bluuebunny/crossref_metadata_2025 huggingface dataset:
Tailoring Surface Roughness Using Additive Manufacturing to Improve Internal Cooling
Authors: Snyder Jacob C. , Thole Karen A.
Published: June 2020

Surface roughness present on internal cooling channels produced with additive manufacturing has been previously shown to augment heat transfer and pressure loss to levels similar to traditionally cast turbulators. Given the ability of the surface roughness to improve the cooling performance of small cooling channels, the question arises on whether there is an optimal combination of random roughness features to maximize internal cooling performance. To investigate this question, test coupons with different surface roughness morphologies and magnitudes were manufactured by manipulating the parameters in the laser powder bed fusion additive manufacturing process. The coupons were tested to characterize the friction factor and Nusselt number of the cooling channels over a range of Reynolds numbers. Results showed that certain roughness combinations outperformed others, increasing the internal cooling performance of the channels. Additionally, manipulation of the performance using the process parameters allowed for reductions in build time, which could be useful for controlling component cost.
Experimental and Theoretical Study of the Cavity Growth of Spherical Fragment Penetrating Liquid-Filled Container
Authors: Chen Anran , Li Xiangdong , Zhou Lanwei , Ji Yangziyi
Published: June 2020

When high-velocity penetrator impacts and penetrates a liquid-filled container such as an aircraft fuel tank, the hydrodynamic ram (HRAM) event occurs. This process could be roughly divided into four phases, each of which could cause different degrees of damage to the liquid-filled container or the surrounding equipment. Spherical fragment impacting tests of different velocities were performed on two sizes of liquid-filled containers to investigate the effect of boundary constraints on cavity growth. The velocity range in the experiment was from 600 m/s to 1400 m/s. Through theoretical analysis and experimental results, it is found that the radial disturbance range of the cavity is not constant in different containers and under different impact velocities. An improved method is presented to modeling the cavity growth in the drag-cavity phases of HRAM events. The approach quantitatively describes the radial disturbance range of the cavity and is appropriate for the calculation of the cavity growth in HRAM. Moreover, the effect of liquid type on cavity growth is studied theoretically. When the fragment velocity is less than Mach 0.5, the length and radius of the cavity are mainly affected by the density of the liquid. When the fragment velocity exceeds Mach 0.5, the characteristics of cavity shape are mainly affected by the acoustic velocity in the liquid.
Experimental and Numerical Analysis of Ratcheting Behavior of SS 316 L Thin-Walled Pipes Subjected to Cyclic Internal Pressure
Authors: Karimi R. , Shariati M.
Published: June 2020

This paper investigates ratcheting behavior of SS316 L thin-walled steel pipes subjected to cyclic internal pressure experimentally and numerically. Numerical simulations were performed using abaqus software, and nonlinear isotropic/kinematic hardening model. According to experimentations, it was found that the ratcheting strain is only significant in the hoop direction of a pipe subjected to cyclic internal pressure. The effects of pressure amplitude and mean pressure on ratcheting behavior of thin walled pipe in hoop direction were studied experimentally and numerically, and it was observed that increasing the pressure amplitude and mean pressure increased the percentage of ratcheting strain. Another important point about the results was the dominance of pressure amplitude on mean pressure. The results showed that at higher mean pressures the effect of pressure amplitude on increasing the percentage of ratcheting strain was greater. Finally, the experimental and numerical results were in good agreement.
Assessment on Stress Estimation Method for Creep Evaluation of Components at Elevated Temperature Within Elastic Analysis Routine
Authors: Gong Cheng , Gao Fu-Hai , Gong Jian-Guo , Xuan Fu-Zhen
Published: June 2020

An accurate stress estimation for creep evaluation is essential for the long-term safe operation of components at elevated temperature. In general, the section-dependent parameter Kt is defined in elastic analysis routine to account for the reduction in extreme fiber bending stress due to the effect of creep action. A constant value is provided for each cross section in ASME III-5 code, but this may induce underestimation or overestimation of the representative stress of the component due to the relevance of parameter Kt to many factors. Therefore, it is essential to re-examine the validity of the parameter Kt in ASME III-5 code for an adequate creep evaluation. In this work, numerical analyses on beam models with a rectangular section are conducted to calculate parameter Kt, and effects of related factors to the parameter Kt are included. The results reveal that the parameter Kt is closely related to the design life, loading level, operation temperature, and loading combinations. It can be higher than that for the pure bending moment (or tensile loading) with the introduction of the tensile loading (or the bending moment). Meanwhile, the parameter Kt may be higher than the value (i.e., 1.25) in ASME III-5 code for a longer design life, a higher loading level, and a higher operation temperature, inducing an overestimation of the representative stress. On the contrary, a smaller value than 1.25 can be found, inducing an underestimation of the representative stress for creep evaluations.
Multiscale Computational Fluid Dynamics Modeling for Personalized Liver Cancer Radioembolization Dosimetry
Authors: Taebi Amirtahà , Vu Catherine T. , Roncali Emilie
Published: June 2020

Yttrium-90 (90Y) radioembolization is a minimally invasive procedure increasingly used for advanced liver cancer treatment. In this method, radioactive microspheres are injected into the hepatic arterial bloodstream to target, irradiate, and kill cancer cells. Accurate and precise treatment planning can lead to more efficient and safer treatment by delivering a higher radiation dose to the tumor while minimizing the exposure of the surrounding liver parenchyma. Treatment planning primarily relies on the estimated radiation dose delivered to tissue. However, current methods used to estimate the dose are based on simplified assumptions that make the dosimetry results unreliable. In this work, we present a computational model to predict the radiation dose from the 90Y activity in different liver segments to provide a more realistic and personalized dosimetry. Computational fluid dynamics (CFD) simulations were performed in a 3D hepatic arterial tree model segmented from cone-beam CT angiographic data obtained from a patient with hepatocellular carcinoma (HCC). The microsphere trajectories were predicted from the velocity field. 90Y dose distribution was then calculated from the volumetric distribution of the microspheres. Two injection locations were considered for the microsphere administration, a lobar and a selective injection. Results showed that 22% and 82% of the microspheres were delivered to the tumor, after each injection, respectively, and the combination of both injections ultimately delivered 49% of the total administered 90Y microspheres to the tumor. Results also illustrated the nonhomogeneous distribution of microspheres between liver segments, indicating the importance of developing patient-specific dosimetry methods for effective radioembolization treatment.
Functional Threshold Power: Relationship With Respiratory Compensation Point and Effects of Various Warm-Up Protocols
Authors: Barranco-Gil David , Gil-Cabrera Jaime , Valenzuela Pedro L. , Alejo Lidia B. , Montalvo-Pérez Almudena , Talavera Eduardo , Moral-González Susana , Lucia Alejandro
Published: June 2020

Purpose: The functional threshold power (FTP), which demarcates the transition from steady state to non-steady-state oxidative metabolism, is usually determined with a 20-minute cycling time trial that follows a standard ∼45-minute warm-up. This study aimed to determine if the standard warm-up inherent to FTP determination is actually necessary and how its modification or removal affects the relationship between FTP and the respiratory compensation point (RCP). Methods: A total of 15 male cyclists (age 35 [9] y, maximum oxygen uptake 66.4 [6.8] mL·kg−1·min−1) participated in this randomized, crossover study. Participants performed a ramp test for determination of RCP and maximum oxygen uptake. During subsequent visits, they performed a 20-minute time trial preceded by the “standard” warm-up that is typically performed before an FTP test (S-WU), a 10-minute warm-up at the power output (PO) corresponding to 60% of maximum oxygen uptake (60%-WU), or no warm-up (No-WU). FTP was computed as 95% of the mean PO attained during the time trial. Results: Although the FTP was correlated with the RCP independently of the warm-up (r = .89, .93, and .86 for No-WU, 60%-WU, and S-WU, respectively; all Ps < .001), the PO at RCP was higher than the FTP in all cases (bias ± 95% limits of agreement = 57 [24], 60 [23], and 57 [32] W for No-WU, 60%-WU, and S-WU, respectively; all Ps < .001 and effect size > 1.70). Conclusions: The FTP is highly correlated with the RCP but corresponds to a significantly lower PO, being these results independent of the warm-up performed (or even with no warm-up).
Unraveling the Gentamicin Drug Product Complexity Reveals Variation in Microbiological Activities and Nephrotoxicity
Authors: Bulman Zackery P. , Cirz Ryan , Hildebrandt Darin , Kane Tim , Rosario Zuelay , Wlasichuk Ken , Park Minjong , Andrews Logan D.
Published: June 2020

The gentamicin drug product is a complex mixture of numerous components, many of which have not individually undergone safety and efficacy assessments. This is in contrast to the majority of medicines that require rigorous characterizations of trace impurities and are dosed as single components. In gentamicin, four components, known as gentamicin congeners C1, C1a, C2, and C2a, comprise the majority of the mixture. A liquid chromatography-mass spectroscopy analysis revealed that the relative abundances of each gentamicin congener in commercial formulations can vary up to 1.
DNM1, a Dynamin-Related Protein That Contributes to Endocytosis and Peroxisome Fission, Is Required for the Vegetative Growth, Sporulation, and Virulence of Metarhizium
robertsii
Authors: Xie Xiangyun , Wang Yulong , Yu Deshui , Xie Rui , Liu Zhenbang , Huang Bo
Published: June 2020

Dnm1
was found to be involved in fungal development and virulence, mediated peroxisomal fission, and normal endocytosis. This finding provides new insights into the cellular processes and pathogenicity in entomopathogenic fungi.
Dimerization of Dengue Virus E Subunits Impacts Antibody Function and Domain Focus
Authors: Thomas Ashlie , Thiono Devina J. , Kudlacek Stephan T. , Forsberg John , Premkumar Lakshmanane , Tian Shaomin , Kuhlman Brian , de Silva Aravinda M. , Metz Stefan W.
Published: June 2020

Dengue virus vaccine development is particularly challenging because vaccines have to provide protection against four different dengue virus stereotypes. The leading dengue virus vaccine candidates in clinical testing are all based on live-virus vaccine platforms and struggle to induce balanced immunity. Envelope subunit antigens have the potential to overcome these limitations but have historically performed poorly as vaccine antigens, because the versions tested previously were presented as monomers and not in their natural dimer configuration. This study shows that the authentic presentation of DENV2 E-based subunits has a strong impact on antibody responses, underscoring the importance of mimicking the complex protein structures that are found on DENV particle surfaces when designing subunit vaccines.
IMP-38-Producing High-Risk Sequence Type 307 Klebsiella pneumoniae Strains from a Neonatal Unit in China
Authors: Wang Siyi , Zhao Juan , Liu Ning , Yang Fang , Zhong Yiming , Gu Xiumei , Jian Zijuan , Yan Qun , Liu Qingxia , Li Hongling , Li Yanming , Liu Jing , Li Hui , Chen Liang , Liu Wenen
Published: June 2020

We described the genome and resistome characterization of a carbapenem-resistant
Klebsiella pneumoniae
ST307 strain carrying
bla
IMP-38
in China. This report highlights that the high-risk ST307 clone continues to acquire different antimicrobial resistance genes, posing significant challenges to clinical practice, and should be closely monitored.
The Genotoxin Colibactin Shapes Gut Microbiota in Mice
Authors: Tronnet Sophie , Floch Pauline , Lucarelli Laetitia , Gaillard Deborah , Martin Patricia , Serino Matteo , Oswald Eric
Published: June 2020

Infections of genotoxic
Escherichia coli
spread concomitantly with urbanized progression. These bacteria may prompt cell senescence and affect DNA stability, inducing cancer via the production of colibactin, a genotoxin shown capable of affecting host DNA in eukaryotic cells. In this study, we show that the action of colibactin may also be directed against other bacteria of the gut microbiota in which genotoxic
E. coli
bacteria have been introduced. Indeed, the presence of genotoxic
E. coli
induced a change in both the structure and function of the gut microbiota. Our data indicate that genotoxic
E. coli
may use colibactin to compete for gut niche utilization.
U-Pb detrital zircon ages of Cambrian–Ordovician sandstones from the Taebaeksan Basin, Korea: Provenance variability in platform shelf sequences and paleogeographic implications
Authors: Cho Moonsup , Cheong Wonseok , Ernst W.G. , Kim Yoonsup , Yi Keewook
Published: June 2020

The early Paleozoic paleogeography of East Gondwanan terranes, including the North China Craton (NCC), is contentious, primarily reflecting the paucity of integrated geochronological, biogeographic, and tectonic data sets. Our new sensitive high-resolution ion microprobe data from 14 sandstones of the Taebaeksan Basin, Korea, indicate that its platform shelf sequences, typified by trilobite faunal assemblages diagnostic of the NCC, record the vestige of coeval arc magmatism. Detrital zircons analyzed from the sandstones yielded Eoarchean to Early Ordovician ages, which define three distinct types of distribution patterns characterized by: (1) double peaks at ca. 1.85 Ga and 2.50 Ga diagnostic of basement rocks in the NCC; (2) minor peaks at ca. 1.75, 1.6, and 1.2–1.1 Ga in addition to double peaks; and finally (3) a scattered array of late Paleoproterozoic to Neoproterozoic zircons lacking double peaks. The marked contrasts among the three types reflect significant changes in provenance, most likely linked to variations in paleo-water depths during the “Sauk” transgression. Longshore- or onshore-directed currents, associated with an increase in water depth, apparently brought outboard oceanic detritus and benthic trilobites into the relatively flat outer shelf of the Taebaeksan Basin. As a result, fine-grained sandstones received a large amount of detritus from distal sources, yielding mixed signatures in zircon age patterns and trilobite assemblages. Excluding the basal sandstone-conglomerate unit, five siliciclastic formations contain syndepositional zircon populations, and their weighted mean 206Pb/238U ages decrease upsection from 512 ± 5 Ma to 483 ± 2 Ma, indicating a sedimentary influx from contemporaneous volcanic activity. In conjunction with arc-related bulk-rock geochemistry and juvenile Nd isotopic signature, early Paleozoic detrital zircons likely represent the first-cycle detritus supplied for ∼30 m.y. from the proto-Japan arc that initially formed at ca. 520 Ma. Together with the occurrence of ca. 700–500 Ma detrital Pacific Gondwana zircons in fine-grained sandstones, Paleozoic arc-sourced detritus suggests that the Korean Peninsula was paleogeographically linked to an ancient convergent margin, perhaps extending from the Terra Australis orogen.
Extensive spontaneous cerebral haemorrhage after Russell’s viper bite
Authors: Chattopadhyay Mounam , Bhattacharya Deepanjan
Published: June 2020

A 30-year-old man presented with altered sensorium following Russell’s viper bite, which was found to be secondary to intracranial hemorrhage secondary to venom-induced consumptive coagulopathy. He was managed conservatively with blood component transfusion and antivenom injection, and successfully discharged.
Bilateral acute anterior uveitis and iris atrophy caused by moxifloxacin
Authors: Hui Benjamin Tsun Kiu , Capewell Nicholas , Ansari Yousuf , Liu Xiaoxuan
Published: June 2020

A 56-year-old paramedic was admitted to hospital and treated for severe pneumonia. Shortly after initiating antibiotic treatment (including moxifloxacin), he developed bilaterally painful eyes and was diagnosed with bilateral acute anterior uveitis (AAU). Three years later, he was referred to the ophthalmology clinic with bilateral iris transillumination suggesting iris atrophy and limited pupillary dilation, indicating iris sphincter muscle paralysis. AAU typically presents unilaterally. An onset of bilateral AAU is unusual and warrants investigation for underlying systemic cause. The fluoroquinolone moxifloxacin has been reported in a limited number of cases as a causative agent of bilateral AAU and iris atrophy. This case provides additional supporting evidence that moxifloxacin may cause degradation of collagen and iris muscle in the eye, as well as elsewhere in the body, such as in blood vessels. Additionally, we present novel anterior segment ocular imaging (using optical coherence tomography) demonstrating the ability to detect iris atrophy using non-invasive imaging.
Multiple myeloma with hepatic amyloid light-chain amyloidosis manifesting as progressive liver failure
Authors: Oye Monique , Sanders Kimberly , Ghali Maged , Alkhasawneh Ahmad
Published: June 2020

We present a case of a 45-year-old man admitted to the hospital with new-onset ascites and bilateral subconjunctival haemorrhages. He was found to have elevated liver enzymes in a hepatocellular pattern and direct hyperbilirubinemia. A diagnostic paracentesis was consistent with portal hypertension (PH). Extensive workup for acute and chronic liver disease was unremarkable. In the absence of clinical evidence of cirrhosis to explain PH, a liver biopsy with hepatic venous pressure gradient was pursued, which revealed proteinaceous material and apple-green birefringence under polarised light consistent with amyloid deposits. Bone marrow biopsy revealed plasma cell neoplasm with proteinaceous deposits consistent with concomitant multiple myeloma with AL amyloidosis. He developed rapidly progressive liver failure and passed shortly after presentation despite treatment with chemotherapy. This case illustrates how primary hepatic amyloidosis can present with a physiology that mimics cirrhosis and can easily be missed.
4-month-old boy coinfected with COVID-19 and adenovirus
Authors: Danley Kelsey , Kent Paul
Published: June 2020

A 4-month-old boy with a history of muscular ventricular septal defect and atopic dermatitis presented with decreased oral intake, loose stools, stuffy nose, mild cough and diaphoresis. The patient had an in-home exposure to COVID-19. The initial respiratory pathogen panel was positive for adenovirus, consistent with his symptoms. The following day, the COVID-19 PCR was also positive. The patient was treated with supportive care, isolation precautions were implemented and the patient was discharged on day 4. This case demonstrates the importance of testing for COVID-19 even if a patient tests positive for another virus due to the possibility of coinfection, especially in children, in order to limit spread of COVID-19 to others.
Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic
Authors: Dijkstra H Paul , Ergen Emin , Holtzhausen Louis , Beasley Ian , Alonso Juan Manuel , Geertsema Liesel , Geertsema Celeste , Nelis Sofie , Ngai Aston Seng Huey , Stankovic Ivan , Targett Stephen , Andersen Thor Einar
Published: June 2020

Background

The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services.

Aim

The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template.

Results

eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education.

Conclusion

teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.
Time-to-scene for opioid overdoses: are unmanned aerial drones faster than traditional first responders in an urban environment?
Authors: Tukel Connor Andrew , Tukel Matthew Ryan , Weinbaum Robert Jacob , Mika Valerie H , Levy Phillip D
Published: June 2020

Introduction

Opioid overdoses claim tens of thousands of lives every year. Many of these deaths might be prevented if overdose-reversal medications such as naloxone are administered in a timely manner. Drones may help overcome barriers to timely arrival on scene for opioid overdoses. This study analyses the time required for a drone carrying naloxone to traverse various distances, simulating the response time for a drone to the scene of an opioid overdose. For comparison, we used the time required for ambulances to traverse similar distances while responding to the scene of actual or suspected opioid overdoses.

Methods

Fifty flight trials, using a modified Dà-Jiāng Innovations (DJI) ‘Inspire 2’ drone, were conducted across seven distances, and the travel time for the drone was then compared with historical response time data from 200 actual or suspected opioid overdose cases that occurred within Detroit, Michigan.

Results

We determined with 95% certainty that drone arrival times were discernibly quicker than ambulance arrival times at all distances where sufficient data were available to perform statistical comparisons including 0.5 km, 1.0 km, 1.5 km, 2.0 km and 3.0 km.

Conclusion

We have shown that a drone is capable of travelling several ranges of straight-line (ie, ‘as the crow flies’) distance faster than an ambulance. Further exploration into the use of drones to deliver life-saving therapies in urban and rural settings is warranted. Head-to-head prospective trials that consider the practical challenges of medical drone delivery are needed to better understand the viability of incorporating this technology into existing emergency response infrastructure.
Effects of adding adjunctive hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers: a protocol for a systematic review with meta-analysis and trial sequential analysis
Authors: Vinkel Julie , Holm Niels Frederich Rose , Jakobsen Janus C , Hyldegaard Ole
Published: June 2020

Introduction

Diabetic foot ulcer represents a major health problem globally. Preliminary studies have indicated that systemic treatment of diabetic foot ulcer patients with hyperbaric oxygen therapy have beneficial effects on wound healing, risk of amputation, glycaemic control, atherosclerosis, inflammatory markers and other clinical and laboratory parameters. This protocol for a systematic review aims at identifying the beneficial and harmful effects of adding hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers.

Methods and analysis

This protocol was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of hyperbaric oxygen therapy in the treatment of diabetic foot ulcer versus any control group with any intervention defined as standard wound care or similar, together with sham interventions. Our primary outcome will be: all-cause mortality, serious adverse events and quality of life. Our secondary outcomes will be: healing of index wound, major amputation and wound infection. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5 and Trial Sequential Analysis. For both our primary and secondary outcomes, we will create a ‘Summary of Findings’ table and use GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment to assess the quality of the evidence.

Ethics and dissemination

We use publicly accessible documents as evidence, there is no participant involvement at an individual level and an institutional ethics approval is not required. The results of the review will be sought published in a peer-reviewed journals, also in the event of insignificant results or null results, and thereby it will be disseminated to clinicians and public available.

PROSPERO registration number

CRD42019139256.
Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan
Authors: Shepherd Thomas Andrew , Ul-Haq Zia , Ul-Haq Mian , Khan Muhammad Firaz , Afridi Adil , Dikomitis Lisa , Robinson Michelle E , Lewis Martyn , Rahman Atif , Dziedzic Krysia , Saeed Umaima , Awan Naila Riaz , Mallen Christian , Farooq Saeed
Published: June 2020

Introduction

There is a significant treatment gap, with only a few community-based services for people with schizophrenia in low-income and middle-income countries. Poor treatment adherence in schizophrenia is associated with poorer health outcomes, suicide attempts and death. We previously reported the effectiveness of supervised treatment in outpatients for schizophrenia (STOPS) for improving treatment adherence in patients with schizophrenia. However, STOPS was evaluated in a tertiary care setting with no primary care involvement, limiting its generalisability to the wider at-risk population. We aim to evaluate the effectiveness of STOPS+ in scaling up the primary care treatment of schizophrenia to a real-world setting.

Methods and analysis

The effectiveness of the STOPS+ intervention in improving the level of functioning and medication adherence in patients with schizophrenia in Pakistan will be evaluated using a cluster randomised controlled trial design. We aim to recruit 526 participants from 24 primary healthcare centres randomly allocated in 1:1 ratio to STOPS+ intervention and enhanced treatment as usual arms. Participants will be followed-up for 12 months postrecruitment. The sample size is estimated for two outcomes (1) the primary clinical outcome is level of functioning, measured using the Global Assessment of Functioning scale and (2) the primary process outcome is adherence to treatment regimen measured using a validated measure. An intention-to-treat approach will be used for the primary analysis.

Ethics and dissemination

Ethical approval has been obtained from Keele University Ethical Review Panel (ref: MH-190017) and Khyber Medical University Ethical Review Board (ref: DIR-KMU-EB/ST/000648). The results of the STOPS+ trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers.

Trial registration number

ISRCTN93243890.
Patients’ experiences of using an e-Health tool for self-management support after prostate cancer surgery: a deductive interview study explained through the FITT framework
Authors: Nilsson Lina , Hellström Amanda , Wennerberg Camilla , Ekstedt Mirjam , Schildmeijer Kristina
Published: June 2020

Objective

To evaluate patients’ experiences of using a web-based application, especially its usability as support for self-care activities after prostate cancer surgery.

Design

A deductive content analysis was used, stemming from the Fit between Individuals, Task and Technology (FITT) framework.

Setting

One surgical department in south of Sweden between October 2015 and April 2016 and between September 2017 and July 2018.

Participants

Fifteen men who had undergone radical prostatectomy for prostate cancer.

Results

By organising data in accordance with the FITT model, three main categories with ten subcategories were identified. Patients gave feedback on functions that suited them and their needs, as well as potential adjustments and improvements. Patients experienced that ePATH gave them easy access to reliable information regarding their rehabilitation. Directed information about ePATH at enrolment was seen as important. ePATH was perceived to have a logical structure that was easy to follow. However, when the structure was unclear, patients became less motivated to use a function.

Conclusions

Patients experienced ePATH as satisfactorily user-friendly and useful as a complementary self-management support after prostate cancer surgery, especially when the information and tasks were tailored to their preferences and the system design features supported individual autonomy.
Effect of reactive balance training on physical fitness poststroke: study protocol for a randomised non-inferiority trial
Authors: Barzideh Azadeh , Marzolini Susan , Danells Cynthia , Jagroop David , Huntley Andrew H , Inness Elizabeth L , Mathur Sunita , Mochizuki George , Oh Paul , Mansfield Avril
Published: June 2020

Introduction

Regular exercise is essential in the chronic phase of stroke recovery for improving or maintaining function, and reducing the risk of a second stroke. To achieve these goals, multiple components of fitness should be targeted with poststroke exercise, including aerobic capacity, strength and balance. However, following the recommended frequency and duration of each component separately can take a long time and lead to fatigue in people with stroke. Therefore, finding types of exercise that target multiple components of fitness all together is valuable.

Reactive balance training (RBT) is a novel type of exercise where individuals repeatedly lose their balance in order to practise balance reactions. When people do RBT, they increase their heart rate and exert forces with their leg muscles which could improve aerobic fitness and muscle strength, respectively. This means that RBT could have the potential to improve multiple components of fitness, simultaneously.

Methods and analysis

This is a randomised controlled non-inferiority trial with internal pilot study. Participants with chronic stroke will be randomly assigned to one of two groups: (1) RBT or (2) aerobic and strength training (AST). Participants in both groups will complete 1 hour of exercise, three times/week for 12 weeks. The primary objective is to determine the effect of RBT on aerobic capacity and knee muscles’ strength. The secondary objective is to determine the effects of RBT and AST on balance control and balance confidence. We expect to find that RBT is superior to AST in terms of improving balance control and balance confidence, yet not inferior to AST in terms of its effects on aerobic capacity and strength.

Ethics and dissemination

Research ethics approval has been received. Results will be disseminated directly to study participants at the end of the trial, and to other stakeholders via publication in a peer-reviewed journal.

Trial registration number

NCT04042961.
Relationship of CT densitometry to lung physiological parameters and health status in alpha-1 antitrypsin deficiency: initial report of a centralised database of the NIHR rare diseases translational research collaborative
Authors: Crossley Diana , Stockley James , Bolton Charlotte E , Hopkinson Nicholas S , Mahadeva Ravi , Steiner Michael , Wilkinson Tom , Hurst John R , Gooptu Bibek , Stockley Robert A
Published: June 2020

Objectives

To establish a database network for the study of alpha-1 antitrypsin deficiency (AATD) and compare the results to CT lung density as the most direct measure of emphysema.

Design

A central electronic database was established to permit the upload of anonymised patient data from remote sites. Prospectively collected CT data were recorded onto disc, anonymised, analysed at the coordinating centre and compared with the clinical features of the disease.

Setting

Tertiary referral centres with expertise in the management of AATD focused on academic Biomedical Research Units and Wellcome Clinical Research Facilities.

Participants

Data were collected from 187 patients over 1 year from eight UK academic sites. This included patient demographics, postbronchodilator physiology, health status and CT. Analysis was undertaken at the coordinating centre in Birmingham.

Results

Patient recruitment in the 12 months reached 94% of target (set at 200) covering the whole spectrum of the disease from those with normal lung function to very severe chronic obstructive lung disease. CT scan suitable for analysis was available from 147 (79%) of the patients. CT density, analysed as the threshold for the lowest 15% of lung voxels, showed statistically significant relationships with the objective physiological parameters of lung function as determined by spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity staging (p<0.001) and carbon monoxide gas transfer (p<0.01). Density also correlated with subjective measures of quality of life (p=0.02).

Conclusions

Establishment of the network for data collection and its transfer was highly successful facilitating future collaboration for the study of this rare disease and its management. CT densitometry correlated well with the objective clinical features of the disease supporting its role as the specific marker of the associated emphysema and its severity. Correlations with subjective measures of health, however, were generally weak indicating other factors play a role.
Social capital and peer influence of tobacco consumption: a cross-sectional study among household heads in rural Uttar Pradesh, India
Authors: Hasan Md Zabir , Cohen Joanna E , Bishai David , Kennedy Caitlin E , Rao Krishna D , Ahuja Akshay , Gupta Shivam
Published: June 2020

Objective

Having the world’s second-largest tobacco-consuming population, tobacco control is a priority agenda of the Indian Government. Yet, there is no evidence of how peer influence and nature of social relationships—defined as social capital—affect tobacco use. This study aimed to explore the role of social capital and peer influence on tobacco consumption among household heads in rural Uttar Pradesh (UP), India.

Design and setting

This study was embedded within the baseline evaluation of Project Samuday. A cross-sectional multistage cluster survey was implemented in six census blocks of Hardoi and Sitapur districts of UP from June to August 2017. Self-reported tobacco consumption status of randomly selected 6218 household heads (≥18 years; men vs women=5312 vs 906) was assessed from 346 rural communities. Peer influence of tobacco use was measured by the non-self cluster proportion of tobacco consumption among respondents. Community engagement, social support, trust and social cohesion were separately measured as unique facets of social capital both at individual and community levels using the Shortened Adapted Social Capital Assessment Tool in India (SASCAT-I). The explanatory power of covariates was assessed using gender-stratified generalised estimating equations (GEE) with robust-variance estimator.

Result

Tobacco consumption patterns were starkly different for men and women (71% vs 14%). The peer influence only affected men (adjusted odds ratio (AOR)=1.10, 95% CI: 1.05 to 1.16, p<0.01), whereas women were more likely to consume tobacco if they were more engaged with community organisations (AOR=1.33, 95% CI=1.07 to 1.66, p<0.01).

Conclusion

Gender alters the way social engagement affects tobacco use in rural India. Countering peer influence on Indian men should be prioritised as a tobacco control strategy. Moreover, as gender mainstreaming is a critical egalitarian agenda in India, further research is needed to understand how social engagement affects tobacco consumption behaviours among women.
Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study
Authors: Stubbs Daniel J , Davies Benjamin M , Bashford Tom , Joannides Alexis J , Hutchinson Peter J , Menon David K , Ercole Ari , Burnstein Rowan M
Published: June 2020

Introduction

Chronic subdural haematoma (cSDH) tends to occur in older patients, often with significant comorbidity. The incidence and effect of medical complications as well as the impact of intraoperative management strategies are now attracting increasing interest.

Objectives

We used electronic health record data to study the profile of in-hospital morbidity and examine associations between various intraoperative events and postoperative stay.

Design, setting and participants

Single-centre, retrospective cohort of 530 cases of cSDH (2014–2019) surgically evacuated under general anaesthesia at a neurosciences centre in Cambridge, UK.

Methods and outcome definition

Complications were defined using a modified Electronic Postoperative Morbidity Score. Association between complications and intraoperative care (time with mean arterial pressure <80 mm Hg, time outside of end-tidal carbon dioxide (ETCO2) range of 3–5 kPa, maintenance anaesthetic, operative time and opioid dose) on postoperative stay was assessed using Cox regression.

Results

53 (10%) patients suffered myocardial injury, while 24 (4.5%) suffered acute renal injury. On postoperative day 3 (D3), 280 (58% of remaining) inpatients suffered at least 1 complication. D7 rate was comparable (57%). Operative time was the only intraoperative event associated with postoperative stay (HR for discharge: 0.97 (95% CI: 0.95 to 0.99)). On multivariable analysis, postoperative complications (0.61 (0.55 to 0.68)), anticoagulation (0.45 (0.37 to 0.54)) and cognitive impairment (0.71 (0.58 to 0.87)) were associated with time to discharge.

Conclusions

There is a high postoperative morbidity burden in this cohort, which was associated with postoperative stay. We found no evidence of an association between intraoperative events and postoperative stay.
PRImary care Management of lower Urinary tract Symptoms in men: protocol for development and validation of a diagnostic and clinical decision support tool (the PriMUS study)
Authors: Pell Bethan , Thomas-Jones Emma , Bray Alison , Agarwal Ridhi , Ahmed Haroon , Allen A Joy , Clarke Samantha , Deeks Jonathan J , Drake Marcus , Drinnan Michael , Dyer Calie , Hood Kerenza , Joseph-Williams Natalie , Marsh Lucy , Milosevic Sarah , Pickard Robert , Schatzberger Tom , Takwoingi Yemisi , Harding Chris , Edwards Adrian
Published: June 2020

Introduction

Lower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology specialists who often recommend treatments that could have been initiated in primary care. GP access to simple, accurate tests and clinician decision tools are needed to facilitate accurate and effective patient management of LUTS in primary care.

Methods and analysis

PRImary care Management of lower Urinary tract Symptoms (PriMUS) is a prospective diagnostic accuracy study based in primary care. The study will determine which of a number of index tests used in combination best predict three urodynamic observations in men who present to their GP with LUTS. These are detrusor overactivity, bladder outlet obstruction and/or detrusor underactivity. Two cohorts of participants, one for development of the prototype diagnostic tool and other for validation, will undergo a series of simple index tests and the invasive reference standard (invasive urodynamics). We will develop and validate three diagnostic prediction models based on each condition and then combine them with management recommendations to form a clinical decision support tool.

Ethics and dissemination

Ethics approval is from the Wales Research Ethics Committee 6. Findings will be disseminated through peer-reviewed journals and conferences, and results will be of interest to professional and patient stakeholders.

Trial registration number

ISRCTN10327305.
Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis
Authors: Sullivan Michael K. , Rankin Alastair J. , Jani Bhautesh D. , Mair Frances S. , Mark Patrick B.
Published: June 2020

Objective

To systematically review the literature exploring the associations between multimorbidity (the presence of two or more long-term conditions (LTCs)) and adverse clinical outcomes in patients with chronic kidney disease (CKD).

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, EMBASE, CINAHL, Cochrane Library and SCOPUS (1946–2019). The main search terms were ‘Chronic Kidney Failure’ and ‘Multimorbid*’.

Eligibility criteria

Observational studies of adults over the age of 18 with CKD stages 3–5, that is, estimated glomerular filtration rate less than 60 mL/min/1.73 m2. The exposure was multimorbidity quantified by measures and the outcomes were all-cause mortality, renal progression, hospitalisation and cardiovascular events. We did not consider CKD as a comorbid LTC.

Data extraction and synthesis

Newcastle-Ottawa Scale for quality appraisal and risk of bias assessment and fixed effects meta-analysis for data synthesis.

Results

Of 1852 papers identified, 26 met the inclusion criteria. 21 papers involved patients with advanced CKD and no studies were from low or middle-income countries. All-cause mortality was an outcome in all studies. Patients with multimorbidity were at higher risk of mortality compared with patients without multimorbidity (total risk ratio 2.28 (95% CI 1.81 to 2.88)). The risk of mortality was higher with increasing multimorbidity (total HR 1.31 (95% CI 1.27 to 1.36)) and both concordant and discordant LTCs were associated with heightened risk. Multimorbidity was associated with renal progression in four studies, hospitalisation in five studies and cardiovascular events in two studies.

Limitations

Meta-analysis could only include 10 of 26 papers as the methodologies of studies were heterogeneous.

Conclusions

There are associations between multimorbidity and adverse clinical outcomes in patients with CKD. However, most data relate to mortality risk in patients with advanced CKD. There is limited evidence regarding patients with mild to moderate CKD, outcomes such as cardiovascular events, types of LTCs and regarding patients from low or middle-income countries.

PROSPERO registration number

CRD42019147424.
Efficacy of antiepileptic drugs in neonatal seizures: a systematic review protocol
Authors: He Yang , Tang Jun , Zhang Meng , Xiong Tao , Ojha Shalini , Choonara Imti , Mu Dezhi
Published: June 2020

Introduction

Seizures are one of the most common neurological disorders of neonates, which is also an emergency in the neonatal intensive care unit. For neonates, the recommended first-line antiepileptic drugs (AEDs) include phenobarbitone, which may be effective in only 50% of seizures. Some new AEDs, such as levetiracetam, have been shown to be effective in adults and older children. However, their efficacy for neonatal seizures remains uncertain. The aim of this investigation is to conduct a systematic review to evaluate the efficacy of all AEDs in neonates. Additionally, the long-term outcomes following neonatal seizures, in relation to the development of cerebral palsy and epilepsy, will be studied.

Method

We will perform a systematic review including randomised controlled studies (RCTs), cohort studies, case-controlled studies and case series studies which evaluated the efficacy of AEDs and short-term and long-term outcomes in neonatal seizures. PubMed, Embase, Web of Science, Cochrane Library and Clinical trial.gov will be searched. There will be no language restriction. Risk bias in RCTs will be evaluated by the Cochrane risk-of-bias tool, while cohort and case-control studies will be evaluated by the Newcastle-Ottawa Scale. A network meta-analysis will be performed by the Bayesian model using WinBUGS V.1.4.3 and R software if there is a high degree of homogeneity among studies. Otherwise, we will perform a narrative review without pooling. Subgroup analyses will be performed in different AEDs and dosage groups.

Outcome

The primary outcomes will be seizure cessation confirmed by electroencephalogram and long-term neurodevelopmental outcome. Secondary outcomes will be neonatal mortality during hospitalisation and suspected drug toxicity.

Ethics and dissemination

Formal ethical approval is not required as no primary data are collected. This systematic review will be disseminated through a peer-reviewed publication.