Design and comparison of tails for bird-scale flapping-wing robots

Flapping-wing robots (so-called ornithopters) are a promising type of platform to perform efficient winged flight and interaction with the environment. However, the control of such vehicles is challenging due to their under-actuated morphology to meet lightweight requirements. Consequently, the flight control of flapping-wing robots is predominantly handled by the tail. Most ornithopters feature a tail with two degrees of freedom but the configuration choice is often arbitrary and without in-depth study. In this paper, we propose a thorough analysis of the design and in-flight performance for three tails. Their design and manufacturing methods are presented, with an emphasis on low weight, which is critical in ornithopters. The aerodynamics of the tails is analyzed through CFD simulations and their performance compared experimentally. The advantages and performance metrics of each configuration are discussed based on flight data. Two types of 3D flight tests were carried out: aggressive heading maneuvers and level turns. The results show that an inverted V-tail outperforms the others regarding maneuverability and stability. From the three configurations, only the inverted V-Tail can perform an aggressive stable banked level turn with a radius of 3.7 m at a turning rate of 1.6 rad/s. This research work describes the impact of the tail configuration choice on the performance of bird-scale flapping-wing robots.Consejo Europeo de Investigación (ERC) 78824

Design of the High-Payload Flapping Wing Robot E-Flap

Autonomous lightweight flapping-wing robots show potential to become a safe and affordable solution for rapidly deploying robots around humans and in complex environments. The absence of propellers makes such vehicles more resistant to physical contact, permitting flight in cluttered environments, and collaborating with humans. Importantly, the provision of thousands of species of birds that have already mastered the challenging task of flapping flight is a rich source of solutions. However, small wing flapping technology is still in its beginnings, with limited levels of autonomy and physical interaction capability with the environment. One significant limitation to this is the low payload available. Here we show the Eagle-inspired Flapping-wing robot E-Flap, a 510 g novel design capable of a 100% of payload, exceeding the requirement of the computing and sensing package needed to fly with a high degree of autonomy. The concept is extensively characterized, both in a tracked indoor space and in outdoor conditions. We demonstrate flight path angle of up to 50° and velocities from as low as 2 m/s to over 6 m/s. Overall, the robotic platform has been proven to be reliable, having performed over 100 flights. Through mechanical and electronics advances, the E-Flap is a robust vehicle prototype and paves the way towards flapping-wing robots becoming a practical fully autonomous flying solution.Consejo Europeo de Investigación 78824

Safe local aerial manipulation for the installation of devices on power lines: Aerial-core first year results and designs

Article number 6220The power grid is an essential infrastructure in any country, comprising thousands of kilometers of power lines that require periodic inspection and maintenance, carried out nowadays by human operators in risky conditions. To increase safety and reduce time and cost with respect to conventional solutions involving manned helicopters and heavy vehicles, the AERIAL-CORE project proposes the development of aerial robots capable of performing aerial manipulation operations to assist human operators in power lines inspection and maintenance, allowing the installation of devices, such as bird flight diverters or electrical spacers, and the fast delivery and retrieval of tools. This manuscript describes the goals and functionalities to be developed for safe local aerial manipulation, presenting the preliminary designs and experimental results obtained in the first year of the project.European Union (UE). H2020 871479Ministerio de Ciencia, Innovación y Universidades de España FPI 201

Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

Background: To analyze the prevalence and main epidemiological, clinical and outcome features of in-Patients with Complex Chronic conditions (PCC) in internal medicine areas, using a pragmatic working definition. Methods: Prospective study in 17 centers from Spain, with 97 in-hospital, monthly prevalence cuts. A PCC was considered when criteria of polypathological patient (two or more major chronic diseases) were met, or when a patient suffered one major chronic disease plus one or more of nine predefined complexity criteria like socio-familial risk, alcoholism or malnutrition among others (PCC without polypathology). A complete set of baseline features as well as 12-months survival were collected. Then, we compared clinical, outcome variables, and PROFUND index accuracy between polypathological patients and PCC without polypathology. Results: The global prevalence of PCC was 61% (40% of them were polypathological patients, and 21% PCC withouth polypathology) out of the 2178 evaluated patients. Their median age was 82 (59.5% men), suffered 2.3 ± 1.1 major diseases (heart diseases (70.5%), neurologic (41.5%), renal (36%), and lung diseases (26%)), 5.5 ± 2.5 other chronic conditions, met 2.5 ± 1.5 complexity criteria, and presented functional decline (Barthel index 55 (25-90)). Compared to polypathological patients, the subgroup of PCC without polypathology were younger, with a different pattern of major diseases and comorbidities, a better functional status, and lower 12-months mortality rates ((36.2% vs 46.8%; p = .003; OR 0.7(0.48-0.86). The PROFUND index obtained adequate calibration and discrimination power (AUC-ROC 0.67 (0.63-0.69)) in predicting 12-month mortality of PCC. Conclusion: Patients with complex chronic conditions are highly prevalent in internal medicine areas; their clinical pattern has changed in parallel to socio-epidemiological modifications, but their death-risk is still adequately predicted by PROFUND index

Diagnostic value of a simplified Pfeiffer questionnaire for polypathological patients

Proyecto Profund.[ES]: Objetivos: Analizar la concordancia, sensibilidad, especificidad y valores predictivos positivo (VPP) y negativo (VPN) de cada pregunta del cuestionario de Pfeiffer (SPMSQ) con respecto al cuestionario completo en pacientes pluripatológicos (PPP). Métodos: Estudio transversal multicéntrico. El SPMSQ se consideró patológico si se registraban 3 o más errores. Para cada pregunta y combinaciones de 2 preguntas se calcularon la concordancia (índice kappa), sensibilidad, especificidad y valores predictivos con respecto al SPMSQ completo. Resultados: De los 1.632 pacientes pluripatológicos incluidos (edad media 77,9 ± 9,8 años, 53% varones), se realizó el SPMSQ a 1.434 (los restantes presentaban delirium) y resultó patológico en el 39%. Las preguntas «¿qué día es hoy?» y «reste de 3 en 3 desde 20» obtuvieron buena concordancia y VPN (85% y 89%, respectivamente); la combinación de ambas aumentó el VPN al 97%. La pregunta «¿cuándo nació?» alcanzó buena concordancia y el mayor VPP (93%). Conclusiones: La combinación de las preguntas «¿qué día es hoy?» y «reste de 3 en 3 desde 20» obtuvo un VPN elevado, y la relacionada con la fecha de nacimiento fue la que consiguió el mayor VPP.[EN] Objectives: To analyse the correlation, sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each question on the Pfeiffer questionnaire (SPMSQ) compared with the full questionnaire for polypathological patients (PPPs). Methods: Multicentre cross-sectional study. An SPMSQ score is considered pathological if 3 or more errors are recorded. For each question and combination of 2 questions, we calculated the correlation (kappa index), sensitivity, specificity and predictive values compared with the full SPMSQ. Results: Of the 1632 PPPs included (mean age, 77.9 ± 9.8 years, 53% men), 1434 performed the SPMSQ (the remaining presented delirium); 39% of the PPPs were pathological. The question “What day is it today?” and the command “Count backwards by 3s from 20” obtained good correlation and NPV (85 and 89%, respectively); the combination of both increased the NPV to 97%. The question “When were you born?’ achieved good correlation and greater PPV (93%). Conclusions: The combination of the question “What day is it today?” and the command “Count backwards by 3s from 20” achieved a high NPV. The question related to the date of birth achieved the highest PPV

Simplification of the Barthel scale for screening for frailty and severe dependency in polypathological patients

Proyecto PROFUND.[ES] Objetivos: Analizar la sensibilidad (S), la especificidad (E) y los valores predictivos positivo (VPP) y negativo (VPN) de cada dimensión del índice de Barthel (IB) con respecto al cuestionario completo en pacientes pluripatológicos (PPP). Métodos: Estudio transversal multicéntrico. Se consideraron dos puntos de corte del IB (≥ 90 puntos para el cribado de fragilidad y < 60 puntos para el diagnóstico de dependencia severa). Para cada dimensión y combinaciones de dos dimensiones se calcularon la S, la E, el VPP y el VPN con respecto al IB completo. Resultados: El IB medio de los 1.632 PPP incluidos (edad media de 77,9 ± 9,8 años, 53% varones) fue 69 ± 31 (< 90 en el 58,7% y < 60 en el 31,4% de pacientes). La dimensión «alimentación» obtuvo los mayores VPN para tener un IB ≥ 60 y ≥ 90 puntos (87% y 99,6%, respectivamente). Las dimensiones «deambular» y «subir y bajar escaleras» obtuvieron el mayor VPP para tener un IB ≥ 60 y ≥ 90 (99,2/99,5% y 81/92%, respectivamente; la combinación de ambas preguntas aumentó el VPP al 95 y al 99,6%, respectivamente. Conclusiones: Los PPP de ámbito hospitalario presentan con elevada frecuencia deterioro funcional. La dimensión referente a alimentarse obtuvo el mayor VPN, por lo que se puede utilizar para el diagnóstico de dependencia severa, mientras que la combinación de deambular y subir y bajar escaleras obtuvo el mayor VPP, pudiendo utilizarse para plantear el cribado de fragilidad de los PPP.[EN] Objectives: To analyse the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). Methods: Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥ 90 points for screening frailty and < 60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. Results: The mean BI of the 1,632 included PPPs (mean age, 77.9 ± 9.8 years; 53% men) was 69 ± 31 (< 90 for 58.7% and < 60 for 31.4% of the patients). The “feeding” measure achieved the highest NPV, for a BI ≥ 60 and ≥ 90 points (87% and 99.6%, respectively). The “walking” and “going up and down stairs” measures achieved the highest PPV, for a BI ≥ 60 and ≥ 90 (99.2%/99.5% and 81%/92%, respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively. Conclusions: PPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs.Peer reviewe

Prognostic stratification and healthcare approach in patients with multiple pathologies

[ES] Los pacientes pluripatológicos constituyen una población prevalente y homogénea, caracterizada por su complejidad clínica, vulnerabilidad, consumo de recursos y mortalidad que requiere una asistencia integral y coordinada. Establecer un pronóstico certero en esta población resulta de utilidad para la toma de decisiones clínicas por parte de los profesionales, la planificación de las preferencias de pacientes y familiares, y el diseño de estrategias en el ámbito de la gestión sanitaria. También es importante para la investigación clínica, al facilitar la posible incorporación de estos pacientes a ensayos clínicos y otros estudios de intervención. Los índices PROFUND y PROFUNCTION son 2 instrumentos pronósticos que predicen de manera fidedigna el riesgo de fallecer o de sufrir un deterioro funcional, respectivamente. Para el abordaje asistencial de los pacientes pluripatológicos se propugna la construcción y ejecución de un plan de acción personalizado, consensuado y adaptado a la realidad del paciente. Este tendrá en cuenta el pronóstico, la evidencia y viabilidad de las intervenciones, así como la sinergia de las metas y estrategias del equipo sanitario con los valores y las preferencias de las personas para conseguir un modelo de salud centrado en apoyar la capacidad de las mismas para gestionar sus enfermedades. En este plan los principales ámbitos de intervención son: la promoción y prevención de la salud, la activación y autogestión del paciente y el cuidador, la red de apoyo social, la optimización farmacoterapéutica, la rehabilitación y medidas de preservación funcional y cognitiva, y la planificación anticipada de decisiones.[EN] Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterised by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies. Two prognostic instruments stand out in terms of suitability for polypathological patients: PROFUND and PROFUNCTION. The former faithfully stratifies the risk of dying at 12 months and four years and the latter, the risk of suffering a significant functional deterioration at 12 months. In terms of the healthcare approach in patients with multiple pathologies, creating and executing a consensual, personalised action plan that is adapted to the patient's reality is encouraged. The plan will consider the prognosis, and the evidence and viability of interventions; its ultimate aim will be to ensure the synergy and alignment of the health team's goals and strategies with peoples’ values and preferences, in order to achieve a more proactive health model focused on supporting patients in their ability to manage their illnesses. In the personalised action plan, the main areas of intervention are: health promotion and prevention; patient and caregiver activation and self-management; activation of a social support network and social support; optimisation of pharmacotherapy; rehabilitation, functional and cognitive preservation measures; and anticipated decision planning

Adaptation of the Palliative Prognostic Index in patients with advanced medical conditions

Los autores en representación de los investigadores del proyecto PALIAR.[Objetivo] Analizar el rendimiento del Palliative Prognostic Index (PPI) en los pacientes con enfermedades médicas en estadio avanzado, y recalibrarlo para adaptarlo al perfil de estos pacientes. [Métodos] Estudio prospectivo observacional multicéntrico. Se incluyeron pacientes con una o más enfermedades médicas avanzadas. Se analizó la calibración (bondad de ajuste de Hosmer-Lemeshow) y el poder discriminativo (curva ROC y área bajo la curva [AUC]) del PPI en la predicción de la mortalidad a los 180 días. La recalibración se llevó a cabo analizando las puntuaciones en el PPI de cada cuartil ascendente de probabilidad de fallecer. Se comparó la precisión del PPI con la obtenida con el índice de Charlson. [Resultados] La mortalidad global de los 1.788 pacientes fue del 37,5%. La calibración en la predicción de mortalidad fue buena (bondad de ajuste con p = 0,21), oscilando la probabilidad pronosticada entre 0-0,25 en el primer cuartil de riesgo, y 0,48-0,8 en el último cuartil. El poder discriminativo fue aceptable (AUC = 0,69; p < 0,0001). En los grupos recalibrados, la mortalidad de los pacientes con 0/1-2/2,5-9,5 ≥ 10 puntos fue del 13, 23, 39 y 68%, respectivamente. La sensibilidad y el valor predictivo negativo del punto de corte de la escala por encima de 0 fueron 96 y 87%, respectivamente; la especificidad y el valor predictivo positivo del punto de corte de la escala por encima de 9,5 fueron del 95 y 68%. La calibración del índice de Charslon fue buena (p = 0,2), y el poder discriminativo subóptimo (AUC = 0,52; p = 0,06). [Conclusiones] El PPI en los pacientes con enfermedades médicas en estadio avanzado puede ser de utilidad para el pronóstico de supervivencia a 6 meses.[Objective] To analyze the accuracy of the Palliative Prognostic Index (PPI) in patients with advanced medical diseases and to recalibrate it in order to adapt it to the profile of these patients. [Methods] Multicenter, prospective, observational study that included patients with one or more advanced medical diseases. Calibration (Hosmer-Lemeshow goodness of fit) and discriminative power (ROC and area under the curve [AUC]) of PPI were analyzed in the prediction of mortality at 180 days. Recalibration was carried out by analyzing the scores on the PPI of each quartile upward of dying probability. Accuracy of PPI was compared with that obtained for the Charlson index. [Results] Overall mortality of the 1.788 patients was 37.5%. Calibration in the prediction of mortality was good (goodness of fit with P=.21), the prognostic probabilities ranging from 0-0,25 in the first quartile of risk and from 0,48-0,8 in the last quartile. Discriminative power was acceptable (AUC=69; P=.0001). In recalibrated groups, mortality of patients with 0/1-2/2.5-9.5/≥10 points was 13, 23, 39 and 68%, respectively. Sensitivity (S) and negative predicative value (NPF) of the cutoff point above 0 points were 96 and 87%, respectively; while specificity (sp) and positive predictive value (PPV) of the cutoff point above 9.5 points were 95 and 68%. Calibration of the Charlson index was good (P=.2), and its discriminative power (AUC=.52; P=.06) was suboptimal. [Conclusions] PPI can be a useful tool in predicting 6-month survival of patients with advanced medical conditions.Peer Reviewe

Selection of interventions aimed at improving medication adherence in patients with multimorbidity

[Objectives]: To select interventions aimed at improving medication adherence in patients with multimorbidity by means of a standardised methodology. [Methods]: A modified Delphi methodology was used to reach consensus. Interventions that had demonstrated their efficacy in improving medication adherence in patients with multimorbidity or in similar populations were identified from a literature search of several databases (PubMed, EMBASE, the Cochrane Library, Center for Reviews and Dissemination, and Web of Science). 11 experts in medication adherence and/or chronic disease scored the selected interventions for appropriateness according to three criteria: strength of the evidence that supported each intervention, usefulness in patients with multimorbidity, and feasibility of implementation in clinical practice. The final set of interventions was selected according to appropriateness and agreement based on the Delphi methodology. [Results]: 566 articles were retrieved in the literature search. Nine systematic reviews were included. 33 interventions were initially selected for evaluation by the panellists. Consensus after two Delphi rounds was reached on 16 interventions. Five interventions were categorized as educational, six as behavioural and five were related to other aspects of interest. [Conclusions]: The interventions selected following a comprehensive and standardized methodology, could be used to improve medication adherence in patients with multimorbidity