bluuebunny/crossref_metadata_2025 huggingface dataset:
Telehealth in the time of Corona: ‘doctor in the house’
Authors: Almallah Yahia Zaki , Doyle Daniel John
Published: December 2020

The COVID‐19 pandemic has led to many physicians working from home whenever possible. Although the concept of ‘remote’ patient care has been around for decades, present circumstances have provided a grand impetus in that direction with a view to protecting both patient and caregiver. In this article, we discuss some of the various challenges to moving forward with telemedicine, drawing in part on our own experiences in dealing with the COVID‐19 pandemic. Clinical, technical, financial and cultural barriers to telemedicine are identified, along with a discussion concerning anticipated benefits. We conclude that the COVID‐19 pandemic will likely forever change how healthcare is conducted as telemedicine figures increasingly prominently in the clinical landscape.
The human approach to supportive interventions: The lived experience of people who care for others who suicide attempt
Authors: Wayland Sarah , Coker Sarah , Maple Myfanwy
Published: December 2020

There is currently limited information about the impact and experiences of a suicide attempt on the well‐being of a person providing care before, during, or after the attempt. Scant evidence available suggests that providing care has a profound impact on the support person or carers’ own physical and psychological health; they may experience adverse health, financial, and functional outcomes, collectively described as ‘caregiver burden’. This project sought to understand insights into the experience of providing care for someone who has previously attempted suicide. The larger study was designed in three phases consisting of an online survey, semi‐structured interviews, and a follow‐up survey. This paper reports the qualitative findings of the interviews which were thematically analysed. Two symbiotic themes emerged: the lived experience of caring and the impact of engagement and support from the healthcare system. The authors concluded that that the carer position is a multidimensional role involving informal agreements and situational or time‐based support. Further, awareness of this shifting relationship needs to be embedded in the provision of care by health professionals following a suicide attempt. Recommendations for enhanced health system response are proposed.
Mediator tail module subunits MED16 and MED25 differentially regulate abscisic acid signaling in Arabidopsis
Authors: Guo Pengcheng , Chong Leelyn , Wu Fangming , Hsu Chuan‐Chih , Li Chuanyou , Zhu Jian‐Kang , Zhu Yingfang
Published: December 2020

MED25 has been implicated as a negative regulator of the abscisic acid (ABA) signaling pathway. However, it is unclear whether other Mediator subunits could associate with MED25 to participate in the ABA response. Here, we used affinity purification followed by mass spectrometry to uncover Mediator subunits that associate with MED25 in transgenic plants. We found that at least 26 Mediator subunits, belonging to the head, middle, tail, and CDK8 kinase modules, were co‐purified with MED25 in vivo. Interestingly, the tail module subunit MED16 was identified to associate with MED25 under both mock and ABA treatments. We further showed that the disruption of MED16 led to reduced ABA sensitivity compared to the wild type. Transcriptomic analysis revealed that the expression of several ABA‐responsive genes was significantly lower in med16 than those in wild type. Furthermore, we discovered that MED16 may possibly compete with MED25 to interact with the key transcription factor ABA INSENSITIVE 5 (ABI5) to positively regulate ABA signaling. Consistently, med16 and med25 mutants displayed opposite phenotypes in ABA response, cuticle permeability, and differential ABI5‐mediated EM1 and EM6 expression. Together, our data indicate that MED16 and MED25 differentially regulate ABA signaling by antagonistically affecting ABI5‐mediated transcription in Arabidopsis.
A clinical evaluation of noninvasive and contactless radiofrequency technique in the treatment of abdominal fat
Authors: Qin Jie , Guo Meng‐er , Xu Xue‐gang , Zhang Chao , Yu Cheng‐qian , Li Yuan‐hong , Chen Hong‐duo
Published: December 2020

Background

There is an increasing demand for fat reduction and body contouring procedures. Noninvasive radiofrequency devices have been used to tighten skin and treat cellulite, but there are few studies confirming their efficacy for abdominal fat reduction.

Objective

This study explored the effects of four noninvasive radiofrequency (RF) treatments on abdominal fat in Asian subjects, evaluating body weight, body mass index (BMI), and waist circumference.

Methods

In this study, 16 patients with abdominal obesity were treated four times with a noninvasive and contactless selective RF device (VANQUISH ME™, BTL Aesthetics). Treatments were 7 days apart and lasted 45 min each. The BMI and circumference of the upper, middle, and lower abdomen were measured at baseline and after each treatment.

Results

There were statistically significant reductions in BMI and abdominal circumference in all 16 patients (P < .05). Most patients only experienced a slight abdominal heat sensation and minimal body sweating during the treatment, and no adverse reactions were observed after the treatment.

Conclusion

The noninvasive and contactless selective RF technique was effective and safe in reducing fat, BMI, and abdominal circumference.
Rise in male cosmetic procedures in dermatology: A 4.5‐year clinical evaluation
Authors: Wang Jordan V. , Valiga Alexander , Albornoz Christian A. , Geronemus Roy G.
Published: December 2020

This commentary examines the growing popularity of cosmetic procedures in men. With the recent increase in aesthetic procedures across the nation, it is important for physicians to understand trends as they evolve, which can help to optimize clinical training, business operations, and practice management. Although the popularity of cosmetic procedures in men has increased, available data on consumer behavior is limited. Our data fills this gap by examining the patterns of cosmetic procedures in men. Due to hormonal and anatomic differences, the pathophysiology of cutaneous aging differs between sexes, which can have significant implications for treatment. Our data demonstrates a positive trend in recent years and also breaks it down by individual procedures.
Gingival overgrowth induced by anticonvulsant drugs: A cross‐sectional study on epileptic patients
Authors: Gallo Claudio , Bonvento Giada , Zagotto Giuseppe , Mucignat‐Caretta Carla
Published: December 2020

Objective

Our aim was to estimate the prevalence of gingival overgrowth (hyperplasia) and to determine whether active molecules affect the severity of overgrowth in a group of epileptic patients.

Background

The effects of phenytoin on oral health have been explored in different studies, yet little information is available on other antiepileptic drugs.

Methods

Data were collected from 213 subjects of both sexes, from 5 to 80 years. Patients taking the same antiepileptic therapy for at least 1 year and meeting the inclusion criteria of the study (n = 162) were subjected to measurement of gingival overgrowth according to the modified Harris and Ewalt classification and O’Leary's plaque control record (OLR). Descriptive statistics were calculated. Data were analyzed using Pearson's r correlation coefficient and chi‐square test. Significance level was set at 5%.

Results

The active drugs lamotrigine, oxcarbazepine, and phenobarbital were significantly associated with gingival overgrowth in 61%, 71%, and 53% of cases, respectively, and phenytoin, valproic acid, and carbamazepine in 50%, 44%, and 32% of cases, respectively.

Conclusion

Different antiepileptic molecules may be related to gingival overgrowth. In addition to phenytoin, also lamotrigine, oxcarbazepine, and phenobarbital were associated with increased prevalence of gingival overgrowth. In the management of epileptic patients, dentists should take into account different drugs as possible causes for gingival overgrowth and warn for possible alternatives.
Burrow structure and utilization in the mudskipper Periophthalmodon septemradiatus from the Mekong Delta
Authors: Dinh Q. M. , Tran L. T. , Phan T. T. , Bui M. T. , Nguyen T. T. K. , Tran D. D. , Vo T. T. , Mai H. V. , Tran L. X. , Ishimatsu A.
Published: December 2020

Several studies indicate that burrows play an essential role in burrowing fish, especially mudskippers, but little is known on burrow morphology and utilization of Periophthalmodon septemradiatus. This study was therefore conducted at five sampling sites from the estuary to upper reaches of Hau River to contribute to the knowledge of the behavior of Pn. septemradiatus, via in situ and ex situ observations of the utilization of burrow structures. Burrows made by polyester resin were used to determine their morphology. The male mudskippers Pn. septemradiatus were observed to excavate burrows using their mouths during the low tide. The burrows' shapes were found to be J, U and W, with 1–3 openings and one bulbous chamber. The chamber was used as egg container where the mudskipper deposits their fertilized eggs. W‐shaped burrows were found to be interconnected chambers where the mudskipper used it to change direction of movements inside the burrow. For the J‐ and U‐shaped burrows, the commonality at all five sites was identified. The W‐shaped burrows were common and were only found at two sites (Long Duc and An Lac Tay). For the burrows' structure, the openings to the surface were oval, circular and bulbous in shape. Yet, there were variations between sites, and the burrows' size was similar during the dry and wet seasons. At different sites, the depth of the burrows seasonally changed. The burrows used by mudskipper provide shelter, spawning sites, and access to feeding grounds for other mudskipper species.
Durability of Macroplastique volume and configuration in women with stress urinary incontinence secondary to intrinsic sphincter deficiency: A retrospective review
Authors: Carroll Timothy F. , Christie Alana , Foreman Melissa , Kuprasertkul Amy , Khatri Gaurav , Zimmern Philippe E.
Published: December 2020

Objectives

To evaluate the durability of Macroplastique® (MPQ) volume and configuration in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using serial three‐dimensional ultrasound (3DUS) measurements.

Methods

Following Institutional Review Board approval, charts of women with SUI and ISD (defined based on leak point pressure; lateral imaging of urethral support without hypermobility) who underwent MPQ were reviewed from a prospectively maintained database. All had at least two serial transperineal 3DUS measurements with no MPQ or other bulking agent injection between measurements. 3DUS was performed using the Philips IU22 ultrasound system with endovaginal 3D 9‐3V end‐fire probe typically at 6‑8 weeks post‐injection and yearly thereafter. The same imaging team blinded to clinical outcomes evaluated volume and configuration (circumferential/symmetric or asymmetric) at each 3DUS.

Results

Between 2011 and 2019, 62 of 174 women met study criteria. Those with prior other bulking agent injection or having ≤1 3DUS follow‐up were excluded. Seventy‐one percent of patients had one injection, while the remainder had two or more (29%). Median time between first and second 3DUS was 12 months. The mean change in MPQ volume between the first and last 3DUS measurement was −0.2 cc (95% CI: −0.5 to 0.004; P = .054). A median of 5.0 cc were injected in each patient. Forty‐seven women had symmetric MPQ at first 3DUS, of whom only five (11%) had a follow‐up 3DUS showing asymmetric MPQ distribution.

Conclusions

At mid‐term follow‐up, repeat transperineal 3DUS after MPQ injection revealed minimal change in volume and configuration in the urethral wall.
Dorsal Root Ganglion Stimulation Normalizes Measures of Pain Processing in Patients with Chronic Low‐Back Pain: A Prospective Pilot Study using Quantitative Sensory Testing
Authors: Chapman Kenneth B. , van Roosendaal Bert‐Kristian , Yousef Tariq A. , Vissers Kris C. , van Helmond Noud
Published: December 2020

Background

Dorsal root ganglion stimulation (DRG‐S) is used as a treatment for chronic low‐back pain (CLBP), although its underlying mechanisms remain elusive. CLBP patients have been found to have reduced mechanoreceptive perception, reduced endogenous analgesia, as well as deep‐tissue hyperalgesia when compared with healthy controls. Using quantitative sensory testing (QST), we studied if DRG‐S in CLBP patients results in changes in pain processing.

Methods

Quantitative sensory testing was performed in patients before trial implantation of a DRG‐S system for CLBP and just before the trial lead removal or at 1‐month follow‐up after the permanent implant. We determined the pressure pain threshold (PPT) and mechanical detection threshold (MDT) at the most painful lower‐back location. PPT was also measured on the contralateral shoulder as a control. We obtained a measure of endogenous inhibitory pain modulation using conditioned pain modulation (CPM).

Results

We enrolled 11 patients (60 ± 16 years). Pain decreased from 8.5 ± 1.0 at baseline to 2.0 ± 1.5 on a 0‐10 numerical rating scale with DRG‐S (P < 0.01). From baseline to with DRG‐S, PPT on the most painful location on the low back increased from 28.7 ± 13.6 to 43.4 ± 17.2 N/cm2(P < 0.01). MDT on the same location decreased from 8.1 ± 10.4 to 3.4 ± 4.7 mN (P = 0.07). PPT on the control location and CPM did not change significantly.

Conclusions

Our results suggest that DRG‐S in CLBP patients reduces deep‐tissue hyperalgesia in the low back, while improving mechanoreceptive perception. These changes in both neuropathic and nociceptive components of CLBP were accompanied by clinical improvements in pain and function.
Psychometric evaluation of the Hospitalisation‐Related Stressors Questionnaire for Elderly Patients
Authors: Yildirim Hilal , Işik Kevser
Published: December 2020

Background

Stress can threaten the health and recovery of patients, and determining the level of stress can be an important factor in curing illnesses. The aim was to adapt the Hospitalisation‐Related Stressors Questionnaire for Elderly Patients (HRSQ‐EP) and perform its psychometric evaluation.

Methods

In the study, the method of developing a scale and determining the construct validity and reliability of this scale was used. The research was carried out with elderly patients who were hospitalised. The research was conducted in two main phases; in the first phase, after providing expert opinion for the language validity of the scale, the content and face validity were confirmed and then confirmatory and exploratory factor analyses were applied for content validity and reliability in the second phase.

Results

The new scale, which was formed as a result of evaluating the construct validity, consisted of three factors and 15 items, and all factors explained 67.1% of the total variance. Kaiser‐Meyer‐Olkin, which determined the suitability of the measurement tool for factor analysis, was determined as 0.901 and Bartlett test 0.000. The adapted short form is a simple and easy‐to‐understand tool for determining the stress levels of hospitalised elderly individuals. HRSQ‐EP provided evidence that it demonstrates adequate internal consistency, reliability and construct validity.

Conclusion

The results suggested that the adapted measurement tool will be useful. The scale is recommended to be evaluated in different populations to determine cultural differences.
Of Bumping and Bending: Foreign Universities’ FDI Strategies in Malaysia
Authors: Schulze Marc Philipp
Published: December 2020

Universities from varying institutional and geographical contexts have increasingly invested in offshore subsidiaries in the Malaysian private higher education sector. Literature on transnational education policy and management as well as economic‐geographic accounts of firms’ transnationalisation or public service provision have not investigated foreign providers’ direct investment and market access strategies in the higher education sector. This paper addresses these gaps, showing how and why foreign actors’ investment and market involvement in Malaysia have changed. Empirical data is drawn from qualitative interviews and policy documents. The research reveals that foreign universities have strategically modified their business partnerships and bi‐national accreditation to bypass and bend state regulation of market access as well as to restructure internal organisation and geographical configuration. The paper proposes conceptualising foreign higher education providers as transnationalising, reflexive networks within networks that respond to dynamic market access regulation by adopting firm‐like investment strategies.
A Mechatronics Approach to Safe, Stable Teleoperation in Medical Applications
Authors: Wang David , Lai Gilbert , Caradima Carmen
Published: December 2020

Currently, remote interactions between patient and surgeon/doctor are limited to visual and audio aspects only. The general objective of the research presented in this paper is to explore force feedback teleoperation to improve the doctor/surgeon’s abilities. A control strategy is proposed which transmits forces, does not need expensive force sensors, and can be shown to be always stable. This technique should work for all “linear” haptic devices. The mechatronics approach has been taken in the mechanical design of the haptic devices to ensure linearity. The work presented in this paper will focus on the interactions between two haptic devices: the Virtual Reality Mouse 1 (VR Mouse), and a 5-bar linkage robot. Time delay issues involved in the teleoperation will also be discussed. The technique proposed in this paper will result in a very inexpensive workstation for teleoperation applications.
An Active Steering Device for Endoscopes
Authors: Szewczyk Jérôme , Troisfontaine Nelly , Bidaud Philippe
Published: December 2020

This paper describes an original active steering device for endoscopes and horoscopes. Its mechanical structure is based on a tubular hyper-redundant mechanism. Distributed SMA actuators with their own local controller are integrated in this structure for producing bending forces in reaction to the interaction detected between the instrument and its environment.

The SMA actuators are two thin NiTi springs in an antagonist configuration. Joint actuation relies on martensite/austenite phase transformation in NiTi alloys. The global behavior of the endoscope is controlled through a multi-agent approach.
Design and Control of a Shape Memory Alloy Wire Bundle Actuator
Authors: Mosley Michael J. , Mavroidis Constantinos
Published: December 2020

In this paper, the design and control of a novel shape memory alloy (SMA) actuator that possesses impressive payload lifting capabilities are presented. The actuator consists of 48 nickel-titanium SMA wires mechanically bundled in parallel forming one powerful artificial muscle. This new linear actuator can apply up to 100 lbf (445 N), which is approximately 300 times its weight, over a maximum distance of 0.5 in. (1.27 cm). The actuator was tested in two different loading configurations — linear displacement and operation of a revolute joint. A PID based controller with the addition of an input shaping function was developed for each loading configuration with excellent results, maintaining steady state error within ± 0.004 in. (0.1 mm) for linear motion and ± 1° for revolute joint rotation. This powerful, compact, and lightweight actuator shows promise for use in space, medical, and other macro-robotic applications.
Trajectory Control of Two DOF Closed-Chain Mechanical Systems
Authors: Guo L. S. , Li Y. F. , Zhang W. J.
Published: December 2020

In this study, we develop some control algorithms for trajectory tracking of two DOF closed-chain mechanical systems separately driven by two servomotors (closed-chain robot), as well as by one CV motor and the other servomotor (so-called hybrid machine) based on their dynamic model. For the former, the exponential stability and validation of PD computed-torque control algorithm are verified for trajectory tracking of both joints and the end-effector of the system. For the latter, a complex PD computed-torque control algorithm with a closed-loop feedback for the servomotor and an open-loop feedforward for the CV motor is proposed. Simulation studies show that the complex PD computed-torque control algorithm is effective when the velocity fluctuation of the CV motor is reduced to 5% by attaching a flywheel on the CV motor shaft.
Design of Actuator Endurance and Reliability Testbed
Authors: Kang Seong-Ho , Cox Daniel J. , Tesar Delbert
Published: December 2020

This paper presents a novel test bed devised for the testing of various types of next generation robot actuators, especially modular actuators. Requirements for actuator tests are different from motor testing because actuators for robotic application are highly unique and specialized devices with numerous parameters and conditions to be considered. To meet the high demand of a particular application, the actuator must be carefully tested using highly advanced measurement equipment. The first section introduces the 4-test bed suite for the evaluation environment of modern actuators with their purposes and measurement parameters. General information on the performance testing of actuators is also given. The hardware and software environment of the Actuator Endurance and Reliability Test Bed (AERTB) is then described in depth. Preliminary tests have been done to verify and check the proper operation of the test bed. Test results show that the developed test bed offers excellent testing capability of robot actuators with ease of use.
On the Implementation of a DCLL Digital Controller for a Robotic Manipulator With Cartesian Trajectory Description
Authors: Martinez-Alfaro Horacio , Pacheco-Cabrera Miguel A.
Published: December 2020

This article shows implementation results of a digital DCLL controller for a Scorbot robotic arm with Cartesian trajectory description. The performance of the DCLL controller was compared with a PD one. The global performance of the DCLL controller was substantially better than the PD showing complete convergence in about two trajectory cycles. In addition, the DCLL controller does not require the computation of inverse kinematics to perform the tracking of the working trajectory.
Rigid Body Dynamical Equations With Lie Algebra
Authors: Gupta Krishna C.
Published: December 2020

A direct derivation is presented for the Generalized Euler’s equation in the translated base system that is located at the center of mass of the body. The use of Lie algebra reveals an interesting property of the time-variant inertia matrix I(t) — its rate of change is the Lie product [Ω, I], where [Ω] is the skew-symmetric representation of the angular velocity ω. This observation also simplifies the derivation. The standard body system form and the ZRP-form are then deduced. With differing meanings of terms, all three forms have a similar appearance: MG = [I] α + [Ω] [I] ω.
Finite Element Analysis of Circular Wedge Connections
Authors: Grossmann Christoph , Tegel Oliver
Published: December 2020

In this paper, the finite element analysis of circular wedge connections is described, and conclusions for the performance of the connection are derived. In the foreground of the examinations are stresses and deformations while tightening of the connection. Starting with the general structural performance, the influences on power transmission like slope, number of wedges, coefficient of sliding friction and outer hub diameter are discussed. An analytic function to describe the gap pressure within the tightened joint is introduced and rates to explain the problem of centering of circular wedge connections are shown. Finally two concepts for dimensioning are presented and recommendations for application of this connection are given.
A Computer Aided Cam Synthesis Tool for Arbitrary Follower Motion Functions
Authors: Li Zhe , Kota Sridhar
Published: December 2020

This paper describes a cam mechanism synthesis and analysis software CamSyn based on Matlab platform. The key feature of this software is its ability to synthesize a cam system with arbitrary follower motion functions. In particular, CamSyn can synthesize a cam profile for multi-rise and multi-return follower displacement functions and is therefore not restricted to typical single dwell-rise-return motion functions. Design examples are given to demonstrate the effectiveness of the software. The underlying design methods and strategies implemented in this software are well known in the published literature.
Investigating Design Methods Through the Design of an Automated Soap Wrapper
Authors: Sundberg Jason S. , Shooter Steven B.
Published: December 2020

In the past decade a proliferation of design methodologies have emerged. Each of these have a slightly different approach ranging from highly-structured methods to more open and creative techniques. This paper describes the design of a real-world system, an automated soap wrapping machine. Throughout the design process, several of the formal methodologies were employed. Some of these techniques proved more beneficial than others. Also, some new techniques were developed to best use some of the features of present computer aided design (CAD) packages.
Modelling and Control of a Closed Chain Flexible Linkage
Authors: Caracciolo R. , Giovagnoni M. , Rossi A. , Trevisani A.
Published: December 2020

The objective of this paper is to describe and numerically test a control scheme for a flexible four-bar linkage. The dynamic response of the mechanism is reproduced by means of an accurate finite element model accounting for geometric and inertial nonlinearities. A reduced number of measured variables is selected to control both rigid-body motion and vibration separately without implementing an estimator of the state of the system. Rigid-body motion control is performed by means of a PID-like regulator while proportional controllers are employed to damp link oscillations. Appropriate devices are proposed to avoid coupling effects among variables. Numerical results demonstrate the effectiveness of the control when it operates at different sampling times.
A Spatial Dynamic Analysis of an Excavator to Determine Bucket/Load Weight
Authors: Duffy Joseph , Crane Carl D.
Published: December 2020

This is essentially a report of the final phase of a major study undertaken for the Caterpillar Technical Center, Peoria, Illinois to determine to a high degree of accuracy the bucket/load weight of an excavator under dynamic conditions.

It was quite remarkable that a relatively simple solution was obtained using a least squares approach (as opposed to using a highly non-linear optimization method) considering that there are a total of nine unknown moments and cross moments of inertia of the bucket/load together with the unknown location of the center of mass and the bucket/load weight in the range of 1200–1650 kg which was finally computed to an accuracy of about 0.15%.
Application of Spatial and Fourier Transforms to the Synthesis of Motion Generation Mechanisms
Authors: Wandling George R. , Qamhiyah Abir , Flugrad Donald R.
Published: December 2020

This work presents an approach for the invariant characterization, storage, and search of planar motion generation mechanisms. The motion of the planar mechanisms is defined by the trace point path and by the relative angle of the linkage to which the trace point is attached. Spatial transformations and Fourier descriptors are used to characterize the motion of planar mechanisms. The invariant characteristic information is then stored in a database. Solution comparison and matching techniques are discussed and implemented. A description of each method and the relative performance of file development and search methods are developed for four-bar mechanisms. Each method may be applied to any motion generation planar mechanism since the output motion is characterized and stored in a database for solution comparison. The specific type of mechanism that generates the motion is not necessarily required for identification of candidate solutions.
Kinematic Analysis of an RSPC Agitator Mechanism
Authors: Fischer Ian S.
Published: December 2020

The displacements of an RSPC mechanism used as a washing-machine agitator is analyzed using a numerical method which can consider the motions in the revolute, ball, prismatic and cylindrical joints of the mechanism. The analysis not only computes the output motions of this spatial mechanism, but also the motions at the intermediate joints.
Inverse Static Analysis of a Planar System With Spiral Springs
Authors: Carricato Marco , Duffy Joseph , Parenti-Castelli Vincenzo
Published: December 2020

In this article the inverse static analysis of a two degrees of freedom planar mechanism equipped with spiral springs is presented. Such analysis aims to detect the entire set of equilibrium configurations of the mechanism once the external load is assigned. While on the one hand the presence of flexural pivots represents a novelty, on the other it extremely complicates the problem, since it brings the two state variables in the solving equations to appear as arguments of both trigonometric and linear functions. The proposed procedure eliminates one variable and leads to write two equations in one unknown only. The union of the root sets of such equations constitutes the global set of solutions of the problem.

Particular attention has been reserved to the analysis of the “reliability” of the final equations: it has been sought the existence of critical situations, in which the solving equations hide solutions or yield false ones. A numerical example is provided. Also, in Appendix it is shown a particular design of the mechanism that offers computational advantages.
Design, Simulation and SFF Techniques for Functional Components
Authors: Langrana Noshir , Qiu Dan , Wu Guohua , Higgins Kathryn , Hsieh Cheng Tiao
Published: December 2020

Development of Solid Freeform Fabrication (SFF) systems has created the opportunity for new approaches in design of functional components, which leverages the inherent strengths of both experiment and numerical simulation. This paper describes an approach in which the computational models are integrated with the rapid prototyping fabrication processes. The parts are fabricated using different materials including wax, PZT, silicone nitride, and 17-4PH stainless steel powders for the SFF hardware (Langrana et al, 2000, Qiu et al, 1999, Danforth et al, 1998) and Ciba-Geigy SL-resin for SLA hardware (Higgins and Langrana, 1998, Higgins and Langrana 1999). The components such as turbine blades, actuators, and fixtures have been designed, simulated and fabricated. The properties of parts have been and are being quantified in terms of accuracy and quality.
A Empirical Tire Model of Non-Steady State Cornering Properties Considering Carcass Elasticity
Authors: Hou Yongping , Hu Yujin , Li Chenggang , Guo Konghui
Published: December 2020

The purpose of this paper is to present two empirical tire models of non-steady state cornering property with respect to yaw angle input in low frequency region on the basis of existing tire model and considering the elasticity of the carcass. Verified by test, theoretical values meet well with test data. Comparing with existing tire models, the models described in the paper have more advantages, and they also have high precision. They can be applied for vehicle dynamics studies.
Mobile Robot Rough-Terrain Control (RTC) for Planetary Exploration
Authors: Iagnemma Karl , Dubowsky Steven
Published: December 2020

Mobile robots are increasingly being developed for high-risk missions in rough terrain situations, such as planetary exploration. Here a rough-terrain control (RTC) methodology is presented that exploits the actuator redundancy found in multi-wheeled mobile robot systems to improve ground traction and reduce power consumption. The methodology “chooses” an optimization criterion based on the local terrain profile. A key element of the method is to be able to estimate the wheel-ground contact angles. A method using an extended Kalman filter is presented for estimating these angles using simple on-board sensors. Simulation results for a wheeled micro-rover traversing Mars-like terrain demonstrate the effectiveness of the algorithms.
An Efficient, Geometric Approach to Rigid Body Motion Interpolation
Authors: Belta Calin , Kumar Vijay
Published: December 2020

This paper develops a method for generating trajectories for a rigid body with specified boundary conditions at the end points.

We consider SE(n–1) to be a submanifold (and a subgroup) of the GL(n, R). Our method involves the generation of optimal trajectories in GL(n, R), and then projecting the trajectories to SE(n–1). We use standard algorithms for deriving the optimal curves in the ambient space. The projection operator allows us to project the optimal curves onto SO(n) and SE(n) to yield motions that are near optimal. Results that illustrating the near optimality of the projected curves are included.
Effect of Difference in Consensus Sequence between HIV-1 Subtype A/E and Subtype B Viruses on Elicitation of Gag-Specific CD8+T Cells and Accumulation of HLA-Associated Escape Mutations
Authors: Zhang Yu , Murakoshi Hayato , Chikata Takayuki , Akahoshi Tomohiro , Tran Giang Van , Nguyen Trung Vu , Gatanaga Hiroyuki , Nguyen Kinh Van , Oka Shinichi , Kuse Nozomi , Takiguchi Masafumi
Published: December 2020

HIV-1 mutations escaped from HIV-specific CD8+T cells are mostly detected as HLA-associated mutations. A diversity of HLA-associated mutations is somewhat distinct to each race and region, since HLA allele distribution differs among them.
Interassociation consensus recommendations for pitch-side emergency care and personal protective equipment for elite sport during the COVID-19 pandemic
Authors: Hodgson Lisa , Phillips Gemma , Gordon Jonathan , Hanson Jonathan , Maclean John , Mathema Prabhat , Smith Andrew , Woolcock Mark , Cowie Charlotte M , Kemp Simon , Patterson Michael , Larkin Jo , Hill Jerry , Rossiter Michael , Elliott Niall , Bennett Pippa , Power Jonathan , Pillay Ari , Singh Harjinder , Sheridan Craig , Hurwood Matthew , Riou Peter , Bennison Anthony , Chakraverty Susan , Tingay Richard , Higgins Richard , Weiler Richard , Jaques Rod , Spencer Simon , Carmont Michael R , Patricios Jon
Published: December 2020

The COVID-19 pandemic has necessitated many novel responses in healthcare including sport and exercise medicine. The cessation of elite sport almost globally has had significant economic implications and resulted in pressure to resume sport in very controlled conditions. This includes protecting pitch-side medical staff and players from infection. The ongoing prevalence of SARS-CoV-2 and the desire to resume professional sport required urgent best practice guidelines to be developed so that sport could be resumed as safely as possible. This set of best practice recommendations assembles early evidence for managing SARS-CoV-2 and integrates expert opinion to provide a uniform and pragmatic approach to enhance on-field and pitch-side safety for the clinician and player. The nature of SARS-CoV-2 transmission creates new hazards during resuscitation and emergency care and procedures. Recommendations for the use and type of personal protective equipment during on-field or pitch-side emergency medical care is provided based on the clinical scenario and projected risk of viral transmission.
Knockdown of Bag3 Synergizes with Olaparib to Kill Ovarian Cancer Cells via Repressing Autophagy
Authors: Wang Kexin , Zheng Jianhua
Published: December 2020

This study aimed at expounding the synergistic effect of Bcl-2-associated athanogene 3 (BAG3) knockdown and poly ADP-ribose polymerase (PARP) inhibitor on ovarian cancer (OC) cells and the potential mechanism. Short hairpin RNA (shRNA) targeting BAG3 (sh-BAG3) was transfected into SK-OV-3 (SKOV-3 ;SKOV3) and A2780 cells, and western blot assay was used to detect transfection efficiency. Cell proliferation and apoptosis were detected by the cell counting kit-8 method, 5-Bromodeoxyuridine (BrdU) experiment and flow cytometry analysis, respectively. The expressions of apoptosis-related proteins Bax and Bcl-2, as well as the expressions of autophagy-related proteins LC3-I, LC3-II and Beclin-1, were examined by western blot assay. Additionally, the cells were treated with autophagy activator rapamycin to investigate whether the tumor-suppressive function of BAG3 knockdown+PARP inhibitor was dependent on autophagy. In this work, we demonstrated that BAG3 knockdown further sensitized OC cells to olaparib treatment, reducing cellular viability and promoting apoptosis. Both sh-BAG3 and olaparib decreased the expression of Beclin-1 and the LC3-II:LC3-I ratio, and their synergism further inhibited the process of autophagy. However, the aforementionede effects were reversed after the cells were treated with rapamycin. Based on these results, we concluded that BAG3 knockdown synergizes with olaparib to kill OC cells in vitro by repressing autophagy.
Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of lymphoma
Authors: Neelapu Sattva S , Adkins Sherry , Ansell Stephen M , Brody Joshua , Cairo Mitchell S , Friedberg Jonathan W , Kline Justin P , Levy Ronald , Porter David L , van Besien Koen , Werner Michael , Bishop Michael R
Published: December 2020

The recent development and clinical implementation of novel immunotherapies for the treatment of Hodgkin and non-Hodgkin lymphoma have improved patient outcomes across subgroups. The rapid introduction of immunotherapeutic agents into the clinic, however, has presented significant questions regarding optimal treatment scheduling around existing chemotherapy/radiation options, as well as a need for improved understanding of how to properly manage patients and recognize toxicities. To address these challenges, the Society for Immunotherapy of Cancer (SITC) convened a panel of experts in lymphoma to develop a clinical practice guideline for the education of healthcare professionals on various aspects of immunotherapeutic treatment. The panel discussed subjects including treatment scheduling, immune-related adverse events (irAEs), and the integration of immunotherapy and stem cell transplant to form recommendations to guide healthcare professionals treating patients with lymphoma.
KEYNOTE-022 part 3: a randomized, double-blind, phase 2 study of pembrolizumab, dabrafenib, and trametinib in BRAF-mutant melanoma
Authors: Ferrucci Pier Francesco , Di Giacomo Anna Maria , Del Vecchio Michele , Atkinson Victoria , Schmidt Henrik , Schachter Jacob , Queirolo Paola , Long Georgina V , Stephens Rosalie , Svane Inge Marie , Lotem Michal , Abu-Amna Mahmoud , Gasal Eduard , Ghori Razi , Diede Scott J , Croydon Elizabeth S , Ribas Antoni , Ascierto Paolo Antonio
Published: December 2020

Background

In the KEYNOTE-022 study, pembrolizumab with dabrafenib and trametinib (triplet) improved progression-free survival (PFS) versus placebo with dabrafenib and trametinib (doublet) without reaching statistical significance. Mature results on PFS, duration of response (DOR), and overall survival (OS) are reported.

Methods

The double-blind, phase 2 part of KEYNOTE-022 enrolled patients with previously untreated BRAFV600E/K-mutated advanced melanoma from 22 sites in seven countries. Patients were randomly assigned 1:1 to intravenous pembrolizumab (200 mg every 3 weeks) or placebo plus dabrafenib (150 mg orally two times per day) and trametinib (2 mg orally one time a day). Primary endpoint was PFS. Secondary endpoints were objective response rate, DOR, and OS. Efficacy was assessed in the intention-to-treat population, and safety was assessed in all patients who received at least one dose of study drug. This analysis was not specified in the protocol.

Results

Between November 30, 2015 and April 24, 2017, 120 patients were randomly assigned to triplet (n=60) or doublet (n=60) therapy. With 36.6 months of follow-up, median PFS was 16.9 months (95% CI 11.3 to 27.9) with triplet and 10.7 months (95% CI 7.2 to 16.8) with doublet (HR 0.53; 95% CI 0.34 to 0.83). With triplet and doublet, respectively, PFS at 24 months was 41.0% (95% CI 27.4% to 54.2%) and 16.3% (95% CI 8.1% to 27.1%); median DOR was 25.1 months (95% CI 14.1 to not reached) and 12.1 months (95% CI 6.0 to 15.7), respectively. Median OS was not reached with triplet and was 26.3 months with doublet (HR 0.64; 95% CI 0.38 to 1.06). With triplet and doublet, respectively, OS at 24 months was 63.0% (95% CI 49.4% to 73.9%) and 51.7% (95% CI 38.4% to 63.4%). Grade 3–5 treatment-related adverse events (TRAEs) occurred in 35 patients (58%, including one death) receiving triplet and 15 patients (25%) receiving doublet.

Conclusion

In BRAFV600E/K-mutant advanced melanoma, pembrolizumab plus dabrafenib and trametinib substantially improved PFS, DOR, and OS with a higher incidence of TRAEs. Interpretation of these results is limited by the post hoc nature of the analysis.
South West England leadership training survey (2019)
Authors: Hayward Samuel , McGlade Sophie , Cockburn Samantha , Ballisat Ben , Smith-Jack Freya , Fleming Carla , Everleigh Mark , Thurlow Jane
Published: December 2020

Introduction

The National Health Service Long Term Plan recognises that excellent quality care requires great leadership. Understanding junior doctor experiences of leadership development can inform organisations to improve trainee leadership skills.

Methods

A survey of South West (SW) England trainees was conducted to capture views on leadership and management training.

Results

Results came from 190 trainees across both SW deaneries, areas of practice and all training stages. Respondents agreed that leadership skills are important for doctors (n=186; 99%). Lack of time was indicated as a barrier to developing leadership skills (n=139; 75.5%). Audits and quality improvement projects were used for developing leadership skills. Colleagues were the main source of support.

Discussion

SW trainees recognise the importance of developing leadership skills, underlining the need to prioritise opportunities for leadership development. Respondents had ideas to improve areas of practice, where ideas were supported, they were implemented.

Conclusion

Compared with national findings SW trainee experiences are positive, with more ideas implemented, more time for developing skills and more resources used. Activities engaged in closely aligned to the 70:20:10 model of leadership. Trainees should be encouraged to access support from peers and create networks of opportunity. Additional research in this area is needed.
What can we learn about systems leadership from the building of a Welsh surge hospital and how might this be applied beyond the current COVID-19 response?
Authors: Beharrell William , Richards Len , Driscoll Martin , Gray Jonathon
Published: December 2020

Background

Methods

It draws on a series of 20 interviews with key protagonists and employs a Bakhtinian approach to narrative analysis, which explores the interplay between individual accounts and larger sociocultural themes.

Results

Conclusions

It concludes that the success in managing the complexity of this project can largely be attributed to a systems leader approach that draws on the power of an agile network to be replenished and redeployed against rapidly evolving strategic objectives. This effectively constitutes a parallel operating structure, which is devoted to the design and implementation of strategy based on a continual assessment of the organisation and serves to strengthen rather than supersede established hierarchical structures of authority.
Comparison of an e-learning package with lecture-based teaching in the management of supraventricular tachycardia (SVT): a randomised controlled study
Authors: Mohee Kevin , Haboubi Hasan N , Protty Majd , Srinivasan Christopher , Townend William , Weston Clive
Published: December 2020

Introduction

To compare the impact of an e-learning package with theoretical teaching on the ability of both graduate and undergraduate medical students to learn the management of supraventricular tachycardia.

Methods

We conducted a randomised, controlled, study at two Welsh medical schools. Participants were graduate-entry and undergraduate medical students, who were randomised (in a 1:1 ratio) to either 1 hour of training using an e-learning package or an hour of lecture-based teaching. The outcome was a comparison, within each group and between groups, of median scores achieved in assessments of knowledge through completion of preintervention, immediate post intervention and 2 weeks postintervention questionnaires.

Results

Of the 97 participants available for randomisation, 47 underwent teaching using the e-learning package and 50 were taught in the lecture group. Median scores were higher in the e-learning package group than the lecture group, though this difference was not statistically significant (4.00 vs 3.00; p=0.08) immediately after intervention. At 2 weeks post intervention, median scores in the e-learning package group were significantly higher than the median scores in the lecture group (4.00 vs 3.00; p=0.002). This was despite a subanalysis of the results demonstrating that subjects in the lecture group reported having seen more cases compared with those in the e-learning group (32 vs 13; p=0.002). Further, there was a significant fall in score over 2 weeks in the group receiving lecture-based teaching, but no such decrease in those using the e-learning package.

Conclusion

E-learning seems to be the preferred method of learning and the method that confers longer retention time for both postgraduate and undergraduate medical students.
Financial implications of trauma patients at a Canadian level 1 trauma center: a retrospective cohort study
Authors: Fontebasso Adam M , Figueira Sonshire , Thavorn Kednapa , Glen Peter , Lampron Jacinthe , Matar Maher
Published: December 2020

Background

Trauma is a cause of significant morbidity and mortality globally, and patients with major trauma require specialized settings for multidisciplinary care. We sought to enumerate the variability of costs of caring for patients at a Canadian level 1 trauma center.

Methods

A retrospective analysis of all adult patients admitted to The Ottawa Hospital trauma service between June 2013 and June 2018 was conducted. Hospital costs and clinical data were collected. Descriptive statistics and multivariable regression analysis using generalized linear model were performed to assess cost variation with patient characteristics. Quintile-based analyses were used to characterize patients in different cost categories. Hospital costs were reported in 2018 Canadian dollars.

Results

A total of 2381 admissions were identified in the 5-year cohort. The mean age of patients was 50.2 years, the mean Injury Severity Score (ISS) was 18.7, the mean Charlson Comorbidity Index (CCI) score was 0.35, and the median total cost was $10 048.54. ISS and CCI score were associated with higher costs (ISS >15; p<0.0001). The most expensive mechanisms of injury (MOIs) were those involving heavy machinery (median total cost $24 074.38), pedestrians involved in road traffic collisions ($20 965.45), patients in motor vehicle collisions ($17 621.01) and motorcycle collisions ($16 220.89), and acts of self-injury ($13 903.69). Patients who experienced in-hospital adverse events were associated with higher costs (p<0.0001). Our multivariable regression analysis showed variation in costs related to male gender, penetrating/violent MOI, ISS, adverse hospital events, CCI score, urgent admission status, hospital 1-year mortality risk score, and alternate level of care designation (p<0.05). Quintile-based analyses demonstrated clinically significant differences between the highest and lowest cost groups.

Discussion

Major trauma was associated with high hospital costs. Modifiable and non-modifiable patient factors were shown to correlate with differing total hospital costs. These findings can aid in the development of funding strategies and resource allocation for this complex patient population.

Level of evidence

Level III evidence for economic and value-based evaluations.