bluuebunny/crossref_metadata_2025 huggingface dataset:
The patient perspective on remote monitoring of patients with an implantable cardioverter defibrillator: Narrative review and future directions
Authors: Timmermans Ivy , Meine Matias , Zitron Edgar , Widdershoven Jos , Kimman Geert , Prevot Sébastien , Rauwolf Thomas , Anselme Frédéric , Szendey Istvan , Romero Roldán Javier , Mabo Philippe , Schaer Beat , Denollet Johan , Versteeg Henneke
Published: June 2017

Background

Studies have shown that remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICDs) is at least comparable to in‐clinic follow‐up with regard to clinical outcomes and might be cost‐effective, yet RPM is not standard clinical practice within Europe. Better insight into the patient perspective on RPM may aid in its acceptance, implementation, and reimbursement. This narrative review (1) summarizes existing evidence on the impact of RPM on patient‐reported outcomes and (2) discusses future directions in examining the patient perspective.

Methods and Results

Literature review indicated that only five randomized trials on RPM in ICD patients included patient‐reported outcomes, with inconclusive results. Observational studies show a trend toward good patient satisfaction and acceptation of RPM. Yet, results should be interpreted with caution due to a number of limitations including a potential selection bias, use of generic/nonvalidated questionnaires, relatively short follow‐up durations, and a lack of subgroup identification.

Conclusion

Although RPM seems to be safe, effective, timely, and efficient, the patient perspective has received little attention so far. The scarce evidence on patient‐reported outcomes in RPM studies seems to be positive, but future trials with a follow‐up of ≥12 months and validated patient‐reported outcome measures are needed. The REMOTE‐CIED study from our group is the first prospective randomized controlled trial primarily designed to examine the patient perspective on RPM, and is powered to identify characteristics associated with RPM satisfaction and benefit. Results are expected in 2018 and will add valuable information to the current evidence.
Institutional logics in inter‐departmental coordination: Why actors agree on a joint policy output
Authors: Hustedt Thurid , Danken Thomas
Published: June 2017

By investigating two German inter‐departmental committees, this article shows that the policy output of these coordination bodies depends on the specific institutional logic evoked throughout the coordination process. While in one of the groups a policy logic prevailed and a joint coordination output was achieved, the other was dominated by a political logic and proved unable to achieve agreement. The article contributes to research on government coordination by showing that actor orientations are crucial for explaining inter‐organizational coordination. The results direct attention to the behavioural implications of coordination structures.
Past Tense and Past Times in Subjunctive Conditionals
Authors: Mackay John
Published: June 2017

Some theories of conditionals maintain that the difference between indicative and subjunctive conditionals involves the standard temporal interpretation of past tense. I provide an argument against such theories. The argument is based on the claim that these views do not correctly predict the correspondence between tense marking and temporal interpretation in certain conditionals.
Validation of a set of informative simple sequence repeats markers for variety identification in Pak‐choi (Brassica rapa L. ssp. chinensis var. communis)
Authors: Su Tongbing , Zhao Xiuyun , Sui Guanglei , Yu Shuancang , Zhang Fenglan , Wang Weihong , Zhang Deshuang , Yu Yangjun
Published: June 2017

A core set of 21 simple sequence repeats (SSR) markers was developed for Pak‐choi (Brassica rapa ssp. chinensis var. communis) variety identification. We initially selected 74 SSR markers which exhibited high polymorphism and reproducibility in SSR detection from 2129 SSRs. Using the 74 SSR‐based dendrogram for 45 inbred lines as calibration, 21 core SSRs were selected out. The utility of this core set SSRs was firstly tested in 45 inbred lines and finally verified in 102 commercial varieties. We also constructed a molecular ladder for each core SSR as a reference standard. Diversity analysis of this core SSR panel in 102 varieties demonstrated that each marker generates 2–3 alleles (averaged 2.33), with polymorphism information content values ranging from 0.01 to 0.56 (averaged 0.31). The averaged values of Shannon information index, observed heterozygosity, expected heterozygosity and Wright's fixation index were 0.59, 0.43, 0.38 and −0.09, respectively. Furthermore, the 21 SSR‐based classifications for 102 varieties were consistent with traditional classification based on morphology. This core SSR panel represents an effective tool for genetic variation analysis in Pak‐choi.
Successful treatment with placenta‐derived decidual stromal cells in a pediatric patient with life‐threatening acute gastrointestinal graft‐versus‐host disease
Authors: Gustafsson Britt , Frisk Per , Szakos Attilla , Sadeghi Behnam , Ringdén Olle , Frost Britt‐Marie
Published: June 2017

Severe aGvHD is a life‐threatening complication after allogeneic HSCT. The GI tract is considered to play a key role in aGvHD, where the disease process can start and is one of the major target organs. Here, we present a case of a one‐year‐old child with a life‐threatening GI‐aGvHD stage IV, post‐HSCT, resistant to steroids and MMF for 4 weeks. He was successfully treated with placenta‐derived DSC.
Body mass index as a predictor of outcomes among pediatric kidney transplant recipient
Authors: Dick André A. S. , Hansen Ryan N. , Montenovo Martin I. , Healey Patrick J. , Smith Jodi M.
Published: June 2017

Controversies exist regarding the impact of obesity on patients undergoing kidney transplantation. We sought to estimate the association between BMI and patient outcomes (survival and graft function) among pediatric kidney transplant patients in the USA. We conducted a retrospective analysis of the United Network for Organ Sharing database (1987‐2013), which revealed 13 014 pediatric patients (<18 years old) who underwent primary kidney transplantation. Patients were stratified into five BMI categories established by the World Health Organizations according to their Z score, which is based on age, gender and BMI. The −2, 0, and +2 categories were collapsed and served as the reference group, while the −3 (thin) and +3 (obese) categories were evaluated for differences in graft and patient survival. The survival rates between these categories were compared using the Kaplan‐Meier estimator. Cox proportional hazards models were constructed to adjust for recipient and donor characteristics to estimate the risk of graft loss and mortality associated with BMI. Logistic regression models were estimated to evaluate whether there was an association between BMI and DGF. There were no differences in overall patient (P=.1655) or graft (P=.1688) survival between the severely thin, normal, and obese patients. Adjusted models also revealed no statistically significant differences in graft or patient survival. There were no differences in the odds of DGF (both unadjusted and adjusted) among the three groups. The prevalence of obesity is increasing among children who present for kidney transplant in the USA. In this national study of pediatric kidney transplant recipients, there was no difference in graft or patient survival and no differences in rates of DGF among obese children compared to normal and underweight children undergoing kidney transplantation.
Mortality prediction in community‐acquired pneumonia: Simplifying reliable tools may be worth it
Authors: Lopez‐Mendoza Diego
Published: June 2017

See related Article
Federation Internationale de Football Association (FIFA) 2014 World Cup Impact on Hospital‐Treated Suicide Attempt (Overdose) in Tehran
Authors: Hassanian‐Moghaddam Hossein , Ghorbani Fatemeh , Rahimi Afsaneh , Farahani Tayyebeh Farmahini , Sani Parvane Sadat Vafaei , Lewin Terry J. , Carter Gregory L.
Published: June 2017

Social influences on suicidal behaviors may be important but are less frequently studied than the influences of mental illness, physical illness, and demographic variables. Major international sporting events may have an impact on suicidal behaviors at the national and local level, an effect possibly mediated by gender and age. We examined the association of hospital‐treated deliberate self‐poisoning episodes (by gender and by age) in Tehran: before, during, and after the 2014 FIFA World Cup held in Brazil, in which the Iranian national team participated and was eliminated after the pool games. We used a time series analysis within an autoregressive integrated moving average model and found a significant increase in hospital‐treated deliberate self‐poisoning during the 4‐week period of the 2014 FIFA World Cup in Brazil in females but a nonsignificant increase in males. A significant increase was also seen in the youngest age group (12–20 years), but not in the two older age groups. If the effects of nonsuccess at major international sporting events could be shown to have a potential harmful effect on aggregate local or national rates of suicidal behaviors, the possibility of preventative interventions and preemptive additional service provision could be planned in advance of these events.
Strain‐based HLA association analysis identified HLA‐DRB1*09:01 associated with modern strain tuberculosis
Authors: Toyo‐oka L. , Mahasirimongkol S. , Yanai H. , Mushiroda T. , Wattanapokayakit S. , Wichukchinda N. , Yamada N. , Smittipat N. , Juthayothin T. , Palittapongarnpim P. , Nedsuwan S. , Kantipong P. , Takahashi A. , Kubo M. , Sawanpanyalert P. , Tokunaga K.
Published: June 2017

Tuberculosis (TB) occurs as a result of complex interactions between the host immune system and pathogen virulence factors. Human leukocyte antigen (HLA) class II molecules play an important role in the host immune system. However, no study has assessed the association between HLA class II genes and susceptibility to TB caused by specific strains. This study investigated the possible association of HLA class II genes with TB caused by modern and ancient Mycobacterium tuberculosis (MTB). The study included 682 patients with TB and 836 control subjects who were typed for
HLA‐DRB1
and
HLA‐DQB1
alleles. MTB strains were classified using a large sequence polymorphism typing method. Association analysis was performed using common HLA alleles and haplotypes in different MTB strains. HLA association analysis of patients infected with modern MTB strains showed significant association for
HLA‐DRB1*09:01 (odds ratio [OR] = 1.82; P‐value = 9.88 × 10−4) and
HLA‐DQB1*03:03 alleles (OR = 1.76; P‐value = 1.31 × 10−3) with susceptibility to TB. Haplotype analysis confirmed that these alleles were in strong linkage disequilibrium and did not exert an interactive effect. Thus, the results of this study showed an association between HLA class II genes and susceptibility to TB caused by modern MTB strains, suggesting the importance of strain‐specific analysis to determine susceptibility genes associated with TB.
Monte Carlo Model for Piezoresistivity of Hybrid Nanocomposites
Authors: Gbaguidi Audrey , Namilae Sirish , Kim Daewon
Published: June 2017

Hybrid nanocomposites with multiple fillers like carbon nanotubes (CNT) and graphene nanoplatelets (GNP) are known to exhibit improved electrical and electromechanical performance when compared to monofiller composites. We developed a two-dimensional Monte Carlo percolation network model for hybrid nanocomposite with CNT and GNP fillers and utilized it to study the electrical conductivity and piezoresistivity as a function of nanocomposite microstructural variations. The filler intersections are modeled considering electron tunneling as the mechanism for electrical percolation. Network modification after elastic deformation is utilized to model the nanocomposite piezoresistive behavior. Systematic improvement in electrical conductivity and piezoresistivity was observed in the hybrid nanocomposites, compared to monofiller CNT nanocomposites. Parametric studies have been performed to show the effect of GNP content, size, aspect ratio, and alignment on the percolation threshold, the conductivity, and piezoresistivity of hybrid CNT–GNP polymer composites.
Effects of Coolant Density, Specific Heat Capacity, and Biot Number on Turbine Vane Cooling Effectiveness
Authors: Luque S. , Jones T. V. , Povey T.
Published: June 2017

This paper describes the effects of coolant-to-mainstream density ratio and specific heat capacity flux ratio (the product of blowing ratio and specific heat capacity ratio) on the overall cooling effectiveness of high pressure (HP) turbine vanes. Experimental measurements have been conducted at correct engine-matched conditions of Mach number, Reynolds number, turbulence intensity, and coolant-to-mainstream momentum flux ratio. Vanes tested were fully cooled production parts from an engine currently in service. A foreign gas mixture of SF6 and Ar was selected for injection as coolant in the facility so that density and blowing ratios were also matched to the engine situation. The isentropic exponent of the foreign gas mixture coincides with that of air. Full-coverage surface maps of overall cooling effectiveness were acquired by an infrared (IR) thermography technique at a range of mainstream-to-coolant temperature ratios. Measurements were subsequently scaled to engine conditions by employing a new theory based on the principle of superposition and a recovery and redistribution temperature demonstrated in previous papers. It is shown that the two aerodynamically matched situations of air- and foreign-gas-cooled experiments give virtually the same effectiveness trends and patterns. Actual levels differ, however, on account of specific heat capacity flux ratio differences. The effect is described and quantified by a one-dimensional analytical model of the vane wall. Differences in Biot number with respect to engine conditions are discussed as they also influence the scaling of turbine metal temperatures.
Experimental Demonstration of AHWR Safety During Prolonged Station Black Out
Authors: Kumar Mukesh , Verma P. K. , Nayak A. K. , Rama Rao A.
Published: June 2017

Fukushima accident has raised a strong concern and apprehension about the safety of a nuclear reactor failing to remove the decay heat following an extreme event. After Fukushima accident, the reactor designers worldwide analyzed the safety margin of the existing and new generation nuclear power plants for such an event. Advanced heavy water reactor (AHWR), designed in India, was also analyzed for even more severe conditions than occurred at Fukushima. AHWR equipped with several passive systems showed its robustness against this type of scenarios. However, several new passive systems were incorporated in AHWR design for maintaining the integrity of the reactor at least for 7 days as a grace period. A passive moderator cooling system (PMCS) and a passive endshield cooling system (PECS) were among the newly introduced safety system in AHWR. An experimental test facility simulating the prolonged station blackout (SBO) case in AHWR has been designed and built. Experiments have been performed in the test facility for simulated conditions of prolonged SBO. The current study shows the performance of AHWR during prolonged SBO case through simulation in the integral test facility. The results indicate that AHWR design is capable of removing decay heat for prolonged period without operator interference.
Numerical Location of Painlevé Paradox-Associated Jam and Lift-Off in a Double-Pendulum Mechanism
Authors: Burns Shane J. , Piiroinen Petri T.
Published: June 2017

In this article, we will introduce the phenomenon known as the Painlevé paradox and further discuss the associated coupled phenomena, jam and lift-off. We analyze under what conditions the Painlevé paradox can occur for a general two-body collision using a framework that can be easily used with a variety of impact laws, however, in order to visualize jam and lift-off in a numerical simulation, we choose to use a recently developed energetic impact law as it is capable of achieving a unique forward solution in time. Further, we will use this framework to derive the criteria under which the Painlevé paradox can occur in a forced double-pendulum mechanical system. First, using a graphical technique, we will show that it is possible to achieve the Painlevé paradox for relatively low coefficient of friction values, and second we will use the energetic impact law to numerically show the occurrence of the Painlevé paradox in the double-pendulum system.
Finite Element Modeling of Avascular Tumor Growth Using a Stress-Driven Model
Authors: Iranmanesh Faezeh , Nazari Mohammad Ali
Published: June 2017

Tumor growth being a multistage process has been investigated from different aspects. In the present study, an attempt is made to represent a constitutive-structure-based model of avascular tumor growth in which the effects of tensile stresses caused by collagen fibers are considered. Collagen fibers as a source of anisotropy in the structure of tissue are taken into account using a continuous fiber distribution formulation. To this end, a finite element modeling is implemented in which a neo-Hookean hyperelastic material is assigned to the tumor and its surrounding host. The tumor is supplied with a growth term. The growth term includes the effect of parameters such as nutrient concentration on the tumor growth and the tumor's solid phase content in the formulation. Results of the study revealed that decrease of solid phase is indicative of decrease in growth rate and the final steady-state value of tumor's radius. Moreover, fiber distribution affects the final shape of the tumor, and it could be used to control the shape and geometry of the tumor in complex morphologies. Finally, the findings demonstrated that the exerted stresses on the tumor increase as time passes. Compression of tumor cells leads to the reduction of tumor growth rate until it gradually reaches an equilibrium radius. This finding is in accordance with experimental data. Hence, this formulation can be deployed to evaluate both the residual stresses induced by growth and the mechanical interactions with the host tissue.
The Failure Window Method and Its Application in Pipeline Burst
Authors: Chen Zhanfeng , Ye Hao , Yan Sunting , Shen Xiaoli , Jin Zhijiang
Published: June 2017

Accurate prediction of the burst pressure is indispensible for the engineering design and integrity assessment of the oil and gas pipelines. A plenty of analytical and empirical equations have been proposed to predict the burst pressures of the pipelines; however, it is difficult to accurately predict the burst pressures and evaluate the accuracy of these equations. In this paper, a failure window method was presented to predict the burst pressure of the pipes. First, the security of the steel pipelines under the internal pressure can be assessed. And then the accuracy of the previous analytical and empirical equations can also be generally evaluated. Finally, the effect of the wall thinning of the pipes on the failure window was systemically investigated. The results indicate that it is extremely formidable to establish an equation to predict the burst pressure with a high accuracy and a broad application, while it is feasible to create a failure window to determine the range of the dangerous internal pressure. Calculations reveal that some predictions of the burst pressure equations like Faupel, Soderberg, Maximum stress, and Nadai (1) are overestimated to some extent; some like ASME, maximum shear stress, Turner, Klever and Zhu–Leis and Baily–Nadai (2) basically reliable; the rest like API and Nadai (3) slightly conservative. With the wall thinning of the steel pipelines, the failure window is gradually lowered and narrowed.
Assessment of Fracture Toughness Using Small Punch Tests of Prenotched Specimens
Authors: Zheng Yangyan , Chen Xiao , Yang Zheng , Ling Xiang
Published: June 2017

In this paper, line- and ring-notched small punch test (SPT) specimens were studied; a three-dimensional (3D) model of a ring-notched SPT specimen was established using the contour integral method, and the validity of the model was verified using ring-notched specimens. The stress and strain fields were analyzed using numerical simulations of a ring-notched SPT specimen, and the change in the stress gradient during deformation was considered. To verify the finite element model, the results of the numerical simulations were compared with those of three-point bending tests and a Gurson–Tvergaard–Needleman (GTN) model. Compared with the line-notched specimen, the ring-notched specimen was more suitable for notch propagation analysis and fracture toughness evaluation. The results of the numerical simulations were in good agreement with those of the experiments, which showed that the numerical model used in this study was correct. For a notch that initiated when the load reached its maximum value, the value of the J integral was 335 × 10−6 kJ/mm2, and at time 0.85Pmax, the value of the J integral was 201 × 10−6 kJ/mm2, and the difference from the result of the three-point bending test was 14.4%. For a notch that initiated during the stretching deformation stage, the relevant fracture toughness was 225 × 10−6 kJ/mm2, and the difference from the result of the three-point bending test was 3%.
Modeling of Cavitation-Induced Air Release Phenomena in Micro-Orifice Flows
Authors: Freudigmann Hans-Arndt , Dörr Aaron , Iben Uwe , Pelz Peter F.
Published: June 2017

Impurities like air bubbles in hydraulic liquids can significantly affect the performance and reliability of hydraulic systems. The aim of this study was to develop a model suited for hydraulic system simulation to determine the rate of degassing of dissolved air in a micro-orifice flow at cavitating conditions. An existing model for the flow through a micro-orifice was extended to account for the generation of vapor which is suggested to play the key-role for the degassing mechanism. In comparison with measurements, the results of the modeling approach imply that diffusive mass transfer of dissolved air into generated vapor cavities is the dominating mechanism for the observed air release phenomena.
A Novel Suction-Side Winglet Design Philosophy for High-Pressure Turbine Rotor Tips
Authors: Zhou Chao , Zhong Fangpan
Published: June 2017

Winglet tips are promising candidates for future high-pressure turbine rotors. Many studies found that the design of the suction-side winglet is the key to the aerodynamic performance of a winglet tip, but there is no general agreement on the exact design philosophy. In this paper, a novel suction-side winglet design philosophy in a turbine cascade is introduced. The winglets are obtained based on the near-tip flow field of the datum tip geometry. The suction-side winglet aims to reduce the tip leakage flow particularly in the front part of the blade passage. It is found that on the casing endwall, the pressure increases in the area where the winglet is used. This reduces the tip leakage flow in the front part of the blade passage and the pitchwise pressure gradient on the endwall. As a result, the size of the tip leakage vortex reduces. A surprising observation is that the novel optimized winglet tip design eliminates the passage vortex and results in a further increasing of the efficiency. The tip leakage loss of the novel winglet tip is 18.1% lower than the datum cavity tip, with an increase of tip surface area by only 19.3%. The spanwise deflection of the winglet due to the centrifugal force is small. The tip heat load of the winglet tip is 17.5% higher than that of the cavity tip. Numerical simulation shows that in a turbine stage, this winglet tip increases the turbine stage efficiency by 0.9% mainly by eliminating the loss caused by the passage vortex at a tip gap size of 1.4% chord compared with a cavity tip.
Fabrication of conductance-controllable standard leak elements on anodic aluminum oxide using a selective coating method
Authors: Wei Benmeng , Zhao Yongheng , Wang Xudi , Wang Yu , Wei Wei , Qiu Keqiang
Published: June 2017

To fabricate conductance-controllable standard leak elements, a selective coating method was developed to achieve a specific open area on anodic aluminum oxide. Aluminum oxide with an optimized thickness was deposited onto anodic aluminum oxide by ion beam sputtering, acting as a cover layer to seal the redundant pores in anodic aluminum oxide. Two leak elements with different uncovered areas were fabricated, and the values of their conductance were measured. The results indicate that the conductance of the leak elements can be controlled by the size of the uncovered area. The diameter of the tubes in the anodic aluminum oxide is approximately 70 nm, and gases such as helium flowing through the tubes exhibit molecular flow from vacuum to atmospheric pressures. Hence, the values of conductance of the leak elements are predictable for noncondensable gas species.
Onset of barotrauma injuries related to number of pile driving strike exposures in hybrid striped bass
Authors: Casper Brandon M. , Halvorsen Michele B. , Carlson Thomas J. , Popper Arthur N.
Published: June 2017

Previous studies exploring injury response to pile driving in fishes presented exposure paradigms (>900 strikes) that emulated circumstances where fish would not leave an area being ensonified. Those studies did not, however, address the question of how many strikes are needed before injuries appear. Thus, the number of strikes paired with a constant single strike sound exposure level (SELss) that can cause injuries is not yet clear. In order to examine this question, hybrid striped bass (white bass Morone chrysops × striped bass Morone saxatilis) were exposed to 8–384 strikes in three different SELss treatments that generated different cumulative sound exposure level values. The treatment with the highest SELss values caused swim bladder injuries in fish exposed to as few as eight pile strikes. These results have important implications for pile driving operations where SELss values meet or exceed the exposure levels used in this study.
Precision and bias in estimating detection distances for beaked whale echolocation clicks using a two-element vertical hydrophone array
Authors: Barlow Jay , Griffiths Emily T.
Published: June 2017

Detection distances are critical for cetacean density and abundance estimation using distance sampling methods. Data from a drifting buoy system consisting of an autonomous recorder and a two-element vertical hydrophone array at ∼100-m depth are used to evaluate three methods for estimating the horizontal distance (range) to beaked whales making echolocation clicks. The precision in estimating time-differences-of-arrival (TDOA) for direct- and surface-reflected-path clicks is estimated empirically using repeated measures over short time periods. A Teager-Kaiser energy detector is used to improve estimates of TDOA for surface-reflected signals. Simulations show that array tilt in the direction of the source cannot be reliably estimated given this array geometry and these measurements of TDOA error, which means that range cannot be reliably estimated. If array tilt can be reduced to less than 0.5°, range can be reliably estimated up to ∼3000 m. If array depth is increased to 200 m and array tilt is less than 1°, range can be reliably estimated up to ∼5000 m. Prior information on the depth of vocalizing beaked whales and estimates of declination angle can be used to precisely estimate range, but different analytical methods are required to avoid bias and to treat distributions of depth probabilistically.
Broadband focusing of underwater sound using a transparent pentamode lens
Authors: Su Xiaoshi , Norris Andrew N. , Cushing Colby W. , Haberman Michael R. , Wilson Preston S.
Published: June 2017

An inhomogeneous acoustic metamaterial lens based on spatial variation of refractive index for broadband focusing of underwater sound is reported. The index gradient follows a modified hyperbolic secant profile designed to reduce aberration and suppress side lobes. The gradient index (GRIN) lens is comprised of transversely isotropic hexagonal microstructures with tunable quasi-static bulk modulus and mass density. In addition, the unit cells are impedance-matched to water and have in-plane shear modulus negligible compared to the effective bulk modulus. The flat GRIN lens is fabricated by cutting hexagonal centimeter scale hollow microstructures in aluminum plates, which are then stacked and sealed from the exterior water. Broadband focusing effects are observed within the homogenization regime of the lattice in both finite element simulations and underwater measurements (20–40 kHz). This design approach has potential applications in medical ultrasound imaging and underwater acoustic communications.
Effect of evaporation and condensation on a thermoacoustic engine: A Lagrangian simulation approach
Authors: Yasui Kyuichi , Izu Noriya
Published: June 2017

Acoustic oscillations of a fluid (a mixture of gas and vapor) parcel in a wet stack of a thermoacoustic engine are numerically simulated with a Lagrangian approach taking into account Rott equations and the effect of non-equilibrium evaporation and condensation of water vapor at the stack surface. In a traveling-wave engine, the volume oscillation amplitude of a fluid parcel always increases by evaporation and condensation. As a result, pV work done by a fluid parcel is enhanced, which means enhancement of acoustic energy in a thermoacoustic engine. On the other hand, in a standing-wave engine, the volume oscillation amplitude sometimes decreases by evaporation and condensation, and pV work is suppressed. Presence of a tiny traveling-wave component, however, results in the enhancement of pV work by evaporation and condensation.
Maximising paediatricians’ roles in improving children’s oral health: lessons from Leicester
Authors: Murphy Jasmine , Moore Rod
Published: June 2017

Aims

To provide an overview of steps taken to improve oral health in one UK city and to review factors relevant to maximising the contribution that paediatricians (and potentially other health professionals) can make to improving oral health.

Methods

The article provides information on the strategic approach taken in Leicester, one of the most ethnically diverse cities in England, and also one of the most deprived. Over a third of children aged 3 years, and half of those aged 5 years, have experience of obvious dental decay. The collaborative strategic approach taken includes implementing a comprehensive evidence-based early intervention programme from birth (Healthy Teeth, Happy Smiles!) and a focus on professional education and engagement. In order to ensure sustainability and further improvement, wider engagement with paediatricians and other primary care providers is essential and is increasingly recognised by professional bodies.

Literature relevant to the factors which inhibit engagement with paediatricians and others is reviewed and highlights issues of knowledge and competency, policies and guidelines, time and capacity and referral and access.

Conclusion

Children’s oral health in England has improved over the last 30 years, but inequalities persist, with those living in areas of higher deprivation experiencing a substantially higher burden of dental disease. The article highlights several potential barriers which can be reduced. Collaboration is encouraged between medical and dental professionals as well as commissioners and providers at both the national and local level in order for oral health to be fully integrated within general health. Such collaboration requires appropriate leadership in order to develop policies that support curriculum changes, drive the implementation of associated guidelines, design integrated healthcare service provision and develop the partnership relationships to support this work.
A retrospective study on the incidence of post-cataract surgery Descemet’s membrane detachment and outcome of air descemetopexy
Authors: Odayappan Annamalai , Shivananda Narayana , Ramakrishnan Seema , Krishnan Tiruvengada , Nachiappan Sivagami , Krishnamurthy Smitha
Published: June 2017

Purpose

To study the anatomic and functional outcome of air descemetopexy in postcataract surgery Descemet’s membrane detachment (DMD).

Design

Retrospective study.

Methods

Setting: Institutional.

Study population: Records of 112 patients who underwent air descemetopexy for postcataract surgery sight-threatening DMD at Aravind Eye Hospital, Pondicherry, between January 2013 and December 2015 were studied.

Main outcome measures: Anatomical outcome refers to reattachment of the Descemet’s membrane (DM). Functional outcome was given by the best-corrected visual acuity.

Results

The mean age was 66.47±8.46 (SD) years, the male to female ratio was 45:67. The incidence of DMD was more in extracapsular cataract extraction (0.26%) and manual small incision cataract surgery (0.11%) than phacoemulsification (0.04%) (p=0.005 and p<0.0001). DMD was more common among surgical trainees (0.17%) than consultants (0.07%) (p≤0.0001). After primary air descemetopexy, 78 (71%) out of the 110 patients had DM reattachment. The complications noted after descemetopexy include persistent DMD (21.8%), corneal decompensation (7.3%), appositional angle closure (18%), pupillary block with air (2.7%) and uveitis (2.7%). Age, sex and timing of intervention did not influence the reattachment rate. Fifteen patients underwent repeat air descemetopexy for persistent DMD among whom nine (60%) had successful reattachment. Almost 75% of patients had vision better than 6/18 1 month after anatomically successful descemetopexy.

Conclusion

Air descemetopexy is a safe and efficient modality of treatment of DMD and should be tried even in patients with severe DMD before planning a major surgery like endothelial keratoplasty.
Long-term clinical outcome of femtosecond laser-assisted lamellar keratectomy with phototherapeutic keratectomy in anterior corneal stromal dystrophy
Authors: Lee Jonghyun , Kim Jin Hyoung , Lee Doh , Chang Ji Woong , Shin Joo Youn , Seo Ji Won , Seo Min Hwan , Moon Nam Ju
Published: June 2017

Purpose

To evaluate long-term outcome of femtosecond laser-assisted lamellar keratectomy (FLK) with phototherapeutic keratectomy (PTK) in patients with anterior corneal stromal dystrophies.

Methods

A total of 10 eyes from seven patients who underwent FLK were included. The patients had suffered from recurrent corneal erosion or visual disturbance in anterior corneal dystrophies (five Avellino dystrophies and two lattice dystrophies). Planar-shaped lamellar keratectomy was performed using femtosecond laser. The amount of corneal excision was determined by the depth of corneal opacity. Additional PTK with mitomycin C application was performed for smoothening of corneal cut surface. The patients were evaluated with following parameters: uncorrected visual acuity, best-corrected visual acuity (BCVA), mean anterior keratometric value, corneal irregularity, corneal high-order aberrations (HOA) and the recurrence of corneal erosion.

Results

Mean duration of follow-up was 64 months (2.5–9.5 years). The BCVA improved more than two lines of Snellen chart at last visit. The changes of keratometric values were within ±1 D in eight out of 10 eyes. Corneal irregularities in central 5 mm cornea and the values of total corneal HOA in central 6 mm cornea decreased by 0.3–3.1 D and 0.01–2.2 µm, respectively. Corneal erosion did not recur in any of those patients during follow-up and corneal dystrophy did not recur in eight out of 10 eyes.

Conclusion

In anterior corneal stromal dystrophies, FLK with PTK can be an effective surgical option to improve VA through decreasing corneal irregularities and HOA, while minimising corneal curvature changes.
Impact of social service and public health spending on teenage birth rates across the USA: an ecological study
Authors: Sipsma Heather L , Canavan Maureen , Gilliam Melissa , Bradley Elizabeth
Published: June 2017

Objective

To examine whether greater state-level spending on social and public health services such as income, education and public safety is associated with lower rates of teenage births in USA.

Design

Ecological study.

Setting

USA.

Participants

50 states.

Primary outcome measure

Our primary outcome measure was teenage birth rates. For analyses, we constructed marginal models using repeated measures to test the effect of social spending on teenage birth rates, accounting for several potential confounders.

Results

The unadjusted and adjusted models across all years demonstrated significant effects of spending and suggested that higher spending rates were associated with lower rates of teenage birth, with effects slightly diminishing with each increase in spending (linear effect: B=−0.20; 95% CI −0.31 to 0.08; p<0.001 and quadratic effect: B=0.003; 95% CI 0.002 to 0.005; p<0.001).

Conclusion

Higher state spending on social and public health services is associated with lower rates of teenage births. As states seek ways to limit healthcare costs associated with teenage birth rates, our findings suggest that protecting existing social service investments will be critical.
Protocol for a randomised controlled trial evaluating the effects of providing essential medicines at no charge: the Carefully seLected and Easily Accessible at No Charge Medicines (CLEAN Meds) trial
Authors: Persaud Nav , Lee Taehoon , Ahmad Haroon , Li Winny , Taglione Michael Sergio , Rajakulasingam Yathavan , Umali Norman , Boozary Andrew , Glazier Richard H , Gomes Tara , Hwang Stephen W , Jüni Peter , Law Michael , Mamdani Muhammad M , Manns Braden , Martin Danielle , Morgan Steve , Oh Paul , Pinto Andrew David , Shah Baiju R , Sullivan Frank M , Thorpe Kevin E , Tu Karen , Laupacis Andreas
Published: June 2017

Introduction

Cost-related non-adherence to medicines is common in low-income, middle-income and high-income countries such as Canada. Medicine non-adherence is associated with poor health outcomes and increased mortality. This randomised trial will test the impact of a carefully selected list of essential medicines at no charge (compared with usual medicine access) in primary care patients reporting cost-related non-adherence.

Methods and analysis

This is an open-label, parallel two-arm, superiority, individually randomised controlled trial conducted in three primary care sites (one urban, two rural) in Ontario, Canada, that was codesigned by a community guidance panel. Adult patients (≥18 years) who report cost-related non-adherence to medicines are eligible to participate in the study. Participants will be randomised to receive free and convenient access to a carefully selected list of 125 essential medicines (based on the WHO’s Model List of Essential Medicines) or usual means of medicine access. Care for patients in both groups will otherwise be unchanged. The primary outcome of this trial is adherence to appropriately prescribed medicines. Secondary outcomes include medicine adherence, appropriate prescribing, blood pressure, haemoglobin A1c, low-density lipoprotein cholesterol, patient-oriented outcomes and healthcare costs. All participants will be followed for at least 12 months.

Ethics and dissemination

Ethics approval was obtained in all three participating sites. Results of the main trial and secondary outcomes will be submitted for publication in a peer-reviewed journal and discussed with members of the public and decision makers.

Trial registration number

NCT02744963.
The impact of interventions to improve the quality of prescribing and use of antibiotics in primary care patients with respiratory tract infections: a systematic review protocol
Authors: Martínez-González Nahara Anani , Coenen Samuel , Plate Andreas , Colliers Annelies , Rosemann Thomas , Senn Oliver , Neuner-Jehle Stefan
Published: June 2017

Introduction

Respiratory tract infections (RTIs) are the most common reason for primary care (PC) consultations and for antibiotic prescribing and use. The majority of RTIs have a viral aetiology however, and antibiotic consumption is ineffective and unnecessary. Inappropriate antibiotic use contributes greatly to antibiotic resistance (ABR) leading to complications, increased adverse events, reconsultations and costs. Improving antibiotic consumption is thus crucial to containing ABR, which has become an urgent priority worldwide. We will systematically review the evidence about interventions aimed at improving the quality of antibiotic prescribing and use for acute RTI.

Methods and analysis

We will include primary peer-reviewed and grey literature of studies conducted on in-hours and out-of-hours PC patients (adults and children): (1) randomised controlled trials (RCTs), quasi-RCTs and/or cluster-RCTs evaluating the effectiveness, feasibility and acceptability of patient-targeted and clinician-targeted interventions and (2) RCTs and other study designs evaluating the effectiveness of public campaigns and regulatory interventions. We will search MEDLINE (EBSCOHost), EMBASE (Elsevier), the Cochrane Library (Wiley), CINHAL (EBSCOHost), PsychINFO (EBSCOHost), Web of Science, LILACS (Latin American and Caribbean Literature on Health Sciences), TRIP (Turning Research Into Practice) and opensgrey.eu without language restriction. We will also search the reference lists of included studies and relevant reviews. Primary outcomes include the rates of (guideline-recommended) antibiotics prescribed and/or used. Secondary outcomes include immediate or delayed use of antibiotics, and feasibility and acceptability outcomes. We will assess study eligibility and risk of bias, and will extract data. Data permitting, we will perform meta-analyses.

Ethics and dissemination

This is a systematic review protocol and so formal ethical approval is not required. We will not collect confidential, personal or primary data. The findings of this review will be disseminated at national and international scientific meetings.

Trial registration number

PROSPERO trial (CRD42017035305).
Shear bands in undrained plane strain compression of Norwegian quick clays
Authors: Thakur Vikas , Nordal Steinar , Viggiani Gioacchino , Charrier Pascal
Published: June 2017

This work presents the results of plane strain tests carried out at the Laboratoire 3SR Grenoble (France) on undisturbed samples of very sensitive Norwegian soft clay. Discussion of the results focuses on the observed failure mechanisms and zones of localized deformation. The tested clay is defined as quick clay because it liquefies completely upon remolding. Thus, careful handling was necessary, and original procedures were developed to place samples in the plane strain testing device with minimum disturbance. Results show that excess pore-water pressure had developed during shear loading and shear strength was lost after the peak, which is a typical phenomenon in sensitive soils. The sample was held between two glass plates to enable visual tracking of the deformations. A digital image correlation analysis revealed a complex pattern of emerging shear bands, with one or two bands dominating and providing a final failure mechanism. Two local pore-water pressure transducers were attached to the sample boundary and showed differences in local excess pore-water pressure. It is suggested that excess pore-water pressure depends on the distance from the transducers to the zones of concentrated shear strains.
Tripolar vortices in ion-temperature-gradient mode with non-Maxwellian electrons in an inhomogeneous magnetoplasma
Authors: Qamar Anisa , Iqbal Javed , Zakir U. , Mirza Arshad M.
Published: June 2017

We consider a low frequency plasma comprising of Kappa distributed electrons and Maxwellian ions embedded in an external magnetic field in toroidal ion-temperature-gradient driven modes. A set of nonlinear equations are derived in the presence of equilibrium density, temperature, and magnetic field gradients. In the nonlinear regime, solutions in the form of tripolar vortices are derived by using Braginskii’s transport equations. It has been observed that the scale lengths over which the nonlinear vortex structures form get modified in the presence of Kappa distributed electrons. In tokamak the present study is applicable where non-Maxwellian population has been observed in electron cyclotron heating experiments and resonant frequency heating.
LOCAL PUBLIC DEBT MANAGEMENT: LESSONS FROM GREECE IN INCLUSIVE ECONOMIC PERSPECTIVE
Authors: ROSEFIELDE STEVEN , LIU YIYI
Published: June 2017

This paper discusses the potential dangers of adversarial debt management in China between central and local authorities. It draws lessons from Germany’s recent mishandling of the Greek debt crisis to illustrate nuances and stresses the wisdom of cooperation and mutual support in restoring balance to local Chinese finance. Inclusive economic theory provides additional insight.
IS THERE MORE OR LESS COMPATIBILITY BETWEEN SYSTEMS WHEN CONSUMERS ARE KEENER ON A RIVAL SYSTEM’S SOFTWARE?
Authors: CHOU CHUNG-HUI
Published: June 2017

A greater level of keenness on a rival system’s software intuitively motivates system manufacturers to raise their degrees of compatibility in order to capture more profit from selling software to rival system users. After constructing a game-theoretic model to investigate system manufacturers’ partial compatibility decisions, this paper surprisingly finds that when consumers are keener on a rival system’s software, hardware price competition is relaxed and system manufacturers reduce the degrees of compatibility. This paper also presents the following three results. First, partial compatibility occurs when the expenditure on system goods is relatively low. Second, the optimal degree of compatibility increases in the expenditure on system goods and decreases in hardware production cost. Third, system manufactures suffer losses on selling hardware when keenness on a rival system’s software is relatively low. According to Lee (2013), this result provides a theoretical interpretation of the phenomenon that platform providers often sell hardware platforms close or below cost in the US video game industry [Lee, R (2013). Vertical integration and exclusively platform and two-sided markets. American Economic Review, 103, 2960–3000].
The elastic transfer model of angular rate modulation in F1-ATPase stalling and controlled rotation experiments
Authors: Volkán-Kacsó S.
Published: June 2017

The recent experimental, theoretical and computational advances in the field of F1-ATPase single-molecule microscopy are briefly surveyed. The role of theory is revealed in the statistical analysis, interpretation and prediction of single-molecule experimental trajectories, and in linking them with atomistic simulations. In particular, a theoretical model of elastically coupled molecular group transfer is reviewed and a detailed method for its application in stalling and controlled rotation experiments is provided. It is shown how the model can predict, using previous experiments, the rates of ligand binding/release processes (steps) and their exponential dependence on rotor angle in these experiments. The concept of Brønsted slopes is reviewed in the context of the single-molecule experiments, and the rate versus rotor angle relations are explained using the elastic model. These experimental data are treated in terms of the effect of thermodynamic driving forces on the rates assuming that the rotor shaft is elastically coupled to stator ring subunits in which the steps occur. In the application of the group transfer model on an extended angular range processes leading up to the transfer are discussed. Implications for large-scale atomistic simulation are suggested for the treatment of torque-generating steps.