bluuebunny/crossref_metadata_2025 huggingface dataset:
Glass Fiber-Reinforced PTFE Gasketed-Joint Under a Retorque
Authors: Williams James P. , Stone Addi-Neequie , Reedy Ryan , Gordon Ali P.
Published: December 2018

Joints gasketed with viscoelastic seals often receive an application of a secondary torque, i.e., retorque, in order to ensure joint tightness and proper sealing. The importance of understanding gasketed joint behavior under various loading conditions and test parameters is paramount to a successful design. The motivation of this study is to characterize and analytically model the initial and retorque load relaxation response of a single 25% glass-fiber reinforced polytetrafluorethylene (PTFE) gasket-bolted joint with serrated flange detail by a single set of experimentally determined modeling constants. The Burger-type viscoelastic modeling constants of the material are obtained through optimization from a baseline load relaxation data and compared to a variety of test cases for both initial and reloadings. Determination of a retorque parameter, α, allowing modeling constants identified from an initial loading to predict the retorque relaxation showed the retarded elasticity or K2 term to be most influential in predicting retorque response. Finally, the validity of the viscoelastic model with the retorque parameter is shown to reasonably predict retorque relaxation responses of all test cases investigated.
Classification of solutions for guided waves in anisotropic composites with large numbers of layers
Authors: Huber Armin M. A. , Sause Markus G. R.
Published: December 2018

Guided waves are used for the non-destructive evaluation in automotive and aerospace industries. There is a trend leaning away from isotropic materials to the manufacturing based on composites. However, the elastic wave dynamics in such materials is considerably more complicated. Much effort has been committed to the calculation of guided waves' dispersion curves in composites. Lots of methods and tools are available, but it becomes difficult when there are more than one hundred layers. In this paper the calculation of dispersion diagrams and mode shapes using the stiffness matrix method is demonstrated. Boundary conditions are implemented into the stiffness matrix method that allow for the separate tracing of the various mode families. Shear horizontal modes are modeled with the transfer matrix method without facing any numerical instability. It is elucidated just how the occurrence of the mode families depends on the system's symmetry and wave propagation direction. As a result, the robustness and reliability of guided wave modeling by using the stiffness method is improved, and more information about the modes is yielded. This is demonstrated on exemplary layups of the fiber reinforced polymer T800/913, with up to 400 layers. Referencing is made against results from DISPERSE® (Imperial College London, London, UK) for selected cases.
Immediate Effects of Dry Needling as a Novel Strategy for Hamstring Flexibility: A Single-Blinded Clinical Pilot Study
Authors: Ansari Noureddin Nakhostin , Alaei Parisa , Naghdi Soofia , Fakhari Zahra , Komesh Shiva , Dommerholt Jan
Published: December 2018

Context: There are numerous studies on the benefits of dry needling (DN) for pain relief. No studies exist examining the effects of DN on hamstring flexibility. Objective: To determine the immediate effects of DN on hamstring flexibility in healthy subjects with shortened hamstrings. Design: A single-blinded, pretest–posttest clinical pilot study. Setting: A university physiotherapy clinic. Subjects: A total of 15 healthy subjects (female = 11; age = 23.26 [4.3] y) with shortened hamstrings participated in this study. Intervention: Subjects received a single session of DN. Three locations on the hamstring muscle group were needled, each for 1 minute. Main Outcome Measures: The active knee extension test, muscle compliance, passive peak torque, and stretch tolerance were measured at baseline, immediately, and 15 minutes after DN. Results: There were statistically significant improvements in all outcome measures immediately after DN and at the 15-minute follow-up. The effect sizes for all outcome measures were large (Cohen’s d ≥ 0.8). No serious adverse events were observed with DN. Conclusions: This is the first study that demonstrates the beneficial effects of DN on hamstring flexibility, muscle compliance, and stretch tolerance without added stretching. The beneficial effects of DN should encourage clinicians to use DN as a novel strategy for increasing muscle flexibility.
Landing Kinematics, Sports Performance, and Isokinetic Strength in Adolescent Male Volleyball Athletes: Influence of Core Training
Authors: Tsai Yi-Ju , Chia Chieh-Chie , Lee Pei-Yun , Lin Li-Chuan , Kuo Yi-Liang
Published: December 2018

Context: Core control and strength are important for reducing the risk of lower-extremity injury. Current evidence on the effect of core training in male adolescent athletes is limited, and other investigations into the effects of core training often emphasized core strength only. Objective: To examine whether core training emphasizing both control and strength of the trunk and hip would improve joint kinematics during landing, sports performance, and lower-extremity muscle strength in adolescent male volleyball athletes. Design: Single group pretest and posttest design. Setting: University laboratory. Participants: Sixteen male participants (age: 13.4 [1] y, height: 167.8 [8.6] cm, mass: 58.6 [13.9] kg, and volleyball experience: 3.8 [1.5] y) from a Division I volleyball team at a junior high school. Main Outcome Measurements: Kinematics of the trunk and lower-extremity during box landing and spike jump landing tasks, volleyball-related sports performance, and isokinetic strength of hip and knee muscles were assessed before and after a 6-week core training program. Results: After training, the participants demonstrated decreased trunk flexion angle (P = .01, Cohen’s d = 0.78) during the box landing task and reduced the maximum knee internal rotation angle (P = .04, Cohen’s d = 0.56) during the spike jump landing task. The average isokinetic strength of hip flexors and external rotators, and knee flexors and extensors also significantly increased (P = .001, Cohen’s d = 0.98; P = .04, Cohen’s d = 0.57; P = .02, Cohen’s d = 0.66; P = .003, Cohen’s d = 0.87, respectively); however, sports performance did not show significant changes. Conclusions: A more erect landing posture following training suggests that the core training program may be beneficial for improving core stability. The long-term effect of core training for knee injury prevention needs further investigation.
Dynamic and Static Assessment of Single-Leg Postural Control in Female Soccer Players
Authors: Meiners Kelly M. , Loudon Janice K.
Published: December 2018

Purpose/Background: Various methods are available for assessment of static and dynamic postural stability. The primary purpose of this study was to investigate the relationship between dynamic postural stability as measured by the Star Excursion Balance Test (SEBT) and static postural sway assessment as measured by the TechnoBody™ Pro-Kin in female soccer players. A secondary purpose was to determine side-to-side symmetry in this cohort. Methods: A total of 18 female soccer players completed testing on the SEBT and Technobody™ Pro-Kin balance device. Outcome measures were anterior, posterior medial, and posterior lateral reaches from the SEBT and center of pressure in the x- and y-axes as well as SD of movement in the forward/backward and medial/lateral directions from the force plate on left and right legs. Bivariate correlations were determined between the 8 measures. In addition, paired Wilcoxon signed-rank tests were performed to determine similarity between limb scores. Results: All measures on both the SEBT and postural sway assessment were significantly correlated when comparing dominant with nondominant lower-extremities with the exception of SD of movement in both x- and y-axes. When correlating results of the SEBT with postural sway assessment, a significant correlation was found between the SEBT right lower-extremity posterior lateral reach (r = .567, P < .05) and summed SEBT (r = .486, P < .05) and the center of pressure in the y-axis. A significant correlation was also found on the left lower-extremity, with SD of forward/backward movement and SEBT posterior medial reach (r = −.511, P < .05). Conclusions: Dynamic postural tests and static postural tests provide different information to the overall assessment of balance in female soccer players. Relationship between variables differed based on the subject’s lower-extremity dominance.
Pain Catastrophizing in College Athletes
Authors: Sciascia Aaron , Waldecker Jacob , Jacobs Cale
Published: December 2018

Background:Pain is the most common patient-reported symptom but the perception of pain is complex, differs between individuals and is not directly proportional to the extent of injury. The relationship between aberrant pain coping strategies such as pain catastrophizing and the presence of pain in competitive athletes should be further established to employ the most optimal treatment.Hypothesis:The hypotheses were that numeric pain rating and pain catastrophizing (Pain Catastrophizing Scale, PCS) scores would have a moderate to strong relationship in college athletes, and athletes with either a current injury or previous injury, or playing with pain, would have significantly higher pain catastrophizing scores compared with noninjured/nonpainful athletes.Study Design:Cross-sectional study.Level of Evidence:III.Methods:College athletes completed a demographic form, injury questionnaire, numeric pain rating, and the PCS. All athletes were medically cleared for sports participation at the time of survey completion. A total PCS score was calculated in addition to a rumination, magnification, and helplessness score. Spearman rank was utilized to measure the strength of relationship between the PCS score and pain rating.Results:A total of 291 athletes from 15 different sports completed the questionnaires (males: 156, females: 135; age: 19 [2] y). Negligible correlations existed between the PCS score and pain (r = .27). Athletes who were currently injured or previously injured had significantly higher PCS scores compared with uninjured athletes (P < .01).Conclusions:Approximately one-third of college athletes reported playing injured and/or with pain, but the relationship between pain rating and PCS score was negligible. The individualistic nature of pain perception and coping strategies would suggest that clinicians may want to consider screening for pain catastrophizing either prior to athletic participation or for athletes not following an expected recovery after injury in an effort to enhance individualized patient care.
Taping Benefits Ankle Joint Landing Kinematics in Subjects With Chronic Ankle Instability
Authors: De Ridder Roel , Willems Tine , Vanrenterghem Jos , Verrelst Ruth , De Blaiser Cedric , Roosen Philip
Published: December 2018

Context: Although taping has been proven effective in reducing ankle sprain events in individuals with chronic ankle instability, insight into the precise working mechanism remains limited. Objectives: To evaluate whether the use of taping changes ankle joint kinematics during a sagittal and frontal plane landing task in subjects with chronic ankle instability. Design: Repeated measure design. Setting: Laboratory setting. Participants: A total of 28 participants with chronic ankle instability performed a forward and side jump landing task in a nontaped and taped condition. The taping procedure consisted of a double “figure of 6” and a medial heel lock. Main Outcome Measures: 3D ankle joint kinematics was registered. Statistical parametric mapping was used to assess taping effect on mean ankle joint angles and angular velocity over the landing phase. Results: For both the forward and side jump, a less plantar flexed and a less inverted position of the ankle joint were found in the preparatory phase till around touchdown (TD) in the taped condition (P < .05). In addition, for both jump landing protocols, a decreased dorsiflexion angular velocity was found after TD (P < .05). During the side jump protocol, a brief period of increased inversion angular velocity was registered after TD (P < .05). Conclusions: Taping is capable of altering ankle joint kinematics prior to TD, placing the ankle joint in a less vulnerable position at TD.
Comparison of Pain Measures Between Tendons of Elite Basketball Players With Different Sonographic Patterns
Authors: Benítez-Martínez Josep C. , Martínez-Ramírez Pablo , Valera-Garrido Fermín , Casaña-Granell Jose , Medina-Mirapeix Francesc
Published: December 2018

Context: The prevalence and negative consequences of the symptoms surrounding patellar tendinopathy constitute an important problem for sports medicine professionals. The identification of potential pain mediators is, therefore, of major interest to improve both the prevention and management of this injury. Objective: To compare the pain experienced by elite male adult basketball players and patterns of patellar tendon abnormalities. Also, to identify whether structural and vascular sonographic abnormalities (focal area of hypoechogenicity, thickening, and neovascularization [NV]) are equal in determining pain perceptions. Design: An observational study with professional basketball teams (ACB—Spanish league). Participants: A total of 73 male basketball players (mean age 26.8 y). Main Outcome Measures: Patellar tendon ultrasonography images. Pain scores were compared between the identified patterns. Multiple regression analysis was used to examine the relative importance of abnormalities. Results: Of the 146 tendons, 91 had some degree of sonographic abnormality. Three main patterns were identified: I (1 structural abnormality without NV), II (2 structural abnormalities without NV), and III (2 structural abnormalities and NV). A total of 31 tendons (21.2%) exhibited pattern I, 46 (31.5%) presented pattern II, and 13 tendons (8.9%) exhibited pattern III. The mean visual analog scale and the Victorian Institute of Sport assessment questionnaire—patellar tendon (VISA-P) scores for pattern III were significantly different (P < .05) compared with patterns I and II; however, the pain pressure threshold (PPT) scores were not. NV was significantly associated with worsened scores for all pain measures; however, the focal area of hypoechogenicity was only associated with PPT scores. Conclusion: Patterns of sonographic abnormalities, including NV, demonstrated greater pain. Although NV determined scores for the visual analog scale, VISA-P, and PPT, the presence of focal area of hypoechogenicity on its own is a determining factor for the PPT. This study suggests that the combination of 2 or more sonographic abnormalities may help explain pain variations among basketball players.
Added Value of Xpert MTB/RIF Ultra for Diagnosis of Pulmonary Tuberculosis in a Low-Prevalence Setting
Authors: Opota Onya , Zakham Fathiah , Mazza-Stalder Jesica , Nicod Laurent , Greub Gilbert , Jaton Katia
Published: December 2018

Xpert MTB/RIF (Xpert) for direct molecular detection of
Mycobacterium tuberculosis
and rifampin resistance from clinical specimens has dramatically improved the diagnosis of tuberculosis (TB). Xpert MTB/RIF Ultra (Ultra) is proposed as a substitute of Xpert with increased sensitivity and improved rifampin resistance detection.
Vitamin E Increases Antimicrobial Sensitivity by Inhibiting Bacterial Lipocalin Antibiotic Binding
Authors: Naguib Marwa M. , Valvano Miguel A.
Published: December 2018

Bacteria exposed to stress mediated by sublethal antibiotic concentrations respond by adaptive mechanisms leading to an overall increase of antibiotic resistance. One of these mechanisms involves the release of bacterial proteins called lipocalins, which have the ability to sequester antibiotics in the extracellular space before they reach bacterial cells. We speculated that interfering with lipocalin-mediated antibiotic binding could enhance the efficacy of antibiotics to kill bacteria. In this work, we report that when combined with bactericidal antibiotics, vitamin E contributes to enhance bacterial killing both
in vitro
and
in vivo.
This adjuvant effect of vitamin E requires the presence of BcnA, a bacterial lipocalin produced by the cystic fibrosis pathogen
Burkholderia cenocepacia
. Since most bacteria produce lipocalins like BcnA, we propose that our findings could be translated into making novel antibiotic adjuvants to potentiate bacterial killing by existing antibiotics.
Metagenomic Discovery of 83 New Human Papillomavirus Types in Patients with Immunodeficiency
Authors: Pastrana Diana V. , Peretti Alberto , Welch Nicole L. , Borgogna Cinzia , Olivero Carlotta , Badolato Raffaele , Notarangelo Lucia D. , Gariglio Marisa , FitzGerald Peter C. , McIntosh Carl E. , Reeves Jesse , Starrett Gabriel J. , Bliskovsky Valery , Velez Daniel , Brownell Isaac , Yarchoan Robert , Wyvill Kathleen M. , Uldrick Thomas S. , Maldarelli Frank , Lisco Andrea , Sereti Irini , Gonzalez Christopher M. , Androphy Elliot J. , McBride Alison A. , Van Doorslaer Koenraad , Garcia Francisco , Dvoretzky Israel , Liu Joceline S. , Han Justin , Murphy Philip M. , McDermott David H. , Buck Christopher B.
Published: December 2018

Although some members of the viral family
Papillomaviridae
cause benign skin warts (papillomas), many human papillomavirus (HPV) infections are not associated with visible symptoms. For example, most healthy adults chronically shed
Gammapapillomavirus
(
Gamma
) virions from apparently healthy skin surfaces. To further explore the diversity of papillomaviruses, we performed viromic surveys on immunodeficient individuals suffering from florid skin warts. Our results nearly double the number of known
Gamma
HPV types and suggest that WHIM syndrome patients are uniquely susceptible to
Gamma
HPV-associated skin warts. Preliminary results suggest that treatment with the drug plerixafor may promote resolution of the unusual
Gamma
HPV skin warts observed in WHIM patients.
Flanking the fenestration: circumferential limb-to-limb stent-assisted coiling of a basilar artery fenestration aneurysm
Authors: Morrison Joseph , Alexander Matthew David , Dowd Christopher F , Cooke Daniel L
Published: December 2018

A man aged 61 years with a history of a ruptured basilar fenestration aneurysm underwent unassisted coiling in 1997 and repeat intervention for a recurrence at the aneurysm mouth in 2011. At repeat intervention, the decision was made to intentionally leave some filling at the base to preserve the parent vessels. Stent-assisted coil embolization, although technically feasible, was not pursued given the relative risks of the procedure. In 2017, the patient returned for repeat surveillance and further coil compaction was found at the aneurysm base. With the advent of more compliant woven stents deliverable through 0.017 microcatheters, stent-assisted coiling was possible. This case demonstrates hereto unseen agility afforded by novel low-profile stents allowing a circumferential approach to a basilar artery fenestration aneurysm and resultant limb-to-limb stent-assisted coiling. Techniques described here may be extended to more common anatomic variants that require stent-assisted coiling.
Death and readmissions after hospital discharge during the December holiday period: cohort study
Authors: Lapointe-Shaw Lauren , Austin Peter C , Ivers Noah M , Luo Jin , Redelmeier Donald A , Bell Chaim M
Published: December 2018

Objective

To determine whether patients discharged from hospital during the December holiday period have fewer outpatient follow-ups and higher rates of death or readmission than patients discharged at other times.

Design

Population based retrospective cohort study.

Setting

Acute care hospitals in Ontario, Canada, 1 April 2002 to 31 January 2016.

Participants

217 305 children and adults discharged home after an urgent admission, during the two week December holiday period, compared with 453 641 children and adults discharged during two control periods in late November and January.

Main outcome measures

The primary outcome was death or readmission, defined as a visit to an emergency department or urgent rehospitalisation, within 30 days. Secondary outcomes were death or readmission and outpatient follow-up with a physician within seven and 14 days after discharge. Multivariable logistic regression with generalised estimating equations was used to adjust for characteristics of patients, admissions, and hospital.

Results

217 305 (32.4%) patients discharged during the holiday period and 453 641 (67.6%) discharged during control periods had similar baseline characteristics and previous healthcare utilisation. Patients who were discharged during the holiday period were less likely to have follow-up with a physician within seven days (36.3%
v
47.8%, adjusted odds ratio 0.61, 95% confidence interval 0.60 to 0.62) and 14 days (59.5%
v
68.7%, 0.65, 0.64 to 0.66) after discharge. Patients discharged during the holiday period were also at higher risk of 30 day death or readmission (25.9%
v
24.7%, 1.09, 1.07 to 1.10). This relative increase was also seen at seven days (13.2%
v
11.7%, 1.16, 1.14 to 1.18) and 14 days (18.6%
v
17.0%, 1.14, 1.12 to 1.15). Per 100 000 patients, there were 2999 fewer follow-up appointments within 14 days, 26 excess deaths, 188 excess hospital admissions, and 483 excess emergency department visits attributable to hospital discharge during the holiday period.

Conclusions

Patients discharged from hospital during the December holiday period are less likely to have prompt outpatient follow-up and are at higher risk of death or readmission within 30 days.
Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period: randomised controlled trial
Authors: Mason Frances , Farley Amanda , Pallan Miranda , Sitch Alice , Easter Christina , Daley Amanda J
Published: December 2018

Objective

To test the effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period.

Design

Two group, double blinded randomised controlled trial.

Setting

Recruitment from workplaces, social media platforms, and schools pre-Christmas 2016 and 2017 in Birmingham, UK.

Participants

272 adults aged 18 years or more with a body mass index of 20 or more: 136 were randomised to a brief behavioural intervention and 136 to a leaflet on healthy living (comparator). Baseline assessments were conducted in November and December with follow-up assessments in January and February (4-8 weeks after baseline).

Interventions

The intervention aimed to increase restraint of eating and drinking through regular self weighing and recording of weight and reflection on weight trajectory; providing information on good weight management strategies over the Christmas period; and pictorial information on the physical activity calorie equivalent (PACE) of regularly consumed festive foods and drinks. The goal was to gain no more than 0.5 kg of baseline weight. The comparator group received a leaflet on healthy living.

Main outcome measures

The primary outcome was weight at follow-up. The primary analysis compared weight at follow-up between the intervention and comparator arms, adjusting for baseline weight and the stratification variable of attendance at a commercial weight loss programme. Secondary outcomes (recorded at follow-up) were: weight gain of 0.5 kg or less, self reported frequency of self weighing (at least twice weekly versus less than twice weekly), percentage body fat, and cognitive restraint of eating, emotional eating, and uncontrolled eating.

Results

Mean weight change was −0.13 kg (95% confidence interval −0.4 to 0.15) in the intervention group and 0.37 kg (0.12 to 0.62) in the comparator group. The adjusted mean difference in weight (intervention−comparator) was −0.49 kg (95% confidence interval −0.85 to −0.13, P=0.008). The odds ratio for gaining no more than 0.5 kg was non-significant (1.22, 95% confidence interval 0.74 to 2.00, P=0.44).

Conclusion

A brief behavioural intervention involving regular self weighing, weight management advice, and information about the amount of physical activity required to expend the calories in festive foods and drinks prevented weight gain over the Christmas holiday period.

Trial registration

ISRCTN Registry
ISRCTN15071781
.
The postoperative handover: a focus group interview study with nurse anaesthetists, anaesthesiologists and PACU nurses
Authors: Randmaa Maria , Engström Maria , Swenne Christine Leo , Mårtensson Gunilla
Published: December 2018

Objectives

To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.

Design

A focus group interview study with a descriptive design using qualitative content analysis of transcripts.

Setting

One anaesthetic clinic at two hospitals in Sweden.

Participants

Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).

Results

Patterns and five categories emerged: (1) having different temporal foci during handover, (2) insecurity when information is transferred from one team to another, (3) striving to ensure quality of the handover, (4) weighing the advantages and disadvantages of the bedside handover and (5) having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient but also that it could threaten the patient's privacy and that frequent interruptions could be disturbing.

Conclusions

The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimise the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision makers need to pay attention to the environment and infrastructure in postanaesthesia care.
Associations between highly active antiretroviral therapy and the presence of HPV, premalignant and malignant cervical lesions in sub-Saharan Africa, a systematic review: current evidence and directions for future research
Authors: Menon Sonia , Rossi Rodolfo , Zdraveska Natasha , Kariisa Mbabazi , Acharya Sushama D , Vanden Broeck Davy , Callens Steven
Published: December 2018

Objectives

In sub-Saharan Africa, substantial international funding along with evidence-based clinical practice have resulted in an unparalleled scale-up of access to antiretroviral treatment at a higher CD4 count. The role and timing of highly active antiretroviral therapy (HAART) in mediating cervical disease remains unclear. The aim of this article is to systematically review all evidence pertaining to Africa and identify research gaps regarding the epidemiological association between HAART use and the presence of premalignant/malignant cervical lesions.

Method

Five databases were searched until January 2017 to retrieve relevant literature from sub-Saharan Africa. Publications were included if they addressed prevalence, incidence or clearance of human papillomavirus (HPV) infection in women undergoing HAART as well as cytological or histological neoplastic abnormalities.

Results

22 studies were included, of which seven were prospective studies. Women receiving HAART are less likely to develop squamous intraepithelial lesions (SILs). There is evidence that duration of HAART along with the CD4 count may reduce the prevalence of high-risk HPV (HR-HPV), suggesting that without HAART, severe immunosuppression increases the risk of becoming or remaining infected with HR-HPV. Furthermore, according to existent literature, the CD4 count, rather than HAART coverage or its duration, plays a central role in the prevalence of cervical intraepithelial neoplasia (CIN) 2 and CIN 3.

Conclusion

Our findings suggest a positive impact of HAART duration, in conjunction and interaction with CD4 count, on reducing the prevalence of HR-HPV. The greatest treatment effect might be seen among women starting at the lowest CD4 count, which may have a more instrumental role in cervical oncogenesis than either HAART use or the treatment duration on the prevalence of CIN 2 and CIN 3. There is still insufficient evidence to show a clear association between HAART coverage and the incidence of invasive cervical cancer. Enhanced surveillance on the impact of HAART treatment is crucial.
Electroacupuncture to alleviate postoperative pain after a laparoscopic appendectomy: study protocol for a three-arm, randomised, controlled trial
Authors: Lee Seunghoon , Nam Dongwoo , Kwon Minsoo , Park Won Seo , Park Sun Jin
Published: December 2018

Background

The purpose of this study is to evaluate the efficacy and safety of electroacupuncture (EA) for postoperative pain after laparoscopic appendectomy compared with sham electroacupuncture (SEA) and no acupuncture treatment.

Methods and analysis

This study is a protocol for a three-arm, randomised, patient-assessor-blinded (to the type of acupuncture treatment), controlled, parallel trial. 138 participants diagnosed with appendicitis and scheduled for laparoscopic appendectomy will be randomly assigned to the EA group (n=46), SEA group (n=46) or control group (n=46). The EA group will receive acupuncture treatment at both regional and distal acupuncture points with electrostimulation. The SEA group will receive sham acupuncture treatment with mock electrostimulation. Both EA and SEA groups will receive a total of four treatments 1 hour preoperative, 1 hour postoperative and during the morning and afternoon the day after surgery with the same routine postoperative pain control. The control group will receive only routine postoperative pain control. The primary outcome is the 11-point Pain Intensity Numerical Rating Scale (PI-NRS) at 24 hours after surgery. The secondary outcomes are the PI-NRS, analgesic consumption, opioid-related side effects, time to first passing flatus, quality of life and adverse events evaluated 6, 12, 24 and 36 hours and 7 days after surgery.

Ethics and dissemination

The study was planned in accordance with the Helsinki Declaration and the Korean Good Clinical Practice Guidelines to protect the participants and was approved by the institutional review board (IRB) of Kyung Hee University Medical Center (KMC IRB-1427–02). The results will be disseminated in peer-reviewed journals and presented at international conferences.

Trial registration number

Clinical Research Information Service (KCT0001328).
Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain
Authors: Toomey Elaine , Matthews James , Hurley Deirdre A
Published: December 2018

Objectives and design

Despite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent/triangulation design.

Setting

Feasibility trial of the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention (ISRCTN49875385), delivered in primary care physiotherapy.

Methods and outcomes

60 SOLAS sessions were delivered across seven sites by nine physiotherapists. Fidelity of delivery of prespecified intervention components was evaluated using (1) audio-recordings (n=60), direct observations (n=24) and self-report checklists (n=60) and (2) individual interviews with physiotherapists (n=9). Quantitatively, fidelity scores were calculated using percentage means and SD of components delivered. Associations between fidelity scores and physiotherapist variables were analysed using Spearman's correlations. Interviews were analysed using thematic analysis to explore potential reasons for fidelity scores. Integration of quantitative and qualitative data occurred at an interpretation level using triangulation.

Results

Quantitatively, fidelity scores were high for all assessment methods; with self-report (92.7%) consistently higher than direct observations (82.7%) or audio-recordings (81.7%). There was significant variation between physiotherapists’ individual scores (69.8% - 100%). Both qualitative and quantitative data (from physiotherapist variables) found that physiotherapists’ knowledge (Spearman's association at p=0.003) and previous experience (p=0.008) were factors that influenced their fidelity. The qualitative data also postulated participant-level (eg, individual needs) and programme-level factors (eg, resources) as additional elements that influenced fidelity.

Conclusion

The intervention was delivered with high fidelity. This study contributes to the limited evidence regarding fidelity assessment methods within complex behaviour change interventions. The findings suggest a combination of quantitative methods is suitable for the assessment of fidelity of delivery. A mixed methods approach provided a more insightful understanding of fidelity and its influencing factors.

Trial registration number

ISRCTN49875385; Pre-results.
Protocol for validation of the 4AT, a rapid screening tool for delirium: a multicentre prospective diagnostic test accuracy study
Authors: Shenkin Susan D , Fox Christopher , Godfrey Mary , Siddiqi Najma , Goodacre Steve , Young John , Anand Atul , Gray Alasdair , Smith Joel , Ryan Tracy , Hanley Janet , MacRaild Allan , Steven Jill , Black Polly L , Boyd Julia , Weir Christopher J , MacLullich Alasdair MJ
Published: December 2018

Introduction

Delirium is a severe neuropsychiatric syndrome of rapid onset, commonly precipitated by acute illness. It is common in older people in the emergency department (ED) and acute hospital, but greatly under-recognised in these and other settings. Delirium and other forms of cognitive impairment, particularly dementia, commonly coexist. There is a need for a rapid delirium screening tool that can be administered by a range of professional-level healthcare staff to patients with sensory or functional impairments in a busy clinical environment, which also incorporates general cognitive assessment. We developed the 4 ’A’s Test (4AT) for this purpose. This study’s primary objective is to validate the 4AT against a reference standard. Secondary objectives include (1) comparing the 4AT with another widely used test (the Confusion Assessment Method (CAM)); (2) determining if the 4AT is sensitive to general cognitive impairment; (3) assessing if 4AT scores predict outcomes, including (4) a health economic analysis.

Methods and analysis

900 patients aged 70 or over in EDs or acute general medical wards will be recruited in three sites (Edinburgh, Bradford and Sheffield) over 18 months. Each patient will undergo a reference standard delirium assessment and will be randomised to assessment with either the 4AT or the CAM. At 12 weeks, outcomes (length of stay, institutionalisation and mortality) and resource utilisation will be collected by a questionnaire and via the electronic patient record.

Ethics and dissemination

Ethical approval was granted in Scotland and England. The study involves administering tests commonly used in clinical practice. The main ethical issues are the essential recruitment of people without capacity. Dissemination is planned via publication in high impact journals, presentation at conferences, social media and the websitewww.the4AT.com.

Trial registration number

ISRCTN53388093; Pre-results.
Paediatric asthma control under a community management model in China: a protocol for a prospective multicentre cohort study
Authors: Xu Juan , Yin Yong , Zhang Hao , Zhong Wen Wei , Zhang Lei , Zhang Jing , Yuan Shu Hua , Zhang Fen , Zhao Li Xia
Published: December 2018

Introduction

Childhood asthma is globally one of the most common respiratory disorders and accounts for more school absences and more hospitalizations than any other chronic illness. The worldwide economic burden of this disease exceeds those of HIV/AIDS and tuberculosis combined. Proper intervention and effective management is of paramount importance for the control and prognosis of paediatric asthma. Unfortunately, the rate of uncontrolled and partially controlled paediatric asthma in China is >90%. This study will use a new management model to investigate the status of asthma control and the adherence of patients to a medication protocol.

Methods

This prospective, multicentre, observational study will be conducted at 15 hospitals on children (n=800) diagnosed with asthma. Each patient will be assigned to either the nearest community hospital or Shanghai Children's Medical Center, whichever is closer to the patient's home, according to the decision of parents. Participants were divided into two groups: tertiary care hospital (Shanghai Children's Medical Center) follow-up group and community hospital follow-up group. The primary outcome will be the difference in the proportion of controlled, partially controlled and uncontrolled asthma among the two groups. Secondary outcomes will be the differences in adherence rate, lung function, exacerbations, growth development, total asthma-related unscheduled visits, days absent from school and loss of working days for the patient's caregiver. Data will be analysed on an intention-to-treat and a per-protocol basis.

Ethics and dissemination

Ethics approval was obtained from the Institutional Review Board of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University of Medicine. We plan to publish the results of this study in a peer-reviewed journal article.
Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research
Authors: Robertshaw Luke , Dhesi Surindar , Jones Laura L
Published: December 2018

Objectives

To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries.

Design

Systematic review and qualitative thematic synthesis.

Methods

Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs.

Results

Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes.

Conclusions

A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group.
A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol
Authors: Bello Aminu K , Ronksley Paul E , Tangri Navdeep , Singer Alexander , Grill Allan , Nitsch Dorothea , Queenan John A , Lindeman Cliff , Soos Boglarka , Freiheit Elizabeth , Tuot Delphine , Mangin Dee , Drummond Neil
Published: December 2018

Introduction

Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery.

Methods and analysis

The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients’ demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3–5 will be presented as age–sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age–sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods.

Ethics and dissemination

The CPCSSN is committed to high ethical standards when dealing with individual data collected, and this work is reviewed and approved by the Network Scientific Committee. The results will be published in peer-reviewed journals and presented at relevant national and international scientific meetings.
Observational study of vascular dementia in the Spanish elderly population according to type 2 diabetes status: trends in incidence, characteristics and outcomes (2004-2013)
Authors: Muñoz-Rivas Nuria , Méndez-Bailón Manuel , Miguel-Yanes José M de , Hernández-Barrera Valentín , Miguel-Díez Javier de , Jimenez-Garcia Rodrigo , López-de-Andrés Ana
Published: December 2018

Objectives

To examine trends overtime in the incidence and in-hospital outcomes of vascular dementia (VaD) hospitalisations in patients aged 70 years or over suffering and not suffering from type 2 diabetes mellitus (T2DM) between 2004 and 2013 in Spain.

Design

Retrospective study.

Setting

Spain.

Participants

National hospital discharge data were used; patients aged ≥70, discharged from a hospital with VaD as a primary diagnosis, were selected.

Main outcome measures

Overall incidence, therapeutic and diagnostic procedures, comorbidities, infectious complications, duration of hospital stays and in-hospital mortality (IHM).

Results

In total, 170 607 admissions for VaD (34.3% with T2DM) were identified. We found a significant upward linear trend in the incidence of VaD for men and women with and without diabetes between 2004 and 2013. The adjusted incidence was higher among people with T2DM over the study period. We found a higher incidence in men than women in all years under study. A positive association between T2DM and VaD hospitalisation was found among both men (IRR 2.14, 95% CI 2.11 to 2.16) and women (incidence rate ratio (IRR) 2.22; 95% CI 2.19 to 2.25). Pneumonia was significantly associated with a higher mortality (OR 2.59, 95% CI 2.52 to 2.67). We found that percutaneous endoscopic gastrostomy was associated with lower IHM (OR 0.37, 95% CI 0.31 to 0.45), while parenteral nutrition had the opposite effect (OR 1.29, 95% CI 1.18 to 1.41). There was no association between diabetes and higher IHM (OR 0.99, 95% CI 0.93 to 1.06). The time-trend analyses of the entire sample showed a significant reduction in mortality in patients with VaD (OR 0.98, 95% CI 0.97 to 0.99).

Conclusions

Incidence rates for VaD hospitalisations were twice as high in patients with diabetes compared with those without. Men had significantly higher incidence rates than women, regardless of diabetes status. In both groups studied, pneumonia and parenteral nutrition were associated with mortality while percutaneous endoscopic gastrostomy was associated with survival. Having diabetes was not associated with higher IHM after hospitalisation with VaD.
Rethinking exercise identity: a qualitative study of physically inactive cancer patients’ transforming process while undergoing chemotherapy
Authors: Adamsen Lis , Andersen Christina , Lillelund Christian , Bloomquist Kira , Møller Tom
Published: December 2018

Objective

To explore physically inactive breast and colon cancer patients’ prediagnosis exercise history and attitudes to physical activity (PA) and experiences in initiating PA while undergoing adjuvant chemotherapy.

Design

An explorative qualitative study guided the interpretive analysis of semistructured, open-ended interviews conducted at initiation of chemotherapy and after 12 weeks. The study was embedded in a pilot randomised controlled trial.

Setting

Participants were recruited from the Oncological Department at a hospital in Copenhagen, Denmark.

Participants

33 patients with cancer, median age 49 years: 25 patients with breast cancer and 8 with colon cancer, 72% with a low cardiac respiratory fitness level and the majority with a high level of education. Patients received adjuvant chemotherapy, oncologist’s PA recommendation and exercise, cancer nurse specialist’s counselling prior to allocation to PA interventions or waitlist control group.

Results

Prediagnosis exercise had been excluded from patients’ daily lives due to perceptions of exercise as boring, lack of discipline and stressful work conditions for both genders. Recommendations from oncologists and nurses inspired the patients to reconsider their attitudes and behaviour by accepting recruitment and participation in PA interventions during chemotherapy. Despite extensive side effects, most patients adhered to their PA commitment due to their perception of the bodily, emotional and social benefits and support of healthcare professionals, peers and family.

Conclusion

The patients’ attitude towards exercise transformed from having no priority in patients’ daily lives prediagnosis to being highly prioritised. This study identified four important phases in the exercise transformation process during the patients’ treatment trajectory of relevance to clinicians in identifying, motivating and supporting physically inactive patients with cancer at long-term risk. Clinicians should address young, highly educated patients with cancer at onset of adjuvant chemotherapy due to their specific risk of a sedentary lifestyle resulting from being in stressful, ambitious careers.

Trial registration number

Current Controlled Trials (ISRCTN24901641), Stage: Qualitative results.