Design, Modeling and Performance Optimization of a Novel Rotary Piezoelectric Motor

This work has demonstrated a proof of concept for a torsional inchworm type motor. The prototype motor has shown that piezoelectric stack actuators can be used for rotary inchworm motor. The discrete linear motion of piezoelectric stacks can be converted into rotary stepping motion. The stacks with its high force and displacement output are suitable actuators for use in piezoelectric motor. The designed motor is capable of delivering high torque and speed. Critical issues involving the design and operation of piezoelectric motors were studied. The tolerance between the contact shoes and the rotor has proved to be very critical to the performance of the motor. Based on the prototype motor, a waveform optimization scheme was proposed and implemented to improve the performance of the motor. The motor was successfully modeled in MATLAB. The model closely represents the behavior of the prototype motor. Using the motor model, the input waveforms were successfully optimized to improve the performance of the motor in term of speed, torque, power and precision. These optimized waveforms drastically improve the speed of the motor at different frequencies and loading conditions experimentally. The optimized waveforms also increase the level of precision of the motor. The use of the optimized waveform is a break-away from the traditional use of sinusoidal and square waves as the driving signals. This waveform optimization scheme can be applied to any inchworm motors to improve their performance. The prototype motor in this dissertation as a proof of concept was designed to be robust and large. Future motor can be designed much smaller and more efficient with lessons learned from the prototype motor

Forages Improve Livelihoods of Smallholder Farmers with Beef Cattle in South Central Coastal Vietnam

In South Central Coastal Vietnam, on-farm research and farmer experience demonstrated the benefits of growing improved forages as a means of improving the year round quantity and quality of feed available for beef cattle. In Binh Dinh, Phu Yen and Ninh Thuan provinces, five new forage species (Panicum maximum, cv. TD58, Brachiaria hybrid cv. Mulato II, Pennisetum purpureum cv.VA06, Paspalum atratum cv. Terenos and Stylosanthes guianensis cv. CIAT 184) were evaluated for yield and crude protein concentration. There was not a consistent yield difference between locations for the forage grasses, but in Binh Dinh province P. maximum TD58 produced the highest yield. The grasses were comparable in crude protein concentration. Stylo CIAT 184 performed relatively well and had the highest crude protein concentration. All species have potential use, depending on the circumstances and site factors such as fertility, drainage and availability of irrigation. This work was expanded to a total of 45 farmers to gain feedback on farmer experience in growing different forages. The percentage of farmers who “liked” the introduced forages was Mulato II, 92%; TD58, 85%; VA06, 82%; Paspalum, 46%; and Stylo, 36%. By far the most important early socio-economic impact of developing perennial forage plots close to households was an average 50% reduction in the amount of labour and time that farmers spend supplying cut and carry forage to their animals. In addition, the growing of forages can meaningfully reduce the grazing pressure on common grazing lands, thereby lowering the potential for environmental degradation

Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Treatment delay is an important indicator of access to tuberculosis diagnosis and treatment. Analyses of patient delay (i.e. time interval between onset of symptoms and first consultation of a health care provider) and health care delay (i.e. time interval between first consultation and start of treatment) can inform policies to improve access. This study assesses the patient, health care provider and total delay in diagnosis and treatment of new smear-positive pulmonary tuberculosis patients, and the risk factors for long delay, in Vietnam.</p> <p>Methods</p> <p>A cross-sectional survey of new patients treated by the National Tuberculosis Control Programme was conducted in 70 randomly selected districts in Vietnam. All consecutively registered patients in one quarter of 2002 were interviewed using a pre-coded structured questionnaire.</p> <p>Results</p> <p>Median (range) delay was 4 weeks (1–48) for total, 3 (1–48) weeks for patient and 1 (0–25) week for health care delay. Patients with long total delay (≥ 12 weeks, 15%) accounted for 49% of the cumulative number of delay-weeks. Independent risk factors (p < 0.05) for long total delay were female sex, middle age, remote setting, residence in the northern or central area, and initial visit to the private sector. For long patient delay (≥ 6 weeks) this was female sex, belonging to an ethnic minority, and living at > 5 km distance from a health facility or in the northern area. For long health care delay (≥ 6 weeks) this was urban setting, residence in the central area and initial visit to a communal health post, TB hospital or the private sector.</p> <p>Conclusion</p> <p>Analyses of patient and treatment delays can indicate target groups and areas for health education and strengthening of the referral system, in particular between the private sector and the NTP.</p

The insecticide resistance status of malaria vectors in the Mekong region

<p>Abstract</p> <p>Background</p> <p>Knowledge on insecticide resistance in target species is a basic requirement to guide insecticide use in malaria control programmes. Malaria transmission in the Mekong region is mainly concentrated in forested areas along the country borders, so that decisions on insecticide use should ideally be made at regional level. Consequently, cross-country monitoring of insecticide resistance is indispensable to acquire comparable baseline data on insecticide resistance.</p> <p>Methods</p> <p>A network for the monitoring of insecticide resistance, MALVECASIA, was set up in the Mekong region in order to assess the insecticide resistance status of the major malaria vectors in Cambodia, Laos, Thailand, and Vietnam. From 2003 till 2005, bioassays were performed on adult mosquitoes using the standard WHO susceptibility test with diagnostic concentrations of permethrin 0.75% and DDT 4%. Additional tests were done with pyrethroid insecticides applied by the different national malaria control programmes.</p> <p>Results</p> <p><it>Anopheles dirus s.s</it>., the main vector in forested malaria foci, was susceptible to permethrin. However, in central Vietnam, it showed possible resistance to type II pyrethroids. In the Mekong delta, <it>Anopheles epiroticus </it>was highly resistant to all pyrethroid insecticides tested. It was susceptible to DDT, except near Ho Chi Minh City where it showed possible DDT resistance. In Vietnam, pyrethroid susceptible and tolerant <it>Anopheles minimus s.l</it>. populations were found, whereas <it>An. minimus s.l</it>. from Cambodia, Laos and Thailand were susceptible. Only two <it>An. minimus s.l</it>. populations showed DDT tolerance. <it>Anopheles vagus </it>was found resistant to DDT and to several pyrethroids in Vietnam and Cambodia.</p> <p>Conclusion</p> <p>This is the first large scale, cross-country survey of insecticide resistance in <it>Anopheles </it>species in the Mekong Region. A unique baseline data on insecticide resistance for the Mekong region is now available, which enables the follow-up of trends in susceptibility status in the region and which will serve as the basis for further resistance management. Large differences in insecticide resistance status were observed among species and countries. In Vietnam, insecticide resistance was mainly observed in low or transmission-free areas, hence an immediate change of malaria vector control strategy is not required. Though, resistance management is important because the risk of migration of mosquitoes carrying resistance genes from non-endemic to endemic areas. Moreover, trends in resistance status should be carefully monitored and the impact of existing vector control tools on resistant populations should be assessed.</p

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Forages improve livelihoods of smallholder farmers with beef cattle in South Central Coastal Vietnam

In South Central Coastal Vietnam, on-farm research and farmer experience demonstrated the benefits of growing improved forages as a means of improving the year-round quantity and quality of feed available for smallholder beef cattle production. In Binh Dinh, Phu Yen and Ninh Thuan provinces, 5 new forage species (Panicum maximum cv. TD58, Brachiaria hybrid cv. Mulato II, Pennisetum purpureum cv. VA06, Paspalum atratum cv. Terenos and Stylosanthes guianensis cv. CIAT 184) were evaluated for yield and crude protein concentration. There was no consistent yield difference between locations for the forage grasses, but in Binh Dinh province P. maximum TD58 produced the highest yield. The grasses were comparable in crude protein concentration. Stylo CIAT 184 produced much less forage than the grasses but had a much higher crude protein concentration. All species have potential use, depending on the circumstances and site factors such as fertility, drainage and availability of irrigation. This work was expanded to a total of 45 farmers to gain feedback on farmer experience in growing different forages. The percentage of farmers who “liked” the introduced forages was Mulato II, 92%; TD58, 85%; VA06, 82%; Paspalum, 46%; and Stylo, 36%. By far the most important early socio-economic impact of developing perennial forage plots close to households was an average 50% reduction in the amount of labor and time that farmers spend supplying cut-and-carry forage to their animals. In addition, the growing of forages can meaningfully reduce the grazing pressure on common grazing lands, thereby lowering the potential for environmental degradation.</p

Risk Factors for Bleeding and Clinical Ineffectiveness Associated with Clopidogrel Therapy: A Comprehensive Meta-Analysis

Although clopidogrel is a frequently used antiplatelet medication to treat and prevent atherothrombotic disease, clinicians must balance its clinical effectiveness with the potential side effect of bleeding. However, many previous studies have evaluated beneficial and adverse factors separately. The objective of our study was to perform a comprehensive meta-analysis of studies of clopidogrel's clinical effectiveness and/or risk of bleeding in order to identify and assess all reported risk factors, thus helping clinicians to balance patient safety with drug efficacy. We analyzed randomized controlled trials (RCTs) of maintenance use in four stages: search for relevant primary articles; abstract and full article screening; quality assessment and data extraction; and synthesis and data analysis. Screening of 7,109 articles yielded 52 RCTs that met the inclusion criteria. Twenty-seven risk factors were identified. "Definite risk factors" were defined as those with aggregated odds ratios (ORs) > 1 and confidence intervals (CIs) > 1 if analyzed in more than one study. Definite risk factors for major bleeding were concomitant aspirin use (OR 2.83, 95% CI 2.04-3.94) and long duration of clopidogrel therapy (> 6 months) (OR 1.74, 95% CI 1.21-2.50). Dual antiplatelet therapy, extended clopidogrel therapy, and high maintenance dose (150 mg/day) of clopidogrel were definite risk factors for any bleeding. Reduced renal function, both mild and severe, was the only definite risk factor for clinical ineffectiveness. These findings can help clinicians predict the risks and effectiveness of clopidogrel use for their patients and be used in clinical decision support tools.This study was supported by the Lilly Endowment, Inc. Physician Scientist Initiative and by Indiana University Health and the Indiana Clinical and Translational Sciences Institute, funded in part by grant #ULI TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award, and The Advances in Medicine (AIM) grant from Cook Medical. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Cook Medical. MTE was supported by NIH/NIDDK K08DK107864

Analysis of clinical malaria disease patterns and trends in Vietnam 2009–2015

Abstract Background Viet Nam has made tremendous progress towards reducing mortality and morbidity associated with malaria in recent years. Despite the success in malaria control, there has been a recent increase in cases in some provinces. In order to understand the changing malaria dynamics in Viet Nam and measure progress towards elimination, the aim of this study was to describe and quantify spatial and temporal trends of malaria by species at district level across the country. Methods Malaria case reports at the Viet Nam National Institute of Malariology, Parasitology, and Entomology were reviewed for the period of January 2009 to December 2015. The population of each district was obtained from the Population and Housing Census-2009. A multivariate (insecticide-treated mosquito nets [ITN], indoor residual spraying [IRS], maximum temperature), zero-inflated, Poisson regression model was developed with spatial and spatiotemporal random effects modelled using a conditional autoregressive prior structure, and with posterior parameters estimated using Bayesian Markov chain Monte Carlo simulation with Gibbs sampling. Covariates included in the models were coverage of intervention (ITN and IRS) and maximum temperature. Results There was a total of 57,713 Plasmodium falciparum and 32,386 Plasmodium vivax cases during the study period. The ratio of P. falciparum to P. vivax decreased from 4.3 (81.0% P. falciparum; 11,121 cases) in 2009 to 0.8 (45.0% P. falciparum; 3325 cases) in 2015. Coverage of ITN was associated with decreased P. falciparum incidence, with a 1.1% (95% credible interval [CrI] 0.009%, 1.2%) decrease in incidence for 1% increase in the ITN coverage, but this was not the case for P. vivax, nor was it the case for IRS coverage. Maximum temperature was associated with increased incidence of both species, with a 4% (95% CrI 3.5%, 4.3%) and 1.6% (95% CrI 0.9%, 2.0%) increase in P. falciparum and P. vivax incidence for a temperature increase of 1 °C, respectively. Temporal trends of P. falciparum and P. vivax incidence were significantly higher than the national average in Central and Central-Southern districts. Conclusion Interventions (ITN distribution) and environmental factors (increased temperature) were associated with incidence of P. falciparum and P. vivax during the study period. The factors reviewed were not exhaustive, however the data suggest distribution of resources can be targeted to areas and times of increased malaria transmission. Additionally, changing distribution of the two predominant malaria species in Viet Nam will require different programmatic approaches for control and elimination

Co-delivery of nitric oxide and antibiotic using polymeric nanoparticles

The rise of hospital-acquired infections, also known as nosocomial infections, is a growing concern in intensive healthcare, causing the death of hundreds of thousands of patients and costing billions of dollars worldwide every year. In addition, a decrease in the effectiveness of antibiotics caused by the emergence of drug resistance in pathogens living in biofilm communities poses a significant threat to our health system. The development of new therapeutic agents is urgently needed to overcome this challenge. We have developed new dual action polymeric nanoparticles capable of storing nitric oxide, which can provoke dispersal of biofilms into an antibiotic susceptible planktonic form, together with the aminoglycoside gentamicin, capable of killing the bacteria. The novelty of this work lies in the attachment of NO-releasing moiety to an existing clinically used drug, gentamicin. The nanoparticles were found to release both agents simultaneously and demonstrated synergistic effects, reducing the viability of Pseudomonas aeruginosa biofilm and planktonic cultures by more than 90% and 95%, respectively, while treatments with antibiotic or nitric oxide alone resulted in less than 20% decrease in biofilm viability.Published versio