bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-colonoscopy colorectal cancers identified by probabilistic and deterministic linkage: results in an Australian prospective cohort
Authors: Subramaniam Kavitha , Ang P W , Neeman Teresa , Fadia Mitali , Taupin Doug
Published: June 2019

Objective

Post-colonoscopy colorectal cancers (PCCRCs) are recognised as a critical quality indicator. Benchmarking of PCCRC rate has been hampered by the strong influence of different definitions and methodologies. We adopted a rigorous methodology with high-detail individual data to determine PCCRC rates in a prospective cohort representing a single jurisdiction.

Setting

We performed a cohort study of individuals who underwent colonoscopy between 2001 and 2008 at a single centre serving Australian Capital Territory (ACT) and enclaving New South Wales (NSW) region. These individuals were linked to subsequent colorectal cancer (CRC) diagnosis, within 5 years of a negative colonoscopy, through regional cancer registries and hospital records using probabilistic and deterministic record linkage. All cases were verified by pathology review. Predictors of PCCRCs were extracted.

Participants

7818 individuals had a colonoscopy in the cohort. Linkage to cancer registries detected 384 and 98 CRCs for notification dates of 2001–2013 (ACT) and 2001–2010 (NSW). A further 55 CRCs were identified from a search of electronic medical records using International Classification of Diseases-10 diagnosis codes. After verification and exclusions, 385/537 CRCs (58% male) were included.

Primary outcome measure

PCCRC rates.

Results

There were 15 PCCRCs in our cohort. The PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was estimated as 0.192% (95% CI 0.095 to 0.289). The index colonoscopy prior to PCCRC was more likely to show diverticulosis (p=0.017 for association, OR 3.56, p=0.014) and have poor bowel preparation (p=0.017 for association, OR 4.19, p=0.009).

Conclusion

In this population-based cohort study, the PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was 0.192%. These data show the ‘real world’ accuracy of colonoscopy for CRC exclusion.
Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies
Authors: Müller Evamaria , Strukava Alena , Scholl Isabelle , Härter Martin , Diouf Ndeye Thiab , Légaré France , Buchholz Angela
Published: June 2019

Design and objectives

We performed a systematic review of studies evaluating healthcare provider (HCP) trainings in shared decision-making (SDM) to analyse their evaluation strategies.

Setting and participants

HCP trainings in SDM from all healthcare settings.

Methods

We searched scientific databases (Medline, PsycInfo, CINAHL), performed reference and citation tracking, contacted experts in the field and scanned the Canadian inventory of SDM training programmes for healthcare professionals. We included articles reporting data of summative evaluations of HCP trainings in SDM. Two reviewers screened records, assessed full-text articles, performed data extraction and assessed study quality with the integrated quality criteria for review of multiple study designs (ICROMS) tool. Analysis of evaluation strategies included data source use, use of unpublished or published measures and coverage of Kirkpatrick’s evaluation levels. An evaluation framework based on Kirkpatrick’s evaluation levels and the Quadruple Aim framework was used to categorise identified evaluation outcomes.

Results

Out of 7234 records, we included 41 articles reporting on 30 studies: cluster-randomised (n=8) and randomised (n=9) controlled trials, controlled (n=1) and non-controlled (n=7) before-after studies, mixed-methods (n=1), qualitative (n=1) and post-test (n=3) studies. Most studies were conducted in the USA (n=9), Germany (n=8) or Canada (n=7) and evaluated physician trainings (n=25). Eleven articles met ICROMS quality criteria. Almost all studies (n=27) employed HCP-reported outcomes for training evaluation and most (n=19) additionally used patient-reported (n=12), observer-rated (n=10), standardised patient-reported (n=2) outcomes or training process and healthcare data (n=10). Most studies employed a mix of unpublished and published measures (n=17) and covered two (n=12) or three (n=10) Kirkpatrick’s levels. Identified evaluation outcomes covered all categories of the proposed framework.

Conclusions

Strategies to evaluate HCP trainings in SDM varied largely. The proposed evaluation framework maybe useful to structure future evaluation studies, but international agreement on a core set of outcomes is needed to improve evidence.

PROSPERO registration number

CRD42016041623.
Is urinary excretion of plasminogen associated with development of pre-eclampsia? An observational, explorative case–control study
Authors: Nielsen Lise H , Kronborg Camilla , Vittinghus Erik , Kitlen Gitte , Jensen Boye L , Knudsen Ulla B , Ovesen Per G
Published: June 2019

Objectives

Pre-eclampsia (PE) is characterised by renal glomerular endotheliosis and injury to the glomerular filtration barrier with proteinuria. Patients with PE display aberrant filtration of the plasma proenzyme plasminogen which is activated, in the tubular fluid, to plasmin. Plasmin may activate the epithelial sodium channel and cause impaired sodium excretion and contribute to hypertension. An explorative study was conducted to test the association between urinary total plasminogen/plasmin and the development of PE. A positive association was hypothesised.

Design

An observational, explorative, nested case–control study of healthy pregnant women.

Settings

A Danish County hospital. Samples were collected between 2001 and 2004.

Participants

1631 healthy pregnant women participated. Urine samples were collected longitudinally six times during pregnancy. 30 developed PE (cases) and were compared with 146 randomly selected healthy pregnant women (controls).

Primary outcome

The association between total plasminogen/plasmin excreted in the urine and PE development is expressed by ORs. Total urinary excretion of plasminogen/plasmin was defined by the urine plasminogen-plasmin/creatinine ratio.

Secondary outcome

The association between urine (u)-albumin/creatinine ratio, u-aldosterone/creatinine ratio and PE development is expressed by ORs. The correlation between urinary (u-) plasmin and u-aldosterone concentration is expressed as a correlation coefficient.

Results

The development of PE in late pregnancy was associated with increased levels of the urine plasminogen-plasmin/creatinine ratio (OR=2.35; 95% CI: 1.12 to 4.93; p<0.05).

U-aldosterone/creatinine ratio did not predict PE at any time. U-albumin/creatinine ratio was positively associated with the development of PE from gestational week 33 (OR=14.04; 95% CI: 2.56 to 76.97; p<0.01) and in week 33–35 (OR=14.15; 95% CI: 3.44 to 58.09; p<0.001) and after gestational week 36, respectively.

Conclusion

Aberrant filtration of plasminogen may contribute to the pathophysiological features of impaired sodium excretion and hypertension associated with PE late in pregnancy. However, increased urinary albumin levels reveal stronger associations with PE development compared with urinary plasminogen levels.
One- and two-year visual outcomes from the Moorfields age-related macular degeneration database: a retrospective cohort study and an open science resource
Authors: Fasler Katrin , Moraes Gabriella , Wagner Siegfried , Kortuem Karsten U , Chopra Reena , Faes Livia , Preston Gabriella , Pontikos Nikolas , Fu Dun Jack , Patel Praveen , Tufail Adnan , Lee Aaron Y , Balaskas Konstantinos , Keane Pearse A
Published: June 2019

Objectives

To analyse treatment outcomes and share clinical data from a large, single-centre, well-curated database (8174 eyes/6664 patients with 120 756 single entries) of patients with neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF). By making our depersonalised raw data openly available, we aim to stimulate further research in AMD, as well as set a precedent for future work in this area.

Setting

Retrospective, comparative, non-randomised electronic medical record (EMR) database cohort study of the UK Moorfields AMD database with data extracted between 2008 and 2018.

Participants

Including one eye per patient, 3357 eyes/patients (61% female). Extraction criteria were ≥1 ranibizumab or aflibercept injection, entry of ‘AMD’ in the diagnosis field of the EMR and a minimum of 1 year of follow-up. Exclusion criteria were unknown date of first injection and treatment outside of routine clinical care at Moorfields before the first recorded injection in the database.

Main outcome measures

Primary outcome measure was change in VA at 1 and 2 years from baseline as measured in Early Treatment Diabetic Retinopathy Study letters. Secondary outcomes were the number of injections and predictive factors for VA gain.

Results

Mean VA gain at 1 year and 2 years were +5.5 (95% CI 5.0 to 6.0) and +4.9 (95% CI 4.2 to 5.6) letters, respectively. Fifty-four per cent of eyes gained ≥5 letters at 2 years, 63% had stable VA (±≤14 letters), 44% of eyes maintained good VA (≥70 letters). Patients received a mean of 7.7 (95% CI 7.6 to 7.8) injections during year 1 and 13.0 (95% CI 12.8 to 13.2) injections over 2 years. Younger age, lower baseline VA and more injections were associated with higher VA gain at 2 years.

Conclusion

This study benchmarks high quality EMR study results of real life AMD treatment and promotes open science in clinical AMD research by making the underlying data publicly available.
What are young Indians saying about mental health? A content analysis of blogs on the It’s Ok To Talk website
Authors: Gonsalves Pattie Pramila , Hodgson Eleanor Sara , Michelson Daniel , Pal Sweta , Naslund John , Sharma Rhea , Patel Vikram
Published: June 2019

Objectives

This study used thematic content analysis to examine submissions to a youth mental health website,www.itsoktotalk.in, in India.

Setting

We considered submissions made to the It’s OK to Talk web platform during the first year of its operation (April 2017–March 2018), focusing specifically on website users based in India.

Participants

We analysed 37 submissions by 33 authors aged 19–31 years (mean age 22 years) from seven Indian cities (New Delhi, Lucknow, Bengaluru, Mumbai, Pune, Hyderabad and Haryana). Eligible submissions were English-language first-person accounts of self-identified mental health problems, submitted in any media format for online publication by authors aged 18 years or older and who were based in India. Eight study participants were additionally involved in a focus group who contributed to the coding process and preparation of the final manuscript.

Results

Four themes were identified: (1) living through difficulties; (2) mental health in context; (3) managing one’s mental health and (4) breaking stigma and sharing hope. Overall, the participants expressed significant feelings of distress and hopelessness as a result of their mental health problems; many described the context of their difficulties as resulting from personal histories or wider societal factors; a general lack of understanding about mental health; and widespread stigma and other negative attitudes. Most participants expressed a desire to overcome mental health prejudice and discrimination.

Conclusions

Personal narratives offer a window into young people’s self-identified priorities and challenges related to mental health problems and recovery. Such insights can inform antistigma initiatives and other public awareness activities around youth mental health.
Predictors of late presentation to renal dialysis: a cohort study of linked primary and secondary care records in East London
Authors: Olaitan Ademola , Ashman Neil , Homer Kate , Hull Sally
Published: June 2019

Objectives

The outcomes and experience of care for patients who start renal replacement therapy (RRT) in an unplanned manner are worse than for those who have planned care. The objective of this study was to examine the primary care predictors of unplanned starts to RRT.

Design

Retrospective cohort study with linked primary care and hospital data.

Setting

128 general practices in East London with a combined population of 1 043 346 people.

Participants

999 consecutive patients starting dialysis at Barts Health National Health Service Trust between September 2014 and August 2017.

Primary outcome measures

Unplanned versus a planned start to dialysis among the cohort of 389 patients with a linked primary care record. An unplanned start to dialysis is defined as receiving nephrology care in the low clearance clinic (or equivalent) for less than 90 days. A planned start is defined as access to pre-dialysis counselling and care for at least 90 days prior to commencing dialysis.

Results

The adjusted logistic regression analysis showed that the most important modifiable risk factors for unplanned dialysis were the absence of a chronic kidney disease (CKD) code in the general practice (GP) record (OR 8.02, 95% CI 3.65 to 17.63) and the absence of prescribed lipid lowering medication (OR 2.37, 95% CI 1.05 to 5.34). Other contributing factors included male gender and a greater number of long-term conditions.

Conclusions

Improving CKD coding in primary care and the additional review and clinical scrutiny associated with this may contribute to a further reduction in unplanned RRT rates.
Cross-sectional study about the use of telemedicine for type 2 diabetes mellitus management in Spain: patient’s perspective. The EnREDa2 Study
Authors: Rodríguez-Fortúnez Patricia , Franch-Nadal Josep , Fornos-Pérez José A , Martínez-Martínez Fernando , de Paz Hector David , Orera-Peña María Luisa
Published: June 2019

Objectives

The usefulness of telemedicine (TM) in type 2 diabetes mellitus (T2DM) has been discussed in recent years. The aim of this study is to describe patients’ perceptions about TM and to identify preferences on TM resources, in Spain.

Design

An observational, cross-sectional study was conducted using a structured questionnaire.

Participants

1036 patients with T2DM accepted to participate in the study (response rate: 68%).

Results

Blood glucose values were recorded by 85.9% of the patients while data such as lifestyle habits were only recorded by 14.4% of the patients. Previous experience in TM was reported by 9.8% of the patients, out of which 70.5% were satisfied with its service and 73.5% considered that the use of TM had optimised their T2DM management. However, most of these patients noted aspects to be improved such as user-friendliness (81.4%), interaction with the medical team (78.4%) and time required for recording/transferring data (78.4%). Experienced patients had better perception about TM usefulness than naïve patients for all listed aspects (p<0.05). Among naïve patients, 38.2% expressed their willingness to participate in TM programmes, but only 4.7% were invited to do so. Patients considered that physicians’ (77.5%) and pharmacists’ (75.5%) encouragement can boost the use of TM.

Conclusions

In Spain, nearly 10% of patients with T2DM have experience with TM and it is well accepted, especially one based on glucometers. Nevertheless, in order to promote TM use, easier and time-saving programmes for patient-physician interaction should be optimised.
Randomised controlled trial (RCT) study design for a large-scale municipal fall prevention exercise programme in community-living older women: study protocol for the Kuopio Fall Prevention Study (KFPS)
Authors: Vilpunaho Tommi , Kröger Heikki , Honkanen Risto , Koivumaa-Honkanen Heli , Sirola Joonas , Kuvaja-Köllner Virpi , Sund Reijo , Rikkonen Toni
Published: June 2019

Introduction

Falls are a substantial health problem in seniors, causing fractures and being the leading cause of fatal injuries. The benefits of physical activity in fall prevention have been shown in randomised controlled trials (RCTs) in small cohorts (eg, ≤200 persons), but there is a gap between the known health effects of exercise and the large-scale implementation of effective activity in communities. Mental health and subjective well-being (SWB) should also be studied since they are strongly related to healthy ageing. Thus far, the proven efficacy of communal strategies to reduce falls and improve healthy ageing is sparse.

Methods and analysis

In 2016, a 2-year RCT was launched in Kuopio, Finland to estimate the efficacy of a large, population-based, fall prevention exercise programme in community-living older women (born 1932–1945). Both the intervention and control group (n=457+457) receive health education. The intervention group is also offered free 6-month supervised training courses (weekly gym training and Taiji sessions), followed by a free 6-month unsupervised use of exercise facilities, as well as unsupervised low-cost exercise is also offered for another 12 months. During the whole 24-month follow-up, controls are free to pursue all their normal physical activities. Both study groups undergo the study measurements three times. Outcome measures include recording of falls, injuries, bone mineral density, changes in health and functional status and cognitive performance, deaths and SWB. Finally, the cost-effectiveness and cost–utility analysis will be conducted from the societal view. The main analyses comparing outcomes between study groups will be conducted using the intention to treat principle.

Ethics and dissemination

The study has been reviewed and approved by the Research Ethics Committee of the Hospital District of North Savo. All regulations and measures of ethics and confidentiality are handled in accordance with the Declaration of Helsinki.

Trial registration number

NCT02665169; Pre-results.
Integrating the prevention and control of rheumatic heart disease into country health systems: a systematic review protocol
Authors: Abrams Jessica , Watkins David , Abdullahi Leila H , Engel Mark E , Zuhlke Liesl J
Published: June 2019

Introduction

Rheumatic heart disease (RHD) is a preventable chronic condition affecting the valves of the heart. RHD prevention and care programmes have historically originated in more developed countries, implemented in a targeted (or vertical) manner and evaluated using non-controlled approaches. Taking a broad view of the integration of RHD activities within the whole system is critical for health planning in low-income regions with a high burden of RHD and less robust health systems. Therefore, we propose to conduct a systematic review to assess RHD programme models in order to gain a better understanding of the extent of integration within relevant health systems.

Methods and analysis

A predefined search strategy will be used to search for relevant articles published in English from January 1990 to December 2017. Electronic databases PubMed, Scopus, Web of Science, Africa Wide, CINAHL, Cochrane Central Register of Controlled Trials, Google Scholar and Global Index Medicus will be searched, as well as reference lists of relevant articles published. A standardised data extraction form will be used to obtain information for analysis from the included studies. The quality, reliability and risk of bias of included studies will be assessed using design-specific criteria. Programme integration will be analysed according to stewardship and governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. Programme inputs, outputs and impact will also be described.

Ethics and dissemination

No ethical approval is required. Findings will be disseminated in a peer-review journal in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

PROSPERO registration number

CRD42017076307
Does attendance of a prenatal education course reduce rates of caesarean section on maternal request? A questionnaire study in a tertiary women hospital in Shanghai, China
Authors: Gao Yifei , Tang Yunhui , Tong Mancy , Du Yan , Chen Qi
Published: June 2019

Objective

Caesarean section rates have significantly increased worldwide. China has a caesarean rate of 46%, with a moderate contribution of caesarean section on maternal request. In this study, we investigated the association between maternal characteristics, attendance at a prenatal education course and caesarean section on maternal request.

Design

Questionnaire study.

Setting

Tertiary hospital in China.

Sample

564 questionnaires.

Methods

On postpartum day 42, questionnaire data were collected. Data including age, parity, gravida, delivery mode, educational level, residence status, living condition and attendance of prenatal education course were analysed.

Primary and secondary outcome measures

Factors associated with caesarean section on maternal request.

Results

46% of women were delivered by caesarean section on maternal request. Maternal age and residence status were all significantly associated with having a caesarean section on maternal request. The OR of an increase in caesarean section on maternal request in women over 30 years was 2.42 (95%confidence limits 1.597 to 3.666), compared with women under 30 years. 75% more women who resided in Shanghai had caesarean section on maternal request, compared with women who resided outside of Shanghai. However, there was a significant reduction (35%) in the number of caesarean sections on maternal request in women who attended a prenatal education course (p=0.029). There was no significant association between attendance of a prenatal education course and the other maternal characteristics studied.

Conclusion

Maternal age is associated with an increased risk of caesarean section on maternal request. For women of all age, attendance of a prenatal education course significantly reduced the rate of caesarean section on maternal request. Our data suggest that promotion of a prenatal education course is an important tool in China to reduce the rate of caesarean section.
Investigation of perioperative work processes in provision of antibiotic prophylaxis: a prospective descriptive qualitative study across surgical specialties in Norway
Authors: Wæhle Hilde Valen , Harthug Stig , Søfteland Eirik , Sevdalis Nick , Smith Ingrid , Wiig Siri , Aase Karina , Haugen Arvid Steinar
Published: June 2019

Objective

Surgical site infections are known postoperative complications, yet the most preventable of healthcare-associated infections. Correct provision of surgical antibiotic prophylaxis (SAP) is crucial. Use of the WHO Safe Surgical Checklist (SSC) has been reported to improve provision of SAP, and reduce infections postoperatively. To understand possible mechanisms and interactions generating such effects, we explored the underlying work processes of SAP provision and SSC performance at the intersection of perioperative procedures and actual team working.

Design

An ethnographic study including observations and in-depth interviews. A combination of deductive and inductive content analysis of the data was conducted.

Setting

Operating theatres with different surgical specialities, in three Norwegian hospitals.

Participants

Observations of perioperative team working (40 hours) and in-depth interviews of 19 experienced perioperative team members were conducted. Interview participants followed a maximum variation purposive sampling strategy.

Results

Analysis identified provision of SAP as a process of linked activities; sequenced, yet disconnected in time and space throughout the perioperative phase. Provision of SAP was handled in relation to several interactive factors: preparation and administration, prescription accuracy, diversity of prescription order systems, patient-specific conditions and changes in operating theatre schedules. However, prescription checks were performed either as formal SSC reviews of SAP items or as informal checks of relevant documents. In addition, use of cognitive reminders and clinical experiences were identified as mechanisms used to enable administration of SAP within the 60 min timeframe described in the SSC.

Conclusion

Provision of SAP was identified as a complex process. Yet, a key element in provision of SAP was the given 60 min. timeframe of administration before incision, provided in the SSC. Thus, the SSC seems beneficial in supporting timely SAP administration practice by either being a cognitive tool and/or as a cognitive intervention.
Venous thromboembolism incidence in the Ireland east hospital group: a retrospective 22-month observational study
Authors: Kevane Barry , Day Mary , Bannon Noirin , Lawler Leo , Breslin Tomas , Andrews Claire , Johnson Howard , Fitzpatrick Michael , Murphy Karen , Mason Olivia , O’Neill Annemarie , Donohue Fionnuala , Ní Áinle Fionnuala
Published: June 2019

Objectives

To determine the incidence of venous thromboembolism (VTE) and the incidence of hospital-acquired VTE (HA-VTE) arising within the population served by the Ireland East Hospital Group (IEHG).

Design

/home/user/Documents/Sathish Kumar G/RFO/June/21-06-2019/bmjopen_iss_9_7_20190621_1/ A retrospective observational study was conducted using hospital discharge data obtained from the hospital inpatient enquiry data reporting system. In this system, VTE events recorded as ‘primary diagnosis’ represented the reason for initial hospital admission, whereas VTE recorded as a ‘secondary diagnosis’ occurred following admission and were therefore used as an approximation of HA-VTE. These data were used to estimate the overall incidence of VTE and the proportion of these events which were hospital-acquired.

Setting

The IEHG is the largest hospital group in the Irish healthcare system and serves a population of over 1 million individuals.

Participants

Data were generated from records pertaining to the 2727 patient admission episodes where a diagnosis of VTE was made during the 22-month study period.

Results

During the study period, 2727 VTE events were recorded within the IEHG (which serves a population of 1 036 279) corresponding to an incidence of 1.44 (95% CI 1.36 to 1.51) per 1000 per annum. 1273 (47%) of VTE events were recorded as secondary VTE. The incidence of VTE was highest among individuals over 85 years of age (16.03 per 1000;95% CI 12.81 to 19.26) and was more common following emergency hospital admission.

Conclusion

These data suggest that HA-VTE accounts for at least 47% of all VTE events arising within a hospital group serving a population of over 1 million individuals within the Ireland. Given that HA-VTE is a well-recognised source of (potentially preventable) hospital deaths, these findings provide a compelling argument for prioritising strategies directed at reducing the risk of VTE among hospital patients served by the IEHG and within the Ireland as a whole.
Robust methods to estimate large-strain consolidation parameters from column experiments
Authors: Qi Shunchao , Simms Paul
Published: June 2019

New approaches are proposed for robustly determining the compressibility and permeability functions for large-strain consolidation (LSC), using limited measurements from one-dimensional tests, such as column or centrifuge experiments. These new methods are developed from several new findings reported in this paper, including (i) new analytical solutions that relate parameters of compressibility functions to the final density profile, (ii) analytical proof of the independence of the shape of the settlement curve from the parameter M, where the permeability or hydraulic conductivity k is given by MeP, e is void ratio, and M and P are material-related constants; and (iii) that when the same k function is employed, for the case of one-dimensional settlement, the optimal values of M and P are located on a unique straight line in the P–lnM space. The third finding was determined from optimization analysis of thousands of LSC simulations. Using different combinations of these new findings, three new methods are developed to estimate the permeability function. The efficiency, robustness, and accuracy of the three methods are investigated by their application to four column tests from the literature. The simplest of the three methods requires only two LSC analyses plus several hand-calculations, demonstrating strong potential for practical use.
Whitewashedness in Teacher Education: Intertextuality Between Colorblindness and the Ferguson Event
Authors: Lee-Johnson Yin Lam
Published: June 2019

Whitewashedness has been trickling down in language classrooms through assimilation and colorblind practices. These practices have irreversible effects on the psyche of immigrant and refugee learners in K-12 schools. This research study investigates 15 teacher candidates’ ideologies regarding colorblindness by empowering them to create intertextual links to Ferguson event, which happened in close proximity to where they teach. The study revealed how colorblindness perpetuated among the teacher candidates when they were in schools as students, how they were empowered to unpack the meaning of colorblindness, and how the White males in the program resisted to acknowledge White privileges and colorblindness.
Strain-Level Determination Procedure for Small-Specimen Cyclic Fatigue Testing in the Asphalt Mixture Performance Tester
Authors: Lee Kangjin “Caleb” , Pape Sonja , Castorena Cassie , Underwood B. Shane , Kim Y. Richard
Published: June 2019

With an increase in small-specimen cyclic fatigue testing using the Asphalt Mixture Performance Tester (AMPT), researchers have observed that the strain-selection guidelines in AASHTO TP 107-14 that are intended for large AMPT cyclic fatigue tests are inadequate for testing small specimens. The machine compliance factor is significantly different for testing small specimens compared with large specimens because of different required load levels, resulting in a significant offset in the relationship between the input strain and the number of cycles to failure. To this end, this paper presents the development and verification of a phenomenological model that relates strain levels to dynamic modulus and number of cycles to failure for small-specimen AMPT cyclic fatigue tests, as well as the development of a corresponding stepped strain-level determination procedure that takes into account cases when the initially selected strain-level results in an unexpected number of cycles to failure. The final procedure includes a table with input strain levels and step strain increments for a wide range of dynamic modulus values as well as a flow chart to guide the use of the step strain adjustment procedure.
Prevalence and genotyping of hepatitis B virus: a cross-sectional study conducted with female sex workers in the Marajó Archipelago, Brazil
Authors: Frade Paula CR , Raiol Nairis C , da Costa Luana M , Pinheiro Luiz ML , Silva-Oliveira Gláucia C , Pinho João RR , Lemos José AR , Martins Luísa C , Oliveira-Filho Aldemir B
Published: June 2019

In South America, the Amazon basin is considered an endemic area of hepatitis B virus (HBV) infection. However, epidemiological studies with vulnerable groups are scarce. Female sex workers (FSWs) are highly vulnerable to sexually transmitted infections due to a combination of their sexual behavior and socio-economic conditions. Thus, this study investigated the prevalence of HBV infections and HBV–hepatitis C virus, HBV–hepatitis D virus, HBV–HIV, and HBV–human T-lymphotropic virus co-infections among FSWs in the Marajó Archipelago, northern Brazil, as well as identifying the HBV genotypes circulating in this population. A total of 153 FSWs in 5 towns and 18 riverside communities were included in the study. The HBV infection and co-infections were diagnosed by enzyme-linked immunosorbent assay and real-time polymerase chain reaction. The HBV genotypes were detected by sequencing and were then analyzed phylogenetically. Most of the FSWs surveyed were single, young, heterosexual, and born locally, with low levels of education. Overall, 21 (13.7%) had been exposed to HBV, and HBV-DNA was detected in 13 (8.5%). Genotypes A (69.2%), D (23.1%), and F (7.7%) were detected. Seven cases of co-infections with other viruses were detected. These findings indicate a clear need for urgent measures to control the spread of HBV and other pathogens, and to promote the health of the local FSWs.
Primary Care Practice Redesign: Challenges in Improving Behavioral Health Care for a Vulnerable Patient Population
Authors: Swavely Deborah , O’Gurek David T. , Whyte Veronica , Schieber Alexandra , Yu Daohai , Tien Allen Y. , Freeman Susan L.
Published: June 2019

This study examined a program focused on integrating mental health in a family medicine practice in an economically challenged urban setting. The program included using a behavioral health technology platform, a behavioral health collaborative composed of community mental health agencies, and a community health worker (CHW). Of the 202 patients screened, 196 were used for analysis; 56% were positive for anxiety, 38% had scores consistent with moderate to severe depression, and 34% were positive for post-traumatic stress disorder. There was a statistically significant difference in the diagnosis of depression when comparing the screened group to a control group. Only 27% of patients followed through with behavioral health referrals despite navigational assistance provided by a CHW and assured access to care through a community agency engaged with the Behavioral Health Alliance. Further qualitative analysis revealed that there were complex patient factors that affected patient decision making regarding follow-up with behavioral health care.
Using Safety Barrier Analysis to Facilitate Quality Improvement in Health Care: Improving Venous Thromboembolism Prophylaxis as a Proof of Concept
Authors: Moore Carlton , Coleman G. Cameron , Chang Jamison , Nagle Max , Sten May-Britt
Published: June 2019

Effective quality improvement is a key factor in optimizing the care of hospitalized patients. Unfortunately, the US health care system has a poor safety record when compared to other major industries. For example, at 250 000 per year, medical errors are the third leading cause of death in the United States. Safety barrier management, a widely used methodology in high-risk industries such as commercial airline transportation and oil drilling, has not been widely used in traditional quality improvement efforts in health care, which rely more on standard lean Six Sigma quality approaches. The authors describe a quality improvement project that uses safety barrier analysis to help inform solutions to improve venous thromboembolism prophylaxis in hospitalized patients. This study found that safety barrier analysis helped inform solutions to improve venous thromboembolism prophylaxis at the study institution and can be a useful adjunct to standard lean Six Sigma methodologies for quality improvement in health care.
Study on pressure pulsation characteristics of reactor coolant pump during the idling transition process
Authors: Wang Xiuli , Lu Yonggang , Zhu Rongsheng , Zhao Yuanyuan , Fu Qiang
Published: June 2019

The idling characteristic of the reactor coolant pump is one of the important indicators for the safe operation of the nuclear power system. The idling transition process of the reactor coolant pump under the power failure accident condition belongs to the transient flow process. During most of the time of the idling transition process, the parameters of flow, rotating speed, and head are all nonlinear changes, and the study of the idling change law is extremely difficult. This paper introduces the nonlinear inertia transient phase of the reactor coolant pump and the principle of wavelet analysis. Based on the experimental results of the idling transition process, the polynomial fitting of the flow curve and the rotating speed curve is fitted, and the idling transient equation is established which is a boundary condition for computational fluid dynamics simulation of the nonlinear idling transient stage of the reactor coolant pump with different types of guide vanes. The signal fluctuation of pressure pulsation time-domain change at the volute outlet in different sub-bands is analyzed by means of a fast, discrete wavelet transform, and the effects of different vane optimizations in different idling stages are analyzed. It was found that the pressure fluctuation amplitude of each sub-frequency range of pump outlet in the model of the shunt guide vane is significantly smaller than that of the normal guide vane.
Vibratory response and acoustic radiation behavior of laminated functionally graded composite plates in thermal environments
Authors: Fu Tao , Chen Zhaobo , Yu Hongying , Hao Qingjun , Zhao Yanzheng
Published: June 2019

The present study is concerned with vibro-acoustic behavior analyses of laminated functionally graded carbon nanotube reinforced composite plates based on Reddy’s higher order shear deformation theory. Four types of carbon nanotubes distributions along the plate thickness are considered, which include uniformly distributed and three other functionally graded distributions. Governing differential equations are derived by means of Hamilton’s principle. The sound pressure and radiation efficiency are calculated with Rayleigh integral. A numerical comparison with available results in the literature is carried out to show the validity of the present model. Furthermore, effects of the carbon nanotubes volume fraction, different thermal environments, lamination angle and carbon nanotubes distribution types on the structural and acoustic response of laminated functionally graded carbon nanotube reinforced composite plates are also investigated.
Turf Toe Review
Authors: Chiou Daniel , Stupay Kristen L. , Waryasz Gregory
Published: June 2019

Turf toe is a term used to describe myriad injuries to the metatarsophalangeal complex of the great toe, which have been associated with the introduction of artificial turf surfaces in sport. If not diagnosed early and treated properly, these injuries can result in chronic pain and loss of mobility. Accurate injury grading through physical exam and advanced imaging is essential to guide treatment, thereby minimizing long-term complications and maximizing an athlete’s recovery and return to play.

Levels of Evidence: Level V
How Religious Composition Around the World Differs between Younger and Older Populations
Authors: Hackett Conrad
Published: June 2019

This graphic shows differences in the religious composition of people around the world by age group. Religious change caused by demographic processes is more than a hypothetical future possibility. The consequences of demographic differences can be seen today by comparing the religious composition of younger and older populations.
Public Concern about Terrorism: Fear, Worry, and Support for Anti-Muslim Policies
Authors: Haner Murat , Sloan Melissa M. , Cullen Francis T. , Kulig Teresa C. , Lero Jonson Cheryl
Published: June 2019

In the era of 9/11, terrorist attacks occur with sufficient frequency and lethality to constitute a realistic threat to the well-being of the American public. Sensing this concern, politicians emphasize the threat of violent attacks to advance a platform of making public safety a priority. In this context, the authors assess the extent, sources, and emotional impact of the public’s concern about terrorism. On the basis of a national survey of 1,000 Americans, the authors examine levels of fear of a terrorist attack and worry about terrorism relative to other potential harms. They also determine whether concern about terrorism translates into support for homeland security measures that target Muslims. Of the predictors in the authors’ models, gender, religiosity, and psychological distress were most consistently associated with fear of terrorism and worry about being a victim of a terrorist attack. Structural equation modeling demonstrated that terrorism-related fear and worry predict support for anti-Muslim policies.
Traffic Lights Intervention Reduces Therapeutic Inertia: A Randomized Controlled Trial in Multiple Sclerosis Care
Authors: Saposnik Gustavo , Mamdani Muhammad , Montalban Xavier , Terzaghi Maria , Silva Berenice , Saladino Maria Laura , Tobler Philippe N. , Caceres Fernando
Published: June 2019

Background: Therapeutic inertia (TI) is a common phenomenon among physicians who care for patients with chronic conditions. We evaluated the efficacy of the traffic light system (TLS) educational intervention to reduce TI among neurologists with MS expertise. Methods: In this randomised, controlled trial, 90 neurologists who provide care to MS patients were randomly assigned to the TLS intervention ( n = 45) or to the control group ( n = 45). The educational intervention employed the TLS, a behavioral strategy that facilitates therapeutic choices by facilitating reflective decisions. The TLS consisted in a short, structured, single session intervention of 5-7 min duration. Participants made therapeutic choices of 10 simulated case-scenarios. The primary outcome was a reduction in TI based on a published TI score (case-scenarios in which a participant showed TI divided by the total number of scenarios where TI was possible ranging from 0 to 8). Results: All participants completed the study and were included in the primary analysis. TI was lower in the TLS group (1.47, 95% CI 1.32-1.61) compared to controls (1.93; 95% CI 1.79-2.08). The TLS group had a lower prevalence of TI compared to controls (0.67, 95% CI 0.62-0.71 vs. 0.82, 95% CI 0.78-0.86; p = 0.001). The multivariate analysis, adjusted for age, specialty, years of practice, and risk preference showed a 70% reduction in TI for the TLS intervention compared to controls (OR 0.30; 95% CI 0.10-0.89). Conclusions: In this randomized trial, the TLS strategy decreases the incidence of TI in MS care irrespective of age, expertise, years for training, and risk preference of participants, which would lead to better patient outcomes.
Simulation Analysis and Comparison of Point of Care Testing and Central Laboratory Testing
Authors: Harder Reed , Wei Keji , Vaze Vikrant , Stahl James E.
Published: June 2019

Background. In response to demand for fast and efficient clinical testing, the use of point-of-care testing (POCT) has become increasingly common in the United States. However, studies of POCT implementation have found that adopting POCT may not always be advantageous relative to centralized laboratory testing. Methods. We construct a simulation model of patient flow in an outpatient care setting to evaluate tradeoffs involved in POCT implementation across multiple dimensions, comparing measures of patient outcomes in varying clinical scenarios, testing regimes, and patient conditions. Results. We find that POCT can significantly reduce clinical time for patients, as compared to traditional testing regimes, in settings where clinic and central testing areas are far apart. However, as distance from clinic to central testing area decreased, POCT advantage over central laboratory testing also decreased, in terms of time in the clinical system and estimated subsequent productivity loss. For example, testing for pneumonia resulted in an estimated average of 27.80 (central lab) versus 15.50 (POCT) total lost productive hours in a rural scenario, and an average of 14.92 (central lab) versus 15.50 (POCT) hours in a hospital-based scenario. Conclusions. Our results show that POCT can effectively reduce the average time a patient spends in the system for varying condition profiles and clinical scenarios. However, the number of total lost productive hours, a more holistic measure, is greatly affected by testing quality, where POCT often is at a disadvantage. Thus, it is important to consider factors such as clinical setting, target condition, testing costs, and test quality when selecting appropriate testing regime.
Characterization of fractured zones via topological analysis of 3D seismic diffraction images
Authors: Protasov Maxim I. , Khachkova Tatyana S. , Kolyukhin Dmitriy R. , Bazaikin Yaroslav V.
Published: June 2019

A workflow for recovering fracture network characteristics from seismic data is considered. First, the presented discrete fracture modeling technique properly describes fracture models on the seismic scale. The key procedure of the workflow is 3D diffraction imaging based on the spectral decomposition of different combinations of selective images. Selective images are obtained by the prestack asymmetric migration procedure, whereas spectral decomposition occurs in the Fourier domain with respect to the spatial dip and the azimuth angles. At the final stage, we performed a topological analysis based on the construction of a merge tree from the obtained diffraction images. The results of the topological algorithm are modeling parameters for the discrete fractures. To analyze the effectiveness of our workflow, a statistical comparison of the recovered parameters and true model parameters was conducted. We used the Kolmogorov-Smirnov test for the statistical analysis of the fracture lengths, whereas the behavior of the Morisita index indicates the statistical distribution of the modeled fracture corridors. Numerical examples with synthetic realistic models provide a detailed, reliable reconstruction of the statistical characteristics of the fracture corridors.
Data-driven internal multiple elimination and its consequences for imaging: A comparison of strategies
Authors: Zhang Lele , Thorbecke Jan , Wapenaar Kees , Slob Evert
Published: June 2019

We have compared three data-driven internal multiple reflection elimination schemes derived from the Marchenko equations and inverse scattering series (ISS). The two schemes derived from Marchenko equations are similar but use different truncation operators. The first scheme creates a new data set without internal multiple reflections. The second scheme does the same and compensates for transmission losses in the primary reflections. The scheme derived from ISS is equal to the result after the first iteration of the first Marchenko-based scheme. It can attenuate internal multiple reflections with residuals. We evaluate the success of these schemes with 2D numerical examples. It is shown that Marchenko-based data-driven schemes are relatively more robust for internal multiple reflection elimination at a higher computational cost.
INDIVIDUALIZED HYDRATION PLANS FOR ULTRADISTANCE ENDURANCE ATHLETES
Authors: Corcoran Michael , Ayotte David
Published: June 2019

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