No abstract

Objective To establish the relationship between circumferential compression on the lower limb during simulated ramp and staircase profile loading, and the resultant relationship with discomfort/pain and tissue oxygenation. Background Excessive mechanical loading by exoskeletons on the body can lead to pressure-related soft tissue injury. Potential tissue damage is associated with objective oxygen deprivation and accompanied by subjective perception of pain and discomfort. Method Three widths of pneumatic cuffs were inflated at the dominant thigh and calf of healthy participants using two inflation patterns (ramp and staircase), using a computer-controlled pneumatic rig. Participants rated discomfort on an electronic visual analog scale and deep tissue oxygenation was monitored using near infrared spectroscopy. Results Circumferential compression with pneumatic cuffs triggered discomfort and pain at lower pressures at the thigh, with wider cuffs, and with a ramp inflation pattern. Staircase profile compression caused an increase in deep tissue oxygenation, whereas the ramp profile compression decreased it. Conclusion Discomfort and pain during circumferential compression at the lower limb is related to the width of pneumatic cuffs, the inflation pattern, and the volume of soft tissue at the assessment site. The occurrence of pain is also possibly related to the decrease in deep tissue oxygenation during compression. Application Our findings can be used to inform safe and comfortable design of soft exoskeletons to avoid discomfort and possible soft tissue injury.

Purpose -The paper seeks to pinpoint new directions of the evolution of knowledge in the Arab region, and to outline the role of knowledge management principles in constructing the knowledge society. Design/methodology/approach -The article addresses initiatives towards narrowing the knowledge gap and building an egalitarian knowledge society in the Arab region. It reviews, interprets and relates the relevant literature and sheds the light on the Arab region's future plans.Findings -The article outlines some of the regionally relevant elements needed for building the knowledge society. It also suggests some means of tapping the diversified workforce's tacit knowledge, reversing the ''brain drain,'' and building potential leadership models.Originality/value -This article represents an overview and interpretation of the role of knowledge management as it relates to the effectiveness of concepts such as ''knowmadism'' and the practicality of ''megatribe knowledge.'' The article provides rendition and a roadmap for decision makers, knowledge workers, and future researchers in the domain of the ''knowledge society'' within the Arab region.

No abstract

Until recently, three-dimensional (3D) printing/additive manufacturing has not been used extensively to create medical devices intended for actual clinical use, primarily on patient safety and regulatory grounds. However, in recent years there have been advances in materials, printers and experience, leading to increased clinical use. The aim of this study was to perform a structured systematic review of 3D-printed medical devices used directly in patient treatment. A search of 13 databases was performed to identify studies of 3D-printed medical devices, detailing fabrication technology and materials employed, clinical application, and clinical outcome. One hundred and ten papers describing 140 medical devices were identified and analyzed. A considerable increase was identified in the use of 3D printing to produce medical devices directly for clinical use in the last three years. This is dominated by printing of patient-specific implants and surgical guides for use in orthopedics and orthopedic oncology, but there is a trend of increased use across other clinical specialties. The prevailing material/3D-printing technology used were titanium alloy/EBM for implants, and PA/SLS or PLA/FDM for surgical guides and instruments. A detailed analysis across medical applications by technology and materials is provided, as well as a commentary regarding regulatory aspects. In general, there is growing familiarity with and acceptance of 3D printing in clinical use.

We report a case of three-dimensional (3D) printing being used to solve a difficult bedside clinical problem and avoidance of substantial risk associated with alternative solutions. A 15-year-old male with advanced cystic fibrosis developed a small (~1mm) linear tear in his Percutaneous Endoscopic Gastrostomy (PEG) tube, approximately 40 mm from the skin surface. The patient’s advanced condition precluded replacement of the PEG tube under general anaesthetic. Attempts to manage the tear with adhesive tapes yielded limited success. 3D printing was used to create a bespoke sealing device overnight, rectifying the leak and allowing enteral feeding to recommence unimpeded. The device is functioning well, several months post-discharge of the patient.

Stenting treatments for the management of disease in the heart, arterial and venous systems, biliary ducts, urethras, ureters, oesophageal tract and prostate have made enormous technical advances since their introduction into clinical use. The progression from metallic to polymer based bio-absorbable stents, coupled with the advances in additive manufacturing techniques, present a unique opportunity to completely re-envision the design, manufacture, and supply chain of stents. This paper looks at current stenting trends and proposes a future where the stent supply chain is condensed from ~150 days to ~20 min. The Cardiologist therefore has the opportunity to become a designer, manufacturer and user with patients receiving custom stents specific to their unique pathology that will be generated, delivered and deployed in the Cath-lab. The paper will outline this potentially revolutionary development and consider the technical challenges that will need to be overcome in order to achieve these ambitious goals. A high level overview of the generating eluting stents in situ program-GENESIS-is outlined including some early experimental work.

Purpose -The purpose of this paper is to provide reinforcement for ITIL V 2.0 implementation process through knowledge management principles embedded in enterprise management-engineering framework (EMEF). Design/methodology/approach -EMEF has been amended to include knowledge management (KM) activities that are imperative for a melioration of ITIL implementation. The framework of four domains has been documented in detail. Additionally, the three major amendments of structure, architecture, and context have been suggested for a configuration management database (CMDB) to comply with KM principles. Findings -There are strong indications that implementing ITIL by following the system-thinking approach may add and sustain competitive advantage. This may be achieved through the leveraging of knowledge, improvement of core competencies, and fostering a customer-consciousness approach. The apprehension of knowledge continuum components, and the differentiation between knowledge types, are critical for fortifying the ITIL process path and supporting the decision-making process throughout ITIL implementation. The four layers of the integrative management domain will significantly contribute to the tuning of operational misalignment between IT and business, and the betterment of the employee and processes effectiveness. The similarities found between ontology objects and CMDB configuration items will raise CMDB information to a higher level of conceptualization. Originality/value -This paper will be valuable for ITIL customers, decision makers, and implementers by providing a more complete framework allowing organizations to attain effectiveness, efficiency and innovation throughout ITIL implementation.