bluuebunny/crossref_metadata_2025 huggingface dataset:
A retrospective study evaluating the tolerability and effectiveness of adjunctive antihypertensive drugs in patients with inadequate response to initial treatment
Authors: Ayyagari Rajeev , Xie Jipan , Cheng David , Wu Eric Q. , Huang Xing‐Yue , Chen Stephanie
Published: June 2018

Real‐world tolerability and effectiveness of nebivolol as first add‐on therapy were compared with hydrochlorothiazide, metoprolol, and amlodipine. Medical records of hypertensive adults initiating nebivolol, hydrochlorothiazide, metoprolol, or amlodipine as first add‐on therapy between December 16, 2010 and July 21, 2011 were retrospectively abstracted (N = 1600; 400/treatment). Outcomes included medication‐related side‐effect rates and blood pressure (BP) reduction and control. Compared with nebivolol, metoprolol and amlodipine had significantly higher side‐effect rates (incidence rate ratio [95% CI]: 1.82 [1.14‐2.92] and 2.67 [1.69‐4.21]), respectively); the hydrochlorothiazide‐nebivolol rate ratio was not significant (1.61 [0.95‐2.71]). All treatments reduced BP at 2 months. Metoprolol, amlodipine, and hydrochlorothiazide were associated with significantly lower odds of achieving 2‐month BP control than nebivolol (odds ratios [95% CI]: 0.34 [0.23‐0.51], 0.51 [0.35‐0.75] and 0.66 [0.44‐0.99], respectively). In a real‐world setting, nebivolol as first add‐on therapy was associated with fewer side effects than metoprolol or amlodipine and with a higher BP control rate than hydrochlorothiazide, metoprolol, or amlodipine.
National Political Parties and Career Paths to the European Parliament
Authors: Aldrich Andrea S.
Published: June 2018

This paper explores how career paths leading to the European Parliament (EP) are influenced by the strategic goals of national political parties. Considering both individual career factors and the national electoral fate of political parties, it determines what conditions increase the likelihood that experienced or inexperienced politicians serve in the EP. Experienced politicians are more likely to reach the EP when they serve vote‐seeking and policy‐seeking parties while inexperienced politicians are more likely to enter the EP when their parties are opportunity seeking. Overall, I find the role of individual ambition is conditioned by party strategy to determine the institutional composition of the EP, contributing to a growing literature on the strategic use of European elections by national political parties. It suggests that the electoral goals of parties should be examined in order to understand the nature of democratic representation in the European Union.
The role of magnetic resonance imaging and endoscopic retrograde cholangiography in the evaluation of disease activity and severity in primary sclerosing cholangitis
Authors: Tenca Andrea , Mustonen Harri , Lind Kati , Lantto Eila , Kolho Kaija‐Leena , Boyd Sonja , Arola Johanna , Jokelainen Kalle , Färkkilä Martti
Published: June 2018

Background & Aims

Endoscopic retrograde cholangiography (ERCP) has been considered the gold standard for the diagnosis and follow‐up of primary sclerosing cholangitis, but it has been replaced by less invasive magnetic resonance imaging and cholangiopancreatography (MRI‐MRCP). However, the role of these two techniques in the evaluation of disease activity and severity needs to be elucidated.

Methods

Patients with primary sclerosing cholangitis (n: 48, male 31, median age: 35.7; 28.0‐44.2) who underwent ERCP and MRI‐MRCP within ±3 months for diagnosis or follow‐up, were reviewed. ERCP and MRI‐MRCP images were scored using the modified Amsterdam score. Serum and biliary cytology markers of disease activity and severity were related to the imaging findings. Agreement on the assessment of the ERCP/MRCP score was calculated by kappa‐statistics. Spearman′s ρ was calculated when appropriate.

Results

The agreement between ERCP and MRCP in scoring bile duct changes for disease severity was only moderate (weighted kappa: 0.437; 95% CI: 0.211‐0.644 for intra‐ and 0.512; 95% CI: 0.303‐0.720 for extra‐hepatic bile ducts). ERCP and MRCP intra‐hepatic scores were associated to the surrogate marker alkaline phosphatase (P = .02 for both). A weak correlation between MRCP score for extra‐hepatic bile ducts and liver transplantation/death was found (Spearman's ρ = .362, 95% CI: 0.080‐0.590, P = .022). A weak correlation between intra‐ (Spearman′s ρ = .322, 95% CI: 0.048‐0.551, P = .022) and extra‐hepatic (Spearman`s ρ = .319, 95% CI: 0.045‐0.549, P = .025) peribiliary enhancement on contrast‐enhanced MRI and severity of biliary cytologic classification was found.

Conclusions

The overall agreement between ERCP and MRI‐MRCP in assessing disease severity was moderate for intra‐ and extra‐hepatic bile ducts. MRI‐MRCP seems to have a minor role as surrogate marker of disease activity and progression in PSC.
Consistent Staffing for Long‐Term Care through On‐Call Pools
Authors: Slaugh Vincent W. , Scheller‐Wolf Alan A. , Tayur Sridhar R.
Published: June 2018

Nursing home managers are increasingly striving to ensure consistency of care, defined as minimizing the number of unique nurse aides who care for a resident during at least one shift over the course of one month. Unfortunately, managers often struggle to provide consistent care, primarily due to last‐minute nurse aide absences and choosing to staff these absences with aides from an external rental agency. We are the first to study the use of an “on‐call” pool—aides on staff who may be called in to work in the event of absences—as an operational strategy to improve consistency. We provide structural results for the relationship between the number of aides in the on‐call pool, staffing cost, and inconsistency level. We also show that a “restricted” on‐call pool—in which the slots in the pool are distributed as evenly as possible across units—outperforms an “open,” or unrestricted, on‐call pool. We further demonstrate that converting full‐time positions to part‐time positions can improve consistency of care if the part‐time aides’ on‐call pool participation rate is sufficiently high. Numerical results for a typical 100‐bed and a 200‐bed facility demonstrate that an on‐call pool can (a) reduce the staffing costs due to absences by 24% while also (slightly) reducing the inconsistency level, or (b) significantly reduce the inconsistency level without increasing costs.
Facies and palaeosol analysis in a progradational distributive fluvial system from the Campanian–Maastrichtian Bauru Group, Brazil
Authors: Batezelli Alessandro , Ladeira Francisco Sergio Bernardes , Nascimento Diego Luciano do , DA Silva Márcio Luiz
Published: June 2018

The Upper Cretaceous Bauru Group in south‐east Brazil consists of alluvial strata whose characteristics and distribution indicate a fluvial system developed in a semi‐arid to arid climate. Sections exposed within a 90 000 km2 study area in Minas Gerais State (in south‐eastern Brazil) were evaluated using facies and palaeosol analysis to formulate depositional and pedogenic models that may account for geomorphic and climate features. From east to west, the study succession records a gradual decrease in grain size, an increase in the width/thickness ratio in channels, a decrease in the lateral and vertical connectivity of channel deposits, and an increase in overbank deposits. The fluvial architecture indicates a braided channel belt, ephemeral ribbon–channels, and an unconfined fluvial facies from east to west in the study area. The lateral and vertical distribution of facies, stratigraphic architecture and palaeocurrent data suggest proximal, medial and distal portions of a progradational distributive fluvial system. The sedimentary dynamics were marked by the building and abandonment of channels related to processes of aggradation, vegetation growth and palaeosol generation. Macromorphological and micromorphological analyses have identified pedological and mineralogical features that indicate an arid to semi‐arid climate with a provenance from the north‐eastern part of the basin (Alto Paranaiba Uplift). From the proximal to the distal portions of the distributive fluvial system, the palaeosol development is different. In the proximal portion, the palaeosols are absent or poorly developed, allowing a possible general comparison with the present soil order: Inceptisols and Aridisols. In the medial portion of the fluvial system, the palaeosols are well‐developed and characterized by Bt, Btk, C and Ck horizons (Alfisols, Aridisols, Inceptisols and Entisols). Poorly drained to well‐drained palaeosols from the base to the top in the distal plain (Aridisols and Inceptisols) are associated with geomorphic and hydromorphic changes in the fluvial system due to progradational evolution. The genetic relationship between the fluvial architecture and the palaeosols enhances the understanding that the sedimentation and pedogenesis that occurs in different portions of the distributive fluvial system are related to the tectonic and climatic evolution of the basin.
Mast cell and plasma cell collision tumor in the spleen of a dog
Authors: Pallatto Valarie A. , Bechtold Molly A.
Published: June 2018

A 9‐year‐old spayed female English Mastiff was referred for outpatient ultrasound due to a 3‐week history of weight loss, vomiting, and decreased appetite. Abdominal ultrasound showed multiple splenic masses of varying sizes and serum chemistry panel showed hyperglobulinemia. Cytologic examination of fine‐needle aspirates of the splenic masses indicated a mast cell and plasma cell collision tumor. Results of serum and urine protein electrophoresis and immunofixation indicated the plasma cell neoplasia was producing IgA immunoglobulins.
Performance characteristics of the turbidimetric ACL‐TOP CTS 300 coagulation analyzer in dogs and cats
Authors: Sharkey Leslie C. , Little Kim J. , Williams Kevin D. , Todd Jeffrey M. , Richardson Rae , Gwynn Angela D. , Rendahl Aaron
Published: June 2018

Objective

To evaluate the technical performance of the turbidimetric ACL‐TOP CTS 300 coagulation analyzer (IL) in dogs and cats and to create reference intervals for standard and novel parameters.

Design

Coagulation testing results from dogs and cats generated by the IL were prospectively compared with another mechanical clot detection system. Precision was documented and reference intervals were created for prothrombin time, activated partial thromboplastin time, and Clauss fibrinogen and D‐dimer values, as well as for the quantitative clot curve parameters (high and low amplitude, delta, and first and second derivative curves). Clot curve signatures containing common artifacts due to lipemia, hemolysis, or preactivation were demonstrated.

Animals

Residual frozen plasma from 20 dogs and 10 cats was used for method comparison; prospectively recruited healthy dogs (n = 48) and cats (n = 45) were used for reference interval and precision studies.

Measurements and Main Results

Bland–Altman analysis showed a proportional positive bias in the IL compared with mechanical clot detection in dogs and a suggestion of a similar pattern in cats. Precision was good and met manufacturer's recommendations for all assays. Reference intervals are reported. Clot curve artifacts were similar in animals to those reported in people.

Conclusions

The turbidimetric system had a slight high proportional positive bias compared with mechanical clot detection. Thus, new reference intervals were generated including for novel parameters generated by clot curve analysis. Some preanalytical errors can be identified by inspection of clot curves. This robust novel technology compares favorably with mechanical endpoint detection methods and can be used in dogs and cats.
Evaluation of the agreement between focused assessment with sonography for trauma (AFAST/TFAST) and computed tomography in dogs and cats with recent trauma
Authors: Walters Andrea M. , O'Brien Mauria A. , Selmic Laura E. , Hartman Sue , McMichael Maureen , O'Brien Robert T.
Published: June 2018

Objective

To determine the agreement between focused assessment with sonography for trauma (FAST) exams and computed tomography (CT) for the detection of pleural and peritoneal fluid and pneumothorax in animals that have sustained recent trauma.

Design

Prospective study.

Setting

University Teaching Hospital.

Animals

Thirteen dogs and 2 cats were enrolled into the study, with 10 having sustained blunt force trauma and 5 penetrating trauma.

Interventions

Abdominal FAST (AFAST) and thoracic FAST (TFAST) exams were performed by emergency room (ER) clinician or house officers and radiology house officers (radiology). TFAST evaluated for the presence of pneumothorax and pleural effusion, and AFAST evaluated for the presence of peritoneal effusion. A minimally sedated, full‐body CT exam was performed on each patient and interpreted by a board‐certified radiologist. The exams were performed in the same order for all patients: ER FAST, followed by radiology FAST, followed by CT, and operators were blinded to the results of the other exams. A kappa statistic was calculated to assess for agreement between the FAST exams and CT.

Measurements and Main Results

The median time to perform all 3 exams was 55 minutes (range 30–150 min). There was moderate to excellent agreement between AFAST and CT for detection of free peritoneal fluid (ERK = 0.82; radiologyK = 0.53), fair to moderate agreement between TFAST and CT for detection of pleural free fluid (ERK = 0.53; radiologyK = 0.36), and poor agreement between TFAST and CT for detection of pneumothorax (ERK = –0.06; radiologyK = –0.12).

Conclusions

FAST exams reliably identify the presence of free fluid in the peritoneal and pleural cavities; however, TFAST is not a reliable method to diagnose pneumothorax in dogs and cats following trauma.
Nurse‐Led Interventions for Hypertension: A Scoping Review With Implications for Evidence‐Based Practice
Authors: Spies Lori A. , Bader Susan Gerding , Opollo Jackline G. , Gray Jennifer
Published: June 2018

Background

Hypertension is the leading preventable contributor to cardiovascular morbidity and mortality, affecting 1 billion people globally. Low‐ and middle‐income countries have increasing rates of hypertension, much of it undiagnosed.

Aims

The purpose of the project is to review studies of nurse‐led hypertension interventions that have been implemented in East Africa and to inform hypertension interventions in low‐resource settings.

Methods

A scoping review was conducted following Arksey and O'Malley's (2005) format. An electronic search in six databases for citations was conducted by the medical librarian author. The parameters for this scoping review were nurse interventions related to hypertension in East Africa.

Results

Fourteen full‐text articles were identified that met inclusion criteria. Nurse‐led interventions for hypertension were found to increase access to care and be cost‐ effective. Medication Adherence Clubs were an innovative intervention that increased the retention of patients in care.

Linking Evidence to Action

This scoping review provides evidence from studies of nurse‐led hypertension interventions in East Africa relevant to implementing or improving hypertension screening, diagnosis, and treatment. Nurses provide 80% of health care in East Africa, and nurse‐led hypertension interventions are critically needed to ameliorate the significant hypertension‐related increases in morbidity and mortality globally.
Simulating Ballast Breakage Under Repeated Loading Using the Discrete Element Method
Authors: Dahal Beema , Mahmud S. M. Naziur , Mishra Debakanta
Published: June 2018

The ballast layer in a railroad track helps distribute loads from the superstructure to the formation; a well-designed ballast layer is also meant to prevent excessive vertical, lateral and longitudinal movement of the track under loading. When subjected to repeated loading, the granular ballast particles often undergo breakage leading to significant changes in the shear strength as well as drainage characteristics of the ballast layer. Excessive ballast degradation leads to increased vertical settlements, and is often associated with speed restrictions and increased passenger discomfort. Several researchers in the past have studied the phenomenon of ballast breakage in a laboratory setting. However, due to complexities associated with these large-scale laboratory tests, detailed parametric studies are often not feasible. In such cases, numerical modeling tools such as the Discrete Element Method (DEM) become particularly useful. This paper presents findings from an ongoing research effort at Boise State University aimed at studying the phenomenon of ballast breakage under repeated loading using a commercially available Discrete Element Package (PFC3D®). Ballast particles were simulated as clusters of balls bonded together, and were allowed to undergo breakage when either the maximum tensile stress or the maximum shear stress exceeded the corresponding bond strength value. Different factors studied during the parametric analysis were: (1) load amplitude; (2) loading frequency; (3) number of cycles of loading; (4) bond strength; and (5) particle size distribution. The objective was to identify the relative importance of different factors that govern the permanent deformation behavior of railroad tracks under loading.
WMATA Wayside Energy Storage Demonstration Project
Authors: Yu Jian G. , Ouattara Moustapha
Published: June 2018

A 2MW Battery Power System (BPS) was installed and tested in a traction power substation on the Orange Line of the Washington Metropolitan Area Transit Authority (WMATA), as a demonstration project. Measurement data were obtained under normal revenue service conditions. In addition, the same installation was tested as an emergency power source to move trains to desired destinations when the traction power system was under a simulated blackout situation. The results were analyzed to assess the ability of the BPS installation to achieve energy saving, peak power reduction, train voltage support and emergency power provision. This paper describes the findings from this demonstration project and the follow-on efforts in WMATA.
An Analysis of the Efficacy of Wayside Hot-Box Detector Data
Authors: Tarawneh Constantine , Aranda James A. , Hernandez Veronica V. , Ramirez Claudia J.
Published: June 2018

Wayside hot-box detectors (HBDs) are devices that are currently used to monitor bearing, axle, and brake temperatures as a way of assessing railcar component health and to indicate any possible overheating or abnormal operating conditions. Conventional hot-box detectors are set to alarm whenever a bearing is operating at a temperature that is 94.4°C (170°F) above ambient, or when there is a 52.8°C (95°F) temperature difference between two bearings that share an axle. These detectors are placed adjacent to the railway and utilize an infrared sensor in order to obtain temperature measurements. Bearings that trigger HBDs or display temperature trending behavior are removed from service for disassembly and inspection. Upon teardown, bearings that do not exhibit any discernible defects are labeled as “non-verified”. The latter may be due to the many factors that can affect the measurement of HBDs such as location of the infrared sensor and the class of the bearing among other environmental factors.

A field test was performed along a route that is more than 483 km (300 mi) of track containing 21 wayside hot-box detectors. Two freight cars, one fully-loaded and one empty, and one instrumentation car pulled by a locomotive were used in this field test. A total of 16 bearings (14 Class F and 2 Class K) were instrumented with K-type bayonet thermocouples to provide continuous temperature measurement. The data collected from this field test were used to perform a systematic study in which the HBD IR sensor data were compared directly to the onboard thermocouple data. The analyses determined that, in general, HBDs tend to overestimate Class K bearing temperatures more frequently than Class F bearing temperatures. Additionally, the temperatures of some bearings were underestimated by as much as 47°C (85°F). Furthermore, the HBD data exhibited some false trending events that were not seen in temperature histories recorded by the bayonet thermocouples. The findings from the field test suggest that HBDs may inaccurately report bearing temperatures, which may contribute to the increased percentage of non-verified bearing removals.

To further investigate the accuracy of the wayside detection systems, a dynamic test rig was designed and fabricated by the University Transportation Center for Railway Safety (UTCRS) research team at the University of Texas Rio Grande Valley (UTRGV). A mobile infrared sensor was developed and installed on the dynamic tester in order to mimic the measurement behavior of a HBD. The infrared temperature measurements were compared to contact thermocouple and bayonet temperature measurements taken on the bearing cup surface. The laboratory-acquired data were compared to actual field test data, and the analysis reveals that the trends are in close agreement. The large majority of temperature measurements taken using the IR sensor have been underestimated with a similar distribution to that of the data collected by the HBDs in field service.
Railway Ballast Strength and Permeability Affecting Track Performance Under Dry and Wet Conditions
Authors: Qamhia Issam , Orihuela Maximilian , Schmidt Scott , Tutumluer Erol , Moaveni Maziar , Basye Colin , Li Dingqing
Published: June 2018

Railway ballast is a major structural component of railroad track that also facilitates the drainage of water. Particle breakage and abrasion due to dynamic loading and environmental impacts causes ballast to age and degrade. The finer materials generated from ballast degradation can adversely affect the track stability especially under wet conditions. This paper investigates through laboratory testing the effect of moisture on the behavior and performance of in-service ballast. The tested ballast samples were initially subjected to an artificial rain system as well as train loadings in the Facility for Accelerated Service Testing (FAST) at the Transportation Technology Center, Inc. (TTCI). The rainy test section experiment applied realistic dynamic freight train loads and continuously monitored the test sections to determine the effects of moisture and saturation conditions on the field performance trends of ballasted track. Accordingly, ballast samples at varying levels of degradation were collected from the test locations to investigate ballast gradations as well as strength and permeability characteristics at dry and wet conditions. Shear strength tests were performed using a large-scale triaxial test machine, known as the TX-24, to study ballast degradation effects on the strength of dry ballast. Materials finer than the 3/8 in. (9.5 mm) were then collected and studied for the moisture-density behavior using a modified Proctor type compactive effort. Shear strength samples with the same gradations and degradation levels were prepared and tested at varying moisture contents of the 3/8 in. (9.5 mm) fraction ranging from 3% to 9%, with the latter being the optimum moisture content of these finer materials. The wet ballast triaxial test samples had strength values only in the range of 38% to 65% of the dry strengths. In addition to the strength tests, constant head permeability tests were also conducted on the ballast samples which demonstrated quite low and negligible horizontal flow amounts through ballast under static pressure heads and at various hydraulic gradients.
Fire Growth in Standard Tests and Railcars
Authors: Luo Charles , Yazdani Soroush , Lattimer Brian Y.
Published: June 2018

Large scale flammability performance of interior finish used on railcars has been evaluated in previous studies using the NFPA 286 room corner fire test, which has a cross-section similar to a railcar. In some studies, the wall containing the door was removed to account for the shorter length of the room compared to the railcar length. The focus of this study is to assess whether the NFPA 286 standard room-corner test with a door represents conditions that developed inside a railcar during a fire. Fire Dynamics Simulator (FDS) was used to model the fire growth in a NFPA 286 standard room-corner test with a door, NFPA 286 room without the wall containing the door, and railcar geometry with a single door open. All three cases had the same exposure fire in a corner and the same lining material. In predictions of the NFPA 286 room-corner test with a door, gas temperature, heat release rate, and time to flashover agreed well with available NFPA 286 standard test data. The simulation results of fire growth inside a railcar with one side door open produced similar conditions and fire growth compared with the standard NFPA 286 room with a door. For simulations on the NFPA 286 room with the wall containing the door removed, it was found that removal of the wall with the door resulted in non-conservative fire growth conditions with the gas temperature and heat release rate under-estimated compared to the standard NFPA 286 room with a door. These simulations indicate that the standard NFPA 286 room-corner test with a door is representative of conditions that would develop inside of a railcar.
Primary calibration by reciprocity method of high-frequency acoustic-emission piezoelectric transducers
Authors: Haas Michael , Cihak-Bayr Ulrike , Tomastik Christian , Jech Martin , Gröschl Martin
Published: June 2018

Although acoustic-emission (AE) piezoelectric transducers have distinctive variations in sensitivity, depending on frequency, propagation medium, and coupling, the vast majority of AE research is conducted by utilizing uncalibrated AE transducers. As a consequence, most results obtained by different groups are not comparable among each other. In this work, primary calibration by the method of reciprocity is shown. Rayleigh and longitudinal wave calibration curves are presented for piezoelectric high-frequency broadband transducer, mounted on steel and aluminium, in the frequency range 300 kHz−4 MHz. Influences on primary calibration of AE transducers, namely, by coupling medium, contact pressure, and propagation medium, are investigated.
Sound transmission loss through triple-walled cylindrical shells with porous layers
Authors: Golzari Masoud , Jafari Ali Asghar
Published: June 2018

Sound transmission loss through triple-walled sandwich cylindrical shells in the presence of an external mean flow is analytically examined. Love's theory and a simplified method based on Biot's theory are considered to describe the motions of thin isotropic shells and wave propagation in the porous material cores, respectively. The random incidence transmission loss in a diffuse field is calculated numerically by considering the limiting incidence angle due to the total internal reflection. The analytical model and numerical code are validated against both experimental and analytical results reported by previous studies. The transmission loss of triple-walled structure in the diffuse sound field is compared with its double-walled counterpart at the same weight. The results generally show a superior performance in the sound insulation for the triple-walled shell, considerably at mid-high and high frequencies, in comparison with its double-walled counterpart at the same weight. The effects of sandwich shell configuration and air gap depth are also investigated on the sound transmission loss.
Coaches’ Perceptions of Athletes’ Psychobiosocial States: The Case of Three Tennis Coach-Athlete Dyads
Authors: Mueller Stephanie , Ruiz Montse C. , Chroni Stiliani Ani
Published: June 2018

Considering the limited attention paid to interpersonal aspects of emotions, this study explored coaches’ perceptions of athletes’ performance-related states and how they used this information for its regulation. Using a case study approach, three coach-athlete dyads from competitive tennis took part in one-on-one semi-structured interviews. Individualized profiling of psychobiosocial states was used to assess athletes’ states in most and least successful performances and as a way of data triangulation. Findings indicated that the coaches paid attention to bodily, motor-behavioural, and operational components of a performance state, and used this information to appropriately adapt their responses to the players’ needs, via the provision of positive reinforcement, and performance-related feedback. The coaches described themselves as calm, patient, and understanding; characteristics that appeared to be vital for the coach-athlete relationship and the coaches’ emotional competence. Findings are discussed within the contexts of emotion regulation and coach-athlete relationship, and how they might be useful to help coaches develop emotional competence.
A tool for finding rare marine species
Authors: Pikitch Ellen K.
Published: June 2018

Environmental DNA analysis shows promise for studying rare and elusive marine species
Dirac-source field-effect transistors as energy-efficient, high-performance electronic switches
Authors: Qiu Chenguang , Liu Fei , Xu Lin , Deng Bing , Xiao Mengmeng , Si Jia , Lin Li , Zhang Zhiyong , Wang Jian , Guo Hong , Peng Hailin , Peng Lian-Mao
Published: June 2018

Cooler electrons for transistors

The operating power of field-effect transistors is constrained in part by the minimum change in voltage needed to change the current output. This subthreshold swing (SS) limit is caused by hotter electrons from a thermal electron source leaking over the potential of the gate electrode. Qiu
et al.
show that graphene can act as a Dirac source that creates a narrower distribution of electron energies. When coupled to a carbon nanotube channel, the decrease in SS would allow the supply voltage to be decreased from 0.7 to 0.5 volts.

Science
, this issue p.
387
Crystallizing a memory
Authors: Ramirez Steve
Published: June 2018

Researchers identify and modulate synaptic correlates of a memory engram
HIV—No time for complacency
Authors: Abdool Karim Quarraisha , Abdool Karim Salim S.
Published: June 2018

Today, the global HIV epidemic is widely viewed as triumph over tragedy. This stands in stark contrast to the first two decades of the epidemic, when AIDS was synonymous with suffering and death. But have we turned the tide on HIV sufficiently to warrant directing our attention and investments elsewhere?
Rapid Antigen Tests for Influenza: Rationale and Significance of the FDA Reclassification
Authors: Green Daniel A. , StGeorge Kirsten
Published: June 2018

Rapid antigen tests for influenza, here referred to as rapid influenza diagnostic tests (RIDTs), have been widely used for the diagnosis of influenza since their introduction in the 1990s due to their ease of use, rapid results, and suitability for point of care (POC) testing. However, issues related to the diagnostic sensitivity of these assays have been known for decades, and these issues gained greater attention following reports of their poor performance during the 2009 influenza A(H1N1) pandemic.
Physicians’ real-world experience with IDegLira: results of a European survey
Authors: Drummond Russell , Baru Ankita , Dutkiewicz Marcelina , Basse Amaury , Tengmark Bengt-Olov
Published: June 2018

Objective

This study aimed to build on the current clinical findings and investigate physicians’ experiences and level of satisfaction in using insulin degludec/liraglutide (IDegLira) to treat patients with type 2 diabetes (T2D).

Research design and methods

This multicountry, European online survey included respondents from primary (n=132) and secondary (n=103) care and examined physicians’ use, confidence and satisfaction with IDegLira. To standardize responses, 24 of 28 questions pertained to an ‘average patient’ with T2D who has no major comorbidities, aged 35–70 years, with average cognitive ability/normal mental status and body mass index ≥25 kg/m2.

Results

The majority (70%) of respondents prescribe IDegLira in the same visit they first mention it, with uncontrolled glycated hemoglobin (HbA1c) (44%) and weight gain (22%) being the most common reasons. On average, physicians reported that patients weighed 95 kg and the HbA1c level was 9.0% at initiation. Physicians also reported the average HbA1c target set was 7.1%; 76% of patients achieved their target. On average, patients achieved their HbA1c target in <6 months, and the average dose of IDegLira in patients in glycemic control was 28 dose steps. Respondents were more satisfied with IDegLira than basal-bolus therapy across all parameters assessed, including reaching HbA1c targets (59%), number of injections (77%) and avoiding weight gain (84%). Correspondingly, 77% of physicians reported that IDegLira had more potential to improve patient motivation compared with basal-bolus to reach target blood glucose levels.

Conclusions

Real-world experience of IDegLira is consistent with previous trials/studies, with no major differences between primary and secondary care. Importantly, the majority of respondents were more/much more satisfied with IDegLira than with basal-bolus therapy.
Designing PrEP and early HIV treatment interventions for implementation among female sex workers in South Africa: developing and learning from a formative research process
Authors: Eakle Robyn , Mutanha Nyaradzo , Mbogua Judie , Sibanyoni Maria , Bourne Adam , Gomez Gabriela , Venter Francois , Rees Helen
Published: June 2018

Objectives

The objective of this research was to design relevant, tailored oral pre-exposure prophylaxis (PrEP) and early antiretroviral (ART) interventions for female sex workers (FSWs) in South Africa. This paper examines the methods, process and outcomes of employing an inductive approach to formative research exploring intervention feasibility and acceptability.

Setting

Research was conducted in several sex work-related settings including five sites in and around clinics and stakeholder offices.

Participants

Participants in this research included stakeholders, experts in the field and FSWs. This included at least 25 separate engagements, 14 local organisations and 8 focus group discussions (FGDs) with 69 participants, in addition to ad hoc meetings.

Results

The first set of outcomes consisted of five selected methods: (1) stakeholder consultations; (2) site assessments and selection; (3) field observations and mapping; (4) development of supportive structures to encourage retention and intervention adherence; (5) FGDs conducted with FSWs to explore specifics of acceptability. In terms of feasibility, two sites were selected in central Johannesburg and Pretoria out of five considered. The urban site contexts varied, necessitating adjustments to intervention implementation. There was overall support for PrEP and early ART from stakeholders and FSWs. Concerns included potential issues with adherence to PrEP (and early ART), possible reduction in condom use, resistance to antiretrovirals and burden on scarce resources. These concerns indicated where special attention should be focused on education, messaging and programming as well as development of supportive structures.

Conclusions

The inductive approach allowed for a wide range of perspectives, defining population needs and accessibility. This research illustrated how similar sex work environments can vary and how implementation of interventions may not be uniform across contexts. Lessons learnt in details could assist in future project designs and implementation of new interventions where feasibility, social and cultural factors affecting acceptability must be considered.
Quality of health literacy instruments used in children and adolescents: a systematic review
Authors: Guo Shuaijun , Armstrong Rebecca , Waters Elizabeth , Sathish Thirunavukkarasu , Alif Sheikh M , Browne Geoffrey R , Yu Xiaoming
Published: June 2018

Objective

Improving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.

Design

Systematic review.

Setting

A wide range of settings including schools, clinics and communities.

Participants

Children and/or adolescents aged 6–24 years.

Primary and secondary outcome measures

Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.

Results

There were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.

Conclusions

More rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.
Multilevel population-based cross-sectional study examining school substance-misuse policy and the use of cannabis, mephedrone and novel psychoactive substances among students aged 11–16 years in schools in Wales
Authors: Midgley Luke S , Murphy Simon , Moore Graham , Hewitt Gillian , White James
Published: June 2018

Objectives

To examine whether young peoples’ risk of cannabis, mephedrone and novel psychoactive substances (NPS) use is associated with school substance-misuse policy.

Design

A cross-sectional survey of secondary school students combined with a School Environment Questionnaire and independently coded school substance-misuse policies (2015/6).

Setting

66 secondary schools in Wales.

Participants

Students aged 11–16 years (n=18 939).

Results

The prevalence of lifetime, past 30-day and daily cannabis use was 4.8%, 2.6% and 0.7%, respectively; lifetime prevalence of mephedrone use was 1.1% and NPS use was 1.5%. Across 66 schools, 95.5% (n=63) reported having a substance-misuse policy, 93.9% (n=62) reported having a referral pathway for drug using students, such that we were insufficiently powered to undertake an analysis. We found little evidence of a beneficial association between lifetime cannabis use and involving students in policy development including student council consultation (OR=1.24, 95% CI 0.89 to 1.73), other student consultation (OR=1.42, 95% CI 0.94 to 2.14) or with the use of isolation (OR=0.98, 95% CI 0.67 to 1.43), with similar results for cannabis use in past 30 days, daily and the lifetime use of mephedrone and NPS. The School Environment Questionnaires found that 39.4% (n=26) schools reported no student involvement in policy development, 42.4% (n=28) reported student council consultation, 18.2% (n=12) used other student consultations and 9.7% (n=3) mentioned isolation. The independently coded content of policies found that no school policy recommended abstinence, one mentioned methods on harm minimisation, 16.1% (n=5) policies mentioned student involvement and 9.7% (n=3) mentioned isolation.

Conclusions

Policy development involving students is widely recommended, but we found no beneficial associations between student involvement in policy development and student drug use. This paper has highlighted the need for further contextual understanding around the policy-development process and how schools manage drug misuse.
Child and adolescent musculoskeletal pain (CAM-Pain) feasibility study: testing a method of identifying, recruiting and collecting data from children and adolescents who consult about a musculoskeletal condition in UK general practice
Authors: Michaleff Zoe A , Campbell Paul , Hay Alastair D , Warburton Louise , Dunn Kate M
Published: June 2018

Objectives

Test a method of identifying, recruiting and collecting data from children and adolescents who consult their general practitioner about a musculoskeletal condition.

Design

Prospective cohort feasibility study.

Setting

13 general practices in West Midlands of England.

Participants

Patients aged 8–19 years who consult their general practice about a musculoskeletal condition. Patients were identified via a relevant musculoskeletal Read code entered at the point of consultation.

Outcome measures

Feasibility was assessed in terms ofstudy processes(recruitment rates),data collection procedures(duration, response variability),resource utilisation(mail-outs) andethical considerations(acceptability).

Results

From October 2016 to February 2017, an eligible musculoskeletal Read code was entered on 343 occasions, 202 patients were excluded (declined, n=153; screened not suitable, n=49) at the point of consultation. The remaining 141 patients were mailed an invitation to participate (41.1%); 46 patients responded to the invitation (response rate: 32.6%), of which 27 patients consented (consent rate: 19.1%). Participants mean age was 13.7 years (SD 2.7) and current pain intensity was 2.8 (SD 2.7). All participants completed the 6-week follow-up questionnaire. All participants found the interview questions to be acceptable and would consider participating in a similar study in the future. The majority of general practitioners/nurse practitioners, and all of the research nurses reported to be adequately informed about the study and found the study processes acceptable.

Conclusion

The expected number of participants were identified and invited, but consent rate was low (<20%) indicating that this method is not feasible (eg, for use in a large prospective study). Recruiting children and adolescents with musculoskeletal conditions in a primary care setting currently presents a challenge for researchers. Further work is needed to identify alternative ways to conduct studies in this population in order to address the current knowledge gap in this field.
Association between sleep duration and stroke prevalence in Korean adults: a cross-sectional study
Authors: Kim Min-Young , Lee Seunghoon , Myong You Ho , Lee Yoon Jae , Kim Me-Riong , Shin Joon-Shik , Lee Jinho , Ha In-Hyuk
Published: June 2018

Objectives

Although sleep, chronic disease and its related mortality are extensively studied areas, the association between stroke and sleep duration is relatively unknown. The aim of this study was to investigate the association between long and short sleep duration and stroke prevalence.

Design

A cross-sectional survey study.

Setting and participants

Adult surveyees (aged ≥19 years) who answered items relating to sleep duration and stroke in the 2010–2014 Korean National Health and Nutrition Surveys (n=17 601).

Outcome measures

Participants were divided into three groups by sleep duration (short: ≤6 hours/day, normal: 7–8 hours/day and long: ≥9 hours/day). Stroke prevalence in each sleep duration group was compared using logistic regression analysis, and sociodemographic characteristics, medical history, lifestyle habits and mental health factors were set as confounding variables.

Results

On adjusting for sex and age, each sleep-duration group displayed significantly different health-related characteristics. The short sleep and long sleep duration groups indicated significantly higher psychological factors for stress perception, depressive symptoms and psychiatric counselling compared with the normal sleep duration group. On adjustment of various confounders, the long sleep duration group demonstrated significantly higher ORs for stroke compared with the normal sleep duration group (OR 1.96, 95% CI 1.06 to 3.61). Also, when stratified by sex, men did not exhibit differences in stroke prevalence by sleep duration, but women showed higher stroke prevalence in the long sleep duration group compared with normal sleep duration (OR 2.94, 95% CI 1.21 to 7.17).

Conclusions

Longer sleep duration was associated with higher stroke prevalence, and this trend was more pronounced in women.
Different defibrillation strategies in survivors after out-of-hospital cardiac arrest
Authors: Zijlstra Jolande A , Koster Rudolph W , Blom Marieke T , Lippert Freddy K , Svensson Leif , Herlitz Johan , Kramer-Johansen Jo , Ringh Mattias , Rosenqvist Mårten , Palsgaard Møller Thea , Tan Hanno L , Beesems Stefanie G , Hulleman Michiel , Claesson Andreas , Folke Fredrik , Olasveengen Theresa Mariero , Wissenberg Mads , Hansen Carolina Malta , Viereck Soren , Hollenberg Jacob
Published: June 2018

Background

In the last decade, there has been a rapid increase in the dissemination of automated external defibrillators (AEDs) for prehospital defibrillation of out-of-hospital cardiac arrest patients. The aim of this study was to study the association between different defibrillation strategies on survival rates over time in Copenhagen, Stockholm, Western Sweden and Amsterdam, and the hypothesis was that non-EMS defibrillation increased over time and was associated with increased survival.

Methods

We performed a retrospective analysis of four prospectively collected cohorts of out-of-hospital cardiac arrest patients between 2008 and 2013. Emergency medical service (EMS)-witnessed arrests were excluded.

Results

A total of 22 453 out-of-hospital cardiac arrest patients with known survival status were identified, of whom 2957 (13%) survived at least 30 days postresuscitation. Of all survivors with a known defibrillation status, 2289 (81%) were defibrillated, 1349 (59%) were defibrillated by EMS, 454 (20%) were defibrillated by a first responder AED and 429 (19%) were defibrillated by an onsite AED and 57 (2%) were unknown. The percentage of survivors defibrillated by first responder AEDs (from 13% in 2008 to 26% in 2013, p<0.001 for trend) and onsite AEDs (from 14% in 2008 to 30% in 2013, p<0.001 for trend) increased. The increased use of these non-EMS AEDs was associated with the increase in survival rate of patients with a shockable initial rhythm.

Conclusion

Survivors of out-of-hospital cardiac arrest are increasingly defibrillated by non-EMS AEDs. This increase is primarily due to a large increase in the use of onsite AEDs as well as an increase in first-responder defibrillation over time. Non-EMS defibrillation accounted for at least part of the increase in survival rate of patients with a shockable initial rhythm.