bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Spray and Pool Scrubbing Efficiencies for Means of Mitigation Against Aerosol Dispersion in the Context of Fuel Debris Retrieval at Fukushima Daiichi: Part I
Authors: Porcheron Emmanuel , Leblois Yohan , Gelain Thomas , Chagnot Christophe , Journeau Christophe , Roulet Damien
Published: June 2021

The general context of this paper is an evaluation of strategies that can be used to mitigate aerosol dispersion during fuel debris or corium retrieval in damaged Fukushima Daiichi reactors. Knowledge of the aerosol source terms released during fuel debris retrieval operations is one of the key factors for assessing aerosol dispersion leading to the potential dissemination of radionuclides into the environment. Our approach is to couple experimental results from integral tests obtained during laser cutting experiments, analytical tests performed in a dedicated facility to reproduce two-phase flow such as flows representative of pool scrubbing and spray scrubbing conditions, and numerical simulations. Integral tests provide relevant information on the airborne particle release fraction during laser cutting for underwater conditions at different water depths, such as the particle concentration and particle size distribution. However, the detailed characterization of two-phase flows, such as the size and velocity of gas bubble and water droplets, is not possible during laser cutting integral tests. Therefore, a more analytical approach is necessary to obtain detailed information on two-phase flow, composed of bubbles in water, inducing pool scrubbing phenomenon, and droplets in gas generated by spray scrubbing systems, which are essential to the physical mechanisms of both processes and enable their respective efficiencies to be evaluated. The main objectives of this work were to develop models and ensure their validation based on experimental approach for predicting the pool scrubbing and spray scrubbing efficiencies in the context of fuel debris removal at Fukushima Daiichi.
Entropy Generation and Poiseuille Number Link in Developing Isothermal Laminar Micro-Flow
Authors: Rastogi Pallavi , Mahulikar Shripad P.
Published: June 2021

It is well-known that Poiseuille number (Po, hitherto viewed mainly as a fluid mechanics parameter) decreases along a hydrodynamically developing flow, from infinity at inlet to a fixed value downstream. This study reveals that the dimensionless entropy generation rate per unit length due to fluid friction (S˙¯′gen,fr) varies exactly the same way; hence, Po and S˙¯gen,fr′ are jointly studied for their dependence. Laminar hydrodynamic development of isothermal flow of incompressible fluid (water) in a circular micro-tube (diameter, D) is examined. Results are obtained for a given flow velocity for different D, and then, numerical experiments are conducted for different flow velocities for the same D-values. Striking similarity in trends of Po and S˙¯gen,fr′ shows a unique linear relation between them for the hydrodynamically developing region. It is theoretically shown that Po is a direct measure of entropy generation due to fluid friction, which explains its numerically obtained linear relation with S˙¯gen,fr′. It is found that in hydrodynamically developing region, both Po and S˙¯gen,fr′, decrease with decreasing D, which is the identified micro-effect.
Individual Drive Cross-Coupled Control System to Compensate for Measurement Error for Roll-to-Roll Contact Pressure Uniformization
Authors: Kim Daehyeon , Kim Youngjin , Park Jimin , Kim Hyeongrae , Kim Juyeon , Oh Dongho
Published: June 2021

Commercialization of printed electronics products requires uniform line width and thickness of the print pattern, which can be accomplished only by uniformization of the contact pressure in the roll-to-roll processs [1]. The conventional contact pressure control system has limitations in compensation, because the indirect measurement of the contact pressure performed by using the load cell generates time-delay error and magnitude error. In this study, a transfer function between the load cell signals and the actual contact pressure is derived to calculate the measurement time-delay, and the error was compensated by using a time-delay predictor. In addition, individual drive cross-coupled control system with time-delay compensator is designed in consideration of the effect that two servo motors have on the pressure on the other side of the impression roll to perform contact pressure uniformization.
Concept of a System Architecture for a Simulation Data Management In the Digital Twin
Authors: Röhm Benjamin , Anderl Reiner
Published: June 2021

The Department of Computer Integrated Design (DiK) at the TU Darmstadt deals with the Digital Twin topic from the perspective of virtual product development. A concept for the architecture of a Digital Twin was developed, which allows the administration of simulation input and output data. The concept was built under consideration of classical CAE process chains in product development. The central part of the concept is the management of simulation input and output data in a simulation data management system in the Digital Twin (SDM-DT). The SDM-DT takes over the connection between Digital Shadow and Digital Master for simulation data and simulation models.

The concept is prototypically implemented. For this purpose, real product condition data were collected via a sensor network and transmitted to the Digital Shadow. The condition data were prepared and sent as a simulation input deck to the SDM-DT in the Digital Twin based on the product development results. Before the simulation data and models are simulated, there is a comparison between simulation input data with historical input data from product development. The developed and implemented concept goes beyond existing approaches and deals with a central simulation data management in Digital Twins.
Design of a 3D Printed Micro-Transmission System for a Detachable Bronchoscope
Authors: Kohanfars Matthew , Li Yu , Morris Karcher , Ahadian Farshad , Talke Frank E.
Published: June 2021

Bronchoscopes are used across a wide range of medical procedures. It is highly desirable for a medical practitioner to have a bronchoscope insertion section that can be detached and reattached to its handle. In this study, a novel detachable bronchoscope with a micro-transmission is proposed, manufactured by 3D printing. The micro-transmission allows for the bronchoscope to be detached and reattached to the insertion section during a medical procedure, while maintaining control of the articulating distal end. The equations for calculating the load of the micro-transmission design are reviewed. The maximum load from different screw lead arrangements is determined experimentally.
Forgotten disease: an atypical case of Lemierre syndrome presenting as a soft tissue abscess
Authors: Kumar Dilpat , Shamsi Wasif Elahi , Gomes Thales , Warsha FNU
Published: June 2021

Lemierre syndrome (LS) is an acute oropharyngeal infection with secondary septic thrombophlebitis and distant septic embolisation. A 29-year-old woman with sore throat, dyspnoea and left shoulder pain, who was on levofloxacin for 3 days, presented with worsening symptoms. She was tachycardic, tachypneic and hypoxic on presentation. CT of neck and chest revealed multiple loculated abscesses on her left lower neck and shoulder, right peritonsillar abscess, thrombosis of the right external jugular vein and multiple bilateral septic emboli to the lungs. She was started on clindamycin and ampicillin sulbactam for LS. She developed septic shock and required intubation due to respiratory failure. Drainage of the left shoulder abscess grewFusobacterium nucleatum. After 2 weeks of a complicated intensive care unit stay, her haemodynamic status improved and she was transferred to the floor. LS has variable presentations, but regardless of the presentation, it is a potentially fatal disease-requiring prompt diagnosis and management.
Extra-axial tentorial medulloblastoma: a rare presentation of a common posterior fossa tumour
Authors: Singh Somesh , Israrahmed Amrin , Verma Vikrant , Singh Vivek
Published: June 2021

Medulloblastoma is a common paediatric posterior fossa tumour typically presenting as midline intra-axial mass involving the cerebellar vermis and/or roof of fourth ventricle with typical radiological features. These can be extra-axial in extremely rare instances with less than 50 cases reported so far in literature. We present a case of 18-year-old boy presenting with ataxia and headache. MRI showed dural mass (involving the left tentorium cerebellum) with typical imaging features of extra-axial lesion. The patient underwent near total excision of the tumour. Histopathology along with immunohistochemistry revealed the mass to be medulloblastoma. We present this case to highlight rarity of this location for medulloblastoma and the importance of considering this in the differential diagnosis of atypical posterior fossa extra-axial lesions. This can help in performing other relevant preoperative workup similar on the lines of medulloblastoma and planning of relevant management.
Cohort profile: the Westlake BioBank for Chinese (WBBC) pilot project
Authors: Zhu Xiao-Wei , Liu Ke-Qi , Wang Ping-Yu , Liu Jun-Quan , Chen Jin-Yang , Xu Xue-Jin , Xu Jin-Jian , Qiu Mo-Chang , Sun Yi , Liu Chun , Bai Wei-Yang , Zhao Pian-Pian , Xia Jiangwei , Gai Si-Rui , Guan Peng-Lin , Qian Yu , Cong Pei-Kuan , Xie Shu-Yang , Zheng Hou-Feng
Published: June 2021

Purpose

The Westlake BioBank for Chinese (WBBC) pilot cohort is a population-based prospective study with its major purpose to better understand the effect of genetic and environmental factors on growth and development from adolescents to adults.

Participants

A total of 14 726 participants (4751 males and 9975 females) aged 14–25 years were recruited and the baseline survey was carried out from 2017 to 2019. The pilot cohort contains rich range of information regarding of demographics and anthropometric measurements, lifestyle and sleep patterns, clinical and health outcomes. Visit the WBBC website for more information (https://wbbc.westlake.edu.cn/index.html).

Findings to date

The mean age of the study samples were 18.6 years for males and 18.5 years for females, respectively. The mean height and weight were 172.9 cm and 65.81 kg for males, and 160.1 cm and 52.85 kg for females. Results indicated that the prevalence of underweight in female was much higher than male, but the prevalence of overweight and obesity in female was lower than male. The mean serum 25(OH)D level in the 14 726 young participants was 22.4±5.3 ng/mL, and male had a higher level of serum 25(OH)D than female, overall, 33.5% of the participants had vitamin D deficiency and even more participants suffered from vitamin D insufficiency (58.2%). The proportion of deficiency in females was much higher than that in males (41.8 vs 16.4%). The issue of underweight and vitamin D deficiency in young people should be paid attention, especially in females. These results reflected the fact that thinness and paler skin are preferred in modern aesthetics of Chinese culture.

Future plans

WBBC pilot is designed as a prospective cohort study and provides a unique and rich data set analysing health trajectories from adolescents to young adults. WBBC will continue to collect samples with old age.
Comparative efficacy and acceptability of psychosocial treatments for disruptive behaviour disorders in children and adolescents: study protocol for a systematic review and network meta-analysis
Authors: Zhang Lin , Ren Zhihong , Ma Xueyao , Hazer-Rau Dilana , Jiang Guangrong , Zhao Chunxiao , Zhao Ziyi , Liu Qianzi , Yuan Fenghui
Published: June 2021

Introduction

Disruptive behaviour disorders are common among children and adolescents, with negative impacts on the youths, their families and society. Although multiple psychosocial treatments are effective in decreasing the symptoms of disruptive behaviour disorders, comprehensive evidence regarding the comparative efficacy and acceptability between these treatments is still lacking. Therefore, we propose a systematic review and network meta-analysis, integrating both direct and indirect comparisons to obtain a hierarchy of treatment efficacy and acceptability.

Methods and analysis

The present protocol will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Ten databases, including Web of Science, PubMed, PsycINFO, MEDLINE, APA PsycArticles, Psychology and Behavioral Sciences Collection, OpenDissertations, The Cochrane Library, Embase and CINAHL, will be searched from inception for randomised controlled trials of psychosocial treatments for children and adolescents with disruptive behaviour disorders, without restrictions on language, publication year and status. The primary outcomes will be efficacy at post-treatment (severity of disruptive behaviour disorders at post-treatment) and acceptability (dropout rate for any reason) of psychosocial treatments. The secondary outcomes will involve efficacy at follow-up, severity of internalising problems and improvement of social functioning. Two authors will independently conduct the study selection and data extraction, assess the risk of bias using the revised Cochrane Collaboration’s Risk of Bias tool and evaluate the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation framework to network meta-analysis. We will perform Bayesian network meta-analyses with a random effects model. Subgroup and sensitivity analyses will be performed to evaluate the robustness of the findings.

Ethics and dissemination

The research does not require ethical approval. Results are planned to be published in journals or presented at conferences. The network meta-analysis will provide information on a hierarchy of treatment efficacy and acceptability and help make a clinical treatment choice.

PROSPERO registration number

CRD42020197448.
How do participatory methods shape policy? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia
Authors: Marchal Bruno , Abejirinde Ibukun-Oluwa Omolade , Sulaberidze Lela , Chikovani Ivdity , Uchaneishvili Maia , Shengelia Natia , Diaconu Karin , Vassall Anna , Zoidze Akaki , Giralt Ariadna Nebot , Witter Sophie
Published: June 2021

Objectives

This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt.

Methods

Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders’ assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these.

Setting

The study was conducted in Tbilisi, Georgia.

Participants

A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops.

Results

Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement.

Conclusions

Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders’ knowledge and expertise on TB service delivery and RBF to codesign a new policy.
Sleep Apnea and Fetal Growth Restriction (SAFER) study: protocol for a pragmatic randomised clinical trial of positive airway pressure as an antenatal therapy for fetal growth restriction in maternal obstructive sleep apnoea
Authors: Hincker Alex , Nadler Jacob , Karan Suzanne , Carter Ebony , Porat Shay , Warner Barbara , Ju Yo-El S , Ben Abdallah Arbi , Wilson Elizabeth , Lockhart Ellen M , Ginosar Yehuda
Published: June 2021

Introduction

Fetal growth restriction (FGR) is a major contributor to fetal and neonatal morbidity and mortality with intrauterine, neonatal and lifelong complications. This study explores maternal obstructive sleep apnoea (OSA) as a potentially modifiable risk factor for FGR. We hypothesise that, in pregnancies complicated by FGR, treating mothers who have OSA using positive airway pressure (PAP) will improve birth weight and neonatal outcomes.

Methods and analysis

The Sleep Apnea and Fetal Growth Restriction study is a prospective, block-randomised, single-blinded, multicentre, pragmatic controlled trial. We enrol pregnant women aged 18–50, between 22 and 31 weeks of gestation, with established FGR based on second trimester ultrasound, who do not have other prespecified known causes of FGR (such as congenital anomalies or intrauterine infection). In stage 1, participants are screened by questionnaire for OSA risk. If OSA risk is identified, participants proceed to stage 2, where they undergo home sleep apnoea testing. Participants are determined to have OSA if they have an apnoea-hypopnoea index (AHI) ≥5 (if the oxygen desaturation index (ODI) is also ≥5) or if they have an AHI ≥10 (even if the ODI is <5). These participants proceed to stage 3, where they are randomised to nightly treatment with PAP or no PAP (standard care control), which is maintained until delivery. The primary outcome is unadjusted birth weight; secondary outcomes include fetal growth velocity on ultrasound, enrolment-to-delivery interval, gestational age at delivery, birth weight corrected for gestational age, stillbirth, Apgar score, rate of admission to higher levels of care (neonatal intensive care unit or special care nursery) and length of neonatal stay. These outcomes are compared between PAP and control using intention-to-treat analysis.

Ethics and dissemination

This study has been approved by the Institutional Review Boards at Washington University in St Louis, Missouri; Hadassah Hebrew University Medical Center, Jerusalem; and the University of Rochester, New York. Recruitment began in Washington University in November 2019 but stopped from March to November 2020 due to COVID-19. Recruitment began in Hadassah Hebrew University in March 2021, and in the University of Rochester in May 2021. Dissemination plans include presentations at scientific conferences and scientific publications.

Trial registration number

NCT04084990.
Impact of the first COVID-19 lockdown on study satisfaction and burnout in medical students in Split, Croatia: a cross-sectional presurvey and postsurvey
Authors: Žuljević Marija Franka , Jeličić Karlo , Viđak Marin , Đogaš Varja , Buljan Ivan
Published: June 2021

Objectives

To evaluate the impact of the first COVID-19 lockdown in 2020 on the burnout and study satisfaction of medical students.

Design

A cross-sectional study with a presurvey and postsurvey.

Setting

University of Split School of Medicine (USSM), Split, Croatia. The lockdown in the COVID-19 pandemic lasted from late March to mid-May 2020. There was a full switch to e-learning at the USSM during this period, and all clinical teaching was stopped.

Participants

Students enrolled in the 2019/2020 academic year. Data were collected before lockdown in December 2019 and January 2020 and again after the end of lockdown in June 2020.

Primary and secondary outcome measures

Study satisfaction was assessed using the study satisfaction survey. Burnout was assessed using two instruments: Oldenburg Burnout Inventory and Copenhagen Burnout Inventory. We used Bayesian statistics to compare before-and-after differences.

Results

437 independent responses (77.2% response rate) were collected before and 235 after lockdown (41.5% response rate). 160 participant responses were eligible for pairing. There was no significant difference for both paired and unpaired participants in study satisfaction before (3.38 on a 1–5 scale; 95% credible interval (95% CrI) 3.32 to 3.44) and after (3.49, 95% CrI 3.41 to 3.57) lockdown. We found no evidence (Bayes factor (BF10) >3.00 as a cut-off value) for an increase in the level of burnout before and after lockdown, both in independent and paired samples.

Conclusions

It seems that the first pandemic-related lockdown and a switch to e-learning did not affect burnout levels among medical students or their perception of their study programme. More insight is needed on the short-term and long-term effects of the COVID-19 pandemic on medical students and their education. Well-structured longitudinal studies on medical student burnout during the COVID-19 pandemic are needed.
Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study
Authors: Schäfer Sarah K , Fleischmann Robert , von Sarnowski Bettina , Bläsing Dominic , Flöel Agnes , Wurm Susanne
Published: June 2021

Introduction

Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.

Methods and analysis

The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1–5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.

Ethics and dissemination

The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.

Trial registration number

NCT04704635.
Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial
Authors: Kallestad Håvard , Saksvik Simen , Vedaa Øystein , Langsrud Knut , Morken Gunnar , Lydersen Stian , Simpson Melanie R , Dørheim Signe Karen , Holmøy Bjørn , Selvik Sara G , Hagen Kristen , Stiles Tore Charles , Harvey Allison , Ritterband Lee , Sivertsen Børge , Scott Jan
Published: June 2021

Introduction

Insomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.

Methods and analysis

A parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.

Ethics and dissemination

The study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.

Trial registration number

ClinicalTrials.gov Registry (NCT04621643); Pre-results.
Rationale and design of the Prevent Anal Cancer Self-Swab Study: a protocol for a randomised clinical trial of home-based self-collection of cells for anal cancer screening
Authors: Nyitray Alan G , Schick Vanessa , Swartz Michael D , Giuliano Anna R , Fernandez Maria E , Deshmukh Ashish A , Ridolfi Timothy J , Ajala Christopher , Brzezinski Bridgett , Sandoval Micaela , Nedjai Belinda , Smith Jennifer S , Chiao Elizabeth Y
Published: June 2021

Introduction

Squamous cell carcinoma of the anus is a common cancer among sexual minority men, especially HIV-positive sexual minority men; however, there is no evidenced-based national screening protocol for detection of anal precancers. Our objective is to determine compliance with annual anal canal self-sampling or clinician-sampling for human papillomavirus (HPV) DNA.

Methods and analysis

This is a prospective, randomised, two-arm clinical study to evaluate compliance with annual home-based versus clinic-based HPV DNA screening of anal canal exfoliated cells. The setting is primary care community-based clinics. Recruitment is ongoing for 400 HIV-positive and HIV-negative sexual minority men and transgender persons, aged>25 years, English or Spanish speaking, no current use of anticoagulants other than nonsteroidal anti-inflammatory drugs and no prior diagnosis of anal cancer. Participants are randomised to either receive a swab in the mail for home-based collection of an anal canal specimen at 0 and 12 months (arm 1) or attend a clinic for clinician collection of an anal canal specimen at 0 and 12 months (arm 2). Persons will receive clinic-based Digital Anal Rectal Examinations and high-resolution anoscopy-directed biopsy to assess precancerous lesions, stratified by study arm. Anal exfoliated cells collected in the study are assessed for high-risk HPV persistence and host/viral methylation. The primary analysis will use the intention-to-treat principle to compare the proportion of those who comply with 0-month and 12-month sampling in the home-based and clinic-based arms. The a priori hypothesis is that a majority of persons will comply with annual screening with increased compliance among persons in the home-based arm versus clinic-based arm.

Ethics and dissemination

The study has been approved by the Medical College of Wisconsin Human Protections Committee. Results will be disseminated to communities where recruitment occurred and through peer-reviewed literature and conferences.

Trial registration number

NCT03489707.
Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study
Authors: Kok Niek , Van Gurp Jelle , van der Hoeven Johannes G , Fuchs Malaika , Hoedemaekers Cornelia , Zegers Marieke
Published: June 2021

Background

Burnout threatens intensive care unit (ICU) professionals’ capacity to provide high-quality care. Moral distress is previously considered a root cause of burnout, but there are other risk factors of burnout such as personality, work–life balance and culture. This study aimed to disentangle the associations of ICU professionals’ moral distress and other risk factors with the components of burnout—emotional exhaustion, depersonalisation and personal accomplishment—suggesting informed burnout prevention strategies.

Methods

Cross-sectional survey completed in 2019 of ICU professionals in two Dutch hospitals. The survey included validated measure for burnout (the Dutch Maslach Burnout Inventory), moral distress (Moral Distress Scale), personality (short Big Five Inventory), work–home balance (Survey Work–Home Interaction Nijmegen) and organisational culture (Culture of Care Barometer). Each of the three components of burnout was analysed as a separate outcome, and for each of the components, a separate regression analysis was carried out.

Results

251 ICU professionals responded to the survey (response rate: 53.3%). Burnout prevalence was 22.7%. Findings showed that moral distress was associated with emotional exhaustion (β=0.18, 95% CI 0.9 to 0.26) and depersonalisation (β=0.19, 95% CI 0.10 to 0.28) and with increased emotional exhaustion mediated by negative work-to-home spillover (β=0.09, 95% CI 0.04 to 0.13). Support from direct supervisors mitigates the association between moral distress and emotional exhaustion (β=0.16, 95% CI 0.04 to 0.27).

Conclusions

Understanding moral distress as a root cause of burnout is too simplified. There is an important interplay between moral distress and work–home imbalance. Interventions that support individual coping with moral distress and a work–home imbalance, and the support of direct supervisors, are paramount to prevent burnout in physicians and nurses.
Age suit simulation replicates in healthy young adults the functional challenges to balance experienced by older adults: an observational study
Authors: Watkins Carole Anne , Higham Ellie , Gilfoyle Michael , Townley Charley , Hunter Sue
Published: June 2021

Background

Age simulation can have a positive effect on empathic understanding and perception of ageing. However, there is limited evidence for its ability to replicate objectively the physical and functional challenges of ageing.

Objective

To observe whether age suit simulation can replicate in healthy young adults the physical and physiological balance disturbance and falls risk experienced by older adults.

Methodology

Healthy young adults aged 20–40 years (16 male) were recruited to the study using convenience sampling from a student population. Participants performed three validated balance tests—Functional Reach Test (FRT), Timed Up and Go (TUG) and Berg Balance Scale (BBS)—first without the age suit and then with the age suit, using a standardised protocol, following the same sequence.

Results

30 participants completed all tests. Statistically significant differences between without-age-suit and with-age-suit performance were recorded for FRT distance (p<0.000005), time taken to complete the TUG (p<0.0005) and BBS score (p<0.001). A comparison of participant scores with normative FRT and TUG scores identified that the suit had ‘aged’ the majority of participants to the normative values for older adults (60+), with some reaching the values for individuals aged 70–89. However, no scores achieved the values indicative of increased falls risk.

Conclusions

The age suit is a valid educational tool that extends the value of age simulation beyond a more general empathising role, enabling those working with an older population to experience and understand the functional challenges to balance experienced by older adults as part of their training.
Is concurrent intravenous alteplase in patients undergoing endovascular treatment for large vessel occlusion stroke cost-effective even if the cost of alteplase is only US$1?
Authors: Ospel Johanna Maria , McDonough Rosalie , Kunz Wolfgang G , Goyal Mayank
Published: June 2021

Background

The added value of intravenous (IV) alteplase in large vessel occlusion (LVO) stroke over and beyond endovascular treatment (EVT) is controversial. We compared the long-term costs and cost-effectiveness of a direct-to-EVT paradigm in LVO stroke patients presenting directly to the mothership hospital to concurrent EVT and IV alteplase.

Methods

We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes. Outcome data were from the DIRECT-MT trial (NCT03469206). Incremental cost-effectiveness ratios and net monetary benefits were calculated and probabilistic sensitivity analysis was performed. Analysis was performed from a healthcare perspective and a societal perspective using both a minimal assumed alteplase cost of US$1 and true alteplase cost.

Results

When assuming a minimal cost of alteplase of $1, EVT with concurrent IV alteplase resulted in incremental lifetime cost of $5664 (healthcare perspective)/$4804 (societal perspective) and a decrement of 0.25 quality-adjusted life years (QALYs) compared with EVT only, indicating dominance of the EVT only approach. Net monetary benefits were consistently higher for EVT only compared with EVT with concurrent alteplase. Probabilistic sensitivity analysis showed increased costs without an increase in QALYs for EVT and concurrent IV alteplase compared with EVT only. Results were even more in favor of EVT when the true cost of alteplase was used for analysis.

Conclusion

EVT without concurrent alteplase is the preferred strategy from a health economic standpoint.
Dietary glycine equivalent and standardized ileal digestible methionine + cysteine levels for male broiler chickens fed low-crude-protein diets
Authors: Aguihe Paschal Chukwudi , Ospina-Rojas Ivan Camilo , Sakamoto Marcia Izumi , Pozza Paulo Cesar , Iyayi Eustace Ayemere , Murakami Alice Eiko
Published: June 2021

This study was conducted to determine the optimum dietary glycine equivalent (Glyequi) level in low-crude-protein diets of 181 g·kg−1 containing varied concentrations of standardized ileal digestible (SID) methionine + cysteine (Met + Cys) for broiler chicks (1–21 d old). A total of 1275, 1-d-old Cobb-Vantress® male broilers were distributed in a 5 × 3 factorial arrangement with a completely randomized design of 15 treatments with five replicates of 17 birds each. Treatments consisted of five levels of dietary Glyequi (14.9, 16.4, 17.9, 19.4, and 20.6 g·kg−1) and three concentrations of SID Met + Cys (7.70, 9.0, and 10.3 g·kg−1). Interactions between Glyequi and SID Met + Cys levels were observed for feed:gain (P = 0.055) and breast meat yield (BMY) (P = 0.017). In 7.7 and 9.0 g SID Met + Cys·kg−1 diets, optimal feed:gain and increased BMY were observed at Glyequi levels not lower than 17.9 g·kg−1. In 10.3 g SID Met + Cys·kg−1 diet, a lower feed:gain was achieved at 19.4 g Glyequi·kg−1. Therefore, a minimum dietary level of 17.9 g Glyequi·kg−1 is needed to increase growth of broilers fed diets containing 7.7 or 9.0 g·kg−1 SID Met + Cys, whereas 19.4 g·kg−1 Glyequi is necessary in diets containing 10.3 g·kg−1 SID Met + Cys for optimum growth.
Dynamic mode decomposition of elliptical liquid jets in crossflow
Authors: Mokhtarpour Keivan , Jadidi Mehdi , Dolatabadi Ali
Published: June 2021

The dynamics of round and elliptical liquid jets in subsonic crossflow was studied using high-speed imaging technique. The experiments were performed at constant gaseous Weber number and liquid–gas momentum flux ratios of 6.45 and 17.87, respectively, with orifices of different aspect ratios (AR) having an equivalent diameter of 0.43 mm. All of the cases were carried out inside an open-loop subsonic wind tunnel with a test section of 100 mm × 100 mm × 750 mm. For each case, dynamic modes were generated directly from the snapshots using a variant of the Arnoldi method known as the dynamic mode decomposition (DMD). The DMD results indicate that elliptical liquid jets have more small-scaled patterns with higher frequencies compared with the round liquid jets. As the first attempt to investigate the dynamics of elliptical liquid jets in crossflow, this study captures the dominant spatiotemporal structures. We also found that the orifice AR can significantly alter the jet wavelengths. The data from this study contribute to understanding the behavior of elliptical liquid jets exposed to gas crossflow in an enhanced capillary breakup regime.
On the initial singularity in Kantowski–Sachs spacetime
Authors: Ghorani Elham , Heydarzade Yaghoub
Published: June 2021

The emergent universe scenario is a proposal for resolving the Big Bang singularity problem in the standard Friedmann–Lemaitre–Robertson–Walker cosmology. In the context of this scenario, the Universe originates from a nonsingular static state. In the present work, considering the realization of the emergent universe scenario, we address the possibility of having a nonsingular Kantowski–Sachs type static state. Considering four and five dimensional models (with and without brane), it is shown that both the existence and stability of a nonsingular state depend on the dimensions of the spacetime and the nature of the fluid supporting the geometry.
LPE: Locality-Based Dead Prediction in Exclusive TLB for Large Coverage
Authors: Yan Jing , Tan Yujuan , Ma Zhulin , Liu Jingcheng , Chen Xianzhang , Wang Chengliang
Published: June 2021

Translation lookaside buffer (TLB) is critical to modern multi-level memory systems’ performance. However, due to the limited size of the TLB itself, its address coverage is limited. Adopting a two-level exclusive TLB hierarchy can increase the coverage [M. Swanson, L. Stoller and J. Carter, Increasing TLB reach using superpages backed by shadow memory, 25th Annual Int. Symp. Computer Architecture (1998); H.P. Chang, T. Heo, J. Jeong and J. Huh Hybrid TLB coalescing: Improving TLB translation coverage under diverse fragmented memory allocations, ACM SIGARCH Comput. Arch. News 45 (2017) 444–456] to improve memory performance. However, after analyzing the existing two-level exclusive TLBs, we find that a large number of “dead” entries (they will have no further use) exist in the last-level TLB (LLT) for a long time, which occupy much cache space and result in low TLB hit-rate. Based on this observation, we first propose exploiting temporal and spatial locality to predict and identify dead entries in the exclusive LLT and remove them as soon as possible to leave room for more valid data to increase the TLB hit rates. Extensive experiments show that our method increases the average hit rate by 8.67%, to a maximum of 19.95%, and reduces total latency by an average of 9.82%, up to 24.41%.
Bifurcation Structures of Nested Mixed-Mode Oscillations
Authors: Sekikawa Munehisa , Inaba Naohiko
Published: June 2021

In recently published work [Inaba & Kousaka, 2020a; Inaba & Tsubone, 2020b], we discovered significant mixed-mode oscillation (MMO) bifurcation structures in which MMOs are nested. Simple mixed-mode oscillation-incrementing bifurcations (MMOIBs) are known to generate [Formula: see text] oscillations for successive [Formula: see text] between regions of [Formula: see text]- and [Formula: see text]-oscillations, where [Formula: see text] and [Formula: see text] are adjacent simple MMOs, e.g. [Formula: see text] and [Formula: see text], where [Formula: see text] is an integer. MMOIBs are universal phenomena of evidently strong order and have been studied extensively in chemistry, physics, and engineering. Nested MMOIBs are phenomena that are more complex, but have an even stronger order, generating chaotic MMO windows that include sequences [Formula: see text] for successive [Formula: see text], where [Formula: see text] and [Formula: see text] are adjacent MMOIB-generated MMOs, i.e. [Formula: see text] and [Formula: see text] for integer [Formula: see text]. Herein, we investigate the bifurcation structures of nested MMOIB-generated MMOs exhibited by a classical forced Bonhoeffer–van der Pol oscillator. We use numerical methods to prepare two- and one-parameter bifurcation diagrams of the system with [Formula: see text], and 3 for successive [Formula: see text] for the case [Formula: see text]. Our analysis suggests that nested MMOs could be widely observed and are clearly ordered phenomena. We then define the first return maps for nested MMOs, which elucidate the appearance of successively nested MMOIBs.
Pseudo-Peakon, Periodic Peakons and Compactons on a Shallow Water Model with Coriolis Effect
Authors: Wen Zhenshu , Chen Guanrong , Li Jibin
Published: June 2021

For a shallow water model with Coriolis effect, by applying the methodologies of dynamical systems and singular traveling wave theory developed by Li and Chen [2007] to its traveling wave system, under different parameter conditions, all possible bounded solutions (solitary wave solution, pseudo-peakon and periodic peakons as well as compactons) are obtained. Some exact explicit parametric representations are presented.
IMPROVEMENT IN STRUCTURAL, OPTICAL AND ELECTRICAL PROPERTIES OF ITO FILM THROUGH AlN AND HfO2BUFFER LAYERS
Authors: AHMED NASER M. , SULAIMAN NOOR HUMAM , ABDULLAH MAHIR FARIS , NAJM ASMAA SOHEIL , AFZAL NAVEED , ALTOWYAN ABEER S. , RAFIQUE MOHSIN
Published: June 2021

Indium Tin Oxide (ITO) films were deposited on glass substrate using radiofrequency (RF) magnetron sputtering technique. To improve the physical characteristics of the ITO film, AlN and HfO2buffer layers were deposited on glass prior to the film deposition. The ITO/glass, ITO/AlN/glass and ITO/HfO2/glass films were annealed using CO2laser and electrical oven heating methods. The crystallinity of the ITO film was improved due to the incorporation of AlN and HfO2buffer layers and also by the post-deposition annealing process. The optical transmittance of the ITO was also increased due to the presence of the buffer layers. Similarly, the annealed ITO films grown on buffer layers exhibited lower values of the sheet resistance as compared to the film deposited without buffer layers. The laser annealing technique was more found to be more effective in reducing the ITO sheet resistance.
Innovation, Finance, and Economic Growth in OECD Countries: New Insights from a Panel Causality Approach
Authors: Pradhan Rudra P. , Nath Tamal , Maradana Rana P. , Sarangi Ajoy K.
Published: June 2021

In this paper, using a panel causality approach, we examine endogenous connections between financial development, innovation, and economic growth in OECD countries for the period 1961–2018. The empirical results of our study show that financial development and innovation support long-run economic growth and that the short-run dynamics facet the multifarious interconnections between financial development, innovation, and economic growth. The strategic insight drawn from this research is that to ensure sustainable economic growth, policy-makers in the OECD countries must pay attention to establishing an integrated structure that looks into co-improvement policies concerning the activities that enhance financial development, innovation, and economic growth.
r-Gatherings on a star and uncertain r-gatherings on a line
Authors: Ahmed Shareef , Nakano Shin-ichi , Rahman Md. Saidur
Published: June 2021

Let [Formula: see text] be a set of [Formula: see text] customers and [Formula: see text] be a set of [Formula: see text] facilities. An [Formula: see text]-gather clustering of [Formula: see text] is a partition of the customers in clusters such that each cluster contains at least [Formula: see text] customers. The [Formula: see text]-gather clustering problem asks to find an [Formula: see text]-gather clustering which minimizes the maximum distance between a pair of customers in a cluster. An [Formula: see text]-gathering of [Formula: see text] to [Formula: see text] is an assignment of each customer [Formula: see text] to a facility [Formula: see text] such that each facility has zero or at least [Formula: see text] customers. The [Formula: see text]-gathering problem asks to find an [Formula: see text]-gathering that minimizes the maximum distance between a customer and his/her facility. In this work, we consider the [Formula: see text]-gather clustering and [Formula: see text]-gathering problems when the customers and the facilities are lying on a “star”. We show that the [Formula: see text]-gather clustering problem and the [Formula: see text]-gathering problem with customers and facilities on a star with [Formula: see text] rays can be solved in [Formula: see text] and [Formula: see text] time, respectively. Furthermore, we prove the hardness of a variant of the [Formula: see text]-gathering problem, called the min-max-sum [Formula: see text]-gathering problem, even when the customers and the facilities are on a star. We also study the [Formula: see text]-gathering problem when the customers and the facilities are on a line, and each customer location is uncertain. We show that the [Formula: see text]-gathering problem can be solved in [Formula: see text] and [Formula: see text] time when the customers and the facilities are on a line, and the customer locations are given by piecewise uniform functions of at most [Formula: see text] pieces and “well-separated” uniform distribution functions, respectively.
A Mixed Finite Element-Based Numerical Method for Elastodynamics Considering Adhesive Interface Damage for Dynamic Fracture
Authors: Panagiotopoulos Christos G. , Tsogka Chrysoula
Published: June 2021

The numerical solution of the elastodynamic problem with kinematic boundary conditions is considered using mixed finite elements for the space discretization and a staggered leap-frog scheme for the discretization in time. The stability of the numerical scheme is shown under the usual CFL condition. Using the general form of Robin-type boundary conditions some cases of debonding and the resulting acoustic emission are studied. The methodology presented finds applications to geophysics such as in seismic waves simulation with dynamic rupture and energy release. In this paper, we focus on problems of fracture occurring at the interface of composite materials. Our goal is to study both the mechanism of crack initiation and propagation, as well as the acoustic emission of the released structure-borne energy which may be used in structural health monitoring and prognosis applications.