bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Aircraft Engine Gas Path Diagnostic Methods Through ProDiMES
Authors: Koskoletos Anastasios O. , Aretakis Nikolaos , Alexiou Alexios , Romesis Christoforos , Mathioudakis Konstantinos
Published: July 2018

Propulsion diagnostic method evaluation strategy (ProDiMES) offers an aircraft engine diagnostic benchmark problem where the performance of candidate diagnostic methods is evaluated while a fair comparison can be established. In the present paper, the performance evaluation of a number of gas turbine diagnostic methods using the ProDiMES software is presented. All diagnostic methods presented here were developed at the Laboratory of Thermal Turbomachinery of the National Technical University of Athens (LTT/NTUA). Component, sensor, and actuator fault scenarios that occur in a fleet of deteriorated twin-spool turbofan engines are considered. The performance of each diagnostic method is presented through the evaluation metrics introduced in the ProDiMES software. Remarks about each methods performance as well as the detectability and classification rates of each fault scenario are made.
In Vivo Quantification of Regional Circumferential Green Strain in the Thoracic and Abdominal Aorta by Two-Dimensional Spiral Cine DENSE MRI
Authors: Wilson John S. , Zhong Xiaodong , Hair Jackson , Robert Taylor W. , Oshinski John N.
Published: July 2018

Regional tissue mechanics play a fundamental role in the patient-specific function and remodeling of the cardiovascular system. Nevertheless, regional in vivo assessments of aortic kinematics remain lacking due to the challenge of imaging the thin aortic wall. Herein, we present a novel application of displacement encoding with stimulated echoes (DENSE) magnetic resonance imaging (MRI) to quantify the regional displacement and circumferential Green strain of the thoracic and abdominal aorta. Two-dimensional (2D) spiral cine DENSE and steady-state free procession (SSFP) cine images were acquired at 3T at either the infrarenal abdominal aorta (IAA), descending thoracic aorta (DTA), or distal aortic arch (DAA) in a pilot study of six healthy volunteers (22–59 y.o., 4 females). DENSE data were processed with multiple custom noise reduction techniques including time-smoothing, displacement vector smoothing, sectorized spatial smoothing, and reference point averaging to calculate circumferential Green strain across 16 equispaced sectors around the aorta. Each volunteer was scanned twice to evaluate interstudy repeatability. Circumferential Green strain was heterogeneously distributed in all volunteers and locations. The mean spatial heterogeneity index (standard deviation of all sector values divided by the mean strain) was 0.37 in the IAA, 0.28 in the DTA, and 0.59 in the DAA. Mean (homogenized) peak strain by DENSE for each cross section was consistent with the homogenized linearized strain estimated from SSFP cine. The mean difference in peak strain across all sectors following repeat imaging was −0.1±2.3%, with a mean absolute difference of 1.7%. Aortic cine DENSE MRI is a viable noninvasive technique for quantifying heterogeneous regional aortic wall strain and has significant potential to improve patient-specific clinical assessments of numerous aortopathies, as well as to provide the lacking spatiotemporal data required to refine patient-specific computational models of aortic growth and remodeling.
Corrosion in Iron and Steel T91 Caused by Flowing Lead–Bismuth Eutectic at 400 °C and 10−7 Mass% Dissolved Oxygen
Authors: Schroer Carsten , Tsisar Valentyn , Durand Adeline , Wedemeyer Olaf , Skrypnik Aleksandr , Konys Jürgen
Published: July 2018

Specimens produced from technically pure iron and two different heats of ferritic/martensitic steel T91 are investigated after exposure to oxygen-containing flowing lead–bismuth eutectic (LBE) at 400 °C, 10−7 mass% dissolved oxygen, and flow velocity of 2 m/s, for exposure times between around 1000 and 13,000 h. The occurring phenomena are analyzed and quantified using metallographic cross sections prepared after exposure. While pure iron mostly shows solution underneath or in the absence of a detached and buckled oxide scale, solution in T91 occurs only in a few spots on the sample surface. However, in the case of one of the investigated heats, a singular event of exceptionally severe solution-based corrosion is observed. The results are compared especially with findings at 450 and 550 °C and otherwise similar conditions as well as austenitic steels tested in the identical experimental run.
Nonlinear Analysis of Human Movement Dynamics Offers New Insights in the Development of Motor Control During Childhood
Authors: Bisi Maria Cristina , Tamburini Paola , Panebianco Giulia Pacini , Stagni Rita
Published: July 2018

When aiming at assessing motor control development, natural walking (NW), and tandem walking (TW) are two locomotor tasks that allow analyzing different characteristics of motor control performance. NW is the reference locomotor task, expected to become more and more automatic with age. TW is a nonparadigmatic task used in clinics to highlight eventual impairments and to evaluate how a child deals with a new challenging motor experience. This work aims at investigating motor development in school-aged children, by assessing quantitatively their performance during TW and NW. Eighty children (6–10 years) participated in the study. Trunk acceleration data and nonlinear measures (recurrence quantification analysis (RQA), and multiscale entropy (MSE)) were used to characterize trunk postural control and motor complexity. The results were analyzed with respect to age and standard clinical assessment of TW (number of correct consecutive steps), by means of Spearman correlation coefficients. RQA and MSE allowed highlighting age-related changes in both postural control of the trunk and motor complexity, while classic standard assessment of TW resulted uniformly distributed in the different age groups. The present results suggest this quantitative approach as relevant when assessing the motor development in schoolchildren and complementary to standard clinical tests.
Making Fuel While the Sun Shines
Authors: Ozalp Nesrin , Sattler Christian , Klausner James F. , Miller James E.
Published: July 2018

This article discusses the potential use of solar energy in various industrial processes. Solar energy is usually considered in terms of making electricity, but it also has the potential to replace fossil fuels in the production of liquid fuels, and in driving endothermic industrial processes. Solar thermochemical processes are feasible, and a solar power concentration process that harnesses sunlight's infrared energy is the best-suited technology for making solar fuels a reality. However, in spite of their appeal, solar thermochemical processes also have the same drawback that direct solar power has: the transient and diurnal nature of sunshine. Fluctuations of available solar radiation – over the course of a day, across different types of weather, and from season to season – present considerable challenges for potential solar-thermal systems. While there are economically affordable and commercially available solutions to some of those problems, substantial research and development is still required.
Mooring System Integrity in Exposed Locations and Narrow Channels
Authors: Flory John , Banfield Steve
Published: July 2018

Larger vessels are now being moored at terminals which are exposed to high waves and in channels which are subjected to passing-ship-induced forces. These situations increase mooring line wear and loads and sometimes cause mooring failures.

This paper will discuss some of the associated problems and some of the solutions.

Use of high-performance fiber ropes instead of wire ropes can decrease mooring loads. These mooring line ropes can be handled by fewer people. The risk of injuries is greatly reduced.

When properly cared for, these fiber ropes last longer than wires in service. But fiber ropes are vulnerable to abrasion damage, especially in vessel fairleads. Special nylon fairlead liners are now available to eliminate this wear problem.

Fiber rope tails are used on mooring lines to increase stretch and reduce peak loads. Greater vessel motions at exposed location moorings have caused cyclic loading fatigue in nylon tails. Industry recommendations have now been clarified to allow the use of longer nylon tails and of polyester tails. More durable nylon tails are now available.

Larger vessels entering into and mooring along confined channels increase the risks of passing ship problems. Passing-ship induced forces increase with vessel size and with the greater speed at which larger vessels must pass in order to maintain steerage.

Computer mooring analyses should be conducted to ensure that mooring arrangements are adequate. These analyses should account for effects of waves at exposed locations and should include appropriate passing-ship forces.

This paper will be of interest to designers and operators of large vessels and of marine terminals intended for such vessels.

Paper published with permission.
Application of ASME Section VIII Division 3 to Compressed Natural Gas Transport
Authors: Sims J. Robert
Published: July 2018

Marine transport of liquefied natural gas (LNG) is well established and extensive precedents for the design of the ships and tanks exist. Fewer precedents exist for the transport of compressed natural gas (CNG). This paper describes the application of composite (fiber) wrapped pressure vessels constructed to the requirements of ASME Section VIII Division 3, Alternative Rules for Construction of High Pressure Vessels (Division 3) to pressure vessels for marine CNG transport. Since the density of CNG is much lower than the density of LNG, efficient transport requires that the pressure vessels be as light as possible while ensuring pressure integrity. The advantages of a composite fiber wrap and of Division 3 construction for this application will be discussed.

Paper published with permission.
Mutually Responsible Competency: Dynamic Positioning Proficiency Development
Authors: Fuhrmann Chad N.
Published: July 2018

DP operators are trained to be reactionary — to know what to do, how to do it, and when to do it — but understanding why certain actions are performed and the potential consequences is lacking. Further, the policies and procedures enacted at the management and regulatory levels fail to address many potential risks, further endangering personnel, the environment, assets, and operations. It is therefore an industry responsibility to monitor and develop the competencies of not only DP operational personnel, but also of shore side management at all levels, and to ensure the applicability of policies and procedures that affect DP operations.

Paper published with permission.
Understanding the Human Element in LNG Bunkering
Authors: Stokes Joanne , Moon Garry , Bend Rachael , Owen Douglas , Wingate Kyle , Waryas Ed
Published: July 2018

Scenario based learning that places you in the various roles within the LNG bunkering process. Understand the knowledge requirements necessary to maximise safety in LNG bunkering operations. Discover how to assess the competency gap between crew, terminal personnel and port staff to mitigate the human element risks in LNG bunkering. Work together to utilize this analysis to determine training that builds upon existing skills, optimizes training times and harmonises with those involved in the operations.

Paper published with permission.
Towing Vessel Safety: Risk-Based Maintenance and Inspection of Towing Vessel Machinery and Systems
Authors: Eckhardt Bartley J. , Squicciarini Peter D.
Published: July 2018

Failures of machinery and systems aboard towing vessels can have devastating consequences to the vessel, its crew, other vessels and their crews, shoreside populations and facilities, cargoes, marine transportation systems, commerce, and the environment. This paper presents a comprehensive methodology for implementing Risk-Based Maintenance and Inspections of towing vessel machinery and systems. Utilizing incident data from the United States Coast Guard (USCG) and other relevant industry information, the authors apply the principles set forth in ANSI/API Recommended Practice 580, Risk-based Inspection [1], as a guideline.

Relatively straightforward to implement, the methodology presented in this paper is expected to improve towing vessel safety, reduce potential dangers associated with towing operations, and provide favorable risk/benefit reward to vessel owners.

Paper published with permission.
Testing and Approval of Ballast Water Treatment Systems
Authors: Mouawad Jad
Published: July 2018

The Ballast Water Management Convention was adopted in 2004 and Guidelines G8 for type approval of ballast water treatment systems were adopted in 2008. Since then, treatment systems have developed and testing procedures and capabilities have improved significantly.

In June 2012, the USCG final rules for the discharge standard of living organisms in ships’ ballast water entered into force. This final ruling includes prescriptive requirements for type approval of treatment systems that differ in substance from the non-mandatory type approval guidelines established under the BWM Convention.

This paper will explain the practical steps towards achieving a G8 type approval based on existing projects, and will address the possibility of combining type approvals following both Guidelines G8 and the USCG final rules.

Paper published with permission.
Jurisdictional Acceptance of Non-ASME Pressure Vessels for Human Occupancy
Authors: Kemper Bart
Published: July 2018

The Code of Federal Regulations specifically adopts the ASME Boiler and Pressure Vessel Code as the standards for diving systems in US waters. Not all hyperbaric systems are made to ASME standards. This paper presents methods used successfully to obtain US Coast Guard and other jurisdictional approval of non-ASME pressure vessels for human occupancy.

Paper published with permission.
The Value of Fostering Physical Literacy
Authors: Whitehead Margaret E. , Durden-Myers Elizabeth J. , Pot Niek
Published: July 2018

This article considers the value of physical literacy. Unequivocal support for aspects of the concept can be found in philosophy, neuroscience, social justice, the nature of human development, psychology, and sociocultural studies. These areas of support will be outlined and then related to the practical value of physical literacy in the school context. This article will close with a discussion centered on claims that physical literacy is an end in itself rather than predominantly a means to other ends. It is the aim of this article to communicate the unique value of fostering physical literacy within the school context, including the support and relationship to other interrelated disciplines.
Hybrid chiral domain walls and skyrmions in magnetic multilayers
Authors: Legrand William , Chauleau Jean-Yves , Maccariello Davide , Reyren Nicolas , Collin Sophie , Bouzehouane Karim , Jaouen Nicolas , Cros Vincent , Fert Albert
Published: July 2018

Competition between magnetic interactions in multilayers stabilizes complex, vertically twisted topological spin textures.
Optical manipulation of magnetic vortices visualized in situ by Lorentz electron microscopy
Authors: Fu Xuewen , Pollard Shawn D. , Chen Bin , Yoo Byung-Kuk , Yang Hyunsoo , Zhu Yimei
Published: July 2018

Lorentz imaging shows hidden states and switching behavior of magnetic vortices under rapid optical excitation and quenching.
Fifteen-minute consultation: liver disease in children
Authors: Mann Jake P , Gallagher Kathy , Fitzpatrick Emer , Dhawan Anil
Published: July 2018

Liver disease in children can present in many ways from the frequently encountered prolonged neonatal jaundice to the comparatively rare acute liver failure. In this article, we will discuss ‘red flags’ of liver disease, the initial investigations required and when to refer to a specialist liver centre. Across all presentations, the degree of elevation of alanine aminotransferase or aspartate aminotransferase provides only little diagnostic information. Measurement of clotting is vital, and coagulopathy should be followed by a trial of intravenous vitamin K before being repeated.
Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity
Authors: Bai Yichen , Nie Huanjie , Wei Shiyu , Lu Xiaohe , Ke Xiaoyun , Ouyang Xuejun , Feng Songfu
Published: July 2018

Background

To evaluate the safety and efficacy of intravitreal conbercept (IVC) injection in the treatment of retinopathy of prematurity (ROP).

Methods

Patients with ROP who underwent IVC injection in Zhujiang Hospital from June 2015 to July 2016 were studied retrospectively. The primary outcome was defined as the regression of plus disease. The secondary outcomes were defined as the presence of recurrence, number of injections and the final regression of disease.

Results

A total of 48 eyes of 24 patients with ROP were included. Among them, 9 eyes of 5 patients had zone I ROP, 35 eyes of 18 patients had zone II ROP and 4 eyes of 2 patients had aggressive posterior ROP. The mean gestational age was 28.5±1.6 weeks, the mean birth weight was 1209.6±228.6 g, the mean postmenstrual age of first injection was 34.2±1.9 weeks and the mean follow-up period was 31.0±4.7 weeks. Forty of 48 eyes (83.3%) received IVC only once, and the regression of plus disease occurred at an average of 3.5±1.5 weeks after the first injection of conbercept. For eight recurrent eyes (16.7%), four eyes received a second IVC and the remaining four eyes received laser photocoagulation, and the regression of plus disease occurred in 3 weeks. No lens opacity, vitreous haemorrhage, entophthalmia or retinal detachment was observed during follow-up.

Conclusion

IVC injection is an effective treatment for ROP.
Trends, prevalence and risk factors of overweight and obesity among women of reproductive age in Bangladesh: a pooled analysis of five national cross-sectional surveys
Authors: Chowdhury Muhammad Abdul Baker , Adnan Md Mohiuddin , Hassan Md Zakiul
Published: July 2018

Objective

To determine the trends, prevalence and risk factors of overweight and obesity among Bangladeshi women of reproductive age from 1999 to 2014.

Design

We analysed nationally representative data from the 1999, 2004, 2007, 2011 and 2014 cross-sectional Bangladesh Demographic and Health Surveys.

Setting

Bangladesh.

Participants

Women aged 15–49 years.

Primary outcome

Overweight/obesity.

Results

A total of 58 192 women were included in the analysis. The prevalence of overweight and obesity among women of reproductive age increased significantly from 7.53% (95% CI 6.83 to 8.29) and 1.82% (95% CI 1.48 to 2.24) in 1999 to 28.37% (95% CI 27.49 to 29.28) and 10.77% (95% CI 10.22 to 11.35) in 2014, respectively. Age, education, wealth index, watching television and contraceptive use were associated with overweight and obesity in both urban and rural areas.

Conclusions

Overweight and obesity prevalence increased significantly among Bangladeshi women of reproductive age between 1999 and 2014. Development of effective low-cost strategies to address the increasing burden of obesity should be a high priority.
Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: a randomised controlled trial
Authors: van der Meer Helene G , Wouters Hans , Pont Lisa G , Taxis Katja
Published: July 2018

Objective

To evaluate if a pharmacist-led medication review is effective at reducing the anticholinergic/sedative load, as measured by the Drug Burden Index (DBI).

Design

Randomised controlled single blind trial.

Setting

15 community pharmacies in the Northern Netherlands.

Participants

157 community-dwelling patients aged ≥65 years who used ≥5 medicines for ≥3 months, including at least one psycholeptic/psychoanaleptic medication and who had a DBI≥1.

Intervention

A medication review by the community pharmacist in collaboration with the patient’s general practitioner and patient.

Primary and secondary outcomes measures

The primary outcome was the proportion of patients whose DBI decreased by at least 0.5. Secondary outcomes were the presence of anticholinergic/sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission and mortality. Data were collected at baseline and 3 months follow-up.

Results

Mean participant age was 75.7 (SD, 6.9) years in the intervention arm and 76.6 (SD, 6.7) years in the control arm, the majority were female (respectively 69.3% and 72.0%). Logistic regression analysis showed no difference in the proportion of patients with a≥0.5 decrease in DBI between intervention arm (17.3%) and control arm (15.9%), (OR 1.04, CI 0.47 to 2.64, p=0.927). Intervention patients scored higher on the Digit Symbol Substitution Test, measure of cognitive function (OR 2.02, CI 1.11 to 3.67, p=0.021) and reported fewer sedative side effects (OR 0.61, CI 0.40 to 0.94, p=0.024) at follow-up. No significant difference was found for other secondary outcomes.

Conclusions

Pharmacist-led medication review as currently performed in the Netherlands was not effective in reducing the anticholinergic/sedative load, measured with the DBI, within the time frame of 3 months. Preventive strategies, signalling a rising load and taking action before chronic use of anticholinergic/sedative medication is established may be more successful.

Trial registration number

NCT02317666.
Seasonal variation in mortality secondary to acute myocardial infarction in England and Wales: a secondary data analysis
Authors: Ogbebor Osakpolor , Odugbemi Babatunde , Maheswaran Ravi , Patel Kavya
Published: July 2018

Background

Acute myocardial infarction (AMI) is a leading cause of death globally. Increase in AMI mortality during winter has also been identified in existing literature. This has been associated with low outdoor and indoor temperatures and increasing age. The relationship between AMI and other factors such as gender and socioeconomic factors varies from study to study. Influenza epidemics have also been identified as a contributory factor.

Objective

This paper aims to illustrate the seasonal trend in mortality due to AMI in England and Wales with emphasis on excess winter mortality (EWM).

Methods

Monthly mortality rates per 10 000 population were calculated from data provided by the UK Office for National Statistics (ONS) for 1997–2005. To quantify the seasonal variation in winter, the EWM estimates (EWM, EWM ratio, Excess Winter Mortality Index) for each year were calculated. Negative binomial regression model was used to estimate the relationship between increasing age and EWM.

Results

The decline in mortality rate for AMI was 6.8% yearly between August 1997 and July 2005. Significant trend for reduction in AMI-associated mortality was observed over the period (p<0.001). This decline was not seen with EWM (p<0.001). 17% excess deaths were observed during winter. This amounted to about 20 000 deaths over the 8-year period. Increasing winter mortality was seen with increasing age for AMI.

Conclusion

EWM secondary to AMI does occur in England and Wales. Excess winter deaths due to AMI have remained high despite decline in overall mortality. More research is needed to identify the relationship of sex, temperature, acclimatisation, vitamin D and excess winter deaths due to AMI.
Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian ART-naive HIV population: a cross-sectional study
Authors: Ekrikpo Udeme E , Akpan Effiong E , Ekott John U , Bello Aminu K , Okpechi Ikechi G , Kengne Andre P
Published: July 2018

Objectives

HIV infection environment presents a classic example of the interplay between infectious diseases and non-communicable diseases (NCDs). Traditional cardiovascular disease (CVD) risk factors abound in the HIV population even before initiation of antiretrovirals (ARVs) and predispose them to the development of stroke and myocardial infarction. This work focuses on determining the prevalence of traditional CVD risk factors among ARV-naive HIV individuals in southern Nigeria.

Methods

This was a cross-sectional study of ARV-naive patients initiating care at the University of Uyo Teaching Hospital HIV clinic cohort to determine the prevalence and correlates of hypertension, diabetes mellitus (DM), obesity and dyslipidaemia.

Results

The sample consisted of 4925 assessed for hypertension, 5223 for obesity, 1818 for DM and 926 for dyslipidaemia. Hypertension prevalence was 26.7% (95% CI 25.5% to 28.0%) with a male preponderance (p=0.02). DM was found in 5.6% (95% CI 4.5% to 6.7%), obesity in 8.3% (95% CI 7.6% to 9.1%) and dyslipidaemia in 29.1% (95% CI 26.1% to 32.1%) with a high prevalence of low high-density lipoprotein-c (42.6%). Hypertension was independently associated with age (OR 1.04 (95% CI 1.03 to 1.05), p<0.001) and body mass index (BMI) (OR 1.06 (95% CI 1.03 to 1.08), p<0.001), obesity with age (OR 1.02 (95% CI 1.01 to 1.03), p<0.001), male gender (OR 0.38 (95% CI 0.29 to 0.49), p<0.001) and CD4 count (OR 2.63 (95% CI 1.96 to 3.53), p<0.001) while dyslipidaemia was associated with BMI (OR 1.05 (95% CI 1.01 to 1.10), p=0.03).

Conclusion

The prevalence of traditional CVD risk factors is high in this ART-naive HIV population. An integrated approach of HIV and NCD screening/treatment may be relevant for centres in sub-Saharan Africa.
Defining acute flares in knee osteoarthritis: a systematic review
Authors: Parry Emma L , Thomas Martin J , Peat George
Published: July 2018

Objective

To identify and critically synthesise definitions of acute flares in knee osteoarthritis (OA) reported in the medical literature.

Design

Systematic review and narrative synthesis. We searched Medline, EMBASE, Web of science and six other electronic databases (inception to July 2017) for original articles and conference abstracts reporting a definition of acute flare (or synonym) in humans with knee OA. There were no restrictions by language or study design (apart from iatrogenic-induced flare-ups, eg, injection-induced). Data extraction comprised: definition, pain scale used, flare duration or withdrawal period, associated symptoms, definition rationale, terminology (eg, exacerbation or flare), baseline OA severity, age, gender, sample size and study design.

Results

Sixty-nine articles were included (46 flare design trials, 17 observational studies, 6 other designs; sample sizes: 15–6085). Domains used to define flares included: worsening of signs and symptoms (61 studies, 27 different measurement tools), specifically increased pain intensity; minimum pain threshold at baseline (44 studies); minimum duration (7 studies, range 8–48 hours); speed of onset (2 studies, defined as ‘sudden’ or ‘quick’); requirement for increased medication (2 studies). No definitions included activity interference.

Conclusions

The concept of OA flare appears in the medical literature but most often in the context of flare design trials (pain increases observed after stopping usual treatment). Key domains, used to define acute events in other chronic conditions, appear relevant to OA flare and could provide the basis for consensus on a single, agreed definition of ‘naturally occurring’ OA flares for research and clinical application.

PROSPERO registration number

CRD42014010169.
Exploring the personal burden of shoulder pain among younger people in Australia: protocol for a multicentre cohort study
Authors: Ackerman Ilana N , Page Richard S , Fotis Kathy , Schoch Peter , Broughton Nigel , Brennan-Olsen Sharon L , Bucknill Andrew , Cross Emily
Published: July 2018

Introduction

Persistent musculoskeletal conditions can impact profoundly on younger people’s quality of life, psychological distress and capacity to work, as shown by previous research involving younger people with osteoarthritis. The personal impacts, in particular, work and parenting impacts, of other musculoskeletal conditions (such as persistent shoulder pain) on younger patient groups remain poorly understood. Furthermore, the personal financial burden associated with managing musculoskeletal conditions is rarely documented. This study aims to investigate well-being, work participation and productivity, shoulder-related parenting disability and out-of-pocket healthcare expenditure among younger people with shoulder pain and evaluate changes over 12 months.

Methods and analysis

One hundred and fifty people aged 20–55 years with shoulder pain of more than 6 weeks’ duration (excluding those with recent history of fracture or dislocation) will be recruited for this cohort study. Participants will be recruited from three major public hospitals in Victoria, Australia, following screening of orthopaedic outpatient clinics lists and referrals. Participants will be asked to complete a baseline questionnaire and 2-week healthcare costs diary, with follow-up data collected at 12 months. Patient-reported outcomes will be collected, including health-related quality of life (HRQoL), shoulder pain and function, psychological distress, shoulder-related parenting disability and work productivity. Information on sociodemographics, employment, health services utilisation and shoulder-related healthcare expenditure will also be collected. Descriptive analysis of baseline data will provide a comprehensive snapshot of the personal burden of shoulder pain. Baseline HRQoL and psychological distress data will be compared with Australian population norms to provide context around well-being. Associations between sociodemographic factors and patient-reported outcomes will be evaluated using univariate and multivariate analyses. Changes in patient-reported outcomes from baseline to 12 months will be analysed using paired t-tests.

Ethics and dissemination

Ethics approval has been obtained. The study findings will be submitted to peer-reviewed journals and presented at relevant scientific meetings.
Care home resident and staff perceptions of the acceptability of nutrition intervention trial procedures: a qualitative study embedded within a cluster randomised feasibility trial
Authors: Stow Ruth Elizabeth , Smith Christina H , Rushton Alison B
Published: July 2018

Objectives

To examine care home resident and staff perceptions of the acceptability of participating in a feasibility trial evaluating nutritional interventions in the treatment of malnutrition.

Design

Exploratory qualitative methodology was used to gather descriptions of resident and staff perceptions of trial procedures, using semi-structured interviews with residents and focus groups with staff. The interviews were used to explore individual perceptions of the acceptability of the assigned intervention and the outcomes measured. Focus groups were used to explore staff experiences of trial participation and perspectives of nutritional support interventions.

Setting

The study was embedded within a cluster randomised feasibility trial, which randomised six care homes to provide standard care (SC), food-based (FB) intervention or oral nutritional supplement (ONS) intervention to residents with, or at risk of, malnutrition.

Participants

Residents in the trial with capacity to consent (n=7) formed the sampling frame for inclusion. Four agreed to be approached by the researcher and to take part in the individual interviews. All were women, representing two arms of the trial (ONS and SC). Twelve staff participated in six focus groups, one at each care home. All participants were women, representing all three arms of the trial.

Results

Major themes that emerged from both interviews and focus groups included the perceived acceptability of trial involvement, the value of residents completing participant-reported outcome measures and the challenges associated with outcomes measurement in this setting. Themes that emerged from the focus groups alone, included the importance of individualising an intervention, and the perceived value of FB and ONS interventions and dietetic input.

Conclusions

Residents and staff perceived involvement in a trial evaluating nutritional interventions to be acceptable, although the challenges associated with research in this setting were acknowledged. Resident preferences were highlighted by staff as an important consideration when implementing a nutrition support plan.

Trial registration number

ISRCTN38047922
Rate of avoidable deaths in a Norwegian hospital trust as judged by retrospective chart review
Authors: Rogne Tormod , Nordseth Trond , Marhaug Gudmund , Berg Einar Marcus , Tromsdal Arve , Sæther Ola , Gisvold Sven , Hatlen Peter , Hogan Helen , Solligård Erik
Published: July 2018

Background

The proportion of avoidable hospital deaths is challenging to estimate, but has great implications for quality improvement and health policy. Many studies and monitoring tools are based on selected high-risk populations, which may overestimate the proportion. Mandatory reporting systems, however, under-report. We hypothesise that a review of an unselected sample of hospital deaths will provide an estimate of avoidability in-between the estimates from these methods.

Methods

A retrospective case record review of an unselected population of 1000 consecutive non-psychiatric hospital deaths in a Norwegian hospital trust was conducted. Reviewers evaluated to what degree each death could have been avoided, and identified problems in care.

Results

We found 42 (4.2%) of deaths to be at least probably avoidable (more than 50% chance of avoidability). Life expectancy was shortened by at least 1 year among 34 of the 42 patients with an avoidable death. Patients whose death was found to be avoidable were less functionally dependent compared with patients in the non-avoidable death group. The surgical department had the greatest proportion of such deaths. Very few of the avoidable deaths were reported to the hospital’s report system.

Conclusions

Avoidable hospital deaths occur less frequently than estimated by the national monitoring tool, but much more frequently than reported through mandatory reporting systems. Regular reviews of an unselected sample of hospital deaths are likely to provide a better estimate of the proportion of avoidable deaths than the current methods.
Man with bilateral inguinal lymphadenopathy
Authors: Delcourt Charlotte , Yombi Jean Cyr , Yildiz Halil
Published: July 2018

Clinical introduction

A 37-year-old man with history of lymph node tuberculosis presented with bilateral inguinal swelling with night sweats but no fever for 2 weeks. He had a cat but he had no history of scratches. He had an extraconjugal sexual intercourse a few weeks before. Physical examination revealed 5 cm tender, erythematous and painful bilateral inguinal adenopathy (figure 1A) and a small ulceration at the base of the penis (figure 1B). Vital signs were normal.

Figure 1

(A) Inguinal lymphadenopathy. (B) Ulceration at the base of the penis.

Question

What is the most likely diagnosis?

Toxoplasmosis

Tuberculosis

Cat-scratch disease

Lymphogranuloma venereum

Syphilis
BET 1: Intravenous tranexamic acid for the treatment of post­partum haemorrhage
Authors: Coss Catherine , Singh Matt , Jones Jeffrey
Published: July 2018

A short-cut review was carried out to see if administering tranexamic acid reduced mortality in patients with postpartum haemorrhage. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. Two randomised controlled trials were found, a smaller one suggesting that treatment with tranexamic acid reduced the volume of blood lost and a much larger study that showed a reduction in mortality due to bleeding in this patient group. There were no significant side effects from this treatment found in either study.
Impaired right ventricular reserve predicts adverse cardiac outcomes in adults with congenital right heart disease
Authors: DeFaria Yeh Doreen , Stefanescu Schmidt Ada C , Eisman Aaron S , Serfas John D , Naqvi Mariam , Youniss Mohamed A , Ryfa Aaron D , Khan Asaad A , Safi Lucy , Tabtabai Sara R , Bhatt Ami B , Lewis Gregory D
Published: July 2018

Objective

The prevalence of heart failure (HF) among adult patients with congenital heart disease (ACHD) is rising. Right ventricle (RV) exercise reserve and its relationship to outcomes have not been characterised. We aim to evaluate the prognostic impact of impaired RV reserve in an ACHD population referred for cardiopulmonary exercise testing (CPET).

Methods

This retrospective study evaluates patients with ACHD who underwent CPET (n=147) with first-pass radionuclide ventriculography at a single tertiary care centre. RV reserve was categorised as normal, mild to moderately or severely impaired. The primary composite clinical outcome included clinical right HF, arrhythmia, transplantation or death.

Results

Patients were median age 41±13 years, 50% were female and median follow-up was 1.1 (IQR: 0.7–2.0) years. Exercise RV reserve was impaired in 103 patients (70%), of whom 32% were asymptomatic. Resting RV systolic function poorly predicted RV reserve, with 52% of patients with severe impairment having a qualitatively normal echocardiographic assessment. The severely impaired reserve group had lower peak oxygen consumption (VO2)(17.2 vs 22.5 mL/kg/min, p<0.0001) compared with the normal reserve group, and was more likely to develop the composite outcome (48% vs 9%, log-rank p<0.001). Severely impaired RV reserve predicted event-free survival after adjusting for peak VO2, age, sex, RV pathology, QRS duration, New York Heart Association class, resting RV ejection fraction and RV dilation by echocardiography or MRI (HR 3.7, 95% CI 1.1 to 13.0, p=0.039).

Conclusion

Impaired RV reserve, occurred in asymptomatic patients, was not well predicted by resting systolic function assessment, and strongly predicted adverse cardiovascular outcomes.
Cessation of dual antiplatelet therapy and cardiovascular events following acute coronary syndrome
Authors: Mazlan-Kepli Wardati , Dawson Jesse , Berry Colin , Walters Matthew
Published: July 2018

Objective

To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) and to explore predictors for recurrent events after DAPT cessation during long-term follow-up.

Methods

We did a retrospective observational cohort study. We included consecutive people with ACS who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation.

Results

1340 patients were included (62% male, mean age 64.9 (13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1 (155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up). Independent predictors for a cardiovascular event following DAPT cessation were age (HR 1.07; 95% CI 1.05 to 1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995 to 0.998; p<0.001) and having revascularisation therapy during the index admission (HR 0.58; 95% CI 0.39 to 0.85; p=0.005).

Conclusions

The rate of cardiovascular events was not significantly increased in the early period post-DAPT cessation compared with later periods in this ACS population. Increasing age, DAPT duration and lack of revascularisation therapy were associated with increased risk of cardiovascular events during long-term follow-up after DAPT cessation.
Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation
Authors: Bagur Rodrigo , Martin Glen Philip , Nombela-Franco Luis , Doshi Sagar N , George Sudhakar , Toggweiler Stefan , Sponga Sandro , Cotton James M , Khogali Saib S , Ratib Karim , Kinnaird Tim , Anderson Richard A , Chu Michael W A , Kiaii Bob , Biagioni Corina , Schofield-Kelly Lois , Loretz Lucca , Torracchi Leonardo , Sekar Baskar , Kwok Chun Shing , Sperrin Matthew , Ludman Peter F , Mamas Mamas A
Published: July 2018

Objectives

To investigate the association of the CharlsonComorbidity Index (CCI) with clinical outcomes after transcatheter aortic valve implantation (TAVI).

Background

Patients undergoing TAVI have high comorbid burden; however, there is limited evidence of its impact on clinical outcomes.

Methods

Data from 1887 patients from the UK, Canada, Spain, Switzerland and Italy were collected between 2007 and 2016. The association of CCI with 30-day mortality, Valve Academic Research Consortium-2 (VARC-2) composite early safety, long-term survival and length of stay (LoS) was calculated using logistic regression and Cox proportional hazard models, as a whole cohort and at a country level, through a two-stage individual participant data (IPD) random effect meta-analysis.

Results

Most (60%) of patients had a CCI ≥3. A weak correlation was found between the total CCI and four different preoperative risks scores (ρ=0.16 to 0.29), and approximately 50% of patients classed as low risk from four risk prediction models still presented with a CCI ≥3. Per-unit increases in total CCI were not associated with increased odds of 30-day mortality (OR 1.09, 95% CI 0.96 to 1.24) or VARC-2 early safety (OR 1.04, 95% CI 0.96 to 1.14) but were associated with increased hazard of long-term mortality (HR 1.10, 95% CI 1.05 to 1.16). The two-stage IPD meta-analysis indicated that CCI was not associated with LoS (HR 0.97, 95% CI 0.93 to 1.02).

Conclusion

In this multicentre international study, patients undergoing TAVI had significant comorbid burden. We found a weak correlation between the CCI and well-established preoperative risks scores. The CCI had a moderate association with long-term mortality up to 5 years post-TAVI.
A shocking bike accident
Authors: Spapen Jerrold , Lochy Stijn , Michiels Vincent
Published: July 2018

Clinical introduction

A man in his late 40s presented with severe chest pain and progressive dyspnoea after hitting a tree at high speed during a bike ride in the woods. On admission, the patient appeared agitated, pale and sweaty. Core temperature was 35.5°C, respiratory rate 35/min and blood pressure 90/50 mm Hg with a regular pulse at 110 beats/min. Physical examination revealed multiple sternal bruises, distended jugular veins and muffled heart sounds (figure 1A). Lactate level was 4.4 mmol/L (normal <2.0 mmol/L) and high-sensitivity cardiac troponin T 0.142 mcg/L (normal <0.005 mcg/L). An ECG and a total body CT scan were performed (figure 1B,C).

Figure 1

(A) Multiple sternal bruises. (B) ECG on admission. (C) Thoracic CT.

Question:  What is the most likely diagnosis?

Inferior myocardial infarction with right ventricular involvement.

Cardiac contusion with tamponade.

Commotio cordis.

Aortic laceration.
Tobacco control and Healthy China 2030
Authors: Goodchild Mark , Zheng Rong
Published: July 2018

Background

The Healthy China 2030 strategy sets ambitious targets for China’s policy-makers, including a decrease in the smoking rate from 27.7% in 2015 to 20% by 2030. China has made progress on tobacco control in recent years, but many key measures remain underused. This study explores the potential for full implementation of these measures to achieve the targeted reduction in smoking by 2030.

Methods

First, a ‘business as usual’ scenario for China’s cigarette market was developed based only on underlying economic parameters. Second, non-price tobacco control measures were then added assuming they are fully implemented by 2030. Third, excise per pack was raised to a level that would increase the real price of cigarettes by 50% in 2030.

Findings

Under the business as usual scenario, the rate of smoking falls to around 26.6% in 2030. When non-price measures are included, the rate of smoking falls to 22.0% (20.9%~23.1%). Thus, non-price measures alone are unlikely to achieve the Healthy China target. Under the third scenario, excise per pack was roughly doubled in 2030 in order to increase real cigarette prices by 50%. The rate of smoking then falls to 19.7% (18.2%~21.3%), reflecting 78 million (59~97 million) fewer smokers compared with 2016. In addition, real excise revenue from cigarettes increases by 21% (−3%~47%) compared with 2016.

Conclusion

Significantly higher tobacco taxes will be needed to achieve Healthy China 2030 target for reduced smoking even after the implementation of other tobacco control measures.
Correcting for nondetection in estimating forest characteristics from single-scan terrestrial laser measurements
Authors: Kuronen Mikko , Henttonen Helena M. , Myllymäki Mari
Published: July 2018

A problem in the single-scan setup of terrestrial laser scanning is that some trees are shaded by others and therefore not detected in the scan. A basic estimator for forest characteristics such as tree density or basal area is based on the visible area of a scanner. However, simply compensating for nondetection by the visible area may result in considerable bias even in Poisson forests, especially if the detection of a tree depends on its size. We propose a new estimator that is a generalization of the visible area based estimator. Most importantly, the new estimator allows different detection rules; for example, full or partial visibility of a tree can be required for detection. By a simulation study, it is shown to work adequately in different types of simulated and empirical forests with different detection rules.
Bruwan Village Taroko
Authors: Chen Chien-Nan , Hu Wan-Hsien , Lin Chia-Wu
Published: July 2018

In 2003, in Taroko National Park’s planning, the upper plateau of Bruwan was commissioned for private operation and management (OT, Operation-Transfer). It was there that Ming-Gang Cheng, partnered with Leader Hotel Group, won the management rights to “Bruwan Village Taroko Vacation House”. Due to the location, limited room numbers, and the many restrictions, most people did not find Bruwan Village Taroko promising. After ten years of management by Ming-Gang Cheng, not only was Bruwan Village Taroko, a cultural and creative hotel rich with Taroko tribal culture, attracting many foreign and domestic visitors, it was also the best known OT project in Taiwan.

Ming-Gang Cheng’s background and entrepreneurial process had been introduced in this case study. Throughout the process, he had made use of various relationship resources, displayed his creativity, and fully integrated the local natural landscapes with the Taroko tribe’s aboriginal culture. Not only had he overcome the difficulties presented when first starting the business under predetermined disadvantages in environmental conditions, his innovative and unique market positioning had brought Bruwan Village Taroko to the global stage. From Ming-Gang Cheng’s background and entrepreneurship of Bruwan Village Taroko, this case intends to investigate topics including entrepreneurial personalities and entrepreneurship, the effect of social capital in entrepreneurship, and innovation under disadvantages.
Shree Cement Ltd.: Nimble and Focused Wins the Race
Authors: Dwivedi Neeraj
Published: July 2018

A first year MBA student from one of the prestigious business schools in India is interning at a start-up investment advisory firm. She has been asked to work on her first project, which requires her to do a strategic analysis of Shree Cement Limited (SCL), a North India cement company. This case gives a description of SCL – its origins, management and business; and the characteristics of the Indian cement industry structure, customer segments and major competitors. The case then presents information on performance and strategy of SCL within the cement industry with a view to highlight the strategies adopted by it to gain competitive advantage in the industry. The case allows students an opportunity to carry out industry and competitive analysis, examine the strategy and performance of SCL and identify its sources of competitive advantage.