bluuebunny/crossref_metadata_2025 huggingface dataset:
The importance of organizational commitment in rural nurses' intent to leave
Authors: Stewart Norma J. , MacLeod Martha L. P. , Kosteniuk Julie G. , Olynick Janna , Penz Kelly L. , Karunanayake Chandima P. , Kulig Judith C. , Labrecque Mary Ellen , Morgan Debra G.
Published: October 2020

Aims

To examine determinants of intention to leave a nursing position in rural and remote areas within the next year, for Registered Nurses or Nurse Practitioners (RNs/NPs) and Licensed Practical Nurses (LPNs).

Design

A pan‐Canadian cross‐sectional survey.

Methods

The Nursing Practice in Rural and Remote Canada II survey (2014–2015) used stratified, systematic sampling and obtained two samples of questionnaire responses on intent to leave from 1,932 RNs/NPs and 1,133 LPNs. Separate logistic regression analyses were conducted for RNs/NPs and LPNs.

Results

For RNs/NPs, 19.8% of the variance on intent to leave was explained by 11 variables; and for LPNs, 16.9% of the variance was explained by seven variables. Organizational commitment was the only variable associated with intent to leave for both RNs/NPs and LPNs.

Conclusions

Enhancement of organizational commitment is important in reducing intent to leave and turnover. Since most variables associated with intent to leave differ between RNs/NPs and LPNs, the distinction of nurse type is critical for the development of rural‐specific turnover reduction strategies. Comparison of determinants of intent to leave in the current RNs/NPs analysis with the first pan‐Canadian study of rural and remote nurses (2001–2002) showed similarity of issues for RNs/NPs over time, suggesting that some issues addressing turnover remain unresolved.

Impact

The geographic maldistribution of nurses requires focused attention on nurses' intent to leave. This research shows that healthcare organizations would do well to develop policies targeting specific variables associated with intent to leave for each type of nurse in the rural and remote context. Practical strategies could include specific continuing education initiatives, tailored mentoring programs, and the creation of career pathways for nurses in rural and remote settings. They would also include place‐based actions designed to enhance nurses' integration with their communities and which would be planned together with communities and nurses themselves.
Mind–body interventions on stress management in pregnant women: A systematic review and meta‐analysis of randomized controlled trials
Authors: Guo Pingping , Zhang Xuehui , Liu Na , Wang Jie , Chen Dandan , Sun Weijia , LI Ping , Zhang Wei
Published: October 2020

Aim

To quantify the effect of mind–body interventions on stress in pregnant women.

Design

A systematic review and meta‐analysis of randomized controlled trials was performed.

Data Sources

PubMed, Embase, CENTRAL, Web of Science and PsycINFO were searched from each database inception to January 2020.

Review methods

Randomized controlled trials regarding mind–body interventions for stress in pregnant women were included. Methodological quality was evaluated using the Cochrane Collaboration ‘Risk of Bias’ tool and meta‐analysis was performed via RevMan 5.3. Subgroup analysis and publication bias assessment were conducted. Post hoc sensitivity analysis was performed to investigate the source of heterogeneity.

Results

In total, 28 studies comprising 1944 participants were included. The overall meta‐analysis showed that antenatal stress of pregnant women in the mind–body interventions groups showed significant high improvements (SMD=−0.94; 95% CI [−1.25, −0.63];p < .00001) compared with the control groups. Results of subgroup analyses indicated that all types of mind–body interventions including mindfulness intervention, cognitive behavioural therapy, relaxation techniques and yoga were beneficial to antenatal stress. Both groups and individual formats mind–body interventions were effective. 4–8 weeks mind–body interventions were seemed as the optimal choice. Moreover, mind–body interventions were concomitant with reducing antenatal anxiety and depression.

Conclusion

Mind–body interventions are promising approaches for stress reduction in pregnant women. Nevertheless, the results should be interpreted with caution because of high heterogeneity and publication bias. Further high‐quality studies are needed to verify the findings.

Impact

Mind–body interventions have been widely implemented to ameliorate antenatal stress, but conflicting results were found across studies. This systematic review and meta‐analysis suggested that mind–body interventions are relatively safe and convenient and can successfully promote antenatal stress. The suggestions proposed in this review may be useful for developing a scientific mind–body interventions regimen and encouraging the application of mind–body interventions in pregnant women, thereby managing antenatal stress effectively.
Pterostilbene enhances sorafenib’s anticancer effects on gastric adenocarcinoma
Authors: Zhao Tingting , Wang Chun , Huo Xinying , He Ming‐Liang , Chen Jinfei
Published: October 2020

Sorafenib has been approved for the treatment of certain cancers in clinic. However, the effects of sorafenib on gastric adenocarcinoma (GAC) were still limited. This study aimed to evaluate both in vitro and in vivo efficacy of sorafenib in combination with pterostilbene (PTE) on the treatment of GAC. Here, the morphological changes and cell viability were recorded in both N87 and MKN45 cells. The cell cycle profile and apoptosis were assessed by flow cytometry. Subcutaneous tumour xenografts were constructed in nude mice, and IHC staining of the dissected tumour tissues was conducted. Our results showed that PTE enhanced sorafenib's inhibitory effects on cell viability. The obvious down‐regulation of cyclin D1, Cdk‐2, Cdk‐4, Cdk‐6 and p62 and the up‐regulation of LC3II, caspase‐9, caspase‐3 and PARP cleavages were observed for the combination treatment with PTE and sorafenib than monotherapy. The combination treatment resulted in a higher level of cell cycle arrest at G1 phase and apoptosis than either drug. Besides, drug combination significantly enhanced the inhibition of tumour growth than sorafenib or PET alone in nude mice. The percentage of Ki‐67‐ and PCNA‐positive cells was distinctly reduced, and the apoptotic cells was obviously increased when compared with single drug therapy. Altogether, PET obviously enhanced sorafenib's antitumour effects against GAC through inhibiting cell proliferation, inducing autophagy and promoting apoptosis. The combination therapy with PET and sorafenib may serve as a novel therapeutic strategy for treating GAC and deserve further clinical trials.
Environmental and morphological constraints interact to drive the evolution of communication signals in frogs
Authors: Muñoz Matías I. , Goutte Sandra , Ellers Jacintha , Halfwerk Wouter
Published: October 2020

Animals show a rich diversity of signals and displays. Among the many selective forces driving the evolution of communication signals, one widely recognized factor is the structure of the environment where animals communicate. In particular, animals communicating by sounds often emit acoustic signals from specific locations, such as high up in the air, from the ground or in the water. The properties of these different display sites may impose different constraints on sound production, and therefore drive signal evolution. Here, we used comparative phylogenetic analyses to assess the relationship between calling site (aquatic versus nonaquatic), body size and call dominant frequency of 160 frog species from the families Ranidae, Leptodactylidae and Hylidae. We found that the frequency of frogs calling from the water was lower than that of species calling outside of the water, a trend that was consistent across the three families studied. Furthermore, phylogenetic path analysis revealed that call site had both direct and indirect effects on call frequency. Indirect effects were mediated by call site influencing male body size, which in turn was negatively associated with call frequency. Our results suggest that properties of display sites can drive signal evolution, most likely not only through morphological constraints imposed on the sound production mechanism, but also through changes in body size, highlighting the relevance of the interplay between morphological adaptation and signal evolution. Changes in display site may therefore have important evolutionary consequences, as it may influence sexual selection processes and ultimately may even promote speciation.
Impact of chronic constipation on health‐related quality of life and work productivity in Japan
Authors: Tomita Toshihiko , Kazumori Kiyoyasu , Baba Kenji , Zhao Xiahong , Chen Yirong , Miwa Hiroto
Published: October 2020

Background and Aim

The impact of chronic constipation on health‐related quality of life (HRQoL), work productivity, and healthcare resource use in Japan is not well understood. This study aimed to evaluate and compare the humanistic burden of respondents with chronic constipation to respondents without chronic constipation and to respondents with type 2 diabetes mellitus (T2DM), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD), respectively.

Methods

This cross‐sectional study collected demographic and general health data and HRQoL data as measured by the Short Form 12‐Item (Version 2) Health Survey and EuroQol 5‐dimension health surveys. Health impacts on employment‐related activities and indirect costs were measured using the Work Productivity and Activity Impairment questionnaire. Propensity score matching was used to identify a control group without chronic constipation. Multivariate generalized linear models were used to identify potential factors that may impact the outcomes of respondents.

Results

A total of 30 001 individuals responded to the Japan National Health and Wellness Survey 2017, whereof 3373 (11.2%) reported having chronic constipation; 963 were physician diagnosed. Compared with matched controls, patients with physician‐diagnosed chronic constipation had lower mean HRQoL scores and higher mean absenteeism, presenteeism, total Work Productivity and Activity Impairment, and indirect costs. Physician‐diagnosed chronic constipation was associated with a higher health burden than T2DM, IBS, and GERD.

Conclusions

Chronic constipation is associated with a considerable health burden, which is higher compared with T2DM, IBS, and GERD. These results suggest an urgent need for effective treatment of Japanese patients with chronic constipation to improve their quality of life.
Succeeding in Aging Research During the Pandemic: Strategies for Fellows and Junior Faculty
Authors: Cohen Andrew B. , Parks Anna L. , Whitson Heather E. , Zieman Susan , Brown Cynthia J. , Boyd Cynthia , Covinsky Kenneth E. , Steinman Michael A.
Published: October 2020

Fellows and junior faculty conducting aging research have encountered substantial new challenges during the COVID‐19 pandemic. They report that they have been uncertain how and whether to modify existing research studies, have faced difficulties with job searches, and have struggled to balance competing pressures including greater clinical obligations and increased responsibilities at home. Many have also wondered if they should shift gears and make COVID‐19 the focus of their research. We asked a group of accomplished scientists and mentors to grapple with these concerns and to share their thoughts with readers of this journal.
Common‐pool resource governance and uneven food security: Regional resilience during the Great Irish Famine, 1845–1852
Authors: Flaherty Eoin
Published: October 2020

This paper deals with two principal questions, drawing closely on the experience of Ireland. First, it addresses a deficit in our knowledge of resource governance institutions and land tenure systems as moderators of the impact of famine. We have known for some time of the extent of common‐pool resource systems in districts of 19th‐century Ireland and wider Europe, but their role in determining levels of ecological risk exposure is less understood. Knowing that both food insecurity and common tenancy were higher in marginal Irish districts, this represents a gap in our understanding of the geographical impact of the Great Irish Famine. Second, although current thinking on common‐pool resource governance suggests that such systems were potentially robust to ecological stress, why did this not translate into greater resilience in Ireland? To make sense of this contradiction, we must consider both the local behaviour of ecological stressors and wider context of Irish colonialism. Using local clustering analysis and geographically weighted regression, we see how the impact of key stressors varied geographically. These findings suggest that analyses of the role of common‐pool resource governance in conferring ecological resilience must be tempered with a fuller appreciation of geopolitical context.
Informal carer experiences of UK dementia services—A systematic review
Authors: Francis Nick , Hanna Paul
Published: October 2020

Accessible summary

What is known on the subject?

Dementia affects an increasing number of people and a person with dementia requires significant levels of care.

Dementia care is often delivered by family members.

Caring for someone with dementia places significant demand on the carer and support for the carer is often needed.

What the paper adds to existing knowledge?

Research has been conducted into caregivers' experiences of caring for someone with dementia, but a synthesis of findings for studies from the UK is needed to collate the research evidence and provide an account of the common trends within the existing research.

This paper adds to existing knowledge by highlighting the key difficulties experienced by carers of a person with dementia in their caring role and their experiences with support services across the existing research evidence.

What are the implications for practice?

Improvements to the process of dementia assessment and the process of receiving a dementia diagnosis are needed.

Information and support needs to be more accessible for the carer of a person with dementia

Cultural differences need to be acknowledged in the support and information offered to carers of a person with dementia.

Aim

To understand the experiences of informal carers' of individuals with dementia in the UK when engaging with services for support in their caring role.

Methods

Following the PRISMA guidelines, a qualitative systematic literature review was carried out. Six Internet databases were searched. Results were screened, and eligible studies were appraised using Critical Appraisal Skills Programme (CASP, 2019) and data synthesized using Evan & Pearson (2001) and Evans (2002).

Results

The search returned 231 records, 11 were selected for critical appraisal and data synthesis. Four main themes (information for carers, process of diagnosing dementia, difficulties accessing support and cultural differences of experiences of services) were extracted.

Discussion

Carers experience services as providing inadequate support for the Person with Dementia (PwD) and themselves for support relating to dementia. Difficulties in receiving information and support were experienced from before diagnosis to end‐of‐life (EoL) care. Additionally, cultural differences were found in carers' experiences.

Implications for practice

The provision of and access to dementia support should be improved; more information for carers about dementia and dementia services is needed; cultural differences need to be appreciated in the support and information offered.
Transverse sectioning in the evaluation of skin biopsy specimens from alopecic dogs
Authors: Bond R. , Hendricks A. , Patterson‐Kane J. , Stevens K. , Brooks Brownlie H. W.
Published: October 2020

Objectives

Transverse sectioning of skin biopsy specimens has revolutionised assessment of human alopecia by demonstration of every hair in each specimen, allowing quantitative evaluation of follicular activity. Since only vertical sectioning is performed routinely in veterinary laboratories, we aimed to determine whether transverse sectioning was a valuable technique in assessment of canine alopecia.

Methods

Paired vertical and transverse sections of biopsy specimens from 31 alopecic dogs were examined independently in triplicate in random order and blinded to previous diagnosis using a standard check‐list proforma. Assessments of key features (follicular activity [anagen/telogen], infundibular hyperkeratosis, sebaceous gland abnormalities, pigment clumping, dermal inflammation) by each sectioning method were compared.

Results

In the 31 cases, (atrophic [n = 13], dysplastic [n = 12], inflammatory diseases [n = 6]), follicular inactivity scores (median, [lower‐upper quartile]) in transverse sections significantly exceeded those in vertical sections (transverse 4 [3‐5], vertical 3 [2‐4]). Agreement between the two sectioning planes was moderate for infundibular hyperkeratosis (kappa = 0.5210) and dermal inflammation (0.4351), fair for sebaceous gland abnormalities (0.3966) and pigment clumping (0.2197), but slight for follicular activity (0.1041). Vertical sectioning demonstrated diagnostically important epidermal pathology (n = 2) and dermal thinning (n = 3) whereas transverse sectioning enhanced assessment of hair growth phase (n = 11), follicular structure and architecture (n = 11), and focal luminal or mural folliculitides (n = 3).

Clinical significance

Transverse sectioning confers significant benefits and complements traditional vertical sectioning in the histological assessment of canine hair follicle diseases, particularly when subtle abnormalities comprise distorted compound follicle architecture, hair cycle arrest or when relatively few adnexal structures are affected.
When disaster strikes: Reconstitution of population density by expansion of survivors
Authors: Kojic Milorad , Milisavljevic Mira
Published: October 2020

Microorganisms have an assortment of stress‐response mechanisms that enable them to survive in the face of environmental stresses. However, with prolonged exposures to severe stresses adaptive stress responses ultimately fail, the affected populations may suffer a massive decline. Recovery of the population density in the aftermath of a massive death is a vital task. Our recent post‐stress regrowth under starvation (RUS) studies prompted us to propose RUS as an adaptation for overcoming consequences of devastating environmental disturbances. RUS should be seen as an integral process having two major aspects: the stress‐induced cellular auto‐decomposition and the recycling of the released nutrients. Here, we summarized what is already known about RUS and suggest a number of questions that are key to understanding the molecular underpinnings of these two operations. We also interrogate the prospect that would conceptualize the auto‐decomposition as a fitness‐maximizing mechanism acting with the purpose of an expedient supply of nutrients. Two further things are of special note: given that some of the RUS‐defective mutants are also impaired in DNA repair, RUS can serve as an important tool for uncovering new determinants operating, in some overlapping fashion, in the protection of genome integrity; also, RUS can serve as a new angle of approach that might, hopefully, assign roles to some of those (up to ~ 30%) of microbial genes that are of unknown function. More generally, understanding post‐stress reconstitution and the underlying mechanisms is a necessary (complementing) part of any comprehensive picture of how microbes cope with very harsh environmental disturbances.
COP1 promotes ABA‐induced stomatal closure by modulating the abundance of ABI/HAB and AHG3 phosphatases
Authors: Chen Qingbin , Bai Ling , Wang Wenjing , Shi Huazhong , Ramón Botella José , Zhan Qidi , Liu Kang , Yang Hong‐Quan , Song Chun‐Peng
Published: October 2020

Plant stomata play a crucial role in leaf function, controlling water transpiration in response to environmental stresses and modulating the gas exchange necessary for photosynthesis. The phytohormone abscisic acid (ABA) promotes stomatal closure and inhibits light‐induced stomatal opening. The Arabidopsis thaliana E3 ubiquitin ligase COP1 functions in ABA‐mediated stomatal closure. However, the underlying molecular mechanisms are still not fully understood.

Yeast two‐hybrid assays were used to identify ABA signaling components that interact with COP1, and biochemical, molecular and genetic studies were carried out to elucidate the regulatory role of COP1 in ABA signaling.

The cop1 mutants are hyposensitive to ABA‐triggered stomatal closure under light and dark conditions. COP1 interacts with and ubiquitinates the Arabidopsis clade A type 2C phosphatases (PP2Cs) ABI/HAB group and AHG3, thus triggering their degradation. Abscisic acid enhances the COP1‐mediated degradation of these PP2Cs. Mutations in ABI1 and AHG3 partly rescue the cop1 stomatal phenotype and the phosphorylation level of OST1, a crucial SnRK2‐type kinase in ABA signaling.

Our data indicate that COP1 is part of a novel signaling pathway promoting ABA‐mediated stomatal closure by regulating the stability of a subset of the Clade A PP2Cs. These findings provide novel insights into the interplay between ABA and the light signaling component in the modulation of stomatal movement.
Pollen development in cotton (Gossypium hirsutum) is highly sensitive to heat exposure during the tetrad stage
Authors: Masoomi‐Aladizgeh Farhad , Najeeb Ullah , Hamzelou Sara , Pascovici Dana , Amirkhani Ardeshir , Tan Daniel K. Y. , Mirzaei Mehdi , Haynes Paul A. , Atwell Brian J.
Published: October 2020

The development of gametes in plants is acutely susceptible to heatwaves as brief as a few days, adversely affecting pollen maturation and reproductive success. Pollen in cotton (Gossypium hirsutum) was differentially affected when tetrad and binucleate stages were exposed to heat, revealing new insights into the interaction between heat and pollen development. Squares were tagged and exposed to 36/25°C (day/night, moderate heat) or 40/30°C (day/night, extreme heat) for 5 days. Mature pollen grains and leaves were collected for physiological and proteomic responses. While photosynthetic competence was not compromised even at 40°C, leaf tissues became leakier. In contrast, pollen grains were markedly smaller after the tetrad stage was exposed to 40°C and boll production was reduced by 65%. Sugar levels in pollen grains were elevated after exposure to heat, eliminating carbohydrate deficits as a likely cause of poor reproductive capacity. Proteomic analysis of pure pollen samples revealed a particularly high abundance of 70‐kDa heat shock (Hsp70s) and cytoskeletal proteins. While short‐term bursts of heat had a minor impact on leaves, male gametophyte development was profoundly damaged. Cotton acclimates to maxima of 36°C at both the vegetative and reproductive stages but 5‐days exposure to 40°C significantly impairs reproductive development.
The first reported case of primary extranodal counterpart of follicular T‐cell lymphoma of submandibular gland
Authors: Muto Reiji , Uemura Naoki , Mitsui Norikazu , Arakawa Fumiko , Negishi Takanori , Miyoshi Hiroaki , Ohshima Koichi , Murayama Toshihiko
Published: October 2020

This is the first reported case of follicular T‐cell lymphoma (FTCL) that primarily developed in the extranodal site of the right submandibular gland. An 86‐year‐old man was detected with a right cervical mass suspected to be malignant lymphoma during his physical examination. Imaging studies revealed that the mass was a submandibular gland tumor. The tumor was excised for diagnosis and treatment. Pathologically, the tumor was composed of densely aggregated lymphocytes with a follicular growth pattern. The immunohistochemical investigation showed that the lymphoma cells expressed CD3, CD4, programmed cell death protein 1, BCL6, chemokine (C‐X‐C motif) ligand 13, and BCL2. Staining of the follicular dendritic cell revealed its meshwork structure limited in the germinal center. Monoclonal rearrangement of the T‐cell receptor was detected using polymerase chain reaction. These findings are consistent with the characteristics of FTCL. Here, we describe the first reported case of extranodal counterpart of FTCL of the submandibular gland. Accumulation and investigation of such extranodal cases is essential.
Age‐related losses in cardiac autonomic activity during a daytime nap
Authors: Chen Pin‐Chun , Sattari Negin , Whitehurst Lauren N. , Mednick Sara C.
Published: October 2020

In healthy, young individuals, a reduction in cardiovascular output and a shift from sympathetic to parasympathetic (vagal) dominance is observed from wake into stages of nocturnal and daytime sleep. This cardiac autonomic profile, measured by heart rate variability (HRV), has been associated with significant benefits for cardiovascular health. Aging is associated with decreased nighttime sleep quality and lower parasympathetic activity during both sleep and resting. However, it is not known whether age‐related dampening of HRV extends to daytime sleep, diminishing the cardiovascular benefits of naps in the elderly. Here, we investigated this question by comparing the autonomic activity profile between young and older healthy adults during a daytime nap and a similar period of wakefulness (quiet wake; QW). For each condition, from the electrocardiogram (ECG), we obtained beat‐to‐beat HRV intervals (RR), root mean square of successive differences between adjacent heart‐beat‐intervals (RMSSD), high‐frequency (HF), low‐frequency (LF) power, and total power (TP), HF normalized units (HFnu), and the LF/HF ratio. As previously reported, young subjects showed a parasympathetic dominance during NREM, compared with REM, prenap rest, and WASO. Moreover, older, compared to younger, adults showed significantly lower vagally mediated HRV (measured by RMSSD, HF, HFnu) during NREM. Interestingly, however, no age‐related differences were detected during prenap rest or QW. Altogether, our findings suggest a sleep‐specific reduction in parasympathetic modulation that is unique to NREM sleep in older adults.
TLR10: Insights, controversies and potential utility as a therapeutic target
Authors: Su Si‐Biao , Tao Lin , Deng Ze‐Ping , Chen Wen , Qin Shan‐Yu , Jiang Hai‐Xing
Published: October 2020

The Toll‐like receptor (TLR) family acts as a bridge connecting innate and acquired immunity. TLR10 remains one of the least understood members of this family. Some studies have examined TLR10 ligands, dimerization of TLR10 with other TLRs, and downstream signalling pathways and functions, but they have often arrived at conflicting conclusions. TLR10 can induce the production of proinflammatory cytokines by forming homodimers with itself or heterodimers with TLR1 or other TLRs, but it can also inhibit proinflammatory responses when co‐expressed with TLR2 or potentially other TLRs. Mutations in the Toll/Interleukin 1 receptor (TIR) domain of TLR10 alter its signalling activity. Polymorphisms in the TLR10 gene can change the balance between pro‐ and anti‐inflammatory responses and hence modulate the susceptibility to infection and autoimmune diseases. Understanding the full range of TLR10 ligands and functions may allow the receptor to be exploited as a therapeutic target in inflammation‐ or immune‐related diseases. Here, we summarize recent findings on the pro‐ and anti‐inflammatory roles of TLR10 and the molecular pathways in which it is implicated. Our goal is to pave the way for future studies of the only orphan TLR thought to have strong potential as a target in the treatment of inflammation‐related diseases.
Poorly crystalline iron and aluminium oxides contribute to the carbon saturation and sorption of dissolved organic carbon in the soil
Authors: Khandakar Tania , Guppy Chris , Rabbi Sheikh M. F. , Daniel Heiko
Published: October 2020

Soil carbon (C) saturation implies an upper limit to a soil's capacity to store C depending on the contents of silt + clay and poorly crystalline Fe and Al oxides. We hypothesized that the poorly crystalline Fe and Al oxides in silt + clay fraction increased the C saturation and thus reduced the capacity of the soil to sorb additional C input. To test the hypothesis, we studied the sorption of dissolved organic carbon (DOC) on silt + clay fractions (<53 µm) of highly weathered oxic soils, collected from three different land uses (i.e., improved pasture, cropping and forest). Soils with high carbon saturation desorbed 38% more C than soils with low C saturation upon addition of DOC, whereas adsorption of DOC was only observed at higher concentration (>15 g kg−1). While high Al oxide concentration significantly increased both the saturation and desorption of DOC, the high Fe oxide concentration significantly increased the desorption of DOC, supporting the proposition that both oxides have influence on the DOC sorption in soil. Our findings provide a new insight into the chemical control of stabilization and destabilization of DOC in soil.
Exploring the components of bleeding outcomes in transfusion trials for patients with hematologic malignancy
Authors: Balitsky Amaris K. , Liu Yang , Van der Meer Pieter F. , Heddle Nancy M. , Arnold Donald M.
Published: October 2020

Background

Clinically significant bleeding in patients with hematologic malignancies is a heterogeneous composite outcome currently defined as World Health Organization (WHO) bleeding Grades 2, 3, and 4. However, the clinical significance of some minor bleeds categorized as WHO Grades 1 and 2 remains controversial. We analyzed the number and frequency of individual signs and symptoms of WHO Grades 1 and 2 bleeds and explored their association with more severe incident bleeds graded as WHO Grades 3 and 4.

Study Design and Methods

We aggregated daily bleeding assessment data from three randomized controlled trials conducted in patients with hematologic malignancies that used bleeding as an outcome. Cox proportional hazard regression analysis was used to identify signs and symptoms categorized as WHO Grades 1 and 2 bleeds that were associated with more severe bleeds (Grades 3 and 4).

Results

We collected data from 315 patients (n = 5476 daily bleeding assessments; 3383 [61.8%] with a bleed documented). A total of 98.3% (3326/3383) were Grade 1 and 2 bleeds and 1.7% (57/3383) were Grades 3 and 4. Grade 1 and 2 bleeds were composed of 20 different bleeding signs and symptoms. Hematuria (hazard ratio, 16.1; 95% confidence interval, 4.4‐59.2; P < .0001) was associated with incident Grade 3 or 4 bleeds.

Conclusion

In patients with hematologic malignancy, only hematuria (microscopic and/or macroscopic) was associated with more severe incident bleeds. This findings require validation in independent data sets.
Cervical disc width index is a reliable parameter and consistent in young growing Dutch Warmblood horses
Authors: Veraa Stefanie , Scheffer Carmen J.W. , Smeets Danielle H.M. , de Bruin Renske B. , Hoogendoorn Arie C. , Vernooij Johannes C.M. , Nielen Mirjam , Back Willem
Published: October 2020

Intervertebral disc disease, as well as the associated alteration of the radiographic intervertebral disc space width, has been reported in horses. Disc height index (DHI) has proven to be an accurate and objective parameter in other species but data related to this parameter are lacking in horses. Therefore, the aims of this retrospective longitudinal diagnostic accuracy study were (a) to evaluate the reliability of measurements within and between observers of the equine Disc Width Index (EDWI) as a parameter for radiographic equine cervical intervertebral disc space width, and (b) to evaluate the sequential development of the EDWI over time. For this, EDWI from all intervertebral disc spaces between second cervical (C) to first thoracic (Th) vertebrae were obtained in a group of 39 Dutch Warmblood horses at 1, 5, and 18 months of age, by one European College of Veterinary Diagnostic Imaging (ECVDI) board‐certified veterinary radiologist (S.V.) and two veterinary students. Bland‐Altmann plots and intraclass Correlation Coefficient revealed a good intra‐ and interobserver agreement. A linear mixed‐effect model did reveal that mean EDWI increases significantly toward the caudal cervical spine, but did not differ significantly for a certain location over time or between sexes. Spearman's rank test did show a significant correlation between the vertebral alignment angle induced by different head‐neck positions and a normalized EDWI (ρ = 0.33,P < .0001). Student'st‐test revealed that the presence of C6‐C7 transposition of the transverse processes did not influence EDWI significantly. It was concluded that EDWI represents a reliable parameter for equine cervical radiographic intervertebral disc space width. Practical implementation of EDWI warrants monitoring in a group of adult horses while maintaining a standardized head‐neck position.
Incidence of hospital‐acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil
Authors: Serpa Leticia Faria , Ortiz Margarita Maria , Lima Anne Chaves , Bueno Línea , Nogueira Paula Cristina , Ferri Cleusa , Santos Vera Lucia Conceição De Gouveia
Published: October 2020

This study aimed to estimate the incidence of hospital‐acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6‐month follow‐up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow‐up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS‐2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04‐1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92‐6.61); in patients admitted for non‐surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12‐3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03‐1.06); high blood pressure (RR = 1.76; 95% CI 1.17‐2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71‐7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75‐0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI‐preventative actions.
Failure Analysis for Evaporator Fin-Tubes of HRSG in CCGT
Authors: Xu Hong
Published: October 2020

The finned evaporator tube of medium pressure evaporator leakage occurred after the no. 1 unit of a combined-cycle gas turbine (CCGT) power station was put into commercial operation for only 40 days (including 24 days of operation and 19 days of shutdown and standby). Cut off a section of failure pipe for a thorough inspection. Macro inspection found that severe corrosion occurred in some local areas of some pipe sections, which led to the obvious thinning of pipe wall thickness, leading to perforation and leakage. Metallographic test and scanning electron microscopy (SEM) showed that the metal materials around the leakage points was qualified and the microstructure was normal. The corrosion products around the leakage points were mainly iron oxide which were generated before the unit had been put into commercial operation. The root cause was that the pH value of water used in the hydraulic test during the commissioning of the unit was as low as 9.2, and after the completion of the hydraulic test, the filled water remained in the boiler for a month and a half before being drained. Researches indicated that if carbon steels were prolonged immersed in demineralized water with a lower pH value, it would inevitably occur severe local corrosion which was due to pitting induced by the activation of inclusions in the steel. After pitting corrosion induced by active inclusions, no obvious pitting corrosion occurred in the surrounding inclusions. Accompanied with the extending of corrosion spots that had been formed, the activation zone continued to expand. Along with the formation of surface rust spots, corrosion developed along the inclusion boundary to the depth of the matrix, and finally caused the perforating and leaking of the tubes. The inner pitting corrosion of fin-tube of evaporator in HRSG could be avoided as long as the relevant provisions of “Guidelines of chemical supervision for combined cycle power plants” (DL/T 1717-2017) were strictly implemented during normal operation of boiler, standby maintenance and water pressure test after overhaul.
Boiler Emissions and Performance Improvement due to Utilization Real-Time Intelligent Sootblowing Boiler Monitoring Place
Authors: Chudnovsky B. , Chatskiy I.
Published: October 2020

As it is well known, deposits in boilers contribute to boiler inefficiency, capacity reductions, and overheated tubes, which lead to tube failures. To improve the heat transfer inside the furnace the fouling deposits obviously should be removed. In order to take fouling into account in the overall furnace and boiler heat balance it is necessary to measure two main parameters — thickness of the deposits and their reflectivity (emissivity) in the wavelength of visible and IR region. In the present paper it is demonstrated how such measurement (see detailed description in Ref [1–3] can be used for on-line automatic sootblowing control. Results of our study demonstrate that dynamics of both parameters (contamination thickness and reflectivity) on the operated boiler can be registered in real time and then interpreted separately. The sootblowing boiler monitoring has been implemented at the 550 MW unit equipped with B&W opposite wall burners. The fouling and thickness sensors (FTR) were installed in different locations of the combustion chamber through its width and height. It was shown that dynamics of thickness and reflectivity variation just after the wall cleaning activation are quite different. Situations have been registered where changes of reflectivity have a significant impact on heat transfer, comparable and sometimes even greater than that of growing fouling thickness. Technique and device exploited in this study appears to be a very useful tool for sootblowing optimization and, as a result, for improvement of boiler efficiency and reduction of water wall erosion and corrosion. The paper presents a strategy to implement a comprehensive automatic control of soot blowing in power plant boilers. The paper will describe the existing installations where individual components are in operation, and describe an integrated system that could combine all these parts to make an integrated intelligent sootblowing system.
Technical Overview and Basis of the Design Section of the NM.1 Standard
Authors: Vetter Lorenz G. , Adams Timothy M. , Fong Sze Shen
Published: October 2020

In the spring of 2019, the ASME published the first edition of the NM.1, NM.2, and NM.3 standards. These standards are for the design of non-metallic pressure piping systems. The focus is thermoplastics (NM.1), glass-fiber reinforced thermoset resins (NM.2), and material data (NM.3). These standards were developed by the Non-Metallic Pressure Piping Standards Committee, reporting to the ASME Board on Pressure Technology. This paper provides an overview and the technical basis of the design sections of the NM.1 Standard. The focus is the basis design requirements for HDPE, PVC, CPVC, PP, and ABS resins. Also discussed are the mandatory and non-mandatory Appendices applicable to the NM.1 design section.
Thermal and Fluid Analysis of Test Canister for Spent Nuclear Fuel
Authors: Charrouf Marwan , Williams Allen
Published: October 2020

The absence of a long-term solution for the storage of spent nuclear fuel prompts utilities in the United States to establish on-site storage for used fuel. The challenges associated with placement of spent fuel in dry cask storage on the power plant’s Independent Spent Fuel Storage Installations (ISFSI’s) include aging management of the stainless steel canisters and monitoring for the possible onset of stress corrosion cracking (SCC). The San Onofre Nuclear Generating Station (SONGS) has initiated a test program to examine the effects of heat generation variations inside a test canister using an electric heater rather than spent fuel on the shell temperatures. The test helps in the evaluation of external environmental factors and shell temperature, and to monitor for SCC. This paper presents the computational fluid dynamics (CFD) modeling developed in support of the test to analyze the air natural circulation in the subgrade enclosure and within the test canister with the electrical heating. The thermal analysis is performed using ANSYS CFX and integrally simulates the flow behavior and heat transfer mechanisms both inside and outside the test canister. Comparison of results from different heat loads that represent the decay heat time-profile, sensitivity to the turbulence model, and modes of heat dissipation are discussed. The CFD results are also compared to in-situ temperature measurements to validate the analysis.
Realization of a Fully Optically Accessible Medium Speed Large Bore Engine Using a Fisheye Optic
Authors: Karmann Stephan , Friedrich Christian , Prager Maximilian , Wachtmeister Georg
Published: October 2020

To address one of the main environmental concerns, the engine out emissions, an enhanced understanding of the combustion process itself is fundamental. Recent optical and laser optical measurement techniques provide a promising approach to investigate and optimize the combustion process regarding emissions. These measurement techniques are already quite common for passenger car and truck size engines and significantly contribute to their improvement. Transferring these measurement techniques to large bore engines from low to high speed is still rather more uncommon especially due to the bigger challenges caused by the engine size and thus much higher stability requirements and design effort for optical accessibility. To cover this new field of research a new approach for a medium speed large bore engine was developed using a fisheye optic mounted centrally in the cylinder head to design a fully optically accessible engine test bench. This new approach is detailed with a test setup layout and a stability concept consisting of cooling systems and the development of a suitable operation strategy based on simulation and experimental verification. The design of this single cylinder engine with 350mm bore and 440mm stroke providing 530kW nominal load at 750 rpm was tested up to 85% nominal load in skipped fire engine operation mode. The measurements of the flame chemiluminescence of a dual fuel combustion of the diesel gas type present proof of the feasibility of the new design as a starting point for future systematic studies on the combustion process of large bore engines.
A Framework for Demand-Side Management With Demand Response Input
Authors: Peinado-Guerrero Miguel A. , Campbell Nicolas A. , Villalobos Jesus R. , Phelan Patrick E.
Published: October 2020

A framework is proposed for demand-side load management (DSLM) of manufacturers participating in demand response (DR) programs. Utilities are increasingly focused on enticing their portfolios of energy end-users to adjust their energy use patterns in a mutually beneficial manner such as with DR programs. DR programs allow the utility to receive bulk peak load reduction and the participating end-user to receive credit towards their electricity bills. Once an end-user is enrolled in a DR program, they receive periodic requests for some amount of load reduction, typically the day before. Failing to respond to a DR signal will usually cost the end-user handsomely. The end-user is often left to their own discretion on how to attain the level of load reduction requested by the utility. For a manufacturer, this means if the request in load reduction is high enough, they will need to figure out how to curtail production. On the other hand, if the load reduction requested is small enough to need no disruption to production, the utility may be missing out on untapped DR capabilities that could be offered from the ability of the manufacturer to reschedule their production. In either case, the availability of an optimal plan for the manufacturer to best schedule its production in response to a DR event can maximize the benefits for both parties. Most of the research found in literature addresses production scheduling with minimal energy use or cost with respect to a time-of-use price tariff. A system that communicates the desires of the utility to the end-user for a DR event and provides the end-user with support in the decision-making process remains to be developed. The framework proposed addresses these shortcomings, considering the introduction of IoT capabilities and the physical constraints of the manufacturer.