bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of Flashing Flow in a Siphon to Extract Condensate in Paper Dryer Application
Authors: Majeed Hamed Abdul , Wang Ting
Published: October 2020

The paper industry uses steam to dry paper web through cylinder dryers. As steam condenses inside the dryer, the condensate is removed by means of either a stationary or a rotary siphon. However, during the siphoning process for transporting the condensate, flashing of the condensate occurs, which could cause backflow or discontinuity in the siphoning process. To resolve this flashing issue, two approaches have been employed: (a) increasing the amount of steam supplied to the cylinder to “blow-through” the stalled condensate–steam mixture and (b) reducing the back pressure by inducing “suction” through a thermocompressor from downstream. The objective of this study is to investigate and improve understanding of the flashing phenomena during condensate transport through the siphon and piping system in order to develop means to reduce the excessive steam consumption during the paper drying process. A computational fluid dynamics (CFD) simulation is performed that uses the Eulerian–Eulerian multiphase method. The steady-state case is first solved to obtain the flow field without flashing. Then, the transient method is initiated by employing evaporation and condensation model. The results show that reduction of local pressure triggers flashing; however, flashing in turn reduces local temperature and subsequently induces condensation, resulting in an alternating flashing and condensation behavior. To maintain continuity of the siphon flow, the inlet pressure fluctuates corresponding to the variation of total vapor volume ratio inside the siphon. The results will be used to modify the current siphon system design and operating practices to reduce the steam consumption.
Evaluation of the Creep Strength of 9Cr-1Mo-V and 1Cr-1Mo-1/4V Castings and Weldments Using Accelerated Creep Testing
Authors: Laney Scot J.
Published: October 2020

The traditional method to generate creep data requires several long term tests; in some cases upward of 100,000 h. These tests are often time and cost prohibitive to perform. Creep data in literature are limited to commonly available materials in set processing conditions. This speaks very little to the properties for new materials, alternate processing of existing materials, as well as properties for weldments and heat affected zones (HAZ) that occur in the fabrication of large equipment. Due to this, several methods have been developed for accelerated creep testing. The stress relaxation test (SRT) is one such method and is discussed as the means to evaluate two different materials and their weldments used in the manufacturing of steam turbine casings. Cast 9Cr-1Mo-V material from two different foundries as well as their weldments and HAZ were tested at temperatures between 550 °C and 700 °C. The SRT generated data closely match that given in literature. In a nearly identical test program, cast 1Cr1Mo¼V steel showed anomalies in the weld and HAZ behavior. Further investigation showed that the incorrect weld metal was used, and in a second attempt, poor welding practice lead to premature specimen failure due to Type IV cracking. These two case studies illustrate the ability of the SRT method to accurately predict creep properties and its sensitivity to detect variations in properties, which can make it useful for rapid verification of casting suppliers and welding procedures for high temperature applications.
Shape and dose control for proximity effect correction on massively parallel electron-beam systems
Authors: Hasan Md Nabid , Lee Soo-Young , Ahn Byung-Sup , Choi Jin , Park Joon-Soo
Published: October 2020

Massively parallel electron-beam (e-beam) systems (MPESs) were developed to increase the writing throughput and demonstrated to be able to write large-scale patterns significantly faster compared to conventional single-beam systems. However, such systems still suffer from the inherent proximity effect due to the electron scattering in the resist. The proximity effect correction (PEC) has been investigated for a long time, and several PEC schemes have been proposed. Though most of the PEC schemes may be employed for an MPES, their direct application would be subject to the system’s constraints, e.g., a relatively large beam size, a fixed exposing interval, and the same deflection angle for all beams, which may lead to nonoptimal correction results. In this work, practical methods for realizing various types of spatial dose distributions required for the PEC and implementing both shape and dose corrections under the MPES constraints have been developed. It has been shown that, with these methods, the proximity effect correction can be performed effectively with the critical dimension error, line edge roughness, and total dose taken into account.
Electromyographic Comparison of Flywheel Inertial Leg Curl and Nordic Hamstring Exercise Among Soccer Players
Authors: Pedersen Helene , Saeterbakken Atle Hole , Vagle Markus , Fimland Marius Steiro , Andersen Vidar
Published: October 2020

Purpose: The Nordic hamstring exercise (NHE) has been shown to considerably reduce hamstring injuries among soccer players. However, as the load in the NHE is the person’s own bodyweight, it is a very heavy exercise and difficult to individualize. The flywheel inertial leg curl (FLC) could be an alternative since the eccentric overload is based on the amount of work produced in the concentric movement. Therefore, the primary aim of this study was to compare the activation in the hamstrings at long muscle lengths in the NHE and the FLC in amateur soccer players. Methods: Fifteen male amateur soccer players performed 5 repetitions in each exercise in a randomized and counterbalanced order. The concentric and eccentric movements were divided into lower and upper phases. Surface EMG was measured distally, proximally, and in the middle, at both muscles. Results: In the lower phase in the eccentric movement, there were no significant differences between the 2 exercises (P = .101–.826). In the lower concentric movement, the FLC led to higher activation in all parts of both the biceps femoris (31%–52%, P < .001) and the semitendinosus (20%–35%, P = .001–.023). Conclusion: Both exercises activated the hamstrings similarly at long muscle lengths during eccentric contractions (Nordic hamstring, nonsignificantly higher). However, when performing concentric contractions, the FLC induced higher activations. Therefore, the FLC could be a useful alternative to the NHE and particularly suitable for weaker athletes before progressing to NHE.
No Influence of Acute Moderate Normobaric Hypoxia on Performance and Blood Lactate Concentration Responses to Repeated Wingates
Authors: Takei Naoya , Kakinoki Katsuyuki , Girard Olivier , Hatta Hideo
Published: October 2020

Background: Training in hypoxia versus normoxia often induces larger physiological adaptations, while this does not always translate into additional performance benefits. A possible explanation is a reduced oxygen flux, negatively affecting training intensity and/or volume (decreasing training stimulus). Repeated Wingates (RW) in normoxia is an efficient training strategy for improving both physiological parameters and exercise capacity. However, it remains unclear whether the addition of hypoxia has a detrimental effect on RW performance. Purpose: To test the hypothesis that acute moderate hypoxia exposure has no detrimental effect on RW, while both metabolic and perceptual responses would be slightly higher. Methods: On separate days, 7 male university sprinters performed 3 × 30-s Wingate efforts with 4.5-min passive recovery in either hypoxia (FiO2: 0.145) or normoxia (FiO2: 0.209). Arterial oxygen saturation was assessed before the first Wingate effort, while blood lactate concentration and ratings of perceived exertion were measured after each bout. Results: Mean (P = .92) and peak (P = .63) power outputs, total work (P = .98), and the percentage decrement score (P = .25) were similar between conditions. Arterial oxygen saturation was significantly lower in hypoxia versus normoxia (92.0% [2.8%] vs 98.1% [0.4%], P < .01), whereas blood lactate concentration (P = .78) and ratings of perceived exertion (P = .51) did not differ between conditions. Conclusion: In sprinters, acute exposure to moderate hypoxia had no detrimental effect on RW performance and associated metabolic and perceptual responses.
Train the Engine or the Brakes? Influence of Momentum on the Change of Direction Deficit
Authors: Fernandes Rebecca , Bishop Chris , Turner Anthony N. , Chavda Shyam , Maloney Sean J.
Published: October 2020

Purpose: Currently, it is unclear which physical characteristics may underpin the change of direction deficit (COD-D). This investigation sought to determine if momentum, speed-, and jump-based measures may explain variance in COD-D. Methods: Seventeen males from a professional soccer academy (age, 16.76 [0.75] y; height, 1.80 [0.06] m; body mass, 72.38 [9.57] kg) performed 505 tests on both legs, a 40-m sprint, and single-leg countermovement and drop jumps. Results: The regression analyses did not reveal any significant predictors for COD-D on either leg. “Large” relationships were reported between the COD-D and 505 time on both limbs (r = .65 to .69; P < .01), but COD-D was not associated with linear momentum, speed-, or jump-based performances. When the cohort was median split by COD-D, the effect sizes suggested that the subgroup with the smaller COD-D was 5% faster in the 505 test (d = −1.24; P < .001) but 4% slower over 0–10 m (d = 0.79; P = .33) and carried 11% less momentum (d = −0.81; P = .17). Conclusion: Individual variance in COD-D may not be explained by speed- and jump-based performance measures within academy soccer players. However, when grouping athletes by COD-D, faster athletes with greater momentum are likely to display a larger COD-D. It may, therefore, be prudent to recommend more eccentric-biased or technically focused COD training in such athletes and for coaches to view the COD action as a specific skill that may not be represented by performance time in a COD test.
See, Reflect, and Act: Using Equity Audits to Enhance Student Success
Authors: Hamilton Michelle , Meaney Karen , Martinez Melissa
Published: October 2020

Promoting the success of all students is one of four institutional goals at Texas State University. Retention and graduation rates provide information regarding the academic progress and success of specific student cohorts. To gain a deeper insight into student success within the undergraduate kinesiology/exercise and sports science program at Texas State University, an equity audit was conducted during the fall 2019 academic semester. An equity audit provides a lens to critically examine institutional data to identify inequities in academic programs and student achievement based on specific variables, such as gender, age, race, and socioeconomic status. This article provides a model for conducting an equity audit in kinesiology/exercise and sports science programs, reports the findings, and highlights strategic actions implemented to combat inequities in student success.
Atomic-scale microstructure of metal halide perovskite
Authors: Rothmann Mathias Uller , Kim Judy S. , Borchert Juliane , Lohmann Kilian B. , O’Leary Colum M. , Sheader Alex A. , Clark Laura , Snaith Henry J. , Johnston Michael B. , Nellist Peter D. , Herz Laura M.
Published: October 2020

Structural secrets of hybrid perovskites

The optoelectronic and photovoltaic applications of polycrystalline hybrid metal halide perovskite films are notable because grain boundaries in most materials cause scattering of charge carriers that decreases performance. Electron microscopy studies of these materials have been hindered by their rapid structural degradation under intense electron beams. Rothmann
et al.
now present an atomic crystallographic structure of formamidinium lead triiodide (FAPbI
3
) polycrystalline thin films obtained by low-electron-dose scanning transmission electron microscopy with advanced image processing. The crystal structure sustains substoichiometry in the A-site cation, has a nearly perfect crystallographic alignment between PbI
2
impurity phases and the FAPbI
3
perovskite, and has atomically clean grain boundaries between polycrystalline domains. These features help to explain the films' surprising regenerative ability, their benign grain boundaries where strain and dislocations appear mostly absent, and why excess lead-iodide precursor can be counterintuitively beneficial.

Science
, this issue p.
eabb5940
Novel Mechanisms of Efflux-Mediated Levofloxacin Resistance and Reduced Amikacin Susceptibility in Stenotrophomonas maltophilia
Authors: Dulyayangkul Punyawee , Calvopiña Karina , Heesom Kate J. , Avison Matthew B.
Published: October 2020

Fluoroquinolone resistance in
Stenotrophomonas maltophilia
is multifactorial, but the most significant factor is overproduction of efflux pumps, particularly SmeDEF, following mutation. Here, we report that mutations in the glycosyl transferase gene
smlt0622
in
S. maltophilia
K279a mutant K M6 cause constitutive activation of SmeDEF production, leading to elevated levofloxacin MIC. Selection of a levofloxacin-resistant K M6 derivative, K M6 LEV
r
, allowed identification of a novel two-component regulatory system, Smlt2645/6 (renamed SmaRS).
Development of a Simple
In Vitro
Assay To Identify and Evaluate Nucleotide Analogs against SARS-CoV-2 RNA-Dependent RNA Polymerase
Authors: Lu Gaofei , Zhang Xi , Zheng Weinan , Sun Jialei , Hua Lan , Xu Lan , Chu Xin-jie , Ding Sheng , Xiong Wen
Published: October 2020

Nucleotide analogs targeting viral RNA polymerase have been proved to be an effective strategy for antiviral treatment and are promising antiviral drugs to combat the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In this study, we developed a robust
in vitro
nonradioactive primer extension assay to quantitatively evaluate the efficiency of incorporation of nucleotide analogs by SARS-CoV-2 RNA-dependent RNA polymerase (RdRp). Our results show that many nucleotide analogs can be incorporated into RNA by SARS-CoV-2 RdRp and that the incorporation of some of them leads to chain termination.
Kinetics of Bacterial Inactivation by Peroxynitric Acid in the Presence of Organic Contaminants
Authors: Yokoyama Takashi , Miyazaki Shinya , Akagi Hiroko , Ikawa Satoshi , Kitano Katsuhisa
Published: October 2020

A good disinfectant for the human body should have various properties, such as strong bactericidal activity, harmlessness to living tissues, and resistance against biological fluids (or other organic contaminants). Peroxynitric acid (PNA) showed a bactericidal effect that was several tens up to several hundred times higher per unit of molarity than that of sodium hypochlorite and peracetic acid, which are used as general disinfectants for medical equipment. Moreover, the high resistance of PNA to organic load was confirmed, indicating that PNA will inactivate bacteria effectively even on contaminated surfaces, such as used medical devices or the human body surface. Therefore, we propose that PNA can be used as a strong disinfectant for the human body.
Bacteriophage Infections of Biofilms of Health Care-Associated Pathogens:
Klebsiella pneumoniae
Authors: Santiago Ariel J. , Donlan Rodney M.
Published: October 2020

Members of the family
Enterobacteriaceae
, such as
Klebsiella pneumoniae
, are considered both serious and urgent public health threats. Biofilms formed by these health care-associated pathogens can lead to negative and costly health outcomes. The global spread of antibiotic resistance, coupled with increased tolerance to antimicrobial treatments in biofilm-associated bacteria, highlights the need for novel strategies to overcome treatment hurdles. Bacteriophages (phages), or viruses that infect bacteria, have reemerged as one such potential strategy. Virulent phages are capable of infecting and killing their bacterial hosts, in some cases producing depolymerases that are able to hydrolyze biofilms. Phage therapy does have its limitations, however, including potential narrow host ranges, development of bacterial resistance to infection, and the potential spread of phage-encoded virulence genes. That being said, advances in phage isolation, screening, and genome sequencing tools provide an upside in overcoming some of these limitations and open up the possibilities of using phages as effective biofilm control agents.
Computationally Optimized Broadly Reactive H2 HA Influenza Vaccines Elicited Broadly Cross-Reactive Antibodies and Protected Mice from Viral Challenges
Authors: Reneer Z. Beau , Jamieson Parker J. , Skarlupka Amanda L. , Huang Ying , Ross Ted M.
Published: October 2020

H2N2 influenza has caused at least one pandemic in the past. Given that individuals born after 1968 have not been exposed to H2N2 influenza viruses, a future pandemic caused by H2 influenza is likely. An effective H2 influenza vaccine would need to elicit broadly cross-reactive antibodies to multiple H2 influenza viruses. Choosing a wild-type virus to create a vaccine may elicit a narrow immune response and not protect against multiple H2 influenza viruses. COBRA H2 HA vaccines were developed and evaluated in mice along with wild-type H2 HA vaccines. Multiple COBRA H2 HA vaccines protected mice from all three viral challenges and produced broadly cross-reactive neutralizing antibodies to H2 influenza viruses.
Azacitidine-induced pneumonitis and literature review
Authors: Nguyen Paul , Safdar Jawarya , Mohamed Abdelaziz , Soubani Ayman
Published: October 2020

We present a case of azacitidine-induced pneumonitis which is a rare adverse drug reaction and reported in less than 0.1% of cases. Common side effects of azacitidine are weakness, nausea, vomiting, constipation, injection site reactions, insomnia, among others. Our patient received azacitidine to treat her acute myeloid leukaemia and began to develop shortness of breath which progressed to dyspnoea at rest after completing a 7-day course of azacitidine and venetoclax. Initial chest X-ray revealed severe airspace disease for which the patient began receiving broad spectrum antibiotics, antifungals and antivirals therapy. Although infectious workup revealed invasive aspergillosis she did not clinically and radiologically improve despite being on isavuconazole until high-dose glucocorticoids were initiated. This case illustrates the importance of recognising and understanding the potential side effects of azacitidine and other chemotherapy agents as some adverse drug reactions can be life-threatening.
Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study
Authors: Shah Anoop S V , Wood Rachael , Gribben Ciara , Caldwell David , Bishop Jennifer , Weir Amanda , Kennedy Sharon , Reid Martin , Smith-Palmer Alison , Goldberg David , McMenamin Jim , Fischbacher Colin , Robertson Chris , Hutchinson Sharon , McKeigue Paul , Colhoun Helen , McAllister David A
Published: October 2020

Objective

To assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.

Design

Nationwide linkage cohort study.

Setting

Scotland, UK, 1 March to 6 June 2020.

Participants

Healthcare workers aged 18-65 years, their households, and other members of the general population.

Main outcome measure

Admission to hospital with covid-19.

Results

The cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in “front door,” intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity.

Conclusions

Healthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.
Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases
Authors: Vinogradova Yana , Coupland Carol , Hippisley-Cox Julia
Published: October 2020

Objective

To assess the risks of breast cancer associated with different types and durations of hormone replacement therapy (HRT).

Design

Two nested case-control studies.

Setting

UK general practices contributing to QResearch or Clinical Practice Research Datalink (CPRD), linked to hospital, mortality, social deprivation, and cancer registry (QResearch only) data.

Participants

98 611 women aged 50-79 with a primary diagnosis of breast cancer between 1998 and 2018, matched by age, general practice, and index date to 457 498 female controls.

Main outcome measures

Breast cancer diagnosis from general practice, mortality, hospital, or cancer registry records. Odds ratios for HRT types, adjusted for personal characteristics, smoking status, alcohol consumption, comorbidities, family history, and other prescribed drugs. Separate results from QResearch or CPRD were combined.

Results

Overall, 33 703 (34%) women with a diagnosis of breast cancer and 134 391 (31%) controls had used HRT prior to one year before the index date. Compared with never use, in recent users (<5 years) with long term use (≥5 years), oestrogen only therapy and combined oestrogen and progestogen therapy were both associated with increased risks of breast cancer (adjusted odds ratio 1.15 (95% confidence interval 1.09 to 1.21) and 1.79 (1.73 to 1.85), respectively). For combined progestogens, the increased risk was highest for norethisterone (1.88, 1.79 to 1.99) and lowest for dydrogesterone (1.24, 1.03 to 1.48). Past long term use of oestrogen only therapy and past short term (<5 years) use of oestrogen-progestogen were not associated with increased risk. The risk associated with past long term oestrogen-progestogen use, however, remained increased (1.16, 1.11 to 1.21). In recent oestrogen only users, between three (in younger women) and eight (in older women) extra cases per 10 000 women years would be expected, and in oestrogen-progestogen users between nine and 36 extra cases per 10 000 women years. For past oestrogen-progestogen users, the results would suggest between two and eight extra cases per 10 000 women years.

Conclusion

This study has produced new generalisable estimates of the increased risks of breast cancer associated with use of different hormone replacement preparations in the UK. The levels of risks varied between types of HRT, with higher risks for combined treatments and for longer duration of use.
Risk factors for new-onset diabetes mellitus after distal pancreatectomy
Authors: Dai Menghua , Xing Cheng , Shi Ning , Wang Shunda , Wu Guangdong , Liao Quan , Zhang Taiping , Chen Ge , Wu Wenming , Guo Junchao , Liu Ziwen
Published: October 2020

Introduction

Several previous studies have reported the incidence of new-onset diabetes mellitus (NODM) after pancreatectomy. Nevertheless, the results were inconsistent. The true rate of NODM after distal pancreatectomy (DP) is still unknown.

Research design and methods

The aim of this study was to investigate the incidence of and the risk factors for NODM after DP. This study enrolled patients who underwent DP between January 2004 and February 2016 at Peking Union Medical College Hospital. Patients with preoperative diabetes mellitus or diagnosed with pancreatic cancer were excluded. The primary outcome was NODM.

Results

A total of 485 patients were enrolled. The median (IQR) of follow-up duration was 30.95 (9.26–180.30) months. The accumulative incidence of NODM was 8.9% at postoperative 6 months, 14.0% at postoperative year one, 22.3% at year three, 27.1% at year five, and 35.5% at year ten. Multivariate analysis showed that the risk of postoperative NODM was positively correlated with age (HR 1.029 (1.013–1.045), p<0.001), preoperative body mass index (BMI) (HR 1.042 (1.003–1.083), p=0.001), operative blood loss (HR 1.0003 (1.0002–1.0010), p<0.001), and length of resected pancreas (HR 1.079 (1.013–1.148), p=0.017). Moreover, concomitant splenectomy (HR 2.001 (1.202–3.331), p=0.008) was associated with significantly higher risk of postoperative NODM.

Conclusion

NODM incidence increased with postoperative time progression. Age, BMI, surgical blood loss, length of resected pancreas and splenectomy were independent risk factors for NODM after DP.

Trial registration number

NCT03030209.
Musculoskeletal complaints in military recruits during their basic training
Authors: Keijsers Noel L W , ter Stal M , Jonkergouw N , Helmhout P H
Published: October 2020

Introduction

Overuse injuries often start with a musculoskeletal complaint, which can progress over time to an injury. Little or no information is known about the development and severity of overuse injuries in military recruits. This study describes the musculoskeletal complaints in Dutch military recruits during their basic training and examines potential predictive factors for dropout due to injury.

Methods

In this prospective cohort study, Dutch military recruits reported complaints of the lower body weekly using a Numeric Rating Scale (NRS) pain score chart during their basic training. Number, location and severity of complaints during each of the first 12 weeks of basic training were analysed.

Results

Of the 930 recruits, 61% reported an NRS pain score of 3 or higher and 34% reported an NRS pain score of 5 or higher at least once. Complaints were mostly reported in the foot and ankle region and least reported in the upper leg region. Injury dropouts (11%) showed significantly higher proportions of complaints and higher maximal pain scores throughout most weeks of basic training. The maximal NRS pain score of the first two weeks was the strongest predictor of dropping out due to injury.

Conclusions

Recruits who drop out due to injury report more severe complaints throughout basic training. Focusing on musculoskeletal complaints in the first phase of training seems helpful to identify recruits who are at risk of developing an injury.
Mental health plan for workers of the London Nightingale Hospital: following the evidence to support staff
Authors: Greenberg Neil , Cooke J , Sullivan E , Tracy D K
Published: October 2020

The COVID-19 pandemic has extracted an enormous physical health toll on many millions worldwide, and the wider societal impact from economic turmoil, unemployment, social isolation and so forth continue to be measured. A less explored aspect has been the psychological impact on treating healthcare staff, with emerging evidence of ‘moral injury’ and mental illness for some. This review explores the evidence base for implementing a tiered model of care to minimise this and foster ‘post-traumatic growth’, and describes the authors’ implementation of this in the London Nightingale hospital, with lessons for the armed forces.
Cohort profile: a collaborative multicentre study of retinal optical coherence tomography in 539 patients with neuromyelitis optica spectrum disorders (CROCTINO)
Authors: Specovius Svenja , Zimmermann Hanna G , Oertel Frederike Cosima , Chien Claudia , Bereuter Charlotte , Cook Lawrence J , Lana Peixoto Marco Aurélio , Fontenelle Mariana Andrade , Kim Ho Jin , Hyun Jae-Won , Jung Su-Kyung , Palace Jacqueline , Roca-Fernandez Adriana , Diaz Alejandro Rubio , Leite Maria Isabel , Sharma Srilakshmi M , Ashtari Fereshte , Kafieh Rahele , Dehghani Alireza , Pourazizi Mohsen , Pandit Lekha , Dcunha Anitha , Aktas Orhan , Ringelstein Marius , Albrecht Philipp , May Eugene , Tongco Caryl , Leocani Letizia , Pisa Marco , Radaelli Marta , Martinez-Lapiscina Elena H , Stiebel-Kalish Hadas , Hellmann Mark , Lotan Itay , Siritho Sasitorn , de Seze Jérôme , Senger Thomas , Havla Joachim , Marignier Romain , Tilikete Caroline , Cobo Calvo Alvaro , Bichuetti Denis Bernardi , Tavares Ivan Maynart , Asgari Nasrin , Soelberg Kerstin , Altintas Ayse , Yildirim Rengin , Tanriverdi Uygur , Jacob Anu , Huda Saif , Rimler Zoe , Reid Allyson , Mao-Draayer Yang , de Castillo Ibis Soto , Yeaman Michael R , Smith Terry J , Brandt Alexander U , Paul Friedemann
Published: October 2020

Purpose

Optical coherence tomography (OCT) captures retinal damage in neuromyelitis optica spectrum disorders (NMOSD). Previous studies investigating OCT in NMOSD have been limited by the rareness and heterogeneity of the disease. The goal of this study was to establish an image repository platform, which will facilitate neuroimaging studies in NMOSD. Here we summarise the profile of the Collaborative OCT in NMOSD repository as the initial effort in establishing this platform. This repository should prove invaluable for studies using OCT to investigate NMOSD.

Participants

The current cohort includes data from 539 patients with NMOSD and 114 healthy controls. These were collected at 22 participating centres from North and South America, Asia and Europe. The dataset consists of demographic details, diagnosis, antibody status, clinical disability, visual function, history of optic neuritis and other NMOSD defining attacks, and OCT source data from three different OCT devices.

Findings to date

The cohort informs similar demographic and clinical characteristics as those of previously published NMOSD cohorts. The image repository platform and centre network continue to be available for future prospective neuroimaging studies in NMOSD. For the conduct of the study, we have refined OCT image quality criteria and developed a cross-device intraretinal segmentation pipeline.

Future plans

We are pursuing several scientific projects based on the repository, such as analysing retinal layer thickness measurements, in this cohort in an attempt to identify differences between distinct disease phenotypes, demographics and ethnicities. The dataset will be available for further projects to interested, qualified parties, such as those using specialised image analysis or artificial intelligence applications.
Exploring maintenance of physical activity behaviour change among people living with and beyond gastrointestinal cancer: a cross-sectional qualitative study and typology
Authors: Grimmett Chloe , Foster Claire , Bradbury Katherine , Lally Phillippa , May Carl R , Myall Michelle , Pinto Bernardine , Corbett Teresa
Published: October 2020

Objectives

In the last decade, there has been a rapid expansion of physical activity (PA) promotion programmes and interventions targeting people living with and beyond cancer (LWBC). The impact that these initiatives have on long-term maintenance of PA remains under-researched. This study sought to explore the experiences of participants in order to characterise those who have and have not successfully sustained increases in PA following participation in a PA intervention after a diagnosis of gastrointestinal (GI) cancer, and identify barriers and facilitators of this behaviour.

Design

Cross-sectional qualitative study. Semi-structured interviews with participants who had previously taken part in a PA programme in the UK, explored current and past PA behaviour and factors that promoted or inhibited regular PA participation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Themes and subthemes were identified. Differences between individuals were recognised and a typology of PA engagement was developed.

Participants

Twenty-seven individuals (n=15 male, mean age=66.3 years) with a diagnosis of GI cancer who had participated in one of four interventions designed to encourage PA participation.

Setting

UK.

Results

Seven themes were identified: disease processes, the role of ageing, emotion and psychological well-being, incorporating PA into everyday life, social interaction, support and self-monitoring and competing demands. A typology with three types describing long-term PA engagement was generated: (1) maintained PA, (2) intermittent PA, (3) low activity. Findings indicate that identifying an enjoyable activity that is appropriate to an individual’s level of physical functioning and is highly valued is key to supporting long-term PA engagement.

Conclusion

The typology described here can be used to guide stratified and personalised intervention development and support sustained PA engagement by people LWBC.
Association for combined exposure to job strain, shift work on mental health among Chinese railway workers: a cross-sectional study
Authors: Jiang Yu , Wu Chuancheng , Hu Tianqi , Chen Meilong , Liu Wei , Zhou Yabing , Chen Zhibing , Xu Xin
Published: October 2020

Objectives

The aim of this study was to assess the effects of coexposure to job strain and shift work on mental health in railway workers.

Design

Cross-sectional study.

Setting

One Railway Bureau Group in China.

Participants

A total of 1270 front-line railway workers.

Outcome measures

The Symptom Checklist-90-Revised questionnaire was used to measure general mental health. Job strain variables were derived from the Job Content Questionnaire. Based on the records of the work schedule 3 months prior to the survey, the following three shift types were identified: fixed day, fixed night and rotating night shifts. Risks associated with mental health were assessed by carrying out logistic regression analysis which was adjusted for age, job tenure, smoking and exercise. Additionally, a crossover analysis was employed for the combined effects.

Results

High levels of job strain were linked to a higher risk of poor mental health (OR=1.53, 95% CI: 1.10 to 2.11). After adjusting for confounding factors, night shifts and rotating night shifts were significant risk factors for mental health (OR=2.21, 95% CI: 1.60 to 3.07; OR=2.36, 95% CI: 1.73 to 3.22). Compared with participants who experienced a low level of job strain and day shifts, those with a high level of job strain and who worked rotating shifts were at the highest risk of poor mental health (OR=4.68, 95% CI: 2.91 to 8.04), whereas the influence of a low level of job strain and rotating night shifts was not statistically significant.

Conclusion

Job strain and night shifts among workers were associated, both independently and in combination, with an increased risk of poor mental health. Our data suggest that job strain contributes to the risk of poor mental health by means of a combined effect with shift work.
Periconceptional surveillance for prevention of anaemia and birth defects in Southern India: protocol for a biomarker survey in women of reproductive age
Authors: Finkelstein Julia L , Fothergill Amy , Johnson Christina B , Guetterman Heather M , Bose Beena , Jabbar Shameem , Zhang Mindy , Pfeiffer Christine M , Qi Yan Ping , Rose Charles E , Krisher Jesse T , Ruth Caleb J , Mehta Rajesh , Williams Jennifer L , Bonam Wesley , Crider Krista S
Published: October 2020

Introduction

Women of reproductive age (WRA) are a high-risk population for anaemia and micronutrient deficiencies. Evidence supports the role of periconceptional nutrition in the development of adverse pregnancy complications. However, in India, there are limited population-based data to guide evidence-based recommendations and priority setting. The objective of this study is to conduct a population-based biomarker survey of anaemia and vitamin B12and folate status in WRA as part of a periconceptional surveillance programme in Southern India.

Methods

WRA (15–40 years) who are not pregnant or lactating and reside within 50 km2of our community research site in Southern India will be screened and invited to participate in the biomarker survey at our research facility at Arogyavaram Medical Centre. After informed consent/assent, structured interviews will be conducted by trained nurse enumerators to collect sociodemographic, dietary, anthropometry, health and reproductive history data. Venous blood samples will be collected at enrolment; whole blood will be analysed for haemoglobin. Plasma, serum and red blood cells (RBCs) will be processed and stored <−80°C until batch analysis. Vitamin B12concentrations will be measured via chemiluminescence, and RBC and serum folate concentrations will be evaluated using the World Health Organisation (WHO)-recommended microbiological assay at our laboratory in Bangalore. A WHO surveillance system will also be established to determine the baseline prevalence of birth defects in this setting.

Ethics and dissemination

This study has obtained clearance from the Health Ministry Screening Committee of the Indian Council of Medical Research. The study protocol was reviewed and approved by the Institutional Review Board at Cornell University and the Institutional Ethics Committees at Arogyavaram Medical Centre and St. John’s Research Institute. Findings from this biomarker survey will establish the burden of anaemia and micronutrient deficiencies in WRA and directly inform a randomised trial for anaemia and birth defects prevention in Southern India. The results of this study will be disseminated at international research conferences and as published articles in peer-reviewed journals.

Trial registration numbers

Clinical trials registration numberNCT04048330,NCT03853304and Clinical Trials Registry of India (CTRI) registration number REF/2019/03/024479.
Impact of a patient-specific national programme aimed at increasing the use of emollient moisturisers to reduce the risk of skin tears: a longitudinal cohort study
Authors: Moffat Anna K , Westaway Kerrie P , Apajee Jemisha , Frank Oliver , Shute Russell , Weston Clare , Blacker Natalie , Le Blanc Vanessa T , Kalisch Ellett Lisa M , Pratt Nicole L , Roughead Elizabeth Ellen
Published: October 2020

Objectives

To evaluate the impact of a patient-specific national programme targeting older Australians and health professionals that aimed to increase use of emollient moisturisers to reduce to the risk of skin tears.

Design

A prospective cohort intervention.

Participants

The intervention targeted 52 778 Australian Government’s Department of Veterans’ Affairs patients aged over 64 years who had risk factors for wound development, and their general practitioners (GPs) (n=14 178).

Outcome measures

An interrupted time series model compared the rate of dispensing of emollients in the targeted cohort before and up to 23 months after the intervention. Commitment questions were included in self-report forms.

Results

In the first month after the intervention, the rate of claims increased 6.3-fold (95% CI: 5.2 to 7.6, p<0.001) to 10 emollient dispensings per 1000 patients in the first month after the intervention. Overall, the intervention resulted in 10 905 additional patient-months of treatment. The increased rate of dispensing among patients who committed to talking to their GP about using an emollient was six times higher (rate ratio: 6.2, 95% CI: 4.4 to 8.7) than comparison groups.

Conclusions

The intervention had a sustained effect over 23 months. Veterans who responded positively to commitment questions had higher uptake of emollients than those who did not.
Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis
Authors: Fadyl Joanna K , Anstiss David , Reed Kirk , Khoronzhevych Mariya , Levack William M M
Published: October 2020

Objectives

To evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work.

Methods

Systematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool.

Results

Eleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions.

Discussion

The meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with ‘usual care’ control groups in populations with mild to moderate mental health conditions.
Global prevalence of spondyloarthritis in low-income and middle-income countries: a systematic review and meta-analysis protocol
Authors: Allado Edem , Moussu Anthony , Bigna Jean Joel , Hamroun Sabrina , Camier Aurore , Chenuel Bruno , Hamroun Aghiles
Published: October 2020

Introduction

In the past decade, the definition of spondyloarthritis (SpA) has undergone major modifications with respect to new diagnostic tools and classifications. With the advent of biotherapies, treatment possibilities in patients with SpA have substantially improved in the last few years. There is great interest in obtaining accurate data on the disease prevalence, especially in regions where data remains scarce such as low-income and middle-income countries (LMICs), in order to measure and understand the needs of their healthcare systems. Therefore, through a global systematic review and meta-analysis, the current study aims to investigate the prevalence of SpA and human leucocyte antigen B27 (HLAB27) and its association with the risk of SpA in the LMIC population.

Methods and analysis

We will include cohort, case–control and cross-sectional studies performed among adults (>15 years) living in LMICs. EMBASE, Medline, Global Index Medicus and Web of Knowledge will be searched for relevant records published until 30 April 2020, without any language restriction. The review will be reported according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. After screening of titles and abstracts, study selection, data extraction and risk of bias assessment by two independent reviewers, we shall assess the studies individually for clinical and statistical heterogeneity. Random-effect meta-analysis will be used to pool studies judged to be clinically homogeneous. Egger’s test and visual inspection of funnel plots will be used to assess publication bias. Results will be presented by WHO subregions.

Ethics and dissemination

Since primary data is not collected in this study, ethical approval is not required. This review is expected to provide relevant data on the epidemiology of SpA, HLAB27 and their association in the global population of LMICs. The final report will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42020163898.
Comparison of health literacy profile of patients with end-stage kidney disease on dialysis versus non-dialysis chronic kidney disease and the influencing factors: a cross-sectional study
Authors: Murali Karumathil , Mullan Judy , Roodenrys Steven , Lonergan Maureen
Published: October 2020

Objectives

Lower health literacy (HL) is associated with poor outcomes in patients with kidney disease. Since HL matches the patient’s competencies with the complexities of the care package, the level of HL sufficient in earlier stages of chronic kidney disease (CKD) may be inadequate for patients with end-stage kidney disease (ESKD) on dialysis. We aimed to analyse the HL profile of patients with ESKD and non-dialysis CKD and examine if there were significant associations with covariates which could be targeted to address HL deficits, thereby improving patient outcomes.

Design and setting

Cross-sectional study of patients with CKD and ESKD from a single Australian health district.

Methods

We assessed the HL profile of 114 patients with CKD and 109 patients with ESKD using a 44-item multidomain Health Literacy Questionnaire (HLQ) and examined its association with demographic factors (age, gender, race), smoking, income, education, comorbidities, carer status, cognitive function and depression. Using multivariable logistic regression models, HL profiles of patients with CKD and ESKD were evaluated after adjusting for covariates.

Results

Patients with ESKD had similar demographics and educational levels compared with patients with CKD. ESKD had significantly higher frequency of vascular disease, cognitive impairment and depression. Patients with ESKD had better HL scores for the social support domain (37.1% vs 19.5% in higher HLQ4 tertile, p=0.004), whereas all other HL domains including engagement with healthcare providers were comparable to CKD. Depression was independently associated with nearly all of the HL domains (HLQ1: OR 2.6, p=0.030; HLQ2: OR 7.9, p=<0.001; HLQ3: OR 7.6, p<0.001; HLQ4: OR 3.5, p=0.010; HLQ5: OR 8.9, p=0.001; HLQ6: OR 3.9, p=0.002; HLQ7: OR 4.8, p=0.001; HLQ8: OR 5.3, p=0.001) and education with HL domains relevant to processing health-related information (HLQ8: OR 2.6, p=0.008; HLQ9: OR 2.5, p=0.006).

Conclusions

Despite very frequent interactions with health systems, patients with ESKD on dialysis did not have higher HL in engagement with health providers and most other HL domains, compared with patients with CKD. Strategies promoting patient–provider engagement and managing depression which strongly associates with lower HL may address the impact of HL deficits and favourably modify clinical outcomes in renal patients.