bluuebunny/crossref_metadata_2025 huggingface dataset:
Tensile properties of synthetic, absorbable monofilament suture materials before and after incubation in phosphate‐buffered saline
Authors: Tobias Karen M. , Kidd Calvin E. , Mulon Pierre‐Yves , Zhu Xiaojuan
Published: October 2019

Objective

To compare tensile properties of synthetic, absorbable, monofilament suture material before and after incubation in phosphate‐buffered saline (PBS).

Study design

Two sizes (2‐0 and 3‐0) of Biosyn, Maxon, Monocryl, PDS II, Securocryl, and Securodox were tested.

Sample population

Ten suture loops per group.

Methods

Tensile strength, elongation, and modulus of suture loops were measured at baseline and after 7, 14, 21, or 28 days of incubation in PBS.

Results

Size, suture material, and size × suture material interaction influenced maximum breaking load, maximum elongation, and modulus of elasticity. At baseline, 2‐0 and 3‐0 Maxon had the highest breaking loads (111.67 N and 79.71 N, respectively) for their size, and 2‐0 PDSII and 3‐0 Securodox had the lowest (68.71 N and 48.73 N, respectively). Maxon 2‐0 and 3‐0 had the greatest elongations (9.68 mm and 8.45 mm, respectively) for their size, and 2‐0 Biosyn and 3‐0 Securocryl had the least (7.21 mm and 6.58 mm, respectively). Biosyn 2‐0 and 3‐0 had the highest modulus. With incubation, Maxon (2‐0), PDS II (2‐0, 3‐0), and Securodox (2‐0, 3‐0) maintained or gained strength over 4 weeks. Strengths of 2‐0 and 3‐0 Biosyn and 3‐0 Maxon were maintained for 2 weeks, while Monocryl and Securocryl lost 20% to 44% of baseline strength within 1 week and 60% to 72% within 2 weeks. Day 7 strengths of 2‐0 Biosyn and 2‐0 Monocryl were greater than baseline strength of 2‐0 PDS II. Strength of 3‐0 Biosyn at day 14 was greater than strength of Monocryl at days 7 and 14 and greater than strength of 3‐0 PDS II, 3‐0 Securodox, and 3‐0 Securocryl at baseline and days 7 and 14.

Conclusion

Suture tensile properties varied with suture size, composition, and brand. At baseline, Maxon suture had the greatest strength and elongation, and Biosyn had the greatest stiffness.

Clinical significance

Tensile strength retention, when reported as a percentage of original strength, provides insufficient information for comparison of suture tensile properties.
Fabrication and Performance Evaluation of Integrated Solar-Driven Membrane Distillation System with Serpentine-shape of Flat Plate Solar Collector for Seawater Desalination
Authors: Hanoin M. A. H. M. , Mohammed N. S. , Arris M. A. I. Z. , Bakar A. I. A. , Mokhtar N. M. , Razak A. A.
Published: October 2019

Solar-powered membrane distillation (SPMD) system has gained its popularity in desalination application for past decade credit to the system efficiency in producing pure water and the utilization of renewable energy. However, most of the past SPMD works used commercial solar thermal collector (STC) as the thermal energy supply to the feed solution and the study only focused on the performance of the system in terms of flux and salt rejection. In this work, a self-made flat plate solar collector (FPSC) with the serpentine-shape pipe was designed and fabricated to study the effect of the STC towards the membrane performance. Before testing, a simulation work of the fluid flow inside the serpentine-shape pipe of the FPSC was analyzed using NX 10.0 computer-aided design simulation. After that, the efficiency of the self-made FPSC system was tested directly to sunlight in order to identify the maximum irradiance and the temperature of the feed solution. Due to the fluctuation of solar irradiance, the experimental setup of the SPMD system was tested using a solar simulator, and the performance was compared with the membrane distillation (MD) system without integration with FPSC system. Based on the simulation data, it can be concluded that the heat losses across the pipe are due to the slower fluid velocity and sudden pressure drop, which attributed to centripetal force and pressure differences. Meanwhile, the outdoor evaluation data showed that the temperatures of collector and water inside the feed tank could reach up to 84°C and 64°C, respectively when the maximum irradiance of 938 W/m2 was applied. For the performance evaluation between with and without the self-made FPSC system, it can be seen that only marginal difference can be observed for the permeate flux and salt rejection with an average difference of 6.06% and 1.29%, respectively.
Fundamentals of RO Membrane Separation Process: Problems and Solutions
Authors: Ismail Ahmad Fauzi , Matsuura Takeshi
Published: October 2019

It is the intention of the authors to let the students understand the underlying principles of membrane separation processes by solving the problems numerically, in general. In particular, in this article problems and answers are presented for reverse osmosis (RO), one of the membrane separation processes driven by the transmembrane hydraulic pressure difference. The transport theories for RO were developed in early nineteen sixties, when the industrial membrane separation processes emerged. These problems are solved step by step using a simple calculator or Excel in computer.
Machine-Tool Error Observer Design With Application to Thermal Error Tracking
Authors: Ko Hua-Wei , Bazzoli Patrick , Nisbett J. Adam , Bristow Douglas , Chen Yujie , Ferreira Placid M. , Kapoor Shiv G.
Published: October 2019

A parameter identification procedure for identifying the parameters of a volumetric error model of a large machine tool requires hundreds of random volumetric error components in its workspace and thus takes hours of measurement time. It causes thermal errors of a large machine difficult to be tracked and compensated periodically. This paper demonstrates the application of the optimal observation design theories to volumetric error model parameter identification of a large five-axis machine. Optimal designs maximize the amount of information carried in the observations. In this paper, K-optimal designs are applied for the construction of machine-tool error observers by determining locations in the workspace at which 80 components of volumetric errors to be measured so that the model parameters can be identified in 5% of an 8-h shift. Many of optimal designs tend to localize observations at the boundary of the workspace. This leaves large volumes of the workspace inadequately represented, making the identified model inadequate. Therefore, the constrained optimization algorithms that force the distribution of observation points in the machine’s workspace are developed. Optimal designs reduce the number of observations in the identification procedure. This opens up the possibility of tracking thermal variations of the volumetric error model with periodic measurements. The design, implementation, and performance of a constrained K-optimal in tracking the thermal variations of the volumetric error over a 400-min period of operation are also reported. About 70–80% of machine-tool error can be explained using the proposed thermal error modeling methodology.
Evaluation of Dynamic Insulation Systems for Residential Buildings in Barcelona, Spain
Authors: Martínez Garriga S. , Dabbagh M. , Krarti M.
Published: October 2019

This paper evaluates the potential energy cost savings when high R-value static insulation layers as well as dynamic insulation materials (DIMs) are applied to residential housing located in Barcelona Spain. The analysis considers three dwelling prototypes to characterize the existing housing stock in Barcelona including detached attached and apartments. In addition three vintages for each housing prototype are defined: before 1979 when building envelope insulation took effect in Spain between 1980 and 2006 and after 2006 when the building envelope insulation code became more restrictive. Using a modified 3R2C network model to determine thermal loads the performance of both static and dynamic insulation systems is evaluated when applied to exterior wall for various housing prototypes in Barcelona. The dynamic insulation R-value is selected based on a 2-step control strategy. The analysis results indicate that DIMs with the largest R-value step (i.e. difference between the high and the low R-values) achieve the highest savings in source energy reaching up to 19% reduction in source heating and cooling energy for the entire housing stock of Barcelona. The annual energy savings achieved by DIMs are valued to be 181 M€/year for the entire existing housing stock in Barcelona. In addition electrical peak demand reduction associated with retrofitting exterior walls for the existing Barcelona housing stock can result in future avoidance of building new power plants and can provide additional 144 M€ and 162 M€ for respectively static and dynamic insulation systems. Considering the current energy mix applying dynamic wall insulation systems for Barcelona existing housing stock could reduce annual CO2 emissions by more than 300 000 tons or 6.80% of the total carbon dioxide currently emitted to heat and cool homes.
Elevated-Temperature Thermal Expansion of PTFE/PEEK Matrix Composite With Random-Oriented Short Carbon Fibers and Graphite Flakes
Authors: Miyase A. , Qu S. , Lo K. H. , Wang S. S.
Published: October 2019

A combined experimental and micromechanics investigation is conducted on elevated-temperature thermal expansion of PTFE/PEEK polymer-matrix composite reinforced with randomly oriented short carbon fibers (CF) and graphite flakes (Gr). In the experimental phase of the study, PTFE/PEEK polymer blends with different amounts of PTFE and four-phase CF/Gr/PTFE/PEEK composites with different volume fractions of graphite flakes were made from compression molding. Scanning electron microscopy was performed to evaluate the microstructure of the PTFE/PEEK matrix and the composite, especially the interface, and the size and dispersion of the particles. X-ray diffraction (XRD) was conducted to provide morphological information on the semi-crystalline PTFE/PEEK matrix of the composite. Differential scanning calorimetry (DSC) and dynamic mechanical analysis (DMA) were carried out to determine transition temperatures and thermomechanical properties of the composite and its constituent phases at the elevated temperature. Thermal expansions of neat PTFE and neat PEEK, the PTFE/PEEK polymer matrix, and the CF/Gr/PTFE/PEEK composite were obtained with a thermal–mechanical analyzer (TMA) in a dilatometric mode. Coefficients of thermal expansion (CTEs) of the PTFE/PEEK matrix and its CF/Gr/PTFE/PEEK composite were then determined from 25 °C up to an elevated temperature 240 °C. To augment the experimental study, micromechanics analyses are also conducted to determine thermal expansion coefficients of the PTFE/PEEK matrix and the CF/GR/PTFE/PEEK composite. The micromechanics solutions elucidate individual roles of different composite constituents, contributions of individual constituent materials’ temperature-dependent thermal and mechanical properties, the importance of composite microstructure and morphology, and the issue of thermal–mechanical coupling on the thermal expansion behavior of the complex CF/Gr/PTFE/PEEK composite at high temperature.
Contraindications and adverse effects in abdominal imaging
Authors: Caraiani Cosmin , Petresc Bianca , Dong Yi , Dietrich Christoph F.
Published: October 2019

Ultrasound (US), computed-tomography (CT) and magnetic resonance imaging (MRI) are the most frequently used imaging techniques in abdominal pathology. US plays a pivotal role in evaluating abdominal disease, sometimes being sufficient for a complete diagnosis and has virtually no contraindications. The usage of US contrast agents will add useful diagnostic information in both hepatic and non-hepatic pathology. CT has, over MRI, the advantage of being readily available. The usage of ionizing radiation is the main pitfall of CT. Allergies and contrast induced nephropathy in patients with an impaired renal function are the major risks of contrast media administration in CT. Its excellent tissue resolution makes MRI a very useful technique in abdominal pathology, the major contraindications being the presence of MRI “unsafe” implants and devices and the presence of metallic foreign bodies, particularly close to vital structures like the eyes or major vessels. Contrast administration in MRI is restricted in patients with renal insufficiency due to the risk of nephrogenic systemic fibrosis. Allergies to MRI contrast media are rare and less important compared to allergies due to CT contrast media
Consonance perception beyond the traditional existence region of pitch
Authors: Carcagno Samuele , Lakhani Saday , Plack Christopher J.
Published: October 2019

Some theories posit that the perception of consonance is based on neural periodicity detection, which is dependent on accurate phase locking of auditory nerve fibers to features of the stimulus waveform. In the current study, 15 listeners were asked to rate the pleasantness of complex tone dyads (2 note chords) forming various harmonic intervals and bandpass filtered in a high-frequency region (all components >5.8 kHz), where phase locking to the rapid stimulus fine structure is thought to be severely degraded or absent. The two notes were presented to opposite ears. Consonant intervals (minor third and perfect fifth) received higher ratings than dissonant intervals (minor second and tritone). The results could not be explained in terms of phase locking to the slower waveform envelope because the preference for consonant intervals was higher when the stimuli were harmonic, compared to a condition in which they were made inharmonic by shifting their component frequencies by a constant offset, so as to preserve their envelope periodicity. Overall the results indicate that, if phase locking is indeed absent at frequencies greater than ∼5 kHz, neural periodicity detection is not necessary for the perception of consonance.
Novel Plasmid-Mediated
tet
(X5) Gene Conferring Resistance to Tigecycline, Eravacycline, and Omadacycline in a Clinical Acinetobacter baumannii Isolate
Authors: Wang Liyuan , Liu Dejun , Lv Yuan , Cui Lanqing , Li Yun , Li Tianmeng , Song Huangwei , Hao Yuxin , Shen Jianzhong , Wang Yang , Walsh Timothy R.
Published: October 2019

A novel, plasmid-mediated, high-level tigecycline resistance
tet
(X) gene variant,
tet
(X5), was detected in a clinical
Acinetobacter baumannii
isolate from China in 2017. Tet(X5) shows 84.5% and 90.5% amino acid identity to Tet(X3) and Tet(X4), respectively, with similar binding sites and a comparable affinity for tetracyclines. The
tet
(X5)-containing plasmid could only be transferred to
A. baumannii
via electrotransformation.
Evaluation of Resistance Development to the Gwt1 Inhibitor Manogepix (APX001A) in
Candida
Species
Authors: Kapoor Mili , Moloney Molly , Soltow Quinlyn A. , Pillar Chris M. , Shaw Karen Joy
Published: October 2019

Manogepix (MGX) targets the conserved fungal Gwt1 enzyme required for acylation of inositol early in the glycosylphosphatidylinositol biosynthesis pathway. The prodrug fosmanogepix is currently in clinical development for the treatment of invasive fungal infections.
Dysregulation of Intestinal Microbiota Elicited by Food Allergy Induces IgA-Mediated Oral Dysbiosis
Authors: Matsui Shohei , Kataoka Hideo , Tanaka Jun-Ichi , Kikuchi Mariko , Fukamachi Haruka , Morisaki Hirobumi , Matsushima Hitomi , Mishima Kenji , Hironaka Shoji , Takaki Takashi , Okahashi Nobuo , Maruoka Yasubumi , Kuwata Hirotaka
Published: October 2019

Food allergy is a life-threatening response to specific foods, and microbiota imbalance (dysbiosis) in gut is considered a cause of this disease. Meanwhile, the host immune response also plays an important role in the disease. Notably, interleukin 33 (IL-33) released from damaged or necrotic intestinal epithelial cells facilitates IL-2-producing CD4 helper T (Th2) responses. However, causal relationships between the gut and oral dysbiosis and food allergy remain unknown.
Differential Modulation of Innate Immune Responses in Human Primary Cells by Influenza A Viruses Carrying Human or Avian Nonstructural Protein 1
Authors: Monteagudo Paula L. , Muñoz-Moreno Raquel , Fribourg Miguel , Potla Uma , Mena Ignacio , Marjanovic Nada , Hartmann Boris M. , Sealfon Stuart C. , García-Sastre Adolfo , Ramos Irene , Fernández-Sesma Ana
Published: October 2019

Influenza A viruses (IAVs) cause seasonal epidemics which result in an important health and economic burden. Wild aquatic birds are the natural host of IAV. However, IAV can infect diverse hosts, including humans, domestic poultry, pigs, and others. IAVs circulating in animals occasionally cross the species barrier, infecting humans, which results in mild to very severe disease. In some cases, these viruses can acquire the ability to be transmitted among humans and initiate a pandemic. The nonstructural 1 (NS1) protein of IAV is an important antagonist of the innate immune response. In this study, using recombinant viruses and primary human cells, we show that NS1 proteins from human and avian hosts show intrinsic differences in the modulation of the innate immunity in human dendritic cells and epithelial cells, as well as different cellular localization dynamics in infected cells.
Interviral Recombination between Plant, Insect, and Fungal RNA Viruses: Role of the Intracellular Ca
2+
/Mn
2+
Pump
Authors: Kovalev Nikolay , Pogany Judit , Nagy Peter D.
Published: October 2019

Viruses with RNA genomes are abundant, and their genomic sequences show astonishing variation. Genetic recombination in RNA viruses is a major force behind their rapid evolution, enhanced pathogenesis, and adaptation to their hosts. We utilized a previously identified intracellular Ca
2+
/Mn
2+
pump-deficient yeast to search for interviral recombinants. Noninfectious viral replication systems were used to avoid generating unwanted infectious interviral recombinants. Altogether, interviral RNA recombinants were observed between plant and insect viruses, and between a fungal double-stranded RNA (dsRNA) virus and an insect virus, in the yeast host. In addition, interviral recombinants between two plant virus replicon RNAs were identified in
N. benthamiana
plants, in which the intracellular Ca
2+
/Mn
2+
pump was depleted. These findings underline the crucial role of the host in promoting RNA recombination among unrelated viruses.
Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis
Authors: Solo Karla , Lavi Shahar , Kabali Conrad , Levine Glenn N , Kulik Alexander , John-Baptiste Ava A , Fremes Stephen E , Martin Janet , Eikelboom John W , Ruel Marc , Huitema Ashlay A , Choudhury Tawfiq , Bhatt Deepak L , Tzemos Nikolaos , Mamas Mamas A , Bagur Rodrigo
Published: October 2019

Objective

To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery.

Design

Systematic review and network meta-analysis.

Data sources

Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019.

Eligibility criteria

for selecting studiesRandomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery.

Main outcome measures

The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death.

Results

This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates.

Conclusions

The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes.

Study registration

PROSPERO registration number CRD42017065678.
Associations between maternal social capital and infant birth weight in three developing countries: a cross-sectional multilevel analysis of Young Lives data
Authors: Lee Hwa-Young , Oh Juhwan , Perkins Jessica M , Heo Jongho , Subramanian S V
Published: October 2019

Objective

To explore how three indicators of social capital (ie, group membership, social support and cognitive social capital and specific types within each type) are associated with infant birth weight.

Study design and settings

Cross-sectional analyses of the first wave of Young Lives Survey data collected in 2002 from India (Andhra Pradesh state), Peru and Vietnam.

Participants

807 mothers in India, 1528 mothers in Peru and 1706 mothers in Vietnam.

Outcomes measure

Infant birth weight was measured in grams. Participation in specific groups, receipt of social support from specific groups or individuals and perceptions of their community were measured for social capital indicators. Two-level random intercept linear regression models were fit separately by country (first level: individual and second level: community).

Results

Maternal group membership displayed a consistent positive association with infant birth weight across the three countries. There was no relationship with maternal cognitive social capital. Membership in a women’s group was associated with infant birth weight consistently in all three countries (b=119.6, 95% CI 21.7 to 217.4 in India, b=133.4, 95% CI 40.9 to 225.9 in Peru, b=60.6, 95% CI 0.5 to 120.6 in Vietnam). However, membership in a political group in Peru was inversely associated with infant birth weight (b=−276.1, 95% CI −465.7 to −86.5).

Conclusion

Although a higher level of social capital is associated with higher infant birth weight, specific types of social capital may have different associations with infant birth weight depending on the social, political or cultural specificity of the country. These results pave the way for additional research on the mechanisms through which social capital influences birth weight outcomes in each country.
Transition in acquired brain injury youth (TrABI-Y): a systematic literature review protocol
Authors: Gauvin-Lepage Jérôme , Farthing Julie , Bissonnette Shana , Koclas Louise , Jaworski Magdalena , Larochelle Josée , St-Pierre-Clément Anne-Sophie
Published: October 2019

Introduction

Acquired brain injury (ABI) in paediatrics refers to children born with a neurological deficit, which will lead to a chronic neurological disorder. As advances in medical paediatric health progress, we are seeing these ABI youth transitioning into adult healthcare services while also going through different life events. Despite the growing number of young adult patients, access to transition programmes to facilitate the transition process is still limited and evidence on the effectiveness of these programmes is inconclusive. The purpose of this paper is to provide the protocol for an upcoming systematic literature review on this important issue.

Methods and analysis

The start of this systematic literature review is planned for 1 October 2019 and will end on 31 December 2021. According to the PICO framework developed, the Population and the Problem of interest (P) will include children, adolescents and young adults (0–18 years) diagnosed with ABI. The selected articles will have to involve an Intervention (I) relating to the healthcare of this population or life transitions from paediatric to adult-oriented care. Studies will be included if a Comparator (C) intervention was used. The expected Outcomes (O) will have to report quantitative or qualitative health-related outcomes post-transition. This comprehensive search of peer-reviewed literature will include articles published between 2010 and 2020. The databases to be searched include Medline, All EBM Reviews, Embase, PsycINFO and CINAHL. The selected articles will be appraised using the Mixed Methods Appraisal Tool. A synthesis of the findings will be drafted to identify the effectiveness of available transition programmes as well as predictors, factors and determinants involved in the transition process.

Ethics and dissemination

This project is not associated with direct individuals. The dissemination plan includes strategies such as using this systematic literature review to develop a research project on transition that will be published.
Efficacy and neural mechanism of acupuncture treatment in older adults with subjective cognitive decline: study protocol for a randomised controlled clinical trial
Authors: Yan Chao-Qun , Zhou Ping , Wang Xu , Tu Jian Feng , Hu Shang-Qing , Huo Jian-Wei , Wang Zhong-Yan , Shi Guang-Xia , Zhang Ya-Nan , Li Jun-Qiu , Wang Jun , Liu Cun-Zhi
Published: October 2019

Introduction

Subjective cognitive decline (SCD) refers to individuals’ perceived decline in memory and/or other cognitive abilities relative to their previous level of performance, while objective neuropsychological deficits are not observed. SCD may represent a preclinical phase of Alzheimer’s disease. At this very early stage of decline, intervention could slow the rate of incipient decline to prolong and preserve cognitive and functional abilities. However, there is no effective treatment recommended for individuals with SCD. Acupuncture, as a non-pharmacological intervention, has been widely employed for patients with cognitive disorders.

Methods and analysis

The proposed study is a randomised, assessor-blinded and placebo-controlled study that investigates the efficacy and mechanism of acupuncture in SCD. Sixty patients with SCD will be randomly allocated either into an acupuncture group or a sham acupuncture group. They will receive 24 sessions of real acupuncture treatment or identical treatment sessions using a placebo needle. Global cognitive changes based on a multidomain neuropsychological test battery will be evaluated to detect the clinical efficacy of acupuncture treatment at baseline and end of treatment. MRI scans will be used to explore acupuncture-related neuroplasticity changes. Correlation analyses will be performed to investigate the relationships between the changes in brain function and symptom improvement.

Ethics and dissemination

The trial was approved by the research ethics committee. The results of the study will be published in a peer-reviewed academic journal and will also be disseminated electronically through conference presentations.

Trial registration number

NCT03444896.
Ward-based Goal-Directed Fluid Therapy (GDFT) in Acute Pancreatitis (GAP) trial: study protocol for a feasibility randomised controlled trial
Authors: Froghi Farid , Soggiu Fiammetta , Ricciardi Federico , Gurusamy Kurinchi , Martin Daniel S , Singh Jeshika , Siddique Sulman , Eastgate Christine , Ciaponi Maria , McNeil Margaret , Filipe Helder , Schwalowsky-Monks Otto , Asis Gretchelle , Varcada Massimo , Davidson Brian R
Published: October 2019

Introduction

Acute pancreatitis is an inflammatory disease of the pancreas with high risk of developing multiorgan failure and death. There are no effective pharmacological interventions used in current clinical practice. Maintaining fluid and electrolyte balance is the mainstay of supportive management. Goal-directed fluid therapy (GDFT) has been shown to decrease morbidity and mortality in surgical conditions with systemic inflammatory response. There is currently no randomised controlled trial (RCT) investigating the role of GDFT based on cardiac output parameters in patients with acute pancreatitis in the ward setting. A feasibility trial was designed to determine patient and clinician support for recruitment into an RCT of ward-based GDFT in acute pancreatitis, adherence to a GDFT protocol, safety, participant withdrawal, and to determine appropriate endpoints for a subsequent larger trial to evaluate efficacy.

Methods and analysis

The GDFT in Acute Pancreatitis trial is a prospective two-centre feasibility RCT. Eligible adults admitted with new onset of acute pancreatitis will be enrolled and randomised into ward-based GDFT (n=25) or standard fluid therapy (n=25) within 6 hours from the diagnosis and continuing for the following 48 hours. Cardiac output parameters will be monitored with a non-invasive device (Cheetah NICOM; Cheetah Medical). The intervention group will consist of a protocolised GDFT approach consisting of stroke volume optimisation with crystalloid fluid boluses, while the control group will receive standard care fluid therapy as advised by the clinical team. The primary endpoint is feasibility. Secondary endpoints will include safety of the intervention, complications, mortality, admission to intensive care unit, cost and quality of life.

Ethics and dissemination

Ethics approval was granted by the London Central Research Ethics Committee (17/LO/1235, project ID: 221872). The results of this trial will be presented to international conference with interest in general surgery and acute care and published in a peer-reviewed journal.

Trial registration number

ISRCTN36077283.
Acupuncture methods for acute migraine attack: a Bayesian network meta-analysis protocol
Authors: Zhou Jing , Li Junlong , Yang Jiwei , Li Jianliang , Wang Chongxin
Published: October 2019

Introduction

Migraine is a primary cause of disability worldwide, particularly affecting young adults and middle-aged women. Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating acute migraine attacks, the methodologies in academic studies and commonly applied practices vary greatly. This study protocol outlines a plan to assess and rank the effectiveness of the different acupuncture methods in order to develop a prioritised acupuncture-based treatment regimen for acute migraine attacks.

Objective

To compare the efficacy of different acupuncture methods and conventional medicinal methods in the treatment of acute migraine attacks.

Methods and analysis

Six databases will be searched, including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang Database from inception to 31 August 2019. The primary outcomes will be assessed using metrics for intensity and duration (in hours) of pain post-treatment. Bayesian network meta-analysis will be conducted using WinBUGS V.1.4.3. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation System to assess the quality of evidence.

Ethics and dissemination

The results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol.

PROSPERO registration number

CRD42019126472.
Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting
Authors: Rees Sophie , Tutton Elizabeth , Achten Juul , Bruce Julie , Costa Matthew L
Published: October 2019

Objectives

Treatment of open fractures is complex and patients may require muscle and skin grafts. The aim of this study was to gain a greater understanding of patient experience of recovery from open fracture of the lower limb 2–4 years postinjury.

Design

A phenomenological approach was used to guide the design of the study. Interviews took place between October 2016 and April 2017 in the participants’ own homes or via telephone.

Setting

England, UK.

Participants

A purposive sample of 25 patients were interviewed with an age range of 26–80 years (median 51), 19 were male and six female, and time since injury was 24–49 months (median 35 months).

Results

The findings identified a focus on struggling to recover as participants created a new way of living, balancing moving forward with accepting how they are, while being uncertain of the future and experiencing cycles of progress and setbacks. This was expressed through three themes: (i) ‘being disempowered’ with the emotional impact of dependency and uncertainty, (ii) ‘being changed’ and living with being fragile and being unable to move freely and (iii) ‘being myself’ with a loss of self, feeling and looking different, alongside recreation of self in which they integrated the past, present and future to find meaningful ways of being themselves.

Conclusion

This study identified the long-term disruption caused by serious injury, the hidden work of integration that is required in order to move forward and maximise potential for recovery. Supportive strategies that help people to self-manage their everyday emotional and physical experience of recovery from injury are required. Research should focus on developing and testing effective interventions that provide support and self-management within a holistic rehabilitation plan.

Trial registration number

Current Controlled TrialsISRCTN33756652; Post-results.
Prostate cancer incidence and mortality in the Baltic states, Belarus, the Russian Federation and Ukraine
Authors: Patasius Ausvydas , Innos Kaire , Barchuk Anton , Ryzhov Anton , Leja Marcis , Misins Janis , Yaumenenka Alesya , Smailyte Giedre
Published: October 2019

Background

Prostate cancer incidence varies internationally largely attributable to differences in prostate-specific antigen (PSA) use. The aim of this study was to provide the most recent detailed international epidemiological comparison of prostate cancer incidence and mortality in six north-eastern European countries (Belarus, Estonia, Latvia, Lithuania, the Russian Federation and Ukraine).

Methods

The number of incident prostate cancer cases was obtained from the countries national cancer registries. Prostate cancer mortality and corresponding population data were extracted from the WHO Mortality Database. Age-specific and age-standardised incidence and mortality rates were calculated (European Standard). The joinpoint regression model was used to provide an average annual percentage change and to detect points in time where significant changes in trends occurred. The observation period was between 13 (Ukraine) and 48 (Estonia) years regarding incidence and around 30 years regarding mortality.

Results

The comparison of prostate cancer incidence in six European countries showed almost sixfold differences in the age-adjusted rates in most recent years with highest incidence rates in Lithuania and Estonia. Through the observation period, overall a continuous rise was seen in incidence in all countries and a continuous rise in mortality, with a stabilisation in Estonia and a decrease in Lithuania in recent years. Data limitations included a descriptive design using ecological data.

Conclusions

A widespread use of PSA testing seems to be responsible for the changes in the epidemiology of the disease in north-eastern European countries. Substantial variation in the incidence of prostate cancer in the Baltic states suggests the possibility that PSA performance and utilisation spread have had a major influence on observed incidence trends, with a lack of effect on prostate cancer mortality.
A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients
Authors: Woods Taylor-Jade , Speck Peter , Kaambwa Billingsley
Published: October 2019

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission.

Methods and analysis

We will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran’s Q and I2statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs.

Ethics and dissemination

Formal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication.

PROSPERO registration number

CRD42019132017
Ambulance use for ‘primary care’ problems: an ethnographic study of seeking and providing help in a UK ambulance service
Authors: Booker Matthew James , Purdy Sarah , Barnes Rebecca , Shaw Ali R G
Published: October 2019

Objectives

To explore what factors shape a service user’s decision to call an emergency ambulance for a ‘primary care sensitive’ condition (PCSC), including contextual factors. Additionally, to understand the function and purpose of ambulance care from the perspective of service users, and the role health professionals may play in influencing demand for ambulances in PCSCs.

Design

An ethnographic study set in one UK ambulance service. Patient cases were recruited upon receipt of ambulance treatment for a situation potentially manageable in primary care, as determined by a primary care clinician accompanying emergency medical services (EMS) crews. Methods used included: structured observations of treatment episodes; in-depth interviews with patients, relatives and carers and their GPs; purposeful conversations with ambulance clinicians; analysis of routine healthcare records; analysis of the original EMS ‘emergency’ telephone call recording.

Results

We analysed 170 qualitative data items across 50 cases. Three cross-cutting concepts emerged as central to EMS use for a PCSC: (1) There exists a typology of nine ‘triggers’, which we categorise as either ‘internal’ or ‘external’, depending on how much control the caller feels they have of the situation; (2) Calling an ambulance on behalf of someone else creates a specific anxiety about urgency; (3) Healthcare professionals experience conflict around fuelling demand for ambulances.

Conclusions

Previous work suggests a range of sociodemographic factors that may be associated with choosing ambulance care in preference to alternatives. Building on established sociological models, this work helps understand how candidacy is displayed during the negotiation of eligibility for ambulance care. Seeking urgent assistance on behalf of another often requires specific support and different strategies. Use of EMS for such problems—although inefficient—is often conceptualised as ‘rational’ by service users. Public health strategies that seek to advise the public about appropriate use of EMS need to consider how individuals conceptualise an ‘emergency’ situation.
‘Your Tube’: the role of different diets in children who are gastrostomy fed: protocol for a mixed methods exploratory sequential study
Authors: Taylor Johanna , O'Neill Mark , Maddison Jane , Richardson Gerry , Hewitt Catherine , Horridge Karen , Cade Janet , McCarter Alison , Beresford Bryony , Fraser Lorna Katharine
Published: October 2019

Introduction

Increasing numbers of children require having all, or part, of their nutritional intake via gastrostomy. More parents are using home-blended meals to feed their children, with many reporting beneficial effects such as improved gastro-oesophageal reflux, less constipation and less distress in their child.

This study aims to identify the important outcomes of tube feeding in this population, compare the safety, outcomes and resource use of those on a home-blended diet compared with a formula diet and assess feasibility of long-term follow-up of children recruited to this study.

Methods and analyses

This is a mixed methods study of children (aged 6 months to 18 years) who are gastrostomy feed dependent recruited via general, community and specialist paediatric and dietetic services.

Workstream1(WS1): a qualitative study involving semistructured interviews with parents (n~20) and young people (n~5–10), and focus groups with health professionals (n~25), will provide evidence of appropriate outcome measures and the feasibility/acceptability of proposed data collection methods for WS2. It will gather data on: desired outcomes of gastrostomy feeding, variability in diets and reasons; use of oral feeding; perceived benefits of the alternative diets, resources associated with gastrostomy feeding and safety issues. Data will be analysed using thematic analysis.

WS2: a cohort study of 300 children who are gastrostomy fed. Data will be collected at months 0, 9 and 18 from parents, children (if appropriate) and clinicians using standardised measures and questionnaires developed specifically for the study. Data collected will include gastrointestinal symptoms, health and other outcomes (child, parent), dietary intake, anthropometry, healthcare usage, safety outcomes and resource use. Outcomes in the home-blended and formula groups will be compared using appropriate multiple regression analyses.

Ethics and dissemination

The study has been approved by a research ethics committee (REC reference: 19/YH/0028). Results will be disseminated through publications and presentations for professionals and families.

Study registration number

ISRCTN13977361.
Discordances between predicted and actual risk in obese patients with suspected cardiac ischaemia
Authors: Litwin Sheldon E , Coles Adrian , Hill C Larry , Alhanti Brooke , Pagidipati Neha , Lee Kerry L , Pellikka Patricia A , Mark Daniel B , Udelson James E , Cooper Lawton , Tardif Jean-Claude , Hoffmann Udo , Douglas Pamela S
Published: October 2019

Objectives

To test the relationship between increasing severity of obesity, calculated risk and observed outcomes.

Methods

Patients with symptoms suggestive of coronary artery disease (CAD) (n=10 003) were stratified according to body mass index (BMI). We compared risk factors, pooled risk scores and physicians’ perception of risk. Cox regression tested the association between BMI and (1) presence of obstructive CAD and (2) composite clinical endpoints (death, cardiovascular death, unstable angina hospitalisation and myocardial infarction).

Results

BMI was ≥30 kg/m2in 48% of patients and ≥35 in 20%. Increasingly obese patients were younger, female and non-smoking but with higher prevalence of hypertension, diabetes, black race and sedentary lifestyle. Pooled risk estimates of CAD were highest in those with mid-range BMI. In contrast, physicians’ estimation of the likelihood of significant CAD based on clinical impression increased progressively with BMI. For a 10% increase in the Diamond-Forrester probability of CAD, the adjusted OR for obstructive CAD was 1.5 (95% CI 1.4 to 1.5) in patients with BMI <35, but only 1.2 (95% CI 1.1 to 1.3) in those with BMI ≥35 (interaction p<0.001). Framingham Risk Score increased across increasing BMI categories. However, there was a strong and consistent inverse relationship between degree of obesity and all three composite clinical endpoints over a median 25 months of follow-up.

Conclusions

Despite perceptions of higher risk and higher risk scores, increasingly obese patients had obstructive CAD less frequently than predicted and had fewer adverse clinical outcomes. There is a need for risk assessment tools and guidelines that account for obesity.

Trial registration number

NCT01174550.
Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study
Authors: Banerjee Amitava , Benedetto Valerio , Gichuru Philip , Burnell Jane , Antoniou Sotiris , Schilling Richard J , Strain William David , Ryan Ronan , Watkins Caroline , Marshall Tom , Sutton Chris J
Published: October 2019

Background

Despite simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (EHRs).

Objective

We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence.

Methods

In UK primary care EHR (The Health Information Network 2011–2016), we investigated adherence and persistence at 1 year for oral anticoagulants (OACs) in adults with incident AF. Baseline characteristics were analysed by OAC and adherence/persistence status. Risk factors for non-adherence and non-persistence were assessed using Cox and logistic regression. Patterns of adherence and persistence were analysed.

Results

Among 36 652 individuals with incident AF, cardiovascular comorbidities (median CHA2DS2VASc[Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category] 3) and polypharmacy (median number of drugs 6) were common. Adherence was 55.2% (95% CI 54.6 to 55.7), 51.2% (95% CI 50.6 to 51.8), 66.5% (95% CI 63.7 to 69.2), 63.1% (95% CI 61.8 to 64.4) and 64.7% (95% CI 63.2 to 66.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. One-year persistence was 65.9% (95% CI 65.4 to 66.5), 63.4% (95% CI 62.8 to 64.0), 61.4% (95% CI 58.3 to 64.2), 72.3% (95% CI 70.9 to 73.7) and 78.7% (95% CI 77.1 to 80.1) for all OACs, VKA, dabigatran, rivaroxaban and apixaban. Risk of non-adherence and non-persistence increased over time at individual and system levels. Increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all OACs. Overall rates of ‘primary non-adherence’ (stopping after first prescription), ‘non-adherent non-persistence’ and ‘persistent adherence’ were 3.5%, 26.5% and 40.2%, differing across OACs.

Conclusions

Adherence and persistence to OACs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across OACs in individuals and populations.