Baseline Improvement Research Articles

Reducing micro-machining errors during electric discharge machining of titanium alloy using nonionic liquids

ABSTRACT The study employs nonionic liquids with cryogenically treated tool electrodes to investigate micro-machining errors. An extensive Full Factorial-based experimental campaign is executed involving unmodified process: 12 experiments (kerosene dielectric as baseline for improvement) and modified process: 108 experiments. In modified process, three distinct nonionic liquid types, their concentration, cryogenically treated electrodes, and pulse ON:OFF time are used. All the nonionic liquid-mixed dielectrics have shown noticeable improvement in terms of achieving low machining errors as compared to the conventional dielectric system. In unmodified process, the aluminum and graphite have produced micro machining errors 151.9 µm and 75 µm, respectively. The Desirability Function has recommended (experimentally validated 17.75 µm micro-machining error) the use of cryogenically treated graphite electrode with pulse ON:OFF time of 50:50 µSec and nonionic liquid S-60 with 25 g/L concentration to achieve minimum micro-machining errors with the highest desirability index of 98.60%.

An Improved YOLO for Road and Vehicle Target Detection Model

The yolo series is the prevalent algorithm for target identification at now. Nevertheless, due to the high real-time, mixed target parity, and obscured target features of vehicle target recognition, missed detection and incorrect detection are common. It enhances the yolo algorithm in order to enhance the network performance of this method while identifying vehicle targets. To properly portray the improvement impact, the yolov4 method is used as the improvement baseline. First, the structure of the DarkNet backbone network is modified, and a more efficient backbone network, FBR-DarkNet, is presented to enhance the effect of feature extraction. In order to better detect obstructed cars, a thin feature layer for focused detection of tiny objects is added to the Neck module to increase the recognition impact. The attention mechanism module CBAM is included to increase the model’s precision and speed of convergence. The lightweight network replaces the MISH function with the H-SWISH function, and the improved algorithm improves by 4.76 percentage points over the original network on the BDD100K data set, with the mAP metrics improving by 8 points, 8 points, and 7 points, respectively, for the car, truck, and bus categories. Compared to other newer and better algorithms, it nevertheless maintains a pretty decent performance. It satisfies the criteria for real-time detection and significantly improves the detection accuracy.

Effectiveness of acupuncture at acupoint BL1 (Jingming) in comparison with artificial tears for moderate to severe dry eye disease: a randomized controlled trial

BackgroundThe global incidence of dry eye disease (DED) is very high. DED seriously affects the quality of life of patients; however, the current curative effect of medicine for moderate to severe DED is poor. This randomized clinical trial was planned to investigate the effect of acupuncture compared with artificial tears (AT) on moderate to severe DED.MethodsA randomized clinical trial was performed at 2 hospitals in China. 120 DED patients were randomly equally divided into an acupuncture and an artificial tear group. Either acupuncture or artificial tears was performed for an 8-week period, and a 24-week follow-up was performed. The primary outcome measure was the Schirmer-I test (SIT) change from baseline. The secondary outcome measures included the numerical rating scale (NRS) change from baseline for improvement in ocular symptoms, the ocular surface disease index (OSDI), the tear-film break-up time (TBUT), corneal fluorescein staining (CFS), and acupuncture acceptability. Adverse events also were monitored and documented.ResultsFor the primary outcome, the mean changes from baseline in the SIT values were significantly different between the acupuncture (5.75 [2.53–9.75]) and AT (0.52 [− 1.18–2.46]) groups at week 8 with a between difference of 5.23 (P < 0.05). Between-group differences of 8.49 in OSDI score change from baseline differed significantly at week 8 (P < 0.05). However, between-group differences of the changes in the average symptom NRS score, TBUT, and CFS did not differ significantly at week 8. Five cases experienced acupuncture-related adverse events.ConclusionsThis randomized clinical trial found that acupuncture at BL1 significantly promoted tear secretion. Acupuncture showed greater benefits than AT for moderate to severe DED. However, the study findings warrant verification.Trial registration Registration number: ChiCTR1800015831. Name of trial registry: Efficacy and safety of acupuncture in the treatment of moderate to severe dry eye disease: a randomized controlled trial. Registered on 23 April 2018 (https://clinicaltrials.gov/).

Effect of stacking sequence of fibre metal laminates with carbon fibre reinforced composites on mechanical attributes: Numerical simulations and experimental validation

Fibre Metal Laminates are structures used primarily in aerospace applications because of their principal advantages such as high strength, lower density, and impact resistance. In the present work, a systematic assessment has been made to evaluate two different stacking sequences of FMLs (Type – I (AA 6061/Carbon Fibre/AA 6061/Carbon Fibre/AA 6061), and Type – II (Carbon Fibre/AA 6061/Carbon Fibre/AA 6061/Carbon Fibre)) against a pure carbon composite (Type - III) as baseline for improvement. The investigations are made for enhanced impact resistance, improved tensile strength, increased flexural capability, microstructural evolution, and surface composition. Mechanical-based testing resulted that Type – I shows significant performance followed by Type – II. The maximum values of tensile strength, impact test, and ultimate load bearing capacity of during flexural test were around 192.92 MPa, 9.3 J, and 155 N, respectively. Correlations of experimental results were drawn against numerical simulation to validate the tensile and flexural results. Microstructural evolution indicated good bonding capability of Type – I FML with the carbon fibre. EDX analysis was carried out analyse surface chemistry. Selected Fibre Metal Laminate sequence can help in improving aeronautical industry's structural applications because of good ductile properties together with fatigue strength and impact resistance.

Evaluation of Radiation Doses from Computed Tomography Conducted in Al Jouf Region (Saudi Arabia)

A safe radiation dose from computed tomography (CT) is normally specified through the Computed Tomography Dose Index (CTDI) as an “effective dose.” Radiation exposure from CT is relatively high in comparison with other radiological tests. In this paper, we evaluate doses used on adult patients during typical CT scans, in Al Jouf, the northern region of Saudi Arabia. Scanning processes were taken place in different parts of the body; including the pelvis, head, abdomen, and chest. The dose indices were calculated using the CT-expo v2.5 computer software. A comparison of the results with similar investigations, regionally and globally, was made. Other comparisons between displayed and calculated dose indices were also performed. The main values of CT volume are the dose index (CTDIvol) and dose-length product (DLP). The effectiveness results for head CTs were 45.0 mGy, 488 mGy.cm, and 5.2 mSv; while for pelvic CTs they were 16.4 mGy, 391 mGy.cm, and 4.0 mSv; whereas for abdominal CTs they were 22.2 mGy, 613 mGy.cm, and 6.5 mSv; finally they were 17.5 mGy, 380 mGy.cm, and 3.9 mSv for chest CTs. It is confirmed that the values obtained are within the internationally accepted values, except for the values of the head examination, in which the effective dose value of 5.2 mSv was higher than the recommended value. This work gives an overview of the doses received by adult patients during regular CT examination. It is the first regional CT dose survey and provides a baseline for improvement and quality control in the region of Al Jouf.

Analysis of patient safety culture in an out of hours primary care service.

Aim of this study, part of a European collaborative research project, was to evaluate the "patient safety culture" (PSC) in a primary care out of hours service in order to provide the management with a baseline for improvement interventions. Cross sectional study with the administration of the Safety Attitude Questionnaire Ambulatory Version (SAQ-AV) administered to all the 56 doctors working out of hours in the ULSS 20 Verona Local Health Trust in April/May 2015. For each item of the questionnaire the average score, standard deviation, non-applicability, percentage of agreement, percentage of disagreement were calculated. Doctors working out of hours appreciate the type of work, feel mutual trust and provide support to each other but only 63.6% would feel safe if they would be a patient; little attention to the rules, protocols and evidence-based practices, poor diffusion of culture to learn from the mistakes of other operators and the difficulty of speaking about the mistakes made were detected. Despite the positive perception of the work provided by the group, the doctors seem to feel that the morale of the operators is not optimal and their overall satisfaction is poor. Workload seems to be perceived as a minor issue, differently from the perception of a lack of attention by the management towards the service, lack of support, feedback and recognition, and the lack of reference points for the operators, risk management procedures, recently graduate staff training, equipment provision, regularity and correctness of drug and prescription supply, lack of and loss of essential information to make decisions and lack of communication leading to dysfunction of care. The questionnaire provides decision-makers with useful information about the patient safety culture, identifying critical areas to address improvement efforts.

BIM for client organisations: a continuous improvement approach

Purpose – The purpose of this paper is to propose a continuous improvement approach for clients to improve their performance and to maximise the benefits gained from building information modelling (BIM) over time. The role of client organisations is considered to be very important to accelerate the implementation of BIM. To do this, they need to clearly understand the implementation mechanisms; determine the level of change required within their organisations; and evaluate how best they can achieve this change. The paper’s concept is based on identifying BIM requirements and documenting them in an Employer Information Requirements (EIR) document based on their capability and maturity to deliver and manage BIM. Design/methodology/approach – The continuous improvement approach is based on introducing gradual details to the client’s EIR, depending on the capability and maturity of the client organisation and their supply chain. The approach uses BSI B/555 maturity levels as a baseline for improvement. Findings – A structured approach for client organisations is presented. This helps them to gradually improve their performance towards BIM implementation, taking into consideration their capability and maturity level. Originality/value – The proposed approach is new to industry and could contribute to the efforts of the industry in reaching higher BSI B/555 maturity levels with minimal risks.

Development of an improved framework for the conceptual design of a rotorcraft

Purpose – The purpose of the present paper is to obtain the capability of designing modern rotorcrafts with enhanced accuracy and reliability. Design/methodology/approach – Among the existing rotorcraft design programs, an appropriate program was selected as a baseline for improvement. It was based on a database comprising conventional fleets of rotorcrafts. The baseline program was not robust because it contained a simple iteration loop, which only monitored the gross weight of the aircraft. Therefore, it is not accurate enough to fulfill the quality and sophistication of a conceptual design framework useful for present and future generations of rotorcrafts. In this paper, the estimation formulas for the sizing and weight of the rotorcraft subsystem were updated by referring to modern aircraft data. In addition, trend curves for various turboshaft engines available these days were established. Instead of using the power estimation algorithm based on the momentum theory with empirical corrections, blade e...

A Risk Factor-based Predictive Model of Outcomes in Carotid Endarterectomy

Accurate knowledge of individualized risks and benefits is crucial to the surgical management of patients undergoing carotid endarterectomy (CEA). Although large randomized trials have determined specific cutoffs for the degree of stenosis, precise delineation of patient-level risks remains a topic of debate, especially in real world practice. We attempted to create a risk factor-based predictive model of outcomes in CEA. We performed a retrospective cohort study involving patients who underwent CEAs from 2005 to 2010 and were registered in the American College of Surgeons National Quality Improvement Project database. Of the 35 698 patients, 20 015 were asymptomatic (56.1%) and 15 683 were symptomatic (43.9%). These patients demonstrated a 1.64% risk of stroke, 0.69% risk of myocardial infarction, and 0.75% risk of death within 30 days after CEA. Multivariate analysis demonstrated that increasing age, male sex, history of chronic obstructive pulmonary disease, myocardial infarction, angina, congestive heart failure, peripheral vascular disease, previous stroke or transient ischemic attack, and dialysis were independent risk factors associated with an increased risk of the combined outcome of postoperative stroke, myocardial infarction, or death. A validated model for outcome prediction based on individual patient characteristics was developed. There was a steep effect of age on the risk of myocardial infarction and death. This national study confirms that that risks of CEA vary dramatically based on patient-level characteristics. Because of limited discrimination, it cannot be used for individual patient risk assessment. However, it can be used as a baseline for improvement and development of more accurate predictive models based on other databases or prospective studies.

Mid-Course Evaluation of a Research Methodology Course as a Baseline for Improvement

Epilepsi merupakan gejala penyerta yang sering terjadi pada anak-anak penderita Cerebral Palsy (CP). EEG merupakan salah satu Gold Standard untuk mendeteksi adanya gelombang aktivitas epilepsi yang terjadi pada anak-anak dengan CP. Tujuan dari penelitian ini adalah untuk mengetahui angka kejadian dan prevalensi Epilepsi pada anak penderita CP. Penelitian ini berupa deskriptif analitik, data diperoleh secara retrospektif terhadap penderita yang memenuhi syarat diagnosis CP dengan epilepsi. Diagnosis ditegakkan berdasarkan telaah rekam medis meliputi anamnesis, pemeriksaan fisik dan neurologis serta pemeriksaan penunjang berupa EEG dan MRI Kepala. Prevalensi penderita CP dengan epilepsi pada penelitian ini adalah 108%. Tipe epilepsi terbanyak pada penderita CP adalah general yaitu 160 penderita (83%), sementara tipe fokal hanya 32 penderita (17%). Pada penderita CP dengan epilepsi, tipe CP terbanyak adalah tetraparesis (81%). Pada penderita CP tanpa epilepsi, tipe CP terbanyak adalah tetraparesis (51 penderita; 65.38%). Gambaran EEG terbanyak pada penderita CP dengan epilepsi adalah multifokal (56%), diikuti perlambatan (26%) dan unifokal (18%). Prevalensi penderita cerebral palsy dengan epilepsi pada penelitian ini mencapai 1.08%. Penderita CP dengan epilepsi mengalami epilepsi tipe general lebih banyak dibandingkan fokal. Sebagian besar penderita cerebral palsy dengan epilepsi mengalami tipe tetraparesis. Sebagian besar gambaran EEG pada penderita cerebral palsy dengan epilepsi adalah multifokal.

A population-based series of uterine carcinosarcomas with long-term follow-up

Background. Carcinosarcomas are a highly malignant type of endometrial carcinomas where extra uterine spread and recurrences are frequent. There is no consensus regarding the best treatment of this group of malignancies. Material and methods. In a complete geographic series of 322 cases of primary uterine carcinosarcomas prophylactic pelvic irradiation and/or chemotherapy was used as postoperative treatment in the majority of the cases. Vaginal brachytherapy was also added as a boost. The primary surgery was extended hysterectomy in 23 cases (10%), and simple hysterectomy in 220 cases (90%). In 46 cases (14%) no major surgery was possible. Results. In the complete series 123 recurrences (38%) were recorded. Locoregional recurrences (11%) and distant recurrences (28%) were most frequent. Type and extent of surgery was not associated with the risk of tumor recurrence. Extended surgery did not reduce the risk of local and regional recurrences. In the complete series, the five-year overall survival rate was 30% and the recurrence-free survival (RFS) rate was 27%. The five-year pelvic disease control was 82% in stage I, 68% in stage II, and 76% for more advanced stages. The five-year locoregional RFS rate was 63% for patients treated with surgery alone, 68% after addition of adjuvant chemotherapy, 86% after adjuvant radiotherapy, and 95% after combined chemotherapy and radiotherapy. Conclusion. Radiotherapy seems to be the most important constituent of the adjuvant therapy. Serious late tissue reactions, requiring surgery, from the bladder and intestine occurred in 2.5% of the irradiated cases. The death of three patients could be related to radiotherapy and of four patients due to the cytotoxic treatment. This population-based series may serve as a baseline for improvements by, e.g. standard care programs and referral to a few specialist centers for this rare and serious disease.

A 3‐month survey of enteral tube feeding and parenteral feeding: a baseline for improvement

This paper presents the results of a 3‐month survey of tube feeding and parenteral nutrition in hospital in‐patients, undertaken to provide information for the development of guidelines by the Hospitals Nutritional Advisory Group and a baseline for future monitoring. This represents the first steps in the audit cycle. The results highlighted the following problems. Total parenteral nutrition is often continued after bowel sounds have returned. Enteral tube feeding is often instituted for only a very short period of time and may be of little nutritional benefit to the patient. Significantly lower amounts of energy and nitrogen are received by the patients in the enterally tube‐fed group than is indicated by their estimated energy and nitrogen requirements. The medical staff noted the start of feeding in 60% of the case notes, however, the aims of feeding and the reason for commencing feeding were never documented. Nutritional aims were defined in the case notes by dietitians for all tube‐fed and 18 of the 20 patients who were parenterally fed.

Physiologic and Antibiotic (Penicillin) Therapy in Chronic Hypertrophic Pulmonary Emphysema

A report is presented of the results of physiologic therapy and antibiotic (penicillin) treatment in patients with pulmonary emphysema. In this group of cases the associated diagnosis was more commonly bronchial asthma, less frequently pulmonary fibrosis, bronchiectasis, sinusitis and chronic bronchitis. The results of treatment may be summarized as follows: Of 86 courses of treatment in 51 patients clinical improvement attributable chiefly to penicillin therapy was marked in 20, moderate in 19, slight in 25; in 22 no improvement took place. The results of physiologically directed therapy in the same group were marked improvement in 9, moderate in 36, slight in 23 and none in 18. Of a total of 86 courses, 66 cases manifested moderate or marked improvement. In analyzing the role played by each therapeutic factor as well as could be determined, 31 of the 66 improved cases appeared to be more influenced by physiologic therapy, 27 by penicillin treatment, with an equal effectiveness in 8 cases. In some of the cases treated in this series previous exposure to physiologic therapy had resulted in a baseline of improvement, which gave the appearance of less striking effect from this type of therapy than might have been anticipated in patients who had not been treated by the procedures used in bronchial relaxation and inhalational therapy. The study of the sputum culture before and after treatment revealed the characteristic disappearance of gram positive organisms in the majority of cases with replacement by gram negative bacteria. In most cases penicillin was administered as an aerosol but favorable results were also obtained with systemic administration. The response to varying modes of treatment of the individual case is presented in tabular form.