bluuebunny/crossref_metadata_2025 huggingface dataset:
Forces in Green Micromachining of Ceramics: An Experimental Investigation on Micromachining of Aluminum Nitride
Authors: Onler Recep , Atre Sundar V. , Burak Ozdoganlar O.
Published: March 2019

This paper presents an investigation of green micromachining (GMM) forces during orthogonal micromachining green-state AlN ceramics. Green-state ceramics contain ceramic powders within a binder; processed samples are subsequently debound and sintered to obtain solid ceramic parts. An effective approach to create microscale features on ceramics is to use mechanical micromachining when the ceramics are at their green state. This approach, referred to as GMM, considerably reduces the forces and tool wear with respect to micromachining of sintered ceramics. As such, fundamental understanding on GMM of ceramics is critically needed. To this end, in this work, the force characteristics of powder injection molded AlN ceramics with two different binder states were experimentally investigated via orthogonal cutting. The effects of micromachining parameters on force components and specific energies were experimentally identified for a tungsten carbide (WC) and a single crystal diamond tools. As expected, the thrust forces were seen to be significantly larger than the cutting forces at low uncut chip thicknesses when using the carbide tool with its large edge radius. The cutting forces are found to be more sensitive to uncut chip thickness than the thrust forces are. When a sharp diamond tool is used, cutting forces are significantly larger than the thrust forces even for small uncut chip thicknesses. The specific energies follow an exponential decrease with increasing uncut chip thickness similar to the common trends in metal cutting. However, due to interaction characteristics between cutting edge and ceramic particles in the green body, evidence of plowing and rubbing along the cutting region was observed even with a sharp diamond tool.
Deciphering the “Art” in Modeling and Simulation of the Knee Joint: Overall Strategy
Authors: Erdemir Ahmet , Besier Thor F. , Halloran Jason P. , Imhauser Carl W. , Laz Peter J. , Morrison Tina M. , Shelburne Kevin B.
Published: March 2019

Recent explorations of knee biomechanics have benefited from computational modeling, specifically leveraging advancements in finite element analysis and rigid body dynamics of joint and tissue mechanics. A large number of models have emerged with different levels of fidelity in anatomical and mechanical representation. Adapted modeling and simulation processes vary widely, based on justifiable choices in relation to anticipated use of the model. However, there are situations where modelers' decisions seem to be subjective, arbitrary, and difficult to rationalize. Regardless of the basis, these decisions form the “art” of modeling, which impact the conclusions of simulation-based studies on knee function. These decisions may also hinder the reproducibility of models and simulations, impeding their broader use in areas such as clinical decision making and personalized medicine. This document summarizes an ongoing project that aims to capture the modeling and simulation workflow in its entirety—operation procedures, deviations, models, by-products of modeling, simulation results, and comparative evaluations of case studies and applications. The ultimate goal of the project is to delineate the art of a cohort of knee modeling teams through a publicly accessible, transparent approach and begin to unravel the complex array of factors that may lead to a lack of reproducibility. This manuscript outlines our approach along with progress made so far. Potential implications on reproducibility, on science, engineering, and training of modeling and simulation, on modeling standards, and on regulatory affairs are also noted.
Three-Dimensional Thermo-Elasto-Hydrodynamic Computational Fluid Dynamics Model of a Tilting Pad Journal Bearing—Part I: Static Response
Authors: Yang Jongin , Palazzolo Alan
Published: March 2019

This paper presents the first simulation model of a tilting pad journal bearing (TPJB) using three-dimensional (3D) computational fluid dynamics (CFD), including multiphase flow, thermal-fluid, transitional turbulence, and thermal deformation of the shaft and pads employing two-way fluid–structure interaction (FSI). Part I presents a modeling method for the static performance. The model includes flow between pads BP, which eliminates the use of an uncertain, mixing coefficient (MC) in Reynold's equation approaches. The CFD model is benchmarked with Reynold's model with a 3D thermal-film, when the CFD model boundary conditions are consistent with the Reynolds boundary conditions. The Reynolds model employs an oversimplified MC representation of the three-dimensional mixing effect of the BP flow and heat transfer, and it also employs simplifying assumptions for the flow and heat transfer within the thin film between the journal and bearing. This manufactured comparison shows good agreement between the CFD and Reynold's equation models. The CFD model is generalized by removing these fictitious boundary conditions on pad inlets and outlets and instead models the flow and temperature between pads. The results show that Reynold's model MC approach can lead to significant differences with the CFD model including detailed flow and thermal modeling between pads. Thus, the CFD approach provides increased reliability of predictions. The paper provides an instructive methodology including detailed steps for properly applying CFD to tilt pad bearing modeling. Parts I and II focus on predicting static and dynamic response characteristic responses, respectively.
On the Nonlinear Energy Interactions in Harmonically Excited Post-Buckled Flexible Inverted Pendulum in the Presence of Friction
Authors: Vyas Vishal , Gandhi Prasanna
Published: March 2019

Nonlinear energy interaction is a fascinating feature of nonlinear oscillators and has been drawing the attention of researchers since the last few decades. Omnipresent friction in mechanical systems can play a crucial role in modifying these interactions. Using post-buckled flexible inverted pendulum as a candidate system we characterize here, theoretically and experimentally, significant changes in the nonlinear energy transfer in the presence of friction at the input side. Particularly, even with relatively low friction, the energy gets transferred in the higher harmonics of excitation close to a resonant mode as against the transfer to higher modes reported previously. We term this new phenomenon as “excitation harmonic resonance locking.” Theoretical modeling and simulations, considering large deformations, based on assumed modes method, and using a simple friction model reasonably capture the experimental observation. In summary, the paper explicates the role of friction in shifting energy transfer frequencies and can be useful in understanding and designing of oscillators and nonlinear vibrating systems.
Cryptococcus neoformansGlucuronoxylomannan and Sterylglucoside Are Required for Host Protection in an Animal Vaccination Model
Authors: Colombo Ana Caroline , Rella Antonella , Normile Tyler , Joffe Luna S. , Tavares Patricia M. , de S. Araújo Glauber R. , Frases Susana , Orner Erika P. , Farnoud Amir M. , Fries Bettina C. , Sheridan Brian , Nimrichter Leonardo , Rodrigues Marcio L. , Del Poeta Maurizio
Published: April 2019

The number of deaths from cryptococcal meningitis is around 180,000 per year. The disease is the second leading cause of mortality among individuals with AIDS. Antifungal treatment is costly and associated with adverse effects and resistance, evidencing the urgency of development of both therapeutic and prophylactic tools. Here we demonstrate the key roles of polysaccharide- and glycolipid-containing structures in a vaccination model to prevent cryptococcosis.
Impact of bacterial probiotics on obesity, diabetes and non-alcoholic fatty liver disease related variables: a systematic review and meta-analysis of randomised controlled trials
Authors: Koutnikova Hana , Genser Bernd , Monteiro-Sepulveda Milena , Faurie Jean-Michel , Rizkalla Salwa , Schrezenmeir Jürgen , Clément Karine
Published: March 2019

Objective

To systematically review the effect of oral intake of bacterial probiotics on 15 variables related to obesity, diabetes and non-alcoholic fatty liver disease.

Design

Systematic review and meta-analysis.

Data sources

Medline, EMBASE and COCHRANE from 1990 to June 2018.

Eligibility criteria

Randomised controlled trials (≥14 days) excluding hypercholesterolaemia, alcoholic liver disease, polycystic ovary syndrome and children <3 years.

Results

One hundred and five articles met inclusion criteria, representing 6826 subjects. In overweight but not obese subjects, probiotics induced improvements in: body weight (k=25 trials, d=−0.94 kg mean difference, 95% CI −1.17 to −0.70, I²=0.0%), body mass index (k=32, d=−0.55 kg/m², 95% CI −0.86 to −0.23, I²=91.9%), waist circumference (k=13, d=−1.31 cm, 95% CI −1.79 to −0.83, I²=14.5%), body fat mass (k=11, d=−0.96 kg, 95% CI −1.21 to −0.71, I²=0.0%) and visceral adipose tissue mass (k=5, d=−6.30 cm², 95% CI −9.05 to −3.56, I²=0.0%). In type 2 diabetics, probiotics reduced fasting glucose (k=19, d=−0.66 mmol/L, 95% CI −1.00 to −0.31, I²=27.7%), glycated haemoglobin (k=13, d=−0.28 pp, 95% CI −0.46 to −0.11, I²=54.1%), insulin (k=13, d=−1.66 mU/L, 95% CI −2.70 to −0.61, I²=37.8%) and homeostatic model of insulin resistance (k=10, d=−1.05 pp, 95% CI −1.48 to −0.61, I²=18.2%). In subjects with fatty liver diseases, probiotics reduced alanine (k=12, d=−10.2 U/L, 95% CI −14.3 to −6.0, I²=93.50%) and aspartate aminotransferases (k=10, d=−9.9 U/L, 95% CI −14.1 to -5.8, I²=96.1%). These improvements were mostly observed with bifidobacteria (Bifidobacterium breve,B. longum),Streptococcus salivariussubsp. thermophilusand lactobacilli (Lactobacillus acidophilus,L. casei,L. delbrueckii) containing mixtures and influenced by trials conducted in one country.

Conclusions

The intake of probiotics resulted in minor but consistent improvements in several metabolic risk factors in subjects with metabolic diseases.

Trial registration number

CRD42016033273.
First incidence, age of onset outcomes and risk factors of onset of DSM-5 oppositional defiant disorder: a cohort study of Spanish children from ages 3 to 9
Authors: Ezpeleta Lourdes , Navarro J Blas , de la Osa Nuria , Penelo Eva , Domènech Josep Maria
Published: March 2019

Objective

To examine the 1-year first incidence and prevalence of oppositional defiant disorder (ODD), the outcomes on psychopathology and functioning by age of onset and the risk factors of onset of ODD from ages 3 to 9 in children from the Spanish general population.

Design

Longitudinal with seven follow-ups and double cohort (ODD and non-ODD children).

Setting

General population of preschool and elementary school children in Barcelona (Spain).

Participants

On a first phase, the parent-rated Strengths and Difficulties Questionnaire conduct problems scale plus ODD Diagnostic and Statistical Manual of Mental Disorders, fourth version, symptoms were used to screen for behavioural problems. The second phase sample size contained 622 cases at age 3 and, at age 9, 418 remained in the study.

Results

The probability of the onset of ODD showed increasing values at ages 4 (R=2.7%) and 5 years (R=4.4%). These values decreased until age 7 (R=1.9%) and increased again until age 9 (R=3.6%). Up to 9 years old, the cumulative risk of new cases of ODD was 21.9%. Early onset was associated with a higher risk of depression comorbidity and later onset with higher functional impairment and symptomatology. Subthreshold ODD, high scores in irritability and headstrong dimensions, attention deficit/hyperactivity disorder and other comorbidity, negative affectivity until age 7, difficulties in inhibit and emotional control, punitive parenting and maternal internalising problems were risk factors of a first episode of ODD during this 7-year period.

Conclusions

The risk of new cases of ODD in the general population at preschool age and during childhood is high. Preschool age is a target period for preventive interventions. Identified risk factors are objectives for targeted and indicated interventions.
Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis
Authors: Tian Limin , Shao Feifei , Qin Yahong , Guo Qian , Gao Cuixia
Published: March 2019

Objectives

There is an increasing prevalence of hypothyroidism and there is a growing body of meta-analyses (MAs) on the association between hypothyroidism and other diseases. However, the methodological quality of the MAs significantly varies. Thus, this study aimed to evaluate and summarise data on the methodological quality of MAs on the associations between hypothyroidism and other diseases using the Assessment of Multiple Systematic Reviews (AMSTAR) scale, providing suggestions for clinical decision-making processes.

Design

To assess the methodological quality of MAs using the AMSTAR scale.

Data sources

A systematic literature search was performed in PubMed, EMBASE, the Cochrane Library, web of science and Chinese Biomedicine Literature Database.

Eligibility criteria

We included MAs that had assessed the association between hypothyroidism and other diseases in humans and that had full texts regardless of the publication status. No restriction applied on language or date.

Data extraction and synthesis

Two reviewers independently screened the titles and abstracts of all searched literature to acquire potentially eligible publications. The full texts of possible eligible publications were downloaded and assessed. Inconsistent comments were resolved through discussions with a third reviewer.

Results

52 studies were included. The average AMSTAR score of the included articles was 8.6 (range: 5–10), and those of English and Chinese MAs were 8.8 and 7.0, respectively. A total of 52 MAs were evaluated, and 19 (36.5%) and 33 (63.5%) of these MAs were of moderate and high quality, respectively. None of the MAs were of low quality. Only two MAs had an a priori design. Items 3, 5 and 9 had the highest compliance (50/52, 96.2%), and aside from item 1, items 7 and 8 had the lowest compliance (33/52,63.5%). According to the results of these MAs, hypothyroidism was significantly associated with cardiovascular diseases, metabolic diseases, neuropsychiatric disorders, breast cancer and pregnancy outcome.

Conclusions

The methodological quality of the included MAs on the association between hypothyroidism and other diseases was moderate to high. MAs with high qualities confirmed that hypothyroidism was significantly associated with cardiovascular diseases, metabolic syndrome, preterm birth and neonatal outcomes. Consideration of scientific quality when formulating conclusions should be made explicit and more attention should be paid to improving the methodological quality of MAs, and increasing their applicability for clinical decision-making.
Complex challenges for patients with protracted incurable cancer: an ethnographic study in a comprehensive cancer centre in the Netherlands
Authors: Buiting Hilde M , van Ark Marleen A C , Dethmers Otto , Maats Emma P E , Stoker Jogien A , Sonke Gabe S
Published: March 2019

Objective

Advances in oncology increasingly result in protracted disease trajectories for patients with incurable cancer. In this disease phase, patients are aware of the incurable nature of cancer although they are not yet approaching the last phase of life. We explored the challenges for patients confronted with protracted incurable cancer.

Design

Ethnographic study (2015–2017) based on conversations with patients, observations at a day-care unit and a selection of information from the medical records of patients who died during the study period.

Setting

The day-care unit of a comprehensive cancer centre in the Netherlands.

Participants

Nineteen patients with stage IV breast cancer (in remission, >1 year after diagnosis) and 11 patients with stage IV lung-cancer (in remission, >6 months after diagnosis).

Results

In patients who had died during the study period, the treatment response often fluctuated between stable, remission and progression throughout the course of the disease. Patients reported that this fluctuation could be overwhelming. However, as patients grew accustomed to having protracted incurable cancer, the distress associated with fluctuations (perceived in scan results) slowly faded. Patients reported that cancer became part of who they were. At the day-care unit, most patients talked about their disease in an optimistic or neutral way and expressed delight in life. They often expressed gratefulness for the possible prolongation of life, expressed hope and tried to stay optimistic. This was frequently reinforced by optimistic doctors and nurses. Relatives, however, could downplay such optimism. Moreover, some patients acknowledged that hope was qualified by their personal challenges regarding their disease.

Conclusions

In situations where tumours remained in remission or were stable for extended periods, patients grew accustomed to having cancer. At the day-care unit, medical professionals typically encouraged an attitude of being hopeful and optimistic, which could be downplayed by relatives. More research is warranted to explore this protracted disease phase and this optimistic view among healthcare professionals.
Changing contribution of area-level deprivation to total variance in age at death: a population-based decomposition analysis
Authors: Seaman Rosie , Riffe Tim , Caswell Hal
Published: March 2019

Objectives

Two processes generate total variance in age at death: heterogeneity (between-group variance) and individual stochasticity (within-group variance). Limited research has evaluated how these two components have changed over time. We quantify the degree to which area-level deprivation contributed to total variance in age at death in Scotland between 1981 and 2011.

Design

Full population and mortality data for Scotland were obtained and matched with the Carstairs score, a standardised z-score calculated for each part-postcode sector that measures relative area-level deprivation. A z-score above zero indicates that the part-postcode sector experienced higher deprivation than the national average. A z-score below zero indicates lower deprivation. From the aggregated data we constructed 40 lifetables, one for each deprivation quintile in 1981, 1991, 2001 and 2011 stratified by sex.

Primary outcome measures

Total variance in age at death and the proportion explained by area-level deprivation heterogeneity (between-group variance).

Results

The most deprived areas experienced stagnating or slightly increasing variance in age at death. The least deprived areas experienced decreasing variance. For males, the most deprived quintile life expectancy was between 7% and 11% lower and the SD is between 6% and 25% higher than the least deprived. This suggests that the effect of deprivation on the SD of longevity is comparable to its effect on life expectancy. Decomposition analysis revealed that contributions from between-group variance doubled between 1981 and 2011 but at most only explained 4% of total variance.

Conclusions

This study adds to the emerging body of literature demonstrating that socio-economic groups have experienced diverging trends in variance in age at death. The contribution from area-level deprivation to total variance in age at death, which we were able to capture, has doubled since 1981. Area-level deprivation may play an increasingly important role in mortality inequalities.
Advice on healthy pregnancy, delivery, motherhood and information on non-communicable diseases in the maternal care programme in Myanmar: a cross-sectional study
Authors: Okawa Sumiyo , Win Hla Hla , Nanishi Keiko , Shibanuma Akira , Aye Phyu Phyu , Saw Thu Nandar , Jimba Masamine
Published: March 2019

Objective

Pregnancy and delivery periods offer an opportunity for counselling women to improve behavioural risk and prevent complications, including non-communicable diseases (NCDs). However, little evidence is available on counselling offered during antenatal and postnatal care (PNC) in Myanmar. This study aimed to assess the contents of advice and information received by women during antenatal and postnatal counselling and to identify factors associated with receiving those advice and information.

Design

Cross-sectional study.

Setting

A predominantly rural township in the Ayeyawady region and a predominantly urban township in the Yangon region.

Participants

1500 women who had given birth in the last 6 weeks to 12 months prior to the survey.

Outcome measures

Receiving advice on 18 items during antenatal counselling, 10 items during postnatal counselling and information on five major NCDs during antenatal care (ANC).

Results

Nearly 52% of women received advice on 18 items during antenatal counselling, and 60% received advice on 10 items during postnatal counselling. About 28% received information on five NCDs during ANC. Women who were living in the Yangon site, who had primary school education or lower and who experienced complications were less likely to receive advice on all items during both antenatal and postnatal counselling. Women who received PNC outside of a healthcare facility and were primiparas were also less likely to receive advice on all items during postnatal counselling. Women living in the Yangon site and those who utilised a private care facility were less likely to receive information on NCDs.

Conclusions

Only 60% of women received advice on healthy pregnancy, delivery and motherhood, whereas 30% received information on NCDs. Although non-modifiable maternal factors were associated with these results, counselling practice can be improved and information on NCDs can be offered as the first step of integrated NCDs care in maternal care programme in Myanmar.
Comprehensive Researcher Achievement Model (CRAM): a framework for measuring researcher achievement, impact and influence derived from a systematic literature review of metrics and models
Authors: Braithwaite Jeffrey , Herkes Jessica , Churruca Kate , Long Janet C , Pomare Chiara , Boyling Claire , Bierbaum Mia , Clay-Williams Robyn , Rapport Frances , Shih Patti , Hogden Anne , Ellis Louise A , Ludlow Kristiana , Austin Elizabeth , Seah Rebecca , McPherson Elise , Hibbert Peter D , Westbrook Johanna
Published: March 2019

Objectives

Effective researcher assessment is key to decisions about funding allocations, promotion and tenure. We aimed to identify what is known about methods for assessing researcher achievements, leading to a new composite assessment model.

Design

We systematically reviewed the literature via the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols framework.

Data sources

All Web of Science databases (including Core Collection, MEDLINE and BIOSIS Citation Index) to the end of 2017.

Eligibility criteria

(1) English language, (2) published in the last 10 years (2007–2017), (3) full text was available and (4) the article discussed an approach to the assessment of an individual researcher’s achievements.

Data extraction and synthesis

Articles were allocated among four pairs of reviewers for screening, with each pair randomly assigned 5% of their allocation to review concurrently against inclusion criteria. Inter-rater reliability was assessed using Cohen’s Kappa (ĸ). The ĸ statistic showed agreement ranging from moderate to almost perfect (0.4848–0.9039). Following screening, selected articles underwent full-text review and bias was assessed.

Results

Four hundred and seventy-eight articles were included in the final review. Established approaches developed prior to our inclusion period (eg, citations and outputs, h-index and journal impact factor) remained dominant in the literature and in practice. New bibliometric methods and models emerged in the last 10 years including: measures based on PageRank algorithms or ‘altmetric’ data, methods to apply peer judgement and techniques to assign values to publication quantity and quality. Each assessment method tended to prioritise certain aspects of achievement over others.

Conclusions

All metrics and models focus on an element or elements at the expense of others. A new composite design, the Comprehensive Researcher Achievement Model (CRAM), is presented, which supersedes past anachronistic models. The CRAM is modifiable to a range of applications.
Translation, cross-cultural adaptation and validation of the traditional Chinese intermittent and constant osteoarthritis pain (ICOAP) questionnaire for knee osteoarthritis
Authors: Sit Regina Wing Shan , Chan Dicken Cheong Chun , Wong Wendy , Yip Benjamin Hon Kei , Chow Lyan Lai Yan , Wong Samuel Y S
Published: March 2019

Objectives

To translate and culturally adapt the Intermittent and Constant Osteoarthritis and Pain (ICOAP) measure to a traditional Chinese version, and to study its psychometric properties in patients with knee osteoarthritis (KOA).

Method

The ICOAP was translated and cross-culturally adapted into traditional Chinese according to the recommended international guidelines. A total of 110 participants with KOA in Hong Kong were invited to complete the traditional Chinese ICOAP (tChICOAP), the Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and the Chinese Short form of Health Survey (SF-12v2). Psychometric evaluations included content validity, construct validity, internal consistency and test and retest reliability.

Results

All participants completed the tChICOAP questionnaire without missing items. The content validity index of all items ranged from 80% to 100%. The tChICOAP total pain and subscale scores had excellent internal consistency with Cronbach’s alpha value (0.902–0.948) and good corrected item-total subscale correlations. It had high test and retest reliability (intra-class correlations 0.924–0.960). The tChICOAP constant, intermittent and total pain scores correlate strongly with the WOMAC pain subscale (r=0.671, 0.678 and 0.707, respectively, p<0.001). The tChICOAP intermittent and total scores correlate strongly with SF-12v2 physical component score (r=−0.590 and −0.558, respectively, p<0.001).

Conclusions

The tChICOAP is a reliable and valid instrument to measure the pain experience of Chinese patients with KOA.
Protocol for the development of versions of the Montreal Cognitive Assessment (MoCA) for people with hearing or vision impairment
Authors: Dawes Piers , Pye Annie , Reeves David , Yeung Wai Kent , Sheikh Saima , Thodi Chyrssoula , Charalambous Anna Pavlina , Gallant Kathleen , Nasreddine Ziad , Leroi Iracema
Published: March 2019

Introduction

Hearing and vision impairments are highly prevalent among older adults and impact commonly used cognitive assessment tools for the identification of dementia. Adaptations of such tests for people with hearing or vision impairment have not been adequately validated among populations with such sensory impairment.

Methods and analysis

We will develop two versions of the Montreal Cognitive Assessment (MoCA) for people with acquired hearing impairment (MoCA-H) or vision impairment (MoCA-V). The MoCA-H and MoCA-V will exclude the existing MoCA items that are presented in spoken or visual format, respectively, and include new suitably adapted items. Participants (n=792) with combinations of hearing, vision and cognitive impairment will complete standard or adapted versions of the MoCA across three language sites (English, French and Greek). Development of the MoCA-H and the MoCA-V will be based on analysis of adapted and standard MoCA items following model-based development to select the combination of items for the MoCA-H and MoCA-V that provide optimal sensitivity and specificity for detection of dementia.

Ethics and dissemination

The study has received ethical approval from respective centres in the UK, France, Greece and Cyprus. The results of the study will be disseminated through peer-reviewed publication, conference presentations, the study website (https://www.sense-cog.eu/), the SENSE-Cog Twitter account (@sense_cog) and the MoCA test website (https://www.mocatest.org/). The main outputs of the study will be versions of the MoCA that are appropriate for use with adults with acquired hearing or vision impairment and will contribute significantly to the clinical care of older people.
The ART of conversation: feasibility and acceptability of a pilot peer intervention to help transition complex HIV-positive people from hospital to community
Authors: Eaton Andrew David , Chan Carusone Soo , Craig Shelley L , Telegdi Erin , McCullagh John W , McClure David , Wilson Walter , Zuniga Leonardo , Berney Kevin , Ginocchio Galo F , Wells Gordon A , Montess Michael , Busch Adam , Boyce Nick , Strike Carol , Stewart Ann
Published: March 2019

Objectives

To pilot a peer-based intervention for people living with HIV who used substances, had challenges with antiretroviral adherence and would be discharged from hospital to community.

Study design

A community-based, quasi-experimental pilot intervention study designed to assess feasibility, acceptability and connection to a community-based HIV organisation.

Setting

This study was conducted in Toronto, Canada, at Casey House (CH; hospital for people living with HIV) in collaboration with the AIDS Committee of Toronto (ACT; community-based HIV organisation).

Participants

People living with HIV who were CH inpatient between 1 April 2017 and 31 March 2018, struggled with antiretroviral adherence, actively used substances and would be discharged to community were eligible. Forty people met criteria, 19 were approached by an inpatient nurse and 17 consented. Average age was 48.8 years (SD=11.4), 58.8% were male and participants averaged 7.8 physical and mental health comorbidities (SD=3.1).

Intervention

Titled ’The ART of Conversation', the three-pronged personalised intervention was developed through input from CH clients and ACT volunteers, all living with HIV. Intervention components were (a) predischarge goal-setting (adherence, substance use and self-identified goal) with the study nurse; (b) predischarge meeting with an HIV+ peer volunteer (PV) and (c) nine postdischarge phone calls between PV and participant, once per day for 3 days, then once per week for 6 weeks.

Primary outcomes

Feasibility was measured through proportion of eligible participants recruited and PV availability. Acceptability was assessed through participant interviews at three times (preintervention, post-intervention and 6 weeks follow-up) and through PV call logs. Client records determined connection to ACT within the study timeframe.

Results

Twelve participants completed the intervention and nine connected with ACT. Predischarge goal-setting and PV meeting were both feasible and acceptable. Postdischarge phone calls were a challenge as half of completers missed at least one call.

Conclusions

Although predischarge goal-setting and PV meeting were feasible, methods to maintain connection following discharge require further investigation.
Risk of benign paroxysmal positional vertigo in patients with depressive disorders: a nationwide population-based cohort study
Authors: Hsu Chiao-Lin , Tsai Shih-Jen , Shen Cheng-Che , Lu Ti , Hung Yao-Min , Hu Li-Yu
Published: March 2019

Objective

The association between depression and benign paroxysmal positional vertigo (BPPV) remains debated. This study aimed to investigate the risk of BPPV in patients with depressive disorders.

Design

Longitudinal nationwide cohort study.

Setting

National health insurance research database in Taiwan.

Participants

We enrolled 10 297 patients diagnosed with depressive disorders between 2000 and 2009 and compared them to 41 188 selected control patients who had never been diagnosed with depressive disorders (at a 1:4 ratio matched by age, sex and index date) in relation to the risk of developing BPPV.

Methods

The follow-up period was defined as the time from the initial diagnosis of depressive disorders to the date of BPPV, censoring or 31 December 2009. Cox proportional hazard regression analysis was used to investigate the risk of BPPV by sex, age and comorbidities, with HRs and 95% CIs.

Results

During the 9-year follow-up period, 44 (0.59 per 1000 person-years) patients with depressive disorders and 99 (0.33 per 1000 person-years) control patients were diagnosed with BPPV. The incidence rate ratio of BPPV among both cohorts calculating from events of BPPV per 1000 person-years of observation time was 1.79 (95% CI 1.23 to 2.58, p=0.002). Following adjustments for age, sex and comorbidities, patients with depressive disorders were 1.55 times more likely to develop BPPV (95% CI 1.08 to 2.23, p=0.019) as compared with control patients. In addition, hyperthyroidism (HR=3.75, 95% CI 1.67–8.42, p=0.001) and systemic lupus erythematosus (SLE) (HR=3.47, 95% CI 1.07 to 11.22, p=0.038) were potential risk factors for developing BPPV in patients with depressive disorders.

Conclusions

Patients with depressive disorders may have an increased risk of developing BPPV, especially those who have hyperthyroidism and SLE.
How does the public conceptualise the quality of care and its measurement in community pharmacies in the UK: a qualitative interview study
Authors: Watson Margaret C , Silver Karin , Watkins Ross
Published: March 2019

Objectives

This study explored citizens’ perspectives about the quality of community pharmacy services in the UK and whether and how the quality of community pharmacy services should be measured.

Design

Semistructured interviews and focus groups were conducted and were audio recorded, transcribed and analysed systematically using an interpretive approach.

Participants

Members of the public were approached via networks, such as Health and Social Care Alliance Scotland, as well as community groups and personal networks.

Setting

Scotland, England and Wales.

Results

Data were collected from 20 participants: 11 interviews and 2 focus groups (in community settings, with five and four participants). Quality was conceptualised as multidimensional with inter-related overarching themes of person-centredness, professionalism and privacy. The importance of relational aspects with pharmacy personnel was emphasised including the need for a ‘friendly’ caring service, continuity of care, being known to personnel, including their awareness of individual’s health conditions: ‘it’s quite a personal service I would say…I think it means that they care about your welfare’. Participants discussed the importance of a professional approach to customer interactions including staff behaviour and appearance. Pharmacy design influenced perceptions of privacy, including having sufficient space or a separate consultation room to promote confidential consultations with a pharmacist. Participants suggested that quality assurance is needed to improve quality and to inspire confidence in the public ‘it would drive up quality standards overall’ but suggested that quality ratings were unlikely to influence their use of specific pharmacies. They emphasised the need for multidimensional quality ratings and for transparency with their derivation.

Conclusions

The public conceptualises quality of community pharmacy services as multidimensional and value relational aspects of care provided by personnel in this setting. While the development and application of quality indicators may drive improvement, it seems unlikely to influence the public’s use of individual pharmacies.
Introduction of a modified obstetric early warning system ­(­MOEWS­)­ at an Ethiopian referral hospital: a feasibility assessment
Authors: Moore Jolene , Thomson Duncan , Pimentil Iona , Fekad Bazezew , Graham Wendy
Published: March 2019

Early warning scores are points-based or colour-coded systems used to detect changes in physiological parameters and prompt earlier recognition and management of deteriorating patients. Vital signs recorded within a coloured zone corresponding to degree of derangement (‘trigger’) should prompt an action. The report of the UK Confidential Enquiry into Maternal and Child Health recommends the use of modified versions in the obstetric population. Currently, there is limited research into the effects of early warning scores in low-resource settings where maternal mortality remains high, and there is a need for low-cost, simple methods to reduce this. A modified obstetric early warning system (MOEWS) was introduced for parturients who had undergone surgical intervention at Felege Hiwot Referral Hospital, a tertiary centre in Bahir Dar, Ethiopia. A guideline was developed to accompany the MOEWS, together with training of healthcare workers. Prior to introduction, the quality of postoperative monitoring was assessed through retrospective case note review. This was reassessed at 8 months and 11 months postimplementation, with assessment of response to ‘triggers’. A questionnaire and qualitative interviews were undertaken to establish views of healthcare workers on its acceptability and usability. Recording of postoperative vital signs improved with the implementation of the MOEWS and was sustained at both monitoring periods. The number of patients with vital signs within the coloured zones (‘trigger’) was reduced, although documented action to these remained low. Staff were positive towards the MOEWS, its impact on patient care and felt confident using the system. The introduction of a MOEWS in an Ethiopian referral hospital in this study appeared to improve the monitoring of postoperative patients. With modifications to suit the setting and senior clinician involvement, coupled with regular training, the early warning score is a feasible and acceptable tool to cope with the unique demands faced in this low-resource setting.
Practical management of polyposis syndromes
Authors: Patel Roshani , Hyer Warren
Published: March 2019

Hereditary bowel tumours are usually part of a distinct syndrome which require management of both intestinal and extra-intestinal disease. Polyposis syndromes include: Familial adenomatous polyposis, MUTYH-associated polyposis, Serrated polyposis syndrome, Peutz-Jeghers syndrome, Juvenile polyposis syndrome and PTEN-hamartomatous syndromes. Of all colorectal cancers (CRC), 5%–10% will be due to an underlying hereditary CRC syndrome. Diagnosis and management of polyposis syndromes is constantly evolving as new scientific and technological advancements are made with respect to identifying causative genes and increased sophistication of endoscopic therapy to treat polyps. This, in addition to data yielded from meticulous record-keeping by polyposis registries has helped to guide management in what are otherwise relatively rare conditions. These data help guide clinical management of patients and their ‘at-risk’ relatives. Diagnosis is both genetic where possible but clinical recognition is key in the absence of an identifiable causative gene. Furthermore, some syndromes can overlap which can additionally complicate diagnosis. The principle goals of polyposis management are first to manage and treat the presenting patient and then to identify ‘at-risk’ patients, through screening and predictive genetic testing, endoscopic surveillance to allow therapy and guide surgical prophylaxis. Due to the complexity of diagnosis and management, patients and their families should be referred to a genetics centre or a polyposis registry where dedicated management can take place.
Comparison of revised Functional Capacity Index scores with Abbreviated Injury Scale 2008 scores in predicting 12-month severe trauma outcomes
Authors: Palmer Cameron S , Cameron Peter A , Gabbe Belinda J
Published: March 2019

Introduction

Anatomical injury as measured by the AIS often accounts for only a small proportion of variability in outcomes after injury. The predictive Functional Capacity Index (FCI) appended to the 2008 AIS claims to provide a widely available method of predicting 12-month function following injury.

Objectives

To determine the extent to which AIS-based and FCI-based scoring is able to add to a simple predictive model of 12-month function following severe injury.

Methods

Adult trauma patients were drawn from the population-based Victorian State Trauma Registry. Major trauma and severely injured orthopaedic trauma patients were followed up via telephone interview including Glasgow Outcome Scale—Extended, the EQ-5D-3L and return to work status. A battery of AIS-based and FCI-based scores, and a simple count of AIS-coded injuries were added in turn to a base model using age and gender.

Results

A total of 20 813 patients survived to 12 months and had at least one functional outcome recorded, representing 85% follow-up. Predictions using the base model varied substantially across outcome measures. Irrespective of the method used to classify the severity of injury, adding injury severity to the model significantly, but only slightly improved model fit. Across the outcomes evaluated, no method of injury severity assessment consistently outperformed any other.

Conclusions

Anatomical injury is a predictor of trauma outcome. However, injury severity as described by the FCI does not consistently improve discrimination, or even provide the best discrimination compared with AIS-based severity scores or a simple injury count.
Current approaches for RNA-labelling to identify RNA-binding proteins
Authors: Gemmill Dannielle , D’souza Simmone , Meier-Stephenson Vanessa , Patel Trushar R.
Published: March 2019

RNA is involved in all domains of life, playing critical roles in a host of gene expression processes, host-defense mechanisms, cell proliferation, and diseases. A critical component in many of these events is the ability for RNA to interact with proteins. Over the past few decades, our understanding of such RNA–protein interactions and their importance has driven the search and development of new techniques for the identification of RNA-binding proteins. In determining which proteins bind to the RNA of interest, it is often useful to use the approach where the RNA molecule is the “bait” and allow it to capture proteins from a lysate or other relevant solution. Here, we review a collection of methods for modifying RNA to capture RNA-binding proteins. These include small-molecule modification, the addition of aptamers, DNA-anchoring, and nucleotide substitution. With each, we provide examples of their application, as well as highlight their advantages and potential challenges.
Multiple roles of clays in radioactive waste confinement – introduction
Authors: Norris Simon
Published: April 2019

Geological disposal provides the safe long-term management solution for higher-activity radioactive waste. The development of a repository (or geological disposal facility) requires a systematic and integrated approach, taking into account the characteristics of the waste to be emplaced, the enclosing engineered barriers, and the host rock and its geological setting.

Clays and clayey material are important in the development of many national geological disposal systems. Clays exhibit many interesting properties, and are proposed both as host rocks and as material for engineered barriers. Whatever their use, clays present various characteristics that make them high-quality barriers to the migration of radionuclides and chemical contaminants. As host rocks, clays are, in addition, hydrogeologically, geochemically and mechanically stable over geological timescales (i.e. millions of years).
A Study ofTrichomonas vaginalisInfection and Correlates in Women with Vaginal Discharge Referred at Fann Teaching Hospital in Senegal
Authors: Tine Roger C. , Sylla Khadime , Ka Rougyatou , Dia Lamine , Sow Doudou , Lelo Souleye , Diallo Khardiata , Faye Babacar , Dieng Thérèse , Ndour Cheikh T. , Sow Ahmet Y.
Published: April 2019

Introduction. Trichomoniasis is nowadays the most prevalent non-viral sexually transmitted infection in the world. In Senegal, the epidemiology of trichomoniasis is not well known. The current study aimed at assessing the prevalence and factors associated withT. vaginalisinfection among women with vaginal discharge.Methods. A retrospective analysis of laboratory records from patients referred at the Fann Teaching Hospital in Dakar, Senegal, for vaginal discharge was carried out. The study covered the period from 2006 to 2011. For each participating woman, a vaginal swab was collected and a wet mount smear performed immediately. Optic microscopic examination with 40x magnification was done to detectT. vaginalisand assess biological modifications such as presence of epithelial cells, white blood cells, and red blood cells. A gram stained smear was also performed and examined under oil immersion (100x magnification) to assess the vaginal flora.Results. Overall, 3893 women were enrolled with a mean age at 31.2 ± 10 years. The prevalence of Trichomoniasis represented 4.8%, 95%CI(3.1-5.7) and it was lower among women less than 30 years (4.1%), while divorced women more likely to be infected compared to married and single women (aOR:2.1, 95%CI (1.2-3.7)). Trichomoniasis was associated with abnormal vaginal flora such as type III (aOR:2.6, 95%CI(1.5-4.4)) and type IV (aOR:3.3, 95%CI(2.1-5.3)). In addition, patients with erythrocytes excretion were more likely to be infected byT. vaginalis(aOR:2.8, 95%CI(1.9-3.9).Conclusion.Trichomonas vaginalisremains prevalent among sexually active women. Strategies aiming at improving disease awareness in these high-risk groups are needed to improve trichomoniasis prevention but extensive epidemiological data are still needed for a better understanding of the disease transmission dynamic.
Ontology-Based Framework for the Automatic Recognition of Activities of Daily Living Using Class Expression Learning Techniques
Authors: Salguero Alberto G. , Delatorre Pablo , Medina Javier , Espinilla Macarena , Tomeu Antonio J.
Published: April 2019

The miniaturization and price reduction of sensors have encouraged the proliferation of smart environments, in which multitudinous sensors detect and describe the activities carried out by inhabitants. In this context, the recognition of activities of daily living has represented one of the most developed research areas in recent years. Its objective is to determine what daily activity is developed by the inhabitants of a smart environment. In this field, many proposals have been presented in the literature, many of them being based onad hocontologies to formalize logical rules, which hinders their reuse in other contexts. In this work, we propose the use of class expression learning (CEL), an ontology-based data mining technique, for the recognition of ADL. This technique is based on combining the entities in the ontology, trying to find the expressions that best describe those activities. As far as we know, it is the first time that this technique is applied to this problem. To evaluate the performance of CEL for the automatic recognition of activities, we have first developed a framework that is able to convert many of the available datasets to all the ontology models we have found in the literature for dealing with ADL. Two different CEL algorithms have been employed for the recognition of eighteen activities in two different datasets. Although all the available ontologies in the literature are focused on the description of the context of the activities, the results show that the sequence of the events produced by the sensors is more relevant for their automatic recognition, in general terms.