A novel method of using sound waves and artificial intelligence for the detection of vehicle's proximity from cyclists and E-scooters

Outdoor air pollution has been found to have a significant adverse effect on health. When the authors attempted to monitor air quality that cyclists or e-scooter users' breath during commuting in different locations for health and safety analysis, it was found that the existence of internal combustion engine (ICE) cars has a significant effect on the pollution levels and the monitoring process. To comprehensively study the effect of cars and traffic on air quality that cyclists and e-scooters users experience, a low-cost and reliable system was needed to detect the proximity of cars that have diesel or petrol engines. Video cameras can be used to visually detect vehicles, but in the modern age with the existence of many electric and hybrid vehicles and the need to reduce the cost of instrumentation, there was a need to determine the passing of vehicles near e-scooter and bike users from the combined engine and tires sounds. To address this issue, this study suggests a novel approach of using sound waves of internal combustion engines and tire sounds during the passing of cars, combined with AI techniques (neural networks), to detect the proximity of cars from cyclists and e-scooter users. Audio-visual data was collected using Go-Pro cameras in order to combine the data with GPS location and pollution levels. Geographical data maps were produced to demonstrate the density of cars that cyclists encounter when on or near the road. This method will enable air quality monitoring research to detect the existence of ICE cars for future correlation with measured pollution levels. The proposed method allows for:•The automated selection of sensitive features from sound waves to detect vehicles.•Low-cost hardware which is independent of orientation that can be integrated with other air quality and GPS sensors.•The successful application of sensor fusion and neural networks.

Microplastics in human blood: Polymer types, concentrations and characterisation using μFTIR

Microplastics (MPs) are an everyday part of life, and are now ubiquitous in the environment. Crucially, MPs have not just been found within the environment, but also within human bodies, including the blood. We aimed to provide novel information on the range of MP polymer types present, as well as their size and shape characteristics, in human whole blood from 20 healthy volunteers. Twenty-four polymer types were identified from 18 out of 20 (90 %) donors and quantified in blood, with the majority observed for the first time. Using an LOQ approach, five polymer types met the threshold with a lower mean ± SD of 2466 ± 4174 MP/L. The concentrations of plastics analysed in blood samples ranged from 1.84 - 4.65 μg/mL. Polyethylene (32 %), ethylene propylene diene (14 %), and ethylene-vinyl-acetate/alcohol (12 %) fragments were the most abundant. MP particles that were identified within the blood samples had a mean particle length of 127.99 ± 293.26 µm (7-3000 µm), and a mean particle width of 57.88 ± 88.89 µm (5-800 µm). The MPs were predominantly categorised as fragments (88 %) and were white/clear (79 %). A variety of plastic additive chemicals were identified including endocrine disrupting-classed phthalates. The procedural blank samples comprised 7 polymer types, that were distinct from those identified in blood, mainly resin (25 %), polyethylene terephthalate (17 %), and polystyrene (17 %) with a mean ± SD of 4.80 ± 5.59 MP/L. This study adds to the growing evidence that MPs are taken up into the human body and are transported via the bloodstream. The shape and sizes of the particles raise important questions with respect to their presence and associated hazards in terms of potential detrimental impacts such as vascular inflammation, build up within major organs, and changes to either immune cell response, or haemostasis and thrombosis.

Development of a bespoke 3D-printed spinal brace for lumbar support

Low back pain (LBP) is a significant contributor to disabilities in the UK. Many factors cause LBP, including poor posture, obesity, and spinal fractures, all resulting in spiralling healthcare costs. If spinal fractures are not properly braced, they can lead to weakened vertebrae in the spine and larger risks that can reoccur. There are many problems with flexible, semi-rigid and rigid braces currently available on the market. We present the user-centred design approach undertaken by a multidisciplinary design team consisting of product designers, design engineers, technical specialists, and healthcare professionals to develop a bespoke 3D-printed spinal brace using a digital design workflow.

Postable peak flow meters: Improving remote patient monitoring from the home

As healthcare providers globally adapt/change their practices because of the ongoing global pandemic, a greater emphasis is being placed on remote/telemedicine diagnostic/monitoring models. To support such a model, especially for respiratory diseases—ie, asthma, chronic obstructive pulmonary disease (COPD), or interstitial lung disease (ILD)—it is essential that data are collected over a sustained time period. As such, the distribution of portable medical devices to patients’ homes poses a significant logistical challenge. We present the user-centred design approach undertaken by a multidisciplinary design team consisting of product designers, design engineers, electronics/programming experts, and healthcare professionals to develop a postable modular peak flow meter.

Development of a PPE visor for female healthcare workers

During the COVID-19 pandemic the demand for personal protective equipment (PPE) has increased dramatically. However, the lack of PPE designed specifically for women is leaving many without adequate protection, as current “universal” solutions fail to address female healthcare workers’ varied needs. Instead, current solutions present users with a host of problems, including discomfort, hindrance, incompatibility with other wearable items, and adjustment difficulties. This paper explores and reflects upon the design thinking approach used to develop a PPE visor for female healthcare workers while following a user-centred design approach/methodology.

Methodologies for true cost accounting in the food sector

The recent development of true cost accounting (TCA) methodologies by various organizations has helped increase transparency in the food sector, but has also made it difficult to compare the results obtained through different methodologies. Here we review major TCA methodologies across five functional units that their assessment framework(s) apply to-namely product, organization, system, geography and investment. Our results show that the bulk of existing frameworks apply to products and/or organizations. According to publicly available documents and case studies published by the framework proponents, we found measurements of externality/dependency, the inclusion of economic, environmental and social effects, as well as the use of comparable metrics to be areas of general consensus; suggested indicators, monetization and aggregation emerged as areas of general divergence. The differences between TCA methodologies identified in this study indicate that collaboration between frameworks is key to their harmonization, ultimately making results more comparable and facilitating engagement in TCA.

Abstract 2590: Genomic analysis points to fibrosis and changes in fat metabolism in oral cancer progression

Head and neck cancer long term survival has only experienced marginal gains over the past 3 decades. Further, there is inadequate understanding of the biology of carcinogenesis and recurrence, as well as its relation to the microenvironment. Deeper understanding of these areas would provide improved molecular target identification. In pursuit of this goal, a small clinical trial collected lesion and adjacent normal-appearing mucosa for subsequent RNA-seq analysis. Patients were grouped by post-surgical pathology as either precancer (hyperplasia - severe dysplasia) or cancer (carcinoma in situ - early stage invasive cancer). Following identification of differentially expressed (DE) genes, DE genesets were submitted for Ingenuity Pathway Analysis (IPA). Hierarchical clustering illustrates distinct separation between lesion and perilesional normal mucosa of the top 100 DE genes. Among the top 25 dysregulated pathways, 50% were associated with creation of fibrotic tumor microenvironment (TME), 20% were related to changes in immune populations inhabiting the TME and 10% devoted to metabolism changes. Subgroup analysis, (precancer vs. cancer), revealed dysregulation of metabolism (~50%) predominating in precancer. Metabolism remained an important dysregulation at 30% of the top 25 pathways in cancer. Protein network analysis, (Metascape on-line tool), confirmed IPA results, illustrating an extensive, previously undescribed, interconnectedness of fibrosis with shifts in fatty acid metabolism from oxidative to gluconeogenesis, providing a foundation for choosing targets amenable to cancer prevention. Several notable pathways are likely contributed to by inflammatory and other cells in the milieu, not precancer cells themselves. So, we dove deeper, using EpIC (Epitope Immunogenicity Characterization) algorithm to assess relative percentages of non-tumor cells based on 20-count gene signatures. Gene expression favored a profile of significantly increasing cancer-associated fibroblasts, decreasing CD-8 killer T cells, and increasing vascular endothelial cells during progression, with macrophage content slightly increasing in cancer specimens. These findings suggest interaction between immunoinflammatory milieu and precancerous cells promoting malignancy. Several high yield target pathways are related to published mechanisms of action for drugs of high interest to our cancer prevention program (pioglitazone/metformin). Further, we confirmed protein network analysis in an additional oral carcinoma dataset from Conway et. al, (Oncotarget 2015).

Citation Format: Gretchen M. Unger, Beverly R. Wuertz, Charles L. Pruett, Matthew Watkins, Patrick M. Gaffney, Frank G. Ondrey. Genomic analysis points to fibrosis and changes in fat metabolism in oral cancer progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2590.

Challenges and opportunities of remotely working from home during Covid-19 pandemic

The demand of online remote working from home significantly increased in 2020/21 due to the Covid-19 pandemic. This unforeseen situation has forced individuals and organisations to rapidly train employees and adopt the use of on-line working styles, seeking to maintain the same level of productivity as working from the office. The paper outlines a survey conducted amongst people working from home to identify the challenges and opportunities this change in workstyle offers. At the beginning of the pandemic, many employees faced difficulties adapting to using online tools and combining their working hours with daily routines and family commitments. However, the results show that within a short period of time the respondents had managed to develop the necessary experience and knowledge for digital working utilising tools such as collaboration platforms and video conferencing. A large proportion of respondents recognised the advantage of eliminating travelling time when working remotely from home which also has a positive impact on the environment and CO2 emissions. However, some drawbacks have been identified such as the lack of face-to-face discussion and informal meetings during working days. The Self-Determination Theory is discussed within the context of this paper and it has been found that the theory could provide an explanation of the efficient and rapid adaptation of the technology be employees.

Tests of a full-scale ITER toroidal interferometer and polarimeter (TIP) prototype on the DIII-D tokamak (invited)

A full-scale ITER toroidal interferometer and polarimeter (TIP) prototype, including an active feedback alignment system, has been installed and tested on the DIII-D tokamak. In the TIP prototype, a two-color interferometry measurement of line-integrated density is carried out at 10.59 μm and 5.22 μm using a CO₂ and quantum cascade laser, respectively, while a separate polarimetry measurement of the plasma-induced Faraday effect is made at 10.59 μm. The TIP prototype is equipped with a piezo tip/tilt stage active feedback alignment system that minimizes noise in the measurement and keeps the diagnostic aligned throughout DIII-D discharges. The measured phase resolution for the polarimeter and interferometer is 0.05° (100 Hz bandwidth) and 1.9° (1 kHz bandwidth), respectively. The corresponding line-integrated density resolution for the vibration-compensated interferometer is δnL = 1.5 × 10¹⁸ m^-2, and the magnetic field-weighted line-integrated density from the polarimeter is δnBL = 1.5 × 10¹⁹ Tm^-2. Both interferometer and polarimeter measurements during DIII-D discharges compare well with the expectations based on calculations using Thomson scattering measured density profiles and magnetic equilibrium reconstructions. Additionally, larger bandwidth interferometer measurements show that the diagnostic is a sensitive monitor of core density fluctuations with demonstrated measurements of Alfvén eigenmodes and tearing modes.

A heterodyne dispersion interferometer for wide bandwidth density measurements on DIII-D

In order to improve both the density and particularly the temporal resolution beyond previous dispersion interferometers (DIs), a heterodyne technique based on an acousto-optic (AO) cell has been added to the DI. A 40 MHz drive frequency for the AO cell allows density fluctuation measurements into the MHz range. A CO₂ laser-based heterodyne DI (HDI) installed on DIII-D has demonstrated that the HDI is capable of tracking the density evolution throughout DIII-D discharges, including disruption events and other rapid transient phenomena. The data also show good agreement with independent density measurements obtained with the existing DIII-D two-color interferometer. The HDI line-integrated density resolution sampled over a 1 s interval is ∼9 × 10¹⁷ m^-2. Density fluctuations induced by MHD instabilities are also successfully measured by the HDI.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Influence of ions on two-dimensional and three-dimensional atomic force microscopy at fluorite-water interfaces

Recent advancement in liquid-environment atomic force microscopy (AFM) has enabled us to visualize three-dimensional (3D) hydration structures as well as two-dimensional (2D) surface structures with subnanometer-scale resolution at solid-water interfaces. However, the influence of ions present in solution on the 2D- and 3D-AFM measurements has not been well understood. In this study, we perform atomic-scale 2D- and 3D-AFM measurements at fluorite-water interfaces in pure water and a supersaturated solution of fluorite. The images obtained in these two environments are compared to understand the influence of the ions in solution on these measurements. In the 2D images, we found clear difference in the nanoscale structures but no significant difference in the atomic-scale contrasts. However, the 3D force images show clear difference in the subnanometer-scale contrasts. The force contrasts measured in pure water largely agree with those expected from the molecular dynamics simulation and the solvent tip approximation model. In the supersaturated solution, an additional force peak is observed over the negatively charged fluorine ion site. This location suggests that the observed force peak may originate from cations adsorbed on the fluorite surface. These results demonstrate that the ions can significantly alter the subnanometer-scale force contrasts in the 3D-AFM images.

A Cost-Effectiveness Analysis of Nintedanib in Idiopathic Pulmonary Fibrosis in the UK

BACKGROUND

International guidelines recommend nintedanib (OFEV^®) as an option for the treatment of idiopathic pulmonary fibrosis (IPF).

OBJECTIVE

The objective of this study was to assess the cost effectiveness of nintedanib versus pirfenidone, N-acetylcysteine and best supportive care (BSC) for the treatment of IPF from a UK payer's perspective.

METHODS

A Markov model was designed to capture the changes in the condition of adults with IPF. Efficacy outcomes included mortality, lung function decline and acute exacerbations. Treatment safety (serious adverse events) and tolerability (overall discontinuation) were also considered. The baseline risk of these events was derived from patient-level data from the placebo arms of nintedanib clinical trials (TOMORROW, INPULSIS-1, INPULSIS-2). A network meta-analysis (NMA) was conducted to estimate the relative effectiveness of the comparator treatments. Quality of life and healthcare resource use data from the clinical trials were also incorporated in the economic model.

RESULTS

Nintedanib showed statistically significant differences against placebo on acute exacerbation events avoided and lung function decline. In the cost-effectiveness analysis, the results were split between two treatments with relative low costs and modest effectiveness (BSC and N-acetylcysteine) and two that showed improved effectiveness (lung function) and higher costs (nintedanib and pirfenidone). All comparators were assumed to have similar projected survival and the difference in quality-adjusted life-years (QALYs) was driven by the acute exacerbations and lung function estimates. In the base-case deterministic pairwise comparison with pirfenidone, nintedanib was found to have fewer acute exacerbations and resulted in less costs and more QALYs gained.

CONCLUSIONS

Compared with BSC (placebo), nintedanib and pirfenidone were the only treatments to show statistical significance in the efficacy parameters. We found substantial uncertainty in the overall cost-effectiveness results between nintedanib and pirfenidone. N-Acetylcysteine was largely similar to BSC but with a worse survival profile. INPULSIS-1 and INPULSIS-2 ClinicalTrials.gov numbers, NCT01335464 and NCT01335477.

Bench testing of a heterodyne CO2 laser dispersion interferometer for high temporal resolution plasma density measurements

A heterodyne detection scheme is combined with a 10.59 μm CO₂ laser dispersion interferometer for the first time to allow large bandwidth measurements in the 10-100 MHz range. The approach employed utilizes a 40 MHz acousto-optic cell operating on the frequency doubled CO₂ beam which is obtained using a high 2nd harmonic conversion efficiency orientation patterned gallium arsenide crystal. The measured standard deviation of the line integrated electron density equivalent phase resolution obtained with digital phase demodulation technique, is 4 × 10¹⁷ m^-2. Air flow was found to significantly affect the baseline of the phase signal, which an optical table cover was able to reduce considerably. The heterodyne dispersion interferometer (DI) approach is found to be robustly insensitive to motion, with measured phase shifts below baseline drifts even in the presence of several centimeters of retroreflector induced path length variations. Plasma induced dispersion was simulated with a wedged ZnSe plate and the measured DI phase shifts are consistent with expectations.

A relationship between three-dimensional surface hydration structures and force distribution measured by atomic force microscopy

Hydration plays important roles in various solid-liquid interfacial phenomena. Very recently, three-dimensional scanning force microscopy (3D-SFM) has been proposed as a tool to visualise solvated surfaces and their hydration structures with lateral and vertical (sub) molecular resolution. However, the relationship between the 3D force map obtained and the equilibrium water density, ρ(r), distribution above the surface remains an open question. Here, we investigate this relationship at an interface of an inorganic mineral, fluorite, and water. The force maps measured in pure water are directly compared to force maps generated using the solvent tip approximation (STA) model and from explicit molecular dynamics simulations. The results show that the simulated STA force map describes the major features of the experimentally obtained force image. The agreement between the STA data and the experiment establishes the correspondence between the water density used as an input to the STA model and the experimental hydration structure and thus provides a tool to bridge the experimental force data and atomistic solvation structures. Further applications of this method should improve the accuracy and reliability of both interpretation of 3D-SFM force maps and atomistic simulations in a wide range of solid-liquid interfacial phenomena.

Gamma ray imager on the DIII-D tokamak

A gamma ray camera is built for the DIII-D tokamak [J. Luxon, Nucl. Fusion 42, 614 (2002)] that provides spatial localization and energy resolution of gamma flux by combining a lead pinhole camera with custom-built detectors and optimized viewing geometry. This diagnostic system is installed on the outer midplane of the tokamak such that its 123 collimated sightlines extend across the tokamak radius while also covering most of the vertical extent of the plasma volume. A set of 30 bismuth germanate detectors can be secured in any of the available sightlines, allowing for customizable coverage in experiments with runaway electrons in the energy range of 1-60 MeV. Commissioning of the gamma ray imager includes the quantification of electromagnetic noise sources in the tokamak machine hall and a measurement of the energy spectrum of background gamma radiation. First measurements of gamma rays coming from the plasma provide a suitable testbed for implementing pulse height analysis that provides the energy of detected gamma photons.

PILOT EVALUATION OF A SIMPLE ADJUNCTIVE METHOD FOR IMPROVED REMOVAL OF ORAL BIOFILM DURING CONVENTIONAL SCALING AND ROOT PLANING THERAPY

Various studies have evaluated the adjunctive use of chemical and antimicrobial treatments to assist in the mechanical removal of oral microbial biofilm from tissue surfaces during scaling and root planning therapy (SRP). The current study demonstrates the elimination of two classes of surrogate molecular markers from periodontal disease sites. This suggests the current agent may be a more effective adjunctive cleansing agent for complete biofilm removal. A patient with advanced chronic periodontitis was subjected to standard SRP therapy, supplemented by irrigation with HYBENX® (HBX). Samples of gingival crevicular fluid were collected with triplicate absorbent paper points from each of three quadrants at three time points: 1) at baseline prior to treatment; 2) after irrigation with the topical agent for 20 seconds and rinsing; and 3) after SRP followed by a second irrigation/rinsing treatment with the agent. Paper points were extracted to assess the presence of 13 bacterial species known to be primarily associated with periodontal disease using DNA pyrosequencing. In addition, the presence of Matrix Metalloproteinase-8 (MMP8), as well as IL-1ß, IL-6, and TNF-alpha were also assessed by immunoassay of the paper point sample extracts. The combined adjunctive treatment indicated a complete absence of detectable bacterial DNA and the four inflammatory mediators from samples taken from the gingival sulci treated with HBX. The advantage of the current adjunctive topical treatment technique is that it is simple and easy to administer in conjunction with standard SRP techniques. It appears to provide a level of cleanliness not currently achieved with other SRP adjunctive procedures.

Molecular phylogeny and evolution of the cone snails (Gastropoda, Conoidea)

We present a large-scale molecular phylogeny that includes 320 of the 761 recognized valid species of the cone snails (Conus), one of the most diverse groups of marine molluscs, based on three mitochondrial genes (COI, 16S rDNA and 12S rDNA). This is the first phylogeny of the taxon to employ concatenated sequences of several genes, and it includes more than twice as many species as the last published molecular phylogeny of the entire group nearly a decade ago. Most of the numerous molecular phylogenies published during the last 15years are limited to rather small fractions of its species diversity. Bayesian and maximum likelihood analyses are mostly congruent and confirm the presence of three previously reported highly divergent lineages among cone snails, and one identified here using molecular data. About 85% of the species cluster in the single Large Major Clade; the others are divided between the Small Major Clade (∼12%), the Conus californicus lineage (one species), and a newly defined clade (∼3%). We also define several subclades within the Large and Small major clades, but most of their relationships remain poorly supported. To illustrate the usefulness of molecular phylogenies in addressing specific evolutionary questions, we analyse the evolution of the diet, the biogeography and the toxins of cone snails. All cone snails whose feeding biology is known inject venom into large prey animals and swallow them whole. Predation on polychaete worms is inferred as the ancestral state, and diet shifts to molluscs and fishes occurred rarely. The ancestor of cone snails probably originated from the Indo-Pacific; rather few colonisations of other biogeographic provinces have probably occurred. A new classification of the Conidae, based on the molecular phylogeny, is published in an accompanying paper.

Abstract 269: Look Ma, No Hands! Cardiopulmonary Resuscitation

Background: CPR saves lives. Community-based, bystander CPR increases survivability by reducing time to compressions. Inadequate chest compressions have been associated with poor patient outcome. There is substantial inter-operator variability in quality and duration. While training laypersons in CPR, we observed that individuals lacking upper body strength had difficulty sustaining effective compressions. An improvised compression technique, transferring the force to the operator’s forearm, immediately resolved this issue.

Objective/hypothesis: We hypothesized that a modified technique would be associated with increased duration of adequate compressions relative to standard CPR.

Methods: Using a convenience sample of 18 paramedic students, we standardized this forearm technique and compared duration of adequate compressions with Standard CPR using Laerdal PC SkillReporting software. Trials were terminated upon 5 consecutive inadequate compressions. Evaluators were blinded to which sequence-randomized technique was being used. Our case-crossover study was approved by the university IRB.

Results:

Limitations: The small, convenience sample of young, fit providers trained in CPR was not representative of the group for whom the improvisation was originally devised. Larger scale testing with greater diversity is indicated.

Conclusions: Our pilot study supported our hypothesis that the forearm CPR method was not inferior to the standard method with respect to time to fatigue. Having the mannequin at hospital bed height likely influenced the effectiveness of both techniques, so ensuing studies will use a mannequin on the ground.

A simple approximation for forces exerted on an AFM tip in liquid

The critical quantity in understanding imaging using an atomic force microscope is the force the sample exerts on the tip. We put forward a simple one-to-one force to water density relationship, explain exactly how it occurs, and in which circumstances it holds. We argue that two wide classes of atomic force microscope (AFM) tip should lead to at least qualitative agreement with our model and represent a significant fraction of AFM tips as currently prepared. This connection between the short-range force and the unperturbed equilibrium water density removes the need to perform simulations for each tip location, conservatively speeding up simulations by around three orders of magnitude compared to current methods that explicitly calculate the force on a tip model at each point in space.

Status and characterization of the lithium beam diagnostic on DIII-D

The 30 keV lithium beam diagnostic on DIII-D is suitable to measure both the radial electron density and poloidal magnetic field profiles in the pedestal. The refurbished system features a new setup to measure the Doppler shift allowing accurate alignment of the spectral filters. The injector has been optimized to generate a stable lithium neutral beam with a current of I = 15-20 mA and a diameter of 1.9 ± 0.1 cm measured by beam imaging. The typical temporal resolution is Δt = 1-10 ms and the radial resolution of ΔR = 5 mm is given by the optical setup. A new analysis technique based on fast Fourier transform avoids systematic error contributions from the digital lock-in analysis and accounts intrinsically for background light correction. Latest upgrades and a detailed characterization of the system are presented. Proof-of-principle measurements of the poloidal magnetic field with a statistical error of typically 2% show a fair agreement with the predictions modeled with the Grad-Shafranov equilibrium solver EFIT within 4%.

A systematic review of the evidence on service user involvement in interpersonal skills training of mental health students

Service user involvement has become a common feature of education programmes for mental health students. However, little is known about the effects of this type of education on the interpersonal skills of students taking part. This paper reports findings from a systematic review that formed part of a wider investigation into service user involvement in teaching interpersonal skills. The review aimed to locate and assess the quality of the published evidence relating to the effects of service user involvement on mental health students interpersonal skills and to synthesize results, using a definition of interpersonal skill that includes attitudes, empathy and skills as its key components. Results from this study indicate that the quality of evidence in this area is poor. However, sufficient synthesis of the evidence base was possible to allow conclusions and recommendations for both research and practice. Conclusions were that the involvement of service users in this area is both acceptable and valuable for students and had specific impacts on attitudes, empathy and skills. Some difficulties and reservations about the style of involvement are discussed. Recommendations for the conduct of future research are also made.

Embedded calibration system for the DIII-D Langmuir probe analog fiber optic links

This paper describes a generally applicable technique for simultaneously measuring offset and gain of 64 analog fiber optic data links used for the DIII-D fixed Langmuir probes by embedding a reference voltage waveform in the optical transmitted signal before every tokamak shot. The calibrated data channels allow calibration of the power supply control fiber optic links as well. The array of fiber optic links and the embedded calibration system described here makes possible the use of superior modern data acquisition electronics in the control room.

Initial results of the high resolution edge Thomson scattering upgrade at DIII-D

Validation of models of pedestal structure is an important part of predicting pedestal height and performance in future tokamaks. The Thomson scattering diagnostic at DIII-D has been upgraded in support of validating these models. Spatial and temporal resolution, as well as signal to noise ratio, have all been specifically enhanced in the pedestal region. This region is now diagnosed by 20 view-chords with a spacing of 6 mm and a scattering length of just under 5 mm sampled at a nominal rate of 250 Hz. When mapped to the outboard midplane, this corresponds to ~3 mm spacing. These measurements are being used to test critical gradient models, in which pedestal gradients increase in time until a threshold is reached. This paper will describe the specifications of the upgrade and present initial results of the system.

Models of the interaction of metal tips with insulating surfaces

We present the results of atomistic simulations of metallic atomic-force-microscopy tips interacting with ionic substrates, with atomic resolution. Chromium and tungsten tips are used to image the NaCl(001) and MgO(001) surfaces. The interaction of the tips with the surface is simulated by using density-functional-theory calculations employing a mixed Gaussian and plane-wave basis and cluster-tip models. In each case, the apex of the metal cluster interacts more attractively with anions in the surfaces than with cations, over the range of typical imaging distances, which leads to these sites being imaged as raised features (bright) in constant-frequency-shift images. We compare the results of the interaction of a chromium tip with the NaCl surface, with calculations employing exclusively plane-wave basis sets and a fully periodic tip model, and demonstrate that the electronic structure of the tip model employed can have a significant quantitative effect on calculated forces when the tip and surface are clearly separated.

Large variation of vacancy formation energies in the surface of crystalline ice

Resolving the atomic structure of the surface of ice particles within clouds, over the temperature range encountered in the atmosphere and relevant to understanding heterogeneous catalysis on ice, remains an experimental challenge. By using first-principles calculations, we show that the surface of crystalline ice exhibits a remarkable variance in vacancy formation energies, akin to an amorphous material. We find vacancy formation energies as low as ~0.1-0.2 eV, which leads to a higher than expected vacancy concentration. Because a vacancy's reactivity correlates with its formation energy, ice particles may be more reactive than previously thought. We also show that vacancies significantly reduce the formation energy of neighbouring vacancies, thus facilitating pitting and contributing to pre-melting and quasi-liquid layer formation. These surface properties arise from proton disorder and the relaxation of geometric constraints, which suggests that other frustrated materials may possess unusual surface characteristics.

Chemical resolution at ionic crystal surfaces using dynamic atomic force microscopy with metallic tips

We demonstrate that well prepared and characterized Cr tips can provide atomic resolution on the bulk NaCl(001) surface with dynamic atomic force microscopy in the noncontact regime at relatively large tip-sample separations. At these conditions, the surface chemical structure can be resolved yet tip-surface instabilities are absent. Our calculations demonstrate that chemical identification is unambiguous, because the interaction is always largest above the anions. This conclusion is generally valid for other polar surfaces, and can thus provide a new practical route for straightforward interpretation of atomically resolved images.

Mechanism of contrast formation in atomic force microscopy in water

We use computer modeling to investigate the mechanism of atomic-scale corrugation in frequency-modulation atomic force microscopy imaging of inorganic surfaces in solution. Molecular dynamics simulations demonstrate that the forces acting on a microscope tip result from the direct interaction between a tip and a surface, and forces entirely due to the water structure around both tip and surface. The observed force depends on a tip structure and is a balance between largely repulsive potential energy changes as the tip approaches and the entropic gain when water is sterically prevented from occupying sites near the tip and surface.

Unambiguous determination of the adsorption geometry of a metal--organic complex on a bulk insulator

Individual molecules of Co-Salen, a small chiral paramagnetic metal--organic Schiff base complex, were deposited on NaCl(001) and subsequently imaged with noncontact atomic force microscopy employing Cr coated tips in a cryogenic ultrahigh vacuum environment. Images were obtained in which both the position and orientation of the adsorbed molecules and the atomic structure of the surface are resolved simultaneously, enabling the determination of the exact adsorption site. Density functional theory calculations were used to identify the ionic sublattice resolved with the Cr tip and also to confirm the adsorption site and orientation of the molecule on the surface. These calculations show that the central Co atom of the molecule physisorbs on top of a Cl ion and is aligned along 110-directions in its lowest energy configuration. In addition, a local energy minimum exists along 100-directions. Due to the chirality of the molecule, two mirror symmetric configurations rotated by approximately +/-5 degrees away from these directions are energetically equivalent. The resulting 16 low energy configurations are observed in the experimental images.

Developing evidence-based process maps for spinal cord injury rehabilitation

STUDY DESIGN

Longitudinal audit.

OBJECTIVES

To develop evidence-based maps of rehabilitation for different lesion categories.

SETTING

Midlands, UK.

METHODS

Over a 5-year period data for all newly injured neurologically damaged patients aged 18 years or more were collected and analyzed (n=280). Data were collected from a functional independence measure (the Needs Assessment Checklist), patient records (paper and electronic) and patient goal planning records. The patients were grouped into different lesion categories. Standard milestones that patients in a given category would be expected to reach in rehabilitation were identified using goals set at goal planning meetings. Time when patients reached these milestones and variation between patients around time in reaching these milestones were calculated.

RESULTS

Median times from onset to admission, onset to rehabilitation and length of rehabilitation are given. Pictorial representations of rehabilitation (rehabilitation maps) were produced, using goals identified, median times of achievement and variation. This paper provides examples of these maps from one particular group, T8-T12 Frankel A.

CONCLUSION

Pathways of care can be used in a number of ways: to identify the need for service change; to audit service change; to provide evidence-based expectations for staff, patients and external parties; to look at variances affecting care; to make this service transparent; to provide figures for comparison with other philosophies of care; and to ensure consistency across the service.

Quantification of breast tissue index from MR data using fuzzy clustering

The study objective was to develop a segmentation technique to quantify breast tissue and total breast volume from magnetic resonance imaging (MRI) data to obtain a breast tissue index (BTI) related to breast density. Our goal is to quantify MR breast density to improve breast cancer risk assessment for certain high-risk populations for whom mammography is of limited usefulness due to high breast density. A semi-automatic 3D segmentation technique was implemented based on a fuzzy c-means technique (FCM) to segment fibroglandular tissue from fat in the breast images. After validation on a phantom, our FCM technique was first used to test the breast tissue measures reproducibility in two consecutive MR examinations of the same patients. The technique was then applied to measure the BTI on 10 high-risk patients. Results of BTI obtained with the semi-automated FCM method were compared with BTI results for the same patients using two other techniques, manual delineation and global threshold. BTI measures correlated well with mammographic densities (Pearson coefficients r = 0.78 using MR manual delineation, and r = 0.75 using MR FCM). The breast tissue index could therefore become a common measure for future studies of using noncontrast MRI data.

Controlled manipulation of atoms in insulating surfaces with the virtual atomic force microscope

We predict how single oxygen ions can be manipulated on the MgO (100) surface and demonstrate the possibility of detecting a single-atom event using a noncontact atomic force microscope. The manipulation process is simulated explicitly in real time with a virtual dynamic atomic force microscope including the full response of the instrumentation and demonstrates a strong dependence on temperature. The proposed new atomistic mechanism and protocols for the controlled manipulation of single atoms and vacancies on insulating surfaces may be relevant for anchoring molecules and metal clusters at these surfaces and controlling their electronic properties.

Reducing transfer times for coronary angiography in patients with acute coronary syndromes: one solution to a national problem

BACKGROUND

Patients with acute coronary syndrome (ACS) are at high risk of further cardiac events and benefit from early intervention, as reflected by international guidelines recommending early transfer to interventional centres. The current average waiting time of up to 21 days contravenes evidence based early intervention, creates geographical inequity of access, wastes bed days, and is unsatisfactory for patients.

METHODS

A regional transfer unit (RTU) was created to expatriate access of ACS patients referred from other centres to the revascularisation service. By redesigning the care pathway patients arriving on the RTU undergo angiography within 24 hours, and then leave the RTU the following day, allowing other ACS patients to be treated.

RESULTS

During the first six months of the RTU, the mean waiting time from referral to procedure decreased from 20 (SD 15) days (range 0-51) to 8 (SD 3) days (range 0-21) for 365 patients transferred from a district general hospital. Ninety seven per cent of patients underwent angiography within 24 hours, 61% having undergone percutaneous coronary intervention at the same sitting, and 78% were discharged home within 24 hours.

CONCLUSIONS

Delivering standards laid out in the National Service Framework, reducing inequalities of care across the region, and facilitating evidence based strategies of care represents a challenging and complex issue. For high risk patients suffering ACS who need early invasive investigation, a coordinated network wide approach together with the creation of an RTU resulted in a 62% reduction in waiting times for no extra resources. Further improvements can be expected through increased capacity of this verified strategy.

Analysis of mouse conceptuses with uniparental duplication/deficiency for distal chromosome 12: comparison with chromosome 12 uniparental disomy and implications for genomic imprinting

Distal mouse chromosome 12 is imprinted. Phenotypic analysis of mouse embryos with maternal or paternal uniparental disomy for the whole of chromosome 12 has characterized the developmental defects associated with the altered dosage of imprinted genes on this chromosome. Here we conduct a characterization of maternal and paternal Dp(dist12) mice using the reciprocal translocation T(4;12)47H. This limits the region analysed to the chromosomal domain distal to the T47H breakpoint in B3 on mouse chromosome 12. Both MatDp(dist12)T47H and PatDp(dist12)T47H conceptuses are non-viable and the frequency of recovery of Dp(dist12) conceptuses by 10.5 days post coitum (dpc) was lower than expected after normal adjacent-1 disjunction. A subset of MatDp(dist12) embryos can survive up to one day post partum. In contrast to paternal uniparental disomy 12 embryos, no live PatDp (dist12) embryos were recovered after 16.5 days of gestation. Other phenotypes observed in maternal and paternal chromosome 12 uniparental disomy mice are recapitulated in the Dp(dist12) mice and include placental, muscle and skeletal defects. Additional defects were also noted in the skin of both MatDp(dist12) and maternal uniparental disomy 12 embryos. This study shows that the developmental abnormalities associated with the altered parent of origin for mouse chromosome 12 can be attributed to the genomic region distal to the T47H breakpoint.

Impact of platelet glycoprotein IIb/IIIa Inhibition on the paclitaxel-eluting stent in patients with stable or unstable angina pectoris or provocable myocardial ischemia (a TAXUS IV substudy)

Whether the benefits that glycoprotein IIb/IIIa inhibitors confer in patients who undergo bare metal stent implantation extend to drug-eluting stents is unknown. We performed a prespecified subgroup analysis of the TAXUS IV study population to examine the effect of procedural glycoprotein IIb/IIIa inhibition during paclitaxel-eluting stent implantation on periprocedural creatine kinase-MB (CK-MB) levels. Glycoprotein (GP) IIb/IIIa inhibitors were administered to 57.7% of patients who had been randomized to receive the TAXUS stent and to 56.7% of those who had been randomized to receive the control stent. Among patients who received the TAXUS stent, the rate of CK-MB increases of >3 times the normal level was 2.6-fold higher in those who received a GP IIb/IIIa inhibitor than in those who did not (11.4% vs 4.4%, p = 0.0015). Composite rates of major adverse cardiac events and target vessel failure were also higher at 1 month in the GP IIb/IIIa group. By multivariate analysis, use of GP IIb/IIIa inhibitors during stenting with the TAXUS stent was an independent predictor of CK-MB increases >3 times the normal level. Further studies are warranted.