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Background: As part of the Integrated Child Development Services program, The Anganwadi system is mainly managed by the Anganwadi worker (AWW). The fundamental tasks performed by Anganwadi workers are crucial and must be completed as effectively as possible. Hence the good health of Anganwadi workers decides how efficiently they can do their allotted work. So, this study was conducted to assess the health profile of Anganwadi workers. Objective: To assess the health profile of Anganwadi workers attending a Health checkup camp at a Tertiary Hospital. Methodology: A cross sectional descriptive study was conducted at a free health camp in a Tertiary Hospital of Mumbai, India, by the staff and interns of the Department of Community medicine. All AWWs who attended the camp were included in the study. AWWs who attended the health checkup camp were assessed for morbidity. Data collected by semi structured questionnaire was entered into Microsoft Excel and analysed using SPSS version-17.0. Results: Most of AWWs were from the age group of between 41-50 years; more than half of them were matriculate and 34(69.38%) workers had an experience of more than 10 years. Around 49% of them were having abnormal BMI and 53% were anaemic. PAP smear findings were abnormal in 4% AWWs. Conclusion: AWWs are considered cornerstone in providing ICDS services, but in this study, we found that most of AWWs themselves were not at their good health. Regular health checkups of healthcare workers of each level should be done to efficiently deliver the healthcare services to people of our country.

Robots support and facilitate tasks in all life fields. Soft robots specifically have the advantages of inherent compliance, safe interaction and flexible deformability. Soft pneumatic network (Pneu-Net) is a soft pneumatic actuator (SPA) composed of network of chambers that is actuated by pneumatic power. Soft Pneu-Net fits the human interface applications perfectly. In this paper, a bio-inspired modular based design for Pneu-Net actuator is developed. The actuator mimics the elephant trunk curling to be employed for rehabilitation of human hand fingers. The actuator is an integrated four Pneu-Net modules actuator which is attached to hand's finger. The main introduced advantages in the new developed actuator are: providing four degrees of freedom (DoF) essential for finger's motion by single compound actuator and developing a methodology for a modular soft Pneu-Net actuator that is efficiently reproducible. The actuator's design is developed using computer aided design (CAD) software SOLIDWORKS. The design is simulated using finite element modeling (FEM) software ABAQUS. Fabrication process uses 3D printed molds. Soft material is molded in the 3D printed molds, forming actuator's modules. Actuator's modules are integrated by adhesion using the soft material. A proposed non-standard hyper-elastic material biaxial tension test is introduced as a quick material properties identification method that can produce a test table used for material identification in the FEM. Enhanced version for the actuator uses reinforcement fibers. Results show advances for the reinforced actuator, as it limits the unwanted actuator's strain and deformation. The reinforced actuator shows improved energy efficiency reaches to 46%., (© 2024. The Author(s).)

The present work investigates the electrocatalysis of oxygen evolution (OE) on a glassy carbon electrode modified with nickel oxide nanoparticles (NPs) (nano-Ni) in an alkaline solution. The nano-Ni is electrodeposited from an acidic sulfate electrolyte containing various additives, such as glucose, glycerol, and dimethyl glyoxime. The NPs are characterized morphologically and electrochemically using scanning electron microscopy and cyclic voltammetry. The elemental composition and electronic state of the modified electrodes were analyzed using X-ray photoelectron spectroscopy. A considerable enhancement in electrocatalytic activity, depending on the additives used, is observed. The study also explores the effect of nickel oxide loading to optimize the process. The highest cathodic shift in the onset potential of the oxygen evolution reaction is achieved with nickel oxide deposited in the presence of ethylene glycol., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

This study presents an analysis and evaluation of gait asymmetry (GA) based on the temporal gait parameters identified using a portable gait event detection system, placed on the lateral side of the shank of both lower extremities of the participants. Assessment of GA was carried out with seven control subjects (CS), one transfemoral amputee (TFA) and one transtibial amputee (TTA) while walking at different speeds on overground (OG) and treadmill (TM). Gait cycle duration (GCD), stance phase duration (SPD), swing phase duration (SwPD), and the sub-phases of the gait cycle (GC) such as Loading-Response (LR), Foot-Flat (FF), and Push-Off (PO), Swing-1 (SW-1) and Swing-2 (SW-2) were evaluated. The results revealed that GCD showed less asymmetry as compared to other temporal parameters in both groups. A significant difference (p < 0.05) was observed between the groups for SPD and SwPD with lower limb amputees (LLA) having a longer stance and shorter swing phase for their intact side compared to their amputated side, resulting, large GA for TFA compared to CS and TTA. The findings could potentially contribute towards a better understanding of gait characteristics in LLA and provide a guide in the design and control of lower limb prosthetics/orthotics., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jin-Taek Seong reports financial support was provided by 10.13039/501100003725National Research Foundation of Korea, and 10.13039/501100000266EPSRC. Jin-Taek Seong reports a relationship with Graduate School of Data Science, Chonnam National University, Gwanju 61186, Republic of South Korea that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Background: Falls are common in older people and individuals with neurological conditions. Parkinson's disease (PD) is known for postural instability causing mobility disabilities, falls and reduced quality of life. The fear of falling (FOF), a natural response to unstable balance, can worsen postural control problems. Evaluating FOF relies largely on affected persons' subjective accounts due to limited objective assessment methods available. The aim of this mixed-methods feasibility study is to develop an assessment method for FOF while in motion and walking within virtual environments. This study will assess a range of FOF-related responses, including cognitive factors, neuromuscular response and postural stability., Methods and Analysis: This feasibility study will consist of four phases: the first two phases will include people without PD, while the other two will include people diagnosed with PD. Participants will be assessed for direct and indirect responses to real life, as well as virtual environment walking scenarios that may induce FOF. Data from questionnaires, different neurophysiological assessments, movement and gait parameters, alongside evaluations of usability and acceptability, will be collected. Semistructured interviews involving both participants and research assistants shall take place to elicit their experiences throughout different phases of the assessments undertaken. Demographic data, the scores of assessment scales, as well as feasibility, usability and acceptability of the measurement methods, will be illustrated via descriptive statistics. Movement and gait outcomes, together with neurophysiological data, will be extracted and calculated. Exploring relationships between different factors in the study will be achieved using a regression model. Thematic analysis will be the approach used to manage qualitative data., Ethics and Dissemination: This feasibility study was approved by the Ethics Committee of the Faculty of Physical Therapy, Kafr El Sheikh University, Egypt (number: P.T/NEUR/3/2023/46). The results of this study will be published in a peer-reviewed journal., Trial Registration Number: ClinicalTrials.gov Registry (NCT05931692)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pyrolysis offers a sustainable and efficient approach to resource utilization and waste management, transforming organic materials into valuable products. The quality and distribution of the pyrolysis products highly depend on the constituents' properties and set process parameters. This research aims to investigate and model this dependency, offering decision-makers a tool to guide them when designing the process for a particular application. Experimental data on the pyrolysis of various types of feedstocks processed at a wide range of pyrolysis temperatures (350-650 °C) are utilized to develop the prediction models. Four variables are modeled: the yield and energy content for both the biochar and bio-oil as a function of the pyrolysis temperature and feedstock characteristics. The models developed had very good prediction power with the coefficient of determination above 90%. The results highlight the advantages of food waste (leftover) as a suitable feedstock to produce biochar at the pyrolysis temperature within the range of 450-550 °C. Furthermore, the biofuels produced from food waste are found to be of good quality, with the bio-oil exceptionally high in energy content (HHV = 34.6 MJ/kg), which is almost 80% of that of diesel. The developed models provide a tool for predicting the biofuel yield and quality based on the feedstock selection and process temperature., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

There is a growing interest in the research and development of Cable Driven Rehabilitation Devices (CDRDs) due to multiple inherent features attractive to clinical applications, including low inertia, lightweight, high payload-to-weight ratio, large workspace, and modular design. However, previous CDRDs have mainly focused on modifying motor impairment in the sagittal plane, despite the fact that neurological disorders, such as stroke, often involve postural control and gait impairment in multiple planes. To address this gap, this work introduces a novel framework for designing a cable-driven lower limb rehabilitation exoskeleton which can assist with bi-planar impaired posture and gait. The framework used a lower limb model to analyze different cable routings inspired by human muscle architecture and attachment schemes to identify optimal routing and associated parameters. The selected cable routings were safeguarded for non-interference with the human body while generating bi-directional joint moments. The subsequent optimal cable routing model was then implemented in simulations of tracking reference healthy trajectory with bi-planar impaired gait (both in the sagittal and frontal planes). The results showed that controlling joints independently via cables yielded better performance compared to dependent control. Routing long cables through intermediate hinges reduced the peak tensions in the cables, however, at a cost of induced additional joint forces. Overall, this study provides a systematic and quantitative in silico approach, featured with accessible graphical user interface (GUI), for designing subject-specific, safe, and effective lower limb cable-driven exoskeletons for rehabilitation with options for multi-planar personalized impairment-specific features., (© 2024. The Author(s).)

This study introduces an innovative approach to enhance the energy efficiency and position control performance of electro-hydraulic systems, employing a comprehensive comparative analysis. It presents and evaluates three control techniques: Proportional-Integral-Derivative (PID) control, Model Predictive Control (MPC), and Neural Network Model Predictive Control (NN-MPC). These methods are systematically assessed across varying load conditions. Notably, our research unequivocally establishes the exceptional performance of the NN-MPC approach, even when confronted with load variations. Furthermore, the study conducts an exhaustive examination of energy consumption by comparing a conventional system, where a flow control valve is not utilized as a hydraulic cylinder bypass, with a proposed system that employs a fully open Flow Control Valve (FCV). The results underscore the remarkable energy savings achieved, reaching up to 9% at high load levels., (© 2024. The Author(s).)

Continuum robots are complex structures that require sophisticated modeling and control methods to achieve accurate position and motion tracking along desired trajectories. They are highly coupled, nonlinear systems with multiple degrees of freedom that pose a significant challenge for conventional approaches. In this paper, we propose a system dynamic model based on the Euler-Lagrange formulation with the assumption of piecewise constant curvature (PCC), where we accounts for the elasticity and gravity effects of the continuum robot. We also develop and apply a particle swarm optimization (PSO) algorithm to optimize the parameters of our developed controllers: an inverse dynamic proportional integral derivative (PID) controller and an inverse dynamic fuzzy logic controller (FLC), where we use the integral time of absolute error (ITAE) as the objective function for the PSO algorithm. We validate our proposed model and optimized controllers through different designed trajectories, simulated using our developed unique animated MATLAB simulation. The results show that the PSO-PID controller improves the rise time, overshoot percentage, and settling time by 16.3%, 31.1%, and 64.9%, respectively, compared to the PID controller without PSO. The PSO-FLC controller shows the best performance among all controllers, with a settling time of 0.7 s and a rise time of 0.4 s, leading to the highest level of precision in trajectory tracking. The ITAE error for the PSO-FLC controller is 11.4% and 29.9% lower than that of the PSO-PID and FLC controllers, respectively., (© 2024. The Author(s).)

Climate change has an impact on the ecosystem, and subsequently, it affects the built environment. Building envelope has a vital role in controlling the integration between indoor and outdoor environmental quality. The responsivity of the façade has proven its efficiency in optimizing the global energy performance of buildings. Adaptive façades are multifunctional reconciling envelope dynamic systems that improve sustainability with the purpose of utilizing environmental parameters. This paper tackles the research gap in integrating façades circularity, adaptive envelopes, and design for disassembly. The research investigates the merge between biodegradability, circularity of adaptive façades components, and interior space micro-climate control for energy efficiency. This paper presents a proof of concept for a circular adaptive façade during two phases in its life cycle: operation and reuse phases. A scientific quantitative method took place which is based on a hybrid method; computational simulation, smart control, and an up-scale model. Adaptability is investigated through the façade life cycle from design to disassembly instead of demolition and consequent waste production, by exploiting sustainable materials. As a result, an empirical prototype is constructed. The prototype provides 3 levels of adaptability across the design, operation, and disassembly for reuse. Subsequently, this work proposes an up-scale physical model that can help in mitigating the climate change effects., (© 2023. The Author(s).)

Amputation levels in Egypt and the surrounding neighborhood require a state intervention to localize the manufacturing of prosthetic feet. Amputations are mainly due to chronic diseases, accidents, and hostilities' casualties. The prosthetic foot type is traditionally classified according to the number of axial rotational movements, and is recently classified according to the energy activeness of the foot. The localization of this industry needs a preliminary survey of the domestic technological levels with respect to the foot type. Upon the results of this survey, the energy storage response foot has appealing metrics to proceed with its manufacturing. A prototype manufacturing chain is designed and a set of these feet with a certain commercial size of 27 is manufactured. Resin impregnation technology for carbon fiber composites is followed in this work. The feet are tested according to ISO 22,675. Based on the dimensional and mechanical results, a manufacturing value chain is proposed with the prospective resin transfer molding technology. This value chain will guarantee the required localization as well as the natural growth of this value chain with all related activities like accreditation of practices as well as manpower certification., (© 2023. Springer Nature Limited.)

Background: Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture., Aim: To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries., Methods: A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score., Results: The results revealed a statistically significant difference between both groups ( P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group ( P = 0.513). A lower surgical site infection rate was noticed in the INFIX group ( P = 0.007)., Conclusion: Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures., Competing Interests: Conflict-of-interest statement: All authors confirm that there is no conflict of interest related to this study., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

The following research proposes a closed loop force control system, which is implemented on a soft robotic prosthetic hand. The proposed system uses a force sensing approach that does not require any sensing elements to be embedded in the prosthetic's fingers, therefore maintaining their monolithic structural integrity, and subsequently decreasing the cost and manufacturing complexity. This is achieved by embedding an aluminum test specimen with a full bridge strain gauge circuit directly inside the actuator's housing rather than in the finger. The location of the test specimen is precisely at the location of the critical section of the bending moment on the actuator housing due to the tension in the driving tendon. Therefore, the resulting loadcell can acquire a signal proportional to the prosthetic's grasping force. A PI controller is implemented and tested using this force sensing approach. The experiment design includes a flexible test object, which serves to visually demonstrate the force controller's performance through the deformation that the test object experiences. Setpoints corresponding to "light", "medium", and "hard" grasps were tested with pinch, tripod, and full grasps and the results of these tests are documented in this manuscript. The developed controller was found to have an accuracy of ±2%. Additionally, the deformation of the test object increased proportionally with the given grasp force setpoint, with almost no deformation during the light grasp test, slight deformation during the medium grasp test, and relatively large deformation of the test object during the hard grasp test.

Background: Tracheotomy is a common procedure for otolaryngologists. The risk of complications is difficult to predict. This study aims to identify measurable preoperative indicators associated with adverse events following tracheotomy., Methods: The charts of adults undergoing tracheotomy for respiratory failure at one of four university-affiliated hospitals between 1/2012 and 8/2018 were reviewed. Complications were analyzed in the context of demographics, physiologic parameters, and comorbidities., Results: Among 507 tracheotomies performed, the most common complications included infection, bleeding, and cardiac arrest. Mortality was 39 % in patients with pulmonary hypertension, 42 % in those with ejection fraction ≤ 40 and 32 % in those with abnormal right ventricular function, double the rates in patients without each of these findings., Conclusion: Many critically ill tracheotomy patients experience significant rates of adverse events. Risk factors for mortality include ejection fraction ≤ 40, pulmonary hypertension, and abnormal ventricular function. These should be considered for use in preoperative counseling., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Although Cable-driven rehabilitation devices (CDRDs) have several advantages over traditional link-driven devices, including their light weight, ease of reconfiguration, and remote actuation, the majority of existing lower-limb CDRDs are limited to rehabilitation in the sagittal plane. In this work, we proposed a novel three degrees of freedom (DOF) lower limb model which accommodates hip abduction/adduction motion in the frontal plane, as well as knee and hip flexion/extension in the sagittal plane. The proposed model was employed to investigate the feasibility of using bi-planar cable routing to track a bi-planar reference healthy trajectory. Various possible routings of four cable configurations were selected and studied with the 3DOF model. The optimal locations of the hip cuffs were determined using optimization. When compared with the five-cable routing configuration, the four-cable routing produced higher joint forces, which motivated the future study of other potential cable routing configurations and their ability to track bi-planar motion.

The global increase in the number of stroke patients and limited accessibility to rehabilitation has promoted an increase in the design and development of mobile exoskeletons. Robot-assisted mobile rehabilitation is rapidly emerging as a viable tool as it could provide intensive repetitive movement training and timely standardized delivery of therapy as compared to conventional manual therapy. However, the majority of existing lower limb exoskeletons continue to be heavy and induce unnecessary inertia and inertial vibration on the limb. Cable-driven exoskeletons can overcome these issues with the provision of remote actuation. However, the number of cables and routing can be selected in various ways posing a challenge to designers regarding the optimal design configuration. In this work, a simulation-based generalized framework for modelling and assessment of cable-driven mobile exoskeleton is proposed. The framework can be implemented to identify a 'suitable' configuration from several potential ones or to identify the optimal routing parameters for a given configuration. For a proof of concept, four conceptual configurations of cable-driven exoskeletons (one with a spring) were developed in a manner where both positive and negative moments could be generated for each joint (antagonistic configuration). The models were analyzed using the proposed framework and a decision metric table has been developed based on the models' performance and requirements. The weight of the metrics can be adjusted depending on the preferences and specified constraints. The maximum score is assigned to the configuration with minimum requirement or error, maximum performance, and vice versa . The metric table indicated that the 4-cable configuration is a promising design option for a lower limb rehabilitation exoskeleton based on tracking performance, model requirements, and component forces exerted on the limb., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Prasad, El-Rich, Awad, Hussain, Jelinek, Huzaifa and Khalaf.)

This paper describes the development of a human gait activity recognition system. A multi-sensor recognition system, which has been developed for this purpose, was reduced to a single sensor-based recognition system. A sensor election method was devised based on the maximum relevance minimum redundancy feature selector to determine the sensor's optimum position regarding activity recognition. The election method proved that the thigh has the highest contribution to recognize walking, stairs and ramp ascending, and descending activities. A recognition algorithm (which depends mainly on features that are classified by random forest, and selected by a combined feature selector using the maximum relevance minimum redundancy and genetic algorithm) has been modified to compensate the degradation that occurs in the prediction accuracy due to the reduction in the number of sensors. The first modification was implementing a double layer classifier in order to discriminate between the interfered activities. The second modification was adding physical features to the features dictionary used. These modifications succeeded to improve the prediction accuracy to allow a single sensor recognition system to behave in the same manner as a multi-sensor activity recognition system.

The large number of poststroke recovery patients poses a burden on rehabilitation centers, hospitals, and physiotherapists. The advent of rehabilitation robotics and automated assessment systems can ease this burden by assisting in the rehabilitation of patients with a high level of recovery. This assistance will enable medical professionals to either better provide for patients with severe injuries or treat more patients. It also translates into financial assistance as well in the long run. This paper demonstrated an automated assessment system for in-home rehabilitation utilizing a data glove, a mobile application, and machine learning algorithms. The system can be used by poststroke patients with a high level of recovery to assess their performance. Furthermore, this assessment can be sent to a medical professional for supervision. Additionally, a comparison between two machine learning classifiers was performed on their assessment of physical exercises. The proposed system has an accuracy of 85% (±5.1%) with careful feature and classifier selection.

This paper aims to enhance the accuracy of human gait prediction using machine learning algorithms. Three classifiers are used in this paper: XGBoost, Random Forest, and SVM. A predefined dataset is used for feature extraction and classification. Gait prediction is determined during several locomotion activities: sitting (S), level walking (LW), ramp ascend (RA), ramp descend (RD), stair ascend (SA), stair descend (SD), and standing (ST). The results are gained for steady-state (SS) and overall (full) gait cycle. Two sets of sensors are used. The first set uses inertial measurement units only. The second set uses inertial measurement units, electromyography, and electro-goniometers. The comparison is based on prediction accuracy and prediction time. In addition, a comparison between the prediction times of XGBoost with CPU and GPU is introduced due to the easiness of using XGBoost with GPU. The results of this paper can help to choose a classifier for gait prediction that can obtain acceptable accuracy with fewer types of sensors.

The soft pneumatic actuators of an assistive exoskeleton hand glove are here designed. The design of the actuators focuses on allowing the actuator to perform the required bending and to restrict elongation or twisting of the actuator. The actuator is then modeled using ABAQUS/CAE, a finite element modeling software, and the open loop response of the model is obtained. The parameters of the actuator are then optimized to reach the optimal parameters corresponding to the best performance. Design of experiment (DOE) techniques are then approached to study the robustness of the system. Software-in-the-loop (SiL) is then approached to control the model variables via a proportional-integral-derivative (PID) control generated by FORTRAN code. The link between the two programs is to be achieved by the user subroutine that is written, where the subroutine receives values from ABAQUS/CAE, performs calculations, and passes values back to the software. The controller's parameters are tuned and then the closed loop response of the model is obtained by setting the desired bending angle and running the model. Furthermore, a concentrated force at the tip of the actuator is added to observe the actuator's response to external disturbance.

Background: The COVID-19 pandemic has resulted in the implementation of rapidly changing protocols and guidelines related to the indications and perioperative precautions and protocols for tracheostomy. The purpose of this study was to evaluate current guidelines for tracheostomy during the COVID-19 pandemic to provide a framework for health systems to prepare as the science evolves over the upcoming months and years., Methods: Literature review was performed. Articles reporting clinical practice guidelines for tracheostomy in the context of COVID-19 were included., Results: A total of 13 tracheotomy guidelines were identified. Two were available via PubMed, five in society or organization websites, and six identified via health system websites or other sources. Five were from Otolaryngology-Head and Neck Surgery specialties, six from Anesthesiology and one from Pulmonary/Critical Care. All (100%) studies recommended postponing elective OR cases in COVID-19 positive patients, while seven recommended reducing team members to only essential staff and three recommended forming a designated tracheostomy team. Recommendations with supporting references are summarized in the article., Conclusions: Tracheostomy guidelines during the COVID-19 pandemic vary by physician groups and specialty, hospital systems, and supply-chain/resource availability. This summary is provided as a point-in-time current state of the guidelines for tracheotomy management in April 2020 and is expected to change in coming weeks and months as the COVID-19 pandemic, virus testing and antibody testing evolves., (© 2020 Wiley Periodicals, Inc.)

Background: This study aims to evaluate the impact of perioperative fluid administration, defined as fluid delivered intraoperatively and in the postanesthesia care unit, on postoperative outcomes., Methods: Medical records of 102 patients with oral cavity squamous cell carcinoma undergoing free flap reconstruction between January 2011 and December 2015 were reviewed. The primary endpoint was development of a postoperative complication according to the Clavien-Dindo classification. Perioperative factors recorded were Washington University Head and Neck Comorbidity Index, operating time, vasopressor use, blood loss, intraoperative fluid, and perioperative fluid., Results: Greater perioperative fluid administration was independently associated with surgical complications, flap complications, overall incidence of any complication, and increased length of stay. Greater intraoperative fluid administration was independently associated with higher rates of surgical complications. Intraoperative delivery of vasopressors was not associated with flap or surgical complications., Conclusion: Receiving less perioperative fluid was associated with fewer complications and decreased length of stay., (© 2019 Wiley Periodicals, Inc.)

Background: The relationship between the functional loading rate and heel velocities was assessed in an active unilateral transfemoral amputee (UTFA) for adaptation to six different commercial prosthetic knees., Objective: To Investigate the short-term process of adaptability for UTFA for two types of prosthetic knees were evaluated, based on the correlation between heel vertical velocity and transient loading rate., Methods: The loading rate was calculated from the slope of ground reaction forces (GRF) and the corresponding time. The heel velocities and GRF were obtained by a motion analysis system., Results: Biomechanical adaptation was evident following a short period of prosthetic knee use based upon the mean transient impact (loading rate) and the heel vertical velocity in slow, normal and fast walking. Trend lines of transient impact versus vertical heel velocity for a set of actively controlled variable damping (microprocessor) and mechanically passive prosthetic knees were all negatively correlated, except for an amputated leg during normal pace and healthy leg during fast pace. For an amputee to adapt well to a prescribed prosthesis excellent coordination between the intact and amputated limbs is required to control placement of the amputated leg to achieve a gait comparable to healthy subjects., Conclusion: There are many factors such as the hip, knee flexion/extension and the ankle plantarflexion/dorsiflexion contributing to the control of the transient impact of an amputee during walking. Therefore, for enhanced control of a prosthetic knee, a multifaceted approach is required. This study showed that UTFA adaption to different prosthetic knees in the short term with slower than self-selected speed is completely achievable based on the negative correlation of ground reaction forces versus linear velocity. Reduced speed may provide the prosthetists with the vision of the amputees' progression of adaptation with a newly prescribed prosthetic knee., (Copyright © 2019 IPEM. Published by Elsevier Ltd. All rights reserved.)

Underactuation is widely used when designing anthropomorphic hand, which involves fewer degrees of actuation than degrees of freedom. However, the similarities between coordinated joint movements and movement variances across different grasp tasks have not been suitably examined. This work suggests a systematic approach to identify the actuation strategy with the minimum number for degrees of actuation for anthropomorphic hands. This work evaluates the correlations of coordinated movements in human hands during 23 grasp tasks to suggest actuation strategies for anthropomorphic hands. Our approach proceeds as follows: first, we find the best description for each coordinated joint movement in each grasp task by using multiple linear regression; then, based on the similarities between joint movements, we classify hand joints into groups by using hierarchical cluster analysis; finally, we reduce the dimensionality of each group of joints by employing principal components analysis. The metacarpophalangeal joints and proximal interphalangeal joints have the best and most consistent description of their coordinated movements across all grasp tasks. The thumb metacarpophalangeal and abduction/adduction between the ring and little fingers exhibit relatively high independence of movement. The distal interphalangeal joints show a high degree of independent movement but not for all grasp tasks. Analysis of the results indicates that for the distal interphalangeal joints, their coordinated movements are better explained when all fingers wrap around the object. Our approach fails to provide more information for the other joints. We conclude that 19 degrees of freedom for an anthropomorphic hand can be reduced to 13 degrees of actuation distributed between six groups of joints. The number of degrees of actuation can be further reduced to six by relaxing the dimensionality reduction criteria. Other resolutions are as follows: (a) the joint coupling scheme should be joint-based rather than finger-based and (b) hand designs may need to include finger abduction/adduction movements.

Obstructive sleep apnea (OSA) is a highly prevalent condition in the context of the global obesity epidemic with significant medical comorbidities and psychosocial implications. The first-line treatment of OSA is continuous positive airway pressure (CPAP). There is evidence to demonstrate an association between nasal obstruction and OSA. Therefore, medications and surgical interventions to address nasal obstruction may play a role in the treatment of OSA. In addition, surgical correction of nasal obstruction has been shown to improve CPAP tolerance and compliance., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This research work aims at realizing a new compliant robotic actuator for safe human-robotic interaction. In this paper, we present the modeling, control, and numerical simulations of a novel Binary-Controlled Variable Stiffness Actuator (BcVSA) aiming to be used for the development of a novel compliant robotic manipulator. BcVSA is the proof of concept of the active revolute joint with the variable recruitment of series-parallel elastic elements. We briefly recall the basic design principle which is based on a stiffness varying mechanism consisting of a motor, three inline clutches, and three torsional springs with stiffness values ( K 0 , 2 K 0 , 4 K 0 ) connected to the load shaft and the motor shaft through two planetary sun gear trains with ratios (4:1, 4:1 respectively). We present the design concept, stiffness and dynamic modeling, and control of our BcVSA. We implemented three kinds of Multiple Model Predictive Control (MPC) to control our actuator. The main motivation of choosing this controller lies in the fact that working principle of multiple MPC and multiple states space representation (stiffness level) of our actuator share similar interests. In particular, we implemented Multiple MPC, Multiple Explicit MPC, and Approximated Multiple Explicit MPC. Numerical simulations are performed in order to evaluate their effectiveness for the future experiments on the prototype of our actuator. The simulation results showed that the Multiple MPC, and the Multiple Explicit MPC have similar results from the robustness point of view. On the other hand, the robustness performance of Approximated Multiple Explicit MPC is not good as compared to other controllers but it works in the offline framework while having the capability to compute the sub-optimal results. We also performed the comparison of MPC based controllers with the Computed Torque Control (CTC), and Linear Quadratic Regulator (LQR). In future, we are planning to test the presented approach on the hardware prototype of our actuator., (Copyright © 2018 Hussain, Albalasie, Awad, Seneviratne and Gan.)

Lower extremity amputees suffer from mobility limitations which will result in a degradation of their quality of life. Wearable sensors are frequently used to assess spatio-temporal, kinematic and kinetic parameters providing the means to establish an interactive control of the amputee-prosthesis-environment system. Gait events and the gait phase detection of an amputee's locomotion are vital for controlling lower limb prosthetic devices. The paper presents an approach to real-time gait event detection for lower limb amputees using a wireless gyroscope attached to the shank when performing level ground and ramp activities. The results were validated using both healthy and amputee subjects and showed that the time differences in identifying Initial Contact (IC) and Toe Off (TO) events were larger in a transfemoral amputee when compared to the control subjects and a transtibial amputee (TTA). Overall, the time difference latency lies within a range of ±50 ms while the detection rate was 100% for all activities. Based on the validated results, the IC and TO events can be accurately detected using the proposed system in both control subjects and amputees when performing activities of daily living and can also be utilized in the clinical setup for rehabilitation and assessing the performance of lower limb prosthesis users.

In this paper, a robust probabilistic formulation for prediction of gait events from human walking activities using wearable sensors is presented. This approach combines the output from a Bayesian perception system with observations from actions and decisions made over time. The perception system makes decisions about the current gait events, while observations from decisions and actions allow to predict the most probable gait event during walking activities. Furthermore, our proposed method is capable to evaluate the accuracy of its predictions, which permits to obtain a better performance and trade-off between accuracy and speed. In our work, we use data from wearable inertial measurement sensors attached to the thigh, shank and foot of human participants. The proposed perception system is validated with multiple experiments for recognition and prediction of gait events using angular velocity data from three walking activities; level-ground, ramp ascent and ramp descent. The results show that our method is fast, accurate and capable to evaluate and adapt its own performance. Overall, our Bayesian perception system demonstrates to be a suitable high-level method for the development of reliable and intelligent assistive and rehabilitation robots.

Loss of joints and severed sensory pathway cause reduced mobility capabilities in lower limb amputees. Although prosthetic devices attempt to restore normal mobility functions, lack of awareness and control of limb placement increase the risk of falling and causing amputee to have high level of visual dependency. Haptic feedback can serve as a cue for gait events during ambulation thus providing sense of awareness of the limb position. This paper presents a wireless wearable skin stretch haptic device to be fitted around the thigh region. The movement profile of the device was characterized and a preliminary work with able-bodied participants and an above-knee amputee to assess the ability of users to perceive the delivered stimuli during static and dynamic mode is reported. Perceptibility was found to be increasing with stretch magnitude. It was observed that a higher magnitude of stretch was needed for the stimuli to be accurately perceived during walking in comparison to static standing, most likely due to the intense movement of the muscle and increased motor skills demand during walking activity.

Haptic feedback to lower limb amputees is essential to maximize the functionality of a prosthetic device by providing information to the user about the interaction with the environment and the position of the prostheses in space. Severed sensory pathway and the absence of connection between the prosthesis and the Central Nervous System (CNS) after lower limb amputation reduces balance control, increases visual dependency and increases risk of falls among amputees. This work describes the design of a wearable haptic feedback device for lower limb amputees using lateral skin-stretch modality intended to serve as a feedback cue during ambulation. A feedback scheme was proposed based on gait event detection for possible real-time postural adjustment. Preliminary perceptual test with healthy subjects in static condition was carried out and the results indicated over 98% accuracy in determining stimuli location around the upper leg region, suggesting good perceptibility of the delivered stimuli.

This paper presents a rule-based real-time gait event/phase detection system (R-GEDS) using a shank mounted inertial measurement unit (IMU) for lower limb amputees during the level ground walking. Development of the algorithm is based on the shank angular velocity in the sagittal plane and linear acceleration signal in the shank longitudinal direction. System performance was evaluated with four control subjects (CS) and one transfemoral amputee (TFA) and the results were validated with four FlexiForce footswitches (FSW). The results showed a data latency for initial contact (IC) and toe off (TO) within a range of ± 40 ms for both CS and TFA. A delay of about 3.7 ± 62 ms for a foot-flat start (FFS) and an early detection of -9.4 ± 66 ms for heel-off (HO) was found for CS. Prosthetic side showed an early detection of -105 ± 95 ms for FFS whereas intact side showed a delay of 141 ±73 ms for HO. The difference in the kinematics of the TFA and CS is one of the potential reasons for high variations in the time difference. Overall, detection accuracy was 99.78% for all the events in both groups. Based on the validated results, the proposed system can be used to accurately detect the temporal gait events in real-time that leads to the detection of gait phase system and therefore, can be utilized in gait analysis applications and the control of lower limb prostheses.

Background: Whether elective lymph neck dissection (ELND) is associated with improved survival in oral squamous cell carcinomas (SCC) of the maxillary alveolus/hard palate is not known., Methods: One hundred ninety-nine patients presenting de novo and receiving treatment for clinically node negative SCC of the maxillary alveolus/hard palate at 2 cancer centers between 1985 and 2011 were analyzed., Results: Forty-two patients (21%) received ELND. Occult nodal metastases were present in 29% of the dissected necks. The ELND group had more T3 to T4 status tumors (62% vs 34%; p < .001) and positive-margin resections (59% vs 38%; p = .019). Patients undergoing ELND experienced lower rates of neck recurrence (6% vs 21%; p = .031), superior 5-year recurrence-free survival (68% vs 45%; p = .026), and overall survival (86% vs 62%; p = .043). ELND was associated with a 2-fold decrease in risk of recurrence in multivariable analysis., Conclusion: ELND was associated with lower rates of recurrence and improved survival in SCC of the maxillary alveolus/hard palate. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1688-E1694, 2016., (© 2015 Wiley Periodicals, Inc.)

Importance: Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging., Objective: To develop a statistical tool capable of predicting an individual patient's risk of developing a major complication after surgery for oral cavity squamous cell carcinoma., Design, Setting, and Participants: Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012., Main Outcomes and Measures: The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III-V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram., Results: Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count, preoperative hematocrit, planned neck dissection, and planned tracheotomy. The nomogram predicted a major complication with a validated concordance index of 0.79. Inclusion of surgical operative variables in the nomogram maintained predictive accuracy (concordance index, 0.77)., Conclusions and Relevance: A statistical tool was developed that accurately estimates an individual patient's risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.

Background: The purpose of this study was to describe and compare how postoperative complications after oral cavity squamous cell carcinoma (SCC) surgery are reported in medical records, institutional billing claims, and national clinical registries., Methods: The medical records of 355 previously untreated patients who underwent surgery for oral cavity SCC at our institution were retrospectively reviewed for postoperative complications. Information was compared with claims and National Surgical Quality Improvement Program (NSQIP) data., Results: We identified 219 patients (62%) experiencing 544 complications (10% major). Billing claims identified 29% of these patients, 36% of overall complications, and 98% of major complications. Of overlapping patients, NSQIP identified 27% of patients, 33% of overall complications, and 100% of major complications noted on chart abstraction., Conclusion: The incidence of minor postoperative complications after oral cavity SCC surgery is relatively high. Both claims data and NSQIP accurately recorded major complications, but were suboptimal compared to chart abstraction in capturing minor complications., (© 2014 Wiley Periodicals, Inc.)

This article presents a virtual prototyping study of a semi-active lower limb prosthesis to improve the functionality of an amputee during prosthesis-environment interaction for level ground walking. Articulated ankle-foot prosthesis and a single-axis semi-active prosthetic knee with active and passive operating modes were considered. Data for level ground walking were collected using a photogrammetric method in order to develop a base-line simulation model and with the hip kinematics input to verify the proposed design. The simulated results show that the semi-active lower limb prosthesis is able to move efficiently in passive mode, and the activation time of the knee actuator can be reduced by approximately 50%. Therefore, this semi-active system has the potential to reduce the energy consumption of the actuators required during level ground walking and requires less compensation from the amputee due to lower deviation of the vertical excursion of body centre of mass., (© IMechE 2015.)

A novel polymeric ionic liquid hybrid film-modified electrode, in which the electrode surface is coated with a hydrophobic hybrid material composed of an ionene polymer with quaternary ammonium sites in its polymeric backbone and ionic liquids, was fabricated by electropolymerization of N,N-dimethylaniline in a hydrophobic ionic liquid, which can be applied for the electrogeneration of a superoxide anion via one-electron reduction of O2 in aqueous media.

Events and phases detection of the human gait are vital for controlling prosthesis, orthosis and functional electrical stimulation (FES) systems. Wearable sensors are inexpensive, portable and have fast processing capability. They are frequently used to assess spatio-temporal, kinematic and kinetic parameters of the human gait which in turn provide more details about the human voluntary control and ampute-eprosthesis interaction. This paper presents a reliable real-time gait event detection algorithm based on simple heuristics approach, applicable to signals from tri-axial gyroscope for lower limb amputees during ramp ascending and descending. Experimental validation is done by comparing the results of gyroscope signal with footswitches. For healthy subjects, the mean difference between events detected by gyroscope and footswitches is 14 ms and 10.5 ms for initial contact (IC) whereas for toe off (TO) it is -5 ms and -25 ms for ramp up and down respectively. For transfemoral amputee, the error is slightly higher either due to the placement of footswitches underneath the foot or the lack of proper knee flexion and ankle plantarflexion/dorsiflexion during ramp up and down. Finally, repeatability tests showed promising results.

In the USA, increasing attention is being paid to adopting a value-based framework for measuring and ultimately improving health care delivery. Value is defined as the benefit achieved relative to costs. The numerator of the value equation includes quality of care and outcomes achieved. The denominator includes costs, both financial costs and harms of treatment. Herein, we describe these elements of value as they pertain to head and neck cancer. A particular focus is to identify areas of the value equation where physicians have some control. We examine quality in each of three dimensions: structure, process, and outcomes. We also adopt Porter's three-tiered hierarchy of outcomes model, with specific outcomes relevant to patients with head and neck and thyroid cancer. Finally, we review issues related to costs and harms. We believe these findings can serve as a framework for further efforts to drive value-based delivery of head and neck cancer care.

The corrosion inhibition of mild steel in 0.5 M H2SO4 solution has been investigated using electrochemical methods, X-ray diffraction (XRD) and scanning electron microscope (SEM). The adsorption and inhibition action of acid corrosion of mild steel using cetyltrimethylammonium bromide (CTABr) and different halides (NaCl, NaBr and NaI) has shown synergetic effect. The results showed that the protection efficiency (P%) has high values at considerable high concentration of CTABr. However, in the presence of the different halides, the P increases dramatically at low concentration of CTABr. Physisorption was proposed from the the values of [Formula: see text]. The synergism parameter (S θ) is found to be greater than unity indicating that the enhanced P% caused by the addition of the halides to the CTABr is due to a co-operative adsorption of both species. Corrosion products phases and surface morphology were studied using X-ray diffraction (XRD) and scanning electron microscopy (SEM), respectively.

Peracetic acid (PAA) has been selectively electroanalyzed in the presence of a large excess of hydrogen peroxide (H(2)O(2)), about 500 fold that of PAA, using Au (111)-like gold electrode in acetate buffer solutions of pH 5.4. Au(111)-like gold electrode was prepared by a controlled reductive desorption of a previously assembled thiol, typically cysteine, monolayer onto the polycrystalline gold (poly-Au) electrode. Cysteine molecules were selectively removed from the Au(111) facets of the poly-Au electrode, keeping the other two facets (i.e., Au(110) and Au(100)) under the protection of the adsorbed cysteine. It has been found that Au(111)-like gold electrode positively shifts the reduction peak of PAA, while, fortunately, shifts the reduction peak of H(2)O(2) negatively, achieving a large potential separation (around 750 mV) between the two reduction peaks as compared with that (around 450 mV) obtained at the poly-Au electrode. This large potential separation between the two reduction peaks enabled the analysis of PAA in the presence of a large excess of H(2)O(2). In addition, the positive shift of the reduction peak of PAA gives the present method a high immunity against the interference of the dissolved oxygen., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The aims of this study were to determine the pharmacokinetic parameters of a single dose of 200 mg oral and rectal artesunate in healthy volunteers, and to suggest a rational dosage regimen for rectal administration. The study design was a randomized open cross-over study of 12 healthy volunteers; the analytical method used was a reversed phase high performance liquid chromatography with post column derivatization and subsequent ultraviolet detection. Pharmacokinetic parameters were derived from the main metabolite alpha-dihydroartemisinin data due to the rapid disappearance of artesunate from the plasma. Dihydroartemisinin following oral administration of artesunate had a significantly higher AUC(0-infinity) (P<0.05 95% confidence interval (CI) -1168.73, -667.61 ng x h/mL(-1)) and Cmax (P<0.05; 95% CI -419.73, -171.44 ng/mL(-1)), and had shorter tmax (P<0.05; 95% CI -0.97, -0.10 h) than that following rectal artesunate. There was no statistically significant difference in the elimination half-life between both routes of administration (P>0.05; 95% CI -0.14, 0.53 h). The relative bioavailability of rectal artesunate was [mean (coefficient of variation %) 54.9 (24.8%) %]. On the basis of these data an 8 hourly dosing regimen per day with rectal artesunate is proposed.

A rapid and highly selective potentiometric method for the simultaneous analysis of peracetic acid (PAA) and hydrogen peroxide (H2O2) has been proposed, for the first time, using glassy carbon (GC) as an indicator electrode and I2/I- potential buffer. On the basis of the large difference in the reaction rates of PAA and H2O2 with I-, which was confirmed using stopped-flow spectrophotometry, a transient potential response corresponding to the reactions of the two species with I- was observed. The response times were typically a few seconds and several minutes for PAA and H2O2, respectively. The effects of the concentrations of molybdate catalyst, H+, I2, and I- in the potential buffer on the selectivity as well as the sensitivity were examined. The potential response obtained using the GC indicator electrode was found to be Nernstian over a wide range of their concentrations (typically from micromolar to millimolar) with slopes of 30.5 and 29.5 mV for PAA and H2O2, respectively (in close agreement with the theoretical value, that is, 29.6 mV). O2 was found to have no substantial effect on the potential change at the GC electrode in the present potential buffer.

Documentation on the efficacy of artesunate in Africa is limited, and no experience of artesunate use in Sudan is documented. Severe malaria in rural areas of Sudan, where facilities for the safe and effective use of parenteral quinine are lacking, is a frequent problem. Early treatment with artesunate suppositories would provide a simple method for use by unskilled staff and would be an alternative approach to treat malaria in settings with poor resources. We describe a hospital-based study of rectal artesunate in 100 adult patients with severe falciparum malaria with a dose derived from pharmacokinetic data (200 mg every 8 hours) over 3 days, which halted progression of severe disease and had a low fatality rate. The dosage schedule led to a rapid clinical response and reduced parasite clearance and fever subsidence times of (31.5 +/- 10.1 hours) and (31.4 +/- 11.1 hours). The sequential treatment of rectal artesunate with either doxycycline or pyrimethamine/sulfadoxine or mefloquine resulted in similar clinical cure rates of around 100%, and the combination of artesunate with either doxycycline or pyrimethamine/sulfadoxine was equally effective as mefloquine in preventing recrudescence. There were no significant adverse effects or signs of toxicity related to the treatment observed during the 28-day follow-up. The combination regimens could be used in areas where there is limited access to parenteral therapy for malaria.

The electrochemical behavior of peroxyacetic acid (PAA) in the presence of hydrogen peroxide (H2O2) has been investigated using cyclic voltammetry and hydrodynamic techniques [rotating disk electrode (RDE) voltammetry and rotating ring-disk electrode (RRDE) voltammetry]. The results have been analyzed aiming at simultaneous electroanalysis of both species. Glassy carbon and gold electrodes were used for this investigation. It was found that the reduction of PAA, as well as H2O2, is highly sensitive to the electrode material; for example, at 100 mV s-1, the reduction peak potentials of PAA were 0.2 and -1.1 V at gold and glassy carbon electrodes, respectively. The well-separated steady-state limiting currents were obtained using a gold electrode for the reduction of both PAA and H2O2 and also a well-defined one for the oxidation of H2O2. On the basis of the RDE experiments, good calibration curves were obtained for both species over a wide range of their concentrations, for PAA and H2O2 in the range of 0.36 to 110 and 0.11 to 34 mM, respectively. The simultaneous and selective electroanalysis of PAA and H2O2 in their coexistence is demonstrated for the first time.

A chromatographic method is described for the determination of sodium artesunate in plasma. This includes cetyltrimethylammonium bromide as a cationic pairing ion in a reversed-phase system using an octadecylsilica 100 x 4.6 mm I.D. 3 microm analytical column with a mobile phase of acetonitrile/acetate buffer at pH7. Column switching incorporating a 5 microm octadecylsilica 100 x 4.6 mm I.D. precolumn is used in addition to off-line solid-phase extraction for pretreatment of plasma samples in order to eliminate interference from endogenous components. Detection is by post-column derivatisation with 1.0 M methanolic KOH followed by UV detection at 289 nm. Calibration is linear over the range 100-1600 ng ml(-1) and the limit of detection is estimated as 20 ng ml(-1). Illustrative results are shown of the artesunate plasma levels determined by the proposed method following the administration of artesunate as tablets and as suppositories to healthy volunteers.