Low Arm Research Articles

The Efficacy of Hemostatic Radiotherapy for Advanced Malignancies Assessed by World Health Organization Bleeding Status

Purpose This retrospective study aimed to evaluate the efficacy of radiotherapy for the palliation of bleeding symptoms of advanced malignancies.Patients and methodsWe included 36 consecutive patients treated for hemostatic intent by radiotherapy at our institution, from August 2013 to January 2019. Patient bleeding status was assessed according to the World Health Organization (WHO) bleeding status before and after radiotherapy.ResultsWe identified 36 consecutive patients, consisting of 14 men and 22 women. The median follow-up period after radiotherapy for all cases was 2.5 months (range: 0.4-37.7 months), and the one-year OS was 47.1% (95% confidence interval: 23.5%-67.6%). Of the 36 patients, 29 (81%) showed improvement by one point or more in the WHO bleeding status. A total of 15 patients received 30 Gy in 10 fractions with a biologically effective dose (BED10) of 39 Gy (high BED arm). The remaining 21 patients had received radiotherapy with a BED10 of less than 39 (low BED arm, range of BED10: 11.2-30 Gy). In the high BED arm, 14 of the 15 patients (91%) showed improvement on the WHO bleeding status. In the low BED arm, 15 of the 21 patients (71%) showed improvement on the WHO bleeding status. There was no statistically significant difference in the improvement rate between the high and low BED arms (p = 0.200).ConclusionThere is no universal standard to evaluate the hemostatic effect of palliative radiotherapy. In this retrospective study, we investigated the clinical outcomes of hemostatic irradiation as assessed by WHO bleeding status.

Correlation between chronic diseases and low muscle mass, strength and quality in adults in China

Objective: To explore the correlation between chronic diseases and muscle mass, strength and quality in adults in China. Methods: Based on the second resurvey of China Kadoorie Biobank (CKB) in 2013-2014, logistic regression models were used to analyze the correlation of different types, number and duration of chronic diseases with low muscle mass, handgrip strength and muscle quality. Results: The prevalence rate of diabetes, coronary heart disease (CHD), stroke and chronic obstructive pulmonary disease (COPD) were 9.6%, 5.8%, 3.2% and 26.8%, respectively, and 38.8% of the participants had at least one disease, and they were more likely to have low handgrip strength and low arm muscle quality (AMQ), and the longer the chronic diseases duration, the higher the risk. The ORs (95%CIs) for low handgrip strength and low AMQ in patients with 1 chronic disease for more than 10 years was 1.64 (1.42-1.90) and 1.83 (1.60-2.10), respectively. The ORs (95%CIs) for low handgrip strength were 1.26 (1.17-1.37), 1.42 (1.23-1.64) and 2.27 (1.55-3.32) and the ORs (95%CIs) for low AMQ were 1.28 (1.18-1.38), 1.67 (1.46-1.92) and 2.41(1.69-3.45), respectively, in patients with 1, 2, ≥3 chronic diseases, the correlation showed a linear trend (P for trend <0.001). Diabetes, CHD and stroke were positively correlated with low handgrip strength and low AMQ. Compared with participants without COPD, COPD patients were more likely to have low appendicular skeletal muscle mass index (ASMI), low total skeletal muscle mass index (TSMI) and low handgrip strength, and the risk was positively correlated with disease duration. Conclusions: Patients with chronic diseases were more likely to have lower muscle strength and muscle quality, especially the patients with multi diseases and longer disease duration. The proportion of low handgrip strength and low AMQ was higher in patients who reported multi-prevalence and longer duration of chronic diseases.

Risk-Stratified Sequential Treatment with Ibrutinib and Rituximab (IR) and IR-CHOP for De-Novo Post-Transplant Lymphoproliferative Disorder: Results of the Tidal Trial

Risk-Stratified Sequential Treatment with Ibrutinib and Rituximab (IR) and IR-CHOP for De-Novo Post-Transplant Lymphoproliferative Disorder: Results of the Tidal Trial

Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials

ABSTRACTBackgroundMeta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design.ObjectivesWe aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes.MethodsWe conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6–24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.ResultsSQ-LNS provision decreased stunting (length-for-age z score < −2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < −2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < −2) by 18%, acute malnutrition (WLZ < −2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < −2) by 13%, and small head size (head circumference-for-age z score < −2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation.ConclusionsThe positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

Evaluation and management of "low" anorectal malformation in male children: an observational study.

ARM with perineal fistula has been traditionally defined as low ARM (LARM). This study was conducted to evaluate LARM in male patients with an emphasis on the role of various factors on the outcome and follow-up of them. It was a retrospective cohort study. The clinical presentation, associated anomalies, and complications were assessed. The operative procedures included cutback anoplasty and others. The patients were followed in the outpatient department. The complications were assessed and managed accordingly. During the study period of 8years, 301 patients were admitted. The complaints included absent or abnormal anal opening, abdominal distension, constipation, and peritonitis. Most of the children (n = 214) presented in the neonatal period. The most common clinical presentation was the perineal fistula. The most common associated anomaly was urologic. Fourteen patients were referred from other centers after complications. The most common problem in follow-up was constipation. LARM in male patients may have a diverse presentation. The associated anomalies need proper assessment. Awareness may avoid delayed presentation and unwanted complications. When managed by an expert, the condition can be effectively managed. Regular follow-up is important.

The psychological distress of parents is associated with reduced linear growth of children: Evidence from a nationwide population survey.

Stunting, an indicator of restricted linear growth, has become a primary measure of childhood undernutrition due to its persistent high prevalence globally, and importance for health and development. Although the etiology is recognized as complex, most analyses have focused on social and biomedical determinants, with limited attention on psychological factors affecting care and nurturing in the home. We assessed whether the psychological distress of parents is related to child linear growth and stunting, and documented the associated risk factors, and examined the relationship between parental distress and behavioral and other risk factors for stunting. We used data from the Indonesia National Health Survey 2013, including 46,315 children 6-59 months of age. Multivariate linear, logistic, and multilevel multinomial logistic regression, using survey weights, were used to assess the relationship between parental distress, as assessed by the WHO Self Reporting Questionnaire (SRQ20), with height-for-age z score (HAZ), stunting, and behavioral and other risk factors for stunting. Maternal, paternal and parental distress (i.e. both maternal and paternal distress) were associated with reduced linear growth of the children by 0.086 (95% CI -0.17, -0.00), 0.11 (95% CI -0.24, -0.02) and 0.19 (95% CI -0.37, -0.00) HAZ-scores, respectively. Maternal and paternal distress increased the risk of mild stunting (HAZ <-1) by 33% (95% CI 1.17,1.50) and 37% (95% CI 1.18,1.60), and the risk of moderate stunting (HAZ <-2) by 25% (95% CI 1.10,1.43) and 28% (95% CI 1.08,1.51]), respectively. Parental stress increased the risk of moderate stunting by 40% (95% CI 1.06,1.85). Amongst specific groups of risk factors, the proportion of HAZ-score lost was associated with socioeconomic factors (30.3%) including, low wealth, low maternal occupational status, low maternal education, rural residence, and low paternal occupational status; physiological factors (15.5%) including low maternal height, low maternal mid-upper arm circumference, being male, low paternal height; behavioral factors (8.9%) including open garbage disposal, paternal smoking, not using iodized salt; and experiencing at least one infectious diseases episode (1.1%). Maternal, paternal and parental stress were associated with reduced linear growth of children. These findings highlight the complex etiology of stunting and suggest nutritional and other biomedical interventions are insufficient, and that promotion of mental and behavioral health programs for parents must be pursued as part of a comprehensive strategy to enhance child growth and development, i.e. improved caretaker capacity, integrated community development, improved parenting skills, as well as reduced gender discrimination, and domestic violence.

Demystifying Cardiac Dose in RTOG-0617

The RTOG-0617 trial presented worse overall survival for patients with lung cancer treated in the high-dose 74 Gy arm compared to those treated with 60Gy. In multi-variable models, whole heart volumetric dose parameters (volume of heart receiving at least 5Gy and 30Gy), and the high-dose treatment arm was found to be associated with survival, rescinding dose escalation. In this abstract, we repeat this survival analysis, but consider cardiac sub-regions to find an explanation for the counterintuitive survival difference observed between the treatment arms.Voxel-wise analysis was performed on dose distributions spatially normalized onto a template patient anatomy. Permutation testing assessed significance, identifying anatomical regions where dose was associated with overall survival. Dose to the identified cardiac sub-region was included in multi-variable modelling. Clinical and dosimetric variables were bootstrapped 500 times into an elastic-net variable selection model to identify variables associated with survival. Variable importance was assessed by (1) magnitude of model coefficients and (2) frequency of selection. Next, multi-variable Cox regression survival models were created to assess significance of dose to the identified cardiac region compared to v5 and v30 parameters used previously.A total of 488 patients, with accurate dose mapping, were included in the voxel-wise analysis. A significance region (P < 0.001) was identified in the base of the heart, centered over the origin of the left coronary artery and atrioventricular node, with median dose 9.5 Gy (high dose arm 10.2 Gy, low dose arm 9.1 Gy). Bootstrapping of clinical variables identified mean lung dose (selected 99%), treatment arm (65%), log tumor volume (66%) and heart region dose (62%) as most important factors associated with survival (v5 and v30 selected < 10%). Multi-variable models included mean lung dose, log tumor volume, age, gender, treatment arm, performance status, smoking history, PET staging and histology and either heart v5, v30 or the identified heart region dose. Heart v5 and v30 were not found to be associated with survival, with treatment arm (P < 0.05) and log tumor volume (P < 0.02) being significant. However, heart region dose was significant (P = 0.02), along with log tumor volume (P = 0.03). Other parameters, including treatment arm were not significant.These results show that dose to cardiac sub-regions is more strongly association with overall survival than whole heart dose parameters. Variable selection showed the importance to include mean lung dose, suggesting an interplay between lung and cardiac dose. The treatment arm effect observed in RTOG-0617 lost its significant once the identified base of heart region dose was included into the model. Our results suggest that the worse survival of the high dose arm in RTOG617 could be explained by the dose delivered to the base of the heart.

The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries

BackgroundKey nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. ObjectivesWe evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. MethodsWe scored the GDQS, Minimum Dietary Diversity–Women (MDD-W), and Alternative Healthy Eating Index–2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15–49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. ResultsCorrelations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive. ConclusionsThe GDQS performed comparably with the MDD-W in capturing nutrient adequacy–related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.

The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults

BackgroundNutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising. ObjectivesTo evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults. MethodsWe scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15–49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models. ResultsIn the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31–0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44–0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45–0.84), and anemia (OR, 0.59; 95% CI: 0.38–0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12–2.80). For comparison, the Minimum Dietary Diversity–Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia. ConclusionsThe GDQS performed capably in capturing nutrient adequacy–related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS’ performance in capturing NCD outcomes in sub-Saharan Africa.

MATERNAL RISK FACTORS OF LOW BIRTH WEIGHT (LBW): SYSTEMATIC REVIEW

Abstract Background: Low Birth Weight Babies (LBW) accounts for 60 - 80% of all neonatal deaths in the world. Not the only major predictor of mortality and morbidity in neonates, individuals with a history of LBW have a greater risk of experiencing various diseases such as hypertension, heart disease, and diabetes later in life. This systematic review study aims to identify maternal risk factors that contributing to LBW Method: Articles published between 2015 - 2020 in the Science Direct, Scopus and Cochrane library databases are systematically reviewed. Eleven articles that met the inclusion and exclusion criteria were included as samples for further review. Results regarding maternal risk factors for LBW events are synthesized systematically .Results: From the search results, there were 818 articles, after the screening process, the final results were 11 articles. Risk factors that are significantly related to LBW incidence in the article, are grouped in the subtheme, include: maternal age (&lt;20 years, and each increase in age), parity (primipara and grandemultipara), low maternal upper arm circumference, hemoglobin levels less than 11 gr / dl, gestational age below 37 weeks, and complications during pregnancy. Conclusion: maternal age, parity, arm circumference, hemoglobin level, gestational age, and complications during pregnancy were significaly found to be maternal risk factors for LBW.

Immune tolerance induction in severe haemophilia A: A UKHCDO inhibitor and paediatric working party consensus update.

In good risk patients (historic inhibitor peak<200BU), the International Immune Tolerance Study demonstrated equal efficacy to induce tolerance between high (200iu/kg/day) and low dose (50iu/kg ×3 times/week) immune tolerance induction (ITI) regimens. However, the trial stopped early on account of the excessive bleed rate in the low dose ITI arm. United Kingdom Haemophilia Centre Doctors' Organization (UKHCDO) Paediatric and Inhibitor working parties considered available ITI data alongside the bi-phenotypic antibody emicizumab (Hemlibra®) efficacy and safety data to develop a consensus guideline for the future UK ITI guideline. This revision of UKHCDO ITI guidance incorporates the recommendation to use emicizumab as a prophylaxis haemostatic agent to reduce bleeding rates and to facilitate low dose and reduced frequency of FVIII CFC for ITI in the majority of children. This consensus protocol will facilitate future evaluation of ITI outcomes in the evolving landscape of haemophilia therapeutics and ITI strategies.

An exploratory study of nivolumab (nivo) with or without ipilimumab (ipi) according to the percentage of tumoral CD8 cells in advanced metastatic cancer.

2573 Background: Immune checkpoint inhibitors (ICIs) have demonstrated durable clinical responses and improved survival in patients (pts) across numerous indications. Despite this progress, the benefit of ICIs is limited to a minority of overall metastatic cancer patients. There is a critical need for biomarkers agnostic of tumor type to inform which pts will benefit from nivo alone versus ipi/nivo combination treatment. Both pre-treatment tumoral CD8 + cells and recruitment of CD8+ T cells in response to ICIs are associated with improved clinical outcomes in patients treated with anti-PD-1 therapy. 1,2,3,4 Here we report the final results of a prospective clinical study in which pts with varying advanced solid tumors were assigned to nivo, with or without ipi, based on the percentage of tumoral CD8 cells at the time of treatment. Methods: We performed a prospective, non-randomized, open-label, multicenter study in which pts with tumoral CD8+ cells ≥ 15% (CD8+ high) received nivo 360mg IV Q3W, followed by nivo maintenance 480mg Q4W. Pts with tumoral CD8+ cells &lt; 15% (CD8+ low) received nivo 360 mg IV Q3W, and ipi at 1 mg/kg IV Q3W for 2 doses and then Q6W for 2 doses, followed by nivo maintenance 480 mg IV Q4W until PD or intolerable toxicity. Primary endpoints were Disease Control Rate (DCR: CR, PR, or SD ≥ 6 months) and CD8 low to high conversion (&lt; 15% to ≥ 15%). Baseline and on-treatment tumor, blood and stool samples were collected for multiomic biomarker analyses. This study was not powered for formal statistical analysis. Up to 200 pts could be enrolled to allow for adaptive exploration of response and CD8 changes. Results: N = 79 pts were enrolled:7 in CD8+ high arm (nivo) and 72 in CD8+ low arm (ipi/nivo). The study enrolled a wide variety of primary solid tumors; the most common were gynecological (n = 15), prostate (12), and head and neck (7). DCR was 14% (1/7; 95% CI 1 - 44) and 24% (17/72; 95% CI 15 - 34) in the CD8 high and CD8 low arms, respectively. Of 39 pts in CD8 low arm with an on-treatment biopsy, 14 (36%; 95% CI 22 - 51) had CD8 conversion; 7/14 pts (50%) who converted had DCR. Immune-related AEs (irAEs) were consistent with known safety profile of both drugs. Conclusions: Ipi/nivo demonstrated clinical responses and increased CD8% in a range of “cold” tumors with low tumoral CD8 cells. There may be an association between increasing CD8% and response. Baseline high CD8% alone does not appear to be sufficient as a pan-cancer predictive biomarker of response to nivo monotherapy. CD8 conversion, response, and irAEs associated with circulating and stool-based biomarkers are under evaluation as composite biomarkers may improve their predictive value. Clinical trial information: 03651271.

Determinants of maternal low mid-upper arm circumference and its association with child nutritional status among poor and very poor households in rural Bangladesh.

Malnutrition among women is a long‐standing public health concern that has significant adverse consequences on the survival and healthy development of children. Maternal mid‐upper arm circumference (MUAC) could potentially represent a simpler alternative to traditional nutritional indicators. This study aimed to investigate the factors associated with low maternal MUAC (as an indicator of being underweight) and address the research question of whether maternal MUAC is significantly associated with children's nutritional status among poor and very poor households in rural Bangladesh. Data on 5,069 households were extracted from the Suchana programme baseline survey, which was carried out in 80 randomly selected unions (the lowest administrative unit of Bangladesh) in Sylhet and Moulvibazar districts between November 2016 and February 2017. The outcome variables were three child nutritional status indicators: wasting, stunting and underweight. Mothers were classified as underweight if their MUAC was less than 23 cm. Separate multiple logistic regression analyses were used to determine the factors potentially associated with maternal underweight status and explore whether maternal underweight status is significantly associated with children's nutritional status. The prevalence of maternal underweight status was 46.7%, and the prevalence of wasting, stunting and underweight among children under two were 10.5%, 44.4% and 31.9%, respectively. After controlling for various socio‐economic and demographic characteristics, maternal MUAC was significantly associated with children's nutritional status in rural Bangladesh.

Affordance-Aware Handovers With Human Arm Mobility Constraints

Reasoning about object handover configurations allows an assistive agent to estimate the appropriateness of handover for a receiver with different arm mobility capacities. While there are existing approaches for estimating the effectiveness of handovers, their findings are limited to users without arm mobility impairments and to specific objects. Therefore, current state-of-the-art approaches are unable to hand over novel objects to receivers with different arm mobility capacities. We propose a method that generalises handover behaviours to previously unseen objects, subject to the constraint of a user's arm mobility levels and the task context. We propose a heuristic-guided hierarchically optimised cost whose optimisation adapts object configurations for receivers with low arm mobility. This also ensures that the robot grasps consider the context of the user's upcoming task, i.e., the usage of the object. To understand preferences over handover configurations, we report on the findings of an online study, wherein we presented different handover methods, including ours, to 259 users with different levels of arm mobility. We find that people's preferences over handover methods are correlated to their arm mobility capacities. We encapsulate these preferences in a statistical relational learner (SRL) that is able to reason about the most suitable handover configuration given a receiver's arm mobility and upcoming task. Using our SRL model, we obtained an average handover accuracy of 90.8% when generalising handovers to novel objects.

Drug Resistance in HIV-Positive Adults During the Initial Year of Antiretroviral Treatment at Ethiopian Health Centers.

BackgroundThe increasing prevalence of antiretroviral drug resistance in Sub-Saharan Africa threatens the success of HIV programs. We have characterized patterns of drug resistance mutations (DRMs) during the initial year of antiretroviral treatment (ART) in HIV-positive adults receiving care at Ethiopian health centers and investigated the impact of tuberculosis on DRM acquisition.MethodsParticipants were identified from a cohort of ART-naïve individuals aged ≥18 years, all of whom had been investigated for active tuberculosis at inclusion. Individuals with viral load (VL) data at 6 and/or 12 months after ART initiation were selected for this study. Genotypic testing was performed on samples with VLs ≥500 copies/mL obtained on these occasions and on pre-ART samples from those with detectable DRMs during ART. Logistic regression analysis was used to investigate the association between DRM acquisition and tuberculosis.ResultsAmong 621 included individuals (110 [17.5%] with concomitant tuberculosis), 101/621 (16.3%) had a VL ≥500 copies/mL at 6 and/or 12 months. DRMs were detected in 64/98 cases with successful genotyping (65.3%). DRMs were detected in 7/56 (12.5%) pre-ART samples from these individuals. High pre-ART VL and low mid-upper arm circumference were associated with increased risk of DRM acquisition, whereas no such association was found for concomitant tuberculosis.ConclusionsAmong adults receiving health center–based ART in Ethiopia, most patients without virological suppression during the first year of ART had detectable DRM. Acquisition of DRM during this period was the dominant cause of antiretroviral drug resistance in this setting. Tuberculosis did not increase the risk of DRM acquisition.

Asymmetric high energy dual optical parametric amplifier for parametric processes and waveform synthesis.

We report on an asymmetric high energy dual optical parametric amplifier (OPA) which is capable of having either the idlers, signals, or depleted pumps, relatively phase locked at commensurate or incommensurate wavelengths. Idlers and signals can be locked on the order of 200 mrad rms or better, corresponding to a 212 as jitter at λ=2 µm. The high energy arm of the OPA outputs a combined 3.5 mJ of signal and idler, while the low energy arm outputs 1.5 mJ, with the entire system being pumped with a 1 kHz, 18 mJ Ti:Sapphire laser. Both arms are independently tunable from 1080 nm-2600 nm. The combination of relative phase locking, high output power and peak intensity, and large tunability makes our OPA an ideal tool for use in difference frequency generation (DFG) in the strong pump regime, and for high peak field waveform synthesis in the near-infrared. To demonstrate this ability we generate terahertz radiation through two color waveform synthesis in air plasma and show the influence of the relative phase on the generated terahertz intensity. The ability to phase lock multiple incommensurate wavelengths at high energies opens the door to a multitude of possibilities of strong pump DFG and waveform synthesis.

3 Phase Ac Servomotor Switching System

The background of the research is the need for switching ac 3 phase servomotor systems for precise position control purposes, in a fairly short displacement step with ac motor actuators. For this purpose, researchers controlled the direction of torque rotation of the servomotor magnetic field by controlling the switching system of the ac 3 phase bridges. The resultant torque of the resulting stator magnetic field represents the desired motor shaft position. For switching systems, we use space vector pulse wide modulation, with the consideration that the switching step is only 8 steps, where 2 steps are the high voltage short circuit arm step and the low voltage short circuit arm. Because the response of the motion is fast enough, the actuator used must be a winding rotor or permanent magnet rotor, better known as servomotor, for the cage rotor ac motor there are obstacles, where the motor loses torque, due to insufficient magnetic field generated by the rotor to move the rotor shaft in time quite short.

Low-cost pick and place anthropomorphic robotic arm for the disabled and humanoid applications

This paper presents the design and development of a new low-cost pick and place anthropomorphic robotic arm for the disabled and humanoid applications. Anthropomorphic robotic arms are weapons similar in scale, appearance, and functionality to humans, and functionality. The developed robotic arm was simple, lightweight, and has four degrees of freedom (DOF) at the hand, shoulder, and elbow joints. The measurement of the link was made close to the length of the human arm. The anthropomorphic robotic arm was actuated by four DC servo motors and controlled using an Arduino UNO microcontroller board. The voice recognition unit drove the command input for the targeted object. The forward and inverse kinematics of the proposed new robotic arm has been analysed and used to program the low cost anthropomorphic robotic arm prototype to reach the desired position in the pick and place operation. This paper’s contribution is in developing the low cost, light, and straightforward weight anthropomorphic arm that can be easily attached to other applications such as a wheelchair and the kinematic study of the specific robot. The low-cost robotic arm’s capability has been tested, and the experimental results show that it can perform basic pick place tasks for the disabled and humanoid applications.

Prospectively scored pulmonary toxicities in non-small cell lung cancer: Results from a randomized phase II dose escalation trial

PurposeProspectively scored radiation pneumonitis (RP) observed in a national, randomized phase II dose-escalation trial for patients with locally advanced non-small cell lung cancer (NSCLC) was investigated. MethodsPatients with stage IIB-IIIB histologically proven NSCLC were treated with concomitant chemo-radiotherapy (oral Vinorelbine 3times/week) at 60 Gy/30fx (A–59pts) and 66 Gy/33fx (B–58pts) from 2009 to 2013 at five Danish RT centers. Grade 2 RP (CTCAEv3.0) was investigated with univariate analysis for association with clinical and dosimetric parameters, including dyspnea and cough at baseline and during RT. Multivariable logistic regression and Cox regression with regularization were used to find a multivariable model for RP ≥ G2. ResultsDespite a tendency of higher mean lung dose in the high-dose arm (median[range] A = 14.9 Gy[5.8,23.1], B = 17.5 Gy[8.6,24.8], p = 0.075), pulmonary toxicities were not significantly different (RP ≥ G2 41%(A) and 52%(B), p = 0.231). A Kaplan Meier analysis of the time to RP ≥ G2 between the two arms did not reach statistical significance (p = 0.180). Statistically significant risk factors for RP ≥ G2 were GTV size (OR = 2.091/100 cm3, p = 0.002), infection at baseline or during RT (OR = 8.087, p = 0.026), dyspnea at baseline (OR = 2.184, p = 0.044) and increase of cough during RT (OR = 2.787, p = 0.008). In the multivariable logistic regression and the Cox regression analysis, the deviances of the most predictive models were within one standard deviation of the null model. ConclusionNo statistical difference between the high- and low dose arm was found in the risk of developing RP. The univariate analysis identified target volume, infection, dyspnea at baseline, and increase of cough during RT as risk factors for RP. The number of patients was too small to establish a statistically sound multivariable model.

A Novel AEB-AODV Based AADITHYA Cross Layer Design Hibernation Algorithm for Energy Optimization in WSN

Wireless Sensor Networks (WSN) has gained significant importance in current scenario because of its ability to monitor as well as understand the physical environment in terms of different parameters like temperature, humidity, pressure etc. There is a plethora of applications in WSN is finding importance ranking from military tracking, surveillance to environmental exploration and wildlife monitoring. The main challenge in WSN is energy efficiency especially when the capacity of battery and availability of energy source is a constraint. To address some of key WSN challenges, a novel routing protocol, a hibernation algorithm (cross layer design) along with the low power hardware design for achieving energy efficiency are proposed here.Because of the fact that WSN has requirement to adapt itself according to the needs of the dynamically changing environment, the quantity of sensor nodes which are part of routing tree cannot be the same and need to adapt itself so that it can precisely observe and forecast the physical surroundings. Initially the routing protocols being used popularly for WSN network layer i.e. AODV, AOMDV, and DSR are compared. The next stage is a proposal for adaptive model for AODV routing protocol for sensor node selection based on residual energy (AEB-AODV) towards improving the efficiency of energy and Quality of Service depending on the mentioned targets of performance. Here, the scheme utilizes fewer sensor nodes at a time along the route to the destination from the source of the event, and place remaining sensor nodes’ transceivers in the sleep mode but microcontroller, sensors and low power transceivers of the nodes are ON. The last module is a combined model capable of achieving improvements in efficiency of energy–adaptive routing model (AEB-AODV) and Hibernation of the sensor nodesi.e. AADITHYA algorithm, which reduces energy consumption, duty cycle to great extent and improved the latency, implemented with low power ARM CORTEX microcontroller and two sets of transceivers, one active power (AP) for data transmission and another very low power (LP) for sending wake up signals and control signals to the hibernating neighbors. Simulation results of AEB-AODV routing protocol and actual test readings of the developed hardware have shown that this method is effective in optimizing the energy usage in the nodes and hence improves the life expectancy of the WSN used for any general application.