bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and Experimental Investigation of a New 2R1T Overconstrained Parallel Kinematic Machine With Actuation Redundancy
Authors: Xu Lingmin , Chai Xinxue , Li Qinchuan , Zhang Liangan , Ye Wei
Published: February 2019

Two rotations and one translation (2R1T) parallel kinematic machines (PKMs) are suitable for the machining of complex curved surfaces, which requires high speed and precision. To further improve rigidity, precision, and avoid singularity, actuation redundancy, and overconstrained PKMs with fixed actuators and limited-degrees of freedom (DOF) limbs are preferred. However, there are few 2R1T PKMs with these features. This paper introduces a new 2R1T overconstrained PKM with actuation redundancy, which is called Tex4. The Tex4 PKM consists of four limited-DOF limbs; that is, two PUR limbs and two 2PRU limbs (where P denotes an actuated prismatic joint, U denotes a universal joint, and R denotes a revolute joint). The kinematic model of the proposed 2PUR-2PRU machine is presented along with the results of mobility, inverse kinematics, and velocity analysis. By considering the motion/force transmissibility, the dimensional parameters of the Tex4 PKM were optimized to obtain an improved satisfactory transmission workspace without singular configurations. Finally, a prototype based on the optimized parameters was fabricated, and its feasibility and accuracy were validated by motion and position error experiments. The Tex4 PKM has the advantages of high rigidity, simple kinematic model, and zero singularity in the workspace, which suggests that it has potential for use in the high-speed machining of curved surfaces.
Characteristics of the Flow Past a Wall-Mounted Finite-Length Square Cylinder at Low Reynolds Number With Varying Boundary Layer Thickness
Authors: Behera Sachidananda , Saha Arun K.
Published: February 2019

Direct numerical simulation (DNS) is performed to investigate the modes of shedding of the wake of a wall-mounted finite-length square cylinder with an aspect ratio (AR) of 7 for six different boundary layer thicknesses (0.0–0.30) at a Reynolds number of 250. For all the cases of wall boundary layer considered in this study, two modes of shedding, namely, anti-symmetric and symmetric modes of shedding, were found to coexist in the cylinder wake with symmetric one occurring intermittently for smaller time duration. The phase-averaged flow field revealed that the symmetric modes of shedding occur only during instances when the near wake experiences the maximum strength of upwash/downwash flow. The boundary layer thickness seems to have a significant effect on the area of dominance of both downwash and upwash flow in instantaneous and time-averaged flow field. It is observed that the near-wake topology and the total drag force acting on the cylinder are significantly affected by the bottom-wall boundary layer thickness. The overall drag coefficient is found to decrease with thickening of the wall boundary layer thickness.
Vortex Pump as Turbine—A Type Turbine for Energy Generation or Recovery Based on Computational Fluid Dynamics Prediction
Authors: Li Wenguang
Published: February 2019

An experimental vortex pump with a specific speed of 76 is investigated to get its performance and flow structure under noncavitation and cavitation conditions when the pump operates as turbine in the reverse direction by using computational fluid dynamics (CFD) method. A method is proposed to extract hydraulic, volumetric, and mechanical efficiencies for the first time. It is shown that a vortex pump can operate as turbine but it is subject to poor cavitation performance. The performance conversion factors of flow rate and head are 2.33 and 2.74 which are much larger than existing centrifugal pumps as turbine with the same specific speed. The conversion factor of efficiency is 0.98, which agrees with the conversion factor of efficiency for a centrifugal pump as turbine. There are a rope cavity and a vortex flow in the same rotational direction of the impeller. It is shown that flow structure is complex in the impeller in pump and turbine modes, particularly on the blade-to-blade surface, while static pressure profile in the volute and impeller as well as the space between the casing and the impeller is simple. The flow in the space between the impeller and the casing cannot be regarded as a forced vortex in both modes. The cavitation performance improvement and rope cavity control may be key issues in the future.
Spatial–Temporal Evolution of Tip Leakage Vortex in a Mixed-Flow Pump With Tip Clearance
Authors: Liu Yabin , Tan Lei
Published: February 2019

Tip clearance in pump induces tip leakage vortex (TLV), which interacts with the main flow and leads to instability of flow pattern and decrease of pump performance. In this work, the characteristics of TLV in a mixed-flow pump are investigated by the numerical simulation using shear stress transport (SST) k–ω turbulence model with experimental validation. The trajectory of the primary tip leakage vortex (PTLV) is determined, and a power function law is proposed to describe the intensity of the PTLV core along the trajectory. Spatial–temporal evolution of the TLV in an impeller revolution period T can be classified into three stages: splitting stage, developing stage, and merging stage. The TLV oscillation period TT is found as 19/160 T, corresponding to the frequency 8.4 fi (fi is impeller rotating frequency). Results reveal that the TLV oscillation is intensified by the sudden pressure variation at the junction of two adjacent blades. On analysis of the relative vorticity transport equation, it is revealed that the relative vortex stretching item in Z direction is the major source of the splitting and shedding of the PTLV. The dominant frequency of pressure and vorticity fluctuations on the PTLV trajectory is 8.4 fi, same as the TLV oscillation frequency. This result reveals that the flow instability in the PTLV trajectory is dominated by the oscillation of the TLV. The blade number has significant effect on pressure fluctuation in tip clearance and on blade pressure side, because the TLV oscillation period varies with the circumferential length of flow passage.
Gas-Induced Motion of a Piston in a Vibrated Liquid-Filled Housing
Authors: Torczynski John R. , O'Hern Timothy J. , Clausen Jonathan R. , Koehler Timothy P.
Published: February 2019

Models and experiments are developed to investigate how a small amount of gas can cause large rectified motion of a piston in a vibrated liquid-filled housing when piston drag depends on piston position so that damping is nonlinear even for viscous flow. Two bellows serve as surrogates for the upper and lower gas regions maintained by Bjerknes forces. Without the bellows, piston motion is highly damped. With the bellows, the piston, the liquid, and the two bellows move together so that almost no liquid is forced through the gaps between the piston and the housing. This Couette mode has low damping and a strong resonance: the piston and the liquid vibrate against the spring formed by the two bellows (like the pneumatic spring formed by the gas regions). Near this resonance, the piston motion becomes large, and the nonlinear damping produces a large rectified force that pushes the piston downward against its spring suspension. A recently developed model based on quasi-steady Stokes flow is applied to this system. A drift model is developed from the full model and used to determine the equilibrium piston position as a function of vibration amplitude and frequency. Corresponding experiments are performed for two different systems. In the two-spring system, the piston is suspended against gravity between upper and lower springs. In the spring-stop system, the piston is pushed up against a stop by a lower spring. Model and experimental results agree closely for both systems and for different bellows properties.
Characterization of ferroelectric hafnium/zirconium oxide solid solutions deposited by reactive magnetron sputtering
Authors: Bouaziz Jordan , Rojo Romeo Pedro , Baboux Nicolas , Vilquin Bertrand
Published: February 2019

The room temperature deposition of 10 nm-thick ferroelectric hafnium/zirconium oxide, (Hf,Zr)O2, thin solid films is achieved with a single hafnium/zirconium, Hf/Zr, alloy target by reactive magnetron sputtering. After rapid thermal annealing (RTA), crystallization of our samples is analyzed by grazing incidence x-ray diffraction. Changing the pressure inside the chamber during deposition leads to grow amorphous or monoclinic phase (m-phase). The authors demonstrate that if the (Hf,Zr)O2 films are crystallized in the m-phase after deposition, no ferroelectric/orthorhombic phase can be obtained further. On the contrary, when the as-deposited film is amorphous, the ferroelectric/orthorhombic phase appears after the RTA.
Error patterns of native and non-native listeners' perception of speech in noise
Authors: Zinszer Benjamin D. , Riggs Meredith , Reetzke Rachel , Chandrasekaran Bharath
Published: February 2019

Speech perception in noise requires both bottom-up sampling of the stimulus and top-down reconstruction of the masked signal from a language model. Previous studies have provided mixed evidence about the exact role that linguistic knowledge plays in native and non-native listeners' perception of masked speech. This paper describes an analysis of whole utterance, content word, and morphosyntactic error patterns to test the prediction that non-native listeners are uniquely affected by energetic and informational masks because of limited information at multiple linguistic levels. The results reveal a consistent disadvantage for non-native listeners at all three levels in challenging listening environments.
Defining the Role of the
Streptococcus agalactiae
Sht-Family Proteins in Zinc Acquisition and Complement Evasion
Authors: Moulin P. , Rong V. , Ribeiro E Silva A. , Pederick V. G. , Camiade E. , Mereghetti L. , McDevitt C. A. , Hiron A.
Published: February 2019

This study examined the role of the two streptococcal histidine triad (Sht) proteins of
Streptococcus agalactiae
in zinc homeostasis and complement resistance. We showed that Sht and ShtII facilitate zinc homeostasis in conjunction with the metal-binding proteins Lmb and AdcAII. Here, we show that the Sht-family proteins are functionally redundant with overlapping roles in zinc uptake. Further, this work reveals that although the Sht-family proteins bind to factor H
in vitro
this did not influence survival in human blood.
Separation of Plasma from Whole Blood by Use of the cobas Plasma Separation Card: a Compelling Alternative to Dried Blood Spots for Quantification of HIV-1 Viral Load
Authors: Carmona Sergio , Seiverth Britta , Magubane Dieketseng , Hans Lucia , Hoppler Matthias
Published: February 2019

Plasma HIV viral load testing is the preferred means of monitoring antiretroviral treatment response. Dried blood spots (DBSs) hold considerable logistical advantages over EDTA samples, but they more frequently misclassify virological failure and have higher limits of detection (LoD).
In Vitro
Susceptibility of Hepatitis C Virus Genotype 1 through 6 Clinical Isolates to the Pangenotypic NS3/4A Inhibitor Voxilaprevir
Authors: Han Bin , Parhy Bandita , Lu Julia , Zhou Eric , Hsieh David , Camus Gregory , Martin Ross , Svarovskaia Evguenia S. , Mo Hongmei , Dvory-Sobol Hadas
Published: February 2019

Voxilaprevir is a direct-acting antiviral agent (DAA) that targets the NS3/4A protease of hepatitis C virus (HCV). High sequence diversity of HCV and inadequate drug exposure during unsuccessful treatment may lead to the accumulation of variants with reduced susceptibility to DAAs, including NS3/4A protease inhibitors such as voxilaprevir.
Draft Genome Sequence of the Putative Marine Pathogen
Thalassobius
sp. I31.1
Authors: Ranson Hilary J. , LaPorte Jason , Spinard Edward , Chistoserdov Andrei Y. , Gomez-Chiarri Marta , Nelson David R. , Rowley David C.
Published: February 2019

Thalassobius
sp. I31.1 is a putative pathogen involved in epizootic shell disease in the American lobster (
Homarus americanus
). We report here the draft genome sequence for
Thalassobius
sp. I31.1 and provide insight into its metabolism and links to environmental pollutant degradation.
Complete Genome Sequence of
Malassezia restricta
CBS 7877, an Opportunist Pathogen Involved in Dandruff and Seborrheic Dermatitis
Authors: Morand Stanislas C. , Bertignac Morgane , Iltis Agnes , Kolder Iris C. R. M. , Pirovano Walter , Jourdain Roland , Clavaud Cécile
Published: February 2019

Malassezia restricta
, one of the predominant basidiomycetous yeasts present on human skin, is involved in scalp disorders. Here, we report the complete genome sequence of the lipophilic
Malassezia restricta
CBS 7877 strain, which will facilitate the study of the mechanisms underlying its commensal and pathogenic roles within the skin microbiome.
Complete Genome Sequences of Mycobacterium smegmatis Phages Chewbacca, Reptar3000, and Riparian, Isolated in Las Vegas, Nevada
Authors: Salisbury Alicia , Cassin Erin , Ayala-Pineda Kevin , Barroga Nicolas , Cadiz Vanessa , Cisneros Ramiro , Fersini Joseph , Jeanite Tiffany , Juste Jonathan , Ines Juvie , Leyva Gabriel , Macalinao Dyanne , Muscelli Spencer , Nhan Sophia , Reyes Gustavo S. , Rhoden Heather , Tan Rodney , Torres Erika , Tran Krystal , Uriarte-Valle Georgette , Wallace Christopher , Wong Simon , Regner Kurt , Strong Christy , Tsourkas Philippos K.
Published: February 2019

Here, we present the complete genome sequences of
Mycobacterium smegmatis
phages Chewbacca, Reptar3000, and Riparian, isolated from soil in Las Vegas, NV. The phages were isolated and annotated by undergraduate students enrolled in the Phage Discovery course offered by the School of Life Sciences at the University of Nevada, Las Vegas.
Whole-Genome Shotgun Sequence of Streptococcus agalactiae Sequence Type 176 Strain 3966RFQB from a Dairy Herd in Selangor, Malaysia
Authors: Bashir A. , Zunita Z. , Jesse F. F. A. , Ramanoon S. Z. , Mohd-Azmi M. L.
Published: February 2019

Streptococcus agalactiae
, commonly known as group B streptococcus (GBS), is among the most implicated pathogens in bovine mastitis worldwide. Proper control measures can curb both economic and public health effects it may cause.
Effects of tracheal occlusion on the neonatal cardiopulmonary transition in an ovine model of diaphragmatic hernia
Authors: DeKoninck Philip L J , Crossley Kelly J , Kashyap Aidan J , Skinner Sasha M , Thio Marta , Rodgers Karyn A , Deprest Jan A , Hooper Stuart B , Hodges Ryan J
Published: February 2019

Objective

Fetoscopic endoluminal tracheal occlusion (FETO) aims to reverse pulmonary hypoplasia associated with congenital diaphragmatic hernia (CDH) and mitigate the associated respiratory insufficiency and pulmonary hypertension after birth. We aimed to determine whether FETO improves the cardiopulmonary transition at birth in an ovine model of CDH.

Methods

In 12 ovine fetuses with surgically induced diaphragmatic hernia (DH; 80 dGA), an endotracheal balloon was placed tracheoscopically at ≈110 dGA and removed at ≈131 dGA (DH+FETO), while 10 were left untreated (DH). At ≈138 dGA, all lambs (survival at delivery: 67% [DH+FETO], 70% [DH]) were delivered via caesarean section and ventilated for 2 hours. Physiological and ventilation parameters were continuously recorded, and arterial blood-gas values were measured.

Results

Compared with DH, DH+FETO lambs had increased wet lung-to-body-weight ratio (0.031±0.004 vs 0.016±0.002) and dynamic lung compliance (0.7±0.1 vs 0.4±0.1 mL/cmH2O). Pulmonary vascular resistance was lower in DH+FETO lambs (0.44±0.11 vs 1.06±0.17 mm Hg/[mL/min]). However, after correction for lung weight, pulmonary blood flow was not significantly different between the groups (4.19±0.57 vs 4.05±0.60 mL/min/g). Alveolar–arterial difference in oxygen tension was not significantly different between DH+FETO and DH (402±41mm Hg vs 401±45 mm Hg).

Conclusions

FETO accelerated lung growth in fetuses with CDH and improved neonatal respiratory function during the cardiopulmonary transition at birth. However, despite improved lung compliance and reduced pulmonary vascular resistance, there were less pronounced benefits for gas exchange during the first 2 hours of life.
Adalimumab for non-infectious uveitis: is it cost-effective?
Authors: Bermejo Inigo , Squires Hazel , Poku Edith N , Cooper Katy , Stevens John W , Hamilton Jean , Wong Ruth , Pearce Ian , Quhill Fahd Mohammed , Denniston Alastair K
Published: February 2019

Background/Aims

Uveitis is inflammation inside the eye. Our objective was to assess the cost-effectiveness of adalimumab compared with current practice (immunosuppressants and systemic corticosteroids) in patients with non-infectious intermediate, posterior or panuveitis and to identify areas for future research.

Methods

A Markov model was built to estimate costs and benefits of the interventions. Systematic reviews were performed to identify the available relevant clinical and cost-effectiveness evidence. Data collected in two key randomised controlled trials (VISUAL I and VISUAL II) were used to estimate the interventions’ effectiveness compared with the trials’ comparator arms (placebo plus limited current practice (LCP)). The analysis was performed from the National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources.

Results

The estimated incremental cost-effectiveness ratios (ICERs) of adalimumab versus LCP for the base case are £92 600 and £318 075 per quality-adjusted life year (QALY) gained for active and inactive uveitis, respectively. In sensitivity analyses, the ICER varied from £15 579 to £120 653 and £35 642 to £800 775 per QALY for active and inactive uveitis.

Conclusion

The estimated ICERs of adalimumab versus LCP are above generally accepted thresholds for cost-effectiveness in the UK. Adalimumab may be more cost-effective in patients with active uveitis at greater risk of blindness. However, there is an unmet need for additional primary data to provide more reliable estimates in several important areas, including effectiveness of adalimumab versus current practice (instead of LCP), incidence of long-term blindness, adalimumab effectiveness in avoiding blindness, and rates and time to remission while on adalimumab.
Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis
Authors: Hislop Andrew Craig , Collins Natalie J , Tucker Kylie , Deasy Margaret , Semciw Adam Ivan
Published: February 2019

Objectives

To determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.

Design

Systematic review with meta-analysis.

Data sources

Medline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.

Eligibility criteria for selecting studies

Randomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included.
Three subgroups of hip exercises were included
: resistance, functional neuromuscular or multimodal exercise.

Results

Eight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).

Conclusion

Walking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.
Improving neurodevelopmental outcomes in children with congenital heart disease: protocol for a randomised controlled trial of working memory training
Authors: Calderon Johanna , Bellinger David C , Hartigan Catherine , Lord Alison , Stopp Christian , Wypij David , Newburger Jane W
Published: February 2019

Introduction

Executive function (EF) impairments are among the most prevalent neurodevelopmental morbidities in youth with congenital heart disease (CHD). To date, no studies have investigated the efficacy of cognitive interventions to improve EF outcomes in children with CHD.

Methods and analysis

This is a single-centre, single-blinded, two-arm randomised controlled trial to test the efficacy of Cogmed Working Memory Training (Cogmed) versus standard of care in children with CHD after open-heart surgery in infancy. Participants will consist of 100 children with CHD aged 7–12 years who underwent open-heart surgery before the age of 12 months. Participants are randomly allocated to either an intervention group including training on the home-based Cogmed intervention for a duration of approximately 5 weeks or a control group who receive the standard of care. We will evaluate the efficacy of Cogmed at post-treatment and 3 months after completion of the intervention. Baseline, post-treatment and 3-month follow-up assessments will include specific measures of EF, cognitive and social functioning, and attention deficit hyperactivity disorder (ADHD) symptoms. The primary outcome of this study is the change in standardised mean score on the List Sorting Working Memory test from the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function. Secondary outcomes include measures of social skills, inhibitory control, cognitive flexibility and behavioural EF as well as ADHD symptoms as measured by the Behavior Rating Inventory of Executive Function, Second Edition, and the Conners Third Edition. The efficacy of the intervention will be evaluated by comparing within-subject differences (baseline to post-treatment, baseline to 3-month follow-up) between the two groups using an intention-to-treat analysis.

Ethics and dissemination

This study has received Institutional Review Board (IRB) approval from Boston’s Children’s Hospital IRB (P00022440) and the Human Protection Agency from the US Department of Defense.

Trial registration number

NCT03023644; Pre-results.
Pre-hospital anaesthesia and assessment of head injured patients presenting to a UK Helicopter Emergency Medical Service with a high Glasgow Coma Scale: a cohort study
Authors: Bootland Duncan , Rose Caroline , Barrett Jack W , Lyon Richard
Published: February 2019

Objectives

Patients who sustain a head injury but maintain a Glasgow Coma Scale (GCS) of 13–15 may still be suffering from a significant brain injury. We aimed to assess the appropriateness of triage and decision to perform prehospital rapid sequence induction (RSI) in patients attended by a UK Helicopter Emergency Medical Service (HEMS) following head injury.

Design

A retrospective cohort study of patients attended by Kent Surrey & Sussex Air Ambulance Trust (KSSAAT) HEMS.

Setting

A mixed urban and rural area of 4.5 million people in South East England.

Participants

GCS score of 13, 14 or 15 on arrival of the HEMS team and clinical findings suggesting head injury. Patients accompanied by the HEMS team to hospital (‘Escorted’), and those that were ‘Assisted’ but conveyed by the ambulance service were reviewed. No age restrictions to inclusion were set.

Primary outcome measure

Significant brain injury.

Secondary outcome measure

Recognition of patients requiring prehospital anaesthesia for head injury.

Results

Of 517 patients, 321 had adequate follow-up, 69% of these were Escorted, 31% Assisted. There was evidence of intracranial injury in 13.7% of patients and clinically important brain injury in 7.8%. There was no difference in the rate of clinically important brain injury between Escorted and Assisted patients (p=0.46). Nineteen patients required an RSI by the HEMS team and this patient group was significantly more likely to have clinically important brain injury (p=0.04).

Conclusion

In patients attended by a UK HEMS service with a head injury and a GCS of 13–15, a small but significant proportion had a clinically important brain injury and a proportion were appropriately recognised as requiring prehospital RSI. For patients deemed not to need a HEMS intervention, differentiating between those with and without clinically important brain injury appears challenging.

Level of evidence

V.
Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for patients with heart failure at hospital discharge
Authors: Fylan Beth , Marques Iuri , Ismail Hanif , Breen Liz , Gardner Peter , Armitage Gerry , Blenkinsopp Alison
Published: February 2019

Introduction

Poor medicines management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal medicines management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses.

Methods

We explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis.

Results

Interviews were conducted with 45 healthcare professionals, with 20 patients at three time points and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised medicines. Traps were features of the system that could produce errors or unintended adverse medication events. Bridges were features of the medicines management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. Props were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events.

Conclusion

The numerous opportunities for HF patient safety to be compromised and for suboptimal medicines management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or ‘props’ put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures.
Pregnancy outcomes of early detected gestational diabetes: a retrospective comparison cohort study, Qatar
Authors: Bashir Mohammed , Baagar Khaled , Naem Emad , Elkhatib Fadi , Alshaybani Noor , Konje Justin C , Abou-Samra Abdul-Badi
Published: February 2019

Objective

To compare pregnancy outcomes in patients with early versus usual gestational diabetes mellitus (GDM).

Design

A retrospective cohort study.

Settings

The Women’s Hospital, Hamad Medical Corporation, Qatar.

Participants

GDM women who attended and delivered in the Women’s Hospital, between January and December 2016. GDM was diagnosed based on the 2013-WHO criteria. The study included 801 patients; of which, 273 E-GDM and 528 U-GDM. Early GDM (E-GDM) and usual GDM (U-GDM) were defined as GDM detected before and after 24 weeks’ gestation, respectively.

Outcomes

Maternal and neonatal outcomes and the impact of timing of GDM-diagnosis on pregnancy outcomes.

Results

At conception, E-GDM women were older (mean age 33.5±5.4 vs 32.0±5.4 years, p<0.001) and had higher body mass index (33.0±6.3 vs 31.7±6.1 kg/m2, p=0.0059) compared with U-GDM. The mean fasting, and 1-hour blood glucose levels were significantly higher in E-GDM vs U-GDM, respectively (5.3±0.7 vs 4.0±0.7 mmol/L, p<0.001 and 10.6±1.7 vs 10.3±1.6 mmol/L, p<0.001). More patients in the U-GDM were managed on diet alone compared with E-GDM (53.6% vs 27.5%, p<0.001). E-GDM subjects gained less weight per week compared with U-GDM (0.02±0.03 vs 0.12±0.03 kg/week, p=0.0274). Maternal outcomes were similar between the two groups apart from a higher incidence of preterm labour (25.5% vs 14.4%; p<0.001) and caesarean section (52.4% vs 42.8%; p=0.01) in E-GDM vs U-GDM, respectively. After correction for covariates; gestational age at which GDM was diagnosed was associated with increased risk of macrosomia (OR 1.06, 95% CI 1.00 to 1.11; p<0.05) and neonatal hypoglycaemia (OR 1.05, 95% CI 1.00 to 1.11; p<0.05).

Conclusion

Our data support the concept of early screening and treatment of GDM in high-risk patients. More data are needed to examine the optimal time for screening.
Cognitive effects of non-surgical brain stimulation for major depressive disorder: protocol for a systematic review and meta-analysis
Authors: Kiebs Maximilian , Hurlemann René , Mutz Julian
Published: February 2019

Introduction

Non-surgical brain stimulation techniques may be considered as alternative or add-on treatments for patients with major depressive disorder who failed to respond to pharmacological interventions. Electroconvulsive therapy has been shown to be highly effective in reducing depressive symptoms but stakeholders remain concerned about adverse cognitive effects. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may be associated with more benign adverse effect profiles and may indeed improve certain cognitive functions such as memory and attention. To guide clinical decision-making, we will carry out a systematic review and meta-analysis of the cognitive effects of eight non-surgical brain stimulation techniques.

Methods and analysis

A systematic literature search of the Embase, PubMed/MEDLINE and PsycINFO databases, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and OpenGrey will be performed. We will include both randomised clinical trials which report on at least one cognitive measure post treatment as well as non-randomised trials and pre-post intervention studies. There are no restrictions to the type of cognitive outcome measures, except that the tests are standardised and psychometrically validated. The Revised Cochrane tool for assessing risk of bias in randomised trials (RoB 2.0) will be used to evaluate included trials. Pre-post studies will be evaluated using the quality assessment tool developed by the US National Heart, Lung and Blood Institute. Meta-analysis, meta-regression, subgroup and sensitivity analyses will be conducted where sufficient data are available.

Ethics and dissemination

No ethical approval is needed to conduct this work. The findings will be submitted for publication in peer-reviewed journals and presented at scientific meetings.

PROSPERO registration number

CRD42018118850.
Accuracy of nature of call screening tool in identifying patients requiring treatment for out of hospital cardiac arrest
Authors: Green Jonathan David , Ewings Sean , Wortham Richard , Walsh Bronagh
Published: February 2019

Background

A new pre-triage screening tool, Nature of Call (NoC), has been introduced into the telephone triage system of UK ambulance services which employ National Health Service Pathways (NHSP). Its function is to provide rapid recognition of patients who may need immediate ambulance dispatch for out-of-hospital cardiac arrest (OHCA) and withholding dispatch for other calls while further triage is undertaken. In this study, we evaluated the accuracy of NoC and NHSP in identifying patients with potentially treatable or imminent OHCA.

Methods

This retrospective, observational study reviewed consecutive calls to a UK ambulance service between October 2016 and February 2017 in which NOC, and then NHSP were applied sequentially. Only those calls for which a corresponding electronic Patient Clinical Record was available were included. Sensitivity and specificity of NOC and NHSP for recognition of an OHCA were determined by comparing allocated priority dispositions with an OHCA Treatment Registry (OHCATR).

Results

Of 96 423 calls received, 71 373 were reviewed. For 590 (0.8%) of these calls, the patients received treatment for OHCA. NOC identified 458 OHCATR patients; NHSP identified 467; together they identified 496. NoC captured 29 patients not identified by NHSP; NHSP captured 38 patients not identified by NOC. For NOC sensitivity was 77.6% (95% CI 74.1 to 80.8) and specificity 86.9% (95% CI 86.6 to 87.1). NHSP sensitivity was 79.2% (95% CI 75.7 to 82.2) and specificity 93.4% (95% CI 93.2 to 93.6). NoC and NHSP combined had a sensitivity of 84.1% (95% CI 80.9 to 86.8) and specificity of 85.3% (95% CI 85.1 to 85.6).

Conclusions

NoC and NHSP call categorisation each achieved similar sensitivity for the identification of OHCATR, identifying most of the same patients, but each captured unique patients. Using both methods sequentially improved accuracy. The 16% of OHCATR patients not identified by either method present a challenge to ambulance dispatch systems.
Canadian and UK/Ireland practice patterns in lumbar puncture performance in febrile neonates with bronchiolitis
Authors: Simone Laura , Lyttle Mark D , Roland Damian , Stephens Derek , Schuh Suzanne
Published: February 2019

Background

Serious bacterial infections in young infants with bronchiolitis are rare. Febrile infants <1 month old with bronchiolitis often receive a lumbar puncture (LP), despite limited data for this practice and lack of clinical practice guidelines for this population. The primary objective was to investigate practice patterns in performance of LPs in the ED management of febrile infants aged ≤30 days with bronchiolitis.

Methods

A cross-sectional survey of two national paediatric emergency research networks (PediatricEmergency Research Canada (PERC) and the PediatricEmergency Research UK/Ireland (PERUKI)) was conducted January to November 2017 using a modified Dillman technique. The survey was preceded by a clinical vignette describing a well appearing, 21-day-old infant with low-grade fever, respiratory findings typical of bronchiolitis and no perinatal serious bacterial infection (SBI) risk features.

Results

The response rate from PERC was 169/250 (68%) and 172/201 (86%) from PERUKI. Nine physicians in training were excluded, leaving 332 eligible participants. Although most physicians believe that neonates with bronchiolitis rarely have meningitis (PERC 141/161 (87.6%); PERUKI 154/171 (90%)) and feel comfortable diagnosing bronchiolitis in this group (PERC 136/161 (84.5%); PERUKI 143/171 (83.6%)), there was significant variation in the proportion who would be likely/very likely to perform an LP (PERC 100/161 (62.1%); PERUKI 15/171 (8.8%)) (p<0.0001). Practice in Canada, <10 years in practice and lack of comfort with diagnosing bronchiolitis represent multivariable predictors of LP; OR 23.7 (95% CI 11.7 to 47.9), 2.3 (95% CI 1.2 to 4.2) and 2.5 (95% CI 1.1 to 5.0), respectively. Rapid knowledge of respiratory syncytial virus positivity would decrease LP probability from 35.4% to 20.2%.

Conclusion

Estimated probability of performing LPs and other interventions in otherwise healthy febrile neonates with bronchiolitis is highly variable between emergency physicians in Canada and the UK/Ireland. Network, <10 years in ED practice and comfort level with diagnosing bronchiolitis in newborns constitute independent predictors of the likelihood of LP performance.
Mediating effect of interpersonal relations on negative emotions and dysmenorrhea in female adolescents
Authors: Mou Lingli , Lei Wei , Chen Jing , Zhang Rong , Liu Kezhi , Liang Xuemei
Published: February 2019

Background

Good interpersonal relationships can improve the negative mood and, to a certain extent, may help relieve dysmenorrhea symptoms. However, there has been no study examining the role of interpersonal relationships in dysmenorrhea and how they may interact with negative emotions.

Aims

To investigate the connection between negative affect and dysmenorrhea, and the role of interpersonal relationships plays in this relationship.

Methods

The Cox Menstrual Symptom Scale (CMSS), short-form of Depression Anxiety Stress Scale, Interpersonal Comprehensive Diagnostic Scale and UCLA (University of California at Los Angeles) Loneliness Scale were applied to 855 adolescent nursing students to collect information on severity and frequency of dysmenorrheal symptoms, negative emotions (including depression, anxiety and stress), interpersonal problems and subjective experience of loneliness among them, and the relationship among these variables was examined.

Results

(1) Both the severity and frequency of dysmenorrhea were positively correlated with negative emotions, loneliness experience and interpersonal problems, while negatively correlated with age at menarche. (2) The negative emotions, romantic relationship and menarche age, but not loneliness and interpersonal problems, significantly contributed to both the severity and frequency of dysmenorrhea. (3) Mediation analysis revealed that the effects of loneliness and interpersonal problems on dysmenorrhea were totally mediated by negative emotions.

Conclusions

This investigation indicates that the relationship between interpersonal relationships and dysmenorrhea is mediated by negative emotions.
Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015
Authors: Dias Roger Daglius , Barros Jacson Venancio de
Published: February 2019

Background

The world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.

Methods

Using the Brazilian Unified Health System (known as ‘Sistema Único de Saúde’ (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.

Results

A total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.

Conclusion

These findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.
Development of a prediction model for 1-year poor prognosis in patients with acute ischemic stroke
Authors: Ling Xia , Shen Bo , Li Kangzhi , Si Lihong , Yang Xu
Published: February 2019

The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ2 value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.
Penthrox: a breath of PHEC air for the military?
Authors: Cohen Hugo M L , Wolstenholme R
Published: February 2019

Prehospital analgesia is vital to good clinical care and inhaled methoxyflurane (Penthrox) would be a valuable addition to the armed forces medical armoury. Penthrox would provide strong, fast-acting, self-administered and safe analgesia to patients with moderate to severe injuries. In addition, it would provide an option for strong analgesia which would not be subject to the regulations that govern controlled or accountable drugs which gives it a unique position as the military moves its focus from large enduring operations to small short-term training teams supported by lone combat medics in remote locations across the globe.
Impact of blood pressure levels within first 24 hours after mechanical thrombectomy on clinical outcome in acute ischemic stroke patients
Authors: Cernik David , Sanak Daniel , Divisova Petra , Kocher Martin , Cihlar Filip , Zapletalova Jana , Veverka Tomas , Prcuchova Andrea , Ospalik Dusan , Cerna Marie , Janousova Petra , Kral Michal , Dornak Tomas , Prasil Vojtech , Franc David , Kanovsky Petr
Published: February 2019

Introduction

Despite early management and technical success of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all patients reach a good clinical outcome. Different factors may have an impact and we aimed to evaluate blood pressure (BP) levels in the first 24 hours after MT.

Methods

Consecutive AIS patients treated with MT were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale (mRS) with a score 0–2 for good outcome. The presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS–MOST criteria.

Results

Of 703 treated patients, completed BP levels were collected in 690 patients (350 males, mean age 71±13 years) with median of admission NIHSS 17 points. Patients with mRS 0–2 had a lower median of systolic BP (SBP) compared with those with poor outcome (131 vs 140 mm Hg, P<0.0001). The rate of SICH did not differ between the patients with a median of SBP <140 mm Hg and ≥140 mm Hg. (5.1% vs 5.1%, P=0.980). Multivariate regression analysis with adjustment for potential confounders showed a median of distolic BP (P=0.024, OR: 0.977, 95% CI: 0.957 to 0.997) as a predictor of good functional outcome after MT, and a median of maximal SBP (P=0.038; OR: 0.990, 95% CI: 0.981 to 0.999) in the patients with achieved recanalization.

Conclusion

Lowering of BP within the first 24 hours after MT may have a positive impact on clinical outcome in treated patients.
National estimates of the use and outcomes of extracorporeal membrane oxygenation after acute trauma
Authors: Hu Parker J , Griswold Lauren , Raff Lauren , Rodriguez Rachel , McGwin Jr Gerald , Kerby Jeffrey David , Bosarge Patrick
Published: February 2019

Background

The use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe acute respiratory distress syndrome is gaining greater acceptance among trauma intensivists. The objective of this study was to review ECMO usage in trauma patients in the USA.

Methods

The National Inpatient Sample (NIS) from years 2002 to 2012 was queried for patients aged 15 and older treated with ECMO who had one or more acute traumatic injuries as defined by the International Diagnostic Codes, Ninth Edition (ICD-9). The primary outcomes of interest were incidence of ECMO and overall inpatient mortality.

Results

A total of 1347 patients were identified in the NIS database who had both ECMO performed and ICD-9 codes consistent with trauma. Patients were predominantly aged 15 to 29 years (31.4%) and were male (65.5%). The incidence of ECMO for patients after traumatic injuries has increased 66-fold during the 10-year period. In-hospital mortality was 48.0% overall, with a decreasing trend during the study period that approached statistical significance (p=0.06).

Discussion

Although ECMO use in patients in the post-trauma setting remains controversial, there is an increasing trend to use ECMO nationwide, suggesting an increasing acceptance and/or increased availability at trauma centers. Given the decrease in mortality during the study period, ECMO as a salvage method in trauma patients remains a potentially viable option. Evaluation in a prospective manner may clarify risks and benefits.

Level of evidence

Level IV, epidemiological.
Congenital cleft sternum with diaphragmatic hernia and radial hemimelia in a kitten
Authors: Weber Lindsey Anne , Phillips Heidi
Published: February 2019

A four‐month‐old male intact domestic shorthair kitten was presented for deformity of the right thoracic limb. Severe carpal varus was noted, and palpation of the ventral thorax revealed the sternum to be divided caudally. The heartbeat was palpable beneath the skin in the expanse created by the sternal division. Incomplete caudal sternal cleft with diaphragmatic hernia was diagnosed. At surgery, herniation of the gall bladder and portions of the liver into the thoracic cavity were noted. The medial aspects of the sternal bars were abraded with rongeurs, and interrupted sutures were placed around the sternebrae to close the thorax following placement of a thoracostomy tube. The diaphragm and abdomen were also closed primarily. The kitten died postoperatively and was found to have acute pulmonary and cardiac lesions. Primary surgical closure is possible, and patients should be monitored carefully in the postoperative period.
Use of regional limb perfusion with amikacin sulphate in the treatment of a severe soft tissue infection in the extremity of a dog
Authors: Abrams Brittany E , Hottinger Heidi , Selmic Laura Elizabeth
Published: February 2019

Intravenous regional limb perfusion (RLP) has been used extensively in equine and human practice to deliver high doses of antimicrobials to bones, joints and the soft tissues in the distal limb. This report highlights the use of this technique, in conjunction with traditional systemic antimicrobial therapy, to achieve clinical resolution of a severe soft tissue infection in the extremity of a dog. Due to the acute severity, rapid progression and lack of response of the infection to broad‐spectrum systemic antibiotics, intravenous RLP with amikacin was utilised successfully, negating the need to intervene with definitive surgery. To the authors’ knowledge, this is the first report utilising intravenous RLP as an adjuvant antimicrobial treatment application in a small animal setting.