Roos Eisma

Anthropological Measurement of Lower Limb and Foot Bones Using Multi-Detector Computed Tomography

Abstract:  Anthropological examination of defleshed bones is the gold standard for osteological measurement in forensic practice. However, multi‐detector computed tomography (MDCT) offers the opportunity of three‐dimensional imaging of skeletal elements, allowing measurement of bones in any plane without defleshing. We present our experiences of the examination of 15 human lower limbs in different states of decomposition using MDCT. We present our method of imaging and radiological measurement of the bones including sex assessment. The radiological measurements were undertaken by three professional groups–anthropology, radiology, and forensic pathology–both at the site of scanning and at a remote site. The results were compared to anthropological oestological assessment of the defleshed bones. We discuss the limitations of this technique and the potential applications of our observations. We introduce the concept of remote radiological anthropological measurement of bones, so‐called tele‐anthro‐radiology and the role that this could play in providing the facility for standardization of protocols, international peer review and quality assurance schemes.

Are guidelines enough?: an introduction to designing web sites accessible to older people

As the Web becomes more integral to day-to-day life, there is a danger that many older people will be excluded if their access needs are not considered by content designers. Although accessibility guidelines for designers are available, experience shows that these guidelines have not been successful enough in producing Web sites accessible to older people. In this paper, the shortcomings of relying solely on accessibility guidelines are reviewed, and several ideas are proposed for encouraging a more holistic approach to accessibility.

From formalin to thiel embalming: What changes? One anatomy department's experiences

In 2009, the Centre for Anatomy and Human Identification started Thiel embalming on a small scale to assess (i) the suitability for our current teaching in which long‐lasting dissection courses are key, (ii) the potential for new collaborations and activities, and (iii) the practical implications of changing our embalming method from formalin to Thiel. Twenty six Thiel‐embalmed cadavers have been used for dissection by staff and students on a taught MSc course, as a model for clinical and surgical training, and increasingly as a model for evaluation of new medical devices and procedures. Our experiences with dissection were mostly positive especially for teaching the musculoskeletal system. Internal organs handle differently from formalin‐fixed organs and dissection manuals need to be adjusted to reflect this. Durability of the cadavers was not an issue, though changes are seen over time due to gradual fluid loss. We have started new collaborations related to postgraduate anatomy teaching and advanced training in surgical and clinical skills. In general, feedback is very positive and demand for cadavers outstrips our current limited supply. Thiel‐embalmed cadavers were found to provide a unique opportunity for evaluation of medical products especially in areas where no suitable alternative model is available, and without the complications associated with clinical testing. This has resulted in new collaborations and research projects. As a result Thiel‐embalmed cadavers are used for longer and for more activities than formalin cadavers: this requires changes in our procedures and staff roles. Clin. Anat. 26:564–571, 2013.

Strategies for teaching older people to use the World Wide Web

Information is increasingly displayed digitally, yet less than half of the population of the UK use the Internet. Older people are especially unlikely to be Internet users and the consequent risks of digital exclusion must be addressed. A training course in computers and web use for older adults took place at the University of Dundee, with 15 participants. The course approach was to simplify application interfaces and to ensure that basic skills were learnt before more complicated tasks were presented. As part of this process, there was a focus on learning to use the computer before learners were introduced to the web with its wide variety of content. The course outcomes were positive and the authors report them here in order to reflect upon the experience and help others who set out to provide training for older people in web use.

E-mail interfaces for older people

The work introduced here concerns the user interface requirements of older users of e-mail. The main goal is to understand better the e-mail needs of older people, and to form a foundation for further developments in simplified and rationalised e-mail interfaces. The approach involved working closely with older computer users to establish their essential requirements, attempting thus to reduce complication and excess functionality in the interface, with the intention that users should find the system easy to learn and use. Requirements were established through interviews and consultation, and once the necessary functionality was identified, prototype interfaces were developed from which older volunteers selected preferred forms. A simulated e-mail system was then built around these preferred forms. Trials with older participants indicated that the design was popular, and gave insights and outcomes, which helped form the agenda for a major project on e-mail for older people

Echogenic regional anaesthesia needles: a comparison study in Thiel cadavers.

Ultrasound guidance is now the standard procedure for regional nerve block in anesthesiology. However, ultrasonic visualisation of needle manipulation and guidance within tissues remains a problem. Two new echogenic needles (Pajunk and Braun) have been introduced to anesthesiology clinical practice but evaluation has been restricted to preserved animal tissue. In this study, the visibility of both echogenic needles was compared with a standard nonechogenic needle in a Thiel cadaver model. A total of 144 intramuscular injections were made in the upper arm in-plane and out-of-plane to the ultrasound beam at four angles (30°, 45°, 60° and 75°). The visibility of the needle was assessed by two independent, blinded observers using a 5-point Likert ordinal scale. Weighted κ for interobserver agreement was 0.77 (95% confidence interval [CI]: 0.68-0.86). The Pajunk echogenic needle was more visible than the Braun standard needle in-plane (p = 0.04), and the Braun standard and Braun echogenic needles out-of-plane (p = 0.02). Independent predictors of visibility using logistic regression were needle (p < 0.001) and plane of insertion (p = 0.08), receiver operator characteristic (ROC) area under the curve 0.90. In conclusion, the Pajunk echogenic needle offers the best visibility for ultrasound-guided regional anesthesia.

An evaluation of Thiel-embalmed cadavers for ultrasound-based regional anaesthesia training and research:

Working hours of UK trainee doctors have recently been reduced to 48 hours per week, reducing exposure to clinical cases. As such, there is widespread acceptance that trainees need to train in environments other than the ward or operating theatre in order to gain practical skills. Formalin-fixed cadavers demonstrate gross muscle and nerve anatomy but needle insertion under ultrasound guidance is poor. In contrast, a new development in medical simulation is the use of Thiel-embalmed cadavers, developed by Professor Thiel of the University of Graz, Austria, using a novel preservation technique that retains full flexibility of the limbs. Thiel cadavers have been used to successfully simulate laparoscopic surgery, neurosurgery and oral surgery. This paper investigates, for the first time, the application of ultrasound-based regional anaesthesia to the Thiel cadaver by tracing the course of peripheral nerves, injecting local anaesthetic around nerves, and reproducing inadvertent intraneural injection by injecting preservative directly into the nerve. The Thiel cadaver provides good conditions for anaesthetists to simulate regional anaesthetic block techniques using ultrasound.

A Qualitative Assessment of Human Cadavers Embalmed by Thiel's Method Used in Laparoscopic Training for Renal Resection.

Human cadaveric tissue is the fundamental substrate for basic anatomic and surgical skills training. A qualitative assessment of the use of human cadavers preserved by Thiels method for a British Association of Urological Surgeons—approved, advanced laparoscopic renal resection skills training course is described in the present study. Four trainees and four experienced laparoscopic surgeons participated in the course. All participants completed a five‐point Likert scale satisfaction questionnaire after their training sessions. The quality of cadaveric tissue and the training session were assessed with particular emphasis placed on the ease of patient positioning, the ease of trocar placement, the preservation of tissue planes, the ease of renal pedicle dissection, and the quality of tissue preservation. All of the participants highly rated the quality of the cadaveric tissue embalmed by Thiels method (mean scores for quality on the five‐point Likert scale were 4.5 and 4.3 by the trainees and experienced laparoscopic surgeons, respectively). All of the steps of laparoscopic renal resection were rated 4.0 or more on the Likert scale by both trainees and faculty members. The initial response rates for using a human cadaver embalmed by Thiels method as a training tool for laparoscopic nephrectomy showed encouraging results. The performance of a laparoscopic nephrectomy on a human cadaver embalmed by Thiels method bears close resemblance to real laparoscopic nephrectomy procedures, and thus demonstrates added advantages to the previously reported models.

The barriers that older novices encounter to computer use

A course on computers was run for computer beginners aged over 55. An iterative and flexible approach aimed to ensure that students’ anxieties and difficulties were addressed as the course proceeded. Several layers of difficulty were encountered, ranging from initial difficulties understanding Windows systems and the working of the mouse to more fundamental and long-term problems such as repeatedly forgetting to move the focus before typing or failing to recognize onscreen objects and understand their behaviours. Inclusive design approaches should benefit from detailed recording of barriers to use, but the diversity of the user population will also necessitate flexibility to ensure inclusivity.

Liver displacement during ventilation in Thiel embalmed human cadavers - a possible model for research and training in minimally invasive therapies

Abstract Respiration-related movement of organs is a complication in a range of diagnostic and interventional procedures. The development and validation of techniques to compensate for such movement requires appropriate models. Human cadavers embalmed with the Thiel method remain flexible and could provide a suitable model. In this study liver displacement during ventilation was assessed in eight Thiel embalmed cadavers, all of which showed thoracic and abdominal motion. Four cadavers displayed realistic lung behaviour, one showed some signs of pneumothorax after prolonged ventilation, one had limited filling of the lungs, and two displayed significant leakage of air into the thorax. A coronal slice containing the largest section through the liver was imaged with a real-time Fast Gradient Echo (FGR) MRI sequence: Craniocaudal displacement of the liver was then determined from a time-series of slices. The maximum liver displacement observed in the cadavers ranged from 7 to 35 mm. The ventilation applied was comparable to tidal breathing at rest and the results found for liver displacement are similar to values in the literature for respiratory motion of the liver under similar conditions. This indicates that Thiel embalmed cadavers have potential as a model for research and training in minimally invasive procedures.