bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical Analysis of Non-Radial Blading in a Low Speed and Low Pressure Turbine for Electric Turbocompounding Applications
Authors: Alvarez-Regueiro Eva , Barrera-Medrano Esperanza , Martinez-Botas Ricardo , Rajoo Srithar
Published: September 2021

This paper presents a CFD-based numerical analysis on the potential benefits of non-radial blading turbine for low speed-low pressure applications. Electric turbocompounding is a waste heat recovery technology consisting of a turbine coupled to a generator that transforms the energy left over in the engine exhaust gases, which is typically found at low pressure, into electricity. Turbines designed to operate at low specific speed are ideal for these applications since the peak efficiency occurs at lower pressure ratios than conventional high speed turbines. The baseline design consisted of a vaneless radial fibre turbine, operating at 1.2 pressure ratio and 28,000rpm. Experimental low temperature tests were carried out with the baseline radial blading turbine at nominal, lower and higher pressure ratio operating conditions to validate numerical simulations. The baseline turbine incidence angle effect was studied and positive inlet blade angle impact was assessed in the current paper. Four different turbine rotor designs of 20, 30, 40 and 50° of positive inlet blade angle are presented, with the aim to reduce the losses associated to positive incidence, specially at midspan. The volute domain was included in all CFD calculations to take into account the volute-rotor interactions. The results obtained from numerical simulations of the modified designs were compared with those from the baseline turbine rotor at design and off-design conditions. Total-to-static efficiency improved in all the non-radial blading designs at all operating points considered, by maximum of 1.5% at design conditions and 5% at off-design conditions, particularly at low pressure ratio. As non-radial fibre blading may be susceptible to high centrifugal and thermal stresses, a structural analysis was performed to assess the feasibility of each design. Most of non-radial blading designs showed acceptable levels of stress and deformation.
Reducing Uncertainty in the Onset of Combustion Instabilities Using Dynamic Pressure Information and Bayesian Neural Networks
Authors: McCartney Michael , Sengupta Ushnish , Juniper Matthew
Published: September 2021

Modern, low emission combustion systems with improved fuel-air mixing are more prone to combustion instabilities and therefore use advanced control methods to balance minimum NOx emissions and and the presence of thermoacoustic combustion instabilities. The exact operating conditions at which the system encounters an instability is uncertain because of sources of stochasticity, such as turbulent combustion, and the influence of hidden variables, such as un-measured wall temperatures or differences in machine geometry within manufacturing tolerances. Practical systems tend to be more elaborate than laboratory systems and tend to have less instrumentation, meaning that they suffer more from uncertainty induced by hidden variables. In many commercial systems, the only direct measurement of the combustor comes from a dynamic pressure sensor. In this study we train a Bayesain Neural Network (BNN) to predict the probability of onset of thermoacoustic instability at various times in the future, using only dynamic pressure measurements and the current operating condition. We show that, on a practical system, the error in the onset time predicted by the BNNs is 45% lower than the error when using the operating condition alone and more informative than the warning provided by commonly used precursor detection methods. This is demonstrated on two systems: (i) a premixed hydrogen/methane annular combustor, where the hidden variables are wall temperatures that depend on the rate of change of operating condition, and (ii) full scale prototype combustion system, where the hidden variables arise from differences between the systems.
Validating Soot Models in LES of Turbulent Flames: The Contribution of Soot Subgrid Intermittency Model to The Prediction of Soot Production in an Aero-Engine Model Combustor
Authors: Pereira Tardelli Lívia , Darabiha Nasser , Veynante Denis , Franzelli Benedetta
Published: September 2021

Predicting soot production in industrial systems using an LES approach represents a great challenge. Besides the complexity in modeling the multi-scale physicochemical soot processes and their interaction with turbulence, the validation of newly developed models is critical under turbulent conditions. This work illustrates the difficulties in evaluating model performances specific to soot prediction in turbulent flames by considering soot production in an aero-engine combustor. It is proven that soot production occurs only for scarce local gaseous conditions. Therefore, to obtain a statistical representation of such rare soot events, massive CPU resources would be required. For this reason, evaluating soot model performances based on parametric studies, i.e., multiple simulations, as classically done for purely gaseous flames, is CPU high-demanding for sooting flames. Then, a new strategy to investigate modeling impact on the solid phase is proposed. It is based on a unique simulation, where the set of equations describing the solid phase are duplicated. One set accounts for the reference model, while the other set is treated with the model under the scope. Assuming neglected solid phase retro-coupling on the gas phase, the soot scalars from both sets experience the same unique temporal and spatial gas phase evolution isolating the soot model effects from the uncertainties on gaseous models and numerical sensitivities. Finally, the strategy capability is proven by investigating the contribution of the soot subgrid intermittency model to the prediction of soot production in the DLR burner.
The Development of Turboexpander-Generators for Gas Pressure Letdown Part II: Economic Analysis
Authors: Liu Jeremy , Khatri Rasish , Sarhan Freddie , Blumber Eric
Published: September 2021

A family of “flow-through” turboexpander-generators (TEGs) has been developed by Calnetix Technologies for hydrogen and natural gas pressure letdown applications. A flow-through TEG includes an axial expansion turbine and can be installed directly between two flanges of an existing pipeline. TEGs can be used to generate power throughout the hydrogen and natural gas transmission infrastructure using existing pressure differentials wherever a Joule-Thomson valve is located. These can be upstream, at terminal stations, and downstream, at governor stations. The expander drives a synchronous permanent magnet high-speed generator supported by active magnetic bearings. This paper describes the innovative axial flow-through system architecture, including the use of process gas for cooling the generator rotor and stator. The primary focus of the paper is the economic analysis of the application. Various TEG subsystem design choices and their impact on cost are discussed, including the generator, bearing, expander wheel, seal, and touchdown bearing resilient mount designs. A payback analysis shows that the natural gas TEG has a payback of 2.1 years when a heat exchanger is required for preheating the gas and 1.9 years when waste heat can be used. The hydrogen TEG has a payback of 2.0 years, and does not require external preheating. Finally, a comparison of this technology with other clean energy solutions is presented, using the Levelized Cost of Electricity (LCOE) formulation. The analysis confirms that the LCOE of the expander-generator ($0.40 per megawatt-hour) compares favorably with other types of conventional and renewable energy technologies on a cost basis.
Fast Reconstruction Method of the Stress Field for the Steam Turbine Rotor Based on Deep Fully Convolutional Network
Authors: Guo Ding , Liu Tianyuan , Zhang Di , Xie Yonghui
Published: September 2021

Since it is difficult to directly measure the transient stress of a steam turbine rotor in operation, a rotor stress field reconstruction model based on deep fully convolutional network for the start-up process is proposed. The stress distribution in the rotor can be directly predicted based on the temperature of a few measurement points. First, the finite element model is used to accurately simulate the temperature and stress field of the rotor start-up process, generating training data for the deep learning method. Next, data of only 15 temperature measurement points are arranged to predict the stress distribution in critical area of the rotor surface, with the accuracy (R2-score) reaching 0.997. The time cost of the trained neural network model at a single case is 1.42s in CPUs and 0.11s in GPUs, shortened by 97.3% and 99.8% with comparison to finite element analysis, respectively. In addition, the influence of the number of temperature measurement points and the training size are discussed, verifying the stability of the model. With the advantages of fast calculation, high accuracy and strong stability, the fast reconstruction model can effectively realize the stress prediction during start-up processes, resulting in the possibility of real-time diagnosis of rotor strength in operation.
The Nature of Finger Enslaving: New Results and Their Implications
Authors: Abolins Valters , Latash Mark L.
Published: September 2021

We present a review on the phenomenon of unintentional finger action seen when other fingers of the hand act intentionally. This phenomenon (enslaving) has been viewed as a consequence of both peripheral (e.g., connective tissue links and multifinger muscles) and neural (e.g., projections of corticospinal pathways) factors. Recent studies have shown relatively large and fast drifts in enslaving toward higher magnitudes, which are not perceived by subjects. These and other results emphasize the defining role of neural factors in enslaving. We analyze enslaving within the framework of the theory of motor control with spatial referent coordinates. This analysis suggests that unintentional finger force changes result from drifts of referent coordinates, possibly reflecting the spread of cortical excitation.
Postnatal immune activation causes social deficits in a mouse model of tuberous sclerosis: Role of microglia and clinical implications
Authors: López-Aranda Manuel F. , Chattopadhyay Ishanu , Boxx Gayle M. , Fraley Elizabeth R. , Silva Tawnie K. , Zhou Miou , Phan Miranda , Herrera Isaiah , Taloma Sunrae , Mandanas Rochelle , Bach Karen , Gandal Michael , Geschwind Daniel H. , Cheng Genhong , Rzhetsky Andrey , White Stephanie A. , Silva Alcino J.
Published: September 2021

Postnatal immune activation leads to social deficits in a mouse model of TSC by abnormal interferon production in microglia.
An electron walks into a quantum bar…
Authors: Carbone Fabrizio
Published: September 2021

Quantum electron-light interaction may find use in microscopy applications
Differential requirement for the Polycomb repressor complex 2 in dendritic cell and tissue-resident myeloid cell homeostasis
Authors: Zhan Yifan , Zhang Yuxia , Zhang Shengbo , Coughlan Hannah , Baldoni Pedro L. , Jacquelot Nicolas , Cao Wang H.J. , Preston Simon , Louis Cynthia , Rautela Jai , Pellegrini Marc , Wicks Ian P. , Alexander Warren S. , Harrison Leonard C. , Lew Andrew M. , Smyth Gordon K. , Nutt Stephen L. , Chopin Michaël
Published: September 2021

PRC2 is essential for the self-renewal of tissue-resident macrophages but dispensable for dendritic cell development and function.
Complete Genome Sequences of Three of the Earliest Community-Associated Methicillin-Resistant Staphylococcus aureus Strains Isolated in Remote Western Australia
Authors: Karakatsanis Nicola M. , Colombi Elena , Mowlaboccus Shakeel , Pearson Julie C. , Coombs Geoffrey W. , Ramsay Joshua P.
Published: September 2021

Initially reported in Western Australia in the 1980s, community-associated methicillin-resistant
Staphylococcus aureus
(CA-MRSA) has become a major cause of
S. aureus
infections globally. We report the complete genome sequences of three of the earliest CA-MRSA strains isolated from remote Australian Indigenous communities in the Kimberley region of Western Australia.
Complete Genome Sequence of Bacillus subtilis BYS2, a Strain with a Broad Inhibitory Spectrum against Pathogenic Bacteria
Authors: Guo Mengjiao , Liu Donghui , Chai Tongjie
Published: September 2021

Bacillus subtilis
BYS2 is a strain with a broad inhibitory spectrum against pathogenic bacteria. In the current study, we report the complete genome sequence of
Bacillus subtilis
BYS2. The chromosome of BYS2 (4,030,791 bp; G+C content, 43.88%) contained 3,914 protein-encoding genes, with 86 tRNAs, 30 rRNAs, and 5 noncoding RNAs (ncRNAs).
Lymphoedema praecox in a young woman: a rare disease
Authors: Vemulakonda Sri Hari Priya , Gaur Naveen Kumar , Shaikh Oseen Hajilal , Kumbhar Uday Shamrao
Published: September 2021

Primary lymphoedema is a rare disorder. Often presents at a young age with asymptomatic limb oedema with gradual progression. We present a 16-year-old woman who presented with a history of swelling of the left lower limb for 6 years. There was the presence of isolated left lower limb oedema, which was a non-pitting type. The patient underwent imaging studies and was diagnosed to have primary lymphoedema. The patient was managed conservatively as the patient did not have any other problems other than the left lower limb oedema.
Can high-intensity interval training improve mental health outcomes in the general population and those with physical illnesses? A systematic review and meta-analysis
Authors: Martland Rebecca , Korman Nicole , Firth Joseph , Vancampfort Davy , Thompson Trevor , Stubbs Brendon
Published: September 2021

Objective

High-intensity interval training (HIIT) is a safe and feasible form of exercise. The aim of this meta-analysis was to investigate the mental health effects of HIIT, in healthy populations and those with physical illnesses, and to compare the mental health effects to non-active controls and other forms of exercise.

Design

Random effects meta-analyses were undertaken for randomised controlled trials (RCTs) comparing HIIT with non-active and/or active (exercise) control conditions for the following coprimary outcomes: mental well-being, symptoms of depression, anxiety and psychological stress. Positive and negative affect, distress and sleep outcomes were summarised narratively.

Data sources

Medline, PsycINFO, Embase and CENTRAL databases were searched from inception to 7 July 2020.

Eligibility criteria for selecting studies

RCTs that investigated HIIT in healthy populations and/or those with physical illnesses and reported change in mental well-being, depression, anxiety, psychological stress, positive/negative affect, distress and/or sleep quality.

Results

Fifty-eight RCTs were retrieved. HIIT led to moderate improvements in mental well-being (standardised mean difference (SMD): 0.418; 95% CI: 0.135 to 0.701; n=12 studies), depression severity (SMD: –0.496; 95% CI: −0.973 to −0.020; n=10) and perceived stress (SMD: −0.474; 95% CI: −0.796 to −0.152; n=4) compared with non-active controls, and small improvements in mental well-being compared with active controls (SMD:0.229; 95% CI: 0.054 to 0.403; n=12). There was a suggestion that HIIT may improve sleep and psychological distress compared with non-active controls: however, these findings were based on a small number of RCTs.

Conclusion

These findings support the use of HIIT for mental health in the general population.

Level of evidence

The quality of evidence was moderate-to-high according to the Grading of Recommendations Assessment, Development and Evaluation) criteria.

PROSPERO registration number

CRD42020182643
Association between tissue oxygenation and myocardial injury in patients undergoing major spine surgery: a prospective cohort study
Authors: Bernholm Katrine Feldballe , Meyhoff Christian S. , Bickler Philip
Published: September 2021

Objective

To describe the association between intraoperative tissue oxygenation and postoperative troponin elevation in patients undergoing major spine surgery. We hypothesised that a decrease in intraoperative skeletal muscle tissue oxygenation (SmO2) was associated with the peak postoperative cardiac troponin value.

Design

This is a prospective cohort study.

Setting

Single-centre, University of California San Francisco Medical Center.

Participants

Seventy adult patients undergoing major elective spine surgery.

Primary and secondary outcome measures

High-sensitivity troponin T (hsTnT) was measured in plasma preoperatively and on the first and second day after surgery to assess the primary outcome of peak postoperative hsTnT. Secondary outcomes included MINS and intensive care unit (ICU) admission within 30 days. Skeletal cerebral tissue oxygenation and SmO2was measured continuously with near-infrared spectroscopy during surgery. The primary exposure variable was time-weighted area under the curve (TW AUC) for SmO2.

Results

Mean age was 65 (33–85) years and 59% were female. No significant association was found between TW AUC for SmO2and peak hsTnT (Spearman’s correlation, rs=0.17, p=0.16). A total of 28 (40%) patients had MINS. ICU admission occurred in 14 (40%) in lower vs 25 (71%) in upper half of patients based on TW AUC for SmO2, p=0.008.

Conclusions

Decrease in SmO2was not a statistically significant predictor for peak troponin value following major spine surgery but is a potential predictor for other postoperative complications.

Trial registration number

NCT03518372.
‘NOPAIN-ROP’ trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial
Authors: Madathil Shamnad , Thomas Deena , Chandra Parijat , Agarwal Ramesh , Sankar M Jeeva , Thukral Anu , Deorari Ashok
Published: September 2021

Objectives

To investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP).

Design

Open-label randomised trial.

Setting

Tertiary care institution.

Participants

Preterm infants who underwent laser photocoagulation for ROP.

Interventions

Infants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase.

Main outcome measures

Proportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.

Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure.

Results

A total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine.

Conclusions

Fentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings.

Trial registration number

CTRI/2018/03/012878.
Effect of ethnicity and other sociodemographic factors on attendance at diabetic eye screening: a 12-month retrospective cohort study
Authors: Olvera-Barrios Abraham , Seltene Michael , Heeren Tjebo F C , Chambers Ryan , Bolter Louis , Tufail Adnan , Owen Christopher G , Rudnicka Alicja R , Egan Catherine , Anderson John
Published: September 2021

Objectives

To examine the association of sociodemographic characteristics with attendance at diabetic eye screening in a large ethnically diverse urban population.

Design

Retrospective cohort study.

Setting

Screening visits in the North East London Diabetic Eye Screening Programme (NELDESP).

Participants

84 449 people with diabetes aged 12 years or older registered in the NELDESP and scheduled for screening between 1 April 2017 and 31 March 2018.

Main outcome measure

Attendance at diabetic eye screening appointments.

Results

The mean age of people with diabetes was 60 years (SD 14.2 years), 53.4% were men, 41% South Asian, 29% White British and 17% Black; 83.4% attended screening. Black people with diabetes had similar levels of attendance compared with White British people. However, South Asian, Chinese and 'Any other Asian' background ethnicities showed greater odds of attendance compared with White British. When compared with their respective reference group, high levels of deprivation, younger age, longer duration of diabetes and worse visual acuity, were all associated with non-attendance. There was a higher likelihood of attendance per quintile improvement in deprivation (OR, 1.06; 95% CI, 1.03 to 1.08), with increasing age (OR per decade, 1.17; 95% CI, 1.15 to 1.19), with better visual acuity (OR per Bailey-Lovie chart line 1.12; 95% CI, 1.11 to 1.14) and with longer time of NELDESP registration (OR per year, 1.02; 95% CI, 1.01 to 1.03).

Conclusion

Ethnic differences in diabetic eye screening uptake, though small, are evident. Despite preconceptions, a higher likelihood of screening attendance was observed among Asian ethnic groups when compared with the White ethnic group. Poorer socioeconomic profile was associated with higher likelihood of non-attendance for screening. Further work is needed to understand how to target individuals at risk of non-attendance and reduce inequalities.
Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): psychosocial consequences and impact on health-related quality of life—a multicentre prospective cross-sectional study
Authors: Andersson Elisabeth , Dai Ydrefelt Ying , Johannesson Marit , Lundbäck Maria , Mannila Maria , Persson Margaretha , Swahn Eva , Bolejko Anetta
Published: September 2021

Objectives

To investigate whether surveillance of pulmonary nodules detected with low-dose CT (LDCT) impacted health-related quality of life and psychosocial consequences in the Swedish population-based study, Swedish CArdioPulmonary bioImage Study (SCAPIS).

Design

A prospective cross-sectional study.

Settings and participants

This multicentre (five sites) observational study, which included a cohort from SCAPIS, consisted of 632 participants with indeterminate pulmonary nodules detected with LDCT. These participants continued surveillance for up to 36 months, during which lung cancer was not detected (surveillance group). Additionally, 972 participants with a negative pulmonary LDCT scan were included as a control group. Matching criteria were LDCT date (±2 weeks), gender and site.

Outcome measures

All participants completed a health-related quality of life questionnaire (RAND-36) and the Consequences of Screening (COS) questionnaire, an average of 3 years after LDCT was conducted at entry into SCAPIS.

Results

Participants were 51–70 years old at study commencement. Overall, the two groups did not differ in demographic or psychosocial variables, smoking habits or pulmonary medical history. Individuals from countries other than Sweden and those with low socioeconomic status were less likely to participate (p<0.001). No effects on health-related quality of life were observed via RAND-36. In COS, the surveillance group demonstrated a higher OR for anxiety about lung cancer (OR 3.96, 95% CI 2.35 to 6.66, p<0.001), experiencing a sense of dejection (OR 1.35, 95% CI 1.06 to 1.72, p=0.015) and thoughts about existential values (OR 1.30, 95% CI 1.04 to 1.60, p=0.018).

Conclusions

Lung surveillance with LDCT contributed to significant experiences of sense of dejection, anxiety about lung cancer and development of thoughts about existential values among participants in the surveillance group compared with the controls. The risk of side effects should be communicated for informed decision-making about (non-)attendance in lung cancer screening.
Identification and comparison of key criteria of feedback of funding decisions: mixed-methods analysis of funder and applicant perspectives
Authors: Fackrell Kathryn , Meadmore Katie , Recio-Saucedo Alejandra , Bull Abby , Fraser Simon , Blatch-Jones Amanda
Published: September 2021

Objective

This study investigated the content, quality and value of feedback given to applicants who applied to one of four research programmes in the UK funded (or jointly funded) by the National Institute for Health Research (NIHR).

Methods

A mixed-method phased approach was conducted using document analysis and an online survey. Phase 1 examined 114 NIHR applicant feedback documents comprised written feedback from funding committees and external peer-reviewers and a conceptual framework of the key components of feedback was developed using content analysis. Phase 2 was an online survey completed by 113 NIHR applicants. Frequencies of responses to closed questions were calculated. Perceptions of quality and value of feedback were identified using content analysis of open-text responses.

Results

In phase 1, a conceptual framework was developed with seven overarching categories: ‘Study structure and quality’; ‘Team and infrastructure’; ‘Acceptability to patients and professionals’; ‘Study justification and design’; ‘Risks and contingencies’; ‘Outputs’; ‘Value for money’. A higher frequency of feedback was provided at stage 2 and for successful applications across the majority of components. In phase 2, frequency data showed that opinion on feedback was dependent on funding outcome. Content analysis revealed four main themes: ‘Committee transparency’; ‘Content validity and reliability’; ‘Additional support’; Recognition of effort and constraints’.

Conclusions

This study provides key insights and understanding into the quality, content and value of feedback provided to NIHR applicants. The study identified key areas for improvement that can arise in NIHR funding applications, as well as in the feedback given to applicants that are applicable to other funding organisations. These findings could be used to inform funding application guidance documents to help researchers strengthen their applications and used more widely by other funders to inform their feedback processes.
Delirium and neuropsychological outcomes in critically Ill patients with COVID-19: a cohort study
Authors: Ragheb Jacqueline , McKinney Amy , Zierau Mackenzie , Brooks Joseph , Hill-Caruthers Maria , Iskander Mina , Ahmed Yusuf , Lobo Remy , Mentz Graciela , Vlisides Phillip E
Published: September 2021

Objective

To characterise the clinical course of delirium for patients with COVID-19 in the intensive care unit, including postdischarge neuropsychological outcomes.

Design

Retrospective chart review and prospective survey study.

Setting

Intensive care units, large academic tertiary-care centre (USA).

Participants

Patients (n=148) with COVID-19 admitted to an intensive care unit at Michigan Medicine between 1 March 2020 and 31 May 2020 were eligible for inclusion.

Primary and secondary outcome measures

Delirium was the primary outcome, assessed via validated chart review method. Secondary outcomes included measures related to delirium, such as delirium duration, antipsychotic use, length of hospital and intensive care unit stay, inflammatory markers and final disposition. Neuroimaging data were also collected. Finally, a telephone survey was conducted between 1 and 2 months after discharge to determine neuropsychological function via the following tests: Family Confusion Assessment Method, Short Blessed Test, Patient-Reported Outcomes Measurement Information System Cognitive Abilities 4a and Patient-Health Questionnaire-9.

Results

Delirium was identified in 108/148 (73%) patients, with median (IQR) duration lasting 10 (4–17) days. In the delirium cohort, 50% (54/108) of patients were African American and delirious patients were more likely to be female (76/108, 70%) (absolute standardised differences >0.30). Sedation regimens, inflammation, delirium prevention protocol deviations and hypoxic-ischaemic injury were likely contributing factors, and the most common disposition for delirious patients was a skilled care facility (41/108, 38%). Among patients who were delirious during hospitalisation, 4/17 (24%) later screened positive for delirium at home based on caretaker assessment, 5/22 (23%) demonstrated signs of questionable cognitive impairment or cognitive impairment consistent with dementia and 3/25 (12%) screened positive for depression within 2 months after discharge.

Conclusion

Patients with COVID-19 commonly experience a prolonged course of delirium in the intensive care unit, likely with multiple contributing factors. Furthermore, neuropsychological impairment may persist after discharge.
Comparison of FORTA, PRISCUS and EU(7)-PIM lists on identifying potentially inappropriate medication and its impact on cognitive function in multimorbid elderly German people in primary care: a multicentre observational study
Authors: Krüger Caroline , Schäfer Ingmar , van den Bussche Hendrik , Bickel Horst , Dreischulte Tobias , Fuchs Angela , König Hans-Helmut , Maier Wolfgang , Mergenthal Karola , Riedel-Heller Steffi G , Schön Gerhard , Weyerer Siegfried , Wiese Birgitt , von Renteln-Kruse Wolfgang , Langebrake Claudia , Scherer Martin
Published: September 2021

Objectives

Our study aimed to assess the frequency of potentially inappropriate medication (PIM) use (according to three PIM lists) and to examine the association between PIM use and cognitive function among participants in the MultiCare cohort.

Design

MultiCare is conducted as a longitudinal, multicentre, observational cohort study.

Setting

The MultiCare study is located in eight different study centres in Germany.

Participants

3189 patients (59.3% female).

Primary and secondary outcome measures

The study had a cross-sectional design using baseline data from the German MultiCare study. Prescribed and over-the-counter drugs were classified using FORTA (Fit fOR The Aged), PRISCUS (Latin for ‘time-honoured’) and EU(7)-PIM lists. A mixed-effect multivariate linear regression was performed to calculate the association between PIM use patients’ cognitive function (measured with (LDST)).

Results

Patients (3189) used 2152 FORTA PIM (mean 0.9±1.03 per patient), 936 PRISCUS PIM (0.3±0.58) and 4311 EU(7)-PIM (1.4±1.29). The most common FORTA PIM was phenprocoumon (13.8%); the most prevalent PRISCUS PIM was amitriptyline (2.8%); the most common EU(7)-PIM was omeprazole (14.0%). The lists rate PIM differently, with an overall overlap of 6.6%. Increasing use of PIM is significantly associated with reduced cognitive function that was detected with a correlation coefficient of −0.60 for FORTA PIM (p=0.002), −0.72 for PRISCUS PIM (p=0.025) and −0.44 for EU(7)-PIM (p=0.005).

Conclusion

We identified PIM using FORTA, PRISCUS and EU(7)-PIM lists differently and found that PIM use is associated with cognitive impairment according to LDST, whereby the FORTA list best explained cognitive decline for the German population. These findings are consistent with a negative impact of PIM use on multimorbid elderly patient outcomes.

Trial registration number

ISRCTN89818205.
Safety and effectiveness of dose-sparing strategies for intramuscular seasonal influenza vaccine: a rapid scoping review
Authors: Lunny Carole , Antony Jesmin , Rios Patricia , Williams Chantal , Ramkissoon Naveeta , Straus Sharon E , Tricco Andrea C
Published: September 2021

Background

The objective of this rapid scoping review was to identify studies of dose-sparing strategies for administration of intramuscular seasonal influenza vaccines in healthy individuals of all ages.

Methods

Comprehensive literature searches were executed in MEDLINE, Embase and the Cochrane library. The grey literature was searched via international clinical trial registries for relevant studies published in English in the last 20 years. We included studies in healthy humans of any age that used any dose-sparing strategy to administer intramuscular seasonal influenza vaccines. Title/abstract and full-text screening were carried out by pairs of reviewers independently. Data extraction was conducted by a single reviewer and verified by a second reviewer. Our outcomes were influenza infections, intensive care unit admission, pneumonia, hospitalisations, adverse events and mortality. Results were summarised descriptively.

Results

A total of 13 studies with 10 351 participants were included in the review and all studies were randomised controlled trials (RCTs) conducted between 2006 and 2019. The most common interventions were the trivalent influenza vaccine (n=10), followed by the quadrivalent influenza vaccine (n=4). Nine studies included infants/toddlers 6–36 months old and one of these studies also included children and adolescents. In these nine studies, no clinical effectiveness outcomes were reported. Of the four adult studies (≥18 years), two studies reported on effectiveness outcomes, however, only one RCT reported on laboratory-confirmed influenza.

Conclusions

Due to the low number of studies in healthy adults and the lack of studies assessing confirmed influenza and influenza-like illness, there remains a need for further evaluation.
Study protocol for yoga-based lifestyle intervention for healthy ageing phenotype in the older adults (yHAP): a two-armed, waitlist randomised controlled trial with multiple primary outcomes
Authors: Majumdar Vijaya , Snigdha Atmakur , Manjunath N K , Nagarathna Raghuram , Mavathur Ramesh , Singh Amit , S R Kalpana , H R Nagendra
Published: September 2021

Introduction

The conceptualisation of healthy ageing phenotype (HAP) and the availability of a tentative panel for HAP biomarkers raise the need to test the efficacy of potential interventions to promote health in older adults. This study protocol reports the methodology for a 24-week programme to explore the holistic influence of the yoga-based intervention on the (bio)markers of HAP.

Methods and analysis

The study is a two-armed, randomised waitlist controlled trial with blinded outcome assessors and multiple primary outcomes. We aim to recruit 250 subjects, aged 60–80 years from the residential communities and old age clubs in Bangalore city, India, who will undergo randomisation into intervention or control arms (1:1). The intervention will include a yoga-based programme tailored for the older adults, 1 hour per day for 6 days a week, spread for 24 weeks. Data would be collected at the baseline and post-intervention, the 24th week. The multiple primary outcomes of the study are the (bio)markers of HAP: glycated haemoglobin, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, and forced expiratory volume in 1 s for physiological and metabolic health; Digit Symbol Substitution Test, Trail Making Tests A and B for cognition; hand grip strength and gait speed for physical capability; loneliness for social well-being and WHO Quality of Life Instrument-Short Form for quality of life. The secondary outcomes include inflammatory markers, tumour necrosis factor-alpha receptor II, C reactive protein, interleukin 6 and serum Klotho levels. Analyses will be by intention-to-treat and the holistic impact of yoga on HAP will be assessed using global statistical test.

Ethics and dissemination

The study is approved by the Institutional Ethics Committee of Swami Vivekananda Yoga Anusandhana Samsthana University, Bangalore (ID: RES/IEC-SVYASA/143/2019). Written informed consent will be obtained from each participant prior to inclusion. Results will be available through research articles and conferences.

Trial registration number

CTRI/2021/02/031373.
Experiences of trial participants and site staff of participating in and running a large randomised trial within fertility (the endometrial scratch trial): a qualitative interview study
Authors: Chatters Robin , White David , Pye Clare , Petrovic Ana , Sizer Anya , Kumar Pavithra , Metwally Mostafa
Published: September 2021

Objectives

To explore the experiences of endometrial scratch (ES) trial participants and site staff of trial recruitment and participation, in order to improve the experience of participants in future trials.

Design

Qualitative study of a subset of participants in the ES randomised controlled trial and a subset of trial site staff.

Setting

A purposeful sample of 9 of the 16 UK Fertility Units that participated in the trial.

Participants

A purposeful sample of 27 trial participants and 7 site staff.

Results

Participants were largely happy with the recruitment practices, however, some were overwhelmed with the amount of information received. Interviewees had positive preconceptions regarding the possible effect of the ES on the outcome of their in vitro fertilisation (IVF) cycle, which often originated from their own internet research and seemed to be exacerbated by how site staff described the intervention. Some participants appeared to not understand that receiving the ES could potentially reduce their chances of a successful IVF outcome. Those randomised to the control arm discussed feeling discontent; site staff developed mechanisms of dealing with this.

Conclusions

A lack of equipoise in both study participants and the recruiting site staff led to trial participants having positive preconceptions of the potential impact of the ES on their upcoming IVF cycle. Trial participants may not have understood the potential harms of participating in a randomised trial. The trial information sheet did not clearly state this; further research should assess how such information should be presented to potential participants, to proportionately present the level of risk, but to not unduly discourage participation. The amount of information fertility patients require about a research study should also be investigated, in order to avoid participants feeling overwhelmed by the amount of information they receive prior to starting IVF.

Trial registration number

ISRCTN23800982.
Low lung function, sudden cardiac death and non-fatal coronary events in the general population
Authors: Zaigham Suneela , Eriksson Karl-Fredrik , Wollmer Per , Engström Gunnar
Published: September 2021

Background

Many of those who suffer from a first acute coronary event (CE) die suddenly during the day of the event, most of them die outside hospital. Poor lung function is a strong predictor of future cardiac events; however, it is unknown whether the pattern of lung function impairment differs for the prediction of sudden cardiac death (SCD) versus non-fatal CEs. We examined measures of lung function in relation to future SCD and non-fatal CE in a population-based study.

Methods

Baseline spirometry was assessed in 28 584 middle-aged subjects, without previous history of CE, from the Malmö Preventive Project. The cohort was followed prospectively for incidence of SCD (death on the day of a first CE, inside or outside hospital) or non-fatal CE (survived the first day). A modified version of the Lunn McNeil’s competing risk method for Cox regression was used to run models for both SCD and non-fatal CE simultaneously.

Results

A 1-SD reduction in forced expiratory volume in 1 s (FEV1) was more strongly associated with SCD than non-fatal CE even after full adjustment (FEV1: HR for SCD: 1.23 (1.15 to 1.31), HR for non-fatal CE 1.08 (1.04 to 1.13), p value for equal associations=0.002). Similar associations were found for forced vital capacity (FVC) but not FEV1/FVC. The results remained significant even in life-long never smokers (FEV1: HR for SCD: 1.34 (1.15 to 1.55), HR for non-fatal CE: 1.11 (1.02 to 1.21), p value for equal associations=0.038). Similar associations were seen when % predicted values of lung function measures were used.

Conclusions

Low FEV1is associated with both SCD and non-fatal CE, but consistently more strongly associated with future SCD. Measurement with spirometry in early life could aid in the risk stratification of future SCD. The results support the use of spirometry for a global assessment of cardiovascular risk.
Palliative care simulation for internal medicine trainees: development and pilot study
Authors: Dewhurst Felicity , Howorth Kate , Billett Hannah , Brown Jolene , Charles Maxwell , Fleming Elizabeth , Gouldthorpe Craig , Huggin Amy , Kavanagh Emily , Kiltie Rachel , Robinson Lucy , Rowley Grace , Simkiss Lauri , Wakefield Donna , Woods Elizabeth , Churm Deepta , Walmsley Rowan , Waterfield Kerry
Published: September 2021

Objectives

Shape of training has recognised that ‘Managing End-of-Life and Applying Palliative Care Skills’ is a key competency for internal medicine trainees. It provides the opportunity and challenge to improve palliative care training for generalist physicians. Simulation has been recognised internationally as a holistic teaching and assessment method. This study aimed to produce a palliative medicine simulation training package for internal medicine trainees for delivery by palliative medicine trainees providing the former opportunity to practice assessment and management of patients with life-limiting illness and the latter teaching and management opportunities.

Methods

A regional group of palliative medicine trainees were trained in simulation and debrief. Nominal and focus group techniques designed a simulation training package. Learning outcomes were mapped to the internal medicine curriculum descriptors.

Results

Palliative simulation for internal medicine trainees (PALL-SIM-IMT) is a training package meeting internal medicine trainees’ curriculum requirements. Regional pilots have demonstrated feasibility for delivery by palliative medicine trainees and improvement in recipients’ confidence in all curriculum descriptors.

Conclusions

PALL-SIM-IMT can aid competency achievement for the provision of generalist palliative care by internal medicine trainees. It allows reciprocal development of palliative medicine trainees’ leadership and teaching skills. National adoption and evaluation is ongoing.
COVID-19 and beyond: how lessons and evidence from implementation research can benefit health systems’ response and preparedness for COVID-19 and future epidemics
Authors: Diop Nafissatou , Kamal Montasser , Renaud Marie , Naffa Sana
Published: September 2021

Early in the COVID-19 pandemic—and based on limited data on the novel coronavirus—it was projected that African countries will be ravaged and the health systems overwhelmed. Fortunately, Africa has so far defied these dire predictions. Many factors account for the less dramatic outcome, in particular the local know-how gained through dealing with previous epidemics, such as Ebola, and the early and coordinated political and public health response, applying a combination of containment and mitigation measures. However, these same measures, exacerbated by existing inequalities, have had negative impacts on vulnerable populations, notably women and children. Furthermore, the observed deterioration of access to and provision of essential health services will likely continue and worsen in countries experiencing future waves of COVID-19 and lacking access to vaccines. The impact of the pandemic on health systems may be one of Africa’s main COVID-19 challenges and women and children its greatest victims. In this article, we argue that just as learning from previous epidemics and coordinated preparation informed Africa’s response to COVID-19, knowledge, innovations and resources from recent implementation research can be leveraged to mitigate the pandemic’s effects and inform recovery efforts. As an example, we present the proven model and multifaceted approach of the Innovating for Maternal and Child Health in Africa Initiative and describe how such a model could be readily applied to building the robust and equitable systems needed to tackle future stresses and shocks, such as epidemics, on health systems while maintaining essential routine services.
Agents of change: the Gaston Labat awardees past, present, and future—the 2021 Gaston Labat Award lecture
Authors: Enneking F Kayser
Published: September 2021

The prior recipients of the Gaston Labat Award can be thought of as change agents because of their driving desire to challenge and improve the status quo. All of us are interconnected and should seek to collectively work toward meaningful change in our communities. The 2021 Gaston Labat lecture pays tribute to past agents of change and inspires those to come by urging everyone to become involved in the solution.
Assessing gage: an online tool for improving gender visibility in STEMM
Authors: McCullagh Elizabeth A. , Bernardi Francesca , Malta Monica , Nowak Katarzyna , Marklein Alison R. , Horne Katie Van , Clark Tiffany Lee , Cheng Susan J. , Zaringhalam Maryam , Edwards Lauren L.
Published: September 2021

Women continue to be underrepresented and less visible in the fields of science, technology, engineering, mathematics, and medicine (STEMM). 500 Women Scientists created and launched in January 2018 a global (>140 countries to date), online, open-access directory of women in STEMM fields. This directory—recently renamed gage—now also includes gender diverse persons (i.e., additional underrepresented genders) in STEMM fields. The purpose of the directory is to make these scientists’ expertise easier to locate and access for conference organizers, journalists, policy makers, educators, and others. Here, we undertake an assessment of the directory using surveys, Google Analytics, and focus groups to understand its efficacy and direction to date and identify future improvements we pledge to undertake. Through this assessment—conducted externally and in accordance with privacy protocols by Concolor Research—we identified who and how people are using our directory, why people signed up to be a resource, and areas for improvement. Through such assessment, we can learn how to enhance the directory’s efficacy and our broader efforts to boost the visibility of underrepresented people in STEMM.