bluuebunny/crossref_metadata_2025 huggingface dataset:
Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis
Authors: de Groot Rosa , van den Hurk Katja , Schoonmade Linda J , de Kort Wim L A M , Brug Johannes , Lakerveld Jeroen
Published: January 2019

Introduction

The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults.

Methods

PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome.

Results

After screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively).

Conclusions

Total and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas.

Prospero registration number

CRD42016043226.
The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil
Authors: J Carter Daniel , Daniel Rhian , Torrens Ana W , N Sanchez Mauro , Maciel Ethel Leonor N , Bartholomay Patricia , Barreira Draurio C , Rasella Davide , Barreto Mauricio L , Rodrigues Laura C , Boccia Delia
Published: January 2019

Background

Evidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate.

Methods

Propensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll.

Results

The average effect of treatment on the treated was estimated as the difference in TB treatment success rate between matched groups (ie, the control and exposed patients, n=2167). Patients with TB receiving BFP showed a treatment success rate of 10.58 percentage points higher (95% CI 4.39 to 16.77) than patients with TB not receiving BFP. This association was robust to sensitivity analyses.

Conclusions

This study further confirms a positive relationship between the provision of conditional cash transfers and TB treatment success rate. Further research is needed to understand how to enhance access to social protection so to optimise public health impact.
Spatial and temporal projections of the prevalence of active tuberculosis in Cambodia
Authors: Prem Kiesha , Pheng Sok Heng , Teo Alvin Kuo Jing , Evdokimov Konstantin , Nang Ei Ei Khaing , Hsu Li Yang , Saphonn Vonthanak , Tieng Sivanna , Mao Tan Eang , Cook Alex R
Published: January 2019

Introduction

Cambodia is among the 30 highest burden of tuberculosis (TB) countries. Active TB prevalence has been estimated using nationally representative multistage sampling that represents urban, rural and remote parts of the country, but the prevalence in non-sampled communes remains unknown. This study uses geospatial Bayesian statistics to estimate point prevalence across Cambodia, and demographic modelling that accounts for secular trends in fertility, mortality, urbanisation and prevalence rates to project the future burden of active TB.

Methods

A Bayesian hierarchical model was developed for the 2011 National Tuberculosis Prevalence survey to estimate the differential effect of age, sex and geographic stratum on active TB prevalence; these estimates were then married with high-resolution geographic information system layers to project prevalence across Cambodia. Future TB projections under alternative scenarios were then derived by interfacing these estimates with an individual-based demographic model.

Results

Strong differences in risk by age and sex, together with geographically varying population structures, yielded the first estimated prevalence map at a 1 km scale. The projected number of active TB cases within the catchment area of each existing government healthcare facility was derived, together with projections to the year 2030 under three scenarios:no future improvement,continualreductionandGDPprojection.

Conclusion

Synthesis of health and geographic data allows likely disease rates to be mapped at a high resolution to facilitate resource planning, while demographic modelling allows scenarios to be projected, demonstrating the need for the acceleration of control efforts to achieve a substantive impact on the future burden of TB in Cambodia.
Profile of a population-based diabetic macular oedema study: the Liverpool Eye and Diabetes Study (Sydney)
Authors: Liew Gerald , Wong Vincent W , Saw Mercy , Tsang Tania E , Nolan Tim , Ong Stephen , Ho I-Van
Published: January 2019

Purpose

The population prevalence of diabetic macular oedema (DME) is unclear. Previous estimates have depended on photographic grading of clinically significant macular oedema, which is subjective and has resulted in widely varying estimates. With the advent of optical coherence tomography (OCT), the presence and severity of DME can now be assessed objectively and accurately.

Methods

The Liverpool Eye and Diabetes Study (LEADS) is a cross-sectional population-based study of patients with type 1 and type 2 diabetes in a multi-ethnic region of Sydney, Australia, to determine the population prevalence of OCT-defined DME, how this varies by ethnicity and association with systemic factors. This report describes the rationale, methodology and study aims.

Results

To date 646 patients out of an expected sample size of 2000 have been recruited. Baseline data are presented for patients with type 1 (n=75, 11.8%) and type 2 (n=562, 88.2%) diabetes recruited to date. Patients with type 1 diabetes were younger (39.5vs60.7 years), with longer duration of diabetes (18.1vs11.7 years), slightly worse glycaemic control (HbA1c 9.0vs8.3), and less likely to have hypertension (30.7vs71.4%), hypercholesterolaemia (33.3vs74.6%) and obesity (31.1vs51.5%, respectively, all p<0.05).

Conclusions

The LEADS will provide objective estimates of the population prevalence of DME, how this varies with ethnicity and associations with systemic disease.
Learning from the transfer of a fellowship programme to support primary care workforce needs in the UK: a qualitative study
Authors: Bryce Carol , Russell Rachel , Dale Jeremy
Published: January 2019

Objectives

Service redesign, including workforce development, is being championed by UK health service policy. It is allowing new opportunities to enhance the roles of staff and encourage multiprofessional portfolio working. New models of working are emerging, but there has been little research into how innovative programmes are transferred to and taken up by different areas. This study investigates the transferability of a 1-year post-Certification of Completion of Training fellowship in urgent and acute care from a pilot in the West Midlands region of England to London and the South East.

Design

A qualitative study using semistructured interviews supplemented by observational data of fellows’ clinical and academic activities. Data were analysed using a thematic framework approach.

Setting and participants

Two cohorts of fellows (15 in total) along with key stakeholders, mentors, tutors and host organisations in London and the South East (LaSE). Fellows had placements in primary and secondary care settings (general practice, emergency department, ambulatory care, urgent care and rapid response teams), together with academic training.

Results

Seventy-six interviews were completed with 50 participants, with observations in eight clinical placements and two academic sessions. The overall structure of the West Midlands programme was retained and the core learning outcomes adopted in LaSE. Three fundamental adaptations were evident: broadening the programme to include multiprofessional fellows, changes to the funding model and the impact that had on clinical placements. These were felt to be key to its adoption and longer-term sustainability.

Conclusion

The evaluation demonstrates a model of training that is adaptable and transferable between National Health Service regions, taking account of changing national and regional circumstances, and has the potential to be rolled out widely.
Improving the working environment for the delivery of safe surgical care in the UK: a qualitative cross-sectional analysis
Authors: Baggaley Alice , Robb Lydia , Paterson-Brown Simon , McGregor Richard J
Published: January 2019

Objectives

The aim of this study was to identify current problems and potential solutions to improve the working environment for the delivery of safe surgical care in the UK.

Design

Prospective, questionnaire-based cross-sectional study.

Setting/participants

Following validation, an electronic questionnaire was distributed to postgraduate local education and training board distribution lists, the Royal College of Surgeons of Edinburgh (RCSEd) mailing lists and trainee organisations. This consisted of a single open-ended question inviting five open-ended responses. Throughout the 13-week study period, the survey was also published on a number of social media platforms.

Results

A total of 505 responders completed the survey, of which 35% were consultants, 30% foundation doctors, 17% specialty trainees, 11% specialty doctors, 5% core trainees and <1% surgical nurse practitioners. A total of 2238 free-text answers detailed specific actions to improve the working environment. These responses were individually coded and then grouped into nine categories (staff resources, non-staff resources, support, working conditions, communication and team work, systems improvement, patient centred, training and education, and miscellaneous).

Conclusions

The results of this study have identified a number of key areas that, if addressed, may improve the environment for the delivery of safer surgical care. Common themes that emerged across all grades included: increased front-line staff; a return to a ‘firm’ structure to improve team continuity; greater senior support; and improved hospital facilities to help staff rest and recuperate. While unlimited funding remains unrealistic, many of the suggestions could be implemented in a cost-neutral fashion and include insightful ideas for remodelling or restructuring the workforce to improve the efficiency of the surgical team. The findings of this study formed the basis of a set of recommendations published by the RCSEd as a discussion paper.
Cost-effectiveness of internet-delivered cognitive–behavioural therapy for adolescents with irritable bowel syndrome
Authors: Sampaio Filipa , Bonnert Marianne , Olén Ola , Hedman Erik , Lalouni Maria , Lenhard Fabian , Ljótsson Brjánn , Ssegonja Richard , Serlachius Eva , Feldman Inna
Published: January 2019

Objective

To assess whether exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.

Design

Within-trial cost-effectiveness analysis.

Setting

Participants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.

Participants

Adolescents (aged 13–17) with a diagnosis of IBS.

Interventions

Participants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.

Outcome measures

The main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.

Results

The base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.

Conclusions

Offering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.

Trial registration number

NCT02306369; Results.
Association between benzodiazepine use and risks of chronic-onset poststroke pneumonia: a population-based cohort study
Authors: Lin Shu-Man , Yang Shih-Hsien , Liang Chung-Chao , Huang Huei-Kai , Loh Ching-Hui
Published: January 2019

Objectives

To investigate the association between benzodiazepine (BZD) use and the risk of chronic-onset poststroke pneumonia.

Design

Population-based propensity-matched retrospective cohort study.

Setting

Taiwan’s National Health Insurance Research Database.

Participants

Patients newly diagnosed with stroke between 2000 and 2012 were identified and, after propensity score matching, 7516 patients were enrolled. Among these, 3758 patients received BZDs after stroke while 3758 did not.

Outcome measures

HRs for developing pneumonia over 1 month after stroke according to BZD use were assessed using Cox proportional hazards regression models. Analyses according to cumulative defined daily doses (cDDDs) of BZDs and stratification for age and sex were also performed.

Results

During a mean follow-up time of 4.4 years, 1027 patients in the BZD cohort and 478 patients in the non-BZD cohort developed pneumonia over 1 month after stroke. Patients using BZDs after stroke had a higher pneumonia risk than did those not using BZDs (52.2vs32.6 per 1000 person-years, adjusted HR (aHR)=2.21, 95% CI (CI)=1.97 to 2.48, p<0.001). Analyses based on cumulative BZD dose revealed that all BZD user subgroups were associated with a higher risk of pneumonia. The aHRs for patients taking 1–90, 91–365 and >365 cDDDs of BZDs were 2.28 (95% CI=2.01 to 2.58; p<0.001), 2.09 (95% CI=1.77 to 2.47; p<0.001) and 2.08 (95% CI=1.72 to 2.52; p<0.001), respectively. The significant association between BZD use and increased pneumonia risk persisted even after stratifying subgroups by age and sex.

Conclusions

BZD use is associated with an increased risk of chronic-onset poststroke pneumonia.
Spatial distribution and temporal trends in social fragmentation in England, 2001−2011: a national study
Authors: Grigoroglou Christos , Munford Luke , Webb Roger T , Kapur Nav , Ashcroft Darren M , Kontopantelis Evangelos
Published: January 2019

Objective

Social fragmentation is commonly examined in epidemiological studies of mental illness as high levels of social fragmentation are often found in areas with high prevalence of mental illness. In this study, we examine spatial and temporal patterns of social fragmentation and its underlying indicators in England over time.

Setting

Data for social fragmentation and its underlying indicators were analysed over the decennial Censuses (2001–2011) at a small area geographical level (mean of 1500 people). Degrees of social fragmentation and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran’s I; changes in correlations over time were quantified using Spearman’s ranking correlation.

Results

Between 2001 and 2011, we observed a strong persistence for social fragmentation nationally (Spearman’s r=0.93). At the regional level, modest changes were observed over time, but marked increases were observed for two of the four social fragmentation underlying indicators, namely single people and those in private renting. Results supported our hypothesis of increasing spatial clustering over time. Moderate regional variability was observed in social fragmentation, its underlying indicators and their clustering over time.

Conclusion

Patterns of social fragmentation and its underlying indicators persisted in England which seem to be driven by the large increases in single people and those in private renting. Policies to improve social cohesion may have an impact on the lives of persons who experience mental illness. The spatial aspect of social fragmentation can inform the targeting of health and social care interventions, particularly in areas with strong social fragmentation clustering.
Trends in road transport collision deaths in the Irish paediatric population: a retrospective review of mortality data, 1991–2015
Authors: McGarvey Cliona , Hamilton Karina , Donnelly Jean , Nicholson Alf J
Published: January 2019

Objective

To establish the incidence of road transport collision (RTC) fatalities in the Irish paediatric population, examining trends in fatality rates over a period of 25 years, during which several national road safety interventions were implemented.

Study design

Retrospective review of death registration details of children 0–19 years in Ireland between January 1991 and December 2015. Trends in mortality rates were investigated using average annual per cent change and Poisson regression analysis.

Results

Proportionate RTC mortality, the majority of which occurred on public roads (94.1%, n=1432) increased with age; <0.3% (<1 year), 8.3% (1–14 years) and 18.4% (15–19 years) (2011–2015 average). Over time, rates declined significantly in all age groups; reductions of 79.0% (4.0 to 0.84/100 000, 1–14 years) and 68.4% (15.5 to 4.9/100 000, 15–19 years) resulted in 537 (95% CI 515 to 566) fewer child deaths (1–19 years) over the period 1996–2015. This reduction was evident for both road user types, the greatest decline (84.8%) among pedestrians 1–14 years (2.1 to 0.32/100 000) and the lowest (66.5%) among occupants 15–19 years, the majority of whom were male (12.4 to 4.2/100 000). The rate of decline was greatest during periods coinciding with introduction of targeted interventions. Risk of death in children 1–14 years was halved in the period after 2002 (incidence rate ratio (IRR) 0.52) while in children 15–19 years old, a significantly lower RTC fatality risk was evident after 2006 and 2010 (IRR 0.68 and IRR 0.50).

Conclusion

Child and adolescent mortality from RTCs has declined dramatically in Ireland, in excess of reductions in overall paediatric mortality. However, rates remain higher than in other EU countries and further effort is required to reduce the number of deaths further, particularly among adolescent males.
Urethral obstruction in dogs: diagnosis and management
Authors: Shales Chris
Published: January 2019

Urethral obstruction is not uncommon in dogs, particularly males. Obstruction can be either partial or complete and can result in a range of clinical signs according to the degree and duration of the condition. This article will review the diagnostic process and the options available for re‐establishing urine flow in the short and longer term.
Disclosing pre‐existing veterinary conditions to insurance companies
Authors: Henderson Kathryn
Published: January 2019

This series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.

In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Disclosing pre‐existing veterinary conditions to insurance companies’, was submitted and is discussed by Kathryn Henderson. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.

The series is being coordinated by Steven McCulloch, senior lecturer in human animal studies at the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study
Authors: Kumar Kevin K , Appelboom Geoffrey , Lamsam Layton , Caplan Arthur L , Williams Nolan R , Bhati Mahendra T , Stein Sherman C , Halpern Casey H
Published: January 2019

Background

The safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative effectiveness model of these therapies.

Methods

A EMBASE/PubMed search of English-language, peer-reviewed articles reporting ABL and DBS for OCD was performed in January 2018. Change in quality of life (QOL) was quantified based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the impact of complications on QOL was assessed. Mean response of Y-BOCS was determined using random-effects, inverse-variance weighted meta-analysis of observational data.

Findings

Across 56 studies, totalling 681 cases (367 ABL; 314 DBS), ABL exhibited greater overall utility than DBS. Pooled ability to reduce Y-BOCS scores was 50.4% (±22.7%) for ABL and was 40.9% (±13.7%) for DBS. Meta-regression revealed no significant change in per cent improvement in Y-BOCS scores over the length of follow-up for either ABL or DBS. Adverse events occurred in 43.6% (±4.2%) of ABL cases and 64.6% (±4.1%) of DBS cases (p<0.001). Complications reduced ABL utility by 72.6% (±4.0%) and DBS utility by 71.7% (±4.3%). ABL utility (0.189±0.03) was superior to DBS (0.167±0.04) (p<0.001).

Interpretation

Overall, ABL utility was greater than DBS, with ABL showing a greater per cent improvement in Y-BOCS than DBS. These findings help guide success thresholds in future clinical trials for treatment refractory OCD.
‘Is it better not to know certain things?’: views of women who have undergone non-invasive prenatal testing on its possible future applications
Authors: Bowman-Smart Hilary , Savulescu Julian , Mand Cara , Gyngell Christopher , Pertile Mark D , Lewis Sharon , Delatycki Martin B
Published: January 2019

Non-invasive prenatal testing (NIPT) is at the forefront of prenatal screening. Current uses for NIPT include fetal sex determination and screening for chromosomal disorders such as trisomy 21 (Down syndrome). However, NIPT may be expanded to many different future applications. There are a potential host of ethical concerns around the expanding use of NIPT, as examined by the recent Nuffield Council report on the topic. It is important to examine what NIPT might be used for before these possibilities become consumer reality. There is limited research exploring views of women on possible future uses of NIPT, particularly those of women who have undergone NIPT. In this study, we examined the views of women who undertook NIPT previously on the acceptability of and interest levels in using NIPT for a number of current and possible future applications. These included several medical conditions encompassing psychiatric, neurodevelopmental and adult-onset conditions as well as non-medical traits such as intelligence. One thousand women were invited to participate and 235 eligible surveys were received. Women generally reported an interest in using NIPT for medical conditions that severely impacted quality of life and with an onset earlier in life and stressed the importance of the accuracy of the test. Concerns were raised about the use of NIPT for non-medical traits. Respondents indicated that termination of pregnancy was not their only reason for testing, particularly in the case of sex. These results can further inform the ethical debate around the increasing integration of NIPT into healthcare systems.
Comparison of bupivacaine plus intrathecal fentanyl and bupivacaine alone for spinal anesthesia with intravenous dexmedetomidine sedation: a randomized, double-blind, noninferiority trial
Authors: Park Sun-Kyung , Lee Joon Hee , Yoo Seokha , Kim Won Ho , Lim Young-Jin , Bahk Jae-Hyon , Kim Jin-Tae
Published: January 2019

Background and objectives

Fentanyl is widely used as an intrathecal adjuvant to local anesthetics to enhance the duration of spinal anesthesia. Recent evidence suggests that intravenous dexmedetomidine prolongs the duration of spinal anesthesia. This noninferiority study evaluated whether bupivacaine alone could provide a noninferior duration of block compared with bupivacaine and fentanyl when intravenous dexmedetomidine was administered intraoperatively.

Methods

Fifty-six patients scheduled for total knee arthroplasty under spinal anesthesia were randomly allocated to receive either bupivacaine 13 mg with intrathecal fentanyl 20 µg (Group BF) or bupivacaine 13 mg (Group B). Both groups underwent intravenous dexmedetomidine sedation throughout the surgery (1 µg kg–1for 10 min, followed by 0.5 µg kg–1h–1). The primary outcome was the time to two-segment regression of the sensory block. The noninferiority margin for the mean difference was predefined as −10 min. Secondary outcomes included postoperative pain scores, analgesics consumptions, and the incidences of pruritus, nausea, and vomiting.

Results

There was no significant difference in the two-segment regression time of sensory block (Group B 109.1±25.0 min vs Group BF 104.3±25.9 min; p=0.484). The mean difference in the two-segment regression time between the 2 groups was 4.8 min (95 % CI −8.9 to 18.6), demonstrating the noninferiority of bupivacaine alone. Secondary outcomes showed no significant differences between the two groups.

Conclusions

The duration of spinal anesthesia with bupivacaine alone is noninferior to that of bupivacaine plus fentanyl in patients receiving intravenous dexmedetomidine intraoperatively. Our results suggest that intrathecal fentanyl may not be required when intravenous dexmedetomidine is administered.

Trial registration number

NCT03105115.
Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block
Authors: Andersen Jakob Hessel , Jaeger Pia , Grevstad Ulrik , Estrup Stine , Geisler Anja , Vilhelmsen Frederik , Dahl Jorgen B , Laier Gunnar Hellmund , Ilfeld Brian M , Mathiesen Ole
Published: January 2019

Background

We tested the joint hypotheses that both perineural and systemic dexmedetomidine prolong the duration of an ulnar nerve block (UNB) compared with ropivacaine alone and that systemic dexmedetomidine is noninferior compared with perineural dexmedetomidine in block prolongation.

Methods

We performed bilateral UNBs in 22 healthy volunteers on two separate days. On the first day, each arm was randomized to either 4 mL ropivacaine 5 mg/mL+1 mL dexmedetomidine 100 µg/mL (Perineural) or 4 mL ropivacaine 5 mg/mL+1 mL saline (Systemic). On the subsequent treatment day, each arm was randomized to 1 mL of saline plus 4 mL of ropivacaine at either 7.5 mg/mL(HiRopi) or 5 mg/mL (NoDex). The primary outcome measure was the duration of sensory block assessed by mechanical discrimination.

Results

Mean sensory block duration was longer in both the Perineural (14.4 hours, 95% CI 13.1 to 15.6) and Systemic treatments (9.2 hours, 95% CI 8.6 to 9.8) compared with the NoDex treatment (7.1 hours, 95% CI 6.6 to 7.6) (p<0.0001 for both). Systemic dexmedetomidine was inferior (not noninferior) compared with perineural dexmedetomidine, as the 95% CI of the difference (mean difference 5.2 hour, 95% CI 4.2 to 6.1) exceeded the noninferiority limit of 3.6 hour. Onset time did not differ among the groups. The other test modalities demonstrated similar block durations as the primary outcome.

Conclusions

Adding dexmedetomidine perineurally to ropivacaine doubles the duration of an UNB. Systemic dexmedetomidine also prolongs the duration of UNB, but has less of an effect compared with the perineural route.

Trial registration number

NCT03222323.
The Denominator problem: estimating the size of local populations of men-who-have-sex-with-men and rates of HIV and other STIs in Switzerland
Authors: Schmidt Axel Jeremias , Altpeter Ekkehardt
Published: January 2019

Objectives

There is no estimate of the current number of men who have sex with men (MSM) in Switzerland, or of their geographical distribution. We aimed to (1) estimate MSM concentration factors and population sizes for 83 Swiss postal code areas (PCA), including the nine largest Swiss cities, and (2) calculate MSM-specific local HIV prevalence and yearly rates of diagnosed HIV, hepatitis C virus (HCV), syphilis and gonorrhoea.

Methods

We triangulated data from general population estimates, MSM online surveys, published data on HIV prevalence and Swiss notification data for HIV and STDs. We compared two different formulae for the estimation of local MSM populations and calculated Bayesian 95%-credible-intervals (CrI) for each PCA.

Results

Across Switzerland, we estimate the MSM population aged 15–64 at roughly 80 000 men (95% CrI 64 000–96 000). (1) MSM in Switzerland were most concentrated in the five largest cities of Zurich, Geneva, Lausanne, Bern and Basel. (2) We estimate that in 2012, 6300 MSM, or 8.0%, were living with HIV, both diagnosed and undiagnosed and 1700 MSM, or 2.2%, had non-suppressed HIV infection. Between 2010 and 2013, average yearly rates of diagnosed HIV, HCV, syphilis and gonorrhoea were 0.3%, 0.02%, 0.4 % and 0.4 %, respectively.

Conclusions

Combining general population data, MSM online surveys and notification data allows the calculation of realistic estimates of local MSM populations and thus proportions of MSM with diagnosed HIV and other STIs, with implications for prevention planning, commissioning of health services and counselling MSM on HIV/STI risk. Our methodology for Switzerland is transferable to other countries with similar data sources.
Quantum tunneling and remnant from a quantum-modified Schwarzschild space–time close to Planck scale
Authors: Qi De-Jiang , Liu Li , Liu Sheng-Xing
Published: January 2019

In this paper, by using the modified Dirac equation based on the generalized uncertainty principle, close to the Planck scale, we investigate the quantum tunneling and remnant of a quantum-modified Schwarzschild space–time. We successfully calculate corrected tunneling rate, Hawking temperature, and minimum nonzero mass. The results also show that the correction of quantum gravity, which effectively inhibits the growth of temperature of quantum-modified Schwarzschild space–time, can prevent the black hole from evaporating completely, predicting the existence of the remnant of a black hole.
Numerical computation of natural convection inside a curved-shape nanofluid-filled enclosure with nonuniform heating of the bottom wall
Authors: Yahiaoui Abdellaziz , Djezzar Mahfoud , Naji Hassane
Published: January 2019

This paper performs a numerical analysis of the natural convection within two-dimensional enclosures (square enclosure and enclosures with curved walls) full of a H2O-Cu nanofluid. While their vertical walls are isothermal with a cold temperature [Formula: see text], the horizontal top wall is adiabatic and the bottom wall is kept at a sinusoidal hot temperature. The working fluid is assumed to be Newtonian and incompressible. Three values of the Rayleigh number were considered, viz., 103, 104, 105, the Prandtl number is fixed at 6.2, and the volume fraction [Formula: see text] is taken equal to 0% (pure water), 10% and 20%. The numerical simulation is achieved using a 2D-in-house CFD code based on the governing equations formulated in bipolar coordinates and translated algebraically via the finite volume method. Numerical results are presented in terms of streamlines, isotherms and local and average Nusselt numbers. These show that the heat transfer rate increases with both the volume fraction and the Rayleigh number, and that the average number of Nusselt characterizing the heat transfer raises with the nanoparticles volume fraction.
Percolation of a random network by statistical physics method
Authors: Lin Hai , Wang Jingcheng
Published: January 2019

In this paper, we develop an analytical framework and analyze the percolation properties of a random network by introducing statistical physics method. To adequately apply the statistical physics method on the research of a random network, we establish an exact mapping relation between a random network and Ising model. Based on the mapping relation and random cluster model (RCM), we obtain the partition function of the random network and use it to compute the size of the giant component and the critical value of the present probability. We extend this approach to investigate the size of remaining giant component and the critical phenomenon in the random network which is under a certain random attack. Numerical simulations show that our approach is accurate and effective.
POPULATION AGING, MIDDLE-INCOME TRAP, AND ECONOMIC GROWTH: AN EMPIRICAL STUDY OF ASIAN ECONOMIES
Authors: PAN JIUN-NAN , CHANG MING-LEI
Published: January 2019

Population aging and the middle-income trap are serious problems felt worldwide, especially in terms of their powerful influence on economic growth. In order to explore the relationships among population aging, middle-income trap, and economic growth, this study uses a panel data of 27 economies in Asia from 1995 to 2016. The primary finding of this study is that lower-middle-income economies are facing the problem of middle-income trap, indicating that the economic growth rates of lower-middle-income economies are slowing down. In addition, population aging has a statistically significant and negative influence on the growth rate of GDP in the high-income economies, but it has a statistically significant and positive influence on the growth rate of GDP in the low-income and lower-middle-income economies. This study suggests that increasing women’s labor participation, technology innovation, and immigration could solve the problems of population aging and the middle-income trap.
THE TIME-VARYING CAUSAL RELATIONSHIP BETWEEN INTERNATIONAL CAPITAL FLOWS AND THE REAL EFFECTIVE EXCHANGE RATE: NEW EVIDENCE FOR CHINA
Authors: ZHAO YANPING , LI XIAOYAN , DE HAAN JAKOB
Published: January 2019

We test the bilateral causal relationship between four types of international capital flows and the real effective exchange rate (REER) in China over the period 1998:Q1 to 2016:Q2 and examine whether the link is time varying. Parameter stability tests suggest that the relationship between capital flows and the RMB REER is time varying both in the short and the long run. Bootstrap rolling-window causality tests suggest bidirectional Granger causal relationships between the current account, portfolio investments and FDI, and the REER in several sub-periods, and a Granger-causal relationship from foreign exchange reserves to the REER in some sub-periods.
BANK DIVERSIFICATION, COMPETITION AND LIQUIDITY CREATION: EVIDENCE FROM MALAYSIAN BANKS
Authors: TOH MOAU YONG , GAN CHRISTOPHER , LI ZHAOHUA
Published: January 2019

This paper examines the effect of bank competition on bank liquidity creation and explores whether the effect varies by the diversification level of banks, using a sample of Malaysian banks from 2001 to 2017. Our preliminary analysis shows that the aggregate, on- and off-balance sheet liquidity creation of banks decreases when their market power drops, suggesting an adverse effect of bank competition on bank liquidity creation. However, the adverse effect diminishes or disappears for highly diversified banks, and this result holds for both asset and income diversification. The results identify diversification as a “buffer” through which banks could insure their liquidity creation business against competition by generating new income sources for the banks and enhancing their tolerance to intermediation margin compression.
SOCIAL INSURANCE UNDER FRAUD AND REDISTRIBUTIVE TAXATION
Authors: WU TSAUR-CHIN MICHAEL , YEN CHIH-TA , HUANG CHE-CHIANG , HU JIN-LI
Published: January 2019

This paper examines the equity and efficiency effects of social insurance in the presence of insurance fraud and linear income taxes and shows the following findings. (i) Under the commonly accepted assumption of decreasing absolute risk aversion (DARA), the social insurance benefit may increase insurance fraud, whereas raising the marginal tax rate (lumpsum transfer) of the linear income tax also causes insurance fraud to increase (decrease). (ii) Equity and efficiency effects of social insurance are conflicting rather than complementary with each other.
Auto Focusing Method of Imaging System of Digital PCR Instrument Based on BP Neural Network
Authors: Chen Shanxiong , Xie Xueqing , Zheng Fangyuan , Wu Sheng
Published: January 2019

The digital PCR instrument is a digital instrument for amplifying specific DNA fragments. The problem studied in this paper is the autofocus problem of its electronic imaging device. Based on the analysis of existing SOM neural network autofocus scheme, we propose an improved scheme-BP neural network for autofocus. It directly takes the SOM input and the actual focus position as the input and output of the BP neural network, which eliminates the process of prior classification and then corresponding to the focus matrix in the original SOM scheme, saving time. The experimental results show that the traditional autofocus method has good focusing effect, but the speed is slow, and the universality of the BP neural network autofocus scheme is not good enough, but within a good accuracy range, the speed is faster. Compared to traditional focusing methods, the autofocus scheme designed in this paper successfully achieves faster focusing speed for biochips.
A Set of New Hermite Kernel Functions in Kernel Extreme Learning Machine and Application in Human Action Recognition
Authors: Liu Xueping , Yue Xingzuo
Published: January 2019

The kernel function has been successfully utilized in the extreme learning machine (ELM) that provides a stabilized and generalized performance and greatly reduces the computational complexity. However, the selection and optimization of the parameters constituting the most common kernel functions are tedious and time-consuming. In this study, a set of new Hermit kernel functions derived from the generalized Hermit polynomials has been proposed. The significant contributions of the proposed kernel include only one parameter selected from a small set of natural numbers; thus, the parameter optimization is greatly facilitated and excessive structural information of the sample data is retained. Consequently, the new kernel functions can be used as optimal alternatives to other common kernel functions for ELM at a rapid learning speed. The experimental results showed that the proposed kernel ELM method tends to have similar or better robustness and generalized performance at a faster learning speed than the other common kernel ELM and support vector machine methods. Consequently, when applied to human action recognition by depth video sequence, the method also achieves excellent performance, demonstrating its time-based advantage on the video image data.
Research and Design of Knowledge System Construction System Based on Natural Language Processing
Authors: Chen Keliang , Zu Yunxiao , Ren Weizheng
Published: January 2019

The digital processing of content resources has subverted the traditional paper content processing model and has also spread widely. The digital resources processed by text structure need to be structured and processed by professional knowledge, which can be saved as a professional digital content resource of knowledge base and provide basic metadata for intelligent knowledge service platform. The professional domain-based knowledge system construction system platform explored in this study is designed based on natural language processing. Natural language processing is an important branch of artificial intelligence, which is the application of artificial intelligence technology in linguistics. The system first extracts the professional thesaurus and domain ontology in the digital resources and then uses the new word discovery algorithm based on the label weight designed by artificial intelligence technology to intelligently extract and clean the new words of the basic thesaurus. At the same time, the relationship system between knowledge points and elements is established to realize the association extraction of targeted knowledge points, and finally the output content is enriched from knowledge points into related knowledge systems. In order to improve the scalability and universality of the system, the extended architecture of the thesaurus, algorithms, computational capabilities, tags, and exception thesaurus was taken into account when designing. At the same time, the implementation of “artificial intelligence [Formula: see text] manual assistance” was adopted. On the basis of improving the system availability, the experimental basis of the optimization algorithm is provided. The results of this research will bring an artificial intelligence innovation after the digitization to the publishing industry and will transform the content service into an intelligent service based on the knowledge system.
Ernest M. Henley’s scientific publications
Authors: Kisslinger Leonard S.
Published: January 2019

In the present paper, we discuss Professor Henley’s published research with Leonard S. Kisslinger and other collaborators.
FRACTAL-BASED ANALYSIS OF THE EFFECT OF MACHINING PARAMETERS ON SURFACE FINISH OF WORKPIECE IN TURNING OPERATION
Authors: PATHIRANAGAMA GEEVIN JITHMAL , NAMAZI HAMIDREZA
Published: January 2019

Analysis of workpiece surface quality is one of the major issues in manufacturing engineering. Turning operation is a famous machining operation that is widely used in machining of materials. In this research, we investigate the surface finish of machined workpiece from turning operation. For this purpose, we employ fractal theory to study the complex structure of machined workpiece’s surface in different conditions. The applied parameters include the variations of cutting depth, feed rate and spindle speed in wet and dry machining conditions. Based on the obtained results, we found the correlation between the increment of fractal dimension of machined surface and the increment of cutting depth, feed rate and spindle speed in wet machining condition. The obtained results will be discussed in relation with the complexity of machined surface. The employed method of analysis in this research can be widely applied to the analysis of the effect of different machining parameters and conditions on the surface quality of machined workpiece in case of different machining operations.
GENERALIZED ITERATED FUNCTION SYSTEMS ON HYPERBOLIC NUMBER PLANE
Authors: TÉLLEZ-SÁNCHEZ GAMALIEL YAFTE , BORY-REYES JUAN
Published: January 2019

Iterated function systems provide the most fundamental framework to create many fascinating fractal sets. They have been extensively studied when the functions are affine transformations of Euclidean spaces. This paper investigates the iterated function systems consisting of affine transformations of the hyperbolic number plane. We show that the basics results of the classical Hutchinson–Barnsley theory can be carried over to construct fractal sets on hyperbolic number plane as its unique fixed point. We also discuss about the notion of hyperbolic derivative of an hyperbolic-valued function and then we use this notion to get some generalization of cookie-cutter Cantor sets in the real line to the hyperbolic number plane.
Materialized View Maintenance: Issues, Classification, and Open Challenges
Authors: Sebaa Abderrazak , Tari Abdelkamel
Published: January 2019

Views materialization is a powerful technique for optimization of query evaluation. However, when data sources are updated, these materialized views (MVs) should be maintained in order to get appropriate queries’ answers. This work provides an overview of the research field of view maintenance, focusing on view maintenance issues and dimensions that cover the most important ones proposed in the literature review. We provide a classification and review the state-of-the-art of view maintenance approaches according to several parameters characterizing their algorithms, including information considered during the view maintenance process, principle used, and the execution mechanism. We provide the most important performance evaluation metrics of view maintenance process while performing a comparative study of some important approaches. Lastly, we give comprehensive perspectives on view maintenance in the different promising environments of MV applications.
DEFAULTABLE CLAIMS IN SWITCHING MODELS WITH PARTIAL INFORMATION
Authors: GAPEEV PAVEL V. , JEANBLANC MONIQUE
Published: January 2019

We study a credit risk model for a financial market in which the local drift rate of the logarithm of the intensity of the default time changes at the times at which certain unobservable external events occur. The risk-neutral dynamics of the default intensity are described by a generalized geometric Brownian motion and the changes of the local drift rate arrive at independent exponential times. We obtain closed form expressions for the rational values of defaultable European-style contingent claims through the filtering estimates of the occurrence of switching times given the filtration generated by the default intensity process.
Slow manifolds for dynamical systems with non-Gaussian stable Lévy noise
Authors: Yuan Shenglan , Hu Jianyu , Liu Xianming , Duan Jinqiao
Published: January 2019

This work is concerned with the dynamics of a class of slow–fast stochastic dynamical systems driven by non-Gaussian stable Lévy noise with a scale parameter. Slow manifolds with exponentially tracking property are constructed, and then we eliminate the fast variables to reduce the dimensions of these stochastic dynamical systems. It is shown that as the scale parameter tends to zero, the slow manifolds converge to critical manifolds in distribution, which helps to investigate long time dynamics. The approximations of slow manifolds with error estimate in distribution are also established. Furthermore, we corroborate these results by three examples from biological sciences.