bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of mannitol in cardiopulmonary bypass prime solution—Prospective randomized double‐blind clinical trial
Authors: Ljunggren Magnus , Sköld Andreas , Dardashti Alain , Hyllén Snejana
Published: July 2019

Background

The optimal prime solution for the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol is widely used in the priming solution for CPB despite the fact that there is no clear consensus on the role of mannitol in cardiac surgery. The aim of this study was to investigate the effect of mannitol in the CPB prime solution.

Methods

This prospective, randomized, double‐blind study included 40 patients with normal cardiac and renal functions, who underwent coronary artery bypass grafting. One group received a prime based on Ringer's acetate (n = 20), and the other a prime consisting of Ringer's acetate with 200 mL mannitol (n = 20). Changes in osmolality, acid‐base status, electrolytes, and renal‐related parameters were monitored.

Results

No significant differences were found in osmolality between the Ringer's acetate group and the mannitol group at any time. The mannitol group showed a pronounced decrease in sodium, from 138.7 ± 2.8 mmol/L at anaesthesia onset, to 133.9 ± 2.6 mmol/L after the start of CPB (P < .001). No differences were seen in the renal parameters between the groups, apart from a short‐term effect of mannitol on peroperative urine production (P = .003).

Conclusion

We observed no effects on osmolality of a prime solution containing mannitol compared to Ringer's acetate‐based prime in patients with normal cardiac and renal function. The use of mannitol in the prime resulted in a short‐term, significant decrease in sodium level.
Spinal and epidural sufentanil and fentanyl in early labour
Authors: Väänänen Antti , Kuukasjärvi Matti , Tekay Aydin , Ahonen Jouni
Published: July 2019

Background and aim

The analgesic effect on labour pain of either spinal or epidural sufentanil or fentanyl was tested in a total of 80 primiparous parturients at an early phase of the delivery. The aim of the study was to compare the level of analgesia achieved within 20 minutes.

Methods

The parturients were randomly assigned to groups receiving either spinal sufentanil (5 µg), epidural sufentanil (20 µg), spinal fentanyl (20 µg) or epidural fentanyl (100 µg), whereafter the parturients were monitored for reported pain during contraction and side effects for 30 minutes. The primary outcome was the level of analgesia achieved within 20 minutes, while the secondary outcome was the time until the administration of the first epidural bolus.

Results

At baseline, the mean maximum pain VAS was 86 (84‐89) mm. At 20 minutes after spinal sufentanil, epidural sufentanil, spinal fentanyl or epidural fentanyl, the maximum VAS was 19 (7‐31), 45 (32‐59), 25 (10‐39) or 52 (40‐63) mm, respectively (P < .01 spin vs epid groups). There were no differences in efficacy between spinal or epidural sufentanil and fentanyl. The mean (95% CI) time to the activation of epidural analgesia was 151 (111‐192), 130 (93‐168), 177 (121‐234) and 112 (80‐143) minutes after spinal sufentanil, epidural sufentanil, spinal fentanyl and epidural fentanyl, respectively.

Conclusions

In terms of a reduction of VAS score at 20 minutes, epidural sufentanil or fentanyl provide 63% and 60% of the analgesic effect of the corresponding spinal analgesia. Epidural sufentanil or fentanyl could be used in situations in which spinal/CSE administration is not possible or desired.
Dynamic c‐Fos changes in mouse brain during acute and protracted withdrawal from chronic intermittent ethanol exposure and relapse drinking
Authors: Smith Rachel J. , Anderson Rachel I. , Haun Harold L. , Mulholland Patrick J. , Griffin William C. , Lopez Marcelo F. , Becker Howard C.
Published: July 2019

Alcohol dependence promotes neuroadaptations in numerous brain areas, leading to escalated drinking and enhanced relapse vulnerability. We previously developed a mouse model of ethanol dependence and relapse drinking in which repeated cycles of chronic intermittent ethanol (CIE) vapor exposure drive a significant escalation of voluntary ethanol drinking. In the current study, we used this model to evaluate changes in neuronal activity (as indexed by c‐Fos expression) throughout acute and protracted withdrawal from CIE (combined with or without a history of ethanol drinking). We analyzed c‐Fos protein expression in 29 brain regions in mice sacrificed 2, 10, 26, and 74 hours or 7 days after withdrawal from 5 cycles of CIE. Results revealed dynamic time‐ and brain region‐dependent changes in c‐Fos activity over the time course of withdrawal from CIE exposure, as compared with nondependent air‐exposed control mice, beginning with markedly low expression levels upon removal from the ethanol vapor chambers (2 hours), reflecting intoxication. c‐Fos expression was enhanced during acute CIE withdrawal (10 and 26 hours), followed by widespread reductions at the beginning of protracted withdrawal (74 hours) in several brain areas. Persistent reductions in c‐Fos expression were observed during prolonged withdrawal (7 days) in prelimbic cortex, nucleus accumbens shell, dorsomedial striatum, paraventricular nucleus of thalamus, and ventral subiculum. A history of ethanol drinking altered acute CIE withdrawal effects and caused widespread reductions in c‐Fos that persisted during extended abstinence even without CIE exposure. These data indicate that ethanol dependence and relapse drinking drive long‐lasting neuroadaptations in several brain regions.
Thermal biology of mosquito‐borne disease
Authors: Mordecai Erin A. , Caldwell Jamie M. , Grossman Marissa K. , Lippi Catherine A. , Johnson Leah R. , Neira Marco , Rohr Jason R. , Ryan Sadie J. , Savage Van , Shocket Marta S. , Sippy Rachel , Stewart Ibarra Anna M. , Thomas Matthew B. , Villena Oswaldo
Published: July 2019

Mosquito‐borne diseases cause a major burden of disease worldwide. The vital rates of these ectothermic vectors and parasites respond strongly and nonlinearly to temperature and therefore to climate change. Here, we review how trait‐based approaches can synthesise and mechanistically predict the temperature dependence of transmission across vectors, pathogens, and environments. We present 11 pathogens transmitted by 15 different mosquito species – including globally important diseases like malaria, dengue, and Zika – synthesised from previously published studies. Transmission varied strongly and unimodally with temperature, peaking at 23–29ºC and declining to zero below 9–23ºC and above 32–38ºC. Different traits restricted transmission at low versus high temperatures, and temperature effects on transmission varied by both mosquito and parasite species. Temperate pathogens exhibit broader thermal ranges and cooler thermal minima and optima than tropical pathogens. Among tropical pathogens, malaria and Ross River virus had lower thermal optima (25–26ºC) while dengue and Zika viruses had the highest (29ºC) thermal optima. We expect warming to increase transmission below thermal optima but decrease transmission above optima. Key directions for future work include linking mechanistic models to field transmission, combining temperature effects with control measures, incorporating trait variation and temperature variation, and investigating climate adaptation and migration.
On the relationship between VDR, RORα and RORγ receptors expression and HIF1‐α levels in human melanomas
Authors: Brożyna Anna A. , Jóźwicki Wojciech , Jetten Anton M. , Slominski Andrzej T.
Published: July 2019

We analysed the correlation between the expression of HIF‐1α (hypoxia‐inducible factor 1 alpha), the nuclear receptors: VDR (vitamin D receptor), RORα (retinoic acid receptor‐related orphan receptor alpha), and RORγ and CYP24A1 (cytochrome P450 family 24 subfamily A member 1) and CYP27B1 (cytochrome P450 family 27 subfamily B member 1), enzymes involved in vitamin D metabolism. In primary and metastatic melanomas, VDR negatively correlated with nuclear HIF‐1α expression (r = −.2273, P = .0302; r = −.5081, P = .0011). Furthermore, the highest HIF‐1α expression was observed in pT3‐pT4 VDR‐negative melanomas. A comparative analysis of immunostained HIF‐1α and CYP27B1 and CYP24A1 showed lack of correlation between these parameters both in primary tumors and melanoma metastases. In contrast, RORα expression correlated positively with nuclear HIF‐1α expression in primary and metastatic lesions (r = .2438, P = .0175; r = .3662, P = .0166). Comparable levels of HIF‐1α expression pattern was observed in localized and advanced melanomas. RORγ in primary melanomas correlated also positively with nuclear HIF‐1α expression (r = .2743, P = .0129). HIF‐1α expression was the lowest in localized RORγ‐negative melanomas. In addition, HIF‐1α expression correlated with RORγ‐positive lymphocytes in melanoma metastases. We further found that in metastatic lymph nodes FoxP3 immunostaining correlated positively with HIF‐1α and RORγ expression in melanoma cells (r = .3667; P = .0327; r = .4208, P = .0129). In summary, our study indicates that the expression of VDR, RORα and RORγ in melanomas is related to hypoxia and/or HIF1‐α activity, which also affects FoxP3 expression in metastatic melanoma. Therefore, the hypoxia can affect tumor biology by changing nuclear receptors expression and molecular pathways regulated by nuclear receptors and immune responses.
Crystal structures of Trypanosoma brucei hypoxanthine – guanine – xanthine phosphoribosyltransferase in complex with IMP, GMP and XMP
Authors: Terán David , Doleželová Eva , Keough Dianne T. , Hocková Dana , Zíková Alena , Guddat Luke W.
Published: July 2019

The 6‐oxopurine phosphoribosyltransferases (PRTs) are drug targets for the treatment of parasitic diseases. This is due to the fact that parasites are auxotrophic for the 6‐oxopurine bases relying on salvage enzymes for the synthesis of their 6‐oxopurine nucleoside monophosphates. In Trypanosoma brucei, the parasite that is the aetiological agent for sleeping sickness, there are three 6‐oxopurine PRT isoforms. Two are specific for hypoxanthine and guanine, whilst the third, characterized here, uses all three naturally occurring bases with similar efficiency. Here, we have determined crystal structures for TbrHGXPRT in complex with GMP, XMP and IMP to investigate the structural basis for substrate specificity. The results show that Y201 and E208, not commonly observed within the purine binding pocket of 6‐oxopurine PRTs, contribute to the versatility of this enzyme. The structures further show that a nearby water can act as an adaptor to facilitate the binding of XMP and GMP. When GMP binds, a water can accept a proton from the 2‐amino group but when XMP binds, the equivalent water can donate its proton to the 2‐oxo group. However, when IMP is bound, no water molecule is observed at that location.

Database

Coordinates and structure factors were submitted to the Protein Data Bank and have accession codes of 6MXB, 6MXC, 6MXD and 6MXG for the TbrHGXPRT.XMP complex, TbrHGXPRT.GMP complex, TbrHGXPRT.IMP complex, and TbrHGPRT.XMP complex, respectively.
Toward feminist geographies of cycling
Authors: Ravensbergen Léa , Buliung Ron , Laliberté Nicole
Published: July 2019

Using a systematic search strategy, this paper reviews the literature about gender and cycling and critically assesses existing approaches to study the topic. Most studies use a binary conceptualization of gender, a cross‐sectional research design, and quantitative analysis to examine male–female differences in cycling behaviours, stated concerns, correlates, and barriers. The two hypotheses at the centre of most of this work are (1) that women cycle less than men due to greater safety concerns and (2) that women cycle less, or at least use bicycles differently than men, because of their more complex travel patterns that arise from greater household responsibilities. While the literature draws attention toward travel characteristics, it often relies on a simple binary conceptualization of gender. In doing so, it identifies differences in male–female cycling patterns, but it rarely sheds light on the gendered processes underlying these differences. In this paper, we argue that research into cycling as a form of mobility could be strengthened by engaging with feminist theories such as performativity, intersectionality, and embodiment to advance a more nuanced understanding of how gender and other axes of identity are intertwined with cycling.
Does board gender diversity affect corporate cash holdings?
Authors: Atif Muhammad , Liu Benjamin , Huang Allen
Published: July 2019

This paper examines whether board gender diversity affects corporate cash holdings using S&P 1500 index firms in the US for the period 2006–2015. We document a significantly negative relationship between board gender diversity and cash holdings. We also find a strong negative effect of female independent directors consistent with monitoring function. Moreover, in accordance with the critical mass theory, we find a negative effect of female directors’ presence and voice on cash holdings. Our findings are robust to alternative econometric specifications, alternative measures of cash holdings and corporate governance, difference‐in‐differences, propensity score matching, and two‐stage least squares. This study offers useful insights into the current global debate on gender diversity and its implications for firms.
Pharmacological and genetic inhibition of fatty acid‐binding protein 4 alleviated cisplatin‐induced acute kidney injury
Authors: Tan Zhouke , Guo Fan , Huang Zhuo , Xia Zijing , Liu Jing , Tao Sibei , Li Lingzhi , Feng Yuying , Du Xiaoyan , Ma Liang , Fu Ping
Published: July 2019

Fatty acid‐binding protein 4 (FABP4) has been confirmed to be involved in the pathogenesis of ischaemia/reperfusion‐ and rhabdomyolysis‐induced acute kidney injury (AKI), and targeting inhibition of FABP4 might be a potential strategy for AKI. Cisplatin as a commonly used cancer chemotherapeutic drug possessed a dose‐limited side effect of nephrotoxicity. However, whether FABP4 inhibition exerted a favourable renoprotection against cisplatin‐induced AKI and the involved mechanisms remained unknown. In the study, cisplatin‐injected mice developed severe AKI symptom as indicated by renal dysfunction and pathological changes, companied by the high expression of FABP4 in tubular epithelial cells. Selective inhibition of FABP4 by BMS309403 at 40 mg/kg/d for 3 days and genetic knockout of FABP4 significantly attenuated the serum creatinine, blood urea nitrogen level and renal tubular damage. Mechanistically, cisplatin injection induced the increased apoptosis and regulated the corresponding protein expression of BCL‐2, BCL‐XL, BAX, cleaved caspase 3 and caspase 12 in the injured kidney tissues. Cisplatin also triggered multiple signal mediators of endoplasmic reticulum (ER) stress including double‐stranded RNA‐activated protein kinase‐like ER kinase, activating transcription factor‐6 and inositol‐requiring enzyme‐1 pathway, as well as CHOP, GRP78 and p‐JNK proteins in the kidneys. Oral administration of BMS309403 significantly reduced the number of renal TUNEL‐positive apoptotic cells. Knockout of FABP4 and BMS309403 notably improved ER stress‐related apoptotic responses. In summary, pharmacological and genetic inhibition of FABP4 modulated apoptosis via the inactivation of ER stress in the tubular epithelial cells of cisplatin‐induced AKI.
A randomized controlled trial of an emollient with ceramide and filaggrin‐associated amino acids for the primary prevention of atopic dermatitis in high‐risk infants
Authors: McClanahan D. , Wong A. , Kezic S. , Samrao A. , Hajar T. , Hill E. , Simpson E.L.
Published: July 2019

Background

Skin barrier dysfunction may precede infantile development of clinical atopic dermatitis (AD). Early‐life emollient therapy to enhance barrier function may prevent or modify AD development in high‐risk infants.

Objectives

(a) To determine whether daily full‐body application of an emollient with ceramide and amino acids (study emollient) can reduce the cumulative AD incidence compared to standard skin care at 1 year of age. (b) To evaluate the study emollient's effect on skin barrier function, natural moisturizing factor and the microbiome using non‐invasive biophysical and biochemical techniques.

Methods

We performed a single‐centre, investigator‐blinded, randomized controlled trial enrolling infants at high risk for AD development determined by family history. The intervention was full‐body once‐daily application of the study emollient. The control arm was asked to not apply full‐body emollient regularly and only use an emollient of their choice for dry skin. The primary outcome was the cumulative incidence of AD diagnosed at 12 months by a blinded investigator.

Results

Less than half the target sample size was enrolled (n = 100, goal sample was 208) with 28% lost to follow‐up. Across all clinical end points, a numerical trend was observed in favour of the intervention, although not statistically significant likely due to lack of power from under‐enrolment. AD was diagnosed in 13.2% vs. 25.0% at 12 months (P = 0.204) and 19.4% vs. 31.0% at 2 years (P = 0.296) in intervention vs. control groups, respectively. There were no significant differences between groups in skin barrier or microbiome assessments. While there were no serious adverse events, there were more cases of reported contact dermatitis in the intervention vs. control arms, 9.3% vs. 4.3%, respectively; however, these events were not related to the study emollient and most mild in severity.

Conclusion

The observed trends suggest a protective effect of daily study emollient therapy compared to control.
Onychoscopy with red light for vascular pattern identification: a study of 33 patients
Authors: Pellacani G. , Alessandrini A. , Mandel V.D. , Martella A. , Brandi N. , Chester J. , Piraccini B.M. , Starace M.
Published: July 2019

Background

Nail dermoscopy (onychoscopy) during physical examination assists in correct diagnosis. Often further magnifications are necessary for an effective differential diagnosis. With the addition of a red light to the dermoscope, important vascular features can be visualized.

Objective

To describe common features observed at onychoscopy with a new device that combines the regular white light with the red light illumination, demonstrating that it is useful for diagnosis of nail disorders.

Methods

We enrolled 33 consecutive patients referred to the Nail Diseases Dermatology Unit of the University of Modena and Reggio Emilia and to the Outpatient Consultation for Nail Disease of the Dermatology Unit of the University of Bologna. Patients were assessed with a standard hand‐held dermoscope and at the red light dermoscope. Dermoscopic images were collected.

Results

The new prototype was used during daily clinical practice and allowed a more accurate visualization of some details that classic onychoscopy can miss. In particular, with the help of the red light it was possible to better visualize nail lesions that were characterized by some kind of colour change or vascular alterations.

Conclusion

The new device of red light for vascular pattern onychoscopy can be a new investigation method to observe nail alterations, especially due to vascular pattern, even with low magnification, without the necessity to use higher resolutions.
Host factors against plant viruses
Authors: Garcia‐Ruiz Hernan
Published: July 2019

Plant virus genome replication and movement is dependent on host resources and factors. However, plants respond to virus infection through several mechanisms, such as autophagy, ubiquitination, mRNA decay and gene silencing, that target viral components. Viral factors work in synchrony with pro‐viral host factors during the infection cycle and are targeted by antiviral responses. Accordingly, establishment of virus infection is genetically determined by the availability of the pro‐viral factors necessary for genome replication and movement, and by the balance between plant defence and viral suppression of defence responses. Sequential requirement of pro‐viral factors and the antagonistic activity of antiviral factors suggest a two‐step model to explain plant–virus interactions. At each step of the infection process, host factors with antiviral activity have been identified. Here we review our current understanding of host factors with antiviral activity against plant viruses.
Power distance and migrant nurses: The liminality of acculturation
Authors: Choi Myung Suk , Cook Catherine Mary , Brunton Margaret A.
Published: July 2019

A dearth of literature focuses on the relationship between acculturation, power distance and liminality for migrant nurses entering foreign workplaces. Expectations are for migrant nurses to be practice‐ready swiftly. However, this aspiration is naïve given the complex shifts that occur in deeply held cultural beliefs and practices and is dependent on an organisational climate of reciprocal willingness to adapt and learn. This exploratory study identified that although a plethora of literature addresses challenges migrant nurses face, there are limited data that link these transitional processes to concepts that might usefully guide transitions. This study draws from the overarching concept of acculturation, together with Hofstede's (2011) notion of power distance and the theory of liminality to explore the experiences of eight migrant nurses. Data highlighted that adjusting to altered hierarchical relationships took many months because negotiating power distance challenged deeply held beliefs and assumptions about professional and organisational hierarchies. Migrant nurses’ accounts indicated a paucity of organisational processes to address these difficulties; therefore, they navigated this liminal space of adjustment to power distance differences in an ad hoc manner. Their acculturation experiences, arguably unnecessarily prolonged, indicate the value in workplace commitment to exploring a collaborative, critically reflective approach to optimise transitions.
Decarbonizing international shipping: An appraisal of the IMO's Initial Strategy
Authors: Doelle Meinhard , Chircop Aldo
Published: July 2019

In April 2018, the International Maritime Organization (IMO) adopted the ‘Initial IMO Strategy on Reduction of GHG Emissions from Ships', the first tangible achievement of the roadmap it set for itself in November 2016. This article assesses the IMO's Initial Strategy in light of the long‐term goals of the Paris Agreement on climate change, and considers its ambition, adequacy and effectiveness in ensuring a fair contribution to the global decarbonization effort. The article offers a brief history of efforts to reduce emissions from international shipping under the United Nations climate regime and the IMO. It then discusses the key elements of the 2018 IMO Strategy, followed by an assessment of its strengths and weaknesses.
Power‐Sharing in the World's Largest Democracy: Informal Consociationalism in India (and Its Decline?)
Authors: Adeney Katharine , Swenden Wilfried
Published: July 2019

India is one of the most diverse countries of the world but operates with a majoritarian Westminster constitution and simple plurality electoral system, albeit also with a federal structure. It was eventually coded as consociational by Arend Lijphart (1996) but this coding was questioned by authors such as Wilkinson (2000) and Adeney (2002). This article assesses the nature of both de jure and de facto power‐sharing in India over its 70 years of independence and tracks the evolution of de jure and de facto power‐sharing in relation to four dimensions of diversity: religion, caste, territory and language. It questions whether the electoral success of Hindu nationalism and the increasing acceptance of ethnic majoritarianism has reduced the degree of power‐sharing in India.
Outcomes in 40 cats with discrete intermediate‐ or large‐cell gastrointestinal lymphoma masses treated with surgical mass resection (2005‐2015)
Authors: Tidd Kathleen S. , Durham Amy C. , Brown Dorothy C. , Velovolu Sridhar , Nagel Jonathan , Krick Erika L.
Published: July 2019

Objective

To report outcomes in cats with discrete intermediate‐ and large‐cell gastrointestinal (GI) lymphoma masses after surgical resection.

Study design

Retrospective clinical case series.

Animals

Forty client‐owned cats in which intermediate‐ or large‐cell GI lymphoma was diagnosed.

Methods

Records of 40 cats in which discrete intermediate‐ or large‐cell GI lymphoma masses were diagnosed between 2005 and 2015 were reviewed. Cats were included if they survived curative intent surgery and had a known outcome for at least two weeks. Postoperative death was permitted. Data collected included anatomic site, surgical margins, lymphoma subtype, chemotherapy use, and postoperative and long‐term outcome (beyond two weeks).

Results

Affected sites consisted of small intestines (n = 23), large intestines (n = 9), and stomach (n = 8). Thirty‐six of 40 cats survived to discharge, and 31 cats were alive at suture removal. Median long‐term follow‐up of 22 cats was 111 days (range, 16‐1407). Cats that survived to suture removal had a median survival time (MST) of 185 days (95% confidence interval: 72‐465). Cats with large intestinal masses lived longer than those with small intestinal or gastric masses whether all cats (MST, 675, 64, 96 days, respectively;P= .03) or only those surviving to suture removal were considered. Complete surgical resection (n = 20) was positively associated with survival (370 vs 83 days,P= .016).

Conclusion

Most cats in this population survived the perioperative period, with MST similar to those reported historically with medical management.

Clinical significance

Surgical resection may be a reasonable consideration in cats with solitary lymphoma, particularly those with large intestinal masses.
Expanding on the Expanding Englishes of the Expanding Circle
Authors: Berns Margie
Published: July 2019

Issue after issue of such journals as World Englishes and English Today deliver insights into and an understanding of the nature of the world's Englishes. Most of these scholarly contributions rely upon the Concentric Circle Model of World Englishes, a central feature of the Kachruvian paradigm since 1985. While the Englishes of each circle are covered in each issue, my interest in this paper is the Expanding Circle. I give attention to its representation in these two journals and to the model's integrity as a tool for investigating the sociolinguistic reality of English worldwide. I first report on two studies which I conducted that examined the representation of the Expanding Circle in the forenamed journals. Each study, conducted in two separate time periods, recorded the number of articles that appeared in each issue, listed the regions and countries covered, and tallied how often each region or country was the focus of an article. I then consider some implications of the findings and apply them to an analysis of the strength of claims made about alleged weaknesses in the Concentric Circles Model. I argue that the more that is known about Expanding Circle Englishes, the more that the model proves to be a robust, productive tool for description and analysis, even as varieties change and develop and users acquire new identities.
Proper Orthogonal Decomposition-Based Method for Predicting Flow and Heat Transfer of Oil and Water in Reservoir
Authors: Sun Xianhang , Li Bingfan , Ma Xu , Pan Yi , Yang Shuangchun , Huang Weiqiu
Published: July 2019

Calculation process of some reservoir engineering problems involves several passes of full-order numerical reservoir simulations, and this makes it a time-consuming process. In this study, a fast method based on proper orthogonal decomposition (POD) was developed to predict flow and heat transfer of oil and water in a reservoir. The reduced order model for flow and heat transfer of oil and water in the hot water-drive reservoir was generated. Then, POD was used to extract a reduced set of POD basis functions from a series of “snapshots” obtained by a finite difference method (FDM), and these POD basis functions most efficiently represent the dynamic characteristics of the original physical system. After injection and production parameters are changed constantly, the POD basis functions combined with the reduced order model were used to predict the new physical fields. The POD-based method was approved on a two-dimensional hot water-drive reservoir model. For the example of this paper, compared with FDM, the prediction error of water saturation and temperature fields were less than 1.3% and 1.5%, respectively; what is more, it was quite fast, where the increase in calculation speed was more than 70 times.
Performance Evaluation of a Solar Greenhouse Dryer at Different Bed Conditions Under Passive Mode
Authors: Ahmad Asim , Prakash Om
Published: July 2019

Greenhouse drying shows a significant role in the bulk level of drying. In the present setup, a greenhouse dryer operating under natural convection mode was designed and fabricated. The sensible heat storage concept was applied to the bed of the drying chamber. Four different beds, namely, gravel bed, ground bed, concrete bed, and black painted gravel bed was being selected for the comparative heat transfer analyses of the proposed setup. The maximum heat gain takes place at the black painted gravel bed conditions, i.e., 53%, while for concrete bed, gravel bed, and ground bed, it is 33%, 49%, and 29%, respectively. Hence, black painted gravel bed condition is strongly recommended for maximum heat storage. The proposed setup was used for drying of tomato flakes in black painted gravel bed condition. It has been found that the moisture content in the tomato flakes has been removed from 96% to 9.10% in 13 h. The average drying efficiency of the proposed greenhouse dryer is found to be 23.49%. The comparative analysis of the performance evaluation has been done with other investigators, and it was found that the drying rate of the proposed setup shows superior performance as compared with others. The design of the proposed greenhouse setup with black painted gravel bed condition is strongly recommended for small-scale industries and farmers.
Wavenumber domain analyses of vibro-acoustic decoupling and noise attenuation in a plate-cavity system enclosed by an acoustic black hole plate
Authors: Wang Xiaodong , Ji Hongli , Qiu Jinhao , Cheng Li
Published: July 2019

The acoustic black hole (ABH) effect is realized in thin plate structures with a decreasing thickness according to a power-law function, and offers potential applications for structure vibration damping enhancement and free-field noise radiation suppression. In this paper, a wavenumber domain method (WNDM) is proposed for the analysis of vibro-acoustic coupling and internal noise reduction mechanism of a pentahedral cavity enclosed by a flexible plate with a two-dimensional ABH indentation, subject to a point force excitation. The system response of the ABH plate-cavity is computed by a validated finite element model. The relationship between the space-averaged sound energy inside the cavity and the spectra of the structural displacement and the acoustic mode of the cavity is established. This allows revealing a dual physical mechanism behind the observed noise reduction: amplitude reduction and mismatching between the wavenumber spectra of the plate displacement and the acoustic field, which results in a weakened vibro-acoustic coupling. An additional configuration with an ABH embedded in an irregular pentagonal wall of the cavity is examined. Despite the increasing complexity in the geometry of the coupling interface and its coupling with the cavity, numerical analyses confirm the generality of the observed physical phenomena and the applicability of the proposed WNDM to more complex system configurations.
Measuring dynamic levels of self-perceived anxiety and concern during simulated mobility tasks in people with non-neovascular age-related macular degeneration
Authors: Taylor Deanna J , Smith Nicholas D , Jones Pete R , Binns Alison M , Crabb David P
Published: July 2019

Background/aims

To assess response to real-world mobility scenarios in people with dry age-related macular degeneration (AMD) using a computer-based test.

Methods

Participants were shown 18 point-of-view computer-based movies simulating walking through real-world scenarios, and pressed a button during scenes which would cause them self-perceived anxiety or concern in their day-to-day life. Button pressure was recorded throughout. Pressure traces were generated, which aligned with each movie time point. Group averages based on AMD severity were generated. Bootstrapped confidence intervals (CIs) for responses by group were generated around traces. Traces were examined to discover events causing the greatest differences between groups.

Results

Participants had early/no AMD (n=8), intermediate AMD (n=7) or geographic atrophy (n=15 (GA)). Median (IQR) logMAR visual acuity was 0.04 (−0.04, 0.18), 0.26 (0.10, 0.40) and 0.32 (0.20, 0.56), respectively. Participants with intermediate AMD or GA recorded greater pressure than those with early and no AMD (Kruskal-Wallis, p=0.04). Four events involving navigating stairs and three under low luminance elicited greatest differences between groups (p<0.001).

Conclusion

People with intermediate AMD or GA likely experience higher levels of concern associated with mobility. The test highlights areas of specific concern. Results should be useful in patient management and educating the public about the everyday effects of AMD.
3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan’s TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach
Authors: Ali Syed Mustafa , Hussain Sumaira , Ishaq Muhammad , Ali Shoukat , Naureen Farah , Noor Arif , Rashid Aamna , Anjum Naveed
Published: July 2019

Objective

WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate.

Methodology

The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradleyet al.

Findings

Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public–private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate.

Conclusion

Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.
The ‘Pleasure&Pregnancy’ web-based interactive educational programme versus expectant management in the treatment of unexplained subfertility: protocol for a randomised controlled trial
Authors: Dancet Eline A F , D’Hooghe Thomas M , Dreischor Felicia , van Wely Madelon , Laan Ellen T M , Lambalk Cornelius B , Repping Sjoerd , Custers Inge M
Published: July 2019

Introduction

Many subfertile couples are diagnosed with (relatively) unexplained subfertility and a good prognosis. National professional guidelines (eg, the Netherlands and UK) advise ‘expectant management (EM)’ for 6–12 months, in which no interaction with healthcare staff is offered. Underpowered studies indicate that face-to-face sex-counselling increases the ongoing pregnancy rates of these couples. In patients with other conditions, web-based interactive educational programmes have the same effect on sexual functioning as face-to-face sex counselling. The ‘Pleasure&Pregnancy randomised controlled trial (RCT)’ will examine in couples with unexplained subfertility and a good prognosis whether a new web-based interactive educational programme results in a higher chance of naturally conceiving an ongoing pregnancy within 6 months as compared with EM.

Methods and analysis

A multicentre RCT with cost-effectiveness analysis will include heterosexual couples diagnosed with (relatively) unexplained subfertility and a good prognosis in Dutch and Belgian secondary or tertiary fertility clinics. Couples will be randomised between 6 months of EM and 6 months of the Pleasure&Pregnancy-programme. This new web-based interactive educational programme includes eight progressive modules of information (on the biology of conception and pleasurable sex) and sensate focus, couple communication and mindfulness exercises. Couples are offered interaction with their coaches via email and can take part in three moderated chat sessions with peers. The primary outcome of this RCT is the probability of naturally conceiving an ongoing pregnancy within 6 months after randomisation. Secondary outcomes include time-to-pregnancy, live birth rate, costs, sexual functioning and personal and relational well-being. Analysis will be according to intention to treat.

Ethics and dissemination

This study has been approved by the Medical Ethical Committees of the Academic Medical Centre (the Netherlands) and the Leuven University Hospital (Belgium). The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications.

Trail registration number

NTR5709; Pre-results.
Effect of a proficiency-based progression simulation programme on clinical communication for the deteriorating patient: a randomised controlled trial
Authors: Breen Dorothy , O’Brien Sinead , McCarthy Nora , Gallagher Anthony , Walshe Nuala
Published: July 2019

Objective

This study aimed to determine the effectiveness of a proficiency-based progression (PBP) training approach to clinical communication in the context of a clinically deteriorating patient.

Design

This is a randomised controlled trial with three parallel arms.

Setting

This study was conducted in a university in Ireland.

Participants

This study included 45 third year nursing and 45 final year medical undergraduates scheduled to undertake interdisciplinary National Early Warning Score (NEWS) training over a 3-day period in September 2016.

Interventions

Participants were prospectively randomised to one of three groups before undertaking a performance assessment of the ISBAR (Identification, Situation, Background, Assessment, Recommendation) communication tool relevant to a deteriorating patient in a high-fidelity simulation facility. The groups were as follows: (i) E, the Irish Health Service national NEWS e-learning programme only; (ii) E+S, the national e-learning programme plus standard simulation; and (iii) E+PBP, the national e-learning programme plus PBP simulation.

Main outcome measures

The primary outcome was the proportion in each group reaching a predefined proficiency benchmark comprising a series of predefined steps, errors and critical errors during the performance of a standardised, high-fidelity simulation assessment case which was recorded and scored by two independent blinded assessors.

Results

6.9% (2/29) of the E group and 13% (3/23) of the E+S group demonstrated proficiency in comparison to 60% (15/25) of the E+PBP group. The difference between the E and the E+S groups was not statistically significant (χ2=0.55, 99% CI 0.63 to 0.66, p=0.63) but was significant for the difference between the E and the E+PBP groups (χ2=22.25, CI 0.00 to 0.00, p<0.000) and between the E+S and the E+PBP groups (χ2=11.04, CI 0.00 to 0.00, p=0.001).

Conclusions

PBP is a more effective way to teach clinical communication in the context of the deteriorating patient than e-learning either alone or in combination with standard simulation.

Trial registration number

NCT02886754; Results.
Evaluation of the referral management systems (RMS) used by GP practices in Northumberland: a qualitative study
Authors: Dew Rosie , Wilkes Scott
Published: July 2019

Objective

Exploring the views of stakeholders to the referral management systems (RMS) used by GP practices in Northumberland, UK to evaluate its perceived effectiveness.

Design

This was an in-depth qualitative semi-structured interview study.

Participants and setting

32 participants (GPs, hospital consultants, referral support, hospital managers, Clinical Commissioning Group manager) in the North East of England, UK.

Method

Interviews using a grounded theory approach and thematic analysis.

Results

The main benefit of RMS mentioned by participants was that it allowed for unnecessary referrals to be vetted by consultants, and helps ensure patients are sent to the correct clinic. Generally, the consultants in our study felt that RMS did not significantly help them reject referrals. Some GPs experienced that RMS undermined GP autonomy and did not help when they had exhausted their abilities to manage a patient in primary care, and it was suggested that in some cases RMS may delay rather than prevent a referral. The main perceived disadvantage of RMS was the additional workload for GPs and consultants, and RMS was felt to be a barrier to commutation between GPs and consultants. Frustration with the system design and lack of knowledge of its cost-effectiveness were articulated.

Conclusion

Although RMS was reported to reduce some unnecessary referrals, the effect of referral delay and rejection is unknown. Although there were some positive attributes described, RMS was mostly received negatively by the stakeholders.
Adapting a club-based medication delivery strategy to a hypertension context: the CLUBMEDS Study in Nigeria
Authors: Santo Karla , Isiguzo Godsent C , Atkins Emily , Mishra Shiva R , Panda Rajmohan , Mbau Lilian , Fayomi Samuel B , Ugwu Collins , Odili Augustine , Virani Salim
Published: July 2019

Introduction

The prevalence of hypertension in sub-Saharan Africa is among the world’s highest; however, awareness, treatment and control of hypertension in this region are suboptimal. Among other barriers, the overburdened healthcare system poses a great challenge for hypertension control. Community peer-support groups are an alternative and promising strategy to improve adherence and blood pressure (BP) control. The CLUBMEDS study aims to evaluate the feasibility and impact of adherence clubs to improve hypertension control in Nigeria.

Methods and analysis

The CLUBMEDS study will include a formative (pre-implementation) qualitative evaluation, a pilot study and a process (postimplementation) qualitative evaluation. At the formative stages, focus group discussions with patient groups and in-depth interviews with healthcare providers, managers and key decision makers will be conducted to understand the feasibility, barriers and facilitators, opportunities and challenges for the successful implementation of the CLUBMEDS strategy. The CLUBMEDS pilot study will be implemented in two primary healthcare facilities, one urban and one rural, in Southeast Nigeria. Each adherence club, which consists of a group of 10–15 patients with hypertension under the leadership of a role-model patient, serves as a support group to encourage and facilitate adherence, BP self-monitoring and medication delivery on a monthly basis. A process evaluation will be conducted at the end of the pilot study to evaluate the acceptability and engagement with the CLUBMEDS strategy. To date, 104 patients were recruited and grouped into nine clubs, in which patients will be followed-up for 6 months.

Ethics and dissemination

The study was approved by the University of Abuja Teaching Hospital and the Federal Teaching Hospital Abakaliki Human Research Ethics Committees and all patients provided informed consent. Our findings will provide preliminary data on the potential effectiveness and acceptance of this strategy in a hypertension context. Study findings will be disseminated via scientific forums.
Right versus left thoracic approach oesophagectomy for oesophageal cancer: a systematic review and meta-analysis protocol
Authors: Chai Tianci , Shen Zhimin , Chen Sui , Lin Yuhan , Zhang Zhenyang , Lin Wenwei , Hong Junjie , Yang Chuangcai , Kang Mingqiang , Lin Jiangbo
Published: July 2019

Introduction

Oesophageal cancer is one of the most common malignant tumours and has been identified as one of the leading causes of cancer death worldwide. Surgery is considered to be the optimal treatment for patients with resectable oesophageal cancer. Oesophagectomy for oesophageal cancer can significantly extend the survival period of patients and provide a potential opportunity for a cure. However, there is still controversy regarding which thoracic approach (right or left) during oesophagectomy for oesophageal cancer can lead to better surgical outcomes globally. This systematic review and meta-analysis will be performed to determine which thoracic approach during oesophagectomy will achieve longer patient survival and will be more beneficial for patients.

Methods and analysis

We will search PubMed, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials and Google Scholar databases for relevant clinical trials published in any language before 1 October 2019. Randomised controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumour pathological stage and ethnicity will be performed.

PROSPERO registration number

CRD42019124133.

Ethics and dissemination

Because this study will be based on published or unpublished records and studies, there is no need for ethics approval. The results of the study will be published in a peer-reviewed journal.