bluuebunny/crossref_metadata_2025 huggingface dataset:
Technical Basis for Revision of Code Case N-809 on Reference Fatigue Crack Growth Curves for Austenitic Stainless Steels in Pressurized Water Reactor Environments
Authors: Cipolla Russell C. , Bamford Warren H. , Hojo Kiminobu , Nomura Yuichiro
Published: October 2021

Reference fatigue crack growth curves for austenitic stainless steels exposed to pressurized water reactor environments have been available in the ASME Code, Section XI in their present form with the publication of Code Case N-809 in Supplement 2 to the 2015 Code Edition. The reference curves are dependent on temperature, loading rate (loading rise time), mean stress (R-ratio), and cyclic stress intensity factor range (ΔK), which are all contained in the model. Since the first implementation of this Code Case, additional data have become available, and the purpose of this paper is to provide the technical basis for revision of the Code Case.

Changes have been made in three areas: R-ratio behavior, threshold for crack growth (ΔKth), and crack growth rate dependence on ΔK. In addition, the temperature model was revisited to study the temperature effects for T < 150°C, where the current model predicts an increase in da/dN based on limited test data at about 100°C (200°F). At this point, the current temperature model is considered conservative and no change is proposed in this revision to N-809.

The R-ratio model has been revised for both high and low carbon stainless steels, a significant improvement over the original procedures. Perhaps the most important revision is in the area of the threshold for the initiation of fatigue crack growth; such data are difficult to obtain, and the previous model was very conservative. Finally, the crack growth exponent was revised slightly to make it consistent with the regression analysis of the original data.
Investigation of Nozzle on Knuckle Region of Dished Head
Authors: Pathre Sujay S. , Mathkar Ameya M. , Gopalakrishnan Shyam
Published: October 2021

ASME Code Section VIII Division 1 [1] provides rules for the shape of openings, size of openings, strength and design of openings, however, the existing rules do not provide any restrictions on the specific location of the nozzle on the dished head knuckle region. Many corporate guidelines/ user design requirements meant for pressure vessel design and specification suggest avoiding placement of any type of nozzle in the knuckle area of a dished head and generally state in their design specification to limit the placement of a nozzle including its reinforcement within the crown area. This applies to Torispherical and Ellipsoidal dished heads.

Code [1] rule UG-37(a) provides the benefit in reinforcement by reducing the required thickness (tr) of the dished head when the nozzle is in the spherical portion of the dished head for the Ellipsoidal and Torispherical dished head.

High stresses occur in the knuckle region of the dished head due to the edge bending effect caused as the cylinder and head try to deform in different directions. For various reasons the user design requirements insist on placing the nozzle in the knuckle region, further compounding the complexity of the stress pattern in the knuckle area.

The work carried out in this paper was an attempt to check whether it is safe to locate a nozzle in the knuckle region of the dished head since the knuckle portion is generally subjected to higher stresses in comparison to the crown portion of a dished head and the Code [1] and [2] does not impose any restrictions for the placement of nozzles in the knuckle region. Also, in this paper an attempt was made to evaluate the induced stresses when equivalent sizes of nozzles are placed in the crown as well as the knuckle portion of the dished head.
Failure Analysis of a Cracked Stainless-Steel Steam-Water Separator
Authors: Shi Jin , Liu Wen , Cheng Xin
Published: October 2021

Currently, austenitic stainless steel has been widely used for the pressure boundary, including reactors, separators and storage tanks serviced in energy, petrochemical, chemical and food industries in view of its inherent corrosion resistance. However, the corrosion resistance may deteriorate under some circumstances such as field welding and inappropriate post-weld heat treatment. A steam-water separator serviced in a power plant was found cracking and a large amount of steam leaked outside. The cracking was located in the heat-affected zone (HAZ) of the joint on the head side of the pressure vessel. The material of the head was SUS 304 austenite stainless steel. Failure analysis was conducted to investigate the cause of cracking. The testing and measurement included chemical composition analysis, metallographic examination, fracture surface observation and deposit elements analysis.

Results showed that the cracking was intergranular and stress corrosion cracking (SCC) was the primary cause of failure. During the fabrication of the separator, the HAZ of the joint was overheated by the thermal input of welding. Brittle carbides such as M23C6 precipitating at the grain boundary, resulted in a narrow belt lack of chromium nearby known as sensitization. The corrosion resistance of the austenite stainless-steel decreased obviously there, and cracking failure occurred rapidly under tensile stress.

The influencing factors discussed in this paper mainly focused on material performance, post-weld heat treatment, and corrosivity of medium. Austenitic stainless steel containing stabilizing elements or with low C content was recommended for the new vessel design in order to avoid similar cracking failure.
More Is Not Always Better—the Double-Headed Role of Fibronectin in Staphylococcus aureus Host Cell Invasion
Authors: Niemann Silke , Nguyen Minh-Thu , Eble Johannes A. , Chasan Achmet I. , Mrakovcic Maria , Böttcher Ralph T. , Preissner Klaus T. , Roßlenbroich Steffen , Peters Georg , Herrmann Mathias
Published: October 2021

Traditionally,
Staphylococcus aureus
has been considered an extracellular pathogen. However, among other factors, the frequent failure of antimicrobial therapy and the ability of the pathogen to cause recurrent disease have established the concept of eukaryotic invasion of the pathogen, thereby evading the host’s immune system.
Infectious SARS-CoV-2 Is Emitted in Aerosol Particles
Authors: Hawks Seth A. , Prussin Aaron J. , Kuchinsky Sarah C. , Pan Jin , Marr Linsey C. , Duggal Nisha K.
Published: October 2021

SARS-CoV-2 is a respiratory virus and has been isolated from the air near COVID-19 patients. Here, using a hamster model of infection, we demonstrate that SARS-CoV-2 is emitted in aerosol particles prior to and concurrent with the onset of mild disease.
Beta Amyloid, Tau Protein, and Neuroinflammation: An Attempt to Integrate Different Hypotheses of Alzheimer’s Disease Pathogenesis
Authors: Garbuz D. G. , Zatsepina O. G. , Evgen’ev M. B.
Published: October 2021

Alzheimer’s disease (AD) is a neurodegenerative disease that inevitably results in dementia and death. Currently, there are no pathogenetically grounded methods for the prevention and treatment of AD, and all current treatment regimens are symptomatic and unable to significantly delay the development of dementia. The accumulation of β-amyloid peptide (Aβ), which is a spontaneous, aggregation-prone, and neurotoxic product of the processing of signaling protein APP (Amyloid Precursor Protein), in brain tissues, primarily in the hippocampus and the frontal cortex, was for a long time considered the main cause of neurodegenerative changes in AD. However, attempts to treat AD based on decreasing Aβ production and aggregation did not bring significant clinical results. More and more arguments are arising in favor of the fact that the overproduction of Aβ in most cases of AD is not the initial cause, but a concomitant event of pathological processes in the course of the development of sporadic AD. The concept of neuroinflammation has come to the fore, suggesting that inflammatory responses play the leading role in the initiation and development of AD, both in brain tissue and in the periphery. The hypothesis about the key role of neuroinflammation in the pathogenesis of AD opens up new opportunities in the search for ways to treat and prevent this socially significant disease.
Efficacy of occlusive wraps used for delivery room care
Authors: Reuter Christina , Ehlers Florian , Vana Philipp , Küster Helmut
Published: October 2021

Background

Guidelines advise for more than 20 years to use occlusive plastic wraps for temperature management during delivery room care but data on efficacy of different types of wrap are still scarce.

Methods

A random sample of seven different types of plastic wrap was tested using prewarmed aluminium blocks.

Results

The most effective wrap increased the time to cool by 2°C by one-third for the core and by 100% for the surface whereas the least effective wrap led to even faster heat loss compared with no wrap at all. The least effective wrap concerning all capacities tested was made from polyurethane that contains potentially toxic and narcotic monomers. Heat and water retention did not correlate to wrap thickness.

Discussion

Large differences in heat and water retention capacity warrant a careful choice of the type of wrap as some might be counterproductive. Wraps containing polyurethane should not be used.
Right frontal meningioma presenting as delusional parasitosis
Authors: Konnakkaparambil Ramakrishnan Kavitha , Mohan Lavanya , Jacob Jwala Jasha , Gopinath Roopasree
Published: October 2021

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.
Adult cystic nephroma masquerading urothelial carcinoma of a calyceal diverticulum
Authors: Debnath Abhik , Cheriyan Abhilash , Gopinathan Vikram Raj , Kumar Santosh
Published: October 2021

We report a complex cystic renal lesion in a 34-year-old man who presented with haematuria. It was managed by laparoscopic radical nephroureterectomy as it mimicked urothelial carcinoma.
Midbrain infarction in inherited protein S deficiency: a rare association
Authors: Chandra Manali , Chandra Atanu , Chakraborty Sayantan , Ghosh Joydeep
Published: October 2021

Inherited thrombophilic disorders are well‐established predisposing factors for venous thromboembolism, but their role in arterial ischaemic stroke is uncertain. The exact mechanism of arterial thrombosis in thrombophilias remains elusive. Herein, we report a case of a 30-year-old woman who was admitted to our facility with sudden-onset right-sided ptosis and ophthalmoplegia. Detailed clinical features, neuroimaging and laboratory evaluation clinched the diagnosis of ischaemic stroke in midbrain due to microvascular obstruction associated with isolated protein S deficiency. She was treated with oral anticoagulant (warfarin) and physiotherapy; without any improvement of her symptoms at 2 months of follow-up. A high index of clinical suspicion is needed in any case of young ischaemic stroke in absence of common cardiac and vascular risk factors, to recognise the presence of inherited thrombophilia.
Ménétrier’s disease in a patient with refractory ulcerative colitis: a clinical challenge and review of the literature
Authors: Rao Sofia , Viola Anna , Ksissa Omar , Fries Walter
Published: October 2021

Ménétrier’s disease (MD) is a rare disease of the stomach, characterised by hypertrophic gastric folds leading to protein loss. The association with ulcerative colitis (UC) is rare but has been reported in the literature. We report a case of a 29-year-old male affected by UC with an additional diagnosis of MD 3 years after UC diagnosis. UC was refractory to several treatment lines (thiopurines, infliximab, vedolizumab and ustekinumab), and the patient underwent colectomy. Octreotide was administered for MD normalising blood biochemistry, but it was not effective in inducing endoscopic remission of the stomach. Treatment options in patients with MD and UC are discussed.
Risk of SARS-CoV-2 transmission from on-field player contacts in amateur, youth and professional football (soccer)
Authors: Schreiber Sebastian , Faude Oliver , Gärtner Barbara , Meyer Tim , Egger Florian
Published: October 2021

Objective

To investigate the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels.

Methods

Between August 2020 and March 2021, football players who tested positive for SARS-CoV-2 and participated in matches or training during the period of potential contagiousness were identified through media search (professional level) and a nationwide registry in Germany (amateur and youth level) to determine symptoms, source of infection and hygiene measures adopted. The definition of potentially infectious players was based on the time of a positive PCR testing and symptom onset. Transmission-relevant contacts on the pitch were evaluated through doubly reviewed video analysis.

Results

Out of 1247 identified football matches and training sessions (1071 amateur and youth level, 176 professional level), 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. At the amateur and youth level, the combination of partial PCR testing (31 of 60 cases) and symptom monitoring within 14 days post-exposure (46 of 60 cases) identified 2 of 60 matches in which follow-up infections occurred that were attributed to non-football activities. This is consistent with the video analysis of 21 matches demonstrating frontal contacts were <1 per player-hour (88%, 30 of 34 players), each lasting no longer than 3 s.

Conclusion

On-field transmission risk of SARS-CoV-2 in football is very low. Sources of infections in football players are most likely not related to activities on the pitch.
Reliability of COVID-19 symptom checkers as national triage tools: an international case comparison study
Authors: Mansab Fatma , Bhatti Sohail , Goyal Daniel
Published: October 2021

Objectives

Triage is a critical component of the pandemic response. It affects morbidity, mortality and how effectively the available healthcare resources are used. In a number of nations the pandemic has sponsored the adoption of novel, online, patient-led triage systems—often referred to as COVID-19 symptom checkers. The current safety and reliability of these new automated triage systems remain unknown.

Methods

We tested six symptom checkers currently in use as triage tools at a national level against 52 cases simulating COVID-19 of various severities to determine if the symptom checkers appropriately triage time-critical cases onward to healthcare contact. We further analysed and compared each symptom checker to determine the discretionary aspects of triage decision-making that govern the automated advice generated.

Results

Of the 52 clinical presentations, the absolute rate of onward referral to any form of healthcare contact was: Singapore 100%, the USA 67%, Wales 65%, England 62%, Scotland 54% and Northern Ireland 46%. Triage decisions were broadly based on either estimates of ‘risk’ or ‘disease severity’. Risk-based symptom checkers were more reliable, with severity-based symptom checkers often triaging time-critical cases to stay home without clinical contact or follow-up.

Conclusion

The COVID-19 symptom checkers analysed here were unable to reliably discriminate between mild and severe COVID-19. Risk-based symptom checkers may hold some promise of contributing to pandemic case management, while severity-based symptom checkers—the CDC and NHS 111 versions—confer too much risk to both public and healthcare services to be deemed a viable option for COVID-19 triage.
Flip the Triangle: using quality improvement methods to embed a positive behaviour support approach on a medium secure forensic ward for men with intellectual disabilities
Authors: Whittle Charlotte , Chingosho George , Parker Kate , Jama Manaal , Babar Sidrah , Njovana Day , Shah Amar
Published: October 2021

Incidents of violence and aggression are serious concerns on a secure ward for people with intellectual disabilities and are often met with increases in physical and restrictive interventions. However, these interventions are usually high risk for both patients and staff and are ineffectual in promoting long-term behaviour change. This study aimed to promote positive culture change and embed the evidence-based practice of positive behaviour support by shifting focus and efforts from the use of physical and restrictive interventions to manage crises to intervening positively and proactively to prevent crises from occurring. The key drivers for change involved increasing access to positive engagement opportunities, expanding the staff team’s repertoire of proactive interventions through training and skill development and supporting staff well-being and resilience. Change ideas occurred alongside a shift in culture that promoted the development of a learning culture, psychological safety and consideration of contextual fit. Quality improvement methods helped the project increase the rate of positive and proactive interventions from 70.65% in December 2018 to 97.18% in January 2020. Increases in staff’s knowledge, confidence and safety were also reported. Lessons and limitations of the project are discussed.
COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India
Authors: Tiwari Arun , Balan Suma , Rauf Abdul , Kappanayil Mahesh , Kesavan Sajith , Raj Manu , Sivadas Suchitra , Vasudevan Anil Kumar , Chickermane Pranav , Vijayan Ajay , John Shaji Thomas , CK Sasidharan , Krishnan Raghuram A , Sudhakar Abish
Published: October 2021

Objectives

To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity.

Design

Hospital-based prospective cohort study.

Setting

Two tertiary care centres in Kerala, India.

Participants

Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention.

Statistical analysis

Pearson χ2test or Fisher’s exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni’s correction was used for multiple comparisons.

Results

We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes.

Conclusions

Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.
I-KID study protocol: evaluation of efficacy, outcomes and safety of a new infant haemodialysis and ultrafiltration machine in clinical use: a randomised clinical investigation using a cluster stepped-wedge design
Authors: Lambert Heather J , Sharma Shriya , Matthews John N S
Published: October 2021

Introduction

The I-KID study aims to determine the clinical efficacy, outcomes and safety of a novel non-CE-marked infant haemodialysis machine, the Newcastle Infant Dialysis Ultrafiltration System (NIDUS), compared with currently available therapy in the UK. NIDUS is specifically designed for renal replacement therapy in small babies between 0.8 and 8 kg.

Methods and analysis

The clinical investigation is taking place in six UK centres. This is a randomised clinical investigation using a cluster stepped-wedge design. The study aims to recruit 95 babies requiring renal replacement therapy in paediatric intensive care units over 20 months.

Ethics and dissemination

The study has high parent and public involvement at all stages in its design and parents will be involved in dissemination of results to parents and professionals via publications, conference proceedings and newsletters. The study has has ethics permissions from Tyne and Wear South Research Ethics Committee.

Trial registration numbers

IRAS ID number: 170 481

MHRA Reference: CI/2017/0066

ISRCT Number: 13 787 486

CPMS ID number: 36 558

NHS REC reference: 16/NE/0008

Eudamed number: CIV-GB-18-02-023105

Link to full protocol v6.0:https://fundingawards.nihr.ac.uk/award/14/23/26
Caffeine and Caffeinism
Authors: Mackay D. C. , Rollins J. W.
Published: October 2021

Caffeine is a widely ingested and generally beneficial drug. However, when taken in excess, anxiety related symptoms become increasingly apparent. A case of caffeinism, which presented as a paranoid delusion, is reported as an extreme example of this.

A study of 60 hospital inpatients revealed that about 40% of them consumed sufficient caffeine to produce symptoms of caffeinism. It is thus recommended that all patients should be questioned on their caffeine intake. Also, caffeinism should be considered as a differential diagnosis of anxiety states.
Motion commotion—a seasickness update
Authors: Pingree B. J. W.
Published: October 2021

This review describes current concepts concerning the aetiology and nature of seasickness. The condition is a manifestation of the more general phenomenon of motion sickness. It may be understood by reference to a neural mismatch hypothesis and details of the nature of the provocative motion are described. Drug treatment of the condition is discussed.
A comparison of Self-Recording Audiometry in Naval Establishments and Clinical Audiometry in a Hospital setting
Authors: Frampton M. C. , Counter R. T.
Published: October 2021

Following the introduction of self-recording audiometers into regular use in non-hospital Royal Naval medical facilities, there has been an increase in the rate of detection of hearing losses and consequent referral for formal audiometry and ENT evaluation at Naval Hospitals. Forty-two sets of audiograms have been examined and the hearing thresholds obtained by the two methods compared. The value of self-recording audiometry even in the often imperfect audiometric conditions available in a Naval sick bay has been confirmed and the midpoint of the tracing established as a reliable indicator of the hearing threshold.
Varicose Veins: optimum compression after surgery and sclerotherapy
Authors: Shouler P. J. , Runchman P. C.
Published: October 2021

Graduated compression stockings are used in both surgical and non-surgical treatment of varicose veins. In a trial of high versus low compression stockings (40mmHg vs 15mmHg at ankle) after varicose vein surgery, both were equally effective in controlling bruising and thrombophlebitis, but low compression stockings proved to be more comfortable.

In a further trial after sclerotherapy, high compression stockings alone produced comparable results to Elastocrepe® bandages with stockings. It is concluded that after varicose vein surgery low compression stockings provide adequate support for the leg and that after sclerotherapy, bandaging is not required if a high compression stocking is used.
Trans-endoscopic balloon dilatation of benign oesophageal strictures: A prospective study as an out-patient procedure
Authors: Joyce W. P. , Walker A. J. , Rees M.
Published: October 2021

Over an 18-month period 70 consecutive patients underwent 100 oesophageal balloon dilatations of their benign peptic strictures by the trans-endoscopic route. All procedures were performed as an out-patient under intravenous sedation. One patient developed respiratory depression from over-sedation. No other complications were seen in this series. The first 50 patients were reviewed by postal questionnaire. The majority (91%) of patients were swallowing normally and all patients except one were happy with the procedure and content to undergo further dilatation should it prove necessary. A cost analysis was performed comparing balloon dilatation with conventional bougienage which is also practised at our hospital. Balloon dilatation as an out-patient procedure is a more cost-effective technique when compared to bougienage and has the potential of saving the health service many thousands of pounds per annum.
The effect of manpower and medical facility reduction on surgical practice during the Gulf Conflict 1991
Authors: Howell G. E. D. , Dale R. F.
Published: October 2021

The General Surgical admissions to Royal Naval Hospital, Stonehouse from 1 April 1990—31 March 1991 were audited. This period included the Gulf War. There remained throughout the build-up to Operation Desert Storm, and during the actual conflict, a requirement to treat Service personnel as well as maintaining surgical training. This paper shows that both criteria were met despite reduced medical manpower and facilities.
The Knee Signature System: a preliminary report
Authors: Smallbone Sarah , Hodkinson S. L.
Published: October 2021

This paper reports on the early results obtained using the Acufex Knee Signature System (KSS) to study ligament laxity.
Passive smoking in the Royal Navy
Authors: Cannon L. B.
Published: October 2021

Passive smoking is an emotive issue and one which has received considerable coverage in the past few years from both the scientific community and the media. The arguments for and against links between passive smoking and disease are as fiercely contested among members of the Royal Navy as among civilians.

This article aims to present the current evidence in favour of such a link and also the views on the matter as expressed by the ship’s company of a Type 22 frigate. Their views will be compared to the result of a similar survey carried out among civilian workforces. Finally, based on the evidence and results presented, strategies for tackling this problem will be discussed.
Comparative female to male consultation rates in NHS Primary Care: Extrapolation to the Royal Navy
Authors: Scott-Moncrieff N. F. J.
Published: October 2021

Prevailing wisdom accepts that women consult their GP more often than men. Those with a modicum of interest will know that across the NHS, all ages and all social classes for all grades of consultation, the approximate ratio is two female consultations for one male consultation. However, if the figures are carefully sifted to identify that group most clearly akin to Royal Naval personnel, the gap widens.

The following figures and discussion describe how in Naval personnel’s age, class and illness matched groups, extrapolating from NHS experience, the ‘typical’ Royal Naval ‘Wren’ might be expected to present as a fresh case (including family planning and pregnancy) three times more commonly and consult an RN GP four times more frequently than her male counterpart.

In addition, a comparison of various pathology groups are compared and pronounced differences discussed.
Colorectal Cancer in the Royal Navy – an opportunity to intervene?
Authors: Cripps N. P. J. , Cannon L. B.
Published: October 2021

Colorectal cancer is uncommon in Royal Naval personnel; an average of two cases are diagnosed annually, often with disease advanced at presentation. During the next five years, 10 serving individuals are likely to present with colorectal cancer and many, if not all of these, already harbour premalignant adenomas or asymptomatic colonic malignancy. Currently over 2,000 servicemen are estimated to carry undiagnosed colorectal adenomas.

Requests for hospital appointments for those reporting a family history of colorectal cancer and who request screening are increasing in frequency. An understanding of the personal implications of a family history of colorectal cancer and a basis for the management of these individuals will be provided.

This paper considers ways in which the impact of colorectal cancer on the Royal Navy and its pensioners could be altered. Evidence derived from population based and family history based colorectal cancer screening studies are organised into a protocol by which the Royal Navy might be examined. The effect of a family history of colorectal cancer on disease incidence and the percentage of positives resulting from faecal occult blood testing are applied to the age profile of the Royal Navy. These show that a maximum of 56 flexible sigmoidoscopies and 90 colonoscopies would be needed in the first year of a programme to attempt the early detection of colorectal neoplasia.

This paper is aimed at gaining feedback from primary and secondary care practitioners so that the possibility of introducing a programme for the early detection of colorectal cancer in the Royal Navy can be considered.
Care of World War II convoy casualties in the Kola area of North Russia. Part 1 – Initial arrangements
Authors: McMillan G. H. G.
Published: October 2021

During much of World War II, the Allied Arctic Convoy Route to North Russia was a vital lifeline to sustain the Russian contribution to the defeat of Germany. Initial convoys were unopposed by enemy forces but it was not long before these joined the fearful elemental forces of the northern seas to reap a rich harvest of war material and human life. Survivors who reached North Russia frequently required skilled hospital care but, sadly, this was not available to any in the initial year or so of the operation. Conditions in host country hospitals are described in this part of the paper. The contribution of the Royal Naval Auxiliary Hospital which was eventually established in the autumn of 1942 under the charge of Temporary Surgeon Lieutenant Commander James Murray McEwan RNVR will be described in Part 2 of this paper which is to be published in the Spring 1996 issue.
The early morbidity of varicose vein surgery
Authors: Mackay D. C. , Summerton D. J. , Walker A. J.
Published: October 2021

The early outcome and morbidity associated with varicose vein surgery were assessed at six months post operation by postal questionnaire. Most cases underwent sapheno-femoral ligation, above-knee stripping of the long saphenous vein and multiple stab avulsions. A 73.8% response rate resulted in 155 replies, and revealed a high incidence (65.8%) of perceived complications within the first two weeks after surgery. The commonest of these were bruising, pain and numbness. Over a third of patients consulted their general practitioner (GP) postoperatively. Half of these required further management or treatment and the rest, reassurance alone. At six months 79.4% were satisfied with the outcome of their surgery, although some still claimed problems with residual veins, skin discoloration, numbness, and ankle or foot discoloration. Eleven percent were referred to hospital for further opinion, mostly because of perceived residual varicose veins. The difference between residual and recurrent varicose veins is discussed. No patient felt that the standard 2.5 day admission was too long, and 12.9% thought it too short. Day case surgery is not a popular option in this population group.

Despite high satisfaction rates, there is a considerable morbidity attached to varicose vein surgery. We believe that good pre- and perioperative communication, augmented by a comprehensive information sheet, is important to prepare patients for those postoperative problems and thus reduces their perceived importance.
Learning in the clinical area: The Portsmouth Partnership experience
Authors: Smith S.
Published: October 2021

This paper outlines a new, innovative method of obtaining a degree pertinent to one’s job description. The Partnership Programme implemented from the University of Portsmouth had its first intake of students in October 1992. The course is primarily aimed for students in full-time employment. Following submission of a portfolio, students can obtain a degree in two years. Students undertake part-time university modules and learning projects at the workplace, the latter forming up to 60% of their total credits. Presently there are only two similar course frameworks in the United Kingdom.
Problem drinking in the Naval Service: A study of personnel identified as alcohol abusers
Authors: Micklewright S
Published: October 2021

A group of naval personnel referred for alcohol problems was studied for a number of characteristics
including sex, service status, age group, Branch, presenting factors, where serving, referral source,
marital status, length of service and family history of alcohol abuse. They were compared with a control group of othernaval personnel.

The alcohol referral group displayed a number of statistically significant differences from the control group. Junior rates, those aged below 20, communications branch personnel and those serving at sea were over represented. The alcohol referrals group were also more likely to be unmarried or divorced, and have a family history of alcohol abuse. Officers, Senior Rates and engineering branch personnel were under represented. With regard to male:female ratio, age group distribution over age 20 and length of service, there were no significant differences between the alcohol referral and control groups. The majority of alcohol referrals were made by Medical and Divisional Officers, the overwhelming reason being disciplinary action related to alcohol abuse.
Evaluating the Tactical Combat Casualty Care principles in civilian and military settings: systematic review, knowledge gap analysis and recommendations for future research
Authors: Strauss Rachel , Menchetti Isabella , Perrier Laure , Blondal Erik , Peng Henry , Sullivan-Kwantes Wendy , Tien Homer , Nathens Avery , Beckett Andrew , Callum Jeannie , da Luz Luis Teodoro
Published: October 2021

Objectives

The Tactical Combat Casualty Care (TCCC) guidelines detail resuscitation practices in prehospital and austere environments. We sought to review the content and quality of the current TCCC and civilian prehospital literature and characterize knowledge gaps to offer recommendations for future research.

Methods

MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched for studies assessing intervention techniques and devices used in civilian and military prehospital settings that could be applied to TCCC guidelines. Screening and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal was conducted using appropriate tools.

Results

Ninety-two percent (n=57) of studies were observational. Most randomized trials had low risk of bias, whereas observational studies had higher risk of bias. Interventions of massive hemorrhage control (n=17) were wound dressings and tourniquets, suggesting effective hemodynamic control. Airway management interventions (n=7) had high success rates with improved outcomes. Interventions of respiratory management (n=12) reported low success with needle decompression. Studies assessing circulation (n=18) had higher quality of evidence and suggested improved outcomes with component hemostatic therapy. Hypothermia prevention interventions (n=2) were generally effective. Other studies identified assessed the use of extended focused assessment with sonography in trauma (n=3) and mixed interventions (n=2).

Conclusions

The evidence was largely non-randomized with heterogeneous populations, interventions, and outcomes, precluding robust conclusions in most subjects addressed in the review. Knowledge gaps identified included the use of blood products and concentrate of clotting factors in the prehospital setting.

Level of evidence

Systematic review, level III.
Chirality detected in Hartley’s electronic oscillator
Authors: Gallas Jason A. C.
Published: October 2021

Chirality is an elusive asymmetry important in science and technology and confined mainly to the quantum realm. This paper reports the observation of chirality in a classical (that is, not quantum) scenario, namely in stability diagrams of an autonomous electronic oscillator with a junction-gate field-effect transistor (JFET) and a tapped coil. As the number of spikes (local maxima) of stable oscillations changes along closed parameter paths, they generate two types of intricate structures. Surprisingly, such pair of structures are artful images of each other when reflected on a mirror. They are dual chiral pairs interconnecting families of stable oscillations in closed loops. Chiral pairs should not be difficult to detect experimentally. This chirality is conjectured to be a generic property of nonlinear oscillators governed by classical (that is, not quantum) equations.
The foundation of the hyperunified field theory I — Fundamental building block and symmetry
Authors: Wu Yue-Liang
Published: October 2021

Starting from the motional property of functional field based on the action principle of path integral formulation while proposing maximum coherence motion principle and maximum locally entangled-qubits motion principle as guiding principles, we show that such a functional field as fundamental building block appears naturally as an entangled qubit-spinor field expressed by a locally entangled state of qubits. Its motion brings about the appearance of Minkowski space–time with dimension determined by the motion-correlation [Formula: see text]-spin charge and the emergence of [Formula: see text]-spin/hyperspin symmetry as fundamental symmetry. Intrinsic [Formula: see text]-spin charge displays a periodic feature as the mod 4 qubit number, which enables us to classify all entangled qubit-spinor fields and space–time dimensions into four categories with respect to four [Formula: see text]-spin charges [Formula: see text]. An entangled decaqubit-spinor field in 19-dimensional hyper-space–time is found to be a hyperunified qubit-spinor field which unifies all discovered leptons and quarks and brings on the existence of mirror lepton–quark states. The inhomogeneous hyperspin symmetry [Formula: see text] as hyperunified symmetry in association with inhomogeneous Lorentz-type symmetry [Formula: see text] and global scaling symmetry provides a unified fundamental symmetry. The maximum locally entangled-qubits motion principle is shown to lay the foundation of hyperunified field theory, which enables us to comprehend long-standing questions raised in particle physics and quantum field theory.
Study of the semileptonic Bc → ηcτ−v̄τ decay in W′ model
Authors: Mahata S. , Maji P. , Biswas S. , Sahoo S.
Published: October 2021

Recently, many discrepancies between the Standard Model (SM) predictions and experimental results have been found in [Formula: see text] quark transitions. Motivated by these discrepancies, we investigated the semileptonic [Formula: see text] decay in [Formula: see text] model. In this paper, we have estimated different decay observables such as branching ratio, lepton flavor universality (LFU) ratio [Formula: see text] and forward–backward asymmetry in the SM as well as in the [Formula: see text] model. In [Formula: see text] model, we find significant deviations from the SM for the observables except for the forward–backward asymmetry. This deviation gives us a possible indication of new physics (NP).
Local dimension of trivial extension and amalgamation of rings
Authors: Khalfaoui Rachida El , Mahdou Najib , Yassemi Siamak
Published: October 2021

Local dimension is an ordinal valued invariant that is in some sense a measure of how far a ring is from being local and denoted [Formula: see text]. The purpose of this paper is to study the local dimension of ring extensions such as homomorphic image, trivial ring extension and the amalgamation of rings.
PUSH-PULL THEORY IN BLACK AND WHITE: EXAMINING RACIAL DIFFERENCES IN FIRM STARTUPS BEFORE AND AFTER THE GREAT RECESSION
Authors: ATKINS RACHEL MB
Published: October 2021

Although Blacks in the United States suffered disproportionately high unemployment, housing and wealth losses during the Great Recession, little is known about the recession’s impact on Black entrepreneurship. This study uses data from the Panel Study of Income Dynamics (PSID) to estimate the difference in probability of starting a business before and after the recession for Black and White households. While the likelihood of starting a business declined for Whites after the Great Recession there were no statistically significant changes in the rate of firm startups among Blacks. Evidence supports the prosperity pull hypothesis for White but not Black entrepreneurs.
Quantum-Inspired Recommendation System with Threshold Proportion Interception
Authors: Qiao Meng , Shan Zheng , Wang Junchao , Sun Huihui , Liu Fudong
Published: October 2021

Modern recommendation systems leverage historical behavior information to generate precise recommendation results for users. However, when the data scale of users and items is large, it is difficult to generate recommendation results in time. Tang proposed a quantum-inspired recommendation algorithm, which could solve the recommendation problem in constant time complexity. However, Tang’s approach is based on a set of assumptions which rely heavily on some empirical parameters. The time complexity for calculating parameters is high. Thus, this approach cannot be directly applied in industrial applications. In this paper, we propose a method, namely, Quantum-inspired Recommendation system with threshold Proportion Interception (QRPI), which is based on the quantum-inspired recommendation system and more suitable for industrial environments. Compared with the existing widely used recommendation algorithms, we show through numerical experiments that our solution can achieve almost the same performance with better efficiency.
Mapping Surgeons Hand/Finger Movements to Surgical Tool Motion During Conventional Microsurgery Using Machine Learning
Authors: Fattahi Sani Mohammad , Ascione Raimondo , Dogramadzi Sanja
Published: October 2021

Purpose: Recent developments in robotics and artificial intelligence (AI) have led to significant advances in healthcare technologies enhancing robot-assisted minimally invasive surgery (RAMIS) in some surgical specialties. However, current human–robot interfaces lack intuitive teleoperation and cannot mimic surgeon’s hand/finger sensing required for fine motion micro-surgeries. These limitations make teleoperated robotic surgery not less suitable for, e.g. cardiac surgery and it can be difficult to learn for established surgeons. We report a pilot study showing an intuitive way of recording and mapping surgeon’s gross hand motion and the fine synergic motion during cardiac micro-surgery as a way to enhance future intuitive teleoperation.

Methods: We set to develop a prototype system able to train a Deep Neural Network (DNN) by mapping wrist, hand and surgical tool real-time data acquisition (RTDA) inputs during mock-up heart micro-surgery procedures. The trained network was used to estimate the tools poses from refined hand joint angles. Outputs of the network were surgical tool orientation and jaw angle acquired by an optical motion capture system.

Results: Based on surgeon’s feedback during mock micro-surgery, the developed wearable system with light-weight sensors for motion tracking did not interfere with the surgery and instrument handling. The wearable motion tracking system used 12 finger/thumb/wrist joint angle sensors to generate meaningful datasets representing inputs of the DNN network with new hand joint angles added as necessary based on comparing the estimated tool poses against measured tool pose. The DNN architecture was optimized for the highest estimation accuracy and the ability to determine the tool pose with the least mean squared error. This novel approach showed that the surgical instrument’s pose, an essential requirement for teleoperation, can be accurately estimated from recorded surgeon’s hand/finger movements with a mean squared error (MSE) less than 0.3%.

Conclusion: We have developed a system to capture fine movements of the surgeon’s hand during micro-surgery that could enhance future remote teleoperation of similar surgical tools during micro-surgery. More work is needed to refine this approach and confirm its potential role in teleoperation.
Distributed Formation Control of UAVs for Circumnavigating a Moving Target in Three-Dimensional Space
Authors: Luo Yanhong , Bai Ao , Zhang Huaguang
Published: October 2021

In this paper, a novel formation control strategy is proposed to address the target tracking and circumnavigating problem of multi-UAV formation. First, two sets of definitions, space angle definition and space vector definition, are presented in order to describe the flight state and construct the desired relative velocity. Then, the relative kinematic model between the UAV and the moving target is established. The distributed control law is constructed by using dynamic feedback linearization so as to realize the tracking and circumnavigating control with the desired velocity, circling radius and relative angular spacing. Next, the exponential stability of the closed-loop system is further guaranteed by properly choosing some corresponding parameters based on the Lyapunov method. Finally, the numerical simulation is carried out to verify the effectiveness of the proposed control method.