bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Two-Stage Design Framework for Two-Dimensional Spatial Packing of Interconnected Components
Authors: Peddada Satya R. T. , James Kai A. , Allison James T.
Published: October 2020

Packing and routing separately are each challenging NP-hard problems. Therefore, solving the coupled packing and routing problem simultaneously will require disruptive methods to better address pressing-related challenges, such as system volume reduction, interconnect length reduction, ensuring non-intersection, and physics (thermal, hydraulic, or electromagnetic) considerations. Here we present a novel two-stage sequential design framework to perform simultaneous physics-based packing and routing optimization. Stage 1 generates interference-free initial layouts that are fed to stage 2 as starting points to perform continuous physics-based optimization. Three distinct strategies for stage 1 have been introduced recently, (1) the force-directed layout method (FDLM), (2) an extension of the shortest path algorithms (SPAs), and (3) a unique geometric topology (UGT) generation algorithm. In stage 2, a gradient-based topology optimization method is used to simultaneously optimize both component locations and interconnect routing paths. In addition to geometric considerations, this method supports optimization based on system behavior by including physics-based objectives and constraints. The proposed framework is demonstrated using three case studies. First, the layout generation methods developed for stage 1 are compared with respect to system performance metrics obtained from stage 2. Second, a multi-objective optimization problem using the epsilon-constraint method is solved to obtain Pareto optimal solutions. Third, an extension to multi-loop systems is demonstrated. In summary, the design automation framework integrates several elements together as a step toward a more comprehensive solution of 3D packing and routing problems with both geometric and physics considerations.
A New Development of a Shadow Density Filter for Manufacturing Constraint and Its Applications to Multiphysics Topology Optimization
Authors: Yoon Gil Ho , Ha Seon Il
Published: October 2020

The present research develops a new shadow filter and presents its usage for structural topology optimization (TO) considering the molding manufacturability. It is important to consider manufacturing methods in designing products. Some geometrical features not allowing molded parts should be removed. In addition, it has been an important issue to efficiently impose these manufacturing constraints in TO. For this purpose, the present research emulates implementation of shadowing of products and applies the shadow images as pseudo-density variables in TO. The use of this shadow density filter ensures that the optimized layouts comply with the conditions of the manufacturing constraints. Various manufacturing conditions can be imposed depending on the direction and the position of the light. Several numerical examples of compliance minimization problem, conjugate heat transfer problem, and fluid–structure interaction problem are solved to demonstrate the validity and effectiveness of the present shadow density filters, and their performances are compared.
Meshing Characteristic of Arc-Toothed Cylindrical Worm Pair and Cutting Geometric Condition of Its Worm
Authors: Meng Qingxiang , Zhao Yaping , Cui Jian , Dou Tonghao
Published: October 2020

The arc-toothed cylindrical worm has an arc tooth profile in a section, which may be the axial section, the normal section, or an offsetting plane of the worm helical surface. The meshing principle for a gearing containing such a worm is established. The normal vector of instantaneous contact line is determined in the natural frame and the meshing performance parameters are obtained without the help of the curvature parameters of the worm helical surface to ensure the established meshing principle is concise and practical. The numerical results show that the worm working length can be beyond half of the thread length and the meshing zone of the worm pair can cover most of the worm gear tooth surface. The instantaneous contact lines are uniformly distributed and the worm pair forms double-line contact. The numerical outcomes of the induced principal curvature show that the contact stress level between the teeth is higher in the middle of the worm gear tooth surface and near its dedendum. The forming condition of the lubricating oil film is poorer in the middle of the worm gear tooth surface and from addendum to dedendum as demonstrated by the numerical results of the sliding angle. The normal arc-toothed worm lathed by an offsetting cutter is recommended to apply in industry after various researches and analyses. The cutting geometric condition of the worm is investigated quantitatively. It is discovered that the rule of the cutter working relief angle changes along the cutting edge during lathing the worm.
Numerical Investigation of Free Convection in a Porous Corrugated Cavity Filled With Silver (Ag) Dispersed Nano-Fluid
Authors: Bhardwaj Saurabh , Dalal Amaresh
Published: October 2020

The present work examines the convective heat transfer characteristics in a two-dimensional (2D) corrugated closed cavity embedded with porous media. The cavity is considered to be filled with silver dispersed water-based nano-fluid. The bottom wall is heated uniformly and non-uniformly in two different cases keeping both side corrugated walls isothermally cold with an adiabatic top wall. The various parameters are selected to perform numerical simulation in the range of solid-volume fraction, 0% ≤ ϕ ≤ 10%, 103 ≤ Ra ≤ 106, and 10−4 ≤ Da ≤ 10−2. The investigation shows that the heat transfer rate shows an increasing trend at high values of Ra and Da due to strong buoyancy forces in uniform and non-uniform heating. However, an increase in heat transfer in uniform heating is more compared to non-uniform heating. It is also observed that the nano-fluid has a great impact on the heat transfer characteristics due to its high value of thermal conductivity and irregular motion of the particles. As a result, the average Nusselt number (Nuavg) shows an increasing trend for increasing solid-volume fraction values.
Magnetic Field Effect on the Buoyancy-Driven Convection and Fluid Motion in Fe3O4/Water Nanofluid Filled Inside an Enclosure With Mutual Orthogonal Heaters
Authors: Kumar Deepak , Kumar Aditya , Subudhi Sudhakar
Published: October 2020

The present paper investigates the buoyancy induced flow and heat transfer in a square enclosure filled with Fe3O4/water nanofluid heated by mutually orthogonal heaters and symmetrically cooled by sidewalls under the influence of a strong uniform magnetic field. The nanofluid is experimentally synthesized by two-step method and the different thermophysical properties are measured. These experimentally determined properties are compared with the classical correlations available in the literature. Those correlations are found to underpredict the dynamic viscosity and thermal conductivity of the nanofluid. The error related to the use of the classical correlations is determined and it increases with the volume fraction. Hence, the experimentally determined properties are directly used in the numerical simulation. The governing equations in the form of nondimensional stream function, vorticity, and energy equations containing experimentally determined properties are solved using the finite difference method (FDM). The consequence of different factors like positions of the heaters, varying range of Rayleigh number (103 ≤ Ra ≤ 106), the extremely low volume fraction of nanofluids (0 ≤ φ ≤ 0.0007), and Hartmann number (0 ≤ Ha ≤ 75) on the heat transport is studied and reported. The study explains and analyzes the streamlines and isotherms at different conditions. The results show that the positions of the horizontal and vertical heater have a significant effect on heat transfer and fluid flow inside the enclosure. Furthermore, the increase in Ha enervates the strength of flow and it leads to the deterioration of heat transfer.
On the Boundary Value Problems of Bending of Thin Elastic Plates With Surface Effects
Authors: Gharahi Alireza , Schiavone Peter
Published: October 2020

We modify classical thin plate theory by incorporating surface effects via the Gurtin–Murdoch surface model to accommodate the mechanical behavior of thin plates at the nanoscale. We formulate the corresponding Dirichlet and Neumann boundary value problems and establish uniqueness results in the appropriate function spaces. In addition, we obtain the fundamental solution of the governing system of equations, which is central to further studies concerning well-posedness analysis of the model by the boundary integral equation method. Finally, we validate our model by comparison with results in the existing literature.
Self-Piercing Riveting of Medium- and High-Strength Al and Mg Alloy Sheets Enabled by In-Process Electric Resistance Heating
Authors: Klein Thomas , Kirov Georg , Ucsnik Stephan
Published: October 2020

Enduring joints of high-strength materials are becoming increasingly important for the manufacturing of highly loaded body-in-white structures, particularly for automobiles, which require structural light-weighting without sacrificing passenger safety. While self-piercing riveting has been proven suitable for various material classes, its application to high-strength, low-ductile materials is hindered by the occurrence of cracks and insufficient penetration. In this work, we demonstrated that these restrictions can be overcome by localized one-sided short-time electric resistance heating. The treatment can be integrated into the riveting process, allowing for short process times. The heating lowers the hardness of the materials to be joined and enables piercing and penetration of the sheets to yield crack-free joints. The local mechanical properties are hardly changed in case of peak-aged sheet material conditions but increase significantly in the close vicinity of the rivet in case of under-aged sheet material conditions. The outstanding static and dynamic mechanical properties of the resulting joints evidence their robustness.
Surface Y2O3 layer formed on air exposed Y powder characterized by XPS
Authors: Cole Kevin M. , Kirk Donald W. , Thorpe Steven J.
Published: October 2020

X-ray photoelectron spectroscopy (XPS) was performed to characterize the air formed Y2O3 surface layer on yttrium powder. Prior to XPS measurements, x-ray diffraction was performed to confirm the presence of Y2O3. The air formed Y2O3 displayed little residual metallic Y remaining at the surface with contamination from hydrocarbons. In addition to the survey scan, detailed charge corrected scans for Y 3s, Y 3p, Y 4s, Y 4p, O 1s, O 2s, and C 1s surface photoelectron signals are reported.
tert-butoxides as precursors for atomic layer deposition of alkali metal containing thin films
Authors: Sønsteby Henrik H. , Bratvold Jon E. , Killi Veronica A.-L. K. , Choudhury Devika , Elam Jeffrey W. , Fjellvåg Helmer , Nilsen Ola
Published: October 2020

Alkali metal containing materials have become increasingly attractive in a world hunting for sustainable energy materials and green functional devices. Lithium- and sodium battery technology, lead-free piezo- and ferroelectric devices, and record-breaking alkali doped tandem perovskite solar cells are among the applications where alkali metal-containing thin films get increasing attention. Atomic layer deposition (ALD) is one of the enabling thin film deposition techniques that offer chemical and geometrical versatility to realize the implementation of such thin films on an applicable scale. The drawback has until recently been a lack of available precursor chemistry that offers self-limiting growth that is fundamental to ALD. The alkali metal tert-butoxides have been shown to exhibit the necessary properties to facilitate saturating growth for Li-, Na-, K-, and Rb-containing compounds. However, the behavior of the tert-butoxides in ALD-growth has been considered difficult to unravel, with processes exhibiting limited control and low reproducibility. Very little has been reported on trends in reaction mechanisms as the mass of the alkali metal increases. Herein, we summarize the existing literature on the use of alkali metal tert-butoxides as precursors in ALD. We consider differences in the structure and behavior of the tert-butoxides as the alkali metal cation becomes heavier. In addition, we present precursor synthesis routes and key information on precursor structure, stability, and mechanistic behavior. Finally, we provide the first ever report of Cs-containing films by ALD to complement previous work on its lighter counterparts.
Usage of Coulomb friction acting on a wedge to attenuate vibration
Authors: Ginsberg Jerry H.
Published: October 2020

Considered herein is a small wedge-shaped block that contacts a rough surface on its angled face, with contact maintained by precompressed springs. The wedge is connected to a large mass that is subjected to a harmonic excitation. The development begins with a derivation of equations for the normal and friction forces, which are shown to depend on the displacement and acceleration of the wedge as well as the external force. Enforcing Coulomb's law for sliding leads to a differential equation of motion in which the effective inertia and stiffness coefficients switch values according to whether the wedge advances or retreats. Algebraic expressions for the displacement in either state are supplemented by an assessment of sticking based on Coulomb's static friction rule. The solutions for motion and the assessment of sticking are assembled in a simple, yet general, algorithm that only requires calculation of algebraic formulas. Transient waveforms of displacement, acceleration, and transmitted force are calculated for a harmonic excitation at the natural frequency of the frictionless system. It is found that very large viscous damping ratios would be required to obtain the same steady-state amplitude.
Associations Between Anthropometric Indicators in Early Life and Cardiorespiratory Fitness, Physical Activity, and Sedentary Time in Adolescence
Authors: Oliveira-Santos José , Santos Rute , Moreira Carla , Abreu Sandra , Lopes Luís , Agostinis-Sobrinho César , Mota Jorge
Published: October 2020

Background: To explore the associations between birth weight and body mass index (BMI) from 6 months to 6 years of age, with cardiorespiratory fitness (CRF), physical activity, and sedentary time in adolescence. Methods: Retrospective school-based study with 539 adolescents (292 girls), mean age of 13.94 (1.62) years. Anthropometric data from birth up to 6 years were extracted from individual child health booklets. CRF was estimated by 20-m shuttle run test. Physical activity and sedentary time were assessed with accelerometers. Results: Birth weight was not associated with any outcome measured in adolescence. From the age of 6 months onwards in girls, and from 3 years in boys, BMI associated inversely with CRF in adolescence. In girls, BMI (at 12 mo and at 3 y of age) associated positively with sedentary time in adolescence, but not with physical activity. In boys, positive associations between BMI at the ages of 3, 5, and 6 years old and time spent in some intensities of physical activity in adolescence were found. Conclusions: BMI during the early years was negatively associated with CRF in adolescence, in a consistent way, for both genders, but with physical activity and sedentary time the associations were scarce and inconsistent, depending on the gender.
Variable Lower Limb Alignment of Clinical Measures With Digital Photographs and the Footscan Pressure System
Authors: Govsa Figen , Nteli Chatzioglou Gkionoul , Hepguler Simin , Pinar Yelda , Bedre Ozden
Published: October 2020

Objective: This study examines the effect of the lower limb misalignment and its possible compensatory effect on plantar pressure in a normal population. The aim of this paper is to present a structured method for the analysis of posture and its changes using a standardized digital photography technique and plantar pressure measuring device. Design: Cohort. Setting: Laboratory. Participants: A total of 200 adult volunteers between 18 and 22 years of age who had no current symptoms of pain and foot or ankle pathology participated in the study. Main Outcome Measures: The gold standard measure of lower limb alignment with weight-bearing status is the mechanical axis and their angles using Image J software. Structural and functional measurements of the same foot were taken using a plantar pressure measuring device. In this study, 5 alignment (thigh, knee, leg, ankle, and foot) characteristics were measured on the lower limb using the 2 techniques, and, additionally, the foot contact area, peak pressure, foot axis, rearfoot angle, and subtalar joint flexibility score were analyzed in 10 different regions of the foot. Results: This study has shown a reasonable correlation between digitalized measurements and plantar pressures values. Quadriceps angle affected midfoot impulse, foot axis angle, subtalar joint minimum angle, and rearfoot angle positively. Subtalar joint flexibility scores were analyzed in 10 different regions of the foot. There was a positive correlation between rearfoot angle and quadriceps angle (P = .009, r = .261). Results of both methods show that they endorse each other. Conclusions: The posture of the standing feet may have influence on lower limb alignment. Currently, there are no studies carried out by using digital photogrammetry and foot scan. The authors claim that patient-friendly digital photogrammetry would have a positive contribution to the monitoring of patients, even including new ones in the treatment programs, reducing any possible loss in the personal and national economy.
Changes of Ankle Dorsiflexion Using Compression Tissue Flossing: A Systematic Review and Meta-Analysis
Authors: Kielur Devin S. , Powden Cameron J.
Published: October 2020

Context: Impaired dorsiflexion range of motion (DFROM) has been established as a predictor of lower-extremity injury. Compression tissue flossing (CTF) may address tissue restrictions associated with impaired DFROM; however, a consensus is yet to support these effects. Objectives: To summarize the available literature regarding CTF on DFROM in physically active individuals. Evidence Acquisition: PubMed and EBSCOhost (CINAHL, MEDLINE, and SPORTDiscus) were searched from 1965 to July 2019 for related articles using combination terms related to CTF and DRFOM. Articles were included if they measured the immediate effects of CTF on DFROM. Methodological quality was assessed using the Physiotherapy Evidence Database scale. The level of evidence was assessed using the Strength of Recommendation Taxonomy. The magnitude of CTF effects from pre-CTF to post-CTF and compared with a control of range of motion activities only were examined using Hedges g effect sizes and 95% confidence intervals. Randomeffects meta-analysis was performed to synthesize DFROM changes. Evidence Synthesis: A total of 6 studies were included in the analysis. The average Physiotherapy Evidence Database score was 60% (range = 30%–80%) with 4 out of 6 studies considered high quality and 2 as low quality. Meta-analysis indicated no DFROM improvements for CTF compared with range of motion activities only (effect size = 0.124; 95% confidence interval, −0.137 to 0.384; P = .352) and moderate improvements from pre-CTF to post-CTF (effect size = 0.455; 95% confidence interval, 0.022 to 0.889; P = .040). Conclusions: There is grade B evidence to suggest CTF may have no effect on DFROM when compared with a control of range of motion activities only and results in moderate improvements from pre-CTF to post-CTF. This suggests that DFROM improvements were most likely due to exercises completed rather than the band application.
Palmitoylation and colitis
Authors: Foley John F.
Published: October 2020

Interrupting the palmitoylation-depalmitoylation cycle of the transcriptional regulator STAT3 relieves IBD symptoms in mice.
Antibody Opsonization Enhances Early Interactions between Yersinia pestis and Neutrophils in the Skin and Draining Lymph Node in a Mouse Model of Bubonic Plague
Authors: Shannon Jeffrey G. , Hinnebusch B. Joseph
Published: October 2020

Bubonic plague results whenYersinia pestisis deposited in the skin via the bite of an infected flea. Bacteria then traffic to the draining lymph node (dLN) where they replicate to large numbers. Without treatment, this infection can result in highly fatal septicemia. Several plague vaccine candidates are currently at various stages of development, but no licensed vaccine is available in the United States. Though polyclonal and monoclonal antibodies (Ab) can provide complete protection against bubonic plague in animal models, the mechanisms responsible for this antibody-mediated immunity (AMI) toY. pestisremain poorly understood.
Toll-Like Receptor 2-Tpl2-Dependent ERK Signaling Drives Inverse Interleukin 12 Regulation in Dendritic Cells and Macrophages
Authors: Groft Sarah G. , Nagy Nancy , Boom W. Henry , Harding Clifford V.
Published: October 2020

This study investigated responses to Toll-like receptor 2 (TLR2)-driven extracellular signal-related kinase (ERK) signaling in dendritic cells (DCs) versus macrophages. TLR2 signaling was induced with Pam
3
Cys-Ser-Lys
4
, and the role of ERK signaling was interrogated pharmacologically with MEK1/2 inhibitor U0126 or genetically with bone marrow-derived macrophages or DCs from

Tpl2
−/−

mice. We assessed cytokine production via enzyme-linked immunosorbent assay (ELISA) or V-Plex, and mRNA levels were assessed via reverse transcriptase quantitative PCR (qRT-PCR).
Mycoplasma bovismbfNEncodes a Novel LRR Lipoprotein That Undergoes Proteolytic Processing and Binds Host Extracellular Matrix Components
Authors: Adamu James Y. , Mitiku Filimon , Hartley Carol A. , Sansom Fiona M. , Marenda Marc S. , Markham Philip F. , Browning Glenn F. , Tivendale Kelly A.
Published: October 2020

Experimental validation of the putative functions of genes inM. boviswill advance our understanding of the basic biology of this economically important pathogen and is crucial in developing prevention strategies. This study demonstrated the extracellular matrix binding ability of a novel immunogenic lipoprotein ofM. bovis, and the role of this protein in adhesion byM. bovissuggests that it could play a role in virulence.
Tennis-specific extension of the International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020
Authors: Verhagen Evert , Clarsen Benjamin , Capel-Davies Jamie , Collins Christy , Derman Wayne , de Winter Don , Dunn Nicky , Ellenbecker Todd S , Forde Raymond , Hainline Brian , Larkin Jo , Reid Machar , Renstrom Per AFH , Stroia Kathleen , Wolstenholme Sue , Pluim Babette M
Published: October 2020

The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, specific recommendations are made for wheelchair tennis.
Burden of cardiovascular diseases associated with fine particulate matter in Beijing, China: an economic modelling study
Authors: Jiang Yawen , Jiang Shan , Ni Weiyi
Published: October 2020

Objective

To evaluate the economic and humanistic burden associated with cardiovascular diseases that were attributable to fine particulate matter (≤ 2.5 μg/m3in aerodynamic diameter; PM2.5) in Beijing.

Methods

This study used a health economic modelling approach to compare the actual annual average PM2.5concentration with the PM2.5concentration limit (35 µg/m3) as defined by the Chinese Ambient Air Quality Standard in terms of cardiovascular disease outcomes in Beijing adult population. The outcomes included medical costs, quality-adjusted life-years (QALYs) and net monetary loss (NML). Beijing annual average PM2.5concentration was around 105 µg/m3during 2013–2015. Therefore, we estimated the differences in cardiovascular outcomes of Beijing adults between exposure to the PM2.5concentration of 105 µg/m3and exposure to the concentration of 35 µg/m3. According to WHO estimates, the hazard ratios of coronary heart disease and stroke associated with the increase of PM2.5concentration from 35 to 105 µg/m3were 1.15 and 1.29, respectively.

Results

The total 1-year excess medical costs of cardiovascular diseases associated with PM2.5pollution in Beijing was US$147.9 million and the total 1-year QALY loss was 92 574 in 2015, amounting to an NML of US$2281.8 million. The expected lifetime incremental costs for a male Beijing adult and a female Beijing adult were US$237 and US$163, the corresponding QALY loss was 0.14 and 0.12, and the corresponding NML was US$3514 and US$2935.

Conclusions

PM2.5-related cardiovascular diseases imposed high economic and QALY burden on Beijing society. Continuous and intensive investment on reducing PM2.5concentration is warranted even when only cardiovascular benefits are considered.
Validation of a brief scale to assess ambulatory patients’ perceptions of reading visit notes: a scale development study
Authors: Wright Julie A , Leveille Suzanne G , Chimowitz Hannah , Fossa Alan , Stametz Rebecca , Clarke Deserae , Walker Jan
Published: October 2020

Objectives

To develop and evaluate the validity of a scale to assess patients’ perceived benefits and risks of reading ambulatory visit notes online (open notes).

Design

Four studies were used to evaluate the construct validity of a benefits and risks scale. Study 1 refined the items; study 2 evaluated underlying factor structure and identified the items; study 3 evaluated study 2 results in a separate sample; and study 4 examined factorial invariance of the developed scale across educational subsamples.

Setting

Ambulatory care in three large health systems in the USA.

Participants

Participants in three US health systems who responded to one of two online surveys asking about benefits and risks of reading visit notes: a psychometrics survey of primary care patients, and a large general survey of patients across all ambulatory specialties. Sample sizes: n=439 (study 1); n=439 (study 2); n=500 (study 3); and n=250 (study 4).

Primary and secondary outcome measures

Questionnaire items about patients’ perceived benefits and risks of reading online visit notes.

Results

Study 1 resulted in the selection of a 10-point importance response option format over a 4-point agreement scale. Exploratory factor analysis (EFA) in study 2 resulted in two-factor solution: a four-item benefits factor with good reliability (alpha=0.83) and a three-item risks factor with poor reliability (alpha=0.52). The factor structure was confirmed in study 3, and confirmatory factor analysis of benefit items resulted in an excellent fitting model, X2(2)=2.949; confirmatory factor index=0.998; root mean square error of approximation=0.04 (0.00, 0.142); loadings 0.68−0.86; alpha=0.88. Study 4 supported configural, measurement and structural invariance for the benefits scale across high and low-education patient groups.

Conclusions

The findings suggest that the four-item benefits scale has excellent construct validity and preliminary evidence of generalising across different patient populations. Further scale development is needed to understand perceived risks of reading open notes.
Availability and use of mHealth for disease diagnosis and treatment support by health workers in sub-Saharan Africa: a scoping review protocol
Authors: Osei Ernest , Kuupiel Desmond , Mashamba-Thompson Tivani Phosa
Published: October 2020

Introduction

Improving healthcare for all is one of the global health priorities, particularly in disease burdened settings such as sub-Saharan Africa (SSA). Considering the high penetration rate of mobile phones in SSA, mobile
health (mHealth) could be used to achieve universal health coverage. The proposed study will map evidence on the availability and use of mHealth for disease diagnosis and treatment support by health workers in SSA.

Methods and analysis

This review will be guided by Arksey and O'Malley’s scoping review framework and Levac et al’s recommendations and guidelines from the Joanna Briggs Institute. A scoping review will be conducted to explore what is known about mHealth for disease diagnosis and treatment support by health workers in SSA and to identify areas for future research. In addition to searching the grey literature, the following databases will be explored from PubMed, MEDLINE and CINAHL with full text via EBSCOhost and ScienceDirect databases. A search in Google Scholar will be considered as an additional information source. The literature search will involve published studies from 2000 to 2020 in any language. This review will cover mHealth for disease diagnosis and treatment support by health workers in SSA. The primary investigator will conduct the title screening, and subsequently, two reviewers will independently conduct abstract and full article screening and data extraction. The results of this proposed review will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-analysis: Extension for Scoping Review guidelines.

Ethics and dissemination

Ethical approval is not required for the scoping review, which is the first stage in a PhD study in public health on accessing mHealth for disease diagnosis and treatment support by health workers in Ghana. The final review will be submitted for publications to a scientific journal, and our results will be presented at appropriate conferences.
While you’re waiting, a waiting room-based, cardiovascular disease-focused educational program: protocol for a randomised controlled trial
Authors: Mcintyre Daniel , Thiagalingam Aravinda , Chow Clara
Published: October 2020

Introduction

Patients with cardiovascular disease (CVD) frequently attend outpatient clinics and spend a significant amount of time in waiting rooms. Currently, this time is poorly used. This study aims to investigate whether providing CVD and cardiopulmonary resuscitation (CPR) education to waiting patients in a cardiology clinic of a large referral hospital improves motivation to change health behaviours, CPR knowledge, behaviours and clinic satisfaction post clinic, and whether there is any impact on reported CVD lifestyle behaviours or relevant CPR outcomes at 30 days.

Methods and analysis

Randomised controlled trial with parallel design to be conducted among 330 patients in the waiting room of a chest pain clinic in a tertiary referral hospital. Intervention (n=220) participants will receive a tablet-delivered series of educational videos catered to self-reported topics of interest (physical activity, blood pressure, diet, medications, smoking and general health) and level of health knowledge. Control (n=110) participants will receive usual care. In a substudy, intervention participants will be randomised 1:1 to receive an extra video on CPR or no extra video. The primary outcome will be the proportion of intervention and control participants who report high motivation to improve physical activity, diet and blood pressure monitoring at end of clinic. The primary outcome of the CPR study will be confidence to perform CPR post clinic. Secondary analysis will examine impact on clinic satisfaction, lifestyle behaviours, CPR knowledge and willingness to perform CPR post clinic and at 30-day follow-up.

Ethics and dissemination

Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee. All patients will provide informed consent via a tablet-based eConsent framework. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.

Trial registration number

ANZCTR12618001725257.
Is fatigue a cue to obtain iron supplements in Odisha, India? A mixed methods investigation
Authors: Yilma Hagere , Sedlander Erica , Rimal Rajiv N , Pattnaik Soumik
Published: October 2020

Objectives

This study aims to understand if fatigue, the main symptom of anaemia, is a health concern that cues women and their referent groups to obtain iron folic acid supplements.

Design

This is a mixed methods study that consisted of a cross-sectional perceptual mapping and card sorting activity along with 16 focus group discussions with women of reproductive age, mothers-in-law and men. Participants of the perceptual mapping and card sorting activity were asked to compare images of anaemia-related items and concepts. Participants in the focus group discussions were asked about their daily life, aspirations and concerns among women and perceptions of anaemia and iron supplementation in the community. The quantitative data were analysed through multidimensional scaling and analyses of variance in SPSS. The qualitative data were analysed through applied thematic analysis using NVivo.

Setting

Bhubaneswar, Odisha, India.

Participants

Women of reproductive age (n=30), mothers-in-law (n=30) and married men (n=30) were randomly selected to participate in the perceptual mapping and card sorting exercise. A separate sample of each group was randomly selected for the focus group discussions (n=148).

Primary and secondary outcome measures

We collected perceptions of dissimilarity between anaemia-related items, including fatigue and medical items; the extent to which these items were perceived as important to health or likable; and qualitative information about gender norms.

Results

Cognitive maps and card sorting revealed that fatigue was conceptualised distinctly from items related to medical treatment and that perceptions around fatigue’s importance to health were low. Women from the focus groups reported that fatigue is a regular part of their daily life.

Conclusion

Our results indicate that fatigue is currently not an adequate cue to seek treatment, perhaps due to the normalisation of fatigue as a part of women’s daily life.
Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys
Authors: Rosta Judith , Bååthe Fredrik , Aasland Olaf G , Isaksson Rø Karin
Published: October 2020

Objectives

To explore and discuss the changes in the levels of work stress for Norwegian doctors in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia) from 2010 to 2019.

Design

Repeated questionnaire surveys in 2010, 2016 and 2019, where samples were partly overlapping.

Setting

Norway.

Participants

A representative sample of 1500–2200 doctors in different job positions. Response rates were 66.7% (1014/1520) in 2010, 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.

Main outcome measure

Validated 9-item short form of the ‘Effort–Reward Imbalance’ questionnaire. A risky level of work stress was defined as an effort/reward ratio above 1.0.

Analyses

Linear mixed models with estimated marginal means of job positions controlled for gender and age. Proportions with 95% CIs.

Results

From 2010 to 2016 and further to 2019, GPs reported a significant increase in levels on the effort scale (ES: 2.96, 3.25, 3.51) and significant decrease in levels on the reward scale (RS: 4.27, 4.05, 3.67). No significant changes were reported by hospital doctors (ES: 3.13, 3.10, 3.14; RS: 4.09, 3.98, 4.04), private practice specialists (ES: 2.58, 2.61, 2.59; RS: 4.32, 4.32, 4.30) and doctors in academia (ES: 2.63, 2.51, 2.52; RS: 4.09, 4.11, 4.14). The proportion of doctors with risky levels of work stress increased significantly for GPs (10.3%, 27.7%, 40.1%), but did not significantly change for hospital doctors (23.0%, 27.3%, 26.9%), private practice specialists (8.2%, 12.7%, 9.4%) and doctors in academia (11.9%, 19.0%, 16.4%).

Conclusion

During a 9-year period, the proportion of risky levels of work stress increased significantly for GPs but did not significantly change for other job positions. This may be partly due to changes in expectations of younger GPs and several healthcare reforms and regulations.
Effects of external inspections on sepsis detection and treatment: a stepped-wedge study with cluster-level randomisation
Authors: Husabø Gunnar , Nilsen Roy Miodini , Solligård Erik , Flaatten Hans Kristian , Walshe Kieran , Frich Jan C , Bondevik Gunnar Tschudi , Braut Geir Sverre , Helgeland Jon , Harthug Stig , Hovlid Einar
Published: October 2020

Objective

To evaluate the effects of external inspections on (1) hospital emergency departments’ clinical processes for detecting and treating sepsis and (2) length of hospital stay and 30-day mortality.

Design

Incomplete cluster-randomised stepped-wedge design using data from patient records and patient registries. We compared care processes and patient outcomes before and after the intervention using regression analysis.

Setting

Nationwide inspections of sepsis care in emergency departments in Norwegian hospitals.

Participants

7407 patients presenting to hospital emergency departments with sepsis.

Intervention

External inspections of sepsis detection and treatment led by a public supervisory institution.

Main outcome measures

Process measures for sepsis diagnostics and treatment, length of hospital stay and 30-day all-cause mortality.

Results

After the inspections, there were significant improvements in the proportions of patients examined by a physician within the time frame set in triage (OR 1.28, 95% CI 1.07 to 1.53), undergoing a complete set of vital measurements within 1 hour (OR 1.78, 95% CI 1.10 to 2.87), having lactate measured within 1 hour (OR 2.75, 95% CI 1.83 to 4.15), having an adequate observation regimen (OR 2.20, 95% CI 1.51 to 3.20) and receiving antibiotics within 1 hour (OR 2.16, 95% CI 1.83 to 2.55). There was also significant reduction in mortality and length of stay, but these findings were no longer significant when controlling for time.

Conclusions

External inspections were associated with improvement of sepsis detection and treatment. These findings suggest that policy-makers and regulatory agencies should prioritise assessing the effects of their inspections and pay attention to the mechanisms by which the inspections might contribute to improve care for patients.

Trial registration

NCT02747121.
Natalizumab versus fingolimod for patients with active relapsing-remitting multiple sclerosis: results from REVEAL, a prospective, randomised head-to-head study
Authors: Butzkueven Helmut , Licata Stephanie , Jeffery Douglas , Arnold Douglas L , Filippi Massimo , Geurts Jeroen JG , Santra Sourav , Campbell Nolan , Ho Pei-Ran
Published: October 2020

Objective

To directly compare the efficacy of natalizumab and fingolimod in patients with active relapsing-remitting multiple sclerosis.

Methods

This phase 4, randomised, rater- and sponsor-blinded, prospective, parallel-group, clinic-based head-to-head study was conducted at 43 sites in nine countries. Patients were randomised (1:1) to intravenous natalizumab 300 mg every 4 weeks or oral fingolimod 0.5 mg once daily for ≤52 weeks. Enrolment-related early study termination precluded assessment of the primary endpoint (evolution of new on-treatment gadolinium-enhancing (Gd+) lesions to persistent black holes). Unplanned exploratory analyses of secondary endpoints evaluated the effects of treatment on the development of new T1 Gd+ lesions and new/newly enlarging T2 lesions, lesion volumes and relapse outcomes.

Results

The intent-to-treat population comprised 108 patients (natalizumab, n=54; fingolimod, n=54); 63 completed ≥24 weeks of treatment. Due to the limited numbers of events and patients at risk, MRI and relapse outcomes were reported over up to 24 and 36 weeks, respectively. The mean number of new T1 Gd+ lesions was numerically lower with natalizumab than with fingolimod by 4 weeks; accumulation rates were 0.02 and 0.09 per week, respectively, over 24 weeks (p=0.004). The cumulative probability of developing ≥1 lesion at 24 weeks was 40.7% with natalizumab versus 58.0% with fingolimod (HR=0.60; 95% CI 0.31–1.16; p=0.126); the corresponding probabilities for ≥2 lesions were 11.5% vs 48.5% (HR=0.25; 95% CI 0.09–0.68; p=0.007). No significant between-group differences were observed for the other MRI outcomes at 24 weeks. The cumulative probability of relapse over follow-up was 1.9% with natalizumab versus 22.3% with fingolimod (HR=0.08; 95% CI 0.01–0.64; p=0.017). Adverse events were consistent with known safety profiles.

Conclusions

These results suggest that natalizumab is more efficacious than fingolimod in reducing multiple sclerosis relapses and T1 Gd+ lesion accumulation in patients with active disease.

Trial registration numbers

NCT02342704; EUCTR2013-004622-29-IT; Post-results.
Rapid ethnographic assessment of the COVID-19 pandemic April 2020 ‘surge’ and its impact on service delivery in an Acute Care Medical Emergency Department and Trauma Center
Authors: Palinkas Lawrence A , Whiteside Lauren , Nehra Deepika , Engstrom Allison , Taylor Mark , Moloney Kathleen , Zatzick Douglas F
Published: October 2020

Objectives

Assess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands.

Design

Rapid clinical ethnography of patient–provider encounters during an initial pandemic ‘surge’ conducted by a team of clinician–researchers using a structured protocol for qualitative data collection and analysis.

Setting

Level 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020.

Participants

Frontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients.

Results

We identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale.

Conclusions

Although limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.
Comparison of the detection rates for retinopathy of prematurity (ROP) of the 2013 Philippine Academy of Ophthalmology (PAO) Revised Philippine Guidelines and the 2005 PAO-Philippine Pediatric Society (PPS) Guidelines for ROP screening in the Philippine General Hospital: a 5-year review
Authors: Paulino Jose Antonio Tan , Santiago Alvina Pauline Dy , Santiago Darby Espiritu
Published: October 2020

Objectives

Compare the detection rates of the 2013 Philippine Academy of Ophthalmology (PAO) guidelines for retinopathy of prematurity (ROP) screening and the 2005 PAO-Philippine Pediatric Society guidelines in identifying infants who develop ROP in the 5-year study period in the Philippine General Hospital (PGH). Secondary objectives include determination of ROP prevalence; correlation of gestational age (GA), birth weight (BW) and other risk factors to ROP; and identification of the most common intervention.

Methods and analysis

Retrospective cross-sectional study of ROP records between 1 December 2013 and 30 November 2018 from the Medical Retina Service of the Department of Ophthalmology and Visual Sciences of the institution was studied. Variables with p value <0.05 were considered significant. STATA V.14 was used for all analysis.

Results

Only 851 of 898 infants screened for ROP were included in the study. Of these 698 would have been screened based on 2005 guidelines. All 118 infants with ROP were identified by both guidelines. Detection rate was higher using the 2005 than the 2013 guidelines (16.9% vs 13.3%, p value=0.0496). ROP prevalence was 9.7%. Among those with ROP, 70% have at least one identified risk factor, topped by sepsis, pneumonia, hyaline membrane disease, blood transfusion and oxygen supplementation. Only 8% required intervention consisting of laser, anti-vascular endothelial growth factor injection, surgery or in combination.

Conclusion

In PGH, no infants with ROP were missed using the 2005 recommendations. There was no added benefit of increasing threshold for BW and GA as recommended by the 2013 PAO guidelines. Screening guidelines should, however, be tailored to institutional needs, requirements and experience.
Prevalence and factors associated with HIV epidemic among female sex workers in Pakistan: results of the fifth round of integrated biological and behavioural surveillance
Authors: Emmanuel Faran , Achakzai Baseer Khan , Reza Tahira
Published: October 2020

Objectives

We examined data collected as part of the fifth round of integrated biological and behavioural surveillance to determine the prevalence and factors associated with HIV infection among female sex workers (FSWs) in Pakistan.

Methods

FSWs were defined as ‘all females, age 13 years and above, who receive money or goods in exchange for sexual services, regardless of the site of operation’. Data were collected between October 2016 and January 2017 in 18 cities using multistage sampling techniques to randomly select FSWs from spots facilitated by peers. Behavioural data were collected by interviewers using structured questionnaires, which was followed by obtaining finger prick blood samples tested for HIV using two rapid tests. Multivariate logistic regression analysis was done to assess independent associations of potential correlates using HIV status as dependent variable.

Results

We invited 5728 FSWs to participate, of which 68 refused to participate (refusal rate=1.2%). Of the 5660 FSWs who participated, 121 were HIV seropositive (weighted HIV prevalence 2.3%; 95% CI 1.9% to 2.7%) mostly concentrated within cities in Sindh. Multivariate analysis showed being uneducated/illiterate (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.4), directly dealing with clients without a pimp (aOR 1.8; 95% CI 1.1 to 2.8), non-use of condom with clients (aOR 1.8; 95% CI 1.1 to 2.8), having sexual contact with people who inject drugs (PWID) (aOR 2.2; 95% CI 1.3 to 3.7) and non-participation in HIV programmes (aOR 1.7; 95% CI 1.0 to 3.1) as factors independently associated with HIV seropositivity.

Conclusions

We found a weighted national HIV prevalence of 2.3% and identified factors independently associated with HIV in FSWs. The country needs to scale up HIV prevention programmes to improve coverage, prioritising FSWs who are illiterate, work independently and have PWID as sex partners. Emphasis should be laid on strategies to improve condom use with both regular and non-regular partners.