bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Instantaneous and Delayed Overlaps on Surface Topography and Wettability of a Femtosecond Laser Textured Surface
Authors: Siddiquie Reshma Y. , Bathe Ravi , Agrawal Amit , Joshi Suhas S.
Published: January 2022

Surface topography modifications using an ultra-short laser is a well-known technique to tune surface characteristics like hydrophobicity, anti-biofouling, anti-icing, enhanced lubrication, and several others. Understanding correlations between surface topography and laser parameters can help generate textures for many useful applications. In this work, the influence of instantaneous and delayed pulse overlap along with the effect of fluence on the femtosecond laser textured surface was investigated. The result shows that, an increase in 10 J/cm2 accumulated fluence can cause a 43% rise in oxygen level on surfaces, with the increase pulse overlap, an increase in the surface roughness (Sa) (0.08 to 0.2 μm) as well as height of the pillars (5–10 μm) was observed. A decrease in surface roughness was observed with a change in line overlap. Other results shows that the spacing between the lines can be increased with a decrease in the line overlap. At the lower pulse overlap, individual pulses were observed with diameter of 5 μm. In addition, the profiles of the microstructures also varied with laser parameters. Sharper pillars were observed at low value of fluence (4.78 J/cm2), whereas with an increase of 10% in pulse overlap along the scan direction, the height of the pillar increased by 5 μm. Larger burr formation and higher surface roughness Sa were observed on stainless steel substrates as compared to that of on Ti6Al4V substrates.
Preliminary Design and Experimental Studies of a Compliant Knee Joint for Pediatric Above Knee Amputees
Authors: Pitre Sahil , Curtin Bryan , Pena Paul , Rouse Ciaphus , Joseph Emma , Hooper Joshua , Tekes Ayse
Published: January 2022

This study presents a passive, self-actuated, 3D printed compliant knee joint for children in developing regions to decrease the overall expense of above knee prosthesis as well as increase the ease to print multiple prosthesis during their growing cycle. A single piece designed five-bar mechanism is proposed to provide adequate human-like gait instead of the traditional pegleg gait provided in previous rigid models. This gait is achieved through the use of both compliant links as well a novel 3D printed approach which is more accustomed to children because of the mechanism’s lightweight. In addition to the compliant knee joint, a compliant ankle possessing a flexure hinge placed at the toe is also designed to provide required bending during the gait cycle. The approach of using a fully passive knee joint enables to limit the weight of the prosthesis to create less of a burden to children and by isolating the need to utilize motors. A test bench consisted of a rack-pinion, two parallel rods, supports, and two servo motors are fabricated to experiment the performance of the knee joint. While the test bench is 3D printed using polylactic acid (PLA), the compliant knee joint is 3D printed in thermoplastic polyurethane (TPU) to emulate the gestures of a real human leg. Simulations are performed in Matlab Simscape to validate that the proposed knee joint mimics the human knee and desired angles.
Stress Analysis of Additive Manufactured Lightweight Spur Gears
Authors: Yılmaz Tufan Gürkan , Kalay Onur Can , Karpat Fatih , Ekwaro-Osire Stephen
Published: January 2022

Additive manufacturing processes (AMP) have grown and spread in the last twenty years. Additive manufacturing methods, which were first used for plastic materials, are now increasingly finding a place in metals. With these methods, more lightweight component designs which cannot be generated with traditional methods can be manufactured. With the spreading of electric drive vehicles, weight reduction is becoming more important since weight is primarily responsible for energy consumption. There is a one-stage gear system in electric vehicles in general. For this reason, the subject of reducing the mass of gears is gaining importance. The weight reduction can be achieved with holes and slots on the gear body for involute spur gears or reducing gear web thickness. Several optimization methods can be used for this aim. Another way is to use light materials for the gear body, while steel material is used in the tooth-rim region. Carbon fiber composites are preferred for this purpose. However, using adhesives to join steel and carbon fiber reinforced plastics may cause problems in different environmental conditions. On the other side, parts are generated with single material with AMP methods. In this study, involute spur gears with different designs convenient for generation by AMP are created in a 3D CAD program. The involute tooth region is defined as design space. The effects of different designs on root stress and tooth stiffness are investigated by finite element analyses. For this purpose, the mathematical modeling of involute spur gear is set to get points of a tooth based on Litvin’s approach in MATLAB. A point cloud code is obtained and imported to the 3D CAD program. After that, three teeth 3D finite element spur gear models are generated. Static analyses are conducted in ANSYS. Meshing force is implemented on the highest point single tooth contact line. Root stress value is the most important reason for tooth root fatigue, one of the most common failure modes of involute spur gears. Tooth deflection and stiffness are significant parameters for the dynamic behavior of involute spur gears. The tooth stiffness affects mesh stiffness and transmission error which are the primary source of gear whine. For these reasons, tooth root stress and tooth deflection values should be determined for different gear designs.

In this study, stress analyses of additive manufactured gears are conducted with the finite element method. The effect of shell thickness, infill radius, and infill stiffener on tooth root stress and deformation is recorded. According to the results, shell thickness is the most effective parameter on the root stress and deformation. It is followed by infill orientation angle and infill radius, respectively.
Tribological Evaluation of a High-Performance Composite Coating
Authors: Renner Peter , Gharib Mohamed , Liang Hong
Published: January 2022

This research presents a new coating on a metal substrate. A carbon steel substrate was used to apply Ni-SiC coatings of various ratios. Wear tests were performed on the coatings and substrate using a linearly reciprocating tribometer with a E52100 carbon steel counterpart. Scratch tests were performed with the same instrument using a tungsten carbide scratch tip. The addition of the coating was found to greatly improve the mechanical properties of the substrate. During experiments studying wear, an E52100 carbon steel ball counterpart was used and its damage was analyzed. This ball showed signs of wear while the coating surfaces showed no sign of abrasion but with only visible adhesive wear. Similarly, scratch tests showed far less material removal in the coating than substrate, showing greatly improved scratch resistance. Additionally, scratch coefficient of friction measured during these tests showed the addition of the coating decreased coefficient of friction to as low as 0.25 compared to the 0.4 of the substrate. The combination of these properties shows that this coating and application method is useful in a wide range of industries.
Effect of Pressure and Temperature on the Performance of Argyrodite Li6PS5Cl0.5Br0.5 Electrolyte for All-Solid-State Lithium Battery
Authors: Dunham Joshua , Frisone Dominic , Amiriyan Mahdi , Hassan Eman , Feng Hu Jung , Farahati Rashid , Farhad Siamak
Published: January 2022

Solid state electrolytes are promising materials for use in lithium-ion batteries for applications in electric vehicles and aircraft. One of the most promising solid electrolytes are the Argyrodite materials, Li6PS5X(X = Cl, Br, I). Among Argyrodites, Li6PS5Cl0.5Br0.5 crystalline material has high ionic conductivity, good processability and excellent electrochemical stability. It is reported in literature that the pelletization pressure and operating pressure and temperature significantly affect the ionic conductivity of argyrodite electrolytes and the cell performance. The focus of this paper is on Li6PS5Cl0.5Br0.5, a crystalline electrolyte material, and the goals are to systematically investigate effects of the pelletization pressure and operating pressure and temperature on the ionic conductivity of this material. The results of this study help to understand the range of pelletization, and operating pressures of all-solid-state lithium sulfur batteries made with Li6PS5Cl0.5Br0.5 crystalline electrolyte material.
Design and Testing of 3D Printed Tissue Scaffolds With Directionally Tunable Stiffness
Authors: Masud Abdullah Al , Arefin Amit M. E. , Chyu Ming-Chien , Egan Paul F.
Published: January 2022

Design and fabrication of beam-based lattices using 3D printing technology have enabled the development of biomedical implants with mechanically efficient scaffolds. For instance, bone tissue scaffolds are engineered implants that could benefit from multi-directional stiffness tuning in relation to the complex loadings of the body. Here, we introduce beam-based lattices with height-adjustable BC-Tetra unit cell designs with different configurations for tuning the elastic modulus along different loading axes. The BC-Tetra unit cell has a tetragonal organization with a square base and adjustable height. Unit cells were designed with a beam diameter of 0.8 mm, porosities of approximately 50% and 70%, and varied unit cell heights for each porosity. Lattices were built during the stereolithography process with E-Shell 600 material that is a biocompatible methacrylic acid-based polymer. Mechanical compression experiments were conducted to investigate the effects of varied BC-Tetra unit cell designs on the longitudinal and transverse elastic moduli of the lattice structures. Mechanical compression testing indicates that the longitudinal elastic modulus of the structures increases with the unit cell height, whereas the transverse elastic modulus decreases. Thus, the adjustment of unit cell height allows tailoring of elastic modulus in multiple directions to ensure implants can adjust the host bone loading while mitigating stress shielding. These results contribute to better design decisions for 3D printed lattice structures with specified mechanical properties that provide new dimensions for biomedical implant design.
Three-Dimensional Velocity and Concentration Measurements of Contaminant Release in a Scaled Urban Array
Authors: Doshi Parth , Fuhrman Gabriel , Moser Dylan , Benson Michael , Van Poppel Bret , Elkins Christopher , Banko Andrew
Published: January 2022

Turbulent atmospheric flows present many challenges to modeling the spread of pollution from manufacturing, accidental exhaust contaminants, and airborne chemical or biological attacks. Computational fluid dynamics (CFD) simulations and reduced order atmospheric dispersion models are used to predict transport and concentration of atmospheric contaminants, but these techniques require validation against experimental data sets. The present work applies magnetic resonance (MR) techniques to measure contaminant flows in an urban array to generate robust data sets for model validation. Magnetic resonance velocimetry (MRV) and concentration (MRC) methods were employed to generate time-averaged, three-dimensional, three-component velocity field and concentration data sets at sub-millimeter resolution — a volume of data far greater than can be measured in large-scale field tests. A scaled urban array comprising 13 buildings at an angle of 26.2° relative to the incoming flow was placed in a water channel test section within an MRI system. A dilute aqueous solution of copper sulfate (CuSO4) was used as the working fluid to achieve a Reynolds number of 20,000 based on the test section’s hydraulic diameter. The test section design included a roughness section to ensure turbulent flow within the scan volume; two vertical injectors created plume-plume and plume-building interactions at a blowing ratio of 0.6. This work is the first of its kind to employ dual injection and buildings oriented at angles other than 90° or 45° to the main flow. Contaminant concentrations of 0.0125M, 0.0625M, and 0.3M were used and the data combined to increase the signal-to-noise ratio in regions of low concentration. Results illustrate flow and concentration details near building wake regions, injector plume mixing, the influence of building blockage on velocity gradients and concentration penetration, and contaminant flux throughout the flow region. Measurement uncertainty was estimated to be approximately ±5% for velocity and ±5% for concentration.
Advanced Melt Rheology Control: A Filling Defects Investigation for Hot Runner Based Injection Molding
Authors: Alqosaibi Khalid , Noor Hussam , Gao Peng , Duhduh Alaauldeen , Coulter John
Published: January 2022

A novel invention called Rheodrop technology is introduced for hot runner based injection molding. The technology allows control over melt rheology by applying desired shear rate values to the polymer melt during and/or in between injection molding cycles. The shear rate is applied by rotating the valve pin inside the hot drops and it is controlled by adjusting the rotational speed. The main goals are to optimize the process and to enhance the properties of molded parts. The focus on this study was incomplete filling defects which can be eliminated by the introduced technology. Numerical simulation and experimental analysis were performed to investigate the incomplete filling issue for hot runner systems. A four cavity hot runner mold was utilized in this research study and the processed material was Acrylonitrile Butadiene Styrene (ABS). Moldflow simulations was presented at three different temperature levels. The cavities were perfectly filled at the highest melt temperature level with incomplete filling resulting at the lower levels of melt temperature. Experimental results showed that implementing Rheodrop technology produces consistent ideal filling throughout the selected range of melt temperatures.
The Effects of a Self-Myofascial Release Program on Isokinetic Hamstrings-to-Quadriceps Strength Ratio and Range of Motion of the Knee Joint Among Athletes With Hamstring Shortness
Authors: Hamzeh Shalamzari Mohammad , Minoonejad Hooman , Seidi Foad
Published: January 2022

Context: Range of motion (ROM) and muscular strength are the main factors that affect athletic performance. Self-myofascial release is a flexibility technique, which is used to inhibit overactive muscle fibers. Objective: To investigate the effects of the 8-week self-myofascial release on the isokinetic hamstrings-to-quadriceps strength ratio (H/QRatio) and the ROM of the knee joint among male athletes with the hamstring shortness. Design: A randomized controlled trial. Setting: Research laboratory. Participants: Twenty-four college-aged male athletes with hamstring shortness were selected for this study and were randomly assigned to a foam rolling group (FOAM, n = 12) and a control group (n = 12). Interventions: Participants in the FOAM group performed supervised self-myofascial release program 3 times per week for 8 weeks. The control group received no intervention. Methods: Data were analyzed via 2-way repeated-measure analysis of variance at the significance level of .05. Main Outcome Measures: ROM and the H/QRatio at the velocities of 60°/s, 120°/s, and 180°/s were measured by an isokinetic dynamometer. Results: The results of 2-way repeated-measure analysis of variance demonstrated that hamstring ROM increased in FOAM group (P = .001). No significant changes were found in H/QRatio after self-myofascial release for FOAM group (P ≥ .05). Conclusions: When compared with other methods of stretching, self-myofascial release with foam rolling may be beneficial in increasing ROM without decreasing H/QRatio in people with the hamstring shortness.
Developing Social Justice Outcomes Through Service Learning Among Sport Management Students
Authors: Arinze Nneka , Mala Jesse , Klein Max , Evanovich Justine
Published: January 2022

Service learning has been recognized as a high-impact educational practice that promotes students’ development of civic engagement and social justice outcomes. However, service-learning courses are not guaranteed to foster social justice outcomes and may perpetuate the very biases and stereotypes that social justice education is designed to counter. In addition, there is a lack of research assessing service-learning courses in sport management that are being used to promote a more critical form of social justice education rather than the mere awareness of social disparities. This article explores the ways in which an intentionally designed social justice service-learning course can potentially lead sport management students toward more equitable perceptions of service relationships. The research team analyzed reflection papers (N = 40) from students who each participated in one semester of the service-learning course across nine consecutive semesters. The following themes emerged from the data: charity-oriented relationship, social justice-oriented relationship, reciprocity, and a critique of paternalism. The findings in this study extend current sport management service-learning research by revealing how a social justice service-learning course can foster a more critical understanding of service through critical discussions, specific readings, critical reflection, and service activities.
Disruption of Active Trans-Sialidase Genes Impairs Egress from Mammalian Host Cells and Generates Highly Attenuated Trypanosoma cruzi Parasites
Authors: Burle-Caldas Gabriela de A. , dos Santos Nailma S. A. , de Castro Júlia T. , Mugge Fernanda L. B. , Grazielle-Silva Viviane , Oliveira Antônio Edson R. , Pereira Milton C. A. , Reis-Cunha João Luís , dos Santos Anderson Coqueiro , Gomes Dawidson Assis , Bartholomeu Daniella C. , Moretti Nilmar S. , Schenkman Sergio , Gazzinelli Ricardo T. , Teixeira Santuza M. R.
Published: January 2022

Trypanosoma cruziis the causative agent of Chagas disease, a neglected tropical disease that affects approximately 6 to 8 million people and for which there is no effective treatment or vaccine. The parasite expresses a family of surface proteins, named trans-sialidases, responsible for transferring sialic acid from host glycoconjugates to parasite mucins.
N7-Methylation of the Coronavirus RNA Cap Is Required for Maximal Virulence by Preventing Innate Immune Recognition
Authors: Pan Ruangang , Kindler Eveline , Cao Liu , Zhou Yu , Zhang Zhen , Liu Qianyun , Ebert Nadine , Züst Roland , Sun Ying , Gorbalenya Alexander E. , Perlman Stanley , Thiel Volker , Chen Yu , Guo Deyin
Published: January 2022

Coronaviruses (CoVs), including SARS-CoV-2, the cause of COVID-19, use several strategies to evade the host innate immune responses. While the cap structure of RNA, including CoV RNA, is important for translation, previous studies indicate that the cap also contributes to viral evasion from the host immune response.
Bacterial Indole as a Multifunctional Regulator of Klebsiella oxytoca Complex Enterotoxicity
Authors: Ledala Nagender , Malik Mishika , Rezaul Karim , Paveglio Sara , Provatas Anthony , Kiel Aaron , Caimano Melissa , Zhou Yanjiao , Lindgren Jonathan , Krasulova Kristyna , Illes Peter , Dvořák Zdeněk , Kortagere Sandhya , Kienesberger Sabine , Cosic Amar , Pöltl Lisa , Zechner Ellen L. , Ghosh Subho , Mani Sridhar , Radolf Justin D. , Matson Adam P.
Published: January 2022

The human gut harbors a complex community of microbes, including several species and strains that could be commensals or pathogens depending on context. The specific environmental conditions under which a resident microbe changes its relationship with a host and adopts pathogenic behaviors, in many cases, remain poorly understood.
Global Analysis of Biomineralization Genes in
Magnetospirillum magneticum
AMB-1
Authors: McCausland Hayley C. , Wetmore Kelly M. , Arkin Adam P. , Komeili Arash
Published: January 2022

Magnetotactic bacteria (MTB) are a group of bacteria that can form nano-sized crystals of magnetic minerals. MTB are likely an important part of their ecosystems, because they can account for up to a third of the microbial biomass in an aquatic habitat and consume large amounts of iron, potentially impacting the iron cycle.
Genome-Scale Modeling Specifies the Metabolic Capabilities of
Rhizophagus irregularis
Authors: Wendering Philipp , Nikoloski Zoran
Published: January 2022

Mounting evidence points to the benefits of the symbiotic interactions between the arbuscular mycorrhiza fungus
Rhizophagus irregularis
and crops; however, the molecular mechanisms underlying the physiological responses of this fungus to different host plants and environments remain largely unknown. We present a manually curated, enzyme-constrained, genome-scale metabolic model of
R. irregularis
that can accurately predict experimentally observed phenotypes.
Decoding Transcription Regulatory Mechanisms Associated with
Coccidioides immitis
Phase Transition Using Total RNA
Authors: Duttke Sascha H. , Beyhan Sinem , Singh Rajendra , Neal Sonya , Viriyakosol Suganya , Fierer Joshua , Kirkland Theo N. , Stajich Jason E. , Benner Christopher , Carlin Aaron F.
Published: January 2022

Infectious pathogens like airborne viruses or fungal spores are difficult to study; they require high-containment facilities, special equipment, and expertise. As such, establishing approaches such as genome editing or other means to identify the factors and mechanisms underlying caused diseases, and, thus, promising drug targets, is costly and time-intensive.
Plate convergence, consumption, collision, coupling, capture, and formation of mantle waves—Linkages to global orogenesis and epeirogeny
Authors: Anderson Thomas H.
Published: January 2022

Widespread episodes of major contractional orogenesis correlate commonly with ages of high-pressure eclogitic rocks formed during bottom-driven, induced subduction of crustal terranes. Rapid exhumation of the deeply emplaced crust has led to the development of the concept of a “tectonic dunk.” The dunk process is a hallmark component of a suite of linked tectonic, magmatic, metamorphic, and sedimentologic processes that systematically follow plate interactions, including collision, coupling, and capture resulting in plate reconfiguration and changes of movement. Plate capture, which takes place during mechanical connection of plates within a “clutch” zone, is followed generally by an abrupt transition to plate stretching in response to drag or plate spin. Plate stretch, which is accommodated during drag by a network of complementary strike-slip and normal faults or during spin by regional domains of transtension, is recorded by “postorogenic,” back-arc extension, basin formation, and magmatism, extensive domains of which comprise large igneous provinces. As a captured continental plate is dragged or rotates, ductile mantle is disrupted and displaced by protuberances, such as a slab coupled against the base of an overriding plate and/or orogenic roots extending down from a cratonic core. The mantle turbulence resembles a wave-like ship’s wake with tsunami-like movement, albeit below crust. The arrival of a moving mantle bulge or wave is inferred to be focused along continental plate margins where subduction is induced, as recorded by magmatism and eclogitic rocks that form during deep emplacement of crustal terranes. Concurrent shortening of crust in the vicinity of the plate margin is inferred from inversion and uplift of marginal rift basins, obduction, and development of fold-and-thrust belts. As the mantle wave passes beneath plate interiors, tens to hundreds of meters of uplift, recorded by oceanic atolls, continental stream incision, regional unconformities, and local transitions to evaporite within shelf settings, record epeirogeny. After passage of the wave, common development of sheet-like bodies of quartzose sandstone, especially during the early Paleozoic, suggest postwave, regional subsidence. Resumption and re-invigoration of extension are recorded by eduction of dunked crust and conspicuous, widespread, volcanic eruptions recorded by tuffaceous layers intercalated with carbonaceous black shale within broad basins developed above thickened crust.
X-Ray Photoelectron Spectroscopy of Murataite Ceramics Containing Lanthanides
Authors: Maslakov K. I. , Teterin Yu. A. , Stefanovskaya O. I. , Kalmykov S. N. , Teterin A. Yu. , Ivanov K. E. , Danilov S. S. , Yudintsev S. V. , Myasoedov B. F.
Published: January 2022

Ceramic samples with the following composition (wt %): 50 TiO2, 10 CaO, 10 MnO2, 5 Al2O3, 5 Fe2O3, 10 ZrO2, 10 Ln2O3 (Ln = La, Ce, Nd, Ho) or 10 СеО2, were studied by X-ray photoelectron spectroscopy. According to the data of X-ray phase analysis and scanning electron microscopy, they consist of murataite, zirconolite, and perovskite. In smaller quantities there are crichtonite, pyrophanite-ilmenite, and rutile. Ce3+ dominates in cerium samples: the Ce3+ : Ce4+ ratio is 3 : 1 and does not depend on the method of adding the element to the charge—in the form of СeО2 or Се2О3. All ceramics are dominated by Fe3+, its fraction is 92–94 rel %, while manganese is represented only by Mn3+ cations.
Prevalence of chronic kidney disease in Asia: a systematic review and analysis
Authors: Liyanage Thaminda , Toyama Tadashi , Hockham Carinna , Ninomiya Toshiharu , Perkovic Vlado , Woodward Mark , Fukagawa Masafumi , Matsushita Kunihiro , Praditpornsilpa Kearkiat , Hooi Lai Seong , Iseki Kunitoshi , Lin Ming-Yen , Stirnadel-Farrant Heide A. , Jha Vivekanand , Jun Min
Published: January 2022

Introduction

The burden of chronic kidney disease (CKD) is growing rapidly around the world. However, there is limited information on the overall regional prevalence of CKD, as well as the variations in national prevalence within Asia. We aimed to consolidate available data and quantify estimates of the CKD burden in this region.

Methods

We systematically searched MEDLINE, Embase and Google Scholar for observational studies and contacted national experts to estimate CKD prevalence in countries of Asia (Eastern, Southern and South Eastern Asia). CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or the presence of proteinuria. For countries without reported data, we estimated CKD prevalence using agglomerative average-linkage hierarchical clustering, based on country-level risk factors and random effects meta-analysis within clusters. Published CKD prevalence data were obtained for 16 countries (of the 26 countries in the region) and estimates were made for 10 countries.

Results

There was substantial variation in overall and advanced (eGFR <30 mL/min/1.73 m2) CKD prevalence (range: 7.0%–34.3% and 0.1%–17.0%, respectively). Up to an estimated 434.3 million (95% CI 350.2 to 519.7) adults have CKD in Asia, including up to 65.6 million (95% CI 42.2 to 94.9) who have advanced CKD. The greatest number of adults living with CKD were in China (up to 159.8 million, 95% CI 146.6 to 174.1) and India (up to 140.2 million, 95% CI 110.7 to 169.7), collectively having 69.1% of the total number of adults with CKD in the region.

Conclusion

The large number of people with CKD, and the substantial number with advanced CKD, show the need for urgent collaborative action in Asia to prevent and manage CKD and its complications.
Towards a harmonised framework for developing quality of care indicators for global health: a scoping review of existing conceptual and methodological practices
Authors: Dudley Lilian , Mamdoo Puni , Naidoo Selvan , Muzigaba Moise
Published: January 2022

Objectives

Despite significant advances in the science of quality of care measurement over the last decade, approaches to developing quality of care indicators for global health priorities are not clearly defined. We conducted a scoping review of concepts and methods used to develop quality of healthcare indicators to better inform ongoing efforts towards a more harmonised approach to quality of care indicator development in global health.

Methods

We conducted a systematic search of electronic databases, grey literature and references for articles on developing quality of care indicators for routine monitoring in all healthcare settings and populations, published in English between 2010 and 2020. We used well-established methods for article screening and selection, data extraction and management. Results were summarised using a descriptive analysis and a narrative synthesis.

Results

The 221 selected articles were largely from high-income settings (89%), particularly the USA (46%), Canada (9%), UK (9%) and Europe (17%). Quality of care indicators were developed mainly for healthcare providers (56%), for benchmarking or quality assurance (37%) and quality improvement (29%), in hospitals (32%) and primary care (26%), across many diseases. The terms ‘quality indicator’ and ‘quality measure’ were the most frequently encountered terms (50% and 21%, respectively). Systematic approaches for quality of care indicator development emerged within national quality of care systems or through cross-country collaborations in high-income settings. Maternal, neonatal and child health (33%), mental health (26%) and primary care (57%) studies applied most components of systematic approaches, but not consistently or rigorously.

Discussion

The current evidence shows variations in concepts and approaches to developing quality of care indicators, with development and application mainly in high-income countries.

Conclusion

Additional efforts are needed to propose ‘best-practice’ conceptual frameworks and methods for developing quality of care indicators to improve their utility in global health measurement.
Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection (BATCH): protocol for a randomised controlled trial
Authors: Waldron Cherry-Ann , Thomas-Jones Emma , Bernatoniene Jolanta , Brookes-Howell Lucy , Faust Saul N , Harris Debbie , Hinds Lucy , Hood Kerenza , Huang Chao , Mateus Céu , Pallmann Philip , Patel Sanjay , Paulus Stéphane , Peak Matthew , Powell Colin , Preston Jennifer , Carrol Enitan D
Published: January 2022

Introduction

Procalcitonin (PCT) is a biomarker more specific for bacterial infection and responds quicker than other commonly used biomarkers such as C reactive protein, but is not routinely used in the National Health Service (NHS). Studies mainly in adults show that using PCT to guide clinicians may reduce antibiotic use, reduce hospital stay, with no associated adverse effects such as increased rates of hospital re-admission, incomplete treatment of infections, relapse or death. A review conducted for National Institute for Health and Care Excellence recommends further research on PCT testing to guide antibiotic use in children.

Methods and analysis

Biomarker-guided duration of Antibiotic Treatment in Children Hospitalised with confirmed or suspected bacterial infection is a multi-centre, prospective, two-arm, individually Randomised Controlled Trial (RCT) with a 28-day follow-up and internal pilot. The intervention is a PCT-guided algorithm used in conjunction with best practice. The control arm is best practice alone. We plan to recruit 1942 children, aged between 72 hours and up to 18 years old, who are admitted to the hospital and being treated with intravenous antibiotics for suspected or confirmed bacterial infection. Coprimary outcomes are duration of antibiotic use and a composite safety measure. Secondary outcomes include time to switch from broad to narrow spectrum antibiotics, time to discharge, adverse drug reactions, health utility and cost-effectiveness. We will also perform a qualitative process evaluation. Recruitment commenced in June 2018 and paused briefly between March and May 2020 due to the COVID-19 pandemic.

Ethics and dissemination

The trial protocol was approved by the HRA and NHS REC (North West Liverpool East REC reference 18/NW/0100). We will publish the results in international peer-reviewed journals and present at scientific meetings.

Trial registration number

ISRCTN11369832.
Exploring the efficacy of psychological treatments for depression: a multiverse meta-analysis protocol
Authors: Plessen Constantin Yves , Karyotaki Eirini , Cuijpers Pim
Published: January 2022

Introduction

In the past four decades, over 700 randomised controlled trials (RCTs) and 80 meta-analyses have examined the efficacy of psychological treatments for depression. Overwhelming evidence suggests that all types of psychological treatments are effective. Yet, many aspects are still unexplored. Meta-analysts could perform hundreds of potential meta-analyses with the current literature, and a comprehensive bird’s-eye view of all published studies is missing. This protocol outlines how a multiverse meta-analysis can evaluate the entire body of the literature on psychological treatments of depression in a single analysis. Thereby, gaps of evidence and areas of robustness are highlighted.

Methods and analysis

We will conduct systematic literature searches in bibliographical databases (PubMed, Embase, PsycINFO and Cochrane Register of Controlled Trials) up until 1 January 2021. We will include all RCTs comparing a psychological treatment with a control condition. We will include studies published in English, German, Spanish or Dutch, and exclude trials on maintenance and relapse prevention as well as dissertations. Two independent researchers will check all records. All self-reported and clinician-rated instruments measuring depression are included. We will extract information on recruitment settings, target groups, age groups, comorbidity, intervention formats, psychotherapy types, number of sessions, control conditions and country. Two independent researchers will assess risk of bias using the Cochrane Risk of Bias assessment tool. As part of the multiverse meta-analysis, unweighted, fixed effect and random effects models will be calculated.

Ethics and dissemination

As we will not collect any primary data, an ethical approval of this protocol is not required. We will publish the results in a peer-review journal and present them at international conferences. We will follow open science practices and provide our code and data.
Video-based smartphone app (‘VIDEA bewegt’) for physical activity support in German adults: a single-armed observational study
Authors: Fischer Tillmann , Stumpf Paul , Schwarz Peter E H , Timpel Patrick
Published: January 2022

Objectives

The primary objective of this study was to investigate the effect of the video-based smartphone app ‘VIDEA bewegt’ over eight programme weeks on physical activity in German adults.

Design

The study used a single-arm observational design, assessing the app’s effectiveness under real-life conditions. Data were collected from July 2019 to July 2020.

Setting

The app is enabling users to access video-based educational content via their smartphone. A clinical visit or in-person contact was not required.

Participants

All individuals registered in the freely available app were invited to take part in the study.

Interventions

The app aims to increase physical activity in everyday life. It combines educative videos on lifestyle-related benefits and instructional videos of strength and endurance exercises to do at home with motivational components like goal setting, documentation of progress and personalised messages.

Primary and secondary outcome measures

Primary outcomes were physical activity based one MET minutes per week (metabolic equivalent) and step numbers.

Secondary outcomes included physical self-efficacy (motivational, maintenance, recovery self-efficacy), health-related quality of life: Mental Health Component Summary score and Physical Health Component Summary score.

Results

Of 97 people included in the data analysis, 55 successfully completed the programme and all questionnaires. Significant increases over eight programme weeks (between T0 and T2) were observed in physical activity based on MET minutes per week, health-related quality of life, and recovery self-efficacy. Time spent sitting and body mass index significantly decreased for those completing the programme.

Conclusions

Although significant benefits of physical activity were observed following a complete-case analysis, results should be dealt with caution. Studies with a larger and less heterogeneous sample and robust study designs able to measure causal effects would be desirable.

Trial registration number

DRKS00017392.
Addition of topical airway anaesthesia to conventional induction techniques to reduce haemodynamic instability during the induction period in patients undergoing cardiac surgery: protocol for a randomised controlled study
Authors: Chen Ting Ting , Lv Meng , Wang Ji Hua , Wei Chuan Song , Gu Chang Ping , Wang Yue Lan
Published: January 2022

Introduction

The aim of this prospective study is to evaluate the effects of combining topical airway anaesthesia with intravenous induction on haemodynamic variables during the induction period in patients undergoing cardiac surgery.

Methods and analysis

This randomised, double-blind, controlled, parallel-group, superiority study from 1 March 2021 to 31 December 2021 will include 96 participants scheduled for cardiac surgery. Participants will be screened into three blocks (ASA II, ASA III, ASA IV) according to the American Society of Anesthesiologists (ASA) grade and then randomly allocated into two groups within the block in a 1:1 ratio. Concealment of allocation will be maintained using opaque, sealed envelopes generated by a nurse according to a computer-generated randomisation schedule. In addition to general intravenous anaesthetics, participants will receive supraglottic and subglottic topical anaesthesia. Changes in arterial blood pressure and heart rate in both groups will be recorded by an independent investigator at the start of anaesthesia induction until the skin incision. If vasopressors are used during this period, the frequency, dosage and types of vasopressors will be recorded. The incidence and severity of participants’ postoperative hoarseness and sore throat will also be assessed.

Ethics and dissemination

This study was approved by the Ethics Committee of Qianfoshan Hospital of Shandong Province (registration number: YXLL-KY-2021(003)). The results will be disseminated through a peer-reviewed publication and in conferences or congresses.

Trial registration number

NCT04744480.
Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives and trainees
Authors: Perrotta Carla , Romero Mariana , Sguassero Yanina , Straw Cecilia , Gialdini Celina , Righetti Natalia , Betran Ana Pilar , Ramos Silvina
Published: January 2022

Objectives

To explore obstetricians’, midwives’ and trainees’ perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services.

Setting

We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants.

Results

Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS.

Conclusions

Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
Prevalence of olfactory dysfunction and quality of life in hospitalised patients 1 year after SARS-CoV-2 infection: a cohort study
Authors: Tan Hui Qi Mandy , Pendolino Alfonso Luca , Andrews Peter J , Choi David
Published: January 2022

Objectives

To determine the long-term prevalence of olfactory and/or gustatory dysfunction (OD±GD), associated risk factors and impact on quality of life (QoL) in previously hospitalised patients with COVID-19 1 year after infection.

Design

A single-centre cohort study.

Setting

Patients admitted at a large central London hospital with COVID-19 infection between 10 February 2020 and 22 May 2020.

Participants

150 adult subjects with previously confirmed SARS-CoV-2 infection were recruited between 10 December 2020 and 29 January 2021. Participants were predominantly male (102/150, 68.0%); mean age 58.0±15.9 years and 41.2% (56/136) were of black, Asian and minority ethnic backgrounds.

Main outcome measures

EQ-5D-5L values and Sino-Nasal Outcome Test-22 (SNOT-22) scores.

Results

Long-term prevalence of OD±GD was 12.8% (19/149) at median time of 264.5 days following SARS-CoV-2 infection onset. Patients with OD±GD had a significantly higher median total SNOT-22 score (46.1; Q1–Q3: 23.0–60.0; 95% CI 23.0 to 60.0) compared with those without (16.0; Q1–Q3: 5.0–30.5; 95% CI 12.0 to 18.0) (p=0.0002), reflecting poorer QoL, particularly psychological well-being (p=0.0004), which was not alleviated with time (p=0.4977). Median EQ-5D-5L value was not significantly different between patients with OD±GD (0.70; Q1–Q3: 0.38–0.83; 95% CI 0.38 to 0.83) and those without (0.83; Q1–Q3: 0.61–0.94; 95% CI 0.75 to 0.89) (p=0.0627). Age, sex, ethnicity, smoking status, highest C reactive protein value, intubation and ventilation, and oxygen supplementation were not found to influence OD±GD (p>0.05).

Conclusions

12.8% of previously hospitalised patients with COVID-19 in London still report persistent problems with smell or taste up to a year after infection, impacting their QoL. Increased holistic support including psychological therapy and olfactory rehabilitation for affected patients may help to reduce long-term morbidity.
Gastric emergencies in older adults: not always the same old story! A tertiary care emergency department observational cohort study
Authors: Rosa Fausto , Covino Marcello , Fransvea Pietro , Cozza Valerio , Quero Giuseppe , Fiorillo Claudio , Simeoni Benedetta , La Greca Antonio , Sganga Gabriele , Gasbarrini Antonio , Franceschi Francesco , Costamagna Guido , Alfieri Sergio
Published: January 2022

Objective

To analyse and compare the clinical outcomes between patients ≥80 years and 65–79 years, who presented to our emergency department (ED) with the two most common gastric emergency (GE) clinical presentation, that is, gastric bleeding and gastric perforation.

Design

Single-centre retrospective cohort study.

Participants

A total of 1011 patients were enrolled: 421 patients aged ≥80 years were compared with a group of 590 patients aged 65–79 years.

Primary and secondary outcome measures

The primary outcome was to compare the overall mortality. Secondary outcomes included major complications, in-hospital length of stay (LOS) and need for surgical procedures.

Results

Patients ≥80 years with GE had different presentations at ED compared with younger patients: they had higher gastrointestinal bleeding (24.9% vs 16.3%, p=0.001), anemisation (14.5% vs 8.8%, p=0.005) and shock (10.9% vs 5.1%, p=0.001) rates. Median LOS, cumulative major complications and mortality rates were similar among the two groups.

Multivariate analysis identified shock, gastric malignancy and gastric fistula as independent predictors for survival.

Conclusions

Patients ≥80 years with GE did not have a higher mortality rate and cumulative major complications as compared to younger elderly patients. Invasive treatments were not associated with a different prognosis in this age group.
Practices and trends in clinical trial registration in the Pan African Clinical Trials Registry (PACTR): a descriptive analysis of registration data
Authors: Ndwandwe Duduzile Edith , Runeyi Sinazo , Pienaar Elizabeth , Mathebula Lindi , Hohlfeld Ameer , Wiysonge Charles Shey
Published: January 2022

Background

The Pan African Clinical Trials Registry (PACTR) is a WHO International Clinical Trials Registry Platform primary register, which caters for clinical trials conducted in Africa. PACTR is the first and, at present, the only member of the Network of WHO Primary Registers in Africa. The aim is to describe and report on the trends of trial records registered in PACTR.

Methods

PACTR was established in 2007 as the AIDS, Tuberculosis, and Malaria Clinical Trials Registry. The scope of the registry was then expanded in 2009 to include all diseases. This is a cross-sectional study of trials registered in PACTR from inception to 18 August 2021. A descriptive analysis of the use and trends of the following data fields: study intervention, disease condition, sex of the participants, sample size, ethics, funding and availability of results was conducted using Microsoft Excel.

Results

The number of trials registered has increased year on year, reaching 606 trials registered in 2020. The total number of trials registered at the time of the analysis was 2998. More than half of the trials in the registry (1655 of 2998, ie, 55%) were prospectively registered. Ethical approval was received by 90% (2691 of 2998) of the registered trials. Factorial assignment as an intervention model was in 20% (589 of 2998) of the trials registered. There were 36% (1083 of 2998) completed trials, of which 3% (94 of 1083) had results available in the registry. The most dominant funding source indicated was self-funding in 23% (693 of 2998) of the registered trials, and 55% (1639 of 2998) had no funding.

Conclusion

Registration on PACTR continues to grow; however, our analysis shows that researchers’ capacity-building is needed to understand the importance of the registry and how this information informs healthcare decisions. Promoting prospective trial registration remains critical to avoid selective reporting bias to inform research gaps.