bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Evaluation of Patellofemoral Instability: A Clinical Reality or Just a Research Field? A Literature review
Authors: Rosa Sergio Barroso , Ewen Peter Mc , Doma Kenji , Ferrer Juan Francisco Loro , Grant Andrea
Published: December 2019

Patellofemoral instability (PFI) is one of the most disabling conditions in the knee, often affecting young individuals. Despite its not uncommon presentation, the underlying biomechanical features leading to this entity are not entirely understood. The suitability of classic physical examination manoeuvres and imaging tests is a matter of discussion among treating surgeons, and so are the findings provided by these means. A potential cause for this lack of consensus is the fact that, classically, the diagnostic approach for PFI has relied on statically obtained data. Many authors advocate for the study of this entity in a dynamic scenario, closer to the actual situation in which the instability episodes occur. In this literature review, we have compiled the available data from the last decades regarding dynamic evaluation methods for PFI and related conditions. Several categories are presented, grouping the related techniques and devices: physical examination, imaging modalities (ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT) and combined methods), arthroscopic evaluation, and others. In conclusion, although a vast number of quality studies are presented, in which comprehensive data about the biomechanics of the patellofemoral joint (PFJ) are described, this evidence has not yet reached clinical practice universally. Most of the data still stays in the research field and is seldom employed to assist a better understanding of the PFI cases and their ideal treatment targets.
Morphological, structural and physiological differences in heteromorphic leaves of Euphrates poplar during development stages and at crown scales
Authors: Zhai J. T. , Li Y. L. , Han Z. J. , Li Z. J.
Published: December 2019

Euphrates poplar (Populus euphratica Oliv.) has heteromorphic leaves including strip, lanceolate, ovate, and broad‐ovate leaves from base to top in the mature canopy.

To clarify how diameter at breast height (DBH) and tree height affect the functional characteristics of all kinds of heteromorphic leaves, we measured the morphological anatomical structure and physiological indices of five crown heteromorphic leaves of P. euphratica at 2, 4, 6, 8, 10, and 12 m from the same site. We also analysed the relationships between morphological structures and physiological characteristics of heteromorphic leaves and DBH and the height of heteromorphic leaves.

The results showed that the number of abnormalities regarding blade width, leaf area, leaf thickness, leaf mass per area, cuticle layer thickness, palisade tissue thickness, and palisade tissue/sponge tissue ratio increased with size order and sampling height gradient. Net photosynthetic rate, transpiration rate, stomatal conductance, instantaneous water use efficiency, stable delta carbon isotope ratio, proline and malondialdehyde (MDA) content increased with DBH and sampling height. By contrast, blade length, leaf shape index, and intercellular CO2 concentration decreased with the increase in path order and sampling height gradient. Although MDA content and leaf sponge thickness were not correlated with DBH or sampling height, other morphological structure and physiological parameters were significantly correlated with these variables. In addition, correlations were found among leaf morphology, anatomical structure, and physiological index parameters indicating that they changed with path order and tree height gradient.

The differences in the morphology, anatomic structure and physiological characteristics of the heteromorphic leaves ofP. euphratica are related to ontogenesis stage and coronal position.
Distortions in oil contract allocation and environmental damage in the presence of corruption
Authors: Akaeze Henry O.
Published: November 2019

This article investigates how distortions in oil contract allocation can alter a government official’s decisions and shows that corruption enlarges the parameter space over which multinational oil companies win the contract against the smaller companies. It is found that corruption superficially creates an equilibrium outcome that looks efficient even when it is not, and diminishes the official’s concern for environmental damage by weighing damage to the public less and oil revenues more. Sensitivity analyses show that for all levels of environmental damage and corruptibility, multinational oil companies always win the contract. An important policy implication is that corruption distorts optimal decisions and causes oil contract allocation decisions to be based primarily on monetary benefit than social welfare.
Pentalogy of Fallot: A case report and overview dental implications
Authors: Kaushal Drishti , Kalra Namita , Tyagi Rishi , Khatri Amit , Biswas Krishna
Published: December 2019

Pentalogy of Fallot is a rare congenital cyanotic heart disease and a variant of tetralogy of Fallot, in which tetralogy of Fallot is associated additionally with an atrial septal defect. It is characterized by right to left intracardiac shunting of blood leading to decreased pulmonary blood flow resulting in the development of cyanotic episodes. The case report aims to present the dental management of an 8‐year‐old child with a repaired cardiac anomaly of pentalogy of Fallot. His medical condition was assessed and physician consent was sought for procedural intervention. All invasive procedures were planned under antibiotic prophylaxis to prevent bacteremia associated endocarditis. Elaborate chairside dental intervention was carried out beginning with preventive schedule, oral prophylaxis and topical fluoride application followed by interception of carious progression with multiple GIC restorations and extractions of retained and grossly decayed teeth. Patient was reviewed on follow‐up visit and no pain, discomfort, or complications were reported. Based on the case report it can be concluded that the medical status in patients affected with Pentalogy of Fallot must be taken into consideration to plan dental treatment and precautions must be taken for prevention of stress induced cyanosis and bacterial endocarditis in such cases.
How old can we go? Evaluating the age limit for effective DNA recovery from historical insect specimens
Authors: Lalonde Melanie M.L. , Marcus Jeffrey M.
Published: December 2019

Historical museum specimens are valuable for exploring population genetics and evolutionary questions because they can provide snapshots of morphological and genetic characteristics from populations over space and time. Unfortunately, DNA found in older museum specimens is frequently degraded, so obtaining genotypes from many individual samples necessary for rigorous molecular population genetic studies is challenging. Previous studies have varied greatly in their success at obtaining genotypes from older preserved insect material. Many well‐intentioned collection curators have used research results showing poor preservation of DNA preserved in museum specimens to inform curatorial best practices, in some cases choosing not to allow DNA extraction by destructive sampling because, in their estimation, the likelihood of success would be low. Recent methodological advances in DNA extraction, amplification, and genotyping have allowed some researchers to include mid‐19th century samples in molecular genetic analyses. Here we present a robust, high‐throughput, and low‐cost DNA extraction and genotyping protocol for historical insect specimens employing restriction digests of PCR products followed by high sensitivity electrophoresis. Using this technique, we obtained mitochondrial haplotypes for 100% of 48 New World Junonia butterfly specimens (Nymphalidae) ranging in age from pre‐1813 to 1909 and show that the haplotype frequencies obtained are statistically indistinguishable from 20th‐century and contemporary reference populations of Junonia (1632 specimens) matched by geographic region. As most extant insect specimens were collected after 1813, based on our findings we would expect that many or even most pinned specimens preserved in museum collections contain usable DNA for mitochondrial haplotyping.
Ultrasonographic appearance of the coelomic cavity organs in healthy veiled chameleons (Chamaeleo calyptratus) and panther chameleons (Furcifer pardalis)
Authors: Melero Adrián , Novellas Rosa , Mallol Claudia , Ríos José , Silvestre Albert Martínez , Martorell Jaume
Published: December 2019

Veiled chameleons (Chamaeleo calyptratus) and panther chameleons (Furcifer pardalis) are the most popular chameleons over the world, and consequently, two of the most frequent species presenting to veterinary practices. However, published studies on normal ultrasonographic anatomy for these lizards are currently lacking. The objectives of this prospective anatomic study were to develop an ultrasound protocol for evaluation of the coelomic cavity in these species and describe the normal ultrasonographic anatomy of the coelomic organs. Seventeen healthy veiled chameleons and 15 healthy panther chameleons were included. A linear 18 MHz transducer was used. Chameleons were sedated and restrained in right lateral recumbency by an assistant. Longitudinal and transverse images were acquired, and authors recorded qualitative and quantitative ultrasonographic characteristics of the coelomic structures. The kidneys, liver, caudal vena cava, hepatic veins, portal vein, gallbladder, wall of the stomach and intestine, gonads and, when distended, urinary bladder could be visualized during ultrasonography of the coelomic cavity in both species. The spleen, pancreas, and adrenal glands could not be identified. Findings from the current study supported the use of ultrasonography for veiled chameleons (Chamaeleo calyptratus) and panther chameleons (Furcifer pardalis) with suspected intracoelomic diseases and provided normal reference information for future studies of these chameleon species.
The Theme of Webern's Variationen für Klavier, Op. 27, Third Movement
Authors: Heneghan Áine
Published: December 2019

Webern's lectures on form (1934) offer insights into the composer's thinking on musical organization, yet they are rarely invoked to illuminate his own music. Inspired by his analyses of Beethoven, the author provides a reading of the theme from the final movement of Webern's Variations
for Piano, Op. 27.
Improving Fuel Economy Estimates on a Chassis Dynamometer Using Air Conditioner Correction Factors
Authors: Reyes Jose Alejandro M. , Quiros Edwin N.
Published: December 2019

Carmakers, regulatory agencies, and consumers share an interest in accurately determining a vehicle’s fuel efficiency under operating conditions that match the expected use. Previous studies have shown that a vehicle’s air conditioning (A/C) system is the most energy-intensive non-propulsive system and significantly reduces fuel economy.

This study aims to design and validate a new method of improving fuel economy estimates obtained on non-climate-controlled chassis dynamometers, as such laboratories are limited to measuring fuel economy with the A/C system deactivated. The methodology proposed herein uses a chassis dynamometer to measure the fuel economy penalty caused by the A/C system at different steady-state conditions. The hypothesis is that these penalties can be imposed accordingly for a given drive cycle to obtain an additional fuel consumption due to A/C.

To validate the proposed methodology, a vehicle was outfitted with a data acquisition system and was driven 50 times around a predefined route using varying A/C settings. The proposed method was then used to estimate the additional fuel consumption due to A/C usage for each of the runs. Comparing the calculated and actual fuel economies showed an average error of 1.924%. It was concluded that the proposed methodology is a viable alternative to existing procedures.
An Energetic and Exergoeconomic Analysis of a CCHP System With Micro Gas Turbine, Organic Rankine Cycle and Ammonia-Water Absorption Refrigeration Cycle
Authors: Doiphode Ganesh V. , Najafi Hamidreza
Published: December 2019

Combined cooling, heating and power generation (CCHP) systems can be utilized for commercial or multi-family residential buildings as efficient and reliable means to satisfy building power requirements and thermal loads. In the present paper, a CCHP system consist of a Bryton cycle, an Organic Rankine cycle (ORC) and an absorption Ammonia-water cycle is considered. A detailed model is developed via MATLAB to assess the performance of the considered cycle from energy, exergy and economic perspectives. Appropriate ranges for inputs are considered and the first law efficiency, second law efficiency and ECOP of the cycle are determined as 77.17%, 33.18% and 0.31 respectively for the given inputs. Exergy destruction rates are found to be greatest primarily in the generator and the absorber of refrigeration cycle followed by the combustion chamber. The total exergy destruction rate in the system is found as 5311.51 kW. The exergoeconomic analysis is performed using SPECO approach to evaluate cost flow rate equations of the complete system and its individual components. Summation of capital investment cost rates and cost rates associated with the exergy destruction for the whole system is found as $18.245 per hour. A parametric study is also performed to provide an understanding on the effect of total pressure ratio and turbine inlet temperature of ORC on the performance of the system.
Optimization of a Biomass Torrefaction Plant With Near Zero Emissions
Authors: Hasan Mahmudul , Haseli Yousef
Published: December 2019

Recent studies have shown that the emissions from conventional torrefaction processes is the second largest contributor to the supply chain. This article presents a torrefaction unit that operates based on oxy-combustion concept, whereby preventing carbon dioxide and nitrogen oxides emissions. The oxygen required in the process is supplied from an Air Separation Unit (ASU) and the working fluid of the new system is carbon dioxide. The process model is implemented in Engineering Equation Solver (EES) and simulation is conducted using the design data of a conventional plant which torrefies wood at 553 K for 17.5 minutes. The overall efficiency of the plant which accounts for both thermal and electrical energy requirement of the process is found to be 88%. The total energy consumption of the system exhibits a minimum at an optimum torrefaction temperature. With willow as the feedstock, the optimum temperature is determined to be 536 K at a residence time of 20 minutes, at which the total equivalent thermal energy required is 2 MJ/kg dry biomass and the energy yield is as high as 91%. The results show that the optimum torrefaction temperature is feedstock dependent and it is lower for a longer residence time.
Numerical Modeling of the Hot Forming Process of Composite Materials
Authors: Wang Hao , Li Bo , Fan Zongyue , Li Xiaobai
Published: December 2019

We present a fully coupled thermomechanical simulation of the hot forming process of composite materials. The raw material is a mixture of resin powders, strengthening particles and reinforcing fibers. Complex material responses in the process, such as phase change (melting and polymerization) and reorientation of the fibers, determine the microstructure and the performance of the final product. A phase-aware incremental mesh-free Lagrangian method is presented to overcome the challenges, which combines the Optimal Transportation Meshfree (OTM) method and the variational thermomechanical constitutive updates, and simulation results including the compression ratio, material properties of the final product and orientation distribution of fibers are recorded. By comparing the simulation results with the experimental measurements, the computational framework is validated, which enables robust and efficient analysis of the sensitivity of the performance of composite materials on their processing parameters.
Model Tests and Numerical Simulation on Effect of Spudcan Penetration on P-Delta of an Adjacent Pile
Authors: Wang Jianhua , Fan Yifei , Guo Dong
Published: December 2019

Model tests under 1g condition and numerical simulations of spudcan penetration in the silty fine sand were conducted to study effects of spudcan penetration on the p-delta effect of adjacent free-head and elastic-head piles subjected to lateral and vertical head loads. The p-delta factors were defined and determined based on the maximum pile shaft bending moments and pile head deflections before and after spudcan penetration, which were used to analyze the variations of the p-delta effect with the spudcan penetration depth. The conclusions were obtained as follows. The p-delta effect depends on the pile head constraint condition, the direction of the lateral pile head load and the spudcan penetration depth. For a free-head pile, the p-delta factors decrease with increasing the spudcan penetration depth. For an elastic-head pile, the p-delta factors also decrease during spudcan penetration and the decreases depend on the spudcan penetration depth and the lateral pile head load direction. The decrease associated with the lateral load direction facing back to the spudcan is larger than that associated with the lateral load direction facing to the spudcan. Therefore, the spudcan penetration does not increase the p-delta effect of adjacent piles subjected to lateral and vertical head loads. But the maximum bending moment and its occurring position change during spudcan penetration.
Hydrodynamic Analysis of Deep-Water Fish Cage in Waves Based on Two Different Methods
Authors: Wang Yihou , Xu Yuwang , Li Shuai , Ren Haojie , Fu Shixiao
Published: December 2019

A fish cage is usually composed of steel columns, buoys, flexible nets and mooring lines. Elastic deformations will occur on these components under waves. The effects of these deformations on the global dynamic responses of the fish cage are still unclear. In this paper, a method considering hydroelastic deformation and a method considering the cage as rigid structure are employed to evaluate the hydrodynamic performance of a fish cage structure. The wave forces acting on these slender components are calculated based on Morison formula. The displacement of the cage and tension forces in the mooring lines obtained from these two methods are compared and the effects of hydroelastic deformation are discussed.
Investigation of the Performance of a Three Stage Combined Power Cycle for Electric Power Plants
Authors: Nageswara Reddy Pereddy , Rao J. S.
Published: December 2019

A three stage combined power cycle with a Brayton cycle as the topping cycle, a Rankine cycle as the middling cycle and an Organic Rankine Cycle (ORC) as the bottoming cycle is proposed in the present investigation. A two-stage Gas Turbine Power Plant (GTPP) with inter-cooling, reheating and regeneration based on the Brayton cycle, a single-stage Steam Turbine Power Plant (STPP) based on the Rankine cycle, and a two-stage ORC power plant with reheating based on ORC with atmospheric air as the coolant is considered in the present study. This arrangement enables the proposed plant to utilize the waste heat to the maximum extent possible and convert it into electric power. As the plant can now operate at low sink temperatures depending on atmospheric air, the efficiency of the combined cycle power plant increases dramatically. Further, Steam Turbine Exhaust Pressure (STEP) is positive resulting in smaller size units and a lower installation cost. A simulation code is developed in MATLAB to investigate the performance of a three stage combined power cycle at different source and sink temperatures with varying pressure in heat recovery steam boiler and condenser-boiler. Performance results are plotted with Gas Turbine Inlet Temperature (GTIT) of 1200 to 1500 °C, Coolant Air Temperature (CAT) of −15 to +25 °C, and pressure ratio of GTPP as 6.25, 9.0 and 12.25 for different organic substances and NH3 as working fluids in the bottoming ORC. Simulation results show that the efficiency of the three stage combined power cycle will go up to 64 to 69% depending on the pressure ratio of GTPP, GTIT, and CAT. It is also observed that the variation in the efficiency of the three stage combined power cycle is small with respect to the type of working fluid used in the ORC. Among the organic working fluids R134a, R12, R22, and R123, R134a gives a higher combined cycle efficiency.
Analysis of Round Trip Efficiency of Thermal Energy Storage in Northern Arizona
Authors: Sepehri Amin , Nelson Brent
Published: December 2019

Energy storage systems provide a variety of benefits, including taking better advantage of renewable electricity when available and smoothing demand by shifting demand peaks to times when electricity prices and demand are lower. When low electricity demand occurs during the nighttime, system wide advantages also occur. These lower nighttime ambient temperatures lead to efficiency improvements throughout the grid, including power generators, transmission and distribution systems, chillers, etc. An analysis of ice thermal energy storage carried out by T. Deetjen et al. in 2018 analyzed fuel consumption of the power generation fleet for meeting cooling demand in buildings as a function of ambient temperature, relative humidity, transmission and distribution current, and baseline power plant efficiency. Their results showed that the effective round trip efficiency for ice thermal energy storage could exceed 100% due to the efficiency gains of nighttime operation. However, their analysis was performed on a case study in Dallas, where relatively high humidities lead to a relatively small diurnal temperature variation during the cooling season. In order to expand on this limitation, our study extends this analysis to a mountain west climate, using northern Arizona as a case study. The climate of the mountain west has several key differences from that of the Dallas case study in the previous work, including lower relative humidity, higher diurnal temperature variation, and near- and below-freezing nighttime temperatures during shoulder seasons that also exhibit cooling demand in buildings. To address these differences, this paper updates the models of Deetjen et al. to consider generator fleet efficiency and chiller/icemaking COP for local weather characteristics relevant to the mountain west, as well as considering the differences between fuel mixes of the generator fleet in nighttime and daytime. Compared to Dallas, the larger temperature variation of northern Arizona leads to higher round trip efficiencies (RTE) over the course of the year in most days of the year (e.g. 313 days of the year in northern Arizona in comparison with 182 days in Dallas), demonstrating frequent achievement of over 100% effective round trip efficiency. The presence of a mature commercial market and the possibility of gaining over 100% effective round trip efficiency create a strong case for cooling thermal energy storage as an energy storage approach. Future work will investigate emissions impacts as well as extend the analysis to additional western climates, including the hot dry and marine climates.
Study on Heat Storage Change Characteristics of a Double Reheat Boiler During Load Cycling Processes
Authors: Wang Zhu , Liu Ming , Zhao Yongliang , Chong Daotong , Yan Junjie
Published: December 2019

The stability of the live and reheat steam temperatures is of great significance for the efficient, flexible and safe operation of coal-fired power plants. The double reheat boilers are large inertia, non-linearity and high coupling. Therefore, the temperature controls of live and reheat steams are very difficult during load cycling processes. The heat storage in the double reheat boiler changes during load cycling process, which will affect the performances of temperature control. In this study, dynamic simulation models of an ultra-supercritical double reheat tower boiler and its temperature control models are developed based on the GSE software. These models are validated. Then, changes of the boiler system heat storage during different load cycling processes are studied. Results reveal that the metal heat storage is more than working medium ones at steady state load. However, the changing quantities of working medium heat storage are more than the metal ones between different loads. During load cycling processes, the changing tendencies of reheat steam temperatures, the difference of heat storage between real-time and steady state values (DHSBRS) and the difference of coal feeding rate between real-time and steady values (DCBRS) are similar. The fluctuations of reheat steam temperatures have a delay compared with DHSBRS ones, and the fluctuations of DHSBRS fluctuation have a delay compared with DCBRS ones. The delay time increases with the load cycling rates. The results are aimed at providing some guidance for the control system design of the double-reheat boiler system and the safe and flexible operation of power plants.
A Look at Major Florida Utilities Future Generation Plans and Impact on Health and Environment
Authors: Smiarowski Lauren R. , Radebach Rebekah R.
Published: December 2019

Due to Florida’s unique location as a peninsula as well as it’s oblong shape, it is difficult as a state to be connected the grid of the rest of the United States. As a result, Florida has many utility companies providing power to the region. The integrated resource plans of these utility companies were reviewed looking at the projects and plans they expect to undertake in the next decade. In recent years, use of fossil-fuel fired power production has been declining as the cost of using renewable sources has become more affordable. This shift towards renewables was evident when reviewing the integrated resource plans. An unexpected consequence of using renewable energy is how it will affect the individuals living near the energy production. Issues this paper will examine include the expected change of Florida’s current and future energy mix as well as how this change will affect the health of those living in the vicinity. A review of various power providers in the state of Florida will be conducted through a review of their integrated resource plans and other research data. The co-authors are a mechanical engineering student and a graduate public health student.
Top Chinese scientist faces questions about publications
Authors: Normile Dennis
Published: November 2019

Case seen as a test of China's efforts to improve research integrity and crack down on scientific misconduct.
The pursuit of Earth's waters
Waters of the World
Sarah Dry
University of Chicago Press, 2019. 338 pp.
Authors: Barnett Lydia
Published: November 2019

A historian shares stories of six scientists who laid foundations for modern climate science
​Treating pyogenic liver abscesses secondary to diverticulitis in a patient using immunosuppressants for Crohn’s disease by performing a sigmoid colectomy
Authors: Pielage Marin , Vogels Sanne , Hoencamp Rigo , van den Bremer Jephta
Published: December 2019

Pyogenic liver abscess (PLA) formation is a rare complication of Crohn’s disease (CD). As symptoms often mimic a CD exacerbation, diagnosis can be delayed leading to severe disease. The current case report describes a case of a patient with a history of CD that was admitted with multiple PLAs, which persisted despite percutaneous drainage combined with antibiotics. After a sigmoid resection, the liver abscesses diminished rapidly.
Pseudogout or pseudolymphoma? Calcium pyrophosphate deposition disease of the cervical spine: a rare presentation and literature review
Authors: Turaga Sanchit , Thomas Michael , Savy Lloyd , Schreiber Benjamin E
Published: December 2019

Calcium pyrophosphate deposition (CPPD) disease is a crystal arthropathy primarily affecting peripheral joints, most commonly the wrist and the knees. However, CPPD in the cervical spine is a rare entity. This report describes a case of CPPD of the cervical spine which presents with symptoms of neck pain and brachalgia. A 62-year-old woman presented with left-sided upper limb and neck pain. MRI scanning revealed a low signal abnormality within the C6 and C7 vertebrae, and the possibility of lymphoma was raised. The patient was recalled for gadolinium-enhanced scans which showed perivertebral and marrow enhancement. Fine-needle aspirate histology initially suggested a spindle cell tumour or lymphoma. However, CT-guided biopsy showed positively birefringent crystals, confirming CPPD. CPPD of the spine is a rare differential of nerve impingement in the cervical spine when MRI scanning perivertebral signal enhancement. Furthermore, CPPD of the spine can mimic malignancy.
Incidence, diagnostic criteria and outcome following ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus in a memory clinic population: a prospective observational cross-sectional and cohort study
Authors: Razay George , Wimmer Melissa , Robertson Iain
Published: December 2019

Objective

To evaluate diagnostic criteria for idiopathic normal pressure hydrocephalus (INPH) among patients with memory impairment, and to estimate the incidence of INPH.

Design

Prospective observational cross-section and cohort study of diagnostic accuracy.

Setting

Memory Disorders Clinic following referral by the medical practitioners.

Participants

408 consecutive patients enrolled 2010–2014.

Outcome measures

Reference diagnostic test was the clinical judgement of an experienced specialist based on the presence of cognitive impairment and/or balance and gait disorders in the presence of dilated ventricles. Mini-Mental State Examination (MMSE), Tinetti balance and gait tests were performed before and 12 months after ventriculoperitoneal shunt surgery. The association between reference diagnosis, clinical and brain CT scan measurements was estimated by multivariate Poisson regression. Triage index diagnostic test scores were calculated from the regression coefficients, with diagnostic thresholds selected using receiver operating characteristic analysis.

Results

The presence of balance and/or gait disorders, especially fear of falling, difficulty standing on toes/heals, urinary disturbances, ventriculomegaly with Evans ratio greater than Combined Diagnostic Threshold (0.377-{Maximum width of posterior horns*0.0054}), strongly predict the diagnosis of INPH; while hallucinations and/or delusions and forgetfulness reduce the likelihood of the diagnosis. This triage index test had high sensitivity (95.2%) and specificity (91.7%). 62 of 408 (15%) participants with cognitive impairment had INPH, an incidence of 11.9/100 000/year and 120/100 000/year over 75 years. 96% of participants following shunting, compared with 45% of the non-shunted, improved by over 25% of available measurable improvement in either MMSE or balance/gait scores (51% difference; 95% CI 28% to 74%; p<0.001), and 56% vs 5% improved by over 50% of maximum in both (51% difference; 95% CI 30% to 73%; p<0.001).

Conclusion

The triage index test score is a simple tool that may be useful for physicians to identify INPH diagnoses and need for referral for shunt surgery, which may improve cognitive, balance and gait functioning.
Factors perceived to facilitate or hinder handwashing among primary students: a qualitative assessment of the Mikono Safi intervention schools in NW Tanzania
Authors: Okello Elialilia , Kapiga Saidi , Grosskurth Heiner , Makata Kenneth , Mcharo Onike , Kinungh'i Safari , Dreibelbis Robert
Published: November 2019

Objective

To qualitatively assess the effects of a multi-modal school-based water, sanitation and hygiene (WASH) intervention on handwashing behaviour among primary students in North Western (NW) Tanzania.

Design

The study was a qualitative assessment of barriers and facilitators to handwashing among students attending primary schools participating in the Mikono Safi Trial (Kiswahili for ‘Clean Hands), a cluster-randomised trial assessing the impact of a school-based WASH intervention on selected soil transmitted helminth infections. Data collection methods included in-depth interviews with teachers, focus group discussions and friendship pair interviews with students collected between April and October 2018. The Capability-Opportunity-Motivation and Behaviour model was used to inform data collection and analysis.

Setting

The study was conducted in four purposively selected intervention schools in three districts of Kagera region, NW Tanzania (Bukoba urban, Bukoba rural and Muleba districts).

Participants

Participants comprised 16 purposively selected teachers aged between 23 and 52 years and 100 students aged 7–15 years

Results

The Mikono Safi intervention increased students’ reported capability and motivation to wash their hands with soap at key times, particularly after visiting the toilet. Improvements in students’ handwashing knowledge and skills were reported by both teachers and students, and motivation for handwashing was enhanced by emotional drivers such as disgust, fear and nurture. Newly established handwashing stations improved the physical opportunity to wash hands, although the availability of water and the provision of soap was not always consistent (eg, due to internal organisational shortcomings or during the dry season). Students and teachers were actively engaged in intervention implementation which created a school community that valued and supported improved hand hygiene.

Conclusion

The intervention was successful in improving capability and motivation for handwashing. Handwashing opportunity was also greatly improved, although the supply with water and soap was sometimes interrupted, calling for much stronger multi-sectoral collaboration to improve access to water at schools.

Trial registration number

ISRCTN45013173; Pre-results.
Is neighbourhood walkability related to body mass index among different age groups? A cross-sectional study of Canadian urban areas
Authors: Thielman Justin , Copes Ray , Rosella Laura C , Chiu Maria , Manson Heather
Published: November 2019

Background

Studies of neighbourhood walkability and body mass index (BMI) have shown mixed results, possibly due to biases from self-reported outcomes or differential effects across age groups. Our objective was to examine relationships between walkability and objectively measured BMI in various age groups, in a nationally representative population.

Methods

The study population came from the 2007–2011 Canadian Health Measures Survey, a cross-sectional survey of a nationally representative Canadian population. In our covariate-adjusted analyses, we included survey respondents aged 6–79 who were not pregnant, did not live in rural areas, were not missing data and were not thin/underweight. We used objectively measured height and weight to calculate BMI among adults aged 18–79 and zBMI among children aged 6–17. We categorised respondents into walkability quintiles based on their residential Street Smart Walk Score values. We performed linear regression to estimate differences between walkability quintiles in BMI and zBMI. We analysed adults and children overall; age subgroups 6–11, 12–17, 18–29, 30–44, 45–64 and 65–79; and sex subgroups.

Results

The covariate-adjusted models included 9265 respondents overall. After adjustment, differences between walkability quintiles in BMI and zBMI were small and not statistically significant, except for males aged 6–17 in the second-highest walkability quintile who had significantly lower zBMIs than those in the lowest quintile.

Conclusion

After accounting for confounding factors, we did not find evidence of a relationship between walkability and BMI in children or adults overall, or in any age subgroup with sexes combined. However, post hoc analysis by sex suggested males aged 6–17 in more walkable areas may have lower zBMIs.
Evaluation of titanium mesh cranioplasty and polyetheretherketone cranioplasty: protocol for a multicentre, assessor-blinded, randomised controlled trial
Authors: Yang Jingguo , Sun Tong , Yuan Yikai , Li Xuepei , Yu Hang , Guan Junwen
Published: December 2019

Introduction

Cranioplasty is a common surgery in neurosurgery department. However, restoring the integrity of skull brings many challenges to surgeons, and the selection of ideal implant materials is throughout the history of cranioplasty. Although titanium mesh was still preferred by many neurosurgeons in cranial reconstruction, the new polyetheretherketone (PEEK) material, for example, is gaining popularity for craniofacial reconstruction today. There remain limited data that compare the outcome of PEEK cranioplasty and titanium mesh cranioplasty. It is necessary to conduct a study to compare outcome of different materials for cranioplasty.

Methods/design

In this multicentre, assessor-blinded, randomised controlled study, we will randomise 140 patients in a 1:1 ratio to PEEK cranioplasty versus titanium cranioplasty. Eligible patients are adults who were diagnosed with cranial defect (due to severe traumatic brain injury, ischaemic stroke, haemorrhagic stroke, infiltrative tumour and so on), the defect size is over 25 cm2, and they need to agree to participate in this trial. Instead of standard examinations, the enrolled patients receive neurological, motor, cognitive function and cerebral hemodynamics examinations as well as cosmetic evaluation. The procedures are repeated 3, 6 months after cranioplasty. The primary outcome, defined as infection or implant exposure after surgery, is the implant failure rate within 6 months. Secondary outcomes include postoperative complication rates, neurological outcomes, motor function, cerebral hemodynamics, cosmetic outcome and the total cost over a 6-month period.

Ethics and dissemination

This trial protocol has been approved by Biomedical Research Ethics Committee of West China Hospital of Sichuan University. All patients will be fully informed the implant materials, potential complications after surgery, responsibilities during the trial, and they will sign the informed consent before joining in this trial. If the patient’s cognitive function is impaired, the patient’s next of kin would be carefully informed. The results will be disseminated through academic conferences, student theses and will be published in a peer-reviewed journal.

Trail registration number

ChiCTR1900024625; Pre-results.
Appropriate use of CT for patients presenting with suspected renal colic: a quality improvement study
Authors: Himelfarb Jonah , Lakhani Anand , Shelton Dominick
Published: December 2019

Introduction

CT use for renal colic has increased costs, radiation exposure and frequently does not alter management. Consequently, choosing wisely (CW) recommends avoiding CT imaging of otherwise healthy patients younger than 50 years presenting with symptoms of recurrent, uncomplicated renal colic. We evaluated the utilisation of CT imaging for this subgroup of patients and subsequently implemented a quality improvement initiative with an aim to reduce unnecessary radiation exposure.

Methods

A retrospective chart review was performed for all patients younger than 50 years who visited Sunnybrook Health Sciences Centre emergency department (ED) between December 2015 and May 2016 with a discharge diagnosis of renal colic. After the audit period, emergency physicians were engaged to perform a root cause analysis and a driver diagram was developed. In December 2016, a clinical decision tool was introduced to standardise the imaging for patients with presumed renal colic. In May 2017, a separate electronic order was created for low-dose CT for renal colic, including a prompt to remind clinicians of the CW recommendation. The impact of these changes was measured over 15 months.

Results

Over the initial audit period, 17/63 (27%) of our target population received a CT to rule out renal colic. Many patients received multiple CT scans for renal colic during past ED visits, while one received a total of 13 CTs. At the time of our interventions, the baseline rate of CT scans in our target population was 37%, which reduced to 29% after our project began.

Conclusion

CT is often used as an initial diagnostic modality for suspected recurrent renal colic despite current guidelines. While this initiative caused only a modest change in management, it led to the introduction of a new low-dose CT scan order specifically to reduce radiation exposure in patients at risk for repeat scans.
Association ofHLA-G3'UTR 14-bp Ins/Del polymorphism with breast cancer among South Indian women
Authors: Kadiam Sony , Ramasamy Thirunavukkarasu , Ramakrishnan Revathi , Mariakuttikan Jayalakshmi
Published: December 2019

Aim

Human leucocyte antigen-G (HLA-G) and tumour necrosis factor-alpha (TNF-α) are potent immune mediators implicated in the pathogenesis of breast cancer. The polymorphisms in the 3' untranslated region (3'UTR) ofHLA-Gand promoter region ofTNF-αare well known to influence their expression levels and may consequently contribute to varied disease predisposition. Therefore, in the present study, we explored the effect ofHLA-G3'UTR (14-bp Ins/Del and +3142 C/G) andTNF-αpromoter (–238 G/A and –308 G/A) polymorphisms on breast cancer risk among South Indian women.

Methods

A total of 342 women (100 patients with breast cancer, 142 patients with benign breast disorder and 100 healthy women volunteers) were enrolled for this study. Genotyping ofHLA-GandTNF-αpolymorphisms were performed by direct PCR DNA amplification and amplification refractory mutation system PCR methods, respectively.

Results

Significantly higher frequencies ofHLA-G14-bp Ins allele and Ins/+3142G haplotype were observed in patients with breast cancer than healthy controls (OR=1.56, Pc=0.036) and patients with benign breast disorder (OR=1.47, Pc=0.046). Similarly, subgroup analysis based on age at diagnosis (age≤50 years and >50 years) of breast cancer revealed higher frequencies of 14-bp Ins allele and Ins/+3142G haplotype in the patients of age >50 years than healthy controls (OR=1.77, Pc=0.03). Additionally, the extended haplotypes and multifactor dimensionality reduction analysis of the studied polymorphisms revealed significant contribution ofHLA-G14-bp Ins/Del polymorphism towards breast cancer risk.

Conclusion

The findings of the present study suggest that theHLA-G14-bp Ins/Del polymorphism could influence breast cancer pathogenesis among South Indian women.
An introduction of an easy-operating and economical technique for tissue microarray preparation
Authors: Chen Yi-Jing , Yang Chun-Mei , Huang Jiang-Sheng , Wang Ping , Lv Yan-Hua , Tang Cheng , Deng Wei
Published: December 2019

Aim

Tissue microarray (TMA) is a powerful and effective tool for in situ tissue analysis. However, manual TMA construction methods showed varied qualities. This study aimed to raise a standardised TMA preparation technique that can be easily operated and is economical.

Methods

A sampling needle was used to punch the tissue rods from the donor block and holes in the recipient block. To indicate the dots’ positions and ensure vertical punching, a novel auxiliary device made using commercial three-dimensional printing technology was attached. The TMA block was made up of tissue rods and a recipient block.

Results

A 77-rod (7×11) TMA block was constructed. The rows and columns were fixed in straight lines. There was no specimen loss during the process of embedding.

Conclusions

An alternative method for the construction of TMA blocks that met the basic requirement of many laboratories and can be effortlessly performed was presented.
Should professional interpreters be able to conscientiously object in healthcare settings?
Authors: Emmerich Nathan , Phillips Christine
Published: December 2019

In a globalised world, healthcare professionals will inevitably find themselves caring for patients whose first language differs from their own. Drawing on experiences in Australia, this paper examines a specific problem that can arise in medical consultations using professional interpreters: whether the moral objections of interpreters should be accommodated as conscientious objections if and when their services are required in contexts where healthcare professionals have such entitlements, most notably in relation to consultations concerning termination of pregnancy and voluntary assisted dying. We argue that existing statements of professional ethics suggest that interpreters should not be accorded such rights. The social organisation of healthcare and interpreting services in Australia may mean those who have serious objections to particular medical practices could provide their services in restricted healthcare contexts. Nevertheless, as a general rule, interpreters who have such objections should avoid working within healthcare.
Variability and predictors of weekly pesticide exposure in applicators from organic, sustainable and conventional smallholder farms in Costa Rica
Authors: Fuhrimann Samuel , Staudacher Philipp , Lindh Christian , van Wendel de Joode Berna , Mora Ana M , Winkler Mirko S , Kromhout Hans
Published: December 2019

Objective

Estimates of pesticide exposure among applicators from low- and middle-income countries (LMICs) are scarce, and exposure assessment methods are sometimes costly or logistically unfeasible. We examined the variability in weeklong pesticide exposure among applicators in Costa Rica and its predictors.

Methods

We conducted a cross-sectional survey among 221 pesticide applicators from organic, sustainable and conventional farms in 2016. We administered structured questionnaires to assess pesticide application practices at two time points (4–6 weeks apart). We adapted an existing algorithm to fit the context of smallholders and derive weekly pesticide exposure scores. We used linear mixed-effect models to examine within-worker and between-worker score variability. We then identified sociodemographic and occupational predictors of weekly pesticide exposure scores.

Results

We observed high within-worker and between-worker variability in weekly pesticide exposures (eg, up to 180-fold and 70-fold differences in average weekly exposures within and between workers, respectively; intraclass correlation coefficient=0.4). Applicators working on conventional and sustainable farms had exposure scores twofold and 1.5-fold higher than those working in organic farms, respectively. Farm workers who received training on pesticide use had weekly pesticide exposure scores of 33% (95% CI 1% to 55%) lower than those who did not receive any training.

Conclusions

In this study of applicators from smallholder farms in Costa Rica, we determined the importance of collecting questionnaire data on self-reported pesticide use repeatedly due to its high variability within workers and absence of application records. Our questionnaire-based exposure algorithm could allow the calculation of semiquantitative estimates of average pesticide exposure for applicators from other LMICs.