Mesh Processing for Computerized Facial Anthropometry

Understanding of the shape and size of different features of the human body from scanned data is necessary for automated design and evaluation of product ergonomics. In this paper, a computational framework is presented for automatic detection and recognition of important facial feature regions, from scanned head and shoulder polyhedral models. A noise tolerant methodology is proposed using discrete curvature computations, band-pass filtering, and morphological operations for isolation of the primary feature regions of the face, namely, the eyes, nose, and mouth. Spatial disposition of the critical points of these isolated feature regions is analyzed for the recognition of these critical points as the standard landmarks associated with the primary facial features. A number of clinically identified landmarks lie on the facial midline. An efficient algorithm for detection and processing of the midline, using a point sampling technique, is also presented. The results obtained using data of more than 20 subjects are verified through visualization and physical measurements. A color based and triangle skewness based schemes for isolation of geometrically nonprominent features and ear region are also presented. [DOI: 10.1115/1.3330420]

General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

Magnetic resonance imaging and ultrasonography in brachial plexus birth injury

Brachial plexus birth injury (BPBI) is caused by stretching, tearing or avulsion of the C5-C8 or Th1 nerve roots during delivery. Foetal-maternal disproportion is the main reason for BPBI. The goal of this study was to find out the incidence of posterior subluxation of the humeral head during first year of life in BPBI and optimal timing of the ultrasonographic screening of the glenohumeral joint. The glenohumeral congruity and posterior subluxation of the humeral head associated to muscle atrophy were assessed and surgical treatment of the shoulder girdle as well as muscle changes in elbow flexion contracture were evaluated. The prospective, population based part of the study included all neonates born in Helsinki area during years 2003-2006. Patients with BPBI sent to the Hospital for Children and Adolescents because of decreased external rotation, internal rotation contracture or deformation of the glenohumeral joint as well as patients with elbow flexion contracture were also included in this prospective study. The incidence of BPBI was calculated to be 3.1/1000 newborns in Helsinki area. About 80% of the patients with BPBI recover totally during the follow-up within the first year of life. Permanent plexus injury at the age of one year was noted in 20% of the patients (0.64/1000 newborns). Muscle imbalance resulted in sonographically detected posterior subluxation in one third of the patients with permanent BPBI. If muscle imbalance and posterior subluxation are left untreated bony deformities will develop. All patients with internal rotation contracture of the glenohumeral joint presented muscle atrophy of the rotator cuff muscles. Especially subscapular and infraspinous muscles were affected. A correlation was found particularly between greatest thickness of subscapular muscle and subluxation of the humeral head, degree of glenoid retroversion, as well as amount of internal rotation contracture. Supinator muscle atrophy was evident among all the studied patients with elbow flexion contracture. Brachial muscle pathology seemed to be an important factor for elbow flexion contracture in BPBI. Residual dysfunction of the upper extremity may require operative treatment such as tendon lengthening, tendon transfers, relocation of the humeral head or osteotomy of the humerus. Relocation of the humeral head improved the glenohumeral congruency among patients under 5 years of age. Functional improvement without remodeling of the glenohumeral joint was achieved by other reconstructive procedures. In conclusion: Shoulder screening by US should be done to all patients with permanent BPBI at the age of 3 and 6 months. Especially atrophy of the subscapular muscle correlates with glenohumeral deformity and posterior subluxation of the humeral head, which has not been reported in previous studies. Permanent muscle changes are the main reason for diminished range of motion of the elbow and forearm. Relocation of the humeral head, when needed, should be performed under the age of 5 years.

Wegener's granulomatosis in Finland in 1981-2000

Objectives: Wegener s granulomatosis (WG) is a vasculitis with a predilection for the airways and kidneys. An increasing incidence and improved prognosis of WG has been shown. The aim of this study was to evaluate the incidence, clinical presentation, diagnostic delay, risk of dialysis-dependent renal insufficiency and mortality of WG in 1981-2000. Patients and methods: Data was retrieved from the Finnish hospital discharge register and hospital case reports. Patients diagnosed with WG in 1981-2000 were included, and their demographic and clinical data recorded. The patients were crossed with the national kidney dialysis register and the national mortality statistics. Results: A total of 492 patients (243 ♂ , 249 ♀) were diagnosed at a mean age of 54 years (SD 18). The incidence increased from 1.9 to 9.3/ million/ year. The median diagnostic delay decreased from 17 to 4 months. Patients presented most often with symptoms of the ear, nose and throat (ENT) (45%), lung (36%), musculoskeletal system (22%) and kidney (11%). Initial lung involvement, constitutional symptoms, high erythrocyte sedimentation rate (ESR) and high ELK scores [(number of simultaneously involved organ groups (ENT, Lung, Kidney)] were associated with a shorter diagnostic delay. Medical treatment of WG patients remained similar in the 1980s and 1990s. Almost 90% of patients received cyclophosphamide (CYC) and more than 90% glucocorticoid medication at some point during the course of the disease. Eighty-four patients (17%) needed dialysis. Initial renal involvement and elevated serum creatinine values were related to an increased risk of dialysis-dependent kidney disease. In two-thirds of the patients, renal impairment was reversible. Dialysis became chronic (>3 months) in 32 patients (6.5%). Nineteen patients (3.9%) received a kidney transplant. Altogether 203 patients (99 men, 104 women) died before 30 June 2005. WG was the underlying cause of death in 37%. The crude one-year and five-year survival rates were 83.3% and 74.2%, respectively. The standardized mortality ratio was 3.43 (95% CI = 2.98 to 3.94). Older age and elevated creatinine level at diagnosis predicted shorter survival. ENT symptoms at presentation and treatment with CYC were associated with better outcome. There was no additional risk associated with male gender or with either of the decades (1981-1990 and 1991-2000) Conclusions: In 1981-2000, the incidence of WG increased ca. 4.5-fold and diagnostic delay decreased to ca. one-fourth, reflecting increased recognition of the disease and improved diagnostic means. WG patients are at great risk of developing dialysis-dependent renal insufficiency and an increased risk of dying. During the study period the treatment of WG did not change markedly, nor did the prognosis improve.

A numerical study of projectile impact on mild steel armour plates

The present article deals with the development of a finite element modelling approach for the prediction of residual velocities of hard core ogival-nose projectiles following normal impact on mild steel target plates causing perforation. The impact velocities for the cases analysed are in the range 818–866.3 m/s. Assessment of finite element modelling and analysis includes a comprehensive mesh convergence study using shell elements for representing target plates and solid elements for jacketed projectiles with a copper sheath and a rigid core. Dynamic analyses were carried out with the explicit contact-impact LS-DYNA 970 solver. It has been shown that proper choice of element size and strain rate-based material modelling of target plate are crucial for obtaining test-based residual velocity.The present modelling procedure also leads to realistic representation of target plate failure and projectile sheath erosion during perforation, and confirms earlier observations that thermal effects are not significant for impact problems within the ordnance range. To the best of our knowledge, any aspect of projectile failure or degradation obtained in simulation has not been reported earlier in the literature. The validated simulation approach was applied to compute the ballistic limits and to study the effects of plate thickness and projectile diameter on residual velocity, and trends consistent with experimental data for similar situations were obtained.

Snoring and sleep apnea in children

Snoring is a primary and major clinical symptom of upper airway obstruction during sleep. Sleep-disordered breathing ranges from primary snoring to significant partial upper airway obstruction, and obstructive sleep apnea. Adult snoring and obstructive sleep apnea have been extensively studied, whereas less is known about these disorders in children. Snoring and more severe obstructive sleep apnea have been shown to have a harmful effect on the neurobehavioral development of children, but the mechanisms of this effect remains unknown. Furthermore, the correlation of this effect to objective sleep study parameters remains poor. This study evaluated the prevalence of snoring in preschool-aged children in Finland. Host and environmental risk factors, and neurobehavioral and neurocognitive symptoms of children suffering from snoring or obstructive sleep apnea were also investigated. The feasibility of acoustic rhinometry in young children was assessed. The prevalence and risk factors of snoring (I) were evaluated by a questionnaire. The random sample included 2100 children aged 1-6 years living in Helsinki. All 3- to 6-year-old children whose parents reported their child to snore always, often, or sometimes were categorized as snorers, and invited to participate to the clinical study (II-IV). Non-snoring children whose parents were willing to participate in the clinical study were invited to serve as controls. Children underwent a clinical ear-nose-throat examination. Emotional, behavioral, and cognitive performances were evaluated by Child Behavioral Checklist (CBCL), Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R) and NEPSY-A Developmental Neuropsychological Assessment (NEPSY). Nasal volume was measured by acoustic rhinometry, and nasal resistance by rhinomanometry. Lateral and posteroanterior cephalometry were performed. A standard overnight ambulatory polysomnography was performed in the home environment. Twenty-six healthy children were tested in order to assess the feasibility of acoustic rhinometry in young children (V). Snoring was common in children; 6.3% of children snored always or often, whereas 81.3% snored never or occasionally. No differences were apparent between snorers and non-snorers regarding age, or gender. Pediatric snoring was associated with recurrent upper respiratory infections, otitis media, and allergic rhinitis. Exposure to parental tobacco smoke, especially maternal smoking, was more common among snorers. Rhinitis was more common among children who exposured to tobacco smoke. Overnight polysomnography (PSG) was performed on 87 children; 74% showed no signs of significant upper airway obstruction during sleep. Three children had obstructive apnea/hypopnea index (OAHI) greater than 5/h. Age, gender, or a previous adenoidectomy or tonsillectomy did not correlate with OAHI, whereas tonsillar size did correlate with OAHI. Relative body weight and obesity correlated with none of the PSG parameters. In cephalometry, no clear differences or correlations were found in PSG parameters or between snorers and non-snorers. No correlations were observed between acoustic rhinometry, rhinomanometry, and PSG parameters. Psychiatric symptoms were more frequent in the snoring group than in the nonsnoring group. In particular, anxious and depressed symptoms were more prevalent in the snoring group. Snoring children frequently scored lower in language functions. However, PSG parameters correlated poorly with neurocognitive test results in these children. This study and previous studies indicate that snoring without episodes of obstructive apnea or SpO2 desaturations may cause impairment in behavioral and neurocognitive functions. The mechanism of action remains unknown. Exposure to parental tobacco smoke is more common among snorers than non-snorers, emphasizing the importance of a smoke-free environment. Children tolerated acoustic rhinometry measurements well.

Studies on Unsteady Pressure Fields in the Region of Separating and Reattaching Flows

Experimental studies on the measurement of pressure fields in the region of separating and reattaching flows behind several two-dimensional fore-bodies and one axisymmetric body are reported. In particular, extensive measurements of mean pressure, surface pressure fluctuation, and pressure fluctuation within the flow were made for a series of two-dimensional fore-body shapes consisting of triangular nose with varying included angle. The measurements from different bodies are compared and one of the important findings is that the maximum values of rms pressure fluctuation levels in the shear layer approaching reattachment are almost equal to the maximum value of the surface fluctuation levels.

Carotid Surgery : A posse ad esse non valet consequentia

According to a large body of evidence, carotid endarterectomy (CEA) can prevent strokes, provided that appropriate inclusion criteria and high-quality perioperative treatment methods are utilised with low complication rates. From the patient s perspective, it is of paramount importance that the operation is as safe and effective as possible. From the community s point of view, it is important that CEA provision prevents as many strokes as possible. In order to define the stroke preventing potential of CEA in different communities, a comparison between eight European countries and Australia was performed including 53 077 carotid interventions. A more detailed evaluation was performed in Finland, the United Kingdom and Egypt. It could be estimated that many potentially preventable strokes occur due to insufficient diagnostics and CEA provision. The number of CEAs should be at least doubled in the Helsinki region. The theoretical power of CEA provision in stroke prevention varied significantly between the countries. Delay from symptom to surgery has been identified as one of the most important factors influencing the effectiveness of CEA. In 2008 only 11% of CEAs in Helsinki university central hospital (HUCH) were performed within the recommended14 days. Registered data of 673 CEAs in HUCH during 2000-2005 was analyzed. There was no systematic error that would have changed the outcome analysis. However it is important that registers are audited regularly and cross matching of different registries is possible. A previously unpublished method of combining medial mandibulotomy, neck incision and carotid artery interposition was carried out as a collaboration of maxillofacial, ear, nose and throat and vascular surgeons. Five patients were operated on with a technique that was feasible and possible to perform with little morbidity, but due to the significant risks involved, this technique should be reserved for carefully selected cases. In stroke prevention, organisational decisions seem far more important than details in interventional procedures when CEA is performed with low complication rates, as was the case in the present study. A TIA clinic approach with close co-operation between the on-call vascular surgeons, neurologists and radiologists should be available at all centres treating these patients. Patients should have a direct and fast admission to the hospital performing CEA.

Mean and fluctuating pressure in boat-tail separated flows at transonic speeds

Experiments were carried out investigating the features of mean and unsteady surface pressure fluctuations in boat-tail separated flows relevant to launch vehicle configurations at transonic speeds. The tests were performed on a generic axisymmetric body in the Mach-number range of 0.7-1.2, and the important geometrical parameters, namely, the boat-tail angle and diameter ratio, were varied systematically. The measurements made included primarily the mean and unsteady surface-pressure fluctuations on nine different model configurations. Flow-visualization studies employing a surface oil flow, and schlieren techniques were carried out to infer features like boundary-layer separation, reattachment, and shock waves in the flow. The features of mean and fluctuating surface pressures are discussed in detail including aspects of similarity. It has been observed that, on a generic configuration employed in the present study, the maximum levels of surface-pressure fluctuations in the reattachment zone are appreciably lower than those found on launch vehicle configurations having a bulbous or hammerhead nose shape. A simple correlation is suggested for the maximum value of rms pressure fluctuations in the reattachment zone at different freestream Mach numbers.

Inception of Cavitation From a Backward Facing Step

Cavitation inception measurements are reported for flow past a downstream facing step with the height of the step varying from about 0.4 to 5 percent of the forebody diameter. The forebody was a 49 mm hemispherical nose and sigmai values were found to be very strong function of the height of the step. In addition, sigmai values were found to depend on whether the boundary layer approaching the step was laminar or turbulent. Generally sigmai values for turbulent case were lower.

Effect of gas injection on drag and surface heat transfer rates for a 30 degrees semi-apex angle blunt body flying at Mach 5.75

Effect of coolant gas injection in the stagnation region on the surface heat transfer rates and aerodynamic drag for a large angle blunt body flying at hypersonic Mach number is reported for two stagnation enthalpies. A 60° apex-angle blunt cone model is employed for this purpose with air injection at the nose through a hole of 2mm diameter. The convective surface heating rates and aerodynamic drag are measured simultaneously using surface mounted platinum thin film sensors and internally mounted accelerometer balance system, respectively. About 35–40% reduction in surface heating rates is observed in the vicinity of stagnation region whereas 15–25% reduction in surface heating rates is felt beyond the stagnation region at stagnation enthalpy of 1.6MJ/kg. The aerodynamic drag expressed in terms of drag coefficient is found to increase by 20% due to the air injection.

Ballistic Studies on TiB2-Ti Functionally Graded Armor Ceramics

The objective of this paper is to discuss the results of the ballistic testing of spark plasma sintered TiB2-Ti based functionally graded materials (FGMs) with an aim to assess their performance in defeating small-calibre armor piercing projectiles. We studied the efficacy of FGM design and compared its ballistic properties with those of TiB2-based composites as well as other competing ceramic armors. The ballistic properties are critically analyzed in terms of depth of penetration, ballistic efficiency, fractographs of fractured surfaces as well as quantification of the shattered ceramic fragments. It was found that all the investigated ceramic compositions exhibit ballistic efficiency (eta) of 5.1 -5.9. We also found that by increasing the thickness of FGM from 5 mm to 7.8 mm, the ballistic property of the composite degraded. Also, the strength of the ceramic compositions studied is sufficient to completely fracture the nose of the pointed projectile used. Analysis of the ceramic fragments (2 mu m-10 mm) showed that harder the ceramic, coarser were the fragments formed. On comparing the results with available armor systems, it has been concluded that TiB2 based composites can show better ballistic properties, except B4C. SEM analysis of the fragments obtained after testing with FGM showed formation of cleavage steps as well as presence of intergranular cracks, indicating that the FGM fractured by mixed mode of failure. It can be concluded that the FGM developed has lower ballistic properties compared to its monolith TiB2-20 wt.% Ti.

The ballistic resistance of thin aluminium plates with varying degrees of fixity along the circumference

The ballistic performance of thin aluminium targets and influence thereon of different circumferential fixity conditions were studied both experimentally and by finite element simulations. A pressure gun was employed to carry out the experiments while the numerical simulations were performed on ABAQUS/Explicit finite element code using Johnson-Cook elasto-viscoplastic material model. 1 mm thick 1100-H12 aluminium plates of free span diameter 255 mm were normally impacted by 19 mm diameter ogive and blunt nosed projectiles. The boundary conditions of the plate were varied by varying the region of fixity along its circumference as 100%, 75%, 50% and 25% in experiments and the numerical simulations. Further, simulations were carried out to compare the response of the plates with 50% and 75% continuous fixity with those with two and three symmetrical intermittent regions of 25% fixity respectively. The variation in the boundary condition has been found to have insignificant influence on the failure mode of the target however; it significantly affected the mechanics of target deformation and its energy absorption capacity. The ballistic limit increased with decrease in the region of fixity. It decreased for intermittent fixity in comparison with equivalent continuous fixity. And, it has been found to be higher for the impact with projectile having blunt nose in comparison with the one having ogive nose. (C) 2014 Elsevier Ltd. All rights reserved.

On the impact of a concave nosed axisymmetric body on a free surface

We report on an experimental study of the vertical impact of a concave nosed axisymmetric body on a free surface. Previous studies have shown that bodies with a convex nose, like a sphere, produce a well defined splash with a relatively large cavity behind the model. In contrast, we find that with a concave nose, there is hardly a splash and the cavity extent is greatly reduced. This may be explained by the fact that in the concave nosed case, the initial impact is between a confined air pocket and the free surface unlike in the convex nosed case. From measurements of the unsteady pressure in the concave nose portion, we show that in this case, the maximum pressures are significantly lower than the classically expected ``water hammer'' pressures and also lower than those generally measured on other geometries. Thus, the presence of an air pocket in the case of a concave nosed body adds an interesting dimension to the classical problem of impact of solid bodies on to a free surface. (C) 2015 AIP Publishing LLC.

Direct Numerical Simulation Of Hypersonic Boundary-Layer Transition Over A Blunt Cone

Direct numerical simulation of transition How over a blunt cone with a freestream Mach number of 6, Reynolds number of 10,000 based on the nose radius, and a 1-deg angle of attack is performed by using a seventh-order weighted essentially nonoscillatory scheme for the convection terms of the Navier-Stokes equations, together with an eighth-order central finite difference scheme for the viscous terms. The wall blow-and-suction perturbations, including random perturbation and multifrequency perturbation, are used to trigger the transition. The maximum amplitude of the wall-normal velocity disturbance is set to 1% of the freestream velocity. The obtained transition locations on the cone surface agree well with each other far both cases. Transition onset is located at about 500 times the nose radius in the leeward section and 750 times the nose radius in the windward section. The frequency spectrum of velocity and pressure fluctuations at different streamwise locations are analyzed and compared with the linear stability theory. The second-mode disturbance wave is deemed to be the dominating disturbance because the growth rate of the second mode is much higher than the first mode. The reason why transition in the leeward section occurs earlier than that in the windward section is analyzed. It is not because of higher local growth rate of disturbance waves in the leeward section, but because the growth start location of the dominating second-mode wave in the leeward section is much earlier than that in the windward section.