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High value manufacturing systems still require ergonomically intensive manual activities. Examples include the aerospace industry where the fitting of pipes and wiring into confined spaces in aircraft wings is still a manual operation. In these environments, workers are subjected to ergonomically awkward forces and postures for long periods of time. This leads to musculoskeletal injuries that severely limit the output of a shopfloor leading to loss of productivity. The use of tools such as wearable sensors could provide a way to track the ergonomics of workers in real time. However, an information processing architecture is required in order to ensure that data is processed in real time and in a manner that meaningful action points are retrieved for use by workers.\ud \ud \ud \ud In this work, based on the Adaptive Control of Thought—Rational (ACT-R) cognitive framework, we propose a Cognitive Architecture for Wearable Sensors (CAWES); a wearable sensor system and cognitive architecture that is capable of taking data streams from multiple wearable sensors on a worker’s body and fusing them to enable digitisation, tracking and analysis of human ergonomics in real time on a shopfloor. Furthermore, through tactile feedback, the architecture is able to inform workers in real time when ergonomics rules are broken. The architecture is validated through the use of an aerospace case study undertaken in laboratory conditions. The results from the validation are encouraging and in the future, further tests will be performed in an actual working environment.

To assess the association between level of resident autonomy and operative times for appendectomies.A single center retrospective analysis of electronic medical record data of patients who underwent an appendectomy from 1/1/2017 to 12/31/2018. Medical record numbers s were matched with cases entered in the ACGME Resident Case Log system. Cases were stratified by resident role ("First Assistant," "Surgeon Junior," "Surgeon Chief," or "Teaching Assistant") and operative times were compared to cases without resident participation using student's t test.Maine Medical Center, Department of Surgery, Portland, Maine.Inclusion criteria: ≥5 years old, underwent appendectomy at a tertiary medical center during the study duration, and either had corresponding Case-log data or had no resident involvement. Patients who underwent appendectomy as part of a larger procedure were excluded.Six hundred eighty-eight patients met inclusion criteria, with residents participating in 574 (83.5%) cases. Overall mean operating time was 51 ± 21.5 minutes. Attending physicians without resident participation had the shortest OR times (43 ± 19.1 minutes). There was no difference in operating time between chief resident involvement and attending physicians without resident participation (45 ± 21; p = 0.43). Cases with residents involved as "First Assistant" (53 ± 18.6 minutes; p = 0.04) "Surgeon Junior" (52 ± 24.0 minutes; p0.001), or "Teaching Assistant" (57 ± 21.6 minutes; p0.001) were found to have longer operating times as compared to attending physicians operating without a resident.Operative times for appendectomies are impacted by resident role. Chief residents' operative times approach that of attendings when operating as Surgeon Chief, however they are significantly longer when operating as Teaching Assistant. Involvement of junior residents in any role lengthen operating times. This suggests that surgical education influences operating room efficiency.

Food environment research is increasingly gaining prominence in low- and middle-income countries (LMICs). However, in the absence of a systematic review of the literature, little is known about the emerging body of evidence from these settings. This systematic scoping review aims to address this gap. A systematic search of 6 databases was conducted in December 2017 and retrieved 920 records. In total, 70 peer-reviewed articles met the eligibility criteria and were included. Collectively, articles spanned 22 LMICs, including upper-middle-income countries (n = 49, 70%) and lower-middle-income countries (n = 18, 26%). No articles included low-income countries. Articles featured quantitative (n = 45, 64%), qualitative (n = 17, 24%), and mixed-method designs (n = 11, 8%). Studies analyzed the food environment at national, community, school, and household scales. Twenty-three articles (55%) assessed associations between food environment exposures and outcomes of interest, including diets (n = 14), nutrition status (n = 13), and health (n = 1). Food availability was associated with dietary outcomes at the community and school scales across multiple LMICs, although associations varied by vendor type. Evidence regarding associations between the food environment and nutrition and health outcomes was inconclusive. The paucity of evidence from high-quality studies is a severe limitation, highlighting the critical need for improved study designs and standardized methods and metrics. Future food environment research must address low-income and lower-middle-income countries, and include the full spectrum of dietary, nutrition, and health outcomes. Improving the quality of food environment research will be critical to the design of feasible, appropriate, and effective interventions to improve public health nutrition in LMICs.

The adoption of the Circular Economy paradigm by industry leads to increased responsibility of manufacturing to ensure a holistic awareness of the environmental impact of its operations. In mitigating negative effects in the environment, current maintenance practice must be considered, not just for the reduction of its own direct impact but also for its potential contribution to a more sustainable lifecycle for the manufacturing operation, its products and related services. Focusing on the matching of digital technologies to maintenance practice in the automotive sector, this paper outlines a framework for organisations pursuing the integration of environmentally aware solutions in their production systems. This research acts as a primer for digital maintenance practice within the Circular Economy and the utilisation of Industry 4.0 technologies for this purpose.

Fibre steering is involved in the development of non-conventional variable stiffness laminates (VSL) with curvilinear paths as well as in the lay-up of conventional laminates with complex shapes. Manufacturability is generally overlooked in design and, as a result, industrial applications do not take advantage of the potential of composite materials. This work develops a design for manufacturing (DFM) tool for the introduction in design of the manufacturing requirements and limitations derived from the fibre placement technology. This tool enables the automatic generation of continuous fibre paths for manufacturing. Results from its application to a plate with a central hole and an aircraft structure – a windshield front fairing – are presented, showing good correlation of resulting manufacturable paths to initial fibre trajectories. The effect of manufacturing constraints is assessed to elucidate the extent to which the structurally optimal design can be reached while conforming to existing manufacturing specifications.

Summary The National Institute for Health and Care Excellence published guidelines for managing early-onset neonatal infections in 2012. It recommended provision for reporting blood cultures (BCs) with growth detected or not detected at 36 h. To determine if this was followed, a telephone survey was conducted amongst lead biomedical scientists based at microbiology laboratories (N = 209) in the UK. Overall, 202/209 responded and 139/202 had on-site facilities for BCs. BC results with growth detected or not detected at 36 h were available out-of-hours in 36/139 (26.6%) and 66/139 (47.5%) neonatal units, respectively. Early discontinuation of antibiotics should lead to improved antibiotic stewardship.

International audience; Multiple recent global nutrition initiatives have recommended actions to transform food systems to improve food environments and food choice. This study aimed to identify actions recommended by these initiatives and understand their similarities and differences. Twelve global nutrition initiatives were reviewed, collectively spanning 13 action themes and accompanying strategies. Action themes were analyzed according to primary focus on either food environments and their food system drivers or food choice. Representation of the 13 actions varied across initiatives. Some actions overlapped; others were infrequently represented. Strategies targeting food environments and their food system drivers were more frequently recommended than strategies targeting food choice for 11 of the 13 action themes. Although these global initiatives share a mission to improve nutrition through food systems and food environments, less attention has been allocated to individual food choice and sustainability.

Non-invasive electrical stimulation methods are often used in experimental settings to investigate the possible modulation of antinociceptive mechanisms. Studies using transcranial direct current stimulation (tDCS) typically incorporate a fade-in, short-stimulation, fade-out sham (placebo) protocol, which is assumed to be indistinct from a 10-30min active protocol on the scalp. However, many studies report that participants can dissociate active stimulation from sham, even during low-intensity 1mA currents. In the present study we assessed whether delivery of a high-intensity 2mA current would exacerbate differences in the perception of active and sham protocols. Two protocols were delivered to 32 healthy, pain-free adults in a double-blinded, within-subjects design (active: 10min of 2mA, and sham: 20s of 2mA), with the anode over the left primary motor cortex and the cathode on the right forehead. Participants were asked “Is the stimulation on?” and “How sure are you?” at 30s intervals during and after stimulation. The differences between active and sham were more consistent and sustained during 2mA than during 1mA. We then quantified how well participants were able to track the presence and absence of stimulation (i.e. their sensitivity) during the experiment using cross-correlations. A good classifier of sensitivity during active tDCS was current strength, but exhibited only moderate specificity during sham. The accuracy of the end-of-study guess was no better than chance at predicting sensitivity. Our results from this methodological approach indicate that the traditional end-of-study guess poorly reflects the sensitivity of participants to stimulation, and may not be a valid method of assessing sham blinding. Further research should be carried out into inter-individual responses to sham-blinding and assessment methods in pain studies and the broader neurostimulation field. Wellcome Trust.

The minimization of energy, waste, and emissions in operations are the foremost sustainability goals in industry. The shift from a linear product lifecycle to a circular one is required, along with increased energy efficiency and reduced resource use, to achieve these goals. This paper examines how the use of Re-Distributed Manufacturing (RdM) and a Product-Service System (PSS) approach, while leveraging the latest digital manufacturing technologies, enables the shift to this new economic model. A case study illustrates this new approach and relates it to the shoe manufacturing industry. The ShoeLab case study includes an outline of the business model options supporting this new approach to sustainable production highlighting the circularity that may be achieved in employing RdM and the latest digital manufacturing technologies in the form of 3-D printing. The research conducted indicates that using IDEF0 modelling could help to realize the full potential of RdM such as the manufacturing and transport of products involving less material, energy and waste.

Low fruit and vegetable consumption is a key contributor to all forms of malnutrition. This qualitative study examined the perceptions of people living in peri-urban villages of Hyderabad, India, to characterise the sources of fruit and vegetables, the fruit and vegetable environment, and to inform future interventions to increase fruit and vegetable consumption. Health and food quality were primarily seen through a food safety lens and negative aspects were frequently attributed to increased pesticide use. Availability, price and affordability of fresh fruit and vegetables were important drivers of their acquisition and consumption. Promoting communal gardens may increase the availability of affordable fruit and vegetables, as would promoting cold storage facilities. Financial incentives would likely be effective in increasing consumption of fruit and vegetables.

Summary Background Viral gastroenteritis is common, especially in young children. In adults, particularly amongst the elderly, it can lead to outbreaks at a time when demands on clinical services are at their peak. Aim To evaluate seasonal screening of young children and elderly patients with suspected viral gastroenteritis using multiplex polymerase chain reaction (PCR) for enteric viruses within a general hospital setting. Methods Stool samples from 200 children aged five years and under were screened for rotavirus, adenovirus, astrovirus, sapovirus and norovirus using multiplex PCR and a combined rotavirus/adenovirus immunochromatographic test (ICT) during the winter of 2012. Diarrhoeal samples submitted to the laboratory from 195 adults aged 65 years and over attending as inpatients were also evaluated by multiplex PCR. Findings One or more enteric viruses were detected by PCR in 56% of children. Rotavirus was the most prevalent virus, found in 19% of samples. Enteric (diarrhoea-associated) adenovirus was detected in 5% of samples and non-enteric adenovirus was detected in 14% of samples. Astrovirus, norovirus and sapovirus were detected in 18%, 12% and 10% of samples, respectively. The ICT yielded a slightly lower rate for rotavirus and enteric adenovirus, but gave more rapid results. Norovirus, rotavirus and adenovirus were detected in 15%, 2.5% and 1% of elderly adults attending hospital as inpatients, respectively. Conclusions Rapid screening of young children (for rotavirus, adenovirus and norovirus) and symptomatic, elderly adults (for norovirus) during winter months may help to limit nosocomial spread.

There has been increasing interest in associations between neighborhood food environments and cardiovascular risk factors. However, results from high-income countries remain inconsistent, and there has been limited research from low- and middle-income countries. We conducted a cross-sectional analysis of the third wave follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 5764, median age 28.8 years) in south India. We examined associations between the neighborhood availability (vendor density per km2 within 400 m and 1600 m buffers of households) and accessibility (distance from the household to the nearest vendor) of fruit/vegetable and highly processed/take-away food vendors with 11 cardiovascular risk factors, including adiposity measures, glucose-insulin, blood pressure, and lipid profile. In fully adjusted models, higher density of fruit/vegetable vendors within 400 m of participant households was associated with lower systolic blood pressure [−0.09 mmHg, 95% confidence interval (CI): −0.17, −0.02] and diastolic blood pressure (−0.10 mmHg, 95% CI: −0.17, −0.04). Higher density of highly processed/take-away food vendors within 400 m of participant households was associated with higher Body Mass Index (0.01 Kg/m2, 95% CI: 0.00, 0.01), waist circumference (0.22 mm, 95% CI: 0.05, 0.39), systolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.06), and diastolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.05). However, within 1600 m buffer, only association with blood pressure remained robust. No associations were found for between neighborhood accessibility and cardiovascular risk factors. Lower density of fruit/vegetable vendors, and higher density of highly processed/take-away food vendors were associated with adverse cardiovascular risk profiles. Public health policies regarding neighborhood food environments should be encouraged in south India and other rural communities in south Asia., Highlights • Greater density of healthy food vendors was associated with lower blood pressure. • Greater density of unhealthy food vendors was associated with higher blood pressure. • Greater density of unhealthy food vendors was associated with higher adiposity. • Public health policies modifying neighborhood food environments should be encouraged.

This paper presents a novel method for dynamic alignment control using infrared light depth imagery to enable automated wheel loading operation for the trim and final automotive assembly line. A key requirement for automated wheel loading is to track the motion of the wheel hub and simultaneously identify the spatial positions and angular orientations of its alignment features in real-time on a moving vehicle body. This requirement is met in this work, where low-cost infrared depth-imaging devices like Microsoft Kinect™ and Asus Xtion™, vastly popular in the gaming industry, are used to track a moving wheel hub and recognise alignment features on both the wheel hub and the wheel in real time in a laboratory environment. Accurate control instructions are then computed to instruct the automation system to rotate the wheel to achieve precise alignment with the wheel hub and load the wheel at the right time. Experimental results demonstrate that the reproducibility error in alignment control satisfies the assembly tolerance of 2 mm for the wheel loading operation, and thus the proposed method can be applied to automate wheel assembly on the trim and final automotive assembly line. The novelty of this work lies in its use of depth imaging for dynamic alignment control, which provides real-time spatial data in all 3 axes simultaneously as against the popularly reported RGB imaging techniques that are computationally more demanding, sensitive to ambient lighting and require the use of additional force sensors to obtain depth axis control data. This paper demonstrates the concept of a light-controlled factory where depth imaging using infrared light and depth image analysis is used to enable intelligent control in automation.

The purpose of this review is to provide an analysis and comparison of publications identified in the area of information flow in supply chain management. Although review articles have extensively analysed supply chain management during the manufacturing phase of the product lifecycle, product development and service phases seems to be largely separated. Therefore a total of 132 journal articles were systematically selected and analysed. In order to enable a methodological approach, a framework is proposed to classify the publications based on the product lifecycle phase and the type of the publication. Each phase of the product lifecycle is discussed in detail and research gaps are identified. Finally cross-phase research gaps are identified to provide guidelines for future research.

The perovskite, BiNb3O9, is a metastable phase in the Bi2O3:Nb2O5 system that forms only when cooled from a liquid phase. Crystals of BiNb3O9 prepared in this way display pseudocubic 2a×2a×2a diffraction patterns, due to non-merohedral twinning of a tetragonal a×a×2a cell, with the doubled axis oriented along all three pseudocubic axes. The structure was refined using data collected on a twinned crystal to R1=0.034 for 318 observed reflections. BiNb3O9 has tetragonal symmetry, P4/mmm with a=3.9459(3) A, c=7.8919(6) A. Partial ordering of Bi atoms and vacancies occurs, with alternate (0 0 1) planes having 28% and 42% Bi occupancies. The Bi atoms are displaced from the A-site special positions by up to 0.4 A. The compound exhibits a relatively high permittivity value of ∼230 at room temperature, and shows a sharp increase with increasing temperature towards an apparent diffuse phase transition above ∼180 °C, with an associated frequency dependent peak in the dielectric loss.

This paper provides a review of the state of the art of relevant work on the use of public mobile data networks for aircraft telemetry and control proposes. Moreover, it describes the characterisation for airborne uses of the public mobile data communication systems known broadly as 3G. The motivation for this study was to explore how this mature public communication systems could be used for aviation purposes. An experimental system was fitted to a light aircraft to record communication latency, line speed, RF level, packet loss and cell tower identifier. Communications was established using internet protocols and connection was made to a local server. The aircraft was flown in both remote and populous areas at altitudes up to 8500 ft in a region located in South East Queensland, Australia. Results show that the average airborne RF levels are better than those on the ground by 21% and in the order of −77 dbm. Latencies were in the order of 500 ms (1/2 the latency of Iridium), an average download speed of 0.48 Mb/s, average uplink speed of 0.85 Mb/s, a packet of information loss of 6.5%. The maximum communication range was also observed to be 70 km from a single cell station. The paper also describes possible limitations and utility of using such communications architecture for both manned and unmanned aircraft systems.

Business processes have been discussed for more than a decade now. However, there are not as of yet comprehensive and substantial benefits that can justify the hype around the concept. This paper contrasts and summarises the main findings of literature research and a targeted survey conducted within the service industry in order to investigate the current state of research and practice regarding key aspects of business processes. The survey involved the participation of 25 respondents working in service industry sectors such as finance, public sector and consultancy. The paper demonstrates that although theoretical developments are dealing with sophisticated issues around business processes, the service industry is reluctant to adopt a similar perspective and still uses simple and manual techniques in dealing with business processes. The main reason is that the service industry is not convinced that a business process approach could bring significant tangible and measurable benefits. This is due to the fact that there is no comprehensive and systematic solution proposed in terms of a fully functional business process software suite. The requirements for an integrated business process management tool include some of the paper's findings.

Congenital bleeding disorders comprise a heterogeneous group of diseases that reflect abnormalities of blood vessels, coagulation proteins and platelets. Studies of these diseases, many of which are rare and several of which result in a mild bleeding diathesis only, have significantly increased our understanding of normal haemostasis. Two lessons have been learned. First, quantitative abnormalities of coagulation proteins and platelets are an important, but not the only, cause of significant haemorrhage; some cases of inherited bleeding disorders reflect synthesis of a dysfunctional coagulation protein or production of abnormal platelets. Diagnostic tests that reflect qualitative abnormalities are therefore important in the evaluation of selected patients with inherited bleeding disorders. Second, in occasional patients the inherited disorder is complex and reflects combined abnormalities of coagulation proteins alone or in association with platelet disorders. In clinical practice it is useful to distinguish disorders that cause significant clinical bleeding from those that cause few or no symptoms. Examples of the former include severe deficiencies of factors VIII and IX, and the homozygous forms of factor II, V, VII, X, XI, XIII, fibrinogen and von Willebrand factor. Comparable platelet disorders include the inherited thrombocytopenias with platelet counts less than 20 x 10(9) litre-1 and the homozygous forms of Bernard-Soulier syndrome and Glanzmann's thrombasthenia. The most frequently encountered mild haemostatic abnormalities include type I von Willebrand's disease, the platelet storage pool deficiency syndromes and the mild and moderate forms of haemophilia A and B; occasionally heterozygous or homozygous forms of the rarer coagulation disorders, e.g. factor XI deficiency, may present with a mild bleeding diathesis. Finally, some disorders are entirely asymptomatic, e.g. factor XII deficiency and deficiencies of other contact coagulation factors. Management of patients with inherited bleeding disorders should reflect knowledge of the specific disorder to be treated plus careful consideration of the clinical circumstance for which therapy is proposed. In all cases, once a decision to treat has been made, the safest efficacious therapy should be given (for example DDAVP in the treatment of patients with mild haemophilia A or type I von Willebrand's disease). Although blood products are now much safer and the risk of blood transmitted viral infections is low, there still remains a risk that transfusion of any blood product may be associated with serious side-effects. As a result, therapy should be given only after careful consideration of the risk: benefit ratio and not merely to treat an abnormal laboratory result.(ABSTRACT TRUNCATED AT 400 WORDS)

A comparative study involving two sets of novel nitric oxide donating compounds was investigated. All target compounds were designed and prepared using traditional synthetic routes that were optimised to allow the efficient incorporation of either a furoxan core or a S-nitrosothiol group. In each synthetic sequence the NO was locked into a five-membered heterocyclic ring linked to an aromatic portion. This synthetic strategy provided the scope to generate a range of products with subtle substituent differences in order to help rationalise any variations seen, between individual compounds, in either the rate of NO release or biological profile. The chemical stability of all compounds was compared under a range of different conditions to ascertain the ease with which each heterocyclic ring breaks open, which is clearly a prerequisite for NO release. Having gained an appreciation of the stability and required handling conditions for each set of NO-donors, the compounds were evaluated for their ability to inhibit the proliferation of a panel of ovarian cancer cell lines. The results suggest that subtle chemical modifications to the structure of these NO-donors, in additional to changing the actual type of NO-donating species, can greatly influence their ability to release NO and act as cytotoxic agents.

Transient electric birefringence studies have been performed on heat denatured xanthan in 4 m urea. The induced birefringence was positive, the Kerr law was obeyed at low field amplitudes and the birefringence saturated at high fields. The orientation mechanism appears to be mainly induced dipolar in character and the magnitude of the induced dipole moment can be explained on the basis of counterion polarization. The molecules behave as independent rods of mean length 0.65 μm with no evidence for ‘hindered rotation’ in moderately concentrated solutions. The molecular rigidity is attributed to extension of the polyanion due to charge charge repulsions or steric hindrance due to the side chains.