bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of the Internal Audit Roles and Auditor Professionalism on Fraud Prevention
Authors: Nurlaela Ela , Mappanyukki Ratna , Surjandari Dwi Asih
Published: September 2021

This research aimed to find the internal audit roles (X1) and the auditor professionalism (X2) at Fraud Prevention in NJC Bank in Kuningan Regency. Samples of this research were the NJC Bank employees. The data collection used in this research is the questionnaire method and the data processing used the SPSS program. The analysis results show that the role of the internal auditor has a significant effect on fraud prevention (H1), the auditor professionalism significantly affects fraud prevention (H2), and the test results simultaneously show that the two independent variables have a significant effect on fraud prevention. Supported the results of the implication of this analysis is to improve the roles of the internal auditors and the professionalism of auditor internal could increase fraud prevention.
Localization of Na+ channel clusters in narrowed perinexi of gap junctions enhances cardiac impulse transmission via ephaptic coupling: a model study
Authors: Ivanovic Ena , Kucera Jan P.
Published: September 2021

It has been proposed that when gap junctional coupling is reduced in cardiac tissue, action potential propagation can be supported via ephaptic coupling, a mechanism mediated by negative electric potentials occurring in narrow intercellular clefts of intercalated discs (IDs). Recent studies showed that sodium (Na+) channels form clusters near gap junction plaques in nanodomains called perinexi, where the ID cleft is even narrower. To examine the electrophysiological relevance of Na+ channel clusters being located in perinexi, we developed a 3D finite element model of two longitudinally abutting cardiomyocytes, with a central Na+ channel cluster on the ID membranes. When this cluster was located in the perinexus of a closely positioned gap junction plaque, varying perinexal width greatly modulated impulse transmission from one cell to the other, with narrow perinexi potentiating ephaptic coupling. This modulation occurred via the interplay of Na+ currents, extracellular potentials in the cleft and patterns of current flow within the cleft. In contrast, when the Na+ channel cluster was located remotely from the gap junction plaque, this modulation by perinexus width largely disappeared. Interestingly, the Na+ current in the ID membrane of the pre‐junctional cell switched from inward to outward during excitation, thus contributing ions to the activating channels on the post‐junctional ID membrane. In conclusion, these results indicate that the localization of Na+ channel clusters in the perinexi of gap junction plaques is crucial for ephaptic coupling, which is furthermore greatly modulated by perinexal width. These findings are relevant for a comprehensive understanding of cardiac excitation.

Key points

Ephaptic coupling is a cardiac conduction mechanism involving nanoscale‐level interactions between the sodium (Na+) current and the extracellular potential in narrow intercalated disc clefts.

When gap junctional coupling is reduced, ephaptic coupling acts in conjunction with the classical cardiac conduction mechanism based on gap junctional current flow.

In intercalated discs, Na+ channels form clusters that are preferentially located in the periphery of gap junction plaques, in nanodomains known as perinexi, but the electrophysiological role of these perinexi has never been examined.

In our new 3D finite element model of two cardiac cells abutting each other with their intercalated discs, a Na+ channel cluster located inside a narrowed perinexus facilitated impulse transmission via ephaptic coupling.

Our simulations demonstrate the role of narrowed perinexi as privileged sites for ephaptic coupling in pathological situations when gap junctional coupling is decreased.
Improvement of Probabilistic Fracture Mechanics Analysis Code PASCAL-SP Regarding Stress Corrosion Cracking in Nickel Based Alloy Weld Joint of Piping System in Boiling Water Reactor
Authors: Mano Akihiro , Yamaguchi Yoshihito , Katsuyama Jinya , Li Yinsheng
Published: September 2021

In the past few decades, cracks because of stress corrosion cracking (SCC) have been detected in the dissimilar weld joints using nickel-based alloy in piping system of boiling water reactors (BWRs). Thus, the structural integrity assessment for such weld joints has become important. Nowadays, probabilistic fracture mechanics (PFM) analysis is recognized as a rational method for structural integrity assessment because it can consider inherent uncertainties of various influencing factors as probability distributions and quantitatively evaluate the failure probability of a cracked component. The Japan Atomic Energy Agency has developed a PFM analysis code PASCAL-SP for a weld joint of piping system in nuclear power plant. This study improves the analysis functions of PASCAL-SP for weld joint using nickel-based alloy in BWR susceptible to SCC. As an analysis example of the improved version of PASCAL-SP, the failure probability of a weld joint is quantitatively evaluated. Furthermore, sensitivity analyses are conducted concerning the effect of leak detection and in-service inspection. From the analysis results, it is concluded that the improved version of PASCAL-SP is useful for structural integrity assessment.
Evaluation of the Creep Rupture Behavior of Alloy 690 Steam Generator Tubes Considering the Pressure Ramp Rate
Authors: Kim Jong-Min , Kim Min-Chul , Kwon Joon-Yeop
Published: September 2021

Steam generator tubes are among the main components that form the pressure boundary of a nuclear power plant and studies of ruptures of steam generator (SG) tubes are important because they can ensure the safety of a nuclear power plant in case of a severe accident. The materials used previously for SG tubes around the world have been replaced and will be replaced by Alloy 690 given its improved corrosion resistance relative to that of Alloy 600. However, studies of the high-temperature creep and creep-rupture characteristics of SG tubes made of Alloy 690 are insufficient compared to those focusing on Alloy 600. In this study, several creep tests were conducted using half-tube shape specimens of the Alloy 690 material at temperatures ranging from 650 °C to 850 °C and stresses in the range of 30–350 MPa, with failure times to creep rupture ranging from 3 h to 870 h. Based on the creep test results, creep life predictions were then made using the well-known Larson–Miller parameter (LMP) method. Steam generator tube rupture tests were also conducted under the conditions of a constant temperature and pressure ramp using SG tube specimens. As the pressure ramp rate increases, the failure behavior changes due to the rapid change in strain near the crack tip. The rupture test equipment was designed and manufactured to simulate the transient state (rapid temperature and pressure changes) in the event of a severe accident condition. After the rupture test, the damage to the SG tubes was predicted using a creep rupture model and a flow stress model. A modified creep rupture model for Alloy 690 SG tube material is proposed based on the experimental results. A correction factor of 1.7 in the modified creep rupture model was derived for the Alloy 690 material. The predicted failure pressure was in good agreement with the experimental failure pressure.
Pneumatic Testing of Piping Assemblies: Criteria for Stored Energy and Pinhole Leak Detectability
Authors: Botros K. K. , Liu V. , Lu J.
Published: September 2021

Pneumatic testing is beneficial as an alternative to hydrotesting particularly in remote areas where access to hydrotest fluids becomes logistically difficult or impossible. In some cases, above-ground pipe supports cannot hold the water weight, or that the pipe is coated/lined with materials that would degrade with water/methanol/glycol mixtures, or the system cannot be fully dried and the remaining hydrotest fluids are detrimental to the service application once the system is commissioned. Additionally, the elevation profile of the piping is such that an excessive number of test sections would be required for hydrotesting according to most codes. The present work is aimed at addressing two salient questions often faced with pneumatic testing. The first is related to the appropriate piping volume to consider for calculating the stored energy in use with ASME Post Construction Committee (PCC)-2 calculation for determining the safe exclusion distance for a given piping geometry and test conditions. It was found that the 8D criteria specified in ASME PCC-2 cannot be generalized for all pipe sizes, different material toughness, grades, wall thicknesses, and test conditions. A criterion is developed based on the ductile fracture arrest length that considers all these factors combined. The second criterion is related to the ability to detect a pinhole leak from the pneumatic test data, again for a given geometry and test conditions, and what constitutes the minimum pinhole effective area in relation to the system total volume, measured uncertainties in the test pressure and temperature over the duration of the test. A seminormalized physics-based parameter is suggested that can be applied to determine the effective pinhole leak size. The methodology is applied to a pneumatic field test on DN200, 12.2 km pipeline lateral.
Experimental Study on Horizontal Fire Spread Characteristics of Transformer Oil
Authors: Li Liyang , GUO Xincheng , Lu Rongsheng , Chen Peng , Shi Congling
Published: September 2021

In order to study the horizontal fire spread characteristics of transformer oil, a series of experiments were carried out on the experimental platform developed, the influence of the initial temperature and the width of the oil pool on the flame propagation, including the propagation speed, flame morphology and the temperature field distribution of the gas-liquid two-phase, was analyzed to reveal the flame propagation characteristics and the oil surface temperature rise law in the process of transformer oil fire propagation, and a theoretical model of coupled liquid-phase convective heat transfer and flame radiation heat transfer was established by combining thermodynamic theory to quantitatively calculate the heat transfer process of surface flow in flame propagation process. Through the theoretical analysis and quantitative calculation of gas-liquid heat transfer, it is proved that the surface flow is mainly driven by surface tension and the flame spreads in the form of pulsation. Combined with the experimental data for verification, it is found that the proportion of liquid-phase convective heat transfer to the total heat flow is much larger than that of flame radiation to the total heat flow, which proves that liquid-phase convective heat transfer is the main mode of surface flow heat transfer.
Experimental Investigation of Direct Fuel Injection Into Low-Oxygen Recompression Interval in a Homogenous Charge Compression Ignition Engine
Authors: Sok Ratnak , Kusaka Jin
Published: September 2021

This work analyzed measured data from a single-cylinder engine operated under the gasoline direction injection homogenous charge compression ignition (GDI-HCCI) mode. The experiments were conducted at a 0.95 equivalence ratio (ϕ) under indicated mean effective pressure of 0.5 MPa and 1500 rpm. A side-mounted injector delivered primary reference fuel (octane number 90) into the combustion chamber during negative valve overlap (NVO) interval. Advanced combustion phase CA50 were observed as a function of the start of injection (SOI) timings. Under ϕ = 0.95, peak NVO in-cylinder pressures were lower than motoring for single and split injections, emphasizing that NVO reactions were endothermic. Zero-dimensional kinetics calculations showed classical reformate species (C3H6, C2H4, CH4) from the NVO rich mixture increased almost linearly due to SOI timings, while H2 and CO were typically low. These kinetically reformed species also shortened predicted ignition delays. This work also analyzed the effects of intake boosting pressure and single versus double pulses injections on CA50, burn duration CA10-90, peak cylinder pressure, combustion noise metrics, thermal efficiency, and emissions. Advanced SOI (single-injection) generated excessive combustion noise metrics over constraint limits, but the double-pulse injection could significantly reduce the metrics (ringing intensity (RI) ≤ 5 MW/m2, maximum pressure rise rate ≤ 0.6 MPa/CA) and NOx emission. The engine's net indicated thermal efficiency (ITE) reached 41% under GDI-HCCI mode against 36% of SI mode for the same operating conditions. Under GDI-HCCI mode and without spark ignition, late fuel injection in the intake stroke could reduce NOx to a single digit.
Experimental and Numerical Assessment on Failure Pressure of Textured Pipelines
Authors: Karampour Hassan , Alrsai Mahmoud , Khalilpasha Hossein , Albermani Faris
Published: September 2021

A series of physical tests and finite element (FE) analyses are conducted to evaluate the failure of smooth (conventional) and textured (proposed concept) pipes. To do so, hydrostatic pressure tests are performed on aluminum beverage cans (ductile failure) and additively manufactured Ti6Al4V-0406 titanium pipes (brittle failure). Mechanical material properties are obtained from tensile tests of coupon samples. In the absence of physical burst pressure tests, FE models are validated against experimental results of external pressure tests and are used to predict the buckle initiation (Pi) and burst pressure (Pb) capacity of the textured pipes with different number of circumferential triangles, N, and base angles, α. Results show that buckle initiation pressures of the textured concept is 2.34 and 1.80 times greater than those of the smooth aluminum cans and titanium pipes, respectively. However, the burst pressure of the textured pipe can only get 3% greater than the smooth pipe. Based on the current results, a textured pipe with N = 6 and α = 30 deg is the optimum textured design.
Numerical Investigation of Hydrodynamic Performance of a Light Buoy With Different Mooring Configurations in Regular Waves
Authors: Li Xin , Chen Yimei , Mao Lilei , Xia Huiyu
Published: September 2021

The single-moored light buoys employed in the lower reaches of the Yangtze River play an important role in indicating ship navigation and ensuring safety. To clarify the interaction between waves and floating buoys moored to the riverbed, this paper applies a numerical approach to investigate the wave-induced motion performance of a light buoy and reveal the effects of different mooring configurations to extend its service life. An open-source smoothed particle hydrodynamics (SPH)-based numerical model named dualsphysics coupled with MoorDyn is implemented. This coupled model is validated by simulating the motion of a moored rectangle buoy in regular waves, and compared with experimental data and the numerical results of reef3d code, a mesh-based computational fluid dynamics (CFD) model. The validation results show that the coupled model reproduces experimental data well and has a smaller deviation in comparison with reef3d. Then, the coupling model is applied to simulate the hydrodynamic performance of the real-size light buoy employed in Yangtze River and investigate the effects of encounter angle between wave propagation direction and mooring chain. The results demonstrate the capability of this coupled mooring model to simulate the motion of a moored buoy in regular waves, and this numerical approach will be extended to simulate the light buoy in more complex environments such as irregular waves, flow or extreme weather in further work.
Teammate Relationships, Loneliness, and the Motivational and Well-Being Experiences of Adolescent Athletes
Authors: Pacewicz Christine E. , Smith Alan L.
Published: September 2021

Interpersonal exchanges may contribute to athletes’ motivational and well-being experiences through their contribution to athletes’ feelings of loneliness. Loneliness is understudied in sport, yet it is potentially salient in connecting social relationships with motivational processes and well-being of athletes. The purpose of the current research was to examine (a) the association of aspects of teammate relationships with athletes’ perceptions of burnout and engagement and (b) whether loneliness explained these associations. Adolescent athletes (N = 279) completed established measures of teammate relationships, loneliness, burnout, and engagement. The mediational model was invariant between boys and girls. Loneliness mediated the relationship of social support (β = −0.14, 0.10), corumination (β = 0.09, −0.06), and appraisal of peer rejection (β = 0.11, −0.08) with burnout and engagement, respectively. Continued examination of athletes’ loneliness will extend understanding of athletes’ motivational and well-being experiences and inform the promotion of adaptive sport experiences.
Mental Health Profiles of Danish Youth Soccer Players: The Influence of Gender and Career Development
Authors: Kuettel Andreas , Durand-Bush Natalie , Larsen Carsten H.
Published: September 2021

The purpose of this study was (a) to investigate gender differences in mental health among Danish youth soccer players, (b) to discover the mental health profiles of the players, and (c) to explore how career progression and mental health are related. A total of 239 Danish youth elite soccer players (M = 16.85, SD = 1.09) completed an online questionnaire assessing mental well-being, depression, anxiety, along with other background variables. Female players scored significantly lower on mental well-being and had four times higher odds of expressing symptoms of anxiety and depression than males. Athletes’ mental health profiles showed that most athletes experience low depression while having moderate mental well-being. Depression, anxiety, and stress scores generally increased when progressing in age, indicating that the junior–senior transition poses distinct challenges to players’ mental health, especially for female players. Different strategies to foster players’ mental health depending on their mental health profiles are proposed.
Of bats and men: Immunomodulatory treatment options for COVID-19 guided by the immunopathology of SARS-CoV-2 infection
Authors: Christie Michael J. , Irving Aaron T. , Forster Samuel C. , Marsland Benjamin J. , Hansbro Philip M. , Hertzog Paul J. , Nold-Petry Claudia A. , Nold Marcel F.
Published: September 2021

SARS-CoV-2 evades immune recognition in humans but not bats, pointing to potential strategies for therapeutic intervention.
Combined immunodeficiency with autoimmunity caused by a homozygous missense mutation in inhibitor of nuclear factor 𝛋B kinase alpha (IKKα)
Authors: Bainter Wayne , Lougaris Vassilios , Wallace Jacqueline G. , Badran Yousef , Hoyos-Bachiloglu Rodrigo , Peters Zachary , Wilkie Hazel , Das Mrinmoy , Janssen Erin , Beano Abdallah , Farhat Khaoula Ben , Kam Christy , Bercich Luisa , Incardona Paolo , Villanacci Vincenzo , Bondioni Maria Pia , Meini Antonella , Baronio Manuela , Abarzua Phammela , Parolini Silvia , Tabellini Giovanna , Maio Stefano , Schmidt Birgitta , Goldsmith Jeffrey D. , Murphy George , Hollander Georg , Plebani Alessandro , Chou Janet , Geha Raif S.
Published: September 2021

A mutation in human IKKα compromises noncanonical NF-κB signaling resulting in primary immunodeficiency associated with autoimmunity.
Carbon and nitrogen isotope evidence for widespread presence of anoxic intermediate waters before and during the Permian-Triassic mass extinction
Authors: Wu Baojin , Luo Genming , Joachimski Michael M. , Wignall Paul B. , Lei Lidan , Huang Junhua , Lai Xulong
Published: September 2021

The largest mass extinction since the advent of animals occurred during the Permian-Triassic (P-Tr) transition, ca. 252 Ma, and is commonly attributed to the eruption of the Siberian Traps large igneous province. However, the direct killing mechanism is still debated. In this study, we investigated marine redox conditions of the intermediate water column that most organisms inhabit with special attention to the time interval before the onset of the mass extinction. The carbon isotope composition of carbonate and organic carbon (δ13Ccarb and δ13Corg) as well as the nitrogen isotope composition of bulk nitrogen (δ15N) were analyzed in four P-Tr boundary sequences (Zhongli, Jianshi, Ganxi, and Chaotian sections), which record a transect from a shallow water carbonate platform to a deep water, lower ramp slope in South China. δ13Ccarb shows a distinct negative shift in all sections and displays a clear, 2–4‰, decreasing gradient accompanying an increase in water depth both before and after the mass extinction. A distinct negative shift in δ15N is observed in the shallow water Zhongli section, whereas a minor negative shift is present in the three deeper water sections. Before the mass extinction, the δ15N values from shallow water sections are higher than those from deeper waters. The low δ15N values close to 0‰ in deeper water sections suggest that microbial nitrogen fixation was the predominant source of biologically available nitrogen before the onset of the mass extinction. Thus, the water depth- dependent gradient in δ13Ccarb and δ15N suggests that an oxygen-deficient intermediate water column was already present before the mass extinction. The uniform δ15N values around 0‰ accompanying the onset of the mass extinction reveal that anoxic intermediate waters expanded into shallow waters. Meanwhile, the distinct positive shift in δ13Corg observed in upper ramp slope sections, i.e., the Jianshi and Ganxi sections, suggests that a euxinic photic zone was at least episodically present in the earliest Triassic. The temporal coincidence between the expansion of intermediate water column anoxia and the onset of the P-Tr mass extinction supports the hypothesis that marine anoxia was a direct killing mechanism.
HbA1c performs well in monitoring glucose control even in populations with high prevalence of medical conditions that may alter its reliability: the OPTIMAL observational multicenter study
Authors: Niwaha Anxious J , Rodgers Lauren R , Greiner Rosamund , Balungi Priscilla A , Mwebaze Raymond , McDonald Timothy J , Hattersley Andrew T , Shields Beverley M , Nyirenda Moffat J , Jones Angus G
Published: September 2021

Introduction

The utility of HbA1c (glycosylated hemoglobin) to estimate glycemic control in populations of African and other low-resource countries has been questioned because of high prevalence of other medical conditions that may affect its reliability. Using continuous glucose monitoring (CGM), we aimed to determine the comparative performance of HbA1c, fasting plasma glucose (FPG) (within 5 hours of a meal) and random non-fasting glucose (RPG) in assessing glycemic burden.

Research design and methods

We assessed the performance of HbA1c, FPG and RPG in comparison to CGM mean glucose in 192 Ugandan participants with type 2 diabetes. Analysis was undertaken in all participants, and in subgroups with and without medical conditions reported to affect HbA1c reliability. We then assessed the performance of FPG and RPG, and optimal thresholds, in comparison to HbA1c in participants without medical conditions thought to alter HbA1c reliability.

Results

32.8% (63/192) of participants had medical conditions that may affect HbA1c reliability: anemia 9.4% (18/192), sickle cell trait and/or hemoglobin C (HbC) 22.4% (43/192), or renal impairment 6.3% (12/192). Despite high prevalence of medical conditions thought to affect HbA1c reliability, HbA1c had the strongest correlation with CGM measured glucose in day-to-day living (0.88, 95% CI 0.84 to 0.91), followed by FPG (0.82, 95% CI 0.76 to 0.86) and RPG (0.76, 95% CI 0.69 to 0.81). Among participants without conditions thought to affect HbA1c reliability, FPG and RPG had a similar diagnostic performance in identifying poor glycemic control defined by a range of HbA1c thresholds. FPG of ≥7.1 mmol/L and RPG of ≥10.5 mmol/L correctly identified 78.2% and 78.8%, respectively, of patients with an HbA1c of ≥7.0%.

Conclusions

HbA1c is the optimal test for monitoring glucose control even in low-income and middle-income countries where medical conditions that may alter its reliability are prevalent; FPG and RPG are valuable alternatives where HbA1c is not available.
Generating insights in uncharted territories: real-time learning from data in critically ill patients–an implementer report
Authors: van de Sande Davy , Van Genderen Michel E. , Huiskens Joost , Veen Robert E. R. , Meijerink Yvonne , Gommers Diederik , van Bommel Jasper
Published: September 2021

IntroductionIn the current situation, clinical patient data are often siloed in multiple hospital information systems. Especially in the intensive care unit (ICU), large volumes of clinical data are routinely collected through continuous patient monitoring. Although these data often contain useful information for clinical decision making, they are not frequently used to improve quality of care. During, but also after, pressing times, data-driven methods can be used to mine treatment patterns from clinical data to determine the best treatment options from a hospitals own clinical data.

MethodsIn this implementer report, we describe how we implemented a data infrastructure that enabled us to learn in real time from consecutive COVID-19 ICU admissions. In addition, we explain our step-by-step multidisciplinary approach to establish such a data infrastructure.

ConclusionBy sharing our steps and approach, we aim to inspire others, in and outside ICU walls, to make more efficient use of data at hand, now and in the future.
Impact of pulse oximetry on hospital referral acceptance in children under 5 with severe pneumonia in rural Pakistan (district Jamshoro): protocol for a cluster randomised trial
Authors: Mir Fatima , Ali Nathwani Apsara , Chanar Suhail , Hussain Amjad , Rizvi Arjumand , Ahmed Imran , Memon Zahid Ali , Habib Atif , Soofi Sajid , Bhutta Zulfiqar Ahmed
Published: September 2021

Background

Pneumonia is a leading cause of death among children under 5 specifically in South Asia and sub-Saharan Africa. Hypoxaemia is a life-threatening complication among children under 5 with pneumonia. Hypoxaemia increases risk of mortality by 4.3 times in children with pneumonia than those without hypoxaemia. Prevalence of hypoxaemia varies with geography, altitude and severity (9%–39% Asia, 3%–10% African countries). In this protocol paper, we describe research methods for assessing impact of Lady Health Workers (LHWs) identifying hypoxaemia in children with signs of pneumonia during household visits on acceptance of hospital referral in district Jamshoro, Sindh.

Methods and analysis

A cluster randomised controlled trial using pulse oximetry as intervention for children with severe pneumonia will be conducted in community settings. Children aged 0–59 months with signs of severe pneumonia will be recruited by LHWs during routine visits in both intervention and control arms after consent. Severe pneumonia will be defined as fast breathing and/or chest in-drawing, and, one or more danger sign and/or hypoxaemia (Sa02 <92%) in PO (intervention) group and fast breathing and/or chest in-drawing and one or more danger sign in clinical signs (control) group. Recruits in both groups will receive a stat dose of oral amoxicillin and referral to designated tertiary health facility. Analysis of variance will be used to compare baseline referral acceptance in both groups with that at end of study.

Ethics and dissemination

Ethical approval was granted by the Ethics Review Committee of the Aga Khan University (4722-Ped-ERC-17), Karachi. Study results will be shared with relevant government and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.

Trial registration number

NCT03588377.
Comparison of three different exercise training modalities (aerobic, strength and mixed) in patients with schizophrenia: study protocol for a multicentre randomised wait-list controlled trial
Authors: García-Garcés Laura , Lacamara Cano Sergio , Cebolla Meliá Yago , Sánchez-López María I , Marqués Azcona David , Lisón Juan Francisco , Peyró-Gregori Loreto
Published: September 2021

Introduction

Numerous studies support the practice of different physical exercise modalities as an effective treatment to address the problems associated with schizophrenia, reporting that they result in improvements in patient symptoms and quality of life. Given the lack of studies comparing different types of training in controlled environments, the aim of this proposed study will be to compare the effects of three physical exercise programmes (strength, aerobic and mixed) on the symptoms, body composition, level of physical activity and health-related quality of life of patients with schizophrenia.

Methods and analysis

A multicentre, single-blinded (evaluator), randomised, wait-list controlled (ratio 2:2:2:1) trial will be conducted with 105 patients recruited from different psychosocial care centres. The participants will be randomised into three 16-week training groups comprising 48 sessions lasting 1 hour each, or to the wait-list control group. The training groups will complete aerobic, strength or mixed (aerobic+strength) training. The participants will be assessed before, immediately after and 6 months after the end of the intervention. The patients in the wait-list control group (n=15) will receive one of the three trainings immediately after the intervention. The study variables will include positive, negative and general symptomology (Positive and Negative Syndrome Scale) as the primary outcome; as secondary outcome: body composition (by assessing body mass index, body fat mass and waist circumference), physical activity levels (International Physical Activity Questionnaire-Short Form) and quality of life (abbreviated WHO Quality of Life questionnaire).

Ethics and dissemination

This study was approved by the ethics committees for Biomedical Research at the CEU Cardenal Herrera University of Valencia, Spain (CEI18/215). Participants will be fully informed of the purpose and procedures of the study, and written informed consent will be obtained. The results from this study will be published in peer-reviewed journals and presented in scientific conferences.

Trial registration number

NCT04987151.
Integrated Measurement for Early Detection (MIDO) as a digital strategy
for timely assessment of non-communicable disease profiles and factors
associated with unawareness and control: a retrospective observational study
in primary healthcare facilities in Mexico
Authors: Gallardo-Rincón Héctor , Montoya Alejandra , Saucedo-Martínez Rodrigo , Mújica-Rosales Ricardo , Suárez-Idueta Lorena , Martínez-Juárez Luis Alberto , Razo Christian , Lozano Rafael , Tapia-Conyer Roberto
Published: September 2021

Objectives

The Carlos Slim Foundation implemented the Integrated Measurement
for Early Detection (MIDO), a screening strategy for non-communicable
diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital
health services focusing on healthcare delivery and
prevention/management of NCDs. We investigated the disease profile of
the screened population and evaluated MIDO’s contribution to the
continuum of care of the main NCDs.

Design

Using data from MIDO and the chronic diseases information system, we
quantified the proportion of the population screened and diagnosed with
NCDs, and measured care linkage/retention and level of control achieved.
We analysed comorbidity patterns and estimated prevalence of predisease
stages. Finally, we estimated characteristics associated with
unawareness and control of NCDs, and examined efficacy of the CASALUD
model in improving NCD control.

Setting

Public primary health centres in 27/32 Mexican states.

Participants

Individuals aged ≥20 years lacking healthcare access.

Results

From 2014 to 2018, 743 000 individuals were screened using MIDO. A
predisease or disease condition was detected in ≥70% of the population
who were unaware of their NCD status. The screening identified 38 417
new cases of type 2 diabetes, 53 133 new cases of hypertension and
208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of
individuals with available blood samples. Comorbidities were highly
prevalent, especially in people with obesity. Only 5.47% (n=17 774) of
individuals were linked with their corresponding primary health centre.
Factors associated with unawareness of and uncontrolled NCDs were sex,
age, and social determinants, for example, rural/urban environment,
access to healthcare service, and education level. Patients with type 2
diabetes treated at clinics under the CASALUD model were more likely to
achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61).

Conclusion

Patient-centred screening strategies such as MIDO are urgently
needed to improve screening, access, retention and control for patients
with NCDs.
Effectiveness and safety of ivermectin in the treatment of COVID-19: protocol for a systematic review and meta-analysis
Authors: Machado Maria Letícia de Lima , Souza Amaxsell Thiago Barros , Linhares Paula Vívian Andrade , Martins Ferreira Caio Fernando , Oliveira Silva David Franciole , Martins Rand Randall , Cobucci Ricardo Ney
Published: September 2021

Introduction

Ivermectin is a drug with antiviral properties and has been proposed as an alternative treatment for patients with COVID-19, in some countries; however, there is limited evidence to support its clinical use. Accordingly, the aim of this review and meta-analysis is to obtain superior evidence on the effectiveness and safety of ivermectin in treatment of COVID-19.

Methods and analysis

We will search in the medical databases and International Clinical Trials Registry Platform databases for randomised clinical trials and quasi-randomised trials published from December 2019. The criteria for inclusion are that infection needs to be confirmed by a real-time PCR or serology test, and the effect of ivermectin has been compared with placebo, symptomatic treatment or no treatment. We will exclude observational studies and clinical trials that involved patients with symptoms suggestive of COVID-19, but without a laboratorial diagnosis. Outcomes of interest include mortality, time to symptom resolution, time of hospitalisation, frequency of invasive mechanical ventilation and extracorporeal membrane oxygenation, incidence of severe acute respiratory syndrome, admission to intensive care unit, viral load, PCR-negative status, percentage of infection after prophylactic use, and total incidence of adverse and side effects. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers will independently select the studies and assess their eligibility. Two other reviewers will independently extract data from each study. Meta-analysis will then be carried out using fixed-effects or random-effects model, using the mean difference for continuous outcomes and the relative risk for dichotomous outcomes. Bias risk will be assessed using the Cochrane risk-of-bias tool. The quality of evidence for each outcome will be assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Review Manager V.5.3.5 will be used for synthesis and subgroup analysis.

Ethics and dissemination

Owing to the nature of the review, ethical approval is not required. The results will be disseminated through peer-reviewed publications.

PROSPERO registration number

CRD42020197395.
The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings
Authors: Woolf Katherine , Melbourne Carl , Bryant Luke , Guyatt Anna L , McManus I Chris , Gupta Amit , Free Robert C , Nellums Laura , Carr Sue , John Catherine , Martin Christopher A , Wain Louise V , Gray Laura J , Garwood Claire , Modhwadia Vishant , Abrams Keith R , Tobin Martin D , Khunti Kamlesh , Pareek Manish
Published: September 2021

Introduction

The COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).

Methods and analysis

A baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.

Ethics and dissemination

The study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals.

Trial registration number

ISRCTN11811602; Pre-results.
Facilitators and barriers to using telepresence robots in aged care settings: a scoping review protocol
Authors: Smith Chelsea , Gregorio Mario , Hung Lillian
Published: September 2021

Introduction

Social isolation is a significant issue in aged care settings (eg, long-term care (LTC) and hospital) and is associated with adverse outcomes such as reduced well-being and loneliness. Loneliness is linked with depression, anxiety, cognitive decline, weakened immune system, poor physical health, poor quality of life and mortality. The use of robotic assistance may help mitigate social isolation and loneliness. Although telepresence robots have been used in healthcare settings, a comprehensive review of studies focusing on their use in aged care for reducing social isolation requires further investigation. This scoping review will focus on the use of telepresence robots to support social connection of older people in care settings.

Methods and analysis

This scoping review will follow Joanna Briggs Institute scoping review methodology. The review team consists of patient partners and family partners, a nurse researcher and a group of students. In the scoping review, we will search the following databases: MEDLINE (Ovid), CINAHL, PsycINFO (EBSCO), Web of Science and ProQuest Dissertations & Theses Global. Google and Google Scholar will be used to search for additional literature. A handsearch will be conducted using the reference lists of included studies to identify additional relevant articles. The scoping review will consider studies of using a telepresence robotic technology with older adults in care settings (ie, LTC and hospital), published in English.

Ethics and dissemination

Since the methodology of the study consists of collecting data from publicly available articles, it does not require ethics approval. By examining the current state of using telepresence to support older people in care settings, this scoping review can offer useful insight into users’ needs (eg, patients’ and care providers’ needs) and inform future research and practice. We will share the scoping review results through conference presentations and an open access publication in a peer-reviewed journal.
Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2)
Authors: Marschner Simone , Chow Clara , Thiagalingam Aravinda , Simmons David , McClean Mark , Pasupathy Dharmintra , Smith Ben J , Flood Victoria , Padmanabhan Suja , Melov Sarah , Ching Cellina , Cheung N Wah
Published: September 2021

Introduction

Gestational diabetes (GDM) contributes substantially to the population burden of type 2 diabetes (T2DM), with a high long-term risk of developing T2DM. This study will assess whether a structured lifestyle modification programme for women immediately after a GDM pregnancy, delivered via customised text messages and further individualised using data from activity monitors, improves T2DM risk factors, namely weight, physical activity (PA) and diet.

Methods and analysis

This multicentre randomised controlled trial will recruit 180 women with GDM attending Westmead, Campbelltown or Blacktown hospital services in Western Sydney. They will be randomised (1:1) on delivery to usual care with activity monitor (active control) or usual care plus activity monitor and customised education, motivation and support delivered via text messaging (intervention). The intervention will be customised based on breastfeeding status, and messages including their step count achievements to encourage PA. Messages on PA and healthy eating will encourage good lifestyle habits. The primary outcome of the study is healthy lifestyle composed of weight, dietary and PA outcomes, to be evaluated at 6 months. The secondary objectives include the primary objective components, body mass index, breastfeeding duration and frequency, postnatal depression, utilisation of the activity monitor, adherence to obtaining an oral glucose tolerance test post partum and the incidence of dysglycaemia at 12 months. Relative risks and their 95% CIs will be presented for the primary objective and the appropriate regression analysis, adjusting for the baseline outcome results, will be done for each outcome.

Ethics and dissemination

Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee (2019/ETH13240). All patients will provide written informed consent. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.

Trial registration number

ACTRN12620000615987; Pre-results.
Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme
Authors: Jacob Prasobh , Gupta Poonam , Shiju Shiny , Omar Amr Salah , Ansari Syed , Mathew Gigi , Varghese Miki , Pulimoottil Jinsograce , Varkey Sumi , Mahinay Menandro , Jesus Darlene , Surendran Praveen
Published: September 2021

Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient’s physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.

A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard ‘run chart rules’ to detect changes in outcomes over time and Welch’s t-test to assess the significance of these outcomes.

This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.

Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.
Competing risks in quality and safety research: a framework to guide choice of analysis and improve reporting
Authors: Marang-van de Mheen Perla J , Putter Hein , Bastiaannet Esther , Bottle Alex
Published: September 2021

When comparing hospitals on their readmission rates as currently done in the Hospital Readmission and Reduction Program (HRRP) in the USA, should we include the competing risk of mortality after discharge, which precludes the readmission, in the analysis? Not including competing risks in current HRRP metrics was raised recently as a limitation with possible unintended consequences, as financial penalties for higher readmission rates are more severe than for higher mortality rates. Incorrectly including or ignoring competing risks can both induce bias. In this paper, we present a framework to clarify situations when competing risks should be taken into account and when they should not. We argue that the research question and the perspective from which it is asked determine whether the competing risk is also of interest and should be included in the analysis, or if only the event of interest should be considered. This information is often not explicitly reported but is needed to interpret whether the results are valid. Using the examples of readmissions and cancer, we show how different research questions fit different perspectives from which these are asked (patient, system, regulatory/insurance). Slightly changing the research question or perspective may thus change the analysis. Even though some may argue that any introduced bias is likely to be small, in the context of the HRRP, even small changes may mean that a hospital will face (higher) financial penalties. The impact of getting it wrong matters.