Adapted Tricycle

This Final Design Review document describes the senior design project carried out by a team of four mechanical engineering students from California Polytechnic State University, San Luis Obispo in conjunction with California Children’s Services for Savannah, a student at San Luis Obispo High School. The purpose of the project is to design an adaptive vehicle for Savannah that serves as a form of exercise and can be easily operated by her with little to no outside assistance. Background into Savannah’s condition is provided as well as previous designs of similar adaptive tricycles, document standards and specifications which constrain design solutions, outline the scope of the project as well as the needs and wants of the end user as understood by the team, and develop a path towards the final design through description of the design process. The final design described in this document is centered around the user’s strongest muscle group (her abdomen and back muscles) to provide all necessary tricycle functions. These functions include steering, powering and braking. In general, the steering mechanism will utilize bevel gears to actuate the front wheel of the tricycle, the powering system will be a ratcheting push bar that is harnessed to the user’s torso, and the braking system will be a brake pad on the front wheel that is engaged by leaning back in the seat. This document contains our team’s process for developing our final design, solid model of our final design, justification calculations, manufacturing plans and engineering drawings, and our schedule for completion of the final product. In addition, a summary of the effects of the COVID-19 pandemic on project completion is provided, including an outline of future documentation which will aid an outside party in development and completion of our intended design, as well as the team’s revised project direction and scope

Thrombelastography and Conventional Coagulation Markers in Chronic Obstructive Pulmonary Disease:A Prospective Paired-Measurements Study Comparing Exacerbation and Stable Phases

Chronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge. This was a multi-center cohort study. COPD patients were enrolled within 72 h of hospitalization. The baseline assessments were Kaolin-TEG and blood samples. Statistical analysis involved using descriptive statistics; the main analysis was a paired t-test comparing coagulation parameters between exacerbation and follow-up. One hundred patients participated, 66% of whom were female, with a median age of 78.5 years and comorbidities including atrial fibrillation (18%) and essential arterial hypertension (45%), and sixty-five individuals completed a follow-up after discharge. No significant variations were observed in Kaolin-TEG or conventional coagulation markers between exacerbation and follow-up. The Activated Partial Thromboplastin Clotting Time (APTT) results were near-significant, with p = 0.08. In conclusion, TEG parameters displayed no significant alterations between exacerbation and follow-up. </p

Calcium Channel Blockers and the Risk of Exacerbation in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Study of 48,488 Outpatients

Patients with chronic obstructive pulmonary disease (COPD) are prone to developing arterial hypertension, and many patients are treated with the calcium channel blocker amlodipine. However, it remains unclear whether using this drug potentially affects the risk of acute severe exacerbations (AECOPD) and all-cause mortality in these patients. The data were collected from Danish national registries, containing complete information on health, prescriptions, hospital admissions, and outpatient clinic visits. The COPD patients (n = 48,488) were matched via propensity score on known predictors of the primary outcome in an active comparator design. One group was exposed to amlodipine treatment, and the other was exposed to bendroflumethiazide, since both of these drugs are considered to be the first choice for the treatment of arterial hypertension according to Danish guidelines. The use of amlodipine was associated with a reduced risk of death from all causes at the 1-year follow-up (hazard ratio 0.69, 95% confidence interval: 0.62–0.76) compared with the use of bendroflumethiazide in the matched patients. No difference in the risk of severe AECOPD was found. In the COPD patients, amlodipine use was associated with a lower risk of death from all causes compared with the use of bendroflumethiazide. Amlodipine seems to be a safe first choice for the treatment of arterial hypertension in COPD patients.publishedVersio