bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability in Muscle Recruitment Strategy Between Operators During Assisted Assembly Tasks
Authors: Qiu Yingxin , Murali Keerthana , Ueda Jun , Okabe Atsushi , Gao Dalong
Published: November 2018

This paper reports the variability in muscle recruitment strategies among individuals who operate a non-powered lifting device for general assembly (GA) tasks. Support vector machine (SVM) was applied to the classification of motion states of operators using electromyography (EMG) signals collected from a total of 15 upper limb, lower limb, shoulder, and torso muscles. By comparing the classification performance and muscle activity features, variability in muscle recruitment strategy was observed from lower limb and torso muscles, while the recruitment strategies of upper limb and shoulder muscles were relatively consistent across subjects. Principal component analysis (PCA) was applied to identify key muscles that are highly correlated with body movements. Selected muscles at the wrist joint, ankle joint and scapula are considered to have greater significance in characterizing the muscle recruitment strategies than other investigated muscles. PCA loading factors also indicate the existence of body motion redundancy during typical pick-and-place tasks.
Development of a Motorized Robotic Walker Guided by an Image Processing System for Human Walking Assistance and Rehabilitation
Authors: Shen Tao , Afsar Md Rayhan , Zhang He , Ye Cang , Shen Xiangrong
Published: November 2018

Impaired mobility negatively impacts a patient’s life, both physically and mentally. Existing tools for the assistance of such individuals include passive walking aids, which tend to disrupt the users’ walking rhythms, and motorized wheelchairs, which preclude the muscle activity of the users’ lower limb. To address these problems, this paper proposes a new robotic walker guided by an image processing system. This system uses visual information from a 3D camera to estimate the user’s position and orientation, and the motion are sent to a PID controller to actuate the robot so that the robot can automatically follow the user to provide assistance if needed. Therefore, for regular walking, the device can accompany the user without interfering with the muscle activity of the lower limbs; for rehabilitation training, it may support the user and provide protection. To reduce the errors of the estimated position and orientation, a discrete derivative term is added into a conventional PI controller to form a mixed PID controller which can reduce the noise from measurement or image processing. Experimental results demonstrated the feasibility of the proposed robotic method, as well as the functionality and effectiveness of the whole robotic system.
Design and Evaluation of a Proportional Myoelectric Controller for Hip Exoskeletons During Walking
Authors: Hsu Hsiang , Kang Inseung , Young Aaron J.
Published: November 2018

The purpose of this study was to explore the effectiveness of a neural controller for a single-joint bilateral hip exoskeleton. The device provides mechanical torque in the sagittal plane and uses series elastic actuators for feedback control. The system consists of three control layers: (1) a high-level controller that estimates the current gait phase, (2) a mid-level controller that converts the electromyography (EMG) signals to desired exoskeleton torques, and (3) a low-level controller that ensures the output torque matches the commanded torque. To evaluate the effectiveness of the proportional EMG controller, one able-body subject walked with the exoskeleton under 3 assistance conditions: (1) a baseline proportional gain condition (× G), (2) a double proportional gain condition (× 2G) for faster scaling, and (3) an on/off set value torque assistance (SV). The third condition provides the same net mechanical power as the baseline (× G) condition to compare whether proportional scaling of the hip torque was significant. The subject’s hip-joint kinematics, metabolic rate, and muscle activities were collected as outcome measurements. In summary, the EMG controller could generate seamless torque to the user with a response time of 80 ms. The × 2G condition resulted in a 23.3% EMG activity reduction while SV condition reduced the metabolic rate by 8.1%. Interestingly, the largest EMG reduction condition (× 2G) did not result in largest metabolic reduction (SV). Our preliminary findings suggest that the proportional scaling of the hip torque may not be the most important parameter to minimize metabolic cost.
Discriminating Spatial Intent From Noisy Joystick Signals for Wheelchair Path Planning and Guidance
Authors: Wolkowicz Kelilah L. , Leary Robert D. , Moore Jason Z. , Brennan Sean N.
Published: November 2018

For patients with amyotrophic lateral sclerosis (ALS), disease progression can cause a loss of motor function. As motor function declines, the dexterity needed to control a wheelchair’s joysticks can also be compromised. The objective of this work is to integrate user sensor inputs and wheelchair position measurements to improve the performance of wheelchair guidance, even in the presence of noisy inputs from the user. This work evaluates probabilistic, model-based methods for blending joystick and position inputs along a series of user-created trajectories, similar to those that a wheelchair user may follow in their day-to-day navigational routines. We answer three key questions in order to associate joystick inputs to path-keeping decisions: 1) What is a path? 2) When are paths different? 3) What is the probability of a particular destination along a path? The algorithmic answers to these questions are verified using experimental wheelchair joystick and position measurements. Using this approach, the goal is to safely guide a wheelchair’s trajectory even if the user is providing ambiguous inputs. This process enables better discrimination of user joystick inputs for navigation algorithms, resulting in improved wheelchair guidance, safety, and patient monitoring.
Development of a 3-DOF Tripedal Stick-Slip Microrobotic Mobile Platform for Unconstrained, Omnidirectional Sample Positioning
Authors: Adibnazari Iman , Nagel William S. , Leang Kam K.
Published: November 2018

This paper presents the development of a piezo-based three-degree-of-freedom (3-DOF), tripedal microrobotic platform that allows for unlimited travel with sub-micron precision over a planar surface. Compliant mechanical amplifiers are incorporated with each piezoelectric stack actuator to improve both the stroke and load-bearing capability of the platform. A forward kinematic model of the stage based on its tripedal leg architecture is derived for each stick-slip step cycle and inverted for feedforward control of the platform. A prototype is constructed using low-cost 3D-printing techniques. Experimental results demonstrate actuator stroke of 29.4 μm on average with a dominant resonance of approximately 860 Hz. Results demonstrate the stage tracks a 3 mm by 3 mm square trajectory in open loop. Feedback control through visual servoing is then simulated on a model that includes flexure dynamics, observed surface interactions, and camera sampling times, reducing the root-mean-square (RMS) tracking error by 90%. This control scheme is then implemented experimentally, resulting in 99% RMS position error reduction relative to when only feedforward control is used.
Brain Computer Interface Using Motor Imagery and Facial Expressions to Control a Mobile Robot
Authors: Kuffuor James , Samanta Biswanath
Published: November 2018

A study is presented on brain computer interface (BCI) using motor imagery (MI) and facial expressions to control a mobile robot. Traditionally, only MI signals are used in BCI applications. In this paper a hybrid approach of using both MI and facial expression stimulations for BCI is proposed. Electroencephalography (EEG) signals were acquired using a sensor system and processed for several MI and facial expressions to extract characteristic features. The features were used to train support vector machine (SVM) based classifiers and the trained classifiers were used to recognize test signals for correct identification of MI and facial expressions. A system was developed to implement the BCI using MI and facial expressions to control a mobile robot. Results of training using MI and facial expressions, individually and together are presented for comparison. The combined features from MI and facial expression stimulations were found to give performance similar to facial expressions but better than MI only.
Integrative Modeling Platform for Design and Control of an Adaptive Wind Turbine Blade
Authors: Nejadkhaki Hamid Khakpour , Hall John F. , Zheng Minghui , Wu Teng
Published: November 2018

A platform for the engineering design, performance, and control of an adaptive wind turbine blade is presented. This environment includes a simulation model, integrative design tool, and control framework. The authors are currently developing a novel blade with an adaptive twist angle distribution (TAD). The TAD influences the aerodynamic loads and thus, system dynamics. The modeling platform facilitates the use of an integrative design tool that establishes the TAD in relation to wind speed. The outcome of this design enables the transformation of the TAD during operation. Still, a robust control method is required to realize the benefits of the adaptive TAD. Moreover, simulation of the TAD is computationally expensive. It also requires a unique approach for both partial and full-load operation. A framework is currently being developed to relate the TAD to the wind turbine and its components. Understanding the relationship between the TAD and the dynamic system is crucial in the establishment of real-time control. This capability is necessary to improve wind capture and reduce system loads. In the current state of development, the platform is capable of maximizing wind capture during partial-load operation. However, the control tasks related to Region 3 and load mitigation are more complex. Our framework will require high-fidelity modeling and reduced-order models that support real-time control. The paper outlines the components of this framework that is being developed. The proposed platform will facilitate expansion and the use of these required modeling techniques. A case study of a 20 kW system is presented based upon the partial-load operation. The study demonstrates how the platform is used to design and control the blade. A low-dimensional aerodynamic model characterizes the blade performance. This interacts with the simulation model to predict the power production. The design tool establishes actuator locations and stiffness properties required for the blade shape to achieve a range of TAD configurations. A supervisory control model is implemented and used to demonstrate how the simulation model blade performs in the case study.
Energy Management of Smart Community With EV Charging Using Distributed Model Predictive Control
Authors: Zhou Fenglin , Li Yaoyu , Wang Wenyi
Published: November 2018

Human activities in buildings are connected by various transportation measures. For the emerging Smart and Connected Communities (S&CC), it is possible to synergize the energy management of smart buildings with the vehicle operation/travel information available from transportation infrastructure, e.g. the intelligent transportation systems (ITS). Such information enables the prediction of upcoming building occupancy and upcoming charging load of electrified vehicles. This paper presents a predictive energy management strategy for smart community with a distributed model predictive control framework, in which the upcoming building occupancy and charging load are assumed to be predictable to certain extent based on the ITS information. An illustrative example of smart community is used for simulation study based on a Modelica simulation model, in which a chilled-water plant sustains the ventilation and air conditioning of three buildings, and each building is assumed to host a number of charging stations. Simulation study is performed to validate the proposed strategy.
A Robotic Ankle-Foot Orthosis for Daily-Life Assistance and Rehabilitation
Authors: Haque Md Rejwanul , Zheng Hao , Thapa Saroj , Kogler Geza , Shen Xiangrong
Published: November 2018

The ankle plays an important role in human movement as it supplies the majority of energy to support an individual’s walking. In this paper, the authors present a robotic ankle-foot orthosis (RAFO), which is essentially a wearable robot that acts in parallel to the user’s biological ankle for motion assistance. Unlike most of the existing robotic ankle-foot ortheses, the RAFO in this paper is a compact and portable assistive device with full energy autonomy, which enables its use in a user’s daily life without the typical limitation associated with tethered operation. The primary performance goal in the design of the RAFO is to provide a torque capacity equivalent to 35% of a 75 kg healthy person’s maximum ankle torque in slow walking, while keeping the weight of the device less than 2 kg. To reach such goal, the orthotic joint is actuated with a compact flat motor coupled with a two-stage transmission that provides a total 200:1 gear ratio. Additionally, a novel two-degree-of-freedom (2-DOF) joint design is incorporated. In addition to the powered dorsiflexion – plantarflexion, the 2-DOF joint also allows passive inversion – eversion of the joint, which greatly improves the comfort in the prolonged wearing of the device. For the control of the powered joint, a finite-state, friction-compensated impedance controller is developed to provide natural interaction with the user and reliable triggering of the powered push-off in walking. A prototype of the RAFO has been fabricated and assembled, and preliminary results demonstrated its effectiveness in assisting the user’s locomotion in treadmill walking experiments.
HuCoM: A Model for Human Comfort Estimation in Personalized Human-Robot Collaboration
Authors: Wang Weitian , Liu Na , Li Rui , Chen Yi , Jia Yunyi
Published: November 2018

Human comfort is significant in human-robot collaboration since it can influence the task efficiency and quality. In this paper, we propose a computational Human Comfort Model (HuCoM) to model and quantify the human comfort during human-robot collaborative manufacturing. Based on the defined primitive comfort rewards and combined comfort rewards, the HuCoM is developed with an incorporation of the static comfort model and the dynamic comfort model. We validate and evaluate the proposed model by several human-robot collaborative tasks via a YuMi robot.
Tendon Tapping Stimulus Characterization Through Contact Modeling
Authors: Meinhold Waiman , Ueda Jun
Published: November 2018

Tendon tapping is a common procedure with both diagnostic and therapeutic applications. Significant variability is observed in the reflex response both between and within even healthy subjects, which is likely partially caused by imprecise control or measurement of the mechanical stimulus. Reducing or measuring stimulus variability is critical to future novel applications of tendon tapping for rehabilitative neuromodulation. This work presents a contact mechanics based method for characterization of tendon mechanical stimulus. This work utilizes easily observable dynamic information about hammer impacts to estimate the properties of impacted tissue.
Implementation of Object Fetching Task and Human Subject Tests Using an Assistive Robot
Authors: Dalal Ankur Vipulkumar , Ghadge Ajinkya Mahadeo , Lundberg Cody Lee , Shin Jeongsik , Sevil Hakki Erhan , Behan Deborah , Popa Dan O.
Published: November 2018

This study presents implementation of an object fetching task with a mobile robotic platform (PR2) for hospital patients. The primary goal of this study is to define the requirements for a robotic nursing assistants. The designed application scenario consists of PR2 robotic platform, human subject as the patient, and a tablet for patient-robot communication. The PR2 robot understands patient’s request and fetches the requested object by performing automated action steps. For this designed scenario, human subject experiments are performed. Furthermore, all human subject test results are presented and observations during tests are provided. These activities are part of a larger effort to establish adaptive robotic nursing assistants for physical tasks in hospital environments.
Reactivity studies and structural properties of Al on compound semiconductor surfaces
Authors: Sarney Wendy L. , Svensson Stefan P. , Wickramasinghe Kaushini S. , Yuan Joseph , Shabani Javad
Published: November 2018

The authors studied the structural properties of Al on III-V semiconductors (InAs, GaAs, and InGaAs) with the aim of creating smooth and abrupt interfaces. Growth conditions, such as the residual As content and the presence of intermediate layers, affect the structural properties of the Al and the underlying semiconductor. The authors find that an ultrathin layer of AlAs on (001) InAs drastically reduces the interface reaction and improves the epitaxial growth of Al. No such layer is necessary for interface reaction mitigation for Al deposited onto InGaAs or GaAs. The crystal orientation of Al planes grown on (001) InAs is [110], but is [111] on InGaAs or GaAs. The authors discuss the significance of the results for realization of structures for proximity superconductivity.
Bioprospecting Reveals Class III ω-Transaminases Converting Bulky Ketones and Environmentally Relevant Polyamines
Authors: Coscolín Cristina , Katzke Nadine , García-Moyano Antonio , Navarro-Fernández José , Almendral David , Martínez-Martínez Mónica , Bollinger Alexander , Bargiela Rafael , Gertler Christoph , Chernikova Tatyana N. , Rojo David , Barbas Coral , Tran Hai , Golyshina Olga V. , Koch Rainhard , Yakimov Michail M. , Bjerga Gro E. K. , Golyshin Peter N. , Jaeger Karl-Erich , Ferrer Manuel
Published: November 2018

Amine transaminases of the class III ω-TAs are key enzymes for modification of chemical building blocks, but finding those capable of converting bulky ketones and (
R
) amines is still challenging. Here, by an extensive analysis of the substrate spectra of 10 class III ω-TAs, we identified a number of residues playing a role in determining the access and positioning of bulky ketones, bulky amines, and (
R
)- and (
S
) amines, as well as of environmentally relevant polyamines, particularly putrescine. The results presented can significantly expand future opportunities for designing (
R
)-specific class III ω-TAs to convert valuable bulky ketones and amines, as well as for deepening the knowledge into the polyamine catabolic pathways.
Suppression of Drug Resistance Reveals a Genetic Mechanism of Metabolic Plasticity in Malaria Parasites
Authors: Guggisberg Ann M. , Frasse Philip M. , Jezewski Andrew J. , Kafai Natasha M. , Gandhi Aakash Y. , Erlinger Samuel J. , Odom John Audrey R.
Published: November 2018

Unique and essential aspects of parasite metabolism are excellent targets for development of new antimalarials. An improved understanding of parasite metabolism and drug resistance mechanisms is urgently needed. The antibiotic fosmidomycin targets the synthesis of essential isoprenoid compounds from glucose and is a candidate for antimalarial development. Our report identifies a novel mechanism of drug resistance and further describes a family of metabolic regulators in the parasite. Using a novel forward genetic approach, we also uncovered mutations that suppress drug resistance in the glycolytic enzyme PFK9. Thus, we identify an unexpected genetic mechanism of adaptation to metabolic insult that influences parasite fitness and tolerance of antimalarials.
Anti-HMGCR antibody-associated necrotising myopathy and its association with statin use
Authors: Abdilla Ylenia , Chircop Charmaine , Vella Norbert
Published: November 2018

A 66-year-old man presented with chest pain and a 1-year history of generalised weakness, accompanied with generalised aches and pains. Symptoms worsened when he was initiated on statins. Investigations yielded high creatine kinase, high HMG-coenzymeA reductase (HMGCR) antibody titre, myopathic features on electromyography and muscle biopsy, and muscle atrophy on MRI. These results were in keeping with anti-HMGCR antibody myopathy. The patient responded well to immunosuppressive therapy.
Renal pseudomass: be aware of splenorenal fusion
Authors: Jafari Hamed , Iranpour Pooya , Haseli Sara
Published: November 2018

Splenosis is the heterotopic implantation of splenic tissue that usually occurs in a previous major abdominal trauma or splenectomy setting. However, splenorenal fusion is an uncommon entity, categorised as a developmental anomaly. There have been several confirmed cases in the literature. Despite some helpful imaging features, it can be easily misdiagnosed as a neoplastic renal mass, resulting in unnecessary nephrectomy. Here we presented a case of splenorenal fusion in an elderly female patient, which was initially misdiagnosed as renal cell carcinoma in sonography. More specific imaging modalities and biopsy are helpful in suggesting the correct diagnosis.
Cluster endophthalmitis due to Stenotrophomonas maltophilia following intravitreal bevacizumab: outcomes of patients from North India
Authors: Agarwal Aniruddha Kishandutt , Aggarwal Kanika , Samanta Ramanuj , Angrup Archana , Biswal Manisha , Ray Pallab , Dogra Mohit , Katoch Deeksha , Bansal Reema , Singh Ramandeep , Dogra Mangat R , Gupta Vishali
Published: November 2018

Purpose

To study features, management and outcomes of cluster endophthalmitis following intravitreal bevacizumab (BCZ) injection in North India.

Methods

In this retrospective study, 28 patients (23 men) (mean age of 59.07±13 years) who received intravitreal injection of BCZ were included. Demographic details, best corrected visual acuity (BCVA), clinical features, microbiological findings and management of patients who developed endophthalmitis after injection of contaminated BCZ injections were reviewed. The organism isolated was Stenotrophomonas maltophilia.

Results

All patients suffered from painful diminution of vision within 24–48 hours. Of the 28 eyes, 12 had lid and corneal oedema, raised intraocular pressure (IOP) (difference between mean preinjection and postinjection IOP: 4.42 mm Hg; p=0.005) and toxic anterior segment syndrome-like picture. 16 eyes presented with clear cornea, severe vitritis and poor media clarity. Among these, three eyes showed posterior hypopyon. Seventeen eyes underwent primary pars plana vitrectomy (PPV) and intravitreal vancomycin+ceftazidime based on severity of inflammation. Eleven eyes underwent primary tap and inject. Among these, four eyes required PPV due to persistent inflammation. Eleven eyes showed positive staining for Gram-negative bacilli. Seven eyes were culture positive for S. maltophilia. Mean preinjection BCVA was 0.77±0.48. The first recorded postinjection BCVA was 2.52±0.82. BCVA (at 1 month) improved to 0.88±0.66.

Conclusions

S. maltophilia can be found contaminating hospital surfaces and water supply. Early PPV, prompt intravitreal antibiotics and close communication with microbiologists greatly aided in salvaging all eyes from our cohort. Majority of the patients recovered their preinjection BCVA and IOP and achieved quiescence of inflammation.
Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE
Authors: Li Lina , Zhong Chenwen , Mei Jie , Liang Yuan , Li Li , Kuang Li
Published: November 2018

Objective

Current healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care.

Design

A cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP.

Setting

Three community health centres in Guangzhou, China.

Participants

698 patients aged 18–89 years.

Main outcome measures

The quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient’s perceptions).

Results

A total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not.

Conclusion

Our findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.
Decision-making for people with dementia and advanced kidney disease: a secondary qualitative analysis of interviews from the Conservative Kidney Management Assessment of Practice Patterns Study
Authors: Scott Jemima , Owen-Smith Amanda , Tonkin-Crine Sarah , Rayner Hugh , Roderick Paul , Okamoto Ikumi , Leydon Geraldine , Caskey Fergus , Methven Shona
Published: November 2018

Objective

To explore dialysis decision-making for adults who lack capacity due to cognitive impairment, a common and under-recognised condition in those with advanced chronic kidney disease (CKD).

Design

Secondary analysis of qualitative data collected during the Conservative Kidney Management Assessment of Practice Patterns Study programme of research was performed. Sixty semistructured interviews were conducted with multiprofessional team members from UK renal centres. Staff were asked about local facilities, the value of conservative kidney management (CKM), when and with whom CKM was discussed and how CKM could be improved. Thematic analysis was employed to identify, characterise and report on themes that emerged from the data, focused on the specific issues experienced by people with dementia.

Setting

A purposive sample of nine UK renal centres differing in the scale of their CKM programmes.

Participants

Clinical directors of renal centres identified staff involved in CKM. Staff were asked to participate if they had experience of low clearance clinics or of caring for patients with advanced CKD (estimated glomerular filtration rate <20mL/min/1.732or >65 years with end-stage kidney disease).

Results

Two overarching themes were identified: factors taken into consideration during decision-making, and the process of decision-making itself. Comorbidity, social support, quality of life and the feasibility of dialysis were reported as factors pertinent to clinicians’ decisions regarding suitability. The majority of renal centres practised multidisciplinary ‘best interests’ decision-making for those without capacity. Attitudes to advance care planning were divided.

Conclusions

In view of the prevalence of cognitive impairment among those with advanced CKD, we suggest consideration of routine assessment of cognition and capacity. In the UK, dialysis is initiated and continued for individuals with dementia and services should be adapted to meet the needs of this population.
Effects of a mindfulness-based intervention (MYmind) for children with ADHD and their parents: protocol for a randomised controlled trial
Authors: Chan Stanley Kam Chung , Zhang Dexing , Bögels Susan M , Chan Christian Shaunlyn , Lai Kelly Yee Ching , Lo Herman Hay Ming , Yip Benjamin Hon Kei , Lau Elsa Ngar Sze , Gao Tiffany Ting , Wong Samuel Yeung Shan
Published: November 2018

Introduction

Mindfulness is one of the potential alternative interventions for children with attention-deficit hyperactivity disorder (ADHD). Some evidence suggests that mindfulness is related to changes in brain regions associated with ADHD. The potential benefits of mindfulness on children with ADHD, as well as the feasibility of this intervention approach, are warranted through prior local and foreign studies. This study aims to evaluate the effect of mindfulness-based group intervention for children with ADHD and their respective parents through a robust research design.

Methods and analysis

This study will adopt a randomised controlled trial design including 140 children aged 8–12 years with ADHD together with one of their parents (n=140). These families will be randomised into intervention group (n=70) who will be offered the MYmind programme delivered by trained healthcare professionals, and an active control group (n=70) who will be offered the CBT programme. The intervention includes 8 weekly 90 min group sessions for children with ADHD (aged 8–12 years) and their respective parents. The primary and secondary outcomes will include children’s attention, ADHD-related symptoms, behaviours, executive function and mindfulness levels measured by validated objective measures and parent’s reported instruments. Parents’ parental stress, parenting styles, ADHD related symptoms, well-being, rumination level and mindfulness levels will also be measured. Analysis is by intention to treat. The effects of intervention will be evaluated by comparing outcomes between the two arms, as well as comparing outcomes within subject through comparing measurements at baseline (T0), immediately after the 8 week intervention (T1) and at 3 (T2) and 6 (T3) months postintervention.

Ethics and dissemination

Ethics approval has been granted by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (The Joint CUHK-NTEC CREC). Participants will be required to sign informed consent form from both parents and children. Findings will be reported in conferences and peer-reviewed publications in accordance with recommendations of Consolidated Standards of Reporting Trials.

Trial registration number

ChiCTR1800014741; Pre-results.
Qualitative cross-country comparison of whether, when and how people diagnosed with lung cancer talk about cigarette smoking in narrative interviews
Authors: Hajdarevic Senada , Rasmussen Birgit H , Overgaard Hasle Trine L , Ziebland Sue
Published: November 2018

Objectives

To compare and examine whether, when and how patients with lung cancer in three countries, with different survival rates, talk about cigarette smoking and its relationship with help-seeking.

Design

A qualitative cross-country comparison with analysis of narrative interviews.

Setting

Participants in Sweden, Denmark and England were interviewed during 2015–2016. Interviews, using a narrative approach, were conducted in participants’ home by trained and experienced qualitative researchers.

Participants

Seventy-two men and women diagnosed with lung cancer were interviewed within 6 months of their diagnosis.

Results

The English participants, regardless of their own smoking status, typically raised the topic of smoking early in their interviews. Smoking was mentioned in relation to symptom appraisal and interactions with others, including health professionals. Participants in all three countries interpreted their symptoms in relation to their smoking status, but in Sweden (unlike England) there was no suggestion that this deterred them from seeking care. English participants, but not Swedish or Danish, recounted reluctance to consult healthcare professionals with their symptoms while they were still smoking, some gave up shortly before consulting. Some English patients described defensive strategies to challenge stigma or pre-empt other people’s assumptions about their culpability for the disease. A quarter of the Danish and 40% of the Swedish participants did not raise the topic of smoking at any point in their interview.

Conclusion

The causal relationship between smoking and lung cancer is well known in all three countries, yet this comparative analysis suggests that the links between a sense of responsibility, stigma and reluctance to consult are not inevitable. These findings help illuminate why English patients with lung cancer tend to be diagnosed at a later stage than their Swedish counterparts.
Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation
Authors: Niederdöckl Jan , Simon Alexander , Schnaubelt Sebastian , Schuetz Nikola , Laggner Roberta , Sulzgruber Patrick , Spiel Alexander O , Herkner Harald , Laggner Anton N , Domanovits Hans
Published: November 2018

Objectives

To assess the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) serum levels for mid-term mortality in patients presenting with symptomatic atrial fibrillation (AF) to an emergency department.

Methods

Non-interventional cohort/follow-up study, including consecutive patients presenting to a tertiary care university emergency department due to symptomatic AF between 2012 and 2016. Multivariable Cox proportional hazard regression models were used to estimate the mortality rates and hazards per 100 patient-years (pry) for NT-proBNP and hs-TnT serum levels in quintiles.

Results

2574 episodes of 1754 patients (age 68 (IQR 58–75) years, female gender 1199 (44%), CHA2DS2-VASc 3 (IQR 1–4)) were recorded. Following the exclusion of incomplete datasets, 1780 episodes were available for analysis. 162 patients deceased during the mid-term follow-up (median 23 (IQR 4–38) months); the mortality rate was 4.72/100 pry. Hazard for death increased with every quintile of NT-proBNP by 1.53 (HR; 95% CI 1.27 to 1.83; p<0.001) and by 1.31 (HR; 95% CI 1.10 to 1.55; p=0.002) with every quintile of hs-TnT in multivariate Cox-regression analysis. No interaction between NT-proBNP and hs-TnT levels could be observed.

Conclusion

Elevated NT-proBNP and hs-TnT levels are independently associated with increased mid-term mortality in patients presenting to an emergency department due to symptomatic AF.

Trial registration number

NCT03272620; Results.
Long-term outcome after atrial correction for transposition of the great arteries
Authors: Couperus Lotte E , Vliegen Hubert W , Zandstra Tjitske E , Kiès Philippine , Jongbloed Monique R M , Holman Eduard R , Zeppenfeld Katja , Hazekamp Mark G , Schalij Martin J , Scherptong Roderick W C
Published: November 2018

Objective

This study assessed adult survival and morbidity patterns in patients who underwent atrial correction according to Mustard or Senning for transposition of the great arteries (TGA).

Methods

In 76 adult patients with TGA (59% male) after atrial correction, long-term survival and morbidity were investigated in three periods: early (<15 years postoperatively), midterm (15–30 years postoperatively) and late (>30 years postoperatively).

Results

The Mustard technique was performed in 41 (54%) patients, and the Senning technique was performed in 35 (46%) patients aged 3.1 (IQR: 2.1–3.8) and 1.0 (IQR: 0.6–3.1; p<0.01) years, respectively. Adult survival was 82% at 39.7 (IQR: 35.9–42.4) years postoperatively and exceeded 50 years in four patients. Supraventricular tachycardia (SVT) occurred in 51% of patients. The incidences of ventricular arrhythmia (0%, 8% and 13%; p<0.01), heart failure (0%, 5% and 19%; p<0.01) and surgical reinterventions (0%, 5% and 11%; p=0.01) increased from early to late follow-up. At last follow-up, RV function was depressed in 31 (46%) patients, and New York Heart Association functional class was ≥2 in 34 (48%) patients. Bradyarrhythmia, SVT and ventricular arrhythmia were associated with depressed RV function (OR: 4.47, 95% CI 1.50 to 13.28, p<0.01; OR: 3.74, 95% CI 1.26 to 11.14, p=0.02; OR: 14.40, 95% CI 2.80 to 74.07, p<0.01, respectively) and worse functional capacity (OR: 2.10, 95% CI 0.75 to 5.82, p=0.16; OR: 2.87, 95% CI 1.06 to 7.81, p=0.04; OR: 8.47, 95% CI 1.70 to 42.10, p<0.01, respectively).

Conclusions

In adult patients with TGA, survival was 82% at 39.7 (IQR: 35.9–42.4) years after atrial correction. Morbidity was high and included SVT as most frequent adverse event. Ventricular arrhythmias, heart failure and surgical reinterventions were common during late follow-up. Adverse events were associated with depressed right ventricle function and reduced functional class.
Challenges in outlier surgeon assessment in the era of public reporting
Authors: Mao Jialin , Resnic Frederic Scott , Girardi Leonard N , Gaudino Mario Fl , Sedrakyan Art
Published: November 2018

Objective

To assess the effect of various evaluation and reporting strategies in determining outlier surgeons, defined by having worse-than-expected mortality after cardiac surgery.

Methods

Our study included 33 394 isolated coronary artery bypass graft (CABG) procedures performed by 136 surgeons and 12 172 surgical aortic valve replacement (SAVR) procedures performed by 113 surgeons between 2010 and 2014. Three current methodologies based on the framework of comparing observed and expected (O/E ratio) mortality, with different distributional assumptions, were examined. We further assessed the consistency of outliers detected by these three methods and the impact of using different time windows and aggregating data of CABG and SAVR procedures.

Results

The three methods were consistent and detected same outliers, with the least conservative method detecting additional outliers (outliers detected for methods 1, 2 and 3: CABG 3 (2.2%), 2 (1.5%) and 8 (5.9%); SAVR 1 (0.9%), 0 (0.0%) and 11 (9.7%)). When numbers of cases recorded were low and events were rare, the two more conservative methods were unlikely to detect outliers unless the O/E ratios were extremely high. However, these two methods were more consistent in detecting the same surgeons as outliers across different time windows for assessment. Of the surgeons who performed both CABG and SAVR, none was an outlier for both procedures when assessed separately. Aggregating data from CABG and SAVR may lead to results to be dominated by the procedure that had a higher caseload.

Conclusions

The choices of outlier assessment method, time window for assessment and data aggregation have an intertwined impact on detecting outlier surgeons, often representing different value assumptions toward patient protection and provider penalty. It is desirable to use different methods as sensitivity analyses, avoid aggregating procedures and avoid rare-event endpoints if possible.
Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting
Authors: Beaton Andrea , Okello Emmy , Scheel Amy , DeWyer Alyssa , Ssembatya Renny , Baaka Olivia , Namisanvu Henrietor , Njeri Angela , Matovu Alphons , Namagembe Imelda , Mccarter Robert , Carapetis Jonathan , DeStigter Kristen , Sable Craig
Published: November 2018

Background

The burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes.

Methods

We conducted a 24-month prospective longitudinal investigation in three Ugandan health centres, using echocardiography for active case finding during antenatal care. Women with and without heart disease were followed to 6 weeks post partum to determine pregnancy outcomes. Prevalence of heart disease was calculated. Per cent attributable risk estimates were generated for maternal, fetal and neonatal mortality.

Results

Screening echocardiography was performed in 3506 women. The prevalence of heart disease was 17 per 1000 women (95% CI 13 to 21); 15 per 1000 was rheumatic heart disease. Only 3.4% of women (2/58) had prior diagnosis. Cardiovascular complications occurred in 51% of women with heart disease, most commonly heart failure. Per cent attributable risk of heart disease on maternal mortality was 88.6% in the exposed population and 10.8% in the overall population. Population attributable risk of heart disease on fetal death was 1.1% and 6.0% for neonatal mortality

Conclusions

Occult maternal heart disease may be responsible for a substantial proportion of adverse pregnancy outcomes in low-resource settings. Rheumatic heart disease is, by far, the most common condition, urging global prioritisation of this neglected cardiovascular disease.
Nebulised recombinant activated factor VII (rFVIIa) does not attenuate the haemorrhagic effects of blast lung injury
Authors: Smith Jason E , Watts S , Spear A M , Wilson C , Kirkman E
Published: November 2018

Introduction

Primary blast lung injury causes intrapulmonary haemorrhage. A number of case reports have suggested the efficacy of recombinant activated factor VII (rFVIIa) in the treatment of diffuse alveolar haemorrhage from a range of medical causes, but its efficacy in blast lung is unknown. The aim of this study was to investigate whether nebulised rFVIIa attenuates the haemorrhagic effects of blast lung injury in an animal model.

Methods

Terminally anaesthetised rabbits subjected to blast lung injury were randomised to receive either rFVIIa or placebo via a nebuliser. The primary outcome was the level of blood iron–transferrin complex, a marker of the extent of blast lung injury, analysed using low temperature electron paramagnetic resonance spectroscopy.

Results

Blast exposure led to a significant fall in iron-bound transferrin in both groups of animals (p<0.001), which remained depressed during the study. There were no significant differences in iron–transferrin between the rFVIIa and placebo treatment groups over the duration of the study (p=0.081), and there was no trend towards elevated iron–transferrin in the rFVIIa-treated group once drug treatment had started. There was suggestive evidence of systemic absorption of rFVIIa given via the inhaled route.

Conclusion

A single dose of nebulised rFVIIa did not attenuate pulmonary haemorrhage in a rabbit model of blast lung injury. As there was some evidence of systemic absorption, the inhaled route does not avoid the concern about potential thromboembolic complications from administration of rFVIIa.
Exponential Independence Number of Some Graphs
Authors: Çiftçi Canan , Aytaç Aysun
Published: November 2018

Let [Formula: see text] be a graph and [Formula: see text]. We define by [Formula: see text] the subgraph of [Formula: see text] induced by [Formula: see text]. For each vertex [Formula: see text] and for each vertex [Formula: see text], [Formula: see text] is the length of the shortest path in [Formula: see text] between [Formula: see text] and [Formula: see text] if such a path exists, and [Formula: see text] otherwise. For a vertex [Formula: see text], let [Formula: see text] where [Formula: see text]. Jäger and Rautenbach [27] define a set [Formula: see text] of vertices to be exponential independent if [Formula: see text] for every vertex [Formula: see text] in [Formula: see text]. The exponential independence number [Formula: see text] of [Formula: see text] is the maximum order of an exponential independent set. In this paper, we give a general theorem and we examine exponential independence number of some tree graphs and thorn graph of some graphs.
Dust static plane symmetric solutions and their conformal vector fields in f(R) theory of gravity
Authors: Shabbir Ghulam , Hussain Fiaz , Mahomed F. M. , Ramzan Muhammad
Published: November 2018

We first find the dust solutions of static plane symmetric spacetimes in the theory of f(R) gravity. Then using the direct integration technique on the solutions obtained, we deduce the conformal vector fields. This is performed in the context of f(R) theory of gravity. There exist six cases. Out of these, in five cases the spacetimes become conformally flat and admit 15 conformal vector fields, whereas in the sixth case, conformal vector fields become Killing vector fields.
Effect of low anisotropy and supernova constraints on cosmological models
Authors: Terohid S. A. A. , Hossienkhani H. , Yousefi H.
Published: November 2018

The 194 supernova Ia data and the effect of anisotropy are combined to reconstruct the dark energy equation of state parameter [Formula: see text] and the deceleration parameter [Formula: see text]. Using the supernovae type Ia data, we evaluate the anisotropy effects (although low) on dark energy parametrization [Formula: see text] and we compare the results with [Formula: see text]CDM model. Present supernova observations are analyzed using a standard [Formula: see text] method and the minimal [Formula: see text] values obtained for each model are compared. We confirm the difficulty of discriminating between these models using present SNIa data only. By means of the maximum likelihood method, we find that the best-fit dynamical [Formula: see text] and [Formula: see text] parameters [Formula: see text] are obtained from the SNIa dataset. In particular, we find the best-fit values of [Formula: see text]CDM model ([Formula: see text] = 0.013, [Formula: see text] = 197.559) for [Formula: see text] = 0.3 and ([Formula: see text] = 0.02, [Formula: see text] = 196.983) for [Formula: see text] = 0.27. Finally, we found that the presence of anisotropy is confirmed in mentioned models via SNIa dataset.
The magnetic properties and domain structures of nanocrystalline Ce–Fe–B magnets with enhanced maximum energy products
Authors: Pan Minxiang , Xu Hui , Li Zhong , Tan Xiaohua , Hou Xueling , Gu Yong , Zhang Pengyue
Published: November 2018

Optimizing of alloy composition and heat-treatment for rapidly solidified Ce–Fe–B magnets can lead nanocrystalline products with enhanced magnetic properties. In this work, the magnetic properties and domain structures of the nanocrystalline Ce[Formula: see text]Fe[Formula: see text]Co1Zr[Formula: see text]B6 have been investigated. The results show that hard Ce2Fe[Formula: see text]B magnetic phase and paramagnetic CeFe2 phase are crystallized for the heat treated alloys, while the volume fraction and grain size of Ce2Fe[Formula: see text]B and CeFe2 phases change significantly with the increase of annealing temperature. The enhanced coercivity H[Formula: see text] of 6.32 kOe and maximum energy products (BH)[Formula: see text] of 5.52 MGOe have been observed for the Ce[Formula: see text]Fe[Formula: see text]Co1Zr[Formula: see text]B6 ribbons at the optimal annealing temperature of 520[Formula: see text]C and 580[Formula: see text]C, respectively. Meanwhile, the magnetization reversal behaviors and the nucleation field of the annealed sample were discussed in detail. The domain structures analysis provides more information on the characteristic of the domain width W as well as the exchange interactions.
Electrostatic beam splitter for polar molecules
Authors: Li Sheng-Qiang
Published: November 2018

An electrostatic beam splitter composed of three charged poles for polar molecules in weak-field-seeking states is proposed. First, the schematic diagram is given. Then we calculate the spatial distribution of the electrical field using the finite element software. We simulate the dynamic process of the loading and splitting polar molecules using the classical Monte Carlo method. We investigate the influences of the longitudinal velocity of the incident molecular beam and the voltages on the performance of our beam splitter. In order to alter the splitting ratio of the molecular beam conveniently, we cut off the two output arms of beam splitter at a certain position. Then we study the influences of the voltages and cutting positions on the splitting ratio. At last, we discuss two methods of keeping the height of guiding center nearly unchanged.