bluuebunny/crossref_metadata_2025 huggingface dataset:
In-Plane and Out-of-Plane Elastodynamics of Thin Rings and Seals
Authors: Turnbull R. , Rahmani R. , Rahnejat H.
Published: April 2019

Thin curved rings used mostly as seals, including in internal combustion engines undergo complex elastodynamic behavior when subjected to a combination of normal radial loading and tangential shear with friction. In turn, their complex modal behavior often results in loss of sealing, increased friction, and power loss. This paper presents a new finite difference approach to determine the response of thin incomplete circular rings. Two interchangeable approaches are presented; one embedding mass and stiffness components in a unified frequency-dependent matrix, and the other making use of equivalent mass and stiffness matrices for the ring structure. The versatility of the developed finite difference formulation can also allow for efficient modification to account for multiple dynamically changing ring support locations around its structure. Very good agreement is observed between the numerical predictions and experimental measurements, particularly with new precision noncontact measurements using laser Doppler vibrometry. The influence of geometric parameters on the frequency response of a high performance motorsport engine's piston compression ring demonstrates the degree of importance of various geometrical parameters on ring dynamic response.
A Design for Additive Manufacturing Ontology to Support Manufacturability Analysis
Authors: Kim Samyeon , Rosen David W. , Witherell Paul , Ko Hyunwoong
Published: April 2019

Design for additive manufacturing (DFAM) provides design freedom for creating complex geometries and guides designers to ensure the manufacturability of parts fabricated using additive manufacturing (AM) processes. However, there is a lack of formalized DFAM knowledge that provides information on how to design parts and how to plan AM processes for achieving target goals. Furthermore, the wide variety of AM processes, materials, and machines creates challenges in determining manufacturability constraints. Therefore, this study presents a DFAM ontology using the web ontology language (OWL) to semantically model DFAM knowledge and retrieve that knowledge. The goal of the proposed DFAM ontology is to provide a structure for information on part design, AM processes, and AM capability to represent design rules. Furthermore, the manufacturing feature concept is introduced to indicate design features that are considerably constrained by given AM processes. After developing the DFAM ontology, queries based on design rules are represented to explicitly retrieve DFAM knowledge and analyze manufacturability using Semantic Query-enhanced Web Rule Language (SQWRL). The SQWRL rules enable effective reasoning to evaluate design features against manufacturing constraints. The usefulness of the DFAM ontology is demonstrated in a case study where design features of a bracket are selected as manufacturing features based on a rule development process. This study contributes to developing a reusable and upgradable knowledge base that can be used to perform manufacturing analysis.
A Physically Consistent Reduced Order Model for Plasma Aeroelastic Control on Compressor Blades
Authors: Motta Valentina , Malzacher Leonie , Bicalho Civinelli de Almeida Victor , Phan Tien Dat , Liebich Robert , Peitsch Dieter , Quaranta Giuseppe
Published: April 2019

Plasma actuators may be successfully employed as virtual control surfaces, located at the trailing edge (TE) of blades, both on the pressure and on the suction side, to control the aeroelastic response of a compressor cascade. Actuators generate an induced flow against the direction of the freestream. As a result, actuating on the pressure side yields an increase in lift and nose down pitching moment, whereas the opposite is obtained by operating on the suction side. A properly phased alternate pressure/suction side actuation allows to reduce vibration and to delay the flutter onset. This paper presents the development of a linear frequency domain reduced order model (ROM) for lift and pitching moment of the plasma-equipped cascade. Specifically, an equivalent thin airfoil model is used as a physically consistent basis for the model. Modifications in the geometry of the thin airfoil are generated to account for the effective chord and camber changes induced by the plasma actuators, as well as for the effects of the neighboring blades. The model reproduces and predicts correctly the mean and the unsteady loads, along with the aerodynamic damping on the plasma equipped cascade. The relationship between the parameters of the ROM with the flow physics is highlighted.
Dynamic Burst Pressure of Cylindrical Explosion Containment Vessels
Authors: Chen Zhanfeng , Yan Sunting , Jin Zhijiang
Published: April 2019

Cylindrical explosion containment vessels (ECVs) are widely applied in transportation, nuclear engineering, public security, and scientific research fields to ensure the safety of the staff and equipment. In this paper, a cylindrical ECV model under a nonuniformly explosive load was established. The nonuniformly explosive load is simplified as parabolic pressure acting on the internal wall of the ECV. And then, based on the stress function method and boundary conditions, an analytical solution of the ECV subjected to the parabolic load was obtained. Next, the dynamic burst pressure equation of the ECV under the explosive load was obtained. In the end, the accuracy of the dynamic burst pressure equation was evaluated by comparing with the finite element method (FEM) under different pulse duration. The results demonstrated that the equation can accurately predict the dynamic burst pressure of the ECV. In addition, our researches can provide a benchmark for approximate or numerical solutions. It is rewarding to analyze the failure problem and evaluate the safety and integrity of the pipe and vessels under a nonuniformly explosive load.
Computational Simulation of the Thermal Performance of a Solar Air Heater Integrated With a Phase Change Material
Authors: Bubnovich Valeri , Reyes Alejandro , Díaz Macarena
Published: April 2019

The performance of a solar collector with wax as a phase change material (PCM) located in a set of staggered pipes configuration was simulated computationally in this work. For the solar radiation of Chile, the accumulation of heat in the PCM system and the heat release at different time intervals were analyzed during the process of energy capture in summer: (a) without wax and with airflow, (b) with wax and without airflow, and (c) with wax and with airflow. Furthermore, the effects of solar radiation (summer and winter) airflow in the collector were analyzed on the performance of the system. The simulation results show that the use of a PCM in a solar air heater allows to store greater amounts of energy and it helps to extend the period of time when the air coming out of the collector has an elevated temperature. By increasing the airflow rate, the efficiency of the system increases and also the energy released to the air to be absorbed.
Rheological Properties and Stability Characteristics of Biochar-Algae-Water Slurry Fuels Prepared by Wet Milling
Authors: Liu Pengfei , Zhu Mingming , Zhang Zhezi , Zhang Dongke
Published: April 2019

This study was aimed to understand the rheological properties and stability characteristics of biochar-algae-water (BAW) slurry fuels prepared by wet milling. A pine sawdust biochar and a chlorella vulgaris algae were used in preparing the slurry fuels. The BAW slurries were formulated by mixing the biochar, algae, de-ionized water, lignosulfonic acid sodium salt, and then the mixture was ball-milled for various times. The BAW slurries with a constant solid loading of 45 wt % were prepared with varied algae proportion in algae/biochar mixture. The apparent viscosity and stability of BAW slurries were measured. It was found that D50 of the particles of the solid in the slurries decreased with increasing milling time. The viscosity of the slurries decreased first and then increased as milling time increased, reaching a minimal value when D50 of the solid was between 3 and 7 μm. The lowest viscosity of BAW slurries achieved at a given solid loading increased with increasing the algae proportion in the solid. The BAW slurries showed better stability at higher algae proportions due to enhanced flocculation.
Crack Growth Behavior of Full-Scale Turbine Attachment Under Combined High and Low Cycle Fatigue
Authors: Hu Dianyin , Yan Lin , Gao Ye , Mao Jianxing , Wang Rongqiao
Published: April 2019

Turbine attachments in the aero-engine are generally subjected to combined high and low cycle fatigue (CCF) loadings, i.e., low cycle fatigue (LCF) loading due to centrifugal and thermal loading stresses superimposed to the aerodynamically induced high cycle fatigue (HCF) loading. The primary focus of this study is to predict the crack growth life for the actual full-scale turbine attachment through experimentally examining the crack growth behavior under CCF loading at elevated temperature. The crack closure effect was first investigated by using the corner-notched (CN) specimen cut from the turbine attachment since the stress state of CN specimen is more similar to turbine attachment than compact tension (CT) specimen. Employing digital image correlation (DIC) technique, the level of crack closure of CN specimen was clarified under different stress ratios (R) for LCF loading. Afterward, a CCF crack growth model for the full-scale turbine attachment was proposed, which takes the crack closure effect, time-independent crack increment, and transient vibrational analysis into account. In order to verify the proposed method, a Ferris wheel system was established to conduct CCF test on the full-scale turbine attachment at elevated temperature. This study provides an effective methodology to predict the fatigue crack growth (FCG) life of full-scale turbine attachment under CCF loading.
On the Periodically Unsteady Interaction of Wakes, Secondary Flow Development, and Boundary Layer Flow in An Annular Low-Pressure Turbine Cascade: An Experimental Investigation
Authors: Sinkwitz Martin , Winhart Benjamin , Engelmann David , di Mare Francesca , Mailach Ronald
Published: April 2019

The experimental results reported in this contribution address the time-dependent impact of periodically unsteady wakes on the development of profile and end wall boundary layers and consequently on the secondary flow system. Experimental investigations are conducted on an annular 1.5 stage axial turbine rig at Ruhr-Universität Bochum’s Chair of Thermal Turbomachines and Aeroengines. The object under investigation is a modified T106 profile low-pressure turbine (LPT) stator row at a representative exit flow Reynolds number of 200,000. By making use of an annular geometry instead of a linear cascade, the influence of curvilinear end walls, nonuniform, increasing pitch across the span and radial flow migration can be represented. Incoming wakes are generated by a variable-speed driven rotor equipped with cylindrical bars. Special emphasis is put on the wake-induced recurrent formation, suppression, weakening, and displacement of individual vortices and separated flow regimes. For this, based on a comprehensive set of time-resolved measurement data, the interaction of impinging bar wakes and boundary layer flow and thus separation and its periodic manipulation along the passage end walls and on the blade suction surface are studied within the frequency domain.
Ultrasound as the first imaging method in severe lung disease. Considerations about a case of pulmonary tuberculosis and review of the literature
Authors: Gavrila Iulia Laura , Badea Radu Ion , Jude Claudia , Socaciu Mihai Adrian , Comsa Mihai , Badea Alexandru Florin
Published: April 2019

Abdominal ultrasound (US) performed as a “primary imaging procedure” is an important diagnostic tool in gastroenterol-ogy. Expanding the routine investigation to the lower thoracic region might sometimes accelerate the diagnosis in inconclusive manifestations such as pulmonary pathology.US is a valuable tool in evaluating patients with breathing difficulties, chest pain, hypoxia, or chest trauma. This paper presents the particular situation of a patient hospitalized in the gastroenterology depart-ment, where the US identified significant pulmonary alterations and changed the final diagnosis from a gastrointestinal disease to pleuro-pulmonary tuberculosis. A brief review of literature is also included, in relation to chest US.
Comparative Analysis of African and Asian Lineage-Derived Zika Virus Strains Reveals Differences in Activation of and Sensitivity to Antiviral Innate Immunity
Authors: Esser-Nobis Katharina , Aarreberg Lauren D. , Roby Justin A. , Fairgrieve Marian R. , Green Richard , Gale Michael
Published: April 2019

Zika Virus (ZIKV), discovered in 1947, is divided into African and Asian lineages. Pandemic outbreaks caused by currently emerging Asian lineage strains are accompanied by high rates of neurological disorders and exemplify the global health burden associated with this virus. Here we compared virological and innate immunological aspects of two ZIKV strains from the Asian lineage, an emerging Brazilian strain and a less-pathogenic Cambodian strain, and the prototypic African lineage ZIKV strain from Uganda. Compared to the replication of other ZIKV strains, the replication of ZIKV Brazil was less sensitive to the antiviral actions of interferon (IFN), while infection with this strain induced weaker and delayed innate immune responses
in vitro
. Our data suggest that ZIKV Brazil directs a passive strategy of innate immune evasion that is reminiscent of a stealth virus. Such strain-specific properties likely contribute to differential pathogenesis and should be taken into consideration when choosing virus strains for future molecular studies.
Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review
Authors: Kehr Jascha , Binfield Alex , Maxwell Fraser , Hornung Tim , Skinner Jonathan R
Published: April 2019

Objective

Guidelines state that verapamil is contraindicated in infants. This is based on reports of cardiovascular collapse and even death after rapid intravenous administration of verapamil in infants with supraventricular tachycardia (SVT). We wish to challenge this contraindication for the specific indication of verapamil sensitive ventricular tachycardia (VSVT) in infants.

Design

Retrospective case series and critical literature review.

Setting

Hospitals within New Zealand.

Patients

We present a series of three infants/young children with VSVT or ‘fascicular VT’.

Results

Three children aged between 8 days and 2 years presented with tachycardia 200–220 beats per minute with right bundle brunch block and superior axis. Adenosine failed to cardiovert and specialist review diagnosed VSVT. There were no features of cardiovascular shock. Verapamil was given as a slow infusion over 10–30 min (rather than as a push) and each successfully cardioverted without incident. Critical review of the literature reveals that cardiovascular collapses were associated with a rapid intravenous push in cardiovascularly compromised infants and/or infants given other long-acting antiarrhythmics prior to verapamil.

Conclusions

Verapamil is specifically indicated for the treatment of fascicular VT, and for this indication should be used in infancy, as well as in older children, as first-line treatment or after failure of adenosine raises suspicion of the diagnosis. We outline how to distinguish this tachycardia from SVT and propose a strategy for the safe intravenous slow infusion of verapamil in children, noting that extreme caution is necessary with pre-existing ventricular dysfunction.
National registry for sudden unexpected deaths of infants and children in England: why do we need one and do families want one?
Authors: Matthews Emma , Blair Peter , Sisodiya Sanjay , Jones Stuart , Sebire Neil , Behr Elijah , Fleming Peter
Published: April 2019

The sudden and unexpected death of an infant or child is devastating. An inability to explain why an infant or child died is difficult to accept for both families and professionals. No reliable national dataset exists to estimate precisely how many infants and children die unexpectedly each year in England. This lack of accurate epidemiological data belies the scale of this public health problem. Detailed controlled observational studies of infant deaths identifying risk factors and providing evidence-based advice for parents has seen a dramatic reduction in incidence over the last 30 years by almost 80% but greater knowledge is needed if future deaths of infants and older children are to be prevented and families optimally supported. We propose that a national registry of sudden unexpected deaths in infancy and childhood would accurately determine incidence, identify unknown risk factors and highlight good care practices, ensuring these can be standardised nationally. For such a project to be successful, however, parents must be at the heart of it. We held a consultation day between families, professionals and supporting charities (The Lullaby Trust, Child Bereavement UK, SUDC UK and CRY) to seek opinion on the desire for a registry and how best to ensure families are engaged. Here, we summarise our rationale for a registry and the feedback we received from attendees regarding their views of the proposal and the practical aspects of administering it.
Hunter syndrome with persistent thrombocytopenia
Authors: Panigrahi Inusha , Dhanorkar Manoj , Didel Siyaram , Koganti Raja Ashok
Published: April 2019

A case of Hunter syndrome, 6½-year-old boy presented with persistent thrombocytopenia and bleeding diathesis. However, cytopenia is not a usual presentation in patients with mucopolysaccharidosis II. After ruling out other causes of severe thrombocytopenia, a clinical possibility of chronic Epstein-Barr virus (EBV) infection was considered. He was treated with intravenous immunoglobulin for refractory thrombocytopenia and intracranial bleed. This was followed by oral prednisolone. The EBV serology was found positive. Platelet counts gradually recovered and no recurrence of bleeds was observed. EBV infection usually causes haematological abnormalities, mainly atypical lymphocytosis, which is a feature of infectious mononucleosis, and uncomplicated cases often present with mild decreases in platelet counts. Severe thrombocytopenia is an extremely rare complication of acute or chronic EBV infection. In Asians, EBV infection should be considered in children presenting with thrombocytopenia, bleeding diathesis and anaemia along with organomegaly.
Loeffler’s endocarditis with isolated left ventricular involvement on cardiac MRI
Authors: Kumar Pramod , Chandrashekhara Sheragaru Hanumanthappa , Kumar Sanjeev , Malhi Amarinder Singh
Published: April 2019

Loeffler endocarditis is an uncommon restrictive cardiomyopathy associated with eosinophilia and endomyocardial fibrosis causing diastolic restriction, predominantly involving the right ventricle. Cardiac MRI plays a crucial role in early detection of disease. Early disease usually responds well to corticosteroids. We describe a case of Loeffler endocarditis with isolated left ventricular involvement on MRI in a young male having hypereosinophilia.
MDS with 5q deletion and rarecKITpositive mastocytosis: a diagnostic and therapeutic challenge
Authors: Sanders Daniel Steven , Fennell Thomas , Chisti Mohammad Muhsin
Published: April 2019

A patient with a diagnosis of myelodysplastic syndrome (MDS) with isolated 5q deletion underwent repeat bone marrow biopsy to assess haematological response after 6 months of initial lenalidomide therapy. Subsequent bone marrow biopsies revealed persistent MDS with del(5q) in addition to a small atypical mast cell population with >25% of mast cells with spindle-shaped morphology and immunohistochemistry characteristics consistent with mastocytosis. Molecular testing on the bone marrow was positive forcKITD816V and the patient was diagnosed with systemic mastocytosis (SM) with an associated haematological neoplasm. MDS with SM is well known to be associated; however, to the best of our knowledge, only one prior case report identifies MDS with del(5q) and associatedcKITD816V positive mastocytosis. While the exact clonal origin of both chromosomal aberrations is unclear, this case illustrates the therapeutic efficacy of lenalidomide in a patient with MDS with del(5q) and rarely associatedcKITpositive SM.
Is ivabradine a wonder drug for atypical POTS?
Authors: Cheema Muhammad Arslan , Zain Muhammad Abdullah , Ullah Waqas , Cheema Khadija
Published: April 2019

Syncope is a sudden loss and gain of consciousness. Traditionally, it is caused by the abnormalities of neurological, cardiac or vasovagal systems. We present a case of a 19-year-old woman presenting with recurrent syncopal episodes with no apparent cause. Examination and investigations were unremarkable for any aetiology except positive tilt tests for postural orthostatic tachycardia syndrome. The purpose of this report is to make physicians aware of the unique presentation of this rare aetiology with recurrent syncopal episodes and the novel management approach.
Complex encephalopathy arising from the combination of opioids and gabapentin
Authors: Singh Harpreet , Handa Richa , Kak Vivek , Wasilewski Alicja
Published: April 2019

The interactions between opioids and gabapentin are more clinically relevant than ever. Prescriptions dispensed for gabapentin increased from 39 million in 2012 to 64 million in 2018 in the USA and are ever increasing. Authors present a challenging case of these interactions. A 58-year-old man presented to the emergency department with acute respiratory failure and altered mental status. He was on high dose opioids and gabapentin as prescription medications. Despite full intensive care support and resolution of his respiratory failure with non-invasive positive pressure ventilation, the patient did not regained consciousness. After ruling out other causes, the diagnosis of gabapentin withdrawal was considered. Gabapentin was administered by a nasogastric tube that quickly resulted in a reversal of his symptoms. We concluded that severe gabapentin withdrawal should be considered in patients on higher doses of gabapentin when it is stopped abruptly. In such patients, gabapentin should be replaced. As most patients are unable to swallow in this situation and intravenous formulation is not available, nasogastric tube can be used for replacement.
Lemierre’s syndrome: a disguised threat
Authors: Alves Sérgio , Stella Lorena , Carvalho Isabel , Moreira Diana
Published: April 2019

Lemierre’s syndrome is a potentially severe disease characterised by suppurative thrombophlebitis of the internal jugular vein and subsequent disseminated septic embolisation. The profile of this syndrome declined in the mid-20th century, coinciding with the introduction of antibiotics. Currently, lack of awareness of this condition delays appropriate treatment and worsens prognosis. We report a case of Lemierre’s syndrome in a 12-year-old girl.
Pleuroparenchymal fibroelastosis (PPFE) treated with lung transplantation and review of the literature
Authors: Ali Muhammad Sajawal , Ramalingam Vijaya Sivalingam , Haasler George , Presberg Kenneth
Published: April 2019

A 26-year-old woman presented with a 15-year history of non-progressive dyspnoea. Chest imaging showed bilateral apical pleural and parenchymal scarring, pleural thickening and bronchiectasis. Pulmonary function tests showed a moderate restrictive defect. Non-invasive workup was non-revealing; therefore, the patient was referred for video-assisted thoracic surgery and lung biopsy. Histopathology revealed pleural thickening and, subpleural parenchymal fibrosis and elastic tissue deposition. Lung parenchyma further away from the pleura was well preserved. Based on these findings, the patient was diagnosed with pleuroparenchymal fibroelastosis (PPFE). Since PPFE is a progressive disorder without effective medical therapies, and given our patient’s worsening symptoms, she underwent bilateral lung transplantation. It has been almost 4 years since the lung transplantation, our patient continues to do well. To the best of our knowledge, to date, this is the longest follow-up reported for a PPFE patient undergoing lung transplantation.
Male occult triple-negative breast cancer
Authors: Alsayed Basma , Abdulla Hussain Adnan , Alaskar Hadi , Dhaif Ali
Published: April 2019

Male breast cancer is a rare but important condition accounting for only 1% of breast cancer worldwide and less than 1% of all male malignancies. Occult male breast cancer is an extremely rare type of male breast cancer that manifests as axillary metastases without an identifiable breast lesion. We report a case of triple-negative occult male breast cancer who underwent modified radical mastectomy.
Crohn’s disease initiated with extraintestinal features
Authors: Chang Jeffrey , Li Chia-Cheng , Achtari Marina , Stoufi Eleana
Published: April 2019

Crohn’s disease (CD) is a multifactorial, chronic immune-mediated disorder. The oral cavity is involved in 0.5% to 20% of the patients with CD. Oral manifestations of CD are sometimes nonspecific and can be overlooked by the clinicians. These manifestations may precede intestinal symptoms and can serve as indicators for early diagnosis. To increase awareness and to contribute to the standard intervention, here we report a paediatric case with persistent idiopathic swelling of the lower lip and perianal fistula. Microscopic examinations revealed multiple non-necrotising granulomas with chronic inflammation, oedema and lymphangiectasia. The patient was treated with metronidazole 500 mg and ciprofloxacin 500 mg twice a day for one month. The perioral lesions were managed with topical 0.03% tacrolimus and oral prednisone 10 mgtwice a day for one month, followed by a tapered regimen of 10 mg/day for another month. The patient’s symptoms improved without full remission at the 6-month follow-up.
Screening for coeliac disease in children and adults living in a slum of Dhaka, Bangladesh
Authors: Gazi Md. Amran , Das Subhasish , Mahfuz Mustafa , Hasan Md. Mehedi , Hossain Md. Shabab , Fahim Shah Mohammad , Alam Md. Ashraful , Noor Zannatun , Gilchrist Carol A , Petri William A , Rahman M Masudur , Mazumder Ramendra Nath , Haque Rashidul , Sarker Shafiqul Alam , Ahmed Tahmeed
Published: April 2019

Background and objective

Serological screening with a confirmation through biopsy has improved the understanding of coeliac disease (CD) epidemiology worldwide. Prevalence of CD in Bangladesh is not yet explored and therefore, we aimed to assess the seroprevalence of CD in slum-dwelling malnourished children and adults in Dhaka.

Methods

Serum samples were collected from three different cohorts: stunted (length-for-age Z-scores (LAZ) <−2) and at risk of stunting children (LAZ <−1 to −2) and malnourished adults (body mass index <18.5 kg/m2). Samples from all the participants were assessed for anti-tissue transglutaminase antibody (tTG-IgA) and total serum IgA by ELISA. Positive tTG-IgA and randomly selected low IgA values were reconfirmed using anti-tTG-IgG and gliadin IgG ELISA. CD was diagnosed when second screening tests were found positive and the participants were further investigated by small bowel biopsy.

Results

A total of 818 participants (240 stunted, 272 at risk of stunting children and 306 malnourished adults) were enrolled in the study. Overall, anti-tTG-IgA was positive in 5/818 (0.6%; 95% CI 0.25% to 1.46%). Of the five positive cases, anti-tTG-IgG and gliadin IgG were found positive in only one participant. Duodenal biopsy of positive participant revealed characteristic lesions of CD. Randomly selected low IgA values were found negative in tTG-IgG and gliadin IgG for all the participants. No participant was found total IgA deficient.

Conclusion

The incidence of coeliac autoimmunity is low in malnourished slum dwellers regardless of age in Bangladesh. It is important to investigate the nationwide prevalence to reveal the definite picture.
The impact and cost-effectiveness of user fee exemption by contracting out essential health package services in Malawi
Authors: Zeng Wu , Sun Daxin , Mphwanthe Henry , Huan Tianwen , Nam Jae Eun , Saint-Firmin Pascal , Manthalu Gerald , Sharma Suneeta , Dutta Arin
Published: April 2019

Objectives

To examine the impact and cost-effectiveness of user fee exemption by contracting out essential health package services to Christian Health Association of Malawi (CHAM) facilities through service-level agreements (SLAs) to inform policy-making in Malawi.

Methods

The analysis was conducted from the government perspective. Financial and service utilisation data were collected for January 2015 through December 2016. The impact of SLAs on utilisation of maternal and child health (MCH) services was examined using propensity score matching and random-effects models. Subsequently, the improved services were converted to quality-adjusted life years (QALYs) gained, using the Lives Saved Tool (LiST), and incremental cost-effectiveness ratios (ICERs) were generated.

Findings

Over the 2 years, a total of $1.5 million was disbursed to CHAM facilities through SLAs, equivalent to $1.24 per capita. SLAs were associated with a 13.8%, 13.1%, 19.2% and 9.6% increase in coverage of antenatal visits, postnatal visits, delivery by skilled birth attendants and BCG vaccinations, respectively. This was translated into 434 lives saved (95% CI 355 to 512) or 11 161 QALYs gained (95% CI 9125 to 13 174). The ICER of SLAs was estimated at $134.7/QALYs gained (95% CI $114.1 to $164.7).

Conclusions

The cost per QALY gained for SLAs was estimated at $134.7, representing 0.37 of Malawi’s per capita gross domestic product ($363). Thus, MCH services provided with Malawi’s SLAs proved cost-effective. Future refinements of SLAs could introduce pay for performance, revising the price list, streamlining the reporting system and strengthening CHAM facilities’ financial and monitoring management capacity.
‘Who assisted with the delivery of (NAME)?’ Issues in estimating skilled birth attendant coverage through population-based surveys and implications for improving global tracking
Authors: Radovich Emma , Benova Lenka , Penn-Kekana Loveday , Wong Kerry , Campbell Oona Maeve Renee
Published: April 2019

The percentage of live births attended by a skilled birth attendant (SBA) is a key global indicator and proxy for monitoring progress in maternal and newborn health. Yet, the discrepancy between rising SBA coverage and non-commensurate declines in maternal and neonatal mortality in many low-income and middle-income countries has brought increasing attention to the challenge of what the indicator of SBA coverage actually measures, and whether the indicator can be improved. In response to the 2018 revised definition of SBA and the push for improved measurement of progress in maternal and newborn health, this paper examines the evidence on what women can tell us about who assisted them during childbirth and methodological issues in estimating SBA coverage via population-based surveys. We present analyses based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted since 2015 for 23 countries. Our findings show SBA coverage can be reasonably estimated from population-based surveys in settings of high coverage, though women have difficulty reporting specific cadres. We propose improvements in how skilled cadres are classified and documented, how linkages can be made to facility-based data to examine the enabling environment and further ways data can be disaggregated to understand the complexity of delivery care. We also reflect on the limitations of what SBA coverage reveals about the quality and circumstances of childbirth care. While improvements to the indicator are possible, we call for the use of multiple indicators to inform local efforts to improve the health of women and newborns.
Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India
Authors: Faruqui Neha , Martiniuk Alexandra , Sharma Abhishek , Sharma Chanchal , Rathore Bhumika , Arora Ramandeep Singh , Joshi Rohina
Published: April 2019

Introduction

Limited access to essential medicines (EMs) for treating chronic diseases is a major challenge in low-income and middle-income countries. Although India is the largest manufacturer of generic medicines, there is a paucity of information on availability, price and affordability of anti-neoplastic EMs, which this study evaluates.

Methods

Using a modified WHO/Health Action International methodology, data were collected on availability and price of 33 strength-specific anti-neoplastic EMs and 4 non-cancer EMs. Seven ‘survey anchor’ hospitals (4 public and 3 private) and 32 private-sector retail pharmacies were surveyed. Median price ratios (MPRs) were calculated by comparing consumer prices with international reference prices (IRPs).

Results

On average, across survey anchor areas (hospital and private-sector retail pharmacies combined), the mean availability of anti-neoplastic EMs and non-cancer medicines was 70% and 100%, respectively. Mean availability of anti-neoplastic EMs was 38% in private-sector retail pharmacies, 43% in public hospital pharmacies and 71% in private hospital pharmacies. Median MPR of lowest-priced generic versions was 0.71 in retail pharmacies. The estimated cost of chemotherapy medicines needed for treating a 30 kg child with standard-risk leukaemia was INR 27 850 (US$442) and INR 17 500 (US$278) for Hodgkin’s lymphoma, requiring 88 and 55 days’ wages, respectively, for the lowest paid government worker.

Conclusion

Most anti-neoplastic EMs are found in survey anchor areas, however, mean availability was less than non-cancer medicines; not meeting the WHO target of 80%. Medicine prices were relatively low in New Delhi compared with IRPs. However, the cost of chemotherapy medicines seems unaffordable in the local context.
Long-term outcomes of urinary tract infection (UTI) in Childhood (LUCI): protocol for an electronic record-linked cohort study
Authors: Lugg-Widger Fiona V , Angel Lianna , Cannings-John Rebecca , Jones Hywel , Lau Mandy , Butler Christopher , Francis Nick A , Hay Alastair D , Heginbothom Margaret , Hood Kerenza , Paranjothy Shantini , Vandervoort Judith , Hughes Kathryn
Published: April 2019

Introduction

Current guidelines advise the prompt diagnosis and treatment of urinary tract infection (UTI) in children to improve both short and longer term outcomes. However, the risk of long-term complications following childhood UTI is unclear.

UTI is relatively common but difficult to diagnose in children as symptoms are non-specific. Diagnosis requires a urine sample, but sampling is difficult and infrequent, and it is not clear if sampling should be given greater priority in primary care. The LUCI study will assess the short, medium and longer term outcomes of childhood UTI associated with routine and systematic sampling practices.

Methods and analysis

Two data sets will be established. The first will consist of routinely collected data (hospital, general practice (GP), microbiology) from children born and resident in Wales, linked via the Secure Anonymised Information Linkage (SAIL) Databank (an ‘e-cohort’). Urine sampling in this data set reflects normal practice ‘routine sampling’. Outcomes (including renal scarring, hypertension, end-stage renal failure, hospital admissions, GP consultations, antibiotic prescriptions) for children with at least one UTI confirmed with microbiological culture (mcUTI) or no mcUTI before the age of 5 will be compared.

The second will combine data from two prospective observational studies (‘DUTY’ and ‘EURICA’) employing systematic urine sampling for children presenting to primary care with acute, undifferentiated illness, linked to routine data via SAIL (Wales) and NHS Digital (England). Outcomes (as above, plus features of mcUTI) for children with an mcUTI in this data set, identified through systematic urine sampling, will be compared with those with an mcUTI identified through routine urine sampling (data set 1).

Ethics and dissemination

The study protocol has been approved by NHS Wales Research Ethics Committee and the Health Research Authority’s Confidentiality Advisory Group. Methods of innovative study design and findings will be disseminated through peer-review journals and conferences. Results will be of interest to clinical and policy stakeholders in the UK.
Comparison between different instruments for measuring health-related quality of life in a population sample, the WHO MONICA Project, Gothenburg, Sweden: an observational, cross-sectional study
Authors: Krantz Emily , Wide Ulla , Trimpou Penelope , Bryman Inger , Landin-Wilhelmsen Kerstin
Published: April 2019

Objective

The general aim was to meet the need for empirical comparative studies of health-related quality of life (HRQoL) assessment instruments, by evaluating and comparing the psychometric properties and results of three different, widely used, generic HRQoL instruments in a population sample. The specific aims were to evaluate the subscales of the different instruments that measure the same domain and to assess the association between the HRQoL measures and a single-item self-rated health scale.

Design

An observational cross-sectional study.

Setting

A population-based sample from Gothenburg, Sweden, was studied in 2008 in the WHO MONItoring of trends and determinants for CArdiovascular disease.

Participants

A total of 414 subjects were included, 77% women, age range 39–78 years.

Interventions

The Nottingham Health Profile (NHP), the Short Form-36 questionnaire (SF-36), the Psychological General Well-Being Index (PGWB) and a self-rated health scale were used.

Outcome measures

Scores were analysed for their psychometric properties, internal consistency (Cronbach’s α), construct validity (Spearman’s rank correlations and R2coefficients) and discriminative ability for the presence of self-rated ill-health.

Results

PGWB and SF-36 had higher Cronbach’s α scores than NHP. All correlations calculated between the subscales that were conceptually similar were significant (p<0.01). All subscales could differentiate the presence of self-rated ill-health according to the self-rated health scale (p<0.001). The self-rated health scale correlated strongly with all of the three HRQoL instruments used.

Conclusions

There was a high concordance between the instruments within each domain that was conceptually similar. All three HRQoL instruments (PGWB, SF-36 and NHP) could discriminate the presence of self-rated ill-health. The simple and quick self-rated health scale correlated strongly with the more time-consuming PGWB, SF-36 and NHP. The result supports the existence of a strong association between the self-rated health scale and HRQoL in the general population.
Effectiveness of an antenatal maternal supplementation with prebiotics for preventing atopic dermatitis in high-risk children (the PREGRALL study): protocol for a randomised controlled trial
Authors: Cabridain Clémentine , Aubert Hélène , Kaeffer Bertrand , Badon Virginie , Boivin Marion , Dochez Vincent , Winer Norbert , Faurel-Paul Elodie , Planche Lucie , Riochet David , Maruani Annabel , Perrotin Franck , Droitcourt Catherine , Lassel Linda , Tching-Sin Martine , Rogers Natasha K , Bodinier Marie , Barbarot Sebastien
Published: April 2019

Introduction

Atopic dermatitis (AD) is a chronic inflammatory disease affecting 10%–15% of children in Europe. There is a need for new primary preventive therapeutic strategies in at-risk populations. Recent research has indicated that atopic diseases are associated with a disrupted gut microbial ‘balance’ in early life raising the possibility that interventions which yield optimal patterns of microflora could improve host’s health. Prebiotics, sugars with immunomodulatory properties that stimulate the diversity of the digestive microbiota, are ideal candidates for such research. So far, most clinical trials have focused on improving infant gut colonisation postnatally. However, prenatal life is a crucial period during which different tolerance mechanisms are put in place. We aim to determine whether antenatal prebiotics supplementation prevents AD in high-risk children.

Methods and analysis

This is a randomised, multicentre, double-blind, trial to evaluate the effectiveness of antenatal prebiotic maternal supplementation (galacto-oligosaccharide/inulin) in pregnant women versus placebo on the occurrence of AD at 1 year of age in at-risk children (defined as having a maternal history of atopic disease). Participating women will be randomised to daily ingestion of a prebiotics or placebo (maltodextrin) from 20 weeks’ gestation until delivery. The primary outcome is the prevalence of AD at 1 year of age, using the version of the UK Working Party Diagnostic Criteria optimised for preventive studies. Key secondary endpoints are AD severity, quality of life and prebiotics tolerance. The target sample size is 376 women (188 patients per group) which will provide 80% power to detect a 33% reduction of the risk of AD in the verum group (α=0.05). The primary analysis will be based on the intention-to-treat principle.

Ethics and dissemination

Results will be presented in peer-reviewed journals and at international conferences. Ethics approval for the study was obtained from the institutional ethical review board of ‘Comité de Protection des Personnes Sud Ouest—Outre-Mer III’ of the University Hospital Centre of Bordeaux (2017/13).

Trial registration number

NCT03183440; Pre-results.
Perception of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement of authors publishing reviews in nursing journals: a cross-sectional online survey
Authors: Tam Wilson W S , Tang Arthur , Woo Brigitte , Goh Shawn Y S
Published: April 2019

Objective

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement has been developed as a guideline for reporting systematic reviews and meta-analyses. Despite the prevalent use of the PRISMA statement in medicine and nursing, no studies have examined authors’ perception of it. The purpose of this study is to explore the perception of the PRISMA statement of authors who published reviews, meta-analyses, or both in nursing journals.

Design

Cross-sectional descriptive study.

Methods

An online survey was conducted among authors who published reviews, meta-analyses, or both in nursing journals between 2011 and 2017. The selected authors’ email addresses were extracted from the PUBMED database. A questionnaire—with a 10-point Likert scale (1—not important at allto 10—very important)—was developed to elicit their responses regarding their perception of not only the PRISMA statement as a whole, but also the individual items therein.

Results

Invitations were sent to 1960 valid email addresses identified, with 230 responses (response rate: 11.7%) and 181 completed responses (completion rate: 9.2%). The average perceived importance of the PRISMA statement was 8.66 (SD=1.35), while the perceived importance for the individual items ranged from 7.74 to 9.32. Six items were rated significantly higher than the average rating, whereas one item was rated significantly lower.

Conclusion

Most respondents perceived the PRISMA statement as important. Items related to information sources, selection, search-flow presentation, summary of findings, limitations and interpretation were deemed more important while the registration was deemed less so.
Randomised controlled trial of simulation-based education for mechanical cardiopulmonary resuscitation training
Authors: Coggins Andrew R , Nottingham Cameron , Byth Karen , Ho Kevin R , Aulia Felicia A , Murphy Margaret , Shetty Amith L , Todd Anna , Moore Nathan
Published: April 2019

Introduction

Mechanical cardiopulmonary resuscitation (M-CPR) is increasingly used in the management of cardiac arrest. There are no previously reported randomised studies investigating M-CPR training. This study of newly trained M-CPR providers hypothesised that a brief simulation-based intervention after 4 months would improve M-CPR performance at 6 months.

Methods

This study used a simulated ‘in situ’ cardiac arrest model. The M-CPR device used was a proprietary Lund University Cardiac Assist System 3 machine (Physio Control, Redmond, Washington, USA). Standardised baseline training was provided to all participants. Following training, baseline performance was assessed. The primary outcome measure was the time taken to initiate M-CPR and the secondary outcome was performance against a checklist of errors. Participants were then randomised to intervention group (simulation training) or control group (routine clinical use of M-CPR). After 6 months the outcome measures were reassessed. Comparative statistical tests used an intention-to-treat analysis.

Results

112 participants were enrolled. The intervention group (n=60) and control group (n=52) had similar demographic characteristics. At the 6-month assessment, median time to M-CPR initiation was 27.0 s (IQR 22.0–31.0) in the intervention group and 31.0 s (IQR 25.6–46.0) in the control group (p=0.003). The intervention group demonstrated fewer errors compared with controls at 6 months (p<0.001)

Conclusion

In this randomised study of approaches to M-CPR training, providers receiving additional simulation-based training had higher retention levels of M-CPR skills. Therefore, when resuscitation skills are newly learnt, provision follow-up training should be an important consideration.
Measuring the impact of step down intermediate care on delayed discharge: an interrupted time series analysis
Authors: Levin Kate A , Crighton Emilia
Published: April 2019

Background

Intermediate care (IC) acts as a bridging service between hospital and home, for those deemed medically fit for discharge but who are delayed in hospital. The aim of this study was to measure the effect of IC and a 72-hour discharge target on days delayed.

Methods

Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6-month phase-in period, using segmented linear regression. Inverclyde and West Dunbartonshire (IWD) was a control. Autoregressive and moving average terms were included in the model, as well as a Fourier term to adjust for seasonality.

Results

Prior to IC, rate of days delayed increased in both Glasgow City and the rest of Scotland. There was a large reduction in rate of days delayed in Glasgow during the phase-in period, greater than the rest of Scotland but comparable with that observed in IWD, with subsequent increases thereafter. Adjusting for changes in IWD, the impact of IC and the discharge target in Glasgow City was a level change of −15.20 (95% CI −17.52 to –12.88) and a trend change of −0.29 (95% CI −0.55 to –0.02). This is equivalent to a predicted reduction due to IC of −16.04 days delayed per 1000 population per month, in June 2016, and a relative reduction of 35%.

Conclusion

IC and the 72-hour discharge target were associated with a reduction in days delayed. Rate of days delayed continued to increase over time, although at a slower rate than if IC had not been implemented.
Role of the Deployed Aeromedical Response Team Squadron (DARTS) on Operation RUMAN
Authors: Woolley Rebecca
Published: April 2019

In September 2017, the British Government called on the military to deliver aid and provide assistance to British Overseas Territories in the Caribbean affected by the devastating category 5 Hurricane, Irma.1 The military and humanitarian operation, named Op RUMAN, saw British military personnel from all services deploy at short notice to assess damage, reinstate vital infrastructure and help islanders get back on their feet as quickly as possible. Members of the Deployed Aeromedical Response Team Squadron (DARTS) were among the first troops deployed to the region. The aim of this paper is to describe the role of DARTS within this Op.