bluuebunny/crossref_metadata_2025 huggingface dataset:
Robotic Shoe: An Ankle Assistive Device for Gait Plantar Flexion Assistance
Authors: Schaller Marcus , Sorkhabadi Seyed Mostafa Rezayat , Zhang Wenlong
Published: August 2020

Gait disorders can be attributed to a variety of factors including aging, injury, and neurological disorders. A common disorder involves the ankle push-off phase of an individual’s gait, which is vital to their ability to walk and propel themselves forward. During the ankle push-off stage, plantar flexor muscles are required to provide a large amount of torque to propel the heel off the ground, thus a condition that compromises the strength of these muscles can greatly affect one’s walking ability. In order to rectify these issues, Ankle-Foot Orthoses (AFO) are used to provide support to a user’s ankle and assist with the force needed for heel off. This article introduces a robotic AFO which was developed with the intent of aiding during the heel-off stage. The proposed design utilizes the user’s body weight to extend constant force springs positioned parallel to the calf to replicate the muscular force generated in plantar flexion. The extended spring is held in place using a ratcheting mechanism which is released with a solenoid during heel up. Similar research has been conducted in which assistive AFO’s have been created, however little research has investigated the use of constant force springs in such devices. A healthy user tested the device on a treadmill and surface electromyography (sEMG) sensors were placed on the user’s plantar flexor muscles to monitor potential reductions in muscular activity resulting from the assistance provided by the AFO device. The data demonstrates the robotic shoe was able to assist during the heel-off stage and reduced activation in the plantar flexor muscles was evident from the EMG data collected.
Assessing Induced Emotions in Employees in a Workplace Setting Using Wearable Devices
Authors: Fortune Emma , Yusuf Yaqoub , Zornes Sarah , Loyo Lopez Jorge , Blocker Renaldo
Published: August 2020

A working environment which elicits positive emotions in employees is vital for employee retention, engagement and productivity. Wearable sensors provide the means to objectively measure the emotional responses of employees in the workplace in real-time. The study aim was to perform a preliminary investigation into the validity of two multimodal systems to classify employee’s emotional responses to positive, neutral or negative video stimuli: (1) using wearable electroencephalography (EEG) in combination with video-based facial expression analysis (FEA), and (2) using a wearable galvanic skin response (GSR) device in combination with video-based FEA. Five office employees each watched three short video clips at three time points during their regular work shifts while wearing EEG sensors on the forehead and GSR sensors on the middle and index fingers of their non-dominant hand with their face in view of a webcam. Russel’s circumplex model of affect was used to determine participant’s emotional responses to the video clips. The GSR device showed greater accuracy than the EEG device at detecting arousal responses to the video stimuli, with agreement, precision, and recall values of 87%, 100% and 80%, respectively, compared to 53%, 62%, and 80% for the EEG device. The FEA/EEG and FEA/GSR circumplex models were both able to accurately detect positive emotions elicited from video stimuli with levels of agreement and recall greater than 73%. Precision for the FEA/EEG model to detect positive stimuli was lower due to misclassification of 40% of both negative and neutral stimuli as positive. Precision values for both circumplex models were very low for detecting negative emotions. The results suggest that the EEG and GSR devices may be capable of detecting arousal when used alone, and detecting positive emotions when used in combination with video-based FEA in real-time in the workplace.
Real-Time Voice Activity Detection Using Neck-Mounted Accelerometers for Controlling a Wearable Vibration Device to Treat Speech Impairment
Authors: Dubey Saurav , Mahnan Arash , Konczak Jürgen
Published: August 2020

Speech analysis using microphones can be problematic for Voice Activity Detection (VAD) in the presence of background noise. This study explored the use of wearable accelerometers instead of microphones. We assessed if accelerometers placed on the neck can be part of a VAD system embedded in a wearable collar-like device that delivers vibro-tactile stimulation (VTS) to the larynx during speech as a therapy for patients with the voice disorder spasmodic dysphonia. Specifically, we aimed to a) find the ideal location for placing accelerometers to the neck, and b) develop a VAD algorithm that detects the onset and offset of speech. Six healthy adult participants (M/F = 3/3, age = 26 (5.1)) vocalized 20 sample sentences with and without VTS at three neck locations: 1) thyroid cartilage, 2) sterno-cleidomastoid, and 3) posterior neck above C7. Based on time-synchronized acceleration and audio signals, VAD algorithm identified the Number of Onsets of Speech and Total Time Voiced. The thyroid cartilage attachment location had over 90% accuracy detecting speech in both measures. The average accuracy of the sternocleidomastoid and C7 locations were below 75% and 15% respectively. VAD accuracy decreased with the presence of VTS trials at all locations. We conclude that accelerometer signals due to tissue motion at thyroid cartilage are most suitable for real-time VAD. These findings support the feasibility of accelerometer-based voice detection for the use in medical devices that target speech and voice disorders.
A New System to Objectively Measure Ankle Proprioception
Authors: Mahnan Arash , Holst-Wolf Jessica , Konczak Jürgen
Published: August 2020

Proprioceptive afferents from the ankle joint are essential feedback for maintaining balance. However, there is no widely accepted test or measurement system available for determining the proprioceptive accuracy of the human ankle joint. Here, we present a system with a novel hardware design that applies an established psychometric testing protocol that generates a Just-Noticeable-Difference (JND) threshold as a measure of ankle proprioceptive acuity at the end of testing. To establish the system validity, twelve healthy adult participants completed the assessment. Testing required 25 trials and took approximately 10 minutes to complete. We show exemplar data of the ankle JND threshold and the summary results for all twelve participants. This assessment has the potential to become a tool for clinicians to identify proprioceptive impairment at the ankle and to assess the efficacy of sensorimotor interventions for improving balance in clinical populations.
An Untethered Electro-Pneumatic Exosuit for Gait Assistance of People With Foot Drop
Authors: Salmeron Lizzette J. , Juca Gladys V. , Mahadeo Satesh M. , Ma Jiechao , Yu Shuangyue , Su Hao
Published: August 2020

Individuals with foot drop caused by stroke or cerebral palsy (CP) have a particular need for robotic ankle exoskeleton. This paper proposes an untethered soft robot using an origami actuator to lift the toes of the wearer. The weight, connections, and complex control of the system are reduced through mechanical design. A compact and portable pneumatic system is designed to perform suction and compression with a single pump. The load test of the actuator shows the capability of 300N in 30 kPa. An untethered, simple and affordable robotic ankle exoskeleton is developed with the pneumatic actuator. The wearer can finish its simple 3-step donning procedure within 1 min.
Research on Dynamics Performance of Two Grouped Virtual Track Train Based on Magic Formula Tire Model
Authors: Jimin Zhang , Chengping Wang , Hechao Zhou
Published: August 2020

The virtual track train is a new type of urban rail vehicle that combines some of the characteristics of bus, tram and light EMU. It is a special fusion of automobile and rail, also it will become a new attempt to alleviate the pressure of urban road traffic. The dynamic performance of the virtual track is also begun since its popularization and application. In this paper, based on the theory of rail vehicle dynamics and tire dynamics, the dynamic performance of two kinds of virtual track train (group A - 5 module and group B - 2 module) is simulated by using multi-rigid body software. Among them, the tire model adopts magic formula tire model, and the dynamic performance evaluation index is vertical stability (Sperling index) and smoothness (total weighted acceleration rms value). Through calculation and analysis, it can be obtained that the vertical stability and smoothness index of the group A are better than the group B under the condition of AW0 and AW2; The vertical stability and smoothness of group A and group B show a downward trend with the increase of speed is, the higher the speed, the worse the vertical stability and the smoothness are. The vertical stability of group A under two conditions the averageness is less than 2.5, the rms value of the total weighted acceleration is less than 0.315, which meet the requirements. The vertical stability of group B can meet the requirements. Its smoothness shows different conclusions under different operating conditions that AW0 can meet the requirements, but AW2 can’t.
Coefficients of Friction: Static Versus Dynamic
Authors: Huang Jack Youqin
Published: August 2020

This paper deals with the problem of static and dynamic (or kinetic) friction, namely the coefficients of friction for the two states. The coefficient of static friction is well known, and its theory and practice are commonly accepted by the academia and the industry. The coefficient of kinetic friction, however, has not fully been understood. The popular theory for the kinetic friction is that the coefficient of dynamic friction is smaller than the coefficient of static friction, by comparison of the forces applied in the two states. After studying the characteristics of the coefficient of friction, it is found that the comparison is not appropriate, because the inertial force was excluded. The new discovery in the paper is that coefficients of static friction and dynamic friction are identical. Wheel “locked” in wheel braking is further used to prove the conclusion.

The key to cause confusions between the two coefficients of friction is the inertial force. In the measurement of the coefficient of static friction, the inertial force is initiated as soon as the testing object starts to move. Therefore, there are two forces acting against the movement of the object, the frictional force and the inertial force. But in the measurement of the coefficient of kinetic friction, no inertial force is involved because velocity must be kept constant.
Considerations for Sensor Selection for Detecting Top-of-Rail (TOR) Lubrication
Authors: Mast Timothy , Neighborgall Campbell , Taheri Masood , Holton Carvel , Ahmadian Mehdi
Published: August 2020

Continued research into the development of prototype optics based Top-of-Rail (TOR) Lubricity sensors has led to the discovery of benefits and drawbacks of different optical sensing technologies. Sensors of many different types have been investigated for their ability to detect track lubricants including Light Detection and Ranging (LIDAR), laser, and LED emitters. The individual performances of these different methods do not always translate directly when adapted for track lubricity measurements. This paper intends to unpack some of these conclusions and their specific relationships to the application for Top-of-Rail condition based monitoring in a revenue service environment.

Railroads use rail lubricants to reduce curving forces that contribute to rail and wheel wear and to increase train efficiency. Top-of-Rail Friction Modifiers (TORFM) and flange grease are applied to the rail by train wheels passing through wayside applicators. TORFM is inherently different from flange grease in that it is an engineered lubricant designed to manage the coefficient of friction to an optimal value for traction and braking forces while reducing lateral forces that contribute to wheel and rail wear. While track lubricants provide a compelling benefit for the railroads, there is a fair amount of ambiguity as to how much should be applied to the track, how far they carry down the track from the point of application, and how long they last beyond the time of application. The empirical methods that are currently available are ad hoc, imprecise, and subject to a large amount of error. It is desired to have sensors that can provide some level of objective assessment of the amount of lubricant available on the rail. Such a sensor can be used to answer many of the tor lubrication questions that currently remain unanswered.

A wide array of laboratory tests are carried out in this study to highlight the ability of several different optical sensors to detect track lubricants in a variety of environmental conditions. These tests are designed to determine the feasibility of each sensor and highlight any issues that may arise during field application. The tests serve as a prelude to field testing the sensors in a revenue service environment. The results of the study indicate that precision optical methods are able to detect the presence of TORFM on the rail surface although some optical methods are more robust in their ability to perform in adverse conditions than others.
Simulation Evaluation of Fouled Ballast Thermal Characteristics
Authors: Tan Yongwen , Chen Yang , Hosseini Sayed-Mohammad , Ahmadian Mehdi
Published: August 2020

This study provides a simulation evaluation of the effect of fouling conditions on the thermal behavior of ballast for the use of railway tracks. Ballast fouling can result in a slurry pumped up to the surface, causing poor foundation strength, rotting of the ties, and other ill effects. To achieve a quick and convenient detection of ballast fouling, a thermal-based non-contacting technique has been proposed and becomes more and more attractive. However, the successful application of this thermal-based fouling-detection technology requires knowledge of the thermal characteristics of ballast, which have not been investigated in prior studies. The objective of this paper is to study the influence of fouling on the thermal behavior of ballast, using an analytical model developed based on one-dimensional conductive heat transfer. The effort to validate the developed model is also included. The general fouling conditions of the ballast — fouled with and without water — are studied through simulation. The simulation results show that, for the case of fouling without water, the ballast under different fouling conditions behaves differently from clean ballast at depths ranging from 0 to 12in under naturally-occurring daily ambient temperature changes, and that the temperature difference peaks at 4-in depth. In addition, increasing the amount of fouling results in less temperature variation in response to the ambient temperature changes. For the case of fouling with water, water is added into the 100% fouled ballast and comparisons are made between the ballasts with different water content. A similar pattern is observed, showing that increasing the amount of water results in a larger temperature difference at all depths considered. Moreover, the maximum temperature difference is observed at the top surface rather than the depth of 4-in as observed in the case of fouling without water.
Spectral cues and temporal integration during cylinder echo discrimination by bottlenose dolphins (Tursiops truncatus)
Authors: Branstetter Brian K. , Van Alstyne Kaitlin R. , Strahan Madelyn G. , Tormey Megan N. , Wu Teri , Breitenstein Rachel A. , Houser Dorian S. , Finneran James J. , Xitco Mark J.
Published: August 2020

Three bottlenose dolphins (Tursiops truncatus) participated in simulated cylinder wall thickness discrimination tasks utilizing electronic “phantom” echoes. The first experiment resulted in psychometric functions (percent correct vs wall thickness difference) similar to those produced by a dolphin performing the task with physical cylinders. In the second experiment, a wide range of cylinder echoes was simulated, with the time separation between echo highlights covering a range from <30 to >300 μs. Dolphin performance and a model of the dolphin auditory periphery suggest that the dolphins used high-frequency, spectral-profiles of the echoes for discrimination and that the utility of spectral cues degraded when the time separation between echo highlights approached and exceeded the dolphin's temporal integration time of ∼264 μs.
Atazanavir, Alone or in Combination with Ritonavir, Inhibits SARS-CoV-2 Replication and Proinflammatory Cytokine Production
Authors: Fintelman-Rodrigues Natalia , Sacramento Carolina Q. , Ribeiro Lima Carlyle , Souza da Silva Franklin , Ferreira André C. , Mattos Mayara , de Freitas Caroline S. , Cardoso Soares Vinicius , da Silva Gomes Dias Suelen , Temerozo Jairo R. , Miranda Milene D. , Matos Aline R. , Bozza Fernando A. , Carels Nicolas , Alves Carlos Roberto , Siqueira Marilda M. , Bozza Patrícia T. , Souza Thiago Moreno L.
Published: August 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is already responsible for far more deaths than previous pathogenic coronaviruses (CoVs) from 2002 and 2012. The identification of clinically approved drugs to be repurposed to combat 2019 CoV disease (COVID-19) would allow the rapid implementation of potentially life-saving procedures. The major protease (Mpro) of SARS-CoV-2 is considered a promising target, based on previous results from related CoVs with lopinavir (LPV), an HIV protease inhibitor.
Scarless Removal of Large Resistance Island AbaR Results in Antibiotic Susceptibility and Increased Natural Transformability in Acinetobacter baumannii
Authors: Godeux Anne-Sophie , Svedholm Elin , Lupo Agnese , Haenni Marisa , Venner Samuel , Laaberki Maria-Halima , Charpentier Xavier
Published: August 2020

With a great diversity in gene composition, including multiple putative antibiotic resistance genes, AbaR islands are potential contributors to multidrug resistance in
Acinetobacter baumannii
. However, the effective contribution of AbaR to antibiotic resistance and bacterial physiology remains elusive. To address this, we sought to accurately remove AbaR islands and restore the integrity of their insertion site. To this end, we devised a versatile scarless genome editing strategy.
Nitrite Production from Nitrate and Its Link with Lactate Metabolism in Oral
Veillonella
spp
Authors: Wicaksono Dimas Prasetianto , Washio Jumpei , Abiko Yuki , Domon Hitomi , Takahashi Nobuhiro
Published: August 2020

The prevalence of dental caries is still high around the world. Dental caries is initiated when the teeth are exposed to acid, such as lactic acid, produced via carbohydrate metabolism by acidogenic microorganisms.
Veillonella
species, which are among the major oral microorganisms, are considered to be beneficial bacteria due to their ability to convert lactic acid to weaker acids and to produce NO
2
–
from NO
3
–
, which is thought to be good for both oral and general health. Therefore, it is clear that there is a need to elucidate the biochemical characteristics of NO
2
–
production in
Veillonella
species. The significance of our research is that we have found that lactate metabolism is linked to NO
2
–
production by
Veillonella
species in the environment found in the oral cavity. This study suggests that
Veillonella
species are potential candidates for maintaining oral and general health.
Genetic and Phenotypic Factors Associated with Persistent Shedding of Shiga Toxin-Producing Escherichia coli by Beef Cattle
Authors: Blankenship Heather M. , Carbonell Samantha , Mosci Rebekah E. , McWilliams Karen , Pietrzen Karen , Benko Scott , Gatesy Ted , Grooms Daniel , Manning Shannon D.
Published: August 2020

Food animal reservoirs contribute to Shiga toxin-producing
Escherichia coli
(STEC) evolution via the acquisition of horizontally acquired elements like Shiga toxin bacteriophages that enhance pathogenicity. In cattle, persistent fecal shedding of STEC contributes to contamination of beef and dairy products and to crops being exposed to contaminated water systems. Hence, identifying factors important for STEC persistence is critical. This longitudinal study enhances our understanding of the genetic diversity of STEC types circulating in a cattle herd and identifies genotypic and phenotypic traits associated with persistence. Key findings demonstrate that multiple STEC types readily persist in and are transmitted across cattle in a shared environment. These dynamics also enhance the persistence of virulence genes that can be transferred between bacterial hosts, resulting in the emergence of novel STEC strain types. Understanding how pathogens persist and diversify in reservoirs is important for guiding new preharvest prevention strategies aimed at reducing foodborne transmission to humans.
The Intermediates in Branched-Chain Amino Acid Biosynthesis Are Indispensable for Conidial Germination of the Insect-Pathogenic Fungus Metarhizium
robertsii
Authors: Luo Feifei , Zhou Hongxia , Zhou Xue , Xie Xiangyun , Li You , Hu Fenglin , Huang Bo
Published: August 2020

Branched-chain amino acid (BCAA) metabolism plays a significant role in many biological activities beyond protein synthesis. Spore germination initiates the first stage of vegetative growth, which is critical for the virulence of pathogenic fungi. In this study, we demonstrated that the keto-acid reductoisomerase MrILVC, a key enzyme for BCAA biosynthesis, from the insect-pathogenic fungus
Metarhizium robertsii
is associated with conidial germination and fungal pathogenicity. Surprisingly, the germination of the Δ
MrilvC
mutant was restored when supplemented with the intermediates of BCAA metabolism rather than three BCAAs. The result was significantly different from that of plant-pathogenic fungi. Therefore, this report highlights that the intermediates in BCAA biosynthesis are indispensable for conidial germination of
M. robertsii
.
Heterogeneous Nuclear Ribonucleoprotein A1 (hnRNP A1) and hnRNP A2 Inhibit Splicing to Human Papillomavirus 16 Splice Site SA409 through a UAG-Containing Sequence in the E7 Coding Region
Authors: Zheng Yunji , Jönsson Johanna , Hao Chengyu , Shoja Chaghervand Shirin , Cui Xiaoxu , Kajitani Naoko , Gong Lijing , Wu Chengjun , Schwartz Stefan
Published: August 2020

Human papillomavirus type 16 (HPV16) belongs to the high-risk-group of HPVs and is causing a variety of anogenital cancers and head and neck cancer. The two HPV16 oncoproteins E6 and E7 prevent apoptosis and promote mitosis and are essential for completion of the HPV16 life cycle and for transformation of the infected cell and maintenance of malignancy. E6 and E7 are produced from two mRNAs that are generated in a mutually exclusive manner by alternative splicing. While E6 protein is made from the unspliced mRNA, E7 is made from the spliced version of the same pre-mRNA. Since sufficient quantities of both E6 and E7 are required for malignant transformation, this intricate arrangement of gene expression renders E6 and E7 expression vulnerable to external interference. Since antiviral drugs to HPV16 are not available, a detailed knowledge of the regulation of HPV16 E6 and E7 mRNA splicing may uncover novel targets for therapy.
Drug Resistance Mutation Frequency of Single-Genome Amplification-Derived HIV-1 Polymerase Genomes in the Cerebrospinal Fluid and Plasma of HIV-1-Infected Individuals under Nonsuppressive Therapy
Authors: St. Bernard Leslie , Abolade Jeremy , Mohri Hiroshi , Markowitz Martin , Evering Teresa H.
Published: August 2020

Several antiretroviral agents do not efficiently enter the CNS, and independent evolution of HIV-1 viral variants in the CNS and plasma can occur. We used single-genome amplification (SGA) in cross-sectional and longitudinal analyses to uniquely define both the identity and relative proportions of drug resistance mutations (DRMs) on individual HIV-1 polymerase genomes in the cerebrospinal fluid (CSF) and plasma in individuals with incomplete viral suppression and known neurocognitive status. Statistically significant differences in the ratio of DRMs in the CSF and plasma were readily found in those on nonsuppressive cART, and overrepresentation of DRMs in the CNS can occur. Although questions about the clinical significance of DRM discordance remain, in the quest for viral eradication, it is important to recognize that a significant, dynamic, compartment-based DRM ratio imbalance can exist, as it has the potential to go unnoticed in the setting of standard clinical drug resistance testing.
Evidence synthesis workshops: moving from face-to-face to online learning
Authors: McCaul Michael , Durao Solange , Kredo Tamara , Garner Paul , Young Taryn , Rohwer Anke
Published: August 2020

Postgraduate training is moving from face-to-face workshops or courses to online learning to help increase access to knowledge, expertise and skills, and save the cost of face-to-face training. However, moving from face-to-face to online learning for many of us academics is intimidating, and appears even more difficult without the help of a team of technologists. In this paper, we describe our approach, our experiences and the lessons we learnt from converting a Primer in Systematic Reviews face-to-face workshop to a 6-week online course designed for healthcare professionals in Africa. We learnt that the team needs a balance of skills and experience, including technical know-how and content knowledge; that the learning strategies needed to achieve the learning objectives must match the content delivery. The online approach should result in both building knowledge and developing skills, and include interactive and participatory approaches. Finally, the design and delivery needs to keep in mind the limited and expensive internet access in some resource-poor settings in Africa.
Effects of synbiotic supplementation on the components of metabolic syndrome in military personnel: a double-blind randomised controlled trial
Authors: Parastouei Karim , Saeidipoor S , Sepandi M , Abbaszadeh S , Taghdir M
Published: August 2020

Introduction

Metabolic syndrome comprises a set of risk factors for chronic diseases including abdominal obesity, increased fasting blood glucose (FBG), altered lipid profile and elevated blood pressure (BP). Due to high prevalence of metabolic syndrome and its complications in the military personnel, the relevant problems should be identified and controlled. Therefore, the present study was conducted to determine the effect of synbiotic supplements on the components of metabolic syndrome in the military personnel with metabolic syndrome.

Methodology

Sixty military personnel with metabolic syndrome were included in this double-blind randomised controlled clinical trial. During the intervention, they were asked to consume one capsule of synbiotic supplement or placebo per day for 8 weeks. Body Mass Index (BMI), waist circumference, BP, FBG and lipid profile were measured before and after the intervention.

Results

The results of the study showed that the synbiotic supplementation had a large significant adjusted effect on the BMI (Cohen’s d=0.82 (95% CI 0.29 to 1.34)). It also had a medium significant adjusted effect on the FBG (Cohen’s d=0.52 (95% CI 0.004 to 1.03)) as well as triglyceride (Cohen’s d=0.65 (95% CI 0.13 to 1.17)).

Conclusion

Findings of the study revealed that synbiotic supplementation may lead to a significant improvement in the BMI, triglyceride and FBG levels in the military personnel. Thus, consumption of synbiotic supplements is recommended as an adjuvant therapy in the military personnel with metabolic syndrome.
A critical appraisal of impact of compounding factors in limb salvage decision making in combat extremity vascular trauma
Authors: Ratnayake Amila S , Bala M , Fox C J , Jayatilleke A U , Thalgaspitiya S P B , Worlton T J
Published: August 2020

Objective

For more than half a century, surgeons who managed vascular injuries were guided by a 6-hour maximum ischaemic time dogma in their decision to proceed with vascular reconstruction or not. Contemporary large animal survival model experiments aimed at redefining the critical ischaemic time threshold concluded this to be less than 5 hours. Our clinical experience from recent combat vascular trauma contradicts this dogma with limb salvage following vascular reconstruction with an average ischaemic time of 6 hours.

Methods

During an 8-month period of the Sri Lankan Civil War, all patients with penetrating extremity vascular injuries were prospectively recorded by a single surgeon and retrospectively analysed. A total of 76 arterial injuries was analysed for demography, injury anatomy and physiology, treatment and outcomes. Subsequent statistical analysis was performed to evaluate the impact of independent variables to include; injury anatomy, concomitant venous, skeletal trauma, shock at presentation and time delay from injury to reconstruction.

Results

In this study, the 76 extremity arterial injuries had a median ischaemic time of 290 (IQR 225–375) min. Segmental arterial injury (p=0.02), skeletal trauma (p=0.05) and fasciotomy (p=0.03) were found to have a stronger correlation to subsequent amputation than ischaemic time.

Conclusions

Multiple factors affect limb viability following compromised distal circulation and our data show a trend towards various subsets of limbs that are more vulnerable due to inherent or acquired paucity of collateral circulation. Early identification and prioritisation of these limbs could achieve functional limb salvage if recognised. Further prospective research should look into the clinical, biochemical and morphological markers to facilitate selection and prioritisation of limb revascularisation.
How do we fight COVID-19? Military medical actions in the war against the COVID-19 pandemic in France
Authors: Pasquier Pierre , Luft A , Gillard J , Boutonnet M , Vallet C , Pontier J-M , Duron-Martinaud S , Dia A , Puyeo L , Debrus F , Prunet B , Beaume S , de Saint Maurice G , Meaudre E , Ficko C , Merens A , Raharisson G , Conte B , Dorandeu F , Canini F , Michel R , Ausset S , Escarment J
Published: August 2020

‘We are at war’, French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France. In just few weeks, the FMMS developed ad hoc medical capabilities to support national health authorities. It additionally developed adaptive, collective en route care via aeromedical and naval units and deployed a military intensive care field hospital. A COVID-19 crisis cell coordinated the French Armed Forces health management. The French Military Centre for Epidemiology and Public Health provided all information needed to guide the decision-making process. Medical centres of the French Armed Forces organised the primary care for military patients, with the widespread use of telemedicine. The Paris Fire Brigade and the Marseille Navy Fire Battalion emergency departments ensured prehospital management of patients with COVID-19. The eight French military training hospitals cooperated with civilian regional health agencies. The French military medical supply chain supported all military medical treatment facilities in France as well as overseas, coping with a growing shortage of medical equipment. The French Armed Forces Biomedical Research Institute performed diagnostics, engaged in multiple research projects, updated the review of the scientific literature on COVID-19 daily and provided expert recommendations on biosafety. Finally, even students of the French military medical academy volunteered to participate in the fight against the COVID-19 pandemic. In conclusion, in an unprecedented medical crisis, the FMMS engaged multiple innovative and adaptive actions, which are still ongoing, in the fight against COVID-19. The collaboration between military and civilian healthcare systems reinforced the shared objective to achieve the goal of ‘saving the greatest number’.
‘Repeat testing without having ‘the talk’ is not meaningful’—healthcare providers’ perceptions on finding a balance between Chlamydia trachomatis testing and primary prevention strategies. A qualitative study in Stockholm, Sweden
Authors: Nielsen Anna , de Costa Ayesha , Gemzell-Danielsson Kristina , Boman Jens , Salazar M
Published: August 2020

Objectives

Chlamydia trachomatis is a public health problem. Widespread testing and re-testing after a sexually transmitted infection (STI) is recommended to contain the epidemic and has been adopted by many countries. A recent study in Stockholm found that serial testing was used as a substitute for condom use by youth presenting at the Youth Health Clinics (YHC). The objectives of this study are to explore frontline healthcare provider’s perception of youth testing repeatedly for C. trachomatis as a substitute for condom use and their views on how this might be addressed.

Design

Qualitative study, in-depth interviews and analysed using content analysis.

Setting

YHC in Stockholm County, Sweden.

Participants

Healthcare providers (HCPs) working at the YHC.

Findings

Testing used as a method of prevention of STIs by youth has been a well-known phenomenon observed by HCPs at the YHC. Despite frustration regarding this behaviour, attitudes towards youth visiting the clinics repeatedly were overall positive. It is seen as an opportunity to reach youth with primary prevention strategies. Time for in-depth conversations with the youth is considered essential to understand the various reasons behind sexual risk-taking and to tailor counselling accordingly. Introducing concepts of self-compassion and self-respect in relation to sex is thought of as an effective intervention to improve sexual health among youth.

Conclusion

HCPs’ views on testing repeatedly for C. trachomatis as means of prevention, range widely from seeing this as ‘a positive strategy for C. trachomatis prevention’ to ‘a waste of healthcare resources’. There was a more unified view on how this should be addressed. Testing without having time to problematise sexual risk-taking was seen as meaningless. In depth, one-on-one counselling was deemed important. While scaling up accessibility to testing services, primary prevention strategies must not be neglected.
Understanding the experiences of long-term maintenance of self-worth in persons with type 2 diabetes in Japan: a qualitative study
Authors: Kato Asuka , Yoshiuchi Kazuhiro , Fujimaki Yuko , Fujimori Shin , Kobayashi Yuka , Yamada Tomohide , Kobayashi Masatoshi , Izumida Yoshihiko , Suzuki Ryo , Yamauchi Toshimasa , Kadowaki Takashi
Published: August 2020

Objective

Persons with type 2 diabetes are often stigmatised for having what is considered a lifestyle-related disease. Accordingly, some blame themselves for their condition, resulting in feelings of low self-worth that ultimately impact their self-management behaviours. However, there are no studies examining why some do not blame themselves for their condition and manage to maintain their self-worth in relation to their illness. This study aimed to explore an understanding of how such persons experience the maintenance of self-worth in relation to their illness over the lifelong course of treatment.

Design

A cross-sectional qualitative study. Face-to-face semistructured interviews were conducted with a purposive sampling strategy. The data was analysed using a qualitative descriptive method that involved concurrent data collection and constant comparative analysis.

Setting

Two tertiary-level hospitals in Japan.

Participants

Thirty-three outpatients with type 2 diabetes who currently had good glycaemic control but had previously had poor glycaemic control.

Results

Three themes explaining the maintenance of self-worth were identified: (1) Participants gained ‘control’ over their illness by living a ‘normal life.’ They found a way to eat preferred foods, dine out with family and friends, travel and work as usual; (2) Participants discovered the positive aspects of type 2 diabetes, as they felt ‘healthier’ from the treatment and felt a sense of security and gratitude for the care they received from healthcare professionals; (3) Participants discovered a new sense of self-worth by moving towards goals for type 2 diabetes treatment and experienced inner growth through positive lifestyle choices.

Conclusions

The process of restoring and maintaining self-worth should be brought to the attention of healthcare professionals in diabetes care. These professionals could help patients discover positive self-representations through diabetes treatment (eg, a realisation that one does not lack self-control) and could aid in increasing patient engagement in diabetes self-management.
Ethnographic investigation of patient–provider communication among African American men newly diagnosed with prostate cancer: a study protocol
Authors: Palmer Nynikka R , Shim Janet K , Kaplan Celia P , Schillinger Dean , Blaschko Sarah D , Breyer Benjamin N , Pasick Rena J
Published: August 2020

Introduction

In the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient–provider communication contributes to suboptimal care, which can be exacerbated by patients’ limited health literacy, providers’ lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making.

Methods and analysis

Using an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients’ understanding of their diagnoses and treatment options, sources of support in decision-making, patient–provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients’ experiences and providers’ perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data.

Ethics and dissemination

To our knowledge, this is the first study to examine in-depth patient–provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.
Real-world outcomes comparison among adults with atrial fibrillation undergoing catheter ablation with a contact force porous tip catheter versus a second-generation cryoballoon catheter: a retrospective analysis of multihospital US database
Authors: Costea Alexandru , Goldstein Laura , Maccioni Sonia , Kalsekar Iftekhar , Khanna Rahul
Published: August 2020

Objective

To compare real-world clinical and economic outcomes among atrial fibrillation (AF) patients undergoing cardiac ablation with the contact force-sensing porous tip THERMOCOOL SMARTTOUCH SF (STSF) catheter versus the Arctic Front Advance Cryoballoon (AFA-CB) catheter.

Design

Retrospective, observational cohort study.

Setting

Premier Healthcare Database (PHD), between 1 September 2016 and 30 June 2018.

Participants

Patients with AF (≥18 years) were included if they had an index ablation procedure performed using the STSF catheter or AFA-CB catheter at a US hospital that consistently provided inpatient and outpatient data to PHD in the 12-month preindex period. Using 1:1 propensity score matching, patient groups were matched on study covariates.

Primary and secondary outcome measures

Cost, length of stay (LOS), readmissions, direct current cardioversion (DCCV) and reablation outcomes were compared between matched cohorts of STSF and AFA-CB patients.

Results

A total of 3015 patients with AF met the study criteria, of which 1720 had ablation using the STSF catheter and 1295 had ablation using the AFA-CB catheter. In the propensity-matched sample, patients receiving ablation with the STSF catheter had ~17% lower total costs (US$23 096 vs US$27 682, p≤0.0001) and ~27% lower supply costs (US$10 208 vs US$13 816, p≤0.0001) versus patients receiving ablation with the AFA-CB catheter. A significantly lower likelihood of 4-month to 6-month cardiovascular-related readmission (OR 0.460, 95% CI 0.220 to 0.959) was associated with the STSF catheter versus the AFA-CB catheter. No significant differences in LOS, room and board cost, 4-month to 6-month all-cause and AF-related readmissions, DCCV and reablation were observed among technologies. Sensitivity analysis restricting patient sample by provider ablation volume demonstrated similar results.

Conclusion

Lower index ablation total and supply costs were observed among patients with AF undergoing cardiac catheter ablation using the STSF catheter versus the AFA-CB catheter.
Comparison of wide field imaging by nurses with indirect ophthalmoscopy by ophthalmologists for retinopathy of prematurity: a diagnostic accuracy study
Authors: Athikarisamy Sam Ebenezer , Lam Geoffrey Christopher , Ross Stuart , Rao Shripada Cuddapah , Chiffings Debbie , Simmer Karen , Bulsara Max K , Patole Sanjay
Published: August 2020

Objectives

Retinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina with the potential to cause irreversible blindness. Timely screening and treatment of ROP are critical. Neonatal nurses trained in wide field digital retinal photography (WFDRP) for screening may provide a safe and effective strategy to reduce the burden of ophthalmologists in performing binocular indirect ophthalmoscopy (BIO). The objective of the study was to determine the diagnostic accuracy of WFDRP in the diagnosis of referral warranting ROP (RWROP).

Design

Prospective diagnostic accuracy study.

Setting

A tertiary neonatal intensive care unit in Perth, Western Australia.

Participants

Preterm infants who fulfilled the Australian ROP screening criteria (gestational age (GA) <31 weeks, birth weight (BW) <1250 g).

Intervention

Sets of 5–6 images per eye (index test) were obtained within 24–48 hours prior to or after the BIO (reference standard), and uploaded onto a secured server. A wide field digital camera (RetCam, Natus, Pleasanton, California, USA) was used for imaging. A paediatric ophthalmologist performed the BIO. The ophthalmologists performing BIO versus reporting the images were masked to each other’s findings.

Primary outcome

The area under the receiver operating characteristic (ROC) curve was used as a measure of accuracy of WFDRP to diagnose RWROP.

Results

A total of 85 infants (mean BW; 973.43 g, mean GA; 29 weeks) underwent a median of two sessions of WFDRP. There were 188 episodes of screening with an average of five images per eye. WFDRP identified RWROP in 7.4% (14/188 sessions) of examinations. In one infant, BIO showed bilateral plus disease and WFDRP did not pick up the plus disease. WFDRP image interpretation had a sensitivity of 80%, specificity of 94.5% for the detection of RWROP. The ‘area under the ROC curve’ was 88% when adjusted for covariates.

Conclusions

WFDRP by neonatal nurses was feasible and effective for diagnosing RWROP in our set up.

Trial registration number

ACTRN12616001386426.
Frailty in major trauma study (FRAIL-T): a study protocol to determine the feasibility of nurse-led frailty assessment in elderly trauma and the impact on outcome in patients with major trauma
Authors: Jarman Heather , Crouch Robert , Baxter Mark , Cole Elaine , Dillane Bebhinn , Wang Chao
Published: August 2020

Introduction

The burden of frailty on older people is easily recognisable by increasing mortality and morbidity, longer hospital stays and adverse discharge locations. In the UK, frailty screening has recently become part of the best practice commissioning tariff within National Health Service England, yet there is no evidence or consensus as to who should carry out this assessment or within which time frame. As major trauma is an increasing burden for older people, there is a need to focus clinician’s attention on early identification of frailty in the emergency department (ED) in patients with major trauma as a way to underpin frailty specific major trauma pathways, to optimise recovery and improve patient experience. Throughout the patient with major trauma pathway, nurses are perhaps best placed to conduct timely clinical assessments working with the patient, family and multidisciplinary team to influence ongoing care. This study aims to determine the feasibility of nurse-led assessment of frailty in patients aged 65 years or more admitted to major trauma centres (MTCs).

Methods and analysis

This is a prospective observational study conducted across five UK MTCs, enrolling 370 participants over 9 months. The primary aim is to determine the feasibility of nurse-led frailty assessment in MTC EDs in patients aged 65 years or more following traumatic injury. The prevalence of frailty and the best assessment tool for use in the ED will be determined. Other outcome measures include quality of life and frailty assessment 6 months after injury, mortality and discharge outcomes.

Ethics and dissemination

The study was given ethical approval by the Social Care Research Ethics Committee (REC no 19/IEC08/0006). Findings will be published in scientific journals and presented to national and international conferences.

Trial registration number

ISRCTN10671514.