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A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice.
A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar’s test for paired data and Fisher’s exact test.
The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population “almost always” versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years.
Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial’s findings.
With good combustion characteristics, hydrogen has been developing as a clean alternative fuel of engines. This study is to develop a diesel/hydrogen dual fuel engine. The hydrogen was added at inlet port in a 4-cylinder direct injection turbocharged diesel engine with an EGR (Exhaust Gas Recirculation) system to investigate engine performance and exhaust pollutant. The measured items are composed of the gas pressure of cylinder, crank angle, consumption rate of diesel, consumption rate of hydrogen, air flow rate, emissions (HC, CO2, NOX, and Smoke), and so on. The authors analyze how the addition of hydrogen with EGR system influences the engine performance and emissions. The diesel/hydrogen dual fuel turbocharged engine can increase the brake thermal efficiency with a greater decrease in emissions compared with the turbocharged diesel engine. Furthermore, the authors little altered the engine structure to get the positive effect of energy saving and pollutant decreasing.
In this study, the fictitious time integration method (FTIM) is applied to investigate wave propagation over an arbitrary bathymetry with measured uncertainty. The FTIM is used to convert the higher-order elliptic mild-slope equation (EMSE) into a FTIM like EMSE (FTIMEMSE). It has the advantage to describe wave transformation from deep water to shallow water region in a large coastal area with numerical efficiency. The validity of the noise resistance for the measured uncertainty of the bathymetry is also studied. In addition, typical examples for waves propagating over an elliptic shoal rest on a horizontal and sloping bottom is presented. It is concluded that the FTIM is robust in the numerical stability and capable of against the noise of the measurement.
The Boltzmann equation (BE) for gas flows is a time-dependent nonlinear differential-integral equation in 6 dimensions. The current simplified practice is to linearize the collision integral in BE by the BGK model using Maxwellian equilibrium distribution and to approximate the moment integrals by the discrete ordinate method (DOM) using a finite set of velocity quadrature points. Such simplification reduces the dimensions from 6 to 3, and leads to a set of linearized discrete BEs. The main difficulty of the currently used (conventional) numerical procedures occurs when the mean velocity and the variation of temperature are large that requires an extremely large number of quadrature points. In this paper, a novel dynamic scheme that requires only a small number of quadrature points is proposed. This is achieved by a velocity-coordinate transformation consisting of Galilean translation and thermal normalization so that the transformed velocity space is independent of mean velocity and temperature. This enables the efficient implementation of Gaussian-Hermite quadrature. The velocity quadrature points in the new velocity space are fixed while the correspondent quadrature points in the physical space change from time to time and from position to position. By this dynamic nature in the physical space, this new quadrature scheme is termed as the dynamic quadrature scheme (DQS). The DQS was implemented to the DOM and the lattice Boltzmann method (LBM). These new methods with DQS are therefore termed as the dynamic discrete ordinate method (DDOM) and the dynamic lattice Boltzmann method (DLBM), respectively. The new DDOM and DLBM have been tested and validated with several testing problems. Of the same accuracy in numerical results, the proposed schemes are much faster than the conventional schemes. Furthermore, the new DLBM have effectively removed the incompressible and isothermal restrictions encountered by the conventional LBM.
Surveillance is integral for the monitoring and control of infectious diseases. We conducted prospective laboratory surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in five Singaporean public-sector hospitals from 2006 to 2010, using WHONET 5.6 for data compilation and analysis. Molecular profiling using multilocus variable-number tandem-repeat analysis, staphylococcal cassette chromosome mec classification and multilocus sequence typing was performed for a random selection of isolates. Our results showed overall stable rates of infection and bacteraemia, although there was significant variance among the individual hospitals, with MRSA rates increasing in two smaller hospitals and showing a trend towards decreasing in the two largest hospitals. The proportion of blood isolates that are EMRSA-15 (ST22-IV) continued to increase over time, slowly replacing the multi-resistant ST239-III. A new MRSA clone – ST45-IV – is now responsible for a small subset of hospital infections locally. More effort is required in Singaporean hospitals in order to reduce the rates of MRSA infection significantly.
In this paper, analytical particular solutions of the augmented polyharmonic spline (APS) associated with Reissner plate model are explicitly derived in order to apply the dual reciprocity method. In the derivations of the particular solutions, a coupled system of three second-ordered partial differential equations (PDEs), which governs problems of Reissner plates, is initially transformed into a single six-ordered PDE by the Hörmander operator decomposition technique. Then the particular solutions of the coupled system can be found by using the particular solution of the six-ordered PDE derived in the first author's previous study. These formulas are further implemented for solving problems of Reissner plates under arbitrary loadings. In the solution procedure, an arbitrary loading measured at some scattered points is first interpolated by the APS and a corresponding particular solution can then be approximated by using the prescribed formulas. After that the complementary homogeneous problem is formally solved by the method of fundamental solutions (MFS). Numerical experiments are carried out to validate these particular solutions.
Stair locomotion is an important but challenging functional activity for people with lower limb pathology. This study aimed to investigate the bilateral changes in force-bearing on lower limbs during stair locomotion in patients with unilateral ACL deficiency. The ground reaction forces (GRF) were collected from three force platforms: One at ground level in front of a 5-step stair and two on the first two steps respectively. Parameters in vertical and anterior-posterior GRF were extracted and compared between the ACL-deficient (ACLD) and control groups. The ACLD group showed significantly slower stepping cadences in both stair ascent and stepping down to the ground (p < 0.05). The vertical GRF in the ACLD group demonstrated smaller peak forces but larger minimum forces between the two peaks than those in the control group during both stair ascent and descent. Significantly reduced anterior propulsive forces and push-off rates in the late stance were also found in both limbs of the ACLD group (p < 0.05). The slower cadences and reduced force-bearing on the affected limb suggested a protective strategy was adopted. However, the anterior loading parameters in the early stance on the unaffected limb demonstrated different adaptations with significantly larger magnitudes during stair ascent but reduced magnitudes during stair descent (p < 0.05). Similar results were also found in the weight- transferring strategies between legs in consecutive steps with a significantly larger percentage of lift-up forces but a smaller percentage of impact forces on the leading unaffected limb. The results of this study indicated a cautious force-bearing strategy and bilateral adaptation were apparent in the patients with unilateral ACL deficiency. This information may provide a safety guideline for the patients and be helpful for a better use of the stair tasks as part of a rehabilitation program.
A multi-cross-correlation method (MCCM) was developed in a particle image velocimetry (PIV) auto-processing system to reduce spurious vectors and improve accuracy of measurements. This technique is an improvement based on conventional cross-correlation method (CCM). Four typical neighboring interrogation windows were specified to be overlapped and calculated by MCCM. A high cross-correlation value is obtained in which many particle images match up with their corresponding spatially shifted partners, and small cross-correlation peaks due to interference of noises during experiments are reduced. Several parameters such as out-of-plane motions, particle size, and seeding density are considered for checking both MCCM and conventional PIV algorithms. The examination gives authenticity to the merits of MCCM for avoiding particles loss or mistaken velocity vectors.
Welded structures are vulnerable to fracture due to cracks, especially at the welds. To investigate the safety of T-Shape welded structures used in some construction sites, a method is proposed in this paper to evaluate the crack occurrence probabilities of the structures. Three major factors that affect the crack occurrence are taken into consideration. They are residual stress, diffusible hydrogen content and chemical composition of the weld metal. In the analysis, finite element analysis is performed to find the residual stress distribution of the structures. The uncertainties of diffusible hydrogen content and chemical composition are treated as random variables. The critical cooling time is found and utilized for evaluating the crack occurrence probability of the welded structure. Numerical results indicate that T-shape welded joints lead to higher residual stresses and higher crack occurrence probabilities in comparison with the traditional butt joints. Therefore, more attention should be paid to this kind of welded joints when they are used.
The previous monolithic active grating bender design met some basic design requirements. However, after a real grating (BM-AGM) had been fabricated and installed for testing, the results showed that the usable length is a mere 60 mm because of the higher-order term error in the surface profile. A method was thus derived to eliminate the higher-order term error by modifying the width of the bender substrate through finite-element method simulation, reducing the residual error from about 100 nm to 6 nm. Owing to the closure of the grating department of Zeiss, ruling the monolithic bender is no longer available and the design has to be modified to a composite-type bender with Si substrate. A prototype was fabricated and assembled to examine all the design situations. The surface roughness of the width-modified Si substrate is around 30 nm before assembly. The residual error after assembly and bending is less than 10 nm. It proves that the design is feasible. However, due to the manufacturing capacity of the vendor, a short-length substrate is required and the design has to be modified. The detailed design modification and testing results are presented in this paper.
There is a growing interest in the application of large area electronics on curved surfaces. One approach towards realizing this goal is to fabricate circuits on planar substrates of thin plastic or metal foil, which are subsequently deformed into arbitrary shapes. The problem that we consider here is the deformation of substrates into a spherical shape, where the strain is determined by geometry and cannot be reduced by simply using a thinner substrate. The goal is to achieve permanent, plastic deformation in the substrates, without exceeding fracture or buckling limits in the device materials.
Our experiments consist of the planar fabrication of amorphous silicon device structures onto stainless steel or Kapton® polyimide substrates, followed by permanent deformation into a spherical shape. We will present empirical experiments showing the dependence of the results on the island/line size of the device materials and the deformation temperature. We have successfully deformed Kapton® polyimide substrates with 100 [.proportional]m wide amorphous silicon islands into a one steradian spherical cap, which subtends 66 degrees, without degradation of the silicon. This work demonstrates the feasibility of building semiconductor devices on plastically deformed substrates despite a 5% average biaxial strain in the substrate after deformation.
The characteristics of YBa2Cu3O7−x (YBCO) thin films by laser ablation on MgO bicrystals have been investigated. The bicrystals were fabricated by hot pressing two single crystals with the configuration of  tilt boundaries. The YBCO films were epitaxial grown with C-axis normal to the both adjacent grains of bicrystals. The FWHM about (005) reflection was 0.4–0.5 degree, indicating the high degree of the oriention for the film with small mosaic spread. Our preliminary study showed that the typical value of Jc on either side of the bicrystal boundary was 0.4–10×106 A/cm2 at 15K, while that across the 10° tilt boundaries was 0.3–9×105 A/cm2 at 15K. These results implied that the artificial grain boundaries effectively weakened the supercurrent, and therefore, the weak-link properties of artificial boundaries were more easily controllable than those of naturally occuring grain boundaries.
Remote Plasma-enhanced Chemical Vapor Deposition (RPCVD) has been used to grow GexSi1−x/Si heteroepitaxial thin films at low temperatures (∼450°C). In situ RHEED has been used to confirm that smooth, single crystal heteroepitaxial films can be grown by RPCVD. Plan-view and cross-sectional TEM have been employed to study the microstructure of the heteroepitaxial films. Lattice imaging high resolution TEM (HRTEM) has shown perfect epitaxial lattice alignment at the heterojunction interfaces. GexSi1−x/Si films which exceed their CLT's appreciably show dense Moiré fringes under plan-view TEM. The spacings between the fringes have been used to estimate the relaxed lattice constants. In addition to the inhomogeneous strain observed in XTEM, Selected Area electron Diffraction (SAD) analysis of the interfaces displays two split patterns. The spacings between the diffraction spots have been used to calculate the lattice constants in the epitaxial films in different crystal directions, which agree very well with the prediction by Vegard's law as well as the estimate from planview TEM analysis. HRTEM analysis also reveals the crystallographic nature of the interfacial misfit dislocations in the relaxed films.