bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Study of Flexible Skin Designs Between a Moving Wing Segment and a Fixed Wing Part on a Full Scale Demonstrator
Authors: Radestock Martin , Riemenschneider Johannes , Falken Alexander , Achleitner Johannes
Published: November 2020

Commercial aircraft today require efficient high-lift and control systems on the wings to reduce the drag in flight or decrease the take-off and landing speeds. Morphing mechanisms are one approach for improved high-lift systems. In most cases the objective function is an increased lift to drag ratio or the noise reduction. On closer examination control systems as well as morphing mechanisms are located in a certain wing segment. The transition between a moving wing part and the fixed wing is a step, which creates additional vortices. This segments the wing in span-wise direction and reduces the efficiency. A flexible skin between a moving and a fixed wing parts smooths the contour and minimize the efficiency reduction of the wing. A full scale demonstrator of a wing segment was manufactured with two flexible skin designs.

The first subcomponent connects a morphing leading edge with a rib of the wing over a span of one meter. The skin is a material mix of ethylene-propylene-diene monomer (EPDM) rubber and fiberglass-reinforced plastic. The rubber is the basis of the skin and the glass-fiber is added as local skin stiffeners in the form of strips in chord-wise direction. The second subcomponent blends the aileron with a rib of the wing in a triangular design. The connection of three different hinges realizes a morphing triangle, which is loaded in an in-plane shear only state of stress in each aileron position. The core of the triangle is a 3D printed structure, which is free in shear. The covering skin is a combination of EPDM with carbon fibers oriented in +/−30° direction to obtain shear compliance and to resist the loads on the triangle.

The deformation of each concept is identified at the demonstrator. Therefore, an optical measurement system scans the surface in the initial and deflected state. The required deformation precision of the concepts differs due to their design. The contour at the leading edge requires a certain shape over the span. The analysis of the skin buckling is one requirement at the transition triangle during the aileron motion.

The experimental results show a smooth transition contour at the leading edge and no buckling effects at the triangle. The results can be used for the validation of simulation models. Furthermore, both skin concepts cover the gap between a moving wing segment and a fixed wing part. The elimination of steps in span-wise direction can improve the aero-acoustic behavior along the wing for future aircraft.
Sensor-Data Reconstruction for Helicopter Structural-Health Monitoring Using Deep Learning
Authors: Harper Andrew D. , Breen Nick , Alvord David , Pendleton David , Hresko Teresa
Published: November 2020

Predictive Maintenance (PMx) methods leverage available heritage data, maintenance records, and vehicle information to forecast rotorcraft failure modes before they become a problem. The goal of PMx is to decrease cost and vehicle downtime while increasing availability. When the required data are incomplete or corrupted, the worst case (grossly conservative) scenario must be assumed and unnecessary costs are incurred. In this manuscript we propose data-science methods to identify and characterize regions of data corruption, and machine-learning (ML) techniques to address the problem of missing and corrupted tri-axial H-60 4G accelerometer data for PMx for a H-60 rotorcraft. Accurate 4G sensor readings are a critical component of helicopter flight regime recognition and flight damage assessment. In contrast to the traditional time-series prediction approach, which commonly use recurrent or long short-term memory (LSTM) networks, our proposed methods use a simpler deep neural network (DNN) to reconstruct the 4G accelerometer signal independently at every time instant. We demonstrate that the DNN approach is a viable option for sensor reconstruction independent of the length of period the sensor malfunctions.
Design of Morphing Strips Using SMA Actuators Under Partial Phase Transformation Operation
Authors: Karakalas Anargyros A. , Machairas Theodoros T. , Lagoudas Dimitris C. , Saravanos Dimitris A.
Published: November 2020

Novel morphing structures show high potential in various engineering applications where shape adaptivity is deemed essential to achieve the optimum functionality under a wide range of operational conditions. Shape memory alloys have been selected as the main actuation elements in a large number of research projects. However, the successful design and realization of a morphing concept is highly dependent on the accuracy of the available modeling tools that provide essential information on the response of both the actuator itself and the whole structure. To this end, a three dimensional, thermodynamically consistent constitutive model that has been recently extended with a modified hardening function to account for partial transformation behavior is adopted to simulate SMA response. The design of a morphing strip system with a SMA ribbon actuator is presented and discussed, while its response is predicted when the effect of partial transformation is taken into account or omitted.
Design and Analysis of a Modular VTOL Drone With Bat-Inspired Wings
Authors: Anachkova Maja , Stankoski Marko , Berberu Mihael , Atanasov Aleksandar , Janevski Jane , Jovanova Jovana
Published: November 2020

The future of technology lies in the diverse characteristics and capabilities of autonomous machines and devices and their application in many technical challenge. Rapid technology development, market globalization and availability of affordable electronics and controllers, have recently resulted in increased scientific and technical interest in drones as autonomous solutions for professional, as well as, amateur applications. On the other hand, researchers have been improving how manmade machines move through air by attempting to replicate animals motion by mimicking their aerial abilities.

In this paper, we propose a development of a bio-inspired modular drone concept motivated by the bats agility, wingspan and wings folding into various shapes. The drone can be tailored for different applications, from sea port mapping, surveying, tank inspection and port traffic control to pollution monitoring and detection of illegal activities. The aerial performances of the drone allow it to be able to conduct windmills monitoring by connecting to their local monitoring units and send alerts to officials in real-time. This small bat-inspired drone is proposed to have an ability of performing flights with precisely defined trajectories. The accent will be put on the interchangeable wings, analysis of their dynamic attributes and transformation possibilities as a crucial segment of the overall drone performance. The design and fabrication process and the flight characteristics of the various wing configurations of the drone are discussed in details. Limitations of the drone, proposed solutions for further development and recommendations are also presented.
System Design and Implementation of a Transient-Motion-Powered IoT Sensor Node
Authors: Li Xin , Tang Hong , Liang Junrui
Published: November 2020

In this paper, we introduce ViPSN-E: a transient-motion-powered IoT sensor node. It carries out motion detection and wireless communication by making good use of the energy harvested from an instantaneous motion. In our design, a piezo-magneto-elastic structure, which is composed of a low-cost piezoelectric cantilever and a pair of magnets, is used to induce a plucking excitation and power generation under a transient and one-way movement. An energy management circuit, which is composed of a self-powered synchronized switch harvesting on inductor (SP-SSHI) interface circuit and a voltage regulator is utilized for efficient energy conversion. Through the sophisticated collaboration between mechatronic design and computer program, the motion information can also be identified and sent out by a wireless communication module. The cyber-electromechanical synergy among mechanical dynamics, power conditioning circuit, and the low-power embedded system is emphasized towards the successful implementation of such a motion-powered IoT device. The prototyped ViPSN-E has done a good job by making good use of the energy associated with each transient plucking motion. With only one plucking excitation, the system can realize motion detection and several rounds of wire-less transmission. The study on ViPSN-E provides valuable guidance towards the self-powered ubiquitous motion-sensing systems.
Sleep Hygiene and Light Exposure Can Improve Performance Following Long-Haul Air Travel
Authors: Fowler Peter M. , Knez Wade , Thornton Heidi R. , Sargent Charli , Mendham Amy E. , Crowcroft Stephen , Miller Joanna , Halson Shona , Duffield Rob
Published: November 2020

Purpose: To assess the efficacy of a combined light exposure and sleep hygiene intervention to improve team-sport performance following eastward long-haul transmeridian travel. Methods: Twenty physically trained males underwent testing at 09:00 and 17:00 hours local time on 4 consecutive days at home (baseline) and the first 4 days following 21 hours of air travel east across 8 time zones. In a randomized, matched-pairs design, participants traveled with (INT; n = 10) or without (CON; n = 10) a light exposure and sleep hygiene intervention. Performance was assessed via countermovement jump, 20-m sprint, T test, and Yo-Yo Intermittent Recovery Level 1 tests, together with perceptual measures of jet lag, fatigue, mood, and motivation. Sleep was measured using wrist activity monitors in conjunction with self-report diaries. Results: Magnitude-based inference and standardized effect-size analysis indicated there was a very likely improvement in the mean change in countermovement jump peak power (effect size 1.10, ±0.55), and likely improvement in 5-m (0.54, ±0.67) and 20-m (0.74, ±0.71) sprint time in INT compared with CON across the 4 days posttravel. Sleep duration was most likely greater in INT both during travel (1.61, ±0.82) and across the 4 nights following travel (1.28, ±0.58) compared with CON. Finally, perceived mood and motivation were likely worse (0.73, ±0.88 and 0.63, ±0.87) across the 4 days posttravel in CON compared with INT. Conclusions: Combined light exposure and sleep hygiene improved speed and power but not intermittent-sprint performance up to 96 hours following long-haul transmeridian travel. The reduction of sleep disruption during and following travel is a likely contributor to improved performance.
Burkholderia pseudomallei Clinical Isolates Are Highly Susceptible
In Vitro
to Cefiderocol, a Siderophore Cephalosporin
Authors: Burnard Delaney , Robertson Gemma , Henderson Andrew , Falconer Caitlin , Bauer Michelle J. , Cottrell Kyra , Gassiep Ian , Norton Robert , Paterson David L. , Harris Patrick N. A.
Published: November 2020

Cefiderocol is a cephalosporin designed to treat multidrug-resistant Gram-negative infections. By forming a chelated complex with ferric iron, cefiderocol is transported into the periplasmic space via bacterial iron transport systems and primarily binds to penicillin-binding protein 3 (PBP3) to inhibit peptidoglycan synthesis. This mode of action results in cefiderocol having greater
in vitro
activity against many Gram-negative bacilli than currently used carbapenems, β-lactam/β-lactamase inhibitor combinations, and cephalosporins.
Dissimilatory Nitrate Reduction to Ammonium (DNRA) and Denitrification Pathways Are Leveraged by Cyclic AMP Receptor Protein (CRP) Paralogues Based on Electron Donor/Acceptor Limitation in Shewanella loihica PV-4
Authors: Liu Shuangyuan , Dai Jingcheng , Wei Hehong , Li Shuyang , Wang Pei , Zhu Tongbin , Zhou Jizhong , Qiu Dongru
Published: November 2020

Some microbes utilize different dissimilatory nitrate reduction (DNR) pathways, including DNR to ammonia (DNRA) and denitrification pathways, for anaerobic respiration in response to ambient carbon/nitrogen ratio changes. Large-scale industrial nitrogen fixation and fertilizer application raise the concern of emission of N
2
O, a stable gas with potent global warming potential, as consequence of microbial respiration, thereby aggravating global warming and climate change. However, little is known about the molecular mechanism underlying the choice of two competing DNR pathways. We demonstrate that the global regulator CRP1, which is widely encoded in bacteria, is required for DNRA in
S. loihica
PV-4 strain, while the CRP2 paralogue is required for transcription of the nitrite reductase gene
nirK
for denitrification. Sufficient carbon source lead to the predominance of DNRA, while carbon source/electron donor deficiency may result in an incomplete denitrification process, raising the concern of high levels of N
2
O emission from nitrate-rich and carbon source-poor waters and soils.
Identification of an Antiretroviral Small Molecule That Appears To Be a Host-Targeting Inhibitor of HIV-1 Assembly
Authors: Reed Jonathan C. , Solas Dennis , Kitaygorodskyy Anatoliy , Freeman Beverly , Ressler Dylan T. B. , Phuong Daryl J. , Swain J. Victor , Matlack Kent , Hurt Clarence R. , Lingappa Vishwanath R. , Lingappa Jaisri R.
Published: November 2020

The success of antiretroviral treatment for HIV-1 is at risk of being undermined by the growing problem of drug resistance. Thus, there is a need to identify antiretrovirals that act on viral life cycle stages not targeted by drugs in use, such as the events of HIV-1 Gag assembly. To address this gap, we developed a compound screen that recapitulates the intracellular events of HIV-1 assembly, including virus-host interactions that promote assembly. This effort led to the identification of a new chemotype that inhibits HIV-1 replication at nanomolar concentrations, likely by acting on assembly. This compound colocalized with Gag and two host enzymes that facilitate capsid assembly. However, resistance selection did not result in compound-specific mutations in
gag
, suggesting that the chemotype does not directly target Gag. We hypothesize that this chemotype represents a first-in-class inhibitor of virus production that acts by targeting a virus-host complex important for HIV-1 Gag assembly.
Supplemental Material: The convexity of carbonate hilltops: 36Cl constraints on denudation and chemical weathering rates and implications for hillslope curvature
Authors: Ben-Asher Matan
Published: November 2020

Figure S1: 36Cl denudation rates vs. mean annual rainfall of samples categorized by hillslope position and samples types; Figure S2: fd and CDF vs. mean annual rainfall, derived from immobile elements; Figure S3: Values of soil creep efficiency (K) vs. mean annual rainfall, estimated from numerical modelling and steady state, table with coordinates of study sites location; Figure S4: Photographs of hard dolo-limestone and soft chalk rocks; Figure S5: Mean hillslopes slope vs. mean relief.
Extracavitary primary effusion lymphoma recurring with syphilis in an HIV-infected patient
Authors: Sohail Ahmed Darakhshan , Poliquin Marc , Julien Louis-André , Routy Jean-Pierre
Published: November 2020

A 59-year-old Caucasian man infected with HIV, in remission from human herpes virus-8-positive extracavitary primary effusion lymphoma (EC-PEL), presented to a sexual health clinic with fever and rectal pain 10 weeks after a single episode of receptive anal sexual intercourse with another man. He was initially treated for a presumptive diagnosis of lymphogranuloma venereum proctitis, then for syphilis on positive serology. Rectosigmoidoscopy revealed a single ulcerated rectal mass; endoscopic biopsies confirmed the recurrence of EC-PEL. The patient received chemotherapy and went into remission. This is the first reported case of EC-PEL occurring synchronously with early syphilis, and specifically at the site of inoculation, which can be a major diagnostic challenge since both conditions may present with lymphadenopathy, mucosal involvement and constitutional symptoms. We reviewed the literature for similar cases and hypothesised that syphilis may have triggered the recurrence of this rare lymphoma.
Effect of a financial incentive (shopping point) on increasing the number of daily walking steps among community-dwelling adults in Japan: a randomised controlled trial
Authors: Tanji Fumiya , Tomata Yasutake , Abe Saho , Matsuyama Sanae , Kotaki Yumika , Nurrika Dieta , Matsumoto Koichi , Liu Yingxu , Zhang Shu , Lu Yukai , Sugawara Yumi , Bando Shino , Yamazaki Teiichiro , Otsuka Tatsui , Sone Toshimasa , Tsuji Ichiro
Published: November 2020

Objective

The aim of this study was to investigate the effect of a financial incentive on the number of daily walking steps among community-dwelling adults in Japan.

Study design

Two-arm, parallel-group randomised controlled trial.

Setting/participants

We recruited physically inactive community-dwelling adults from Sendai city, Japan. Eligible participants were randomly allocated to an intervention or a wait list control group. Pedometers were used to assess the mean number of daily steps in three periods: baseline (weeks 1–3), intervention (weeks 4–6) and follow-up (weeks 7–9).

Intervention

The intervention group was offered a financial incentive (shopping points) to meet the target number of increased daily steps in the intervention period.

Main outcome measures

The primary outcome was an increase in the mean number of daily steps in the intervention and follow-up periods compared with baseline.

Results

Seventy-two participants (69.4% women; mean age, 61.2±16.2 years; mean number of daily steps at baseline, 6364±2804) were randomised to the intervention (n=36) and control groups (n=36). During the intervention period, the increase in mean daily steps was significantly higher in the intervention group (1650, 95% CI=1182 to 2119) than in the control group (514, 95% CI=136 to 891; p<0.001). However, the difference between groups was not significant at follow-up after the incentives were removed (p=0.311). In addition, compared with controls, a significantly higher proportion of participants in the intervention group showed an increase in mean daily steps of ≥1000 (69.4% vs 30.6%, respectively; OR=5.17, 95% CI=1.89 to 14.08). There were no adverse effects from the intervention.

Conclusions

The present results suggest that financial incentives are effective in promoting short-term increases in physical activity.

Trial registration number

UMIN000033276.
Adaptions to the National Diabetes Prevention Programme lifestyle change curriculum by Hawai‘i Federally Qualified Health Centers: a qualitative descriptive study
Authors: Stupplebeen David , Pirkle Catherine , Domingo Jermy-Leigh , Nett Blythe , Sentell Tetine , Keliikoa L Brooke
Published: November 2020

Objective

The objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for Federally Qualified Health Center (FQHC) patients in Hawaiʻi, an ethnically diverse state with a high proportion of Native Hawaiians and Pacific Islanders (NHPI).

Research design and methods

We used a qualitative descriptive approach. First, we conducted a document review of existing programmatic notes and materials followed by video interview calls with 13 lifestyle coaches at 7 FQHCs implementing in-person LCPs. Lifestyle coaches catalogued, described and explained the rationale for adaptations. The research team counted adaptations if they met a specific adaptation definition derived from several sources. Community and cultural relevancy of adaptations were analysed using an existing framework for weight loss and diabetes prevention for NHPIs.

Results

The average number of adaptations per FQHC was 8.61 (range: 4–16). Adaptations fell into 11 broad categories such as off-site community field trips, food-related and nutrition-related activities, and physical activity opportunities. Novel adaptations included goal setting with motivational interviewing and dyadic recruitment. Field trips and in-class food demonstrations addressed the most constructs related to weight loss and diabetes prevention for NHPI, including social and community barriers, familial barriers and barriers to self-efficacy.

Conclusions

Lifestyle coaches were culturally attuned to the needs of LCP participants, particularly from NHPI communities. Policy-makers should recognise the extra work that LCP coaches do in order to increase enrollment and retention in these types of programmes.
Intensive care units follow-up: a scoping review protocol
Authors: Prevedello Danielle , Fiore Marco , Creteur Jacques , Preiser J C
Published: November 2020

Introduction

Increasing numbers of patients are surviving critical illness, leading to growing concern about the potential impact of the long-term consequences of intensive care on patients, families and society as a whole. These long-term effects are together known as postintensive care syndrome and their presence can be evaluated at intensive care unit (ICU) follow-up consultations. However, the services provided by these consultations vary across hospitals and units, in part because there is no validated standard model to evaluate patients and their quality of life after ICU discharge. We describe a protocol for a scoping review focusing on models of ICU follow-up and the impact of such strategies on improving patient quality of life.

Methods and analysis

In this scoping review, we will search the literature systematically using electronic databases (MEDLINE - from database inception to June 15th 2020) and a grey literature search. We will involve stakeholders as recommended by the Joanna Briggs Institute approach developed by Peterset al. The research will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

Ethics and dissemination

This study does not require ethics approval, because data will be obtained through a review of published primary studies. The results of our evaluation will be published in a peer-reviewed journal and will also be disseminated through presentations at national and international conferences.
Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study
Authors: George Mala , Dinant Geert-Jan , Kentiba Efrem , Teshome Teklu , Teshome Abinet , Tsegaye Behailu , Spigt Mark
Published: November 2020

Objectives

To evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.

Design

A cross-sectional study.

Setting

Two public referral hospitals in Tigray, Ethiopia.

Participants

A total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.

Primary and secondary outcome measures

A total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.

Results

The strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.

Conclusions

Our finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.
Assessing the safety and feasibility of neoadjuvant hormone and radiation therapy followed by robot-assisted radical prostatectomy for treating locally advanced prostate cancer: protocol for an open-label, dose-escalation, single-centre, phase I clinical trial
Authors: Xiao Yu-Tian , Zhao Xianzhi , Chang Yifan , Lu Xiaojun , Wang Ye , Zhang Huojun , Ren Shancheng
Published: November 2020

Introduction

Patients with locally advanced prostate cancer are at high risk of recurrence after definitive treatment. There are emerging data that radical prostatectomy can delay the progression of castration resistance and potentially prolong survival. Neoadjuvant radiation therapy improves local control and has shown survival benefit with favourable toxicity profiles in several other malignancies. We have designed this trial to investigate whether this combination, which theoretically maximises local control, is a safe and feasible approach for treating locally advanced prostate cancer.

Methods and analysis

This study is a phase I, open-label study to investigate the safety and feasibility of neoadjuvant hormone and radiation therapy followed by robot-assisted radical prostatectomy by a traditional 3+3 dose-escalation design with four planned radiation dose levels (39.6 Gy/22F, 45 Gy/25F, 50.4 Gy/28F and 54 Gy/30F). Locally advanced prostate cancer patients with positive pelvic and/or retroperitoneal lymph nodes will be recruited. The primary objective is to determine the adverse events and maximal tolerable dose (MTD) of neoadjuvant radiotherapy. Toxicity will be assessed using the National Cancer Institute Common Toxicity Criteria V.5.0.

Ethics and dissemination

This protocol was approved by the Institutional Review Board of Shanghai Changhai Hospital (ref. CHEC2019-070 and CHEC2019-082). The study will be performed in compliance with applicable local legislation and in accordance with the ethical principles developed by the World Medical Association in the Declaration of Helsinki 2013. Study results will be disseminated through conferences and peer-reviewed scientific journals.

Trial registration numbers

ChiCTR1900022716; ChiCTR1900022754.
Socioethnic disparities in severe maternal morbidity in Western Australia: a statewide retrospective cohort study
Authors: Adane Akilew A , Farrant Brad M , Marriott Rhonda , White Scott W , Bailey Helen D , Shepherd Carrington C J
Published: November 2020

Objectives

To assess the scale of ethnic inequalities in severe maternal morbidity (SMM) rates and quantify the contribution of maternal characteristics to these disparities.

Design

Retrospective cohort study.

Setting

Whole-of-population linked administrative data from 2002 to 2015 in Western Australia.

Participants

Women with 410 043 birth events (includes all births from the same pregnancy) of 20 weeks’ or more gestation, including terminations for congenital anomalies.

Primary and secondary outcome measures

Women with SMM were identified based on a composite indicator of SMM using diagnosis and procedure codes developed for use in routinely collected data. Mothers were classified into seven ethnic groups, based on their reported ethnic origin. The associations between maternal ethnic origin and SMM were examined using a log-binomial model, which estimates risk ratios (RRs) and 95% CIs. The Blinder-Oaxaca decomposition technique was employed to partition the disparity in SMM between Aboriginal and Caucasian populations into ‘explained’ and ‘unexplained’ components.

Results

During the study period, 9378 SMM cases were documented. In the adjusted model, Aboriginal (RR 1.73, 95% CI 1.59 to 1.87), African (RR 1.64, 95% CI 1.43 to 1.89) and ‘other’ ethnicity (RR 1.49, 95% CI 1.37 to 1.63) women were at significantly higher risk of SMM compared with Caucasian women. Teenage and older mothers and socioeconomically disadvantaged women were also at greater risk of SMM. Differences in sociodemographic characteristics explained 33.2% of the disparity in SMM between Aboriginal and Caucasian women.

Conclusions

There are distinct disparities in SMM by ethnicity in Western Australia, with a greater risk among Aboriginal and African women. While improvements in SES and a reduction in teenage pregnancy can potentially support a sizeable reduction in SMM rate inequalities, future research should investigate other potential pathways and targeted interventions to close the ethnicity disparity.
First year medical students’ perceptions of the impact of wearing scrubs on professional identity: a narrative analysis in the United Arab Emirates
Authors: Sorrell Sara , Ibrahim Halah
Published: November 2020

Objectives

Medical school serves as a critical developmental period for future physicians, during which students begin to form a professional identity. Just as personal appearance, particularly clothing, is an important external expression of one’s personal identity, ‘uniforms’ in healthcare, including white coats and scrubs, symbolise status and a group identity. There are, however, limited studies on the impact of physician attire on medical students’ formation of professional identity. Accordingly, through qualitative analysis of written narratives, we sought to analyse medical students’ experiences of wearing professional physician attire, namely scrubs, and how the uniform impacted their confidence level, performance and behaviours, as well as their identity as future physicians.

Design

Qualitative analysis of medical student’s written narratives.

Setting

Khalifa University College of Medicine and Health Sciences (KU CMHS) is a new medical school in the United Arab Emirates, with an inaugural class of 30 students admitted in August 2019. It is the only medical school in the city of Abu Dhabi, and the only school in the country that follows a postgraduate medical curriculum.

Participants

All first year medical students at KU CMHS were purposively sampled.

Methods

Students completed a voluntary online anonymous questionnaire. We employed a social identity approach to data analysis. Thematic content analysis was conducted on their narratives to identify themes.

Results

We identified three major themes, namely (1) emotions, (2) logistics and (3) interpersonal relationships.

Conclusions

Medical students form early perceptions regarding physician attire and its impact on their professional identity. Engaging in conversations regarding professional attire with educators or mentors could provide an important opportunity for students to discuss and explore professional identity early in training.
Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities
Authors: Machado Daiane Borges , McDonald Keltie , Castro-de-Araujo Luis F S , Devakumar Delan , Alves Flávia Jôse Oliveira , Kiss Lígia , Lewis Glyn , Barreto Mauricio L
Published: November 2020

Objective

To estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years.

Design

We conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian municipalities between 2008 and 2014. Multivariable negative binomial regression models were used to examine the relationship between homicide and suicide rates. Robustness of results was explored using sensitivity analyses to examine the influence of data quality, population size, age and sex on the relationship between homicide and suicide rates.

Setting

A nationwide study of municipality-level data.

Participants

Mortality data and corresponding population estimates for municipal populations aged 10 years and older.

Primary and secondary outcome measures

Age-standardised suicide rates per 100 000.

Results

Municipal suicide rates were positively associated with municipal homicide rates; after adjusting for socioeconomic and demographic factors, a doubling of the homicide rate was associated with 22% increase in suicide rate (rate ratio=1.22, 95% CI: 1.13 to 1.33). A dose–response effect was observed with 4% increase in suicide rates at the third quintile, 9% at the fourth quintile and 12% at the highest quintile of homicide rates compared with the lowest quintile. The observed effect estimates were robust to sensitivity analyses.

Conclusions

Municipalities with higher homicide rates have higher suicide rates and the relationship between homicide and suicide rates in Brazil exists independently of many sociodemographic and socioeconomic factors. Our results are in line with the hypothesis that changes in homicide rates lead to changes in suicide rates, although a causal association cannot be established from this study. Suicide and homicide rates have increased in Brazil despite increased community mental health support and incarceration, respectively; therefore, new avenues for intervention are needed. The identification of a positive relationship between homicide and suicide rates suggests that population-based interventions to reduce homicide rates may also reduce suicide rates in Brazil.
Cohort profile: Design and implementation of the Danish Physiotherapy Research Database for patients receiving primary care with chronic disease
Authors: Næss-Schmidt Erhard , Andersen Nils-Bo de Vos , Christiansen David Høyrup , Nielsen Jørgen Feldbæk , Stubbs Peter William
Published: November 2020

Purpose

Free of charge physiotherapy (FCP) is free physiotherapy provided by the Danish government for patients with a range of chronic diseases. To date, the population has not been described in depth making evaluation and decision making difficult. The purpose of this study was to (1) describe the development and the content of a novel clinical physiotherapy database for FCP (PhysDB-FCP) and (2) present the cohort profile based on the data collected.

Participants

Ninety-nine clinics (17 460 FCP patients) were invited to participate in the development process from 2018 to 2019. Eleven clinics consented (2780 FCP patients) and 534 patients performed the physiotherapy assessment using the PhysDB-FCP tool, with 393/534 completing the patient survey.

Findings to date

The content of the PhysDB-FCP was developed through an iterative process involving consensus between clinical and research workgroups. Prior to using the tool all consenting sites received training to use/administer the tool. All data were collected/stored using the PhysDB-FCP. Items finally chosen for the PhysDB-FCP included demographic information, questions about health status and daily functioning, functional tests, treatment plan and validated questionnaires. The initial patient cohort composed of 63.4% women with main diagnoses of multiple sclerosis (22.7%) and Parkinson’s disease (17.0%). The ability to perform personal/instrumental activities of daily living and functional ability varied widely. Other non-physiotherapy related issues were identified in numerous patients (ie, 34.9% of patients were at risk of depression) and multidisciplinary interventional approaches could be considered.

Future plans

The current study has provided a comprehensive description of patients receiving FCP, using data collected from the novel PhysDB-FCP. Collected information can be used to facilitate microlevel to macrolevel programme evaluation and decisions. Although the PhysDB-FCP is promising, the tool requires optimisation before it is implemented regionally and/or nationally.
Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis
Authors: Paskins Zoe , Crawford-Manning Fay , Cottrell Elizabeth , Corp Nadia , Wright Jenny , Jinks Clare , Bishop Simon , Doyle Alison , Ong Terence , Gittoes Neil , Leonardi-Bee Jo , Langley Tessa , Horne Robert , Sahota Opinder
Published: November 2020

Objective

To explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics.

Design

A systematic review of primary qualitative studies. Seven databases were searched from inception to July 2019. Screening, data extraction and quality assessment of full-articles selected for inclusion were performed independently by two authors. A framework synthesis was applied to extracted data based on the theoretical framework of acceptability (TFA). The TFA includes seven domains relating to sense-making, emotions, opportunity costs, burden, perceived effectiveness, ethicality and self-efficacy. Confidence in synthesis findings was assessed.

Setting

Any developed country healthcare setting.

Participants

Patients, healthcare professionals, managers, payers and academics.

Intervention

Experiences and views of oral and intravenous bisphosphonates.

Results

Twenty-five studies were included, mostly describing perceptions of oral bisphosphonates. We identified, with high confidence, how patients and healthcare professionals make sense (coherence) of bisphosphonates by balancing perceptions of need against concerns, how uncertainty prevails about bisphosphonate perceived effectiveness and a number of individual and service factors that have potential to increase self-efficacy in recommending and adhering to bisphosphonates. We identified, with moderate confidence, that bisphosphonate taking induces concern, but has the potential to engender reassurance, and that both side effects and special instructions for taking oral bisphosphonates can result in treatment burden. Finally, we identified with low confidence that multimorbidity plays a role in people’s perception of bisphosphonate acceptability.

Conclusion

By using the lens of acceptability, our findings demonstrate with high confidence that a theoretically informed, whole-system approach is necessary to both understand and improve adherence. Clinicians and patients need supporting to understand the need for bisphosphonates, and clinicians need to clarify to patients what constitutes bisphosphonate treatment success. Further research is needed to explore perspectives of male patients and those with multimorbidity receiving bisphosphonates, and patients receiving intravenous treatment.

PROSPERO registration number

CRD42019143526.
Barriers and facilitators to changes in adolescent physical activity during COVID-19
Authors: Ng Kwok , Cooper Jemima , McHale Fiona , Clifford Joanna , Woods Catherine
Published: November 2020

Objectives

COVID-19 restrictions reduced adolescents’ opportunities for physical activity (PA). The purpose of this study was to examine how adolescent PA changed during school closures, to identify the key barriers and facilitators for these changes during lockdown and to use this information to understand how to manage future crises’ situations positively to prevent physical inactivity.

Methods

Irish adolescents (N=1214; ages 12–18 years) participated in an online cross-sectional study during April 2020, including items on PA level, changes in PA and reasons for change in an open-ended format. Numeric analyses were through multiple binary logistic regressions, stratified by changes in PA during lockdown and inductive analysis of open coding of text responses.

Results

Adolescents reported they did less PA (50%), no change (30%) or did more PA during lockdown (20%). Adolescents who did less PA were more likely to be overweight (OR=1.8, CI=1.2–2.7) or obese (OR=2.2, CI=1.2–4.0) and less likely to have strong prior PA habits (OR=0.4, CI=0.2–0.6). The most cited barriers to PA were coronavirus, club training cancelled and time. Strong associations for doing more PA included participation in strengthening exercises at least three times in the past 7 days (OR=1.7, CI=1.3–2.4); facilitators were more time, coronavirus and no school.

Conclusion

COVID-19 restrictions were both a barrier to and an opportunity for PA. Parents, schools, public health, communities and industries must collaborate to prevent physical inactivity at times of crisis, especially for vulnerable groups.
Cut-Off Value of Serum Homocysteine in Relation to Increase of Coronary Artery Calcification
Authors: Jung Susie , Kim Yu-Na , Choi Beom-Hee , Joo Nam-Seok
Published: November 2020

A recent study reported that coronary artery calcification (CAC) and serum homocysteine were well associated; however, no report is available for the cut-off value of serum homocysteine according to increase of coronary-artery calcification volume score (CVS). The data of 469 out of 777 subjects in 1 health promotion center located in Seoul were selected after exclusion of the missing data of serum homocysteine and CVS. CVS was categorized into 2 groups: CVS=0 and CVS>0. Serum homocysteine according to the CVS groups was compared, and the cut-off value of serum homocysteine according to the increase of CVS (>0) was calculated using the receiver operating characteristic curve. Mean age was 54.5 years and the proportion of females was 22.2%. Mean serum homocysteine concentration and CVS were 11.2 μmol/L and 50.4, respectively. After adjustments for age and sex, serum homocysteine was associated with CVS (r=0.167, p=0.001), and Log(Homocysteine) also showed a significant difference according to the CVS groups. The cut-off value of serum homocysteine according to the increase of CVS (>0) was 9.45 μmol/L (area under the curve=0.569 (95% CI 0.512 to 0.625), p=0.015). The cut-off value of serum homocysteine was 9.45 μmol/L according to the increase of coronary-artery CVS.
Participant retention in trauma intensive care unit (ICU) follow-up studies: a post-hoc analysis of a previous scoping review
Authors: Rawal Himanshu , Young Daniel L , Nikooie Roozbeh , Al Ani Awsse H , Friedman Lisa Aronson , Vasishta Sumana , Haut Elliott R , Colantuoni Elizabeth , Needham Dale M , Dinglas Victor D
Published: November 2020

Background

The study aimed to synthesize participant retention-related data for longitudinal follow-up studies of survivors from trauma intensive care units (ICUs).

Methods

Within a published scoping review evaluating ICU patient outcomes after hospital discharge, two screeners independently searched for trauma ICU survivorship studies.

Results

There were 11 trauma ICU follow-up studies, all of which were cohort studies. Twelve months (range: 1–60 months) was the most frequent follow-up time point for assessment (63% of studies). Retention rates ranged from 54% to 94% across time points and could not be calculated for two studies (18%). Pooled retention rates at 3, 6, and 12 months were 75%, 81%, and 81%, respectively. Mean patient age (OR 0.85 per 1-year increase, 95% CI 0.73 to 0.99, p=0.036), percent of men (OR 1.07, 95% CI 1.04 to 1.10, p=0.002), and publication year (OR 0.89 per 1-year increase, 95% CI 0.82 to 0.95, p=0.007) were associated with retention rates. Early (3-month) versus later (6-month, 12-month) follow-up time point was not associated with retention rates.

Discussion

Pooled retention rates were >75%, at 3-month, 6-month, and 12-month time points, with wide variability across studies and time points. There was little consistency with reporting participant retention methodology and related data. More detailed reporting guidelines, with better author adherence, will help improve reporting of participant retention data. Utilization of existing research resources may help improve participant retention.

Level of evidence

Level III: meta-analyses (post-hoc analyses) of a prior scoping review.
Selected highlights of the production of light (anti-)(hyper-)nuclei in ultra-relativistic heavy-ion collisions
Authors: Dönigus Benjamin
Published: November 2020

The production of light (anti-)nuclei and (anti-)hypernuclei in ultra-relativistic heavy-ion collisions, but also in more elementary collisions as proton–proton and proton–nucleus collisions, became recently a focus of interest. In particular, the fact that these objects are all loosely bound compared to the temperature and energies, e.g. the kinetic energies involved, is often stressed out to be special for their production. The binding energies of these (anti-)nuclei is between 130 keV ($${\mathrm {\Lambda }}$$Λseparation energy in the hypertriton) and about 8 MeV per nucleon. Whereas the connected temperatures are of the order of 100 to 160 MeV. This lead to some difficulties in the interpretation of the usually discussed production models, i.e. coalescence and statistical-thermal models, as will be discussed here. In this brief review we discuss selected highlights of the production of light (anti-)nuclei, such as (anti-)deuteron, (anti-)helium and (anti-)alpha nuclei. In addition, we will discuss the current status of the highly debated lifetime of the (anti-)hypertriton and connected measurements and model results.
Tolerance versus synaptic noise in dense associative memories
Authors: Agliari Elena , De Marzo Giordano
Published: November 2020

The retrieval capabilities of associative neural networks are known to be impaired by fast noise, which endows neuron behavior with some degree of stochasticity, and by slow noise, due to interference among stored memories; here, we allow for another source of noise, referred to as “synaptic noise,” which may stem from i. corrupted information provided during learning, ii. shortcomings occurring in the learning stage, or iii. flaws occurring in the storing stage, and which accordingly affects the couplings among neurons. Indeed, we prove that this kind of noise can also yield to a break-down of retrieval and, just like the slow noise, its effect can be softened by relying on density, namely by allowingp-body interactions among neurons.
Deflection of light around a rotating BTZ black hole
Authors: Kala Shubham , Nandan Hemwati , Sharma Prateek
Published: November 2020

We present a detailed study of gravitational lensing around a rotating Bañados–Teitelboim–Zanelli (BTZ) black hole in (2 + 1)-dimensional gravity. The study of orbits for massless test particle around this BH spacetime is performed to describe the nature of cosmological constant in lower dimensions. We study the effect of cosmological constant on the photon orbit in view of other critical parameters. The bending angle of light is studied in view of different values of cosmological constant for direct and retrograde motion of test particles. It is being observed that the bending angle slightly decreases as the value of cosmological constant increases in the negative region.
Representation theory of symmetric groups and the strong Lefschetz property
Authors: Kang Seok-Jin , Kim Young Rock , Shin Yong-Su
Published: November 2020

We investigate the structure and properties of an Artinian monomial complete intersection quotient [Formula: see text]. We construct explicit homogeneous bases of [Formula: see text] that are compatible with the [Formula: see text]-module structure for [Formula: see text], all exponents [Formula: see text] and all homogeneous degrees [Formula: see text]. Moreover, we derive the multiplicity formulas, both in recursive form and in closed form, for each irreducible component appearing in the [Formula: see text]-module decomposition of homogeneous subspaces.
Proinflammatory cytokines inhibit thiamin uptake by human and mouse pancreatic acinar cells: involvement of transcriptional mechanism(s)
Authors: Anandam Kasin Yadunandam , Srinivasan Padmanabhan , Yasujima Tomoya , Al-Juburi Saleh , Said Hamid M.
Published: November 2020

Findings of the current study demonstrate, for the first time, that exposure of pancreatic acinar cells to proinflammatory cytokines (including hyper IL-6) cause significant inhibition in vitamin B1 (thiamin; a micronutrient that is essential for normal cellular energy metabolism) and that this effect is mediated at the level of transcription of the thiamin transporter genes SLC19A2 and SLC19A3.