bluuebunny/crossref_metadata_2025 huggingface dataset:
Methods for the health technology assessment of complex interventions: a protocol for a scoping review
Authors: Baghbanian Abdolvahab , Merlin Tracy , Carter Drew , Wang Shuhong
Published: November 2020

Introduction

In healthcare policy and economic literature, research on the health technology assessment (HTA) of complex interventions (CIs) is becoming increasingly important. In many developed countries, HTA guides decision-making to help achieve greater value for money when funding health care. However, research has yet to identify the forms of evidence and evaluation criteria that should be used in the HTA of CIs. Previous research has established that the HTA of CIs requires multiple factors to be evaluated but there is no agreement on which factors ought always to be considered. There is equally little agreement on which forms of evidence ought to be collected or synthesised and how. We plan to perform a systematic scoping review in order to identify the range of evaluation criteria and types of evidence currently used in the HTA of CIs.

Method and analysis

This protocol was developed to guide the methodological framework for the conduct of a scoping review on health technology assessment (HTA) of complex interventions (CIs), using the Joanna Briggs Institute guidelines and the six-stage framework proposed by Arksey and O’Malley, in addition to more recent innovations in scoping review methodology. A grey literature search will supplement the primary searches of seven electronic databases for studies available in English between January 2000 and August 2020. Two reviewers will independently screen all search results for inclusion and data will be extracted using a customised data extraction or charting form. Any dispute will be resolved by consensus or through arbitration by a third author. The mnemonic Population, Concept and Context will be adopted to establish criteria for selecting relevant literature, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review will be used for reporting the results. Several explanatory-descriptive methods will be used for analysing the extracted data including frequency and trend analyses as well as reflexive thematic coding and analysis.

Mapping evidence on the HTA of CIs will allow us to gain a better understanding of both established and emerging practices, including the information types, requirements, values and parameters that are incorporated in the HTA of CIs. We also expect the findings of the scoping review to help identify research gaps that will guide future studies. As healthcare becomes more complex in its delivery, it is timely to determine how these complex interventions should be assessed so that policy decisions can be made about whether implementation and public funding is warranted.

Ethics and Dissemination

This scoping review will involve secondary analysis of already collected data, and thus, does not require ethics approval. The research findings will be submitted to peer-reviewed journals for publication and will also be disseminated at conferences and seminars.
Feasibility of reporting results of large randomised controlled trials to participants: experience from the Fluoxetine Or Control Under Supervision (FOCUS) trial
Authors: Mead Gillian , Dennis Martin
Published: November 2020

Objectives

Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.

Design

In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.

Setting

UK stroke services.

Participants

3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.

Results

Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.

Conclusion

It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.

Trial registration number

ISRCTN83290762; Post-results.
The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA study): a protocol study
Authors: Espiritu Adrian I , Sy Marie Charmaine C , Anlacan Veeda Michelle M , Jamora Roland Dominic G
Published: November 2020

Introduction

The SARS-CoV-2, virus that caused the COVID-19 global pandemic, possesses a neuroinvasive potential. Patients with COVID-19 infection present with neurological signs and symptoms aside from the usual respiratory affectation. Moreover, COVID-19 is associated with several neurological diseases and complications, which may eventually affect clinical outcomes.

Objectives

The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA) study investigators will conduct a nationwide, multicentre study involving 37 institutions that aims to determine the neurological manifestations and factors associated with clinical outcomes in COVID-19 infection.

Methodology and analysis

This is a retrospective cohort study (comparative between patients with and without neurological manifestations) via medical chart review involving adult patients with COVID-19 infection. Sample size was determined at 1342 patients. Demographic, clinical and neurological profiles will be obtained and summarised using descriptive statistics. Student’s t-test for two independent samples and χ2 test will be used to determine differences between distributions. HRs and 95% CI will be used as an outcome measure. Kaplan-Meier curves will be constructed to plot the time to onset of mortality (survival), respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, length of ICU stay and length of hospital stay. The log-rank test will be employed to compare the Kaplan-Meier curves. Stratified analysis will be performed to identify confounders and effects modifiers. To compute for adjusted HR with 95% CI, crude HR of outcomes will be adjusted according to the prespecified possible confounders. Cox proportional regression models will be used to determine significant factors of outcomes. Testing for goodness of fit will also be done using Hosmer-Lemeshow test. Subgroup analysis will be performed for proven prespecified effect modifiers. The effects of missing data and outliers will also be evaluated in this study.

Ethics and dissemination

This protocol was approved by the Single Joint Research Ethics Board of the Philippine Department of Health (SJREB-2020–24) and the institutional review board of the different study sites. The dissemination of results will be conducted through scientific/medical conferences and through journal publication. The lay versions of the results may be provided on request.

Trial registration number

NCT04386083.
Cytokines and their relationship with the severity and prognosis of coronavirus disease 2019 (COVID-19): a retrospective cohort study
Authors: Liu Qing Quan , Cheng Anying , Wang Yiru , Li Haifang , Hu Liu , Zhao Xuecheng , Wang Tao , He Fan
Published: November 2020

Objective

To delineate the characteristics and clinical significance of plasma inflammatory cytokines altered in COVID-19.

Design

Retrospective, single-centre cohort study.

Setting

Tongji Hospital in Wuhan, China.

Participants

Among a cohort of 308 patients with a diagnosis of COVID-19, 138 patients died while 170 patients recovered and were discharged from the hospital. The data were collected until 27 February 2020.

Primary and secondary outcome measures

Clinical characteristics and laboratory findings were obtained from electronic medical records using data collection forms.

Results

The percentage of patients with elevated interleukin 2 receptor (IL-2R), IL-6, IL-8, IL-10 and tumour necrosis factor (TNF) increased with severity of disease (p<0.0001 for all). IL-2R (p<0.0001), IL-6 (p<0.0001), IL-8 (p=0.0001), IL-10 (p<0.0001) and TNF (p<0.0001) were also twofold to 20-fold higher in patients who died compared with those who recovered. Also, IL-6 and IL-10 increased in both the progressive patient groups: moderate (p=0.0026) and severe (p<0.0001). In multivariate analysis, higher levels of IL-2R (OR 1.001, 95% CI 1.000 to 1.002, p=0.031) and IL-6 (OR 1.013, 95% CI 1.003 to 1.024, p=0.015) on admission were associated with increasing odds of in-hospital death, independent of other covariates, including severity of disease and lymphocyte count.

Conclusion

Increased proinflammatory and anti-inflammatory cytokines, including IL-2R, IL-6, IL-8, TNF and IL-10, showed an obvious association with both COVID-19 severity and in-hospital mortality. Thus, our study indicates that cytokines are valuable in predicting the severity of COVID-19 and helps in distinguishing critically ill patients from the less affected ones.
Progression of vital signs during ambulance transport categorised by a paediatric triage model: a population-based historical cohort study
Authors: Nielsen Vibe Maria Laden , Kløjgård Torben , Bruun Henrik , Søvsø Morten Breinholt , Christensen Erika Frischknecht
Published: November 2020

Objectives

To examine the severity and progression of acute illness or injury in children using vital signs obtained during ambulance transport and categorised according to a paediatric triage model.

Design

A population-based historical cohort study using data from prehospital patient medical records linked to a national civil registration database.

Setting

Emergency medical services providing ground-level transport in a mixed urban–rural region with three hospitals in Denmark.

Participants

25 039 events with patients aged <18 years attended by emergency medical services dispatched after a 1-1-2 emergency call during the years 2006–2018.

Primary and secondary outcome measures

Distribution of the first observed vital signs according to a paediatric triage model: heart rate, Glasgow Coma Score, respiratory rate, oxygen saturation and oxygen treatment, and proportion of patients progressing to a triage score with a lower level of urgency during ambulance transport.

Results

The proportion of patients with the first observed vital signs outside the normal age-specific range was as follows: 33.6% for heart rate, 15.3% for Glasgow Coma Score, 17.4% for respiratory rate and 37.4% for oxygen saturation regardless of oxygen treatment. The proportion of patients progressing to a triage score with a lower level of urgency during transport varied with age: 146/354 (41.2%) for age 0–2 months, 440/986 (44.6%) for age 3–11 months, 1278/3212 (39.8%) for age 1–2 years, 967/2814 (34.4%) for age 3–7 years and 4029/13 864 (29.1%) for age 8–17 years (p<0.001). One-day mortality was 3.05 deaths per 1000 patient-days (95% CI 2.43 to 3.83).

Conclusions

One third of the patients’ condition progressed to a triage score with a lower level of urgency during ambulance transport. Vital sign documentation in paediatric patients was incomplete, and educational initiatives should be taken to increase documentation of vital signs, especially in patients aged ≤2 years.
Randomised controlled trial of integrated trauma-focused psychotherapy for traumatic stress and substance use among adolescents: trial protocol
Authors: Mills Katherine L , Barrett Emma , Back Sudie E , Cobham Vanessa E , Bendall Sarah , Perrin Sean , Brady Kathleen T , Ross Joanne , Peach Natalie , Kihas Ivana , Cassar Joanne , Schollar-Root Olivia , Teesson Maree
Published: November 2020

Introduction

Post-traumatic stress disorder (PTSD) and substance use disorder frequently co-occur and tend to have their onset during adolescence. Although research has highlighted the importance of treating these disorders in an integrated fashion, there is a dearth of empirically validated integrated treatment options for adolescents with this comorbidity. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy of an integrated trauma-focused cognitive–behavioural treatment for traumatic stress and substance use among adolescents (Concurrent Treatment of PTSD and Substance Use Using Prolonged Exposure - Adolescent (COPE-A)), relative to a supportive counselling control condition (Person-Centred Therapy (PCT)).

Methods and analysis

A two-arm, parallel, single-blind RCT with blinded follow-up at 4 and 12 months poststudy entry will be conducted in Sydney, Australia. Participants (n~100 adolescents aged 12–18 years) and their caregivers (caregiver participation is optional) will be allocated to undergo either COPE-A or PCT (allocation ratio 1:1) using minimisation. Both therapies will be delivered individually by project psychologists over a maximum of 16 sessions of 60–90 min duration and will include provision of up to four 30 min optional caregiver sessions. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for DSM-5.

Ethics and dissemination

Ethical approval has been obtained from the human research ethics committees of the Sydney Children’s Hospital Network (HREC/17/SCHN/306) and the University of Sydney (HREC 2018/863). Findings will be published in peer-reviewed journals and presented at scientific conferences.

Trial registration number

ACTRN12618000785202; Pre-reults.

Protocol version

Version 1, 31 July 2017.
Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states
Authors: Pardhan Shahina , Vaughan Megan , Zhang Jufen , Smith Lee , Chichger Havovi
Published: November 2020

Objective

Conjunctivitis has been reported in people suffering from COVID-19. However, many ocular symptoms are associated with the term ‘conjunctivitis’ which may be misleading. It is also unknown whether ocular symptoms were different in chronic sufferers of anterior eye diseases, when they were experienced or how long they lasted for compared with other COVID-19 symptoms.

Methods

An online structured questionnaire obtained self-report data from people who had a confirmed diagnosis of COVID-19. Data for the type, frequency and duration of different COVID-19 symptoms were ascertained. Anterior eye symptoms experienced by participants in the pre-COVID-19 state were compared with during the COVID-19 state.

Results

Data from 83 participants showed that the most reported COVID-19 symptoms were dry cough (66%), fever (76%), fatigue (90%) and loss of smell/taste (70%). The three most common ocular symptoms experienced by participants were photophobia (18%), sore eyes (16%) and itchy eyes (17%). The frequency of sore eyes was significantly higher (p=0.002) during COVID-19 state (16%) compared with pre-COVID-19 state (5%). There were no differences between males and females (p>0.05). 81% of participants reported to have experienced ocular symptoms within 2 weeks of other COVID-19 symptoms, and 80% reported they lasted for less than 2 weeks.

Conclusion

The most significant ocular symptom experienced by people suffering from COVID-19 was sore eyes. Other symptoms associated with other types of conjunctivitis, such as mucous discharge and gritty eyes linked to bacterial infection, did not reach significance. The term ‘conjunctivitis’ is too broad and should be used with caution.
Establishing and maintaining a robust Role 2 Afloat organisation within the Royal Naval Medical Services
Authors: Matthews J J , Mercer S J , Khan M A , Hillman C M , Robin J , Scott T E
Published: November 2020

In 2009, the Royal Navy (RN) reconfigured the Role 2 maritime medical treatment capability, the Role 2 Afloat (R2A). This capability is now firmly established on a number of platforms in the fleet and was recently externally validated on RFA MOUNTS BAY prior to completion of an operational deployment supporting contingency operations in the Mediterranean. This article outlines the future challenges for R2A and offers suggestions on how to maintain a robust R2A organisation within the Royal Naval Medical Service (RNMS).
Peripheral venous disease and its implications for military practice
Authors: Swain C , Khan M
Published: November 2020

Peripheral venous disease includes a spectrum of conditions which can be considered in two categories, corresponding to venous anatomy: superficial, and deep. Superficial diseases, including varicose veins and superficial thrombophlebitis, are relatively common conditions which present in the primary care setting and require appropriate management. Deep vein thrombosis (DVT) can significantly impact on operational capability and future deployability and employability.

This review discusses venous anatomy and physiology, and the clinical picture of venous disease, including classification and management within the military setting.
The Role 2 Afloat custodian
Authors: Hudson J , Mercer S
Published: November 2020

The Role 2 Afloat (R2A) capability is now firmly established on several maritime platforms using the 370 Module (afloat) equipment. This year has seen the appointment on board ships that support R2A of a new full-time role, the Medical Module Manager (MMM), who is responsible for the equipment on board. This article outlines the new role.
Using simple exercise tests in the field to assess susceptibility to Acute Mountain Sickness; the Chester Step Test may be a useful predictor
Authors: Thornton HE , Williams T Harcourt
Published: November 2020

Introduction

We undertook an observational study with eight volunteer participants which aimed to identify whether simple cardio-respiratory measurements, before and after different forms of exercise testing, could offer a reliable means of predicting Acute Mountain Sickness (AMS). Three tests were used, all of which were easily performed in the mountain environment.

Methods

During an expedition to Mt Elbrus (5642m), in the Caucasus region of Russia, daily cardiorespiratory observations were made on eight subjects after exercise testing, and compared with Lake Louise Self-Assessment Questionnaire (LLSAQ) scores.

Results

At all altitudes, the Chester Step Test (CST) demonstrated differences in the time taken to reach 80% of the calculated maximum heart rate between participants due to variance in levels of aerobic fitness. At 3800m, there was a significant difference (t = 3.06, p = 0.02) between those who reached 80% of their maximum heart rate rapidly, and those who did not. This difference was associated with symptoms of severe AMS; the group who developed more severe symptoms were able to exercise for longer than the group who demonstrated mild AMS (Mann-Whitney U score: p = 0.004).

Conclusions

Despite small numbers, these results suggest that there is a difference between mountaineers who develop severe AMS and those who are less severely affected, upon testing of their aerobic capacity. This may reflect adaptation of the cardiovascular system, and further investigation is warranted.
An evaluation of the mental health of servicewomen in the perinatal period
Authors: Guest R
Published: November 2020

Background

Depression and anxiety are the most common mental health disorders during the perinatal period. The aims of this study were to observe the potential scale and impact of perinatal low mood in the military population, to ascertain if patients were recognised and treated appropriately during maternity leave and to identify potential barriers to care.

Methods

A 10-question survey was designed using an online platform in consultation with military community mental health professionals, and sent out via Royal Naval maternity cells and relevant social media.

Results

Of 249 respondents, 68% had concerns regarding their mood in the perinatal period; 54% were unaware they could access help from Defence mental health during maternity leave and 65% had one or more risk factors for developing perinatal mood disturbance. Using the Edinburgh Postnatal Depression Scale, 54% felt that they had had a problem with perinatal low mood. Of these 71% reported having symptoms on their return to work and 80% felt that these had impacted on family relationships. Free text comments were separated into seven themes, namely: isolation, military implications, information flow between the civilian and military healthcare systems, knowledge of healthcare professionals, stigma, return to work and positive comments.

Conclusions

Issues explored in this paper concern: increased risk; information flow; barriers to presentation; isolation; and medical service knowledge gaps. Suggested action points include increased input from medical services into maternity groups, phone contact from sick bays to servicewomen on maternity leave, improvements in information flow, maternity-specific return to work medical, maternity leads within military practices and areas for potential future research.
The management of inflammatory bowel disease in the UK Armed Forces
Authors: Holden A , Booth R , Howes J
Published: November 2020

Inflammatory bowel disease is the umbrella term for ulcerative colitis and Crohn’s disease. Diagnosis is assisted by thorough history-taking, examination and targeted investigations, but endoscopic analysis is required to confirm the diagnosis. Multiple challenges exist in the deployed environment and, depending on the level of care available, repatriation may be required. In the deployed environment, prior to diagnosis, isolation in case of an infective cause of symptoms is key, along with close monitoring and symptomatic management. Inflammatory bowel disease is a bar to selection to the UK Armed Forces, but service may continue in some cases if diagnosis occurs during a military career. Due to high relapse rates, severity of symptoms and side effects of therapies, continued military service may not be possible in the long term.
Prone position ventilation in the Role 2 Afloat environment
Authors: Hill A , Hillman C , Scott T E
Published: November 2020

Prone position ventilation is a life-saving technique for the management of hypoxic respiratory failure in ventilated patients. It has particular application in the isolated Role 2 Afloat (R2A) environment where both human and material resources are limited. It can be achieved with minimal training. This article describes the rationale behind prone position ventilation and equips the reader with the knowledge base that will allow the technique to be instigated.
How has military use of medical imaging in austere environments changed? A comparison between deployments of the Victorian era and today
Authors: Lee A J , Gibb I E , Stevenson T
Published: November 2020

Over 100 years ago, in the late 19thcentury, the British military first deployed radiological equipment to theatres of war, notably to Afghanistan during the Tirah campaign and to Sudan during the River War. The efforts of early radiological pioneers, and the clear diagnostic utility their equipment offered, quickly saw radiology formally incorporated into military medicine as its own discipline. The two World Wars saw the specialisation advance rapidly in scope and capability. To draw comparison with earlier conflicts, the early 21stcentury saw modern medical imaging equipment utilised in the same geographical regions: first as part of Op HERRICK in Afghanistan from 2003-14; and currently as part of Op TRENTON in South Sudan.

In the intervening period throughout the 20thcentury, the capability has developed enormously. Initially the ‘Roentgen Ray’, X-ray was used to identify bone fractures and locate and identify foreign bodies located within wounds, thus reducing the risk of infection and further trauma previously inflicted by surgical exploration, whilst also giving added precision to extraction of bullets and fragmentation. Modern day military radiology further improves diagnostic capability, giving a more comprehensive picture of injuries sustained and providing assistance in treatment. State-of-the-art radiological equipment can now be routinely operated in the most austere military environments. Nonetheless, modern military radiologists face similar challenges to their Victorian counterparts in delivering capability, notably climate, equipment fragility and environmental hazards. Whilst equipment continues to evolve, the need for resourcefulness and adaptability amongst those personnel operating and maintaining it remains undiminished.
Increasing Role 2 Afloat capability on the Bay Class platforms – lessons from Exercise AZRAQ SERPENT 2018
Authors: Matthews J J
Published: November 2020

A recent medical proof of concept exercise (Exercise AZRAQ SERPENT 2018) allowed the opportunity for a United States Navy Surgical Team to deploy onto one of the Bay Class platforms (RFA CARDIGAN BAY). This team was utilised in a serial during the exercise to establish a secondary operating position within the medical complex. This showed that the standard Role 2 Afloat team deployed to Bay Class platforms could be supplemented by an additional small surgical team to increase the capability offered and allow a third patient to be treated concurrently. The lessons from this exercise are discussed.
The inception of the Bastion Protocol for trauma CT scanning
Authors: Carter N J , Kirkwood G W , Miles R , Gay D A T
Published: November 2020

During Operation HERRICK, increasing numbers of battlefield casualties resulted in the need for innovation in the medical management of trauma. The aim of diagnostic radiology was to provide fast and accurate diagnostic information to the trauma team. The Bastion Protocol Computed Tomography (CT) Traumagram played a vital part in achieving this aim in the Joint Force Role 3 Medical Treatment Facility (R3), Camp Bastion.

The CT Traumagram comprises a non-contrast CT scan of the head, followed by a biphasic intravenous contrast injection with single-pass acquisition from the Circle of Willis to the ischial tuberosities or as far down the legs as is necessary. Diagnostic CT, once a time-consuming process, became one of the major medical successes of Operation HERRICK. As a result, the Bastion Protocol, in modified forms, has been widely accepted and adopted in civilian trauma practice throughout the United Kingdom (UK). This paper aims to document the inception of the Bastion Protocol.
Of men and moulds
Authors: Watkins P E
Published: November 2020

In 2015, this Journal carried a commentary on a paper relating to probably the most important medical discovery of the 20thcentury.1The original paper appeared in 1945, and reported the Robert Campbell Oration to the Ulster Medical Society, given by Professor Sir Alexander Fleming.2In this he described the discovery and subsequent development of penicillin. It is now 90 years since Fleming made his discovery, which altered the practice of medicine.
The effectiveness of pre-impregnated permethrin in military clothing in the prevention of insect bites
Authors: Biggs D
Published: November 2020

Introduction

When on operational deployment, or where a vector-borne disease threat has been identified, military personnel wear uniform that has been pre-impregnated with permethrin insecticide to prevent insect bites, as part of an integrated approach to bite avoidance in order to reduce disease non-battle injury. This article reports a study that was carried out to investigate whether the clothing treatments currently in use are effective at preventing insect bites.

Methods

A human volunteer study was conducted using two different species of mosquito and clothing subjected to different washing schedules. The number of landing events and probing events, and insect mortality, were recorded.

Results

There was a marked increase in mosquito activity as the amount of viable permethrin was reduced through washing. There was a statistically significant difference between 50 washes and the negative control, and between 50 and 5 washes. As clothing is increasingly washed, its effectiveness is reduced.

Conclusion

The use of pre-impregnated uniform does not provide complete protection against biting insects throughout the life of the garment. No single means of protection will prevent personnel from being bitten, and a suite of personal and communal measures should be employed to reduce the risk of vector-borne disease, including the use of insect repellent, mosquito nets, anti-malarial chemoprophylaxis and re-treatment of clothing against biting insects in order to reduce the risk of disease transmission. Since this study, alternative means of clothing treatment have been sought to reinforce the pre-treated uniforms issued. Advice and direction is available, specific to the environment personnel are deploying to, based upon risk.
Too hot to handle: how quickly do surgical instruments cool sufficiently to use safely following sterilisation using the Medical Device Decontamination Capability (Forward)?
Authors: Roper D , McClean A , Hand C J
Published: November 2020

The Role 2 Basic medical treatment facility deploys with the Medical Device Decontamination Capability (MDDC) (Forward) to sterilise re-usable surgical instruments. After use, the instrument sets are placed in a wire basket, unwrapped and sterilised using MDDC (Forward). The instrument sets are taken out of the steriliser at 69°C but need to cool before reaching a safe handling temperature. If the instruments are needed immediately for surgery, current practice is to pour water over the instruments to speed the cooling process, although it is not known how long instruments take to reach a safe working temperature range. We compared the current standard practice of cooling against four other methods in order to establish the optimum technique.
Physiotherapy support to the Carrier Strike Group
Authors: Rutter T , Matthews J J
Published: November 2020

The recent First of Class Flying Trials for the F-35 Lightning 2 took place on HMS QUEEN ELIZABETH (QNLZ) during the WESTLANT 18 deployment. WESTLANT 18 took place over four months off the eastern seaboard of the United States of America and involved a busy daily flying programme. The deployment was supported by a full Role 2 Afloat (R2A) team. The Role 1 team onboard was augmented during WESTLANT 18 with a physiotherapist. Data collected during WESTLANT 18 suggests that provision of a physiotherapist to support the Carrier Strike Group (CSG) is a force enabler and force protection asset, as they are able to keep patients on board who would otherwise require aeromedical evacuation back to the United Kingdom. The deployed physiotherapist was well employed and, when complemented by plain radiography and supported by an embarked orthopaedic surgeon, saved a significant amount of lost working hours and the associated costs of investigations and treatment in the host nation. This reduces the risk to operational capability due to musculoskeletal injury to the aircrew or to the ship’s company and embarked forces.
Military combat movements and exercises: is there a role for adopting sports nutrition carbohydrate recommendations during exercise?
Authors: King A J , Mellor A , O’Hara J P
Published: November 2020

The daily energy requirements for specialist military troops can reach 5000 kcal during training and wartime deployment. Maintaining energy balance is important for health and physical and mental performance in this population, who can effectively be considered as high-performance endurance athletes. In the sporting world, a balanced diet consisting of 50-60% carbohydrate (CHO), 20-25% protein and 25-30% fat is recommended for these athletes. CHO intake is regarded as a key dietary constituent, as this substrate provides the sole fuel source during high-intensity exercise. However, achieving such high CHO intake rates can be challenging for military personnel, especially in the field. In sports nutrition, athletes commonly use dietary CHO supplements to reduce this deficit. There may be lessons and insight from nutrition and metabolism in sport that could provide Royal Marines, Medical Officers and other embedded medical professionals with strategies to increase CHO intake during intense training or combat situations.

This review will highlight the exercise demands of infantry soldiering, will suggest supplementary strategies to increase CHO intake, in addition to dietary intake, and will describe the metabolic effects of CHO ingestion during prolonged activity in the context of military exercise.
Trauma system funding: implications for the surgeon health policy advocate
Authors: Lin Saunders , Johnson Christian , Opelka Frank , Liepert Amy
Published: November 2020

Background

Trauma systems improve mortality for the most severely injured patients; however, these systems are managed by individual states with different funding mechanisms, which can lead to inconsistencies in the quality of care. This study compiles trauma system legislation and regulations of funding sources and creates a trauma funding categorization system. Such data help to inform the systems of trauma care delivery within and between states.

Methods

Online searches of state statutes were performed to establish the presence of legislative code to establish a trauma system, the presence of legislative code that funds these trauma systems, and the amount of funding that was allocated to each state’s trauma system in fiscal year 2016 to 2017. Following this, each state’s trauma system was contacted via email and telephone to further obtain this information.

Results

Specific state legislation creating a trauma system was identified in 48 states (96%). Data for categorization of trauma system funding were obtained in 30 states (60%). Of these 30 states, 29 have legislation funding their trauma systems. 17 states funded their trauma systems through general appropriations legislation, 10 states used percentages of fines from criminal and misdemeanor offenses, and 7 states used fees and taxes. New York state does not have any specific funding legislation. Individual state financial contributions to state trauma systems ranged from $55 000 to $25 899 450, annually.

Discussion

There is a limited amount of trauma system funding details available, and among these there is wide variation of funding source types and amounts allotted toward trauma systems. It is difficult to obtain and summate legislative information for use for surgical health policy advocacy efforts. Further study and method development to disseminate comprehensive and comparative legislative and regulatory data and information to physicians and other trauma system stakeholders are needed.

Level of evidence

III, economic and valued-based evaluation; analyses based on limited alternatives and costs; poor estimates.
Evidence gaps and research needs in current guidance on feeding children from birth to 24 months
Authors: Atkinson Stephanie A. , Jimenez Elizabeth Yakes , Pérez-Escamilla Rafael
Published: November 2020

A United States National Academies report summarized recommendations on what and how to feed infants and young children in high-income countries from 43 eligible guideline documents. Consistency existed across many recommendations, but some differences occurred in topic areas, age groupings, and methodological approaches. Future development of guidelines on feeding of infants and young children requires new research and a rigorous evidence-based review process that is harmonized within and across countries and incorporates dissemination and implementation guidance.

Novelty: New research and rigorous methods are recommended to develop future harmonized guidance on feeding of infants and young children that incorporates dissemination and implementation methods.
A Seismic Image Denoising Method Based on Kernel-prediction CNN Architecture
Authors: Lou Li , Li Yong
Published: November 2020

To filter noises and preserve the details of seismic images, a denoising method based on kernel prediction convolution neural network (CNN) architecture is proposed. The method consists of two convolution layers and a residual connection, containing a source sensing encoder, a spatial feature extractor and a kernel predictor. The scalar kernel was normalized by the softmax function to obtain the denoised images. In addition, to avoid excessive blur at the expense of image details, the authors put forward the concept of asymmetric loss function, which would enable users to control the level of residual noise and make a trade-off between variance and deviation. The experimental results show the proposed method achieved good denoising effect. Compared with some other excellent methods, the proposed method increased the peak signal-to-noise ratio (PSNR) by about 1.0–3.2 dB for seismic images without discontinuity, and about 1.8–3.9 dB for seismic images with discontinuity.
Modeling Method of Tax Management System Based on Artificial Intelligence
Authors: Li HongBiao
Published: November 2020

The transformation of taxation processes and the optimization and modeling of their management systems are hot topics in many disciplines such as public management and computer science. Therefore, the intelligent tax management is used to implement the tax process. Meanwhile, tax indicators are adopted as independent variables, and the Logistic regression model is applied to check the selected cases to determine corporate information, which further eliminates less relevant indicators based on the selection results to obtain a more accurate model. In addition, the system modularization design method is applied to design and plan the specific function process of system realization in detail, establishing the necessary business function which can be formed. Moreover, the test process is performed according to the simulation test of the function and the performance of the tax management module. It is proved that the application level of the design module in the paper can meet the current needs, and has the ability of intelligent data analysis and discrimination, which can be promoted within the scope of tax management.
Research on the Evaluation of the Dissemination Ability of Sci-Tech Periodicals Based on Hesitant Fuzzy Linguistic
Authors: Liu Bing , Lv Zhijun , Zhu Nan , Chang Dongyu
Published: November 2020

Although there is much discussion on the evaluation of the dissemination ability of sci-tech periodicals, there is no perfect evaluation method system in the existing studies, and especially the evaluation model is not operable. This paper converts the qualitative evaluation of the dissemination ability into a multi-criteria decision-making problem, and proposes a research method of sci-tech periodicals dissemination ability based on hesitant fuzzy linguistic. Firstly, this paper systematically combs the research progress of the evaluation of dissemination ability of sci-tech periodicals and multi-criteria decision-making under uncertainty. Then, a multi-criteria decision-making method based on hesitant fuzzy linguistic correlation is proposed, which fully considers the preferences of decision makers and effectively integrates the incomplete compensation hypothesis. Finally, the periodical topic planning, knowledge popularization recognition, publishing market operation ability and supporting discipline construction are selected as empirical conditions to verify the applicability and effectiveness of the model. At the same time, in order to make the empirical results more objective and scientific, the density clustering results of the questionnaire are used instead of the decision-maker membership score in the evaluation of dissemination ability. Theoretical analysis and empirical results show that the method proposed in this paper can be effectively applied to the evaluation of the dissemination ability of sci-tech periodicals.
Effect of Dark Personalities on Knowledge Hiding Behaviour at Higher Education Institutions
Authors: Karim Dewan Niamul
Published: November 2020

A key concern in the way of improving knowledge sharing practices is knowledge hiding behaviour. Literature shows that knowledge hiding is a prevalent phenomenon in organisations including higher education institutions (HEIs) and is largely determined by the personality of the knowledge holders. Thus, the present study attempts to examine the effect of dark personalities (undesirable personality traits comprising of Machiavellianism, narcissism, and psychopathy) on knowledge hiding behaviour of faculty members at HEIs. Based on 139 valid responses from the full-time faculty members serving in various private universities in Bangladesh, the study revealed that both Machiavellianism and psychopathy have significant positive association with knowledge hiding behaviour of the academics, whereas narcissism is insignificantly related with knowledge hiding behaviour. This study indicated that dark personalities play a key role in academics’ inclination to hide knowledge.
An Improved Reflectance Prediction Model for Halftone Printing Dot Based on Monte Carlo Method
Authors: Liu Honghao , Zhang Kaixing , Liu Xianxi , Wang Jinxing , Lee Heow Pueh
Published: November 2020

The improved reflectance prediction model for printing dot was established with the Monte Carlo method. Reflectance model is a useful approach to predict and control printing quality, which was widely used in color duplication field. The Monte Carlo prediction model for printing dot is a simulation model, satisfying industrial virtual reality needs, which could simulate reflectance data as well as dot shape image. This paper mainly focuses on improving the existing reflectance model for printing dot with simulation program, expanding dot simulation area from one single dot to nine dots. The results showed that the reflectance value closely approached the measured value with high dot area in particular and the correlation coefficient improved to 0.924. 100,000 times was shown to be the optimal number of simulated photon under regular printing condition. The expanding simulation area could significantly eliminate interactive influence among the dots. The photon distribution and dot shape could be sufficiently simulated through this model, providing a reference for quality control. The results indicate that the improved reflectance model increased the reflectance accuracy and could further promote optical study about color duplication.
Parabolic revolution surfaces of finite type in simply isotropic 3-spaces
Authors: Kelleci Akbay Alev
Published: November 2020

In this paper, we classify parabolic revolution surfaces in the three-dimensional simply isotropic space [Formula: see text] under the condition [Formula: see text] where [Formula: see text] is the Laplace operator with respect to first and second fundamental form and [Formula: see text], [Formula: see text] are some real numbers. Also, as an application, we give some explicit examples for these surfaces.
Effect of Fibers Configuration on Nonlinear Vibration of Anisotropic Dielectric Elastomer Membrane
Authors: Allahyari Ehsan , Asgari Masoud
Published: November 2020

To describe the specific behavior of soft biological tissues that can be regarded as incompressible, a strain energy function for fiber-reinforcement materials based on two isotropic and anisotropic deformation invariants is developed and investigated. The anisotropic properties of simple composite materials were initially studied and now extensive hyperelastic modeling is used to analyze the dynamic characteristics of a dielectric elastomer membrane that experiences finite strains and is reinforced by one family of fiber. It should be noted that the presence of fibers in the rubber matrix will strengthen the structure, but here the presence of fibers will greatly reduce the electric field required to activate the dielectric elastomer and thus be stimulated with a lower voltage. It even helps to reduce the issue of instability that is a common thing in dielectric elastomers. Therefore, the effect of fiber angle orientation in an anisotropic dielectric elastomer under combined loads of biaxial tensile forces and an electric field with a focus on the damping effects is completely studied for different cases. Based on the Gent model, phase diagrams, dynamic response diagrams, and resonance frequency diagrams are also plotted for several values of fibers directions and damping coefficients.
Relationship between the brain and the central pattern generator based on recurrent neural network
Authors: Lu Qiang
Published: November 2020

In animals, the command centers in the brain can drive the locomotion. However, it remains unclear how the brain modulates the locomotor central pattern generator (CPG). In this paper, a novel model is established to describe the relation between the brain and the CPG with time delay. The artificial recurrent neural network (RNN) consists of various computational modules that are used to model the brain. The brain synchronization under amplitude and frequency variations of the CPG and the effect of the RNN parameters variations on the CPG are investigated. In the paper, the excitatory neuron probability and average connections number are parameter space of RNN and the parameter space of CPG, which include frequency and amplitude. According to the simulation results, the best RNN synchronization could be obtained by finding the optimum parameters space between the RNN and the CPG. I propose that the parameter space of some CPGs is related to the parameter space of the brain. This leads to a brain load decrement that facilities the control action. The results are meaningful to investigate how to study the relationship between the brain and the locomotion.
Do Not Cut Wood with an Angle Grinder, or You Might Lose a Finger: A Retrospective Study
Authors: Tsumura Takuya , Matsumoto Taiichi , Matsushita Mutsumi , Kishimoto Katsuma , Shiode Hayao
Published: November 2020

Background: Angle grinders are a handheld power tool used for grinding and polishing stone, metal, and concrete. Some people, however, use them with a circular saw blade attachment for cutting wood and consequently, suffer injuries. We aimed to investigate the underlying cause and mechanisms of injuries caused by cutting wood with an angle grinder.

Methods: We conducted a retrospective study using medical records from our trauma center and identified 15 patients treated for angle grinder injury between 2017 and 2018. Moreover, we contacted the National Consumer Affairs Center of Japan for further information about angle grinder injuries.

Results: Nine of the 15 patients used angle grinders improperly, of which only three patients were aware of the risk of injury. The details of the nine patients were as follows: the types of injuries: complete finger amputation (n = 2), partial finger amputation (n = 1), tendon injury with phalangeal fracture (n = 5), and tendon injury alone, (n = 1); the causes of accidents: kickback (n = 7) and glove entanglement (n = 2); and the accident situations: on-the-job (n = 5) and do-it-yourself (n = 4).

Conclusions: The primary cause of angle grinder injury caused by cutting wood was a lack of user knowledge that an angle grinder cannot be used as a cutting tool. Appropriate feedback from hand surgeons are necessary to urge manufacturers to take safety measures.