bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparative Analysis of Information Gathering Meetings Conducted by Novice Design Teams Across Multiple Design Project Stages
Authors: Loweth Robert P. , Daly Shanna R. , Hortop Amy , Strehl Elizabeth A. , Sienko Kathleen H.
Published: January 2021

Designers often gather information, for instance through stakeholder or domain expert meetings, to understand their design problems and develop effective solutions. However, few previous studies have provided in-depth descriptions of novice engineering designers’ approaches to conducting information gathering meetings. In this preliminary study, we analyzed data from six capstone mechanical engineering design teams to identify the types of individuals from whom teams gathered information, when these meetings occurred, and how teams solicited information during meetings. Teams in our study exhibited a range of information gathering behaviors that aligned with recommended practices, particularly in their early meetings. We also observed relatively few instances of teams exhibiting behaviors that were less similar to recommended practices during their meetings. However, our findings revealed two key trends across teams that represented specific opportunities for improvement and that may reflect characteristic novice approaches to conducting information gathering meetings. First, teams explored domain experts’ perspectives in depth during meetings and met with additional domain experts to inform their projects. Teams' meetings with project partners contained few instances of deep exploratory information gathering behaviors in comparison. In addition, teams seemed to finalize design decisions during early design meetings and were less likely to conduct information gathering meetings during later design phases. The comprehensive descriptions of novice mechanical engineering designers’ approaches provided in our preliminary study provide an entry point for further investigations that can inform engineering training, tools, and pedagogy for conducting effective meetings.
Design, Kinematics, and Application of Axially and Radially Expandable Modular Soft Pneumatic Actuators
Authors: Wang Nianfeng , Chen Bicheng , Ge XianDong , Zhang Xianmin , Chen Wei
Published: January 2021

Recently, soft pneumatic actuators (SPAs) have drawn increasing attention due to their ease of fabrication, high customizability, and intrinsic softness. Inspired by modular design, two kinds of SPAs, including an axial elongation soft pneumatic actuator (aeSPA) and a radial expansion soft pneumatic actuator (reSPA), are proposed in this paper, followed by their modeling, fabrication, and application in locomotion robots. The relationships between pressure and displacement of these SPAs are deduced based on the Yeoh model and the principle of virtual work, which has a good agreement with experimental results. Five modular worm-like crawling robots are fabricated by assembling the aeSPAs and reSPAs in different morphologies, and crawling tests are performed under different conditions to show the adaptivity of robots.
Connectivity Calculation-Based Automatic Synthesis of Planar Multi-Loop Mechanisms
Authors: Huang Peng , Ding Huafeng , Yang Wenjian , Xu Gongyue
Published: January 2021

The creative design of kinematic structures with excellent performance remains an open issue in the quest for developing novel multi-loop mechanisms. This study presents an automatic method to synthesize all nonisomorphic planar multi-loop mechanisms satisfying the required connectivity between the base and the end-effector. First, based on the connectivity matrix calculation, all multi-loop mechanisms are generated from synthesized kinematic chains. Second, the concepts of perimeter, canonical, and characteristic graphs of multi-color topological graphs are addressed to acquire the simplified characteristic hybrid code (SCHC) in order to eliminate isomorphic multi-loop mechanisms. Then, an automatic method to synthesize all nonisomorphic planar multi-loop mechanisms with the required connectivity between the base and the end-effector is provided. Finally, a practical application of this synthesis method is illustrated by taking the mechanical arm of a face-shovel hydraulic excavator as an example to demonstrate the effectiveness of the method.
Generic Implant Positioning Technology Based on Hole Projections in X-Ray Images
Authors: Windolf Markus , Richards Robert Geoff
Published: January 2021

Implant placement plays a key role in trauma and orthopedics. In this paper, a generic technological concept for implant positioning assistance is outlined. The system utilizes conventional radiographic devices for imaging and tracking and embeds into surgical workflows without the need for complex navigation equipment. It is based on feature extraction from cylindrical hole-projections in X-ray images for determining spatial alignment of implant and anatomy. Basic performance of a prototype system was experimentally verified in terms of tracking accuracy and robustness under varying conditions. In a second step, the system was developed into a set of application modules, each serving a pressing clinical need: Plating of the proximal humerus, cephalic nail and dynamic hip-screw placement, general anatomic plating, distal nail interlocking with adjustment of femoral anteversion and corrective osteotomies. Module prototypes were tested according to their degree of maturity from feasibility assessment in wet-labs to clinical handling tests. Orientation tracking of reference objects yielded an accuracy and precision of 0.1±0.71 deg (mean±standard deviation) with a maximum error of 4.68 deg at unfavorable conditions. This base-performance translated, e.g., into a precision of ±1.2 mm (standard deviation) screw-tip to joint distance at proximal humerus plating, or into a precision of lag screw positioning in the femoral head of ±0.6 mm in craniocaudal and ±1.6 mm in anterioposterior direction. The concept revealed strong potential to improve surgical outcomes in a broad range of orthopedic applications due to its generic and simplistic nature. Comprehensive validation activities must follow for clinical introduction.
Modeling and Model Validation of Thermal Behavior of Railway Disc During Single Braking
Authors: Zewang Yuan , Chun Tian , Mengling Wu , Jiajun Zhou , Chao Chen
Published: January 2021

The current thermal model of railway disc braking is rather coarse as the heat source is treated to be uniformly distributed. By using a Gaussian mixture function, the thermal behavior of railway disc braking was modeled. Simulations and full-scale rig tests of emergency braking about metro train at 40–100 km/h were conducted. The differences between the maximum temperatures calculated by the Gaussian mixture heat source method (GMHS method) and measurements are 2.56–4.71 °C. The relative errors between the maximum temperatures calculated by the GMHS method and thermal mechanical coupling method (TMC method) are no more than 2.53%. The temperature curves obtained by the GMHS method oscillate about their centerline with the same oscillating period to the TMC method. The time cost by the GMHS method is only 0.91–3.05% of the TMC method at the same conditions. The results indicate that the proposed GMHS method is accurate and efficient, which is more suitable for engineering application.
Neural Network Prediction of Boundary Layer Flashback
Authors: Leask Scott B. , McDonell Vincent G. , Samuelsen Scott
Published: January 2021

Flashback is a major concern for engine operation and safety, particularly with progress toward renewably producible and cleaner-burning fuels, such as hydrogen fuel blends. This work extends prior progress in developing models for predicting the onset of boundary layer flashback. While prior attempts have developed models based on analytical theory or through phenomenological considerations, problem complexity has inhibited flashback understanding and, hence, model performance. The goal of this work is to address current model performance limitations by leveraging the representational flexibility offered by neural networks (NNs) in predicting boundary layer flashback. This is demonstrated through two applications. The first demonstrates the utility of training an NN on only a subproblem, thereby preserving model intuition. The second presents a predictive boundary layer flashback model using only a NN. Focus is placed on developing NN models which are practical; the input and output variables are easily measurable and controllable prior to experimentation.
Experimental Investigation of a Small-Scale Organic Rankine Cycle Turbo-Generator Supported on Gas-Lubricated Bearings
Authors: Rosset Kévin , Pajot Olivier , Schiffmann Jürg
Published: January 2021

Waste heat recovery (WHR) is expected to contribute to reducing CO2 emissions from trucks. Organic Rankine cycle (ORC) systems show the highest potential for this application, but still lack efficient small-scale expansion devices, in practice. A novel turbogenerator (TG) supported on gas-lubricated bearings is presented in this paper. The device combines a single-stage radial-inflow turbine and a permanent-magnet machine in a single rotating part supported on aerodynamic bearings, lubricated with the working fluid (R245fa). The oil-free expander was tested within a dedicated ORC test setup. It was driven up to its nominal speed of 100 krpm, generated up to 2.3 kW of electrical power, and reached a peak overall efficiency of 67%. Although the prototype was not actively cooled, the mechanical losses of the rotor shaft and the iron loss of the electrical machine reached their nominal levels. Only the copper loss was at a part-load level. The electromechanical efficiency of the TG reached 91% and is expected to increase while testing the device at higher load. This proof of concept confirms the high-speed and low-loss potential of gas-lubricated bearings for small-scale dynamic expanders.
Conjugate Heat Transfer Simulation and Entropy Generation Analysis of Gas Turbine Blades
Authors: Ju Yaping , Feng Yi , Zhang Chuhua
Published: January 2021

Reynolds-averaged Navier–Stokes (RANS) model-based conjugate heat transfer (CHT) method is so far popularly used in simulations and designs of internally cooled gas turbine blades. One of the important factors influencing the RANS-based CHT method's prediction accuracy is the choice of turbulence models for different fluid regions because the blade passage flow and internal cooling have considerably different flow features. However, most studies in the open literature adopted the same turbulence models in the blade passage flow and internal cooling. Another important issue is the comprehensive evaluation of the losses caused by the flow and heat transfer for both fluid and solid regions. In this study, a RANS-based CHT solver suitable for subsonic/transonic flows was developed based on OpenFOAM and then validated and used to explore suitable RANS turbulence model combinations for internally cooled gas turbine blades. Entropy generation, being able to weigh the losses caused by both flow friction and heat transfer, was used in the analyses of two vanes with smooth and ribbed cooling ducts to reveal the loss mechanisms. Findings indicate that the combination of the k–ω SST–γ–Reθ transition model for passage flow and the standard k–ε model for internal cooling provided the best agreement with measurement data. The relative error of vane surface dimensionless temperature was less than 3%. The variations of entropy generation with different internal cooling inlet velocities and temperatures indicate that reducing entropy generation was contradictory with enhancing heat transfer performance. This study, which provides a reliable computing tool and a comprehensive performance parameter, has an important application value for the design of advanced internally cooled gas turbine blades.
Bayesian Surrogate Learning for Uncertainty Analysis of Coupled Multidisciplinary Systems
Authors: Ghoreishi Seyede Fatemeh , Imani Mahdi
Published: January 2021

Engineering systems are often composed of many subsystems that interact with each other. These subsystems, referred to as disciplines, contain many types of uncertainty and in many cases are feedback-coupled with each other. In designing these complex systems, one needs to assess the stationary behavior of these systems for the sake of stability and reliability. This requires the system level uncertainty analysis of the multidisciplinary systems, which is often computationally intractable. To overcome this issue, techniques have been developed for capturing the stationary behavior of the coupled multidisciplinary systems through available data of individual disciplines. The accuracy and convergence of the existing techniques depend on a large amount of data from all disciplines, which are not available in many practical problems. Toward this, we have developed an adaptive methodology that adds the minimum possible number of samples from individual disciplines to achieve an accurate and reliable uncertainty propagation in coupled multidisciplinary systems. The proposed method models each discipline function via Gaussian process (GP) regression to derive a closed-form policy. This policy sequentially selects a new sample point that results in the highest uncertainty reduction over the distribution of the coupling design variables. The effectiveness of the proposed method is demonstrated in the uncertainty analysis of an aerostructural system and a coupled numerical example.
An Efficient Multi-Objective Robust Optimization Method by Sequentially Searching From Nominal Pareto Solutions
Authors: Xia Tingting , Li Mian
Published: January 2021

Multi-objective optimization problems (MOOPs) with uncertainties are common in engineering design. To find robust Pareto fronts, multi-objective robust optimization (MORO) methods with inner–outer optimization structures usually have high computational complexity, which is a critical issue. Generally, in design problems, robust Pareto solutions lie somewhere closer to nominal Pareto points compared with randomly initialized points. The searching process for robust solutions could be more efficient if starting from nominal Pareto points. We propose a new method sequentially approaching to the robust Pareto front (SARPF) from the nominal Pareto points where MOOPs with uncertainties are solved in two stages. The deterministic optimization problem and robustness metric optimization are solved in the first stage, where nominal Pareto solutions and the robust-most solutions are identified, respectively. In the second stage, a new single-objective robust optimization problem is formulated to find the robust Pareto solutions starting from the nominal Pareto points in the region between the nominal Pareto front and robust-most points. The proposed SARPF method can reduce a significant amount of computational time since the optimization process can be performed in parallel at each stage. Vertex estimation is also applied to approximate the worst-case uncertain parameter values, which can reduce computational efforts further. The global solvers, NSGA-II for multi-objective cases and genetic algorithm (GA) for single-objective cases, are used in corresponding optimization processes. Three examples with the comparison with results from the previous method are presented to demonstrate the applicability and efficiency of the proposed method.
Pt Nanoparticles on Carbon Nanodots-Titania Composite for Enhanced Electro Oxidation of Alcohol Fuels
Authors: Gwebu Sandile Surprise , Matthews Thabo , Maxakato Wendy Nobanathi
Published: January 2021

The severe corrosion of carbon supports in harsh fuel cell conditions has attracted the development of ceramic-based catalyst supports. Platinum nanoparticles supported on the carbon nanodots (CNDs)-titania (TiO2) composite were synthesized in three steps: Firstly, an inorganic support, titania (TiO2) was synthesized by a hydrolysis method. Secondly, the (CNDs-titania) nanocomposite support was prepared by sonicating pre-synthesized carbon nanodots (CNDs) and TiO2 in equal volumes of ethylene glycol/water solution. Lastly, nanosized Pt particles were deposited onto the CNDs-titania composite by a polyol method to form a platinum/(CNDs-titania nanocatalyst. X-ray photoelectron spectroscopy (XPS), transmission electron microscope (TEM), and X-ray difractommetry (XRD) were used to study surface morphology of the synthesized materials. Platinum loading onto the (CNDs-titania) composite support was quantified by ICP-OES. The electrooxidation of alcohol fuels was investigated in acidic electrolytes using chronoamperometric and voltammetric techniques. It was noted that the addition of TiO2 increases electroactivity of the nanocatalysts. The platinum/(CNDs-titania) nanocatalyst exhibited superior electroactivity during methanol and ethanol electrooxidation compared to the platinum/CNDs and Pt/C benchmark standards. Chronoamperometry (CA) curves showed that the platinum/(CNDs-titania) nanocatalyst exhibited outstanding anti-poisoning properties relative to the platinum/CNDs and commercial Pt/C nanocatalysts.
Investigation of the Matching Relation Between Impeller and Flow Channel of Regenerative Flow Pumps
Authors: Li Qian-qian , Wu Cheng-shuo , Qian Bo , Wu Peng , Huang Bin , Wu Da-zhuan
Published: January 2021

As a specific radial flow pump, the regenerative flow pump (RFP) usually has a low efficiency. In this study, in order to explore the matching mechanism, three cases with various matching relations were investigated by the methods of theoretical calculation, computational fluids dynamics (CFD) simulation, and experiment test. The results illustrate that the theoretical prediction, numerical simulation, and experimental data are in good agreement. Furthermore, when the matching relation expressed by a ratio of the channel's and blade's radial length is equal to 1, the geometrical profiles of RFP can well guide the circulation flow into the channel at large radii and into the impeller at small radii, forming intense longitudinal vortex. The steady, strong exchange flow is characterized by the inflow and outflow regions approximately half of the isosurface. The axial vortex motion without apparent flow separation and irregular flow is observed in the impeller, a low velocity annulus exists in the medium radii of the impeller without other distinct velocity clouds, and a low velocity strip and a high velocity annulus in the channel are, respectively, performed along the blade's pressure surface and the channel's outer radii. All of this corresponds to the best pump's performance and the largest efficiency of the impeller and channel. This work promotes a systematical understanding of the matching mechanism between impeller and flow channel in the RFP and could provide some reference for the design and performance optimization for RFP.
Quantum dot lasers—History and future prospects
Authors: Norman Justin C. , Mirin Richard P. , Bowers John E.
Published: January 2021

We describe the initial efforts to use molecular beam epitaxy to grow InAs quantum dots on GaAs via the Stranski–Krastanov transition and then discuss the initial efforts to use these quantum dots to demonstrate quantum dot lasers. We discuss the developments in quantum dot lasers over the past 20 years and the future prospects for these lasers for scientific and commercial applications.
Adipose saturation reduces lipotoxic systemic inflammation and explains the obesity paradox
Authors: Khatua Biswajit , El-Kurdi Bara , Patel Krutika , Rood Christopher , Noel Pawan , Crowell Michael , Yaron Jordan R. , Kostenko Sergiy , Guerra Andre , Faigel Douglas O. , Lowe Mark , Singh Vijay P.
Published: January 2021

Saturated fat breaks down less during sudden illnesses, resulting in lower monomer concentrations, and reducing disease severity.
Keratinocytes control skin immune homeostasis through de novo–synthesized glucocorticoids
Authors: Phan Truong San , Schink Leonhard , Mann Jasmin , Merk Verena M. , Zwicky Pascale , Mundt Sarah , Simon Dagmar , Kulms Dagmar , Abraham Susanne , Legler Daniel F. , Noti Mario , Brunner Thomas
Published: January 2021

Keratinocytes control tissue homeostasis and skin inflammation via immunosuppressive glucocorticoids.
Bandwidth-unlimited polarization-maintaining metasurfaces
Authors: Song Q. , Khadir S. , Vézian S. , Damilano B. , Mierry P. D. , Chenot S. , Brandli V. , Genevet P.
Published: January 2021

A general method of designing polarization and angular nondispersive metasurface with unlimited bandwidth is provided.
Layer- and gate-tunable spin-orbit coupling in a high-mobility few-layer semiconductor
Authors: Shcherbakov Dmitry , Stepanov Petr , Memaran Shahriar , Wang Yaxian , Xin Yan , Yang Jiawei , Wei Kaya , Baumbach Ryan , Zheng Wenkai , Watanabe Kenji , Taniguchi Takashi , Bockrath Marc , Smirnov Dmitry , Siegrist Theo , Windl Wolfgang , Balicas Luis , Lau Chun Ning
Published: January 2021

Rashba spin-orbit coupling in atomically thin InSe is varied layer by layer and by tuning out-of-plane electric field.
Multidrug-Resistant Plasmodium falciparum Parasites in the Central Highlands of Vietnam Jeopardize Malaria Control and Elimination Strategies
Authors: Quang Huynh Hong , Chavchich Marina , Trinh Nguyen Thi Minh , Edgel Kimberly A. , Edstein Michael D. , Martin Nicholas J.
Published: January 2021

Plasmodium falciparum
resistance to dihydroartemisinin-piperaquine has spread through the Greater Mekong Subregion to southwestern Vietnam. In 2018 to 2019, we collected 127
P. falciparum
isolates from Dak Nong (36), Dak Lak (55), Gia Lai (13), and Kon Tum (23) provinces in Vietnam’s Central Highlands and found parasites bearing the
Pfkelch13
C580Y mutation and multiple
plasmepsin 2/3
genes (mean prevalence, 17.9%; range, 4.3% to 27.8%), conferring resistance to dihydroartemisinin-piperaquine.
Pharmacokinetic Study of Rectal Artesunate in Children with Severe Malaria in Africa
Authors: Fanello Caterina , Hoglund Richard M. , Lee Sue J. , Kayembe Daddy , Ndjowo Pauline , Kabedi Charlie , Badjanga Benjamin B. , Niamyim Phettree , Tarning Joel , Woodrow Charles , Gomes Melba , Day Nick P. , White Nicholas J. , Onyamboko Marie A.
Published: January 2021

When severe malaria is suspected in children, the WHO recommends pretreatment with a single rectal dose of artesunate before referral to an appropriate facility. This was an individually randomized, open-label, 2-arm, crossover clinical trial in 83 Congolese children with severe
falciparum
malaria to characterize the pharmacokinetics of rectal artesunate.
Sialidase of
Glaesserella parasuis
Augments Inflammatory Response via Desialylation and Abrogation of Negative Regulation of Siglec-5
Authors: Song Yuping , Pan Qicong , Xiao Jing , Li Wenjie , Ma Hui , Chen Huanchun , Cai Xuwang , Xu Xiaojuan
Published: January 2021

Siglecs are sialic acid-binding immunoglobulin-like lectins that play an important role in tissue homeostasis, immune response, and pathogen infection. Bacterial sialidases act on natural ligands of Siglecs, interfering with the Siglec-mediated immune response.
Glaesserella parasuis
is a porcine bacterial pathogen that secretes sialidase.
Performance Characteristics of BinaxNOW COVID-19 Antigen Card for Screening Asymptomatic Individuals in a University Setting
Authors: Okoye Nkemakonam C. , Barker Adam P. , Curtis Kenneth , Orlandi Richard R. , Snavely Emily A. , Wright Cameron , Hanson Kimberly E. , Pearson Lauren N.
Published: January 2021

We compared the performance of the Abbott BinaxNOW COVID-19 antigen card to that of a standard reverse transcription-PCR (RT-PCR) assay (Thermo Fisher TaqPath COVID-19 Combo kit) for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2,645 asymptomatic students presenting for screening at the University of Utah. SARS-CoV-2 RNA was detected in 1.7% of the study participants by RT-PCR.
In Chronic Infection, HIV Gag-Specific CD4
+
T Cell Receptor Diversity Is Higher than CD8
+
T Cell Receptor Diversity and Is Associated with Less HIV Quasispecies Diversity
Authors: Pilkinton Mark A. , McDonnell Wyatt J. , Barnett Louise , Chopra Abha , Gangula Rama , White Katie D. , Leary Shay , Currenti Jennifer , Gaudieri Silvana , Mallal Simon A. , Kalams Spyros A.
Published: January 2021

Human T cells recognize portions of viral proteins bound to host molecules (human leukocyte antigens) on the surface of infected cells. T cells recognize these foreign proteins through their T cell receptors (TCRs), which are formed by the assortment of several available V, D, and J genes to create millions of combinations of unique TCRs.
Parenteral lipid emulsions in the preterm infant: current issues and controversies
Authors: Frazer Lauren C , Martin Camilia R
Published: January 2021

Parenteral lipid emulsions are a necessary component of nutrition for extremely low gestational age newborns until adequate levels of enteral intake are established. Historically, Intralipid, a 100% soybean oil emulsion, has filled this role. Newer multicomponent lipid emulsions containing a mixture of other oils, including olive oil and fish oil, are now available as options, although the regulatory approval for use in neonates varies worldwide. When dosed at currently published recommendations, each of these lipid emulsions meets total fat and energy requirements without a risk of essential fatty acid deficiency. Thus, when choosing which lipid emulsion to provide, the answer must be based on the metabolic differences induced as a result of these fatty acid-rich emulsions and whether the emulsions provide a health advantage or pose a health risk. The questions of induced fatty acid profiles, health benefit and health risk are discussed sequentially for multicomponent lipid emulsions. Despite the growing acceptance of multicomponent lipid emulsions, there is concern regarding changes in blood fatty acid levels and potential health risk without strong evidence of benefit. There remains no ideal parenteral lipid emulsion option for the preterm infant. Standardising future animal and human studies in lipid delivery with the inclusion of lipid metabolism data will iteratively provide answers to inform the optimal lipid emulsion for the preterm infant.
Onset of IgA nephropathy in a patient treated with infliximab for ankylosing spondylitis
Authors: Baert Charlotte Anne , Aydin Selda , Leroy Philippe , Durez Patrick
Published: January 2021

We report the case of a 43-year-old man, suffering from ankylosing spondylitis and treated with Infliximab 5 mg/kg every 2 months, with an excellent disease control. During a follow-up consultation, an incipient renal insufficiency is detected. A urine analysis showed haematuria and proteinuria and a renal puncture-biopsy revealed an image of IgA nephropathy.

Several cases of IgA nephropathy have been reported in the literature associated with ankylosing spondylitis. Some of them occur in patients treated with antitumour necrosis factor, but it is unclear whether this pathology is caused by the treatment or whether treatment failed to prevent its occurrence.

Our clinical case highlights the importance of regular monitoring of renal function in patients with ankylosing spondylitis, as well as urinary spotting.

The question of whether the disease itself, the treatment or other factors such as immune dysregulation could be held responsible for kidney disease will be addressed in the discussion.
Inhibitor development in mild haemophilia after a major surgery for periampullary cancer (Whipple’s procedure) in an elderly man
Authors: Ganju Neha , Rajendran Jayapal , Aggarwal Mukul , Dash Nihar
Published: January 2021

Around the world, with the availability of factor concentrates, patients with haemophilia have undergone major and minor surgeries. Inhibitor development in early postoperative period leading to inadequate factor recovery and ongoing bleeding is a nightmare for both operating surgeon as well as haematologists. We describe a case of an elderly man with mild haemophilia A, who was diagnosed with pancreatic carcinoma and underwent Whipple’s procedure. After an uneventful procedure, he developed high-titre inhibitors and bleeding a week after surgery posing major challenges in his management. The case highlights the importance of experienced surgeons, trained haematologists, regular monitoring of factor assay/inhibitors, adequate factor and bypassing-agent support while performing such procedures.
Misoprostol-augmented induction of labour for third trimester fetal demise in a patient with prior hysterotomies
Authors: Beshar Isabel , Thomson Karolina , Byrne James
Published: January 2021

A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.

She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.

Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.
Understanding abortion-related complications in health facilities: results from WHO multicountry survey on abortion (MCS-A) across 11 sub-Saharan African countries
Authors: Qureshi Zahida , Mehrtash Hedieh , Kouanda Seni , Griffin Sally , Filippi Veronique , Govule Philip , Thwin Soe Soe , Bello Folasade Adenike , Gadama Luis , Msusa Ausbert Thoko , Idi Nafiou , Goufodji Sourou , Kim Caron Rahn , Wolomby-Molondo Jean-Jose , Mugerwa Kidza Yvonne , Bique Cassimo , Adanu Richard , Fawole Bukola , Madjadoum Thierry , Gülmezoglu Ahmet Metin , Ganatra Bela , Tunçalp Özge
Published: January 2021

Introduction

Complications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.

Methods

A cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.

Results

There were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).

Conclusion

There is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.
Pneumatic femoral broaching in direct anterior approach hip arthroplasty
Authors: Nizam Ikram , Batra Ashish Vinodkumar , Gogos Sophia , Alva Avinash
Published: January 2021

Aim

The aim of this study is to report the safety and efficacy of the Woodpecker pneumatic broaching system in direct anterior hip arthroplasty.

Methods

649 primary elective anterior bikini total hip arthroplasties (THA) using Woodpecker broaching over a 5-year period were included. Patients undergoing a THA through a different surgical approach, revision THA or arthroplasties for hip fractures were excluded (n=219). Preoperative and postoperative Harris Hip Scores (HHS) and postoperative radiographs were analysed to identify femoral fractures and femoral component positioning. Complications and component survivorship until most recent follow-up were analysed.

Results

The average time taken for femoral preparation using Woodpecker broaching system was 2.8 min (1.4–7.5 min) in both cemented and uncemented THAs. Radiographic analysis revealed 67.3% of the stems were placed in 0°–1.82° of varus and 32.7% placed in 0°–1.4° of valgus. Average HHS were 24.4 preoperatively, with significant improvements at 6 weeks (80.95), 6 months (91.91) and 12 months (94.18) of follow-up. Complications not directly attributed to Woodpecker broaching included three intraoperative femoral fractures (0.4%), three periprosthetic postoperative fractures (0.3%), two cases of stem subsidence (0.3%) and two wound infections (0.3%). At the most recent follow-up, the survivorship of the acetabular component was 99.7% and the femoral component was 99.1%, with mean follow-up of 2.9 years (0.5–5 years).

Conclusion

The pneumatic Woodpecker device is a safe and effective alternative tool in minimally invasive direct anterior hip replacement surgery for femoral broaching performed on a standard table.
Evaluation of early medication persistence with omidenepag isopropyl, a topical selective prostaglandin EP2 agonist, in patients with glaucoma: a retrospective two-institute study
Authors: Nakakura Shunsuke , Kanamori Akiyasu , Fukuma Yasuko , Wakabayashi Seita , Nagata Yuki , Adachi Miku
Published: January 2021

Objectives

We evaluated early medication persistence with new topical antiglaucoma eyedrops, omidenepag isopropyl 0.002% (a selective prostaglandin EP2 agonist).

Design and setting

Retrospective two-institute study in Himeji and Akashi in Japan.

Participants

We analysed patients with glaucoma who were prescribed topical omidenepag isopropyl from November 2018 to December 2019. From the last outpatient visit of patients until February 2020, 235 patients were prescribed a new solution of omidenepag isopropyl (129 patients in the initial monotherapy group, 85 in the switching group (switched from another topical antiglaucoma eyedrops), 19 added to another topical antiglaucoma eyedrops group, and 2 were lost to follow-up)). Additionally, we recruited 98 patients (3 were lost to follow-up) who received initial latanoprost 0.005% monotherapy during the same period as a control group.

Outcomes

Medication persistence failure was defined as drug discontinuation due to any adverse effects or change of therapy. Kaplan-Meier survival analysis was performed with a Cox regression analysis.

Results

Among 233 patients, 48 (20%) showed failure of treatment; the median persistence time of all patients was 165 days, and the median time until discontinuation of omidenepag isopropyl was 45 days. The total persistence rates were 85%, 80% and 70% at 3, 6 and 12 months, respectively. Risk factors for failure were male gender (HR: 1.45, p=0.023) and monotherapy/switching (HR: 1.715, p=0.002). Comparison between latanoprost and omidenepag isopropyl monotherapy, only male gender (HR: 1.43, p=0.016) was a significant risk factor. Failures associated with omidenepag isopropyl were due to insufficient intraocular pressure-lowering efficiency (n=26, observed during all the period), followed by conjunctival hyperaemia (n=10) and visual acuity disturbance (n=5) in patients who were observed until 3 months.

Conclusion

Medication persistence with omidenepag isopropyl is mostly positive; however, clinicians should also be cautious of early failure.
Rugby Health and Well-Being Study: protocol for a UK-wide survey with health data cross-validation
Authors: Panagodage Perera Nirmala Kanthi , Radojčić Maja R , Filbay Stephanie R , Griffin Steffan A , Gates Lucy , Murray Andrew , Hawkes Roger , Arden Nigel K
Published: January 2021

Introduction

Rugby football (Union and League) provides physical activity (PA) with related physical and mental health benefits. However, as a collision sport, rugby research and media coverage predominantly focus on injuries in elite players while the overall impact on health and well-being remains unclear. This study aims to provide a greater understanding of the risks and benefits of rugby participation in a diverse sample of men and women, current and former rugby Union and League players from recreational to the elite level of play. We will explore: (1) joint-specific injuries and concussion; (2) joint pain and osteoarthritis (OA); (3) medical and mental health conditions; (4) PA and sedentary behaviour and (5) well-being (quality of life, flourishing and resilience).

Methods and analysis

The Rugby Health and Well-being Study is designed in two phases: (1) a UK-wide cross-sectional survey and (2) cross-validation using health register data from Scotland. Participants will be at least 16 years old, current or former rugby players who have played rugby for at least one season. We will report standardised, level of play-, sex- and age-stratified prevalence of joint injury, concussion, medical conditions and PA. We will describe injury/concussion prevention expectations and protective equipment use. Rugby-related factors associated with injury, pain, OA, PA, health and well-being will be explored in regression models. We will compare joint pain intensity and duration, elements of pain perception and well-being between recreational and elite players and further investigate these associations in regression models while controlling for confounding variables. In the second phase, we will validate self-reported with health register data, and provide further information on healthcare use.

Ethics and dissemination

The Yorkshire and the Humber—Leeds East Research Ethics Committee (REC reference: 19/HY/0377) has approved this study (IRAS project ID 269424). The results will be disseminated through scientific publications, conferences and social media.
‘Not just a piece of skin in front of you’—a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals
Authors: de Vere Hunt Isabella Joy , McNiven Abigail , Roberts Amanda , Parmar Himesh , McPherson Tess
Published: January 2021

Background

There is little qualitative research in the UK focussing on adolescents’ experience of their healthcare providers, and inflammatory skin conditions are a common heath problem in adolescence.

Aim

To explore the experiences of adolescents with eczema and psoriasis with healthcare professionals, and to distil the participants’ key messages for their healthcare providers.

Design

This is a secondary thematic analysis of interviews with adolescents with eczema or psoriasis.

Participants

There were a total of 41 text transcripts of interviews with young people with eczema or psoriasis who had given permission for secondary analysis; 23 of the participants had eczema, and 18 psoriasis. Participants were living in the UK at time of interview, and aged 15–24 years old.

Results

We have distilled the following key messages from young people with eczema and psoriasis for healthcare providers: (1) address the emotional impact; (2) give more information, with the subtheme and (3) appreciate patient research. We identified the following eczema-specific themes: (ECZ-4) ‘It’s not taken seriously’; (ECZ-5) offer choice in treatment and (ECZ-6) lack of structure/conflicting advice. Two psoriasis-specific themes were identified: (PSO-4) feeling dehumanised/treat me as a person; and (PSO-5) think about how treatments will affect daily life.

Conclusion

This qualitative data analysis highlights the need for greater recognition of the emotional impact of skin disease in adolescence, and for more comprehensive provision of information about the conditions. We call for greater sensitivity and flexibility in our approach to adolescents with skin disease, with important implications for healthcare delivery to this group.
Gender differences within the barriers to smoking cessation and the preferences for interventions in primary care a qualitative study using focus groups in The Hague, The Netherlands
Authors: Dieleman Lieke Agathe , van Peet Petra G , Vos Hedwig M M
Published: January 2021

Objectives

This research aimed to provide a deeper insight into the gender-specific barriers to smoking cessation and gender-specific preferences for interventions in primary care, in order to contribute to better aligned cessation care for women.

Design

Qualitative study using focus groups.

Setting

Regularly smoking female and male adults were recruited from four different general practices in The Hague (The Netherlands).

Participants

A total of 11 women and nine men participated. Participants included were regular smokers with a minimum age of 18 and sufficient command of the Dutch language, who were willing to talk about smoking cessation. Inclusion ended when saturation was reached for both women and men. Participants were selected by means of purposeful sampling, whereby looking at age, educational level and experience with quitting.

Results

The main barriers to smoking cessation in women were psychological factors, such as emotion and stress, compared with environmental factors in men. Women indicated they were in need of support and positivity, and both women and men expressed the desire for assistance without judgement. Contrary to men, women were not drawn to restrictions and (dis)incentives.

Conclusion

When counselling smokers, in women the focus should be on perceived internal problems, as opposed to more external obstacles in men. Contrary to men, female smokers seem to prefer non-coercive interventions, such as a group intervention offering support and positivity. Future research should focus on these gender differences, and how they could improve treatment in primary care.
Automatic brain lesion segmentation on standard magnetic resonance images: a scoping review
Authors: Gryska Emilia , Schneiderman Justin , Björkman-Burtscher Isabella , Heckemann Rolf A
Published: January 2021

Objectives

Medical image analysis practices face challenges that can potentially be addressed with algorithm-based segmentation tools. In this study, we map the field of automatic MR brain lesion segmentation to understand the clinical applicability of prevalent methods and study designs, as well as challenges and limitations in the field.

Design

Scoping review.

Setting

Three databases (PubMed, IEEE Xplore and Scopus) were searched with tailored queries. Studies were included based on predefined criteria. Emerging themes during consecutive title, abstract, methods and whole-text screening were identified. The full-text analysis focused on materials, preprocessing, performance evaluation and comparison.

Results

Out of 2990 unique articles identified through the search, 441 articles met the eligibility criteria, with an estimated growth rate of 10% per year. We present a general overview and trends in the field with regard to publication sources, segmentation principles used and types of lesions. Algorithms are predominantly evaluated by measuring the agreement of segmentation results with a trusted reference. Few articles describe measures of clinical validity.

Conclusions

The observed reporting practices leave room for improvement with a view to studying replication, method comparison and clinical applicability. To promote this improvement, we propose a list of recommendations for future studies in the field.
Protocol for a scoping review of the qualitative literature on Indigenous infant feeding experiences
Authors: Monteith Hiliary , Galloway Tracey , Hanley Anthony J
Published: January 2021

Introduction

Prudent infant nutrition, including exclusive breastfeeding to 6 months, is essential for optimal short-term and long-term health. Quantitative research to date has documented that many Indigenous communities have lower breastfeeding rates than the general population and that this gap in breastfeeding initiation and maintenance may have an important impact on chronic disease risk later in life. However, there are critical knowledge gaps in the literature regarding factors that influence infant feeding decisions. Qualitative research on infant feeding experiences provides a broader understanding of the challenges that Indigenous caregivers encounter, and insights provided by this approach are essential to identify research gaps, community engagement strategies, and programme and policy development. The objective of this review is to summarise the qualitative literature that describes breastfeeding and other infant feeding experiences of Indigenous caregivers.

Methods and analysis

This scoping review will follow guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, the Joanna Briggs Institute and the methodological framework from Arksey and O’Malley. In October 2020, we will conduct an electronic database search using Medline, Embase, The Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO, and Scopus, and will focus on qualitative studies. Publications that have a focus on infant feeding in Canada, the USA, Australia and New Zealand, and the Indigenous caregiver experience from the caregiver perspective, will be included. We will conduct a grey literature search using Indigenous Studies Portal, country-specific browser searches, and known government, association, and community websites/reports. We will map themes and concepts of the publications, including study results and methodologies, to identify research gaps, future directions, challenges and best practices in this topic area.

Ethics and dissemination

Ethical approval is not required for this review as no unpublished primary data will be included. The results of this review will be shared through peer-reviewed publications and conference presentations. This protocol is registered through the Open Science Framework (osf.io/4su79).