bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic orofacial pain, cognitive‐emotional‐motivational considerations: A narrative review
Authors: Heir Gary M.
Published: June 2019

The following material was presented to an esteemed group of colleagues, Chinese physicians and stomotologists, friends and fellow panellists from around the globe at the Core China Conference, Nanjing China. Modern medicine accepts that a dichotomy exists between the mind, psyche and emotions and the rest of the body as if they function independently, having little downward up upward influence, one on the other. However, history teaches a different lesson. The influence of the emotional state of the patient plays a significant role effecting hormonal, neuroimmunological and peripheral modulatory factors influencing the pain experience. This brief discussion reviews the roots of modern Western Medicine in Traditional Chinese Medicine, and how we have come back to the realisation of the mind‐body concept in treating the patient as a single entity and not as a collection of systems.
Phylogeography of a cryptic speciation continuum in Eurasian spadefoot toads (Pelobates)
Authors: Dufresnes Christophe , Strachinis Ilias , Suriadna Nataliia , Mykytynets Galyna , Cogălniceanu Dan , Székely Paul , Vukov Tanja , Arntzen Jan W. , Wielstra Ben , Lymberakis Petros , Geffen Eli , Gafny Sarig , Kumlutaş Yusuf , Ilgaz Çetin , Candan Kamil , Mizsei Edvárd , Szabolcs Márton , Kolenda Krzysztof , Smirnov Nazar , Géniez Philippe , Lukanov Simeon , Crochet Pierre‐André , Dubey Sylvain , Perrin Nicolas , Litvinchuk Spartak N. , Denoël Mathieu
Published: June 2019

Cryptic phylogeographic diversifications provide unique models to examine the role of phylogenetic divergence on the evolution of reproductive isolation, without extrinsic factors such as ecological and behavioural differentiation. Yet, to date very few comparative studies have been attempted within such radiations. Here, we characterize a new speciation continuum in a group of widespread Eurasian amphibians, thePelobatesspadefoot toads, by conducting multilocus (restriction site associated DNA sequencing and mitochondrial DNA) phylogenetic, phylogeographic and hybrid zone analyses. Within theP. syriacuscomplex, we discovered species‐level cryptic divergences (>5 million years ago [My]) between populations distributed in the Near‐East (hereafterP. syriacussensustricto[s.s.]) and southeastern Europe (hereafterP. balcanicus), each featuring deep intraspecific lineages. Altogether, we could scale hybridizability to divergence time along six different stages, spanning from sympatry without gene flow (P. fuscusandP. balcanicus, >10 My), parapatry with highly restricted hybridization (P. balcanicusandP. syriacus s.s., >5 My), narrow hybrid zones (~15 km) consistent with partial reproductive isolation (P. fuscusandP. vespertinus, ~3 My), to extensive admixture between Pleistocene and refugial lineages (≤2 My). This full spectrum empirically supports a gradual build up of reproductive barriers through time, reversible up until a threshold that we estimate at ~3 My. Hence, cryptic phylogeographic lineages may fade away or become reproductively isolated species simply depending on the time they persist in allopatry, and without definite ecomorphological divergence.
The dormancy‐specific regulator, SutA, is intrinsically disordered and modulates transcription initiation in Pseudomonas aeruginosa
Authors: Bergkessel Megan , Babin Brett M. , VanderVelde David , Sweredoski Michael J. , Moradian Annie , Eggleston‐Rangel Roxana , Hess Sonja , Tirrell David A. , Artsimovitch Irina , Newman Dianne K.
Published: June 2019

Though most bacteria in nature are nutritionally limited and grow slowly, our understanding of core processes like transcription comes largely from studies in model organisms doubling rapidly. We previously identified a small protein of unknown function, SutA, in a screen of proteins synthesized in Pseudomonas aeruginosa during dormancy. SutA binds RNA polymerase (RNAP), causing widespread changes in gene expression, including upregulation of the ribosomal RNA genes. Here, using biochemical and structural methods, we examine how SutA interacts with RNAP and the functional consequences of these interactions. We show that SutA comprises a central α‐helix with unstructured N‐ and C‐terminal tails, and binds to the β1 domain of RNAP. It activates transcription from the rrn promoter by both the housekeeping sigma factor holoenzyme (Eσ70) and the stress sigma factor holoenzyme (EσS) in vitro, but has a greater impact on EσS. In both cases, SutA appears to affect intermediates in the open complex formation and its N‐terminal tail is required for activation. The small magnitudes of in vitro effects are consistent with a role in maintaining activity required for homeostasis during dormancy. Our results add SutA to a growing list of transcription regulators that use their intrinsically disordered regions to remodel transcription complexes.
Genetic basis and timing of a major mating system shift inCapsella
Authors: Bachmann Jörg A. , Tedder Andrew , Laenen Benjamin , Fracassetti Marco , Désamoré Aurélie , Lafon‐Placette Clément , Steige Kim A. , Callot Caroline , Marande William , Neuffer Barbara , Bergès Hélène , Köhler Claudia , Castric Vincent , Slotte Tanja
Published: June 2019

A crucial step in the transition from outcrossing to self‐fertilization is the loss of genetic self‐incompatibility (SI). In the Brassicaceae,SIinvolves the interaction of female and male specificity components, encoded by the genesSRKandSCRat the self‐incompatibility locus (S‐locus). Theory predicts thatS‐linked mutations, and especially dominant mutations inSCR, are likely to contribute to loss ofSI. However, few studies have investigated the contribution of dominant mutations to loss ofSIin wild plant species.

Here, we investigate the genetic basis of loss ofSIin the self‐fertilizing crucifer speciesCapsella orientalis, by combining genetic mapping, long‐read sequencing of completeS‐haplotypes, gene expression analyses and controlled crosses.

We show that loss ofSIinC. orientalisoccurred < 2.6 Mya and maps as a dominant trait to theS‐locus. We identify a fixed frameshift deletion in the male specificity geneSCRand confirm loss of maleSIspecificity. We further identify anS‐linked smallRNAthat is predicted to cause dominance of self‐compatibility.

Our results agree with predictions on the contribution of dominantS‐linked mutations to loss ofSI, and thus provide new insights into the molecular basis of mating system transitions.
Trichome regulator SlMIXTA‐like directly manipulates primary metabolism in tomato fruit
Authors: Ying Shiyu , Su Min , Wu Yu , Zhou Lu , Fu Rao , Li Yan , Guo Hao , Luo Jie , Wang Shouchuang , Zhang Yang
Published: June 2019

Trichomes are storage compartments for specialized metabolites in many plant species. In trichome, plant primary metabolism is significantly changed, providing substrates for downstream secondary metabolism. However, little is known of how plants coordinate trichome formation and primary metabolism regulation. In this report, tomato (Solanum lycopersicum) trichome regulator SlMIXTA‐like is indicated as a metabolic regulation gene by mGWAS analysis. Overexpression of SlMIXTA‐like in tomato fruit enhances trichome formation. In addition, SlMIXTA‐like can directly bind to the promoter region of gene encoding 3‐deoxy‐7‐phosphoheptulonate synthase (SlDAHPS) to activate its expression. Induction of SlDAHPS expression enhances shikimate pathway activities and provides substrates for downstream secondary metabolism. Our data provide direct evidence that trichome regulator can directly manipulate primary metabolism, in which way plants can coordinate metabolic regulation and the formation of storage compartments for specialized metabolites. The newly identified SlMIXTA‐like can be used for future metabolic engineering.
Studying Immigrant Policy One Law at a Time
Authors: Monogan James E.
Published: June 2019

This article shows that, in the study of immigrant integration policy in the U.S. states, it is critical to report data and coding decisions for individual laws. This analysis uses an updated and public database of law‐level decisions, which includes 2,703 legislative actions recorded by the National Conference of State Legislatures from 2005 to 2016. These data are used to estimate models of aggregate state policy activity in a variety of ways: as a single continuum of policy balance versus separate models of welcoming and hostile, lumping all policy subareas together versus analyzing a specific subarea, and lumping all years together in one cross section versus panel analysis. The results in these models differ enough to indicate that reporting codes for individual‐level laws is absolutely essential so that each researcher easily can construct the measure that fits his or her theoretical framework best.
Forest restoration on floodplains mantled with legacy sediments: removing sediments appears unnecessary for successful restoration
Authors: Sweeney Bernard W. , Dunbar Amanda , Dow Charles L. , Daniels Melinda D.
Published: June 2019

Recent studies suggest very low survival of seedlings planted in streamside areas containing thick (>1 m) deposits of legacy alluvial sediments. We planted 2,450 seedlings representing eight species in a streamside area with thick legacy sediments and monitored them for 5 years. The overall survival of approximately 60% (range across species: approximately 38–74%) was surprisingly high and mean overall growth per seedling (approximately 3.27 m) was very good, ranging between 2.5 and 4.7 m depending on tree species. Although both seedling survival and growth exhibited significant spatial variation, none of the results supports the idea that legacy sediment thickness up to 1.5 m is an important factor with regard to success of streamside reforestation. For survival, soil depth was significant for the sediment accretion zone but not the legacy sediment zone. For growth, the response was significant and positive, with the eight species on average growing significantly better as legacy sediment increased in thickness. The results suggest that the presence of legacy sediment up to 1.5 m thick should not preclude the successful restoration of natural forest along stream channels in the eastern Piedmont of North America. Finally, the study suggests that the U.S. federal criteria for reforestation success (i.e. 222 stems per hectare after 5 years) can still be met on legacy sediment sites by increasing the planting density approximately 25% from the required minimum of 296 stems per hectare to 370.
Assessment of genetic diversity and mating system of Acacia cyclops restoration and remnant populations
Authors: Millar Melissa A. , Coates David J. , Byrne Margaret , Krauss Siegfried L. , Jonson Justin , Hopper Stephen D.
Published: June 2019

Acacia cyclops, or Ngaamarur, is a common coastal shrub or small tree of the southwest of Western Australia and South Australia used for restoration in these landscapes and elsewhere. Knowledge of genetic diversity and mating systems of restoration populations is often lacking but can help inform likely restoration success. We compared genetic diversity and mating system parameters at three restoration populations of A. cyclops to nearby remnant reference populations. Mean levels of genetic diversity in restoration populations (Na = 1.806, Ne = 1.560, He = 0.270, Ho = 0.359) were not significantly different from those in the reference populations (Na = 1.833, Ne = 1.574, He = 0.269, Ho = 0.352) suggesting diverse seed collections were made for restoration. Allelic genetic divergence among restoration and reference populations was low (DST ≤ 0.04) suggesting that seeds were of local provenance. Mating system parameters were similar among restoration (tm = 0.989, tm–ts = 0.010, rpm = 0.392) and reference populations (tm = 0.868, tm–ts = 0.039, rpm = 0.410), suggesting functionality of the mating system and restitution of generalist insect pollinator services in restored populations at 7, 10, and 12 years after planting. Lower levels of heterozygosity in progeny compared to adults suggest post‐germination or late‐acting selection against inbred seedlings. Evidence for selection and seedling attrition further emphasizes the benefits of collections from many individuals in well‐connected outcrossed source populations. Overall, results suggest available local genetic diversity was captured and restoration populations have mating systems equivalent to those of reference populations.
The intergenerational continuity of parental conditional regard and its role in mothers’ and adolescents’ contingent self‐esteem and depressive symptoms
Authors: Otterpohl Nantje , Steffgen Sarah Teresa , Stiensmeier‐Pelster Joachim , Brenning Katrijn , Soenens Bart
Published: June 2019

Although research has documented the adverse consequences of parental academic conditional regard in different developmental periods, few studies have examined antecedents and, in particular, the possibility of intergenerational continuity of this parenting dimension. The current study aimed to identify patterns of intergenerational similarity in two types of conditional regard (i.e., positive and negative). Additionally, it examined mothers’ and adolescents’ contingent self‐esteem (CSE) and depressive symptoms as outcomes of this process. In total, 211 mothers and their 10‐ to 16‐year‐old adolescents filled out questionnaires assessing perceived conditional regard in the relationship with their own mother (i.e., grandmothers’, and mothers’ conditional positive (PACPR) and negative regard (PACNR)), contingent self‐esteem (i.e., maternal child‐invested CSE and adolescents’ academic CSE), and maternal and adolescents’ depressive symptoms. Results revealed direct intergenerational similarity for PACPR, but not for PACNR. Within generations, PACPR was related positively to CSE, which, in turn, was related positively to depressive symptoms. Moreover, PACNR was related positively to depressive symptoms. Our findings provide preliminary evidence for the intergenerational continuity of conditional regard, which has important consequences because of its relation to CSE and subsequent depressive symptoms within both generations.
Cache Valley virus: A scoping review of the global evidence
Authors: Waddell Lisa , Pachal Nicole , Mascarenhas Mariola , Greig Judy , Harding Shannon , Young Ian , Wilhelm Barbara
Published: June 2019

Cache Valley virus (CVV) is a mosquito‐borne RNA virus detected throughout North America, Central America and parts of South America. A limited number of human case reports have described severe illness. CVV infection has been associated with outbreaks of congenital defects in small ruminants in Canada and the United States. A scoping review was conducted to identify, characterize and summarize research on CVV, and to identify research gaps. A structured search was conducted in eight electronic databases, with additional search verification and grey literature investigation. All captured studies were independently appraised by two reviewers for relevance and data characterization. The review captured 143 relevant studies investigating CVV epidemiology (n = 104), pathogenesis (n = 37), viral characteristics (n = 24), transmission (n = 14), diagnostic test performance (n = 8) and mitigation strategies (n = 2). Evidence of CVV infection was found in mosquito studies (n = 47), and serological evidence of exposure was demonstrated in animals (n = 41), as well as human (n = 20) studies. In sheep, five outbreaks of birth defects following asymptomatic dam CVV infection during the first 50 days of pregnancy were reported. Only six human cases of CVV‐associated illness were captured, with case symptoms described as initially non‐specific, progressing to more severe clinical signs (e.g., meningitis). No research was identified investigating treatment, societal knowledge and risk perception, economic burden or predictive models related to the impact of climate change on CVV. CVV circulates in mosquito and animal species across a large area of the Americas. Small ruminants are the only animals in which CVV‐associated clinical disease has been extensively studied. It is likely that human cases are under‐reported or misdiagnosed. Future research should focus on the impact of CVV infection in human and animal populations.
Spatial difference can occur between activated and damaged muscle areas following electrically‐induced isometric contractions
Authors: Fouré Alexandre , Le Troter Arnaud , Ogier Augustin C. , Guye Maxime , Gondin Julien , Bendahan David
Published: June 2019

Key points

T2 mapping combined to image registration and statistical parametric mapping analysis is a suitable methodology to accurately localize and compare the extent of both activated and damaged muscle areas.

Activated muscle areas following electrically‐induced isometric contractions are superficial, but damaged regions are muscle specific and can be related to the muscle morphology and/or the relative spatial position within a muscle group leading to potential intramuscular muscle shear strain.

Tissues other than active skeletal muscle fibres can be altered during unaccustomed neuromuscular electrical stimulation‐induced isometric contractions.

Skeletal muscle isometric contractions induced by neuromuscular electrical stimulation (NMES) exercise can generate damage within activated muscles. This study aimed at comparing the localization and the extent of NMES‐activated muscle areas and induced damage regions using magnetic resonance imaging. Thirteen healthy subjects performed a single bout of NMES‐induced isometric contractions known to induce a decrease in maximal voluntary isometric contraction (MVC) and increase in muscle volume and transverse relaxation time (T2). All the parameters were measured before, immediately after (POST), 7 days (D7), 14 days (D14) and 21 days (D21) after the NMES session. Spatial normalization of T2 maps were performed to compare the localization of muscle activation areas and damaged muscle regions from statistical mapping analyses. A significant decrease in MVC was found at POST (−26 ± 9%) and in delayed time at D7 (−20 ± 6%) and D14 (−12 ± 5%). Although muscle activation was statistically detected through T2 increase at POST in superficial parts of the two muscles located beneath the stimulation electrodes (i.e. vastus lateralis and vastus medialis), alterations quantified in a delayed time from increased T2 were mainly located in the deep muscle region of the vastus lateralis (+57 ± 24% of mean T2) and superficial area of the vastus medialis (+24 ± 16% of mean T2) at D7 and were still observed in whole muscle at D21. The discrepancy between activated and damaged areas in the vastus lateralis implies that tissues other than active skeletal muscle fibres were altered during unaccustomed NMES‐induced isomeric contractions.
Computational Fluid Dynamic Prediction and Physical Mechanisms Consideration of Thermal Separation and Heat Transfer Processes Inside Divergent, Straight, and Convergent Ranque–Hilsch Vortex Tubes
Authors: Bazgir Adib , Nabhani Nader , Bazooyar Bahamin , Heydari Ali
Published: June 2019

The design of Ranque–Hilsch vortex tube (RHVT) seems to be interesting for refrigeration and air conditioning purposes in industry. Improving thermal efficiency of the vortex tubes could increase the operability of these innovative facilities for a wider heat and cooling demand to this end; it is of an interest to understand the physical phenomena of thermal and flow patterns inside a vortex tube. In this work, the flow phenomena and the thermal energy transfer in RHVT are studied for three RHVT: straight, divergent, and convergent vortex tubes. A three-dimensional numerical analysis of swirling or vortex flow is performed, verified, and validated against previous experimental and numerical data reported in literature. The flow field and the temperature separation inside an RHVT for different configuration of straight, five angles of divergent hot tube (1 deg, 2 deg, 3 deg, 4 deg, and 6 deg) and five angle of convergent hot tube (0.5 deg, 0.8 deg, 1 deg, 1.5 deg, and 2 deg) are investigated. The thermal performance for all investigated RHVTs configuration is determined and quantitatively assessed via visualizing the stream lines for all three scenarios.
Observation of Strange Nonchaotic Dynamics in the Frame of State-Controlled Cellular Neural Network-Based Oscillator
Authors: Megavarna Ezhilarasu P. , Suresh K. , Thamilmaran K.
Published: June 2019

In this paper, the strange nonchaotic dynamics of a quasi-periodically driven state-controlled cellular neural network (SC-CNN) based on a simple chaotic circuit is investigated using hardware experiments and numerical simulations. We report here two different routes to strange nonchaotic attractors (SNAs) taken by this SC-CNN based circuit system. These routes were confirmed using rational approximation (RA) theory, finite time Lyapunov exponents, spectrum of the largest Lyapunov exponents and their variance, and phase sensitivity exponent. It is observed that the results from both computer simulations as well as laboratory experiments have spectacular resemblance.
Experimental and Numerical Investigations on Jet Impingement Cooling for Electronic Modules
Authors: Chu Wen-Xiao , Huang Kuan-Chang , Amer Mohammed , Wang Chi-Chuan
Published: June 2019

In this paper, the influence of outlet arrangement and plenum structure on impingement cooling is experimentally and numerically investigated in a typical 1-U confined server space. Three outlets include Z-type, bilateral, and U-type arrangements, and the plenum configurations contain partially inclined, fully inclined, and staged layouts. As a result, using the U-type outlet or staged plenum may prominently compromise the impingement cooling performance on the target plates with lower pumping power. With numerical investigation, it is found that, for the case with Z-type outlet, the flowrate of jet impingement increases alongside the streamwise direction. Besides, the impingement stagnation region on target plates with the minimum thermal resistance may shift toward the outlet. Meanwhile, the uniformity of jet impingement can be improved by 10.7% and 50.3% when the bilateral and U-type outlets are applied, respectively, and the jet impingement is changed to perpendicular direction due to the opposite cross flow from the coming flow direction. On the other hand, by applying the inclined plenum and staged plenum, the uniformity of jet impingement can be dramatically improved by 113.9% and 215.1%, respectively. However, the local jet impingement velocity distribution is still nonuniform. Hence, a novel design of impingement plate based on the concept of Coanda effect is proposed. The peak value of the thermal resistance on target plate can be reduced by 21.8% and 16.0% at the center region and the fore part of the jet array.
Study of Uncertainties and Objective Function Modeling Effects on Probabilistic Optimization Results
Authors: Braydi Oussama , Lafon Pascal , Younes Rafic
Published: June 2019

In this work, we study the effect of uncertainties modeling and the choice of objective function on the results of optimization design problems in deterministic and probabilistic contexts. Uncertainties modeling are studied in two cases identified in the literature. The results show how the choice of two different objective functions, which lead to the same results in deterministic case, may lead to opposite results in probabilistic case. Also, the results show how the uncertainties modeling type can affect the antagonism between mean and standard deviation in the reliability-based robust design optimization (RBRDO) problems. Three mechanical applications chosen from the literature are used to illustrate these cases.
Analytical and Numerical Study of a Pulsatile Flow in a Porous Tube
Authors: Sidnawi Bchara , Santhanam Sridhar , Wu Qianhong
Published: June 2019

Lateral leakage is encountered in many biological and chemical applications such as renal flows and filtration processes. In this paper, we report a comprehensive analytical and numerical method to examine pulsatile flow in a porous-walled tube, with leakage flow rate or permeation coefficient prescribed. In the first scenario, the analytical results have been obtained when the leakage flow rate is small as compared to the axial flow rate. Numerical simulations using ansysFluent were performed for cases where both the pulsatile Reynolds number based on the amplitude of the axial velocity and the leakage ratio (ratio of leakage velocity amplitude to the mean axial velocity amplitude) were varied. The comparison between the analytical and the numerical results indicates that the analytical solution for the axial velocity had an increasing deviation from the numerical results with the increasing pulsatile Reynolds number, or increasing leakage ratio. Interestingly, the analytical radial velocity almost overlapped with its numerical counterpart, for all considered cases. In the second scenario where a permeation coefficient for the leakage is prescribed, an analytical solution was obtained. Importantly, the solution in the second scenario suggests the criteria based on the wall permeability for the application of the analytical method developed herein.
Steel–Concrete Composite Pressure Vessels for Hydrogen Storage at High Pressures
Authors: Jawad Maan , Wang Yanli , Feng Zhili
Published: June 2019

The need to store large quantities of hydrogen in large diameter steel vessels under high pressures results in shell thicknesses that are too large to produce by most steel mills and not practical to fabricate. Accordingly, a research program was undertaken by Oak Ridge National Laboratory to develop a new concept of combining steel with concrete to construct such vessels economically and practically. The concept is to fabricate vessels where the steel shell thickness is approximately one half that required to resist the hoop forces due to internal pressure. As such, the steel shell is designed to carry the full amount of the longitudinal forces in the vessel but only one half of the hoop loads due to internal pressure. The other half of the hoop loads is carried by a prestressed and reinforced concrete shell. In large diameter vessels, the cost of the shell can further be reduced by using layered steel shell construction rather than solid-wall construction. Such shell construction has also the added advantage of easily venting the hydrogen that permeates through the steel shell directly to the atmosphere through vent holes. This mechanism prevents the hydrogen from damaging the steel shell. The theoretical formulation of the steel concrete shell design is presented in this paper. In addition, details of a full-scale mock up vessel designed, fabricated, and tested to prove the proposed methodology are given.
Generalized Plane Strain Study of Rotational Autofrettage of Thick-Walled Cylinders—Part II: Numerical Evaluation
Authors: Kamal S. M. , Perl M.
Published: June 2019

The theoretical modeling of the rotational autofrettage of a thick-walled cylinder based on the generalized plane strain assumption has been presented in part I of the paper. In order to access the potentiality of the proposed theoretical model, the numerical evaluation of the analytical solutions is important. This part of the paper presents numerical evaluation of the generalized plane strain model for typical thick-walled cylinders. The residual hoop stress generated in the rotational autofrettage of a typical gun barrel is compared with the residual hoop stresses in the conventional hydraulic and swage autofrettage processes. Comparison shows that the rotationally autofrettaged gun barrel is capable of producing the same level of compressive residual hoop stress at the inner surface as that of the hydraulic autofrettage. In order to corroborate the analytical solution, a three-dimensional finite element method (3D FEM) analysis of the rotational process is carried out in ANSYS finite element package and the results are compared with the theoretical results. The comparison shows a good matching of the results between the theoretical evaluation and the 3D FEM analysis. Finally, a short feasibility analysis of the rotational autofrettage process of typical cylinders is carried out for the practical realization of the process.
Serious games, a game changer in teaching neonatal resuscitation? A review
Authors: Ghoman Simran K , Patel Siddhi D , Cutumisu Maria , von Hauff Patrick , Jeffery Thomas , Brown Matthew R G , Schmölzer Georg M
Published: June 2019

Background

Neonatal healthcare professionals require frequent simulation-based education (SBE) to improve their cognitive, psychomotor and communication skills during neonatal resuscitation. However, current SBE approaches are resource-intensive and not routinely offered in all healthcare facilities. Serious games (board and computer based) may be effective and more accessible alternatives.

Objective

To review the current literature about serious games, and how these games might improve knowledge retention and skills in neonatal healthcare professionals.

Method

Literature searches of PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science and EMBASE databases were performed to identify studies examining serious games in neonatology. All games, such as board games, tabletop games, video games, screen-based simulators, tabletop simulators and virtual reality games were included.

Results

Twelve serious games were included in this review (four board games, five video games and three virtual reality games). Overall, knowledge improvement was reported for the RETAIN (REsuscitationTrAINing for healthcare professionals) board game (10% increase in knowledge retention) and The Neonatology Game (4.15 points higher test score compared with control). Serious games are increasingly incorporated into Nursing and Medical School Curriculums to reinforce theoretical and practical learning.

Conclusions

Serious games have the potential to improve healthcare professionals’ knowledge, skills and adherence to the resuscitation algorithm and could enhance access to SBE in resource-intensive and resource-limited areas. Future research should examine important clinical outcomes in newborn infants.
Direct oral anticoagulant and AKI: apixaban-induced acute interstitial nephritis
Authors: DiMaria Christina , Hanna Wael , Murone Julie , Reichart James
Published: June 2019

Direct oral anticoagulants (DOACs)—dabigatran, rivaroxaban, apixaban and edoxaban—are changing the landscape of clinical practice for patients requiring short and long-term anticoagulation. We report a patient with no history of kidney disease developing acute interstitial nephritis (AIN) after starting a DOAC, apixaban. To date, this is the first biopsy proven case of apixaban-induced AIN.
Estimating the costs of the national basic public health services in Zhuhai, China, through activity-based costing: a cross-sectional study
Authors: Wang Zan , Ao Qin , Luo Yinbo , Wang Qi , Lu Zuxun , Liu Jun’an
Published: June 2019

Objective

Our research aims to estimate the per capita cost of 13 items in the basic public health service (BPHS) project in Zhuhai, China, and provide an economical basis for the improvement of the cost compensation mechanism used by the government.

Design

This research is a cross-sectional study.

Setting

A total of 19 primary healthcare facilities (PHFs) in Zhuhai, China, are involved in this research.

Participants

A total of 152 participants (114 personnel engaged in BPHS, 19 financial personnel and 19 PHF heads) were included in this study, which was conducted from May 2017 to July 2017.

Primary and secondary outcome measures

We used the activity-based costing model to calculate the cost of providing BPHS in Zhuhai. An analytical hierarchy process was used to determine the difficulty dimension and workload coefficient.

Results

The weights of the difficulty dimensions in the provision of BPHS in Zhuhai were 35.04% (coordination of residents), 24.03% (staff workload), 21.36% (complexity of work-related skills) and 19.59% (basic qualities of staff). The average difficulty coefficient of each subproject was 5.28. The actual per capita cost of BPHS provision in 2016 was 97.48 RMB (12.76 EUR), which was higher than the actual standard compensation of 55 RMB (7.2 EUR) in Zhuhai. Immunisation was the most costly among the 13 service items (17.82 RMB or 2.33 EUR per person), whereas the management of tuberculosis was the least costly item (0.57 RMB or 0.07 EUR per person).

Conclusions

Government funds for basic public health services cannot compensate for the actual costs. Accordingly, subsidies should be increased based on the actual per capita cost for sustainable BPHS development. The government should improve the methods used in cost estimation and measures used as the basis for awarding performance incentives.
Clinical observations and a Healthcare Failure Mode and Effect Analysis to identify vulnerabilities in the security and accounting of medications in Ontario hospitals: a study protocol
Authors: de Vries Maaike , Fan Mark , Tscheng Dorothy , Hamilton Michael , Trbovich Patricia
Published: June 2019

Introduction

An increasing number of opioids and other controlled substances are being stolen from healthcare facilities, diverting medications from their intended medical use to be used or sold illicitly. Many incidents of medication loss from Canadian hospitals are reported as unexplained losses. Together, this suggests not only that vulnerabilities for diversion exist within current medication-use processes (MUPs), but that hospitals lack robust mechanisms to accurately track and account for discrepancies and loss in inventory. There is a paucity of primary research investigating vulnerabilities in the security and accounting of medications across hospital processes. The purpose of this study is to map hospital MUPs, systematically identify risks for diversion or unintentional loss and proactively assess opportunities for improvements to medication accounting and security.

Methods and analysis

We will conduct human factors-informed clinical observations and a Healthcare Failure Mode and Effect Analysis (HFMEA). We will observe hospital personnel in the intensive care unit, emergency department and inpatient pharmacy in two hospitals in Ontario, Canada. Observations will capture how participants complete tasks, as well as gather contextual information about the environment, technologies and processes. A multidisciplinary team will complete an HFMEA to map process flow diagrams for the MUPs in the observed clinical units, identify and prioritise potential methods of medication loss (failure modes) and describe mechanisms or actions to prevent, detect and trace medication loss.

Ethics and dissemination

We received province-wide research ethics approval via Clinical Trials Ontario Streamlined Research Review System, and site-specific approvals from each participating hospital. The results from this study will be presented at conferences and meetings, as well as published in peer-reviewed journals. The findings will be shared with hospitals; professional, regulatory and accreditation organisations; patient safety and healthcare quality organisations and equipment and drug manufacturers.
Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review
Authors: Cary Doug , Briffa Kathy , McKenna Leanda
Published: June 2019

Objectives

The objectives of this scoping review were to identify (1) study designs and participant populations, (2) types of specific methodology and (3) common results, conclusions and recommendations from the body of evidence regarding our research question; is there a relationship between sleep posture and spinal symptoms.

Design

Scoping review.

Data sources

PEDro, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Medline, ProQuest, PsycINFO, SportDISCUS and grey literature from inception to 10 April 2018.

Data selection

Using a modified Arksey and O’Malley framework, all English language studies in humans that met eligibility criteria using key search terms associated with sleep posture and spinal symptoms were included.

Data extraction

Data were independently extracted by two reviewers and mapped to describe the current state of the literature. Articles meeting the search criteria were critically appraised using the Downs and Black checklist.

Results

From 4186 articles, four articles were identified, of which three were epidemiological and one interventional. All studies examined three or more sleep postures, all measured sleep posture using self-report and one study also used infrared cameras. Two studies examined symptoms arising from the lumbar spine, one the cervical spine and one the whole spine. Waking pain and stiffness were the most common symptoms explored and side lying was generally protective against spinal symptoms.

Conclusions

This scoping review highlights the importance of evaluating sleep posture with respect to waking symptoms and has provided preliminary information regarding relationships between sleep posture and spinal symptoms. However, there were not enough high-quality studies to adequately answer our research question. It is recommended future research consider group sizes and population characteristics to achieve research goals, that a validated measure be used to assess sleep posture, that characteristics and location of spinal symptoms are clearly defined and that the side lying posture is subclassified.
Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014: a case note review study
Authors: Cross-Sudworth Fiona , Knight Marian , Goodwin Laura , Kenyon Sara
Published: June 2019

Objectives

Local reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews.

Design

Anonymised case notes review.

Participants

All 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012–2014.

Main outcome measures

The number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed.

Results

The care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140).

Conclusions

This systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time.
Research priorities in regional anaesthesia education and training: an international Delphi consensus survey
Authors: Chuan Alwin , Ramlogan Reva
Published: June 2019

Objectives

Education in regional anaesthesia covers several complex and diverse areas, from theoretical aspects to procedural skills, professional behaviours, simulation, curriculum design and assessment. The objectives of this study were to summarise these topics and to prioritise these topics in order of research importance.

Design

Electronic structured Delphi questionnaire over three rounds.

Setting

International.

Participants

38 experts in regional anaesthesia education and training, identified through the American Society of Regional Anesthesia Education Special Interest Group research collaboration.

Results

82 topics were identified and ranked in order of prioritisation. Topics were categorised into themes of simulation, curriculum, knowledge translation, assessment of skills, research methodology, equipment and motor skills. Thirteen topics were ranked as essential research priority, with four topics each on simulation and curriculum, three topics on knowledge translation, and one topic each on methodology and assessment.

Conclusions

Researchers and educators can use these identified topics to assist in planning and structuring their research and training in regional anaesthesia education.
A focused mapping review and synthesis of a priori risk factors associated with medical misconduct
Authors: Croft Edward , Clark Maria Tighe , Efstathiou Nikolaos , Bradbury-Jones Caroline
Published: June 2019

Background

Medical misconduct is an international problem. It is judged according to whether a doctor has endangered the health of the public. Little is known about the risk factors associated with medical misconduct. To inform patient safety, we undertook a focused mapping review and synthesis (FMRS) of tribunal reports retrieved from the Medical Practitioners Tribunal Service (MPTS).

Methods

A four-phase FMRS was undertaken: (1) identification and retrieval of 1-year tribunal transcripts from the MPTS (focus), (2) analysis of transcripts to identify patterns mapped to ‘a priori’ risk factors (mapping), (3) peer review of the data (calibration) and (4) creation of a risk profile (synthesis).

Results

Out of the 351 investigative tribunals, 249 (70.94%) resulted in a guilty verdict. 82.73% of all guilty verdicts led to the removal of the doctor from practice. Through the identification of four a priori risk factors, we developed a model of risk associated with medical misconduct: (1) being male, (2) primary medical qualification (PMQ) outside of the UK, (3) working within general practice and surgical specialties, and (4) having passed PMQ more than 20 years ago. Notable ‘unconfirmed’ factors, such as locum work, PMQ achieved outside of the European Union, increasing age and lack of clinical guidance are also relevant to what is deemed professional behaviour and what is not.

Conclusions

The findings can inform debates about patient safety and lay the groundwork for further research into medical misconduct. Prospective studies should focus on confirming the contributory factors and relationship between these four a priori risk factors for medical misconduct: being male, PMQ outside of the UK, increasing age and working in general practice or surgical settings.
Acupuncture for chemotherapy-induced peripheral neuropathy: a randomised controlled pilot study
Authors: D’Alessandro Eduardo Guilherme , Nebuloni Nagy Daniela Ribeiro , de Brito Christina May Moran , Almeida Elisangela Pinto Marinho , Battistella Linamara Rizzo , Cecatto Rebeca Boltes
Published: June 2019

Chemotherapy-induced peripheral neuropathy (CIPN) can cause loss of independence and poor quality of life (QoL) due to severe disabilities, but in spite of its importance there is still a lack of data for the management of CIPN. Acupuncture has showed promising results and may be a cost-effective option for the treatment.

Objectives

To evaluate the effect of acupuncture treatment on neurological symptoms of CIPN and QoL of oncological patients.

Methods

We performed a clinical, single-centre, randomised and controlled pilot study that involved 33 adult patients with cancer and CIPN randomised into two groups (control and acupuncture treated with 10 sessions, two times per week). Both groups were subjected to a complete physical examination and clinical assessment with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Scale V.2.0, FIM Scale, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) Scale and Visual Analogue Scale for pain before and 5 weeks after treatment.

Results

There were no adverse events, and we found statistical differences in groups in physical (p=0.03) and function (p=0.04) domains of EORTC QLQ-C30 when comparing control and acupuncture groups. About NCI CTCAE Scale and neuropathy sensory symptoms, we found better results in acupuncture group, comparing pretreatment and post-treatment analyses (p=0.01). In control group, we have no differences after 5 weeks (p=0.11).

Conclusion

Although these results suggest an interesting effect of acupuncture on this patient population, the clinical significance has remained unclear. Given the tendency towards benefit and the lack of adverse effects, the authors recommend a follow-up acupuncture trial using higher follow-up time and better sample size.

Trial registration number

NCT02309164.
Automatic recognition of different types of acute leukaemia in peripheral blood by image analysis
Authors: Boldú Laura , Merino Anna , Alférez Santiago , Molina Angel , Acevedo Andrea , Rodellar José
Published: June 2019

Aims

Morphological differentiation among different blast cell lineages is a difficult task and there is a lack of automated analysers able to recognise these abnormal cells. This study aims to develop a machine learning approach to predict the diagnosis of acute leukaemia using peripheral blood (PB) images.

Methods

A set of 442 smears was analysed from 206 patients. It was split into atraining setwith 75% of these smears and atesting setwith the remaining 25%. Colour clustering and mathematical morphology were used to segment cell images, which allowed the extraction of 2,867 geometric, colour and texture features. Several classification techniques were studied to obtain the most accurate classification method. Afterwards, the classifier was assessed with the images of thetesting set. The final strategy was to predict the patient’s diagnosis using the PB smear, and the final assessment was done with the cell images of the smears of thetesting set.

Results

The highest classification accuracy was achieved with the selection of 700 features with linear discriminant analysis. The overall classification accuracy for the six groups of cell types was 85.8%, while the overall classification accuracy for individual smears was 94% as compared with the true confirmed diagnosis.

Conclusions

The proposed method achieves a high diagnostic precision in the recognition of different types of blast cells among other mononuclear cells circulating in blood. It is the first encouraging step towards the idea of being a diagnostic support tool in the future.