bluuebunny/crossref_metadata_2025 huggingface dataset:
SMART SOLAR POWERED TENT
Authors: Sridharan Rahul , Sriram Maruti , Rajkumar E
Published: May 2021

Many Engineering Technologies and day to day applications are now moving towards a eco friendly and environment free solutions for the routine processes. This paper investigates on how the environment friendly products which doesn’t hinder the day to day activities done by the humans without causing any harm to the nature by involving unique engineering technologies which can help the product to be sold in the market and helping the humans to utilize the nature’s resource and fulfilling the daily activities. This main objective of the regular tent existing in the market are based on different needs and specifications but it isn’t able to fulfill the purpose either it isn’t long lasting or not portable to carry for long distance travelling or on tough mountains for hiking. Therefore, to put an end to this everlasting issue this product is developed to cater all the needs of a traveler irrespective of the place he goes. The unique part of this tent is that it is completely powered by solar energy as it will provide in and around electricity in the tent as it has solar panel and LED lights are stuck around it to provide light. Researchers have compared with regular tents with the solar powered tents and notice that apart from lighting the place it can kill the bacteria by ultraviolet rays and keeping the place clean and can be used for necessary chores done during travelling. The Optimized form of product is that it’s a multifunctional and can be used in any sort of place and any sort of travelling.
Suitability Of Standard Fracture Test Specimens For Low Constraint Conditions
Authors: Ekabote Nagaraj , Kodancha Krishnaraja G. , Kudari S.K.
Published: May 2021

Test specimen selection plays a vital role in successful transformation of laboratory fracture parameter findings to the real fracture behavior of any component. The ASTM and BSI Standard test methods for measurement of fracture toughness are dominated by high constraint specimens like Compact Tension (C(T)) and Single Edge Notch Bend (SEN(B)). However, most cracks in real time structure are shallow and surrounded by low constraint. Hence, the standard specimen like Middle Crack Tension (M(T)) in ASTM and Clamped Single Edge Notch Tension (Clamped SEN(T)) specimen in BSI, yield fracture toughness value to be test specimen dependent. The Clamped SEN(T) specimen suitable for various real pipeline (low constraint conditions) application has been widely reported in literature, that however in not the case for M(T) specimen which has scarcely reported. The 3D numerical analysis of SEN(T) and M(T) specimens with an identical flaw size for fracture toughness and constraint parameters (T-stress) under linear-elastic conditions are dealt in this article. The standard specimen that emulates low constraint fracture behaviour forms the basis for recommending suitable specimen for defined real time conditions. The conservatism associated with usage of standard specimen to find fracture parameters for an application has been quantified in this work for field implementation by practitioners in fracture mechanics.
Tensile behavior of lotus natural fiber and e-glass fibers reinforced with epoxy composites
Authors: Abhijith A V , Dharmarajan Thayyil Abhishith , Narendiranath Babu T
Published: May 2021

This paper is concerned with the study of tensile properties of lotus fiber reinforced with epoxy composites. Specimens of epoxy composites were made from natural fibers by arranging them in uniaxial, biaxial as well as in criss-cross manner with and without E-glass fiber. To enhance the mechanical properties, fibers were undergone alkaline treatment (NaOH) and later they were fabricated using hand lay-up technique. It is understood from the results that better tensile properties were shown by uniaxial and minimal by biaxial arrangement.
Trust Based Fake Node Identification in Social Networking Sites
Authors: Spoorthy A S , sinha Somnath
Published: May 2021

In recent years Social Networking is very commonly used for communications. It is the platform where users are free to join and share their data between groups of people. Due to the openness of this network any one can use multiple fake identifications and fraud the people into its group. These types of fake profiles are required to be identified and wipe out from the network. Some of the Social Networking Sites (SNS) that are commonly used are Twitter, Facebook, Instagram, WhatsApp, WeChat etc. These SNSs are already have some mechanism to identify fake profiles and prevent them from such type of malicious activities but are not sufficiently efficient. This paper represents comprehensive literature review for identification mechanism of fake account on Facebook and proposes a new mechanism to stop this type of harmful activities by using graph based activity diagram.
USE OF CORRUGATED PIPE HEAT EXCHANGERS IN WASTE HEAT RECOVERY STEAM GENERATORS
Authors: Nayak Sukanta , Jena Satyasreet , Khan Abu Sharique Shamshad , Paswan Mani Kant , Sharma Vinod Kumar
Published: May 2021

Heat exchangers are used for a variety of purposes in various domestic, commercial& industrial applications. Some common examples are sensible heating & sensible cooling in chemical processes, condensation and steam generation in power plants, and recovery of waste heat etc. Heat exchangers performance enhancement can lead to more economical design of heat exchanger which increases energy, material & cost savings related to heat exchange process. Making corrugation on pipe surface is one such method. Numerous works has been carried out in this area, where parameters such as inside diameter of pipe, corrugation pitch, corrugation depth, temperature and phase of liquid has been studied. Corrugation of tubes can increase both the inner and outer surface convective heat transfer coefficient without any considerable rise in pressure drop. It also results in increase in mixing of fluid, flow turbulence, unsteadiness by limiting the fluid boundary layer growth adjacent to the tube surface.
Improvement of hot corrosion resistance of dissimilar weldments by current pulsing in a simulated power plant environment
Authors: Muthu S M , Arivarasu M , Mohanty Saurav , Arivazhagan N
Published: May 2021

Hot corrosion studies are of utmost importance for welded components in the power plant industry as well as for industries which deal with exposure to the high-temperature corrosive environment. The failure of welded components at high temperatures has often led to the reduced service life of a component and catastrophic disasters. This has been a significant engineering challenge in the design of welded components. It is generally seen that the failure of the welded sections mostly occurs because of the deposition of molten salt over the weldments which accelerate the hot corrosion reactions. In this present research work, two dissimilar base materials, AISI 4340 and AISI 304L have been welded with two different welding processes namely continuous current gas tungsten arc welding (CCGTAW) and pulsed current gas tungsten arc welding (PCGTAW) while making use of ERNiCr-3 as filler material. A comparative study of the dissimilar welded plates was carried out by simulating a molten salt environment at 600°C involving hot corrosion behavior. By analyzing the microstructure and thermo-gravimetric data, it is concluded that the pulsed current gas tungsten arc welding process has superior corrosion resistance properties while using ERNiCr-3 as the filler material as compared to the continuous current gas tungsten arc welding process.
Design and value engineering of a high temperature high pressure multifunctional compression moulding unit to manufacture zero defect parts
Authors: Gopinath K V , Padmanabhan K
Published: May 2021

Hot compression moulding is one of the better techniques employed to make zero defect products. This paper mainly discusses about the conversion of a conventional hydraulic press into a high pressure, high temperature compression moulding unit at a low cost using local state of the art methodology. A normal press used for blanking, drawing and various metal forming operations is modified here by addition of top and bottom platens with heating coils controlled by PID controllers to operate up to 500°c within which high Temperature Plastics, Aluminium, Tin, Lead, Magnesium etc. can be hot compacted with foil films and reinforcements or can be hot forged with matching dies. In this paper, hot compression moulding as a sound technique for manufacturing zero defect thermoplastic and advanced thermoplastic based composites is demonstrated and emphasized based on a defect evaluation of the moulded parts using an ultrasound scanning technique.
Robotic Assembly Sequence Generation Using Improved Fruit Fly Algorithm By Applying Gross And Fine Motion As Fitness Equation
Authors: Bala Murali Gunji , Sridharan  , Deepak BBVL , Muthra Rajashekara Reddy , BB Biswal , Bahubalendruni MVA Raju
Published: May 2021

Robotic assembly plays a major role in manufacturing industries to reduce the cost of overall product. As the assembly is one of the major manufacturing processes, which involves much information like contact information between the parts, tools needed during assembly, part orientation information during assembly and many more. Most of the researchers considered grippers changes, assembly time, directional changes, part orientation and energy of the part as fitness function. In this research work authors made attempt to consider gross and fine motion as fitness equation to generate optimal assembly sequences with Improved Fruit Fly Algorithm (IFFA). The proposed algorithm is implemented on many industrial products to obtain the optimal assembly sequences.
Static structural analysis of hip joint with various profiles by finite element method
Authors: Nemmani Abhinav , Mutra Rajasekhara Reddy , Balamurali Gunji
Published: May 2021

The hip joint is one of the primary joints which give stability to the body. The hip anthroplasty surgery is performed due to constant wear and tear of the hip due to a person’s age and various factors. Due to this surgery, the joints are replaced by the implants made up of mostly Cobalt Chromium alloy (CoCr), Titanium alloy, Stainless Steel (SS316L). A comparative study will be done amongst these materials so as to choose the better one. Also various shapes with different design profiles will be modeled and analyzed by using finite element method and the best results will be tabulated. The profiles studied are circular, ellipse and rectangular profile. The main aim of this research is to find best material as implant and also best design so that minimum amount of wear takes place during practical situations for the comfort of the person. Based on various results obtained by Finite element analysis (FEA) like Von-Mises stress, Total deformation, Equivalent Elastic Strain, it has been found that the CoCr is the best material to be used as hip implants for static loading conditions.
Nitrogen enriched air for Nox reduction in Diesel engine
Authors: Baskar Ponnusamy , Rajan S Prithivi , Saraf Maggi
Published: May 2021

This paper analyzes the impact of nitrogen enriched air on emissions, in cylinder pressure, heat released during the working cycle and fuel consumption of a diesel engine. The experiment was performed on a naturally aspirated single cylinder diesel engine by increasing the nitrogen concentration supplied through a cylinder and NOx, CO, THC emissions were all measured with the help of a five gas analyzer. It was observed that enriching the inlet air with nitrogen decreases the NOx concentration considerably with a penalty on hydrocarbon emissions and thus the fuel conversion efficiency.
Conceptual designs for solving problems
Authors: Gnanaraj S Darius
Published: May 2021

The creativity skills of students are required to be improved by making them to work on projects. Project based learning (PBL) helps students to develop their skills. VIT has introduced a project based subject known as Technical Answers for Real World Problems (TARP). This paper presents the details of the mode of handling this subject and the procedures for assigning project works to students and the method of reviewing their progress in their project component. The experience gained through handling this subject is presented in this paper along with the outcome of the project works carried out by a few groups of students.
Manufacturing and Analysis of Banana-Epoxy Composite fibre
Authors: Narendra Kumar U , Mannayee Giriraj , Thiyagu C , Reddy G Karthik , Sai P , Reddy Yogesh , Kanishka V , Venkatachalam G
Published: May 2021

The usage of natural fibre as reinforcement in polymer composites has increased in the recent years with rising concerns of environmental pollution and the heavy dependence on synthetic fibres from petroleum products of the middle east and the amount of material available in the tropical countries for such low prices. These materials can decrease our dependency on conventional materials like plastics, thereby decreasing the amount of pollution we cause on disposal and manufacturing of those. In general, the impact strength of the natural fibre composites is considered to be low and this experiment quantifies these results. This research describes the fabrication of a polymer composite, using banana fibre as the reinforcement and epoxy as the polymer matrix. A sequence of samples was prepared by varying various parameters like length, volume fraction and treatment of the fibre. The parameters were optimized using Taguchi’s DOE and the combination of parameters which yields us the best result and the contribution of each parameter. The impact strength has been studied using IZOD impact tester. The work has quantified that the impact strength of the composite depends mostly on the volume fraction and also only up to a certain range and then decreases as we increase the quantity of fibre. The same goes with both alkali treatment and length of the fibre which also contribute respectively. The optimum length, volume fraction and chemical are 1mm, 25 wt% and 2% NaOH treatment shows better result.
Influence of CNTs in protecting Air Plasma Sprayed Al2O3-3wt%TiO2 Coated Surface
Authors: Mohammed Thalib Basha G , Venkateshwarlu B
Published: May 2021

The Al2O3-3wt%TiO2 powders reinforced by Carbon nanotubes (CNTs) were used to prepare composite coatings by Air Plasma Spraying (APS) process. The coatings derived from APS process were varied in the percentage proportion of CNTs such as 2wt%, 4wt%, and 6wt% respectively. The coated surfaces were evaluated by means of scratch testing. The SEM micrographs of scratched samples showed the intensity of penetration during scratching gets reduced due to the presence of CNTs film over the surface. Also, the CNT reinforced coated samples showed a significant improvement in mechanical and microstructural properties such as microhardness, porosity as well as surface roughness.
A Study on Reliance of Artificial Intelligence Embodied Robots roles in Health Applications
Authors: Kumar Mohan P
Published: May 2021

A ramifications of PC usage to demonstrate and/or recreate insightful conduct is called man-made consciousness. As a rule where the improvement and examination that learn and/or to perform clever conduct with insignificant human intercession. In this paper the scientist centre around the information encapsulation in mechanical framework with man-made reasoning generalizes the estimation of realities substantially more powerfully than different elements, theoretically changing the associations among individuals or in any event, moving specialists. An example investigation of a huge clinic that has connected with various Computer based intelligence computerized systems in various bits of its restorative administrations organization office was taken for sorts of data epitome, each with an obvious fixation and sees how this AI robot structure supports ability to get information, process it and give a well-described respect the end-customer. Further an investigation was made on the connection between avoidance or treatment procedures and patient’s results dependent on the perplexing calculations sent in the AI automated framework. Challengingly, scientist endeavours to legitimize the focal issue could be caught by the inquiry “How does strolling identify with intuition?”
Fabrication of Bio-Scaffold by Additive manufacturing technique for Bone Synthesis using Generative Design
Authors: Renold Elsen S , Mahendran T , Atkare Piyush P , Bhosale Amit A
Published: May 2021

In tissue engineering, the main objective is the regeneration of damaged tissues and organs which is caused due to diseases, injuries, and inherited medical conditions. Today with the help of tissue engineering, damaged tissues and organs can be repaired with the use of artificially made structures for support, often called the scaffold. To construct a 3D structure, materials with special properties such as bioresorsablity and biocompatibility are used. This 3D structure is similar to the area of tissue implant to recover injury and regeneration of tissue. The porosity of the matrix should be maintained to promote the differentiation of cells at the control rate. Generative design is an iterative process that includes a Machine-learning program that creates a definite number of design outputs for the given loads and boundary conditions by the designer. The main objective of generative design is to increase the stiffness and to reduce the mass keeping the strength constant. In this Generative design has been used to get the optimum results using Polylactic Acid (PLA). The model of scaffold is based on the injury in femur bone thus the forces acting on the Juvenile hip joint in a one-legged stance are considered. In the last decade, intensive research had been carried out for the development of scaffold with the use of bio fabrication methods to reduce the time of manufacturing, increase precision, and decrease the cost of production.
Improving the cycle fatigue life of spring steel by a novel thermal cycling process
Authors: Hu Wangyang , Li Jingkun , Li Kaisong , Zhang Tingjun , Ren Xueping
Published: May 2021

A novel thermal cycling process was applied on the 65Mn spring to improve the cycle fatigue life. Results demonstrate that the cycle fatigue life after the thermal cycling process was improved from 3 times to 14 times, with an improvement of 470%. The fine, equiaxed grains were observed on the fracture surface. Moreover, the prolongation of cracks was prevented by the high density of interfaces, and the slipping and rotating between the grains consumed the applied energy during the cycling process, contributing to the improvement of cycle fatigue life.
Fabrication and characterization of titanium-alloy 3D printed solenoid inductors and their sensor applications
Authors: Tan Jun Ying , Ciappesoni Mark , Kim Sung Jin , Kim Jungkwun ‘JK’
Published: May 2021

Recent progress in 3D printing has brought many interests in developing functional devices in various applications by enabling the exploration of complex 3D structures. This paper presents the first fully metal printed standalone 3D solenoid microinductors using a high-power laser with a biocompatible Ti-alloy. Fine powder-based 6AL-4V Eli Titanium was directly printed using an automated gantry laser system with 60 μm resolution to form the inductors without any substrate. A substrate-less 10-turn solenoid as a testbed was printed out and characterized, and additional designs of 20 and 40 turn inductors were further explored. The wire of the inductor was designed to have a 700-micron square cross-section and a winding gap of 300 microns. The successfully fabricated 10-turn titanium-alloy solenoid inductor showed an average inductance of 130 nH, a low-frequency resistance of 0.8 ohms at 0.3 MHz, and a quality factor of 10.5 at 30 MHz respectively. Additional electrodeposition of copper to the 10-turn inductor demonstrated process compatibility with the conventional micromachining process. The standalone inductor printing method saves a significant volume from where the conventional substrate dimensions often take more than the volume of the device. Also, the standalone inductor can directly be used as a sensor device. Examples of force-displacement sensing applications were presented using the 10-turn and 19-turn round edge solenoid inductors.
A bio-inspired soft planar actuator capable of broadening its working area
Authors: Zeyb Sayyadan Seyed Mohammad , Moniri Mohammad Mehdi
Published: May 2021

Soft actuators are an integral part of many soft robots that make them compliant and adaptable. In many previous studies, soft pneumatic actuators were designed and utilized generally to create bending motions. Due to the limited capabilities becomes ineffective where axial elongation is required. Here, we introduce a planar bioinspired soft pneumatic actuator capable of increasing its working area through both longitudinal elongation and bending motions, separately and or simultaneously. The actuator consists of two similar linear soft pneumatic actuators with agap between them. To study the performance of the planar actuator, four normalized sizes of gaps were considered between the linear actuators, analyzed through FEM, and validated by conducting experimental tests. On average, experimental results on the planar actuator demonstrate that the working area is 2.40 times bigger than the working area that just resulted from the bending motion. The results also indicate that the actuator can attain stability under 0.8 s, create a blocked force up to 18 N, and a bending angle up to 240° at the pressure 3.0Bars. Broadening the working area can be an outstanding feature that enables soft robots to be versatile and advantageous in many more applications in real and unstructured environments.
The operator norm on weighted discrete semigroup algebras ℓ¹(𝑆,𝜔)
Authors: Dedania H. , Patel J.
Published: May 2021

Let

ω
\omega

be a weight on a right cancellative semigroup

S
S

. Let

‖
⋅

‖

ω

\|\cdot \|_{\omega }

be the weighted norm on the weighted discrete semigroup algebra

ℓ
1

(
S
,
ω
)

\ell ^1(S, \omega )

. In this paper, we prove that the weight

ω
\omega

satisfies F-property if and only if the operator norm

‖
⋅

‖

ω
o
p

\| \cdot \|_{\omega op}

of

‖
⋅

‖

ω

\| \cdot \|_{\omega }

is exactly equal to another weighted norm

‖
⋅

‖

ω
~

1

\| \cdot \|_{\widetilde {\omega }_1}

. Though its proof is elementary, the result is unexpectedly surprising. In particular, the operator norm

‖
⋅

‖

1
o
p

\| \cdot \|_{1 op}

is same as the

ℓ
1

\ell ^1

- norm

‖
⋅

‖
1

\| \cdot \|_1

on

ℓ
1

(
S
)

\ell ^1(S)

. Moreover, various examples are discussed to understand the relation among

‖
⋅

‖

ω
o
p

\| \cdot \|_{\omega op}

,

‖
⋅

‖

ω

\| \cdot \|_{\omega }

, and

ℓ
1

(
S
,
ω
)

\ell ^1(S, \omega )

.
A Moser’s non-twist theorem for nearly integrable mappings with self-intersection property
Authors: Ma Zhichao , Xu Junxiang
Published: May 2021

In this paper, we consider a family of nearly integrable mappings on annulus, which has self-intersection property and depends on a small parameter. Without any twist condition, we prove that for many sufficiently small parameters the mappings admit an invariant closed curve. Our result is useful for Lagrange stability of Duffing equations.
Generic uniqueness and stability for the mixed ray transform
Authors: de Hoop Maarten , Saksala Teemu , Uhlmann Gunther , Zhai Jian
Published: May 2021

We consider the mixed ray transform of tensor fields on a three-dimensional compact simple Riemannian manifold with boundary. We prove the injectivity of the transform, up to natural obstructions, and establish stability estimates for the normal operator on generic three dimensional simple manifold in the case of

1
+
1

1+1

and

2
+
2

2+2

tensors fields.

We show how the anisotropic perturbations of averaged isotopic travel-times of

q
S

qS

-polarized elastic waves provide partial information about the mixed ray transform of

2
+
2

2+2

tensors fields. If in addition we include the measurement of the shear wave amplitude, the complete mixed ray transform can be recovered. We also show how one can obtain the mixed ray transform from an anisotropic perturbation of the \text{Dirichlet-to-Neumann} map of an isotropic elastic wave equation on a smooth and bounded domain in three dimensional Euclidean space.
Coxiella burnetii and Related Tick Endosymbionts Evolved from Pathogenic Ancestors
Authors: Brenner Amanda E , Muñoz-Leal Sebastián , Sachan Madhur , Labruna Marcelo B , Raghavan Rahul
Published: May 2021

Both symbiotic and pathogenic bacteria in the family Coxiellaceae cause morbidity and mortality in humans and animals. For instance, Coxiella-like endosymbionts (CLEs) improve the reproductive success of ticks—a major disease vector, while Coxiella burnetii causes human Q fever, and uncharacterized coxiellae infect both animals and humans. To better understand the evolution of pathogenesis and symbiosis in this group of intracellular bacteria, we sequenced the genome of a CLE present in the soft tick Ornithodoros amblus (CLEOA) and compared it to the genomes of other bacteria in the order Legionellales. Our analyses confirmed that CLEOA is more closely related to C. burnetii, the human pathogen, than to CLEs in hard ticks, and showed that most clades of CLEs contain both endosymbionts and pathogens, indicating that several CLE lineages have evolved independently from pathogenic Coxiella. We also determined that the last common ancestorof CLEOA and C. burnetii was equipped to infect macrophages and that even though horizontal gene transfer (HGT) contributed significantly to the evolution of C. burnetii, most acquisition events occurred primarily in ancestors predating the CLEOA–C. burnetii divergence. These discoveries clarify the evolution of C. burnetii, which previously was assumed to have emerged when an avirulent tick endosymbiont recently gained virulence factors via HGT. Finally, we identified several metabolic pathways, including heme biosynthesis, that are likely critical to the intracellular growth of the human pathogen but not the tick symbiont, and show that the use of heme analog is a promising approach to controlling C. burnetii infections.
Exploring Race Differences in Satisfaction With Rehabilitation Following Total Knee Arthroplasty: A Qualitative Study
Authors: Bove Allyn M , Dong Erin , Hausmann Leslie R M , Piva Sara R , Brach Jennifer S , Lewis Allen , Fitzgerald G Kelley
Published: May 2021

Background

The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA).

Method

We conducted a series of qualitative focus group discussions with groups of non-Hispanic White and non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of postoperative physical therapy received, and overall satisfaction with the postoperative rehabilitation process.

Results

Thirty-six individuals participated in focus groups. Three major themes emerged: (i) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in “prehabilitation,” and often mentioned specific interventions they felt were most helpful in their recovery. (ii) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (iii) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers.

Conclusions

Individuals undergoing TKA can largely expect positive rehabilitation experiences postoperatively. However, some barriers to postoperative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.
Blood-Based Biomarkers and Long-term Risk of Frailty—Experience From the Swedish AMORIS Cohort
Authors: Wennberg Alexandra M , Ding Mozhu , Ebeling Marcus , Hammar Niklas , Modig Karin
Published: May 2021

Background

Frailty is associated with reduced quality of life, poor health outcomes, and death. Past studies have investigated how specific biomarkers are associated with frailty but understanding biomarkers in concert with each other and the associated risk of frailty is critical for clinical application.

Methods

Using a sample aged ≥59 years at baseline from the Swedish AMORIS (Apolipoprotein MOrtality RISk) cohort (n = 19 341), with biomarkers measured at baseline (1985–1996), we conducted latent class analysis with 18 biomarkers and used Cox models to determine the association between class and frailty and all-cause mortality.

Results

Four classes were identified. Compared to the largest class, the Reference class (81.7%), all other classes were associated with increased risk of both frailty and mortality. The Anemia class (5.8%), characterized by comparatively lower iron markers and higher inflammatory markers, had hazard ratio (HR) = 1.54, 95% confidence interval (CI) 1.38, 1.73 for frailty and HR = 1.76, 95% CI 1.65, 1.87 for mortality. The Diabetes class (6.5%) was characterized by higher glucose and fructosamine, and had HR = 1.59, 95% CI 1.43, 1.77 for frailty and HR = 1.74, 95% CI 1.64, 1.85 for mortality. Finally, the Liver class (6.0%), characterized by higher liver enzyme levels, had HR = 1.15, 95% CI 1.01, 1.30 for frailty and HR = 1.40, 95% CI 1.31, 1.50 for mortality. Sex-stratified analyses did not show any substantial differences between men and women.

Conclusions

Distinct sets of commonly available biomarkers were associated with development of frailty and monitoring these biomarkers in patients may allow for earlier detection and possible prevention of frailty, with the potential for improved quality of life.
Increasing efficiencies from integrating control and elimination programmes for soil-transmitted helminths and schistosomiasis
Authors: Rollinson David , Sankar Girija , Stephens Mariana , Gouvras Anouk , Waltz Johannes , Tchuem Tchuenté Louis Albert , Imtiaz Rubina
Published: May 2021

Attention is now beginning to focus on implementation of the new WHO NTD Roadmap (2021–2030), which presents single disease alliances and coalitions with an opportunity to consider novel ways to integrate and adapt control and elimination programmes to meet the new goals. This discussion piece links the parasitic worm diseases, caused by soil-transmitted helminths and schistosomes, highlighting that neglected tropical disease-control programmes could potentially benefit from greater cohesion and innovation, especially when increasing efforts to achieve elimination goals.
Identifying UK travellers at increased risk of developing pneumococcal infection: a novel algorithm
Authors: Ellsbury Gillian , Campling James , Madhava Harish , Slack Mary
Published: May 2021

Background

In 2016, the travel subcommittee of the UK Joint Committee on Vaccination and Immunisation (JCVI) recommended that 13-valent PCV (PCV13) could be offered to travellers aged over 65 years, visiting countries without infant PCV immunization programmes. This study aimed to identify, collate and review the available evidence to identify specific countries where UK travellers might be at an increased risk of developing pneumococcal infection. The data were then used to develop an algorithm, which could be used to facilitate implementation of the JCVI recommendation.

Methods

We conducted a systematic search of the published data available for pneumococcal disease, PCV vaccine implementation, coverage data and programme duration by country. The primary data sources used were World Health Organization databases and the International Vaccine Access Centre Vaccine Information and Epidemiology Window-hub database. Based on the algorithm, the countries were classified into ‘high overall risk’, ‘intermediate overall risk’ and ‘low overall risk’ from an adult traveller perspective. This could determine whether PCV13 should be recommended for UK adult travellers.

Results

A data search for a total of 228 countries was performed, with risk scores calculated for 188 countries. Overall, 45 countries were classified as ‘high overall risk’, 86 countries as ‘intermediate overall risk’, 57 countries as ‘low overall risk’ and 40 countries as ‘unknown’.

Conclusion

To our knowledge this is the first attempt to categorize the risk to UK adult travellers of contracting pneumococcal infection in each country, globally. These findings could be used by national travel advisory bodies and providers of travel vaccines to identify travellers at increased risk of pneumococcal infection, who could be offered PCV immunization.
A public code for astrometric microlensing with contour integration
Authors: Bozza Valerio , Khalouei Elahe , Bachelet Etienne
Published: May 2021

We present the first public code for the calculation of the astrometric centroid shift occurring during microlensing events. The computation is based on the contour integration scheme and covers single and binary lensing of finite sources with arbitrary limb darkening profiles. This allows for general detailed investigations of the impact of finite source size in astrometric binary microlensing. The new code is embedded in version 3.0 of vbbinarylensing, which offers a powerful computational tool for extensive studies of microlensing data from current surveys and future space missions.
Quantifying the Impact of Nasopharyngeal Specimen Quality on Severe Acute Respiratory Syndrome Coronavirus 2 Test Performance
Authors: Richard-Greenblatt Melissa , Ziegler Matthew J , Bromberg Valerie , Huang Elizabeth , Abdallah Hatem , Tolomeo Pam , Lautenbach Ebbing , Glaser Laurel , Kelly Brendan J
Published: May 2021

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction (RT-PCR) cycle threshold (Ct) has been used to estimate quantitative viral load, with the goal of targeting isolation precautions for individuals with coronavirus disease 2019 (COVID-19) and guiding public health interventions. However, variability in specimen quality can alter the Ct values obtained from SARS-CoV-2 clinical assays. We sought to define how variable nasopharyngeal (NP) swab quality impacts clinical SARS-CoV-2 test sensitivity.

Methods

We performed amplification of a human gene target (β-actin) in parallel with a clinical RT-PCR targeting the SARS-CoV-2 ORF1ab gene for 1282 NP specimens collected from patients with clinical concern for COVID-19. We evaluated the relationship between NP specimen quality, characterized by late Ct values for the human gene target β-actin Ct, and the probability of SARS-CoV-2 detection via logistic regression, as well as the linear relationship between SARS-CoV-2 and β-actin Ct.

Results

Low-quality NP swabs are less likely to detect SARS-CoV-2 (odds ratio, 0.607 [95% credible interval {CrI}, .487–.753]). We observed a positive linear relationship between SARS-CoV-2 and β-actin Ct values (slope, 0.181 [95% CrI, .097–.264]), consistent with a reduction in detection of 0.181 cycles for each additional cycle of the β-actin target. COVID-19 disease severity was not associated with β-actin Ct values.

Conclusions

Variability in NP specimen quality significantly impacts the performance of clinical SARS-CoV-2 assays, and caution should be taken when interpreting quantitative SARS-CoV-2 Ct results. If unrecognized, low-quality NP specimens, which are characterized by a low level of amplifiable human DNA target, may limit the successful application of SARS-CoV-2 Ct values to direct infection control and public health interventions.
REDUCING PELVIS RADIOGRAPH EXPOSURE IN CHILDREN USING A DOSE SIMULATION X-RAY RESEARCH SOFTWARE
Authors: Boënnec Ronan , Dujardin Paul-Armand , Meunier Benjamin , Rafin Jean-Michel , Sirinelli Dominique , Brunereau Laurent , Morel Baptiste
Published: May 2021

Pelvis radiography is a frequent X-ray examination. The objective of our study was to determine the minimum dose to be delivered without reducing the quality. We included 60 children having a pelvis X-ray in four groups that were equally represented by weight ranges. A software simulated, for each radiograph, six additional simulated photonic noise images corresponding to 100, 80, 64, 50, 40 and 32% of the initial dose. The 360 radiographs were blindly scored by two radiologists using a semi-quantitative Likert scale. There was no significant difference in scoring between the reference radiograph and simulated radiographs at 80% of the dose in children between 0 and 15 kg and over 35 kg. Inter-observer reproducibility was moderate to very good. Pelvis X-ray doses might be reduced by 20% in children in our institution. Software that produces simulated X-ray with decreasing dose might be a useful tool for an optimization process.
Peristomal Pyoderma Gangrenosum Responding to Risankizumab
Authors: Weigelt Maximillian A. , Kirsner Robert S.
Published: May 2021

Evidence to support available therapies for pyoderma gangrenosum (PG) is limited. Many patients do not respond to topical therapies such as tacrolimus or topical steroids. Currently favored oral systemic treatments (eg, cyclosporine and steroids) achieve complete remission in only 50% of patients and have unfavorable adverse effect profiles. There is a growing body of evidence to support biologic agents for the treatment of PG, but their exact role remains unclear. Here the authors present a patient with peristomal PG, the first reported case of PG responding to treatment with risankizumab, an anti-interleukin 23 monoclonal antibody. Risankizumab may represent an effective and relatively safe treatment for PG that merits additional exploration in prospective, controlled studies.
Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act
Authors: Vashi Anita A. , Urech Tracy , Wu Siqi , Boothroyd Derek , Mehta Paril , Dalton Aaron L. , Brill Elizabeth , Kessler Chad , Asch Steven M.
Published: May 2021

Background:

Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities.

Objectives:

The aim was to describe trends in UC use, identify predictors of UC benefit use, and understand the factors associated with community UC use versus VA emergency department (ED) or urgent care center (UCC) use.

Study Design:

Using VA administrative data, this was a retrospective cross-sectional study of Veterans that were enrolled in VA in FY19. Veterans were classified into 3 groups: UC benefit users, benefit non-users, and VA ED/UCC users.

Methods:

We used summary statistics to compare population characteristics across user groups. To determine whether predisposing, enabling, and need factors predicted UC benefit use and setting choice (community UCC vs. VA ED/UCC), 2 logistic regression models were fitted to assess odds of UC use.

Results:

From June 6, 2019 through February 29, 2020, 138,305 Veterans made 175,821 community UC visits. The majority of visits were made by White males who were not subject to co-pays. The average cost to VA for UC visits was $132 (SD=$135). Upper respiratory infections were the most common reason for UC use. Being younger, female, and living farther from a VA ED/UCC was associated with greater UC benefit use compared with both benefit non-users and VA ED/UCC users.

Conclusions:

The new benefit expands Veteran access to UC services for low-acuity conditions.
National Media Coverage of the Veterans Affairs Waitlist Scandal
Authors: Jones Audrey L. , Fine Michael J. , Taber Peter A. , Hausmann Leslie R.M. , Burkitt Kelly H. , Stone Roslyn A. , Zickmund Susan L.
Published: May 2021

Background:

On April 23, 2014, US media outlets broadcast reports of excessive wait times and “secret” waitlists at some Veterans Affairs (VA) hospitals, precipitating legislation to increase Veterans’ access to private sector health care.

Objective:

The aims were to assess changes in Veterans’ distrust in the VA health care system before and after the media coverage and explore sex and racial/ethnic differences in the temporal patterns.

Methods:

Veterans completed semistructured interviews on health care satisfaction from June 2013 to January 2015, including a validated scale of health system distrust (range: 1–5). We used linear splines with knots at 90-day intervals to assess changes in distrust before and after April 23, 2014 (“day 0”) in linear mixed models. To explore sex and racial/ethnic differences in temporal patterns, we stratified models by sex and tested for interactions of race/ethnicity with time.

Results:

For women (n=600), distrust scores (mean=2.09) increased by 0.45 in days 0–90 (P<0.01), then decreased by 0.45 in days 90–180 (P<0.01). Among men (n=575), distrust scores (mean=2.05) increased by 0.18 in days 0–90 (P=0.059). Distrust levels were significantly higher for Black versus White women (time adjusted mean difference=0.21) and for Black and Hispanic versus White men (differences=0.26 and 0.18). However, the temporal patterns did not vary by race/ethnicity for women or men (interaction P=0.85 and 0.21, respectively).

Conclusions:

Health system distrust increased in women following media coverage of VA access problems and was higher in Black/Hispanic versus White Veterans at all time periods. Such perceptions could influence Veteran decisions to seek health care in the community rather than VA.
Prognostic Value of Coronary Artery Disease–Reporting and Data System Score for Major Adverse Cardiac Events in Patients Attending the Emergency Department With Acute Chest Pain
Authors: Park Jiwoo , Hur Jin , Han Kyunghwa , Im Dong Jin , Lee Kye Ho , Suh Young Joo , Hong Yoo Jin , Lee Hye-Jeong , Kim Young Jin , Choi Byoung Wook
Published: May 2021

Objective

This study aimed to compare the prognostic performance of Coronary Artery Disease (CAD)–Reporting and Data System (CAD-RADS) score with those of clinical risk factors and the extent of CAD classification for predicting major adverse cardiac events in emergency department patients.

Methods

A total of 779 patients with acute chest pain at low to intermediate risk for CAD underwent cardiac computed tomography angiography. The primary end point was early and late major adverse cardiac events. We developed the following models: model 1, clinical risk factors; model 2, clinical risk factors and CAD-RADS scores; model 3, clinical risk factors and extent of CAD.

Results

The C-statistics revealed that both CAD-RADS score and CAD extent improved risk stratification over the clinical risk factors (C-index for early events: C-index: 0.901 vs 0.814 and 0.911 vs 0.814; C-index for late events: 0.897 vs 0.808 and 0.905 vs 0.808; all P < 0.05).

Conclusions

The CAD-RADS score had additional risk prediction benefits over clinical risk factors for emergency department patients.
Computed Tomography Imaging Findings for Predicting Histological Subtypes and Clinical Outcomes in Patients With Head and Neck Nodal Involvement of Diffuse Large B-Cell Lymphoma and Follicular Lymphoma
Authors: Imada Hiroki , Kato Hiroki , Ando Tomohiro , Matsuo Masayuki
Published: May 2021

Objective

This study aimed to assess computed tomography (CT) imaging findings for predicting the histological subtypes and clinical outcomes in patients with head and neck nodal involvement of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL).

Methods

This retrospective study included 64 patients with histologically confirmed head and neck nodal lymphoma (43 with DLBCL and 21 with FL) who underwent pretreatment CT examinations. The CT imaging findings were retrospectively assessed and compared according to the 2 pathologies and their clinical outcomes.

Results

Multiplicity (86% vs 57%, P < 0.05), necrosis (44% vs 5%, P < 0.01), ill-demarcated margin (33% vs 0%, P < 0.01), and surrounding fat stranding (56% vs 14%, P < 0.01) were significantly more frequent in DLBCLs than in FLs. Multivariate logistic regression analysis revealed that necrosis was a significant factor for predicting the diagnosis of DLBCL (P < 0.01). Multiplicity (100% vs 67%, P < 0.01), bilaterality (44% vs 13%, P < 0.05), and surrounding fat stranding (69% vs 28%, P < 0.01) were significantly more frequent in the poor outcome group than in the good outcome group. Multivariate logistic regression analysis revealed that bilaterality and surrounding fat stranding were significant factors for predicting poor outcomes (P < 0.05).

Conclusions

In patients with head and neck nodal lymphoma, necrosis was useful for predicting the diagnosis of DLBCL, whereas bilaterality and surrounding fat stranding were useful for predicting poor outcomes.
Prediction of Patient Height and Weight With a 3-Dimensional Camera
Authors: Dane Bari , Singh Vivek , Nazarian Matthew , O'Donnell Thomas , Liu Shu , Kapoor Ankur , Megibow Alec
Published: May 2021

Objective

The aim of this study was to determine accuracy of height and weight prediction by a 3-dimensional (3D) camera.

Methods

A total of 453 patients whose computed tomography imaging used a 3D camera from December 19, 2018 to March 19, 2019 were retrospectively identified. An image of each patient was taken before the computed tomography by a 3D camera mounted to the ceiling. Using infrared imaging and machine learning algorithms, patient height and weight were estimated from this 3D camera image. A total of 363 images were used for training. The test set consisted of 90 images. The height and weight estimates were compared with true height and weight to determine absolute and percent error. A value of P < 0.05 indicated statistical significance.

Results

There was 2.0% (SD, 1.4) error in height estimation by the 3D camera, corresponding to 3.35 cm (SD, 2.39) absolute deviation (P = 1, n = 86). Weight estimation error was 5.1% (SD, 4.3), corresponding to 3.99 kg (SD, 3.11) absolute error (P = 0.74, n = 90).

Conclusion

Pictures obtained from a 3D camera can accurately predict patient height and weight.
Current Status of Radiomics and Deep Learning in Liver Imaging
Authors: Chu Linda C. , Park Seyoun , Kawamoto Satomi , Yuille Alan L. , Hruban Ralph H. , Fishman Elliot K.
Published: May 2021

Artificial intelligence is poised to revolutionize medical image. It takes advantage of the high-dimensional quantitative features present in medical images that may not be fully appreciated by humans. Artificial intelligence has the potential to facilitate automatic organ segmentation, disease detection and characterization, and prediction of disease recurrence. This article reviews the current status of artificial intelligence in liver imaging and reviews the opportunities and challenges in clinical implementation.