Deep vein thrombosis (DVT) is a severe medical condition that can affect patients who are long-term bed-ridden, due to diseases such as stroke. Current prevention methods for DVT focus on either ...pharmacological prophylaxis or mechanical prophylaxis, where current mechanical prophylaxis systems that target prevention of DVT have limited success rates as patients are still susceptible to occurrences of DVT even with long-term usage of such systems. Therefore, this paper sought to present the design of a soft robotic exosock using soft pneumatic actuators to assist in passive ankle exercises for the prevention of DVT and to conduct a preliminary study on healthy human subjects to evaluate the effectiveness of this device in assisting ankle motion in terms of the range of motion assisted on the ankle. Our findings indicated that the exosock was able to provide assisted ankle plantarflexion-dorsiflexion to the subjects. Furthermore, our results showed that we were able to achieve an average of 16.4±1.3° of dorsiflexion from a resting position of the ankle with an average error of 2.7±1.4° in the real-time feedback of the ankle through a joint measurement unit. Therefore, the soft robotic exosock can potentially be used in the clinical rehabilitation of bedridden patients to prevent DVT while allowing for real-time feedback of the ankle off site.
It is unclear whether health-related quality of life (HRQoL) is impaired in patients with nonalcoholic fatty liver disease (NAFLD) without advanced fibrosis and how this compares with the general ...population. We aimed to assess HRQoL in patients with NAFLD in comparison to the general population and any associations of fibrosis severity and metabolic comorbidities with impairments in HRQoL.
We prospectively enrolled 513 consecutive patients with NAFLD who completed the EuroQol 5-dimensional questionnaire (EQ-5D) and Chronic Liver Disease Questionnaires (CLDQ). Demographic and clinical information, liver biopsy results, and/or liver stiffness (LS) by transient elastography were recorded. A general population sub-cohort of the Health Survey for England 2018 was used as a comparator (n = 5483), and a 1:1 propensity-score (PS) matching was performed, according to age, sex, body mass index, and type 2 diabetes mellitus (T2DM).
EQ-5D-5L utility was significantly lower in 466 PS-matched patients with NAFLD compared with PS-matched controls (0.77 ± 0.27 vs 0.84 ± 0.19; P < .001), even in those without advanced fibrosis (F ≤2 or LS <8kPa) (0.80 ± 0.24 vs 0.84 ± 0.19; P = .024). HRQoL measures (EQ-5D-5L, EQ-VAS, CLDQ) did not differ between patients with NAFLD with and without advanced fibrosis. LS was independently associated with lower EQ-5D-5L in all patients with NAFLD but not in those without advanced fibrosis. In the latter, lower EQ-5D-5L was associated with female sex, T2DM, and depression.
Patients with NAFLD, even those without advanced fibrosis, have worse HRQoL compared with the general population. In patients with NAFLD without advanced fibrosis, HRQoL is independently associated with non-liver comorbidities but not LS. Multi-disciplinary management is therefore required in NAFLD, irrespective of fibrosis severity.
Display omitted
This paper presents a soft robotic glove designed to assist individuals with functional grasp pathologies in performing activities of daily living. The glove utilizes soft fabric-regulated pneumatic ...actuators that are low-profile and require lower pressure than previously developed actuators. They are able to support fingers and thumb motions during hand closure. Upon pressurization, the actuators are able to generate sufficient force to assist in hand closing and grasping during different manipulation tasks. In this work, experiments were conducted to evaluate the performances of the actuators as well as the glove in terms of its kinetic and kinematic assistance on a healthy participant. Additionally, surface electromyography and radio-frequency identification techniques were adopted to detect user intent to activate or deactivate the glove. Lastly, we present preliminary results of a healthy participant performing different manipulation tasks with the soft robotic glove controlled by surface electromyography and radio-frequency identification techniques.
Abstract
Site visitation is a crucial aspect of civil engineers’ job scope as it provides them with first-hand construction data. However, due to the recent COVID-19 pandemic, construction site ...visitations are restricted, making the tasks of a civil engineer impossible to achieve. The main objective of this research is to find out and suggest a remedy to the problems commonly faced by civil engineers through the help of Augmented Reality (AR). Hence, the study’s objective is to analyse AR’s functionalities and suggest its best application to communicate spacious awareness via visual feedback for civil engineers. For maximum usability, an integrated software suite is proposed that provides access to AR worksites, measured data, and allows peer communication. This addressed the whole spectrum of problems faced by civil engineers with the switch to remote working. However, with the COVID-19 pandemic, the limitation of this project is that testing could not be executed to determine the efficacy of the said solution. Furthermore, the proposed solution has limitations, such as requiring pre-constructed infrastructure in applicable construction sites. Therefore, regular quality assurance (QA) and quality control (QC) are required to ensure proper functionality. In the future, AR LiDAR sensors could be a possibility as it provides increased accuracy of AR measurements which is critical in engineering.
To review and evaluate the efficacy and complication rates of external and internal blepharoptosis repair techniques in pediatric patients.
The systematic review protocol was published on PROSPERO ...(CRD42020197343). Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched without date limitations. Two independent reviewers evaluated the articles for inclusion. Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS-I tool, respectively.
Of 2,228 articles screened, 23 studies involving 730 patients were included. There were 20 case series and 3 retrospective cohort studies, but no randomized controlled studies. Overall study quality was low with serious risk of bias according to the GRADE and ROBINS-I criteria, respectively. External levator resection was the most studied procedure, evaluated in 18 studies. Seven studies investigated internal approaches including the Fasanella-Servat procedure. There was no standardized evaluation of surgical efficacy. Reoperation rates were 16.6% (range 3.6-50.9%) for external levator resection compared with 22.2% (range 0.0-25.8%) for internal approaches. The commonest postoperative complications were not sight-threatening. The most consistently reported complication was undercorrection, occurring at rates of 8.4% (range 2.4-16.7%) and 15.3% (range 2.7-75.0%) for external levator resection and internal approaches, respectively. There were no consistently applied, validated patient-reported outcomes or cosmetic outcomes.
External and internal approaches have been successfully employed in pediatric blepharoptosis repair. However, noncomparative designs and risk-of-bias limit existing studies. Thus, prospectively designed studies with standardized outcome measures are required to minimize reporting bias, facilitate evidence synthesis, and support clinical decision making.
Soft robotics have come to the forefront of devices available for rehabilitation following stroke; however, objective evaluation of the specific brain changes following rehabilitation with these ...devices is lacking. In this study, we utilized functional Magnetic Resonance Imaging (fMRI) and dynamic causal modeling (DCM) to characterize the activation of brain areas with a MRI compatible glove actuator compared to the conventional manual therapy. Thirteen healthy volunteers engaged in a motor-visual fMRI task under four different conditions namely active movement, manual passive movement, passive movement using a glove actuator, and crude tactile stimulation. Brain activity following each task clearly identified the somatosensory motor area (SMA) as a major hub orchestrating activity between the primary motor (M1) and sensory (S1) cortex.
During the glove-induced passive movement, activity in the motor-somatosensory areas was reduced, but there were significant increases in motor cortical activity compared to manual passive movement. We estimated the modulatory signaling from within a defined sensorimotor network (SMA, M1, and S1), through DCM and highlighted a dual-gating of sensorimotor inputs to the SMA. Proprioceptive signaling from S1 to the SMA reflected positive coupling for the manually assisted condition, while M1 activity was positively coupled to the SMA during the glove condition. Importantly, both the S1 and M1 were shown to influence each other’s connections with the SMA, with inhibitory nonlinear modulation by the M1 on the S1-SMA connection, and similarly S1 gated the M1-SMA connection. The work is one of the first to have applied effective connectivity to examine sensorimotor activity ensued by manual or robotic passive range of motion exercise, crude tactile stimulation, and voluntary movements to provide a basis for the mechanism by which soft actuators can alter brain activity.
•Proprioceptive drive elicited by passive range of motion exercise may activate supplementary and primary motor cortex.•Somatosensory cortex gates interaction between supplementary and primary motor cortex reciprocating signals to the former.•Primary motor or somatosensory cortex initiates feedback to supplementary motor area for proprioceptive motor integration.•This study implies the benefit of passive range of motion exercise to promote motor functional activity of the brain.
Various hand exoskeletons have been proposed for the purposes of providing assistance in activities of daily living and rehabilitation exercises. However, traditional exoskeletons are made of rigid ...components that impede the natural movement of joints and cause discomfort to the user. This paper evaluated a soft wearable exoskeleton using soft elastomeric actuators. The actuators could generate the desired actuation of the finger joints with a simple design. The actuators were characterised in terms of their radius of curvature and force output during actuation. Additionally, the device was evaluated on five healthy subjects in terms of its assisted finger joint range of motion. Results demonstrated that the subjects were able to perform the grasping actions with the assistance of the device and the range of motion of individual finger joints varied from subject to subject. This work evaluated the performance of a soft wearable exoskeleton and highlighted the importance of customisability of the device. It demonstrated the possibility of replacing traditional rigid exoskeletons with soft exoskeletons that are more wearable and customisable.
We present a novel case of a patient with nephrotic syndrome and previous left pneumonectomy who had a massive pulmonary embolism of his remnant right pulmonary artery. He underwent surgical ...embolectomy and veno-arterial extracorporeal membrane oxygenation (ECMO). Early embolectomy using retrograde pulmonary perfusion and post-operative ECMO helped the patient survive this catastrophic event.
A variety of shared care models have been developed, which aim to stratify glaucoma patients according to risk of disease progression. However, there is limited published data on the rate of glaucoma ...progression in the hospital vs community setting. Here we aimed to compare rates of glaucomatous visual field progression in the Cambridge Community Optometrist Glaucoma Scheme (COGS) and Addenbrooke's Hospital Glaucoma Clinic (AGC).
A retrospective comparative cohort review was performed. Patients with five or more visual field tests were included. Zeiss Forum software was used to calculate the MD progression rate (dB/year). Loss of sight years (LSY) were also calculated for both COGS and AGC.
Overall, 8465 visual field tests from 854 patients were reviewed. In all, 362 eyes from the AGC group and 210 eyes from COGS were included. The MD deterioration rate was significantly lower in the COGS patients compared with the AGC group (-0.1 vs -0.3 dB/year; p < 0.0001). No patients in the COGS group were predicted to become blind within their lifetime by LSY analysis. Fifteen patients were at risk in the AGC group.
This service evaluation shows that COGS is an effective scheme to stratify lower risk glaucoma patients, increasing the capacity within hospital eye services. COGS patients have a lower rate of visual field deterioration compared to AGC patients. Effective communication between community and tertiary schemes is essential to facilitate transfer of patients requiring further hospital management reliably and efficiently, with the potential for low-risk patients to be followed safely in the community.
PDF
