bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting Demand of Distributed Product Service Systems by Binomial Parameter Mapping: A Case Study of Bike Sharing Station Expansion
Authors: Watson Bryan C. , Telenko Cassandra
Published: April 2019

Quantitative approaches for estimating user demand provide a powerful tool for engineering designers. We hypothesized that estimating binomial distribution parameters n (user population size) and p (user population product affinity) from historical user data can predict demand in new situations for distributed product service systems. Distributed product service systems allow individuals to use shared products at different geographic locations as opposed to owning them. This approach is demonstrated on a major bike-sharing system (BSS) expansion. BSSs position rental bikes around a city in docks at prescribed locations. BSS operators must predict the rider demand when sizing new docking stations, but current demand estimation methods may not be suitable for distributed systems. The main contribution of this paper is the development and application of a revealed preference demand estimation method for distributed product service systems. While much current research seeks to solve distributed system operational problems, we estimate the user population characteristic to provide insight into the initial installation design problem. We introduce the use of spatial surface plots to extrapolate binomial parameters n and p over the service area. These surfaces allow more accurate prediction of relative ridership levels at new station locations. By utilizing Spearman's rho as a comparison benchmark, our approach yields a stronger correlation between our prediction and the observed new station utilization (rho = 0.83, stations = 46, p < 0.01) than the order implemented by the BSS operator (rho = 0.59, stations = 46, p < 0.01).
Design and Transmission Error Analysis of CBR Reducer
Authors: Sun Xiaoxiao , Han Liang , Wang Jian
Published: April 2019

A new one-stage type cycloid drive reducer named China Bearing Reducer (CBR) is designed and its tooth contact analysis is investigated. First, the CAD model is built in SolidWorks and the structure of CBR reducer is introduced. Its advantages and disadvantages are compared with rotor vector (RV) reducer and harmonic drive reducer. Second, the mathematic model of cycloid profile and modified cycloid profile are established based on gear meshing and differential geometry, and the tooth shapes of three different modifications are compared with CBR25 reducer. Third, the conventional TCA method is described and a new TCA method by using discretized points is proposed to calculate transmission error and contact force of cycloid drive. Both the methods are used to compute the unloaded transmission error of CBR25 reducer to compare the computational efficiency. Finally, three different modified methods of tooth profile are investigated by using the new TCA method to calculate transmission error and contact force of CBR25 reducer, and the results show that the negative isometric and negative offset modified method is best for CBR25 reducer to reduce transmission error and contact force. The prototype of CBR25 reducer is manufactured and the transmission error and hysteresis curve are measured by using a testing bench. The results show that the new TCA method can be used to calculate transmission error and help better design the CBR reducer.
A Moving Morphable Voids Approach for Topology Optimization With Closed B-Splines
Authors: Du Bingxiao , Yao Wen , Zhao Yong , Chen Xiaoqian
Published: April 2019

Topology optimization with moving morphable voids (MMVs) is studied in this paper. B-spline curves are used to represent the boundaries of MMVs in the structure. Kreisselmeier–Steinhauser (KS)-function is also implemented to preserve the smoothness of the structural boundary in case the intersection of the curves happen. In order to study the influence of continuity, we propose pseudo-periodic closed B-splines (PCBSs) to construct curves with an arbitrary degree. The selection of PCBS parameters, especially the degree of B-spline, is studied and discussed. The classic Messerschmitt–Bolkow–Blohm (MBB) case is taken as an example in the numerical experiment. Results show that with the proper choice of B-spline degrees and number of control points, PCBSs have enough flexibility and stability to represent the optimized material distribution. We further reveal the mechanism of the merging process of holes and find that high-order degree PCBS could preserve more separated voids. A support beam design problem of microsatellite is also studied as an example to demonstrate the capability of the proposed method.
Applying a Unit-Consistent Generalized Matrix Inverse for Stable Control of Robotic Systems
Authors: Zhang Bo , Uhlmann Jeffrey
Published: April 2019

It is well understood that the robustness of mechanical and robotic control systems depends critically on minimizing sensitivity to arbitrary application-specific details whenever possible. For example, if a system is defined and performs well in one particular Euclidean coordinate frame then it should be expected to perform identically if that coordinate frame is arbitrarily rotated or scaled. Similarly, the performance of the system should not be affected if its key parameters are all consistently defined in metric units or in imperial units. In this paper we show that a recently introduced generalized matrix inverse permits performance consistency to be rigorously guaranteed in control systems that require solutions to underdetermined and/or overdetermined systems of equations. We analyze and empirically demonstrate how these theoretical guarantees can be directly obtained in a practical robotic arm system.
Rapid and Stable Microbial Community Assembly in the Headwaters of a Third-Order Stream
Authors: Teachey Morgan E. , McDonald Jacob M. , Ottesen Elizabeth A.
Published: April 2019

Headwater streams are critical introduction points of microbial diversity for larger connecting rivers and play key roles in the establishment of taxa that partake in in-stream nutrient cycling. We examined the microbial community composition of a first- through third-order stream using fine-scale temporal and spatial regimes. Our results show that the bacterioplankton community develops rapidly and predictably from the headwater population with increasing total stream length. Along the length of the stream, the microbial community exhibits substantial diversity loss and enriches repeatedly for select taxa across days and years, although the relative abundances of individual taxa vary over time and space. This repeated enrichment of a stable stream community likely contributes to the stability and flexibility of downstream communities.
Insights into the Phylogeny, Nodule Function, and Biogeographic Distribution of Microsymbionts Nodulating the Orphan Kersting’s Groundnut [
Macrotyloma geocarpum
(Harms) Marechal & Baudet] in African Soils
Authors: Mohammed Mustapha , Jaiswal Sanjay K. , Dakora Felix D.
Published: April 2019

Rhizobia play important roles in agroecosystems, where they contribute to improving overall soil health through their symbiotic relationship with legumes. This study explored the microsymbionts nodulating Kersting’s groundnut, a neglected orphan legume. The results revealed the presence of different bradyrhizobial populations with high N
2
-fixing efficiencies as the dominant symbionts of this legume across diverse agroecologies in Africa. Our findings represent a useful contribution to the literature in terms of the community of microsymbionts nodulating a neglected cultivated legume and its potential for elevation as a major food crop. The presence of potentially novel bradyrhizobial symbionts of Kersting’s groundnut found in this study offers an opportunity for future studies to properly describe, characterize, and delineate these isolates functionally and phylogenetically for use in inoculant production to enhance food/nutritional security.
Sensitive and Specific Whole-Cell Biosensor for Arsenic Detection
Authors: Jia Xiaoqiang , Bu Rongrong , Zhao Tingting , Wu Kang
Published: April 2019

Arsenic poisoning is a severe public health issue. Rapid and simple methods for the sensitive and specific monitoring of arsenic concentration in drinking water are needed. In this study, we designed an arsenic WCB with a positive feedback amplifier. It is highly sensitive and able to detect arsenic below the WHO limit level. In addition, it also significantly improves the specificity of the biosensor toward arsenic, giving a signal that is about 10 to 20 times stronger in response to As(III) than to other metals. This work not only provides simple but effective arsenic biosensors but also demonstrates the importance of genetic engineering, particularly the use of positive feedback amplifiers, in designing WCBs.
Comparative Metagenomics Reveals Enhanced Nutrient Cycling Potential after 2 Years of Biochar Amendment in a Tropical Oxisol
Authors: Yu Julian , Deem Lauren M. , Crow Susan E. , Deenik Jonathan , Penton C. Ryan
Published: April 2019

The incorporation of biochar into soil is a promising management strategy for sustainable agriculture owing to its potential to sequester carbon and improve soil fertility. Expanding the addition of biochar to large-scale agriculture hinges on its lasting beneficial effects on the microbial community. However, there exists a significant knowledge gap regarding the specific role that biochar plays in altering the key biological soil processes that influence plant growth and carbon storage in soil. Previous studies that examined the soil microbiome under biochar amendment principally characterized only how the composition alters in response to biochar amendment. In the present study, we shed light on the functional alterations of the microbial community response 2 years after biochar amendment. Our results show that biochar increased the abundance of genes involved in denitrification and carbon turnover and that biochar-amended soil microcosms had a reduction in cumulative CO
2
production.
Human Bile-Mediated Regulation of
Salmonella
Curli Fimbriae
Authors: González Juan F. , Tucker Lauren , Fitch James , Wetzel Amy , White Peter , Gunn John S.
Published: April 2019

Typhoid fever is caused by
Salmonella enterica
serovar Typhi, and 3% to 5% of patients become chronic gallbladder (GB) carriers (also known as “Typhoid Marys”). We have previously demonstrated a role for
Salmonella
biofilm formation on gallstones as a primary mechanism of carriage. In this study, we found that the important biofilm extracellular matrix component curli fimbria is induced in an
in vitro
human GB model system. This induction is specific to human bile and increases as the biofilm matures. We also found that the biofilm and curli regulator CsgD play a key role in this observed induction. This work further enhances our understanding biofilm-mediated chronic carriage and provides a potential target for eliminating persistent GB infection by
S
. Typhi.
Evidence of Sharing of Klebsiella pneumoniae Strains between Healthy Companion Animals and Cohabiting Humans
Authors: Marques Cátia , Belas Adriana , Aboim Catarina , Cavaco-Silva Patrícia , Trigueiro Graça , Gama Luís Telo , Pomba Constança
Published: April 2019

This study aimed to characterize the fecal colonization and sharing of
Klebsiella pneumoniae
strains between companion animals and humans living in close contact. Fecal samples were collected from 50 healthy participants (24 humans, 18 dogs, and 8 cats) belonging to 18 households.
Development of Influenza B Universal Vaccine Candidates Using the “Mosaic” Hemagglutinin Approach
Authors: Sun Weina , Kirkpatrick Ericka , Ermler Megan , Nachbagauer Raffael , Broecker Felix , Krammer Florian , Palese Peter
Published: April 2019

This work reports a universal influenza B virus vaccination strategy based on focusing antibody responses to conserved head and stalk epitopes of the hemagglutinin. Recombinant mosaic influenza B hemagglutinin proteins and recombinant viruses have been generated as novel vaccine candidates. This vaccine strategy provided broad cross-protection in the mouse model. Our findings will inform and drive development toward a more effective influenza B virus vaccine.
Zika Virus Subverts Stress Granules To Promote and Restrict Viral Gene Expression
Authors: Bonenfant Gaston , Williams Nina , Netzband Rachel , Schwarz Megan C. , Evans Matthew J. , Pager Cara T.
Published: April 2019

Many viruses inhibit SGs. In this study, we observed that ZIKV restricts SG assembly, likely by relocalizing and subverting specific SG proteins to modulate ZIKV replication. This ZIKV-SG protein interaction is interesting, as many SG proteins are also known to function in neuronal granules, which are critical in neural development and function. Moreover, dysregulation of different SG proteins in neurons has been shown to play a role in the progression of neurodegenerative diseases. The likely consequences of ZIKV modulating SG assembly and subverting specific SG proteins are alterations to cellular mRNA transcription, splicing, stability, and translation. Such changes in cellular ribostasis could profoundly affect neural development and contribute to the devastating developmental and neurological anomalies observed following intrauterine ZIKV infection. Our study provides new insights into virus-host interactions and the identification of the SG proteins that may contribute to the unusual pathogenesis associated with this reemerging arbovirus.
Bacterial Stabilization of a Panel of Picornaviruses
Authors: Aguilera Elizabeth R. , Nguyen Y , Sasaki Jun , Pfeiffer Julie K.
Published: April 2019

Recent studies have shown that bacteria promote infection and stabilization of poliovirus particles, but the breadth of these effects on other members of the
Picornaviridae
family is unknown. Here, we compared the effects of bacteria on four distinct members of the
Picornaviridae
family. We found that bacteria reduced inactivation of all of the viruses during bleach treatment, but not all viral strains were stabilized by bacteria during heat treatment. Overall, our data provide insight into how bacteria play differential roles in picornavirus stability.
Marine RNA Virus Quasispecies Are Distributed throughout the Oceans
Authors: Vlok Marli , Lang Andrew S. , Suttle Curtis A.
Published: April 2019

Very little is known about aquatic RNA virus populations and genome evolution. This is the first study that analyzes marine environmental RNA viral assemblages in an evolutionary and broad geographical context. This study contributes the largest marine RNA virus metagenomic data set to date, substantially increasing the sequencing space for RNA viruses and also providing a baseline for comparisons of marine RNA virus diversity. The new viruses discovered in this study are representative of the most abundant family of marine RNA viruses, theMarnaviridae, and expand our view of the diversity of this important group. Overall, our data and analyses provide a foundation for interpreting marine RNA virus diversity and evolution.
Rectal adenocarcinoma with rectoprostatic fistula following prostate brachytherapy
Authors: Moss Basil Francis , Peracha Amjad M
Published: April 2019

An 80-year-old man with history of prostate cancer successfully treated with brachytherapy was initially thought to have Fournier’s gangrene until imaging detected a rectoprostatic fistula. Although this is known to be a rare complication of prostate brachytherapy, in this case the aetiology was a new primary rectal adenocarcinoma. It was not possible to catheterise per urethra owing to the fistula, so he was fitted with suprapubic catheter, and underwent palliative loop colostomy. Brachytherapy carries a low risk of second primary cancers, although two previous cases reported such cancers as radiation induced. This is, to our knowledge, the first case of rectal adenocarcinoma following prostate brachytherapy in the literature.
Rapidly enlarging, giant hepatic cyst growing pseudomonas
Authors: Sayma Meelad , Walters Huw RF , Hesford Christian , Tariq Zohaib , Nakhosteen Ali
Published: April 2019

A 74-year-old woman presented with dyspnoea and fever on a background of a large hepatic cyst thought to be stable in size. During her admission, she developed worsening shortness of breath. An echocardiogram revealed severely impaired cardiac output due to external compression by the hepatic cyst, which had grown rapidly. This was drained under ultrasound guidance and cultures of this fluid grewPseudomonas aeruginosa: the organism responsible for the persistence of this giant hepatic cyst.
Intractable acute ischaemic priapism occurring secondary to newly commenced olanzapine
Authors: Farag Matthew , Goad Jeremy , Temelcos Catherine
Published: April 2019

We present a case of intractable acute ischaemic priapism occurring secondary to newly commenced olanzapine. It demonstrates rapid intervention in a stepwise approach aiming to restore penile flaccidity in order to prevent chronic damage to the corpora cavernosa. After an unsuccessful conservative approach, our patient underwent two formal distal penile shunt procedures with no effective penile detumescence. Subsequently, bilateral proximal penile shunts were performed comprising a right corpus cavernosum to corpus spongiosum anastomosis and a left saphenous vein to left corpus cavernosum anastomosis. The patient remained an inpatient for observation, and detumescence was gradually achieved over several days after this procedure. However, follow-up revealed erectile dysfunction, and it was explained to the patient that he was unlikely to achieve further erections and that a penile implant was the only realistic option.
Primary adrenal leiomyosarcoma with inferior vena cava extension in a 70-year-old man
Authors: Doppalapudi Sai K , Shah Tejash , Fitzhugh Valerie A , Bargman Vladislav
Published: April 2019

Primary adrenal leiomyosarcoma, a malignant soft tissue tumour originating from the smooth muscle of the inferior vena cava and adrenal vein, is rarely described in the literature. Cases are often diagnosed at an advanced stage as the tumour is not hormone-producing. We describe a 70-year-old man who presented with lower extremity swelling and abdominal varices and was subsequently found to have a large adrenal mass on imaging. Our case is among the few reported primary adrenal leiomyosarcomas in which a CT-guided biopsy was used to aid in diagnosis.
Comparing APLS and oranges: caution with the use of direct-acting oral anticoagulants (DOACs) instead of warfarin in the treatment of antiphospholipid syndrome (APLS)
Authors: Benger Matthew , Vink Jasper , Snell Luke Blagdon , Breen Karen
Published: April 2019

A 63-year-old woman with known antiphospholipid syndrome (APLS) presented with catastrophic APLS and multiorgan dysfunction after a change in her anticoagulation from warfarin to rivaroxaban. Evidence suggests direct-acting oral anticoagulants (DOACs) like rivaroxaban may be less effective than warfarin in secondary prevention of thrombotic events in high-risk APLS patients.
A rare mimic of acute stroke: rapidly progressing Miller-Fisher Syndrome to acute motor and sensory axonal neuropathy variant of Guillain-Barre Syndrome
Authors: de Castillo Lennie Lynn Chua , Diestro Jose Danilo Bengzon , Ignacio Katrina Hannah Dizon , Pasco Paul Matthew Dimaguila
Published: April 2019

Ophthalmoplegia, ataxia and areflexia characterise the clinical triad of Miller-Fisher Syndrome (MFS). When the disease presents acutely, it can mimic posterior circulation stroke. We describe a case of an adult patient presenting with sudden dizziness, diplopia, vomiting, and loss of balance. She was initially managed as a case of a brainstem stroke, but the progression of craniopathies without deterioration in sensorium coupled with areflexia clinched the diagnosis of MFS two days into her admission. On the third day, her MFS progressed rapidly to acute motor and sensory axonal neuropathy (AMSAN) variant of Guillain-Barre Syndrome, a rare occurrence in patients with MFS, with only four reported cases including our own. Among the four cases, ours is the only one still non-ambulatory eight months after the initial onset of symptoms. The case highlights the importance of early recognition of MFS in patients with ophthalmoplegia and ataxia despite initially normal reflexes.
Congenital methaemoglobinaemia diagnosed in an adolescent boy
Authors: Paul Amal , Chacko Sujith Thomas
Published: April 2019

A 14-year-old boy of Asian origin presented with a history of bluish discolouration of the finger and toenail bed with associated mild fatiguability on exertion since early childhood. Clinical examination revealed bilaterally symmetric uniform central cyanosis with no associated clubbing. Cardiovascular and respiratory system examination was normal. Pulse oximetry revealed an oxygen saturation of 87% in all four limbs. Transthoracic and transoesophageal echocardiography showed no evidence of shunt lesions. In view of the past diagnosis of pulmonary arteriovenous fistulae made at 4 years of age, a repeat cardiac catheterisation study was done, which revealed no shunt at any level. Interestingly, arterial oxygen tension of the chocolate-brown blood was normal in all the samples, suggesting the possibility of methaemoglobinaemia. Co-oximetry revealed methaemoglobin levels of 36%, confirming the diagnosis. Secondary causes were ruled out. The family was counselled about the hereditary nature of the condition.
Anaesthetic management of a patient with Fontan physiology for electrophysiology study and catheter ablation
Authors: Lim Denise Yan Yin , Suhitharan Thangavelautham , Kothandan Harikrishnan
Published: April 2019

The success of the Fontan procedure for congenital single ventricle anatomy has resulted in adult patients with Fontan physiology requiring anaesthesia for cardiac and non-cardiac procedures. We present the perioperative management of a patient with Fontan physiology who underwent electrophysiological study with radiofrequency ablation for atrial tachycardia under general anaesthesia. Good communication between the multidisciplinary teams, a detailed understanding of the patient’s complex cardiac anatomy and physiology, as well as the ability to recognise and manage perioperative complications all play a vital role for a successful outcome.
Optimal imaging conditions for the diagnosis of pleuroperitoneal communication
Authors: Nakayama Takashin , Hashimoto Kohei , Kiriyama Takeshi , Hirano Keita
Published: April 2019

A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.
Transradial approach in the treatment of a sacral dural arteriovenous fistula: a technical note
Authors: Orru Emanuele , Tsang Chun On Anderson , Klostranec Jesse M , Pereira Vitor M
Published: April 2019

Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.
Genetic aspects of idiopathic paediatric uveitis and juvenile idiopathic arthritis associated uveitis in Chinese Han
Authors: Deng Jing , Tan Handan , Hu Jiayue , Su Guannan , Cao Qingfeng , Huang Xinyue , Zhou Chunjiang , Wang Yao , Kijlstra Aize , Yang Peizeng
Published: April 2019

Background

Idiopathic paediatric uveitis (IPU) and juvenile idiopathic arthritis associated uveitis (JIA-U) are the two most common entities in paediatric uveitis. This study addressed the possible association of IPU and JIA-U with genes that had been shown earlier to be associated with juvenile idiopathic arthritis.

Methods

We carried out a case-control association study involving 286 IPU, 134 JIA-U patients and 743 healthy individuals. A total of 84 candidate single nucleotide polymorphisms (SNPs) in 60 genes were selected for this study. The MassARRAY platform and iPLEX Gold Genotyping Assay was used to genotype 83 candidate SNPs and the remaining SNP (rs27293) was analysed using the TaqMan SNP Genotyping Assay.

Results

No evidence was found for an association of the candidate polymorphisms tested with IPU. Six SNPs (PRM1/rs11074967, JAZF1/rs73300638, IRF5/rs2004640, MEFV/rs224217, PSMA3/rs2348071 and PTPN2/rs7234029) showed an association with JIA-U (p<1.0×10−2).

Conclusion

Our findings showed associations of six SNPs (PRM1/rs11074967, JAZF1/rs73300638, IRF5/rs2004640, MEFV/rs224217, PSMA3/rs2348071 and PTPN2/rs7234029) with JIA-U. No association was detected between the 84 tested SNPs and IPU.
Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults
Authors: Ingoe Helen MA , Coleman Elizabeth , Eardley William , Rangan Amar , Hewitt Catherine , McDaid Catriona
Published: April 2019

Objectives

Multiple systematic reviews have reported on the impact of rib fracture fixation in the presence of flail chest and multiple rib fractures, however this practice remains controversial. Our aim is to synthesise the effectiveness of surgical rib fracture fixation as evidenced by systematic reviews.

Design

A systematic search identified systematic reviews comparing effectiveness of rib fracture fixation with non-operative management of adults with flail chest or unifocal non-flail rib fractures. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Science Citation Index were last searched 17 March 2017. Risk of bias was assessed using the Risk Of Bias In Systematic reviews (ROBIS) tool. The primary outcome was duration of mechanical ventilation.

Results

Twelve systematic reviews were included, consisting of 3 unique randomised controlled trials and 19 non-randomised studies. Length of mechanical ventilation was shorter in the fixation group compared with the non–operative group in flail chest; pooled estimates ranged from −4.52 days, 95% CI (−5.54 to –3.5) to −7.5 days, 95% CI (−9.9 to –5.5). Pneumonia, length of hospital and intensive care unit stay all showed a statistically significant improvement in favour of fixation for flail chest; however, all outcomes in favour of fixation had substantial heterogeneity. There was no statistically significant difference between groups in mortality. Two systematic reviews included one non-randomised studies of unifocal non-flail rib fracture population; due to limited evidence the benefits with surgery are uncertain.

Conclusions

Synthesis of the reviews has shown some potential improvement in patient outcomes with flail chest after fixation. For future review updates, meta-analysis for effectiveness may need to take into account indications and timing of surgery as a subgroup analysis to address clinical heterogeneity between primary studies. Further robust evidence is required before conclusions can be drawn of the effectiveness of surgical fixation for flail chest and in particular, unifocal non-flail rib fractures.

PROSPERO registration number

CRD42016053494.
Mapping the use of soft systems methodology for change management in healthcare: a scoping review protocol
Authors: Augustsson Hanna , Churruca Kate , Braithwaite Jeffrey
Published: April 2019

Introduction

It is notoriously challenging to implement evidence-based care and to update and improve healthcare practices. One reason for the difficulty is the complexity of healthcare and the powerful influence of context on implementation and improvement efforts. Thus, there is a need for multifaceted, flexible change methods that takes these complexities into consideration. One approach that has the potential in this regard is soft systems methodology (SSM). However, little is known about how SSM has been applied in healthcare settings, making it difficult to assess the usefulness of SSM for implementation science or improvement research. The aim of the proposed scoping review is to examine and map the use and outcomes of SSM in healthcare.

Methods and analysis

The review will adapt the framework outlined by Arksey and O’Malley (2005). Citations will be uncovered through a comprehensive database search of the peer-reviewed literature. Two reviewers will conduct a two-stage review and selection process where the titles/abstracts are examined followed by a screening of full texts of the selected citations. Reference lists of included citations will be snowballed to identify potential additional citations. Inclusion criteria are English language, peer-reviewed empirical papers focusing on the application of SSM in a healthcare setting. Both general information about the citations and information related to the objective of the review will be extracted from the included citations and entered into a data charting form. The extracted information will be reported in diagrams and tables and summarised to present a narrative account of the literature. The proposed review will provide information on the potential for using SSM to affect change in healthcare.

Ethics and dissemination

No primary data will be collected, and thus ethical permission is unnecessary. Dissemination of results include peer-reviewed publications and conference presentations.
Healthcare resource utilisation and cost associated with elevated potassium levels: a Danish population-based cohort study
Authors: Kim Kun , Thomsen Reimar Wernich , Nicolaisen Sia Kromann , Hasvold Lars Pål , Palaka Eirini , Sørensen Henrik Toft
Published: April 2019

Objectives

To investigate healthcare costs associated with hyperkalaemia (HK) among patients with chronic kidney disease (CKD), heart failure (HF) or diabetes.

Design

Before–after cohort study of patients with HK and matched patients without HK.

Setting

Population-based databases covering primary and secondary care for the entire of Northern Denmark.

Participants

Patients with a first incident record of CKD (n=78 372), HF (n=14 233) or diabetes (n=37 479) during 2005–2011. Among all patients experiencing a first HK event (potassium level >5.0 mmol/L), healthcare costs were compared during 6 months before and 6 months after the HK event. The same cost assessment was conducted 6 months before and after a matched index date in a comparison cohort of patients without HK.

Primary and secondary outcome measures

Mean costs of hospital care, general practice and dispensed drugs converted to 2018 Euros.

Results

Overall, 17 747 (23%) CKD patients, 5141 (36%) HF patients and 4183 (11%) diabetes patients with a first HK event were identified. More than 40% of all HK patients across the patient groups had subsequent HK events with successively shorter times between the events. In CKD patients, overall mean costs were €5518 higher 6 months after versus before first HK, while €441 higher in matched CKD patients without HK, yielding HK-associated costs of €5077. Corresponding costs associated with a HK event were €6018 in HF patients, and €4862 in diabetes patients.

Conclusions

Among CKD, HF and diabetes patients, an incident HK event was common, and a large proportion of the patients experienced recurrent HK events. Substantial increase in healthcare costs associated with a HK event was observed in the HK patients compared with non-HK patients. These results are important to better understand the potential economic impact of HK among high-risk comorbid patients in a real-wold setting and help inform decision-making for clinicians and healthcare providers.
Prevalence and practice for rare diseases in primary care: a national cross-sectional study in the USA
Authors: Jo Ara , Larson Samantha , Carek Peter , Peabody Michael R , Peterson Lars E , Mainous Arch G
Published: April 2019

Objectives

There are more than 7000 rare diseases in the USA, and they are prevalent in 8% of the population. Due to life-threatening risk and limited therapies, early detection and treatment are critical. The purpose of this study was to explore characteristics of visits for patients with rare diseases seen by primary care physicians (PCPs).

Design

The study used a cross sectional study using a national representative dataset, the National Ambulatory Medical Care Survey for the years 2012–2014.

Setting

Primary care setting.

Participants

Visits to PCPs (n=22 306 representing 354 507 772 office visits to PCPs).

Primary outcome measures

Prevalence of rare diseases in visits of PCPs was the primary outcome. Bivariate analyses and logistic regression analyses were used to compare patients with rare diseases and those without rare diseases and examined characteristics of PCP visits for rare diseases and practice pattern.

Results

Among outpatient visits to PCPs, rare diseases account for 1.6% of the visits. The majority of patients with rare diseases were established patients (93.0%) and almost half (49.0%) were enrolled in public insurance programmes. The time spent in visits for rare diseases (22.4 min) and visits for more common diseases (21.3 min) was not significantly different (p=0.09). In an adjusted model controlling for patient characteristics (age, sex, types of insurance, reason for this visit, total number of chronic disease, having a rare disease and established or new patient), patients with rare diseases were 52% more likely to be referred to another provider (OR 1.52, 95% CI, 1.01 to 2.28).

Conclusions

Visits for rare diseases are uncommon in primary care practice. Future research may help to explain whether this low level of management of rare diseases in primary care practice is consistent with a goal of a broad scope of care.
BET 1: High-flow nasal oxygen therapy in bronchiolitis
Authors: Jaconelli Tom , Rajah Fatemah
Published: April 2019

A shortcut review was carried out to establish whether high-flow nasal oxygen was better than standard oxygen therapy in infants with signs and symptoms of bronchiolitis at reducing the need for escalation of therapy. Three papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that high-flow nasal oxygen has a role in the management of bronchiolitis and may reduce the need for escalation of therapy with patients with bronchiolitis under the age of 1 year.
BET 2: Pain management in patients who show awareness during CPR
Authors: Lundsgaard Rune Sarauw , Lundsgaard Kristine Sarauw
Published: April 2019

A shortcut review was carried out to establish whether pin management or sedation is indicated to improve outcome in patients who show signs of awareness during cardiopulmonary resuscitation (CPR). Seven papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that awareness during CPR or CPR-induced consciousness is rare but increasingly reported. Further research is needed before definite guidance can be given. Local advice should be followed
First family case of haemoglobinopathy Titusville in France and literature overview
Authors: Ruetsch Caroline , Raffort Juliette , Panaia-Ferrari Patricia , Deconde Célia , Caruba-Bafghi Celine , Naimi Mourad , Kavafyan Juliette , Suissa Laurent , Chinetti Guilia
Published: April 2019

Normal haemoglobin is a tetramer molecule, consisting of two α and β haemoglobin chains. Haemoglobinopathies occur when abnormalities in these proteins are present. More than 1000 naturally occurring human haemoglobin variants with single amino acid substitution throughout the molecule have been identified and can be discovered through their clinical and biological manifestations. Here, we report the case of a 60-year-old woman for whom no oximetry results were obtained during blood gas analysis (BGA) and the values of oxygen saturation obtained from pulse oximetry (73%) and co-oximetry (90%) differed. Haemoglobin analysis demonstrated the presence of a variant in the alpha chain. Clinical history of the patient and her family revealed they carry a haemoglobin variant (Titusville type), thus representing the first French family case reported. Those results raised the question whether the presence of this variant could be the cause of the errors encountered during BGA.
Change in type-2 biomarkers and related cytokines with prednisolone in uncontrolled severe oral corticosteroid dependent asthmatics: an interventional open-label study
Authors: Busby John , Holweg Cecile T J , Chai Akiko , Bradding Peter , Cai Fang , Chaudhuri Rekha , Mansur Adel H , Lordan James Laurence , Matthews John G , Menzies-Gow Andrew , Niven Robert , Staton Tracy , Heaney Liam G
Published: April 2019

Type-2 biomarkers and related cytokines (IL-5, IL-13), lung function and asthma symptoms were measured in 44 poorly-controlled severe oral corticosteroid (OCS)-dependent asthmatics for up to 88 days after a 7-day prednisolone boost (0.5 mg/kg). High-dose OCS reduced median blood eosinophils (−60 cells/µl; 95% CI −140 to 10), periostin (−8.4 ng/mL; −11.6 to –2.8), FeNO (−19.0 ppb; −28.5 to –4.0), IL-5 (−0.17 pg/mL; −0.28 to –0.08) and IL-13 (−0.15 pg/mL; −0.27 to –0.03). There were small improvements in mean FEV1(0.16 L; 0.05 to 0.27) and (Asthma Control Questionnaire) ACQ-7 score (0.3; 0.0 to 0.7). Study measures returned to baseline 1-month postintervention. Following rescue OCS, 1 month is sufficient before using type-2 biomarkers to guide long-term treatment.

Trial registration number

NCT01948401.
Have e-cigarettes renormalised or displaced youth smoking? Results of a segmented regression analysis of repeated cross sectional survey data in England, Scotland and Wales
Authors: Hallingberg Britt , Maynard Olivia M , Bauld Linda , Brown Rachel , Gray Linsay , Lowthian Emily , MacKintosh Anne-Marie , Moore Laurence , Munafo Marcus R , Moore Graham
Published: April 2019

Objectives

To examine whether during a period of limited e-cigarette regulation and rapid growth in their use, smoking began to become renormalised among young people.

Design

Interrupted time-series analysis of repeated cross-sectional time-series data.

Setting

Great Britain

Participants

248 324 young people aged approximately 13 and 15 years, from three national surveys during the years 1998–2015.

Intervention

Unregulated growth of e-cigarette use (following the year 2010, until 2015).

Outcome measures

Primary outcomes were prevalence of self-reported ever smoking and regular smoking. Secondary outcomes were attitudes towards smoking. Tertiary outcomes were ever use of cannabis and alcohol.

Results

In final models, no significant change was detected in the pre-existing trend for ever smoking (OR 1.01, CI 0.99 to 1.03). There was a marginally significant slowing in the rate of decline for regular smoking (OR 1.04, CI 1.00 to 1.08), accompanied by a larger slowing in the rate of decline of cannabis use (OR 1.21, CI 1.18 to 1.25) and alcohol use (OR 1.17, CI 1.14 to 1.19). In all models and subgroup analyses for smoking attitudes, an increased rate of decline was observed after 2010 (OR 0.88, CI 0.86 to 0.90). Models were robust to sensitivity analyses.

Conclusions

There was a marginal slowing in the decline in regular smoking during the period following 2010, when e-cigarettes were emerging but relatively unregulated. However, these patterns were not unique to tobacco use and the decline in the acceptability of smoking behaviour among youth accelerated during this time. These analyses provide little evidence that renormalisation of youth smoking was occurring during a period of rapid growth and limited regulation of e-cigarettes from 2011 to 2015.

Trial registration number

Research registry number: researchregistry4336
Liquefaction and post-liquefaction assessment of lightly cemented sands
Authors: Rasouli Habib , Fatahi Behzad , Nimbalkar Sanjay
Published: April 2019

Post-liquefaction response of lightly cemented sands during an earthquake may change and become similar to uncemented sands due to bonding breakage. In the current study, the effect of degree of cementation on liquefaction and post-liquefaction behaviour of lightly cemented sands was studied through a series of cyclic and monotonic triaxial tests. Portland cement with high early strength and Sydney sand were used to reconstitute the lightly cemented specimens with unconfined compression strength ranging from 25 to 220 kPa. A series of multi-stage soil element tests including stress-controlled cyclic loading events with different amplitudes and post-cyclic undrained monotonic shearing tests were carried out on both uncemented and cemented specimens. Furthermore, a series of undrained monotonic shearing tests without cyclic loading history on different types of specimens was conducted to investigate the effect of cyclic loading history on the post-cyclic response of the specimens. The results show that residual excess pore-water pressure is correlated to the cyclic degradation of lightly cemented sands during cyclic loading. In addition, optical microstructure images of the cemented specimens after liquefaction showed that a major proportion of cementation bonds remained unbroken, which resulted in a superior post-liquefaction response with respect to initial stiffness and shear modulus in comparison to the uncemented sand.
Role of hydrogen in ground and excited state studies of 2-aryl-3-hydroxychromenones in different solvents
Authors: Kaur Kulvir , Tomar Jyoti , Bansal Manisha
Published: April 2019

Radical scavenging activity (%SC) of three 2-heteroaryl 3-hydroxy chromenones (3-HCs) relative to 3-hydroxy flavones (3-HF) has been determined, using 2,2-diphenyl-1-picrylhydrazyl (DPPH) as a radical scavenger both in methanol (MeOH) and acetonitrile (ACN) as solvents. Among the three 3-HCs, 2-(furan-2-yl)-3-hydroxy-4 H-chromen-4-one (FHC), 3-hydroxy-2-(thiophene-2-yl)-4H-chromen-4-one (THC), and 3-hydroxy-2-(pyrrol-2-yl)-4H-chromen-4-one (PHC), the last 3-HC was included in our earlier reported studies on absorption, emission, and excitation spectra. Detailed studies on the excited state intramolecular proton transfer (ESIPT) on PHC relative to other three 3-HCs have been given. Order of %SCs is PHC > FHC > THC > 3-HF in MeOH and PHC > FHC ≈ THC > 3-HF in ACN, which are similar to that of intensity ratio of normal and tautomeric forms (IN*/IT*). Both %SC and IN*/IT* depend upon the potential of hydrogen of 3-hydroxy in 3-HCs in their ground and excited states, respectively. It has been found that for PHC, IN*/IT* and %SC are distinctly high compared with other chromenones. It is concluded that the determination of %SC can be as important as IN*/IT* for these.
The Identification and Evaluation Model for Test Paper’s Color and Substance Concentration
Authors: Guan Jinlan , Ou Jiequan , Liu Guanghua , Chen Minna , Lai Yuting
Published: April 2019

The colorimetric method is usually used to test the concentration of substances. However, this method has a big error since different people have different sensitivities to colors. In this paper, in order to solve the identification problem of the color and the concentration of the test paper, firstly, we found out that the concentration of substance is correlated with the color reading by using the Pearson’s Chi-squared test method. And by the concentration coefficient of Pearson correlation analysis, the concentration of substance and color reading is highly correlated. Secondly, according to the RGB value of the paper image, the color moments of the image are calculated as the characteristics of the image, and the Levenberg–Marquardt (LM) neural network is established to classify the concentration of the substance. The accuracy of the training set model is 94.5%, and the accuracy of the test set model is 87.5%. The model precision is high, and the model has stronger generalization ability. Therefore, according to the RGB value of the test paper image, it is effective to establish the LM neural network model to identify the substance concentration.
Self-Adapting Patch Strategies for Face Recognition
Authors: Li Zhi-Ming , Li Wen-Juan , Wang Jun
Published: April 2019

In this paper, we propose two self-adapting patch strategies, which are obtained by employing the integral projection technique on images’ edge images, while the edge images are recovered by the two-dimensional discrete wavelet transform. The patch strategies are equipped with the advantage of considering the single image’s unique properties and maintaining the integrity of some particular local information. Combining the self-adapting patch strategies with local binary pattern feature extraction and the classifier of the forward and backward greedy algorithms under strong sparse constraint, we propose two new face recognition methods. Experiments are run on the Georgia Tech, LFW and AR face databases. The obtained numerical results show that the new methods outperform some related patch-based methods to a larger extent.
An Experimental Study of Metastability-Induced Glitching Behavior
Authors: Polzer Thomas , Huemer Florian , Steininger Andreas
Published: April 2019

The increasing number of clock domain crossings in modern systems-on-chip makes the careful consideration of metastability paramount. However, the manifestation of metastability at a flip-flop output is often unduly reduced to late transitions only, while glitches are hardly ever accounted for. In this paper we study the occurrence of glitches resulting from metastability in detail. To this end we propose a measurement circuit whose principle substantially differs from the conventional approach, and by that allows to reliably detect glitches. By means of experimental measurements on an FPGA target we can clearly identify late transitions, single glitches and double glitches as possible manifestations of metastability. Some of these behaviors are unexpected as they do not follow from the traditional modeling theory. We also study the dependence of metastable behavior on supply voltage. Beyond confirming that, as reported in previous literature, the metastable decay constant [Formula: see text] is voltage-dependent, we also produce strong evidence that the relative occurrence of glitches is not voltage-dependent.