bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance Enhancement and Emission Control of a Direct Injection-Diesel Engine Using a Self-Rotating Injection Strategy—A Numerical and Experimental Study
Authors: Pichandi Chandrasekar , Sudharsan Natteri M.
Published: January 2022

Fuel injection system influences the spray characteristics to achieve faster combustion and better control over emissions. The combination of orifice number, diameter, injection duration, and rotation is suggested for better emission control and efficiency. In the present work, a novel self-rotating injector is designed and fabricated. Simulation is performed in three-dimensional closed-cycle geometry of a 661 cc diesel engine for static as well as rotating fuel injection having three, five, and nine holes by varying the rotational speed of 1500 and 2500 rpm, orifice diameter, and injection duration to ensure the same injection velocity. The three-hole rotating cases were studied and compared with static numerical simulation. The results found that due to the rotational effect, the engine’s thermal efficiency improved by 3.82% and 5.11% while the NOx emissions decreased by 2.34% and 5.57% for 1500 and 2500 rpm, respectively, at the cost of carbon monoxide and soot emissions. Increasing the rotational speed was found to improve temperature uniformity at higher speeds, thus increases the efficiency and lower NOx. By increasing the number of orifice holes, it was observed that both thermal efficiency and NOx increased. Controlling the primary and diffusion combustion, it is possible to improve the efficiency without increasing NOx emissions. This was possible with a combination of rotating injectors and varying the start of injection. The fabricated self-rotating nozzle based on the above simulations was found to perform better than the static injector under no-load conditions.
Investigation on a Solar Thermal Power Plant With a Packed Bed Heat Storage Unit
Authors: Yue Chen , Gao Pengju , Xu Yang , Schaefer Laura A.
Published: January 2022

The objective of the present work is to research the dynamic thermal performance of the solar power plant during the phase change material (PCM) capsule heat storage tank discharging process. Therefore, a transient, one-dimensional two-phase model for a packed bed latent heat storage unit and a comprehensive concentrating solar power generation system that combines a CO2 Brayton cycle and organic Rankine cycle were integrated. The influences of the key parameters of the packed bed PCM capsule heat storage tank on the overall power output and thermal efficiency of the system during discharge have been investigated, including the heat transfer fluid (HTF) velocity, the diameter of the PCM capsule, and the height of heat storage tank. The orthogonal analysis method is selected in this article, and the results showed that the maximal transient power output and overall power output of the actual combined cycle mode are decreased about 22% and 25%, respectively, in this research, compared with the idea Carnot cycle mode. That the HTF velocity in the thermal energy storage tank can be used to control the transient power output of the solar thermal power system. Using the small-sized filler capsule is an effective method to increase the thermal performance of the concentrated solar power (CSP) combined cycle system. Moreover, the corresponding discharging time is increased obviously, and the CSP with a high packed bed height can generate a more stable power output value during thermal energy discharging.
Low-Frequency Multimode Vibration Suppression of an Acoustic Black Hole Beam by Shunt Damping
Authors: Wan Zhiwei , Zhu Xiang , Li Tianyun , Nie Rui
Published: January 2022

The ideal acoustic black hole (ABH) can achieve wave gathering and zero reflection of elastic waves. In practice, ABHs have to be truncated, limiting their application in lower frequency range. Aiming at improving the ABH beam's vibration suppression ability at low frequencies, this study proposes a shunt damping-ABH composite beam by pasting shunt damping instead of ordinary damping on the ABH tip. The energy method is employed to solve the vibration equation of the ABH beam. The admissible function is the Mexican hat wavelet. The proposed method is verified by the finite element method. Compared with the uniform beam, the numerical results show the ABH beam has a noticeable attenuating effect in high-frequency range due to the ABH effect, but almost has no attenuating effect in the low-frequency range. Therefore, we introduce shunt damping to enhance the low-frequency vibration control. The shunt damping is composed of circuits connected to a piezoelectric patch. The effects of different circuits connected to the piezoelectric patch are discussed. The R–L shunt circuit and L–C parallel blocking circuit can simultaneously suppress the multimode vibration peak of the ABH beam at the low frequency successfully. Finally, a vibration experiment of ABH beam combined with shunt damping is implemented to verify the present method's feasibility and the shunt damping effect. The proposed shunt damping-ABH composite beam could improve the suppressing ability in both the low and high-frequency ranges.
An examination of the resonances in modern flutes with ergonomically angled headjoints
Authors: Saenger Katherine L.
Published: January 2022

This paper investigates the passive resonance spectra of a modern Boehm flute body outfitted with a variety of transverse and end-blown ergonomic headjoints in an attempt to determine if there is anything intrinsic to the acoustics of these instruments that keeps them from being as good as the same flute with a standard headjoint. With the exception of a commercial U-shaped, recurved headjoint, the ergonomic headjoints examined were all home-built from plastic pipe Tees connected to the flute body by means of a modular jointed neck. Spectra were collected with a pressure-based method that uses a localized sound source placed just outside the flute's embouchure hole to generate forward-going and backward-going pressure waves (with amplitudes P+ and P−) inside the flute. Power spectra (P++P−2 vs frequency) are obtained by Fourier analysis of the acoustic pressure recorded by a microphone positioned inside the headjoint. The spectra are modeled with a transfer matrix method that extracts the input impedance from the computed values of P+ and P− at the measurement position. Detailed results on tuning and harmonicity provide clues to the differences between these instruments but suggest no fundamental deficiencies in the flutes designed to be ergonomic.
Acute Ingestion of Ketone Monoesters and Precursors Do Not Enhance Endurance Exercise Performance: A Systematic Review and Meta-Analysis
Authors: Brooks Emma , Lamothe Gilles , Nagpal Taniya S. , Imbeault Pascal , Adamo Kristi , Kara Jameel , Doucet Éric
Published: January 2022

There has been much consideration over whether exogenous ketone bodies have the capacity to enhance exercise performance through mechanisms such as altered substrate metabolism, accelerated recovery, or neurocognitive improvements. This systematic review aimed to determine the effects of both ketone precursors and monoesters on endurance exercise performance. A systematic search was conducted in PubMed, SPORTDiscus, and CINAHL for randomized controlled trials investigating endurance performance outcomes in response to ingestion of a ketone supplement compared to a nutritive or nonnutritive control in humans. A meta-analysis was performed to determine the standardized mean difference between interventions using a random-effects model. Hedge’s g and 95% confidence intervals (CI) were reported. The search yielded 569 articles, of which eight were included in this review (80 participants; 77 men and three women). When comparing endurance performance among all studies, no significant differences were found between ketone and control trials (Hedges g = 0.136; 95% CI [−0.195, 0.467]; p = .419). Subanalyses based on type of endurance tests showed no significant differences in time to exhaustion (Hedge’s g = −0.002; 95% CI [−0.312, 0.308]; p = .989) or time trial (Hedge’s g = 0.057; 95% CI [−0.282, 0.395]; p = .744) values. Based on these findings, exogenous ketone precursors and monoesters do not exert significant improvements on endurance exercise performance. While all studies reported an increase in blood ketone concentrations after ingestion, ketone monoesters appear to be more effective at raising concentrations than precursors.
Comparison of 5 Normalization Methods for Knee Joint Moments in the Single-Leg Squat
Authors: Hirsch Steven M. , Chapman Christopher J. , Frost David M. , Beach Tyson A.C.
Published: January 2022

Ratio scaling is the most common magnitude normalization approach for net joint moment (NJM) data. Generally, researchers compute a ratio between NJM and (some combination of) physical body characteristics (eg, mass, height, limb length, etc). However, 3 assumptions must be verified when normalizing NJM data this way. First, the regression line between NJM and the characteristic(s) used passes through the origin. Second, normalizing NJM eliminates its correlation with the characteristic(s). Third, the statistical interpretations following normalization are consistent with adjusted linear models. The study purpose was to assess these assumptions using data collected from 16 males and 16 females who performed a single-leg squat. Standard inverse dynamics analyses were conducted, and ratios were computed between the mediolateral and anteroposterior components of the knee NJM and participant mass, height, leg length, mass × height, and mass × leg length. Normalizing NJM-mediolateral by mass × height and mass × leg length satisfied all 3 assumptions. Normalizing NJM-anteroposterior by height and leg length satisfied all 3 assumptions. Therefore, if normalization of the knee NJM is deemed necessary to address a given research question, it can neither be assumed that using (any combination of) participant mass, height, or leg length as the denominator is appropriate nor consistent across joint axes.
Effects of 7 Consecutive Systematic Applications of Cryotherapy With Compression
Authors: Jutte Lisa S. , Paracka Dylan J.
Published: January 2022

Context: Postsurgical and acute orthopedic patients are frequently treated with consecutive systematic cryotherapy despite the void of data to support treatment safety or effectiveness. The purpose of this study was to examine the occurrence of frostbite and measure skin temperatures during the systematic application of 2 cryocompression protocols. Design: A repeated-measures design guided this study. Methods: Nine healthy, college-aged participants (4 men and 5 women; age = 20.7 [1.2] y; height = 174 [11.01] cm; mass = 74 [14] kg) received both cryocompression protocols separated by ≥ 1 week. The static cryocompression protocol consisted of seven 40-minute “on” cycles of cryotherapy (4.4°C) with 45 mm Hg of compression, each followed by a 30-minute “off” cycle (no cryotherapy, compression set at 5 mm Hg). The intermittent cryocompression protocol consisted of seven 40-minute “on” cycles of cryotherapy (4.4°C) with compression alternating between 5 and 45 mm Hg, each followed by a 30-minute “off” cycle (no cryotherapy, compression set at 5 mmHg). At the end of each “on” and “off” cycle, we used a checklist to assess for frostbite, a PT-6 thermocouple to measure skin temperature (in degrees Celsius), and a 10-cm Likert scale to assess comfort. Results: None of the participants experienced any signs or symptoms of frostbite. There were no differences in skin temperature between the compression conditions over time (F14,112 = 1.43; P = .149) nor were there any differences between the 2 compression conditions (F1,8 = 3.75; P = .087; 1−β = 0.40). The skin temperatures were statistically different over the course of all 7 “on” and “off” cycles (F14,112 = 95.12; P < .001). There was no difference between the skin temperatures produced at the end of each “on” cycle. Conclusions: The application of 7 consecutive cryotherapy treatments with compression did not result in any signs or symptoms of frostbite and produced similar skin temperatures with each “on” cycle.
Shifting acetylation during starvation
Authors: Wong Wei
Published: January 2022

Glucose deprivation in yeast redirects histone acetylation to promote the production of acetyl-CoA.
Development of an Anti-Acinetobacter baumannii Biofilm Phage Cocktail: Genomic Adaptation to the Host
Authors: Blasco L. , Bleriot I. , González de Aledo M. , Fernández-García L. , Pacios O. , Oliveira H. , López M. , Ortiz-Cartagena C. , Fernández-Cuenca F. , Pascual Á. , Martínez-Martínez L. , Pachón J. , Azeredo J. , Tomás M.
Published: January 2022

The need for alternatives to antibiotic therapy due to the emergence of multidrug resistant bacteria (MDR), such as the nosocomial pathogen
Acinetobacter baumannii
, has led to the recovery of phage therapy. In addition, phages can be combined in cocktails to increase the host range.
Selective Estrogen Receptor Modulators Limit Alphavirus Infection by Targeting the Viral Capping Enzyme nsP1
Authors: Mudgal Rajat , Bharadwaj Chandrima , Dubey Aakriti , Choudhary Shweta , Nagarajan Perumal , Aggarwal Megha , Ratra Yashika , Basak Soumen , Tomar Shailly
Published: January 2022

Alphaviruses cause animal or human diseases that are characterized by febrile illness, debilitating arthralgia, or encephalitis. Selective estrogen receptor modulators (SERMs), a class of FDA-approved drugs, have been shown to possess antiviral activities against multiple viruses, including hepatitis C virus, Ebola virus, dengue virus, and vesicular stomatitis virus.
Aliidiomarina shirensis
as Possible Source of the Integron- and Plasmid-Mediated Fosfomycin Resistance Gene
fosC2
Authors: Ortiz de la Rosa Jose-Manuel , Nordmann Patrice , Zong Zhiyong , Poirel Laurent
Published: January 2022

In-silico
analysis and cloning experiments identified a
fosC2-
like fosfomycin resistance gene in the chromosome of
Aliidiomarina shirensis
, with our data suggesting that this bacterium might be added to the list of species identified as reservoirs of
fos
-like genes that were subsequently acquired by other Gram-negative species. Indeed, the
fosC2
gene was identified as acquired in
Providencia huaxinensis
and
Aeromonas hydrophila
isolates, with this gene being located in class 1 integron structures in the latter cases.
The Innate Immune Response in the Marmoset during the Acute Pneumonic Disease Caused by Burkholderia pseudomallei
Authors: Ngugi Sarah , Laws Thomas , Simpson Andrew J. , Nelson Michelle
Published: January 2022

Burkholderia pseudomallei
is the causative agent of melioidosis, a severe human infection that is difficult to treat with antibiotics and for which there is no effective vaccine. Development of novel treatments rely upon appropriately characterized animal models.
An Adaptable and Modular Set of Laboratory Exercises Connecting Genotype to Phenotype in Sporulating Bacillus subtilis
Authors: McLoon Anna L. , Camp Amy H. , Rahn-Lee Lilah
Published: January 2022

Practical lab exercises that help students draw connections between genotype and phenotype, and make and test predictions about the identity of mutants, are invaluable in college-level cell biology, genetics, and microbiology courses. While many bacteria are easy to grow and manipulate within the time and resource constraints of a laboratory course, their phenotypes are not always observable or relevant-seeming to college students.
Using What’s at Hand: The Creation of an Online Microbiology Outreach Program
Authors: Hurse Deidre , Kemp Kyeorda , Grogan James , Taylor Tracey A. H.
Published: January 2022

Outreach programs lead to increased student interest to pursue careers in science fields. However, hosting existing programs during a pandemic has proven difficult. We used “The Seven Principles of Good Practice,” which emphasizes interactions between the instructor and students, feedback, and peer interactions, to design an online microbiology program for high school students.
Quorum Sensing Promotes Phage Infection in Pseudomonas aeruginosa PAO1
Authors: Xuan Guanhua , Lin Hong , Tan Lin , Zhao Gang , Wang Jingxue
Published: January 2022

Phage resistance is a major limitation of phage therapy, and understanding the mechanisms by which bacteria block phage infection is critical for the successful application of phage therapy. In the present study, we found that
Pseudomonas aeruginosa
PAO1 uses
las
QS to promote phage infection by upregulating the expression of
galU
, which is necessary for the synthesis of phage receptor lipopolysaccharides.
Comparative Genomics of Borderline Oxacillin-Resistant Staphylococcus aureus Detected during a Pseudo-outbreak of Methicillin-Resistant S. aureus in a Neonatal Intensive Care Unit
Authors: Sawhney Sanjam S. , Ransom Eric M. , Wallace Meghan A. , Reich Patrick J. , Dantas Gautam , Burnham Carey-Ann D.
Published: January 2022

In this study, we found a high prevalence of
Staphylococcus aureus
isolates exhibiting a borderline oxacillin resistance phenotype (BORSA) in our neonatal intensive care unit (NICU) serendipitously due to the type of MRSA screening agar used by our laboratory for active surveillance cultures. Subsequent phenotypic and molecular characterization highlighted an unexpected prevalence and variability of BORSA isolates.
A Phosphoinositide-Binding Protein Acts in the Trafficking Pathway of Hemoglobin in the Malaria Parasite Plasmodium falciparum
Authors: Mukherjee Angana , Crochetière Marie-Ève , Sergerie Audrey , Amiar Souad , Thompson L. Alexa , Ebrahimzadeh Zeinab , Gagnon Dominic , Lauruol Florian , Bourgeois Alexandra , Galaup Thomas , Roucheray Stéphanie , Hallée Stéphanie , Padmanabhan Prasad K. , Stahelin Robert V. , Dacks Joel B. , Richard Dave
Published: January 2022

Malaria represents an enormous burden for a significant proportion of humanity and the lack of vaccines and problems with drug resistance to all antimalarials demonstrate the need to develop new therapeutics. Inhibitors of phosphoinositide metabolism are currently being developed as antimalarials but our understanding of this biological pathway is incomplete.
JIB-04 Has Broad-Spectrum Antiviral Activity and Inhibits SARS-CoV-2 Replication and Coronavirus Pathogenesis
Authors: Son Juhee , Huang Shimeng , Zeng Qiru , Bricker Traci L. , Case James Brett , Zhou Jinzhu , Zang Ruochen , Liu Zhuoming , Chang Xinjian , Darling Tamarand L. , Xu Jian , Harastani Houda H. , Chen Lu , Gomez Castro Maria Florencia , Zhao Yongxiang , Kohio Hinissan P. , Hou Gaopeng , Fan Baochao , Niu Beibei , Guo Rongli , Rothlauf Paul W. , Bailey Adam L. , Wang Xin , Shi Pei-Yong , Martinez Elisabeth D. , Brody Steven L. , Whelan Sean P. J. , Diamond Michael S. , Boon Adrianus C. M. , Li Bin , Ding Siyuan
Published: January 2022

The coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2 infection, is an ongoing public health disaster worldwide. Although several vaccines are available as a preventive measure and the FDA approval of an orally bioavailable drug is on the horizon, there remains a need for developing antivirals against SARS-CoV-2 that could work on the early course of infection.
A Toxin-Conjugated Recombinant Protein Targeting gp120 and gp41 for Inactivating HIV-1 Virions and Killing Latency-Reversing Agent-Reactivated Latent Cells
Authors: Wang Xinling , Xu Wei , Liu Zezhong , Wu Yanling , Wang Qian , Cao Miao , Ying Tianlei , He Na , Lu Lu , Jiang Shibo
Published: January 2022

Although HIV-1 replication was successfully controlled by antiretroviral drugs, cure strategy for HIV-1/AIDS is still lacking. The long-lived HIV reservoir is considered one of the major obstacles to an HIV/AIDS cure.
Human Respiratory Syncytial Virus NS2 Protein Induces Autophagy by Modulating Beclin1 Protein Stabilization and ISGylation
Authors: Chiok Kim , Pokharel Swechha M. , Mohanty Indira , Miller Lindsay Grace , Gao Shou-Jiang , Haas Arthur L. , Tran Kim C. , Teng Michael N. , Bose Santanu
Published: January 2022

Understanding host-virus interactions is essential for the development of effective interventions against respiratory syncytial virus (RSV), a paramyxovirus that is a leading cause of viral pneumonia in infants. RSV induces autophagy following infection, although the viral factors involved in this mechanism are unknown.
LuxT Is a Global Regulator of Low-Cell-Density Behaviors, Including Type III Secretion, Siderophore Production, and Aerolysin Production, in Vibrio harveyi
Authors: Eickhoff Michaela J. , Fei Chenyi , Cong Jian-Ping , Bassler Bonnie L.
Published: January 2022

Bacteria precisely tune gene expression patterns to successfully react to changes that occur in the environment. Defining the mechanisms that enable bacteria to thrive in diverse and fluctuating habitats, including in host organisms, is crucial for a deep understanding of the microbial world and also for the development of effective applications to promote or combat particular bacteria.
Narrow is normal: Exploring the extent and significance of flooded marine shelves in icehouse, transitional, and greenhouse climate settings
Authors: Burgess Peter M. , Zhang Jinyu , Steel Ronald
Published: January 2022

Marine shelves are a ubiquitous feature of modern Earth, developed across a wide range of scales in many sedimentary basins and representing the flooded portion of basin-margin clinoform topsets. Analysis of 80 clinoforms from 10 basins spanning Cenozoic and Mesozoic icehouse, transitional, and greenhouse climate settings indicates that normalized mean greenhouse marine shelf width is 33% of normalized mean total measured clinoform topset length. The equivalent value for transitional settings is 43%, and 72% for icehouse marine shelves. These values demonstrate that greenhouse marine shelves were substantially narrower than icehouse equivalents, suggesting that narrower shelves with persistent shelf-edge deltas were a consequence of lower rates of accommodation change in greenhouse climate intervals that lacked the large ice sheets required to drive high-amplitude high-frequency glacio-eustasy. Because greenhouse climates have been the dominant mode through Earth history, narrow shelves have probably been the dominant form, and conceptual models based on modern relatively wide shelves may be poor predictors of paleogeography, sediment routing, and sediment partitioning throughout much of Earth history.
Middle Oxfordian carbon cycle perturbation expressed in the Smackover Formation, Gulf of Mexico
Authors: Eldrett James S.
Published: January 2022

The Middle–Late Jurassic opening of the central Atlantic and proto-Caribbean seaways connecting the Pacific with the Tethys Ocean combined with rising sea level led to a major oceanographic and climatic reorganization conducive to the development of widespread carbonate platforms and diverse reefs. The timing of this shift in carbonate production and opening of the Tethys Ocean is well-constrained from outcrops in Europe and western Asia and marked by a notable positive carbon isotope (δ13C) excursion in the middle Oxfordian Gregoryceras transversarium ammonite Zone, termed “MOxE”. However, the temporal constraints from the western arm of the circum-global seaway through the proto-Caribbean and Gulf of Mexico are not well resolved. Presented here are the first paired organic and carbonate carbon-oxygen isotope records from the Smackover Formation, Gulf of Mexico, that record a positive δ13C isotope excursion that is correlated to the middle Oxfordian transversarium Zone. These data are the first record of the MOxE in the Western Hemisphere and provide temporal constraints on the opening of the Gulf of Mexico. Furthermore, the existence of similar δ13C profiles from European basins strongly suggests a coeval response of the carbon cycle to the opening of the central Atlantic and proto-Caribbean seaways connecting the Pacific with the Tethys Ocean.
Cerebral arterial and venous thrombosis due to COVID-19 vaccine-induced immune thrombotic thrombocytopenia
Authors: Pang Elaine , Ghosh Soumya , Chemmanam Thomas , Grove Carolyn , Phillips Tim
Published: January 2022

Vaccine-induced immune thrombotic thrombocytopenia (VITT) rarely develops after many COVID-19 vaccines. A 51-year-old woman re-presented to hospital with a 4 day history of headache, vomiting, diarrhoea and left calf pain, 11 days after her first dose of ChAdOx1nCoV-19 (AstraZenica) vaccine. Her neurological examination was normal. Blood tests demonstrated a low platelet count, raised D-dimer and CRP, and a positive heparin/anti-PF4 antibody assay. CT venogram demonstrated widespread cerebral venous sinus thrombosis. She was commenced on fondaparinux and intravenous immunoglobulins. The following day she developed an asymmetric quadriplegia and aphasia. CT angiogram demonstrated new bilateral cervical internal carotid artery (ICA) thrombi. She underwent stent-retriever mechanical thrombectomy of bilateral ICA and cerebral venous sinuses. Next day she had right hemiparesis and expressive dysphasia, which are improving. Thromboses due to VITT can progress rapidly to involve cerebral arteries and venous sinuses, and may warrant urgent arterial and venous thrombectomy to reduce morbidity and mortality.
Management of femoral shaft infected nonunion through customised Ilizarov external fixator assembly in a morbidly obese patient
Authors: Ilyas Muhammad Saad , Sattar Abdul , Zehra Uruj , Aziz Amer
Published: January 2022

A 19-year-old morbidly obese man presented with infected nonunion of femoral shaft fracture. Patient had history of 13 failed fixation surgeries, assessment revealed 3-centimetre limb-length discrepancy with 3-centimetre gap nonunion. Wound debridement, primary compression and external fixation using a customised Ilizarov external fixation assembly were planned. A four-ring customised assembly was applied. Partial weight bearing was allowed from first postoperative day on walker. Patient was kept on a monthly follow-up. After complete union at 10 months after surgery, frame was dynamised. After 6 months of dynamisation, frame was removed, at that time patient was full weight bearing. Knee was still stiff with a range of motion of 0°–20°, and there was 6 cm of limb length discrepancy, which was managed with a shoe raise. At 9 months after frame removal, patient is mobile with fully united bone. Ilizarov external fixator can be a good managing option in such difficult and complicated cases.
Novel case of takotsubo cardiomyopathy following COVID-19 vaccination
Authors: Stewart Caitlin , Gamble David T , Dawson Dana
Published: January 2022

We present an unusual case of takotsubo cardiomyopathy (TTC) following administration of the second dose of the DNA ChadOX1 nCOV-19 (AZD122) vaccination. This woman in her early 50s presented to the emergency department 8 days following her vaccine with central chest pain. Initial investigations revealed a raised troponin and evolving T wave inversion on ECG. Acute coronary syndrome management was commenced. Further investigations revealed non-obstructive coronary arteries on coronary angiography and imaging revealed hypokinesia of the anterior and anterior-septal walls in the apex and midcavity level, myocardial oedema and no infarction, all in keeping with TTC. Given the large-scale roll out of vaccinations during the COVID-19 pandemic better understanding of potential adverse events is essential. This is the first case report of TTC following a second dose of the DNA ChadOX1 nCOV-19 (AZD122) vaccination.
Anthropometric and adiposity indicators and risk of type 2 diabetes: systematic review and dose-response meta-analysis of cohort studies
Authors: Jayedi Ahmad , Soltani Sepideh , Motlagh Sheida Zeraat-talab , Emadi Alireza , Shahinfar Hosein , Moosavi Hanieh , Shab-Bidar Sakineh
Published: January 2022

Objective

To present a comprehensive review of the association between measures of body weight, waist, and fat, and different ratios of these measures, and the risk of type 2 diabetes.

Design

Systematic review and dose-response meta-analysis of cohort studies.

Data sources

PubMed, Scopus, and Web of Science up to 1 May 2021.

Review methods

Cohort studies looking at the association between general or central adiposity and body fat content and the risk of type 2 diabetes in the general adult population were included. Two of the authors extracted the data in duplicate. Random effects dose-response meta-analyses were performed to estimate the degree of the associations. Curvilinear associations were modelled with a one stage weighted mixed effects meta-analysis.

Results

216 cohort studies with 2.3 million individuals with type 2 diabetes among 26 million participants were identified. Relative risks were 1.72 (95% confidence interval 1.65 to 1.81; n=182 studies) for an increase in body mass index of 5 units, 1.61 (1.52 to 1.70; n=78) for a 10 cm larger waist circumference, 1.63 (1.50 to 1.78; n=34) for an increase in waist-to-hip ratio of 0.1 units, 1.73 (1.51 to 1.98; n=25) for an increase in waist-to-height ratio of 0.1 units, 1.42 (1.27 to 1.58; n=9) for an increase in visceral adiposity index of 1 unit, 2.05 (1.41 to 2.98; n=6) for a 10% higher percentage body fat, 1.09 (1.05 to 1.13, n=5) for an increase in body shape index of 0.005 units, 2.55 (1.59 to 4.10, n=4) for a 10% higher body adiposity index, and 1.11 (0.98 to 1.27; n=14) for a 10 cm larger hip circumference. A strong positive linear association was found between body mass index and the risk of type 2 diabetes. Positive linear or monotonic associations were also found in all regions and ethnicities, without marked deviation from linearity at a specific cut-off value. Indices of central fatness, independent of overall adiposity, also had positive linear or monotonic associations with the risk of type 2 diabetes. Positive linear or monotonic associations were also found for total and visceral fat mass, although the number of studies was small.

Conclusions

A higher body mass index was associated with a greater risk of developing type 2 diabetes. A larger waist circumference, independent of overall adiposity, was strongly and linearly associated with the risk of type 2 diabetes.

Systematic review registration

PROSPERO CRD42021255338.
Efficacy and safety of efpeglenatide in key patient subgroups from the BALANCE randomized trial, stratified by pre-diabetes status, BMI, and age at baseline
Authors: Pratley Richard E , Jacob Stephan , Baek Seungjae , Trautmann Michael E , Hompesch Marcus , Han OakPil , Stewart John , Sorli Christopher H , Shaunik Alka , Yoon Kun-Ho
Published: January 2022

Introduction

Efpeglenatide is a long-acting glucagon-like peptide-1 receptor agonist being developed to improve glycemic control in type 2 diabetes (T2D). In the BALANCE 205 study (NCT02075281), efpeglenatide significantly reduced body weight versus placebo in patients with obesity, or overweight with comorbidities, and without T2D. These subanalyses explore the efficacy and safety of efpeglenatide in subgroups of patients with pre-diabetes and stratified by body mass index (BMI) or age from the BALANCE study.

Research design and methods

The 20-week BALANCE study randomized patients with BMI ≥30 kg/m2 or ≥27 kg/m2 with comorbidities, and without diabetes, to efpeglenatide 4 mg or 6 mg once weekly, 6 mg or 8 mg once every 2 weeks, or placebo. For these subanalyses, patients were stratified by pre-diabetes status (glycated hemoglobin (HbA1c) 5.7%−6.4% (39–46 mmol/mol) or fasting plasma glucose (FPG) 100–125 mg/dL) and by BMI or age < or ≥ median values (34.9 kg/m2 and 44 years, respectively) at baseline.

Results

In patients with pre-diabetes at baseline, all efpeglenatide doses led to greater proportions of patients reverting to normoglycemia (40.6%–64.3%) versus placebo (10.0%), and greater reductions in HbA1c (0.30%–0.38%), FPG (7.7–14.1 mg/dL), and weight (5.6–7.3 kg) versus placebo (nominal p<0.05 for all). In patients with BMI or age < or ≥ median, greater reductions in weight were observed with all efpeglenatide doses versus placebo (nominal p<0.01 for all). The most common adverse events in patients receiving efpeglenatide across patient subgroups were gastrointestinal adverse events.

Conclusions

These results are consistent with the overall BALANCE population and suggest beneficial effects of efpeglenatide on glycemic control and body weight regardless of pre-diabetes status, age, or BMI at baseline. The effects of efpeglenatide on glycemic control in patients with pre-diabetes suggest it might help reduce the likelihood of at-risk patients developing diabetes.
Glycemic outcomes among rural patients in the type 1 diabetes T1D Exchange registry, January 2016–March 2018: a cross-sectional cohort study
Authors: Gill Arashpreet , Gothard M David , Briggs Early Kathaleen
Published: January 2022

Introduction

Does rural status influence glycemic outcomes among participants in the type 1 diabetes T1D Exchange clinic registry?

Research design and methods

Data from the T1D Exchange clinic registry between January 2016 and March 2018 were identified by rural–urban status and stratified by age and hemoglobin A1c (HbA1c). Multivariable regression modeling was performed to isolate HbA1c differences. A full model including all significant (p<0.05 via two-sided testing) differential factors was determined with an additional indicator for rural status, and adjusted for duration of diabetes, use of continuous glucose monitoring device, age, race/ethnicity, and private insurance status. The model was reduced using backwards elimination stepwise procedures until only significant factors remained.

Results

Mean HbA1c levels for all rural participants were significantly higher (8.71%; 72 mmol/mol) compared with the urban group (8.48%; 69 mmol/mol), p<0.001. For youth under 13 years of age, rural participants had a higher mean HbA1c (8.65%; 71 mmol/mol) compared with urban (8.45% 69 mmol/mol), p=0.022. Rural youth (13–<18 years) had a higher mean HbA1c (9.39%; 79 mmol/mol) than urban youth (9.14%; 76 mmol/mol), p<0.001. Rural young adults (18–<26 years) had a higher mean HbA1c (9.07%; 76 mmol/mol) than urban young adults (8.88%; 74 mmol/mol), p=0.042. Rural adults (≥26 years; n=589) were the only group that did not have a higher mean HbA1c (7.76%, 61.3 mmol) than urban adults (n=4770; 7.72%, 60.9 mmol/mol), p=0.503. Rural locale was highly significant (beta=0.175, p<0.001) despite controlling for potentially confounding differences between rural and urban groups.

Conclusions

Among this T1D Exchange cohort, there is a pattern of higher mean HbA1c being associated with rural status, even after adjustment for characteristic differences, most strikingly among those under 26 years of age. This disparity and contributing factors need to be more thoroughly studied to provide effective solutions.
Beyond A to E: addressing the unfamiliar issues arising in the acute and immediate phase post-catastrophe
Authors: Reckless Adam , McPhail S , Lillington C , Kingsley-Smith B
Published: January 2022

During a time in which there is increased focus on level 5 and 6 prehospital emergency care provision and utilisation in the deployed military space, it is important to consider the range of care that more junior medical practitioners may be exposed to. The initial response to a catastrophe at a level pertaining to General Duties Medical Officers or similar forward-deployed tri-service personnel comprises acute care and triage skills, which are widely taught through prehospital courses and Foundation training. However, beyond that, the necessary workload becomes less clear. To provide comprehensive care in-theatre, there is the need to consider more nuanced and unfamiliar issues such as components in the immediate postcatastrophe landscape. These include aspects such as care of human remains, mental health, chronic conditions in the acute phase and the scope of military medical assistance within the wider relief effort. This is a paper commissioned as a part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.
Improvement of behavioural pattern and alpha-synuclein levels in autism spectrum disorder after consumption of a beta-glucan food supplement in a randomised, parallel-group pilot clinical study
Authors: Raghavan Kadalraja , Dedeepiya Vidyasagar Devaprasad , Ikewaki Nobunao , Sonoda Tohru , Iwasaki Masaru , Preethy Senthilkumar , Abraham Samuel JK
Published: January 2022

Background

Autism spectrum disorders (ASDs) are a wide range of behavioural disabilities for which there are no definite interventional modalities available. Remedial therapies remain the only option but with varying outcomes. We have evaluated the Childhood Autism Rating Scale (CARS) and alpha-synuclein levels in this parallel-group, multiple-arm pilot clinical study after supplementation with a biological response modifier beta-glucan food supplement (Nichi Glucan).

Methods

Six subjects with ASD (n=6) Gr. 1 underwent conventional treatment comprising remedial behavioural therapies and L-carnosine 500 mg per day, and 12 subjects (n=12) Gr. 2 underwent supplementation with the Nichi Glucan 0.5 g two times per day along with the conventional treatment.

Results

There was a significant decrease in the CARS score in all of the children of the Nichi Glucan Gr.2 compared with the control (p=0.034517). Plasma levels of alpha-synuclein were significantly higher in Gr. 2 (Nichi Glucan) than in the control group Gr. 1 (p=0.091701).

Conclusion

Improvement of the behavioural pattern CARS score and a correlating alpha-synuclein level, followed by a safe beta-glucan food supplement, warrants further research on other parameters, such as gut-microbiota evaluation, and relevant neuronal biomarkers which is likely to cast light on novel solutions.
Retrospective study of the influence of hypothyroidism on liver function before radioiodine therapy in China: a comparison analysis based on patients with differentiated thyroid cancer
Authors: Ji Yanhui , Zheng Wei , Meng Zhaowei , Wu Cailan , Tan Jian , Wang Renfei
Published: January 2022

Purpose

The aim of the present study is to investigate the risk factors for hepatic dysfunction before radioiodine therapy in patients with differentiated thyroid cancer (DTC).

Methods

996 patients (314 men, 682 women; age of 45.07±12.98 years) with postoperative DTC were recruited and divided into two groups including patients with and without hepatic dysfunction. The changes in baseline data and traced liver function levels, together with other metabolic profiles, were compared between the two groups.

Result

Overall, 31.6% of patients had hepatic dysfunction. Higher aspartate aminotransferase and/or alanine aminotransferase was the most common abnormality (the prevalence rate was 47.5%). The percentages of mild and moderate hepatic dysfunction were 80.0% and 20.0%, respectively. Univariate analyses demonstrated that the most prominent risk factors for hepatic dysfunction (OR=0.324–3.171, p<0.01) were male sex with levothyroxine discontinuation and free triiodothyronine <2.01 pmol/L, free thyroxine (FT4) <4.78 pmol/L, thyroid-stimulating hormone >78.195 µIU/mL, total cholesterol >5.17 mmol/L, triglycerides (TG) >1.71 mmol/L and more than 21 days of thyroid hormone withdrawal. Multivariate analyses demonstrated that for men, FT4 <3.80 pmol/L and TG ≥1.28 mmol/L were the most prominent risk factors.

Conclusions

Patients with minor hepatic dysfunction and ortholiposis are more likely to recover to normal liver function. Patients with moderate hepatic dysfunction should be treated with hepatoprotective drugs. For men, FT4 and TG levels tended to be associated with hepatic dysfunction, and the prognosis of hepatic dysfunction was closely related to the TG level.
Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative
Authors: Sugand Kapil , Aframian Arash , Park Chang , Sarraf Khaled M
Published: January 2022

Objective

This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak.

Design

A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019.

Setting

Hospitals from six major urban cities were recruited around the UK, including London.

Participants

A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion.

Primary and secondary outcome measures

Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used.

Results

During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon.

Conclusion

Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.
Effects of working environments with minimum night lighting on night-shift nurses’ fatigue and sleep, and patient safety
Authors: Hoshi Hokuto , Iwasa Hajime , Goto Aya , Yasumura Seiji
Published: January 2022

Objective

Nurses working rotating shifts often suffer from insomnia or similar disorders because exposure to room lighting at night inhibits melatonin secretion, resulting in a disturbed circadian rhythm. This study investigated whether dark room lighting would be preferable to brighter rooms in terms of (1) fatigue and sleepiness while working, (2) quality of sleep and (3) non-interference with work performance among nurses.

Methods

This study used a non-randomised open-label trial between night shifts using dark (110 lx) and bright (410 lx) room lighting on the desk surface. A total of 20 nurses were enrolled in the trial from November 2015 to February 2016 at a hospital in Japan. All participants worked first with dark room lighting and then with bright room lighting. The participants completed a self-administered questionnaire at enrolment, which was collected this at the end of the intervention.

Results

Fatigue and sleepiness were significantly higher in dark room lighting than in bright room conditions (p<0.05). There were no significant differences in sleep quality between the dark and well-lit conditions. We detected no significant differences in the number of reported incidents or accidents comparing the two types of environments.

Conclusion

Dark room lighting did not ameliorate fatigue and sleepiness during night shifts. Additionally, there was no evidence of improvement in sleep quality among nurses. These findings are important, however, in terms of managing hospital risk.
Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis
Authors: Bourne Richard S , Jennings Jennifer K , Panagioti Maria , Hodkinson Alexander , Sutton Anthea , Ashcroft Darren M
Published: January 2022

Background

Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.

The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.

Methods

The systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations.

Results

Seventeen studies were eligible, 15 (88%) were uncontrolled before-after studies. The intervention components included education of staff (n=8 studies), medication review (n=7), guidelines (n=6), electronic transfer/handover tool or letter (n=4) and medicines reconciliation (n=4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR=0.45 (95% CI 0.31 to 0.63), I2=55%, n=9) and hospital discharge (OR=0.39 (95% CI 0.2 to 0.76), I2=75%, n=9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95% CI 0.22 to 1.11), I2=62%, n=4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95% CI 0.13 to 0.55), I2=67%, n=6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process.

Conclusions

Multicomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.