bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-Term Optimization of a Combined Cycle Power Plant Integrated With an Inlet Conditioning Unit
Authors: Mantilla Weimar , Garcia José , Guédez Rafael , Source Alessandro
Published: April 2021

Under new scenarios with high shares of renewable electricity, combined cycle gas turbines (CCGTs) are required to improve their flexibility to help balance the power system. Simultaneously, liberalization of electricity markets and the complexity of its hourly price dynamics are affecting the CCGT profitability, leading the need for optimizing its operation. An inlet conditioning unit (ICU) offers the benefit of power augmentation and “minimum environmental load” (MEL) reduction by controlling the gas turbine (GT) inlet temperature using cold thermal energy storage (TES) and a heat pump (HP). Consequently, an evaluation of a CCGT integrated with this unit including a day-ahead optimized operation strategy was developed in this study. To establish the hourly dispatch of the power plant and the operation mode of the ICU, a mixed-integer linear programing (MILP) optimization was formulated, aiming to maximize the operational profit of the plant within a 24 h horizon. To assess the impact of the unit operating under this dispatch strategy, historical data have been used to perform annual simulations of a reference power plant located in Turin, Italy. Results indicate that the power plant's operational profit increases by achieving a wider operational range during peak and off-peak periods. For the specific case study, it is estimated that the net present value (NPV) of the CCGT integrated with the ICU is 0.5% higher than the CCGT without it. Results also show that the unit reduces the MEL by approximately 1.34% and can increase the net power output by 0.17% annually.
Transient Flutter Stability Analysis of Structural Mistuned Blisk by Energy Growth Method
Authors: Ouyang Luohui , Bi Qingzhen , Chen Hua , Shang Hai , Zhu Limin
Published: April 2021

Blisks suffer from flutter, a self-sustained vibration caused by aerodynamic coupled forces. This instability could cause serious damage to the blades and the machine. Flutter stability is usually analyzed based on the eigenvalue method in the aspect of the linear structural dynamic system, which transforms a dynamics stability analysis into a point of equilibrium in an infinite time scale. However, in reality, most of the blisk vibrations arise on a finite time horizon. The transient vibration amplification may cause serious damage. This paper proposes a transient flutter stability analysis method in a finite time for structural mistuned blisk based on the energy growth method. First, two common blisk models coupled aerodynamic force with different complexity are built and are all expressed in the state space representation. A novel energy growth method is then employed to analyze the transient stability and to find the maximum energy growth of the models. The optimal initial condition which leads to the maximum energy growth is obtained. A new flutter stability criterion is developed to consider the transient stability based on the energy growth method and the infinite time stability based on the eigenvalue method. The new transient stability method is verified by two numerical studies. It is found that the structural mistuned blisk model which is traditionally predicted stable still has a transient instability in a finite time due to the non-normal property of the dynamic state matrix.
Additively Manufactured Compliant Hybrid Gas Thrust Bearing for Supercritical Carbon Dioxide Turbomachinery: Experimental Evaluation and Fluid–Structure Model Predictions
Authors: Ertas Bugra , Gary Keith , Delgado Adolfo
Published: April 2021

This paper presents rotating test results and advances an analytical predictive fluid–structure model for a new type of gas-lubricated thrust bearing fabricated using direct metal laser melting. The bearing concept in this study is a compliant hybrid gas thrust bearing that uses external pressurization to increase load carrying capacity, where the testing campaign in this study was only focused on steady-state static performance. The need for the bearing concept comes from enabling highly efficient supercritical carbon dioxide (sCO2) turbomachinery by replacing oil-lubricated bearings with process gas lubrication. Leveraging the process gas of the turbomachine for bearing lubrication results in lowered bearing power loss, simplified mechanical design, and allows for novel oil-free hermetic drivetrains resulting in an efficient emission-free system. The new concept utilizes hydrostatic pressurization on individual tilting pads flexibly mounted with hermetic squeeze film dampers (HSFDs). This paper focuses on rotating tests of a 173 mm outer diameter gas thrust bearing in air up to 10 krpm and hydrostatic inlet pressures to 365 psi (2.52 MPa). The influence of thrust runner speed and bearing inlet pressure on force deflection characteristics and load carrying capability of the gas film were experimentally evaluated. This work also advances a predictive fluid–structure thrust bearing model using an isothermal ideal-gas-based compressible Reynolds flow equation directly coupled to a lumped stiffness element possessing axial and rotational degrees-of-freedom. The rotating testing demonstrated load capability of 1816 lbs (8.1 kN), which equates to a thrust bearing unit load of 67 psi (0.46 MPa). Gas film force–deflection curves reveal a nonlinear relationship between thrust load and film clearance. Comparison of film thickness values with the predictive model show good agreement under high load and inlet pressure, however deviate as load and pressure decrease. Load capability was shown to increase with increasing hydrostatic inlet pressure, while the increase in thrust runner speed revealed a small decrease in load capacity.
Control of Spatial Hyperchaos in Higher Order MIMO Cascade Nonlinear Systems
Authors: Zlatkovic Bojana M. , Samardzic Biljana
Published: April 2021

In this paper, dynamics of higher order multiple input multiple output (MIMO) cascade nonlinear systems, MIMOn, (n>3), is analyzed using simulation of bifurcation and Lyapunov diagrams and spatial phase portraits. One of the characteristics of these systems is the possibility of spatial hyperchaos appearance. Control of spatial hyperchaos in MIMOn systems using modified Pyragas method is analyzed, also. The results are illustrated by example of MIMO6 system.
Rituximab-resistant splenic memory B cells and newly engaged naive B cells fuel relapses in patients with immune thrombocytopenia
Authors: Crickx Etienne , Chappert Pascal , Sokal Aurélien , Weller Sandra , Azzaoui Imane , Vandenberghe Alexis , Bonnard Guillaume , Rossi Geoffrey , Fadeev Tatiana , Storck Sébastien , Fadlallah Jehane , Meignin Véronique , Rivière Etienne , Audia Sylvain , Godeau Bertrand , Michel Marc , Weill Jean-Claude , Reynaud Claude-Agnès , Mahévas Matthieu
Published: April 2021

Rituximab-resistant memory B cells and newly engaged naive B cells join to fuel subsequent autoimmune responses in patients with relapsing ITP.
Brain injury instructs bone marrow cellular lineage destination to reduce neuroinflammation
Authors: Shi Samuel X. , Shi Kaibin , Liu Qiang
Published: April 2021

Intracerebral hemorrhage skews bone marrow hematopoietic stem cells toward myeloid cell lineages that reduce neuroinflammation and brain injury.
Triple-modality therapy maximizes antitumor immune responses in a mouse model of mesothelioma
Authors: Murakami Junichi , Wu Licun , Kohno Mikihiro , Chan Mei-Lin , Zhao Yidan , Yun Zhihong , Cho B. C. John , de Perrot Marc
Published: April 2021

Combining IL-15 superagonist and anti-GITR agonist therapy enhances antitumor effects of radiation therapy in a mouse model of mesothelioma.
Dynamic Pneumococcal Genetic Adaptations Support Bacterial Growth and Inflammation during Coinfection with Influenza
Authors: Smith Amanda P. , Lane Lindey C. , van Opijnen Tim , Woolard Stacie , Carter Robert , Iverson Amy , Burnham Corinna , Vogel Peter , Roeber Dana , Hochu Gabrielle , Johnson Michael D. L. , McCullers Jonathan A. , Rosch Jason , Smith Amber M.
Published: April 2021

Streptococcus pneumoniae
(pneumococcus) is one of the primary bacterial pathogens that complicates influenza virus infections. These bacterial coinfections increase influenza-associated morbidity and mortality through a number of immunological and viral-mediated mechanisms, but the specific bacterial genes that contribute to postinfluenza pathogenicity are not known.
Complete Genome Sequence of Rhodopseudomonas palustris RCB100, an Anoxygenic Phototroph That Degrades 3-Chlorobenzoate
Authors: Haq Irshad UI , Fixen Kathryn R.
Published: April 2021

The purple nonsulfur bacterium
Rhodopseudomonas palustris
RCB100 anaerobically degrades 3-chlorobenzoate (3-CBA), a halogenated pollutant.
R. palustris
RCB100 uses 3-CBA as a carbon source, while most
R. palustris
strains cannot. We report the complete genome sequence of strain RCB100 to help gain insight into how this bacterium degrades 3-CBA.
Viral Metagenomic Analysis Reveals a Human Rhinovirus from Hospitalized Neonates
Authors: Li Hong , Xiao Yuqing , Lü Jinquan , Zhang Wen , Lu Hongyan
Published: April 2021

Here, the coding-complete genome of a human rhinovirus (HRV) belonging to the HRV-A clade was determined from a pool containing nine nasopharyngeal secretion specimens from hospitalized neonates. PCR screening indicated that this HRV variant was present in a cohort of 45 hospitalized neonates, with a positivity rate of 11.1% (5/45 patients).
Near-Complete Genome Sequences of Eight Human Astroviruses Recovered from Diarrheal Stool Samples of Hospitalized Children in Coastal Kenya in 2019
Authors: Lambisia Arnold W. , Phan My V. T. , de Laurent Zaydah R. , Cotten Matthew , Nokes D. James , Agoti Charles N.
Published: April 2021

Here, using a sequence-independent sequencing approach (M. V. Phan, P. Hong Anh, N. Van Cuong, B. Oude Munnink, et al., Virus Evol 2:vew027, 2016,
https://doi.org/10.1093/ve/vew027
), we determined human astrovirus (HAstV) genome sequences from eight diarrheal stool samples collected in coastal Kenya in 2019. Phylogenetic analysis identified the following 4 genotypes: HAstV-1 (
n
= 4), HAstV-2 (
n
= 1), HAstV-3 (
n
= 1), and HAstV-5 (
n
= 2).
Complete Genome Sequence of Campylobacter coli Bacteriophage CAM-P21
Authors: Huang Hung-Hsin , Zhang Yu , Asoshima Nanami , Duc Hoang Minh , Sato Jun , Masuda Yoshimitsu , Honjoh Ken-ichi , Miyamoto Takahisa
Published: April 2021

Bacteriophage CAM-P21, isolated from a beef mince sample in Japan using
Campylobacter coli
, has a 12,587-bp genome encoding 18 putative coding sequences with an average GC content of 31.19%.
Whole-Genome Sequence of
Avian coronavirus
from a 15-Year-Old Sample Confirms Evidence of GA08-like Strain Circulation 4 Years Prior to Its First Reported Outbreak
Authors: Goraichuk Iryna V. , Davis James F. , Kulkarni Arun B. , Afonso Claudio L. , Suarez David L.
Published: April 2021

Here, we report the complete genome sequence of an
Avian coronavirus
strain GA08-like isolate from a fecal sample from a broiler chicken collected in Georgia, USA, in 2004. The viral genome in this 15-year-old sample provides evidence for the circulation of the GA08-like strain at least 4 years before its first report in 2008.
Supplemental Material: Diverse marine fish assemblages inhabited the paleotropics during the Paleocene-Eocene thermal maximum
Authors: El-Sayed Sanaa , al. et
Published: April 2021

Additional details of geology and biostratigraphy of Ras Gharib A; list of fossils collected to date, and supplementary references; R code for faunal analyses; and compositional data for Late Cretaceous-Eocene marine fish assemblages.
Interfacial Synthesis: Morphology, Structure, and Properties of Interfacial Formations in Liquid–Liquid Systems
Authors: Golubina E. N. , Kizim N. F.
Published: April 2021

The results of studies in the field of interfacial synthesis and interfacial formations in liquid–liquid systems are summarized. The mechanisms of the processes of interfacial synthesis are considered. Data on the self-assembly of nanoparticles, films, and 3D materials are given. The properties of materials of interfacial formations in systems with rare-earth elements and di(2-ethylhexyl)phosphoric acid, obtained both in the presence and absence of local vibrations, are described. It was established that materials obtained in the presence of local vibrations in the interfacial layer have higher density, melting point, and magnetic susceptibility and lower electric conductivity. The effect of force field parameters on the properties of interfacial formations is considered. Practical applications and prospects for research in the field of interfacial formations are discussed.
Ethical issues in treatment of babies born at 22 weeks of gestation
Authors: Lantos John D
Published: April 2021

Many centres now report that more than half of babies born at 22 weeks survive and most survivors are neurocognitively intact. Still, many centres do not offer life-sustaining treatment to babies born this prematurely. Arguments for not offering active treatment reflect concerns about survival rates, rates of neurodevelopmental impairment and cost. In this essay, I examine each of these arguments and find them ethically problematic. I suggest that current data ought to lead to two changes. First, institutional culture should change at institutions that do not offer treatment to babies born at 22 weeks. Second, we need more research to understand best practices for these tiny babies.
Acute heart failure: on the track of a rare disease
Authors: Andrade Joana , Freitas André , Costa Susana , Baptista Rui
Published: April 2021

Eosinophilic granulomatosis with polyangiitis is an antineutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis with cardiac involvement in more than 60% of cases. Authors describe the case of a 48-year-old woman who presented with progressively worsening asthenia, dyspnoea and macular, non-painful, non-itchy cutaneous lesions. She had signs of congestion on clinical examination and a history of asthma and nasal polyps. Blood tests showed eosinophilia (11.2%), positive troponin I (9698 μg/L), elevated B-type natriuretic peptide (2047 pg/mL) and positive C reactive protein (6.68 mg/dL). Echocardiogram displayed moderate left ventricular enlargement, left ventricular ejection fraction of 28% and mild pericardial effusion. Levosimendan relieved the congestion. Additional testing confirmed positive antinuclear antibodies with ANCA-negative autoimmune pattern. Cardiac magnetic resonance showed severely depressed systolic function due to diffuse hypokinesia. Cardiac biopsy had intercellular oedema and eosinophilic infiltrate. Treatment with prednisolone and cyclophosphamide was started. This is a case of a rare disease presenting with life-threatening cardiac involvement.
Chlamydia (lymphogranuloma venereum) peritonitis in a male patient
Authors: Antonik Magdalena , Ovens Katie J , Labib Peter L , Briggs Christopher D
Published: April 2021

A 49-year-old man presented with a 1-week history of abdominal pain, distension, diarrhoea and fatigue. CT of the abdomen and pelvis revealed peritonitis with no identifiable cause. Diagnostic laparoscopy was performed, which excluded gastrointestinal perforation. Peritoneal fluid tested positive forChlamydia trachomatisand rectal swabs were positive forC. trachomatisserovars consistent with lymphogranuloma venereum (LGV). Additional blood tests also revealed a diagnosis of syphilis. This is a rare documented case of LGV peritonitis in a male without associated immunodeficiency. The patient recovered well following laparoscopic washout and a course of appropriate antibiotics.
Effects of wearing a cloth face mask on performance, physiological and perceptual responses during a graded treadmill running exercise test
Authors: Driver Simon , Reynolds Megan , Brown Katelyn , Vingren Jakob L , Hill David W , Bennett Monica , Gilliland Taylor , McShan Evan , Callender Librada , Reynolds Erin , Borunda Nate , Mosolf John , Cates Casey , Jones Alan
Published: April 2021

Objectives

To (1) determine if wearing a cloth face mask significantly affected exercise performance and associated physiological responses, and (2) describe perceptual measures of effort and participants’ experiences while wearing a face mask during a maximal treadmill test.

Methods

Randomised controlled trial of healthy adults aged 18–29 years. Participants completed two (with and without a cloth face mask) maximal cardiopulmonary exercise tests (CPETs) on a treadmill following the Bruce protocol. Blood pressure, heart rate, oxygen saturation, exertion and shortness of breath were measured. Descriptive data and physical activity history were collected pretrial; perceptions of wearing face masks and experiential data were gathered immediately following the masked trial.

Results

The final sample included 31 adults (age=23.2±3.1 years; 14 women/17 men). Data indicated that wearing a cloth face mask led to a significant reduction in exercise time (−01:39±01:19 min/sec, p<0.001), maximal oxygen consumption (VO2max) (−818±552 mL/min, p<0.001), minute ventilation (−45.2±20.3 L/min), maximal heart rate (−8.4±17.0 beats per minute, p<0.01) and increased dyspnoea (1.7±2.9, p<0.001). Our data also suggest that differences in SpO2and rating of perceived exertion existed between the different stages of the CPET as participant’s exercise intensity increased. No significant differences were found between conditions after the 7-minute recovery period.

Conclusion

Cloth face masks led to a 14% reduction in exercise time and 29% decrease in VO2max, attributed to perceived discomfort associated with mask-wearing. Compared with no mask, participants reported feeling increasingly short of breath and claustrophobic at higher exercise intensities while wearing a cloth face mask. Coaches, trainers and athletes should consider modifying the frequency, intensity, time and type of exercise when wearing a cloth face mask.
From direct engagement to technical support: a programmatic evolution to improve large community health worker programs in Bihar, India
Authors: Wilhelm Jess , Mahapatra Tanmay , Das Aritra , Sonthalia Sunil , Srikantiah Sridhar , Galavotti Christine , Shah Hemant , Creanga Andreea A
Published: April 2021

Introduction

In 2011, through a multipartner Integrated Family Health Initiative (IFHI), CARE started supporting maternal and neonatal health (MNH) improvement goals in 8 of 38 districts in Bihar, India. The programme included a frontline health worker (FHW) component offering health advice through household visits and benefited from CARE’s direct engagement during IFHI, which then evolved into statewide Technical Support Unit (TSU) to the Government of Bihar in 2014.

Methods

Using eight rounds of state-representative household surveys with mothers of infants aged 0–2 months (N=73 093) linked with two facility assessments conducted during 2012–2017, we assessed changes in FHW visit coverage, intensity and quality between IFHI and TSU phases. Using logistic regression models, we ascertained associations between FHW outputs and three MNH core practices: ≥3 antenatal care check-ups (ANC3+), institutional delivery and early breastfeeding initiation.

Results

Women’s receipt of 1+ FHW visits declined from 60.2% (IFHI phase) to 46.3% (TSU phase) in the eight IFHI districts, being below 40% statewide during the TSU phase. Despite a parallel decline in FHW visit quality measured as the number of health advice received, all three outcomes improved during the TSU versus IFHI phase in IFHI districts. We found significant positive associations between all three outcomes and receipt of 1+ FHW visits and programme phase (TSU vs IFHI) in the eight IFHI districts. During the TSU phase, receipt of 2+ FHW visits in the third trimester increased the odds of women receiving ANC3+ (adjusted OR (aOR)=1.21; 95% CI: 1.13 to 1.31), delivering in a facility (aOR=1.64; 95% CI: 1.51 to 1.77) and initiating breast feeding early (aOR=1.18; 95% CI: 1.05 to 1.18). Independent of the number and timing of FHW visits, we also found positive associations between women reporting higher than lower quality of FHW interactions and receiving outcome-specific advice and all three MNH outcomes.

Conclusion

Implementation of large community-based interventions under the technical support model should be continuously and strategically evaluated and adapted.
How machine learning is embedded to support clinician decision making: an analysis of FDA-approved medical devices
Authors: Lyell David , Coiera Enrico , Chen Jessica , Shah Parina , Magrabi Farah
Published: April 2021

Objective

To examine how and to what extent medical devices using machine learning (ML) support clinician decision making.

Methods

We searched for medical devices that were (1) approved by the US Food and Drug Administration (FDA) up till February 2020; (2) intended for use by clinicians; (3) in clinical tasks or decisions and (4) used ML. Descriptive information about the clinical task, device task, device input and output, and ML method were extracted. The stage of human information processing automated by ML-based devices and level of autonomy were assessed.

Results

Of 137 candidates, 59 FDA approvals for 49 unique devices were included. Most approvals (n=51) were since 2018. Devices commonly assisted with diagnostic (n=35) and triage (n=10) tasks. Twenty-three devices were assistive, providing decision support but left clinicians to make important decisions including diagnosis. Twelve automated the provision of information (autonomous information), such as quantification of heart ejection fraction, while 14 automatically provided task decisions like triaging the reading of scans according to suspected findings of stroke (autonomous decisions). Stages of human information processing most automated by devices were information analysis, (n=14) providing information as an input into clinician decision making, and decision selection (n=29), where devices provide a decision.

Conclusion

Leveraging the benefits of ML algorithms to support clinicians while mitigating risks, requires a solid relationship between clinician and ML-based devices. Such relationships must be carefully designed, considering how algorithms are embedded in devices, the tasks supported, information provided and clinicians’ interactions with them.
How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients
Authors: Glynn Kevin , McKenna Frank , Lally Kevin , O’Donnell Muireann , Grover Sandeep , Chakrabarti Subho , Avasthi Ajit , Mattoo Surendra K , Sharma Akhilesh , Ghosh Abhishek , Shah Ruchita , Hickey David , Fitzgerald James , Davis Brid , O'Regan Niamh , Adamis Dimitrious , Williams Olugbenja , Awan Fahad , Dunne C , Cullen Walter , McInerney Shane , McFarland John , Jabbar Faiza , O'Connell Henry , Trzepacz Paula T , Leonard Maeve , Meagher David
Published: April 2021

Objectives

To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.

Design

Cross-sectional study.

Setting

International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.

Participants

1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).

Primary and secondary outcome measures

Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.

Results

Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).

Conclusions

This study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.
Efficacy of the iDBT-Pain skills training intervention to reduce emotional dysregulation and pain intensity in people with chronic pain: protocol for a single-case experimental design with multiple baselines
Authors: Norman-Nott Nell , Wilks Chelsey , Hesam-Shariati Negin , Schroeder Jessica , Suh Jina , Czerwinski Mary , Gustin Sylvia Maria
Published: April 2021

Introduction

Difficulties in emotional regulation are key to the development and maintenance of chronic pain. Recent evidence shows internet-delivered dialectic behaviour therapy (iDBT) skills training can reduce emotional dysregulation and pain intensity. However, further studies are needed to provide more definitive evidence regarding the efficacy of iDBT skills training in the chronic pain population.

Methods and analysis

A single-case experimental design (SCED) with multiple baselines will be used to examine the efficacy of a 4-week iDBT-Pain skills training intervention (iDBT-Pain intervention) to reduce emotional dysregulation and pain intensity in individuals with chronic pain. The iDBT-Pain intervention encompasses two components: (1) iDBT-Pain skills training sessions (iDBT-Pain sessions) and (2) the iDBT-Pain skills training web application (iDBT-Pain app). Three individuals with chronic pain will be recruited and randomly allocated to different baseline phases (5, 9 or 12 days). Following the baseline phase, participants will receive six 60–90 min iDBT-Pain sessions approximately 4 or 5 days apart, delivered by a psychologist via Zoom. To reinforce learnings from the iDBT-Pain sessions, participants will have unlimited use of the iDBT-Pain app. A 7-day follow-up phase (maintenance) will follow the intervention, whereby the iDBT-Pain sessions cease but the iDBT-Pain app is accessible. Emotional regulation, as the primary outcome measure, will be assessed using the Difficulties in Emotion Regulation Scale. Pain intensity, as the secondary outcome measure, will be assessed using a visual analogue scale. Generalisation measures will assess psychological state factors (depression, anxiety and coping behaviour), alongside sleep quality, well-being and harm avoidance. SCEDs are increasingly considered effective designs for internet-delivered psychological interventions because SCED enables the investigation of interindividual variability in a heterogeneous population such as chronic pain.

Ethics and dissemination

This trial was approved by the University of New South Wales (HC200199). Results will be published in peer-reviewed journals.

Trial registration number

ACTRN12620000604909.
Current smoking status as a predictor of cerebral infarction in men: a retrospective cohort study in South Korea
Authors: Lee Sang Min , Oh Chang-Mo , Kim Min-Ho , Ha Eunhee , Hong Minha , Ryoo Jae-Hong
Published: April 2021

Objectives

We examined the relationship between duration (pack-year) of smoking and the risk of developing cerebral infarction in Korean men.

Design

Retrospective cohort study.

Setting

National Health Insurance Service-National Sample Cohort in Korea.

Participants

Of 125 743 male participants from the National Health Insurance System undergoing medical health check-up in 2009, 114 377 were included in the final analysis.

Primary and secondary outcome measures

Development of cerebral infarction according to smoking duration after adjusting for age, body mass index, systolic blood pressure, fasting blood glucose, total cholesterol, γ-glutamyltransferase, estimated glomerular filtration rate, alcohol intake and physical activity.

Results

During 495 827.3 person-years of follow-up, 1450 incident cases of cerebral infarction developed between 2009 and 2013. The multivariate adjusted HRs (95% CI) for cerebral infarction between groups 2, 3 and 4 by duration of smoking were 1.02 (0.88 to 1.19), 1.36 (1.19 to 1.56) and 1.49 (1.28 to 1.74), respectively. In our secondary analysis by smoking status, the HR (95% CI) of former smokers showed a significant relationship in the unadjusted model but did not show statistically significant associations in the multivariate adjusted model. The HR (95% CI) of current smokers showed significant relationship in both the unadjusted and multivariate adjusted models (p for trend <0.001).

Conclusions

The study indicates that the prolonged duration of smoking (pack-year) increases the risk of cerebral infarction. Current smoking poses a higher risk for the development of cerebral infraction than former smoking among Korean men, indicating that current smoking cessation would be more protective.
Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: the DiaPROM randomised controlled pilot trial
Authors: Hernar Ingvild , Graue Marit , Richards David A , Strandberg Ragnhild B , Nilsen Roy Miodini , Rekdal Magne , Løvaas Karianne Fjeld , Madsen Tone V , Tell Grethe S , Haugstvedt Anne
Published: April 2021

Objective

To pilot test the proposed DiaPROM trial components and address uncertainties associated with conducting a full-scale randomised controlled trial (RCT) to evaluate whether such a trial is feasible.

Design

Two-arm pilot RCT.

Participants

Adults aged ≥18–39 years, with minimum 1 year type 1 diabetes duration, attending outpatient follow-up. Exclusion criteria were pregnancy, severe cognitive, somatic or psychiatric conditions and impaired vision.

Randomisation and intervention

All participants completed electronic Patient-Reported Outcome Measures (PROMs) prior to the annual diabetes consultation. Using computer-generated block-randomisation without blinding, we assigned participants in a 1:1 ratio stratified by sex to receive standard care or an intervention. Physicians reviewed diabetes distress scores (Problem Areas In Diabetes scale) and referred individuals with scores ≥30 or single item(s) ≥3 to minimum two diabetes nurse consultations where reported problems were reviewed and discussed.

Outcomes

Recruitment and retention rates; participants perceptions about intervention components. Variance and estimated between-group differences in follow-up scores (Diabetes Distress Scale(DDS),WHO 5-Well-being Index,Perceived Competence for Diabetes Scaleandglycaemic control) and DDS correlation with baseline scores, to assist sample size calculations.

Results

We randomised 80 participants to the control or intervention arm (one participant was later excluded). 23/39 intervention arm participants qualified for additional consultations and 17 attended. 67/79 attended the 12-month follow-up (15.2% attrition); 5/17 referred to additional consultations were lost to follow-up (29.4% attrition). Participants reported PROMs as relevant (84.6%) and acceptable (97.4%) but rated the usefulness of consultations as moderate to low. Baseline mean±SD DDS score was 2.1±0.69; DDS SD was 0.71 (95% CI: 0.60 to 0.86) at follow-up; correlation between baseline and follow-up DDS scores was 0.8 (95% CI: 0.7 to 0.9).

Conclusions

The pilot trial revealed need for intervention modifications ahead of a full-scale trial to evaluate use of PROMs in diabetes consultations. Specifically, participant acceptability and intervention implementation need further investigation.
Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomised controlled trial protocol
Authors: Ullman Amanda J , August Deanne , Kleidon Tricia , Walker Rachel , Marsh Nicole M , Bulmer Andrew , Pearch Benjamin , Runnegar Naomi , Schults Jessica A , Leema Joanne , Lee-Archer Paul , Biles Cathy , Southam Katrina , Gibson Victoria , Byrnes Joshua , Ware Robert S , Chopra Vineet , Coulthard Alan , Mollee Peter , Rickard Claire M , Harris Patrick N A
Published: April 2021

Introduction

Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications.

Methods and analysis

A multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve); (2) chlorhexidine gluconate-impregnated PICC (with external clamp)) and one control group ((3) conventional polyurethane PICC (with external clamp)). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome isPICC failure, a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication; thrombotic complications; infective complications; adverse events (local or systemic reaction); PICC dwell time; patient/parent satisfaction; and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI.

Ethics and dissemination

Ethical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published.

Trial registration number

ACTRN12619000022167.
Towards a middle-range theory of ‘Stability of home-based care arrangements for people living with dementia’ (SoCA-Dem): findings from a meta-study on mixed research
Authors: Köhler Kerstin , Dreyer Jan , Hochgraeber Iris , von Kutzleben Milena , Pinkert Christiane , Roes Martina , Holle Bernhard
Published: April 2021

Background

Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability?

Methods

Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis.

Results

99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process ofchangeandbalancingover time; (2) the characteristics of the care arrangement, includingneeds, thecarer role, thedyadic relationshipandresources; and (3) the context, which is determined bysociety and cultureand the respectivehealthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer.

Discussion

This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice.

Other

This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).
Short-term morbidity and mortality following radical cystectomy: a systematic review
Authors: Maibom Sophia Liff , Joensen Ulla Nordström , Poulsen Alicia Martin , Kehlet Henrik , Brasso Klaus , Røder Martin Andreas
Published: April 2021

Objective

To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these.

Design

Systematic review.

Methods

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle–Ottawa Scale.

Results

The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8–68.8) for in-house complications, 39.0% (range 27.3–80.0) for 30-day complications and 58.5% (range 36.1–80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9–4.7) for in-house mortality, 2.1% (0.0–3.7) for 30-day mortality and 4.7% (range 0.0–7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC.

Conclusion

Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC.

PROSPERO registration number

104937.
Barthel Index-based functional status as a prognostic factor in young and middle-aged adults with newly diagnosed gastric, colorectal and lung cancer: a multicentre retrospective cohort study
Authors: Morishima Toshitaka , Sato Akira , Nakata Kayo , Matsumoto Yoshifumi , Koeda Nobuyuki , Shimada Hiroko , Maruhama Tsutomu , Matsuki Daisaku , Miyashiro Isao
Published: April 2021

Objectives

Functional status assessments of activities of daily living may improve prognostic precision during initial diagnostic evaluations in young and middle-aged adults with cancer. However, the association between pretreatment functional status and survival in these patients is poorly understood. This study aimed to evaluate the prognostic value of functional status in young and middle-aged patients with cancer.

Design

Multicentre retrospective cohort study.

Setting

We used a cancer registry from Osaka Prefecture, Japan. The data were linked to administrative claims data from 35 hospitals in the same prefecture.

Participants

Patients aged 18–69 years who received new diagnoses of gastric, colorectal or lung cancer between 2010 and 2014.

Main outcome measure

Cox proportional hazards models of 5-year all-cause mortality were developed to examine the prognostic impact of pretreatment functional status, which was categorised into three levels of functional disability (none, moderate and severe) based on Barthel Index scores. The models controlled for age, sex, comorbidities, cancer stage and tumour histology.

Results

We analysed 12 134 patients. Higher mortality risks were significantly associated with moderate functional disability (adjusted HR 1.44 (95% CI 1.18 to 1.75), 1.35 (95% CI 1.08 to 1.68) and 1.74 (95% CI 1.50 to 2.03) in patients with gastric, colorectal and lung cancer, respectively) and severe functional disability (adjusted HR 3.56 (95% CI 2.81 to 4.51), 2.37 (95% CI 1.89 to 2.95) and 2.34 (95% CI 2.00 to 2.75) in patients with gastric, colorectal and lung cancer, respectively).

Conclusion

Accounting for functional status at cancer diagnosis may improve the prediction of survival time in young and middle-aged adults with cancer. Functional status has potential applications in survival predictions and risk adjustments when analysing outcomes in patients with cancer.
Multicentre randomised double-blinded placebo-controlled trial of favipiravir in adults with mild COVID-19
Authors: Bosaeed Mohammad , Alharbi Ahmad , Hussein Mohammad , Abalkhail Mohammed , Sultana Khizra , Musattat Abrar , Alqahtani Hajar , Alshamrani Majid , Mahmoud Ebrahim , Alothman Adel , Alsaedy Abdulrahman , Aldibasi Omar , Alhagan Khalid , Asiri Abdullah Mohammed , AlJohani Sameera , Al-Jeraisy Majed , Alaskar Ahmed
Published: April 2021

Introduction

A novel coronavirus, designated SARS-CoV-2, caused an international outbreak of a respiratory illness, termed COVID-19 in December 2019. There is a lack of specific therapeutic agents based on evidence for this novel coronavirus infection; however, several medications have been evaluated as a potential therapy. Therapy is required to treat symptomatic patients and decrease the virus carriage duration to limit the communitytransmission.

Methods and analysis

We hypothesise that patients with mild COVID-19 treated with favipiravir will have a shorter duration of time to virus clearance than the control group. The primary outcome is to evaluate the effect of favipiravir on the timing of the PCR test conversion from positive to negative within 15 days after starting the medicine.

Adults (>18 years, men or nonpregnant women, diagnosed with mild COVID-19 within 5 days of disease onset) are being recruited by physicians participating from the Ministry of National Guard Health Affairs and the Ministry of Health ethics committee approved primary healthcare centres. This double-blind, randomised trial comprises three significant parts: screening, treatment and a follow-up period. The treating physician and patients are blinded. Eligible participants are randomised in a 1:1 ratio to either the therapy group (favipiravir) or a control group (placebo) with 1800 mg by mouth two times per day for the first day, followed by 800 mg two times per day for 4–7 days. Serial nasopharyngeal/oropharyngeal swab samples are obtained on day 1 (5 days before therapy). On day5±1 day, 10±1 day, 15±2 days, extra nasopharyngeal/oropharyngeal PCR COVID-19 samples are requested.

The primary analysis population for evaluating both the efficacy and safety outcomes will be a modified intention to treat population. Anticipating a 10% dropout rate, we expect to recruit 288 subjects per arm. The results assume that the hazard ratio is constant throughout the study and that the Cox proportional hazard regression is used to analyse the data.

Ethics and dissemination

The study was approved by the King Abdullah International Medical Research Centre Institutional Review Board (28 April 2020) and the Ministry of Health Institutional Review Board (1 July 2020). Protocol details and any amendments will be reported tohttps://clinicaltrials.gov/ct2/show/NCT04464408. The results will be published in peer-reviewed journals.

Trial registration number

National Clinical Trial Registry (NCT04464408).
Provider variability in the intraoperative use of neuromuscular blocking agents: a retrospective multicentre cohort study
Authors: Althoff Friederike C , Xu Xinling , Wachtendorf Luca J , Shay Denys , Patrocinio Maria , Schaefer Maximilian S , Houle Timothy T , Fassbender Philipp , Eikermann Matthias , Wongtangman Karuna
Published: April 2021

Objective

To assess variability in the intraoperative use of non-depolarising neuromuscular blocking agents (NMBAs) across individual anaesthesia providers, surgeons and hospitals.

Design

Retrospective observational cohort study.

Setting

Two major tertiary referral centres, Boston, Massachusetts, USA.

Participants

265 537 adult participants undergoing non-cardiac surgery between October 2005 and September 2017.

Main outcome measures

We analysed the variances in NMBA use across 958 anaesthesia and 623 surgical providers, across anaesthesia provider types (anaesthesia residents, certified registered nurse anaesthetists, attendings) and across hospitals using multivariable-adjusted mixed effects logistic regression. Intraclass correlations (ICC) were calculated to further quantify the variability in NMBA use that was unexplained by other covariates. Procedure-specific subgroup analyses were performed.

Results

NMBAs were used in 183 242 (69%) surgical cases. Variances in NMBA use were significantly higher among individual surgeons than among anaesthesia providers (variance 1.32 (95% CI 1.06 to 1.60) vs 0.24 (95% CI 0.19 to 0.28), p<0.001). Procedure-specific subgroup analysis of hernia repairs, spine surgeries and mastectomies confirmed our findings: the total variance in NMBA use that was unexplained by the covariate model was higher for surgeons versus anaesthesia providers (ICC 37.0% vs 13.0%, 69.7% vs 25.5%, 69.8% vs 19.5%, respectively; p<0.001). Variances in NMBA use were also partially explained by the anaesthesia provider’s hospital network (Massachusetts General Hospital: variance 0.35 (95% CI 0.27 to 0.43) vs Beth Israel Deaconess Medical Center: 0.15 (95% CI 0.12 to 0.19); p<0.001). Across provider types, surgeons showed the highest variance, and anaesthesia residents showed the lowest variance in NMBA use.

Conclusions

There is wide variability across individual surgeons and anaesthesia providers and institutions in the use of NMBAs, which could not sufficiently be explained by a large number of patient-related and procedure-related characteristics, but may instead be driven by preference. Surgeons may have a stronger influence on a key aspect of anaesthesia management than anticipated.