bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatigue Assessment and Monitoring of a Dented Pipeline Specimen
Authors: Freire J. L. F. , Paiva V. E. L. , Gonzáles G. L. G. , Vieira R. D. , Maneschy J. E. , D’Almeida A. L. F. S. , Ribeiro A. S.
Published: November 2019

The present paper reports initial results from an investigation program launched with the objective of presenting combinations of analytical, experimental and numerical methods to predict and monitor fatigue initiation and fatigue damage progression in equipment such as pressure vessels, tanks, piping and pipelines with dents or complex shaped anomalies. The monitoring of fatigue initiation and propagation in the actual specimens used nondestructive infrared inspection techniques. Thermoelasticity stress analysis (TSA), three-dimensional digital image correlation (3D-DIC) and fiber optic Bragg strain gages (FBSG) were used to determine strains at fatigue hot spots locations. Strain fields determined from the experimental measurements and from finite element analysis (FEA) were combined with the fatigue Coffin-Manson strain-life equation and the Miner’s fatigue damage rule to predict fatigue life (Nc). Results from one tested 3 m long tubular specimen containing a complex shaped dent are reported and fully analyzed.
Development of Optimized Welding Consumable for Joining Type 410 Martensitic Stainless Steel
Authors: Lawson Benjamin J. , Alexandrov Boian T. , Bundy Joseph C. , Benson David , Penso Jorge A.
Published: November 2019

Type 410 martensitic stainless steel is used in some downstream hydro-processing installations, due to its good resistance to sulfide corrosion and chloride stress corrosion cracking. Industry experience with Type 410 steel welds, using generic welding consumables, has shown difficulties in meeting the weld metal and HAZ hardness and toughness requirements. Recent research has pointed out the wide composition specifications of Type 410 base metal and welding consumables as the leading cause for significant hardness and toughness variations, related to exceeding the A1 temperature during PWHT and formation of fresh martensite, and to retention of significant amounts of delta ferrite. Predictive equations for the A1 temperature and the content of retained delta ferrite were used to identify optimal composition for Type 410 welding consumables with delta ferrite content below 20% and A1 temperature close to the upper end of the ASME specified PWHT range. Experimental metal core filler wire was manufactured and tested to validate the A1 temperature and delta ferrite content. A test weld in Type 410 steel was produced with the new filler wire and subjected to PWHT, metallurgical characterization, and mechanical testing. The weld metal and HAZ properties met the corresponding NACE and ASME hardness and toughness requirements.
Creep Life Evaluations of ASME B31.1 Allowance for Variation From Normal Operations: 11 Materials
Authors: Cohn Marvin J. , Haupt Ron
Published: November 2019

The ASME B31.1-2018 Power Piping Code (Code) paras. 102.2.4, 102.3.3, and 104.8.2 provide an allowance regarding operating above the design temperature and design pressure for short time periods. The concept of allowing occasional operation for short periods of time at higher than the design pressure or design temperature has been in the Code since 1967. These 1967 Code para. 102.2.4 limitations were based on engineering judgment that can now be quantitatively evaluated for the additional creep life consumption (creep rupture damage accumulation).

This study primarily is a quantitative estimate of the permitted increased life consumption, considering minimum creep rupture properties, associated with the 2018 Code operating allowances for piping materials operating in the creep range. Eleven base metal materials are considered in this paper — low carbon steel, 1.25Cr 0.5Mo, 2.25Cr 1Mo, 9Cr 1 Mo V, Type 304 SS, Type 316 SS, Type 316L SS, Type 321 SS, Type 321H SS, Type 347 SS, and Type 347H SS. Results of this evaluation may be used to improve the ASME B31.1 Code, including a technical basis for a possible revision to para. 102.2.4.

Previous studies have revealed that Grade P22 base metal creep damage is slightly more sensitive to stress than Grade P11 material creep rupture damage, and Grade P91 base metal creep damage is substantially more sensitive to stress than Grade P22 material creep rupture damage. Therefore, the allowable pressure and temperature variations result in a range of increased creep life consumption for different materials. The intent of this study was to modify the two Code allowance criteria so that the permitted increased creep life consumption (considering the minimum creep rupture properties of the material) of Allowance B is about the same amount as the increased creep life consumption result of Allowance A for the same material.

Consequently, this study was performed to realign the allowable increased creep rupture life consumption of Allowance B to be approximately equivalent to the allowable increased creep life consumption of Allowance A. If the Allowance B event duration is increased from 80 hours per year to 400 hours per year, the Allowance B increased creep life consumption is slightly less than the Allowance A life consumption for each of these materials.
A Methodology to Assess Elbow Fittings With Localized Material Variations
Authors: Ghosh Pritha , Kulkarni Mandar , Vyvial Brent , Ferguson James
Published: November 2019

Elbow fittings are manufactured using quenching and tempering heat treatment processes. Such fittings can occasionally exhibit localized regions with lower yield strength than the design target, potentially due to non-uniform heat treatment. This paper presents an analytical methodology to examine the influence of these localized lower yield zones on the load capacity of the affected pipe fitting. In parallel, full-scale testing has been performed to quantify the actual response of the elbows under a combination of different loading conditions. The experimental data is used to validate the analytical approach. Details of the analytical method include a two-fold criterion: a global failure based on elastic–plastic stress analysis and a local failure based on the tri-axial strain limit per ASME Boiler and Pressure Vessel Code Section VIII, Division 2. This paper presents the details of the finite element model development, assessment procedure, validation and parametric analysis of the size and location of the low yield zones in the elbow fittings. The fittings are analyzed for three possible operating scenarios: internal pressure, internal pressure with opening moment and internal pressure with closing moment. To characterize the influence of the low yield zone on the strength of the pipe, a parameter termed as “effective yield strength” is introduced. This approach is further demonstrated and found suitable for predicting burst pressures of components with lower yield zones of various diameters and thicknesses. This assessment method can be further extended to assess other pipeline components that exhibit similar behavior.
A Study on Degree of Conservatism of Two Safety Assessment Methods for Piping and Vessels With Defects
Authors: He Meng , Li Haitao , Han Zhiyuan , Xie Guoshan , Sun Liang , Wang Weihua
Published: November 2019

Flaws (defects), such as local thinning due to corrosion, inevitably exist in piping and pressure vessels. These defects can be evaluated using the fitness for service (FFS) method provided in the GB/T 19624 standard. Recently, the GB/T 35013 standard (Fitness-for-service assessment of pressure equipments), which provides another FFS assessment method for local thinning on piping and vessels, has been published. The evaluation method for local thinning in the GB/T 35013 standard is generally similar to that in the API 579-1/ASME FFS-1 (2016), but is totally different from that in the GB/T 19624. In this paper, the differences of the local thinning assessment methods in the GB/T 35013 (or API 579-1/ASME FFS-1 (2016)) and the GB/T 19624 are summarized, and the degree of conservatism comparisons between these standards are presented. The maximum allowable operating pressure (Prmax) that takes into account the effect of defects for straight pipe sections and vessels under different defect sizes and safety factors in these two standards have been calculated and compared. Monte Carlo simulations have been carried out to estimate the failure probability (Pf) and reliability of the straight pipe sections and vessels with different safety factors using the GB/T 19624.
Valve Modeling Methods for Modal Analysis
Authors: Farrell Ronald , Ezekoye L. Ike
Published: November 2019

This paper presents several modeling methods for performing a valve assembly modal analysis. It discusses the background of the methods, their strengths and limitations, and then introduces a new approach that can be used in performing valve modal analysis. An early paper presents a classical approach based on a lumped mass model and the Rayleigh energy principal to determine primary mode natural frequencies. A follow up paper reaffirms the classical method and introduces enhancements. A recent paper provides a comparative study of the classical approach, laboratory testing, and solid modeling results using the finite element analysis program ANSYS Mechanical. In this paper, a third approach is presented, which is an extension of the classical method, where 3-D beam-based geometry is defined using the ANSYS SpaceClaim program that is then ported to ANSYS Mechanical. The classical and solid modeling approaches from the previously cited papers are reviewed to highlight the modeling evolution and then the newly developed approach is presented. An example is presented that compares natural frequency results of the new method and the previous methods.

The motivation for the new method is to provide better compatibility with 3-D piping system models, which are typically used to study the effect of valve mass and stiffness on system response without the complexity of a solid model or the difficulty of communicating the details of a classical model to the system modeler.

Much of the process of creating a 3-D beam model is automated. It uses input from an existing classical model and employs the following ANSYS software packages: SpaceClaim, Workbench, Mechanical, and ACT. A great feature of the resulting 3-D model is that beam geometry is more realistic to scale, and therefore provides valuable user feedback for checking model validity. This approach is an improvement over the classical model where only manual data input validation is possible. Other benefits of the new method are covered in greater detail in the paper.
Large Ranges in Power Piping Girth Weld Creep Rupture Lives
Authors: Cohn Marvin J. , Faham Fatma G.
Published: November 2019

Stress analysis evaluations of high energy piping systems operating in the creep range have revealed that each piping system has a large range of ASME B31.1 Code stresses. It is typical that there are only a few locations of high stresses and many more locations of much lower Code stresses. Over the past 20 years, the authors have evaluated several hundred piping systems operating in the creep range, including main steam, hot reheat, high pressure, and intermediate pressure systems constructed of Grade 11 (1¼-Cr-½Mo-Si), Grade 22 (2¼Cr-1Mo), and Grade 91 (9Cr-1Mo-V) materials. Stress contour plots illustrate the significant range of Code stresses (sometimes factors greater than 2) at various piping system locations. This study also considered the variation of high stress locations for the initial as-designed piping stress analysis versus the as-found stresses associated with field anomalies. The stress contour plots also illustrate that field anomalies in sister units can result in different high stress locations from one unit to another. In addition, significant unintended field anomalies may result in as-found analysis high stress locations at low stress as-designed (expected) analysis locations.

Since there is a large range of stresses in these power piping systems, the girth welds have a significant range of creep rupture lives. In Grade 11 material operating at 1000°F (538°C), an 18% stress increase results in 50% decrease in creep rupture life. In Grade 22 material operating at 1000°F, a 12% stress increase results in 50% decrease in creep rupture life. In Grade 91 material operating at 1060°F (571°C), an 8% stress increase results in 50% decrease in creep rupture life. For Grades 11, 22, and 91, the creep rupture times are a function of stress to the powers of 4, 6, and 9, respectively. Consequently, the evaluation of the large range of stresses in these piping systems revealed that the piping system girth welds can have creep rupture lives varying by more than a factor of 10. The large range of piping stresses and associated large range in creep rupture lives within a piping system are illustrated as stress histograms for several example piping systems. Four case studies illustrate successful selection of girth weldments with the most in-service related creep damage.
Magnetic Barkhausen Noise Method for Characterisation of Low Alloy Steel
Authors: Kadavath Gokulnath , Mathew Jino , Griffin James , Parfitt David , Fitzpatrick Michael E.
Published: November 2019

Application of NDE techniques to operating reactor materials is useful for the determination of deviations resulting from material inhomogeneity and long-term degradation of properties from irradiation damage. A new programme, Nondestructive Evaluation System for the Inspection of Operation-Induced Material Degradation in Nuclear Power Plants (NOMAD), focuses on the non-destructive investigations of Reactor Pressure Vessel (RPV) steels in ageing reactors to better assess the integrity for lifetime management. In this study, Magnetic Barkhausen Noise (MBN) is used to characterise the effect of inhomogeneties in a Jominy end-quench test specimen subjected to differential cooling rates. The effect of material state encompassing different variables such as surface roughness, microstructure, hardness and residual stress is correlated with the MBN Root Mean Square (RMS) parameter in order to enhance the understanding of the embrittlement phenomena. These studies will contribute to the development of a tool that can monitor and quantify the extent of material degradation in operating nuclear power plants.
Computational Evaluation of Thermal Barrier Coatings: Two-Phase Thermal Transport Analysis
Authors: Irick Kevin , Fathi Nima
Published: November 2019

In the power plant industry, the turbine inlet temperature (TIT) plays a key role in the efficiency of the gas turbine and, therefore, the overall — in most cases combined — thermal power cycle efficiency. Gas turbine efficiency increases by increasing TIT. However, an increase of TIT would increase the turbine component temperature which can be critical (e.g., hot gas attack). Thermal barrier coatings (TBCs) — porous media coatings — can avoid this case and protect the surface of the turbine blade. This combination of TBC and film cooling produces a better cooling performance than conventional cooling processes. The effective thermal conductivity of this composite is highly important in design and other thermal/structural assessments. In this article, the effective thermal conductivity of a simplified model of TBC is evaluated. This work details a numerical study on the steady-state thermal response of two-phase porous media in two dimensions using personal finite element analysis (FEA) code. Specifically, the system response quantity (SRQ) under investigation is the dimensionless effective thermal conductivity of the domain. A thermally conductive matrix domain is modeled with a thermally conductive circular pore arranged in a uniform packing configuration. Both the pore size and the pore thermal conductivity are varied over a range of values to investigate the relative effects on the SRQ. In this investigation, an emphasis is placed on using code and solution verification techniques to evaluate the obtained results. The method of manufactured solutions (MMS) was used to perform code verification for the study, showing the FEA code to be second-order accurate. Solution verification was performed using the grid convergence index (GCI) approach with the global deviation uncertainty estimator on a series of five systematically refined meshes for each porosity and thermal conductivity model configuration. A comparison of the SRQs across all domain configurations is made, including uncertainty derived through the GCI analysis.
Characterization of bidirectional impulse turbines for thermoacoustic engines
Authors: Timmer Michael A. G. , van der Meer Theo H.
Published: November 2019

A bidirectional impulse turbine to convert thermoacoustic power into electricity is investigated. Experimental measurements are done with a loudspeaker for varying acoustic conditions and turbine loads. The results are used to characterize the turbine performance and compare it to steady flow turbomachinery and turbines in oscillating water columns. A dimensional analysis is done to identify the variables that influence the turbine performance, after which a scaling is determined that uniquely determines the efficiency of the turbine. The work is finished by providing the impedance of the bidirectional turbine such that it can be implemented in a thermoacoustic engine.
Herpes Simplex Virus Latency Is Noisier the Closer We Look
Authors: Singh Navneet , Tscharke David C.
Published: November 2019

During herpes simplex virus (HSV) latency, the viral genome is harbored in peripheral neurons in the absence of infectious virus but with the potential to restart infection. Advances in epigenetics have helped explain how viral gene expression is largely inhibited during latency. Paradoxically, at the same time, the view that latency is entirely silent has been eroding. This low-level noise has implications for our understanding of HSV latency and should not be ignored.
Cell Cycle-Dependent Flagellar Disassembly in a Firebug Trypanosomatid
Leptomonas pyrrhocoris
Authors: He Cynthia Y. , Singh Adarsh , Yurchenko Vyacheslav
Published: November 2019

Current understanding of flagellum biogenesis during the cell cycle in trypanosomatids is limited to a few pathogenic species, including
Trypanosoma brucei
,
Trypanosoma cruzi
, and
Leishmania
spp. The most notable characteristics of trypanosomatid flagella studied so far are the extreme stability and lack of ciliary disassembly/absorption during the cell cycle. This is different from cilia in
Chlamydomonas
and mammalian cells, which undergo complete absorption prior to cell cycle initiation. In this study, we examined flagellum duplication during the cell cycle of
Leptomonas pyrrhocoris
. With the shortest duplication time documented for all Trypanosomatidae and its amenability to culture on agarose gel with limited mobility, we were able to image these cells through the cell cycle. Rapid, cell cycle-specific flagellum disassembly different from turnover was observed for the first time in trypanosomatids. Given the observed length-dependent growth rate and the presence of different disassembly mechanisms, we proposed a min-max model that can account for the flagellar length variation observed in
L. pyrrhocoris
.
Recurrent metastatic breast cancer presenting with portal hypertension and pseudocirrhosis
Authors: Adler Maciej , Tang Ivan , Gach Michael William , MacFaul George
Published: November 2019

We present a case of a 63-year-old woman with an acute history of abdominal distension and shortness of breath. She had no risk factors for liver disease though her prior medical history was positive for breast carcinoma, in remission for 14 years. Examination and investigations were initially consistent with decompensated cirrhosis, thought to be due to subclinical autoimmune hepatitis. Imaging revealed hepatic contour irregularity, atrophy of the liver parenchyma and numerous lesions highly suggestive for multifocal hepatocellular carcinoma. Surprisingly, tissue histology revealed no evidence of cirrhosis, but recurrence of breast cancer which had mimicked cirrhosis. Pseudocirrhosis may be indistinguishable from true cirrhosis without histopathology. It has previously been linked to chemotherapy-induced hepatic injury and nodular regenerative hyperplasia, although our case illustrates an uncommon pathophysiology. Pseudocirrhosis often represents a poor prognosis even with a good baseline performance status, and early involvement of palliative care specialists may be advisable.
Determinants of longitudinal change in insulin clearance: the Prospective Metabolism and Islet Cell Evaluation cohort
Authors: Semnani-Azad Zhila , Johnston Luke W , Lee Christine , Retnakaran Ravi , Connelly Philip W , Harris Stewart B , Zinman Bernard , Hanley Anthony J
Published: November 2019

Objective

To evaluate multiple determinants of the longitudinal change in insulin clearance (IC) in subjects at high risk for type 2 diabetes (T2D).

Research design and methods

Adults (n=492) at risk for T2D in the Prospective Metabolism and Islet Cell Evaluation cohort, a longitudinal observational cohort, had four visits over 9 years. Values from oral glucose tolerance tests collected at each assessment were used to calculate the ratios of both fasting C peptide-to-insulin (ICFASTING) and areas under the curve of C peptide-to-insulin (ICAUC). Generalized estimating equations (GEE) evaluated multiple determinants of longitudinal changes in IC.

Results

IC declined by 20% over the 9-year follow-up period (p<0.05). Primary GEE results indicated that non-European ethnicity, as well as increases in baseline measures of waist circumference, white cell count, and alanine aminotransferase, was associated with declines in ICFASTINGand ICAUCover time (all p<0.05). There were no significant associations of IC with sex, age, physical activity, smoking, or family history of T2D. Both baseline and longitudinal IC were associated with incident dysglycemia.

Conclusions

Our findings suggest that non-European ethnicity and components of the metabolic syndrome, including central obesity, non-alcoholic fatty liver disease, and subclinical inflammation, may be related to longitudinal declines in IC.
Gallstone ileus: a review
Authors: Inukai Koichi
Published: November 2019

BackgroundGallstone ileus is an important complication of cholecystolithiasis. In general, surgery is the treatment of choice for such cases, but clinicians face difficulty in the selection of an appropriate approach. Closure of a cholecystoenteric fistula can be achieved through one-stage or two-stage operation. Two-stage operation has a lower mortality rate than a one-stage procedure, but persistence of the cholecystoenteric fistula is associated with the risk of carcinogenesis and recurrence of gallstone ileus.

ObjectiveThis study reviews the different surgical approaches according to the impaction site of the gallstone, using data of previous studies by our group and clinical reports in the literature.

ConclusionsFirst, for cases involving impaction at the duodenum, the cholecystoenteric fistula can be repaired in the same surgical field, and one-stage operation obtains favourable outcome; hence, one-stage operation is considered as treatment of choice. Second, for cases involving impaction at the small intestine, natural closure of the cholecystoenteric fistula or low mortality is expected; hence, two-stage operation may be performed, possibly using minimally invasive laparoscopy. Third, for cases involving impaction at the colon, natural closure of the cholecystocolonic fistula is unlikely, and patients have a high risk of reflux cholangitis due to faecal fluid; hence, one-stage operation is considered as treatment of choice.
The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018
Authors: Salari Paola , Di Giorgio Laura , Ilinca Stefania , Chuma Jane
Published: November 2019

Introduction

Progress towards effective service coverage and financial protection—the two dimensions of Universal Health Coverage (UHC)—has been limited in Kenya in the last decade. The government of Kenya has embarked on a highly ambitious reform programme currently being piloted in four Kenyan counties and aiming at national rollout by 2022. This study provides an updated assessment of the performance of the Kenyan health system in terms of financial protection allowing to monitor trends over time. In light of the UHC initiative, the study provides a baseline to assess the impact of the UHC pilot programme and inform scale-up plans. It also investigates household characteristics associated with catastrophic payments.

Methods

Using data from the Kenya Household Health Expenditure and Utilization Survey (KHHEUS) 2018, we investigated the incidence and intensity of catastrophic and impoverishing health expenditure. We used a logistic regression analysis to assess households’ characteristics associated with the probability of incurring catastrophic health expenditures.

Results

The results show that the incidence of catastrophic payments is more severe for the poorest households and in the rural areas and mainly due to outpatient services. Results for the impoverishing effect suggest that after accounting for out-of-pocket(OOP) payments, the proportion of poor people increases by 2.2 percentage points in both rural and urban areas. Thus, between 1 and 1.1 million individuals are pushed into poverty due to OOP payments. Among the characteristics associated with the probability of incurring OOP expenditures, socioeconomic conditions, the presence of elderly and of people affected by chronic conditions showed significant results.

Conclusion

Kenya is still lagging behind in terms of protecting its citizens against financial risks associated with ill health and healthcare seeking behaviour. More effort is needed to protect the most vulnerable population groups from the high costs of illness.
Polymorphisms of genes related to vitamin D metabolism and transportation and its relationship with the risk of osteoporosis: protocol for a multicentre prospective cohort study in China
Authors: Wang Jing , Shu Bing , Li Chen-Guang , Xie Xing-Wen , Liang De , Chen Bo-Lai , Lin Xin-Chao , Wei Xu , Wang Liang , Leng Xiang-Yang , Zhou Ying-Jie , Chen Pei-Zhan , Tao Yu-Ren , Zhou Yong , Zhang Yan , Cui Xue-Jun , Lu Sheng , Wang Hui , Shi Qi , Wang Yong-Jun
Published: November 2019

Introduction

Osteoporotic fracture is one of the most common causes of disability and a major contributor to medical care costs in many regions of the world. The polymorphisms of genes related to vitamin D metabolism and transportation are associated with variation in bone mineral density and the risk of osteoporosis.

Methods and analysis

The China Community-based Cohort of Osteoporosis study is an observational, longitudinal, multicentre, prospective cohort study for middle-aged and older permanent residents of China, which has been ongoing in six cities since 2016. Female residents aged 45–80 years old and male residents aged 50–80 years old are identified through permanent resident lists. All the enrolled participants will complete questionnaires on their personal characteristics and histories. The bone mineral density of their lumbar vertebrae and left hip will be measured and serum bone metabolism parameters assessed. Polymorphisms of genes related to vitamin D metabolism and transportation will be detected, and their relationship with the risk of osteoporosis, and osteoporotic fracture, will be analysed. About 18 000 residents will be involved in the study.

Ethics and dissemination

The study was approved by Institutional Ethics Board of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine (2016LCSY065). Results will be published in peer-reviewed journals. The results of this study are expected to improve the understanding of the association between polymorphisms of genes related to vitamin D metabolism and transportation and the risk of osteoporosis and osteoporotic fracture among middle-aged and older residents of China.

Trial registration number

NCT02958020
Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study
Authors: Ansbro Éimhín Mary , Biringanine Michel , Caleo Grazia , Prieto-Merino David , Sadique Zia , Perel Pablo , Jobanputra Kiran , Roberts Bayard
Published: November 2019

Objective

We aimed to evaluate an Integrated Diabetic Clinic within a Hospital Outpatient Department (IDC-OPD) in a complex humanitarian setting in North Kivu, Democratic Republic of Congo. Specific objectives were to: (1) analyse diabetes intermediate clinical and programmatic outcomes (blood pressure (BP)/glycaemic control, visit volume and frequency); (2) explore the association of key insecurity and related programmatic events with these outcomes; and (3) describe incremental IDC-OPD programme costs.

Design

Retrospective cohort analysis of routine programmatic data collected from January 2014 to February 2017; analysis of programme costs for 2014/2015.

Setting

Outpatient diabetes programme in Mweso hospital, supported by Médecins sans Frontières, in North Kivu, Demographic Republic of Congo.

Participants

Diabetes patients attending IDC-OPD.

Outcome measures

Intermediate clinical and programmatic outcome trends (BP/ glycaemic control; visit volume/frequency); incremental programme costs.

Results

Of 243 diabetes patients, 44.6% were women, median age was 45 (IQR 32–56); 51.4% were classified type 2. On introduction of IDC-OPD, glucose control improved and patient volume and visit interval increased. During insecurity, control rates were initially maintained by a nurse-provided, scaled-back service, while patient volume and visit interval decreased. Following service suspension due to drug stock-outs, patients were less likely to achieve control, improving on service resumption. Total costs decreased 16% from 2014 (€36 573) to 2015 (€30 861). Annual cost per patient dropped from €475 in 2014 to €214 in 2015 due to reduced supply costs and increased patient numbers.

Conclusions

In a chronic conflict setting, we documented that control of diabetes intermediate outcomes was achievable during stable periods. During insecure periods, a simplified, nurse-led model maintained control rates until drug stock-outs occurred. Incremental per patient annual costs were lower than chronic HIV care costs in low-income settings. Future operational research should define a simplified diabetes care package including emergency preparedness.
Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms
Authors: Ott Thomas , Stracke Jascha , Sellin Susanna , Kriege Marc , Toenges Gerrit , Lott Carsten , Kuhn Sebastian , Engelhard Kristin
Published: November 2019

Objectives

During a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a ‘cannot intubate, cannot oxygenate’ situation.

Design

Due to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study.

Setting

We collected data in our institutional simulation centre between November 2016 and November 2017.

Participants

We included 40 experienced staff anaesthesiologists at our tertiary university hospital centre.

Intervention

The participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records.

Primary outcome measures

The difference in ‘time to ventilation through cricothyrotomy’ between the two situations was the primary outcome measure.

Results

The results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3–40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time.

Conclusion

Cricothyrotomy, which is the most crucial treatment for cardiac arrest in a ‘cannot intubate, cannot oxygenate’ situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.
Systematic review of the measurement properties of performance-based functional tests in patients with neck disorders
Authors: McGee Steven , Sipos Taylor , Allin Thomas , Chen Celia , Greco Alexandra , Bobos Pavlos , MacDermid Joy
Published: November 2019

Objectives

The purpose of this systematic review is to identify and synthesise studies evaluating performance-based functional outcome measures designed to evaluate the functional abilities of patients with neck pain.

Design

Systematic review.

Data sources

A literature search using PubMed, Scopus, CINAHL, EMBASE, COCHRANE, Google Scholar and a citation mapping strategy was conducted until July 2019.

Eligibility criteria

More than half of the study’s patient population had neck pain or a musculoskeletal neck disorder and completed a functional-based test. Clinimetric properties of at least one performance-based functional tests were reported. Both traumatic and non-traumatic origins of neck pain were considered.

Data extraction and synthesis

Relevant data were then extracted from selected articles using an extraction guide. Selected articles were appraised using the Quality Appraisal for Clinical Measurement Research Reports Evaluation Form (QACMRR).

Results

The search obtained 12 articles which reported on four outcome measures (functional capacity evaluations (FCE), Baltimore Therapeutic Equipment Work Simulator II (BTEWS II), Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA)) and a physiotherapy test package, to assess the functional abilities in patients with mechanical neck pain. Of the selected papers: one reports content validity, five construct validity, four reliability, one sensitivity to change and one both reliability and construct validity. QACMRR scores ranged from 68% to 95%.

Conclusions

This review found very good quality evidence that the FIT-HaNSA has excellent inter and intra-rater reliability and very weak to weak convergent validity. Excellent quality evidence of fair test-retest reliability, weak convergent validity and very weak known groups validity for the BTEWS II test was found. Good to excellent quality evidence exists that an FCE battery has poor to excellent reliability and very weak to strong validity. Good to excellent quality of weak to strong validity and trivial to strong effect sizes were found for a physiotherapy test package.

Prospero registration number

CRD42018112358
Discussions during shared decision-making in older adults with advanced renal disease: a scoping review
Authors: Raj Rajesh , Thiruvengadam Srivathsan , Ahuja Kiran Deep Kaur , Frandsen Mai , Jose Matthew
Published: November 2019

Objectives

This review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.

Design

We followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.

Data sources

PubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).

Eligibility criteria for inclusion

Articles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.

Data extraction and synthesis

Two independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.

Results

248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.

Conclusion

When discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.
Are there differences between those doctors who apply for a training post in Foundation Year 2 and those who take time out of the training pathway? A UK multicohort study
Authors: Cleland Jennifer , Prescott Gordon , Walker Kim , Johnston Peter , Kumwenda Ben
Published: November 2019

Introduction

Knowledge about the career decisions of doctors in relation to specialty (residency) training is essential in terms of UK workforce planning. However, little is known about which doctors elect to progress directly from Foundation Year 2 (F2) into core/specialty/general practice training and those who instead opt for an alternative next career step.

Objective

To identify if there were any individual differences between these two groups of doctors.

Design

This was a longitudinal, cohort study of ‘home’ students who graduated from UK medical schools between 2010 and 2015 and completed the Foundation Programme (FP) between 2012 and 2017.

We used the UK Medical Education Database (UKMED) to access linked data from different sources, including medical school performance, specialty training applications and career preferences. Multivariable regression analyses were used to predict the odds of taking time out of training based on various sociodemographic factors.

Results

18 380/38 905 (47.2%) of F2 doctors applied for, and accepted, a training post offer immediately after completing F2. The most common pattern for doctors taking time out of the training pathway after FP was to have a 1-year (7155: 38.8%) or a 2-year break (2605: 14.0%) from training. The odds of not proceeding directly into core or specialty training were higher for those who were male, white, entered medical school as (high) school leavers and whose parents were educated to degree level. Doctors from areas of low participation in higher education were significantly (0.001) more likely to proceed directly into core or specialty training.

Conclusion

The results show that UK doctors from higher socioeconomic groups are less likely to choose to progress directly from the FP into specialty training. The data suggest that widening access and encouraging more socioeconomic diversity in our medical students may be helpful in terms of attracting F2s into core/specialty training posts.
Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes (LP-MAESTRO): a protocol
Authors: Smith Chris , Hewison Jenny , West Robert M , Guthrie Elspeth , Trigwell Peter , Crawford Mike J , Czoski Murray Carolyn J , Fossey Matt , Hulme Claire , Tubeuf Sandy , House Allan
Published: November 2019

Introduction

We describe the protocol for a project that will use linkage of routinely collected NHS data to answer a question about the nature and effectiveness of liaison psychiatry services in acute hospitals in England.

Methods and analysis

The project will use three data sources: (1) Hospital Episode Statistics (HES), a database controlled by NHS Digital that contains patient data relating to emergency department (ED), inpatient and outpatient episodes at hospitals in England; (2) ResearchOne, a research database controlled by The Phoenix Partnership (TPP) that contains patient data relating to primary care provided by organisations using the SystmOne clinical information system and (3) clinical databases controlled by mental health trusts that contain patient data relating to care provided by liaison psychiatry services. We will link patient data from these sources to construct care pathways for patients who have been admitted to a particular hospital and determine those patients who have been seen by a liaison psychiatry service during their admission.

Patient care pathways will form the basis of a matched cohort design to test the effectiveness of liaison intervention. We will combine healthcare utilisation within care pathways using cost figures from national databases. We will compare the cost of each care pathway and the impact of a broad set of health-related outcomes to obtain preliminary estimates of cost-effectiveness for liaison psychiatry services. We will carry out an exploratory incremental cost-effectiveness analysis from a whole system perspective.

Ethics and dissemination

Individual patient consent will not be feasible for this study. Favourable ethical opinion has been obtained from the NHS Research Ethics Committee (North of Scotland) (REF: 16/NS/0025) for Work Stream 2 (phase 1) of the Liaison psychiatry—measurement and evaluation of service types, referral patterns and outcomes study. The Confidentiality Advisory Group at the Health Research Authority determined that Section 251 approval under Regulation 5 of the Health Service (Control of Patient Information) Regulations 2002 was not required for the study ‘on the basis that there is no disclosure of patient identifiable data without consent’ (REF: 16/CAG/0037).

Results of the study will be published in academic journals in health services research and mental health. Details of the study methodology will also be published in an academic journal. Discussion papers will be authored for health service commissioners.
How do foodservice dietitians and dietetic students learn about environmental sustainability? A scoping review protocol
Authors: McCormack Joanna , Noble Christy , Ross Lynda , Cruickshank Denise , Bialocerkowski Andrea
Published: November 2019

Introduction

Healthcare services are responsible for 7% of Australia’s carbon emissions, or 35 772 kt per annum, with 44% of these attributed to hospitals and an unknown proportion originating from the kitchen. Carbon emissions contribute to climate change that is predicted to adversely impact health outcomes. Healthcare professionals and institutions have an opportunity to reduce their impact on the climate. Australian dietitians, however, are not required to learn about environmental sustainability during their tertiary education. This scoping review will identify pedagogical frameworks employed by educational institutions and providers of professional development, to describe how foodservice dietitians and dietetic students develop environmental sustainability capabilities.

Methods and analysis

The scoping review methodology established by Arksey and O’Malley will be used for this review. Papers will be included if they focus on dietitians or dietetic students learning about environmental sustainability in the foodservice domain. Nine databases, Business Source Complete, CINAHL, Cochrane, Edge (via informit), EMBASE, MEDLINE, Proquest, Scopus and Web of Science, will be searched from their inception. Grey literature will also be identified by searching theses databases, professional bodies databases and Google Scholar. Eligible articles will be identified by screening papers by their title and abstract, followed by a full-text review. The study selection process will be completed independently by the primary investigator and the research team. Any discrepancies will be resolved through discussion. The extracted data including citation information, information on the intervention and outcomes will be summarised using descriptive statistics. Themes describing the pedagogical underpinnings of the interventions, the measurement tools and the impact of the learning activities will be synthesised narratively.

Ethics and dissemination

The results will inform the development of evidence-based pedagogical frameworks to enhance the capabilities of foodservice dietitians and dietetic students in environmental sustainability. Dissemination will occur through conference presentations, peer-reviewed journals and distribution through national accrediting bodies.
Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back-related leg pain: protocol for a systematic review
Authors: Mistry Jai , Heneghan Nicola R , Noblet Timothy , Falla Deborah , Rushton Alison
Published: November 2019

Introduction

Neuropathic low back-related leg pain (LBLP) can be a challenge to healthcare providers to diagnose and treat. Accurate diagnosis of neuropathic pain is fundamental to ensure appropriate intervention is given. However, to date there is no gold standard to diagnose neuropathic LBLP. Patient examination guidelines and screening tools have been developed and validated for the purpose of diagnosing neuropathic pain in LBLP; however, there has been no systematic review conducted to compare the diagnostic validity of these methods. Therefore, this systematic review will investigate the diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in LBLP.

Methods and analysis

This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocols. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro, PubMed, key journals and grey literature will be searched rigorously to find diagnostic accuracy studies investigating patient examination data to identify neuropathic pain in LBLP patients. Two independent reviewers will conduct the search, extract the data and assess risk of bias for included studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The overall quality of included studies will be evaluated using Grading of Recommendations, Assessment, Development and Evaluation guidelines. A meta-analysis will be conducted if deemed appropriate. Otherwise, a narrative synthesis will be conducted.

Ethics and dissemination

No research ethics is required for this systematic review since patient data will not be collected. This review will help to inform healthcare professionals and researchers on the most effective means in which to diagnose neuropathic pain in LBLP. Results of this review will be submitted for publication in a peer-review journal and conference presentations.

PROSPERO registration number

CRD42019140861