bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mechanism of Crater Wear of Cemented Carbide Tools
Authors: Trigger K. J. , Chao B. T.
Published: February 2022

This paper presents an analysis of tool-wear data in terms of fundamental variables consistent with the nature of the contact and rubbing of clean metallic surfaces. Wear of cemented-carbide tools on the top surface is examined in the light of the mechanism of frictional wear as proposed originally by Holm and recently as modified by Burwell, Strang, and Archard. It has been found that wear at the top surface is essentially of the transfer type and that the formation of crater wear is strongly temperature-dependent. For a given tool-work combination, the top face wear can be correlated with tool-chip interface temperature in a manner predictable from the simple laws of adhesion wear in combination with the theory of rate process.
Study of Die Wear by Means of Radioactivated Surfaces
Authors: Jaoul B. J.
Published: February 2022

The recent development of the production of radioactive isotopes has given rise to a number of new techniques which may be applied in several fields of science, especially medicine, biology, chemistry, and mechanics. The study of wear by friction is a very good field for applying radioactivation techniques. Several investigations have been made on gear wear, ram wear, and so on. In these studies, one of the abrading members is radioactive and the products of its wear may be located in the lubricant. In the study of dry friction, e.g, in cylinders, automobile tires, tools, etc., the radioactive particles may be found on the unactivated member. In this paper a particular application is explained—namely, the wear of a die face during the hot extrusion of steels.
Water-Column Separation in Pump Discharge Lines
Authors: Richards R. T.
Published: February 2022

Water-column separation is a common, but rarely discussed, surge phenomenon which may result in serious damage to water-pumping plants. This paper briefly describes the nature of water-column separation, the physical factors which bring it about, and the equipment effective in controlling it. The discussion is illustrated by field test data taken from typical water-pumping plants associated with the cooling-water supply for steam electric stations.
Structural Stability of Modified 12-Chromium Alloys
Authors: Hagel W. C. , Becht E. F.
Published: February 2022

In addition to possessing an attractive combination of mechanical properties for turbine applications, certain modified 12-chromium alloys were found to be structurally stable after long-time static aging and service exposure at high temperatures. However, two precipitation reactions have been observed to occur unpredictably in 12 Cr-Co-W-V alloy. The precipitating phases have been identified, and their effects upon mechanical properties are reported. After about 200 hr at 800 to 950 F (445 to 510 C), precipitation of chromium-rich ferrite causes decreased impact resistance and increased hardness; after about 6000 hr under stress at 950 to 1200 F (510 to 650 C), sigma formation causes an extreme decrease in impact resistance and no significant increase in hardness.
New Techniques in Metal-Cutting Research
Authors: Backer W. R. , Krabacher E. J.
Published: February 2022

Information on newly developed research techniques for studying the metal-cutting process is presented in this paper. Tool-wear and grinding-wheel-wear measurement methods are discussed, and techniques for research into the mechanism of those wear processes are described. New equipment for studies of the mechanics of machining processes, including force measurements and chip-formation analysis, is also described. Representative data are presented to show how research utilizing these techniques contributes to the knowledge of machining principles.
Heat Transfer to, and Temperature Distribution in, a Metal-Cutting Tool
Authors: Rall D. L. , Giedt W. H.
Published: February 2022

An analytical and experimental investigation of heat transfer to, and the resulting temperature distribution in, a metal-cutting tool during orthogonal cutting is described. A rectangular parallelepiped-shaped tool is postulated and a product solution developed for the temperature distribution under the conditions of a continuous uniform release of heat over the tool-chip contact area and heat loss from each side arbitrarily specified. To test the validity of this solution two high-speed lathe tools with 0-deg and 15-deg back-rake angles were uniquely instrumented with thermocouples located in the tool bodies at selected distances from the cutting edges. Representative temperature records obtained during dry orthogonal cutting of SAE 1020 steel with these tools are presented. Extrapolation of temperature measurements to the center of the tool-chip contact area gave values for the average tool-chip interface temperatures which agree quite closely with results of other investigators. Average heat rates to the tools are determined and the applicability of the product solution is discussed.
Closed Systems for Testing Compressors
Authors: Johnson R. M.
Published: February 2022

The closed system is discussed in its broad applications to the shop testing of centrifugal and displacement compressors. The essential requirements for the design and operation of test systems to use various gases are reviewed. Instrumentation and procedures necessary to meet the ASME Power Test Code standards of accuracy are considered in detail. Suggestions are made for code revisions needed to bring closed-system testing more fully within the scope of the test codes.
Effect of Turbine-Blade Cooling on Efficiency of a Simple Gas-Turbine Power Plant
Authors: Rohsenow W. M.
Published: February 2022

The efficiency of a simple gas-turbine cycle can be increased by designing it to operate at higher turbine-inlet temperatures. In order to operate these turbines at higher temperatures it is necessary to cool the blades and possibly the casing and rotors in the earlier stages until the gases are reduced to a value between 1000 and 1500 F depending on the kind of metal employed. Various methods of cooling turbine blades have been investigated by the NACA and published in various unclassified technical reports since 1947. A survey of some of this work is presented by Ellerbrock (1). The present work is an investigation of the effects of blade cooling on the thermodynamic performance of a simple gas-turbine plant. A companion paper (9) extends the present analysis to include the effect of cooling-system losses.
Synonymy of Quadraseta brennani Goff & Whitaker, 1984 with Quadraseta antillarum (Brennan, 1967) (Trombidiformes: Trombiculidae)
Authors: Huang-Bastos Matheus , Arbex Rafaela Luiza , Bassini-Silva Ricardo , Welbourn Cal , Ochoa Ron , Jacinavicius Fernando De Castro , Barros-Battesti Darci Moraes
Published: February 2022

Chiggers are ectoparasites of vertebrates and can cause trombiculiasis or transmit pathogens to their hosts. In the Neotropical region, the genus Quadraseta Brennan includes 16 valid species. Quadraseta antillarum (Brennan) and Quadraseta brennani (Goff & Whitaker), are morphologically identical and we propose the synonymy of Q. brennani with Q. antillarum, based on examination of both type series. The little big-eared bat, Micronycteris megalotis Gray from Venezuela is recorded as a new host.
Concurrent Validity of a Continuous Glucose-Monitoring System at Rest and During and Following a High-Intensity Interval Training Session
Authors: Clavel Pauline , Tiollier Eve , Leduc Cédric , Fabre Marina , Lacome Mathieu , Buchheit Martin
Published: February 2022

Purpose: To assess the concurrent validity of a continuous blood-glucose-monitoring system (CGM) postbreakfast, preexercise, exercise, and postexercise, while assessing the impact of 2 different breakfasts on the observed level of validity. Methods: Eight nondiabetic recreational athletes (age = 30.8 [9.5] y; height = 173.6 [6.6] cm; body mass = 70.3 [8.1] kg) took part in the study. Blood glucose concentration was monitored every 10 minutes using both a CGM (FreeStyle Libre, Abbott, France) and finger-prick blood glucose measurements (FreeStyle Optimum) over 4 different periods (postbreakfast, preexercise, exercise, and postexercise). Two different breakfasts (carbohydrates [CHO] and protein oriented) over 2 days (2 × 2 d in total) were used. Statistical analyses included the Bland–Altman method, standardized mean bias (expressed in standardized units), median absolute relative difference, and the Clarke error grid analysis. Results: Overall, mean bias was trivial to small at postbreakfast (effect size ± 90% confidence limits: −0.12 ± 0.08), preexercise (−0.08 ± 0.08), and postexercise (0.25 ± 0.14), while moderate during exercise (0.66 ± 0.09). A higher median absolute relative difference was observed during exercise (13.6% vs 7%–9.5% for the other conditions). While there was no effect of the breakfast type on the median absolute relative difference results, error grid analysis revealed a higher value in zone D (ie, clinically unsafe zone) during exercise for CHO (10.5%) compared with protein (1.6%). Conclusion: The CGM device examined in this study can only be validly used at rest, after both a CHO and protein-rich breakfast. Using CGM to monitor blood glucose concentration during exercise is not recommended. Moreover, the accuracy decreased when CHO were consumed before exercise.
Professional Development for Early Career DBER Scholars through In-Person and Virtual Career Panel Workshops
Authors: Musgrove Miranda M. Chen , Genné-Bacon Elizabeth , Gray Kelsey , Heim Ashley B. , Karippadath Anupriya , Magalhães Rita Margarida , Tripp Brie , Zelaya Anna J.
Published: February 2022

In discipline-based education research (DBER), early career scholars, such as graduate students and postdoctoral researchers, observe a slew of possible career pathways. Yet, there is a lack of opportunities to learn about such pathways, particularly when transitioning from traditional science, technology, engineering, or math (STEM) disciplinary training into a DBER position.
Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial
Authors: Gadjradj Pravesh S , Rubinstein Sidney M , Peul Wilco C , Depauw Paul R , Vleggeert-Lankamp Carmen L , Seiger Ankie , van Susante Job LC , de Boer Michiel R , van Tulder Maurits W , Harhangi Biswadjiet S
Published: February 2022

Objective

To assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar disc herniation.

Design

Multicentre randomised controlled trial with non-inferiority design.

Setting

Four hospitals in the Netherlands.

Participants

613 patients aged 18-70 years with at least six weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 patients receiving PTED who were the learning curve cases performed by surgeons who did not do PTED before the trial.

Interventions

PTED (n=179) compared with open microdiscectomy (n=309).

Main outcome measures

The primary outcome was self-reported leg pain measured by a 0-100 visual analogue scale at 12 months, assuming a non-inferiority margin of 5.0. Secondary outcomes included complications, reoperations, self-reported functional status as measured with the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery. Outcomes were measured until one year after surgery and were longitudinally analysed according to the intention-to-treat principle. Patients belonging to the PTED learning curve were omitted from the primary analyses.

Results

At 12 months, patients who were randomised to PTED had a statistically significantly lower visual analogue scale score for leg pain (median 7.0, interquartile range 1.0-30.0) compared with patients randomised to open microdiscectomy (16.0, 2.0-53.5) (between group difference of 7.1, 95% confidence interval 2.8 to 11.3). Blood loss was less, length of hospital admission was shorter, and timing of postoperative mobilisation was earlier in the PTED group than in the open microdiscectomy group. Secondary patient reported outcomes such as the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery, were similarly in favour of PTED. Within one year, nine (5%) in the PTED group compared with 14 (6%) in the open microdiscectomy group had repeated surgery. Per protocol analysis and sensitivity analyses including the patients of the learning curve resulted in similar outcomes to the primary analysis.

Conclusions

PTED was non-inferior to open microdiscectomy in reduction of leg pain. PTED resulted in more favourable results for self-reported leg pain, back pain, functional status, quality of life, and recovery. These differences, however, were small and may not reach clinical relevance. PTED can be considered as an effective alternative to open microdiscectomy in treating sciatica.

Trial registration

NCT02602093ClinicalTrials.gov
NCT02602093
.
Effect of alcohol consumption on haemoglobin level among non-pregnant reproductive age women in Ethiopia: a cross-sectional secondary data analysis of the 2016 Ethiopian Demographic Health Survey
Authors: Diress Gedefaw , Endalifer Melese Linger
Published: February 2022

Objective

The aim of this study was to assess the effect of alcohol consumption on haemoglobin levels among non-pregnant reproductive age women using national representative data.

Method

A secondary data analysis was conducted using data from the 2016 Ethiopia Demographic and Health Survey. The main outcome of interest was anaemia defined as a haemoglobin value <12 g/which was measured using HemoCue, and adjusted for both altitude and smoking status. The main exposure variable was alcohol consumption. Both multivariable logistic regression and generalised linear model were employed to assess the association between alcohol consumption and anaemia and to compare the mean of haemoglobin between the non-drinkers and three alcohol consumption frequency categories, respectively, after adjusting for the potential confounders.

Result

In the current analysis, a total of 13 436 non-pregnant women were included. The overall prevalence of anaemia among non-pregnant women was 23.2% of which 17.9% were mildly anaemic, 4.6% were moderately anaemic and 0.7% were severely anaemic. There was a significant negative association between anaemia and respondents’ history and frequency of alcohol consumption in the pooled sample. Among non-pregnant women, the odds of having anaemia were decreased with a history of alcohol drinking (adjusted OR (AOR)=0.32 (95% CI: 0.214 to 0.394)). Women who drunk alcohol less than once a week ((AOR=0.54 (95% CI: 0.31 to 0.94), those who drunk alcohol at least once a week (AOR=0.50 (95% CI: 0.28 to 0.88)) and who drunk alcohol almost every day in the last 12 months (AOR=0.42 (95% CI: 0.21 to 0.81)) had significantly lower odds of having anaemia than women who had not ever taken a drink that contain alcohol.

Conclusion

This study showed that nearly a quarter of non-pregnant women in Ethiopia were found to be anaemic. Alcohol consumption increases haemoglobin concentration. Further cohort or experimental studies are therefore needed to further assess the relationship between alcohol consumption and haemoglobin level among Ethiopian populations.
Associations between antenatal maternal diet and other health aspects with infant temperament in a large multiethnic cohort study: a path analysis approach
Authors: Schoeps Anja , Gontijo de Castro Teresa , Peterson Elizabeth R , Wall Clare , D'Souza Stephanie , Waldie Karen E , Morton Susan
Published: February 2022

Objectives

The aim of this study was to assess the association of antenatal maternal dietary patterns (DPs) and other health aspects with infant temperament in a large multiethnic cohort, taking maternal personality and prenatal stress into account.

Design and methods

Using data from 3968 children born in 2009/2010 and their mothers from the Growing Up in New Zealand cohort, infant temperament was assessed at 9 months using the Infant Behavior Questionnaire-Revised Very Short Form. Maternal antenatal diet and other health aspects were assessed antenatally. Maternal DPs (n=4) were derived using principal components analysis based on food intake reported on a 44-item food frequency questionnaire. Path analyses investigated factors associated with infant temperament, namely maternal personality, prenatal maternal stress, DPs and other health aspects, including potential inter-relations and mediating effects.

Results

Women who scored higher in the fusion DP (standardised beta (β)=0.05; 95% CI 0.02 to 0.09) and healthy DP (β=0.05; 95% CI 0.02 to 0.09), who exercised more (β=0.04; 95% CI 0.01 to 0.07), and who drank less alcohol (β=−0.05; 95% CI −0.08 to –0.02) were more likely to have infants with an overall less difficult temperament. Sex-specific differences were found in the associations between maternal DP and infant temperament. Maternal personality and prenatal stress were significantly associated with all dimensions of infant temperament. The strongest predictors for a more difficult temperament were prenatal stress (β=0.12; 95% CI 0.08 to 0.15) and the personality dimensions neuroticism (β=0.10; 95% CI 0.07 to 0.14) and extraversion (β=−0.09; 95% CI −0.12 to –0.06).

Conclusions

Associations of antenatal maternal diet and health aspects with infant temperament were statistically significant but small. While they should not be overinterpreted as being deterministic, the findings of this study support the link between maternal modifiable health-related behaviours and infant temperament outcomes.
Comparing ivWatch biosensor to standard care to identify extravasation injuries in the paediatric intensive care: a protocol for a randomised controlled trial
Authors: McBride Craig Antony , Rahiman Sarfaraz , Schlapbach Luregn J , Schults Jessica A , Kleidon Tricia M , Kennedy Melanie , Paterson Rebecca S , Byrnes Joshua , Ware Robert S , Ullman Amanda Judith
Published: February 2022

Introduction

Peripheral intravenous catheters (PIVCs) frequently fail during therapy administration, resulting in infusates pooling in the surrounding tissue. These extravasation injuries can cause significant pain, tissue destruction and scarring. ivWatch is a biosensor that uses visible and near-infrared light to measure tissue changes surrounding the PIVC and alert clinicians when extravasation may occur. The effectiveness of ivWatch, in comparison to clinical observation, in decreasing injury severity is unknown. The present study aims to investigate whether using ivWatch may potentially detect injury earlier and decrease the severity of PIVC extravasation injuries.

Methods and analysis

A single centre, parallel group, open-label superiority randomised controlled trial comparing (a) standard care (clinical observation) to (b) ivWatch monitoring in addition to standard care, to decrease the severity of extravasation injuries. 200 children with PIVCs inserted in the distal half of the limb, receiving intermediate-risk to high-risk infusates for ≥24 hours, will be consecutively recruited at a paediatric intensive care unit in Queensland, Australia. The primary outcome is extravasation severity, measured by the Cincinnati Children’s Extravasation Harm Scale. Secondary outcomes include severity assessed with three-dimensional camera imaging, extravasation volume, treatment sequelae, the number of PIVCs used and dwell time, quality of life and healthcare costs. The between treatment difference in extravasation severity will be compared using ordinal logistic regression, with the treatment group included as the main effect, and reported with corresponding 95% CIs. Estimates of value will be presented as net monetary benefits and cost per reduction in extravasation injury severity, both presented with corresponding 95% credible intervals.

Ethics and dissemination

This study received approval from the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (reference number: HREC/20/QCHQ/60867) and the Griffith University HREC (reference number: 2020/310) and will be disseminated via peer-reviewed publications and conference presentations.

Trial registration number

ACTRN12620000317998.
Comparative efficacy and safety of oral anticoagulants for the treatment of venous thromboembolism in the patients with different renal functions: a systematic review, pairwise and network meta-analysis
Authors: Su Xiaole , Yan Bingjuan , Wang Lihua , Cheng Hong , Chen Yipu
Published: February 2022

Objectives

To compare the efficacy and safety of direct oral anticoagulants (DOACs) in patients with venous thromboembolism (VTE) and different renal functions.

Design

Systematic review containing pairwise and Bayesian network meta-analysis of randomised controlled trials (RCTs).

Data sources

MEDLINE, EMBASE and Cochrane Library.

Eligibility criteria

RCTs reporting the efficacy and safety outcomes of DOACs in different creatinine clearance (CrCl) subgroups.

Data extraction and synthesis

Data extraction and quality assessment were undertaken by two independent reviewers. Data were pooled using the DerSimonian-Laird method in pairwise meta-analysis. Network meta-analysis within a Bayesian framework was conducted.

Results

Data from 10 RCTs were included. In the treatment of acute VTE, DOACs did not significantly reduce recurrent VTE or VTE-related death (OR, 0.96; 95% CI, 0.82 to 1.11) but significantly reduced bleeding events (0.76, 0.68 to 0.90) compared with warfarin. In the extended treatment of VTE, DOACs produced significant benefits in recurrent VTE or VTE-related death (0.23, 0.16 to 0.29), but significantly increased bleeding events (1.86, 1.04 to 3.33) compared with placebo/aspirin. There were no significant differences in efficacy and safety of DOACs among the three CrCl stratified subgroups in acute and extended treatment of VTE (p for subgroup heterogeneity >0.1). Bayesian network meta-analysis suggested that apixaban 2.5 mg and 5 mg two times per day were associated with a lower risk of bleeding than dabigatran, rivaroxaban, warfarin and aspirin in the subgroup with CrCl >80 mL/min.

Conclusions

For the treatment of acute VTE, DOACs are similar to warfarin in reducing recurrent VTE and VTE-related death but are significantly superior to warfarin in reducing the risk of bleeding. For the efficacy and safety of DOACs across different CrCl stratifications (30–50, 50–80 and more than 80 mL/min), no significant difference was found. In light of minimal evidence, apixaban might be associated with a lower risk of bleeding in patients with VTE and CrCl >80 mL/min.

PROSPERO registration number

CRD42018090896.
Culture and understanding the role of feedback for health professions students: realist synthesis protocol
Authors: Fullerton Paul Douglas , Sarkar Mahbub , Haque Shamsul , McKenzie Wendy
Published: February 2022

Introduction

Clinical education has moved to a ‘competency-based’ model with an emphasis on workplace-based learning and assessment which, in turn, depends on feedback to be effective. Further, the understanding of feedback has changed from information about a performance directed to the learner performing the task, to a dialogue, which enables the learner to act and develop.

In health professional education, feedback is a complex interaction between trainee, supervisor and the healthcare system. Most published research on feedback in health professional education originates in Europe and North America. Our interest is on the impact of Culture on this process, particularly in the context of Asian cultures.

The (scientific) realist approach of Pawson and Tilley provides a means to examine complex interventions in social situations, and thus is an appropriate lens to use for this study. This is a protocol for a realist synthesis which asks how, why and in what circumstances do Asian Cultures influence health professional trainees to seek, respond to and use feedback given in the clinical environment, if at all.

Methods and analysis

An initial search was performed to help define the scope of the review question and develop our initial programme theory. The formal electronic search was carried out in February 2020 and included: CINAHL, ERIC, Medline and PsycInfo, and repeated in October 2020. Retrieved articles were imported into Covidence for screening and data extraction, after which components of the Context–Mechanisms–Outcomes configurations will be sought to refine the initial programme theory.

Ethics and dissemination

As this study is a literature review, ethics approval is not required.

The findings will be documented in line with the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) publications standards for Realist syntheses, and we plan to disseminate the findings by means of a peer-reviewed journal article and conference presentation(s).
Psychological distress of frontline healthcare workers in the intensive care unit during the early stage of the COVID-19 pandemic: a qualitative study from China
Authors: Yin Zhao , Zhang Wan , Jia Xuedong , Wang Xiaojuan , Hao Jie , Yang Yantao , Zhang Xiaojian , Du Shuzhang , Yue Xiaohong
Published: February 2022

Objective

The rapid spread of COVID-19 has overwhelmed healthcare systems across the world. During the early stage of the pandemic, frontline healthcare workers (FHWs) caring for patients at intensive care units (ICUs) faced extreme pressure and challenges. This qualitative study aimed to describe the different phases of psychological distress of FHWs during the early stage of the COVID-19 pandemic.

Design

Qualitative study.

Setting

The First Affiliated Hospital of Zhengzhou University, a designated hospital for patients with COVID-19 in central China.

Participants

Eight physicians and six nurses working in the ICU who provided direct patient care for COVID-19 patients.

Methods

A descriptive phenomenological study using thematic analysis was applied. Semi-structured one-on-one interviews over telephone or Wechat (a social platform in China) rather than face-to-face interviews were conducted due to quarantine. Interviews were audio-recorded and transcribed verbatim and then were analysed thematically.

Findings

A total of 14 interviews were conducted, and each interview lasted 20–60 min. Five thematic categories were identified, and the participants’ psychological experiences were classified into five stages (1) the mobilisation period: a sense of responsibility with worries; (2) the preparation period: worries, fears and doubts about the epidemic; (3) the transitional period: complex and diverse psychological feelings; (4) the adaptation period: self-adjustment and help from external support and (5) the reflection period: a reflection on life and nature.

Conclusion

The study showed that the COVID-19 pandemic had significant psychological impacts on FHWs. Self-regulation and external support help FHWs to overcome challenges to a certain extent. More attention should be paid to the psychological wellbeing of ICU FHWs in COVID-19-designated hospitals.
Do difficulties in emotional processing predict procedure pain and shape the patient’s colonoscopy experience?
Authors: Pontone Stefano , Lauriola Marco , Palma Rossella , Panetta Cristina , Tomai Manuela , Baker Roger
Published: February 2022

Objectives

Pain and fear of colonoscopy are inter-related; they make the colonoscopy experience unpleasant and impede adherence to colorectal cancer screening and prevention campaigns. According to previous research, fear and pain have been found to depend on patients’ maladaptive cognitions and exaggerated emotional responses. The present study investigated whether emotional processing difficulties predicted colonoscopy pain and the associated catastrophising thoughts.

Design

Prospective, observational, blinded.

Method

A sample of 123 patients was assessed for specific emotional processing difficulties (ie, suppression of emotions, unprocessed emotions, failure to control emotions, avoidance of emotional triggers and impoverished emotional experience) and anxiety-related variables (ie, worry, anxiety and depression) before colonoscopy. A trained medical doctor rated patients’ behavioural manifestations of pain during colonoscopy. After complete recovery from sedation, the patients rated the endoscopy experience using perceived pain and situation-specific pain catastrophising scales.

Results

About half of the patients were above the cut-off for anxiety before the procedure. Notwithstanding sedation, behavioural manifestations of pain during colonoscopy indicated probable or moderate pain for about one-third of the patients. Failure to control emotions, poor emotional experience and avoiding emotional triggers were positively correlated with behavioural manifestations of pain, self-reported pain and pain catastrophising. Regression analyses, controlling for gender, age, colonoscopy experience and sedation, revealed that avoidance of emotional triggers uniquely contributed to predicting pain outcomes.

Conclusions

Early identification of emotional processing difficulties associated with pain catastrophising can help define personalised psychological preparation paths to manage negative emotions in patients who fear colonoscopy pain.
Off-label indications of aspirin in gynaecology and obstetrics outpatients at two Chinese tertiary care hospitals: a retrospective cross-sectional study
Authors: Shen Sijie , Yang Jianhui , Chen Yao , Xie Jingxian , Huang Yanni , Lin Wubin , Liao Yufang
Published: February 2022

Objective

To investigate the prevalence of off-label aspirin indications and the level of scientific support for off-label indications of aspirin in gynaecology and obstetrics outpatients.

Design

A retrospective cross-sectional study.

Setting

Two tertiary hospitals (a general hospital and a women and children’s specialised hospital) in Xiamen, a city located on the southeastern coast of China.

Participants

A total of 4257 prescriptions were included for 2091 female patients aged >18 who visited the gynaecology and obstetrics outpatient clinics and received aspirin treatment.

Outcome measures

The primary measure of this study was the proportion of off-label indications and of off-label indications supported by strong scientific evidence. Evidence from clinical guidelines and Micromedex is shown using descriptive statements. On-label indications of drugs in the same class as aspirin were also referred to for off-label aspirin use without strong evidence support.

Results

All indications of aspirin on outpatient prescriptions were determined as off-label use in this study. The most frequent off-label indication was recurrent miscarriage (2244 prescriptions, 52.71%). Totally, 30.94% of the prescriptions were supported by strong evidence for indications, including recurrent miscarriage with antiphospholipid syndrome and prophylaxis for pre-eclampsia. No drugs in the same class as aspirin had on-label indications for off-label aspirin use without strong evidence support.

Conclusions

This study demonstrated that all indications of aspirin used in gynaecology and obstetrics outpatients at the two tertiary hospitals were off-label and not always supported by strong evidence, implicating that physicians should be cautious when issuing off-label prescriptions. More original clinical research on off-label aspirin use is needed to provide reference for routine clinical practice.
Challenges associated with e-cigarette use by people in custody in Scottish prisons: a qualitative interview study with prison staff
Authors: O'Donnell Rachel , Brown Ashley , Eadie Douglas , Mitchell Danielle , Bauld Linda , Demou Evangelia , Purves Richard , Sweeting Helen , Hunt Kate
Published: February 2022

Objectives

Little is known about the perspectives of staff working in prisons where e-cigarettes are permitted. Scotland now permits people in custody (PiC), but not staff/visitors to use e-cigarettes, following implementation of smoke-free prisons policy in 2018. Previous studies, conducted before and immediately after the introduction of e-cigarettes in Scottish prisons, have evidenced stakeholder support for their use by PiC. This study focuses on key challenges associated with e-cigarette use in prisons, using data collected from prison staff once e-cigarettes had been allowed in a smoke-free environment for 6–9 months.

Setting

Five prisons in Scotland.

Participants

Sixteen qualitative interviews were conducted with prison staff from five prisons varying by population (sex, age and sentence length). Data were managed and analysed using the framework approach.

Results

While these staff confirmed strong support for the smoke-free prison policy and reported some benefits of replacing tobacco with e-cigarettes, they also spoke of the challenges e-cigarettes pose. These included: workplace e-cigarette vapour exposures; perceptions that e-cigarettes provide a new, effective way for some PiC to take illegal drugs, particularly new psychoactive substances; organisational challenges relating to the value attached to e-cigarettes in prisons; and implications for long-term nicotine use and tobacco cessation. Staff anticipated difficulties in tightening restrictions on e-cigarette use by PiC given its scale and significance among this population.

Conclusions

Maximising the benefits of e-cigarette use by PiC is likely to require multiple measures to support effective and safe use and e-cigarette reduction/cessation where desired. This includes monitoring any misuse of e-cigarettes, and provision of guidance and support on appropriate e-cigarette use and how to limit or quit use if desired. Findings are relevant to jurisdictions considering or planning changes in prison smoking or vaping policies.
Missed opportunities in hypertension risk factors screening in Indonesia: a mixed-methods evaluation of integrated health post (POSBINDU) implementation
Authors: Widyaningsih Vitri , Febrinasari Ratih Puspita , Pamungkasari Eti Poncorini , Mashuri Yusuf Ari , Sumardiyono Sumardiyono , Balgis Balgis , Koot Jaap , Landsman-Dijkstra Jeanet , Probandari Ari
Published: February 2022

Objectives

To assess the implementation and contextual barriers of POSBINDU, a community-based activity focusing on screening of non-communicable diseases (NCDs), mainly hypertension and diabetes, in Indonesia.

Design

This was a concurrent mixed-methods study, with a cross-sectional analysis of secondary data and focus group discussions (FGDs) on stakeholder of POSBINDU.

Setting

The study was conducted in seven districts in three provinces in Indonesia, with approximately 50% of the primary healthcare (PHC) were selected as areas for data collection (n PHC=100).

Participants

From 475 POSBINDU sites, we collected secondary data from 54 224 participants. For the qualitative approach, 21 FGDs and 2 in-depth interviews were held among a total of 223 informants.

Primary outcomes and measures

Proportion of POSBINDU visitors getting the hypertension screening and risk factors’ assessment, and barriers of POSBINDU implementation.

Results

Out of the 114 581 POSBINDU visits by 54 224 participants, most (80%) were women and adults over 50 years old (50%) showing a suboptimal coverage of men and younger adults. Approximately 95.1% of visitors got their blood pressure measured during their first visit; 35.3% of whom had elevated blood pressure. Less than 25% of the visitors reported to be interviewed for NCDs risk factors during their first visit, less than 80% had anthropometric measurements and less than 15% had blood cholesterol examinations. We revealed lack of resources and limited time to perform the complexities of activities and reporting as main barrier for effective hypertension screening in Indonesia.

Conclusions

This study showed missed opportunities in hypertension risk factors screening in Indonesia. The barriers include a lack of access and implementation barriers (capability, resources and protocols).
Epidemiological and outcome analysis of COVID-19-associated pneumothorax: multicentre retrospective critical care experience from Qatar
Authors: Akram Jaweria , Yousaf Zohaib , Alabbas Yasir , Almoyaaf Mustafa Ibrahim Abdullah , Ibrahim Abdus Salam Saif , Kharma Nadir
Published: February 2022

Objectives

To study the incidence, characteristics, treatment, associated risk factors and outcome of COVID-19-associated pneumothorax in intensive care unit (ICU).

Design

Retrospective observational data review.

Setting

A multicentre study from ICUs of three tertiary care hospitals in Qatar.

Participants

1788 patients with COVID-19 pneumonia requiring ICU admission from 1 March 2020 to 1 November 2020 were enrolled in this study.

Interventions

Not applicable.

Primary and secondary outcome measures

The primary endpoint was to identify the incidence of COVID-19-associated pneumothorax in patients requiring ICU admission. Secondary endpoints were to determine the associated risk factors, treatment, mortality and morbidity.

Results

1788 patients from 3 centres were reviewed in the study. The total episodes of pneumothorax were 75. Pneumothorax occurred in 4.2% of the patients with COVID-19 pneumonia requiring ICU admission. The majority of the subjects were male (n=72, 96%). The mean age was 55.1 (±12.7 years). The majority of the subjects were nationals of South Asian countries and the Middle East and North Africa regions. 52% (n=39) of the patients were previously healthy without comorbidities before ICU admission. The recurrence rate was 9.3%. The median length of ICU stay was 28 days (20.5–45.8 days). After developing pneumothorax, the length of mechanical ventilation ranged from 6 to 32 days, with a median of 13 days. 44% of patients eventually ended up with tracheostomy. In-hospital mortality in the patients with COVID-19-related pneumothorax was 53.3% (n=40). The odds of mortality in patients with COVID-19 pneumonia with pneumothorax is 7.15 (95% CI 4.45 to 11.48, p<0.0001) compared with those who did not develop pneumothorax. This indicates pneumothorax is a potential independent risk factor associated with mortality in patients with COVID-19 pneumonia requiring ICU admission.

Conclusions

Pneumothorax is a common complication in patients with COVID-19 requiring ICU admission, associated with poor prognosis and outcome.

Trial registration number

The study was approved by the Medical Research Centre (MRC) Qatar. (MRC-01-20-1116).
PrEP distribution in pharmacies: a systematic review
Authors: Kennedy Caitlin E , Yeh Ping Teresa , Atkins Kaitlyn , Ferguson Laura , Baggaley Rachel , Narasimhan Manjulaa
Published: February 2022

Introduction

Novel mechanisms of service delivery are needed to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Providing PrEP directly through pharmacies could offer an additional option for reaching potential users.

Methods

We conducted a systematic review of studies examining effectiveness, values and preferences of end users and health workers, and cost of PrEP initiation and continuation through pharmacies (pharmacy access). We searched PubMed, CINAHL, LILACS and EMBASE through 2 December 2020. We also searched clinical trial registries and recent HIV conference abstracts. Standardised methods were used to search, screen and extract data from included studies.

Results

No studies met the inclusion criteria for the effectiveness review, for either PrEP initiation or continuation. However, six ‘case studies’ presenting non-comparative data from PrEP pharmacy programmes demonstrated feasibility of this model in the USA. Eleven studies reported values and preferences of end users and health workers. In the USA, Kenya and South Africa, potential PrEP clients generally supported pharmacy access, although some preferred clinics. One study of PrEP pharmacy clients found all would ‘definitely recommend’ the programme. Six studies found pharmacists were generally supportive of offering PrEP; one study including doctors found more limited favour, while one study of diverse Kenyan stakeholders found broad support. Three studies reported cost data indicating client willingness to pay in the USA and Kenya and initial sustainability of a clinic financial model in the USA.

Conclusion

Provision of PrEP through pharmacies has been demonstrated to be feasible in the USA and acceptable to potential end users and stakeholders in multiple settings. Limited evidence on effectiveness and requirements for laboratory testing and assurance of high-quality services may limit enthusiasm for this approach. Further research is needed to determine if pharmacy access is a safe and effective way to help achieve global HIV prevention goals.

PROSPERO registration number

CRD42021231650.
Readiness of healthcare providers for e-hospitals: a cross-sectional analysis in China before the COVID-19 period
Authors: Li Peiyi , Luo Yunmei , Yu Xuexin , Mason Elizabeth , Zeng Zhi , Wen Jin , Li Weimin , Jalali Mohammad S
Published: February 2022

Objectives

The growth and development of smartphones and eHealth technologies have enabled the potential for extended care hospitals (e-hospitals) in China in order to facilitate the success of a primary healthcare centre (PHC)-based integrated delivery model. Although the adoption of e-hospitals is essential, few studies have directed their research towards understanding the perspectives of healthcare providers. This study aims to identify the current readiness of healthcare providers to adopt e-hospital technologies, determine the factors influencing this adoption and describe the perceived facilitators and barriers in regard to working at e-hospitals.

Design

A cross-sectional study conducted in Sichuan, China, between June and September 2019.

Settings

Information was collected from healthcare providers who have more than 3 years of work experience from a tertiary hospital, secondary hospital, PHCs and private hospital.

Participants

2298 medical professionals were included in this study.

Outcome measure

This study included a self-administered questionnaire that was used to assess participants’ sociodemographic characteristics, online medical practices, willingness to use e-hospitals and perceived facilitators/barriers to working at e-hospitals. Multivariate regression analysis was performed in order to evaluate the independent factors associated with e-hospital work.

Results

Overall, 86.3% had a positive response towards working at e-hospitals. Age (p<0.05), familiarity with e-hospitals (p<0.001) and prior work practices in online healthcare settings (p<0.001) were associated with participants’ readiness to work at e-hospitals. Gender, education level, professional level, the tier of their affiliated hospital and workload were not statistically associated. Healthcare providers who had positive attitudes towards e-hospitals considered improved efficiency, patient satisfaction, communication among physicians, increased reputation and income, and alleviated workload to be advantages of adoption. The participants who were unwilling to work at e-hospitals perceived lack of time, insufficient authenticity/reliability and underdeveloped policies as potential barriers.

Conclusion

Improving operative proficiency in electronic devices, accommodating to work schedules, increasing familiarity with e-hospitals and regulating practices will improve the readiness of healthcare providers to work at e-hospitals.
Improving birth preparedness and complication readiness in rural India through an integrated microfinance and health literacy programme: evidence from a quasi-experimental study
Authors: Ahmad Danish , Mohanty Itismita , Niyonsenga Theophile
Published: February 2022

Objective

Recently, a novel community health programme—the integrated microfinance and health literacy (IMFHL) programme was implemented through microfinance-based women’s only self-help groups (SHGs) in India to promote birth preparedness and complication readiness (BPCR) to improve maternal health. The study evaluated the impact of the IMFHL programme on BPCR practice by women in one of India’s poorest states—Uttar Pradesh—adjusting for the community, household and individual variables. The paper also examined for any diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in programme villages.

Design

Quasi-experimental study using cross-sectional survey data.

Settings

Secondary survey data from the IMFHL programme were used.

Participants

Survey data were collected from 17 244 women in households with SHG member and non-member households in rural India.

Primary outcomes

Multivariable logistic regression was used to estimate main and adjusted IMFHL programme effects on maternal BPCR practice in their last pregnancy.

Results

Membership in SHGs alone is positively associated with BPCR practice, with 17% higher odds (OR=1.17, 95% CI 1.07 to 1.29, p<0.01) of these women practising BPCR compared with women in villages without the programmes. Furthermore, the odds of practising complete BPCR increase to almost 50% (OR=1.48, 95% CI 1.35 to 1.63, p<0.01) when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members when the health literacy component was integrated into the SHG model.

Conclusions

The results suggest that SHG membership exerts a positive impact on planned health behaviour and a diffusion effect of BPCR practice from members to non-members when SHGs are enriched with a health literacy component. The study provides evidence to guide the implementation of community health programmes seeking to promote BPCR practise in low resource settings.
Randomised controlled trial of a web-based low carbohydrate diet intervention for adults with type 2 diabetes: the T2Diet study protocol
Authors: Dening Jedha , George Elena S , Ball Kylie , Mohebbi Mohammadreza , Shariful Islam Sheikh Mohammed
Published: February 2022

Introduction

Type 2 diabetes (T2D) management frequently involves a multidisciplinary care team. However, standard care for patients with T2D is the central role of the general practice physician, and consists of routine appointments to monitor glycaemic status and overall health. Dietary modification is an essential component of T2D management. Evidence suggests that a low carbohydrate diet (LCD) provides better clinical outcomes for people with T2D compared with other diets. However, providing dietary support in face-to-face settings is challenged by issues of availability and accessibility. Provided in conjunction with standard care, digital interventions can help bridge this gap. The objective of this paper is to describe the protocol of a randomised controlled trial (RCT) of a web-based intervention that will evaluate the effectiveness of standard care plus web-based LCD intervention when compared with standard care only.

Methods and analysis

In a two-arm parallel RCT, 100 adults with non-insulin-dependent T2D aged between 40 and 89 years will be randomised to either a theoretically informed 16-week automated web-based LCD intervention plus standard care or standard care only. LCD recommendations emphasise consuming nutrient-dense whole foods and encourage a daily carbohydrate goal of 50–100 g, with an objective of achieving 10% to <26% carbohydrates from total energy intake. Assessments will take place at baseline and 16 weeks. The primary outcome will be haemoglobin A1c. Additional data collected will include dietary intake, self-efficacy, weight and height, anti-diabetes medication and dosages, and diabetes-related comorbidities. Process evaluation will consist of a mixed-methods assessment of website engagement metrics, user experience and participants’ perspectives.

Ethics and dissemination

All study procedures have been approved by the Deakin University Human Research Ethics Committee (2020-349). Study findings will be disseminated widely through public, professional and academic presentation and publication.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12621000096853).