bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal shifts in iso/anisohydry revealed from daily observations of plant water potential in a dominant desert shrub
Authors: Guo Jessica S. , Hultine Kevin R. , Koch George W. , Kropp Heather , Ogle Kiona
Published: September 2019

Plant species are characterized along a spectrum of isohydry to anisohydry depending on their regulation of water potential (Ψ), but the plasticity of hydraulic strategies is largely unknown. The role of environmental drivers was evaluated in the hydraulic behavior of Larrea tridentata, a drought‐tolerant desert shrub that withstands a wide range of environmental conditions.

With a 1.5 yr time‐series of 2324 in situ measurements of daily predawn and midday Ψ, the temporal variability of hydraulic behavior was explored in relation to soil water supply, atmospheric demand and temperature.

Hydraulic behavior in Larrea was highly dynamic, ranging from partial isohydry to extreme anisohydry. Larrea exhibited extreme anisohydry under wet soil conditions corresponding to periods of high productivity, whereas partial isohydry was exhibited after prolonged dry or cold conditions, when productivity was low.

Environmental conditions can strongly influence plant hydraulic behavior at relatively fast timescales, which enhances our understanding of plant drought responses. Although species may exhibit a dominant hydraulic behavior, variable environmental conditions can prompt plasticity in Ψ regulation, particularly for species in seasonally dry climates.
Perioperative anaphylaxis in children: Etiology, time sequence, and patterns of clinical reactivity
Authors: Khaleva Ekaterina , Franz Amber , Garvey Lene Heise , Jay Nicola , Ylescupidez Alyssa , Bahnson Henry T. , du Toit George
Published: September 2019

Background

Perioperative anaphylaxis (PA) in children is an uncommon but potentially life‐threatening complication associated with anesthesia. Early identification and management of PA is essential to optimize clinical outcomes.

Methods

We performed a retrospective study of anesthesia records from pediatric patients with PA from centers in the United Kingdom, France, and the United States over a period of 10 years. Time sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing.

Results

Twenty‐nine children with PA were included. Median age was 11 years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Life‐threatening hypotension was the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6 minutes (SD: 6, range: 1‐25). The causative allergen was identified in 15 patients.

Conclusion

Severe hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimize the prediction, identification, and early management of PA in children.
Differential physiological and biochemical responses of Quercus infectoria and Q. libani to drought and charcoal disease
Authors: Ghanbary Ehsan , Tabari Kouchaksaraei Masoud , Zarafshar Mehrdad , Bader Karl‐Friedrich M. , Mirabolfathy Mansoureh , Ziaei Maryam
Published: September 2019

The vast oak‐dominated forests of the Zagros Mountains in southwestern Iran currently undergo large‐scale dieback driven by a combination of drought and increasing incidence of charcoal disease caused by the fungal pathogens Biscogniauxia mediterranea and Obolarina persica. Here, we explore the interactive effects between drought and charcoal disease agents on the physiology and biochemistry of Quercus infectoria and Quercus libani seedlings. The combination of pathogen attack and water limitation hampered plant development, especially in Q. libani seedlings, negatively affecting growth, biomass production, photosynthetic efficiency, and leaf water potential. An increase in markers of oxidative damage together with the upregulation of the antioxidant defense revealed that drought stress and pathogen infection led to pro‐oxidative conditions in both oak species, especially in Q. libani, where larger changes in malondialdehyde and hydrogen peroxide occurred. The upregulation of the antioxidant system was more prominent in Q. infectoria than in Q. libani, resulting in enhanced enzyme activity and accumulation of non‐enzymatic antioxidants. Fungal infection stimulated the activity of chitinase, phenylalanine ammonia lyase and β‐1,3‐glucanase in Q. infectoria leaves and this response became more pronounced under water shortage. Our study highlights that drought stress greatly intensifies the effects of the charcoal disease. Moreover, our findings imply superior stress resistance of Q. infectoria conferred by a highly efficient antioxidant system, strong osmotic adjustment (through proline), and increases in resistance enzymes and secondary metabolites (phenols and flavonoids). Future investigations should focus on adult trees in their natural habitat including interactions with soil factors and other pathogens like nematodes, bacteria and other fungi. Because the present research was conducted on oak seedlings, the findings can be considered by forest nursery managers.
Silica‐associated lung disease: An old‐world exposure in modern industries
Authors: Barnes Hayley , Goh Nicole S.L. , Leong Tracy L. , Hoy Ryan
Published: September 2019

Despite silica dust exposure being one of the earliest recognized causes of lung disease, Australia, USA, Israel, Turkey and other countries around the world have recently experienced significant outbreaks of silicosis. These outbreaks have occurred in modern industries such as denim jean production, domestic benchtop fabrication and jewellery polishing, where silica has been introduced without recognition and control of the hazard. Much of our understanding of silica‐related lung disease is derived from traditional occupations such as mining, whereby workers may develop slowly progressive chronic silicosis. However, workers in modern industries are developing acute and accelerated silicosis over a short period of time, due to high‐intensity silica concentrations, oxidative stress from freshly fractured silica and a rapid pro‐inflammatory and pro‐fibrotic response. Appropriate methods of screening and diagnosis remain unclear in these workers, and a significant proportion may go on to develop respiratory failure and death. There are no current effective treatments for silicosis. For those with near fatal respiratory failure, lung transplantation remains the only option. Strategies to reduce high‐intensity silica dust exposure, enforced screening programmes and the identification of new treatments are urgently required.
Analysis of Contacts in Friction Damped Turbine Blades Using Dimensionless Numbers
Authors: Hoffmann Thomas , Panning-von Scheidt Lars , Wallaschek Jörg
Published: September 2019

A novel design approach for friction hysteresis measurements is introduced to simplify the characterization of turbine blade contact dynamics. It makes use of dimensionless numbers of a metallic friction contact undergoing small, periodic displacements. Such contacts are used in turbine blades to lower resonance amplitudes by energy dissipation through friction. Nonetheless, this approach is not limited to this field. The dimensionless numbers for characterization of the contact are derived based on a generic contact that is typical for applications in turbine blades. A dimensionless number can be found that characterizes the contact extensively. Several friction hysteresis measurements are conducted on a special test rig in a systematic manner exploring a large parameter space for the derived dimensionless number. Based on the experiments, it is concluded that the normalized measured friction hysteresis loops show similitude despite being measured with parameters spanning a wide range. It results in the possibility to design friction hysteresis tests for friction damped turbine blades in a simple and representative way.
Surrogate-Assisted Modeling and Robust Optimization of a Micro Gas Turbine Plant With Carbon Capture
Authors: Giorgetti Simone , Coppitters Diederik , Contino Francesco , Paepe Ward De , Bricteux Laurent , Aversano Gianmarco , Parente Alessandro
Published: September 2019

The growing share of wind and solar power in the total energy mix has caused severe problems in balancing the electrical power production. Consequently, in the future, all fossil fuel-based electricity generation will need to be run on a completely flexible basis. Microgas turbines (mGTs) constitute a mature technology which can offer such flexibility. Even though their greenhouse gas emissions are already very low, stringent carbon reduction targets will require them to be completely carbon neutral: this constraint implies the adoption of postcombustion carbon capture (CC) on these energy systems. Despite this attractive solution, an in-depth study along with a robust optimization of this system has not yet been carried out. Hence, in this paper, a typical mGT with exhaust gas recirculation has been coupled with an amine-based CC plant and simulated using the software aspenplus. A rigorous rate-based simulation of the CO2 absorption and desorption in the CC unit offers an accurate prediction; however, its time complexity and convergence difficulty are severe limitations for a stochastic optimization. Therefore, a surrogate-based optimization approach has been used, which makes use of a Gaussian process regression (GPR) model, trained using the aspenplus data, to quickly find operating points of the plant at a very low computational cost. Using the validated surrogate model, a stochastic optimization has been carried out. As a general result, the analyzed power plant proves to be intrinsically very robust, even when the input variables are affected by strong uncertainties.
Optimal Cooling Channel Layout in a Hot Enclosure Subject to Natural Convection
Authors: Yang Sam , Ordonez Juan C.
Published: September 2019

We analyzed the optimal cooling channel layouts emerged from minimizing the total entropy generation ST and mean enclosure temperature T¯ in a hot enclosure subject to natural convection. The conservation of mass, momentum, and energy were solved numerically in two-dimensional (2D) space using the finite element method, and an ant colony optimization algorithm was employed to determine the optimal layouts with respect to the number of cooling channels (N) and Rayleigh number (Ra). The total allocatable cooling channel area was fixed in all cases and thus each channel area decreased with increasing N. Subsequently, we examined the heat transfer and flow characteristics based on temperature field, streamlines, and local Bejan number of each optimum and deduced the following: (1) All optimal channel layouts were symmetric about the vertical enclosure centerline; however, the optima resulting in ST,min and T¯min did not always coincide and depended heavily on the flow configuration dictated by N and Ra; (2) the competing nature between heat transfer and its irreversibility was pronounced at low Ra and N when convection and fluid friction were ineffective; and (3) the first and second law performance improved as N increased in most cases. Furthermore, results verified the global convergence and robustness of the ant colony optimization approach in solving a layout optimization problem with pure natural convection.
Promising Neutron Irradiation Applications at the High Temperature Engineering Test Reactor
Authors: Ho Hai Quan , Honda Yuki , Hamamoto Shimpei , Ishii Toshiaki , Takada Shoji , Fujimoto Nozomu , Ishitsuka Etsuo
Published: September 2019

The high temperature gas-cooled reactor (HTGR) has advantages for irradiation applications such as large space available for irradiation at reflector region and high thermal neutron spectrum with the graphite moderator. High temperature engineering test reactor (HTTR), a prismatic type of the HTGR, has been constructed to establish and upgrade the basic technologies for the HTGRs. Many irradiation regions are reserved in the HTTR to be served as a potential tool for an irradiation test reactor in order to promote innovative basic researches such as materials, fusion reactor technology, and radiation chemistry. This study shows the overview of some possible irradiation applications at the HTTRs including neutron transmutation doping silicon (NTD-Si) and Iodine-125 (125I) productions. The HTTR has possibility to produce about 40 tons of doped Si-particles per year for fabrication of spherical silicon solar cell. Besides, the HTTR could also produce about 1.8 × 105 GBq/yr of 125I isotope, comparing to 3.0 × 103 GBq of total 125I supplied in Japan in 2016.
Research on the Conversion Relationship for Three-Point Bending Specimen With Fixed Constraints in the Large Deformation Stage
Authors: Yu Hai-Yang , Zhou Guo-Yan , Zhuang Fa-Kun
Published: September 2019

In this study, based on the rod tensile model, a conversion relationship between three-point bending specimen with fixed constraints (TPBSF) and uniaxial creep data in the large deformation stage is defined by the reference stress method. Using finite element method, conversion coefficients are determined. Then it is verified by the creep test data of A7N01 at 350 °C (Zhuang, F. K., 2014, “Research on Creep Test Method of Small Specimen Based on Beam Bending Theory,” Ph.D. thesis, East China University of Science and Technology, Shanghai, China). The results show that creep stress exponent n is the same, but creep constant B obtained by rod tensile model is much closer to uniaxial creep than beam bending model. Finally, effects of geometric parameters and friction on conversion coefficients are investigated. On this basis, the specimen cross section aspect ratio greater than 1 and the indenter radius larger than 1 mm are recommended to minimize the influence of TPBSF geometric parameters on conversion coefficients. The influence of friction on conversion coefficients can be negligible.
Effect of Sidewall Conductance on Nusselt Number for Rayleigh-Bénard Convection: A Semi-Analytical and Experimental Correction
Authors: Madanan U. , Goldstein R. J.
Published: September 2019

The effect of sidewall conductance on Nusselt number for the Rayleigh-Bénard convection is examined by performing nearly identical sets of experiments with sidewalls made of three different materials. These experimental results are utilized to extrapolate and estimate the Nusselt number for an ideal zero-thermal-conductivity sidewall case, which is the case when the sidewalls are perfectly insulating. A semi-analytical model is proposed, based on the concept of extended surfaces, to compute the discrepancy in Nusselt number caused by the presence of finite thermal conductance of the sidewalls. The predictions obtained using this model are found to be in good agreement with the corresponding experimentally determined values.
A New Structural Bump Foil Model With Application From Start-Up to Full Operating Conditions
Authors: Arghir Mihai , Benchekroun Omar
Published: September 2019

This paper presents a new structural bump foil model that can handle all operating conditions from start-up to full speed. The model is based on a nonlinear contact algorithm with friction and gaps. The top foil is modeled as a curved beam while bump foil uses a coupled truss model. The model considers the gaps between the bump foil and the bearing casing, between the bump foil and the top foil and between the rotor and the top foil. Thus, any numerical interference between the rotor and the top foil is avoided. A mixed lubrication model is used for the thin film pressures. Following this algorithm, contact pressures appear if the film thickness is less than three times the equivalent roughness of the rotor and of the top foil. Fluid pressures are calculated from numerical solutions of Reynolds equation while contact pressures, if present, are calculated with the model of Greenwood and Williamson. The model is validated by comparisons with the experimental results obtained for start-up operating conditions of a first-generation foil bearing of 38.1 mm diameter with static loads of 10–50 N. Theoretical predictions of the start-up torque and takeoff speed compare well with experimental results. It is also shown how manufacturing bump height errors can explain the differences between theoretical and experimental predictions. Further validations are presented for the same bearing operating at high speeds (30, 45, and 55 krpm) and heavy static loads (up to 200 N). The calculated minimum film thickness and attitude angle are compared with experimental data from the literature.
Numerical Modeling of Nanofluid Thermal Conductivity: The Effect of Nanonetwork on Thermal Transport Behavior
Authors: Ma Binjian , Banerjee Debjoyti
Published: September 2019

Nanofluids have drawn increasing attention in heat transfer applications due to their anomalous enhancement of the thermophysical properties in contemporary literature. Various studies have shown that the addition of minute concentration of the nanoparticles to a base solvent can yield dramatic enhancement of the effective thermal conductivity. A number of parameters have been reported to affect the level of such enhancement such as size, shape, morphology, concentration, and material properties of the nanoparticles. Many different theoretical models have also been proposed in the past literature for predicting the thermal conductivity of nanofluids under different conditions. In general, these models are based on either simplified static composite model or nanoconvection effect considering the Brownian motion of the nanoparticles. However, a few studies have explored the impact of nanoparticle aggregation on the nanofluid thermal conductivity. In particular, the formation of porous percolation structure by the nanoparticles can alter the effective thermal conductivity of nanofluid substantially. In this study, a two-stage numerical simulation is performed to analyze the thermal transport behavior inside nanofluid considering different levels of percolation network formed by the nanoparticles. Based on the simulation results, an empirical model is developed to predict the effective thermal conductivity of nanofluid as a function of nanoparticle size, concentration, and the permeability of nano-aggregation. The results demonstrated a strong dependence of nanofluid thermal conductivity on the nanocluster density, where a looser nanonetwork can yield a significantly higher level of thermal conductivity enhancement under the same particle size and concentration conditions.
Assessing the Sensitivity of Stall-Regulated Wind Turbine Power to Blade Design Using High-Fidelity Computational Fluid Dynamics
Authors: Sanvito Andrea G. , Persico Giacomo , Campobasso M. Sergio
Published: September 2019

This study provides a novel contribution toward the establishment of a new high-fidelity simulation-based design methodology for stall-regulated horizontal axis wind turbines. The aerodynamic design of these machines is complex, due to the difficulty of reliably predicting stall onset and poststall characteristics. Low-fidelity design methods, widely used in industry, are computationally efficient, but are often affected by significant uncertainty. Conversely, Navier–Stokes computational fluid dynamics (CFD) can reduce such uncertainty, resulting in lower development costs by reducing the need of field testing of designs not fit for purpose. Here, the compressible CFD research code COSA is used to assess the performance of two alternative designs of a 13-m stall-regulated rotor over a wide range of operating conditions. Validation of the numerical methodology is based on thorough comparisons of novel simulations and measured data of the National Renewable Energy Laboratory (NREL) phase VI turbine rotor, and one of the two industrial rotor designs. An excellent agreement is found in all cases. All simulations of the two industrial rotors are time-dependent, to capture the unsteadiness associated with stall which occurs at most wind speeds. The two designs are cross-compared, with emphasis on the different stall patterns resulting from particular design choices. The key novelty of this work is the CFD-based assessment of the correlation among turbine power, blade aerodynamics, and blade design variables (airfoil geometry, blade planform, and twist) over most operational wind speeds.
Application of a Graded Approach to Support the National Research Universal Reactor U-2 Experimental Loop Return to Service
Authors: Karam M.
Published: September 2019

The National Research Universal (NRU) reactor at Canadian Nuclear Laboratories (CNL) operated safely for over 60 years and supported a wide range of applications including, testing of fuels and materials under typical power reactor conditions in two experimental loops (U-1 and U-2). Both experimental loops had been taken out of service to address seismic deficiencies. CNL applied a graded approach to successfully return one of these loops, the U-2 Loop to service. The graded approach, without compromising safety, applied a risk informed methodology commensurate to the potential risk posed by the operation of the U-2 Loop. The work enabled the U-2 Loop to resume operation until the NRU reactor was permanently shut down in Mar. 31, 2018, generating valuable data that will be used in the development of advanced nuclear fuels and materials. This paper describes the graded approach employed by CNL that supported U-2 loop return to service (RTS). The use of graded approach is articulated to support development of safety and licensing cases for small modular reactor projects.
Heat Loss Characteristics of Pipe Flange Joints: Experiments and Simulations
Authors: Zheng Xiaotao , Zhang Xiaohai , Gao Jiuyang , Ma Linwei , Wang Wei , Xu Jianmin , Yu Jiuyang
Published: September 2019

Sealing performance and heat loss are important factors for pipe flange joints (PFJs) subjected to medium or high temperatures. Heat loss is of great interest in practical engineering for uninsulated PFJs. Since an insulation layer may degrade the sealing performance of PFJs, heat loss of PFJs was tested and simulated considering various ambient temperatures of −10 °C, 0 °C, 10 °C, 20 °C, 30 °C, and 40 °C, with wind speeds of 0 m/s and 3 m/s and flange joint target temperatures of 200 °C, 300 °C, and 400 °C. It is worth noting that the experiments were performed during summer for high ambient temperatures and during winter for low ambient temperatures. As expected, the steady temperature slightly increases with the increase of external ambient temperature. For the same flange joint temperature, a 3 m/s wind speed decreases significantly the steady temperature, especially when the higher target temperature is applied. If the external wind speed is 3 m/s and the flange joint target temperatures are 200 °C, 300 °C, and 400 °C, respectively, the heat loss increases by approximately 38.4%, 30.7% and 23.6% when the ambient temperature changes from 30 °C to 10 °C. Moreover, the simulated temperatures agree well with the tested temperatures in most cases, and the average error is approximately 8%. The energy saving efficiency under the windless condition is approximately on average 26% higher than that with a wind speed of 3 m/s.
Discussion: “Consideration of a Stress-Based Criterion for Local Failure and Its Implementation in a Damage Mechanics Model” (Nakamura, H., 2019, ASME J. Pressure Vessel Technol., 141(4), p. 041405)
Authors: Hojo Kiminobu
Published: September 2019

The present commentary concerns some doubtful results included in the discussed paper.
Biomimetic composites with enhanced toughening using silk-inspired triblock proteins and aligned nanocellulose reinforcements
Authors: Mohammadi Pezhman , Aranko A. Sesilja , Landowski Christopher P. , Ikkala Olli , Jaudzems Kristaps , Wagermaier Wolfgang , Linder Markus B.
Published: September 2019

Silk-like proteins produced in bacteria are used as adhesives for cellulose nanofibrils to make a new biological material.
Quantum Hall–based superconducting interference device
Authors: Seredinski Andrew , Draelos Anne W. , Arnault Ethan G. , Wei Ming-Tso , Li Hengming , Fleming Tate , Watanabe Kenji , Taniguchi Takashi , Amet François , Finkelstein Gleb
Published: September 2019

Pushing superconductivity to the edge: Physicists make a SQUID using quantum Hall edge states.
Optical generation of high carrier densities in 2D semiconductor heterobilayers
Authors: Wang Jue , Ardelean Jenny , Bai Yusong , Steinhoff Alexander , Florian Matthias , Jahnke Frank , Xu Xiaodong , Kira Mackillo , Hone James , Zhu X.-Y.
Published: September 2019

We realize Mott transition from interlayer exciton to charge-separated electron/hole plasmas in 2D WSe
2
/MoSe
2
heterobilayers.
Unfolding adsorption on metal nanoparticles: Connecting stability with catalysis
Authors: Dean James , Taylor Michael G. , Mpourmpakis Giannis
Published: September 2019

Simple and powerful physics-based adsorption model on nanoparticles is developed using statistics, DFT, and tabulated properties.
RIG-I activation is critical for responsiveness to checkpoint blockade
Authors: Heidegger Simon , Wintges Alexander , Stritzke Florian , Bek Sarah , Steiger Katja , Koenig Paul-Albert , Göttert Sascha , Engleitner Thomas , Öllinger Rupert , Nedelko Tatiana , Fischer Julius C. , Makarov Vladimir , Winter Christof , Rad Roland , van den Brink Marcel R.M. , Ruland Jürgen , Bassermann Florian , Chan Timothy A. , Haas Tobias , Poeck Hendrik
Published: September 2019

Aberrant tumor-intrinsic RIG-I signaling is a crucial mechanism underlying cancer resistance to anti–CTLA-4 immunotherapy.
Jo1-antisynthetase syndrome and severe interstitial lung disease with organising pneumonia on histopathology with favourable outcome on early combined treatment with corticosteroids, mycophenolate mofetil and rituximab
Authors: Rüegg Christine A , Maurer Britta , Laube Irène , Scholtze Dieter
Published: September 2019

Antisynthetase syndrome is a rare autoimmune disease and represents a distinct entity within the idiopathic inflammatory myopathies. Its variable systemic manifestations are composed of myositis, interstitial lung disease, non-erosive arthritis, fever, Raynaud’s phenomenon, hyperkeratotic skin changes and the presence of antibodies against aminoacyl-transfer-RNA-synthetases. Interstitial lung disease is the major determinant of morbidity and mortality. The role of lung biopsy remains controversial but it might be considered on an individual basis and may provide information regarding prognosis and treatment response. An integrated clinical, radiological and pathological approach to interstitial lung disease has to be emphasised. Due to the rarity of the disease, no standardised treatment guidelines for antisynthetase syndrome exist. We discuss a patient with anti-Jo1-autoantibody antisynthetase syndrome with proximal myositis and severe, rapid onset, interstitial lung disease with a histopathological pattern of organising pneumonia on surgical lung biopsy and good response to early combined immunosuppressive treatment with corticosteroids, mycophenolate mofetil and rituximab.
ICON PART-T 2019–International Scientific Tendinopathy Symposium Consensus: recommended standards for reporting participant characteristics in tendinopathy research (PART-T)
Authors: Rio Ebonie Kendra , Mc Auliffe Sean , Kuipers Irene , Girdwood Michael , Alfredson Hakan , Bahr Roald , Cook Jill L , Coombes Brooke , Fu Siu Ngor , Grimaldi Alison , de Vos Robert-Jan , Lewis Jeremy S , Maffulli Nicola , Malliaras Peter , Magnusson S P , Oei Edwin H G , Purdam Craig Robert , Rees Jonathan D , Scott Alex , Gravare Silbernagel Karin , Speed Cathy , Akker-Scheek Inge van den , Vicenzino Bill T , Weir Adam , Wolf Jennifer Moriatis , Zwerver Johannes
Published: September 2019

We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the International Scientific Tendon Symposium, Groningen 2018. We reviewed 263 papers to form statements for consensus and invited 30 HCPs from different disciplines and geographical locations; 28 completed the survey and 15 attended the meeting. There was consensus that the following data should be reported for cases and controls: sex, age, standing height, body mass, history of tendinopathy, whether imaging was used to confirm pathology, loading tests, pain location, symptom duration and severity, level of disability, comorbidities, physical activity level, recruitment source and strategies, and medication use history. Standardised reporting of participant characteristics aims to benefit patients and clinicians by guiding researchers in the conduct of their studies. We provide free resources to facilitate researchers adopting our recommendations.
Intergenerational transfer of health inequalities: exploration of mechanisms in the Birth to Twenty cohort in South Africa
Authors: von Fintel Dieter , Richter Linda
Published: September 2019

South Africa’s history of colonialism andApartheidcontributed to its extreme levels of inequality. Twenty-five years after the transition to democracy, socio-economic and health inequalities continue to rank among the highest in the world. The Birth to Twenty+ study follows a cohort born in urban Johannesburg in 1990 through their early lives and into young adulthood. Also known as ‘Mandela’s Children’, these ‘children of the ‘90s’ were the first generation to be raised in a democratic society, whose elected government implemented policies to achieve greater socio-economic and health equality. Correlating early life outcomes to those of their parents provides a baseline estimate of intergenerational transmission of historical inequality. Analyses of their early life course indicates the potential breakdown in inequality in the first generation. This paper provides an overview of empirical results on intergenerational change in socio-economic status and health during South Africa’s political transition. Access to infrastructural services improved, and poverty reduced following the rapid expansion of unconditional cash transfers mainly to children and pensioners. However, unemployment remained high and job discrimination continued. Inequalities in health follow similar patterns, and progress did not equate to convergence. Some catch-up physical growth occurred—both across groups and over time—but not sufficient to bridge cognitive inequalities. Socio-economic and health inequalities continued as the children of the ‘90s reached young adulthood. Based on knowledge of other transitions, it is likely that these inequalities will only start to break down in later generations, provided social and economic progress holds steady.
Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact
Authors: Herrod Philip J J , Adiamah Alfred , Boyd-Carson Hannah , Daliya Prita , El-Sharkawy Ahmed M , Sarmah Panchali B , Hossain Tanvir , Couch Jennifer , Sian Tanvir S , Wragg Andrew , Andrew David R , Parsons Simon L , Lobo Dileep N
Published: September 2019

Objectives

To quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy.

Design

This questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations. Emotions were also quantified on a 5-point Likert scale.

Setting

Five NHS Hospital Trusts in the East Midlands region of England.

Participants

We identified 796 participants who had their elective operations cancelled between 1 November 2017 and 31 March 2018 and received responses from 339 (43%) participants.

Interventions

Participants were posted a modified version of a validated quality of life questionnaire with a prepaid return envelope.

Main outcome measures

The primary outcome measures were the financial and psychological impact of the cancellation of elective surgery on patients and their families.

Results

Of the 339 respondents, 163 (48%) were aged <65 years, with 111 (68%) being in employment. Sixty-six (19%) participants had their operations cancelled on the day. Only 69 (62%) of working adults were able to return to work during the time scheduled for their operation, with a mean loss of 5 working days (SD 10). Additional working days were lost subsequently by 60 (54%) participants (mean 7 days (SD 10)). Family members of 111 (33%) participants required additional time off work (mean 5 days (SD 7)). Over 30% of participants reported extreme levels of sadness, disappointment, anger, frustration and stress. At least moderate concern about continued symptoms was reported by 234 (70%) participants, and 193 (59%) participants reported at least moderate concern about their deteriorating condition.

Conclusions

The cancellation of elective surgery during the winter had an adverse impact on patients and the economy, including days of work lost and health-related anxiety. We recommend better planning, and provision of more notice and better support to patients.
Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods
Authors: Amoakoh-Coleman Mary , Ansah Evelyn , Klipstein-Grobusch Kerstin , Arhinful Daniel
Published: September 2019

Objective

To assess the completeness of obstetric referral letters/notes at the district level of healthcare.

Design

An implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data.

Setting

Three (3) districts in the Greater Accra region of Ghana.

Participants

Pregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses.

Intervention

An enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms.

Outcome

Completeness of obstetric referral letters/notes.

Results

Proportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons.

Conclusions

Most obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.
Psychometric properties of the Arabic version of EPDS and BDI-II as a screening tool for antenatal depression: evidence from Qatar
Authors: Naja Sarah , Al-Kubaisi Noora , Chehab Mohamad , Al-Dahshan Ayman , Abuhashem Nada , Bougmiza Iheb
Published: September 2019

Objectives

The current study aimed to validate and determine the psychometric properties of the Arabic versions of the Beck Depression Inventory-II (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS) in Qatar.

Design

A cross-sectional study design was employed.

Setting

Antenatal care (ANC) clinics at nine primary healthcare centres.

Participants

Pregnant women (n=128) aged 15–46 years in different trimesters of pregnancy, attending the ANC clinics as well as capable of reading and writing in the Arabic language.

Results

A total of 128 participants were enrolled. On conducting the receiver operating characteristic (ROC) analysis, the EPDS showed a larger area under the curve at 0.951 than the BDI-II tool (0.912). Using Youden’s index, a score>13 on the EPDS (87% sensitivity, 90% speciﬁcity) and>19 on the BDI-II (96% sensitivity, 73% speciﬁcity) allowed for the greatest division between depressed and non-depressed participants.

Conclusion

To address the under-recognition of antenatal depression, physicians at primary healthcare centres in Qatar should be encouraged to utilise the EPDS to screen pregnant women seeking ANC services.
Patient and provider factors associated with enrolment in the pre-end-stage renal disease pay-for-performance programme in Taiwan: a cross-sectional study
Authors: Hu Hsiao-Yun , Jian Feng-Xuan , Lai Yun-ju , Yen Yung-Feng , Huang Nicole , Hwang Shang Jyh
Published: September 2019

Objective

The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan have been ranked the highest worldwide. Therefore, the National Health Insurance Administration has implemented the pre-ESRD pay-for-performance (P4P) programme since November 2006, which had significantly reduced the incidence of dialysis and all-cause mortality. This study aimed to identify the factors associated with the enrolment in the pre-ESRD P4P programme.

Design

Cross-sectional study.

Setting

The National Health Insurance research database 2007–2012 in Taiwan.

Participants

Patients with prevalent pre-ESRD aged more than 18 years between January 2007 and December 2012 were enrolled. Patient demographics and hospital characteristics between P4P and non-P4P groups were compared. A logistic regression model was used to analyse the factors associated with P4P enrolment, and a generalised estimating equation was used to verify the results.

Primary outcome measure

Enrolment in the pre-ESRD P4P programme.

Results

In total, 82 991 patients were enrolled in the programme, with a 45.6% participation rate. Patients who were males (adjusted OR (AOR)=0.89, 95% CI=0.86 to 0.91) and employed (AOR=0.95, 95% CI=0.92 to 0.97) had a significantly lower probability to be enrolled in the programme. Older patients (66–75 years old, AOR=1.23, 95% CI=1.14 to 1.33) and those with higher Charlson Comorbidities Index (CCI 5+, AOR=4.01, 95% CI=3.55 to 4.53) tended to be enrolled in the programme, while those in the 76+ years age group were not (AOR=1.03, 95% CI=0.95 to 1.13). Hospitals located in the central (AOR=1.48, 95% CI=1.05 to 2.08) and Kao-Ping regions (AOR=1.62, 95% CI=1.18 to 2.22) also tended to enrol patients in the pre-ESRD P4P programme. Enrolment rates increased over time.

Conclusion

Pre-ESRD patients of the female gender, greater age and more comorbidities were more likely to be enrolled in the pre-ESRD P4P programme. Healthcare providers and health authorities should focus attention on patients who are male, younger and with less comorbidities to improve the healthcare quality and equality for all pre-ESRD patients.
Rapid, proteomic urine assay for monitoring progressive organ disease in Fabry disease
Authors: Doykov Ivan D , Heywood Wendy E , Nikolaenko Valeria , Śpiewak Justyna , Hällqvist Jenny , Clayton Peter Theodore , Mills Philippa , Warnock David G , Nowak Albina , Mills Kevin
Published: September 2019

Background

Fabry disease is a progressive multisystemic disease, which affects the kidney and cardiovascular systems. Various treatments exist but decisions on how and when to treat are contentious. The current marker for monitoring treatment is plasma globotriaosylsphingosine (lyso-Gb3), but it is not informative about the underlying and developing disease pathology.

Methods

We have created a urine proteomic assay containing a panel of biomarkers designed to measure disease-related pathology which include the inflammatory system, lysosome, heart, kidney, endothelium and cardiovascular system. Using a targeted proteomic-based approach, a series of 40 proteins for organ systems affected in Fabry disease were multiplexed into a single 10 min multiple reaction monitoring Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) assay and using only 1 mL of urine.

Results

Six urinary proteins were elevated in the early-stage/asymptomatic Fabry group compared with controls including albumin, uromodulin, α1-antitrypsin, glycogen phosphorylase brain form, endothelial protein receptor C and intracellular adhesion molecule 1. Albumin demonstrated an increase in urine and could indicate presymptomatic disease. The only protein elevated in the early-stage/asymptomatic patients that continued to increase with progressive multiorgan involvement was glycogen phosphorylase brain form. Podocalyxin, fibroblast growth factor 23, cubulin and Alpha-1-Microglobulin/Bikunin Precursor (AMBP) were elevated only in disease groups involving kidney disease. Nephrin, a podocyte-specific protein, was elevated in all symptomatic groups. Prosaposin was increased in all symptomatic groups and showed greater specificity (p<0.025–0.0002) according to disease severity.

Conclusion

This work indicates that protein biomarkers could be helpful and used in conjunction with plasma lyso-Gb3 for monitoring of therapy or disease progression in patients with Fabry disease.
EULAR points to consider for the development, evaluation and implementation of mobile health applications aiding self-management in people living with rheumatic and musculoskeletal diseases
Authors: Najm Aurélie , Nikiphorou Elena , Kostine Marie , Richez Christophe , Pauling John D , Finckh Axel , Ritschl Valentin , Prior Yeliz , Balážová Petra , Stones Simon , Szekanecz Zoltan , Iagnocco Annamaria , Ramiro Sofia , Sivera Francisca , Dougados Maxime , Carmona Loreto , Burmester Gerd , Wiek Dieter , Gossec Laure , Berenbaum Francis
Published: September 2019

Background

Mobile health applications (apps) are available to enable people with rheumatic and musculoskeletal diseases (RMDs) to better self-manage their health. However, guidance on the development and evaluation of such apps is lacking.

Objectives

The objective of this EULAR task force was to establish points to consider (PtC) for the development, evaluation and implementation of apps for self-management of RMDs.

Methods

A systematic literature review of app content and development strategies was conducted, followed by patient focus group and an online survey. Based on this information and along with task force expert opinion, PtC were formulated in a face-to-face meeting by a multidisciplinary task force panel of experts, including two patient research partners. The level of agreement among the panel in regard to each PtC was established by anonymous online voting.

Results

Three overarching principles and 10 PtC were formulated. Three PtC are related to patient safety, considered as a critical issue by the panel. Three are related to relevance of the content and functionalities. The requirement for transparency around app development and funding sources, along with involvement of relevant health professionals, were also raised. Ease of app access across ages and abilities was highlighted, in addition to considering the cost benefit of apps from the outset. The level of agreement was from 8.8 to 9.9 out of 10.

Conclusion

These EULAR PtC provide guidance on important aspects that should be considered for the development, evaluation and implementation of existing and new apps.
Changes in asthma mortality in England and Wales since 2001
Authors: Shaw Dominick E , Gaynor Catherine M , Fogarty Andrew W
Published: September 2019

The number of deaths from asthma in England and Wales has not changed significantly over the last decade. This lack of improvement has received attention from both national asthma guidelines and the media. We examined asthma death data from the Office for National Statistics, stratified by age band. Every 5-year age band below the age of 80 years has seen a large reduction in mortality between 2001 and 2017, whereas numbers of asthma deaths have increased by 81% for people aged 80 years or above. This increase in older people dying from asthma requires explanation.
Big tobacco focuses on the facts to hide the truth: an algorithmic exploration of courtroom tropes and taboos
Authors: Risi Stephan , Proctor Robert N
Published: September 2019

Objective

To use methods from computational linguistics to identify differences in the rhetorical strategies deployed by defence versus plaintiffs’ lawyers in cigarette litigation.

Methods

From 318 closing arguments in 159 Engle progeny trials (2008–2016) archived in the Truth Tobacco Industry Documents, we calculated frequency scores and Mann-Whitney Rho scores of plaintiffs versus defence corpora to discover ‘tropes’ (terms used disproportionately by one side) and ‘taboos’ (terms scrupulously avoided by one side or the other).

Results

Defence attorneys seek to place the smoker on trial, using his or her friends and family members to demonstrate that he or she must have been fully aware of the harms caused by smoking. We show that ‘free choice,’ ‘common knowledge’ and ‘personal responsibility’ remain key strategies in cigarette litigation, but algorithmic analysis allows us to understand how such strategies can be deployed without actually using these expressions. Industry attorneys rarely mention personal responsibility, for example, but invoke that concept indirectly, by talking about ‘decisions’ made by the individual smoker and ‘risks’ they assumed.

Conclusions

Quantitative analysis can reveal heretofore hidden patterns in courtroom rhetoric, including the weaponisation of pronouns and the systematic avoidance of certain terms, such as ‘profits’ or ‘customer.’ While cigarette makers use words that focus on the individual smoker, attorneys for the plaintiffs refocus agency onto the industry. We show how even seemingly trivial parts of speech—like pronouns—along with references to family members or words like ‘truth’ and ‘facts’ have been weaponised for use in litigation.