Single Observer Research Articles

Discrete Reduced-order Active Disturbance Rejection Control for Marine engines using Variable Sampling Rate Control Scheme under Limited Bandwidth

In this paper, the reduced-order active disturbance rejection control (RADRC) is studied for marine engine speed control. The benefits of using RADRC are demonstrated by bode diagram method with the transfer function between input disturbance and system output. Discrete RADRC and active disturbance rejection control (ADRC) are designed for marine engine speed control by adopting variable sampling rate control method. The proposed method is assessed by experiment on a hard-in-loop (HIL) engine test platform. Except the step-response indexes, ADRC and RADRC are compared in more indexes. The results demonstrate that RADRC has superiority during the sudden load varying process. For steady-state, a single smaller observer bandwidth in RADRC can make a good compromise for a wide range engine speed. It also has been found that the index of total variation (TV) in control input for RADRC is inferior to the ADRC. Overall, RADRC is a promising method for marine engine speed control.

545 Deep learning/artificial intelligence for automatic measurement of global longitudinal strain by echocardiography

Abstract Funding Acknowledgements The Norwegian Health Association, South-Eastern Norway regional health Authority and the national program for clinical therapy research (KLINBEFORSK). Background Global longitudinal strain (GLS) by echocardiography has incremental prognostic value in patients with acute myocardial infarction and heart failure compared to left ventricular (LV) ejection fraction and provides more reproducible measurements of LV function. Recent advances in machine learning for image analysis now open the possibility for robust fully automated tracing of the LV and measurement of global longitudinal strain (GLS), without any operator input. This could make real-time GLS possible and remove inter-reader variability, thus resulting in saved time and improved test-retest reliability. The aim of the present study was to investigate how measurements by this novel automatic method compares to conventional speckle tracking analyses of GLS. Methods 100 transthoracic echocardiographic examinations were included from a clinical database of patients with acute myocardial infarction or de-novo heart failure. Examinations were included consecutively and regardless of image quality. Simpson biplane LV ejection fraction ranged from 7 to 70%. Images of three standard apical planes from each examination were analysed using our novel and fully automated GLS method based on deep learning technology. The automated GLS measurements were compared to conventional speckle tracking GLS measurements of the same acquisitions using vendor specific format and software (EchoPAC, GE Healthcare), performed by a single experienced observer. Results GLS was -11.6 ± 4.5% and -12.8 ± 5.0% for the deep learning method and the conventional method, respectively. Bland-Altman analysis showed a bias of -0.7 ± 1,9% and 95% limits of agreement of -4,6 to 3.1. No clear value dependent bias was found by visual inspection (Figure A). Feasibility for measurement of GLS was 93% for the deep learning based method and 99% for the conventional method. The limits of agreement found in our study is comparable to findings in the intervendor comparison study by the EASCVI/ASE/Industry Task force to standardize deformation imaging. Conclusion This novel deep learning based method succeeds without any operator input to automatically identify and classify the three apical standard views, trace the myocardium, perform motion estimation and measure global longitudinal strain. This could further facilitate the clinical use of GLS as an important tool for enhancing clinical decision-making. Abstract 545 Figure.

Individualised automated lameness detection in dairy cows and the impact of historical window length on algorithm performance

Lameness is an important economic problem in the dairy sector, resulting in production loss and reduced welfare of dairy cows. Given the modern-day expansion of dairy herds, a tool to automatically detect lameness in real-time can therefore create added value for the farmer. The challenge in developing camera-based tools is that one system has to work for all the animals on the farm despite each animal having its own individual lameness response. Individualising these systems based on animal-level historical data is a way to achieve accurate monitoring on farm scale. The goal of this study is to optimise a lameness monitoring algorithm based on back posture values derived from a camera for individual cows by tuning the deviation thresholds and the quantity of the historical data being used. Back posture values from a sample of 209 Holstein Friesian cows in a large herd of over 2000 cows were collected during 15 months on a commercial dairy farm in Sweden. A historical data set of back posture values was generated for each cow to calculate an individual healthy reference per cow. For a gold standard reference, manual scoring of lameness based on the Sprecher scale was carried out weekly by a single skilled observer during the final 6 weeks of data collection. Using an individual threshold, deviations from the healthy reference were identified with a specificity of 82.3%, a sensitivity of 79%, an accuracy of 82%, and a precision of 36.1% when the length of the healthy reference window was not limited. When the length of the healthy reference window was varied between 30 and 250 days, it was observed that algorithm performance was maximised with a reference window of 200 days. This paper presents a high-performing lameness detection system and demonstrates the importance of the historical window length for healthy reference calculation in order to ensure the use of meaningful historical data in deviation detection algorithms.

Minimal Order Linear Functional Observers Design for Multicell Series Converter

The requirement of high voltage-power level for many applications like the energy conversion system give rise to use a structure of a multilevel converter like the multicell series converter. To benefit as much as possible from this power converter an appropriate voltage distribution for each cell must be performed, hence the need to estimate this voltages. This paper aims to design a minimal single linear functional observer for a multicell series converter to estimate the capacitor voltages. Based on its hybrid model, an observability study prove the ability to estimate this capacitor voltages. Also a linear functional observers are proposed using a direct procedure without solving the Sylvester equation and based on an operation mode classification approach. Simulations of four-cells multicell converter are given in order to check the efficiency of the converter’s hybrid model and the performance of the proposed minimal single linear functional observers.

Assessment of degenerative changes in the temporomandibular joint: A retrospective cone-beam computed tomography study

Context: Degenerative temporomandibular joint (TMJ) disorders may show radiological characteristics similar to remodeling changes in an asymptomatic joint. Aims: The aim of the study was to evaluate the bone changes in the condylar process of the TMJ in patients and associate the changes with age and gender. Settings and Design: The study was conducted in the Department of Oral Medicine and Radiology, AJ Institute of Dental Sciences over a period of 2 years following institutional ethical clearance. Data were retrieved from the computer database and assessed using cone-beam computed tomography (CBCT) (NewTom VGi evo). Subjects and Methods: Two hundred TMJ CBCT images were assessed in 100 patients. The study sample was carefully selected to exclude patients with any medical problems. The same bone changes in the condylar process were found in at least two consecutive slices by a single observer to avoid misinterpretation. Statistical Analysis: Data were collected and subjected to statistical analysis using kappa statistics for intraobserver reliability and using Chi-square test for comparison of parameters (P

Diagnosis of time-delay fractional systems using observer-based methods

In this paper, two model-based methods are considered for the diagnosis of time-delay fractional systems. Time-delay fractional Luenberger observer without unknown input and time-delay fractional unknown input observer are developed and used for fault detection and isolation. A single observer scheme is needed for fault detection and a bank of generalized (respectively dedicated) observers is required for fault isolation. A theoretical study investigating the convergence condition for each observer-based method in terms of matrix inequalities is presented. Residual sensitivities to faults and to disturbances are studied. Time-delay fractional unknown input observer parameters are computed to obtain structured residuals. This observer ensures unknown input decoupling from the state which results residual insensitive to unknown inputs. Two numerical examples to validate the efficiency of the proposed approaches are given.

Algebraic approaches for the design of simultaneous observers for linear systems

In this study, algebraic techniques are proposed to design observers capable of estimating the state of multiple linear continuous-time systems. In order to pursue this objective, first an algebraic technique is given to compute the set of all the linear inverses of the observability map of a single plant. Such a result is then used to characterise, through algebraic geometry tools, the simultaneous observability of multiple linear systems both in the forced and in the autonomous case. Such a characterisation is finally employed to design a single observer that is capable of estimating the state of multiple linear systems.

Entanglement and objectivity in pure dephasing models

We study the relation between the emergence of objectivity and qubit-environment entanglement generation. We find that although entanglement with the unobserved environments is irrelevant (since sufficiently strong decoherence can occur regardless), entanglement with the observed environments is crucial. In fact, the appearance of an objective qubit-observed-environment state is strictly impossible if their joint evolution does not lead to entanglement. Furthermore, if a single observer has access to a single environment (no macrofractions) then the required orthogonality of the observed environmental states comes only as a consequence of the system-enviornment state becoming strongly entangled (maximally entangled for the given initial occupation of the qubit if the environmental state is initially pure).

Contribution of thermal imaging in determining the depth of pediatric acute burns.

Early burn wound assessment is a major problem in pediatrics. It involves regular clinical evaluations, and may be helped by objective tools, such as thermal imagers. Because of the skin temperature difference between partial and full thickness burns, due to injured vascular perfusion of the dermis in the latter, it could precisely identify areas with superficial burns which could heal from controlled wound healing, and those with deep burns which would need skin graft, at an early stage. The objective of this study was to assess the validity of the Flir one thermal imager® for this purpose. Thermal images were obtained by a single observer three times after burn: day 1-3 (T1); day 4-7 (T2); day 8-10 (T3). ΔT (temperature difference between burned area and healthy skin) was calculated on a tablet with Flir One application. Validity was assessed by comparing ΔT obtained at each time between two groups at day 15 depending on the healing time of the burn wounds : before or after day 15. Primary outcome was the AUC (area under curve) of the ROC (Receiver operating characteristic) curve for ΔT at T1, T2 and T3, representing the ability of the Flir One Thermal Imager® to discriminate between a healing time <15 days and >15 days. 40 patients were included (13 months to 13 years old). AUC at T1 and T2 are 0.700 (95% CI: 0.649; 0.925) and 0.787 (95% CI: 0.523; 0.877), respectively. AUC at T3 is 0.968 (95% CI: 0.918; 1.00). A ΔT threshold of -1.2°C at T3 is associated with a specificity of 100% allowing to diagnose as of day 8 all the patients having deep burns which heal after 15 days. The Flir One Thermal Imager® is an inexpensive, non-invasive, and easy-to-use device. It measures indirectly but with an excellent specificity the dermis perfusion reflecting the burns depth in children. However its low sensitivity calls for additional research to allow skin grafts earlier in common practice and decrease the length of stay.

Assessment of Basic Ankle Arthroscopy Skills in Orthopedic Trainees.

There is increasing emphasis on assessing resident competency, but little has been published on how to best evaluate trainee competency for ankle arthroscopy. The purpose of this study was to validate an objective model for assessing basic ankle arthroscopy knowledge and operative skills on a cadaveric ankle. The Diagnostic Ankle Arthroscopy Skills Scoring System was adapted from previously validated assessment tools for knee arthroscopy. The scoring system included (1) an oral questionnaire (0-23 points), (2) an operative task-specific checklist (0-19 points), and (3) a global operative skills rating (12-60 points). Thirty-three trainees consisting of orthopedic residents and medical students performed a diagnostic ankle arthroscopy on a cadaveric ankle and were assessed by a single observer, while a subset were tested by 2 evaluators to determine interobserver reliability. There was strong correlation between educational level and scores on the global operative skills rating scale (r = 0.967, P < .0001), task-specific checklist (r = 0.815, P < .815), and oral questionnaire (r = 0.896, P < .0001). The global operative skills scores significantly improved with training level, and the largest difference was between medical students and senior residents. The most notable year-to-year increases in skill were between postgraduate year (PGY) 1 and 2 (P < .01) and between PGY2 and PGY3 (P < .05). Oral questionnaire and task-specific checklists were significantly lower for medical students than PGY1 residents (P < .001). There was also significant improvement in the oral questionnaire between senior and junior residents (P < .05). There was a moderate correlation between number of self-reported ankle arthroscopy cases and scores on the global operative skills score (r = 0.7019, P < .0001). Interobserver reliability was high for the global operative skills scores (interclass correlation coefficient = 0.89). The study revealed a valid measure to objectively assess trainees' ankle arthroscopy clinical knowledge and operative skills in a bioskills laboratory. This tool should enable residency programs to evaluate competency and track individual trainee progress over time.

QTc Prolongation in Patients with Dementia and Mild Cognitive Impairment: Neuropsychological and Brain Imaging Correlations.

The QTc interval is the electrocardiographic manifestation of ventricular depolarization and repolarization. This marker is often prolonged in acute and chronic neurological conditions. The cause of the cerebrogenic QT prolongation remains unclear. The aim of the study was to analyze the relation between QTc interval and the degree of cognitive impairment and structural brain imaging changes in patients with dementia and mild cognitive impairment (MCI). To this aim, 269 patients were screened, of whom 61 met one or more exclusion criteria. The remaining 208 patients (56 control subjects, 44 patients with MCI, and 108 with dementia) were recruited. Eighty-five patients using drugs causing prolongation of QT interval were further excluded. The QT interval was measured manually in all 12 leads by a single blinded observer, assuming the longest QT value adjusted for heart rate by using the Bazett's formula. All patients underwent a structural brain imaging and the following measures were obtained: the bicaudate ratio and the periventricular hyperintensity and deep white matter hyperintensity using the modified Fazekas scale. Prolonged QTc interval was prevalent in 1) patients with dementia, especially in those with moderate-severe degree; 2) subjects with impairment of praxis and attention, low functional status, and behavioral symptoms; 3) patients with global and temporal atrophy and with higher scores on the Fazekas or leukoaraiosis scales. Degenerative and vascular processes might play a main role in QTc interval prolongation because of the damage to brain areas involved in the control of the autonomic cardiac nervous system.

Radial Extracorporeal Shock Wave Treatment Promotes Bone Growth and Chondrogenesis in Cultured Fetal Rat Metatarsal Bones.

Substantial evidence exists to show the positive effects of radialextracorporeal shock wave therapy (ESWT) on bone formation. However, it is unknown whether rESWT can act locally at the growth plate level to stimulate linear bone growth. One way to achieve this is to stimulate chondrogenesis in the growth plate without depending on circulating systemic growth factors. We wished to see whether rESWT would stimulate metatarsal rat growth plates in the absence of vascularity and associated systemic growth factors. To study the direct effects of rESWT on growth plate chondrogenesis, we asked: (1) Does rESWT stimulate longitudinal bone growth of ex vivo cultured bones? (2) Does rESWT cause any morphological changes in the growth plate? (3) Does rESWT locally activate proteins specific to growth plate chondrogenesis? Metatarsal bones from rat fetuses were untreated (controls: n = 15) or exposed to a single application of rESWT at a low dose (500 impulses, 5 Hz, 90 mJ; n = 15), mid-dose (500 impulses, 5 Hz, 120 mJ; n = 14) or high dose (500 impulses, 10 Hz, 180 mJ; n = 34) and cultured for 14 days. Bone lengths were measured on Days 0, 4, 7, and 14. After 14 days of culturing, growth plate morphology was assessed with a histomorphometric analysis in which hypertrophic cell size (> 7 µm) and hypertrophic zone height were measured (n = 6 bones each). Immunostaining for specific regulatory proteins involved in chondrogenesis and corresponding staining were quantitated digitally by a single observer using the automated threshold method in ImageJ software (n = 6 bones per group). A p value < 0.05 indicated a significant difference. The bone length in the high-dose rESWT group was increased compared with that in untreated controls (4.46 mm ± 0.75 mm; 95% confidence interval, 3.28-3.71 and control: 3.50 mm ± 0.38 mm; 95% CI, 4.19-4.72; p = 0.01). Mechanistic studies of the growth plate's cartilage revealed that high-dose rESWT increased the number of proliferative chondrocytes compared with untreated control bones (1363 ± 393 immunopositive cells per bone and 500 ± 413 immunopositive cells per bone, respectively; p = 0.04) and increased the diameter of hypertrophic chondrocytes (18 ± 3 µm and 13 ± 3 µm, respectively; p < 0.001). This was accompanied by activation of insulin-like growth factor-1 (1015 ± 322 immunopositive cells per bone and 270 ± 121 immunopositive cells per bone, respectively; p = 0.043) and nuclear factor-kappa beta signaling (1029 ± 262 immunopositive cells per bone and 350 ± 60 immunopositive cells per bone, respectively; p = 0.01) and increased levels of the anti-apoptotic proteins B-cell lymphoma 2 (718 ± 86 immunopositive cells per bone and 35 ± 11 immunopositive cells per bone, respectively; p < 0.001) and B-cell lymphoma-extra-large (107 ± 7 immunopositive cells per bone and 34 ± 6 immunopositive cells per bone, respectively; p < 0.001). In a model of cultured fetal rat metatarsals, rESWT increased longitudinal bone growth by locally inducing chondrogenesis. To verify whether rESWT can also stimulate bone growth in the presence of systemic circulatory factors, further studies are needed. This preclinical proof-of-concept study shows that high-dose rESWT can stimulate longitudinal bone growth and growth plate chondrogenesis in cultured fetal rat metatarsal bones. A confirmatory in vivo study in skeletally immature animals must be performed before any clinical studies.

Ultrasound examination of the cervix for predicting labor induction success: failed validation in a routine clinical setting of a successful previous pilot study.

Induction of labor (IL) involves an overload of work in hospitals, as well as increased intervention. Traditionally, the Bishop score (BS) has been used to predict the outcome of a IL, but there is a growing interest in studying the predictive capacity of ultrasound variables. Validate a pilot predictive model performed by a single observer (Alvarez-Colomo C), based on clinical parameters and ultrasound parameters, that showed a significant association with the IL result, obtaining a correct prediction of vaginal delivery in 82.8%, with 15% false positive (FP). This validation was carried out under the usual conditions of clinical practice by four observers without distinction. A prospective, observational study was conducted between September 2010-July 2012, recruiting 231 single pregnancies (Group 2), who were to initiate the IL process, according to the methodology and inclusion criteria of the Alvarez-Colomo study (Group 1151 patients). The outcome variable was the method of delivery. Only fetal head-perineal distance (FHPD), cervical length (CL) and BS showed significant association with the result of IL. After applying the logistic regression equation of the pilot study, the model developed by these four observers reached a predictive capacity of 70.74% (FP = 20%). Clinical characteristics were similar in both groups. Statistically significant differences were found between the two groups for: FHPD, posterior cervical angle (PCA) and funnel existence. It has not been possible to validate the mathematical model of Alvarez's study in the daily conditions of clinical practice, probably due to differences in the ultrasound measurement of FHPD.

NIMG-03. PROSPECTIVE PHASE II RANDOMIZED TRIAL COMPARING PROTON THERAPY VS. PHOTON IMRT FOR GBM: SECONDARY ANALYSIS COMPARISON OF PROGRESSION FREE SURVIVAL BETWEEN RANO VS. CLINICAL AND RADIOLOGICAL ASSESSMENT

Abstract PURPOSE To compare tumor progression based on clinical radiological assessment and on Response Assessment in Neuro-Oncology (RANO) criteria between GBM patients treated with proton radiotherapy (PT) vs. photon intensity modulated radiotherapy (IMRT). METHODS Eligible patients were enrolled on the described prospective phase II trial and had MR imaging at baseline and follow-up beyond 12 weeks from treatment completion. ‘Clinical’ progression was based on a radiology report of progression in combination with changes in treatment due to suspected disease progression. A single blinded observer applied RANO criteria to determine the RANO-based tumor progression. RESULTS Of 90 enrolled patients, 66 were evaluable, with median follow-up of 19.8 (Range: 3.2–65.1) months; median of 22.6 months for PT (n=25) vs. 18.9 months for IMRT (n=41). Median time to progression (TTP) was 7.9 months based on clinical progression criteria (8.1 months IMRT, 6.3 months PT) and 7.2 months (7.3 months IMRT, 5.7 months PT) by RANO criteria (p=ns for all). Median ‘clinical’ progression-free survival (PFS) was 8.7 (Range: 6.4–11.1) months; 8.9 months IMRT vs. 8.7 months PT (p=0.065). Median RANO PFS was 8.3 (range, 5.8–11.6) months: 8.3 months IMRT vs. 6.9 months PT (p=0.226). There were 14 discrepant cases: 3 had progression based on ‘clinical’ but not RANO criteria, and 11 had progression based on RANO but not ‘clinical’ criteria. CONCLUSION Based on this secondary analysis of a randomized trial of PT vs. IMRT for GBM, there was no difference in tumor progression relative to treatment technique used. There was no statistical difference in PFS noted between clinical and RANO-based assessments, but RANO criteria identified progression more often than clinical assessment, and TTP was shortened with the use of RANO criteria alone. Further development of tumor assessment tools that improve consistency and accuracy of determining tumor progression are needed to guide therapeutic trials in GBM.

Applicability of two bone age assessment methods to children from Saudi Arabia

To assess the applicability of the Greulich & Pyle (G&P) and Tanner & Whitehouse (TW3) methods to children from Saudi Arabia using both subjective (manual) rating and BoneXpert software. Bone age (BA) was assessed using the G&P and TW3 methods, firstly by independent manual rating of two observers, followed by a single observer using the BoneXpert software program. In total, 420 hand trauma radiographs for Saudi Arabians (220 males, 329 left, age range 1-18 years) performed in the period January 2012 to September 2016 were assessed. Paired sample t test was used to compare the difference between mean BA and mean chronological age (CA) and to compare the difference between manual and BoneXpert ratings. Statistical analysis was undertaken using SPSS v.25. A statistically significant difference was found between BA and CA in males when using the G&P (mean difference -0.36±1 years, p<0.01) and TW3 (mean difference -0.22±0.9 years, p=0.03) methods, but not in females for either G&P (mean difference 0.13±1.2 years) or TW3 (mean difference 0.08±1.1 years). In males, BoneXpert results conformed to the manual ratings for TW3, but not for G&P, for which the mean difference between manual and BoneXpert ratings was -0.27±0.5 years (p<0.01). The present results indicate that manual and BoneXpert-derived G&P and TW3 bone age assessment can be applied with no modification to Saudi Arabian females; however, only TW3 BoneXpert-derived BA can be applied without caution to Saudi Arabian males.

Visual Perception Entropy Measure

This paper is about a theoretical framework on perceptual reproduction quality assessment. Visual perception is the main theme for two approaches on image metrics: visual performance and image quality. Visual performance looks at the perception of standard elementary images, such as gratings, by different observers or by a single observer in different visual conditions; image quality looks at the perception of variations of the same complex scene by a standard observer. In the audiovisual field, all the configurations approved by the creative team must be reproduced in the final viewing. This cannot be measured by visual performance or image quality indexes. A third approach is needed, which may be called perceptual reproduction quality assessment. Visual perception assessment is not measuring defects, per se; it is built to evaluate the perceptual effectiveness of a given scene coding through a given reproduction technology. It is only dependent on the number of configurations being perceived through a given theater system relative to the various configurations reproduced and approved in the review room. As such, it is a statistical measure. It is, in fact, similar to the definition of relative entropy. One important fact is that this evaluation must include a model of visual perception. This paper illustrates how relative entropy and entropy loss can be estimated, while taking into account the coding transform, the projector performances, maximum light, and the characteristics of the human visual system. This scheme works easily for monochromatic content. Color, trichromacy, is quite challenging. The size of configurations goes from 2 12 to 2 36 , around 6 billion configurations. Calculation and memory requirements are huge. Nonlinearities are adding complexity, leading to calculation of an upper limit only of entropy loss. The presentation of results is also a challenge. One way to solve this is to separately process lightness and chromatic information. In summary, the main arguments in this paper are: 1) besides image quality and visual performance, there is a need for perceptual reproduction quality assessment; 2) entropy is the proper statistical estimator for evaluating the perceptual reproduction quality; and 3) color reproduction quality estimation requires processing lightness and chromatic attributes separately.

Understanding Nursing Workflow for Inpatient Education Delivery: Time and Motion Study.

BackgroundDiabetes self-management education and support improves diabetes-related outcomes, but many persons living with diabetes do not receive this. Adults with diabetes have high hospitalization rates, so hospital stays may present an opportunity for diabetes education. Nurses, supported by patient care technicians, are typically responsible for delivering patient education but often do not have time. Using technology to support education delivery in the hospital is one potentially important solution.ObjectiveThe aim of this study was to evaluate nurse and patient care technician workflow to identify opportunities for providing education. The results informed implementation of a diabetes education program on a tablet computer in the hospital setting within existing nursing workflow with existing staff.MethodsWe conducted a time and motion study of nurses and patient care technicians on three medical-surgical units of a large urban tertiary care hospital. Five trained observers conducted observations in 2-hour blocks. During each observation, a single observer observed a single nurse or patient care technician and recorded the tasks, locations, and their durations using a Web-based time and motion data collection tool. Percentage of time spent on a task and in a location and mean duration of task and location sessions were calculated. In addition, the number of tasks and locations per hour, number of patient rooms visited per hour, and mean time between visits to a given patient room were determined.ResultsNurses spent approximately one-third of their time in direct patient care and much of their time (60%) on the unit but not in a patient room. Compared with nurses, patient care technicians spent a significantly greater percentage of time in direct patient care (42%; P=.001). Nurses averaged 16.2 tasks per hour, while patient care technicians averaged 18.2. The mean length of a direct patient care session was 3:42 minutes for nurses and 3:02 minutes for patient care technicians. For nurses, 56% of task durations were 2 minutes or less, and 38% were one minute or less. For patient care technicians, 62% were 2 minutes or less, and 44% were 1 minute or less. Nurses visited 5.3 and patient care technicians 9.4 patient rooms per hour. The mean time between visits to a given room was 37:15 minutes for nurses and 33:28 minutes for patient care technicians.ConclusionsThe workflow of nurses and patient care technicians, constantly in and out of patient rooms, suggests an opportunity for delivering a tablet to the patient bedside. The average time between visits to a given room is consistent with bringing the tablet to a patient in one visit and retrieving it at the next. However, the relatively short duration of direct patient care sessions could potentially limit the ability of nurses and patient care technicians to spend much time with each patient on instruction in the technology platform or the content.

Development of scoring systems for abnormal rising and lying down by dairy cattle, and their relationship with other welfare outcome measures

The objective of this study was to develop two scoring systems to measure the extent of abnormal rising and lying-down behaviors in dairy cows, and to assess the relationship of the behaviors with other welfare outcome measures. Forty-eight lactating Holstein cows were randomly selected in a tie-stall house and enrolled over 2 replicates. Each replicate was video recorded for 24 h, once per week for 10 consecutive weeks. In weeks 1, 2, and 3 of replicate 1, all rising and lying-down events were identified from the video recordings by a single trained observer. Behaviors recorded while rising included duration of rising (sec), attempts at rising, presence (1) or absence (0) of contact with environment, backward movement on carpal joints, delayed rising, and horse rising. Behaviors recorded while lying-down were duration of intention movements (sec), duration of lying-down (sec), attempts at lying-down, presence (1) or absence (0) of contact with environment, hindquarters shifting, slipping, and dog-sitting. An event classifier was also used to categorize each rising and lying-down event as normal (0) or abnormal (1) based on the presence of at least one abnormal behavior. Averaging scores for each behavior and event classifier from 4 daytime events and 2 night-time events was sufficient to yield a strong correlation with full 24 h averages for each behavior and event classifier (rs ≥ 0.82). Three independent observers were trained to score all behaviors and the event classifier with high repeatability (≥ 0.80 κ). The observers were each assigned a portion of weeks 2, 3, 6, 8, and 10 of replicates 1 and 2 to score the daily percentage occurrence of each behavior and event classifier using the outlined regime. Lameness status and injury were also assessed live by trained observers, and lying time was automatically recorded in weeks 2, 3, 6, 8, and 10 of replicates 1 and 2. Multivariate mixed models were used to assess the association of each behavior with other measures, including of welfare. A subset of the behaviors was positively associated with injury severity and body size, and negatively associated with lying time (P ≤ 0.05). Both scoring systems were highly repeatable tools for assessing the extent of abnormal rising and lying-down behaviors in dairy cows, and were associated with other welfare outcomes indicative of cow comfort.

Reduced uterine volume after induction of puberty in women with hypogonadism.

Adequate uterine growth is an essential component of pubertal induction with exogenous oestradiol in those with hypogonadism. Poor uterine development will render the individual vulnerable in the context of fertility. We assessed uterine size using ultrasound in those who had undergone pubertal induction treatment compared with a reference group who had experienced spontaneous puberty. This is a single-centre, retrospective, cross-sectional study of women who underwent pubertal induction compared with a reference group. Ninety-five women with hypogonadism who had previously undergone pubertal induction and were receiving maintenance oestrogen replacement as adults were recruited: 48 women with Turner syndrome, 32 with premature ovarian insufficiency and 15 with gonadotrophin deficiency. The reference group consisted of 35 nulliparous women attending with male factor subfertility with a normal pelvis on ultrasonography. Pelvic ultrasound was performed by a single observer. Uterine dimensions (total length, anterior-posterior (AP), transverse, uterine volume and fundal cervical AP ratio (FCR) measurements) were recorded. Clinical details were also recorded. Those with hypogonadism had significantly reduced uterine dimensions compared with the reference group (uterine length 64mm vs 71mm P=<.05, uterine volume 28.9mL vs 43.9mL P=<.05). All women in the reference group attained a mature uterine configuration with a FCR >1, compared with 84% of those with hypogonadism (P=.01). A total of 24% and 48% of the diagnostic group had total uterine length and uterine volume measurements less than the 5th percentile of the reference group, respectively. In a subgroup of 22 women in whom serum oestradiol concentrations could be analysed, there was a positive correlation between this parameter and uterine volume. Despite standard oestrogen therapy, uterine growth is often compromised in those with hypogonadism. Uterine health has historically been overlooked in pubertal induction protocols; however, with increasing options for fertility treatment, adequate uterine development is crucial. Given the variation in uterine size witnessed, a more tailored approach to treatment with regular monitoring of uterine dimensions should be advocated.

Clinical and dynamometric results of hip abductor system repair by trochanteric hydroxyapatite plate with modular implant after resection of proximal femoral tumors

IntroductionThe capacity of the hydroxyapatite-coated trochanteric screwed plates used with modular hip implants to restore abductor system efficacy after proximal femoral tumor resection has never been assessed. We therefore conducted a retrospective study aiming to: (1) quantitatively evaluate abduction conservation on dynamometry according to use of digastric reinsertion, conserving continuity between the gluteus medius and vastus lateralis muscles, or not, and of standard versus small-offset; (2) assess radiographic trochanteric plate fixation; (3) assess functional scores; and (4) assess complications. HypothesisTrochanteric reinsertion better conserves abduction strength when reinsertion is digastric. Patients and methodsThirty-one patients undergoing proximal femoral tumor resection between 2006 and 2016 with reconstruction by Stanmore METS™ modular implant with trochanteric plate were included. Twenty-one had digastric fixation between the gluteus medius and vastus lateralis and 10 had simple trochanteric fixation without digastric continuity. Abduction strength was compared between sides on dynamometer. Sixteen patients had full assessment of muscle strength, by a single observer; there were 8 deaths, 5 patients lost to follow-up, and 2 cases of material removal. ResultsAbduction strength conservation versus the contralateral side was 55.2±23.3% (range, 5.8–86.1%): 66.6±13.0% (46.4–86.1) with versus 36.0±24.7% (5.8–63.2%) without digastric continuity (p=0.01); severe limp rate was 4/21 when digastric continuity was preserved (19%) versus 6/10 (60%) (p=0.04), and radiologic trochanteric reinsertion stability rate was 19/21 (90%) versus 4/10 (40%) (p=0.005). Standard femoral offset conserved greater abduction strength: 64.9±20.0% versus small-offset 45.4±23.2% (p=0.05). Toronto Extremity Salvage Score (TESS) was 89±9.4%, and Musculoskeletal Tumor Society (MSTS) score 75.4±5.4%. There were 6 complications (19%): 4 infections, 1 dislocation, and 1 plate removal; the single dislocation (3%) was in the digastric conservation group. TESS (90.7±7.8% vs 88.3±4) and MSTS score (75.6±4.0% vs 75.1±3.7) and complications [4/21 (19%) vs 2/10 (20%)] did not differ according to digastric or non-digastric reinsertion (p=1). ConclusionsAbduction strength with a modular implant using a hydroxyapatite-coated trochanteric plate was better conserved by digastric trochanteric reinsertion, resulting in less limping, although the complications rate and functional scores were unaffected. Longer term assessment is needed to confirm this conservation of abduction strength. Level of evidenceIV, retrospective study without control group.