Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care

Background: It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care. Methodology/Principal Findings: Cancer patients receiving radiotherapy over abdominal/pelvic regions were randomized to verum (penetrating) acupuncture (n = 109; 99 provided data) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106; 101 provided data) performed with a telescopic non-penetrating needle at a sham point 2-3 times/week during the whole radiotherapy period. The acupuncture cohort was compared to a reference cohort receiving standard care (n = 62; 62 provided data). The occurrence of emesis in each group was compared after a mean dose of 27 Gray. Nausea and vomiting were experienced during the preceding week by 37 and 8% in the verum acupuncture group, 38 and 7% in the sham acupuncture group and 63 and 15% in the standard care group, respectively. The lower occurrence of nausea in the acupuncture cohort (verum and sham) compared to patients receiving standard care (37% versus 63%, relative risk (RR) 0.6, 95 % confidence interval (CI) 0.5-0.8) was also true after adjustment for potential confounding factors for nausea (RR 0.8, CI 0.6 to 0.9). Nausea intensity was lower in the acupuncture cohort (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p = 0.002). The acupuncture cohort expected antiemetic effects from their treatment (95%). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (RR 1.6; Cl 1.2-2.4). Conclusions/Significance: Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving standard care, possibly through a general care effect or due to the high level of patient expectancy.Original Publication:Anna Enblom, Mats Lekander, Mats Hammar, Anna Johnsson, Erik Onelov, Martin Ingvar, Gunnar Steineck and Sussanne Börjeson, Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care, 2011, PLOS ONE, (6), 3, .http://dx.doi.org/10.1371/journal.pone.0014766Licensee: Public Library of Science (PLoS)http://www.plos.org

Application of Fastsim with variable coefficient of friction using twin disc experimental measurements

In the field of railway simulation, it is a general assumption to consider the coefficient of friction as a known and constant value. This hypothesis is clearly not correct as friction is a consequence of the operating conditions (an output, not an input) and many factors can cause friction coefficient to change. In this paper, numerical algorithms based on the simplified theory of Kalker (Fastsim) and capable of modelling variable friction are studied and improved to match experimental measurements. Experimental creep curves from twin disc measurements are used to extract the friction parameters required by the numerical algorithms. Different friction functions are tested to correlate the effect of the contaminants and the pressure on the coefficient of friction. Finally, two examples are shown to highlight the differences between modelling the wheel–rail contact with variable or constant coefficient of friction and their implications in the estimation of the interaction forces and wear.This research was supported by Universitat Politecnica de Valencia (Spain).Rovira Cardete, A.; Roda Buch, A.; Lewis, R.; Marshall, M. (2012). Application of Fastsim with variable coefficient of friction using twin disc experimental measurements. Wear. 274-275:109-126. doi:10.1016/j.wear.2011.08.019S109126274-27

Prediction model for wheel profile wear and rolling contact fatigue

A lifetime prediction tool for railway wheels and rails should be able to predict both wear and rolling contact fatigue (RCF), which are the two main deterioration phenomena. Several models exist to predict wear or RCF, but not many models exist which can predict both. In this study, two of these RCF prediction models have been extended. The performance of these models has been studied through a parametric study where multi-body simulations (MBS) provided the input to the models. The influences of several parameters which can have an effect on the wheel/rail life have been studied in order to find the behaviour of the different models. These parameters are: curve radius, worn wheel and rail profiles, coefficient of friction, primary stiffness, track irregularities, and cant deficiency. This paper describes the differences between the two models and shows that the adjustments of the models have a significant influence on RCF prediction.</p

Proposed procedure and trial simulation of rail profile evolution due to uniform wear

A procedure for numerical simulation of rail wear and the corresponding profile evolution has been formulated. The wear is assumed to be uniform in the sense that the profiles remain constant along the track portion to be investigated. A simulation set is selected defining the vehicles running on the track, their operating conditions, and contact parameters. Several variations of input data may be included together with the corresponding occurrence probability. Simulation of multi-body dynamics is used to calculate contact forces and positions, and Archard's wear equation is applied for the calculation of wear depth. Wear coefficients as a function of contact pressure and relative sliding velocity are collected from different test results. Trial calculations of four non-lubricated and two lubricated curves with radii from 303 to 802 m show qualitatively reasonable results in terms of profile shape development and difference in wear mechanisms between gauge corner and rail head. The wear rates related to traffic tonnage are, however, overestimated and the lubrication efficiency underestimated. It is expected that model refinements in terms of environmental influence and contact stress calculation are useful to improve the quantitative results.</p

A simplified index for evaluating subsurface initiated rolling contact fatigue from field measurements

A previous simplification of the Dang Van equivalent stress measure for assessment of subsurface initiated rolling contact fatigue (RCF) related to wheel-rail contact is modified. The new criterion is intended for real-time assessment of subsurface RCF from measured wheel-rail contact forces. The only needed parameters in the new expression for the equivalent stress are the vertical force and the wheel and rail radii. Comparisons between the new and the original criterion are carried out and show good agreement for the studied cases of tangent track operations. By employing principles of vehicle dynamics the criterion is further extended to the case of operations in curves. Reasonable consistency was found for curve radii down to approximately 2000 m

Wheel-rail contact mechanics

Introduction. General contact modeling. Wheel-rail contact analysis. Computer simulation tools for railway vehicle dynamics. Future trends. Sources of further information and advice. References

Prediction of wheel profile wear and crack growth – comparisons with measurements

A model which can predict the length of the surface crack and crack depth in rails was developed in a previous study by the authors B. Dirks, R. Enblom, A. Ekberg, M. Berg (2015) []. In the present study, verification of this crack prediction model in combination with a wear prediction model was done against wheel measurements. For a period of 15 months, the wheels of three units of a Stockholm commuter train were measured with respect to wear and crack development for verification of the wheel life prediction tool. Vehicle-track dynamics simulations were used to calculate the forces and contact positions for the wear and crack prediction models. It can be concluded that the wear prediction model gives reasonable results, especially considering the large scatter in the wheel profile measurements. Although the wheel life prediction tool could not be verified, since the crack prediction model had to be recalibrated for the current wheel application, the results appear promising.</p