Single Point Of Contact Research Articles

A highly specialist mental health prescribing pharmacist in a virtual GP practice - experience from a large London general practice

Abstract Introduction Historically, the career path for highly specialist pharmacists has been focussed on secondary and tertiary services. Recent developments to ensure high quality medication optimisation and improvement of patient access to appropriate medication has seen many pharmacists join GP practices. Alongside this is the drive by the NHS to improve the quality of mental health care in the primary care setting. Digitalisation and providing virtual platforms also improves access to health care for many individuals who are less able to commute and provides an option when there is disruption to face to face services. Aims To identify the number of appointments completed in an 8-week period, and evaluate the types of referrals, prescription details and the feedback from consultations with the Highly Specialist Mental Health Pharmacist. Methods Anonymised details from consultations carried out in an 8-week period were collected, which included details of appointments, the referral process, prescription details and feedback. The data underwent descriptive statistical analysis. Ethical review was not required as the study was a service evaluation. Results The reviewed patient journey for those newly identified with a mental illness, those who self identify as having a mental illness and those with a complex mental illness is presented. Post holder experience is shared. In a 7 clinical session week, with 30 minute consultations a total of 445 patients were scheduled an appointment, 393 patients completed their consultation. 61% of patients were referred for psychotherapy, 18% referred to secondary services. In 43% of patients’ medication was prescribed by the pharmacist, 32% had no medication prescribed while 23% of patients had medication deprescribed (stopped or reduced) Patient feedback was available for 50 patients, 47 left 5 star reviews, 3 left 1 star reviews as they could not get the platform link to work to attend the consultation. Discussion/Conclusion Although a small study, the preliminary data shows a high rate of patient attendance and feedback from patients was higher than expected. There is a single point of contact for the practice to risk assess, screen and follow up patients with a mental illness (including serious mental illness). Working in isolation, virtually and making pharmacist interventions after prescribing has occurred are very different ways of working compared to secondary care. With the correct infrastructure, improved referral rates and understanding of specialist pharmacist knowledge and experience - pharmacists can look to joining GP practices as a career option in a highly specialist role.

Nanoscale patterning of metallic surfaces with laser patterned tools using a nanoimprinting approach

In this study, we demonstrate that metallic substrates with a nanocrystalline grain size can be structured down to the micro- and nanometre range during a room temperature nanoimprinting process. WC-Co hard metal dies are patterned by Direct Laser Interference Patterning (DLIP), generating an array of separated asperities with a height of 4.7 µm and a spacing of 11.3 µm. Additionally, Laser Induced Periodic Surface Structures (LIPSS) with a spacing of 500 nm are formed as a hierarchical substructure. The patterned dies can be used to deform metallic substrates due to their high hardness. For structure replication, the WC-Co tool is pressed onto a nanocrystalline CuZn30 model alloy at room temperature. The pattern transfer process from the hard metallic tool to the nanocrystalline alloy is discussed in detail: At low contact pressures, the asperities on the tools act as single contact points, leading to the formation of separated dimples with a depth of up to 0.8 µm in the nanocrystalline alloy. At high contact pressures, the tool pattern, including the LIPSS is almost completely transferred to the substrate. The formed asperities protrude out of the surface, with a height to width aspect ratio of 0.4. It is thereby demonstrated, that plastic flow processes during the imprinting of nanocrystalline alloys allow for the replication of the DLIP tool pattern, even down to nano-scaled LIPSS. The imprinted array of surface asperities exhibits hydrophobic properties, due to a combined topographical and chemical influence on the wetting behaviour.

A Descriptive Analysis of Patients With Attempted Suicide at a Rural Level I Trauma Center.

For patients with self-harm, suicide attempt, or suicide completion, the trauma bay is often the single point of contact. Regional differences and patterns exist for suicide that should be studied to enhance preventive strategies. Our goal was to critically evaluate the suicidal population of Southeast Georgia over a 9-year period. A retrospective review of our trauma database from January 2010 through December 2019 was conducted at a Level I Trauma Center. All ages were included. All patients arriving with attempted suicide or death due to a suicidal complication were included. Patients with deaths highly suspicious for suicide were also included. Exclusion criteria included accidental motor vehicle death, accidental generalized deaths, and accidental drowning. Age, gender, race, ethnicity, mechanism of injury (MOI), death rates, length of stay (LOS), injury severity score (ISS), home zip code, day of the week, transfer vs. from scene, location of injury, alcohol levels, and urine drug screening results were analyzed. From 2010 to 2019, there were 381 total suicides with 260 survivals and 121 completions (mortality: 31.7%) at our Level I Trauma Center. The majority of suicides were performed by middle-aged White men with an average age of 40 years (SD: 17.2). This was true even if the White race was not the majority race in the patient's zip code. The majority of the time, these patients presented directly from the scene and, if the patient's suicide location was known, it usually took place at their home. Other common areas included secluded areas, such as wooded areas, and personal vehicles. Of the suicides, 11.6% were performed within the criminal justice system including jail and solitary confinement. The average LOS following admission was 7.51 days (SD: 22.1). The majority of suicides came from the metro Savannah district, which has higher unemployment and poverty rates than other parts of our study area. Gun violence was the most common MOI for suicide (75%). If suicide was attempted via a penetrating mechanism including glass, knife, or gun, there was an increased rate of death when compared to our general data (38% vs. 31%). When the gun mechanisms were analyzed as a group, there was a 57% rate of death after arrival at the hospital. Acute alcohol intoxication was present in 56.6% of patients and 80 (21%) had drugs in their system. Our data demonstrate epidemiologic and socioeconomic trends in Southeast Georgia. This included increased alcohol intoxication, deaths related to gun use, and in a higher incidence of suicide among White males, including geographic locations where the White race is not the majority. Suicides and suicide attempts were also more common in areas with higher unemployment rates.

Respiratory-Induced Amplitude Modulation of Forcecardiography Signals.

Forcecardiography (FCG) is a novel technique that records the weak forces induced on the chest wall by cardio-respiratory activity, by using specific force sensors. FCG sensors feature a wide frequency band, which allows us to capture respiration, heart wall motion, heart valves opening and closing (similar to the Seismocardiogram, SCG) and heart sounds, all simultaneously from a single contact point on the chest. As a result, the raw FCG sensors signals exhibit a large component related to the respiratory activity, referred to as a Forcerespirogram (FRG), with a much smaller, superimposed component related to the cardiac activity (the actual FCG) that contains both infrasonic vibrations, referred to as LF-FCG and HF-FCG, and heart sounds. Although respiration can be readily monitored by extracting the very low-frequency component of the raw FCG signal (FRG), it has been observed that the respiratory activity also influences other FCG components, particularly causing amplitude modulations (AM). This preliminary study aimed to assess the consistency of the amplitude modulations of the LF-FCG and HF-FCG signals within the respiratory cycle. A retrospective analysis was performed on the FCG signals acquired in a previous study on six healthy subjects at rest, during quiet breathing. To this aim, the AM of LF-FCG and HF-FCG were first extracted via a linear envelope (LE) operation, consisting of rectification followed by low-pass filtering; then, the inspiratory peaks were located both in the LE of LF-FCG and HF-FCG, and in the reference respiratory signal (FRG). Finally, the inter-breath intervals were extracted from the obtained inspiratory peaks, and further analyzed via statistical analyses. The AM of HF-FCG exhibited higher consistency within the respiratory cycle, as compared to the LF-FCG. Indeed, the inspiratory peaks were recognized with a sensitivity and positive predictive value (PPV) in excess of 99% in the LE of HF-FCG, and with a sensitivity and PPV of 96.7% and 92.6%, respectively, in the LE of LF-FCG. In addition, the inter-breath intervals estimated from the HF-FCG scored a higher R2 value (0.95 vs. 0.86) and lower limits of agreement (± 0.710 s vs. ±1.34 s) as compared to LF-FCG, by considering those extracted from the FRG as the reference. The obtained results are consistent with those observed in previous studies on SCG. A possible explanation of these results was discussed. However, the preliminary results obtained in this study must be confirmed on a larger cohort of subjects and in different experimental conditions.

Experiences of resuming life after immunotherapy and associated survivorship care needs: a qualitative study among patients with metastatic melanoma.

BackgroundImmune checkpoint inhibitors (ICIs) have significantly improved the overall survival of patients with metastatic melanoma. It is unclear how the growing group of metastatic melanoma survivors resume their lives after treatment, and which needs they have regarding survivorship care (SSC).ObjectivesTo gain an in‐depth understanding of metastatic melanoma survivors’ experiences of resuming life after ICIs and their associated SSC needs.MethodsA qualitative study was conducted among 20 patients with metastatic melanoma in whom ICIs had been discontinued after ongoing tumour response. One focus group (n = 9) was held, which was complemented by 11 individual interviews. Purposive sampling was used to select a variable sample in terms of sex, age, time since discontinuation of ICIs, and perceived impact of the disease. A topic guide was used to structure the (group) interviews, which were transcribed verbatim and analysed in a thematic content analysis, using several phases of coding.ResultsIn resuming life after ICIs, the prognosis switch often caused mixed feelings among patients, mainly because of the uncertainty about the future. Demands and expectations from self and others, persistent complaints and new problems in different life domains often make it challenging to proceed with life as it was prior to metastatic cancer. Patients indicated they needed to find a new balance, which included learning to cope with uncertainty and a changed perspective on life and close relationships. In terms of SSC needs, patients particularly stressed the need for more tailored patient information, available at one location. In addition, they emphasized the need to know who to turn to in case of questions and indicated the need for psychosocial support, also for their close relatives.ConclusionsMetastatic melanoma survivors face various challenges in resuming life after ICIs and are left with several unmet SSC needs. Efforts should be focused on offering psychosocial supportive care in addition to medical care, from diagnosis onwards, taking into account the patient’s close relatives. A single point of contact and personalized survivorship care plan (SCP) could be of added value in guiding them through the patient journey, which is, given its multidisciplinary nature, particularly important in melanoma care. What is already known about this topic? Since the introduction of immune checkpoint inhibitors (ICIs) the overall survival of patients with metastatic melanoma has improved significantly, leading to a growing group of melanoma survivors.Melanoma survivors may face various problems and challenges in resuming life after treatment, which may be associated with unmet survivorship care (SSC) needs.An in‐depth understanding of their experiences with resuming life and the associated SSC needs is currently lacking. What does this study add? Metastatic melanoma survivors experience various challenges after immunotherapy, from the uncertain prognosis switch to the struggle of finding a new balance in life.Besides negative aspects, such as complaints in different life domains, the patient journey is often accompanied by positive outcomes, for example a changed perspective on life.They stress the need for tailored patient information and broader supportive care, also for their close relatives. What are the clinical implications of this work? In addition to medical care, efforts should be focused on offering psychosocial supportive care, including return‐to‐work issues, from diagnosis onwards, ideally taking into account the patient’s close relatives.To guide them through the patient journey, a single point of contact and a personalized survivorship care plan (SCP) could be of added value.The latter is particularly important in melanoma care, given its multidisciplinary nature.

3PL Relationship Management Practices as a Cost Reduction Tool in the Supply Chain: A Case of Stellar Logistics

Purpose: The purpose of the study was to examine the nature of the 3PL relationship as a tool for cost reduction at Stellar Logistics Limited. It also examined the challenges affecting the effectiveness of the 3PL relationship.
 Methodology: A quantitative research approach was utilised to measure and analyse the data descriptively. Structured questionnaires and interviews were conducted to elicit data from the supply chain exerts at Stellar Logistics Company Limited. Data analysis was done based on 30 cases and at the firm level in terms of a unit of analysis. 3PL relationship management is the key tool that links all members of the supply chain at Stellar Logistics.
 Findings: The study proves management members of Stellar Logistics are aware effective 3PL relationship management leads to mutual trust and confidence in the company and are also aware that commitment is a key factor in creating a stable third-party relationship. Selection and evaluation are crucial in achieving valuable partnerships in the 3PL relationship process as it has the highest response rate in the company. The relationship system at Stellar Logistics requires creating a win/win for 3PL contracting parties. Improper record management makes it difficult to keep track of all shipments at the company. There is a lack of collaboration between the shippers, carriers, and the end customers of the company which affects 3PL relationship management at the company. Finally, unforeseen delays affect the delivery of goods to customers at the company.
 Recommendations: Stellar Company can help resolve its 3PL relationship problems by setting clear expectations. Again, Stellar Logistics must establish single points of contact. The study also recommend that the company must measure performance in order to salvage its 3PL relationship challenges. Stellar logistics must also involve their 3PL provider in long-term planning.

Actual situation of handling Tokyo 2020 Games-related patients at a designated hospital during COVID-19 pandemic.

In preparation for the Tokyo 2020 Olympic and Paralympic Games, our hospital was responsible for accepting mainly media representatives, marketing partners, and other Games staff. Given that restricting our regular capacity to treat certain groups of patients could potentially result in social losses, to avoid this we made rigorous preparations for the entire hospital to accept Games-related patients. It was rational to set up a single 24-h contact point at the Emergency Department for making the decision on whether to accept the patient or not and for coordinating the patient's medical care. With respect to language support, International Health Care Center staffs were made available as interpreters on weekdays. Multilingual support was available all day via an application run on tablet devices. During a 67-day period, the hospital accepted 31 Games-related patients (mean age 43.4 years, male: female ratio 25:6). Eighteen patients were from Europe, 4 patients each were from North America and Asia, 2 each were from Central America, South America, and Africa, and 1 was from Oceania. The most common cause of visits was COVID-19, but none were severe cases. Other causes were diverse and included moderate and severe conditions. We summarized the challenges and experiences in handling Tokyo 2020 Games-related patients at a designated hospital during the COVID-19 pandemic.

Stably Immobilizing Sub‐3 nm High‐Entropy Pt Alloy Nanocrystals in Porous Carbon as Durable Oxygen Reduction Electrocatalyst

AbstractImmobilizing ultrafine high‐entropy Pt alloy nanocrystals (HENs) in porous carbon (PC) with strong interface interaction, which is crucial to efficient and durable oxygen reduction reaction (ORR), remains a challenge. In this study, an anchoring‐carbonization strategy for strongly bonding sub‐3 nm HENs in ordered mesoporous carbon is reported. When heating the orderly assembled composites containing hydrophobic organometallic precursors, structure directing agent F127, and hydrophilic resol, F127 is first removed at moderate temperature region, leading to reduced metallic species directly anchored on partially carbonized resol framework. Then along further temperature increase, in situ carbonization of resol around the HENs, enables more effective plane bonding rather than a single point contact of HENs with carbon. It not only enhances the anchor strength, but also inhibits migration and size growth of HENs along the subsequent high‐temperature carbonization. As a result, senary, septenary, octonary, and denary Pt‐based HENs with average nanocrystal sizes of 2.2, 2.6, 2.9, and 2.8 nm, respectively, are successfully imbedded into porous carbon. In electrocatalytic ORR, porous carbon‐supported senary Pt‐based HENs (6‐HENs/PC) exhibit superior activity and durability, representing a promising electrocatalyst. This strategy allows for the preparation of a range of ultrafine HENs strongly loaded on porous carbon for wide applications.

HAPT-EDGE: HAPTICS IN SOFT EFFECTORS FOR SMART INTERACTIVE ASSISTIVE FRAMEWORKS

Tactile sensors help in modeling the intrinsic and external touch sensation. Tactile sensing can refer to the touch in multiple points of contact and refer to the process of detecting and measuring a given property of a contact event in a predetermined area at multiple points of contact. The Haptic system helps in creating a “sense of touch” about the environment through stimuli at a single contact point. Effectors are the end point of robotic frameworks that interact with the real world. From prosthetic hands to precision grippers, effectors made of soft flexible materials have been used for various biomedical applications. The research goal of this project is to integrate haptics in soft effectors for two-way communication in an assistive framework. In this research, we will investigate the use of haptics for creating environmental awareness and for taking the user input. Modeling the user input using the haptics will include interpreting the hand gestures. The proposed framework will use the haptic signals at specific frequencies to provide sensor feedback and interpret the user’s hand gestures as user inputs for navigation assistance. In implementing such a framework, the research will also focus on the use of micro actuators or vibration motors for providing precise feedback. The framework will include custom-made soft effectors, robotic cane/walker, algorithms to model the user input, actuators, and vibration sensitive filaments for closing the loop. This research will significantly contribute to the next generation mobility assistive frameworks with interactive feature.

Tethers: A Traveler's Ode to Book Swaps, Big and Small

TethersA Traveler's Ode to Book Swaps, Big and Small SarahBelle Selig (bio) Click for larger view View full resolution A frequent traveler currently winding her way through Central America celebrates the free book swaps along the way, and all the hope and longing nestled amongst their shelves. I'll speak of cathedrals. Of sandwiches and cobblestone, of midnights spent in hot springs and the red sands of the Namib slipping through my fingers. When I return home at last, I will remember most strongly the moments of discovery, of catharsis, of flavor, and share them too often with exasperated loved ones. I will not speak of the books that I read along the way, though they filled the crevices of my days. And least of which will I speak of the bookshelves I found them on, the dusty book swaps in hostel common areas and corner cafés that I frequented, though they too were moments of discovery and catharsis. I will forget them, in time, as they quietly fade to make space for more cathedrals, more natural wonders. But these shelves do not mind the forgetting. Give, take: that is all they ask. [End Page 34] For the perennial traveler, a book swap is more than a minute of respite from the babel outdoors, a freebie when the last of one's coins have been spent on a museum ticket, a street snack, shampoo. A book swap is a new town without a map; a treasure hunt for the sword-shy. If I have the afternoon to linger, a book swap is window shopping the streets of Oaxaca, or selecting the perfect flavor of gelato on a hot day. If I've a bus to catch, or a hangover nestled between my brows, it is frustrating and terribly high-stakes: a fillet knife sliding down the delicate spine of a mackerel. On these shelves, there is no pecking order. Here gathers a ménage of authors who would, in your typical bookstore, live on opposite walls, split by genre and popularity, by surname and sales price. Much like the way I share this cramped dorm room with travelers from South Korea, Argentina, Australia, Trinidad and Tobago; that most private space, shared for one night with people of different languages and histories who would otherwise live a world apart, a single point of contact before we scatter across continents. I imagine the evenings, if these authors whisper to one another like we do, two strange soirées swapping gossip in the dark. Far from the hands of booksellers and publicists, a book swap is a step back in time, before best-seller lists and starred reviews, before book banners flashing bright in our webpage margins. It does not matter who designed the cover or endorsed it on Twitter or how many awards it won. For those of us mad enough to be authors by trade, this is an encouraging thought. It is the book business distilled to its purest form: a writer writes a story, a reader reads it. It is a chance for us—not for sales, nor recognition; the units on our P&Ls will not change—but to finally realize that old dream, to be on the other side of that blessed communion when a young reader finds herself in an author's words and for a moment stops feeling so scared. A book swap is a balm for loneliness. It is here at this altar that two dozen hands from two dozen countries have all left an offering. Because that is what it is, to leave a book for another to find: an offering of oneself, a small fraction of one's hope and longing left like breadcrumbs in the dirt. And when I place my book just so, with a secret kiss to its cover—in that perfect vacancy that book swaps always seem to have, as if they are waiting for just this book to arrive—I imagine the person who will find it, and we are tethered, that reader and I, though we will never know the sound of each other's laughter. We are tethered to each other and to...

Respiratory Modulation of Sternal Motion in the Context of Seismocardiography

Wearable sensing has enabled physiological monitoring in everyday life. Clinically, cardiovascular and respiratory monitoring commonly requires separate devices. However, for feasibility in wearable systems, they are integrated into a single device. Since seismocardiography (SCG) records the motion of the chest wall, it has the potential to monitor both vital signs. The primary application of SCG is cardiovascular monitoring. As a result, its ability to detect respiration has been less defined. This study characterizes how SCG is affected by respiration and consequently, how respiratory metrics can be derived from these effects. The sternal motion of 40 subjects was recorded using an inertial measurement unit with a spirometer for reference. Three scenarios were examined with the subject at rest, holding their breath at peak inhalation, and holding their breath when exhaled. Three main aspects of respiratory modulation were explored: amplitude modulation, frequency modulation, and baseline wandering. The SCG amplitude was observed to be dependent on respiratory volume whereas baseline and frequency modulation were dependent on inhalation phase. All three effects were employed separately in the calculation of respiratory rate. Estimations from baseline wandering, amplitude modulation, and heart rate modulation produced r-squared values of 0.71, 0.44, and 0.66, respectively. The accuracy of tidal volume measurement was limited by a high inter-subject variability. Estimation of the respiratory waveform produced an average r-squared of 0.76 using multivariate linear regression. This demonstrates the potential of SCG as a tool for respiratory monitoring within an integrated, non-invasive cardiorespiratory monitoring system from a single point of contact.

Nurse driven outpatient wound center: Reducing readmission with wound care excellence

There is a growing need for new and innovative ways to care for patients in the ambulatory setting, including providing wound care for patients.A vascular surgery department in a large urban academic medical center noted there was an increasing number of patients with chronic wounds that needed weekly care. The number of patients, the time needed to provide wound care, and limited clinic space was creating a strain on traditional clinic hours.Collaboration between one of the vascular surgery advanced practice registered nurses (APRN) and vascular registered nurse (RN) led to the creation of a vascular wound clinic. Patients with chronic wounds were identified by vascular surgeons at one institution and referred to the wound clinic. A retrospective chart review was used to look at number of patients, number of visits per patient, surgical interventions, number of wounds closed, size of wounds, and complications.The ability to provide a single point of contact for the patient's vascular surgery and wound care needs allowed the clinic to provide comprehensive care for 29 patients and close more than 75% of wounds. The retrospective chart review found that patients receiving weekly wound care with clear communication from the multidisciplinary team, the nursing and nurse practitioner interventions kept most patients out of the hospital, with only two unplanned readmissions to the hospital, neither due to chronic wounds.This nursing led wound clinic was able to accommodate complex vascular surgery patients, heal chronic wounds, and decrease unplanned readmissions. Expanding the clinic to assist with limb salvage and more podiatric patients is providing a new patient base and improving the care for the community that it serves.

“It gave her that soft landing”: Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury

ABSTRACT Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants’ experience of the TRS: (1) structure after hospital discharge; (2) a “soft landing”; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.

MO050: The First Report from the National COVID-19 Autopsy Registry in Germany

Abstract BACKGROUND AND AIMS Autopsies are an invaluable tool in medicine for studying the pathophysiology of diseases, including kidney diseases and causes of death. To facilitate multicenter autopsy-based studies and to provide a single point of contact for data analysis and reporting, the German COVID-19 Autopsy Registry (DeRegCOVID) was launched in April 2020 to uncover effects on pulmonary (micro)vasculature, systemic viral spread including the kidneys or interaction with the immune system. METHOD The electronic registry uses a web-based electronic data collection system. Participation is voluntary and biomaterial remains at each site (decentralized biobanking). As of October 2021, the registry included N = 1129 autopsy cases with 69 271 individual data points containing information on 18 674 available biospecimens, including kidneys as part of the standard sampling protocol, collected at 29 German sites. RESULTS In the N = 1095 eligible records, the male-to-female ratio was 1–8:1, with peaks at 65–69 and 80–84 years in men and >85 years in women. Analysis of the chain of events leading directly to death showed that in 86% of autopsy cases, COVID-19 was the actual cause of death, whereas in 14% of cases, COVID-19 was a concomitant disease. The most common immediate cause of death was diffuse alveolar injury/acute respiratory distress syndrome, followed by multiorgan failure, including the kidneys. The registry supports several scientific projects, informs the public and provides reports to federal health authorities, which led to a change in the German Infection Protection Act and facilitated autopsies during pandemics. CONCLUSION A national autopsy registry can provide multicenter quantitative information on COVID-19 deaths at the national level to support medical research, policy decisions and public discussions. Previous and ongoing studies also showed the potential of autopsies for nephrology research.

A Comparison of Heart Pulsations Provided by Forcecardiography and Double Integration of Seismocardiogram.

Seismocardiography (SCG) is largely regarded as the state-of-the-art technique for continuous, long-term monitoring of cardiac mechanical activity in wearable applications. SCG signals are acquired via small, lightweight accelerometers fixed on the chest. They provide timings of important cardiac events, such as heart valves openings and closures, thus allowing the estimation of cardiac time intervals of clinical relevance. Forcecardiography (FCG) is a novel technique that records the cardiac-induced vibrations of the chest wall by means of specific force sensors, which proved capable of monitoring respiration, heart sounds and infrasonic cardiac vibrations, simultaneously from a single contact point on the chest. A specific infrasonic component captures the heart walls displacements and looks very similar to the Apexcardiogram. This low-frequency component is not visible in SCG recordings, nor it can be extracted by simple filtering. In this study, a feasible way to extract this information from SCG signals is presented. The proposed approach is based on double integration of SCG. Numerical double integration is usually very prone to large errors, therefore a specific numerical procedure was devised. This procedure yields a new displacement signal (DSCG) that features a low-frequency component (LF-DSCG) very similar to that of the FCG (LF-FCG). Experimental tests were carried out using an FCG sensor and an off-the-shelf accelerometer firmly attached to each other and placed onto the precordial region. Simultaneous recordings were acquired from both sensors, together with an electrocardiogram lead (used as a reference). Quantitative morphological comparison confirmed the high similarity between LF-FCG and LF-DSCG (normalized cross-correlation index >0.9). Statistical analyses suggested that LF-DSCG, although achieving a fair sensitivity in heartbeat detection (about 90%), has not a very high consistency within the cardiac cycle, leading to inaccuracies in inter-beat intervals estimation. Future experiments with high-performance accelerometers and improved processing methods are envisioned to investigate the potential enhancement of the accuracy and reliability of the proposed method.

An elastic rod in frictional contact with a rigid cylinder

We investigate the load transmission along an elastic rod of finite cross-section in contact with a rigid cylinder, as system often referred to as the generalized capstan problem. In the presence of friction, the idealized classic capstan equation predicts that the tension along a perfectly thin and flexible filament increases exponentially along the contact region. In practical applications, however, the validity of the idealized capstan equation is compromised due to the interplay between finite rod thickness, bending stiffness, and the forces applied at the rod extremities. Here, we combine precision model experiments, finite element simulations, and theoretical modeling to investigate the contact mechanics and the force transmission along an elastic rod in frictional contact with a rigid cylinder. We study two cases when the rod is either static or sliding. First, we focus on the static case, in the absence of friction, by considering equal loads at both extremities of the rod. We show that as the loading force is increased, the nature of contact transitions from a localized region to an extended band at the surface of the cylinder. The latter is characterized by double-peaked contact force distribution. In the sliding case, friction is activated by inducing a relative motion between the rod and the cylinder. We applied a fixed loading force at one rod extremity while pulling the other extremity at a constant velocity. The driving force is monitored during sliding. For increasing loading forces, we find that the force ratio is non-monotonic and displays a local minimum, in contradiction with the constant ideal capstan prediction. This minimum force ratio coincides with the transition from a single contact point to an extended contact region. A theoretical analysis based on Euler’s elastica serves to rationalize the results from the physical and numerical experiments. In addition to predicting the nature of the contact region (single point versus extended line), our model provides quantitative predictions for the wrapping angle and the driving-to-loading force ratio. Finally, we leverage our mechanics-based framework to predictively understand the force ratio at the ends of two commercially available engineering belts (spring-steel and polyurethane) in sliding contact with a steel cylinder.

Development and analysis of the two-regime transient tyre model for combined slip

This paper refines the two-regime transient theory developed by Romano et al. [Romano L, Bruzelius F, Jacobson B. Unsteady-state brush theory. Vehicle Syst Dyn. 2020;59:11–29. DOI: 10.1080/00423114.2020.1774625.] to include the effect of combined slip. A nonlinear system is derived that describes the non-steady generation of tyre forces and considers the coupling between the longitudinal and lateral characteristics. The proposed formulation accounts for both the carcass and the bristle dynamics, and represents a generalisation of the single contact point models. A formal analysis is conducted to investigate the effect of the tyre carcass anisotropy on the properties of the system. It is concluded that a fundamental role is played by the ratio between the longitudinal and lateral relaxation lengths. In particular, it is demonstrated that the maximum slip that guarantees (partial) adhesion conditions does not coincide with the stationary value and decreases considerably for highly anisotropic tyres. The dissipative nature of the model is also analysed using elementary tools borrowed from the classic theory for nonlinear systems. A comparison is performed against the single contact point models, showing a good agreement especially towards the full-nonlinear one. Furthermore, compared to the single contact point models, the two-regime appears to be able to better replicate the exact dynamics of the tyre forces predicted by the complete brush theory. Finally, the transient model is partially validated against experimental results.

A realist evaluation of a home-based end of life care service for children and families: what works, for whom, how, in what circumstances and why?

BackgroundChildren’s palliative and end of life care is underpinned internationally by a commitment to provide care and support in the family’s preferred place, which may include home, hospital or hospice. Limited evidence on models of best practice for the provision of children’s end of life care at home is available. This realist evaluation of a novel, home-based end of life care service explored what works for whom, how, in what circumstances and why.MethodsAdopting principles of realist evaluation, an initial programme theory (IPT) was developed from multiple data sources including a scoping review, service documentation review, audit of service data, and qualitative data gathered from stakeholder (n = 6) and family interviews (n = 10). Three families who had used the service were identified as case studies and interviews with professionals involved in their care (n = 20) were conducted to test the IPT. The findings informed the revised CMOs illustrating the contexts and mechanisms which underpin how and why the service works and for whom.ResultsCMO configurations were identified explaining how and why the service works for families across five core components: anticipatory approach to care planning and delivery, advance care planning, service responsiveness and flexibility, 24/7 nurse-led service with 24-h medical support, and partnership working. Key mechanisms include establishing trusting relationships, building skills and parent confidence to deliver care, early advance care planning discussions with clear documentation, providing a single point of contact for families, workforce planning and resources to deliver the service as intended, effective communication and leadership within and between providers of the service, and use of joint policies and procedures. Recommendations for future development and expansion of the service are also discussed.ConclusionsThe findings highlight core components making this service a success and areas of challenge which continue to be addressed as the service develops. With increasing demand for home-based end of life care for children these components provide a structure which can help to guide service development to meet the needs of these families in other regions to ensure that children and families receive good quality care in their place of choice.

Dynamic modeling and analysis of bundled linear ultrasonic motors with non-ideal driving

To achieve larger thrust and higher power in applications, multiple linear ultrasonic motors are usually combined. However, in previous researches, the motion mechanism of bundled linear ultrasonic motors is not explained clearly. Most researchers focus upon the description of experiments and the interpretation of experimental results, therefore until now, the dynamic model of the bundled linear ultrasonic motors has not been well established. In order to obtain deeper physical insight into the motion principle and provide a theoretical basis for better control of the bundled linear ultrasonic motors, a dynamic model for bundled linear ultrasonic motors is established in this paper. In this model, the contact interface is simplified to be a single point contact model and the impact of the clamping part on the performance of motor is considered. Using this model, the output characteristics of the bundled linear ultrasonic motors are investigated by discussing the influence of some important factors including preload, exciting voltage and exciting frequency. Test results show the proposed dynamic model is able to predict the output performance of the bundled motors. Moreover, the proposed model is not only suitable for the researched motor, but also can be extended to other bundled linear ultrasonic motors.

Riemann Zeta Based Surge Modelling of Continuous Real Functions in Electrical Circuits

Riemann zeta is defined as a function of a complex variable that analytically continues the sum of the Dirichlet series, when the real part is greater than unity. In this paper, the Riemann zeta associated with the finite energy possessed by a 2mm radius, free falling water droplet, crashing into a plane is considered. A modified zeta function is proposed which is incorporated to the spherical coordinates and real analysis has been performed. Through real analytic continuation, the single point of contact of the drop at the instant of touching the plane is analyzed. The zeta function is extracted at the point of destruction of the drop, where it defines a unique real function. A special property is assumed for some continuous functions, where the function’s first derivative and first integral combine together to a nullity at all points. Approximate reverse synthesis of such a function resulted in a special waveform named the dying-surge. Extending the proposed concept to general continuous real functions resulted in the synthesis of the corresponding function’s Dying-surge model. The Riemann zeta function associated with the water droplet can also be modeled as a dying–surge. The Dying- surge model corresponds to an electrical squeezing or compression of a waveform, which was originally defined over infinite arguments, squeezed to a finite number of values for arguments placed very close together with defined final and penultimate values. Synthesized results using simulation software are also presented, along with the analysis. The presence of surges in electrical circuits will correspond to electrical compression of some unknown continuous, real current or voltage function and the method can be used to estimate the original unknown function.