial parameters of 25 female and 24 male college-aged participants. The outcome of this study indicates that the inertial estimates for the upper and lower trunk are most sensitive to the volume function and not very sensitive to the density function. Although it appears that the uniform density function has a greater influence on inertial estimates in the lower trunk region than in the upper trunk region, this is likely due to the (overestimated) density value used. When geometric models are used to estimate body segment parameters, care must be taken in choosing a model that can accurately estimate segment volumes. Researchers wanting to develop accurate geometric models should focus on the volume function, especially in unique populations (e.g., pregnant or obese individuals).

Fatigability of back extensor muscles and low back pain during pregnancy.

BACKGROUND: Back pain is the most frequently reported musculo-skeletal problem during pregnancy. High muscle fatigability has been associated with back pain in the general population. During pregnancy, the gradual increase in loads may have a training effect, increasing strength and endurance of back muscles. This adaptation however may be too slow, or insufficient to be significant in light of other changes during pregnancy. METHODS: Thirty-two pregnant women performed a fatigue test which consisted of maintaining a fixed load of 70 Nm for 60 s while the surface EMG of the longissimus lumborum and multifidus muscles were recorded bilaterally at 14, 24 and 34 weeks of pregnancy. The measure of fatigability was the highest absolute slope of the median frequency of the power spectrum of the EMG of the four muscles. Occurrence and severity of back pain were reported on questionnaires at 14, 19, 24, 29 and 34 weeks. Binomial logistic regressions between back pain occurrence and the median frequency slopes were calculated. FINDINGS: None of the five logistic analyses demonstrated an improvement of the one-predictor model over the constant-only model, which indicates that the degree of fatigability of back extensor muscles did not predict the occurrence of back pain in our sample. INTERPRETATION: Fatigability of back extensor muscles was not found to be a predictor of back pain during pregnancy. This result should be taken with caution due to the small number of participants and broad definition of back pain used, and should be confirmed by studies with a larger number of participants.

Evaluation of forearm support provided by the Workplace Board on perceived tension, comfort and productivity in pregnant and non-pregnant computer users.

The aim of the study was to evaluate the effect of forearm support provided by the Workplace Board on perceived tension, comfort and productivity among pregnant and non-pregnant female computer workers. Ten pregnant and 18 non-pregnant women participated in the study. Participants completed three sets of tension/discomfort questionnaires at two week intervals. The first set was completed prior to any workstation intervention; the second set was completed after two weeks working with an ergonomically adjusted workstation; the third set was completed after two weeks working with the Workplace Board integrated into the office workstation. With the Workplace Board, decreased perceived tension was reported in the left shoulder, wrist and low back in non-pregnant women only. The Board was generally liked by all participants, and increased comfort and productivity in all areas, with the exception of a negative effect on productivity of general office tasks. The board is suitable for integration in most office workstations and for most users, but has no special benefits for pregnant women.

A comparison between a new model and current models for estimating trunk segment inertial parameters.

Modeling of the body segments to estimate segment inertial parameters is required in the kinetic analysis of human motion. A new geometric model for the trunk has been developed that uses various cross-sectional shapes to estimate segment volume and adopts a non-uniform density function that is gender-specific. The goal of this study was to test the accuracy of the new model for estimating the trunk's inertial parameters by comparing it to the more current models used in biomechanical research. Trunk inertial parameters estimated from dual X-ray absorptiometry (DXA) were used as the standard. Twenty-five female and 24 male college-aged participants were recruited for the study. Comparisons of the new model to the accepted models were accomplished by determining the error between the models' trunk inertial estimates and that from DXA. Results showed that the new model was more accurate across all inertial estimates than the other models. The new model had errors within 6.0% for both genders, whereas the other models had higher average errors ranging from 10% to over 50% and were much more inconsistent between the genders. In addition, there was little consistency in the level of accuracy for the other models when estimating the different inertial parameters. These results suggest that the new model provides more accurate and consistent trunk inertial estimates than the other models for both female and male college-aged individuals. However, similar studies need to be performed using other populations, such as elderly or individuals from a distinct morphology (e.g. obese). In addition, the effect of using different models on the outcome of kinetic parameters, such as joint moments and forces needs to be assessed.

Back pain of working pregnant women: identification of associated occupational factors.

The objective of this study was to identify major occupational factors that were significantly correlated with back pain in pregnant women working in higher education, health care and service areas. A total of 73 working pregnant women were surveyed using questionnaires specifically designed for evaluating correlations between occupational factors and severity of back pain; 37 women were interviewed at both 20 and 34 weeks of pregnancy, 17 at 20 weeks only, and 19 were interviewed at 34 weeks only. "Rest breaks allowed" and "job autonomy" were negatively correlated with severity of back pain at 20 weeks of pregnancy. "Staying in a confined area" and "having restricted space" were positively correlated with severity of back pain at 34 weeks of pregnancy. The study suggests that allowing pregnant women to take more rest breaks and to have more job autonomy may reduce the severity of back pain during early pregnancy, and that allowing movement outside the working area and providing less restricted space may reduce back pain during late pregnancy.

Effect of a desk attachment board on posture and muscle activity in women during computer work.

Working at a computer is part of a large number of jobs and has been associated with upper extremity musculoskeletal disorders and back pain. The study evaluated the effects of a board attachment on upper extremity and back. The findings are mixed in that the board may have a positive effect in preventing back pain, but may be detrimental to upper extremities. Effect of a desk attachment board on upper extremity and trunk posture, and muscle activity was assessed in women video display terminal users. Participants completed a standard 20-min computer task under two conditions: 1) using a standard desk; 2) using a desk attachment board designed to support the forearms. Bilateral electromyography of the trapezius, multifidus and longissimus muscles and the right anterior deltoid and forearm extensor muscles was recorded. 3-D trunk and upper extremity posture was monitored. Participants were tested before and after 2 weeks of familiarisation with the board in their workplace. Perceived tension and discomfort were recorded before and after use of the board. Use of the board tended to increase muscle activity in the right trapezius and forearm extensor and to decrease muscle activity in the back. Perceived tension in the low back decreased slightly with the board. The board may be useful in reducing tension in the low back during computer work, but may adversely affect the upper extremities.