Adaptive Manufacturing for Healthcare During the COVID-19 Emergency and Beyond

During the COVID-19 pandemic, global health services have faced unprecedented demands. Many key workers in health and social care have experienced crippling shortages of personal protective equipment, and clinical engineers in hospitals have been severely stretched due to insufficient supplies of medical devices and equipment. Many engineers who normally work in other sectors have been redeployed to address the crisis, and they have rapidly improvised solutions to some of the challenges that emerged, using a combination of low-tech and cutting-edge methods. Much publicity has been given to efforts to design new ventilator systems and the production of 3D-printed face shields, but many other devices and systems have been developed or explored. This paper presents a description of efforts to reverse engineer or redesign critical parts, specifically a manifold for an anaesthesia station, a leak port, plasticware for COVID-19 testing, and a syringe pump lock box. The insights obtained from these projects were used to develop a product lifecycle management system based on Aras Innovator, which could with further work be deployed to facilitate future rapid response manufacturing of bespoke hardware for healthcare. The lessons learned could inform plans to exploit distributed manufacturing to secure back-up supply chains for future emergency situations. If applied generally, the concept of distributed manufacturing could give rise to “21st century cottage industries” or “nanofactories,” where high-tech goods are produced locally in small batches

Design and Test of a Nb3Sn Subscale Dipole Magnet for Training Studies

As part of a collaboration between CEA/Saclay and the Superconducting Magnet Group at LBNL, a subscale dipole structure has been developed to study training in Nb3Sn coils under variable pre-stress conditions. This design is derived from the LBNL Subscale Magnet and relies on the use of identical Nb{sub 3}Sn racetrack coils. Whereas the original LBNL subscale magnet was in a dual bore 'common-coil' configuration, the new subscale dipole magnet (SD) is assembled as a single bore dipole made of two superposed racetrack coils. The dipole is supported by a new mechanical structure developed to withstand the horizontal and axial Lorentz forces and capable of applying variable vertical, horizontal and axial preload. The magnet was tested at LBNL as part of a series of training studies aiming at understanding of the relation between pre-stress and magnet performance. Particular attention is given to the coil ends where the magnetic field peaks and stress conditions are the least understood. After a description of SD design, assembly, cool-down and tests results are reported and compared with the computations of the OPERA3D and ANSYS magnetic and mechanical models

Mechanical Analysis of the Nb3Sn Dipole Magnet HD1

The Superconducting Magnet Group at Lawrence Berkeley National Laboratory (LBNL) has recently fabricated and tested HD1, a Nb3Sn dipole magnet. The magnet reached a 16 T field, and exhibited training quenches in the end regions and in the straight section. After the test, HD1 was disassembled and inspected, and a detailed 3D finite element mechanical analysis was done to investigate for possible quench triggers. The study led to minor modifications to mechanical structure and assembly procedure, which were verified in a second test (HD1b). This paper presents the results of the mechanical analysis, including strain gauge measurements and coil visual inspection. The adjustments implemented in the magnet structure are reported and their effect on magnet training discussed

Design and Fabrication of a Supporting Structure for 3.6m Long Nb3Sn Racetrack Coils

As part of the LHC Accelerator Research Program (LARP), three US national laboratories (BNL, FNAL, and LBNL) are currently engaged in the development of superconducting magnets for the LHC Interaction Regions (IR) beyond the current design. As a first step towards the development of long Nb{sub 3}Sn quadrupole magnets, a 3.6 m long structure, based on the LBNL Subscale Common-Coil Magnet design, will be fabricated, assembled, and tested with aluminum-plate 'dummy coils'. The structure features an aluminum shell pre-tensioned over iron yokes using pressurized bladders and locking keys (bladder and key technology). Pre-load homogeneity and mechanical responses are monitored with pressure sensitive films and strain gauges mounted on the aluminum shell and the dummy coils. The details of the design and fabrication are presented and discussed, and the expected mechanical behavior is analyzed with finite element models

Effectiveness of a mobile smoking cessation service in reaching elderly smokers and predictors of quitting

<p>Abstract</p> <p>Background</p> <p>Different smoking cessation programmes have been developed in the last decade but utilization by the elderly is low. We evaluated a pilot mobile smoking cessation service for the Chinese elderly in Hong Kong and identified predictors of quitting.</p> <p>Methods</p> <p>The Mobile Smoking Cessation Programme (MSCP) targeted elderly smokers (aged 60 or above) and provided service in a place that was convenient to the elderly. Trained counsellors provided individual counselling and 4 week's free supply of nicotine replacement therapy (NRT). Follow up was arranged at 1 month by face-to-face and at 3 and 6 months by telephone plus urinary cotinine validation. A structured record sheet was used for data collection. The service was evaluated in terms of process, outcome and cost.</p> <p>Results</p> <p>102 governmental and non-governmental social service units and private residential homes for the elderly participated in the MSCP. We held 90 health talks with 3266 elderly (1140 smokers and 2126 non-smokers) attended. Of the 1140 smokers, 365 (32%) received intensive smoking cessation service. By intention-to-treat, the validated 7 day point prevalence quit rate was 20.3% (95% confidence interval: 16.2%–24.8%). Smoking less than 11 cigarettes per day and being adherent to NRT for 4 weeks or more were significant predictors of quitting. The average cost per contact was US$54 (smokers only); per smoker with counselling: US$168; per self-reported quitter: US$594; and per cotinine validated quitter: US$827.</p> <p>Conclusion</p> <p>This mobile smoking cessation programme was acceptable to elderly Chinese smokers, with quit rate comparable to other comprehensive programmes in the West. A mobile clinic is a promising model to reach the elderly and probably other hard to reach smokers.</p

Quench Detection for High-Temperature Superconductor Conductors Using Acoustic Thermometry

Detecting local heat-dissipating zones in high-temperature superconductor (HTS) magnets is a challenging task due to slow propagation of such zones in HTS conductors. For long conductor lengths, voltage-based methods may not provide a sufficient sensitivity or redundancy, and therefore nonvoltage-based detection alternatives are being sought. One of those is the recently proposed method of Eigen Frequency Thermometry (EFT), which is an active acoustic technique for a fast and nonintrusive detection of 'hot spots,' utilizing temperature dependence of the conductor elastic moduli. In this work, we demonstrate the efficiency of EFT for detecting localized heating in a 1.2-m-long sample of REBCO tape immersed in liquid nitrogen, and benchmark sensitivity of the acoustic detection with respect to voltage, hot spot temperature, and power dissipation in the conductor. Modifying the original technique for differential mode of operation enables a much improved sensitivity, and adds a hot spot localization capability. Furthermore, we adapt this technique to subscale coils wound with REBCO CORC conductor built in the framework of U.S. Magnet Development Program. A successful thermal-based detection of dissipation onset at the critical current for a two-layer canted CORC dipole assembly is discussed

Short report: Ambulatory blood pressure in normotensive compared with hypertensive subjects

Objective: To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement. Subjects: Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (CBP ≤140/90 mmHg), 719 were borderline hypertensive (systolic CBP 141-159 mmHg or diastolic CBP 91-94 mmHg) and 1773 were definitely hypertensive. Of the subjects in the last of these categories, 1324 had systolic hypertension (systolic CBP ≥160 mmHg) and 1310 had diastolic hypertension (diastolic CBP ≥95 mmHg). Hypertension had been diagnosed from the mean of two to nine (median two) CBP measurements obtained at one to three (median two) visits. Results: The 95th centiles of the 24-h ABP distributions in the normotensive subjects were (systolic and diastolic, respectively) 133 and 82 mmHg. Of the subjects with systolic hypertension, 24% had 24-h systolic ABP ≤133 mmHg. Similarly, 30% of those with diastolic hypertension had 24-h diastolic ABP <82 mmHg. The probability that hypertensive subjects had 24-h ABP below these thresholds tended to increase with age and was two- to fourfold greater if the CBP of the subject had been measured at only one visit and if fewer than three CBP measurements had been averaged for establishing the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for 24-h systolic ABP and by 26% for 24-h diastolic ABP, and for each 5-mmHg increment in diastolic CBP it decreased by 6 and 9%, respectively. Conclusions: The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of hypertensive subjects had an ABP which was below the 95th centile of the ABP of normotensive subjects, but this proportion decreased if the hypertensive subjects had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined. © Current Science Ltd.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Ambulatory blood pressure in normotensive and hypertensive subjects: Results from an international database

Objective: To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement. Subjects: Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (CBP 160 mmHg) and 1310 had diastolic hypertension (diastolic CBP >95 mmHg). Combined systolic and diastolic hypertension was present in 861 subjects. Hypertension had been diagnosed from the mean of two to nine (median two) CBP measurements obtained at one to three (median two) visits. Results: The 95th centiles of the ABP distributions in the normotensive subjects were (systolic and diastolic, respectively) 133 and 82 mmHg for 24-h ABP, 140 and 88 mmHg for daytime ABP and 125 and 76 mmHg for night-time ABP, respectively. Of the subjects with systolic hypertension, 24% had 24-h systolic ABP <133 mmHg. Similarly, 30% of those with diastolic hypertension had 24-h diastolic ABP <82 mmHg. The probability that hypertensive subjects had 24-h ABP below these thresholds tended to increase with age and was two- to fourfold greater if the CBP of the subject had been measured at only one visit and if fewer than three CBP measurements had been averaged for establishing the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for 24-h systolic ABP and by 26% for 24-h diastolic ABP, and for each 5-mmHg increment in diastolic CBP it decreased by 6 and 9%, respectively. In comparison with 24-h ABP, the overlap in the daytime and night-time ABP between normotensive and hypertensive subjects was of similar magnitude and was influenced by the same factors. Conclusions: The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of hypertensive subjects had an ABP which was below the 95th centile of the ABP of normotensive subjects, but this proportion decreased if the hypertensive subjects had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined. © Current Science Ltd.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database

Objective: To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement. Subjects: Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (systolic CBP ≤ 140 mmHg and diastolic CBP ≤ 90 mmHg) and 1773 were hypertensive (systolic CBP ≥ 160 mmHg and/or diastolic CBP ≥ 90 mmHg). Of the latter, 1324 had systolic and 1310 had diastolic hypertension. Results: Ninety-five percent of the normotensive subjects had a 24-h ABP below (systolic and diastolic, respectively) 133 and 82 mmHg. Of the patients with systolic hypertension, 24% had a 24-h systolic ABP of < 133 mmHg. Similarly, 30% of those with diastolic hypertension had a 24-h diastolic ABP of < 82 mmHg. The probability that hypertensive patients had a 24-h ABP below these thresholds was higher in women than in men, increased with age and was 2- to 4-fold greater if the CBP of the patient had been measured at only one visit and if fewer than 3 CBP measurements had been averaged to establish the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for the 24-h systolic ABP and by 25% for the 24-h diastolic ABP, and for each 5 mmHg increment in diastolic CBP it increased by 6 and 9%, respectively. Conclusion: The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of the hypertensive patients had an ABP which was below the 95th centile of the ABP in normotensive subjects, but this proportion decreased if the hypertensive patients had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined. © 1995.SCOPUS: re.jinfo:eu-repo/semantics/publishe