bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: a scoping review
Authors: Hinton Ladson , Tran Duyen , Nguyen Thuc-Nhi , Ho Janis , Gitlin Laura
Published: November 2019

Introduction

Despite increasing numbers of persons living with Alzheimer’s disease and Alzheimer’s-related dementias (AD/ADRD) in Asia, particularly in low-income countries (LIC) and middle-income countries (MIC), surprisingly little is known about the current state of the evidence for family caregiver interventions. The objectives of this scoping review were to: (1) describe the evidence for efficacy of family dementia-caregiver psychosocial interventions in Asian countries, (2) compare evidence across LIC, MIC, and high-income countries (HIC), and (3) characterise cultural adaptions to interventions developed outside Asia.

Methods

The inclusion criteria included: (1) conducted in Asia (2) included an intervention delivered to a family caregiver of a person living with AD/ADRD, (3) reported quantitative outcomes for the family caregiver and (4) published in a peer-reviewed journal with full text available in English.

Results

Thirty intervention trials were identified meeting inclusion criteria and all reported statistically significant (p<0.05) improvement in one or more caregiver outcomes. Interventions usually included multiple components. The most frequently reported outcomes (ie, by ≥20% of studies) were caregiver depression, burden, quality of life and self-efficacy. Overall, 26 (87%) of the studies were conducted in HIC in Asia, primarily in Hong Kong SAR—China and Taiwan, and only 4 (13%) in LIC and MIC in Asia. Seven studies (23%) used interventions developed in USA and several described cultural adaptations.

Conclusion

This scoping review found substantial evidence, particularly from high-income Asian countries, that a wide range of interventions improve AD/ADRD family caregiver outcomes. However, critical knowledge gaps exist, particularly for LIC and MIC in Asia, where the number of persons with dementia is numerically largest and projected to increase dramatically in coming decades. The field could also benefit from more detailed descriptions of the process and types of cultural adaptations to interventions.
After the Astana declaration: is comprehensive primary health care set for success this time?
Authors: Kraef Christian , Kallestrup Per
Published: November 2019

Primary health care (PHC) strengthening in order to achieve the Sustainable Development Goal has again, 40 years after the Alma-Ata declaration, been declared a priority by the global health community. Despite initial progress the Alma-Ata vision of Health for All by the year 2000 was not realised. In this analysis we (1) examine the challenges that comprehensive PHC faced after the Alma-Ata declaration, (2) provide an analysis of the current opportunities and threats to comprehensive PHC strengthening on the global, national and community level and (3) review the most important policy recommendations and related evidence to address these threats for success of the Astana declaration.

Factors that are predominantly opportunities are the treasure of historical lessons from the past 40 years, the increased attention to social and environmental determinants of health, the global economic growth and new technologies, in particular digital medicine, which also have the potential to revolutionise community involvement.

Factors that are currently predominantly threats are insecurity, conflicts and disease outbreaks; lack of sustained political commitment and inappropriate monitoring and evaluation structures; inappropriate and unsustainable financing models; insufficient health workforce recruitment, employment and retention; missing support of physicians and their professional organisations; inadequately addressing the needs of the community and not giving attention to gender equity. In contrast to the policy and evidence context in 1978 when Alma-Ata was passed there are today policy recommendations and a large body of evidence that can address the threats to comprehensive PHC—and turn them into opportunities.
Knowledge, attitude and self-efficacy of elderly caregivers in Chinese nursing homes: a cross-sectional study in Liaoning Province
Authors: Zhang Huijun , Sun He
Published: November 2019

Objective

This study aimed to investigate the perceptions of elderly caregivers in Chinese nursing homes (NHs) and associated factors with regard to knowledge, attitude about elderly and self-efficacy.

Setting

A cross-sectional questionnaire survey was conducted in 12 NHs in Liaoning Province, China.

Participants

A total of 403 caregivers from 12 NHs were surveyed.

Outcome measures

Data were collected using a self-administered questionnaire composed of the Palmore’s Facts on Aging Quiz I, Kogan’s Attitude Towards Old People Scale, General Self-Efficacy Scale and background characteristics of participants. An average score for knowledge, attitude and self-efficacy was calculated. Differences across groups were evaluated using Student’s t-test and analysis of variance. Multivariable linear regression models were established to estimate the associated factors.

Results

The participating caregivers reported a relative low score on knowledge about the elderly (10.42±2.79), attitude towards old people (127.85±14.36) and self-efficacy (27.12±4.9). Multivariable regression analysis showed that respondents who had high educational level (β=0.212, 95% CI 0.193 to 0.824), received prejob training (β=0.193, 95% CI 0.081 to 1.169) and had high job satisfaction (general satisfaction:β=0.345, 95% CI 0.223 to 1.875; very satisfied:β=0.322, 95% CI 0.210 to 1.283) gave a positive rating on knowledge. Caregivers who were employed as formal staff (β=0.155, 95% CI 0.116 to 1.670), earned a high income (β=0.214, 95% CI 0.117 to 1.461) and had an interest in working with the elderly (β=0.141, 95% CI 0.088 to 1.508) tended to develop a positive attitude towards the elderly. However, caregivers who were female (β=−0.110, 95% CI −1.751 to −0.080) and had long work experience (β=−0.130, 95% CI −1.527 to −0.110) developed negative perception. Caregivers who were older (β=0.215, 95% CI 0.139 to 1.027), received prejob training (β=0.143, 95% CI 0.113 to 1.024), had an interest in working with the elderly (β=0.154, 95% CI 0.114 to 1.015), had high job satisfaction (β=0.177, 95% CI 0.116 to 1.223) and perceived better health status for the elderly (partial disability:β=0.437, 95% CI 0.259 to 1.600; no disability:β=0.288, 95% CI 0.153 to 1.211) gave a positive rating on self-efficacy.

Conclusion

Knowledge about the elderly, attitude towards old people and self-efficacy of elderly caregivers in Chinese NHs were at low levels. Some targeted intervention programmes, such as conducting professional training for aged care and a performance-based payment system, should be given priority to improve these attributes.
Observational study comparing the accuracy/variability between the ERSPC and the PCPT risk calculators for the prediction of significant prostate cancer in patients with PSA <10 ng/mL
Authors: Gomez Gomez Enrique , Salamanca Bustos Juan José , Carrasco Valiente Julia , Fernandez Rueda Jose Luis , Blanca Ana , Valero Rosa José , Bravo Arrebola Ines , Marquez López Javier , Jimenez Vacas Juan Manuel , Luque Raul Miguel , Requena Tapia Maria José
Published: November 2019

Introduction

Risk calculators (RCs) are easy-to-use tools considering available clinical variables that could help to select those patients with risk of prostate cancer (PCa) who should undergo a prostate biopsy.

Objective

To perform a comparison for the prediction of significant PCa (SigPCa) between the European Randomised Study of Screening for PCa (ERSPC) and the PCa Prevention Trial (PCPT) RCs in patients with prostate-specific antigen (PSA) between 3 and 10 ng/mL through an evaluation of the accuracy/variability between two consecutive PSA values.

Setting

An observational study in a major university hospital in the south of Spain.

Methods and participants

An observational study was performed in patients who underwent a prostate biopsy. SigPCa probabilities were calculated with the two PSA measures using ERSPC3/4+digital rectal examination and PCPT v2+free PSA RCs. The prediction of SigPCa was determined by the area under the receiver operating characteristic curve (AUC). Calibration, discrimination and decision curve analysis were studied. The variability between both RCs’ agreement was compared using Cohen’s kappa coefficient.

Results

510 patients were analysed (87 diagnosed with SigPCa). The median PSA values were 5.3 and 5 ng/mL for PSA1 and PSA2, respectively. Both RCs overestimated the risk in the case of high-risk probabilities. Discriminative ability for SigPCa was similar between models with an AUC=0.73 (0.68–0.79) for ERSPC-RC versus 0.73 (0.67–0.79) for PCPT-RC. ERSPC-RC showed less variability than PCPT-RC, with a constant agreement (k=0.7–0.8) for usual range of clinical decision-making. Remarkably, a higher number of biopsies would be avoided using the ERSPC-RC, but more SigPCa would be missed along all the risk probabilities.

Conclusions

Both RCs performed similar in the prediction of SigPCa. However, ERSPC-RC seems to be more stable for intraindividual PSA variations.
Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)
Authors: Forstner Johanna , Kunz Aline , Straßner Cornelia , Uhlmann Lorenz , Kuemmel Stephanie , Szecsenyi Joachim , Wensing Michel
Published: November 2019

Introduction

Hospital stays are critical events as they often disrupt continuity of care. This process evaluation aims to describe and explore the implementation of the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern). The evaluation concerns the intervention fidelity, reach in targeted populations, perceived effects, working mechanisms, feasibility, determinants for implementation, including contextual factors, and associations with the outcomes evaluation. The aim of the VESPEERA programme is the development, implementation and evaluation of a structured admission and discharge programme in general practices and hospitals.

Methods and analysis

The process evaluation is linked to the VESPEERA outcomes evaluation, which has a quasi-experimental multi-centre design with four study arms and is conducted in hospitals and general practices in Germany. The VESPEERA programme comprises several components: an assessment before admission, an admission letter, a telephonic discharge conversation between hospital and general practice before discharge, discharge information for patients, structured planning of follow-up care after discharge in the general practice and a telephone monitoring for patients with a risk of rehospitalisation. The process evaluation has a mixed-methods design, incorporating interviews (patients, both care providers who do and do not participate in the VESPEERA programme, total n=75), questionnaires (patients and care providers who participate in the VESPEERA programme, total n=475), implementation plans of hospitals, data documented in general practices, claims-based data and hospital process data. Data analysis is descriptive and explorative. Qualitative data will be transcribed and analysed using framework analysis based on the Consolidated Framework for Implementation Research. Associations between the outcomes of the program and measures in the process evaluation will be explored in regression models.

Ethics and dissemination

Ethics approval has been obtained by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018). Results will be disseminated through a final report to the funding agency, articles in peer-reviewed journals and conferences.

Trial registration number

http://www.drks.de/DRKS00015183.

Trial status

The study protocol on hand is the protocol V.1.1 from 18 June 2018. Recruitment for interviews started on 3 September 2018 and will approximately be completed by the end of May 2019.
Capitalising on shared goals for family planning: a concordance assessment of two global initiatives using longitudinal statistical models
Authors: Li Qingfeng , Rimon Jose G , Ahmed Saifuddin
Published: November 2019

Objective

Family planning is unique among health interventions in its breadth of health, development and economic benefits. The complexity of formulating effective strategies to promote women’s and girls’ access to family planning calls for closer coordination of resources and attention from all stakeholders. Our objective was to quantify the concordance of two global initiatives: Family Planning 2020’s adding 120 million modern contraceptive users by 2020 (proposed during The London Summit 2012 by Gates Foundation) and satisfying the 75% demand for modern contraceptives by 2030 (proposed by United States Agency for International Development). A demonstration of their concordance, or lack thereof, provides an understanding of the proposed quantitative goals and helps to formulate collective strategies.

Design and setting

We applied fixed effects longitudinal models to assess the convergence of the two initiatives. The implications of success in one initiative on achieving the other are simulated to illustrate their shared goals. Publicly available data on contraceptive use, unmet need and met need from national surveys are used. Extensive model validations were conducted to check and confirm models’ predictive performance.

Results

Our results show that the 75% demand satisfied initiative will reach 82 million additional modern users by 2020 and 120 million by early 2023. Following FP2020’s proposed annual increase of modern contraceptive use, 9 of the 41 commitment-making countries will reach the 75% target by 2020; another 8 countries will do so by 2030. Extending FP2020’s proposed contraceptive growth to 2030 implies the achievement of the 75% target in less than half (17) of the 41 commitment-making countries.

Conclusion

The results from the statistical exercise demonstrate that the two global initiatives move toward the same goal of promoting access to family planning and overall both are ambitious. Closer coordination between major stakeholders in international family planning may stimulate more efficient mobilisation and utilisation of global sources, which is urgently needed to accelerate the progress toward satisfying women’s need for family planning.
Exploring sustainable primary care responses to intimate partner violence in New Zealand: Qualitative use of complexity theory
Authors: Gear Claire , Koziol-Mclain Jane , Eppel Elizabeth
Published: November 2019

Objective

To explore what affects sustainable responses to intimate partner violence within New Zealand primary care settings using complexity theory.

Design

Primary care professional interviews on intimate partner violence as a health issue are analysed using a complexity theory-led qualitative research methodology grounded in poststructuralism.

Setting

Four general practices in one region of the North Island of New Zealand, two serving a general patient population and two adopting an indigenous approach.

Participants

Seventeen primary care professionals and management from the four recruited general practices.

Results

The complex adaptive system approach the ‘Triple R Pathway’, calls attention to system interactions influencing intimate partner violence responsiveness across health system levels. Four exemplars demonstrate the use of the Triple R Pathway. Two key system areas challenge the emergence of primary care responsiveness: (1) Non-recognition of intimate partner violence as a key determinant of ill-health. (2) Uncertainty and doubt.

Conclusions

The relationship between intimate partner violence and ill-health is not well recognised, or understood in New Zealand, at both policy and practice levels. Inadequate recognition of socioecological determinants of intimate partner violence leads to a simple health system response which constrains primary care professional responsiveness. Constant intervention in system interactions is needed to promote the emergence of sustainable responses to intimate partner violence.
Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database
Authors: Kuo Ling-wei , Fu Chih-Yuan , Liao Chien-An , Liao Chien-Hung , Hsieh Chi-Hsun , Wang Shang-Yu , Chen Shao-Wei , Cheng Chi-Tung
Published: November 2019

​Objectives

To assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan.

​Design

A nationwide, retrospective cohort study.

​Setting

An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI.

​Participants

Patients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis.

​Primary and secondary outcome measures

The primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables.

​Results

In univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001).

​Conclusion

Even with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.
Later emergency provider shift hour is associated with increased risk of admission: a retrospective cohort study
Authors: Tyler Patrick D , Fossa Alan , Joseph Joshua W , Sanchez Leon D
Published: November 2019

Background

Understanding factors that drive admissions is critical to containing cost and optimising hospital operations. We hypothesised that, due to multiple factors, emergency physicians would be more likely to admit a patient seen later in their shift.

Methods

Retrospective study examining all patient visits at a large academic hospital from July 2010 to July 2016. Patients with missing data (n=191) were excluded. 294 031 emergency department (ED) visits were included in the final analysis. The exposure of interest was the time during the shift at which a patient was first evaluated by the clinician, and outcome was hospital admission. We used a generalised estimating equation with physician as the clustering level to adjust for patient age, gender, Emergency Severity Index (ESI, 1=most severe illness, 5=least severe illness) and 24 hours clock time. We also conducted a stratified analysis by three ESI categories.

Results

From the 294 031 ED visits, 5977 were seen in the last hour of the shift. Of patients seen in the last shift hour, 43% were admitted versus 39% seen at any other time during the shift. There was a significant association between being evaluated in the last hour (RR 1.03, 95% CI 1.01 to 1.06) and last quarter (RR 1.02, 1.01 to 1.03) of shift and the likelihood of admission. Patients with an ESI Score of 4–5 saw the largest effect sizes (RR 1.62, 0.996–2.635 for last hour and RR 1.24, 0.996–1.535 for last quarter) but these were not statistically significant. Additionally, there was a trend towards increased likelihood of admission later in shift; the relative risk of admission was 1.04 in hour 6, (1.02–1.05), 1.03 in hour 7 (1.01–1.05), 1.04 in hour 8 (1.01–1.06) and 1.06 in hour 9 (1.013–1.101).

Conclusions

There is a small but significant association between a patient being evaluated later in an emergency physician’s shift and their likelihood of being admitted to the hospital.
Palliative and end-of-life care and junior doctors: a systematic review and narrative synthesis
Authors: Bharmal Aamena , Morgan Tessa , Kuhn Isla , Wee Bee , Barclay Stephen
Published: November 2019

Background

Palliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.

Aim

To review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care.

Methods

Systematic literature review and narrative synthesis.

Results

A search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.

Conclusion

Medical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.
High rates of treatment failure forMycoplasma genitaliumamong men and women attending a sexual health clinic
Authors: Ovens Katie Jane , Reynolds-Wright John Joseph , Cross Elizabeth Louise Anne , Rickwood Lucinda , Hassan-Ibrahim Mohammed Osman , Soni Suneeta
Published: November 2019

Background

Mycoplasma genitalium(Mgen) causes non-gonococcal urethritis (NGU) and is believed to cause pelvic inflammatory disease (PID). High rates of macrolide resistance are well documented globally for Mgen. In Brighton, patients with NGU and PID are tested for Mgen and test of cure (TOC) offered post-treatment.

Methods

Demographic, clinical and treatment history data were collected over a 12-month period for all Mgen-positive patients in a Brighton-based genitourinary clinic.

Results

There were 114 patients with Mgen. 18% (61/339) of men with NGU and 9% (15/160) of women with PID had Mgen. 62/114 (54%) returned for first test TOC 4 weeks after treatment. 27/62 (44%) had a positive TOC; 25/27 (92.6%) had received azithromycin first line (500 mg stat then 250 mg OD for 4 days), 1/27 (3.7%) had received moxifloxacin first line (400 mg OD for 14 days) and 1/27 (3.7%) had received doxycycline first line (100 mg BD for 7 days). 20/27 (74%) returned for a second TOC 4 weeks later. 5/20 (25%) patients were positive on second TOC; 3/5 (60%) had received azithromycin second line and 2/5 (40%) had received moxifloxacin second line. Patients were more likely to have a positive TOC if they were at risk of reinfection (9/27 positive TOC vs 3/35 negative TOC; p=0.02). Patients given moxifloxacin were more likely to have a negative TOC (1/27 positive TOC vs 9/35 negative TOC; p=0.03) than those who received other antibiotic regimens.

Conclusions

Treatment failure rates for Mgen following azithromycin use are substantial, raising concerns regarding resistance. However, reinfection risk may contribute, suggesting a requirement for improved public awareness and clinician knowledge.
Reproductive health needs of recently incarcerated youth during community reentry: a systematic review
Authors: Barnert Elizabeth , Sun Ava , Abrams Laura , Chung Paul J
Published: November 2019

Background

Youth involved in the juvenile justice system have high reproductive health needs and, on exiting detention, face the challenging transition of reentry. We conducted a systematic literature review to describe what is known about youths’ reproductive health needs during community reentry after incarceration.

Methods

We searched PubMed, CINAHL, Cochrane Library, and Google Scholar for articles containing key words with the concepts ‘child or adolescent’, ‘incarcerated’ and 'reentry'. In the search, we defined the concept of ‘reentry’ as within 1 month prior to release (to include interventions involving pre-release planning) and up to 18 months after release from incarceration.

Results

Our search yielded 2187 articles. After applying all exclusion criteria, 14 articles on reproductive health remained for extraction. The articles provided data on the following aspects of youths’ reproductive health: frequency of condom use (eight articles), sexual risk behaviours other than lack of condom use (seven articles), and prevalence of sexually transmitted infections (three articles).

Conclusions

The literature on the reproductive health needs of youth undergoing reentry is extremely limited. Current intervention studies yield mixed but promising results and more intervention studies that address both pre-release reentry planning and the post-incarceration period are needed. Given incarcerated youths’ well-documented reproductive health disparities compared with non-incarcerated adolescents, the identified gaps represent important opportunities for future research and programmatic emphasis.
Early assessment with a virtual reality haptic simulator predicts performance in clinical practice
Authors: Al-Saud Loulwa M , Mushtaq Faisal , Mann Richard P , Mirghani Isra'a , Balkhoyor Ahmed , Harris Richard , Osnes Cecilie , Keeling Andrew , Mon-Williams Mark A , Manogue Michael
Published: November 2019

Background

Prediction of clinical training aptitude in medicine and dentistry is largely driven by measures of a student’s intellectual capabilities. The measurement of sensorimotor ability has lagged behind, despite being a key constraint for safe and efficient practice in procedure-based medical specialties. Virtual reality (VR) haptic simulators, systems able to provide objective measures of sensorimotor performance, are beginning to establish their utility in facilitating sensorimotor skill acquisition, and it is possible that they may also inform the prediction of clinical performance.

Methods

A retrospective cohort study examined the relationship between student performance on a haptic VR simulator in the second year of undergraduate dental study with subsequent clinic performance involving patients 2 years later. The predictive ability was tested against a phantom-head crown test (a traditional preclinical dental assessment, in the third year of study).

Results

VR scores averaged across the year explained 14% of variance in clinic performance, while the traditional test explained 5%. Students who scored highly on this averaged measure were ~10 times more likely to be high performers in the clinical crown test. Exploratory analysis indicated that single-trial VR scores did not correlate with real-world performance, but the relationship was statistically significant and strongest in the first half of the year and weakened over time.

Conclusions

The data demonstrate the potential of a VR haptic simulator to predict clinical performance and open up the possibility of taking a data-driven approach to identifying individuals who could benefit from support in the early stages of training.
Compact star in Tolman–Kuchowicz spacetime in the background of Einstein–Gauss–Bonnet gravity
Authors: Bhar Piyali , Singh Ksh. Newton , Tello-Ortiz Francisco
Published: November 2019

The present work is devoted to the study of anisotropic compact matter distributions within the framework of five-dimensional Einstein–Gauss–Bonnet gravity. To solve the field equations, we have considered that the inner geometry is described by Tolman–Kuchowicz spacetime. The Gauss–Bonnet Lagrangian $$\mathcal {L}_{GB}$$LGB is coupled to the Einstein–Hilbert action through a coupling constant, namely $$\alpha $$α. When this coupling tends to zero general relativity results are recovered. We analyze the effect of this parameter on the principal salient features of the model, such as energy density, radial and tangential pressure and anisotropy factor. These effects are contrasted with the corresponding general relativity results. Besides, we have checked the incidence on an important mechanism: equilibrium by means of a generalized Tolman–Oppenheimer–Volkoff equation and stability through relativistic adiabatic index and Abreu’s criterion. Additionally, the behavior of the subliminal sound speeds of the pressure waves in the principal directions of the configuration and the conduct of the energy-momentum tensor throughout the star are analyzed employing the causality condition and energy conditions, respectively. All these subjects are illuminated by means of physical, mathematical and graphical surveys. The M–I and the M–R graphs imply that the stiffness of the equation of state increases with $$\alpha $$α; however, it is less stiff than GR.
Memories of my early career in relativity physics
Authors: Trautman Andrzej , Salisbury Donald
Published: November 2019

This interview is focused on university studies and early career in relativity physics including thesis work under Leopold Infeld dealing with gravitational waves. Trautman’s recollections include the collaboration with Ivor Robinson and relationships with relevant personalities like Felix Pirani, Jerzy Plebanski, Roger Penrose and Peter Bergmann.
Spectrality of Moran measures with finite arithmetic digit sets
Authors: Liu Zong-Sheng , Dong Xin-Han
Published: November 2019

Let [Formula: see text] be a prime and [Formula: see text] be a sequence of finite arithmetic digit sets in [Formula: see text] with [Formula: see text] uniformly bounded, and let [Formula: see text] be the discrete probability measure on the finite set [Formula: see text] with equal distribution. For [Formula: see text], the infinite Bernoulli convolution [Formula: see text] converges weakly to a Borel probability measure (Moran measure). In this paper, we study the existence of exponential orthonormal basis for [Formula: see text].
Regularity of CR mappings of abstract CR structures
Authors: Lamel Bernhard , Mir Nordine
Published: November 2019

We study the [Formula: see text] regularity problem for CR maps from an abstract CR manifold [Formula: see text] into some complex Euclidean space [Formula: see text]. We show that if [Formula: see text] satisfies a certain condition called the microlocal extension property, then any [Formula: see text]-smooth CR map [Formula: see text], for some integer [Formula: see text], which is nowhere [Formula: see text]-smooth on some open subset [Formula: see text] of [Formula: see text], has the following property: for a generic point [Formula: see text] of [Formula: see text], there must exist a formal complex subvariety through [Formula: see text], tangent to [Formula: see text] to infinite order, and depending in a [Formula: see text] and CR manner on [Formula: see text]. As a consequence, we obtain several [Formula: see text] regularity results generalizing earlier ones by Berhanu–Xiao and the authors (in the embedded case).
Effect of graphene lateral size on the microstructure and properties of graphene/copper composites
Authors: Zhang Dandan , Xiao Huaxing , Jiang Wei , Cao Xia , Ye Manyu , Huang Lu , Tang Tao
Published: November 2019

Copper matrix composites reinforced with graphene nanoplatelets (GNPs) were prepared by vacuum hot pressing of ball milled mixtures of powders. Two grades of GNPs were used; one with average thickness of 2 nm and average lateral size of 6 [Formula: see text]m and another with much larger lateral size of 80 [Formula: see text]m. Microstructure and properties of as-prepared composites containing 10 vol.% GNPs were studied. The GNPs sheets are uniformly distributed and well aligned in the Cu matrix. The microstructure observation shows that the GNPs-2–6 exhibits a better dispersion in the Cu matrix than GNPs-2–80. The addition of fine GNPs-2–6 lead to [Formula: see text]31% higher tensile strength and approximately same electrical conductivity of the Cu matrix, while the GNPs-2–80/Cu composite only shows a [Formula: see text]15% increase of tensile strength and a lower electrical conductivity than the Cu matrix.
Effect of shielding gas flow rate on arc behaviors in GMAW with single cable-typed wire
Authors: Hu Qingxian , Zhang Lei , Pu Juan , Zhu Caichen
Published: November 2019

A three-dimensional numerical model of arc in gas metal arc welding (GMAW) with single cable-typed wire was established based on the theory of arc physics. The influences of different shielding gas flow rates on the features of temperature field, velocity field and pressure field were investigated. The results showed that the maximum velocity of arc plasma along radial direction and the arc pressure on the surface of workpieces were increased obviously with the increase of the shielding gas flow rate, while the arc temperature was changed little. This phenomenon was mainly attributed to the increasing collisions between arc plasmas and the self-rotation action of cable-typed wires. The arc temperature at the tip of the cable-typed wire reached the maximum. The maximum flow velocity of arc plasma was located at the tip of wire (2–8 mm). The arc pressures in the central axis reached the maximum pressure. The simulation results were in agreement with the experimental results.
Numerical study of heat transfer and Hall current impact on peristaltic propulsion of particle-fluid suspension with compliant wall properties
Authors: Bhatti M. M. , Ellahi Rahmat , Zeeshan A. , Marin M. , Ijaz N.
Published: November 2019

In this paper, the effects of heat transfer and Hall current on the sinusoidal motion of solid particles through a planar channel has been discussed. The walls of the channel are considered as compliant under the effects of magnetohydrodynamics. The mathematical formulation has been performed using energy equation, momentum equation, and Ohm’s law. The modeled equations are further modified by taking the assumption of a zero Reynolds number and long wavelength. Numerical shooting technique has been employed to solve the nonlinear differential equations. The impact of all the emerging parameters such as wall rigidity, wall tension, mass characterization, Hall parameter, Hartmann number, Weissenberg number, particle volume fraction, Prandtl number, and Eckert number, respectively. Particularly, we discussed their effects on velocity and temperature profile.
Real-Time Mobile-Based Electrocardiogram System for Remote Monitoring of Patients with Cardiac Arrhythmias
Authors: Bazi Yakoub , Al Rahhal Mohamad M. , AlHichri Haikel , Ammour Nassim , Alajlan Naif , Zuair Mansour
Published: November 2019

In this study, we propose an electrocardiogram (ECG) system for the simultaneous and remote monitoring of multiple heart patients. It consists of three main components: patient, sever, and monitoring units. The patient unit uses a wearable miniature sensor that continuously measures ECG signals and sends them to a smart mobile phone via a Bluetooth connection. In the mobile device, the ECG signals can be stored, displayed on screen, and automatically transmitted to a distant server unit over the internet; the server stores ECG data from several patients. Health care stakeholders use a monitoring unit to retrieve the ECG signals of multiple patients at any time from the server for display and real-time automatic analysis. The analysis includes segmentation of the ECG signal into separate heartbeats followed by arrhythmia detection and classification. When compared to existing real-time ECG systems, where the detection of abnormalities is usually performed using simple rules, the proposed system implements a real-time classification module that is based on a support vector machine (SVM) classifier. Extensive experimental results on ECG data obtained from a TechPatientTMsimulator, a real person, and 20 records from the MIT arrhythmia database are reported and discussed.
Stabilization Control with Optimal L1-Gain and L∞-Gain for Positive T-S Fuzzy Systems
Authors: Wang Jiaxian , Li Junmin
Published: November 2019

In this paper, the problem of stabilization with optimal L1-gain for positive T-S fuzzy systems is investigated with the use of linear Lyapunov function. A T-S fuzzy model for positive nonlinear system is established to study the stabilization control for the positive system. Sufficient condition for stabilization is presented in term of linear programming. The static output-feedback fuzzy controller is constructed to guarantee that the closed-loop system is controlled positive, asymptotically stable and the L1-gains from the exogenous inputs to the regulated output is minimized, respectively. Moreover, the stabilization problem with optimal L∞-gain for positive T-S fuzzy systems is solved. Finally, three examples are presented to show the effectiveness of the theoretical results.
An Extended TODIM Method Based on Novel Score Function and Accuracy Function under Intuitionistic Fuzzy Environment
Authors: Zhang Dong , Bao Xin , Wu Chong
Published: November 2019

Recently, multi-attribute decision making (MADM) approaches concerning decision maker’s psychological behaviors have received increasing attention, but few of them have taken all the criteria interactions (positive, negative and dependent interactions) into consideration. In this paper, we combine the TODIM (an acronym in Portuguese of interactive and multi-criteria decision making) method with the 2-additive fuzzy measure and Choquet integral theory to demonstrate how criteria interactions can be determined and further extend it into intuitionistic fuzzy environment. To begin with, we propose the novel score function and accuracy function to compare the difference among intuitionistic fuzzy sets, which have been proven to be more effective and rational than the existing measure functions. Next, we construct the nonlinear programming model based on maximum-entropy principal to obtain the optimal criteria interactions. Further, 2-additive Choquet-based dominance degree is defined whereby we put forward the 2-additive Choquet integral-based TODIM method under intuitionistic fuzzy environment to handle more challenging MADM problems. Finally, we present results of a didactic example, which concerns selection of suppliers for a manufacturing company, to evaluate the validity and rationality of proposed approach.
A Novel Weakest t-Norm based Fuzzy Importance Measure for Fuzzy Fault Tree Analysis of Combustion Engineering Reactor Protection System
Authors: Kumar Mohit
Published: November 2019

Recently, a new fuzzy fault tree analysis (FFTA) has been developed to propagate and quantify the epistemic uncertainties occurring in qualitative data such as expert opinions or judgments. It is well known that the weakest triangular norm (Tw) based fuzzy arithmetic operations preserve the shape of the fuzzy numbers, provide more exact fuzzy results and effectively reduce uncertainty range. The objective of this paper is to develop a novel Tw-based fuzzy importance measure to identify the critical basic events in FFTA. The proposed approach has been demonstrated by applying it to a case study to identify the critical components of the Group 1 of the U.S. Combustion Engineering Reactor Protection System (CERPS). The obtained results are then compared to the results computed by the existing well-known importance measures of conventional as well as FFTA. The computed results confirm that the proposed Tw -based importance measure is feasible to identify the critical basic events in FFTA in more exact way.
Cardioprotection conferred by sodium-glucose cotransporter 2 inhibitors: a renal proximal tubule perspective
Authors: Silva dos Santos Danúbia , Polidoro Juliano Z. , Borges-Júnior Flávio A. , Girardi Adriana C. C.
Published: November 2019

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, also known as gliflozins, improve glycemia by suppressing glucose reuptake in the renal proximal tubule. Currently, SGLT2 inhibitors are primarily indicated as antidiabetic agents; however, their benefits extend far beyond glucose control. Cardiovascular outcome trials indicated that all studied SGLT2 inhibitors remarkably and consistently reduce cardiovascular mortality and hospitalization for heart failure (HF) in type 2 diabetes (T2D) patients. Nevertheless, the mechanisms underlying the unprecedented cardiovascular benefits of gliflozins remain elusive. Multiple processes that directly or indirectly improve myocardial performance may be involved, including the amelioration of proximal tubular dysfunction. Therefore, this paper provides a perspective on the potential cellular and molecular mechanisms of the proximal tubule that may, at least in part, mediate the cardioprotection conferred by SGLT2 inhibitors. Specifically, we focus on the effects of SGLT2 on extracellular volume homeostasis, including its plausible functional and physical association with the apical Na+/H+ exchanger isoform 3 as well as its complex and its possible bidirectional interactions with the intrarenal angiotensin system and renal sympathetic nervous system. We also discuss evidence supporting a potential benefit of gliflozins in reducing cardiovascular risk, attributable to their effect on proximal tubule handling of uric acid and albumin as well as in erythropoietin production. Unraveling the mechanisms behind the beneficial actions of SGLT2 inhibitors may not only contribute to a better understanding of the pathophysiology of cardiovascular diseases but also enable repurposing of gliflozins to improve the routine management of HF patients with or without T2D.
Pupil-associated states modulate excitability but not stimulus selectivity in primary auditory cortex
Authors: Schwartz Zachary P. , Buran Brad N. , David Stephen V.
Published: November 2019

Recent research in mice indicates that luminance-independent fluctuations in pupil size predict variability in spontaneous and evoked activity of single neurons in auditory and visual cortex. These findings suggest that pupil is an indicator of large-scale changes in arousal state that affect sensory processing. However, it is not known whether pupil-related state also influences the selectivity of auditory neurons. We recorded pupil size and single-unit spiking activity in the primary auditory cortex (A1) of nonanesthetized male and female ferrets during presentation of natural vocalizations and tone stimuli that allow measurement of frequency and level tuning. Neurons showed a systematic increase in both spontaneous and sound-evoked activity when pupil was large, as well as desynchronization and a decrease in trial-to-trial variability. Relationships between pupil size and firing rate were nonmonotonic in some cells. In most neurons, several measurements of tuning, including acoustic threshold, spectral bandwidth, and best frequency, remained stable across large changes in pupil size. Across the population, however, there was a small but significant decrease in acoustic threshold when pupil was dilated. In some recordings, we observed rapid, saccade-like eye movements during sustained pupil constriction, which may indicate sleep. Including the presence of this state as a separate variable in a regression model of neural variability accounted for some, but not all, of the variability and nonmonotonicity associated with changes in pupil size.

NEW & NOTEWORTHY Cortical neurons vary in their response to repeated stimuli, and some portion of the variability is due to fluctuations in network state. By simultaneously recording pupil and single-neuron activity in auditory cortex of ferrets, we provide new evidence that network state affects the excitability of auditory neurons, but not sensory selectivity. In addition, we report the occurrence of possible sleep states, adding to evidence that pupil provides an index of both sleep and physiological arousal.
Precursors to Cholangiocarcinoma
Authors: Hucl Tomas
Published: November 2019

Cancers of the biliary tract include intra- and extrahepatic cholangiocarcinomas and gallbladder cancer. Biliary tract cancers are diseases with unfavorable prognoses. In recent years, several lesions have been described as precursors that precede biliary cancers. They include flat and microscopic lesions known as biliary intraepithelial neoplasia, macroscopic and tumor-forming intraductal papillary biliary neoplasia, intraductal tubular neoplasia, and mucinous cystic neoplasm of the bile duct. These conditions are rarely diagnosed, while their natural history and progression to cancer have yet to be adequately characterized. This review examines the epidemiology, pathology, molecular biology, diagnosis, and therapy of these various precursors. Further research is required if we are to better understand this evolving field and improve the prevention and early detection of bile duct cancer.
D-Ring-Modified Analogues of Luotonin A with Reduced Planarity: Design, Synthesis, and Evaluation of Their Topoisomerase Inhibition-Associated Cytotoxicity
Authors: Almansour Abdulrahman I. , Kumar Raju Suresh , Arumugam Natarajan , Bianchini Giulia , Menéndez J. Carlos , Mohammad Faruq , Dupadahalli Kotresha , Altaf Mohammad
Published: November 2019

A- and D-ring-modified luotonin-inspired heterocycles have been synthesized and were evaluated for their activity against the viability of four cancer cell lines in vitro, namely, MCF7, HCT116, JURKAT, and NCI-H460. The analysis of results indicated that two of the synthesized derivatives displayed good inhibition against the growth of the human colon cancer HCT116 cell line, with potencies lower than but in the same order of magnitude as camptothecin (CPT). These two luotonin analogues also showed an activity similar to that of the highly potent alkaloid CPT as inhibitors of topoisomerase I and also inhibited topoisomerase II. These results show that complete planarity is not a strict requirement for topoisomerase inhibition by luotonin-related compounds, paving the way to the design of analogues with improved solubility.
An Atypical Case of Oral Squamous Cell Carcinoma of Mandibular Alveolus
Authors: Abraham Seba , Mallika Bhagyalekshmi , Reshma Arunima , Kassim ReejaMol Mohammed
Published: November 2019

Oral squamous cell carcinoma is the most common type of oral malignant neoplasm. As per literature, squamous cell carcinomas of the alveolar ridge account for 9% of all the oral carcinomas. The oral squamous cell carcinoma shares clinical similarity with various forms of inflammatory gingival lesions and is often misdiagnosed in our routine dental practice. The dentist should have precise knowledge regarding the clinical manifestation of this deadly disease as early diagnosis and prompt treatment can reduce morbidity and mortality of the disease.