bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Burmester Theory in the Design of Compliant Mechanisms
Authors: Mettlach Gregory A. , Midha Ashok
Published: February 2021

Compliant mechanisms have been defined as mechanical systems that derive some or all of their mobility from the flexibility of one or more of their members. In general, due to the large-deflection nature of the compliant members, analysis and synthesis of compliant mechanisms have typically required a numerical iterative solution method. Recently, analytical loop-closure synthesis techniques have been extended to the design of compliant mechanisms, by utilizing the concept of an equivalent pseudo-rigid-body model for a compliant mechanism. These developments have greatly simplified the synthesis of compliant mechanisms. These mechanisms have been synthesized for three precision points using analytical and graphical methods. In rigid-link mechanism design, additional precision points may be incorporated by using Burmester theory. With this enhancement as the motivation, this paper presents the first use of Burmester theory to design compliant mechanisms for four and five precision points. This is facilitated by use of the concept of an equivalent pseudo-rigid-body model. Burmester theory yields a linear set of kinematic equations, allowing for their easy utilization herein. Also for some design problems, this theory can provide a graphical representation of all possible solutions for compliant mechanisms. In addition to the specification of precision points for compliant mechanisms, input torque and/or potential energy values may also be prescribed.
Computing an Assembled Configuration for the McPherson Strut Suspension System
Authors: Zou Hong-Liu , Wang Jia-Yi , Abdel-Malek Karim A. , Alkam Moh’d
Published: February 2021

Geometry analysis for the kinematic design of the McPherson strut suspension system is presented. Analytical formulations for computing variational constraints of spatial joints are derived. Using this method, a designer may alter design variables and determine the propagated effect throughout the underlying mechanism. The McPherson suspension is represented using graph theory and closed loops are converted to a tree-like structure by cutting joints and introducing new constraints. A change in link length or link orientation is propagated through the model and a new assembled configuration is computed. The analytical formulation and its numerical solution methods are presented. The aim of this work is to provide the user of the experimental computer code with a method for the design and redesign of the McPherson suspension system.
Isotropic Coordinates, Circularity, and Bezout Numbers: Planar Kinematics From a New Perspective
Authors: Wampler Charles W.
Published: February 2021

It is commonly recognized that a convenient formulation for problems in planar kinematics is obtained by considering links to be vectors in the complex plane. However, scant attention has been paid to the natural interpretation of complex vectors as isotropic coordinates. These coordinates, often considered a special trick for analyzing four-bar motion, are in fact uniquely suited to two new techniques for analyzing polynomial systems: the BKK bound and the product-decomposition bound. From this synergistic viewpoint, a fundamental formulation of planar kinematics is developed and used to prove several new results, mostly concerning the degree and circularity of the motion of planar linkages. Useful for both analysis and synthesis of mechanisms, the approach both simplifies theoretical proofs and facilitates the numerical solution of mechanism problems.
Synthesis of Four-Bar Function Generators by an Iterative Learning Control Procedure
Authors: Phan Minh Q. , Chew Meng-Sang
Published: February 2021

This paper investigates the applicability of learning control theory to mechanism synthesis via the classical four-bar function generator problem. A function to be generated by a mechanism can be looked upon as a trajectory to be tracked. The parameters that define the mechanism can be thought of as the control inputs. In this sense, the problem of synthesizing a mechanism to generate a particular output function can be treated as a “control” problem. Moreover, it is a learning control problem if the mechanism is synthesized by an iterative process. At each trial or iteration, a learning scheme modifies the mechanism dimensions based on how well it generates the desired function in the previous trial so that the synthesized mechanism approximates the desired output function more and more closely. With this thinking, concepts and tools from learning control theory can be adapted to the mechanism synthesis problem. It will be shown that mechanisms with minimum residual error or minimum structural error can be synthesized by a procedure analogous to that derived for iterative learning control. The starting angles of the input and output links are learned together with the mechanism dimensions. By the use of weighted cost functionals, iterative learning schemes that handle the tradeoff between the emphasis on a certain portion of the output trajectory (e.g., local control) and the mechanism dimensions can be derived in a straight forward manner. Numerical examples are used to illustrate the utility and flexibility of the learning formulation.
Design of Adjustable Spherical Four-Bar Linkages As Continuous Passive Motion Devices for Anatomic Joints Rehabilitation
Authors: Hong Boyang , Erdman Arthur , Ham Kealy
Published: February 2021

Continuous passive motion (CPM) is an important treatment in postoperative rehabilitation of human joints. It can improve the range of motion (ROM), reduce joint stiffness and accelerate the recovery process. The concept of CPM can be applied in many joint rehabilitation applications, including ankle joints, knee joints and elbow joints. However, even within a single type of joint, the ROM can be significantly different from person to person. Adjustable spherical linkage is appropriate for these applications. The following procedure is introduced: synthesize the first set of positions and selects the center point and circle point. Then, with the same center point and circle point, by altering some design parameters, i.e., the length of the input link and output link, a new set of positions can be synthesized. This idea is more practical in three-plus-two position synthesis, but can also be applied to four-plus-three position synthesis, with a significant increase in complexity.

The above synthesis method can be applied to any generic adjustable spherical linkage application. In this paper, this method is tailored to an anatomical joint application for CPM machine design. Clinical motion data is directly used to define the orientation of the joint. The details of this method are illustrated by an example, the ankle joint. The first set of synthesis positions is obtained from the clinical data and a list of designed candidates is presented. After that, we introduced a second set of synthesis positions from the clinical data. The adjustable spherical linkage is synthesized with the common ground pivot. By using this method, an adjustable CPM machine can be designed to cover the minimum ROM and maximum ROM. This machine can be used to more than one patient, as well as throughout a single patient’s full recovery.
Design of Entrance Door Mechanism for Sabreliner Jet Aircraft
Authors: Berg Timothy J. , Erdman Arthur G.
Published: February 2021

The redesign of the entrance door of a Sabreliner corporate jet to improve access to the aircraft cabin is described. The current aircraft design uses a door that opens into the cabin space allowing the top of the door to swing through the opening. The door rotates into its final position where it becomes the entrance steps to the aircraft cabin. In the present configuration, the open door is inclined 60° with the top step situated 14 inches above the cabin floor.

This paper presents two new designs for the cabin door where the top step is reduced to the same height as the cabin floor. In addition, the incline of the steps has been reduced from 60° to about 45° improving access to the cabin. The final designs, developed using LINCAGES 4[1] and LINCAGES 6[2] computer software, are 6-bar mechanisms — one using pin joints and the other using a rotating slider link. In both cases, the floating coupler (the door) is driven by hand.
Closed-Form Determination of the Location of a Rigid Body by Seven In-Parallel Linear Transducers
Authors: Innocenti Carlo
Published: February 2021

The paper presents an original analytic procedure for unambiguously determining the relative position and orientation (location) of two rigid bodies based on the readings from seven linear transducers. Each transducer connects two points arbitrarily chosen on the two bodies. The sought-for rigid-body location simply results by solving linear equations. The proposed procedure is suitable for implementation in control of fully-parallel manipulators with general geometry. A numerical example shows application of the reported results to a case study.
Optimization of Multibody Dynamics Using Pointwise Constraints and Arbitrary Functions
Authors: Urruzola Javier , Avello Alejo , Celigüeta Juan T.
Published: February 2021

Multibody dynamics optimization requires the computation of sensitivities of the objective function and the constraints. This calculation can be done by two methods, direct differentiation and adjoint variable method, that are reviewed in this paper. In either cases, the complexity of the terms that appear in the formulation makes almost a need the use of symbolic computation for the derivation of sensitivities. An existing symbolic manipulator designed for multibody optimization has been enhanced with new and more powerful capabilities. The use of arbitrary functions as design variables and pointwise constraints permits the solution of more complex optimization problems. Some illustrative examples prove the capacity of the method to handle complex optimization problems.
Barriers, Expectancy-Value Beliefs, and Physical Activity Engagement Among Adults With Visual Impairments
Authors: Kirk T.N. , Haegele Justin A. , Zhu Xihe
Published: February 2021

The purpose of this inquiry was to examine the relationship between barriers to physical activity, expectancy-value variables, and physical activity engagement among adults with visual impairments. Using a descriptive correlational approach, a sample of 214 adults with visual impairments (Mage = 43.14, SD = 13.67) completed questionnaires pertaining to barriers to physical activity, expectancy-value beliefs about physical activity, and physical activity engagement. Data were analyzed via correlation and hierarchical regression. The final regression model explained 20.30% of variance in physical activity (p < .001). Intrinsic value (β = 0.26, p = .01) and expectancy beliefs (β = 0.33, p < .001) each emerged as significant predictors of physical activity engagement, which suggests that expectancy-value theory may have some utility for investigating the physical activity engagement of individuals with visual impairments. However, the lack of significant contribution of other variables such as attainment and utility values, as well as barriers factors, underscores the need for additional research in this area.
Nonleisure-Time Physical Activity Guidance Following Minor Ischemic Stroke: A Randomized Clinical Trial
Authors: Ashizawa Ryota , Yamashita Kazuma , Take Koki , Okawara Kengo , Mochizuki Eri , Sakamoto Asuka , Yoshimoto Yoshinobu
Published: February 2021

The purpose of this single-masked randomized clinical trial was to examine whether nonleisure-time physical activity guidance (NLTPAG) improves physical activity levels in patients after minor ischemic stroke. Patients who had been hospitalized for minor ischemic stroke in an acute care hospital (National Health Institute Stroke Scale ≤ 5) were randomized to either an NLTPAG group (n = 17) or a leisure-time physical activity guidance group (n = 16). NLTPAG focused on reducing sedentary behavior and increasing the frequency of walking for shopping and household activities to improve physical activity levels in daily life. Physical activity levels significantly improved only in participants in the NLTPAG group (initial assessment: metabolic equivalents of task = 12.6; final assessment: metabolic equivalents of task = 14.8;p = .035,r = .51). These results suggest that NLTPAG may be effective for improving physical activity levels in patients after minor ischemic stroke.
The Relationships Between Training Load, Type of Sport, and Sleep Among High-Level Adolescent Athletes
Authors: Aloulou Anis , Duforez Francois , Léger Damien , De Larochelambert Quentin , Nedelec Mathieu
Published: February 2021

Purpose: To evaluate the effects of sporting activities, training loads, and athletes’ characteristics on sleep among high-level adolescent athletes, in a controlled training and academic environment. Methods: A total of 128 high-level adolescent athletes (age = 15.2 [2.0] y), across 9 different sports, completed common sleep questionnaires and were monitored daily (7.3 [2.7] d) during a typical in-season training period. Sleep was analyzed using actigraphy and sleep diaries, whereas training load was evaluated using the session rating of perceived exertion, and muscle soreness and general fatigue were reported with the aid of visual analog scales. Separate linear mixed-effects models were fitted, including the athlete as a random effect and the following variables as fixed effects: the sport practiced (categorical predictor), daily training load, age, and sex. Different models were used to compare sleep variables among sports and to assess the influence of training load, age, and sex. Results: The mean total sleep time was 7.1 (0.7) hours. Swimmers presented increased sleep fragmentation, training loads, perceived muscle soreness, and general fatigue compared with athletes who engaged in other sports. Independent of any sport-specific effects, a higher daily training load induced an earlier bedtime and reduced total sleep time and perceived sleep quality, with higher sleep fragmentation. Moreover, female athletes experienced increased total sleep time and worse sleep quality in response to stress compared with those in males. Conclusion: In a controlled training and academic environment, high-level adolescent athletes did not achieve the recommended sleep duration. Impaired sleep quality and quantity could be partially explained by increased training loads.
Exploring Coaches’ Perceptions of the Feasibility of a Movement-Oriented Games-Based Assessment Within “Made to Play” Programs
Authors: Morley David , Miller Andrew , Rudd James , Issartel Johann , Goodway Jackie , O’Connor Donna , Harvey Stephen , Ogilvie Paul , van Rossum Thomas
Published: February 2021

Coaches can provide an appropriate environment for children to develop a range of movement skills, but there is a dearth of research exploring the creation of appropriate resources to support the coach in developing and assessing children’s Complex Movement Skills. There is also a lack of research around coaches’ perceived feasibility of the limited resources in this area. Therefore, the purpose of this study was to design and then assess the feasibility of a Movement-Oriented Games-Based Assessment (MOGBA) for children aged 8–12 years, to be used by coaches within “Made to Play” programs. Thirteen coaches from across the United States and the United Kingdom used pilot materials to assess the feasibility of MOGBA over a 9-week period. Individual, paired, and focus group interviews were structured and data were thematically analyzed using Bowen et al.’s feasibility framework. Findings suggested that MOGBA provided a welcomed and much needed enhancement to their programs, with effective use of technology-enhanced coaching. Coaching involved notions of pedagogy and assessment, with issues emerging around class size and complexity of assessment. Coaches often used MOGBA covertly and flavored the resource to the sport being delivered, and this revealed to coaches the capability of children not viewed before.
Cognitive–Perceptual–Affective–Motivational Dynamics During Incremental Workload Accounting for Exertion Tolerance
Authors: Alvarez-Alvarado Stacey , Tenenbaum Gershon
Published: February 2021

Inquiry of the psychological states during the exercise experience failed to fully account for the role of motivation to adhere and the disposition of exertion tolerance (ET). The current study expands the scope of the integrated cognitive–perceptual–affective framework by measuring the motivation to sustain effort in two physical tasks and accounting for ET. Thirty male participants performed cycling and isometric handgrip tasks to assess the progression of the rating of perceived exertion, attentional focus, affective responses, and motivation to adhere, along with an incremental workload. The ET was determined by a handgrip task time to voluntary exhaustion. The findings indicated significant time effects and linear trends for perceived exertion, attentional focus, affect, and perceived arousal but not motivation to adhere during the handgrip and cycling tasks. The ET played a key role in the integrity of the model, particularly in perceptual, attentional, and affective responses. The intended model serves to stimulate new research into adaptation mechanisms.
Perseverance will explore history of ancient lake
Authors: Voosen Paul
Published: February 2021

Newly arrived Mars rover will probe rocks to reveal how wet planet was—and for how long.
Hunt for renewable plastics clears a hurdle
Authors: Service Robert F.
Published: February 2021

Solving alkalinity problem may help make plastics from CO
2
, water, and electricity.
The influence of juvenile dinosaurs on community structure and diversity
Authors: Schroeder Katlin , Lyons S. Kathleen , Smith Felisa A.
Published: February 2021

Not enough room

Modern carnivore communities include species that span a range of body sizes. For example, on the African savannah, there are small species (mongooses), medium species (wild dogs), and large species (lions). This variation reflects available prey sources that best suit each group. Carnivorous dinosaur communities, however, were missing species that fall into the middle, or mesocarnivore, group as adults. Schroeder
et al.
looked across communities, space, and time and found that this absence appears to have been driven by the distinctive biology of dinosaurs, in which giant adults start out as tiny hatchlings. Growing juvenile dinosaurs thus filled the other niches and limited trophic species diversity.

Science
, this issue p.
941
SARS-CoV-2 dependence on host pathways
Authors: Wong Jason P. , Damania Blossom
Published: February 2021

A drug that inhibits host protein synthesis shows antiviral activity against SARS-CoV-2
Imaging the Late Triassic lithospheric architecture of the Yidun Terrane, eastern Tibetan Plateau: Observations and interpretations
Authors: Zhan Qiong-Yao , Zhu Di-Cheng , Wang Qing , Cawood Peter A. , Xie Jin-Cheng , Liu Xiang , Li Shi-Min , Zhang Liang-Liang , Zhao Zhi-Dan
Published: February 2021

The present-day lithospheric architecture of modern and ancient orogens can be imaged by geophysical techniques. For ancient orogens, unravelling their architecture at the time of formation is hindered by later tectono-magmatic events. In this paper, we use spatial variations in radiogenic isotopic compositions of Late Triassic magmatism from the Yidun Terrane, eastern Tibetan Plateau, to establish its lithospheric architecture during the Triassic. Comprehensive geochemical and isotopic data of Late Triassic magmatic rocks from four transects across the Yidun Terrane document eastward enrichment in whole-rock Nd, Sr, and zircon Hf isotopic compositions. Mafic and felsic rocks of major plutons show coherent and nonlinear trends in the Zr and P2O5 systematics and have limited variation of isotopic compositions. This indicates that Late Triassic magmatic differentiation was dominated by fractionation of mantle-derived mafic magmas. The spatial isotopic trends result from changing mantle sources, including variable contributions of isotopically depleted asthenospheric mantle and isotopically enriched subcontinental lithospheric mantle (SCLM) to magma sources. The spatial variation of mantle sources suggests a westward thinning of the SCLM during the Triassic. We propose that this architecture is most likely associated with eastward subduction of oceanic lithosphere of the Jinshajiang Ocean located at the west of the Yidun Terrane, immediately prior to the Late Triassic magmatism.
Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual
Authors: Verberne Daan P J , van Mastrigt Ghislaine A P G , Ponds Rudolf W H M , van Heugten Caroline M , Kroese Mariëlle E A L
Published: February 2021

Objective

To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual.

Design

Economic evaluation within a comparative effectiveness research design.

Setting

Primary care (2016–2017) and community settings (2011–2013) in the Netherlands.

Participants

Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation.

Interventions

Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke.

Primary and secondary outcome measures

Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale.

Results

Health outcomes were significantly better in stroke aftercare for QALYs (Δ=0.05; 95% CI 0.01 to 0.09) and social participation (Δ=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were €1208 higher in stroke aftercare than in care-as-usual (95% CI −€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-as-usual (95% CI −€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-to-pay level.

Conclusions

Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.
Factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting: a qualitative study
Authors: Gilbert Anthony W , Jones Jeremy , Stokes Maria , May Carl R
Published: February 2021

Objectives

To identify, characterise and explain factors that influence patient preferences, from the perspective of patients and clinicians, for virtual consultations in an orthopaedic rehabilitation setting.

Design

Qualitative study using semi-structured interviews and abductive analysis.

Setting

A physiotherapy and occupational therapy department situated within a tertiary orthopaedic centre in the UK.

Participants

Patients who were receiving orthopaedic rehabilitation for a musculoskeletal problem. Occupational therapists, physiotherapists or therapy technicians involved in the delivery of orthopaedic rehabilitation for patients with a musculoskeletal problem.

Results

Twenty-two patients and 22 healthcare professionals were interviewed. The average interview length was 48 minutes. Four major factors were found to influence preference: the situation of care (the ways that patients understand and explain their clinical status, their treatment requirements and the care pathway), the expectations of care (influenced by a patients desire for contact, psychological status, previous care and perceived requirements), the demands on the patient (due to each patients respective social situation and the consequences of choice) and the capacity to allocate resources to care (these include financial, infrastructural, social and healthcare resources).

Conclusion

This study has identified key factors that appear to influence patient preference for virtual consultations in orthopaedic rehabilitation. A conceptual model of these factors, derived from empirical data, has been developed highlighting how they combine and compete. A series of questions, based on these factors, have been developed to support identification of preferences in a clinical setting.
Additional Treatments to the Local tumour for metastatic prostate cancer-Assessment of Novel Treatment Algorithms (IP2-ATLANTA): protocol for a multicentre, phase II randomised controlled trial
Authors: Connor Martin John , Shah Taimur Tariq , Smigielska Katarzyna , Day Emily , Sukumar Johanna , Fiorentino Francesca , Sarwar Naveed , Gonzalez Michael , Falconer Alison , Klimowska-Nassar Natalia , Evans Martin , Naismith Olivia Frances , Thippu Jayaprakash Kamalram , Price Derek , Gayadeen Shiva , Basak Dolan , Horan Gail , McGrath John , Sheehan Denise , Kumar Manal , Ibrahim Azman , Brock Cathryn , Pearson Rachel A. , Anyamene Nicola , Heath Catherine , Shergill Iqbal , Rai Bhavan , Hellawell Giles , McCracken Stuart , Khoubehi Bijan , Mangar Stephen , Khoo Vincent , Dudderidge Tim , Staffurth John Nicholas , Winkler Mathias , Ahmed Hashim Uddin
Published: February 2021

Introduction

Survival in men diagnosed withde novosynchronous metastatic prostate cancer has increased following the use of upfront systemic treatment, using chemotherapy and other novel androgen receptor targeted agents, in addition to standard androgen deprivation therapy (ADT). Local cytoreductive and metastasis-directed interventions are hypothesised to confer additional survival benefit. In this setting, IP2-ATLANTA will explore progression-free survival (PFS) outcomes with the addition of sequential multimodal local and metastasis-directed treatments compared with standard care alone.

Methods

A phase II, prospective, multicentre, three-arm randomised controlled trial incorporating an embedded feasibility pilot. All men with new histologically diagnosed, hormone-sensitive, metastatic prostate cancer, within 4 months of commencing ADT and of performance status 0 to 2 are eligible. Patients will be randomised to Control (standard of care (SOC)) OR Intervention 1 (minimally invasive ablative therapy to prostate±pelvic lymph node dissection (PLND)) OR Intervention 2 (cytoreductive radical prostatectomy±PLND OR prostate radiotherapy±pelvic lymph node radiotherapy (PLNRT)). Metastatic burden will be prespecified using the Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease (CHAARTED) definition. Men with low burden disease in intervention arms are eligible for metastasis-directed therapy, in the form of stereotactic ablative body radiotherapy (SABR) or surgery. Standard systemic therapy will be administered in all arms with ADT±upfront systemic chemotherapy or androgen receptor agents. Patients will be followed-up for a minimum of 2 years. Primary outcome: PFS. Secondary outcomes include predictive factors for PFS and overall survival; urinary, sexual and rectal side effects. Embedded feasibility sample size is 80, with 918 patients required in the main phase II component. Study recruitment commenced in April 2019, with planned follow-up completed by April 2024.

Ethics and dissemination

Approved by the Health Research Authority (HRA) Research Ethics Committee Wales-5 (19/WA0005). Study results will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT03763253; ISCRTN58401737
How digital health solutions align with the roles and functions that support hospital to home transitions for older adults: a rapid review study protocol
Authors: Singh Hardeep , Armas Alana , Law Susan , Tang Terence , Steele Gray Carolyn , Cunningham Heather V , Thombs Rachel , Ellen Moriah , Sritharan Jasvinei , Nie Jason X , Plett Donna , Jarach Carlotta Micaela , Thavorn Kednapa , Nelson Michelle L A
Published: February 2021

Introduction

Older adults may experience challenges during the hospital to home transitions that could be mitigated by digital health solutions. However, to promote adoption in practice and realise benefits, there is a need to specify how digital health solutions contribute to hospital to home transitions, particularly pertinent in this era of social distancing. This rapid review will: (1) elucidate the various roles and functions that have been developed to support hospital to home transitions of care, (2) identify existing digital health solutions that support hospital to home transitions of care, (3) identify gaps and new opportunities where digital health solutions can support these roles and functions and (4) create recommendations that will inform the design and structure of future digital health interventions that support hospital to home transitions for older adults (eg, the pre-trial results of the Digital Bridge intervention; ClinicalTrials.gov Identifier:NCT04287192).

Methods and analysis

A two-phase rapid review will be conducted to meet identified aims. In phase 1, a selective literature review will be used to generate a conceptual map of the roles and functions of individuals that support hospital to home transitions for older adults. In phase 2, a search on MEDLINE, EMBASE and CINAHL will identify literature on digital health solutions that support hospital to home transitions. The ways in which digital health solutions can support the roles and functions that facilitate these transitions will then be mapped in the analysis and generation of findings.

Ethics and dissemination

This protocol is a review of the literature and does not involve human subjects, and therefore, does not require ethics approval. This review will permit the identification of gaps and new opportunities for digital processes and platforms that enable care transitions and can help inform the design and implementation of future digital health interventions. Review findings will be disseminated through publications and presentations to key stakeholders.
Surgical repair of primary non-complex rhegmatogenous retinal detachment in the modern era of small-gauge vitrectomy
Authors: Moinuddin Omar , Abuzaitoun Rebhi O , Hwang Min W , Sathrasala Sanjana K , Chen Xing D , Stein Joshua D , Johnson Mark W , Zacks David N , Wubben Thomas J , Besirli Cagri G
Published: February 2021

Objective

To report anatomic and visual outcomes of pars plana vitrectomy (PPV), as well as scleral buckling (SB) and PPV/SB as surgical treatments for the management of primary, non-complex rhegmatogenous retinal detachment (RRD).

Methods and analysis

Data from 751 eyes that underwent PPV, SB or combined PPV/SB as a surgical treatment for primary non-complex RRD with at least 3 months of follow-up were analysed to determine rates of single surgery anatomic success (SSAS) and final anatomic success (FAS). Patients or the public were not involved in the design, conduct or reporting of this research.

Results

PPV accounted for 89.0% (n=668), PPV/SB for 6.8% (n=51) and SB for 4.2% (n=32) cases. Overall SSAS (91.2% PPV, 84.3% PPV/SB, 93.8% SB; p=0.267) and FAS (96.7% PPV, 94.1% PPV/SB and 100.0% SB; p=0.221) were reported for the three surgical groups. SSAS and FAS were similar for lens status, macular detachment status and the presence or absence of inferior retinal breaks for each of the PPV, PPV/SB and SB groups.

Conclusions

In this large, single institution, retrospective case series, we report surgical outcomes for patients with primary non-complex RRD managed with PPV, SB or PPV/SB in the modern era of small-gauge vitrectomy. We demonstrate that primary PPV without adjunct SB provides excellent anatomic and visual outcomes irrespective of lens status, macular involvement or pathology location.
Insight from patients and healthcare professionals on the implementation of virtual clinics in patients with inflammatory bowel disease
Authors: Kumar Aditi , Quraishi Mohammed Nabil , de Silva Shanika , Trudgill Nigel John , Steed Helen , Brookes Matthew James , Cooney Rachel
Published: February 2021

Introduction

During COVID-19, the management of outpatient inflammatory bowel disease (IBD) changed from face-to-face (F2F) to telephone and video consultations across the UK. We surveyed patients with IBD and IBD healthcare professionals (HCPs) to evaluate the impact of this abrupt transition on patient and HCP satisfaction outcomes, including the barriers and enablers of this service.

Methods

Patient satisfaction surveys were sent to patients who had a telephone consultation from May to July 2020. A second survey was sent to IBD HCPs across the UK. Questions from both surveys consisted of a mixture of multiple-choice options, ranking answers as well as short-answer questions.

Results

210 patients and 114 HCPs completed the survey. During COVID-19, there was a significantly greater use of telephone, video or a mixture of consultation. F2F consultations were consistently preferred by patients, with 50% of patients indicating they did not want the option of for video consultations. Patients were more likely to prefer a telephone consultation if they were stable and needed routine review. Significantly fewer HCPs (5.3%) intend to use F2F consultations alone, preferring the use of telephone (20.2%) or combinations of telephone/F2F (22.8%), telephone/video (4.4%) or combination of all three consultation types (34.2%). 63% indicated they intend to incorporate video consultations in the future.

Conclusion

Telephone and video consultations need to be balanced proportionately with F2F clinics to achieve both patient and HCP satisfaction. Further research needs to be done to explore the use of video medicine in patients with IBD.
Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders
Authors: Jain Amit , Dai Tinglong , Myers Christopher G , Jain Punya , Aggarwal Shruti
Published: February 2021

Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority? Potential future waves (or a future pandemic) may lead to additional surgical shutdown and subsequent reopening. Deciding which cases to prioritise in the face of limited health system capacity has emerged as a new challenge for healthcare leaders. Here we present an ethically grounded and operationally efficient surgical prioritisation framework for healthcare leaders and practitioners, drawing insights from decision analysis and organisational sciences.
Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization
Authors: Shapiro Maksim , Walker Melanie , Carroll Kate T , Levitt Michael R , Raz Eytan , Nossek Erez , Delavari Nader , Mir Osman , Nelson Peter Kim
Published: February 2021

Adoption of middle meningeal artery embolization in the management of chronic subdural hematomas has led to a renewed interest in dural vascular anatomy. The readily identifiable major dural arteries and potential hazards associated with their embolization are well described. Less emphasized are several levels of intrinsic dural angioarchitecture, despite their more direct relationship to dural based diseases, such as subdural hematoma and dural fistula. Fortunately, microvascular aspects of dural anatomy, previously limited to ex vivo investigations, are becoming increasingly accessible to in vivo visualization, setting the stage for synthesis of the old and the new, and providing a rationale for the endovascular approach to subdural collections in particular. In contrast with traditional anatomical didactics, where descriptions advance from larger trunks to smaller pedicles, we present a strategic approach that proceeds from a fundamental understanding of the dural microvasculature and its relationship to larger vessels.
Reduction of thromboembolic complications during the endovascular treatment of unruptured aneurysms by employing a tailored dual antiplatelet regimen using aspirin and prasugrel
Authors: Higashiguchi Saeko , Sadato Akiyo , Nakahara Ichiro , Matsumoto Shoji , Hayakawa Motoharu , Adachi Kazuhide , Hasebe Akiko , Suyama Yoshio , Omi Tatsuo , Yamashiro Kei , Wakako Akira , Ishihara Takuma , Kawazoe Yushi , Kumai Tadashi , Tanabe Jun , Suyama Kenichiro , Watanabe Sadayoshi , Suzuki Takeya , Hirose Yuichi
Published: February 2021

Background

Thromboembolic complications (TECs) are frequent during the endovascular treatment of unruptured aneurysms. To prevent TECs, dual antiplatelet therapy using aspirin and clopidogrel is recommended for the perioperative period. In patients with a poor response, clopidogrel is a risk factor for TECs. To prevent TECs, our study assessed the stratified use of prasugrel.

Methods

Patients who underwent endovascular therapy for unruptured cerebral aneurysms from April 2017 to August 2019 were enrolled in this clinical study and given premedication with aspirin and clopidogrel for 2 weeks prior to the procedure. P2Y12 reaction units (PRU) were measured using the VerifyNow assay on the day before the procedure (tailored group). In subgroups with PRU <240, the clopidogrel dose was maintained (CPG subgroup). In subgroups with PRU ≥240, clopidogrel was changed to prasugrel (PSG subgroup). We compared the occurrence of TECs with retrospective consecutive cases from January 2015 to March 2017 without PRU assessments (non-tailored group). The frequency of TECs within 30 days was assessed as the primary endpoint.

Results

The tailored and non-tailored groups comprised 167 and 50 patients, respectively. TECs occurred in 11 (6.6%) and 8 (16%) patients in the tailored and non-tailored groups (P=0.048), respectively. The HR for TECs was significantly reduced in the tailored group (HR 0.3, 95% CI 0.11 to 0.81); P=0.017) compared with the non-tailored group.

Conclusion

The results suggest that tailored dual antiplatelet therapy medication with PRU significantly reduces the frequency of TECs without increasing hemorrhagic complications.
Stenting the carotid artery from radial access using a Simmons guide catheter
Authors: Heck Don , Jost Alec , Howard George
Published: February 2021

Background

Carotid artery stenting (CAS) is a procedure for stroke prevention, usually done from femoral artery access. Reports of CAS using radial artery access have adopted techniques similar to those used for transfemoral CAS. Initial experience with a simpler and lower profile technique for transradial carotid stenting is described here.

Methods

Of 55 consecutive elective CAS cases with standard (not bovine) arch anatomy performed during a 15 month time period by the same operator, 20 were selected for transradial treatment using a 6 F Simmons 2 guide catheter. This was a retrospective analysis of those initial 20 patients compared with the 35 patients treated with elective transfemoral CAS. The CAS database was reviewed for clinical indications, technique, procedure and fluoroscopy times, and clinical outcomes.

Results

All procedures were technically successful (no crossovers). No patient had a decline in National Institutes of Health Stroke Scale score or modified Rankin Scale score within 30 days. Mean (95% CI) procedural times for transradial CAS were slightly higher than transfemoral CAS (29.4 (26.0 to 32.7) vs 23.8 (21.2 to 26.4) min, p=0.0098). Mean (95% CI) fluoroscopy times were also higher for transradial CAS compared with transfemoral CAS (9.6 (8.0 to 11.2) vs 6.4 (5.4 to 7.4), p=0.0006). One patient developed a radial artery pseudoaneurysm which required elective surgical repair.

Conclusion

Transradial carotid stenting using the described lower profile technique provides another effective option in the array of surgical procedures for the treatment of carotid artery stenosis. Relative procedural and fluoroscopy times may initially be longer compared with transfemoral carotid stenting for experienced CAS operators, although absolute differences are small.
Radial first or patient first: a case series and meta-analysis of transradial versus transfemoral access for acute ischemic stroke intervention
Authors: Siddiqui Adnan H , Waqas Muhammad , Neumaier Jenna , Zhang Jeff F , Dossani Rimal H , Cappuzzo Justin M , Van Coevering III Russell J , Rai Hamid H , Monteiro Andre , Sonig Ashish , Davies Jason M , Snyder Kenneth V , Levy Elad I
Published: February 2021

Background

Few studies have compared technical success and effectiveness of transradial access (TRA) versus transfemoral access (TFA) for mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We compared the two approaches for technical success, effectiveness, and outcomes.

Methods

We retrospectively compared TRA with TFA for AIS MT at our institute. We additionally performed a systematic review and meta-analysis of studies describing the use of TRA alone or in comparison with TFA for MT. Primary outcomes included rate of successful reperfusion (thrombolysis in cerebral infarction (TICI)>2b), number of passes, access-site complications, and 3- month mortality and favorable functional outcomes (modified Rankin Scale (mRS) score 0–2).

Results

A total of 222 consecutive patients (TRA=93, TFA=129) were included in our case series. The rate of successful reperfusion was significantly higher for the TFA cohort (91.4% vs 79.6%, P=0.01) with lower mean number of passes (1.8±1.2 vs 2.4±1.6, P=0.014). Three-month mortality in the TFA group was lower (22.1% vs 40.9% for the TRA cohort (P=0.004), with a higher rate of favorable functional outcomes (51.3% vs 34.1%, P=0.015). A meta-analysis of 10 studies showed significant heterogeneity in rates of successful reperfusion (57.1% to 95.6%, heterogeneity=67.55%, P=0.001). None of the previous comparative studies reported 3-month mortality and functional outcomes.

Conclusions

This case series demonstrate a higher successful reperfusion rate, fewer passes, lower 3-month mortality, and improved 3-month functional outcomes with TFA. The systematic review highlights the inadequacy of existing evidence. Prospective comparative studies are needed before a ‘radial-first’ approach can be adopted for stroke intervention.
Treatment of distal unruptured intracranial aneurysms using a surface-modified flow diverter under prasugrel monotherapy: a pilot safety trial
Authors: de Castro-Afonso Luis Henrique , Nakiri Guilherme Seizem , Abud Thiago Giansante , Monsignore Lucas Moretti , Freitas Rafael Kiyuze , de Oliveira Ricardo Santos , Colli Benedicto Oscar , dos Santos Antônio Carlos , Abud Daniel Giansante
Published: February 2021

Background

Flow diverters (FDs) are effective in the treatment of carotid aneurysms. Compared with carotid aneurysms, the treatment of distal intracranial aneurysms with FDs has been associated with a relatively high incidence of complications. Low thrombogenic modified-surface FDs may reduce ischemic complications and allow for the use of a single antiplatelet medication. The aim of this study was to assess the safety and efficacy of the p48 MW HPC Flow Modulation Device (Phenox GmbH, Bochum, Germany) to treat distal intracranial aneurysms used in combination with prasugrel monotherapy.

Methods

This was a single-center, prospective, pivotal, open, single-arm study. Patients were included in this study from December 2019 to September 2020. The primary endpoints were the incidence of any neurologic deficit after treatment until 1 month of follow-up, defined as National Institutes of Health Stroke Scale (NIHSS) ≥1, and the incidence of acute ischemic lesions in magnetic resonance imagin (MRI) images 48 hours after treatment. The secondary endpoint was the rate of complete occlusion of the aneurysms at the 1-month follow-up.

Results

Twenty-one patients harboring 27 distal aneurysms of the anterior circulation were included. Mean age was 57.8 (SD 9.7) years, and 16 patients were female (80%). No patient had neurologic symptoms at the 1-month follow-up. Four patients (20%) had asymptomatic acute brain ischemic lesions on MRI. Complete aneurysm occlusion occurred in 9/27 (33.3%) aneurysms at the 1-month follow-up.

Conclusion

In this pilot safety trial, treatment of distal intracranial aneurysms with p48 MW HPC under monotherapy with prasugrel appeared to be safe.
American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part II: recommendations
Authors: Haskins Stephen C , Bronshteyn Yuriy , Perlas Anahi , El-Boghdadly Kariem , Zimmerman Joshua , Silva Marcos , Boretsky Karen , Chan Vincent , Kruisselbrink Richelle , Byrne Melissa , Hernandez Nadia , Boublik Jan , Manson William Clark , Hogg Rosemary , Wilkinson Jonathan N , Kalagara Hari , Nejim Jemiel , Ramsingh Davinder , Shankar Hariharan , Nader Antoun , Souza Dmitri , Narouze Samer
Published: February 2021

Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identified and outlined for achieving competency in the use of POCUS, specifically, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It also discusses barriers to POCUS education and training and proposes a list of educational resources. For each POCUS section, learning goals and specific skills were presented in the Indication, Acquisition, Interpretation, and Medical decision-making framework.