Parameters Identification for a Composite Piezoelectric Actuator Dynamics

This work presents an approach for identifying the model of a composite piezoelectric (PZT) bimorph actuator dynamics, with the objective of creating a robust model that can be used under various operating conditions. This actuator exhibits nonlinear behavior that can be described using backlash and hysteresis. A linear dynamic model with a damping matrix that incorporates the Bouc–Wen hysteresis model and the backlash operators is developed. This work proposes identifying the actuator’s model parameters using the hybrid master-slave genetic algorithm neural network (HGANN). In this algorithm, the neural network exploits the ability of the genetic algorithm to search globally to optimize its structure, weights, biases and transfer functions to perform time series analysis efficiently. A total of nine datasets (cases) representing three different voltage amplitudes excited at three different frequencies are used to train and validate the model. Four cases are considered for training the NN architecture, connection weights, bias weights and learning rules. The remaining five cases are used to validate the model, which produced results that closely match the experimental ones. The analysis shows that damping parameters are inversely proportional to the excitation frequency. This indicates that the suggested hysteresis model is too general for the PZT model in this work. It also suggests that backlash appears only when dynamic forces become dominant

A Refreshable and Portable E-Braille System for the Blind and Visually Impaired

Braille is a communication system to assist the blind and visually impaired. Present an approach to measure fingertip forces while identifying Braille characters. Implement a force sensory feedback in the device to measure the force developed on the fingertip. Introduce a preliminary design for the device. Build a prototype for the device and evaluate its functionality and integrate its component

A Refreshable and Portable E-Braille System for the Blind and Visually Impaired

The objective of this research is to design an affordable Braille tactile display that is wearable, refreshable, and portable. The device is intended to be used as an output device that can playback stored media. It can be also incorporated with current Braille reading technologies. The device will control both the electrical and mechanical stimulations to optimize the sensation and ensure extended use of the device. This work is concerned mainly with the mechanical aspects of the design. This research proposed the development of a finger-wearable, scanning-style electric stimulation based (electrotactile) Braille display with sensing and adaptive rendering/actuation functions for assisting the BVI. E-Braille technology will allow the BVI to perform important tasks such as reading, writing, typing in Braille, printing text, browsing the Internet, engaging in on-line conversations, and perceiving graphics. Combined with the Cyber-Infrastructure network technology, E-Braille will allow the BVI to access more text, books and libraries anytime and anywhere. Additionally, the proposed E-Braille will provide a tool for collaborative research in the biomedical field involving psychophysicists, neurocytologists, electrochemists, and cognitive scientists. E-Braille will fill a gap in portable and adaptive seeing rehabilitation technology by providing the BVI with a fast, refreshable, and individualized electronic Braille tactile display. The proposed E-Braille system will dramatically enhance the lives of millions of the BVI by providing them with unprecedented access to information and communication at an affordable price and using the state-of-the-art sensing technology

A COMPARISON BETWEEN THE EFFECT OF DIFFERENT PRESSURES OF AIR PARTICLE ABRASION BEFORE AND AFTER SINTERING WITH AND WITHOUT ZIRCONIA LINER ON BOND STRENGTH OF RESIN TO ZIRCONIA SURFACE

This study aimed to compare the effect of different pressures of air particle abrasion 2 and 4 bars before and after sintering with and without zirconia liner on SBS of resin to zirconia Surface. Materials and Methods: 54 zirconia cuboids 8×8×3 mm were milled and divided into 6 equal groups (N=9) according to surface treatment; sintered with ceramic liner application and 2 bars pressure (SL2) and with 4 bars pressure (SL4), sintered with no ceramic liner and 2 bars pressure (SN2) and 4 bars pressure (SN4), unsintered with no ceramic liner and 2 bars pressure (UN2) and 4 bars pressure (UN4). Specimens underwent thermocycling (1000 cycles) between 5 ̊ and 55 ̊ Celsius with dwell time of 10 seconds, and submitted to SBS test. Data was statistically analysed. Results: All 4 bars APA groups showed higher SBS than 2 bars groups with significant difference between SL4 group (4.7±2.07) and SL2 group (2.58±1.94). Groups with APA before sintering (12.42±2.56) showed significantly higher SBS than APA after sintering (6.35±3.7). SL2 group showed least SBS with significant difference (2.58±1.94) compared to UN2 (11.83±3.35) and SN2 (7.87±2.12). SL4 group (4.7±2.07) showed the least SBS compared to the UN4 (13±1.38), and SN4 (10.24±2.94) groups. Conclusion: It was found that APA of zirconia surface before sintering yielded superior performance than APA after sintering, also 4 bars APA pressure application showed higher SBS than 2 bars pressure, application and firing of ceramic liner onto zirconia surface didn’t enhance SBS

ARA-Homotopy Perturbation Technique with Applications

In this study, we propose a novel combination method between the ARA integral transform and the homotopy perturbation approach to solve systems of nonlinear partial differential equations. The difficulty arising in solving nonlinear partial differential equations could simply be overcome by using He’s polynomials during the application of the new method. The proposed technique can provide the solutions of the target problems without pre-assumptions or restrictive constrains in addition to avoiding the round-off errors. The efficiency of the new method is illustrated by applying it to solve different examples of systems of nonlinear partial differential equations. We discuss three interesting applications and solve them by the new approach, called ARA-homotopy perturbation method and get exact solutions, also the results are illustrated in figures

The Effect of Vitamin D treatment on COVID 19- Patients, an Inverted Propensity Score Weighting (IPSW), and Inverted Probability of Treatment Weighting (IPTW) Analyzed Study

Background Vitamin D3 (1,25(OH)2 cholecalciferol) as a treatment for COVID 19 patients is being disputed, and a clear clinical benefit is not being confirmed. Methods A retrospective evaluation for COVID-19 patients who were treated with various cumulative doses of vitamin D. Data was extracted from the COVID-19 database, it included patients admitted to three hospitals in Amman, Jordan. Characteristics of patients were tabulated and compared for all-cohort, and propensity score index (PSI) adjustment, The comparison was based on two vitamin D strata ((≤ 149,000 i.u. and > 150,000 i.u.). Logistic regression analysis was utilized to predict recovery, the need for oxygen, and all-cause mortality for all-cohort, IPSW, and IPTW patients, based on vitamin D cumulative doses during their hospital stay. Results             1131 all-cohort and 768 PSI-adjusted patients were recruited. Except for antibiotics and antivirals, all other characteristics were balanced (P = NS). There were 1017 patients on vitamin D, 847 received cumulative ≤ 149,000 i.u., and 170 patients received cumulative dose ≥ 150,000 i.u. (Range 1000 – 385000). It was demonstrated that escalating cumulative doses of vitamin D did not contribute to the assessed outcomes; all-cohort patients (OR = 1.000, 95% C.I. 1.000 to 1.000), IPSW (OR = 1.000, 95% C.I. 1.000 to 1.000), and the IPTW (OR = 1.000, 95% C.I. 1.000 to 1.000). Conclusion             In our patients’ cohorts, we could not demonstrate a beneficial effect for vitamin D therapy in COVID-19 patients for recovery, the need for home oxygen, and all-cause mortality, by hospital discharge

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised