bluuebunny/crossref_metadata_2025 huggingface dataset:
Strategies for Isothermal, Real-Time, Transient Pipeline Models in Shut-In Conditions
Authors: Okungbowa Norense , Brown Trent
Published: November 2018

Onshore, liquid pipelines are often modeled with isothermal models. Ignoring thermal effects is justified because thermal effects are of secondary importance and because the data, such as burial depth, soil thermal conductivity, soil heat capacity, and soil density, required to accurately predict thermal behavior in buried pipelines is not known accurately. In addition, run speeds are faster for isothermal models than for rigorous thermal models, which is particularly important in real-time models. One condition where thermal effects become important is when a pipeline is shut-in. Pumps increase the temperature of the fluid, so the fluid temperature is, on average, greater than ambient temperature. When a pipeline is shut-in, the temperature decreases causing a corresponding decrease in pressure. Since an isothermal model does not account for this behavior, the decreasing pressure can be misinterpreted as a leak. This paper discusses a strategy for correcting the model to properly account for the behavior in shut-in conditions. The strategy is applied to real-time pipeline models using Synergi Pipeline Simulator (SPS), although the method is applicable to any isothermal model.
Operational Change Assessments: A Proactive Approach to Managing Pipeline Integrity
Authors: Fernuik Kelsey , Keane Sean , Akonko Saheed , Jomha Omer , Limming Wayne
Published: November 2018

This paper presents a safety case program approach used by Enbridge to assess proposed operational changes. This approach identifies the impact to threats, barriers, and consequences associated with a proposed change, and ensure the safety of the system is not compromised by following a plan-do-check-act methodology.

Enbridge integrity management uses a plan-do-check-act system. A key aspect of this is the integrity plan which is developed for each asset to balance integrity requirements (fitness for service) with business drivers (risk and asset plan). Completion of a safety case provides an independent check for each pipeline segment within the system, ensuring identified risks are managed to as low as reasonably practicable (ALARP). Additional mitigation actions are identified and implemented in the event that ALARP is not met.

Operational parameters are a key consideration in the development of the integrity plan and include variables such as flow rate, injection and delivery locations, service, maximum allowable operating pressures, temperature and pressure cycling. The safety case program acts as a check by considering the threats associated with the proposed change to operational parameters, and then identifies whether or not the current pipeline integrity barriers for that asset are sufficient for the proposed operation, and if ALARP is still achieved based on the safety case program assessment. Where current barriers are not sufficient, actions are identified and put into place as required. The program also considers alignment to set demonstrated program performance targets, including reliability targets such as probability of failure, and deterministic targets which are used to confirm the safety case status.

This paper details the operational change assessment process within the safety case program, and discusses the benefits where the process was used.
Breathing New Life to Aging Pipeline Infrastructure Using Unique Wireline Inspection Techniques and Pipe-Lining Technology
Authors: Goudy Clay , Gutiérrez Alex
Published: November 2018

Mexico’s Energy Reform has opened up various interesting and unique opportunities for energy infrastructure. A CO2 pipeline project that was recently completed in southern Mexico provides a perfect example of how to breathe new life to deteriorated pipeline infrastructure — infrastructure that would have typically been written off. By coupling a unique pipeline inspection method with a novel lining system, two 28-kilometer (17 mile) pipelines were rehabilitated in record time and in a cost-effective manner. The project consisted of two 12 and 18-inch (300 and 450 millimeters) CO2 transport pipelines that had been out of service for 22 years and that are a central component for a high-profile fertilizer project. Replacing these deteriorated assets with a new transport pipeline was not an option due to time, environmental, permitting and budgetary constraints. The rehabilitated system had to offer a minimum 25-year service life required by the owner.

To put this aging infrastructure back into service, it was essential to assess the condition of the pipelines with a high level of accuracy and precision which would allow for the rehabilitation of the pipeline and installation of an interactive liner to extend the system’s serviceable life for a minimum of 25 years. The challenge, however, was that these pipelines were non-piggable by traditional methods.

By using a tethered MFL and Caliper ILI solution, the pipelines were each inspected in 13 separate sections with the level of detail necessary to assess the condition and suitability of the rehabilitation strategy selected for the project. Fast-track scheduling constraints required 24-hour data analysis turnaround of reports identifying and discriminating areas of modest and significant corrosion as well as deformations including areas of significant weld slag which could complicate the installation of the liners.

Once high-quality data was available, pinpoint repairs were possible with a combination of carbon fiber reinforcement and steel pipe replacement. Afterwards, the pipelines were internally lined with a patented process that effectively provides a double containment system. A grooved liner and the host steel pipe create an annular space that is pressurized with air and remotely monitored. The system is able to detect even a small pressure drop in the annulus that would occur in case the integrity is breached, or a pinhole develops in the steel pipe. With the grooved liner, external repairs can be conducted while the line continues to operate without interrupting CO2 service to the plant.

By applying these novel solutions, the rehabilitated pipelines will transport carbon dioxide to a revitalized fertilizer plant in a safe and efficient manner for the next 25 years.
Economic and Operational Evaluation of the Use of Drag Reducing Agents in a Pipeline
Authors: Amorim Bruno Henrique S. , Pires Luis Fernando G. , Menezes Ivan , Montalvão António Filipe F. , Limeira Fábio M.
Published: November 2018

The use of drag reduction agents (DRA) can be a decisive factor in determining the technical and economic feasibility of new pipelines projects, meeting the demands not foreseen and seasonality accommodation without large investments in infrastructure. Knowing the friction reduction mechanism and its impact on the operating procedure of existing products is essential in order to have the guarantee of the benefit for your application.

Most of the works published report field experiences obtained from its application, seeking to determine the influence that internal and external factors have on the polymer. Knowing these effects is essential for better application performance. However, few authors have sought to identify the best way to operate an existing pipeline with DRA, with either an increase in capacity or an energy reduction.

Operationally, the use of drag reducing agents may decrease the currently used arrangement of pumps, or even the complete shutdown of a pumping station. In this context, the use of drag reducers may be a suitable solution for decreasing power consumption in fluid transport pipelines of petroleum and derivatives.

This paper presents a case study of the application of drag reducing agents in a Brazilian high-energy pipeline. It features five intermediate pumping stations and three withdrawal points along its nearly one thousand kilometer stretch. With the aid of a computer simulation software, it is proposed a methodology to evaluate the best application condition, minimizing pump costs, polymer volume and meeting the scheduled demand of the month.

This methodology first sought to validate the computational model of the pipeline. It was made a historical survey and inserted into the simulator, in order to reproduce faithfully a monthly operation. A sensitivity analysis is performed to determine which pump stations are most relevant. It was established an initial concentration of polymer to be injected in the sending refinery, aiming the reduction of arrangement or total shutdown of the subsequent station and keeping volume delivered on all points. The other bases remain working according to the operation of the month. This procedure is then repeated for the other bases, resulting in a combined and continuous injection, minimizing the operating costs.

An economic evaluation is finally performed to quantify the benefits of this application. A reduction in energy consumption of 49% was noticed, and considering the costs with DRA, the monthly movement had a 35% drop in the total costs of operation.
Determining Pipeline Depth of Cover at River Crossings by Data Integration
Authors: Chan Peter , Wei Jin
Published: November 2018

Having sufficient depth of cover ensures pipeline protection and is a regulatory requirement. Confirming the pipeline depth of cover on dry land is generally easy and produces accurate results. However, determining the pipeline depth of cover at a river crossing can be problematic because of accessibility difficulties and the increased measurement errors from aboveground surveys.

The difficulty of determining the pipeline depth of cover at river crossings can be resolved by integrating both the aboveground survey data and the inline inspection data. By comparing both sets of data, errors from both above survey data and inline inspection data can be detected.

This paper describes watercourse management, aboveground DOC surveys, and a spreadsheet based tool developed for both the quick verification of aboveground survey results, and the calculation of the true DOC at water crossings without needing to set new GPS tie-points on both banks of the crossing and running a new ILI.
Are Pipelines Being Held to an Unreasonably High Standard of Performance?
Authors: Murray Alan
Published: November 2018

The media and sections of the public have shown recently an acute interest in Pipeline operational performance incident statistics. Published data for North America shows that 99.999% of crude oil and petroleum products shipped by pipelines reach their destination safely. Some pipeline operators claim even better performance, 99.9996 % being one example. However, should failing to deliver 4 barrels of product for every million shipped be a legitimate cause for concern? If not how about the more general case of 1 per one hundred thousand?

Is pipeline performance being singled out unreasonably when compared to other threats to public and environmental wellbeing such as medical malpractice or industrial waste contamination? Evidence from Canada and elsewhere, indicates that, during their hospital stay, an appreciable number of patients, one in every 18, experience adverse events, such as medication error, injurious falls, infections, and other medical misadventures. Errors (mostly minor), in fulfilling pharmaceutical prescriptions show an even higher error rate — 1 in 4 in one recent study, yet the public appears to be unperturbed.

A common thread is determining what constitutes an acceptable level of risk whether individual or societal, voluntary or involuntary. Besides providing a broader context for pipeline risk, the paper explores the origin and intent of the environmental screening standard of 1 in 10−6, as well as the concept of setting risk tolerance to be as low as reasonably practicable — ALARP. The question of why there may be a reticence for many Pipeline Regulators to set, as other industries have, a prescriptive value for ALARP is considered.
Guidelines for Quantitative Risk Model Development
Authors: Koduru Smitha D. , Skow Jason B.
Published: November 2018

A critical review of quantitative risk analysis (QRA) models used in the pipeline industry was conducted as part of a project titled “Critical Review of Candidate Pipeline Risk Models”, which was carried out for the U.S. Department of Transportation Pipeline and Hazardous Materials Safety Administration (PHMSA). Guidelines for the development and application of pipeline QRA models were developed as a part of this project, following an extensive literature review and an industry survey.

The guidelines provide a framework for performing QRA for natural gas and hazardous liquids transmission pipelines, and address risk estimation, which involves estimating the failure frequency and failure consequences. They are intended to assist operators in developing new QRA models, and in identifying and addressing gaps in their existing models. They are also intended to help regulators evaluate the accuracy, completeness, and effectiveness of the QRA models developed by operators.
Burst Pressure of Wrinkles Under High Longitudinal Strain
Authors: Zhou Honggang , Wang Yong-Yi , Nanney Steve
Published: November 2018

Wrinkles may form in pipelines experiencing high longitudinal strains in areas of ground movement and seismic activities. Current assessment procedures for wrinkles were developed and validated under the assumption that the predominant loading was internal pressure and that the level of longitudinal strain was low. The impact of wrinkles on the burst pressure of pipes under high longitudinal strain is not known. This paper describes work funded by US DOT PHMSA on the assessment of burst pressure of wrinkled pipes under high longitudinal strain.

Both numerical analyses and full-scale tests were conducted to examine the burst pressure of wrinkled pipes. The numerical analysis results were compared with the full-scale test data. The effect of wrinkles on burst pressure were discussed. The biaxial loading conditions in the pipe were found affect the burst pressure of wrinkled pipes.
CTOD-Resistance Curve Testing and Evaluation for Clamped SENT Specimens
Authors: Zhu Xian-Kui , McGaughy Tom
Published: November 2018

To assess the integrity of pipelines containing cracks, single edge-notched tension (SENT) specimens in the end-clamped conditions have been widely adopted in the oil and gas industry to measure fracture toughness or resistance curves in terms of the J-integral or crack-tip opening displacement (CTOD). The CTOD toughness is often utilized in the strain-based design, and thus its measurement is important to the pipeline industry. Two types of CTOD-R curve test methods are available for a single SENT specimen test: J-conversion method and double clip gage (DCG) measurement method. However, these two CTOD test methods often determine different R-curves, leading to a long-running dispute.

To better understand the difference of the two CTOD test methods as well as the effect of material strain hardening rate on CTOD-R curves, a set of clamped SENT specimens are tested for two ductile steels with a high strain hardening rate (A36) and a low strain hardening rate (X80). Experimental R-curves are analyzed for the two steels, and results show that the CTOD-R curves determined using the J-conversion method and the DCG method are comparable for X80, but significantly different for A36. To study the root cause, elastic-plastic finite element analyses are performed for the SENT specimens of A36 and X80. With the numerical results of J-integral and CTOD, different CTOD estimation methods are evaluated, and the root causes of their differences are analyzed. On this basis, discussions are made on how to use the two types of CTOD-R curves in the pipeline design and integrity assessment.
Simultaneous Quantification of
Plasmodium
Antigens and Host Factor C-Reactive Protein in Asymptomatic Individuals with Confirmed Malaria by Use of a Novel Multiplex Immunoassay
Authors: Jang Ihn Kyung , Tyler Abby , Lyman Chris , Kahn Maria , Kalnoky Michael , Rek John C. , Arinaitwe Emmanuel , Adrama Harriet , Murphy Maxwell , Imwong Mallika , Ling Clare L. , Proux Stephane , Haohankhunnatham Warat , Rist Melissa , Seilie Annette M. , Hanron Amelia , Daza Glenda , Chang Ming , Das Smita , Barney Rebecca , Rashid Andrew , Landier Jordi , Boyle David S. , Murphy Sean C. , McCarthy James S. , Nosten François , Greenhouse Bryan , Domingo Gonzalo J.
Published: November 2018

Malaria rapid diagnostic tests (RDTs) primarily detect
Plasmodium falciparum
antigen histidine-rich protein 2 (HRP2) and the malaria-conserved antigen lactate dehydrogenase (LDH) for
P. vivax
and other malaria species. The performance of RDTs and their utility is dependent on circulating antigen concentration distributions in infected individuals in a population in which malaria is endemic and on the limit of detection of the RDT for the antigens.
Toward the Development of a Circulating Free DNA-BasedIn VitroDiagnostic Test for Infectious Diseases: a Review of Evidence for Tuberculosis
Authors: Fernández-Carballo B. Leticia , Broger Tobias , Wyss Romain , Banaei Niaz , Denkinger Claudia M.
Published: November 2018

The detection of circulating free DNA (cfDNA) has transformed the field of oncology and prenatal diagnostics. Clinical application of cfDNA for disease diagnosis and monitoring, however, is relatively recent in the field of infectious disease.
Evasion of Immune Surveillance in Low Oxygen Environments Enhances Candida albicans Virulence
Authors: Lopes José Pedro , Stylianou Marios , Backman Emelie , Holmberg Sandra , Jass Jana , Claesson Rolf , Urban Constantin F.
Published: November 2018

Successful human colonizers have evolved mechanisms to bypass immune surveillance. Infiltration of PMNs to the site of infection led to the generation of a low oxygen niche. Exposure to low oxygen levels induced fungal cell wall masking, which in turn hindered pathogen sensing and antifungal responses by PMNs. The cell wall masking effect was prolonged by increasing lactate amounts produced by neutrophil metabolism under oxygen deprivation. In an invertebrate infection model,
C. albicans
was able to kill infected
C. elegans
nematodes within 2 days under low oxygen conditions, whereas the majority of uninfected controls and infected worms under normoxic conditions survived. These results suggest that
C. albicans
benefited from low oxygen niches to increase virulence. The interplay of
C. albicans
with innate immune cells under these conditions contributed to the overall outcome of infection. Adaption to low oxygen levels was in addition beneficial for
C. albicans
by reducing susceptibility to selected antifungal drugs. Hence, immunomodulation of host cells under low oxygen conditions could provide a valuable approach to improve current antifungal therapies.
Laparoscopic IPOM repair of an acquired abdominal intercostal hernia
Authors: Luqman Muhammad Qais , Mughal Afzaal , Waldron Ronan , Khan Iqbal Z
Published: November 2018

Acquired abdominal intercostal hernia (AAIH) is an infrequent occurrence whereby intra-abdominal contents herniate into intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. These hernias are difficult to diagnose and should always be suspected when a chest wall swelling occur after major or minor trauma. Surgical repair is warranted in symptomatic patients. The majority of AAIHs are repaired through an open approach using tension-free mesh, with significant recurrence risk. Recently, laparoscopic and robot-assisted repairs have been proposed. We discuss a 49-year-old man presented through outpatient setting with a 5-year history of ongoing left subcostal discomfort and a reducible lump. His history included a workplace accident 5 years ago. Contrast-enhanced abdominal CT confirmed AAIH with omentum herniation into the sac. A successful laparoscopic repair with intraperitoneal onlay mesh technique using composite mesh was performed.
Early life factors for myopia in the British Twins Early Development Study
Authors: Williams Katie M , Kraphol Eva , Yonova-Doing Ekaterina , Hysi Pirro G , Plomin Robert , Hammond Christopher J
Published: November 2018

Purpose

Myopia is an increasingly prevalent condition globally. A greater understanding of contemporaneous, early life factors associated with myopia risk is urgently required, particularly in younger onset myopia as this correlates with higher severity and increased complications in adult life.

Methods

Analysis of a subset of the longitudinal, UK-based Twins Early Development Study (n=1991) recruited at birth between 1994 and 1996. Subjective refraction was obtained from the twin’s optometrists; mean age 16.3 years (SD 1.7). Myopia was defined as mean spherical equivalent ≤−0.75 dioptres. A life course epidemiology approach was used to appropriately weight candidate myopia risk factors during critical periods of eye growth. Adjusted ORs for myopia were estimated using multivariable logistic regression models at each life stage, together with variance explained (r2) and area under the receiver operator characteristic curve (AUROC) statistic of predictive models.

Results

Factors significantly associated with myopia included level of maternal education (OR 1.33, 95% CI 1.11 to 1.59), fertility treatment (OR 0.63, 95% CI 0.43 to 0.92), summer birth (OR 1.93, 95% CI 1.28 to 2.90) and hours spent playing computer games (OR 1.03, 95% CI 1.01 to 1.06). The total variance explained by this model was 4.4 % (p<0.001) and the AUROC was 0.68 (95% CI 0.64 to 0.72). Consistent associations were observed with socioeconomic status, educational attainment, reading enjoyment and cognitive variables, particularly verbal cognition, at multiple points over the life course.

Conclusions

This study identifies known and novel associations with myopia during childhood development; associated factors identified in early life reflect sociological and lifestyle trends such as rates of maternal education, fertility treatment, early schooling and computer games.
Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis
Authors: Zheng Yayuan , Zhu Jianhong , Liu Yuyu , Lai Weiguang , Lin Chunyu , Qiu Kaifen , Wu Junyan , Yao Weimin
Published: November 2018

Objective

To compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD).

Design

Systematic review and meta-analysis of randomised controlled trials.

Data sources

PubMed, Embase, Cochrane databases, and clinical trial registries searched from inception to April 2018.

Eligibility criteria

Randomised controlled trials comparing triple therapy with dual therapy or monotherapy in patients with COPD were eligible. Efficacy and safety outcomes of interest were also available.

Data extraction and synthesis

Data were collected independently. Meta-analyses were conducted to calculate rate ratios, hazard ratios, risk ratios, and mean differences with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations assessment, development, and evaluation).

Results

21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy. The overall safety profile of triple therapy is reassuring, but pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).

Conclusions

Use of triple therapy resulted in a lower rate of moderate or severe exacerbations of COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.

Study registration

Prospero CRD42018077033.
Does perception of drug-related harm change with age? A cross-sectional online survey of young and older people
Authors: Cheeta Survjit , Halil Adem , Kenny Matthew , Sheehan Erin , Zamyadi Roxanne , Williams Adrian Lloyd , Webb Lucy
Published: November 2018

Objectives

To investigate how young and older people perceive the harms associated with legal and illegal drugs.

Design

Cross-sectional study: adults aged 18–24 years versus 45+ completed an online survey ranking the perceived harms associated with 11 drugs on 16 drug-related harm criteria.

Setting

Online survey.

Participants

184 participants aged 18–24 years (113 female: mean age 21: SD 1.3) and 91 participants aged 45+ (51 female: mean age 60: SD 8.5).

Main outcome measures

‘Perception of drug-related harms’: This was measured using a rating scale ranging from 1 (no risk of harm) to 4 (high risk of harm). Participants were also asked about sources which informed their perception on drug-related harms as well as their own personal self-reported drug experiences.

Results

Of the illegal drugs, heroin, methamphetamine and cocaine were rated as the most harmful and cannabis was rated as the least harmful. Alcohol and tobacco were also rated as less harmful. The results showed that perceptions of drug-related harms were inconsistent with current knowledge from research on drugs. Furthermore, perceptions on drug harms were more conservative in the 45+ group for a number of illegal drugs and tobacco. However, the 45+ age group did not perceive alcohol as any more harmful than the younger group.

Conclusions

This survey demonstrates that the greatest misperception was in relation to alcohol-related harms which did not change with age. In order to minimise harms, this misperception needs to be addressed through education and policies that legislate drug use.
Risk of olfactory dysfunction of the workers in the automobile repair, printing, shoemaking and plating industries in Korea: a cross-sectional study
Authors: Lee Soo-Jin , Kim Eun-Mi , Cho Seok-Hyun , Song Jaechul , Jang Tae-Won , Lee Mi-Young
Published: November 2018

Objectives

The present study was performed to investigate the prevalence of olfactory dysfunction in workers exposed to hazardous substances in a variety of occupations in Korea.

Methods

We designed a cross-sectional study. The exposed group (n=296) consisted of Korean workers in the automobile repair, printing, shoemaking and plating industries and was compared with office workers (non-exposed group, n=99). A self-report questionnaire was administered to the subjects for demographic characteristics. In addition, olfactory function was evaluated using the Korean version of Sniffin’s Stick (KVSS) I and II test, which has been reported to be valid and reliable in Korean subjects. KVSS I score ≥7 or KVSS II score ≥30 was classified as normal, KVSS I score <7 or KVSS II score <30 was classified as oflactory dysfunction. The statistical analyses were performed with olfactory dysfunction as a dependent variable to calculate prevalence ratio (PR) of the exposed group.

Results

The prevalence of olfactory dysfunction was 21.2% in office, 45.1% in automobile repair, 69.7% in printing and 88.9% in shoemaking and plating workers. The adjusted PR was highest in plating (3.589, 95% CI 1.957 to 6.583), followed by shoemaking (3.136, 95% CI 1.763 to 5.579), printing (2.669, 95% CI 1.610 to 4.424) and automobile repair (1.914, 95% CI 1.105 to 3.317) workers.

Conclusions

In comparison with office workers, the prevalence of olfactory dysfunction and the PR of olfactory dysfunction were very high in the four occupational groups. This finding could be an important basis for establishing the olfactory dysfunction prevention policy for workers who are exposed to hazardous substances or work in high-risk occupations.
Drug use in street sex workers (DUSSK) study protocol: a feasibility and acceptability study of a complex intervention to reduce illicit drug use in drug-dependent female street sex workers
Authors: Jeal Nicola , Patel Rita , Redmond Niamh M , Kesten Joanna M , Ramsden Sophie , Macleod John , Coast Joanna , Telfer Maggie , Wilcox David , Nowland Gill , Horwood Jeremy
Published: November 2018

Introduction

Poor health of sex workers continues to be a source of international concern. Sex work is frequently linked with problematic drug use and drug-dependent sex workers typically work on the street, experiencing the greatest risks to health compared with the general population. Street sex workers (SSWs) are much more likely to have experienced incidences of physical and sexual assault, increasing their risk of developing post-traumatic stress disorder (PTSD). We have developed a novel complex intervention designed to reduce illicit drug use in drug-dependent female SSWs which involves: female SSW drug treatment groups (provided by a specialist charity) in a female SSW setting (female sex worker charity premises) provided by female-only staff, PTSD care with eye movement desensitisation and reprocessing (EMDR) therapy provided by female staff from National Health Service (NHS) mental health services.

Methods and analysis

A mixed methods study investigating the feasibility and acceptability of this intervention to inform the design of a future randomised controlled trial. The study aims to recruit up to 30 participants from November 2017 to March 2018 at a single site, with the intervention being delivered until December 2018. It will gather quantitative data using questionnaires and group attendance. Drug treatment group observations and in-depth interviews undertaken with up to 20 service users and 15 service providers to examine experiences and acceptability of the intervention. Study feasibility will be assessed by evaluating the recruitment and retention of participants to the intervention; the feasibility of NHS and third sector organisations working closely to coordinate care for a SSW population; the potential for specialist NHS mental health services to screen and provide EMDR therapy for drug-dependent SSWs and potential costs of implementing the intervention.

Ethics and dissemination

This study was approved by South West–Frenchay Research Ethics Committee (REC reference: 17/SW/0033; IRAS ID: 220631) and the Health Research Authority (HRA). Findings will be disseminated through research conferences and peer-reviewed journals.
Effectiveness and safety of modified ‘Huoxue Shugan’ formulas on coronary heart disease combined with depression: protocol for a systematic review
Authors: Chen Mingtai , Men Ling , Ou Lijun , Li Tao , Li Meihuan , Zhong Xiaoling , Zhang Jian , Zhang Zhong
Published: November 2018

Objective

To assess the clinical effectiveness and safety of modified ‘Huoxue Shugan’ (HXSG) formulas used as Chinese herbal medicine in treating patients with coronary heart disease (CHD) and depression.

Methods

A systematic literature search of articles up to March 2018 will be performed in the following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System and Wanfang Database. Inclusion criteria are as follows: randomised controlled trials of modified HXSG formulas in patients with CHD and depression. The primary outcome measures will be CHD-related clinical evaluation (frequency of acute angina, severity of angina pectoris, ECG changes, dose of nitroglycerin) and the scores or amount of reduction in scales measuring depression (ie, the Hamilton Depression Scale or other widely used depression scales). The safety outcome measures will be adverse events, liver and kidney function. RevMan V.5.3 software will be used for data synthesis, sensitivity analyses, subgroup analyses and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata V.12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Ethics and dissemination

This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal.

PROSPERO registration number

CRD42018089641.
Temporal and geographic patterns of stab injuries in young people: a retrospective cohort study from a UK major trauma centre
Authors: Vulliamy Paul , Faulkner Mark , Kirkwood Graham , West Anita , O’Neill Breda , Griffiths Martin P , Moore Fionna , Brohi Karim
Published: November 2018

Objectives

To describe the epidemiology of assaults resulting in stab injuries among young people. We hypothesised that there are specific patterns and risk factors for injury in different age groups.

Design

Eleven-year retrospective cohort study.

Setting

Urban major trauma centre in the UK.

Participants

1824 patients under the age of 25 years presenting to hospital after a stab injury resulting from assault.

Outcomes

Incident timings and locations were obtained from ambulance service records and triangulated with prospectively collected demographic and injury characteristics recorded in our hospital trauma registry. We used geospatial mapping of individual incidents to investigate the relationships between demographic characteristics and incident timing and location.

Results

The majority of stabbings occurred in males from deprived communities, with a sharp increase in incidence between the ages of 14 and 18 years. With increasing age, injuries occurred progressively later in the day (r2=0.66, p<0.01) and were less frequent within 5 km of home (r2=0.59, p<0.01). Among children (age <16), a significant peak in injuries occurred between 16:00 and 18:00 hours, accounting for 22% (38/172) of injuries in this group compared with 11% (182/1652) of injuries in young adults. In children, stabbings occurred earlier on school days (hours from 08:00: 11.1 vs non-school day 13.7, p<0.01) and a greater proportion were within 5 km of home (90% vs non-school day 74%, p=0.02). Mapping individual incidents demonstrated that the spike in frequency in the late afternoon and early evening was attributable to incidents occurring on school days and close to home.

Conclusions

Age, gender and deprivation status are potent influences on the risk of violent injury in young people. Stab injuries occur in characteristic temporal and geographical patterns according to age group, with the immediate after-school period associated with a spike in incident frequency in children. This represents an opportunity for targeted prevention strategies in this population.
Prevalence and patterns of multimorbidity in Amazon Region of Brazil and associated determinants: a cross-sectional study
Authors: Araujo Maria Elizete A , Silva Marcus T , Galvao Tais F , Nunes Bruno P , Pereira Mauricio G
Published: November 2018

Objectives

To estimate the prevalence of multimorbidity and to identify factors associated with it in the adult population from the metropolitan region of Manaus.

Design

Cross-sectional population-based study.

Setting

Interviews conducted between May and August of 2015 in eight cities that compose the metropolitan region of Manaus, Amazonas, Brazil.

Participants

4001 adults aged ≥18 years.

Primary outcome measures

Multimorbidity, measured by the occurrence of ≥2 and ≥3 chronic diseases, was the primary outcome. The associated factors were investigated by calculating the prevalence ratio (PR) obtained by Poisson regression, with robust adjustment of the variance in a hierarchical model. A factor analysis was conducted to investigate multimorbidity clusters.

Results

Half of the interviewees were women. The presence of a chronic disease was reported by 57.2% (95% CI 56.6% to 59.7%) of the interviewees, and the mean morbidity was 1.2 (1.1–1.2); 29.0% (95% CI 27.6% to 30.5%) reported ≥2 morbidities and 15.2% (95% CI 14.1% to 16.4%) reported ≥3 chronic conditions. Back pain was reported by one-third of the interviewees. Multimorbidity was highest in women, PR=1.66 (95% CI 1.50 to 1.83); the elderly, PR=5.68 (95% CI 4.51 to 7.15) and individuals with worse health perception, PR=3.70 (95% CI 2.73 to 5.00). Associated factors also included undergoing medical consultations, hospitalisation in the last year, suffering from dengue in the last year and seeking the same healthcare service. Factor analysis revealed a pattern of multimorbidity in women. The factor loading the most strength of association in women was heart disease. In men, an association was identified in two groups, and lung disease was the disease with the highest factorial loading.

Conclusion

Multimorbidity was frequent in the metropolitan region of Manaus. It occurred most often in women, in the elderly and in those with worse health perception.
A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol
Authors: Sippola Suvi , Grönroos Juha , Sallinen Ville , Rautio Tero , Nordström Pia , Rantanen Tuomo , Hurme Saija , Leppäniemi Ari , Meriläinen Sanna , Laukkarinen Johanna , Savolainen Heini , Virtanen Johanna , Salminen Paulina
Published: November 2018

Introduction

Recent studies show that antibiotic therapy is safe and feasible for CT-confirmed uncomplicated acute appendicitis. Spontaneous resolution of acute appendicitis has already been observed over a hundred years ago. In CT-confirmed uncomplicated acute diverticulitis (left-sided appendicitis), studies have shown no benefit from antibiotics compared with symptomatic treatment, but this shift from antibiotics to symptomatic treatment has not yet been widely implemented in clinical practice. Recently, symptomatic treatment of uncomplicated acute appendicitis has been demonstrated in a Korean open-label study. However, a double-blinded placebo-controlled study to illustrate the role of antibiotics and spontaneous resolution of uncomplicated acute appendicitis is still lacking.

Methods and analysis

The APPAC III (APPendicitis ACuta III) trial is a multicentre, double-blind, placebo-controlled, superiority randomised study comparing antibiotic therapy with placebo in the treatment CT scan-confirmed uncomplicated acute appendicitis aiming to evaluate the role of antibiotics in the resolution of uncomplicated acute appendicitis. Adult patients (18–60 years) with CT scan-confirmed uncomplicated acute appendicitis (the absence of appendicolith, abscess, perforation and tumour) will be enrolled in five Finnish university hospitals.

Primary endpoint is success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without surgical intervention within 10 days after initiating randomised treatment (treatment efficacy). Secondary endpoints include postintervention complications, recurrent symptoms after treatment up to 1 year, late recurrence of acute appendicitis after 1 year, duration of hospital stay, sick leave, treatment costs and quality of life. A decrease of 15 percentage points in success rate is considered clinically important difference. The superiority of antibiotic treatment compared with placebo will be analysed using Fisher’s one-sided test and CI will be calculated for proportion difference.

Ethics and dissemination

This protocol has been approved by the Ethics Committee of Turku University Hospital and the Finnish Medicines Agency (FIMEA). The findings will be disseminated in peer-reviewed academic journals.

Trial registration number

NCT03234296; Pre-results.
Patients’ attendance patterns to different healthcare settings and perceptions of stakeholders regarding screening for chronic, non-communicable diseases in high street dental practices and community pharmacy: a cross-sectional study
Authors: Yonel Zehra , Sharma Praveen , Yahyouche Asma , Jalal Zahraa , Dietrich Thomas , Chapple Iain L
Published: November 2018

Objective

Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals.

Design

Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively.

Setting

Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey.

Participants

1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires.

Outcome measures

The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored.

Results

12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions.

Conclusions

This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.
Tacrolimus in non-Asian patients with SLE: a real-life experience from three European centres
Authors: Tani Chiara , Elefante Elena , Martin-Cascón Miguel , Belhocine Meriem , Lavilla Olleros Cristina , Vagelli Roberta , Stagnaro Chiara , Costedoat-Chalumeau Nathalie , Ruiz-Irastorza Guillermo , Mosca Marta
Published: November 2018

Objectives

To analyse the real-life practice on the use of Tacrolimus (TAC) in patients with systemic lupus erythematosus (SLE) from three European SLE referral centres.

Methods

Adult patients with SLE regularly followed at three European referral centres were included. Demographics, cumulative organ involvement, treatment history, Systemic Lupus Disease Activity Index (SLEDAI), laboratory features and physician’s judgement were collected at baseline and at 3–6–12 months after starting TAC.

Results

29 patients were included (89% female, mean age 38±9 years). Ethnicity was predominantly Caucasian (82%), Black African (11%), Hispanic (3.5%) and Caribbean (3.5%). The main indications for TAC prescription were renal involvement (82.7%), arthritis (10.3%), cutaneous manifestations (6.8%), haematological manifestations (6.8%), serositis (3.4%). At 3 months, there was a clinical improvement in 21 patients (72.4%) and 9 of these experienced a complete resolution of symptoms (31%). This corresponds to: (1) a significant decrease in the mean SLEDAI; (2) a significant decrease in the mean 24  hours proteinuria; a significant increase in C3 and stable creatinine values. At 6 months (n=25), the physician declared an improvement in 19 patients (76%) and a complete resolution of symptoms in 9 (36%). The same trend was observed at 12 months of follow-up. TAC was discontinued in nine pts (31%); reasons for discontinuation were inefficacy (13.8%), drug intolerance (10%) and disease remission (6.9%).

Conclusions

Despite the limitation due to the small number of patients and the uncontrolled nature of the study, these data show that TAC can be considered a valid therapeutic option in patients with SLE, especially for renal involvement.
Predictors of persistent disease activity and long quiescence in systemic lupus erythematosus: results from the Hopkins Lupus Cohort
Authors: Giannakou Ioanna , Chatzidionysiou Katerina , Magder Laurence S , Györi Noemi , van Vollenhoven Ronald , Petri Michelle A
Published: November 2018

Objectives

The aim of this study is to identify prognostic factors of persistent disease activity and long quiescence in systemic lupus erythematosus (SLE).

Methods

Patients enrolled in the Hopkins Lupus Cohort from 1987 to 2012, who attended at least three visits per year during 3 consecutive years following baseline and had available information on disease activity were included. Patterns of SLE disease activity over the 3-year period were defined as: persistent long quiescent (pLQ), persistent relapsing-remitting (pRR), persistent chronic active (pCA) and mixed based on Modified SLE Disease Activity Index (M-SLEDAI). Possible predictors of pCA (vs pLQ, pRR and mixed) and pLQ (vs pCA, pRR and mixed) were identified by univariate and multivariate logistic regression analyses.

Results

916 patients were included. In the multivariate analysis, use of hydroxychloroquine (OR: 0.45, 95%  CI 0.22 to 0.92, p=0.03), African American ethnicity (OR: 2.36, 95%  CI 1.15 to 4.85, p=0.02) and baseline SLEDAI (OR: 1.10, 95%  CI 1.03 to 1.17, p=0.005) remained significant predictors of pCA. Higher education (>12 years; OR. 2.07, 95%  CI 1.07 to 4.03, p=0.03) and lower baseline SLEDAI (OR: 0.67, 95%  CI 0.56 to 0.82, p<0.001) were significant predictors of pLQ, while African American (OR: 0.38, 95%  CI 0.17 to 0.83, p=0.02) and female patients (OR: 0.26, 95%  CI 0.12 to 0.57, p<0.001) were less likely to achieve pLQ.

Conclusion

African American ethnicity and high disease activity at baseline predict chronic activity in SLE, regardless of treatment, years of education and income. Higher education, low disease activity at baseline and male sex predict long quiescence. The use of hydroxychloroquine is independently associated with a lower risk of chronically active disease.