APPLICATION OF HOUSE OF QUALITY IN THE CONCEPTUAL DESIGN OF BATIK WAX EXTRUDER AND PRINTER

Malaysian batik production is dominated by two techniques known as hand-drawn batik, or batik tjanting, and stamp batik, or batik block. In comparison to batik block, the more popular batik tjanting takes a longer time to produce. A Standardized Nordic Questionnaire (SNQ) for musculoskeletal symptom examination involving batik artisans in Kelantan and Terengganu identified high rates of musculoskeletal disorders in respondents due to their working posture during the batik tjanting process. It was also observed that the number of workers and artisans willing to participate in the traditional batik industry is on the decline. These problems have led to a systematic Quality Functional Deployment approach to facilitate the decision-making process for the conceptual design of an automatic batik printer. In this study, house of quality (HOQ) was applied to identify the critical features for a batik printer based on the voice of the customer (VOC). A survey done to rate the importance of VOC using an 8-point Likert scale revealed that the batik practitioners topmost priority for the batik printer feature is the 'ability to adjust and maintain the temperature of wax' (17.54%) while the non-batik practitioners chose 'ability to deliver a variety of complex designs' (15.94%). The least required feature for the batik printer was related to the size of the batik printer. The mapping between customer requirements (VOC) and technical requirements identified that the extruder design (21.3%), the heating element (18%), and nozzle diameter (17.8%) were the most critical components for the batik printer. Several conceptual designs of the extrusion unit, cartesian-based batik printer, and 2D image conversion using open-sourced software were proposed at the end of this work. ABSTRAK: Pengeluaran batik Malaysia telah didominasi oleh dua teknik yang dikenali sebagai batik lukisan-tangan (batik canting) dan batik cap (batik blok). Sebagai perbandingan, batik canting yang popular mengambil masa lebih lama bagi dihasilkan. Soal Selidik Nordic Standad (SNQ) bagi meneliti gejala muskuloskeletal melibatkan tukang batik di Kelantan dan Terengganu telah menunjukkan persamaan kadar muskuloskeletal yang tinggi pada postur badan semasa bekerja canting batik. Bilangan pekerja yang terlibat dalam industri tradisional batik ini turut terjejas. Masalah-masalah ini telah mengarah kepada kaedah Pengerahan Fungsi Kualiti bagi membantu proses membuat keputusan dalam rekaan konsep pencetak batik automatik. Kajian ini telah mengadaptasi Kualiti Rumah (HOQ) bagi mengesan ciri-ciri kritikal pada pencetak batik berdasarkan suara pelanggan (VOC). Kaji selidik telah dilakukan bagi menilai kepentingan VOC menggunakan skala Likert 8-poin. Didapati keutamaan yang diperlukan oleh 17.54% ahli batik adalah; ciri pencetak batik ini perlu mempunyai ‘keupayaan dalam menyelaras dan menetapkan suhu lilin’, manakala sebanyak 15.94% bukan ahli batik memilih ‘keupayaan pencetak ini harus berjaya menghasilkan pelbagai rekaan yang kompleks’. Ciri yang kurang diberi tumpuan adalah berkaitan saiz pencetak batik. Persamaan antara kehendak pelanggan (VOC) dan kehendak teknikal dalam mengenal pasti komponen-komponen penting bagi pencetak batik adalah rekaan penyemperit (21.3%), elemen pemanas (18%), dan diameter nozel (17.8%). Pelbagai rekaan konsep bagi unit penyemperit, pencetak batik canting, dan imej konversi 2D menggunakan perisian sumber terbuka telah dicadangkan di bahagian akhir kajian ini.

Investigation of Screen Time Inclination and the Accompanying Visual and Musculoskeletal Discomfort in Young Smartphone Users

The purpose of this study is to investigate the screen time inclination and its accompanying visual and musculoskeletal discomfort in young smartphone users. Thirty-one smartphone users aged between 20 - 30 years old were recruited through convenient sampling. The screen time patterns were recorded daily for a week and documented using Action Dash on Google Play Store according to the times of the day (morning, afternoon evening and night). Accompanying visual and musculoskeletal symptoms were examined through a self-reporting questionnaire survey. The questions used in the questionnaire were adapted and modified from the Asthenopia Questionnaire and Nordic Musculoskeletal Questionnaire. Results showed that young smartphone users spent approximately 30 % of their time on screen and were relatively similar for different times of the day. Daily screen time was approximately 7.36 ± 1.74 h. Most users engaged in WhatsApp (74 %), followed by YouTube (68 %), Instagram (65 %) and Twitter (39 %). Tired eyes were reported by all smartphone users. A positive correlation was only found between weekly screen time and eye strain (p < 0.05). All musculoskeletal symptoms were self-reported by young smartphone users in our study but anatomical locations varied in percentages. Neck pain was the most significant musculoskeletal symptom associated with screen time (OR = 4.80, 95 % CI: 0.95 - 24.14, p < 0.05). Every smartphone user reported at least 1 type of visual symptom. All smartphone users reported tired eyes. In conclusion, our results showed that smartphone users spent one third of their time daily on-screen and mostly on social media. Tired eyes and neck pain were the most common accompanying symptoms. Visuo-skeletal symptoms are common among young and healthy smartphone users. Our findings advocate that future strategic plans to address digital related health problems from the perspective of health education, promotion and protection should be inclusive of youth. HIGHLIGHTS Excessive screen time is a public health concern Adverse health implications have been linked to excessive electronic usage Smartphone users spend one-third of their time daily on-screen and mostly on social media Visuo-skeletal symptoms are common among young and healthy smartphone users Tired eyes and neck pain are the most common accompanying symptoms GRAPHICAL ABSTRACT

Low Back Pain and Its Correlations with Poor Sleep Quality Among Healthcare Providers

Introduction: Low back pain is found to be the most common occupational and work-related musculoskeletal symptom worldwide. Its prevalence was found to be almost twice among healthcare providers (HCPs) than in other occupations. It is observed that the prevalence of poor sleep quality is higher in HCPs than the general population. To the best of our knowledge, this reciprocal relationship is still unresolved. Thus, this study aims to establish the relationship between low back pain and sleep quality among HCPs in Saudi Arabia. Methodology: An anonymous cross-sectional questionnaire-based study was performed on HCPs in Saudi Arabia. The questionnaire consisted of three sections. The first section included the biographical data of the participants; the second included Oswestry Disability Index (ODI) and Nordic musculoskeletal questionnaire for low back pain; and the third section was the Pittsburgh Sleep Quality Index (PSQI). Informed consent from each participant and ethical approval were taken before the commencement of the study. Result: Four hundred and forty-two respondents participated and completed the questionnaire. Nearly two-thirds of the respondents were male (62.7%) while the rest were female (37.3%). Most of the respondents were living in either the central (23.3%) or the northern (23.3%) regions. It was found that the correlation between global PSQI and ODI score was positively highly statistically significant (r = 0.235; p < 0.001). The correlation between ODI score and PSQI components including subjective sleep quality (r = 0.229; p = 0.007), habitual sleep efficiency (r = 0.229; p < 0.01), and daytime dysfunction were also positively highly statistically significant. Conclusion: HCPs in Saudi Arabia with higher low back pain disability rating demonstrated poorer overall sleep quality and vice versa. However, further research is needed to investigate whether this relationship is dependent on each other in terms of causality.

Prevalence of Musculoskeletal Disorder among College Students in Times of COVID-19 Pandemic - An Observational Study

Background: Musculoskeletal disorders are defined as disorders and/or injuries that affect muscles, tendons, skeleton, cartilage, ligaments and nerves. Due to Covid-19, educational institutions were shut down which led to dependency on online classes. Due to decreased physical activity and spending more time on electronic devices in incorrect postures may lead to musculoskeletal disorders. Purpose of study: To find out the prevalence of musculoskeletal disorders among college students during Covid-19 pandemic to help students know the most prone body areas for musculoskeletal discomfort so as to plan for ergonomic modification and for uplifting musculoskeletal health. Methodology: A ‘Nordic Musculoskeletal Questionnaire’ was filled by 250 college students by means of Google forms. Statistical analysis was done using Microsoft Excel 2007. Results: Among 250 students 64.4% had at least one musculoskeletal symptom in the previous year. The affection was in Lower back (38%), Neck (36.4%), Shoulder (27.20%), Upper back (22%), Knee (13.60%), Wrist (13.20%), Ankle (12.40%), Elbow (6.80%), Hip (6.40%). Conclusion: This study concluded that due to increased screen-time on electronic devices during COVID-19 led to high prevalence of musculoskeletal disorders (64.4%) in college students. The highest musculoskeletal disorder was found in Lower back region (38%). Key words: Musculoskeletal disorder, College students, COVID-19.

774The appropriateness of the Effort-Reward Imbalance ratio for investigating musculoskeletal symptoms

Background Effort-reward imbalance (ERI), an indicator of occupational stress, can provide valuable insights into musculoskeletal symptom (MSS) outcomes for workers. The ERI ratio is typically used in analysis, rather than the effort and reward variables individually, or the reward sub-scales (promotion opportunities, job security and esteem). The appropriateness of this approach has not been investigated. We were interested in the association between the ERI ratio and its components (e.g. effort, promotion opportunities), and MSS outcomes (the presence of any MSSs, and a range of consequences) in professional musicians. Methods Employed, professional musicians completed a questionnaire that included the short version of the Effort-Reward Imbalance questionnaire, and questions regarding their MSSs. Regressions were performed to determine the association between the ERI ratio and other ERI components, and MSS outcomes. Results The ERI ratio was associated with a number of MSS outcomes, including chronic MSSs and MSSs that impaired playing, however this relationship appeared to be driven by increased perceived effort, not by reward. Conclusions Our findings highlight the need to investigate the individual ERI components (e.g. subscales), rather than just the ERI ratio, when investigating the association between occupational stress and MSS outcomes. By doing so, more targeted recommendations can be made, which for musicians include reducing their perceived effort to lower their MSS burden. Key messages Studies investigating the association between occupational stress and MSS outcomes should investigate the individual components and subscales of the ERI model.

Younger age of onset and uveitis associated with HLA-B27 and delayed diagnosis in Thai patients with axial spondyloarthritis

To identify characteristics associated with HLA-B27, and to identify factors associated with delayed diagnosis in Thai patients with axial spondyloarthritis (axSpA). This cross-sectional study included Thai patients were diagnosed with axSpA by a rheumatologist at Siriraj Hospital. Clinical data were collected. Regression analyses were employed to identify factors associated with study outcomes. Of total 177 patients, 127 (72%) were positive HLA-B27. Uveitis [Odds ratio (OR) 4.0], age at onset of the first musculoskeletal symptom of ≤ 28 years [OR 3.5], female [OR 0.4], and psoriasis [OR 0.4] were significantly associated with HLA-B27 in multiple regression analysis. Those with positive HLA-B27 had less spinal flexibility. Elevated C-reactive protein (p = 0.012) was associated with shorter delay in diagnosis, while uveitis (p < 0.001) and younger age at onset of the first symptom (p = 0.002) were associated with longer delay in diagnosis in multiple regression analysis. Younger age at onset of the first musculoskeletal symptom and uveitis were associated with HLA-B27 and delayed diagnosis in axSpA patients. Young people with musculoskeletal symptom and uveitis should be referred to a rheumatologist to rule out or make a timely diagnosis of axSpA.

Using Bayesian Networks to identify musculoskeletal symptoms influencing the risk of developing Psoriatic Arthritis in people with psoriasis

Objectives To explore Bayesian networks (BNs) in understanding the relationships between musculoskeletal symptoms and the development of PsA in people with psoriasis. Methods Incident cases of psoriasis were identified between 1998 and 2015 from the UK Clinical Research Practice Datalink. Musculoskeletal symptoms identified by medcodes were concatenated into primary groups, each made up of several sub-groups. Baseline demographics for gender, age, body mass index (BMI), psoriasis severity, alcohol use and smoking status were also extracted. Several BN structures were composed using a combination of expert knowledge and data-oriented modelling using: 1) primary musculoskeletal symptom groups, 2) musculoskeletal symptom sub-groups and 3) demographic variables. Predictive ability of the networks using the receiver operating characteristic curve (AUC) was calculated. Results Over one million musculoskeletal symptoms were extracted for the 90,189 incident cases of psoriasis identified, of which 1409 developed PsA. The BN analysis yielded direct relationships between gender, BMI, arthralgia, finger pain, fatigue, hand pain, hip pain, knee pain, swelling, back pain, myalgia and PsA. The best BN, achieved by using the more site-specific musculoskeletal symptom sub-groups, was 76% accurate in predicting the development of PsA in a test set and had an AUC of 0.73 (95% confidence interval (CI): 0.70-0.75). Conclusion The presented BN model may be a useful method to identify clusters of symptoms that predict the development of PsA with reasonable accuracy. Using a BN approach, we have shown that there are several symptoms which are predecessors of PsA, including fatigue, specific types of pain, and swelling.

Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)

Background: Involvement of the axial skeleton (sacroiliac joints and spine) is a relatively frequent manifestation associated with psoriatic skin disease, mostly along with involvement of peripheral musculoskeletal structures (peripheral arthritis, enthesitis, dactylitis), which are referred to as psoriatic arthritis (PsA). Data suggest that up to 30% of patients with psoriasis have PsA. Depending on the definition used, the prevalence of axial involvement varies from 25% to 70% of patients with PsA. However, there are currently no widely accepted criteria for axial involvement in PsA.Objective: The overarching aim of the Axial Involvement in Psoriatic Arthritis (AXIS) study is to systematically evaluate clinical and imaging manifestations indicative of axial involvement in patients with PsA and to develop classification criteria and a unified nomenclature for axial involvement in PsA that would allow defining a homogeneous subgroup of patients for research. Design: Prospective, multicenter, multinational, cross-sectional study. Methods and analyses: In this multicenter, multinational, cross-sectional study, eligible patients [adult patients diagnosed with PsA and fulfilling Classification Criteria for Psoriatic Arthritis (CASPAR) with musculoskeletal symptom duration of ⩽10 years not treated with biological or targeted synthetic disease-modifying anti-rheumatic drugs] will be recruited prospectively. They will undergo study-related clinical and imaging examinations. Imaging will include radiography and magnetic resonance imaging examinations of sacroiliac joints and spine. Local investigators will evaluate for the presence of axial involvement based on clinical and imaging information which will represent the primary outcome of the study. In addition, imaging will undergo evaluation by central review. Finally, the central clinical committee will determine the presence of axial involvement based on all available information. Ethics: The study will be performed according to the ethical principles of the Declaration of Helsinki and International Council for Harmonisation Good Clinical Practice guidelines. The study protocol will be approved by the individual Independent Ethics Committee / Institutional Review Board of participating centers. Written informed consent will be obtained from all included patients.Registration: ClinicalTrials.gov ID: NCT04434885.

Assessment of Musculoskeletal Pain, Fatigue and Grip Strength in Hospitalized Patients with COVID-19

IMPORTANCE Coronavirus disease 2019 (COVID-19) is an emerging disease that was declared as a pandemic by WHO. Although there are many retrospective studies to present clinical aspects of the COVID-19, still the involvement of the musculoskeletal system has not been deeply investigated.OBJECTIVE To classify the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relationship of these parameters with the severity and laboratory values of the disease. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed at the IUC-Cerrahpaşa Pandemic Clinic. Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. Data were recorded from May 15,2020, to June 30, 2020.MAIN OUTCOMES AND MEASURES Demographic data, comorbidities, musculoskeletal symptoms, laboratory findings and CT scans were recorded. To determine the disease severity 2007 idsa/ats guidelines for community acquired pneumonia was used. Myalgia severity was calculated by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer.RESULTS 103 patients (68.7%) were nonsevere and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, showed significant correlation with disease severity. There was severe myalgia according to NRS regardless of disease severity. The physical fatigue severity score was significantly higher in severe cases, whereas no relationship was found with mental fatigue score. Female patients with severe infection had lower grip strength with a mean value of 18.26 kg (P= .010) in dominant hand, whereas no relationship was found between disease severity and grip strength in male patients, but the mean values in both genders and in decades appears below the specified normative values. Lactate dehydrogenase (LDH) level and lymphocyte count were significantly correlated with lower grip strength. LDH, C-reactive protein (CRP) and D-dimer levels were above the normal range in patients with myalgia, arthralgia and fatigue. CONCLUSIONS AND RELEVANCE Musculoskeletal symptoms are quite common aside from other multi-systemic symptoms in patients with COVID-19. Arthralgia, which is related to the disease severity, should be considered apart from myalgia. COVID-19 patients have severe ischemic myalgia regardless of the disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is related with the disease activity especially in women. Muscular involvement in coronavirus disease is a triangle of myalgia, physical fatigue, and functional impairment.