bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperoxia speeds pulmonary oxygen uptake kinetics and increases critical power during supine cycling
Authors: Goulding Richie P. , Roche Denise M. , Marwood Simon
Published: May 2019

New Findings

What is the central question of this study?

Critical power is a fundamental parameter defining high‐intensity exercise tolerance and is related to the phase II time constant of pulmonary oxygen uptake kinetics (). To test whether this relationship is causal, we assessed the impact of hyperoxia on and critical power during supine cycle exercise.

What is the main finding and its importance?

The results demonstrate that hyperoxia increased muscle oxygenation, reduced (i.e. sped up the oxygen uptake kinetics) and, subsequently, increased critical power when compared with normoxia. These results therefore suggest that is a determinant of the upper limit for steady‐state exercise, i.e. critical power.

The present study determined the impact of hyperoxia on the phase II time constant of pulmonary oxygen uptake kinetics () and critical power (CP) during supine cycle exercise. Eight healthy men completed an incremental test to determine maximal oxygen uptake and the gas exchange threshold. Eight separate visits followed, whereby CP, and absolute concentrations of oxyhaemoglobin ([HbO2]; via near‐infrared spectroscopy) were determined via four constant‐power tests to exhaustion, each repeated once in normoxia and once in hyperoxia (fraction of inspired O2 = 0.5). A 6 min bout of moderate‐intensity exercise (70% of gas exchange threshold) was also undertaken before each severe‐intensity bout, in both conditions. Critical power was greater (hyperoxia, 148 ± 29 W versus normoxia, 134 ± 27 W; P = 0.006) and the reduced (hyperoxia, 33 ± 12 s versus normoxia, 52 ± 22 s, P = 0.007) during severe exercise in hyperoxia when compared with normoxia. Furthermore, [HbO2] was enhanced in hyperoxia compared with normoxia (hyperoxia, 67 ± 10 μm versus normoxia, 63 ± 11 μm; P = 0.020). The was significantly related to CP in hyperoxia (R2 = 0.89, P < 0.001), but no relationship was observed in normoxia (r = 0.07, P = 0.68). Muscle oxygenation was increased, reduced and CP increased in hyperoxia compared with normoxia, suggesting that is an independent determinant of CP. The finding that was related to CP in hyperoxia but not normoxia also supports this notion.
Fishnet Statistical Size Effect on Strength of Materials With Nacreous Microstructure
Authors: Luo Wen , Bažant Zdeněk P.
Published: May 2019

The statistical size effect has generally been explained by the weakest-link model, which is valid if the failure of one representative volume element (RVE) of material, corresponding to one link, suffices to cause failure of the whole structure under the controlled load. As shown by the recent formulation of fishnet statistics, this is not the case for some architectured materials, such as nacre, for which one or several microstructural links must fail before reaching the maximum load or the structure strength limit. Such behavior was shown to bring about major safety advantages. Here, we show that it also alters the size effect on the median nominal strength of geometrically scaled rectangular specimens of a diagonally pulled fishnet. To derive the size effect relation, the geometric scaling of a rectangular fishnet is split into separate transverse and longitudinal scalings, for each of which a simple scaling rule for the median strength is established. Proportional combination of both then yields the two-dimensional geometric scaling and its size effect. Furthermore, a method to infer the material failure probability (or strength) distribution from the median size effect obtained from experiments or Monte Carlo simulations is formulated. Compared to the direct estimation of the histogram, which would require more than ten million test repetitions, the size effect method requires only a few (typically about six) tests for each of three or four structure sizes to obtain a tight upper bound on the failure probability distribution. Finally, comparisons of the model predictions and actual histograms are presented.
Soft Sensing for Gas-Condensate Field Production Using Parallel-Genetic-Algorithm-Based Data Reconciliation
Authors: Wang Dan , Gong Jing , Kang Qi , Fan Di , Yang Juheng
Published: May 2019

During present offshore gas-condensate production, multiphase flow-meters, due to its exceedingly high cost, are being substituted by a soft sensing (SS) technique for estimating total and single-well flowrates through sensor measurements and physical models. In this work, the inverse problem is solved by data reconciliation (DR), minimizing weighted sum of errors with constraints integrating multiple two-phase flow models. The DR problem is solved by parallel genetic algorithm (PGA) without complex calculations required by conventional optimization. The newly developed SS method is tested by data from a realistic gas-condensate production system. The method is proved of good accuracy and robustness with invalid individual pressure sensor or unavailable total flowrate measurements. Meanwhile, the proposed method shows good parallel performance and the time cost of each DR process can meet the demand of engineering application.
Effect of the Nozzle Radiation on the Fused Filament Fabrication Process: Three-Dimensional Numerical Simulations and Experimental Investigation
Authors: Cosson Benoît , Akué Asséko André Chateau
Published: May 2019

This paper addresses heat distribution issues in fused filament fabrication (FFF) process. Three-dimensional (3D) numerical simulations and experimental investigations are performed during additive manufacturing of parts by FFF process. The transient numerical simulations of the filament temperature field are based on the finite difference method. Experimental measurements of the temperature field are carried out using infrared thermography. The proposed model mainly highlights the contribution of heat exchange from the nozzle to the fabricated part and from filament to filament. Optimum adhesion of filaments deposited by FFF requires control of the thermal history. The nozzle radiation is taken into account as a source term in the heat balance equation. The temperature fields of the printed parts computed by numerical simulations are in very good agreement with the temperature fields measured by infrared thermograph. The 3D numerical model provides information on how the nozzle affects the temperature field of the printed part. This source term must be taken into account for the optimization of the FFF process.
Geometric Design With Multiple Realizable Motion Tasks in the Vicinity of a Planar Mechanism–Environment Contact
Authors: Robson Nina , Chen Binyun
Published: May 2019

This paper applies geometric design principles to planar mechanical systems, attempting to explain complex motion in mechanism–object/environment interaction for realizing multiple kinematic tasks in the vicinity of a contact location. The latter is a critical feature not fully captured in existing design methodologies. This is achieved through the development of a general planar geometric model that allows the derivation of multiple velocity and acceleration specifications compatible with mechanism–object curvature constraints in the vicinity of the contact. By incorporating these higher-order kinematic specifications into the design task formulation, contemporary planar kinematic synthesis is generalized allowing robust designs. The results are illustrated by the kinematic synthesis of two planar revolute–revolute (RR) linkages that are able to push and roll-slide along the object’s curvature in the vicinity of a contact location, a hybrid hand that incorporates a four-bar prosthetic finger that is able to grasp objects in two different modes, and a six-bar orthotic wheelchair for disabled canines that integrates body tilt and climbing motions.
Existence of tritonymphal stage of Stigmaeus elongatus Berlese (Acari: Stigmaeidae), with numerical variations in some body setae in its adult stage
Authors: Doğan Sibel , Doğan Salih , Zeytun Erhan
Published: May 2019

Tritonymphal stage of Stigmaeus elongatus Berlese (Stigmaeidae) has been described here. Distinguishing features among the adults and three nymphal stages of S. elongatus are presented. The presence of tritonymphal stage within the family is referred for the first time in this study. It is thought that this nymphal stage can occur optionally in response to certain circumstances. It is also given here information on intraspecific numerical variations in some body setae occurring in males and females of S. elongatus.
Comparative operando XPS studies of quasi-Fermi level splitting and open-circuit voltage in CZTSe/CdS and CIGS/CdS junctions and device structures
Authors: Teeter Glenn , Harvey Steven P. , Perkins Craig L. , Ramanathan Kannan , Repins Ingrid L.
Published: May 2019

This contribution describes operando x-ray photoelectron spectroscopy (opXPS) studies of Cu(In,Ga)Se2 (CIGS) and Cu2ZnSnSe4 (CZTSe) absorber layers and device structures. X-ray-excited valence-band and core-level spectra were acquired on bare absorber surfaces and after CdS and ZnO:Al depositions in standard absorber/CdS/ZnO/ZnO:Al device stacks. OpXPS data sets were acquired at various x-ray fluxes, with and without white-light illumination. From these measurements, quasi-Fermi level splitting (ΔEF) values in the absorber/CdS junctions were measured directly as a function of excitation conditions. For both CIGS and CZTSe, results show that ΔEF proportional to the full open-circuit voltage (VOC) of the completed devices is present after the deposition of the CdS layer—i.e., ΔEF = qVOC—demonstrating that the so-called VOC deficit in CZTSe solar cells is also present at this stage of processing. The authors find that photoexcitation due to x-rays or stray visible light during XPS or similar measurements can produce measurable photovoltages in materials, absorber/CdS junctions, and finished devices. In situ current density versus voltage measurements on a typical CIGS device reveal that x-ray-induced photoexcitation associated with typical XPS measurement conditions is equivalent to ∼3 × 10−3 suns, which in this study produced VOC = 440 mV. These findings demonstrate that accounting for photoexcitation conditions during XPS or similar measurements can improve band-offset determinations and produce more reliable values for the junction built-in voltage. The implications of the study findings on the CZTSe VOC deficit and device performance are discussed.
Efficacy assessments in ultrasonic spinning rheometry: Linear viscoelastic analysis on non-Newtonian fluids
Authors: Yoshida Taiki , Tasaka Yuji , Murai Yuichi
Published: May 2019

We have progressively developed an ultrasonic spinning rheometry (USR) that has the potential to visualize complex details of rheology, such as time-dependence, coexistence of gel and sol, effective viscosity of multiphase fluids, and other particulars. This rheometry makes it possible to overcome the main issues in conventional rheometry, originating from nonideal velocity profiles in the complex fluids. The most notable advantage of USR is the ability to perform “local” rheological evaluations from only the velocity information for a short-time period by solving the equation of motion. This benefit is provided while avoiding noise augmentations by introducing a linear viscoelastic analysis in the frequency domain. Solving the equation of motion with a rheological model equation in the frequency domain, multiple rheological parameters are quantified by minimizing the cost function. In this paper, the analysis presented by USR is verified by comparative experiments using a rheometer with the typical geometry of parallel disks. As a complementary technique for conventional rheometers, the USR efficacies are shown through rheological assessments for Newtonian, shear-thinning, and thixotropic fluids. Additionally, USR can provide instantaneous flow curves O(1 s) that lead to understanding the rheology in complex fluids with time-dependency.
Identifying Regimens Containing TBI-166, a New Drug Candidate against
Mycobacterium tuberculosis In Vitro
and
In Vivo
Authors: Zhang Ye , Zhu Hui , Fu Lei , Wang Bin , Guo Shaochen , Chen Xi , Liu Zhongquan , Huang Haihong , Yang Tianjian , Lu Yu
Published: May 2019

TBI-166, derived from riminophenazine analogues, is under development in a phase I clinical trial in China. TBI-166 showed more potent anti-tuberculosis (anti-TB) activity than did clofazimine in
in vitro
and animal experiments.
In Vitro
Activity of Fenticonazole against
Candida
and Bacterial Vaginitis Isolates Determined by Mono- or Dual-Species Testing Assays
Authors: Sanguinetti Maurizio , Cantón Emilia , Torelli Riccardo , Tumietto Fabio , Espinel-Ingroff Ana , Posteraro Brunella
Published: May 2019

We determined the
in vitro
activity of fenticonazole against 318 vaginitis isolates of
Candida
and bacterial species and selected 28 isolates for time-kill studies. At concentrations equal to 4× MIC, fenticonazole reached the 99.9% killing endpoint by ∼10 h for
Staphylococcus aureus
,
Streptococcus agalactiae
, and
Escherichia coli
and by ∼17 h for
Candida albicans
and
Candida parapsilosis
; and at concentrations equal to 8× MIC, by ∼19 and ∼20 h for
Candida glabrata
and
Candida tropicalis
, respectively.
Citrobacter rodentium Induces Tissue-Resident Memory CD4
+
T Cells
Authors: Bishu S. , Hou G. , El Zaatari M. , Bishu S. R. , Popke D. , Zhang M. , Grasberger H. , Zou W. , Stidham R. W. , Higgins P. D. R. , Spence J. R. , Kamada N. , Kao J. Y.
Published: May 2019

Tissue-resident memory T cells (T
RM
cells) are a novel population of tissue-restricted antigen-specific T cells. T
RM
cells are induced by pathogens and promote host defense against secondary infections. Although T
RM
cells cannot be detected in circulation, they are the major memory CD4
+
and CD8
+
T-cell population in tissues in mice and humans.
Positioning of the Motility Machinery in Halophilic Archaea
Authors: Li Zhengqun , Kinosita Yoshiaki , Rodriguez-Franco Marta , Nußbaum Phillip , Braun Frank , Delpech Floriane , Quax Tessa E. F. , Albers Sonja-Verena
Published: May 2019

Archaea are ubiquitous single cellular microorganisms that play important ecological roles in nature. The intracellular organization of archaeal cells is among the unresolved mysteries of archaeal biology. With this work, we show that cells of haloarchaea are polarized. The cellular positioning of proteins involved in chemotaxis and motility is spatially and temporally organized in these cells. This suggests the presence of a specific mechanism responsible for the positioning of macromolecular protein complexes in archaea.
Massively Parallel Fitness Profiling Reveals Multiple Novel Enzymes in
Pseudomonas putida
Lysine Metabolism
Authors: Thompson Mitchell G. , Blake-Hedges Jacquelyn M. , Cruz-Morales Pablo , Barajas Jesus F. , Curran Samuel C. , Eiben Christopher B. , Harris Nicholas C. , Benites Veronica T. , Gin Jennifer W. , Sharpless William A. , Twigg Frederick F. , Skyrud Will , Krishna Rohith N. , Pereira Jose Henrique , Baidoo Edward E. K. , Petzold Christopher J. , Adams Paul D. , Arkin Adam P. , Deutschbauer Adam M. , Keasling Jay D.
Published: May 2019

P. putida
lysine metabolism can produce multiple commodity chemicals, conferring great biotechnological value. Despite much research, the connection of lysine catabolism to central metabolism in
P. putida
remained undefined. Here, we used random barcode transposon sequencing to fill the gaps of lysine metabolism in
P. putida
. We describe a route of 2-oxoadipate (2OA) catabolism, which utilizes DUF1338-containing protein
P. putida
5260 (PP_5260) in bacteria. Despite its prevalence in many domains of life, DUF1338-containing proteins have had no known biochemical function. We demonstrate that PP_5260 is a metalloenzyme which catalyzes an unusual route of decarboxylation of 2OA to
d
-2-hydroxyglutarate (
d
-2HG). Our screen also identified a recently described novel glutarate metabolic pathway. We validate previous results and expand the understanding of glutarate hydroxylase CsiD by showing that can it use either 2OA or 2KG as a cosubstrate. Our work demonstrated that biological novelty can be rapidly identified using unbiased experimental genetics and that RB-TnSeq can be used to rapidly validate previous results.
Clonal yet Different: Understanding the Causes of Genomic Heterogeneity in Microbial Species and Impacts on Public Health
Authors: Andam Cheryl P.
Published: May 2019

Why are members of a microbial species not the same? They may be clonal, but microbial populations are often composed of multiple cocirculating lineages distinguished by large phenotypic and genetic differences. Species and the mechanisms of speciation have been notoriously challenging to study in microbes owing to pervasive horizontal gene flow, widespread geographical distribution, and cryptic ecological niches that structure microbial populations.
Role of Multiple Infections on Immunological Variation in Wild Populations
Authors: Tate Ann T.
Published: May 2019

A central challenge in the fields of evolutionary immunology and disease ecology is to understand the causes and consequences of natural variation in host susceptibility to infectious diseases. As hosts progress from birth to death in the wild, they are exposed to a wide variety of microorganisms that influence their physical condition, immune system maturation, and susceptibility to concurrent and future infection.
Diplopia: a unique presentation of recurrence of a salivary gland carcinoma
Authors: Mackinlay David , Ferguson Aaron Stephen James , White Sharon , Manickavasagam Jaiganesh
Published: May 2019

A 79-year-old man with a history of radical excision of a left submandibular gland carcinoma ex-pleomorphic adenoma presented with a new 2 cm lump in his left submandibular region which proved to be recurrence on surgical excision. During work up for revision surgery he developed a right VI cranial nerve palsy, which was attributed to his microvascular status having had a history of three previous transient ischemic attacks (TIAs). 6 months later, his palsy had not resolved. MRI revealed new soft tissue by the cavernous segment of the internal carotid artery. The exact source of this was unclear as there was no evidence of local recurrence or nodal disease. A repeat MRI scan 16 months later revealed further growth of abnormal tissue in the cavernous sinus and the primary submandibular location, now involving multiple nerves including branches of cranial nerves IV, V, VI, VII and XII making surgical excision impossible.
Retinal haemorrhage in a child with optic neuritis and acute disseminated encephalomyelitis
Authors: Kelly Patrick , Vincent Andrea , Nolan Melinda , Bastin Sonja
Published: May 2019

A 2-year-old presented with lethargy, acute visual loss, fixed dilated pupils and severe bilateral retinal haemorrhages. The retinal findings raised concerns about abusive head trauma, but subsequent investigations confirmed the diagnosis of bilateral optic neuritis associated with acute disseminated encephalomyelitis.
Spatial reorganisation of the somatosensory cortex in a patient with a low-grade glioma
Authors: Das Sunit , Morrison Melanie , Tam Fred , Graham Simon
Published: May 2019

Multiple authors have speculated that functional plasticity of the neural networks required for speech and motor function may occur in the setting of low-grade brain tumours. Here, we present the case of a 39-year-old right-handed woman found on presentation for intermittent right-hand tingling and twitching to have a low-grade glioma involving the somatosensory cortex on both structural and functional MRI. Intraoperative awake mapping identified gyral dissociation of the somateosensory areas for right arm and leg sensation. These findings demonstrate that brain plasticity may be dramatic in the setting of a low-grade glioma, and emphasise the critical need for careful brain mapping when considering tumour resection in these patients.
Successful thrombolysis for acute ischaemic stroke after reversal of dabigatran etexilate with idarucizumab
Authors: Loh Chee Hoou , Herkes Geoffrey
Published: May 2019

We report the experience of reversing dabigatran prior to administering systemic thrombolysis for acute ischaemic cerebellar stroke, which was well tolerated with no haemorrhagic complications after thrombolysis. Given the increasingly common use of dabigatran for atrial fibrillation, the use of idarucizumab to reverse of dabigatran is a novel treatment that should be considered as an important adjunct to facilitate thrombolysis for ischaemic strokes and minimise haemorrhagic complications.
Risk factors for disease progression in low-teens normal-tension glaucoma
Authors: Baek Sung Uk , Ha Ahnul , Kim Dai Woo , Jeoung Jin Wook , Park Ki Ho , Kim Young Kook
Published: May 2019

Background/Aims

To investigate the risk factors for disease progression of normal-tension glaucoma (NTG) with pretreatment intraocular pressure (IOP) in the low-teens.

Methods

One-hundred and two (102) eyes of 102 patients with NTG with pretreatment IOP≤12 mm Hg who had been followed up for more than 60 months were retrospectively enrolled. Patients were divided into progressor and non-progressor groups according to visual field (VF) progression as correlated with change of optic disc or retinal nerve fibre layer defect. Baseline demographic and clinical characteristics including diurnal IOP and 24 hours blood pressure (BP) were compared between the two groups. The Cox proportional hazards model was used to identify the risk factors for disease progression.

Results

Thirty-six patients (35.3%) were classified as progressors and 66 (64.7%) as non-progressors. Between the two groups, no significant differences were found in the follow-up periods (8.7±3.4 vs 7.7±3.2 years; p=0.138), baseline VF mean deviation (−4.50±5.65 vs −3.56±4.30 dB; p=0.348) or pretreatment IOP (11.34±1.21 vs 11.17±1.06 mm Hg; p=0.121). The multivariate Cox proportional hazards model indicated that greater diurnal IOP at baseline (HR=1.609; p=0.004), greater fluctuation of diastolic BP (DBP; HR=1.058; p=0.002) and presence of optic disc haemorrhage during follow-up (DH; HR=3.664; p=0.001) were risk factors for glaucoma progression.

Conclusion

In the low-teens NTG eyes, 35.3% showed glaucoma progression during the average 8.7 years of follow-up. Fluctuation of DBP and diurnal IOP as well as DH were significantly associated with greater probability of disease progression.
Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): study protocol for a randomised controlled trial
Authors: Stevenson Jessica , Campbell Katrina L , Brown Mark , Craig Jonathan , Howard Kirsten , Howell Martin , Khalid Rabia , Sud Kamal , Teixeira-Pinto Armando , Thiagalingam Aravinda , Tong Allison , Chow Clara , Lee Vincent W
Published: May 2019

Introduction

Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis.

Methods and analysis

Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken.

Ethics and dissemination

The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee—Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications.

Trial registration number

ACTRN12617001084370; Pre-results.
Public health impact model estimating the impact of introducing an adjuvanted recombinant zoster vaccine into the UK universal mass vaccination programme
Authors: van Oorschot Desirée A M , Hunjan Manjit , Bracke Benjamin , Lorenc Stéphane , Curran Desmond , Starkie-Camejo Helen
Published: May 2019

Objectives

In 2013, the herpes zoster (HZ) immunisation programme was introduced in the UK, recommending vaccination of adults 70 years of age (YOA) with the zoster vaccine live (ZVL), the only vaccine available at the time. The recently approved adjuvanted recombinant zoster vaccine (RZV) has a substantially different clinical profile that may offer additional benefits.

This study aimed to 1) assess the public health impact (PHI) of introducing RZV in the UK compared with the current vaccination strategy and 2) explore via scenario analyses the optimal age group of vaccination in terms of PHI.

Design

A previously developed health economic model was adapted to the UK setting.

Setting

Calculations were based on efficacy data from pivotal clinical trials, HZ incidence and postherpetic neuralgia (PHN) probability from a UK study and HZ-associated complication rates from published literature.

Population

The base-case population considered a 2018-projected UK vaccination cohort of individuals 70 YOA.

Interventions

Vaccination with ZVL or RZV, assuming a first-dose coverage of 48.3% for both vaccines and 70% compliance for the second dose of RZV.

Outcome measures

Outcomes included reduction of HZ and PHN cases, complications and the use of healthcare resources over a life-time horizon. The impact of coverage and second-dose compliance was also explored.

Results

Compared with no vaccination, RZV would lead to a reduction of 30 262 HZ and 5409 PHN cases while ZVL would lead to a reduction of 7909 HZ and 3567 PHN cases. The number needed to vaccinate to prevent 1 HZ case is 12 with RZV and 45 with ZVL. The highest PHI with RZV could be achieved in individuals 60 or 65 YOA.

Conclusion

Under the model assumptions, RZV is predicted to avert more HZ and PHN cases compared with ZVL. Results were robust under different scenario and sensitivity analyses.
Online health information in a rural residential population in Zhejiang Province, China: a cross-sectional study
Authors: Qiu Yan , Ren Wen , Liu Ying , Yin Pei , Ren Jingjing
Published: May 2019

Objective

To determine the prevalence, degree of trust and usefulness of the online health information seeking source and identify associated factors in the adult population from the rural region of China.

Design

A cross-sectional population-based study.

Setting

A self-designed questionnaire study was conducted between May and June 2015 in four districts of Zhejiang Province.

Participants

652 adults aged ≥18 years (response rate: 82.8%).

Primary outcome measures

The prevalence, degree of trust and usefulness of online health information was the primary outcome. The associated factors were investigated by χ2test.

Results

Only 34.8% of participants had faith in online health information; they still tended to select and trust a doctor which is the first choice for sources of health information. 36.7% of participants, being called ‘Internet users’, indicated that they had ever used the internet during the last 1 year. Among 239 internet users, 40.6% of them reported having sought health information via the internet. And 103 internet users responded that online health information was useful. Inferential analysis demonstrated that younger adults, individuals with higher education, people with a service-based tertiary industry career and excellent health status used online health information more often and had more faith in it (p<0.001).

Conclusions

Using the internet to access health information is uncommon in the rural residential adult population in Zhejiang, China. They still tend to seek and trust health information from a doctor. Internet as a source of health information should be encouraged.
Does binge drinking between the age of 18 and 25 years predict alcohol dependence in adulthood? A retrospective case–control study in France
Authors: Tavolacci Marie-Pierre , Berthon Quentin , Cerasuolo Damiano , Dechelotte Pierre , Ladner Joel , Baguet Alexandre
Published: May 2019

Objective

A retrospective case–control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood.

Setting

The Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France.

Participants

Cases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking.

Results

166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25.

Conclusions

Frequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence.

Trial registration number

NCT03204214; Results.
Counterintuitive results from observational data: a case study and discussion
Authors: Doty Erik , Stone David J , McCague Ned , Celi Leo Anthony
Published: May 2019

Objective

To explore the issue of counterintuitive data via analysis of a representative case in which the data obtained was unexpected and inconsistent with current knowledge. We then discuss the issue of counterintuitive data while developing a framework for approaching such findings.

Design

The case study is a retrospective analysis of a cohort of coronary artery bypass graft (CABG) patients. Regression was used to examine the association between perceived pain in the intensive care unit (ICU) and selected outcomes.

Setting

Medical Information Mart for Intensive Care-III, a publicly available, de-identified critical care patient database.

Participants

844 adult patients from the database who underwent CABG surgery and were extubated within 24 hours after ICU admission.

Outcomes

30 day mortality, 1 year mortality and hospital length of stay (LOS).

Results

Increased pain levels were found to be significantly associated with reduced mortality at 30 days and 1 year, and shorter hospital LOS. A one-point increase in mean pain level was found to be associated with a reduction in the odds of 30 day and 1 year mortality by a factor of 0.457 (95% CI 0.304 to 0.687, p<0.01) and 0.710 (95% CI 0.571 to 0.881, p<0.01) respectively, and a 0.916 (95% CI −1.159 to –0.673, p<0.01) day decrease in hospital LOS.

Conclusion

The finding of an association between increased pain and improved outcomes was unexpected and clinically counterintuitive. In an increasingly digitised age of medical big data, such results are likely to become more common. The reliability of such counterintuitive results must be carefully examined. We suggest several issues to consider in this analytic process. If the data is determined to be valid, consideration must then be made towards alternative explanations for the counterintuitive results observed. Such results may in fact indicate that current clinical knowledge is incomplete or not have been firmly based on empirical evidence and function to inspire further research into the factors involved.
Comparative effectiveness and safety of low-strength and high-strength direct oral anticoagulants compared with warfarin: a sequential cohort study
Authors: Pratt Nicole L , Ramsay Emmae , Kalisch Ellett Lisa M , Duszynski Katherine , Shakib Sepehr , Kerr Mhairi , Caughey Gillian , Roughead Elizabeth Ellen
Published: May 2019

Objectives

The aim of this study was to compare effectiveness and safety of low-strength and high-strength direct oral anticoagulants (DOACs) with warfarin in the Australian Veteran population.

Design

Sequential cohort study using inverse probability of treatment weighting (IPTW) and propensity score matching. Initiators of high-strength (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) and low-strength DOACS (apixaban 2.5 mg, dabigatran 110 mg, rivaroxaban 15 mg) were compared with warfarin initiators.

Setting

Australian Government Department of Veterans’ Affairs claims database.

Participants

4836 patients who initiated oral anticoagulants (45.8%, 26.0% and 28.2% on low-strength, high-strength DOACs and warfarin, respectively) between August 2013 and March 2015. Mean age was 85, 75 and 83 years for low-strength, high-strength DOACs and warfarin initiators, respectively.

Main outcome measures

One-year risk of hospitalisation for ischaemic stroke, any bleeding event or haemorrhagic stroke. Secondary outcomes were 1-year risk of hospitalisation for myocardial infarction and death.

Results

Using the IPTW method, no difference in risk of ischaemic stroke or bleeding was found with low-strength DOACs compared with warfarin. As a class, no increased risk of myocardial infarction was found for low-strength DOACs, however, risk was elevated for apixaban (HR 2.25, 95% CI 1.23 to 4.13). For high-strength DOACs, no difference was found for ischaemic stroke compared with warfarin, however, there was a significant reduction in risk of bleeding events (HR 0.63, 95% CI 0.44 to 0.89) and death (HR 0.40, 95% CI 0.28 to 0.58). Propensity score matching showed no difference in risk of ischaemic stroke or bleeding.

Conclusion

We found that in the practice setting both DOAC formulations were similar to warfarin with regard to effectiveness and had no increased risk of bleeding.
Identifying a retrospective cohort of adolescents with chronic health conditions from a paediatric hospital prior to transfer to adult care: the Calgary Transition Cohort
Authors: Schraeder Kyleigh , Nettel-Aguirre Alberto , Mackie Andrew , Barrett Olesya , Johnson David W , Ryan Allan Ronald , Dimitropoulos Gina , Samuel Susan
Published: May 2019

Purpose

The Calgary Transition Cohort was created to examine health service utilisation by adolescents affected by chronic health conditions seen in a tertiary paediatric hospital in the province of Alberta, Canada. The cohort includes adolescents who received care before the implementation of a hospital-wide intervention to improve transitions to adult care.

Participants

Using hospital records, a stepwise methodology involving a series of algorithms based on adolescents’ visit frequency to a hospital ambulatory chronic care clinic (CCC) was used to identify the cohort. A visit frequency of ≥4 visits in any 24-month window, during the ages of 12–17 years old, was used to identify eligible adolescents, as agreed on by key stakeholders and chronic disease clinical providers, and reflects the usual practice at the hospital for routine care of children with chronic disease.

Findings to date

Adolescents with ≥4 visits to the same CCC in any 2-year period (n=1344) with a median of 8.7 years of follow-up data collected (range 1.4–9.1). The median age at study entry was 14 years (range 12–17) and 22 years (range 14–24) at study exit. The cohort was linked (97% successful match proportion) to their population-level health records that allowed for examination of occurrence of chronic disease codes in health utilisation encounters (ie, physician claims, hospital admissions and emergency room visits). At least one encounter with a chronic disease code (International Classification of Diseases, 9th/10th Revisions) was observed during the entire study window in 87.9% of the cohort.

Future plans

The Calgary Transition Cohort will be used to address existing knowledge gaps about health service utilisation by adolescents, seen at a tertiary care hospital, affected by a broad group of chronic health conditions. These adolescents will require transition to adult-oriented care. Longitudinal analysis of health service use patterns over a 9-year window (2008–2016) will be conducted.
International multiphase mixed methods study protocol to develop a patient-reported outcome instrument for children and adolescents with lower limb deformities
Authors: Chhina Harpreet , Klassen Anne , Kopec Jacek A , Oliffe John , Cooper Anthony
Published: May 2019

Introduction

Our recent systematic review has indicated the lack of a patient-reported outcome (PRO) instrument to measure health-related quality of life (HRQOL) of children and adolescents with lower limb deformities. We are developing a PRO instrument which will be applicable internationally across various countries. This manuscript describes our approach to the development of a new PRO instrument for measuring HRQOL for children and adolescents with lower limb deformities.

Methods and analysis

Three phases in the development of this PRO instrument are as described: (1) This phase involves the development of a conceptual framework of HRQOL and item pool that is used to inform a set of preliminary scales. We have developed a preliminary conceptual framework of HRQOL based on our systematic review. Qualitative interviews are being conducted at five sites in Canada, Ethiopia, India and the USA. An item pool will be generated from this qualitative phase. The preliminary items and scales will be sent out to children at the five participating centres. Cognitive debriefing interviews will gather detailed feedback on the items from the children. Expert opinion will be sought from clinicians from the participating centres. (2) During this phase, an international field-test study will be conducted to refine the scales and examine their psychometric properties. (3) During this phase, tests of reliability, validity and responsiveness will be conducted. Phase 1 will also involve translations and cultural adaptations. At the end of this study, we expect to produce an internationally applicable PRO instrument which is scientifically sound and clinically relevant to the lower limb deformity population.

Ethics and dissemination

This study is approved by Research Ethics Boards for each of the participating sites.

Results of this study will be published in peer-reviewed journals and presented at national and international conferences. An integrated knowledge translation approach is applied to engage patients, families and clinicians from the start of the study.
Investigating the feasibility of a patient feedback tool to improve safety in Australian primary care: a study protocol
Authors: Hernan Andrea L , Kloot Kate , Giles Sally J , Beks Hannah , McNamara Kevin , Binder Marley J , Versace Vincent
Published: May 2019

Introduction

Patients are a valuable source of information about ways to prevent harm in healthcare, and can provide feedback about the factors that contribute to safety incidents. The Primary Care Patient Measure of Safety (PC PMOS) is a novel and validated tool that captures patient feedback on safety and can be used by primary care practice teams to identify and prevent safety incidents. The aim of this study is to assess the feasibility of PC PMOS as a tool for data-driven safety improvement and monitoring in Australian primary care.

Methods and analysis

Feasibility will be assessed using a mixed-methods approach to understand the enablers, barriers, acceptability, practicability, intervention fidelity and scalability of C PMOS as a tool for safety improvement across six primary care practices in the south-west region of Victoria. Patients over the age of 18 years attending their primary care practice will be invited to complete the PC PMOS when presenting for an appointment. Staff members at each practice will form a safety improvement team. Staff will then use the patient feedback to develop and implement specific safety interventions over a 6-month period. Data collection methods during the intervention period includes audio recordings of staff meetings, overt observations at training and education workshops, reflexive researcher insights, document collection and review. Data collection postintervention includes patient completion of the PC PMOS and semistructured interviews with staff. Triangulation and thematic analysis techniques will be employed to analyse the qualitative and content data. Analysis methods will use current evidence and models of healthcare culture, safety improvement and patient involvement in safety to inform the findings.

Ethics and dissemination

Ethics approval was granted by Deakin University Human Ethics Advisory Group, Faculty of Health (HEAG-H 175_2017). Study results will be disseminated through local and international conferences and peer-reviewed publications.
Treatment of stable chronic obstructive pulmonary disease: protocol for a systematic review and evidence map
Authors: Dobler Claudia C , Farah Magdoleen H , Morrow Allison S , Alsawas Mouaz , Benkhadra Raed , Hasan Bashar , Prokop Larry J , Wang Zhen , Murad M Hassan
Published: May 2019

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease, usually caused by tobacco smoking, but other important risk factors include exposures to combustion products of biomass fuels and environmental pollution. The introduction of several new (combination) inhaler therapies, increasing uncertainty about the role of inhaled corticosteroids and a rapid proliferation of the literature on management of stable COPD in general, call for novel ways of evidence synthesis in this area. A systematic review and evidence map can provide the basis for shared decision-making tools and help to establish a future research agenda.

Methods and analysis

This systematic review will follow an umbrella systematic review design (also called overview of reviews). We plan to conduct a comprehensive literature search of Ovid MEDLINE (including epub ahead of print, in process and other non-indexed citations), Ovid Embase, Ovid Cochrane Database of Systematic Reviews and Scopus from database inception to the present. We will include systematic reviews that assessed the effectiveness of any pharmacological or non-pharmacological intervention on one or more patient-important outcomes and/or lung function in patients with stable COPD. For every intervention/outcome pair, one systematic review will be included. An a priori protocol will guide, which systematic reviews will be chosen, how their credibility will be evaluated, and how the quality of the body of evidence will be rated. Data will be synthesised into an evidence map that will present a matrix that depicts each available treatment for stable COPD with a quantitative estimate on symptoms/outcomes from the patient perspective, along with an indication of the size and certainty in the evidence.

Ethics and dissemination

Approval by a research ethics committee is not required since the review will only include published data. The systematic review will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42018095079
ABO blood type and risk of porcine bioprosthetic aortic valve degeneration: SWEDEHEART observational cohort study
Authors: Persson Michael , Edgren Gustaf , Dalén Magnus , Glaser Natalie , Olsson Martin L , Franco-Cereceda Anders , Holzmann Martin J , Sartipy Ulrik
Published: May 2019

Objective

Blood type A antigen on porcine aortic bioprostheses might initiate an immune reaction leading to an increased frequency of structural valve deterioration in patients with blood type B or O. The aim was to analyse the association between ABO blood type and porcine bioprosthetic aortic valve degeneration.

Design

Observational nationwide cohort study.

Setting

Swedish population-based study.

Participants

Adult patients (n=3417) who underwent surgical aortic valve replacement and received porcine bioprosthetic aortic valves between 1995 and 2012 from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. The study database was enriched with information from other national registers.

Exposure

The patients were categorised into type A/AB and type B/O blood groups.

Primary and secondary outcome measures

Primary outcome measure was aortic valve reoperation, and secondary outcomes were heart failure and all-cause mortality. We report risk estimates that account for the competing risk of death.

Results

In total, 3417 patients were identified: 1724 (50.5%) with blood type A/AB and 1693 (49.5%) with blood type B/O. Both groups had similar baseline characteristics. The cumulative incidence of aortic valve reoperation was 3.4% (95% CI 2.5% to 4.4%) and 3.6% (95% CI 2.6% to 4.6%) in the type B/O and the A/AB group, respectively, at 15 years of follow-up (absolute risk difference: −0.2% (95% CI −1.5% to 1.2%)). There was no significantly increased risk for aortic valve reoperation in patients with blood type B/O compared with type A/AB (HR 0.95, 95% CI 0.62 to 1.45). There was no significant difference in absolute or relative risk of heart failure or death between the groups.

Conclusions

We found no significant association between patient blood type and clinical manifestations of structural valve deterioration following porcine aortic valve replacement. Our findings suggest that it is safe to use porcine bioprosthetic valves without consideration of ABO blood type in the recipient.

Trial registration number

NCT02276950