bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficiency of a Fixed Displacement Pump With Flow Control Using an Inlet Metering Valve
Authors: Ali Hasan H. , Wisch Julie K. , Fales Roger C. , Manring Noah D.
Published: September 2018

Axial piston pumps with variable volumetric displacement are often used to control flow and pressure in hydraulic systems. The displacement control mechanism in these pumps occupies significant space and accounts for significant cost in the pump design. Fixed displacement pumps have lower cost and a more compact design but suffer from a significant energy consumption disadvantage due to the need to control flow and pressure by throttling flow and bypassing unused flow to pressures below the discharge pressure. An inlet metering valve-controlled pump marks a recent development in pumping technology for hydraulic systems. In this design, an inlet metering valve restricts inlet flow reducing inlet pressure so that the specific volume of the fluid is increased as it enters a fixed displacement pump. By altering the specific volume of the working fluid, the inlet metering valve permits precise control over the pump discharge flow. This paper presents a theoretical model for inlet metered pump efficiency. The work considers additional sources of energy loss unique to the inlet metering system. Experimental results associated with inlet metered pump efficiency are presented. A comparison of the theoretical model and the experimental results is also included. It is determined that the current efficiency model accurately predicts efficiencies determined using experimental data.
Robust Stability Analysis of Uncertain Linear Fractional-Order Systems With Time-Varying Uncertainty for 0 < α < 2
Authors: Tavazoei Mohammad , Asemani Mohammad Hassan
Published: September 2018

This paper focuses on the stability analysis of linear fractional-order systems with fractional-order 0<α<2, in the presence of time-varying uncertainty. To obtain a robust stability condition, we first derive a new upper bound for the norm of Mittag-Leffler function associated with the nominal fractional-order system matrix. Then, by finding an upper bound for the norm of the uncertain fractional-order system solution, a sufficient non-Lyapunov robust stability condition is proposed. Unlike the previous methods for robust stability analysis of uncertain fractional-order systems, the proposed stability condition is applicable to systems with time-varying uncertainty. Moreover, the proposed condition depends on the fractional-order of the system and the upper bound of the uncertainty matrix norm. Finally, the offered stability criteria are examined on numerical uncertain linear fractional-order systems with 0<α<1 and 1<α<2 to verify the applicability of the proposed condition. Furthermore, the stability of an uncertain fractional-order Sallen–Key filter is checked via the offered condition.
A Low-Cost Motion Capture System for Small-Scale Wave Energy Device Tank Testing
Authors: Paparella Francesco , Sivcev Satja , Toal Daniel , Ringwood John V.
Published: September 2018

The measurement of the motion of a small-scale wave energy device during wave tank tests is important for the evaluation of its response to waves and the assessment of power production. Usually, the motion of a small-scale wave energy converter (WEC) is measured using an optical motion tracking system with high precision and sampling rate. However, the cost for an optical motion tracking system can be considerably high and, therefore, the overall cost for tank testing is increased. This paper proposes a low-cost capture system composed of an inertial measurement unit and ultrasound sensors. The measurements from the ultrasound sensors are combined optimally with the measurements from the inertial measurement unit through an extended Kalman filter (EKF) in order to obtain an accurate estimation of the motion of a WEC.
Pneumatosis cystoides intestinalis (PCI) in a patient with undiagnosed systemic sclerosis
Authors: Singh Gurpreet , Johnson Christopher , Gill Rosie , De Cruz Peter
Published: September 2018

Pneumatosis cystoides intestinalis (PCI) refers to the presence of gas within the wall of the small or large intestine. The pathophysiology is incompletely understood and is probably multifactorial in nature. PCI is a known but rare complication of systemic scleroderma, and the aetiology of PCI in patients with scleroderma is not fully understood. We present the case of a patient who was referred to gastroenterology clinic by her general practitioner for investigation of 8 months of weight loss, urgency, diarrhoea, bloating and crampy abdominal pain. Extensive investigations were performed to exclude infective, inflammatory or malignant aetiologies for these symptoms. She was diagnosed with PCI on her colonoscopy and was subsequently screened for secondary causes. Our patient was diagnosed with the limited cutaneous (CREST) variant of systemic scleroderma. This case report illustrates that PCI could be an uncommon presentation of systemic sclerosis, therefore clinicians should be aware of the association between these conditions.
Perianeurysmal vasogenic oedema (PAVO) following aneurysm embolisation: a unique case of asymptomatic long-term progression and review of the literature
Authors: Robinson Anthony Ernest , Phatouros Constantine Chris
Published: September 2018

Perianeurysmal vasogenic oedema is a recognised although rare phenomenon following endovascular treatment of certain intracranial aneurysms. We present a unique case of asymptomatic perianeurysmal vasogenic oedema following bare platinum coil embolisation of an incidentally discovered right middle cerebral artery aneurysm that slowly increased over a period of 6 years before stabilising and regressing. During this time, the coiled aneurysm per se remained completely stable on serial magnetic resonance angiography.
Unusual case of primary pulmonary Hodgkin’s lymphoma presenting with a continuous murmur
Authors: Conti Luca , Pisani David , Gatt Alexander , Montefort Stephen
Published: September 2018

Systemic to pulmonary fistulas are an unusual entity, even more so in association with Hodgkin’s lymphoma. We herein report a case of a 33-year-old woman that presented with an incidental lung lesion on a chest radiograph with an associated high-frequency continuous murmur over the lesion. The diagnosis of primary pulmonary Hodgkin’s lymphoma, nodular sclerosis type, was obtained by a CT transthoracic biopsy. We achieved an excellent response after polychemotherapy with near-complete disappearance of the mass and a residual faint systolic murmur over the lesion.
Severe calcium pyrophosphate dihydrate deposition disease of the metacarpophalangeal joints
Authors: Rigsbee Cody A , Sizemore Travis C , Lohr Kristine M
Published: September 2018

We report a case of calcium pyrophosphate deposition disease (CPPD) with an unusual presentation of severe chondrocalcinosis with atypical large burden deposited in the metacarpophalangeal joints as well as more typical deposition in wrists and knees as demonstrated on plain radiographs. A 77-year-old African-American woman 1-year status post parathyroidectomy for hyperparathyroidism initially presented to the rheumatology clinic to treat suspected rheumatoid arthritis given her pattern of joint involvement but was found to have CPPD. The patient’s history is notable for end-stage renal disease which complicates medical management. This case illustrates radiographic findings of CPPD and explores the challenges of treating CPPD in the setting of comorbid conditions.
Associations between physical activity and cataract treated surgically in patients with diabetes: findings from the 45 and Up Study
Authors: Wu Changfan , Han Xiaotong , Yan Xixi , Shang Xianwen , Zhang Lei , He Mingguang
Published: September 2018

Aim

To investigate the association between physical activity (PA) and incidence of cataract surgery among patients with diabetes.

Methods

We obtained data from all diabetic subjects aged 45-65 years from the baseline of the prospective 45 and Up Study from 2006 to 2009 and linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) until 2016. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on PBS. Cataract surgery was determined based on the MBS, and metabolic equivalent intensity level number of PA sessions per week was used to assess PA. Cox regression was used to assess the association between baseline PA and cataract surgery during the follow-up.

Results

A total of 9113 diabetic participants in the 45 and Up Study were included in the current analysis with a mean age of 57.3±5.2 years (43.6% female). During a mean follow-up of 8.8 years, 950 participants (10.4% of baseline) received cataract surgery with a corresponding incidence of 12.4/1000 person-years. Cox regression analysis showed that people with less PA (p=0.01), older age (p<0.001), female gender (p<0.001), higher educational level (p<0.001) and longer diabetic duration (p<0.001) had significantly higher cataract surgery risk. Participants with a PA level of ≥14 sessions per week had 19% decreased risk of cataract surgery compared to those with <5 sessions per week. Stratification analysis showed that participants with more obesity (p value for interaction=0.03), not taking insulin (p value for interaction=0.01) and without cardiovascular disease (p value for interaction=0.008) could benefit significantly more from PA in reducing their cataract surgery risk.

Conclusions

More vigorous PA was independently associated with a reduced risk of cataract surgery in working-aged patients with diabetes.
Temporal and spatial associations between influenza and asthma hospitalisations in New York City from 2002 to 2012: a longitudinal ecological study
Authors: Trinh Pauline , Jung Tae Hyun , Keene Danya , Demmer Ryan T , Perzanowski Matthew , Lovasi Gina
Published: September 2018

Objectives

To determine whether asthma hospitalisations of children and adults in the five boroughs of New York City are correlated with influenza hospitalisations temporally and spatially.

Design

A longitudinal ecological study.

Inclusion criteria

We reviewed the Statewide Planning and Research Cooperative System’s records of hospitalisations in Manhattan, Bronx, Queens, Brooklyn and Staten Island from 2002 to 2012. All hospitalisations with a primary diagnosis of either asthma or influenza were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes.

Methods

A time-series regression analysis was performed using aggregate monthly counts of influenza hospitalisations as predictors of asthma hospitalisations. Time-series regression models were also applied to different age groups and boroughs to examine the magnitude of influenza and asthma correlations across strata. The per cent excess risk was also calculated across age groups and boroughs.

Results

Time-series analysis of the overall population revealed a significant positive correlation between influenza and asthma hospitalisations (p=0.011). When stratifying by age, there was a significant positive correlation between asthma and influenza hospitalisations for individuals 18 and older (p<0.01), and no significant correlation found for age groups younger than 18. Percentages of excess risk of influenza-related asthma hospitalisations also increased with increasing age with adults 18–44, 45–64 and 65+ having excess risk percentages of 2.9%, 3.4% and 4%, respectively. Time-series analysis by location revealed positive significant correlations between asthma and influenza hospitalisations in Brooklyn (p=0.03) and Manhattan (p<0.01). Manhattan and Brooklyn had a 2.5% and 1.6%, respectively, percentage of excess risk of influenza-related asthma hospitalisations.

Conclusion

Influenza and asthma hospitalisations are significantly associated at the population level among adults. These associations vary by age and geographical location. Influenza prevention strategies targeting adult populations, particularly individuals living in Manhattan and Brooklyn, have the potential for meaningful reduction of influenza-related asthma hospitalisations.
Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study
Authors: Male Leanne Rachel , Noble Adam , Snape Darlene Ann , Dixon Peter , Marson Tony
Published: September 2018

Objectives

To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not.

Design

Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism.

Setting

In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study.

Participants

181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure.

Results

Five main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days.

Conclusions

Implementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.
Association of body mass index and age with incident diabetes in Chinese adults: a population-based cohort study
Authors: Chen Ying , Zhang Xiao-Ping , Yuan Jie , Cai Bo , Wang Xiao-Li , Wu Xiao-Li , Zhang Yue-Hua , Zhang Xiao-Yi , Yin Tong , Zhu Xiao-Hui , Gu Yun-Juan , Cui Shi-Wei , Lu Zhi-Qiang , Li Xiao-Ying
Published: September 2018

Objective

Type 2 diabetes mellitus is increasing in young adults, and greater adiposity is considered a major risk factor. However, whether there is an association between obesity and diabetes and how this might be impacted by age is not clear. Therefore, we investigated the association between body mass index (BMI) and diabetes across a wide range of age groups (20–30, 30–40, 40–50, 50–60, 60–70 and ≥70 years old).

Design

We performed a retrospective cohort study using healthy screening programme data.

Setting

A total of 211 833 adult Chinese persons >20 years old across 32 sites and 11 cities in China (Shanghai, Beijing, Nanjing, Suzhou, Shenzhen, Changzhou, Chengdu, Guangzhou, Hefei, Wuhan, Nantong) were selected for the study; these persons were free of diabetes at baseline.

Primary and secondary outcome measures

Fasting plasma glucose levels were measured and information regarding the history of diabetes was collected at each visit. Diabetes was diagnosed as fasting plasma glucose ≥7.00 mmol/L and/or self-reported diabetes. Patients were censored at the date of diagnosis or the final visit, whichever came first.

Results

With a median follow-up of 3.1 years, 4174 of the 211 833 participants developed diabetes, with an age-adjusted incidence rate of 7.35 per 1000 persons. The risk of incident diabetes increased proportionally with increasing baseline BMI values, with a 23% increased risk of incident diabetes with each kg/m2increase in BMI (95% CI 1.22 to 1.24). Across all age groups, there was a linear association between BMI and the risk of incident diabetes, although there was a stronger association between BMI and incident diabetes in the younger age groups (age×BMI interaction, p<0.0001).

Conclusions

An increased BMI is also independently associated with a higher risk of developing diabetes in young adults and the effects of BMI on incident diabetes were accentuated in younger adults.
Impact of bariatric surgery on neural food processing and cognition: an fMRI study
Authors: Schulze Marcel , Sörös Peter , Vogel Wolfgang , Münte Thomas F , Müller Helge H O , Philipsen Alexandra
Published: September 2018

Introduction

The Roux-en-Y gastric bypass (RYGB) is one of the most widely used techniques for bariatric surgery. After RYGB, weight loss up to 50%–70% of excess body weight, improvement of insulin-resistance, changes in food preferences and improvements in cognitive performance have been reported. This protocol describes a longitudinal study of the neural correlates associated with food-processing and cognitive performance in patients with morbid obesity before and after RYGB relative to lean controls.

Methods and analysis

This study is a pre–post case–control experiment. Using functional MRI, the neural responses to food stimuli and a working memory task will be compared between 25 patients with obesity, pre and post RYGB, and a matched, lean control group. Resting state fMRI will be measured to investigate functional brain connectivity. Baseline measurements for both groups will take place 4 weeks prior to RYGB and 12 months after RYGB. The effects of RYGB on peptide tyrosine tyrosine and glucagon-like polypeptide-1 will also be determined.

Ethics and dissemination

The project has received ethical approval by the local medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-073). Results will be published in a peer-reviewed journal as original research and on international conferences.

Trial registration number

DRKS00012495; Pre-results.
Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Women’s Cohort Study (UKWCS)
Authors: Moy Foong Ming , Greenwood Darren C , Cade Janet E
Published: September 2018

Objectives

Breast cancer is associated with overweight and obesity after menopause. However, clothing size as a proxy of adiposity in predicting postmenopausal breast cancer is not widely studied. We aimed to explore the relationships between postmenopausal breast cancer risk with adipose indicators (including clothing sizes) and weight change over adulthood.

Design

Prospective cohort study.

Setting

England, Wales and Scotland.

Participants

17 781 postmenopausal women from the UK Women’s Cohort Study.

Primary outcome measure

Incident cases of malignant breast cancers (International Classification of Diseases (ICD) 9 code 174 and ICD 10 code C50).

Results

From 282 277 person-years follow-up, there were 946 incident breast cancer cases with an incidence rate of 3.35 per 1000 women. Body mass index (HR: 1.04; 95% CI: 1.02 to 1.07), blouse size (HR: 1.10; 1.03 to 1.18), waist circumference (HR: 1.07; 1.01 to 1.14) and skirt size (HR: 1.14;1.06 to 1.22) had positive associations with postmenopausal breast cancer after adjustment for potential confounders. Increased weight over adulthood (HR: 1.02; 1.01 to 1.03) was also associated with increased risk for postmenopausal breast cancer.

Conclusions

Blouse and skirt sizes can be used as adipose indicators in predicting postmenopausal breast cancer. Maintaining healthy body weight over adulthood is an effective measure in the prevention of postmenopausal breast cancer.
Experiences of women with cardiac disease in pregnancy: a systematic review and metasynthesis
Authors: Dawson Angela J , Krastev Yordanka , Parsonage William A , Peek Michael , Lust Karin , Sullivan Elizabeth A
Published: September 2018

Objective

Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services.

Method

We conducted a systematic search of peer-reviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women’s experiences extracted from each publication to inform new healthcare practices and communication.

Results

Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences.

Conclusions

There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidence-based guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decision-making must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care.
Changing trends in suicide rates in South Korea from 1993 to 2016: a descriptive study
Authors: Lee Sang-Uk , Park Jong-Ik , Lee Soojung , Oh In-Hwan , Choi Joong-Myung , Oh Chang-Mo
Published: September 2018

Objectives

The South Korean government has recently implemented policies to prevent suicide. However, there were few studies examining the recent changing trends in suicide rates. This study aims to examine the changing trends in suicide rates by time and age group.

Design

A descriptive study using nationwide mortality rates.

Setting

Data on the nationwide cause of death from 1993 to 2016 were obtained from Statistics Korea.

Participants

People living in South Korea.

Interventions

Implementation of national suicide prevention policies (first: year 2004, second: year 2009).

Primary outcome measures

Suicide was defined as ‘X60-X84’ code according to the ICD-10 code. Age-standardised suicide rates were estimated, and a Joinpoint regression model was applied to describe the trends in suicide rate.

Results

From 2010 to 2016, the suicide rates in South Korea have been decreasing by 5.5% (95% CI −10.3% to −0.5%) annually. In terms of sex, the suicide rate for men had increased by 5.0% (95% CI 3.6% to 6.4%) annually from 1993 to 2010. However, there has been no statistically significant change from 2010 to 2016. For women, the suicide rate had increased by 7.5% (95% CI 6.3% to 8.7%) annually from 1993 to 2009, but since 2009, the suicide rate has been significantly decreasing by 6.1% (95% CI −9.1% to −3.0%) annually until 2016. In terms of the age group, the suicide rates among women of almost all age groups have been decreasing since 2010; however, the suicide rates of men aged between 30 and 49 years showed continuously increasing trends.

Conclusion

Our results showed that there were differences in the changing trends in suicide rate by sex and age groups. Our finding suggests that there was a possible relationship between implementation of second national suicide prevention policies and a decline in suicide rate.
Nurse-led medicines’ monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines
Authors: Jordan Sue , Banner Timothy , Gabe-Walters Marie , Mikhail Jane M , Round Jeff , Snelgrove Sherrill , Storey Mel , Wilson Douglas , Hughes David
Published: September 2018

Introduction

Improved medicines’ management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes.

Methods and analysis

This process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method.

Ethics and dissemination

Ethical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators.

Trial registration number

NCT03110471.
What is the evolution of stroke unit’s accessibility in metropolitan France from 2009 to 2014? A trend analysis of over 600 000 patients using national hospital databases.
Authors: Istvan Marion , Lecoffre Camille , Bayat Sahar , Béjot Yannick , Le Strat Yann , De Peretti Christine , Gao Fei , Olié Valérie , Grimaud Olivier
Published: September 2018

Objectives

We aimed to study trends in stroke unit (SU) admission during a period of their deployment in France and to assess whether this led to better and more equitable access to this specialised care.

Design

Analysis of records from the national hospital database.

Setting

All acute care hospitals in metropolitan France for the period 2009–2014.

Participants

Over 600 000 patients admitted in acute care with a main diagnosis of stroke.

Main outcome measures

Admission to a SU.

Results

Between 2009 and 2014, the number of stroke admissions rose from 93 728 to 109 456, and the proportion of SU admission from 23% to 44%. Overall, characteristics associated with higher probability of SU admission were: male gender, younger age, ischaemic stroke type, medium level of comorbidity and larger size of town of residence. Although likelihood of SU admission increased in all patients’ categories during the study period, we identified steeper positive temporal trends among older patients, those with more comorbidities and those residing in medium or small towns (all p values <0.001), suggesting a ‘catching up’ phenomena. Temporal trends of men and women did not differ however.

Conclusions

Admission to SU nearly doubled in France between 2009 and 2014. Faster trends observed for patients with lower admission to SU suggest that equity in access has improved over the period.
Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study
Authors: Beom Jin Ho , Kim Min Joung , You Je Sung , Lee Hye Sun , Kim Ji Hoon , Park Yoo Seok , Shin Dong Min , Chung Hyun Soo
Published: September 2018

Objectives

To analyse changes in the quality of cardiopulmonary resuscitation (CPR) according to driving patterns encountered during ambulance transport, using a virtual reality simulator.

Design

Prospective, cross-over, randomised study.

Setting

This study was conducted at the National Fire Service Academy, Cheonan-si, Korea.

Participants

Emergency medical technicians (39 men and 9 women) attending the National Fire Service Academy for clinical training with ≥6 months field experience or having performed ≥10 CPR. Individuals who withdrew consent were excluded.

Outcome measures

CPR quality parameters (eg, chest compression depth and its variability).

Results

Chest compressions were performed for 8 min each in a stationary and driving state. The mean chest compression depths were 54.8 mm and 55.3 mm during these two states, respectively (p=0.41). The SD of the chest compression depth was significantly higher while in the driving (7.6 mm) than in the stationary state (6.5 mm; p=0.04). The compression depths in the speed bump and sudden stop sections were 51.5 mm and 50.6 mm, respectively, which was shallower than those in all other sections (p<0.001). The correct hand position rate was low in the speed bump, sudden stop and right-hand cornering sections (65.4%, 71.5% and 72.5%, respectively; p=0.001)

Conclusions

Although we found no differences in chest compression quality parameters between the stationary and driving states, the variability in the chest compression depth increased in the driving state. When comparing CPR quality parameters according to driving patterns, we noted a shallower compression depth, increased variability and decreased correct hand position rate in the speed bump, sudden stop and right-hand cornering sections. The clinical significance of these changes in CPR quality during ambulance transport remains to be determined. Future studies on how to reduce changes in the quality of CPR (including research on equipment development) are needed.
Access to care for people with alcohol use disorder in France: a mixed-method cross-sectional study protocol (ASIA)
Authors: Costa Marie , Marcellin Fabienne , Coste Marion , Barré Tangui , Nordmann Sandra , Mora Marion , Maradan Gwenaëlle , Tanti Marc , Cutarella Christophe , Casanova Danielle , Levy-Bellaiche Sabrina , Polomeni Pierre , Simon Nicolas , Roux Perrine , Carrieri Maria-Patrizia
Published: September 2018

Introduction

Alcohol use disorder (AUD) is a major public health concern worldwide. In France, only 10% of people with AUD (PWAUD) receive medical care. General practitioners (GP) are one of the main entry points for AUD care. The present ongoing study, entitled ASIA (Access to Care and Indifference toward Alcohol,Accès aux Soins et Indifference à l’Alcoolin French), aims to improve knowledge about factors associated with access to care for AUD by exploring related GP and PWAUD practices, experiences and perceptions.

Methods and analysis

The ASIA project is an ongoing cross-sectional multisite study based on a complementary mixed-method approach (quantitative and qualitative) using a convergent parallel design. The double-perspective design of the study will enable us to collect and compare data regarding both PWAUD and GP points of view. For the PWAUD quantitative study, 260 PWAUD will be interviewed using a telephone-based questionnaire. For the qualitative study, 36 PWAUD have already been interviewed. The GP quantitative study will include 100 GP in a 15 min survey. Fifteen GP have already participated in semistructured interviews for the qualitative study. Logistic regression will be used to identify predictors for access to care. With respect to data analyses, qualitative interviews will be analysed using semantic analysis while quantitative logistic regression will be used for quantitative interviews.

Ethics and dissemination

This study was approved by the CNIL (French National Commission on Informatics and Liberties) (approval reference number: C16-10, date of approval: 17 July 2017), the CCTIRS (Advisory Committee on Information Processing in Material Research in the Field of Health) and the CEEI (Evaluation and Ethics Committee) (approval reference number: 16–312, date of approval: 8 July 2016) of INSERM (French National Institute of Health and Medical Research). Results from ASIA will be disseminated in peer-reviewed publications, conference presentations, reports and in a PhD thesis.
Recorded atypical hallucinations in psychotic and affective disorders and associations with non-benzodiazepine hypnotic use: the South London and Maudsley Case Register
Authors: Birnie Karen Isabel , Stewart Robert , Kolliakou Anna
Published: September 2018

Objectives

Hallucinations are present in many conditions, notably psychosis. Although under-researched, atypical hallucinations, such as tactile, olfactory and gustatory (TOGHs), may arise secondary to hypnotic drug use, particularly non-benzodiazepine hypnotics (‘Z drugs’). This retrospective case-control study investigated the frequency of TOGHs and their associations with prior Z drug use in a large mental healthcare database.

Methods

TOGHs were ascertained in 2014 using a bespoke natural language processing algorithm and were analysed against covariates (including use of Z drugs, demographic factors, diagnosis, disorder severity and other psychotropic medications) ascertained prior to 2014.

Results

In 43 339 patients with International Classification of Diseases, Tenth Edition schizophreniform or affective disorder diagnoses, 324 (0.75%) had any TOGH recorded (0.54% tactile, 0.24% olfactory, 0.06% gustatory hallucinations). TOGHs were associated with male gender, black ethnicity, schizophreniform diagnosis and higher disorder severity on Health of the National Outcome Scales. In fully adjusted models, tactile and olfactory hallucinations remained independently associated with prior mention of Z drugs (ORs 1.86 and 1.60, respectively).

Conclusions

We successfully developed a natural language processing algorithm to identify instances of TOGHs in the clinical record. TOGHs overall, tactile and olfactory hallucinations were shown to be associated with prior mention of Z drugs. This may have implications for the diagnosis and treatment of patients with comorbid sleep and psychiatric conditions.
We want to know: patient comfort speaking up about breakdowns in care and patient experience
Authors: Fisher Kimberly A , Smith Kelly M , Gallagher Thomas H , Huang Jim C , Borton James C , Mazor Kathleen M
Published: September 2018

Objective

To assess patient comfort speaking up about problems during hospitalisation and to identify patients at increased risk of having a problem and not feeling comfortable speaking up.

Design

Cross-sectional study.

Setting

Eight hospitals in Maryland and Washington, District of Columbia.

Participants

Patients hospitalised at any one of eight hospitals who completed the Hospital Consumer Assessment of Healthcare Providers and Systems survey postdischarge.

Main outcome measures

Response to the question ‘How often did you feel comfortable speaking up if you had any problems in your care?’ grouped as: (1)no problemsduring hospitalisation, (2)alwaysfelt comfortable speaking up and (3)usually/sometimes/neverfelt comfortable speaking up.

Results

Of 10 212 patients who provided valid responses, 4958 (48.6%) indicated they had experienced a problem during hospitalisation. Of these, 1514 (30.5%) did not always feel comfortable speaking up. Predictors of having a problem during hospitalisation included age, health status and education level. Patients who were older, reported worse overall and mental health, were admitted via the Emergency Department and did not speak English at home were less likely to always feel comfortable speaking up. Patients who were not always comfortable speaking up provided lower ratings of nurse communication (47.8 vs 80.4; p<0.01), physician communication (57.2 vs 82.6; p<0.01) and overall hospital ratings (7.1 vs 8.7; p<0.01). They were significantly less likely to definitely recommend the hospital (36.7% vs 71.7 %; p<0.01) than patients who were always comfortable speaking up.

Conclusions

Patients frequently experience problems in care during hospitalisation and many do not feel comfortable speaking up. Creating conditions for patients to be comfortable speaking up may result in service recovery opportunities and improved patient experience. Such efforts should consider the impact of health literacy and mental health on patient engagement in patient-safety activities.
Using clinical simulation to study how to improve quality and safety in healthcare
Authors: Lamé Guillaume , Dixon-Woods Mary
Published: September 2018

Simulation can offer researchers access to events that can otherwise not be directly observed, and in a safe and controlled environment. How to use simulation for the study of how to improve the quality and safety of healthcare remains underexplored, however. We offer an overview of simulation-based research (SBR) in this context. Building on theory and examples, we show how SBR can be deployed and which study designs it may support. We discuss the challenges of simulation for healthcare improvement research and how they can be tackled. We conclude that using simulation in the study of healthcare improvement is a promising approach that could usefully complement established research methods.
Outcome after myocardial infarction without obstructive coronary artery disease
Authors: Williams Michael J A , Barr Peter R , Lee Mildred , Poppe Katrina K , Kerr Andrew J
Published: September 2018

Objective

The medium-term outcome and cause of death in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not well characterised. The aim of this study was to compare mortality and rates of recurrent events in post myocardial infarction (MI) patients with obstructive coronary artery disease (CAD) and in patients with MINOCA compared with an age and sex-matched cohort without cardiovascular disease (CVD).

Methods

We performed a national cohort study of consecutive patients undergoing coronary angiography for MI during 2 years between 2013 and 2015 from the All New Zealand Acute Coronary Syndrome—Quality Improvement (ANZACS QI) registry. MI patient registry data were linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD formed the comparison group.

Results

Of the 8305 patients with MI, 897 (10.8%) were classified as MINOCA. Compared with those without known CVD, the adjusted HRs for the primary outcome (all-cause death or recurrent non-fatal MI) were 7.81 (95% CI 6.64 to 9.19, p<0.0001) in those with obstructive CAD and 4.64 (95% CI 3.54 to 6.10, p<0.0001) in those with MINOCA. Kaplan-Meier all-cause mortality at 2 years was 7.9% for those with obstructive CAD, with nearly half being CVD deaths (3.6% CVD deaths and 4.5% non-CVD deaths, respectively). In contrast, MINOCA all-cause mortality was 4.9% with non-CVD death (4.5%) predominating.

Conclusions

MINOCA is common and has an adverse outcome rate approximately half than that of those with obstructive CAD. The predominant contributor to mortality is non-CVD death. The rate of events in MINOCA is significantly greater than the population without CVD.
British rubber and cable industry cohort: 49-year mortality follow-up
Authors: McElvenny Damien Martin , Mueller William , Ritchie Peter , Cherrie John W , Hidajat Mira , Darnton Andrew J , Agius Raymond M , de Vocht Frank
Published: September 2018

Background

The International Agency for Research on Cancer (IARC) has determined there is sufficient evidence that working in the rubber manufacturing industry increases the risk of cancers of the stomach, lung, bladder and leukaemia and lymphoma.

Objectives

To examine mortality patterns of a prospective cohort of men from the rubber and cable manufacturing industries in Great Britain.

Methods

SMRs were calculated for males aged 35+ years at start of follow-up in 1967–2015 using the population of England and Wales as the external comparator. Tests for homogeneity and trends in SMRs were also completed.

Results

For all causes, all malignant neoplasms, non-malignant respiratory diseases and circulatory diseases, SMRs were significantly elevated, and also particularly for cancers of the stomach (SMR=1.26,95% CI 1.18 to 1.36), lung (1.25,95% CI 1.21 to 1.29) and bladder (1.16,95% CI 1.05 to 1.28). However, the observed deaths for leukaemia, non-Hodgkin’s lymphoma (NHL) and multiple myeloma were as expected. Bladder cancer risks were elevated only in workers exposed to antioxidants containing 1-naphthylamine and 2-naphthylamine.

Conclusions

This study provides evidence of excess risks in the rubber industry for some non-cancer diseases and supports IARC’s conclusions in relation to risks for cancers of the bladder, lung and stomach, but not for leukaemia, NHL or multiple myeloma.
Association between dimensions of the psychosocial and physical work environment and latent smoking trajectories: a 16-year cohort study of the Canadian workforce
Authors: Dobson Kathleen G , Gilbert-Ouimet Mahée , Mustard Cameron A , Smith Peter M
Published: September 2018

Background

This study aimed to determine the number of latent smoking trajectories among Canadians employed in the workforce over a 16-year period, and if latent trajectories in dimensions of the physical and psychosocial work environment were associated with specific smoking trajectories.

Methods

We studied 5461 employed adults from the longitudinal Canadian National Population Health Survey. Daily cigarette consumption was measured biannually from 1994 to 2010. Work environment factors (skill discretion, decision authority, psychological demands, job insecurity, physical exertion and workplace social support) were measured in 1994 and then from 2000 to 2010 using an abbreviated form of the Job Content Questionnaire. Smoking and work environment trajectories were derived using group-based trajectory modelling. Associations between work environment trajectory classes and smoking trajectory classes were estimated using multinomial logistic regression.

Results

Four latent smoking trajectories were seen: non-smokers; ceasing smokers (consuming ~14 cigarettes/day in 1994 and 0 in 2008–2010); smokers (consuming ~7 cigarettes/day between 1994 and 2010); and heavy smokers (consuming ~22 cigarettes/day in 1994 and ~14 in 2010). Lower skill discretion, high psychological demands, high physical exertion and low social support trajectories were associated with membership in the heavy smoking trajectory compared with the non-smoking trajectory. Low decision authority, high psychological demands and high physical exertion trajectories were associated with membership in the ceasing compared with the non-smoking trajectory.

Conclusions

Certain physical and psychosocial work environment trajectories were associated with heavy and ceasing smoking behaviours over a 16-year period. The role of the work environment should be further considered in smoking cessation programmes.
Phosphatidylethanolamine Participates in the Stimulation of the Contact System of Coagulation by Very-Low-Density Lipoproteins
Authors: Klein Sonja , Spannagl Michael , Engelmann Bernd
Published: September 2018

Abstract—

We have analyzed the influence of plasma lipoproteins on the activation of the contact pathway of blood coagulation in platelet-rich plasma (PRP). The formation of thrombin in PRP incubated in vitro was abolished by the factor XIIa antagonist corn trypsin inhibitor and by severe factor XII deficiency, indicating mediation by the contact system. Addition of VLDL to the PRP shortened the lag period and increased the generation of thrombin. There was no effect of HDL and LDL. In whole blood, VLDL accelerated the rate of fibrin formation, the procoagulant effect being prevented by factor XII deficiency and by corn trypsin inhibitor. The thrombin formation in the PRP was strongly increased by microemulsions of the VLDL lipids while it was reduced by the aqueous phase of the particles. Separation of the VLDL lipids indicated the phospholipid component as the major activating principle. Vesicles supplemented with all VLDL phospholipids but lacking specifically the fraction containing phosphatidylethanolamine (PE) prolonged the lag time. The PE containing fraction alone as well as vesicles enriched with egg PE shortened the lag period. In summary, VLDL stimulates the contact pathway of blood coagulation, ethanolamine phospholipids being the most active components of the particles.
Novel ICD Programming and Inappropriate ICD Therapy in CRT-D Versus ICD Patients
Authors: Kutyifa Valentina , Daubert James P. , Schuger Claudio , Goldenberg Ilan , Klein Helmut , Aktas Mehmet K. , McNitt Scott , Stockburger Martin , Merkely Bela , Zareba Wojciech , Moss Arthur J.
Published: September 2018

Background—

The Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT.

Methods and Results—

The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25–0.57;
P
<0.001). High-rate cut-off or delayed ventricular tachycardia therapy programming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A];
P
<0.001 for all). There was a significant reduction in inappropriate anti-tachycardia pacings in both group and a significant reduction in inappropriate ICD shock in CRT-D patients.

Conclusions—

Patients implanted with a CRT-D have lower risk of inappropriate ICD therapy than those with an ICD. Innovative ICD programming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients.

Clinical Trial Registration—

http:
//clinicaltrials.gov
; Unique identifier: NCT00947310.