Extension Arm Research Articles

Nonsurgical orthodontic treatment using bone-anchored maxillary protraction in a patient with unilateral cleft lip and palate.

Class III malocclusion due to a retrognathic maxilla is common in patients with cleft lip and palate. Skeletally anchored maxillary protraction using screw-anchored mini-plates combined with intraoral elastics has shown promising results in achieving orthopedic changes and maintaining the outcome until the completion of the growth. This case report presents the course of treatment in a patient with unilateral cleft lip and palate and multiple congenitally missing teeth treated with bone-anchored maxillary protraction until the end of growth. Four mini-plates (Bollard plates) were used during comprehensive fixed orthodontic treatment to protract the dentition and close the space where teeth were missing, extrude the canine, and force eruption of the second premolar using extension arms and cantilevers. A 2-year follow-up at age 17 showed stable occlusion and maintenance of soft tissue results. Bone-anchored maxillary protraction treatment in a patient with cleft lip and palate demonstrates proper orthopedic results and could be a viable alternative to orthognathic surgery.

A new method for motion stability improving of dual-robotic ultrasonic nondestructive testing system

The dual-robotic ultrasonic nondestructive testing (NDT) system equipped with extension arm is an effective means to realize automatic ultrasonic testing of composite semi-enclosed workpieces. However, this cantilever structure amplifies the tiny vibrations of the inspection system, which seriously affects the coupling effect and the resolution of ultrasonic inspection. To solve the problem, this paper proposes a S-shaped acceleration and deceleration feature control algorithm to improve the motion stability and further to improve the inspection resolution of dual-robotic ultrasonic NDT system. Furthermore, the specific steps of S-shaped acceleration and deceleration features control algorithm in trajectory planning of the dual-robotic ultrasonic NDT system are described in detail. Comparative experiments of motion stability show that the acceleration in the x direction at the left and right ends of the detection area decreased significantly, from 0.15 to 0.08 m/s2 and the ultrasonic image of the internal defects have a higher resolution and smoother edges. The improvement plays an important role in promoting the resolution at the left and right ends of the detection area.

Design and kinematic analysis of a deployable mechanism for soft sheets grasping

In the automation process of the garment industry, a notable challenge arises from the presence of flexible materials characterized by irregular shapes, posing difficulties for robotic grasping. This article addresses this challenge by proposing a gripper manipulator centered around the 4 P-RRP quadrilateral cone folding mechanism as the core driving mode, with the angled four-bar linkage mechanism serving as the extension arm. Utilizing screw theory, the developability of the 4 P-RRP four-pyramid mechanism with one degree of freedom is verified, forming the basis for its adoption as the central driving mechanism. Furthermore, an in-depth analysis of the geometric properties of the robot’s extension arm leads to the derivation of an optimal folding ratio structure, which is seamlessly integrated into the robot design. Kinematic equations for the mechanism are formulated and solved using the D-H parameter method to obtain the kinematic solution. The investigation demonstrates that the manipulator utilizing the quadrilateral cone folding mechanism significantly enhances adaptability to irregular shapes. By incorporating this proposed mechanism, robots can efficiently manipulate flexible materials across various garment manufacturing applications.

Senescence in common octopus, Octopus vulgaris: Morphological, behavioural and functional observations

Understanding senescence in semelparous species not only deepens our knowledge of the evolution of aging but also highlights the diversity of life strategies that have evolved in the natural world. This terminal phase occurs at the end of the lifecycle and is particularly evident in the common octopus, Octopus vulgaris, Cuvier 1797, a semelparous species with terminal reproduction. The aim of the present work was to document the natural process of senescence in specimens raised in captivity for two consecutive generations and the differences in morphology, behaviour and functional traits between the two sexes. Both sexes showed similar affections in the skin, with unhealed wounds, paler colors, and white lesions. At the same temperature males lived longer (six to seven months) than females, and showed extensive arm tip damage, with the exception of the hectocotylus that was fully functional until the very last day. Females, contrarily to males, lose 35.4–46.8% of their body weight during brooding and senescence. Uncommon behaviours were registered during this terminal phase like egg laying outside of the den, egg ingestion or copulation between males. These observations provide new data that will help to better understand this terminal phase and the natural processes occurring in both sexes at the end of their life cycle.

Design of a High Flux Beam Characterization Device for Falling Particle Receivers

This paper outlines the design and error analysis for a flux characterization device (i.e. flux wand) which traverses the aperture of a falling particle receiver cavity providing the incident power measurement needed for the calculation of receiver efficiency without significantly disrupting receiver output. The design features a linear actuator, water cooled extension arm, and refractory bar. The refractory bar/flux wand is a diffusely reflective surface which reflects light as it is translated across the receiver aperture to provide a light intensity distribution that is correlated to a measured flux. The component sizing, constrained by a typical 30 frame per second camera and a 4-point average of the measured reflectance, is presented. Simulation reveals the error that results from a 5% variation in flux wand reflectance is within 4% of the true value.

Bayesian model updating of super high‐rise building for construction simulation

SummaryA finite element model was established using SAP2000 software for the C1 tower, a super high‐rise building in the second phase of the Nanjing Financial City project, and the construction process of the tower was simulated. The C1 tower adopts a frame core tube extension arm and ring truss structure system, with 87 floors above ground and five floors underground. The roof structure has an elevation of 416.6 m. Precise measurements of inter‐story compression deformation were conducted using advanced surveying equipment. Sensitivity analysis, based on the finite difference method, identified the shear wall elastic modulus, frame column elastic modulus, steel beam elastic modulus, and shear wall unit weight as four highly influential parameters. Employing the Bayesian principle, the Markov Chain Monte Carlo (MCMC) method was applied to determine the posterior density probability function of the parameters targeted for modification. Subsequently, the Metropolis–Hastings (MH) sampling algorithm was employed to refine the C1 Tower model. This refinement significantly reduced the root mean square error between the measured and simulated vertical displacements, achieving an error reduction of approximately 10% from 6.082 to around 2.160. The modified material parameters, for the most part, adhered to a normal distribution assumption and exhibited mean values in the posterior probability density functions for the elastic modulus of Q345 steel beams, C70 frame columns, and C60 shear walls. Compared to the initial finite element parameters, the variation range was approximately 13% to 17%. These results serve as a validation of the effectiveness of the proposed method.

Effects of UAS Rotor Wash on Air Quality Measurements.

Laboratory and field tests examined the potential for unmanned aircraft system (UAS) rotor wash effects on gas and particle measurements from a biomass combustion source. Tests compared simultaneous placement of two sets of CO and CO2 gas sensors and PM2.5 instruments on a UAS body and on a vertical or horizontal extension arm beyond the rotors. For 1 Hz temporal concentration comparisons, correlations of body versus arm placement for the PM2.5 particle sensors yielded R2 = 0.85 and for both gas sensor pairs exceeded R2 of 0.90. Increasing the timestep to 10 s average concentrations throughout the burns improved the R2 value for the PM2.5 to 0.95 from 0.85. Finally, comparison of whole-test average concentrations further increased the correlations between body- and arm-mounted sensors, exceeding R2 of 0.98 for both gases and particle measurements. Evaluation of PM2.5 emission factors with single factor ANOVA analyses showed no significant differences between the values derived from the arm, either vertical or horizontal, and those from the body. These results suggest that rotor wash effects on body- and arm-mounted sensors are minimal in scenarios where short duration, time-averaged concentrations are used to calculate emission factors and whole-area flux values.

MARPE expander activation load with different configurations of extender arms heights: in-vitro evaluation.

Evaluate the load mini-implants exert on the artificial bone when expanding the MARPE EX in three different extension arm configurations. A device simulating the human palate was fabricated and attached to a universal testing machine, for conducting tests with different MARPE expanders (n=5): non-adjustable/control (MARPE SL, Peclab) or with low, intermediate, and high extender arms (MARPE EX, Peclab). The expanders were manually activated until failure of the device occurred, and maximum load values were recorded. Load averages were also calculated for every five activations until the twentieth activation. The generalized linear mixed model for repeated measures over time showed that there was significant increase in load with activations for all expanders (p=0.0004). Up to the twentieth activation, the expander with low extender arms presented higher load than the others, while the expander with high extender arms showed lower load values (p<0.05). There was no significant difference among expanders regarding the number of activations (p=0.0586), although there was a trend towards fewer activations until fracture for the control expander. It was observed that the higher the configuration, the lower the force the mini-implants delivered to the bone. The control expander provided a force magnitude similar to that of the adjustable expander when positioned at the intermediate height. The activation load of MARPE expanders is influenced by the type of presentation of the extensor arms, with higher configurations resulting in lower force delivered by the mini-implants to the bone.

Moment arms of the coracobrachialis and short head of biceps following a Latarjet procedure: a modeling study

BackgroundThe Latarjet procedure transfers the coracoid process to the anterior glenoid. This prevents recurrent anterior humeral dislocation but alters the origin of the coracobrachialis (CBR) and short head of bicep (SHB). The impact of this alteration on the moment arms of these muscles has not been examined. MethodsThe Newcastle Shoulder Model was updated with 15 heathy cadaveric bone models to create customized shoulder models. The CBR and SHB muscles were attached to the anterior glenoid via an elliptical wrapping object. Muscle moment arms were calculated for abduction, forward flexion, scapula plane elevation and internal rotation with 20⁰ and 90⁰ abduction. Statistical comparison between native and Latarjet moment arms was performed using spm1D. ResultsBy transferring the origin of CBR and SHB to the anterior glenoid, both muscles had extension moment arms during glenohumeral elevation in coronal, sagittal, and scapular plane. Their average moment arms during abduction (CBR: -30.4±3.2mm; SHB: -29.8±3.0mm) and forward flexion (CBR: -26.0±3.1mm; SHB: -26.2±3.2mm) suggested that their role after Latarjet changed, compared with that of their role in a native shoulder (p<0.001). At higher abduction levels both the muscles had higher internal rotation moment arms compared to the native shoulder. ConclusionThe Latarjet procedure affected the moment arms of the CBR and SHB. Both muscles had increased extension and internal rotation moment arms at higher degrees of elevation, compared to the native shoulders, this suggests that these muscles act as dynamic stabilizers after Latarjet.

408 Awardee Talk: Team Approach to Beef Cattle Extension Programming

Abstract Over 100 years ago, the Smith Lever Act created the Cooperative Extension Service in conjunction with the land grant institutions. Extension has seen much change with a never-ending list of challenges presenting themselves. Graduate training programs are typically discipline focused, answering questions using the scientific method. Most new hires have limited exposure to Extension educational program development and likely have not received training in curriculum planning, program assessment or logic model development. The learning curve can be even steeper when one accepts a position with multiple disciplinary responsibilities or outside their industry sector focus (i.e., cow/calf verses feedlot nutrition). Success is often determined by developing relationships with experienced faculty both at their institution and others in the region. Guidance can be sought from these experienced individuals, knowledge can be gained from their successes and failures, and one can learn the Extension arm of the land grant system quickly from these relationships. Relationships should not be limited to the home department of the individual but should reach across disciplines to engage others to work with and learn from to aid in developing a system-wide view of agricultural production. Regional research and extension groups are key contributors to building multi-state programming of new Extension specialists. Access to funds is critical for the implementation of Extension programming and these networks increase funding opportunities. My success in Extension is a shared success with all those that were kind enough to take the time to teach me a little of their area of expertise. Having the willingness to be part of a team in developing Extension programming for beef cattle has resulted in a rewarding career. New hires in the Extension specialist role will find building a team to work with to develop effective beef programs will ease their transition from graduate student to Extension specialist.

Multimodal analysis of the biomechanical impact of knee angle on the Sit-to-Stand transition

BackgroundThe Sit-to-Stand (STS) transition is one of the most used activities of daily living and vital for independence. Neurological, or physical injuries impairing functional mobility or sensory feedback often require rehabilitative programs or therapeutic interventions. Understanding the biomechanical elements of daily movements and the interaction between these elements may help inform rehabilitation protocols and optimize targeted interventions, such as stimulation protocols. Research questionWhat are the effects of different initial knee angle, arm facilitation and proprioceptive input on leg muscle activation patterns and balance during and after a sit-to-stand? MethodsEMG of four lower limb muscles were recorded in 20 healthy participants as well centre-of-pressure sway amplitude and velocity, as participants stood from a seated position. Initial knee angles were set to various levels of extension (80°, 90°, 100°) and surface stability and arm facilitation were altered using a foam mat or crossing arms. Data were analysed across 3 phases of the STS transition. ResultsMore extended knee angles resulted in greater mediolateral sway during each phase (p < .01) and had a detrimental effect on anterior-posterior sway in phases 1 and 3. EMG data suggested more extended initial knee angles also increased EMG activity of the Tibialis Anterior (p < .001) and Bicep Femoris (p < .02) within Phases 1 and 2 to assist lift and stabilisation. SignificanceFindings of this study outline phase-based muscle involvement as well as the compounding effects of reduced proprioceptive input and knee angle, on difficulty of the STS transition. Such results emphasising the need to take sensory and mobility issues into consideration when designing rehabilitative programs or stimulation control systems.

Light and Affordable Vision System for Mouth Opening–Closing Movement Deviation Assessment in Women with Mild Temporomandibular Joint Disorder

(1) Background: This paper aims to demonstrate a novel and, in terms of application, universal method of the qualitative and quantitative assessment of mandibular movement. (2) Methods: Mandibular movements are recorded by a mono-vision system where a digital camera is fixed on a special extension arm attached to the patient’s head. The described method was used to check lateral deviations in 25 women with mild temporomandibular joint disorder (TMD) and in 25 women from the control group. The maximum deviation (MAX) and mean deviation (MSE) parameters were examined. In addition, the occurrence of parafunctions and joint clicking in the temporomandibular joints was checked in the examined individuals. (3) Results: Among the women with mild TMD, a significantly higher MSE parameter was found compared to the control group. Joint clicking also occurred significantly more frequently. The parameter of MAX did not differ significantly between the examined groups. (4) Conclusions: In women with mild TMD, a lack of movement coordination between the right and left joints can be observed. The method’s high availability combined with simple use makes it a valuable tool for experts in different fields who diagnose and treat stomatognathic system disorders.

PO-01-169 CLINICAL APPLICATION OF A NOVEL 31MM CRYOBALLOON FOR PULMONARY VEIN ISOLATION FOR PAROXYSMAL ATRIAL FIBRILLATION: PROCEDURAL DATA FROM THE FIT ARM OF FROZEN AF

Cryoablation of pulmonary veins (PV)s to treat paroxysmal atrial fibrillation (PAF) is well established, however there are limited choices in balloon sizes for cryoablation. Data have recently been collected on a new cryoballoon system with novel capability to deliver cryoablation in a standard 28mm diameter balloon or an expanded 31mm diameter, using the same catheter. Demonstrate the clinical utility of an expandable diameter cryoballoon, and discuss the potential advantages for occlusion, antral positioning, and lesion size. As part of the FROZEN AF Trial (NCT04133168) 50 patients received PVI ablation to treat PAF with a cryoballon capable of ablation at 28mm or 31mm. Follow-up is continuing, but we present procedural data and clinical application of this balloon. The extension arm of the FROZEN AF trial (NCT04133168) included 50 pts, 46% female and aged 64±13 years, indicated for PV isolation for treatment of PAF. Acute isolation was successful in all pts. Average procedure time was 101±59 min, with LA dwell of 51 min, and fluoroscopy of 7 min. General anesthesia was used in all patients, and the majority (49/50) underwent a single transeptal puncture. The novel 31mm configuration was used in 65% of ablations. In the 198 ablations performed at 31mm, 97.5% achieved a Grade 3 or 4 occlusion. Average nadir temperature was -54.89°C, and average TTI was 44s. In PVs where the first ablation was performed at 31mm the single shot isolation rate was significantly higher than in PVs where the first ablation was performed at 28mm. Data by PV are listed in Table 1. Notably, there was a low rate of phrenic nerve impairment, with only 1 instance of transient paralysis which resolved prior to discharge. Additionally, in a subset of pts at a single center, occlusion was assessed at both 28mm and 31mm, Figure 1. Preliminary landmark-based analysis of a subset of veins suggests that inflation to 31mm results in a marked antral shift of balloon position. The combination of maneuverability and variable size may make this balloon particularly useful in addressing challenges resulting from patient-to-patient variability in PV size and geometry. In particular, the choice between 28 and 31mm diameter in a single device may facilitate obtaining good occlusion, and the more antral positioning of a large balloon may give physicians more discretion as to the size and location of PVI lesions. As, the FROZEN AF trial is ongoing, long-term results in these patients are awaited.Tabled 1Usage, Occlusion and Single Shot Isolation rate of 28 and 31mm Balloon Sizesn Grade 4 Occlusion / N Total Ablation (%)n Single Shot Isolation / N PV (%)Pulmonary Vein28mm31mm28mm31mmLeft superior (LSPV)18 / 23 (78.3)41 / 45 (91.1)2/8 (25%)19/34 (55.9%)Left inferior (LIPV)17 / 19 (89.5)29 / 38 (76.3)4/12 (33.3%)23/30 (76.7%)Left common (LCPV)5 / 7 (71.4)6 / 19 (31.6)0/0 (%)1/8 (12.5%)Left middle (LMPV)1 / 1 (100)-1/1 (100%)0/0 (%)Right superior (RSPV)9 / 18 (50)49 / 56 (87.5)1/5 (20%)27/43 (62.8%)Right inferior (RIPV)21 / 38 (58.3)33 / 37 (89.2)10/24 (41.7%)17/24 (70.8%)Right common (RCPV)1 / 3 (33.3)2 / 3 (66.7)0/1 (0%)0/1 (0%)Total72 / 109 (67.3)160 / 198 (80.8)18/51 (35.3%)87/140 (62.1%)Single shot success in veins where first ablation was performed with specified balloon size. Only ablations with duration > 60s included in ablation counts Open table in a new tab

Prospective Hemophilia Inhibitor PUP Study reveals distinct antibody signatures during FVIII inhibitor eradication.

Factor VIII (FVIII) inhibitor formation is a major clinical concern during replacement therapy in patients with hemophilia A. Immune tolerance induction (ITI) is the only therapeutic approach to attempt inhibitor eradication and establishment of long-term immune tolerance to FVIII. Hemophilia Inhibitor Previously Untreated Patient (PUP) Study (HIPS) was a prospective clinical trial to investigate changes in the immune system of PUPs with severe hemophilia A. Five patients who developed persistent FVIII inhibitors during HIPS entered an ITI extension arm (HIPS-ITI). During HIPS-ITI, inhibitor patients received ITI with the same FVIII product (a single source of recombinant, human full-length FVIII) used in HIPS until successful tolerance, declared failure, or a maximum of 2 years after HIPS-ITI enrollment, whichever came first. Blood samples and clinical data were collected monthly. Longitudinal FVIII-binding antibody signatures, associated binding specificities, and apparent affinities were determined for each patient at each sampling time point. ITI was successful or partially successful in 2 patients and failed in 3. Both groups presented with distinct FVIII-specific antibody signatures. ITI success required the disappearance of FVIII inhibitors, which was associated with the eradication or sustained titer minimization of high-affinity FVIII-specific antibodies, particularly of the immunoglobulin G1 (IgG1) and IgG4 subclasses. In contrast, ITI failure, as reflected by FVIII inhibitor persistence, was associated with persistent high-affinity FVIII-specific antibodies. Interestingly, 1 patient with partial ITI success and 1 patient with ITI failure developed apparent oligoreactive FVIII-binding antibodies during ITI. The explanation of the true nature of these antibodies requires more comprehensive follow-ups in future studies. This trial was registered at www.clinicaltrials.gov as #NCT01652027.

Three-dimensional changes after maxillary molar distalization with a miniscrew-anchored cantilever.

To evaluate the changes after maxillary molar distalization in Class II malocclusion using the miniscrew-anchored cantilever with an extension arm. The sample included 20 patients (9 male, 11 female; mean age 13.21 ± 1.54 years) with Class II malocclusion, treated with the miniscrew-anchored cantilever. Lateral cephalograms and dental models obtained before (T1) and after molar distalization (T2) were evaluated using Dolphin software and 3D Slicer. Superimposition of digital dental models using regions of interest on the palate was performed to evaluate three-dimensional displacement of maxillary teeth. Intragroup change comparisons were performed using dependent t-test and Wilcoxon test (P < 0.05). The maxillary first molars were distalized to overcorrected Class I. The mean distalization time was 0.43 ± 0.13 years. Cephalometric analysis demonstrated significant distal movement of the maxillary first premolar (-1.21 mm, 95% confidence interval [CI]: -0.45, -1.96) and maxillary first (-3.38 mm, 95% CI: -2.88, -3.87) and second molars (-2.12 mm, 95% CI: -1.53, -2.71). Distal movements increased progressively from the incisors to the molars. The first molar showed small intrusion (-0.72 mm, 95% CI: 0.49, -1.34). In the digital model analysis, the first and second molars showed a crown distal rotation of 19.31° ± 5.71° and 10.17° ± 3.84°, respectively. The increase in maxillary intermolar distance, evaluated at the mesiobuccal cusps, was 2.63 ± 1.56 mm. The miniscrew-anchored cantilever was effective for maxillary molar distalization. Sagittal, lateral, and vertical movements were observed for all maxillary teeth. Distal movement was progressively greater from anterior to posterior teeth.

Direct observation of Piezo1 conformational states.

PIEZOs are mechanosensitive ion channels that convert force into chemoelectrical signals. Mechanotransduction is thought to be initiated through the deformation of extensive arms of transmembrane domains emanating from a central ion-conducting pore. Structural studies show these arms adopt a symmetric bowl-shaped conformation, forming a dome of membrane that can be flatted and expanded by force. However, direct observation of channel conformation in a cell and an understanding of how the arms are engaged during mechanotransduction is lacking. Here, we use site-specific labeling and intramolecular fluorescent imaging to examine PIEZO1 conformation in a cell membrane. We show the arms of PIEZO1 are bent by the plasma membrane at rest and exhibit pronounced variation in flexibility along their length. Using stimuli which are known to modulate channel activity, we also show that the degree of arm extension from the central pore correlates with channel activation and inhibition. Our findings highlight how the cellular environment can shape PIEZO1 conformation and demonstrate a structure-function relationship between channel conformation and activation. More broadly, this study provides a basic understanding of how PIEZO1 senses mechanical force and presents a technical framework for the study of single-molecule protein conformation using direct nanoscopic imaging.

Computer-assisted analysis of functional internal rotation after reverse total shoulder arthroplasty: implications for component choice and orientation

PurposeFunctional internal rotation (IR) is a combination of extension and IR. It is clinically often limited after reverse total shoulder arthroplasty (RTSA) either due to loss of extension or IR in extension. It was the purpose of this study to determine the ideal in-vitro combination of glenoid and humeral components to achieve impingement-free functional IR.MethodsRTSA components were virtually implanted into a normal scapula (previously established with a statistical shape model) and into a corresponding humerus using a computer planning program (CASPA). Baseline glenoid configuration consisted of a 28 mm baseplate placed flush with the posteroinferior glenoid rim, a baseplate inclination angle of 96° (relative to the supraspinatus fossa) and a 36 mm standard glenosphere. Baseline humeral configuration consisted of a 12 mm humeral stem, a metaphysis with a neck shaft angle (NSA) of 155° (+ 6 mm medial offset), anatomic torsion of -20° and a symmetric PE inlay (36mmx0mm). Additional configurations with different humeral torsion (-20°, + 10°), NSA (135°, 145°, 155°), baseplate position, diameter, lateralization and inclination were tested. Glenohumeral extension of 5, 10, 20, and 40° was performed first, followed by IR of 20, 40, and 60° with the arm in extension of 40°—the value previously identified as necessary for satisfactory clinical functional IR. The different component combinations were taken through simulated ROM and the impingement volume (mm3) was recorded. Furthermore, the occurrence of impingement was read out in 5° motion increments.ResultsIn all cases where impingement occurred, it occurred between the PE inlay and the posterior glenoid rim. Only in 11 of 36 combinations full functional IR was possible without impingement. Anterosuperior baseplate positioning showed the highest impingement volume with every combination of NSA and torsion. A posteroinferiorly positioned 26 mm baseplate resulting in an additional 2 mm of inferior overhang as well as 6 mm baseplate lateralization offered the best impingement-free functional IR (5/6 combinations without impingement). Low impingement potential resulted from a combination of NSA 135° and + 10° torsion (4/6 combinations without impingement), followed by NSA 135° and -20° torsion (3/6 combinations without impingement) regardless of glenoid setup.ConclusionThe largest impingement-free functional IRs resulted from combining a posteroinferior baseplate position, a greater inferior glenosphere overhang, 90° of baseplate inclination angle, 6 mm glenosphere lateralization with respect to baseline setup, a lower NSA and antetorsion of the humeral component. Surgeons can employ and combine these implant configurations to achieve and improve functional IR when planning and performing RTSA.Level of evidenceBasic Science Study, Biomechanics.

Does Motorcycle Autonomous Emergency Braking (MAEB) mitigate rider injuries and fatalities? Design of effective working parameters and field test validation of their acceptability

Autonomous Emergency Braking on Motorcycles (MAEB) was shown to be a promising technology to improve Powered-Two-Wheeler (PTW) user safety, deploying autonomously a braking action to reduce impact speed when pre-crash conditions are detected. The applicability of MAEB with effective working parameters still needs to be proved in real-world working conditions. The goal of this paper is to define MAEB working parameters for effective mitigation of injuries and to validate their real-world applicability through field tests in representative riding scenarios of intervention.The results of previous studies and injury risk functions for motorcyclists were employed to define a set of MAEB working parameters (duration of intervention ≥ 0.60 s, target declaration of 0.5 g, fade-in jerk of 2 g/s) which enable MAEB impact speed reductions capable of mitigating injuries. Field tests were then carried out involving common riders as participants and employing a test protocol consistent with previous studies. Automatic Braking (AB) interventions were intended to reproduce unexpected MAEB activations in different riding conditions including straight-line riding and lane-change manoeuvres reproducing an avoidance action. The tests were carried out using a sport-touring motorcycle provided with extension arms to prevent capsizing and equipped with an automatic braking system which was activated remotely by researchers.Thirty-one participants involved in the test experienced AB interventions riding in straight-line and lane-change at a mean speed ranging from 41 km/h to 47 km/h. In the 0.5 g test session, the AB system performed mean deceleration 0.48 g reached with 2.0 g/s fade-in jerk for a duration of around 1.1 s. Both subjective assessment and vehicle data analysis indicated that the participants were consistently able to easily control the vehicle during the automatic braking interventions and were always able to complete a lane-change manoeuvre. No signal of incipient loss of vehicle control was recorded in on-board videos nor identified in the behaviour and body movement by participants. The tested MAEB working parameters performed speed reductions capable to reduce impact speed up to 15 km/h, potentially reducing serious injuries (MAIS3+) by 15 %.The proposed MAEB working parameters were proved as effective in reducing vehicle speed and feasible from end-users’ perspective. The designed MAEB intervention was shown to be applicable in straight line riding and to allow the rider to manoeuvre the vehicle for the execution of avoidance actions.

Edoxaban for Thromboembolism Prevention in Pediatric Patients With Cardiac Disease

BackgroundStandard of care (SOC) anticoagulation for thromboembolism (TE) prevention in children with cardiac disease includes low molecular weight heparins or vitamin K antagonists. Limited data exists for alternate use of direct oral anticoagulants in children. ObjectivesThe investigators aimed to obtain safety and efficacy data for edoxaban in children. MethodsWe performed a phase 3, multinational, prospective, randomized, open-label, blinded-endpoint trial in patients <18 years of age with cardiac disease (ENNOBLE-ATE [Edoxaban for Prevention of Blood Vessels Being Blocked by Clots (Thrombotic Events) in Children at Risk Because of Cardiac Disease] trial). Patients were randomized 2:1 to age- and weight-based oral edoxaban once daily vs SOC for 3 months (main study period), stratified by cardiac diagnosis. Both groups could continue in an open-label edoxaban extension arm through 1 year. The primary endpoint was adjudicated clinically relevant bleeding (CRB). The main secondary endpoint was symptomatic TE or asymptomatic intracardiac thrombosis. ResultsThe modified intention-to-treat cohort included 167 children. One patient per group experienced a nonmajor CRB in the main period. Treatment-emergent adverse events occurred in 46.8% (51 of 109) with edoxaban and 41.4% (24 of 58) with SOC. One SOC patient experienced 2 TE events (DVT with PE). Among 147 children in the extension, 1 CRB event (0.7%) and 4 TEs occurred (2.8%; 2 strokes and 2 of 33 Kawasaki disease patients with coronary artery thromboses and/or myocardial infarctions). ConclusionsEdoxaban is a potential alternative mode of thromboprophylaxis in children with cardiac disease showing low rates of CRB and TEs with advantages of once daily dosing and infrequent monitoring requirement. (ENNOBLE-ATE [Edoxaban for Prevention of Blood Vessels Being Blocked by Clots] (Thrombotic Events) in Children at Risk Because of Cardiac Disease trial; NCT03395639).

Glenoid Track Width Is Smaller Under Dynamic Conditions: An In Vivo Dual-Fluoroscopy Imaging Study

Background: The glenoid track concept has been widely used to assess the risk of instability due to bipolar bone loss. The glenoid track width was commonly used as 83% of the glenoid width to determine if a lesion was on-track or off-track. However, the value was obtained under static conditions, and it may not be able to reflect the actual mechanism of traumatic dislocation during motion. Purpose: To compare the glenoid track width under dynamic and static conditions using a dual-fluoroscopic imaging system. Study Design: Controlled laboratory study. Methods: In total, 40 shoulders of 20 healthy volunteers were examined for both dynamic and static tests within a dual-fluoroscopic imaging system at 5 different arm positions: 30°, 60°, 90°, 120°, and 150° of abduction, keeping the shoulder at 90° of external rotation. The participants performed a fast horizontal arm backswing for dynamic tests while keeping their arm in maximum horizontal extension for static tests. Computed tomography scans were used to create 3-dimensional models of the humerus and scapula for 2-dimensional to 3-dimensional image registration. Magnetic resonance imaging scans were obtained to delineate the medial margin of the rotator cuff insertion. The glenoid track width was measured as the distance from the anterior rim of the glenoid to the medial margin of the rotator cuff insertion and compared between static and dynamic conditions. Results: The mean glenoid track widths at 30°, 60°, 90°, 120°, and 150° of abduction were significantly smaller under dynamic conditions (88%, 81%, 72%, 69%, and 68% of the glenoid width) than those under static conditions (101%, 92%, 84%, 78%, and 77% of the glenoid width) (all P < .001). The glenoid track width significantly decreased with the increasing abduction angles in the range of 30° to 120° under static conditions (all P < .003) and 30° to 90° under dynamic conditions (all P < .001). Conclusion: A smaller dynamic-based value should be considered for the glenoid track width when distinguishing on-track/off-track lesions. Clinical evidence is needed to establish the superiority of the dynamic-based value over the static-based value as an indicator for augmentation procedures. Clinical Relevance: Some off-track lesions might be misclassified as on-track lesions when the original commonly used static-based value of 83% is used as the glenoid track width.