bluuebunny/crossref_metadata_2025_split huggingface dataset:
Design and Evaluation of a Smooth-Locking-Based Customizable Prosthetic Knee Joint
Authors: Wang Kunyang , Williams Harry , Qian Zhihui , Wei Guowu , Xiu Haohua , Chen Wei , Lu Xuewei , Jin Jianqiao , Ren Lei , Liang Wei , Ren Luquan 
Published: May 2023

Abstract
Limb loss affects many people from a variety of backgrounds around the world. The most advanced commercially available prostheses for transfemoral amputees are fully active (powered) designs but remain very expensive and unavailable in the developing world. Consequently, improvements of low-cost, passive prostheses have been made to provide high-quality rehabilitation to amputees of any background. This study explores the design and evaluation of a smooth-locking-based bionic knee joint to replicate the swing phase of the human gait cycle. The two-part design was based on the condyle geometry of the interface between the femur and tibia obtained from magnetic resonance (MR) images of the human subject, while springs were used to replace the anterior and posterior cruciate ligaments. A flexible four-bar linkage mechanism was successfully achieved to provide not only rotation along a variable instantaneous axis but also slight translation in the sagittal plane, similar to the anatomical knee. We systematically evaluated the effects of different spring configurations in terms of stiffness, position, and relaxion length on knee flexion angles during walking. A good replication of the swing phase was achieved by relatively high stiffness and increased relaxation length of springs. The stance phase of the gait cycle was improved compared to some models but remained relatively flat, where further verification should be conducted. In addition, 3D printing technique provides a convenient design and manufacturing process, making the prosthesis customizable for different individuals based on subject-specific modeling of the amputee’s knee.
Origami-Inspired Variable Stiffness Actuator for Safe Human–Robot Interaction
Authors: Zheng Bowen , Xu Pengpeng , Guo Zhaoqi , Xie Longhan 
Published: May 2023

Abstract
In this paper, an origami-inspired variable stiffness actuator (OVSA) is proposed. Innovatively borrowing from the origami principle, OVSA uses torsion springs and hinges to form a transformable hexagonal structure as the special elastic component. While having a light and compact structure, it can also theoretically realize the change of stiffness from zero to infinity. Archimedean Spiral Cam (ASC) is used as a transmission element to connect the motor and elastic components further increasing the compactness of the structure. In addition, the OVSA requires very little torque to maintain stiffness under deflection conditions, which improves energy efficiency. In this paper, the stiffness equation of OVSA is established and verified by experiments. The results show that its stiffness is high when the deflection angle is close to 0 deg and decreases rapidly with the increase of deflection angle, which makes it have sufficient safety.
System Thermal-Hydraulics Model for Fluoride Salt-Cooled Reactor Based on Small Modular Advanced High Temperature Reactor (SmAHTR) Design Concept
Authors: Wang Shujun , Huang Xianmin , Bromley Blair P. 
Published: May 2023

Abstract
A system thermal-hydraulics model for a fluoride-salt-cooled high-temperature reactor (FHR) based on the small modular advanced high-temperature reactor (SmAHTR) design concept is developed, using RELAP5-3D. The SmAHTR components modeled in the simulations include the reactor core, lower plenum, upper plenum, top plenum, three primary heat exchangers (PHXs) equipped with three primary pumps, and three director reactor auxiliary cooling system (DRACS) equipped with three fluid diodes. Flows through the reactor core are represented by 19 individual fuel channels, one reflector-hole channel, and one downcomer channel. In each of the 19 SmAHTR fuel block channels, the fuel elements are modeled in five groups using five heat structures, each with their corresponding power level. The total reactor power is 125 MWth. Using representative core power distributions for the SmAHTR at beginning-of-cycle (BOC) and at end-of-cycle (EOC), two steady-state system thermal-hydraulic model simulations with RELAP5-3D were performed using a nominal pressure drop loss factor of 1.5 for all nine junctions in each of the 19 fuel channels modeled. Exit coolant temperatures ranged from 688 °C to 739 °C (BOC) and from 696 °C to 721 °C (EOC), while peak fuel centerline temperatures in the highest power block were 1249 °C (BOC) and 1029 °C (EOC). By adjusting the loss factors to modify coolant flow rates in each channel, a more uniform exit coolant temperature was possible, ranging from 701 °C to 709 °C (BOC) and 698 °C to 714 °C (EOC), while peak fuel centerline temperatures were reduced to 1204 °C (BOC) and 988 °C (EOC), giving results more consistent with earlier studies of the SmAHTR.
Studies on the Effect of Substrate Preheating, Interlayer Dwell, and Heat Treatment on Microstructure, Residual Stress, and Mechanical Properties of IN625 Superalloy Built by Direct Metal Deposition
Authors: Mohsin Khan K. , Rao Thella Babu , Manjunath B. N. , Abhinav K. , Vinod A. R. , Mohammed Raffi 
Published: May 2023

Abstract
In this investigation, IN625 alloy samples were processed by the directed energy deposition (DED) approach under various metal deposition strategies such as substrate preheating, interlayer dwell and with combined substrate preheating, interlayer dwell, as well as postheat treatment. The processed sample’s microstructural characteristics, residual stress, microhardness, and tensile properties are assessed in comparison to the manufacturing strategies. Rapid heat dissipation caused finer microstructure near the substrate. There is a growth of columnar grain structure epitaxially in the build direction. The progressive microstructure change seen in the build direction across the cross section was due to the gradual rise of heat accumulation between subsequent layers. The interdendritic zones contained Laves phases. Laves phases have a high Nb, Mo, as well as Si content, according to the energy-dispersive spectroscope (EDS) spectrum. The field emission scanning microscopy (FESEM) microstructural morphology of the deposited samples after their postheat treatment has shown a new microstructure with the combination of equiaxed (recrystallized) and columnar dendritic structure with the reconstruction of columnar dendritic solidification microstructure into equiaxed grains. Heat treatment caused the Laves phases to dissolve in the matrix of IN625 alloy, which led to the precipitation of nanometric γ″ phases. The deposition strategies with substrate preheating significantly decreased the residual stress with moderately improved mechanical properties. The combination of substrate preheating, interlayer dwell, and postheat treatment has shown an outstanding reduction of residual stress along with a remarkable improvement in tensile strength with the retainment of an equivalent ductility compared with other strategies.
Physical Performance and Mobility Tests Using Telehealth: A Feasibility Study With Athletes
Authors: Jales Maycon Thomas Moises , Barbosa Germanna Medeiros , Gonçalves Gustavo Viotto , Fialho Hilmaynne Renaly Fonseca , Calixtre Letícia Bojikian , Kamonseki Danilo Harudy 
Published: May 2023

Context: Physical performance tests (PPTs) and mobility tests have been widely used in sports rehabilitation. However, the feasibility of PPTs and mobility tests via telehealth is unknown. Objectives: To verify the feasibility of PPTs and mobility tests to assess athletes via telehealth. Design: This is a feasibility study. Participants: Athletes enrolled in a sports team or club for at least 2 years and with previous enrollment in a competitive league were recruited through advertisements on social media. The athletes included in this study (mean age = 25.9 y, from different sports) performed a battery of PPTs and mobility tests for the lower-extremity or upper-extremity and trunk, according to their sport modality. Main Outcome Measure: The feasibility was assessed with recruitment, success, and dropout rates. In addition, athletes’ perceptions of easiness, satisfaction, and safety during the lower-extremity or upper-extremity and trunk PPTs and mobility tests were assessed. Results: Seventy-three athletes were included, between January and April 2021: 41 were allocated to the lower-extremity and 32 to the upper-extremity and trunk PPTs and mobility test, according to their sports modality. The overall dropout rate was 20.55%; >89% of the athletes agreed that the PPTs and mobility tests via telehealth were easy to perform, >78% were satisfied, and >75% felt safe during the assessments. Conclusion: This study indicated that these 2 batteries of performance and mobility tests via telehealth are feasible to assess the lower and upper-extremities, and the trunk of athletes, considering the adherence, athletes’ perception of easiness, satisfaction, and safety.
Impact of the global gag rule on women’s contraceptive use and reproductive health outcomes in Ethiopia: a pre–post and difference-in-difference analysis
Authors: Sully Elizabeth A , Seme Assefa , Shiferaw Solomon , Chiu Doris W , Bell Suzanne O , Giorgio Margaret 
Published: May 2023

ObjectiveTo assess the impacts of the Protecting Life through Global Health Assistance policy (otherwise known as the expanded global gag rule (GGR)) on women’s sexual and reproductive health (SRH) in Ethiopia. The GGR prohibits all non-US non-governmental organisations (NGOs) receiving US Government global health funding from providing, referring or advocating for abortion.DesignPre–post analysis and difference-in-difference analysis.SettingSix regions of Ethiopia (Tigray, Afar, Amhara, Oromiya, SNNPR and Addis Ababa).ParticipantsPanel of 4909 reproductive-age women recruited from the Performance Monitoring for Accountability 2018 survey, administered face-to-face surveys in 2018 and 2020.MeasuresWe assessed impacts of the GGR on contraceptive use, pregnancies, births and abortions. Due to the 2019 ‘Pompeo Expansion’ and widespread application of the GGR, we use a pre–post analysis to investigate changes in women’s reproductive outcomes. We then use a difference-in-differences design to measure the additional effect of NGOs refusal to comply with the policy and the resulting loss in funding; districts are classified as more exposed if organisations impacted by lost funding were providing services there and women are classified based on their district.ResultsAt baseline, 27% (n=1365) of women were using a modern contraceptive (7% using long-acting reversible contraceptive methods (LARCs) and 20% using short-acting methods. The pre–post analysis revealed statistically significant declines from 2018 to 2020 in the use of LARCs (−0.9, 95% CI: −1.6 to –0.2) and short-acting methods (−1.0, 95% CI: −1.8 to –0.2). These changes were deviations from prior trends. In our difference-in-differences analysis, women exposed to non-compliant organisations experienced greater declines in LARC use (−1.5, 95% CI: −2.9 to –0.1) and short-acting method use (−1.7, 95% CI: −3.2 to –0.1) as compared with less-exposed women.ConclusionsThe GGR resulted in a stagnation in the previous growth in contraceptive use in Ethiopia. Longer-term strategies are needed to ensure that SRH progress globally is protected from changes in US political administrations.
Mortality in residential care facilities for people with disability: a descriptive cross-sectional analysis of statutory notifications in Ireland
Authors: McMahon Martin J , O'Connor Aisling M , Dunbar Paul , Delany Anna , Behan Laura , Grogan Carol , Keyes Laura M 
Published: May 2023

ObjectivesTo determine incidence of death in residential care facilities for people with disability in Ireland, primary cause of death, associations of facility characteristics and deaths, and to compare characteristics of deaths reported as expected and unexpected.DesignDescriptive cross-sectional study.SettingAll residential care facilities for people with disability operational in Ireland in 2019 and 2020 (n=1356).Participantsn=9483 beds.Main outcome measuresAll expected and unexpected deaths notified to the social services regulator. Cause of death as reported by the facility.Results395 death notifications were received in 2019 (n=189) and 2020 (n=206). 45% (n=178) were for unexpected deaths. Incidence of death per 1000 beds per year was 20.83 for all, 11.44 for expected and 9.39 for unexpected deaths. Respiratory disease was the most common cause of death, accounting for 38% (n=151) of all deaths. In adjusted negative binomial regression analysis, congregated settings versus non-congregated (incidence rate ratio (95% CI): 2.59 (1.80 to 3.73)) and higher bed numbers (highest vs lowest quartile) (4.02 (2.19 to 7.40)) were positively associated with mortality. There was also a positive n-shaped association with category of nursing staff-to-resident ratio when compared with zero nurses. Emergency services were contacted for 6% of expected deaths. Of the deaths reported as unexpected, 29% were receiving palliative care and 10.8% had a terminal illness.ConclusionAlthough incidence of death was low, residents of congregated and larger settings had higher incidence of death than residents of other settings. This should be a consideration for practice and policy. Given the high contribution of respiratory diseases to deaths and the potential avoidability of these, there is a need for improved respiratory health management in this population. Nearly half of all deaths were reported as unexpected; however, overlap in the characteristics of expected and unexpected deaths highlights the need for clearer definitions.
Association between remnant lipoprotein cholesterol levels and risk of non-alcoholic fatty liver disease in non-obese populations: a Chinese longitudinal prospective cohort study
Authors: Miao Yanju , Tao Hong 
Published: May 2023

ObjectivesThe association between remnant lipoprotein cholesterol (RLP-C) levels and the incidence of non-alcoholic fatty liver disease (NAFLD) is unclear, especially in non-obese populations.SettingWe used data from a health assessment database. The assessment was conducted at the Wenzhou Medical Center from January 2010 to December 2014. The patients were divided into low, middle and high RLP-C groups according to tertiles of RLP-C, and baseline metabolic parameters were compared among the three groups. Kaplan-Meier analysis and Cox proportional hazards regression were used to evaluate the relationship between RLP-C and NAFLD incidence. Additionally, sex-specific associations between RLP-C and NAFLD were examined.Participants16 173 non-obese participants from the longitudinal healthcare database.Outcome measureNAFLD was diagnosed using abdominal ultrasonography and clinical history.ResultsParticipants with higher RLP-C levels tended to have higher blood pressure, liver metabolic index and lipid metabolism index than those with middle or low RLP-C (p<0.001). During the 5-year follow-up period, 2322 (14.4%) participants developed NAFLD. Participants with high and middle RLP-C levels were at a higher risk of developing NAFLD, even after adjusting for age, sex, body mass index and main metabolic parameters (HR 1.6, 95% CI 1.3, 1.9, p<0.001; and HR 1.3, 95% CI 1.1, 1.6, p=0.01, respectively). The effect was consistent in subgroups of different ages, systolic blood pressures and alanine aminotransferase levels, except for sex and direct bilirubin (DBIL). These correlations, beyond traditional cardiometabolic risk factors, were stronger in males than females (HR 1.3 (1.1, 1.6) and HR 1.7 (1.4, 2.0), p for interaction 0.014 for females and males, respectively).ConclusionsIn non-obese populations, higher RLP-C levels indicated a worse cardiovascular metabolic index. RLP-C was associated with the incidence of NAFLD, independent of the traditional risk factors of metabolism. This correlation was more substantial in the male and low DBIL subgroups.
Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services
Authors: Matthes Anni , Wolf Florian , Wilde Elmar , Bleidorn Jutta , Markwart Robby 
Published: May 2023

ObjectivesOut-of-hours outpatient emergency medical services (OEMS) provide healthcare for patients with non-life-threatening conditions in need for urgent care when outpatient practices are closed. We studied the use of point-of-care-testing of C-reactive protein (CRP-POCT) at OEMS.DesignCross-sectional questionnaire-based survey.SettingSingle centre OEMS practice in Hildesheim, Germany (October 2021 to March 2022).ParticipantsOEMS physicians answering a questionnaire immediately after performing CRP-POCTs (CUBE-S Analyzer, Hitado) on any patients.Primary and secondary outcomesImpact of CRP-POCTs on clinical decision-making and perceived usefulness.ResultsIn the 6-month study period, 114 valid CRP-POCTs were performed in the OEMS practice by 18 physicians and the questionnaire was answered in 112 cases (response rate: 98.2%). CRP-POCTs were used in the diagnosis of inflammatory diseases of the gastrointestinal tract (60.0%), respiratory tract infections (17.0%), urinary tract infections (9.0%) and other non-gastrointestinal/non-specified infections (11.0%). The use of a CRP-POCT resulted in a change of the physicians’ clinical decision in 83.3% of the cases. Specifically, in 13.6% and 35.1% of the cases, rapid CRP measurements led to decision changes in the (1) initiation of antimicrobial therapy and (2) other drug treatment, respectively. Notably, in 60% of all cases, the use of a CRP-POCT reportedly changed the decision on hospitalisation/non-hospitalisation of OEMS patients. In respect of antimicrobial therapy and hospitalisation, these decision changes primarily (≥73%) promoted ‘step-down’ decisions, that is, no antibiotic therapy and no hospital admission. In the great majority of CRP-POCT applications (≥95%), OEMS physicians reported that rapid CRP measurements increased the confidence in their diagnostic and therapeutic decision. In almost all cases (97%), physicians rated the CRP-POCT use as useful in the treatment situation.ConclusionQuantitative CRP-POCT promotes step-down clinical decisions and strengthens the clinical confidence of physicians in out-of-hours OEMS.
Companion restrictions in the emergency department during COVID-19: physician perceptions from the Western Cape, South Africa
Authors: Wiebe Lauren E , Alvesson Helle Molsted , Stassen Willem 
Published: May 2023

ObjectivesTo determine emergency department (ED) physicians’ perceptions regarding hospital companions being prohibited from accompanying the patient during COVID-19.DesignTwo qualitative datasets were combined. Data collected included voice recordings, narrative interviewing and semistructured interviews. A reflexive thematic analysis was conducted and guided by the Normalisation Process Theory.SettingSix hospital EDs in the Western Cape, South Africa.ParticipantsConvenience sampling was used to recruit a total of eight physicians working full time in the ED during COVID-19.ResultsThe lack of physical companions provided an opportunity for physicians to assess and reflect on a companion’s role in efficient patient care. Physicians perceived that the COVID-19 restrictions illuminated that patient companions engaged in the ED as providers contributing to patient care by providing collateral information and patient support, while simultaneously engaging as consumers detracting physicians from their priorities and patient care. These restrictions prompted the physicians to consider how they understand their patients largely through the companions. When companions became virtual, the physicians were forced to shift how they perceive their patient, which included increased empathy.ConclusionThe reflections of providers can feed into discussions about values within the healthcare system and can help explore the balance between medical and social safety, especially with companion restrictions still being practised in some hospitals. These perceptions illuminate various tradeoffs physicians had to consider throughout the pandemic and may be used to improve companion policies when planning for the continuation of the COVID-19 pandemic and future disease outbreaks.
How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care
Authors: Khazen Maram , Sullivan Erin E , Arabadjis Sophia , Ramos Jason , Mirica Maria , Olson Andrew , Linzer Mark , Schiff Gordon D 
Published: May 2023

ObjectivesThe quest to measure and improve diagnosis has proven challenging; new approaches are needed to better understand and measure key elements of the diagnostic process in clinical encounters. The aim of this study was to develop a tool assessing key elements of the diagnostic assessment process and apply it to a series of diagnostic encounters examining clinical notes and encounters’ recorded transcripts. Additionally, we aimed to correlate and contextualise these findings with measures of encounter time and physician burnout.DesignWe audio-recorded encounters, reviewed their transcripts and associated them with their clinical notes and findings were correlated with concurrent Mini Z Worklife measures and physician burnout.SettingThree primary urgent-care settings.ParticipantsWe conducted in-depth evaluations of 28 clinical encounters delivered by seven physicians.ResultsComparing encounter transcripts with clinical notes, in 24 of 28 (86%) there was high note/transcript concordance for the diagnostic elements on our tool. Reliably included elements were red flags (92% of notes/encounters), aetiologies (88%), likelihood/uncertainties (71%) and follow-up contingencies (71%), whereas psychosocial/contextual information (35%) and mentioning common pitfalls (7%) were often missing. In 22% of encounters, follow-up contingencies were in the note, but absent from the recorded encounter. There was a trend for higher burnout scores being associated with physicians less likely to address key diagnosis items, such as psychosocial history/context.ConclusionsA new tool shows promise as a means of assessing key elements of diagnostic quality in clinical encounters. Work conditions and physician reactions appear to correlate with diagnostic behaviours. Future research should continue to assess relationships between time pressure and diagnostic quality.