Understanding factors impacting patient-reported outcome measures integration in routine clinical practice: an umbrella review.

PURPOSE: Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice. METHODS: An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework. RESULTS: 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, 'change champions' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators. CONCLUSIONS: The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.

Anterior Cruciate Ligament Reconstruction and Accelerated Rehabilitation with InternalBrace™ Augmentation in a Professional Footballer.

INTRODUCTION: Interest in anterior cruciate ligament (ACL) repair has been increasing as an alternative to traditional reconstructive techniques and encouraging results have been demonstrated using internal bracing with suture tape augmentation (FiberTape®, Arthrex, Naples, Florida). ACL repair is challenging if the rupture is mid-substance or distal. We describe the case of a hybrid ACL reconstruction with internal brace augmentation. MATERIALS AND METHODS: This retrospective case report documents the rehabilitation process of a 31-year-old professional footballer who had an isolated ACL rupture. The patient underwent a hybrid ACL reconstruction with bone-patellar tendon-bone autograft and suture tape augmentation 10 days after his injury. A task-based rehabilitation programme defined by six progressive phases relevant to performance-based outcome measures was undertaken. Each phase had clear, functional, progressive goals incorporating exercises to improve mobility, neuromuscular control, strength, and a progressive return to running and sport-specific movements. RESULTS: Using the rehabilitation framework outlined, this player produced excellent results in all objective criteria postoperatively and was able to return to unrestricted full team training in under five months (146 days) following surgery. CONCLUSIONS: This case presentation demonstrates the safe and accelerated return to professional football following ACL reconstruction augmented with internal bracing. The player was able to meet all criteria-based aspects of return to play.

A SERS-Active Electrospun Polymer Mesh for Spatially Localized pH Measurements of the Cellular Microenvironment.

Extracellular pH (pHe) is an important chemical factor in many cellular processes and disease pathologies. The routine sampling of pHe in vitro could lead to innovative advances in therapeutics. To this end, we have fabricated a novel gold-coated polymer mesh, which facilitates the real-time measurement of pHe via surface-enhanced Raman scattering (SERS). In this proof of concept study, we apply our SERS sensor to measure metabolically induced changes in the pHe of carcinoma-derived cell line HepG2/C3A. We demonstrate that gold-coated polyurethane electrospun nanofibers (AuNF) have strong and reproducible SERS spectra of surface-adsorbed analytes. By functionalizing AuNF with pH-responsive reporter 4-mercaptobenzoic acid (MBA), we have developed an accurate pH SERS sensor for the extracellular microenvironment. We cultured HepG2/C3A on the surface of MBA-AuNF and measured an acidic shift in pHe at the cell-fiber interface. Following exposure to staurosporine, an apoptosis-inducing drug, we observed changes in the HepG2/C3A cellular morphology indicative of controlled cell death, and detected an increase in the pHe of HepG2/C3A. These results demonstrate how subtle changes in pHe, induced by the metabolic activity of cells, can be measured with our novel SERS sensor MBA-AuNF. The excellent pH measurement performance of MBA-AuNF provides a unique platform to study extracellular pH on the microscale and will help to deepen our understanding of pHe in disease pathology.

Uniqueness of the Phase Transition in Many-Dipole Cavity Quantum Electrodynamical Systems.

The possibility of a superradiant phase transition in light-matter systems is the subject of much debate, due to numerous apparently conflicting no-go and counter no-go theorems. Using an arbitrary-gauge approach we show that a unique phase transition does occur in archetypal many-dipole cavity QED systems, and that it manifests unambiguously via a macroscopic gauge-invariant polarization. We find that the gauge choice controls the extent to which this polarization is included as part of the radiative quantum subsystem and thereby determines the degree to which the abnormal phase is classed as superradiant. This resolves the long-standing paradox of no-go and counter no-go theorems for superradiance, which are shown to refer to different definitions of radiation.

Bubble Dislodgment in a Capillary Network with Microscopic Multichannels and Multibifurcation Features.

Bubble lodgment in a complex capillary network is a common issue in many industrial and biological processes. Research work reported in the literature only investigated bubble dislodgment in single channels and did not consider the effect of network complexity on the dislodgment. This paper focuses on the pressure required to dislodge single bubbles from a microscopic capillary network and investigates the factors affecting the dislodging pressure to facilitate the precise control of bubble flows in porous media. A capillary network with multibifurcation and a smoothly changed diameter is designed to closely mimic the structure of the physiological vascular networks. Over 600 bubble dislodgment experiments have been conducted to understand the effect of the network structure, channel dimensions, and bubble length on the dislodging pressure. The results indicate that the network structure is a dominant factor affecting the dislodging pressure that increases with the increase in network complexity. The effect of bubble length on the dislodging pressure depends on the bubble length. When the bubble length is less than a certain value, which is around 2 mm in this study, the dislodging pressure increases significantly with the decrease of bubble length. When the bubble length is larger than 2 mm, the dislodging pressure is independent of the bubble length. A model has been proposed to explain the bubble dislodgment in complex capillary networks. The impact of the network structure on the bubble dislodging pressure is characterized by a parameter c j. The model indicates that the dislodging pressure is the function of bubble length, channel dimension, and network structure. The analysis of model parameters NB j and MA j shows that parameter c j, rather than the channel size, dominates the dislodging pressure for bubbles with a length greater than 2 mm, and the increase rate of the dislodging pressure is significantly affected by both channel size and parameter c j.

Dover sole.

Negative pressure pulmonary edema (NPPE) is a clinical syndrome well described in the literature and easy to recognize in cases of suspicion, but probably underdiagnosed. It can be a cause of morbidity and admission to the intensive care unit of healthy young individuals. It is present in approximately one in every thousand anesthetics and in 10% of the episodes of upper airway obstruction that are observed in routine clinical practice. It is a non-cardiogenic form of pulmonary oedema thought to be caused by the highly negative intra-thoracic pressure generated when trying to breathe against an acute obstruction. We report a case of NPPE after an airway obstruction in a young male patient.

The Limpet: A ROS-Enabled Multi-Sensing Platform for the ORCA Hub.

The oil and gas industry faces increasing pressure to remove people from dangerous offshore environments. Robots present a cost-effective and safe method for inspection, repair, and maintenance of topside and marine offshore infrastructure. In this work, we introduce a new multi-sensing platform, the Limpet, which is designed to be low-cost and highly manufacturable, and thus can be deployed in huge collectives for monitoring offshore platforms. The Limpet can be considered an instrument, where in abstract terms, an instrument is a device that transforms a physical variable of interest (measurand) into a form that is suitable for recording (measurement). The Limpet is designed to be part of the ORCA (Offshore Robotics for Certification of Assets) Hub System, which consists of the offshore assets and all the robots (Underwater Autonomous Vehicles, drones, mobile legged robots etc.) interacting with them. The Limpet comprises the sensing aspect of the ORCA Hub System. We integrated the Limpet with Robot Operating System (ROS), which allows it to interact with other robots in the ORCA Hub System. In this work, we demonstrate how the Limpet can be used to achieve real-time condition monitoring for offshore structures, by combining remote sensing with signal-processing techniques. We show an example of this approach for monitoring offshore wind turbines, by designing an experimental setup to mimic a wind turbine using a stepper motor and custom-designed acrylic fan blades. We use the distance sensor, which is a Time-of-Flight sensor, to achieve the monitoring process. We use two different approaches for the condition monitoring process: offline and online classification. We tested the offline classification approach using two different communication techniques: serial and Wi-Fi. We performed the online classification approach using two different communication techniques: LoRa and optical. We train our classifier offline and transfer its parameters to the Limpet for online classification. We simulated and classified four different faults in the operation of wind turbines. We tailored a data processing procedure for the gathered data and trained the Limpet to distinguish among each of the functioning states. The results show successful classification using the online approach, where the processing and analysis of the data is done on-board by the microcontroller. By using online classification, we reduce the information density of our transmissions, which allows us to substitute short-range high-bandwidth communication systems with low-bandwidth long-range communication systems. This work shines light on how robots can perform on-board signal processing and analysis to gain multi-functional sensing capabilities, improve their communication requirements, and monitor the structural health of equipment.

The influence of a simple blood transfusion policy on overtransfusion in acute upper gastrointestinal haemorrhage.

Blood transfusion is widely used in the management of acute upper gastrointestinal haemorrhage (AUGIH). Trial data suggests that excessive transfusion may be detrimental, yet overtransfusion remains commonplace. This study reports the impact of introducing a simple cross-match policy in a district general hospital, which resulted in a substantial fall in the prevalence of overtransfusion (odds ratio 0.43; 95% confidence interval 0.19-0.98), with potential patient benefits in terms of rebleeding, and a reduction in the total blood transfused from 162 to 121 units per 100 patients with AUGIH. For the cost of blood alone, this corresponds to projected savings across the NHS in England in excess of £2 million per annum.

Multigait soft robot.

This manuscript describes a unique class of locomotive robot: A soft robot, composed exclusively of soft materials (elastomeric polymers), which is inspired by animals (e.g., squid, starfish, worms) that do not have hard internal skeletons. Soft lithography was used to fabricate a pneumatically actuated robot capable of sophisticated locomotion (e.g., fluid movement of limbs and multiple gaits). This robot is quadrupedal; it uses no sensors, only five actuators, and a simple pneumatic valving system that operates at low pressures (< 10 psi). A combination of crawling and undulation gaits allowed this robot to navigate a difficult obstacle. This demonstration illustrates an advantage of soft robotics: They are systems in which simple types of actuation produce complex motion.

Soft Robotics: A Route to Equality, Diversity, and Inclusivity in Robotics.

Robotics is entering our daily lives. The discipline is increasingly crucial in fields such as agriculture, medicine, and rescue operations, impacting our food, health, and planet. At the same time, it is becoming evident that robotic research must embrace and reflect the diversity of human society to address these broad challenges effectively. In recent years, gender inclusivity has received increasing attention, but it still remains a distant goal. In addition, awareness is rising around other dimensions of diversity, including nationality, religion, and politics. Unfortunately, despite the efforts, empirical evidence shows that the field has still a long way to go before achieving a sufficient level of equality, diversity, and inclusion across these spectra. This study focuses on the soft robotics community-a growing and relatively recent subfield-and it outlines the present state of equality and diversity panorama in this discipline. The article argues that its high interdisciplinary and accessibility make it a particularly welcoming branch of robotics. We discuss the elements that make this subdiscipline an example for the broader robotic field. At the same time, we recognize that the field should still improve in several ways and become more inclusive and diverse. We propose concrete actions that we believe will contribute to achieving this goal, and provide metrics to monitor its evolution.

Perspective for soft robotics: the field's past and future.

Since its beginnings in the 1960s, soft robotics has been a steadily growing field that has enjoyed recent growth with the advent of rapid prototyping and the provision of new flexible materials. These two innovations have enabled the development of fully flexible and untethered soft robotic systems. The integration of novel sensors enabled by new manufacturing processes and materials shows promise for enabling the production of soft systems with 'embodied intelligence'. Here, four experts present their perspectives for the future of the field of soft robotics based on these past innovations. Their focus is on finding answers to the questions of: how to manufacture soft robots, and on how soft robots can sense, move, and think. We highlight industrial production techniques, which are unused to date for manufacturing soft robots. They discuss how novel tactile sensors for soft robots could be created to enable better interaction of the soft robot with the environment. In conclusion this article highlights how embodied intelligence in soft robots could be used to make soft robots think and to make systems that can compute, autonomously, from sensory inputs.

Design and Fabrication of a Fully-Integrated, Miniaturised Fluidic System for the Analysis of Enzyme Kinetics.

The lab-on-a-chip concept, enabled by microfluidic technology, promises the integration of multiple discrete laboratory techniques into a miniaturised system. Research into microfluidics has generally focused on the development of individual elements of the total system (often with relatively limited functionality), without full consideration for integration into a complete fully optimised and miniaturised system. Typically, the operation of many of the reported lab-on-a-chip devices is dependent on the support of a laboratory framework. In this paper, a demonstrator platform for routine laboratory analysis is designed and built, which fully integrates a number of technologies into a single device with multiple domains such as fluidics, electronics, pneumatics, hydraulics, and photonics. This facilitates the delivery of breakthroughs in research, by incorporating all physical requirements into a single device. To highlight this proposed approach, this demonstrator microsystem acts as a fully integrated biochemical assay reaction system. The resulting design determines enzyme kinetics in an automated process and combines reservoirs, three-dimensional fluidic channels, optical sensing, and electronics in a low-cost, low-power and portable package.

Nonconjugate quantum subsystems.

We introduce an alternative way to understand the decomposition of a quantum system into interacting parts and show that it is natural in several physical models. This enables us to define a reduced density operator for a working system interacting with a thermal bath that is consistent with the inclusion of the interaction Hamiltonian within the working system's energy. We subsequently provide a self-consistent formulation of quantum thermodynamics that incurs nontrivial physical corrections to thermodynamic relations and quantities previously defined within the literature.

A Haptic Sleeve as a Method of Mechanotactile Feedback Restoration for Myoelectric Hand Prosthesis Users.

Current myoelectric upper limb prostheses do not restore sensory feedback, impairing fine motor control. Mechanotactile feedback restoration with a haptic sleeve may rectify this problem. This randomised crossover within-participant controlled study aimed to assess a prototype haptic sleeve's effect on routine grasping tasks performed by eight able-bodied participants. Each participant completed 15 repetitions of the three tasks: Task 1-normal grasp, Task 2-strong grasp and Task 3-weak grasp, using visual, haptic, or combined feedback All data were collected in April 2021 in the Scottish Microelectronics Centre, Edinburgh, UK. Combined feedback correlated with significantly higher grasp success rates compared to the vision alone in Task 1 (p < 0.0001), Task 2 (p = 0.0057), and Task 3 (p = 0.0170). Similarly, haptic feedback was associated with significantly higher grasp success rates compared to vision in Task 1 (p < 0.0001) and Task 2 (p = 0.0015). Combined feedback correlated with significantly lower energy expenditure compared to visual feedback in Task 1 (p < 0.0001) and Task 3 (p = 0.0003). Likewise, haptic feedback was associated with significantly lower energy expenditure compared to the visual feedback in Task 1 (p < 0.0001), Task 2 (p < 0.0001), and Task 3 (p < 0.0001). These results suggest that mechanotactile feedback provided by the haptic sleeve effectively augments grasping and reduces its energy expenditure.

Personalised 3D printed respirators for healthcare workers during the COVID-19 pandemic.

Widespread issues in respirator availability and fit have been rendered acutely apparent by the COVID-19 pandemic. This study sought to determine whether personalized 3D printed respirators provide adequate filtration and function for healthcare workers through a Randomized Controlled Trial (RCT). Fifty healthcare workers recruited within NHS Lothian, Scotland, underwent 3D facial scanning or 3D photographic reconstruction to produce 3D printed personalized respirators. The primary outcome measure was quantitative fit-testing to FFP3 standard. Secondary measures included respirator comfort, wearing experience, and function instrument (R-COMFI) for tolerability, Modified Rhyme Test (MRT) for intelligibility, and viral decontamination on respirator material. Of the 50 participants, 44 passed the fit test with the customized respirator, not significantly different from the 38 with the control (p = 0.21). The customized respirator had significantly improved comfort over the control respirator in both simulated clinical conditions (p < 0.0001) and during longer wear (p < 0.0001). For speech intelligibility, both respirators performed equally. Standard NHS decontamination agents were able to eradicate 99.9% of viral infectivity from the 3D printed plastics tested. Personalized 3D printed respirators performed to the same level as control disposable FFP3 respirators, with clear communication and with increased comfort, wearing experience, and function. The materials used were easily decontaminated of viral infectivity and would be applicable for sustainable and reusable respirators.

Soft Robots for Ocean Exploration and Offshore Operations: A Perspective.

The ocean and human activities related to the sea are under increasing pressure due to climate change, widespread pollution, and growth of the offshore energy sector. Data, in under-sampled regions of the ocean and in the offshore patches where the industrial expansion is taking place, are fundamental to manage successfully a sustainable development and to mitigate climate change. Existing technology cannot cope with the vast and harsh environments that need monitoring and sampling the most. The limiting factors are, among others, the spatial scales of the physical domain, the high pressure, and the strong hydrodynamic perturbations, which require vehicles with a combination of persistent autonomy, augmented efficiency, extreme robustness, and advanced control. In light of the most recent developments in soft robotics technologies, we propose that the use of soft robots may aid in addressing the challenges posed by abyssal and wave-dominated environments. Nevertheless, soft robots also allow for fast and low-cost manufacturing, presenting a new potential problem: marine pollution from ubiquitous soft sampling devices. In this study, the technological and scientific gaps are widely discussed, as they represent the driving factors for the development of soft robotics. Offshore industry supports increasing energy demand and the employment of robots on marine assets is growing. Such expansion needs to be sustained by the knowledge of the oceanic environment, where large remote areas are yet to be explored and adequately sampled. We offer our perspective on the development of sustainable soft systems, indicating the characteristics of the existing soft robots that promote underwater maneuverability, locomotion, and sampling. This perspective encourages an interdisciplinary approach to the design of aquatic soft robots and invites a discussion about the industrial and oceanographic needs that call for their application.

Limpet II: A Modular, Untethered Soft Robot.

The ability to navigate complex unstructured environments and carry out inspection tasks requires robots to be capable of climbing inclined surfaces and to be equipped with a sensor payload. These features are desirable for robots that are used to inspect and monitor offshore energy platforms. Existing climbing robots mostly use rigid actuators, and robots that use soft actuators are not fully untethered yet. Another major problem with current climbing robots is that they are not built in a modular fashion, which makes it harder to adapt the system to new tasks, to repair the system, and to replace and reconfigure modules. This work presents a 450 g and a 250 × 250 × 140 mm modular, untethered hybrid hard/soft robot-Limpet II. The Limpet II uses a hybrid electromagnetic module as its core module to allow adhesion and locomotion capabilities. The adhesion capability is based on negative pressure adhesion utilizing suction cups. The locomotion capability is based on slip-stick locomotion. The Limpet II also has a sensor payload with nine different sensing modalities, which can be used to inspect and monitor offshore structures and the conditions surrounding them. Since the Limpet II is designed as a modular system, the modules can be reconfigured to achieve multiple tasks. To demonstrate its potential for inspection of offshore platforms, we show that the Limpet II is capable of responding to different sensory inputs, repositioning itself within its environment, adhering to structures made of different materials, and climbing inclined surfaces.

Online quench-flow electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry for elucidating kinetic and chemical enzymatic reaction mechanisms.

We have developed an automated quench-flow microreactor which interfaces directly to an electrospray ionization (ESI) mass spectrometer. We have used this device in conjunction with ESI Fourier transform ion cyclotron resonance mass spectrometry (FTICR MS) to demonstrate the potential of this approach for studying the mechanistic details of enzyme reactions. For the model system chosen to test this device, namely, the pre-steady-state hydrolysis of p-nitrophenyl acetate by the enzyme chymotrypsin, the kinetic parameters obtained are in good agreement with those in the literature. To our knowledge, this is the first reported use of online quench-flow coupled with FTICR MS. Furthermore, we have exploited the power of FTICR MS to interrogate the quenched covalently bound enzyme intermediate using top-down fragmentation. The accurate mass capabilities of FTICR MS permitted the nature of the intermediate to be assigned with high confidence. Electron capture dissociation (ECD) fragmentation allowed us to locate the intermediate to a five amino acid section of the protein--which includes the known catalytic residue, Ser(195). This experimental approach, which uniquely can provide both kinetic and chemical details of enzyme mechanisms, is a potentially powerful tool for studies of enzyme catalysis.

Orientation mapping with Kikuchi patterns generated from a focused STEM probe and indexing with commercially available EDAX software.

Relating a crystal's microscopic structure-such as orientation and size-to a material's macroscopic properties is of great importance in materials science. Although most crystal orientation microscopy is performed in the scanning electron microscope (SEM), transmission electron microscopy (TEM)-based methods have a number of benefits, including higher spatial resolution. Current TEM orientation methods have either specific hardware requirements or use software that has limited scope, utility, or availability. In this article, a technique is described for orientation mapping using Kikuchi diffraction patterns generated from a focused STEM probe. One key advantage is that indexing and analysis of the patterns and maps occurs in the robust OIM Analysis software, currently widely used for electron backscatter diffraction (EBSD) and transmission Kikuchi diffraction (TKD) analysis. It was found that with minimal to no image processing and by changing only a few software parameters, reliable indexing of Kikuchi patterns is possible. Three samples, a deformed ß-Titanium (Ti), a medium carbon heat-treated steel, and BaCe0.8Y0.2O3-δ were tested to determine the effectiveness of the approach. In all three measurements the algorithms effectively and reliably determined the phases and the crystal orientations of the features measured. For the two orientation maps produced, less than 5% of the patterns were misindexed including boundary areas where overlapping patterns existed. An angular resolution of 0.15° was achieved while features <25 nm were able to be spatially resolved.

Gauge ambiguities imply Jaynes-Cummings physics remains valid in ultrastrong coupling QED.

Ultrastrong-coupling between two-level systems and radiation is important for both fundamental and applied quantum electrodynamics (QED). Such regimes are identified by the breakdown of the rotating-wave approximation, which applied to the quantum Rabi model (QRM) yields the apparently less fundamental Jaynes-Cummings model (JCM). We show that when truncating the material system to two levels, each gauge gives a different description whose predictions vary significantly for ultrastrong-coupling. QRMs are obtained through specific gauge choices, but so too is a JCM without needing the rotating-wave approximation. Analysing a circuit QED setup, we find that this JCM provides more accurate predictions than the QRM for the ground state, and often for the first excited state as well. Thus, Jaynes-Cummings physics is not restricted to light-matter coupling below the ultrastrong limit. Among the many implications is that the system's ground state is not necessarily highly entangled, which is usually considered a hallmark of ultrastrong-coupling.