bluuebunny/crossref_metadata_2025 huggingface dataset:
A
Tree-Shaped Support Structure for Additive Manufacturing Generated by Using a Hybrid of Particle Swarm Optimization and Greedy Algorithm
Authors: Zhu Lin , Feng Ruiliang , Li Xianda , Xi Juntong , Wei Xiangzhi
Published: April 2019

Reducing the volume of support structures is a critical means for saving materials and budgets of additive manufacturing, and tree structure is an effective topology for this purpose. Although a few articles in literature and commercial software have been devoted to developing tree-supports, those tree-supports are generated based on geometry optimization or user-defined parameters, which cannot guarantee a minimum volume with robust fabrication guarantee. To address this issue, we propose a set of formulas for stably growing the tree-supports with physical constraints based on 3D printing experiments using fused decomposition modelling (FDM) machines, and a volume minimization mechanism using a hybrid of particle swarm optimization (PSO) method and a greedy algorithm. We show that this combination is effective in reducing the volume of tree-supports and the simulations reveal that the volume curves monotonically descent to a constant within a short time, and our experimental results show that the models with the tree-supports can be manufactured stably.
A Method of Generating Spiral Tool Path for Direct Three-Axis Computer Numerical Control Machining of Measured Cloud of Point
Authors: Xu Jinting , Xu Longkun , Sun Yuwen , Lee Yuan-Shin , Zhao Jibin
Published: April 2019

Smooth continuous spiral tool paths are preferable for computer numerical control (CNC) machining due to their good kinematic and dynamic characteristics. This paper presents a new method to generate spiral tool paths for the direct three-axis CNC machining of the measured cloud of point. In the proposed method, inspired by the Archimedean spiral passing through the radial lines in a circle, 3D radial curves on the cloud of point are introduced, and how to construct the radial curves on the complex cloud of point is discussed in detail and then a practical and effective radial curve construction method of integrating boundary extraction, region triangulation, mesh mapping, and point projection is proposed. On the basis of the radial curves, the spiral tool path can be generated nicely by interpolating the radial curves using a spiral curve. Besides, the method of identifying and eliminating the overcuts and undercuts in the spiral tool path resulting from the interpolation error is also presented for good surface quality. Finally, several examples are given to validate the proposed method and to show its potential in practical applications when quality parametric models and mesh models are not available.
Change in Shear Modulus of Healthy Lower Leg Muscles After Treadmill Running: Toward a Noninvasive Diagnosis of Chronic Exertional Compartment Syndrome
Authors: Sadeghi Seyedali , Johnson Matthew , Bader Dov A. , Cortes Daniel H.
Published: April 2019

Chronic exertional compartment syndrome (CECS) is an exercise-induced condition, in which high pressure develops in one or several lower leg compartments, resulting in pain, numbness, and temporary muscle paresis. Diagnosis of CECS is assisted by measurements of intracompartment pressures (ICP) at rest, 1-min and 5-min after cessation of running exercise (Pedowitz criteria). ICP is measured via needle manometry, which is an invasive procedure. We have recently shown that intramuscular pressure is correlated to shear modulus measured via shear wave elastography (SWE) (Spearman's correlation coefficient = 0.99). The objectives of this study were to quantify temporal changes in shear modulus of muscle in lower leg compartments of healthy individuals before and after running exercise, and to evaluate a Pedowitz-like criterion for diagnosis of CECS using muscle shear modulus as biomarker. Specifically, the shear modulus of the tibialis anterior (TA) and peroneus longus (PL) was measured at time intervals of 1 min for 10 min after cessation of exercise. The shear modulus of the TA, PL, Soleus and Tibialis posterior were also measured bilaterally before, and at 1- and 5-min after exercise in a procedure that resembles the Pedowitz test for ICP. The shear modulus of all compartments increased significantly in both legs 1-min postexercise and gradually decreased to prerunning values. 50% of such decrease occurred at between 3 and 5 min after cessation of exercise. Additionally, the change in shear modulus followed a similar pattern than ICP in the Pedowitz-like protocol. Therefore, SWE has the potential to diagnose CECS noninvasively.
Investigating the Effect of the Closure in Partially-Averaged Navier–Stokes Equations
Authors: Pereira Filipe S. , Eça Luís , Vaz Guilherme
Published: April 2019

The importance of the turbulence closure to the modeling accuracy of the partially-averaged Navier–Stokes equations (PANS) is investigated in prediction of the flow around a circular cylinder at Reynolds number of 3900. A series of PANS calculations at various degrees of physical resolution is conducted using three Reynolds-averaged Navier–Stokes equations (RANS)-based closures: the standard, shear-stress transport (SST), and turbulent/nonturbulent (TNT) k–ω models. The latter is proposed in this work. The results illustrate the dependence of PANS on the closure. At coarse physical resolutions, a narrower range of scales is resolved so that the influence of the closure on the simulations accuracy increases significantly. Among all closures, PANS–TNT achieves the lowest comparison errors. The reduced sensitivity of this closure to freestream turbulence quantities and the absence of auxiliary functions from its governing equations are certainly contributing to this result. It is demonstrated that the use of partial turbulence quantities in such auxiliary functions calibrated for total turbulent (RANS) quantities affects their behavior. On the other hand, the successive increase of physical resolution reduces the relevance of the closure, causing the convergence of the three models toward the same solution. This outcome is achieved once the physical resolution and closure guarantee the precise replication of the spatial development of the key coherent structures of the flow.
Consideration of a Stress-Based Criterion for Local Failure and Its Implementation in a Damage Mechanics Model
Authors: Nakamura Hitoshi
Published: April 2019

Analyses of the notched tension tests of carbon steel show that ductile failure is initiated when the sum of flow stress and mean stress reaches the limit for the material, regardless of stress triaxiality. Therefore, this explicit critical stress condition could be a candidate criterion for local failure. An equation expressing the relation between stress triaxiality and critical strain was derived from the critical stress condition, and it was found that the critical strain diagram obtained by the equation nearly overlapped with that obtained by the conventional empirical equation. This suggests that the critical stress condition can be approximately determined if the critical strain diagram was obtained for a particular steel. The critical stress condition was consistent with the classical void nucleation theory, and the theory was incorporated into the void nucleation term of stress control in the Gurson–Tvergaard (GT) model—a well-known damage mechanics model for ductile failure. Since only the strain-controlled term is used in the recent GT model, herein, a finite element method (FEM) code was newly developed to implement the GT model with the stress-controlled term. Notched tension tests were analyzed with the critical stress condition using the developed code, and the analyses reproduced the failure behaviors and critical strains of the tests considerably well. These results strongly support the practicality of the stress-based criterion and demonstrate that ductile failure could be appropriately predicted by combining the GT model using the void nucleation term of stress control with the critical stress condition.
The Effect of the Temperature Difference on the Performance of Photovoltaic-Thermoelectric Hybrid Systems
Authors: El Mliles M. , El Kouari Y. , Hajjaji A.
Published: April 2019

The performance of the photovoltaic-thermoelectric (PV-TE) hybrid system was examined using three types of PV cells and a thermoelectric generator (TEG) based on bismuth telluride. The investigated PV cells are amorphous silicon (a-Si), monocrystalline silicon (mono-Si), and cadmium telluride (CdTe). The results showed that the TEG contribution can overcome the degradation of the PV cell efficiency with increasing temperature at the minimal working condition. This condition corresponds to the critical temperature difference across the TEG that guarantees the same efficiency of the hybrid system as that of the PV cell alone at 298 K. The obtained results showed that the critical temperature difference is 13.3 K, 44.1 K, and 105 K for the a-Si, CdTe, and mono-Si PV cell, respectively. In addition, the general expression of the temperature difference across the TEG needed for an efficiency enhancement by a ratio of r compared with a PV cell alone at 298 K was given. For an efficiency enhancement by 5 % (r = 1.05), the temperature difference required is 30.2 K, 61.3 K, and 116.1 K for the a-Si, CdTe, and mono-Si PV cells, respectively. These values cannot be achieved practically only in the case of the a-Si PV cell. Moreover, a TE material with a high power factor can reduce this temperature difference and improve the performance of the hybrid system. This work provides a tool that may be useful during the selection of the PV cell and the TE material for the hybrid system.
On the Simulation of Mitral Valve Function in Health, Disease, and Treatment
Authors: Sacks Michael S. , Drach Andrew , Lee Chung-Hao , Khalighi Amir H. , Rego Bruno V. , Zhang Will , Ayoub Salma , Yoganathan Ajit P. , Gorman Robert C. , Gorman Joseph H.,
Published: April 2019

The mitral valve (MV) is the left atrioventricular heart valve that regulates blood flow between the left atrium and left ventricle (LV) during the cardiac cycle. Contrary to the aortic valve (AV), the MV is an intimately coupled, fully functional part of the LV. In situations where the MV fails to fully close during systole, the resulting blood regurgitation into the left atrium typically causes pulmonary congestion, leading to heart failure and/or stroke. The causes of MV regurgitation can be either primary (e.g., myxomatous degeneration) where the valvular tissue is organically diseased, or secondary (typically induced by ischemic cardiomyopathy) termed ischemic mitral regurgitation (IMR), is brought on by adverse LV remodeling. IMR is present in up to 40% of patients and more than doubles the probability of cardiovascular morbidity after 3.5 years. There is now agreement that adjunctive procedures are required to treat IMR caused by leaflet tethering. However, there is no consensus regarding the best procedure. Multicenter registries and randomized trials would be necessary to prove which procedure is superior. Given the number of proposed procedures and the complexity and duration of such studies, it is highly unlikely that IMR procedure optimization will be achieved by prospective clinical trials. There is thus an urgent need for cell and tissue physiologically based quantitative assessments of MV function to better design surgical solutions and associated therapies. Novel computational approaches directed toward optimized surgical repair procedures can substantially reduce the need for such trial-and-error approaches. We present the details of our MV modeling techniques, with an emphasis on what is known and investigated at various length scales. Moreover, we show the state-of-the-art means to produce patient-specific MV computational models to develop quantitatively optimized devices and procedures for MV repair.
Evolution of Microexplosion Phenomenon in Parent–Child Droplets of Water in Biodiesel Emulsions Enhanced by Different Surfactant Dosages and Hydrophilic–Lipophilic Balance Values
Authors: Abdul Karim Z. A. , Khan Mohammed Yahaya , Aziz A. Rashid A.
Published: April 2019

This experimental study endeavors to investigate the evolution of microexplosion phenomenon of water in biodiesel emulsion droplets with the base fuel (B5) containing 95% diesel and 5% of palm oil methyl ester (POME). Parameters such as water content varied from 9%, 12%, and 15%, surfactant dosages of 5%, 10%, and 15% and the hydrophilic–lipophilic balance (HLB) values of 6, 7, 8, and 9 were varied to study its impact on microexplosion phenomenon. Three different sizes of emulsion droplets of approximately Ø2.8 mm, Ø2.2 mm, and Ø0.3 mm were visualized for the evolution of microexplosion phenomenon under the Leidenfrost effect using hot plate as a heat source. The evolution of microexplosion phenomenon of parent droplets, puffing behavior, and waiting time was visualized with high-resolution images. It was observed that the coalescence process was the dominating factor in inducing the microexplosion, and the coalescence process can either be advanced or be delayed by the surfactant dosage. The waiting time for the microexplosion was found to be influenced by the surfactant dosage and the droplet size. The rate of phase change of emulsions and puffing was found to be influenced by the surfactant dosage. By analyzing the postbehavior of the child droplets formed after the microexplosion of the parent droplet, it was observed that the child droplets undergo a series of puffing process and eventually microexplosion phenomenon also. The size of the parent droplets has a significant influence on the size of the child droplet.
Review on Reaction Mechanisms of Sulfur Species During Coal Combustion
Authors: Ma Honghe , Zhou Lu , Lv Sichen , Chew Jia Wei , Wang Zhijian
Published: April 2019

Various low-NOx combustion technologies have been widely applied as primary measures to limit NOx emission in coal-fired boilers. However, this leads to the formation of high concentrations of H2S in the fuel-rich zone and thus causes high-temperature corrosion of the water-wall. In order to suppress the formation of H2S near the water-wall, it is necessary to have adequate knowledge of the reaction mechanisms of sulfur species during coal combustion. Therefore, this work systematically reviews the current state-of-the-art concerning reaction mechanisms for sulfur species, including global mechanisms, detailed mechanisms, and reduced mechanisms. Additionally, two operation techniques, namely, near-wall air and multi-hole-wall air, are introduced to avoid high-temperature corrosion caused by H2S. Finally, some new research directions are recommended to further reveal the reaction mechanisms of sulfur species and to test the feasibility of multi-hole-wall air on preventing high-temperature corrosion.
Bat-inspired signal design for target discrimination in human echolocation
Authors: Sumiya Miwa , Ashihara Kaoru , Yoshino Kazuki , Gogami Masaki , Nagatani Yoshiki , Kobayasi Kohta I. , Watanabe Yoshiaki , Hiryu Shizuko
Published: April 2019

Echolocating bats exhibit sophisticated sonar behaviors using ultrasounds with actively adjusted acoustic characteristics (e.g., frequency and time-frequency structure) depending on the situation. In this study, the utility of ultrasound in human echolocation was examined. By listening to ultrasonic echoes with a shifted pitch to be audible, the participants (i.e., sighted echolocation novices) could discriminate the three-dimensional (3D) roundness of edge contours. This finding suggests that sounds with suitable wavelengths (i.e., ultrasounds) can provide useful information about 3D shapes. In addition, the shape, texture, and material discrimination experiments were conducted using ultrasonic echoes binaurally measured with a 1/7 scaled miniature dummy head. The acoustic and statistical analyses showed that intensity and timbre cues were useful for shape and texture discriminations, respectively. Furthermore, in the discrimination of objects with various features (e.g., acrylic board and artificial grass), the perceptual distances between objects were more dispersed when frequency-modulated sweep signals were used than when a constant-frequency signal was used. These suggest that suitable signal design, i.e., echolocation sounds employed by bats, allowed echolocation novices to discriminate the 3D shape and texture. This top-down approach using human subjects may be able to efficiently help interpret the sensory perception, “seeing by sound,” in bat biosonar.
Psychometric function slope for speech-in-noise and speech-in-speech: Effects of development and aging
Authors: Sobon Kathryn A. , Taleb Nardine M. , Buss Emily , Grose John H. , Calandruccio Lauren
Published: April 2019

Masked sentence recognition was evaluated in normal-hearing children (8.8–10.5 years), young adults (18–28 years), and older adults (60–71 years). Consistent with published data, speech recognition thresholds were poorer for young children and older adults than for young adults, particularly when the masker was composed of speech. Psychometric function slopes were steeper for young children and older adults than for young adults when the masker was two-talker speech, but not when it was speech-shaped noise. Multiple factors are implicated in the age effects observed for speech-in-speech recognition at low signal-to-noise ratios.
Staphylococcus aureus
Colonization of the Human Nose and Interaction with Other Microbiome Members
Authors: Laux Claudia , Peschel Andreas , Krismer Bernhard
Published: April 2019

Staphylococcus aureus
is usually regarded as a bacterial pathogen due to its ability to cause multiple types of invasive infections. Nevertheless,
S. aureus
colonizes about 30% of the human population asymptomatically in the nares, either transiently or persistently, and can therefore be regarded a human commensal as well, although carriage increases the risk of infection. Whereas many facets of the infection processes have been studied intensively, little is known about the commensal lifestyle of
S. aureus
. Recent studies highlight the major role of the composition of the highly variable nasal microbiota in promoting or inhibiting
S. aureus
colonization. Competition for limited nutrients, trace elements, and epithelial attachment sites, different susceptibilities to host defense molecules and the production of antimicrobial molecules by bacterial competitors may determine whether nasal bacteria outcompete each other. This chapter summarizes our knowledge about mechanisms that are used by
S. aureus
for efficient nasal colonization and strategies used by other nasal bacteria to interfere with its colonization. An improved understanding of naturally evolved mechanisms might enable us to develop new strategies for pathogen eradication.
Noncoding RNA
Authors: Desgranges E. , Marzi S. , Moreau K. , Romby P. , Caldelari I.
Published: April 2019

Regulatory RNAs, present in many bacterial genomes and particularly in pathogenic bacteria such as
Staphylococcus aureus
, control the expression of genes encoding virulence factors or metabolic proteins. They are extremely diverse and include noncoding RNAs (sRNA), antisense RNAs, and some 5′ or 3′ untranslated regions of messenger RNAs that act as sensors for metabolites, tRNAs, or environmental conditions (e.g., temperature, pH). In this review we focus on specific examples of sRNAs of
S. aureus
that illustrate how numerous sRNAs and associated proteins are embedded in complex networks of regulation. In addition, we discuss the CRISPR-Cas systems defined as an RNA-interference-like mechanism, which also exist in staphylococcal strains.
Extracellular Matrix Interactions with Gram-Positive Pathogens
Authors: Hammerschmidt Sven , Rohde Manfred , Preissner Klaus T.
Published: April 2019

The main strategies used by pathogenic bacteria to infect eukaryotic tissue include their adherence to cells and the extracellular matrix (ECM), the subsequent colonization and invasion as well as the evasion of immune defences. A variety of structurally and functionally characterized adhesins and binding proteins of gram-positive bacteria facilitate these processes by specifically recognizing and interacting with various components of the host ECM, including different collagens, fibronectin and other macromolecules. The ECM affects the cellular physiology of our body and is critical for adhesion, migration, proliferation, and differentiation of many host cell types, but also provides the support for infiltrating pathogens, particularly under conditions of injury and trauma. Moreover, microbial binding to a variety of adhesive components in host tissue fluids leads to structural and/or functional alterations of host proteins and to the activation of cellular mechanisms that influence tissue and cell invasion of pathogens. Since the diverse interactions of gram-positive bacteria with the ECM represent important pathogenicity mechanisms, their characterization not only allows a better understanding of microbial invasion but also provides clues for the design of novel therapeutic strategies to manage infectious diseases.
Setting up school-based diabetes clinics to engage adolescents who frequently ‘were not brought to clinic’ and improve self-management
Authors: Alins Sahun Yolanda , Camara Kerry , Gething Kathryn , Shenck Daniel , Gane Jason , Tse Yincent
Published: April 2019

Optimising attendance rates in outpatient’s clinics is important to ensure good clinical care and to avoid waste of scarce medical resources. We identified a cohort of teenagers that frequently were not brought (WNB) to the paediatric diabetes multidisciplinary clinics, compromising patient care and reducing compliance with National Padiatric Diabetes Audit (NPDA) standards. As these teenagers attend five local secondary schools, we initiated a quality improvement project to test the benefit of taking clinics into schools. From January 2017, after extensive engagement with stakeholders, quarterly clinic at school with a diabetic nurse and physician were offered to all teenagers with type 1 diabetes mellitus in these five schools. A semistructured interview was administered to identify their concerns about diabetes. HbA1c was checked, and glucose meters were downloaded. Outcome data were compared with previous 9 months. 34 teenagers were targeted (17 initially identified as frequent non-attenders and 17 controls at same schools). The hospital WNB rate was reduced in the intervention group by 50%, and patients not seen at least once in 3 months reduced from 9/17 to 1/17. Teenage patients expressed an increased positive experience. Relevant knowledge gaps and emotional difficulties were additionally identified and addressed. Lifestyle issues not previously known to team were also unveiled, for example, poor school attendance, bullying or high-risk behaviours. School clinics improved contact in this difficult to reach group. It shows promise as a vehicle to enhance engagement of young people in self-care, actively preparing them for transition.
Women and children first? Gender equity in paediatric medicine
Authors: Davis Tessa , Goldstein Henry , Hall Dani , Lawton Ben , Leo Grace Sze Yin , Yoshida Rie , Tagg Andrew
Published: April 2019

There has been an increased focus on diversity and inclusion in medicine in recent years—the field of medicine still has a long way to go to reach gender equity. We assess how paediatrics is performing by examining the role gender plays in our specialty; and we propose some practical solutions to reach an equitable state. Achieving gender equity is not a simple or easy option and will require an ongoing commitment from all facets of the profession.
Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm
Authors: Sood Vivek , Pattanashetti Navin , Ramachandran Raja , Gupta Krishan Lal
Published: April 2019

Cryptococcal infection constitutes around 3% of opportunistic infections in solid organ transplant recipients. Most common organ affected in renal transplant recipients (RTRs) is central nervous system and usually presents with chronic meningoencephalitis (CME). Ischaemic stroke as a consequence of cryptococcal meningoencephalitisis rare and possibly due to the involvement of intracranial vessel by exudates causing vasculitis-related thrombosis. In this context, we describe an unusual case of asymptomatic cryptococcaemia in an RTR, progressing on to acute ischaemic stroke secondary to acute CME with near complete neurological recovery following timely diagnosis, early and appropriate antifungal treatment. The index case attempts to re-emphasise the significance of mandatory screening required to exclude the possibility of dissemination of cryptococcaemia in RTRs besides highlighting the requirement of prolonged induction phase with combination therapy, particularly in presence of stroke.
Disease of the past re-emerging in modern Australian society
Authors: Uddin Mohammed Arif , Robson Christopher , Dotel Ravindra
Published: April 2019

A 28-year-old man with fever, atraumatic lower limb pain and rash was noted to have multiple areas of ecchymosis involving both lower limbs. He was anaemic and also had a grossly swollen left leg. Differential diagnoses of compartment syndrome, vascular tear, platelet and clotting factor disorders, vasculitis and myositis were ruled out. Scurvy was only considered after failing to reach a diagnosis. A dietary history revealed consumption of a restricted diet with no fresh fruits or vegetables. Diagnosis was supported by an undetectable vitamin C level in blood and a rapid improvement of symptoms on oral vitamin C replacement. Prevalence of vitamin C deficiency in developed countries is also discussed.
Splenic artery aneurysm in a patient of autosomal dominant polycystic kidney disease: beyond tenuous concomitance!
Authors: Sood Vivek , Pattanashetti Navin , Gupta Krishan Lal , Ramachandran Raja
Published: April 2019

Splenic artery aneurysm (SAA) is rare, with risk of rupture especially if diameter is >2 cm. It is usually asymptomatic and detected incidentally on imaging either in young pregnant women or elderly cirrhotic patients. Extracranial vascular abnormalities known to be associated with autosomal dominant polycystic kidney disease (ADPKD) include ascending aortic aneurysms, dissections of coronary and vertebral arteries and rarely SAA. We describe a rare case of incidentally detected SAA in a patient with end stage renal disease due to ADPKD during evaluation of persistent gross haematuria, with no evidence of cranial or other extracranial aneurysms.
Cost of a delay
Authors: Pradhan Aditya , Singh Rana Yajvender Pratap , Sinha Harish K , Goel Sunny
Published: April 2019

Abandoning a renal transplant operation during a live-related transplant is a rare occurrence. We recently encountered a case of previously undiagnosed coarctation of aorta (CoA) in the recipient during surgery. This was diagnosed by the absence of femoral pulses, a Doppler scan showing monophasic flows bilaterally in the iliac arteries and a difference in the mean arterial pressure between the radial artery and iliac artery of 50 mm Hg. The donor and recipient surgery were abandoned. A CT aortogram was done on the recipient which showed a tight CoA. An angioplasty was performed and a bare metal stent placed for correction of CoA. After a week, transplantation was performed, and the patient made an uneventful recovery. This case highlights the importance of assessment of the peripheral pulses and noting a radiofemoral delay, which was missed in the preoperative assessment.
Hereditary segmental neurofibromatosis: a report of three cases in a family
Authors: Jindal Rashmi , Shirazi Nadia , Rawat Kinnari
Published: April 2019

Hereditary segmental neurofibromatosis (SNF) is an extremely rare form of SNF with nine families reported till date. SNF is considered to be a result of mosaicism and hereditary transmission is possibly explained by increased susceptibility of mutations at neurofibromatosis gene loci. We report here three members of an Indian family with SNF. Our index case, a 20-year-old woman had multiple soft to firm papules and nodules over right shoulder associated with severe intermittent pain. Her father had three similar nodules over left upper arm and elder sister had two such nodules over right upper arm. The father and elder sister were incidentally diagnosed and they had never sought medical advice considering their lesions to be a familial trait. In the absence of symptoms, many familial cases of SNF are missed thus making any systematic analysis to ascertain its genetic basis difficult.
Aberrant internal carotid artery in the middle ear: the duplication variant
Authors: Anagiotos Andreas , Kazantzi Maria , Tapis Marios
Published: April 2019

Vascular variants concerning the internal carotid artery (ICA) at the skull base level are rare. Correct workup and diagnosis in case of suspicion of such a variant are important as it mimics glomus tumours and could complicate myringotomy or middle ear surgery. We report a case of a 39-year-old woman presented with a 6-month history of right pulsatile tinnitus and aural fullness. Ear microscopy examination revealed a pale red pulsatile mass anterior to the umbo. Radiological assessment using CT and MRI/magnetic resonance angiography confirmed the diagnosis of an aberrant ICA. Interestingly, a duplication of the ICA was demonstrated, in which the enlarged inferior tympanic artery presented as the aberrant ICA, whereas a narrower collateral hypoplastic native ICA was also present. A conservative approach with regular follow-up appointments was recommended.
Simple and novel technique for fabrication of prosthetic vaginal dilators
Authors: Patnana Arun Kumar , Chugh Ankita , Chugh Vinay Kumar , Shekhar Shashank
Published: April 2019

Vaginal agenesis is one of the major congenital anomalies affecting women. Postoperative prosthetic vaginal dilators are indicated in patients treated surgically for vaginal agenesis. Although different dental materials such as acrylics and silicone-coated materials are used, addition silicones alone have never been used for the fabrication of prosthetic vaginal dilators. Addition silicone materials have advantages, such as high elastic recovery, high tear and tensile strengths, which aid in the definitive use of vaginal dilators. Vaginal dilators fabricated using addition silicone materials act as an efficient prosthesis in terms of function and ease of use in surgically treated vaginal agenesis patients.
Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery
Authors: Tantiphlachiva Kasaya , Sahakitrungruang Chucheep , Pattanaarun Jirawat , Rojanasakul Arun
Published: April 2019

Objective

Endoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.

Design

Retrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of <0.05 is considered significant.

Results 

We enrolled 339 subjects; 109 (M:F 91:18, mean age 41.7±13.6 years) of 115 in EAUS group and 230 in no-EAUS group (M:F 195:35, mean age 42.6±13.0 years). There were higher proportions of recurrent cases (24.8% vs 13.9%, p=0.014) and complex FiA (80.7% vs 50.4%, p=0.001) in EAUS group. Postoperative FISS (mean±SE) were increased in both groups; preoperative versus postoperative FISS were 0.36±0.20 versus 0.59±0.25 in EAUS group (p=0.056) and 0.31±0.12 versus 0.76±0.17 in no-EAUS group (p<0.001). EAUS had significant effects on cFISS in both univariate analysis,F(1,261)=4.053, p=0.045; and multivariate analysis,F(3,322)=3.147, p=0.025, Wilk’s Lambda 0.972. Other associated factors included recurrent fistula (F(3,322)=0.777, p=0.007, Wilk’s Lambda 0.993) and fistula classification (F(3,322)=16.978, p<0.001, Wilk’s Lambda 0.863). After a mean follow-up of 33.6±28.6 weeks, success rate was 63.3%(EAUS) and 60% (no-EAUS), p=0.822. Factors associated with clinical outcomes were fistula complexity, number of tracts, recurrence, number of previous surgery and type of operations. Accuracy of EAUS was 90.8% and not related to clinical outcomes (p=0.522).

Conclusion

EAUS had favourable effects on functional outcome after FiA surgery while multiple factors were associated with clinical outcomes. EAUS is useful, accurate, inexpensive and can be the first tool for planning of complex and recurrent FiA.
Positive and negative social support and depressive symptoms according to economic status among adults in Korea: cross-sectional results from the Health Examinees-Gem Study
Authors: Lee Hwa-Young , Oh Juhwan , Kawachi Ichiro , Heo Jongho , Kim Sujin , Lee Jong-Koo , Kang Daehee
Published: April 2019

Objectives

The interaction between positive and negative social support as well as each domain of social support and income on depressive symptom has not been much explored. We aimed to examine the associations of positive and negative social support with the risk of depressive symptoms among urban-dwelling adults in Korea, focusing on those interaction effects.

Design

We used the first wave of a large-scale cohort study called The Health Examinees-Gem Study. Positive and negative support scores ranged between 0 and 6; the variables were then categorised into low, medium, and high groups. A two-level random intercept linear regression model was used, where the first level is individual and the second is the community. We further tested for interactions between each domain of social supports and household income.

Setting

A survey conducted at 38 health examination centres and training hospitals in major Korean cities and metropolitan areas during 2009–2010.

Participants

21 208 adult men and women aged between 40 and 69 in Korea (mean age: 52.6, SD: 8.0).

Outcome measures

Depressive symptoms score measured by Epidemiologic Studies-Depression Scale, with scores ranging from 0 to 60.

Results

Level of positive and negative social support showed a negative and positive association with depressive symptom score with statistical significance at p<0.05, respectively. When the interaction terms among household income and social supports were examined, a negative association between level of positive social support and depressive symptom score was more pronounced as income was lower and level of negative social support was higher. Similarly, positive association between level of negative social support and depressive symptom score was more pronounced as income was lower and level of positive social support was lower.

Conclusions

Our findings suggest that strategies for encouraging positive social support and discouraging negative social support for disadvantaged individuals might be effective in reducing depression in Korea.
Identification of earlier predictors of pregnancy complications through wearable technologies in a Brazilian multicentre cohort: Maternal Actigraphy Exploratory Study I (MAES-I) study protocol
Authors: Souza Renato T , Cecatti Jose Guilherme , Mayrink Jussara , Galvão Rafael Bessa , Costa Maria Laura , Feitosa Francisco , Rocha Filho Edilberto , Leite Debora F , Vettorazzi Janete , Tedesco Ricardo P , Santana Danielly S , Souza Joao Paulo
Published: April 2019

Introduction

Non-invasive tools capable of identifying predictors of maternal complications would be a step forward for improving maternal and perinatal health. There is an association between modification in physical activity (PA) and sleep–wake patterns and the occurrence of inflammatory, metabolic, pathological conditions related to chronic diseases. The actigraphy device is validated to estimate PA and sleep–wake patterns among pregnant women. In order to extend the window of opportunity to prevent, diagnose and treat specific maternal conditions, would it be possible to use actigraphy data to identify risk factors for the development of adverse maternal outcomes during pregnancy?

Methods and analysis

A cohort will be held in five centres from the Brazilian Network for Studies on Reproductive and Perinatal Health. Maternal Actigraphy Exploratory Study I (MAES-I) will enrol 400 low-risk nulliparous women who will wear the actigraphy device on their wrists day and night (24 hours/day) uninterruptedly from 19 to 21 weeks until childbirth. Changes in PA and sleep–wake patterns will be analysed throughout pregnancy, considering ranges in gestational age in women with and without maternal complications such as pre-eclampsia, preterm birth (spontaneous or provider-initiated), gestational diabetes, maternal haemorrhage during pregnancy, in addition to perinatal outcomes. The plan is to design a predictive model using actigraphy data for screening pregnant women at risk of developing specific adverse maternal and perinatal outcomes.

Ethics and dissemination

MAES-I has been reviewed and approved by each institutional review board and also by the National Council for Ethics in Research. Detailed information about the study is provided in the Brazilian Cohort website (www.medscinet.com/samba) and findings will be published in the scientific literature and institutional webpages.
Locked-in syndrome in Sweden, an explorative study of persons who underwent rehabilitation: a cohort study
Authors: Svernling Kajsa , Törnbom Marie , Nordin Åsa , Sunnerhagen Katharina S
Published: April 2019

Objective

Locked-in syndrome (LiS) is a rare condition, characterised by a complete paresis except for vertical eye movements and blinking with cognitive functions intact, commonly caused by ischaemia in the ventral pons. Previous studies have indicated that persons with LiS can live on for many years and have a good quality of life (QoL). To our knowledge, LiS has never been studied in Sweden. The aim was to explore LiS in Sweden; describing population characteristics, living situation, mortality/cause of death and health-related QoL/impact on participation.

Design

Explorative, nationwide study with two parts (quantitative and qualitative). Persons registered in the national quality register WebRehab during 2007–2014 were eligible.

Participants

Ten persons were identified in part 1, four participated in part 2. During part 1, data were collected from WebRehab, medical charts and registers, while questionnaires and interviews were used during part 2.

Results

Seven out of 10 were men, median age at onset was 49 years and the cause of LiS was in all cases stroke, 70% of which ischaemic. Three were deceased with a median time of survival of 1.9 years. Seven were still alive, with a median time elapsed since onset of 5.8 years. Three participants experienced good QoL. Information, respect from professionals and more specialised technical devices were three areas containing unfulfilled needs.

Conclusion

This was the first study conducted in Sweden and the characteristics of this population were like those studied abroad. In this study, the persons with LiS who were interviewed expressed the need for proper care, appropriate technical aids and a supportive environment in order to have QoL. However, there is still much room for improvements.
Exploring the clinical context of adopting an instrumented insole: a qualitative study of clinicians’ preferences in England
Authors: Lin Denise , Papi Enrica , McGregor Alison H
Published: April 2019

Objectives

This study explores clinicians’ views of the clinical uptake of a smart pressure-sensing insole, named Flexifoot, to enhance the care and management of patients with osteoarthritis (OA). Clinicians are key users of wearable technologies, and can provide appropriate feedback for a specific device for successful clinical implementation.

Design

Qualitative study with in-depth, semi-structured interviews, analysed using inductive analysis to generate key themes.

Setting

Conducted in a University setting.

Participants

30 clinicians were interviewed (11 physiotherapists, 11 orthopaedic surgeons, 5 general practitioners, 3 podiatrists).

Results

All clinicians regarded Flexifoot to be useful for the care and management of patients in adjunction to current methods. Responses revealed four main themes: use, data presentation, barriers to use and future development. Flexifoot data were recognised as capable of enhancing information exchange between clinicians and patients, and also between clinicians themselves. Participants supported the use of feedback for rehabilitation, screening and evaluation of treatment progress/success purposes. Flexifoot use by patients was encouraged as a self-management tool that may motivate them by setting attainment goals. The data interface should be secure, concise and visually appealing. The measured parameters of Flexifoot, its duration of wear and frequency of data output would all depend on the rationale for its use. The clinicians and patients must collaborate to optimise the use of Flexifoot for long-term monitoring of disease for patient care in clinical practice. Many identified potential other uses for Flexifoot.

Conclusions

Clinicians thought that Flexifoot may complement and improve current methods of long-term patient management for OA or other conditions in clinical settings. Flexifoot was recognised to be useful for objective measures and should be tailored carefully for each person and condition to maximise compliance. Adopting the device, and other similar technologies, requires reducing the main barriers to use (time, cost, patient compliance) before its successful implementation.
Diet quality in relation to healthy ageing: the Israeli Longitudinal Study on Aging (ILSA)—a study protocol
Authors: Goshen Abigail , Goldbourt Uri , Shohat Tamar , Shimony Tal , Keinan-Boker Lital , Gerber Yariv
Published: April 2019

Introduction

Population ageing is accelerating rapidly in Israel as well as worldwide, necessitating adaptation of the healthcare system and consideration of new approaches that serve the specific needs of older adults. In addition to cognitive function, frailty is one of the most challenging expressions of physical and mental ageing, a multidimensional syndrome of increased vulnerability. Several studies have shown that low intake of certain micronutrients and protein is associated with higher risk of frailty and cognitive impairment. However, whether global diet quality is involved in the aetiology of the latter outcomes is unclear.

Methods and analysis

We are conducting, among older adult subjects who took part in ‘Mabat Zahav’ (Israeli National Health and Nutrition Survey of Older Adults) in 2005–2006 (T0, n=1852), an extensive follow-up interview (T1) that includes comprehensive geriatric assessment and evaluation of general health and quality of life. Diet quality is evaluated using the Healthy Eating Index (HEI) 2010, based on 24-hour diet recall measured at T0 and T1. Frailty is assessed using two different approaches: the phenotype framework and the accumulation of deficits model. Cognitive function is assessed by Mini-Mental State Examination (MMSE) and cognitive decline is assessed by the difference between repeated MMSE measurements. Different analytic methods will be applied to evaluate the role of diet quality in development of frailty and cognitive decline with inverse probability weighting used to minimise attrition bias. About 600 subjects are expected to be interviewed between May 2017 and December 2019.

Ethics and dissemination

Ethical approval was obtained from the Helsinki Committee of Sheba Medical Center, Tel Hashomer, Israel and the Ethical Committee of Tel-Aviv University. All participants sign an informed consent form. The findings of the study will be published in peer-reviewed journals.
Pathways and associated costs of care in patients with confirmed and presumptive tuberculosis in Tanzania: A cross-sectional study
Authors: Mhalu Grace , Hella Jerry , Mhimbira Francis , Said Khadija , Mosabi Thomas , Mlacha Yeromin P , Schindler Christian , Gagneux Sébastien , Reither Klaus , de Hoogh Kees , Weiss Mitchell G , Zemp Elisabeth , Fenner Lukas
Published: April 2019

Objective

To assess pathways and associated costs of seeking care from the onset of symptoms to diagnosis in patients with confirmed and presumptive tuberculosis (TB).

Design

Cross-sectional study.

Setting

District hospital in Dar es Salaam, Tanzania.

Participants

Bacteriologically confirmed TB and presumptive TB patients.

Primary and secondary outcome measures

We calculated distance in metres and visualised pathways to healthcare up to five visits for the current episode of sickness. Costs were described by medians and IQRs, with comparisons by gender and poverty status.

Results

Of 100 confirmed and 100 presumptive TB patients, 44% of confirmed patients sought care first at pharmacies after the onset of symptoms, and 42% of presumptive patients did so at hospitals. The median visits made by confirmed patients was 2 (range 1–5) and 2 (range 1–3) by presumptive patients. Patients spent a median of 31% of their monthly household income on health expenditures for all visits. The median total direct costs were higher in confirmed compared with presumptive patients (USD 27.4 [IQR 18.7–48.4] vs USD 19.8 [IQR 13.8–34.0], p=0.02), as were the indirect costs (USD 66.9 [IQR 35.5–150.0] vs USD 46.8 [IQR 20.1–115.3], p<0.001). The indirect costs were higher in men compared with women (USD 64.6 [IQR 31.8–159.1] vs USD 55.6 [IQR 25.1–141.1], p<0.001). The median total distance from patients’ household to healthcare facilities for patients with confirmed and presumptive TB was 2338 m (IQR 1373–4122) and 2009 m (IQR 986–2976) respectively.

Conclusions

Patients with confirmed TB have complex pathways and higher costs of care compared with patients with presumptive TB, but the costs of the latter are also substantial. Improving access to healthcare and ensuring integration of different healthcare providers including private, public health practitioners and patients themselves could help in reducing the complex pathways during healthcare seeking and optimal healthcare utilisation.
Simulation-based training for increasing health service board members’ effectiveness: protocol for a cluster-randomised controlled trial
Authors: Faulkner Nicholas , Wright Breanna , Bragge Peter , Lennox Alyse , Bismark Marie , Boag Jane , Boffa Sophie , Waxman Bruce
Published: April 2019

Introduction

Research indicates that health service boards can influence quality of care. However, government reviews have indicated that board members may not be as effective as possible in attaining this goal. Simulation-based training may help to increase board members’ ability to effectively communicate and hold hospital staff to account during board meetings.

Methods and analysis

To test effectiveness and feasibility, a prospective, cluster-randomised controlled trial will be used to compare simulation-based training with no training. Primary outcome variables will include board members’ perceived skill and confidence in communicating effectively during board meetings, and board members’ perceptions of board meeting processes. These measures will be collected both immediately before training, and 3 months post-training, with boards randomly assigned to intervention or control arms. Primary analyses will comprise generalised estimating equations examining training effects on each of the primary outcomes. Secondary analyses will examine participants’ feedback on the training.

Ethics and dissemination

Research ethics approval has been granted by Monash University (reference number: 2018-12076). We aim to disseminate results through peer-reviewed journal publication, conference presentation and social media.

Trial registration number

Open Science Framework:http://osf.io/jaxt6/; Pre-results.