bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of subcritical water processing on the extraction of compounds, composition, and functional properties of asparagus by‐product
Authors: Iwassa Isabela J. , dos Santos Ribeiro Marcos A. , Meurer Eduardo C. , Cardozo‐Filho Lúcio , Bolanho Beatriz C. , da Silva Camila
Published: April 2019

The aim of this study was to submit the asparagus by‐product to the subcritical water treatment, evaluating the extraction of antioxidants compounds (AC) and total reducing sugars (TRS), as well as, the composition and technological properties of the residual material. The effects of temperature (100–160 °C) and pressure (100–200 bar) on extraction were evaluated, for total extraction time of 120 min. The results showed that the increase in temperature favored the removal of AC and this variable did not cause modification of most of the compounds identified by mass spectra analysis. The highest removal of AC was observed up to 30 min. The increase in temperature decreased the TRS content. The pressure did not affect the extraction of sugars and AC in the conditions evaluated. The treatment was efficient for the modification of the physico‐chemical composition and technological properties of residual material, reducing the TRS content and improving the ratio of soluble fiber to insoluble fiber.

Practical applications

Asparagus by‐product can be an interesting source of nutrients, like dietary fiber and antioxidant compounds. To maximize the antioxidant yield obtained from this by‐product, it can be used the subcritical water extraction (SWE) that is considered a green solvent. Besides this, the SWE promotes the concentration of dietary fibers of the treated material, due to the sugars removal, and improves the functional properties, which can facilitate the utilization of this material in the development of new food products.
Compelling Results That a Problem‐Solving Intervention Improves Hospice Family Caregiver Outcomes
Authors: Cagle John G.
Published: April 2019

This editorial comments on the article by Demiris et al.
Caring for an older person with dementia in the Emergency Department (ED): An Appreciative Inquiry exploring family member and ED nurse experiences
Authors: Watkins Sarah , Murphy Fiona , Kennedy Catriona , Dewar Belinda , Graham Margaret
Published: April 2019

Aims and objectives

To generate insights about what matters and is valued by family members of older people with dementia in the emergency department. To explore the experiences of emergency nurses looking after older people with dementia in an episode of care.

Background

In the emergency department, older people with dementia are at risk of suboptimal care. Little is known of the experiences of family members of being with an older person with dementia in the emergency department or the experiences of emergency nurses looking after older people with dementia in this environment.

Design and methods

Phase 1 Data Analysis of the Discovery Phase of an Appreciative Inquiry study. Study participants were family members of older people with dementia and emergency nurses. Data collection methods included interviews with family members of older people with dementia and 30 hr of participant observation working alongside emergency nurses. This study was guided by the Standards for Reporting Qualitative Research.

Results

Two themes emerged from the analysis: What matters to family members with four subthemes and challenges for family members and nurses in the emergency department with two subthemes.

Conclusion

This study demonstrates that some emergency nurses are connecting with family members even in the briefest of clinical encounters. It is feasible for more emergency nurses to do the same more of the time.

Relevance to clinical practice

The older person with dementia must be given a triage category of no less than 3 (to be seen by the doctor within the hour) on arrival in the department. Further education is needed to assist emergency nurses to establish rapport and incorporate family member insights as part of care planning and assessment of the needs of the older person with dementia.
After Disclosure: A Research Protocol to Respond to Disclosures of Abuse and Sexual Violence in Research With Adults With Intellectual Disabilities
Authors: Sammet Moring Nechama , Parish Susan L. , Mitra Monika , Alterio Nancy A.
Published: April 2019

People with intellectual disabilities (ID) have high lifetime risk of abuse and assault, including sexual violence. As adults with ID participate in research, researchers must be prepared for disclosures of past or current abuse. In collaboration with our state's protective agency, we developed a protocol for responding effectively to disclosures of sexual violence from adult research participants with ID. We completed a literature review clarifying best practices for responding to disclosures of abuse by adults with ID. The literature focused on various professionals but we were unable to find evidence clarifying researchers' roles in responding to sexual violence. Working with our state protective services agency, we adapted these practices to develop protocols and an algorithm for responding to disclosure, as well as materials for participants. Our protocol for abuse reporting considers all members of the research team to be mandated reporters, emphasizes informed consent, and details specific steps for responding to disclosures of abuse in the context of research. It represents a collaboration between academic researchers and community partners. Research participation by people with ID may represent an opportunity for disclosure of past or current abuse, and therefore, it is imperative that researchers are equipped to respond effectively. Policy‐level responses to prevent abuse and enable justice are also needed; however, ensuring that researchers respond systematically and effectively to disclosures is crucial to the ethical conduct of research with a vulnerable population. We anticipate that the frequency with which researchers will need to use this protocol will depend on the nature of their research. In practice, we recommend including this protocol as part of the overall study protocol and submitting it for Institutional Review Board (IRB) approval. Future research to test our protocol in the field is recommended.
Synergistic effect of extreme climatic events and urbanization on population density of the ghost crab Ocypode quadrata (Fabricius, 1787)
Authors: Machado Phillipe M. , Tavares Davi C. , Zalmon Ilana R.
Published: April 2019

The combined effects of urbanization and extreme climatic events were examined on the ghost crab Ocypode quadrata, a well‐recognized ecological indicator in sandy beaches. The effect of storm waves was assessed before and after these climate events in beaches with different levels of urbanization in the coast of Brazil, Tropical Atlantic Ocean. The number of burrows was used as a metric for the population size of O. quadrata and the number of humans along the beaches as a proxy for the urbanization level. Significant differences were recorded in this species’ population density according to the human pressure. Our core modelling approach showed that the number of O. quadrata burrows was lower after storm waves in urbanized zones, compared to non‐urbanized ones. The interaction between storm waves and urbanization impacted the number of O. quadrata burrows negatively, and suggest that species’ populations are more vulnerable to the combined effects of extreme climatic events and urbanization. Extreme events are predicted to increase in frequency in the next few decades, and may modify or impair ecosystem functioning in sandy beaches by reducing populations of the O. quadrata, an important beach scavenger, which markedly contribute to the flux of energy in coastal trophic webs.
Use of a donor iliac vein graft for reconstruction of the inferior vena cava in liver transplantation for hepatoblastoma with caval extension
Authors: Hort Amy , Karpelowsky Jonathan , Shun Albert , Thomas Gordon
Published: April 2019

Complete microscopic tumor resection is critical for successful treatment of hepatoblastoma, and this may include when liver transplantation is required. For tumors involving the IVC or PV, complete resection should include the involved IVC or PV to ensure full tumor clearance. When this is required, the venous reconstruction at transplant or post‐excision can be challenging. We present the management of an 18‐month‐old girl with PRETEXT Stage IV (P, V, F) hepatoblastoma and IVC involvement, where native caval resection and reconstruction was required. The preoperative staging following neoadjuvant chemotherapy was POSTTEXT Stage IV (P, V, F). An orthotopic liver transplantation was performed using a left lateral segment graft from a deceased adult donor. With native hepatectomy, retrohepatic IVC resection from just above the hepatic venous confluence to just above the entry of the right adrenal vein was performed. For caval reconstruction, a venous graft from a deceased donor was used. The graft included the lower IVC with the right common iliac vein and a short stump of the left common iliac vein. The common iliac was a perfect size match for the IVC, and the three natural ostia matched the upper cava, lower cava, and the outflow from the donor left hepatic vein. The patient had an uneventful postoperative course and remains well and disease‐free 2 years after transplant with continued patency of the reconstructed cava. When indicated, a donor iliac vein graft with its natural ostia should be considered in caval reconstruction for pediatric liver transplantation.
Workplace democracy—The recent debate
Authors: Frega Roberto , Herzog Lisa , Neuhäuser Christian
Published: April 2019

The article reviews the recent debate about workplace democracy. It first presents and critically discusses arguments in favor of democratizing the firm that are based on the analogy with states, meaningful work, the avoidance of unjustified hierarchies, and beneficial effects on political democracy. The second part presents and critically discusses arguments against workplace democracy that are based on considerations of efficiency, the difficulties of a transition towards democratic firms, and liberal commitments such as the rights of employees and owners to work for or invest in nondemocratic firms. The conclusion summarizes the debate and argues that experiments with democratic workplaces as what Erik Olin Wright calls “real utopias” could deliver new insights and thus move the discussion forward.
Measuring and Managing Ex Ante Transaction Costs in Public Sector Contracting
Authors: Petersen Ole Helby , Baekkeskov Erik , Potoski Matthew , Brown Trevor L.
Published: April 2019

Transaction cost attributes, such as the complexity of the product being purchased, shape the risk that government contracts will fail. When transaction cost risks are particularly strong, a common prescription is to avoid contracting altogether or, if it is unavoidable, to spend additional resources on contract management activities. This article presents evidence on the size and variability of governments' ex ante transaction cost spending, using original data from 72 contracts issued by 47 Danish local governments. Ex ante transaction costs average 2.7 percent per contract and are relatively higher when services are more complex and lower when governments have prior contracting experience and contracts were larger. The analyses suggest the importance of distinguishing between transaction cost attributes and governments' choices to spend resources in response to them. Effective management spending in the face of transaction costs can help governments organize and capture value from contracting with private businesses.
Bootstrapping mean‐squared errors of robust small‐area estimators: Application to the method‐of‐payments surveys data
Authors: Jiongo Valery D. , Nguimkeu Pierre
Published: April 2019

This paper proposes a new bootstrap procedure for mean‐squared errors of robust small‐area estimators. We formally prove the asymptotic validity of the proposed bootstrap method and examine its finite‐sample performance through Monte Carlo simulations. The results show that our procedure performs well and competes with existing ones. We also provide an application to the estimation of the total volume and value of cash, debit card, and credit card transactions in Canada as well as in its provinces and subgroups of households. In particular, we found that there is a significant average annual decline rate of 3.1% in the volume of cash transactions and that this decline is relatively higher among high‐income households living in heavily populated provinces. Our bootstrap estimator also provides indicators of quality useful in selecting the best small‐area predictor among several alternatives in practice.
Researching Rural Housing: With an Artist in Residence
Authors: Gkartzios Menelaos , Crawshaw Julie
Published: April 2019

This article presents a unique amalgam across artistic research and rural sociology. We draw on a collaborative art residence programme between a University and an arts organisation in England, which invited an artist to respond to a highly contentious topic in rural England: housing development. The ambition for the residency was, firstly, to provide new perspectives on rural housing research, and, secondly, to provide a space for engagement between the local community, planners and academics. Through our interdisciplinary collaboration, we explore how Sander Van Raemdonck’s artistic process worked towards these ambitions. The artistic practice involved a walk with the local community, a peripatos, in a post‐industrial site proposed for housing development. Drawing on the artistic practice, the interdisciplinary team developed then a second walk, a ‘walkshop’, to mediate between housing/planning experts and reflect on the experience of the artistic practice. Following those artists and social scientists that already utilise walking as a method, we argue that the artistic peripatos can support a multi‐sensory way of communicating, a way to get ‘under the skin of a place’. More critically, we argue that artist in residence programmes provide rich opportunity to develop interdisciplinary research with artists.
Impact of External Communication on Internal Brand Management Outcomes Using Employees as a Second Audience: A Comparative Analysis of Manufacturing and Service Sectors of Pakistan
Authors: Rizvi Syed Hussain Raza , Siddiqui Danish Ahmed
Published: April 2019

This study investigated the effect of External Brand Communications on internal brand management practices using brand commitment and brand understanding as factors determining the phenomenon and subsequently analyzing the effect of both internal and external factors on brand citizenship behavior. A sample size of 300 respondents was selected from manufacturing and service oriented companies and the effects were analyzed using Structural Equation Modeling. It was found that there is significant and positive influence of brand understanding in determination of brand citizenship behavior and reflected mediating role of external communication congruence. Furthermore, it has also found that internal brand management practices are more evident in case of manufacturing firm i.e. a reputed Biscuits Manufacturing Company as compare to financial firm i.e. a renowned Private Limited Bank. It reveals necessity of work required in case of Private Limited Bank to work on external communication practices and integrate it with internal brand management practices to increase its role in determination of employee behavior and their role in propagating brand image as second audience.
Determination of physical mechanism responsible for the capacitance-voltage weak inversion “hump” phenomenon in n-InGaAs based metal-oxide-semiconductor gate stacks
Authors: Krylov Igor
Published: April 2019

Weak inversion capacitance-voltage (C-V) “hump” is a widely observed phenomenon at n-InGaAs based metal oxide semiconductor (MOS) structures. The mechanism responsible for this phenomenon is still under discussion. The C-V hump can be explained as an interaction of interface states with either one or both semiconductor energy bands. Each of the proposed mechanisms leads to a different interpretation of C-V hump. Simulating the mechanisms by relevant equivalent circuits, the capacitance and conductance characteristics of the MOS structure were calculated and compared with experimental results. The mechanism responsible for the C-V hump was determined.
Does fossil site record dino-killing impact?
Authors: Barras Colin
Published: April 2019

Astonishment, skepticism greet claim that North Dakota site captures impact day.
Moderns said to mate with late-surviving Denisovans
Authors: Gibbons Ann
Published: April 2019

Genomes from New Guineans suggest mixing, perhaps as recently as 15,000 years ago.
U.K. fusion reactor will test fuel of future power plants
Authors: Clery Daniel
Published: April 2019

The Joint European Torus will use deuterium-tritium fuel after €100 million deal with the European Union extends facility.
Spatiotemporal dynamics of molecular pathology in amyotrophic lateral sclerosis
Authors: Maniatis Silas , Äijö Tarmo , Vickovic Sanja , Braine Catherine , Kang Kristy , Mollbrink Annelie , Fagegaltier Delphine , Andrusivová Žaneta , Saarenpää Sami , Saiz-Castro Gonzalo , Cuevas Miguel , Watters Aaron , Lundeberg Joakim , Bonneau Richard , Phatnani Hemali
Published: April 2019

Spatiotemporal gene expression in ALS

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects nerve cells in the brain and the spinal cord. It has proven difficult to identify the early stages of disease and where it spreads within the body. Maniatis
et al.
used RNA sequencing to define transcriptomic changes over the course of disease in different regions of the spinal cord of a mouse ALS model and a postmortem human ALS spinal cord. From changes in gene expression, they identified disease-associated pathways and established the key steps in motor neuron degeneration observed in ALS.

Science
, this issue p.
89
Small peptide–mediated self-recognition prevents cannibalism in predatory nematodes
Authors: Lightfoot James W. , Wilecki Martin , Rödelsperger Christian , Moreno Eduardo , Susoy Vladislav , Witte Hanh , Sommer Ralf J.
Published: April 2019

Peptides let nematodes know family

To maximize fitness, organisms need to be able to recognize their own species, especially in the proximity of closely related individuals. Lightfoot
et al.
identified a hypervariable small peptide in the predatory nematode
Pristionchus pacificus
that is involved in species recognition to prevent predation of kin. They induced modifications in the carboxyl terminus of the peptide with a CRISPR-Cas9 system, which showed that this region is necessary for self-recognition. This molecular recognition system appears to prevent cannibalism and thus enables the worm to focus on appropriate prey species.

Science
, this issue p.
86
Fowl play
Wingspan
Elizabeth Hargrave
Stonemaier Games, 2019.
Authors: Chuang Angela
Published: April 2019

When birding meets board games, everyone wins
A glance into the end of a planetary system
Authors: Fossati Luca
Published: April 2019

Planetesimals can closely orbit white dwarfs
Manfred Eigen (1927–2019)
Authors: Pecht Israel , Jovin Thomas
Published: April 2019

Pioneer in ultrafast chemical kinetics and evolution theory
In Vitro
and
In Vivo
Exposure-Effect Relationship of Liposomal Amphotericin B against Aspergillus fumigatus
Authors: Siopi Maria , Mouton Johan W. , Pournaras Spyros , Meletiadis Joseph
Published: April 2019

In vitro
pharmacokinetic/pharmacodynamic data of liposomal amphotericin B (L-AMB) were compared with animal data from neutropenic and nonneutropenic models of azole-susceptible and azole-resistant invasive aspergillosis. L-AMB was equally effective.
Численное моделирование динамики цилиндрической зоны турбулентного смешения в продольном сдвиговом потоке
Authors: Фомина Анжелла Владимировна , Fomina Anzhella Vladimirovna , Черных Геннадий Георгиевич , Chernykh Gennadii Georgievich
Published: April 2019

Построена основанная на усовершенствованной двухпараметрической модели турбулентности численная модель динамики цилиндрической локализованной области турбулентных возмущений в продольном горизонтально однородном сдвиговом потоке однородной жидкости. Результаты численных экспериментов демонстрируют существенное порождение энергии турбулентности за счет сдвигового течения. Рассмотрен вопрос о подобии течения по сдвиговому числу Фруда. Показано, что при достаточно больших значениях этого параметра, соответствующих малым градиентам скорости сдвигового течения, наблюдается подобие течения.
Association between hypotension and serious illness in the emergency department: an observational study
Authors: Hagedoorn Nienke N , Zachariasse Joany M , Moll Henriette A
Published: April 2019

Background

The value of routine blood pressure measurement in the emergency department (ED) is unclear.

Objective

To determine the association between hypotension in addition to tachycardia and the Shock Index for serious illness.

Design

Observational study.

Setting

University ED (2009–2016).

Participants, methods and main outcomes

Routine data collected from consecutive children <16 years. Using logistic regression, we assessed the association between hypotension (adjusted for tachycardia) and Shock Index (ratio heart rate/blood pressure [BP]) for serious illness. The predictive accuracy (sensitivity, specificity) for hypotension and Shock Index was determined for serious illness, defined as intensive care unit (ICU) and hospital admissions.

Results

We included 10 698 children with measured BP. According to three age-adjusted clinical cut-offs (Advanced Paediatric Life Support, Paediatric Advanced Life Support and Paediatric Early Warning Score), hypotension was significantly associated with ICU admission when adjusted for tachycardia (range OR 2.6–5.3). Hypotension showed low sensitivity (range 0.05–0.12) and high specificity (range 0.95–0.99) for ICU admission. Combining hypotension and tachycardia did not change the predictive value for ICU admission. Similar results were found for hospitalisation. Shock index was associated with serious illness. However, no specific cut-off value was identified in different age groups.

Conclusions

Hypotension, adjusted for tachycardia, is associated with serious illness, although its sensitivity is limited. Shock index showed an association with serious illness, but no acceptable cut-off value could be identified. Routine BP measurement in all children to detect hypotension has limited value in the ED. Future studies need to confirm which patients could benefit from BP measurement.
Massive pulmonary embolism presenting initially as acute psychosis
Authors: Co Michael Lawrenz Ferreras , Agdamag Arianne Clare , Esteban Marcus Juan , Mateo Roselyn
Published: April 2019

This is a case of a 68-year-old man with Parkinson’s disease who was admitted in the psychiatry floor for new-onset aggressive behaviour and hallucinations. On the third day of hospitalisation, he suddenly developed dyspnoea followed by an ECG showing atrial fibrillation with rapid ventricular response. A few seconds later, he went into cardiac arrest; he was resuscitated after multiple rounds of Advanced Cardiovascular Life Support. A transthoracic echo showed hypokinetic and enlarged right ventricle. A CT Chest showed a saddle embolus. Patient was provided with systemic thrombolysis, which led to an improvement in his haemodynamic status. Interestingly, his psychotic symptoms also improved. In this paper, we present and review how pulmonary embolism can be associated with acute psychosis.
Successful use of anakinra for colchicine-intolerant, corticosteroid-dependent recurrent pericarditis secondary to postcardiac injury syndrome after pacemaker placement
Authors: Saad Shaukat Muhammad Hamza , Shabbir Muhammad Asim , Mookherjee Sulagna , Peredo-Wende Ruben
Published: April 2019

A 54-year-old woman was referred to our centre for the third recurrence of colchicine-intolerant, corticosteroid dependent iatrogenic post-traumatic pericarditis after pacemaker placement 3 months prior to the first episode. The initial episode and each recurrence were associated with a pericardial effusion requiring drainage. Evaluation for pericardial infection, malignancy, autoimmune disease and pacemaker lead perforation was negative. After fourth recurrence and fifth pericardial drainage in 3 months, a trial of anakinra (interleukin-1 inhibitor), in addition to swift symptom resolution successfully prevented subsequent symptomatic and echocardiographic recurrence. Corticosteroids were tapered and eventually discontinued. At 4-month follow-up, the patient continues to be on daily anakinra 100 mg subcutaneous (SQ) daily without adverse effects.
Are public–private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho
Authors: Hellowell Mark
Published: April 2019

Many governments in sub-Saharan Africa are seeking to establish public–private partnerships (PPPs) for the financing and operation of new healthcare facilities and services. While there is a large empirical literature on PPPs in high-income countries, we know much less about their operation in low-income and middle-income countries. This paper seeks to inform debates about the use of PPPs in sub-Saharan Africa by describing the planning and operation of a high-profile case in Maseru, Lesotho. The paper highlights several beneficial impacts of the transaction, including the achievement of high clinical standards, alongside a range of key challenges—in particular, the higher-than-anticipated costs to the Ministry of Health. Governments have budget-related incentives to promote the use of PPPs—even in cases in which they may threaten financial sustainability in the long term. To address this, future proposals for PPPs need to be exposed to more effective scrutiny and challenge, taking into account state capacity to proficiently manage and pay for contracted services.
Assessing health impacts of home food gardens with Wind River Indian Reservation families: protocol for a randomised controlled trial
Authors: Porter Christine M , Wechsler Alyssa M , Naschold Felix , Hime Shawn J , Fox Lanae
Published: April 2019

Introduction

This community-based participatory research,Growing Resilience,will be the first full-scale randomised controlled trial we have identified that is designed to evaluate impacts of home gardening on family health. It is based on observational studies suggesting home food gardening has myriad health benefits, Wind River Indian Reservation (WRIR) families’ interest in home gardening and the need to end Native American health disparities with empowering, appropriate and effective health interventions.

Methods and analysis

A total of 100 Native American families in WRIR who have not gardened recently but want to garden will be randomly allocated (1:1) to intervention (receiving 2 years of support designing, installing and maintaining a home food garden of at least 80 square feet (approximately 7 square meters) or to delayed-intervention control (receiving same gardening support after 2 years of data collection). Willing family members aged 5 and up will participate in data collection each February and August for 2 years, with blood, biometric and survey measures at each. The primary outcome is adult body mass index (BMI). Secondary outcomes include child BMI, and adult hand strength, self-reported physical and mental health, diabetes control and food security. Primary analysis will be intention to treat (ITT), using univariate and bivariate descriptive statistics followed by a mixed model to estimate the ITT effect of the intervention using analysis of covariance (ANCOVA) estimation. We will also examine treatment affects using a gardening fidelity measure, combined adult and child BMI outcomes using a lambda mu and sigma (LMS) Z-score reference data set and possible mechanisms of health impacts.

Ethics and dissemination

This protocol was approved by the University of Wyoming Institutional Review Board (IRB) and the project’s Community Advisory Board. De-identified data will be shared with each tribe, and results will be published in peer-reviewed journals, summarised for distribution in WRIR, and shared at a national event to be hosted in WRIR in 2020.

Trial registration number

NCT02672748; Pre-results.
Comparative efficacy and safety of surgical and invasive treatments for adults with degenerative lumbar spinal stenosis: protocol for a network meta-analysis and systematic review
Authors: Chen Lingxiao , H Ferreira Paulo , R Beckenkamp Paula , L Ferreira Manuela
Published: April 2019

Introduction

Surgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions. To address this, we will perform a network meta-analysis (NMA) and systematic review to compare the efficacy and safety of surgical and invasive procedures for adults with degenerative lumbar spinal stenosis.

Methods and analysis

We will include randomised controlled trials assessing surgical and invasive treatments for adults with degenerative lumbar spinal stenosis. We will search AMED, CINAHL, EMBASE, the Cochrane Library and MEDLINE. Only English studies will be included and no restriction will be set for publication status. For efficacy, our primary outcome will be physical function. Secondary outcomes will include pain intensity, health-related quality of life, global impression of recovery, work absenteeism and mobility. For safety, our primary outcome will be all-cause mortality. Secondary outcomes will include adverse events (number of events or number of people with an event) and treatment withdrawal due to adverse effect. Two reviewers will independently select studies, extract data and assess the risk of bias (Revised Cochrane risk-of-bias tool for randomized trials) of included studies. The quality of the evidence will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation framework. Random-effects NMA will be performed to combine all the evidence under the frequentist framework and the ranking results will be presented through the surface under the cumulative ranking curve and mean rank. All analyses will be performed in Stata and R.

Ethics and dissemination

No ethical approval is required. The research will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42018094180.
Predicting fracture risk in patients with chronic obstructive pulmonary disease: a UK-based population-based cohort study
Authors: Akyea Ralph Kwame , McKeever Tricia M , Gibson Jack , Scullion Jane E , Bolton Charlotte E
Published: April 2019

Objective

To assess the incidence of hip fracture and all major osteoporotic fractures (MOF) in patients with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients and to evaluate the use and performance of fracture risk prediction tools in patients with COPD. To assess the prevalence and incidence of osteoporosis.

Design

Population-based cohort study.

Setting

UK General Practice health records from The Health Improvement Network database.

Participants

Patients with an incident COPD diagnosis from 2004 to 2015 and non-COPD patients matched by age, sex and general practice were studied.

Outcomes

Incidence of fracture (hip alone and all MOF); accuracy of fracture risk prediction tools in COPD; and prevalence and incidence of coded osteoporosis.

Methods

Cox proportional hazards models were used to assess the incidence rates of osteoporosis, hip fracture and MOF (hip, proximal humerus, forearm and clinical vertebral fractures). The discriminatory accuracies (area under the receiver operating characteristic [ROC] curve) of fracture risk prediction tools (FRAX and QFracture) in COPD were assessed.

Results

Patients with COPD (n=80 874) were at an increased risk of fracture (both hip alone and all MOF) compared with non-COPD patients (n=308 999), but this was largely mediated through oral corticosteroid use, body mass index and smoking. Retrospectively calculated ROC values for MOF in COPD were as follows: FRAX: 71.4% (95% CI 70.6% to 72.2%), QFracture: 61.4% (95% CI 60.5% to 62.3%) and for hip fracture alone, both 76.1% (95% CI 74.9% to 77.2%). Prevalence of coded osteoporosis was greater for patients (5.7%) compared with non-COPD patients (3.9%), p<0.001. The incidence of osteoporosis was increased in patients with COPD (n=73 084) compared with non-COPD patients (n=264 544) (adjusted hazard ratio, 1.13, 95% CI 1.05 to 1.22).

Conclusion

Patients with COPD are at an increased risk of fractures and osteoporosis. Despite this, there is no systematic assessment of fracture risk in clinical practice. Fracture risk tools identify those at high risk of fracture in patients with COPD.
Effect of nutrition interventions on diet-related and health outcomes of Aboriginal and Torres Strait Islander Australians: a systematic review
Authors: Gwynn Josephine , Sim Kyra , Searle Tania , Senior Alistair , Lee Amanda , Brimblecombe Julie
Published: April 2019

Objective

To review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people.

Study design

Systematic review of peer-reviewed literature.

Data sources

MEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet.

Study selection

Peer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people.

Data extraction and synthesis

Two independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots.

Results

Thirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes.

Conclusions

Store-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation.

PROSPERO registration number

CRD42015029551.
Preoperative oral hygiene recommendation before open-heart surgery: patients’ adherence and reduction of infections: a quality improvement study
Authors: Pedersen Preben Ulrich , Tracey Anita , Sindby Jesper Eske , Bjerrum Merete
Published: April 2019

Aim

To implement recommendations for oral hygiene before elective open-heart surgery in a thoracic surgery ward and to evaluate whether the number of patients who needed to be treated with antibiotics postoperatively was reduced.

Background

Healthcare systems are challenged to implement initiatives that reduce the development of nosocomial infections, to offer patients a safe and cost-efficient treatment and to reduce the use of antibiotics. Previous interventions have focused on staff behaviour in reducing postoperative infections. In this study, patients were recommended to carry out oral hygiene as recommended in a clinical guideline.

Methods

A quasiexperimental design with a control and an intervention group was used. Information on adherence to the recommendation was collected at admission. All medical information and prescriptions of antibiotics were obtained from patients’ medical records. Data were reported as intention to treat.

Results

Altogether 972 patients (506 controls and 466 interventions) were included in the study. Of the intervention patients, 405 (86.9%, 95% CI 83.3 to 89.8) reported that they had adhered to the oral hygiene recommendation. 64 (12.6%) control patients and 36 (7.7%) in the intervention group (p=0.015) were treated with antibiotics postoperatively.

Conclusions

It was feasible to involve patients in a programme for oral hygiene and thereby reduce the number of patients needing antibiotics after open-heart surgery and this might contribute to reducing costs.
PROgnostic Model for Advanced Cancer (PRO-MAC)
Authors: Hum Allyn , Wong Yoko Kin Yoke , Yee Choon Meng , Lee Chung Seng , Wu Huei Yaw , Koh Mervyn Yong Hwang
Published: April 2019

Objective

To develop and validate a simple prognostic tool for early prediction of survival of patients with advanced cancer in a tertiary care setting.

Design

Prospective cohort study with 2 years’ follow-up.

Setting

Single tertiary teaching hospital in Singapore.

Participants

The study includes consecutive patients diagnosed with advanced cancer who were referred to a palliative care unit between 2013 and 2015 (N=840). Data were randomly split into training (n=560) and validation (n=280) sets.

Results

743 (88.5%) patients died with a mean follow-up of 97.0 days (SD 174.0). Cox regression modelling was used to build a prognostic model, cross-validating with six randomly split dataset pairs. Predictor variables for the model included functional status (Palliative Performance Scale, PPS V.2), symptoms (Edmonton Symptom Assessment System, ESASr), clinical assessment (eg, the number of organ systems with metastasis, serum albumin and total white cell count level) and patient demographics. The area under the receiver operating characteristic curve using the final averaged prognostic model was between 0.69 and 0.75. Our model classified patients into three prognostic groups, with a median survival of 79.0 days (IQR 175.0) for the low-risk group (0–1.5 points), 42.0 days (IQR 75.0) for the medium-risk group (2.0–5.5 points), and 15.0 days (IQR 28.0) for the high-risk group (6.0–10.5 points).

Conclusions

PROgnostic Model for Advanced Cancer (PRO-MAC) takes into account patient and disease-related factors and identify high-risk patients with 90-day mortality. PPS V.2 and ESASr are important predictors. PRO-MAC will help physicians identify patients earlier for supportive care, facilitating multidisciplinary, shared decision-making.
Cortical grey matter sodium accumulation is associated with disability and secondary progressive disease course in relapse-onset multiple sclerosis
Authors: Brownlee Wallace J , Solanky Bhavana , Prados Ferran , Yiannakas Marios , Da Mota Patricia , Riemer Frank , Cardoso Manuel Jorge , Ourselin Sebastian , Golay Xavier , Gandini Wheeler-Kingshott Claudia , Ciccarelli Olga
Published: April 2019

Objective

Sodium (23Na)-MRI is an emerging imaging technique to investigate in vivo changes in tissue viability, reflecting neuroaxonal integrity and metabolism. Using an optimised23Na-MRI protocol with smaller voxel sizes and improved tissue contrast, we wanted to investigate whether brain total sodium concentration (TSC) is a biomarker for long-term disease outcomes in a cohort of patients with relapse-onset multiple sclerosis (MS), followed from disease onset.

Methods

We performed a cross-sectional study in 96 patients followed up ~ 15 years after a clinically isolated syndrome (CIS) and 34 healthy controls. Disease course was classified as CIS, relapsing-remitting MS or secondary progressive MS (SPMS). We acquired1H-MRI and23Na-MRI and calculated the TSC in cortical grey matter (CGM), deep grey matter, normal-appearing white matter (WM) and WM lesions. Multivariable linear regression was used to identify independent associations of tissue-specific TSC with physical disability and cognition, with adjustment for tissue volumes.

Results

TSC in all tissues was higher in patients with MS compared with healthy controls and patients who remained CIS, with differences driven by patients with SPMS. Higher CGM TSC was independently associated with Expanded Disability Status Scale (R2=0.26), timed 25-foot walk test (R2=0.23), 9-hole peg test (R2=0.23), Paced Auditory Serial Addition Test (R2=0.29), Symbol Digit Modalities Test (R2=0.31) and executive function (R2=0.36) test scores, independent of grey matter atrophy.

Conclusions

Sodium accumulation in CGM reflects underlying neuroaxonal metabolic abnormalities relevant to disease course heterogeneity and disability in relapse-onset MS. TSC and should be considered as an outcome measure in future neuroprotection trials.
Waistel Gordon Gerrand
Authors: Gerrand Craig , Gerrand Fergus , Gerrand Lindsay , Crawford Iain
Published: April 2019

He spent his professional life working for the state veterinary service, through which he developed a special interest in food hygiene. In later years, he was assistant chief veterinary officer for Scotland.
Large-scale experimental evaluation of soil saturation effect on behaviour of buried pipes under operational loads
Authors: Randeniya Chamal , Robert D.J. , Li Chun-Qing , Kodikara Jayantha
Published: April 2019

The behaviour of pipelines in unsaturated soil is fundamentally different from that of pipelines buried in dry or saturated soils. However, the effect of soil saturation on buried pipe behaviour has been overlooked in past research mainly due to the very limited large-scale experimental studies available. Most of the available studies on buried pipes in unsaturated soil are based on numerical modelling that analyses the pipe behaviour using a calibrated soil model developed on the basis of fundamental unsaturated soil characteristics. Investigations with such approaches may not be acceptable owing largely to unverified or complicated pipe–soil interactions and three-dimensional stress re-distributions. In this paper, the effect of soil saturation on buried pipe behaviour is investigated using a comprehensive large-scale experimental setup. A detailed methodology of large-scale testing, which was used to obtain pipe deformations as well as soil stresses with reference to a cast iron pipeline buried in low-plasticity clay under different soil saturation levels, is presented. The results obtained from large-scale experiments are compared with those of three-dimensional finite element analysis. Results produced in this paper reveal that the degree of water saturation of backfill soil can significantly affect the pipe deformation under internal and external loadings.
Bulk viscous Bianchi-I embedded cosmological model in f(R,T) = f1(R) + f2(R)f3(T) gravity
Authors: Yadav Anil Kumar , Sahoo P. K. , Bhardwaj Vinod
Published: April 2019

In this paper, we have searched the existence of bulk viscous Bianchi-I embedded cosmological model in [Formula: see text] gravity by taking into account the simplest coupling between matter and geometry such that [Formula: see text] and [Formula: see text] with [Formula: see text] a constant. To obtain the deterministic solution, we assume the scale factor in hybrid form — product of power law and exponential type of function that describes a model of transitioning universe and explain the physical behavior of early universe as well as present universe. It has been found that in the presence of bulk viscosity, the solution is stable and in favor of realization of the energy conditions (ECs) which turn into imply the derived model agrees with the cosmological viability. Some physical aspects of the model have been also discussed.
Superstatistics with symmetric distribution function: Discrete and continuous local temperatures
Authors: Chung Won Sang , Hassanabadi Hassan
Published: April 2019

In this paper, we find more possible distributions of superstatistics which are symmetric with respect to the global equilibrium inverse temperature. We consider the multilevel distribution with different weights and the case of continuous local inverse temperature. For these two cases, we discuss the classical oscillator problem and photon statistics.
Solving a Potential Clustering Game
Authors: Bouchama Kahina , Lallouet Arnaud , Radjef Mohammed Said , Sais Lakhdar
Published: April 2019

Data clustering is the unsupervised classification of a set of objects into groups (clusters), according to their similarities. This can be seen as a form of equilibrium, which is the motivation that led to recent formulations of the data clustering task using game theoretic models. In this context, we propose a novel game-theoretic clustering approach reducing the clustering task to that of searching for a pure Nash equilibrium of a potential game, which corresponds to a stable clustering. Interestingly, the existence and the convergence towards such equilibrium are established, and we experimentally prove that such stability is not always guaranteed by the classical k-means algorithm. We also propose an iterative best-response algorithm for solving this potential clustering game. This algorithm is implemented and tested on several real-world and artificial datasets. Considering most of clustering quality measures, the obtained results are compared to those provided by both the classical k-means and by an hybridization of these two algorithms.