A porohyperelastic lubrication model for articular cartilage in the natural synovial joint

This work focuses on the proposed mechanisms for the lubrication of synovial joints and applies them to an idealised bearing geometry considering a porohyperelastic material (cartilage) rotating against a stationary rigid impermeable surface. The model captures the behaviour of all lubrication regimes including fluid film formation and boundary contact as the load capacity is increased, representing a major advancement in modelling cartilage mechanics. Transient responses in the fluid phase are shown to be faster than those in the solid phase with the former decaying over time as fluid is exuded from the material. The complex behaviour of fluid migrating to and from the lubricating film is captured which leads to a better understanding of the hydration and friction mechanisms observed

Fabrication of cartilage-inspired hydrogel/entangled polymer–elastomer structures possessing poro-elastic properties

The ability to replicate the load-bearing properties of articular cartilage is attractive for many engineering applications, particularly bearings where low friction, low wear, and high durability are required. Hydrogels are widely used materials spanning many diverse applications owing to their lubricity and unique mechanical/chemical properties. The poor mechanical characteristics of conventional hydrogels, especially their compressive behavior, limit their application in load-bearing applications despite their favorable properties such as poro/viscoelasticity and lubricity. This paper demonstrates a cartilage-inspired approach to produce a structure that benefits from water-swelling resistant and ultrafast recovery behavior of elastomers as well as the stress-relaxation and energy dissipation properties of hydrogels. A method is presented in this work to fabricate interconnected macro-porous elastomers based on sintering poly(methyl methacrylate) beads. The porous elastomer imparted structural support and resilience to its composite with an infused-grafted hydrogel. At 30% strain and depending upon the strain rate, the composite exhibited a load-bearing behavior that was 14–19 times greater than that of pristine hydrogel and approximately 3 times greater than that of the porous elastomer. The equilibrium elastic modulus of the composite was 452 kPa at a strain range of 10%–30%, which was close to the values reported for the modulus of cartilage tested with similar experimental parameters defined in this study. The dissipated energy for the composite at strain rates of 1 and 10–3 s–1 was enhanced by 25-, 25-, 5-, and 15-fold as compared to that for the pristine hydrogel and the porous elastomer, respectively. The cyclic loading tests at two strain rates showed that the composite immediately recovers its load-bearing properties with the maximum load recovery staying above 95% of its initial values throughout the testing. The permeability of the structures was measured experimentally, and the results showed a decrease of permeability by 3 orders of magnitude following hydrogel grafting

Analysis of coupled heat and moisture transfer in masonry structures

Evaluation of effective or macroscopic coefficients of thermal conductivity under coupled heat and moisture transfer is presented. The paper first gives a detailed summary on the solution of a simple steady state heat conduction problem with an emphasis on various types of boundary conditions applied to the representative volume element -- a periodic unit cell. Since the results essentially suggest no superiority of any type of boundary conditions, the paper proceeds with the coupled nonlinear heat and moisture problem subjecting the selected representative volume element to the prescribed macroscopically uniform heat flux. This allows for a direct use of the academic or commercially available codes. Here, the presented results are derived with the help of the SIFEL (SIimple Finite Elements) system.Comment: 23 pages, 11 figure

Additional psychometric information and vision-specific questionnaires are available for age-realted macular degeneration

Purpose: To present psychometric information and studies dealing with questionnaires for age-related macular degeneration (AMD) and visually impaired patients in addition to the study by Finger et al. "Quality of life in AMD: a review of available vision-specific psychometric tools". We propose that their literature search should not have focused solely on the specific eye disease AMD. Methods: The literature search was partly replicated (PubMed) by using "visual impairment" instead of "macular degeneration" as free text words. Psychometric information was obtained from the additional studies. Preliminary results from a differential item functioning (DIF) analysis used to examine the relationship between item responses on the Vision-related quality of life Core Measure (VCM1) of AMD patients versus patients with other eye conditions are discussed. Results: Eight studies of visually impaired patient populations, including AMD patients, are discussed, with psychometric information from six vision-specific questionnaires. The VCM1 items did not present DIF, which means that the items were equally interpreted by all patients. Conclusions: The results on DIF and the additional studies presented here confirm that a specific eye disorder is of minor importance in the choice of a vision-specific questionnaire or, in this case, a literature search

Aerodynamic Drag Reduction of Emergency Response Vehicles

This paper presents the first experimental and computational investigation into the aerodynamics of emergency response vehicles and focusses on reducing the additional drag that results from the customary practice of adding light-bars onto the vehicles’ roofs. A series of wind tunnel experiments demonstrate the significant increase in drag that results from the light bars and show these can be minimized by reducing the flow separation caused by them. Simple potential improvements in the aerodynamic design of the light bars are investigated by combining Computational Fluid Dynamics (CFD) with Design of Experiments and metamodelling methods. An aerofoil-based roof design concept is shown to reduce the overall aerodynamic drag by up to 20% and an analysis of its effect on overall fuel consumption indicates that it offers a significant opportunity for improving the fuel economy and reducing emissions from emergency response vehicles. These benefits are now being realised by the UK’s ambulance service

Influence of the gender on the relationship between heart rate and blood pressure

Blood Pressure (BP) and Heart Rate (HR) provide information on clin-ical condition along 24h. Both signals present circadian changes due to sympa-thetic/parasympathetic control system that influence the relationship between them. Moreover, also the gender could modify this relation, acting on both con-trol systems. Some studies, using office measurements examined the BP/HR re-lation, highlighting a direct association between the two variables, linked to sus-pected coronary heart disease. Nevertheless, till now such relation has not been studied yet using ambulatory technique that is known to lead to additional prog-nostic information about cardiovascular risks. In order to examine in a more ac-curate way this relation, in this work we evaluate the influence of gender on the BP/HR relationship by using hour-to-hour 24h ambulatory measurements. Data coming from 122 female and 50 male normotensive subjects were recorded using a Holter Blood Pressure Monitor and the parameters of the linear regression fit-ting BP/HR were calculated. Results confirmed those obtained in previous stud-ies using punctual office measures in males and underlined a significant relation between Diastolic BP and HR during each hour of the day in females; a different trend in the BP/HR relation between genders was found only during night-time. Moreover, the circadian rhythm of BP/HR is similar in both genders but with different values of HR and BP at different times of the day

Re-evaluating a vision-related quality of life questionnaire with item response theory (IRT) and differential item functioning (DIF) analyses

Background: For the Low Vision Quality Of Life questionnaire (LVQOL) it is unknown whether the psychometric properties are satisfactory when an item response theory (IRT) perspective is considered. This study evaluates some essential psychometric properties of the LVQOL questionnaire in an IRT model, and investigates differential item functioning (DIF). Methods: Cross-sectional data were used from an observational study among visually-impaired patients (n = 296). Calibration was performed for every dimension of the LVQOL in the graded response model. Item goodness-of-fit was assessed with the S-X2-test. DIF was assessed on relevant background variables (i.e. age, gender, visual acuity, eye condition, rehabilitation type and administration type) with likelihood-ratio tests for DIF. The magnitude of DIF was interpreted by assessing the largest difference in expected scores between subgroups. Measurement precision was assessed by presenting test information curves; reliability with the index of subject separation. Results: All items of the LVQOL dimensions fitted the model. There was significant DIF on several items. For two items the maximum difference between expected scores exceeded one point, and DIF was found on multiple relevant background variables. Item 1 ‘Vision in general’ from the “Adjustment” dimension and item 24 ‘Using tools’ from the “Reading and fine work” dimension were removed. Test information was highest for the “Reading and fine work” dimension. Indices for subject separation ranged from 0.83 to 0.94. Conclusions: The items of the LVQOL showed satisfactory item fit to the graded response model; however, two items were removed because of DIF. The adapted LVQOL with 21 items is DIF-free and therefore seems highly appropriate for use in heterogeneous populations of visually impaired patients. (aut.ref.

Verifying 4D gated radiotherapy using time-integrated electronic portal imaging: a phantom and clinical study

<p>Abstract</p> <p>Background</p> <p>Respiration-gated radiotherapy (RGRT) can decrease treatment toxicity by allowing for smaller treatment volumes for mobile tumors. RGRT is commonly performed using external surrogates of tumor motion. We describe the use of time-integrated electronic portal imaging (TI-EPI) to verify the position of internal structures during RGRT delivery</p> <p>Methods</p> <p>TI-EPI portals were generated by continuously collecting exit dose data (aSi500 EPID, Portal vision, Varian Medical Systems) when a respiratory motion phantom was irradiated during expiration, inspiration and free breathing phases. RGRT was delivered using the Varian RPM system, and grey value profile plots over a fixed trajectory were used to study object positions. Time-related positional information was derived by subtracting grey values from TI-EPI portals sharing the pixel matrix. TI-EPI portals were also collected in 2 patients undergoing RPM-triggered RGRT for a lung and hepatic tumor (with fiducial markers), and corresponding planning 4-dimensional CT (4DCT) scans were analyzed for motion amplitude.</p> <p>Results</p> <p>Integral grey values of phantom TI-EPI portals correlated well with mean object position in all respiratory phases. Cranio-caudal motion of internal structures ranged from 17.5–20.0 mm on planning 4DCT scans. TI-EPI of bronchial images reproduced with a mean value of 5.3 mm (1 SD 3.0 mm) located cranial to planned position. Mean hepatic fiducial markers reproduced with 3.2 mm (SD 2.2 mm) caudal to planned position. After bony alignment to exclude set-up errors, mean displacement in the two structures was 2.8 mm and 1.4 mm, respectively, and corresponding reproducibility in anatomy improved to 1.6 mm (1 SD).</p> <p>Conclusion</p> <p>TI-EPI appears to be a promising method for verifying delivery of RGRT. The RPM system was a good indirect surrogate of internal anatomy, but use of TI-EPI allowed for a direct link between anatomy and breathing patterns.</p

Patient-centred measurement in ophthalmology – a paradigm shift

Ophthalmologists and researchers in ophthalmology understand what a rapidly evolving field ophthalmology is, and that to conduct good research it is essential to use the latest and best methods. In outcomes research, one modern initiative has been to conduct holistic measurement of outcomes inclusive of the patient's point of view; patient-centred outcome. This, of course, means including a questionnaire. However, the irony of trying to improve outcomes research by being inclusive of many measures is that the researcher may not be expert in all measures used. Certainly, few people conducting outcomes research in ophthalmology would claim to be questionnaire experts. Most tend to be experts in their ophthalmic subspecialty and probably simply choose a popular questionnaire that appears to fit their needs and think little more about it. Perhaps, unlike our own field, we assume that the field of questionnaire research is relatively stable. This is far from the case. The measurement of patient-centred outcomes with questionnaires is a rapidly evolving field. Indeed, over the last few years a paradigm shift has occurred in patient-centred measurement