bluuebunny/crossref_metadata_2025 huggingface dataset:
Aerodynamic Performance of Turbine Center Frames With Purge Flows—Part II: The Influence of Individual Hub and Tip Purge Flows
Authors: Zerobin Stefan , Aldrian Christian , Peters Andreas , Heitmeir Franz , Göttlich Emil
Published: March 2018

The aerodynamic behavior of turbine center frame (TCF) ducts under the presence of high-pressure turbine (HPT) purge flows was experimentally investigated in this two-part paper. While the first part of the paper demonstrated the impact of varying the purge flow rates (PFR) on the loss behavior of two different TCF designs, the second part concentrates on the influence of individual hub and tip purge flows on the main flow evolution and loss generation mechanisms through the TCF ducts. Therefore, measurements were conducted at six different operating conditions in a one and a half stage turbine test setup, featuring four individual purge flows injected through the hub and tip, forward and aft cavities of the HPT rotor. The outcomes of this first-time assessment indicate that a HPT purge flow reduction generally benefits TCF performance. Decreasing one of the rotor case PFRs leads to an improved duct pressure loss. The purge flows from the rotor aft hub and tip cavities are demonstrated to play a particularly important role for improving the duct aerodynamic behavior. In contrast, the forward rotor hub purge flow actually stabilizes the flow in the TCF duct and reducing this purge flow can penalize TCF performance. These particular HPT/TCF interactions should be taken into account whenever high-pressure turbine purge flow reductions are pursued.
Nonproprietary Flow-Induced Vibration Analysis of San Onofre Nuclear Generating Station Replacement Steam Generators to ASME Code Section III Appendix N
Authors: Blevins R. D.
Published: March 2018

Flow-induced vibration analysis of the San Onofre Nuclear Generating Station (SONGS) replacement steam generators (RSG) is made using nonproprietary public data for these steam generators on the Nuclear Regulatory Commission public web site (www.NRC.gov). The analysis uses the methodology of Appendix N Section III of the ASME Boiler and Pressure Vessel Code, Subarticle N-1300 Flow-Induced Vibration of Tubes and Tube Banks. First, the tube geometry is assembled, and overall flow and performance parameters are developed at 100% design flow; then, the analysis is made to determine the flow velocity in the gap between tubes and tube natural frequencies and mode shapes. Finally, the mass damping and reduced velocity for tubes on the U bend are assembled and plotted on the ASME code Figure N-11331-4 fluid elastic stability diagram.
Effect of Char Structure Evolution During Pyrolysis on Combustion Characteristics and Kinetics of Waste Biomass
Authors: Yin Yanshan , Yin Jie , Zhang Wei , Tian Hong , Hu Zhangmao , Ruan Min , Song Ziyou , Liu Liang
Published: March 2018

Two waste biomass materials, pine needle (PN) and corn stalk (CS), were pyrolyzed at different temperatures (200–900 °C). The organic functional groups and carbonaceous structure of the biomass chars were characterized by Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy, respectively. The combustion characteristics and kinetics of biomass chars were investigated by thermogravimetric analysis (TGA). The content of carbon-, hydrogen-, and oxygen-containing functional groups in the biomass samples decreases with an increase in preparation temperature, leading to more aromatic macromolecular structure at elevated pyrolysis temperatures. With increasing pyrolysis temperature, the comprehensive combustibility index (S) of both chars related to combustion reactivity generally decreases especially for CS char because of the loss of active groups. However, the Raman spectra show that the degree of order decreases with increasing pyrolysis temperature from 400 to 700 °C because of the generation of isolated sp2 carbon.
Derivation of Wave Mode Orthogonality From Reciprocity in Direct Notation
Authors: Pau Annamaria
Published: March 2018

The purpose of this brief note is to present an alternative way of deriving the orthogonality relations for wave modes, by approaching the reciprocity relationship in direct notation, with the tools provided by tensor algebra and analysis. In this way, the classical result of elastodynamics is obtained through the instruments of continuum mechanics.
Acoustic Response of Multiple Shallow Cavities and Prediction of Self-Excited Acoustic Oscillations
Authors: Shaaban Ayman A. , Ziada Samir
Published: March 2018

Self-sustaining oscillations of flow over ducted cavities and in corrugated pipes are a known source of tonal noise and excessive vibration in industrial applications. Corrugated pipes can be modeled as a series of axisymmetric cavities. In the current study, the aero-acoustic sources generated by one-, two-, and three-cavity configurations have been experimentally investigated by means of the standing wave method (SWM) for a wide range of Strouhal numbers and acoustic excitation levels. The source strength is found to increase in a nonlinear manner with increasing the number of cavities. Moreover, the self-excited acoustic resonances of the same cavity combinations are investigated. The source characteristics are compared with the observed lock-in range from the self-excited experiments. A prediction model is also developed to utilize the measured source characteristics for estimating the amplitude of the cavities self-sustained oscillations. The self-excited experimental data are used to assess the effect of acoustic absorption at the cavity edges. This absorption is found to be substantial and must be accounted for in the prediction model. When the model is supplemented with appropriate loss coefficients, it predicts fairly well the pulsation amplitude within the resonance lock-in range of the studied multiple cavity configurations.
The Varying Compliance Resonance in a Ball Bearing Rotor System Affected by Different Ball Numbers and Rotor Eccentricities
Authors: Yang Rui , Hou Lei , Jin Yulin , Chen Yushu , Zhang Zhiyong
Published: March 2018

The varying compliance (VC) vibration directly reflects the oscillation intensity of a rolling bearing, and it can be fully revealed in the VC resonance. Moreover, we define the bearing vibration intensity as the bearing vibration information in this paper. Besides the rolling element number of the bearing, the rotor eccentricity is also an inevitable influencing factor for the VC vibration. This paper focuses on the VC resonance characteristics in a ball bearing rotor system. An analytical model is established, and the vibration responses of the system are calculated in a large speed range with the consideration of different ball numbers and different rotor eccentricities. The theoretical results show that the VC vibration is clearer in low-speed range where the VC resonance exist, while it is suppressed in high-speed range. In general, the intensity of the VC resonance decreases with the increase of ball numbers and is not sensible to the rotor eccentricities in low-speed range. Finally, a ball bearing rotor experiment system is setup, the VC resonance is clearly detected, and the high-quality bearing vibration information is obtained. The experimental results qualitatively agree with the theoretical results.
Draft Genome Sequences of Endophytic Isolates of Klebsiella variicola and Klebsiella pneumoniae Obtained from the Same Sugarcane Plant
Authors: Reyna-Flores Fernando , Barrios-Camacho Humberto , Dantán-González Edgar , Ramírez-Trujillo José Augusto , Lozano Aguirre Beltrán Luis Fernando , Rodríguez-Medina Nadia , Garza-Ramos Ulises , Suárez-Rodríguez Ramón
Published: March 2018

Endophytic
Klebsiella variicola
KvMx2 and
Klebsiella pneumoniae
KpMx1 isolates obtained from the same sugarcane stem were used for whole-genome sequencing. The genomes revealed clear differences in essential genes for plant growth, development, and detoxification, as well as nitrogen fixation, catalases, cellulases, and shared virulence factors described in the
K. pneumoniae
pathogen.
Effect of Acupuncture on the Tlr2/4-Nf-κB Signalling Pathway in a Rat Model of Traumatic Brain Injury
Authors: Lin Shu-jun , Cao Lu-xi , Cheng Shao-bing , Dai Qiu-fu , Lin Ji-huan , Pu Liu , Chen Wei-hao , Zhang Yu-juan , Chen Shu-lian , Zhang Yi-min
Published: March 2018

Objective

To study the effect of acupuncture on the TLR2/4-NF-κB signalling pathway in the cortex of Sprague-Dawley rats following traumatic brain injury (TBI), and investigate the possible mechanism underlying the effects of acupuncture on scar repair.

Methods

TBI was established using Feeney's free-falling epidural percussion model. In total, 108 rats were randomly divided into a normal group (n=18), untreated TBI model group (TBI group, n=36) and manual acupuncture-treated TBI group (TBI+MA, n=36). Each group of rats was subdivided into three time groups: 3-day (3d), 7-day (7d) and 14-day (14d). No treatment was given to rats in the normal and TBI groups. The TBI+MA group received manual acupuncture at GV20, GV26, GV16 through GV15, and bilateral LI4. mRNA expression of TLR2, TLR4, NF-κB and protein in the rat cortices was quantified using real-time fluorescence quantitative polymerase chain reaction (qPCR) and Western blot analyses.

Results

The modified neurological severity score (mNSS) scores of the TBI+MA group were improved compared with baseline scores 12 hours after modelling, and improved at 7d and 14d compared with the TBI group (P<0.05), while the score of the TBI group did not improve until 14d compared to baseline. mRNA and protein expression of TLR2, TLR4 and NF-κB in the TBI group were higher than the normal group at 3d (P<0.05), reached a peak at 7d, then began to decrease at 14d. mRNA and protein expression of TLR2, TLR4 and NF-κB were higher in the TBI+MA group compared with the TBI group at 3d (P<0.05), were significantly down-regulated at 7d (P<0.01), and decreased to normal levels at 14d.

Conclusions

Acupuncture has a bidirectional regulatory effect on the TLR2/4-NF-κB signalling pathway-related genes TLR2, TLR4 and NF-κB in the TBI rat cortex, promoting their expression in the early stage and inhibiting it in the later stage.
How to use… a blood film
Authors: McNaughten Ben , Thompson Anthony , Macartney Christine , Thompson Andrew
Published: March 2018

The diagnostic relevance of the blood film cannot be underestimated in the assessment of children with suspected primary or secondary haematological conditions. The blood film not only serves as a diagnostic tool but also allows for screening, monitoring of disease progression and therapeutic response in children with a variety of haematological conditions. This article outlines the appearance of normal paediatric and neonatal blood films. The technical aspects involved in preparing a blood film are discussed. Consideration is given to the indications for preparing a blood film and some of the limitations of blood films. Finally, attempts are made to highlight the role of the blood film in the diagnosis of some common paediatric and neonatal conditions.
Detection of exhaled carbon dioxide following intubation during resuscitation at delivery
Authors: Hunt Katie A , Yamada Yosuke , Murthy Vadivelam , Srihari Bhat Prashanth , Campbell Morag , Fox Grenville F , Milner Anthony D , Greenough Anne
Published: March 2018

Objectives

End tidal carbon dioxide (ETCO2) monitoring can facilitate identification of successful intubation. The aims of this study were to determine the time to detect ETCO2following intubation during resuscitation of infants born prematurely and whether it differed according to maturity at birth or the Apgar scores (as a measure of the infant’s condition after birth).

Design

Analysis of recordings of respiratory function monitoring.

Setting

Two tertiary perinatal centres.

Patients

Sixty-four infants, with median gestational age of 27 (range 23–34)weeks.

Interventions

Respiratory function monitoring during resuscitation in the delivery suite.

Main outcome measures

The time following intubation for ETCO2levels to be initially detected and to reach 4 mm Hg and 15 mm Hg.

Results

The median time for initial detection of ETCO2following intubation was 3.7 (range 0–44) s, which was significantly shorter than the median time for ETCO2to reach 4 mm Hg (5.3 (range 0–727) s) and to reach 15 mm Hg (8.1 (range 0–827) s) (both P<0.001). There were significant correlations between the time for ETCO2to reach 4 mm Hg (r=−0.44, P>0.001) and 15 mm Hg (r=−0.48, P<0.001) and gestational age but not with the Apgar scores.

Conclusions

The time for ETCO2to be detected following intubation in the delivery suite is variable emphasising the importance of using clinical indicators to assess correct endotracheal tube position in addition to ETCO2monitoring. Capnography is likely to detect ETCO2faster than colorimetric devices.
Eleven years of retinopathy of prematurity in one neonatal intensive care unit in Jakarta, Indonesia
Authors: Siswanto J Edy , Widodo Nani H , Sauer Pieter J J
Published: March 2018

Background

Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data on the incidence of ROP in Indonesia, in relation to birth weight (BW) and gestational age (GA), are limited.

Objective

To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia.

Methods

We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened.

Results

In 2005–2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000–1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1–2 and 10 (17%) showed ROP 3–5. In the 1000–1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1–2 and nine (4%) with ROP 3–5. Twenty-two (13%) of the 163 screened infants weighing 1500–2000 g showed ROP 1–2 and two (1.2%) had ROP 3–5. Eight (18%) of the 44 screened infants born with a BW of more than 2000 g showed ROP 1–2 and none showed ROP 3–5.

Conclusion

The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000–1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a BW of 1500–2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.
Reliability of anthropometric measurements in children with special needs
Authors: Hardy Jane , Kuter Hayley , Campbell Malcolm , Canoy Dexter
Published: March 2018

Objective

To determine the reliability of anthropometric and body composition measurements in children with special needs.

Design

Observational study.

Setting

Specialist support schools (primary and secondary) in Manchester, UK.

Participants

53 children with moderate-to-severe learning disability; 30 non-standers (14 boys) and 23 standers (15 boys). Mean ages were 11 years (range 3–20) for non-standers and 12.4 years (range 8–19) for standers.

Measures

Anthropometric measures included: height/length, segmental measures, weight, skinfolds, body circumferences and body composition estimated from bioelectrical impedance analysis (BIA). These were measured twice, 2–4 weeks apart.

Main outcome measures

Reliability was assessed using the technical error of measurement (TEM).

Results

The TEM for height and supine length was 0.55 cm for standers and 2.47 cm for non-standers, respectively. For non-standers, the TEMs for knee height and tibial length were 0.81 and 1.57 cm, respectively. The TEM for weight was 0.55 kg for standers and 0.75 kg for non-standers. For skinfold thickness, the TEM was smaller for non-standers than standers. The TEM for mid-upper arm circumference for standers and non-standers was 0.91 and 0.82 cm, respectively. The TEM for BIA in standers and non-standers was 34.7 and 54.1 Ω, respectively. Some measurements, including waist circumferences, were difficult to obtain reliably.

Conclusions

Anthropometric and body composition measurements were feasible to obtain in children with special needs. However, the reliability of these measures differs between non-standers and standers and should be considered when choosing appropriate measures.
Case of hepatic flexure ectopic pregnancy medically managed with methotrexate
Authors: Trail Charlotte Elizabeth , Watson Andrew , Schofield Alice Martha
Published: March 2018

Abdominal pregnancies represent 1.4% of extrauterine pregnancies. A literature search of six cases involving bowel ectopic pregnancies provided anecdotal treatment options. This case involves a woman admitted at 6 weeks gestation with right iliac fossa and shoulder tip pain. An ultrasound scan revealed an empty uterus with free fluid in both adnexa and a 31×21 mm heterogenous mass adjacent to the right ovary. At laparoscopy, an ectopic pregnancy was identified at the hepatic flexure. The patient received two doses of methotrexate and monitored until the beta human chorionic gonadotropin reduced. The decision to manage with methotrexate was balanced against reported cases of bowel perforation and the possibility that a section of bowel may need removal if the pregnancy showed signs of invasion. Maternal mortality rate with abdominal pregnancy is 20% due to the risk of massive haemorrhage from placental separation or invasion of bowel vasculature. Medical treatment here was successful and avoided extensive surgery.
Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients
Authors: King Enda , Franklyn-Miller Andrew , Richter Chris , O’Reilly Eamon , Doolan Mark , Moran Kieran , Strike Siobhan , Falvey Éanna
Published: March 2018

Background

Clinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.

Objective

To examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.

Methods

Two hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110°cutting manoeuvre.

Results

Following rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6–1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49–0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted.

Conclusions

Rehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.
Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up
Authors: Øiestad Britt Elin , Holm Inger , Risberg May Arna
Published: March 2018

Objectives

To examine the associations between return to pivoting sport following ACL reconstruction (ACLR) and knee osteoarthritis (OA), and self-reported knee symptoms, function and quality of life after 15 years.

Methods

Study sample included 258 participants with ACLR 15 years previously. Return to pivoting sport (handball, soccer and basketball) data were collected by interviews, and symptomatic OA was defined as Kellgren and Lawrence grade ≥2 plus almost daily knee pain in the last month. Self-reported symptoms, function and quality of life were assessed with the Knee Injury and Osteoarthritis Outcome Score. Adjusted regression models were used to analyse the associations between return to pivoting sport and OA (present or not), and self-reported outcomes. P values ≤0.05 were considered statistically significant.

Results

Two hundred and ten (81%) participants (57% men) with a mean age of 39.1 (±8.7) years completed the 15-year follow-up, and 109 (52%) had returned to pivoting sport. Returning to pivoting sport was associated with less symptomatic OA (OR 0.28, 95% CI 0.09 to 0.89) and radiographic OA (OR 0.40, 95% CI 0.17 to 0.98), adjusted for age, sex, combined injury, self-reported knee function, and time between injury and surgery. Those who returned to pivoting sport had better function in activities of daily living (ADL).

Conclusion

The participants with ACLR who returned to pivoting sport had lower odds of knee OA and better self-reported ADL function. Further investigation is required to understand the clinical significance of these findings.
Ability of postoperative delirium to predict intermediate-term postoperative cognitive function in patients undergoing elective surgery at an academic medical centre: protocol for a prospective cohort study
Authors: Aranake-Chrisinger Amrita , Cheng Jenny Zhao , Muench Maxwell R , Tang Rose , Mickle Angela , Maybrier Hannah , Lin Nan , Wildes Troy , Lenze Eric , Avidan Michael Simon
Published: March 2018

Introduction

Postoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery. Our central hypothesis is that patients with POD are more likely to have declines in cognition and quality of life 1 year after surgery compared with patients without POD. We aim to clarify whether these associations are independent of potentially confounding factors. We will also explore the association between POD and incident dementia.

Methods and analysis

This study will recruit 200 patients from the ongoing Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study. Patients who live ≤45 miles from the study centre or have a planned visit to the centre 10–16 months postoperatively will be eligible. Patients with POD, measured by the Confusion Assessment Method, will be compared with patients without delirium. The primary outcome of cognitive function and secondary outcomes of quality of life and incident dementia will be compared between cohorts. Cognition will be measured by Trails A and B and Stroop Color and Word Test, quality of life with Veteran’s RAND 12-item Health Survey and incident dementia with the Short Blessed Test. Multivariable regression analyses and a Cox proportional hazards analysis will be performed. All results will be reported with 95% CIs and α=0.05.

Ethics and dissemination

The study has been approved by the Washington University in St. Louis Institutional Review Board (IRB no 201601099). Plans for dissemination include scientific publications and presentations at scientific conferences.

Trial registration number

NCT02241655.
Prevalence and causes of visual impairment amongst older adults in a rural area of North India: a cross-sectional study
Authors: Malhotra Sumit , Vashist Praveen , Kalaivani Mani , Gupta Noopur , Senjam Suraj Singh , Rath Ramashankar , Gupta Sanjeev Kumar
Published: March 2018

Objectives

To determine the prevalence, causes and associated factors for visual impairment (VI) in rural population of Jhajjar district, Haryana, north India.

Methods

A community-based, cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 50 years and above were selected using compact segment cluster sampling approach. Presenting visual acuity using LogMAR E chart was measured along with collection of other demographic details as part of the house-to-house survey. Subjective refraction and torch light examination were performed at a clinic site within the village to ascertain VI and its cause. VI was considered when presenting visual acuity was less than 6/18 in the better eye. Common causes of VI viz uncorrected refractive errors, cataract, central corneal opacity and others were noted by optometrists. Descriptive analysis was undertaken. Multivariate logistic regression analysis was performed for determining associated factors with VI.

Results

Out of 2025 enumerated adults, 1690 (83.5%) were examined at the household level and 1575 (78%) completed all study procedures. The prevalence of VI was found to be 24.5% (95% CI 21.1 to 26.3) and blindness was 5% (95% CI 3.9 to 6.1). The most common causes of VI were uncorrected refractive errors (50%) and cataract (37%). The VI in study participants was found to be associated with age, gender, marital and educational status.

Conclusions

VI is still a public health problem in rural population of Jhajjar district, Haryana. Provision of spectacles and cataract surgical services are simple interventions to address this issue.
Protocol for a pragmatic randomised controlled trial of Body Brain Life—General Practice and a Lifestyle Modification Programme to decrease dementia risk exposure in a primary care setting
Authors: Kim Sarang , McMaster Mitchell , Torres Susan , Cox Kay L , Lautenschlager Nicola , Rebok George W , Pond Dimity , D’Este Catherine , McRae Ian , Cherbuin Nicolas , Anstey Kaarin J
Published: March 2018

Introduction

It has been estimated that a 10%–25% reduction in seven key risk factors could potentially prevent 1.1–3.0 million Alzheimer’s disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia.

Methods and analysis

A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-to-face dementia risk-reduction intervention (Body Brain Life—General Practice (BBL-GP)); (2) a 6-week face-to-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University—Alzheimer’s Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index.

Ethics and dissemination

This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions.

Trial registration number

ACTRN12616000868482
Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden
Authors: Guwatudde David , Absetz Pilvikki , Delobelle Peter , Östenson Claes-Göran , Olmen Van Josefien , Alvesson Helle Molsted , Mayega Roy William , Ekirapa Kiracho Elizabeth , Kiguli Juliet , Sundberg Carl Johan , Sanders David , Tomson Göran , Puoane Thandi , Peterson Stefan , Daivadanam Meena
Published: March 2018

Introduction

Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes.

Methods and analysis

An adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in self-management, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose.

Ethics and dissemination

The study has received approval in Uganda from the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and from the Uganda National Council for Science and Technology; in South Africa from the Biomedical Science Research Ethics Committee of the University of the Western Cape; and in Sweden from the Regional Ethical Board in Stockholm. Findings will be disseminated through peer-reviewed publications and scientific meetings.

Trial registration number

ISRCTN11913581; Pre-results.
Development and validation of a casemix classification to predict costs of specialist palliative care provision across inpatient hospice, hospital and community settings in the UK: a study protocol
Authors: Guo Ping , Dzingina Mendwas , Firth Alice M , Davies Joanna M , Douiri Abdel , O’Brien Suzanne M , Pinto Cathryn , Pask Sophie , Higginson Irene J , Eagar Kathy , Murtagh Fliss E M
Published: March 2018

Introduction

Provision of palliative care is inequitable with wide variations across conditions and settings in the UK. Lack of a standard way to classify by case complexity is one of the principle obstacles to addressing this. We aim to develop and validate a casemix classification to support the prediction of costs of specialist palliative care provision.

Methods and analysis

Phase I: A cohort study to determine the variables and potential classes to be included in a casemix classification. Data are collected from clinicians in palliative care services across inpatient hospice, hospital and community settings on: patient demographics, potential complexity/casemix criteria and patient-level resource use. Cost predictors are derived using multivariate regression and then incorporated into a classification using classification and regression trees. Internal validation will be conducted by bootstrapping to quantify any optimism in the predictive performance (calibration and discrimination) of the developed classification. Phase II: A mixed-methods cohort study across settings for external validation of the classification developed in phase I. Patient and family caregiver data will be collected longitudinally on demographics, potential complexity/casemix criteria and patient-level resource use. This will be triangulated with data collected from clinicians on potential complexity/casemix criteria and patient-level resource use, and with qualitative interviews with patients and caregivers about care provision across difference settings. The classification will be refined on the basis of its performance in the validation data set.

Ethics and dissemination

The study has been approved by the National Health Service Health Research Authority Research Ethics Committee. The results are expected to be disseminated in 2018 through papers for publication in major palliative care journals; policy briefs for clinicians, commissioning leads and policy makers; and lay summaries for patients and public.

Trial registration number

ISRCTN90752212.
Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care
Authors: Burn Anne-Marie , Fleming Jane , Brayne Carol , Fox Chris , Bunn Frances
Published: March 2018

Objectives

In 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.

Design

Qualitative study involving interviews, focus groups and thematic content analysis.

Setting

Primary care and secondary care across six counties in the East of England.

Participants

Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.

Results

We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.

Conclusions

The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.
Anaesthesia workload measurement devices: qualitative systematic review
Authors: Almghairbi Dalal S , Marufu Takawira C , Moppett Iain K
Published: March 2018

Background

Management of mental workload is a key aspect of safety in anaesthesia but there is no gold-standard tool to assess mental workload, risking confusion in clinical and research use of such tools.

Objective

This review assessed currently used mental workload assessment tools.

Methods

A systematic literature search was performed on the following electronic databases; Cochrane, EMBASE, MEDLINE, SCOPUS and Web of Science. Screening and data extraction were performed individually by two authors. We included primary published papers focusing on mental workload assessment tools in anaesthesia.

Results

A total of 2331 studies were screened by title, 32 by full text and 24 studies met the inclusion criteria. Six mental workload measurement tools were observed across included studies. Reliability for the Borg rating scales and Vibrotactile device was reported in two individual studies. The rest of the studies did not record reliability of the tool measurements used. Borg rating scales, NASA-TLX and task-oriented mental work load measurements are subjective, easily available, readily accessible and takes a few minutes to complete. However, the vibrotactile and eye-tracking methods are objective, require more technical involvement, considerable time for the investigator and moderately expensive, impacting their potential use.

Conclusion

We found that the measurement of mental workload in anaesthesia is an emerging field supporting patient and anaesthetist safety. The self-reported measures have the best evidence base.
Phosphorylated Hsp27 is mutually exclusive with ATRX loss and the IDH1R132Hmutation and may predict better prognosis among glioblastomas without the IDH1 mutation and ATRX loss
Authors: Cai Hong-Qing , Wang Peng-Fei , Zhang Hai-Peng , Cheng Zhi-Jian , Li Shou-Wei , He Jie , Zhang Yu , Hao Jia-Jie , Wang Ming-Rong , Yan Chang-Xiang , Wan Jing-Hai
Published: March 2018

Aim

To identify biomarkers for accurate classification of glioma.

Patients and methods

We evaluated the heat shock protein 27 (Hsp27), phosphorylated Hsp27 (p-Hsp27), ATRX and IDH1R132Hproteins using immunohistochemistry in 421 glioma tissues. The χ2test was used to assess the relationship between molecular alterations and clinico-pathological parameters. Kaplan-Meier survival curves were constructed, and differences were detected by the log-rank test.

Results

We found that Hsp27 and p-Hsp27 were mainly expressed in aggressive astrocytic gliomas. However, neither Hsp27 nor p-Hsp27 expression was related to survival time for any grade of glioma. Interestingly, p-Hsp27 was mutually exclusive with ATRX loss (ATRX−) and the IDH1R132Hmutation, except for one case of anaplastic astrocytoma. We classified glioblastomas (GBMs) into three subtypes: ATRX−/IDH1R132H, high p-Hsp27 expression (p-Hsp27+) and none of these three markers. ATRX-/IDH1R132Hshowed the longest median survival (19.6 months). The prognostic difference between p-Hsp27+and none of these three markers was significant (15.0 vs 13.1 months, P=0.045). Moreover, p-Hsp27+predicted better sensitivity for standard therapy among GBMs without the IDH1 mutation and ATRX loss (26.3 vs 15.5 months, P=0.008).

Conclusion

p-Hsp27 is a novel biomarker of glioma and might have important clinical value for further classification of patients with wild-type IDH1 and normal ATRX expression, for evaluating prognosis and for guidance for adjuvant therapy.
Identification of IgG3-specific epitope that remedies problem in diagnostic IgG subclass determination due to human genetic variation
Authors: Howie Heather L , Wang Xiaohong , Kapp Linda , Lebedev Jenna N , Zimring James C
Published: March 2018

There are four subtypes of human IgG with different effector functions. Quantifying the relative amount of each IgG subtype is important for laboratory diagnosis in multiple settings. However, in an evolving landscape of the appreciation of human variability and the need for precision/personalised laboratory diagnosis, it has also been shown that there are numerous natural variants of IgG subtypes, with at least 29 having been described. It has recently been reported that commercially available polyclonal antisera to IgG3 cross react with variants of other IgG subtypes, while available monoclonal anti-IgG3 have a blind-spot for the IgG3-04 variant. Herein, we report that IgG3-04 contains an epitope in common with all known IgG3 variants and absent in other subtypes. A novel monoclonal anti-IgG3 is described that is specific to IgG3 but without any blind-spots for known IgG3 variants, providing a remedy to the problem of genetic variability of IgG3.
‘He who helps the guilty, shares the crime’? INGOs, moral narcissism and complicity in wrongdoing
Authors: Buth Pete , de Gryse Benoit , Healy Sean , Hoedt Vincent , Newell Tara , Pintaldi Giovanni , del Valle Hernan , Sheather Julian C , Wong Sidney
Published: March 2018

Humanitarian organisations often work alongside those responsible for serious wrongdoing. In these circumstances, accusations of moral complicity are sometimes levelled at decision makers. These accusations can carry a strong if unfocused moral charge and are frequently the source of significant moral unease. In this paper, we explore the meaning and usefulness of complicity and its relation to moral accountability. We also examine the impact of concerns about complicity on the motivation of humanitarian staff and the risk that complicity may lead to a retreat into moral narcissism. Moral narcissism is the possibility that where humanitarian actors inadvertently become implicated in wrongdoing, they may focus more on their image as self-consciously good actors than on the interests of potential beneficiaries. Moral narcissism can be triggered where accusations of complicity are made and can slew decision making. We look at three interventions by Médecins Sans Frontières that gave rise to questions of complicity. We question its decision-guiding usefulness. Drawing on recent thought, we suggest that complicity can helpfully draw attention to the presence of moral conflict and to the way International Non-Governmental Organisations (INGOs) can be drawn into unintentional wrongdoing. We acknowledge the moral challenge that complicity presents to humanitarian staff but argue that complicity does not help INGOs make tough decisions in morally compromising situations as to whether they should continue with an intervention or pull out.
Clinical characteristics and patient-reported outcomes in patients with inadequately controlled rheumatoid arthritis despite ongoing treatment
Authors: Taylor Peter C , Alten Rieke , Gomez-Reino Juan J , Caporali Roberto , Bertin Philippe , Sullivan Emma , Wood Robert , Piercy James , Vasilescu Radu , Spurden Dean , Alvir Jose , Tarallo Miriam
Published: March 2018

Background

Despite the wide array of treatments available for rheumatoid arthritis (RA), some patients continue to report unmet clinical needs. We investigated the extent of inadequate disease control in patients with RA.

Methods

Data were drawn from the Adelphi 2014 RA Disease-Specific Program in France, Germany, Italy, Spain and the UK. Rheumatologists provided patient demographics, comorbidities, satisfaction with RA control and other clinical details. Patients reported their level of satisfaction and completed the EuroQoL 5-Dimensions Health Questionnaire and Work Productivity and Activity Impairment Questionnaire. Patients had been on their current therapy ≥3 months and had 28-joint disease activity scores (DAS28) reported. Adequately controlled (DAS28 ≤3.2) and inadequately controlled (DAS28 >3.2) patient cohorts were compared using univariate tests.

Results

Of 1147 patients, 74% were women, the mean age was 52 years and the mean time since RA diagnosis was 7 years. Twenty-seven percent of patients had inadequately controlled RA, whereas 73% had adequately controlled RA. Inadequately controlled patients were more affected clinically versus adequately controlled patients; 69% vs 13% had moderate/severe RA, the current level of pain was 4.6 vs 2.3, and 67% vs 41% experienced flares, respectively (all p<0.0001). Inadequately controlled patients had higher rates of depression (16% vs 5%; p<0.0001), worse health state, greater work and activity impairment, and lower satisfaction rates among the patients and their physicians than the adequately controlled cohort.

Conclusion

RA was insufficiently controlled in over a quarter of patients despite their current therapy and this had a negative impact on the patients.
High Arctic plants show independent responses to pollination and experimental warming
Authors: Robinson Samuel V.J. , Henry Gregory H.R.
Published: March 2018

Arctic plants will experience both higher temperatures and changes to their pollination regime under future climate change scenarios. However, reproductive responses to pollination, warming, and a pollination–warming interaction likely vary with seasonal timing in phenology, and may be more pronounced in early-flowering plants than later-flowering plants. To test these hypotheses, we applied hand pollination and exclusion treatments to three Arctic plant species (early-flowering Salix arctica Pall., mid-season flowering Dryas integrifolia Vahl, and late-flowering Papaver radicatum Rottb.) inside and outside of open-top chambers (OTCs), to determine how pollination and warming may interact. We found that OTCs did not significantly reduce visitation by insects, nor did they reduce seed production in wind-pollinated S. arctica. Flower production and seed germination rates for D. integrifolia matched the predictions for warmth- and pollen-limited plants. Reproduction in P. radicatum did not respond strongly to either warming or pollination. Overall, we found that High Arctic plant reproduction is affected independently by pollination and OTC warming, indicating that plant responses to ongoing increases in temperature will not be strongly altered by changes in insect pollination.
Three ways to solve critical ϕ4 theory on 4 − 𝜖 dimensional real projective space: Perturbation, bootstrap, and Schwinger–Dyson equation
Authors: Hasegawa Chika , Nakayama Yu
Published: March 2018

In this paper, we solve the two-point function of the lowest dimensional scalar operator in the critical [Formula: see text] theory on [Formula: see text] dimensional real projective space in three different methods. The first is to use the conventional perturbation theory, and the second is to impose the cross-cap bootstrap equation, and the third is to solve the Schwinger–Dyson equation under the assumption of conformal invariance. We find that the three methods lead to mutually consistent results but each has its own advantage.