bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Parameter Identification Method for Tire Models
Authors: Jiang Junzhao , Lu Jianwei , Li Jinhui , Li Lei
Published: February 2017

A novel parameter identification method for dynamics models of pneumatic tire was presented. The parameter identification process and methodology relate to Nelder-Mead algorithm, genetic algorithm and random value method. Based on experimental data and tire modeling of PAC2002, the lateral force parameters, longitudinal force parameters and aligning moment parameters were identified by using the presented identification approach. It can be found that the novel parameter identification approach is more accurate and efficient, which can provide theoretic evidence for tire modeling and analysis. Moreover, a software system that integrates the parameter identification methodology was compiled and developed by using MATLAB and C++, which can provide a quick and efficient parameter identification process for engineering application in the future.
Surface Roughness Identification in End Milling Using Vibration Signals and Fuzzy Clustering
Authors: Abu-Mahfouz Issam , Banerjee Amit , Rahman A. H. M. Esfakur
Published: February 2017

The study presented involves the identification of surface roughness in Aluminum work pieces in an end milling process using fuzzy clustering of vibration signals. Vibration signals are experimentally acquired using an accelerometer for varying cutting conditions such as spindle speed, feed rate and depth of cut. Features are then extracted by processing the acquired signals in both the time and frequency domain. Techniques based on statistical parameters, Fast Fourier Transforms (FFT) and the Continuous Wavelet Transforms (CWT) are utilized for feature extraction. The surface roughness of the machined surface is also measured. In this study, fuzzy clustering is used to partition the feature sets, followed by a correlation with the experimentally obtained surface roughness measurements. The fuzzifier and the number of clusters are varied and it is found that the partitions produced by fuzzy clustering in the vibration signal feature space are related to the partitions based on cutting conditions with surface roughness as the output parameter. The results based on limited simulations are encouraging and work is underway to develop a larger framework for online cutting condition monitoring system for end milling.
The Effects of Carbon Fiber Misalignment on Material Composite Strength
Authors: Stangler Luke , Du Jikai
Published: February 2017

Nondestructive Evaluation (NDE) is an effective way for determining material properties. More specifically, ultrasonic waves along with visual measurements from a microscope can be used to systematically determine the elastic modulus of single ply composites that are subject to an altered manufacturing process. In this approach, the magnitudes of specific ultrasonic wave velocities are applied through Chirstoffel’s equations to determine the necessary five elastic constants that describe the elastic modulus of transversely isotropic composites. On the other hand, fiber misalignment measurements are taken through via digital microscopy to satisfy a statistical approach for the determination of the same elastic modulus. The Paper Physics Approach (PPA) and Laminate Analogy Approach (LAA) are utilized to predict the elastic modulus of unidirectional carbon fiber samples. A two parameter Weibull distribution is expected to satisfy the probability density of the fiber length and fiber orientation variation which will then be implemented into the Halpin-Tsai equations that will determine the elastic modulus. In terms of results, the mean fiber length from the visual approach is approximately 250 μm and the mean fiber misalignment is just over 3°. The elastic moduli range from 7 GPa to 9 GPa depending on the approach. Destructive mechanical testing led to an average elastic modulus value of 8.49 GPa.
Modeling the Effects of Texture on Thermal Expansion in Pressed PBX 9502 Components
Authors: Buechler Miles A. , Miller Nathan A. , Luscher D. J. , Schwarz Ricardo B. , Thompson Darla Graff
Published: February 2017

This paper demonstrates the effects of texture induced during pressing of PBX 9502 charges. We quantify the spatially variable anisotropic thermal strains associated with preferred orientation of TATB crystallographic (002) poles within manufactured components. The modeling approach is based on a series of three models. First, a component-level finite element model of the charge during consolidation from powder into pressed explosives is used to predict the deformation associated with this process. The deformation predicted from these simulations is used with a texture evolution model to estimate orientation distributions for TATB crystals at every integration point within the HE charge. The orientation distributions estimated using the texture evolution model are used within a self-consistent homogenization scheme to predict the spatially-variable macroscopic or aggregate thermal strain as a function of temperature at every location within the pressed component. Results are compared with measurements of texture and anisotropic thermal expansion for several locations sampled from pressed explosive components.
Effect of Free-Stream Turbulence on the Loads Experienced by a Marine Hydrokinetic Turbine
Authors: Lawrence Angela M. , Vinod Ashwin , Banerjee Arindam
Published: February 2017

Marine Hydrokinetic Turbines (MHkT) are a new class of renewable energy devices that harvest the kinetic energy of the flowing water in rivers or tides. In these environments, the approach flow contains elevated levels of free-stream turbulence (FST) and large coherent structures, which affect the performance and structural loading of the turbine as well as the signature of the downstream wake. Very little is understood about these interactions and how they cross-couple to impact river morphology, flood conveyance, and sediment transport. The current work uses controlled laboratory experiments to investigate the effects of FST on both component and system level metrics of MHK turbines. Homogeneous, free-stream turbulence levels ranging from 1% to 10% were achieved by employing a Makita type active-grid turbulence generator that is placed at the entrance of the water channel test section and is equipped with motor controlled winglet shafts. For component level measurements, loads acting on an MHK turbine hydrofoil at angles of attack ranging from −40° to +40° were measured using a two-axis load cell. Turbulence was shown to influence the stall angle of the hydrofoil. Stall occurred at ∼17° in the laminar free-stream but was postponed to ∼25° in the turbulent free-stream. An increase in the lift was observed at all angles greater than 10° with the increase being more significant in the post-stall regime. The drag measured in the turbulent free-stream was higher at angles less than 20° and greater than 25 ° but was lower at points in between. Concluding from the obtained lift to drag ratios, FST was observed to decrease performance while operating at angles less than the stall angle, and increase performance in the post-stall regime. For the system level measurements, a comparison of performance characteristics that includes the mean and standard deviations of the power coefficient (CP), and thrust coefficient (CT) between the turbulent and the laminar free-stream cases was performed. The results show a ∼2 fold increase in standard deviation of CT; however, elevated levels of FST have a weak effect on mean performance characteristics.
An Experimental Study on Human Milk Viscosity
Authors: Alatalo Diana , Hassanipour Fatemeh
Published: February 2017

Human milk is a complex fluid suspension of many ingredients — such as fats, proteins, lactose, and minerals — that differs greatly from bovine and other mammalian milks. The rheological properties of human milk impact its flow inside the breast and when fed through artificial feeding methods. Past research concerning the flow characteristics of human milk is extremely limited and does not account for milks non-Newtonian behavior. In order to produce an accurate model of milk flow in the human breast, experimental work was performed on human milk donated by eight mothers at different stages of lactogenesis II.

The results of this small study reveal the complexity of human milk flow characteristics and the challenges involved with modeling its flow, especially at low shear rates. Within the human breast, shear rates vary greatly from as low as 12 s−1 to as high as 2.5 × 1016 s−1 depending on the ductal system geometry and flow rate. For researchers involved in experimentation, the environmental conditions, handling methods, and age of milk are extremely important and must be reported if the data is to be of any value. Further experimentation is required to fully understand the mechanisms behind the time-dependence behavior of human milk.
Revealing physical interaction networks from statistics of collective dynamics
Authors: Nitzan Mor , Casadiego Jose , Timme Marc
Published: February 2017

Recording only the statistics of driven, asynchronous dynamics reveals a network’s interaction structure.
Realization of continuous Zachariasen carbon monolayer
Authors: Joo Won-Jae , Lee Jae-Hyun , Jang Yamujin , Kang Seog-Gyun , Kwon Young-Nam , Chung Jaegwan , Lee Sangyeob , Kim Changhyun , Kim Tae-Hoon , Yang Cheol-Woong , Kim Un Jeong , Choi Byoung Lyong , Whang Dongmok , Hwang Sung-Woo
Published: February 2017

Continuous Zachariasen carbon monolayer, a novel amorphous 2D carbon allotrope, was synthesized on germanium surface.
Evolutionary fine-tuning of conformational ensembles in FimH during host-pathogen interactions
Authors: Kalas Vasilios , Pinkner Jerome S. , Hannan Thomas J. , Hibbing Michael E. , Dodson Karen W. , Holehouse Alex S. , Zhang Hao , Tolia Niraj H. , Gross Michael L. , Pappu Rohit V. , Janetka James , Hultgren Scott J.
Published: February 2017

Evolutionary selection fine-tunes conformational ensembles of FimH for optimal bladder colonization by
E. coli
during UTI.
Structural transitions and guest/host complexing of liquid crystal helical nanofilaments induced by nanoconfinement
Authors: Kim Hanim , Ryu Seong Ho , Tuchband Michael , Shin Tae Joo , Korblova Eva , Walba David M. , Clark Noel A. , Yoon Dong Ki
Published: February 2017

A perfectly aligned liquid crystal phase can be achieved by an interaction with helical nanofilament under nanoconfinement.
The Siderophore Product Ornibactin Is Required for the Bactericidal Activity of Burkholderia contaminans MS14
Authors: Deng Peng , Foxfire Adam , Xu Jianhong , Baird Sonya M. , Jia Jiayuan , Delgado Keren H. , Shin Ronald , Smith Leif , Lu Shi-En
Published: February 2017

Burkholderia contaminans
MS14 was isolated from soil in Mississippi. When it is cultivated on nutrient broth-yeast extract agar, the colonies exhibit bactericidal activity against a wide range of plant-pathogenic bacteria. A bacteriostatic compound with siderophore activity was successfully purified and was determined by nuclear magnetic resonance spectroscopy to be ornibactin. Isolation of the bactericidal compound has not yet been achieved; therefore, the exact nature of the bactericidal compound is still unknown. During an attempt to isolate the bactericidal compound, an interesting relationship between the production of ornibactin and the bactericidal activity of MS14 was characterized. Transposon mutagenesis resulted in two strains that lost bactericidal activity, with insertional mutations in a nonribosomal peptide synthetase (NRPS) gene for ornibactin biosynthesis and a
luxR
family transcriptional regulatory gene. Coculture of these two mutant strains resulted in restoration of the bactericidal activity. Furthermore, the addition of ornibactin to the NRPS mutant restored the bactericidal phenotype. It has been demonstrated that, in MS14, ornibactin has an alternative function, aside from iron sequestration. Comparison of the ornibactin biosynthesis genes in
Burkholderia
species shows diversity among the regulatory elements, while the gene products for ornibactin synthesis are conserved. This is an interesting observation, given that ornibactin is thought to have the same defined function within
Burkholderia
species. Ornibactin is produced by most
Burkholderia
species, and its role in regulating the production of secondary metabolites should be investigated.

IMPORTANCE
Identification of the antibacterial product from strain MS14 is not the key feature of this study. We present a series of experiments that demonstrate that ornibactin is directly involved in the bactericidal phenotype of MS14. This observation provides evidence for an alternative function for ornibactin, aside from iron sequestration. Ornibactin should be further evaluated for its role in regulating the biosynthesis of secondary metabolites in other
Burkholderia
species.
Novel Three-Component Phenazine-1-Carboxylic Acid 1,2-Dioxygenase in Sphingomonas wittichii DP58
Authors: Zhao Qiang , Hu Hong-Bo , Wang Wei , Huang Xian-Qing , Zhang Xue-Hong
Published: February 2017

Phenazine-1-carboxylic acid, the main component of shenqinmycin, is widely used in southern China for the prevention of rice sheath blight. However, the fate of phenazine-1-carboxylic acid in soil remains uncertain.
Sphingomonas wittichii
DP58 can use phenazine-1-carboxylic acid as its sole carbon and nitrogen sources for growth. In this study, dioxygenase-encoding genes,
pcaA1A2
, were found using transcriptome analysis to be highly upregulated upon phenazine-1-carboxylic acid biodegradation. PcaA1 shares 68% amino acid sequence identity with the large oxygenase subunit of anthranilate 1,2-dioxygenase from
Rhodococcus maanshanensis
DSM 44675. The dioxygenase was coexpressed in
Escherichia coli
with its adjacent reductase-encoding gene,
pcaA3
, and ferredoxin-encoding gene,
pcaA4
, and showed phenazine-1-carboxylic acid consumption. The dioxygenase-, ferredoxin-, and reductase-encoding genes were expressed in
Pseudomonas putida
KT2440 or
E. coli
BL21, and the three recombinant proteins were purified. A phenazine-1-carboxylic acid conversion capability occurred
in vitro
only when all three components were present. However,
P. putida
KT2440 transformed with
pcaA1A2
obtained phenazine-1-carboxylic acid degradation ability, suggesting that phenazine-1-carboxylic acid 1,2-dioxygenase has low specificities for its ferredoxin and reductase. This was verified by replacing PcaA3 with RedA2 in the
in vitro
enzyme assay. High-performance liquid chromatography–mass spectrometry (HPLC-MS) and nuclear magnetic resonance (NMR) analysis showed that phenazine-1-carboxylic acid was converted to 1,2-dihydroxyphenazine through decarboxylation and hydroxylation, indicating that PcaA1A2A3A4 constitutes the initial phenazine-1-carboxylic acid 1,2-dioxygenase. This study fills a gap in our understanding of the biodegradation of phenazine-1-carboxylic acid and illustrates a new dioxygenase for decarboxylation.

IMPORTANCE
Phenazine-1-carboxylic acid is widely used in southern China as a key fungicide to prevent rice sheath blight. However, the degradation characteristics of phenazine-1-carboxylic acid and the environmental consequences of the long-term application are not clear.
S. wittichii
DP58 can use phenazine-1-carboxylic acid as its sole carbon and nitrogen sources. In this study, a three-component dioxygenase, PcaA1A2A3A4, was determined to be the initial dioxygenase for phenazine-1-carboxylic acid degradation in
S. wittichii
DP58. Phenazine-1-carboxylic acid was converted to 1,2-dihydroxyphenazine through decarboxylation and hydroxylation. This finding may help us discover the pathway for phenazine-1-carboxylic acid degradation.
Multitarget Quantitative PCR Improves Detection and Predicts Cultivability of the Pathogen Burkholderia pseudomallei
Authors: Göhler Andre , Trung Trinh Thanh , Hopf Verena , Kohler Christian , Hartleib Jörg , Wuthiekanun Vanaporn , Peacock Sharon J. , Limmathurotsakul Direk , Tuanyok Apichai , Steinmetz Ivo
Published: February 2017

Burkholderia pseudomallei
is present in the environment in many parts of the world and causes the often-fatal disease melioidosis. The sensitive detection and quantification of
B. pseudomallei
in the environment are a prerequisite for assessing the risk of infection. We recently reported the direct detection of
B. pseudomallei
in soil samples using a quantitative PCR (qPCR) targeting a single type three secretion system 1 (TTSS1) gene. Here, we extend the qPCR-based analysis of
B. pseudomallei
in soil by validating novel qPCR gene targets selected from a comparative genomic analysis. Two hundred soil samples from two rice paddies in northeast Thailand were evaluated, of which 47% (94/200) were
B. pseudomallei
culture positive. The TTSS1 qPCR and two novel qPCR assays that targeted open reading frames (ORFs) BPSS0087 and BPSS0745 exhibited detection rates of 76.5% (153/200), 34.5% (69/200), and 74.5% (150/200), respectively. The combination of TTSS1 and BPSS0745 qPCR increased the detection rate to 90% (180/200). Combining the results of the three qPCR assays and the BPSS1187 nested PCR previously published, all 200 samples were positive by at least one PCR assay. Samples positive by either TTSS1 (
n
= 153) or BPSS0745 (
n
= 150) qPCR were more likely to be direct-culture positive, with odds ratios of 4.0 (95% confidence interval [CI], 1.7 to 9.5;
P
< 0.001) and 9.0 (95% CI, 3.1 to 26.4;
P
< 0.001), respectively. High
B. pseudomallei
genome equivalents correlated with high CFU counts by culture. In conclusion, multitarget qPCR improved the
B. pseudomallei
detection rate in soil samples and predicted culture positivity. This approach has the potential for use as a sensitive environmental screening method for
B. pseudomallei
.

IMPORTANCE
The worldwide environmental distribution of the soil bacterium
Burkholderia pseudomallei
remains to be determined. So far, most environmental studies have relied on culture-based approaches to detect this pathogen. Since current culture methods are laborious, are time consuming, and have limited sensitivity, culture-independent and more sensitive methods are needed. In this study, we show that a
B. pseudomallei
-specific qPCR approach can detect significantly higher numbers of
B. pseudomallei
-positive soil samples from areas where it is endemic compared with that from culture. The use of multiple independent
B. pseudomallei
-specific qPCR targets further increased the detection rate of
B. pseudomallei
compared with that from single targets. Samples with a high molecular
B. pseudomallei
load were more likely to be culture positive. We conclude that our quantitative multitarget approach might be useful in defining areas where there is a risk of
B. pseudomallei
infections in different parts of the world.
Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study
Authors: Eckhoff Christian , Straume Bjørn , Kvernmo Siv
Published: February 2017

Objectives

To examine the association between multisite musculoskeletal pain in adolescence and mental health disorders in young adulthood.

Design and setting

Data were obtained from a linkage between the Norwegian Patient Registry (2008–2012) and the Norwegian Arctic Adolescent Health Study, a school-based survey conducted among 10th grade students in North Norway (2003–2005).

Participants

In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage.

Outcome measures

Mental healthcare use and disorders from age 18–20 to 23–25 years (5 years).

Methods

Musculoskeletal pain was measured by the number of musculoskeletal pain sites. Multivariable logistic regression was used to explore the association with later mental healthcare use and disorders.

Results

Multisite adolescent musculoskeletal pain was significantly associated with an increase in mental healthcare use and mental health disorders in young adulthood. The relationship was stronger for anxiety and mood disorders, in both genders. Overall, the association between musculoskeletal pain and later mental health problems was attenuated after controlling for adolescent psychosocial and mental health problems, not by physical or sedentary activity. This could be due to confounding or mediation. However, when examining different mental health disorders, we found musculoskeletal pain to be significantly associated with anxiety disorders, and showing a strong trend in mood disorders, when adjusted for the adolescent factors.

Conclusions

Physicians should be aware that multisite adolescent pain is associated with mental health problems in adolescence, and that these adolescents are at increased risk of mental health disorders in young adulthood. As youth troubled by mental health problems commonly present physical symptoms it is important to examine for psychosocial problems in order to offer early interventions.
Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study
Authors: Dudley L , Kettle C , Waterfield J , Ismail Khaled M K
Published: February 2017

Objective

To explore women's lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT).

Design

A nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology.

Participants and setting

A purposive sample of six women at 6–9 months postnatal who participated in the RCT were interviewed in their own homes.

Results

Following Giorgi's analytical framework the verbatim transcripts were analysed for key themes. Women's lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme ‘participating in the RCT’ was ‘a priori’ with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options.

Conclusions

To the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option.

Trial registration number

ISRCTN05754020; results.
ESPACOMP Medication Adherence Reporting Guidelines (EMERGE): a reactive-Delphi study protocol
Authors: Helmy R , Zullig L L , Dunbar-Jacob J , Hughes D A , Vrijens B , Wilson I B , De Geest S
Published: February 2017

Introduction

Medication adherence is fundamental to achieving optimal patient outcomes. Reporting research on medication adherence suffers from some issues—including conceptualisation, measurement and data analysis—that thwart its advancement. Using the ABC taxonomy for medication adherence as the conceptual basis, a steering committee of members of the European Society for Patient Adherence, COMpliance, and Persistence (ESPACOMP) launched an initiative to develop ESPACOMP Medication Adherence Reporting Guidelines (EMERGE). This paper is a protocol for a Delphi study that aims to build consensus among a group of topic experts regarding an item list that will support developing EMERGE.

Methods and analysis

This study uses a reactive-Delphi design where a group of topic experts will be asked to rate the relevance and clarity of an initial list of items, in addition to suggesting further items and/or modifications of the initial items. The initial item list, generated by the EMERGE steering committee through a structured process, consists of 26 items distributed in 2 sections: 4 items representing the taxonomy-based minimum reporting criteria, and 22 items organised according to the common reporting sections. A purposive sample of experts will be selected from relevant disciplines and diverse geographical locations. Consensus will be achieved through predefined decision rules to keep, delete or modify the items. An iterative process of online survey rounds will be carried out until consensus is reached.

Ethics and dissemination

An ethics approval was not required for the study according to the Swiss federal act on research involving human beings. The participating experts will be asked to give an informed consent. The results of this Delphi study will feed into EMERGE, which will be disseminated through peer-reviewed publications and presentations at conferences. Additionally, the steering committee will encourage their endorsement by registering the guidelines at the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network and other relevant organisations.
Randomised trial assessing the impact of framing of fracture risk and osteoporosis treatment benefits in patients undergoing bone densitometry
Authors: Kalluru Rama , Petrie Keith J , Grey Andrew , Nisa Zaynah , Horne Anne M , Gamble Greg D , Bolland Mark J
Published: February 2017

Objectives

The accuracy of patients' perception of risk is important for decisions about treatment in many diseases. We framed the risk of fracture and benefits of treatment in different ways and assessed the impact on patients' perception of fracture risk and intentions to take medication.

Design

Randomised trial of 4 different presentations of fracture risk and likely benefits from osteoporosis treatment.

Setting

Academic centre.

Participants

200 patients undergoing bone densitometry.

Intervention

Presentation that framed the patient's absolute fracture risk either as the chance of having or not having an event, with their likely benefits from osteoporosis treatment in natural frequencies or numbers needed to treat.

Outcomes

Participants' views about their fracture risk and the need for osteoporosis treatment.

Results

The median 5-year fracture risk threshold participants regarded as high enough to consider preventative medication was 50–60%, and did not change substantially after the presentation. The median (Q1, Q3) 5-year risk initially estimated by participants was 20% (10, 50) for any fracture and 19% (10, 40) for hip fracture. 61% considered their fracture risk was low or very low, and 59–67% considered their fracture risk was lower than average. These participant estimates were 2–3 times higher than Garvan calculator estimates for any fracture, and 10–20 times higher for hip fracture. Participant estimates of fracture risk halved after the presentation, but remained higher than the Garvan estimates (1.5–2 times for any fracture, 5–10 times for hip fracture). There was no difference in these outcomes between the randomised groups. Participants' intentions about taking medication to prevent fractures were not substantially affected by receiving information about fracture risk and treatment benefits.

Conclusions

Altering the framing of estimated fracture risks and treatment benefits had little effect on participants' perception of the need to take treatment or their individual fracture risk.

Trial registration number

ACTRN12613001081707; Pre-results.
Feasibility of peer assessment and clinical audit to self-regulate the quality of physiotherapy services: a mixed methods study
Authors: Maas Marjo J M , Nijhuis-van der Sanden Maria W G , Driehuis Femke , Heerkens Yvonne F , van der Vleuten Cees P M , van der Wees Philip J
Published: February 2017

Objectives

To evaluate the feasibility of a quality improvement programme aimed to enhance the client-centeredness, effectiveness and transparency of physiotherapy services by addressing three feasibility domains: (1) acceptability of the programme design, (2) appropriateness of the implementation strategy and (3) impact on quality improvement.

Design

Mixed methods study.

Participants and setting

64 physiotherapists working in primary care, organised in a network of communities of practice in the Netherlands.

Methods

The programme contained: (1) two cycles of online self-assessment and peer assessment (PA) of clinical performance using client records and video-recordings of client communication followed by face-to-face group discussions, and (2) clinical audit assessing organisational performance. Assessment was based on predefined performance indicators which could be scored on a 5-point Likert scale. Discussions addressed performance standards and scoring differences. All feasibility domains were evaluated qualitatively with two focus groups and 10 in-depth interviews. In addition, we evaluated the impact on quality improvement quantitatively by comparing self-assessment and PA scores in cycles 1 and 2.

Results

We identified critical success features relevant to programme development and implementation, such as clarifying expectations at baseline, training in PA skills, prolonged engagement with video-assessment and competent group coaches. Self-reported impact on quality improvement included awareness of clinical and organisational performance, improved evidence-based practice and client-centeredness and increased motivation to self-direct quality improvement. Differences between self-scores and peer scores on performance indicators were not significant. Between cycles 1 and 2, scores for record keeping showed significant improvement, however not for client communication.

Conclusions

This study demonstrated that bottom-up initiatives to improve healthcare quality can be effective. The results justify ongoing evaluation to inform nationwide implementation when the critical success features are addressed. Further research is necessary to explore the sustainability of the results and the impact on client outcomes in a full-scale study.
Health Education and Activity – Lessening The Inequalities in mental health (HEA – LTI mental health)
Authors: Richmond Georgia , Kenny Conor , Ahmed Jabed , Stephenson Lucy , lindsay jamie , Earls Patrick , Mullin Donncha , Ryland Howard
Published: February 2017

Patients suffering from mental health illness have considerably more physical health disease burden than the rest of the population and are more likely to die 10 to 20 years younger compared with their peers. Diabetes, cardiovascular and respiratory disease have been recognised as contributing factors to premature death. Furthermore patients with severe mental illness undertake lower levels of physical activity.

The aim of the project was therefore to address the inequalities in physical health that affect patients with mental health illness through designing and implementing a sustainable, transferable, patient-centred education and activity intervention.

The objective of the project was to increase patient motivation to change behaviour as a result of physical health interventions by increasing patients' physical health understanding, motivation to change their physical health behaviour, motivation to do exercise and by reducing their anxiety.

The method used was a prospective cohort study in four eighteen bed psychosis inpatient units. The units were across two large London hospitals in one Hospital Trust involving male and female inpatients with a range of mental health issues.

The intervention was comprised of two components. The first component was a weekly 45 minute teaching group designed in collaboration with patients focusing on the key domains that affect the physical health of mental health patients. Four discussion domains (heart health, diabetes and weight, smoking and lung disease, cancer screening and substance misuse) were undertaken, with each cycle lasting four weeks. The second component was a weekly 45 minute exercise group (‘normalisation activity’) in collaboration with patients and the multidisciplinary team.

The intervention was evaluated at the end of each cycle and four cycles in total took place.

Weekly pre and post intervention measures were undertaken comprising of a self reported change in understanding, motivation to change physical health behaviours, confidence to change, anxiety and motivation to exercise.

The result was a 26% improvement in self-reported understanding across the four domains following teaching. Furthermore patient anxiety reduced by on average 35%, self-reported motivation to change increased by 20%, motivation to do exercise by 26% and confidence to change by 16% as a result of the intervention.

The authors conclude that a collaborative approach to education and activity between the Multidisciplinary Team (MDT) and service user results in sustained improvement in understanding of physical health, motivation to change behaviour and to do exercise. It also results in improved confidence and reduced anxiety.
Progressive prediction of hospitalisation in the emergency department: uncovering hidden patterns to improve patient flow
Authors: Barak-Corren Yuval , Israelit Shlomo Hanan , Reis Ben Y
Published: February 2017

Introduction

One of the factors contributing to ED crowding is the lengthy delay in transferring an admitted patient from the ED to an inpatient department (ie, boarding time). An earlier start of the admission process using an automatic hospitalisation prediction model could potentially shorten these delays and reduce crowding.

Methods

Clinical, operational and demographic data were retrospectively collected on 80 880 visits to the ED of Rambam Health Care Campus in Haifa, Israel, from January 2011 to January 2012. Using these data, a logistic regression model was developed to predict patient disposition (hospitalisation vs discharge) at three progressive time points throughout the ED visit: within the first 10 min, within an hour and within 2 hours. The algorithm was trained on 50% of the data (n=40 440) and tested on the remaining 50%.

Results

During the study time period, 58 197 visits ended in discharge and 22 683 in hospitalisation. Within 1 hour of presentation, our model was able to predict hospitalisation with a specificity of 90%, sensitivity of 94% and an AUCof 0.97. Early clinical decisions such as testing for calcium levels were found to be highly predictive of hospitalisations. In the Rambam ED, the use of such a prediction system would have the potential to save more than 250 patient hours per day.

Conclusions

Data collected by EDs in electronic medical records can be used within a progressive modelling framework to predict patient flow and improve clinical operations. This approach relies on commonly available data and can be applied across different healthcare settings.
Emergency department syndromic surveillance to investigate the health impact and factors associated with alcohol intoxication in Reunion Island
Authors: Vilain Pascal , Larrieu Sophie , Mougin-Damour Katia , Marianne Dit Cassou Pierre-Jean , Weber Marc , Combes Xavier , Filleul Laurent
Published: February 2017

In Reunion Island, alcohol is the most tried out psychoactive substance. To our knowledge, few indicators measuring the health burden of alcohol use exist on the island. In this context, an exploratory analysis based on syndromic surveillance data was implemented in order to describe the emergency department (ED) visits for alcohol intoxication (AI) and factors associated with their variations.

An analysis of anonymized records routinely collected by the syndromic surveillance system was carried out. A daily indicator of ED visits for AI was built from a selection of ICD-10 codes between 2010 and 2012. Health impact of AI was first described comparing this indicator to all causes ED visits. Then, AI visits were analyzed with time-series methods using generalized additive Poisson regression models allowing for overdispersion. The following variables were included in the model: long-term trend, seasonality, day of the week, public and school holidays, days of festival and minimum social benefits payday.

During the study period, 16 652 visits for AI were recorded in EDs of Reunion Island. AI visits were the second reason for ED visits (i.e. 4%) after traumatism. AI visits mainly concerned men (87%) and the age group of 25-54 years (69%). There was a significant increase in ED visits for AI during days of benefits payday, weekends and publics holidays.

This study demonstrated the interest of syndromic surveillance to monitor non-infectious diseases. Time-series models showed a robust association between ED visits for AI and several factors.
Abortion and fertility control in Pakistan: the role of misoprostol
Authors: Chahal Harneet , Mumtaz Zubia
Published: February 2017

Objective

To examine how availability of misoprostol has impacted women's abortion-seeking behaviour in Pakistan.

Design

Focused ethnography.

Setting

A facility providing reproductive health services, including induced abortions in Chakwal, a small town in Northern Punjab, Pakistan.

Population

Women who came to the clinic seeking an abortion or who had had one in the last 6 months (n=23) and all healthcare providers working in the facility (n=14).

Methods

Semi-structured interviews (n=37), a focus group discussion (n=1) and participant observation (n=41). Latent content analysis was conducted drawing on principles of constant comparison to generate key themes in reported experiences.

Results

All the respondents had sought an abortion to limit their fertility. Although some reported contraceptive use, improper use, undesirable side effects and restrictions on use had led to the unwanted pregnancy. All the women specifically requested misoprostol within days of their pregnancy, suggesting that they not only had knowledge of misoprostol as a backup in case of contraceptive failure, but may have pre-planned its use ofin place ofusing contraception. Women reconciled their decision to undergo an abortion by describing it as a mistake, miscarriage or menstrual cycle issue.

Conclusions

Misoprostol's availability, ease of use and effectiveness have increased the role of abortion in fertility control.
Presentation of SLE in UK primary care using the Clinical Practice Research Datalink
Authors: Nightingale Alison L , Davidson Julie E , Molta Charles T , Kan Hong J , McHugh Neil J
Published: February 2017

Objectives

To describe the presenting symptoms of SLE in primary care using the Clinical Practice Research Database (CPRD) and to calculate the time from symptom presentation to SLE diagnosis.

Methods

Incident cases of SLE were identified from the CPRD between 2000 and 2012. Presenting symptoms were identified from the medical records of cases in the 5 years before diagnosis and grouped using the British Isles Lupus Activity Group (BILAG) symptom domains. The time from the accumulation of one, two and three BILAG domains to SLE diagnosis was investigated, stratified by age at diagnosis (<30, 30–49 and ≥50 years).

Results

We identified 1426 incident cases (170 males and 1256 females) of SLE. The most frequently recorded symptoms and signs prior to diagnosis were musculoskeletal, mucocutaneous and neurological. The median time from first musculoskeletal symptom to SLE diagnosis was 26.4 months (IQR 9.3–43.6). There was a significant difference in the time to diagnosis (log rank p<0.01) when stratified by age and disease severity at baseline, with younger patients <30 years and those with severe disease having the shortest times and patients aged ≥50 years and those with mild disease having the longest (6.4 years (IQR 5.8–6.8)).

Conclusions

The time from symptom onset to SLE diagnosis is long, especially in older patients. SLE should be considered in patients presenting with flaring or chronic musculoskeletal, mucocutaneous and neurological symptoms.
Sildenafil improves clinical signs and radiographic features in dogs with congenital idiopathic megaoesophagus: a randomised controlled trial
Authors: Quintavalla F. , Menozzi A. , Pozzoli C. , Poli E. , Donati P. , Wyler D. K. , Serventi P. , Bertini S.
Published: February 2017

We evaluated the efficacy of oral sildenafil citrate in dogs with congenital idiopathic megaoesophagus (CIM). Twenty‐one puppies were randomly assigned to two groups (treatment and control). The dogs were given sildenafil oral suspension 1 mg/kg every 12 hours for 14 days or placebo in a masked fashion. Clinical signs (frequency of regurgitation and weight gain) and oesophagrams (relative oesophageal diameter, ROD) were evaluated in order to assess the efficacy of drug treatment, by examiners who were unaware of the study protocol. In addition, a set of in vitro experiments on isolated samples of canine lower oesophageal sphincter (LOS) was performed, and the effects of increasing concentrations of sildenafil on basal tone and electrically‐stimulated motility were assessed. Sildenafil administration significantly reduced the number of regurgitation episodes (0.88±1.40 v 2.65±1.56, P<0.0001) and significantly increased weight gain in the treated dogs compared to controls (79.76±28.30 per cent v 53.40±19.30 per cent, P=0.034). ROD values, at the end of the treatment period, were significantly decreased in the sildenafil group, compared to pre‐treatment values (0.97±0.19 v 0.24±0.14, P<0.0001), in contrast to control subjects (0.98±0.17 v 1.10±0.25, P=0.480). In accordance with the in vivo findings, sildenafil dose‐dependently reduced basal tone and increased electrically‐induced relaxation of dog LOS samples. These results suggest that sildenafil citrate helps ameliorate clinical and radiographic signs in dogs with CIM by reducing LOS tone, and could represent a novel therapeutic tool for the treatment of this disease.
Differences in nutrient content of eggs and larvae as indicators for improvement of broodstock nutrition in walleye (Sander vitreus) production
Authors: Mejri Sahar , Tremblay Réjean , Vandenberg Grant , Moren Mari , Khemis Ines Ben , Audet Céline
Published: February 2017

The aim of this study was to increase our knowledge about the nutritional needs of walleye (Sander vitreus (Mitchill, 1818)) broodstock. Two dietary treatments were tested: the first consisted of frozen Atlantic mackerel (Scomber scombrus L., 1758) pieces with a supplement of experimental dry pellets and the second consisted of frozen Atlantic mackerel pieces with a supplement of commercial trout pellets. Hatching success was highest in eggs from the wild broodstock. Eggs and larvae from wild fish were characterized by the highest levels of linoleic (LOA; 18:2 n–6) and linolenic (LNA; 18:3 n–3) fatty acids in the neutral lipids. They had the lowest level of docosahexaenoic acid (DHA) in both neutral and polar lipids. The results suggest the importance of the amino acids leucine, lysine, methionine, and serine for better egg survival. Vitamin A1content was similar in eggs from wild fish and the younger broodstock from both treatment groups, but was 10 times lower in eggs from older broodstock. Vitamin A2was highest in eggs from wild fish. Our results showed that neither of the two diets really resulted in egg or larval quality that were comparable with that of wild fish.
Stop Think: a simple approach to encourage the self-assessment of learning
Authors: Guy Richard , Byrne Bruce , Dobos Marian
Published: February 2017

A simple “stop think” approach was developed to encourage the self-assessment of learning. A key element was the requirement for students to rate their feeling of difficulty before [FOD(pre)] and after [FOD(post)] completing each of three authentic anatomy and physiology concept map exercises. The cohort was divided into low- (group L) and high-performing (group H) groups (based on final subject marks). Both FOD(pre)(group L) and FOD(post)(groups L and H) were significantly negatively correlated with score for some maps. A comparison of FOD(pre)and FOD(post)showed that students changed their mind about difficulty in 58–70% of the completed maps. Students who changed their estimation were asked to provide explanatory comments, and an increase in difficulty was related to problems with map link generation. For students who found the maps easier, 40% of comments indicated that map generation prompted recall of information from memory. Both difficulty estimations and comments supported the contention that students were self-assessing their interaction with the concept maps. Group H was significantly older than group L, had significantly higher levels of deep strategic and deep motivational learning, and had significantly higher marks in two of three concept map exercises. Notwithstanding these differences, the results from the “stop think” approach were similar between groups, indicating that it may be appropriate for students of varying academic ability. It is suggested that “stop think” may be a useful approach to encourage student self-assessment, an important step in assisting self-regulated learning development.
Transcranial Doppler-determined change in posterior cerebral artery blood flow velocity does not reflect vertebral artery blood flow during exercise
Authors: Washio Takuro , Sasaki Hiroyuki , Ogoh Shigehiko
Published: February 2017

We examined whether a change in posterior cerebral artery flow velocity (PCAv) reflected the posterior cerebral blood flow in healthy subjects during both static and dynamic exercise. PCAv and vertebral artery (VA) blood flow, as an index of posterior cerebral blood flow, were continuously measured during an exercise trial using transcranial Doppler (TCD) ultrasonography and Doppler ultrasound, respectively. Static handgrip exercise significantly increased both PCAv and VA blood flow. Increasing intensity of dynamic exercise further increased VA blood flow from moderate exercise, while PCAv decreased to almost resting level. During both static and dynamic exercise, the PCA cerebrovascular conductance (CVC) index significantly decreased from rest (static and high-intensity dynamic exercise, −11.5 ± 12.2% and −18.0 ± 16.8%, means ± SD, respectively) despite no change in the CVC of VA. These results indicate that vasoconstriction occurred at PCA but not VA during exercise-induced hypertension. This discrepancy in vascular response to exercise between PCA and VA may be due to different cerebral arterial characteristics. Therefore, to determine the effect of exercise on posterior cerebral circulation, at least, we need to carefully consider which cerebral artery to measure, regardless of exercise mode.

NEW & NOTEWORTHY We examined whether transcranial Doppler-determined flow velocity in the posterior cerebral artery can be used as an index of cerebral blood flow during exercise. However, the changes in posterior cerebral artery flow velocity during exercise do not reflect vertebral artery blood flow.