bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of gender and disability on the economic well‐being of disabled women in the United Kingdom: A longitudinal study between 2009 and 2014
Authors: Kim Eun Jung , Parish Susan L. , Skinner Tina
Published: February 2019

The present study examined the economic well‐being of disabled and nondisabled men and women in the United Kingdom. Using the 2009–2014 Life Opportunities Survey (N = 6,159 adults), the study is the first longitudinal study to empirically compare the economic well‐being of disabled women in contrast to disabled men and nondisabled men and women. Hierarchical linear modelling and hierarchical linear logistic modelling were used to estimate the longitudinal changes. Findings indicate that, overall, disabled women's economic well‐being improved significantly between 2009 and 2014 even after controlling for other demographic characteristics. However, the improvements were not substantial enough to significantly narrow the economic disparities between disabled women and disabled men and nondisabled men and women. Disabled women remained worse off than disabled men and nondisabled men and women in 2014 as they did in 2009. The findings indicate that intersectional discrimination against disabled women exist in the United Kingdom. Findings from this study provide empirical evidence to support policies that enhance the economic security of disabled women.
Politically Alienated Through Low‐Wage Work? Evidence from Panel Data
Authors: Schraff Dominik
Published: February 2019

Does low‐wage work lead to political alienation? Even though low‐wage sectors have grown in the advanced industrialized world, empirical evidence so far is sparse. This paper uses household panel data to investigate the effect of low‐wage work spells on political alienation. We argue that repeated low‐wage work spells lead to preference divergence between a low‐income and the median‐income earner, leading to withdrawal from democratic politics among low‐wage earners. Using Swiss household panel data and fixed‐effects regressions, we show that the accumulation of low‐wage work spells decreases systemic trust. In a second step, we demonstrate that an interaction of eroding systemic trust with low‐wage work is associated with increased individual abstention probabilities. These results highlight the threat of a systematic under‐representation of low‐wage workers in the political sphere.
Cockroach Milli-Robot With Improved Load Capacity
Authors: Yun Dongwon , Fearing Ronald S.
Published: February 2019

In the field of milli-robots, several methods of constructing robots by laminating materials and then folding have been developed. Among these methods, smart composite microstructures (SCM) is widely used for making lightweight small mobile robots. However, in the case of a robot manufactured by the SCM method, due to flexible and easily deformable links and joints, it is often difficult to obtain proper kinematic movement due to deformation of the structure when a heavy load is applied. In this paper, studies on the mechanism design and manufacturing were carried out to increase the load capacity of robots manufactured by SCM. First, we modified the kinematics of the robot to reduce off-axis loading on flexure joints by using a planar 6 bar leg mechanism, which was fabricated using a new multilayer SCM process. Second, the fabrication process is improved to reduce peeling of laminate structures by introducing integrated rivets at joints. Finally, alternative materials, such as balsa, are used. To verify the design and fabrication improvements, we compared the payloads after applying the proposed methods to an existing cockroach robot design. Compared to the previous design, speed with a 50-g payload increased from 7 to 30 cm per second.
Multipass Serpentine Cooling Designs for Negating Coriolis Force Effect on Heat Transfer: 45-deg Angled Rib Turbulated Channels
Authors: Singh Prashant , Ji Yongbin , Ekkad Srinath V.
Published: February 2019

Rotation-induced Coriolis and centrifugal buoyancy forces result in significant modification of cooling characteristics of blade pressure and suction side internal walls. The nonuniformity in cooling, coupled with high-speed rotation, results in increased levels of thermal stresses. To address this problem, this study presents two multipassage configurations featuring 45-deg angled turbulators, in four- and six-passage designs. Experiments were carried out under stationary and rotating conditions using transient liquid crystal thermography to measure detailed heat transfer coefficient. It has been shown through experimental data that heat transfer characteristics of the new configurations’ pressure and suction side internal walls were very similar under rotating conditions, at both local and global scales. The heat transfer levels under rotating conditions were also similar to those of the stationary conditions. The contribution of multiple passages connected with 180-deg bends toward overall frictional losses has been evaluated in terms of pumping power and normalized friction factor. The configurations are ranked based on their thermal hydraulic performances over a wide range of Reynolds numbers. The four-passage ribbed configuration had slightly higher heat transfer levels compared with those of the corresponding six-passage ribbed configuration.
A Simulation Study on the Effects of Race Surface Waviness on Cage Dynamics in High-Speed Ball Bearings
Authors: Niu Linkai
Published: February 2019

The effects of the race surface waviness on the cage dynamics, including cage slip ratios, cage instabilities, and time-averaged cage wear rates, in high-speed ball bearings are investigated. A dynamic model of high-speed ball bearings considering the cage effect and the race surface waviness is proposed. Based on the proposed dynamic model, the effects of the maximum wave amplitude (MWA) and the wave order (WO) of race surface waviness on cage slip ratio, cage instability, and time-averaged cage wear rate are investigated. The results show that the race surface waviness has a great effect on the cage dynamics. The waviness would increase the random impacts between balls and cage pockets and thus cause more instable motion of the cage. Although the ball skidding and the cage slip ratio decrease with the increase of MWA, the cage instability and the cage wear rate become severe when MWA increases. In addition, the effect of WO on cage dynamics is nonlinear. The current investigation could provide a theoretical tool for an in-depth understanding of the dynamics in a high-speed ball bearing.
A Unit-Consistent Error Measure for Multibody Systems With Unilateral Constraints
Authors: Enzenhöfer Andreas , Peiret Albert , Teichmann Marek , Kövecses József
Published: February 2019

Modeling multibody systems subject to unilateral contacts and friction efficiently is challenging, and dynamic formulations based on the mixed linear complementarity problem (MLCP) are commonly used for this purpose. The accuracy of the MLCP solution method can be evaluated by determining the error introduced by it. In this paper, we find that commonly used MLCP error measures suffer from unit inconsistency leading to the error lacking any physical meaning. We propose a unit-consistent error measure, which computes energy error components for each constraint dependent on the inverse effective mass and compliance. It is shown by means of a simple example that the unit consistency issue does not occur using this proposed error measure. Simulation results confirm that the error decreases with convergence toward the solution. If a pivoting algorithm does not find a solution of the MLCP due to an iteration limit, e.g., in real-time simulations, choosing the result with the least error can reduce the risk of simulation instabilities and deviation from the reference trajectory.
Computational Functional Failure Analysis to Identify Human Errors During Early Design Stages
Authors: Irshad Lukman , Ahmed Salman , Demirel H. Onan , Tumer Irem Y.
Published: February 2019

Detection of potential failures and human error and their propagation over time at an early design stage will help prevent system failures and adverse accidents. Hence, there is a need for a failure analysis technique that will assess potential functional/component failures, human errors, and how they propagate to affect the system overall. Prior work has introduced functional failure identification and propagation (FFIP), which considers both human error and mechanical failures and their propagation at a system level at early design stages. However, it fails to consider the specific human actions (expected or unexpected) that contributed toward the human error. In this paper, we propose a method to expand FFIP to include human action/error propagation during failure analysis so a designer can address the human errors using human factors engineering principals at early design stages. The capabilities of the proposed method is presented via a hold-up tank example, and the results are coupled with digital human modeling to demonstrate how designers can use these tools to make better design decisions before any design commitments are made.
Measurements of Adhesion Force Between a Single Silver Particle Interacting With Hastelloy X and Inconel 617
Authors: Mokgalapa Naphtali M. , Ghosh Tushar K. , Tompson Robert V. , Loyalka Sudarshan K.
Published: February 2019

Silver is generated in the reactor core during normal operation of very high temperature reactors (VHTRs). It may be transported as aerosols in the reactor circuit and plates out at different points in the reactor including the intermitted heat exchanger. The resuspension of particles in high temperature reactors is closely associated with source term analysis including the environment safety assessment. Adhesion force is important in determining resuspension rate used in resuspension calculations. In this work, the atomic force microscope was used to measure the adhesive force between a spherical silver particle and VHTRs structural materials of Hastelloy X and Inconel 617. These forces were also predicted through the Johnson-Kendall-Roberts (JKR) theoretical model. The theoretically calculated values (when the particle size of 15.1 μm diameter was used) are higher than the measured results by a factor of a 1000. However, when surface roughness was taken into account, an improved comparison between the theoretically predicted values and the measured values was observed. In fact, the comparisons between the theoretically predicted values and the measured results show a deviation that ranges from 0.155 to 0.422 in the case of Hastelloy X and from 0.243 to 0.503 in the case of Inconel 617. The data generated provide insight into the significant influence that surface roughness has on the adhesion force. This adhesion force data may be important in understanding the adhesion of silver particles to Hastelloy X and Inconel 617, and may contribute to particle resuspension calculations.
Analysis of Loss of Heat Sink for ITER Divertor Cooling System Using Modified RELAP/SCDAPSIM/MOD 4.0
Authors: Saraswat S. P. , Ray D. , Munshi P. , Allison C.
Published: February 2019

The present work includes thermal hydraulic modeling and analysis of loss of heat sink (LOHS) accident for the ITER divertor cooling system. The analysis is done for the new design of full tungsten divertor. The new design is also analyzed for different local heat loads ranging from 10 MW/m2 to 20 MW/m2 (while maintaining the total heat load 200 MW) under the steady-state fluid conditions. The LOHS event is selected since divertor is the most sensitive component to loss or reduction in coolability of divertor primary heat transport system (DV-PHTS) loop as it receives large heat flux from plasma. The main objective of this analysis is to find margins to unwanted conditions like overstress temperatures of structure and elevated water level in the pressurizer. The analysis is done by modified thermal hydraulic code RELAP/SCDAPSIM/MOD 4.0. The results obtained are compared with the results of old divertor design which uses carbon fiber composite (CFC) layer to show that how the new design of divertor behaves compared to the older design under the accident scenario. A detailed model of DV-PHTS loop and its ancillary system is presented. The model includes promotional integral differential (PID) controller for controlling the pressurizer heater and spray system. A detailed pump model is also included in the present analysis which was previously used as a time-dependent junction. The analysis shows that under the accident scenario, (a) the divertor structure temperature at the critical sites (inner vertical target (IVT) and outer vertical target (OVT)) is always within the design limit and does not affect the structural integrity of the divertor. (b) The water level in the pressurizer increases moderately and finely controlled by the PID controller, and pressurizer safety valve does not open.
Suite for Smooth Particle Hydrodynamic Code Relevant to Spherical Plasma Liner Formation and Implosion
Authors: Schillo Kevin , Cassibry Jason , Rodriguez Mitchell , Thompson Seth
Published: February 2019

Three-dimensional (3D) modeling of magneto-inertial fusion (MIF) is at a nascent stage of development. A suite of test cases relevant to plasma liner formation and implosion is presented to present the community with some exact solutions for verification of hydrocodes pertaining to MIF confinement concepts. MIF is of particular interest to fusion research, as it may lead to the development of smaller and more economical reactor designs for power and propulsion. The authors present simulated test cases using a new smoothed particle hydrodynamic (SPH) code called SPFMax. These test cases consist of a total of six problems with analytical solutions that incorporate the physics of radiation cooling, heat transfer, oblique-shock capturing, angular-momentum conservation, and viscosity effects. These physics are pertinent to plasma liner formation and implosion by merging of a spherical array of plasma jets as a candidate standoff driver for MIF. An L2 norm analysis was conducted for each test case. Each test case was found to converge to the analytical solution with increasing resolution, and the convergence rate was on the order of what has been reported by other SPH studies.
The Critical Pressure at the Onset of Flame Instability of Syngas/Air/Diluent Outwardly Expanding Flame at Different Initial Temperatures and Pressures
Authors: Wang Ziyu , Bai Ziwei , Yu Guangying , Yelishala Sai , Metghalchi Hameed
Published: February 2019

Syngas has gained attention recently due to its high energy density and environmentally friendly characteristics. Flame stability plays an important role in flame propagation in energy conversion devices. Experimental studies were performed in a cylindrical chamber to investigate flame instability of syngas/air/diluent mixture. A Z-shape Schlieren system coupled with a high-speed complementary metal–oxide–semiconductor camera was used to record flame pictures up to 40,000 frames per second. In this research, syngas is a mixture of hydrogen and carbon monoxide and diluent is a blend of 14% CO2 and 86% N2 with the same specific heat as the burned gases. Three main flame instabilities namely Rayleigh–Taylor (body force) instability, hydrodynamic instability, and thermal-diffusive instability have been studied. For the onset of flame instability, a power law correlation for the ratio of critical pressure to initial pressure of syngas/air/diluent flames over a wide range of initial temperatures (298–450 K), initial pressures (1.0–2.0 atm), equivalence ratios (0.6–3.0), diluent concentrations (0–10%), and hydrogen percentages (5–25%) in the fuel has been developed.
Quasi-Static Thermal Modeling of Multiscale Sliding Contact for Unlubricated Brush Seal Materials
Authors: Xia Qingfeng , Gillespie David R. H. , Owen Andrew K. , Franceschini Gervas
Published: February 2019

Prediction of contact temperature between two materials in high-speed rubbing contact is essential to model wear during unlubricated contact. Conventionally, assumptions of either a steady or an annular heat source are used for slow and high speed rotation, respectively. In this paper, a rotating heating source is solved using an in-house finite element method code. This captures the full geometry and rotating speed of the rubbing bodies. Transient heat transfer is modeled quasi-statically, eliminating the need for a transient 3D simulation. This model is shown to be suitable for contact temperature prediction over a wide range of rotating speeds, anisotropic thermal conductivity, and nonuniform thermal boundary conditions. The model calculates heat partition accurately for a thin rotating disk and short pin combination, which cannot be predicted using the existing analytical solutions. The method is validated against ansys mechanical and experimental infrared thermography. Results demonstrate that the annular source assumption significantly underpredicts contact temperature, especially at the rubbing interface. Explicit modeling of a thin disk results in higher heat partition coefficients compared with the commonplace semi-infinite length assumption on both static and rotating components. The thermal anisotropy of tuft-on-disk configurations is evaluated and compared to a uniform pin-on-disk configuration. Despite the effective thermal conductivity (ETC) in the bristle tuft being approximately 1 order of magnitude lower than along the bristle length (treating the bristle pack as a porous medium), its impact on heat partition and contact temperature is shown to be limited.
Kinetic and Cross-Sectional Studies on the Genesis of Hypoargininemia in Severe Pediatric
Plasmodium falciparum
Malaria
Authors: Rubach Matthew P. , Zhang Haoyue , Florence Salvatore M. , Mukemba Jackson P. , Kalingonji Ayam R. , Anstey Nicholas M. , Yeo Tsin W. , Lopansri Bert K. , Thompson J. Will , Mwaikambo Esther D. , Young Sarah , Millington David S. , Weinberg J. Brice , Granger Donald L.
Published: February 2019

The low bioavailability of nitric oxide (NO) and its precursor, arginine, contributes to the microvascular pathophysiology of severe falciparum malaria. To better characterize the mechanisms underlying hypoargininemia in severe malaria, we measured the plasma concentrations of amino acids involved in
de novo
arginine synthesis in children with uncomplicated falciparum malaria (UM;
n
 = 61), children with cerebral falciparum malaria (CM;
n
 = 45), and healthy children (HC;
n
 = 109).
Contribution of Active Iron Uptake to Acinetobacter baumannii Pathogenicity
Authors: Runci Federica , Gentile Valentina , Frangipani Emanuela , Rampioni Giordano , Leoni Livia , Lucidi Massimiliano , Visaggio Daniela , Harris Greg , Chen Wangxue , Stahl Julia , Averhoff Beate , Visca Paolo
Published: February 2019

Acinetobacter baumannii
is an important nosocomial pathogen. Mechanisms that allow
A. baumannii
to cause human infection are still poorly understood.
Oxidative Pathways of Deoxyribose and Deoxyribonate Catabolism
Authors: Price Morgan N. , Ray Jayashree , Iavarone Anthony T. , Carlson Hans K. , Ryan Elizabeth M. , Malmstrom Rex R. , Arkin Adam P. , Deutschbauer Adam M.
Published: February 2019

Deoxyribose is one of the building blocks of DNA and is released when cells die and their DNA degrades. We identified a bacterium that can grow with deoxyribose as its sole source of carbon even though its genome does not contain any of the known genes for breaking down deoxyribose. By growing many mutants of this bacterium together on deoxyribose and using DNA sequencing to measure the change in the mutants’ abundance, we identified multiple protein-coding genes that are required for growth on deoxyribose. Based on the similarity of these proteins to enzymes of known function, we propose a 6-step pathway in which deoxyribose is oxidized and then cleaved. Diverse bacteria use a portion of this pathway to break down a related compound, deoxyribonate, which is a waste product of metabolism. Our study illustrates the utility of large-scale bacterial genetics to identify previously unknown metabolic pathways.
Unique Patterns and Biogeochemical Relevance of Two-Component Sensing in Marine Bacteria
Authors: Held Noelle A. , McIlvin Matthew R. , Moran Dawn M. , Laub Michael T. , Saito Mak A.
Published: February 2019

Marine microbes must manage variation in their chemical, physical, and biological surroundings. Because they directly link bacterial physiology to environmental changes, TCS systems are crucial to the bacterial cell. This study surveyed TCS systems in a large number of marine bacteria and identified key phylogenetic and lifestyle patterns in environmental sensing. We found evidence that, in comparison with bacteria as a whole, marine organisms have irregular TCS system constructs which might represent an adaptation specific to the marine environment. Additionally, we demonstrate the biogeochemical relevance of TCS systems by correlating the presence of the PMT9312_0717 response regulator protein to phosphate concentrations in the South Pacific. We highlight that despite their potential ecological and biogeochemical relevance, TCS systems have been understudied in the marine ecosystem. This report expands our understanding of the breadth of bacterial TCS systems and how marine bacteria have adapted to survive in their unique environment.
Adalimumab-induced acute myeloid leukaemia in a patient with Crohn’s disease
Authors: Alzahrani Talal , Nuqali Abdulelah , Naser Nejat , Jariwala Amar R
Published: February 2019

We present a patient with Crohn’s disease under treatment with adalimumab who developed acute myeloid leukaemia (AML) with core-binding factor beta gene rearrangement. This case report emphasises the importance of long-term close follow-up of patients receiving adalimumab because of the increased risk of developing AML and other malignancies.
Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study
Authors: Alene Kefyalew Addis , Adane Akilew Awoke , Yifiru Sisay , Bitew Bikes Destaw , Adane Aynishet , Koye Digsu Negese
Published: February 2019

Objective

The aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control.

Study design and settings

A cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital.

Participants

Randomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants.

Outcome measures

The main outcomes were knowledge and self-reported practice of health workers about MDR-TB.

Results

A total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10; 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78; 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79; 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85; 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven; one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64; 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85; 95% CI 1.11, to 13.34) wards, being in the age groups of 26–30 years (AOR=2.70; 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42; 95% CI 1.77, to 11.00).

Conclusions

This study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for health workers to increase their knowledge about MDR-TB.
Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care
Authors: Lazzerini Marzia , Senanayake Hematha , Mohamed Rishard , Kaluarachchi Athula , Fernando Roshini , Sakalasuriya Anshumalie , Ihsan Fathima Reshma , Saravanabhava Namasivayam , Gamaathige Nalin , Jayawardane Madura , Gamage Ruwan Vidana , Covi Benedetta , Wanzira Humphrey , Businelli Caterina , Piccoli Monica
Published: February 2019

Objectives

This study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC).

Design

Observational study.

Setting

De Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka.

Data collection and analysis

From July 2015 to June 2017, 150 variables were collected for each delivery using a standardised form and entered into a database. Data were analysed every 8 months, and the results made available to local staff. Outcomes of the study included: technical problems; data completeness; data accuracy; key database findings; and use of data.

Results

7504 deliveries were recorded. No technical problem was reported. Data completeness exceeded that of other existing hospital recording systems. Less than 1% data were missing for maternal variables and less than 3% for newborn variables. Mistakes in data collection and entry occurred in 0.01% and 0.09% of maternal and newborn data, respectively. Key QoC indicators identified in comparison with international standards were: relatively low maternal mortality (0.053%); relatively high maternal near-miss cases (3.4%); high rate of induction of labour (24.6%), caesarean section (30.0%) and episiotomy (56.1%); relatively high rate of preterm births (9.4%); low birthweight rate (16.5%); stillbirth (0.97%); and of total deaths in newborn (1.98%). Based on key indicators identified, a list of recommendations was developed, including the use checklists to standardise case management, training, clinical audits and more information for patients. A list of lessons learnt with the implementation of the data collection system was also drawn.

Conclusions

The study shows that the implemented system of data collection can produce a large quantity of reliable information. Most importantly, this experience provides an example on how database findings can be used for discussing hospital practices, identifying gaps and to agree on recommendations for improving QoC.
Health assets in a global context: a systematic review of the literature
Authors: Van Bortel Tine , Wickramasinghe Nuwan Darshana , Morgan Antony , Martin Steven
Published: February 2019

Objective

To provide an up-to-date overview of health assets in a global context both from a theoretical perspective and its practical applications to address health inequalities and achieve sustainable health.

Design

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources

A comprehensive search, including 10 electronic bibliographic databases and hand searches, was undertaken to capture the wide range of terms associated with ‘health assets’ and ‘asset-based approaches to health’.

Eligibility criteria

Any peer-reviewed published and grey literature in English related to ‘health assets’ or ‘assets’ in a ‘health’ context was included without any date, country or study design restrictions and the quality of evidence was appraised according to the Oxford Level of Evidence.

Outcomes

A broad consideration of all outcome measures including clinical outcomes, patient-level, community-level and population-level impacts and costs, was adopted.

Results

478 publications were included. Health assets were researched in 40 countries, predominantly in the West such as the USA and the UK. A number of broad health assets were identified including community and individual assets. Even though research was conducted in a number of different settings, most occurred in the community, clinical, care or educational settings. A wide variety of interventions and approaches were implemented, most commonly related to education and/or training, asset mapping or asset approaches.

Conclusions

Globally, authors most often referred to general ‘health assets’, ‘assets’ or some form of ‘community asset’ in relation to health. Overall, the idea of health assets is framed within a positive paradigm focusing on health creation rather than curative approaches. The sustained credibility of the global ‘health assets’ literature depends on future research on definitional, theoretical and evaluative issues in order to convince policy-makers and service commissioners of its necessity and added value to the traditional deficit approach.
Exploring the added value of hospital-registry data for showing local service outcomes: cancers of the ovary, fallopian tube and peritoneum
Authors: Roder David , Davy Margaret , Selva-Nayagam Sid , Paramasivam Sellvakumaran , Adams Jacqui , Keefe Dorothy , Miller Caroline , Powell Kate , Fusco Kellie , Buranyi-Trevarton Dianne , Oehler Martin K
Published: February 2019

Objectives

To explore the added value of hospital-registry data on invasive epithelial ovarian, tubal and peritoneal cancers.

Design

Historic cohort analyses.

Methods

Unadjusted and adjusted regression.

Setting

Major South Australian hospitals.

Participants

1596 women (1984–2015 diagnoses).

Results

5-Year and 10-year survival was 48% and 41%, respectively, equivalent to relative survival for Australia and the USA. After adjusting for age, clinical and geographic factors, risk of ovarian cancer death was 25% lower in 2010–2015 than 1984–1989. Women generally had surgical treatment (87%) in their first round of care. This was more common for younger patients (adjusted OR (95% CIs) 0.17 (0.04 to 0.65) for 80+ vs <40 years) and earlier International Federation of Gynecology and Obstetrics stages (adjusted OR 0.48 (0.13 to 1.78) for stage IIIB/C and 0.13 (0.04 to 0.45) for stage IV vs stage IA). Most (74%) had systemic therapy, which was more common for advanced stages (adjusted ORs >15.0 for stages III and IV vs stage IA). Few (9%) had radiotherapy. Women generally had systemic therapy (74%), without difference by service accessibility and socioeconomic disadvantage, suggesting equity. However, surgery was less common for residents of the most compared with least remote areas (adjusted OR 0.49 (0.24 to 0.99)); and more common prior to adjustment in the highest versus lowest socioeconomic category (unadjusted OR 1.55 (1.01 to 2.39)), but this elevation did not apply after adjustment (adjusted OR 0.19 (0.63 to 2.25)), with the difference largely explained by stage.

Conclusions

Hospital-registry data add value for assessing local service delivery. Equivalent survival to Australia-wide and USA survival, and temporal gains after adjusting for stage and other patient characteristics are reassuring. Survival gains may reflect therapeutic benefits of more extensive surgery and improved chemotherapy regimens.
Multicentre randomised controlled trial to investigate usefulness of the rapid diagnostic βLACTA test performed directly on bacterial cell pellets from respiratory, urinary or blood samples for the early de-escalation of carbapenems in septic intensive care unit patients: the BLUE-CarbA protocol
Authors: Garnier Marc , Gallah Salah , Vimont Sophie , Benzerara Yahia , Labbe Vincent , Constant Anne-Laure , Siami Shidasp , Guerot Emmanuel , Compain Fabrice , Mainardi Jean-Luc , Montil Mélissa , Quesnel Christophe
Published: February 2019

Introduction

The dramatic increase of the incidence of infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) has led to an increase of 50% of carbapenem consumption all around Europe in only 5 years. This favours the spread of carbapenem-resistant Gram-negative bacilli (GNB), causing life-threatening infections. In order to limit use of carbapenems for infections actually due to ESBL-PE, health authorities promote the use of rapid diagnostic tests of bacterial resistance. The objective of this work conducted in the intensive care unit (ICU) is to determine whether an early de-escalation of empirical carbapenems guided by the result of the βLACTA test is not inferior to the reference strategy of de-escalating carbapenems after the antibiogram result has been rendered.

Methods and analysis

This multicentre randomised controlled open-label non-inferiority clinical trial will include patients suffering from respiratory and/or urinary and/or bloodstream infections documented with GNB on direct examination and empirically treated with carbapenems. Empirical carbapenems will be adapted before the second dose depending on the results of the βLACTA test performed directly on the microbiological sample (intervention group) or after 48–72 hours depending on the definite antibiogram (control group). The primary outcome will combine 90-day mortality and percentage of infection recurrence during the ICU stay. The secondary outcomes will include the number of carbapenems defined daily doses and carbapenem-free days after inclusion, the proportion of new infections during ICU stay, new colonisation of patients’ digestive tractus with multidrug-resistant GNB, ICU and hospital length of stay and cost-effectiveness ratio.

Ethics and dissemination

This protocol has been approved by the ethics committee of Paris-Ile-de-France IV, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.

Trial registration number

NCT03147807.
Does care in a specialised stroke prevention clinic improve poststroke blood pressure control: a protocol for a randomised comparative effectiveness study
Authors: Sharrief Anjail Z , Hinojosa Evelyn , Cooksey Gail , Okpala Munachi N , Avritscher Elenir B , Pedroza Claudia , Denny Mary Carter , Samuels Joshua , Tyson Jon E , Savitz Sean I
Published: February 2019

Introduction

Hypertension is a major risk factor for recurrent stroke, and blood pressure (BP) reduction is associated with decreased risk of stroke recurrence. However, many stroke survivors have poorly controlled BP after their initial stroke. The Stroke Transitions Education and Prevention (STEP) Clinic was established to provide a comprehensive approach to stroke risk factor reduction.

Methods and analysis

This randomised comparative effectiveness study was designed to assess the impact of care in the STEP clinic versus usual care on poststroke BP reduction. Eligible hospitalised patients with ischaemic stroke, haemorrhagic stroke or transient ischaemic attack are scheduled for a clinic screening visit within 4 weeks of discharge if they meet baseline inclusion criteria. At the clinic visit, patients who have uncontrolled BP, defined as automated office BP ≥135/85 mm Hg are randomised (1:1) to either the STEP clinic or usual care for management. STEP clinic patients receive instructions to self-monitor, a BP monitor, sleep apnoea screening, dietary counselling, review of BP monitoring records and adjustment of medications. Patients are followed by a neurologist and a stroke-trained nurse practitioner. Usual care participants are seen by a neurologist and recommendations for secondary prevention are sent to primary care providers. The primary outcome is the difference in mean daytime ambulatory systolic BP at 6 months, assessed using linear regression analysis. Secondary outcomes include 24 hours ambulatory BP, medication adherence and medication self-efficacy, and composite cardiovascular events.

Ethics and dissemination

This study was approved by the Institutional Review Boards at the McGovern Medical School at the University of Texas Health Sciences Center and the Georgetown University School of Medicine. Uninsured and Spanish-speaking patients are included in the study.

Trial registration number

NCT02591394; Pre-results.
A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study
Authors: Myers Bronwyn , Carney Tara , Browne Felicia A , Wechsberg Wendee M
Published: February 2019

Objectives

Sexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects of a novel trauma-informed substance use and sexual risk reduction intervention for young South African women.

Design

A single arm feasibility test and qualitative interviews of participants.

Participants

Sixty women, between 18 and 25 years of age, who reported trauma exposure, substance use and recent condom-less sex were recruited. Twenty participants were randomly selected for qualitative interviews.

Intervention

A six-session group-based intervention.

Main outcome measures

We examined the proportion of women who provided consent, completed counselling and were retained in the study. Qualitative interviews explored intervention acceptability. Preliminary effects of the intervention on substance use, mental health (depression, psychological distress and trauma symptoms) and sexual risk outcomes (STI symptoms, number of partners and condomless sex) were explored.

Results

Of the 66 eligible women, 91% were enrolled. Intervention completion rates were low; 35% attended all sessions. On average, participants attended four sessions (M=3.8, SD=1.3). A 93% follow-up rate was achieved at the 3-month endpoint. In this single group design, reductions in the proportion of participants who tested positive for methamphetamine, cannabis and methaqualone were observed at the 3-month endpoint. Symptoms of depression, psychological distress and trauma; number of STI symptoms; and number of sexual partners also decreased. Outcomes were similar for participants who completed up to four and those who completed five or more sessions. Participants thought the intervention was highly beneficial and proposed modifications to enhance acceptability.

Conclusions

This novel intervention seems acceptable and holds potential benefits for trauma-exposed women who use substances. Truncating the intervention may enhance the likelihood of its implementation. The efficacy of the intervention for improving substance use, sexual risk and mental health outcomes requires testing in a controlled design.
Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry
Authors: van den Houten Marijn ML , Jansen Sandra CP , Sinnige Anneroos , van der Laan Lijckle , Vriens Patrick WHE , Willigendael Edith M , Lardenoije Jan-Willem HP , Elshof Jan-Willem M , van Hattum Eline S , Lijkwan Maarten A , Nyklíček Ivan , Rouwet Ellen V , Koelemay Mark JW , Scheltinga Marc RM , Teijink Joep AW
Published: February 2019

Introduction

Despite guideline recommendations advocating conservative management before invasive treatment in intermittent claudication, early revascularisation remains widespread in patients with favourable anatomy. The aim of the Effect of Disease Level on Outcomes of Supervised Exercise in Intermittent Claudication Registry is to determine the effect of the location of stenosis on the outcomes of supervised exercise in patients with intermittent claudication due to peripheral arterial disease.

Methods and analysis

This multicentre prospective cohort study aims to enrol 320 patients in 10 vascular centres across the Netherlands. All patients diagnosed with intermittent claudication (peripheral arterial disease: Fontaine II/Rutherford 1–3), who are considered candidates for supervised exercise therapy by their own physicians are appropriate to participate. Participants will receive standard care, meaning supervised exercise therapy first, with endovascular or open revascularisation in case of insufficient effect (at the discretion of patient and vascular surgeon). For the primary objectives, patients are grouped according to anatomical characteristics of disease (aortoiliac, femoropopliteal or multilevel disease) as apparent on the preferred imaging modality in the participating centre (either duplex, CT angiography or magnetic resonance angiography). Changes in walking performance (treadmill tests, 6 min walk test) and quality of life (QoL; Vascular QoL Questionnaire-6, WHO QoL Questionnaire-Bref) will be compared between groups, after multivariate adjustment for possible confounders. Freedom from revascularisation and major adverse cardiovascular disease events, and attainment of the treatment goal between anatomical groups will be compared using Kaplan-Meier survival curves.

Ethics and dissemination

This study has been exempted from formal medical ethical approval by the Medical Research Ethics Committees United ‘MEC-U’ (W17.071). Results are intended for publication in peer-reviewed journals and for presentation to stakeholders nationally and internationally.

Trial registration number

NTR7332; Pre-results.
Self-harm and social media: thematic analysis of images posted on three social media sites
Authors: Shanahan Nicola , Brennan Cathy , House Allan
Published: February 2019

Objectives

To explore the nature of images tagged as self-harm on popular social media sites and what this might tell us about how these sites are used.

Design

A visual content and thematic analysis of a sample of 602 images captured from Twitter, Instagram and Tumblr.

Results

Over half the images tagged as self-harm had no explicit representation of self-harm. Where there was explicit representation, self-injury was the most common; none of these portrayed images of graphic or shocking self-injury. None of the images we captured specifically encouraged self-harm or suicide and there was no image that could be construed as sensationalising self-harm.

Four themes were found across the images: communicating distress, addiction and recovery, gender and the female body, identity and belonging.

Conclusions

Findings suggest that clinicians should not be overly anxious about what is being posted on social media. Although we found a very few posts suggesting self-injury was attractive, there were no posts that could be viewed as actively encouraging others to self-harm. Rather, the sites were being used to express difficult emotions in a variety of creative ways, offering inspiration to others through the form of texts or shared messages about recovery.
Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life
Authors: Kennedy Beatrice , Chen Ruoqing , Fang Fang , Valdimarsdottir Unnur , Montgomery Scott , Larsson Henrik , Fall Katja
Published: February 2019

Background

While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.

Methods

In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.

Results

We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.

Conclusion

Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.
Towards Data-Driven Simulation Modeling for Mobile Agent-Based Systems
Authors: Keller Nicholas , Hu Xiaolin
Published: February 2019

Simulation models are widely used to study complex systems. Current simulation models are generally handcrafted using expert knowledge (knowledge-driven); however, this process is slow and introduces modeler bias. This article presents an approach towards data-driven simulation modeling by developing a framework that discovers simulation models in an automated way for mobile agent-based applications. The framework is comprised of three components: (1) a model space specification, (2) a search method (genetic algorithm), and (3) framework measurement metrics. The model space specification provides a formal specification for the general model structure from which various models can be generated. The search method is used to efficiently search the model space for candidate models that exhibit desired behavior patterns. The five framework measurement metrics: flexibility, comprehensibility, controllability, composability, and robustness, are developed to evaluate the overall framework. The results demonstrate that it is possible to discover a variety of interesting models using the framework.
Ethanol withdrawal mitigates fatty liver by normalizing lipid catabolism
Authors: Thomes Paul G. , Rasineni Karuna , Yang Li , Donohue Terrence M. , Kubik Jacy L. , McNiven Mark A. , Casey Carol A.
Published: February 2019

We are investigating the changes in hepatic lipid catabolism that contribute to alcohol-induced fatty liver. Following chronic ethanol (EtOH) exposure, abstinence from alcohol resolves steatosis. Here, we investigated the hepatocellular events that lead to this resolution by quantifying specific catabolic parameters that returned to control levels after EtOH was withdrawn. We hypothesized that, after its chronic consumption, EtOH withdrawal reactivates lipid catabolic processes that restore lipostasis. Male Wistar rats were fed control and EtOH liquid diets for 6 wk. Randomly chosen EtOH-fed rats were then fed control diet for 7 days. Liver triglycerides (TG), lipid peroxides, key markers of fatty acid (FA) metabolism, lipophagy, and autophagy were quantified. Compared with controls, EtOH-fed rats had higher hepatic triglycerides, lipid peroxides, and serum free fatty acids (FFA). The latter findings were associated with higher levels of FA transporters (FATP 2, 4, and 5) but lower quantities of peroxisome proliferator-activated receptor-α (PPAR-α), which governs FA oxidation. EtOH-fed animals also had lower nuclear levels of the autophagy-regulating transcription factor EB (TFEB), associated with lower hepatic lipophagy and autophagy. After EtOH-fed rats were refed control diet for 7 days, their serum FFA levels and those of FATPs fell to control (normal) levels, whereas PPAR-α levels rose to normal. Hepatic TG and malondialdehyde levels in EtOH-withdrawn rats declined to near control levels. EtOH withdrawal restored nuclear TFEB content, hepatic lipophagy, and autophagy activity to control levels. EtOH withdrawal reversed aberrant FA metabolism and restored lysosomal function to promote resolution of alcohol-induced fatty liver.

NEW & NOTEWORTHY Here, using an animal model, we show mechanisms of reversal of fatty liver and injury following EtOH withdrawal. Our data indicate that reactivation of autophagy and lysosome function through the restoration of transcription factor EB contribute to reversal of fatty liver and injury following EtOH withdrawal.