Haemophilia and joint disease: pathophysiology, evaluation and management

In patients with haemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. Bleeding most commonly occurs in the knees, elbows, and ankles, and is often evident from early childhood. The pathogenesis of haemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (haemophilic synovitis) that contribute to end-stage degeneration (haemophilic arthropathy); with pain and limitation of motion severely affecting patients’ quality of life. If joint bleeding is not treated adequately, it tends to recur, resulting in a vicious cycle that must be broken to prevent the development of chronic synovitis and degenerative arthritis. Effective prevention and management of haemophilic arthropathy includes the use of early, aggressive prophylaxis with factor replacement therapies, as well as elective procedures, including restorative physical therapy, analgesia, aspiration, synovectomy, and orthopaedic surgery. Optimal treatment of patients with haemophilia requires a multidisciplinary team comprising a haematologist, physiotherapist, orthopaedic practitioner, rehabilitation physician, occupational therapist, psychologist, social workers, and nurses.Journal of Comorbidity 2011;1(1):51–59

ESP for Suppression of Jackknifing in an Articulated Bus

The Electronic Stability Program (ESP) is becoming increasingly popular in vehicles as a means to prevent spin-out and lane departure accidents, and is nowadays a standard feature in most cars. From 2012 the ESP will also be a standard feature in buses. As a first step, this thesis is dedicated to implementing an ESP for an articulated bus in simulation using Matlab/Simulink. The core of the ESP is a yaw rate controller that calculates a moment about the center of gravity of the front part of the bus to stabilize it. Integrated in the ESP are also an Anti-lock Braking System (ABS) and an Anti-Spin Regulation (ASR) system, which are model-based controllers that produce the brake pressures needed to achieve the desired moment. For the articulated bus it is clear that the fact that the bus consists of two parts makes the problem of stabilizing the bus more difficult. Furthermore, for articulated vehicles it is known that the risk of having the vehicle folding, known as jackknifing, during cornering is a major problem. However, the ESP is found to stabilize the bus for a large number of maneuvers and loading configurations, as well as suppressing jackknifing

Derivation of a Six Degrees-of-Freedom Ground-Vehicle Model for Automotive Applications

This report contains derivations of a rigid double-track ground vehicle model including roll and pitch dynamics, using a Newton-Euler modeling approach. Suspension is incorporated in the model. The suspension system is modeled as a rotational spring and damper system, where the spring and damper constants for each wheel have been lumped to two constants, one for each degree of freedom. The resulting chassis model is of fifth order. In addition, a first-order approach to take load transfer into account is discussed, which gives an additional degree of freedom. The model is derived with the aim of accurate simulation, but should also be possible to utilize for nonlinear control design

Extending the Occupancy Grid Concept for Low-Cost Sensor Based SLAM

The simultaneous localization and mapping problem is approached by using an ultrasound sensor and wheel encoders. To be able to account for the low precision inherent in ultrasound sensors, the occupancy grid notion is extended. The extension takes into consideration with which angle the sensor is pointing, to compensate for the issue that an object is not necessarily detectable from all position due to deficiencies in how ultrasonic range sensors work. Also, a mixed linear/nonlinear model is derived for future use in Rao-Blackwellized particle smoothing

Evaluation of the relationship between capillary and venous plasma glucose concentrations obtained by the HemoCue Glucose 201+ system during an oral glucose tolerance test

Abstract In 55 women with previous gestational diabetes mellitus, simultaneous capillary and venous plasma glucose concentrations were measured at 0, 30 and 120 min during a 75 g oral glucose tolerance test (OGTT). The aims of the study were to examine the relationship between capillary and venous glucose measurements, and to establish equations for the conversion of capillary and venous glucose concentrations using the HemoCue Glucose 201+ system. Additionally, the correlation between the capillary and venous glucose concentrations with the diagnostic cut-off limits proposed by the World Health Organization (WHO) in 1999 was evaluated. Capillary glucose concentrations were consistently higher than venous glucose concentrations at all time points of the OGTT (p < 0.001), and the correlations between the measurements were statistically highly significant (p < 0.001). The differences between the samples were greatest in the non-fasting state as revealed by the 95% prediction intervals (mmol/L) in Bland-Altman plots; ? 0.54 at 0 min, ? 2.01 at 30 min, and ? 1.35 at 120 min. Equivalence values for capillary plasma glucose concentrations derived from this study tended to be higher than those proposed by the WHO as diagnostic cut-off limits. Stratifying subjects by glucose tolerance status according to the WHO criteria revealed disagreements related to glucose values close to the diagnostic cut-off points. The study findings highlight the uncertainty associated with derived equivalence values. However, capillary plasma glucose measurements could be suitable for diagnostic purposes in epidemiological studies and when translating results on a group basis

A Convex Approach to Path Tracking with Obstacle Avoidance for Pseudo-Omnidirectional Vehicles

This report addresses the related problems of trajectory generation and time-optimal path tracking with online obstacle avoidance. We consider the class of four-wheeled vehicles with independent steering and driving on each wheel, also referred to as pseudo-omnidirectional vehicles. Appropriate approximations of the dynamic model enable a convex reformulation of the path-tracking problem. Using the precomputed trajectories together with model predictive control that utilizes feedback from the estimated global pose, provides robustness to model uncertainty and disturbances. The considered approach also incorporates avoidance of a priori unknown moving obstacles by local online replanning. We verify the approach by successful execution on a pseudo-omnidirectional mobile robot, and compare it to an existing algorithm. The result is a significant decrease in the time for completing the desired path. In addition, the method allows a smooth velocity trajectory while avoiding intermittent stops in the path execution

von Willebrand's disease: a report from a meeting in the Åland islands

von Willebrand's disease (VWD) is probably the most common bleeding disorder, with some studies indicating that up to 1% of the population may have the condition. Over recent years interest in VWD has fallen compared to that of haemophilia, partly the result of focus on blood-borne diseases such as HIV and hepatitis. Now the time has come to revisit VWD, and in view of this some 60 international physicians with clinical and scientific interest in VWD met over 4 days in 2010 in the Åland islands to discuss state-of-the-art issues in the disease. The Åland islands are where Erik von Willebrand had first observed a bleeding disorder in a number of members of a family from Föglö, and 2010 was also the 140th anniversary of his birth. This report summarizes the main papers presented at the symposium; topics ranged from genetics and biochemistry through to classification of VWD, pharmacokinetics and laboratory assays used in the diagnosis of the disease, inhibitors, treatment guidelines in different age groups including the elderly who often have comorbid conditions that present challenges, and prophylaxis. Other topics included managing surgeries in patients with VWD and the role of FVIII in VWF replacement, a controversial subject