bluuebunny/crossref_metadata_2025 huggingface dataset:
Young People's Use and Perceptions of Emergency Contraceptives in Sub‐Saharan Africa: Existing Insights and Knowledge Gaps
Authors: Both Rosalijn
Published: September 2013

Despite growing international attention to the sexual and reproductive health and rights of young people, their uptake of modern contraceptive methods remains low, especially in Sub‐Saharan Africa. This article focuses on young people's use of a relatively new contraceptive method, emergency contraceptives (ECs). Emergency contraceptives can be used after intercourse and have been marketed to be used when other contraceptives fail or after unplanned, unprotected intercourse. This article reviews qualitative evidence from seven studies on young people's experiences with this contraceptive method. Many users of ECs were in their twenties, well‐educated, and either single or in a relationship. Repeated use was found in four of the studies, and ECs may fit within an existing range of post‐coital methods used to prevent pregnancies. While concerns about side effects were reported frequently among non‐users of ECs, other women preferred ECs above other hormonal contraceptive methods. Men were actively involved, for example, as providers of information to their partners, and as purchasers of ECs. Young people's understandings of ECs hence differ from the meanings inscribed to these pills at an international level. Further research on this topic is needed to ensure that young people's (emergency) contraceptive needs are well understood and responded to.
Tris–EDTAsignificantly enhances antibiotic efficacy against multidrug‐resistantPseudomonas aeruginosa in vitro
Authors: Buckley Laura M. , McEwan Neil A. , Nuttall Tim
Published: September 2013

Background

Multidrug‐resistantPseudomonas aeruginosacommonly complicates chronic bacterial otitis in dogs.

Hypothesis/Objectives

The aim of thisin vitrostudy was to determine the effect of ethylenediaminetetraacetic acid–tromethamine (Tris–EDTA) on the minimal bactericidal concentrations (MBCs) and minimal inhibitory concentrations (MICs) of marbofloxacin and gentamicin for multidrug‐resistantP. aeruginosaisolates from cases of canine otitis.

Methods

Eleven isolates were identified as multidrug resistant on disc diffusion; 10 were resistant to marbofloxacin and two were resistant to gentamicin. Isolates were incubated for 90 min with each antibiotic alone and in combination with Tris–EDTAat concentrations of 0.075 μg/mL to 5 mg/mL for marbofloxacin, 0.001 μg/mL to 10 mg/mL for gentamicin and 17.8:4.7 to 0.14:0.04 mg/mL for Tris–EDTA. Positive and negative controls were included. Aliquots of each antibiotic and/or Tris–EDTAconcentration were subsequently transferred to sheep blood agar to determine theMBCs, and tryptone soy broth was added to the remaining suspensions to determine theMICs.

Results

Tris–EDTAalone was bacteriostatic but not bactericidal at any concentration. The addition of Tris–EDTAsignificantly reduced the medianMBC(from 625 to 468.8 μg/mL;P < 0.001) andMIC(from 29.3 to 2.4 μg/mL;P = 0.008) of marbofloxacin, and the medianMBC(from 625 to 39.1 μg/mL) andMIC(from 19.5 to 1.2 μg/mL) of gentamicin (bothP < 0.001).

Conclusions and clinical importance

Tris–EDTAsignificantly reduced theMBCs andMICs of marbofloxacin and gentamicin for multidrug‐resistantP. aeruginosa in vitro. This may be of use to clinicians managing these infections in dogs.
Integral division points on curves
Authors: Grant David , Ih Su-Ion
Published: September 2013

Let $k$ be a number field with algebraic closure $ \overline{k} $, and let $S$ be a finite set of primes of $k$ containing all the infinite ones. Let $E/ k$ be an elliptic curve, ${\mit{\Gamma} }_{0} $ be a finitely generated subgroup of $E( \overline{k} )$, and $\mit{\Gamma} \subseteq E( \overline{k} )$ the division group attached to ${\mit{\Gamma} }_{0} $. Fix an effective divisor $D$ of $E$ with support containing either: (i) at least two points whose difference is not torsion; or (ii) at least one point not in $\mit{\Gamma} $. We prove that the set of ‘integral division points on $E( \overline{k} )$’, i.e., the set of points of $\mit{\Gamma} $ which are $S$-integral on $E$ relative to $D, $ is finite. We also prove the ${ \mathbb{G} }_{\mathrm{m} } $-analogue of this theorem, thereby establishing the 1-dimensional case of a general conjecture we pose on integral division points on semi-abelian varieties.
Investigation of Heat Transfer in Evaporator of Microchannel Loop Heat Pipe
Authors: Yakomaskin Alexander A. , Afanasiev Valery N. , Zubkov Nikolay N. , Morskoy Dmitry N.
Published: September 2013

Loop heat pipes (LHP) are heat transfer devices which use evaporation and condensation of working fluid to transfer heat and use capillary forces to provide fluid circulation in a closed loop. One of the main applications of LHP is cooling of electronic components. Further development of this field is associated with miniaturization. Thus, there are strict limits imposed upon size of elements of heat transfer devices in electronics cooling. One of such elements is an evaporator of the LHP, its main element. This paper deals with the LHP evaporator and is aimed at showing dependence of wick conductivity, thickness, and vapor flow geometry on overall heat transfer performance. An open loop experimental setup was created. Experiments were carried out with various configurations. The evaporator consisted of a microchannel (MC) plate, with groove widths of 100 and 300 μm, wick (metal and nonmetal porous materials were used) and a compensation chamber (CC). Heat load varied from 20 to 140 W in steps of 20 W. The area of the heater was equal to 19 × 19 mm2. The working fluid is de-ionized water. Experimental results include data on temperature distribution across the wick's height, temperature of microchannel's surface, and temperature of water in the compensation chamber. The results reveal a potential for performing optimization of the zone of evaporation in order to produce thinner LHP evaporators.
On the Development of an Experimental Testing Platform for the Vortex Machining Process
Authors: Howard Stephen C. , Chesna Jacob W. , Smith Stuart T. , Mullany Brigid A.
Published: September 2013

The development of an experimental platform for studying Vortex Machining is presented. This process uses oscillating probes to generate localized vortices in polishing slurry in a region near to a workpiece surface. These vortices create material removal footprints having lateral dimensions typically measuring tens of micrometers. From studies of the process variables and subsequent machining footprints a number of process controls have been implemented and are discussed herein. These include a localized metrology frame to control specimen to probe position, coarse-fine translation axes for submicrometer motion control, closed-loop control of probe oscillation, and a slurry height control system. To illustrate the fidelity of these additional controls, the evolution from early machining footprints to the recent production of footprint arrays are presented. While process stability issues remain, machining footprints of near Gaussian shape having dimensions of 10–20 μm diameter and 40 nm depth after machining for 30 min can be reproduced.
Extrusion Process Modeling for Aqueous-Based Ceramic Pastes—Part 1: Constitutive Model
Authors: Li Mingyang , Tang Lie , Landers Robert G. , Leu Ming C.
Published: September 2013

The extrusion process for aqueous-based ceramic pastes is complex due to the non-Newtonian behavior of these pastes. In this study, the extrusion process is modeled by characterizing the ceramic paste viscosity using a modified Herschel–Bulkley model. The steady-state relationship between plunger velocity and extrusion force is built based on this viscosity model and the Navier–Stokes equations. The influence of air, which may be trapped in the paste during the paste preparation and loading processes, is also examined as it significantly affects the dynamic response of the extrusion force. Combining these effects with the steady-state extrusion model, a constitutive law for the extrusion process of aqueous-based ceramic pastes is created. Because of the compressibility introduced by the trapped air, the dynamic response of the extrusion force is described by a first-order nonlinear equation when plunger velocity is taken as an input. It is shown that the extrusion response time depends on the amount of air in the extruder and the magnitude of the extrusion force. Air bubble release, a phenomenon that causes the extrusion force to suddenly drop due to the change of paste volume in the nozzle, is analyzed based on the developed constitutive model.
Origami Design by Topology Optimization
Authors: Fuchi Kazuko , Diaz Alejandro R.
Published: September 2013

An origami design method based on topology optimization is introduced. The design of a folding pattern is cast as a problem of assigning presence and type of fold to lines in a “ground structure,” using folding angles as design variables. A ground structure for origami design has lines drawn on a two dimensional domain, showing all line segments that may appear as crease lines in the folded geometry. For a given ground structure and folding angles, the 3D geometry of the folded sheet can be computed using the mathematics of origami. A topology optimization method is then used to find an optimal combination of folding angles, which results in a folding pattern with desired, target geometric properties.
Designing Freeform Origami Tessellations by Generalizing Resch's Patterns
Authors: Tachi Tomohiro
Published: September 2013

In this research, we study a method to produce families of origami tessellations from given polyhedral surfaces. The resulting tessellated surfaces generalize the patterns proposed by Ron Resch and allow the construction of an origami tessellation that approximates a given surface. We will achieve these patterns by first constructing an initial configuration of the tessellated surfaces by separating each facets and inserting folded parts between them based on the local configuration. The initial configuration is then modified by solving the vertex coordinates to satisfy geometric constraints of developability, folding angle limitation, and local nonintersection. We propose a novel robust method for avoiding intersections between facets sharing vertices. Such generated polyhedral surfaces are not only applied to folding paper but also sheets of metal that does not allow 180 deg folding.
Analysis of Potential Solutions to Audible Tire Cavity and Rim Coupling Resonance Noise
Authors: Sainty Samuel , Tawaf Anthony , Richard Jonathan , Mohamed Zamri , Wang Xu
Published: September 2013

The coupling of the tire cavity and tire rim resonance imparts a force upon the wheel spindle which is transmitted to the vehicle interior to produce undesirable noise levels. Modifications to the tire rim or tire cavity can decouple these resonances by shifting the natural frequency outside of the 200–250 Hz range to reduce the audible noise levels. Through experiment and analysis several potential solutions have been compared for their commercial viability. Modifications of the rim included the Kühl wheel design and the implementation of a Helmholtz resonator, whilst tire cavity modifications included the extrusion of rubber from the tire into the cavity, the introduction of a sound absorption material and an elastic ring with separator fins which extends into the cavity due to centrifugal forces. Through QFD analysis the elastic ring design was found to be most commercially viable in terms of performance, cost, safety, versatility, durability and manufacturing readiness.
Accurate Designing of Flat-Walled Multi-Layered Lining System Using Genetic Algorithm for Application in Anechoic Chambers
Authors: Dabbagh Vahid , Keshavarz Reza , Ohadi Abdolreza
Published: September 2013

In anechoic chambers, the flat-walled multilayered acoustic lining systems are cheaper and easier to install than conventional wedge type systems. Sequence, material and thickness of layers are all design variables. By choosing the right configuration, the acoustical performance and overall thickness of flat-walled multilayered systems can be comparable to conventional wedge systems. In this study, the materials considered include air and poroelastic materials such as polyurethane foams, melamine foams, and glass wool. In order to evaluate acoustical performance of a given configuration, the poroelastic materials are modeled using Biot’s formulations instead of a simpler impedance method to get more accurate results. A genetic algorithm implemented within ModeFRONTIER optimization software was used to select configurations which have a cut-off frequency of 100 Hz or less. The configuration that met this requirement with the smallest overall thickness was determined optimal. This configuration has an overall thickness of 65.8 cm and is composed of 4 different polyurethane foams. Since a considerable difference was observed between the cut-off frequencies obtained using Biot’s model and the simpler impedance method, this justifies the use of Biot’s model in the optimization.
Experimental Characterization of a Car Window Excited by Turbulent Flow Using Scanning Sound Intensity Techniques
Authors: Fernandez Comesaña Daniel , Iglesias Eduardo Latorre , Smith Malcolm , de Bree Hans-Elias
Published: September 2013

Reducing the aerodynamic noise produced by turbulent flow exciting a car window is one of the current noise control challenges in the automotive industry. Flow separation and later reattachment into a turbulent boundary layer and turbulent wake occur because of flow over the A-pillar and the wing mirror. Experiments have been carried out to represent an idealised wing mirror noise problem using flow over a half cylinder exciting a flat plate. A scanning P-U (pressure-particle velocity) probe was used to measure various aspects of the window response and sound radiation, including the energy distribution of the vibrating surface, the total radiated sound power and hence the radiation efficiency. In addition, experimental results showed that the operational deflection shapes of the car window can be visualized by using scanning particle velocity measurements, obtaining similar results as with step-by-step measurements using a roving accelerometer. The scanning sound intensity maps also proved to be helpful for detecting weaknesses of the initial experimental setup as part of the experimental optimization.
Comparison of Measured and Modeled DNL Values in the Vicinity of the SCEL Airport, Santiago, Chile
Authors: Glisser Max , Osses Alejandro , Albornoz Claudio , Gerard Christian
Published: September 2013

This paper presents a methodology to obtain the day-night average sound pressure levels DNL from continuous measurements. The methodology is used for processing data acquired during 3 days of the summer of 2011 at a point located 9,500 meters to the south of the SCEL airport in Santiago of Chile, considering the unique contribution of aircraft noise. Additionally, this measured DNL is compared with a modeling performed for the same point via the software Integrated Noise Model version 7.0b. Finally, using the model settled, a calculation was made to find values of DNL on the same points where measurements were made in 2003 under the Environmental Impact Assessment for the second runway of the SCEL Airport. The results were compared and discussed.
Singular Mode Characteristics of Fluid-Structure Interaction Modal Formulations
Authors: Cipolla Jeffrey L.
Published: September 2013

Modal formulations for linear acoustic and vibration problems are important for model order reduction as well as physical interpretation and insight. In the case of structural acoustic systems, a number of formulations exist for the computation of the modes of the coupled system: these may be referred to as ‘coupled modes’, ‘in-water modes’, etc. These modes have the desirable property that they diagonalize the undamped structural-acoustic problem, making forced-response computations in the time- and frequency-domains trivial. In this paper, we review a number of alternative formulations for the undamped FSI mode problem, and concentrate on a particular aspect: the existence and nature of the singular modes of the systems, i.e. the modes at zero frequency. Corresponding to rigid-body modes in linear elastic systems, these modes are essential for accurate low-frequency performance of reduced-order models. It is found that the original, nonsymmetric system of Zienkiewicz and Newton [53] maintains physically reasonable singular mode properties, while many other formulations do not.
Optimizing the Spatial Distribution of Damping in Structures With Boundary Damping
Authors: McDaniel J. Gregory , Wixom Andrew S.
Published: September 2013

The present work seeks to optimize the spatial distribution of damping in structures with boundary damping. This work is motivated by design considerations, such as weight and cost, that often limit the amount of damping that can be used. In such cases, the designer must choose the spatial distribution of damping in order to reduce the structural vibration. One intuitively expects that the presence of boundary damping affects the optimal distribution of damping in the structure. In particular, one expects that the optimal design places damping treatments away from such boundaries in order to achieve an even distribution of power flow from the structure. To investigate this effect, finite element models of vibrating structures are developed in which the spatial distribution of damping is parameterized. These parameters are regarded as optimization parameters that are searched to minimize a cost function related to vibration or noise, such as the average response of the structure over a frequency band. Examples are presented that illustrate the effect of boundary damping on the optimal distribution of damping.
Modified Steepest-Descent Path Method in Solving Weyl Integration Representation of Vector Wave Bases
Authors: Shih Po-Jen , Ho Meng-Cheng
Published: September 2013

Weyl integration representation is ever regarded as a wave source. Weyl integration has feature of double Fourier integral formulas, and the traditional steepest-descent path method has been dealt with convergence of oscillatory terms in the integrands of wave source. Unfortunately, to solve the reflective or scattering waves, the equations contain singular poles and branch cuts on the complex plane, because variables of the integrands are shown in denominators and in square-root terms. Singular poles represent the Rayleigh waves, and they can be solved by residue values. However, the branch cuts on the complex plane represent the head waves, and integral paths are not allowed to pass across the branch cuts. They need to solve through applying numerical integration. This paper provides a deformed integral path from the traditional integral path to the path in which the exponential terms could decay rapidly, the singular poles are considered, and the branch cut paths are counted. This demonstrates benefits of the modified steepest-descent path method in solving the vector wave bases formed in Weyl integration for elastodynamic, poroelastodynamic, and electromagnetic waves.
Application of the Beam-Forming Technique for Damage Detection in Composite Plate
Authors: Monaco Ernesto , Ricci Fabrizio , Lecce Leonardo , Boffa Natalino Daniele
Published: September 2013

The utilization of guided waves generated and sensed by an array of phased sensors allows steering the wave-front in a specific direction (beamforming technique). In this work a linear array of sensors is used to generate an ultrasonic wavefront steered in a specific direction. Numerical simulations are carried out with the LS-DYNA, an explicit Finite Element (FE) code, on a CFRP plate. The damage to be identified is a delamination produced by an impact (BVID). The array of sensors consists of a number of disk-shaped piezo patches. From the echo reflected and returning back to the array, it’s possible to evaluate the time of flight of the signal (TOF) from which the distance of the damage from the sensors array can be determined, and the angular position of the crack by evaluating the time shift of the signal received by each sensor in the array. The experimental tests are carried out in a 0.5m × 0.5m ×2.2 mm CFRP plate with the same sensor array and delamination used in the simulation. A number of receivers located along the panel edges have been also used to detect the damage direction in pitch-catch mode.
Gyro Rock Crusher and Asphalt Plant Sound Power Levels
Authors: Scarton Henry A. , Wilt Kyle R.
Published: September 2013

Sound power levels including the distribution into octaves from a large 149 kW (200 horsepower) gyro rock crusher and separate asphalt plant are presented. These NIST-traceable data are needed for estimating sound pressure levels at large distances (such as occurs on adjoining property to a quarry) where atmospheric attenuation may be significant for the higher frequencies. Included are examples of the computed A-weighted sound pressure levels at a distance from the source, including atmospheric attenuation. Substantial low-frequency sound power levels are noted which are greatly reduced in the far-field A-weighted sound pressure level calculations.
A Drill Rod Coulomb Friction Damper
Authors: Scarton Henry A. , Guthrie Anne R. , Wilt Kyle R.
Published: September 2013

A Coulomb friction damper, consisting of a case-hardened roll-threaded collar resting against a reverse taper segment of drill rod, is studied for its noise-reduction potential. Axial impact causes the drill rod to be excited in many transverse bending modes of vibration, along with longitudinal and torsional resonances. Due to the inertia of the collar, simultaneous axial and rotational self-tightening motion occurs on the rolled thread. The collar consequently presses on the case-hardened tapered surface of the drill rod, inducing interfacial frictional rubbing, resulting in 5–45 dB of attenuation in peak acceleration of the modes of vibration, and reduction in decay time on the order of 10 seconds.
Molecular radiotherapy: The NUKFIT software for calculating the time‐integrated activity coefficient
Authors: Kletting P. , Schimmel S. , Kestler H. A. , Hänscheid H. , Luster M. , Fernández M. , Bröer J. H. , Nosske D. , Lassmann M. , Glatting G.
Published: September 2013

Purpose:

Calculation of the time‐integrated activity coefficient (residence time) is a crucial step in dosimetry for molecular radiotherapy. However, available software is deficient in that it is either not tailored for the use in molecular radiotherapy and/or does not include all required estimation methods. The aim of this work was therefore the development and programming of an algorithm which allows for an objective and reproducible determination of the time‐integrated activity coefficient and its standard error.

Methods:

The algorithm includes the selection of a set of fitting functions from predefined sums of exponentials and the choice of an error model for the used data. To estimate the values of the adjustable parameters an objective function, depending on the data, the parameters of the error model, the fitting function and (if required and available) Bayesian information, is minimized. To increase reproducibility and user‐friendliness the starting values are automatically determined using a combination of curve stripping and random search. Visual inspection, the coefficient of determination, the standard error of the fitted parameters, and the correlation matrix are provided to evaluate the quality of the fit. The functions which are most supported by the data are determined using the corrected Akaike information criterion. The time‐integrated activity coefficient is estimated by analytically integrating the fitted functions. Its standard error is determined assuming Gaussian error propagation. The software was implemented using MATLAB.

Results:

To validate the proper implementation of the objective function and the fit functions, the results of NUKFIT and SAAM numerical, a commercially available software tool, were compared. The automatic search for starting values was successfully tested for reproducibility. The quality criteria applied in conjunction with the Akaike information criterion allowed the selection of suitable functions. Function fit parameters and their standard error estimated by using SAAM numerical and NUKFIT showed differences of <1%. The differences for the time‐integrated activity coefficients were also <1% (standard error between 0.4% and 3%). In general, the application of the software is user‐friendly and the results are mathematically correct and reproducible. An application of NUKFIT is presented for three different clinical examples.

Conclusions:

The software tool with its underlying methodology can be employed to objectively and reproducibly estimate the time integrated activity coefficient and its standard error for most time activity data in molecular radiotherapy.
Nonlocal denoising using anisotropic structure tensor for 3D MRI
Authors: Wu Xi , Liu Shujuan , Wu Min , Sun Huaiqiang , Zhou Jiliu , Gong Qiyong , Ding Zhaohua
Published: September 2013

Purpose:

Noise in magnetic resonance imaging (MRI) data is widely recognized to be harmful to image processing and subsequent quantitative analysis. To ameliorate the effects of image noise, the authors present a structure‐tensor based nonlocal mean (NLM) denoising technique that can effectively reduce noise in MRI data and improve tissue characterization.

Methods:

The proposed 3D NLM algorithm uses a structure tensor to characterize information around tissue boundaries. The similarity weight of a pixel (or patch), which determines its contribution to the denoising process, is determined by the intensity and structure tensor simultaneously. Meanwhile, similarity of structure tensors is computed using an affine‐invariant Riemannian metrics, which compares tensor properties more comprehensively and avoids orientation inaccuracy of structure subsequently. The proposed method is further extended for denoising high dimensional MRI data such as diffusion weighted MRI. It is also extended to handle Rician noise corruption so that denoising effects are further enhanced.

Results:

The proposed method was implemented in both simulated datasets and multiply modalities of real 3D MRI datasets. Comparisons with related state‐of‐the‐art algorithms demonstrated that this method improves denoising performance qualitatively and quantitatively.

Conclusions:

In this paper, high order structure information of 3D MRI was characterized by 3D structure tensor and compared for NLM denoising in a Riemannian space. Experiments with simulated and real human MRI data demonstrate a great potential of the proposed technique for routine clinical use.
4D CT lung ventilation images are affected by the 4D CT sorting method
Authors: Yamamoto Tokihiro , Kabus Sven , Lorenz Cristian , Johnston Eric , Maxim Peter G. , Diehn Maximilian , Eclov Neville , Barquero Cristian , Loo Billy W. , Keall Paul J.
Published: September 2013

Purpose:

Four‐dimensional (4D) computed tomography (CT) ventilation imaging is a novel promising technique for lung functional imaging. The current standard 4D CT technique using phase‐based sorting frequently results in artifacts, which may deteriorate the accuracy of ventilation imaging. The purpose of this study was to quantify the variability of 4D CT ventilation imaging due to 4D CT sorting.

Methods:

4D CT image sets from nine lung cancer patients were each sorted by the phase‐based method and anatomic similarity‐based method, designed to reduce artifacts, with corresponding ventilation images created for each method. Artifacts in the resulting 4D CT images were quantified with the artifact score which was defined based on the difference between the normalized cross correlation for CT slices within a CT data segment and that for CT slices bordering the interface between adjacent CT data segments. The ventilation variation was quantified using voxel‐based Spearman rank correlation coefficients for all lung voxels, and Dice similarity coefficients (DSC) for the spatial overlap of low‐functional lung volumes. Furthermore, the correlations with matching single‐photon emission CT (SPECT) ventilation images (assumed ground truth) were evaluated for three patients to investigate which sorting method provides higher physiologic accuracy.

Results:

Anatomic similarity‐based sorting reduced 4D CT artifacts compared to phase‐based sorting (artifact score, 0.45 ± 0.14 vs 0.58 ± 0.24,p = 0.10 at peak‐exhale; 0.63 ± 0.19 vs 0.71 ± 0.31, p = 0.25 at peak‐inhale). The voxel‐based correlation between the two ventilation images was 0.69 ± 0.26 on average, ranging from 0.03 to 0.85. The DSC was 0.71 ± 0.13 on average. Anatomic similarity‐based sorting yielded significantly fewer lung voxels with paradoxical negative ventilation values than phase‐based sorting (5.0 ± 2.6% vs 9.7 ± 8.4%, p = 0.05), and improved the correlation with SPECT ventilation regionally.

Conclusions:

The variability of 4D CT ventilation imaging due to 4D CT sorting was moderate overall and substantial in some cases, suggesting that 4D CT artifacts are an important source of variations in 4D CT ventilation imaging. Reduction of 4D CT artifacts provided more physiologically convincing and accurate ventilation estimates. Further studies are needed to confirm this result.
Visual failure in the elderly and dysphagia
Authors: Gore David G , Maharaj Aruna , Doddridge Nicola
Published: September 2013

A 91-year-old man presented with a history of acute dysphagia. Clinical examination found reduced oxygen saturations and lung basal crepitations. Blood tests revealed mild anaemia, leukocytosis and acute renal failure. Chest X-ray demonstrated two oesophageal foreign bodies (FBs) and consolidation at the left lung base. Dysphagia resolved following the removal of two coins at oesophagogastroduodenoscopy, the man did not recall ingesting coins. His coin ingestion was attributed to poor visual acquity and he was referred for eye examination and advised to keep coins separate from food and medication. Children and the aged are likely to swallow FBs; causes of ingestion include reduced ability to chew and/or distinguish between objects. Most FBs pass spontaneously, however those that become stuck are likely to impact in the oesophagus. It is important to consider visual acuity for both compliance with medication and to prevent ingestion of FBs.
Coexistence of scleroderma with multiple myeloma: a rare association
Authors: Gajendra Smeeta , Gupta Richa , Gupta Ritu , Kumar Lalit
Published: September 2013

Coexistence of scleroderma with multiple myeloma (MM) is an unusual finding with unclear significance. Only 13 cases of MM with scleroderma have been reported until now. We report a case of a 24-year-old man with 8-year history of progressive thickening of skin all over the body. Histopathology of skin lesion was consistent with scleroderma. Bone marrow biopsy showed interstitial and focal increase in plasma cells and increased bone marrow fibrosis. Skeletal survey showed osteopenia, but no osteolytic lesion or fracture. The patient was diagnosed as scleroderma with coexistence of immunoglobulin A, κMM. The patient recovered with improvement of skin lesions after 9 months of therapy with thalidomide and dexamethasone.
Shiga toxin producingE colibloodstream infection secondary toStrongyloidespenetration through intestinal mucosa
Authors: Cyr Sancta , Nagpal Avish , Sohail Muhammad Rizwan
Published: September 2013

A 51-year-old woman with diabetes, who immigrated to the USA 22 years ago from Laos, was admitted to the hospital for evaluation of fever, abdominal pain, vomiting and diarrhoea. A workup for acute gastroenteritis revealed a positive stool PCR for Shiga toxin-producingEscherichia coli. Two sets of blood cultures drawn at admission were positive forE coli. A review of her previous medical records revealed the presence of eosinophilia, up to 20%, 14 years prior to that was never investigated. Therefore, stool samples were examined and two of three specimens were positive forStrongyloides stercoralislarvae, confirming the diagnosis ofStrongyloideshyperinfection syndrome.
Long-lasting response to crizotinib in brain metastases due toEML4-ALK-rearranged non-small-cell lung cancer
Authors: Kinoshita Yoshiaki , Koga Yasutaka , Sakamoto Atsuhiko , Hidaka Kouko
Published: September 2013

Anaplastic lymphoma kinase (ALK)rearranged non-small-cell lung cancer (NSCLC) is highly responsive to crizotinib, an oral ATP-competitive selective inhibitor ofALK. However, crizotinib exhibits extremely poor blood–brain barrier penetration; therefore, it is considered to play a limited role in the treatment of brain metastases. We present a case of a 50-year-old man with a diagnosis ofALK-rearranged NSCLC with brain metastasis and malignant pleural effusion. Despite the several systemic chemotherapy regimens and whole brain radiotherapy, brain metastasis was refractory; therefore, crizotinib was initiated. A CT scan showed a slight reduction in the brain metastasis and no change in intrathoracic disease 17 weeks after initiating crizotinib. Moreover, CT obtained 12 months after crizotinib treatment revealed brain metastasis without progression. To our knowledge, the present case is the second report of crizotinib-responsive brain metastases due toechinoderm microtubule-associated protein-like 4-ALK (EML4-ALK)-rearranged NSCLC.
Hemophagocytic syndrome with atypical presentation in an adolescent
Authors: Valente Pinto Marta , Esteves Isabel , Bryceson Yenan , Ferrão Anabela
Published: September 2013

A 14-year-old adolescent presented with a prolonged fever, abnormal liver function, anaemia, thrombocytopaenia, but a good general status. Diagnosis of hemophagocytic lymphohistiocytosis (HLH) was suspected, in spite of the initial indolent course. Secondary causes were excluded, but no specific mutation indicative of primary HLH was found. The patient started with specific therapy, but progressed with reactivations and later with persistently active disease. Haematopoietic stem cell transplantation was not successful and the adolescent died 7 months after diagnosis.
PP02 Cost-Effectiveness of New left Ventricular Assist Devices (LVADS) for Patients with advanced Heart Failure: Analysis of the UK NHS Bridge to Transplant (BTT) programme
Authors: Clarke A , Pulikottil-Jacob R , Connock M , Suri G , Kandala N-B , Maheswaran H , Banner N , Sutcliffe P
Published: September 2013

Background

Public health measures aim to prevent people from reaching tertiary prevention or palliative or heroic care. Nevertheless these remain the only options for some people. There is an expanding population with very severe heart failure and although heart transplant is the optimal treatment, this option is dependent on a diminishing supply of donor hearts. For more than a decade, the NHS has supported the transplant programme for patients awaiting a donor heart with a ‘bridge to transplant’ programme - surgical implantation of a mechanical pump to support left ventricular function called a Left Ventricular Assist Device (LVAD). Alternatively individuals waiting for a heart receive medical management with drugs such as intravenous inotropes.

Methods

A semi-Markov multi-state economic model was built using NHS costs data and data for patients listed for transplant in the UK NHS Blood and Transplant Data Base (BTDB). Quality adjusted life years (QALYs) gained and incremental cost per QALY were calculated for patients receiving LVADs compared to those receiving medical management with inotrope support.

Results

Patients were mainly white: 86%; male 84.2% (95% CI 79.4, 88.0) and middle aged - mean age 50.8 years (49.3, 52.4). BMI was 26.5 (25.7, 27.3). 25.2% (17.4, 35.1) patients had diabetes. 83.5% (78.0, 87.9) had the highest level of heart failure (NYHA Class IV). 235 patients received a second or third generation LVAD between 2002 -2012 of whom 14% received a heart transplant. 307 patients received medical management and 67% received a transplant. LVADs conferred improved survival compared to medical management. LVADs cost £80,569 per device at 2011 prices. Estimated probabilistic incremental cost effectiveness ratio (ICER) was £53,527/QALY (£31,802, £94,853) over a lifetime horizon. Estimates were sensitive to choice of comparator, likelihood of receiving a transplant and time to transplant. Reducing device cost by 15% brought the ICER down to £50,106/QALY.

Discussion

New left ventricular assist devices (LVADs) deliver greater health benefits at higher cost than medical management in the UK. Cost-effectiveness estimates are hampered by the lack of randomised comparative evidence. Relatively small reductions in costs of LVADs would bring them into line with other interventions for end of life care already recommended for adoption within the UK NHS by NICE. National Institute for Health Research, UK. Project number HTA 12/02/01.
PP04 Persisting Gender Differences and Attenuating Age Differences in Cardiovascular Drug use for Prevention and Treatment of Coronary Heart Disease
Authors: Koopman C , Vaartjes I , Heintjes E M , Spiering W , Dis I van , Herings R M C , Bots M I
Published: September 2013

Background

Evidence on recent time trends in age-gender differences in cardiovascular drug use is scarce. We studied time trends in age-gender-specific cardiovascular drug use for primary prevention, in-hospital treatment and secondary prevention of CHD.

Methods

The PHARMO database network was used for record linkage of drug dispensing, hospitalisation and population data to identify drug use between 1998 and 2010 in 1,206,469 persons ≥25 years eligible for primary prevention, 84,621 persons hospitalised for an acute coronary syndrome (ACS) and 15,651 persons eligible for secondary prevention.

Results

Between 2003 and 2010, the proportion of women that used lipid lowering drugs for primary prevention was lower compared with the proportion of men (5.8% vs. 7.4% in 2010, P < 0.001). The higher proportion of women that used blood pressure lowering drugs in primary prevention, compared to men, attenuated over time (P < 0.001, 14.1% vs. 15.3% in 2010). During hospital admission for an ACS, the proportion of women that used cardiovascular drugs was lower compared to men. In long-term secondary prevention (36 months after hospital discharge) for ACS patients, drug use was lowest in young women. The proportion receiving lipid lowering drugs declined after the age of 75. This age difference attenuated over time (P < 0.001), however a marked decline in lipid lowering drug use after age 85 years remained in all three settings.

Conclusion

The use of cardiovascular drugs for in-hospital treatment, primary and secondary prevention of CHD increased in recent years in the Netherlands. Age differences in drug use tended to attenuate over time, while gender differences persisted.
PP06 Cardiovascular Risk Factor Patterns in Long-Settled Roma and Recently Settled Indian Populations
Authors: Bhopal A , Bhopal R S
Published: September 2013

Background

Linguistic and genetic evidence shows that Romani people, now numbering around 10-12 million in Europe, originate from North India. Romanis are thought to have migrated from North India around 10th-11th Century AD. Cardiovascular health is extremely poor in recently settled Indians living in Europe. Diabetes is also highly prevalent. As Romanis emigrated from India, we hypothesised their cardiovascular health would be similar to recently settled South Asians. The recent Indian migration of the 1950’s onwards comes 500 years after the Romani’s first movements into Europe.

Methods

This paper is not a systematic review but, background data were found by a search for abstracts using PubMed. Key search terms were Roma/Romani/Gypsy/Gipsy and/or health, cardiovascular health, genetics, linguistics, diabetes, stroke, Body Mass Index, maternal health and birth outcomes. In all over 70 abstracts were read, of which 30 were discarded due to lack of relevance to the specific review focus while 4 were discarded due to being unable to gain access to the journal. 36 papers were downloaded from online journals and from this 19 papers were used in final the review. The websites of the United Nations Development programme, the World Health Organisation, the Open Society Institute and the Roma Decade of Inclusion were examined. Grey literature was particularly valuable in drawing demographic data.

The results use data from key papers which are compared to the best equivalent data available on the same topic of Indians living in the United Kingdom.

Results

Studies have shown Romanis to have higher levels of several cardiovascular risk factors when compared to local populations; these include diabetes (30% vs. 10%), central obesity (38% vs. 20%), hypertriglyceridemia (66% vs. 39%), smoking and raised BMI. Low birth weight and gestational age also mirror trends of the Indian ethnic origin population in the United Kingdom.

Romanis in Europe are well documented to have a 10-15 year reduced average lifespan compared to the majority - the age distribution pyramid in fact more resembles a developing country pattern than that of industrialised countries.

Conclusion

Our findings demonstrate commonality of several cardiovascular risk factors – underlying reasons for this are discussed. This work potentially offers insights into the high rates of cardiovascular diseases in both populations. To our knowledge no previous work has examined the matter from this perspective.
PP08  Work Status and Blood Pressure – “A Job of Work”
Authors: McCarthy V J C , Perry I J , Harrington J M , Greiner B A
Published: September 2013

Background

The effect of work on blood pressure (BP) relative to a non-working status with appropriate adjustment for confounders is not well defined. High job control has been found to be associated with lower BP and with nocturnal BP dipping. However, with older workers this may be compromised.

Methods

A cross-sectional study was carried out on a sample of the Irish general population. In total, 2,047 males and females aged 50-69 years were recruited. Data were collected on socio-demographic factors, medication and clinic BP measurements on workers (n= 1,025) and non-workers (n= 950). A sub-sample of the participants had ambulatory blood pressure monitoring (ABPM) done (n= 1,112). Job control was measured using two scales from the Copenhagen Psychosocial Questionnaire (COPSOQ) – possibility for development and influence at work. Nocturnal systolic blood pressure (SBP) dipping was the reduction in SBP from day to night-time and was calculated using the following formula (1-asleep SBP/awake SBP)*100.

Results

Those who were hypertensive on the clinic and ABPM SBP readings tended to be >58 years, male, overweight/obese and taking anti-hypertensive medication. Typically workers were younger, male, had a normal body mass index and had significantly lower clinic SBP than non-workers (p≤0.02). In analysis adjusted for socio-demographic factors, there was a significant difference between workers and non-workers for SBP dipping (OR 1.69 [95% CI 1.13, 2.53], p=0.01), but not for clinic or asleep SBP. When the analysis was stratified by anti-hypertensive treatment, workers were significantly more likely than non-workers to have a high clinic SBP (1.45 [1.00, 2.11]) and SBP dipping (2.07 [1.19, 3.61]). Looking only at workers, those who were on anti-hypertensive treatment with a high possibility for development were three times more likely to be SBP dippers than those with a low possibility for development (p= 0.03). There was no significant association found for influence at work and SBP dipping.

Discussion

While workers had higher clinic SBP readings than non-workers they were also more likely to have nocturnal SBP dipping a factor known to be beneficial to cardiovascular health. Furthermore, this study showed that allowing workers to develop their skills in the workplace positively influenced their blood pressure.
PP16 The Contribution of Changes in Diet and other Risk Factors to recent Favourable Trends in Blood Pressure in Middle-Aged Irish Adults
Authors: Perry I J , Harrington J M , Kabir Z , Browne G , Fitzgerald A P , Kearney P M
Published: September 2013

Background

Recent declines in cardiovascular mortality in Ireland and other developed countries are partially attributable to favourable secular trends in blood pressure (BP). However the underlying causes of these BP trends are not well defined. In particular, the contribution of changes in the dietary and other lifestyle determinants of population BP levels is unclear. We examined changes in distribution and determinants of systolic blood pressure (SBP) in middle-aged Irish adults over a 12 year period

Methods

Data are from two cross-sectional studies of men and women aged 47-73 years recruited from 17 General Practices in Cork and Kerry (N = 1018, response rate 70%) and from one large General Practice in Cork (N = 2047, response rate 67%) in 1998 and 2010 respectively. Similar procedures were used at both time points, including recruitment methods, exclusion criteria, health and lifestyle questionnaire, dietary assessment (food frequency questionnaire [FFQ]) and physical examination (height, weight and blood pressure). Dietary quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) score constructed from the FFQ: higher scores indicating healthier diets. Changes in mean SBP were examined in linear regression models and are presented as means (95% CI).

Results

Mean SBP fell by 7.1 mmHG (138.0, 130.9) in men and 4.7 mmHG (133.0, 128.3) in women between 1998 and 2010. Adjusted for age, gender and education mean SBP, was 5.8 mmHG (-7.3, -4.5) lower in 2010 than in 1998. Average BMI increased from 27.8 (4.0) to 29.1 (4.1) in men and from 27.4 (4.6) to 28.0 (5.1) in women. By contrast diet quality improved over the period in men and women from 22.5 (4.4) to 27.6 (5.6) and from 23.5 (4.7) to 30.1 (5.6) respectively. Significant trends in physical activity (favourable), smoking (favourable), and alcohol intake (unfavourable) were observed. The proportion of the sample with doctor diagnosed hypertension increased from 25% to 29% over the 12 year period. Adjusting for age, gender, education, BMI, smoking and alcohol the change in mean SBP remained relatively unchanged. Adjusting for DASH diet score the mean SBP change it was reduced to 4.1 mmHG (-6.5, -1.7) and on further adjustment for doctor diagnosed hypertension it was reduced to 3.9 mmHG (-6.3, -1.6).

Discussion

The findings suggest that average blood pressures levels in the population are falling, despite increasing prevalence of obesity. Much of the change is due to improvements in diet.