bluuebunny/crossref_metadata_2025 huggingface dataset:
Modeling and Simulation of Moored-Floating Structures Using the Tension Element Method
Authors: Martin Tobias , Kamath Arun , Bihs Hans
Published: July 2019

The derivation of a discrete mooring model for floating structures is presented in this paper. The method predicts the steady-state solution for the shape of an elastic cable and the tension forces under consideration of static loads. It is based on a discretization of the cable in mass points connected with straight but elastic bars. The successive approximation is applied to the resulting system of equations which leads to a significant reduction of the matrix size in comparison to the matrix of a Newton–Raphson method. The mooring model is implemented in the open-source computational fluid dynamics (CFD) model REEF3D. The solver has been used to study various problems in the field of wave hydrodynamics and fluid–structure interaction. It includes floating structures through a level set function and captures its motion using Newton and Euler equations in six degrees-of-freedom (6DOF). The fluid–structure interaction is solved explicitly using an immersed boundary method based on the ghost cell method. The applications show the accuracy of the solver and the effects of mooring on the motion of floating structures.
Dry Sliding Tribological Behavior of Columnar-Grained Fe2B Intermetallic Compound Under Different Loads
Authors: Li Kemin , Huang Zhifu , Min Ting , Liu Jiamei , Zhang Lei , Zheng Qiaoling
Published: July 2019

The dry sliding tribological behavior of a columnar-grained Fe2B intermetallic compound under different normal loads was evaluated by scanning electron microscopy (SEM), XPS, and 3D laser scanning microscope. The results indicated that under a load of 12 N, after a 35 min break-in period, the dynamic friction coefficient decreased from 0.78 to about 0.6 and this low value was maintained until the end of test. When the normal load increased from 4 N to 20 N, both the average friction coefficient and wear rate values initially decreased and then increased. The lowest values of the average friction coefficient and wear rate were obtained under a load of 12 N. As the load increased from 4 N to 12 N, a complete film formed on worn surface. Nevertheless, when the load increased to 16 N, severe self-induced vibration occurred and a corrugated ribbon appeared on the surface. Furthermore, severe damage on the worn surface was caused by cycling vibration under the 20 N load. Under 4 N and 12 N, the main wear mechanism was abrasive wear, while under a load of 20 N, fracture wear and abrasive wear were the mian wear mechanisms. The friction products were composed of B2O3, H3BO3, SiO2, and FexOy. More specifically, Fe2O3 was generated under 4 N load, Fe2O3 and Fe3O4 were produced under 12 N load, and the mixture of FeO, Fe2O3, and Fe3O4 appeared under 20 N load.
Experimental Study on Tribological Property of MoS2 Nanoparticle in Castor Oil
Authors: Yu Rui , Liu Jinxiang , Zhou Yang
Published: July 2019

In this paper, the antiwear and antifriction performance of MoS2 nanoparticle in castor oil was studied. The ball-on-disc tests were performed for different concentrations of MoS2 nanoparticle. Coefficient of friction, wear loss, and worn surface morphology were investigated. The results show that MoS2 nanoparticle could reduce the possibility of asperities direct contact, resulting in the reduction of the coefficient of friction and adhesive wear. However, MoS2 nanoparticle in excessive concentration could agglomerate into large particles, playing the role of an abrasive particle, which reduces the beneficial effects of MoS2 nanoparticle.
Wear Analysis of Spatial Parallel Mechanisms With Multiple Three-Dimensional Spherical Clearance Joints
Authors: Xiulong Chen , Yonghao Jia
Published: July 2019

The goal of this work is to investigate the dynamic responses of the parallel mechanism with irregular clearances caused by wear and to further reveal the influences of multiple clearance interaction on wear. The motion model and the force model of spherical clearance joint based on a continuous contact force model and a static friction model are established. The dynamic equation of the spatial parallel mechanism considering two spherical clearance joints is derived. A general wear analysis strategy to establish spherical clearance joint with sustainable updation of the surface profile is presented, and the dynamic responses of parallel mechanism after wear are studied. The interaction between two wear joints with different initial clearance values is further investigated. The results show that it is necessary to consider the factor of irregular clearances caused by wear in the analysis of dynamics behavior for precision mechanisms. Proper distribution of clearance values can reduce wear of clearance joint and improve the useful life of mechanism to a certain extent. This work provides a foundation for life prediction and reliability analysis of parallel mechanisms.
Numerical Investigations on the Sealing Performance of a Reciprocating Seal Based on the Inverse Lubrication Method
Authors: Wang Jun , Li Yongkang , Lian Zisheng
Published: July 2019

The work presented in this paper describes a new approach to calculate the film profile, friction, and fluid transport of a reciprocating U-cup seal used in a hydraulic piston pump. An innovative partial lubrication model of the seal is developed, which connects the inverse hydrodynamic lubrication method and Greenwood–Williamson asperity contact model. Finite element models (FEM) were established to simulate deformation behavior under-mounted and pressurized process using finite element code ansys. Based on the finite element simulations, corresponding numerical calculations have been made using the matlab with the inverse hydrodynamic lubrication and asperity contact theories. The accuracy of these models was validated against existing experimental data to ensure that they can predict the sealing performance sufficiently. The effects of the operating parameters as well as the magnitude of interference on the sealing performance in terms of friction, fluid transport, and film thickness were discussed. The results of the simulation indicate that the interference fit, sealed pressure, and rod velocity play significant roles to improve the wear and seizure resistance capability that is critical to the service life of the seal.
Estimated Physical Activity in Adolescents by Wrist-Worn GENEActiv Accelerometers
Authors: Sanders Sarah G. , Jimenez Elizabeth Yakes , Cole Natalie H. , Kuhlemeier Alena , McCauley Grace L. , Van Horn M. Lee , Kong Alberta S.
Published: July 2019

Background: Reports of physical activity (PA) measured via wrist-worn accelerometers in adolescents are limited. This study describes PA levels in adolescents at baseline of an obesity prevention and weight management trial. Methods: Adolescents (n = 930) at 8 high schools wore an accelerometer for 7 days, with average acceleration values of <50 mg, >150 mg, and >500 mg categorized as sedentary, moderate, and vigorous PA, respectively. In a 3-level mixed-effects generalized linear model, PA was regressed on sex, weight status, and day of week. Daily PA was nested within students, and students within schools, with random effects included for both. Results: Adolescents accumulated a median of 40 minutes daily of moderate to vigorous PA (MVPA). MVPA was significantly different for teens with obesity versus teens with normal weight (−5.4 min/d, P = .03); boys versus girls (16.3 min/d, P < .001); and Sundays versus midweek (−16.6 min/d, P < .001). Average sedentary time increased on weekends (Saturday: 19.1 min/d, P < .001; Sunday: 44.8 min, P < .001) relative to midweek but did not differ by sex or weight status. Conclusions: Interventions to increase PA in adolescents may benefit from focusing on increasing weekend PA and increasing MVPA in girls.
Do Birds of a Feather Flock Together Within a Team-Based Physical Activity Intervention? A Social Network Analysis
Authors: Edney Sarah , Olds Tim , Ryan Jillian , Plotnikoff Ronald , Vandelanotte Corneel , Curtis Rachel , Maher Carol
Published: July 2019

Background: Homophily is the tendency to associate with friends similar to ourselves. This study explored the effects of homophily on team formation in a physical activity challenge in which “captains” signed up their Facebook friends to form teams. Methods: This study assessed whether participants (n = 430) were more similar to their teammates than to nonteammates with regard to age, sex, education level, body mass index, self-reported and objectively measured physical activity, and negative emotional states; and whether captains were more similar to their own teammates than to nonteammates. Variability indices were calculated for each team, and a hypothetical variability index, representing that which would result from randomly assembled teams, was also calculated. Results: Within-team variability was less than that for random teams for all outcomes except education level and depression, with differences (SDs) ranging from +0.15 (self-reported physical activity) to +0.47 (age) (P < .001 to P = .001). Captains were similar to their teammates except in regard to age, with captains being 2.6 years younger (P = .003). Conclusions: Results support hypotheses that self-selected teams are likely to contain individuals with similar characteristics, highlighting potential to leverage team-based health interventions to target specific populations by instructing individuals with risk characteristics to form teams to help change behavior.
Differences in the Physical Activity, Sedentary Time, and BMI of Finnish Grade 5 Students
Authors: Salin Kasper , Huhtiniemi Mikko , Watt Anthony , Hakonen Harto , Jaakkola Timo
Published: July 2019

Background: This study examined the distribution of objectively measured physical activity (PA) and sedentary time of fifth-grade students during school, leisure time, and physical education (PE) classes. Demographic, anthropometric, and PA data were collected from 17 representative Finnish schools. Methods: To estimate the PA and sedentary time, participants (N = 592) wore wGT3X-BT ActiGraphs for 7 consecutive days. Comparisons were made between genders and different BMI groups. Results: From the study sample, 43.7% met the moderate to vigorous PA (MVPA) guidelines. Participants spent 62.2% of the day sedentary and 8.2% in moderate and vigorous activities. Boys performed more MVPA than girls, and girls were more sedentary during school days. Boys had more MVPA than girls in leisure time, but there were no differences in sedentary time. However, an examination of PA assessed during PE classes revealed no differences between boys and girls. Normal-weight boys engaged in more MVPA than overweight and obese boys. No differences were found for girls. Conclusions: The PA levels differ between different BMI groups in leisure time and during school but not during PE lessons. PA for overweight children should be targeted and compulsory PE time should be increased to achieve the PA guidelines.
Aggie Play: A Gender-Relevant Physical Activity Program for Girls
Authors: Post Phillip , Palacios Rebecca
Published: July 2019

A majority of U.S. children age 6–17 years do not meet the recommended 60 min of moderate to vigorous physical activity per day. Girls are less likely to meet these daily physical activity guidelines than boys. Following a call for greater gender-relevant physical activity programming, Aggie Play, an after-school physical activity program, engaged female student athletes to serve as active role models who lead girls through high-energy activities twice a week over a school year. The purpose of this study was to explore how Aggie Play affected girls’ self-efficacy and expected enjoyment for physical activity, time spent in various physical activity intensities during free play, and fitness, relative to a control group. Results revealed that the girls participating in Aggie Play increased ratings of physical activity self-efficacy and enjoyment compared with girls at a control site. Aggie Play girls also demonstrated greater improvements on the muscle-endurance test than girls at a control site. Results are consistent with prior gender-relevant physical activity and physical education research. This study extends prior results by documenting the benefits of gender-relevant physical activity programming when led by active female role models.
Effects of a 12-Week Exercise Intervention on Subsequent Compensatory Behaviors in Adolescent Girls: An Exploratory Study
Authors: Massie Rachel , Smallcombe James , Tolfrey Keith
Published: July 2019

Purpose: Chronic exercise programs can induce adaptive compensatory behavioral responses through increased energy intake (EI) and/or decreased free-living physical activity in adults. These responses can negate the benefits of an exercise-induced energy deficit; however, it is unclear whether young people experience similar responses. This study examined whether exercise-induced compensation occurs in adolescent girls. Methods: Twenty-three adolescent girls, heterogeneous for weight status, completed the study. Eleven adolescent girls aged 13 years completed a 12-week supervised exercise intervention (EX). Twelve body size–matched girls comprised the nonexercise control group (CON). Body composition, EI, free-living energy expenditure (EE), and peak oxygen uptake () were measured repeatedly over the intervention. Results: Laboratory EI (EX: 9027, 9610, and 9243 kJ·d−1 and CON: 9953, 9770, and 10,052 kJ·d−1 at 0, 12, and 18 wk, respectively; effect size [ES] = 0.26, P = .46) and free-living EI (EX: 7288, 6412, and 5273, 4916 kJ·d−1 and CON: 7227, 7128, and 6470, 6337 kJ·d−1 at 0, 6, 12, and 18 wk, respectively; ES ≤ 0.26, P = .90) did not change significantly over time and were similar between groups across the duration of the study. Free-living EE was higher in EX than CON (13,295 vs 12,115 kJ·d−1, ES ≥ 0.88, P ≥ .16), but no significant condition by time interactions were observed (P ≥ .17). Conclusion: The current findings indicate that compensatory changes in EI and EE behaviors did not occur at a group level within a small cohort of adolescent girls. However, analysis at the individual level highlights large interindividual variability in behaviors, which suggests a larger study may be prudent to extend this initial exploratory research.
Effect of Macrolide and Rifampin Resistance on Fitness of
Rhodococcus equi
during Intramacrophage Replication and
In Vivo
Authors: Willingham-Lane Jennifer M. , Berghaus Londa J. , Berghaus Roy D. , Hart Kelsey A. , Giguère Steeve
Published: July 2019

The soil-dwelling, saprophytic actinomycete
Rhodococcus equi
is a facultative intracellular pathogen of macrophages and causes severe bronchopneumonia when inhaled by susceptible foals. Standard treatment for
R. equi
disease is dual-antimicrobial therapy with a macrolide and rifampin. Thoracic ultrasonography and early treatment with antimicrobials prior to the development of clinical signs are used as means of controlling endemic
R. equi
infection on many farms.
A Recombinant Attenuated
Yersinia pseudotuberculosis
Vaccine Delivering a
Y. pestis
YopE
Nt138
-LcrV Fusion Elicits Broad Protection against Plague and Yersiniosis in Mice
Authors: Singh Amit K. , Curtiss Roy , Sun Wei
Published: July 2019

In this study, a novel recombinant attenuated
Yersinia pseudotuberculosis
PB1+ strain (χ10069) engineered with Δ
yopK
Δ
yopJ
Δ
asd
triple mutations was used to deliver a
Y. pestis
fusion protein, YopE amino acid 1 to 138-LcrV (YopE
Nt138
-LcrV), to Swiss Webster mice as a protective antigen against infections by yersiniae.
In Vitro
Double-Stranded RNA Synthesis by Rotavirus Polymerase Mutants with Lesions at Core Shell Contact Sites
Authors: Steger Courtney L. , Brown Mackenzie L. , Sullivan Owen M. , Boudreaux Crystal E. , Cohen Courtney A. , LaConte Leslie E. W. , McDonald Sarah M.
Published: July 2019

Rotaviruses are important pathogens that cause severe gastroenteritis in the young of many animals. The viral polymerase VP1 mediates all stages of viral RNA synthesis, and it requires the core shell protein VP2 for its enzymatic activity. Yet, there are several gaps in knowledge about how VP2 engages and activates VP1. Here, we probed the functional significance of 5 distinct VP2 contact sites on VP1 that were revealed through previous structural studies. Specifically, we engineered alanine amino acid substitutions within each of the 5 VP1 regions and assayed the mutant polymerases for the capacity to synthesize RNA in the presence of VP2 in a test tube. Our results identified residues within 3 of the VP2 contact sites that are critical for robust polymerase activity. These results are important because they enhance the understanding of a key step of the rotavirus replication cycle.
Differentiating Epidemic from Endemic or Sporadic Infectious Disease Occurrence
Authors: Riley Lee W.
Published: July 2019

One important scope of work of epidemiology is the investigation of infectious diseases that cluster in time and place. Clusters of infectious disease may represent outbreaks or epidemics in which the cases share in common a point source exposure or an infectious agent in a chain of transmission pathways. Investigations of outbreaks of an illness can facilitate identification of a source, risk, or cause of the illness. However, most infectious disease episodes occur not as part of any apparent outbreaks but as sporadic infections. Multiple sporadic infections that occur steadily in time and place are referred to as endemic disease. How does one investigate sources and risk factors for sporadic or endemic infections? As part of the
Microbiology Spectrum
Curated Collection: Advances in Molecular Epidemiology of Infectious Diseases, this review discusses limitations of traditional approaches and advantages of molecular epidemiology approaches to investigate sporadic and endemic infections. Using specific examples, the discussions show that most sporadic infections are actually part of unrecognized outbreaks and that what appears to be endemic disease occurrence is actually comprised of multiple small outbreaks. These molecular epidemiologic investigations have unmasked modes of transmission of infectious agents not known to cause outbreaks. They have also raised questions about the traditional ways to measure incidence and assess sources of drug-resistant infections in community settings. The discoveries made by the application of molecular microbiology methods in epidemiologic investigations have led to creation of new public health intervention strategies that have not been previously considered.

*

This article is part of a curated collection.
Challenging diagnosis of resistance to thyroid hormone in a patient with pituitary adenoma
Authors: Carvalho Cunha Nelson , Gomes Leonor , Bastos Margarida
Published: July 2019

The elevation of thyroid hormone with a normal or elevated thyroid-stimulation hormone (TSH) occurs uncommonly. This set a diagnosis challenge between TSH-secreting pituitary adenoma and resistance to thyroid hormone (RTH). We report a case of a young female patient with palpitations, with elevated thyroid hormone and non-suppressed TSH. TSH receptor antibody was undetectable. Thyroid ultrasound revealed mild heterogeneous goitre, and MRI revealed a microadenoma with 7.5 mm length in pituitary’s left lobe. Pituitary hormones were within normal ranges. The thyrotropin-releasing hormone stimulation test showed normal TSH elevation, consistent with RTH. The genetic test revealed a mutation in heterozygosity in THRB gene (G344R) confirming RTH-beta. No pituitary surgery or thyroidectomy was performed nor were prescribed any antithyroid drugs. Inappropriate secretion of TSH requires a high level of clinical suspicion and the proper laboratory, genetic and radiological studies to conduct a correct diagnosis and prevent unnecessary and potential harmful therapies.
Cardiac arrest in a young healthy male patient secondary to kratom ingestion: is this ’legal high' substance more dangerous than initially thought ?
Authors: Abdullah Hafez Mohammad Ammar , Haq Iqra , Lamfers Randall
Published: July 2019

Kratom is a psychoactive herb that has stimulant properties at low doses and has opioid-like properties at higher doses. It has been used for centuries in southeast Asia as a stimulant but has gained increasing popularity as a substitute for opioids in western countries as it is easily available. As most cases of kratom use involve other drugs too, the Food and Drug Administration (FDA) has stopped short of restricting kratom due to difficulty in assessing the adverse effects of kratom alone. We present the case of a young healthy 35-year-old man who suffered a cardiac arrest due to kratom use with no other coingestants. He was subsequently intubated and found to have systolic dysfunction and small brain infarcts. Fortunately, he made a successful recovery and was discharged after a stay at thebehavioural health centre. Our case highlights the potential adverse effects of kratom and the need to regulate its use.
Unduly long left main (79 mm) coronary artery arising from right coronary sinus in a 64-year-old diabetic man
Authors: Sinha Santosh Kumar , Aggarwal Puneet , Razi Mahmodula , Krishna Vinay
Published: July 2019

Coronary artery anomalies are usually an incidental finding on coronary angiogram. Most of them are benign, although few of them are malignant which may cause sudden cardiac death. A 64-year-old diabetic, hypertensive man underwent coronary angiography for evaluation of exertional dyspnoea, and angina which revealed an anomalous left main coronary artery (LMCA) arising from right coronary sinus which was unduly long (79 mm) but free from any disease. To the best of our knowledge after extensive search in literature, this is the longest LMCA to be ever reported. The patient was managed conservatively.
Bilateral independent periodic lateralised epileptiform discharges at presentation followed by rapid recovery: novel observations from a case of Epstein-Barr virus encephalitis
Authors: Iyer Rajesh Shankar , Ramalingam Ramakrishnan Tirupur Chinnappan , Akhtar Saleem , Ponnadan Shabeer
Published: July 2019

Bilateral independent periodic lateralised epileptiform discharges (BIPLEDs) in electroencephalograms (EEGs) are commonly caused by anoxic encephalopathy and central nervous system infections. They are associated with coma and high mortality and are thus markers of poor prognosis. We present a case of encephalitis who presented with BIPLEDs in EEG. Though the clinical, EEG and MRI features closely resembled herpes simplex encephalitis, further investigations proved it to be Epstein-Barr virus (EBV) encephalitis. Despite the presence of BIPLEDs in the EEG, the patient had a rapid clinical response to therapy with acyclovir. We emphasise that BIPLEDs may not always indicate poor prognosis especially in the setting of EBV encephalitis.
Diffuse large B-cell lymphoma recurrence presenting as multiple, progressive cranial neuropathies
Authors: Goron Abby R , Devlin Stephen , Schwartz Stacy
Published: July 2019

A 58-year-old man with a history of rheumatoid arthritis and stage IV diffuse large B-cell lymphoma, in complete remission with no evidence of residual disease on positron emission tomography/CT after completing six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy, presented with acute onset of dysphagia to solids and liquids. On further evaluation, his dysphagia was attributed to a vagus nerve palsy, and later during his admission, he developed rapidly progressing left facial and vestibulocochlear nerve palsies. Imaging studies displayed pathological enhancement of bilateral seventh and eighth cranial nerves, concerning for leptomeningeal recurrence of lymphoma. Cerebrospinal fluid analysis and flow cytometry were confirmatory, revealing markedly atypical monotypic CD19 positive B cells.
Severe presentation of antibody-negative, postinfectious steroid-responsive encephalitis and atonic bladder after herpes simplex encephalitis
Authors: Mrad Luay , Moustakas Argirios , Fuino Robert , Waheed Waqar
Published: July 2019

A 75-year-old woman presented with new onset of confusion, intense episodic dizziness and formed visual hallucinations. Herpes simplex encephalitis and non-convulsive temporal lobe seizures were confirmed with cerebrospinal fluid (CSF) and electroencephalography testing. In addition, her hospital course was complicated by syndrome of inappropriate antidiuretic hormone secretion and atonic bladder contributing to an episode of urinary tract infection. After completing 3 weeks of acyclovir treatment, the patient became obtunded with right arm choreiform movements and persistent inflammatory CSF findings not attributable to persistent herpes simplex virus infection or other confounding factors. The patient responded to steroid treatment. Repeated autoimmune and paraneoplastic evaluations were negative. Both clinical (cognitive testing and atonic bladder) and CSF inflammatory finding improved in the follow-up period.
Colonic metastases 13 years after the primary ovarian cancer: a case study with a brief review of literature
Authors: Bhange Snehal A , Bhansali Mehul , Shaikh Tanveer , Ajgaonkar Utkarsh
Published: July 2019

Metastatic ovarian malignancy is a known and dreaded complication of ovarian malignancy. Ovarian malignancies primarily disseminate through the peritoneal cavity and are only superficially invasive. They rarely metastasise through the haematogenous route, but that occurs in the presence of heavy peritoneal disease. The involvement of the colon in advanced ovarian malignancy is mostly through the peritoneal seedlings. It is very rare for an ovarian malignancy to invade through the serosa into the submucosa and mucosa of an adjacent colonic segment in the absence of active peritoneal disease. This occurring 13 years after the primary malignancy and after receiving a full course of chemotherapy is very interesting. There is always a possibility of a second primary cancer but in this case immunohistochemistry clearly clinched the diagnosis of an ovarian metastasis to the colon.
Non-typhoidal salmonellosis presenting as acute calculus cholecystitis
Authors: Juma Fatema , Cave Joshua J , Gonzales Hector , Moore Luke Stephen Prockter
Published: July 2019

Non-typhoidalSalmonella spp.are Gram-negative bacilli, which typically cause a clinical picture of gastroenteritis and, less commonly, patients may become a chronic carrier of the pathogen within their gallbladder. We describe a rare clinical presentation of a non-typhoidalSalmonella spp.infection as acute calculus cholecystitis in an adult patient.Salmonella entericasubsp. Salamae (ST P4271) was grown from cholecystostomy fluid, and the patient subsequently underwent a laparoscopic cholecystectomy that demonstrated a necrotic gallbladder fundus. We advise that microbiological sampling of bile is essential, especially in the context of foreign travel, to detect unusual pathogens as in this case or common pathogens that may have unusual antimicrobial resistance. Given the necrotic gallbladder as in this case, we also advise that early cholecystectomy should be strongly considered in these patients.
Anthropometric changes and risk of diabetes: are there sex differences? A longitudinal study of Alberta’s Tomorrow Project
Authors: Ye Ming , Robson Paula J , Eurich Dean T , Vena Jennifer E , Xu Jian-Yi , Johnson Jeffrey A
Published: July 2019

Objectives

To characterise the sex-specific difference in the association between anthropometric changes and risk of diabetes in the general population in Canada.

Setting and participants

From 2000 to 2008, Alberta’s Tomorrow Project (ATP) invited Alberta’s residents aged 35–69 years to a prospective cohort study. A total of 19 655 diabetes-free ATP participants having anthropometrics measured at the baseline and follow-ups were included.

Design and outcome measures

A longitudinal study design was used to examine the association between anthropometric changes and risk of diabetes and the sex difference in this association. Changes in weight, body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR) were calculated as the difference between baseline and follow-up measures. Diabetes cases were identified using the Canadian National Diabetes Surveillance System algorithm with administrative healthcare data (2000–2015) linked to the ATP cohort. The sex-specific association between anthropometric changes and incidence of diabetes were examined by multivariable Cox regression models.

Results

Changes in weight, BMI, WC and WHR over time were positively associated with incidence of diabetes in both men and women. The sex difference in risk of diabetes associated with 1 standard deviation (SD) increase in anthropometrics was 0.07 (95% CI −0.02 to 0.14) for weight, 0.08 (95% CI −0.03 to 0.17) for BMI, 0.07 (95% CI −0.02 to 0.15) for WC and 0.09 (95% CI 0.03 to 0.13) for WHR. Similar results were found in sex difference in the associations with changes per 5% and changes per categories (5% loss, ±5%, 5% gain).

Conclusions

The positive association between anthropometric changes and risk of diabetes was generally stronger in men than in women. However, this sex-specific difference of approximately 10% of the total risk associated with anthropometric changes had limited significance. For population-based public health programmes aiming to control obesity and incidence of diabetes, it may not be necessary to set up sex-specific goals for anthropometric reduction.
Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive survey-based overview
Authors: Mulyanto Joko , Kringos Dionne S , Kunst Anton E
Published: July 2019

Objective

Monitoring inequality in healthcare utilisation is essential to reduce persistent inequalities in health in lower-middle income countries. This study aimed to assess socioeconomic inequalities in the utilisation of primary care, secondary care and preventive care in Indonesia.

Methods

A cross-sectional study was conducted using data from the 2014 Indonesia Family Life Survey with a total of 42 083 adult participants. Socioeconomic status (SES) was measured by educational level and income. Healthcare utilisation was measured in: (1) primary care, (2) outpatient in secondary care, (3) inpatient care and (4) cardiovascular-related preventive care. The magnitude of inequalities was measured using the relative index of inequality (RII).

Results

Small educational inequalities were found for primary care utilisation (RII 1.13, 95% CI 1.01 to 1.26). Larger educational inequalities were found for outpatient secondary care (RII 10.35, 95% CI 8.11 to 13.22) and inpatient care (RII 2.78, 95% CI 2.32 to 3.32). The largest educational inequalities were found for preventive care, particularly regarding blood glucose tests (RII 30.31, 95% CI 26.13 to 35.15) and electrocardiography tests (RII 30.90, 95% CI 24.97 to 38.23). Compared with educational inequalities, income inequalities were larger for primary care (RII 1.68, 95% CI 1.52 to 1.85) and inpatient care (RII 3.11, 95% CI 2.63 to 3.66), but not for outpatient secondary care and preventive care.

Conclusions

Socioeconomic inequalities in healthcare utilisation in Indonesia are particularly large in secondary and preventive care. Therefore, it is recommended to prioritise policies focused on improving timely, geographical and financial access to secondary and preventive care for lower SES groups.
Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis
Authors: Li Juan , Zhong Dongling , Ye Jing , He Mingxing , Liu Xicen , Zheng Hui , Jin Rongjiang , Zhang Shao-lan
Published: July 2019

Introduction

Multiple rehabilitation therapies have been reported to be effective for poststroke balance impairment. However, the comparative effectiveness of these rehabilitation therapies is still unclear. Therefore, the aim of this study is to summarise evidence and identify the most effective rehabilitation therapy for poststroke balance impairment.

Methods and analysis

The following databases will be searched: China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Data, the Chinese Science and Technology Periodical Database, Medline, Excerpt Medical Database (EMBASE), Web of Science, the Cochrane Library, from inception to June 2019. All randomised controlled trials that have used rehabilitation interventions to treat poststroke balance impairment will be included. The primary outcomes are the Berg Balance Scale, the Fugl-Meyer Assessment (balance), the Postural Assessment Scale for Stroke, as well as the function in sitting test, the Sitting Balance Scale, the Ottawa Sitting Scale, the Activities-specific Balance Confidence Scale, the Overall Balance Index and the Brunel Balance Assessment. The secondary outcomes include the Barthel Index, the Functional Ambulation Category Scale, fall rates, the Timed Up and Go test, the MOS 36-Item Short-Form Health Survey, and adverse events. To ensure that all relevant studies are included without personal bias, study selection, data extraction and quality assessment will be performed independently by two reviewers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. Review Manager V.5.3 software will be used to make bias risk diagram and pairwise meta-analysis, while network data synthesis will be performed using WinBUGS V.1.4.3 and R software.

Ethics and dissemination

Ethics approval is not required for systematic review and network meta-analysis. The results will be submitted to a peer review journal or at a conference.

Trial registration number

PROSPERO (CRD 42018107441).
Challenges in the implementation of primary health care reforms: a qualitative analysis of stakeholders’ views in Turkey
Authors: Espinosa-González Ana Belén , Normand Charles
Published: July 2019

Objectives

This study aims to assess the implementation of the Family Medicine Programme (FMP), which has taken place in Turkey from 2005 to 2010 as a set of comprehensive primary health care (PHC) reforms and involved changes in professional organisation (eg, family medicine specialisation) and service provision (eg, patients’ registration list). Our particular interest is to identify the challenges and limitations that PHC physicians and academicians have encountered in the implementation of the FMP which could have influenced the delivery of care and utilisation of services.

Design

We applied the framework method to analyse data obtained through semi-structured interviews conducted in the field. This qualitative approach involved the categorisation of raw data into a predefined framework, which comprised challenges and limitations identified in the literature, and the emergence of a new framework, whose categories corresponded to challenges and limitations identified through thematic analysis of our data.

Setting

PHC centres and academic departments from five Turkish provinces.

Participants

PHC physicians and academicians involved in training and/or research were invited to participate. 20 participants agreed to take part and, due to schedule limitations, 15 participants (seven PHC physicians and eight academicians) completed the interviews.

Results

Shortcomings in the planning of the reforms, inadequate commitment to integration of PHC in the system and collateral effects of a market model in healthcare emerged as limitations to successful FMP implementation. Uncertainty about care quality and physicians’ ethical values as well as perceptions of organisational injustice among healthcare workers were contributing challenges.

Conclusions

A systems thinking approach in the FMP design and implementation could help foresee and address these limitations. In decentralisation processes, such as FMP, shared governance by including PHC stakeholders in policy-making and planning could alleviate misalignment of interests and positively affect PHC performance, for example, by removing barriers to gatekeeping implementation.
Economic burden of managing oral cancer patients in Sri Lanka: a cross-sectional hospital -based costing study
Authors: Amarasinghe Hemantha , Jayasinghe Ruwan Duminda , Dharmagunawardene Dilantha , Attygalla Manjula , Scuffham Paul A , Johnson Newell , Kularatna Sanjeewa
Published: July 2019

Objective

Cancer of the oral cavity is the leading malignancy among males in Sri Lanka, and sixth among women. This study aimed to estimate costs of managing patients with oral cancer (OCA) in Sri Lanka for a 12 month period from diagnosis.

Design

Hospital based costing study.

Settings

Four selected cancer treatment centres in Sri Lanka.

Participants

Sixty-nine OCA patients: 60 were males and 12 had recurrent tumours.

Outcome

Societal perspectives (healthcare, household and indirect costs) were itemised. Costs to the healthcare system included surgery, Intensive Care Unit (ICU) care, chemotherapy and radiotherapy. Capital costs including apportioned value of land, buildings, equipment and furniture. Household costs consisted of out of pocket expenditure for healthcare and indirect costs of lost income. Costs were estimated from the stage of presentation for treatment to 1 year of follow-up.

Results

Mean cost of managing a single stage II OCA patient for 1 year was Sri Lankan rupees (SLR) 58 979 (US$394, at the midyear exchange rate in 2016) to the health system. Mean household cost was SLR 77 649 (US$518). The annual cost of managing a stage III or IV patient was SLR 303 620 (US$2027), with household costs of SLR 71 932 (US$480).

Conclusions

Owing to the high incidence of OCA in Sri Lanka, the economic costs associated with these diseases are enormous, resulting in negative impacts on both the healthcare system and individual families, seriously impacting the country’s economy. Policy-makers should take note of this burden and increase steps for prevention and control of this devastating disease.
Systematic review and meta-analysis of the association between peripheral inflammatory cytokines and generalised anxiety disorder
Authors: Costello Harry , Gould Rebecca L , Abrol Esha , Howard Robert
Published: July 2019

Objective

Inflammation has been implicated in the aetiology of mental illness. We conducted the first systematic review and meta-analysis of the association between peripheral markers of inflammation and generalised anxiety disorder (GAD).

Design

Systematic review and meta-analysis of studies measuring peripheral cytokine levels in people with GAD compared with controls.

Data sources

MEDLINE (1950–), EMBASE (1947–), PsycINFO (1872–) and Web of Science (1945–) databases up until January 2018.

Eligibility criteria

Primary, quantitative research studies of people with a diagnosis of GAD assessed using a standardised clinical interview that measured peripheral inflammatory markers.

Data extraction and synthesis

Two independent reviewers extracted data and assessed study quality. Meta-analysis using a random-effects model was conducted for individual cytokines where data from three or more studies were available.

Results

14 of 1718 identified studies met the inclusion criteria, comprising 1188 patients with GAD and 10 623 controls. In total 16 cytokines were evaluated. Significantly raised levels of C reactive protein (CRP), interferon-γ and tumour necrosis factor-α were reported in patients with GAD compared with controls in two or more studies. Ten further proinflammatory cytokines were reported to be significantly raised in GAD in at least one study. However, 5 of 14 studies found no difference in the levels of at least one cytokine. Only CRP studies reported sufficient data for meta-analysis. CRP was significantly higher in people with GAD compared with controls, with a small effect size (Cohen’s d=0.38, 0.06–0.69), comparable with that reported in schizophrenia. However, heterogeneity was high (I2=75%), in keeping with meta-analyses of inflammation in other psychiatric conditions and reflecting differences in participant medication use, comorbid depression and cytokine sampling methodology.

Conclusion

There is preliminary evidence to suggest an inflammatory response in GAD, but it remains unclear whether inflammatory cytokines play a role in the aetiology. GAD remains a poorly studied area of neuroinflammation compared with other mental disorders, and further longitudinal studies are required.
Peer influence in adolescent drinking behaviour: a protocol for systematic review and meta-analysis of stochastic actor-based modeling studies
Authors: Ivaniushina Valeria , Titkova Vera , Alexandrov Daniel
Published: July 2019

Introduction

Alcohol consumption is a considerable public health problem that is especially harmful to young people. To develop effective prevention programmes targeted at adolescents, it is important to understand the social mechanisms triggering alcohol consumption. Among such mechanisms, peer influence plays an important role. The effects of peer influence are very difficult to evaluate because of the entanglement with social selection, that is, a tendency of people to befriend others with similar behaviour. The recently developed stochastic actor-oriented models (SAOM) approach is designed to disentangle social influence from social selection. The aim of this study is to conduct a systematic review and meta-analysis of studies employing SAOM methodology to evaluate the effects of social influence on adolescent drinking behaviour.

Methods and analysis

In order to analyse the co-evolution of alcohol consumption and adolescent friendship networks, we will collect articles that use SAOM methodology through systematic electronic searches in Web of Science, Scopus, PubMed, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), EBSCOhost (MEDLINE, SocINDEX, Academic Source, ERIC), ProQuest (ProQuest Dissertations and Theses Global), PsycINFO (PsycNET), Excerpta Medica database (Embase) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We will collect the literature from academic journals, dissertations/theses, reports and conference materials. Three reviewers will retrieve and independently assess potentially relevant material in terms of whether they comply with prespecified criteria. Subsequently, we will summarise the results of the studies in a systematic review. If a sufficient number of studies can be found, SAOM quantitative results will be extracted and meta-analysed. The project will go from 1 December 2018 to 1 December 2019.

Ethics and dissemination

Ethical approval will not be required as our work is based on published studies. A list of all the studies included in this work will be available for review. We plan dissemination in a peer-reviewed international scientific journal and through conference presentations. Our review will highlight the peer effect of peers in adolescent drinking behaviour and provide guidance for developing effective prevention and intervention programmes. We expect it to be informative for policy and practice, decision-making as well as for further research in public health and sociology of adolescents.

PROSPERO registration number

CRD42019119836.
Changes in conventional cardiovascular risk factors and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations in two population-based cross-sectional surveys: the SAMINOR Study
Authors: Siri Susanna Ragnhild Andersdatter , Eliassen Bent Martin , Jacobsen Bjarne K , Melhus Marita , Broderstad Ann Ragnhild , Michalsen Vilde Lehne , Braaten Tonje
Published: July 2019

Objective

To describe changes in cardiovascular risk factors and in the estimated 10-year risk of acute myocardial infarction (AMI) or cerebral stroke (CS) between SAMINOR 1 (2003–2004) and SAMINOR 2 (2012–2014), and explore if these changes differed between Sami and non-Sami.

Design

Two cross-sectional surveys.

Setting

Inhabitants of rural Northern Norway.

Participants

Participants were aged 40–79 years and participated in SAMINOR 1 (n=6417) and/or SAMINOR 2 (n=5956).

Primary outcome measures

Generalised estimating equation regressions with an interaction term were used to estimate and compare changes in cardiovascular risk factors and 10-year risk of AMI or CS between the two surveys and by ethnicity.

Results

Mean cholesterol declined by 0.50, 0.43 and 0.60 mmol/L in women, Sami men and non-Sami men, respectively (all p<0.001). Sami men had a small decline in mean high-density lipoprotein (HDL) cholesterol and an increase in mean triglycerides (both p<0.001), whereas non-Sami showed no change in these variables. Non-Sami women had an increase in mean HDL cholesterol (p<0.001) whereas Sami women had no change. Triglycerides did not change in non-Sami and Sami women. Systolic and diastolic blood pressure declined by 3.6 and 1.0 mm Hg in women, and 3.1 and 0.7 in men, respectively (all p<0.01). Mean waist circumference increased by 6.7 and 5.9 cm in women and men, respectively (both p<0.001). The odds of being a smoker declined by 35% in women and 46% in men (both p<0.001). Estimated 10-year risk of AMI or CS decreased in all strata of sex and ethnicity (p<0.001), however, Sami women had a smaller decline than non-Sami did.

Conclusions

Independent of ethnicity, there was a decline in mean cholesterol, blood pressure, smoking, hypertension (women only) and 10-year risk of AMI or CS, but waist circumference increased. Relatively minor ethnic differences were found in changes of cardiovascular risk factors.
Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): a pilot randomised controlled trial protocol
Authors: Lewis Kimberley , Culgin Sarah , Jaeschke Roman , Perri Dan , Marchildon Corry , Hassall Kelly , Piraino Thomas , Thabane Lehana , Almubarak Yousef , Alshahrani Mohammed S , Rochwerg Bram , Baw Bandar , Szczeklik Wojciech , Karachi Tim , Alhazzani Waleed
Published: July 2019

Introduction

Endotracheal intubation and invasive mechanical ventilation are lifesaving interventions that are commonly performed in the intensive care unit (ICU). Laryngeal oedema is a known complication of intubation that may cause airway obstruction in a patient on extubation. To date, the only test available to predict this complication is the cuff leak test (CLT); however, its diagnostic accuracy and utility remains uncertain. Herein, we report the protocol for the CuffLeak and AirwayObstruction in MechanicallyVentilated ICU Patients (COMIC) pilottrial.

Methods and analysis

This will be a multicentred, pragmatic, pilot randomised controlled trial (RCT). We will enrol 100 mechanically ventilated patients in the ICU who are deemed ready for extubation. We will exclude patients at a high risk of laryngeal oedema. All enrolled patients will have a CLT done before extubation. In the intervention arm, the results of the CLT will be communicated to the bedside physician, and decision to extubate will be left to the treating team. In the control arm, respiratory therapist will not communicate the results of the CLT to the treating physician, and the patient will be extubated regardless of the CLT result. Randomisation will be done in a 1:1 allocation ratio, stratified by size of the endotracheal tube and duration of invasive mechanical ventilation.

Although we will examine all clinical outcomes relevant for the future COMIC RCT, the primary outcomes of the COMIC pilottrial will be feasibility outcomes including: consent rate, recruitment rate and protocol adherence. Clinical outcomes include postextubation stridor, reintubation, emergency surgical airway, ICU mortality, in hospital mortality, duration of mechanical ventilation and ICU length of stay in days.

Ethics and dissemination

The Hamilton Integrated Research Ethics Board, Imam Abdulrahman Bin Faisal University Institutional Review Board and Bioethical Commission of the Jagiellonian University approved this study. The trial results will be disseminated via publication in peer-reviewed journals.

Trial registration number

NCT03372707.