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The increasing prevalence of aortic stenosis (AS) and the increasing number of patients indicated for transcatheter aortic valve implantation (TAVI) can lead to increased hospital constraints. This study aimed to compare, from the hospital perspective, the costs, resource use, and 30-day clinical outcomes of patients who underwent TAVI under an optimized or standard clinical pathway. A single-center, retrospective study was conducted among patients with native AS who underwent TAVI between January 2018 and March 2021. Patients who underwent optimized lean TAVI were propensity-score matched 1:1 to those who underwent standard TAVI. In-hospital costs and 30-day clinical outcomes were compared between the 2 groups. A total of 182 patients (91 in each group) were included in the final analysis. Baseline covariates were well balanced after matching. Patients who underwent lean TAVI had shorter length of stay (median [interquartile range] 3.0 days [2.0 to 6.0] vs 6.0 days [5.0 to 9.0], p0.001). Patients in the lean TAVI group incurred lower total costs than did those in the standard TAVI group (mean ± SD: $41,346 ± 10,062 vs $50,471 ± 15,115, p = 0.002). There was no between-group difference in 30-day all-cause mortality (2.2% vs 1.1%, p = 0.573) and pacemaker implantations (5.5% vs 6.6%, p = 0.788). Rates of procedural complications were comparable between groups. In conclusion, lean TAVI leads to hospital efficiencies without compromising patient safety. Efforts to streamline the TAVI procedure should be encouraged to improve access to TAVI for patients with AS, amid resource constraints.

Intelligent and accurate determination of the position and orientation, or pose, of a workpiece which is manually placed is essential for automating fabrication tasks such as welding. In this paper, a novel algorithm based on minimizing the area of a boundary enclosing partial scan data points is proposed for detecting both the pose and assembly of tubular joints with the aid of reference ideal models. The proposed algorithm can also be applied to tubular joints with non-cylindrical cross sections. The fit-up information obtained can be used to determine whether realignment is required or combined with the pose information to re-plan paths for subsequent tasks. The focus of existing state-of-the-art is on objects with features, and the localization of featureless objects such as generic tubular joints using partial and sparse scan data remains a challenge. The proposed algorithm is applied to an actual robotic welding system to locate a tubular workpiece. Experiment results using the scan data as ground truth show that root mean square error is less than 1% of the pipe diameters, considering both brace and chord components with diameters greater than 200 mm.

Use of glucose-lowering agents is a cornerstone in combating type 2 diabetes (T2DM). Treatment guidelines have changed significantly over the past decade. We report temporal trends in medication utilization, glycemic control and rate of severe hypoglycemia in T2DM patients at a tertiary referral center in Singapore.We analyzed data of 36 924 T2DM patients seen at Singapore General Hospital from 2007 to 2017. Annual age-, sex- and racially-standardized proportions of patients (a) prescribed with each class of glucose-lowering agent, (b) on various glucose-lowering regimens, and (c) had an HbAFrom 2007 to 2017, use of metformin (45.9% to 59.6%) and insulin (24.4% to 57.9%) increased, while utilization of sulfonylureas (52.0% to 44.9%) decreased (all P 0.001). Utilization of dipeptidyl peptidase-4 inhibitors (1.2% to 31.2%) and sodium-glucose cotransporter-2 inhibitors (0.5% to 7.4%) increased from 2008 to 2017 and 2012 to 2017, respectively (all P 0.001). More patients were prescribed a combination of insulin and oral agents (17.3% to 46.0%, P 0.001). The proportion of patients with HbAMedication utilization patterns have changed significantly over the past 11 years with a shift towards newer agents. Glycemic control has remained stable, and rate of severe hypoglycemia increased. Further analysis is required before causal relationships can be inferred.背景: 使用降糖药物治疗是对抗2型糖尿病(T2DM)的重要组成部分。在过去的十年中，治疗指南发生了显著的变化。我们报告了在新加坡的一个三级转诊中心里，T2DM患者的药物使用、血糖控制以及严重低血糖发生率随着时间的变化趋势。 方法: 我们分析了36924名从2007至2017年间在新加坡综合医院就诊的T2DM患者数据。每年按年龄、性别以及种族-标准化后的患者比例使用logistic回归进行分析，纳入分析的患者包括(a)所处方的每类降糖药物，(b)正在使用的各种降糖治疗方案，以及(c)HbA1c小于6%、6%至小于7%、7%至小于8%、8%至小于9%，或者9%至更高水平。采用泊松回归法来评估严重低血糖的标准化发生率。 结果: 从2007至2017年，二甲双胍(从45.9%至59.6%)与胰岛素(从24.4%至57.9%)的使用率增加了，而磺脲类药物的使用率下降了(从52.0%至44.9%)(全部P0.001)。从2008至2017年与从2012至2017年，二肽基肽酶-4抑制剂(从1.2%至31.2%)与钠-葡萄糖共转运体-2抑制剂(从0.5%至7.4%)的使用率也增加(全部P0.001)。有更多比例(从17.3%至46.0%)的患者处方是联合使用胰岛素与口服药物治疗(P0.001)。HbA1c大于等于8%的患者比例(从33.7%至36.0%)增加了(P0.001)。严重低血糖的发生率也升高了(从5.0至8.4次/每100名患者/年，P0.001)。 结论: 在过去的11年中，药物的使用模式发生了显著的变化，变得愈来愈倾向于选择新的治疗药物。血糖控制情况保持稳定，但是严重低血糖的发生率有所上升。在推断因果关系之前需要进一步的分析。.

Background Periventricular leukoaraiosis may be an important pathological change in postural instability gait disorder (PIGD), a motor subtype of Parkinson's disease (PD). Clinical diagnosis of PIGD may be challenging for the general neurologist. Purpose To evaluate 1) the utility of a fully automated volume‐based morphometry (Vol‐BM) in characterizing imaging diagnostic markers in PD and PIGD, including, 2) novel deep gray nuclear lesion load (GMab), and 3) discriminatory performance of a Vol‐BM model construct in classifying the PIGD subtype. Study Type Prospective. Subjects In all, 23 PIGD, 21 PD, and 20 age‐matched healthy controls (HC) underwent MRI brain scans and clinical assessments. Field Strength/Sequence 3.0T, sagittal 3D‐magnetization‐prepared rapid gradient echo (MPRAGE), and fluid‐attenuated inversion recovery imaging (FLAIR) sequences. Assessment Clinical assessment was conducted by a movement disorder neurologist. The MR brain images were then segmented using an automated multimodal Vol‐BM algorithm (MorphoBox) and reviewed by two authors independently. Statistical Testing Brain segmentation and clinical parameter differences and dependence were assessed using analysis of variance (ANOVA) and regression analysis, respectively. Logistic regression was performed to differentiate PIGD from PD, and discriminative reliability was evaluated using receiver operating characteristic (ROC) analysis. Results Significantly higher white matter lesion load (WMab) (P

Background Burnout describes emotional exhaustion (EE), depersonalization (DP), and low personal achievement caused by work and is known to bring about negative consequences to practitioners, patients, and health systems. Various organizational and personal factors, such as organizational strategies and resilience, have been associated with this phenomenon. However, there is a paucity of data describing the prevalence of burnout among pharmacy staff within Singapore and Asia, especially in the pharmacy technician (PT) population. Objectives This study aimed to (1) quantify burnout in PTs in patient-care sectors in Singapore and (2) explore factors that may be associated with burnout. Methods A cross-sectional survey among PTs in patient-care areas in Singapore, which includes hospitals, primary and secondary care institutions, and retail pharmacies, across both public and private sectors was conducted from February to April 2020. The Maslach Burnout Inventory – Human Services Survey and Brief Resilience Scale were used to assess burnout and resilience among participants. Demographic, employment, and well-being information were also collected and summarized. Univariate analysis and multivariate logistic regression were used to assess associations between burnout and potential risk and impact factors. Results Slightly more than half (52.0%) of PTs reported burnout (EE score ≥ 27 or DP ≥ 10 or both). Statistically significant factors associated with burnout include resilience, age, years of experience, ethnicity, marital status, nationality, highest qualifications, pharmacy-related certification, full-time employment status, and work hours. Impact associated with burnout includes intent for job change, job satisfaction, sleep, and presence of mental conditions. Statistically significant reported reasons for burnout and ways to build resilience were also elucidated. Conclusion Burnout affects most PTs in Singapore and is primarily driven by workload and nature of their work, low resilience, and poor social support structures. National and organizational efforts are needed to arrest the vicious cycle that propagates burnout in PTs.

Background/aims Inflammatory bowel disease (IBD) is associated with considerable impairment of patients' health-related quality of life (HRQoL). Knowledge of factors that significantly affect IBD patients' HRQoL can contribute to better patient care. However, the HRQoL of IBD patients in non-Western countries are limited. Hence, we assessed the HRQoL of Singaporean IBD patients and identified its determinants. Methods A prospective, cross-sectional study was conducted at Singapore General Hospital outpatient IBD Centre. The HRQoL of IBD patients was assessed using the short IBD questionnaire (SIBDQ), Short Form-36 physical and mental component summary (SF-36 PCS/MCS) and EuroQol 5-dimensions 3-levels (EQ-5D-3L) and visual analogue scale (VAS). Independent samples t-test was used to compare HRQoL between Crohn's disease (CD) and ulcerative colitis (UC). Determinants of HRQoL were identified through multiple linear regression. Results A total of 195 IBD patients (103 UC, 92 CD) with a mean disease duration of 11.2 years were included. There was no significant difference in HRQoL between patients with UC and CD. Factors that significantly worsened HRQoL were presence of active disease (b=-6.293 [SIBDQ], -9.409 [PCS], -9.743 [MCS], -7.254 [VAS]), corticosteroids use (b=-7.392 [SIBDQ], -10.390 [PCS], -8.827 [MCS]), poor medication adherence (b=-4.049 [SIBDQ], -1.320 [MCS], -8.961 [VAS]), presence of extraintestinal manifestations (b=-13.381 [PCS]), comorbidities (b=-4.531 [PCS]), non-employment (b=-9.738 [MCS], -0.104 [EQ-5D-3L]) and public housing (b=-8.070 [PCS], -9.207 [VAS]). Conclusions The HRQoL is impaired in this Asian cohort of IBD. The magnitude of HRQoL impairment was similar in UC and CD. Clinical characteristics were better determinants of patients' HRQoL than socio-demographic factors. Recognizing the factors that impact patients' HRQoL would improve the holistic management of IBD patients.

In this paper, we propose a Nyquist plot-based method for finite-frequency reshaping of the mechanical plant considering a low-order controller, which significantly reduces the large gap between actual robust stability and desired probability tolerance for closed-loop stability $(1-\epsilon )$ due to linear matrix inequality conservatism. The solution region for the open-loop Nyquist plot is derived based on the simultaneous use of two Nyquist planes. The chance-constrained robust stability criterion is represented on one Nyquist plane using a square region centered at $(-1+j0)$ , which has to be avoided over all frequencies. The other Nyquist plane contains commonly used graphical constraints from performance specifications. Our simulation results using the proposed graphical method achieves a robust stability of 97.1% based on a desired probability tolerance of $(1-\epsilon )=0.70$ for closed-loop robust stability. As such, a high-bandwidth control system with the desired disturbance attenuation capabilities while ensuring stable zeros is achieved as compared with the existing methods in the literature.

Purpose of review Patient-reported outcome measures (PROMs) and patient registries both play important roles in assessing patient outcomes. However, no study has examined the use of PROMs among registries involving patients with type 2 diabetes mellitus (T2DM). Our objective is twofold: first, to review the range of PROMs used in registry-based studies of patients with T2DM; second, to describe associations between these PROMs, T2DM and its complications. Recent findings The International Consortium for Health Outcomes Measurement (ICHOM) Diabetes Standard Set recommended routine usage of PROMs to assess psychological well-being, diabetes distress, and depression among patients with T2DM. A wide variety of PROMs were used among the 15 studies included in this review. Quality of life, depressive symptoms and treatment adherence were the most common aspects of T2DM that utilised PROMs for assessment. Adoption of PROMs among registries of patients with T2DM remains uncommon, non-routine and with few that are validated before use.

BACKGROUND Primary medication non-adherence (PMN), defined as failure to obtain newly prescribed medications, results in adverse clinical and economic outcomes. We aimed to (a) assess the prevalence of PMN in six common chronic diseases: asthma and/ or chronic obstructive pulmonary disease, depression, diabetes mellitus, hyperlipidaemia, hypertension and osteoporosis; (b) identify and categorise factors associated with PMN; (c) explore characteristics that contributed to heterogeneity between studies. METHODS We performed a systematic search in MEDLINE, Embase, Cochrane Library, CINAHL and PsycINFO. Studies published in English between January 2008 and August 2018 assessing PMN in subjects aged ≥18 years were included. We used the Cochrane risk of bias tool, Newcastle-Ottawa Scale and National Heart, Lung and Blood Institute Quality Assessment Tool to assess the quality of randomised controlled trials, cohort and cross-sectional studies, respectively. Findings were reported using the PRISMA checklist. PMN rates were pooled using a random effects model. We summarised factors associated with PMN descriptively. Subgroup analysis was performed to explore sources of heterogeneity. RESULTS We screened 3083 articles and included 33 (5 randomised controlled trials, 26 cohort and 2 cross-sectional studies, n = 539 156), of which 31 (n = 519 971) were used in meta-analysis. The pooled PMN rate was 17% (95% CI: 15%-20%). Pooled PMN rates were highest in osteoporosis (25%, 95% CI: 7%-44%) and hyperlipidaemia (25%, 95% CI: 18%-32%) and lowest in diabetes mellitus (10%, 95% CI: 7%-12%). Factors commonly associated with PMN include younger age, number of concurrent medications, practitioner specialty and higher co-payment. Type of chronic disease, age, study setting and PMN definition contributed to heterogeneity between studies (all P

In this paper, a Nyquist plot-based method which reduces the conservatism associated with Linear Matrix Inequality (LMI) approximation of ambiguous chance constraints is proposed for the design of robust mechatronic systems. The mechanical plant and controller are redesigned over finite frequencies by shaping the open loop Nyquist plot to avoid an ambiguous chance-constrained robust stability disc. Commonly used graphical constraints such as the sensitivity disc are also included in order to satisfy the performance specifications. Our simulation results using the proposed graphical method achieves a robust stability of 91.8% based on a desired probability tolerance for closed-loop stability of (1 — e) = 0.70 as compared with LMI approximation, which requires the standard deviation of the parametric uncertainties to be reduced by four times in order to satisfy an identical (1 — e), and achieves a robust stability of 100%.

Automatic welding of tubular TKY joints is an important and challenging task for the marine and offshore industry. In this paper, a framework for tubular joint detection and motion planning is proposed. The pose of the real tubular joint is detected using RGB-D sensors, which is used to obtain a real-to-virtual mapping for positioning the workpiece in a virtual environment. For motion planning, a Bi-directional Transition based Rapidly exploring Random Tree (BiTRRT) algorithm is used to generate trajectories for reaching the desired goals. The complete framework is verified with experiments, and the results show that the robot welding torch is able to transit without collision to desired goals which are close to the tubular joint.

Object detection for large tubular joints is one of the major challenges for robotic welding. These tubular joints are texture-less objects with a shiny and strongly reflective surface. Additionally, they are attached with large fixtures resulting in dense self-occlusion. Due to this, it is difficult to plug-and-play existing 3D object recognition pipelines. This paper presents a hierarchical CAD tree (HCT), generated using a 3D CAD model at the root node, partial views as successive layer nodes and segmented-partial views, as leaf nodes of the tree. This hierarchical approach stores the assembly information of the leaf nodes that is used for our hypothesis verification pipeline. The complete method is tested using a RGB-D sensor mounted on a robotic manipulator on a gantry, to detect tubular joints in a shipyard environment. The framework demonstrates that the proposed approach can detect horizontal and diagonal configurations of tubular joints despite high levels of occlusion.

Automated and accurate determination of the pose of a roughly placed workpiece is essential for fabrication tasks such as robotic welding. In this paper, an algorithm based on cylinder fitting and Iterative Closest Point (ICP) alignment is proposed for detecting both the pose and assembly error of tubular joints in a T-, K-, or Y-shaped configuration using partial scan data. A typical TKY joint consists of a brace and a chord component. In order to also compute the assembly error, the poses of the individual joint components are determined separately. The pose information is obtained by aligning scan data points with ideal CAD models using cylinder fitting and ICP matching techniques. Due to uniformity of the chord surface, assembly error due to a translation along, or a rotation about the chord longitudinal axis are not determined. The assembly error obtained can be used to determine whether realignment is required, or combined with the pose information to re-plan paths for subsequent tasks. The effectiveness of the proposed algorithm is verified with simulation studies and application to an actual robotic welding system to locate a tubular workpiece.

Tumor-specific antibody drugs can serve as cancer therapy with minimal side effects. A humanized antibody, PRL3-zumab, specifically binds to an intracellular oncogenic phosphatase PRL3, which is frequently expressed in several cancers. Here we show that PRL3-zumab specifically inhibits PRL3+ cancer cells in vivo, but not in vitro. PRL3 antigens are detected on the cell surface and outer exosomal membranes, implying an ‘inside-out’ externalization of PRL3. PRL3-zumab binds to surface PRL3 in a manner consistent with that in classical antibody-dependent cell-mediated cytotoxicity or antibody-dependent cellular phagocytosis tumor elimination pathways, as PRL3-zumab requires an intact Fc region and host FcγII/III receptor engagement to recruit B cells, NK cells and macrophages to PRL3+ tumor microenvironments. PRL3 is overexpressed in 80.6% of 151 fresh-frozen tumor samples across 11 common cancers examined, but not in patient-matched normal tissues, thereby implicating PRL3 as a tumor-associated antigen. Targeting externalized PRL3 antigens with PRL3-zumab may represent a feasible approach for anti-tumor immunotherapy., Phosphatase of regenerating liver 3 (PRL3) is usually found intracellularly, and is over-expressed in cancer cells. Here the authors show that PRL-3 is also detectable on cell surface, and can be recognized by PRL3-zumab to recruit immune cells into tumor to promote anti-tumor immunity, thereby implicating PRL-3 as a potential tumor antigen.

In this brief, we propose a convex separable parametrization technique for finite frequency reshaping of the mechanical plant and low-order controller in high-performance mechatronic systems simultaneously. Using the generalized Kalman–Yakubovich–Popov lemma with low-order moments and support for parametric uncertainties, the individual chance-constrained robust stability criterion is formulated and solved via several convex linear matrix inequalities while ensuring stable zeros with a positive realness condition. Our simulation results on the Pb–Zr–Ti active suspension in a commercial $3.5''$ dual-stage hard disk drive achieve a high-bandwidth control system and desired disturbance attenuation capabilities, with a stability of 98.2% in proportion of perturbed systems as compared with standard methods in the current literature.

ZnO nanostructure based energy harvesting devices (ZnO nanogenerator) were fabricated using ZnO nanorods with the surface modified using a polyelectrolyte assembly comprising bi-layers of Polydiallyldimethylammonium chloride and Polystyrene sulfonate. The peak open-circuit voltage device characteristics and power delivered across a load increased in relation to the number of bi-layers in the polyelectrolyte deposition. At the highest loading of polyelectrolyte the energy harvesters generated a peak power density of 426 µW cm−2 and 1 V peak open-circuit voltage at a peak tip acceleration of 50 g. This compares to 35 µW cm−2 without polyelectrolyte. We relate this significant enhancement in device performance to the screening of mobile carriers due to an interaction of the polar polyelectrolyte materials with the surface of the ZnO nanostructures. It is proposed that the adsorption of the polyelectrolyte on the ZnO interacts with the surface defects and reduces the rate of screening and trapping of carriers leading to increased performance.

High-performance mechatronics have specifications which are difficult to achieve when the mechanical plant is non-minimum phase and a low-order controller is used. In this paper, an integrated servo-mechanical design algorithm is proposed for systematic finite frequency redesign of a mechanical plant using the generalized Kalman---Yakubovic---Popov Lemma. The synthesis of a minimum phase plant is carried out based on a predesigned low-order controller, positive realness constraints, and performance specifications of the overall control system. Our simulation results using the proposed algorithm achieve a high-bandwidth control system with disturbance attenuation capabilities at the phase-stabilized resonant modes of the plant with the low-order controller.

Lightly damped resonant modes at above the Nyquist frequency which are not phase-stabilized result in aliased narrow-band disturbances. In this paper, an elliptical transformation-based scheme is proposed for phase-stabilization of resonant modes at above the Nyquist frequency. Our experimental results on the Pb-Zr-Ti active suspension in a commercial 3.5 ${''}$ dual-stage hard disk drive show that narrow-band disturbances are suppressed without large spillover effects at an aliased resonant mode at 4.23 kHz, which is in close proximity with an out-of-phase resonant mode at 3.50 kHz.

Performance specifications and robust stabilization of mechatronics are generally difficult to achieve simultaneously with a low-order controller. In this paper, an integrated servo-mechanical design algorithm is proposed for finite frequency redesign of a mechanical plant using the Generalized Kalman-Yakubovic-Popov (GKYP) Lemma. The plant is synthesized based on a pre-designed low-order controller, and robust stability criterion of the overall control system in the presence of Gaussian plant parametric perturbations is also included. Our simulation results using the proposed algorithm achieve a high-bandwidth control system with disturbance attenuation capabilities at the phase-stabilized resonant modes of the plant, and is robustly stable to uniform plant parametric perturbations with the low-order controller.

In this paper, a filling control strategy is proposed for robotic welding of thick materials which requires multipass welding. The multi-pass welding process is formulated as a closed-loop control design problem. A PI controller is used in the baseline loop for regulating the seam boundary error in the current pass; a non-causal feedforward controller is designed using the H∞ loop shaping technique for regulating the error from previous welding passes. Simulation results show that as compared to without using a feedforward controller, error propagation on the seam boundary will be eliminated within six passes for disturbances occurring only in the first filling pass, and error amplification is contained within four passes for disturbances occurring at the same position in every filling pass.

In this paper, a modified entropy-based algorithm is proposed for identification and reconstruction of a complex weld geometry. The edge of the weld geometry is identified based on minimizing a modified entropy-type cost function, and the weld geometry is reconstructed based on the detected edge. In addition, the volume of the weld geometry is computed using the point cloud samples of the identified weld geometry, and the effects of Gaussian noise are also considered. Our simulation results using the proposed reconstruction algorithm demonstrate efficient identification and reconstruction of a complex weld geometry in the presence of Gaussian noise.

In this paper, an adaptive sampling algorithm is proposed for reconstruction of a complex weld geometry based on the obtained 3D point cloud. Several pivotal samples for reconstructing the weld geometry are selected from the point cloud using a randomized strategy in the initial stage of the iterative algorithm. Based on the pivotal samples, the model is incrementally refined in the second stage by adaptive sampling of the neighbors using three depth comparison functions. Our simulation results using the proposed sampling algorithm demonstrate significant improvements in total samples drawn, number of iterations, and computation time while ensuring zero duplicate acceptance, as compared to random sampling approaches with and without replacement.

Integrated servo-mechanical design is commonly solved using numerical methods. In this paper, allowable regions for the redesigned open loop Nyquist plot are derived based on performance and chance-constrained robust stability specifications, considering high-frequency reshaping of the mechanical plant based on a low-order controller. Our simulation results on the Pb-Zr-Ti active suspension in a commercial 3.5" dual-stage hard disk drive achieve a single-stage feedback control system with guaranteed disturbance attenuation capabilities and robust stability.

Integrated servo-mechanical design for achieving control specifications and robust stabilization of high-performance mechatronics is generally a nonlinear and nonconvex optimization problem. In this paper, a convex separable parametrization is proposed for simultaneous finite frequency redesign of the mechanical plant and controller considering performance specifications and plant parameter distributions of known mean, variance, and support. The robust stability criterion is satisfied using several convex constraints under the conditional-value-at-risk measure. Our simulation results using the proposed algorithm achieve a high-bandwidth control system with guaranteed disturbance attenuation capabilities at the phase-stabilized resonant modes, and is robustly stable under distributional changes in plant parameters.

Integrated servo-mechanical design for achieving positive realness constraints and control specifications of high-performance mechatronics is generally a nonlinear and nonconvex optimization problem. In this paper, a generalized Kalman-Yakubovic-Popov Lemma-based algorithm is proposed for simultaneous finite frequency redesign of the mechanical plant and controller using a convex separable parametrization. Our simulation results using the proposed algorithm achieve a high-bandwidth control system with disturbance attenuation capabilities at the phase-stabilized resonant modes. An identical closed-loop performance is achieved with a reduced-order controller from considering the mechanical realization of controller anti-resonant zeros.