bluuebunny/crossref_metadata_2025 huggingface dataset:
Back massage intervention for improving health and sleep quality among intensive care unit patients
Authors: Hsu Wen‐Chi , Guo Su‐Er , Chang Chia‐Hao
Published: April 2019

Background

A massage may relax muscles, improve blood circulation and reduce pain and anxiety while also improving sleep quality by increasing comfort. However, there is little research on whether a back massage improves sleep quality in intensive care unit (ICU) patients.

Aims and objectives

This study examined the effects of a back massage on improving vital signs, sleep quality, anxiety and depression among ICU patients.

Design

Adopting a quasi‐experimental design, convenience sampling was used to recruit ICU patients from a medical centre in Southern Taiwan. The experimental group received back massages for three consecutive days (n = 30), while controls received usual care (n = 30).

Methods

The Verran and Snyder‐Halpern Scale and the Hospital Anxiety and Depression Scale were used, and subjective and objective sleep time (wrist actigraphy and sleep duration from nurse observations) was recorded. The effect of the intervention was examined using a generalized estimating equation model with a robust standard error and an exchangeable working correlation matrix adjusting for time.

Results

The results show that subjective sleep quality scores in ICU patients were low. Mean observed sleep time (measured by nurses) was 3·9 h, but mean sleep time measured using wrist actigraphy was 5·9 h. Back massages improved breathing in patients, increased sleep quality reflected by both subjective and objective data and were associated with a significant change in anxiety.

Conclusions

These findings suggest that a 10‐min back massage can improve sleep quality, sleep duration, breathing and anxiety in ICU patients.

Relevance to clinical practice

The implementation of a back massage shows positive improvements in the sleep quality of ICU patients. The training and theory of massage interventions should be further applied when developing courses in critical care nursing.
On polyphyly of the former section Ochlopoa and the hybridogenic section Acroleucae (Poa , Poaceae): insights from molecular phylogenetic analyses
Authors: Nosov Nikolai N. , Tikhomirov Valery N. , Machs Eduard M. , Rodionov Alexander V.
Published: April 2019

In this study, sequence data from the inert nuclear region ITS1‐5.8S rDNA‐ITS2 and the chloroplast region trnL–F, as well as a few morphological characters, are analysed to the relationships among known annual Poa (bluegrasses). It is shown that all taxa from the Poa annua aggregate distinguished by lemma characters and growth form have identical ITS and trnL–trnF sequences, all ITS sequences of this aggregate are the same as thethose of P. supina, and all trnL–trnF sequences are homologous with those of P. infirma. Furthermore, no differences were found between unusual morphotypes of P. supina with short spinules on their panicle branches and typical plants, but Siberian samples were found to have a slightly differentiated trnL–trnF region. These results suggest a hybrid origin of the Asian annual bluegrasses. Their maternal genome is close to that of P. sect. Homalopoa, but their ITS sequences are different. Some ITS sequences from annual Asian bluegrasses are resolved among representatives of P. sect. Stenopoa while for other (morphologically closely similar) species they fall in a clade with representatives of P. sect. Malacanthae. The latter group is distant from P. sect. Ochlopoa and is better treated as a separate section, viz P. sect. Acroleucae. The American annual bluegrasses are heterogeneous and also rather distant from P. sect. Ochlopoa. Poa chapmaniana, a species with cleistogamic flowers, is nested among the basal Subantarctic sections, far away from the taxa with which it has previously been considered related. It is indeed closer to P. sect. Ochlopoa than to other annual American bluegrasses. Thus, the studied annual species in fact belong to four independent evolutionary lines (or six including the separate genus Eremopoa and the Turkish Poa jubata), one of which, Acroleucae, has gone through three reticulation events. As in previous studies, our analysis did not support the generic status of P. sect. Ochlopoa.
Group‐based trajectory modelling for BMI trajectories in childhood: A systematic review
Authors: Mattsson Molly , Maher Gillian M. , Boland Fiona , Fitzgerald Anthony P. , Murray Deirdre M. , Biesma Regien
Published: April 2019

Childhood obesity is an important public health issue. We aimed to systematically review studies that used group‐based trajectory modelling approaches to investigate body mass index (BMI) trajectories in early childhood, explore associated determinants, and the association with body composition outcomes. Five databases were searched systematically for studies using group‐based trajectory modelling approaches to track BMI trajectories from birth. Fourteen studies using latent class growth analysis or growth mixture modelling to track BMI trajectories were identified. Three or four trajectories were identified in most studies. High maternal pre‐pregnancy BMI was the most frequently identified risk factor for membership of a rapid gain trajectory. Significant associations between rapid weight gain and stable high trajectories and body measures at follow‐up were identified by several studies. Relatively similar trajectories were identified across studies. Trajectories characterized by rapid weight gain were associated with several predictors, as well as body measures at follow‐up, however not with great consistency. Similar associations with body measure outcomes were found for stable high and rapid gain trajectories, suggesting that long‐term outcomes do not differ greatly between children with consistently high BMI and children with rapid increases in BMI. As the shape and timing of the trajectories differed between studies, it is difficult to draw conclusions.
The Impact of Student Loan Debt and Student Loan Delinquency on Total, Sex‐, and Age‐specific Suicide Rates during the Great Recession
Authors: Jones Roderick W.
Published: April 2019

In 2012, the outstanding student loan balance in the United States surpassed $1 trillion, and between 2005 and 2012, the student loan delinquency rate increased by 77 percent. Simultaneously, by the end of the 2005–2012 time period, the total suicide rate in the United States reached the highest levels in more than a decade. To investigate the recent trends in student loans and suicide, this paper examined the association between state‐level student loan debt, student loan delinquency, and total, age‐, and sex‐specific suicide rates. The study used a hybrid (decompositional) longitudinal regression approach to examine the relationship between student loan debt, delinquency, and suicide rates during the 2005–2012 time period. The results showed student loan delinquency had a positive and significant effect on several of the suicide rates examined within states but had no effect on suicide rates between states net of controls. The results also showed student loan debt had a significant and negative association with suicide for people ages 20–24 and 25–34.
Cash‐for‐care payments in Europe: Changes in resource allocation
Authors: Gori Cristiano , Morciano Marcello
Published: April 2019

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time.

This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind?
Simulation of depth and wind effects on the hydraulic efficiency of sedimentation tanks
Authors: Alighardashi Abolghasem , Goodarzi Danial
Published: April 2019

In this research, we aim to investigate the effects of the depth and wind effect on the surface of water on the hydraulic efficiency of the sedimentation tanks in water and wastewater treatments plants. A verified two‐dimensional numerical study was performed to evaluate hydraulic performance of series settling tanks by four different depths of 2.5, 3, 3.5 and 4 (m). Wind velocities of 5 and 7 (m/s) in co‐current and counter‐current direction of water flow in sedimentation tank were applied on the surface of the water. In this study, k–ε turbulent model and passive scalar tracer were used to perform the simulations. The research confirms that wind influence on the surface of water causes recirculation zones and increases the length of recirculation zones. In both windy and normal situation, the Real Hydraulic Retention Time and the effective volume of sedimentation tanks increases widely as the depth of the tank.
Association of postprandial triglyceride responses with insulin resistance among rotational night shift healthcare workers
Authors: Kiranmala Keithellakpam , Aslam Mohammad , Mishra Brijesh Kumar , Jhamb Rajat , Madhu Sri Venkata
Published: April 2019

New Findings

What is the central question of this study?

Does long‐term rotational night shift work among healthcare workers alter postprandial triglyceride metabolism, and are the postprandial triglyceride responses associated with insulin resistance?

What is the main finding and its importance?

Rotational night shift duties in healthcare workers might have a negative impact on postprandial triglyceride responses and insulin sensitivity. This is the first study in which postprandial triglyceride responses among shift workers exposed to long‐term night shifts have been studied.

Studies on the postprandial period demonstrate that in experimental conditions, abrupt or acute changes in sleep timing and work are followed by significantly altered postprandial glucose, insulin secretion and lipid tolerance. Whether shift work results in altered postprandial triglyceride (PPTG) metabolism in the long term is not known. In the present study, we aimed to ascertain the association between PPTG and shift work in relationship to cardiometabolic risks and to compare the PPTG response among healthcare workers with and without night shift duties. Twenty healthcare workers with rotational night shifts (group 2) and 20 age‐ and sex‐matched healthcare workers who had not done night shift duty in the past 1 year or ever (group 1) were recruited. Only subjects with normal glucose tolerance were recruited. A standardized fat challenge test was done in all study subjects. The postprandial triglyceride area under the curve (PPTG AUC) showed overall (n = 40) a significant positive correlation with fasting insulin and homeostatic model assessment of insulin resistance (HOMA‐IR) (r = 0.40, P = 0.01 and r = 0.37, P = 0.01, respectively) and in group 2 (r = 0.49, P = 0.02 and r = 0.44, P = 0.042, respectively). The PPTG peak also showed a significant positive correlation with fasting insulin and HOMA‐IR in group 2 (r = 0.52, P = 0.01 and r = 0.47, P = 0.03, respectively). No significant correlation was found in group 1. The PPTG AUC and PPTG peak were, however, comparable between both groups. The findings of this pilot study suggest that rotational night shift duties in healthcare workers might have a negative impact on metabolic parameters, including postprandial triglyceride responses and insulin sensitivity.
Comparative Study of Wall-Shear Stress at the Ascending Aorta for Different Mechanical Heart Valve Prostheses
Authors: Li Qianhui , Hegner Franziska , Bruecker Christoph H.
Published: April 2019

An experimental study is reported which investigates the wall shear stress (WSS) distribution in a transparent model of the human aorta comparing an St. Jude Medical (SJM) Regent bileaflet mechanical heart valve (BMHV) with the Lapeyre-Triflo FURTIVA trileaflet mechanical heart valve (TMHV) in physiological pulsatile flow. Elastic microcantilever structures, calibrated as micropillar WSS sensors by microparticle-image-velocimetry measurements, are applied to the wall along the ascending aorta (AAo). The peak WSS values in the BMHV are observed to be almost twice that of the values seen in the TMHV. Flow field analysis illuminates that these peaks are linked to the jet-like flows generated in the valves interacting with the aortic wall. Not only the magnitude but also the impact regions are specific for different valve designs. The side-orifice jets generated by the BMHV travel along the aortic wall in the AAo, impacting the wall throughout the AAo. However, the jets generated by TMHV impact further downstream in the AAo and results in a reduced WSS.
Self-Excited and Hidden Attractors in an Autonomous Josephson Jerk Oscillator: Analysis and Its Application to Text Encryption
Authors: Kingni Sifeu Takougang , Kuiate Gaetan Fautso , Tamba Victor Kamdoum , Pham Viet-Thanh , Hoang Duy Vo
Published: April 2019

By converting the resistive capacitive shunted junction model to a jerk oscillator, an autonomous chaotic Josephson jerk oscillator which can belong to oscillators with hidden and self-excited attractors is designed. The proposed autonomous Josephson jerk oscillator has two or no equilibrium points depending on DC bias current. The stability analysis of the two equilibrium points shows that one of the equilibrium points is unstable while for the other equilibrium point, the existence of a Hopf bifurcation is established. The dynamical behavior of autonomous Josephson jerk oscillator is analyzed by using standard tools of nonlinear analysis. For a suitable choice of the parameters, an autonomous Josephson jerk oscillator can generate antimonotonicity, periodic oscillations, self-excited chaotic attractors, hidden chaotic attractors, hidden chaotic bubble attractors, and coexistence between periodic and chaotic self-excited attractors. Finally, a text cryptographic encryption scheme with the help of generalized function projective synchronization of the proposed autonomous Josephson jerk oscillators in hidden chaotic attractor regime is illustrated through a numerical example, showing that a high-level security device can be produced using this system.
Seismic Analysis of Open-Top Storage Tanks With Flexible Foundation
Authors: Bohra Harsh , Azzuni Eyas , Guzey Sukru
Published: April 2019

The behavior of aboveground storage tanks subjected to seismic excitation was investigated using numerical methods by taking flexibility of foundation into account. The hydrostatic load due to stored liquid has an axisymmetric distribution on the tank shell and base. However, during seismic events, the hydrodynamic load originating from the seismic acceleration of liquid in the tank starts to act in the direction of the earthquake motion. This leads to a nonaxisymmetric loading distribution, which may result in buckling and uplifting of the tank structure. Finite element models were created having nonlinear material properties and large deformation capabilities. Three different tank geometries with liquid height to tank radius aspect ratios of 0.67, 1.0, and 3.0 were selected representing broad, nominal, and slender tanks. These tanks were subjected to two different hydrodynamic loading based on Housner's and Jacobsen–Veletsos' pressure distributions, which forms the basis of design provisions used in American Petroleum Institute API 650 and Eurocode 8, respectively. These pressure distributions were formulated under the assumption of rigid tank wall and base. Furthermore, each tank for a given geometry was subjected to two different foundations: (1) representing a rigid foundation and (2) representing a flexible foundation. The flexible foundation was created using a series of compression-only elastic springs attached to tank base having equivalent soil stiffness. Static analysis corresponding to maximum dynamic force was performed. The finite element results for circumferential and longitudinal stress in the shell were compared with the provisions of API 650. It was found that the effect of foundation flexibility from the practical design point of view may be neglected for broad tanks, but should be considered for nominal and slender tanks.
Analysis of Residual Stresses in the Transition Zone of Tube-to-Tubesheet Joints
Authors: Bouzid Abdel-Hakim , Pourreza Mohammad
Published: April 2019

The rigorous stress analysis of tube-to-tubesheet joints requires a particular attention to the transition zone of the expanded tube because of its impact on joint integrity. This zone is the weakest part of the joint due to the presence of high tensile residual stresses produced during the expansion process, which coupled to in-service loadings and harsh corrosive fluids results in joint failure. In fact, it is often subjected to stress corrosion cracking caused by intergranular attack leading to plant shutdown. Therefore, the evaluation of the residual stresses in this zone is of major interest during the design phase and its accurate assessment is necessary to achieve a reliable joint in service. In this study, an analytical model to evaluate the residual axial and hoop stresses in the transition zone of hydraulically expanded tubes based on an elastic perfectly plastic material behavior has been developed. The model is capable of predicting the stress state when maximum expansion pressure is applied and after its release. Three main regions are identified in the transition zone: the fully plastic region, the partially plastic region, and the elastic region. Therefore, various theories have been applied to analyze the stresses and deformations neglecting the elastoplastic region because of simplicity. The validation of analytical model is conducted by comparison of the results with those of 3D finite element models of two typical joints of different geometries and mechanical properties. The effect strain hardening and reverse yielding of the expansion zone are also investigated.
Compendious Review on “Internal Flow Physics and Minimization of Flow Instabilities Through Design Modifications in a Centrifugal Pump”
Authors: Mandhare Neeta A. , Karunamurthy K. , Ismail Saleel
Published: April 2019

Centrifugal pumps are one of the significant consumers of electricity and are one of the most commonly encountered rotodynamic machines in domestic and industrial applications. Centrifugal pumps operating at off-design conditions are often subject to different periodic flow randomness, which in turn hampers functionality and performance of the pump. These limitations can be overcome by modification in the conventional design of different components of a centrifugal pump, which can assuage flow randomness and instabilities, reconstitute flow pattern and minimize hydraulic flow losses. In this article, flow vulnerabilities like pressure and flow inconsistency, recirculation, boundary layer separation, adverse rotor–stator interaction, and the effects on operation and performance of a centrifugal pump are reviewed. This article also aims to review design modification attempts made by different researchers such as impeller trimming, rounding, geometry modification of different components, providing microgrooves on the impeller and others. Based on the findings of this study, it is concluded that some design modifications of the impeller, diffuser, and casing result in improvement of functionality, efficiency, and reduction in pressure fluctuations, flow recirculation, and vibrations. Design modifications should improve the performance without hampering functionality and useful operational range of the pump. Considerable research is still necessary to continue understanding and correlating flow physics and design modifications for the pump impeller, diffuser, and casing.
Standard Rating Charts for Low Global Warming Potential Refrigerants Flowing Through Adiabatic Helical Capillary Tube
Authors: Pandey Badrish , Reddy Desireddy Shashidhar , Khan Mohd. Kaleem , Pathak Manabendra
Published: April 2019

The present research work is undertaken to develop ASHRAE like standard rating charts for currently used refrigerants R-134a and R-410A and their potential low global warming potential (GWP) substitutes R-1234yf and R-32, respectively. A self-adjustable mass prediction algorithm has been developed using an averaging technique. Based on this, a matlab code dynamically linked to refprop v. 9.0 software has been developed that solves governing equations of mass, momentum, and energy. Two-phase flow inside the capillary tube is assumed homogeneous and metastability is ignored in the proposed model. The proposed numerical models are in good agreement with the available experimental data with overall percentage mean deviation is less than 6%. Coil diameter plays an important role in adjusting the mass flow rate in the helical capillary tube. Coiling of capillary tube causes an increase in friction pressure drop and a reduction in refrigerant mass flow rate. It has been found that the mass flow rate reduces by about 5% as coil diameter is reduced from 120 to 20 mm.
Development of a Hybrid Lagrangian–Eulerian Model to Describe Spark-Ignition Processes at Engine-Like Turbulent Flow Conditions
Authors: Scarcelli Riccardo , Zhang Anqi , Wallner Thomas , Som Sibendu , Huang Jing , Wijeyakulasuriya Sameera , Mao Yijin , Zhu Xiucheng , Lee Seong-Young
Published: April 2019

With the engine technology moving toward more challenging (highly dilute and boosted) operation, spark-ignition processes play a key role in determining flame propagation and completeness of the combustion process. On the computational side, there is plenty of spark-ignition models available in literature and validated under conventional, stoichiometric spark ignition (SI) operation. Nevertheless, these models need to be expanded and developed on more physical grounds since at challenging operation they are not truly predictive. This paper reports on the development of a dedicated model for the spark-ignition event at nonquiescent, engine-like conditions, performed in the commercial CFD code converge. The developed methodology leverages previous findings that have expanded the use and improved the accuracy of Eulerian-type energy deposition models. In this work, the Eulerian energy deposition is coupled at every computational time-step with a Lagrangian-type evolution of the spark channel. Typical features such as spark channel elongation, stretch, and attachment to the electrodes are properly described to deliver realistic energy deposition along the channel during the entire ignition process. The numerical results are validated against schlieren images from an optical constant volume chamber and show the improvement in the simulation of the spark channel during the entire ignition event, with respect to the most commonly used energy deposition approach. Further developmental pathways are discussed to provide more physics-based features from the developed ignition model in the future.
Mucus accumulation in the lungs precedes structural changes and infection in children with cystic fibrosis
Authors: Esther Charles R. , Muhlebach Marianne S. , Ehre Camille , Hill David B. , Wolfgang Matthew C. , Kesimer Mehmet , Ramsey Kathryn A. , Markovetz Matthew R. , Garbarine Ian C. , Forest M. Gregory , Seim Ian , Zorn Bryan , Morrison Cameron B. , Delion Martial F. , Thelin William R. , Villalon Diane , Sabater Juan R. , Turkovic Lidija , Ranganathan Sarath , Stick Stephen M. , Boucher Richard C.
Published: April 2019

Increased airway mucus, occurs before infection or structural lung disease in early cystic fibrosis and promotes inflammation.
Exploring patients’ expectations and preferences of glaucoma surgery outcomes to facilitate healthcare delivery and inform future glaucoma research
Authors: Kulkarni Bina Bhaskar , Leighton Paul , King Anthony J
Published: April 2019

Introduction

Glaucoma is a lifelong condition often requiring surgical intervention. To allow us to inform patients’ expectations of surgery effectively, it is important to understand patients’ preferences and concerns regarding outcomes from glaucoma treatments including surgery.

Aims

To explore what clinical and social outcomes of glaucoma surgery are important to patients.

Methods

Forty-five glaucoma patients undergoing medical glaucoma treatments or surgery were recruited for focus group interviews to determine their opinions regarding the outcomes of glaucoma treatments. Thematic analysis was performed with NVivo software.

Results

Themes identified were understanding glaucoma, understanding surgery treatments and understanding treatment outcomes. The most important outcomes of the glaucoma surgery reported by the patients were social factors. Patients felt that being able to maintain their driving licence is a strong indicator of successful glaucoma treatment/surgery. Other important outcomes were independent living, ability to care for their family and having a good-quality social life. When considering novel surgical treatments, most patients felt that certainty of successful outcome and proven longevity of the effect are the primary motivators for choosing these treatments.

Conclusions

Patients understood that clinical measures were surrogates for maintaining visual function, but ability to maintain independent living was the most important outcome from their treatment. For newer treatments patients wished to know more about long-term outcomes when considering this option.
Psychotherapy for mental health symptoms and disorders in elite athletes: a narrative review
Authors: Stillman Mark A , Glick Ira D , McDuff David , Reardon Claudia L , Hitchcock Mary E , Fitch Vincent M , Hainline Brian
Published: April 2019

Background

Athletes, like non-athletes, suffer from mental health symptoms and disorders that affect their lives and their performance. Psychotherapy, either as the sole treatment or combined with other non-pharmacological and pharmacological strategies, is a pivotal component of management of mental health symptoms and disorders in elite athletes. Psychotherapy takes the form of individual, couples/family or group therapy and should address athlete-specific issues while being embraced as normative by athletes and their core stakeholders.

Main findings

This narrative review summarises controlled and non-controlled research on psychotherapy for elite athletes with mental health symptoms and disorders. In summary, treatment is similar to that of non-athletes—although with attention to issues that are athlete-specific. Challenges associated with psychotherapy with elite athletes are discussed, including diagnostic issues, deterrents to help-seeking and expectations about services. We describe certain personality characteristics sometimes associated with elite athletes, including narcissism and aggression, which could make psychotherapy with this population more challenging. The literature regarding psychotherapeutic interventions in elite athletes is sparse and largely anecdotal.
Cross-sectional study of patients with axial spondyloarthritis fulfilling imaging arm of ASAS classification criteria: baseline clinical characteristics and subset differences in a single-centre cohort
Authors: Bubová Kristyna , Forejtová Šárka , Zegzulková Kateřina , Gregová Monika , Hušáková Markéta , Filková Mária , Hořínková Jana , Gatterová Jindřiška , Tomčík Michal , Szczuková Lenka , Pavelka Karel , Šenolt Ladislav
Published: April 2019

Objective

This study compared demographic, clinical and laboratory characteristics between patients with radiographic and non-radiographic axial spondyloarthritis (axSpA).

Methods

In this single-centre cross-sectional study, a total of 246 patients with axSpA fulfilling the imaging arm of Assessment of SpondyloArthritis International Society classification criteria were recruited. A total of 140 patients were diagnosed as non-radiographic axial spondyloarthritis (nr-axSpA), and 106 patients had ankylosing spondylitis (AS). Sociodemographic characteristics, disease manifestations, clinical and laboratory disease activity and their differences between subsets were analysed. P values below 0.05 with CI 95% were considered statistically significant.

Results

More nr-axSpA patients were women (61.4%) compared with 24.7% of AS patients. First symptoms developed earlier in AS patients compared with nr-axSpA (23.0 (IQR 17.5–30.0) vs 27.8 (IQR 21.0–33.7) years, p=0.001). Disease manifestations did not differ, but patients with nr-axSpA experienced peripheral arthritis more frequently (35.7% vs 17.0%, p=0.001) with less hip involvement (8.6% vs 18.9%, p=0.022) compared with patients with AS. Patients with AS exhibited worse spinal mobility and physical function compared with nr-axSpA. AS Disease Activity Scores and CRP levels were significantly higher in patients with AS compared with nr-axSpA (2.4 (IQR 1.7–2.8) vs 2.0 (IQR 1.1–2.3), p=0.022 and 7.1 (IQR 2.6–14.9) vs 2.5 (IQR 0.8–8.2) mg/L, p<0.001, respectively).

Conclusions

Our data demonstrated some known and also novel differences between the two imaging arm fulfilling axSpA subgroups. Non-radiographic patients were mostly women who had experienced shorter disease duration, milder disease activity and better functional status with less hip involvement but more peripheral arthritis compared with patients with AS.
Grip strength among Indigenous and non-Indigenous Australian adults: a longitudinal study of the effects of birth size and current size
Authors: Howarth Timothy , Davison Belinda , Singh Gurmeet
Published: April 2019

Objectives

Indigenous Australians are born smaller than non-Indigenous Australians and are at an increased risk of early onset of frailty. This study aimed to identify the relationship between birth size, current size and grip strength, as an early marker of frailty, in Indigenous and non-Indigenous young adults.

Design

Cross sectional data from two longitudinal studies: Aboriginal birth cohort (Indigenous) and top end cohort (non-Indigenous).

Setting

Participants reside in over 40 urban and remote communities across the Northern Territory, Australia.

Participants

Young adults with median age 25 years (IQR 24–26); 427 participants (55% women), 267 (63%) were remote Indigenous, 55 (13%) urban Indigenous and 105 (25%) urban non-Indigenous.

Outcome measures

Reliable birth data were available. Anthropometric data (height, weight, lean mass) and grip strength were directly collected using standardised methods. Current residence was classified as urban or remote.

Results

The rate of low birthweight (LBW) in the non-Indigenous cohort (9%) was significantly lower than the Indigenous cohort (16%) (−7%, 95% CI −14 to 0, p=0.03). Indigenous participants had lower grip strength than non-Indigenous (women, −2.08, 95% CI −3.61 to –0.55, p=0.008 and men, −6.2, 95% CI −9.84 to –2.46, p=0.001). Birth weight (BW) was associated with grip strength after adjusting for demographic factors for both women (β=1.29, 95% CI 0.41 to 2.16, p=0.004) and men (β=3.95, 95% CI 2.38 to 5.51, p<0.001). When current size (lean mass and body mass index [BMI]) was introduced to the model BW was no longer a significant factor. Lean mass was a positive indicator for grip strength, and BMI a negative indicator.

Conclusions

As expected women had significantly lower grip strength than men. Current size, in particular lean mass, was the strongest predictor of adult grip strength in this cohort. BW may have an indirect effect on later grip strength via moderation of lean mass development, especially through adolescence and young adulthood.
Approaches to governance of participant-led research: a qualitative case study
Authors: Grant Azure Dominique , Wolf Gary Isaac , Nebeker Camille
Published: April 2019

Objectives

Participant-led research (PLR) is a rapidly developing form of citizen science in which individuals can create personal and generalisable knowledge. Although PLR lacks a formal framework for ethical review, participants should not be excused from considering the ethical implications of their work. Therefore, a PLR cohort consisting of 24 self-trackers aimed to: (1) substitute research ethics board procedures with engagement in ethical reflection before and throughout the study and (2) draft principles to encourage further development of the governance and ethical review of PLR.

Methods

A qualitative case study method was used to analyse the ethical reflection process. Participants discussed study risks, risk management strategies and benefits pre-project, during a series of weekly webinars, via individual meetings with the participant-organisers, and during semi-structured interviews at project completion. Themes arising from discussions and interviews were used to draft prospective principles to guide PLR.

Results

Data control, aggregation and identifiability were the most common risks identified. These were addressed by a commitment to transparency among all participants and by establishing participant control via self-collection and self-management of data. Group discussions and resources (eg, assistance with experimental design and data analysis) were the most commonly referenced benefits of participation. Additional benefits included greater understanding of one’s physiology and greater ability to structure an experiment. Nine principles were constructed to encourage further development of ethical PLR practices. All participants expressed interest in participating in future PLR.

Conclusions

Projects involving a small number of participants can sustain engagement in ethical reflection among participants and participant-organisers. PLR that prioritises transparency, participant control of data and ongoing risk-to-benefit evaluation is compatible with the principles that underlie traditional ethical review of health research, while being appropriate for a context in which citizen scientists play the central role.
Slow release oral morphine versus methadone for the treatment of opioid use disorder
Authors: Klimas Jan , Gorfinkel Lauren , Giacomuzzi Salvatore M , Ruckes Christian , Socías M Eugenia , Fairbairn Nadia , Wood Evan
Published: April 2019

Objective

To assess the efficacy of slow release oral morphine (SROM) as a treatment for opioid use disorder (OUD).

Design

Systematic review and meta-analysis of randomised controlled trials (RCTs).

Data sources

Three electronic databases were searched through 1 May 2018: the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We also searched the following electronic registers for ongoing trials: ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Current Controlled Trials and the EU Clinical Trials Register.

Eligibility criteria for selecting studies

We included RCTs of all durations, assessing the effect of SROM on measures of treatment retention, heroin use and craving in adults who met the diagnostic criteria for OUD.

Data extraction and synthesis

Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the random-effects model and expressed as risk ratios (RRs) or mean differences with 95% CIs. Heterogeneity was assessed (χ2statistic) and quantified (I2statistic) and a sensitivity analysis was undertaken to assess the impact of particular high-risk trials.

Results

Among 1315 records screened and four studies reviewed, four unique randomised trials met the inclusion criteria (n=471), and compared SROM with methadone. In the meta-analysis, we observed no significant differences between SROM and methadone in improving treatment retention(RR=0.98; 95%CI: 0.94 to 1.02, p=0.34) and heroin use (RR=0.96; 95% CI: 0.61 to 1.52, p=0.86). Craving data was not amenable to meta-analysis. Available data implied no differences in adverse events, heroin, cocaine or benzodiazepine use.

Conclusions

Meta-analysis of existing randomised trials suggests SROM may be generally equal to methadone in retaining patients in treatment and reducing heroin use while potentially resulting in less craving. The methodological quality of the included RCTs was low-to-moderate.
Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study
Authors: Bobbio Flavio , Di Gennaro Francesco , Marotta Claudia , Kok John , Akec Gabriel , Norbis Luca , Monno Laura , Saracino Annalisa , Mazzucco Walter , Lunardi Marta
Published: April 2019

Objective

Our cross-sectional study aimed at evaluating the diagnostic performance of Focused Assessment with Sonography for HIV-associated tuberculosis (FASH) to detect extrapulmonary tuberculosis in extremely resource-limited settings, with visceral leishmaniasis as a differential diagnosis with overlapping sonographic feature.

Design

Cross-sectional study.

Setting

Voluntary Counselling and Testing Centre (VCT) of Yirol Hospital, South Sudan.

Participants

From May to November 2017, 252 HIV-positive patients out of 624 newly admitted to VCT Centre were registered for antiretroviral treatment. According to the number of trained doctors available to practise ultrasound (US) scan, a sample of 100 patients were screened using the FASH protocol.

Interventions

Following a full clinical examination, each patient was scanned with a portable US scanner in six different positions for pleural, pericardial, ascitic effusion, abdominal lymphadenopathy and hepatic/splenic microabscesses, according to the FASH protocol. A k39 antigen test for visceral leishmaniasis was also performed on patients with lymphadenopathy and/or splenomegaly. All demographic, clinical and HIV data, as well as FASH results and therapy adjustments, were recorded following the examination.

Results

The FASH protocol allowed the detection of pathological US findings suggestive of tuberculosis in 27 out of the 100 patients tested. Overall, FASH results supported tuberculosis treatment indication for 16 of 21 patients, with the treatment being based exclusively on FASH findings in half of them (8 patients). The group of FASH-positive patients had a significantly higher proportion of patients with CD4 count below 0.2 x109/L (n=22, 81%) as compared with FASH-negative patients (n=35, 48%) (p=0.003). Moreover, 48% (n=13) of FASH-positive patients had CD4 below 100 cells/mm3. All patients tested had a negative result on k39 antigen test.

Conclusion

FASH was found to be a relevant diagnostic tool to detect signs of tuberculosis. Further research is needed to better define a patient profile suitable for investigation and also considering diagnostic accuracy.
Risk of ischaemic stroke in patients with migraine: a longitudinal follow-up study using a national sample cohort in South Korea
Authors: Lee Sang-Yeon , Lim Jae-Sung , Oh Dong Jun , Kong Il Gyu , Choi Hyo Geun
Published: April 2019

Objective

Accumulating evidence has supported the association between migraine and stroke, but the causative association remains unclear. We aimed to investigate the risks of different types of stroke in patients with migraine.

Design

A longitudinal follow-up study.

Setting

Data collected from a national cohort between 2002 and 2013 by the South Korea Health Insurance Review and Assessment.

Participants

We extracted the data from patients with migraine (n=41 585) and 1:4 matched controls (n=1 66 340) and analysed the occurrence of ischaemic and haemorrhagic strokes. The migraine group included participants treated for migraine (International Classification of Disease-10 (ICD-10): G43)≥2 times. Haemorrhagic stroke (I60-I62) and ischaemic stroke (I63) were determined based on the admission histories. The crude and adjusted HRs were calculated using Cox proportional hazard models, and the 95% CI were determined. Subgroup analyses stratified by age and sex were also performed.

Results

Higher rates of ischaemic stroke were observed in the migraine group (2.3% [964/41,585]) than in the control group (2.0% [3294/166 340], P<0.001). The adjusted HR for ischaemic stroke was 1.18 (95% CI=1.10 to 1.26) in the migraine group (P<0.001). Compared with control subjects, participants who reported migraine with aura and migraine without aura had increased adjusted HRs of 1.44 (95% CI=1.09 to 1.89) and 1.15 (95% CI=1.06 to 1.24), respectively, for ischaemic stroke, but no increased risk of haemorrhagic stroke. In our subgroup analysis, a strong association between migraine and ischaemic stroke was observed in young patients, specifically young women. The contribution of migraine to the occurrence of ischaemic stroke was also observed in middle-aged women and old women (each P<0.05). The risk of haemorrhagic stroke did not reach statistical significance in any age group.

Conclusion

Migraine is associated with an increased risk of ischaemic stroke, but not haemorrhagic stroke.
Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial
Authors: Gagnon Marie-Pierre , Ndiaye Mame Awa , Larouche Alain , Chabot Guylaine , Chabot Christian , Buyl Ronald , Fortin Jean-Paul , Giguère Anik , Leblanc Annie , Légaré France , Motulsky Aude , Sicotte Claude , Witteman Holly O , Kavanagh Eric , Lépinay Frédérick , Roberge Jacynthe , Délétroz Carole , Abbasgholizadeh-Rahimi Samira
Published: April 2019

Introduction

Multimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients’ and their informal caregivers’ needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making.

Methods and analysis

This project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health.

Ethics and dissemination

This study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals.

Trial registration number

NCT03628963; Pre-results.
Requested withdrawal of mechanical ventilation in six patients with motor neuron disease
Authors: Messer Ben , Armstrong Alison , Doris Thomas , Williams Tim
Published: April 2019

Objectives

Mechanical ventilation (MV) has been shown to improve survival and quality of life in motor neuron disease (MND). However, during the progression of MND, there may come a point when MV is no longer felt appropriate. Association of Palliative Medicine Guidelines have been recently published to help clinicians withdraw MV at the request of patients with MND in a safe and compassionate manner to ensure that symptoms of distress and dyspnoea are minimised.

Methods

In this report, we discuss the palliative and ventilatory management of six ventilator-dependent patients with MND who had requested the withdrawal of MV as part of their end-of-life care.

Results

We have withdrawn MV from six patients with MND at their request and our practice has been influenced by the Association of Palliative Medicine Guidelines.

Conclusion

Withdrawal of MV in MND at a patient’s request is challenging but is also a fundamental responsibility of healthcare teams. We discuss the lessons we have learnt which will influence our practice and help other teams in the future.
Factors influencing palliative care in advanced dementia: a systematic review
Authors: Mataqi Mona , Aslanpour Zoe
Published: April 2019

Background

Dementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs.

Aim

To investigate the factors influencing provision of PC services for people with advanced dementia.

Methods

A systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed,CINAHLand Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data.

Key findings

In total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning.

Conclusions

Even though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.