bluuebunny/crossref_metadata_2025 huggingface dataset:
Different approaches to heart valve decellularization: A comprehensive overview of the past 30 years
Authors: Naso Filippo , Gandaglia Alessandro
Published: October 2017

Xenogeneic decellularized heart valve scaffolds have the potential to overcome the limitations of existing bioprosthetic heart valves that have limited duration due to calcification and tissue degeneration phenomena. This article presents a review of 30 years of decellularization approaches adopted in cardiovascular tissue engineering, with a focus on the use, either individually or in combination, of different detergents. The safety and efficacy of cell‐removal procedures are specifically reported and discussed, as well as the structure and biomechanics of the treated extracellular matrix (ECM). Detergent residues within the ECM, production of hyaluronan fragments, safe removal of cellular debris, and the persistence of the alpha‐Gal epitope after the decellularization treatments are of particular interest as parameters for the identification of the best tissue for the manufacture of bioprostheses. Special attention has also been given to key factors that should be considered in the manufacture of the next generation of xenogeneic bioprostheses, where tissues must retain the ability to be remodeled and to grow in weight along with body reshaping.
THE CENTRAL SUBGROUPS OF THE NONABELIAN TENSOR SQUARES OF SOME BIEBERBACH GROUPS WITH ELEMENTARY ABELIAN 2-GROUP POINT GROUP
Authors: Abdul Ladi Nor Fadzilah , Masri Rohaidah , Mohd Idrus Nor'ashiqin , Sarmin Nor Haniza , Yee Ting Tan
Published: October 2017

Bieberbach groups are torsion free crystallographic groups. In this paper, our focus is on the Bieberbach groups with elementary abelian 2-group point group,  The central subgroup of the nonabelian tensor square of a group  is generated by  for all  in  The purpose of this paper is to compute the central subgroups of the nonabelian tensor squares of two Bieberbach groups with elementary abelian 2-point group of dimension three.
HUMAN IDENTIFICATION BASED ON HEART SOUND AUSCULTATION POINT
Authors: Nur Fariza I. , Salleh Sh-Hussain , Noman Fuad , Hussain Hadri
Published: October 2017

The application of human identification and verification has widely been used for over the past few decades.  Drawbacks of such system however, are inevitable as forgery sophisticatedly developed alongside the technology advancement.  Thus, this study proposed a research on the possibility of using heart sound as biometric. The main aim is to find an optimal auscultation point of heart sounds from either aortic, pulmonic, tricuspid or mitral that will most suitable to be used as the sound pattern for personal identification.  In this study, the heart sound was recorded from 92 participants using a Welch Allyn Meditron electronic stethoscope whereas Meditron Analyzer software was used to capture the signal of heart sounds and ECG simultaneously for duration of 1 minute.  The system is developed by a combination Mel Frequency Cepstrum Coefficients (MFCC) and Hidden Markov Model (HMM).  The highest recognition rate is obtained at aortic area with 98.7% when HMM has 1 state and 32 mixtures, the lowest Equal Error Rate (EER) achieved was 0.9% which is also at aortic area.  In contrast, the best average performance of HMM for every location is obtained at mitral area with 99.1% accuracy and 17.7% accuracy of EER at tricuspid area.
NANO-MOSFETs IMPLEMENTATION OF DIFFERENT LOGIC FAMILIES OF TWO INPUTS NAND GATE TRANSISTOR LEVEL CIRCUITS: A SIMULATION STUDY
Authors: Chek Yee Ooi , Soo King Lim
Published: October 2017

In this paper, simulation study has been carried out on two inputs logic NAND transistor circuits with four different logic families, namely (i) nano-CMOS NAND gate, (ii) nano-MOSFET loaded n-type nano-MOSFET NAND gate, (iii) resistive loaded nano-MOSFET NAND gate, and (iv) pseudo nano-MOSFET NAND gate. The simulation tool used is WinSpice. All the n-type and p-type nano-MOSFETs have channel length (L) 10 nm with width (W) 125 nm or 250 nm, depending on type of logic families. The problem with downscaling of nano-MOSFET is the implementation of low power high speed nano-MOSFET transistor circuit. Simulated timing diagrams for input and output waveforms showed correct logical NAND gate operations for all four logic families. Transient analysis on nano-MOSFET loaded n-type nano-MOSFET NAND gate shows that theoretical modeling calculation of rise time (tr), fall time (tf) and maximum operating frequency (fmax) are reasonably matched simulated output result of WinSpice. All the logic family circuits studied shown reduction in dynamic power when MOSFET is downscaled to nanometer regime.
Arithmetic properties of Apéry-like numbers
Authors: Delaygue É.
Published: October 2017

We provide lower bounds for$p$-adic valuations of multisums of factorial ratios which satisfy an Apéry-like recurrence relation: these include Apéry, Domb and Franel numbers, the numbers of abelian squares over a finite alphabet, and constant terms of powers of certain Laurent polynomials. In particular, we prove Beukers’ conjectures on the$p$-adic valuation of Apéry numbers. Furthermore, we give an effective criterion for a sequence of factorial ratios to satisfy the$p$-Lucas property for almost all primes$p$.
Wavelet-Based Multiresolution Bispectral Analysis for Detection and Classification of Helicopter Drive-Shaft Problems
Authors: Hassan Mohammed A. , Habib Michael R. , Abul Seoud Rania A. , Bayoumi Abdel M.
Published: October 2017

Condition monitoring and fault diagnostics in rotorcraft have significant effect on improving safety level and reducing operational and maintenance costs. In this paper, a new method is proposed for fault detection and diagnoses of AH-64D (Apache helicopter) tail rotor drive-shaft problems. The proposed method depends on decomposing signal into different frequency ranges using mother wavelet. The most informative part of the vibration signal is then determined by calculating Shannon entropy of each part. Bispectrum is calculated for this part to investigate quadratic nonlinearities in this segment. Then, search algorithm is used to extract minimum number of indicative features from the bispectrum, which are then fed to classification algorithms. In order to quantitatively evaluate the proposed method, six classification algorithms are compared against each other such as fine K-nearest neighbor (KNN), cubic KNN, quadratic discriminant analysis, linear support vector machine (SVM), Gaussian SVM, and neural network. Comparison criteria include accuracy, precision, sensitivity, F score, true alarm, recall, and error classification accuracy (ECA). The proposed method is verified using real-world vibration data collected from a dedicated AH-64D helicopter tail rotor drive train (TRDT) research test bed. The proposed algorithm proves its ability in finding minimum number of indicative features and classifying the shaft faults with superior performance.
Double Wall Cooling of a Full-Coverage Effusion Plate, Including Internal Impingement Array Cooling
Authors: Ligrani Phil , Ren Zhong , Liberatore Federico , Patel Rajeshriben , Srinivasan Ram , Ho Yin-Hsiang
Published: October 2017

New experimental data are provided for full-coverage effusion cooling and impingement array cooling, as applied simultaneously onto the respective external and internal surfaces of a single instrumented test plate. For the effusion cooled surface, presented are spatially resolved distributions of surface adiabatic film cooling effectiveness, and surface heat transfer coefficients. For the impingement cooled surface, presented are spatially resolved distributions of surface Nusselt numbers. Impingement jet arrays at different jet Reynolds numbers, from 7930 to 18,000, are employed. Experimental data are given for spanwise and streamwise impingement hole spacing such that coolant jet hole centerlines are located midway between individual effusion hole entrances. For the effusion cooling, streamwise hole spacing and spanwise hole spacing (normalized by effusion hole diameter) are 15 and 4, respectively. Effusion hole angle is 25 deg, and effusion plate thickness is 3.0 effusion hole diameters. In regard to the impingement cooled cold-side surface of the effusion plate, associated surface Nusselt number variations provide evidence that impingement jets are turned and redirected as they cross the impingement passage, just prior to the entrance of coolant into individual effusion holes. In regard to the effusion cooled hot-side surface of the effusion plate, when compared at particular values of injectant and mainstream Reynolds numbers, streamwise location x/de and blowing ratio BR, significantly increased thermal protection is provided when the effusion coolant is provided by an array of impingement cooling jets (compared to a cross flow channel supply arrangement).
Shoe–Floor Interactions in Human Walking With Slips: Modeling and Experiments
Authors: Trkov Mitja , Yi Jingang , Liu Tao , Li Kang
Published: October 2017

Shoe–floor interactions play a crucial role in determining the possibility of potential slip and fall during human walking. Biomechanical and tribological parameters influence the friction characteristics between the shoe sole and the floor and the existing work mainly focus on experimental studies. In this paper, we present modeling, analysis, and experiments to understand slip and force distributions between the shoe sole and floor surface during human walking. We present results for both soft and hard sole material. The computational approaches for slip and friction force distributions are presented using a spring-beam networks model. The model predictions match the experimentally observed sole deformations with large soft sole deformation at the beginning and the end stages of the stance, which indicates the increased risk for slip. The experiments confirm that both the previously reported required coefficient of friction (RCOF) and the deformation measurements in this study can be used to predict slip occurrence. Moreover, the deformation and force distribution results reported in this study provide further understanding and knowledge of slip initiation and termination under various biomechanical conditions.
Damage Accumulation Modeling and Rate Dependency of Spinal Dura Mater
Authors: Ramo Nicole , Shetye Snehal S. , Puttlitz Christian M.
Published: October 2017

As the strongest of the meningeal tissues, the spinal dura mater plays an important role in the overall behavior of the spinal cord-meningeal complex (SCM). It follows that the accumulation of damage affects the dura mater's ability to protect the cord from excessive mechanical loads. Unfortunately, current computational investigations of spinal cord injury (SCI) etiology typically do not include postyield behavior. Therefore, a more detailed description of the material behavior of the spinal dura mater, including characterization of damage accumulation, is required to comprehensively study SCI. Continuum mechanics-based viscoelastic damage theories have been previously applied to other biological tissues; however, the current work is the first to report damage accumulation modeling in a tissue of the SCM complex. Longitudinal (i.e., cranial-to-caudal long-axis) samples of ovine cervical dura mater were tensioned-to-failure at one of three strain rates (quasi-static, 0.05/s, and 0.3/s). The resulting stress–strain data were fit to a hyperelastic continuum damage model to characterize the strain-rate-dependent subfailure and failure behavior. The results show that the damage behavior of the fibrous and matrix components of the dura mater are strain-rate dependent, with distinct behaviors when exposed to strain rates above that experienced during normal voluntary neck motion suggesting the possible existence of a protective mechanism.
Research on Cooling Methods of Voice Coil Motor
Authors: Zhou Pu , Zhang Yue , Dai Xuechang , Wang Qiang , Wu Weiliang
Published: October 2017

Voice coil motor (VCM) has advantages of small volume, light weight, rapid response to velocity and acceleration, uniform mechanical characteristics, etc. It is widely used in various types of servo control systems. Because of the compact structure, heat dissipation from VCM becomes more difficult. In special circumstances, cooling technology has become an important factor of the cost and life restriction. It is investigated a VCM in this paper, which needs frequent action and operate in high ambient temperature. Using the flow-solid coupling method, the temperature field of components in the motor is simulated under natural and forced cooling. To verify the simulated results an experiment is carried out. It is indicated that the forced cooling is a necessary auxiliary for operation of such types of coil motor.
Single fiber surface enhanced Raman scattering probe
Authors: Basu Srismrita , Hou HsuanChao , Biswas Debsmita , Daniels-Race Theda , Lopez Mandi , Michael Mathis J. , Feldman Martin
Published: October 2017

Raman spectroscopy is a time honored technique for identifying molecular structures. In surface enhanced Raman scattering close proximity of the sample to so-called “hot spots” in a rough metallic surface enhances the Raman signal strength enormously. For in vivo applications an optical fiber in a narrow probe is desirable to minimize invasiveness. Unfortunately, in a long fiber to the spectrometer Raman scattering within the fiber masks the signal from the specimen. Systems are available which avoid this problem by using one fiber to transmit the exciting light, additional fibers to collect the scattered Raman light, and metallic nanoparticles disbursed within the specimen. Unfortunately, the Raman signal is up to thousands of times smaller than for a single fiber. In addition, variation in the dispersion of the nanoparticles makes comparisons between sites problematical. The authors have retained the advantages of a single fiber by coupling a short length to the spectrometer via a 1 m long air path in an articulated mirrored arm. The fiber is inside a 0.5 mm ID stainless steel needle and has gold nanoparticles glued to its end. Representative spectra were obtained from various biological tissues, and distinct differences between cancerous and benign mouse colon cells were observed.
Estimating the sound speed of a shallow-water marine sediment from the head wave excited by a low-flying helicopter
Authors: Bevans Dieter A. , Buckingham Michael J.
Published: October 2017

The frequency bandwidth of the sound from a light helicopter, such as a Robinson R44, extends from about 13 Hz to 2.5 kHz. As such, the R44 has potential as a low-frequency sound source in underwater acoustics applications. To explore this idea, an experiment was conducted in shallow water off the coast of southern California in which a horizontal line of hydrophones detected the sound of an R44 hovering in an end-fire position relative to the array. Some of the helicopter sound interacted with seabed to excite the head wave in the water column. A theoretical analysis of the sound field in the water column generated by a stationary airborne source leads to an expression for the two-point horizontal coherence function of the head wave, which, apart from frequency, depends only on the sensor separation and the sediment sound speed. By matching the zero crossings of the measured and theoretical horizontal coherence functions, the sound speed in the sediment was recovered and found to take a value of 1682.42 ± 16.20 m/s. This is consistent with the sediment type at the experiment site, which is known from a previous survey to be a fine to very-fine sand.
Jamming and overpacking fuzzy microgels: Deformation, interpenetration, and compression
Authors: Conley Gaurasundar M. , Aebischer Philippe , Nöjd Sofi , Schurtenberger Peter , Scheffold Frank
Published: October 2017

Superresolution microscopy unravels the nanoscale properties of densely packed stimuli-responsive polymer microgels.
Electrotunable artificial molecules based on van der Waals heterostructures
Authors: Zhang Zhuo-Zhi , Song Xiang-Xiang , Luo Gang , Deng Guang-Wei , Mosallanejad Vahid , Taniguchi Takashi , Watanabe Kenji , Li Hai-Ou , Cao Gang , Guo Guang-Can , Nori Franco , Guo Guo-Ping
Published: October 2017

Electrically controlled evolution from an artificial molecule to an artificial atom in atomically thin MoS
2
is demonstrated.
Complete Genome Sequence of
Escherichia
Phage OSYSP
Authors: Yesil Mustafa , Huang En , Yang Xu , Yousef Ahmed E.
Published: October 2017

Bacteriophage OSYSP is a new anti-
Escherichia coli
O157:H7 phage isolated from municipal wastewater in Ohio. OSYSP is potent against enterohemorrhagic
E. coli
and is a candidate biocontrol agent for food and therapeutic applications. In this paper, we present the important genetic features of this phage based on its complete genome sequence.
Whole-Genome Sequence of a Megasphaera elsdenii Strain Isolated from the Gut of a Healthy Indian Adult Subject
Authors: Bag Satyabrata , Ghosh Tarini Shankar , Das Bhabatosh
Published: October 2017

Megasphaera elsdenii
has been previously reported in the gut of ruminating animals. Its role as an animal probiotic is being investigated, specifically from the perspective of enhancing animal productivity. Herein, we report the draft genome sequence of
M. elsdenii
strain indica isolated from the stool sample of a healthy Indian subject.
Significant correlation between meibomian gland dysfunction and keratitis in young patients with Demodex brevis infestation
Authors: Liang Lingyi , Liu Yan , Ding Xiaohu , Ke Hongmin , Chen Chuan , Tseng Scheffer C G
Published: October 2017

Aims

To report the clinical characteristics and correlation between meibomian gland dysfunction (MGD) and keratitis in young patients with ocular demodicosis.

Methods

Observational case series of 60 patients younger than 35 years with ocular demodicosis, of which the diagnosis was based on microscopic counting of Demodex folliculorum and D. brevis of epilated lashes. Severity of keratitis and MGD was graded by photography and meibography, respectively, in a masked fashion.

Results

MGD was detected in 54/60 (90%) patients with the loss of meibomian gland in the upper lid more than the lower lid (p<0.001). Blepharoconjunctivitis and a variety of corneal pathologies were noted in 47/60 (78.3%) and 39/60 (65%) patients, respectively. For a total of 120 eyes, normal cornea was noted in 53 (44.2%) eyes, superficial punctate keratitis or limbitis was noted in 17 (14.2%), while corneal stromal infiltration was found in 50 (41.7%) eyes. Both univariate and multivariate analyses showed that the severity of meibomian gland loss was significantly correlated with higher D. brevis count and more severe keratitis (all p<0.05). Rapid resolution of keratitis and blepharoconjunctivitis was accompanied by significant reduction of the Demodex count in 48 patients receiving lid scrub directed to kill mites.

Conclusions

There is a significant correlation between MGD and keratitis in young patients with ocular demodicosis especially inflicted by D. brevis.
Efficacy of a movement control injury prevention programme in adult men’s community rugby union: a cluster randomised controlled trial
Authors: Attwood Matthew J , Roberts Simon P , Trewartha Grant , England Mike E , Stokes Keith A
Published: October 2017

Background

Exercise programmes aimed at reducing injury have been shown to be efficacious for some non-collision sports, but evidence in adult men’s collision sports such as rugby union is lacking.

Objective

To evaluate the efficacy of a movement control injury prevention exercise programme for reducing match injuries in adult men’s community rugby union players.

Methods

856 clubs were invited to participate in this prospective cluster randomised (single-blind) controlled trial where clubs were the unit of randomisation. 81 volunteered and were randomly assigned (intervention/control). A 42-week exercise programme was followed throughout the season. The control programme reflected ‘normal practice’ exercises, whereas the intervention focused on proprioception, balance, cutting, landing and resistance exercises.

Outcome measures were match injury incidence and burden for: (1) all ≥8 days time-loss injuries and (2) targeted (lower limb, shoulder, head and neck, excluding fractures and lacerations) ≥8 days time-loss injuries.

Results

Poisson regression identified no clear effects on overall injury outcomes. A likely beneficial difference in targeted injury incidence (rate ratio (RR), 90% CI=0.6, 0.4 to 1.0) was identified, with a 40% reduction in lower-limb incidence (RR, 90% CI=0.6, 0.4 to 1.0) and a 60% reduction in concussion incidence (RR, 90% CI=0.4, 0.2 to 0.7) in the intervention group. Comparison between arms for clubs with highest compliance (≥median compliance) demonstrated very likely beneficial 60% reductions in targeted injury incidence (RR, 90% CI=0.4, 0.2 to 0.8) and targeted injury burden (RR, 90% CI=0.4, 0.2 to 0.7).

Conclusions

The movement control injury prevention programme resulted in likely beneficial reductions in lower-limb injuries and concussion. Higher intervention compliance was associated with reduced targeted injury incidence and burden.
Prevalence of illness, poor mental health and sleep quality and low energy availability prior to the 2016 Summer Olympic Games
Authors: Drew Michael , Vlahovich Nicole , Hughes David , Appaneal Renee , Burke Louise M , Lundy Bronwen , Rogers Margot , Toomey Mary , Watts David , Lovell Gregory , Praet Stephan , Halson Shona L , Colbey Candice , Manzanero Silvia , Welvaert Marijke , West Nicholas P , Pyne David B , Waddington Gordon
Published: October 2017

Objective

Establish the prevalence of illness symptoms, poor sleep quality, poor mental health symptoms, low energy availability and stress-recovery state in an Olympic cohort late in the 3 months prior to the Summer Olympic Games.

Methods

Olympic athletes (n=317) from 11 sports were invited to complete questionnaires administered 3 months before the Rio 2016 Olympic Games. These questionnaires included the Depression, Anxiety and Stress Questionnaire, Perceived Stress Scale, Dispositional Resilience Scale, Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy Availability in Females Questionnaire (LEAF-Q), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and custom-made questionnaires on probiotic usage and travel. Multiple illness (case) definitions were applied. ORs and attributable fractions in the population were used. Factor analyses were used to explore the relationships between variables.

Results

The response rate was of 42% (male, n=47, age 25.8±4.1 years; female, n=85, age 24.3±3.9 years). Low energy availability was associated with sustaining an illness in the previous month (upper respiratory, OR=3.8, 95% CI 1.2 to 12). The main factor relating to illness pertained to a combination of anxiety and stress-recovery states (as measured by the REST-Q-52 item). All participants reported at least one episode of illness in the last month (100% prevalence).

Conclusions

All participants reported at least one illness symptom in the previous month. Low energy availability was a leading variable associated with illness in Olympic-class athletes. The estimates duration of symptoms ranged from 2 to 7 days. Factor analyses show the interdependence of various health domains and support multidisciplinary care.
Leisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies
Authors: Xu Wei , Wang Hui Fu , Wan Yu , Tan Chen-Chen , Yu Jin-Tai , Tan Lan
Published: October 2017

Background

There is considerable evidence of the favourable role of more physical activity (PA) in fighting against dementia. However, the shape of the dose–response relationship is still unclear.

Objective

To quantitatively investigate the relationship between dementia and PA.

Design

PubMed, EMBASE, Ovid and the Cochrane Library were searched for prospective studies published from 1 January 1995 to 15 October 2016. Two types of meta-analyses were performed with a focus on the dose–response relationship using two stage generalised least squares regression.

Results

The primary analysis exhibited a dose–response trend for all-cause dementia (ACD), Alzheimer’s disease (AD) but not for vascular dementia (VD). In the dose–response analysis, either ACD (ptrend<0.005; pnon-linearity=0.87) or AD (ptrend<0.005; pnon-linearity=0.10) exhibited a linear relationship with leisure time PA (LTPA) over the observed range (0–2000 kcal/week or 0–45 metabolic equivalent of task hours per week (MET-h/week)). Specifically, for every 500 kcal or 10 MET-h increase per week, there was, on average, 10% and 13% decrease in the risk of ACD and AD, respectively.

Conclusions

We have reported, for the first time, the dose–response relationship between LTPA and dementia, further supporting the international PA guideline from the standpoint of dementia prevention.
Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol
Authors: Aery Anjana , Rucchetto Anne , Singer Alexander , Halas Gayle , Bloch Gary , Goel Ritika , Raza Danyaal , Upshur Ross E G , Bellaire Jackie , Katz Alan , Pinto Andrew David
Published: October 2017

Objectives

Addressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits?

Methods

An advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site.

Ethics and dissemination

Key ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings.

Trial registration number

Clinicaltrials.gov:NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.
Effect of levothyroxine on the progression of carotid intima-media thickness in subclinical hypothyroidism patients: a meta-analysis
Authors: Zhao Tong , Chen Baomin , Zhou Yingying , Wang Xinyi , Zhang Yuanyuan , Wang Haoyu , Shan Zhongyan
Published: October 2017

Background

Subclinical hypothyroidism (SCH) has been associated with increased carotid intima-media thickness (C-IMT) in recent studies, but the effects of levothyroxine (L-T4) therapy on C-IMT in SCH patients are still controversial.

Aim

To evaluate the effect of L-T4 therapy on endothelial function as determined by C-IMT in patients with SCH.

Methods

BeforeJuly 2016, we searched the PubMed, Embase, Cochrane Library and Google Scholar databases, selecting published randomised controlled trials (RCTs) and self-controlled trials for the meta-analysis.

Results

Three RCTs with 117 patients were considered appropriate for the meta-analysis. The results of the meta-analysis indicated that L-T4 significantly decreased the development of C-IMT (weighted mean difference (WMD) −0.05 mm, 95% CI −0.08 to –0.01 mm; p=0.025). We also analysed nine studies (self-controlled trials) with 247 patients and extracted the IMT of SCH patients before and after L-T4 treatment. After L-T4 therapy, the pooled estimate of the WMD of decreased C-IMT was −0.04 mm (95% CI −0.07 to –0.02 mm; p=0.05). Subgroup analysis showed that L-T4 therapy was associated with a decrease in C-IMT among patients of mixed genders (WMD −0.03 mm, 95% CI −0.06 to –0.01 mm; p=0.145). L-T4 therapy was associated with a decrease in C-IMT among female patients (WMD −0.07 mm, 95% CI −0.14 to –0.01; p=0.186). Longer treatment (>6 months) also resulted in a significant decrease in C-IMT (WMD −0.05 mm, 95% CI −0.08 to –0.02; p=0.335).

Conclusion

This meta-analysis indicates that L-T4 treatment of SCH patients can reduce C-IMT, possibly as a result of the reduction of total cholesterol, triglyceride, low density lipoprotein, systolic blood pressure, diastolic blood pressure, lipoprotein(a), and flow-mediated dilatation. Decreased C-IMT was observed in SCH patients after long-term (>6 months) L-T4 treatment. RCTs with larger samples are needed to verify these observations.
Caregivers’ quality of life and psychological health in response to functional, cognitive, neuropsychiatric and social deficits of patients with brain tumour: protocol for a cross-sectional study
Authors: Ramirez Carole , Christophe Véronique , Dassonneville Charlotte , Grynberg Delphine
Published: October 2017

Introduction

Patients with gliomas generally present cognitive, neuropsychiatric and functional deficits. Although previous research has shown that their caregivers present a poor quality of life and poor mental health, only a few studies have tested in a comprehensive way which deficits/preserved abilities of patients predominantly impact their caregivers. Furthermore, only a few studies have focused on the social impact of gliomas, which may also damage the caregivers’ quality of life. Therefore, this cross-sectional study aims to investigate which patients’ impairments are particularly deleterious for the caregivers and whether the histological characteristics of the gliomas also affect their quality of life.

Methods and analysis

In order to examine these research questions, this study intends to include 180 patients (60 patients with grade II gliomas, 60 patients with grade III gliomas and 60 patients with grade IV gliomas), their caregivers and 60 healthy controls. While patients will complete a full battery of cognitive, neuropsychiatric, functional and social tests, caregivers will complete questionnaires about their quality of life, depression, anxiety and burden. Patients’ performances and caregivers’ reports of depression and anxiety will be compared with the scores of healthy controls. Eventually, our aim will be to provide specific care support both to reduce patients’ deficits and alleviate caregivers’ difficulties.

Ethics and dissemination

The study has obtained the approval of the local faculty ethics committee (‘Comité d’éthique en sciences comportementales’; 2016–5 S41 and 2015–3 S37). On completion of the study, data will be kept by Lille University for 5 years before they are destroyed. Study findings will be disseminated through peer-reviewed journal publications and conference presentations with no reference to a specific individual.
Cross-sectional study of the provision of interventional oncology services in the UK
Authors: Zhong Jim , Atiiga Peter , Alcorn Des J , Kay David , Illing Rowland , Breen David J , Railton Nicholas , McCafferty Ian J , Haslam Philip J , Wah Tze Min
Published: October 2017

Objective

To map out the current provision of interventional oncology (IO) services in the UK.

Design

Cross-sectional multicentre study.

Setting

All National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards.

Participants

Interventional radiology (IR) departments in all NHS trusts/health boards in the UK.

Results

A total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures.

Conclusion

The provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services.
Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study
Authors: Evandrou Maria , Falkingham Jane C , Qin Min , Vlachantoni Athina
Published: October 2017

Objectives

This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.

Design

The study uses a cross-sectional survey design.

Setting

The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states—Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu—in 2011.

Statistical analyses

Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately.

Results

The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households.

Conclusions

Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be ‘hidden’ within well-off households.
Factors associated with patient activation in an Australian population with comorbid diabetes and chronic kidney disease: a cross-sectional study
Authors: Zimbudzi Edward , Lo Clement , Ranasinha Sanjeeva , Fulcher Gregory R , Jan Stephen , Kerr Peter G , Polkinghorne Kevan R , Russell Grant , Walker Rowan G , Zoungas Sophia
Published: October 2017

Objective

To evaluate the extent of patient activation and factors associated with activation in adults with comorbid diabetes and chronic kidney disease (CKD).

Design

A cross-sectional study.

Setting

Renal/diabetes clinics of four tertiary hospitals across the two largest states of Australia.

Study population

Adult patients (over 18 years) with comorbid diabetes and CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2).

Main outcome measures

Patients completed the Patient Activation Measure, the Kidney Disease Quality of Life and demographic and clinical data survey from January to December 2014. Factors associated with patient activation were examined using χ2or t-tests and linear regression.

Results

Three hundred and five patients with median age of 68 (IQR 14.8) years were studied. They were evenly distributed across socioeconomic groups, stage of kidney disease and duration of diabetes but not gender. Approximately 46% reported low activation. In patients with low activation, the symptom/problem list, burden of kidney disease subscale and mental composite subscale scores were all significantly lower (all p<0.05). On multivariable analysis, factors associated with lower activation for all patients were older age, worse self-reported health in the burden of kidney disease subscale and lower self-care scores. Additionally, in men, worse self-reported health in the mental composite subscale was associated with lower activation and in women, worse self-reported health scores in the symptom problem list and greater renal impairment were associated with lower activation.

Conclusion

Findings from this study suggest that levels of activation are low in patients with diabetes and CKD. Older age and worse self-reported health were associated with lower activation. This data may serve as the basis for the development of interventions needed to enhance activation and outcomes for patients with diabetes and CKD.
Interpreting diagnostic tests with continuous results and no gold standard: a common scenario explained using the tuberculin skin test
Authors: Dobler Claudia C , Murad M Hassan
Published: October 2017

Practitioners of evidence-based medicine commonly encounter diagnostic tests with continuous results and no gold standard. In contrast, the traditional critical appraisal teachings assume a binary test (2×2 table) with a gold standard. In this guide, we use the example of the tuberculin skin test to illustrate a simple approach facilitated by using stratum-specific likelihood ratios and odds of developing future patient-important events. This approach can aid practitioners in the interpretation and application of diagnostic tests to patient care.
Perceived support at work after critical incidents and its relation to psychological distress: a survey among prehospital providers
Authors: Gouweloos-Trines Juul , Tyler Mark P , Giummarra Melita J , Kassam-Adams Nancy , Landolt Markus A , Kleber Rolf J , Alisic Eva
Published: October 2017

Introduction

Prehospital providers are at increased risk for psychological distress. Support at work after critical incidents is believed to be important for providers, but current guidelines are in need of more scientific evidence. This study aimed to investigate: (1) to what extent prehospital providers experience support at work; (2) whether support at work is directly associated with lower distress and (3) whether availability of a formal peer support system is related to lower distress via perceived colleague support.

Methods

This cross-sectional study surveyed prehospital providers from eight western industrialised countries between June and November 2014. A supportive work environment was operationalised as perceived management and colleague support (Job Content Questionnaire), availability of a formal peer support system and having enough time to recover after critical incidents. The outcome variable was psychological distress (Kessler 10). We conducted multiple linear regression analyses and mediation analysis.

Results

Of the 813 respondents, more than half (56.2%) were at moderate to high risk of psychological distress. Participants did not consistently report support at work (eg, 39.4% were not aware of formal peer support). Perceived management support (b (unstandardised regression coefficient)=−0.01, 95% CI −0.01 to 0.00), having enough time to recover after critical incidents (b=−0.07, 95% CI −0.09 to −0.04) and perceived colleague support (b=−0.01, 95% CI −0.01 to 0.00) were related to lower distress. Availability of formal peer support was indirectly related to lower distress via increased perceived colleague support (β=−0.04, 95% CI −0.02 to −0.01).

Conclusions

Prehospital providers at risk of psychological distress may benefit from support from colleagues and management and from having time to recover after critical incidents. Formal peer support may assist providers by increasing their sense of support from colleagues. These findings need to be verified in a longitudinal design.
High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B
Authors: Kim Gi-Ae , Lim Young-Suk , Han Seungbong , Choi Jonggi , Shim Ju Hyun , Kim Kang Mo , Lee Han Chu , Lee Yung Sang
Published: October 2017

Objective

High serum HBV DNA levels are associated with high risks of hepatocellular carcinoma (HCC) and cirrhosis in patients with chronic hepatitis B (CHB). Although the immune-tolerant (IT) phase is characterised by high circulating HBV DNA levels, it remains unknown whether antiviral treatment reduces risks of HCC and mortality.

Design

This historical cohort study included HBeAg-positive patients with CHB with high HBV DNA levels (≥20 000 IU/mL) and no evidence of cirrhosis at a tertiary referral hospital in Korea from 2000 to 2013. The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT ≥80 IU/mL) treated with nucleos(t)ide analogues.

Results

The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p<0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (HR 2.54; 95% CI 1.54 to 4.18) and death/transplantation (HR 3.38; 95% CI 1.85 to 6.16) than the IA group, which was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses.

Conclusions

Untreated IT-phase patients with CHB had higher risks of HCC and death/transplantation than treated IA-phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT-phase patients.
Primary schools and the amplification of social differences in child mental health: a population-based cohort study
Authors: Marryat Louise , Thompson Lucy , Minnis Helen , Wilson Philip
Published: October 2017

Background

This paper examines socioeconomic inequalities in mental health at school entry and explores changes in these inequalities over the first 3 years of school.

Methods

The study utilises routinely collected mental health data from education records and demographic data at ages 4 and 7 years, along with administrative school-level data. The study was set in preschool establishments and schools in Glasgow City, Scotland. Data were available on 4011 children (59.4%)at age 4 years, and 3166 of these children were followed at age 7 years (46.9% of the population). The main outcome measure was the teacher-rated Goodman’s Strengths and Difficulties Questionnaire (4–16 version) at age 7 years, which measures social, emotional and behavioural difficulties.

Results

Children living in the most deprived area had higher levels of mental health difficulties at age 4 years, compared with their most affluent counterparts (7.3%vs4.1% with abnormal range scores). There was a more than threefold widening of this disparity over time, so that by the age of 7 years, children from the most deprived area quintile had rates of difficulties 3.5 times higher than their more affluent peers. Children’s demographic backgrounds strongly predicted their age 7 scores, although schools appeared to make a significant contribution to mental health trajectories.

Conclusions

Additional support to help children from disadvantaged backgrounds at preschool and in early primary school may help narrow inequalities. Children from disadvantaged backgrounds started school with a higher prevalence of mental health difficulties, compared with their more advantaged peers, and this disparity widened markedly over the first 3 years of school.
A shared data approach more accurately represents the rates and patterns of violence with injury assaults
Authors: Gray Benjamin J , Barton Emma R , Davies Alisha R , Long Sara J , Roderick Janine , Bellis Mark A
Published: October 2017

Background

To investigate whether sharing and linking routinely collected violence data across health and criminal justice systems can provide a more comprehensive understanding of violence, establish patterns of under-reporting and better inform the development, implementation and evaluation of violence prevention initiatives.

Methods

Police violence with injury (VWI) crimed data and emergency department (ED) assault attendee data for South Wales were collected between 1 April 2014 and 31 March 2016 to examine the rates and patterns of VWI. Person identifiable data (PID) were cross-referenced to establish if certain victims or events were less likely to be reported to criminal justice services.

Results

A total of 18 316 police crimed VWI victims and 10 260 individual ED attendances with an assault-related injury were considered. The majority of ED assault attendances (59.0%) were unknown to police. The key demographic identified as under-reporting to police were young males aged 18–34 years, while a significant amount of non-reported assaults involved a stranger. The combined monthly age-standardised rates were recalculated and on average were 74.7 (95% CI 72.1 to 77.2) and 66.1 (95% CI 64.0 to 68.2) per 100 000 population for males and females, respectively. Consideration of the additional ED cases resulted in a 35.3% and 18.1% increase on the original police totals for male and female VWI victims.

Conclusions

This study identified that violence is currently undermeasured, demonstrated the importance of continued sharing of routinely collected ED data and highlighted the benefits of using PID from a number of services in a linked way to provide a more comprehensive picture of violence.