bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrogen Embrittlement in Inconel 718 Produced by Selective Laser Melting
Authors: Macoretta Giuseppe , Beghini Marco , Monelli Bernardo Disma , Valentini Renzo , Aiello Francesco , Moda Mattia
Published: October 2021

Inconel 718 is widely used to produce components subjected to relatively high temperatures and heavy loads. However, this alloy is also employed in aggressive environments promoting the production of hydrogen on the metal surface. Selective Laser Melting (SLM) is an emerging technology for the production of structural components, thanks to its ability to create complex geometries and reduce material consumption. Components produced by SLM are typically characterized by a peculiar microstructure and residual stresses that can affect hydrogen migration and accumulation. While the mechanical properties and fatigue endurance were deeply investigated in recent years, the resistance of SLMed Inconel 718 to the Hydrogen Embrittlement (HE) requires further investigation.

The present paper deals with the effects of the SLM process on reducing the strength and ductility of Inconel 718. Standard tensile tests and slow strain rate tests were carried out for different hydrogen concentrations. Hydrogen content was measured in each specimen after the mechanical test. Fractographic analyses, along with hydrogen diffusion models, were carried out to preliminarily investigate the hydrogen effect on the material strength.
30 CM Horizontal Drop of a Surrogate 17x17 PWR Fuel Assembly
Authors: Kalinina Elena , Ammerman Doug , Grey Carissa , Flores Gregg , Lujan Lucas , Saltzstein Sylvia , Michel Danielle
Published: October 2021

The 30 cm drop is the remaining NRC normal conditions of transport (NCT) regulatory requirement (10 CFR 71.71) for which there are no data on the response of spent fuel. While obtaining data on the spent fuel is not a direct requirement, it allows for quantifying the risk of fuel breakage resulting from a cask drop from a height of 30 cm or less. Because a full-scale cask and impact limiters are very expensive, 3 consecutive drop tests were conducted to obtain strains on a full-scale surrogate 17 × 17 PWR assembly. The first step was a 30 cm drop of a 1/3 scale cask loaded with dummy assemblies. The second step was a 30 cm drop test of a full-scale dummy assembly. The third step was a 30 cm drop of a full-scale surrogate assembly. The results of this final test are presented in this paper. The test was conducted in May 2020. The acceleration pulses on the surrogate assembly were in good agreement with the expected pulses derived from steps 1 and 2. This confirmed that during the 30 cm drop the surrogate assembly experienced the same conditions as it would have if it had been dropped in a full-scale cask with impact limiters. The surrogate assembly was instrumented with 27 strain gauges. Pressure paper was inserted between the rods within the two long and two short spacer grid spans in order to register the pressure in case of rod-to-rod contact. The maximum observed peak strain on the surrogate assembly was 1,724 microstrain at the bottom end of the assembly. The pressure paper sheets from the two short spans were blank. The pressure paper sheets from the two long spans, except a few middle ones, showed marks indicating rod-to-rod contact. The maximum estimated contact pressure was 4,100 psi. The longitudinal bending stress corresponding to the maximum observed strain value (calculated from the stress-strain curve for low burnup cladding) was 22,230 psi. Both values are significantly below the yield strength of the cladding. The major conclusion is that the fuel rods will maintain their integrity following a 30 cm drop inside of a transportation cask.
Development of Mini-Compact Tension Specimen Fabrication and Test Methods in Hot Cell for Post-Irradiation Examination of Reactor Pressure Vessel Steels
Authors: Naziris Frideriki , Versteylen Casper , Frith Frederick , Bregman Marcel , Kolluri Murthy
Published: October 2021

Most standard surveillance programs for pressurized water reactors (PWR), do not contain enough surveillance specimens for their long-term operation (LTO) beyond the original design life of 40 years. The use of testing methods based on small/sub-sized specimen such as mini-CT (0.16 CT, 4 mm thickness) is considered a promising approach to overcome this limitation. The feasibility of fracture toughness testing using sub-sized CT specimen has been generally demonstrated in Japanese-US lead Round Robin programs for un-irradiated materials. However, application of miniature testing techniques on irradiated materials in hot cells comes along with several technical challenges such as remote controlled machining, application of the extensometers, manipulator sensitivity etc. In addition, the dimensional tolerances of the standard CT specimen defined in the ASTM E1921 standard are defined as a function of specimen width, resulting in severer absolute tolerance for the miniature specimen. This paper presents an in-cell fabrication method of a modified mini-CT specimen and a testing facility suitable for hot cell use. This work is performed at NRG within the framework of the STRUMAT project, funded by the Netherlands Ministry of Economic Affairs. A slightly modified miniature CT specimen is chosen, which allows “outboard” clip gage mounting for direct load-line displacement (LLD) measurement. In addition, a wide notch configuration with a height of 0.6 mm, 0.1 mm wider than specified in the ASTM E1921 standard, is used. This modified specimen geometry facilitates the in-cell fabrication of the mini-CT specimen and eases the remote handling and testing procedure. Three-dimensional finite element analysis validation was carried out to determine the effect of these modifications on the stress state of the specimen. It is demonstrated that the modifications to the mini-CT specimen geometry will not lead to significant deviations in the stress patterns and J-integral values compared to the standard geometry.
Overview of Revisions to the ASME Boiler and Pressure Vessel Code Section VIII Division 3 for the 2021 Edition and Near Future
Authors: Maslowski Adam P. , Sarzynski Melanie , Peters Daniel , Subramanian Kannan
Published: October 2021

This paper provides an overview of the significant revisions to the upcoming 2021 edition of the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code (BPVC) Section VIII Division 3, Alternative Rules for Construction of High Pressure Vessels, as well as potential changes to future editions under consideration by the Subgroup on High Pressure Vessels (SG-HPV).
Study on Influence of Branch Connection That Affects to Design Length of Pressure Design Under External Pressure
Authors: Lee Kyoung-hun
Published: October 2021

Pressure design of straight pipe under external pressure is performed in accordance with ASME B31.3 and Section VIII, Division 1 of Boiler and Pressure Vessel Code. And design length of straight pipe shall be defined in accordance with UG-28 and UG-29.

However, there is no specific guideline about the design length which includes branch connection in piping system. Even though the branch connection is not a stiffening component, calculated result shows that increased design length can be considered for piping including the branch connection compared to straight pipe.

This paper presents the study result that shows a tendency depending on several geometry parameters (e.g. Ratio of a diameter of header pipe to a thickness of header pipe.) using elastic buckling analysis performed in accordance with ASME Boiler and Pressure Vessel Code, Section VIII, Division 2. In addition to the result, this paper compares the design length of straight pipe with that of piping system including the branch connection under about the same eigenvalue condition which is called as a “Buckling load multiplier”. Shell element is enough to check the tendency and compare various results by comparison with solid model, because the result is related to overall structural integrity rather than local stress. Shell element is used in the elastic buckling analysis.
Vibration Attenuation of Periodic Composite Pipeline Considering Fluid Structure Interaction
Authors: Zeng Qingna , Wang Donghui , Zang Fenggang , Zhang Yixiong
Published: October 2021

In this paper, vibration attenuation characteristic of periodic composite pipeline is studied, focusing on the fluid structure interaction (FSI). Besides fluid velocity and pressure, Poisson coupling and friction coupling are also taken into consideration. A novel modified transfer matrix method (TMM) is proposed to investigate the distribution of band gap structures (BGs), and attenuation intensity within stop band frequency is also accurately predicted. BGs and Frequency response function for axial, transverse, torsional and their coupled modes are calculated and validated with each condition, and display excellent consistency with Shen’s results. In order to explore FSI effect of different models, pipe without fluid loading, with inner fluid taken as additional mass and pipe considering FSI effect are all presented. It is found that BGs with Bragg scattering mechanism are generated in all three models, but the distribution differs greatly, thus the FSI effect could not be ignored in practical engineering applications. The work in this paper provides novel method and useful reference for noise and vibration reduction of pipeline system conveying fluid.
Two Way Coupled Fields Multi-Physics Modeling Is Investigated as an Additional Approach to Address Fluid Elastic Instability
Authors: Breach Michael
Published: October 2021

Two way coupled fields multi-physics modeling is investigated as an additional approach to address out-of-plane FEI. It is established in the literature that to model the damping-controlled fluid elastic instability, a finite time delay between tube vibration and fluid perturbation must be realized. The phase lag between tube vibration and flow perturbation due to damping must be adequately captured by the model. The effects of tube frequency, turbulence level, location, and mean gap velocity on the relative phase values must also be captured. This approach will allow the time delay between tube vibration and flow perturbation due to damping, as well as turbulence, and stiffness to be intrinsically modeled. We will introduce the applicability of the method to in-plane FEI in a future paper once we have based lined it against out of plane FEI empirical results.
In-Service Inspection of Extended Dry Storage of Spent Nuclear Fuel, Part I: Crawler Technology Development
Authors: Meyer Ryan M. , Renshaw Jeremy , Beard Jamie , Tatman Jon , Keene Matt , Plante Paul , Fales Neil , Grant Gabriel , Wolf Uwe , Mauskar Karan , Dunn Darrell , Lin Bruce
Published: October 2021

This paper describes development and demonstration of remote crawling systems to support periodic examinations of interim dry storage system (DSS) canisters for spent nuclear fuel in the USA. Specifically, this work relates to robotic crawler developments for “canister” based DSS systems, which form the majority population of DSSs in the USA for interim storage of spent nuclear fuel. Consideration of potential degradation of the welded stainless-steel canister in these systems is required for continued usage in the period of extended operation (PEO) beyond their initial licensed or certified terms. Challenges with performing the periodic examinations are associated with physical access to the canister surface, which is constrained due to narrow annulus spaces between the canister and the overpack, tortuous entry pathways, and high temperatures and radiation doses that can be damaging to materials and electronics. Motivations for performing periodic examinations and developing robotic crawlers for performing those examinations remotely will be presented, and several activities to demonstrate robotic crawlers for different DSS systems are summarized.
Transient Thermal Modeling of the High Burnup Demonstration Research Project Cask Using STAR-CCM+ and COBRA-SFS
Authors: Richmond D. J. , Fort J. A. , Suffield S. R.
Published: October 2021

The Department of Energy in collaboration with the Electric Power Research Institute is in the process of conducting the High Burnup Demonstration Project, where the objective is to characterize the performance of high-burnup fuel in long term storage. As part of this demonstration, a TN-32B dry storage cask was instrumented and loaded with spent nuclear fuel at North Anna Nuclear Generating Station in November 2017. The project cask provides a unique opportunity to gain information on spent fuel and cask performance from an in-service operational system. The cask was instrumented with thermocouples inside of the fuel assemblies, then loaded and dried using normal procedures. After the drying process a thermal soak period where the cask was left indoors was used to obtain steady temperatures for model comparison along with surface temperatures. This paper details thermal modeling validation work that was done to model both the steady state and transient cases. Two modeling tools were used to predict temperatures in the cask. The general purpose CFD and heat transfer code STAR-CCM+ was used with both a detailed pin-by-pin model along with a more efficient k-effective simplification. The other code is COBRA-SFS, a purpose-built detailed thermal modeling tool developed and maintained at PNNL. Results from all the modeling tools were compared blind to the test data. Each model utilized general design information and compared reasonably well to the blind steady state data using convection and surface temperature boundary conditions. Post-test adjustments were later made to better reflect the “as built” conditions of the cask. Based on lessons learned from the steady state analysis the vacuum drying process was modeled in both codes. Utilizing the measured loading conditions the transient models were able to compare very well with the measured data. Overall the project showed an ability to model spent fuel storage conditions very well and future work is planned to generalize the methodology used for vacuum drying.
Design and Test of Pressure Vessels for Contained Blast and Fragment Impact
Authors: Wattis Greg , Mathis James , Hunt Laura , Mullin Scott , Beissel Steven
Published: October 2021

A special subset of pressures vessels are required to fully contain internal explosive blasts for commercial and government agencies conducting blast-related research and testing. In some cases these blast chambers must also safely contain the impact of high-speed fragments that may be created from cased munitions and devices. Both of these loading conditions require specific analysis methods, for example penetration mechanics and specialized dynamic finite element simulation. Careful attention must also be paid to the construction of these blast chambers, which typically utilize very thick steel plate, large forgings and pressings, and thorough weld procedure and inspection development. Beside the typical steel pressure vessel body, many ports are needed in such vessels, including those that house thick windows. These elements are typically the areas of highest stress concentration. Fatigue analysis is also conducted, using the predicted stress states, to ensure the pressure vessel will survive the required number of tests. Due to the potentially hazardous operation of the vessel, they must also undergo extensive post-construction proof testing to verify their safety and to validate the design/analysis approach. Methods to address the repetitive impulsive loading and fatigue failure are described in ASME BPVC Code Case 2564-5 Impulsively Loaded Pressure Vessels. An approach taken to satisfy those guidelines is described in this paper.

Southwest Research Institute (SwRI) has designed, constructed, and tested many blast chambers in the last 30 years. This paper discusses the specialized work needed for this class of vessel, including dynamic finite element analysis that accounts for shock pressure and quasi-static pressure. To illustrate the different steps specific examples are provided for key areas such as entry doorways and the viewports. Evaluation of internal shielding and transparency materials that must withstand impact are described. Example proof test methods are described and data obtained during recent projects will be included to demonstrate results.
Research on Numerical Calculation Model of Impact Load on Reef in Deep Sea
Authors: Liu Shuai , Huang Xuan , Feng Zhipeng , Jiang Xiaozhou , Wang Bihao , Wu Wanjun
Published: October 2021

In the deep sea, one of the main threats to the structural safety of ships is the impact load caused by reef. This paper established a numerical calculation model which is suitable for simulating the impact load on reef in the deep sea. The model considers the coupling effects of large deformation, fluid-structure interaction, and material plastic deformation. The mesh size, material constitutive model and fluid structure coupling method are studied. The explicit dynamic analysis method is verified by the AISI experiment which there is little difference between the numerical simulation results and the experimental results. Based on the method, the model considering the effect of fluid-structure interaction (FSI) is established and the effectiveness of the FSI is verified by the theoretical results of the national military standard. Then, fluid structure interaction algorithm is studied. Finally, the model which is suitable for simulating the collision between ship and reef in deep sea is established. The effect of reef size and shape on the impact load was studied. It can be seen that the shape and size of the reef mainly affect the contact area and contact stiffness and have a great impact on the impact load. It can provide load input for the structural design of ship and ship equipments. In addition, the model has strong applicability and can be used to calculate the impact load in deep sea. However, the impact load caused by reef also depends on the material property of the ship and reefs condition of the navigation area.
Simulations of Crack Extensions in Small Arc-Shaped Tension Specimens of Uncharged and Hydrogen-Charged 21-6-9 Austenitic Stainless Steels Using Nodal Release Method
Authors: Sung Shin-Jang , Wu Shengjia , Pan Jwo , Korinko Paul S.
Published: October 2021

Crack extensions in small side-grooved arc-shaped tension specimens of uncharged and hydrogen-charged conventionally forged 21-6-9 stainless steels are simulated using two-dimensional plane strain finite element analyses with the nodal release method. The finite element analyses are conducted with the input crack extension-displacement curves from the experiments. The crack extensions are simulated by releasing the nodal points ahead of the initial crack tips. The crack extensions follow the experimental results based on the electric potential drop method. The maximum opening stresses and the separation work rates as functions of the crack extension are then determined for determination of the cohesive strength and cohesive energy for a two-dimensional cohesive zone modeling approach. With the nodal release method for crack extensions, the experimental J-R curves are shown to be significantly higher than the separation work rates and therefore the use of the experimental J-integral values as guides for the selections of the cohesive energies should be careful for small fracture specimens. The computational results are useful for identification of the varying cohesive strengths and cohesive energies for the two-dimensional cohesive zone modeling of crack extensions in small fracture specimens.
Single-Phase Elastic Metamaterials for Wave Filtering
Authors: Vasconcelos Ana C. A. , Schott Dingena , Aragón Alejandro M. , Jovanova Jovana
Published: October 2021

This paper discusses an elastic metamaterial for filtering energy from certain frequencies of an incoming wave. The unit cell, which is composed by a single material, is built to obtain a local resonance band gap. Since Bloch-Floquet’s periodic condition is enforced to the unit cell, the dynamic characteristics of the metamaterial is obtained by only evaluating such structure. The attenuation mechanism is guaranteed by visualizing bandwidths in which the wave propagation is prohibited. Such bandwidths, denoted as band gaps, are observed in the band structure diagram of the unit cell and in the transmissibility loss over the metamaterial. The assemble of unit cells with different internal geometries results in a filtering mechanism. The proposed single-phase metamaterial could be applied in structures requiring vibration control for selective frequencies.
Coupled-mode field computations for media with locally reacting irregular boundaries
Authors: Ivansson Sven M.
Published: October 2021

Coupled-mode methods have been used in underwater acoustics to compute three-dimensional sound propagation and scattering. Significant computational simplifications are possible for media with a lateral variation restricted to cylindrically symmetric anomalies, such as seamounts, and also for media which are invariant in one of the horizontal directions. Typically, the upper and lower depth boundaries of the medium have then been horizontal and flat. This paper generalizes the discrete coupled-mode method with a reflection- (or scattering-) matrix formulation to media with irregular and locally reacting boundaries. Horizontal and vertical segments thereby approximate a sloping boundary. Incorporation of the boundary conditions in a correct way necessitates modifications of the basic equation systems. Additional coupling matrices appear, involving integration of normal-mode products over the depth increments for adjacent regions of the medium. The paper includes three computational examples. One is from underwater acoustics with an island that rises above the sea level. The other two are from atmospheric acoustics with sound propagation over a locally reacting irregular ground surface. Using nonlinear optimization, it is possible to select a suitable artificial absorbing medium termination for a mode representation of the field.
Utilization Efficiency of Human Milk Oligosaccharides by Human-Associated
Akkermansia
Is Strain Dependent
Authors: Luna Estefani , Parkar Shanthi G. , Kirmiz Nina , Hartel Stephanie , Hearn Erik , Hossine Marziiah , Kurdian Arinnae , Mendoza Claudia , Orr Katherine , Padilla Loren , Ramirez Katherine , Salcedo Priscilla , Serrano Erik , Choudhury Biswa , Paulchakrabarti Mousumi , Parker Craig T. , Huynh Steven , Cooper Kerry , Flores Gilberto E.
Published: October 2021

Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk and provide several benefits to developing infants, including the recruitment of beneficial bacteria to the human gut.
Akkermansia
strains are largely considered beneficial bacteria and have been detected in colostrum, breast milk, and young infants.
A. muciniphila
Muc
T
belonging to the AmI phylogroup contributes to the HMO deconstruction capacity of the infant. Here, using phylogenomics, we examined the genomic capacities of four
Akkermansia
phylogroups to deconstruct HMOs.
Potent Induction of Envelope-Specific Antibody Responses by Virus-Like Particle Immunogens Based on HIV-1 Envelopes from Patients with Early Broadly Neutralizing Responses
Authors: Beltran-Pavez Carolina , Bontjer Ilja , Gonzalez Nuria , Pernas Maria , Merino-Mansilla Alberto , Olvera Alex , Miro Jose M. , Brander Christian , Alcami Jose , Sanders Rogier W. , Sanchez-Merino Victor , Yuste Eloisa
Published: October 2021

It is generally accepted that an effective HIV-1 vaccine should be able to induce broad-spectrum neutralizing antibodies. Since most of these antibodies require long periods of somatic maturationin vivo, several groups are developing immunogens, based on the HIV envelope protein, that require complex and lengthy immunization protocols that would be difficult to implement in the general population.
Sialic Acid Binding Sites in VP2 of Bluetongue Virus and Their Use during Virus Entry
Authors: Wu Weining , Roy Polly
Published: October 2021

To date no receptor has been assigned for non-enveloped bluetongue virus. To determine if the outermost spike-like VP2 protein is responsible for host cell attachment via interaction with sialic acids, we first generated a protein-based VP2-nanoparticle, for the multivalent presentation of recombinant VP2 protein.
African Swine Fever Virus F317L Protein Inhibits NF-κB Activation To Evade Host Immune Response and Promote Viral Replication
Authors: Yang Jinping , Li Shasha , Feng Tao , Zhang Xiangle , Yang Fan , Cao Weijun , Chen Hongjun , Liu Huisheng , Zhang Keshan , Zhu Zixiang , Zheng Haixue
Published: October 2021

African swine fever (ASF) is one of the most important pig diseases, causing a high case fatality rate and trade restrictions upon reported outbreaks. The limited understanding of the functions of the proteins of the causative agent, African swine fever virus (ASFV), has become a primary barrier to developing available commercial ASFV vaccines.
Impact of Sickle Cell Trait Hemoglobin on the Intraerythrocytic Transcriptional Program of Plasmodium falciparum
Authors: Saelens Joseph W. , Petersen Jens E. V. , Freedman Elizabeth , Moseley Robert C. , Konaté Drissa , Diakité Seidina A. S. , Traoré Karim , Vance Natalie , Fairhurst Rick M. , Diakité Mahamadou , Haase Steven B. , Taylor Steve M.
Published: October 2021

Sickle-trait hemoglobin (HbAS) confers nearly complete protection from severe, life-threatening malaria, yet the molecular mechanisms that underlie HbAS protection from severe malaria remain incompletely understood. Here, we used transcriptome sequencing (RNA-seq) to measure the impact of HbAS on the blood-stage transcriptome of
Plasmodium falciparum
in
in vitro
time series experiments and
in vivo
samples from natural infections.
Generalisability and performance of an OCT-based deep learning classifier for community-based and hospital-based detection of gonioscopic angle closure
Authors: Randhawa Jasmeen , Chiang Michael , Porporato Natalia , Pardeshi Anmol A , Dredge Justin , Apolo Aroca Galo , Tun Tin A , Quah Joanne HuiMin , Tan Marcus , Higashita Risa , Aung Tin , Varma Rohit , Xu Benjamin Y
Published: October 2021

Purpose

To assess the generalisability and performance of a deep learning classifier for automated detection of gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images.

Methods

A convolutional neural network (CNN) model developed using data from the Chinese American Eye Study (CHES) was used to detect gonioscopic angle closure in AS-OCT images with reference gonioscopy grades provided by trained ophthalmologists. Independent test data were derived from the population-based CHES, a community-based clinic in Singapore, and a hospital-based clinic at the University of Southern California (USC). Classifier performance was evaluated with receiver operating characteristic curve and area under the receiver operating characteristic curve (AUC) metrics. Interexaminer agreement between the classifier and two human examiners at USC was calculated using Cohen’s kappa coefficients.

Results

The classifier was tested using 640 images (311 open and 329 closed) from 127 Chinese Americans, 10 165 images (9595 open and 570 closed) from 1318 predominantly Chinese Singaporeans and 300 images (234 open and 66 closed) from 40 multiethnic USC patients. The classifier achieved similar performance in the CHES (AUC=0.917), Singapore (AUC=0.894) and USC (AUC=0.922) cohorts. Standardising the distribution of gonioscopy grades across cohorts produced similar AUC metrics (range 0.890–0.932). The agreement between the CNN classifier and two human examiners (Ҡ=0.700 and 0.704) approximated interexaminer agreement (Ҡ=0.693) in the USC cohort.

Conclusion

An OCT-based deep learning classifier demonstrated consistent performance detecting gonioscopic angle closure across three independent patient populations. This automated method could aid ophthalmologists in the assessment of angle status in diverse patient populations.
Changes in self-reported sexually transmitted infections and symptoms among married couples in India from 2006 to 2016: a repeated cross-sectional multivariate analysis from nationally representative data
Authors: Choi Jasmin , Bahl Deepika , Arora Monika , Xuan Ziming
Published: October 2021

Objective

To assess the changes in prevalence of past-year self-reported sexually transmitted infections (STIs) and its symptoms among married couples between 2006 and 2016 in India, overall and by socioeconomic status.

Design

This cross-sectional study uses the two most recent waves (2005–2006 vs 2015–2016) of nationally representative health surveys in India. We examined the changes of self-reported STI and symptoms among married couples aged 15–54 by overall and by socioeconomic status. Adjusted logistic regression was used to assess the changes, accounting for covariates and the complex survey design.

Setting

Cross-sectional, nationally representative population-based survey in 2005–2006 and 2015–2016 from National Family Health Survey data from Demographic and Health Survey.

Participants

39 257 married couples aged 15–49 years for the 2005–2006 survey wave and 63 696 married couples aged 15–49 years for the 2015–2016 wave.

Outcome measure

Self-reported STI was used as a primary outcome measure.

Results

In 2016, 2.5% of married women reported having had an STI in the past year, a significant increase from 1.6% in 2006 (p<0.001). The past-year self-reported STI prevalence among married men significantly increased from 0.5% in 2006 to 1.1% in 2016 (p<0.001). Adjusted results showed that the uptrend of couples’ self-reported STI was more significant among those whose husbands are currently employed and those families in middle or higher wealth quintiles. Alarmingly, among couples who reported STI or symptoms, they were less likely to seek advice or treatment in 2016 as compared with 2006 (adjusted OR=0.50, p<0.001, 95% CI=0.40 to 0.61).

Conclusion

The study identifies a substantial increase in self-reported STI prevalence with a notable treatment seeking gap among married couples in India over the past decade.
Cross-sectional study to develop and describe psychometric characteristics of a patient-reported instrument (PROFFIT) for measuring financial toxicity of cancer within a public healthcare system
Authors: Riva Silvia , Arenare Laura , Di Maio Massimo , Efficace Fabio , Montesarchio Vincenzo , Frontini Luciano , Giannarelli Diana , Bryce Jane , Del Campo Laura , De Lorenzo Francesco , Iannelli Elisabetta , Traclò Francesca , Gitto Lara , Jommi Claudio , Vaccaro Concetta Maria , Barberio Daniela , Cinieri Saverio , Porta Camillo , Del Mastro Lucia , Zagonel Vittorina , Cogoni Alessio Aligi , Bordonaro Roberto , Gimigliano Anna , Piccirillo Maria Carmela , Guizzaro Lorenzo , Gallo Ciro , Perrone Francesco
Published: October 2021

Objectives

To measure and explain financial toxicity (FT) of cancer in Italy, where a public healthcare system exists and patients with cancer are not expected (or only marginally) to pay out-of-pocket for healthcare.

Setting

Ten clinical oncological centres, distributed across Italian macroregions (North, Centre, South and Islands), including hospitals, university hospitals and national research institutes.

Participants

From 8 October 2019 to 11 December 2019, 184 patients, aged 18 or more, who were receiving or had received within the previous 3 months active anticancer treatment were enrolled, 108 (59%) females and 76 (41%) males.

Intervention

A 30-item prefinal questionnaire, previously developed within the qualitative tasks of the project, was administered, either electronically (n=115) or by paper sheet (n=69).

Primary and secondary outcome measures

According to the protocol and the International Society for Pharmacoeconomics and Outcomes Research methodology, the final questionnaire was developed by mean of explanatory factor analysis and tested for reliability, internal consistency (Cronbach’s α test and item-total correlation) and stability of measurements over time (test–retest reliability by intraclass correlation coefficient and weighted Cohen’s kappa coefficient).

Results

After exploratory factor analysis, a score measuring FT (FT score) was identified, made by seven items dealing with outcomes of FT. The Cronbach’s alpha coefficient for the FT score was 0.87 and the item-total correlation coefficients ranged from 0.53 to 0.74. Further, nine single items representing possible determinants of FT were also retained in the final instrument. Test–retest analysis revealed a good internal validity of the FT score and of the 16 items retained in the final questionnaire.

Conclusions

The Patient-Reported Outcome for Fighting FInancial Toxicity (PROFFIT) instrument consists of 16 items and is the first reported instrument to assess FT of cancer developed in a country with a fully public healthcare system.

Trial registration number

NCT03473379.
Prevalence and factors associated with multimorbidity among older adults in Malaysia: a population-based cross-sectional study
Authors: Shariff Ghazali Sazlina , Seman Zamtira , Zainuddin Nabilah Hanis , Omar Mohd. Azahadi , Sooryanarayana Rajini , Ariaratnam Suthahar , Mohd Tohit Noorlaili , Ho Bee Kiau , Krishnapillai Ambigga Devi , Zainal Abidin Sheleaswani Inche
Published: October 2021

Objectives

To determine the prevalence and factors associated with multimorbidity among community-dwelling older adults in Malaysia.

Design

A population-based cross-sectional study.

Setting

13 states and 3 Federal Territories in Malaysia.

Participants

A total of 3966 adults aged 60 years and above were extracted from the nationwide National Health and Morbidity Survey (NHMS) 2018 data set.

Primary outcome measures

Multimorbidity was defined as co-occurrence of at least two known chronic non-communicable diseases in the same individual. The chronic diseases included hypertension, type 2 diabetes mellitus, dyslipidaemia and cancer.

Results

The prevalence of multimorbidity among Malaysian older adults was 40.6% (95% CI: 37.9 to 43.3). The factors associated with multimorbidity were those aged 70–79 years (adjusted OR (AOR)=1.30; 95% CI=1.04 to 1.63; p=0.019), of Indian (AOR=1.69; 95% CI=1.14 to 2.52; p=0.010) and Bumiputera Sarawak ethnicities (AOR=1.81; 95% CI=1.14 to 2.89; p=0.013), unemployed (AOR=1.53; 95% CI=1.20 to 1.95; p=0.001), with functional limitation from activities of daily livings (AOR=1.66; 95% CI=1.17 to 2.37; p=0.005), physically inactive (AOR=1.28; 95% CI=1.03 to 1.60; p=0.026), being overweight (AOR=1.62; 95% CI=1.11 to 2.36; p=0.014), obese (AOR=1.88; 95% CI=1.27 to 2.77; p=0.002) and with abdominal obesity (AOR=1.52; 95% CI=1.11 to 2.07; p=0.009).

Conclusion

This study highlighted that multimorbidity was prevalent among older adults in the community. Thus, there is a need for future studies to evaluate preventive strategies to prevent or delay multimorbidity among older adults in order to promote healthy and productive ageing.
Experiences with opt-in, at-home screening for SARS-CoV-2 at a primary school in Germany: an implementation study
Authors: Wachinger Jonas , Schirmer Maximilian , Täuber Nicole , McMahon Shannon A , Denkinger Claudia M
Published: October 2021

Background

Over the course of the pandemic, many countries have repeatedly closed schools and shifted schoolchildren to remote learning. However, evidence for negative mental and physiological health consequences of such measures for schoolchildren is increasing, highlighting the need for evidence-based recommendations on how to safely reopen schools. This study aims to assess implementation experiences, acceptability and feasibility of opt-in, at-home SARS-CoV-2 screening using rapid diagnostic tests (RDTs) to facilitate safe face-to-face teaching during a pandemic.

Methods

We present data from a prospective study implementing an RDT-based screening programme at a primary school in southwest Germany. In addition to quantitative data collected to assess screening diagnostic yield (number of participants, tests handed out to participants, positive RDT results reported), we conducted qualitative in-depth interviews with participating pupils, parents and school stakeholders to elicit implementation experiences and screening perceptions.

Results

The screening intervention was highly accepted and appreciated among participants; no screening-associated positive RDT was reported over the duration of the study. Self-testing at home before coming to school was feasible, but more positive consequences of screening participation (eg, easing of mask mandates) besides a personal feeling of safety would have been appreciated across respondent groups. Participants preferred home-based RDTs over some other measures, particularly mask mandates. Despite the RDTs being licensed as self-tests in Germany, additional training can help avoid mistakes, and ensuring intervention ownership and improving pre-implementation communication can facilitate buy-in.

Conclusions

Antigen-RDT-based SARS-CoV-2 screening programmes relying on self-testing at home are a feasible and acceptable supplement to the public health toolbox to facilitate a safe return to face-to-face teaching at schools.

Trial registration number

DRKS00024845.
Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework
Authors: Ishizawa Takeaki , McCulloch Peter , Muehrcke Derek , Carus Thomas , Wiesel Ory , Dapri Giovanni , Schneider-Koriath Sylke , Wexner Steven D , Abu-Gazala Mahmoud , Boni Luigi , Cassinotti Elisa , Sabbagh Charles , Cahill Ronan , Ris Frederic , Carvello Michele , Spinelli Antonino , Vibert Eric , Terasawa Muga , Takao Mikiya , Hasegawa Kiyoshi , Schols Rutger M , Pruimboom Tim , Murai Yasuo , Matano Fumihiro , Bouvet Michael , Diana Michele , Kokudo Norihiro , Dip Fernando , White Kevin , Rosenthal Raul J
Published: October 2021

Objectives

Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development,Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures.

Design

Narrative literature review with analysis of IDEAL stage of each field of study.

Setting

All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery.

Main outcome measures

The IDEAL stage of research evidence was determined for each specialty field using a previously described approach.

Results

196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported.

Conclusions

Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
Spiritual interventions for cancer pain: a systematic review and narrative synthesis
Authors: Hindmarch Thomas , Dalrymple James , Smith Matthew , Barclay Stephen
Published: October 2021

Background

Pain is a common and debilitating cancer-related symptom. In palliative care, physical, psychological, social and spiritual factors are thought to contribute to individual experience of pain. Consequently, spiritual care interventions are advocated in the management of cancer-related pain.

Aim

To systematically review the published literature concerning spiritual interventions in the management of cancer-related pain.

Methodology

Seven databases (Medline, CINAHL, EMBASE, PsycINFO, Cochrane, Scopus and Web of Science) were searched for quantitative studies of pain in patients with cancer receiving spiritual care interventions, with additional reference and citation searches. Research quality and relevance was appraised using Gough’s ‘Weight of Evidence’ framework prior to narrative synthesis.

Results

The search identified 12 822 articles, of which 11 were included in the synthesis. Few studies have investigated spiritual interventions in the management of cancer pain: a minority of these demonstrate statistical benefit. Some evidence suggests spiritual care may aid in coping with pain, rather than altering pain intensity. Spiritual interventions are well received by patients with cancer and do not appear to cause harm.

Conclusion

Current evidence provides limited support for the use of spiritual care interventions in the management of cancer pain. The paucity and heterogeneity of literature points to a need for high-quality research with judgements of spiritual intervention efficacy made on an individual basis.

PROSPERO registration number

CRD42020190194.
Cardiovascular considerations for scuba divers
Authors: Tso Jason V , Powers Joshua M , Kim Jonathan H
Published: October 2021

As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine ‘fitness-to-dive’. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.
Humoral immunity to SARS-CoV-2 mRNA vaccination in multiple sclerosis: the relevance of time since last rituximab infusion and first experience from sporadic revaccinations
Authors: König Marton , Lorentzen Åslaug Rudjord , Torgauten Hilde Marie , Tran The Trung , Schikora-Rustad Stine , Vaage Eline Benno , Mygland Åse , Wergeland Stig , Aarseth Jan , Aaberge Ingeborg Aase S , Torkildsen Øivind , Holmøy Trygve , Berge Tone , Myhr Kjell-Morten , Harbo Hanne Flinstad , Andersen Jan Terje , Munthe Ludvig Andre , Søraas Arne , Celius Elisabeth Gulowsen , Vaage John Torgils , Lund-Johansen Fridtjof , Nygaard Gro Owren
Published: October 2021

Introduction

The effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.

Objective

To characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).

Methods

All pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3–12 weeks after full vaccination, and compared with healthy subjects.

Results

528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.

Conclusions

Patients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations.
Relational aspects of regulating clinical work: examining electronic and in-person compliance mechanisms
Authors: Bajpai Kartikeya , Chown Jillian , Astik Gopi , Green Kristine
Published: October 2021

Background

Clinical documentation quality is an important way to facilitate clinical communication, improve patient safety metrics and optimise hospital coding and public reporting. However, the monitoring of clinicians by external individuals (ie, those outside the profession or emanating from outside clinical teams) raises difficult questions relating to the autonomy of clinicians and an organisation’s control over clinical work. Typically, documentation improvement initiatives have relied solely on electronic monitoring systems to vet clinician documentation. In such systems, quality personnel monitor clinical documentation and, on encountering potentially problematic content, use an electronic querying system to ask the clinicians to voluntarily clarify or modify the text if appropriate. Importantly, clinicians retain their professional autonomy and can choose to disagree with documentation requests. The current study empirically examines a clinical documentation improvement program which takes a different approach. This programme uses two modes of querying clinicians: (1) conventional electronic documentation clarification queries and (2) in-person verbal documentation clarification requests.

Methods

We conducted regression analyses using archival documentation query data (n=19 650) from an American teaching hospital to compare the efficacy of conventional electronic documentation clarification queries and in-person verbal documentation clarification requests. Our dependent variable is the length of time between the documentation clarification request and the resolution of the query (ie, the time until a clinician responds).

Findings

Our analyses demonstrate that in-person verbal documentation clarification requests are associated with a 30-hour reduction in the time it takes for a query to be resolved relative to electronic-only queries.

Practical implications

The results suggest that while electronic regulatory systems might afford hospitals with opportunities to scale quality initiatives in a cost-effective manner, organisational efforts to influence clinical work may yet benefit from the human touch of in-person regulator–clinician interaction. Furthermore, the replacement of in-person compliance interactions with digital compliance requests can potentially produce negative compliance outcomes.