Arm-support exoskeleton reduces shoulder muscle activity in ceiling construction.

The objective of this study was to assess the efficacy and user's impression of an arm-support exoskeleton in complex and realistic ceiling construction tasks. 11 construction workers performed 9 tasks. We determined objective and subjective efficacy of the exoskeleton by measuring shoulder muscle activity and perceived exertion. User's impression was assessed by questionnaires on expected support, perceived support, perceived hindrance and future intention to use the exoskeleton. Wearing the exoskeleton yielded persistent reductions in shoulder muscle activity of up to 58% and decreased perceived exertion. Participants reported limited perceived hindrance by the exoskeleton, as also indicated by no increase in antagonistic muscle activity. The findings demonstrate the high potential of an arm-support exoskeleton for unloading the shoulder muscles when used in the dynamic and versatile working environment of a ceiling construction worker, which is in line with the consistent intention of the workers to use the exoskeleton in the future.Practitioner Summary: The majority of research focuses on the effect of using an arm-support exoskeleton during isolated postures and prescribed movements. We investigated the efficacy of an exoskeleton during a complex and realistic work, namely ceiling construction. Shoulder muscle activity was lower in almost all tasks when wearing the exoskeleton.

What about the human in human robot collaboration?

In this review we address the human in human robot collaboration (HRC). Although there are different hypotheses on potential effects of HRC on job quality, defined as the quality of the working environment and its effect on the employee's well-being, a comprehensive theory is still lacking. How does HRC influence job quality on an individual level and how can we adapt HRC to boost positivity at work? We identified four job quality related factors that are of relevance in HRC: (1) Cognitive Workload, (2) Collaboration Fluency, (3) Trust, and (4) Acceptance and Satisfaction. Increasing awareness and being able to adapt the robot to the individual operator are crucial to improve the aforementioned factors. Implementing predictable robots, that offer a clear advantage to the human and take into account operators' preferences, will bring us closer to a human-centered collaboration. Practitioner Summary: The effect of human robot collaboration (HRC) on job quality is still under debate. Design characteristics of HRC, such as collaboration design, robot design, and workplace design affect job quality related factors. Using a participatory design approach, as to align robot capabilities to end-users' preferences, will enhance HRC and improve job quality. Abbreviations: HRC: human robot collaboration; OECD: organisation for economic co-operation and development.

Potentials and current shortcomings in the cooperation between German centers for rare diseases and primary care physicians: results from the project TRANSLATE-NAMSE.

BACKGROUND: The TRANSLATE-NAMSE project with the strengthening of the centers for rare diseases with their affiliation to the European Reference Networks was a major step towards the implementation of the German National Plan of Action for People with Rare Diseases establishing better care structures. As primary care physicians, general practitioners and pediatricians play a central role in the diagnosis of patients with rare disease, as it is usually them referring to specialists and rare disease centers. Therefore, the interface management between primary care physicians and the centers for rare diseases is of particular importance. METHODS: In a mixed-method-approach an anonymous postal survey of 1,500 randomly selected primary care physicians in Germany was conducted with focus on (1) knowledge about a center for rare diseases and how it works, (2) in case of cooperation, satisfaction with the services provided by centers, and (3) expectations and needs they have with regard to the centers. In addition, in-depth telephone interviews were conducted with physicians who had already referred patients to a center. RESULTS: In total, 248 physicians responded to the survey, and 15 primary care physicians were interviewed. We observed a wide lack of knowledge about the existence of (45.6% confirmed to know at least one center) about how to access rare disease centers (50.4% of those who know a center confirmed knowledge) and what the center specializes in. In case of cooperation the evaluation was mostly positive. CONCLUSION: To improve medical care, the interplay between primary care physicians and rare disease centers needs to be strengthened. (1) To improve the communication, the objectives and functioning of the rare disease centers should become more visible. (2) Other projects dealing with the analysis and improvement of interface management between centers and primary care physicians, as described in the National Plan of Action for People with Rare Diseases, need to be implemented immediately. (3) If the project is evaluated positively, the structures of TRANSLATE-NAMSE should be introduced nationwide into the German health care system to ensure comprehensive, quality-assured care for people with rare diseases with special consideration of the key role of primary care physicians-also taking into account the financial expenditures of this new care model.

Simple and compact diode laser system stabilized to Doppler-broadened iodine lines at 633 nm.

We present a compact iodine-stabilized laser system at 633 nm, based on a distributed-feedback laser diode. Within a footprint of 27×15cm2, the system provides 5 mW of frequency-stabilized light from a single-mode fiber. Its performance was evaluated in comparison to Cs clocks representing primary frequency standards, realizing the SI unit Hz via an optical frequency comb. With the best suited absorption line, the laser reaches a fractional frequency instability below 10-10 for averaging times above 10 s. The performance was investigated at several iodine lines, and a model was developed to describe the observed stability on the different lines.

Is Optical Coherence Tomography a Potential Tool to Evaluate Marginal Adaptation of Class III/IV Composite Restorations In Vivo?

OBJECTIVE: Margin analysis of Class III and IV composite restorations in vitro and in vivo occurred by scanning electron microscopy (SEM) and optical coherence tomography (OCT). The results were compared and related to clinical evaluation. METHODS AND MATERIALS: Eight Class III composite restorations were imaged in vitro using OCT and SEM. The margins were analyzed quantitatively. OCT signals were verified by assignment to the criteria perfect margin, gap, and positive/negative ledge. In vivo quantitative margin analysis of Class III/IV composite restorations made of the micro-hybrid composite Venus combined with the self-etch adhesive iBond Gluma inside (1-SE) or etch-and-rinse adhesive Gluma Comfort Bond (2-ER) (all Heraeus Kulzer) was carried out using OCT and SEM after 90 months of clinical function. The results were compared with clinical evaluation (US Public Health Service criteria; marginal integrity, marginal discoloration). RESULTS: In vitro, the correlation between OCT and SEM was high for all four margin criteria (Kendall tau b [τb] correlation: 0.64-0.92, pi≤0.026), with no significant differences between OCT and SEM (pi≥0.63). In vivo, a moderate correlation was observed (τb: 0.38-0.45, pi<0.016). Clinically, the cumulative failure rate in the criterion marginal integrity was higher for the 1-SE group (baseline 90 M, p=0.011). Similarly, OCT and SEM detected higher percentages of the criterion gap in the 1-SE group (p: 0.027/0.002), in contrast to perfect margin. Both, gap and perfect margin ranged widely between 0.0% and 88.7% (OCT) and between 0.0% and 89.0% (SEM). CONCLUSION: Despite the positive selection bias after 90 months with only a few patients left, quantitative margin analysis allows for differentiation between the two adhesives at this specific date. OCT in particular offers the possibility to evaluate marginal integrity directly in vivo.

The influence of gait and speed on the dynamic navicular drop - A cross sectional study on healthy subjects.

INTRODUCTION: Variations of gait speed influence kinematic variables that may have an effect on dynamic foot deformation. The influence of gait speed on the navicular drop has not yet been investigated. METHODS: The navicular drop was evaluated in static and dynamic conditions using a 3D-motion capture system. The dynamic navicular drop was evaluated on a treadmill while walking and running at three different speeds. A repeated measures ANOVA and post-hoc tests were conducted to evaluate the differences in dynamic navicular drop, corresponding unloaded navicular height at foot strike and loaded navicular height during stance. RESULTS: Higher walking speed led to a significant decrease in navicular height at foot strike and a subsequent decrease of dynamic navicular drop (p=0.006). Across increasing running speeds, minimum navicular height was significantly decreased which in consequence led to an increased dynamic navicular drop (p=0.015). For walking and running at the same speed, there was a large effect of gait style with an increase of dynamic navicular drop by 3.5mm (p<0.001) during running. DISCUSSION: The change of gait from walking to running at the same speed had a large effect on dynamic navicular drop. The values of navicular height at foot strike and minimum navicular height during stance should be taken into account for the interpretation of dynamic navicular drop measures. Static and dynamic navicular drop measures differ substantially.

Antimicrobial peptides as a possible interlink between periodontal diseases and its risk factors: A systematic review.

Antimicrobial peptides (AMPs) play a critical role in controlling innate and acquired immune responses. Local dysregulation of AMP is implicated in the pathogenesis of periodontal diseases as a response to periodontal pathogen challenge. Changes in AMP expression also characterize tobacco smoking, diabetes mellitus, obesity and rheumatoid arthritis, which are established risk factors of periodontal diseases, suggesting AMP may act as putative mechanistic links between these. The aim was to evaluate and summarize critically the current evidence pertaining to interrelationships between AMPs, periodontal diseases and selected periodontal disease risk factors. General and theme specific keywords were used to search the PUBMED database for studies relevant to AMP, periodontal diseases, smoking, diabetes mellitus, obesity and rheumatoid arthritis and critically reviewed. A total of 131 abstracts and 119 full text articles were screened for relevance; 13 studies were selected for inclusion after critical review. Local AMP dysregulation characteristic to periodontal diseases appears to occur within a broader landscape of complex systemic immune perturbations independently induced by smoking, metabolic and rheumatoid disease. The nature of these interactions and mechanistic pathways involved are inadequately understood. AMPs could be possible mechanistic interlinks between periodontal diseases and its risk factors. However, such evidence is very limited and more in vivo and in vitro studies are necessary to clarify the nature of such relationships. A greater understanding of AMPs as shared mediators is essential for unraveling their value as therapeutic or biomarker candidates.

Application of micro-FTIR mapping and SEM to study compositional heterogeneity of siltstones: Example from the Late Devonian-Early Mississippian Middle Bakken Member.

This paper explores the applicability of micro-FTIR mapping to study heterogeneity of organic matter-lean siltstones. Closely spaced samples of Late Devonian dolomitic siltstones of the Middle Bakken Member were analysed with micro-FTIR, powder X-ray diffraction, and scanning electron microscopy (SEM) to explore the distribution and chemical properties of organic matter (OM), muscovite/feldspar/clay group, carbonates, and quartz, and their influence on porosity and permeability of these rocks. Our results show that quartz is the dominant component of the samples, and the main mineralogical differences between the samples are reflected in the abundance of carbonate minerals. Organic matter content is usually far below 1 wt. % and dominantly represented by terrestrially derived vitrinite and inertinite. Micro-FTIR mapping demonstrates that the more spatially connected quartz and muscovite/feldspar/clays become, the larger permeability in the rock develops, and these correlations are especially strong for planes parallel to bedding. In contrast, carbonate connectivity shows a strong negative correlation with permeability. No correlations between connectivity of components and porosity have been detected. These observations suggest that micro-FTIR not only can document compositional heterogeneity of siltstones, but also has potential to help understanding their permeability systems.

The microstructure, local indium composition and photoluminescence in green-emitting InGaN/GaN quantum wells.

In this work, we analyse the microstructure and local chemical composition of green-emitting Inx Ga1-x N/GaN quantum well (QW) heterostructures in correlation with their emission properties. Two samples of high structural quality grown by metalorganic vapour phase epitaxy (MOVPE) with a nominal composition of x = 0.15 and 0.18 indium are discussed. The local indium composition is quantitatively evaluated by comparing scanning transmission electron microscopy (STEM) images to simulations and the local indium concentration is extracted from intensity measurements. The calculations point out that the measured indium fluctuations may be correlated to the large width and intensity decrease of the PL emission peak.

Atomic resolution elemental mapping using energy-filtered imaging scanning transmission electron microscopy with chromatic aberration correction.

This paper addresses a novel approach to atomic resolution elemental mapping, demonstrating a method that produces elemental maps with a similar resolution to the established method of electron energy-loss spectroscopy in scanning transmission electron microscopy. Dubbed energy-filtered imaging scanning transmission electron microscopy (EFISTEM) this mode of imaging is, by the quantum mechanical principle of reciprocity, equivalent to tilting the probe in energy-filtered transmission electron microscopy (EFTEM) through a cone and incoherently averaging the results. In this paper we present a proof-of-principle EFISTEM experimental study on strontium titanate. The present approach, made possible by chromatic aberration correction, has the advantage that it provides elemental maps which are immune to spatial incoherence in the electron source, coherent aberrations in the probe-forming lens and probe jitter. The veracity of the experiment is supported by quantum mechanical image simulations, which provide an insight into the image-forming process. Elemental maps obtained in EFTEM suffer from the effect known as preservation of elastic contrast, which, for example, can lead to a given atomic species appearing to be in atomic columns where it is not to be found. EFISTEM very substantially reduces the preservation of elastic contrast and yields images which show stability of contrast with changing thickness. The experimental application is demonstrated in a proof-of-principle study on strontium titanate.

Determining oxygen relaxations at an interface: A comparative study between transmission electron microscopy techniques.

Nowadays, aberration corrected transmission electron microscopy (TEM) is a popular method to characterise nanomaterials at the atomic scale. Here, atomically resolved images of nanomaterials are acquired, where the contrast depends on the illumination, imaging and detector conditions of the microscope. Visualization of light elements is possible when using low angle annular dark field (LAADF) STEM, annular bright field (ABF) STEM, integrated differential phase contrast (iDPC) STEM, negative spherical aberration imaging (NCSI) and imaging STEM (ISTEM). In this work, images of a NdGaO3-La0.67Sr0.33MnO3 (NGO-LSMO) interface are quantitatively evaluated by using statistical parameter estimation theory. For imaging light elements, all techniques are providing reliable results, while the techniques based on interference contrast, NCSI and ISTEM, are less robust in terms of accuracy for extracting heavy column locations. In term of precision, sample drift and scan distortions mainly limits the STEM based techniques as compared to NCSI. Post processing techniques can, however, partially compensate for this. In order to provide an outlook to the future, simulated images of NGO, in which the unavoidable presence of Poisson noise is taken into account, are used to determine the ultimate precision. In this future counting noise limited scenario, NCSI and ISTEM imaging will provide more precise values as compared to the other techniques, which can be related to the mechanisms behind the image recording.

How precise can atoms of a nanocluster be located in 3D using a tilt series of scanning transmission electron microscopy images?

In this paper, we investigate how precise atoms of a small nanocluster can ultimately be located in three dimensions (3D) from a tilt series of images acquired using annular dark field (ADF) scanning transmission electron microscopy (STEM). Therefore, we derive an expression for the statistical precision with which the 3D atomic position coordinates can be estimated in a quantitative analysis. Evaluating this statistical precision as a function of the microscope settings also allows us to derive the optimal experimental design. In this manner, the optimal angular tilt range, required electron dose, optimal detector angles, and number of projection images can be determined.

Ankle joint pressure changes in high tibial and distal femoral osteotomies: a cadaver study.

AIMS: To assess the effect of high tibial and distal femoral osteotomies (HTO and DFO) on the pressure characteristics of the ankle joint. MATERIALS AND METHODS: Varus and valgus malalignment of the knee was simulated in human cadaver full-length legs. Testing included four measurements: baseline malalignment, 5° and 10° re-aligning osteotomy, and control baseline malalignment. For HTO, testing was rerun with the subtalar joint fixed. In order to represent half body weight, a 300 N force was applied onto the femoral head. Intra-articular sensors captured ankle pressure. RESULTS: In the absence of restriction of subtalar movement, insignificant migration of the centre of force and changes of maximal pressure were seen at the ankle joint. With restricted subtalar motion, more significant lateralisation of the centre of force were seen with the subtalar joint in varus than in valgus position. Changes in maximum pressure were again not significant. CONCLUSION: The re-alignment of coronal plane knee deformities by HTO and DFO altered ankle pressure characteristics. When the subtalar joint was fixed in the varus position, migration of centre of force after HTO was more significant than when the subtalar joint was fixed in valgus. Cite this article: Bone Joint J 2017;99-B:59-65.

How Octogenarians with Bladder Cancer Are Treated in a Maximum-Care Hospital: The Real-Life Experience.

INTRODUCTION: With increasing life expectancy, curative treatment of octogenarians with urothelial carcinoma of the bladder (UCB) becomes more important. MATERIALS AND METHODS: The treatment modalities of 276 octogenarians with UCB who were treated at the University Hospital of Erlangen between 1982 and 2011 were assessed retrospectively. RESULTS: One hundred forty-six patients had non-muscle invasive bladder cancer (NMIBC) while 71 had muscle invasive bladder cancer (MIBC). No data was available for 59 patients. Eighty-five (58.2%) of the 146 patients with NMIBC received transurethral resection of the bladder tumor (TURBT) only, another 38 patients (26%) underwent additional intravesical therapy; and 8.9% were treated with radiochemotherapy (RCT), 4.1% with radiotherapy (RT), 1.4% with systemic chemotherapy and 1.4% with radical cystectomy (RC). Of the 71 patients suffering from MIBC, 39 (54.9%) received TURBT alone. A potentially curative therapy was performed on 31 of the 71 patients with MIBC (43.7%). Of these, 16 patients (51.6%) received RCT, 9 patients (29.0%) RT and 6 patients (19.4%) RC. In Kaplan-Meier analysis, patients with MIBC had better median overall survival with curative treatment compared to TURBT alone (28 vs. 9 months; p < 0.001, log-rank test). CONCLUSIONS: By offering a wide range of treatment options, over 43% of octogenarians with MIBC received a curative therapy at a maximum care hospital.

Dentin Protection of Different Desensitizing Varnishes During Stress Simulation: An In Vitro Study.

OBJECTIVE: The aim of this study was to investigate dentin protection of different desensitizing varnishes (light- and self-curing) during acid action/abrasion stress and thermocyclic loading in vitro. METHODS: Dentin discs of 2 mm thickness were cut from 120 human molars, embedded, and polished. Specimens were randomized into five groups (n=24): A, negative control; B, Gluma Desensitizer; C, Cervitec plus (self-curing); D, Seal&Protect; and E, Admira Protect (light-curing). In groups B-E, varnish was applied on two-thirds of the dentin surface, and one-third acted as internal control. Stress cycle (2 cycles/day) for specimens were as follows: 1, acid action (pH: 2.9: five minutes); 2, remineralization (synthetic saliva: 60 minutes); 3, brushing (100 strokes); 4, thermocycling (five cycles); and 5, remineralization (synthetic saliva: six hours) for each group (n=12) for 30 (15 days) or 60 times (30 days). Specimens were analyzed using an incident light microscope. Substance loss was measured in micrometers. Statistical analysis was performed with the multiple contrast test (p<0.05). RESULTS: Groups B and C had a significantly lower dentin loss than A (p<0.01). After 30 days, group A showed the highest dentin loss (p<0.01), whereas the other groups lacked a significant difference regarding their substance loss (dentin and/or varnish; p>0.05). Varnish layer loss was shown for groups D and E with a remaining protective layer; groups A-C showed dentin removal. CONCLUSION: All four varnishes are protective compared with an untreated control. Light-curing varnishes might provide higher dentin protection than self-curing materials.

Locating light and heavy atomic column positions with picometer precision using ISTEM.

Recently, imaging scanning transmission electron microscopy (ISTEM) has been proposed as a promising new technique combining the advantages of conventional TEM (CTEM) and STEM (Rosenauer et al., 2014 [1]). The ability to visualize light and heavy elements together makes it a particularly interesting new, spatially incoherent imaging mode. Here, we evaluate this technique in term of precision with which atomic column locations can be measured. By using statistical parameter estimation theory, we will show that these locations can be accurately measured with a precision in the picometer range. Furthermore, a quantitative comparison is made with HAADF STEM imaging to investigate the advantages of ISTEM.

Micropapillary morphology is an indicator of poor prognosis in patients with urothelial carcinoma treated with transurethral resection and radiochemotherapy.

Purpose of this study was to evaluate prognostic impact of rare variants of urothelial bladder cancer (BC) after treatment with combined radiochemotherapy (RCT). To this end tumour tissue of 238 patients with urothelial carcinoma (UC) treated with transurethral resection of the bladder (TUR-B) and RCT with curative intent was collected. Histomorphological analysis included re-evaluation and semi-quantitative assessment of rare UC subtypes. Additionally, human epidermal growth factor receptor 2 (HER2) chromogenic in situ hybridisation (CISH) was performed in tumours with a micropapillary component exceeding 30 %. Long-term follow-up was available for 200 patients (range 3-282 months). Variant UC histology was found in 45 of 238 tumours, most frequently micropapillary UC (N = 17) including cases with a small fraction of tumour with micropapillary morphology. The mere presence of micropapillary morphology did not affect prognosis. In tumours with extensive (≥30 %) micropapillary morphology (N = 8) Kaplan-Meier analysis revealed significantly worse cancer specific survival (CSS) (P = 0.002) compared to conventional UC (mean survival times 97 months and 229 months, respectively). Univariate Cox regression analysis of cases with ≥30 % micropapillary morphology revealed a hazard ratio of 4.726 (95 % CI 1.629-13.714) for CSS (P = 0.004). CISH revealed HER2 gene amplification in 3/10 tumours with ≥30 % micropapillary component. In conclusion, for BC treated with TUR-B and RCT, the presence of micropapillary morphology in more than 30 % of the tumour is an adverse prognostic factor. Further studies are needed to evaluate a potential benefit of different, especially multimodal treatment strategies for micropapillary UC and also other subtypes of UC. Her2 represents a promising therapeutic target in a subset of micropapillary UC.

Efficacy Management of Urolithiasis: Flexible Ureteroscopy versus Extracorporeal Shockwave Lithotripsy.

OBJECTIVES: To evaluate the efficacy of flexible ureterscopy (fURS) and extracorporal shockwave lithotripsy (SWL) in the treatment of urolithiasis, complemented by a subgroup analysis of lower pole calyx. METHODS: Retrospective analysis of patients treated by fURS or SWL was performed by independent variables such as gender, age, nephrolith size, double-J stent (DJ stent) and stone localisation. RESULTS: Out of 326 patients, 165 were treated by SWL and 161 by fURS. Complete stone removal was achieved by fURS in 83.2% and by SWL in 43.0% (p < 0.001). Asymptomatic behaviour (88-89%) and complication rate (10-11%) were nearly the same in both methods. A higher retreatment rate for SWL was necessary; otherwise, an auxillary DJ stent was performed more often preoperative before fURS. The subgroup analysis of lower pole calyx confirmed these evaluations. CONCLUSIONS: Complete stone-free removal was almost 8 times higher after fURS compared to SWL. The efficacy of fURS in treatment of urolithiasis is substantially higher than the efficacy of SWL.

Appraising the methodological quality of cadaveric studies: validation of the QUACS scale.

Although systematic reviews are conducted in the field of anatomical research, no instruments exist for the assessment of study quality. Thus, our objective was to develop a valid tool that reliably assesses the methodological quality of observational cadaveric studies. The QUACS scale (QUality Appraisal for Cadaveric Studies) was developed using an expert consensus process. It consists of a 13-item checklist addressing the design, conduct and report of cadaveric dissection studies. To evaluate inter-rater reliability, a blinded investigator obtained an initial pool of 120 observational cadaveric studies. Sixty-eight of them were selected randomly according to sample size calculations. Three independent researchers rated each publication by means of the QUACS scale. The reliability of the total score was estimated using the intraclass correlation coefficient (ICC). To assess agreement among individual items, margin-free kappa values were calculated. For construct validity, two experts (an anatomist and an experienced physician) categorized the quality of 15 randomly selected studies as 'excellent' (4 points), 'moderate to good' (3 points), poor to moderate' (2 points) or 'poor' (1 point). Kendall's tau rank correlation was used to compare the expert ratings with the scores on the QUACS scale. An evaluation of feasibility was carried out during the reliability analysis. All three raters recorded the duration of quality appraisal for each article. Means were used to describe average time exposure. The ICC for the total score was 0.87 (95% confidence interval: 0.82-0.92; P < 0.0001). For individual items, margin-free kappa values ranged between 0.56 and 0.96 with an agreement of 69-97% among the three raters. Kendall's tau B coefficient of the association between expert ratings and the results obtained with the QUACS scale was 0.69 (P < 0.01). Required rating time per article was 5.4 ±â€…1.6 min. The QUACS scale is highly reliable and exhibits strong construct validity. Thus, it can confidently be applied in assessing the methodological quality of observational dissection studies.