Clinical Outcomes of Maxillomandibular Advancement Surgery for the Treatment of Obstructive Sleep Apnea

Objective: To evaluate clinical and radiographic treatment outcomes after maxillomandibular advancement (MMA) surgery on subjects suffering from obstructive sleep apnea (OSA). Materials and Methods: This was a retrospective cohort analysis. Subjects underwent pre- and post-surgical polysomnography (PSG) studies and were also asked to complete a subjective self-assessment via the Epworth Sleepiness Scale (ESS) questionnaire. Twenty-two patients (11 male, 11 female) met the inclusion criteria. Results: The mean pre-surgical apnea-hypopnea index (AHI) score was 48.4 (+/-31.3) and mean ESS score was 11.6 (+/-4.6). After surgery, the mean AHI reduced to 14.0 (+/-15.0) and ESS reduced to 5.7 (+/-3.5). Treatment success was observed in 19 of 22 (86.4%) patients and 8 of 22 (36.4%) met the criteria for treatment cure. Conclusions: MMA surgery is an effective treatment for patients suffering from OSA. Subjective sleepiness levels were significantly reduced after surgery. There were no pre- or post-surgical variables that acted as predictors of successful treatment

Isolation and characterisation of a novel Nesterenkonia species from a human bloodstreaminfection

Poste

Position tracking control in torque mode for a robotic running foot for footwear testing

Available automatic footwear testing systems still lack flexibility and bio-fidelity to represent the human foot and reproduce the wear conditions accurately. The first part of this article introduces a new design of the robotic running foot for footwear testing using cable conduit mechanisms. This robotic running foot is integrated with an upper leg mechanism to form a complete integrated footwear testing system. The cable conduit mechanisms help remove the bulky actuators and transmissions out of the fast-moving robotic foot. Thus, this robotic running foot design not only allows high-power actuators to be installed, but also avoids a significant dynamic mass and inertia effects on the upper leg mechanism. This means that the integrated footwear testing system can have multiple powered degrees of freedom in the robotic running foot and simulate much higher human running speeds than other available systems. However, cable conduit mechanisms cause significant challenges in control approaches, especially in high-speed systems, due to their nonlinear transmission characteristics. Furthermore, the robotic running foot actuators must operate in a torque/force control mode to reproduce the foot–shoe interaction during gaits while it is critical to control the foot joints’ position in the swing phase of gaits. The latter part of this article presents a study on position tracking control in torque mode for the robotic running foot joints using adaptive and proportional–integral–derivative control designs to evaluate the system’s ability to mimic the human foot kinematics in running. Both controllers proved their effectiveness, implying that the proposed control approach can be implemented on the integrated footwear testing system to control the foot joints’ position in the swing phase of running gaits

Direct torque control for cable conduit mechanisms for the robotic foot for footwear testing

© 2018 Elsevier Ltd As the shoe durability is affected directly by the dynamic force/pressure between the shoe and its working environments (i.e., the contact ground and the human foot), a footwear testing system should replicate correctly this interaction force profile during gait cycles. Thus, in developing a robotic foot for footwear testing, it is important to power multiple foot joints and to control their output torque to produce correct dynamic effects on footwear. The cable conduit mechanism (CCM) offers great advantages for designing this robotic foot. It not only eliminates the cumbersome actuators and significant inertial effects from the fast-moving robotic foot but also allows a large amount of energy/force to be transmitted/propagated to the compact robotic foot. However, CCMs cause nonlinearities and hysteresis effects to the system performance. Recent studies on CCMs and hysteresis systems mostly addressed the position control. This paper introduces a new approach for modelling the torque transmission and controlling the output torque of a pair of CCMs, which are used to actuate the robotic foot for footwear testing. The proximal torque is used as the input signal for the Bouc–Wen hysteresis model to portray the torque transmission profile while a new robust adaptive control scheme is developed to online estimate and compensate for the nonlinearities and hysteresis effects. Both theoretical proof of stability and experimental validation of the new torque controller have been carried out and reported in this paper. Control experiments of other closed-loop control algorithms have been also conducted to compare their performance with the new controller effectiveness. Qualitative and quantitative results show that the new control approach significantly enhances the torque tracking performance for the system preceded by CCMs

Therapeutic capsule endoscopy: Opportunities and challenges

10.1260/2040-2295.2.4.459Journal of Healthcare Engineering24459-47

Comparative activity of tedizolid and glycopeptide combination therapies for the treatment of Staphylococcus aureus infections: an in vitro and in vivo evaluation against strains with reduced susceptibility to glycopeptides

Investigator Initiated Research Grant from Merck Sharpe and Dohme Ltd

Emergence of phenotypic and genotypic antimicrobial resistance in Mycobacterium tuberculosis.

Concentration dependency of phenotypic and genotypic isoniazid-rifampicin resistance emergence was investigated to obtain a mechanistic understanding on how anti-mycobacterial drugs facilitate the emergence of bacterial populations that survive throughout treatment. Using static kill curve experiments, observing two evolution cycles, it was demonstrated that rifampicin resistance was the result of non-specific mechanisms and not associated with accumulation of drug resistance encoding SNPs. Whereas, part of isoniazid resistance could be accounted for by accumulation of specific SNPs, which was concentration dependent. Using a Hollow Fibre Infection Model it was demonstrated that emergence of resistance did not occur at concentration-time profiles mimicking the granuloma. This study showed that disentangling and quantifying concentration dependent emergence of resistance provides an improved rational for drug and dose selection although further work to understand the underlying mechanisms is needed to improve the drug development pipeline

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

The impact of COVID-19 non-pharmaceutical interventions on the lived experiences of people living in Thailand, Malaysia, Italy and the United Kingdom: A cross-country qualitative study.

This qualitative study explores the impact of non-pharmaceutical interventions (NPIs), including social distancing, travel restrictions and quarantine, on lived experiences during the first wave of the COVID-19 pandemic in Thailand (TH), Malaysia (MY), Italy (IT) and the United Kingdom (UK). A total of 86 interviews (TH: n = 28; MY: n = 18; IT: n = 20; UK: n = 20) were conducted with members of the public, including healthcare workers (n = 13). Participants across countries held strong views on government imposed NPIs, with many feeling measures lacked clarity. Most participants reported primarily negative impacts of NPIs on their lives, including through separation, isolation and grief over missed milestones; work-related challenges and income loss; and poor mental health and wellbeing. Nonetheless, many also experienced inadvertent positive consequences, including more time at home to focus on what they most valued in life; a greater sense of connectedness; and benefits to working life. Commonly employed coping strategies focused on financial coping (e.g. reducing spending); psycho-emotional coping (e.g. engaging in spiritual practices); social coping and connectedness (e.g., maintaining relationships remotely); reducing and mitigating risks (e.g., changing food shopping routines); and limiting exposure to the news (e.g., checking news only occasionally). Importantly, the extent to which participants' lived experiences were positive or negative, and their ability to cope was underpinned by individual, social and economic factors, with the analysis indicating some salient differences across countries and participants. In order to mitigate negative and unequal impacts of NPIs, COVID-19 policies will benefit from paying closer attention to the social, cultural and psychological-not just biological-vulnerabilities to, and consequences of public health measures