Tuesday, June 30, 2020

Plant Extracts as Anticancer agent - Juniper Publishers

Drug Designing & Development - Juniper Publishers 

Abstract

Cancer is a global disease that will ultimately lead to death. Though there are therapies, such as radiotherapy, chemotherapy and chemically derived drugs to treat and prolong this life-threatening disease, research have been progressing on the use of plant extracts as anti-cancerous agents. Guyana has a highly rich bio diversified forest, who’s aqueous and ethanolic crude extracts can be used to test for their anti-cancerous effects. In addition, natural products, both novel and non-novel can be isolated, and their anticancer activity investigated. Once successful, isolated natural products can be subjected to clinical trials and should add to the list of isolated natural products used as anti-cancerous agents. The use of plant extracts as anticancer drugs should be superior to that of current treatments such as chemotherapy, because plant extracts have less side effects and some are toxic to cancerous cells. Thus, there is a need to screen the bio diversified flora of Guyana for its anticancer effect.

Keywords: Cancer; Therapies; Bio diversified Flora; Plant extracts; Anti-cancer agents; Crude drugs; Botanical; Derived Drugs; Isolated natural; Anticancer effect; Chemically derived drugs; Herbal medicine; Alternative treatment; Alkaloids; Antioxidant property; Secondary metabolites

Abbreviations: BRs: Brassinosteroids; MLF: 4’-Methoxy Licoflavanone; ALF: Alpinumi Soflavone; DNA: Deoxyribonucleic Acid

Introduction

Globally, cancer is a disease that severely affects the human population, ultimately resulting in death. The disease is characterized by cells in the human body, undergoing uncontrollable mitotic divisions, resulting in the formation of tumors s of malignant cells which can lead to a metastatic state [1]. Tumors causes many of the symptoms of cancer by pressuring, crushing and destroying surrounding non-cancerous cells and tissues [2]. This abnormal growth is caused by the damage of the cell DNA as a result of chemical and environmental factors. Environmental factors include exposure to tobacco smoke etc. According to the American Cancer Society, deaths arising from cancer constitute, 2-3% of the annual worldwide deaths [3]. There has been an increase in the mortality rate resulting from cancer over the years. Cancer is the second leading cause of death in the USA.

The major causes of cancer are smoking, dietary imbalances, hormones and chronic infections, resulting in chronic inflammation [2-4]. Cancer treatment depends on the stage and type of cancer. These include surgery, radiation therapy, chemotherapy, biological therapy, hormone therapy etc. Despite the positive effects, and its use to combat cancer, chemotherapy and radiation therapy can cause traumatic side effects such as fatigue, sleep disturbance, appetite loss, hair loss, sore mouth, changes in taste, fever and infection, anxiety, depression, nausea and vomiting. These side effects are often difficult to manage. Other harmful effects of these treatments include hormonal and reproductive problems, effects on the immunologic system, heart diseases, effects on kidney and urinary bladder, effects on gastrointestinal organs, neurologic and psychological changes [4-5] etc. Thus, there is an urgent need to find an alternative treatment for cancer. This alternative complementary medicine comes from herbs. An herb, also known as a botanical, is a plant or plant part used for its scent, flavor and its therapeutic properties. The crude ethanolic and aqueous extract of plants from the Guyanese flora have been shown to possess antimicrobial [6-17] and antidiabetic activities [18]. However, their anticancer research profile remains untouched. It must be stressed that mankind first medicine were herbs and research should continue in that direction to exploit herbal medicines.

Chemically derived drugs

Chemically derived drugs used in the treatment of cancer includes 5-azacytidine (azacytidine; Vidaza) and 5-aza-2-deoxycytidine (decitabine; Dacogen) [19] etc. However, these drugs have toxic side effects. Hence, the need for the use of plant based complementary treatments.

Plants used in the treatment of cancer

Over the years, plant extracts have been studied for their anticancer activities. The results have been promising. Table 1 shows a list of some plants used for their anticancer activities. The list will continue to expand, as herbal cancer research continues. In Guyana, the anticancer activity of plants has received very little attention. However, its anticipated soon, this will be addressed.
Material Science
The anticancer activities of plants may be due to a single compound or a combination of compounds. These compounds include polyphenols, brassinosteroids and taxols. Polyphenolic compounds include flavonoids, tannins, curcumin, resveratrol and gallacatechins [20]. Resveratol are found in foods including peanuts, grapes and red wine. Gallacatechins are present in green tea. Polyphenols reduce the risk of cancers and improve a person health by virtue of their natural antioxidant properties [20-22]. Polyphenols are thought to kill cancer cells via apoptosis. They can achieve apoptosis via the mobilization of copper ions which are bound to chromatin inducing DNA fragmentation. In the presence of Cu (II) ions, resveratrol was seen to be capable of DNA degradation. In addition, polyphenols can interfere with proteins which are present in cancer cells, thus destroying cancer cells [23].

Flavonoids are another class of compounds with anticancer activities. They are from the polyphenolic compounds and constitute a large family of plant secondary metabolites with over 10,000 known structures [24]. Several plants have been investigated for their high flavonoid content and anti-cancer activity [24-28]. There is a high content of flavonoid compounds in anthocyanins, flavones, flavonols, chalcones in seed of certain plants [27]. Plant extracts have also shown anticancer effects. For example, flavonoids extracted from Erythrina suberosa stem bark (4’-Methoxy licoflavanone (MLF) and Alpinumi soflavone (ALF) were shown to have cytotoxic effects in HL-60 human leukaemia cells [27]. Fern leaf extracts, which are rich in flavonoids, have demonstrated high percentage of anticancer activity [28]. Purified flavonoids from plant extracts have also shown anti-cancer activities against other human cancers including hepatoma (Hep-G2), cervical carcinoma (Hela) and breast cancer (MCF-7) [27]. Brassinosteroids (BRs) are naturally occurring compounds found in plants which have hormones regulation process that controls growth, differentiation of cells, elongation of stem and root cells, resistance and tolerance against disease and stress. Some Naturally BRs have shown anti-cancerous effects. For example, 28-homocastasterone (28-homoCS) and 24-epibrassinolide (24 epiBL) [28-30].

Anticancer natural products

Anticancer Natural Products derived from plants, which have been proven successful at clinical trials have been reported. These drugs are administered as part of a patient’s dietary intake [31], Examples of natural products isolated from plants that have been used as anticancer drugs are vinca alkaloids such as vincristine, vinblastine, vinorelbine, vindesine and vinflunine. These drugs inhibit microtubules formation of cancerous cells by binding to β-tubulin. Another class includes the Taxanes such as paclitaxel and its analogue docetaxel. These drugs function as microtubule inhibitor of cancerous cells. Paclitaxel prevents replication of cancer cells as it stabilizes or polymerises microtubules in the cells [32,33]. Drugs combination may have a synergistic effect that augment their anticancer activity and improve their efficacy as therapeutic agents. This is noticeable with vinca alkaloids, Taxus diterpenes, Podophyllum lignans and Camptotheca alkaloids in plant extracts [34]. Figure 1 shows some isolated natural products with anticancer activity.
Material Science


Conclusion

Thus, there is an urgent need to continue the use of herbal medicines to combat cancer. Plant extracts are advantageous in that they are selective i.e. non-toxic to normal cells, but cytotoxic to cancer cells. Guyana’s flora needs urgent screening to add to the list of plants that can combat against cancerous cells. In addition, isolation of natural products may lead to new anticancerous agents.

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Monday, June 29, 2020

Promoting Knowledge of Cognitive Dysfunction in Minority Older Communities, their Caregivers and Clinicians - Juniper Publishers

Gerontology & Geriatric Medicine - Juniper Publishers

Abstract

Objectives: Lack of knowledge about geriatric conditions is a barrier that prevents older minority populations from receiving optimal healthcare. We aim to develop an educational initiative to improve the knowledge gap on cognitive dysfunction in three target populations: older minority community members, their caregivers, and healthcare professionals (HCPs).
Methods: A nested mixed-methods with an interventional pre-post assessment approach was used for this community-based educational initiative. Educational sessions on memory loss were developed and conducted. 182 community members, 63 caregivers and 133 HCPs participated. Pre-posttest questionnaires and qualitative data were collected to measure the impact.
Results: The results showed significant improvements in knowledge in all three participant groups. The qualitative comments showed improved understanding and intentions to change.
Discussion: Development of an educational program on cognitive dysfunction targeting community members, caregivers and HCPs who take care of older patients is feasible in underserved community and clinical settings.

Keywords: Cognitive dysfunction Educational initiative Ethnogeriatrics Older minority populations

Abbrevations: MCI: Mild Cognitive Impairment; HCP: Health Care Providers; HRSA: Health Resources and Services Administration; MSK: Memorial Sloan Kettering Cancer Center; GRIP: Geriatric Resource Interprofessional Program; CBOs: Community-Based Organizations

Introduction

One important public health dilemma is the multi-layer challenge associated with the care of the older adult, specifically focused on cognitive health. The US population is getting older and growing more racially diverse. The number of racial/ethnic minority populations has increased from 46 million in 1980 to 83 million in 2000, with an estimated increase to 157 million by 2030 [1]. Minorities and older adults represent an intersection of populations that are particularly vulnerable to suboptimal care. The causes are complex and focus on racial and ethnic disparities in health resulting from socioeconomic status, unequal access to care, differences in behavioral, environmental and genetic risk factors, and social and cultural biases that influence the quality of care [2]. Moreover, ageism tends to reinforce social inequalities as it is more pronounced towards poor people or those with dementia [3]. An estimated 5.4 million Americans have Alzheimer’s disease, and by mid-century, this number is projected to grow to 13.8 million [4]. Today, someone in the US develops Alzheimer’s disease every 66 seconds. By 2050, one new case of Alzheimer’s is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year [4]. Studies have shownthat more years of education is associated with a lower risk for dementia [5]. It is no surprise that dementia afflicts minority populations more than Caucasians; African Americans are twice as likely, and Hispanics are about one and one-half times as likely, to have Alzheimer’s or other dementias compared to Caucasians [6]. Several barriers to addressing cognitive dysfunction exist within both the older and minority populations. These barriers include poverty, lack of transportation, illiteracy, cultural taboos regarding dementia and poor communication [7-9]. For example, in New York City (NYC), 23% of the population is categorized as having low-English proficiency. Many people in the community with Mild Cognitive Impairment (MCI) and Alzheimer’s disease do not recognize cognitive, functional or behavioral impairment as abnormal [10]. This lack of understanding can have serious effects on health, and because they or their caregivers cannot recognize and acknowledge the deficits, they do not seek treatment. Daily functioning may be compromised because they lack adequate judgment of situations [11]. Enough education needs to be given to those affected and to the community at large to aid in preventive care and to improve understanding of early diagnosis and disease management.

Caregivers play a crucial and physically, mentally and emotionally demanding role in the management of patients with serious chronic diseases. People with dementia typically require more supervision, are less likely to express gratitude for the help they receive and are more likely to be depressed. These factors have been linked to negative caregiver physical and psychosocial outcomes [12]. Family caregivers often feel unprepared to provide care, have inadequate knowledge to deliver proper care, and receive little guidance from the formal health care providers [13]. Family caregivers may not know when they need community resources, and then may not know how to access and best utilize available resources [14]. Without this support, caregivers often neglect their own health care needs to assist their family member, causing deterioration in the caregiver’s health and well-being [15].Despite the growth in the older population, there is an unmet need in healthcare workforce to take care of these patients’ needs. While the demand for physicians specialized in the medical care of older adults is increasing, the interest among medical students for a career in geriatrics is slow to follow [16]. Though the coverage of geriatric topics at medical schools is increasing, students still express significant reservations about their abilities to treat older patients. In one national survey, only 27 % of graduating familypractice residents and only 13% of graduating internal-medicine residents felt very prepared to care for nursing-home patients. Although a large majority of graduating psychiatry residents felt very prepared to diagnose and treat delirium (71%) and major depression (96%), only 56% felt very prepared to diagnose and treat dementia [17]. In this paper, we examine the role held by three specific groups of people in the care of cognitive health in underserved ethnically diverse populations: the older adult community members themselves, their caregivers, and the health care providers (HCP) taking care of them. Each role has significant opportunity in improving knowledge and in understanding the disease and its appropriate management. We focused our efforts on a large-scale educational program to address these gaps in knowledge, focusing on cognition in older adults, for all three groups.

Methods

Team development

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary federal agency for improving health care to people who are geographically isolated, and economically or medically vulnerable. Through the Geriatric Workforce Enhancement Program (GWEP), HRSA provides funds to improve the healthcare of older adults through education and training. With the GWEP award, the Geriatrics service at Memorial Sloan Kettering Cancer Center (MSK) established the Geriatric Resource Interprofessional Program (GRIP). The GRIP team serves as content experts and a teaching core that includes representation from occupational and physical therapy, pharmacy, nutrition, medicine, nursing, social work, psychiatry, immigrant health and members from the GRIP’scommunity and clinical partners that serve community-dwelling older adults in culturally diverse and medically underserved areas. The community-based organizations (CBOs) and clinical sites are experts in the populations they serve. Team members teach each other about their respective professions, context, and its unique relevance in the health management of the older adult during the process of developing appropriate community, caregiver and HCP educational material. Via GRIP, multiple professionals’ expertise and perspectives are infused into one educational program targeted for each audience.

Target population

We targeted three groups of learners: older community members, caregivers, and HCPs. All participants were selected by convenience sampling. Older adults were accessed through regular attendance to community programs in the NYC area, partnered with GRIP. The NYC boroughs of Queens and Brooklyn were targeted for their ethnic diversity to cater to the underserved. The borough of Queens in NYC is the most ethnically diverse urban area in the US with 74% of the population being Hispanic, African American or Asian and 48% being foreign born. The borough of Brooklyn is about 34% African American, 13% Asian and 19% Hispanic or Latino with about 36% of the population being foreign born [18]. The partner CBOs marketed for the educational programs through phone calls, digital and print advertising, and through in person reminders at other educational programs. Caregivers were approached through CBO staff who targeted invitations to this caregiver-client group. Digital and print marketing were also utilized for the caregiver audience. HCPs included residents and fellows in training, attendings, nursing staff including nurse practitioners, and social workers. Sessions for staff were conducted at scheduled educational settings, like monthly staff training and conferences at NYC area hospitals. Participation in the sessions and completion of related assessments were voluntary and explained as such by site staff with the help of interpreter(s) if needed.

Content development and implementation

Across all content development, the GRIP team used the Patient Education Materials Assessment Tool -A/V (PEMAT) [19] to rate the content’s understandability and actionability. GRIP team members, including CBO representatives, provided feedback to the presenter about content organization, language, and engagement. Cultural responsiveness was discussed to ensure attendees would be able to connect and identify with the material and that the material was communicated in a culturally appropriate way, accounting for traditions and norms around aging and health.To understand the educational gaps of older community members, regular attendants of our partner CBO educational programs at senior centers, religious institutions, public libraries and CBO headquarters completed an informal needs assessment. Older community members were asked to rank the followingtopics on their interest level, on a scale from 1 to 4 (1 being their first choice and 4 their last) on four listed topics: nutrition, falls, memory loss and cancer. Thirty-five older adults responded to this survey and 71% indicated memory loss as most interesting to them. From this, the GRIP team focused initial efforts to develop the memory loss and dementia program. In the Fall 2015, the primary presenter, a geriatrician, developed the audiovisual module Memory Loss & Dementia, for the community older adult population. The material incorporated imagery that the target audience could relate to, such as Yoga, ethnic foods and landscapes for sessions developed for the South Asian communities. The geriatrician presented the material to the GRIP team. Using the PEMAT, GRIP team members rated the material and the scores for understandability and actionability were 59% and 78% respectively. The material was revised based on the feedback, improving these scores to 83% and 90%. Five of the 8 lectures were interpreted, 4 to the predominant South Asian language (Hindi or Bengali) and 1 to Spanish. The remaining 3 lectures were delivered to English speaking audiences.

To identify the educational needs and the interests of caregivers, the GRIP conducted a 90-minute focus group. The subject of memory loss was identified as a topic of interest. A module called Caregiver Education: Cognitive Impairment was developed. Per GRIP’s content development process, it underwent a PEMAT review (83% understandability and 80% actionability), with the presenter adjusting after the feedback regarding organization, language and cultural responsiveness. Since most caregivers identified as South Asian, 4 of the 7 sessions were provided in English with simultaneous interpretation to the predominantly understood language of the group, Hindi. Though the majority caregivers were native Gujarati speakers, the most commonly understood language in the group was Hindi. The remaining 3 sessions did not need interpretation or translation as it was to English-speaking audiences.

Given the well-documented shortage of appropriately trained HCPs in the care of the older adults, the subject of memory loss/ dementia/delirium, was well-suited for our HCP target population. Four modules were created to meet the needs of each types and level of HCP audience: Delirium in Older Hospital Patients (Post Graduate Year -PGY- 1-3), Assessment and Management of Cognitive Impairment in the Older Adult (Interprofessional), Cognitive Impairment in the Older Adult (Nursing), and Dementia & Delirium (PGY1). In this large educational initiative across three learner groups, between November 2015 and January 2019, the following sessions were implemented: Memory Loss & Dementia (older community members) was conducted 8 times at 7 different centers. Caregiver Education: Cognitive Impairment was offered 7 times at 3 different centers (one being a video live-stream program) for caregivers. The 10 sessions for HCPs comprised one of the four modules described and were conducted in 5 different sites.

Measures

This study was conducted as a nested mixed-methods pre-post intervention design to incorporate quantitative pre and post data and qualitative data after the intervention to assess its effectiveness (20). Questionnaires were developed to assess knowledge uptake after participation. They contained five to six multiple choice questions and were translated to multiple languages. They were administered prior to and immediately after participation in the educational program. Pre- and post-questionnaires were matched using an identification case number. In August 2018, the pre-post questions for community members were modified to increase the difficulty of one question due to ceiling effect (question was too easy on baseline). As seen in (Table 2), we are presenting the aggregate results for the sessions prior to and after this change in measure for the Memory Loss & Dementia sessions. Completion of the questionnaires was voluntary and anonymous, and the publication of these data was approved by the MSK Institutional Review Board.

Novel Techniques in Bone Arthritis & Development Research

Analysis

Analyses were conducted using the statistical program SPSS 21 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp). Demographic characteristics, including age, gender, language preference and birthplace, were analyzed using descriptive statistics (mean, frequencies and standard deviations). Paired samples t-tests were used to evaluate change in knowledge on the programs on preand post-assessments. A p-value less than .05 was considered statistically significant. Qualitative analyses were conducted using thematic content analysis, the most frequent themes are presented on (Table 3).

Novel Techniques in Bone Arthritis & Development Research
df: Degrees of Freedom
Sessions conducted before August 2018
Sessions conducted after August 2018: Questionnaire B includes increased difficulty in listed questions

Results

The total sample consisted of 378 participants:182 community members, 63 caregivers, and 133 HCPs. Sociodemographic data is presented in (Table 1). Of the older community members who reported demographic information, the mean age was 68 (SD=7.8) and three out of five were female (59%). The majority were Asian (87%), half reported their native language to be Bengali (52%), and 71% were born in a South Asian country (India, Pakistan, Bangladesh and Nepal). Caregivers had a mean age of 60 (SD=12.4). The majority were females (89%) and almost two thirds were Asian (61%). The primary language of 47% of the caregivers was English, followed by Gujarati (27%). One third were born in USA (33%) and 42% were born in South Asia.
Novel Techniques in Bone Arthritis & Development Research
Note: a Mean and Standard Deviations presented instead of frequencies; b Other languages include: Arabic, Armenian, Bahasa, French, German, Guyanese, Hebrew, Hindi, Kannada, Korean, Nepali, Persian, Poshto, Punjabi, Romanian, Russian, Tagalog, Tamil, Telugu, Turkish, Urdu, Vietnamese; c Other Countries by region include: 1) in South Asia, Bangladesh, India, Pakistan, Nepal, 2) in Latin America, Brazil, Colombia, Puerto Rico, Dominican Republic, Paraguay, El Salvador, 3) in Western Europe, England, Germany, Ireland, 4) in Eastern Europe, Poland, Romania, Russia, Botswana, Greece, 5) in East Asia & Pacific Islands, China, Philippines, Korea, Taiwan, Vietnam, 6) in Middle East, Israel, Syria, Turkey, Bahrain, Iran, Saudi Arabia, Lebanon, Iraq, Cyprus, in 7) Caribbean (non-Hispanic) & Guyanas, Jamaica, Trinidad, Haiti, and 8) in Africa, Cameroon.

Providers had a mean age of 35 years (SD=11.1), two thirds were females (65%), almost half (51%) were Asian, the native language of two thirds (69%) was English followed by Korean (12%). Most of the providers were born in USA (49%), followed by East Asian countries (28%). Almost half of the medical professionals were residents (49%), followed by nurses (24%), medical students (19%), physicians (5%), patient care technicians (2%), and social workers (2%). The t-tests for paired samples are presented in (Table 2). The results indicate a statistically significant difference for the sessions, Memory Loss & Dementia [t (76) = -2.12, p< .04], conducted with older community members after the measure assessment was updated in August 2018. The pre-post evaluations for the sessions on Memory Loss & Dementia prior to upscaling of difficulty in the measure conducted between April 2017 to May 2018 did not yield significant results [t (104) = -0.16 p = .87]. The sessions conducted with caregivers: Caregiver Education: Cognitive Impairment showed highly significant increase in knowledge [t (62) = -4.12, p < .001]. Among the HCP sessions Delirium in Older Hospitalized Patients (PGY1-3) [t(74) = -9.11, p < .001]; Cognitive Impairment in the Older Adult (Nursing) [t(14) = -2.94, p = .01]; and Dementia and Delirium (PGY 1) [t(20) = -2.93, p = .009] showed improvement in knowledge. There were no significant improvements in knowledge for the Assessment and Management of Cognitive Impairment in the Older Adult (Interprofessional) group. All participants were given the opportunity to provide feedback after completion of the sessions and asked how this information would change their daily behavior or practice. These responses were categorized into common broad themes which reflect improved understanding and plans to make behavioral changes. Selected themes and comments are presented in (Table 3). Overall, older adults described specific behavior changes they would make, as well as resources they would seek out to clarify doubts and obtain care. Caregivers commented on knowledge gained as well as future planning for those older family members who might need dementia care. HCPs reported increased knowledge and detailed clinical practice changes they planned to make in the care of older adults with cognitive impairment.

Discussion

Our results demonstrate the successful development and application of an educational program to improve the understanding of cognitive syndromes in older minority communities. We see consistent, significant improvements in knowledge among older adults, caregivers and HCPs, and qualitative data that describe improved understanding and planned changes in behavior after the sessions. We identified educational needs of older community dwelling ethnic minority members and their caregivers to provide culturally responsive educational sessions, in their language in a familiar and comfortable environment. This specific educational and cultural tailoring made sessions interactive and open for community members and caregivers to approach it with a sense of familiarity. There is a well described national shortage of geriatricians in the US [21, 22]. Few medical residents choose the extra year of training required to become a geriatrician, and those going into other specialties typically get little exposure to the health needs of older adults during their training. Internists, family medicine doctors and other HCPs such as nurse practitioners and physician assistants provide most care for older adults and they should be trained [21-23] Educational programs like ours help to correct the deficits in geriatric medicine knowledge in non-geriatrician HCPs. This is one way of improving the quality of healthcare received by older patients.

The implementation of this educational approach came with its own set of challenges. Community health education in underserved populations is complex: One major barrier we faced was the wide range in literacy levels of the community member participants. It ranged from a few people who were illiterate and could not write their name in their primary language to people with post-secondary and professional degrees. In many cases, community organizers and members of the GRIP team had to sit one-on-one with participants to fill the questionnaires. Tailoring a pre-post questionnaire to assess knowledge change in such an audience proved challenging Additionally, we had to adjust educational materials to ensure understandability. Some audiences wanted more detailed information and others didnot, so adjustments would often have to be made during the presentation. These adjustments might have limited the ability to accurately capture knowledge gain. After analyzing the difficulty level of the questions based on initial sessions with a wide range of audiences, we noted consistent high achievement on one item. We modified that item to increase the difficulty of a question and subsequent results showed statistical significance in knowledge improvement. The community members’ qualitative comments showed a positive impact. In the case of the HCPs, with higher and more homogeneous educational attainment, the quantitative analysis showed a significant improvement in knowledge uptake and it paralleled the qualitative comments.

Another barrier we faced was adapting to the multiple cultures and primary languages of the community and caregiver participants. The sessions were interpreted to the most understood predominant primary language of the audience and the questionnaires and take-home resources were translated into the same language. However, it is still probable that the sessions were not fully understood by all members who attended because some participants spoke different variations of the primary language or a different primary language entirely. We conformed to cultural practices by learning the cultural norms of the community prior to conducting in each session. The sessions conducted at a mosque for example had physical partitions between seating areas for the male and female participants, and our own staff members respected these boundaries and conformed to the dress codes and interactions. Transportation and access to the community centers by participants varied. Even in NYC, where public transportation is available, it is a challenge for some older community members and the attendance also depended on the weather. We tried to schedule sessions according to the best times of day for the caregiver groups and utilized existing protected meeting times for HCPs to maintain attendance.

Future directions

We will need ongoing educational efforts and future studies to assess the long-term benefits of these interventions in increasing awareness and promoting a more proactive approach to care from the community members and their caregivers. Patient reported outcomes could be measured in community clinics after educational interventions. Behavioral intention measures after the sessions are also worth exploring. Caregiver related measures such as stress, satisfaction with medical care, knowledge retention and change in behavior should be evaluated long-term. Continued retention of knowledge and the implementation of geriatric principles by HCPs in their daily practices could also be studied. Strategies to address challenges around health literacy and surveys will continue to be addressed and cultural responsiveness will continue to be integrated into the data collection procedures.

Conclusion

We have successfully developed and applied a critical educational program about memory loss for older communitymembers, their caregivers and HCPs in diverse underserved areas of NYC. The education was very well received and prompted the attendees to propose behavior changes that could potentially improve the care of individuals with cognitive disfunction. We demonstrated significant short-term knowledge uptake on memory loss and cognitive health among the three audiences. The long-term effect of the knowledge gain and behavior change needs to be better determined on future studies.


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Friday, June 26, 2020

Need for Newer Drug Delivery Systems-An Opinion - Juniper Publishers

Journal of Nanomedicine - Juniper Publishers

Opinion

From the starting of the human life; the quest is going on for newer and better alternatives, and in case of drugs it will continue; continue till we find a drug with maximum efficacy and no side effects or lesser side effects. Many agents, particularly chemotherapeutic agents, have limited clinical use and are compromised by dose limiting toxic effect. Thus, the therapeutic effectiveness of the existing drugs is enhanced by formulating them in an advantageous way. In the past few years, considerable attention has been focused on the development of new drug delivery system (NDDS). The NDDS should ideally fulfill two conditions. Firstly, it should deliver the drug at a rate needed by the body, over the period of treatment. Secondly, it should readily make the availability of active entity at the site of action. Conventional dosage forms are unable to meet these conditions. In the current scenario, no available drug delivery system behaves ideally and perfectly, but concrete steps have been taken to achieve them through various novel approaches in drug delivery. Approaches are aimed to achieve this goal, by paying considerable attention either to control the distribution of drug by incorporating it in a carrier system, or by changing the structure of the drug at the molecular level, or to limit the input of the drug into the bio-environment to ensure an appropriate profile of distribution. Novel drug delivery system is aimed at providing some control, either temporal or spatial nature, or both, of drug release in the body. Novel drug delivery attempts to either sustain drug action at a predetermined and predefined rate, or by maintaining a relatively constant, effective drug level in the body with concomitant minimization of undesirable and unintended side effects. Drug action can also be localized by spatial placement of controlled release systems adjacent to, or in the diseased tissue or organ; or target drug action by using carriers or similar chemical derivative to deliver drug to target cell type.

Various types of pharmaceutical carriers such as particulate, polymeric, macromolecular, and cellular carrier are present. Particulate type carrier also termed as a colloidal carrier system, includes lipid particles (low- and high-density lipoprotein LDL and HDL, respectively), microspheres, nanoparticles, polymeric micelles and vesicular like liposomes, niosomes pharmacosomes, virosomes, etc. The vesicular systems are highly ordered assemblies of one or several concentric lipid bilayers formed, when certain amphiphilic building blocks are confronted with water. Vesicles can be formulated from a diverse range of amphiphilic building blocks. Several drugs particularly chemotherapeutic agents have narrow therapeutic window. Their use in clinical practice is limited and compromised by dose limiting toxic effect. To overcome this, several attempts have been made to achieve all lofty goals through novel approaches in drug delivery. A number of novel drug delivery systems have emerged encompassing various routes of preformulation and administration, to achieve controlled and targeted drug delivery. Novel drug delivery systems attempt to work either by controlled release, or by maintaining a relatively constant, effective drug level in the body with concomitant minimization of unwanted side effects. It can also localize drug action by spatial placement of controlled release systems adjacent to, or in the diseased tissue or organ; or target drug action by using carriers or chemical derivatization to deliver drug to particular target cell type. An ideal controlled drug-delivery system should possess two features: the ability to reach its therapeutic target and the ability to release the active pharmaceutical ingredient in a controlled manner.

To obtain this objective, approaches are being evaluated and implemented by paying considerable thought to control the distribution of drug by incorporating it in a carrier system or by altering the structure of the drug at the molecular level, or to control the entry of drug into the bioenvironment to ensure an appropriate profile of distribution and delivery. The various pharmaceutical carriers are polymeric, particulate, macromolecular and cellular carrier. Particulate type carrier also termed as a colloidal carrier system; it includes lipid particles (low- and high-density lipoprotein-LDL and HDL, respectively), nanoparticles, microspheres, polymeric micelles and vesicular like liposomes, niosomes, pharmacosomes, virosomes, etc.  


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Thursday, June 25, 2020

The Association between Education and Income and Health in a Developing Country: Do We Measure Perception or Reality? - Juniper Publishers

Journal of Public Health - Juniper Publishers

Abstract

The salience of income and education on health may differ in resource-deficit environments. This study explored this relationship and its measurement in rural Vietnam. Participants were 343 women with education level of 5.1 grades and household incomes equaling $170/ month. Women were interviewed by trained indigenous women health advocates. Results indicated that the perception of income level is a better predictor of health than actual income. Education is not a significant predictor of health. Measures of perception of income were more important predictors than actual income. Actual disease burden was more effective than a brief, general measure of health.

Keywords: International; Health Perception and Income and Education; Vietnam; Indigenous Health Advocates; Developing World Income and Health

Introduction

Conducting research and designing interventions in the developing world pushes our methodologies and knowledge to its limits. Researchers make assumptions and create hypotheses based on the current literature, most of which has been conducted in the developed countries. When applying them to the developing world, these assumptions are often in advertently exported without being tested. One such assumption is the relationship between income, education, and health. In developed countries, this relationship is substantial [1]. The pathway between education and income to improved health is intertwined because both are highly correlated. The pathways, however, in a resource deficit environment, such as in the developing world, are more convoluted. The relationship between the two and its impact on health in the aggregate is supported but is not on individual levels in developing countries [2]. The purpose of this study was to explore this relationship and ways of measuring it. Measures with a history of use in a developing country typically emerge from studies conducted on majority populations in major cities. In Vietnam, only somewhat educated indigenous people speak the national language. Indigenous people unfamiliar with answering multiple choice or Likert scales, call into question the use of complex scales when simple questions may be sufficient. Therefore, medical and public health studies frequently use one question self-report statements. A few studies have used pictorial assessments to produce more valid research among indigenous people.

Income, Education and Health

In the developed world income has been a strong predictor of physical [3,4] and mental health [5] in developed country diseases such as cardiovascular disease [6], cancer [7], and diabetes [8]. In the developing world, parasitic and infectious diseases are responsible for the highest disease burden [9]. Only one study investigated conditions leading to helminths and parasites resulting in an association with environmental conditions and sanitation which result from poverty but not income or education directly [10]. There is little information on how income and education interact with the conditions that lead to parasitic disease or incidence of parasites in developing countries. Education and income are measures of status in the developed world. But in countries that do not operate as meritocracies, education and income are less important in determining status than heritage. In some developing countries, income levels are adjusted by the government so that income does not reflect the position or the education required to function in that position. An underground system of favors and services enhance income. In a resource-deficit environment, only a few may have access to health essentials. Under these conditions, neither objective nor subjective perceived income nor education may be predictive of health status. To the degree that income and education matter, designers of interventions that target parasitic disease rates must understand how these factors are associated with health.

The pathway from education or income to disease burden due to parasites is complex. Parasitic disease contributes to financial hardship through malnutrition due to low-protein, iron and vitamins in individual’s diet, along with inadequate health care, and poorer living conditions [11] and both income and education have an interactive effect of these conditions with childhood vaccines [12]. In the developed society, the empirical evidence suggests that education has a significant impact on health via mediating factors such as economic, social, interpersonal, health knowledge and behavior mediators [13]. These mediating factors equip individuals with the ability to access health care, engage in activities that promote wellbeing, and possess psychological and coping resources such as social support, stress management, and proper nutrition, in the developed world [14]. The benefit of education for women shows up when moving from primary to secondary education levels and for men when moving from secondary to post-secondary education levels. Among people in the developing world, where the norm is limited to only primary education, education may not hold any predictive power. Two studies in India and Kenya demonstrated that deworming children, while leading to better school attendance did not result in higher test scores [15]. Yet, height (presumably due to better health and nutrition) was positively correlated with education among adults in several South American countries [16]. And two other studies found no effects for education and health, one of which used the same methods as the Indian study [17]. Many people never go beyond 5th grade in rural Vietnam. If the point at which education begins to influence health practices occurs at higher levels, the advantage would not be seen. Those who do attain secondary or tertiary education levels seldom return to their villages due to lack of employment. While both education levels and income levels may vary somewhat even under these conditions, they may not vary together. In an investigation using mathematical modeling, Akguch (2010) demonstrated that different levels of education were associated with varying levels of income growth depending on the development levels of countries. In the least developed countries, growth in tertiary education seemed to benefit less than growth in primary education levels in the aggregate with more benefit derived from improving the quality. These studies suggest that there is no straightforward correlation between education and income across countries.

Measuring Income, Education and Health

Measuring income: Studies typically measure income categorically. Such measures may be subject to image management bias [18]. In countries in which image is a high value, such a method is likely to be inaccurate. The inaccuracies can be prevented through asking for an actual amount within the time space that people naturally consider, such as a presenttime orientation. In this study, actual income was measured by asking the amount earned by the entire household in one month. Individuals’ personal beliefs about their social status are reliably and strongly related to their overall health. Two studies demonstrated that subjective SES was a better predictor of health in Britain [19] and in the US [20], all developing countries. In developing countries, hosting societies that value image, perception may be more important and may actually provide more variance in measurement than actual income. Nancy Adler et al. [21] developed a pictorial way of measuring subjective comparative social status that does not require language. The picture is a ladder, a concept understood in all societies, and asks the responder to mark the rung on which her family stands relative to her community.

Measuring Education: In rural Vietnam, the majority of participants have less than 5th grade or a small percentage reaching 12 years, with no evidence of anything in between. The reason is twofold: for a student to continue in school, he/ she must pass a test and the family must have the income to send the child to another village to attend. Few current adults have had this advantage. Therefore, education should be measured in years of education, not levels. Measuring general health in selfreport studies. Developing world studies emerge from public health and typically use specific straightforward questions, often one or two questions asking the respondent to rate their or their family’s health on a Likert scale. While broadly accepted, the measure is likely to be inaccurate due to optimism bias, image protection efforts and other unconscious processes influencing memory. Yet, if general health can be adequately measured using one sentence, it could lead to more studies being conducted in challenging environments.

Methodology

This study took place in remote areas of Central Vietnam and was part of a larger study testing an intervention. This study tested the following hypotheses: Perceived income levels will be significantly different than actual income level. A checklist of actual disease experience (FHQ) will be significantly different than perceived self-report measure of family health. Education and income will correlate and predict health status? Is actual or perceived income more predictive of health status? The study was approved by an ethical review board and the Vietnamese government. Informed consent was obtained.

Participants

Three hundred and forty-three women were recruited through the local Women’s Union. Ages ranged from 20-67, x = 38 (sd =10.2) in two villages. Ninety-four percent were married and living with their spouses. The majority of the husbands and wives worked at the same vocation. Sixty-six percent were farmers, 9% fishers, 3.9% were solely homemakers, and the rest were tradespeople, such as bricklayers and laborers. They had 5.5 years (sd = 3.1) of school on average and household income was x = $137 (sd = $70) / month for families of 4.3 people. These women had x = 2.8 (sd = 1.3) children per family, and their childrens’ average age was 9.8 (sd = 5.1).

Measures

All questionnaires were translated and back-translated into Vietnamese by a certified translator. The questionnaires were all answered using a trained health advocate in interviews.
Income: Income was measured in two ways, first, as an actual amount with the question asked, “How much money does your entire family earn in a month?” The second assessment of income was perceived comparative financial status within the community using Nancy Adler’s 10 question subjective SES ladder which has been shown to be effective when assessing individuals’ self-report of social status [22]. Respondents were asked, “Imagine that the rungs of this ladder represents your community with the top rung being those who have the most and the bottom rung being those who have the least. Put an X where you place your family financially.”
Measuring Health: One question asking, “How do you rate your health overall?” The five point Likert scale was answered using 1 = poor to 5 = excellent. A second measure, the Family Health Questionnaire was also included. The FHQ, developed by the World Health Organization, measures 22 specific conditions ranging from menstrual cramps to heart disease. Four diseases were added because of their prevalence in the area in which data were gathered, malaria, dengue fever, typhoid, and cholera. The scale has three columns next to each disease in which a participant checks whether they were bothered “not at all (0)”, “a little (1)” or “a lot (2)” by that ailment during the last month. Education was a straightforward question rather than asking about levels of schooling in order to obtain a figure that can be compared [23]. The question was, “How many years did you go to school?”

Results

Using a one-sample t-test, findings indicated that there was a significant difference between perceived income levels and actual income (t =25, df=168, p <.000. There was a dramatic and significant difference between using brief question and FHQ to measure health (t = 11.13, df = 343, p < .000). A series of correlations were performed on measures of income coupled with measures of health. Actual income was modestly and negatively correlated with health measured by FHQ (r = -0.215, p <.006) and perceived income was also negatively significantly correlated with health measured by FHQ (r = -0.223, p <.004). Both actual and perceived income levels were entered into a stepwise regression resulting in perceived income as the stronger predictor of health as measured by the FHQ (F (df =158) = 8.9, p <.003). Perceived income level within the communities is more relevant in health research than actual income levels in rural Vietnam. Not surprisingly, when the same analyses were conducted using the one question rating scale, results were not significant, thus indicating that in measuring health, the actual disease-specific health information is a better practice than nonspecific general sense of health, while in measuring income levels, the relative measure is more important than actual measures of income [25,26]. There were no significant correlations between education and health regardless of how health was measured, either perceived or actual disease conditions. Additionally, education and income were both significantly correlated but these correlations are more modest than one would see in developed world research, with perceived financial status (r = .249, p < .000) more highly correlated with number of years in school than actual income levels (r = .20, p < .002).

Discussion

The practice of using one question to measure health in developing world research is relied upon because of the difficulties involved in translating measures and validating the constructs measured. However, this study suggests that there is danger in such a practice. This study demonstrates that the reliance on short-cut measures may be inaccurate and lead to faulty research. Furthermore, the measures that were most effective in this study were those that transcended language. The perceived income measure was pictorial. The findings in this study corresponds with prior research findings indicating that the higher individuals rated themselves in the social hierarchy, the better health they had (Adler & Epel, 2000) as well. The best health measure was a list of illness conditions with the participant simply checking if they were bothered by that condition this month, none, a little, or a lot. In a communal society, it is possible that the perceived standing would be held more important than actual income, especially since even those with higher income levels do not have appreciably different lives than others in the same village. It is also possible that education did not make a difference in health because we measured it by asking number of years in school and not by attendance within those years. In rural Vietnam, planting and harvesting supercedes regular school attendance. Parasitic disease rates are very high and interfere with attendance and children stay home to care for younger siblings while parents till the fields. Thus, education may matter more than is revealed in this study. Future research should include attendance and quality as well. Additionally, the resulting lack of significance could be due to the fact that most of the people did not go beyond primary school years and the difference in impact may not be realized until many more years of school are achieved. In rural developing country areas, education is does not appear to be a factor due to low variance.

While education and income are strong correlates of health in developed countries, this link is questionable in developing world conditions. This study found a correlation between perceived and actual income with health, with perceived income being more relevant but did not find a significant association between education and health. Therefore, perception of income levels should be addressed in developing and testing interventions.

Limitations

As in many studies conducted in areas where indigenous languages and constructs blend with the national language, the way questions are asked impose a challenge. Testing populations that are unfamiliar with testing in general pose a problem that has not been studied. Future studies should focus on how indigenous populations comprehend various ways of asking questions in research. Another limitation is that this study did not use an objective measure of health such as testing for actual parasites. Education measure did not elicit information on school attendance where truancy is a common part of life.

Implications and Conclusion

When measuring income, perceived income appears to be either more understood or more predictive than actual income. Studies should not rely on one or two sentence general questions when asking about health. It appears that a very specific measure is required. In this study, the list of actual conditions and amount of discomfort was predictive. The findings of this study suggest that best practices in research include: use of pictorial relative measures with income, specific years in school and attendance for education, and specific disease conditions for general health.


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Wednesday, June 24, 2020

Long-Term Follow-Up in a Male Patient with Micro-TSH-Oma Diagnosed at 8-Yr-Old - Juniper Publishers

Endocrinology and Thyroid Research - Juniper Publishers


Abstract

Background:TSH-secreting pituitary adenomas (TSH-omas) are very rare and an infrequent cause of thyrotoxicosis.
Case Report:A 7.9-yr-old boy was referred to our Pediatric Endocrinology Unit due to a goiter. On admission, patient was thyrotoxic with diffuse goiter. Laboratory evaluation suggested inappropriate TSH secretion as the cause of hyperthyroidism: high serum TSH in presence of elevated levels of TT4, TT3 and fT4, and TSH unresponsive to TRH stimulation and to T3 suppression. Initially, α-subunit (aSU) was in the upper limit of normalcy and pituitary MRI was normal. One year after, patient was still hyperthyroid, despite regular use of methimazole; TSH was 12.6 mU/mL, αSU was elevated and MRI detected a pituitary 8 mm width adenoma, establishing the diagnosis of TSH-oma. Peak GH (ng/dL) on ITT and TSH after TRH were 5.9 and 4.2, respectively. Cortisol and prolactin (PRL) responded normally to ITT and TRH tests. Transsphenoidal surgery was done and, postoperatively, transient diabetes insipidus and adrenal insufficiency ensued. Two and five months after surgery fT4, TT4 and TT3 were normal, albeit peak TSH after TRH was 1.54. PRL and GH were unresponsive to adequate stimuli. Fourteen months after surgery, TT4, TT3 and fT4 were low normal. He presented with low IGF-1, low GH peak on dinanic tests and hypogonadism and was treated with recombinant human growth hormone (rhGH) and testostenone. At 16 yr-old, we reached final height, above target height.
Conclusion: TSH-oma may be an etiology of thyrotoxicosis in children. To our knowledge, this is one of the youngest patients with TSH-oma yet reported.

Keywords: Pituitary tumor; TSH-oma; Hyperthyroidism; Thyrotoxicosis; Transsphenoidal surgery; Final height

Introduction

In most children with thyrotoxicosis the main cause is Graves’ disease. Other causes include toxic adenoma, thyroiditis, iodine-induced hyperthyroidism, McCune-Albright syndrome, syndrome of resistance to thyroid hormone (RTH) and thytroid-stimulating hormone (TSH) secreting pituitary adenoma (TSH-oma). TSH-oma comprises 0.5 to 3% of all pituitary tumors. Patients present with signs and symptoms related to thyroid hormone (TH) excess and/or to tumor size (headache, visual field disturbances, cranial nerve palsies). The presence of goiter is frequent [1,2]. Elevated TH levels in presence of non-suppressed TSH should occur in TSH-omas, as well as in other conditions such as early phase of destructive thyroiditis, irregular replacement of l-thyroxine, assay interference of heterophilic antibodies and RTH. The combination of high serum free TH, inappropriately normal or elevated TSH, high serum α-subunit (αSU) or increased αSU/TSH molar ratio and a pituitary tumor strongly suggests the diagnosis of a TSH-oma.

Triiodothyronine (T3) suppression test is generally reserved for patients with inconclusive results in above tests, because genetic tests for detection of mutations in thyroid receptor (TR)α and TRβ genes are expensive. Administering long-acting somatostatin analogs has been proposed for distinguishing between thyrotropinomas and RTH, since patients with thyrotropinomas would be likely to show a significant reduction in free thyroxine (fT4) and T3 levels. Approximately one third of patients with TSH-oma were misdiagnosed as having primary hyperthyroidism and mistakenly treated with thyroidectomy or radioiodine [2]. The majority of TSH-omas is monoclonal in origin, like other types of pituitary adenomas. Pituitary-specific transcription factor-1 (Pit-1) may play a role in adenomatous cell proliferation and its overexpression was detected in growth hormone- (GH), prolactin- (PRL) and TSH-secreting adenomas more frequently than in normal pituitary. Reduced expression of TR was demonstrated, and it could explain the abnormal negative feedback of TH on TSH production by tumor cells [2,3].

TSH-omas are more fibrotic than other pituitary tumors and it can worsen surgical outcome and somatostatin analog treatment should be considered as the first-line treatment in adults with macroinvasive TSH-omas [2,4,5]. Such an adenoma is infrequent in adults and has rarely been report in children, we describe an 8-yr-old boy with TSH-oma, and his follow-up until final height. The patient and his mother assigned consentient term.

Case Presentation

A 7.9-yr-old white pre-pubertal boy was referred to Pediatric Endocrinology Unit due to goiter. His mother noticed he was more irritable, and lost weight albeit an increased appetite. History was negative for insomnia, headache or visual disturbance. Physical examination disclosed a lean and hyperactive child with stare opened eyes, warm and moist hands, with fine tremors. Height was 138cm (1.78SDS; target height -0.96SDS), weight 27.2kg (0.40SDS), and BMI 14.28 (-1.14SDS). Pulse rate was regular (108bpm) and blood pressure 100/60mmHg. Thyroid was tender, diffusely enlarged (app.30g). Deep tendon reflexes were exacerbated. Laboratory work-up revealed a bone age (BA, Greulich & Pyle) of 9-yr, and the following thyroid function profile (normal values in brackets) was found: TT3 181.9 (45- 137ng/dL), TT4 24 (6-12μg/dL), fT4 3.68 (0.71-1.85ng/dL), TSH 4.77 (0.49-4.67μU/mL); basal and peak TSH on TRH test 4.6 and 6.2, respectively; pre and post T3 suppression test RAIU (24h) values were 42.1 and 30% respectively, while TSH did not change significantly (4.15) whereas fT4 exhibited some reduction (2.64). Anti-thyroid receptor (TRAb), anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) antibodies were negative. Calcium and PTH levels were normal. αSU was 0.86 (≤0.8ng/mL), αSU/TSH molar ratio 2 (<1) and magnetic resonance imaging (MRI) of pituitary was normal.

Patient was managed with propranolol (1 mg/kg/day) and methimazole (MTZ, 0.5 mg/kg/day) and thereafter, with MTZ exclusively. Table 1 summarizes main preoperative clinical and laboratory events. While on MTZ, T4 and T3 did not normalize, TSH values ranged between 5.81 and 12.59 and goiter was slightly enlarged. MTZ was withdrawn and thyroid and pituitary functions were evaluated three weeks later. On combined insulin hypoglycemia (ITT)/TRH tests, prolactin (PRL) and cortisol rose properly, peak GH (ng/mL) was 5.9 and TSH was unresponsive (Table 2). Basal LH and FSH were normal and IGF-I was 434 (30- 289 ng/mL). RAIU was elevated (75.8%) and rose paradoxically (87%) after T3 suppression test. Sex hormone-binding globulin (SHBG) was 233 (13-71 nmol/L), and T4-binding globulin (TBG) was 16 (10-29 mg/dL). Repeated TRAb, anti-TG and anti-TPO were negative. At this time αSU was high to 0.949 (αSU/TSH 4.7) and pituitary MRI revealed the presence of an 8 mm width microadenoma (Figure 1).
CA = Chronological age

vTranssphenoidal surgery (TSS) was performed and a well-demarcated, fibrous and firm adenoma was excised. The pathologic specimen showed adenoma cells that were immunopositively only for TSH and chromogranin and negative for LH, FSH, PRL, ACTH, and GH. Eighteen hours after surgery, serum TSH and fT4 descended to 0.53 and 1.8, respectively and goiter and thyrotoxicosis signs diminished as well. On the 3rd day postoperatively, acute adrenal insufficiency and transient diabetes ensued. Hydrocortisone and DDAVP were given and maintained for 2 and 14 months, respectively. Two months after TSS, ACTH was 12 (10-50 pg/mL) and IGF-1 64 (74-388 ng/mL). Peak GH and cortisol (μg/dL) on ITT were 0.2 and 26.9 respectively. PRL and TSH responses to TRH were blunted; however, RAIU was normal (23.8%). One year after surgery, BA was 11.5, TT3, TT4 and fT4 were in the low-normal range for age, calorimetry was sub-normal and pituitary MRI showed no evidence of tumor.

He had gained weight, but growth velocity was <1 cm/yr despite adequate replacement dose of l-thyroxine (88 μg/day) He was put on rhGH (0,033 mg/kg/day) and growth velocity improved significantly (9.2 cm/yr). Three years after surgery, he is still pre-pubertal and growing normally (on both l-thyroxine and rGH). Last pituitary MRI was normal and aSU lower than 0.05 (aSU/TSH 0.61). His BA was 13.0 (chronological age 12.5) and peak LH and FSH after GnRH were 1.1 and 1.4 mU/mL, respectively. At that time, testosterone replacement was started and after 9 months, he was pubertal. Five years after surgery, rhGH was suspended, because he reached height above target height. Six months later, testosterone replacement was stopped. However, pubertal stage did not evolve and IGF-1 was 145 (226- 903 ng/mL), testosterone (250 mg/month) and rhGH (0.6 mg/ day) were re-started. At his last visit, at 16.3 yr.-old, height was 178.9 cm (0.59 SDS) and pituitary MRI was normal. Figure 2 shows his height and weight SDS during follow-up and table 3 summarizes main postoperative clinical and laboratory events.
*Basal cortisol = 3.43 mg/dL (6-19); urine density = 1005; ** Total testosterone = 106 ng/dL (<100); peak LH and FSH after GnRH = 1.1 and 1.4 mU/mL; CA = Chronological age; BA = bone age; rhGH = ecombinant human growth hormone.

Discussion

Once inappropriate TSH secretion syndrome is identified, specific investigation to differentiate a TSH-oma of RTH is mandatory [2]. In our patient, TSH was not responsive to TRH stimulation test and both aSU and aSU/TSH molar ratio were high. In not previously treated subjects with RTH, the TSH response to TRH is preserved, and aSU/TSH is normal. Moreover, in RTH subjects a decreased secretion of TSH after supraphysiological doses of TH is usually accompanied by a reduction in RAIU [6], what was not observed in our patient. These findings suggest that RTH was not likely. TSH-omas are rare in adults and to our knowledge our patient is one of the youngest children with hyperthyroidism due to TSH-oma ever reported. Other 13 children or adolescents described were 8-yr. or older (8 to 16yr) and had macroadenoma except a 13 yr-old girl who had microadenoma and a 15 yr-old girl whose tumor size was not decribed [7-19].

In this case, pituitary MRI suggested microadenoma, although 88% of TSH-omas are usually large and invasive [2,20]. Patient underwent TSS because the primary goal of treatment of TSHomas is, whenever possible, the complete removal of the tumor [2]. TSH, TH and aSU levels reduced soon after surgery and one week after, patient was euthyroid. TSS was successful in regard the complete removal of the tumor, although in the follow-up central hypothyroidism, and GH, PRL, LH and FSH deficiencies succeeded. Panhypopituitarism and diabetes insipidus also have been reported [14].

The first case of a patient with TSH-oma and normal aSU was described in 1991 [21]. Valdes-Socin et al. observed normal aSU in more than 60% of the cases. High aSU is often associated with bad prognosis and was found more frequently in macro than in microadenomas [4]. The high percentage of patients with normal aSU could difficult differential diagnosis with RTH. Absence of TSH response to TRH may be suggestive of presence of a TSHoma. In difficult cases, genetic analysis looking for the presence of a mutation in TRβ gene may easily help to discriminate between the two disorders [2]. SHBG could also be a useful test yet its level was almost invariably normal in patients with RTH but often high in thyrotoxic patients with TSH-oma [2]. One challenging situation is those patients with an invisible adenoma on MRI and near-normal aSU, as initially occurred in our patient, whose diagnosis was done one year after inappropriate treatment with MTZ; possibly, that promoted tumor growth.

This case shows interesting aspects: the age of the patient at diagnosis; the finding of a normal MRI in contraposition to the elevated aSU/TSH molar ratio that was not adequately interpreted; growth of the tumor during MTZ, blunted TSH response to TRH in the post-operative phase in contradiction to diminished calorimetry, low-normal values of fT4, TT4 and TT3, and normal RAIU. We presented a comprehensive evaluation of a patient with TSH-oma followed for more than 8yr, who attained a final height, in accordance with the target height due to adequate therapeutic management.

Learning points

i. Once inappropriate TSH secretion syndrome is identified, specific investigation to differentiate a TSH-oma of RTH is mandatory, even in children.
ii. Patients who have TSH-oma could be misdiagnosed as having primary hyperthyroidism and, thus, mistakenly treated with antithyroid drugs or thyroid ablation.
iii. TSH-oma may be a microadenoma and be present even when aSU is near-normal or normal and it is a challenging situation.
iv. After surgery, follow-up should be prolonged and hormonal deficiencies should be diagnosed and treated. 


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Tuesday, June 23, 2020

Review on Stationary CPT Technologies and Coil Designs for EVs - Juniper Publishers

Material Science - Juniper Publishers

Abstract

In the recent decade, the driving range of pure EVs with zero emission target has become a popular topic as the massive battery requirement for longer distance travels means higher vehicle cost and longer time of recharging periods. Stationary CPT charging solutions could be an alternative to reduce EVs weight, size and energy storage unit costs. Fortunately, with progressive success of low-power CPT charging applications proposed to be commercially produced in the past decade, hundreds of kilowatts level high-power CPT charging techniques for EVs are more and more expected to be an optimally suitable solution for recharging EV batteries, providing higher propulsion and delivering continuously longer driving range in the next generations of the EVs. The idea of deploying inductive coupling for EVs has acquired a lot of attentions in the last decade due to the contributions and advancements of power electronics, switching power supply, semiconductors, microprocessors, electrochemistry, material sciences, control technologies, electromagnetics and so on, despite many challenges to be addressed including EV manufacturing integration with CPT system under the chassis, infrastructure difficulties, system maintenance on both vehicle and transmitting ground sides, actual CPT performance with real-time coupling on real-world road. In order to ensure the realization and enhance the sustainability in transportation sector with the emerging CPT ideas, currently the stationary CPT charging solutions based on inductive power transfer (IPT) have been developed from laboratory level as a first step to the practical tests of commercial realizations. In a few industrial fields nowadays, some of the proposed CPT technologies with specific coupler coil designs have been expected for real-world applications. This article presents a state of the art of the CPT technologies and focuses on reviewing current coil designs for high-power contactless energy transfer for EVs in the literature.

Keywords: Contactless power transfer (CPT); Wireless power transmitting (WPT); Inductive power transfer (IPT); Coupler; Coil designs; Ferromagnetic materials; Ferrite cores; Charging efficiency; Power transfer ratings

Introduction

The mainly significant performance parameters and objectives of a satisfied CPT system are power transfer rating level, maximum charging distance, system maximum efficiency, charging tolerance to misalignments, system size and weight. The power level can refer to how long one full battery recharge would take for a full driving range of EV. The maximum charging distance determines the vehicle chassis structure for achieving contactless charging. The system efficiency is the overall comprehensive parameter of the entire system, which illustrates how electrically efficiently the CPT phenomenon operates from AC power supply end to DC battery end for the EV. Charging tolerance could reveal how the horizontal and longitudinal misalignments caused by EV drivers’ parking habits impact the actual coupling charging and power delivered between primary coil and secondary coil, which also indicates how the flexibility and advantages of CPT systems are when compared with conventional plug-in charging methods. The stationary CPT technologies could comprise loosely inductive coupling and electromagnetic resonant coupling depending upon different operating frequency range levels and capacitive compensation adoptions, which are both based on inductive coupling phenomenon and most of the time are collectively called inductive power transfer (IPT) in the literature.

Principles of Stationary CPT systems

For the technical background and fundamental principles of contactless power transfer systems, Figure 1 and Figure 2 illustrate the typical systematic diagram and basics of IPT based stationary CPT systems. When the IPT charging system is activated by the signal from EVs reaching over the particular charging platform, the power supply under pavement will provide 230V AC mains to a transformer converter which could convert and rectify the high voltage power to required range of DC voltage. Then, a high frequency (HF) inverter converts the low frequency DC power to HF AC power. Before being sent to transmitting pad, the HF AC power is supposed to go through the compensation module [1] which is considered to optimize the transformer loss factor. Contactless power transfer coupler transmits the power to the vehicle side via effects of magnetic flux linkage namely inductive phenomenon. After receiving the induced AC power, the compensation circuit and rectifier/AC-DC converter would operate on the power then the DC to DC converter of direct conversion method converts the energy to a required voltage with appropriate low frequencies for battery energy storage in the end of the whole CPT system. At a basic level of a real-world CPT system, a power supply requirement before the coupling module as depicted in Figure 2 is supposed to include an input rectifier and filtering section, an H bridge inverter section and current controller if necessary.
Material Science
Material Science


History

In 1887, Nikola Tesla invented induction machine that converts electrical power to mechanical power from a stator to a rotor, which inspired Tesla again to come up with the idea of wirelessly transmitting energy via large air gaps based on the principle of electromagnetic induction machine that was just technically and commercially proved by himself. In 1901, the concept of wireless power transmitting (WPT) was firstly proposed and was believed by Nikola Tesla that it can be used to transfer electricity even far from America to Europe with an electromagnetics based giant tower named Wardenclyffe tower in USA, which was terminated by US government in 1917 and proved that the actual coupling distance is a huge obstacle to WPT efficiency and effectiveness. Since then, some experiments were implemented in order to wirelessly transfer power to a moving train with coupled energy but still went unsuccessful, which on the other hand proved that only low-power signal could be transmitted over large distances such as radio frequency (RF) signals, microwaves, etc. A conclusion was made at that time that electrical power wirelessly transmitted is practically impossible from a power point of view throughout the rest of 19th century [2]. Whilst on the ‘signals’ side, the sciences over communication systems, non-contacted current sensors and inductive antennas had been significantly developed based on Maxwell equations, laws of Ampere’s and Faraday’s and attempts of Nikola Tesla’s WPT.

With the attempts of powering EVs inductively since 1970s, stationary CPT topics were re-proposed at the same time. In 1986, Kelly and Owens [3] designed a wireless power transfer method for a low-power level aircraft entertainment system with 38 kHz currents going through wires under the carpet successfully coupling and delivering 8 W power for each passenger entertainment platform despite very low transfer efficiency. In 1990, this wireless aircraft entertainment system powering innovation named ‘regulator for inductively coupled power distribution system’ was enhanced with a voltage controller and was patented by Turner and Roth for Boeing aircrafts in the US [4]. In the beginning of 1990s, as academic pioneers, Boys and Green developed a systematic stationary CPT technology and patented it in the US [5] with the first definitional names in this area: inductive power transfer (IPT) or inductively coupled power transmission (ICPT) system, which includes an elongate inductor, parallel capacitive compensation, paralleled pickup coils, decoupling and voltage controllers [6]. This complete IPT system was modified and improved with enhanced control circuits by Boys, Covic and Green in 2000, which resulted in an output of up to 600W with a maximum voltage of 600V at 10 kHz by the system power supply [7] and, thereby from the power point of view, it was apparently unable to sufficiently power tens of kilowatts level EVs or to accomplish hundreds of kilowatts level required fast highpower battery charging cycles of EVs.

Since 2000, the performances of different stationary CPT approaches were significantly improved most of the cases in lab researches rather than industrial level applications. In 2007, MIT WiTricity project group made a demonstration and claimed that their wireless power transmission system can lighten a 60-W bulb over 1 and 2 meters at 9.9 MHz with a transfer efficiency of between 30% and 90%. This demonstration itself was convincing but the measured results were unavoidably doubtful when analysed according to previous studies and experiments over the past decades in the literature. Nevertheless, the development of stationary CPT technologies has been facilitated dramatically by the academic interests and the commercial market requirement of EVs towards pursuits of zero emission transportation era in the 21st century.

Current status

Among the various previous studies and reports in the literature, it can be noticed that numerous subtopics have been covered and many breakthroughs have been made towards the CPT system performance optimization and the commercially productive realization for EVs. A variety of applications based on inductive power transfer principle have diversified and the actual technical challenges have been becoming more noticeable at the same time, especially for the stationary and dynamic high power required contactless charging for real-world EVs. Nonetheless, the inductive coupling-based CPT technologies and the derived techniques are promising. This section briefly reviews the developments of stationary charging for EVs over the past decade and presents the state of the art of stationary CPT method.

More recently within the past decade, a series of research institutes, university research groups and industrial manufacturers have been playing pioneer roles in this field and making new knowledge contributions from different aspects. Oak Ridge National Laboratory (ORNL), as a bullet research institute sponsored by the US Department of Energy in the CPT area, has carried out some practical experiments empirically resulting in some analyses and conclusive methods in the national research centre lab in Tennessee. ORNL focuses on grid-tied high frequency power inverter, grid side regulation converter, control system and loosely coupled coil design. Based on the new ultra-thin silicon IGBT technology, an experimental power inverter and a grid-tied power converter were designed and tested by ORNL in 2012 [8], which aims to minimize the mass and size of the coil, rectifier, filtering, wires, and other components mounted on the secondary side of vehicle chassis [9].

A 5-kW output inductive stationary CPT system was designed by a group of the Utah State University, in which an external 37-W power required FPGA sensors/controller was added to the CPT system for the dual-side control. Circular coils and LCL converter were used in this system. Practical experiments in this study were used to validate the effectiveness of the proposed schematic, by which the researchers claimed that the system can maintain a very optimistic efficiency from the grid side to the load in spite of too many ideally assumed conditions that were made in the derivative analyses and post-data processing [10]. Nonetheless, a dual-side control method in this report was proposed to the inductive coupling system as an innovative way. A researcher of the University of British Columbia deployed a set of magnetic gears as transmitting and receiving magnets, an electric motor on the ground side and a generator on a car chassis to realize a wireless power transmitting, which is implemented and accomplished via coupling magnetic gears and driving the generator on the car to power the vehicle motor. It was claimed that this system could reach a maximum transmission part efficiency of 81% with a transferred power of 1.6 kW at a very low frequency of 150 Hz [11]. Regarding the feasibility and realization by gear coupling and re-generating electricity in a real-world EV charging application, the proposed system seems to be doubtful in this study as the additional process of driving the secondary generator via the magnetic field stored energy for inductively producing the electricity itself would unavoidably introduce more power losses eventually contributing to a further reduction of overall system efficiency ratio.

Two researchers of the Setsunan university in Japan conducted investigations on several different coil dimensions, in which it was found that three-dimensional horn-shaped antennas as transmitting and receiving coils could lead to higher power transfer efficiency than patch and array antennas whilst the patch antennas in a nature of planar could be more practical and suitable for EVs chassis CPT system installation. Thus, the size and operation performance are to be a trade-off when considering the entire stationary CPT system from design to actual fabrication onto EVs. In this study [12] of the University of Setsunan, the system operating frequency is between 1.2 Ghz and 2.45 GHz, which is in a range of HF. Besides, it is claimed that the array antennas perform with lower transmission loss than patch antennas at 2.45 GHz and with a transmission efficiency of over 20% despite of unknown actual power transferred through the entire system.

A team of Tokyo University contributed numbers of reports to the field of CPT technologies in the past ten years. Based on the method conceptualized and named with electromagnetic resonant coupling by MIT WiTricity in 2007, the research group of Tokyo University started studying the feasibility and technical performance of this method with theoretical and practical depth since 2009. Different from the previous inductive power transfer (IPT) methods and concepts, the proposed electromagnetic resonant coupling technology emphasizes on impedance matching [13] in order for the whole system to approximate to magnetic resonance, by which predictably the energy transfer efficiency of the CPT system could be optimized and theoretically the actual power rating to the load could be very satisfactory.

This group of researchers considered the CPT technology as small-sized helical antenna transmission topics and pure electrical equivalence problems [14,15] which led to a convenience of investigating the system with the antenna scattering parameter (S-parameter) analysis and the direct experimental methods of using a vector network analyser (VNA) [16] to measure the outputs at a usable frequency of the industrial, scientific and medical (ISM) band-13.56 MHz [17]. Significantly, the impedance matching theory contributes to the theoretical structure construction of CPT technologies, especially for the magnetic resonance accomplishment in this case. Whilst, the over-idealized impedance matching circuits used in this case neglects the non-linear magnetic circuit part in the coupling module, which determines a lot regarding how the actual electromagnetic flux distribution contributes to the real-time coupling phenomenon over the air or core based distance with non-linear magnetic characteristics in nature such as B-H curves and hysteresis effects in the electromagnetic field. Thus, the absolutely equivalent circuit method in the case of this research group may be not sufficiently appropriate and suitable for a CPT system scenario. Besides, working at megahertz level operating frequency and considering the system as a pure antenna problem especially with traditional scattering parameter analysis may be not proper as firstly the real-world CPT systems are not milliwatts level ‘signal transmission’ topics from power point of view, and secondly the VNA measurement with a two-port network S-parameter method may not be adequately applicable any more when it comes to kilowatts level electrical power issues despite of resonance status.

Nevertheless, the University of Tokyo team did make contributions towards the knowledge gaps at that time in the last years of 2000s. With the same methodology, a battery hybrid energy storage system was also studied by this research group, by which it is claimed that both the transmission side power control configuration and the receiving antenna side controller were designed to achieve satisfactory power charging without communication units between transmitting and receiving antennas [18]. However, the Tokyo University research team turned to study the CPT systems in a loosely coupled frequency range in the order of kilohertz [19] rather than megahertz anymore since about 2014. More practically in laboratory and realistically in applications this time, the researchers mainly investigated the circuit topologies, transmission coil types, control methods and capacitor compensations in depth, pointing out that the effectiveness of magnetic resonance to the wireless power transfer coupling purpose and proving that the new methodology contributes more to the system efficiency and power transfer rating issues [20] with results of 40-90% and 60W, respectively. On the other side in industry, several technology driven companies and manufacturers have also been making contributions to the field of emerging wireless power transfer technologies for stationary charging from multiple levels and aspects over the past twenty years, such as WiTricity Corporation, Bombardier, HEVO Power, Qualcomm Group, Conductix-Wampfler etc.

As mentioned before in the last section, WiTricity as a corporation was founded by a group of MIT researchers to investigate and invent wireless energy transmission terminals for commercial purposes since the first demonstration in 2006. With the proposed resonance coupling method, WiTricity team designed a CPT system with tuned coils to wirelessly transfer power which was claimed with 60 W to 3.3 kW over one meter at 145-kHz operating frequency [21-24]. Afterwards in 2011, some other researchers in East Asia carried out resonant coupling simulations based on WiTricity designs and studies the position tolerance of the method, by which it was claimed that the simulated WiTricity model showed a maximum performance at 2.34 MHz with a coil distance of 50 mm [25]. However, in this report a real power rating and effectively convincing system efficiency were not derived and discussed in detail although the peak values of output voltage magnitudes corresponding to various coil distances and frequencies were recorded and compared.

Bombardier Transportation company, a leading technology and solution supplier in Germany, tested their wireless static charging system called PRIMOVE for buses in 2013. As part of the pure electric public buses, the PRIMOVE system has been integrated with improved EV system via this project. Bombardier designed their own control unit named ‘vehicle detection and segment control’ (VDSC) and interface called ‘supervisory control and data acquisition’ (SCADA) subsystems at industrial levels [26], which seems to be feasible and successful in the real-world application despite of insufficient technical reports or data released and published yet. HEVO Power is another technology provider in the US which aims to innovate a wireless charging system for public transportations. This company proposed a stationary system requiring a fixed operating frequency of 85 kHz and targeting at transferring up to 10-kW power over an air gap of about 30 cm. It was claimed in 2014 that the receiving side prototype mounted on the vehicle weighs 11 to 23 kg and that the heating problems on both the vehicle and ground charging sides can be prevented by their parking zone design and mobile phone app monitoring [27]. Qualcomm, a pioneer company dedicated in communication technologies, informatics and lately emerging wireless power transmission, has also been implementing research programs towards an optimal wireless charging equipment for both lowpower electronic devices and high-power charging applications.

Qualcomm Halo is a specific project regarding achieving CPT charging for EVs. Qualcomm aims to realize three options of charging power ratings for future customers in their report in 2013, which are 3.3 kW, 6.6 kW and 20 kW and targets at very high and stable efficiency rate of over 90%. With IPT method, proposed BiPolar and DD coil designs, Qualcomm claimed that their Halo IPT system used 20-kHz operating frequency in the simulation experiments and trial runs of this prototype would be implemented in East London in 2011. It can be noticed that, from the official reports and research report [28] in collaboration with Auckland University, Qualcomm Halo project is very practically profound and technically convincing with strong simulation supports and mathematically theoretical representations by themselves and other researchers [29].

Besides, the double D method has been patented by Qualcomm years ago from commercial point of view. Conductix-Wampfler, another technology company in CPT research, is very dedicated in investigating inductive power transfer (IPT) techniques and already patented their own IPT trademark in the US. This company focuses on developing IPT system for automated guided vehicles (AGV) in warehouse applications with robotics [30,31]. According to their reports until 2018, Conductix-Wampfler aims to produce the power supply module, charging mat and power pickup with charging manager unit. Technically, the power supply AC voltage can be one-phase 100-240V or three-phase 380-480 V at 50 or 60 Hz, the output power and current can be 1.5 kW and 5 A, respectively. Their power pickup namely receiving coil module with charging manager subsystem aims to inductively receive about 55 V induced voltage and 10 A current to send to charge a 24-V DC battery with 12-A and 144-W after the power regulation, DC/DC converter and current monitoring of the charging manager subsystem. The dimensions of power pickup pad and charging mat are H 80.3 mm x W 222 mm x D 216 mm and H 7 mm x W 435 mm x D 180 mm, respectively. The aim of the charging distance is 10 mm. It can be seen that Conductix-Wampfler shows not only respectful ambitions but also technical skills in the industrial applications for AGV in warehouse systems.

Proposed designs of coupling coils

As the most important part of contactless power transfer systems with regards to the overall system outputs and performances, the coupling module design especially the coil geometry design plays a significant role in order for any types of CPT architectures from both the power electronics and electromagnetics perspectives to eventually address the three main objectives: electrical power transfer ratings of the system; efficiencies including overall system efficiency to the load end and coupling part efficiency; CPT air gaps namely charging distances. Therefore, it is very worthwhile proposing, analysing and evaluating various coil designs to comprehensively implement the investigations upon CPT technologies. In this section, the proposed coil designs in the literature until present are to be enumerated and briefly analysed.

Circular coils

Until present, from the academic studies to the real-world commercial applications, the circular coil designs have become the most common and acceptable approaches for various powerlever devices such as wireless charging pads for smart phones and many other portable electronic products. Also, as for the initial feasibility for high-power level EVs contactless charging, circular coil with its derivative topologies has been focused and developed towards the optimizations and some of them are originally derived from traditional pot cores, according to the reports in the literature [32-34]. Within the current studies and even commercial level applications, most of the circular coil designs are coreless especially for low-power cases [35-37]. As known in transformer theories and applications, the ferromagnetic cores like ferrite cores are deployed to prevent excessive energy loss into surrounding air and materials due to existence of magnetic leakage. And with the fairly tiny air gap design crossing the core structure instead of completely enclosed core loop, the core windings can have minimum disadvantages when effects of proximity occur due to hysteresis loss and eddy current loss. Similarly and theoretically, deploying ferromagnetic cores like ferrite in CPT coil designs is able to constrain magnetic flux lines to expected paths and to shape the actual electromagnetic field in order to enhance the effectiveness of coupling, which consequently improves the wireless energy transfer system performance.

In most small-scale low-power CPT systems for portable electronic devices like cell phones, wireless charging pads with coreless coils can acquire more popularity due to pursuits of relatively thin and lighter design from real-world customers, certainly under acceptable conditions such as charging power rating and basic efficiency to be at least satisfied by manufacturers’ efforts on advanced electronic circuitry and control unit designs. However, high-power CPT applications are more supposed to need cores to assure the satisfactions of the overall system performance [38,39], for instance, the circular coil couplers with solid ferrite pads could form the flux distribution much better. A design of circular coil with ferrite pad is shown in Figures 3 &4 [10], in which the dimension is in mm. And two coreless circular coil designs are illustrated in Figures 5&6 for comparisons.

In addition, the derivatives of circular design have also been depicted here in Figures 5&6 [40]. In this article, the former design could be called a design of simplified planar circular coreless coils and the latter one could be called a design of simplified coreless solenoid coils, with a categorization nomenclature based on the characteristics and natures introduced above. The model in Figure 7 could be named a design of circular ring coreless coils, which illustrates expected magnetic flux lines and distributions in 3D magnetic simulation. It can be seen that with no ferrite pads or cores, the flux lines flow through the coils showing more naturally and smoothly curved paths in air, which can be different from the circular coils with shaping effects by ferromagnetic materials such as ferrite pads used on the external sides.
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Planar square coils

Geometrically, square windings can take better advantage of the space under the chassis of vehicles for system installation. Some reports also have already presented the designs regarding square coils and the derivatives and practically tested. The Oak Ridge National Laboratory (ORNL) in the US proposed the detailed designs of their square coupler shown in Figures 8&9 [8,9,41] for which a category name of ‘planar square coil without a cavity’ can be applied based on the reviewed designs and categorization nomenclature in this article. The square coils of ORNL are singlelayered with multiple circles of windings as illustrated and the winding wires are made of copper. No ferromagnetic materials are used in this design. Considering different magnetic flux lines generated and formed by whether or not a cavity exists in the planar coils, another derivative design can be categorized into ‘planar square coils’ here. Compared with the planar square coil without a cavity prototype, the model that can be named the ‘planar square coil with a cavity’ has been presented in [42], which is nearly based on the same dimensional parameters except the empty cavity design existence within the coils as shown in Figures 10&11.
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Solenoidal square coils

When the installation space under a vehicle chassis is not a major issue, for instance for small-sized automated guided electric vehicles (AGEV) in warehouse rather than on public traffic road, a combination design of solenoid coils and square coils can be proposed, which here is named ‘solenoidal square coil’ despite a different name in the original report [43]. By a comparison analysis in this article, it can be explained that, the huge dimensional size of this kind of design can take advantage of the intracavity space of the AGEV and theoretically present the optimal performance of both planar square coil and solenoidal coil due to a larger internal magnetic flux area and path length as shown in Figure 12. Expectedly, this solenoidal square coil design can improve the magnetic flux density and eventually enhance the power transfer efficiency and power rating, which however still needs to be tested and proved with actual system output performance and feasibility yet.
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Helical solenoid coils

Similar to conventional solenoid structure, the helical solenoid coil categorized here can be one of the applicable CPT coupler designs. As shown in Figures 13&14 [44], the helical solenoid coil design ideally has two coaxial solenoids with horizontal flux central lines in parallel. With one solenoid as transmitting coil on the primary side and another solenoid as receiving coil on the secondary mounted on the vehicle chassis. Figure 14 shows a cross section of a helical solenoid coil with single-layered windings. This coil structure theoretically has satisfactory mutual inductance when two coils have zero misalignment in parallel and short coupling distance, especially for small electronic devices. However, this design may have low tolerance to misalignments which could be a challenge from the EV customer end in realworld high-power applications if installed on vehicle chassis. Ferrite cores can be inserted into the cylindrical centre in helical solenoid coil design for coupling enhancement.
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Multilayer helical coils

A novel design called ‘multi-layered helical coil’ is illustrated in Figures15&16. Theoretically, with numbers of winding turns and layers, the coil coupling, and mutual inductance will be increased, consequently enhancing the CPT system performance. When it comes to high frequency applications like CPT charging for EVs, the total effects of proximity losses will be significant if the distance of each turn and layer separation are too close, which lowers the system efficiency [45]. Thus, this design is not suitable for high frequency, space tightened and high power required applications. Further investigations and experimental results from practical prototypes rather than ideal simulation models are still required to study this multi-layered helical coil design for the feasibility and realization of CPT charging of EVs in the future.
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Mixed-type coils design

An innovative structure design shown in Figure 17 was proposed by a team in Japan in 2015. This mixed-typed coil design [19] is supposed to allow higher tolerance to misalignments, smaller size and more compact installation for energy receiving side on EVs as two coaxial square solenoid coils on the transmitting side are expected to generate stronger magnetic field in order for the circular receiving coil to capture more amount of magnetic flux lines. Expectedly, the overall coil magnetic flux distribution of the CPT system could be boosted when compared with a pure circular coil design for the same size of chassis of EVs. However, this design still needs to be further theoretically studied, practically tested and comprehensively analysed from modelling to experiment due to few reports in the literature until present.
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Double D coils

A structure of double D shaped coils was proposed by Qualcomm Halo program as illustrated in Figure 18. Two coils of the ideal D shape winded with one long copper wire are on the ground side as a transmitter, and a polarized receiving coil with two partially overlapping windings is on the EV chassis side [46]. This DD design was reported to produce higher coupling than a same-sized circular coil structure [47,48]. However, further developments about DD coil design and its derivatives are required by more numerical results and effective system performance.
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H-shaped coupler coils

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A novel H-shaped coupler with ferromagnetic materials as cores was proposed in [39,49]. In order to enhance the magnetic field flux density and CPT coupling performance, different core materials were tested and analysed. Besides, it was found that the objectives of CPT systems can be addressed by adding shielding shells. Especially with aluminium semi-enclosed shielding shell, the CPT prototype can produce better electromagnetic characteristics and output more satisfactory system performance [50], which reflects the effectiveness and feasibility of using ferromagnetic materials and shielding methods Figure 19.

Asymmetric coils

The asymmetric coil structured in Figure 20 was proposed in 2014 in order to investigate the impact of tolerance to the stationary CPT system performance. The receiving coil is smaller than the energy transiting coil set with a purpose of improving the tolerance of misalignments when parking a vehicle [51]. This structurally innovative coupler design with a transmitting bottom set size of 200 cm x 100 cm each and a pickup set size of 16 cm x 16 cm each is claimed to output 15 kW at 20 kHz and the maximum misalignments can be 40 cm and 20 cm for lateral and longitudinal axes. This coil design contains ferrite cores as a ferromagnetic material to facilitate the field. The power supply is a current source of maximum 100 A in the simulation models. Nevertheless, further studies about the feasibility for real-world EVs contactless charging with this type of design are required in the future, addressing the other major objectives of CPT systems.
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Conclusion

In this article, the brief history and basics of CPT systems using inductive power transfer have been introduced. A series of both leading research institutes and pioneer industrial companies worldwide have been listed and discussed in terms of the development directions, proposed methods and concepts over CPT technologies. In addition, most of the currently proposed coupler coil designs have been described and reviewed towards the major objectives of CPT technologies.  

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