bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of hard‐to‐differentiate dune stratification types in the Permian Coconino Sandstone (Arizona, USA)
Authors: Maithel Sarah A. , Brand Leonard R. , Whitmore John H.
Published: June 2020

Dune stratification types, which include grainfall, grainflow and ripple lamination, provide a record of the fine‐scale processes that deposited sediment on palaeo‐dune foresets. While these facies are relatively easy to distinguish in some cross‐bedded sandstones, for others – like the Permian Coconino Sandstone of northern and central Arizona – discrete stratification styles are hard to recognize at the bedding scale. Furthermore, few attempts have been made to classify fine‐scale processes in this sandstone, despite its renown as a classic aeolian dune deposit and Grand Canyon formation. To interpret depositional processes in the Coconino Sandstone, cross‐bed facies were characterized using a suite of sedimentary textures and structures. Bedding parameters were described at multiple scales via a combination of field and laboratory methods, including annotated outcrop photomosaics, strike and dip measurements, sandstone disaggregation and laser‐diffraction particle analysis, high‐resolution scans of thin sections, and scanning electron microscopy. Cross‐beds were observed to be laterally extensive along‐strike, with most dip angles ranging from the mid‐teens to mid‐twenties. While some cross‐bed sets are statistically coarser near their bases, others exhibit no significant vertical sorting trends. Both massive and laminated textures are visible in high‐resolution scans of thin sections, but laminae contacts are commonly indistinct, making normal and reverse grading difficult to define. Diagenetic features, such as stylolite seams and large pores, are also present in some samples and might indicate alteration of original textures like detrital clay laminae and carbonate minerals. Observed textures and sedimentary structures suggest that the cross‐beds may consist of grainflow and grainfall deposits, but these remain difficult to differentiate at outcrop and thin‐section scales. This characterization of fine‐scale processes will play a critical part in the development of depositional models for the Coconino Sandstone and elucidate interpretations for similar cross‐bedded formations.
Regional Resilience in Times of a Pandemic Crisis: The Case of COVID‐19 in China
Authors: Gong Huiwen , Hassink Robert , Tan Juntao , Huang Dacang
Published: June 2020

The notion of resilience to analyse how fast systems recover from shocks has been increasingly taken up in economic geography, in which there is a burgeoning literature on regional resilience. Regional resilience is a place‐sensitive, multi‐layered and multi‐scalar, conflict‐ridden and highly contingent process. The nature of shocks is one important impact factor on regional resilience. Arguably, so far, most literature on regional resilience has dealt with the financial crisis in 2008/2009. In this research note, we will analyse both the particular characteristics of the current COVID‐19 crisis, as well as its effects on regional recovery and potential resilience in China, where it started. We conclude that a complex combination of the characteristics of the current COVID‐19 crisis, the institutional experience of dealing with previous pandemic and epidemic crises, government support schemes, as well as regional industrial structures, might potentially affect the recovery and resilience rates of Chinese regions.
Indirect trade and direct trade: Evidence from Japanese firm transaction data
Authors: Ito Tadashi , Saito Yukiko Umeno
Published: June 2020

This paper attempts to establish stylised facts on direct and indirect trade and its relationship with firm performance using firm transaction data of Japanese firms, with the special goal of shedding light on regional aspects of indirect exports/imports. The major findings are as follows: (a) firms in regional areas are smaller in size than those in a metropolitan area, and firms in regional areas are less likely to participate in export or import, even after controlling for firm size; (b) direct and indirect exports/imports in terms of the number of firms, employees, and sales values represent 40%–70% of the regional economies; (c) indirect exporters/importers in the previous period are likely to be direct exporters/importers in the subsequent period, which suggests the effects of learning in terms of procedures for conducting exporting/importing, searching for customers/suppliers, and gaining information on foreign markets; and (d) both direct export/import firms and indirect export/import firms in the previous period tend to have higher firm performance in the subsequent period.
Fatima Al-Fihri Founder of the First World University
Authors: Fejzić-Čengić Fahira
Published: June 2020

The first modern university concept is made up of a set of simple and proven facts that are rarely studied at European Universities today, from Sarajevo to London. Simply they are just consciously suppressed. This makes the link from the mind disappeared unable to answer the question: how the mid-sluggish religious centuries-old period of Europe was awakened, stepping into a new age. Thus, the current islamophobia would be more easily overcome and people as mankind could more easily cooperate and settle in the beauty of life. Young women, and the founder Fatima Al-Fihri from the Karaouine, University in Africa, established curricula, degrees, diplomas, gown and tassels, and sent the first large volumes of translated books, scientific discoveries and insights for the establishment of early European universities such as Sorbonne, Bologna, Padua from Tunisia, Morocco, Africa, actually from the huge library of the Al Fihri University, University of Al-Karaouine. Can this truth be embedded into the curricula of modern university knowledge?
Study Tribological Properties of MoDTC and Its Interactions With Metal Detergents
Authors: Zhang Dongya , Li Zhongwei , Wei Xian , Wang Liping , Xu Jinbao , Liu Yufeng
Published: June 2020

Recently, the synergistic tribological properties between molybdenum dialkyldithiocarbamate (MoDTC) and metal detergents have been the focus of significant attention due to the high requirements of engine oil. In this study, an SRV tribometer and four-ball machine were used to study the tribological performance of MoDTC combined with three types of metal detergents with different base numbers. Meanwhile, the detergency of the three metal detergents was also investigated using the hot tube test and crankcase simulation test. The results showed that (i) a high-based detergent possessed an excellent detergency performance compared with that of low-based detergents. (ii) The tribological properties of the base oil with a content of 0.75% MoDTC were superior to those of other contents at elevated temperatures. (iii) The metal detergents with a higher base number showed the best thermal stability, detergency performance, and anti-wear performance among the three types of metal detergents. The anti-wear mechanism was that the synergistic action of active elements in MoDTC and metal detergents promoted the generation of a tribological film.
Sustained CAD/CAE Application Integration: Supporting Simplified Models
Authors: Kirkwood Robert , Sherwood James A.
Published: June 2020

Computer-aided design/computer-aided manufacturing/computer-aided engineering (CAD/CAM/CAE) integration offers designers, analysts, and manufacturers the opportunity to share the data throughout the product development process. Finite element (FE) meshing applications integrated with the solid model data from CAD systems represent a major subset of CAD/CAM/CAE integration. In an earlier paper, it was demonstrated that virtual persistent identifiers (VPIs) can be used to assure or repair sustained integration with successive versions of neutral-format solid models. From that article, several follow-on issues become apparent. The geometry as per the CAE model often differs from the CAD model, so even with cross-format issues resolved, significant obstacles to sustained CAD/CAE integration remain. Along with simplification, the current article investigates additional techniques for further automating the recognition of changes between CAD models, reducing the manual interaction to just a few minutes. The article goes on to demonstrate how associativity can be sustained when using current versions of neutral formats like STEP and IGES. The overall point of the paper is to show that given a precise recognition of the differences between two solid models, a generalized means of ad-hoc integration is possible. This point is demonstrated through two case studies where simplifications of the CAD geometry are made to facilitate the meshing of the part. The integration is shown to be maintained across successive versions and to address a range of simplification processing. A summary of best practices for efficiently accommodating sustained CAD/CAE integration is also presented.
A Novel Omnidirectional Self-Locked Energy Absorption System Inspired by Windmill
Authors: Liu Yizhe , Xiong Feng , Yang Kuijian , Chen Yuli
Published: June 2020

Impact accidents cause great damage to lives and properties because the destructiveness, direction, and action mode of impact loadings can hardly be predicted. Ordinary thin-walled tube systems for energy absorption require outside constraints or inside fasteners to avoid tube splashing, which affects the modifiability of the systems and limits their application in emergencies. In an effort to break through this limitation, inspired by windmill, a novel omnidirectional self-locked energy absorption system has been proposed. The proposed system is made up of thin-walled tubes with windmill-liked cross section, which are specially designed to interlock with adjacent tubes and thus provide constraints among individual tubes to resist impact loadings in spatial arbitrary directions. The spatial omnidirectional self-locking capability of the windmill-inspired system is demonstrated under distributed and concentrated impact loadings. Moreover, the windmill-inspired system shows higher energy absorption efficiency than that of the widely used round tube system and previous self-locked system under loadings in various directions, and their energy absorption properties can be further improved by combining with the round tube system, adjusting the geometric parameter of each tube and designing the arrangement of tubes with different properties in the system. This work may shed light on the energy absorption system design and expand the application of self-locked energy absorption systems.
Ultrasound-Guided Percutaneous Liver Biopsy: A Review on Obtaining Adequate Specimens
Authors: de Lange Danny , van den Dobbelsteen John J. , Moelker Adriaan , van de Berg Nick J.
Published: June 2020

This literature review was conducted to evaluate liver biopsy adequacy, including total core length (TCL), number of portal tracts (PT), fragmentation, and complication rates, as a function of needle type and gauge. A systematic electronic search was performed in the Web of Science and Google Scholar databases, according to the PRISMA statement. Eligible data, describing in vivo percutaneous ultrasound-guided human liver biopsy quality outcomes, were compared to adequacy criteria of the American Association for the Study of Liver Diseases (AASLD, TCL ≥ 20 mm, PT ≥ 11). An adequate mean number of PTs was found in 83% of biopsy needles assessed between 2012 and 2019, compared to 0% between 1998 and 2004. For TCL, this was 44% and 33%, respectively. Increasing the needle diameter enhanced TCL (result in 50% of included studies) and PT count (100%), and reduced fragmentation rates (75%), whereas no effect on pain or complications was found (83%). In total, five needle types achieved adequate PT counts, using 16 G (3×), 17 G (1×), or 18 G (1×) needles. Adequacy was reached using either a core needle biopsy (CNB, 3×) approach with one pass, or a fine needle aspiration (FNA, 2×) approach with two passes. The recommendations for biopsy adequacy can be met using 16/17 G FNA or 16/18 G CNB needles. Currently, many publications still present substandard liver biopsy quality outcomes. Although minimizing biopsy invasiveness is desirable, a decreased diameter or number of passes is ill-judged when reliability of biopsy outcomes is at stake.
Low Frequency Wave Loads and Damping of Four MODUs in Severe Seastates With Current
Authors: Fonseca Nuno , Stansberg Carl Trygve , Larsen Kjell , Bjørkli Rune , Vigesdal Tjerand , Dalane Oddgeir
Published: June 2020

Model tests have been performed with four mobile offshore drilling units (MODUs) with the aim of identifying wave drift forces and low-frequency damping. The MODUs configuration is different, namely on the number and diameter of columns; therefore, the sample is representative of many of the existing concepts. The model scale is the same as well as the wave and current conditions. The experimental program includes irregular waves with systematic variations of the significant wave height, wave peak period, current velocity, and vessel heading. A nonlinear data analysis technique (cross bi-spectral analysis) is applied to identify the surge and sway quadratic transfer functions (QTFs) of the slowly varying excitation, together with the linearized low-frequency damping. The paper also presents a semi-empirical formula developed in the scope of the EXWAVE JIP to correct potential flow mean wave drift force coefficients of Semis in high seastates with current. The empirical QTFs are then compared with numerical predictions. Comparisons with potential flow coefficients lead to conclusions on the role of viscous drift. The semi-empirical formula is assessed based on comparisons with test results and concluded that it provides a significant improvement compared to potential flow predictions.
On Efficient Surrogate Model Development for the Prediction of the Long-Term Extreme Response of a Moored Floating Structure
Authors: Lim HyeongUk , Manuel Lance , Min Low Ying
Published: June 2020

This study focuses on the development of efficient surrogate models by polynomial chaos expansion (PCE) for the prediction of the long-term extreme surge motion of a moored floating offshore structure. The structure is subjected to first-order and second-order (difference-frequency) wave loading. Uncertainty in the long-term response arises from contrasting sea state conditions, characterized by significant wave height, Hs, and spectral peak period, Tp, and their relative likelihood of occurrence; these two variables are explicitly included in the PCE-based uncertainty quantification (UQ). In a given sea state, however, response simulations must be run for the associated Hs and Tp; in such simulations, typically, a set of random amplitudes and phases define an irregular wave train consistent with that sea state. These random amplitudes and phases for all the frequency components in the wave train introduce additional uncertainty in the simulated waves and in the response. The UQ framework treats these two sources of uncertainty—from Hs and Tp on the one hand, and the amplitude and phase vectors on the other—in a manner that efficiently yields long-term surge motion extreme predictions consistent with more expensive Monte Carlo simulations (MCS) that serve as the “truth” system. To reduce uncertainty in response extremes that result from sea states with a low likelihood of occurrence, importance sampling is employed with both MCS- and PCE-based extreme response predictions. Satisfactory performance with such efficient surrogate models can help in assessing the long-term response of various offshore structures.
Modeling of Crossed Roller Bearings Considering Roller Roundness Deformation
Authors: Tong Van-Canh , Jung Eui-Wook , Hong Seong-Wook
Published: June 2020

This paper presents a quasi-static five degrees-of-freedom model of crossed roller bearings that considers roller roundness deformation. The existing models of rolling element bearing do not account for ball and/or roller roundness deformation. However, in the case of crossed roller bearing, roundness deformation of rollers can be significant because of high contact load per unit length of rollers. In this paper, the roller roundness deformation was included by using a formulation of the roller as a cylinder under compression by two flat surfaces. The inertial loading due to rotational speed effect was considered by including the centrifugal force and gyroscopic moment of rollers. Experiments were performed to validate the proposed model, and calculated and measured axial displacements of the bearing under axial loads yielded a good correlation. Extensive simulations were conducted to show the importance of roller roundness deformation and the applicability of the proposed model. The developed model for crossed roller bearing will be useful for the design and extensive analysis of crossed roller bearings.
Dynamic Frictional Slip Along Rock Faults
Authors: Reches Ze’ev
Published: June 2020

The dynamic behavior of rock faults reflects the response of the shape and composition of the fault to the applied loading and environmental conditions. The interaction between the fault properties and the loading system is controlled by multiple variables that act simultaneously to generate an inherently complex behavior. Integrating multiple variables can illuminate the controlling mechanisms of fault dynamic, and five examples of such integration are evaluated here, including power-density, which quantifies the energy dissipation rate on the slipping fault, PV-factor, which evaluates the damage potential, impulse-density, which combines effect of slip-velocity and slip-duration, the weakening distance of transition to thermal weakening, and the kinematic-load, which integrates slip-velocity and slip-distance. The examination of relevant experimental observations indicates that these variables provide effective quantification tools for fault dynamic strength, fault wear, fault damage, melting, and mineralogical transformation.
The Cost-Sorted Distance Method for Identifying Minima Within Firefly Optimization Results: Application to Engineering Design
Authors: Elliott Christopher M. , Ferguson Scott M. , Buckner Gregory D.
Published: June 2020

This paper provides a detailed description of the cost-sorted distance (CSD) method for visually and computationally identifying objective function minima within clustered population-based optimization results. CSD requires sorting the design vector population by cost and computing Euclidean distances between each pair of designs. It may be applied in conjunction with any population-based optimization method (e.g., particle swarm, genetic algorithm, simulated annealing, ant colony, firefly), but it is naturally compatible with the firefly algorithm (FA) because FA also requires the distances between each pair of design vectors and benefits from cost-sorting the population (the computational work required for CSD is a byproduct of FA). A modified FA is presented that uses CSD to more thoroughly search near potential minima and a systematic method for tuning the algorithm to reliably identify multiple minima is documented. The tuned algorithm's efficacy is demonstrated using a class of benchmark problems and a “real world” electromechanical design problem, where the identification of attractive design alternatives can be challenging.
Numerical Investigation on Heat Transfer Characteristics in Electronic Cavity of Downhole Measurement-While-Drilling System
Authors: Tang Song , Liang Zheng , Zhu Yulong
Published: June 2020

In recent years, the number of deep wells and ultra-deep wells is increasing gradually, and the bottom hole temperature of many wells reaches more than 200 °C, which puts forward higher requirement for the downhole measurement-while-drilling system. In this paper, a new active cooling method is proposed to protect electronic components in the electronic cavity from high temperature. The circuit board is cooled by direct contact with the cold end of a custom split-Stirling refrigerator. According to the different heat loads, the electronic components can operate in the proper temperature range by adjusting the piston motion frequency and inflation pressure. At the same time, the electronic cavity is filled with thermal insulation material to induce heat leakage from the environment. The thermal resistance of solid insulation material, argon, and vacuum is studied, and the required effective cooling power is determined. When the thermal insulation material is vacuum, which is the best resistance medium when compared with solid insulation material and argon according to the research results, the effects of the structure size of circuit board and electronic cavity, material property and operational environment on the required effective cooling power and maximum temperature on the room temperature chamber wall of the split-Stirling refrigerator are discussed.
In situ, in vivo, and in operando imaging and spectroscopy of liquids using microfluidics in vacuum
Authors: Yu Xiao-Ying
Published: June 2020

This review offers a succinct overview of the development of a vacuum-compatible microfluidic reactor system for analysis at the liquid vacuum interface (SALVI), and its diverse applications in in situ, in vivo, and in operando imaging of liquid surfaces as well as the air-liquid (a-l), liquid-liquid (l-l), and solid-liquid (s-l) interfaces in the past decade. SALVI is one of the first microfluidics-based reactors that has enabled direct analysis of volatile liquids in vacuum surface tools such as scanning electron microscopy (SEM) and time-of-flight secondary ion mass spectrometry (ToF-SIMS). Its integration into ambient and vacuum spectroscopy and microscopy is illustrated. Several applications are highlighted including (1) imaging nanoparticles in liquid using in situ SEM; (2) mapping the evolving l-l interface using in situ x-ray absorption spectroscopy and ToF-SIMS; (3) following complex a-l interfacial oxidation reaction products using in situ ToF-SIMS; (4) capturing biological interfaces of cells and microbes via in vivo multimodal and correlative imaging; and (5) monitoring the dynamic solid electrode and liquid electrolyte interface using in operando molecular imaging. Finally, outlook and recommendations are presented. Besides showing the holistic information volume obtained by real-time multiplexed imaging, this review intends to convey the importance of tool development in revolutionizing surface and interface analysis using vacuum platforms previously limited to solid surfaces. Microfluidics is manifested to be not limited to ambient conditions in many examples in this review. Moreover, fundamental interfacial phenomena underpinning mass and charge transfer can now be pursued in real time via innovated chemical imaging and spectroscopy.
Atomic layer etching of metals with anisotropy, specificity, and selectivity
Authors: Sang Xia , Xia Yantao , Sautet Philippe , Chang Jane P.
Published: June 2020

In this work, a special focus is given to atomic layer etching (ALE) of metals, since this is a relatively new field but is expected to grow rapidly given the major advancements potentially enabled via metal incorporation throughout the manufacturing process of integrated circuits. The impact of John Coburn’s work on the development of ALE processes is analyzed with a focus on ion energy and the neutral-to-ion ratio. To realize atomic precision in removing etch-resistant materials with complex compositions or structures, the surface reactivity would replace etch rate as the parameter of interest to control the chemical contrast needed for selectivity. The desirable etching anisotropy dictates the usage of directional ions. John Coburn’s work on ion-enhanced etching of Si serves as an example that a fine control of ion energy and the neutral-to-ion ratio could be the gateway of reactivity control, which is demonstrated with recent progress on thermal-plasma ALE of Ni. The effect of surface reactivity is studied from first-principle atomistic calculations and confirms the experimental findings.
3M-052, a synthetic TLR-7/8 agonist, induces durable HIV-1 envelope–specific plasma cells and humoral immunity in nonhuman primates
Authors: Kasturi Sudhir Pai , Rasheed Mohammed Ata Ur , Havenar-Daughton Colin , Pham Mathew , Legere Traci , Sher Zarpheen Jinnah , Kovalenkov Yevgeny , Gumber Sanjeev , Huang Jessica Y. , Gottardo Raphael , Fulp William , Sato Alicia , Sawant Sheetal , Stanfield-Oakley Sherry , Yates Nicole , LaBranche Celia , Alam S. Munir , Tomaras Georgia , Ferrari Guido , Montefiori David , Wrammert Jens , Villinger Francois , Tomai Mark , Vasilakos John , Fox Christopher B. , Reed Steven G. , Haynes Barton F. , Crotty Shane , Ahmed Rafi , Pulendran Bali
Published: June 2020

Our study describes robust and durable induction of HIV-1–specific antibody as well as germinal center and plasma cellular responses in rhesus macaques.
Activation of the NLRP3 Inflammasome by Particles from the Echinococcus granulosus Laminated Layer
Authors: Casaravilla Cecilia , Pittini Álvaro , Rückerl Dominik , Allen Judith E. , Díaz Álvaro
Published: June 2020

The interaction of dendritic cells and macrophages with a variety of rigid noncellular particles triggers activation of the NLRP3 inflammasome and consequent secretion of interleukin 1β (IL-1β). Noncellular particles can also be generated in the context of helminth infection, since these large pathogens often shed their outermost structures during growth and/or molting. One such structure is the massive, mucin-based, soft, flexible laminated layer (LL), which protects the larval stages of cestodes of the genus
Echinococcus
.
hnRNP K Is a Novel Internal Ribosomal Entry Site-Transacting Factor That Negatively Regulates Foot-and-Mouth Disease Virus Translation and Replication and Is Antagonized by Viral 3C Protease
Authors: Liu Wenming , Yang Decheng , Sun Chao , Wang Haiwei , Zhao Bo , Zhou Guohui , Yu Li
Published: June 2020

The translation of picornaviral genome RNA mediated by the internal ribosomal entry site (IRES) is a crucial step for virus infections. Virus-host interactions play a critical role in the regulation of IRES-dependent translation, but the regulatory mechanism remains largely unknown. In this study, we identified an ITAF, hnRNP K, that negatively regulates FMDV replication by inhibiting viral IRES-mediated translation. In addition, we describe a novel translational regulation mechanism involving the proteolytic cleavage of hnRNP K by FMDV protease 3C. The cleavage of hnRNP K yields two cleavage products with opposite functions: the cleavage product hnRNP K
1–364
retains a partial inhibitory effect on IRES activity, and the cleavage product hnRNP K
364–465
becomes a positive regulator of FMDV replication. Our findings shed light on the effect of a novel ITAF on the translational regulation of picornavirus and provide new insights into translational control during viral infection.
Changes in productivity associated with algal-microbial shifts during the Early Triassic recovery of marine ecosystems
Authors: Du Yong , Song Huyue , Tong Jinnan , Algeo Thomas J. , Li Zhe , Song Haijun , Huang Jiandong
Published: June 2020

The recovery of marine ecosystems in the aftermath of the Permian-Triassic mass extinction was accompanied by significant carbon-cycle perturbations, as reflected in large-amplitude global excursions in Lower Triassic carbonate carbon isotope records. In the present study, we generated paired carbonate carbon (δ13Ccarb), organic carbon (δ13Corg), and nitrogen (δ15N) isotope records along with molar C/N ratios for a composite section in the Chaohu area of Anhui Province (northern Yangtze Platform, South China) that spans the entire Lower Triassic. These records document concurrent changes among multiple proxies related to marine plankton community composition, productivity rates, and nutricline structure, providing unparalleled insights into changes at the base of the marine trophic web during the Early Triassic recovery interval.

Changes in carbonate-organic carbon isotopic differences (Δ13Ccarb-org) and C/N ratios indicate a general shift from anoxygenic photoautotrophy to eukaryotic algal productivity during the Early Triassic. The prevalence of prokaryotic photoautotrophs in the Griesbachian to Smithian was due to frequent environmental disturbance, whereas the reestablishment of eukaryotic algae as dominant primary producers in the Spathian reflects a general amelioration of marine environments at that time. Positive δ13Ccarb excursions and brief spikes toward higher Δ13Ccarb-org and C/N ratios around the Induan-Olenekian boundary and Smithian-Spathian boundary record transient shifts toward improved conditions and temporary rebounds of algal productivity. A negative δ15N shift was associated with decreasing δ13Ccarb, indicating that marine productivity was closely linked to N-fixation intensity owing to a general nutrient-N deficiency. Synchronous fluctuations of δ13Ccarb and δ13Corg through the Olenekian reflect changes in the δ13C of oceanic dissolved inorganic carbon, but the more limited variation in δ13Corg may have been due to concurrent changes in algal-microbial assemblages and, thus, net photosynthetic fractionation of carbon isotopes.
Supplemental Material: Teaching with Digital 3D Models of Minerals and Rocks
Authors: Andrews G.D.M.
Published: June 2020

Methodology
Getting health services right for 16–25 year-olds
Authors: Rigby Emma , Hagell Ann , Davis Marion , Gleeson Helena , Mathews Gabrielle , Turner Gill
Published: June 2020

The 2019 NHS England Long Term Plan set out the ambition to work across the 0–25 age range to support children and young people as they make the transition to early adulthood. Within this broad age bracket, how do we ensure we get health services right for 16–25 year-olds including the transfer to adult services? In this paper, we explore the evidence supporting youth-friendly and developmentally appropriate healthcare approaches and what these mean in practice for young people and healthcare professionals. Examples from primary and secondary care, as well as the perspectives of a young person, illustrate the challenges and solutions.
Complete resolution of a hamstring intramuscular tendon injury on MRI is not necessary for a clinically successful return to play
Authors: Vermeulen Robin , Almusa Emad , Buckens Stan , Six Willem , Whiteley Rod , Reurink Guus , Weir Adam , Moen Maarten , Kerkhoffs Gino M M J , Tol Johannes L
Published: June 2020

Background

Clinical decision-making around intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine. For this injury, MRI at return to play (RTP) might improve RTP decision-making; however, no studies have investigated this.

Objective

Our objectives were to describe MRI characteristics at RTP, to evaluate healing and to examine the association of MRI characteristics at RTP with reinjury for clinically recovered hamstring intramuscular tendon injuries.

Methods

We included 41 athletes with hamstring intramuscular tendon injuries and an MRI at baseline and RTP. For both MRIs, we used a standardised scoring form that included intramuscular tendon injury characteristics. We recorded reinjuries during 1-year follow-up.

Results

At RTP, 56% of the intramuscular tendons showed a partial or complete thickness tendon discontinuity. Regarding healing from injury to RTP, 18 of 34 (44% overall) partial-thickness tendon discontinuities became continuous and 6 out of 7 (15% overall) complete thickness tendon discontinuities became partial-thickness tendon discontinuities. Waviness decreased from 61% to 12%, and 88% of tendons became thickened. We recorded eight (20%) reinjuries within 1 year. Intramuscular tendon characteristics at RTP between participants with or without a reinjury were similar.

Conclusion

Complete resolution of an intramuscular tendon injury on MRI is not necessary for clinically successful RTP. From injury to RTP, the intramuscular tendon displayed signs of healing. Intramuscular tendon characteristics of those with or without a reinjury were similar.
“Most of what they do, we cannot do!” How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi
Authors: Topp Stephanie M , Carbone Nicole B , Tseka Jennifer , Kamtsendero Linda , Banda Godfrey , Herce Michael E
Published: June 2020

Background

In the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi’s three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT.

Methods

We conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2–4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches.

Results

Across all three models, PMTCT LHWs carried out a number of ‘targeted’ activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women’s fears and uncertainties; (ii) enhancing women’s social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members’ recognition of and trust in services.

Conclusion

PMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the ‘treat-all’ era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.
Large-scale public venues as medical emergency sites in disasters: lessons from COVID-19 and the use of Fangcang shelter hospitals in Wuhan, China
Authors: Fang Dongping , Pan Shengjie , Li Zaishang , Yuan Ting , Jiang Benran , Gan Di , Sheng Bai , Han Jing , Wang Tao , Liu Zhongmin
Published: June 2020

Since the COVID-19 outbreak, Wuhan has adopted three methods of admitting patients for treatment: designated hospitals, newly built temporary hospitals and Fangcang shelter hospitals. It has been proven that converting large-scale public venues such as stadiums and exhibition centres into Fangcang shelter hospitals, which serve as hospitals for isolation, treatment and disease monitoring of patients with mild symptoms, is the most effective way to control virus transmission and reduce mortality. This paper presents some experiences learnt from treating COVID-19 in Wuhan, the first city to report the outbreak and which suffered from a shortage of emergency supplies, heavy workload among staff and a shortage of hospital beds during the early stages of the pandemic. The experiences include location, accessibility, spacious outdoor area, spacious indoor space, power supply, architectural layout design and partition isolation, ventilation, sewage, and problems in the construction and management of Fangcang shelter hospitals. During the COVID-19 pandemic, traditional approaches to disaster preparedness have demonstrated intrinsic problems, such as poor economic performance, inefficiency and lack of flexibility. Converting large-scale public venues into Fangcang shelter hospitals is an important means to rapidly improve the function of the city’s healthcare system during a pandemic. This valuable experience in Wuhan will help other countries in their battle against the current COVID-19 pandemic and will also contribute to disaster preparedness and mitigation in the future.
Effect and safety of gemtuzumab ozogamicin for the treatment of patients with acute myeloid leukaemia: a systematic review protocol
Authors: Muhamad Nor A , Mohd Dali Nor S , Mohd Yacob Aliza , Kassim Mohd S A , Lodz Noor A , Abdul Wahid S F , Aris Tahir
Published: June 2020

Introduction

Acute myeloid leukaemia (AML) is a type of cancer in which the bone marrow makes abnormal myeloblasts (a type of white blood cell), red blood cells or platelets. Gemtuzumab ozogamicin (GO) holds promise as a new agent that also could be efficacious in newly diagnosed AML with acceptable toxicity. This paper describes the design of a protocol to conduct a systematic review of published studies assessing GO for the treatment of AML.

Method and analysis

We will conduct a systematic review of randomised controlled trials that investigate the effect and safety of GO for the treatment of patients with AML. We will search for any eligible articles from selected electronic databases. We will follow the Preferred Reporting Items for Systematic reviews and Meta-Analysis for study selection and reporting. We will use The Cochrane Handbook for Systematic Reviews of Interventions and Meta-Analysis as guidance to select eligible studies. All data will be extracted using a standardised data extraction form.

Ethics and dissemination

There was no patient involved in this study, therefore no ethical consideration is needed. The findings of this study will be disseminated in a peer-reviewed journal and any relevant conference presentation.

PROSPERO registration number

CRD42019123286.
Prevalence of multimorbidity with frailty and associations with socioeconomic position in an adult population: findings from the cross-sectional HUNT Study in Norway
Authors: Vinjerui Kristin Hestmann , Boeckxstaens Pauline , Douglas Kirsty A , Sund Erik R
Published: June 2020

Objectives

To explore prevalences and occupational group inequalities of two measures of multimorbidity with frailty.

Design

Cross-sectional study.

Setting

The Nord-Trøndelag Health Study (HUNT), Norway, a total county population health survey, 2006–2008.

Participants

Participants older than 25 years, with complete questionnaires, measurements and occupation data were included.

Outcomes

≥2 of 51 multimorbid conditions with ≥1 of 4 frailty measures (poor health, mental illness, physical impairment or social impairment) and ≥3 of 51 multimorbid conditions with ≥2 of 4 frailty measures.

Analysis

Logistic regression models with age and occupational group were specified for each sex separately.

Results

Of 41 193 adults, 38 027 (55% female; 25–100 years old) were included. Of them, 39% had ≥2 multimorbid conditions with ≥1 frailty measure, and 17% had ≥3 multimorbid conditions with ≥2 frailty measures. Prevalence differences in percentage points (pp) with 95% confidence intervals of those in high versus low occupational group with ≥2 multimorbid conditions and ≥1 frailty measure were largest in women age 30 years, 17 (14 to 20) pp and 55 years, 15 (13 to 17) pp and in men age 55 years, 15 (13 to 17) pp and 80 years, 14 (9 to 18) pp. In those with ≥3 multimorbid conditions and ≥2 frailty measures, prevalence differences were largest in women age 30 years, 8 (6 to 10) pp and 55 years, 10 (8 to 11) ppand in men age 55 years, 9 (8 to 11) pp and 80 years, 6 (95% CI 1 to 10) pp.

Conclusion

Multimorbidity with frailty is common, and social inequalities persist until age 80 years in women and throughout the lifespan in men. To manage complex multimorbidity, strategies for proportionate universalism in medical education, healthcare, public health prevention and promotion seem necessary.
Key factors influencing the prescribing of statins: a qualitative study among physicians working in primary healthcare facilities in Indonesia
Authors: Irawati Sylvi , Prayudeni Sari , Rachmawati Riris , Wita I Wayan , Willfert Bob , Hak Eelko , Taxis Katja
Published: June 2020

Objectives

To elicit key factors influencing physicians’ decision to prescribe statins.

Design

A qualitative study using a phenomenological approach within a pragmatism interpretive framework. A combination of purposive and snowball sampling was used to recruit physicians. Data were collected through face-to-face, semistructured interviews with physicians working in primary healthcare facilities in a capital of a province in Indonesia. We recorded and verbatim transcribed the interviews. Coding was done independently by two researchers and data were analysed using phenomenological data analyses. Key factors influencing physicians’ decision to prescribe statins were classified into factors at the microlevels, mesolevels and macrolevels according to the structural model by Scoggins et al.

Participants and setting

Physicians working in primary healthcare facilities in a capital of a province in Indonesia.

Results

Ten physicians were included in the study. Key factors at the microlevel were that physicians knew guidelines in general, but there was uncertainty how to take into account the level of total cholesterol in combination with other cardiovascular risk factors such as diabetes and hypertension. At the macrolevel, the new National Health Insurance System (NHIS) that appeared to facilitate the prescription of statins though more clinical information should be integrated in the system’s platform to support appropriate prescribing.

Conclusions

The findings indicate lack of awareness of specific details in current guideline recommendations. Appropriate prescribing of statins should be enhanced using the new NHIS.
Systematic review and meta-analysis of prognostic factors of acute exacerbation of idiopathic pulmonary fibrosis
Authors: Kamiya Hiroyuki , Panlaqui Ogee Mer
Published: June 2020

Objective

To clarify prognostic factors of acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF).

Design

A systematic review and meta-analysis.

Data sources

Medline, Embase and Science Citation Index Expanded were searched from 2002 through 1 March 2019.

Eligibility criteria for selecting studies

The review included primary studies addressing the association between the outcomes such as all-cause mortality of AE of IPF and its potential prognostic factors, which were designated as any clinical information related to the outcomes.

Data extraction and synthesis

Two reviewers extracted relevant data independently and assessed risk of bias. Univariate results were pooled using a random-effect model if at least three studies were available. Prognostic factors were determined based on significant and consistent results on both univariate and multivariate analyses in the majority of studies.

Results

Out of a total of 6763 articles retrieved, 37 were eligible and 31 potential prognostic factors for all-cause mortality were selected. Each study was subject to certain methodological shortcomings. The following five factors were statistically significant by a meta-analysis of univariate results, which was confirmed by multivariate analysis, that is, Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR 1.10, 1.01 to 1.19), partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio (ORs 0.99 in two studies and HRs 0.31 and 0.99 in two studies, respectively), lactate dehydrogenase (LDH) (HRs 1.002, 1.003, 1.01 and 1.02), white blood cell (WBC) count (OR 1.38, 1.04 to 1.83) and oxygen therapy before AE (HRs 3.68, 1.05 to 12.9 and 2.34, 1.04 to 5.28) (multivariate analysis, 95% CI).

Conclusions

APACHE II score, PaO2/FiO2 ratio, LDH, WBC count and oxygen therapy before AE were deemed as prognostic factors of AE of IPF. Although there are some methodological limitations in this study, these findings are reliable due to consistent results by both univariate and multivariate analyses.

PROSPERO registration number

CRD42018106172.
Randomised controlled trial assessing the effect of a technology-assisted gait and balance training on mobility in older people after hip fracture: study protocol
Authors: Maranesi Elvira , Riccardi Giovanni Renato , Lattanzio Fabrizia , Di Rosa Mirko , Luzi Riccardo , Casoni Elisa , Rinaldi Nadia , Baldoni Renato , Di Donna Valentina , Bevilacqua Roberta
Published: June 2020

Introduction

Deficits in balance and walking ability are relevant risk factors for falls during ageing. Moreover, falls are a risk factor for future falls, strongly associated with adverse health outcomes, such as fear of falling or fractures, particularly, hip fracture. For this reason, the development of prevention tools and innovative rehabilitation strategies is one of the main objectives in geriatrics. Effective interventions to promote hip recovery after hip fracture are characterised by intensive and repetitive movements. One treatment approach is to increase the number of steps during the rehabilitation sessions and to improve the balance and the endurance of the patients in the use of technological devices.

Methods and analysis

This randomised controlled trial aimed to evaluate an innovative rehabilitation treatment of elderly patients with hip fractures. A total of 195 patients with hip fractures will be recruited and randomly divided into three groups: traditional rehabilitation programme, traditional rehabilitation programme plus TYMO system and traditional rehabilitation programme plus Walker View. Assessments will be performed at baseline, at the end of treatment, at 6 months, and at 1 and 2 years after the end of the treatment. Only subjects hospitalised 4 weeks prior to the beginning of the study will be taken into consideration. Twenty treatment sessions will be conducted, divided into three training sessions per week, for 7 weeks. The technological intervention group will carry out 30 min sessions of traditional therapy and 20 min of treatment with a technological device. The control group will perform traditional therapy sessions, each lasting 50 min. The primary outcomes are risk of falling, gait performance and fear of falling.

Ethics and dissemination

The study was approved by the Istituto di Ricerca e Cura a Carattere Scientifica, Istituto Nazionale Ricovero e Cura Anziani Ethics Committee, with identification code number 19 014. Trial results will be submitted for publication in journals and conferences.

Trial registration number

NCT04095338.