A bidirectional fabric-based soft robotic glove for hand function assistance in patients with chronic stroke.

BACKGROUND: Chronic stroke patients usually experience reduced hand functions, impeding their ability to perform activities of daily living (ADLs) independently. Additionally, improvements in hand functions by physical therapy beyond six months after the initial onset of stroke are much slower than in the earlier months. As such, chronic stroke patients could benefit from an assistive device to enhance their hand functions, allowing them to perform ADLs independently daily. In recent years, soft robotics has provided a novel approach to assistive devices for motor impaired individuals, offering more compliant and lightweight alternatives to traditional robotic devices. The scope of this study is to demonstrate the viability of a fabric-based soft robotic (SR) glove with bidirectional actuators in assisting chronic stroke study participants with hand impairments in performing ADLs. METHODS: Force and torque measurement tests were conducted to characterize the SR Glove, and hand functional tasks were given to eight chronic stroke patients to assess the efficacy of the SR Glove as an assistive device. The tasks involved object manipulation tasks that simulate ADLs, and the series of tasks was done by the participants once without assistance for baseline data, and once while using the SR Glove. A usability questionnaire was also given to each participant after the tasks were done to gain insight into how the SR Glove impacts their confidence and reliance on support while performing ADLs. RESULTS: The SR Glove improved the participants' manipulation of objects in ADL tasks. The difference in mean scores between the unassisted and assisted conditions was significant across all participants. Additionally, the usability questionnaire showed the participants felt more confident and less reliant on support while using the SR Glove to perform ADLs than without the SR Glove. CONCLUSIONS: The results from this study demonstrated that the SR Glove is a viable option to assist hand function in chronic stroke patients who suffer from hand motor impairments.

Development of a novel hybrid securing actuator for a self-securing soft robotic hand exoskeleton.

The development of soft robotic hand exoskeletons for rehabilitation has been well-reported in the literature, whereby the emphasis was placed on the development of soft actuators for flexion and extension. Little attention was focused on developing the glove interface and attachments of actuators to the hand. As these hand exoskeletons are largely developed for personnel with impaired hand function for rehabilitation, it may be tedious to aid the patients in donning and doffing the glove, given that patients usually have stiff fingers exhibiting high muscle tone. To address this issue, a hybrid securing actuator was developed and powered pneumatically to allow for rapid securing and release of a body segment. As a proof of concept, the actuator was further adapted into a self-securing glove mechanism and assembled into a complete self-securing soft robotic hand exoskeleton with the attachment of bidirectional actuators. Our validation tests show that the self-wearing soft robotic hand exoskeleton can easily conform and secure onto the human hand and assist with manipulation tasks.

A Wearable Soft Robotic Exoskeleton for Hip Flexion Rehabilitation.

Leg motion is essential to everyday tasks, yet many face a daily struggle due to leg motion impairment. Traditional robotic solutions for lower limb rehabilitation have arisen, but they may bare some limitations due to their cost. Soft robotics utilizes soft, pliable materials which may afford a less costly robotic solution. This work presents a soft-pneumatic-actuator-driven exoskeleton for hip flexion rehabilitation. An array of soft pneumatic rotary actuators is used for torque generation. An analytical model of the actuators is validated and used to determine actuator parameters for the target application of hip flexion. The performance of the assembly is assessed, and it is found capable of the target torque for hip flexion, 19.8 Nm at 30°, requiring 86 kPa to reach that torque output. The assembly exhibits a maximum torque of 31 Nm under the conditions tested. The full exoskeleton assembly is then assessed with healthy human subjects as they perform a set of lower limb motions. For one motion, the Leg Raise, a muscle signal reduction of 43.5% is observed during device assistance, as compared to not wearing the device. This reduction in muscle effort indicates that the device is effective in providing hip flexion assistance and suggests that pneumatic-rotary-actuator-driven exoskeletons are a viable solution to realize more accessible options for those who suffer from lower limb immobility.

Prevention of influenza during mismatched seasons in older adults with an MF59-adjuvanted quadrivalent influenza vaccine: a randomised, controlled, multicentre, phase 3 efficacy study.

BACKGROUND: The absolute degree of protection from influenza vaccines in older adults has not been studied since 2001. This study aimed to show the clinical efficacy of an MF59-adjuvanted quadrivalent influenza vaccine (aQIV) in adults 65 years or older compared with adults not vaccinated to prevent influenza. METHODS: We did a randomised, stratified, observer-blind, controlled, multicentre, phase 3 study at 89 sites in 12 countries in 2016-17 northern hemisphere and 2017 southern hemisphere influenza seasons. We enrolled community-dwelling male and female adults aged 65 years and older who were healthy or had comorbidities that increased their risk of influenza complications. We stratified eligible participants by age (cohorts 65-74 years and ≥75 years) and risk of influenza complications (high and low) and randomly assigned them (1:1) via an interactive response technology to receive either aQIV or a non-influenza comparator vaccine. We masked participants and outcome assessors to the administered vaccine. Personnel administering the vaccines did not participate in endpoint assessment. The primary outcome was absolute vaccine efficacy assessed by RT-PCR-confirmed influenza due to any influenza strain in the overall study population (full analysis set) from day 21 to 180 or the end of the influenza season. Vaccine efficacy was calculated on the basis of a Cox proportional hazard regression model for time to first occurrence of RT-PCR-confirmed influenza due to any strain of influenza. Safety outcomes were assessed in the overall study population. This trial was registered with ClinicalTrials.gov, NCT02587221. FINDINGS: Northern hemisphere enrolment occurred between Sept 30, 2016, and Feb 28, 2017, and southern hemisphere enrolment between May 26, 2017, and 30 June 30, 2017. aQIV was administered to 3381 participants, who subsequently had 122 (3·6%) RT-PCR-confirmed influenza cases, and the comparator was administered to 3380 participants, who subsequently had 151 (4·5%) influenza cases. The majority, 214 (78·4%) of 273, were caused by influenza A H3N2. Most antigenically characterised isolates were mismatched to the vaccine strain (118 [85%] of 139). Vaccine efficacy was 19·8% (multiplicity-adjusted 95% CI -5·3 to 38·9) against all influenza and 49·9% (-24·0 to 79·8) against antigenically matched strains, when the protocol definition of influenza-like illness was used. The most common local solicited adverse event was injection site pain, reported by 102 (16·3%) of 624 participants in the aQIV group and 71 (11·2%) of 632 of participants in the comparator group. Deaths were evenly distributed; none were considered related to study vaccines. The safety profile for aQIV was similar to previously reported trials. INTERPRETATION: The prespecified criterion for showing the efficacy of aQIV in older adults was not met during the influenza seasons with high amounts of vaccine strain mismatch. Vaccine efficacy was higher against influenza cases associated with higher fever, which represent more clinically significant disease. FUNDING: Seqirus UK.

Pre-existing chronic medical illnesses and follow up status among active pulmonary tuberculosis cases in a district population

@#Introduction: The knowledge of pre-existing medical illnesses and their follow up status among active pulmonary tuberculosis (PTB) subjects can help in tuberculosis (TB) control programme. The aims of our study were to examine: the prevalence of pre-existing chronic medical illnesses, the follow up status of known pre-existing co-morbid and to distinguish between diagnosed and undiagnosed preexisting tuberculosis related chronic medical illnesses among our active PTB subjects. Methods: We conducted a retrospective review of demographic and clinical data of active PTB subjects that were diagnosed between January 2015 and June 2017 in the district of Manjung, Perak, Malaysia. Among the 302 TB clinical notes reviewed, 253 patients were included. Subjects below the age of 18 years and whose follow up centres for their medical illnesses that were located outside of Manjung were excluded. Demographic and clinical data were collected using pre-tested data collection form by trained investigators. The data was analysed using SPSS Version 20.0. Results: We identified diabetes mellitus as the most prevalent pre-existing co-morbid (77 cases) and almost 90% (68 cases) of these diabetic subjects were diagnosed prior to active PTB diagnosis. This was followed by Human Immunodeficiency Virus and Hepatitis C infection which accounted for 12.0% (30 cases) of the study populations. Among 132 subjects who had pre-existing chronic medical illnesses, only 74 subjects (29%) were under regular follow up at healthcare facilities in Manjung prior to PTB diagnosis. Conclusion: Overall, our research provides evidence on the existence of wide variation of clinical background among active PTB subjects.

Generalizing Duchenne to sad expressions with binocular rivalry and perception ratings.

Discrete emotion theories emphasize the modularity of facial expressions, while functionalist theories suggest that a single facial action may have a common meaning across expressions. Smiles involving the Duchenne marker, eye constriction causing crow's feet, are perceived as intensely positive and sincere. To test whether the Duchenne marker is a general index of intensity and sincerity, we contrasted positive and negative expressions with and without the Duchenne marker in a binocular rivalry paradigm. Both smiles and sad expressions involving the Duchenne marker were perceived longer than non-Duchenne expressions, and participants rated all Duchenne expressions as more affectively intense and more sincere than their non-Duchenne counterparts. Correlations between perceptual dominance and ratings suggested that the Duchenne marker increased the dominance of smiles and sad expressions by increasing their perceived affective intensity. The results provide evidence in favor of Darwin's hypothesis that specific facial actions have a general function (conveying affect intensification and sincerity) across expressions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

How to reduce the latent social risk of disease: the determinants of vaccination against rabies in Taiwan.

To control the latent social risk of disease, the government usually spreads accurate information and attempts to improve the public's attitude toward adopting prevention. However, these methods with the Knowledge, Attitudes, and Practices (KAP) model do not always work. Therefore, we used the theory of planned behavior (TPB) to understand dog owners' behavior and distinguished the knowledge effect as objective knowledge (OK) and subjective knowledge (SK). A total of 310 dog owners completed a questionnaire based on our model. We employed structural equation modeling to verify the structural relationships and found three main results. First, our model was fit, and each path was significant. People with better attitudes, stronger subjective norms, and more perceptive behavioral control have stronger behavioral intention. Second, perceived behavioral control, not attitude, was the best predictive index in this model. Finally, on perceived behavioral control, subjective knowledge showed more influence than objective knowledge. We successfully extended TPB to explain the behavioral intention of dog owners and presented more workable recommendations. To reduce the latent social risk of disease, the government should not only address dog owners' attitudes, but also their subjective norms and perceptive behavioral control. Indeed, perceptive behavioral control and SK showed the most influence in this model. It is implied that the self-efficacy of dog owners is the most important factor in such a behavior. Therefore, the government should focus on enhancing dog owners' self-efficacy first while devoted to prevention activities.

Finite element modelling of implant designs and cortical bone thickness on stress distribution in maxillary type IV bone.

The aims of this study were to examine the effect of implant neck design and cortical bone thickness using 3D finite element analysis and to analyse the stability of clinical evidence based on micromotion and principal stress. Four commercial dental implants for a type IV bone and maxillary segments were created. Various parameters were considered, including the osseointegration condition, loading direction and cortical bone thickness. Micromotion and principal stresses were used to evaluate the failure of osseointegration and bone overloading, respectively. It was found that the maximum stress of the peri-implant bone decreased as cortical bone thickness increased. The micromotion level in full osseointegration is less than that in non-osseointegration and it also decreases as cortical bone thickness increases. The cortical bone thickness should be measured before surgery to help select a proper implant. In the early stage of implantation, the horizontal loading component induces stress concentration in bone around the implant neck more easily than does the vertical loading component, and this may result in crestal bone loss.

Retrospective chart review of a referenced EEG database in assisting medication selection for treatment of depression in patients with eating disorders.

BACKGROUND: A retrospective chart review was undertaken in a private clinic to examine the clinical outcomes for patients with an eating disorder comorbid with depression or bipolar illness who underwent a referenced electroencephalographic (EEG) database analysis to help guide medication selection. METHOD: We examined 33 charts for patients with the primary psychiatric diagnosis of an eating disorder and comorbid major depressive disorder or bipolar disorder who underwent a quantitative EEG database assessment to provide additional information for choices of medication. The current analysis includes data from 22 subjects who accepted treatments based on information from the referenced-EEG medication database. Hamilton Depression Rating Scale, Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and hospitalization data were examined for these patients. RESULTS: Patients whose EEG data was used for clinical treatment reported significant decreases in associated depressive symptoms (HDRS scores), overall severity of illness (Clinical Global Impression-Severity), and overall clinical global improvement (Clinical Global Impression- Improvement). This cohort also reported fewer inpatient, residential, and partial hospitalization program days following referenced-EEG compared with the two-year period prior to treatment. CONCLUSION: These findings are consistent with previously reported data for patients with eating disorders and suggest the need for future studies using EEG data correlated with those from other patients with similar quantitative EEG features.

2009 Pandemic influenza H1N1: paediatric perspectives

Children, especially those younger than 5 years of age and those with chronic medical conditions, such as respiratory diseases, neurological diseases, immunosuppression, receiving longterm aspirin therapy, obesity or co-infection with bacteria, are at an increased risk of pandemic H1N1 infection-related complications. This paper reviews the underlying medical conditions associated with death or complications of pandemic H1N1 infection in children.

Loss of chloroplast protease SPPA function alters high light acclimation processes in Arabidopsis thaliana L. (Heynh.).

SPPA1 is a protease in the plastids of plants, located in non-appressed thylakoid regions. In this study, T-DNA insertion mutants of the single-copy SPPA1 gene in Arabidopsis thaliana (At1g73990) were examined. Mutation of SPPA1 had no effect on the growth and development of plants under moderate, non-stressful conditions. It also did not affect the quantum efficiency of photosynthesis as measured by dark-adapted F(v)/F(m) and light-adapted Phi(PSII). Chloroplasts from sppA mutants were indistinguishable from the wild type. Loss of SPPA appears to affect photoprotective mechanisms during high light acclimation: mutant plants maintained a higher level of non-photochemical quenching of Photosystem II chlorophyll (NPQ) than the wild type, while wild-type plants accumulated more anthocyanin than the mutants. The quantum efficiency of Photosystem II was the same in all genotypes grown under low light, but was higher in wild type than mutants during high light acclimation. Further, the mutants retained the stress-related Early Light Inducible Protein (ELIP) longer than wild-type leaves during the early recovery period after acute high light plus cold treatment. These results suggest that SPPA1 may function during high light acclimation in the plastid, but is non-essential for growth and development under non-stress conditions.