bluuebunny/crossref_metadata_2025 huggingface dataset:
Inverse Margin Filtration Applied for Surface Water Treatment
Authors: Bello Sergio Luiz , Nonato Thyara Campos Martin , Filho Paulo Belli , Neto Augusto Oliveira , Sens Maurício Luiz
Published: August 2021

Technologies to be applied under the context of protection and revitalization of surface water must be developed and improved in order to enhance the quality of aquatic ecosystems. In this way, this study aimed to evaluate the treatment performance of an inverse margin filtration system (IMF) applied in surface water treatment. The IMF was monitored during 1 year through the classic water quality parameters, and thus the treatment performance along the filtration path was identified. The results showed an average removal efficiency of 41% for turbidity, 35% for apparent color, 43% for true color, 26% for total suspended solids and total organic carbon, 53% for nitrogen, 46% for phosphorus, 91% for iron, 8% for manganese, and 100% for fecal coliforms. In this way, the IMF system proved to be a technology that can be applied in the treatment of water in lentic environments.
O Método das Dependências na Redução de Placas Astrográficas
Authors: Machado L. E. , Netto E. R. , Vieira G.G. , Caldeira J. F. , Debehogne H.
Published: August 2021

Dependencies and 165 astrometric positions of asteroids are given; 58 of these refer to asteroids of the Ephemeridi Malik Planet/1981, while 107 are not included in this publication. Further research will reveal the true identify of theses 11 photographed celestial bodies. The G.P.O. refractor telesco pe of ESO, La Silla, was used, observations being made by Dr. H. Debehogne and R.R. Freitas Mourão, National Observato ry, Rio de Janeiro. Reduction was accomplished at the Valon go Observatory, UFRJ, through the method of dependencies;for comparison, the method of least squares was also used. The importance of publishing dependencies is emphasized.
Dynamic Stability Research on the Double-Cylinder Turbines Marine Propulsion System With Unsymmetrical Load
Authors: Xu Jianghai , Jiao Chunxiao , Zou Donglin , Ta Na , Rao Zhushi
Published: August 2021

The double-cylinder turbines' (DCT) propulsion system is widely applied to large-scale ships, while the instability mechanism of the system lacks theoretical and scientific research. Based on gear transmission principle and finite width journal bearings theory, the lateral-torsional-axial model of the system considering multiple nonlinear and time-varying factors is established. The effects of the unsymmetrical load parameters on the stability of the coupled system have been explored and quantified. Results indicate that the phenomenon of instability gradually occurs with the increase of excitation frequency, the decrease of load ratio between the two inputs or the decrease of input load value, and the vibration of the gear pair on the low load side is more severe. Furthermore, the vibration amplitude is related not only to the load parameters but also to the distance between the gear pair and the load input disk. Finally, the influence of the oil whip on the system stability is crucial, especially when the system is in an unstable state. This study puts forward the stability boundary of the DCT propulsion system and provides a theoretical reference for the optimization and adjustment of the load parameters.
Free Response of a Rotational Nonlinear Energy Sink Coupled to a Linear Oscillator: Fractality, Riddling, and Initial-Condition Sensitivity at Intermediate Initial Displacements
Authors: Ding Ke , Pearlstein Arne J.
Published: August 2021

Free response of a rotational nonlinear energy sink (NES) inertially coupled to a linear oscillator is investigated for dimensionless initial rectilinear displacements ranging from just above the smallest amplitude at which nonrotating, harmonically rectilinear motion is unstable absent direct rectilinear damping, up to the next-largest amplitude at which such motion is orbitally stable. With motionless initial conditions (MICs), i.e., initial velocity of the primary mass and initial angular velocity of the NES mass both zero, predicted behavior for two previously investigated combinations of the dimensionless parameters (characterizing rotational damping, and coupling of rectilinear and rotational motions) differs strongly from that found at smaller initial displacements (Ding and Pearlstein, 2021, “Free Response of a Rotational Nonlinear Energy Sink: Complete Dissipation of Initial Energy for Small Initial Rectilinear Displacements,” J. Appl. Mech., 88(1), p. 011005). For both combinations, a wide range of MICs leads to solutions displaying transient chaos and depending sensitively on initial conditions, giving rise to fractality and riddling in the relationship between initial conditions and asymptotic solutions. Absent direct rectilinear damping of the linear oscillator, for one combination of parameters there exists a wide range of MICs with trajectories leading to time-harmonic, orbitally stable “special” solutions with a single amplitude, but no MICs are found for which all initial energy is dissipated. For the other combination, no such special solutions are found, but there exist MICs for which all initial energy is dissipated. With direct rectilinear damping, sensitivity extends to a measure of settling time, which can be extremely sensitive to initial conditions. A statistical approach to this sensitivity is discussed, along with implications for design and implementation.
Measurement of Pure Shear Constitutive Relationship From Torsion Tests Under Quasi-Static, Medium, and High Strain Rate Conditions
Authors: Zhang Longhui , Townsend David , Petrinic Nik , Pellegrino Antonio
Published: August 2021

Torsion tests provide important shear stress and shear strain relationships to reveal the fundamental plastic flow response of a material. Bespoke torsion techniques complemented by digital image correlation are developed to accurately measure the shear stress–strain relationship at quasi-static, medium rate 9/s, and high strain rate above 1000/s. The equipment used includes a screw-driven mechanical system, a hydraulic Instron machine and a Campbell thin-walled tube split Hopkinson torsion bar equipped with an ultrahigh-speed camera. A near alpha Ti3Al2.5V alloy was used as a model material in this study. A four-camera digital image system has been constructed to monitor the material deformation and failure during a low rate torsion test, to gain further insight into plastic deformation of the tubular specimen. Shear stress–strain relationship of the Ti3Al2.5V alloy exhibits noticeable strain rate sensitivity. Observations of the strain hardening rate evolution indicate that the hardening capacity of Ti3Al2.5V is both strain and strain rate dependent. High strain rate torsional stress–strain relationship shows lower strain hardening, compared to the response obtained from a shear compression specimen. The present techniques are demonstrated to be suitable for the measurement of pure shear constitutive relationship, including rate sensitivity and failure of the material.
The Use of Zero-Mass Particles in Analytical and Multi-Body Dynamics: Sphere Rolling on An Arbitrary Surface
Authors: Udwadia Firdaus E. , Mogharabin Nami
Published: August 2021

Zero-mass particles are, as a rule, never used in analytical dynamics, because they lead to singular mass matrices. However, recent advances in the development of the explicit equations of motion of constrained mechanical systems with singular mass matrices permit their use under certain circumstances. This paper shows that the use of such particles can be very efficacious in some problems in analytical dynamics that have resisted easy, general formulations, and in obtaining the equations of motion for complex multi-body systems. We explore the ease and simplicity that suitably used zero-mass particles can provide in formulating and simulating the equations of motion of a rigid, non-homogeneous sphere rolling under gravity, without slipping, on an arbitrarily prescribed surface. Computational results comparing the significant difference in the motion of a homogeneous sphere and a non-homogeneous sphere rolling down an asymmetric arbitrarily prescribed surface are obtained, along with measures of the accuracy of the computations. While the paper shows the usefulness of zero-mass particles applied to the classical problem of a rolling sphere, the development given is described in a general enough manner to be applicable to numerous other problems in analytical and multi-body dynamics that may have much greater complexity.
Effect of Bath Agitation on the Transient Cooling by Quenching Process
Authors: Kacem Amine , Bourouga Brahim , Ould El Moctar Ahmed
Published: August 2021

During the quenching process, the liquid bath is usually agitated to homogenize the temperature and to enhance convective heat transfer. The purpose of this paper is to characterize on the one hand the agitation of a water bath due to the movement of a three-blade turbine and on the other, the cooling of an Inconel 718 part being quenched in a stirred water bath. Velocity measurements were taken by particle image velocimetry (PIV) with and without the metallic part. We found that the velocity field became purely axial when we were far enough away from the turbine. Moreover, a high turbulent mixing level was shown for this type of jet. Velocity measurements were carried out for two agitation intensities. The axial velocity amplitude, as well as the turbulent kinetic energy, decreased dramatically as the rotational speed of the propeller decreased from 410 to 100 rpm. This caused the thermal behavior of the part to differ during quenching. Indeed, we found that the part cooled faster under stronger agitation. During the film boiling and transition phases, no appreciable effect of agitation could be observed. However, from the middle of the nucleate boiling phase, the part-bath heat transfer coefficient was found to decrease much less rapidly with the surface temperature if agitation was strong than if it was weak or if the bath was completely calm. In such a case of strong agitation, both nucleate boiling and convection concomitantly ensure part cooling.
Advanced Temperature Control Applied on An Industrial Box Furnace
Authors: Tudon-Martinez Juan C. , Lozoya-Santos Jorge de-J. , Cantu-Perez Alberto , Cardenas-Romero Andrea
Published: August 2021

The current control system of an industrial box furnace usually uses a proportional-integral-derivative (PID) controller. Typically, this control system requires on-site tuning and specific heuristic knowledge, such that the furnace can have acceptable performance but not optimal. However, by using a proper model in the operating range of the furnace from the designing phase, it can be designed a more efficient control system capable to reach better performance in this industrial process. In this sense, the main objective of this paper is the design and validation of an advanced control strategy in the early design stage of an industrial box furnace. The goals are to decrease the controller tuning time during the furnace commissioning process, improve the furnace performance with respect to classical industrial controllers, and decrease the system energy expenses. Thus, a comparative analysis in a simulated environment has been carried out between the performance of a PID controller by its typical industrial use, a model predictive control (MPC) due to the optimal results in similar industrial processes, and a virtual reference feedback tuning (VRFT) control by its feasibility of implementation. Results show that the advanced MPC and VRFT controllers are more efficient in the used fuel/gas than the PID. MPC shows the best balance between performance and actuation, it improves the control performance up to 87.2% with respect to the VRFT controller.
Direct-simulation Monte Carlo modeling of reactor-scale gas-dynamic phenomena in a multiwafer atomic-layer deposition batch reactor
Authors: Thiruppathiraj Sudharshanaraj , Ryu Seung-Min , Uh Jiho , Raja Laxminarayan L.
Published: August 2021

Atomic layer deposition (ALD) using multiwafer batch reactors has now emerged as the manufacturing process of choice for modern microelectronics at a massive scale. Stringent process requirements of thin film deposition uniformity within wafer (WiW) and wafer–wafer (WTW) in the batch, film conformity along submicrometer wafer features, thin film quality, and the utilization of expensive precursors in the reactor dictate ALD reactor design and process parameter optimization. This paper discusses a particle-based direct-simulation Monte Carlo (DSMC) of the full reactor scale simulation that overcomes the low Knudsen number limitation of typical continuum computational fluid dynamics approaches used for modeling low-pressure ALD reactors. A representative industrial multiwafer batch reactor used for the deposition of Si-based thin films with N2 and Si2Cl6 (hexachlorodisilane) as process feed gases with pressures in the range 43–130 Pa and a uniform reactor temperature of 600 °C is simulated. The model provides detailed insights into the flow physics associated with the transport of the precursor species from the inlets, through wafer feed nozzles, into the interwafer regions, and finally through the outlet. The reactor operating conditions are shown to be in the slip/transitional flow regime for much of the reactor volume and especially the feed gas nozzle and interwafer regions (where the Knudsen number approaches ∼0.2), justifying the need for a high-Knudsen number DSMC approach as in this work. For the simulated conditions, the nonuniformity of precursor species immediately above the wafer surface is predicted to be within <1% for a given wafer and <2% across the entire multiwafer stack. Results indicate that higher pressure degrades WiW and WTW uniformity. A reactor flow efficiency is defined and found to be ∼99%, irrespective of the chamber pressure.
Observations of the Ag(3 × 1) phase on Ge(111)
Authors: Mullet Cory H. , Rosen Anna L. , Chiang Shirley
Published: August 2021

Low-energy electron diffraction and low-energy electron microscopy were used to study the (3 × 1) phase of Ag on Ge(111) for temperatures less than 540 °C. This phase was observed when depositing 0.05–0.1 ML Ag at 370 °C. The (3×3)R30o phase formed when depositing 0.3 ML Ag at 170 °C, and then annealing to 200−360 °C resulted in a nonreversible phase transition to [(4 × 4) + (3 × 1)] phases at 360 °C. The 3 phase appears to be metastable for temperatures <250 °C since subsequent cooling did not cause it to reappear. These experimental observations suggest modifications to a published phase diagram for Ag/Ge(111).
Self-localization of buoyless fishing gear and other objects on the sea floor
Authors: Baumgartner Mark F. , Partan Jim
Published: August 2021

End lines used in commercial trap/pot fishing pose a significant entanglement risk to whales, sea turtles, and sharks. Removal of these ropes for buoyless fishing is being considered by the United States and Canadian governments, but a method to systematically locate the gear without an attached buoy is required. A method was developed for an acoustic modem to self-localize and broadcast its location to nearby ships to minimize gear conflict, optimize power consumption, and reduce lost gear. This method was implemented using a research modem that self-localized to within 5 m of its estimated location on the sea floor.
Autonomous learning and interpretation of channel multipath scattering using braid manifolds in underwater acoustic communications
Authors: McCarthy Ryan A. , Gupta Ananya Sen , Kemerling Madison
Published: August 2021

In this work, we explore machine learning through a model-agnostic feature representation known as braiding, that employs braid manifolds to interpret multipath ray bundles. We generate training and testing data using the well-known BELLHOP model to simulate shallow water acoustic channels across a wide range of multipath scattering activity. We examine three different machine learning techniques—k-nearest neighbors, random forest tree ensemble, and a fully connected neural network—as well as two machine learning applications. The first application applies known physical parameters and braid information to determine the number of reflections the acoustic signal may undergo through the environment. The second application applies braid path information to determine if a braid is an important representation of the channel (i.e., evolving across bands of higher amplitude activity in the channel). Testing accuracy of the best trained machine learning algorithm in the first application was 86.70% and the testing accuracy of the second application was 99.94%. This work can be potentially beneficial in examining how the reflectors in the environment changeover time while also determining relevant braids for faster channel estimation.
A noncoding RNA modulator potentiates phenylalanine metabolism in mice
Authors: Li Yajuan , Tan Zhi , Zhang Yaohua , Zhang Zhao , Hu Qingsong , Liang Ke , Jun Yao , Ye Youqiong , Li Yi-Chuan , Li Chunlai , Liao Lan , Xu Jianming , Xing Zhen , Pan Yinghong , Chatterjee Sujash S. , Nguyen Tina K. , Hsiao Heidi , Egranov Sergey D. , Putluri Nagireddy , Coarfa Cristian , Hawke David H. , Gunaratne Preethi H. , Tsai Kuang-Lei , Han Leng , Hung Mien-Chie , Calin George A. , Namour Fares , Guéant Jean-Louis , Muntau Ania C. , Blau Nenad , Sutton V. Reid , Schiff Manuel , Feillet François , Zhang Shuxing , Lin Chunru , Yang Liuqing
Published: August 2021

RNA solution for a genetic problem

Phenylketonuria provides a classic case of the benefit of newborn metabolic screening: It is a single-gene disease that can be detected at birth, and its neurological effects can be prevented by dietary therapy. Unfortunately, this is not always straightforward because the disease-causing mutations in phenylalanine hydroxylase vary between patients and affect the severity of the phenotype, such that some patients’ symptoms do not fully respond to the available interventions. Li
et al
. identified two long noncoding RNAs, one in mice and one in humans, that interact with phenylalanine hydroxylase and modulate its function (see the Perspective by Ben-Tov Perry and Ulitsky). Administration of modified RNAs mimicking their effects ameliorated the disease phenotype in mouse models of phenylketonuria. —YN
Suppressing atomic diffusion with the Schwarz crystal structure in supersaturated Al–Mg alloys
Authors: Xu W. , Zhang B. , Li X. Y. , Lu K.
Published: August 2021

Locking structure to high temperature

Because of atomic diffusion, metal alloys with nanometer-sized crystal grains do not retain their structure at high temperature. Xu
et al
. found that a minimum-interface structure allows a supersaturated aluminum-magnesium alloy to be retained at temperatures higher than the melting point. This system is known for high atomic diffusivity, highlighting the importance of the underlying interface structure. These observations have implications for designing structural alloys for high-temperature applications. —BG
An action agenda for Africa's electricity sector
Authors: Puig Daniel , Moner-Girona Magda , Kammen Daniel M. , Mulugetta Yacob , Marzouk Atef , Jarrett Maximilian , Hailu Yohannes , Nakićenović Nebojša
Published: August 2021

Modernization and expansion require heightened efforts
Quantum-enhanced sensing of displacements and electric fields with two-dimensional trapped-ion crystals
Authors: Gilmore Kevin A. , Affolter Matthew , Lewis-Swan Robert J. , Barberena Diego , Jordan Elena , Rey Ana Maria , Bollinger John J.
Published: August 2021

Quantum enhanced sensing

Harnessing quantum mechanical effects is expected to provide an advantage over classical sensing technology. By entangling the center-of-mass motional state of approximately 150 ions trapped in a two-dimensional Coulomb crystal with their collective spin state, Gilmore
et al
. demonstrate a quantum-enhanced measurement sensitivity of displacement and electric field. Such enhanced sensitivity could, for instance, find application in probing proposed weak interactions between dark matter and normal matter, as well as enhancing gravitational wave detection. —ISO
Treatments for Alzheimer's disease emerge
Authors: Selkoe Dennis J.
Published: August 2021

Anti-amyloid immunotherapies will provide the first disease-modifying therapeutics
Watching a hydroperoxyalkyl radical (•QOOH) dissociate
Authors: Hansen Anne S. , Bhagde Trisha , Moore Kevin B. , Moberg Daniel R. , Jasper Ahren W. , Georgievskii Yuri , Vansco Michael F. , Klippenstein Stephen J. , Lester Marsha I.
Published: August 2021

Spectral fingerprint of stabilized •QOOH

Carbon-centered radicals containing the hydroperoxy group, commonly denoted as •QOOH, are elusive but are among the most critical intermediate species for kinetic modeling of hydrocarbon oxidation in various atmospheric and combustion processes. Their direct experimental observation is a long-standing challenge, with only one successful previous attempt. Using a combination of infrared activation spectroscopy and an ultraviolet laser–induced fluorescence detection method, Hansen
et al
. directly characterized the vibrational structure of a •QOOH intermediate in isobutane oxidation, collisionally stabilized and isolated, and followed its dissociative evolution under infrared activation with time and energy resolution. High-level electronic structure calculations revealed an important role of heavy-atom tunneling in this process. —YS
Manipulating neuronal circuits, in concert
Authors: Yang Weijian
Published: August 2021

Two-photon holographic optogenetics enables precise modulation of brain activity
Maturation of HIV-1
Authors: Hikichi Yuta , Freed Eric O.
Published: August 2021

Structural transformation of HIV-1 matrix during virus maturation promotes infection
Draft Genome Sequences of Two Multidrug-Resistant Sequence Type 405 Escherichia coli Isolates without Clinical Infection
Authors: Chamieh Amanda , Zgheib Rita , El-Sawalhi Sabah , Azar Eid , Rolain Jean-Marc
Published: August 2021

We present the genome sequences of two carbapenemase-producing sequence type 405
Escherichia coli
clinical isolates, strains Marseille-Q1950 and Marseille-Q1951. The isolates were obtained 1 month apart during the patient’s hospitalization in Lebanon, in May (Marseille-Q1950) and June (Marseille-Q1951) 2019. The genome sizes of strains Marseille-Q1950 and Marseille-Q1951 were 5,181,515 bp and 5,213,451 bp, respectively.
Genome Sequences of Lactococcus garvieae and Lactococcus petauri Strains Isolated from Traditional Montenegrin Brine Cheeses
Authors: Martinovic Aleksandra , Cabal Adriana , Nisic Andjela , Sucher Jasmin , Stöger Anna , Allerberger Franz , Ruppitsch Werner
Published: August 2021

Lactococcus garvieae
and
Lactococcus petauri
cause lactococcosis in fish. Both species have also been isolated from various food products and are considered emerging zoonotic pathogens. Here, we report the genomes of
L. garvieae
INF126 and
L. petauri
INF110, obtained from traditional Montenegrin brine cheeses.
Whole-Genome Sequences of SARS-CoV-2 Lineage B.1.525 Strains (Variant η) Detected from Patients in the Abruzzo Region (Central Italy) during Spring 2021
Authors: Delli Compagni Emiliano , Mangone Iolanda , Bonfini Barbara , Di Gennaro Annapia , Teodori Liana , Leone Alessandra , Casaccia Claudia , Portanti Ottavio , Averaimo Daniela , Zilli Katiuscia , Malatesta Daniela , Ancora Massimo , Scialabba Silvia , Di Domenico Marco , Lorusso Alessio
Published: August 2021

Novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are emerging worldwide. Here, we report the complete genome sequences of 13 severe acute SARS-CoV-2 strains belonging to lineage B.1.525 (variant η).
Postural orthostatic tachycardia syndrome (POTS) occurring during treatment for breast cancer
Authors: Babra Deshveer , Youn Suhyun , Devendra Senan
Published: August 2021

Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.
First description of a retrobulbar haemorrhage in a paediatric patient
Authors: Hindocha Hirvi , Edwards Sarah
Published: August 2021

An 8-year-old girl presented to the paediatric emergency department 3 days after left orbital exploration for an orbital floor fracture. She had been vomiting for the last 24 hours and her mother’s primary reason for presentation was that she was unable to keep down any analgesia . She reported pain in that eye and was unable to see. On examination, the eye was swollen and had yellow discharge. A CT scan was performed to rule out an infective collection and, unexpectedly, showed a retrobulbar haematoma. Ophthalmology was called and she was immediately taken to theatre for a lateral canthotomy for decompression. Fortunately, she regained her vision following this but, had the retrobulbar haematoma not been recognised urgently, she may have lost her vision permanently in that eye. Retrobulbar haematomas are quite rare in children this age and there is very little published literature on this topic.
Extreme laryngeal candidiasis: airway obstruction
Authors: Murray Susan C , Thompson Christopher SG , Walker David L , Bannister Miles
Published: August 2021

We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain ofCandida albicansrequiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.
Anaesthetic challenges in perioperative management of thoracic paraganglioma in an 8-year-old child
Authors: maurya Ram Gopal , Gautam Shefali , Singh Gyan Prakash , srinivas Chaitra
Published: August 2021

Pheochromocytomas (PCC) are catecholamine-secreting tumours that arise from chromaffin cells of the sympathoadrenal system. These rare catecholamine-secreting tumours arising from adrenal glands are termed as PCC and those from extra-­adrenal sites are termed paraganglioma (PGL). Thoracic PGL is very rarely found. we report the anaesthetic challenges and management of an 8-year-old child with functional thoracic PGL and its successful outcome.
Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke’s encephalopathy
Authors: Hor Esther Shan Lin , Singh Gurpreet Pal , Omar Nurul Akhmar , Russell Vincent
Published: August 2021

We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke’s encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE—highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.
Developing a health economic model for Asians with type 2 diabetes based on the Japan Diabetes Complications Study and the Japanese Elderly Diabetes Intervention Trial
Authors: Tanaka Shiro , Langer Jakob , Morton Tim , Hoskins Nicki , Wilkinson Lars , Tanaka-Mizuno Sachiko , Kawasaki Ryo , Moriya Tatsumi , Horikawa Chika , Aida Rei , Araki Atsushi , Fujihara Kazuya , Sone Hirohito
Published: August 2021

Introduction

Cost-effectiveness analyses are becoming increasingly important in Japan following the introduction of a health technology assessment scheme. The study objective was to develop an economic model to evaluate the cost-effectiveness of two interventions for type 2 diabetes in a Japanese population.

Research design and methods

The Japan Diabetes Complications Study/Japanese Elderly Diabetes Intervention Trial risk engine (JJRE) Cost-Effectiveness Model (JJCEM) was developed, incorporating validated risk equations in Japanese patients with type 2 diabetes from the JJRE. Weibull regression models were developed for progression of the model outcomes, and a targeted literature review was performed to inform default values for utilities and costs. To illustrate outcomes, two simulated analyses were performed in younger (aged 40 years) and older (aged 80 years) Japanese populations, comparing a hypothetical treatment with placebo.

Results

The model considers a population based on user-defined values for 11 baseline characteristic parameters and simulates rates of diabetic complications over a defined time horizon. Costs, quality-adjusted life years, and an incremental cost-effectiveness ratio are estimated. The model provides disaggregated results for two competing interventions, allowing visualization of the key drivers of cost and utility. A scatterplot of simulations and cost-effectiveness acceptability curve are generated for each analysis.

Conclusions

This is the first cost-effectiveness model for East Asian patients with type 2 diabetes, developed using Japan-specific risk equations. This population constitutes the largest share of the global population with diabetes, making this model highly relevant. The model can be used to evaluate the cost-effectiveness of anti-diabetic interventions in patients with type 2 diabetes in Japan and other East Asian populations.
A health systems resilience research agenda: moving from concept to practice
Authors: Saulnier Dell D , Blanchet Karl , Canila Carmelita , Cobos Muñoz Daniel , Dal Zennaro Livia , de Savigny Don , Durski Kara N , Garcia Fernando , Grimm Pauline Yongeun , Kwamie Aku , Maceira Daniel , Marten Robert , Peytremann-Bridevaux Isabelle , Poroes Camille , Ridde Valery , Seematter Laurence , Stern Barbara , Suarez Patricia , Teddy Gina , Wernli Didier , Wyss Kaspar , Tediosi Fabrizio
Published: August 2021

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.
Update on Noma: systematic review on classification, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease
Authors: Speiser Sophie , Langridge Benjamin , Birkl Moira Melina , Kubiena Harald , Rodgers Will
Published: August 2021

Introduction

Noma is a significant yet neglected disease which affects some of the least developed countries in the world. The long-term benefit and safety of Noma surgical reconstructive missions have recently been under scrutiny due to a perceived lack of measurable outcomes and appropriate follow-up. This study analyses and reports on classifications, outcome measurement tools and follow-up for reconstructive surgery after Noma disease.

Methods

This systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The three medical databases Medline, EMBASE and Web of Sciences were searched, articles published between 1 January 1983 and 15 April 2020 were included. All primary evidence on reconstructive surgery following Noma disease, reporting data on outcome after surgery, follow-up time and complications were included. Extracted data were aggregated to generate overall and population corrected mean outcomes and complication rates.

Results

Out of 1393 identified records, 31 studies including 1110 Noma patients were analysed. NOITULP and Montandon/WHO were the most commonly used classification systems. Mouth opening (MO) and complication rates were the two most often reported outcomes. Overall mean complication rate was 44%, reported by 24 studies. Postoperative MO was reported by eight publications, of which, five reported long-term outcomes (>12 months). Mean MO improved by 20 mm when compared with mean population weighted preoperative MO (7 mm). At long-term follow-up, MO decreased to 20 mm.

Conclusions

Studies reporting on neglected diseases in developing countries often lack methodological rigour. Surgeons should be mindful during patient examination by using a classification system that allows to compare preoperative versus postoperative state of disease. Short-term mission surgery is a vital part of healthcare delivery to underdeveloped and poor regions. Future missions should aim at sustainable partnerships with local healthcare providers to ensure postoperative care and long-term patient-oriented follow-up. A shift towards a diagonal treatment delivery approach, whereby local surgeons and healthcare staff are educated and empowered, should be actively promoted.

PROSPERO registration number

CRD42020181931.
Common factors in serious case reviews of child maltreatment where there is a medical cause of death: qualitative thematic analysis
Authors: Garstang Joanna , Eatwell Daisy , Sidebotham Peter , Taylor Julie
Published: August 2021

Aim

To identify the common factors in serious case reviews (SCRs) where a child has died of a medical cause.

Design

Qualitative thematic analysis.

Background

SCRs take place when neglect or abuse results in children dying or being seriously harmed. Known key factors within SCRs include parental substance misuse, mental health problems and domestic abuse. To date, there has been no investigation of children who die of a medical cause where there are concerns about child maltreatment.

Data sources

A list of SCRs relating to deaths through medical causes was provided from previous coded studies and accessed from the National Society for the Prevention of Cruelty to Children National Case Review Repository. Twenty-three SCRs with a medical cause of death from 1 April 2009 to 31 March 2017 were sourced.

Results

20 children died of an acute condition and 12 of a chronic condition; 20 of the deaths were unexpected and maltreatment contributed to the deaths of 18 children. Most children were aged either <1 year or >16 years at the time of death. Many parents were caring for a child with additional vulnerabilities including behavioural issues (6/23), learning difficulties (6/23), mental health issues (5/23) or a chronic medical condition (12/23). Common parental experiences included domestic violence/abuse (13/23), drug/alcohol misuse (10/23), mental ill health or struggling to cope (7/23), criminal history (11/23) and caring for another vulnerable individual (8/23). Most children lived in a chaotic household characterised by missed medical appointments (18/23), poor school attendance (11/23), poor physical home environment (7/23) and disguised compliance (12/23). All 23 SCRs reported elements of abusive or neglectful parenting. In most, there was an evidence of cumulative harm, where multiple factors contributed to their premature death. At the time of death, 11 children were receiving social care support.

Conclusion

Although the underlying medical cause of the child’s death was often incurable, the maltreatment that often exacerbated the medical issue could have been prevented.
Quantifying conflict zones as a challenge to certification of Guinea worm eradication in Africa: a new analytical approach
Authors: Kelly-Hope Louise A , Molyneux David H
Published: August 2021

Objectives

To quantify conflict events and access across countries that remain to be certified free of transmission ofDracunculus medinensis(Guinea worm disease) or require postcertification surveillance as part of the Guinea Worm Eradication Programme (GWEP).

Setting and participants

Populations living in Guinea worm affected areas across seven precertification countries and 13 postcertification sub-Saharan African countries.

Outcome measures

The number of conflict events and rates per 100 000 population, the main types of conflict and actors reported to be responsible for events were summarised and mapped across all countries. Chad and Mali were presented as case studies. Guinea worm information was based on GWEP reports. Conflict data were obtained from the Armed Conflict Location and Event Data Project. Maps were created using ArcGIS V.10.7 and access was measured as regional distance and time to cities.

Results

More than 980 000 conflict events were reported between 2000 and 2020, with a significant increase since 2018. The highest number and rates were reported in precertification Mali (n=2556; 13.0 per 100 000), South Sudan (n=2143; 19.4), Democratic Republic of Congo (n=7016; 8.1) and postcertification Nigeria (n=6903; 3.4), Central Africa Republic (n=1251; 26.4), Burkina Faso (n=2004; 9.7). Violence against civilians, protests and battles were most frequently reported with several different actors involved including Unidentified Armed Groups and Boko Haram. Chad and Mali had contracting epidemiological and conflict situations with affected regions up to 700 km from the capital or 10 hours to the nearest city.

Conclusions

Understanding the spatial–temporal patterns of conflict events, identifying hotspots, the actors responsible and their sphere of influence is critical for the GWEP and other public health programmes to develop practical risk assessments, deliver essential health interventions, implement innovative surveillance, determine certification and meet the goals of eradication.
Built environments for inpatient stroke rehabilitation services and care: a systematic literature review
Authors: Lipson-Smith Ruby , Pflaumer Luis , Elf Marie , Blaschke Sarah-May , Davis Aaron , White Marcus , Zeeman Heidi , Bernhardt Julie
Published: August 2021

Objectives

To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff.

Design

A convergent segregated review design was used to conduct a systematic review.

Data sources

Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020.

Eligibility criteria for selecting studies

Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff.

Data extraction and synthesis

Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies.

Results

Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being.

Conclusions

Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care.

PROSPERO registration number

CRD42020158006.
Perceived anxiety and physical activity behaviour changes during the early stages of COVID-19 restrictions in community-dwelling adults in Canada: a cross-sectional study
Authors: McCormack Gavin R , Doyle-Baker Patricia K , Petersen Jennie A , Ghoneim Dalia
Published: August 2021

Objectives

The COVID-19 pandemic changed daily routines, including physical activity, which could influence physical and mental health. In our study, we describe physical activity and sedentary behaviour patterns in relation to the pandemic and estimate associations between anxiety and physical activity and sedentary behaviour in community-dwelling adults.

Design

Cross-sectional study.

Setting

Calgary, Alberta, Canada.

Participants

Between April and June 2020, a random sample of 1124 adults (≥18 years) completed an online questionnaire.

Primary and secondary outcomes

The online questionnaire captured current walking, moderate intensity, vigorous intensity and total physical activity and sedentary behaviour (ie, sitting and leisure-based screen time), perceived relative changes in physical activity, sedentary and social behaviours since the pandemic, perceived seriousness and anxiety related to COVID-19, and sociodemographic characteristics. Differences in sociodemographic characteristics, perceived relative change in behaviour and current physical activity and sedentary behaviour were compared between adults with low and high anxiety.

Results

Our sample (n=1047) included more females (60.3%) and fewer older adults (19.2%). Most participants (88.4%) considered COVID-19 as extremely or very serious and one-third (32.9%) felt extremely or very anxious. We found no differences (p>0.05) in current physical activity or sedentary behaviour by anxiety level. The largest perceived change in behaviours included social distancing, driving motor vehicles, use of screen-based devices, watching television and interactions with neighbours. We found anxiety-related differences (p<0.05) in perceived changes in various behaviours.

Conclusions

Changes in physical activity, sedentary behaviour and social behaviour occurred soon after the COVID-19 pandemic was declared, and some of these changes differed among those with low and high anxiety.
Psyllium reduces inulin-induced colonic gas production in IBS: MRI andin vitrofermentation studies
Authors: Gunn David , Abbas Zainab , Harris Hannah C , Major Giles , Hoad Caroline , Gowland Penny , Marciani Luca , Gill Samantha K , Warren Fred J , Rossi Megan , Remes-Troche Jose Maria , Whelan Kevin , Spiller Robin C
Published: August 2021

Objective

Health-promoting dietary fibre including inulin often triggers gastrointestinal symptoms in patients with IBS, limiting their intake. Our aim was to test if coadministering psyllium with inulin would reduce gas production.

Design

A randomised, four-period, four-treatment, placebo-controlled, crossover trial in 19 patients with IBS. Subjects ingested a 500 mL test drink containing either inulin 20 g, psyllium 20 g, inulin 20 g+ psyllium 20 g or dextrose 20 g (placebo). Breath hydrogen was measured every 30 min with MRI scans hourly for 6 hours. Faecal samples from a subset of the patients with IBS were tested using anin vitrofermentation model. Primary endpoint was colonic gas assessed by MRI.

Results

Colonic gas rose steadily from 0 to 6 hours, with inulin causing the greatest rise, median (IQR) AUC(0–360 min)3145 (848–6502) mL·min. This was significantly reduced with inulin and psyllium coadministration to 618 (62–2345) mL·min (p=0.02), not significantly different from placebo. Colonic volumes AUC(0–360 min)were significantly larger than placebo for both inulin (p=0.002) and inulin and psyllium coadministration (p=0.005). Breath hydrogen rose significantly from 120 min after inulin but not psyllium; coadministration of psyllium with inulin delayed and reduced the maximum increase, AUC(0–360 min)from 7230 (3255–17910) ppm·hour to 1035 (360–4320) ppm·hour, p=0.007.

Fermentationin vitroproduced more gas with inulin than psyllium. Combining psyllium with inulin did not reduce gas production.

Conclusions

Psyllium reduced inulin-related gas production in patients with IBS but does not directly inhibit fermentation. Whether coadministration with psyllium increases the tolerability of prebiotics in IBS warrants further study.

Trial registration number

NCT03265002.
Gene of the month: FH
Authors: Zyla Roman E , Hodgson Anjelica
Published: August 2021

Fumarate hydratase (FH), encoded by theFHgene, is an enzyme which catalyses the conversion of fumarate to L-malate as part of the tricarboxylic acid cycle. Biallelic germline mutations inFHresult in fumaric aciduria, a metabolic disorder resulting in severe neurological and developmental abnormalities. Heterozygous germline mutations inFHresult in hereditary leiomyomatosis and renal cell carcinoma, a cancer predisposition syndrome.FHdeficiency has multiple oncogenic mechanisms including through promotion of aerobic glycolysis, induction of pseudohypoxia, post-translational protein modification and impairment of DNA damage repair by homologous recombination. FH-deficient neoplasms can present with characteristic morphological features that raise suspicion forFHalterations and also frequently demonstrate loss of FH immunoreactivity and intracellular accumulation of 2-succinocysteine, also detected by immunohistochemistry.