bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and fabrication of Al2O3f/SiCN composite with excellent microwave absorbing and mechanical properties
Authors: Liu Xiaoling , Xue Jimei , Yang Fan , Ye Fang , Fan Xiaomeng , Cheng Laifei
Published: June 2020

A new kind of structural and functional integration ceramic matrix composite material was prepared from high‐performance alumina (Al2O3) fibers and absorbing silicon carbonitride (SiCN) ceramics via a combination of polymer infiltration pyrolysis (PIP) and chemical vapor infiltration (CVI) methods. The Al2O3 fiber annealed at its cracked temperature had enhanced permittivity, because the sizing agent on the Al2O3 fiber surface was cracked into pyrolysis carbon. For PIP + CVI Al2O3f/SiCN composites, PIP SiCN matrix with low conductivity was used as the matching phase, while CVI SiCN matrix with medium permittivity and dielectric loss was regarded as the reinforcing phase distributed in porous PIP SiCN matrix and inter‐bundles of Al2O3 fiber to improve their mechanical and microwave absorption properties. The fracture toughness and flexural strength of Al2O3f/SiCN composite were determined to be 9.4 ± 0.5 MPa m1/2 and 279 ± 28 MPa, respectively. Based on the design principles for impedance matching, the Al2O3f/SiCN composites before and after oxidation were used as loss and impedance layers, respectively. It was found that the optimized composite had the lowest reflection coefficient (RC) of −70 dB and the effective absorption bandwidth covering the whole X‐band. In conclusion, Al2O3f/SiCN composite can serve as a high‐temperature structural material with excellent microwave absorption properties for aerospace applications.
Family quality of life among Taiwanese children with developmental delay before and after early intervention
Authors: Chiu S.‐J. , Lin I.‐F. , Chou Y.‐T. , Chien L.‐Y.
Published: June 2020

Background

Although early intervention (EI) practitioners emphasise the importance of individualised family‐centred services for families of children with developmental delay (DD), few empirical studies have evaluated whether EI can improve family quality of life (FQOL). This study aimed to investigate the trajectory of FQOL and its predictors among families of children with DD during the first 12 months of EI.

Methods

This study employed a prospective cohort design. Data were collected using structured questionnaires at the placement meeting before the commencement of EI, as well as 3, 6 and 12 months later. We recruited 142 primary caregivers of children with DD in northern Taiwan from March 2015 to August 2016. FQOL was measured using the Mandarin Chinese version of the Beach Centre FQOL Scale. Family resilience (FR) was measured using the Mandarin Chinese version of the FR Assessment Scale. Other independent variables included socio‐demographics, type of DD and EI services. Generalised estimating equations were used to perform multivariate analysis.

Results

Family quality of life exhibited a significant quadratic trend in the 12 months surrounding EI. The score was the lowest before EI started (89.85), then increased to peak (94.87) at 6 months and then decreased slightly to 92.34 at 12 months. FR followed a significantly increased linear trend during the period. There were significant and positive correlations between FQOL and FR across all time points. Multivariate analysis showed that employed caregivers, FR, sufficient caregiving manpower and satisfaction with marital quality were positively associated with FQOL. Receiving more types of EI services and having fathers who were not Taiwanese nationals were negatively associated with FQOL.

Conclusions

Family quality of life and FR increased significantly after receiving EI, revealing the latter's effectiveness. Unemployment, poor marital quality, father being an immigrant, low FR and insufficient family caregiving manpower were associated with lower FQOL, suggesting that these families require more assistance.
Want to make me happy? Tell me about your experiences but not your objects
Authors: Bastos Wilson
Published: June 2020

Evidence indicates that experiences bring greater benefits to consumers than objects. Extending this research beyond the actual purchaser, this work examines individuals who experience the purchase only indirectly via a conversation—listeners. It explores how conversations about experiential versus material purchases affect listeners socially and emotionally. Results show that hearing about others' experiences (vs. objects) advances listeners' happiness more. This finding shows that the scope of experiential purchases' advantage is wider than previously known. Further, this work identifies a sequential mechanism: Conversations about experiences (vs. objects) are more substantive, allowing listeners to build stronger social connections with tellers and, in turn, gain more happiness from the interaction. Critically, this mechanism explains the effect above and beyond a previously‐advanced mechanism via perceived motivation. Additionally, this work identifies a boundary of the model: purchase valence. Theoretical and practical implications for managers, consumers, and policymakers are discussed.
Objective evaluation of an occlusive overnight intensive patch containing onion extract and allantoin for hypertrophic scars
Authors: Guertler Anne , Schwaiger Hannah , Poetschke Julian , Steckmeier Stephanie , Gauglitz Gerd
Published: June 2020

Background

Patients suffering from hypertrophic scars often describe esthetic, functional, and psychological impairments. While current guidelines for the treatment of pathologic scarring recommend the use of onion extract containing gels and sheets, hard evidence for its efficacy remains scarce due to inconsistent data. Onion extract and allantoin containing occlusive overnight intensive patches (OIP) were introduced as a recent option for noninvasive scar management. However, objective data demonstrating their efficacy are missing.

Aims

This study is the first to objectively evaluate the benefit and safety of an OIP for hypertrophic scars using a three‐dimensional imaging device and a standardized scar scale.

Methods

Twelve patients with untreated, three to twelve months old hypertrophic scars received an OIP for 3 months. The assessment was performed using PRIMOS®pico, a three‐dimensional imaging device and POSAS, a standardized scar questionnaire at baseline, one and 3 months after the last treatment.

Results

Objective evaluation at three months follow‐up (FU) showed a significant decrease in scar height of 28.8% (baseline mean: 2.08 ± 0.68 mm, three months FU mean: 1.48 ± 0.52 mm) and a reduction in scar volume of 31.9% (baseline mean: 454.33 ± 265.53 mm3, 3 months FU mean: 309.58 ± 224.28 mm3). Pain and pruritus subsided under treatment. There were no negative side effects.

Conclusion

Overnight intensive patches is a convenient, painless, safe, affordable and effective prevention and treatment option for hypertrophic scars. Treatment should be performed at least for 3 months for visible effects.
An injectable liposome for sustained release of icariin to the treatment of acute blunt muscle injury
Authors: Wang Jinwu , Zhu Gaosheng , Wang Xingyu , Cai Jie , Xie Linzhen , Zheng Wenhao , Feng Yongzeng , Guo Qiang , Chen Hua , Cai Leyi
Published: June 2020

Objectives

Icariin, extracted from Epimedium, is a kind of flavonoid and possesses osteogenesis and antioxidant. This study aimed to evaluate the therapeutic effects of icariin liposome on acute blunt skeletal muscle injury in rats.

Methods

Icariin liposome was prepared by the thin-film dispersion method. After muscle injury, the corresponding treatment measures were given every day for two weeks. Recovery and mechanism of muscle injury were evaluated by QRT-PCR, HE, immunohistochemistry, malondialdehyde, superoxide dismutase and serological tests.

Key findings

The particle size, polydispersity index, zeta potential, encapsulation efficiency and drug loading of icariin liposomes were 171.37 ± 38.23 nm, 0.27 ± 0.01, −5.59 ± 1.36 mV, 78.15 ± 2.04% and 15.62%, respectively. The QRT-PCR showed that icariin liposome significantly promoted the expression of MHCIIB and vimentin. Through HE, immunohistochemistry, ELISA and serological tests, we found that icariin liposome effectively promoted desmin expression, reduced collagen I expression and inhibited the production of pro-inflammatory factors, including TNF-α and IL-6. Icariin liposome therapy significantly reduced the level of malondialdehyde and increased the activity of superoxide dismutase.

Conclusions

Icariin liposome has excellent therapeutic effects on acute blunt muscle injury in rats by improving immunity, repairing cytoskeleton and cellular integrity, anti-inflammation, anti-fibrosis and antioxidant stress.
Telephone‐guided imagery rehearsal therapy for nightmares: Efficacy and mediator of change
Authors: Lancee Jaap , Effting Marieke , Kunze Anna E.
Published: June 2020

The currently best‐supported psychological treatment for nightmares is imagery rehearsal therapy. The problem, however, is that not enough trained practitioners are available to offer this treatment. A possible solution is to conduct imagery rehearsal therapy in a guided self‐help format. In the current study, 70 participants with nightmares according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders were randomized to either telephone‐guided imagery rehearsal therapy (n = 36) or a wait‐list condition (n = 34). Participants in the imagery rehearsal therapy condition received three sessions over the course of 5 weeks. Every treatment session was followed by telephone support delivered by postgraduate students. Participants who received imagery rehearsal therapy showed larger improvements on nightmare frequency (d = 1.03; p < .05), nightmare distress (d = 0.75; p < .05) and insomnia severity (d = 1.12; p < .001) compared with the participants in the wait‐list condition. The effects were sustained at 3‐ and 6‐month follow‐up. No significant effects were observed on the number of nights with nightmares per week, anxiety and depression. In line with earlier reports, the treatment effect was mediated by the increase of mastery at mid‐treatment, underlining the mechanistic value of mastery in imagery rehearsal therapy. The present study demonstrates that it is possible to deliver imagery rehearsal therapy in a self‐help format supported by unexperienced therapists and with relatively little time investment. This opens possibilities in terms of cost‐effectiveness, scalability and dissemination of imagery rehearsal therapy in the treatment of nightmares.
The genetic polymorphism down‐regulating HLA‐DRB1 enhancer activity facilitates HBV persistence, evolution and hepatocarcinogenesis in the Chinese Han population
Authors: Deng Yang , Li Peng , Liu Wenbin , Pu Rui , Yang Fan , Song Jiahui , Yin Jianhua , Han Xue , Li Chengzhong , Zhao Jun , Wang Hongyang , Cao Guangwen
Published: June 2020

Genetic predisposition of human leucocyte antigen (HLA)‐DR has been linked to nonresponse to hepatitis B virus (HBV) vaccination. We sought to reveal their effects on chronic infection and evolution of HBV and development of hepatocellular carcinoma (HCC). Genetic polymorphisms at HLA‐DR enhancer regions were genotyped in 4588 participants using quantitative PCR. HBV mutations were determined by sequencing. A dual‐luciferase assay was applied to detect the enhancer activity. Associations between HLA‐DR polymorphisms and postoperative prognosis were investigated in another cohort of 397 HBV‐infected HCC patients. Variant alleles (rs3135395‐T, rs3135338‐C and rs477515‐T) were significantly associated with a decreased risk of HBV persistence in Chinese patients. rs3135395‐T, rs3135338‐C, rs477515‐T and rs2395178‐G also significantly decreased HCC risk. rs3135395‐T, rs477515‐T and rs2395178‐G were inversely associated with the generation of A1762T/G1764A, T1753V and C1653T, the HCC‐risk HBV mutations. Multiplicative interactions of the variant genotypes with the HCC‐risk HBV mutations were significantly associated with a decreased risk of HCC. In multivariate Cox analysis, rs477515‐T independently predicted a favourable prognosis, with a hazard ratio of 0.48 (P = .002). The activity of the HLA‐DRB1 enhancer with rs477515‐T was significantly higher than that with rs477515‐C. The activity of the HLA‐DRB1 enhancer with rs477515‐T and that with rs477515‐C was significantly up‐regulated by interferon‐γ and interleukin‐4, respectively. Interleukin‐6 significantly inhibited the HLA‐DRB1 enhancer activity, and this effect was more evident in those carrying rs477515‐T. Polymorphisms predisposing to down‐regulation of HLA‐DR facilitate the Th1‐to‐Th2 transition and promote HCC development, possibly via selecting the HCC‐risk HBV mutations. This can be transformed into specific prophylaxis of HCC.
Optimal investment, derivative demand, and arbitrage under price impact
Authors: Anthropelos Michail , Robertson Scott , Spiliopoulos Konstantinos
Published: June 2020

This paper studies the optimal investment problem with random endowment in an inventory‐based price impact model with competitive market makers. Our goal is to analyze how price impact affects optimal policies, as well as both pricing rules and demand schedules for contingent claims. For exponential market makers preferences, we establish two effects due to price impact: constrained trading and nonlinear hedging costs. To the former, wealth processes in the impact model are identified with those in a model without impact, but with constrained trading, where the (random) constraint set is generically neither closed nor convex. Regarding hedging, nonlinear hedging costs motivate the study of arbitrage free prices for the claim. We provide three such notions, which coincide in the frictionless case, but which dramatically differ in the presence of price impact. Additionally, we show arbitrage opportunities, should they arise from claim prices, can be exploited only for limited position sizes, and may be ignored if outweighed by hedging considerations. We also show that arbitrage‐inducing prices may arise endogenously in equilibrium, and that equilibrium positions are inversely proportional to the market makers' representative risk aversion. Therefore, large positions endogenously arise in the limit of either market maker risk neutrality, or a large number of market makers.
Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis
Authors: Das Bibhuti B. , Prusty Bhupesh K. , Niu Jianli , Sue Paul K.
Published: June 2020

CMV infection remains a significant cause of morbidity among pediatric HTx recipients We explored the implications of CMV infection on post‐transplant outcomes among CMV risk‐stratified pediatric HTx recipients receiving VGC prophylaxis. Children who underwent HTx between January 2010 and October 2016 were stratified according to CMV risk at time of transplant and evaluated for evidence of post‐transplant CMV infection, rejection, CAV, and graft loss. Among 97 children, 41 (42%) were considered HR or IR risk for CMV infection and received VGC prophylaxis. CMV DNAemia was observed in 34% of children, including 71% HR, 40% IR, and 18% LR individuals. Median time to CMV DNAemia following VGC prophylaxis was 32D among HR vs 277D in IR subjects (P = .042). No difference in overall graft loss was noted among groups, but CMV HR children had decreased rejection‐free survival (3.5 years) compared to IR (6 years,P = .015) and LR children (8 years,P = .0003). CMV was noted on EMB in 13% of children but was not associated with increased CAV, rejection or graft loss. High‐risk CMV status was associated with decreased time to CMV infection despite VGC prophylaxis, compared to IR, and decreased rejection‐free survival times compared to both IR and LR recipients. Detection of CMV on EMB was not associated with increased rejection, CAV or graft loss. Additional studies are needed to explore the impact of CMV infection on rejection‐free survival in HTx recipients.
Photodynamic Therapy and Immune Checkpoint Blockade†
Authors: Cramer Gwendolyn M. , Moon Edmund K. , Cengel Keith A. , Busch Theresa M.
Published: June 2020

Immune checkpoints including PD‐1 and CTLA‐4 help to regulate the intensity and timeframe of the immune response. Since they become upregulated in cancer and prevent sufficient antitumor immunity, monoclonal antibodies against these checkpoints have shown clinical promise for a range of cancers. Multimodal treatment plans combining immune checkpoint inhibitors with other therapies, including photodynamic therapy (PDT), may help to expand treatment efficacy and minimize side effects. PDT's cytotoxic effects are spatially limited by the light activation process, constraining PDT direct effects to the treatment field. The production of damage‐associated molecular patterns and tumor‐associated antigens from PDT can encourage accumulation and maturation of antigen‐presenting cells and reprogram the tumor microenvironment to be more susceptible to therapies targeting immune checkpoints.
Judgments of Capability and Conformity as Distinct Forms of Social Judgments, and the Way They Interact to Shape Evaluator Decisions
Authors: Topaler Başak , Küp Eyüp Tolunay
Published: June 2020

Objective

Social judgments are evaluators’ opinions about the social properties of a set of actors. Different types of judgments rendered by the evaluators and potential interactions between them may have major consequences for the actors who are evaluated. In this article, we distinguish between judgments of capability and conformity, and examine their concurrent and interdependent effects on evaluator impressions.

Methods

We investigate these dynamics in the context of authors competing for the best paper award at the Academy of Management (AoM) conference.

Results

Findings of our empirical analyses demonstrate interdependent effects of capability and conformity judgments on the committee members’ decisions. We demonstrate that evaluators expect greater conformity to their ideal template from more capable actors who have greater potential to contribute to these ideals.

Conclusion

Our study advances the literature on social judgments by showing that congruence (or incongruence) among distinct types of judgment shape evaluators’ decisions, beyond their independent effects.
The role of viscoelastic testing in the management of the parturient
Authors: Waters Jonathan H.
Published: June 2020

Viscoelastic testing is the measurement of how the viscoelastic properties of blood change as blood clots. In pregnancy, unique changes in clotting function occur overall to make the pregnant woman hypercoagulable. Viscoelastic testing may be able to play a role in guiding placement of epidural and spinal anesthetics by demonstrating enhanced coagulation function, even when there are individual parts of the coagulation system that are abnormal, for example, thrombocytopenia. These tools may also play a role in addressing the management of maternal hemorrhage, which in the United States is on the rise. This review discusses the opportunity to use viscoelastic testing in the parturient.
Energy Dissipation During Prey Capture Process in Spider Orb Webs
Authors: Jiang Yanhui , Nayeb-Hashemi Hamid
Published: June 2020

Capture of a prey by spider orb webs is a dynamic process with energy dissipation. The dynamic response of spider orb webs under prey impact requires a multi-scale modeling by considering the material microstructures and the assembly of spider silks in the macro-scale. To better understand the prey capture process, this paper addresses a multi-scale approach to uncover the underlying energy dissipation mechanisms. Simulation results show that the microstructures of spider dragline silk play a significant role on energy absorption during prey capture. The alteration of the microstructures, material internal friction, and plastic deformation lead to energy dissipation, which is called material damping. In addition to the material damping in the micro-scale modeling, the energy dissipation due to drag force on the prey is also taken into consideration in the macro-scale modeling. The results indicate that aerodynamic drag, i.e., aero-damping, plays a significant role when the prey size is larger than a critical size.
Analysis and Modeling of Liquid Holdup in Low Liquid Loading Two-Phase Flow Using Computational Fluid Dynamics and Experimental Data
Authors: Ballesteros Miguel , Ratkovich Nicolás , Pereyra Eduardo
Published: June 2020

Low liquid loading flow occurs very commonly in the transport of any kind of wet gas, such as in the oil and gas, the food, and the pharmaceutical industries. However, most studies that analyze this type of flow do not cover actual industry fluids and operating conditions. This study focused then on modeling this type of flow in medium-sized (6-in [DN 150] and 10-in [DN 250]) pipes, using computational fluid dynamics (CFD) simulations. When comparing with experimental data from the University of Tulsa, the differences observed between experimental and CFD data for the liquid holdup and the pressure drop seemed to fall within acceptable error, around 20%. Additionally, different pipe sections from a Colombian gas pipeline were simulated with a natural gas-condensate mixture to analyze the effect of pipe inclination and operation variables on liquid holdup, in real industry conditions. It was noticed that downward pipe inclinations favored smooth stratified flow and decreased liquid holdup in an almost linear fashion, while upward inclinations generated unsteady wavy flows, or even a possible annular flow, and increased liquid holdup and liquid entrainment into the gas phase.
A new Discotrachytes species (Acari: Uropodina) from a banana plantation in Yemen with notes to the genus Discotrachytes Berlese, 1903

Authors: Kontschán Jenő
Published: June 2020

Discotrachytes vanharteni sp. nov. is discovered and described based on females, males and deutonymphs collected in a banana plantation in Yemen. The new species differs from its congeners in the shape of the genital shield and the sternal setae of the females. A diagnosis of the genus Discotrachytes Berlese is presented with a list of the known species. Ten Uropoda species are moved to the genus Discotrachytes: D. ehimensis (Hiramatsu, 1979) comb. nov.; D. granata (Hiramatsu & Hirschmann, 1978) comb. nov.; D. grandis (Hiramatsu & Hirschmann, 1979) comb. nov.; D. granosa (Hiramatsu & Hirschmann, 1978) comb. nov.; D. orbis (Vitzthum, 1925) comb. nov.; D. ornata (Hiramatsu & Hirschmann, 1978) comb. nov.; D. procera (Hiramatsu & Hirschmann, 1979) comb. nov.; D. procerasimilis (Hiramatsu & Hirschmann, 1979) comb. nov.; D. regia (Vitzthum, 1921) comb. nov.; D. regiasimilis (Hirschmann, 1972); and D. verrucosa (Hiramatsu, 1980) comb. nov. A new key to the known Discotrachytes species is also presented.
Development and Preliminary Validation of a Sport-Specific Self-Report Measure of Identity Foreclosure
Authors: Brewer Britton W. , Caldwell Christine M. , Petitpas Albert J. , Van Raalte Judy L. , Pans Miquel , Cornelius Allen E.
Published: June 2020

A sport-specific, self-report measure of identity foreclosure was developed through a systematic process that included item pool generation, expert review, administration of items to a development sample of intercollegiate student athletes (N = 326), item evaluation, and administration of scales to validation samples of intercollegiate student athletes (N = 322, N = 54, and N = 64, respectively). The process yielded two four-item scales reflecting commitment to the occupational identity of athlete and one 4-item scale reflecting active exploration of roles other than that of athlete that (a) are internally consistent and temporally stable, (b) demonstrate preliminary factorial and convergent validity, and (c) can be used to create indices of identity foreclosure tailored to the sport context. The resulting Sport-Specific Measure of Identity Foreclosure has potential utility as an assessment tool for research and practice with athletes.
Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and
Staphylococcus aureus
Decolonization
Authors: Lepelletier Didier , Maillard Jean Yves , Pozzetto Bruno , Simon Anne
Published: June 2020

Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant
Staphylococcus aureus
(MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash, but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an expert’s workshop on resistance and MRSA decolonization.
Hazara Nairovirus Requires COPI Components in both Arf1-Dependent and Arf1-Independent Stages of Its Replication Cycle
Authors: Fuller J. , Álvarez-Rodríguez B. , Todd E. J. A. A. , Mankouri J. , Hewson R. , Barr J. N.
Published: June 2020

Nairoviruses are tick-borne enveloped RNA viruses that include several pathogens responsible for fatal disease in humans and animals. Here, we analyzed host genes involved in trafficking networks to examine their involvement in nairovirus replication. We revealed important roles for genes that express multiple components of the COPI complex, which regulates transport of Golgi apparatus-resident cargos. COPI components influenced at least two stages of the nairovirus replication cycle: an early stage prior to and including gene expression and also a later stage during assembly of infectious virus, with COPI knockdown reducing titers by approximately 1,000-fold. Importantly, while the late stage was Arf1 dependent, as expected for canonical COPI vesicle formation, the early stage was found to be Arf1 independent, suggestive of a previously unreported function of COPI unrelated to vesicle formation. Collectively, these data improve our understanding of nairovirus host-pathogen interactions and suggest a new Arf1-independent role for components of the COPI coatomer complex.
High-Resolution Longitudinal Dynamics of the Cystic Fibrosis Sputum Microbiome and Metabolome through Antibiotic Therapy
Authors: Raghuvanshi Ruma , Vasco Karla , Vázquez-Baeza Yoshiki , Jiang Lingjing , Morton James T. , Li Danxun , Gonzalez Antonio , DeRight Goldasich Lindsay , Humphrey Gregory , Ackermann Gail , Swafford Austin D. , Conrad Douglas , Knight Rob , Dorrestein Pieter C. , Quinn Robert A.
Published: June 2020

Subjects with cystic fibrosis battle polymicrobial lung infections throughout their lifetime. Although antibiotic therapy is a principal treatment for CF lung disease, we have little understanding of how antibiotics affect the CF lung microbiome and metabolome and how much the community changes on daily timescales. By analyzing 594 longitudinal CF sputum samples from six adult subjects, we show that the sputum microbiome and metabolome are dynamic. Significant changes occur during times of stability and also through pulmonary exacerbations (CFPEs). Microbiome alpha-diversity increased as a CFPE developed and then decreased during treatment in a manner corresponding to the reduction in the log ratio of anaerobic bacteria to classic pathogens. Levels of metabolites from the pathogen
P. aeruginosa
were also highly variable through time and were negatively associated with anaerobes. The microbial dynamics observed in this study may have a significant impact on the outcome of antibiotic therapy for CFPEs and overall subject health.
Nasal insertion depths for neonatal intubation
Authors: Maiwald Christian Achim , Neuberger Patrick , Mueller-Hansen Ingo , Goelz Rangmar , Michel Jörg , Esser Michael , Engel Corinna , Franz Axel R , Poets Christian F
Published: June 2020

Aim

Data on the depth of nasal intubation in neonates are rare, although this is the preferred route in some countries. Therefore, recommendations on optimal nasal intubation depths based on gestational age (GA) and weight are desirable.

Methods

We determined the distances between the middle of thoracic vertebrae 2 (T2) and the tip of the endotracheal tube in 116 X-rays from nasally intubated neonates. The intubation depth (tip to nostril distance) that was documented in the digital patient’s file was then corrected for this distance to reach an optimal nasal insertion depth. Results were plotted against the infant’s GA and weight.

Results

GA-based and birthweight-based charts and formulas for the nasal intubation depth in infants with a GA between 24 and 43 weeks and body weight between 400 and 4500 g were created.

Conclusions

Generated data may help in predicting optimal insertion depths for nasal intubation in neonates.
Swine-influenza (H1N1 influenza) mimicking a case of high altitude pulmonary oedema (HAPO)
Authors: Jha Vishal , Jha Aditi
Published: June 2020

Here we present a case of a 37-year-old soldier of Indian Army, posted in high altitude area of Ladakh region (>4200 m), who after rejoining after a month leave, presented with dry cough, low-grade fever and dyspnoea on exertion while undergoing acclimatisation, and on examination, was detected to have hypoxaemia, fever and bilateral fine crepitations on chest auscultation. He was started on treatment for high altitude pulmonary oedema at a medical aid post, and later referred to General Hospital at Leh. The course of the illness was complicated by worsening hypoxaemia, continuous high-grade fever, leucopenia and hypotension. Focused medical history revealed that he had travelled to the state of Gujarat during his leave, where high incidence of H1N1 influenza was being reported during the ongoing pandemic. Oseltamivir was empirically started, in addition to parenteral antibiotics and he was started on inotropic support. In view of severe hypoxaemia, not responding to non-invasive ventilation, he was intubated and placed on mechanical ventilation. The patient turned out to be H1N1 positive and succumbed to his illness 3 days later.
Oral mucocele in infant with an unusual presentation
Authors: Suryavanshi Rishi , Abdullah Ahsan , Singh Neerja , Astekar Madhusudan
Published: June 2020

Mucocele is a benign lesion characterised by an extravasation or retention of mucous secretion in submucosal tissue from minor salivary glands. The occurrence of mucocele is common in the oral cavity, with more than 70% of cases on lower labial mucosa. The occurrence of mucocele on the tongue is considered rare and accounted for only 2.25% in the previous literature. Histopathological examination plays a great role in the confirmation of the clinical diagnosis. Management of mucocele is at times challenging. This paper highlights a rare case of mucocele in a 5-month-old infant who was successfully managed under day-care anaesthesia.
Real-life outcomes in spasticity management: features affecting goal achievement
Authors: Singh Rajiv , Clarke Alison
Published: June 2020

Background/objective

Spasticity is a complex and common condition but there is a lack of ‘real-world’ data on goal setting and spasticity treatment, as well as identifying those features that might be associated with goal achievement. Our aim was to provide such data.

Methods

Prospective attenders at a multi-disciplinary spasticity clinic over 2 years followed for consecutive appointments. Patient demographics and doses of botulinum toxin injected were documented. Main outcome was achievement of a primary goal but secondary goals were also recorded. Independent variables were examined for association to the outcome.

Results

A total of 606 goals were set in 224 patients. The majority (75.2%) were achieved with similar levels across active (72.5%), passive (75.7%) and pain (78.6%) goals. However, in terms of the primary goal, active primary goals were achieved less frequently (59.7%) than non-active primary goal (74.2%). A logistic regression confirmed that this was the only independent variable associated with primary goal achievement. The majority of patients (61.6%) required changes to their treatment between appointments, irrespective of time since diagnosis, age or aetiology.

Conclusions

Most goals set in spasticity clinic can be achieved irrespective of type of goal. However, active goals may be harder to accomplish when they are set as a primary goal. This may reflect the desire of individuals to prioritise a desirable goal rather than one that is achievable. While goal setting is important in the management of spasticity patients, very few patient or treatment factors are associated with outcome prediction. Further work needs to identify features that may predict successful outcome.
Systematic review protocol for assessing central auditory functions of Alzheimer’s disease and its preclinical stages
Authors: Jayakody Dona M P , Tarawneh Hadeel Y , Menegola Holly K , Yiannos Jessica M , Friedland Peter L , Wilson Wayne J , Martins Ralph N , Sohrabi Hamid R
Published: June 2020

Introduction

A number of studies have reported an association between peripheral hearing impairment, central auditory processing and Alzheimer’s disease (AD) and its preclinical stages. Both peripheral hearing impairment and central auditory processing disorders are observed many years prior to the clinical manifestation of AD symptoms, hence, providing a long window of opportunity to investigate potential interventions against neurodegenerative processes. This paper outlines the protocol for a systematic review of studies examining the central auditory processing functions in AD and its preclinical stages, investigated through behavioural (clinical assessments that require active participation) central auditory processing tests.

Methods and analysis

We will use the keywords and Medical Subject Heading terms to search the following electronic databases: MEDLINE, PsychINFO, PubMed, Scopus, EMBASE and CINAHL Plus. Studies including assessments of central auditory function in adults diagnosed with dementia, AD and its preclinical stages that were published before 8 May 2019 will be reviewed. This review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Data analysis and search results will be reported in the full review. This manuscript has designed the protocols for a systematic review that will identify the behavioural clinical central auditory processing measures that are sensitive to the changes in auditory function in adults with AD and its preclinical stages. Such assessments may subsequently help to design studies to examine the potential impact of hearing and communication rehabilitation of individuals at risk of AD.

Ethics and dissemination

Ethical approval is not required as this manuscript only reports the protocols for conducting a systematic review as primary data will only be reviewed and not be collected. The results of this systematic review will be disseminated through publication and in scientific conferences.

PROSPERO registration number

CRD42017078272.
Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis
Authors: Chen Zhihan , Wang Rui , Zhang Min , Wang Yitong , Ren Yulan
Published: June 2020

Introduction

Opioid use disorder (OUD) is a worldwide health problem. Clinical trials indicated that acupuncture combined with medication is effective in OUD, however, there are different conclusions presented by previous trials. This study is designed to evaluate the efficacy and safety of acupuncture combined with medication in OUD.

Methods and analysis

PubMed, CENTRAL, Embase, Web of Science, CINAHL, PsycINFO, ProQuest Dissertation and Theses, AMED, OpenGrey, Clinicaltrials.gov and who.int/trialsearch will be searched in September 2019 without a language restriction. Randomised controlled trials (RCTs) and quasi-RCTs which included participants with OUD receiving acupuncture therapy combined with medication versus control group will be included in this study. Two reviewers will independently screen studies, extract data, assess risk of bias by the Cochrane risk of bias assessment tool and assess quality of evidence by Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Any disagreements will be arbitrated by the third reviewer. Data synthesis and analysis will be conducted by using RevMan V.5.3. Subgroup analyses, sensitivity analysis, meta-regression and reporting bias assessment will be conducted if necessary and appropriate.

Ethics and dissemination

On account of the nature of this systematic review and meta-analysis, ethical approval is not required. The results will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42019123436.
Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine
Authors: Sarhan Mohammed B A , Shannon Harry S , Fujiya Rika , Jimba Masamine , Giacaman Rita
Published: June 2020

Objectives

Health literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties.

Design

We conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews.

Setting and participants

We conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017.

Methods

We translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach’s alpha, MacDonald’s omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale’s average inter-item correlation.

Results

EFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach’s alpha, MacDonald’s omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59.

Conclusion

HAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.
Assessing the transparency of informed consent in feasibility and pilot studies: a single-centre quality assurance study protocol
Authors: Khan Mohammed I , Holek Matthew , Bdair Faris , Mbuagbaw Lawrence , Eldridge Sandra M , Chan Claire L , Campbell Michael J , Bond Christine M , Hopewell Sally , Lancaster Gillian A , Thabane Lehana
Published: June 2020

Introduction

Pilot/feasibility studies assess the feasibility of conducting a larger study. Although researchers ought to communicate the feasibility objectives to their participants, many research ethics guidelines do not comment on how informed consent applies to pilot studies. It is unclear whether researchers and research ethics boards clearly communicate the purpose of pilot studies to participants consenting.

The primary objective of this study is to assess whether pilot/feasibility studies submitted for ethics approval to a research ethics board transparently communicate the purpose of the study to participants through their informed consent practice. A highly transparent consent practice entails the consent documents communicate: (1) the term ‘pilot’ or ‘feasibility’ in the title; (2) the definition of a pilot/feasibility study; (3) the primary objectives of the study are to assess feasibility; (4) the specific feasibility objectives; and (5) the criteria for the study to successfully lead to the main study. The secondary objectives are to assess whether there is a difference between submitted and revised versions of the consent documents (revisions are made to obtain research ethics approval), to determine factors associated with transparent consent practices and to assess the consistency with which pilot and feasibility studies assess feasibility outcomes as their primary objectives.

Methods and analysis

This is a retrospective review of informed consent information for pilot/feasibility studies submitted to the Hamilton integrated Research Ethics Board, Canada. We will look at submitted and revised consent documents for pilot/feasibility studies submitted over a 14-year period. We will use descriptive statistics to summarise data, reporting results as percentages with 95% CIs, and conduct logistic regression to determine characteristics associated with transparent consent practices.

Ethics and dissemination

The study protocol was approved by the Hamilton integrated Research Ethics Board, and the results of this study will be submitted for publication in a peer-reviewed journal.
Pulse oximeter with integrated management of childhood illness for diagnosis of severe childhood pneumonia at rural health institutions in Southern Ethiopia: results from a cluster-randomised controlled trial
Authors: Tesfaye Solomon H , Gebeyehu Yabibal , Loha Eskindir , Johansson Kjell Arne , Lindtjørn Bernt
Published: June 2020

Objective

To assess whether pulse oximetry improves health workers’ performance in diagnosing severe childhood pneumonia at health centres in Southern Ethiopia.

Design

Parallel cluster-randomised trial.

Setting

Government primary health centres.

Participants

Twenty-four health centres that treat at least one pneumonia case per day in Southern Ethiopia. Children aged between 2 months and 59 months who present at health facilities with cough or difficulty breathing were recruited in the study from September 2018 to April 2019.

Intervention arm

Use of the Integrated Management of Childhood Illness (IMCI) algorithm and pulse oximeter.

Control arm

Use of the IMCI algorithm only.

Primary and secondary outcome measures

The primary outcome was the proportion of children diagnosed with severe pneumonia. Secondary outcomes included referred cases of severe pneumonia and treatment failure on day 14 after enrolment.

Result

Twenty-four health centres were randomised into intervention (928 children) and control arms (876 children). The proportion of children with severe pneumonia was 15.9% (148 of 928 children) in the intervention arm and 3.9% (34 of 876 children) in the control arm. After adjusting for differences in baseline variables children in the intervention arm were more likely to be diagnosed as severe pneumonia cases as compared with those in the control arm (adjusted OR: 5.4, 95% CI 2.0 to 14.3, p=0.001).

Conclusion

The combined use of IMCI and pulse oximetry in health centres increased the number of diagnosed severe childhood pneumonia.

Trial registration number

PACTR201807164196402.
Is virtual reality effective to teach prevention of surgical site infections in the operating room? study protocol for a randomised controlled multicentre trial entitled VIP Room study
Authors: Masson Claire , Birgand Gabriel , Castro-Sánchez Enrique , Eichel Vanessa Maria , Comte Alexa , Terrisse Hugo , Rubens-Duval Brice , Gillois Pierre , Albaladejo Pierre , Picard Julien , Bosson Jean Luc , Mutters Nico Tom , Landelle Caroline
Published: June 2020

Introduction

Some surgical site infections (SSI) could be prevented by following adequate infection prevention and control (IPC) measures. Poor compliance with IPC measures often occurs due to knowledge gaps and insufficient education of healthcare professionals. The education and training of SSI preventive measures does not usually take place in the operating room (OR), due to safety, and organisational and logistic issues. The proposed study aims to compare virtual reality (VR) as a tool for medical students to learn the SSI prevention measures and adequate behaviours (eg, limit movements…) in the OR, to conventional teaching.

Methods and analysis

This protocol describes a randomised controlled multicentre trial comparing an educational intervention based on VR simulation to routine education. This multicentre study will be performed in three universities: Grenoble Alpes University (France), Imperial College London (UK) and University of Heidelberg (Germany). Third-year medical students of each university will be randomised in two groups. The students randomised in the intervention group will follow VR teaching. The students randomised in the control group will follow a conventional education programme. Primary outcome will be the difference between scores obtained at the IPC exam at the end of the year between the two groups. The written exam will be the same in the three countries. Secondary outcomes will be satisfaction and students’ progression for the VR group. The data will be analysed with intention-to-treat and per protocol.

Ethics and dissemination

This study has been approved by the Medical Education Ethics Committee of the London Imperial College (MEEC1920-172), by the Ethical Committee for the Research of Grenoble Alpes University (CER Grenoble Alpes-Avis-2019-099-24-2) and by the Ethics Committee of the Medical Faculty of Heidelberg University (S-765/2019). Results will be published in peer-reviewed medical journals, communicated to participants, general public and all relevant stakeholders.
A novel patient-reported outcome monitoring with clinical feedback system in bariatric surgery care: study protocol, design and plan for evaluation
Authors: Hegland Pål André , Aasprang Anny , Kolotkin Ronette L , Moltu Christian , Tell Grethe S , Andersen John Roger
Published: June 2020

Background

Consultations before and after bariatric surgery should include structured assessments of patients’ health-related quality of life (HRQOL) and mental health. One way to conduct this assessment is to implement patient-reported outcome monitoring with a clinical feedback system (PRO/CFS).

Aim

We will explore patients’ and healthcare professionals’ experiences when a PRO/CFS is an integrated part of bariatric surgery care.

Methods and analyses

This is a design paper in which a PRO/CFS will be implemented in two bariatric outpatient clinics. All patients who have an appointment with a healthcare professional prior to, and 3 and 12 months after surgery, will be asked to complete six digital questionnaires measuring HRQOL, mental health, bowel symptoms and eating self-efficacy prior to each consultation. A digital summary report generated from the patient’s responses will form the basis for the clinical consultation. A team of patient representatives, healthcare professionals and researchers will be involved in all phases of designing the PRO/CFS to ensure its relevance for clinical consultations. The patients’ experiences will be explored with a generic 12-item questionnaire, developed for use in outpatient clinics, prior to and 12 months after bariatric surgery. We will conduct focus-group interviews with patients and healthcare professionals to explore their experiences when PRO/CFS is integrated into the consultations.

Ethics and dissemination

Written informed consent will be obtained for all participants in the study. The project is approved by the Norwegian Centre for Research Data, Department of Data Protection Services (ref. no. 282738). The project has also undergone Data Protection Impact Assessments, both at Førde Hospital Trust and at St. Olav Hospital (registration no. 2016/3912). Data from the qualitative and quantitative studies will be kept in de-identified form in a secured research database, and the findings will be published in international peer-reviewed journals and presented at scientific conferences.