bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-Loop Rover: A Kind of Modular Rolling Robot Constructed by Multi-Loop Linkages
Authors: Tian Yaobin , Kong Xianwen , Xu Kun , Ding Xilun
Published: August 2020

This paper proposes a new kind of modular rolling robot called multi-loop rover (MLR), which is essentially a multi-loop linkage that is able to roll and switch its rolling directions. For ease of rolling, the MLR retains a multi-loop topological structure composed of a number of strut and node modules. First, the modular design and assembling method are introduced to construct an MLR. Then, the mobility is analyzed based on screw theory, and a brief formula is presented to calculate the degree-of-freedoms of the robot. The results show that all node modules only have translational motions, which can significantly reduce the complexity of kinematics. The forward and inverse kinematics are conducted to show the deformation properties. Based on the kinematic rolling principle, the morphing strategies for rolling and turning functions are developed. Finally, a physical prototype is manufactured and a serial of experiments are carried out to verify the proposed method.
Numerical Study of Magnetic Field Influence on Three-Dimensional Flow Regime and Combined-Convection Heat Exchange Within Concentric and Eccentric Rotating Cylinders
Authors: Sodagar-Abardeh Javad , Nasery Payam , Arabkoohsar Ahmad , Farzaneh-Gord Mahmood
Published: August 2020

The forced and natural flows of fluid within an annulus caused by the rotation of cylinders and temperature differences of the inner and outer walls are observed in various engineering applications. In this research, the laminar flow regime and mixed convection inside a ring-shaped horizontal concentric and eccentric space for an incompressible fluid are studied in the existence of an axial magnetic field. The present work is the first effort to investigate the influence of a magnetic field on flow and combined-convection heat exchange characteristics within an annulus with a cold outer cylinder and an inner hot cylinder. Here, the properties of the flow and heat transfer characteristics are studied using the finite volume method. Numerical procedures are mainly investigated for recognizing the influence of Hartmann number (in the range of 0 ≤ Ha ≤ 100), as the representative of the magnetic force, on velocity components, Nusselt number, streamlines, and isothermal lines. One of the notable effects is that when Ha number increases, it will reduce the vorticity of the fluid and buoyancy forces. As a result, streamlines and isothermal lines can be seen more constant as regular concentric circles. A rise in Ha number decreases the range of local Nu number variation for both cylinders. The average Nu number for the outer and inner cylinders has different trends when Ha number increases. Taking concentric cylinders as an example, this parameter for the inner and the outer cylinders increases and decreases by about 1.2 and 1.6, respectively.
Swirling Flow Regimes and Gas Carry-Under in Gas–Liquid Cylindrical Cyclone Separator in a Separated Outlet Configuration
Authors: Kolla Srinivas Swaroop , Mohan Ram S. , Shoham Ovadia
Published: August 2020

Gas carry-under (GCU) and the corresponding gas volume fraction (GVF) in the gas–liquid cylindrical cyclone (GLCC©)2 liquid outlet occurs even within its normal operational envelope (OPEN). Few studies are available on GLCC, GCU, and GVF, which have been carried out in a GLCC operated in a metering loop configuration. This study focuses on GLCC GCU and GVF in swirling flow under separated outlet configuration with active control, which increases the GLCC OPEN significantly. A state-of-the-art test facility is used to acquire extensive GCU and GVF data for both air–water and air–oil flow in a 3″ diameter GLCC. The GLCC is equipped with three sequential trap sections to measure the instantaneous GVF and gas evolution in its lower part below the inlet. Also, gas trap sections are installed in the GLCC liquid outlet leg to measure the overall time-averaged GCU and GVF. The extensive acquired data shed light on the complex flow behavior in the lower part of the GLCC and its effect on the GCU and GVF in the GLCC. Tangential wall jet impingement from the GLCC inlet is the cause of gas entrainment and swirling in the lower GLCC body. The swirling flow mechanisms in the lower part of the GLCC are identified, which affect the GCU and GVF. The liquid viscosity and surface tension also affect the results. The GCU and GVF in the GLCC liquid outlet reduce as the superficial liquid velocities are increased for both air–oil and air–water flows, whereby the superficial gas velocities do not have a significant effect. The GCU and GVF for air–water flow are three orders of magnitude lower as compared to the air–oil flow.
Determination of Dynamic Drainage Volume in Water-Flood Operations Based on Fluid Flow Velocity Field Delineation
Authors: Zhao Xiang , Qian Qihao , Shi Chengfang , Wang John Yilin
Published: August 2020

Dynamic drainage volume is a useful measure in evaluating well completions, well spacing, and water-flood operations. It is usually approximated with a two-dimensional circle or a three-dimensional (3D) box that encloses a well using empirical correlations and production/injection volumes. While this approximation may be convenient, it certainly is not a good estimation for the effective and dynamic drainage volume, which is key for improved recovery. This paper proposes a new method to compute dynamic drainage volumes based on reservoir simulation results. A 3D fluid flow velocity field is first generated and then visualized as a function of time. Through velocity thresholding, one can delineate flow regions, and accurately and parsimoniously determine well drainage in water-flood operations. Our new method was proven to be more efficient and practical as demonstrated in a field-based synthetic model with nine injectors and 16 producers formed as an inverted five-spot water-flood pattern commonly used in the field, and a benchmark SPE 9 model. The novelty of the method lies in that a 3D fluid velocity field is generated to determine dynamic drainage volume. Our new method could be applied to optimize well placement and improve well operation, and finally increase the production in a heuristic, instructive, and cost-effective manner to maximize the estimated ultimate recovery.
Study of Energy Saving Analysis for Different Industries
Authors: Abdel-Hadi Ahmad , Salem Abdel Rahman , Abbas Ahmad I. , Qandil Mohammad , Amano Ryoichi S.
Published: August 2020

This study analyzes the energy consumption and saving performance in the industries in the U.S.A. All energy assessments implemented were for facilities whose annual energy consumptions were less than 9,000,000 kWh (small- and medium-sized industries) that belong to the manufacturing industries with Standard Industrial Classification (SIC) codes ranging from 2000 to 3999 in addition to SIC codes starting with 49. In this study, assessments are classified based on the SIC codes with recommendations analysis for each classification to get a better idea of what recommendations were suggested in each major industrial sector, knowing that 68 assessments were made, and their SIC ranged from 14 to 49. In addition, this study could be considered as a guide for energy engineers and other personnel involved in the energy assessment process. The information investigated can give a better prediction for composing better energy-demanding industries and minimizing energy consumption. More than 61 energy assessments were conducted for manufacturing facilities and analyzing the data gathered and processed. Through the research, the Fabricated Metal industry achieved the highest average kWh savings and cost savings within the industries studied in this study. According to the average gigajoule (GJ) savings, the fabricated metal industry ranked second within the studied industries. Conversely, Food and Kindred Products achieved the highest GJ energy savings within the studied industries. Lighting, motors, compressors, and heating, ventilation, and air conditioning (HVAC) were the most contributing industries in a total of 547 recommendations.
Experimental Characterization of a Large-Range Parallel Kinematic XYZ Flexure Mechanism
Authors: Awtar Shorya , Quint Jason , Ustick John
Published: August 2020

Previously, we reported the conceptual design of a novel parallel-kinematic flexure mechanism that provides large and decoupled motions in the X, Y, and Z directions, along with good actuator isolation, and small parasitic error motions (Awtar, S., Ustick, J., and Sen, S., 2012, “An XYZ Parallel-Kinematic Flexure Mechanism With Geometrically Decoupled Degrees of Freedom,” ASME J. Mech. Rob., 5(1), p. 015001). This paper presents the detailed design and fabrication of a high-precision experimental setup to characterize and validate the motion attributes of this proposed flexure design via comprehensive measurements. The unique aspects of this experimental setup include a novel modular construction and exact-constraint assembly of the flexure mechanism from 12 identical parallelogram flexure modules. The flexure mechanism along with the sensing and actuation setup in the experiment is designed to enable large range (10 mm) in each direction. Experimental measurements and finite-elements analysis demonstrate <3% variation in motion direction stiffness, 20.4% lost motion, <11.6% cross-axis error, <3.3% actuator isolation, and <9.5 mrad motion stage rotation over the entire 10 mm × 10 mm × 10 mm range of motion.
Robust Observer-Based Finite Time Sliding Mode Control for One-Sided Lipschitz Systems With Uncertainties
Authors: Ren Junchao , Sun Jie , Li Fangfang
Published: August 2020

This paper investigates the problem of observer-based finite time sliding mode control (SMC) for a class of one-sided Lipschitz (OSL) systems with uncertainties. The parameter uncertainties are assumed to be time-varying norm-bounded appearing not only in both the state and output matrices but also in the nonlinear function. For a time interval [0,T], we divide it into two parts: one part is the reaching phase within [0,T*] and another part is the sliding motion phase within [T*,T]. First, the reachability of the sliding mode surface with T*≤T is proved. Next, several conditions are proposed which ensure robust finite time boundedness (FTB) of the corresponding closed-loop systems in the interval [0,T*] and [T*,T], respectively. Then, the sufficient conditions, which guarantee robust finite time boundedness of the closed-loop system in whole time interval [0,T], are given in terms of linear matrix inequalities (LMIs), and further the robust observer and controller can be designed in an LMI frame. A convex optimization problem subject to LMIs is formulated to optimize the desired performance indices of interest to us. Finally, a practical example is given to demonstrate the effectiveness of the proposed methods.
Assessment of Low-Re Turbulence Models and Analysis of Turbulent Flow in Porous Media Consisting of Square Cylinders With Different Diameter Ratios
Authors: Alonzo-Garcia Alejandro , Mendoza-Rosas Ana T. , Díaz-Viera Martín A. , Martínez-Delgadillo Sergio A. , Martínez-Mendoza Edgar G.
Published: August 2020

This paper presents a comparative study of volume average predictions between low-Reynolds-number (LRN) turbulence models: Abe–Kondoh–Nagano (AKN), Lam–Bremhorst, Yang–Shih, standard k–ϵ, and k–ω. A porous medium, which represents conditions in which the flow path changes rapidly, was defined as an infinite array of square cylinders. In addition, to explore the effect of particle size on the rapid expansion and contraction of the flow paths, the diameter ratio (DR) of the square cylinders was systematically varied from 0.2 to 0.8. This generalization revealed new insights into the flow. The Reynolds number (ReD) covered a turbulent range of 500 to 500 × 103, and the porosity ϕ was varied from 0.27 to 0.8. The correlations of the turbulent kinetic energy (k), its dissipation rate (ε), and macroscopic pressure gradient as a function of ϕ, which are useful in macroscopic turbulence modeling, are presented. The results show that the AKN model yields better predictions of the volume-averaged flow parameters because it is better suited to reproduce recirculation zones. For all the DRs, at high ϕ, the distances between walls are high, and the interstitial velocities are low. Consequently, wake flows are produced, and energy losses by friction are moderate. As the flow becomes increasingly bound, the wakes are suppressed and disrupted, and k and ε increase owing to shear layer interactions and frictional forces. Distinctive low-velocity recirculation patterns appear inside pores depending on DR.
Passive Reduction of Leakage by Transverse Jet
Authors: Wasilczuk Filip , Flaszyński Paweł , Kaczyński Piotr , Szwaba Ryszard , Doerffer Piotr , Marugi Krzysztof
Published: August 2020

This article presents investigations of mass flow reduction in a gap above a fin by the air curtain technique. The proposed method uses slots in the fin to generate a bypass flow and to create a fluidic barrier in the gap above the fin. Both numerical and experimental researches were conducted and the air curtain proved to be effective, showing the mass flow reduction up to about 20%. The comparison of numerical simulations and experimental data showed good agreement, and the flow structure details were analyzed based on the numerical results. The analysis shows that the blown air in the gap leads to creation of streamwise vortices. They enforce crosswise nonuniformity of the flow velocity in the gap and downstream, what finally influences on higher dissipation effects and mass flow reduction in the gap.
Droplet Impingement on a Surface at Low Reynolds Numbers
Authors: Seksinsky Drue , Marshall Jeffrey S.
Published: August 2020

A computational study was conducted of axisymmetric droplet impingement on a flat surface at low droplet Reynolds numbers. The study was motivated by the problem of deposition of melted volcanic ash particles within aircraft gas turbine engines. The computations were performed using the combined level-set volume-of-fluid method for droplet Reynolds numbers between 0.05 and 10. The computational predictions were validated using existing experimental data. The computations indicate that contact radius increases over short time in proportion to the square root of time, in agreement with short-time analytical predictions. Typical assumptions made in development of approximate droplet impingement models were evaluated for low Reynolds number droplet impingement. The droplet shape was well approximated by a truncated spherical cap through most of the impingement process. The surface area over which the droplet spreads increases with increase in Reynolds number. The axial velocity component was found to be approximately independent of radial location over most of the droplet, and the radial velocity component was observed to vary log-normally in the axial coordinate and linearly in radius. The energy dissipation rate was distributed throughout the droplet for low Reynolds numbers cases, but became increasingly localized near the contact line as the Reynolds number increased past unity.
Discrepancy in the Aerodynamic Property and Flowfield of a Symmetric Airfoil Produced by the Stationary and Moving Ground Effect
Authors: Tremblay-Dionne V. , Lee T.
Published: August 2020

The discrepancy in the aerodynamic property and flowfield of a symmetric airfoil produced by the stationary and moving ground effect was quantified through surface pressure and particle-image-velocimetry measurements. The results show that the stationary ground effect produced a higher lift than the moving ground due to the flow passage restriction caused by the longitudinal boundary layer developed on its ground surface. In close ground proximity, the formation of a ground vortex beneath the airfoil's leading-edge region speeded up the flow, leading to a lower lift than its moving-ground counterpart. For the moving ground, the ground vortex was absent. In close ground proximity, the moving ground effect generated a larger wake and drag than the stationary ground effect.
Multi-Objective Optimization of a High Specific Speed Centrifugal Volute Pump Using Three-Dimensional Inverse Design Coupled With Computational Fluid Dynamics Simulations
Authors: Zhang Luying , Davila Gabriel , Zangeneh Mehrdad
Published: August 2020

This paper presents three different multiobjective optimization strategies for a high specific speed centrifugal volute pump design. The objectives of the optimization consist of maximizing the efficiency and minimizing the cavitation while maintaining the Euler head. The first two optimization strategies use a three-dimensional (3D) inverse design method to parametrize the blade geometry. Both meridional shape and 3D blade geometry are changed during the optimization. In the first approach, design of experiment (DOE) method is used and the pump efficiency is obtained from computational fluid dynamics (CFD) simulations, while cavitation is evaluated by using minimum pressure on blade surface predicted by 3D inverse design method. The design matrix is then used to create a surrogate model where optimization is run to find the best tradeoff between cavitation and efficiency. This optimized geometry is manufactured and tested and is found to be 3.9% more efficient than the baseline with reduced cavitation at high flow. In the second approach, only the 3D inverse design method output is used to compute the efficiency and cavitation parameters and this leads to considerable reduction to the computational time. The resulting optimized geometry is found to be similar to the computationally more expensive solution based on 3D CFD results. In order to compare the inverse design based optimization to the conventional optimization, an equivalent optimization is carried out by parametrizing the blade angle and meridional shape.
Compliance of the 24-Hour Movement Guidelines in 9- to 11-Year-Old Children From a Low-Income Town in Chile
Authors: Toledo-Vargas Marcelo , Perez-Contreras Patricio , Chandia-Poblete Damian , Aguilar-Farias Nicolas
Published: August 2020

Background: The purpose was to determine the proportion of 9- to 11-year-old children meeting the 24-hour movement guidelines (24-HMG) in a low-income town from Chile. Methods: Physical activity, sedentary behavior (recreational screen), and sleep times were measured with both questionnaire and accelerometer in 258 children from third to sixth grade. Meeting the 24-HMG was defined as having ≥60 minutes per day of moderate to vigorous physical activity, ≤2 hour day of screen time, and 9 to 11 hours of sleep per night. Compliance rates were calculated as self-reported 24-HMG, with all estimations based on questionnaires, and mixed 24-HMG, in which physical activity and sleep were determined with an accelerometer and sedentary behavior was determined with a questionnaire. Results: About 198 children (10.1 [0.8] y, range 9–11 y) provided valid data for estimating self-reported 24-HMG, and 141 for mixed 24-HMG. Only 3.2% and 0.7% met the 24-HMG when using the self-reported and mixed methods, respectively. When assessing individual recommendations, 13.1% and 3.7% of the sample were physically active based on the self-report and accelerometer, respectively. About a quarter met the sedentary behavior recommendations, while around 50% met the sleep recommendations with both self-reported and mixed methods. Conclusions: An extremely low percentage of the participants met the 24-HMG. Multicomponent initiatives must be implemented to promote healthy movement behaviors in Chilean children.
Dissolved Microcystin Release Coincident with Lysis of a Bloom Dominated by
Microcystis
spp. in Western Lake Erie Attributed to a Novel Cyanophage
Authors: McKindles Katelyn M. , Manes Makayla A. , DeMarco Jonathan R. , McClure Andrew , McKay R. Michael , Davis Timothy W. , Bullerjahn George S.
Published: August 2020

Viral attack on cHABs may contribute to changes in community composition during blooms, as well as bloom decline, yet loss of bloom biomass does not eliminate the threat of cHAB toxicity. Rather, it may increase risks to the public by delivering a pool of dissolved toxin directly into water treatment utilities when the dominating
Microcystis
spp. are capable of producing microcystins. Detecting, characterizing, and quantifying the major cyanophages involved in lytic events will assist water treatment plant operators in making rapid decisions regarding the pool of microcystins entering the plant and the corresponding best practices to neutralize the toxin.
Unveiling Crucivirus Diversity by Mining Metagenomic Data
Authors: de la Higuera Ignacio , Kasun George W. , Torrance Ellis L. , Pratt Alyssa A. , Maluenda Amberlee , Colombet Jonathan , Bisseux Maxime , Ravet Viviane , Dayaram Anisha , Stainton Daisy , Kraberger Simona , Zawar-Reza Peyman , Goldstien Sharyn , Briskie James V. , White Robyn , Taylor Helen , Gomez Christopher , Ainley David G. , Harding Jon S. , Fontenele Rafaela S. , Schreck Joshua , Ribeiro Simone G. , Oswald Stephen A. , Arnold Jennifer M. , Enault François , Varsani Arvind , Stedman Kenneth M.
Published: August 2020

Viruses are the most abundant biological entities on Earth. In addition to their impact on animal and plant health, viruses have important roles in ecosystem dynamics as well as in the evolution of the biosphere. Circular Rep-encoding single-stranded (CRESS) DNA viruses are ubiquitous in nature, many are agriculturally important, and they appear to have multiple origins from prokaryotic plasmids. A subset of CRESS-DNA viruses, the cruciviruses, have homologues of capsid proteins encoded by RNA viruses. The genetic structure of cruciviruses attests to the transfer of capsid genes between disparate groups of viruses. However, the evolutionary history of cruciviruses is still unclear. By collecting and analyzing cruciviral sequence data, we provide a deeper insight into the evolutionary intricacies of cruciviruses. Our results reveal an unexpected diversity of this virus group, with frequent recombination as an important determinant of variability.
Interspecies Microbial Fusion and Large-Scale Exchange of Cytoplasmic Proteins and RNA in a Syntrophic
Clostridium
Coculture
Authors: Charubin Kamil , Modla Shannon , Caplan Jeffrey L. , Papoutsakis Eleftherios Terry
Published: August 2020

We report that two different bacterial organisms engage in heterologous cell fusion that leads to massive exchange of cellular material, including proteins and RNA, and the formation of persistent hybrid cells. The interspecies cell fusion observed here involves a syntrophic microbial system, but these heterologous cell fusions were observed even under nonstrict syntrophic conditions, leaving open the possibility that strict syntrophy may not be necessary for interspecies cell fusion and cellular material exchange. Formation of hybrid cells that contain proteins and RNA from both organisms is unexpected and unprecedented. Such fusion events are likely widely distributed in nature, but have gone undetected. The implications are profound and may shed light onto many unexplained phenomena in human health, natural environments, evolutionary biology, and biotechnology.
Respiratory Bacteria Stabilize and Promote Airborne Transmission of Influenza A Virus
Authors: Rowe Hannah M. , Livingston Brandi , Margolis Elisa , Davis Amy , Meliopoulos Victoria A. , Echlin Haley , Schultz-Cherry Stacey , Rosch Jason W.
Published: August 2020

Infection with influenza A virus (IAV), especially when complicated with a secondary bacterial infection, is a leading cause of global mortality and morbidity. Gaining a greater understanding of the transmission dynamics of IAV is important during seasonal IAV epidemics and in the event of a pandemic. Direct bacterium-virus interactions are a recently appreciated aspect of infectious disease biology. Direct interactions between IAV and specific bacterial species of the human upper respiratory tract were found to promote the stability and infectivity of IAV during desiccation stress. Viral environmental stability is an important aspect during transmission, suggesting a potential role for bacterial respiratory communities in IAV transmission. Airborne transmission of IAV was abrogated upon depletion of nasal bacterial flora with topical antibiotics. This defect could be functionally complemented by
S. pneumoniae
coinfection. These data suggest that bacterial coinfection may be an underappreciated aspect of IAV transmission dynamics.
The impact of weathering upon the roughness characteristics of a splay of the active fault system responsible for the massive 2016 seismic sequence of the Central Apennines, Italy
Authors: Corradetti Amerigo , Zambrano Miller , Tavani Stefano , Tondi Emanuele , Seers Thomas Daniel
Published: August 2020

Fault roughness constitutes a key element in the understanding of earthquake nucleation, and surficial asperities on the fault plane play a critical role in slip dynamics and frictional behavior during the seismic cycle. Since it is not generally feasible to recover fault roughness profiles or maps directly at the seismogenic sources, faults at the Earth’s surface are typically used as analogues. However, these analogue fault surfaces are often subjected to weathering and erosion, which in turn, reduces their representativeness as seismogenic faults. Rupture along active faults episodically exposes “fresh” fault planes at the Earth’s surface, which represent the best available targets for the evaluation of fault roughness generated at seismogenic depths.

Here we present a study conducted on a splay of the Mt. Vettore fault system in the Central Apennines, Italy, along a vertical transect that includes both a weathered and freshly exposed portion of the fault. The latter was exposed after the dramatic Mw 6.5 shock that hit the area on 30 October 2016. We have produced a highly detailed model (i.e., point cloud) of a section of the fault using structure from motion-multiview stereo photogrammetry to assess its roughness parameters (i.e., the Hurst fractal parameter) and to determine the extent to which these parameters are affected by weathering assuming that they had similar fractal characteristics when reaching the surface.

Our results show that weathering can modify the value of the fractal parameters. In particular, by independently analyzing different patches of the fault, we have observed that the smoother and recently exposed portions have an average Hurst exponent of 0.52 while the average Hurst exponent of zones with more prolonged exposure times is 0.64. Accordingly, we conclude that by using high-resolution point clouds, it is possible to recognize patches of faults having a similar intensity of deterioration attributable to weathering.
Pancreaticopleural fistula: an uncommon cause of amylase-rich pleural effusion
Authors: Kraskovsky Valeri , Mackenzie Brianne , Mador Martin Jeffery
Published: August 2020

Pancreaticopleural fistula (PPF) causing pleural effusion as a complication of chronic pancreatitis is a rare finding. We present this finding in a 52-year-old man with a medical history significant for alcohol abuse, acute on chronic pancreatitis and severe chronic obstructive pulmonary disease, who presented with worsening dyspnoea for 3 days. CT scan of the chest showed a new large right-sided pleural effusion. Thoracentesis was performed and pleural fluid analysis showed an amylase-rich, exudative pleural effusion. The effusion reaccumulated within 3 days necessitating repeat thoracentesis. Endoscopic retrograde chloangiopancreatography showed contrast leak through a single disruption in the dorsal pancreatic duct, suspicious for an underlying PPF. The patient underwent stenting of the pancreatic duct with subsequent resolution of right-sided pleural effusion.
Using structural and functional MRI as a neuroimaging technique to investigate chronic fatigue syndrome/myalgic encephalopathy: a systematic review
Authors: Almutairi Basim , Langley Christelle , Crawley Esther , Thai Ngoc Jade
Published: August 2020

Objective

This systematic review aims to synthesise and evaluate structural MRI (sMRI) and functional MRI (fMRI) studies in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

Methods

We systematically searched Medline and Ovid and included articles from 1991 (date of Oxford diagnostic criteria for CFS/ME) to first April 2019. Studies were selected by predefined inclusion and exclusion criteria. Two reviewers independently reviewed the titles and abstracts to determine articles for inclusion, full text and quality assessment for risk of bias.

Results

sMRI studies report differences in CFS/ME brain anatomy in grey and white matter volume, ventricular enlargement and hyperintensities. Three studies report no neuroanatomical differences between CFS/ME and healthy controls. Task-based fMRI investigated working memory, attention, reward and motivation, sensory information processing and emotional conflict. The most consistent finding was CFS/ME exhibited increased activations and recruited additional brain regions. Tasks with increasing load or complexity produced decreased activation in task-specific brain regions.

Conclusions

There were insufficient data to define a unique neural profile or biomarker of CFS/ME. This may be due to inconsistencies in finding neuroanatomical differences in CFS/ME and the variety of different tasks employed by fMRI studies. But there are also limitations with neuroimaging. All brain region specific volumetric differences in CFS/ME were derived from voxel-based statistics that are biased towards group differences that are highly localised in space. fMRI studies demonstrated both increases and decreases in activation patterns in CFS/ME, this may be related to task demand. However, fMRI signal cannot differentiate between neural excitation and inhibition or function-specific neural processing. Many studies have small sample sizes and did not control for the heterogeneity of this clinical population. We suggest that with robust study design, subgrouping and larger sample sizes, future neuroimaging studies could potentially lead to a breakthrough in our understanding of the disease.
Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study
Authors: Holton Alice E , Keeney Cora , Ryan Benedict , Cousins Gráinne
Published: August 2020

Objective

Previous prevalence estimates of POtentially Serious Alcohol–Medication INteractions in Older adults (POSAMINO) are based on in-home inventories of medications; however, this method is associated with under-reporting of medications when compared with dispensing records. This study aims to estimate the prevalence of POSAMINO among community-dwelling older adults using drug dispensing data from the community pharmacy setting.

Design

Cross-sectional study.

Setting

Irish Community Pharmacy.

Participants

1599 consecutive older adults presenting with a prescription to 1 of 120 community pharmacies nationwide; community-dwelling, aged ≥65 years, able to speak and understand English, with no evidence of cognitive impairment. The mean age of sample was 75.5 years (SD 6.5); 55% (n=884) female.

Measures

38 POSAMINO criteria were identified using participants’ pharmacy dispensing records linked to self-reported alcohol consumption (beverage-specific quantity and frequency measures) over the last 12 months.

Results

The overall prevalence of POSAMINO in the study population was 28%, with 10% at risk of at least one POSAMINO criteria and 18% at risk of two or more. Exposure to POSAMINO most commonly involved cardiovascular agents (19%) and central nervous system agents (15%). Exposure to a higher number of POSAMINO criteria was associated with younger age (adjusted incident rate ratio (AIRR): 0.97; 95% CI: 0.95 to 0.98), male sex (AIRR: 0.55; 95% CI: 0.45 to 0.67) and a higher number of comorbidities (AIRR: 1.05; 95% CI: 1.01 to 1.13).

Conclusion

This study adds to the growing body of evidence, which suggests that older adults are vulnerable to potentially serious alcohol–medication interactions, particularly those involving cardiovascular and central nervous system agents, increasing their risk of orthostatic hypotension, gastrointestinal bleeds and increased sedation. Application of the POSAMINO criteria at the point of prescribing may facilitate the risk stratification of older adults and prioritise alcohol screening and brief alcohol interventions in those at greatest risk of harm.
Understanding parents’ experiences of disease course and influencing factors: a 3-year follow-up qualitative study among parents of children with functional abdominal pain
Authors: Brekke Mette , Brodwall Anne
Published: August 2020

Objective

Functional abdominal pain is a common symptom in children and adolescents. Three years ago, we investigated the experiences among parents whose children had chronic abdominal pain but no somatic diagnosis. The aim of the present follow-up study was to explore those families’ current situations.

Design

Interviews with open questions about the families’ current pain situations were carried out by the first author. Interviews were audio-recorded and transcribed, and subsequently analysed using descriptive content analysis.

Setting

Urban and rural areas in two municipalities in Southern Norway.

Participants

Parents of children with abdominal pain who had been referred to a local hospital by their general practitioner and had been discharged without a somatic diagnosis. Fifteen parents of 14 children aged 8–17 years who had also been interviewed in 2016.

Results

Nine of the children had recovered from their abdominal pain. During the pain period, the parents reported frustration with not having a diagnosis nor a specific treatment for their child’s abdominal pain. The siblings in some families received less attention and were afraid that something serious might happen to their sister or brother. The parents wished that their child’s school cared more about the child when they had weeks of absence. All parents maintained that their child’s pain was physical, although they thought that psychological aspects might have influenced the symptoms. The parents stated that they, as well as their children, needed guidance from professionals to understand the complex pain situation.
Global and regional incidence, mortality and disability-adjusted life-years for Epstein-Barr virus-attributable malignancies, 1990–2017
Authors: Khan Gulfaraz , Fitzmaurice Christina , Naghavi Mohsen , Ahmed Luai A
Published: August 2020

Objective

To determine the global and regional burden of Epstein-Barr virus (EBV)-attributed malignancies.

Design

An international comparative study based on the Global Burden of Disease (GBD) Study estimates.

Setting

Global population by age, sex, region, demographic index and time.

Methods and outcome measures

The burden of EBV-attributed Burkitt lymphoma (BL), Hodgkin lymphoma (HL), nasopharyngeal carcinoma (NPC) and gastric carcinoma (GC) was estimated in a two-step process. In the first step, the fraction of each malignancy attributable to EBV was estimated based on published studies; this was then applied to the GBD estimates to determine the global and regional incidence, mortality and disability-adjusted life-years (DALYs) for each malignancy by age, sex, geographical region and social demographic index (SDI) from 1990 to 2017.

Results

The combined global incidence of BL, HL, NPC and GC in 2017 was 1.442 million cases, with over 973 000 deaths. An estimated 265 000 (18%) incident cases and 164 000 (17%) deaths were due to the EBV-attributed fraction. This is an increase of 36% in incidence and 19% in mortality from 1990. In 2017, EBV-attributed malignancies caused 4.604 million DALYs, of which 82% was due to NPC and GC alone. The incidence of both of these malignancies was higher in high and middle-high SDI regions and peaked in adults aged between 50 and 70 years. All four malignancies were more common in males and the highest burden was observed in East Asia.

Conclusions

This study provides comprehensive estimates of the burden of EBV-attributed BL, HL, NPC and GC. The overall burden of EBV-related malignancies is likely to be higher since EBV is aetiologically linked to several other malignancies not included in this analysis. Increasing global population and life expectancy is expected to further raise this burden in the future. The urgency for developing an effective vaccine to prevent these malignancies cannot be overstated.
Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis
Authors: Hovlid Einar , Braut Geir Sverre , Hannisdal Einar , Walshe Kieran , Bukve Oddbjørn , Flottorp Signe , Stensland Per , Frich Jan C
Published: August 2020

Objectives

External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections.

Methods

We performed a literature search (1980–January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change.

Results

We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation’s current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance.

Conclusions

External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.
Palliative care utilisation: family carers’ behaviours and determinants—a qualitative interview study
Authors: Scherrens Anne-Lore , Beernaert Kim , Magerat Laurence , Deliens Luc , Deforche Benedicte , Cohen Joachim
Published: August 2020

Objectives

Most research on starting palliative care focuses on the role of healthcare services and professional carers. However, patients and their family carers may also play a role. Especially opportunities for starting palliative care might exist among family carers. This study focused on family carers by identifying their behaviours and underlying determinants that might contribute to starting palliative care.

Methods

A qualitative study with 16 family carers of deceased persons who used palliative care was conducted using semistructured, face-to-face interviews. Constant comparison analysis was used to identify groups of behaviours that influenced starting palliative care and related determinants. The behavioural determinants were matched with concepts in existing behavioural theories. A preliminary behavioural model was developed.

Results

Most reported behaviours regarding starting palliative care were related to communicating with the seriously ill person, other family members and professional carers; seeking information and helping the seriously ill person process information from professional carers; and organising and coordinating care. Determinants facilitating and hindering these behaviours included awareness (eg, of poor health), knowledge (eg, concerning palliative care), attitudes (eg, negative connotations of palliative care) and social influences (eg, important others’ opinions about palliative care).

Conclusions

This study identified relevant family carers’ behaviours and related determinants that can contribute to starting palliative care. As these determinants are changeable, the palliative care behavioural model that resulted from this study can serve as a basis for the development of behavioural interventions aiming at supporting family carers in performing behaviours that might contribute to starting palliative care.
Palliative sedation therapy for terminal movement disorders
Authors: Partain Daniel Kent , Zehm April
Published: August 2020

Palliative sedation therapy (PST) can be a challenging area of palliative medicine because of the complex ethical considerations involved. PST is a medical therapy used for refractory symptoms in terminally ill patients and is often considered ethically justified due to the principle of double effect. Even in cases where PST is clearly indicated such as refractory cancer pain, there is potential for moral distress among clinicians. Here, we present a unique case in which multiple therapeutic options were limited in a patient with overlapping diagnoses of catatonia, medication-induced extrapyramidal symptoms, and dementia with Lewy bodies. We review how existing frameworks can be applied to similar situations and offer practical strategies to support medical decision-making regarding PST and reduce the risk of moral distress among clinicians.
Frequency of diabetes and other comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy and their impact on clinical presentation and response to therapy
Authors: Doneddu Pietro Emiliano , Cocito Dario , Manganelli Fiore , Fazio Raffaella , Briani Chiara , Filosto Massimiliano , Benedetti Luana , Bianchi Elisa , Jann Stefano , Mazzeo Anna , Antonini Giovanni , Cosentino Giuseppe , Marfia Girolama Alessandra , Cortese Andrea , Clerici Angelo Maurizio , Carpo Marinella , Schenone Angelo , Siciliano Gabriele , Luigetti Marco , Lauria Giuseppe , Rosso Tiziana , Cavaletti Guido , Beghi Ettore , Liberatore Giuseppe , Santoro Lucio , Spina Emanuele , Peci Erdita , Tronci Stefano , Ruiz Marta , Cotti Piccinelli Stefano , Verrengia Elena Pinuccia , Gentile Luca , Leonardi Luca , Mataluni Giorgia , Piccolo Laura , Nobile-Orazio Eduardo
Published: August 2020

Objectives

To determine the prevalence of different comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and their impact on outcome, treatment choice and response.

Methods

Using a structured questionnaire, we collected information on comorbidities from 393 patients with CIDP fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society criteria included in the Italian CIDP database.

Results

One or more comorbidities were reported by 294 patients (75%) and potentially influenced treatment choice in 192 (49%) leading to a less frequent use of corticosteroids. Response to treatment did not differ, however, from that in patients without comorbidities. Diabetes (14%), monoclonal gammopathy of undetermined significance (MGUS) (12%) and other immune disorders (16%) were significantly more frequent in patients with CIDP than expected in the general European population. Patients with diabetes had higher disability scores, worse quality of life and a less frequent treatment response compared with patients without diabetes. Patients with IgG-IgA or IgM MGUS had an older age at CIDP onset while patients with other immune disorders had a younger age at onset and were more frequently females. IgM MGUS was more frequent in patients with motor CIDP than in patients with typical CIDP.

Conclusions

Comorbidities are frequent in patients with CIDP and in almost 50% of them have an impact on treatment choice. Diabetes, MGUS and other immune diseases are more frequent in patients with CIDP than in the general population. Only diabetes seems, however, to have an impact on disease severity and treatment response possibly reflecting in some patients a coexisting diabetic neuropathy.
Serum free testosterone and asthma, asthma hospitalisations and lung function in British adults
Authors: Han Yueh-Ying , Yan Qi , Yang Ge , Chen Wei , Forno Erick , Celedon Juan Carlos
Published: August 2020

Objective

We examined the relation between serum-free testosterone and asthma, wheeze, asthma hospitalisations and lung function in older adults.

Design

Cross-sectional study.

Setting

UK.

Participants

256 419 adults aged 40 to 69 years, recruited from 2006 to 2010.

Main outcome measures

Multivariable logistic or linear regression was used for the analysis of free testosterone and physician-diagnosed asthma, current wheeze, asthma hospitalisations and lung function measures, which was adjusted for serum estradiol, smoking status and other covariates.

Results

Free testosterone levels above the lowest quartile (Q1) were significantly associated with lower odds of asthma in both women (adjusted OR (aOR) for Q4 (the highest quartile) versus Q1=0.67, 95% CI=0.64 to 0.71) and men (aOR for Q4 versus Q1=0.87, 95% CI=0.82 to 0.91). Among subjects with asthma, free testosterone levels above Q1 were significantly associated with lower odds of current wheeze in women (aOR range=0.78 to 0.87), and free testosterone levels in Q4 were associated with lower odds of current wheeze in men (aOR for Q4 versus Q1=0.86, 95% CI=0.77 to 0.95). Among women with asthma, free testosterone levels in Q4 were also associated with lower odds of ≥1 asthma hospitalisation. Among men, free testosterone was positively associated with FEV1 and FVC. Among women, free testosterone was negatively and weakly associated with FVC.

Conclusion

In a large study of British adults, elevated free testosterone levels are associated with lower odds of asthma and current wheeze in women and men, lower odds of asthma hospitalisations in women, and higher FEV1 and FVC in men.

Dissemination to participants, and related patient and public communities

The results of the study will be linked to the UK Biobank website.
Associations of CT evaluations of antigravity muscles, emphysema and airway disease with longitudinal outcomes in patients with COPD
Authors: Tanabe Naoya , Sato Susumu , Tanimura Kazuya , Oguma Tsuyoshi , Sato Atsuyasu , Muro Shigeo , Hirai Toyohiro
Published: August 2020

Multiple CT indices are associated with disease progression and mortality in patients with COPD, but which indices have the strongest association remain unestablished. This longitudinal 10-year observational study (n=247) showed that the emphysema severity on CT is more closely associated with the progression of airflow limitation and that a reduction in the cross-sectional area of erector spinae muscles (ESMCSA) on CT is more closely associated with mortality than the other CT indices, independent of patient demographics and pulmonary function. ESMCSAis a useful CT index that is more closely associated with long-term mortality than emphysema and airway disease in patients with COPD.