bluuebunny/crossref_metadata_2025 huggingface dataset:
Alternative prenatal care interventions to alleviate Black–White maternal/infant health disparities
Authors: Adams Crystal , Thomas Shameka Poetry
Published: November 2017

This paper attempts to forward the maternal health literature that critiques standard prenatal care in the United States by drawing on intersectionality, medicalization, and fundamental causation theories. We argue that these theories deepen our understanding of the maternal health experiences of Black women and can help explain why alternative prenatal care interventions have value for Black pregnant women. Alternative models of prenatal care, which include the use of midwives, doulas, and group prenatal care, are associated with equal or better health outcomes for infants and mothers compared to the standard prenatal model in the United States. We begin by drawing on these sociological perspectives to identify gaps in the maternal health literature that is critical of standard biomedical maternal health approaches. We then go on to describe select alternative methods of prenatal care and then provide a summary of the epidemiological literature as it relates to sociodemographic trends in usage and the relative effectiveness of alternative models compared to standard care. We conclude by arguing that a joint, critical application of these three theories can help scholars explain the utility of alternative interventions for African American maternal/infant health and can inform policies that aim to alleviate Black–White maternal/infant health disparities.
A novel HLA‐A*26 allele, HLA‐A*26:01:44, identified in a Caucasian individual
Authors: Mostafa A. A. , Petrosenko M. , Stamm L. , Khan F. , Berka N.
Published: November 2017

HLA‐A*26:01:44 differs from HLA‐A*26:01:01 by a single substitution in exon 5.
PROPER ORTHOGONAL DECOMPOSITION: A TOOL TO STUDY THE UNDERLYING PHYSICS OF TURBULENCE
Authors: Mohd Yahya Syed , Anwer Syed Fahad , Sanghi Sanjeev
Published: November 2017

Wall bounded turbulence have been investigated by many authors to understand the underlying physics, experimentally as well as numerically with different techniques and methods. Enormous studies are reported in the literature in the field of turbulence to get the insight of near wall structure in a broad spectrum of Reynolds number. To recognize the contribution of different turbulent scales in a flow a well-known technique, Proper Orthogonal decomposition (POD) is used. Dynamical behaviour of coherent structure in a turbulent channel flow submitted to high temperature gradient is investigated via proper orthogonal decomposition (POD). The turbulent data is generated using thermal large eddy simulation (TLES) of channel flow at Re = 180 for two values of temperature ratio between hot and cold wall. The POD technique is applied to fluctuating part of the velocity to study the temporal evolution of the most energetic modes. It is observed that dominant flow structures are elongated in streamwise direction which further distorted due to the interaction with bean shaped propagating modes. The plotted average energy E(t) as a function of non-dimensional time shows a constant level of fluctuating energy with one little peak at t+ = 1000, all other smaller spikes are showing constant fluctuations about mean line. This behavior at  quantitatively describe the role of temperature stratification which stabilizes the roll mode energy and prevent them from breakup into smaller scales thus affects the interaction process during turbulent burst event resulting in a chugging or relaminarizing phenomenon. It is observed that thermal stratification decreases the bursting rate by slowing the breaking mechanism of streamwise elongated modes to larger number of bean shaped modes which results in relaminarization of the flow near hot wall.
FLAMMABILITY AND BURNING RATES OF LOW QUALITY BIOGAS AT ATMOSPHERIC CONDITION
Authors: Suhaimi Mohd Suardi , Saat Aminuddin , Abdul Wahid Mazlan
Published: November 2017

This study focuses on the flammability and burning rate of simulated and actual biogas-air mixture for equivalence ratio of 0.5 to 1.0. The content of simulated biogas was set at 50% CH4 and 50% CO2 to emulate the typical composition of low quality biogas. Studies on low quality biogas combustion with this particular CH4 and CO2 content are still scarce in literature. It was found that the flammability limits fall within the same range for both simulated and actual biogas from 0.6 to 0.9 which is substantially narrower compared to pure methane. Incidence of flame buoyancy were observed for both simulated and actual biogas at equivalence ratio of 0.6 and 0.7. The maximum burning rates were almost identical for simulated and actual biogas at 21.18 cm/s and 24.74 cm/s respectively. It was also found that the peak of burning rate occurs at the leaner equivalence ratio of 0.8 for both simulated and actual biogas. These observations imply the significance of CO2 on biogas combustion. Compared to pure methane, the reduction in burning rate and the shift in the peak burning rate to the leaner mixture suggest the physical and chemical effects of CO2 on biogas combustion. Physically, the presence of CO2 could adversely affect the temperature driven CH4 preferential diffusion into the reaction zone since CO2 could absorb some of the heat released during combustion. When present at 50% or higher, CO2 could significantly reduce OH radical formation thereby narrowing the flammability limits and reducing the burning rates.
TRIBOLOGICAL PROPERTIES OF POTENTIAL BIO-BASED LUBRICANTS FROM RBD PALM STEARIN AND PALM FATTY ACID DISTILLATE
Authors: Zuan A. M. S. , Syahrullail S. , Yahya W. J. , Shafiq M. N. , Fawwaz Y. M.
Published: November 2017

Palm-based oil properties, which consist of long fatty acid chains, have the potential to replace current mineral oils. Recent studies have shown that palm-based oil has comparable lubricating properties to those of commercial engine oil. However, several palm oil products yet to be discover as lubricants such as RBD Palm Stearin (RBD PS) and Palm Fatty Acid Distillate (PFAD) due to its solid form properties. In this study, both RBD PS and PFAD has been tested for the suitability as lubricant in the tribological experiments consists of anti-wear test and extreme pressure test according to ASTM standards of D4172 B and 2783 respectively. In ASTM D4172 B, test has been conducted with 40kg load and 1200 rpm speed at 75°C in duration of 60 minutes while in ASTM 2783 the temperature and speed are remain constant at 45°C and 1760 rpm in duration of 10 minutes with increasing loads until failure detected. Mineral Oil (MO) has been used as a direct comparison between commercial engine oil and bio-based palm oil. Results shows PFAD has recorded lowest average coefficient of friction (COF), wear scar diameter (WSD) and surface roughness at 0.038, 433µm and 0.188µm in anti-wear test. In the extreme pressure test, RBD PS shows the earliest failure of 4mm wear scar diameter at 126kg followed by palm fatty acid distillate and mineral oil at 130kg and 146kg load.
EFFECT OF VARYING THE DOUBLE RADIAL SWIRLER CONFIGURATION ON THE FLUID DYNAMIC AND EMISSIONS PERFORMANCES IN A CAN COMBUSTOR
Authors: Md Zainul Mohd Najib , Mohd Jaafar Mohammad Nazri , Mat Lazim Tholudin
Published: November 2017

The main purpose of this article is to present the fluid dynamic and combustion performances of a can combustor applying double radial flow swirler. Analysis was conducted using Computational Fluid Dynamics simulation (CFD) and compared with experimental works conducted by previous researchers. Air pollution, in the form of gaseous emissions from gas turbine generator reportedly increasing every year. Design modifications was identified and used in this study where air swirler been proven able to reduce the formation rate of gaseous emission such as NOx and CO during combustion.  Swirler in a burner is a device that serves to improve the air and fuel mixture in the main combustion zone. Swirlers, presently studied are from a combination of two radial swirlers with different vane angle (primary and secondary) such as 30o/40o, 30o/50o and 30o/60o.  Application of Ansys Fluent 14 CFD solvers was used in this study. Turbulent flow model used was from Reynolds Average Navier-Stokes (RANS) type involving k-ϵ. The fuel used is diesel. The parameters studied were wall temperature distribution along the combustor, the volume of NOx and volume of CO in the main combustion zone. Results from this study showed that the combination of 30o/60o generates the lowest gaseous emissions production rate. The highest average percentage error obtained by simulation studies compared to the actual experimental values for NOx was 22% and CO was 17.8%. Comparison between simulation and actual study proves that the simulation method can be used for preliminary decision and able to be used as benchmark to determine which is the best swirler configuration.
HELICAL TWISTED EFFECT OF SPIRAL PIPE IN GENERATING SWIRL FLOW FOR COAL SLURRIES CONVEYANCE
Authors: Yanuar Yanuar , T. Waskito Kurniawan , Mau Sealtial , Wulandari Winda , P. Sari Sri
Published: November 2017

This paper proposes methods to reduce energy consumption for the transportation of coal slurries. Spiral pipe is one of the methods that can improve drag reduction at certain velocity as well as prevent decomposition at the pipe bottom and generate homogenous particles distribution. The objective is to investigate the influence of using spiral pipe to pressure drop and homogeneity of coal slurries. The pipe angles (β) are 140, 230, 400 and 560, the pipe test loop is set up with entrance length 3000 mm. Pressure Transducer and pitot tube are used in the measurements. Percentage of the particle concentrations are varied by weight of 30 %, 40 % and 50 %. The helical angle gives significant effect to eliminate decomposition at the pipe bottom. At CW 50 %, homogeneity of the slurries can reach around 96 % at helical angle 230, It means the mixture between solid material and water more uniform, using circular pipe the homogeneity is only 74 %. Weight concentration of the solid particles and Reynolds number gives significant effect to the drag reduction. Flow of CW =50 % slurry at Re~5x104 through 23° spiral pipe can increase drag reduction by about 30%. Velocity profiles were obtained from numerical CFD simulation validated experimental results make clear the flow characteristics.
Nonlinear Models for Magnet Placement in Individually Actuated Magnetic Cilia Devices
Authors: Banka Nathan , Devasia Santosh
Published: November 2017

This paper presents a model for predicting the optimal magnet placement in magnetic cilia devices that achieve individual control via localization of the driving magnetic field. In this configuration, each cilium is controlled by a magnetic field source which is limited in spatial extent, and the cilia are spaced sufficiently far apart that the control remains uncoupled. An implementation is presented using an electromagnetic field source to attain large-deformation actuation (transverse deflections of 47% of the length). The large deformations are achieved by exploiting the nonlinear response of a flexible cantilever in a nonuniform magnetic field. However, the same nonlinearities also pose a modeling challenge: the overall performance is sensitive to the location of the electromagnet and the location that produces the largest deflections is nonlinearly dependent on the strength of the magnetic field. The nonlinear displacement of the cilium is predicted using a finite element model of the coupled magnetic–structural equations for static inputs at varying field strengths and magnet positions. The deflection at the model-predicted optimal placement is within 5% of the experiment-predicted optimal placement. Moreover, actuator placement using a model that does not include the nonlinearities is estimated to result in performance loss of about 50% peak deflection. This result emphasizes the importance of capturing nonlinearities in the system design.
Set-Point Adaptation Strategy of Air Systems of Light-Duty Diesel Engines for NOx Emission Reduction Under Acceleration Conditions
Authors: Min Kyunghan , Kim Haksu , Han Manbae , Sunwoo Myoungho
Published: November 2017

Modern diesel engines equip the exhaust gas recirculation (EGR) system because it can suppress NOx emissions effectively. However, since a large amount of exhaust gas might cause the degradation of drivability, the control strategy of EGR system is crucial. The conventional control structure of the EGR system uses the mass air flow (MAF) as a control indicator, and its set-point is determined from the well-calibrated look-up table (LUT). However, this control structure cannot guarantee the optimal engine performance during acceleration operating conditions because the MAF set-point is calibrated at steady operating conditions. In order to optimize the engine performance with regard to NOx emission and drivability, an optimization algorithm in a function of the intake oxygen fraction (IOF) is proposed because the IOF directly affects the combustion and engine emissions. Using the NOx and drivability models, the cost function for the performance optimization is designed and the optimal value of the IOF is determined. Then, the MAF set-point is adjusted to trace the optimal IOF under engine acceleration conditions. The proposed algorithm is validated through scheduled engine speeds and loads to simulate the extra-urban driving cycle of the European driving cycle. As validation results, the MAF is controlled to trace the optimal IOF from the optimization method. Consequently, the NOx emission is substantially reduced during acceleration operating conditions without the degradation of drivability.
Numerical and Experimental Analysis of Impinging Synthetic Jets for Cooling a Point-Like Heat Source
Authors: Glowienko Robert , Derlien Hans , Ertunc Oezguer , Delgado Antonio
Published: November 2017

High power light emitting diodes (LEDs) being used for low and high beam in automotive lighting need active cooling of their heat sinks by radial or axial fans. But the moving elements of the fan cause abrasion, noise, and high energy consumption. Synthetic jets can replace conventional fans with their disadvantages and allow the directed cooling of LEDs. Therefore, in this paper, flow and heat transfer characteristics of impinging synthetic jets are investigated numerically and experimentally as an alternative to cooling LEDs with fans. It is shown that the impact plate brings forward the laminar-turbulent transition of the jets temporally and spatially. The impact plate itself should not be positioned in the region of the free jet's transition height. Increasing the frequency of the synthetic jet has a greater influence on the heat transfer compared to an increase in amplitude. The maximum cooling performance is achieved for all jet configurations with moderate distances between the orifice and the impact plate. In this case, the jet reaches its highest mass flow and impulse and its lowest temperature.
Application of the WSGG Model to Solve the Radiative Transfer in Gaseous Systems With Nongray Boundaries
Authors: da Fonseca Roberta Juliana Collet , Fraga Guilherme Crivelli , da Silva Rogério Brittes , França Francis Henrique Ramos
Published: November 2017

This paper presents a methodology for the application of the weighted-sum-of-gray-gases (WSGG) model to systems where the medium is bounded by nongray surfaces. The method relies on the assumption that each gray gas absorption coefficient is randomly spread across the entire wavenumber spectrum. It follows that, in the spectral integration of the radiative transfer equation (RTE), the local emission term can be computed by the joint probability of emission from the subsections of the spectrum related to each gray gas coefficient and from each wall emissivity band. One advantage of the proposed methodology is that it allows the use without any modification of WSGG correlations that are available in the literature. The study presents a few test cases considering a one-dimensional (1D), nonuniform medium slab composed of H2O and CO2, bounded by nongray surfaces. The accuracy of the methodology is assessed by direct comparison with line-by-line (LBL) calculations.
Multivariate Response Rotordynamic Modeling and Sensitivity Analysis of Tilting Pad Bearings
Authors: Urbiola-Soto Leonardo
Published: November 2017

Achieving an optimal design of journal bearings is a very challenging effort due to the many input and output variables involved, including rotordynamic and tribological responses. This paper demonstrates the use of a multivariate response modeling approach based on response surface design of experiments (RSDOE) to design tilting pad bearings. It is shown that an optimal configuration can be achieved in the early stages of the design process while substantially reducing the amount of calculations. To refine the multivariate response model, statistical significance of the factors was assessed by examining the test's p-value. The effect coefficient calculation complemented the statistical hypothesis testing as an overall quantitative measure of the strength of factors, namely; main effects, quadratic effects, and interactions between variables. This provided insight into the potential nonlinearity of the phenomena. Once arriving at an optimized design, a sensitivity analysis was performed to identify the input variables whose variabilities have the greatest influence on the mean of a given response. Finally, an analysis of percent contribution of each input variable standard deviation to the actual response standard deviation was performed.
Dynamic Similarity in Turbine Deposition Testing and the Role of Pressure
Authors: Sacco C. , Bowen C. , Lundgreen R. , Bons J. P. , Ruggiero E. , Allen J. , Bailey J.
Published: November 2017

The role of absolute pressure in deposition testing is reviewed from first principles. Relevant dimensionless parameters for deposition testing are developed and dynamic similarity conditions are assessed in detail. Criteria for establishing appropriate conditions for laboratory studies of deposition are established pursuant to the similarity variables. The role of pressure is particularly singled out for consideration relative to other variables such as temperature, particle size, and test article geometry/scaling. A case study is presented for deposition in a generic array of impinging jets. A fixed quantity (2 g) of 0–10 μ Arizona road dust (ARD) is delivered to the impingement array at three different temperatures (290, 500, and 725 K) and at fixed pressure ratio. Deposition results are presented for operating pressures from 1 to 15 atm. Surface scans show that the height of deposit cones at the impingement sites decreases with increasing pressure at constant temperature and pressure ratio. This reduction is explained by the lower “effective” Stokes number that occurs at high particle Reynolds numbers, yielding fewer particle impacts at high pressure. A companion computational fluid dynamics (CFD) study identifies the additional role of Reynolds number in both the impingement hole losses and the shear layer thickness.
Artificially lit surface of Earth at night increasing in radiance and extent
Authors: Kyba Christopher C. M. , Kuester Theres , Sánchez de Miguel Alejandro , Baugh Kimberly , Jechow Andreas , Hölker Franz , Bennie Jonathan , Elvidge Christopher D. , Gaston Kevin J. , Guanter Luis
Published: November 2017

Earth’s artificially lit area is expanding at 2.2% per year, with existing lit areas brightening by 2.2% per year.
Synthetic “smart gel” provides glucose-responsive insulin delivery in diabetic mice
Authors: Matsumoto Akira , Tanaka Miyako , Matsumoto Hiroko , Ochi Kozue , Moro-oka Yuki , Kuwata Hirohito , Yamada Hironori , Shirakawa Ibuki , Miyazawa Taiki , Ishii Hitoshi , Kataoka Kazunori , Ogawa Yoshihiro , Miyahara Yuji , Suganami Takayoshi
Published: November 2017

A synthetic polymer gel–based insulin delivery device provides an artificial pancreas–like function in healthy and diabetic mice.
Battle over drilling in Arctic refuge reignites
Authors: Cornwall Warren
Published: November 2017

North America's largest and healthiest caribou herd could be at risk, conservationists fear.
Congress offers defense scientists a bigger payday
Authors: Mervis Jeffrey
Published: November 2017

Legislation boosts royalties that scientists at military laboratories can get from their patented inventions.
The fundamental advantages of temporal networks
Authors: Li A. , Cornelius S. P. , Liu Y.-Y. , Wang L. , Barabási A.-L.
Published: November 2017

In network science, change is good

Historically, network science focused on static networks, in which nodes are connected by permanent links. However, in networked systems ranging from protein-protein interactions to social networks, links change. Although it might seem that permanent links would make it easier to control a system, Li
et al.
demonstrate that temporality has advantages in real and simulated networks. Temporal networks can be controlled more efficiently and require less energy than their static counterparts.

Science
, this issue p.
1042
The way forward for vector control
Authors: Hemingway Janet
Published: November 2017

Pesticide resistance must be countered to control insects that serve as disease vectors
Response to Comment on “Water harvesting from air with metal-organic frameworks powered by natural sunlight”
Authors: Kim Hyunho , Rao Sameer R. , Kapustin Eugene A. , Narayanan Shankar , Yang Sungwoo , Furukawa Hiroyasu , Umans Ari S. , Yaghi Omar M. , Wang Evelyn N.
Published: November 2017

The Comment by Meunier states that the process we described in our report cannot deliver the claimed amount of liquid water in an arid climate. This statement is not valid because the parameters presented in our study were inappropriately combined to draw misguided conclusions.
Three-dimensional mechanical metamaterials with a twist
Authors: Frenzel Tobias , Kadic Muamer , Wegener Martin
Published: November 2017

Getting twisted with metamaterials

In the classical picture of solid mechanics, deformation in response to stress is constrained owing to limitations on the degrees of freedom. For instance, when you push on a material, you do not expect it to twist in response. Frenzel
et al.
designed a mechanical metamaterial with a pronounced twist to the left or right when pushed (see the Perspective by Coulais). Designing this type of chirality for a macroscopic material is unexpected, but it points to a more general strategy for developing materials with unusual deformation behavior.

Science
, this issue p.
1072
; see also p.
994
Soft robotic ventricular assist device with septal bracing for therapy of heart failure
Authors: Payne Christopher J. , Wamala Isaac , Bautista-Salinas Daniel , Saeed Mossab , Van Story David , Thalhofer Thomas , Horvath Markus A. , Abah Colette , del Nido Pedro J. , Walsh Conor J. , Vasilyev Nikolay V.
Published: November 2017

A soft robotic device assists blood flow in isolated left or right heart failure by applying rhythmic loading to either ventricle.
Complete 4.55-Megabase-Pair Genome of “
Candidatus
Fluviicola riflensis,” Curated from Short-Read Metagenomic Sequences
Authors: Banfield Jillian F. , Anantharaman Karthik , Williams Kenneth H. , Thomas Brian C.
Published: November 2017

We report the 4.55-Mbp genome of “
Candidatus
Fluviicola riflensis” (
Bacteroidetes
) that was manually curated to completion from Illumina data. “
Ca
. Fluviicola riflensis” is a facultative anaerobe. Its ability to grow over a range of O
2
levels may favor its proliferation in an aquifer adjacent to the Colorado River in the United States.
Complete Genome Sequence of Human Coronavirus Strain 229E Isolated from Plasma Collected from a Haitian Child in 2016
Authors: Bonny Tania S. , Subramaniam Kuttichantran , Waltzek Thomas B. , Elbadry Maha A. , Beau De Rochars Valery Madsen , Telisma Taina , Rashid Mohammed , Morris J. Glenn , Lednicky John A.
Published: November 2017

Human coronavirus strain 229E (HCoV-229E) and human alphaherpesvirus 1 were isolated from the plasma of a Haitian child in 2016 with suspected arbovirus diseases. To our knowledge, this is the first description of HCoV-229E in human plasma, which is the focus of this article.
Draft Genome Sequence of the Arsenic-Resistant Bacterium Brevundimonas denitrificans TAR-002
T
Authors: Tsubouchi Taishi , Kaneko Yukihiro
Published: November 2017

We report the 3.2-Mb draft genome sequence of
Brevundimonas denitrificans
strain TAR-002
T
, isolated from deep-sea floor sediment. The draft genome sequence of strain TAR-002
T
consists of 3,231,216 bp in 44 contigs, with a G+C content of 68.47%, 3,866 potential coding sequences (CDSs), 3 rRNAs, and 45 tRNAs.
Draft Genome Sequence of an Indian Marine Cyanobacterial Strain with Fast Growth and High Polyglucan Content
Authors: Pathania Ruchi , Ahmad Ahmad , Srivastava Shireesh
Published: November 2017

Marine cyanobacteria play an important role in global carbon cycling and are a potential source of polyglucans for biotechnological purposes. This report provides the draft sequence of an Indian marine cyanobacterium,
Synechococcus elongatus
BDU 130192, which shows fast growth and high polyglucan content. The genome sequence will help in understanding the unique properties of this organism.
Complete Genome Sequences of Campylobacter jejuni Strains Isolated from Retail Chicken and Chicken Gizzards
Authors: Marasini Daya , Fakhr Mohamed K.
Published: November 2017

Genome sequences of
Campylobacter jejuni
FJ3124 and ZP3204 isolated from retail chicken gizzards and
Campylobacter jejuni
TS1218 isolated from retail chicken showed the presence of 1,694,324-, 1,763,161-, and 1,762,596-bp circular chromosomes, respectively.
Campylobacter jejuni
ZP3204 and TS1218 harbored large tetracycline resistance plasmids with type IV secretion systems.
A Novel Biomimetic Nanosponge Protects the Retina from the Enterococcus faecalis Cytolysin
Authors: LaGrow Austin L. , Coburn Phillip S. , Miller Frederick C. , Land Craig , Parkunan Salai Madhumathi , Luk Brian T. , Gao Weiwei , Zhang Liangfang , Callegan Michelle C.
Published: November 2017

Endophthalmitis is a serious, potentially blinding infection that can result in vision loss, leaving a patient with only the ability to count fingers, or it may require enucleation of the globe. The incidence of postoperative endophthalmitis has markedly increased over the past 2 decades, paralleling the rise in ocular surgeries and intravitreal therapies.
E. faecalis
is a leading cause of infection following ocular procedures, and such infections are increasingly difficult to treat due to multidrug resistance. Cytolysin is the primary virulence factor responsible for retinal tissue damage in
E. faecalis
eye infections. Treatment of these infections with antibiotics alone does not impede ocular damage and loss of visual function. Pore-forming toxins (PFTs) have been established as major virulence factors in endophthalmitis caused by several bacterial species. These facts establish a critical need for a novel therapy to neutralize bacterial PFTs such as cytolysin. Here, we demonstrate that biomimetic nanosponges neutralize cytolysin, protect the retina, preserve vision, and may provide an adjunct detoxification therapy for bacterial infections.
Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study
Authors: Dohbit Julius Sama , Foumane Pascal , Tochie Joel Noutakdie , Mamoudou Fadimatou , Temgoua Mazou N , Tankeu Ronni , Aletum Veronica , Mboudou Emile
Published: November 2017

Background and objectives

Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon.

Design

A retrospective cohort study.

Setting

A tertiary hospital in Yaounde, Cameroon.

Participants

Cases of VBD of newborns weighing 2500–3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500–3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery.

Outcome measures

Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction.

Results

Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001).

Conclusion

The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications.
Use of driving-impairing medicines by a Spanish population: a population-based registry study
Authors: Gutierrez-Abejón Eduardo , Herrera-Gómez Francisco , Criado-Espegel Paloma , Alvarez F Javier
Published: November 2017

Objective

To assess the use of driving-impairing medicines (DIM) in the general population with special reference to length of use and concomitant use.

Design

Population-based registry study.

Setting

The year 2015 granted medicines consumption data recorded in the Castile and León (Spain) medicine dispensation registry was consulted.

Participants

Medicines and DIM consumers from a Spanish population (Castile and León: 2.4 million inhabitants).

Exposure

Medicines and DIM consumption. Patterns of use by age and gender based on the length of use (acute: 1–7 days, subacute: 8–29 days and chronic use: ≥30 days) were of interest. Estimations regarding the distribution of licensed drivers by age and gender were employed to determine the patterns of use of DIM.

Results

DIM were consumed by 34.4% (95% CI 34.3% to 34.5%) of the general population in 2015, more commonly with regularity (chronic use: 22.5% vs acute use: 5.3%) and more frequently by the elderly. On average, 2.3 DIM per person were dispensed, particularly to chronic users (2.8 DIM per person). Age and gender distribution differences were observed between the Castile and León medicine dispensation registry data and the drivers’ license census data. Of all DIM dispensed, 83.8% were in the Anatomical Therapeutic Chemical code group nervous system medicines (N), which were prescribed to 29.2% of the population.

Conclusions

The use of DIM was frequent in the general population. Chronic use was common, but acute and subacute use should also be considered. This finding highlights the need to make patients, health professionals, health providers, medicine regulatory agencies and policy-makers at large aware of the role DIM play in traffic safety.
Identifying clinical features in primary care electronic health record studies: methods for codelist development
Authors: Watson Jessica , Nicholson Brian D , Hamilton Willie , Price Sarah
Published: November 2017

Objective

Analysis of routinely collected electronic health record (EHR) data from primary care is reliant on the creation of codelists to define clinical features of interest. To improve scientific rigour, transparency and replicability, we describe and demonstrate a standardised reproducible methodology for clinical codelist development.

Design

We describe a three-stage process for developing clinical codelists. First, the clear definition a priori of the clinical feature of interest using reliable clinical resources. Second, development of a list of potential codes using statistical software to comprehensively search all available codes. Third, a modified Delphi process to reach consensus between primary care practitioners on the most relevant codes, including the generation of an ‘uncertainty’ variable to allow sensitivity analysis.

Setting

These methods are illustrated by developing a codelist for shortness of breath in a primary care EHR sample, including modifiable syntax for commonly used statistical software.

Participants

The codelist was used to estimate the frequency of shortness of breath in a cohort of 28 216 patients aged over 18 years who received an incident diagnosis of lung cancer between 1 January 2000 and 30 November 2016 in the Clinical Practice Research Datalink (CPRD).

Results

Of 78 candidate codes, 29 were excluded as inappropriate. Complete agreement was reached for 44 (90%) of the remaining codes, with partial disagreement over 5 (10%). 13 091 episodes of shortness of breath were identified in the cohort of 28 216 patients. Sensitivity analysis demonstrates that codes with the greatest uncertainty tend to be rarely used in clinical practice.

Conclusions

Although initially time consuming, using a rigorous and reproducible method for codelist generation ‘future-proofs’ findings and an auditable, modifiable syntax for codelist generation enables sharing and replication of EHR studies. Published codelists should be badged by quality and report the methods of codelist generation including: definitions and justifications associated with each codelist; the syntax or search method; the number of candidate codes identified; and the categorisation of codes after Delphi review.
BET 1: Can the Manchester Acute Coronary Syndromes and Troponin-only Manchester Acute Coronary Syndromes decision aids rule out acute coronary syndromes in the emergency department?
Authors: Reynard Charles , Ismail Husam , Hadden Nicholas
Published: November 2017

A short-cut review was carried out to establish whether the Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids can safely rule out acute coronary syndromes in patients presenting to the ED with suspected cardiac chest pain. Six studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that both rules have high sensitivity for acute coronary syndromes, including the detection of major adverse cardiac events at 30 days. The original MACS algorithm may have marginally greater sensitivity than T-MACS but has inferior specificity and requires the use of a biomarker assay (for heart-type fatty acid binding protein) that is not currently widely used in practice.
Abstracts from international Emergency Medicine Journals
Authors: Weber Ellen J
Published: November 2017

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
13 Prophylactic antibiotics for penetrating injury: a review of practice at a major trauma centre, literature review and recommendations
Authors: Kamarova Marharyta , Kendall Richard
Published: November 2017

Background

There is a lack of clarity regarding the use of prophylactic antibiotics for patients presenting with penetrating injuries. A structured literature review and review of penetrating injury records in an MTC was undertaken with a view to help guide clinical practice.

Method

Searches were conducted on Medline (1946–2017), Embase (1974–2017), and Cochrane (up to 2017) using key words pertaining to penetrating trauma, prophylactic antibiotics and infection. Cases of penetrating injury presenting to one MTC during 2015–2016 were extracted from the TARN database. Patient information (age, sex), injury details (ISS score, anatomical site, nature), antibiotic use in ED, and infectious outcomes were analysed.

Results

A 2012 systematic review by Bosmanet al.included 11 RCTs, totalling 1234 patients with blunt and penetrating chest injuries requiring tube thoracostomy. Those that were given prophylactic antibiotics were less likely to develop empyema (OR:0.32), pneumonia (OR:0.51) and wound infections (OR:0.41) compared to placebo.

A 2013 Cochrane meta-analysis on penetrating abdominal trauma found no RCTs comparing infection outcomes for prophylactic antibiotics vs placebo. No further trials have since been done. EAST guidelines (2012) recommend a single dose of prophylactic antibiotics for penetrating abdominal trauma. No relevant trials were found for penetrating soft tissue injuries.

70 penetrating injuries for 2015–2016 were recorded on TARN, 40 of which were transfers from other hospitals. Half of the total injuries were stabbings, with the rest being shootings, falls and crush injuries. 62.5% of patients were given prophylactic antibiotics in ED. 83% of the remaining patients received antibiotics for another indication.

Conclusions

Strong evidence exists for the use of prophylactic antibiotics for chest wounds requiring tube thoracostomy. The Cochrane review concluded that there is no evidence base for prophylactic antibiotic use for penetrating abdominal trauma, with EAST recommendations based on weaker evidence.

Drawing conclusions about infectious outcomes from TARN data is difficult due to low total numbers, differences in record-keeping for secondary transfers and a high proportion of patients with another requirement for antibiotics.

For penetrating thoracic injury requiring chest drain there is evidence of benefit for prophylactic antibiotics, in other patients with penetrating injury due to the current lack of evidence, clinical judgement based on the circumstances of penetrating injury is recommended.
2 Major incident triage and the implementation of a new triage tool, the MPTT-24
Authors: Vassallo James , Smith Jason
Published: November 2017

Introduction

Over the last decade, a number of European cities including London, have witnessed high profile terrorist attacks resulting in major incidents with large numbers of casualties. Triage, the process of categorising casualties on the basis of their clinical acuity, is a key principle in the effective management of major incidents.

The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool which in comparison to existing triage tools, including the 2013 UK NARU Sieve, demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations.

To improve the applicability and usability of the MPTT we increased the upper respiratory rate threshold to 24 breaths per minute (MPTT-24), to make it divisible by four, and included an assessment of external catastrophic haemorrhage. The aim of this study was to conduct a feasibility analysis of the proposed MPTT-24 (figure 1).

Figure 1

MPTT-24

Methods

A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult (>18 years) patients presenting between 2006–2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they had received one or more life-saving interventions.

Using first recorded hospital physiology, patients were categorised as P1 or not-P1 by existing triage tools and both MPTT and MPTT-24. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage with a McNemar test to determine statistical significance.

Results

Basic study characteristics are shown in Table 1. Both the MPTT and MPTT-24 outperformed all existing triage methods with a statistically significant (p<0.001) absolute reduction of between 25.5%–29.5% in under-triage when compared to existing UK civilian methods (NARU Sieve). In both populations the MPTT-24 demonstrated an absolute reduction in sensitivity with an increase in specificity when compared to the MPTT. A statistically significant difference was observed between the MPTT and MPTT-24 in the way they categorised TARN and JTTR cases as P1 (p<0.001).

Table 1

Study characteristics

Table 2

Performance analysis

Conclusion

Existing UK methods of primary major incident triage, including the NARU Sieve, are not fit for purpose, with unacceptably high rates of under-triage. When compared to the MPTT, the MPTT-24 allows for a more rapid triage assessment and continues to outperform existing triage tools at predicting need for life-saving intervention. Its use should be considered in civilian and military major incidents.
20 Risk factors for admission at three, urban emergency departments in england: a cross-sectional analysis of attendances over one month
Authors: Pope Ian , Ismail Sharif , McCoy David , Harris Tim
Published: November 2017

Objective

To investigate factors associated with unscheduled admission following presentation to Emergency Departments (EDs) at three hospitals in England.

Design and setting

Cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (Site 1), and two district general hospitals (Sites 2 and 3). Variables included: patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included.

Outcome measure

The primary outcome for the study was unscheduled admission.

Participants

All adults aged 16 and over attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered.

Results

Outcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at Sites 2 and 3 (AOR relative to Site 1 for Site 2 was 1.89, 95% CI:1.74 to 2.05, p<0.001), and for patients of black or black British ethnicity (1.29, 1.16–1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the ‘four-hour target’ (a rule that limits patient stays in EDs to four hours in the NHS in England) emerged as a strong driver for admission in this analysis (3.61, 3.30–3.95, p<0.001).

Conclusion

This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED- and clinician-level behaviour relating to admission decisions. The four-hour target is a strong driver for emergency admission.
21 Daily dynamic discharge – a whole system solution to ED crowding
Authors: Kerr Jacques , Maitland Helen , Bell Claire , White Julie , Hunter Alan
Published: November 2017

Introduction

ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard.1Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.

In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED.

Methods

A series of meetings were held between the Unscheduled Care Team and the clinical and managerial staff of Dumfries and Galloway Royal Infirmary over a two-week period to train staff on implementing the elements of the Daily Dynamic Discharge approach. These included holding a daily whiteboard meeting with input from the multidisciplinary team, early determination of an Estimated Date of Discharge (EDD) for each patient, and conducting ‘golden hour’ ward rounds whereby the highest acuity patients were seen first followed by those who were expected to be discharged that day, thus increasing the number of discharges by 12 pm.

Results

Over a twelve-week period the average number of weekly discharges increased from 26.5 to 30.2, i.e., an average increase of 3.7 discharges per week. Average length of stay dropped from 6.8 days to 6.2 days, a saving of 0.6 days.

The median discharge time was 32 min earlier once DDD had been implemented. Previously, a third (33%) of patients were discharged before 4 pm; after implementation, this rose to 44%.

Discussion

Emergency Department activity, and particularly crowding, is the barometer for the rest of the hospital, and the only way to guarantee that patients who require admission, get into the right bed, and in a timely way, is to ensure that the downstream wards discharge sufficient numbers early in the day to accommodate admissions from the ED.

The DDD approach has been shown to be effective in increasing the number of discharges by 12 pm, smoothing the admission/discharge profile, and is now being adopted in other hospitals throughout Scotland.

Reference

Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust2006;184(5):213–216.