bluuebunny/crossref_metadata_2025 huggingface dataset:
Heat Transfer and Fluid Friction During Viscous Flow Across Banks of Tubes—III: A Study of Tube Spacing and Tube Size
Authors: Bergelin O. P. , Brown G. A. , Hull H. L. , Sullivan F. W.
Published: July 2022

In the course of a research program on tubular heat exchangers, pressure-drop and heat-transfer data are reported for heating and cooling a medium-viscosity oil flowing across banks of vertical tubes in seven test exchangers. The apparatus variables include equilateral triangle, in-line square, and staggered square arrangements; tube sizes of ⅜ in, and ¾ in. OD; and pitch ratios of 1.25 and 1.50. The results are shown both in simple plots of pressure drop and coefficient of heat transfer versus the rate of flow, and in generalized correlations. Tentative correlations are provided for friction and heat transfer which bring the data for these seven tube banks somewhat closer together than previous correlations. In a comparison of the heat-transfer coefficient versus pumping-power loss per unit surface area, the smaller diameter tubes at the smaller pitch ratio give the best performance.
Experimental Evaluation of Human Shape Factors With Respect to Floor Areas
Authors: Hutchinson F. W.
Published: July 2022

Results are presented for the shape factor of an average standing person with respect to energy in the form of heat received from a floor area. The use of shape factors is essential in determining conditions of comfort in a heated or cooled enclosure.
Furnace Heat Absorption in Paddy’s Run Pulverized-Coal-Fired Steam Generator, Using Turbulent Burners, Louisville, Ky.: Part I—Variation in Heat Absorption as Shown by Measurement of Surface Temperature of Exposed Side of Furnace Tubes
Authors: Wheater R. I. , Howard M. H.
Published: July 2022

This report is one of three current formal reports (1) covering the activities of the ASME Special Research Committee on Furnace Performance Factors in connection with the furnace performance tests which were conducted at the Paddy’s Run Station of the Louisville Gas and Electric Company in Louisville, Kentucky. The furnace heat absorption and its distribution in the furnace, as reported in this paper, were determined by the “ΔT method,” which consists of using the difference in temperature between the surface of the exposed face of the tube and the mixture within the tube to measure the heat absorption at representative locations. The companion paper, Part II, covers the furnace performance as measured by a heat balance of the furnace. Part III presents a correlation of the results.
Furnace Heat Absorption in Paddy’s Run Pulverized-Coal-Fired Steam Generator, Using Turbulent Burners, Louisville, Ky.: Part II—Furnace Heat-Absorption Efficiency as Shown by Temperature and Composition of Gases Leaving the Furnace
Authors: Corey R. C. , Cohen Paul
Published: July 2022

This paper is part of the second of a series of formal reports on investigations of heat absorption and distribution of heat transfer in representative pulverized-coal-fired boiler furnaces, sponsored by the ASME Special Research Committee on Furnace Performance Factors. The results are presented of fifteen determinations of heat absorption in the furnace of a 640,000 lb per hr boiler with horizontal firing, operating at 950 psig and 900 F at the superheater outlet. The effect on furnace heat-absorption efficiency is shown for variation of (a) the heat available in the furnace, (b) the excess air, (c) the setting of the secondary-air vanes of the turbulent burners, and (d) at low loads, the number and location of the burners used. Detailed data are given for the distribution of excess air and gas temperature at the furnace outlet. The heat-absorption data are analyzed in terms of radiation heat transfer, and the significance of flame location, volume, and shape is discussed.
Furnace Heat Absorption in Paddy’s Run Pulverized-Coal-Fired Steam Generator, Using Turbulent Burners, Louisville, Ky.: Part III—Comparison and Correlation of the Results of Furnace Heat-Absorption Investigation
Authors: Hemenway H. H. , Wheater R. I.
Published: July 2022

In this paper, the results of the two companion papers (Parts I and II) are compared. Some of the possible sources of error are noted. Slightly revised calculated results are obtained by taking weighted averages of the data. The revised results are examined to determine which tests are the most dependable. An equation showing the relationship between furnace exit-gas temperature and furnace heat-absorption rate for a fixed burner adjustment is developed. From the revised results the effect of various factors on furnace performance is shown.
Oil Holes and Grooves in Plain Journal Bearings
Authors: McKee S. A. , White H. S.
Published: July 2022

Data are presented showing the performance of plain journal bearings having various arrangements of oil holes and grooves operating in a four-bearing friction machine with forced-feed lubrication. Tests cover operation where the oil is fed through the bearing shell by means of five arrangements, including one, two, or four oil holes; one axial or one circumferential groove. Tests were also run with three arrangements for feeding oil from the center of a hollow shaft. These were one or two oil holes in the shaft, or one oil hole terminating in a flat on the surface of the shaft. Two clearance-diameter ratios were used with each arrangement. Test runs were made at constant speed and at a number of loads, which were unidirectional relative to the bearings. The data cover operation with one oil at one oil-inlet temperature and two speeds. In some of the tests the loads were increased until unstable lubrication was reached. The test results include the frictional characteristics, values of ZN/P at transition between stable and unstable lubrication, and data on thermal behavior and on oil flow. A summary of the general behavior of the various arrangements is given.
Calibrations of Six Beth-Flow Meters at Alden Hydraulic Laboratory, Worcester Polytechnic Institute
Authors: Hooper L. J.
Published: July 2022

Six Beth-Flow tubes were calibrated by means of a volumetric tank at the Alden Hydraulic Laboratory to determine their suitability as flow-metering elements. Four of the six meters tested had practically the same coefficients with flow in either direction. The flow coefficients were constant above a Reynolds number of 100,000. Further tests are necessary to determine manufacturing tolerances and the effects of disturbed flow due to various types of piping arrangements.
Suppression Mechanism and Prediction Model of Top Burr in Metal Milling Under Ice Boundary Constraint
Authors: Liu Haibo , Wang Chengxin , Li Pengchao , Wang Songjian , Li Xu , Wang Yongqing
Published: July 2022

During metal milling, top burrs will inevitably appear on the edge of the workpiece, which seriously reduces the edge quality and assembly accuracy of the workpiece, thereby reducing the service performance of the product. This study innovatively proposes an ice boundary constraint (IBC) method to avoid top burrs formation during cutting. First, the formation mechanism of the top burrs is analyzed, and the principle of IBC is interpreted. Then, an analytical model is established to realize the cutting analysis, obtain the stress distribution during cutting, and explore the plastic deformation process of the workpiece edge, thus revealing top burrs suppression mechanism and predicting top burrs height. Afterwards, based on the proposed analytical model, finite element method (FEM) is used to simulate the stress distribution at the top edge to verify the stress analysis results of the analytical model. Finally, the effectiveness of IBC method and the prediction accuracy of the analytical model are verified by aluminum alloy 2024 (AA2024) milling experiments. The experimental results show that IBC method can reduce the top burrs height by 54.62% on average, and the percentage of average prediction error of the analytical model is limited to 16.66%. Moreover, the milling experiments of carbon steel and aluminum alloy 6061 (AA6061) are carried out under the same process parameters, and the results show that IBC method can realize the suppression of top burrs of different materials. This study can provide valuable theoretical and practical reference for the minimization of burrs formation during cutting.
Design of a Compact Gear-Spring Mechanism for Static Balancing of Variable Payloads
Authors: Nguyen Vu Linh
Published: July 2022

The design of mechanisms for the static balancing of a rotating and weight-varying link has tremendous implications for mechanical structures and robotic systems. This article presents a compact gear-spring mechanism (CGSM) for the static balancing of variable payloads. The CGSM is constructed with a three-gear train and a tension spring mounted on a rotating link with a mass to be statically balanced. The static balancing design of the CGSM is realized by imposing geometrical constraints on the links and then deriving the spring parameters from analytical equations. The payload variability of the CGSM is obtained through an energy-free adjustment of the settling position of the spring when the rotating link is vertical. A theoretical model and experimental tests are provided to demonstrate the performance of the CGSM. Experimental studies showed that the CGSM could be maintained over a prescribed workspace without input forces. The actuator torque and accumulated energy consumption of the CGSM were practically decreased by up to 89.4% and 95.7%, respectively, within a range of payloads from 0.2 kg to 0.8 kg.
Itch-specific neurons in the ventrolateral orbital cortex selectively modulate the itch processing
Authors: Jiang Shan , Wang Yi-Song , Zheng Xiao-Xia , Zhao Shan-Lan , Wang Yi , Sun Lin , Chen Peng-Hui , Zhou Yi , Tin Chung , Li Hong-Li , Sui Jian-Feng , Wu Guang-Yan
Published: July 2022

Itch is a cutaneous sensation that is critical in driving scratching behavior. The long-standing question of whether there are specific neurons for itch modulation inside the brain remains unanswered. Here, we report a subpopulation of itch-specific neurons in the ventrolateral orbital cortex (VLO) that is distinct from the pain-related neurons. Using a Tet-Off cellular labeling system, we showed that local inhibition or activation of these itch-specific neurons in the VLO significantly suppressed or enhanced itch-induced scratching, respectively, whereas the intervention did not significantly affect pain. Conversely, suppression or activation of pain-specific neurons in the VLO significantly affected pain but not itch. Moreover, fiber photometry and immunofluorescence verified that these itch- and pain-specific neurons are distinct in their functional activity and histological location. In addition, the downstream targets of itch- and pain-specific neurons were different. Together, the present study uncovers an important subpopulation of neurons in the VLO that specifically modulates itch processing.
Vocal signals facilitate cooperative hunting in wild chimpanzees
Authors: Mine Joseph G. , Slocombe Katie E. , Willems Erik P. , Gilby Ian C. , Yu Miranda , Thompson Melissa Emery , Muller Martin N. , Wrangham Richard W. , Townsend Simon W. , Machanda Zarin P.
Published: July 2022

Cooperation and communication likely coevolved in humans. However, the evolutionary roots of this interdependence remain unclear. We address this issue by investigating the role of vocal signals in facilitating a group cooperative behavior in an ape species: hunting in wild chimpanzees. First, we show that bark vocalizations produced before hunt initiation are reliable signals of behavioral motivation, with barkers being most likely to participate in the hunt. Next, we find that barks are associated with greater hunter recruitment and more effective hunting, with shorter latencies to hunting initiation and prey capture. Our results indicate that the coevolutionary relationship between vocal communication and group-level cooperation is not unique to humans in the ape lineage and is likely to have been present in our last common ancestor with chimpanzees.
Rapidly expanding spin-polarized exciton halo in a two-dimensional halide perovskite at room temperature
Authors: Yumoto Go , Sekiguchi Fumiya , Hashimoto Ruito , Nakamura Tomoya , Wakamiya Atsushi , Kanemitsu Yoshihiko
Published: July 2022

Monitoring of the spatially resolved exciton spin dynamics in two-dimensional semiconductors has revealed the formation of a spatial pattern and long-range transport of the spin-polarized excitons, which holds promise for exciton-based spin-optoelectronic applications. However, the spatial evolution has been restricted to cryogenic temperatures because of the short exciton spin relaxation times at room temperature. Here, we report that two-dimensional halide perovskites can overcome this limitation owing to their relatively long exciton spin relaxation times and substantial exciton-exciton interactions. We demonstrate the emergence of a halo-like spatial profile in spin-polarized exciton population and its ultrafast expansion at room temperature by performing time-resolved Faraday rotation imaging of spin-polarized excitons in two-dimensional perovskite (C
4
H
9
NH
3
)
2
(CH
3
NH
3
)
3
Pb
4
I
13
. Exciton-exciton exchange interactions induce density-dependent nonlinear relaxation and ultrafast transport of exciton spins and give rise to a rapidly expanding halo-like spatial pattern. The density-dependent spatial control suggests the potential of using two-dimensional halide perovskites for spin-optoelectronic applications.
Versatile synthesis of dendritic mesoporous rare earth–based nanoparticles
Authors: Yu Hongyue , Wang Wenxing , Liu Minchao , Zhao Tiancong , Lin Runfeng , Hou Mengmeng , Kou Yufang , Chen Liang , Elzatahry Ahmed A. , Zhang Fan , Zhao Dongyuan , Li Xiaomin
Published: July 2022

Rare earth–based nanomaterials that have abundant optical, magnetic, and catalytic characteristics have many applications. The controllable introduction of mesoporous channels can further enhance its performance, such as exposing more active sites of rare earth and improving the loading capacity, yet remains a challenge. Here, we report a universal viscosity-mediated assembly strategy and successfully endowed rare earth–based nanoparticles with central divergent dendritic mesopores. More than 40 kinds of dendritic mesoporous rare earth–based (DM-REX) nanoparticles with desired composition (single or multiple rare earth elements, high-entropy compounds, etc.), particle diameter (80 to 500 nanometers), pore size (3 to 20 nanometers), phase (amorphous hydroxides, crystalline oxides, and fluorides), and architecture were synthesized. Theoretically, a DM-REX nanoparticle library with 393,213 kinds of possible combinations can be constructed on the basis of this versatile method, which provides a very broad platform for the application of rare earth–based nanomaterials with rational designed functions and structures.
Epithelial HVEM maintains intraepithelial T cell survival and contributes to host protection
Authors: Seo Goo-Young , Takahashi Daisuke , Wang Qingyang , Mikulski Zbigniew , Chen Angeline , Chou Ting-Fang , Marcovecchio Paola , McArdle Sara , Sethi Ashu , Shui Jr-Wen , Takahashi Masumi , Surh Charles D. , Cheroutre Hilde , Kronenberg Mitchell
Published: July 2022

Intraepithelial T cells (IETs) are in close contact with intestinal epithelial cells and the underlying basement membrane, and they detect invasive pathogens. How intestinal epithelial cells and basement membrane influence IET survival and function, at steady state or after infection, is unclear. The herpes virus entry mediator (HVEM), a member of the TNF receptor superfamily, is constitutively expressed by intestinal epithelial cells and is important for protection from pathogenic bacteria. Here, we showed that at steady-state LIGHT, an HVEM ligand, binding to epithelial HVEM promoted the survival of small intestine IETs. RNA-seq and addition of HVEM ligands to epithelial organoids indicated that HVEM increased epithelial synthesis of basement membrane proteins, including collagen IV, which bound to β1integrins expressed by IETs. Therefore, we proposed that IET survival depended on β1integrin binding to collagen IV and showed that β1integrin–collagen IV interactions supported IET survival in vitro. Moreover, the absence of β1integrin expression by T lymphocytes decreased TCR αβ+IETs in vivo. Intravital microscopy showed that the patrolling movement of IETs was reduced without epithelial HVEM. As likely consequences of decreased number and movement, protective responses toSalmonella entericawere reduced in mice lacking either epithelial HVEM, HVEM ligands, or β1integrins. Therefore, IETs, at steady state and after infection, depended on HVEM expressed by epithelial cells for the synthesis of collagen IV by epithelial cells. Collagen IV engaged β1integrins on IETs that were important for their maintenance and for their protective function in mucosal immunity.
Supplemental Material: Cretaceous–Cenozoic cooling history of the Qiangtang terrane and implications for Central Tibet formation
Authors: Bi Wenjun , Li Yalin , al. et
Published: July 2022

Table S1: Our and published low-temperature thermochronological data from the Qiangtang Terrane. Table S2: Sample details.
Demyelinating polyneuropathy associated with chronic inactive hepatitis B infection
Authors: Babatin Mohamed A , AlJohani Awatef
Published: July 2022

This is a case report of a 42-year-old female patient with chronic inactive hepatitis B virus (HBV) infection who presented with relapsing chronic inflammatory demyelinating polyneuropathy (CIDP). Her initial attack was of acute onset (ie, acute CIDP) resembling Guillain-Barré syndrome that responded well to intravenous immunoglobulin (IVIG) therapy. The second episode was chronic and refractory to IVIG. She was managed with plasma exchange, long-term corticosteroids, immunosuppressants and HBV antiviral therapy. She showed both clinical and electromyographic improvement, with no recurrence after 2 years of follow-up.
Rare case of rectosigmoid stricture causing transverse colon volvulus
Authors: Westfall Kristen , Brown Rebecca , Chang Melissa
Published: July 2022

A 60-year-old woman with remote history of sleeve gastrectomy presented with altered mental status after an unwitnessed fall. She was found to be hypothermic with lactic acidaemia, leucocytosis, positive urinalysis, and dilated ascending and transverse colon on cross-sectional imaging, initially thought to be secondary to faecal loading. She was admitted to the medical intensive care unit for resuscitation and broad-spectrum antibiotics for presumed urinary sepsis. She became acutely altered and underwent urgent flexible sigmoidoscopy by gastroenterology to evaluate for ischaemic colitis. During the procedure, there was concern for iatrogenic colon injury given the friability of the colonic mucosa, so the patient was taken urgently for exploratory laparotomy. Intraoperatively, she was found to have a transverse colon volvulus with large areas of patchy, gangrenous bowel without evidence of gross perforation. A rectosigmoid stricture with associated serosal tear, but no full-thickness injury was identified. An extended left hemicolectomy and end transverse colostomy was performed resulting in improvement in the patient’s clinical status and eventual discharge to subacute rehab.
Mucoepidermoid carcinoma of retromolar area: an incidental finding
Authors: Savithri Vindhya , Suresh Rakesh , Janardhanan Mahija , Veeraraghavan Ravi
Published: July 2022

Salivary gland tumours can arise in any location in the oral cavity but are rather rare in the retromolar region. The majority of the salivary neoplasms arising here are malignant in nature. Mucoepidermoid carcinoma is more commonly seen in the palate. Tumours arising in the retromolar region tend to show symptoms late in onset and may be greater in extent than evident clinically. Imaging studies will help in understanding the full extent of these lesions. We report a case of mucoepidermoid carcinoma arising in a young female patient who reported for orthodontic correction. In the course of examination, a palpable swelling was identified in the right retromolar area, which was eventually diagnosed as intermediate-grade mucoepidermoid carcinoma. Wide resection with adjuvant radiotherapy was the treatment given for the patient.
Type la glycogen storage disease complicated with diabetes mellitus: the role of flash continuous glucose monitoring
Authors: Marcalo Jose , Oliveira Anabela , Nunes Patrícia Almeida , do Vale Sónia
Published: July 2022

A 22-year-old woman with type Ia glycogen storage disease was referred to the endocrinology department with new-onset diabetes mellitus—glycated haemoglobin (HbA1c) of 8.2%. She had suffered from repeated bouts of hypoglycaemia since the first days of her life. The diagnosis was made at 5 months old, after clinical investigations revealed mixed dyslipidaemia, lactic acidosis and hepatomegaly. Compound heterozygosity was documented at the age of 4. The basis of her initial treatment was starch and reinforced soy milk, ingested multiple times a day and night. The patient suffered from obesity since childhood. This case shows a rare association between glycogen storage disease type Ia and diabetes mellitus. A multidisciplinary approach was implemented. Through diet and use of flash continuous glucose monitoring, we were able to improve patient’s adherence and metabolic profile. Hypoglycaemia and hyperglycaemia risk significantly decreased; 86% time in range (70–180 mg/dL), 6% hypoglycaemia and 6.3% HbA1c in recent evaluations.
Challenges of left atrial appendage closure device and anticoagulation in a patient with immune thrombocytopenia (ITP)
Authors: Uddin Mohammed M , Pervez Eskara , Usama Muhammad , Mir Tanveer , Regmi Neelambuj , Kottam Anupama
Published: July 2022

Among patients with atrial fibrillation (AF) who have high risk of bleeding secondary to haematologic disorders, left atrial appendage (LAA) occlusion therapy has been shown to be an excellent alternative to long-term use of oral anticoagulation for thromboembolic stroke prevention. However, there remains a major concern of device-associated thrombosis post-procedure, that can lead to life-threatening embolic events. To this date, there is no systematic guideline for the selection and management of patients with haematological disorders with LAA occlusion therapy, especially in those with platelet disorders such as immune thrombocytopenia (ITP). Patients with platelet disorders are at a higher risk for bleeding; however, that does not prevent such patients from thromboembolic events secondary to AF. We present a case of ITP with permanent AF, where an LAA device was complicated by thrombus formation due to challenges faced with anticoagulation therapy.
Anterior segment biometric measurements explain misclassifications by a deep learning classifier for detecting gonioscopic angle closure
Authors: Shen Alice , Chiang Michael , Pardeshi Anmol A , McKean-Cowdin Roberta , Varma Rohit , Xu Benjamin Y
Published: July 2022

Background/aims

To identify biometric parameters that explain misclassifications by a deep learning classifier for detecting gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images.

Methods

Chinese American Eye Study (CHES) participants underwent gonioscopy and AS-OCT of each angle quadrant. A subset of CHES AS-OCT images were analysed using a deep learning classifier to detect positive angle closure based on manual gonioscopy by a reference human examiner. Parameter measurements were compared between four prediction classes: true positives (TPs), true negatives (TNs), false positives (FPs) and false negatives (FN). Logistic regression models were developed to differentiate between true and false predictions. Performance was assessed using area under the receiver operating curve (AUC) and classifier accuracy metrics.

Results

584 images from 127 participants were analysed, yielding 271 TPs, 224 TNs, 77 FPs and 12 FNs. Parameter measurements differed (p<0.001) between prediction classes among anterior segment parameters, including iris curvature (IC) and lens vault (LV), and angle parameters, including angle opening distance (AOD). FP resembled TP more than FN and TN in terms of anterior segment parameters (steeper IC and higher LV), but resembled TN more than TP and FN in terms of angle parameters (wider AOD). Models for detecting FP (AUC=0.752) and FN (AUC=0.838) improved classifier accuracy from 84.8% to 89.0%.

Conclusions

Misclassifications by an OCT-based deep learning classifier for detecting gonioscopic angle closure are explained by disagreement between anterior segment and angle parameters. This finding could be used to improve classifier performance and highlights differences between gonioscopic and AS-OCT definitions of angle closure.
Management of pneumonia in critically ill patients
Authors: Cillóniz Catia , Torres Antoni , Niederman Michael S
Published: July 2022

Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location’s epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series
Authors: Patel Aatish , Bilinska Julia , Tam Jerry C H , Da Silva Fontoura Dayana , Mason Claire Y , Daunt Anna , Snell Luke B , Murphy Jamie , Potter Jack , Tuudah Cecilia , Sundramoorthi Rohan , Abeywickrema Movin , Pley Caitlin , Naidu Vasanth , Nebbia Gaia , Aarons Emma , Botgros Alina , Douthwaite Sam T , van Nispen tot Pannerden Claire , Winslow Helen , Brown Aisling , Chilton Daniella , Nori Achyuta
Published: July 2022

Objective

To characterise the clinical features of monkeypox infection in humans.

Design

Descriptive case series.

Setting

A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022.

Participants

197 patients with polymerase chain reaction confirmed monkeypox infection.

Results

The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.

Conclusions

These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission.
When do persuasive messages on vaccine safety steer COVID-19 vaccine acceptance and recommendations? Behavioural insights from a randomised controlled experiment in Malaysia
Authors: Hing Nicholas Yee Liang , Woon Yuan Liang , Lee Yew Kong , Kim Hyung Joon , Lothfi Nurhyikmah M , Wong Elizabeth , Perialathan Komathi , Ahmad Sanusi Nor Haryati , Isa Affendi , Leong Chin Tho , Costa-Font Joan
Published: July 2022

Introduction

Vaccine safety is a primary concern among vaccine-hesitant individuals. We examined how seven persuasive messages with different frames, all focusing on vaccine safety, influenced Malaysians to accept the COVID-19 vaccine, and recommend it to individuals with different health and age profiles; that is, healthy adults, the elderly, and people with pre-existing health conditions.

Methods

A randomised controlled experiment was conducted from 29 April to 7 June 2021, which coincided with the early phases of the national vaccination programme when vaccine uptake data were largely unavailable. 5784 Malaysians were randomly allocated into 14 experimental arms and exposed to one or two messages that promoted COVID-19 vaccination. Interventional messages were applied alone or in combination and compared against a control message. Outcome measures were assessed as intent to both take the vaccine and recommend it to healthy adults, the elderly, and people with pre-existing health conditions, before and after message exposure. Changes in intent were modelled and we estimated the average marginal effects based on changes in the predicted probability of responding with a positive intent for each of the four outcomes.

Results

We found that persuasive communication via several of the experimented messages improved recommendation intentions to people with pre-existing health conditions, with improvements ranging from 4 to 8 percentage points. In contrast, none of the messages neither significantly improved vaccination intentions, nor recommendations to healthy adults and the elderly. Instead, we found evidence suggestive of backfiring among certain outcomes with messages using negative attribute frames, risky choice frames, and priming descriptive norms.

Conclusion

Message frames that briefly communicate verbatim facts and stimulate rational thinking regarding vaccine safety may be ineffective at positively influencing vaccine-hesitant individuals. Messages intended to promote recommendations of novel health interventions to people with pre-existing health conditions should incorporate safety dimensions.

Trial registration number

NCT05244356.
What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries
Authors: Mulupi Stephen , Ayakaka Irene , Tolhurst Rachel , Kozak Nicole , Shayo Elizabeth Henry , Abdalla Elhafiz , Osman Rashid , Egere Uzochukwu , Mpagama Stellah G , Chinouya Martha , Chikaphupha Kingsley Rex , ElSony Asma , Meme Helen , Oronje Rose , Ntinginya Nyanda Elias , Obasi Angela , Taegtmeyer Miriam
Published: July 2022

Objectives

Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda.

Study design

Qualitative descriptive study.

Settings

Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries.

Participants

We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach.

Results

We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease.

Conclusion

Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.
Towards a cervical cancer-free future: women’s healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa
Authors: Okyere Joshua , Aboagye Richard Gyan , Seidu Abdul-Aziz , Asare Bernard Yeboah-Asiamah , Mwamba Bupe , Ahinkorah Bright Opoku
Published: July 2022

Objective

We investigated the association between women’s healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa.

Design

Secondary data from the Demographic and Health Surveys of six countries in sub-Saharan Africa were used. We employed multilevel binary logistic regression modelling.

Setting

Sub-Saharan Africa.

Participants

Women aged 15–49 years in Benin (n=5282), Côte d’Ivoire (n=1925), Cameroon (n=7558), Kenya (n=6696), Namibia (n=1990) and Zimbabwe (n=5006).

Primary outcome measures

Cervical cancer screening uptake.

Results

The overall prevalence of cervical cancer screening across the six sub-Saharan African countries was 13.4%. Compared with women whose healthcare decisions were made solely by husbands/partners/someone else, the likelihood of cervical cancer screening uptake was significantly higher among women who took healthcare decisions in consultation with their husbands/partners (aOR=1.38; 95% CI 1.19 to 1.59), but highest among those who made healthcare decisions alone (aOR=1.66; 95% CI 1.44 to 1.91). Women aged between 40 and 45 years (aOR=5.18; 95% CI 3.15 to 8.52), those with higher education (aOR=2.13; 95% CI 1.57 to 2.88), those who had ever heard of cervical cancer (aOR=32.74; 95% CI 20.02 to 53.55), read newspaper or magazine at least once a week (aOR=2.11; 95% CI 1.83 to 2.44), listened to the radio at least once a week (aOR=1.35; 95% CI1.18 to 1.52) and those in households with richest wealth index (aOR=1.55; 95% CI 1.20 to 2.00) had significantly higher odds of screening for cervical cancer compared to their counterparts.

Conclusion

Women who are able to make autonomous healthcare decisions and those who practice shared decision making are more likely to uptake cervical cancer screening. Therefore, policy interventions should focus on empowering women to be able to take autonomous healthcare decisions or shared decision making while targeting subpopulations (ie, multiparous and rural-dwelling women, as well as those in other religious affiliations aside from Christianity) that are less likely to uptake cervical cancer screening. Also, the radio and print media could be leveraged in raising awareness about cervical cancer screening to accelerate cervical cancer screening uptake in sub-Saharan Africa.
Exploratory analyses of clinical trial data used for health technology assessments: a retrospective evaluation
Authors: Oddens Björn J , Agaku Israel T , Snyder Ellen S , Malbecq William , Wang William WB , Kaplan Karen M , Koch Gary G , Rockhold Frank W
Published: July 2022

Objectives

To examine the validity and statistical limitations of exploratory analyses of clinical trial data commonly requested by agencies responsible for determining which medical products may be financed or reimbursed by a healthcare system.

Design

This was a retrospective review of efficacy and safety analyses conducted for German Health Technology Assessment (HTA) evaluations with a decision date between 2015 and 2020, and an illustrative safety-related exploratory analysis of data from two phase III clinical trials of verubecestat (an anti-amyloid drug whose development was stopped for lack of efficacy) as would be mandated by the German HTA agency.

Results

We identified 422 HTA evaluations of 404 randomised controlled clinical trials. For 140 trials (34.7%), the evaluation was based on subpopulations of participants in the originating confirmatory trial (175 subpopulations were assessed). In 57% (100 of 175), the subpopulation sample size was 50% or less of the original study population. Detailed analysis of five evaluations based on subpopulations of the original trial is presented. The safety-related exploratory analysis of verubecestat led to 206 statistical analyses for treatments and 812 treatment-by-subgroup interaction tests. Of 31 safety endpoints with an elevated HR (suggesting association with drug treatment), the HR for 81% of these (25 of 31) was not elevated in both trials. Of the 812 treatment-by-subgroup interactions evaluated, 26 had an elevated HR for a subgroup in one trial, but only 1 was elevated in both trials.

Conclusions

Many HTA evaluations rely on subpopulation analyses and numerous post hoc statistical hypothesis tests. Subpopulation analysis may lead to loss of statistical power and uncontrolled influences of random imbalances. Multiple testing may introduce spurious findings. Decisions about benefits of medical products should therefore not rely on exploratory analyses of clinical trial data but rather on prospective clinical studies and careful synthesis of all available evidence based on prespecified criteria.
Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol
Authors: Gudi Nachiket , Swain Ansuman , Kulkarni Muralidhar M , Pattanshetty Sanjay , Zodpey Sanjay
Published: July 2022

Introduction

Tobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings.

Methods and analysis

This scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation.

Ethics and dissemination

This review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.
Neuromuscular and structural tendon adaptations after 6 weeks of either concentric or eccentric exercise in individuals with non-insertional Achilles tendinopathy: protocol for a randomised controlled trial
Authors: Contreras-Hernandez Ignacio , Falla Deborah , Martinez-Valdes Eduardo
Published: July 2022

Introduction

There is limited evidence on the neural strategies employed by the central nervous system to control muscle force in the presence of non-insertional Achilles tendinopathy (NIAT). Additionally, the neuromuscular mechanisms by which exercise may help to resolve tendon pain remain unclear.

Objective

This study aims to first establish changes in the gastrocnemius-soleus motor unit firing properties after applying a training protocol of 6 weeks based on either controlled eccentric or concentric contractions in individuals with NIAT. Second, we want to determine changes in the level of pain and function and mechanical and structural properties of the Achilles tendon after applying the same training protocol. Additionally, we want to compare these variables at baseline between individuals with NIAT and asymptomatic controls.

Methods and analysis

A total of 26 individuals with chronic (>3 months) NIAT and 13 healthy controls will participate in the study. Individuals with NIAT will be randomised to perform eccentric or concentric training for 6 weeks. Motor unit firing properties of the medial gastrocnemius, lateral gastrocnemius and soleus muscles will be assessed using high-density surface electromyography, as well as Achilles tendon length, cross-sectional area, thickness and stiffness using B-mode ultrasonography and shear wave elastography. Moreover, participants will complete a battery of questionnaires to document their level of pain and function.

Ethics and dissemination

Ethical approval (ERN-20-0604A) for the study was obtained from the Science, Technology, Engineering and Mathematics Ethical Review Committee of the University of Birmingham. The results of the study will be published in peer-review journals.

Trial registration number

ISRCTN46462385.
Advancing the development of real-world data for healthcare research in China: challenges and opportunities
Authors: Zhong Jia , Zhang Jun , Fang Honghao , Liu Larry , Xie Jipan , Wu Eric
Published: July 2022

Various real-world data (RWD) sources have emerged in China with the intention of generating real-world evidence (RWE) that can be used in clinical and regulatory decision-making. Despite these efforts, significant barriers remain that hinder high-quality healthcare research. A workshop with 30 representatives from healthcare research agencies, technology companies focused on healthcare big data and pharmaceutical companies was held in December 2020 to identify strategies to overcome the barriers associated with the usability and quality of RWD in China. Across all sectors, examples of barriers identified included inconsistencies in terminology and non-standardised coding practices; the absence of longitudinal data; the absence of transparent data processing and validation practices; and the inability to access and share RWD. While cutting-edge technological innovations and data solutions provided powerful tools, the development of collaborative and synergistic research networks across multiple stakeholders is key to generate accessible, high-quality RWD in China. RWD has the potential to provide clinical, regulatory and reimbursement decision-makers with critical insights that can improve healthcare delivery in China. However, barriers to its access, collection and use must be addressed to generate RWE to guide healthcare stakeholders.
Improving routine prenatal penicillin allergy testing for reported penicillin allergy
Authors: Gill Margaret M , Gasner Sara , Banken Alisha , Park Miguel , Weaver Amy , Sharpe Emily , Theiler Regan
Published: July 2022

Background

Patients with self-reported antibiotic allergies have a higher cost of care, more frequent infections with resistant bacteria and worse health outcomes than patients without antibiotic allergies. Ultimately, less than 5% of patients who report a penicillin allergy have a clinically significant immune-mediated hypersensitivity reaction when tested. As 10%–30% of the population of pregnant patients are colonised for group BStreptococcus(GBS) and guidelines recommend penicillin as the treatment of choice for GBS, current recommendations support penicillin allergy testing in pregnant patients who report an allergy.

Methods and intervention

In this quality improvement project, nursing staff used an algorithm outlining inclusion and exclusion criteria to determine which patients were eligible to have penicillin allergy testing completed. Penicillin allergy testing consisted of a skin test using benzylpenicilloyl polylysine (Pre-Pen), penicillin G potassium, amoxicillin and alkaline hydrolysis mix (penicilloate) as a prick skin test, followed by intradermal skin test and finally an oral challenge with either amoxicillin or penicillin. Patient outcomes were analysed to evaluate the impact of the intervention.

Results

Of the 1266 patients receiving prenatal care during the intervention, 236 (19%) reported a history of penicillin allergy, and 212 if these were eligible for testing. 150 of the eligible patients were offered penicillin allergy testing. 101 patients (67%) completed testing and 49 (33%) declined testing. Seven patients (7%) had positive penicillin allergy testing, while 94 patients (93%) had negative penicillin allergy testing and were immediately de-labelled as penicillin allergic. Seventeen of the de-labelled patients subsequently tested positive for GBS colonisation, and all received intrapartum penicillin without adverse events.

Conclusions

Pursuing penicillin allergy testing for pregnant patients with reported penicillin allergy is a safe and feasible approach, allowing for allergy de-labelling and safe, guideline-driven antimicrobial therapy during subsequent labour and delivery hospitalisations. Cost-effectiveness of the allergy testing and impact on later episodes of care should be further investigated.