bluuebunny/crossref_metadata_2025 huggingface dataset:
Design Tool for Topology Optimization of Self Supporting Variable Density Lattice Structures for Additive Manufacturing
Authors: McConaha Matthew , Venugopal Vysakh , Anand Sam
Published: January 2021

Additive manufacturing (AM) allows for the inclusion of complicated geometric features that are impractical or impossible to manufacture by other means. Among such features is the collection of intricate and periodic strut-like geometries known as lattice structures. Lattice structures are desirable for their ability to provide stiffness through a large number of supporting members while employing void space within the geometry as a means to reduce part material volume. Strut thicknesses of every lattice in a part are generally not well optimized in order to maximize part stiffness, and often every lattice unit cell is identical throughout the part. This work presents a lattice density optimization methodology that is able to find the optimal graded lattice density distribution for maximizing the part stiffness and also improving the additive manufacturability of the part. The material property interpolation scheme used in SIMP optimization is replaced by a representative volume element (RVE)-based interpolation scheme that more accurately captures the material properties of the prescribed lattice structure at an arbitrary density. A filter has been developed that allows for trimming of unnecessary lattices while simultaneously ensuring that the geometry remains self-supporting during the AM build process. This filter is incorporated seamlessly within the topology optimization routine. This increases the optimality of the resulting design when compared with full-domain lattice filling and increases the viability of the design from a manufacturing standpoint when compared with unconstrained lattice trimming.
Generalized Lévêque Solution for Ducts of Arbitrary Cross Section
Authors: Bennett T. D.
Published: January 2021

The asymptotic limit for perimeter averaged convection is generalized for short ducts of arbitrary cross section. A correction factor to Lévêque's original analysis is derived in terms of the state of wall shear stress under conditions of fully developed flows for walls of constant temperature (T) and constant heat flux (H1 and H2). This analysis is performed for four duct geometries: elliptic, rhombic, rectangular, and regular polygons. The magnitude of this correction is greatest for the H2 wall condition and for ducts having walls with acute corners. The results of this analysis can be incorporated into a generalized correlation for the full Graetz problem in ducts of arbitrary cross section.
Quantitative Representation of Aleatoric Uncertainties in Network-Like Topological Structural Systems
Authors: Wang Zihan , Xu Hongyi
Published: January 2021

The complex topological characteristics of network-like structural systems, such as lattice structures, cellular metamaterials, and mass transport networks, pose a great challenge for uncertainty qualification (UQ). Various UQ approaches have been developed to quantify parametric uncertainties or high dimensional random quantities distributed in a simply connected space (e.g., line section, rectangular area, etc.), but it is still challenging to consider the topological characteristics of the spatial domain for uncertainty representation and quantification. To resolve this issue, a network distance-based Gaussian random process uncertainty representation approach is proposed. By representing the topological input space as a node-edge network, the network distance is employed to replace the Euclidean distance in characterizing the spatial correlations. Furthermore, a conditional simulation-based sampling approach is proposed for generating realizations from the uncertainty representation model. Network node values are modeled by a multivariate Gaussian distribution, and the network edge values are simulated conditionally on the node values and the known network edge values. The effectiveness of the proposed approach is demonstrated on two engineering case studies: thermal conduction analysis of 3D lattice structures with stochastic properties and characterization of the distortion patterns of additively manufactured cellular structures.
A Preliminary Investigation Into the Feasibility of Semi-Autonomous Surgical Path Planning for a Mastoidectomy Using LSTM-Recurrent Neural Networks
Authors: Korte Christopher , Schaffner Grant , McGhan Catharine L. R.
Published: January 2021

Path planning algorithms for robotics can be as simple as having an operator program waypoints into a robot's controller and having the robot perform a simple task such as welding. This works well in an industrial setting but will not work for complicated tasks such as performing surgery. Another approach would be to use a constraint function in programing a robot to perform surgery, but it would be difficult to capture and represent all of the surgeon's information in the mathematical terms required for a cost function. A third approach, and the one utilized in this study, is to train a set of artificial neural networks (ANNs) using recorded surgeons' motions when manipulating a surgical instrument during procedure training using a surgery simulator. This has the advantage of indirectly capturing the surgeon's abilities and intentions without needing to explicitly capture all of the motion information that must be encoded from their trajectory planning and decision-making, and then, say, creating a complex constraint function using that information. In this research effort, virtually captured surgical trajectories from trained surgeons were used to train ANNs, after being preprocessed into three subtasks. Each set of subtask data was used to train a separate ANN. Each of the ANNs was trained using a custom cost function and evaluated using custom metrics. During the training, the positions of fiducial markers, recorded during procedure attempts, were used to orient the recorded path relative to the patient's anatomy. Although the ANN-generated trajectories were not used to perform surgery on a live patient in this study, the fiducial marker position information is intended to be exploited during a real procedure to position, orient, and scale a tool trajectory to suit a patient's specific anatomy. The trained ANNs were subjected to several tests to assess their safety and robustness. We found that even when trained on a small number of datasets, the ANNs converged and could generate output trajectories that were still assessed to be safe even when slight changes in the fiducial marker placement locations were given.
Selection of an Ideal Coolant to Ward Off the Thermal Runaway of a Pouch Type Li-Ion Battery Module
Authors: Monika Kokkula , Chakraborty Chanchal , Roy Sounak , Dinda Srikanta , Singh Satyapaul A. , Datta Santanu Prasad
Published: January 2021

To uphold the temperature within an acceptable range of Li-ion batteries in electric vehicles, appropriate thermo-regulation strategies should be implemented. If the temperature is increased beyond the permissible range during the charging/discharging cycle, there is a possibility of overheating and electrolyte fire, which leads to degradation of the lifecycle and capability of the cell. This research suggests the usage of nanofluids as a heat transfer medium for active thermal management. A numerical approach is employed to analyze the effectiveness of nanofluids and their impact on the temperature gradient within the battery module. The thermal performance of water and water:ethylene glycol-based nanofluid is numerically examined where the water shows better performance due to excellent thermal properties, whereas the dispersion of nanoparticles in base fluids shows a notable effect on reducing the temperature of the battery module, while a limited effect on temperature uniformity. Besides, an enhancement in performance is seen with the growth in the volume fraction of nanoparticles amid an increased pumping power at the same time. The impact of different functioning parameters such as inlet velocity, coolant temperature, and discharge rate is also analyzed for water-based nanofluids. Results indicate that with an increase in coolant velocity, alumina nanofluid can provide better uniformity and reduce the battery module temperature than the base fluid.
Measurement and Prediction of Decomposed Energy Efficiencies of Lithium Ion Batteries With Two Charge Models
Authors: Huang Yuhao , Su Yan , Garg Akhil
Published: January 2021

A new process decomposed calculation method is developed to compare the cycle based charge, discharge, net, and overall energy efficiencies of lithium-ion batteries. Multi-cycle measurements for both constant current (CC) and constant current to constant voltage (CC-CV) charge models have been performed. Unlike most conventional efficiency calculation methods with one mean open-circuit voltage (OCV) curve, two OCV curves are calculated separately for the charge and discharge processes. These two OCV curves help to clarify the intra-cycle charge, discharge, net, and overall energy efficiencies. The relationships of efficiencies versus state of charge, state of quantity, and scaled stresses are demonstrated. Efficiency degradation patterns versus cycle numbers and scaled stresses are also illustrated with the artificial neural network (ANN) prediction method. The decaying ratios of the overall efficiencies are about 2% and 0.3% in the first 30 cycles, for CC and CC-CV, respectively. Hence, efficiencies of the CC-CV model are more stable compared with the CC model, which are shown by both experimental and ANN prediction results.
Recent Developments in Hybrid Surface Metal Matrix Composites Produced by Friction Stir Processing: A Review
Authors: Sharma Daulat Kumar , Badheka Vishvesh , Patel Vivek , Upadhyay Gautam
Published: January 2021

The metal matrix composites combine the metallic properties of a tough and ductile matrix with properties of reinforcement particles, simultaneously develop the functional properties by proper selection of reinforcements for projected applications. However, hard ceramics reinforcements decrease toughness and ductility of soft matrix and restrict their wide applications. The surface metal matrix composites (SMMCs) preserve the matrix properties with added advanced surface properties by reinforcing particles only in the surface layer. The hybrid surface metal matrix composites (HSMMCs) with more than one reinforcement gained attention in material processing due to their noble tribological behavior and surface properties, which cannot be attained in mono composites. Conventional liquid-phase processing techniques to fabricate hybrid surface composites result in the formation of undesirable brittle compounds, detrimental to desirable properties of composites. Friction stir processing (FSP), a solid-state processing technique, has been used by many investigators using different reinforcements to fabricate mono as well as hybrid surface composites. Friction stir processed (FSPed) hybrid surface composites have not been extensively reviewed. The current review provides a comprehensive understanding of the latest developments of FSP in hybrid surface composites manufacturing. This paper review different reinforcement strategies in the fabrication of FSPed hybrid surface composites and also the effects of single-pass, multipass, and change in pass direction on microstructure and resultant properties. Finally, future directions and challenges to FSPed hybrid surface composites are summarized. This review article containing important information on hybrid surface composites fabrication by FSP will be useful to academicians and investigators in the field.
Dimethyl Ether and Liquefied Petroleum Gas Co-Fumigation and Oxidation Catalyst Exhaust Aftertreatment: A Synergy for Improvement of Thermal Efficiency and Emissions in a Dual-Fuel Engine
Authors: Kamei Wittison , Sahoo Niranjan , Prasad V. V. D. N.
Published: January 2021

Gaseous hydrocarbon (HC) fuels or alcohols can partially replace diesel in compression ignition engines through the dual-fuel mode of combustion. However, such dual-fuel mode faces the challenges of high carbon monoxide (CO) and unburnt HC emissions and low thermal efficiency, particularly at low loads. The objective of this study is to achieve dual-fuel engine thermal efficiency and emissions better than those of a diesel mode while utilizing alternative fuels. A new approach consisting of a combined strategy using dimethyl ether (DME) as a co-fumigant with liquefied petroleum gas (LPG) and deployment of a customized oxidation catalyst in a single-cylinder diesel engine is presented. DME is a high-cetane oxygenate which can be produced from renewable biomass feedstock. DME and LPG are miscible, and they can be handled and stored similarly. The diesel energy replacements (36–64%) by DME and LPG are studied at low-load to part-load conditions. A customized oxidation catalyst is benchmarked with a commercial one. The dual-fuel combustion exhibits low-temperature and high-temperature reactions with significant improvement in combustion phasing. The dual-fuel mode outperforms the diesel mode and has higher thermal efficiency. The dual-fuel mode with the customized oxidation catalyst achieves emissions of CO, HC, and smoke lower than those of the diesel mode by up to 94%, 89%, and 94%, respectively. The dual-fuel engine effectively utilizes the alternative fuels and achieves drastically reduced emissions and higher thermal efficiency as compared with the diesel mode.
EGR1 is a gatekeeper of inflammatory enhancers in human macrophages
Authors: Trizzino Marco , Zucco Avery , Deliard Sandra , Wang Fang , Barbieri Elisa , Veglia Filippo , Gabrilovich Dmitry , Gardini Alessandro
Published: January 2021

The EGR1 transcription factor blunts macrophage activation by coordinating epigenetic repression of inflammatory enhancers.
Real-time observation and control of optical chaos
Authors: Fan Linran , Yan Xiaodong , Wang Han , Wang Lihong V.
Published: January 2021

Compressive ultrafast photography allows real-time imaging and control of optical chaos phenomena.
Induction of muscle-regenerative multipotent stem cells from human adipocytes by PDGF-AB and 5-azacytidine
Authors: Yeola Avani , Subramanian Shruthi , Oliver Rema A. , Lucas Christine A. , Thoms Julie A. I. , Yan Feng , Olivier Jake , Chacon Diego , Tursky Melinda L. , Srivastava Pallavi , Potas Jason R. , Hung Tzongtyng , Power Carl , Hardy Philip , Ma David D. , Kilian Kristopher A. , McCarroll Joshua , Kavallaris Maria , Hesson Luke B. , Beck Dominik , Curtis David J. , Wong Jason W. H. , Hardeman Edna C. , Walsh William R. , Mobbs Ralph , Chandrakanthan Vashe , Pimanda John E.
Published: January 2021

Human adipocytes are a source of tissue-regenerative multipotent stem cells.
Oldest cave art found in Sulawesi
Authors: Brumm Adam , Oktaviana Adhi Agus , Burhan Basran , Hakim Budianto , Lebe Rustan , Zhao Jian-xin , Sulistyarto Priyatno Hadi , Ririmasse Marlon , Adhityatama Shinatria , Sumantri Iwan , Aubert Maxime
Published: January 2021

An image of a pig painted at least 45,500 years ago on a cave wall in Sulawesi may be the earliest figurative rock art ever found.
The Arp1/11 minifilament of dynactin primes the endosomal Arp2/3 complex
Authors: Fokin Artem I. , David Violaine , Oguievetskaia Ksenia , Derivery Emmanuel , Stone Caroline E. , Cao Luyan , Rocques Nathalie , Molinie Nicolas , Henriot Véronique , Aumont-Nicaise Magali , Hinckelmann Maria-Victoria , Saudou Frédéric , Le Clainche Christophe , Carter Andrew P. , Romet-Lemonne Guillaume , Gautreau Alexis M.
Published: January 2021

Dendritic actin networks grow in an autocatalytic manner starting from the uncapped minifilament of dynactin.
Structures of
Rhodopseudomonas palustris
RC-LH1 complexes with open or closed quinone channels
Authors: Swainsbury David J. K. , Qian Pu , Jackson Philip J. , Faries Kaitlyn M. , Niedzwiedzki Dariusz M. , Martin Elizabeth C. , Farmer David A. , Malone Lorna A. , Thompson Rebecca F. , Ranson Neil A. , Canniffe Daniel P. , Dickman Mark J. , Holten Dewey , Kirmaier Christine , Hitchcock Andrew , Hunter C. Neil
Published: January 2021

High-resolution structures of reaction-center light-harvesting 1 complexes provide new insights into quinone dynamics.
Cell cycle inertia underlies a bifurcation in cell fates after DNA damage
Authors: Nathans Jenny F. , Cornwell James A. , Afifi Marwa M. , Paul Debasish , Cappell Steven D.
Published: January 2021

Cells advance through G
1
phase for 2 hours after DNA damage, and if not stopped in time, they will enter S phase with damaged DNA.
Spatiotemporal single-cell profiling reveals that invasive and tissue-resident memory donor CD8
+
T cells drive gastrointestinal acute graft-versus-host disease
Authors: Tkachev Victor , Kaminski James , Potter E. Lake , Furlan Scott N. , Yu Alison , Hunt Daniel J. , McGuckin Connor , Zheng Hengqi , Colonna Lucrezia , Gerdemann Ulrike , Carlson Judith , Hoffman Michelle , Olvera Joe , English Chris , Baldessari Audrey , Panoskaltsis-Mortari Angela , Watkins Benjamin , Qayed Muna , Suessmuth Yvonne , Betz Kayla , Bratrude Brandi , Langston Amelia , Horan John T. , Ordovas-Montanes Jose , Shalek Alex K. , Blazar Bruce R. , Roederer Mario , Kean Leslie S.
Published: January 2021

Flow cytometric and transcriptomic analyses reveal coordinated tissue infiltration and tissue residence of donor T cells that drive gastrointestinal GVHD.
The Ethanologenic Bacterium Zymomonas mobilis Divides Asymmetrically and Exhibits Heterogeneity in DNA Content
Authors: Fuchino Katsuya , Chan Helena , Hwang Ling Chin , Bruheim Per
Published: January 2021

With increasing environmental concerns about the exhausting use of fossil fuels, development of a sustainable biofuel production platform has been attracting significant public attention. Ethanologenic
Z. mobilis
species are endowed with an efficient ethanol fermentation capacity that surpasses, in several respects, that of baker’s yeast (
Saccharomyces cerevisiae
), the most-used microorganism for ethanol production.
Bilateral vocal fold paresis: the only presenting sign of anti-MUSK antibody myasthenia gravis
Authors: Arman Sam , Kock Norman , Mochloulis George , Kanabar Gorande
Published: January 2021

A previously fit and well 53-year-old man was referred to the otolaryngology clinic with intermittent stridor and was found to have bilateral vocal fold paresis. Subsequent airway compromise necessitated emergency surgical tracheostomy. The man was discharged home with tracheostomy in situ and a diagnosis of idiopathic bilateral vocal cord palsy, as all primary investigations were negative. Neurological disease was suspected following readmission to hospital several weeks later with diplopia. Electromyography and serum antibody testing confirmed a diagnosis of anti-muscle-specific tyrosine kinase antibody positive myasthenia gravis (MuSK-MG); a subset of MG where autoantibodies are directed against MuSK. Resolution of bilateral vocal fold paresis was found 8 months after a short course of immunoglobulin (intravenous immunoglobulin (IVIg)) and daily mycophenolate therapy was commenced. Multidisciplinary teamwork between ear, nose and throat surgeons, neurologists and speech therapists enabled successful decannulation of tracheostomy. The patient has recovered well and remains minimally symptomatic.
Myocarditis in SARS-CoV-2 negative patients with suspected preceding infection
Authors: Henwood Matthew , Lake Daniel , Allen Felix , Sange Mansoor
Published: January 2021

SARS-CoV-2 is primarily a respiratory disease; however, there have been multiple reports of associated myocarditis. In our 463 bedded, district general hospital, we noted an influx of young patients with myocarditis shortly after the peak of the outbreak. We report two cases presenting with myocarditis, both of whom tested negative for the virus despite clinical and biochemical evidence of recent infection. Diagnosis was made based on positive transthoracic echocardiogram (TTE) findings and a raised troponin, not in the context of suspected acute coronary syndrome. We recommend that patients with negative coronavirus tests should still be considered at risk of potential sequelae from the disease. There should be a low threshold for performing basic cardiac investigations: ECG, troponin and TTE as well as seeking a cardiology opinion. Colchicine is a recognised treatment for viral pericarditis and should be considered as adjunctive treatment; however, further research is required specific to SARS-CoV-2.
Posterior circulation stroke presenting as a new continuous cough: not always COVID-19
Authors: Warraich Mazhar , Bolaji Paul , Das Saugata
Published: January 2021

A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.
Adherence to recommendations for endoscopy practice during COVID-19 pandemic in Latin America: how are we doing it?
Authors: Murcio-Pérez Enrique , Zamarripa-Mottú Raúl Antonio , Andrade-DePaulo Gustavo , Aguilar-Nájera Octavio , Tchekmedyian Jorge Asadur , Blanco-Velasco Gerardo , Solórzano-Pineda Omar Michel , Hernández-Mondragón Oscar Victor , Tellez-Avila Felix
Published: January 2021

Background and aims

Digestive endoscopy is considered a high-risk procedure for COVID-19. Recommendations have been made for its practice during the pandemic. This study was conducted to determine adherence to recommendations for endoscopy practice during the COVID-19 pandemic in Latin America (LA).

Methods

A survey was conducted of endoscopists from LA consisting of 43 questions for the evaluation of four items: general and sociodemographic features, and preprocedure, intraprocedure and postprocedure aspects.

Results

A response was obtained from 338 endoscopists (response rate 34.5%) across 15 countries in LA. In preprocedure aspects (hand washing, use of face masks for patients, respiratory triage area, training for the placement/removal of personal protective equipment (PPE) and availability of specific area for the placement/removal of PPE), there was adherence in <75%. Regarding postprocedure aspects, 77% (261/338) had reused PPE, mainly the N95 respirator or higher, and this was with a standardised decontamination procedure only in 32% (108/338) of the time. Postprocedure room decontamination was carried out by 47% on >75% of occasions. In relationship to intraprocedure aspects (knowledge of risk and type of endoscopic procedures, use of PPE, airway management in patients and infrastructure), there was adherence in >75% for all the parameters and 78% of endoscopists only performed emergencies or time-sensitive procedures.

Conclusions

Adherence to the recommendations for endoscopy practice during the COVID-19 pandemic is adequate in the intraprocedure aspect. However, it is deficient in the preprocedure and postprocedure aspects.
Transitioning from donor aid for health: perspectives of national stakeholders in Ghana
Authors: Mao Wenhui , McDade Kaci Kennedy , Huffstetler Hanna E , Dodoo Joseph , Abankwah Daniel Nana Yaw , Coleman Nathaniel , Riviere Judy , Zhang Jiaqi , Nonvignon Justice , Bharali Ipchita , Bandara Shashika , Ogbuoji Osondu , Yamey Gavin
Published: January 2021

Background

Ghana’s shift from low-income to middle-income status will make it ineligible to receive concessional aid in the future. While transition may be a reflection of positive changes in a country, such as economic development or health progress, a loss of support from donor agencies could have negative impacts on health system performance and population health. We aimed to identify key challenges and opportunities that Ghana will face in dealing with aid transition, specifically from the point of view of country-level stakeholders.

Methods

We conducted key informant interviews with 18 stakeholders from the government, civil society organisations and donor agencies in Ghana using a semistructured interview guide. We performed directed content analysis of the interview transcripts to identify key themes related to anticipated challenges and opportunities that might result from donor transitions.

Results

Overall, stakeholders identified challenges more frequently than opportunities. All stakeholders interviewed believe that Ghana will face substantial challenges due to donor transitions. Challenges include difficulty filling financial gaps left by donors, the shifting of national priorities away from the health sector, lack of human resources for health, interrupted care for beneficiaries of donor-funded health programmes, neglect of vulnerable populations and loss of the accountability mechanisms that are linked with donor financing. However, stakeholders also identified key opportunities that transitions might present, including efficiency gains, increased self-determination and self-sufficiency, enhanced capacity to leverage domestic resources and improved revenue mobilisation.

Conclusion

Stakeholders in Ghana believe transitioning away from aid for health presents both challenges and opportunities. The challenges could be addressed by conducting a transition readiness assessment, identifying health sector priorities, developing a transition plan with a budget to continue critical health programmes and mobilising greater political commitment to health. The loss of aid could be turned into an opportunity to integrate vertical programmes into a more comprehensive health system.
Active & Safe Central: using a mixed-methods design and the RE-AIM framework to evaluate a sport and recreational injury prevention resource for practitioners in Canada
Authors: Richmond Sarah A. , Bruin Samantha , Black Amanda M , Pike Ian , Babul Shelina
Published: January 2021

Objectives

An online, evidence-based resource was created to support the development of sport and recreational injury prevention programmes. The resource, called Active & Safe Central (www.activesafe.ca), provides evidence-based information across the public health approach for a number of sport and recreational activities. The objective of this project was to evaluate the perceived usefulness of Active & Safe Central as an educational tool.

Design

A mixed-methods study design, guided by the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework, was used to evaluate Active & Safe Central.

Setting

Data were collected using an online survey, available to all users of the site, and focus groups (n=2) that took place in Vancouver and Toronto, Canada.

Participants

Survey respondents (n=87) were recruited online, including parents, coaches, youth and adult athletes, and teachers. Focus group participants (n=16) were key stakeholders and end users, recruited from academia, local health sectors, sport and recreational organisations, and not-for-profit injury prevention organisations.

Results

Post launch, there were 1712 users visiting the website 2306 times (sessions), with the majority representing new users, over returning users (87.5% and 12.5%, respectively). There were 6340 page visits, with the most popular pages including soccer, playgrounds and ice hockey. Active & Safe Central was reported as a credible source of evidence-based sport and recreational information and that the site would be recommended to others. Information collected from focus group participants was used to inform necessary adaptations to the online platform, including critical navigation issues, visualisations and interactivity. The major themes that emerged from focus group and survey data included increased awareness of injury prevention recommendations and that the recommendations would be used in one’s own sporting activity and/or practice.

Conclusions

The results of the evaluation suggest the tool is a useful resource for sport and recreational injury information that has significant potential to impact prevention practice.
KEPT-app trial: a pragmatic, single-blind, parallel, cluster-randomised effectiveness study of pelvic floor muscle training among incontinent pregnant women: study protocol
Authors: Sidik Sherina Mohd , Jaffar Aida , Foo Chai Nien , Muhammad Noor Azimah , Abdul Manaf Rosliza , Ismail Siti Irma Fadhilah , Alagirisamy Parwathi , Ahmad Fazlah Amalina Farhi , Suli Zailiza , Goodyear-Smith Felicity
Published: January 2021

Introduction

Pelvic floor muscle training (PFMT) strongly recommended to incontinent pregnant women. The Kegel Exercise Pregnancy Training-app trial is a multicentre cluster-randomised study aims to assess the effectiveness and its cost-effectiveness of the mobile app guidance in PFMT among incontinent pregnant women.

Methods and analysis

370 pregnant women (aged 18 years old and above) will be recruited with International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. Ten clusters (primary care clinics) will be randomly assigned to either PFMT or usual care in a 1:1 ratio by an independent researcher (sealed envelope). The primary outcome will be urinary incontinence, and the secondary outcomes (quality of life; PFMT adherence, psychological status and mobile apps’ usability) will be assessed at four measurement time points (t0: baseline) and postintervention (t1: 4 weeks, t2: 8 weeks and t3: 8 weeks postnatal). T-test analysis will determine any significant differences at the baseline between the control and intervention groups. The mixed-model analysis will determine the effectiveness of the intervention at the population-average level for both the primary and secondary outcomes. For the cost-effectiveness analysis, expenditures during the study and 6 months after the intervention will be compared between the groups using the multiway sensitivity analysis. The recruitment planned will be in December 2020, and the planned end of the study will be in August 2021.

Ethics and dissemination

This study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM-2019–368) and Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia, NMRR-19-412-47116 (IIR) with the ANZCTR registration. This study will obtain informed written consent from all the study participants. The results which conform with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials will be published for dissemination in peer-reviewed journals and conference proceedings.

Trial registration number

ACTRN12619000379112.
Key drivers of innovativeness appraisal for medicines: the Italian experience after the adoption of the new ranking system
Authors: Galeone Carlotta , Bruzzi Paolo , Jommi Claudio
Published: January 2021

Objective

In 2017, the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) introduced a standardised process to appraise innovativeness of medicines. Innovative medicines are provided speeder market access and dedicated funds. Innovativeness criteria are: unmet therapeutic need, added therapeutic value and quality of the evidence (Grading of Recommendations Assessment, Development and Evaluation method). We investigated the role played by these three criteria on the final decision aimed to understand how the new Italian innovativeness appraisal framework was implemented.

Design

A desk research gathered AIFA’s appraisal reports on innovativeness and data analyses were conducted. No patients were directly involved in this study.

Setting and participants

We scrutinised all 77 appraisal reports available on AIFA’s website (2017–2020).

Primary and secondary outcome measures

The impact of the three domains on final decision was investigated through a series of univariate analyses.

Results

Among 77 appraisal reports on innovativeness available, 49 (64%) and 28 (36%) were for oncology and non-oncology medicines, respectively. The appraisals were equally distributed among ‘fully innovative’ (36%), ‘conditionally innovative’ (30%) and ‘not innovative’ (34%). Added therapeutic value was the most important driver on innovativeness decision, followed by quality of the evidence. Drugs for rare diseases and with paediatric/mixed indications were appraised ‘innovative’ by a larger proportion, but no statistical significance was found.

Conclusions

Despite some limitations, including the moderate number of appraisals, this paper provides an insight into the determinants of innovativeness appraisals for medicines in Italy and the accuracy of the appraisal process. This has important implications in terms of transparency and accountability in the prioritisation process applied to innovative medicines.
Long-term trends and regional variations of hypertension incidence in China: a prospective cohort study from the China Health and Nutrition Survey, 1991–2015
Authors: Luo Yunmei , Xia Fan , Yu Xuexin , Li Peiyi , Huang Wenzhi , Zhang Wei
Published: January 2021

Objective

The aim is to explore the trends of hypertension incidence and regional variations in China from 1991 to 2015.

Design

A dynamic prospective cohort study.

Setting

China Health and Nutrition Survey 1991–2015.

Participants

12 952 Chinese adults aged 18+ years.

Primary outcome measures

Incident hypertension from 1993 to 2015.

Results

Age-standardised hypertension incidence increased from 40.8 per 1000 person-years (95% CI 38.3 to 43.4) between 1993 and 1997 to 48.6 (95% CI 46.1 to 51.0) between 2011 and 2015. The increasing trends were further supported by results from subsequent extended Cox proportional hazard model. In addition, results from the modelling analysis showed that individuals in eastern, central and northeastern China had greater risks of hypertension occurrence in comparison with their counterparts in western China.

Conclusion

Hypertension incidence increased during the study period. The growth called for more attention on the health education and health promotion of individuals with great risks.
Orthopaedic medical examination for young amateur athletes: a repeated cross-sectional study from 2014 to 2018
Authors: Yokoe Takuji , Tajima Takuya , Yamaguchi Nami , Nagasawa Makoto , Ota Tomomi , Morita Yudai , Chosa Etsuo
Published: January 2021

Objectives

Medical examinations for adult elite athletes are performed all over the world, however, no studies in the relevant English literature have reported on orthopaedic medical examinations for young amateur athletes. The purpose of this study was to report the results of orthopaedic medical examinations of the spine and lower extremities in young amateur athletes.

Methods

This repeated cross-sectional study from 2014 to 2018 included a total of 323 young amateur athletes (age, 12–18 years) who were active in one of the following four sports: boxing, canoeing, weightlifting and track and field. The orthopaedic medical examination consisted of six assessments (physical examinations, the generalised joint laxity, muscle and joint tightness, static alignment and muscle volume of the lower extremities and the medial longitudinal arch of the foot). Questions regarding pain in the spine and lower extremities were also performed.

Results

Among 323 young amateur athletes, 17 (5.3%) had received orthopaedic treatment at the time of the medical examination, with spondylolysis being the most common cause (29.4%, 5/17). Among 306 young athletes who had not received orthopaedic treatment, 61 (19.9%) had at least one positive finding in physical examinations or had pain in the spine or lower extremities. Anterior drawer test of the ankle and Kemp test for the spine accounted for 34% and 28% of positive findings, respectively. Low back pain and knee pain accounted for 58% and 16% of pain, respectively.

Conclusions

The present study showed that approximately one-fifth of young amateur athletes who had not received orthopaedic treatment had pain in the spine and lower extremities and positive findings in physical examinations that may require orthopaedic treatments. In addition to the early detection of injuries, orthopaedic medical examinations for young amateur athletes provide an opportunity to educate such athletes.
Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review
Authors: Subbe Christian Peter , Tellier Genevieve , Barach Paul
Published: January 2021

Objectives

Review available evidence for impact of electronic health records (EHRs) on predefined patient safety outcomes in interventional studies to identify gaps in current knowledge and design interventions for future research.

Design

Scoping review to map existing evidence and identify gaps for future research.

Data sources

PubMed, the Cochrane Library, EMBASE, Trial registers.

Study selection

Eligibility criteria: We conducted a scoping review of bibliographic databases and the grey literature of randomised and non-randomised trials describing interventions targeting a list of fourteen predefined areas of safety. The search was limited to manuscripts published between January 2008 and December 2018 of studies in adult inpatient settings and complemented by a targeted search for studies using a sample of EHR vendors. Studies were categorised according to methodology, intervention characteristics and safety outcome.

Results from identified studies were grouped around common themes of safety measures.

Results

The search yielded 583 articles of which 24 articles were included. The identified studies were largely from US academic medical centres, heterogeneous in study conduct, definitions, treatment protocols and study outcome reporting. Of the 24 included studies effective safety themes included medication reconciliation, decision support for prescribing medications, communication between teams, infection prevention and measures of EHR-specific harm. Heterogeneity of the interventions and study characteristics precluded a systematic meta-analysis. Most studies reported process measures and not patient-level safety outcomes: We found no or limited evidence in 13 of 14 predefined safety areas, with good evidence limited to medication safety.

Conclusions

Published evidence for EHR impact on safety outcomes from interventional studies is limited and does not permit firm conclusions regarding the full safety impact of EHRs or support recommendations about ideal design features. The review highlights the need for greater transparency in quality assurance of existing EHRs and further research into suitable metrics and study designs.
The Irish National Adverse Event Study-2 (INAES-2): longitudinal trends in adverse event rates in the Irish healthcare system
Authors: Connolly Warren , Rafter Natasha , Conroy Ronan M , Stuart Cornelia , Hickey Anne , Williams David J
Published: January 2021

Objectives

To quantify the prevalence and nature of adverse events in acute Irish hospitals in 2015 and to assess the impact of the National Clinical Programmes and the National Clinical Guidelines on the prevalence of adverse events by comparing these results with the previously published data from 2009.

Design and methods

A retrospective chart review of 1605 admissions to eight Irish hospitals in 2015, using identical methods to those used in 2009.

Results

The percentage of admissions associated with one or more adverse events was unchanged (p=0.48) at 14% (95% CI=10.4% to 18.4%) in 2015 compared with 12.2% (95% CI=9.5% to 15.5%) in 2009. Similarly, the prevalence of preventable adverse events was unchanged (p=0.3) at 7.4% (95% CI=5.3% to 10.5%) in 2015 compared with 9.1% (95% CI=6.9% to 11.9%) in 2009. The incidence densities of preventable adverse events were 5.6 adverse events per 100 admissions (95% CI=3.4 to 8.0) in 2015 and 7.7 adverse events per 100 admissions (95% CI=5.8 to 9.6) in 2009 (p=0.23). However, the percentage of preventable adverse events due to hospital-associated infections decreased to 22.2% (95% CI=15.2% to 31.1%) in 2015 from 33.1% (95% CI=25.6% to 41.6%) in 2009 (p=0.01).

Conclusion

Adverse event rates remained stable between 2009 and 2015. The percentage of preventable adverse events related to hospital-associated infection decreased, which may represent a positive impact of the related national programmes and guidelines.
Barriers and facilitators to meeting recommended physical activity levels among new immigrant and refugee children in Saskatchewan, Canada
Authors: Lane Ginny , Nisbet Christine , Johnson Shanthi , Candow Darren , Chilibeck Philip D. , Vatanparast Hassan
Published: January 2021

Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3–4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4–90.0%). Age and income predicted physical activity among males, while parents’ education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children’s preference for screen time. Schools played a central role in newcomer children’s health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them.

Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3–4-year-olds did. Age and income predicted males’ physical activity, while parents’ education level predicted females’ physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity.
DYNAMICAL ANALYSIS OF THE MEMINDUCTOR-BASED CHAOTIC SYSTEM WITH HIDDEN ATTRACTOR
Authors: QI AIXUE , MUHAMMAD KHAN , LIU SHUAI
Published: January 2021

The meminductor is a new type of memory circuit element which is defined based on the memristor. To explore the application of the meminductor in the nonlinear circuits, a mathematical model of meminductor is proposed and applied to nonlinear circuits. In this work, a simple meminductor-based chaotic system is designed. The equilibrium point of the system is controlled by the externally excited sinusoidal signal in the circuit. No matter what the value of the externally excited signal is, the chaotic attractor generated by the proposed system is hidden. The dynamic characteristics of the system are analyzed by theoretical analysis and numerical simulation. The results show that the dynamic behaviors of the system are affected by the circuit parameters and the circuit running time. The proposed system shows some novel nonlinear phenomena, such as transient chaos and state transitions. In addition, the existence of coexisting attractors, such as chaotic, periodic and quasi-periodic attractors, is analyzed in different initial states.
Corporate Governance and Transparency in Japan
Authors: Aman Hiroyuki , Beekes Wendy , Brown Philip
Published: January 2021

Corporate governance (CG) reformists typically presume better-governed companies are more transparent to investors. We focus on CG and transparency in Japan, where CG has been an ongoing issue. Using local ratings of Japanese companies’ CG and data on corporate disclosures and their associated stock returns, we do find better-governed Japanese companies have made more frequent and timelier disclosures, and their share prices have reflected value-relevant information earlier. While these results hold for good news, they do not hold for bad. Consequently, governance guidance in Japan may not have resulted in both timelier and more balanced release of newsworthy information.
Life Sentences and Perpetual Confinement
Authors: Seeds Christopher
Published: January 2021

The past 40 years have been a time of great change in life sentencing, during which the use of life sentences has dramatically grown and the quality of life sentences has markedly hardened. The rise of life without parole in the United States is a particularly recognizable development, but life sentencing has increased worldwide, and the use of other forms of punishment that hold people in prison until death has also intensified. This article focuses on these transformations by examining several important areas in which thinking and scholarship on life sentencing have been altered and spurred by recent developments. The review concludes by pointing to gaps in the field of research and highlighting issues on which social scientific research on life sentencing has more to contribute going forward.
Relationship between Damage Rate of High‐Voltage Electrical Equipment and Instrumental Seismic Intensity
Authors: Liu Rushan , Xiong Mingpan , Tian Deyuan
Published: January 2021

Based on the actual damage data of high‐voltage electrical equipment in electric substations in the Wenchuan earthquake, this paper uses the cumulative Gaussian distribution function to describe the relationship between the damage rate of high‐voltage electrical equipment and the instrumental seismic intensity. The instrumental seismic intensity at strong motion observation stations in the Wenchuan earthquake is calculated, and the Kriging interpolation method is used to estimate the instrumental seismic intensity at 110 kV and above voltage level substations in Mianyang, Deyang, Guangyuan, and Chengdu of Sichuan Province. A cumulative Gaussian distribution function is then used to fit the damage rate‐instrumental seismic intensity relationship curve for six types of high‐voltage electrical equipment such as the transformer, circuit breaker, voltage mutual inductor, current mutual inductor, isolating switch, and lightning arrester. The results show that transformers have the highest vulnerability during earthquakes, and they suffered a certain level of damage even under low instrumental intensity. The second most vulnerable equipment is the circuit breaker, followed by the lightning arrester, transformer, and isolating switch, which share a similar vulnerability curve.