Cobham (United States)

New patient visits in the orthopaedic oncology clinic are medically complex and emotionally nuanced. Previous orthopaedic literature has shown that clear communication of the diagnosis and plan can be difficult, resulting in worse outcomes. This study aimed to validate the use of a novel patient encounter card (PEC) to improve patient/physician postencounter satisfaction. All new patients who presented to the clinics of three fellowship-trained orthopaedic oncologists from September 2023 to March 2025 were included. In the preintervention phase, visits were conducted without modification. Patients were queried on satisfaction, whether concerns were addressed, understanding of the treatment plan, and perceived patient/physician connection. During the intervention phase, a PEC was implemented. The "patient" side was completed in the waiting room; the "physician" side during the visit. Patients then completed the same postvisit survey. Residents and fellows were surveyed at the end of each clinic. All statistical analysis was done using STATA V18. A total of 245 patients were surveyed. During the intervention phase, patient scores improved across all 12 patient satisfaction and competency metrics. Following the intervention, 94% of patients strongly agreed that the doctor listened to what they had to say and 93% felt that their main concern had been addressed. Compared with the control group, markedly more patients reported being "very satisfied" with their visit (P = 0.048) and "very confident" that they made the most of their visit (P = 0.041). Markedly more patients also reported that they were involved in their treatment plan as much as they wanted to be (P = 0.046). Finally, 100% of surveyed physicians believed that the intervention improved clinical efficiency. PECs improve patient experience and strengthen patient-physician communication while maintaining clinical efficiency in orthopaedic oncology consultations. This simple, low-cost intervention may be effective across a range of medical and surgical specialties.

Background: The Impella ventricular assist device is often used in patients (pts) with complex coronary artery disease undergoing high-risk percutaneous coronary interventions (PCI). Limited data exits on the risks and benefits of these devices in elderly pts. Aim: To compare major bleeding and major adverse cardiac and cerebrovascular events (MACCE) in pts undergoing Impella-assisted PCI, categorized by age groups. Methods: Data was collected for quality control on pts undergoing Impella-assisted PCI. Pts were divided by age into three groups: ≤69, 70-79 and ≥80 years. Bleeding was classified by Bleeding Academic Research Consortium (BARC). MACCE was the composite of major bleeding (BARC ≥3), death and post-PCI myocardial infarction and stroke. Results: From 2010 to 2018, 252 pts had Impella-assisted PCI (Table). Pts ≤69 were often male, presented with STEMI or NSTEMI (61%) and had lower left ventricular ejection fraction (LVEF) complicated by cardiogenic shock (CS). Bleeding complications, mortality and MACCE were similar among the groups. Covariate adjustment showed pts 70-79 were not at a higher risk of MACCE compared to ≤69 pts, whereas pts ≥80 had 2.7-fold odds of MACCE compared to pts ≤69 (Figure). Conclusion: In Impella-assisted PCI pts: 1) indications for Impella varies across different ages; 2) younger pts (≤69) were healthier but in the midst of an acute coronary syndrome with severely reduced LVEF and CS; 3) BARC ≥3, mortality and MACCE were similar among the three groups; 4) by multivariable analysis, older age, female sex, STEMI and pre-PCI CS were independent predictors of MACCE; and 5) the odds of MACCE increased by almost 3-fold in pts ≥80 when compared to younger pts.

This letter presents the development of a dc–20 GHz impedance tuner in a 45-nm silicon-on-insulator complementary metal–oxide–semiconductor (CMOS) process. The proposed tuner consists of several short transmission line sections and tunable capacitors made up of small interdigital capacitors and switches. To increase the power handling capability, a switch topology using triple-stacked transistors and parallel capacitors is developed. The combination of the tuner architecture and the capacitor-switch arrangement enables the new tuner to have wideband operation, good tuning range, low loss, and high-power handling. The fabricated tuner can operate with RF power up to 27 dBm and provide a characteristic impedance tuning range from 56 to <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$36~\Omega $ </tex-math></inline-formula> over dc–20-GHz bandwidth. In different operating states, the tuner demonstrates an insertion loss of 0.25–1.25 dB, an output 1-dB compression point (OP1dB) of better than 24 dBm, and an input third-order intercept point (IIP3) of better than 40 dBm.

The use of non-invasive ventilation (NIV) devices such as continuous positive airway pressure and bi-level positive airway pressure machines have been associated with an increased incidence of dry eye disease (DED). To understand how the use of these ventilation masks impacts the eyes, a review of the pathophysiology of DED and an evaluation of recent studies investigating the effects of NIV use on the severity and incidence of this condition were performed. It was found that the use of face masks associated with the ventilation devices exhibited a positive correlation to the incidence and severity of numerous ocular pathologies. However, the benefits of non-invasive mechanical ventilation are undeniable in treating conditions such as obstructive sleep apnea, chronic obstructive pulmonary disease, and respiratory failure; therefore, proper education, behavioral modifications, and treatment can help reduce or prevent the adverse effects that NIV have on the eyes.

Timing Verification is a fundamental step in real-time embedded systems, with measurement-based timing analysis (MBTA) being the most common approach used to that end. We present a Space case study on a real platform that has been modified to support a probabilistic variant of MBTA called MBPTA. Our platform provides the properties required by MBPTA with the predicted WCET estimates with MBPTA being competitive to those with current MBTA practice while providing more solid evidence on their correctness for certification.

Coupling between closely spaced wideband analog radio frequency integrated circuits can cause degradation in device performance. Methods for reducing the coupling between packages were tested, with a strong focus on maintaining manufacturability and minimizing any increase in coupling between structures within the package. Methods include the application of magnetic absorbing material or resistive sheets to the package surface and the inclusion of conductive vias in the package walls. Package modifications were tested from 5–40 GHz through both full-wave simulation and physical measurement. The best tradeoff in performance and manufacturability below 20 GHz was found using 250-Ω/sq. resistive sheets connected to the return plane with vias in the package corners, while above 20 GHz, the best tradeoff was found by covering the package with magnetic absorbing materials. The magnetic absorbing material can be embedded directly in the package polymer itself, allowing easy manufacture.

Tasks running in MPSoCs experience contention delays when accessing MPSoC's shared resources, complicating task timing analysis and deriving execution time bounds. Understanding the Actual Contention Delay (ACD) each task suffers due to other corunning tasks, and the particular hardware shared resources in which contention occurs, is of prominent importance to increase confidence on derived execution time bounds of tasks. And, whenever those bounds are violated, ACD provides information on the reasons for overruns. Unfortunately, existing MPSoC designs considered in real-time domains offer limited hardware support to measure tasks' ACD losing all these potential benefits. In this paper we propose the Contention Cycle Stack (CCS), a mechanism that extends performance monitoring counters to track specific events that allow estimating the ACD that each task suffers from every contending task on every hardware shared resource. We build the CCS using a set of specialized low-overhead Performance Monitoring Counters for the Cobham Gaisler GR740 (NGMP) MPSoC — used in the space domain — for which we show CCS's benefits.