bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Differences in the Perception of Safety in Public Transport
Authors: Ouali Laila Ait Bihi , Graham Daniel J. , Barron Alexander , Trompet Mark
Published: March 2020

Concerns over women's safety on public transport systems are commonly reported in the media. We develop statistical models to test for gender differences in the perception of safety and satisfaction on urban metros and buses by using large-scale unique customer satisfaction data for 28 world cities over the period 2009–2018. Results indicate a significant gender gap in the perception of safety, with women being 10% more likely than men to feel unsafe in metros (6% for buses). This gender gap is larger for safety than for overall satisfaction (3% in metros and 2.5% in buses), which is consistent with safety being one dimension of overall satisfaction. Results are stable across specifications and robust to inclusion of city level and time controls. We find heterogeneous responses by sociodemographic characteristics. Data indicate that 45% of women feel secure in trains and metro stations (and 55% in buses). Thus the gender gap encompasses more differences in transport perception between men and women rather than an intrinsic network fear. Additional models test for the influence of metro characteristics on perceived safety levels and find that more acts of violence, larger carriages and emptier vehicles decrease women's feeling of safety.
A novel HLA‐B*08 allele, HLA‐B*08:253, was identified by next generation sequencing in two Russian individuals
Authors: Loginova Maria , Paramonov Igor , Verevkina Luybov , Zarubin Maksim
Published: March 2020

The new HLA‐B*08:253 allele characterized in Russian individuals.
Toward Comprehensive Industrial Computed Tomography Image Quality Assessment: I. Phantom Design
Authors: Li Xin , Dentinger Aaron , Brault Michelle , Ross William R. , Osterlitz Mark , Fu Lin , Wu Mingye , Price J. Scott , De Man Bruno , Bueno Clifford , Fitzgerald Paul
Published: March 2020

When comparing the performance of different industrial X-ray computed tomography (CT) systems, reconstruction algorithms, or scan protocols, it is important to assess how well the required inspection and measurement tasks can be performed. Furthermore, it can be very informative to quantify image quality (IQ) metrics that can provide insight into the IQ characteristics that lead to the resulting inspection or measurement task performance. Inspection and measurement task performance is determined by basic characteristics such as spatial resolution; feature contrast, size, and shape; random noise (noise due to statistical uncertainty in measurements); and image artifacts. In this report, we describe a modular phantom set that enables robustly quantifying these characteristics and also enables assessing the performance of the inspection or measurement tasks themselves. The phantom set includes two phantom bodies and several insert types that can be optionally installed in the bodies. Phantom body extensions can be optionally included to increase scatter. The phantom bodies combined with the available insert types can comprehensively evaluate all important IQ metrics and inspection or measurement tasks. The precisely-known phantom body geometry and insert location, geometry, and orientation supports automatic analysis of large, complex experiments of multiple variables. This phantom set, with the associated image analysis software, could potentially serve as a general evaluation method for non-destructive testing (NDT) CT.
A Model-Based Study of Transmit-Receive Longitudinal Arrays for Inspection of Subsurface Defects
Authors: Mohseni Ehsan , Macleod Charles , Javadi Yashar , Vithanage Randika K. W. , Qiu Zhen , Lines David , Foster Euan , Lukacs Peter , Vasilev Momchil , Zimermann Rastislav , Pierce S. Gareth , Gachagan Anthony
Published: March 2020

Dual matrix transmit-receive longitudinal (TRL) arrays have been shown to provide an improved signal to noise ratio in the near field zone which makes them the most suitable array configuration for the inspection of near-surface defects. This study aims to compare the performance of different configurations for transmit-receive longitudinal matrix arrays. For this purpose, four matrix configurations of 2 × 32, 4 × 16, 4 × 32, and 8 × 16 elements are investigated using EXTENDE CIVA modeling package. The array operating frequencies investigated are either 5 MHz or 10 MHz. The effect of different natural focal depths, arrays separation distances, dynamic electronic depth focusing, and electronic beam skewing for these TRL arrays are considered in models prepared in CIVA. The inspection of a series of flat bottom holes extended up to a few millimeters under the surface using the selected TRL configurations is also investigated in the study. It is found that the performance of focusing for near-surface areas is more efficient using the 4 × 16 and 8 × 16 elements configurations as compared with the others, and the signal amplitudes of the defects located deeper in the target material are almost independent of the configuration.
Ultrasonic Flaw Recognition by Multi-Angle Phased Array Data Integration
Authors: Zhang Wei , Wang Xinyan , Guan Xuefei
Published: March 2020

This study presents a method of ultrasonic flaw identification using phased array ultrasonic inspection data. Raw data from each individual channel of the phased array ultrasonic inspection are obtained. The data trimming and de-noising are employed to retain the data within the boundary of the inspected object and remove the speckle noise components from the raw data, respectively. The resulting data are passed into a sequence of signal processing operations to identify embedded flaws. A shape-based filtering method is proposed to reduce the intensity of geometric noise components due to the non-uniform microstructures introduced in the manufacturing process. The resulting data matrices are integrated to obtain the intensity matrix of the possible flaw regions. Thresholding is applied to the intensity matrix to obtain the potential flaw regions, followed by a connected component analysis to identify the flaws. The overall method is demonstrated and validated using realistic phased array experimental data.
Enhanced Ultrasonic Imaging and Non-Destructive Evaluation Using Angle-of-Arrival Estimation in Dimension-Reduced Beam Space
Authors: Li Minghui
Published: March 2020

Robust defect detection in the presence of grain noise originating from material microstructures is a challenging yet essential problem in ultrasonic non-destructive evaluation (NDE). In this paper, a novel method is proposed to suppress the gain noise and enhance the defect detection and imaging. The defect echo and grain noise are distinguished through analyzing the spatial location where the echo is originating from. This is achieved by estimation of the angle of arrival (AOA) of the returned echo and evaluation of the likelihood that the echo is reflected from the point where the array is focused or otherwise from the random reflectors like the grain boundaries. The method explicitly addresses the statistical models of the defect echoes and the spatial noise across the array aperture, as well as the correlation between the flaw signal and the interfering echoes; estimates the AOA and the likelihood in a dimension-reduced beam space via a linear transformation; and determines a weighting factor based on the mean likelihood. The factors are then normalized and utilized to correct and weigh the NDE images. Experiments on industrial samples of austenitic stainless steel and INCONEL Alloy 617 are conducted with a 5 MHz transducer array, and the results demonstrate that the grain noise is reduced by about 20 dB while the defect reflection is well retained, thus the great benefits of the method on enhanced defect detection and imaging in ultrasonic NDE are validated.
Geometric Deep Learning for Shape Correspondence in Mass Customization by Three-Dimensional Printing
Authors: Huang Jida , Sun Hongyue , Kwok Tsz-Ho , Zhou Chi , Xu Wenyao
Published: March 2020

Many industries, such as human-centric product manufacturing, are calling for mass customization with personalized products. One key enabler of mass customization is 3D printing, which makes flexible design and manufacturing possible. However, the personalized designs bring challenges for the shape matching and analysis, owing to the high complexity and shape variations. Traditional shape matching methods are limited to spatial alignment and finding a transformation matrix for two shapes, which cannot determine a vertex-to-vertex or feature-to-feature correlation between the two shapes. Hence, such a method cannot measure the deformation of the shape and interested features directly. To measure the deformations widely seen in the mass customization paradigm and address the issues of alignment methods in shape matching, we identify the geometry matching of deformed shapes as a correspondence problem. The problem is challenging due to the huge solution space and nonlinear complexity, which is difficult for conventional optimization methods to solve. According to the observation that the well-established massive databases provide the correspondence results of the treated teeth models, a learning-based method is proposed for the shape correspondence problem. Specifically, a state-of-the-art geometric deep learning method is used to learn the correspondence of a set of collected deformed shapes. Through learning the deformations of the models, the underlying variations of the shapes are extracted and used for finding the vertex-to-vertex mapping among these shapes. We demonstrate the application of the proposed approach in the orthodontics industry, and the experimental results show that the proposed method can predict correspondence fast and accurate, also robust to extreme cases. Furthermore, the proposed method is favorably suitable for deformed shape analysis in mass customization enabled by 3D printing.
Atomic layer deposition of amorphous antimony sulfide (a-Sb2S3) as semiconductor sensitizer in extremely thin absorber solar cell
Authors: Mahuli Neha , Halder Debabrata , Paul Ankan , Sarkar Shaibal K.
Published: March 2020

Atomic layer deposition of amorphous antimony sulfide (a-Sb2S3) is demonstrated with an alternating exposure of tris(dimethylamino)antimony (TDMASb) and hydrogen sulfide (H2S) at 150 °C in a custom-built viscous flow reactor. Growth mechanism and deposition chemistry are investigated by in situ quartz crystal microbalance and in situ Fourier Transform Infrared spectroscopy. Reaction hypothesis facilitating the binary reaction is established by quantum mechanical density functional theory calculations that essentially support the experimental findings. The developed material is used as a photon harvester in solar cells under extremely thin absorber configuration, with TiO2 and Spiro-OMeTAD as electron and hole transporting layers, respectively. Investigation of charge injection properties with surface photovoltage spectroscopy reveals low but non-negligible density of interfacial (sensitizer/TiO2) electronic defects. The conventional viscous flow reactor configuration is modified to showerhead-type reactor configuration to achieve better uniformity and conformality of a-Sb2S3 on highly porous TiO2 scaffolds. a-Sb2S3 device performance is optimized to achieve the highest power conversion efficiencies of 0.5% while annealed crystalline c-Sb2S3 device reaches power conversion efficiencies of 1.9% under 1 sun illumination.
Cell reprogramming using extracellular vesicles from differentiating stem cells into white/beige adipocytes
Authors: Jung Youn Jae , Kim Hark Kyun , Cho Yoonsuk , Choi Ji Suk , Woo Chang Hee , Lee Kyoung Soo , Sul Jae Hoon , Lee Chan Mi , Han Jihoon , Park Jae Hyung , Jo Dong-Gyu , Cho Yong Woo
Published: March 2020

Extracellular vesicles derived during differentiation of stem cells have the potential to induce tissue-specific differentiation.
COVID-19 needs a big science approach
Authors: Berkley Seth
Published: March 2020

There is an unprecedented race to develop a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With at least 44 vaccines in early-stage development, what outcome can we expect? Will the first vaccine to cross the finish line be the safest and most effective? Or will it be the most well-funded vaccines that first become available, or perhaps those using vaccine technologies with the fewest regulatory hurdles? The answer could be a vaccine that ticks all these boxes. If we want to maximize the chances for success, however, and have enough doses to end the coronavirus disease 2019 (COVID-19) pandemic, current piecemeal efforts won't be enough. If ever there was a case for a coordinated global vaccine development effort using a “big science” approach, it is now.
Combating COVID-19—The role of robotics in managing public health and infectious diseases
Authors: Yang Guang-Zhong , J. Nelson Bradley , Murphy Robin R. , Choset Howie , Christensen Henrik , H. Collins Steven , Dario Paolo , Goldberg Ken , Ikuta Koji , Jacobstein Neil , Kragic Danica , Taylor Russell H. , McNutt Marcia
Published: March 2020

COVID-19 may drive sustained research in robotics to address risks of infectious diseases.
Beyond synuclein: Organelle accumulation in Lewy bodies may drive neurodegeneration
Authors: Davis Albert A.
Published: March 2020

Organelle sequestration in Lewy bodies correlates more closely with neurodegeneration than α-synuclein aggregation alone.
Sequencing and Characterization of Five Extensively Drug-Resistant Salmonella enterica Serotype Typhi Isolates Implicated in Human Infections from Punjab, Pakistan
Authors: Tagg Kaitlin A. , Amir Afreenish , Ikram Aamer , Chen Jessica C. , Kim Justin Y. , Meservey Elizabeth , Joung Yoo J. , Halpin Jessica L. , Batra Dhwani , Leeper Molly M. , Katz Lee S. , Saeed Asim , Freeman Molly , Watkins Louise Francois , Salman Muhammad , Folster Jason P.
Published: March 2020

A large outbreak of extensively drug-resistant (XDR)
Salmonella enterica
serotype Typhi infections is ongoing in Pakistan, predominantly in Sindh Province. Here, we report the sequencing and characterization of five XDR
Salmonella
Typhi isolates from the Punjab province of Pakistan that are closely related to the outbreak strain and carry the same IncY plasmid.
Proterozoic and Paleozoic evolution of the Blue Ridge geologic province in northern Virginia, USA
Authors: Burton William C. , Schindler J. Stephen
Published: March 2020

This field guide presents a one-day trip across the northern Virginia Blue Ridge geologic province and highlights published geologic mapping of Mesoproterozoic rocks that constitute the core of the Blue Ridge anticlinorium and Neoproterozoic cover-sequence rocks on the fold limbs. The guide presents zircon SHRIMP (sensitive high-resolution ion microprobe) U-Pb crystallization ages of granitoid rocks and discusses the tectonic and petrologic evolution of basement rocks during the Mesoproterozoic. U-Pb data show more of a continuum for Blue Ridge Mesoproterozoic magmatic events, from ca. 1.18–1.05 Ga, than previous U-Pb TIMS (thermal ionization mass spectrometry)-based models that had three distinct episodes of plutonic intrusion. All of the younger dated rocks are found west of the N-S–elongate batholith of the Neoproterozoic Robertson River Igneous Suite, suggesting that the batholith occupies a fundamental Mesoproterozoic crustal boundary that was likely a fault. Narrow belts of paragneiss may represent remnants of pre-intrusive country rock, but some were deposited close to 1 Ga according to detrital zircon U-Pb ages.

For late Neoproterozoic geology, the guide focuses on lithologies and structures associated with early rifting of the Rodinia supercontinent, including small rift basins preserved on the eastern limb of the anticlinorium. These basins have locally thickened packages of clastic metasedimentary rocks that strike into and truncate abruptly against Mesoproterozoic basement along apparent steep normal faults. Both basement and cover were intruded by NE-SE–striking and steeply dipping, few-m-wide diabase dikes that were feeders to late Neoproterozoic Catoctin Formation metabasalt that overlies the rift sediments. The relatively weak dikes facilitated the deformation that led to the formation of the Blue Ridge anticlinorium during the middle to late Paleozoic as the vertical dikes were transposed and rotated during formation of the penetrative cleavage.
Age and tectonic significance of diamictites at the Devonian–Mississippian transition in the central Appalachian Basin
Authors: Ettensohn Frank R. , Seckinger D. Clay , Eble Cortland F. , Clayton Geoff , Li Jun , Martins Gustavo A. , Hodelka Bailee N. , Lo Edward L. , Harris Felicia R. , Taghizadeh Noushin
Published: March 2020

This trip explores three different occurrences of a diamictite-bearing unit in the transition between Upper Devonian redbeds of the Hampshire Formation (alluvial and fluvial deposits) and Mississippian sandstones and mudstones of the Price/Pocono Formations (deltaic deposits). Palynology indicates that all the diamictites examined are in the LE and LN miospore biozones, and are therefore of Late Devonian, but not latest Devonian, age. Their occurrence in these biozones indicates correlation with the Cleveland Member of the Ohio Shale, Oswayo Member of the Price Formation, and Finzel tongue of the Rockwell Formation in the central Appalachian Basin and with a large dropstone (the Robinson boulder) in the Cleveland Member of the Ohio Shale in northeastern Kentucky. Although several lines of evidence already support a glaciogenic origin for the diamictites, the coeval occurrence of the dropstone in open-marine strata provides even more convincing evidence of a glacial origin. The diamictites are all coeval and occur as parts of a shallow-marine incursion that ended Hampshire/Catskill alluvial-plain accumulation in most areas; however, at least locally, alluvial redbed accumulation continued after diamictite deposition ended. The diamictites are parts of nearshore, marginal-marine strata that accumulated during the Cleveland-Oswayo-Finzel transgression, which is related to global eustasy and to foreland deformational loading during the late Acadian orogeny. Detrital zircon data from clasts in a diamictite at Stop 3 (Bismarck, West Virginia) indicate likely Inner Piedmont, Ordovician plutonic sources and suggest major Acadian uplift of Inner Piedmont sources during convergence of the exotic Carolina terrane with the New York and Virginia promontories. Hence, the Acadian orogeny not only generated high mountain source areas capable of supporting glaciation in a subtropical setting, but also through deformational foreland loading, abetted regional subsidence and the incursion of shallow seas that allowed mountain glaciers access to the open sea.
Adenocarcinoma of an ileal conduit developing 8 years after cystoprostatectomy for locally advanced prostate carcinoma
Authors: Boettge Katherina Renate , Paasch Christoph , Schrader Mark , Strik Martin
Published: March 2020

A 70-year-old patient was treated in September 2017 for a malignancy in an ileal conduit (IC) which he received in 2009 for the treatment of prostate cancer. The tumour was found incidentally during a routine sonography. A CT scan revealed a mass near the IC. An endoscopy with biopsies showed an intraepithelial neoplasia of the ileal mucosa in the IC. We performed a segmental ileal resection. Histological findings revealed an ileal adenocarcinoma. The postoperative course was uneventful. The patient has remained alive without tumour recurrence up to the most recent negative CT screening in April 2019. Secondary malignancies after urinary diversions are a well-known complication, including procedures using small bowel parts for the urinary diversion. Adenocarcinomas arising in an IC are rarely described in literature. Concerning said tumour entity, surgical removal is often recommended. There is no evidence for the success of chemotherapy or radiation due to insufficient clinical trials. When diagnosing a mass in an IC, a secondary malignancy should be taken under consideration.
Preventive measures to avoid vertical transmission in untreated pregnant women with HIV/AIDS
Authors: Rincón Franco Sara , Uriel Montserrat , Rodríguez Luis Martín , Romero Infante Ximena Carolina
Published: March 2020

The HIV/AIDS during pregnancy has high morbidity and mortality, without optimal prevention and treatment. The advanced stage cases are found in developing countries due to late detection, but, also in developed countries due to immigration; therefore, the professionals should know the management steps for these patients. The implementation of specific interventions can reduce vertical transmission incidence until 1%–8%. It is presented a case of a pregnant woman with AIDS detected during first hospitalisation, due to a ventilatory failure by opportunistic germs; at the delivery the specific interventions were implemented, being able to eliminate vertical transmission to the newborn. This article explains the four main aspects to be considered for reducing vertical transmission (detection of HIV, viral load levels-CD4 lymphocyte count, way and moment of childbirth and antiretroviral therapy) and shares experiences of the management of an advanced case, in order to help professionals to handle these cases and its complications.
Transitioning a patient from injectable opioid agonist therapy to sublingual buprenorphine/naloxone for the treatment of opioid use disorder using a microdosing approach
Authors: Caulfield Mackenzie Duncan Gregory , Brar Rupinder , Sutherland Christy , Nolan Seonaid
Published: March 2020

In the wake of North America’s opioid crisis, access to evidence-based treatment for opioid use disorder (OUD) is of critical importance. While buprenorphine/naloxone and methadone are currently indicated as first-line medications for the treatment of OUD, there are a proportion of individuals who do not benefit from these therapies. Recent Canadian guidelines suggest the use of alternate therapies, including slow-release oral morphine or injectable opioid agonist therapy (iOAT) for individuals unsuccessful with either methadone or buprenorphine/naloxone. While the guidelines highlight the need to intensify OUD treatment as disease severity increases, equally important is the consideration for deintensification of treatment (eg, from iOAT to an oral opioid agonist treatment (OAT) option) following successful stabilisation. Literature addressing how best to accomplish this, however, is currently lacking. Accordingly, the case presented here describes a patient that successfully transitions from iOAT to oral buprenorphine/naloxone using a novel induction approach termed microdosing.
Computerised speech and language therapy can help people with aphasia find words following a stroke
Authors: Cook Rob , Davidson Peter , Martin Rosie
Published: March 2020

The study

Palmer R, Dimairo M, Cooper C, et al. Self-managed, computerised speech and language therapy for patients with chronic aphasia post-stroke compared with usual care or attention control (Big CACTUS): a multicentre, single-blinded, randomised controlled trial.
Lancet Neurol
2019;18:821-33.

This project was funded by the NIHR Health Technology Assessment Programme (project number 12/21/01) and the Tavistock Trust for Aphasia.

To read the full NIHR Signal, go to:
https://discover.dc.nihr.ac.uk/content/signal-000864/after-a-stroke-computerised-speech-and-language-therapy-can-help-people-find-words
Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India
Authors: Exum Natalie G , Gorin Emma M , Sadhu Goutam , Khanna Anoop , Schwab Kellogg J
Published: March 2020

Background

The most ambitious sanitation campaign to end open defecation (OD) in India came to a close on 2 October 2019 and there are limited independent, robust data to measure its success. We aimed to evaluate Rajasthan’s claim of open defecation free status in March 2018 under the Swachh Bharat Mission (SBM) or ‘Clean India Mission’ by measuring OD trends from 2016 to 2018.

Methods

We used publicly available data from Performance Monitoring and Accountability 2020, a representative survey with two-stage stratified cluster sampling. Enumeration areas were the primary sampling units selected by the probability proportional ­to ­size method. The repeated cross-sectional surveys independently collected household water and sanitation data in Rajasthan (n=20 485). Among households reporting toilet access, the data were pooled across the four rounds for an observational analysis using logistic regression. The primary outcome measure was regular OD among households with access to toilet facilities.

Findings

Between October 2016 and July 2018 main OD practices in rural Rajasthan households decreased from 63.3% (95% CI 57.0% to 69.6%) to 45.8% (95% CI 38.4% to 53.2%) and in urban households from 12.6% (95% CI 6.0% to 19.1%) to 9.4% (95% CI 4.0% to 14.7%). Households with regular OD occurring despite access to a toilet made up 21.7% (95% CI 16.9% to 26.6%) of rural and 12.1% (95% CI 3.6% to 20.7%) of urban Rajasthan as of July 2018. The multivariate logistic regression revealed that factors related to water stress and sanitation sharing were associated with household members regularly practising OD.

Conclusions

These data highlight the importance of a continued focus on constructing toilets that are affordable with low water requirements during the next phase of SBM. An independent survey that can provide robust estimates of OD is needed to monitor progress of toilet construction and use.
Impact of the test and treat policy on delays in antiretroviral therapy initiation among adult HIV positive patients from six clinics in Johannesburg, South Africa: results from a prospective cohort study
Authors: Onoya Dorina , Sineke Tembeka , Hendrickson Cheryl , Mokhele Idah , Maskew Mhairi , Long Lawrence C , Fox Matthew
Published: March 2020

Objectives

To assess delays to antiretroviral therapy (ART) initiation before and after the Universal Test and Treat (UTT) and the same-day initiation (SDI) of ART policy periods in Johannesburg, South Africa.

Design

Prospective cohort study.

Setting

Patients were recruited from six primary health clinics in Johannesburg.

Participants

Overall, 1029 newly diagnosed HIV positive adults (≥18 years) were consecutively enrolled by referral from the testing counsellor between April and December 2015 (pre-UTT n=146), July and August 2017 (UTT, n=141) and October 2017 and August 2018 (SDI, n=742).

Main outcome measures

Cox proportional hazards regression was used to assess predictors of 30 days ART initiation. Additionally, predictors of immediate ART initiation were evaluated using Poisson regression.

Results

Overall, 30 days ART proportions were 71.9% overall, 36.9% pre-UTT (44.3% of those eligible), 65.9% under UTT and 79.9% under the SDI policy. The median days to ART initiation declined from 21 pre-UTT (IQR: 15–30) to 8 (IQR: 6–16) under UTT and 5 days (IQR: 0–8) under the SDI policy. However, only 150 (20.2%) of the SDI cohort-initiated ART immediately after HIV diagnosis. Living in a two-adult home (adjusted HR (aHR) 1.2 vs living alone, 95% CI 1.0 to 1.5) increased the likelihood of 30-day ART. Missing baseline cluster of differentiation four (CD4) data decreased the likelihood of 30 days ART by 40% (aHR 0.6 vs CD4 <350 cells/µL, 95% CI 0.5 to 0.7). More women took up immediate ART (adjusted relative risk (aRR) 1.3, 95% CI 1.0 to 1.9). Participants ≥40 years (aRR 0.6 vs 18–24 years, 95% CI 0.4 to 0.9) were less likely to start ART immediately after HIV diagnosis. However, immediate ART rates increased with longer policy implementation time (aRR 0.2 for <3 months vs >10 months, 95% CI 0.1 to 0.4).

Conclusions

The study results highlight a positive move towards earlier ART initiation during the UTT and SDI periods and emphasise a need to increase same-day ART implementation further.
Cognitive–behavioural group therapy for adolescents with ADHD: study protocol for a randomised controlled trial
Authors: Nøvik Torunn Stene , Haugan Anne-Lise Juul , Lydersen Stian , Thomsen Per Hove , Young Susan , Sund Anne Mari
Published: March 2020

Introduction

Persistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive–behavioural therapy (CBT) programme for adolescents with ADHD aged 14–18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD.

Methods and analysis

We conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV.

Ethics and dissemination

The Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere.

Trial registration number

NCT02937142
Factors impacting on retention, success and equitable participation in clinical academic careers: a scoping review and meta-thematic synthesis
Authors: Vassie Claire , Smith Sue , Leedham-Green Kathleen
Published: March 2020

Objectives

To examine and synthesise current evidence on the factors that affect recruitment, retention, participation and progression within the clinical academic pathway, focusing on equitable participation across protected characteristics including gender, ethnicity and sexual orientation.

Design

Scoping review and meta-thematic synthesis.

Data sources

Web of Science, Google Scholar.

Article selection

We conducted a scoping review of English language articles on factors affecting recruitment, retention, progression and equitable participation in clinical academic careers published in North America, Australasia and Western Europe between January 2005 and April 2019. The most recent and relevant 39 articles were selected for meta-thematic synthesis using detailed inclusion/exclusion criteria.

Data extraction

The articles were purposively sampled to cover protected characteristics and career stages and coded for factors related to equitable participation. 17 articles were fully coded. No new themes arose after nine papers. Themes and higher level categories were derived through an iterative consensual process.

Results

13 discrete themes of factors impacting on equitable participation were identified including societal attitudes and expectations; national and organisational policies, priorities and resourcing; academic and clinical workplace cultures; supportive, discriminatory and compensatory interpersonal behaviours and personal factors related to social capital, finances, competing priorities, confidence and ambition, and orientation to clinical, academic and leadership roles.

Conclusions

The broad and often interconnected nature of these factors suggests that interventions will need to address structural and cultural factors as well as individual needs. In addition to standard good practice on equality and diversity, we suggest that organisations provide equitable support towards early publication success and targeted mentoring; address financial and role insecurity; address the clinical workplace culture; mitigate clinical–academic–personal role conflicts and overload; ensure that promotional structures and processes encourage diverse applicants and promote family-friendly, coherent and transparent national career pathways.
Androgen deprivation therapy and the risk of iron-deficiency anaemia among patients with prostate cancer: a population-based cohort study
Authors: Wu Fang-Jen , Li I-Hsun , Chien Wu-Chien , Shih Jui-Hu , Lin Yi-Chun , Chuang Chin-Min , Cheng Yih-Dih , Kao Li-Ting
Published: March 2020

Objectives

The administration of androgen deprivation therapy (ADT) to patients with metastatic prostate cancer might be associated with some adverse effects such as anaemia; however, few studies have been performed in East Asian populations. This study aimed to investigate the association between ADT and iron-deficiency anaemia (IDA) among patients with prostate cancer in a population-based nationwide cohort.

Design

Cohort study.

Setting

Taiwan.

Participants

Data for the cohort study were retrieved from the Taiwan National Health Insurance Research Database. Propensity score matching was used to select 7262 patients with prostate cancer who received ADT as the study group and 3631 patients who did not receive ADT as the control group.

Primary and secondary outcome measures

This study individually tracked patients over a 3-year study period and identified those who were subsequently diagnosed with IDA following the index date.

Results

The incidence rates of IDA in the study and control groups were 1.66 (95% CI CI 1.45 to 1.86) and 1.01 per 100 person-years (95% CI 0.78 to 1.25), respectively. Furthermore, proportional Cox regression revealed an HR of 1.62 (95% CI 1.24 to 2.12) for IDA in the study group after adjusting for patients’ age, monthly income, geographic location, residential urbanisation level and incidence of hyperlipidaemia, diabetes, hypertension, coronary heart disease, inflammatory bowel disease, other cancers and gastrointestinal bleeding.

Conclusion

Compared with its non-use among patients with prostate cancer, ADT use was associated with a higher risk of IDA.
Built environment changes and active transport to school among adolescents: BEATS Natural Experiment Study protocol
Authors: Mandic Sandra , Hopkins Debbie , García Bengoechea Enrique , Moore Antoni , Sandretto Susan , Coppell Kirsten , Ergler Christina , Keall Michael , Rolleston Anna , Kidd Gavin , Wilson Gordon , Spence John C
Published: March 2020

Introduction

Natural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014–2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019–2022) will examine the effects of BE changes on adolescents’ active transport to school in Dunedin, New Zealand.

Methods and analysis

The BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning.

Ethics and dissemination

The BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders.

Trial registration number

ACTRN12619001335189.
Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital
Authors: Pratt Kelsey Jones , Hernandez Beverly , Blancato Robert , Blankenship Jeanne , Mitchell Kristi
Published: March 2020

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers’ support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.
Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project
Authors: Tew Garry Alan , Bedford Robin , Carr Esther , Durrand James William , Gray Joanne , Hackett Rhiannon , Lloyd Scott , Peacock Sarah , Taylor Sarah , Yates David , Danjoux Gerard
Published: March 2020

Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL. A multidisciplinary, cross-sector team introduced PREP-WELL in January 2018. PREP-WELL provided comprehensive assessment and management of perioperative risk factors in the weeks before surgery. During a 12-month pilot, patients were referred from five surgical specialties at James Cook University Hospital. Data were collected on participant characteristics, behavioural and health outcomes, intervention acceptability and costs, and process-related factors. By December 2018, 159 referrals had been received, with 75 patients (47%) agreeing to participate. Most participants opted for a supervised programme (72%) and were awaiting vascular (43%) or orthopaedic (35%) surgery. Median programme duration was 8 weeks. The service was delivered as intended with participants providing positive feedback. Health-related quality of life (HRQoL; EuroQol 5D (EQ-5D) utility) and functional capacity (6 min walk distance) increased on average from service entry to exit, with mean (95% CI) changes of 0.108 (−0.023 to 0.240) and 35 m (−5 to 76 m), respectively. Further increases in EQ5D utility were observed at 3 months post surgery. Substantially more participants were achieving recommended physical activity levels at exit and 3 months post surgery compared with at entry. The mean cost of the intervention was £405 per patient; £52 per week. The service was successfully implemented within existing preoperative pathways. Most participants were very satisfied and improved their risk profile preoperatively. Funding has been obtained to support service development and expansion for at least 2 more years. During this period, alternative pathways will be developed to facilitate wider access and greater uptake.
Using and implementing care bundles for patients with acute admission for COPD: qualitative study of healthcare professionals’ experience in four hospitals in England
Authors: Shaw Ali , Morton Katherine , King Anna , Chalder Melanie , Calvert James , Jenkins Sue , Purdy Sarah
Published: March 2020

Background

Care bundles are sets of evidence-based interventions to improve quality of hospital care at admission and discharge. Within a wider multi-method evaluation of care bundles for adults with an emergency admission for acute exacerbations of chronic obstructive pulmonary disease, a qualitative study was conducted. The aim was to evaluate how bundles were used, and healthcare professionals’ experiences of the impact of bundles on the process of care delivery.

Methods

Within the wider evaluation, four acute hospitals that were using COPD care bundles were purposefully sampled for geographical variation. Qualitative data were gathered through non-participant observation of patient care and interviews with healthcare professionals, patients and carers. This paper reports a thematic analysis of data from observation and interviews with professionals.

Results

Healthcare professionals generally experienced care bundles as positive for standardising working practices and patient care, valuing how bundles could support a clear care pathway for patients, enable transitions between settings and identify postdischarge support required by patients. Successful use of bundles was perceived as more likely with the presence of either (or both) a clinical champion for bundles and system-based initiatives such as financial incentives, within a local culture of quality improvement. Challenges in accurately diagnosing COPD hampered bundle use, including delivery of bundles to those subsequently considered ineligible, or missed opportunities to deliver admission bundles to those with COPD.

Conclusion

Care bundles shape admission and discharge care processes for patients with COPD, from the perspective of staff involved in their delivery. However, different organisational, staff and clinical factors aid or hinder bundle use in an acute hospital context, suggesting potentially resolvable reasons for variable implementation of bundles. Finally, bundles may enhance staff experience of care delivery, even if the impact on patient outcomes remains uncertain.
Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices
Authors: Campos Jessica K , Cheaney II Barry , Lien Brian V , Zarrin David A , Vo Chau D , Colby Geoffrey P , Lin Li-Mei , Coon Alexander L
Published: March 2020

Flow diverters and flow disruption technology, alongside nuanced endovascular techniques, have ushered in a new era of treating cerebral aneurysms. Here, we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.
Hydrazine derivative synthesis by trifluoroacetyl hydrazide alkylation
Authors: Chauhan Pradeep S. , Brettell Skye , Ramakotaiah Mulamreddy , Diarra Sitan , Nguyen Anh Minh Thao , Wei Xiaozheng , Hamdane Yousra , Yongo-Luwawa Charity Deborah , Lubell William D.
Published: March 2020

N′-Alkyl hydrazides were effectively synthesized by routes featuring installation, alkylation, and removal of a trifluoroacetyl group. A set of amino acid derived hydrazides were acylated using trifluoroacetic anhydride, and the resulting trifluoroacetyl hydrazides were alkylated with alcohols in Mitsunobu reactions and with alkyl halides under alkaline conditions. Removal of the trifluoroacetyl group was affected under reductive and hydrolytic conditions to provide the respective N′-alkyl hydrazides. This three-step process may be performed without isolation of intermediates to yield N′-alkyl hydrazide after a single chromatographic purification.
Current Understanding of the Mechanism of Water Oxidation in Photosystem II and Its Relation to XFEL Data
Authors: Cox Nicholas , Pantazis Dimitrios A. , Lubitz Wolfgang
Published: March 2020

The investigation of water oxidation in photosynthesis has remained a central topic in biochemical research for the last few decades due to the importance of this catalytic process for technological applications. Significant progress has been made following the 2011 report of a high-resolution X-ray crystallographic structure resolving the site of catalysis, a protein-bound Mn4CaOxcomplex, which passes through ≥5 intermediate states in the water-splitting cycle. Spectroscopic techniques complemented by quantum chemical calculations aided in understanding the electronic structure of the cofactor in all (detectable) states of the enzymatic process. Together with isotope labeling, these techniques also revealed the binding of the two substrate water molecules to the cluster. These results are described in the context of recent progress using X-ray crystallography with free-electron lasers on these intermediates. The data are instrumental for developing a model for the biological water oxidation cycle.