bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining the distribution of benefits of a free Maternal and Child Health programme in Enugu State, Nigeria: a benefit incidence analysis
Authors: Eze Philomena , Ezenduka Charles , Obikeze Eric , Ogbuabor Daniel , Arize Ifeyinwa , Ezenwaka Uchenna , Onwujekwe Obinna
Published: September 2020

Objective

To determine the population groups that benefit from a Free Maternal and Child Health (FMCH) programme in Enugu State, South‐east Nigeria, so as to understand the equity effects of the programme.

Method

A community‐based survey was conducted in rural and urban local government areas (LGAs) to aid the benefit incidence analysis (BIA) of the FMCH. Data were elicited from 584 randomly selected women of childbearing age. Data on their level of utilisation of FMCH services and their out‐of‐pocket expenditures on various FMCH services that they utilised were elicited. Benefits of the FMCH were valued using the unit cost of providing services while the net benefit was calculated by subtracting OOP expenditures made for services from the value of benefits. Costs were calculated in local currency (Naira (₦)) and converted to US Dollars. The net benefits were disaggregated by urban–rural locations and socio‐economic status (SES). Concentration indices were computed to provide the level of SES inequity in BIA of FMCH.

Results

The total gross benefit incidence was ₦2.681 million ($7660). The gross benefit that was consumed by the urban dwellers was ₦1.581 million ($4517.1), while the rural dwellers consumed gross benefits worth ₦1.1 million ($3608.20). However, OOP expenditure for the supposedly FMCH was ₦6 527 580 (US$18 650.2) in the urban area, while it was ₦3, 194, 706 (US$ 9127.7) among rural dwellers. There was negative benefit incidence for the FMCH because the OOP exceeded the gross benefits at the point of use of services. There was no statistically significant difference in the benefit incidence and OOP expenditure between the urban and rural dwellers and across socio‐economic groups.

Conclusion

The distribution of the gross benefits of the FMCH programme indicates that it may not have achieved the desired aim of enhanced access particularly to the low‐income population. Crucially, the high level of OOP erased whatever societal gain the FMCH was developed to provide. Hence, there is a need to review its implementation and re‐strategise to reduce OOP and achieve greater access for improved effectiveness of the programme.
Iron status and self‐reported fatigue in blood donors
Authors: Spencer Bryan R. , Fox Matthew P. , Wise Lauren A. , Cable Ritchard G. , Mast Alan E.
Published: September 2020

Background

Fatigue is a reported symptom of iron depletion, but studies in blood donors show no conclusive link. We conducted an observational analysis of data from the STRIDE randomized trial to evaluate association of iron status with self‐reported fatigue.

Study Design and Methods

Three blood centers randomly assigned 692 frequent donors to education or iron supplementation treatments. Biomarkers for iron status were measured during 20 to 24 months of follow‐up. A fatigue score was derived from an 11‐item questionnaire at baseline and final visits, and associations between iron status and fatigue were assessed.

Results

Final lab and questionnaire data were evaluable from 337 subjects. At baseline, female sex, older age, and anemia were associated with fatigue, but iron status was not. Mean (±SD) fatigue score change was 0.0 (±0.5). Mean (±SD) increase in iron stores was 1.0 (±3.5) mg/kg, but changes in body iron stores were not associated with fatigue score changes (0.01 per mg/kg; 95% CI, −0.01 to 0.02) or with fatigue (RR, 1.01; 95% CI, 0.99 to 1.04). The only factor associated with fatigue score changes was baseline fatigue (0.36; 95% CI, 0.25 to 0.48).

Conclusion

Among high‐frequency donors, neither iron status at baseline nor changes in iron status predicted fatigue during follow‐up, with improvements limited to those with higher levels of baseline fatigue. Assessment of the association between iron and fatigue in blood donors benefits from careful consideration of study design and the study population.
Differences in the clinical practice of small animal CPR before and after the release of the RECOVER guidelines: Results from two electronic surveys (2008 and 2017) in the United States and Canada
Authors: Donaldson Liam , Stevenson Mark A. , Fletcher Daniel J. , Gillespie Íde , Kellett‐Gregory Lindsay , Boller Manuel
Published: September 2020

Objective

To assess whether the clinical approach to CPR has changed following the publication of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines in 2012.

Design

Internet‐based survey.

Setting

Academia and referral practice.

Subjects

Four hundred and ninety‐one small animal veterinarians in clinical practice in the United States and Canada.

Interventions

An internet‐based survey assessing the clinical approach to small animal CPR was circulated with the assistance of veterinary professional organizations on 2 separate occasions: prior to (2008) and following (2017) publication of the 2012 (RECOVER) guidelines. Survey questions identical to both surveys solicited details of clinician approaches to CPR preparedness, basic life support (BLS), and advanced life support (ALS). Respondents were grouped into level of expertise (board‐certified specialists [BCS, n = 202] and general practitioners in emergency clinics [GPE, n = 289]), and year of response to the survey (2008, n = 171; 2017, n = 320).

Measurements and Main Results

Compliance with the RECOVER guidelines pertaining to CPR preparedness (P < 0.01), BLS (P < 0.01), and ALS P < 0.01) was consistently higher in respondents to the 2017 survey compared to those of the 2008 survey. Being a BCS was associated with significantly higher compliance with the RECOVER recommendations than GPE in the domains of preparedness (P = 0.02), BLS (P < 0.01), and ALS (P < 0.01). Increases in age of the respondent had a negative effect on compliance with the BLS guidelines (P < 0.01), while gender had no effect.

Conclusions

Compared to 2008, current practices in small animal CPR in the North American emergency and critical care community shifted toward those recommended in the RECOVER guidelines across all CPR domains. This supports the notion that uptake of the RECOVER guidelines among veterinary emergency or critical care clinicians was sufficient to lead to a change in the practice of CPR.
The importance of bone marrow and the immune system in driving increases in blood pressure and sympathetic nerve activity in hypertension
Authors: Ahmari Niousha , Hayward Linda F. , Zubcevic Jasenka
Published: September 2020

New Findings

What is the topic of this review?

This manuscript provides a review of the current understanding of the role of the sympathetic nervous system in regulation of bone marrow‐derived immune cells and the effect that the infiltrating bone marrow cells may have on perpetuation of the sympathetic over‐activation in hypertension.

What advances does it highlight?

We highlight the recent advances in understanding of the neuroimmune interactions both peripherally and centrally as they relate to blood pressure control.

The sympathetic nervous system (SNS) plays a crucial role in maintaining physiological homeostasis, in part by regulating, integrating and orchestrating processes between many physiological systems, including the immune system. Sympathetic nerves innervate all primary and secondary immune organs, and all cells of the immune system express β‐adrenoreceptors. In turn, immune cells can produce cytokines, chemokines and neurotransmitters capable of modulating neuronal activity and, ultimately, SNS activity. Thus, the essential role of the SNS in the regulation of innate and adaptive immune functions is mediated, in part, via β‐adrenoreceptor‐induced activation of bone marrow cells by noradrenaline. Interestingly, both central and systemic inflammation are well‐established hallmarks of hypertension and its co‐morbidities, including an inflammatory process involving the transmigration and infiltration of immune cells into tissues. We propose that physiological states that prolong β‐adrenoreceptor activation in bone marrow can disrupt neuroimmune homeostasis and impair communication between the immune system and SNS, leading to immune dysregulation, which, in turn, is sustained via a central mechanism involving neuroinflammation.
A Numerical Study on the Energy Performance of a Novel Furnace With Acidic Gas Trap Absorbers
Authors: Zhang Mingkan , LaClair Tim , Wang Lingshi , Liu Xiaobing , Gao Zhiming , Momen Ayyoub M. , Gluesenkamp Kyle
Published: September 2020

Natural gas furnaces are widely used in US residential and commercial building markets. An important issue for natural gas furnaces is serious corrosion and fouling problems caused by acidic gas, such as SOx. An advanced adsorption technology based on acidic gas trap (AGT) absorbers offers the possibility to remove SOx acidic gas from natural gas furnaces with high efficiency and low cost, thereby enabling the development of condensing furnaces without the use of expensive corrosion resistant materials in the heat exchanger. A three-dimensional (3D) computational fluid dynamics (CFD) model has been developed to evaluate the heat transfer performance of a furnace with AGT absorbers and to compare it with a baseline conventional furnace without the AGT. Moreover, an axisymmetric model has been built focusing on the absorbing process in the AGT. The baseline conventional furnace used for the study is a commercial condensing furnace (Rheem 92% AFUE 84,000 BTU Multi-Position Gas Furnace). This furnace was completely disassembled, and the dimensions of each part were carefully measured and used to build a detailed CFD model. A model representing the new furnace, incorporating the AGT absorbers, was developed by adding the AGT system to the conventional furnace model. For the CFD analysis, a mixture model was employed to characterize the heat and mass transfer during the condensing process in the furnace while considering three components — air, water vapor and liquid water. Condensation takes place in the condensing heat exchanger, where water vapor changes phase to liquid water, and the latent heat is thus used in the furnace for useful heating. The simulation results characterize the energy performance of both the conventional furnace and the novel furnace with AGT absorbers, as well as the reactive processing in the AGT. These results provide insightful guidance for the development of the AGT absorber-based furnace from the perspective of its energy performance and will be used to further optimize this novel furnace design.
3D Light Field Projection and the Associate 3D Photolithography
Authors: Wen Sy-Bor , Zhang Hongjie
Published: September 2020

3D light field camera has been provided as a valid method to capture 3D surface topography with a microlens array. Through inverting the propagation direction, 3D virtual image projection can also be achieved with conventional optics and a microlens array. By compressing the 3D virtual image from the microlens array with an additional lens, microscale 3D virtual image can be achieved. We propose that microscale 3D virtual image can be valuable in microscale 3D fabrication. In this study, we provide a theoretical basis to combine femtosecond laser with the above mentioned 3D virtual image reconstruction scheme to cure photopolymers. With multiphoton effects induced by femtosecond laser, we expect 3D patterning of regions inside the photopolymer can be possible. Compared with the demonstration of 3D patterning with continuous near UV light and the proposed 3D light field projection scheme, curing of photopolymer can be limited to focal points (i.e., voxel) of the projected microscale 3D surface with two photon absorption effect when femtosecond light with high enough intensity is applied. The required femtosecond light intensity is also determined in this study. We expect this new 3D photolithography method can be valuable in fast and high precision patterning of micro to macro structures in materials that are photoactive.
Thermal Conductivity Study of Biomass Reinforced Polymer Composites
Authors: Dikici Birce , Motagi Samarth , Kantamani Prahruth , Ayyagari Suma , Al-Haik Marwan
Published: September 2020

The aim of this study was to investigate the thermal conductivity of natural fiber reinforced polymer composites (NFRP) as potential structural materials. As a natural fiber, Bermuda grass seeds, conifer cones and pinecones are selected. The matrix comprised Vinyl ester resin. The mechanical properties (tensile strength and Young’s modulus) and fractography analysis were investigated in our previous study (Dikici B. M. S.-H., 2019).

In the current study, the thermal conductivity was probed using transient plane source technique implemented in the TPS 2500S Thermal Constants Analyzer. The addition of 9% Bermuda fibers yielded a decrease of approximately 19.3% in thermal conductivity compared to that of the neat epoxy. With the addition of 9% nano cellulose fibers, a decrease of approximately 40.7% in thermal conductivity was observed in the nanocellulose/vinyl ester resin composite compared to the neat vinyl ester samples.
An Investigation on Chevron Plate Heat Exchanger Filled With Organic Phase Change Material
Authors: Kumar Sunil , Thyagarajan Ashok , Banerjee Debjyoti
Published: September 2020

Thermal management is one of the challenging areas in the view of shrinking devices size requiring efficient cooling to take care of the thermal load. The shrinking size of devices require efficient cooling for thermal load balance capabilities. This complicated requirement can be fulfilled with the help of Thermal Energy Storage (TES) systems. Phase Change Material (PCM) is one of the best examples of TES system. This paper deals with experimental investigation on Chevron Plate Heat Exchanger (CPHE) filled with an organic PCM PureTemp 29. PCM offers efficient performance in storing and releasing large quantities of thermal energy at any given temperature. Water is used as a Heat Transfer Fluid. The melting of PCM also known as discharging is studied at 5, 8 and 10 GPH. The flow of hot water at 38 °C and 32 °C through CPHE leads to melting of PCM known as discharging process. While, the flow of cold water at 20 °C and 26°C respectively through CPHE leads to solidification of PCM known as charging process. Load capacity and thermal efficiency of the PCM has been discussed in order to provide and estimation for future design modifications and efficiency enhancement of heat exchangers.
Dynamic Gesture Design and Recognition for Human-Robot Collaboration With Convolutional Neural Networks
Authors: Chen Haodong , Tao Wenjin , Leu Ming C. , Yin Zhaozheng
Published: September 2020

Human-robot collaboration (HRC) is a challenging task in modern industry and gesture communication in HRC has attracted much interest. This paper proposes and demonstrates a dynamic gesture recognition system based on Motion History Image (MHI) and Convolutional Neural Networks (CNN). Firstly, ten dynamic gestures are designed for a human worker to communicate with an industrial robot. Secondly, the MHI method is adopted to extract the gesture features from video clips and generate static images of dynamic gestures as inputs to CNN. Finally, a CNN model is constructed for gesture recognition. The experimental results show very promising classification accuracy using this method.
Modeling Force Fluctuations in Incremental Sheet Forming
Authors: Prize Michael , Bristow Douglas , Landers Robert
Published: September 2020

Incremental Sheet Forming (ISF) is a versatile manufacturing method in which a three-dimensional part is fabricated by progressively deforming a metal sheet. This is typically done via a robot with a single point tool following a defined trajectory. During this process a reaction force between the forming tool and sheet is generated. This force, denoted the forming force and defined as the force acting perpendicular to the sheet, has been modeled in several studies. Given a part with homogenous material, a fixed part geometry, and constant process parameters, these models predict the forming force will be constant. However, many studies have shown that this force fluctuates during the process. This paper augments the model by accounting for changes in process parameters due to robot geometric errors to describe these fluctuations. The model is experimentally validated, and the fluctuations of the forming force are reduced by 51% by modifying the tool path based on the identified robot geometric error.
Development of CAM Software to Achieve Automated NC Program Generation: Application to Machining From Near Net Shape Material
Authors: Nishida Isamu , Shirase Keiichi
Published: September 2020

A method to automatically calculate tool paths and apply to machining from near net shape material is proposed. At first, this study proposes a contour line model, in which the product model is minutely divided on the plane along any one axial direction and the contour lines to show the cross section of the product is superimposed. Subsequently, this study proposes a method to calculate the tool positions according to the interference amount between product surface and tool. Furthermore, this study proposes the method to calculate tool paths for near net shape material.

The case study was conducted to validate the effectiveness of the proposed method. As the result of this case study, it was confirmed that the proposed method can automatically generate the tool paths for near net shape. The machining efficiency from near net shape material will be better than that from box shape material. The results showed that the proposed method has good potential to perform customized manufacturing, and realize both high productivity and reliability in machining operation.
Feature-Based Transfer Learning for Bearing Fault Recognition Without Available Fault Data
Authors: Cooper Clayton , Liu Dongdong , Zhang Jianjing , Gao Robert X.
Published: September 2020

Machine learning has demonstrated its effectiveness in fault recognition for mechanical systems. However, sufficient data for establishing accurate and reliable fault detection methods is not always available in real-world applications. Transfer learning leverages the knowledge learned from a source domain in order to bypass limitations in data availability and facilitate effective analysis in a target domain. For mechanical fault recognition, existing transfer learning methods mainly focus on transferring knowledge between different operating conditions which require training samples corresponding to all desired fault conditions from the target domain in order to realize domain adaptation. However faulted data in real applications is usually unavailable and impractical to collect. In this paper, a transfer learning-based cross-machine bearing fault recognition method is investigated. This new method sees domain adaptation take place without faulted data being available in the target domain, and thus alleviates data availability limitations. The effectiveness of the method is demonstrated in a case study in which the bearing diagnostic method is transferred from an electric motor to a wind turbine.
Shaping brain structure: Genetic and phylogenetic axes of macroscale organization of cortical thickness
Authors: Valk Sofie L. , Xu Ting , Margulies Daniel S. , Masouleh Shahrzad Kharabian , Paquola Casey , Goulas Alexandros , Kochunov Peter , Smallwood Jonathan , Yeo B. T. Thomas , Bernhardt Boris C. , Eickhoff Simon B.
Published: September 2020

Functional and evolutionary patterning converges at the level of macroscale cortical structural organization.
Model uncertainty, political contestation, and public trust in science: Evidence from the COVID-19 pandemic
Authors: Kreps S. E. , Kriner D. L.
Published: September 2020

Communications engaging uncertainty in COVID-19 research affect public trust in science and support for science-based policy.
The myeloid type I interferon response to myocardial infarction begins in bone marrow and is regulated by Nrf2-activated macrophages
Authors: Calcagno David M. , Ng Richard P. , Toomu Avinash , Zhang Claire , Huang Kenneth , Aguirre Aaron D. , Weissleder Ralph , Daniels Lori B. , Fu Zhenxing , King Kevin R.
Published: September 2020

The type I interferon response after myocardial infarction induces a cytoprotective Nrf2-dependent program in cardiac macrophages.
Transformative Approach To Investigate the Microphysical Factors Influencing Airborne Transmission of Pathogens
Authors: Otero Fernandez Mara , Thomas Richard J. , Oswin Henry , Haddrell Allen E. , Reid Jonathan P.
Published: September 2020

A transformative approach to identify the physicochemical processes that impact the biological decay rates of bacteria in aerosol droplets is described. It is shown that the evaporation process and changes in the phase and morphology of the aerosol particle during evaporation impact microorganism viability. The equilibrium droplet size was found to affect airborne bacterial viability. Furthermore, the presence of
Escherichia coli
MRE162 in a droplet does not affect aerosol growth/evaporation but influences the dynamic behavior of the aerosol by processing the culture medium prior to aerosolization, affecting the hygroscopicity of the culture medium; this highlights the importance of the inorganic and organic chemical composition within the aerosolized droplets that impact hygroscopicity. Bacteria also act as crystallization nuclei. The novel approach and data have implications for increased mechanistic understanding of aerosol survival and infectivity in bioaerosol studies spanning the medical, veterinary, farming, and agricultural fields, including the role of microorganisms in atmospheric processing and cloud formation.
Effects of home-based mirror therapy and cognitive therapeutic exercise on the improvement of the upper extremity functions in patients with severe hemiparesis after a stroke: a protocol for a pilot randomised clinical trial
Authors: Gonzalez-Santos Josefa , Soto-Camara Raul , Rodriguez-Fernández Paula , Jimenez-Barrios Maria , Gonzalez-Bernal Jeronimo , Collazo-Riobo Carla , Jahouh Maha , Bravo-Anguiano Yolanda , Trejo-Gabriel-Galan Jose M
Published: September 2020

Introduction

Neuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke.

Methods and analysis

This is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months).

Ethics and dissemination

This protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke.

Trial registration number

ClinicalTrials.gov (NCT04163666).
01  Major trauma triage tools study (MATTS) triage tools summary
Authors: Holt Christopher , Fuller Gordon , Keating Samuel , Turner Janette , Irving Andy , Herbert Esther
Published: September 2020

Introduction

The aim of this project is to identify major trauma triage tools currently in use by ambulance services in England, Wales and internationally and subsequently complete a detailed document analysis of these tools. The review will aim to detect the most commonly used predictors of major trauma whilst identifying the evidence behind them.

Methods

A variety of triage tools used internationally were acquired through analysis of systematic reviews freely available on PubMed. The 46 identified tools included: 40 adult/general, 4 paediatric-specific and 2 geriatric-specific tools. Following the acquisition of all triage tools, they were analysed by diagnostic criteria and a detailed spreadsheet produced. Each row of the spreadsheet represented a different triage criterion and each cell was colour coded to suggest the correct course of action for patient management.

Results

In total, 63 separate clinical features and triaging criteria were identified. These were categorised into five major groups (most common variables):

Physiology (GCS, Low BP).

Anatomy (Chest trauma, traumatic amputation).

Mechanism of injury (Falls, high speed RTC).

Modifiers for high risk groups (Age >55/65, pregnant)

Time limit to the nearest MTC (>45 minutes).

Additionally, crew concern is a potential predictor in 14 tools. Despite many tools using similar predictors, their respective predictor cut-points varied widely (e.g. from GCS ≤14 to <9).

From the tools assessed, two basic tool structures were discerned:

A flowchart style format (34 tools)

A points-based scoring system (7 tools)

Conclusions

The various major trauma triaging tools currently in use in the NHS and worldwide are highly varied. Although there are commonly used domains variable cut-points often varied. Given this significant difference between services’ tools, and variability of clinician interpretation of those criteria, large variations in standards of major trauma triaging are likely.
PP10  How senior paramedics determine a futile resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study
Authors: Coppola Ali , Black Sarah , Endacott Ruth
Published: September 2020

Background

Pulseless electrical activity, a non-shockable cardiac arrest, is treated using advanced life support resuscitation. When resuscitation fails, evidenced-based guidelines are limited on when to stop resuscitation. This led to one UK Ambulance Service developing a local guideline for senior paramedics to cease resuscitation when considered futile. The aim of this study was to examine clinical, patient and system factors of a futile resuscitation for pulseless electrical activity and how senior paramedics apply these factors to the decision-making process.

Design and Methods

An explanatory sequential mixed method design conducted in a single UK Ambulance Service. Cessation of resuscitation data was retrieved for all adult patients suffering an Out of Hospital Cardiac Arrest from 1st December 2015 to 31st December 2018. Cases subject to a coronial or police investigation were excluded. Senior paramedics made decisions to cease resuscitation for 50 patients at the scene and these were reviewed in detail. Interviews were conducted with six senior paramedics, who provide telephone clinical support to on-scene paramedics.

Results

The mean patient age was 78 years, the majority were male (n=30, 60%) had a witnessed collapse (n=37, 74%) and had a PEA rate below 50 (n=46, 92%). There were no significant associations between patient demographics and clinical or system factors. Themes arising from paramedic interviews included concepts that defined futility, the impact of decision-making, conflicting views and supportive clinical decision tools.

Conclusion

Whilst there were no significant associations between variables, senior paramedics balanced patient survival with resuscitation futility by interpreting key factors, such as patient demographics and clinical factors. This multifactorial approach questions termination of resuscitation based on clinical factors alone. It identifies a group of PEA patients, when resuscitation is not successful, may be considered for termination of resuscitation. Research using a larger sample is warranted to explore the validity of these criteria.

Acknowledgements

The authors would like to thank Professor Jonathan Benger for his valuable input and guidance as the educational supervisor for this study. J. Lynde and H. Trebilcock for quantitative data extraction. L. Tremayne and E. Freeman, qualitative data coding. Thank you to all the paramedics who participated.
PP17  Is weight just a number? The accuracy of UK ambulance paediatric weight guidance – findings from a cross sectional study
Authors: Charlton Karl , Capsey Matt , Moat Chris
Published: September 2020

Background

The weight of children is the cornerstone of their clinical management. It determines fluid quantities, drug dosages and defibrillation power, which are administered on a per kilogram basis. Gold standard care for all paediatric patients who attend hospital involves being weighed using scales. This is not possible in the out of hospital setting, where weight derives from a guidance table based upon age. No evidence exists to indicate if the page by age approach indicated in current ambulance guidelines meets the reference standard of 70% of estimations within 10% of actual weight and 95% within 20% of actual weight.

Methods

We used a cross sectional study design and collected data from a convenience sample of children who attended the outpatient’s department of a major hospital in England between July and September 2019. All children aged between one and eleven years who were weighed were eligible for inclusion. Outcomes were to determine if the page by age approach meets the reference standard and to determine any implications for care.

Results

Three hundred and forty-one children were included in this study. Each age group consisted of varying numbers of children. 50.5% (172/341) of the sample were female. Observed weights ranged from 8.28 to 82.70 kg (median 20.60 kg). The mean weight of girls versus boys was 24.69 kg and 23.39 kg respectively (95% CI -4.12–1.32, p=0.3123). Observed weights were greater than the page for age guidance in all age groups and the accuracy of this approach diminishes with age.

Conclusion

Page by age weight guidance does not meet the reference standard. Most paediatric prehospital care is administered by age and not weight. In the absence of an accurate weight, ambulance clinicians should continue to use the page for age system, although the gold standard remains to use an accurate weight measurement.
PP22  An exploration of the facilitators and barriers to paramedics’ assessment and treatment of pain in paediatric patients following trauma (EX-PAT)
Authors: Handyside Barry , Pocock Helen , Deakin Charles
Published: September 2020

Background

A cross-sectional service evaluation within South Central Ambulance Service (SCAS) revealed deficiencies in the assessment and management of paediatric patients’ pain resulting from trauma. This suggested a need for further work to identify facilitators and barriers to pain assessment and management amongst this patient group. Studies looking into the barriers and facilitators to paramedics’ assessment and management of paediatrics in pain have been conducted internationally and not solely in traumatic events. These studies are not transferable to the UK setting due to prehospital emergency care differences within these countries.

Methods

This study will utilise qualitative research methods.The study population will be qualified paramedics. In-depth semi structured interviews will be conducted using a guide developed from previous studies and refined at patient and public involvement events. The expected numbers of participants will be 12–15 but will continue to the point of data saturation. Thematic analysis of data will be performed using an open coding technique guided by Braun and Clarke’s six step framework. Once complete member checking will take place with each participant.

Results

It is anticipated that both positive and negative aspects of paramedics’ role during these incidents will be identified. Previous literature has identified support from colleagues, interaction with parents, and the ability to alleviate pain as facilitators. Barriers have included current educational practices, lack of exposure, guidelines, the prehospital environment, difficulty in assessing young children and difficulty in providing pain relief. It is therefore likely that these themes may emerge but identification of UK-specific barriers and facilitators is anticipated.

Conclusions

With no previous study of this nature conducted before in the UK this could valuably inform the education and teaching provision of ambulance services and universities as well as a platform for policy makers and guideline producers to enhance the tools available to paramedics.
PP27  What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the united kingdom
Authors: Snooks Helen , Khanom Ashra , Cole Robert , Edwards Adrian , Edwards Bethan , Evans Bridie , Foster Theresa , Fothergill Rachael , Gripper Penny , Hampton Chelsey , John Ann , Petterson Robin , Porter Alison , Rosser Andy , Scott Jason
Published: September 2020

Background

Emergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern.

Aims and Objectives

To describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation.

Methods

We conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire, for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach.

Results

Twelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600 – 900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre, contact made with callers and their GP with an aim of discouraging further calls; to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. No formal audits or evaluations were reported.

Conclusions

Ambulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Within service care focused mainly on reducing calls whilst multi-disciplinary case management aimed to resolve clinical and emotional needs of patients. However, there is currently inadequate evidence to inform commissioning, policy or practice development.
Left ventricular longitudinal shortening: relation to stroke volume and ejection fraction in ageing, blood pressure, body size and gender in the HUNT3 study
Authors: Støylen Asbjørn , Dalen Håvard , Molmen Harald Edvard
Published: September 2020

Background

Aims of this cross-sectional study were to assess: the relative contribution of left ventricular (LV) systolic long-axis shortening (mean mitral annular plane systolic excursion, MAPSE) to stroke volume (SV), the mechanisms for preserved ejection fraction (EF) despite reduced MAPSE, the age dependency of myocardial volume and myocardial systolic compression.

Methods

Linear dimensions and longitudinal and cross-sectional M-modes were acquired in 1266 individuals without history of heart disease, diabetes or known hypertension from the third wave of the Nord-Trøndelag Health Study. Measurements were entered into a half-ellipsoid LV model for volume calculations, and volumes were related to age, body size (body surface area, BSA), sex and blood pressure (BP).

Results

Mean BP and proportion with hypertensive values increased with increasing age. MAPSE contributed to 75% of SV, with no relation to age or BSA as both MAPSE and SV decreased with increasing age. LV end-diastolic volume (LVEDV) and SV increased with BSA and decreased with higher age; EF was not related to age or BSA. Myocardial volume increased with higher age and BSA, with an additional gender dependency. The association of age with myocardial volume was not significant when corrected for BP, while both systolic and diastolic BP were significant associated with myocardial volume. Myocardial compression was less than 3%.

Conclusions

MAPSE contributes approximately 75% and short axis shortening 25% to SV. Both decline with age, but their percentage contributions to SV are unchanged. EF is preserved by the simultaneous decrease in LVEDV and SV. Myocardial volume is positively associated with age, but this is only related to higher BP, which may have implications for BP treatment in ageing. The myocardium is near incompressible.
Preoperative retrograde reintubation during partial tracheal resection and anastomosis in a cat with severe tracheal stenosis
Authors: Michielsen Anneleen Jozef Helena Cristoffel , Bosmans Tim , Van Goethem Bart , Binetti Anna , Schauvliege Stijn
Published: September 2020

A seven‐month‐old European shorthair cat was presented with dyspnoea and expiratory stridor due to a severe obstructive tracheal stenosis. Surgical resection of the stenotic area and anastomosis of the remaining parts of the trachea were performed. The anaesthetic management of a patient during tracheal resection is an anaesthetic challenge. Total intravenous anaesthesia with propofol and a continuous rate infusion of fentanyl were chosen to maintain a surgical anaesthetic depth and to ensure pain control. Endotracheal extubation was necessary at a specific time during the surgical procedure. However, subsequent oral reintubation was complicated, due to patient positioning and the presence of laryngeal spasms. Reintubation was only successful by means of a modified retrograde intubation technique. Recovery was satisfactory and uneventful.
63,XX, SRY‐negative, pseudohermaphroditism in a Somali wild ass (Equus asinus somalicus)
Authors: Gillis James , Bercier Marjorie , Rattner Francine K , Citino Scott
Published: September 2020

A six‐month‐old Somali wild ass (Equus asinus somalicus) scheduled for a routine health exam presented with masculinised external genitalia, which included an enlarged phallus‐like clitoris that was not connected to the urethra. A gonadectomy was conducted to sterilise the individual. Histological examination of the gonads revealed normal ovarian tissue with a recent corpus luteum, developing follicles and no testicular tissue. Karyotype analysis classified the individual as female, 63,XX, sex‐determining region Y‐negative, which is normal for a female Somali wild ass. Serum testosterone was analysed via enzyme immunoassay and was found to be below detectable concentrations. Although similar cases have been reported in domestic equids, this is the first case of intersex reported in a non‐domestic equid.
Elimination of cationic azodye from aqueous media using doped polyaniline (PANI): adsorption optimization and modeling
Authors: Jadhav Smita , Jaspal Dipika
Published: September 2020

An adsorbent doped polyaniline (PANI) has been explored for the elimination of a cationic azodye, basic red 46 (BR-46), from textile effluent. Essential factors from batch mode have been studied to investigate their effect on the removal of BR-46. The investigated data have been applied to two prevalent adsorption isothermal models (i.e., Langmuir and Freundlich). In addition to the coefficients of determination, six different statistical error functions have been used to identify the most appropriate model for the existing process. The Langmuir model has been shown to be the best adsorption isotherm with minimum error values and a high coefficient of determination value (R2 > 0.999). The maximum monolayer adsorption capacity observed was 1.83 × 10−4 mol g−1 at 50 °C. Thermodynamic parameters of Gibb’s free energy, enthalpy, and entropy were found to be –30.06 KJ mol−1, 374 J mol−1, and 97.25 J mol−1 K−1, respectively. The positive values of enthalpy and entropy indicate the process to be endothermic. The amount of the dye adsorbed increased from 1.02 to 5.42 × 10−5 g in moving from 30 to 50 °C. The measured energy of activation was 17.467 kJ mol−1. The maximum percent removal of BR-46 from wastewater has been 93% at pH 8.
ZnS nanowires growth on two different types of substrate using simple thermal evaporation method
Authors: Abadllah B. , Kakhia M. , Obaide A. , Zetoun W.
Published: September 2020

ZnS nanowires films were grown on two different substrates silicon and glass, with PbS dopant at 5 wt.%, using thermal evaporation method. The silicon is single crystal (only Si), while the glass is as amorphous substrate (mainly SiO2). In the used substrates, the morphology was confirmed by Atomic Force Microscopy (AFM) as well as Scanning Electron Microscopy (SEM) images (cross-section and surface). High Resolution Transmission Electron Microscopy (HRTEM) has been used to confirm the ZnO nanowires for doped films (PbS:ZnS) in both silicon and glass substrates, with diameter less than 50 nm and the thickness was varied from 2000 nm to 3000 nm. The undoped film has dense structure and is thin with thickness of 200 nm. The growth of nanowires is not affected by the two substrate types (silicon and glass). The compositions of chemical films have been verified by energy dispersive X-ray spectroscopy (EDX), and it confirms that ZnS is the main compound. X-ray Diffraction (XRD) investigated the crystallographic properties with wurtzite structure. Optical properties (transparency and bandgap) were deduced from UltraViolet Visible (UV-Vis) spectra of ZnS films (PbS 0 and 5 wt.%) deposited on glass substrate. Raman, Photoluminescence (PL) and Fourier transform infrared (FTIR) techniques confirm ZnS composition and its nonstructural growth. Finally, a good agreement between the XRD, FTIR and HRTEM analyses was found.
The analysis of electron scattering among multiplying layer in EBAPS using optimized Monte Carlo method
Authors: Bai Jinzhou , Bai Yonglin , Hou Xun , Cao Weiwei , Yang Yang , Wang Bo , Bai Xiaohong , Li Siqi
Published: September 2020

Electron bombarded Active Pixel Sensor (EBAPS) is well known for its low noise in low-light level imaging, high mechanical integration, and a relatively low cost. It plays an important role in areas of the industrial process as well as the fundamental scientific research. However, the performance of EBAPS is intensively influenced by the structural parameters (i.e. the acceleration voltage between cathode and anode, thickness of the passivation layer, etc.). Due to the influence of these factors mentioned above, the performance of EBAPS is restricted to achieve its best condition. Herein, a model based on the optimized Monte Carlo method was proposed for effectively analyzing the scattering behavior of electrons within the electron multiplier layer. Unlike traditional simulation, which only deals with the electron scattering in longitudinal, in this paper, we simulate the electron scattering character not only in horizontal but also vertical among the multiplier layer, which would react to the influence induced by structural parameters more complete and more precise. Based on the proposed model, an experimental prototype of EBAPS is built and its detection sensitivity achieves [Formula: see text] lux under spectral response of ultraviolet (UV) spectroscopy, which improved a lot from our former design. The proposed model can be used for analyzing the influence induced by structural parameters, which exhibit enormous potential for exploring the high-gain EBAPS.
Mixed Element Networks with Series Capacitors Separated by Unit Elements
Authors: Şengül Metin , Çakmak Gökhan
Published: September 2020

In this work, high-pass mixed-element networks with series capacitors separated by unit elements are analyzed. First, the description of the networks via two frequency variables is given. Then, explicit coefficient relations for the descriptive polynomials are derived in terms of the single-variable boundary polynomial coefficients. Finally, the derived relations are used to design a high-pass mixed-element matching network. The series capacitors can be converted to short-ended stubs by means of Richard’s transformation. Thus, the obtained network is suitable for microstrip production.
PCTBC: Power Control Tree-Based Cluster Approach for Sybil Attack in Wireless Sensor Networks
Authors: Singh Surinder , Saini Hardeep Singh
Published: September 2020

Wireless Sensor Networks (WSNs) have come across several things which include collecting data, handling data and distribution for super visioning specific applications such as the services needed, managing anything that occurred naturally, etc. They totally rely on applications. Therefore, the WSNs are classified under major networks. This is very essential. It can be defined as a network of networks that helps in proper flow of data. The main characteristics of WSN include its continuous changes in topologies, connected nodes with several chips and tunic routing protocol. There should be the better utilization of the available resources so that its life span may exceed. There should be an effective usage of available assets to avoid the waste. In our research, we propose a hybrid approach, namely, the Power Control Tree-Based Cluster (PCTBC) to identify the Sybil attacks in WSNs. It employs several stages structured clustering of nodes based on position and identity verification. This approach is utilized for the usage of energy consumption, effectiveness of detecting Sybil attacks inside clusters. The main aspects put into consideration are the efficient routing protocol of the distance between the hops and the energy power remains, where the distance between the hops is being computed using the Received Signal Strength Indication (RSSI) and also the packet transmission can be properly tuned on the basis of the distance. Also, the proposed approach considers the energy consumption for the transmission of the defined packet.
Overcharging dilaton black holes in (2 + 1) dimensions to extremality and beyond
Authors: Düztaş Koray , Jamil Mubasher
Published: September 2020

We test whether static charged dilaton black holes in [Formula: see text] dimensions can be turned into naked singularities by sending in test particles from infinity. We derive that overcharging is possible and generic for both extremal and nearly extremal black holes. Our analysis also implies that nearly extremal charged dilaton black holes can be continuously driven to extremality and beyond, unlike nearly extremal Ban̆ados–Teitelboim–Zanelli, Kerr and Reissner–Nordström black holes which are overspun or overcharged by a discrete jump. Thus, the weak form of the cosmic censorship conjecture and the third law of black hole thermodynamics are both violated in the interaction of charged dilaton black holes in [Formula: see text] dimensions, with test particles. We also derive that there exist no points, where the heat capacity vanishes or diverges in the transition from black holes to naked singularities. The phase transitions that could potentially prevent the formation of naked singularities do not occur.