The difficult-to-treat, therapy-resistant cough: Why are current cough treatments not working and what can we do?

Cough can persist despite exhaustive diagnostic and therapeutic effort and has been termed 'idiopathic' or 'unexplained' but perhaps 'difficult to treat' cough is a more appropriate description. In this article the reasons for poor treatment response are discussed. These include a lack of physician fidelity to management guidelines, patient non-adherence and the lack of effective medicines. A number of randomized controlled trials have been undertaken including low dose opiate therapy, the use of a speech pathology intervention, oral antibiotics and antidepressants. The success or otherwise of such interventions will be discussed. A number of approaches to deal with the problem of 'difficult to treat cough' will be considered.

Dendrons with spermine surface groups as potential building blocks for nonviral vectors in gene therapy

This paper investigates a series of dendrons based on the Newkome dendritic scaffold that displays a naturally occurring polyamine (spermine) on their surface. These dendrons have previously been shown to interact with DNA in a generation dependent manner with the more highly branched dendrons exhibiting a strong multivalency effect for the spermine surface groups. In this paper, we investigate the ability of these dendrons to transfect DNA into cells (human breast carcinoma cells, MDA-MB-231, and murine myoblast cells, C2C12) as determined by the luciferase assay. Although the dendrons are unable to transfect DNA in their own right, they are capable of delivering DNA in vitro when administered with chloroquine, which assists with escape from endocytic vesicles. The cytotoxicity of the dendrons was determined using the XTT assay, and it was shown that the dendrons were nontoxic either alone or in the presence of DNA. However, when administered with DNA and chloroquine, the most highly branched dendron did exhibit some cytotoxicity. This paper elucidates the relationship between in vitro transfection efficiency and toxicity. While transfection efficiencies are modest, the low toxicity of the dendrons, both in their own right, and in the presence of DNA, provides encouragement that this type of building block, which has a relatively high affinity for DNA, will provide a useful starting point for the further synthetic development of more effective gene transfection agents.

Investigation of Aircraft Panel Deformations during Riveting Process

In collaboration with Airbus-UK, the dimensional growth of small panels while being riveted with stiffeners is investigated. The stiffeners have been fastened to the panels with rivets and it has been observed that during this operation the panels expand in the longitudinal and transverse directions. It has been observed that the growth is variable and the challenge is to control the riveting process to minimize this variability. In this investigation, the assembly of the small panels and longitudinal stiffeners has been simulated using low and high fidelity nonlinear finite element models. The models have been validated against a limited set of experimental measurements; it was found that more accurate predictions of the riveting process are achieved using high fidelity explicit finite element models. Furthermore, through a series of numerical simulations and probabilistic analyses, the manufacturing process control parameters that influence panel growth have been identified. Alternative fastening approaches were examined and it was found that dimensional growth can be controlled by changing the design of the dies used for forming the rivets.

Prediction of Limit Cycle Oscillations Using an Implicit Aeroelastic-Harmonic Balance Method

This work proposes a extends a novel approach to compute tran sonic Limit Cycle Oscillations using high fidelity analysis. CFD based Harmonic Balance methods have proven to be efficient tools to predict periodic phenomena. This paper’s contribution is to present a methodology to determine the unknown frequency of oscillations using an implicit for- mulation of the HB method to accurately capture Limit Cycle Oscillations (LCOs); this is achieved by defining a frequency updating procedure based on a coupled CFD/CSD Harmonic Balance formulation to find the LCO condition. A pitch/plunge aerofoil and respective linear structural models is used to exercise the new method. Results show consistent agreement between the proposed and time-marching methods for both LCO amplitude and frequency.

Investigation of Limit Cycle Oscillations Using Aeroelastic-Harmonic Balance Method

This work investigates limit cycle oscillations in the transonic regime. A novel approach to predict Limit Cycle Oscillations using high fidelity analysis is exploited to accelerate calculations. The method used is an Aeroeasltic Harmonic Balance approach, which has been proven to be efficient and able to predict periodic phenomena. The behaviour of limit cycle oscillations is analysed using uncertainty quantification tools based on polynomial chaos expansions. To improve the efficiency of the sampling process for the polynomial-chaos expansions an adaptive sampling procedure is used. These methods are exercised using two problems: a pitch/plunge aerofoil and a delta-wing. Results indicate that Mach n. variability is determinant to the amplitude of the LCO for the 2D test case, whereas for the wing case analysed here, variability in the Mach n. has an almost negligible influence in amplitude variation and the LCO frequency variability has an almost linear relation with Mach number. Further test cases are required to understand the generality of these results.

A study to evaluate the introduction of simulation as a teaching strategy for the mental health and learning disability fields of nursing, in an undergraduate nursing curriculum within one higher education institution

High Fidelity Simulation or Human Patient Simulation is an educational strategy embedded within nursing curricula throughout many healthcare educational institutions. This paper reports on an evaluative study that investigated the views of a group of Year 2 undergraduate nursing students from the mental health and the learning disability fields of nursing (n = 75) in relation to simulation as a teaching pedagogy. The study took place in the simulation suite within a School of Nursing and Midwifery in the UK. Two patient scenarios were used for the session and participants completed a 22-item questionnaire consisting of three biographical information questions and a 19-item Likert scale. Descriptive statistics were employed to illustrate the data and non-parametric testing (Mann-Whitney U test) was employed to test a number of hypotheses. Overall students were positive about the introduction of patient scenarios using the human patient simulator into the undergraduate nursing curriculum. This study used a small, convenience sample in one institution and therefore the results obtained cannot be generalised to nursing education before further research can be conducted with larger samples and a mixed-method research approach. However these results provide encouraging evidence to support the use of simulation within the mental health and the learning disability fields of nursing, and the development and implementation of further simulations to complement the students’ practicum.

Simulated peer assessment initiative aimed at increasing the competency of nursing students within fields of nursing

Newly qualified nurses have been educated and assessed as being proficient carrying out certain procedures ,one such insertion of nasogastric feeding tube. Link between theory and practice will be explored. Highlighting the value of low fidelity simulation and peer assessment to enhance skills and competencies.

Evaluation of Multidisciplinary Delivery of Surgical Anatomy Teaching

Title Evaluation of Multidisciplinary Delivery of Surgical Anatomy Teaching

Authors Walsh I.K., Taylor S.J., Dorman A, Boohan M.

Objectives To evaluate the efficacy of newly introduced multidisciplinary methods to deliver Surgical Anatomy teaching to undergraduate medical students.

Design and Setting Qualitative and quantitative study using questionnaires and focus groups, employing students of the perioperative and emergency medicine (POEM) module of the phase 4 undergraduate medical curriculum at Queen’s University Belfast.

Outcome Measures To determine:
(1) if multidisciplinary teaching is effective in delivering surgical anatomy teaching,
(2) student’s learning preferences regarding this teaching method.
Results The questionnaire response rate was 89% (216 of 244 students; female: male ratio 1.25) and 42 students participated in 6 focus groups. Mean questionnaire responses indicated a favourable opinion on quality assurance items and multidisciplinary teaching. 81% of students agreed that multidisciplinary teaching enhanced learning and 86% felt that this did not adversely affect interaction. A positive contribution towards POEM learning was reported for Radiology (95% of students), Anatomy (93%) and Surgery (78%). The benefits of multidisciplinary teaching were congruent for Anatomy, Radiology and Surgery with 78% of students indicating a perceived favourable association with learning. Multidisciplinary teaching was not associated with diluted interaction, with 62% of students describing interaction as sufficient. 88% of students positively ranked tutor characteristics of enthusiasm and encouragement as being strongly associated with teacher quality. Positive perception of overall quality was strongly associated with learning preferences as well as more generic quality assurance issues (80% students; alpha coefficient 0.83).
The results were supported by triangulation of the above quantitative data with qualitative data generated by the focus groups. Whilst students frequently misunderstood the meaning of “multidisciplinary teaching”, there was an appreciation of the method’s worth; students recognised and valued the relevance of Anatomy, Radiology and Surgery teaching to POEM learning. The importance of vertically integrating Anatomy into all stages of the undergraduate curriculum was especially recognised.

Reference Aarnio M, Nieminen J, Pyorala E, Lindbolm-Ylanne S. Motivating medical students to learn. 2010 Med Teach;32(4):199-204.

Multiobjective design optimization of IGBT power modules considering power cycling and thermal cycling

Insulated-gate bipolar transistor (IGBT) power modules find widespread use in numerous power conversion applications where their reliability is of significant concern. Standard IGBT modules are fabricated for general-purpose applications while little has been designed for bespoke applications. However, conventional design of IGBTs can be improved by the multiobjective optimization technique. This paper proposes a novel design method to consider die-attachment solder failures induced by short power cycling and baseplate solder fatigue induced by the thermal cycling which are among major failure mechanisms of IGBTs. Thermal resistance is calculated analytically and the plastic work design is obtained with a high-fidelity finite-element model, which has been validated experimentally. The objective of minimizing the plastic work and constrain functions is formulated by the surrogate model. The nondominated sorting genetic algorithm-II is used to search for the Pareto-optimal solutions and the best design. The result of this combination generates an effective approach to optimize the physical structure of power electronic modules, taking account of historical environmental and operational conditions in the field.

Building pH Sensors into Paper-based Small-molecular Logic Sys-tems for Very Simple Detection of Edges of Objects

Genetically-engineered bacteria and reactive DNA networks detect edges of objects, as done in our retinas and as also found within computer vision. We now demonstrate that simple molecular logic systems (a combination of a pH sensor, a photo acid generator and a pH buffer spread on paper) without any organization can achieve this relatively complex computational goal with good-fidelity. This causes a jump in the complexity achievable by molecular logic-based computation and extends its applicability. The molecular species involved in light dose-driven 'off-on-off' fluorescence is diverted in the ‘on’ state by proton diffusion from irradiated to unirradiated regions where it escapes a strong quencher, thus visualizing the edge of a mask.

Prediction of Transonic Limit-Cycle Oscillations Using an Aeroelastic Harmonic Balance Method

This work proposes a novel approach to compute transonic limit-cycle oscillations using high-fidelity analysis. Computational-Fluid-Dynamics based harmonic balance methods have proven to be efficient tools to predict periodic phenomena. This paper’s contribution is to present a new methodology to determine the unknown frequency of oscillations, enabling harmonic balance methods to accurately capture limit-cycle oscillations; this is achieved by defining a frequency-updating procedure based on a coupled computational-fluid-dynamics/computational-structural-dynamics harmonic balance formulation to find the limit-cycle oscillation condition. A pitch/plunge airfoil and delta wing aerodynamic and respective linear structural models are used to validate the new method against conventional time-domain simulations. Results show consistent agreement between the proposed and time-marching methods for both limit-cycle oscillation amplitude and frequency while producing at least a one-order-of-magnitude reduction in computational time.

Interface management for automating finite element analysis workflows

This paper outlines the importance of robust interface management for facilitating finite element analysis workflows. Topological equivalences between analysis model representations are identified and maintained in an editable and accessible manner. The model and its interfaces are automatically represented using an analysis-specific cellular decomposition of the design space. Rework of boundary conditions following changes to the design geometry or the analysis idealization can be minimized by tracking interface dependencies. Utilizing this information with the Simulation Intent specified by an analyst, automated decisions can be made to process the interface information required to rebuild analysis models. Through this work automated boundary condition application is realized within multi-component, multi-resolution and multi-fidelity analysis workflows.

Finite element modelling of composite structures under crushing load

This paper details the theory and implementation of a composite damage model, addressing damage within a ply (intralaminar) and delamination (interlaminar), for the simulation of crushing of laminated composite structures. It includes a more accurate determination of the characteristic length to achieve mesh objectivity in capturing intralaminar damage consisting of matrix cracking and fibre failure, a load-history dependent material response, an isotropic hardening nonlinear matrix response, as well as a more physically-based interactive matrix-dominated damage mechanism. The developed damage model requires a set of material parameters obtained from a combination of standard and non-standard material characterisation tests. The fidelity of the model mitigates the need to manipulate, or "calibrate", the input data to achieve good agreement with experimental results. The intralaminar damage model was implemented as a VUMAT subroutine, and used in conjunction with an existing interlaminar damage model, in Abaqus/Explicit. This approach was validated through the simulation of the crushing of a cross-ply composite tube with a tulip-shaped trigger, loaded in uniaxial compression. Despite the complexity of the chosen geometry, excellent correlation was achieved with experimental results.

Predicting low velocity impact damage and Compression-After-Impact (CAI) behaviour of composite laminates

Low-velocity impact damage can drastically reduce the residual strength of a composite structure even when the damage is barely visible. The ability to computationally predict the extent of damage and compression-after-impact (CAI) strength of a composite structure can potentially lead to the exploration of a larger design space without incurring significant time and cost penalties. A high-fidelity three-dimensional composite damage model, to predict both low-velocity impact damage and CAI strength of composite laminates, has been developed and implemented as a user material subroutine in the commercial finite element package, ABAQUS/Explicit. The intralaminar damage model component accounts for physically-based tensile and compressive failure mechanisms, of the fibres and matrix, when subjected to a three-dimensional stress state. Cohesive behaviour was employed to model the interlaminar failure between plies with a bi-linear traction–separation law for capturing damage onset and subsequent damage evolution. The virtual tests, set up in ABAQUS/Explicit, were executed in three steps, one to capture the impact damage, the second to stabilize the specimen by imposing new boundary conditions required for compression testing, and the third to predict the CAI strength. The observed intralaminar damage features, delamination damage area as well as residual strength are discussed. It is shown that the predicted results for impact damage and CAI strength correlated well with experimental testing without the need of model calibration which is often required with other damage models.

Modelling Damage in Thin-Walled Structures [Keynote speaker]

A high-fidelity composite damage model is presented and applied to predict low-velocity impact damage, compression after impact (CAI) strength and crushing of thin-walled composite structures. The simulated results correlated well with experimental testing in terms of overall force-displacement response, damage morphologies and energy dissipation. The predictive power of this model makes it suitable for use as part of a virtual testing methodology, reducing the reliance on physical testing.