Robert Elkington

A strong attendance from Leeds biotribology researchers to the TriboUK 2022 conference hosted by Imperial College London.

The University of Leeds walked away with both of the 1st prizes! Sarah Crossland won the top presentation prize for her talk on the measurement of foot plantar skin strain using digital image methods, and Rob Elkington won the top poster prize for his poster on polyelectrolyte functionalised PEEK for focal cartilage resurfacing.

Checkout the Leeds biotribology PhD student posters below from Sarah Crossland, Beril Yenigul, and Rob Elkington!

Sarah Crossland: Measurement of foot plantar skin strain using Digital Image Correlation methods for diabetic foot assessment

Beril Yenigul: Validation Rig Design and Results Design of a Facet Joint Replacement for Cervical Spine and Modification of a Hip Simulator for Simultaneous Friction Analysis and Validation of the Testing Method

Robert Elkington: Taking a PEEK at cartilage resurfacing

Many of us believe that the extraordinary scientific advances that have led to the dramatic improvement of our health status are the prerogative of humanity. Unfortunately, the reality is quite different.

To give you some numbers, osteoarthritis affects 7% of the global population, more than 500 million people worldwide, with women disproportionately affected by the condition [1]. The number of persons affected worldwide increased by 48 percent from 1990 to 2019, and osteoarthritis was the 15^th leading cause of years lived with disability (YLDs) [1]. Despite these numbers, many people with osteoarthritis still don’t get the first-line treatments (such as education and support for self-management, physical activity, exercise, and guidelines to maintain healthy body weight) and they are missing out on the care they need to live their lives to the fullest. For those particularly living in low- and middle-income countries (LMICs) this problem is exacerbated by the fact that both health-system and individual-level determinants influence access to care [2].

But let’s start in order. What is osteoarthritis? Osteoarthritis (OA) is the most common degenerative joint disease, a major cause of pain and disability, and a source of societal cost [3]. The disease compromises the structural and functional integrity of articular cartilage – the thick load-bearing tissue lining the ends of long bones – as well as the adjacent bone and other joint tissues [4]. The biological changes cause pain and limited mobility, which profoundly impacts a person’s everyday life, by restricting the ability to participate effectively in society, which can lead to social prejudice and exclusion from decision-making [2]. OA thereby leads to social, economic, and societal burdens, which are further compounded by the health challenges associated with increasing life expectancy and the prevalence of obesity in our global population [5].

While many of the barriers to providing OA treatment are universal, it is known that LMICs confront unique challenges and requirements. Although various difficulties have been raised, little is known about these obstacles and needs: disparity of care; expenses of providing and receiving treatment; and a lack of training for health workers [2].

The “Joint Effort Initiative” (JEI), an international consortium of doctors, researchers, and consumers led by the Osteoarthritis Research Society International (OARSI), was established with the goal of improving the global implementation of coordinated best-evidence osteoarthritis care. Driven by the huge impact of this chronic, complex condition, the JEI invited clinician-researchers from South Africa, Brazil, and Nepal to discuss their perspectives on challenges and opportunities in implementing the best-evidence care at the OARSI World Pre-Congress Workshop on April 28^th 2021, to better understand some of the issues surrounding osteoarthritis care in LMICS [2]. There were five major themes that emerged when it came to overcoming obstacles to providing the best evidence-based osteoarthritis care [2]:

-Health inequities: refers to disparities in the ability of different groups of individuals to achieve their full health potential, which is commonly defined socially, economically, demographically, or geographically. In South Africa, Brazil, and Nepal, there are substantial links between health and wealth, with health disparities linked to high levels of poverty and aggravated by a lack of health insurance. For example, in rural areas of South Africa, access to healthcare is more limited. Furthermore, various political parties govern different provinces in South Africa, affecting the care accessible in each location and resulting in fragmentation of health services. In Brazil, it is estimated that over 18% of the population has poor access to healthcare, which rises to over 32% in rural areas. People from minority ethnic groups and those from lower socioeconomic strata have even less access. Many persons with OA in Nepal’s rural areas receive no care at all [2].

-Unaffordability of OA care: in both South Africa and Brazil, although the public health systems provide the majority of the OA care, there are significant wait times and insufficient support to help patients due to a lack of resources, so in Brazil for example people generally pay for their own OA therapy. In Nepal, since you must have health insurance to pay for OA treatment, many people simply do not have access to healthcare because it is too expensive [2].

-Lack of coordinated OA care: there is a dearth of specialized, coordinated osteoarthritis care, which is especially acute in rural locations [2].

-Unimportance of OA: OA is not considered an important disease and is often overlooked in low- and middle-income countries, where health budgets are restricted. For example, in South Africa, Brazil and Nepal, there is a scarcity of published OA research and no continuing national data collection for OA [2].

-Inexperienced: There is a general shortage of health professionals who provide OA therapy, and graduates are underprepared, particularly in rural areas [2].

But despite these major problems, efforts are being made for developing solutions and strategies to improve OA care in LMICs. In particular, these improvements are based on 3 major themes:

• Upskill health workers via high-quality education and training: in South Africa, there are various training programs and the idea is to push these on a national basis in order to better integrate OA care into current health services. In Brazil, even if osteoarthritis is generally neglected, and in Nepal, they are also trying to educate and train health professionals through professional societies and universities to deliver best-evidence OA care [2].
• Leverage national health priorities: since the treatments for osteoarthritis have not progressed as quickly as treatments for many other musculoskeletal and chronic noncommunicable disorders, the idea is to improve OA care by adapting successful practices and strategies from other areas of public health [2].
• Use existing resources and advancements: to improve OA care, existing health breakthroughs and technologies could be expanded. For example, in these three countries, they are focusing on mobile health technology, so that they can reach a large part of the population quickly, even outside the urban area. This technology is already used for other diseases, so why not use it for osteoarthritis? In Nepal, furthermore, they are also trying to make more use of direct patient access to physiotherapists to manage pain [2].

In short, we cannot escape the bitter reality. Inequalities in osteoarthritis care between population groups exist in all countries, especially in low- and -middle-income countries. But fortunately, something is moving and despite many obstacles, as we can see from this article, there are also many opportunities and strategies for future implementations. The hope is that with these simple solutions, such as adopting strategies that have proven successful in other health conditions and providing education to health professionals and people with osteoarthritis [2], we can improve the care of osteoarthritis in the world and specifically in LMICs as soon as possible.

This article was written by Alessio Amicone as part of an ongoing series of scientific communications written and curated by BioTrib’s Early Stage Researchers.

Alessio is investigating the Elucidation of Friction-Induced Failure Mechanisms in Fibrous Collagenous Tissues at ETH Zürich, Switzerland.

References

[1] Hunter DJ, March L, Chew M. Osteoarthritis in 2020 and beyond: a Lancet Commission. Lancet. 2020 Nov 28;396(10264):1711-1712. Epub 2020 Nov 4.

[2] Eyles Jillian P., Sharma Saurab, Telles Rosa Weiss, Namane Mosedi, Hunter David J., Bowden Jocelyn L. Implementation of Best-Evidence Osteoarthritis Care: Perspectives on Challenges for, and Opportunities From, Low and Middle-Income Countries. Frontiers in Rehabilitation Sciences. 2022.

[3] Chen D, Shen J, Zhao W, et al. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Res. 2017; 5:16044. Published 2017 Jan 17.

[4] Griffin, Timothy M.; Guilak, Farshid The Role of Mechanical Loading in the Onset and Progression of Osteoarthritis, Exercise and Sport Sciences Reviews: October 2005 – Volume 33 – Issue 4 – p 195-200

[5] Egloff C, Hügle T, Valderrabano V. Biomechanics and pathomechanisms of osteoarthritis. Swiss Med Wkly. 2012 Jul 19;142:w13583.

When I first entered Uppsala University’s engineering building, Ångströmlaboratoriet, I found one thing particularly interesting. Tens of books are nailed high up on the walls. Judging by the placement, I thought these books were obviously not for reading. Upon asking around, I learned that these books were printed doctorate theses that were nailed during the unique Swedish academic tradition called Spikning (or thesis nailing…literally!).

Several weeks before their thesis defense, the doctoral student announces the thesis nailing ritual and celebration. Usually, they will nail a physical copy of their thesis on the walls where their department resides. Of course, another copy will be nailed on an announcement board in the main hall of the building. A little ‘party’ comes after the nailing action, where the colleagues and supervisor can congratulate the doctoral student.

It seems that this tradition has a long history. Inspiration for Spikning may have come from Martin Luther’s nailing of 95 theses on church doors in the 15^th century [1]. Since various Christian denomination was already influential in Europe during that time, the idea does not seem too farfetched. If that is indeed true, then it just makes Spikning even more special. After all, I doubt we have many customs from the 15^th century that is still a widespread practice now.

I find this unique Swedish academic tradition fascinating because it acts as both an announcement and a celebration. The journey to a doctoral degree is never easy. For many, I am sure it means years of commitment, effort, and perseverance. Thesis nailing offers doctoral students something extraordinary on their finish line: remembrance. The doctor may leave far from the university after the defense, but their thesis copy will stay long. In the corridor where my department resides, the thesis nailed on the walls dates as far back as the 1970s. Decades will pass, technologies will become obsolete, new knowledge will come, but something to remember the achievement will stay. I hope, by the end of BioTrib, I will be able to leave something that I can be proud of on a wall of Uppsala University.

Reference

[1]          “The (seeminlgy) strange custom of nailing PhD theses!,” Chalmeristbloggen, Mar. 09, 2015. https://chalmeristbloggen.wordpress.com/2015/03/09/the-seeminlgy-strange-custom-of-nailing-phd-theses/ (accessed Mar. 14, 2022).

This article was written by Vidhiaza Leviandhika as part of an ongoing series of scientific communications written and curated by BioTrib’s Early Stage Researchers.

Vidhiaza is researching the Development of Development of 3D-printed gradient alloys for joint implant component at Uppsala University, Sweden

Mr. Manoj Rajankunte Mahadeshwara attended the course on ‘Bioreactors and Growth Environments for Tissue Engineering’ organized by Keele university. This interactive training course was spread across 2 days which targeted at postgraduate students (MSc and PhD) in industry and academia. Attendees were provided with a comprehensive understanding of the use of Bioreactors in Tissue Engineering. The course focused on bioreactors and growth environments for tissue engineering, covering bone, cartilage and connective tissues.

A bioreactor is a simulator that simulates the physiogical or pathological micro environment including physiological loading.

He along with his team participated in the Bioreactor design challenge and has won the competition. His team designed the Bioreactor design for simulation of synovial joints – ‘BIOSYN’. This design was made to achieve three objectives which are:

1. To investigate the cartilage-synovial fluid interface.
2. To establish the effect of hydrostatic pressure of synovial fluid on cartilage/ tissue engineering construct
3. To investigate how natural/artificial synovial fluid compositions affect cartilage (viability, differentiation status, etc.)

Manoj Rajankunte Mahadeshwara is currently a Tribos Erasmus joint Master’s student, pursuing a master’s in Tribology.

Manoj will be joining the University of Leeds in October 2022 for a PhD between the School of Dentistry and the Institute of Functional Surfaces (iFS) funded by a Bragg Centre for Materials Research PhD Scholarship.

Fika (pronounced fee-ka) is a Swedish coffee break ritual. Swedes sit twice a day, about 10 a.m. in the morning and 3 p.m. in the afternoon. Fika is a Swedish word that roughly translates to “coffee and cake,” but it doesn’t quite capture the essence of the concept. “Fika” is an important component of socializing and maintaining a state of relaxation during the day and between jobs in Sweden, and you do not need to book it in your calendar.

In a nutshell, fika means ‘leaving your work behind and recharging your batteries.’

If you want to explore more about the essential Swedish ritual fika, there is a six-part web series (by Fabian Schmid) online. It is a way of life for some people, an institution for others, and a religion for others; it means different things to different individuals. But one thing is certain: in Sweden, it is a must for a healthy work-life balance.

People were advised to work from home when the covid-pandemic was at its peak, as they would be unable to randomly bump into someone or interact. Despite the pandemic, the Swedes continued to have fika with their coworkers, friends, and family (if in person, following the regulations in keeping the distance). They coined the term “virtual fika,” in which you sit in front of your camera with coffee, cake, and other refreshments and participate in fika.

Personally, I was astounded by the Swedish affection for fika. It not only gives you a respite from work, but it also improves your work efficiency by allowing you to refresh your thoughts for a few minutes. Furthermore, several studies have shown that it can significantly improve the bonding between colleagues in the workplace. Morley et al. [1] brilliantly discusses the fika and its role in today’s academic environment.

‘Fika allows my PhD students to communicate with me more freely and openly about project-related and, more significantly, personal matters. So that I may assist my students in any way I can,’ says Nazanin Emami, professor at Lulea University of Technology’s Division of Machine Element.

As an early-stage researcher, I can discuss my spontaneous project ideas with my colleagues and supervisor, discuss lab concerns, express my opinions on current events, cooperate with other colleagues, keep updates on other projects and and so on. This not only provides me an idea of what’s going on in the industry, but also about my colleague’s innovation and progress. Everything starts with fika and follows the formal protocol, whether it’s trying a new test approach or purchasing a new equipment for the lab. I find that having a moment of freshness helps me figure out where I am with my project. It can also enable your thought process to be redirected to a certain problem. Therefore, it helps to strengthen our relationship as colleagues.

References:

[1] Louise Morley, Petra Angervall, Caroline Berggren & Susanne Dodillet (2018) Re-purposing fika: rest, recreation or regulation in the neoliberalized Swedish University?, European Journal of Higher Education, 8:4, 400-414, DOI: 10.1080/21568235.2018.1458637

This article was written by Dilesh Raj Shrestha as part of an ongoing series of scientific communications written and curated by BioTrib’s Early Stage Researchers.

Dilesh is researching the Development of 3D-printable, self-lubricated polymer composites with improved wear resistance for total joint replacement at Luleå University of Technology, Sweden.

For many years, joint replacement of damaged hips has been a standard treatment in orthopaedic surgery. There is currently no mechanism for early detection of implant failure following surgery. Early detection of total hip replacement (THR) failure could lead to more proactive surgical intervention and better patient outcomes. In this instance, the Acoustic Emission (AE) measuring approach may be a good fit as a diagnostic indication for joint health, implant failure modes, and gait analysis.

The previous study’s AE monitoring technique did not collect patient motion data, making it hard to make accurate comparisons between AE events and implant motions, or to determine whether specific AEs are caused by specific implant articulation angles, loads, or angular velocities. FitzPatrick et al. (2022) established a concurrent technique of AE monitoring to combine lower-limb motion and AE data to enable temporal interpretation of acoustic information for gait analysis to study this issue.

Three patients (two males and one female) between the ages of 50 and 70 were taken for a combined AE and gait analysis. They underwent a ceramic-on-ceramic implant bearing hip replacement. Four passive ultrasonic receivers set in a flexible array on the patient’s skin surface from the iliac crest to the upper femur were used to identify AEs. As the patient walked across the room in a straight line at a self-selected speed over a force plate, AE data were recorded. A motion analysis system with six infrared tracking cameras recorded the patient’s limb motions at the same time.

Their findings revealed that AEs are significantly linked to the stance phase of walking, when implant loads are high and the hip joint’s angular velocity is high. The key observation from the male patient was that all of the recorded squeaks happened between 30% and 50% of their individual gait cycle, which pertains to terminal stance, across all walking tests. Interestingly, the situation was significantly different for the female patient; total voltage magnitudes were lowered, and AEs of significant magnitude occurred consistently during the stance phase.

Based on current findings, the exact mechanism that causes implant squeaking is unknown. As a result, ongoing research aims to collect combined AE and gait data from more hip replacement patients in order to evaluate if the findings apply to a larger group of patients and to get greater insight into quantitative relationships between AE activity and hip joint dynamics.

Source: FitzPatrick, A. J., et al. “Synchronized acoustic emission and gait analysis of total hip replacement patients.” Biomedical Signal Processing and Control 74 (2022): 103488.

This article was written by MM Raihan as part of an ongoing series of scientific communications written and curated by BioTrib’s Early Stage Researchers.

Raihan is researching In-situ Measurement of Nano-scale Wear Utilising Advanced Sensors at University of Leeds, UK.