bluuebunny/crossref_metadata_2025 huggingface dataset:
Reviewer Acknowledgements
Authors: Young James
Published: June 2020

International Journal of Social Science Studies (IJSSS) would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this issue. Many authors, regardless of whether IJSSS publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this issue.Reviewers for Volume 8, Number 4Abdul Azim Akhtar, Independent Academic & Researcher, Delhi, IndiaAhmet Yıkmış, Abant Izzet Baysal Univeersity, TurkeyAmany Albert, Beni-Suef University, EgyptAna Uka, Beder University, AlbaniaAntónio Calha, Polytechnic Institute of Portalegre, PortugalBassam Yousef Ibrahim Banat, Al-Quds University, PalestineBo Li, St Ambrose University, USAElena Montanari, Politecnico Di Milano, ItalyEncarnación ABAD ARENAS, National University of Distance Education (UNED), SpainJehu Onyekwere Nnaji, University of Naples II, Italy and Globe Visions Network Italy, ItalyJihyoung Kim, Pyeongtaek University, South KoreaJohn Boulard Forkuor, Kwame Nkrumah University of Science and Technology (KNUST) , GhanaK.O. Aramide, The Polytechnic Ibadan, NigeriaLaura Diaconu Maxim, "Alexandru Ioan Cuza University" of Iasi, RomaniaMei-Ling Lin, National Open University, TaiwanMiriam Parise, Università Cattolica del Sacro Cuore, ItalyMohamed Mehdi Jelassi, IHEC Carthage, TunisiaNadarajah Pushparajah, University of Jaffna, Sri LankaNikias Sarafoglou, GMU, SwedenQingzhi Huan, Peking University, ChinaRachita Shrivastava Roy, Department of Higher Education, Chhatisgarh-India, IndiaRiam Elmorshedy, South Valley University, EgyptRonaldo R. Larioque, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY, PhilippinesSaid Aldhafri, Sultan Qaboos University and The Research Counci, OmanSudershan Pasupuleti, The University of Texas, USASusheelabai Srinivasa, University of Texas Rio Grande Valley, United StatesTracey A. Monson, CCIP for Childcare in Practice, Queens University Belfast, Republic of IrelandUğur DEMİRCİ, Turkish National Police, TurkeyYanzhe Zhang, Jilin University, China, China/AustraliaYusramizza Md Isa, Universiti Utara Malaysia, Malaysia James YoungEditorial AssistantOn behalf of,The Editorial Board of International Journal of Social Science StudiesRedfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USAURL: http://ijsss.redfame.com
A System to Package Perspective on Transient Thermal Management of Electronics
Authors: de Bock H. Peter , Huitink David , Shamberger Patrick , Lundh James Spencer , Choi Sukwon , Niedbalski Nicholas , Boteler Lauren
Published: June 2020

There are many applications throughout the military and commercial industries whose thermal profiles are dominated by intermittent and/or periodic pulsed thermal loads. Typical thermal solutions for transient applications focus on providing sufficient continuous cooling to address the peak thermal loads as if operating under steady-state conditions. Such a conservative approach guarantees satisfying the thermal challenge but can result in significant cooling overdesign, thus increasing the size, weight, and cost of the system. Confluent trends of increasing system complexity, component miniaturization, and increasing power density demands are further exacerbating the divergence of the optimal transient and steady-state solutions. Therefore, there needs to be a fundamental shift in the way thermal and packaging engineers approach design to focus on time domain heat transfer design and solutions. Due to the application-dependent nature of transient thermal solutions, it is essential to use a codesign approach such that the thermal and packaging engineers collaborate during the design phase with application and/or electronics engineers to ensure the solution meets the requirements. This paper will provide an overview of the types of transients to consider—from the transients that occur during switching at the chip surface all the way to the system-level transients which transfer heat to air. The paper will cover numerous ways of managing transient heat including phase change materials (PCMs), heat exchangers, advanced controls, and capacitance-based packaging. Moreover, synergies exist between approaches to include application of PCMs to increase thermal capacitance or active control mechanisms that are adapted and optimized for the time constants and needs of the specific application. It is the intent of this transient thermal management review to describe a wide range of areas in which transient thermal management for electronics is a factor of significance and to illustrate which specific implementations of transient thermal solutions are being explored for each area. The paper focuses on the needs and benefits of fundamentally shifting away from a steady-state thermal design mentality to one focused on transient thermal design through application-specific, codesigned approaches.
Thermal Modeling in Metal Additive Manufacturing Using Graph Theory: Experimental Validation With Laser Powder Bed Fusion Using In Situ Infrared Thermography Data
Authors: Reza Yavari M. , Williams Richard J. , Cole Kevin D. , Hooper Paul A. , Rao Prahalada
Published: June 2020

The objective of this work is to provide experimental validation of the graph theory approach for predicting the thermal history of additively manufactured parts. The graph theory approach for thermal modeling in additive manufacturing (AM) was recently published in these transactions. In the present paper, the graph theory approach is validated with in situ infrared thermography data in the context of the laser powder bed fusion (LPBF) additive manufacturing process. We realize the foregoing objective through the following four tasks. First, two kinds of test shapes, namely, a cylinder and cone, are made in two separate builds on a production-type LPBF machine (Renishaw AM250); the material used for these tests is stainless steel (SAE 316L). The intent of both builds is to influence the thermal history of the part by controlling the cooling time between the melting of successive layers, called the interlayer cooling time (ILCT). Second, layer-wise thermal images of the top surface of the part are acquired using an in situ a priori calibrated infrared camera. Third, the thermal imaging data obtained during the two builds is used to validate the graph theory-predicted surface temperature trends. Fourth, the surface temperature trends predicted using graph theory are compared with results from finite element (FE) analysis. The results substantiate the computational advantages of the graph theory approach over finite element analysis. As an example, for the cylinder-shaped test part, the graph theory approach predicts the surface temperature trends to within 10% mean absolute percentage error (MAPE) and approximately 16 K root mean squared error (RMSE) relative to the surface temperature trends measured by the thermal camera. Furthermore, the graph theory-based temperature predictions are made in less than 65 min, which is substantially faster than the actual build time of 171 min. In comparison, for an identical level of resolution and prediction error, the finite element approach requires 175 min.
Micro/Meso-Scale Mechanical Machining 2020: A Two-Decade State-of-the-Field Review
Authors: Samuel Johnson , Jun Martin B. G. , Ozdoganlar O. Burak , Honegger Andrew , Vogler Mike , Kapoor Shiv G.
Published: June 2020

Micro/meso-scale mechanical machining (M4) processes are miniaturized versions of conventional machining processes such as milling, drilling, and turning, where material removal is accomplished by physical contact between the micro/meso-scale cutting tool and the workpiece. The objective of this review paper is to provide an assessment of the state-of-the-field related to M4 processes during the last two decades. Key systems-level issues related to the deployment of M4 processes including micro/meso-scale machine tool (mMT) design, sensing/calibration, cutting tools, and lubrication strategies are discussed. Emerging material systems are identified along with the specific challenges posed for the development of microstructure-based process models. The topic of micro/meso-scale machining dynamics is reviewed both in terms of recent research findings as well as unresolved challenges posed by the complexity of experimental characterization and modeling. Finally, key industry trends are discussed along with promising interdisciplinary drivers that are expected to influence this field in the upcoming decade.
Stochastic Cutting Force Modeling and Prediction in Machining
Authors: Liu Yang , Xiong Zhenhua , Liu Zhanqinag
Published: June 2020

As the cutting force plays an important role in machining, the modeling of cutting force has drawn considerable interests in recent years. However, most of current methods were focused on the deterministic modeling of cutting force, while the inherent stochasticity of cutting force is rarely considered for general metal cutting machining. Thus, a stochastic model is proposed in this paper to predict the stochastic cutting force by considering realistic cutting conditions, including the inhomogeneity of cutting material and the multi-mode machining system. Specifically, we transform the constant cutting coefficient in previous models into a stationary Gaussian process in the proposed stochastic model. As for the tool vibration, the uncut chip thickness is also modeled in a stochastic manner. Moreover, it is found that the random cutting coefficients can be estimated conveniently through experiments and effectively simulated by stochastic differential equations at any timescale. Then, the stochastic cutting force can be predicted numerically by combining the stochastic model and the multi-mode dynamic equations. For verification, a three-mode machining system was set up, and workpieces with different metal alloys were tested. It is found that the random cutting coefficients estimated are insensitive to cutting parameters, and the prediction results show satisfactory agreement with experimental results in both time and statistical domains. The proposed method can provide rich statistical information of cutting forces, which can facilitate related applications like tool condition monitoring when the on-line measurement of cutting force is not preferred or even impossible.
Investigations Into Heat Transfer and Aerodynamic Performance of a Worn Squealer Tipped Turbine Stage
Authors: Yan Xin , Ye Mingliang , He Kun
Published: June 2020

Heat transfer and aerodynamic performance in worn squealer tip gap of a high-pressure gas turbine stage were numerically investigated. Effects of the starting location of wear and wear depth on tip heat transfer coefficient distributions and stage efficiency were analyzed to evaluate the aero-thermal performance degradations in the gas turbine stage after wear. At three starting locations of wear and five wear depths, flow patterns in worn squealer tip gap of the turbine stage were visualized and compared with the original design case. The results show that the counter-rotating vortex systems in tip cavity, as well as the interactions between leakage vortex and passage vortex, are significantly affected by the degree of wear damage. The starting location of wear and wear depth have pronounced influences on heat transfer and aerodynamic performance in squealer tip gap. After wear, the stage efficiency is decreased by about 0.3–1%, as the wear depth is equal to clearance gap size. In the serious worn case, thermal load on tip cavity floor is increased by about 60%, while the heat transfer on rims is reduced by about 20%. However, compared with the original design case, the area-averaged heat transfer coefficient on shroud is reduced by 5% at most.
Risk Assessment of Road Vehicles Under Wind Gust Excitation
Authors: Zhang Xiaoyu , Proppe Carsten
Published: June 2020

Crosswind stability of vehicles has attracted a lot of attention in the past years. Accidents caused by strong crosswind occupy a relatively small proportion. However, they may have unproportionally large contribution to serious and fatal injuries. In order to assess the crosswind stability of road vehicles in a more realistic way, risk analysis for road vehicles running under realistic wind excitation has to be considered. This paper summarizes the method for risk analysis of crosswind stability of road vehicles. A nonstationary model for the wind forces and moments acting on a running vehicle is presented and analyzed in detail. In addition, guidelines for speed limitations or traffic restrictions are developed. Based on the risk analysis, a practical method to determine the critical mean wind speeds for a wind warning system is proposed.
Finite Volume Method for Fractional Maxwell Viscoelastic Fluid Over a Moving Plate With Convective Boundary Condition
Authors: Zhao Jinhu
Published: June 2020

A novel finite volume method about the boundary layer flow and heat transfer of fractional viscoelastic fluid over a moving plate with convective boundary condition is developed. The fractional Maxwell model and fractional Fourier's law are employed in the constitutive relations. Numerical solutions are obtained and validated by exact solutions of special case with source terms. The effects of fractional parameters on the flow and heat transfer characteristics are analyzed. Results show that the viscoelastic fluid performs shear-thickening property with the increase of fractional parameter. Moreover, the variations of the average Nusselt number demonstrate that the viscoelastic fluid characterized by fractional Fourier's law has short memory in heat conduction process.
Micromechanical Modeling for the Damage Accumulation and Adhesive Wear of Metallic Materials Containing Inclusions
Authors: Wu Aizhong , Weng Lin , Hu Dingyu , Liao Aihua
Published: June 2020

Metallic materials usually contain some amounts of inclusions which are known to affect their mechanical properties since the bonding strength of the matrix–inclusion interface is relatively low, voids or cracks are thus easily formed under a tensile loading. However, under a contact loading, the effects of subsurface inclusions on the sliding wear of metallic materials are not thoroughly understood. In this work, a micromechanical model is proposed to study the shear fracture and wear of metallic materials containing random inclusions. With the model, crack branching and crack aggregation during contact loading are simulated, and the formation process of sheet-like wear particles is clarified. It is demonstrated that the subsurface micro-cracks, particularly those near inclusions, and their subsequent evolution play a major role in the adhesive wear. This investigation is helpful in understanding the adhesive mechanism of wear, and the proposed model could be a promising approach for the prediction of adhesive wear.
Logistic models and artificial intelligence in the sonographic assessment of adnexal masses – a systematic review of the literature
Authors: Grigore Mihaela , Popovici Razvan Mihai , Gafitanu Dumitru , Himiniuc Loredana , Murarasu Mara , Micu Romeo
Published: June 2020

Adnexal masses are common, yet challenging, in gynecological practice. Making the differential diagnosis between their benign and malignant condition is essential for optimal surgical management, but reliable pre-surgical differentiation is sometimes difficult using clinical features, ultrasound examination, or tumor markers alone. A possible way to improve the diagnosis is using artificial intelligence (AI) or logistic models developed based on compiling and processing clinical, ultrasound, and tumor marker data together. Ample research has already been conducted in this regard that medical practitioners could benefit from. In this systematic review, we present logistic models and methods using AI, chosen based on their demonstrated high performance in clinical practice. Although some external validation of these models has been performed, further prospective studies are needed in order to select the best model or to create a new, more efficient, one for the pre-surgical evaluation of ovarian masses.
First-principles study of magnetism and electric field effects in 2D systems
Authors: Cheng Hai-Ping , Liu Shuanglong , Chen Xiao , Zhang Long , Fry James N.
Published: June 2020

This review article provides a bird's-eye view of what first-principles based methods can contribute to next-generation device design and simulation. After a brief overview of methods and capabilities in the area, the authors focus on published work by their group since 2015 and current work on CrI3. The authors introduce both single- and dual-gate models in the framework of density functional theory and the constrained random phase approximation in estimating the Hubbard U for 2D systems vs their 3D counterparts. A wide range of systems, including graphene-based heterogeneous systems, transition metal dichalcogenides, and topological insulators, and a rich array of physical phenomena, including the macroscopic origin of polarization, field effects on magnetic order, interface state resonance induced peak in transmission coefficients, spin filtration, etc., are covered. For CrI3, the authors present their new results on bilayer systems such as the interplay between stacking and magnetic order, pressure dependence, and electric field induced magnetic phase transitions. The authors find that a bare bilayer CrI3, graphene|bilayer CrI3|graphene, hexagonal boron nitride (h-BN)|bilayer CrI3|h-BN, and h-BN|bilayer CrI3|graphene all have a different response at high field, while at small field, the difference is small except for graphene|bilayer CrI3|graphene. The authors conclude with discussion of some ongoing work and work planned in the near future, with the inclusion of further method development and applications.
Persistence of Bacteriophage Phi 6 on Porous and Nonporous Surfaces and the Potential for Its Use as an Ebola Virus or Coronavirus Surrogate
Authors: Whitworth Carrie , Mu Yi , Houston Hollis , Martinez-Smith Marla , Noble-Wang Judith , Coulliette-Salmond Angela , Rose Laura
Published: June 2020

Understanding the persistence of enveloped viruses helps inform infection control practices and procedures in health care facilities and community settings. These data convey to public health investigators that enveloped viruses can persist and remain infective on surfaces, thus demonstrating a potential risk for transmission. Under these laboratory-simulated Western indoor hospital conditions, we assessed the suitability of phi 6 as a surrogate for environmental persistence research related to enveloped viruses, including EBOV and coronaviruses.
Fiber-1, Not Fiber-2, Directly Mediates the Infection of the Pathogenic Serotype 4 Fowl Adenovirus via Its Shaft and Knob Domains
Authors: Wang Weikang , Liu Qian , Li Tuofan , Geng Tuoyu , Chen Hongjun , Xie Quan , Shao Hongxia , Wan Zhimin , Qin Aijian , Ye Jianqiang
Published: June 2020

Among 12 serotypes of fowl adenovirus (FAdV), FAdV-1, FAdV-4, and FAdV-10 all carry two fiber genes (i.e., fiber-1 and fiber-2), whereas other serotypes have only one. As important viral surface proteins, the fibers play vital roles in the infection and pathogenesis of FAdV. However, the importance of the fibers to the infection and pathogenesis of FAdV may be different from each other. Recent studies reveal that fiber-2 is identified as a determinant of virulence, but which fiber triggers the infection of FAdV-4 remains unknown. In this study, fiber-1 was identified as a key factor for directly mediating the infection of FAdV-4 through its shaft and knob domains, whereas fiber-2 did not play a role in triggering FAdV-4 infection. The results suggest that fiber-1 and its knob domain may serve as a target for identifying the receptor of FAdV-4 and developing efficient drugs or vaccines against FAdV-4.
The Trait Repertoire Enabling Cyanobacteria to Bloom Assessed through Comparative Genomic Complexity and Metatranscriptomics
Authors: Cao Huansheng , Shimura Yohei , Steffen Morgan M. , Yang Zhou , Lu Jingrang , Joel Allen , Jenkins Landon , Kawachi Masanobu , Yin Yanbin , Garcia-Pichel Ferran
Published: June 2020

We pragmatically delineate the trait repertoire that enables organismal niche specialization. We based our approach on the tenet, derived from evolutionary and complex-system considerations, that genomic units that can significantly contribute to fitness in a certain habitat will be comparatively more complex in organisms specialized to that habitat than their genomic homologs found in organisms from other habitats. We tested this in cyanobacteria forming harmful water blooms, for which decades-long efforts in ecological physiology and genomics exist. Our results essentially confirm that genomics and ecology can be linked through comparative complexity analyses, providing a tool that should be of general applicability for any group of organisms and any habitat, and enabling the posing of grounded hypotheses regarding the ecogenomic basis for diversification.
Isolated Heme A Synthase from Aquifex aeolicus Is a Trimer
Authors: Zeng Hui , Zhu Guoliang , Zhang Shuangbo , Li Xinmei , Martin Janosch , Morgner Nina , Sun Fei , Peng Guohong , Xie Hao , Michel Hartmut
Published: June 2020

Heme A is a vital redox cofactor unique for the terminal cytochrome
c
oxidase in mitochondria and many microorganisms. It plays a key role in oxygen reduction by serving as an electron carrier and as the oxygen-binding site. Heme A is synthesized from heme O by an integral membrane protein, heme A synthase (HAS). Defects in HAS impair cellular respiration and have been linked to various human diseases, e.g., fatal infantile hypertrophic cardiomyopathy and Leigh syndrome. HAS exists as a stable oligomeric complex, and studies have shown that oligomerization of eukaryotic HAS is necessary for its proper function. However, the molecular architecture of the HAS oligomeric complex has remained uncharacterized. The present study shows that HAS forms trimers and reveals how the oligomeric arrangement contributes to the complex stability and flexibility, enabling HAS to perform its catalytic function effectively. This work provides the basic understanding for future studies on heme A biosynthesis.
Visceral Adiposity Index is a predictor of incident colorectal cancer: a population-based longitudinal study
Authors: Okamura Takuro , Hashimoto Yoshitaka , Hamaguchi Masahide , Obora Akihiro , Kojima Takao , Fukui Michiaki
Published: June 2020

Objective

The Visceral Adiposity Index (VAI) is a marker of visceral fat accumulation and dysfunction. We aimed to investigate the association between VAI and incident colorectal cancer (CRC).

Design

In this historical cohort study of 27 921 (16 434 men and 11 487 women) participants, we divided the participants into tertiles according to VAI. We calculated VAI: men, VAI = (waist circumference (WC)/(39.68+1.88 × body mass index (BMI))) × (triglycerides (TG)/1.03) × (1.31/high-density lipoprotein cholesterol (HDL)); women, VAI = (WC/(36.58+1.89 × BMI)) × (TG/0.81) × (1.52/HDL). We performed Cox proportional hazard models, adjusting for sex, age, smoking, alcohol consumption, exercise, haemoglobin A1c and systolic blood pressure.

Results

During the median 4.4-year follow-up, 116 participants developed CRC. Compared with the lowest tertile, the HRs of incident CRC in the middle and the highest tertiles were 1.30 (95% CI 0.76 to 2.28, p=0.338) and 2.41 (1.50 to 4.02, p<0.001) in univariate analysis. Moreover, the HRs of incident CRC in the middle and the highest tertiles were 1.27 (0.73 to 2.23, p=0.396) and 1.98 (1.15 to 3.39, p=0.013) after adjusting for covariates.

Conclusions

VAI can be a predictor of incident CRC. For early detection, we should encourage people with high VAI to undergo screening for CRC.
Functional neurological disorders: effective teaching for health professionals
Authors: Lehn Alexander , Navaratnam Dharsha , Broughton Megan , Cheah Vince , Fenton Alison , Harm Karl , Owen Diana , Pun Paul
Published: June 2020

Objectives

To provide an outline for the delivery of an educational course or lecture about functional neurological disorders (FND) that is directed towards health professionals with varying clinical knowledge and to highlight the educational efficacy that can be derived from a well-designed educational platform.

Method

Through multidisciplinary collaboration, a course designed to develop the skills for diagnosis and management of FND was created. Elements essential to the delivery of education are: (A) knowledge creation; (B) facilitating multidisciplinary cross-pollination; (C) listening to patients’ experiences; (D) communication skills practice; (E) case studies; (F) discipline specific mentoring; (G) establishing and addressing participant learning goals and (H) developing collegial and referral networks. Changes in participants’ knowledge and clinical practice were assessed via anonymous questionnaires before and after the course.

Results

Dramatically improved knowledge and confidence in assessment and management of people with FND has been found both immediately following the course as well as on 6-month follow-up.

Conclusion

It is possible to make real change in the understanding and management of medical and allied health clinicians working with people with FND with a low-cost intervention. Also, the development of educational networks and multidisciplinary collaboration can lead to the creation of therapeutic platforms for the diagnosis, management and advocacy of this patient group.
Randomised, double-blinded, placebo-controlled trial to investigate the role of laparoscopic transversus abdominis plane block in gastric bypass surgery: a study protocol
Authors: Jarrar Amer , Budiansky Adele , Eipe Naveen , Walsh Caolan , Kolozsvari Nicole , Neville Amy , Mamazza Joseph
Published: June 2020

Introduction

Evaluating the efficacy of a laparoscopically guided, surgical transversus abdominis plane (TAP) and rectus sheath (RS) block in reducing analgesic consumption while improving functional outcomes in patients undergoing laparoscopic bariatric surgery.

Methods

150 patients Living with obesity undergoing elective laparoscopic Roux-En-Y gastric bypass for obesity will be recruited to this double-blinded, placebo-controlled randomised controlled trial from a Bariatric Centre of Excellence over a period of 6 months. Patients will be electronically randomised on a 1:1 basis to either an intervention or placebo group. Those on the intervention arm will receive a total of 60 mL 0.25% ropivacaine, divided into four injections: two for TAP and two for RS block under laparoscopic visualisation. The placebo arm will receive normal saline in the same manner. A standardised surgical and anaesthetic protocol will be followed, with care in adherence to the Enhanced Recovery after Bariatric Surgery guidelines.

Analysis

Demographic information and relevant medical history will be collected from the 150 patients enrolled in the study. Our primary efficacy endpoint is cumulative postoperative narcotic use. Secondary outcomes are peak expiratory flow, postoperative pain score and the 6 min walk test. Quality of recovery (QoR) will be assessed using a validated questionnaire (QoR-40). Statistical analysis will be conducted to assess differences within and between the two groups. The repeated measures will be analysed by a mixed modelling approach and results reported through publication.

Ethics and dissemination

Ethics approval was obtained (20170749-01H) through our institutional research ethics board (Ottawa Health Science Network Research Ethics Board) and the study results, regardless of the outcome, will be reported in a manuscript submitted for a medical/surgical journal.

Trial registration number

Pre-results NCT03367728.
Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study
Authors: Vestergaard Anne Høy Seemann , Neergaard Mette Asbjoern , Christiansen Christian Fynbo , Nielsen Henrik , Lyngaa Thomas , Laut Kristina Grønborg , Johnsen Søren Paaske
Published: June 2020

Objectives

End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD).

Design

A nationwide register-based cohort study.

Setting

Data on all in-hospital admissions obtained from nationwide Danish medical registries.

Participants

All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015.

Outcome measures

Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region.

Results

Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.

Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%).

Conclusion

Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.
Descriptive study of workplace demand, control and bullying among migrant and Australian-born workers by gender: does workplace support make a difference?
Authors: Reid Alison , Daly Alison , LaMontagne Anthony D , Milner Allison , Ronda Pérez Elena
Published: June 2020

Objective

The objective of this study is to examine the relationship between bullying in migrants and Australians and types of workplace Iso-strain, by gender.

Design and setting

Two descriptive cross-sectional surveys of the Australian working population.

Participants

Australian-born workers of Caucasian ancestry (n=1051, participant response rate=87.3%) and workers born in New Zealand (n=566), India (n=633) and the Philippines (n=431) (participant response rate=79.5%).

Primary and secondary outcomes measures

Using logistic regression, we examined whether self-reported assessment of various forms of bullying in the workplace was associated with Iso-strain (job with high demands and low control and without social support), gender and migrant status.

Results

The prevalence of workplace bullying within the previous year was 14.5%. Sexual harassment, though rare (n=47, 1.8%), was reported by more women than men (83% vs 17%, χ2=19.3, p<0.0001) and more Australia or New Zealand born workers compared to India or the Philippines workers (75.5% vs 25.5%, χ2=4.6, p=0.032). Indian-born women had lower adjusted OR for being bullied and for being intimidated compared to other women. Independent of migrant status, Iso-strain (1), (low support from boss) and Iso-strain (2), (low support from colleagues) predicted being bullied. Women were more likely to be in an Iso-strain (1) job than men (18.7% vs 13.6%, p=0.013) and had twice the risk of being both verbally abused and intimidated compared to men (OR 9 vs OR 5.5, p<0.0001).

Conclusion

Workplace bullying was more likely for women than men. There were few differences between workers from different migrant groups. Iso-strain was the strongest predictor of workplace bullying. Workplaces should encourage supportive and collegiate work environments.
Racial and socioeconomic disparities in patient experience of clinician empathy: a protocol for systematic review and meta-analysis
Authors: Roberts Brian W , Trzeciak Christian J , Puri Nitin K , Mazzarelli Anthony J , Trzeciak Stephen
Published: June 2020

Introduction

Clinician empathy is a vital component of high-quality healthcare. Healthcare disparities may reflect a societal lack of empathy for disadvantaged persons in general, and recent research suggests that socioeconomic disparities exist in patient satisfaction with clinicians. However, it is currently unclear if there are disparities in patient experience of empathy from clinicians. Our objective is to systematically analyse the scientific literature to test the hypothesis that racial and socioeconomic status (SES) disparities exist in patient-reported experience of clinician empathy.

Methods and analysis

In accordance with published methodological guidelines for conducting a systematic review, we will analyse studies reporting patient assessment of clinician empathy using the Consultation and Relational Empathy (CARE) measure, which to date is the most commonly used and well-validated methodology in clinical research for measuring clinician empathy from the patient’s perspective. We will use a standardised data collection template and assess study quality (risk of bias) using the Newcastle-Ottawa Scale. We will abstract data for the CARE measure stratified by race and SES, and we will contact the corresponding authors to obtain stratified data by race/SES if not reported in the original manuscript. Where appropriate, we will pool the data and perform quantitative meta-analysis to test if non-white (compared to white) patients and low SES (compared to high SES) patients report lower scores for clinician empathy.

Ethics and dissemination

No individual patient-level data will be collected and thus the proposed systematic review does not require ethical approval. This systematic review will test if racial and SES differences exist in patient experience of clinician empathy, and will inform future research to help promote healthcare equity.

PROSPERO registration number

CRD42019142809.
Duration of sick leave after same-day discharge for lower extremity arterial disease and varicose vein interventions in active population of French patients, 2013–2016: observational study
Authors: Hamid Asma , Lamirault Guillaume , Gouëffic Yann , Le Meur Nolwenn
Published: June 2020

Objective

To assess whether disparities in rates of same-day discharge for lower extremities arterial disease (5%) and varicose vein interventions (90%) are associated with the burden of postprocedural rehabilitation process, measured through the duration of sick leave.

Design

Retrospective observational study using French National Health Insurance data in 2012–2016.

Setting

The French National Health Data System (Système National des Données de Santé), which covers 98.8% of the 66 million people in the French population.

Participants

French workforce population aged 18 to 65 years old who underwent a first angioplasty with stent placement for lower extremities arterial disease (LEAD, n=30 238) or a first varicose vein intervention (n=265 670) between 2013 and 2016.

Main outcome measures

Duration and renewals of sick leave within 180 days after endovascular intervention, continuity of care and prescription indices to assess coordination among healthcare professionals after intervention associated with specific intervention settings: conventional (inpatient) or same-day discharge (outpatient). Association was estimated by multivariate negative binomial regressions adjusting for age, gender and comorbidities.

Results

Outpatient settings decrease the incidence rate ratio (IRR) of the number of cumulated days of sick leave by 14% in both interventions. The increasing variety of prescribers decreases the IRR of cumulated days of sick leave and prescription renewals for varicose interventions by 25% and 21%, respectively, but increases them for LEAD interventions by 240% and 106%. Less coordination between healthcare specialists increases the IRR of cumulative days of sick leave and renewals by 37% and 29% for varicose, and 11% and 9% for LEAD interventions.

Conclusions

Low rates of outpatients in LEAD angioplasty does not seem related to the duration of sick leave. Outpatient setting reduces the duration of sick leave and their renewals, whatever the intervention. Coordination of healthcare professionals is a key element of interventions follow-up with pathology specificities.
Evaluation of the General Practice Pharmacist (GPP) intervention to optimise prescribing in Irish primary care: a non-randomised pilot study
Authors: Cardwell Karen , Smith Susan M , Clyne Barbara , McCullagh Laura , Wallace Emma , Kirke Ciara , Fahey Tom , Moriarty Frank
Published: June 2020

Objective

Limited evidence suggests integration of pharmacists into the general practice team could improve medicines management for patients, particularly those with multimorbidity and polypharmacy. This study aimed to develop and assess the feasibility of an intervention involving pharmacists, working within general practices, to optimise prescribing in Ireland.

Design

Non-randomised pilot study.

Setting

Primary care in Ireland.

Participants

Four general practices, purposively sampled and recruited to reflect a range of practice sizes and demographic profiles.

Intervention

A pharmacist joined the practice team for 6 months (10 hours/week) and undertook medication reviews (face to face or chart based) for adult patients, provided prescribing advice, supported clinical audits and facilitated practice-based education.

Outcome measures

Anonymised practice-level medication (eg, medication changes) and cost data were collected. Patient-reported outcome measure (PROM) data were collected on a subset of older adults (aged ≥65 years) with polypharmacy using patient questionnaires, before and 6 weeks after medication review by the pharmacist.

Results

Across four practices, 786 patients were identified as having 1521 prescribing issues by the pharmacists. Issues relating to deprescribing medications were addressed most often by the prescriber (59.8%), compared with cost-related issues (5.8%). Medication changes made during the study equated to approximately €57 000 in cost savings assuming they persisted for 12 months. Ninety-six patients aged ≥65 years with polypharmacy were recruited from the four practices for PROM data collection and 64 (66.7%) were followed up. There were no changes in patients’ treatment burden or attitudes to deprescribing following medication review, and there were conflicting changes in patients’ self-reported quality of life.

Conclusions

This non-randomised pilot study demonstrated that an intervention involving pharmacists, working within general practices is feasible to implement and has potential to improve prescribing quality. This study provides rationale to conduct a randomised controlled trial to evaluate the clinical and cost-effectiveness of this intervention.
Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study
Authors: Vaes Bert , Indestege Paulien , Serneels Tinne , Hegendörfer Eralda , van Peet Petra G , Poortvliet Rosalinde K E , Wallemacq Pierre , Gussekloo Jacobijn , Degryse Jan
Published: June 2020

Objectives

To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers.

Design

Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study.

Setting

General practice, Belgium and The Netherlands.

Participants

The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD.

Outcome measures

The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models.

Results

Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI −0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)).

Conclusions

This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.
Barriers in care for children with life-threatening conditions: a qualitative interview study in the Netherlands
Authors: Brouwer Marije , Maeckelberghe Els L M , van der Heide Agnes , Hein Irma , Verhagen Eduard
Published: June 2020

Objective

To identify barriers, as perceived by parents, to good care for children with life-threatening conditions.

Design

In a nationwide qualitative study, we held in-depth interviews regarding end-of-life care with parents of children (aged 1 to 12 years) who were living with a life-threatening illness or who had died after a medical trajectory (a maximum of 5 years after the death of the child). Sampling was aimed at obtaining maximum variety for a number of factors. The interviews were transcribed and analysed.

Setting

The Netherlands.

Participants

64 parents of 44 children.

Results

Parents identified six categories of difficulties that create barriers in the care for children with a life-threatening condition. First, parents wished for more empathetic and open communication about the illness and prognosis. Second, organisational barriers create bureaucratic obstacles and a lack of continuity of care. Third, parents wished for more involvement in decision-making. Fourth, parents wished they had more support from the healthcare team on end-of-life decision-making. Fifth, parents experienced a lack of attention for the family during the illness and after the death of their child. Sixth, parents experienced an overemphasis on symptom-treatment and lack of attention for their child as a person.

Conclusions

The barriers as perceived by parents focussed almost without exception on non-medical aspects: patient-doctor relationships; communication; decision-making, including end-of-life decision-making; and organisation. The perceived barriers indicate that care for children with a life-threatening condition focusses too much on symptoms and not enough on the human beings behind these symptoms.
Alcohol-related mortality following the loss of a child: a register-based follow-up study from Norway
Authors: Christiansen Solveig Glestad , Reneflot Anne , Stene-Larsen Kim , Hauge Lars Johan
Published: June 2020

Objectives

The death of one’s child is one of the most stressful events a person can experience. Research has shown that bereaved parents have a higher mortality than non-bereaved parents. This increased mortality might partly be caused directly by long-term stress. However, changes in health behaviour such as an increase in alcohol consumption might also play a role. This study examines the association between losing a child and alcohol-related mortality. In addition to Cox regression models using data covering the entire Norwegian adult population, we employ sibling fixed-effect models in order to partly control for genes and childhood experiences that might be associated with both losing a child and alcohol-related mortality.

Design

A follow-up study between 1986 and 2014 based on Norwegian register data.

Setting

Norway.

Participants

The entire Norwegian adult population.

Primary outcome measure

Alcohol-related mortality.

Results

An increased alcohol-related mortality was found among parents who had experienced the death of a child. The HR of alcohol-related mortality among those bereaved of a child was 1.59 (95% CI 1.48 to 1.71) compared with non-bereaved parents, for women 2.03 (95% CI 1.78 to 2.32) and for men 1.46 (95% CI 1.34 to 1.59). After including sibling fixed effects, the HR of alcohol-related mortality among parents who had lost a child was 1.30 (95% CI 1.03 to 1.64).

Conclusions

This study provides evidence of an elevated alcohol-related mortality among parents who have lost a child compared with non-bereaved parents. Although strongly attenuated, there is still an association when adjusting for genetic predisposition for alcohol problems as well as childhood environment using sibling fixed-effect models.
Clinician responses to legal requests for hastened death: a systematic review and meta-synthesis of qualitative research
Authors: Patel Tejal , Christy Kayonne , Grierson Lawrence , Shadd Joshua , Farag Alexandra , O'Toole Danielle , Lawson Jennifer , Vanstone Meredith
Published: June 2020

Background

The legalisation of medical assistance in dying in numerous countries over the last 20 years represents a significant shift in practice and scope for many clinicians who have had little-to-no training to prepare them to sensitively respond to patient requests for hastened death.

Aims

Our objective was to review the existing qualitative literature on the experiences of healthcare providers responding to requests for hastened death with the aim of answering the question: how do clinicians make sense of, and respond to patients’ expressed wishes for hastened death?

Methods

We performed a systematic review and meta-synthesis of primary qualitative research articles that described the experiences and perspectives of healthcare professionals who have responded to requests for hastened death in jurisdictions where MAiD (Medical Assistance in Dying) was legal or depenalised. A staged coding process was used to identify and analyse core themes.

Results

Although the response to requests for hastened death varied case-by-case, clinicians formulated their responses by considering seven distinct domains. These include: policies, professional identity, commitment to patient autonomy, personal values and beliefs, the patient-clinician relationship, the request for hastened death and the clinician’s emotional and psychological response.

Conclusion

Responding to a request for hastened death can be an overwhelming task for clinicians. An approach that takes into consideration the legal, personal, professional and patient perspectives is required to provide a response that encompasses all the complexities associated with such a monumental request.