bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Length Scales on the Boiling Enhancement of Structured Copper Surfaces
Authors: Rahman Md Mahamudur , McCarthy Matthew
Published: May 2017

Boiling heat transfer can be substantially altered with the addition of surface structures. While significant enhancements in critical heat flux (CHF) and heat transfer coefficient (HTC) have been demonstrated using this approach, fundamental questions remain about the nature of enhancement and the role of structure length scale. This work presents a systematic investigation of structures from 100's of nanometers to several millimeters. Specifically, copper substrates were fabricated with five different microchannel geometries (characteristic lengths of 300 μm to 3 mm) and four different copper oxide nanostructured coatings (characteristic lengths of 50 nm to 50 μm). Additionally, twenty different multiscale structures were fabricated coinciding with each permutation of the various microchannels and nanostructures. Each surface was tested up to CHF during pool boiling of saturated water at atmospheric conditions. The nanostructured coatings were observed to increase CHF via surface wicking, consistent with existing models, but decrease HTC due to the suppression of the nucleation process. The microchannels were observed to increase both CHF and HTC, generally outperforming the nanostructured coatings. The multiscale surfaces exhibited superior performance, with CHF and HTC values as high as 313 W/cm2 and 461 kW/m2 K, respectively. Most importantly, multiscale surfaces were observed to exhibit the individual enhancement mechanisms seen from each length scale, namely, increased nucleation and bubble dynamics from the microchannels and wicking-enhanced CHF from the nanostructures. Additionally, two of the surfaces tested here exhibited uncharacteristically high HTC values due to a decreasing wall superheat at increasing heat fluxes. While the potential mechanisms producing this counterintuitive behavior are discussed, further research is needed to definitively determine its cause.
Microscale Morphology Effects of Copper–Graphene Oxide Coatings on Pool Boiling Characteristics
Authors: Jaikumar Arvind , Rishi Aniket , Gupta Anju , Kandlikar Satish G.
Published: May 2017

Enhanced pool boiling heat transfer, with simultaneous increase in critical heat flux (CHF) and heat transfer coefficient (HTC), is desired to improve overall system efficiency and reduce equipment size and cost. This paper focuses on combining graphene oxide (GO) and porous copper particles to generate microstructures based on their ability to enhance HTC, CHF, or both. Three pool boiling performance characteristics based on CHF improvements and wall superheat reductions are identified: Type I—reduction in wall superheat only, type II—increase in CHF only, and type III—increase in CHF with reduction in wall superheat at higher heat fluxes. Specific microscale morphologies were generated using (a) screen-printing and (b) electrodeposition techniques. In type-I, rapid bubble activity due to increased availability of nucleation cavities was seen to influence the reduction in the wall superheats, while no increase in CHF was noted. Roughness-augmented wettability was found to be the driving mechanism in type-II enhancement, while wicking and increased nucleation site density were responsible for the enhancement in type-III. An HTC enhancement of ∼216% in type-I and a CHF improvement of ∼70% in type-II were achieved when compared to a plain copper surface with water. In type-III enhancement, a CHF of 2.2 MW/m2 (1.8× over a plain surface) with a HTC of 155 kW/m2 °C (∼2.4× over a plain surface) was obtained. Furthermore, close correlation between the boiling performance and the microscale surface morphology in these three categories has been identified.
Exact Solutions for Nonaxisymmetric Vibrations of Radially Inhomogeneous Circular Mindlin Plates With Variable Thickness
Authors: Yuan Jianghong , Wei Xiaona , Huang Yin
Published: May 2017

The nonaxisymmetric transverse free vibrations of radially inhomogeneous circular Mindlin plates with variable thickness are governed by three coupled differential equations with variable coefficients, which are quite difficult to solve analytically in general. In this paper, we discover that if the geometrical and material properties of the plates vary in generalized power form along the radial direction, then the complicated governing differential equations can be reduced into three uncoupled second-order ordinary differential equations which are very easy to solve analytically. Most strikingly, for a class of solid circular Mindlin plates with absolutely sharp edge, the natural frequencies can be expressed explicitly in terms of elementary functions, with the corresponding mode shapes given in terms of Jacobi polynomials. These analytical expressions can serve as benchmark solutions for various numerical methods.
Detection of Combined n/γ Fission Signatures Induced by an Epithermal Neutron Source
Authors: Ocherashvili A. , Bogucarska T. , Beck A. , Heger G. , Mosconi M. , Roesgen E. , Crochemore J.-M. , Mayorov V. , Varasino G. , Pedersen B.
Published: May 2017

In this paper, a method is presented for the detection of special nuclear materials (SNMs) in shielded containers, which is both sensitive and applicable under field conditions. The method uses an external pulsed neutron source to induce fission in SNM and subsequent detection of the fast prompt fission neutrons. The detectors surrounding the container under investigation are liquid scintillation detectors able to distinguish gamma rays from fast neutrons by means of pulse shape discrimination method (PSD). One advantage of these detectors, besides the ability for PSD analysis, is that the analog signal from a detection event is of very short duration (typically few tens of nanoseconds). This allows the use of very short coincidence gates for the detection of the prompt fission neutrons in multiple detectors, while benefiting from a low background coincidence rate, yielding a low detection limit. Another principle advantage of this method derives from the fact that the external neutron source is pulsed. By proper time gating, the interrogation can be conducted by epithermal source neutrons only. These neutrons do not appear in the fast neutron signal following the PSD analysis, thus providing a fundamental method for separating the interrogating source neutrons from the sample response in the form of fast fission neutrons. This paper describes laboratory tests with a configuration of eight detectors in the Pulsed Neutron Interrogation Test Assembly (PUNITA). Both the photon and neutron signature for induced fission is observed, and the methods used to isolate these signatures are described and demonstrated.
Effects of hydrogen ion irradiation on zinc oxide etching
Authors: Li Hu , Karahashi Kazuhiro , Friederich Pascal , Fink Karin , Fukasawa Masanaga , Hirata Akiko , Nagahata Kazunori , Tatsumi Tetsuya , Wenzel Wolfgang , Hamaguchi Satoshi
Published: May 2017

Mechanisms of zinc oxide (ZnO) etching by hydrocarbon plasmas were investigated both experimentally and theoretically with the use of a mass-selected ion beam system and first-principle quantum mechanical (QM) simulation based on the density functional theory. The mass-selected ion beam experiments have shown that the sputtering yield of ZnO increases by a pretreatment of the ZnO film by energetic hydrogen (H) ion injections prior to heavy ion bombardment, suggesting that chemically enhanced etching of ZnO by hydrocarbon plasmas is closely related to hydrogen storage and/or formation of damage in the ZnO layer by energetic hydrogen injections. In this study, the effects of hydrogen storage in ZnO are examined. First-principle QM simulation of ZnO interacting with H atoms has shown that H atoms in ZnO form hydroxyl (OH) groups (or partially convert ZnO to ZnOH), which results in the weakening or breaking of the Zn–O bonds around H atoms and thus makes the ZnO film more prone to physical sputtering. The formation of hydroxyl groups in ZnO is also expected to occur in ZnO etching by hydrocarbon plasmas and increase its sputtering yields over those by inert-gas plasmas generated under similar conditions.
Vowel space density as an indicator of speech performance
Authors: Story Brad H. , Bunton Kate
Published: May 2017

The purpose of this study was to develop a method for visualizing and assessing the characteristics of vowel production by measuring the local density of normalized F1 and F2 formant frequencies. The result is a three-dimensional plot called the vowel space density (VSD) and indicates the regions in the vowel space most heavily used by a talker during speech production. The area of a convex hull enclosing the vowel space at specific threshold density values was proposed as a means of quantifying the VSD.
Antiarrhythmics cure brain arrhythmia: The imperativeness of subthalamic ERG K
+
channels in parkinsonian discharges
Authors: Huang Chen-Syuan , Wang Guan-Hsun , Tai Chun-Hwei , Hu Chun-Chang , Yang Ya-Chin
Published: May 2017

Antiarrhythmics and proarrhythmics targeting ERG K
+
channels act oppositely to tune parkinsonian brain rhythms and motor behaviors.
In vivo mapping of tissue- and subcellular-specific proteomes in
Caenorhabditis elegans
Authors: Reinke Aaron W. , Mak Raymond , Troemel Emily R. , Bennett Eric J.
Published: May 2017

New approach enables unbiased determination of tissue- and subcellular-specific protein location within a live animal.
Australian shelf sediments reveal shifts in Miocene Southern Hemisphere westerlies
Authors: Groeneveld Jeroen , Henderiks Jorijntje , Renema Willem , McHugh Cecilia M. , De Vleeschouwer David , Christensen Beth A. , Fulthorpe Craig S. , Reuning Lars , Gallagher Stephen J. , Bogus Kara , Auer Gerald , Ishiwa Takeshige ,   Expedition 356 Scientists
Published: May 2017

Sediments from Western Australia show how westerly winds made the southwest wetter during the Miocene (18 to 6 million years ago).
Self-assembled micro-organogels for 3D printing silicone structures
Authors: O’Bryan Christopher S. , Bhattacharjee Tapomoy , Hart Samuel , Kabb Christopher P. , Schulze Kyle D. , Chilakala Indrasena , Sumerlin Brent S. , Sawyer W. Gregory , Angelini Thomas E.
Published: May 2017

High-precision 3D printing of liquid silicone is achieved using a new oil-based microgel as a support medium.
Newest member of human family is surprisingly young
Authors: Gibbons Ann
Published: May 2017

Archaic species may have coexisted with our ancestors.
NIH to cap grants for well-funded investigators
Authors: Kaiser Jocelyn
Published: May 2017

New system would limit researchers to the equivalent of three R01 grants.
Restored iron transport by a small molecule promotes absorption and hemoglobinization in animals
Authors: Grillo Anthony S. , SantaMaria Anna M. , Kafina Martin D. , Cioffi Alexander G. , Huston Nicholas C. , Han Murui , Seo Young Ah , Yien Yvette Y. , Nardone Christopher , Menon Archita V. , Fan James , Svoboda Dillon C. , Anderson Jacob B. , Hong John D. , Nicolau Bruno G. , Subedi Kiran , Gewirth Andrew A. , Wessling-Resnick Marianne , Kim Jonghan , Paw Barry H. , Burke Martin D.
Published: May 2017

Shipping iron around in small packages

Iron plays a crucial role in a wide variety of biological functions, which in turn rely on the proteins that transport the metal in and out of cells. Grillo
et al.
used a simple lipophilic small molecule that binds iron ions to restore transport in animal models with deficiencies in iron transporters. This cyclic ketol, hinokitiol, was first tested in yeast and then shown to promote gut iron absorption in rats and mice, as well as hemoglobin production in zebrafish.

Science
, this issue p.
608
Visualizing dynamic microvillar search and stabilization during ligand detection by T cells
Authors: Cai En , Marchuk Kyle , Beemiller Peter , Beppler Casey , Rubashkin Matthew G. , Weaver Valerie M. , Gérard Audrey , Liu Tsung-Li , Chen Bi-Chang , Betzig Eric , Bartumeus Frederic , Krummel Matthew F.
Published: May 2017

Search and capture in space and time

How immunological T cells scan target cells for ligands is poorly understood. Cai
et al.
examined microvillar dynamics in living T cells in three dimensions and real time. The T cells palpated all spots on a surface within about 1 min through rapid movements of their microvilli. The time it took to scan the surface matched the movement rate of cells through tissues. These contacts took place in the absence of T cell receptor recognition and were stabilized independently of signaling or the cytoskeleton. Instead, stabilization depended on ligand affinity. The findings explain why many of the previously described components of the immunological synapse and T cell receptor signaling reside on three-dimensional microvillar-derived projections.

Science
, this issue p.
eaal3118
Holliday junction resolvases mediate chloroplast nucleoid segregation
Authors: Kobayashi Yusuke , Misumi Osami , Odahara Masaki , Ishibashi Kota , Hirono Masafumi , Hidaka Kumi , Endo Masayuki , Sugiyama Hiroshi , Iwasaki Hiroshi , Kuroiwa Tsuneyoshi , Shikanai Toshiharu , Nishimura Yoshiki
Published: May 2017

Resolution achieved

Chloroplasts possess multiple copies of their own chloroplast DNA that are packaged into DNA-protein complexes known as nucleoids. The shape, number, and distribution of chloroplast nucleoids change markedly depending on the cell cycle, developmental stage, and nutritional environment. Kobayashi
et al.
identified Holliday junction resolvase as a key factor in the dynamism of chloroplast nucleoids in the unicellular green algae
Chlamydomonas reinhardtii
. The gene encoding the resolvase is ubiquitously conserved among green plants. Disruption or down-regulation of this gene also disturbed chloroplast nucleoid organization and segregation in the land plant
Arabidopsis thaliana
.

Science
, this issue p.
631
Inhibiting the oncogenic translation program is an effective therapeutic strategy in multiple myeloma
Authors: Manier Salomon , Huynh Daisy , Shen Yu J. , Zhou Jia , Yusufzai Timur , Salem Karma Z. , Ebright Richard Y. , Shi Jiantao , Park Jihye , Glavey Siobhan V. , Devine William G. , Liu Chia-Jen , Leleu Xavier , Quesnel Bruno , Roche-Lestienne Catherine , Snyder John K. , Brown Lauren E. , Gray Nathanael , Bradner James , Whitesell Luke , Porco John A. , Ghobrial Irene M.
Published: May 2017

Targeting translation initiation in multiple myeloma induces inhibition of a specific oncogenic translation program.
A Single Negative Result for
van
Quantitative PCR on Enrichment Broth Can Replace Five Rectal Swab Cultures in Screening for Vancomycin-Resistant Enterococci
Authors: Fonville J. M. , van Herk C. M. C. , Das P. H. A. C. , van de Bovenkamp J. H. B. , van Dommelen L.
Published: May 2017

The increased incidence of infections by vancomycin-resistant
Enterococcus
(VRE) causes an accumulation of patients who are either colonized with VRE or flagged as potentially colonized with VRE. Since such patients require precautionary isolation upon admission to a hospital, rapid methods to establish VRE colonization status would improve patient care and optimize hospital operation. We evaluated
van
quantitative PCR (qPCR) on one enrichment broth as a VRE-screening approach. We obtained 255 sets of five rectal specimens from 243 patients. The specimens were cultured using an amoxicillin-containing enrichment broth. Subsequently, a chromogenic agar was incubated and suspect colonies were inoculated on a blood agar plate and characterized by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF), followed by a vancomycin Etest in cases in which
Enterococcus
spp. were detected. The culturing results were compared with the outcome of
van
qPCR on all enrichment broths of the first rectal swab. The
van
qPCR was positive for 43% of the sample sets (
vanA
,
n
= 5;
vanB
,
n
= 101;
vanA
and
vanB
,
n
= 3). Based on culture data, 20 (7.8%) of the sets were VRE positive in at least one of five samples. The negative predictive value of
van
qPCR on the first enrichment broth was 99.3%. With a cutoff quantification cycle (

C
q

) value of >35 to discriminate negative and positive samples, 87% of the negative patients can be identified within a day after obtaining the sample, compared to 7 days in the culturing approach. VRE screening using qPCR on one enrichment broth can quickly identify non-VRE-colonized patients and therefore decrease costs and limit unnecessary isolation restrictions.
Comparison of the Vitek MS and Bruker Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Systems for Identification of Rhodococcus equi and Dietzia spp
Authors: de Alegría Puig Carlos Ruiz , Pilares Lilian , Marco Francesc , Vila Jordi , Martínez-Martínez Luis , Navas Jesús
Published: May 2017

Rhodococcus equi
causes pyogranulomatous pneumonia in domesticated animals and immunocompromised humans.
Dietzia
spp. are environmental bacteria that have rarely been associated with human infections.
R. equi
and
Dietzia
spp. are closely related actinomycetes. Phenotypic discrimination between
R. equi
and
Dietzia
on the basis of their Gram stain morphology and colony appearance is problematic. Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) is a fast, reliable, and cost-effective method for identification of a wide variety of microorganisms. We have evaluated the performance of Bruker Biotyper versus that of Vitek MS for identification of a collection of 154 isolates identified at the source as
R. equi
that includes isolates belonging to the genus
Dietzia
. PCR amplification of the
choE
gene, encoding a cholesterol oxidase, and 16S rRNA sequencing were considered the reference methods for
R. equi
identification. Biotyper identified 131 (85.1%) of the 154 isolates at the species level, and this figure increased to 152 (98.7%) when the species cutoff was reduced from a score of ≥2.000 to ≥1.750. Vitek MS correctly identified at the species level 130 (84.4%) isolates as long as bacteria were extracted with ethanol but only 35 (22.7%) isolates when samples were prepared by direct extraction from colonies. The two systems allowed differentiation between
R. equi
and
Dietzia
spp., but identification of all
Dietzia
sp. isolates at the species level needed sequencing of the 16S rRNA gene.
Structural Definition of Duck Major Histocompatibility Complex Class I Molecules That Might Explain Efficient Cytotoxic T Lymphocyte Immunity to Influenza A Virus
Authors: Wu Yanan , Wang Junya , Fan Shuhua , Chen Rong , Liu Yanjie , Zhang Jianhua , Yuan Hongyu , Liang Ruiying , Zhang Nianzhi , Xia Chun
Published: May 2017

A single dominantly expressed allele of major histocompatibility complex class I (MHC I) may be responsible for the duck's high tolerance to highly pathogenic influenza A virus (HP-IAV) compared to the chicken's lower tolerance. In this study, the crystal structures of duck MHC I (Anpl-UAA*01) and duck β2-microglobulin (β2m) with two peptides from the H5N1 strains were determined. Two remarkable features were found to distinguish theAnpl-UAA*01 complex from other known MHC I structures. A disulfide bond formed by Cys95and Cys112and connecting the β5 and β6 sheets at the bottom of peptide binding groove (PBG) inAnpl-UAA*01 complex, which can enhance IAV peptide binding, was identified. Moreover, the interface area between duck MHC I and β2m was found to be larger than in other species. In addition, the two IAV peptides that display distinctive conformations in the PBG, B, and F pockets act as the primary anchor sites. Thirty-one IAV peptides were used to verify the peptide binding motif ofAnpl-UAA*01, and the results confirmed that the peptide binding motif is similar to that of HLA-A*0201. Based on this motif, approximately 600 peptides from the IAV strains were partially verified as the candidate epitope peptides forAnpl-UAA*01, which is a far greater number than those for chicken BF2*2101 and BF2*0401 molecules. Extensive IAV peptide binding should allow for ducks with thisAnpl-UAA*01 haplotype to resist IAV infection.

IMPORTANCEDucks are natural reservoirs of influenza A virus (IAV) and are more resistant to the IAV than chickens. Both ducks and chickens express only one dominant MHC I locus providing resistance to the virus. To investigate how MHC I provides IAV resistance, crystal structures of the dominantly expressed duck MHC class I (pAnpl-UAA*01) with two IAV peptides were determined. A disulfide bond was identified in the peptide binding groove that can facilitateAnpl-UAA*01 binding to IAV peptides.Anpl-UAA*01 has a much wider recognition spectrum of IAV epitope peptides than do chickens. The IAV peptides bound byAnpl-UAA*01 display distinctive conformations that can help induce an extensive cytotoxic T lymphocyte (CTL) response. In addition, the interface area between the duck MHC I and β2m is larger than in other species. These results indicate that HP-IAV resistance in ducks is due to extensive CTL responses induced by MHC I.
Granulomatosis with polyangiitis: seeing the diagnosis
Authors: Blumberg Max J , Tung Cynthia I , May Lindsay A , Patel Sangita P
Published: May 2017

A 41-year-old woman presented to her primary doctor with nausea, back pain and lower extremity oedema. Initial labs showed elevated serum creatinine and white blood cell count (WBC), which her doctor attributed to ibuprofen use and a recent upper respiratory infection. Five days later, she presented to the eye clinic with eye pain, redness and blurred vision. She was diagnosed with iritis, conjunctivitis and keratitis. The inflammatory eye disease with decreased renal function prompted the ophthalmologist to initiate systemic autoimmune and infectious disease work-up. Before laboratory testing was complete, she developed severe haemoptysis. Diagnosis of granulomatosis with polyangiitis (GPA) was confirmed using blood testing, radiological imaging and kidney biopsy. She received plasmapheresis, then cyclophosphamide and prednisone with good effect. This case highlights the need to consider GPA in the differential when patients present with inflammatory eye disease with decreased renal function and the need for multispecialty collaboration including ophthalmologists in the diagnosis of GPA.
Bilateral corneal injury after face-paint application to upper eyelids
Authors: Ho Derek Kwun-hong , Ramessur Ravi , Webber Sue
Published: May 2017

A 40-year-old woman with no known medical conditions or allergies presented with severely painful, watery eyes and blurred vision. She reported topical application of face-paint onto both upper eyelids prior to attending a Halloween party. She subsequently noticed a burning sensation, epiphora and misty vision within a few hours. On examination, bilateral large corneal epithelial defects were highlighted with fluorescein dye under cobalt-blue light. Antibiotic ointment, mydriatic and sodium ascorbate 10% eye-drops were given, and patient was advised to keep the eyelids shut to promote healing. No corneal defects were visible by day 4 and the patient was discharged with vision recovering to normal levels.
Prognostic factors for musculoskeletal injury identified through medical screening and training load monitoring in professional football (soccer): a systematic review
Authors: Hughes T , Sergeant JC , Parkes M , Callaghan M
Published: May 2017

Objectives

To identify prognostic factors and models for spinal and lower extremity injuries in adult professional/elite football players from medical screening and training load monitoring processes.

Methods

The MEDLINE, AMED, EMBASE, CINAHL Plus, SPORTDiscus electronic bibliographic databases and the Cochrane Database of Systematic Reviews were searched from inception to July 2016. Searches were limited to original research, published in peer reviewed journals of any language. The Quality in Prognostic Studies (QUIPS) tool was used for appraisal and the modified GRADE approach was used for synthesis. Prospective and retrospective cohort study designs of spinal and lower extremity injury incidence were found from populations of adult professional/elite football players, between 16 and 40 years. Non-football or mixed sports were excluded.

Results

858 manuscripts were identified. Removing duplications left 551 studies, which were screened for eligibility by title and abstract. Of these, 531 studies were not eligible and were excluded. The full text of the remaining 20 studies were obtained; a further 10 studies were excluded. 10 studies were included for appraisal and analysis, for 3344 participants.

Conclusions

Due to the paucity and heterogeneity of the literature, and shortcomings in methodology and reporting, the evidence is of very low or low quality and therefore cannot be deemed robust enough to suggest conclusive prognostic factors for all lower limb musculoskeletal injury outcomes identified. No studies were identified that examined spinal injury outcomes or prognostic models.
The heart of the matter: cardiac assessment in professional footballers
Authors: Speers C , Seth A , Patel K , Gillett M , Rakhit D
Published: May 2017

Aim

Sudden cardiac death is the leading medical cause of death during exercise.1Our objective was to retrospectively analyse the routine cardiac assessment of professional footballers to aid physician management and improve player safety.

Methods

Footballers from five professional clubs between March 2012 and October 2014 were included (n=265). All were performed in line with the recommendations of the Football Association Cardiology Committee, incorporating clinical examination, 12-lead ECG, echocardiography and health questionnaire.2Data was retrospectively collected, inspected and analysed using Excel spreadsheets. Findings were classified as ‘normal’ or ‘not normal’, and not normal assessments were further broken down into ‘clear-cut pathology’ (pathology with widely accepted guidance on management) or ‘grey screen’.

Results

Footballers were aged 13 to 37 years, with 69% aged over 18 and 31% under. The majority of the review population was White European (66%). Of the review population 11% had ‘not normal’ assessments, of these assessments 83% were considered grey screens (by Consultant Cardiologist) requiring further investigation or surveillance. Overall clear-cut pathology was identified in 2%.

Conclusions

A high proportion of the players (9%) had grey screens. The majority of these were due to ECG or structural abnormalities, which are clinically challenging to differentiate from physiological adaptation of the athletic heart and potentially fatal conditions. The extent to which these findings put the athlete at risk of a life threatening cardiac event is un-?quantified. Team physician’s need to be aware of managing the on-going risk with these patients and ensure suitable ?follow up and assessment on a regular basis to mitigate this.
Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor–patient conversations in primary care consultations in Malaysia
Authors: Syed Ayeshah , Mohd Don Zuraidah , Ng Chirk Jenn , Lee Yew Kong , Khoo Ee Ming , Lee Ping Yein , Lim Abdullah Khatijah , Zainal Azlin
Published: May 2017

Objective

To investigate whether the use of apatient decision aid (PDA) for insulin initiation fulfils its purpose of facilitating patient-centred decision-making through identifying how doctors and patients interact when using the PDA during primary care consultations.

Design

Conversation analysis of seven single cases of audio-recorded/video-recorded consultations between doctors and patients with type 2 diabetes, using a PDA on starting insulin.

Setting

Primary care in three healthcare settings: (1) one private clinic; (2) two public community clinics and (3) one primary care clinic in a public university hospital, in Negeri Sembilan and the Klang Valley in Malaysia.

Participants

Clinicians and seven patients with type 2 diabetes to whom insulin had been recommended. Purposive sampling was used to select a sample high in variance across healthcare settings, participant demographics and perspectives on insulin.

Primary outcome measures

Interaction between doctors and patients in a clinical consultation involving the use of a PDA about starting insulin.

Results

Doctors brought the PDA into the conversation mainly by asking information-focused ‘yes/no’ questions, and used the PDA for information exchange only if patients said they had not read it. While their contributions were limited by doctors’ questions, some patients disclosed issues or concerns. Although doctors’ PDA-related questions acted as a presequence to deliberation on starting insulin, their interactional practices raised questions on whether patients were informed and their preferences prioritised.

Conclusions

Interactional practices can hinder effective PDA implementation, with habits from ordinary conversation potentially influencing doctors’ practices and complicating their implementation of patient-centred decision-making. Effective interaction should therefore be emphasised in the design and delivery of PDAs and in training clinicians to use them.
Telehealthcare for patients suffering from chronic obstructive pulmonary disease: effects on health-related quality of life: results from the Danish ‘TeleCare North’ cluster-randomised trial
Authors: Lilholt Pernille Heyckendorff , Witt Udsen Flemming , Ehlers Lars , Hejlesen Ole K
Published: May 2017

Objective

To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD).

Design

A cluster-randomised trial with 26 municipal districts that were randomly assigned either to an intervention group whose members received telehealthcare in addition to usual practice or to a control group whose members received usual practice only (13 districts in each arm).

Setting

Twenty-six municipal districts in the North Denmark Region of Denmark.

Participants

Patients who fulfilled the Global Initiative for COPD guidelines and one of the following criteria: COPD Assessment Test score ≥10; or Medical Research Dyspnoea Council Scale ≥3; or Modified Medical Research Dyspnoea Council Scale ≥2; or ≥2 exacerbations during the past 12 months.

Main outcome measures

Health-related quality of life (HRQoL) assessed by the physical component summary (PCS) and mental component summary (MCS) scores of the Short Form 36-Item Health Survey, Version 2. Data were collected at baseline and at 12 month follow-up and analysed according to the intention-to-treat principle with complete cases, n=574 (258 interventions; 316 controls) and imputed data, n=1225 (578 interventions, 647 controls) using multilevel modelling.

Results

In the intention-to-treat analysis (n=1225), the raw mean difference in PCS from baseline to 12 month follow-up was −2.6 (SD 12.4) in the telehealthcare group and −2.8 (SD 11.9) in the usual practice group. The raw mean difference in MCS scores in the same period was −4.7 (SD 16.5) and −5.3 (SD 15.5) for telehealthcare and usual practice, respectively. The adjusted mean difference in PCS and MCS between groups at 12 months was 0.1 (95% CI −1.4 to 1.7) and 0.4 (95% CI −1.7 to 2.4), respectively.

Conclusions

The overall sample and all subgroups demonstrated no statistically significant differences in HRQoL between telehealthcare and usual practice.

Trial registration number

NCT01984840; Results.
The effect of empagliflozin on oxidative nucleic acid modifications in patients with type 2 diabetes: protocol for a randomised, double-blinded, placebo-controlled trial
Authors: Larsen Emil List , Cejvanovic Vanja , Kjær Laura Kofoed , Vilsbøll Tina , Knop Filip Krag , Rungby Jørgen , Poulsen Henrik Enghusen
Published: May 2017

Introduction

Cardiovascular disease is the leading cause of morbidity and mortality in patients with type 2 diabetes (T2D). Although glycaemic control reduces microvascular complications, the effect of intensive treatment strategies or individual drugs on macrovascular diseases is still debated. RNA oxidation is associated with increased mortality in patients with T2D. Inspired by animal studies showing effect of a sodium-glucose cotransporter-2 (SGLT-2) inhibitor (empagliflozin) on oxidative stress and a recent trial evaluating empagliflozin that demonstrated improved cardiovascular outcomes in patients with T2D at high risk of cardiovascular events, we hypothesise that empagliflozin lowers oxidative stress.

Methods and analysis

In this randomised, double-blinded and placebo-controlled study, 34 adult males with T2D will be randomised (1:1) to empagliflozin or placebo once daily for 14 days as add-on to ongoing therapy. The primary endpoints will be changes in 24-hour urinary excretion of 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2’-deoxyguanosine (8-oxodG) determined before and after intervention (by ultra-performance liquid chromatography tandem mass-spectrometry). Additionally, fasting levels of malondialdehyde (MDA) will be determined in plasma before and after intervention (by high-performance liquid chromatography). Further, the plasma levels of iron, transferrin, transferrin-saturation, and ferritin are determined to correlate the iron metabolism to the markers of oxidative modifications.

Ethics and dissemination

The study protocol has been approved by the Regional Committee on Biomedical Research Ethics (approval number H-16017433), the Danish Medicines Agency, and the Danish Data Protection Agency, and will be carried out under the surveillance and guidance of the GCP unit at Bispebjerg Frederiksberg Hospital, University of Copenhagen in compliance with the ICH-GCP guidelines and in accordance with the Declaration of Helsinki. The results of this study will be presented at national and international conferences, and submitted to a peer-reviewed international journal with authorship in accordance with Internation Committee of Medical Journal Editors (ICMJE) Recommendations state.

Trial registration

Study name: EMPOX; Pre-results: clinicaltrials.gov (NCT02890745). Protocol version 5.1 - August, 2016.
Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol
Authors: Kua Chong-Han , Yeo Cindy Ying Ying , Char Cheryl Wai Teng , Tan Cheryl Wei Yan , Tan Poh Ching , Mak Vivienne SL , Lee Shaun Wen Huey , Leong Ian Yi-Onn
Published: May 2017

Introduction

An ageing population has become an urgent concern for Asia in recent times. In nursing homes, polypharmacy has also become a compounding issue. Deprescribing practice is an evidence-based strategy to provide a better outcome in this group of patients; however, its implementation in nursing homes is often challenging, and prospective outcome data on deprescribing practice in the elderly is lacking. Our study assesses the implementation of team-care deprescribing to understand the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice.

Methods and analysis

This multicentre prospective study consists of a prestudy interview questionnaire, and a preintervention and postintervention study to be conducted in the nursing home setting on residents at least 65 years old and on five or more medications. We will employ a cluster randomised stepped-wedge interventional design, based on a five-step (reviewing, checking, discussion, communication and documentation) team-care deprescribing practice coupled with the use of a deprescribing guide (consisting of Beers and STOPP criteria, as well as drug interaction checking), to assess the health and pharmacoeconomic outcome in nursing homes’ practice. Primary outcome measures of the intervention will consist of fall risks using a fall risk assessment tool. Other outcomes assessed include fall rates, pill burden including number of pills per day, number of doses per day and number of medications prescribed. Cost-related measures will include the use of cost–benefit analysis, which is calculated from the medication cost savings from deprescribing. For the prestudy interview questionnaire, findings will be analysed qualitatively using thematic analysis.

Ethics and dissemination

This study is approved by the Domain Specific Review Board of National Healthcare Group, Singapore (2016/00422) and Monash University Human Research Ethics Committee (2016-1430-7791). The study findings shall be disseminated in international conferences and peer-reviewed publications. The study is registered with ClinicalTrials.gov (NCT02863341), Pre-results
Autism spectrum disorder: updated prevalence and comparison of two birth cohorts in a nationally representative Australian sample
Authors: May Tamara , Sciberras Emma , Brignell Amanda , Williams Katrina
Published: May 2017

Objectives

This study aimed to (1) provide an update on the prevalence of parent-reported autism spectrum disorder (ASD) diagnosis and new information about teacher-reported ASD in two nationally representative Australian cohorts at ages 10–11 years, (2) examine differences in cohort demographic and clinical profiles and (3) compare the prevalence of teacher-reported ASD and any changes in categorisation over time across the cohorts.

Design

Secondary analyses were undertaken using data from the Longitudinal Study of Australian Children (LSAC).

Participants

Children were recruited at kindergarten age (K cohort; birth year 1999/2000) and birth (B cohort; birth year 2003/2004), with follow-up of every 2  years for six waves.

Primary outcome measures

Parent-reported and teacher-reported ASD diagnosis was ascertained at three time points (waves 4–6).

Results

At age 10–11 years, the adjusted prevalence of parent-reported ASD diagnosis was 3.9% (95% CI 3.2 to 4.5) and 2.4% (95% CI 1.6 to 2.9) in the B and K cohorts, respectively. Teacher-reported prevalence of ASD was 1.7% (95% CI 1.2 to 2.1) in the B cohort and 0.9% (95% CI 0.56 to 1.14) in the K cohort. Parents reported fewer conduct and peer problems and teachers more pro-social behaviour in B relative to K cohort ASD children. Children reported only by parents in the later-born B cohort had milder behaviour problems than parent-agreed and teacher-agreed cases. Although individual switching to ASD from other categories from 8–9 to 10–11 years was low (K cohort n=5, B cohort n=6), teachers reported more children with ASD in the B than K cohort at 10–11 years and fewer children with emotional/ behavioural problems.

Conclusions

The higher prevalence of parent-reported and teacher-reported ASD diagnosis in the later-born cohort may be partially explained by identifying children with milder behavioural problems as ASD and a change in the use of diagnostic categories in schools.
Efficacy and safety of ipragliflozin and metformin for visceral fat reduction in patients with type 2 diabetes receiving treatment with dipeptidyl peptidase-4 inhibitors in Japan: a study protocol for a prospective, multicentre, blinded-endpoint phase IV randomised controlled trial (PRIME-V study)
Authors: Koshizaka Masaya , Ishikawa Ko , Ishikawa Takahiro , Kobayashi Kazuki , Takemoto Minoru , Horikoshi Takuro , Shimofusa Ryota , Takahashi Sho , Nagashima Kengo , Sato Yasunori , Tatsuno Ichiro , Terano Takashi , Hashimoto Naotake , Kuribayashi Nobuichi , Uchida Daigaku , Yokote Koutaro
Published: May 2017

Introduction

In Japan, dipeptidyl peptidase-4 (DPP-4) inhibitors are frequently used as the treatment of choice for patients with type 2 diabetes. In some cases, however, poor glycaemic and body weight control issues persist despite treatment with DPP-4 inhibitors. Previous researchers have revealed that sodium-dependent glucose transporter-2 (SGLT-2) inhibitors reduce both plasma glucose levels and body weight in patients with type 2 diabetes. However, further investigation regarding the effects of SGLT-2 inhibitors on body composition, especially in the Asian population who tends to have relatively low-to-moderate body mass indices, is required. Therefore, we aim to determine the effects of treatment with SGLT-2 inhibitors or metformin for reducing visceral fat in 106 Asian patients with type 2 diabetes who were undergoing treatment with the DPP-4 inhibitor sitagliptin (50 mg daily) for poor glycaemic control.

Methods and analysis

A prospective, multicentre, blinded-endpoint phase IV randomised controlled study will be conducted to evaluate the safety and efficacy of a 24-week treatment with either an SGLT-2 inhibitor (ipragliflozin) or metformin for reducing visceral fat and plasma glucose levels in patients with type 2 diabetes. Patients who satisfy the eligibility criteria will be randomised (1:1) to receive ipragliflozin (50 mg daily) or metformin (1000 mg daily). The primary outcome is the rate of change in the total area of visceral fat for patients in both treatment groups, measured using CT, after 24 weeks of therapy. Two radiologists, blinded to the clinical information, will perform centralised analysis of the images in a unified measurement condition.

Ethics and dissemination

The protocol was approved by the institutional review board of each hospital. This study is ongoing and due to finish in April 2017. The findings of this study will be disseminated via peer-reviewed publications and conference presentations, and will also be disseminated to participants.

Trial registration number

UMIN000015170, R000016861 (https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000016861); Pre-results
Developing a decision rule to optimise clinical pharmacist resources for medication reconciliation in the emergency department
Authors: De Winter Sabrina , Vanbrabant Peter , Laeremans Pieter , Foulon Veerle , Willems Ludo , Verelst Sandra , Spriet Isabel
Published: May 2017

Background

The process of obtaining a complete medication history for patients admitted to the hospital from the ED at hospital admission, without discrepancies, is error prone and time consuming.

Objectives

The goal of this study was the development of a clinical decision rule (CDR) with a high positive predictive value in detecting ED patients admitted to hospital at risk of at least one discrepancy during regular medication history acquisition, along with favourable feasibility considering time and budget constraints.

Methods

Data were based on a previous prospective study conducted at the ED in Belgium, describing discrepancies in 3592 medication histories. Data were split into a training and a validation set. A model predicting the number of discrepancies was derived from the training set with negative binomial regression and was validated on the validation set. The performance of the model was assessed. Several CDRs were constructed and evaluated on positive predictive value and alert rate.

Results

The following variables were retained in the prediction model: (1) age, (2) gender, (3) medical discipline for which the patient was admitted, (4) degree of physician training, (5) season of admission, (6) type of care before admission, number of (7) drugs, (8) high-risk drugs, (9) drugs acting on alimentary tract and metabolism, (10) antithrombotics, antihaemorrhagics and antianaemic preparations, (11) cardiovascular drugs, (12) drugs acting on musculoskeletal system and (13) drugs acting on the nervous system; all recorded by the ED physician on admission. The final CDR resulted in an alert rate of 29% with a positive predictive value of 74%.

Conclusion

The final CDR allows identification of the majority of patients with a potential discrepancy within a feasible workload for the pharmacy staff. Our CDR is a first step towards a rule that could be incorporated into electronic medical records or a scoring system.
What is the overlap between HIV and shigellosis epidemics in England: further evidence of MSM transmission?
Authors: Mohan Keerthi , Hibbert Matthew , Rooney Graeme , Canvin Malcolm , Childs Tristan , Jenkins Claire , Simms Ian , Kirwan Peter , Delpech Valerie , Yin Zheng , Hughes Gwenda , Field Nigel
Published: May 2017

Background

Evidence suggests that sexual transmission between men has replaced foreign travel as the predominant mode ofShigellatransmission in England. However, sexuality and HIV status are not routinely recorded for laboratory-reportedShigella,and the role of HIV in theShigellaepidemic is not well understood.

Methods

The Modular Open Laboratory Information System containing allShigellacases reported to Public Health England (PHE) and the PHE HIV and AIDS Reporting System holding all adults living with diagnosed HIV in England were matched using a combination of Soundex code, date of birth and gender.

Results

From 2004 to 2015, 88 664 patients were living with HIV, and 10 269Shigellacases were reported in England; 9% (873/10 269) ofShigellacases were diagnosed with HIV, of which 93% (815/873) were in men.Shigellacases without reported travel history were more likely to be living with HIV than those who had travelled (14% (751/5427) vs 3% (134/4854); p<0.01). From 2004 to 2015, the incidence ofShigellain men with HIV rose from 47/100 000 to 226/100 000 (p<0.01) peaking in 2014 at 265/100 000, but remained low in women throughout the study period (0–24/100 000). AmongShigellacases without travel and with HIV, 91% (657/720) were men who have sex with men (MSM). HIV precededShigelladiagnosis in 86% (610/720), and 65% (237/362) had an undetectable viral load (<50 copies/mL).

Discussion

We observed a sustained increase in the national rate of shigellosis in MSM with HIV, who may experience more serious clinical disease. Sexual history, HIV status and STI risk might require sensitive investigation in men presenting with gastroenteritis.
PAMAM dendrimers in drug delivery: loading efficacy and polymer morphology
Authors: Chanphai P. , Bekale L. , Sanyakamdhorn S. , Agudelo D. , Bérubé G. , Thomas T.J. , Tajmir-Riahi H.A.
Published: May 2017

The binding efficacy of anticancer drugs doxorubicin and tamoxifen with polyamidoamine (PAMAM-G4) dendrimers was studied in aqueous solution at physiological pH. The results of multiple spectroscopic methods, transmission electron microscopy (TEM), and molecular modeling of conjugated drug–polymer were examined. Structural analysis showed that drug–polymer conjugation occurs mainly via H-bonding and hydrophilic and hydrophobic contacts. Doxorubicin forms a more stable conjugate with PAMAM-G4 than tamoxifen. The drug loading efficacy was 40%–50%. The TEM images showed major changes in the PAMAM morphology upon drug encapsulation. Modeling showed that drug is located in the polymer surface and in the internal cavities. PAMAM nanoparticles are capable of transporting doxorubicin and tamoxifen in vitro. This minireview presents the most recent work performed with the dendrimers demonstrating their usefulness for drug delivery in cancer therapy.
Decoration of ZnO nanorod arrays by Cu nanocrystals via magnetron sputtering
Authors: Liu Yangsi , Gao Wei
Published: May 2017

ZnO nanorods were decorated by Cu nanocrystals via magnetron sputtering to form Cu/ZnO nanocomposite arrays. The crystal structure and morphology of Cu/ZnO nanocomposite arrays were characterized by XRD and SEM. The optical absorbance of Cu/ZnO nanocomposite arrays was measured using a UV-vis spectrophotometer and their potential applications were discussed.
ON THE TOPOLOGICAL CLASSIFICATION OF FRACTAL SQUARES
Authors: RAO FENG , WANG XIAOHUA , WEN SHENGYOU
Published: May 2017

A fractal square is a nonempty compact set in the plane satisfying [Formula: see text], where [Formula: see text] is an integer and [Formula: see text] is nonempty. We give the topological classification of fractal squares with [Formula: see text] and [Formula: see text].