System modeling and vibration reduction of a flexible beam under rotary motion

The objective of this thesis work is to reduce the end-point vibration of a flexible beam using the feedback control of the partial state variables. The dynamic model is derived from the assumed-modes method. The new feature of this model is that it is applicable to control system analysis and synthesis. A practical example is presented to illustrate the use of control law to improve the transient response --Abstract, page ii

THE ANALYSIS OF PULLING FORCE CURVES IN TUG-OF-WAR

The purpose of this study is to analyze the pulling force curves in DFB and AFB movements that produced by elite tug-of-war athletes. The subjects are 11 female high school athletes who have been trained more than two years for tug-of-war. Data is analyzed by paired-sample t-test. The results show that force-related parameters are all different significantly between two movements, and time-related parameters are not significant. The DFB movement has higher value in MaxF, AveF, FS and lower value in MinF. We suggest to avoid the decay of pulling force while adopting DFB movement, and increase MaxF, AveF, and FS while adopting AFB movement. Within the start of 2sec we suggest the team to take the DFB movements in order to produce powerful pulling force, then transform to the AFB movements to keep the team formation

Efficacy of the visual cognitive assessment test for mild cognitive impairment/mild dementia diagnosis: a meta-analysis

BackgroundMild cognitive impairment (MCI) is an intermediate stage between normal ageing and dementia. The early identification of MCI is important for timely intervention. The visual cognitive assessment test (VCAT) is a brief language-neutral screening tool for detecting MCI/mild dementia. This meta-analysis evaluated the diagnostic efficacy of the VCAT for MCI/mild dementia.MethodsMedline, Embase, Google Scholar, and Cochrane Library were searched from their inception until August 2023 to identify studies using VCAT to diagnose MCI/mild dementia. The primary outcome was to assess the diagnostic accuracy of the VCAT for detecting MCI/mild dementia through area under the receiver operating characteristic curve (AU-ROC) analysis. The secondary outcome was to explore the correlation between VCAT scores and MCI/mild dementia presence by comparing scores among patients with and without MCI/mild dementia. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated.ResultsFive studies with 1,446 older adults (mean age 64–68.3 years) were included. The percentage of participants with MCI/mild dementia versus controls ranged from 16.5% to 87% across studies. All studies were conducted in Asian populations, mostly Chinese, in Singapore and Malaysia. The pooled sensitivity was 80% [95% confidence interval (CI) 68%–88%] and the specificity was 75% (95% CI 68%–80%). The AU-ROCC was 0.77 (95% CI 0.73–0.81). Patients with MCI/mild dementia had lower VCAT scores than the controls (mean difference −6.85 points, p < 0.00001).ConclusionVCAT demonstrated acceptable diagnostic accuracy in distinguishing MCI/mild dementia in cognitively normal older adults. As a language-neutral and culturally unbiased tool, the VCAT shows promise in detecting MCI/mild dementia. Further studies in non-Asian populations are required.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42023453453

Esophageal secondary peristalsis following acid infusion and chemical clearance correlate with mucosal integrity and acid sensitivity in GERD patients

BACKGROUND: Acid sensitivity can be altered in patients with gastroesophageal reflux disease (GERD). Secondary peristalsis helps clear gastro-esophageal refluxate and residual ingested food bolus. OBJECTIVES: The aim of this study was to investigate the associations among acid sensitivity, esophageal mucosal integrity, chemical clearance, and secondary peristalsis before and after esophageal acid infusion. DESIGN: This was an investigator-initiated, prospective, cross-sectional study. METHODS: Adult reflux patients underwent high resolution manometry and 24 h impedance-pH monitoring off acid suppression to identify GERD phenotypes, including non-erosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH). Secondary peristalsis was assessed using five rapid 20 mL air injections into the esophagus before and after infusion of hydrochloric acid (0.1 N) into the mid-esophagus. Conventional acid infusion parameters recorded included lag time, intensity rating, and sensitivity score. Chemical clearance was evaluated using the post-reflux swallow-induced peristaltic wave (PSPW), and mucosal integrity was assessed by the mean nocturnal baseline impedance (MNBI) derived from impedance-pH monitoring. RESULTS: A total of 88 patients (age 21-64 years, 62.5% women) completed the study including 12 patients with NERD, 45 with RH, and 31 with FH. There was no significant difference in acid infusion parameters between patients with NERD, RH, and FH. Upon acid infusion, patients who exhibited successful secondary peristalsis had longer lag time, higher MNBI, and shorter bolus contact time than those without secondary peristalsis. Meanwhile, patients with intact PSPW demonstrated significantly higher intensity ratings in response to acid perfusion and higher MNBI than those with impaired PSPW. The lag time correlated positively with MNBI ( CONCLUSION: In conclusion, the protective effect of esophageal secondary peristalsis and chemical clearance on esophageal mucosal integrity was demonstrated. Concerning acid sensitivity, longer lag time in patients with intact secondary peristalsis may be attributed to better esophageal mucosal integrity, while stronger intensity ratings may have a greater tendency to induce PSPW and protect esophageal mucosal integrity

Comparison of a Chinese Herbal Medicine (CCH1) and Lactulose as First-Line Treatment of Constipation in Long-Term Care: A Randomized, Double-Blind, Double-Dummy, and Placebo-Controlled Trial

Many institutionalized patients and their healthcare providers are dissatisfied with current laxative therapy. This study compared therapeutic efficacy, safety, and laxative cost of an herbal formula (CCH1) and lactulose for long stay patients with constipation. In this double-blind, double-dummy, and placebo-controlled trial, we randomized 93 residents with chronic constipation from two long-term care facilities in Taiwan to receive either CCH1 with lactulose placebo or CCH1 placebo with lactulose for 8 weeks, then followed up for 4 weeks without study medication. Both treatments were effective and well tolerated for patients, but CCH1 produced more spontaneous bowel movements, less rectal treatments, less amount of rescue laxative, and lower laxative cost than lactulose during treatment. No significant differences were found in stool consistency, stool amount, global assessment, and safety concerns. In conclusion, our results suggest that CCH1 may have better efficacy and could be used as an alternative option to lactulose in the treatment of constipation in long-term care

Influence of Rectal Decompression on Abdominal Symptoms and Anorectal Physiology following Colonoscopy in Healthy Adults

Background. Postcolonoscopy abdominal discomfort and bloating are common. The aim of this study was to evaluate whether rectal decompression improved distension-induced abdominal symptoms and influenced anorectal physiology. Methods. In 15 healthy subjects, rectal distension was achieved by direct air inflation into the rectum by colonoscopy. Placement of rectal and sham tube was then performed in each subject on a separate occasion. The anorectal parameters and distension-induced abdominal symptoms were recorded. Results. Anorectal parameters were similar between placements of rectal tube and sham tube except for greater rectal compliance with rectal tube than with sham tube (P<0.05). Abdominal pain and bloating were significantly reduced by rectal tube and sham tube at 1 minute (both P<0.05) and 3 minutes (both P<0.05). After placement of rectal tube, abdominal pain at 3 minutes correlated positively with first sensation (r=0.53, P=0.04), and bloating at 3 minutes also correlated positively with urge sensation (r=0.55, P=0.03). Conclusions. Rectal decompression with either rectal or sham tube improved distension-induced abdominal symptoms. Our study indicates that the mechanisms that improved abdominal symptoms by rectal decompression might be mediated by a central pathway instead of a peripheral mechanism

Body Mass Index–Mortality Relationship in Severe Hypoglycemic Patients With Type 2 Diabetes

AbstractBackgroundHypoglycemia is associated with a higher risk of death. This study analyzed various body mass index (BMI) categories and mortalities of severe hypoglycemic patients with type 2 diabetes mellitus (DM) in a hospital emergency department.MethodsThe study included 566 adults with type 2 diabetes who were admitted to 1 medical center in Taiwan between 2008 and 2009 with a diagnosis of severe hypoglycemia. Mortality data, demographics, clinical characteristics and the Charlson’s Comorbidity Index were obtained from the electronic medical records. Patients were stratified into 4 study groups as determined by the National institute of Health (NiH) and World Health organization classification for BMi, and the demographics were compared using the analysis of variance and χ2 test. Kaplan-Meier’s analysis and the Cox proportional-hazards regression model were used for mortality, and adjusted hazard ratios were adjusted for each BMi category among participants.ResultsAfter controlling for other possible confounding variables, BMI <18.5 kg/m2 was independently associated with low survival rates in the Cox regression analysis of the entire cohort of type 2 DM patients who encountered a hypoglycemic event. Compared to patients with normal BMI, the mortality risk was higher (adjusted hazard ratios = 4.9; 95% confidence interval [CI] = 2.4-9.9) in underweight patients. Infection-related causes of death were observed in 101 cases (69.2%) and were the leading cause of death.ConclusionsAn independent association was observed between BMI less than 18.5 kg/m2 and mortality among type 2 DM patient with severe hypoglycemic episode. Deaths were predominantly infection related

Application of artificial intelligence in measuring novel pH-impedance metrics for optimal diagnosis of GERD

Novel metrics extracted from pH-impedance monitoring can augment the diagnosis of gastroesophageal reflux disease (GERD). Artificial intelligence (AI) is being widely used to improve the diagnostic capabilities of various diseases. In this review, we update the current literature regarding applications of artificial intelligence in measuring novel pH-impedance metrics. AI demonstrates high performance in the measurement of impedance metrics, including numbers of reflux episodes and post-reflux swallow-induced peristaltic wave index and, furthermore, extracts baseline impedance from the entire pH-impedance study. AI is expected to play a reliable role in facilitating measuring novel impedance metrics in patients with GERD in the near future

The efficacy and safety of cuttlebone for lowering serum phosphate in patients with end-stage renal disease: a meta-analysis of randomized controlled trials

Background: The efficacy of cuttlebone for treating hyperphosphatemia in patients with end-stage renal disease and its safety remained unclear.Methods: Randomized controlled trials comparing the efficacy of cuttlebone with conventional interventions were retrieved from MEDLINE, EMBASE, Cochrane Library, Airiti Library, and other major Chinese databases until 1 February 2023. The primary outcome was circulating phosphate concentration, while secondary outcomes included circulating calcium and intact parathyroid hormone levels, calcium–phosphorus product, and treatment-related side-effects.Results: Analysis of nine studies published between 2000 and 2019 including 726 participants showed a lower circulating phosphate concentration in the cuttlebone group than in controls [mean difference (MD) = −0.23, 95% CI: −0.39 to −0.06, p = 0.006, I2 = 94%, 726 patients] and a dose-dependent effect of cuttlebone against hyperphosphatemia. Therapeutic benefits were noted after both short-term (1–2 months) and long-term (3–6 months) treatments. Besides, patients receiving hemodialysis showed a better response to cuttlebone than those receiving peritoneal dialysis. There was no difference in circulating calcium level (mean difference = 0.03, 95% CI: −0.01 to 0.07, p = 0.17, I2 = 34%, 654 patients), while patients receiving cuttlebone showed lower circulating iPTH level and calcium-phosphorus product (MD = −43.63, 95% CI: −74.1 to −13.16, p = 0.005, I2 = 76%, 654 patients), (MD = −0.38, 95% CI: −0.38 to −0.01, p = 0.04, I2 = 83%, 520 patients). No difference in the risks of constipation, gastrointestinal discomfort, and elevated blood calcium was noted between the two groups.Conclusion: Compared with conventional phosphate-binding agents, cuttlebone more efficiently suppressed hyperphosphatemia with a dose-dependent effect. The limited number of included studies warrants further clinical investigations to verify our findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42023396300