bluuebunny/crossref_metadata_2025 huggingface dataset:
Medium to High Strain-Rate Characterization of Lead Free Solder Alloys Through Metal Cutting Experiments
Authors: Singh Yuvraj , Udupa Anirudh , Chandrasekar Srinivasan , Subbarayan Ganesh
Published: December 2019

Studies on medium to high strain-rate characterization (≥ 0.1s−1) of lead-free solder are relatively few, primarily due to the lack of available methods for testing. Prior work in literature uses Split Hopkinson Bar (SPHB) experiments for high strain-rate characterization (≥ 300s−1) [1,2], while a modified micro-scale tester is used for medium strain-rate characterization (0.005s−1 to 300s−1) [3] and an impact hammer test setup for testing in a strain-rate regime from 1s−1 to 100s−1 [4]. However, there is still limited data in strain-rate regimes of relevance, specifically for drop shock applications. In this paper, we present orthogonal metal cutting as a novel method to characterize lead-free solder alloys. Experiments are carried out using a wedgelike tool that cuts through a work piece at a fixed depth and rake angle while maintaining a constant cutting velocity. These experiments are conducted at room temperature on Sn1.0Ag0.5Cu bulk test specimens with strain-rates varying from 0.32 to 48s−1. The range of strain-rates is only limited by the ball screw driven slide allowing higher strain-rates if needed. The strains and strain-rates are captured through Particle Image Velocimetry (PIV) using sequential images taken from a high-speed camera just ahead of the cutting tool. The PIV enables non-contact recording of high strain-rate deformations, while the dynamometer on the cutting head allows one to capture the forces exerted during the cutting process. Results for the stress-strain response obtained through the experiments are compared to prior work for validation. Orthogonal metal cutting is shown to be a potentially attractive method for characterization of solder at higher strain-rates.
Enabling Thermal Management of High-Powered Server Processors Using Passive Thermosiphon Heat Sink
Authors: Kulkarni Devdatta P. , Tunuguntla Priyanka , Tan Guixiang , Carte Casey
Published: December 2019

In recent years, rapid growth is seen in computer and server processors in terms of thermal design power (TDP) envelope. This is mainly due to increase in processor core count, increase in package thermal resistance, challenges in multi-chip integration and maintaining generational performance CAGR. At the same time, several other platform level components such as PCIe cards, graphics cards, SSDs and high power DIMMs are being added in the same chassis which increases the server level power density. To mitigate cooling challenges of high TDP processors, mainly two cooling technologies are deployed: Liquid cooling and advanced air cooling. To deploy liquid cooling technology for servers in data centers, huge initial capital investment is needed. Hence advanced air-cooling thermal solutions are being sought that can be used to cool higher TDP processors as well as high power non-CPU components using same server level airflow boundary conditions.

Current air-cooling solutions like heat pipe heat sinks, vapor chamber heat sinks are limited by the heat transfer area, heat carrying capacity and would need significantly more area to cool higher TDP than they could handle. Passive two-phase thermosiphon (gravity dependent) heat sinks may provide intermediate level cooling between traditional air-cooled heat pipe heat sinks and liquid cooling with higher reliability, lower weight and lower cost of maintenance. This paper illustrates the experimental results of a 2U thermosiphon heat sink used in Intel reference 2U, 2 node system and compare thermal performance using traditional heat sinks solutions. The objective of this study was to showcase the increased cooling capability of the CPU by at least 20% over traditional heat sinks while maintaining cooling capability of high-power non-CPU components such as Intel’s DIMMs. This paper will also describe the methodology that will be used for DIMMs serviceability without removing CPU thermal solution, which is critical requirement from data center use perspective.
Thermal Analysis of High Efficiency High Speed Drives
Authors: Khakpour Yasmin , Chen Weilun Warren , Channegowda Parikshith , Pearson Matthew R. , Lee Yongduk , Arnedo Luis
Published: December 2019

The thermal management of the PCB based power electronics is a key element to ensure safe operating conditions and to meet lifetime, reliability and safety requirements. This is challenging for applications above 1 kW because the substrate material used in a PCB such as FR-4 has very low heat conducting properties. Hence, there is a limit on how much loss can be dissipated from the board and for that reason this approach has only been adopted in the industry for very low power applications. With the proposed multilevel topology, WBG devices, and innovative thermal management strategies it is possible to expand the PCB based power electronics approach to power ratings between 1kW and 10 kW. For instance, an improvement in the thermal resistance of the PCB can be obtained by soldering a discrete WBG device with a TO-263 package directly on a PCB with about one inch square copper area around the device which will act as a heat spreader. Then, a further substantial reduction in the thermal resistance of a PCB is possible by the application of electrical vias. In principle each via is a copper sleeve through the board or through a part of the board. Where, instead of using its electrical function, a via can also be used as a thermal conductor. In this work, the thermal analysis of the PCB and the effect of number of vias as well as the effect of filling the vias with a thermally conductive material has been studied. The design has been optimized for the number of vias and the modeling results have been verified with experimental tests.
Addressing the Challenges in Laser Micro-Machining and Bonding of Silicon Microchannel Cold-Plate and 3D-Manifold for Embedded Cooling Applications: Perfect Debris Removal
Authors: Hazra Sougata , Jung Ki Wook , Iyengar Madhusudan , Malone Chris , Asheghi Mehdi , Goodson Kenneth E.
Published: December 2019

Laser machining is an inexpensive and fast alternative to conventional microfabrication techniques that produce complicated three-dimensional, hierarchical structures. One of the major issues plaguing the use of laser micromachining to manufacture commercially usable devices is the formation of debris during cutting and the difficulty in removing these debris efficiently after the machining process. For silicon substrates, this debris can interfere with surrounding components and cause problems during bonding with other substrates by preventing uniform conformal contact.

This study summarizes several post-process techniques that can be employed for complete debris removal during etching of Silicon samples using an Nd/YVO4 pulsed (∼ 1–3 kW) UV laser, detailing the advantages and drawbacks of each approach. A method that was found to be particularly promising to achieve very smooth surfaces with almost complete debris removal was the use of PDMS as a high rigidity protective coating. In the process, a novel technique to strip PDMS from Silicon surface was developed and a study was carried out to optimize the process. The result of this study is very valuable to the microfabrication industry where smooth and clean substrate surfaces are highly desirable. This work could facilitate adoption and significant improvements to the process of using UV lasers to create microstructures for commercial applications as well as in a research environment.
Stress Evaluation of Flexible Displays With Multiple-Laminations Architecture Enabled by Experimental Measurement and Simulation Based Factorial Design
Authors: Lee Chang-Chun , Huang Pei-Chen , Wang Chi-Wei , Chuang Oscar
Published: December 2019

Fatigue behavior of multiple-stacked film-type flexible displays under flexural load has received considerable research attention, whereas the requirement of a considerably thin and flexible packaging structure with single/multiple neutral axis has not been systemically explored. Consequently, this study evaluated the flexural load induced strain and corresponding resistance change in flexible display architecture by both experimental and simulation works. The relationship between mechanical strains and the relevant resistance change in a touch panel module is estimated by both nonlinear finite element analysis and actual experiments. The aforementioned results revealed that the simulated strain and the resistance change of indium tin oxide (ITO) film were increased as the bending radius becomes narrow. Moreover, the influences of several mechanical parameters within an entire organic light-emitting diode device package with multiple coatings were estimated by a simulation-based parametric study. It should be noted that the structure design would lead the single/multiple neutral axis (N.A.) occurred in the concerned flexible displays. Among all the designed structural and material properties, the Young’s modulus of the adhesive is the most dominant factor to determine the bending strain of ITO film and the phenomenon occurrence of multiple N.A. The analytic results indicated that the multiple N.A. design is contributed to decrease the flexural strain and corresponding resistance change of ITO film. Therefore, the design rules of single/multiple N.A. and its influences on stress-induced electric variation in flexible display are revealed.
Effects of Thermal Cycling on the Mechanical and Microstructural Evolution of SAC305 Lead-Free Solder
Authors: Hasan S. M. Kamrul , Fahim Abdullah , Suhling Jeffrey C. , Hamasha Sa’d , Lall Pradeep
Published: December 2019

Lead free electronic assemblies are often subjected to thermal cycling during qualification testing or during actual use. The dwell periods at the high temperature extreme during thermal cycling cause thermal aging phenomena in the solder material, including microstructural evolution and material property degradation. In addition, lead free solders can also experience aging effects during the ramp periods between the low and high temperature extremes of the cycling.

In this study, the mechanical behavior evolution occurring in SAC305 lead free solder subjected to various thermal cycling exposures has been investigated. Uniaxial test specimens were prepared by reflowing solder in rectangular cross-section glass tubes with a controlled temperature profile. After reflow solidification, the samples were placed into the environmental chamber and thermally cycled from −40 C to +125 C under a stress-free condition (no load). Several thermal cycling profiles were examined including: (1) 90 minute cycles with 15 minutes ramps and 30 minutes dwells, (2) air-to-air thermal shock exposures with 30 minutes dwells and near instantaneous ramps, (3) 30 minute cycles with 15 minutes ramps and no dwells (saw tooth profile), (4) 150 minute cycles with 45 minutes ramps and 30 minutes dwells, and (5) no cycling (simple aging at the high temperature extreme). For each profile, 10–15 samples were cycled for various durations of cycling (e.g. 48, 96, and 240 cycles), which were equivalent to various aging times at the high temperature extreme of T = 125 C.

After cycling, the stress-strain curves and mechanical properties including effective elastic modulus and Ultimate Tensile Strength (UTS) of all the cycled samples were measured. For each cycling profile, the evolutions of the mechanical properties were characterized as a function of the cycling duration, as well as the net aging time at the high temperature extreme. Comparison of the results of various thermal cycling profiles showed that the detrimental effects of aging are accelerated in a thermal cycling environment. Furthermore, microstructure evolution during thermal cycling has also been investigated to validate the observed mechanical properties degradation. The test results revealed that the mechanical properties degradation of SAC305 are higher in thermal cycling compared to simple equivalent aging. For example, the elastic modulus and UTS of SAC305 reduced by 41%, and 38%, respectively after 5 days aging whereas these properties reduced by 69%, and 51%, respectively after 5 days equivalent aging using thermal cycling profile #4 (240 cycles).
High Strain Rate Mechanical Properties of SAC-Q With Sustained Elevated Temperature Storage at 100°C
Authors: Lall Pradeep , Mehta Vishal , Suhling Jeff , Locker David
Published: December 2019

Leadfree electronics in harsh environments may often be exposed to elevated temperature for the duration of storage, process and usage in addition to high strain rate triggering loads during drop-impact, vibration and shock. These electronic components may get exposed to high strain rates of 1 to 100 per seconds and operating temperature up to 200°C in the critical surroundings. SAC solder alloys (e.g. SAC-Q (CYCLOMAX), and Innolot) are being considered for use in fine-pitch electronic components. SAC-Q consists of Sn-Ag-Cu alloy in addition to Bi (SAC+Bi). The data presented till date for lead-free solders like SAC-Q alloy at high aging temperature and at high strain rate are for 50°C sustained exposure. In this paper, effect of sustained exposure of 100°C on high strain rate properties of SAC-Q is studied. Thermally aged SAC-Q samples at 100°C have been tested at a range of strain rates including 10, 35, 50, and 75 per second and operating temperatures starting from 25°C up to 200°C. Stress-strain curves are established for the given range of strain rates and operating temperatures. Also, the computed experimental results and data have been fit to the Anand Viscoplasticity model for SAC-Q for comparison.
Flexure and Twist Test Reliability Assurance of Flexible Electronics
Authors: Lall Pradeep , Narangaparambil Jinesh , Leever Ben , Miller Scott
Published: December 2019

Additively Printed Flexible electronics in wearable application may be subjected to twisting or flexing depending on the form factor and the location of use. There is a dearth of standards for testing and reliability assurance of flexible electronics and reliability data for various use conditions. In this paper, a test protocol has been developed for twisting and flexing on aerosol-jet additively printed flexible circuits. Test patterns with commonly used traces geometries have been developed, aerosol-jet printed, and thermally sintered at various conditions. Reliability data has been acquired under both twist and flex using resistance monitoring. Failure mechanisms have been studied for both deformation modes.
Parametric and Sensitivity Analysis of Power Module Design
Authors: Boteler L. M. , Fish M. C. , Berman M. S.
Published: December 2019

As technology becomes more electrified, thermal and power engineers need to know how to improve power modules to realize their full potential. Current power module technology involves planar ceramic-based substrates with wirebond interconnects and a detached heat sink. There are a number of well-known challenges with the current configuration including heat removal, reliability due to coefficient of thermal expansion (CTE) mismatch, and parasitic inductance. Various solutions have been proposed in literature to help solve many of these issues: alternate substrates, advanced thermal interface materials, compliant die attach, thermal ground planes, high performing heat sinks, superconducting copper, wirebondless configurations, etc. While each of these technologies have their merits, this paper will perform a holistic analysis on a power module and identify the impact of improving various technologies on the device temperature. Parametric simulations were performed to assess the impact of many aspects of power module design including material selection, device layout, and heat sink choice. Materials that have been investigated include die attach, substrate, heat spreader, and thermal interface materials. In all cases, the industry standard was compared to the state of the art to quantify the advantages and/or disadvantages of adopting the new technologies. A sensitivity analysis is also performed which shows how and where the biggest benefits could be realized when redesigning power modules and determining whether to integrate novel technologies.
Computational Form Factor Study of a 3rd Generation Open Compute Server for Single-Phase Immersion Cooling
Authors: Shah Jimil M. , Bhatt Chinmay , Rachamreddy Pranavi , Dandamudi Ravya , Saini Satyam , Agonafer Dereje
Published: December 2019

Networking and computing dependency has been increasing in the modern world, thus, boosting the growth of data centers in leading business domains like banking, education, transportation, social media etc. Data center is a facility that incorporates an organization’s IT operations and equipment, as well as where it stores, processes and manages the data. To fulfill the increasing demands of data storage and data processing, a corresponding increase in server performance is needed. This causes a subsequent increment in power consumption and heat generation in the servers due to high performance processing units. Currently, air cooling is the most widely used thermal management technique in data centers, but it has started to reach its limitations in cooling high packaging densities. Therefore, industries are looking for single-phase immersion cooling using various dielectric fluids to reduce the operational and cooling costs by enhancing the thermal management of servers. This research work aims at increasing the rack density by reducing the form factor of a 3rd Generation Open Compute Server using single-phase immersion cooling. A computational study is conducted in the operational range of temperatures and the thermal efficiency is optimized. A parametric study is conducted by changing the inlet velocities and inlet temperatures of cooling liquid for different heights of the open compute 3rd generation server. A comparative study is then carried out for white mineral oil and synthetic fluid (EC100).
Perceived Barriers to Reporting Mental and Behavioral Illness in the Fire Service
Authors: Thews Kami N. , Winkelmann Zachary K. , Eberman Lindsey E. , Potts Kirsten A. , Games Kenneth E.
Published: December 2019

Firefighters are exposed to psychological stress while on duty that could lead to mental and behavioral illnesses that may go unreported. We surveyed firefighters to identify their perceived barriers encountered when attempting to report a mental and behavioral illness with a follow-up question related to how difficult the selected barrier was in the reporting process. A total of 314 firefighters completed the instrument, with most indicating they experienced cultural barriers such as social norms from administration and peers. The findings demonstrate an overall demand for a cultural change within the fire service for a supportive environment that encourages reporting.
Comparison of Trunk Muscle Activity During Modified Side-Bridge Exercises and Traditional Side Bridge Exercise
Authors: Choi Chi-Whan , Koo Jung-Wan , Jeong Yeon-Gyu
Published: December 2019

Context: The modified side-bridge exercise is designed for some special situations in which it is impossible to tolerate the compressive load on the side supported during the side bridge, such as in the older people with a hip or knee replacement and even in athletes with shoulder pain. Objectives: To examine the effects of 3 modified side-bridge exercises on the spinal stability muscles compared with traditional side-bridge (TSB) exercises for healthy men. Design: The effects of different exercises on the muscle activities of the external oblique (EO), internal oblique (IO), and quadratus lumborum (QL) during TSB exercise, both legs lift on side lying (BLLS), torso lift on a 45° bench while side lying (TLBS), and wall side bridge (WSB) were analyzed with the 1-way repeated-measures analysis of variance. Setting: This study was conducted in a university hospital laboratory. Participants: A total of 20 healthy men were recruited for this study. Interventions: The participants performed TSB, BLLS, TLBS, and WSB in a random order. Main Outcome Measures: Surface electromyography measured the muscle activity of the EO, IO, and QL. A 1-way repeated-measures analysis of variance assessed the statistical significance of the EO, IO, and QL muscle activity. When there was a significant difference, a Bonferroni adjustment was performed. Results: BLLS and TLBS showed similar effects to TSB in the EO, IO, and QL muscle activity, whereas WSB showed significantly less QL muscle activity than TSB (P < .05). Moreover, TLBS was significantly greater in the muscle activity of QL and EO than WSB (P < .05). Conclusion: BLLS and TLBS may be effective rehabilitation techniques to activate EO, IO, and QL in patients who are unable to perform TSB as spine stability exercises.
The Effects of Crude Oil and Dispersant on the Larval Sponge Holobiont
Authors: Luter Heidi M. , Whalan Steve , Andreakis Nikos , Abdul Wahab Muhammad , Botté Emmanuelle S. , Negri Andrew P. , Webster Nicole S.
Published: December 2019

Larvae of the sponge
R. odorabile
survived exposure to high concentrations of petroleum hydrocarbons; however, their ability to settle and metamorphose was adversely affected at environmentally relevant concentrations, and these effects were paralleled by marked changes in sponge gene expression and preceded by disruption of the symbiotic microbiome. Given the ecological importance of sponges, uncontrolled hydrocarbon releases from shipping accidents or production could affect sponge recruitment, which would have concomitant consequences for reef ecosystem function.
Quantifying Methane and Methanol Metabolism of “
Methylotuvimicrobium buryatense
” 5GB1C under Substrate Limitation
Authors: He Lian , Fu Yanfen , Lidstrom Mary E.
Published: December 2019

Methanotrophic metabolism has been under investigation for decades using biochemical and genetic approaches. Recently, a further step has been taken toward understanding methanotrophic metabolism in a quantitative manner by means of flux balance analysis (FBA), a mathematical approach that predicts fluxes constrained by mass balance and a few experimental measurements. However, no study has previously been undertaken to experimentally quantitate the complete methanotrophic central metabolism. The significance of this study is to fill such a gap by performing
13
C INST-MFA on a fast-growing methanotroph. Our quantitative insights into the methanotrophic carbon and energy metabolism will pave the way for future FBA studies and set the stage for rational design of methanotrophic strains for industrial applications. Further, the experimental strategies can be applied to other methane or methanol utilizers, and the results will offer a unique and quantitative perspective of diverse methylotrophic metabolism.
Extensional tectonics rooted in orogenic collapse: Long-lived disintegration of the Semail Ophiolite, Oman
Authors: Braathen Alvar , Osmundsen Per Terje
Published: December 2019

Significant post-orogenic extension of the renowned Semail Ophiolite and substrata in Oman resulted in the formation of metamorphic core complexes juxtaposed with an array of Maastrichtian-Paleogene extensional basins. During this evolution, basins became progressively localized. The geometry of the large-scale and long-lived extensional system changes laterally across the core complexes and reveals several generations of domes and detachments, some of which were progressively exhumed. Progressive excision and dismemberment of the ophiolite link to major fabrics in the core complexes and gradual focusing of extensional basins.
Importance of clinical tests in ocular myasthenia
Authors: Saluja Gunjan , Samdani Asha , Bhatia Priyavrat
Published: December 2019

A 24-year-old otherwise healthy male presented to us with unilateral ptosis and contralateral lid retraction with limitation of extraocular movements; the disease had a gradual chronic course, which raised a suspicion of ocular myasthenia. Ice pack test was performed, which improved the ptosis; further investigations confirmed the diagnosis of ocular myasthenia. Patient was started on pyridostigmine and oral prednisolone which improved the extraocular movements and ptosis.
Hodgkin’s lymphoma with HLH and complete remission with brentuximab-based therapy
Authors: Knox Blaine , Singh Daulath , Mai Hanh , Mirza Kamran
Published: December 2019

A 63-year-old man presented to the hospital with generalised weakness, fatigue and a 22 kg weight loss 4 months after being diagnosed with sarcoidosis on a mediastinal lymph node biopsy, with minimal improvement in symptoms on prednisone and methotrexate therapy. On arrival, he was found to have a haemoglobin of 57 g/L and platelet count of 82×109/L. Further work-up revealed six of eight diagnostic criteria for haemophagocytic lymphohistiocytosis (HLH): fever >38.9°C, splenomegaly, cytopaenia, hypertriglyceridaemia, haemophagocytosis and elevated ferritin >31 000 ng/mL. He was also found to have Epstein-Barr viraemia with greater than 17 000 copies. Bone marrow biopsy showed the presence of haemophagocytic histiocytes and evidence of classic Hodgkin’s lymphoma. He was started on HLH-94 protocol. Later treatment was switched to lymphoma-directed therapy and he finished six cycles of A+AVD (brentuximab vedotin, doxorubicin, vinblastine and dacarbazine) with end-of-treatment positron emission tomography/CT and bone marrow negative for lymphoma.
Mycobacterium mucogenicumskin and soft tissue infection of the breast mimicking idiopathic granulomatous mastitis
Authors: Krueger Karen , Guggina Lauren M
Published: December 2019

We present a case of a 28-year-old woman who came to medical attention after noticing a breast mass associated with an overlying eroded plaque of the skin. A core biopsy of the breast mass was negative for malignancy but demonstrated granulomatous inflammatory changes. Acid-fast bacilli and Gomori methenamine-silver stains were negative for microorganisms. The patient was diagnosed with presumptive idiopathic granulomatous mastitis and started on oral steroids. Her symptoms progressed. Tissue culture from a repeat biopsy grewMycobacterium mucogenicum. The patient responded well to combination oral antimicrobial therapy.
Case of atypical cutaneousMycobacteriumchelonaeinfection in patient of systemic lupus erythematosus after cyclophosphamide therapy
Authors: Rasool Sheraz , Afifi Amr , De Lord Denise
Published: December 2019

Mycobacteriumchelonaeis one of the rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infections have been reported associated with tattoo parlours, pedicures and cosmetic procedures. But disseminated infection is usually associated with individuals who are immunocompromised, predominantly affecting limbs but sparing abdomen and back. We herein present a case where patient was on immunosuppressive therapy and developed locally severe infection around right ankle. A 69-year-old woman known to rheumatology presents in outpatients with severe pain in right ankle, unable to bear weight, oedematous right foot and lower leg. There was extensive erythematous cellulitic skin rash around right ankle and lower leg. She had background history of systemic lupus erythematosus with previous history of cardiac myositis and left foot drop. She had six cycles of cyclophosphamide for flare of lupus and after last cycle developed this presentation. Skin biopsy was arranged with dermatologist, cultures from which grewM.chelonae. She was admitted and started on triple regimen forM.chelonaeas per Microbiology guidelines with intention to complete 6–12 months treatment. Patient responded very well to treatment but unfortunately, she died after 5 months on treatment due to other comorbidities and likely cause of death was cardiac arrhythmia.
Recurrent leiomyoma of the vulva mimicking peripheral nerve sheath tumour
Authors: Kothandaraman Keerthana , Dorairajan Gowri , Subbaiah Murali , Dorairajan LN , Badhe Bhawana A , Keepanasseril Anish
Published: December 2019

Leiomyoma, a benign monoclonal tumour, is very rarely found in extrauterine sites, especially in the vulval region. Histopathology of the soft tissue tumours affecting this region is similar and immunohistochemistry (IHC) may be essential to confirm the diagnosis. We report a case of a 63-year-old postmenopausal woman who presented with a recurrent vulval mass involving the clitoris and left labia majora with suspected urethral involvement. Although the wedge biopsy was reported as peripheral nerve sheath tumour, staining with smooth muscle actin clinched the diagnosis of leiomyoma, highlighting the importance of IHC for diagnosis.
Visceral leishmaniasis presenting as haemophagocytic lymphohistiocytosis
Authors: Vanhinsbergh Lewis , Mason Aaron , Godfrey Andrew
Published: December 2019

A 53-year-old man presented with a number of hospital admissions for investigation of fever of unknown origin. He became gradually weaker with significant weight loss, pancytopenia and progressive splenomegaly over a 6-month period of extensive investigation. This was undertaken at different NHS hospitals with involvement of multiple medical specialists. Clinical criteria for haemophagocytic lymphohistiocytosis were met. Following investigation, this was felt likely secondary to a low-grade lymphoma of the spleen, necessitating splenectomy for diagnostic and therapeutic purposes. Ultimately, this risky surgical procedure was avoided when positiveLeishmaniaserology led to successful treatment with amphotericin B.
Idiopathic hypereosinophilic syndrome presenting as monoplegia
Authors: Kushwah Saraswati , Gulia Manisha , Gupta Monica , Tahlan Anita
Published: December 2019

Idiopathic hypereosinophilic syndrome (IHES) is a rare disorder. It is characterised by persistent eosinophilia with eosinophil mediated tissue infiltration and organ dysfunction. Clinical features of IHES vary widely, as it may present with dermatological, pulmonary, gastrointestinal, cardiac or neurological symptoms. We hereby report a female patient who presented with sudden onset upper limb monoplegia and after thorough investigations she was diagnosed as a case of IHES. She was managed with corticosteroids and improved with same.
Neuro-Sweet disease in a Japanese woman with Sjögren’s syndrome
Authors: Kodama Tatsuya , Yamazaki Yuki , Takeo Hiroaki
Published: December 2019

Sweet disease (SD) is a multisystem inflammatory disorder characterised by fever, cutaneous erythematous plaques and aseptic neutrophilic infiltration of various organs. Neuro-Sweet disease (NSD) is a known rare central nervous system complication of SD. We describe a case of a 39-year-old Japanese woman who was diagnosed as NSD associated with Sjögren’s syndrome. She was successfully treated with systemic corticosteroid therapy.
Does general anesthesia affect neurodevelopment in infants and children?
Authors: McCann Mary Ellen , Soriano Sulpicio G
Published: December 2019

General anesthesia has been unequivocally linked to abnormal development of the central nervous system, leading to neurocognitive impairments in laboratory models. In vitro and in vivo studies have consistently shown that exposure to GABA agonists (eg, volatile anesthetics, midazolam, and propofol) or NMDA antagonists (eg, ketamine, isoflurane, and nitrous oxide) produces dose dependent and developmental age dependent effects on various neuronal transmission systems. Exposure to these drugs increases neuronal cell death in juvenile animals including rats, mice, and non-human primates. The possibility of anesthetic induced neurotoxicity occurring in children has led to concerns about the safety of pediatric anesthesia. A spectrum of behavioral changes has been documented after general anesthetic exposure in young children, including emergence delirium, which may be evidence of toxicity. Most clinical studies are retrospective; specifics about medications or monitoring are unavailable and many of the outcomes may not be sensitive to detect small neurocognitive deficits. Some of these retrospective studies have shown an association between anesthesia exposure at a young age and neurocognitive deficits, but others have not. Practitioners and families should be reassured that although general anesthetics have the potential to induce neurotoxicity, very little clinical evidence exists to support this.
Improved well-being and decreased disease burden after 1-year use of flash glucose monitoring (FLARE-NL4)
Authors: Fokkert Marion , van Dijk Peter , Edens Mireille , Barents Eglantine , Mollema Jeanine , Slingerland Robbert , Gans Reinold , Bilo Henk
Published: December 2019

Introduction

The FreeStyle Libre is a flash glucose monitoring (FSL-FGM) system. Compared with finger-prick based self-monitoring of blood glucose, FSL-FGM may provide benefits in terms of improved glycemic control and decreased disease burden.

Methods

Prospective nationwide registry. Participants with diabetes mellitus (DM) used the FSL-FGM system for a period of 12 months. End points included changes in HbA1c, hypoglycemia, health-related quality of life (12-Item Short Form Health Surveyv2(SF-12v2) and 3-level version of EuroQol 5D (EQ-5D-3L)), a specifically developed patient-reported outcome measures (PROMs) questionnaire, diabetes-related hospital admission rate and work absenteeism. Measurements were performed at baseline, and after 6 months and 12 months.

Results

1365 persons (55% male) were included. Mean age was 46 (16) years, 77% of participants had type 1 DM, 16% type 2 DM and 7% other forms. HbA1c decreased from 64 (95%CI 63 to 65) mmol/mol to 60 (95%CI 60 to 61) mmol/mol with a difference of −4 (95% CI −6 to 3) mmol/mol. Persons with a baseline HbA1c >70 mmol/mol had the most profound HbA1c decrease: −9 (95% CI −12 to to 5) mmol/mol. EQ-5D tariff (0.03 (95%CI 0.01 to 0.05)), EQ-VAS (4.4 (95%CI 2.1 to 6.7)) and SF-12v2mental component score (3.3 (95%CI 2.1 to 4.4)) improved. For most, PROMs improved. Work absenteeism rate (/6 months) and diabetes-related hospital admission rate (/year) decreased significantly, from 18.5% to 7.7% and 13.7% to 2.3%, respectively.

Conclusions

Real world data demonstrate that use of FSL-FGM results in improved well-being and decreased disease burden, as well as improvement of glycemic control.
Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings
Authors: Zhao Feng , Doroshenko Olena , Lekhan Valery N , Kriachkova Lilia V , Goroshko Alona
Published: December 2019

Objectives

This article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine.

Data and methods

The original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts.

Result

We observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity and area under ROC-curve (AUC)=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity and AUC=0.900 (р=0.001) for the duration of hospitalisations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.

We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals’ general medicine departments (64.6%; 95% СІ 63.0 to 66.3)compared with other departments included in the analysis.

Conclusion

The proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimising the excessive hospital capacities in Ukraine.
Healthcare providers’ perception of the referral system in maternal care facilities in Aceh, Indonesia: a cross-sectional study
Authors: Diba Farah , Ichsan Ichsan , Muhsin Muhsin , Marthoenis Marthoenis , Sofyan Hizir , Andalas Mohammad , Monfared Ida , Richert Katharina , Kaplan Lennart , Rogge Lisa , Doria Siobhan , Samadi Samadi , Vollmer Sebastian
Published: December 2019

Objectives

Our study investigates the barriers perceived by staff in the referral systems in maternal healthcare facilities across Aceh province in Indonesia.

Design

With a cross-sectional approach, two sets of surveys were administered during September to October 2016 in 32 sampling units of our study. We also collected referral data in the form of the frequency of ingoing and outgoing referral cases per facility.

Setting

In three districts, Aceh Besar, Banda Aceh and Bireuen, a total of 32 facilities including hospitals, community health centres, and private midwife clinics that met the criteria of providing at least basic emergency obstetric and neonatal care (BEonC) were covered.

Participants

Across the 32 healthcare centres, 149 members of staff (mainly midwives) agreed to participate in our surveys.

Primary and secondary outcome measures

The first survey consisted of 65 items focusing on organisational measures as well as case numbers for example, patient counts, mortality rate and complications. The second survey with 68 items asked healthcare providers about a range of factors including attitudes towards the referral process in their facility and potential barriers to a well-functioning system in their district.

Results

Overall, mothers’/families’ consent as well as the complex administration process were found to be the main barriers (36% and 12%, respectively). Healthcare providers noted that information about other facilities has the biggest room for improvement (37%) rather than transport, timely referral of mothers and babies, or the availability of referral facilities.

Conclusions

The largest barrier perceived by healthcare providers in our study was noted to be family consent and administrative burden. Moreover, lack of information about the referral system itself and other facilities seemed to be affecting healthcare providers and mothers/families alike and improvements perhaps through a shared information system is needed.
Internal consistency and reliability of the Swiss-French translation of the venous leg ulcer self efficacy tool (VeLUSET)
Authors: Probst Sebastian , Turcotte Mathieu , Buehrer Skinner Monika
Published: December 2019

Objective

This study was conducted to assess the psychometric properties of the translated and adapted Venous Leg Ulcer Self Efficacy Tool (VeLUSET) in the new cultural context.

Design

Validation study

Setting

Three outpatient clinics in Western Switzerland.

Participants

32 consecutive persons with venous leg ulcers (VLU).

Main outcome measures

To determine the internal consistency and reliability of the VeLUSET for use in a Swiss-French speaking venous leg ulcer population.

Results

Overall, the Cronbach alpha for the VeLUSET-FR was 0.96 (95% CI 0.93 to 0.98) on test and retest. Lin’s concordance correlation coefficient of test and retest scores was 0.93 (95% CI 0.86 to 0.96).

Conclusion

The results indicate that the VeLUSET-FR is a valid and reliable instrument for measuring self-efficacy among Swiss-French persons affected by a venous leg ulcer. Our findings show that the psychometric properties are similar to those of the original tool. Therefore, we suggest that the VeLUSET-FR can be effectively used for measuring self-efficacy in Swiss-French persons with VLU.
Diagnostic accuracy of E-cadherin for malignanteffusions: a systematic review and meta-analysis
Authors: Chen Fangying , Dai Luqi , An Jing , Zeng Ni , Chen Lei , Shen Yongchun
Published: December 2019

Background

The differential diagnosis of malignant effusion remains a clinical challenge. We aim to summarise all relevant literature studies in order to determine the overall clinical value of E-cadherin in the diagnosis of malignant effusion by meta-analysis.

Methods

PubMed, the Cochrane Library Database, Medline (Ovid), Web of Science, CNKI, WANFANG and WEIPU databases are thoroughly searched up to 15 March2018. The calculated pooled sensitivity, specificity, likelihood ratio (LR), diagnostic OR(DOR) and the summary receiver operating characteristic (SROC) curve were plotted.

Results

A total of 15 studies were included in the analysis. The sensitivity and specificity of E-cadherin in the diagnosis of malignant effusion were determined to be high, with a sensitivity of 0.83(95%CI0.79 to 0.87) and a specificity of 0.96(95%CI0.90 to 0.98). The positive LR was determined to be 21.10(95%CI 8.54 to 52.11), the negative LR was determined to be 0.17(95% CI 0.14 to 0.22) and the DOR was determined to be 121.34(95%CI 49.11 to 299.80). The SROC curve exhibited a high overall diagnostic, with the area under the curve measured to be 0.91(95% CI 0.89 to 0.93). Subgroup analysis showed the method (cell blocks or smears), sample size (≥100 or<100), geographical location (Asia, Europe or USA) and impact factor of each article (≥3 or<3) were not the sources of overall heterogeneity.

Conclusion

E-cadherin exhibits very good diagnostic accuracy for the diagnosis for malignant effusion; thus, it can be helpful in the process of clinical decisions.
Sebaceous naevus in a dama gazelle (Nanger dama mhorr)
Authors: Ravera Iván , Ramis Antonio , Carbonell María Dolores , Serra Claudio Iván
Published: December 2019

Since 2006 the Dama gazelle has been considered a critically endangered species by the IUCN. At present, the captive population is distributed in several zoos around the world. Bioparc (Valencia, Spain) has a captive population of 9 individuals. A two‐month‐old male dama gazelle (Nanger dama mhorr) living at the Bioparc facilities, developed an annular verrucous hyperpigmented fairly alopecic cutaneous plaque on the left lateral aspect of the thorax. Haematoxylin and eosin study revealed an exophytic papillary epidermal hyperplasia with mild orthokeratotic hyperkeratosis. In the subjacent dermis, a glandular well‐differentiated epithelial tissue proliferation was observed. At the periphery, significant immature reserve cells were identified, and in some central areas of the proliferating glands, an amorphous eosinophilic material corresponding to cystic degeneration was observed. Resection margins were clear, and no signs of malignancy were observed. Diagnosis was consistent with sebaceous naevus. After a 12‐month follow‐up period, no relapse was noticed.
Hepatocutaneous syndrome in a Maltese, diagnosis, treatment and the value of CT in the diagnosis
Authors: Almendros Angel , Sandy Jeanine Rhoda , Kirberger Robert M
Published: December 2019

A 10‐year‐old Maltese neutered female was presented for lip dermatitis and mild generalised pruritus. On examination, there were multiple lesions affecting the peri‐oral and peri‐nasal mucocutaneous junctions as well as distal limbs. Serum chemistry and a bile acids test were indicative of hepatocellular injury and hepatic dysfunction. Plasma amino acids were markedly depleted. Ultrasonography of the liver revealed a honeycombed appearance. A CT scan was performed to rule out a porto‐vascular abnormality, hepatic or pancreatic neoplasia. Abnormalities in hepatic architecture are described in this confirmed case of hepatocutaneous syndrome (HCS) for the first time on CT. This is the first reported case of HCS in Hong Kong. The dog was treated with a high‐quality protein diet and amino acids transfusions. Eleven months after presentation the dog was still alive with good control of clinical signs.
Active vitamin D activates chondrocyte autophagy to reduce osteoarthritis via mediating the AMPK–mTOR signaling pathway
Authors: Kong Chunyu , Wang Changlei , Shi Yuquan , Yan Lei , Xu Junhua , Qi Wufang
Published: December 2019

Osteoarthritis (OA) is a common joint degenerative disease. Vitamin D (VD) is essential for bone health. We hypothesized that active VD could be used as a therapeutic treatment for OA. Low serum levels of 25-hydroxyvitamin D [25(OH)D] have been found in patients with OA, and thus the serum level of VD could be diagnostic of OA. To test this, we established a mouse model of OA. The results from staining with hematoxylin–eosin and Safranin O – Fast Green indicated that active VD reduced the symptoms of OA in mice. The results from Western blotting indicated that treatment with VD increased the activity of the p-AMPK–AMPK signaling pathway and decreased the p-mTOR–mTOR pathway; it also increased the ratio of LC3II:LC3I antibodies and the protein expression levels of Beclin-1, but decreased the level of p62. Further, treatment with VD reduced the levels of tumor necrosis factor-α and interleukin-6 both in cartilage tissues and in chondrocytes. Administration of the AMPK inhibitor compound C and autophagy inhibitor 3-methyladenine (3-MA) reversed these changes following VD treatment. In addition, the results from transfection with mRFP-GFP-LC3 indicated that active VD led to autophagosome aggregation in OA chondrocytes. 3-MA inhibited cell autophagy and promoted inflammation in OA. This study provides evidence that active VD activate chondrocyte autophagy to reduce OA inflammation via activating the AMPK–mTOR signaling pathway. Treatment with active VD could be a novel therapeutic option for OA.
Reduction of multiple scattering of high-energy positively charged particles during channeling in single crystals
Authors: Scandale W. , Esposito L. S. , Garattini M. , Rossi R. , Zhovkovska V. , Natochii A. , Addesa F. , Iacoangeli F. , Galluccio F. , Murtas F. , Afonin A. G. , Chesnokov Yu. A. , Durum A. A. , Maisheev V. A. , Sandomirskiy Yu. E. , Yanovich A. A. , Smirnov G. I. , Gavrikov Yu. A. , Ivanov Yu. M. , Koznov M. A. , Malkov M. V. , Malyarenko L. G. , Mamunct I. G. , Borg J. , James T. , Hall G. , Pesaresi M.
Published: December 2019

We present the experimental observation of the reduction of multiple scattering of high-energy positively charged particles during channeling in single crystals. According to our measurements the rms angle of multiple scattering in the plane orthogonal to the plane of the channeling is less than half that for non-channeled particles moving in the same crystal. In the experiment we use focusing bent single crystals. Such crystals have a variable thickness in the direction of beam propagation. This allows us to measure rms angles of scattering as a function of thickness for channeled and non-channeled particles. The behaviour with thickness of non-channeled particles is in agreement with expectations whereas the behaviour of channeled particles has unexpected features.
Contributions from $${\Phi }_{B2}$$ to the B $${\rightarrow }$$ PP decays within the QCD factorization
Authors: Chang Qin , Chen Lili , Zhang Yunyun , Sun Junfeng , Yang Yueling
Published: December 2019

With the potential for the improvements of measurement precision, the refinement of theoretical calculation on hadronic B weak decays is necessary. In this paper, we study the contributions of B mesonic distribution amplitude $${\Phi }_{B2}$$ΦB2 within the QCD factorization approach, and find that $${\Phi }_{B2}$$ΦB2 contributes to only the nonfactorizable annihilation amplitudes for the B$${\rightarrow }$$→PP decays (P denotes the ground SU(3) pseudoscalar mesons). Although small, the $${\Phi }_{B2}$$ΦB2 contributions might be helpful for improving the performance of the QCD factorization approach, especially for the pure annihilation $$B_{d}$$Bd$${\rightarrow }$$→$$K^{+}K^{-}$$K+K- and $$B_{s}$$Bs$${\rightarrow }$$→$${\pi }^{+}{\pi }^{-}$$π+π- decays.