bluuebunny/crossref_metadata_2025 huggingface dataset:
Accurate Prediction of Loss Using High Fidelity Methods
Authors: Przytarski Pawel J. , Wheeler Andrew P. S.
Published: February 2021

Further improvements in aero-engine efficiencies require accurate prediction of flow physics and incurred loss. Currently, the computational requirements for capturing these are not known leading to inconsistent loss predictions even for scale-resolving simulations depending on the chosen convergence criteria. This work investigates two aspects of loss generation using high-fidelity simulation. In the first case study, we look at the effect of resolution on capturing entropy generation rate by simulating a Taylor-Green vortex canonical flow. The second case study focuses on the effect of resolution on flow physics and loss generation and uses a compressor cascade subjected to freestream turbulence. The results show that both resolving local entropy generation rate and capturing the inception and growth of instabilities are critical to accuracy of loss prediction. In particular, the interaction of free-stream turbulence at the leading-edge and development of instabilities in the laminar region of the boundary layer are critical to capturing loss.
The Effects of Inlet Boundary Layer Condition and Periodically Incoming Wakes on Secondary Flow in a Low Pressure Turbine Cascade
Authors: Schubert Tobias , Chemnitz Silvio , Niehuis Reinhard
Published: February 2021

A particular turbine cascade design is presented with the goal of providing a basis for high quality investigations of endwall flow under high-speed conditions with unsteady inflow. The key feature of the design is an integrated two-part flat plate serving as a cascade endwall at part-span, which enables a variation of the inlet endwall boundary layer conditions. The new design is applied to the T106A low pressure turbine cascade for endwall flow investigations in the High-Speed Cascade Wind Tunnel of the Institute of Jet Propulsion at the Bundeswehr University Munich. Measurements are conducted under realistic flow conditions (M2th = 0.59, Re2th = 2 · 105) in three cases of varying endwall boundary layer conditions with and without periodically incoming wakes. The endwall boundary layer is characterized by 1D-CTA measurements upstream of the blade passage. Secondary flow is evaluated by five-hole-probe measurements in the turbine exit flow. A strong similarity is found between the time-averaged effects of unsteady inflow conditions and the effects of changing inlet endwall boundary layer conditions regarding the attenuation of secondary flow. Furthermore, the experimental investigations show that all design goals for the improved T106A cascade are met.
On High-Resolution Pressure Amplitude and Phase Measurements Comparing Fast-Response Pressure Transducers and Unsteady Pressure-Sensitive Paint
Authors: Bitter Martin , Stotz Stephan , Niehuis Reinhard
Published: February 2021

This paper presents the simultaneous application of fast-response pressure transducers and unsteady pressure-sensitive paint (unsteady PSP) for the precise determination of pressure amplitudes and phases up to 3000 Hz. These experiments have been carried out on a low-pressure turbine blade cascade under engine-relevant conditions (Re, Ma, and Tu) in the high-speed cascade wind tunnel. Periodic blade/vane interactions were simulated at the inlet to the cascade using a wake generator operating at a constant perturbation frequency of 500 Hz. The main goal of this paper is the detailed comparison of amplitude and phase distributions between both flow sensing techniques at least up to the second harmonic of the wake generator’s fundamental perturbation frequency (i.e., 1000 Hz). Therefore, a careful assessment of the key drivers for relative deviations between measurement results as well as a detailed discussion of the data processing is presented for both measurement techniques. This discussion outlines the mandatory steps which were essential to achieve the quality as presented down to pressure amplitudes of several Pascal even under challenging experimental conditions. Apart from the remarkable consistency of the results, this paper reveals the potential of (unsteady) PSP as a future key flow sensing technique in turbomachinery research, especially for cascade testing. The results demonstrate that PSP was able to successfully sense pressure dynamics with very low fluctuation amplitudes down to 8 Pa.
High-Rate Anisotropic Properties in Human Infant Parietal and Occipital Bone
Authors: Metcalf Robert M. , Comstock Jessica M. , Coats Brittany
Published: February 2021

Computational models of infant head impact are limited by the paucity of infant cranial bone material property data, particularly with regard to the anisotropic relationships created by the trabecular fibers in infant bone. We previously reported high-rate material property data for human infant cranial bone tested perpendicular to trabeculae fiber orientation. In this study, we measure the anisotropic properties of human infant cranial bone by analyzing bending modulus parallel to the trabeculae fibers. We tested human bone specimens from nine donors ranging in age from 32 weeks gestational age to 10 months at strain rates of 12.3−30.1 s−1. Bending modulus significantly increased with donor age (p=0.008) and was 13.4 times greater along the fiber direction compared to perpendicular to the fibers. Ultimate stress was greater by 5.1 times when tested parallel to the fibers compared to perpendicular (p=0.067). Parietal bone had a higher modulus and ultimate stress compared to occipital bone, but this trend was not significant, as previously shown perpendicular to fiber orientation. Combined, these data suggest that the pediatric skull is highly age-dependent, anisotropic, and regionally dependent. The incorporation of these characteristics in finite element models of infant head impact will be necessary to advance pediatric head injury research and further our understanding of the mechanisms of head injury in children.
Boundary Vorticity Analysis and Shedding Dynamics of Transient Cavitation Flow Around a Twisted Hydrofoil
Authors: Li Xiaojun , Liu Yaoyao , Zhu Zuchao , Lin Peifeng , Linmin Li
Published: February 2021

The objective of this paper is to investigate the dynamic characteristics of transient cavitating flow over a twisted NACA0009 hydrofoil. The large eddy simulation (LES) approach is selected for the computation of fluid flow and the Zwart model is used for the mass transfer due to cavitation. Moreover, the skin-friction coefficient and boundary-vorticity flux (BVF) are used to study the flow separation. Numerical results show that the attached shear layer separates from the boundary layer and then squeezes to form the separation line under the obstruction of the reentrant jet. The analysis based on the terms of vorticity transport equation demonstrates that vortex stretching and vortex dilatation terms dominate the evolution of the multiscale vortex. Moreover, the secondary shedding induced by the side-entrant jet enhances the instability of partial cavities and the underlying mechanism is comprehensively revealed. Furthermore, the feature of the pressure fluctuation indicates that high pressure generated by the cavity collapse at the tail simultaneously propagates to the leading edge and downstream of the hydrofoil. This enhances the intensity of the reentrant jet and side-entrant jet, promoting occurrences of flow separation near the suction surface and cavity shedding to a certain extent.
Design of a Single-Degree-of-Freedom Immersive Rehabilitation Device for Clustered Upper-Limb Motion
Authors: Zhao Ping , Zhang Yating , Guan Haiwei , Deng Xueting , Chen Haodong
Published: February 2021

Mechanical devices such as robots are widely adopted for limb rehabilitation. Due to the variety of human body parameters, the rehabilitation motion for different patients usually has its individual pattern; hence, we adopt clustering-based machine learning technique to find a limited number of motion patterns for upper-limb rehabilitation, so that they could represent the large amount of those from people who have various body parameters. By using the regression motion of the clustering result as the target, in this article, we seek to apply kinematic mapping-based motion synthesis framework to design a 1-degree-of-freedom (DOF) mechanism, such that it could lead the patients’ upper limb through the target motion. Also, considering rehab training generally involves a large amount of repetition on a daily basis, this article has developed a rehab system with unity3d based on virtual reality (VR). The proposed device and system could provide an immersive experience to the users, as well as the rehab motion data to the administrative staff for evaluation of users’ status. The construction of the integrated system and the experimental trial of the prototype are presented at the end of this article.
Variable Degree-of-Freedom Spatial Mechanisms Composed of Four Circular Translation Joints
Authors: Kong Xianwen
Published: February 2021

This paper deals with the construction and reconfiguration analysis of a spatial mechanism composed of four circular translation (G) joints. Two links connected by a G joint, which can be in different forms such as a planar parallelogram, translate along a circular trajectory with respect to each other. A spatial 4G mechanism, which is composed of four G joints, usually has one degree-of-freedom (DOF). First, a 2-DOF spatial 4G mechanism is constructed. Then, a novel variable-DOF spatial 4G mechanism is constructed starting from the 2-DOF 4G mechanism using the approach based on screw theory. Finally, the reconfiguration analysis is carried out in the configuration space using dual quaternions and tools from algebraic geometry. The analysis shows that the variable-DOF spatial 4G mechanism has one 2-DOF motion mode and one to two 1-DOF motion modes and reveals how the 4G mechanism can switch among these motion modes. By removing one link from two adjacent G joints each and two links from each of the remaining two G joints, we can obtain a queer-rectangle and a queer-parallelogram, which are the generalization of the queer-square or derivative queer-square in the literature. The approach in this paper can be extended to the analysis of other types of coupled mechanisms using cables and gears and multi-mode spatial mechanisms involving G joints.
Contrastive perception of duration and F0 cues for stop categorization
Authors: Lee-Kim Sang-Im
Published: February 2021

This study examined the role of linguistic experience in the contrastive perception of suprasegmental cues for stop categorization. Korean-speaking learners of Mandarin and naive listeners labeled word-medial unaspirated stops (e.g., ma.pa) as either fortis [long closure–high F0] or lenis [short closure–low F0]. The results revealed comparable effects of relative duration for both groups: shorter neighboring vowels elicited more fortis responses, arising from longer perceived stop closure. However, F0 contours were processed contrastively only for the learners: stops were perceived as fortis before vowels with lower offset F0, which may have contributed to a higher perceived onset F0.
Influence of Side Uncertainty on Knee Kinematics of Female Handball Athletes During Sidestep Cutting Maneuvers
Authors: Bedo Bruno Luiz Souza , Cesar Guilherme Manna , Moraes Renato , Mariano Fábio Pamplona , Vieira Luiz Henrique Palucci , Andrade Vitor Luiz , Santiago Paulo Roberto Pereira
Published: February 2021

Noncontact anterior cruciate ligament ruptures generally occur during unanticipated sidestep cutting maneuvers when athletes have their visual attention focused on the opponent. The authors investigated the influence of uncertainty related to the side to perform the sidestep cutting maneuver on knee kinematics of female handball athletes. A total of 31 female handball athletes performed the sidestep cutting maneuver during anticipated and uncertain conditions. During the uncertain condition, visual cues indicated the direction of the reactive sidestep cutting maneuver. Between-condition differences were compared using the Studentttest for paired samples calculated with statistical parametric mapping. Lower knee flexion angle was detected during the uncertain condition compared with the anticipated condition for the nondominant limb (0%–8% of the sidestep cycle). Knee abduction was larger during the uncertain condition for both the dominant (15%–41% of the sidestep cycle) and nondominant (0%–18% of the sidestep cycle) limbs compared with the anticipated condition. The nondominant leg showed higher knee abduction (36%–68% of the sidestep cycle) during the uncertain condition compared with the anticipated condition. The athletes’ approach velocity was slower during the uncertain condition. The uncertain condition impacted knee kinematics and potentially positioned the joint at greater risk of injury by decreasing the flexion angle in the nondominant leg and increasing the joint valgus bilaterally.
Loss of TGFβ signaling increases alternative end-joining DNA repair that sensitizes to genotoxic therapies across cancer types
Authors: Liu Qi , Palomero Luis , Moore Jade , Guix Ines , Espín Roderic , Aytés Alvaro , Mao Jian-Hua , Paulovich Amanda G. , Whiteaker Jeffrey R. , Ivey Richard G. , Iliakis George , Luo Daxian , Chalmers Anthony J. , Murnane John , Pujana Miquel Angel , Barcellos-Hoff Mary Helen
Published: February 2021

The impact of TGFβ signaling on DNA repair competency is observed in a pan-cancer analysis of survival after treatments that cause DNA damage.
Nicotinamide for the treatment of heart failure with preserved ejection fraction
Authors: Abdellatif Mahmoud , Trummer-Herbst Viktoria , Koser Franziska , Durand Sylvère , Adão Rui , Vasques-Nóvoa Francisco , Freundt Johanna K. , Voglhuber Julia , Pricolo Maria-Rosaria , Kasa Michael , Türk Clara , Aprahamian Fanny , Herrero-Galán Elías , Hofer Sebastian J. , Pendl Tobias , Rech Lavinia , Kargl Julia , Anto-Michel Nathaly , Ljubojevic-Holzer Senka , Schipke Julia , Brandenberger Christina , Auer Martina , Schreiber Renate , Koyani Chintan N. , Heinemann Akos , Zirlik Andreas , Schmidt Albrecht , von Lewinski Dirk , Scherr Daniel , Rainer Peter P. , von Maltzahn Julia , Mühlfeld Christian , Krüger Marcus , Frank Saša , Madeo Frank , Eisenberg Tobias , Prokesch Andreas , Leite-Moreira Adelino F. , Lourenço André P. , Alegre-Cebollada Jorge , Kiechl Stefan , Linke Wolfgang A. , Kroemer Guido , Sedej Simon
Published: February 2021

The NAD
+
precursor nicotinamide improves diastolic dysfunction caused by aging, hypertension, or metabolic syndrome in rodents.
The Polybasic Cleavage Site in SARS-CoV-2 Spike Modulates Viral Sensitivity to Type I Interferon and IFITM2
Authors: Winstone Helena , Lista Maria Jose , Reid Alisha C. , Bouton Clement , Pickering Suzanne , Galao Rui Pedro , Kerridge Claire , Doores Katie J. , Swanson Chad M. , Neil Stuart J. D.
Published: February 2021

The furin cleavage site in the spike protein is a distinguishing feature of SARS-CoV-2 and has been proposed to be a determinant for the higher transmissibility between individuals, compared to SARS-CoV-1. One explanation for this is that it permits more efficient activation of fusion at or near the cell surface rather than requiring processing in the endosome of the target cell.
Draft Genome Sequence of Comamonas jiangduensis Strain YW1
T
Authors: Kangale Luis Johnson , Levasseur Anthony , Raoult Didier , Ghigo Eric , Fournier Pierre-Edouard
Published: February 2021

Here, we report the draft genome sequence of
Comamonas jiangduensis
strain YW1
T
(DSM 100319
T
, CSUR Q1714
T
, CCTCC AB 2012033
T
 ,  KACC 16697
T
).
Comamonas jiangduensis
is a new
Comamonas
species that was isolated from agricultural soil. The genome sequence from strain YW1
T
has been assembled into 322 contigs for a total size of 2,758,586 bp, with a G+C content of 59.1%.
Supplemental Material: The role of slab geometry in the exhumation of cordilleran-type orogens and their forelands: Insights from northern Patagonia
Authors: Genge Marie C. , Mazzoli Stefano , al. et
Published: February 2021

Input files for inverse thermal modeling of the results presented in Figures S1a and S1b.
A rare case of right shoulder pain
Authors: Bansari Asha , Radhakrishnan Nila S , Kattan Juan Nicolas
Published: February 2021

We present a case of a 19-year-old man with right shoulder pain lasting for several months. Abdominal imaging revealed a right adrenal mass directly invading vascular structures into the right atrium. Widespread metastatic adrenocortical carcinoma was confirmed on biopsy. He opted for palliative mitotane treatment with home hospice care. This case emphasises the importance of considering abdominal masses in the differential diagnosis of persistent right shoulder pain after common causes have been ruled out. Early diagnosis could be potentially life-saving.
Rare case of autoimmune hypothyroidism presenting with pancytopenia
Authors: Samanta Joydeep , Saha Avishek , Mitra Souveek
Published: February 2021

Hypothyroidism can involve any organ system in the body with the involvement of haematopoietic system seen in about 30% of the cases. Anaemia is the most common haematological involvement with the affection of other cell lines being exceedingly rare and limited to occasional case reports. Here we present a case of a 14-year-old boy who presented with fever and pancytopenia and was later diagnosed to be a case of autoimmune hypothyroidism.
Stillbirth as the primary manifestation of disseminated tuberculosis in a young immunocompetent mother with multiple perforations of the ileum
Authors: Rajput Deepak , Gupta Amit , Roshan Ravi , Kumar Arvind
Published: February 2021

Tuberculosis (TB), a significant cause of morbidity and mortality worldwide, is particularly relevant in low/middle-income countries like India, where the disease is endemic. The female reproductive system is very vulnerable to this infection with, the clinical presentation being utterly silent in most patients. Symptoms of TB in pregnancy may initially be attributed to the gravidity itself besides temporary concealment of associated weight loss by the normally occurring weight gain during the pregnancy. Untreated TB may cause pregnancy loss by either placental damage or direct harm to both the mother and child. We report a case of latent disseminated TB in a young immunocompetent female that was revealed in the postpartum state (after full-term stillbirth delivery at home) as 20 ileal perforations secondary to intestinal TB. Due to ongoing sepsis and delayed presentation to the hospital, the patient could not be salvaged despite the best possible efforts.
Paratesticular liposarcoma: a rare cause of scrotal lump
Authors: Ng Michael , Pascoe John , Kugathasan Gana , Parsons Brian
Published: February 2021

Paratesticular tumours are tumours arising from within the scrotum not of testicular origin. They may originate from the epididymis, spermatic cord, tunica vaginalis and other supporting structures. Preoperative diagnosis can be difficult as benign and malignant cases are often indistinguishable and may be confused with other benign or malignant pathology (testicular tumours or hernias).

We describe the presentation and management of a patient managed at our centre (a tertiary referral teaching hospital).

A high index of suspicion for malignancy should be considered when managing atypical scrotal lumps to ensure optimal management. This is particularly important when managing sarcomas due to the risk of local recurrence and spread.
The importance of a thorough clinical examination in adolescent girls presenting with acute urinary retention
Authors: Rai Oman , Lama Sanju , Wazir Pandita Sanjay
Published: February 2021

We present an adolescent girl with a 1-day history of acute urinary retention and lower abdominal pain. She was admitted to the paediatric ward for ongoing treatment and investigations. Due to a myriad of factors including pain and anxiety, challenges posed included an incomplete initial abdominal and external genital examination. This case report highlights the importance of a focused history and performing an appropriate sensitive examination at the time of presentation. Furthermore, we explore the common causes of new onset urinary retention and unravel the case as it unfolds. We also highlight differential diagnoses (however, uncommon), which must be considered and not overlooked to avoid unnecessary investigations and to ensure timely management.
Sickness absence after carpal tunnel release: a multicentre prospective cohort study
Authors: Newington Lisa , Ntani Georgia , Warwick David , Adams Jo , Walker-Bone Karen
Published: February 2021

Objectives

To describe when patients return to different types of work after elective carpal tunnel release (CTR) surgery and identify the factors associated with the duration of sickness absence.

Design

Multicentre prospective observational cohort study.

Setting and participants

Participants were recruited preoperatively from 16 UK centres and clinical, occupational and demographic information were collected. Participants completed a weekly diary and questionnaires at four and 12 weeks postoperatively.

Outcomes

The main outcome was duration of work absence from date of surgery to date of first return to work.

Results

254 participants were enrolled in the study and 201 provided the follow-up data. Median duration of sickness absence was 20 days (range 1–99). Earlier return to work was associated with having surgery in primary care and a self-reported work role involving more than 4 hours of daily computer use. Being female and entitlement to more than a month of paid sick leave were both associated with longer work absences. The duration of work absence was strongly associated with the expected duration of leave, as reported by participants before surgery. Earlier return to work was not associated with poorer clinical outcomes reported 12 weeks after CTR.

Conclusions

There was wide variation in the duration of work absence after CTR across all occupational categories. A combination of occupational, demographic and clinical factors was associated with the duration of work absence, illustrating the complexity of return to work decision making. However, preoperative expectations were strongly associated with the actual duration of leave. We found no evidence that earlier return to work was harmful. Clear, consistent advice from clinicians preoperatively setting expectations of a prompt return to work could reduce unnecessary sickness absence after CTR. To enable this, clinicians need evidence-informed guidance about appropriate timescales for the safe return to different types of work.
International study of definitions of English-language terms for suicidal behaviours: a survey exploring preferred terminology
Authors: De Leo Diego , Goodfellow Benjamin , Silverman Morton , Berman Alan , Mann John , Arensman Ella , Hawton Keith , Phillips M R , Vijayakumar Lakshmi , Andriessen Karl , Chavez-Hernandez Ana-Maria , Heisel Marnin , Kolves Kairi
Published: February 2021

Objectives

Explore international consensus on nomenclatures of suicidal behaviours and analyse differences in terminology between high-income countries (HICs) and low/middle-income countries (LMICs).

Design

An online survey of members of the International Organisation for Suicide Prevention (IASP) used multiple-choice questions and vignettes to assess the four dimensions of the definition of suicidal behaviour: outcome, intent, knowledge and agency.

Setting

International.

Participants

Respondents included 126 individuals, 37 from 30 LMICs and 89 from 33 HICs. They included 40 IASP national representatives (65% response rate), IASP regular members (20% response rate) and six respondents from six additional countries identified by other organisations.

Outcome measures

Definitions of English-language terms for suicidal behaviours.

Results

The recommended definition of ‘suicide’ describes a fatal act initiated and carried out by the actors themselves. The definition of ‘suicide attempt’ was restricted to non-fatal acts with intent to die, whereas definition of ‘self-harm’ more broadly referred to acts with varying motives, including the wish to die. Almost all respondents agreed about the definitions of ‘suicidal ideation’, ‘death wishes’ and ‘suicide plan’. ‘Aborted suicide attempt’ and ‘interrupted suicide attempt’ were not considered components of ‘preparatory suicidal behaviour’. There were several differences between representatives from HICs and LMICs.

Conclusion

This international opinion survey provided the basis for developing a transcultural nomenclature of suicidal behaviour. Future developments of this nomenclature should be tested in larger samples of professionals, including LMICs may be a challenge.
Formative peer assessment in higher healthcare education programmes: a scoping review
Authors: Stenberg Marie , Mangrio Elisabeth , Bengtsson Mariette , Carlson Elisabeth
Published: February 2021

Objectives

Formative peer assessment focuses on learning and development of the student learning process. This implies that students are taking responsibility for assessing the work of their peers by giving and receiving feedback to each other. The aim was to compile research about formative peer assessment presented in higher healthcare education, focusing on the rationale, the interventions, the experiences of students and teachers and the outcomes of formative assessment interventions.

Design

A scoping review.

Data sources

Searches were conducted until May 2019 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre. Grey literature was searched in Library Search, Google Scholar and Science Direct.

Eligibility criteria

Studies addressing formative peer assessment in higher education, focusing on medicine, nursing, midwifery, dentistry, physical or occupational therapy and radiology published in peer-reviewed articles or in grey literature.

Data extractions and synthesis

Out of 1452 studies, 37 met the inclusion criteria and were critically appraised using relevant Critical Appraisal Skills Programme, Joanna Briggs Institute and Mixed Methods Appraisal Tool tools. The pertinent data were analysed using thematic analysis.

Result

The critical appraisal resulted in 18 included studies with high and moderate quality. The rationale for using formative peer assessment relates to giving and receiving constructive feedback as a means to promote learning. The experience and outcome of formative peer assessment interventions from the perspective of students and teachers are presented within three themes: (1) organisation and structure of the formative peer assessment activities, (2) personal attributes and consequences for oneself and relationships and (3) experience and outcome of feedback and learning.

Conclusion

Healthcare education must consider preparing and introducing students to collaborative learning, and thus develop well-designed learning activities aligned with the learning outcomes. Since peer collaboration seems to affect students’ and teachers’ experiences of formative peer assessment, empirical investigations exploring collaboration between students are of utmost importance.
Indigenous perspectives on concepts and determinants of flourishing in a health and well-being context: a scoping review protocol
Authors: Nelson Vicky , Derrett Sarah , Wyeth Emma
Published: February 2021

Introduction

Indigenous people, including Māori in New Zealand, face many inequities in health and the determinants of health. Historically, the analysis and reporting of Indigenous health in the literature has usually taken a western medical view, often with a descriptive and deficit-oriented approach—ignoring the holistic nature of Indigenous health. This project takes a nondeficit approach and is interested in the factors that support the health and well-being of Indigenous people, including Māori. Flourishing is a recent and increasingly used term within the well-being literature; however, concepts, theories and determinants related to Indigenous flourishing are largely unknown. This scoping review aims to identify, describe and synthesise the nature and extent of the current empirical literature related to concepts, theories and determinants of Indigenous flourishing, in health and well-being contexts.

Methods and analysis

Scoping review methods and guidelines included in the framework developed by Arksey and O’Malley, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, will be followed for best practice and reporting of this scoping review. The literature for this review will be identified by searching the following databases: Medline (OVID), EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MAI journal, the Cochrane Library and Google Scholar. The research team has formulated a systematic search strategy, which will be restricted to articles published between January 1970 and May 2020 and published in the English language. Two reviewers will independently screen eligible studies for final study selection. A third reviewer will resolve any discrepancies that arise. Data from included studies will be extracted and included in thematic analysis, using a tool developed iteratively by the research team.

Ethics and dissemination

Ethical approval was not required for this review. Dissemination of results will include publication in peer-reviewed journal articles, presentation of results at conferences and interactive discussions with a project expert advisory group. This scoping review also informs a larger project, examining the long-term health and flourishing of Māori, the Indigenous people of New Zealand and their whānau (families).
Enabling first and second year doctors to negotiate ethical challenges in end-of-life care: a qualitative study
Authors: Donnelly Sinead , Walker Simon
Published: February 2021

Objective

To understand the unique ethical and professional challenges confronting first and second year doctors in caring for people who are dying, and to learn what factors help or hinder them in managing these.

Method

6 first year and 7 second year doctors were interviewed one-to-one by a senior palliative medicine physician (SD), quarterly over 12 months, using a semistructured approach. Thematic analysis was conducted with the findings, following the general inductive approach.

Results

21 hours of recorded interviews were analysed by SD, and ethical and professional issues were identified. These were discussed with SW, and sorted into seven broad categories. The participants’ accounts of the issues convey a strong ethical sensitivity, developed through their undergraduate training. A recurring challenge for them through their first 12–24 months of work as doctors is being responsible for the decisions, knowing that what they do can have life and death consequences. The participants frequently describe senior doctors as an important source of support, and the lack of such support as leading to moral distress and demoralisation. Another important factor is having opportunity to discuss and reflect on the decisions after they are made. Where such reflection had been facilitated properly, participants displayed considerable growth in their ability to manage ethical challenges.

Conclusion

Senior support and opportunities for reflection need to be recognised as key factors in enabling first and second year to respond appropriately to ethical challenges in end-of-life care, and in sustaining their well-being through this critical stage of their professional life.
Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial
Authors: Phillips Iain , Allan Lindsey , Hug Adele , Westran Naomi , Heinemann Claudia , Hewish Madeleine , Mehta Ajay , Saxby Helen , Ezhil Veni
Published: February 2021

Introduction

European Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention.

Methods

In this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA),

Results

96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention.

Conclusion

A large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.
Uptake and efficacy of bilateral risk reducing surgery in unaffected female BRCA1 and BRCA2 carriers
Authors: Marcinkute Ruta , Woodward Emma Roisin , Gandhi Ashu , Howell Sacha , Crosbie Emma J , Wissely Julie , Harvey James , Highton Lindsay , Murphy John , Holland Cathrine , Edmondson Richard , Clayton Richard , Barr Lester , Harkness Elaine F , Howell Anthony , Lalloo Fiona , Evans D Gareth
Published: February 2021

Background

Women testing positive for BRCA1/2 pathogenic variants have high lifetime risks of breast cancer (BC) and ovarian cancer. The effectiveness of risk reducing surgery (RRS) has been demonstrated in numerous previous studies. We evaluated long-term uptake, timing and effectiveness of risk reducing mastectomy (RRM) and bilateral salpingo-oophorectomy (RRSO) in healthy BRCA1/2 carriers.

Methods

Women were prospectively followed up from positive genetic test (GT) result to censor date. χ² testing compared categorical variables; Cox regression model estimated HRs and 95% CI for BC/ovarian cancer cases associated with RRS, and impact on all-cause mortality; Kaplan-Meier curves estimated cumulative RRS uptake. The annual cancer incidence was estimated by women-years at risk.

Results

In total, 887 women were included in this analysis. Mean follow-up was 6.26 years (range=0.01–24.3; total=4685.4 women-years). RRS was performed in 512 women, 73 before GT. Overall RRM uptake was 57.9% and RRSO uptake was 78.6%. The median time from GT to RRM was 18.4 months, and from GT to RRSO–10.0 months. Annual BC incidence in the study population was 1.28%. Relative BC risk reduction (RRM versus non-RRM) was 94%. Risk reduction of ovarian cancer (RRSO versus non-RRSO) was 100%.

Conclusion

Over a 24-year period, we observed an increasing number of women opting for RRS. We showed that the timing of RRS remains suboptimal, especially in women undergoing RRSO. Both RRM and RRSO showed a significant effect on relevant cancer risk reduction. However, there was no statistically significant RRSO protective effect on BC.
Advances in neuroimaging to support translational medicine in dementia
Authors: Cope Thomas Edmund , Weil Rimona Sharon , Düzel Emrah , Dickerson Bradford C , Rowe James Benedict
Published: February 2021

Advances in neuroimaging are ideally placed to facilitate the translation from progress made in cellular genetics and molecular biology of neurodegeneration into improved diagnosis, prevention and treatment of dementia. New positron emission tomography (PET) ligands allow one to quantify neuropathology, inflammation and metabolism in vivo safely and reliably, to examine mechanisms of human disease and support clinical trials. Developments in MRI-based imaging and neurophysiology provide complementary quantitative assays of brain function and connectivity, for the direct testing of hypotheses of human pathophysiology. Advances in MRI are also improving the quantitative imaging of vascular risk and comorbidities. In combination with large datasets, open data and artificial intelligence analysis methods, new informatics-based approaches are set to enable accurate single-subject inferences for diagnosis, prediction and treatment that have the potential to deliver precision medicine for dementia. Here, we show, through the use of critically appraised worked examples, how neuroimaging can bridge the gaps between molecular biology, neural circuits and the dynamics of the core systems that underpin complex behaviours. We look beyond traditional structural imaging used routinely in clinical care, to include ultrahigh field MRI (7T MRI), magnetoencephalography and PET with novel ligands. We illustrate their potential as safe, robust and sufficiently scalable to be viable for experimental medicine studies and clinical trials. They are especially informative when combined in multimodal studies, with model-based analyses to test precisely defined hypotheses.
Insufficient respiratory hazard identification in the safety data sheets for cleaning and disinfection products used in healthcare organisations across England and Wales
Authors: Lee Sewon , Povey Andrew C , Seed Martin J , van Tongeren Martie
Published: February 2021

Background

Exposure to cleaning and disinfection products has been associated with respiratory disorders such as asthma in cleaning and healthcare workers. Safety data sheets (SDSs) provide information on hazardous chemicals that are present in products to help users with risk assessment and implement appropriate control measures. However, they have potential limitations in identifying respiratory hazards due to a lack of regulatory test methods for respiratory sensitisation and irritation of chemicals.

Methods

SDSs were first used to identify chemicals on the database as respiratory sensitisers and irritants. A quantitative structure–activity relationship (QSAR) model and an asthmagen list established by the Association of Occupational and Environmental Clinics (AOEC) were used to identify potential respiratory sensitisers and irritants (by the AOEC list only) in the cleaning and disinfection products.

Results

From a total of 459 cleaning and disinfection products used in healthcare organisations across England and Wales, 35 respiratory sensitisers not labelled as such on the SDS were identified by QSAR or AOEC. Only 2% of cleaning and disinfection products contained at least one respiratory sensitiser as identified by their SDSs; this was increased to 37.7% of products when the QSAR or the AOEC list was used.

Conclusions

A significantly higher proportion of cleaning products contain respiratory hazardous chemicals, particularly respiratory sensitisers than would be expected from the information provided by SDSs alone. Cleaners and healthcare workers may, therefore, be insufficiently protected.
Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management
Authors: Khubber Shameer , Chana Rajdeep , Meenakshisundaram Chandramohan , Dhaliwal Kamal , Gad Mohomed , Kaur Manpreet , Banerjee Kinjal , Verma Beni Rai , Shekhar Shashank , Khan Muhummad Zia , Khan Muhammad Shahzeb , Khan Safi , Sammour Yasser , Tsutsui Rayji , Puri Rishi , Kalra Ankur , Bakaeen Faisal G , Simpfendorfer Conrad , Ellis Stephen , Johnston Douglas , Pettersson Gosta , Kapadia Samir
Published: February 2021

Background

Coronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.

Methods

We performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.

Results

We identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.

Conclusion

Our analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.
Gongs galore: phaleristic study of the relative risk of a healing art related New Year Honour
Authors: Mellor Katie , Powell Arfon G M T , James Osian P , Robinson David B , Hopkins Luke , Egan Richard John , Lewis Wyn G
Published: February 2021

Objectives

To compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias.

Design

Observational study of UK honours system including comparative analysis of proportional representation of the UK medical workforce.

Participants

Recipients of NYHs from 2010 to 2019.

Main outcome measures

Absolute risk of receiving an NYH, related to medical specialty, gender and geographical region. Relative risk (RR) of receiving an NYH for services to healthcare related to specialty.

Results

11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving an NYH was 0.76 (95% CI 0.68 to 0.84, p<0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n=181), with public health, clinical oncology and general medicine specialties most likely to be rewarded (RR 20.35 (95% CI 9.61 to 43.08, p<0.001), 8.43 (95% CI 2.70 to 26.30, p<0.001) and 8.22 (95% CI 6.22 to 10.86, p<0.001)), respectively; anaesthetists received fewest NYHs (RR 0.52 (95% CI 0.13 to 2.10), p=0.305). Men were more likely to receive NYHs than women (OR 0.44, 95% CI 0.36 to 0.54; p<0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p=0.003), 39 (10.6%) Wales (p<0.001) and 26 (7.1%) Northern-Ireland (p<0.001).

Conclusions

Relative risk of receiving an NYH varied over 150-fold by specialty, twofold by gender and threefold by geographical location. Public health physicians are perceived to be the pick of the parade.
Influence of nest temperature on morphology of Leatherback Turtle (Dermochelys coriacea) hatchlings incubated in hatcheries in Oaxaca, Mexico
Authors: García-Grajales J. , Meraz-Hernando J.F. , Arcos García J.L. , Ramírez-Fuentes E.
Published: February 2021

The influence of nest incubation temperatures on carapace shape and morphological traits of Leatherback Turtle (Dermochelys coriacea (Vandelli, 1761)) hatchlings incubated in two hatcheries in Oaxaca, Mexico, was evaluated. This study was carried out from October 2016 through May 2017. On each beach, there are community groups consisting of volunteers not affiliated with universities who protect and relocate the nests to increase hatching success. In each translocated nest, a data logger was placed in the centre of the egg mass. Hatchlings were collected as they emerged from each nest. The carapaces of the hatchlings were photographed and subjected to geometric morphometric analysis; also, hatchlings were weighed and their bodies measured. The mean temperature of 12 nests in each hatchery was recorded, with no significant differences between hatcheries. The principal component analysis revealed an overlapping of the carapace shape under different temperature durations. Temperature had a significant influence on hatchling morphology. Higher mean incubation temperatures produced hatchlings with low mass, smaller appendages, narrower carapace widths, and shorter flipper lengths. Lower mean incubation temperatures produced hatchlings with greater mass, wider appendage widths, wider carapace widths, and longer flipper lengths. Results indicate that the Leatherback hatchlings incubated in hatcheries demonstrate morphology that varies in relation to nest incubation temperature in a similar way to hatchlings produced in natural environments.
Understanding the energy dependence of $$B_2$$ in heavy ion collisions: interplay of volume and space-momentum correlations
Authors: Gaebel Vincent , Bonne Michel , Reichert Tom , Burnic Ajdin , Hillmann Paula , Bleicher Marcus
Published: February 2021

The deuteron coalescence parameter $$B_2$$

B
2

in proton+proton and nucleus+nucleus collisions in the energy range of $$\sqrt{s_{NN}}=$$

s

NN

=

900–7000 GeV for proton + proton and $$\sqrt{s_{NN}}=$$

s

NN

=

2–2760 GeV for nucleus + nucleus collisions is analyzed with the Ultrarelativistic Quantum Molecular Dynamics (UrQMD) transport model, supplemented by an event-by-event phase space coalescence model for deuteron and anti-deuteron production. The results are compared to data by the E866, E877, PHENIX, STAR and ALICE experiments. The $$B_2$$

B
2

values are calculated from the final spectra of protons and deuterons. At lower energies, $$\sqrt{s_{NN}}\le 20$$

s

NN

≤
20

GeV, $$B_2$$

B
2

drops drastically with increasing energy. The calculations confirm that this is due to the increasing freeze-out volume reflected in $$B_2\sim 1/V$$

B
2

∼
1
/
V

. At higher energies, $$\sqrt{s_{NN}}\ge 20$$

s

NN

≥
20

GeV, $$B_2$$

B
2

saturates at a constant level. This qualitative change and the vanishing of the volume suppression is shown to be due to the development of strong radial flow with increasing energy. The flow leads to strong space-momentum correlations which counteract the volume effect.
On the instability of localized EM pulses in nonlinear electrodynamics with account of temperature effects
Authors: Belonenko Mikhail B. , Konobeeva Natalia N. , Zhukov Alexander V.
Published: February 2021

Based on Maxwell’s equations, we study the development of electromagnetic pulse instability in nonlinear electrodynamics beyond approximation of slowly varying amplitudes and phases. The action was chosen from the Heisenberg–Euler Lagrangian based on the invariants of the electromagnetic field. We analyze the scenario for the evolution of instability, which turns out to be consistent with the earlier conclusion done within the approximation of slowly varying amplitudes and phases. In this study, we take into account the influence of temperature. The rate of pair production under the Schwinger mechanism is estimated.