bluuebunny/crossref_metadata_2025 huggingface dataset:
Life Cycle Performance Estimation and In-Flight Health Monitoring for Gas Turbine Engine
Authors: Lu Feng , Zheng Wenhua , Huang Jinquan , Feng Min
Published: June 2016

A long-term gas-path fault diagnosis and its rapid prototype system are presented for on-line monitoring of a gas turbine engine. Toward this end, a nonlinear hybrid model-based performance estimation and abnormal detection method are proposed in this paper. An adaptive extended Kalman particle filter (AEKPF) estimator is developed and used to real time estimate engine health parameters, which depict gas turbine performance degradation condition. The health parameter estimators are then pushed into a buffer memory and for periodical renewing baseline model (BM) performance, and the BM is utilized to detect engine anomaly over its life course. The threshold in abnormal detection schemes is adapted to the modeling errors during the engine lifetime. The rapid prototyping system is designed and built up based on the National Instrument (NI) CompactRIO (CRIO) for evaluating gas turbine engine performance estimation and anomaly detection. A number of experiments are carried out to demonstrate the advantages of the proposed abnormal detection scheme and effectiveness of the designed rapid prototype system to the problem of gas turbine life cycle anomaly detection.
Thermal and Transport Properties of NaCl–KCl–ZnCl2 Eutectic Salts for New Generation High-Temperature Heat-Transfer Fluids
Authors: Li Peiwen , Molina Edgar , Wang Kai , Xu Xiankun , Dehghani Ghazal , Kohli Amit , Hao Qing , Kassaee Mohamad H. , Jeter Sheldon M. , Teja Amyn S.
Published: June 2016

Three eutectic salts from a system of halide salts NaCl–KCl–ZnCl2 were chosen for detailed study of thermal and transport properties with the objective of developing a next generation high-temperature heat-transfer fluid (HTF) for concentrated solar thermal power (CSP) technology. The acceptable range of the working temperatures for the HTF is from below 250 °C to at least 800 °C. The tested properties are presented here for the three candidate eutectic salts, including melting point, heat of fusion, heat capacity, vapor pressure, viscosity, density, and thermal conductivity. Data-fitted equations are provided for all the measured properties for convenience in engineering application. It is concluded that the three eutectic salts can satisfy the needs for a high-temperature HTF and thus are recommended as a new generation high-temperature HTF.
Biomechanical Behaviors in Three Types of Spinal Cord Injury Mechanisms
Authors: Khuyagbaatar Batbayar , Kim Kyungsoo , Man Park Won , Hyuk Kim Yoon
Published: June 2016

Clinically, spinal cord injuries (SCIs) are radiographically evaluated and diagnosed from plain radiographs, computed tomography (CT), and magnetic resonance imaging. However, it is difficult to conclude that radiographic evaluation of SCI can directly explain the fundamental mechanism of spinal cord damage. The von-Mises stress and maximum principal strain are directly associated with neurological damage in the spinal cord from a biomechanical viewpoint. In this study, the von-Mises stress and maximum principal strain in the spinal cord as well as the cord cross-sectional area (CSA) were analyzed under various magnitudes for contusion, dislocation, and distraction SCI mechanisms, using a finite-element (FE) model of the cervical spine with spinal cord including white matter, gray matter, dura mater with nerve roots, and cerebrospinal fluid (CSF). A regression analysis was performed to find correlation between peak von-Mises stress/peak maximum principal strain at the cross section of the highest reduction in CSA and corresponding reduction in CSA of the cord. Dislocation and contusion showed greater peak stress and strain values in the cord than distraction. The substantial increases in von-Mises stress as well as CSA reduction similar to or more than 30% were produced at a 60% contusion and a 60% dislocation, while the maximum principal strain was gradually increased as injury severity elevated. In addition, the CSA reduction had a strong correlation with peak von-Mises stress/peak maximum principal strain for the three injury mechanisms, which might be fundamental information in elucidating the relationship between radiographic and mechanical parameters related to SCI.
Heat Transfer and Boiling Crisis at Droplets Evaporation of Ethanol Water Solution
Authors: Misyura S. Y.
Published: June 2016

Droplets evaporation and boiling crisis of ethanol water solution were studied experimentally. At intensive nucleate boiling within a droplet, most evaporation relates to an increase in the area of the wetting droplet surface and only 10–20% of evaporation relates to the effect of diffusion and a change in the thermal–physical coefficients. In alcohol solution with mass salt concentration C0 = 25–35%, maximal instability of the bubble microlayer is observed. The critical heat flux behaves nonmonotonously due to changes in mass alcohol concentration in the solution, and there are two extrema. The maximal value of sustainability coefficient at droplets evaporation of ethanol solution corresponds to C0 of 25–30%. The heat transfer coefficient of ethanol water solution of droplet in the suspended state decreases with a rise of wall overheating and spheroid diameter. Experimental dependence of the vapor layer height on wall overheating at boiling crisis was observed. The height of this layer at Leidenfrost temperature was many times higher than the surface microroughness value. The liquid–vapor interface oscillates, and this extends the transitional temperature zone associated with a droplet's boiling crisis.
A Novel Finish Hobbing Methodology for Longitudinal Crowning of a Helical Gear With Twist-Free Tooth Flanks by Using Dual-Lead Hob Cutters
Authors: Tran Van-The , Hsu Ruei-Hung , Tsay Chung-Biau
Published: June 2016

In the gear finish hobbing process, to obtain a twist-free tooth flank of helical gears, a novel hobbing method for longitudinal crowning is proposed by applying a new hob’s diagonal feed motion with a dual-lead hob cutter. Wherein the hob’s diagonal feed motion is set as a second order function of hob’s traverse movement and tooth profile of hob cutter is modified in a dual-lead form with pressure angle changed in it’s longitudinal direction. The proposed method is verified by using two computer simulation examples to compare topographies of the crowned work gear surfaces hobbed by the standard and dual-lead rack cutters. The results reveal the superiority of the proposed novel finish hobbing method.
Evaluation of Football Helmets to Prevent Concussions
Authors: Kalapa David A. K.
Published: June 2016

Football players experience impacts to the head, some of which cause mild traumatic brain injuries known as concussions. Players wear helmets to reduce injury risk, and this study compares two helmets to determine their effectiveness in reducing potential concussions. The helmets analyzed are a “classic” type made of large foam pad pieces, and a “new” type made of small honeycomb pads. Both helmets share the same external polycarbonate shell & padding materials. Three helmet to helmet collisions are studied: case one: “classic on classic,” case two: “classic on new,” & case three: “new on new.” Using finite element analysis method, stresses and contact pressures are calculated. For three collisions with the same forces applied, a player in case one experiences 0.96 MPa contact pressure at the skull, while a player in case three experiences 0.87 MPa. In case two the player wearing the “new” helmet is exposed to 0.9 MPa at the skull, while the player wearing the “classic” is exposed to 0.95 MPa at the skull. It is concluded that if a player uses a “classic” instead of “new” helmet, pressure on the skull is reduced by 9.4%, reducing the risk of that player sustaining a concussion.
An Evaluation of Formal Strategies to Create Stable and Reusable Parametric Feature-Based 3D Models
Authors: Camba Jorge D. , Cosin Ana , Contero Manuel
Published: June 2016

In this paper, we present a comparative review of publicly available and professionally accepted CAD modeling strategies and best practices for history-based parametric design that focus on reusability: Delphi’s horizontal modeling, explicit reference modeling, and resilient modeling. Some aspects considered in our study include the rationale to avoid the creation of unnecessary feature interdependencies, the sequence and selection criteria for those features, and the effects of parent/child relations on model reuse. We provide a preliminary evaluation of these strategies using a simple industrial CAD model. We analyze the internal structure of the models by comparing the robustness, flexibility, and complexity of the parametric representation. Finally, we provide a set of general guidelines to identify the best modeling strategy based on the characteristics of the design.
Pattern Driven Decision Making Approach to Engineering Systems Design: Concept
Authors: Fukuda Shuichi
Published: June 2016

This paper points out that in team decision making where members come from many different fields, pattern driven decision making approach is very much effective. It not only satisfies each member, but it also leads to thought-to-be-the most reasonable decision. AI succeeded by introducing pattern based reasoning, but in traditional AI, its patterns are expressed in the form of a list, i.e., the sequence of symbols. In other words, patterns in AI are one-dimensional.

But increasing complexities and complicatedness call for many different kinds of knowledge and experience so that such one dimensional pattern matching does not really provide an adequate tool for decision making for problems which involve many different disciplines.

In this paper, it is pointed out that if we introduce Mahalanobis-Taguchi System, which permits multidimensional pattern matching, it facilitates team decision making for a problem which needs a wide variety of expertise to solve and to which rational approaches are difficult to apply.
Mixed Model Assembly Line Sequencing by Minimizing Utility Work and Using Genetic Algorithm
Authors: uz Zaman Uzair Khaleeq , Baqai Aamer Ahmed
Published: June 2016

Owing to the recent developments in the field of industrial automation, assembly lines have played an integral role in the economic uplift of the industrial units. Mixed Model Assembly Lines are the answer to a variety of scenarios which involve customized production following a particular ‘product mix’, i.e., several models of a product are jointly processed on a line, in an increased quantity, quality and productive environment. Hence, to determine the optimal operating schedule/sequence of the operations along with other impacting factors such as total utility work, setup cost, part consumption rates, etc., still remains a widely researched topic today. Moreover, sequencing problems are termed as NP-hard and a variety of sequencing heuristics have been applied in literature to solve them. The heuristic, Genetic Algorithm, was formulated based on binary encoding/decoding, two point cross over and uniform mutation, and applied in this paper to optimize two objectives; one, to minimize total utility work and two, to generate sequence of the models as per the first goal. A methodology was hence, developed to test and analyze the impact of factors such as number of stations, length of stations, conveyor speed, time of operations, number of primary models, and Minimum Part Set on the concerned objectives. An attempt was also made to model the entire process with IDEF0 modeling technique. Industry-oriented problems were then presented to test the algorithm in real world conditions. Finally, the results were critically examined and respective improvement measures were stated.
Mining Big Data in Manufacturing: Requirement Analysis, Tools and Techniques
Authors: Roy Utpal , Zhu Bicheng , Li Yunpeng , Zhang Heng , Yaman Omer
Published: June 2016

Data Mining has tremendous potential and usefulness in improving the effectiveness of decision-making in manufacturing. Tools and techniques of data mining can be intelligently applied from product design analysis to the product repair and maintenance. Vast amount of data in the form of documents (text), graphical formats (CAD-file), audio/video, numbers, figures and/or hypertext are available in any typical manufacturing system. Our ultimate goal is to develop data-driven methodologies to solve manufacturing problems using data mining techniques. As a precursor, based on a literature study, this paper investigates selective manufacturing areas to identify the requirements for applying data mining techniques in solving potential manufacturing problems. The reviewed manufacturing areas are: (i) the “Design Intent” retrieval process for the product design and manufacturing, (ii) selection of materials, (iii) performance evaluations of manufacturing process design and operation management, and (iv) product inspection, and after-sales services (repair and maintenance). Industrial efforts towards addressing “Big Data” issues have also been briefly narrated in this paper. Lastly, the paper discusses two important data–related issues that may affect any applications of the data mining tools and techniques — (i) uncertainty involved in data collection, and (ii) interoperability of data collected at different levels of an enterprise.
Design Optimization of Ultrasonic Transducer Element by Evolutionary Algorithm
Authors: Arif Tariq M. , Ji Zhiming
Published: June 2016

Focused ultrasonic wave generation in bio-medical applications depends primarily on the transducer’s shape, piezoelectric material and the arrangements of transducer elements over the piston surface for specific power and pulse repetition frequency (PRF). For a given surface area, knowing the relationship between the transducer element’s geometry and the generated pressure will be useful for improving the transducer designs. In this study, patterns of pressure field variations with several selected transducer design variables (kerf, transducer element’s number and element’s width-height) have been investigated. These patterns indicate that there is an optimum shape and arrangement of transducer elements in a given area to achieve highest possible pressure at the focused zone. The number of design variables and their combinations can be used in this case is considerably large, and a Genetic Algorithm (GA) based evolutionary global search method is used to optimize design shape and the distribution of ultrasonic transducer element.
Effect of Rim Thickness on Tooth Root Stress and Mesh Stiffness of Internal Gears
Authors: Karpat F. , Engin B. , Dogan O. , Yuce C. , Yilmaz T. G.
Published: June 2016

In recent years, internal gears are used commonly in a number of automotive and aerospace applications especially in planetary gear drives. Planetary gears have many advantages such as compactness, large torque-to-weight ratio, large transmission ratios, reduced noise and vibrations. Although internal gears have many advantages, there are not enough studies on it. Designing an internal gear mechanism includes two important parameters. The gear mesh stiffness which is the main excitation source of the system. In this paper, 2D gear models are developed in order to compute gear mesh stiffness for various rim thicknesses and different rim shapes of the internal gear design. Effects of root stress with varying rim thickness and some tooth parameters are investigated by using 2D gear models. The stress calculated according to ISO 6336 and the stresses calculated against FEM are compared. These results are well-matched. It is observed that when the rim thicknesses are increased, both the maximum bending stresses and gear mesh stiffness are decreased considerably.
Systems Competency for Engineering Practice
Authors: Flumerfelt Shannon , Kahlen Franz-Josef , Alves Anabela , Calvo-Amodio Javier , Hoyle Chris
Published: June 2016

Affecting holistic development of the early engineer practitioner is a topic of concern emanating from the Academy, the workplace and engineering organizations alike. For example, concerns over gaps in ethics competency, communication abilities, and team management have been documented. The gap between the rapidly growing body of knowledge in the engineering profession and the effectiveness of early engineering practice does exist. This means that while early career engineers generally know enough about engineering sciences, they are lacking in the ability to connect that information to effective engineering practice in the workplace. The shortfall in the holistic development of the early career engineer, therefore, is based in the problematic technical-behavioral relationship expressed in differences in engineering knowledge versus workplace practice. This problem has been recognized by many organizations such as the American Society of Mechanical Engineers (V2030), the National Academy of Engineering (Grand Challenges for Engineering; Engineer of 2020; Educating the Engineer of 2020; and Changing the Conversation), the Royal Academy of Engineers, and the National Science Foundation/University of Michigan (5XME Project).
Embankment Stabilization Techniques for Railroads on Permafrost
Authors: Addison Priscilla E. , Lautala Pasi , Oommen Thomas , Vallos Zachary
Published: June 2016

Degrading permafrost conditions around the world has resulted in stability issues for civil structures founded on top of them. Railway lines have very limited tolerance for differential settlements, making it a priority for railway owners in permafrost regions to consider embankment stabilization measures that ensure smooth and safe operations.

Several passive and active engineered solutions have been developed to address the permafrost stability issues, such as awnings, shading boards, crushed rock embankments, ventiduct embankments, and thermosyphons. Local site conditions, including soil type, soil temperature, ice content, and precipitation determines which method is selected for a particular site and in most cases the best stabilization solution is a combination of two or more alternatives. When potential solution can be identified, it will only be implemented if perceived benefits exceed the implementation and maintenance costs.

This paper aims to provide a brief literature review on some common embankment stabilization solutions with consideration to the Hudson Bay Railway (HBR) in northern Manitoba, Canada which has been witnessing thaw settlements for extensive time period. It will discuss the applicability of the different methods, the advantages and disadvantages of the different methods, as well as the benefits to be derived by utilizing a combination of methods.
Platelets and coronary artery disease: Interactions with the blood vessel wall and cardiovascular devices
Authors: Reinthaler Markus , Braune Steffen , Lendlein Andreas , Landmesser Ulf , Jung Friedrich
Published: June 2016

In view of the rare presence of studies concerning platelet function as risk factor in atherosclerotic patients, processes underlying thromboembolic events are reviewed in this paper. The morphology and the structural organization—membrane receptors, the open canalicular and dense tubular systems, the cytoskeleton, mitochondria, granules, lysosomes, and peroxisomes—of platelets are described. Platelet function under physiological conditions in atherosclerosis and after implantation of cardiovascular devices is summarized.
Segmentation of malignant lesions in 3D breast ultrasound using a depth‐dependent model
Authors: Tan Tao , Gubern‐Mérida Albert , Borelli Cristina , Manniesing Rashindra , van Zelst Jan , Wang Lei , Zhang Wei , Platel Bram , Mann Ritse M. , Karssemeijer Nico
Published: June 2016

Purpose:

Automated 3D breast ultrasound (ABUS) has been proposed as a complementary screening modality to mammography for early detection of breast cancers. To facilitate the interpretation of ABUS images, automated diagnosis and detection techniques are being developed, in which malignant lesion segmentation plays an important role. However, automated segmentation of cancer in ABUS is challenging since lesion edges might not be well defined. In this study, the authors aim at developing an automated segmentation method for malignant lesions in ABUS that is robust to ill‐defined cancer edges and posterior shadowing.

Methods:

A segmentation method using depth‐guided dynamic programming based on spiral scanning is proposed. The method automatically adjusts aggressiveness of the segmentation according to the position of the voxels relative to the lesion center. Segmentation is more aggressive in the upper part of the lesion (close to the transducer) than at the bottom (far away from the transducer), where posterior shadowing is usually visible. The authors used Dice similarity coefficient (Dice) for evaluation. The proposed method is compared to existing state of the art approaches such as graph cut, level set, and smart opening and an existing dynamic programming method without depth dependence.

Results:

In a dataset of 78 cancers, our proposed segmentation method achieved a mean Dice of 0.73 ± 0.14. The method outperforms an existing dynamic programming method (0.70 ± 0.16) on this task (p = 0.03) and it is also significantly (p < 0.001) better than graph cut (0.66 ± 0.18), level set based approach (0.63 ± 0.20) and smart opening (0.65 ± 0.12).

Conclusions:

The proposed depth‐guided dynamic programming method achieves accurate breast malignant lesion segmentation results in automated breast ultrasound.
Fantasy Sport, FoMO, and Traditional Fandom: How Second-Screen Use of Social Media Allows Fans to Accommodate Multiple Identities
Authors: Larkin Ben A. , Fink Janet S.
Published: June 2016

Fantasy sport has become a prominent topic of study for sport management scholars over the last decade, and along with the rise of this research have come questions regarding how fantasy sport involvement impacts fans’ loyalty to their favorite team(s). Although this question has been posed several times, results have been mixed. We posit that this is largely attributable to the fact that to this point researchers have not considered the situational environment under which fantasy sport has proliferated or the psychological processes of consumers facing multiple consumption options. Therefore, we examined a model featuring fear of missing out as an antecedent to fantasy sport involvement, social media involvement, and team identity salience during games. Furthermore, we examine the role social media involvement plays in allowing fans to accommodate both their fantasy sport and team identities during games. Theoretical and practical implications are discussed.
A universal system to select gene-modified hepatocytes in vivo
Authors: Nygaard Sean , Barzel Adi , Haft Annelise , Major Angela , Finegold Milton , Kay Mark A. , Grompe Markus
Published: June 2016

Genetically modified hepatocytes can be selected pharmacologically using a protective shRNA directed against a tyrosine catabolic enzyme.
RNAi targeting multiple cell adhesion molecules reduces immune cell recruitment and vascular inflammation after myocardial infarction
Authors: Sager Hendrik B. , Dutta Partha , Dahlman James E. , Hulsmans Maarten , Courties Gabriel , Sun Yuan , Heidt Timo , Vinegoni Claudio , Borodovsky Anna , Fitzgerald Kevin , Wojtkiewicz Gregory R. , Iwamoto Yoshiko , Tricot Benoit , Khan Omar F. , Kauffman Kevin J. , Xing Yiping , Shaw Taylor E. , Libby Peter , Langer Robert , Weissleder Ralph , Swirski Filip K. , Anderson Daniel G. , Nahrendorf Matthias
Published: June 2016

Nanoparticles deliver siRNA for multigene silencing of endothelial cell adhesion molecules, which dampens leukocyte recruitment in atherosclerosis and myocardial infarction in mice.
Wide-area OCT angiography gives the big picture
Authors: Evans Conor
Published: June 2016

A wide-area angiography method provides label-free, depth-resolved blood vessel imaging over centimeter-sized fields of view.
Stem cells flex their muscle regenerative potential
Authors: Ulery Bret D.
Published: June 2016

Mesenchymal stem cells can induce skeletal muscle regeneration from remote bioactive scaffolds.
History Leaves Its Mark on Soil Bacterial Diversity
Authors: Martiny Jennifer B. H.
Published: June 2016

Dispersal is closely tied to the origin and maintenance of microbial diversity. With its focus on a narrow group of soil bacteria, recent work by Andam and colleagues on
Streptomyces
has provided perhaps the strongest support so far that some bacterial diversity in soils can be attributed to regional endemism (C. P. Andam et al., mBio 7:e02200-15, 2016,
http://dx.doi.org/10.1128/mBio.02200-15
). This means that dispersal is limited enough to allow for evolutionary diversification. Further analyses suggest that signatures of climate conditions more than 10,000 years ago can be detected in contemporary populations of this genus. These legacies have implications for how future climate change might alter soil microbial diversity.
Bacterial Adrenergic Sensors Regulate Virulence of Enteric Pathogens in the Gut
Authors: Moreira Cristiano G. , Russell Regan , Mishra Animesh Anand , Narayanan Sanjeev , Ritchie Jennifer M. , Waldor Matthew K. , Curtis Meredith M. , Winter Sebastian E. , Weinshenker David , Sperandio Vanessa
Published: June 2016

Enteric pathogens such as enterohemorrhagic
Escherichia coli
(EHEC) and
Citrobacter rodentium
, which is largely used as a surrogate EHEC model for murine infections, are exposed to several host neurotransmitters in the gut. An important chemical exchange within the gut involves the neurotransmitters epinephrine and/or norepinephrine, extensively reported to increase virulence gene expression in EHEC, acting through two bacterial adrenergic sensors: QseC and QseE. However, EHEC is unable to establish itself and cause its hallmark lesions, attaching and effacing (AE) lesions, on murine enterocytes. To address the role of these neurotransmitters during enteric infection, we employed
C. rodentium
. Both EHEC and
C. rodentium
harbor the locus of enterocyte effacement (LEE) that is necessary for AE lesion formation. Here we show that expression of the LEE, as well as that of other virulence genes in
C. rodentium
, is also activated by epinephrine and/or norepinephrine. Both QseC and QseE are required for LEE gene activation in
C. rodentium
, and the
qseC
and
qseE
mutants are attenuated for murine infection.
C. rodentium
has a decreased ability to colonize dopamine β-hydroxylase knockout (Dbh
−/−
) mice, which do not produce epinephrine and norepinephrine. Both adrenergic sensors are required for
C. rodentium
to sense these neurotransmitters and activate the LEE genes during infection. These data indicate that epinephrine and norepinephrine are sensed by bacterial adrenergic receptors during enteric infection to promote activation of their virulence repertoire. This is the first report of the role of these neurotransmitters during mammalian gastrointestinal (GI) infection by a noninvasive pathogen.

IMPORTANCE
The epinephrine and norepinephrine neurotransmitters play important roles in gut physiology and motility. Of note, epinephrine and norepinephrine play a central role in stress responses in mammals, and stress has profound effects on GI function. Bacterial enteric pathogens exploit these neurotransmitters as signals to coordinate the regulation of their virulence genes. The bacterial QseC and QseE adrenergic sensors are at the center of this regulatory cascade.
C. rodentium
is a noninvasive murine pathogen with a colonization mechanism similar to that of EHEC, enabling the investigation of host signals in mice. The presence of these neurotransmitters in the gut is necessary for
C. rodentium
to fully activate its virulence program, in a QseC/QseE-dependent manner, to successfully colonize its murine host. Our study data provide the first example of epinephrine and norepinephrine signaling within the gut to stimulate infection by a bacterial pathogen in a natural animal infection.
Spontaneous subarachnoid hemorrhage due to ruptured cavernous internal carotid artery aneurysm after medical prolactinoma treatment
Authors: Khalsa Siri Sahib , Hollon Todd C , Shastri Ravi , Trobe Jonathan D , Gemmete Joseph J , Pandey Aditya S
Published: June 2016

Aneurysms of the cavernous segment of the internal carotid artery (ICA) are believed to have a low risk of subarachnoid haemorrhage (SAH), given the confines of the dural rings and the anterior clinoid process. The risk may be greater when the bony and dural protection has been eroded. We report a case of spontaneous SAH from rupture of a cavernous ICA aneurysm in a patient whose large prolactinoma had markedly decreased in size as the result of cabergoline treatment. After passing a balloon test occlusion, the patient underwent successful endovascular vessel deconstruction. This case suggests that an eroding skull base lesion may distort normal anterior cranial base anatomy and allow communication between the cavernous ICA and subarachnoid space. The potential for SAH due to cavernous ICA aneurysm rupture should be recognised in patients with previous pituitary or other skull base lesions adjacent to the cavernous sinus.
Acute intermittent porphyria leading to posterior reversible encephalopathy syndrome (PRES): a rare cause of abdominal pain and seizures
Authors: Dagens Andrew , Gilhooley Michael James
Published: June 2016

Acute intermittent porphyria (AIP) is an inherited deficiency in the haem biosynthesis pathway. AIP is rare, affecting around 1 in 75 000 people. Acute attacks are characterised by abdominal pain associated with autonomic, neurological and psychiatric symptoms. AIP is rarely associated with posterior reversible encephalopathy syndrome (PRES). PRES is a clinicoradiological condition caused by the failure of the posterior circulation to autoregulate, resulting in cerebral oedema, headaches, nausea and seizures. This association is important because drugs used in the management of seizures may worsen an attack of AIP. This article describes a case of AIP and PRES in a young woman.
Comparative efficacy of selective serotonin reuptake inhibitors (SSRI) in treating major depressive disorder: a protocol for network meta-analysis of randomised controlled trials
Authors: Jia Yongliang , Zhu Hongmei , Leung Siu-wai
Published: June 2016

Introduction

There have been inconsistent findings from randomised controlled trials (RCTs) and systematic reviews on the efficacies of selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment of major depressive disorder (MDD). Besides inconsistencies among randomised controlled trials (RCTs), their risks of bias and evidence grading have seldom been evaluated in meta-analysis. This study aims to compare the efficacy of SSRIs by conducting a Bayesian network meta-analysis, which will be the most comprehensive evaluation of evidence to resolve the inconsistency among previous studies.

Methods and analyses

SSRIs including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline and vilazodone have been selected. Systematic database searching and screening will be conducted for the RCTs on drug treatment of patients with MDD according to pre-specified search strategies and selection criteria. PubMed, the Cochrane Library, EMBASE, ScienceDirect, the US Food and Drug Administration Website, ClinicalTrial.gov and WHO Clinical Trials will be searched. Outcome data including Hamilton Depression Rating Scale (HDRS), Montgomery-Åsberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) from eligible RCTs will be extracted. The outcomes will be analysed as ORs and mean differences under a random-effects model. A Bayesian network meta-analysis will be conducted with WinBUGS software, to compare the efficacies of SSRIs. Subgroup and sensitivity analysis will be performed to explain the study heterogeneity and evaluate the robustness of the results. Meta-regression analysis will be conducted to determine the possible factors affecting the efficacy outcomes. The Cochrane risk of bias assessment tool will be used to assess the RCT quality, and the Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the strength of evidence from the meta-analysis.

Ethics and dissemination

No ethical approval is required because this study includes neither confidential personal patient data nor interventions with patients.

Protocol registration number

CRD42015024879.
Association between different risk factors and vascular accelerated ageing (EVA study): study protocol for a cross-sectional, descriptive observational study
Authors: Gomez-Marcos Manuel A , Martinez-Salgado Carlos , Gonzalez-Sarmiento Rogelio , Hernandez-Rivas Jesus Ma , Sanchez-Fernandez Pedro L , Recio-Rodriguez Jose I , Rodriguez-Sanchez Emiliano , García-Ortiz Luis
Published: June 2016

Introduction

The process of population ageing that is occurring in developed societies represents a major challenge for the health system. The aim of this study is to analyse factors that have an influence on early vascular ageing (EVA), estimated by carotid-femoral pulse wave velocity (cf-PWV) and Cardio Ankle Vascular Index (CAVI), and to determine differences by gender in a Spanish population.

Methods and analysis

An observational, descriptive, cross-sectional study.

Study population

From the population assigned to the participating healthcare centres, a cluster random sampling stratified by age and gender will be performed to obtain 500 participants aged between 35 and 75. Those who meet the inclusion criteria and give written informed consent will be included in the study.

Measurements

Main dependent variables: cf-PWV determined using the SphygmoCor System and CAVI estimated using VASERA. Secondary dependent variables: telomere length, carotid intima-media thickness, central and peripheral augmentation index, ankle-brachial pulse wave velocity, ankle-brachial index, retinal arteriovenous index, and renal and cardiac organ damage. Independent variables: lifestyles (physical activity, adherence to the Mediterranean diet, alcohol and tobacco consumption); psychological factors (depression, anxiety and chronic stress); inflammatory factors and oxidative stress.

Ethics and dissemination

The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent form agreeing to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow the understanding of the relationship of the different influencing factors and their relative weight in the development of EVA. At least 5 publications in first-quartile scientific journals are planned.

Trial registration number

NCT02623894; Pre-results.
Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain
Authors: Godfrey Emma , Galea Holmes Melissa , Wileman Vari , McCracken Lance , Norton Sam , Moss-Morris Rona , Pallet John , Sanders Duncan , Barcellona Massimo , Critchley Duncan
Published: June 2016

Introduction

Chronic low back pain (CLBP) is a common condition and source of significant suffering, disability and healthcare costs. Current physiotherapy treatment is moderately effective. Combining theory-based psychological methods with physiotherapy could improve outcomes for people with CLBP. The primary aim of this randomised controlled trial (RCT) is to evaluate the efficacy of Physiotherapy informed by Acceptance and Commitment Therapy (PACT) on functioning in patients with CLBP.

Methods and analysis

The PACT trial is a two-armed, parallel-group, multicentre RCT to assess the efficacy of PACT in comparison with usual physiotherapy care (UC). 240 patients referred to physiotherapy with CLBP will be recruited from three National Health Service (NHS) hospitals trusts. Inclusion criteria are: age ≥18 years, CLBP ≥12-week duration, scoring ≥3 points on the Roland-Morris Disability Questionnaire (RMDQ) and adequate understanding of spoken and written English to participate. Patients will be randomised to PACT or UC (120 per arm stratified by centre) by an independent randomisation service and followed up at 3 and 12 months post randomisation. The sample size of 240 will provide adequate power to detect a standardised mean difference of 0.40 in the primary outcome (RMDQ; 5% significance, 80% power) assuming attrition of 20%. Analysis will be by intention to treat conducted by the trial statistician, blind to treatment group, following a prespecified analysis plan. Estimates of treatment effect at the follow-up assessments will use an intention-to-treat framework, implemented using a linear mixed-effects model.

Ethics and dissemination

This trial has full ethical approval (14/SC/0277). It will be disseminated via peer-reviewed publications and conference presentations. The results will enable clinicians, patients and health service managers to make informed decisions regarding the efficacy of PACT for patients with CLBP.

Trial registration number

ISRCTN95392287; Pre-results.
The Participative Design of an Endoscopy Facility using Lean 3P
Authors: Smith Iain
Published: June 2016

In the UK, bowel cancer is the second largest cancer killer. Diagnosing people earlier can save lives but demand for endoscopies is increasing and this can put pressure on waiting times.

To address this challenge, an endoscopy unit in North East England decided to improve their facilities to increase capacity and create environments that improve the experience of users. This presented a significant opportunity for step change improvement but also a problem in terms of creating designs that meet user requirements whilst addressing structural or space constraints.

The Lean design process known as ‘3P’ (standing for the production preparation process) was utilised as a participative design strategy to engage stakeholders in the design of the new department. This involved a time-out workshop (or 3P event) in which Lean and participative design tools were utilised to create an innovative design based on ‘point of delivery’ (POD) principles. The team created a design that demonstrated an increase in treatment room capacity by 25% and bed capacity by 70% whilst reducing travel distance for patients by 25.8% and staff by 27.1%. This was achieved with an increase in available space of only 13%.

The Lean 3P method provided a structured approach for corporate and clinical staff to work together with patient representatives as cross-functional teams. This participative approach facilitated communication and learning between stakeholders about care processes and personal preferences. Lean 3P therefore appears to be a promising approach to improving the healthcare facilities design process to meet user requirements.
Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project
Authors: Shabbir Asad , Wali Gorav , Steuer Alan
Published: June 2016

Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result.

A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS of inpatients awaiting social packages and placement. The four daily initiatives were:

1. A morning board round between nurses and doctors to prioritise new or sick patients for early review.

2. A post ward round meeting between the multidisciplinary team to expedite rehabilitation and plan discharges early.

3. An evening board round to highlight which patients needed discharge paperwork for the next day to alleviate the wait for pharmacy.

4. A ‘computer on wheels’ on ward rounds so investigations could be ordered and reviewed at the bedside allowing more time to address patient concerns.

A control month in August 2013 and five intervention cycles were completed between September 2013 and January 2014. Prior to intervention, mean time taken for patients to be discharged with a package of care, once declared MFFD, was 25 days. With intervention this value dropped to 1 day. The total LoS fell from 46 days to 16 days. It was also found that the time taken from admission to MFFD status was reduced from 21 days to 15 days.

In conclusion this data shows that with four simple modifications to ward behaviour unnecessary inpatient stay can be significantly reduced.
Eliminating guidewire retention during ultrasound guided central venous catheter insertion via an educational program, a modified CVC set, and a drape with reminder stickers
Authors: Peh Wee Ming , Jia Loh Wann , chee phua ghee , Min Loo Chian
Published: June 2016

Guidewire retention is a severe but preventable complication from central venous catheter (CVC) insertion. There were three cases of guidewire retention during CVC insertion in the medical intensive care unit (MICU) in Singapore General Hospital, in the period between December 2011 and February 2012. The primary objective of this quality improvement project was to eliminate future incidences of guidewire retention during CVC insertion in the MICU and medical intermediate care area (MICA) via a structured educational program and a cost effective modified CVC set. The secondary objective was to perform a cost analysis and comparison between the use of the conventional hospital CVC set and drape with our newly modified CVC dressing kit.

Root cause analysis of the three cases identified major factors leading to guidewire retention. Interventions were planned and tested using PDSA cycles. Internal medicine trainees rotating through MICU and MICA during the period between February 2012 and June 2013 underwent a multi-modal structured CVC insertion training program with hands on simulation. They also used a newly modified CVC dressing kit and drape. The CVC dressing kit was modified (CVC PLUS) to include a sterile drape with reminder stickers stating “REMOVE the GUIDEWIRE,” as well as a sterile ultrasound sleeve. The total number of CVC insertions performed and guidewire retentions were monitored.

During the period of study there were 320 CVC insertions in the MICU and MICA. Since this quality improvement project was initiated, and up to the submission of this article, there have not been any further cases of guidewire retention in the MICU and MICA. The total cost reduction per use of CVC PLUS was S$29.26 (Singaporean Dollars).

A multi-modal structured training program, integrated with a modified, pre-packed CVC set, and drapes with reminder stickers (all included in CVC PLUS) were cost effective, and improved patient safety by eliminating guidewire retention during CVC insertion.
Evaluation of inhaler handling-errors, inhaler perception and preference with Spiromax, Easyhaler and Turbuhaler devices among healthy Finnish volunteers: a single site, single visit crossover study (Finhaler)
Authors: Sandler Niklas , Holländer Jenny , Långström Disa , Santtila Pekka , Saukkonen Anni , Torvinen Saku
Published: June 2016

Introduction

Correct inhaler technique and device preference are positively correlated with improved adherence and clinical outcomes. This study was designed to investigate inhaler technique mastery and device preference for three different dry powder inhalers, Spiromax, Easyhaler and Turbuhaler.

Methods

This was a single site, single visit, crossover study assessing device mastery, handling errors and preference using empty Spiromax, Easyhaler and Turbuhaler devices in healthy adult Finnish volunteers. Inhaler naïve adult participants were observed by healthcare professionals (HCPs) to evaluate the proportion of participants achieving device mastery (defined as an absence of HCP observed errors) using a three-step approach: (1) intuitive use (with no instructions), (2) after reading the patient information leaflet and (3) after HCP instruction. HCPs monitored and recorded errors based on device-specific handling error checklists. At the end of the study, participants completed a device preference questionnaire and rated their satisfaction with the three devices.

Results

Spiromax was correctly used by 37.5% and 93.3% of participants in steps 1 and 2, respectively, compared with 0% and 58.3% with Easyhaler, and 9.2% and 76.7% with Turbuhaler. All three devices showed high mastery (>95%) in step 3. The most common error reported with Spiromax was related to the orientation of the device. Not shaking the device was the most common error with Easyhaler. Errors in priming the device were the most common with Turbuhaler. Spiromax, Easyhaler and Turbuhaler were rated as the ‘easiest device to use’ by 73.1%, 12.6% and 14.3% of participants, respectively. The HCP instructions clearly improved the use of all devices.

Conclusion

Higher levels of device mastery, including intuitive/ease of use, were reported by naïve users when using Spiromax compared with Easyhaler and Turbuhaler.
NOACs versus warfarin for stroke prevention in patients with AF: a systematic review and meta-analysis
Authors: Hicks Tim , Stewart Fiona , Eisinga Anne
Published: June 2016

Background

Warfarin has been the anticoagulant of choice for the prevention of ischaemic stroke in patients with atrial fibrillation (AF). Novel oral anticoagulants (NOACs) are increasingly used as an alternative.

Objectives

The objective of this review was to evaluate the efficacy and safety of the NOACs versus warfarin in patients with AF.

Search methods

Medline, EMBASE and grey literature search for all phase II and III randomised control trials.

Data collection/analysis

Two authors independently reviewed abstracts and performed data extraction of eligible full-text articles. Revman V.5 was used for meta-analysis.

Main results

12 studies were identified with a total study population of 77 011. NOACs demonstrated a reduction in the composite of stroke or systemic embolic events OR 0.85 (95% CI 0.75 to 0.98), a 52% reduction in intracranial haemorrhage OR 0.48 (95% CI 0.40 to 0.57) and a 14% reduction in mortality OR 0.86 (0.82 to 0.91). The 30-day end of study switch to warfarin demonstrated an in increase in stroke or systemic embolic events OR 2.60 (95% CI 1.61 to 4.18) and an increase in major bleeding OR 2.19 (95% CI 1.42 to 3.36).

Conclusions

NOACs are superior to warfarin for the prevention of the composite of stroke and systemic embolism in patients with AF and an additional risk factor for stroke. There is a significant reduction in intracranial haemorrhage, which drives the finding of significantly lower mortality. During the poststudy switch from NOACs to warfarin there is an excess of the composite of stroke and systemic embolism as well as major bleeding events, which may be of significance in clinical practice.