bluuebunny/crossref_metadata_2025 huggingface dataset:
A balanced approach to identifying, prioritising and evaluating all potential consequences of quality improvement: modified Delphi study
Authors: Toma Madalina , Dreischulte Tobias , Gray Nicola M , Guthrie Bruce
Published: March 2019

Objectives

Healthcare is a complex system, so quality improvement will commonly lead to unintended consequences which are rarely evaluated. In previous qualitative work, we proposed a framework for considering the range of these potential consequences, in terms of their desirability and the extent to which they were predictable or expected during planning. This paper elaborates on the previous findings, using consensus methods to examine what consequences should be identified, why and how to prioritise, evaluate and interpret all identified consequences, and what stakeholders should be involved throughout this process.

Design

Two-round modified Delphi consensus study.

Setting and participants

Both rounds were completed by 60 panellists from an academic, clinical or management background and experience in designing, implementing or evaluating quality improvement programmes.

Results

Panellists agreed that trade-offs (expected undesirable consequences) and unpleasant surprises (unexpected undesirable consequences) should be actively considered. Measurement of harmful consequences for patients, and those with high workload or financial impact was prioritised, and their evaluation could also involve the use of qualitative methods. Clinical teams were agreed as important to involve at all stages, from identifying potential consequences, prioritising which of those to systematically evaluate, undertaking appropriate evaluation and interpreting the findings. Patients were necessary in identifying consequences, managers in identifying and prioritising, and improvement advisors in interpreting the data.

Conclusion

There was consensus that a balanced approach to considering all the consequences of improvement can be achieved by carefully considering predictable trade-offs from the outset and deliberately pausing after implementation to identify any unexpected surprises and make an informed decision as to whether quantitative or qualitative evaluation is needed and feasible. Stakeholders’ roles in in the process of identifying, prioritising, evaluating and interpreting potential consequences should be explicitly addressed within planning and revisited during and after implementation.
Impact of donor with evidence of bacterial infections on deceased donor liver transplantation: a retrospective observational cohort study in Taiwan
Authors: Chan Kun-Ming , Cheng Chih-Hsien , Wu Tsung-Han , Lee Chen-Fang , Wu Ting-Jung , Chou Hong-Shiue , Lee Wei-Chen
Published: March 2019

Objective

The shortage of available donor organs is an unsolvable concern leading to an expansion in the donor criteria for organ transplantation. Here, we describe our experience and assess the outcomes in recipients who obtained a graft from a donor with bacterial infections in deceased donor liver transplantation (DDLT).

Methods

All DDLTs between January 1991 and February 2017 were retrospectively reviewed. Patients were categorised into two groups based on the recipients who obtained a graft from a donor with (group I) or without (group II) evidence of bacterial infections. Outcomes and bacterial infections were compared between the two groups of recipients.

Results

Overall, a total of 285 DDLTs were performed from 248 donors consisting of 48 split liver grafts and 208 whole liver grafts. Of those, 98 recipients (group I, 34.3%) were transplanted with a graft from 78 donors with positive bacterial cultures. Donor sputum cultures had the highest rate of positive bacterial growth, accounting for 26.6% of donors. Overall survival (OS) was not significantly different between the two groups (p=0.9746). The OS rates at 1 and 3 years were 73.5% and 69.2%, respectively, in the group I recipients versus 68.8% and 62.4% in the group II recipients. Importantly, no hospital mortality was related to donor-derived bacterial infections.

Conclusion

Transmission of bacteria from the donor to the recipient is infrequent in DDLT. Therefore, potential donors with positive bacterial infections should not be excluded for organ transplantation to increase organ availability and ameliorate the organ shortage.
Deep and Frequent Phenotyping study protocol: an observational study in prodromal Alzheimer’s disease
Authors: Koychev Ivan , Lawson Jennifer , Chessell Tharani , Mackay Clare , Gunn Roger , Sahakian Barbara , Rowe James B , Thomas Alan J , Rochester Lynn , Chan Dennis , Tom Brian , Malhotra Paresh , Ballard Clive , Chessell Iain , Ritchie Craig W , Raymont Vanessa , Leroi Iracema , Lengyel Imre , Murray Matt , Thomas David L , Gallacher John , Lovestone Simon
Published: March 2019

Introduction

Recent failures of potential novel therapeutics for Alzheimer’s disease (AD) have prompted a drive towards clinical studies in prodromal or preclinical states. However, carrying out clinical trials in early disease stages is extremely challenging—a key reason being the unfeasibility of using classical outcome measures of dementia trials (eg, conversion to dementia) and the lack of validated surrogate measures so early in the disease process. The Deep and Frequent Phenotyping (DFP) study aims to resolve this issue by identifying a set of markers acting as indicators of disease progression in the prodromal phase of disease that could be used as indicative outcome measures in proof-of-concept trials.

Methods and analysis

The DFP study is a repeated measures observational study where participants will be recruited through existing parent cohorts, research interested lists/databases, advertisements and memory clinics. Repeated measures of both established (cognition, positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) markers of pathology, structural MRI markers of neurodegeneration) and experimental modalities (functional MRI, magnetoencephalography and/or electroencephalography, gait measurement, ophthalmological and continuous smartphone-based cognitive and other assessments together with experimental CSF, blood, tear and saliva biomarkers) will be performed. We will be recruiting male and female participants aged >60 years with prodromal AD, defined as absence of dementia but with evidence of cognitive impairment together with AD pathology as assessed using PET imaging or CSF biomarkers. Control participants without evidence of AD pathology will be included at a 1:4 ratio.

Ethics and dissemination

The study gained favourable ethical opinion from the South Central—Oxford B NHS Research Ethics Committee (REC reference 17/SC/0315; approved on 18 August 2017; amendment 13 February 2018). Data will be shared with the scientific community no more than 1 year following completion of study and data assembly.
Internet-based, therapist-guided, cognitive–behavioural therapy for body dysmorphic disorder with global eligibility for inclusion: an uncontrolled pilot study
Authors: Gentile Andrew J , La Lima Christopher , Flygare Oskar , Enander Jesper , Wilhelm Sabine , Mataix-Cols David , Rück Christian
Published: March 2019

Objectives

Cognitive–behavioural therapy (CBT) has been shown to be an effective treatment for body dysmorphic disorder (BDD), but access to treatment around the world is limited. One way to increase access is to administer CBT remotely via the internet. This study represents the first effort to remotely deliver a therapist-supported, internet-based CBT treatment with no restrictions on enrolment based on geographical location, and it aims to assess whether this treatment can be delivered safely across international borders, with outcomes comparable to previous BDD-NET trials.

Design

Uncontrolled clinical trial.

Participants

Patients (n=32) in nine different countries were recruited primarily through internet advertisements.

Intervention

BDD-NET is a 12-week treatment, consisting of eight treatment modules previously shown to be effective in a Swedish version.

Setting

Therapists based at a single, secondary care centre in Sweden provided active guidance and feedback throughout the treatment via asynchronous electronic messages.

Main outcome measure

The clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, mid-treatment (6 weeks), post-treatment and at the 3-month follow-up.

Results

There were significant improvements on BDD-YBOCS scores (F(3, 71.63)=31.79, p<0.001), that were maintained at 3-month follow-up. Mean differences from baseline in BDD-YBOCS scores were −8.12 (week 6), –12.63 (post-treatment) and −11.71 (3-month follow-up). 47% and 50% of participants were considered treatment responders at post-treatment and 3-month follow-up, respectively. Additionally, remission rates were 28% at post-treatment and 44% at 3-month follow-up. The treatment was also deemed acceptable by patients.

Conclusions

The results suggest that BDD-NET can be safely and effectively delivered across international borders to a culturally diverse sample. Larger scale randomised controlled trials with more participants from non-Western cultures are warranted to further validate the cross-cultural generalisability of this treatment.

Trial registration number

NCT03517384.
Economic evaluation of the cost of different methods of retesting chlamydia positive individuals in England
Authors: Looker Katharine J , Buitendam Erna , Woodhall Sarah C , Hollis Emma , Ong Koh-Jun , Saunders John M , Dunbar Kevin , Turner Katherine M E
Published: March 2019

Objectives

The National Chlamydia Screening Programme (NCSP) in England opportunistically screens eligible individuals for chlamydia infection. Retesting is recommended three3 months after treatment following a positive test result, but no guidance is given on how local areas should recall individuals for retesting. Here , we compare cost estimates for different recall methods to inform the optimal delivery of retesting programmes.

Design

Economic evaluation.

Setting

England.

Methods

We estimated the cost of chlamydia retesting for each of the six most commonly used recall methods in 2014 based on existing cost estimates of a chlamydia screen. Proportions accepting retesting, opting for retesting by post, returning postal testing kits and retesting positive were informed by 2014 NCSP audit data. Health professionals ‘sense-checked’ the costs.

Primary and secondary outcomes

Cost and adjusted cost per chlamydia retest; cost and adjusted cost per chlamydia retest positive.

Results

We estimated the cost of the chlamydia retest pathway, including treatment/follow-up call, to be between £45 and £70 per completed test. At the lower end, this compared favourably to the cost of a clinic-based screen. Cost per retest positive was £389–£607. After adjusting for incomplete uptake, and non-return of postal kits, the cost rose to £109–£289 per completed test (cost per retest positive: £946–£2,506). The most economical method in terms of adjusted cost per retest was no active recall as gains in retest rates with active recall did not outweigh the higher cost. Nurse-led client contact by phone was particularly uneconomical, as was sending out postal testing kits automatically.

Conclusions

Retesting without active recall is more economical than more intensive methods such as recalling by phone and automatically sending out postal kits. If sending a short message service (SMS) could be automated, this could be the most economical way of delivering retesting. However, patient choice and local accessibility of services should be taken into consideration in planning.
‘Managing scarcity’– a qualitative study on volunteer-based healthcare for chronically ill, uninsured migrants in Berlin, Germany
Authors: Linke Charlotte , Heintze Christoph , Holzinger Felix
Published: March 2019

Objectives

In Germany, healthcare for people lacking legal residency status and European Union citizens without health insurance is often provided by non-governmental organisations. Scientific studies assessing the situation of the patients with chronic diseases in this context are scarce. We aimed to characterise medical care for chronically ill migrants without health insurance and outline its possibilities and limitations from the treating physicians’ perspective.

Design

Qualitative semi-structured interviews; qualitative content analysis.

Setting

Organisations and facilities providing healthcare for uninsured migrants: free clinics, medical practices and public health services.

Participants

14 physicians working regularly in healthcare for uninsured migrants.

Results

Delayed contact to the healthcare system was frequently addressed in the interviews. Care was described as constrained by a scarcity of resources that often impedes adequate treatment for many conditions, most pronounced in the case of oncological diseases or chronic viral infections (HIV, hepatitis). For other chronic conditions such as cardiovascular diseases or diabetes, some diagnostics and basic medications were described as partially available, while management of complications or rehabilitative measures are frequently unfeasible. For the patients with mental health problems, attainability of psychotherapeutic treatment is reported as severely limited. Care is predominantly described as fragmented with limitations to information flow and continuity. Which level of care a patient receives appears to depend markedly on the respective non-governmental organisation and the individual commitment, subjective decisions and personal connections of the treating physician.

Conclusions

Restrictions in medical care for uninsured migrants have even more impact on chronically ill patients. Volunteer-based care often constitutes an inadequate compensation for regular access to the healthcare system, as it is strongly influenced by the limitation of its resources and its arbitrariness.
‘Being normal’ and self-identity: the experience of volunteering in individuals with severe mental disorders—a qualitative study
Authors: Pérez-Corrales Jorge , Pérez-de-Heredia-Torres Marta , Martínez-Piedrola Rosa , Sánchez-Camarero Carlos , Parás-Bravo Paula , Palacios-Ceña Domingo
Published: March 2019

Objective

This study sought to explore the views and experiences of a group of people with severe mental disorders (SMDs) who performed volunteer services.

Design

A qualitative phenomenological study.

Setting

Community public mental health services of the Community of Madrid and the province of Barcelona (Spain).

Participants

Purposive sampling techniques were used between September 2016 and April 2017. The inclusion criteria were: individuals aged 18–65 years who participated in volunteer activities during the performance of this study, based on the regulations of volunteer services in Spain and the community of Madrid; a diagnosis of non-organic psychotic disorder (F20.x, F21, F22, F24, F25, F28, F29, F31.x, F32.3 and F33) according to the International Classification of Diseases, 10th Revision; an evolution of ≥2 years; and a moderate to severe dysfunction of global functioning with scores ≤70 in the Global Assessment of Functioning Scale. Ultimately, 23 people with SMD participated in the study with a mean age of 47 years (SD 8.23).

Methods

Data were collected through in-depth interviews and researcher field notes. A thematic analysis was performed following appropriate guidelines for qualitative research.

Results

Two main themes emerged to describe the experience of participating in volunteer activities: (1) rebuilding self-identity, based on the participant’s experience of volunteering, of acquiring a new role and a new perceived identity that made them feel valued and respected; and (2) being a so-called normal person with a ‘normal’ life, based on recovering a sense of normality, unmarked by the illness, thanks to daily responsibilities and occupations.

Conclusions

Qualitative research offers insight into the way people with SMD experience volunteering and may help to improve understanding of the underlying motivations that drive these individuals. These findings may be applied to improve guidance during their process of recovery and subsequent inclusion into society.
Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review
Authors: Fernandes Agreli Heloise , Murphy Michael , Creedon Sile , Ni Bhuachalla Cliodhna , O’Brien Deirdre , Gould Dinah , Savage Eileen , Barry Fiona , Drennan Jonathan , Smiddy Maura P , Condell Sarah , Horgan Sinead , Murphy Siobhan , Wills Teresa , Burton Aileen , Hegarty Josephine
Published: March 2019

Objective

To explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.

Design

Scoping review.

Methods

A methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.

Results

From an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing ontheprofessional–patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional’s power).

Conclusions

There is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs.
Knowledge and motivations of researchers publishing in presumed predatory journals: a survey
Authors: Cobey Kelly D , Grudniewicz Agnes , Lalu Manoj M , Rice Danielle B , Raffoul Hana , Moher David
Published: March 2019

Objectives

To develop effective interventions to prevent publishing in presumed predatory journals (ie, journals that display deceptive characteristics, markers or data that cannot be verified), it is helpful to understand the motivations and experiences of those who have published in these journals.

Design

An online survey delivered to two sets of corresponding authors containing demographic information, and questions about researchers' perceptions of publishing in the presumed predatory journal, type of article processing fees paid and the quality of peer review received. The survey also asked six open-ended items about researchers' motivations and experiences.

Participants

Using Beall’s lists, we identified two groups of individuals who had published empirical articles in biomedical journals that were presumed to be predatory.

Results

Eighty-two authors partially responded (~14% response rate (11.4%[44/386] from the initial sample, 19.3%[38/197] from second sample) to our survey. The top three countries represented were India (n=21, 25.9%), USA (n=17, 21.0%) and Ethiopia (n=5, 6.2%). Three participants (3.9%) thought the journal they published in was predatory at the time of article submission. The majority of participants first encountered the journal via an email invitation to submit an article (n=32, 41.0%), or through an online search to find a journal with relevant scope (n=22, 28.2%). Most participants indicated their study received peer review (n=65, 83.3%) and that this was helpful and substantive (n=51, 79.7%). More than a third (n=32, 45.1%) indicated they did not pay fees to publish.

Conclusions

This work provides some evidence to inform policy to prevent future research from being published in predatory journals. Our research suggests that common views about predatory journals (eg, no peer review) may not always be true, and that a grey zone between legitimate and presumed predatory journals exists. These results are based on self-reports and may be biased thus limiting their interpretation.
Active change interventions to de-implement low-value healthcare practices: a scoping review protocol
Authors: Parker Gillian , Rappon Tim , Berta Whitney
Published: March 2019

Background

There is recognition that the overuse of procedures, tests and medications strains the healthcare system financially and can cause unnecessary stress and harm to patients. In recent years, several initiatives have targeted the reduction or elimination of low-value practices in healthcare. Research suggests that passive interventions, such as the publication of guidelines, are often not sufficient to change behaviour and that active change interventions - interventions which actively implement strategies to change practices - are required to effect significant, sustained practice change. The purpose of this scoping review is to identify and characterise studies of active change interventions designed to reduce or eliminate low-value healthcare practices.

Methods

We will conduct a review of MEDLINE, EMBASE, CINAHL and Scopus databases from inception. Building on previous research, 40 key terms will be used to search literature. The screening process will be conducted separately by two researchers, with discrepancies resolved by a third. Empirical studies of active change interventions used to reduce or eliminate low-value practices will be included. Descriptive statistics and thematic analysis will be used to categorise the characteristics of the studies.

Ethics and dissemination

Ethics approval is not required for this study. This scoping review will provide insights into the impact of several characteristics of active change interventions, including the number of interventions (single-faceted or multifaceted) and the level of implementation (individual or organisational). These results can provide guidance and direction for future research in de-implementation. The results will be disseminated through presentations at national and international conferences and the publication of a manuscript.
Exploring communication between parents and clinical teams following children’s heart surgery: a survey in the UK
Authors: Pagel Christina , Bull Catherine , Utley Martin , Wray Jo , Barron David J , Stoica Serban , Tibby Shane M , Tsang Victor , Brown Katherine L
Published: March 2019

Objective

To explore communication between clinicians and families of children undergoing heart surgery.

Design

This study was part of a larger study to select, define and measure the incidence of postoperative complications in children undergoing heart surgery. Parents of children recruited to a substudy between October 2015 and December 2017 were asked to complete a questionnaire about communication during their child’s inpatient stay. We explored all responses and then disaggregated by the following patient characteristics: presence of a complication, length of stay, hospital site, ethnicity and child’s age. This was a descriptive study only.

Setting

Four UK specialist hospitals.

Results

We recruited 585 children to the substudy with 385 responses (response rate 66%).

81% of parents reported that new members of staff always introduced themselves (18% sometimes, 1% no). Almost all parents said they were encouraged to be involved in decision-making, but often only to some extent (59% ‘yes, definitely’; 37% ‘to some extent’). Almost two-thirds of parents said they were told different things by different people which left them feeling confused (10% ‘a lot’; 53% ‘sometimes’). Two-thirds (66%) reported that staff were definitely aware of their child’s medical history (31% ‘to some extent’). 90% said the operation was definitely explained to them (9% ‘to some extent’) and 79% that they were definitely told what to do if they were worried after discharge (17% ‘to some extent’).

Parents of children with a complication tended to give less positive responses for involvement in decision-making, consistent communication and staff awareness of their child’s medical history. Parents whose children had longer stays in hospital tended to report lower levels of consistent communication and involvement in decision-making.

Conclusions

Our results emphasise the need for consistent communication with families, particularly where complications arise or for children who have longer stays in the hospital.
Electrodiagnostic data-driven clustering identifies a prognostically different subgroup of patients with chronic inflammatory demyelinating polyneuropathy
Authors: Baek Seol-Hee , Hong Yoon-Ho , Choi Seok-Jin , Ahn So Hyun , Park Kee Hong , Shin Je-Young , Sung Jung-Joon
Published: March 2019

Objective

This study aimed to explore the correlations between electrodiagnostic (EDX) features in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and to investigate whether EDX data-driven clustering can identify a distinct subgroup regarding clinical phenotype and treatment response.

Methods

We reviewed clinical and EDX data of 56 patients with definite CIDP fulfilling the 2010 European Federation of Neurological Societies and Peripheral Nerve Society criteria at two teaching hospitals. A hierarchical agglomerative clustering algorithm with complete linkage was used to partition the patients into subgroups with similar EDX features. A stepwise logistic regression analysis was performed to evaluate predictors of the long-term outcome.

Results

EDX data-driven clustering partitioned the patients into two clusters, identifying a distinct subgroup characterised by coexistence of prominent conduction slowing and markedly reduced distally evoked compound muscle action potential (CMAP) amplitudes. This cluster of patients was significantly over-represented by an atypical subtype (distal acquired demyelinating symmetric polyneuropathy) compared with the other cluster (70% vs 26.1%, p=0.042). Furthermore, patients in this cluster invariably showed favourable long-term treatment outcome (100% vs 63%, p=0.023). In logistic regression analyses, the initial disability (OR 6.1, 95% CI 2.4 to 25.4), F-wave latency (OR 0.93, 95% CI 0.86 to 0.98) and distal CMAP duration (OR 0.96, 95% CI 0.91 to 0.99) were significant predictors of the poor long-term outcome.

Conclusion

Our results show that EDX data-driven clustering could differentiate a pattern of EDX features with prognostic implication in patients with CIDP. Reduced distally evoked CMAPs may not necessarily predict poor responses to treatment, and active treatment is warranted when prominent slowing of conduction is accompanied in the distal segments.
Legal framework versus moral framework: military physicians and nurses coping with practical and ethical dilemmas
Authors: Hooft Francesca Baukje
Published: March 2019

Within military operations, military physicians and nurses experience a dual loyalty to their professional identities. The moral frameworks of the medical and military professions are not similar, and require different kinds of choices and action from its members. But above all, the legal framework in which the healthcare personnel has to operate while deployed is different from the medical moral standards. Military necessity is prioritised over medical necessity. In debates on dual loyalty, legal frameworks should be considered as a more decisive factor in ethical decision-making processes. Legal frameworks, both general and mission-specific, support this prioritisation of military necessity, complicating the work of military physicians and nurses. During the post-Cold War era, in which neutrality and moral supremacy have served as legitimising factors for military peacekeeping or humanitarian missions, this misalignment between the moral and the legal framework is problematic. What is legally correct or justifiable may not be morally acceptable to either the medical professional standards or to the general public. The legal framework should be given more prominence within the debates on dual loyalty and military medical ethics. This paper argues that the misalignment between the legal and moral framework in which deployed healthcare personnel has had to operate complicated ethical decision-making processes, impeded their agency, and created problems ranging from military operational issues to personal trauma and moral injury for the people involved, and ultimately decreasing the legitimacy of the armed forces within society.
Analysis of case study presenting ground anchor load-transfer response in shale stratum
Authors: Bryson L. Sebastian , Giraldo Jorge Romana
Published: March 2019

This paper presents the analysis of the instrumentation and monitoring of ground anchors for a landslide stabilization system located at the State Route 82 Bridge, near Brecksville, Summit County, Ohio (SUM 82). The stabilization system consisted of two tieback walls. Site conditions and design aspects are considered; also, the construction sequence is presented. Field performance data were collected during and after construction, representing a total monitoring period of about 340 days. Load transfer was studied based on strain gage measurements along the bonded length of the anchors. Load variation during preproduction and performance tests of the anchors is described and discussed. A numerical procedure is presented to evaluate the anchor load–deformation characteristics based on the t-z approach. Two strain-softening load-transfer functions were used at the interface between the bonded length of the anchors and the rock. The analysis shows that the prediction of the load–displacement curve for each anchor is more influenced by the selected ultimate side frictional resistance along the anchor–rock interface than the shear stiffness of the interface. This study concludes that it is critical that peak and residual load characteristics be included in the load-transfer models for anchors installed in rock.
Structure analysis of a dragline tooth and its wear prediction
Authors: Das Manbodh Kumar , Sarkar Shibayan , Choudhary Bhanwar Singh
Published: March 2019

Dragline teeth are used to dig overburden rocks and fill the bucket by its action in surface mining. Thus, these teeth are very important for a better performance of the dragline. In the present investigation, efforts were made to determine the failure zone within the teeth through modeling, using the finite element software ANSYS workbench. The maximum deformation and maximum von-Mises stress were 0.286 mm and 801.38 MPa, respectively. From fatigue analysis, the minimum tool life was 24 540 cycle and the minimum factor of safety was 0.1 at the tip of the tool. Beyond the cutting edge (tip), the factor of safety was greater than 1.13. Finite element analysis was extended by varying the working load on the edge of the tool (68–86 tonnes) as well as the cutting angle (30°–36°). It was found that if the working load was increased, both corresponding maximum deformation and maximum von-Mises stress were increased, while the factor of safety was decreased. In the scanning electron microscopy analysis, wear phenomena such as rock intermixed, fracture of WC-grain, oxidized WC-grain, plastic deformation, cavity formation, cracking, and crushing were visible at magnification of 1000×.
Influence of inverter output voltage harmonic on surface-mounted permanent-magnet synchronous motor performance
Authors: Qiu Hongbo , Zhang Yong , Yang Cunxiang , Yi Ran
Published: March 2019

The application of an inverter is becoming more and more widespread in the surface-mounted permanent-magnet synchronous motor (SMPMSM). A large number of voltage harmonics can be generated by the inverter. The electromagnetic torque, loss, and air-gap magnetic density of the SMPMSM are affected by voltage harmonic. To analyze its influence, taking a 3 kW 1500 r/min SMPMSM as an example, a two-dimensional transient electromagnetic field model is established. The correctness of the model is verified by comparing the experimental data with the calculated data. Firstly, the finite element method is used to calculate the electromagnetic field of the SMPMSM, and the performance parameters of the SMPMSM are obtained. Based on these parameters, the influence of voltage harmonic on motor performance is analyzed quantitatively. Secondly, the influence of the voltage harmonic on the air-gap magnetic field is analyzed, and the influence degree of the time harmonic on the air-gap magnetic field is determined. At the same time, torque ripple, average torque, and loss are studied when the different harmonics orders, amplitudes, and phase angles are contained in voltage, and the variation is obtained. Finally, the variation mechanism of eddy current loss is revealed. The conclusion of this paper provides reliable theoretical guidance for improving motor performance.
A brief review of condition monitoring techniques for the induction motor
Authors: Kumar Dileep , Daudpoto Jawaid
Published: March 2019

The induction motor is widely used in industry owing to its simple construction and low cost. In this paper, we present a state-of-the-art review of condition monitoring techniques for the induction motor. As the induction motor is used in many production processes, its uninterrupted and cost-effective functioning is of prime importance. Condition monitoring of the induction motor enables detection and prediction of different developing faults. Various techniques have been reported in literature for induction motor fault detection. In this paper, a brief review of these techniques is presented. Major induction motor faults and their sources are also described.
Effects of Preoperative Statin on Acute Kidney Injury After Off‐Pump Coronary Artery Bypass Grafting
Authors: Park Jungchan , Lee Jong‐Hwan , Kim Keoung Ah , Lee Seung‐Hwa , Lee Young Tak , Kim Wook Sung , Min Jeong Jin
Published: March 2019

Background

Although many patients with coronary artery disease are using statins before off‐pump coronary artery bypass grafting (
OPCAB
) following current guidelines, recent studies have raised concerns regarding adverse effects of preoperative statins on postoperative kidney function. We evaluated the effects of preoperative statins on acute kidney injury (
AKI
) after
OPCAB
.

Methods and Results

We enrolled 1783 consecutive
OPCAB
patients in either a statin or nonstatin group based on preoperative use of statins. Propensity scores were used to adjust the differences between the groups. The primary outcome was incidence of postoperative
AKI
according to Kidney Disease: Improving Global Outcomes criteria. To evaluate the dose‐related renal effects of statins, the statin group was divided into low‐ and moderate‐ or higher dose groups based on preoperative statin dose. The incidence of postoperative
AKI
was 15.7% and 13.5% in the nonstatin and statin groups, respectively, and preoperative statins did not increase the incidence of postoperative
AKI
(odds ratio: 0.84; 95%
CI,
0.61–1.15;
P
=0.27). In dose‐related analysis, the moderate‐ or higher dose group showed lower incidence of postoperative
AKI
in comparison with the nonstatin group (odds ratio: 0.61; 95% CI, 0.39–0.95;
P
=0.03). However, no difference was found between low‐dose and nonstatin groups (odds ratio: 1.17; 95% CI, 0.75–1.84;
P
=0.49) or between moderate‐ or higher dose and low‐dose statin groups (odds ratio: 0.84; 95%
CI,
0.5–1.41;
P
=0.51) in the incidence of postoperative
AKI
.

Conclusions

Neither preoperative statin use nor statin dose increased the risk of
AKI
after
OPCAB
. Preoperative statin therapy is not harmful in patients receiving
OPCAB
.
Relationship Between Body Mass Index, Antidiabetic Agents, and Midterm Mortality in Patients With Both Type 2 Diabetes Mellitus and Acute Coronary Syndrome
Authors: Jong Chien‐Boon , Li Hung‐Yuan , Pan Shin‐Liang , Hsieh Mu‐Yang , Su Fang‐Ying , Chen Kuan‐Chun , Yin Wei‐Hsian , Chan Shih‐Hung , Wu Yen‐Wen , Wang Kuo‐Yung , Chang Kuan‐Cheng , Hwang Juey‐Jen , Wu Chih‐Cheng
Published: March 2019

Background

The aim of this study was to determine the influence of various antidiabetic therapies on the relationship between body mass index and all‐cause mortality in patients with diabetes mellitus and acute coronary syndrome.

Methods and Results

This was a prospective, observational study comprising 1193 patients diagnosed with type 2 diabetes mellitus and acute coronary syndrome. The patients were stratified into 4 body mass index categories, and their mortality rates were compared using time‐dependent Cox regression analysis using normal weight (body mass index, 18.5–23.9) as the reference. Subsequently, the influence of antidiabetic therapies on the association between
BMI
and mortality were analyzed. Seventy‐four patients (6.2%) died over 2 years of follow‐up. The mortality rate was lowest in the class I obese group (3.35%) and highest in the normal‐weight group (9.67%). After adjusting for covariates, class I obesity paradoxically remained significantly protective against mortality compared with normal weight (hazard ratio, 0.141;
P
=0.049); interaction term analysis showed that insulin therapy influenced this “obesity paradox” (
P
=0.045). When the patients were stratified by insulin use, the protective effect of obesity disappeared in the insulin‐treated patients but persisted in the non–insulin‐treated patients.

Conclusions

In patients with type 2 diabetes mellitus and acute coronary syndrome, the relationship between body mass index and mortality rate is U‐shaped, with class I obesity representing the nadir and normal weight the peak. The protective effect of obesity disappeared in patients treated with insulin.
Long‐Term Clinical Outcomes of Late Stent Malapposition Detected by Optical Coherence Tomography After Drug‐Eluting Stent Implantation
Authors: Im Eui , Hong Sung‐Jin , Ahn Chul‐Min , Kim Jung‐Sun , Kim Byeong‐Keuk , Ko Young‐Guk , Choi Donghoon , Jang Yangsoo , Hong Myeong‐Ki
Published: March 2019

Background

The relationship between late stent malapposition (
LSM
) and adverse cardiovascular events is controversial. Studies are needed to evaluate long‐term (>5 years) clinical outcomes of LSM detected by optical coherence tomography (
OCT
) after drug‐eluting stent implantation.

Methods and Results

We investigated long‐term clinical outcomes of
OCT
‐detected
LSM
in 351 patients who received drug‐eluting stents and were examined by both poststent and follow‐up
OCT
(175±60 days after drug‐eluting stent implantation) from January 2009 to December 2011.
LSM
was observed in 99 patients (28%). We evaluated the cumulative rate of composite events (cardiovascular death, target‐vessel–related myocardial infarction, target‐vessel revascularization, and stent thrombosis). During 80.1±24.5 months of follow‐up, very late stent thrombosis did not occur in any patients with
LSM
. The cumulative 8‐year rate of composite events was 7.3% in patients with
LSM
and 10.5% in patients without
LSM
(
P
=0.822, log‐rank test). We further divided patients into the following 4 groups: patients with both late‐persistent and late‐acquired stent malapposition (n=23), patients with late‐persistent stent malapposition alone (n=45), patients with late‐acquired stent malapposition alone (n=31), and patients without
LSM
(n=252). The cumulative 8‐year rates of composite events were similar among these 4 groups (0%, 9.6%, 9.7%, and 10.5%, respectively;
P
=0.468 by log‐rank test).

Conclusions

During long‐term follow‐up (>5 years), very late stent thrombosis did not occur in patients with
OCT
‐detected
LSM
. The rates of adverse clinical events were similar between patients with
LSM
versus those without
LSM
. Presence of
OCT
‐detected
LSM
was not associated with unfavorable clinical outcomes.
The “Oculo‐Appositional Reflex”: Should Optical Coherence Tomography–Detected Stent Malapposition Be Corrected?
Authors: Ali Ziad A. , Karimi Galougahi Keyvan , Shlofmitz Richard A. , Mintz Gary S.
Published: March 2019

See Article by
Im et al
Disparities in the Enrollment and Timing of Special Education for Asian American and Pacific Islander Students
Authors: Cooc North
Published: March 2019

School districts in the United States are required to monitor the overrepresentation of students of color in special education, yet recent studies have challenged these trends and suggest students of color may be underrepresented for services guaranteed under federal law. Missing in many of these discussions on disproportionality are the needs of Asian Americans and Pacific Islanders (AAPIs), a group consistently underrepresented in special education. Previous studies, however, do not examine the vast heterogeneity in experiences among AAPIs and how special education trends may differ across AAPI ethnic subgroups. Using longitudinal data on 10 cohorts of 42,807 total kindergartners from a school district over a 10-year period, this study probes deeper into underrepresentation by disaggregating participation trends and the timing of services for 11 AAPI ethnic subgroups. Results indicate that most AAPI student groups are underrepresented in special education and first receive services later than White peers. These patterns remain even after accounting for student background, level of acculturation, and school fixed effects.
MyDiaText™: Feasibililty and Functionality of a Text Messaging System for Youth With Type 1 Diabetes
Authors: Kaushal Tara , Montgomery Kathleen A. , Simon Reid , Lord Kelly , Dougherty Jennifer , Katz Lorraine E. Levitt , Lipman Terri H.
Published: March 2019

Purpose

The purpose of this study was to determine the feasibility and functionality of MyDiaText™, a website and text messaging platform created to support behavior change in adolescents with type 1 diabetes (T1DM) and to evaluate user satisfaction of the application.

Methods

This study was a nonrandomized, prospective, pilot trial to test the feasibility and user interface with MyDiaText, a text message system for 10- to 17-year-old youths with newly diagnosed T1DM. Feasibility was evaluated by assessing for the user’s ability to create a profile on the website. Functionality was defined by assessing whether a subject responded to at least 2 text messages per week and by their accumulating points on the website. User satisfaction of the text messaging system was assessed using an electronic survey. The 4 phases of this study were community engagement—advisory sessions, screening and enrollment, intervention, and follow-up.

Results

Twenty subjects (14 male, 6 female) were enrolled. All subjects were able to create a profile, and of these, 86% responded to at least 2 text messages per week. A survey administered during follow-up showed that users enjoyed reading text messages, found them useful, and thought the frequency of messages was appropriate.

Conclusion

MyDiaText is a feasible, functional behavioral support tool for youth with T1DM. Users of the application reported high satisfaction with text messages and the reward system.
Estimating and Comparing Response Times in Traditional and Connected Environments
Authors: Sharma Anshuman , Zheng Zuduo , Kim Jiwon , Bhaskar Ashish , Haque Md. Mazharul
Published: March 2019

Response time (RT) is a critical human factor that influences traffic flow characteristics and traffic safety, and is governed by drivers’ decision-making behavior. Unlike the traditional environment (TE), the connected environment (CE) provides information assistance to drivers. This in-vehicle informed environment can influence drivers’ decision-making and thereby their RTs. Therefore, to ascertain the impact of CE on RT, this study develops RT estimation methodologies for TE (RTEM-TE) and CE (RTEM-CE), using vehicle trajectory data. Because of the intra-lingual inconsistency among traffic engineers, modelers, and psychologists in the usage of the term RT, this study also provides a ubiquitous definition of RT that can be used in a wide range of applications. Both RTEM-TE and RTEM-CE are built on the fundamental stimulus–response relationship, and they utilize the wavelet-based energy distribution of time series of speeds to detect the stimulus–response points. These methodologies are rigorously examined for their efficiency and accuracy using noise-free and noisy synthetic data, and driving simulator data. Analysis results demonstrate the excellent performance of both the methodologies. Moreover, the analysis shows that the mean RT in CE is longer than the mean RT in TE.
Prevalence Rates of Students Identified for Special Education and Their Interstate Variability: A Longitudinal Approach
Authors: Pullen Paige C. , Ashworth Kristen E. , Ryoo Ji Hoon
Published: March 2019

We investigated the variability across states in the prevalence of learning disabilities (LD) as reported by the U. S. Department of Education’s Office of Special Education Programs (OSEP). This expanded upon the work of Hallahan and colleagues on interstate prevalence rate variability of special education disability categories by focusing on a longitudinal analysis. Furthermore, we examined the effect of response to intervention (RTI) on the change in identification of LD more than 12 years from Fall 2000 through Fall 2011 for ages 6 to 17 years. We used the coefficient of variation (CV) to compare variability of prevalence rates and applied a piecewise regression to examine the effect of RTI. The results are consistent with Hallahan and colleagues’ previous findings—LD continues to demonstrate the least prevalence rate variability across states of all disability categories. LD prevalence variability is almost as minimal as that of some naturally occurring and medically diagnosed conditions (e.g., diabetes, asthma). We discuss these results within the context of changing LD identification methods, such as RTI, and decreasing prevalence of LD, suggesting possible reasons for potential changes in both prevalence and its interstate variability in the future.
Performing Agency Theory and the Neoliberalization of the State
Authors: Christiaens Tim
Published: March 2019

According to Streeck and Vogl, the neoliberalization of the state has been the result of political-economic developments that render the state dependent on financial markets. However, they do not explain the discursive shifts that would have been required for demoting the state to the role of an agent to bondholders. I propose to explain this shift via the performative effect of neoliberal agency theory. In 1976, Michael Jensen and William Meckling claimed that corporate managers are agents to shareholding principals, which implied that their main task was the procurement of shareholder value. Agency theory subsequently prescribes a series of measures to ensure the alignment of principal and agent interests in corporations. The diffusion of agency theory, however, moved beyond corporate governance to reconfigure the state. Due to its reliance on capital markets, the state supposedly likewise becomes an agent of the investment public and should procure bondholder value.
Why is Neo-liberalism so Resilient?
Authors: Gamble Andrew
Published: March 2019

Neo-liberalism rose to prominence during the stagflation crisis of the 1970s and consolidated its position as the dominant western ideology after the collapse of communism in Europe in the 1990s. Neo-liberalism is not a monolithic doctrine but has several different strands, including Ordoliberalism and Anglo-American economic liberalism. The latter became closely associated with globalisation, financialisation and deregulation, which helped produce the boom in the world economy during the 1990s but also created the conditions for the financial crash in 2008. Despite the scale of that crisis neo-liberalism has remained resilient as an ideology and as a policy regime. Different dimensions of this resilience are explored – the role of the state, geopolitics, class politics, electoral politics, and the hegemony of neo-liberal ideas – and whether this resilience is likely to continue.