bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear Structural Dynamics of Macro-Fiber Composite Cantilevers for Resonant Actuation
Authors: Tan David , Yavarow Paul , Erturk Alper
Published: November 2017

Macro-fiber composite (MFC) piezoelectric materials are used in a variety of applications employing the converse piezo-electric effect, ranging from bioinspired actuation to vibration control. Most of the existing literature to date considered linear material behavior for geometrically linear oscillations. However, in many applications, such as bioinspired locomotion using MFCs, material and geometric nonlinearities are pronounced and linear models fail to represent and predict the governing dynamics. The predominant types of nonlinearities manifested in resonant actuation of MFC cantilevers are piezoelectric softening, geometric hardening, inertial softening, as well as internal and external dissipative effects. In the present work, we explore nonlinear actuation of MFC cantilevers and develop a mathematical framework for modeling and analysis. An in vacuo actuation scenario is considered for a broad range of voltage actuation levels to accurately identify the sources of dissipation. Several experiments are conducted for an MFC bimorph cantilever, and model simulations are compared with nonlinear experimental frequency response functions under resonant actuation. The resulting experimentally validated framework can be used for simulating the dynamics of MFCs under resonant actuation, as well as parameter identification and structural optimization for nonlinear operation regime.
Investigating the Effect of Thermoelectric Processing on Ionic Aggregation in Thermoplastic Ionomers
Authors: Vijayaraghavan Prasant , Sundaresan Vishnu-Baba
Published: November 2017

Ionomers are a class of polymers which contain a small fraction of charged groups in the polymer backbone. These ionic groups aggregate (termed ionic aggregates) to form temporary cross-links that break apart over the ionic dissociation temperature and re-aggregate on cooling, influencing the mechanical properties of these polymers. In addition to enhanced mechanical properties, some ionomers also exhibit self-healing behavior. The self-healing behavior is a consequence of weakly bonded ionic aggregates breaking apart and re-aggregating after puncture or a ballistic impact. The structure and properties of ionomers have been studied over the last several decades; however, there is a lack of understanding of the influence of an electrostatic field on ionic aggregate morphology. Characterizing the effect of temperature and electric field on the formation and structure of these ionic aggregates will lead to preparation of ionomers with enhanced structural properties. This work focuses on Surlyn 8940 which a poly-ethylene methacryclic acid co-polymer in which a fraction of the carboxylic acid is terminated by sodium. In this work, Surlyn is thermoelectrically processed over its ionic dissociation temperature in the presence of a strong electrostatic field. Thermal studies are performed on the ionomer to study the effect of the thermoelectric processing. It is shown that the application of a thermoelectric field leads to increase in the ionic aggregate order in these materials and reduction in crystal size distribution. Thermal Analysis is performed using a Differential Scanning Calorimeter and the resulting thermogram analysis shows that thermoelectric processing increases the peak temperature and onset temperature of melting by 4 C and 20 C respectively. The peak width at half maximum of the melting endotherm is reduced by 10 C due to thermoelectric processing. This serves as a measure of the increased crystallinity. A parametric study on the effect of field duration and field strength is also performed.
Low-Frequency Elastic Wave Focusing and Harvesting via Locally Resonant Metamaterials
Authors: Tol Serife , Degertekin F. Levent , Erturk Alper
Published: November 2017

Elastic lens and mirror concepts that have been explored to date for enhanced structure-borne wave energy harvesting are suitable for relatively high-frequency waves (e.g. tens of kHz), which are very much outside the typical ambient structural frequency energy spectrum. One direct way of reducing the design frequency of such phononic crystal-based lens and reflector/mirror designs is to increase their size, which would yield very large dimensions to operate at ambient vibration frequencies (∼hundreds of Hz). In this work, we exploit locally resonant (LR) metamaterials to enable low-frequency elastic wave focusing via LR lens and mirror concepts with practical size limitations. LR lens is designed in a similar way to its phononic crystal counterpart by tailoring the refractive index profile of the LR unit cell distribution. However, LR approach enables altering the dispersion characteristics, and thereby the phase velocity distribution, at much lower frequencies right below the local resonance frequency. Other than the local resonance frequency of the unit cells, the key factor in design is the mass ratio of the resonators to achieve a desired refractive index profile and focusing. LR mirror uses the low-frequency bandgap which is right above the resonance frequency of the unit cells. LR unit cells arranged in the form of a parabola, for instance, makes a low-frequency LR mirror that operates in the bandgap for plane wave focusing. These LR focusing concepts can be used in vibration civil, aerospace, and mechanical systems to localize and harvest structure-borne wave energy.
Self-Sensing Solid Materials via Delamination Buckling
Authors: Liu Suihan , Burgueño Rigoberto
Published: November 2017

Strain in solid materials under external loads cannot be visualized until they reach a high value or failure occurs; and the common measuring method of using strain sensors is effective but limited to wiring or power supply. In this study, we introduce a new concept of self-sensing solid materials by designing thin surface circular delamination regions on a material body to sense and predict the elastic global strain through controlled elastic local buckling. Delamination buckling is an undesirable failure occurrence in laminated composites under compression. However, it can translate imperceptible small global strains on the main material body to a visible large deformation in the surface of the delaminated region due to buckling. We analytically studied the buckling and post-buckling response of a clamped circular thin plate with unilateral constraint using an energy method to obtain the critical buckling loads, the buckling configurations, and the center out-of-plane displacement under uniaxial and biaxial loading conditions. The results show that for a given buckling configuration in the local region, the global strain condition of the main material body can be predicted. The study thus explores and proves a feasible way to design self-sensing materials through controlled delamination buckling.
Characterization of an Electrorheological Fluid for Rehabilitation Robotics Applications
Authors: Davidson Joseph R. , Krebs Hermano Igo
Published: November 2017

Compared to clinic-based systems, rehabilitation robots designed for home use could enable increased accessibility and intensity of therapy for stroke survivors. To move upper extremity rehabilitation robots from the clinic to the home, the designs must become smaller, lighter, and less complex. One path to reducing the size of the robot’s hardware is to replace conventional actuators with smaller designs utilizing the unique properties of smart materials. As a first step towards reducing the size of upper extremity rehabilitation robots, this paper presents results from a characterization study of a prototype electrorheological fluid. The fluid’s dynamic yield stress was first measured using a modified controlled stress rheometer. A testbed was then developed to analyze the mechanical performance of a custom brake filled with the fluid. System parameters measured included braking torque at varying electric field strengths as well as the fluid’s speed of response. Maximum torque output was 4.80 N-m at an electric field strength of 3 kV/mm. Experimental results also indicate that the fluid’s activation and relaxation times will enable sufficient control bandwidth for the desired application. However, non-linear effects, such as field-dependent hysteresis, are significant and may require compensation from the controller supervising interaction between the robot and patient.
The Effect of Infill Patterns and Annealing on Mechanical Properties of Additively Manufactured Thermoplastic Composites
Authors: Rangisetty Sridher , Peel Larry D.
Published: November 2017

Recently, carbon fiber-reinforced thermoplastics (CFRTPs) have become popular choices in desktop-based additive manufacturing, but there is limited information on their effective usage. In Fused Deposition Modeling (FDM), a structure is created by layers of extruded beads. The degree of bonding between beads, bead orientation, degree of interlayer bonding, type of infill and the type of material, determines overall mechanical performance. The presence of chopped fibers in thermoplastics increases melt viscosity, changes coefficients of thermal expansion, may have layer adhesion issues, and causes increased wear on nozzles, which makes FDM fabrication of thermoplastic composites somewhat different from neat thermoplastics. In the current work, best practices and the effect of annealing and infill patterns on the mechanical performance of FDM-fabricated composite parts were investigated. Materials included commercially available PLA, CF-PLA, ABS, CF-ABS, PETG, and CF-PETG. Two sets of ASTM D638 tensile and ASTM D790 flexural test specimens with 3 different infill patterns and each material were fabricated, one set annealed, and all tested. Anisotropic behavior was observed as a function of infill pattern. As expected, strength and stiffness were higher when the beads were oriented in the direction of the load, even for neat resins. All fiber-filled tensile results showed an increase in stiffness, but surprisingly, not in strength (likely due to very short fiber lengths). Tests of annealed specimens resulted in clear improvements in tensile strength, tensile stiffness and flexural strength for PLA, CF-PLA, and PETG, CF-PETG but a reduction in flexural stiffness. Also, annealing resulted in mixed improvements for ABS and CF-ABS and is only useful in certain infill patterns. This work also establishes ‘Best Practices’ of FDM-type fabrication of thermoplastic composite structures and documents the minimum critical fiber lengths and fiber fractions of several CF-filled FDM filaments.
Broadband ship noise and its potential impacts on Indo-Pacific humpback dolphins: Implications for conservation and management
Authors: Liu Mingming , Dong Lijun , Lin Mingli , Li Songhai
Published: November 2017

Ship noise pollution has raised considerable concerns among regulatory agencies and cetacean researchers worldwide. There is an urgent need to quantify ship noise in coastal areas and assess its potential biological impacts. In this study, underwater broadband noise from commercial ships in a critical habitat of Indo-Pacific humpback dolphins was recorded and analyzed. Data analysis indicated that the ship noise caused by the investigated commercial ships with an average length of 134 ± 81 m, traveling at 18.8 ± 2.5 km/h [mean ± standard deviation (SD), n = 21] comprises mid-to-high components with frequencies approaching and exceeding 100 kHz, and the ship noise could be sensed auditorily by Indo-Pacific humpback dolphins within most of their sensitive frequency range. The contributions of ship noise to ambient noise were highest in two third-octave bands with center frequencies of 8 and 50 kHz, which are within the sensitive hearing range of Indo-Pacific humpback dolphins and overlap the frequency of sounds that are biologically significant to the dolphins. It is estimated that ship noise in these third-octave bands can be auditorily sensed by and potentially affect the dolphins within 2290 ± 1172 m and 848 ± 358 m (mean ± SD, n = 21), respectively.
Snowball Earth climate dynamics and Cryogenian geology-geobiology
Authors: Hoffman Paul F. , Abbot Dorian S. , Ashkenazy Yosef , Benn Douglas I. , Brocks Jochen J. , Cohen Phoebe A. , Cox Grant M. , Creveling Jessica R. , Donnadieu Yannick , Erwin Douglas H. , Fairchild Ian J. , Ferreira David , Goodman Jason C. , Halverson Galen P. , Jansen Malte F. , Le Hir Guillaume , Love Gordon D. , Macdonald Francis A. , Maloof Adam C. , Partin Camille A. , Ramstein Gilles , Rose Brian E. J. , Rose Catherine V. , Sadler Peter M. , Tziperman Eli , Voigt Aiko , Warren Stephen G.
Published: November 2017

We review recent observations and models concerning the dynamics of Cryogenian global glaciation and their biological consequences.
Ecological restoration success is higher for natural regeneration than for active restoration in tropical forests
Authors: Crouzeilles Renato , Ferreira Mariana S. , Chazdon Robin L. , Lindenmayer David B. , Sansevero Jerônimo B. B. , Monteiro Lara , Iribarrem Alvaro , Latawiec Agnieszka E. , Strassburg Bernardo B. N.
Published: November 2017

Natural forest recovery is an effective ecological alternative to tree planting in tropical forests under certain conditions.
Directed differentiation of human pluripotent stem cells to blood-brain barrier endothelial cells
Authors: Qian Tongcheng , Maguire Shaenah E. , Canfield Scott G. , Bao Xiaoping , Olson William R. , Shusta Eric V. , Palecek Sean P.
Published: November 2017

We report a defined method for differentiating human pluripotent stem cells to brain endothelial cells.
ω-3 polyunsaturated fatty acids direct differentiation of the membrane phenotype in mesenchymal stem cells to potentiate osteogenesis
Authors: Levental Kandice R. , Surma Michal A. , Skinkle Allison D. , Lorent Joseph H. , Zhou Yong , Klose Christian , Chang Jeffrey T. , Hancock John F. , Levental Ilya
Published: November 2017

Dietary lipids change membrane phenotypes, which can be used to affect lineage specification in stem cells.
Brain implant trials spur ethical discussions
Authors: Underwood Emily
Published: November 2017

Who is responsible for invasive devices that clinical trial participants want to keep?
Cordilleran Ice Sheet mass loss preceded climate reversals near the Pleistocene Termination
Authors: Menounos B. , Goehring B. M. , Osborn G. , Margold M. , Ward B. , Bond J. , Clarke G. K. C. , Clague J. J. , Lakeman T. , Koch J. , Caffee M. W. , Gosse J. , Stroeven A. P. , Seguinot J. , Heyman J.
Published: November 2017

Disappearance of an ice sheet

The Cordilleran Ice Sheet is thought to have covered westernmost Canada until about 13,000 years ago, even though the warming and sea level rise of the last deglaciation had begun more than a thousand years earlier. This out-of-phase behavior has puzzled glaciologists because it is not clear what mechanisms could account for it. Menounos
et al.
report measurements of the ages of cirque and valley glaciers that show that much of western Canada was ice-free as early as 14,000 years ago—a finding that better agrees with the record of global ice volume (see the Perspective by Marcott and Shakun). Previous reconstructions seem not to have adequately reflected the complexity of ice sheet decay.

Science
, this issue p.
781
; see also p.
721
How the news media activate public expression and influence national agendas
Authors: King Gary , Schneer Benjamin , White Ariel
Published: November 2017

Measuring the impact of the media

The active participation of the people is one of the central components of a functioning democracy. Kinget al.performed a real-world randomized experiment in the United States to understand the causal effect of news stories on increasing public discussion of a specific topic (see the Policy Forum by Gentzkow). Social media posts increased by almost 20% the first day after the publication of news stories on a wide range of topics. Furthermore, the posts were relatively evenly distributed across political affiliation, gender, and region of the United States.

Science, this issue p.776; see also p.726
Redox-sensitive alteration of replisome architecture safeguards genome integrity
Authors: Somyajit Kumar , Gupta Rajat , Sedlackova Hana , Neelsen Kai John , Ochs Fena , Rask Maj-Britt , Choudhary Chunaram , Lukas Jiri
Published: November 2017

Metabolic regulation of genome stability

Cells respond to metabolic fluctuations by adjusting the speed of DNA replication as a safeguard for genome stability. Somyajit
et al.
elucidate the cellular mechanisms that align replication fork dynamics with metabolic pathways (see the Perspective by Gómez-González and Aguilera). The elevation of reactive oxygen species (ROS) levels under metabolic stress dissociates a replication accelerator from the replisome and leads to replication slowdown, thus preventing replication stress. Studying this genome surveillance mechanism in cancer cells with elevated ROS levels and increased replication adaptability may provide opportunities to specifically target tumors.

Science
, this issue p.
797
; see also p.
722
Lewis acid enhancement by hydrogen-bond donors for asymmetric catalysis
Authors: Banik Steven M. , Levina Anna , Hyde Alan M. , Jacobsen Eric N.
Published: November 2017

Lewis acid catalysis tackled by tag team

Molecular catalysts with two closely spaced nitrogen-hydrogen groups can act like a tweezer, activating a carbon center by latching onto a leaving group through double hydrogen bonding and then pulling it away. In the resultant ion pair, the shape of the catalyst can bias an ensuing reaction to favor just one of two possible mirror-image products. Banik
et al.
used this motif to activate a Lewis acid cocatalyst, pulling a leaving group off silicon instead of carbon (see the Perspective by Mattson). The combined pair of catalysts is more effective for reactions such as asymmetric cycloadditions that involve weaker leaving groups on carbon.

Science
, this issue p.
761
; see also p.
720
The need to regulate replication fork speed
Authors: Gómez-González Belén , Aguilera Andrés
Published: November 2017

Fork speed modulation counteracts redox imbalance to safeguard genome integrity
Updated Systematic Review and Meta-Analysis of Acupuncture for Chronic Knee Pain
Authors: Zhang Qinhong , Yue Jinhuan , Golianu Brenda , Sun Zhongren , Lu Ying
Published: November 2017

Objective

To assess the effectiveness and safety of acupuncture for the treatment of chronic knee pain (CKP).

Methods

We searched the MEDLINE, EMBASE, Cochrane CENTERAL, CINAHL and four Chinese medical databases from their inception to June 2017. We included randomised controlled trials of acupuncture as the sole treatment or as an adjunctive treatment for CKP. The primary outcome was pain intensity measured by visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and 11-point numeric rating scale. Secondary outcome measurements included the 36-Item Short Form Health Survey and adverse events. The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria and the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) checklist.

Results

Nineteen trials were included in this systematic review. Of these, data from 17 studies were available for analysis. Regarding the effectiveness of acupuncture alone or combined with other treatment, the results of the meta-analysis showed that acupuncture was associated with significantly reduced CKP at 12 weeks on WOMAC pain subscale (mean difference (MD) −1.12, 95% confidence interval (CI) −1.98 to −0.26, I2=62%, 3 trials, 608 participants) and VAS (MD −10.56, 95% CI −17.69 to −3.44, I2=0%, 2 trials, 145 patients). As for safety, no difference was found between the acupuncture and control groups (risk ratio 1.08, 95% CI 0.54 to 2.17, I2=29%).

Conclusion

From this systematic review, we conclude that acupuncture may be effective at relieving CKP 12 weeks after acupuncture administration, based on the current evidence and our protocol. However, given the heterogeneity and methodological limitations of the included trials, we are currently unable to draw any strong conclusions regarding the effectiveness of acupuncture for chronic knee pain. In addition, we found that acupuncture appears to have a satisfactory safety profile, although further studies with larger numbers of participants are needed to confirm the safety of this technique.

Strengths

Systematic review without language restrictions.

Limitations

Only a few high-quality and consistent trials could be included in this review.
Optical coherence tomographic angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
Authors: Gaier Eric D , Gilbert Aubrey L , Cestari Dean M , Miller John B
Published: November 2017

Aims

We set out to determine the optical coherence tomographic angiography (OCT-A) characteristics of arteritic anterior ischaemic optic neuropathy (AAION) in the context of giant cell arteritis (GCA).

Methods

This is an observational case series of four patients with AAION secondary to GCA, three with unilateral AAION and one with bilateral AAION. We reviewed the charts, fundus photography, visual fields, fluorescein angiography (FA) and OCT-A images for all patients to identify a unifying theme in a range of AAION clinical severity. Imaging of two healthy control eyes from two patients of similar age to the patients in our series were used for comparison.

Results

Superficial peripapillary capillary dilation was seen in eyes with acute AAION. It was also noted in the fellow eyes of two patients. Retinal capillary perfusion defects corresponded to visual field loss. Dense optic disc oedema and cotton-wool spots imparted blockage effects. OCT-A laminar analysis did not highlight the choroidal/choriocapillaris perfusion defects seen on FA in two patients. Follow-up OCT-A was obtained in two patients and revealed progression to superficial peripapillary capillary attenuation that corresponded with visual field loss.

Conclusions

There are acute and chronic vascular changes in AAION that are detectable by OCT-A that correspond with visual function. Though the microvascular changes seen in GCA and AAION are not specific, the nearly ubiquitous findings among preclinical and clinically affected eyes in this series of patients with GCA support OCT-A as a potentially useful adjunctive diagnostic test in the work-up of ambiguous cases of suspected ischaemic optic neuropathy.
Simulation-based inter-professional education to improve attitudes towards collaborative practice: a prospective comparative pilot study in a Chinese medical centre
Authors: Yang Ling-Yu , Yang Ying-Ying , Huang Chia-Chang , Liang Jen-Feng , Lee Fa-Yauh , Cheng Hao-Min , Huang Chin-Chou , Kao Shou-Yen
Published: November 2017

Objectives

Inter-professional education (IPE) builds inter-professional collaboration (IPC) attitude/skills of health professionals. This interventional IPE programme evaluates whether benchmarking sharing can successfully cultivate seed instructors responsible for improving their team members’ IPC attitudes.

Design

Prospective, pre-post comparative cross-sectional pilot study.

Setting/participants

Thirty four physicians, 30 nurses and 24 pharmacists, who volunteered to be trained as seed instructors participated in 3.5-hour preparation and 3.5-hour simulation courses. Then, participants (n=88) drew lots to decide 44 presenters, half of each profession, who needed to prepare IPC benchmarking and formed Group 1. The remaining participants formed Group 2 (regular). Facilitators rated the Group 1 participants’ degree of appropriate transfer and sustainable practice of the learnt IPC skills in the workplace according to successful IPC examples in their benchmarking sharing.

Results

For the three professions, improvement in IPC attitude was identified by sequential increase in the post-course (second month, T2) and end-of-study (third month, T3) Interdisciplinary Education Perception Scale (IEPS) and Attitudes Towards Healthcare Teams Scale (ATHCTS) scores, compared with pre-course (first month, T1) scores. By IEPS and ATHCTS-based assessment, the degree of sequential improvements in IPC attitude was found to be higher among nurses and pharmacists than in physicians. In benchmarking sharing, the facilitators’ agreement about the degree of participants’appropriate transfer and sustainable practice learnt ‘communication and teamwork’ skills in the workplace were significantly higher among pharmacists and nurses than among physicians. The post-intervention random sampling survey (sixth month, Tpost) found that the IPC attitude of the three professions improved after on-site IPC skill promotion by new programme-trained seed instructors within teams.

Conclusions

Addition of benchmark sharing to a diamond-based IPE simulation programme enhances participants’ IPC attitudes, self-reflection, workplace transfer and practice of the learnt skills. Furthermore, IPC promotion within teams by newly trained seed instructors improved the IPC attitudes across all three professions.
Study protocol for the Cities Changing Diabetes programme: a global mixed-methods approach
Authors: Napier A. David , Nolan John J , Bagger Malene , Hesseldal Louise , Volkmann Anna-Maria
Published: November 2017

Introduction

Urban living has been shown to affect health in various ways. As the world is becoming more urbanised and almost two-thirds of people with diabetes now live in cities, research into the relationship between urban living, health and diabetes is key to improving the lives of many. The majority of people with diabetes have type 2 diabetes, a subset linked to overweight and obesity, decreased physical activity and unhealthy diets. Diabetes has significant consequences for those living with the condition as well as their families, relationships and wider society. Although care and management are improving, complications remain common, and diabetes is among the leading causes of vision loss, amputation, neuropathy and renal and cardiovascular disease worldwide. We present a research protocol for exploring the drivers of type 2 diabetes and its complications in urban settings through the Cities Changing Diabetes (CCD) partnership programme.

Methods and analysis

A global study protocol is implemented in eight collaborating CCD partner cities. In each city, academic institutions, municipal representatives and local stakeholders collaborate to set research priorities and plan implementation of findings. Local academic teams execute the study following the global study protocol presented here. A quantitative Rule of Halves analysis obtains measures of the magnitude of the diabetes burden, the diagnosis rates in each city and the outcomes of care. A qualitative Diabetes Vulnerability Assessment explores the urban context in vulnerability to type 2 diabetes and identifies social factors and cultural determinants relevant to health, well-being and diabetes.

Ethics and dissemination

The protocol steers the collection of primary and secondary data across the study sites. Research ethics board approval has been sought and obtained in each site. Findings from each of the local studies as well as the result from combined multisite (global) analyses will be reported in a series of core scientific journal papers.
Naoxuekang, Xinnaoshutong and Xuesaitong capsules for treating stroke: a protocol for a randomised controlled trial
Authors: Chen Huiling , Cao Hongbo , Guo Xu , Zhao Meidan , Xia Qing , Chen Bo , Zhao Tieniu , Gao Wenyuan
Published: November 2017

Introduction

After stroke, hemiplegia, dysphasia and facial paralysis can manifest during the convalescent period. Currently, no Chinese patent medicine (CPM) is previously reported to cure each of these symptoms primarily, and thus, there are no relevant instructions for the use of CPM. This study presents a new approach based on comparative effectiveness research to distinguish the curative effects of three CPMs that are often used in stroke convalescence to determine the ideal medicine for the treatment of each symptom.

Methods and analysis

In this multicentre and double-blind clinical trial, stratified randomisation is used to group the patients according to their primary symptoms (hemiplegia, dysphasia and facial paralysis). Three strata will be enrolled, with 80 eligible participants included in each stratum. Each stratum will be randomly and equally divided into four groups, and each group will receive one of the following treatments: Naoxuekang, Xinnaoshutong (XNST), Xuesaitong (XST) or placebo. This study will include two stages: the initial treatment period (30 days) and a follow-up period (180 days). Three replicates for each data point will be completed during this trial. The first visit will occur on day 0 after enrolment, the second visit on day 30±2 and the third visit on day 210±5. The Delphi technique is adopted to achieve index weighting, which ensures that the evaluation outcome is patient oriented. The weighted index value will be computed as the final measurement index of the outcome.

Ethics and dissemination

This study has been approved by the Medical Ethics Committee of Tianjin University of Traditional Chinese Medicine (registration number TJUTCM-EC20160007). The results will be offered for publication in peer-reviewed journals.

Trial registration number

This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-17010397). The date of registration was 11 January 2017.
Quality of reporting of pilot and feasibility cluster randomised trials: a systematic review
Authors: Chan Claire L , Leyrat Clémence , Eldridge Sandra M
Published: November 2017

Objectives

To systematically review the quality of reporting of pilot and feasibility of cluster randomised trials (CRTs). In particular, to assess (1) the number of pilot CRTs conducted between 1 January 2011 and 31 December 2014, (2) whether objectives and methods are appropriate and (3) reporting quality.

Methods

We searched PubMed (2011–2014) for CRTs with ‘pilot’ or ‘feasibility’ in the title or abstract; that were assessing some element of feasibility and showing evidence the study was in preparation for a main effectiveness/efficacy trial. Quality assessment criteria were based on the Consolidated Standards of Reporting Trials (CONSORT) extensions for pilot trials and CRTs.

Results

Eighteen pilot CRTs were identified. Forty-four per cent did not have feasibility as their primary objective, and many (50%) performed formal hypothesis testing for effectiveness/efficacy despite being underpowered. Most (83%) included ‘pilot’ or ‘feasibility’ in the title, and discussed implications for progression from the pilot to the future definitive trial (89%), but fewer reported reasons for the randomised pilot trial (39%), sample size rationale (44%) or progression criteria (17%). Most defined the cluster (100%), and number of clusters randomised (94%), but few reported how the cluster design affected sample size (17%), whether consent was sought from clusters (11%), or who enrolled clusters (17%).

Conclusions

That only 18 pilot CRTs were identified necessitates increased awareness of the importance of conducting and publishing pilot CRTs and improved reporting. Pilot CRTs should primarily be assessing feasibility, avoiding formal hypothesis testing for effectiveness/efficacy and reporting reasons for the pilot, sample size rationale and progression criteria, as well as enrolment of clusters, and how the cluster design affects design aspects. We recommend adherence to the CONSORT extensions for pilot trials and CRTs.
Qualitative study to understand the barriers to recruiting young people with cancer to BRIGHTLIGHT: a national cohort study in England
Authors: Kenten Charlotte , Martins Ana , Fern Lorna A , Gibson Faith , Lea Sarah , Ngwenya Nothando , Whelan Jeremy S , Taylor Rachel M
Published: November 2017

Objectives

BRIGHTLIGHT is a national evaluation of cancer services for teenagers and young adults in England. Following challenges with recruitment, our aim was to understand more fully healthcare professionals’ perspectives of the challenges of recruiting young people to a low-risk observational study, and to provide guidance for future recruitment processes.

Design

Qualitative.

Setting

National Health Service (NHS) hospitals in England.

Methods

Semistructured telephone interviews with a convenience sample of 23 healthcare professionals. Participants included principal investigators/other staff recruiting into the BRIGHTLIGHT study. Data were analysed using framework analysis.

Results

The emergent themes were linked to levels of research organisational management, described using the levels of social network analysis: micro-level (the individual; in this case the target population to be recruited—young people with cancer); meso-level (the organisation; refers to place of recruitment and people responsible for recruitment); and macro-level (the large-scale or global structure; refers to the wider research function of the NHS and associated policies). Study-related issues occurred across all three levels, which were influenced by the context of the study. At the meso-level, professionals’ perceptions of young people and communication between professionals generated age/cancer type silos, resulting in recruitment of either children or adults, but not both by the same team, and only in the cancer type the recruiting professional was aligned to. At the macro-level the main barrier was discordant configuration of a research service with a clinical service.

Conclusions

This study has identified significant barriers to recruitment mainly at the meso-level and macro-level, which are more challenging for research teams to influence. We suggest that interconnected whole-system changes are required to facilitate the success of interventions designed to improve recruitment. Interventions targeted at study design/management and the micro-level only may be less successful. We offer solutions to be considered by those involved at all levels of research for this population.
Studying Impact of Nutrition on Growth (SING): a prospective cohort for comparing the health outcomes of young children with the dietary quality score
Authors: Lee Albert , Cheung Calvin Ka-man , Lo Kenneth , Keung Vera Mei-wan , Mui Lancelot Wai-ho , Tam Wilson W S
Published: November 2017

Introduction

This study aims to explore the prospective association between the dietary quality (DQ) of preschoolers and their health status in Hong Kong, with the body mass index as the main outcome variable.

Methods and analysis

This prospective cohort study has recruited 3539 children aged between 2 and 4 years old, with a follow-up period of 4 years. Their diet was reported by their parents by a 3-day food diary, and their body weight and height were measured yearly with standardised instruments. Questionnaires were administered to parents to acquire information of the children’s prenatal development and dietary intake before their age of 2 years and of their baseline lifestyle and family backgrounds. The DQ was measured by the Healthy Eating Index as a continuous scale, while the exposure was defined as having a higher dietary quality score. Data were analysed using SPSS V.24. Linear and logistic regressions were used to examine the association of those predictive factors to the outcomes. Generalised estimating equations will be used to examine the longitudinal changes of the outcomes. A pilot study has been conducted, the preliminary results from which are presented in this cohort profile.

Ethics and dissemination

This study has been approved by the Joint Chinese University of Hong Kong and New Territory East Cluster Clinical Research Ethics Committee (CREC Ref No: 2013–632). Written informed consent was obtained from all subjects. The results will be published in due course.
A population-based case-control study of hospitalisation due to head injuries among bicyclists and motorcyclists in Taiwan
Authors: Pai Chih-Wei , Chen Yi-Chu , Lin Hsiao-Yu , Chen Ping-Ling
Published: November 2017

Introduction

According to official statistics in Taiwan, the main body region of injury causing bicyclist deaths is the head, and bicyclists are 2.6 times more likely to be fatally injured than motorcyclists. There is currently a national helmet law for motorcyclists but not for bicyclists.

Objectives

The primary aim of this study was to determine whether bicyclist casualties have higher odds of head-related hospitalisation than motorcyclists. This study also aims to investigate the determinants of head injury-related hospitalisation among bicyclists and motorcyclists.

Methods

Using linked data from the National Traffic Accident Dataset and the National Health Insurance Research Database for the period 2003–2012, this study investigates the crash characteristics of bicyclist and motorcyclist casualties presenting to hospitals due to motor vehicle crashes. Head injury-related hospitalisation was used as the study outcome for both road users to evaluate whether various factors (eg, human attributes, road and weather conditions, vehicle characteristics) are related to hospital admission of those who sustained serious injuries.

Results

Among 1 239 474 bicyclist and motorcyclist casualties, the proportion of bicyclists hospitalised for head injuries was higher than that of motorcyclists (10.0% vs 6.5%). However, the multiple logistic regression model shows that, after adjustment of this result for other factors such as helmet use, bicyclists were 18% significantly less likely to be hospitalised for head injuries than motorcyclists (AOR 0.82, 95% CI 0.79 to 0.85). Other important determinants of head injury-related hospitalisation for bicyclists and motorcyclists include female riders, elderly riders, crashes occurring in rural areas, moped riders, riding unhelmeted, intoxicated bicyclists and motorcyclists, unlicensed motorcyclists, dusk and dawn conditions and single-vehicle crashes.

Conclusions

Our finding underscores the importance of helmet use in reducing hospitalisation due to head injuries among bicyclists while current helmet use is relatively low.
The messages presented in online electronic cigarette promotions and discussions: a scoping review protocol
Authors: McCausland Kahlia , Maycock Bruce , Jancey Jonine
Published: November 2017

Introduction

Electronic cigarettes have become increasingly popular over the last 10 years. These devices represent a new paradigm for tobacco control offering smokers an opportunity to inhale nicotine without inhaling tobacco smoke. To date there are no definite conclusions regarding the safety and long-term health effects of electronic cigarettes; however, there is evidence that they are being marketed online as a healthier alternative to traditional cigarettes. This scoping review aims to identify and describe the breadth of messages (eg, health, smoking-cessation and price related claims) presented in online electronic cigarette promotions and discussions.

Methods and analysis

A scoping review will be undertaken adhering to the methodology outlined in The Joanna Briggs Institute Manual for Scoping Reviews. Six key electronic databases will be searched to identify eligible studies. Studies must be published in English between 2007 and 2017, examine and/or analyse content captured from online electronic cigarette promotions or discussions and report results for electronic cigarettes separately to other forms of tobacco delivery. Studies will be screened initially by title and abstract, followed by full-text review. Results of the search strategy will be reported in a PRISMA flow diagram and presented in tabular form with accompanying narrative summary.

Ethics and dissemination

The methodology consists of reviewing and collecting data from publicly available studies, and therefore does not require ethics approval. Results will be published in a peer reviewed journal and be presented at national/international conferences. Additionally, findings will be disseminated via social media and online platforms. Advocacy will be key to informing policy makers of regulatory and health issues that need to be addressed.

Registration details

The review was registered prospectively with The Joanna Briggs Institute Systematic Reviews database.
Improving cardiac operating room to intensive care unit handover using a standardised handover process
Authors: Gleicher Yehoshua , Mosko Jeffrey David , McGhee Irene
Published: November 2017

Handovers from the cardiovascular operating room (CVOR) to the cardiovascular intensive care unit (CVICU) are complex processes involving the transfer of information, equipment and responsibility, at a time when the patient is most vulnerable. This transfer is typically variable in structure, content and execution. This variability can lead to the omission and miscommunication of critical information leading to patient harm. We set out to improve the quality of patient handover from the CVOR to the CVICU by introducing a standardised handover protocol.

This study is an interventional time-series study over a 4-month period at an adult cardiac surgery centre. A standardised handover protocol was developed using quality improvement methodologies. The protocol included a handover content checklist and introduction of a formal ‘sterile cockpit’ timeout. Implementation of the protocol was refined using monthly iterative Plan-Do-Study-Act. The primary outcome was the quality of handovers, measured by a Handover Score, comprising handover content, teamwork and patient care planning indicators. Secondary outcomes included handover duration, adherence to the standardised handover protocol and handover team satisfaction surveys.

37 handovers were observed (6 pre intervention and 31 post intervention). The mean handover score increased from 6.5 to 14.0 (maximum 18 points). Specific improvements included fewer handover interruptions and more frequent postoperative patient care planning. Average handover duration increased slightly from 2:40 to 2:57 min. Caregivers noted improvements in teamwork, content received and patient care planning. The majority (>95%) agreed that the intervention was a valuable addition to the CVOR to CVICU handover process.

Implementation of a standardised handover protocol for postcardiac surgery patients was associated with fewer interruptions during handover, more reliable transfer of critical content and improved patient care planning.
Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care
Authors: Grant Suzanne , Guthrie Bruce
Published: November 2017

Background

Prescribing is a high-volume primary care routine where both speed and attention to detail are required. One approach to examining how organisations approach quality and safety in the face of high workloads is Hollnagel’s Efficiency and Thoroughness Trade-Off (ETTO). Hollnagel argues that safety is aligned with thoroughness and that a choice is required between efficiency and thoroughness as it is not usually possible to maximise both. This study aimed to ethnographically examine the efficiency and thoroughness trade-offs made by different UK general practices in the achievement of prescribing safety.

Methods

Non-participant observation was conducted of prescribing routines across eight purposively sampled UK general practices. Sixty-two semistructured interviews were also conducted with key practice staff alongside the analysis of relevant practice documents.

Results

The eight practices in this study adopted different context-specific approaches to safely handling prescription requests by variably prioritising speed of processing by receptionists (efficiency) or general practitioner (GP) clinical judgement (thoroughness). While it was not possible to maximise both at the same time, practices situated themselves at various points on an efficiency-thoroughness spectrum where one approach was prioritised at particular stages of the routine. Both approaches carried strengths and risks, with thoroughness-focused approaches considered safer but more challenging to implement in practice due to GP workload issues. Most practices adopting efficiency-focused approaches did so out of necessity as a result of their high workload due to their patient population (eg, older, socioeconomically deprived).

Conclusions

Hollnagel’s ETTO presents a useful way for healthcare organisations to optimise their own high-volume processes through reflection on where they currently prioritise efficiency and thoroughness, the stages that are particularly risky and improved ways of balancing competing priorities.
DE-CODE: a coding scheme for assessing debriefing interactions
Authors: Seelandt Julia C , Grande Bastian , Kriech Sarah , Kolbe Michaela
Published: November 2017

Debriefings are crucial for learning during simulation-based training (SBT). Although the quality of debriefings is very important for SBT, few studies have examined actual debriefing conversations. Investigating debriefing conversations is important for identifying typical debriefer–learner interaction patterns, obtaining insights into associations between debriefers’ communication and learners’ reflection and comparing different debriefing approaches. We aim at contributing to the science of debriefings by developing DE-CODE, a valid and reliable coding scheme for assessing debriefers’ and learners’ communication in debriefings. It is applicable for both direct, on-site observations and video-based coding.

Methods

The coding scheme was developed both deductively and inductively from literature on team learning and debriefing and observing debriefings during SBT, respectively. Inter-rater reliability was calculated using Cohen’s kappa. DE-CODE was tested for both live and video-based coding.

Results

DE-CODE consists of 32 codes for debriefers’ communication and 15 codes for learners’ communication. For live coding, coders achieved good inter-rater reliabilities with the exception of four codes for debriefers’ communication and two codes for learners’ communication. For video-based coding, coders achieved substantial inter-rater reliabilities with the exception of five codes for debriefers’ communication and three codes for learners’ communication.

Conclusion

DE-CODE is designed as micro-level measurement tool for coding debriefing conversations applicable to any debriefing of SBT in any field (except for the code medical input). It is reliable for direct, on-site observations as well as for video-based coding. DE-CODE is intended to allow for obtaining insights into what works and what does not work during debriefings and contribute to the science of debriefing.