bluuebunny/crossref_metadata_2025 huggingface dataset:
Analytical studies on waves in nonlinear transmission line media
Authors: Pinar Zehra
Published: February 2019

In this study, we introduce the lossy nonlinear transmission line equation, which is the dissipative-dispersive equation and an important problem of electrical transmission lines. For the engineers and physicist, the equation and its exact solutions are important so to obtain the exact solutions; one of the modifications of auxiliary equation method based on Chebyshev differential equation is studied. The results are discussed and given in details. Recently, the studies of lossy transmission line equation have been challenging, thus, it is believed that the proposed solutions will be key part of further studies for waves in nonlinear transmission line media, which has mixed dissipative-dispersive behavior.
Effects of antiarrhythmics on the electrical restitution in perfused guinea‐pig heart are critically determined by the applied cardiac pacing protocol
Authors: Osadchii Oleg E.
Published: February 2019

New Findings

What is the central question of this study?

Are modifications in the restitution of ventricular action potential duration induced by antiarrhythmic drugs the same when assessed with premature extrastimulus application at variable coupling intervals (the standard stimulation protocol) and with steady state pacing at variable rates (the dynamic stimulation protocol)?

What is the main finding and its importance?

With class I and class III antiarrhythmics, the effects on electrical restitution determined with the standard stimulation protocol dissociate from those obtained during dynamic pacing. These findings indicate a limited value of the electrical restitution assessments based on extrasystolic stimulations alone, as performed in the clinical studies, in estimating the outcomes of antiarrhythmic drug therapies.

A steep slope of the ventricular action potential duration (APD) to diastolic interval (DI) relationships (the electrical restitution) can precipitate tachyarrhythmia, whereas a flattened slope is antiarrhythmic. The derangements in APD restitution responsible for transition of tachycardia to ventricular fibrillation can be assessed with cardiac pacing at progressively increasing rates (the dynamic stimulation protocol). Nevertheless, this method is not used clinically owing to the risk of inducing myocardial ischaemia. Instead, the restitution kinetics is determined with a premature extrastimulus application at variable coupling intervals (the standard stimulation protocol). Whether the two protocols are equivalent in estimating antiarrhythmic drug effects is uncertain. In this study, dofetilide and quinidine, the agents blocking repolarizing K+ currents, increased epicardial APD in perfused guinea‐pig hearts, with effects being greater at long vs. short DIs. These changes were more pronounced during dynamic pacing compared to premature extrastimulations. Accordingly, although both agents markedly steepened the dynamic restitution, there was only a marginal increase in the standard restitution slope with dofetilide, and no effect with quinidine. Lidocaine and mexiletine, selective Na+ channel blockers, prolonged the effective refractory period without changing APD, and increased the minimum DI that enabled ventricular capture during extrastimulations. No change in the minimum DI was noted during dynamic pacing. Consequently, although lidocaine and mexiletine reduced the standard restitution slope, they failed to flatten the dynamic restitution. Overall, these findings imply a limited value of the electrical restitution assessments with premature extrastimulations alone in discriminating arrhythmic vs. antiarrhythmic changes during drug therapies.
Analysis of Determining the Leadership Approach and Factors Influencing Managerial Perceptions of the Agricultural Organizations’ President: An Empirical Exploration
Authors: Yilmaz Hasan
Published: February 2019

The goal of this paper was to identify the leadership approach and dimensions influencing the managerial perceptions of the agricultural organization’s president. This research was carried out with agricultural organization presidents by using questionnaires. For this purpose, 29 items were given to presidents and a Likert scale used for the degree of agreement of each item. Factor analysis, Cronbach alpha coefficient was situated to be 0.933. To specify the dimensions influencing the managerial perception of agricultural organization’s president principle component analysis with varimax rotation was used. Eigenvalue belongs to seven of 29 items was calculated higher than one. As a result of this analysis, seven dimensions were examined. These dimensions clarified 75.75% of the total variance. The main aspects influencing the managerial perception of agricultural organization’s president were constructed to be motivation and team spirit, the power of initiative, put the organization interests over their individual interests, devotion to duty, entrepreneurial spirit, empathy ability and sense of belonging to an organization.
La atención a las madres durante el proceso de parto en algunos servicios de salud de la ciudad de Medellín: un acontecimiento enmarcado en el neoliberalismo y la mercantilización de la vida
Authors: Arango Urrea Juan David , Molina Berrío Diana Patricia , Mejía Merino Cristina María , Faneyra Zapata Lyda
Published: February 2019

Objetivo: comprender los significados que tiene el personal asistencial sobre la influencia que ejerce el contexto de salud y las condiciones laborales en la atención a las madres durante el proceso de parto, en algunos servicios de salud de la ciudad de Medellín en los años 2015-2016. Metodología: estudio de naturaleza cualitativa, usando la metodología propuesta por la teoría fundamentada (TF) de Anselm Strauss y Julieth Corbin. Resultados y conclusión: las relaciones entre el personal asistencial y las gestantes en proceso de parto están enmarcadas en un macrocontexto, como lo es el Sistema de Salud de Colombia, y una perspectiva neoliberal que mercantiliza la vida. El cierre de muchos servicios de maternidad y algunas condiciones laborales difíciles han afectado las relaciones entre el personal de salud y las madres durante el proceso de parto.
Control Variate Multifidelity Estimators for the Variance and Sensitivity Analysis of Mesostructure–Structure Systems
Authors: Xu Hongyi , Liu Zhao
Published: February 2019

Variance and sensitivity analysis are challenging tasks when the evaluation of system performances incurs a high-computational cost. To resolve this issue, this paper investigates several multifidelity statistical estimators for the responses of complex systems, especially the mesostructure–structure system manufactured by additive manufacturing. First, this paper reviews an established control variate multifidelity estimator, which leverages the output of an inexpensive, low-fidelity model and the correlation between the high-fidelity model and the low-fidelity model to predict the statistics of the system responses. Second, we investigate several variants of the original estimator and propose a new formulation of the control variate estimator. All these estimators and the associated sensitivity analysis approaches are compared on two engineering examples of mesostructure–structure system analysis. A multifidelity metamodel-based sensitivity analysis approach is also included in the comparative study. The proposed estimator demonstrates its strength in predicting variance when only a limited number of expensive high-fidelity data are available. Finally, the pros and cons of each estimator are discussed, and recommendations are made on the selection of multifidelity estimators for variance and sensitivity analysis.
Statistical Tolerance Analysis With Sensitivities Established From Tolerance-Maps and Deviation Spaces
Authors: Chitale Aniket N. , Davidson J. K. , Shah Jami J.
Published: February 2019

Math models aid designers in assessing relationships between tolerances that contribute to variations of a dependent dimension that must be controlled to achieve some design function at a target (functional) feature. The Tolerance-Maps© (T-Maps©) model for representing limits to allowable manufacturing variations is applied to identify the sensitivity of a dependent dimension to each contributing tolerance of the relationship. For each contributing feature and tolerances specified on it, the appropriate T-Map is chosen from a library of T-Maps, each represented in its own respective local reference frame. Each chosen T-Map is then transformed to the coordinate frame at the target feature, and the accumulation T-Map of these is formed with the Minkowski sum. The shape of a functional T-Map/deviation space is circumscribed (fitted) to this accumulation map. Since fitting is accomplished numerically by intersecting geometric shapes, T-Maps/deviation spaces are constructed with linear half-spaces. The sensitivity for each tolerance-and-feature combination is determined by perturbing the tolerance, refitting the functional shape to the modified accumulation map, and forming a ratio of the increment of functional tolerance to the perturbation. Taking tolerance-feature combinations one by one, sensitivities for an entire stack can be built. For certain loop equations, the same sensitivities result by fitting the functional shape to the T-Map/deviation space for each feature, without a Minkowski sum, and forming the overall result as a scalar sum. Sensitivities are used to optimize tolerance assignments by identifying the tolerances that most strongly influence the dependent dimension at the target feature. Form variations are not included in the analysis.
Method for Enabling a Root of Trust in Support of Product Data Certification and Traceability
Authors: Hedberg Thomas D. , Krima Sylvere , Camelio Jaime A.
Published: February 2019

Trust in product data quality (PDQ) is critical to successful implementation of the model-based enterprise (MBE). Such trust does not extend to the exchange and the reuse of three-dimensional (3D) product models across the product life cycle because verifiable traceability in the product data is lacking. This assurance is especially crucial when “siloed” manufacturing functions produce the product data that is not fully interoperable and thus requires frequent reworking to enable its reuse. Previous research showed how public key infrastructure (X.509-PKI) from the X.509 standard could be used to embed digital signatures into the product data for the purposes of certification and traceability. This paper first provides an overview and review of technologies that could be integrated to support trust throughout the product life cycle. This paper then proposes a trust structure that supports several data transaction types. Then, the paper presents a case study for common configuration management (CM) workflows that are typically found in regulated industries. Finally, the paper draws conclusions and provides recommendations for further research for enabling the product life cycle of trust (PLOT).
Mechanical Characterization and Modeling of Direct Metal Laser Sintered Stainless Steel GP1
Authors: Siddiqui Sanna F. , Fasoro Abiodun A. , Cole Calvin , Gordon Ali P.
Published: February 2019

The additive manufacturing (AM) process is unique in that it can facilitate anisotropy because of the layer-by-layer deposition technique intrinsic to this process. In order to develop a component for a desired application, it is necessary to understand the mechanics that facilitate this material behavior. This study investigates how build orientation affects the mechanical performance of as-built direct metal laser sintered (DMLS) stainless steel (SS) GP1 (also referred to as 17-4PH) through strain-controlled monotonic tension and completely reversed low-cycle fatigue (LCF) testing. The anisotropic behavior of DMLS SS GP1 is assessed for samples built along the horizontal plane. Fracture surfaces were found to exhibit ductile responses that were consistent with the σ–ε curves. Constitutive models (i.e., Ramberg–Osgood, Hahn) based upon linear elasticity and nonlinear plasticity are presented and used to simulate the monotonic discontinuous stress–strain yielding response of this material, which are found to be in agreement with the experimental data. A collection of low-cycle fatigue tests reveals initial strain hardening to stabilization, followed by softening to fracture. Tensile and fatigue material constants determined from experimental findings are also presented in this study. Plasticity effects on the life of varying build orientations are explored.
Individualized frequency importance functions for listeners with sensorineural hearing loss
Authors: Yoho Sarah E. , Bosen Adam K.
Published: February 2019

The Speech Intelligibility Index includes a series of frequency importance functions for calculating the estimated intelligibility of speech under various conditions. Until recently, techniques to derive frequency importance required averaging data over a group of listeners, thus hindering the ability to observe individual differences due to factors such as hearing loss. In the current study, the “random combination strategy” [Bosen and Chatterjee (2016). J. Acoust. Soc. Am. 140, 3718–3727] was used to derive frequency importance functions for individual hearing-impaired listeners, and normal-hearing participants for comparison. Functions were measured by filtering sentences to contain only random subsets of frequency bands on each trial, and regressing speech recognition against the presence or absence of bands across trials. Results show that the contribution of each band to speech recognition was inversely proportional to audiometric threshold in that frequency region, likely due to reduced audibility, even though stimuli were shaped to compensate for each individual's hearing loss. The results presented in this paper demonstrate that this method is sensitive to factors that alter the shape of frequency importance functions within individuals with hearing loss, which could be used to characterize the impact of audibility or other factors related to suprathreshold deficits or hearing aid processing strategies.
Honeybees forage more successfully without the “dance language” in challenging environments
Authors: I’Anson Price R. , Dulex N. , Vial N. , Vincent C. , Grüter C.
Published: February 2019

Honeybees forage more successfully by reducing their reliance on social information from the dance language.
Source apportionment of circum-Arctic atmospheric black carbon from isotopes and modeling
Authors: Winiger P. , Barrett T. E. , Sheesley R. J. , Huang L. , Sharma S. , Barrie L. A. , Yttri K. E. , Evangeliou N. , Eckhardt S. , Stohl A. , Klimont Z. , Heyes C. , Semiletov I. P. , Dudarev O. V. , Charkin A. , Shakhova N. , Holmstrand H. , Andersson A. , Gustafsson Ö.
Published: February 2019

Isotopes pinpoint strong seasonal variations in black carbon sources with consistent patterns at sites around the Arctic.
Hydraulic traits are coordinated with maximum plant height at the global scale
Authors: Liu Hui , Gleason Sean M. , Hao Guangyou , Hua Lei , He Pengcheng , Goldstein Guillermo , Ye Qing
Published: February 2019

Coordination between plant height and xylem traits is aligned with habitat aridity across the Earth’s terrestrial biomes.
Strictures of a microchannel impose fierce competition to select for highly motile sperm
Authors: Zaferani Meisam , Palermo Gianpiero D. , Abbaspourrad Alireza
Published: February 2019

Motility-based competition dynamics at microfluidic strictures suggests a sperm-selection mechanism in the reproductive tract.
Influenza binds phosphorylated glycans from human lung
Authors: Byrd-Leotis Lauren , Jia Nan , Dutta Sucharita , Trost Jessica F. , Gao Chao , Cummings Sandra F. , Braulke Thomas , Müller-Loennies Sven , Heimburg-Molinaro Jamie , Steinhauer David A. , Cummings Richard D.
Published: February 2019

A novel array of human lung glycans reveals influenza A virus binding to phosphorylated as well as sialylated N-glycans.
Slow slip events in the roots of the San Andreas fault
Authors: Rousset Baptiste , Bürgmann Roland , Campillo Michel
Published: February 2019

By analyzing GPS time series, we have detected an averaged
M
w
4.9 slow slip event in the roots of the San Andreas fault.
Rapid depletion of ESCRT protein Vps4 underlies injury-induced autophagic impediment and Wallerian degeneration
Authors: Wang Haiqiong , Wang Xuejie , Zhang Kai , Wang Qingyao , Cao Xu , Wang Zhao , Zhang Shuang , Li Ang , Liu Kai , Fang Yanshan
Published: February 2019

The ESCRT complex protein Vps4 is rapidly depleted upon nerve injury, causing autophagic impediment and axonal degeneration.
Inhibition of Vesicular Transport Influences Fungal Susceptibility to Fluconazole
Authors: Demuyser Liesbeth , Van Dyck Katrien , Timmermans Bea , Van Dijck Patrick
Published: February 2019

Fungal infections pose a substantial threat to the human population. They can cause either mild and relatively harmless infections or invasive and often lethal diseases in patients with a weakened immune system.
Natural Strain Variation Reveals Diverse Biofilm Regulation in Squid-Colonizing
Vibrio fischeri
Authors: Rotman Ella R. , Bultman Katherine M. , Brooks John F. , Gyllborg Mattias C. , Burgos Hector L. , Wollenberg Michael S. , Mandel Mark J.
Published: February 2019

Biofilms are surface-associated, matrix-encased bacterial aggregates that exhibit enhanced protection to antimicrobial agents. Previous work has established the importance of biofilm formation by a strain of luminous
Vibrio fischeri
bacteria as the bacteria colonize their host, the Hawaiian bobtail squid. In this study, expansion of this work to many natural isolates revealed that biofilm genes are universally required, yet there has been a shuffling of the regulators of those genes. This work provides evidence that even when bacterial behaviors are conserved, dynamic regulation of those behaviors can underlie evolution of the host colonization phenotype. Furthermore, this work emphasizes the importance of investigating natural diversity as we seek to understand molecular mechanisms in bacteria.
Postglacial faulting near Crater Lake, Oregon, and its possible association with the Mazama caldera-forming eruption
Authors: Bacon Charles R. , Robinson Joel E.
Published: February 2019

Volcanoes of subduction-related magmatic arcs occur in a variety of crustal tectonic regimes, including where active faults indicate arc-normal extension. The Cascades arc volcano Mount Mazama overlaps on its west an ∼10-km-wide zone of ∼north-south–trending normal faults. A lidar (light detection and ranging) survey of Crater Lake National Park, reveals several previously unrecognized faults west of the caldera. Postglacial vertical separations measured from profiles across scarps range from ∼2 m to as much as 12 m. Scarp profiles commonly suggest two or more postglacial surface-rupturing events. Ignimbrite of the ca. 7.6 ka climactic eruption of Mount Mazama, during which Crater Lake caldera formed, appears to bury fault strands where they project into thick, valley-filling ignimbrite. Lack of lateral offset of linear features suggests principally normal displacement, although predominant left stepping of scarp strands implies a component of dextral slip. West-northwest–east-southeast and north-northwest–south-southeast linear topographic elements, such as low scarps or ridges, shallow troughs, and straight reaches of streams, suggest that erosion was influenced by distributed shear, consistent with GPS vectors and clockwise rotation of the Oregon forearc block.

Surface rupture lengths (SRL) of faults suggest earthquakes of (moment magnitude) Mw6.5 from empirical scaling relationships. If several faults slipped in one event, a combined SRL of 44 km suggests an earthquake of Mw7.0. Postglacial scarps as high as 12 m imply maximum vertical slip rates of 1.5 mm/yr for the zone west of Crater Lake, considerably higher than the ∼0.3 mm/yr long-term rate for the nearby West Klamath Lake fault zone. An unanswered question is the timing of surface-rupturing earthquakes relative to the Mazama climactic eruption. The eruption may have been preceded by a large earthquake. Alternatively, large surface-rupturing earthquakes may have occurred during the eruption, a result of decrease in east-west compressive stress during ejection of ∼50 km3 of magma and concurrent caldera collapse.
Charity financial support to motor neuron disease (MND) patients in Greater London: the impact of patients’ socioeconomic status—a cross-sectional study
Authors: Gkiouleka Anna , Manning Alison , Smith Dianna , Malaspina Andrea , Gallo Valentina
Published: February 2019

Objective

There is an immense socioeconomic burden for both the patients with motor neuron disease (MND) and their families. The aim of this study is to evaluate the extent to which the provision offered by the Motor Neurone Disease Association is distributed among patients with MND living in the ethnically and socially diverse area of Greater London, according to the patients’ socioeconomic situation and needs.

Setting

Greater London, where age and sex-adjusted prevalence rates of MND in 2016 were calculated.

Participants

Prevalent MND cases in Greater London, using anonymised data extracted from the Association’s database.

Exposure

Demographic and socioeconomic characteristics

Primary and secondary outcome measures

Receiving a Motor Neurone Disease Association grant, and the amount of money received.

Results

396 individuals with amyotrophic lateral sclerosis were detected, the age-specific and sex-specific prevalence of MND was 4.02 per 100 000 inhabitants, higher among men (5.13 per 100 000) than women (3.01 per 100 000). Men were statistically significantly 40% less likely to receive a grant compared with women; among grant recipients, the younger the age of the participant, the higher the size of the grant received. The Index of Multiple Deprivation was not associated with either receiving a grant nor the amount of money received, among recipients.

Conclusion

Financial support by the Motor Neurone Disease Association is provided across individuals and across boroughs regardless of their socioeconomic circumstances. Differences that benefits women and younger patients were detected.
Clinical evaluation of deep brain stimulation of nucleus accumbens/anterior limb of internal capsule for opioid relapse prevention: protocol of a multicentre, prospective and double-blinded study
Authors: Qu Liang , Ge Shunnan , Li Nan , Wang Wei , Yang Kaijun , Wu Ping , Wang Xuelian , Shi Jie
Published: February 2019

Introduction

Deep brain stimulation (DBS) is a new potential surgical treatment for opioid dependence. However, the implement of DBS treatment in addicted patients is currently controversial due to the significant associated risks. The aim of this study was mainly to investigate the therapeutic efficacy and safety of bilateral DBS of nucleus accumbens and the anterior limb of the internal capsule (NAc/ALIC-DBS) in patients with refractory opioid dependence (ROD).

Methods and analysis

60 patients with ROD will be enrolled in this multicentre, prospective, double-blinded study, and will be followed up for 25 weeks (6 months) after surgery. Patients with ROD (semisynthetic opioids) who meet the criteria for NAc/ALIC-DBS surgery will be allocated to either the early stimulation group or the late stimulation group (control group) based on the randomised ID number. The primary outcome was defined as the abstinence rate at 25 weeks after DBS stimulation on, which will be confirmed by an opiate urine tests. The secondary outcomes include changes in the Visual Analogue Scale (VAS) score for craving for opioid drugs, body weight, as well as psychological evaluation measured using the 17-item Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Pittsburgh Sleep Quality Index, Fagerstrom test for nicotine dependence assessment, social disability screening schedule, the Activity of Daily Living Scale, the 36-item Short Form-Health Survey and safety profiles of both groups.

Ethics and dissemination

The study received ethical approval from the medical ethical committee of Tangdu Hospital, The Fourth Military Medical University, Xi’an, China. The results of this study will be published in a peer-reviewed journal and presented at international conferences.

Trial registration number

NCT03424616; Pre-results.
Can the Easter break induce a long-term break of exercise routines? An analysis of Danish gym data using a regression discontinuity design
Authors: Fredslund Eskild Klausen , Leppin Anja
Published: February 2019

Objectives

Many sedentary individuals are aware of the health benefits of regular physical activity and start becoming more physically active. Yet, despite good intentions, many struggle to keep up initial exercise levels and experience a decline in exercise frequency. A possible explanation is that it is hard to establish habits or routines, and that such routines—once established—might be easy to break. In this paper, we analyse whether a break in habitual/routine behaviour—induced by the Easter holidays—results in individuals exercising less after the break.

Methods

The study included a sample of 1210 members of a Danish chain of fitness centres who were gym members at least since the preceding New Year’s Day. Participants granted access to gym attendance data, which were automatically recorded when entering the gym. We use a regression discontinuity design encompassing a time period of 10 weeks prior to and 10 weeks after Easter.

Results

We found a significant and relevant discretionary drop in exercise frequency right after the Easter holidays of 0.24 times per week (p=0.001) corresponding to a fall of 12.25% compared with the week prior to the Easter holidays. The effect was especially profound for individuals below retirement age and for individuals who had attended the gym with a higher frequency (twice a week or more) in the 6 weeks prior to the Easter break.

Discussion

This information is potentially relevant for helping individuals maintain an exercise habit. Motivational support should focus on the time period after normative breaks, such as Easter or other holidays.
SUcceSS, SUrgery for Spinal Stenosis: protocol of a randomised, placebo-controlled trial
Authors: Anderson David B , Ferreira Manuela L , Harris Ian A , Davis Gavin A , Stanford Ralph , Beard David , Li Qiang , Jan Stephen , Mobbs Ralph J , Maher Christopher G , Yong Renata , Zammit Tara , Latimer Jane , Buchbinder Rachelle
Published: February 2019

Introduction

Central lumbar spinal stenosis (LSS) is a common cause of pain, reduced function and quality of life in older adults. Current management of LSS includes surgery to decompress the spinal canal and alleviate symptoms. However, evidence supporting surgical decompression derives from unblinded randomised trials with high cross-over rates or cohort studies showing modest benefits. This protocol describes the design of the SUrgery for Spinal Stenosis (SUcceSS) trial —the first randomised placebo-controlled trial of decompressive surgery for symptomatic LSS.

Methods and analysis

SUcceSS will be a prospectively registered, randomised placebo-controlled trial of decompressive spinal surgery. 160 eligible participants (80 participants/group) with symptomatic LSS will be randomised to either surgical spinal decompression or placebo surgical intervention. The placebo surgical intervention is identical to surgical decompression in all other ways with the exception of the removal of any bone or ligament. All participants and assessors will be blinded to treatment allocation. Outcomes will be assessed at baseline and at 3, 6, 12 and 24 months. The coprimary outcomes will be function measured with the Oswestry Disability Index and the proportion of participants who have meaningfully improved their walking capacity at 3 months postrandomisation. Secondary outcomes include back pain intensity, lower limb pain intensity, disability, quality of life, anxiety and depression, neurogenic claudication score, perceived recovery, treatment satisfaction, adverse events, reoperation rate and rehospitalisation rate. Those who decline to be randomised will be invited to participate in a parallel observational cohort. Data analysis will be blinded and by intention to treat. A trial-based cost-effectiveness analysis will determine the potential incremental cost per quality-adjusted life year gained.

Ethics and dissemination

Ethics approval has been granted by the NSW Health (reference:17/247/POWH/601) and the Monash University (reference: 12371) Human Research Ethics Committees. Dissemination of results will be via journal articles and presentations at national and international conferences.

Trial registration number

ACTRN12617000884303; Pre-results.
How is patient-centred care addressed in women’s health? A theoretical rapid review
Authors: Gagliardi Anna R , Dunn Sheila , Foster Angel , Grace Sherry L , Green Courtney R , Khanlou Nazilla , Miller Fiona A , Stewart Donna E , Vigod Simone , Wright Frances C
Published: February 2019

Purpose

Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patient-centred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptualised in research.

Methods

We conducted a theoretical rapid review of PCCW in four health conditions. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs index for English-language articles published from January 2008 to February 2018 inclusive that investigated PCC and involved at least 50% women aged 18 or older. We analysed findings using a six-domain PCC framework, and reported findings with summary statistics and narrative descriptions.

Results

After screening 2872 unique search results, we reviewed 51 full-text articles, and included 14 (five family planning, three preventive care, four depression, one cardiovascular disease and one rehabilitation). Studies varied in how they assessed PCC. None examined all six PCC framework domains; least evaluated domains were addressing emotions, managing uncertainty and enabling self-management. Seven studies that investigated PCC outcomes found a positive association with appropriate health service use, disease remission, health self-efficacy and satisfaction with care. Differing views about PCC between patients and physicians, physician PCC attitudes and geographic affluence influenced PCC. No studies evaluated the influence of patient characteristics or tested interventions to support PCCW.

Conclusion

There is a paucity of research that has explored or evaluated PCCW in the conditions of interest. We excluded many studies because they arbitrarily labelled many topics as PCC, or simply concluded that PCC was needed. More research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCW. Policies and incentives may also be needed to stimulate greater awareness and delivery of PCCW.
A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
Authors: Baxter Ruth , Taylor Natalie , Kellar Ian , Lawton Rebecca
Published: February 2019

Background

The positive deviance approach seeks to identify and learn from those who demonstrate exceptional performance. This study sought to explore how multidisciplinary teams deliver exceptionally safe care on medical wards for older people.

Methods

A qualitative positive deviance study was conducted on four positively deviant and four slightly-above-average matched comparator wards, which had been identified using routinely collected NHS Safety Thermometer data. In total, 70 multidisciplinary staff participated in eight focus groups to explore staff perceptions about how their teams deliver safe patient care. A thematic analysis was conducted in two stages: first to identify the tools, processes, strategies, and cultural and social contexts that facilitated safety across all wards; and second to generate hypotheses about the characteristics that facilitated ‘positively deviant’ patient care.

Results

Based on identifiable qualitative differences between the positively deviant and comparison wards, 14 characteristics were hypothesised to facilitate exceptionally safe care on medical wards for older people. This paper explores five positively deviant characteristics that healthcare professionals considered to be most salient. These included the relational aspects of teamworking, specifically regarding staff knowing one another and working together in truly integrated multidisciplinary teams. The cultural and social context of positively deviant wards was perceived to influence the way in which practical tools (eg, safety briefings and bedside boards) were implemented.

Conclusion

This study exemplifies that there are no ‘silver bullets’ to achieving exceptionally safe patient care on medical wards for older people. Healthcare leaders should encourage truly integrated multidisciplinary ward teams where staff know each other well and work as a team. Focusing on these underpinning characteristics may facilitate exceptional performances across a broad range of safety outcomes.
Relating Experienced To Recalled breathlessness Observational (RETRO) study: a prospective study using a mobile phone application
Authors: Sandberg Jacob , Lansing Robert , Anderberg Peter , Currow David , Sundh Josefin , Ahmadi Zainab , Palmqvist Sebastian , Ekström Magnus
Published: February 2019

Background

Breathlessness, the subjective sensation of breathing discomfort, is common and appears in the daily life of people with cardiorespiratory diseases. Physicians often rely on patient’s history based on symptom recall. The relation between recalled and experienced breathlessness is still poorly understood. This paper presents the protocol for a study primarily aimed at evaluating the relationship between experienced breathlessness and (1) recalled breathlessness and (2) predicted future breathlessness.

Methods

A mobile phone application will be used to collect data during daily life. Medically stable participants, ≥18 years of age with mean daily breathlessness of Numerical Rating Scale (NRS) 3/10 and able to use a mobile phone with internet will rate their breathlessness intensity on a 0–10 NRS prompted the user several times daily for 1 week. Participants will recall their breathlessness each day and week. Multivariable random effects regression models will be used for statistical analyses.

Results

Results of the study will be submitted for publication in peer-reviewed journals and presented at relevant conferences.

Discussion

This protocol describes a study aimed at investigating previously unknown areas of the experience and recall of breathlessness using a new method of data collection.

Registration details

Prospectively registered with ClinicalTrials.gov (Nr:NCT03468205).

Ethics and dissemination

The study has received ethical approval from the Regional Ethical Review Board Lund (DNr 2017/149). After a general study information including that participation is entirely voluntary, participants will answer the eligibility criteria and be asked to consent to participate before entering the study questions. Written informed consent to participate will be obtained for participants in the clinical sub-cohort. Participation can be discontinued at the discretion of the participant in which case no further data will be collected.
Palliative medicine and hospital readmissions in end-stage liver disease
Authors: Rush Barret , Fruhstofer Clark , Walley Keith R , Celi Leo Anthony , Brahmania Mayur
Published: February 2019

Background

Patients with end-stage liver disease (ESLD) have a reduced life expectancy and a significant symptom burden. Our aim is to determine if inpatient palliative care (PC) referral for patients with ESLD is associated with decreased hospital readmission rates.

Methods

The 2013 US Nationwide Readmission Database (NRD) was used for the current analysis. The NRD allows for longitudinal analysis of all patient hospital admissions across 22 states. Patients ≥18 years of age with a diagnosis of ESLD with at least two decompensating events were included in the analysis. PC referral at the index hospitalisation divided the cohort into two groups, which were tracked for 9 months.

Results

A total of 14 325 172 hospital admissions from the 2013 NRD were examined. In the first 3 months of 2013, a total of 3647 patients with ESLD were admitted with 206 (5.6%) receiving PC referral during the index admission. After the index hospitalisation, patients referred to PC were more likely to be discharged to skilled nursing facilities (45.5% vs 14.7%; p<0.01) or hospice/home care (32.9% vs 15.3%; p<0.01). After propensity score matching, those patients referred to PC demonstrated a significantly lower rate of 1-year hospital readmission (11.0% vs 32.1%; p<0.01).

Conclusion

Inpatient PC referral for patients with ESLD was associated with lower rates of hospital readmission. Early concurrent PC referral likely has added beneficial effects beyond quality of life issues and symptom management.
Palliative care quality measures: an exploratory study
Authors: Buja Alessandra , Rivera Michele , Baldo Vincenzo , Soattin Marta , Rizzolo Ylenia , Zamengo Giuseppe , Boscolo Sarah , Ghiotto Maria Cristina , Damiani Gianfranco
Published: February 2019

Objectives

The aim of this study was to investigate how palliative care service structures and processes correlate with their outputs and outcomes, measuring the latter respectively in terms of intensity of care and death at home.

Methods

The Veneto Regional Health Authorities collected a set of 37 quality indicators for the year 2016, covering the following five dimensions: service integration, service structure, accessibility, professional processes and organisational processes. Their validity was assessed by a panel of 29 palliative care experts. A score was assigned to each indicator on the basis of its relevance. Non-parametric correlations between the care quality indicators and the measures of the palliative care outputs and outcomes were investigated, along with the presence of a monotonic trend in the performance of the local health units (LHU) grouped by ‘low’, ‘medium’ or ‘high’ scores and differences between these groups of LHUs.

Results

The data showed that palliative care service structure and professional processes were the dimensions correlating significantly with the intensity of care coefficient. An increasingly significant statistical trend was found in both the intensity of care coefficient and the proportion of deaths at home for the three groups of LHUs in terms of the professional processes dimension.

Conclusions

Despite its limitations, this study brought to light some statistically significant findings that are worth investigating in larger samples. To achieve improvements in the quality of palliative care, it is important for healthcare providers to know which variables most affect the output and especially the outcomes of the services offered.
Training in therapeutic endoscopy: meeting present and future challenges
Authors: Anderson John , Lockett Melanie
Published: February 2019

Medical endoscopy trainees face numerous, often conflicting demands on their time. This can result in suboptimal endoscopy training and in difficulty achieving certification in basic endoscopy within the existing 5-year training programme. Endoscopic management of acute gastrointestinal bleeding and basic polypectomy are integral to basic service provision. Competence in these and other therapeutic procedures, including dealing with complications, is currently acquired opportunistically, or through experiential independent practice. This article proposes several potential solutions that may help with endotherapy training in the current UK training programmes. It also addresses issues relating to speciality training when reduced to 4 years in 2022. Advanced endotherapy training needs to be optimised by understanding how to select individuals with the appropriate skills and how to accelerate therapeutic training at the appropriate time. Training programmes will need to adapt and can learn from countries where the pathway is more developed and established. Future training will include a dedicated subspeciality training programme for advanced therapy with competitive entry. Advanced therapy training will be matched to service needs. Scoring systems for case complexity integrated with regional and supraregional networks, would allow referral of selected cases to the most appropriate specialised units.
Recurrent myocardial infarction in a 50-year-old woman
Authors: Mactier Iain , Dalzell Jonathan R , Carrick David
Published: February 2019

Clinical introduction

A 50-year-old woman presented with an inferoposterior ST-elevation myocardial infarction (STEMI) and underwent emergency percutaneous coronary intervention (PCI). Angiography revealed acute occlusion of the circumflex and right coronary (RCA) arteries. PCI was uncomplicated. Her medical history included asthma, hypertension and chronic sinusitis.

Three months later, she presented with a non-STEMI (NSTEMI), and angiogram showed a new focal stenosis in the left anterior descending artery. Pressure wire assessment induced severe coronary spasm. After liberal intracoronary nitrate, fractional flow reserve measured 0.71, so a further stent was implanted. Six days later, she was readmitted with another NSTEMI. Repeat angiogram revealed patent stents, with severe spasm of the distal RCA which improved following nitrate (figure 1A,B). Four days later, she was readmitted with further NSTEMI. Coronary angiography was not felt to be appropriate, and she was discharged with vasodilator therapy.

Figure 1

(A) Angiogram of RCA pre nitrates; (B) Angiogram of RCA post nitrates; (C) CT brain post cardiac arrest; (D) CMR post cardiac arrest.

The following day, she had an out-of-hospital ventricular fibrillation (VF) arrest and was successfully resuscitated. CT brain showed no evidence of neurological injury (figure 1C). Cardiac magnetic resonance imaging (CMR) was performed prior to implantable cardioverter defibrillator (ICD) implantation (figure 1D). Eosinophils had been persistently elevated with a peak of 1.78×109 (normal: 0.02–0.5×109). Antinuclear antibodies and antineutrophil cytoplasmic antibodies (ANCA) were negative.

Question?

What is the diagnosis for her recurrent acute coronary syndrome and VF arrest?

Aggressive atherosclerotic coronary artery disease.

Prinzmetal’s variant angina.

Loeffler endocarditis.

Coronary vasculitis.
Left ventricular mechanical dispersion predicts arrhythmic risk in mitral valve prolapse
Authors: Ermakov Simon , Gulhar Radhika , Lim Lisa , Bibby Dwight , Fang Qizhi , Nah Gregory , Abraham Theodore P , Schiller Nelson B , Delling Francesca N
Published: February 2019

Objective

Bileaflet mitral valve prolapse (MVP) with either focal or diffuse myocardial fibrosis has been linked to ventricular arrhythmia and/or sudden cardiac arrest. Left ventricular (LV) mechanical dispersion by speckle-tracking echocardiography (STE) is a measure of heterogeneity of ventricular contraction previously associated with myocardial fibrosis. The aim of this study is to determine whether mechanical dispersion can identify MVP at higher arrhythmic risk.

Methods

We identified 32 consecutive arrhythmic MVPs (A-MVP) with a history of complex ventricular ectopy on Holter/event monitor (n=23) or defibrillator placement (n=9) along with 27 MVPs without arrhythmic complications (NA-MVP) and 39 controls. STE was performed to calculate global longitudinal strain (GLS) as the average peak longitudinal strain from an 18-segment LV model and mechanical dispersion as the SD of the time to peak strain of each segment.

Results

MVPs had significantly higher mechanical dispersion compared with controls (52 vs 42 ms, p=0.005) despite similar LV ejection fraction (62% vs 63%, p=0.42) and GLS (−19.7 vs −21, p=0.045). A-MVP and NA-MVP had similar demographics, LV ejection fraction and GLS (all p>0.05). A-MVP had more bileaflet prolapse (69% vs 44%, p=0.031) with a similar degree of mitral regurgitation (mostly trace or mild in both groups) (p>0.05). A-MVP exhibited greater mechanical dispersion when compared with NA-MVP (59 vs 43 ms, p=0.0002). Mechanical dispersion was the only significant predictor of arrhythmic risk on multivariate analysis (OR 1.1, 95% CI 1.02 to 1.11, p=0.006).

Conclusions

STE-derived mechanical dispersion may help identify MVP patients at higher arrhythmic risk.
Nuclear factor erythroid 2-related factors 1 and 2 are able to define the worst prognosis group among high-risk diffuse large B cell lymphomas treated with R-CHOEP
Authors: Kari Esa , Teppo Hanna-Riikka , Haapasaari Kirsi-Maria , Kuusisto Milla Elvi Linnea , Lemma Aurora , Karihtala Peeter , Pirinen Risto , Soini Ylermi , Jantunen Esa , Turpeenniemi-Hujanen Taina , Kuittinen Outi
Published: February 2019

Aims

Oxidative stress markers and antioxidant enzymes have previously been shown to have prognostic value and associate with adverse outcome in patients with diffuse large B cell lymphoma (DLBCL). Nuclear factor erythroid 2-related factor 1 (Nrf1) and factor 2 (Nrf2) are among the principal inducers of antioxidant enzyme production. Kelch ECH associating protein 1 (Keap1) is a negative regulator of Nrf2, and BTB (BR-C, ttk and bab) domain and CNC homolog 1 (Bach1) represses the function of both factors. Their significance in DLBCL prognosis is unknown.

Methods

Diagnostic biopsy samples of 76 patients with high-risk DLBCL were retrospectively stained with immunohistochemistry for Nrf1, Nrf2, Keap1 and Bach1, and correlated with clinical data and outcome.

Results

Nuclear Nrf2 and nuclear Bach1 expression were associated with adverse clinical features (anaemia, advanced stage, high IPI, high risk of neutropaenic infections), whereas cytoplasmic Nrf1 and Nrf2 were associated with favourable clinical presentation (normal haemoglobin level, no B symptoms, limited stage). None of the evaluated factors could predict survival alone. However, when two of the following parameters were combined: high nuclear score of Nrf2, low nuclear score of Nrf1, high cytoplasmic score of Nrf1 and low cytoplasmic score of Keap1 were associated with significantly worse overall survival.

Conclusions

Nrf1 and Nrf2 are relevant in disease presentation and overall survival in high-risk DLBCL. Low nuclear expression of Nrf1, high cytoplasmic expression of Nrf1, high nuclear expression of Nrf2 and low cytoplasmic expression of Keap1 are associated with adverse outcome in this patient group.