bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of Total Suspended Solids, Turbidity and Colour of Palm Oil Mill Effluent using Hybrid Coagulation-Fltrafiltration Process
Authors: Ng W. Q. , Lai S. O. , Chong K. C. , Lee S. S. , Koo C. H. , Chong W. C.
Published: December 2018

High consumption and production of palm oil have led to the massive generation of palm oil mill effluent (POME). This study was intended to reduce the total suspended solids (TSS), turbidity and colour using hybrid coagulation-ultrafiltration process. POME was pre-treated with coagulation process using polyaluminium chloride (PAC) and optimization of operating condition for coagulation process was performed. The coagulation results revealed that optimum pH, dosage of coagulant and rapid mixing speed were pH 4, 600 mg/L and 200 rpm, respectively. It achieved the highest percent reduction of TSS, turbidity and colour with 99.74%, 94.44% and 94.60%, respectively. Ultrafiltration (UF) membrane was fabricated using polyethersulfone (PES), polyvinylpyrrolidone (PVP) and titanium dioxide (TiO2­) nanoparticle. Different concentrations ranging from zero and 1.0 wt% of TiO2 nanoparticles were added into the dope solution. The characterization studies of UF membranes confirmed that higher concentration of TiO2 provided higher pure water permeability and more porous structure in the UF membranes. The amount of TiO2 in membrane only affected the permeate flux but had no obvious effects on the reduction of TSS, turbidity and colour. The optimum transmembrane pressure was found to be 3 bar, resulting in the greatest reduction of TSS, turbidity and colour.
Chemical Cleaning of Fouled Polyethersulphone Nanofiltration Membranes with Ethylenediaminetetraacetic Acid
Authors: Chong V. Y. F. , Koo C. H. , Thiam H. S. , Lai S. O.
Published: December 2018

This study mainly investigated the potential use of ethylenediaminetetraacetic acid (EDTA) as the chemical cleaning agent to restore the permeate flux of organically fouled polyethersulfone (PES) nanofiltration (NF) membranes under varying applied pressures. The cleaning efficiency was quantified based on flux recovery rate. The results showed that the optimum EDTA concentration is 1.0 wt%, within the range investigated, which proved that higher concentration does not necessary enhance the cleaning efficiency. The results also demonstrated that the highest flux recovery was achieved at the applied pressure of 14 bar regardless of EDTA concentration. Overall, the maximum flux recovery that could be achieved is only 35.03%, implying EDTA is not very effective in removing foulants from the PES NF membranes.
Drone Scale Coaxial Rotor Aerodynamic Interactions Investigation
Authors: Shukla Dhwanil , Komerath Narayan
Published: December 2018

Coaxial rotor uninhabited aerial vehicles (UAVs) are compact compared to single rotor UAVs of comparable capacity. At the low Reynolds numbers (Re) where they operate, the simplifying assumptions from high Re rotor aerodynamics are not valid. The low Re coaxial rotor flowfield is studied including aerodynamic interactions and their effect on performance. The evolution of the wake is captured using high-speed stereo particle image velocimetry (SPIV). Improvement of upper rotor performance due to viscous swirl recovery from the lower rotor is discovered and then verified by analyzing PIV data. Interesting vortex–vortex sheet interactions are observed under the coaxial rotor affecting wake structure spatially and temporally. A qualitative model explaining the observed wake interaction phenomena is presented. Comparison with the performance of high Re rotors shows higher profile and induced drag at low Re for the same thrust coefficient.
Effects of Downstream Structures on Aero Elastic Energy Harvesters From Wake-Induced Vibration
Authors: Uttayopas Pakorn , Kittichaikarn Chawalit
Published: December 2018

An upstream cylindrical bluff body connected to a tip body via an aluminum cantilever beam was tested as energy harvester in a wind tunnel. The characteristics and behavior of the different tip body configurations and lengths of aluminum cantilever beam were studied to optimize design to extract wind energy. Particular attention was paid to measure vibration amplitude and frequency response as a function of reduced velocity. Dynamic response showed that the device's behavior was dependent on both tip body shape and cantilever beam length. Flow visualization tests showed that high amplitude vibration was obtainable when a vortex was fully formed on each side of the downstream tip body. This was exemplified in a symmetrical triangular prism tip body at L/D1 = 5, where its structure's vibration frequency was close to its natural frequency. At such configuration, electrical energy was captured using a polyvinylidene fluoride (PVDF) piezoelectric beam of different load resistances, where an optimized load resistance could be found for each Reynolds number. Although power output and efficiency obtained were considerably weak when compared to those of traditional wind turbine, the design merits further research to improve its performance under various circumstances.
Rayleigh–Taylor Instability of Swirling Annular Layer With Mass Transfer
Authors: Awasthi Mukesh Kumar
Published: December 2018

The interfacial instability of Rayleigh–Taylor type at the cylindrical boundary involving the liquid phase and vapor phase of a fluid has been considered when the vapor is warmer than the liquid. We use viscous potential flow theory to include the viscosity at the interface. To examine the stability of the arrangement, the normal-mode analysis is performed together with the effect of heat as well as mass transfer and free swirl. The physical system consists of an annular fluid layer restricted in a cylinder with vapor phase in the core. This work investigates the effect of a variety of variables on the instability of the interface. It is found that when the heat transfer constant increases, the range of stability increases. Also, the range of stability increases faster in the presence of swirling.
Validation of an In Vivo Medical Image-Based Young Human Lumbar Spine Finite Element Model
Authors: Mills Matthew J. , Sarigul-Klijn Nesrin
Published: December 2018

Mathematical models of the human spine can be used to investigate spinal biomechanics without the difficulties, limitations, and ethical concerns associated with physical experimentation. Validation of such models is necessary to ensure that the modeled system behavior accurately represents the physics of the actual system. The goal of this work was to validate a medical image-based nonlinear lumbosacral spine finite element model of a healthy 20-yr-old female subject under physiological moments. Range of motion (ROM), facet joint forces (FJF), and intradiscal pressure (IDP) were compared with experimental values and validated finite element models from the literature. The finite element model presented in this work was in good agreement with published experimental studies and finite element models under pure moments. For applied moments of 7.5 N·m, the ROM in flexion–extension, axial rotation, and lateral bending were 39 deg, 16 deg, and 28 deg, respectively. Excellent agreement was observed between the finite element model and experimental data for IDP under pure compressive loading. The predicted FJFs were lower than those of the experimental results and validated finite element models for extension and torsion, likely due to the nondegenerate properties chosen for the intervertebral disks and morphology of the young female spine. This work is the first to validate a computational lumbar spine model of a young female subject. This model will serve as a valuable tool for predicting orthopedic spinal injuries, studying the effect of intervertebral disk replacements using advanced biomaterials, and investigating soft tissue degeneration.
Pyrolysis and High Performance Plasma Treatment Applied to Spent Ion Exchange Resins
Authors: Castro Hernán Ariel , Rodríguez Raúl Ariel , Luca Vittorio , Bianchi Hugo Luis
Published: December 2018

Treatment and conditioning of spent ion exchange resins from nuclear facilities is a complex process that not only should contemplate obtaining a stable product suitable for long-term storage and/or disposal, but also have to take into account the treatment of secondary currents generated during the process. The combination of low temperature pyrolysis treatment and high performance plasma treatment (HPPT) of the off-gas generated could be a novel solution for organic matrix nuclear wastes with economic and safety advantages. In the present work, results of lab scale studies associated with the pyrolysis off-gas characterization and the performance and operating parameters influence on the removal of model compounds in a laboratory-scale flow reactor, using inductively coupled plasma under subatmospheric conditions, are shown. The pyrolysis off-gas stream was largely characterized and the evolution of main compounds of interest as function of temperature process was established. The results of plasma assays with the model compound demonstrate a high destruction and removal efficiency (>99.990%) and a good control over the final gas products. First results of a bench scale arrangement combining both processes are presented and bode well for the application of this combined technology.
Multitechnique investigation into the aqueous behavior of plasma polymers
Authors: Askew Hannah J. , Jarvis Karyn L. , McArthur Sally L.
Published: December 2018

Plasma polymers are often used in applications requiring aqueous immersion; therefore, it is important to understand how this exposure affects the physical and chemical properties of the films. Three different plasma polymer films were deposited at different distances from the electrode, and the film properties were characterized using contact angle, ellipsometry, and x-ray photoelectron spectroscopy. The film behaviors in aqueous solutions were studied via quartz crystal microbalance with dissipation (QCM-D). Exposure to buffer solutions produced significant swelling of the plasma polymerized acrylic acid films, with swelling increasing with distance from the powered electrode, results that could be correlated with changes in film chemistry. Plasma polymerized octadiene and allylamine exhibited little swelling. These films exhibited changes in thickness and contact angle with respect to distance from the electrode, but this had little influence on their behavior in aqueous solution. By combining QCM-D with the more traditional surface chemical analysis techniques, the authors have been able to explore both swelling behavior and the effect that sample position and thus deposition parameters have on film properties and aqueous behavior. This approach gives the authors the basis to define deposition parameters to assist the engineering of thin films for applications such as biosensing and tissue engineering applications where specific chemistries and film behaviors are desired.
Putting Laurel and Yanny in context
Authors: Bosker Hans Rutger
Published: December 2018

Recently, the world's attention was caught by an audio clip that was perceived as “Laurel” or “Yanny.” Opinions were sharply split: many could not believe others heard something different from their perception. However, a crowd-source experiment with >500 participants shows that it is possible to make people hear Laurel, where they previously heard Yanny, by manipulating preceding acoustic context. This study is not only the first to reveal within-listener variation in Laurel/Yanny percepts, but also to demonstrate contrast effects for global spectral information in larger frequency regions. Thus, it highlights the intricacies of human perception underlying these social media phenomena.
Genome Sequences of Actinobacteria from Extreme Environments in Colombia
Authors: Cantillo Angela , Shapiro Nicole , Woyke Tanja , Kyrpides Nikos C. , Baena Sandra , Zambrano María Mercedes
Published: December 2018

We sequenced six actinobacterial genomes isolated from a salt mine and from soil in a high-mountain Páramo ecosystem. The strains belonged to the genera
Streptomyces
,
Nesterenkonia
, and
Isoptericola
and were sequenced due to their antimicrobial and cytotoxic activities.
Complete Genome Sequence of Enterobacter xiangfangensis Pb204, a South African Strain Capable of Synthesizing Gold Nanoparticles
Authors: Ho Nicholas Ryan , Kondiah Kulsum , De Maayer Pieter
Published: December 2018

Enterobacter xiangfangensis
Pb204, isolated from acid mine decant from a uranium mine, produces a wide variety of gold nanoparticles (AuNPs), ranging from large triangular plates to small spherical AuNPs. The complete genome sequence of this isolate incorporates an integrative and conjugative element which may be pivotal to AuNP synthesis.
Escherichia coli NGF-1, a Genetically Tractable, Efficiently Colonizing Murine Gut Isolate
Authors: Ziesack Marika , Karrenbelt Michiel A. P. , Bues Johannes , Schaefer Elena , Silver Pamela , Way Jeffrey
Published: December 2018

The genome of the murine commensal strain
Escherichia coli
NGF-1 contains a 5.03-Mbp chromosome and plasmids of 40.2 kbp and 8.56 kbp. NGF-1 efficiently colonizes the mouse gut and is genetically tractable.
Examining the effectiveness of examination at 6–8 weeks for developmental dysplasia: testing the safety net
Authors: Reidy Mike , Collins Caitlin , MacLean Jamie G B , Campbell Donald
Published: December 2018

Objective

The ‘GP check’ at 6–8 weeks forms part of the selective surveillance system for developmental dysplasia of the hip (DDH) in the UK. It is imperative to pick up DDH within the first months of life to allow for non-invasive treatment and the avoidance of surgery. We aim to investigate the effectiveness of hip examination at 6–8 weeks.

Methods

This is a longitudinal observational study including all infants born in our region in the 5 years following 2006. Early presentation was defined as diagnosis within 14 weeks of birth and late presentation after 14 weeks. Treatment records for early and late DDH as well as referrals for ultrasound (US) following examination at 6–8 weeks were analysed. Attendance of the examination at 6–8 weeks in those patients who went on to present with a late DDH was also analysed.

Results

23 112 live births occurred during the study period. There were 141 confirmed cases of DDH. 400 referrals for US were received following examination at 6–8 weeks; 6 of these had a positive finding of DDH. 27 patients presented after 14 weeks and were classified as late presentations. 25 of these patients had attended examination at 6–8 weeks and no abnormality had been identified.

Conclusions

The sensitivity of examination at 6–8 weeks was only 19.4%, its specificity was 98% and it had a positive predictive value of 1.5%. For many years the check at 6–8 weeks has been thought of as a means to identify those children not identified as neonates; however, we found that four out of five children with DDH were not identified by the check at 6–8 weeks. Unfortunately, we conclude that the presumed safety net of the examination in its current form is not reliable.
Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study
Authors: Brorsson Anna Lena , Lindholm Olinder Anna , Viklund Gunnel , Granström Therese , Leksell Janeth
Published: December 2018

Objective

Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents’ perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion.

Research design and methods

In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts.

Results

Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes.

Conclusions

GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach.

Trial registration number

ISRCTN22444034; Results.
Health assets in older age: a systematic review
Authors: Hornby-Turner Yvonne Claire , Peel Nancye May , Hubbard Ruth Eleanor
Published: December 2018

Background

Finding ways to optimise health in older age is key to reducing the impact of population ageing on health and social care systems. A salutogenic approach takes into account an individual’s health assets—internal or external strengths or accessible resources which improve and preserve physical, social and mental wellness, independence and quality of life. The aim of this narrative systematic review was to provide a summary and appraisal of the evidence for factors that act as health assets within personal, social, economic and environmental domains.

Methods

Systematic searches of databases were conducted for literature published in peer-reviewed journals between January 2000 and November 2016. Selection criteria included community dwelling populations aged 65 years and over and publications written in English. Data on study population, design, measures of health status, factors within the four previously stated domains and results were extracted. Study quality was independently assessed using an appraisal instrument.

Results

Twenty-three publications, including 78 422 participants, from more than 13 different countries were identified for inclusion in this review. There was strong evidence that higher scores of self-rated health, psychological well-being and life satisfaction were associated with better health in older age. Social network and contact with family and friends, and engagement in leisure and social activities were important support mechanisms. Education and financial resources consistently proved to be key economic health assets for older adults.

Conclusions

Implementing an asset-based approach to health promotion uncovers the skills, knowledge, connections and potential of the individual and the community. This approach is an ideal opportunity for government health bodies and their partners to respond to the challenges faced by global ageing.

Factors are often interdependent and cumulative, suggesting the potential for an instrument to measure the accumulated effect of health assets on health status in older adults.
Modeling lifetime costs and health outcomes attributable to secondhand smoke exposure at home among Korean adult women
Authors: Lee Jiyae , Han Ah Ram , Choi Dalwoong , Lim Kyung-Min , Bae SeungJin
Published: December 2018

Purpose

The aim of this research is to estimate lifetime costs and health consequences for Korean adult women who were exposed to secondhand smoke (SHS) at home.

Methods

A Markov model was developed to project the lifetime healthcare costs and health outcomes of a hypothetical cohort of Korean women who are 40 years old and were married to current smokers. The Korean epidemiological data were used to reflect the natural history of SHS-exposed and non-exposed women. The direct healthcare costs (in 2014 US dollars) and quality-adjusted life years (QALYs) were annually discounted at 5% to reflect time preference. The time horizon of the analysis was lifetime and the cycle length was 1 year. Deterministic and probabilistic sensitivity analyses were conducted.

Results

In the absence of SHS exposure, Korean women will live 41.32 years or 34.56 QALYs before discount, which corresponded to 17.29 years or 15.35 QALYs after discount. The SHS-exposed women were predicted to live 37.91 years and 31.08 QALYs before discount and 16.76 years and 14.62 QALYs after discount. The estimated lifetime healthcare cost per woman in the SHS non-exposed group was US$11 214 before the discount and US$2465 after discount. The negative impact of SHS exposure on health outcomes and healthcare costs escalated as the time horizon increased, suggesting that the adverse impact of SHS exposure may have higher impact on the later part of the lifetime. The result was consistent across a wide range of assumptions.

Conclusion

Life expectancy might underestimate the impact of SHS exposure on health outcomes, especially if the time horizon of the analysis is not long enough. Early intervention on smoking behaviour could substantially reduce direct healthcare costs and improve quality of life attributable to SHS exposure.
Interaction of ACE genotype and salt intake on hypertension among Chinese Kazakhs: results from a population-based cross-sectional study
Authors: Wang Yuyan , Zhang Biao , Hou Lei , Han Wei , Xue Fang , Wang Yanhong , Tang Yong , Liang Shaohua , Wang Weizhi , Asaiti Kuliqian , Wang Zixing , Hu Yaoda , Wang Lei , Qiu Changchun , Zhang Mingtao , Jiang Jingmei
Published: December 2018

Objectives

To explore the effect of interaction between ACE genotype and salt intake on hypertension among Chinese Kazakhs, and to compare applications of interactions between logistic model and generalised partially linear tree-based regression (GPLTR) model.

Design

Population-based cross-sectional study.

Setting

Hong Dun, North Xinjiang, China.

Participants

Non-consanguineous Chinese Kazakh participants (n=916, 342 men and 574 women) aged ≥30 years.

Main outcome measures

Association between ACE genotype and hypertension, association between salt intake and hypertension, and interaction of ACE genotype and salt intake on hypertension in two models.

Results

Associations between salt intake and hypertension were different in ACE genotype of II and ID+DD. Under the logistic models, main and interaction effects were not observed for men, but effects were present in opposite directions for women (main effect of ACE: OR=0.20, p=0.003; interaction effect: OR=1.07, p=0.027). Under the GPLTR model, Bayesian information criterion trees included both salt intake and ACE genotype as split variables. Individuals with a salt intake ≥19.5 g/day and ID+DD genotypes had a 3.99-fold (p=0.004) higher risk of hypertension compared with the II genotype for men, whereas salt intake <20.1 g/day and ID+DD genotypes had an OR=0.55 (p=0.014) compared with the II genotype for women.

Conclusions

An interaction of ACE genotype and salt intake on hypertension was observed among Chinese Kazakhs but in different ways according to sex. The GPLTR model appears to be more suitable for an exploration of interactions in complex diseases.
Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments
Authors: Harrison Mark , Milbers Katherine , Hudson Marie , Bansback Nick
Published: December 2018

Objectives

To review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences.

Methods

A systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. Inclusion criteria: peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers.

Design

Systematic review.

Results

We identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers.

Conclusions

Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.
Detecting organisational innovations leading to improved ICU outcomes: a protocol for a double-blinded national positive deviance study of critical care delivery
Authors: Chiou Howard , Jopling Jeffrey K , Scott Jennifer Yang , Ramsey Meghan , Vranas Kelly , Wagner Todd H , Milstein Arnold
Published: December 2018

Introduction

There is substantial variability in intensive care unit (ICU) utilisation and quality of care. However, the factors that drive this variation are poorly understood. This study uses a novel adaptation of positive deviance approach—a methodology used in public health that assumes solutions to challenges already exist within the system to detect innovations that are likely to improve intensive care.

Methods and analysis

We used the Philips eICU Research Institute database, containing 3.3 million patient records from over 50 health systems across the USA. Acute Physiology and Chronic Health Evaluation IVa scores were used to identify the study cohort, which included ICU patients whose outcomes were felt to be most sensitive to organisational innovations. The primary outcomes included mortality and length of stay. Outcome measurements were directly standardised, and bootstrapped CIs were calculated with adjustment for false discovery rate. Using purposive sampling, we then generated a blinded list of five positive outliers and five negative comparators.

Using rapid qualitative inquiry (RQI), blinded interdisciplinary site visit teams will conduct interviews and observations using a team ethnography approach. After data collection is completed, the data will be unblinded and analysed using a cross-case method to identify themes, patterns and innovations using a constant comparative grounded theory approach. This process detects the innovations in intensive care and supports an evaluation of how positive deviance and RQI methods can be adapted to healthcare.

Ethics and dissemination

The study protocol was approved by the Stanford University Institutional Review Board (reference: 39509). We plan on publishing study findings and methodological guidance in peer-reviewed academic journals, white papers and presentations at conferences.
Alterations in the brain’s connectome during recovery from severe traumatic brain injury: protocol for a longitudinal prospective study
Authors: Conde Virginia , Andreasen Sara Hesby , Petersen Tue Hvass , Larsen Karen Busted , Madsen Karine , Andersen Kasper Winther , Akopian Irina , Madsen Kristoffer Hougaard , Hansen Christian Pilebæk , Poulsen Ingrid , Kammersgaard Lars Peter , Siebner Hartwig Roman
Published: December 2018

Introduction

Traumatic brain injury (TBI) is considered one of the most pervasive causes of disability in people under the age of 45. TBI often results in disorders of consciousness, and clinical assessment of the state of consciousness in these patients is challenging due to the lack of behavioural responsiveness. Functional neuroimaging offers a means to assess these patients without the need for behavioural signs, indicating that brain connectivity plays a major role in consciousness emergence and maintenance. However, little is known regarding how changes in connectivity during recovery from TBI accompany changes in the level of consciousness. Here, we aim to combine cutting-edge neuroimaging techniques to follow changes in brain connectivity in patients recovering from severe TBI.

Methods and analysis

A multimodal, longitudinal assessment of 30 patients in the subacute stage after severe TBI will be made comprising an MRI session combined with electroencephalography (EEG), a positron emission tomography session and a transcranial magnetic stimulation (TMS) combined with EEG (TMS/EEG) session. A group of 20 healthy participants will be included for comparison. Four sessions for patients and two sessions for healthy participants will be planned. Data analysis techniques will focus on whole-brain, both data-driven and hypothesis-driven, connectivity measures that will be specific to the imaging modality.

Ethics and dissemination

The project has received ethical approval by the local ethics committee of the Capital Region of Denmark and by the Danish Data Protection. Results will be published as original research articles in peer-reviewed journals and disseminated in international conferences. None of the measurements will have any direct clinical impact on the patients included in the study but may benefit future patients through a better understanding of the mechanisms underlying the recovery process after TBI.

Trial registration number:NCT02424656; Pre-results.
Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to improve patient outcomes. Protocol for an observational study
Authors: Geeson Cathy , Wei Li , Franklin Bryony Dean
Published: December 2018

Introduction

Medicines optimisation is a key role for hospital pharmacists, but with ever-increasing demands on services there is a need to increase efficiency while maintaining patient safety. The aim of this study is to develop a prognostic model, the Medicines Optimisation Assessment Tool (MOAT), which can be used to target patients most in need of pharmacists' input while in hospital.

Methods and analysis

The MOAT will be developed following recommendations of the Prognosis Research Strategy partnership. Using a cohort study we will prospectively include 1500 adult patients from the medical wards of two UK hospitals. Data on medication-related problems (MRPs) experienced by study patients will be collected by pharmacists at the study sites as part of their routine daily clinical assessment of patients. Data on potential risk factors such as polypharmacy, renal impairment and the use of 'high risk' medicines will be collected retrospectively from the information departments at the study sites, laboratory reporting systems and patient medical records. Multivariable logistic regression models will then be used to determine the relationship between potential risk factors and the study outcome of preventable MRPs that are at least moderate in severity. Bootstrapping will be used to adjust the MOAT for optimism, and predictive performance will be assessed using calibration and discrimination. A simplified scoring system will also be developed, which will be assessed for sensitivity and specificity.

Ethics and dissemination

This study has been approved by the Proportionate Review Service Sub-Committee of the National Health Service Research Ethics Committee Wales REC 7 (16/WA/0016) and the Health Research Authority (project ID 197298). We plan to disseminate the results via presentations at relevant patient/public, professional, academic and scientific meetings and conferences, and will submit findings for publication in peer-reviewed journals.

Trial registration number

NCT02582463.
Resource use, characteristics and outcomes of prolonged non-invasive ventilation: a single-centre observational study in China
Authors: Duan Jun , Bai Linfu , Zhou Lintong , Han Xiaoli , Jiang Lei , Huang Shicong
Published: December 2018

Objective

To report the resource use, characteristics and outcomes of patients with prolonged non-invasive ventilation (NIV).

Design

A single-centre observational study.

Setting

An intensive care unit of a teaching hospital.

Participants

Patients who only received NIV because of acute respiratory failure were enrolled. Prolonged NIV was defined as subjects who received NIV ≥14 days. A total of 1539 subjects were enrolled in this study; 69 (4.5%) underwent prolonged NIV.

Main outcome measures

Predictors of prolonged NIV and hospital mortality.

Results

The rate of do-not-intubate (DNI) orders was 9.1% (140/1539). At the beginning of NIV, a DNI order (OR 3.95, 95% CI 2.25 to 6.95) and pH ≥7.35 (2.20, 1.27 to 3.82) were independently associated with prolonged NIV. At days 1 and 7 of NIV, heart rate (1.01 (1.00 to 1.03) and 1.02 (1.00 to 1.03], respectively) and PaO2/FiO2<150 (2.19 (1.25 to 3.85) and 2.05 (1.04 to 4.04], respectively) were other independent risk factors for prolonged NIV. When patients who died after starting NIV but prior to 14 days were excluded, the association was strengthened. Regarding resource use, 77.1% of subjects received NIV<7 days and only accounted for 47.0% of NIV-days. However, 18.4% of subjects received NIV 7–13.9 days and accounted for 33.4% of NIV-days, 2.9% of subjects received NIV 14–20.9 days and accounted for 9.5% of NIV-days, and 1.6% of subjects received NIV≥21 days and accounted for 10.1% of NIV-days.

Conclusions

Our results indicate the resource use, characteristics and outcomes of a prolonged NIV population with a relatively high proportion of DNI orders. Subjects with prolonged NIV make up a high proportion of NIV-days and are at high risk for in-hospital mortality.
Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review
Authors: Patel Vanisha , Champaneria Rita , Dretzke Janine , Yeung Joyce
Published: December 2018

Objective

Older patients with hip fractures who are undergoing surgery are at high risk of significant mortality and morbidity including postoperative delirium. It is unclear whether different types of anaesthesia may reduce the incidence of postoperative delirium. This systematic review will investigate the impact of anaesthetic technique on postoperative delirium. Other outcomes included mortality, length of stay, complications and functional outcomes.

Design

Systematic review of randomised controlled trials and non-randomised controlled studies.

Data sources

Bibliographic databases were searched from inception to June 2018. Web of Science and ZETOC databases were searched for conference proceedings. Reference lists of relevant articles were checked, and clinical trial registers were searched to identify ongoing trials.

Eligibility criteria

Studies were eligible if general and regional anaesthesia were compared in patients (aged 60 and over) undergoing hip fracture surgery, reporting primary outcome of postoperative delirium and secondary outcomes of mortality, length of hospital stay, adverse events, functional outcomes, discharge location and quality of life. Exclusion criteria were anaesthetic technique or drug not considered current standard practice; patients undergoing hip fracture surgery alongside other surgery and uncontrolled studies.

Results

One hundred and four studies were included. There was no evidence to suggest that anaesthesia type influences postoperative delirium or mortality. Some studies suggested a small reduction in length of hospital stay with regional anaesthesia. There was some evidence to suggest that respiratory complications and intraoperative hypotension were more common with general anaesthesia. Heterogeneity precluded meta-analysis. All findings were described narratively and data were presented where possible in forest plots for illustrative purposes.

Conclusions

While there was no evidence to suggest that anaesthesia types influence postoperative delirium, the evidence base is lacking. There is a need to ascertain the impact of type of anaesthesia on outcomes with an adequately powered, methodologically rigorous study.

PROSPERO registration number

CRD42015020166.
Observational study of the status of coronary risk biomarkers among Negritos with metabolic syndrome in the east coast of Malaysia
Authors: Mokhsin Atiqah , Mokhtar Siti Shuhada , Mohd Ismail Aletza , M Nor Fadzilah , Shaari Syahrul Azlin , Nawawi Hapizah , Yusoff Khalid , Abdul Rahman Thuhairah , Hoh Boon Peng
Published: December 2018

Objectives

To determine the prevalence of metabolic syndrome (MS), ascertain the status of coronary risk biomarkers and establish the independent predictors of these biomarkers among the Negritos.

Settings

Health screening programme conducted in three inland settlements in the east coast of Malaysia and Peninsular Malaysia.

Subjects

150 Negritos who were still living in three inland settlements in the east coast of Malaysia and 1227 Malays in Peninsular Malaysia. These subjects were then categorised into MS and non-MS groups based on the International Diabetes Federation (IDF) consensus worldwide definition of MS and were recruited between 2010 and 2015. The subjects were randomly selected and on a voluntary basis.

Primary and secondary outcome measures

This study was a cross-sectional study. Serum samples were collected for analysis of inflammatory (hsCRP), endothelial activation (sICAM-1) and prothrombogenesis [lp(a)] biomarkers.

Results

MS was significantly higher among the Malays compared with Negritos (27.7%vs12.0%). Among the Malays, MS subjects had higher hsCRP (p=0.01) and sICAM-1 (p<0.05) than their non-MS counterpart. There were no significant differences in all the biomarkers between MS and the non-MS Negritos. However, when compared between ethnicity, all biomarkers were higher in Negritos compared with Malays (p<0.001). Binary logistic regression analysis affirmed that Negritos were an independent predictor for Lp(a) concentration (p<0.001).

Conclusions

This study suggests that there may possibly be a genetic influence other than lifestyle, which could explain the lack of difference in biomarkers concentration between MS and non-MS Negritos and for Negritos predicting Lp(a).
Cohort profile: the Buffalo OsteoPerio microbiome prospective cohort study
Authors: Banack Hailey R , Genco Robert J , LaMonte Michael J , Millen Amy E , Buck Michael J , Sun Yijun , Andrews Christopher A , Hovey Kathleen M , Tsompana Maria , McSkimming Daniel I , Zhao Jiwei , Wactawski-Wende Jean
Published: December 2018

Purpose

The Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study is a prospective cohort study focused on the relationship between the microbiome and oral and systemic health outcomes in postmenopausal women. The cohort was established to examine how the oral microbiome is affected by (and how it affects) periodontal disease presence, severity and progression and to characterise the relationship between the microbiome, lifestyle habits and systemic disease outcomes.

Participants

Participants (n=1342) were postmenopausal women who were participating in the Women’s Health Initiative observational study at the Buffalo, New York clinical centre. There were 1026 participants at the 5-year follow-up visit and 518 at the 15-year visit.

Findings to date

Data collected include questionnaires, anthropometric measures, serum blood and saliva samples. At each clinic visit, participants completed a comprehensive oral examination to measure oral health and the oral microbiome. Preliminary findings have contributed to our understanding of risk factors for periodontal disease and the relationship between the oral microbiome and periodontal disease.

Future plans

The novel microbiome data collected on a large sample of participants at three time points will be used to answer a variety of research questions focused on temporal changes in the microbiome and the relationship between the oral microbiome and oral and systemic disease outcomes. Little is currently known about the relationship between the oral microbiome and health outcomes in older adults; data from the OsteoPerio cohort will fill this gap. Microbiome samples are currently being analysed using next-generation sequencing technology with an anticipated completion date of late 2018.
Identifying patient-important outcomes in medication-assisted treatment for opioid use disorder patients: a systematic review protocol
Authors: Sanger Nitika , Shahid Hamnah , Dennis Brittany B , Hudson Jackie , Marsh David , Sanger Stephanie , Worster Andrew , Teed Rand , Rieb Launette , Tugwell Peter , Hutton Brian , Shea Beverley , Beaton Dorcas , Corace Kimberly , Rice Danielle , Maxwell Lara , Samaan M Constantine , de Souza Russell J , Thabane Lehana , Samaan Zainab
Published: December 2018

Introduction

Illicit opioid use has become a national crisis in Canada, with over 65 000 people seeking treatment for opioid use disorder (OUD) in Ontario and British Columbia alone. Medication-assisted treatment (MAT) is a common treatment for OUD. There is substantial variability in treatment outcomes used to evaluate effectiveness of MAT, making it difficult to establish clinically and scientifically relevant treatment effect. Furthermore, patients are often excluded from the process of determining these outcomes. The primary objective of this review is to examine outcomes currently used to measure MAT effectiveness and to identify patient-relevant outcomes to enhance effectiveness of treatment options. This review refers to patient-important outcomes as those outcomes patients consider important to or markers of treatment success.

Methods and analysis

MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, National Institutes for Health Clinical Trials Registry and WHO International Clinical Trials Registry Platform databases will be searched. We will search databases from inception to the date the search is ran. Studies of interest include those evaluating the effectiveness of MAT for patients with OUD, with or without consultation with patients regarding what they consider to be important as an indicator of treatment success. Results will be analysed using thematic analysis and qualitative analysis where possible. This will result in comprehensive synthesis of all outcomes and measures found related to OUD treatment effectiveness.

Ethics and dissemination

We are collaborating with Canadian Addiction Treatment Centres which provide MAT to patients with OUD who will participate in disseminating study results. Dissemination strategies will involve sharing study results through workshops, presentations, peer-reviewed publications, study reports, community presentations and resources in primary care settings.

PROSPERO registration number

CRD42018095553.
Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study
Authors: Griffiths Peter , Maruotti Antonello , Recio Saucedo Alejandra , Redfern Oliver C , Ball Jane E , Briggs Jim , Dall'Ora Chiara , Schmidt Paul E , Smith Gary B
Published: December 2018

Objective

To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality.

Design

This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk.

Participants

138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015.

Outcomes

In-hospital deaths.

Results

Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient’s stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality.

Conclusion

Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.
Chair ICO/UVIC-UCC of palliative care at the University of Vic – Central University of Catalonia: an innovative multidisciplinary model of education, research and knowledge transfer
Authors: Gómez-Batiste Xavier , Lasmarías Cristina , Amblàs Jordi , Costa Xavier , Ela Sara , Mir Sarah , Calsina-Berna Agnès , Espaulella Joan , Santaugènia Sebastià , Pujol Ramon , Geli Marina Geli , Calle Candela
Published: December 2018

Objectives

Generation and dissemination of knowledge is a relevant challenge of palliative care (PC). The Chair Catalan Institute of Oncology (ICO)/University of Vic (UVIC) of Palliative Care (CPC) was founded in 2012, as a joint project of the ICO and the University of Vic/Central of Catalonia to promote the development of PC with public health and community-oriented vision and academic perspectives. The initiative brought together professionals from a wide range of disciplines (PC, geriatrics, oncology, primary care and policy) and became the first chair of PC in Spain. We describe the experience of the CPC at its fifth year of implementation.

Methods

Data collection from annual reports, publications, training and research activities.

Results

Results for period 2012–2017 are classified into three main blocks: (1) Programme: (a) The advanced chronic care model (Palliative needs (NECPAL)); (b) the psychosocial and spiritual domains of care (Psychosocial needs (PSICPAL)); (c) advance care planning and shared decision making (Advance care planning (PDAPAL)); and (d) the compassive communities projects (Society involvement (SOCPAL)). (2) Education and training activities: (a) The master of PC, 13 editions and 550 professionals trained; (b) postgraduate course on psychosocial care, 4 editions and 140 professionals trained; and (c) workshops on specific topics, pregraduate training and online activities with a remarkable impact on the Spanish-speaking community. (3) Knowledge-transfer activities and research projects: (a) Development of 20 PhDs projects; and (b) 59 articles and 6 books published.

Conclusion

Being the first initiative of chair in PC in Spain, the CPC has provided a framework of multidisciplinary areas that have generated innovative experiences and projects in PC.