bluuebunny/crossref_metadata_2025 huggingface dataset:
Recuperator Performance Assessment in Humidified Micro Gas Turbine Applications Using Experimental Data Extended With Preliminary Support Vector Regression Model Analysis
Authors: De Paepe Ward , Pappa Alessio , Coppitters Diederik , Montero Carrero Marina , Tsirikoglou Panagiotis , Contino Francesco
Published: December 2020

Cycle humidification applied to micro gas turbines (mGTs) offers a solution to overcome their limited operational flexibility in terms of variable electrical and thermal power production when used in a combined heat and power (CHP) application. Although the positive impact of this cycle humidification on the performance has already been proven numerically and experimentally, very detailed modeling of the system performance remains challenging, especially the determination of the recuperator effectiveness, which has the highest impact on the final cycle performance. Indeed, the recuperator performance depends strongly on the mass flow rate of the air stream and its humidification level, two parameters that are difficult to measure accurately. Accurate modeling of the recuperator performance under both dry and humidified conditions is thus essential for correct assessment of the potential of humidified mGT cycles in decentralized energy systems (DESs). In this paper, we present a detailed analysis of the recuperator performance under humidified conditions using averaged experimental data, extended with the application of a support vector regression (SVR) on a time series to improve noise-modeling of the output signal, and thus enhance the accuracy of the monitoring process. In a first step, the missing experimental parameters, air mass flow rate and humidity level, were obtained indirectly, using rotational speed, fuel flow rate, exhaust gas composition and pressure level measurements in combination with the compressor map. Despite the low accuracy, some general trends regarding the recuperator performance could be observed based on these experimental data, indicating that the recuperator, despite having an increased total exchanged heat flux, is actually too small to exploit the full potential of the humidification. In a second step, by means of the SVR model, a first attempt was made to improve the accuracy and reduce the scatter on the recuperator performance determination. The predicted results with the SVR indicated indeed a reduced scatter on the determinations of the air mass flow rate and the amount of introduced water, opening a pathway toward online recuperator performance prediction.
Experimental Study of the Dynamic Permeability in Two-Stage Gravel Packs Considering Particle Blockage and Remigration
Authors: Qi Minhui , Li Mingzhong , Guo Tiankui , Li Yuan , Li Yanchao , Gao Song
Published: December 2020

The two-stage gravel-packing technique has been widely adopted in the development of unconsolidated sandstone reservoirs with high sanding rates and silt contents. Compared with the traditional gravel-packing operation, the lifespan and long-term conductivity of the two-stage gravel pack improve significantly. In the present study, an experimental study was undertaken to determine the dynamic permeability change of two-stage gravel packs during sand production. Thirty-nine groups of flooding tests were carried out with various experimental settings, and the pressure drop of each section (i.e., the sanding section, gravel bed I, and gravel bed II) was monitored dynamically during flooding. The permeability characteristics of each section were used to determine the mechanisms of sanding, pore blockage, and particle remigration under different packing arrangements. Using the proposed experimental setup, a sensitivity analysis was carried out to study the parameters that may affect the permeability of the sand pack, such as the two-stage gravel size, packing length, flooding rate, and silty sand content. Based on the observed permeability recovery phenomena in gravel bed I during the experiments, a dynamic permeability prediction model considering the remigration of deposited particles was proposed. Compared with the traditional deep-bed filtration model and the experimental results, the verification showed that the new model is more suitable for predicting the dynamic permeability of two-stage gravel packs.
Revisiting Theoretical Limits for One Degree-of-Freedom Wave Energy Converters
Authors: Tom Nathan M.
Published: December 2020

This work revisits the theoretical limits of one degree-of-freedom wave energy converters (WECs). This work considers the floating sphere used in the OES Task 10 WEC modeling and verification effort for analysis. Analytical equations are derived to determine bounds on displacement amplitude, time-averaged power (TAP), and power-take-off (PTO) force. A unique result found shows that the TAP absorbed by a WEC can be defined solely by the inertial properties and radiation hydrodynamic coefficients. In addition, a unique expression for the PTO force was derived that provides lower and upper bounds when resistive control is used to maximize power generation. For complex conjugate control, this same expression only provides a lower bound, as there is theoretically no upper bound. These bounds assist in comparing the performance of the floating sphere if it were to extract energy using surge or heave motion. The analysis shows because of differences in hydrodynamic coefficients for each oscillating mode, there are different frequency ranges that provide better power capture efficiency. The influence of a motion constraint on TAP while utilizing a nonideal power take-off is examined and found to reduce the losses associated with bidirectional energy flow. The expression to calculate TAP with a nonideal PTO is modified by the electrical conversion efficiency and the ratio of the PTO spring and damping coefficients. The PTO spring and damping coefficients were separated in the expression, allowing for limits to be set on the PTO coefficients to ensure net power generation.
Modular Heat Sinks for Enhanced Thermal Management of Electronics
Authors: Hoque Muhammad Jahidul , Günay Alperen , Stillwell Andrew , Gurumukhi Yashraj , Pilawa-Podgurski Robert C. N. , Miljkovic Nenad
Published: December 2020

Power electronics are vital for the generation, conversion, transmission, and distribution of electrical energy. Improving the efficiency, power density, and reliability of power electronics is an important challenge that can be addressed with electrothermal codesign and optimization. Current thermal management approaches utilize metallic heat sinks (HSs), resulting in parasitic load generation due to different potentials between electronic components on the printed circuit board (PCB). To enable electrical isolation, a thermal interface material (TIM) or gap pad is placed between the PCB and HS, resulting in poor heat transfer. Here, we develop an approach to eliminate TIMs and gap pads through modularization of metallic HSs. The use of smaller modular heat sinks (MHSs) strategically placed on high power dissipation areas of the PCB enables elimination of electrical potential difference, and removal of electrical isolation materials, resulting in better cooling performance due to direct contact between devices and the HS. By studying a gallium nitride (GaN) 2 kW DC–DC power converter as a test platform for electrothermal codesign using the modular approach, and benchmarking performance with a commercial off-the-shelf HS design, we showed identical power dissipation rates with a 54% reduction in HS volume and a 8 °C reduction in maximum GaN device temperature. In addition to thermal performance improvement, the MHS design showed a 73% increase in specific power density with a 22% increase in volumetric power density.
Evaluating factors influencing infrasonic signal detection and automatic processing performance utilizing a regional network
Authors: Dannemann Dugick Fransiska K. , Stump Brian W. , Blom Philip S. , Marcillo Omar E. , Hayward Chris T. , Carmichael Joshua D. , Arrowsmith Stephen
Published: December 2020

Physical and deployment factors that influence infrasound signal detection and assess automatic detection performance for a regional infrasound network of arrays in the Western U.S. are explored using signatures of ground truth (GT) explosions (yields). Despite these repeated known sources, published infrasound event bulletins contain few GT events. Arrays are primarily distributed toward the south-southeast and south-southwest at distances between 84 and 458 km of the source with one array offering azimuthal resolution toward the northeast. Events occurred throughout the spring, summer, and fall of 2012 with the majority occurring during the summer months. Depending upon the array, automatic detection, which utilizes the adaptive F-detector successfully, identifies between 14% and 80% of the GT events, whereas a subsequent analyst review increases successful detection to 24%–90%. Combined background noise quantification, atmospheric propagation analyses, and comparison of spectral amplitudes determine the mechanisms that contribute to missed detections across the network. This analysis provides an estimate of detector performance across the network, as well as a qualitative assessment of conditions that impact infrasound monitoring capabilities. The mechanisms that lead to missed detections at individual arrays contribute to network-level estimates of detection capabilities and provide a basis for deployment decisions for regional infrasound arrays in areas of interest.
The effect of fundamental frequency contour similarity on multi-talker listening in older and younger adults
Authors: Wasiuk Peter A. , Lavandier Mathieu , Buss Emily , Oleson Jacob , Calandruccio Lauren
Published: December 2020

Older adults with hearing loss have greater difficulty recognizing target speech in multi-talker environments than young adults with normal hearing, especially when target and masker speech streams are perceptually similar. A difference in fundamental frequency (f0) contour depth is an effective stream segregation cue for young adults with normal hearing. This study examined whether older adults with varying degrees of sensorineural hearing loss are able to utilize differences in target/masker f0 contour depth to improve speech recognition in multi-talker listening. Speech recognition thresholds (SRTs) were measured for speech mixtures composed of target/masker streams with flat, normal, and exaggerated speaking styles, in which f0 contour depth systematically varied. Computational modeling estimated differences in energetic masking across listening conditions. Young adults had lower SRTs than older adults; a result that was partially explained by differences in audibility predicted by the model. However, audibility differences did not explain why young adults experienced a benefit from mismatched target/masker f0 contour depth, while in most conditions, older adults did not. Reduced ability to use segregation cues (differences in target/masker f0 contour depth), and deficits grouping speech with variable f0 contours likely contribute to difficulties experienced by older adults in challenging acoustic environments.
Effect of temporal misalignment on understanding Mandarin sentences in simulated combined electric-and-acoustic stimulation
Authors: Wu Hongde , Lin Wanhua , Chen Fei , Zheng Dingchang
Published: December 2020

The present work assessed Mandarin sentence understanding when the electric and acoustic portions are not temporally aligned in simulated combined electric-and-acoustic stimulation (EAS). A relative time shift was added between the electric and acoustic portions, simulating the temporal misalignment effect in EAS processing. The processed stimuli were played to normal-hearing listeners to recognize. Experimental results showed a significant decrease of the intelligibility score caused by the temporal misalignment in the two portions of EAS processing, suggesting the need to avoid temporal misalignment in EAS. The preceding acoustic-portion more significantly decreased the understanding of EAS-processed Mandarin stimuli than the preceding electric-portion.
What Do We Know About Research on Parasport Coaches? A Scoping Review
Authors: Bentzen Marte , Alexander Danielle , Bloom Gordon A. , Kenttä Göran
Published: December 2020

The purpose of this scoping review was to provide a broad overview of the literature pertaining to parasport coaches, including information regarding the size and scope of research, the populations and perspectives obtained, and the type of methods used to conduct the research. Data were collected and analyzed using a six-stage framework for conducting scoping reviews. The results revealed that the majority of articles were based on interviews, and an overwhelming majority of the participants were men coaching at the high-performance level in North America. Three of the most frequent topics were becoming a parasport coach, being a parasport coach, and having general parasport coaching knowledge. Articles ranged in date from 1991 to 2018, with 70% of empirical articles published from 2014 onward, indicating an emerging interest in this field of research. This review has the potential to advance the science and practice of parasport coaching at all levels.
DNA methyltransferase 3B deficiency unveils a new pathological mechanism of pulmonary hypertension
Authors: Yan Yi , He Yang-Yang , Jiang Xin , Wang Yong , Chen Ji-Wang , Zhao Jun-Han , Ye Jue , Lian Tian-Yu , Zhang Xu , Zhang Ru-Jiao , Lu Dan , Guo Shan-Shan , Xu Xi-Qi , Sun Kai , Li Su-Qi , Zhang Lian-Feng , Zhang Xue , Zhang Shu-Yang , Jing Zhi-Cheng
Published: December 2020

DNA methyltransferase 3B is identified as a protective target against pulmonary vascular remodeling.
Aerolysin nanopores decode digital information stored in tailored macromolecular analytes
Authors: Cao Chan , Krapp Lucien F. , Al Ouahabi Abdelaziz , König Niklas F. , Cirauqui Nuria , Radenovic Aleksandra , Lutz Jean-François , Peraro Matteo Dal
Published: December 2020

Informational polymers are deciphered by aerolysin pores.
Cryo-shocked cancer cells for targeted drug delivery and vaccination
Authors: Ci Tianyuan , Li Hongjun , Chen Guojun , Wang Zejun , Wang Jinqiang , Abdou Peter , Tu Yiming , Dotti Gianpietro , Gu Zhen
Published: December 2020

Liquid nitrogen–treated tumor cells serve as a drug carrier and cancer vaccine to facilitate chemo-immunotherapy.
Overturning circulation, nutrient limitation, and warming in the Glacial North Pacific
Authors: Rae J. W. B. , Gray W. R. , Wills R. C. J. , Eisenman I. , Fitzhugh B. , Fotheringham M. , Littley E. F. M. , Rafter P. A. , Rees-Owen R. , Ridgwell A. , Taylor B. , Burke A.
Published: December 2020

Enhanced overturning circulation in the glacial North Pacific caused warming, nutrient limitation, and lower atmospheric CO
2
.
On high-temperature evolution of passivation layer in Li–10 wt % Mg alloy via in situ SEM-EBSD
Authors: Kaboli Shirin , Noel Pierre , Clément Daniel , Demers Hendrix , Paolella Andrea , Bouchard Patrick , Trudeau Michel L. , Goodenough John B. , Zaghib Karim
Published: December 2020

An in situ surface observation reveals the surface structural changes during heating of a Li–10 wt % Mg alloy sheet.
Integration of intra-sample contextual error modeling for improved detection of somatic mutations from deep sequencing
Authors: Abelson Sagi , Zeng Andy G. X. , Nofech-Mozes Ido , Wang Ting Ting , Ng Stanley W. K. , Minden Mark D. , Pugh Trevor J. , Awadalla Philip , Shlush Liran I. , Murphy Tracy , Chan Steven M. , Dick John E. , Bratman Scott V.
Published: December 2020

Espresso efficiently distinguishes true mutations from background noise common in deep sequencing data.
Reflections on the future of swarm robotics
Authors: Dorigo Marco , Theraulaz Guy , Trianni Vito
Published: December 2020

Swarm robotics will tackle real-world applications by leveraging automatic design, heterogeneity, and hierarchical self-organization.
Convalescent plasma in COVID-19: Does use case matter?
Authors: Nadkarni Girish N.
Published: December 2020

A randomized controlled trial of convalescent plasma in severe COVID-19 shows no benefits.
Re-productive brain stimulation
Authors: Vellanki Priyathama
Published: December 2020

Kisspeptin agonists restore gonadotropin secretion.
The Shared Resistome of Human and Pig Microbiota Is Mobilized by Distinct Genetic Elements
Authors: Wang Chao , Song Yuqin , Tang Na , Zhang Gang , Leclercq Sébastien Olivier , Feng Jie
Published: December 2020

There is growing concern that antibiotic resistance genes could spread from the husbandry environment to human pathogens through dissemination mediated by mobile genetic elements. In this study, we investigated the contribution of mobile genetic elements to the abundance of highly prevalent antibiotic resistance genes found in commensal bacteria of both human and pig intestinal microbiota originating from the same region.
A Fast and Accessible Method for the Isolation of RNA, DNA, and Protein To Facilitate the Detection of SARS-CoV-2
Authors: Ponce-Rojas Jose Carlos , Costello Michael S. , Proctor Duncan A. , Kosik Kenneth S. , Wilson Maxwell Z. , Arias Carolina , Acosta-Alvear Diego
Published: December 2020

Management of the coronavirus disease 2019 (COVID-19) pandemic requires widespread testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A main limitation for widespread SARS-CoV-2 testing is the global shortage of essential supplies, among them RNA extraction kits.
Draft Genome Sequences of Two Polycyclic Tetramate Macrolactam Producers,
Streptomyces
sp. Strains JV180 and SP18CM02
Authors: Qi Yunci , Nepal Keshav K. , Greif Jennifer , Martini Cole , Tomlinson Chad , Markovic Christopher , Fronick Catrina , Blodgett Joshua A. V.
Published: December 2020

Here, we report the draft genome sequences of two related
Streptomyces
sp. strains, JV180 and SP18CM02. Despite their isolation from soils in Connecticut and Missouri (USA), respectively, they are strikingly similar in gene content. Both belong to the
Streptomyces griseus
clade and harbor several secondary metabolite biosynthetic gene clusters.
Complete Genome Sequence of an Australian Strain of the Lichen-Forming Fungus Endocarpon pusillum (Hedwig)
Authors: Mead Oliver L. , Gueidan Cécile
Published: December 2020

The cosmopolitan lichen-forming fungus
Endocarpon pusillum
(Hedwig) has previously been used as a model for the study of symbiosis and drought resistance. Here, we present the annotated genome of the Australian strain
Endocarpon pusillum
EPUS1.4. This genome sequence provides additional information on the ability of this species to produce secondary metabolites.
Draft Genome Sequence of a Novel Methylobacterium brachiatum Strain Isolated from Human Skin
Authors: Cremers Geert , Kenyon Angelique , Gubbels Niels , Jansen Matthijs , van Alen Theo A. , Berben Tom , Op den Camp Huub J. M.
Published: December 2020

Methylobacterium brachiatum
MBRA is an aerobic alphaproteobacterium isolated from the human skin on methanol-containing minimal medium. The genome was sequenced using Illumina and Nanopore technology, and the genome was assembled using Unicycler.
M. brachiatum
MBRA possesses two
xoxF
genes, one
mxaF/mxaI
, and a complete serine pathway.
Draft Genome Sequence of a Filamentous Anoxygenic Phototrophic Bacterium, “
Candidatus
Roseilinea sp. Strain NK_OTU-006,” Recovered from Metagenomic Data of a Hot Spring Microbial Mat
Authors: Martinez Joval N. , Kawai Shigeru , Saini Mohit Kumar , Tank Marcus , Hanada Satoshi , Thiel Vera
Published: December 2020

We report here the metagenome-assembled draft genome of an uncultured filamentous anoxygenic phototroph of the phylum
Chloroflexota
(formerly
Chloroflexi
), “
Candidatus
Roseilinea sp. strain NK_OTU-006,” recovered from hot spring-associated microbial mats. The 3.6-Mb genome is estimated to be 94% complete and comprises 117 contigs encoding 3,203 predicted genes, including a full-length rRNA operon.
Retrospective Analysis of the Relationship between Two Anthrax Outbreaks in Kazakhstan Based on Genomic Data
Authors: Shevtsov Alexandr , Vergnaud Gilles , Amirgazin Asylulan , Lukhnova Larissa , Izbanova Uinkul , Shevtsov Vladislav , Ramankulov Yerlan
Published: December 2020

We present a retrospective analysis of strains from two anthrax outbreaks in western Kazakhstan in 2009. The outbreaks occurred during the same period and in the same area located close to main roads, favoring a single source of infection. However, multilocus variable-number tandem-repeat analysis (MLVA), canonical single-nucleotide polymorphism (CanSNP) analysis, and genome-wide analysis demonstrated that the outbreaks were not connected.
Complete Genome Sequence of
Faecalibacillus intestinalis
JCM 34082, Isolated from Feces from a Healthy Japanese Female
Authors: Sakamoto Mitsuo , Ikeyama Nao , Toyoda Atsushi , Murakami Takumi , Mori Hiroshi , Ohkuma Moriya
Published: December 2020

Here, we report the complete genome sequence of
Faecalibacillus intestinalis
JCM 34082, a member of the family
Erysipelotrichaceae
that was isolated from feces from a healthy Japanese woman. The genome assembly comprised 2,869,982 bp, with a G+C content of 29.8%.
Complete Genome Sequence of Francisella tularensis Live Vaccine Strain NR-28537 (BEI Master Cell Bank)
Authors: Player Robert A. , Verratti Kathleen J. , Grady Sarah L. , Beck Linda C. , Goodwin Bruce G. , Earnhart Christopher G. , Sozhamannan Shanmuga
Published: December 2020

The genome of
Francisella tularensis
live vaccine strain NR-28537 was sequenced by a hybrid approach utilizing an Oxford Nanopore Technologies R9 flow cell and an Illumina MiSeq platform.
De novo
assembly of the resulting long and short reads produced a single-contig whole-genome sequence.
Human Papillomavirus 16 (HPV16) E2 Repression of TWIST1 Transcription Is a Potential Mediator of HPV16 Cancer Outcomes
Authors: Fontan Christian T. , Das Dipon , Bristol Molly L. , James Claire D. , Wang Xu , Lohner Hannah , Atfi Azeddine , Morgan Iain M.
Published: December 2020

HPV16-positive cancers have a better clinical outcome that their non-HPV anatomical counterparts. Furthermore, the presence of HPV16 E2 RNA predicts a better outcome for HPV16-positive tumors; the reasons for this are not known.
Trace-element and Sr and Nd isotopic geochemistry of Cretaceous bentonites in Wyoming and South Dakota tracks magmatic processes during eastward migration of Farallon arc plutons
Authors: Hannon Jeffrey S. , Dietsch Craig , Huff Warren D.
Published: December 2020

Bentonite beds, which are clay deposits produced by the submarine alteration of volcanic tephra, preserve millions of years of volcanic products linked to magmatic systems for which records are otherwise lost through erosion and alteration. Cretaceous strata from the Bighorn Basin, Wyoming, and southwestern South Dakota contain bentonites that originated from arc magmatism produced by subduction of the Farallon plate. We analyzed the bulk major- and trace-element geochemistry, and the 87Sr/86Sr (n = 87) and 143Nd/144Nd (n = 26) isotopic compositions of individual bentonite beds from these areas spanning 40 m.y. of volcanism to recover signals of magmatic processes and to attempt to trace bentonite geochemical and isotopic signatures to contemporaneous Cordilleran plutonic rocks. Using multiple immobile elements (e.g., Zr, TiO2, Nb, Ta, and rare earth elements), distinct temporal trends show variations in the effects of mineral fractionation and changes in crustal thickness. Bentonite Sr and Nd isotopic compositions allow ash beds to be correlated with specific batholithic complexes in Idaho and western Montana. With this data set, we observed the following: (1) The volcanic arc migrated across the 0.706 isopleth between 115 and 105 Ma; (2) between 105 and 95 Ma, magmatism stalled in central Idaho and was supported through significant MASH (mixing-assimilation-storage-homogenization) processing; (3) by 85 Ma, a shallowing subduction angle resulted in the eastward migration of the volcanic front into western Montana while volcanism in Idaho diminished; and (4) around 75 Ma, evidence of Idaho volcanism is lost. Montana plutonism continued with significant assimilation of radiogenic basement and regional centers of local magma emplacement (i.e., Pioneer batholith).
Physiological responses to facemask application in newborns immediately after birth
Authors: Gaertner Vincent D , Rüegger Christoph Martin , O'Currain Eoin , Kamlin C Omar Farouk , Hooper Stuart B , Davis Peter G , Springer Laila
Published: December 2020

Objective

Application of a face mask may induce apnoea and bradycardia, possibly via the trigeminocardiac reflex (TCR). We aimed to describe rates of apnoea and bradycardia in term and late-preterm infants following facemask application during neonatal stabilisation and compare the effects of first facemask application with subsequent applications.

Design

Subgroup analysis of a prospective, randomised trial comparing two face masks.

Setting

Single-centre study in the delivery room

Patients

Infants>34 weeks gestational age at birth

Methods

Resuscitations were video recorded. Airway flow and pressure were measured using a flow sensor. The effect of first and subsequent facemask applications on spontaneously breathing infants were noted. When available, flow waveforms as well as heart rate (HR) were assessed 20 s before and 30 s after each facemask application.

Results

In total, 128 facemask applications were evaluated. In eleven percent of facemask applications infants stopped breathing. The first application was associated with a higher rate of apnoea than subsequent applications (29% vs 8%, OR (95% CI)=4.76 (1.41–16.67), p=0.012). On aggregate, there was no change in median HR over time. In the interventions associated with apnoea, HR dropped by 38bpm [median (IQR) at time of facemask application: 134bpm (134–150) vs 96bpm (94–102) 20 s after application; p=0.25] and recovered within 30 s.

Conclusions

Facemask applications in term and late-preterm infants during neonatal stabilisation are associated with apnoea and this effect is more pronounced after the first compared with subsequent applications. Healthcare providers should be aware of the TCR and vigilant when applying a face mask to newborn infants.

Trial registration number

ACTRN12616000768493.
Insulin autoimmune syndrome: a rare cause of spontaneous hypoglycaemia in non-diabetic individuals
Authors: Ravindra Shruthi , Shetty Sahana
Published: December 2020

Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycaemia, characterised by recurrent hypoglycaemic episodes secondary to insulin autoantibodies in individuals who are not exposed to exogenous insulin. We are reporting a case of IAS in a 64-year-old gentleman, who presented with predominant postprandial hypoglycaemic episodes. On biochemical evaluation, he was found to have hyperinsulinemic hypoglycaemia. Localisation studies with MRI abdomen and endoscopic ultrasound (EUS) were negative for pancreatic tumour. Tests sent for insulin antibody levels were elevated. The patient was treated with frequent meals, acarbose and glucocorticoids. Patient condition improved and did not experience hypoglycaemia on follow-up.
Posterior reversible encephalopathy syndrome in a patient with serotonin syndrome
Authors: Prakash Sanjay , Rathore Chaturbhuj , Kaushikkumar Rana
Published: December 2020

Serotonin syndrome (SS) is a drug-induced clinical syndrome, characterised by a triad of cognitive impairment, autonomic hyperactivity and neuromuscular abnormalities. Hypertension, one of the common autonomic manifestations in SS, may lead to lead to several life-threatening conditions. Herein, we report a case of SS who had posterior reversible encephalopathy syndrome (PRES) because of high blood pressure.

A young male with a 5-month history of chronic tension-type headache and depression had been receiving amitriptyline and paroxetine. Increment of paroxetine led to the development of various new clinical features, fulfilling the Hunter criteria of SS. MRI brain revealed high-signal intensity lesions on T2 fluid-attenuated inversion recovery, and T2-weighted imaging in the posterior regions of the occipital, parietal, temporal and cerebellum lobes, suggestive of PRES. The patient responded to cyproheptadine. Autonomic hyperactivity, due to SS, is the most likely explanation of this association.
Bilateral total conservative parotidectomy: a tale behind an aesthetic surgery
Authors: Riju Jeyashanth , George Philip , Vidya Konduru , Tirkey Amit Jiwan
Published: December 2020

Any facial swelling is associated with stress for the patient due to cosmesis. Especially when one has bilateral symmetrical enlarged parotids, having exhausted all available conservative management, surgery becomes the last resort; which in such cases pose specific challenges. A 29-year-old man presented with problems of bilateral symmetrical enlarged parotid lesion for 5 years, which did not have an adequate response to medical line of management. He underwent proposed surgery and was diagnosed to have chronic sclerosing parotitis (CSS). The challenges faced during surgery of this non-neoplastic inflammatory lesion, with significant fibrosis, is being described. He recovered completely without any complications related to surgery. CSS rarely affects bilateral parotid glands. Surgery, results of which are outstanding, must be considered in cases where these lesions do not respond to medical line of management. Bilateral total conservative parotidectomy with sternocleidomastoid flap reconstruction provides excellent aesthesis and improves quality of life.
Cerebral venous sinus thrombosis in a patient with concomitant Graves’ disease and squamous cell carcinoma of the cervix
Authors: Chee Yong Chuan , Abdul Halim Sanihah
Published: December 2020

Cerebral venous sinus thrombosis (CVST) is caused by either acquired or inherited pro-thrombotic states. Hyperthyroidism is a less recognised predisposing factor of CVST, and the causality has been debated. We report a case of a life-threatening CVST in a 40-year-old woman, with uncommon dual risk factors: hyperthyroidism and advanced squamous cell carcinoma of the cervix. CVST should be considered as a differential diagnosis when a patient with hyperthyroidism presents with new-onset headache or other neurological symptoms. Further assessment to elucidate other covert risk factors may need to be continuously carried out, when the causal relationship of one apparent cause has not been well established.
Internal herniation during pregnancy after banded Roux-en-Y gastric bypass: a unique location
Authors: Bonouvrie Daniëlle Susan , Boerma Evert-Jan , van Dielen Francois M H , Leclercq Wouter K G
Published: December 2020

A 26-year-old multigravida, 30+3weeks pregnant woman, was referred to our tertiary referral centre with acute abdominal pain and vomiting suspected for internal herniation. She had a history of a primary banded Roux-en-Y gastric bypass (B-RYGB). The MRI scan showed a clustered small bowel package with possible mesenteric swirl diagnosed as internal herniation. A diagnostic laparoscopy was converted to laparotomy showing an internal herniation of the alimentary limb through the silicone ring. The internal herniation was reduced by cutting the silicone ring. Postoperative recovery, remaining pregnancy and labour were uneventful. During pregnancy after B-RYGB, small bowel obstruction can in rare cases occur due to internal herniation through the silicone ring. Education regarding this complication should be provided before bariatric surgery. Treatment of women, 24 to 32 weeks pregnant, in a specialised centre for bariatric complications with a neonatal intensive care unit is advised to improve maternal and neonatal outcome.
Primary facial nerve paraganglioma: report and review of the literature
Authors: Berry Jonathan Austin , Nathan Cherie Ann O , Flowers Ashley B , Mankekar Gauri
Published: December 2020

This report describes the diagnosis and treatment of a patient with a rare primary facial nerve paraganglioma as well as a review of the current literature. A 60-year-old male patient presented to our clinic with a 4-month history of left-sided progressive facial paralysis House-Brackmann V. Biopsy taken during facial nerve (FN) decompression confirmed the diagnosis of paraganglioma. The left FN was sacrificed during resection of the mass and a 12-7 jump graft, using the left greater auricular nerve, was performed with acceptable outcomes. The rarity of these tumours does not discount their clinical importance or the necessity to include them in the differential when presented with unilateral FN paralysis. Investigation should begin with CT and MRI imaging to identify and localise the potential mass. Histologic confirmation requires tissue. While surveillance imaging is occasionally an option, often complete surgical resection of the mass and sacrifice of the nerve is necessary.
Paediatric inflammatory multisystem syndrome temporally associated with COVID-19: a new virus and a new case presentation
Authors: Makiello Phoebe , Svirpliene Sima , Finlay Lisa , McKnight Jean
Published: December 2020

An 11-year-old boy presented with features resembling those described in health alerts on Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), including persistent fever, haemodynamic instability and abdominal pain. Laboratory tests, including raised inflammatory markers, D-dimer, troponin and a coagulopathy, were consistent with PIMS-TS. Our patient required transfer to the paediatric intensive care unit; an echocardiography revealed left ventricular dysfunction. He was treated with intravenous immunoglobulins (Igs), corticosteroids and aspirin, with full resolution of clinical symptoms. A follow-up echocardiogram 1 month after discharge was unremarkable.

Three SARS-CoV-2 PCRs on respiratory samples, taken over the initial 4-day period, were negative, as was a SARS-CoV-2 PCR on faeces 1 month after presentation; titres of IgG were clearly elevated. The negative PCRs in the presence of elevated titres of IgG suggest that the inflammatory syndrome might have developed in a late phase of COVID-19 infection when the virus was no longer detectable in the upper airway.
Comparison of several survey-based algorithms to ascertain type 1 diabetes among US adults with self-reported diabetes
Authors: Casagrande Sarah S , Lessem Sarah E , Orchard Trevor J , Bullard Kai McKeever , Geiss Linda S , Saydah Sharon H , Menke Andy , Imperatore Giuseppina , Rust Keith F , Cowie Catherine C
Published: December 2020

Introduction

Defining type of diabetes using survey data is challenging, although important, for determining national estimates of diabetes. The purpose of this study was to compare the percentage and characteristics of US adults classified as having type 1 diabetes as defined by several algorithms.

Research design and methods

This study included 6331 respondents aged ≥18 years who reported a physician diagnosis of diabetes in the 2016–2017 National Health Interview Survey. Seven algorithms classified type 1 diabetes using various combinations of self-reported diabetes type, age of diagnosis, current and continuous insulin use, and use of oral hypoglycemics.

Results

The percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/m2, respectively) and percentage using oral hypoglycemics (16.1%, 11.1%, and 19.0%, respectively) were lower than for all other algorithms assessed. Among those defined by continuous insulin use alone (algorithm 1), the estimates for mean age and age of diagnosis (54.3 and 30.9 years, respectively) and BMI (30.9 kg/m2) were higher than for other algorithms.

Conclusions

Estimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification.
Effectiveness–implementation hybrid type 2 study evaluating an intervention to support ‘information work’ in dementia care: an implementation study protocol
Authors: De Poli Chiara , Oyebode Jan R , Binns Christopher , Glover Richard , Airoldi Mara
Published: December 2020

Introduction

Patients with long-term conditions consistently report a lack of information around services and support available to them. This unmet need for information is significant among people with dementia and family carers. A quality improvement intervention is being carried out to tackle this issue as part of a co-creation initiative in the North East of England (UK). The intervention consists of the dissemination (via the local Community Mental Health Services for Older People) of a leaflet about services available to people with dementia and their family carers in the study site. This protocol is reported in accordance with the Standards for Reporting Implementation Studies.

Methods and analysis

This effectiveness–implementation hybrid type 2 study aims at understanding (1) the unfolding and outcomes of the implementation strategy, (2) the outcomes of the intervention (for people with dementia and family carers, staff implementing the intervention and local service providers) and (3) the contribution of co-creation to the design and implementation of the intervention and its outcomes. The prospective theory of change of the intervention articulated by local stakeholders is used as a reference framework against which to assess the implementation and outcomes of the intervention. Evaluation data will be collected through in-depth interviews with people with dementia and family carers receiving the intervention, staff implementing the intervention and managers from local service providers. Referral data from local service providers will be collected to triangulate the interview data. A focus group with key stakeholders will support the sense-making of findings. The realist configuration of mechanism–context–outcome, operationalised using an information behaviour model, will inform data analysis and interpretation.

Ethics and dissemination

Ethical and research governance approvals have been obtained from the West Midlands—South Birmingham Research Ethics Committee. The results of the study will be submitted for publication in peer-reviewed journals and disseminated through conferences.
Establishment of a communication environment supporting low-health literacy in the Hungarian community pharmacies: the introduction of a methodological recommendation: a before–after study
Authors: Szilvay András , Somogyi Orsolya , Meskó Attiláné , Szűcs-Polonkai Kata , Zelkó Romána , Hankó Balázs
Published: December 2020

Objectives

The research aimed to support the effectiveness and necessity of the communication training and methodology introduced in the postgraduate pharmacy training and community pharmacy practice in Hungary.

Design

Two cross-sectional questionnaire surveys before and after the introduction of a methodological recommendation.

Setting

69 Hungarian community pharmacies.

Participants

The study included 333 pharmacists and pharmacy technicians from community pharmacies, 890 and 847 patients (over 18 who bought their prescribed medication) at the beginning and the end of the project, respectively.

Interventions

A 3-day postgraduate health literacy-focused communication training followed by the ‘Train the trainer’ teaching method at pharmacies, then the introduction of the learnt methodology using uniform information materials and a communication checklist.

Primary and secondary outcome measures

Primary: total score of the staff and patient questionnaires and the change in score due to the intervention, total and for each question. Secondary: the differences between sexes, age groups, marital statuses, educational attainments and types of settlement.

Results

The mean score of the preintervention patient group was 64.07% which increased to 72.72% by the end of the project (p<0.001). For staff, the mean score of the initial questionnaires was 74.47%, and that of the final questionnaires was 85.21% (p<0.001). According to both groups, professionals made the most progress in encouraging patients to ask questions.

Conclusions

It can be stated that the presented methodology can be used to develop the communication skills of a large number of professionals in a short time, using a small number of instructors, so it is worthwhile to introduce this methodology as part of compulsory postgraduate training.
Prevalence and determinants of incomplete or not at all vaccination among children aged 12–36 months in Dabat and Gondar districts, northwest of Ethiopia: findings from the primary health care project
Authors: Atnafu Asmamaw , Andargie Gashaw , Yitayal Mezgebu , Ayele Tadesse Awoke , Alemu Kassahun , Demissie Getu Debalkie , Wolde Haileab Fekadu , Dellie Endalkachew , Azale Telake , Geremew Bisrat Misganaw , Kebede Adane , Teshome Destaw Fetene , Gebremedhin Tsegaye , Derso Terefe
Published: December 2020

Objective

Ethiopia is one of the Africa’s signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12–36 months in Dabat and Gondar districts, Northwest Ethiopia.

Study design

The study is community-based cross-sectional study.

Study setting

Dabat and Gondar Zuria districts, Northwest Ethiopia.

Participants

Mothers/caregivers with children aged 12–36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis.

Methods

A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination.

Outcomes

Incomplete or not at all vaccination.

Results

The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25).

Conclusions

In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease.
Needlestick and sharps injuries in an Indonesian tertiary teaching hospital from 2014 to 2017: a cohort study
Authors: Yunihastuti Evy , Ratih Dewi Mira , Aisyah Matdoan Rifkiah , Hidayah Ainum Jhariah , Widhani Alvina , Sulaiman Andri Sanityoso , Karjadi Teguh Harjono , Soejono Czeresna Heriawan
Published: December 2020

Objective

Needlestick and sharps injuries among healthcare workers (HCWs) pose significant occupational health problems. We aim to provide incidence and other epidemiological aspects of needlestick and sharp injuries (NSSIs) among HCWs in a tertiary teaching hospital in Indonesia, to inform the evaluation of NSSIs prevention programme.

Methods

A cohort study was conducted at Cipto Mangunkusumo Hospital in Jakarta. We analysed data of the sharps injury programme at the hospital between January 2014 and December 2017. Incidence of NSSIs was calculated per 1000 person-years (1000-PY).

Results

Over the 4-year period, a total of 286 NSSIs were reported. The mean NSSIs incidence rate for 4 years was 13.3/1000-PY, peaking in 2015 (15.5/1000-PY) then decreasing afterward. Most NSSIs were experienced by nurses (42.7%), but the highest incidence was among midwives (18.9/1000-PY), followed by nurses, medical students and medical doctors (15.2/1000-PY, 12.6/1000-PY and 11.8/1000-PY, respectively). The devices causing the highest proportion of NSSIs were hollow-bore needles (66.8%), followed by suture needles (14.3%) and solid needles (10.8%). 9.4% of NSSIs were related to insulin pen injection. Of all the incidents, 31.3% occurred during surgical procedures, 25.9% during blood collections, 14.3% during administering injection of drugs and 13.3% during waste cleaning.

Conclusion

In conclusion, this study showed varied incidences of NSSI among different occupations, with the highest among midwives and nurses. Many unsafe work practices still continue, which is of utmost concern. We suggest opportunities for prevention including training and cultivating safer workplace practices.
Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas
Authors: Wilkinson Dominic , Zohny Hazem , Kappes Andreas , Sinnott-Armstrong Walter , Savulescu Julian
Published: December 2020

Objective

As cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICUs) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help inform triage guidance by exploring the views of lay people about factors to include in triage decisions.

Design, setting and participants

Online survey between 29th of May and 22nd of June 2020 based on hypothetical triage dilemmas. Participants recruited from existing market research panels, representative of the UK general population. Scenarios were presented in which a single ventilator is available, and two patients require ICU admission and ventilation. Patients differed in one of: chance of survival, life expectancy, age, expected length of treatment, disability and degree of frailty. Respondents were given the option of choosing one patient to treat or tossing a coin to decide.

Results

Seven hundred and sixty-three participated. A majority of respondents prioritised patients who would have a higher chance of survival (72%–93%), longer life expectancy (78%–83%), required shorter duration of treatment (88%–94%), were younger (71%–79%) or had a lesser degree of frailty (60%–69%, all p<0.001). Where there was a small difference between two patients, a larger proportion elected to toss a coin to decide which patient to treat. A majority (58%–86%) were prepared to withdraw treatment from a patient in intensive care who had a lower chance of survival than another patient currently presenting with COVID-19. Respondents also indicated a willingness to give higher priority to healthcare workers and to patients with young children.

Conclusion

Members of the UK general public potentially support a broadly utilitarian approach to ICU triage in the face of overwhelming need. Survey respondents endorsed the relevance of patient factors currently included in triage guidance, but also factors not currently included. They supported the permissibility of reallocating treatment in a pandemic.