bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study on Sodium–Concrete Reaction in Presence of Internal Heating
Authors: Kawaguchi Munemichi , Miyahara Shinya , Uno Masayoshi
Published: January 2020

The sodium–concrete reaction (SCR) is an important phenomenon during severe accidents in sodium-cooled fast reactors (SFRs), as it generates large volumes of hydrogen and aerosols in the containment vessel along with structural concrete ablation. In this study, the chemical reaction beneath the internal heater (800 °C) was investigated in SCR experiments with internal heating. The experiments simulate the effects of obstacles and heating on the SCR. Especially, we focused on the concrete ablation phenomenon because the hydrogen generation is sourced from the moisture in the concrete. The effects of internal heating on the self-termination mechanism are also discussed. The internal heater on the concrete hindered the transport of sodium (Na) into the concrete. Therefore, the reaction between Na and the concrete began at the periphery of the internal heater, where the concrete ablation depth was larger than under the internal heater. The high Na pool temperature (800 °C) largely increased the Na aerosol-release rate, which was explained by Na evaporation and formed a porous reaction-product layer. The Si mass balance and image mapping by an electron-probe micro-analyzer yielded consistent porosities in the reaction-product layer (0.54–0.59). The porous reaction products suppressed the amount of Na transported into the reaction front. Regardless of the internal heater placement, the Na concentration around the reaction front was limited to around 30 wt %. The Na concentration condition was dominantly responsible for the self-termination of the internally heated SCR.
Fracture and Energetic Strength Scaling of Soft, Brittle, and Weakly Nonlinear Elastomers
Authors: Gonzalez Kevin , Xue Jing , Chu Andy , Kirane Kedar
Published: January 2020

An investigation is presented into the fracture and energetic strength scaling of soft and brittle polydimethylsiloxane (PDMS)-based elastomers. Mode I tensile fracture tests on pre-cracked specimens of various sizes are carried out with two PDMS elastomers significantly varying in their stiffness, strength, and toughness. The results are interpreted within the existing framework of the energetic type II Bazant size effect law (SEL). The SEL is found to be applicable to the PDMS elastomers despite their nonlinear stress-strain behavior. This is because the nonlinearity is rather weak, making the strain energy approximately proportional to the square of the nominal stress, similar to linear elastic materials. It is found that at the lab scale, the structural strength of both elastomers scales in a self-similar fashion with specimen size and falls on the large size asymptote of the SEL. Then, the strengths of much smaller specimens are numerically predicted using the cohesive crack model. For both elastomers, these strengths are found to fall squarely on the transitional part of the SEL, implying incomplete self-similarity and a transition to quasi-brittle fracturing. This is due to the increased dominance of the fracture process zone whose size is estimated by various methods. It is shown that if this transition is not accounted for, the structural strength can be over-predicted by 140% or even more for smaller sizes. Thus, for the first time, it is shown that soft elastomers, if weakly nonlinear, exhibit conformance to the energetic type II strength scaling laws.
Finite Element-Predicted Effects of Screw Configuration in Proximal Humerus Fracture Fixation
Authors: Tilton Maryam , Armstrong April D. , Wee Hwabok , Hast Michael W. , Manogharan Guha , Lewis Gregory S.
Published: January 2020

Internal fixation with the use of locking plates is the standard surgical treatment for proximal humerus fractures, one of the most common fractures in the elderly. Screw cut-out through weak cancellous bone of the humeral head, which ultimately results in collapse of the fixed fracture, is the leading cause of failure and revision surgery. In an attempt to address this problem, surgeons often attach the plate with as many locking screws as possible into the proximal fragment. It is not thoroughly understood which screws and screw combinations play the most critical roles in fixation stability. This study conducted a detailed finite element analysis to evaluate critical parameters associated with screw cut-out failure. Several clinically relevant screw configurations and fracture gap sizes were modeled. Findings demonstrate that in perfectly reduced fracture cases, variation of the screw configurations had minor influence on mechanical stability of the fixation. The effects of screw configurations became substantial with the existence of a fracture gap. Interestingly, the use of a single anterior calcar screw was as effective as utilizing two screws to support the calcar. On the other hand, the variation in calcar screw configuration had minor influence on the fixation stability when all the proximal screws (A-D level) were filled. This study evaluates different screw configurations to further understand the influence of combined screw configurations and the individual screws on the fixation stability. Findings from this study may help decrease the risk for screw cut-out with proximal humerus varus collapse and the associated economic costs.
Research Opportunities and Challenges in Engineering System Evolution
Authors: Zhang Guanglu , Morris Elissa , Allaire Douglas , McAdams Daniel A.
Published: January 2020

Research in engineering system evolution studies the technical performance (e.g., speed, capacity, and energy efficiency) and the functional and architectural changes of engineering systems (e.g., automobiles, aircrafts, laptops, and smartphones) over time. The research results of engineering system evolution help designers, R&D managers, investors, and policy makers to generate innovative design concepts, set reasonable R&D targets, invest in promising technologies, and develop effective incentive policies. In this paper, we introduce engineering system evolution as an emerging research area. We develop a cyclic model to understand the general structure of engineering system evolution and summarize seven basic research questions accordingly. A review and analysis of prior research related to engineering system evolution is provided to identify the pioneering works in this promising research area. We also discuss the challenges and opportunities in the quantitative and qualitative study of engineering system evolution for future research.
Label-Free cDNA Detection Based on Radiofrequency Scattering Parameters: A New Approach for an Inexpensive Gene Sensor
Authors: Gnaim Rima , Sheviryov Julia , Golberg Alexander , Ames Gerardo , Oziel Moshe , González César A.
Published: January 2020

A new gene detection technique that is fast, inexpensive, and easy-to-use is urgently needed in hospitals, clinics, and laboratories without access to expensive equipments. The lack of a practical, minimally invasive, and economical method constitutes the main impediment to the promotion of genetic medicine in developing countries. Radiofrequency scattering parameters are an inexpensive gene sensor potentially capable of noninvasively identifying biological materials. They represent a quantitative value for the electromagnetic reflection/transmission characteristics of certain molecular markers in a given frequency domain. The S21 parameter is the difference between the signal received and that transmitted. The aim of this study is to evaluate the S21 transmittance parameters (magnitude and phase) as an indirect impedance measurement for detecting the label-free complementary deoxyribonucleic acid (cDNA) amplification of the 16S ribosomal subunit gene. S21 values showed differences associated with distinct cDNA concentrations. Hence, this technique could possibly facilitate the design of an inexpensive, label-free, and easy-to-use gene sensor.
Strain-Based Failure Assessment Based on a Reference Strain Method for Welded Pipelines
Authors: Lee Jae-Sung , Kim Myung-Hyun
Published: January 2020

Engineering critical assessment (ECA) is an evaluation procedure for structures with flaws and has been widely applied for assessing pipeline integrity. The standards for structural integrity assessment, including BS 7910, involve stress-based ECA, and they are known to produce overly conservative results. Therefore, strain-based ECA has been recently developed as an alternative approach. One of the effective methods for improving the accuracy of strain-based ECA is the reference strain method. However, only a limited number of studies have applied this method to welded pipelines. Therefore, a numerical analysis based on strain-based ECA was performed for girth-welded joints with a circumferentially oriented internal surface crack. Particular attention was given to the strength mismatch effects. The equivalent stress–strain curve in BS7910 was used to reflect the strength mismatch effects in the reference strain. The results of the proposed method were validated with the results of a finite element analysis (FEA) in terms of the J-integral. Previous methods and the proposed method exhibit a reasonable correlation of the J-integral in the case of over-matching (OM). In the under-matching (UM) cases, while the previous procedures tended to underestimate or excessively overestimate the elastic-plastic energy release rate in comparison with the FEA, the proposed method evaluated the J-integral of pipelines with sufficient accuracy.
Section VIII: Division 2–Alternative Rules
Authors: Osage David A. , Rodery Clay D. , Pastor Thomas P. , Brown Robert G. , Henry Philip A. , Sowinski James C.
Published: January 2020

This chapter covers alternative rules to the construction of pressure vessels under Section VIII, Division 2. The Section is made up of nine parts and the organization within each part is as follows: rules and requirements, nomenclature, tables, figures, normative annexes, and informative annexes. Part 1 contains general requirements addressing the following subjects: reference standards, units of measurement, tolerances, and technical inquiries. Part 2 consolidates the responsibilities and duties of the User, Manufacturer, and Authorized Inspector. It also contains general requirements for report forms and maintenance of records. Part 3 contains all requirements related to materials of construction and is organized in a similar fashion to Part AM of VIII-2. The coverage includes materials permitted for construction of vessel parts, and supplemental requirements for ferrous materials, Cr–Mo steels, Q and T steels with enhanced tensile properties, nonferrous metals, and boltings and castings. The requirements of Part 4 provide design rules for commonly used pressure vessel shapes under pressure loading and, within specified limits, rules or guidance for treatment of other loadings. Design requirements for the application of the design-by-analysis methodology in VIII-2 are described in Part 5. Detailed design procedures utilizing the results from a stress analysis are provided to evaluate components for plastic collapse, local failure, buckling, and cyclic loading. Part 6 consolidates the various fabrication requirements from old VIII-2 and VIII-1. Part 7 contains the requirements for examination during construction of pressure vessels. Part 7A covers the responsibilities and duties for inspection and examination during construction of pressure vessels. Part 8, which contains the rules pertaining to the pressure testing of the vessel following completion of fabrication, describes requirements for hydrostatic testing and pneumatic testing. The requirements for overpressure protection of vessels built in accordance with this VIII-2 are provided in Part 9.
AlOx surface passivation of black silicon by spatial ALD: Stability under light soaking and damp heat exposure
Authors: Heikkinen Ismo T. S. , Koutsourakis George , Virtanen Sauli , Yli-Koski Marko , Wood Sebastian , Vähänissi Ville , Salmi Emma , Castro Fernando A. , Savin Hele
Published: January 2020

Scientific breakthroughs in silicon surface passivation have enabled commercial high-efficiency photovoltaic devices making use of the black silicon nanostructure. In this study, the authors report on factors that influence the passivation stability of black silicon realized with industrially viable spatial atomic layer deposited (SALD) aluminum oxide (AlOx) under damp heat exposure and light soaking. Damp heat exposure conditions are 85 °C and 85% relative humidity, and light soaking is performed with 0.6 sun illumination at 75 °C. It is demonstrated that reasonably thick (20 nm) passivation films are required for both black and planar surfaces in order to provide stable surface passivation over a period of 1000 h under both testing conditions. Both surface textures degrade at similar rates with 5 and 2 nm thick films. The degradation mechanism under damp heat exposure is found to be different from that in light soaking. During damp heat exposure, the fixed charge density of AlOx is reduced, which decreases the amount of field-effect passivation. Degradation under light soaking, on the other hand, is likely to be related to interface defects between silicon and the passivating film. Finally, a thin chemically grown SiOx layer at the interface between the AlOx film and the silicon surface is shown to significantly increase the passivation stability under both light soaking and damp heat exposure. The results of this study provide valuable insights into surface passivation degradation mechanisms on nanostructured silicon surfaces and pave the way for the industrial production of highly stable black silicon devices.
Compromised Dynamic Postural Stability Under Increased Load Carriage Magnitudes
Authors: LaGoy Alice D. , Johnson Caleb , Allison Katelyn F. , Flanagan Shawn D. , Lovalekar Mita T. , Nagai Takashi , Connaboy Chris
Published: January 2020

Warfighter performance may be compromised through the impact of load carriage on dynamic postural stability. Men and women may experience this impact to differing extents due to postural stability differences. Therefore, the authors investigated the effect of load magnitude on dynamic postural stability in men and women during a landing and stabilization task. Dynamic postural stability of 32 subjects (16 women) was assessed during the unilateral landing of submaximal jumps under 3 load conditions: +0%, +20%, and +30% body weight. Dynamic postural stability was measured using the dynamic postural stability index, which is calculated from ground reaction force data sampled at 1200 Hz. Two-way mixed-measures analysis of variance compared dynamic postural stability index scores between sexes and loads. Dynamic postural stability index scores were significantly affected by load (P = .001) but not by sex or by the sex by load interaction (P > .05). Dynamic postural stability index scores increased between the 0% (0.359 ± 0.041), 20% (0.396 ± 0.034), and 30% (0.420 ± 0.028) body weight conditions. Increased load negatively affects dynamic postural stability with similar performance decrements displayed by men and women. Men and women warfighters may experience similar performance decrements under load carriage conditions of similar relative magnitudes.
Hereditary spastic paraplegia SPG8 mutations impair CAV1-dependent, integrin-mediated cell adhesion
Authors: Lee Seongju , Park Hyungsun , Zhu Peng-Peng , Jung Soon-Young , Blackstone Craig , Chang Jaerak
Published: January 2020

Hereditary spastic paraplegia–associated mutations in a WASH complex component impair integrin-mediated cell adhesion.
The GPCR accessory protein MRAP2 regulates both biased signaling and constitutive activity of the ghrelin receptor GHSR1a
Authors: Rouault Alix A. J. , Rosselli-Murai Luciana K. , Hernandez Ciria C. , Gimenez Luis E. , Tall Gregory G. , Sebag Julien A.
Published: January 2020

An accessory protein suppresses β-arrestin–dependent signaling and constitutive activity of the ghrelin receptor.
Near-Complete Genome Sequences of
Rice Yellow Mottle Virus
Isolates from Senegal
Authors: Tall H. , Aribi J. , Camara S. , Pinel-Galzi A. , Poulicard N. , Fargette D. , Hébrard E.
Published: January 2020

Rice yellow mottle virus
in Senegal is reported here for the first time. The near-complete genomic sequences of two isolates (Se1 and Se5) were obtained. A comparison with 18 sequences from West Africa revealed a new cluster with an isolate from Gambia, located at a basal position in the phylogenetic tree.
Complete Genome Sequence of an American Isolate of Pepino Mosaic Virus
Authors: Abrahamian Peter , Hammond John , Hammond Rosemarie W.
Published: January 2020

Pepino mosaic virus (PepMV) is a widely distributed tomato virus. The complete genome sequence of the PepMV isolate US3 from infected tomato fruit was determined. The genome is 6,410 nucleotides long and has a poly(A) tail. US3 shares the highest similarity with strains belonging to the European genotype.
Draft Genome Sequences of Two
Pseudomonas
Strains That Are Able To Use Furan Derivatives as Their Sole Carbon Source
Authors: Farkas Carlos , Donoso Raúl A. , Gárate-Castro Carla , Villegas Pamela , Durán Roberto E. , Seeger Michael , Pérez-Pantoja Danilo
Published: January 2020

Pseudomonas
sp. strains ALS1279 and ALS1131 were isolated from wastewater treatment facilities on the basis of their ability to use furfural, a key lignocellulose-derived inhibitor, as their only carbon source. Here, we present the draft genome sequences of both strains, which can shed light on catabolic pathways for furan compounds in pseudomonads.
Complete Genome Sequence of Lactobacillus plantarum Strain JDARSH, Isolated from Sheep Milk
Authors: Patil Abhinandan , Dubey Anamika , Malla Muneer Ahmad , Disouza John , Pawar Shivaji , Alqarawi Abdulaziz A. , Hashem Abeer , Abd_Allah Elsayed Fathi , Kumar Ashwani
Published: January 2020

Lactobacillus plantarum
strain JDARSH, a potential probiotic with a wide range of functions, was isolated from sheep milk. Here, we report the whole-genome sequence of this bacterium. The draft genome yielded a 3.20-Mb genome and 2,980 protein-coding sequences.
Metagenome-Assembled Genome Sequences of Five Strains from the
Microtus ochrogaster
(Prairie Vole) Fecal Microbiome
Authors: Donovan Meghan , Lynch Michael D. J. , Mackey Calvin S. , Platt Grayson N. , Washburn Brian K. , Vera Daniel L. , Trickey Darryl J. , Charles Trevor C. , Wang Zuoxin , Jones Kathryn M.
Published: January 2020

The prairie vole (
Microtus ochrogaster
) is an important model for the study of social monogamy and dual parental care of offspring. Characterization of specific host species-microbe strain interactions is critical for understanding the effects of the microbiota on mood and behavior. The five metagenome-assembled genome sequences reported here represent an important step in defining the prairie vole microbiome.
Genome Sequences of Chikungunya Virus Strains from Bangladesh and Thailand
Authors: Pyke Alyssa T. , McMahon Jamie , Burtonclay Peter , Nair Neelima , De Jong Amanda
Published: January 2020

We sequenced the genomes of two chikungunya virus isolates obtained from viremic patients who had traveled to Australia. The first patient acquired the infection in Bangladesh in 2017, and the second was infected in Thailand in 2019. Phylogenetic sequence analysis demonstrated that both isolates belonged to the East/Central/South African genotype.
Bilateral hamstring origin calcification: rare presentation of Gitelman syndrome
Authors: Mohan Rahul , Dhotare Satish Vinayakrao , Unnikrishnan P Nithin , Jakaraddi Chetan
Published: January 2020

This case report is the first case to our knowledge of intratendinous or peritendinous calcification reported in Gitelman syndrome (GS) patients. GS represents the clinical manifestations of inactivation of theSlc12a3genes encoding the thiazide-sensitive sodium chloride cotransporter and theTrpm6-Mggenes encoding the magnesium transporters in the distal convoluted tubule. Hence, the biochemical findings resemble those with thiazide diuretics such as hypokalaemia, hypomagnesaemia, hypocalciuria, metabolic alkalosis and low normal blood pressure. Serum calcium and phosphate levels are usually unaffected in GS unless associated with hyperparathyroidism or other hypercalcaemic aetiologies. We report a 69-year-old male patient with a history of GS who presented with bilateral ischial tuberosity tenderness. Further investigations confirmed the calcification of bilateral hamstring origin. Chondrocalcinosis is a known association of GS; however, extra-articular calcification is rare. Literature review illustrates sclerochoroidal calcification as the only reported soft tissue calcification apart from chondrocalcinosis.
Transient parkinsonism associated with acute Legionnaires’ disease
Authors: Su Johnny S , Honsberger Steven , Husnain Muhammad G
Published: January 2020

A 44-year-old right-handed man with a 5-day history of non-productive cough associated with subjective fevers/chills and night sweats presented to the emergency department with slurred speech. Radiography and urine antigen testing confirmed the diagnosis ofLegionella pneumonia. The hospital course was complicated by acute hypoxic respiratory failure that required 7 days of invasive mechanical ventilation. Following extubation, the patient had dysarthria and developed new parkinsonism features. Brain imaging revealed a non-specific focal lesion in the left frontal lobe of unclear significance. Ciprofloxacin was decided as the final antibiotic of choice for its favourable central nervous system profile. Levodopa–carbidopa was initiated to help activate the basal ganglia. The patient had complete resolution of pneumonia and transient parkinsonism. He was able to regain most of his baseline functional status with intensive rehabilitation.
Medication-induced hyperglycemia: pediatric perspective
Authors: Tosur Mustafa , Viau-Colindres Johanna , Astudillo Marcela , Redondo Maria Jose , Lyons Sarah K
Published: January 2020

Medication-induced hyperglycemia is a frequently encountered clinical problem in children. The intent of this review of medications that cause hyperglycemia and their mechanisms of action is to help guide clinicians in prevention, screening and management of pediatric drug-induced hyperglycemia. We conducted a thorough literature review in PubMed and Cochrane libraries from inception to July 2019. Although many pharmacotherapies that have been associated with hyperglycemia in adults are also used in children, pediatric-specific data on medication-induced hyperglycemia are scarce. The mechanisms of hyperglycemia may involve β cell destruction, decreased insulin secretion and/or sensitivity, and excessive glucose influx. While some medications (eg, glucocorticoids, L-asparaginase, tacrolimus) are markedly associated with high risk of hyperglycemia, the association is less clear in others (eg, clonidine, hormonal contraceptives, amiodarone). In addition to the drug and its dose, patient characteristics, such as obesity or family history of diabetes, affect a child’s risk of developing hyperglycemia. Identification of pediatric patients with increased risk of developing hyperglycemia, creating strategies for risk reduction, and treating hyperglycemia in a timely manner may improve patient outcomes.
The role of HIV viral load in mathematical models of HIV transmission and treatment: a review
Authors: Glass Tracy , Myer Landon , Lesosky Maia
Published: January 2020

Introduction

HIV viral load (VL) is accepted as a key biomarker in HIV transmission and pathogenesis. This paper presents a review of the role of VL testing in mathematical models for HIV prevention and treatment.

Methods

A search for simulation models of HIV was conducted in PubMed, yielding a total of 1210 studies. Publications before the year 2000, studies involving animals and analyses that did not use mathematical simulations were excluded. The full text of eligible articles was sourced and information about the intervention and population being modelled, type of modelling approach and disease monitoring strategy was extracted.

Results and discussion

A total of 279 studies related to HIV simulation models were included in the review, though only 17 (6%) included consideration of VL or VL testing and were evaluated in detail. Within the studies that included assessment of VL, routine monitoring was the focus, and usually in comparison to alternate monitoring strategies such as clinical or CD4 count-based monitoring. The majority of remaining models focus on the impact or delivery of antiretroviral therapy (n=68; 27%), pre-exposure prophylaxis (n=28; 11%) and/or HIV testing (n=24; 9%) on population estimates of HIV epidemiology and exclude consideration of VL. Few studies investigate or compare alternate VL monitoring frequencies, and only a small number of studies overall (3%) include consideration of vulnerable population groups such as pregnant women or infants.

Conclusions

There are very few simulations of HIV treatment or prevention that include VL measures, despite VL being recognised as the key determinant of both transmission and treatment outcomes. With growing emphasis on VL monitoring as key tool for population-level HIV control, there is a clear need for simulations of HIV epidemiology based on VL.
Legislative landscape for traditional health practitioners in Southern African development community countries: a scoping review
Authors: Abrams Amber Louise , Falkenberg Torkel , Rautenbach Christa , Moshabela Mosa , Shezi Busisiwe , van Ellewee Suné , Street Renee
Published: January 2020

Background and objectives

Globally, contemporary legislation surrounding traditional health practitioners (THPs) is limited. This is also true for the member states of the Southern African Development Community (SADC). The main aim of this study is to map and review THP-related legislation among SADC countries. In order to limit the scope of the review, the emphasis is on defining THPs in terms of legal documents.

Methods

This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methods. Two independent reviewers reviewed applicable legal definitions of THPs by searching the Southern African Legal Information Institute (SAFLII) database in April 2018 for legislation and bills. To identify additional legislation applicable in countries not listed on SAFLII and/or further relevant SADC legislation, the search engines, Google and PubMed, were used in August 2018 and results were reviewed by two independent reviewers. Full texts of available policy and legal documents were screened to identify policies and legislation relating to the regulation of THPs. Legislation was deemed relevant if it was a draft of or promulgated legislation relating to THPs.

Results

Four of 14 Southern African countries have legislation relating to THPs. Three countries, namely South Africa, Namibia and Zimbabwe, have acknowledged the roles and importance of THPs in healthcare delivery by creating a council to register and formalise practices, although they have not operationalised nor registered and defined THPs. In contrast, Tanzania has established a definition couched in terms that acknowledge the context-specific and situational knowledge of THPs, while also outlining methods and the importance of local recognition. Tanzanian legislation; thus, provides a definition of THP that specifically operationalises THPs, whereas legislation in South Africa, Namibia and Zimbabwe allocates the power to a council to decide or recognise who a THP is; this council can prescribe procedures to be followed for the registration of a THP.

Conclusions

This review highlights the differences and similarities between the various policies and legislation pertaining to THPs in SADC countries. Legislation regarding THPs is available in four of the 14 SADC countries. While South Africa, Tanzania, Namibia and Zimbabwe have legislation that provides guidance as to THP recognition, registration and practices, THPs continue to be loosely defined in most of these countries. Not having an exact definition for THPs may hamper the promotion and inclusion of THPs in national health systems, but it may also be something that is unavoidable given the tensions between lived practices and rigid legalistic frameworks.
Lithium for Fracture Treatment (LiFT): a double-blind randomised control trial protocol
Authors: Nam Diane , Balasuberamaniam Phumeena , Milner Katrine , Kunz Monica , Vachhani Kathak , Kiss Alex , Whyne Cari
Published: January 2020

Introduction

Fracture healing can fail in up to 10% of cases despite appropriate treatment. While lithium has been the standard treatment for bipolar disorder, it may also have a significant impact to increase bone healing in patients with long bone fractures. To translate this knowledge into clinical practice, a randomised clinical trial (RCT) is proposed.

Methods and analysis

A multicentre double blind, placebo-controlled RCT is proposed to evaluate the efficacy of lithium to increase the rate and predictability of long bone fracture healing in healthy adults compared to lactose placebo treatment. 160 healthy individuals from 18 to 55 years of age presenting with shaft fractures of the femur, tibia/fibula, humerus or clavicle will be eligible. Fractures will be randomised to placebo (lactose) or treatment (300 mg lithium carbonate) group within 2 weeks of the injury. The primary outcome measure will be radiographic union defined as visible callus bridging on three of the four cortices at the fracture site using a validated radiographic union score. Secondary outcome measures will include functional assessment and pain scoring.

Ethics and dissemination

Participant confidentiality will be maintained with publication of results. Research Ethics Board Approval: Sunnybrook Research Institute (REB # 356–2016). Health Canada Approval (HC6-24-C201560). Results of the main trial and secondary endpoints will be submitted for publication in a peer-reviewed journal and presented at conferences.

Trial registration number

NCT02999022.
Predictors of cerebrovascular event reoccurrence in patients with depression: a retrospective cohort study
Authors: Cai Wa , Mueller Christoph , Shetty Hitesh , Perera Gayan , Stewart Robert
Published: January 2020

Objectives

To identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history.

Methods

We used the Maudsley Biomedical Research Centre Case Register to identify patients aged 50 years or older with a diagnosis of depressive disorder between 2008 and 2017 and a previous history of hospitalised CBVD. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence or death due to CBVD. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales, medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD reoccurrence.

Results

Of 1292 patients with depression and CBVD (mean age 75.6 years; 56.6% female), 264 (20.4%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95% CI, 1.01 to 1.04) (p=0.002), physical health problems (moderate to severe HR, 2.47; 95% CI, 1.45 to 4.19) (p=0.001), anticoagulant (HR, 1.40; 95% CI, 1.01 to 1.93) (p=0.041) and antipsychotic medication (HR, 0.66; 95% CI 0.44 to 0.99) (p=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence.

Conclusions

Approximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of 20 months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing.
Efficacy of adjunctive azithromycin versus single-dose cephalosporin prophylaxis for caesarean scar defect: study protocol for a randomised controlled trial
Authors: Cai Yanqing , Pan Hongjie , Zhang Jian , Cheng Weiwei , Shi Yiru , Zeng Min , Shi Liye , Yu Jin , Shen Ying , Chen Shan , Zhu Qian , Mol Ben W , Huang Ding
Published: January 2020

Introduction

Perioperative infections may be considered predictors of caesarean scar defect (CSD), and multidose antibiotics have a protective effect against CSD. However, the ability of adjunctive azithromycin combined with cephalosporin to reduce the prevalence of CSD remains unclear. The planned study aims to clarify the protective effect of antibiotics against CSD and to assess the effectiveness of adjunctive azithromycin prophylaxis for CSD.

Methods and analysis

This study is a double-blind, parallel-control randomised clinical trial that will be carried out at the International Peace Maternity and Child Health Hospital. A total of 220 eligible patients will be randomised (1:1) to receive either adjunctive azithromycin or single-dose cephalosporin 30 min before the incision. The evaluation criteria are the prevalence and characteristics of CSD as assessed by transvaginal ultrasound (TVU) and saline infusion sonohysterography (SIS) at 42 days, 6 months and 12 months after delivery. The primary outcome will be the prevalence of CSD, and the characteristics of CSD will be assessed by TVU and SIS 42 days after delivery; all other outcomes are secondary.

Ethics and dissemination

This protocol received authorisation from the Medical Research Ethics Committee of International Peace Maternity and Child Health Hospital on 25 April 2018 (approval no. GKLW2017-84). The findings will be reported in peer-reviewed publications and presentations at international scientific meetings.

Trial registration number

ChiCTR-INR-17013272.
Barriers to access of healthcare services by the immigrant population in Scandinavia: a scoping review protocol
Authors: Appoh Lily , Felix Franca , Pedersen Preben Ulrich
Published: January 2020

Introduction

Access to healthcare services for legal immigrants in Scandinavia is part of the policy agenda of the various governments as they strive to provide equal healthcare services to its citizens. Legal immigrants have the same rights as natives; however, studies have shown that there are inequalities in access to healthcare services between legal immigrants and natives. The extent of access depends on several factors, including organisational, social, financial and cultural factors. The lack of these factors acts as a barrier to access of healthcare services. The aim of this review is to map and report the evidence available on the barriers to access of healthcare services by legal immigrants in Scandinavia.

Methods and analysis

We will adopt the six-stage framework developed by Arksey and O’Malley: (1) identifying the research question(s); (2) searching for relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results; (6) conducting consultation exercises refined by Levacet aland the Joanna Briggs Institute. The search strategy for this scoping review will involve electronic databases including Ovid Medline, PsycINFO, Ovid EMBASE, PubMed and Google Scholar, in addition to grey literature from websites of relevant organisations. Data will be extracted and charted by two independent reviewers. A narrative summary of the findings will be presented.

Ethics and dissemination

This is a review of the literature and all data will be obtained from publicly available materials; therefore, ethics approval is not required. The findings from this study will be disseminated as publications in peer-reviewed journals, at relevant national and international conferences, and as presentations to the health authorities in several municipalities in the Trøndelag region of Norway.
Dementia among migrants and ethnic minorities in Italy: rationale and study protocol of the ImmiDem project
Authors: Canevelli Marco , Lacorte Eleonora , Cova Ilaria , Cascini Silvia , Bargagli Anna Maria , Angelici Laura , Giusti Angela , Pomati Simone , Pantoni Leonardo , Vanacore Nicola
Published: January 2020

Introduction

Due to the ongoing demographic and epidemiological transitions, estimating the phenomenon of dementia in migrants and minority groups, exploring its characteristics and challenges and implementing dedicated healthcare policies, constitute emerging and urgent matters for Western countries. In the present paper we describe the rationale and design of the ‘Dementia in immigrants and ethnic minorities living in Italy: clinical-epidemiological aspects and public health perspectives” (ImmiDem) project.

Methods and analysis

Three main aims will be pursued by the ImmiDem project. First, a survey of all Italian dementia services will be conducted with dedicated questionnaires in order to estimate and describe the proportion and characteristics of migrants seeking help for cognitive disturbances. The different clinical approaches for diagnosing dementia and the challenges encountered in the assessment of cognitive functioning and in the provision of care in these groups of individuals will also be investigated. Second, record linkage procedures of data routinely collected in regional Health Information Systems will be conducted in order to identify and monitor migrant individuals with dementia living in the Lazio region. Third, tailored national and local care-coordination pathways and/or good practices dedicated to migrants affected by dementia and cognitive disorders will be identified and promoted.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of the Italian National Institute of Health (protocol 10749; 5 April 2018). The project was launched in November 2018 and will end in November 2021. The findings of the project will be disseminated through scientific peer-reviewed journals as well as to the public via the Dementia Observatory website (https://demenze.iss.it).
Developing a framework to incorporate real-world evidence in cancer drug funding decisions: the Canadian Real-world Evidence for Value of Cancer Drugs (CanREValue) collaboration
Authors: Chan Kelvin , Nam Seungree , Evans Bill , de Oliveira Claire , Chambers Alexandra , Gavura Scott , Hoch Jeffrey , Mercer Rebecca E , Dai Wei Fang , Beca Jaclyn , Tadrous Mina , Isaranuwatchai Wanrudee
Published: January 2020

Background

Oncology therapy is becoming increasingly more expensive and challenging the affordability and sustainability of drug programmes around the world. When new drugs are evaluated, health technology assessment organisations rely on clinical trials to inform funding decisions. However, clinical trials are not able to assess overall survival and generalises evidence in a real-world setting. As a result, policy makers have little information on whether drug funding decisions based on clinical trials ultimately yield the outcomes and value for money that might be expected.

Objective

The Canadian Real-world Evidence for Value of Cancer Drugs (CanREValue) collaboration, consisting of researchers, recommendation-makers, decision makers, payers, patients and caregivers, are developing and testing a framework for Canadian provinces to generate and use real-world evidence (RWE) for cancer drug funding in a consistent and integrated manner.

Strategy

The CanREValue collaboration has established five formal working groups (WGs) to focus on specific processes in the generation and use of RWE for cancer drug funding decisions in Canada. The different RWE WGs are: (1) Planning and Drug Selection; (2) Methods; (3) Data; (4) Reassessment and Uptake; (5) Engagement. These WGs are acting collaboratively to develop a framework for RWE evaluation, validate the framework through the multiprovince RWE projects and help to integrate the final RWE framework into the Canadian healthcare system.

Outcomes

The framework will enable the reassessment of cancer drugs, refinement of funding recommendations and use of novel funding mechanisms by decision-makers/payers across Canada to ensure the healthcare system is providing clinical benefits and value for money.
Factors affecting utilisation of traditional Korean medical services by privately insured persons: a retrospective study using Korean Health Panel Survey (KHPS)
Authors: Jung Boyoung , Kim Juchul , Ha In-Hyuk , Lee Jinho
Published: January 2020

Objective

This study aimed to use the Korean Health Panel Survey (KHPS) data to identify the key factors that influence decisions regarding the use of traditional Korean medicine (TKM) by privately insured persons.

Design

A retrospective study on episodic KHPS data from 2009 to 2013.

Setting

Nationwide-based survey using the KHPS data.

Participants

The study included outpatients aged ≥20 years who had used private medical insurance at least once during the 5 years of the survey. After excluding cases where TKM was not used and those with missing values, this study ultimately included 1874 patients.

Primary and secondary outcome measures

The main dependent variable was TKM utilisation (number of outpatient visits and outpatient costs of TKM). We used multiple linear regression analysis to identify determinants of TKM while controlling for clustered errors.

Results

Approximately 6.1% (1874) of all doctor visits (30 982) were characterised as TKM services. For therapeutic purposes, TKM visits increased despite not being guaranteed in private health insurance (coefficient=3.0, p=0.045) and TKM outpatient costs decreased (coefficient=−0.3, p=0.001). Women used more therapeutic TKM services than men (coefficient=2.8, p<0.001). Older patient groups used more therapeutic TKM services than younger patient groups (coefficient=11.5, p=0.012), but paid less on outpatient costs than younger groups (coefficient=−1.0, p=0.001). For preventive services, sex and age were not statistically significant factors. Regardless of the purpose of the visit, the more chronic diseases, the more people who have previously experienced TKM service use more TKM services (p<0.001).

Conclusions

Despite a policy to reduce services that are not guaranteed by private health insurance, the increase in the number of outpatient visits for uncovered therapeutic TKM services implies a high public need for TKM in Korea.
Protocol for the derivation and external validation of a 30-day mortality risk prediction model for older patients having emergency general surgery (PAUSE score—Probability of mortality Associated with Urgent/emergent general Surgery in oldEr patients score)
Authors: Feng Simon , Van Walraven Carl , Lalu Manoj , Moloo Husein , Musselman Reilly , McIsaac Daniel I
Published: January 2020

Introduction

People 65 years and older represent the fastest growing segment of the surgical population. Older age is associated with doubling of risk when undergoing emergency general surgery (EGS) procedures and often coexists with medical complexity and considerations of end-of-life care, creating prognostic and decisional uncertainty. Combined with the time-sensitive nature of EGS, it is challenging to gauge perioperative risk and ensure that clinical decisions are aligned with the patient values. Current preoperative risk prediction models for older EGS patients have major limitations regarding derivation and validation, and do not address the specific risk profile of older patients. Accurate and externally validated models specific to older patients are needed to inform care and decision making.

Methods and analysis

We will derive, internally and externally validate a multivariable model to predict 30-day mortality in EGS patients >65 years old. Our derivation sample will be individuals enrolled in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016 having 1 of 7 core EGS procedures. Postulated predictor variables have been identified based on previous research, clinical and epidemiological knowledge. Our model will be derived using logistic regression penalised with elastic net regularisation and ensembled using bootstrap aggregation. The resulting model will be internally validated using k-fold cross-validation and bootstrap validation techniques and externally validated using population-based health administrative data. Discrimination and calibration will be reported at each step.

Ethics and dissemination

Ethics for NSQIP data use was obtained from the Ottawa Hospital Research Ethics Board; external validation will use routinely collected anonymised data legally exempt from research ethics review. The final risk score will be published in a peer-reviewed journal. We plan to further disseminate the model as an online calculator or application for clinical use. Future research will be required to test the clinical application of the final model.
International phase 1 study protocol to develop a health state classification system for a preference-based measure for women with breast cancer: the BREAST-Q Utility module
Authors: Kaur Manraj , Pusic Andrea L , Cano Stefan J , Xie Feng , Bordeleau Louise , Zhong Toni , Klassen Anne
Published: January 2020

Introduction

Concerns unique to women with breast cancer can include impact of cancer on body image, sexual well-being and changes in breast appearance and sensation. These important issues are not captured by the existing generic preference-based measures (PBMs) and no breast cancer-specific PBM currently exists. This Phase 1 protocol describes a mixed-methods study to develop and validate the descriptive health state classification system for a breast cancer-specific PBM, called the BREAST-Q Utility module.

Methods and analysis

A heterogeneous sample of women aged 18 years and older diagnosed with breast cancer who are undergoing or have had treatment for breast cancer will be invited to participate in qualitative interviews. Participants will be asked to describe impact of their diagnosis and treatment(s) on their health-related quality of life (HRQOL). Interviews will be audio recorded, transcribed verbatim and coded using a line-by-line approach. At the end of each interview, based on each participant’s cancer treatment history, patients will complete the mastectomy, breast-conserving therapy or reconstruction module of BREAST-Q, with modified 5-point Likert scale to measure importance of the BREAST-Q concepts. Both sources of data will be analysed to identify the most important HRQOL concerns.

A conceptual framework and item pool will be developed from the qualitative dataset. Preliminary version of the BREAST-Q Utility module will be created and refined at an in-person meeting of multidisciplinary experts. Content validity of the Utility module will be examined (cognitive debriefing, expert feedback). Psychometric properties of Utility module will be evaluated in a large sample of women with breast cancer.

Ethics and dissemination

The study has been approved by Hamilton Integrated Research Ethics Board, Canada. Results of this study will be presented at international conferences and published in peer-reviewed journals.