bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Connecting the dots’ for generating a momentum for Universal Health Coverage in Bangladesh: findings from a cross-sectional descriptive study
Authors: Ahmed Syed Masud , Rawal Lal B , Naher Nahitun , Hossain Tarek
Published: July 2019

Objective

This study was conducted to explore how and whether, the strategic grants made by the Rockefeller Foundation (RF) in different sectors of health systems in the inception phase were able to ‘connect the dots’ for ‘generating a momentum for Universal Health Coverage (UHC)’ in the country.

Design

Cross-sectional descriptive study, using document review and qualitative methods.

Setting

Bangladesh, 17 UHC-related projects funded by the RF Transforming Health Systems (THS) initiative during 2010–2013.

Data

Available reports of the completed and on-going UHC projects, policy documents of the government relevant to UHC, key-informant interviews and feedback from grant recipients and relevant stakeholders in the policy and practice.

Outcome measures

Key policy initiatives undertaken for implementing UHC activities by the government post grants disbursement.

Results

The RF THS grants simultaneously targeted and connected the academia, the public and non-profit development sectors and news media for awareness-building and advocacy on UHC, develop relevant policies and capacity for implementation including evidence generation. This strategy helped relevant stakeholders to come together to discuss and debate the core concepts, scopes and modalities of UHC in an attempt to reach a consensus. Additionally, experiences gained from implementation of the pilot projects helped in identifying possible entry points for initiating UHC activities in a low resource setting like Bangladesh.

Conclusions

During early years of UHC-related activities in Bangladesh, strategic investments of the RF THS initiative played a catalytic role in sensitising and mobilising different constituencies for concerted activities and undertaking necessary first steps. Learnings from this strategy may be of help to countries under similar conditions of ‘low resource, apparent commitment, but poor governance,’ on their journey towards UHC.
Textured shoe insoles to improve balance performance in adults with diabetic peripheral neuropathy: study protocol for a randomised controlled trial
Authors: Hatton Anna L , Gane Elise M , Maharaj Jayishni N , Burns Joshua , Paton Joanne , Kerr Graham , Rome Keith
Published: July 2019

Introduction

Peripheral neuropathy is a major risk factor for falls in adults with diabetes. Innovative footwear devices which artificially manipulate the sensory environment at the feet, such as textured shoe insoles, are emerging as an attractive option to mitigate balance and walking problems in neuropathic populations. This study aims to explore whether wearing textured insoles for 4 weeks alters balance performance in adults with diabetic peripheral neuropathy.

Methods and analysis

A prospective, single-blinded randomised controlled trial with parallel groups will be conducted on 70 adults with diabetic peripheral neuropathy. Adults with a diagnosis of peripheral neuropathy (secondary to type 2 diabetes), aged ≥18 years, ambulant over 20 m (with/without an assistive device), will be recruited. Participants will be randomised to receive a textured insole (n=35) or smooth insole (n=35), to be worn for 4 weeks. During baseline and post intervention assessments, standing balance (foam/firm surface; eyes open/closed) and walking tasks will be completed barefoot, wearing standard shoes only, and two different insoles (smooth, textured). The primary outcome measure will be centre of pressure (CoP) velocity, with higher values indicating poorer balance. Secondary outcome measures include walking quality (gait velocity, base of support, stride length and double-limb support time), physical activity levels, foot sensation (light-touch pressure, vibration) and proprioception (ankle joint position sense), and other balance parameters (CoP path length, anteroposterior and mediolateral excursion). Patient-reported outcomes will be completed evaluating foot health, frequency of falls and fear of falling. Data will be analysed using a repeated measures mixed models approach (including covariates) to establish any differences between-groups, for all outcome measures, over the intervention period.

Ethics and dissemination

Ethical approval has been obtained from the institutional Human Research Ethics Committee (#2017000098). Findings will be disseminated at national and international conferences, through peer-reviewed journals, workshops and social media.

Trial registration number

ACTRN12617000543381; Pre-results.
Protocol of the China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP): a 10-year project to improve quality of care by building up a regional STEMI care network
Authors: Zhang Yan , Yu Bo , Han Yaling , Wang Jianan , Yang Lixia , Wan Zheng , Zhang Zheng , Chen Yuguo , Fu Xianghua , Gao Chuanyu , Li Bao , Chen Jiyan , Wu Ming , Ma Yitong , Zhao Xingsheng , Chen Yundai , Yan Hongbing , Xiang Dingcheng , Fang Weiyi , Mehta Sameer , Naber Christoph K , Ge Junbo , Huo Yong
Published: July 2019

Introduction

Successful ST-segment elevation myocardial infarction (STEMI) management is time-sensitive and is based on prompt reperfusion mainly to reduce patient mortality. It has evolved from a single hospital care to an integrated regional network approach over the last decades. This prospective study, named the China STEMI Care Project (CSCAP), aims to show how implementation of different types of integrated regional STEMI care networks can improve the reperfusion treatment rate, shorten the total duration of myocardial ischaemia and lead to mortality reduction step by step.

Methods and analysis

The CSCAP is a prospective, multicentre registry study of three phases. A total of 18 provinces, 4 municipalities and 2 autonomous regions in China were included. Patients who meet the third universal definition of myocardial infarction and the Chinese STEMI diagnosis and treatment guidelines are enrolled. Phase 1 (CSCAP-1) focuses on the in-hospital process optimisation of primary percutaneous coronary intervention (PPCI) hospitals, phase 2 (CSCAP-2) focuses on the PPCI hospital-based regional STEMI care network construction together with emergency medical services and adjacent non-PPCI hospitals, while phase 3 (CSCAP-3) focuses on the whole-city STEMI care network construction by promoting chest pain centre accreditation. Systematic data collection, key performance index assessment and subsequent improvement are implemented throughout the project to continuously improve the quality of STEMI care.

Ethics and dissemination

The study has been reviewed and approved by the Ethics Committee of Peking University First Hospital. Ranking reports of quality of care will be generated available to all participant affiliations. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses.

Trial registration number

NCT03821012.
Safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade cervical intraepithelial neoplasia associated with human papillomavirus: a systematic review protocol
Authors: Gonçalves Caroline Amélia , Lopes-Júnior Luís Carlos , Nampo Fernando Kenji , Zilly Adriana , Mayer Paulo César Morales , Pereira-da-Silva Gabriela
Published: July 2019

Introduction

Eighty per cent of the sexually active population will get human papillomavirus (HPV) infection, which is the most prevalent sexually transmitted disease worldwide. Persistence of high-grade HPV infection may evolve to a cervical intraepithelial neoplasia (CIN), and these lesions may be precursors of cervical cancer. However, this progression can be prevented by the administration of therapeutic vaccines which use the main oncoproteins responsible for cancer development in an attempt to trigger a more specific and effective immunological response against this disorder. We aim to evaluate the safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN 2/3 associated with HPV.

Methods and analysis

A systematic review of clinical trials will be undertaken. Medline, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Scopus will be searched, with no restriction regarding publication date. Primary outcomes will include measures related to safety, efficacy and the immunogenicity of the therapeutic vaccines used in these patients. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for randomised controlled trials, and the quality evidence of the risk of bias in single studies will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A narrative synthesis will be done for all included studies. Outcomes will be analysed according to the subgroups of HPV type, CIN grade, route of vaccine administration and vaccine type. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score for both fixed and random effect models. I2statistics will be used to assess heterogeneity and identify their potential sources.

Ethics and dissemination

Ethical approval is not required as primary data will not be collected. Findings will be disseminated widely via peer-reviewed publication and in different media, for example, conferences, congresses or symposia.

PROSPERO registration number

CRD42017077428.
The effect of smell and taste of milk during tube feeding of preterm infants (the Taste trial): a protocol for a randomised controlled trial
Authors: Beker Friederike , Macey Judith , Liley Helen , Hughes Ian , Davis Peter G , Twitchell Emily , Jacobs Susan
Published: July 2019

Introduction

Smell and taste of milk are not generally considered when tube feeding preterm infants. Preterm infants have rapid growth, particularly of the brain, and high caloric needs. Enteral feeding is often poorly tolerated which may lead to growth failure and long-term neurodevelopmental impairment. Smell and taste are strong stimulators of digestion and metabolism. We hypothesise that regular smell and taste during tube feeding will improve weight z-scores of very preterm infants at discharge from hospital.

Methods and analysis

Taste is a randomised, unblinded two-centre trial. Infants born at <29 weeks’ gestation and/or <1250 g at birth and admitted to a participating neonatal intensive care unit are eligible. Randomisation occurs before infants receive two hourly feeds for 24 hours. Infants are randomised to either smell and taste of milk with each tube feed or tube feeding without the provision of smell and taste. The primary outcome is weight z-score at discharge. Secondary outcomes include: days to full enteral feeds, duration of parenteral nutrition, rate of late-onset sepsis, post menstrual age at removal of nasogastric tube and at discharge from hospital, anthropometric data and neurodevelopmental outcomes at 2 years of corrected age.

Ethics and dissemination

Human Research Ethics Committees of Mater Misericordiae (trial reference number: HREC/16/MHS/112) and the Royal Women’s Hospital (trial reference number: 17/21) last approved the trial protocol (version 4.2; Date: 18 December 2018) and recruitment commenced in May 2017 and November 2017, respectively. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences.

Trial registration number

ACTRN12617000583347.
Development of a point of care system for automated coma prognosis: a prospective cohort study protocol
Authors: Connolly John F , Reilly James P , Fox-Robichaud Alison , Britz Patrick , Blain-Moraes Stefanie , Sonnadara Ranil , Hamielec Cindy , Herrera-Díaz Adianes , Boshra Rober
Published: July 2019

Introduction

Coma is a deep state of unconsciousness that can be caused by a variety of clinical conditions. Traditional tests for coma outcome prediction are based mainly on a set of clinical observations. Recently, certain event-related potentials (ERPs), which are transient electroencephalogram (EEG) responses to auditory, visual or tactile stimuli, have been introduced as useful predictors of a positive coma outcome (ie, emergence). However, such tests require the skills of clinical neurophysiologists, who are not commonly available in many clinical settings. Additionally, none of the current standard clinical approaches have sufficient predictive accuracies to provide definitive prognoses.

Objective

The objective of this study is to develop improved machine learning procedures based on EEG/ERP for determining emergence from coma.

Methods and analysis

Data will be collected from 50 participants in coma. EEG/ERP data will be recorded for 24 consecutive hours at a maximum of five time points spanning 30 days from the date of recruitment to track participants’ progression. The study employs paradigms designed to elicit brainstem potentials, middle-latency responses, N100, mismatch negativity, P300 and N400. In the case of patient emergence, data are recorded on that occasion to form an additional basis for comparison. A relevant data set will be developed from the testing of 20 healthy controls, each spanning a 15-hour recording period in order to formulate a baseline. Collected data will be used to develop an automated procedure for analysis and detection of various ERP components that are salient to prognosis. Salient features extracted from the ERP and resting-state EEG will be identified and combined to give an accurate indicator of prognosis.

Ethics and dissemination

This study is approved by the Hamilton Integrated Research Ethics Board (project number 4840). Results will be disseminated through peer-reviewed journal articles and presentations at scientific conferences.

Trial registration number

NCT03826407.
Longitudinal effect of nocturnal R-R intervals changes on cardiovascular outcome in a community-based cohort
Authors: Sankari Abdulghani , Ravelo Laurel Anne , Maresh Scott , Aljundi Nawar , Alsabri Bander , Fawaz Serene , Hamdon Mulham , Al-kubaisi Ghazwan , Hagen Erika , Badr M Safwan , Peppard Paul
Published: July 2019

Rationale

Sleep-disordered breathing (SDB) is strongly linked to adverse cardiovascular outcomes (cardiovascular diseases (CVD)). Whether heart rate changes measured by nocturnal R-R interval (RRI) dips (RRI dip index (RRDI)) adversely affect the CVD outcomes is unknown.

Objectives

To test whether nocturnal RRDI predicts CVD incidence and mortality in the Wisconsin Sleep Cohort study (WSCS), independent of the known effects of SDB on beat-to-beat variability.

Methods

The study analysed electrocardiograph obtained from polysomnography study to assess the nocturnal total RRDI (the number of RRI dips divided by the total recording time) and sleep RRDI (the number of RRI dips divided by total sleep time). A composite CVD risk as a function of total and sleep RRDI was estimated by Cox proportional hazards in the WSCS.

Results

The study sample consisted of 569 participants from the WSCS with no prior CVD at baseline were followed up for up to 15 years. Nocturnal total RRDI (10-unit change) was associated with composite CVD event(s) (HR, 1.24 per 10-unit increment in RRDI (95% CI 1.10 to 1.39), p<0.001). After adjusting for demographic factors (age 58±8 years old; 53% male; and body mass index 31±7 kg/m2), and apnoea–hypopnoea index (AHI 4%), individuals with highest total nocturnal RRDI category (≥28 vs<15 dips/hour) had a significant HR for increased incidence of CVD and mortality of 7.4(95% CI 1.97 to 27.7), p=0.003). Sleep RRDI was significantly associated with new-onset CVD event(s) (HR, 1.21 per 10-unit increment in RRDI (95% CI 1.09 to 1.35), p<0.001) which remained significant after adjusting for demographic factors, AHI 4%, hypoxemia and other comorbidities.

Conclusion

Increased nocturnal RRDI predicts cardiovascular mortality and morbidity, independent of the known effects of SDB on beat-to-beat variability. The frequency of RRDI is higher in men than in women, and is significantly associated with new-onset CVD event(s) in men but not in women.
Data quality audit of a clinical quality registry: a generic framework and case study of the Australian and New Zealand Hip Fracture Registry
Authors: Tan Aidan Christopher , Armstrong Elizabeth , Close Jacqueline , Harris Ian Andrew
Published: July 2019

Objectives

The value of a clinical quality registry is contingent on the quality of its data. This study aims to pilot methodology for data quality audits of the Australian and New Zealand Hip Fracture Registry, a clinical quality registry of hip fracture clinical care and secondary fracture prevention.

Methods

A data quality audit was performed by independently replicating the data collection and entry process for 163 randomly selected patient records from three contributing hospitals, and then comparing the replicated data set to the registry data set. Data agreement, as a proxy indicator of data accuracy, and data completeness were assessed.

Results

An overall data agreement of 82.3% and overall data completeness of 95.6% were found, reflecting a moderate level of data accuracy and a very high level of data completeness. Half of all data disagreements were caused by information discrepancies, a quarter by missing discrepancies and a quarter by time, date and number discrepancies. Transcription discrepancies only accounted for 1 in every 50 data disagreements. The sources of inaccurate and incomplete data have been identified with the intention of implementing data quality improvement.

Conclusions

Regular audits of data abstraction are necessary to improve data quality, assure data validity and reliability and guarantee the integrity and credibility of registry outputs. A generic framework and model for data quality audits of clinical quality registries is proposed, consisting of a three-step data abstraction audit, registry coverage audit and four-step data quality improvement process. Factors to consider for data abstraction audits include: central, remote or local implementation; single-stage or multistage random sampling; absolute, proportional, combination or alternative sample size calculation; data quality indicators; regular or ad hoc frequency; and qualitative assessment.
Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support
Authors: Holmgren A Jay , Co Zoe , Newmark Lisa , Danforth Melissa , Classen David , Bates David
Published: July 2019

Background

Electronic health records (EHR) can improve safety via computerised physician order entry with clinical decision support, designed in part to alert providers and prevent potential adverse drug events at entry and before they reach the patient. However, early evidence suggested performance at preventing adverse drug events was mixed.

Methods

We used data from a national, longitudinal sample of 1527 hospitals in the USA from 2009 to 2016 who took a safety performance assessment test using simulated medication orders to test how well their EHR prevented medication errors with potential for patient harm. We calculated the descriptive statistics on performance on the assessment over time, by years of hospital experience with the test and across hospital characteristics. Finally, we used ordinary least squares regression to identify hospital characteristics associated with higher test performance.

Results

The average hospital EHR system correctly prevented only 54.0% of potential adverse drug events tested on the 44-order safety performance assessment in 2009; this rose to 61.6% in 2016. Hospitals that took the assessment multiple times performed better in subsequent years than those taking the test the first time, from 55.2% in the first year of test experience to 70.3% in the eighth, suggesting efforts to participate in voluntary self-assessment and improvement may be helpful in improving medication safety performance.

Conclusion

Hospital medication order safety performance has improved over time but is far from perfect. The specifics of EHR medication safety implementation and improvement play a key role in realising the benefits of computerising prescribing, as organisations have substantial latitude in terms of what they implement. Intentional quality improvement efforts appear to be a critical part of high safety performance and may indicate the importance of a culture of safety.
Important outcomes of moral case deliberation: a Euro-MCD field survey of healthcare professionals’ priorities
Authors: Svantesson Mia , de Snoo-Trimp Janine C , Ursin Göril , de Vet Henrica CW , Brinchmann Berit S , Molewijk Bert
Published: July 2019

Background

There is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.

Methods

A North European field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.

Results

All outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.

Conclusions

The findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such asmoralreflexivity andmoralattitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument.
Too much medicine: not enough trust? A response
Authors: Parker Joshua
Published: July 2019

In their paper ’Too much medicine: not enough trust?' Zoë Fritz and Richard Holton explore the connection between trust and overtreatment and overinvestigation. Whilst their paper is insightful, here I argue that much more could be made of a doctor’s (mis)trust and how this exacerbates overtreatment and overinvestigation. By taking Fritz and Holton’s view of trust as having ‘our best interests at heart’ as my starting point, I argue that doctor’s do not always trust that patients or the system has their interests at heart and so use overtreatment and overinvestigation to protect themselves. I also point to the tensions created by a lack of trust on the doctor’s part as a focal point for much needed sustained ethical analysis.
Off-label use of bevacizumab in the treatment of retinal disease: ethical implications
Authors: Rohowetz Landon James
Published: July 2019

Anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionised the treatment of a variety of ophthalmic conditions and has become the first-line therapy for a range of retinal diseases. Bevacizumab, a VEGF inhibitor first approved for the treatment of colorectal cancer, has been shown to be nearly or virtually as effective and safe as other anti-VEGF therapies in the treatment of certain retinal diseases but is not approved or registered by the Food and Drug Administration or European Medicines Agency. While other anti-VEGF options are approved and registered, they are generally more expensive and less accessible. Accordingly, despite its off-label status, bevacizumab is frequently used for a variety of disabling retinal diseases. Indeed, bevacizumab is included on the World Health Organization’s list of essential medicines. However, its use in some parts of the world remains restricted due to its off-label status. How, then, should healthcare authorities approach this situation? What are the ethical and societal implications of adhering to a standard and generally effective evaluation and approval system while restricting access to a potentially cost-saving therapy? In countries where its use is not restricted, how should providers approach off-label treatment with bevacizumab? By examining the evidence behind bevacizumab’s efficacy and safety and evaluating the individual and societal implications of off-label use and restriction, this paper illustrates the ethical factors providers and policy makers must consider in the off-label use of bevacizumab and ultimately argues for increased access to bevacizumab in the treatment of retinal disease.
To die, to sleep, perchance to dream? A response to DeMichelis, Shaul and Rapoport
Authors: Gamble Joel L , Gamble Nathan K , Pruski Michal
Published: July 2019

In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors’ reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.
Dermatitis among workers in Ontario: results from the Occupational Disease Surveillance System
Authors: Shakik Sharara , Arrandale Victoria , Holness Dorothy Linn , MacLeod Jill S , McLeod Christopher B , Peter Alice , Demers Paul A
Published: July 2019

Objectives

Dermatitis is the most common occupational skin disease, and further evidence is needed regarding preventable risk factors. The Occupational Disease Surveillance System (ODSS) derived from administrative data was used to investigate dermatitis risk among industry and occupation groups in Ontario.

Methods

ODSS cohort members were identified from Workplace Safety and Insurance Board (WSIB) accepted lost time claims. A case was defined as having ≥2 dermatitis physician billing claims during a 12-month period within 3 years of cohort entry. A 3-year look-back period prior to cohort entry was used to exclude prevalent cases without a WSIB claim. Workers were followed for 3 years or until dermatitis diagnosis, age 65 years, emigration, death or end of follow-up (31 December 2016), whichever occurred first. Age-adjusted and sex-adjusted Cox proportional hazard models estimated HRs and 95% CIs. The risk of dermatitis was explored using a job exposure matrix that identifies exposure to asthmagens, many of which also cause contact dermatitis.

Results

Among 597 401 workers, 23 843 cases of new-onset dermatitis were identified. Expected elevated risks were observed among several groups including furniture and fixture industries, food and beverage preparation and chemicals, petroleum, rubber, plastic and related materials processing occupations and workers exposed to metal working fluids and organic solvents. Decreased risk was observed among farmers, nurses and construction industries, and occupations exposed to latex and indoor cleaning products.

Conclusions

ODSS can contribute to occupational dermatitis surveillance in Ontario by identifying occupational groups at risk of dermatitis that can then be prioritised for prevention activities.
Initial management of immune thrombocytopaenia in adults based on risk stratification
Authors: Umakanthan Jaydev Manikkam , Dhakal Prajwal , Gundabolu Krishna , Kallam Avyakta , Almquist Daniel R , Bhatt Vijaya Raj
Published: July 2019

Patients with immune thrombocytopaenia (ITP) have a wide spectrum of disease severity and bleeding risk even at similar platelet counts. Hence, additional clinical and laboratory factors may be considered in the evaluation of bleeding risk in ITP. Risk stratification based on predicted bleeding risk may help to identify high-risk patients and guide the initial management of ITP in adults requiring treatment. Recent evidence supports the use of high-dose dexamethasone therapy over prednisone in the initial management of ITP because of improved initial response rates, shorter median time to response and better safety profile. A risk-stratified approach to management of ITP is hoped to reduce bleeding complications in high-risk patients; however, the outcomes of such management approach need to be studied prospectively. Additionally, whether therapy intensification or combination of dual therapy such as intravenous immunoglobulin or rituximab in combination with dexamethasone can reduce bleeding complications in high-risk ITP should be studied in the future.
Prevalence and persistence ofChlamydia trachomatis-specific antibodies after occasional and recurrent infections
Authors: Öhman Hanna , Rantsi Tiina , Joki-Korpela Päivi , Tiitinen Aila , Surcel Heljä-Marja
Published: July 2019

Objectives

Population-basedChlamydia trachomatisseroepidemiological studies help to identify trends in chlamydia infection. However, an improved understanding of the antibody response to infection is required when using serology to estimate cumulative incidence. Thus, the objectives of this longitudinal, retrospective, biobank-based study were to assess the appearance and persistence ofC. trachomatismajor outer membrane protein (MOMP)-specific serum IgG antibodies after infection and to evaluate the role of antibodies in providing protective immunity against recurrent infection.

Methods

Data of notifiedC. trachomatisinfections in Finland were obtained from the National Infectious Diseases Register. Serum samples were acquired from the Finnish Maternity Cohort. 411 women with single chlamydia infection and 62 women with recurrent infections, and for whom suitable paired serum samples were available, were included in the study. Antibody appearance, persistence after infection and the impact of recurrent infections were evaluated. IgG antibodies specific for MOMP were measured from serum using an ELISA method.

Results

Anti-C. trachomatisMOMP-specific IgG antibodies were detected in 65.5% (269/411) of women within 3 months of notification of infection. In the absence of recurrent infection, seroprevalence declined to 34.5% (142/411) 3–10 years after the initial infection. The serum antibody levels at baseline correlated positively with seroprevalence at follow-up. Reinfection boosted the humoral immune response by increasing seroprevalence and the serum antibody levels. Seroprevalence within 3 months after first notification of infection was 65.5% (19/29) in women who were later diagnosed with recurrent infection, comparable with women with single notification of infection (65.5%, 269/411).

Conclusions

Approximately one-third of women with single notification of chlamydia infection remain seropositive 3–10 years after the initial infection. The concentration of antibodies remained stable during the follow-up. Recurrent infection boosted the humoral immune response, but reinfection occurred despite the presence of pre-existing antibodies.
The future of cattle veterinary practice: insights from a qualitative study
Authors: Woodward Hannah , Cobb Kate , Remnant John
Published: July 2019

The British livestock sector is constantly changing due to environmental and economic pressures, consequentially causing a shift in demand on farm veterinary services. The aim of this study was to explore the future of cattle veterinary practice, using a qualitative approach. Telephone interviews were organised with key opinion leaders within the cattle farm and veterinary sectors to discuss their opinions on the future of the profession. The interviews were recorded and transcribed, and thematic analysis was used to interpret the data. The analysis of these interviews resulted in the development of six key themes that emerged as being important in the future of cattle veterinary practice; veterinary business structure, veterinary practice income, collaboration, the changing role of the cattle vet, the vet–farmer relationship and the new generation of cattle vets. The study identified that the role of the cattle veterinary practitioner in the UK is changing with an increasing focus on data handling, people management and training and advisory skills. It is important that these findings are accounted for in the development of undergraduate and postgraduate veterinary training.
Chronic cannabis use and circulating biomarkers of neural health, stress, and inflammation in physically active individuals
Authors: Lisano Jonathon K. , Kisiolek Jacob N. , Smoak Peter , Phillips Kristina T. , Stewart Laura K.
Published: July 2019

Previous research has associated cannabis use with altered circulating neurotrophins and biomarkers of immune health, but these relationships have yet to be fully explored in physically active individuals. The specific aim of this study was to explore the relationships between biomarkers of neural health: nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), immune health: interleukin 6 (IL-6), C-reactive protein (CRP), and cortisol, as well as the presence of depression, in physically active cannabis users (CU) and nonusers (NU). Male and female participants (N = 30; CU, n = 15, NU, n = 15) provided intravenous blood samples and underwent assessment of body composition, maximal oxygen consumption, and depression (Beck Depression Inventory-II (BDI-II)). Samples were analyzed for concentrations of NGF, BDNF, IL-6, CRP, and cortisol using ELISAs. CU and NU were compared using an unpaired t test. Pearson’s correlation and multiple linear regression were used to evaluate relationships among variables. There were no significant differences in body size or composition, maximal oxygen consumption, total BDI-II Score, concentrations of NGF, IL-6, CRP, or cortisol between groups. BDNF was significantly lower in CU compared with NU (p = 0.02), with a significant negative relationship between BDNF and CRP (p = 0.02). Mean concentrations of CRP placed CU at higher risk for cardiovascular disease compared with NU. Total BDI-II score negatively correlated with BDNF (p = 0.02) and positively correlated with CRP (p = 0.02).

Novelty Plasma BDNF was significantly lower in physically active cannabis users compared with NU. CU were classified at moderate risk for cardiovascular disease based on average circulating CRP compared with low risk for NU.
Influence of moisture infiltration on flexible pavement cracking and optimum timing for surface seals
Authors: Haider Syed Waqar , Masud Muhammad Munum , Chatti Karim
Published: July 2019

Moisture increase in pavement subsurface layers has a significant influence on granular material properties that affect the expected pavement performance. In situ moisture variations over time in an unbound base layer depend on water infiltration after precipitation and pavement surface conditions. Consequently, base resilient modulus (MR) is reduced, which leads to premature failure and reduced service life. This paper presents long-term pavement performance (LTPP) data analyses for quantifying the effect of moisture infiltration through surface cracking on flexible pavement performance. Subsurface moisture data obtained through the seasonal monitoring program (SMP) time domain reflectometry (TDR) are an excellent source for quantifying the moisture-related damage in flexible pavement located in different climates. An artificial neural network (ANN) model was developed based on the SMP data for flexible pavement sections. The results show that higher levels of cracking will lead to an increase in moisture levels within the base layer, which leads to a significant decrease in the base MR. For flexible pavement, the maximum reduction in base MR ranged from 18% to 41% and from 153% to 175% for the pavement sections located in dry and wet regions, respectively. Consequently, the performance of pavement sections located in wet climates is adversely affected. The findings imply that an adequate and timely preservation treatment for cracking sealing (e.g., surface seals) can enhance the pavement’s service life, especially in wet climates. The results suggest that cracks should be sealed when the extent of fatigue cracking is within 6% and 11% for the flexible pavement sections located in wet and dry climates, respectively.
Estimated remaining fatigue life of flexible pavements based on the normalized comprehensive area ratio deflection parameter
Authors: Loganathan Karthikeyan , Isied Mayzan M. , Coca Ana Maria , Souliman Mena I. , Romanoschi Stefan , Dessouky Samer
Published: July 2019

A lot of pavement deflection data are available that may be utilized as a tool to evaluate the structural capacity of pavement structures at network and project levels. Falling weight deflectometer (FWD) is one of the most widely utilized devices in pavement deflection testing. Under FWD testing, deflections generated at several lateral locations as a result of surface loading application are recorded. One of the major downsides of the static FWD testing is the traffic disturbance due to the required lane closures during testing. As an effort to reduce the amount of the required FWD testing on the network level, this study aims to run an advanced computer simulation analysis to mimic the FWD deflection bowl obtained from the field. The entire simulated FWD deflection bowl was utilized in the development of the new comprehensive pavement deflection bowl area parameters. The tensile strain at the bottom of the asphalt layer was successfully related to the developed normalized comprehensive area ratio parameter ([Formula: see text]) and to the number of load repetitions to fatigue failure. The newly developed parameter was evaluated utilizing data for 35 long term pavement performance sections in Texas. The newly developed [Formula: see text] can be easily implemented and utilized as a tool in any pavement management systems.
Effects of fire rotation interval and overstory type on ambient soil temperatures in ponderosa pine forests in Arizona
Authors: Weise David R. , Sackett Stephen S. , Haase Sally M. , Johnson Nels
Published: July 2019

Ambient soil temperatures were measured every four weeks from May 1986 to November 1986 at three depths under the organic forest floor in ponderosa pine (Pinus ponderosa Lawson & C. Lawson) forests in three stand types subjected to periodic prescribed burning. Temperatures at the organic layer – soil surface interface in sawtimber stands were higher and more variable than in pole and saplings stands. Temperature variability reached a maximum in the summer and decreased into the fall and early winter. Soil temperature variability decreased as depth below the surface increased. Three years after the low-intensity prescribed burns, soil temperatures in the burned stands were not significantly different from the those in the unburned controls, suggesting that any effect, though none was detected, of the low-intensity prescribed burns on soil temperature and belowground processes affected by temperature is short-lived in these stands.
Multiple-relaxation-time lattice Boltzmann simulation of natural convection with multiple heat sources in a rectangular cavity
Authors: Li Peisheng , Lian Xiaolong , Chen Yue , Zhang Ying , Zhao Wandong , Ma Chunyang
Published: July 2019

Natural convection and heat transfer in a square cavity with multiple heat sources was investigated through a multiple-relaxation-time (MRT) collision model and lattice Boltzmann method (LBM) in the current work. The MRT-LBM model was verified by a former experiment and numerical findings with different Ra numbers from 103 to 105, which proved the MRT-LBM model is effective to handle the flow and transfer. The heat transfer that developed inside the cavity was analyzed under different width, height, and lateral offset of heat source in this paper. Moreover, the change of spacing between two symmetrically distributed heat sources was discussed. The results showed that the heat exchange efficiency was augmented by increasing width, height, and spacing of the heater, but it was reduced by increasing lateral offset. Specifically, the Nusselt number of the upper wall decreased by increasing height of heat source, and the left and right walls showed better heat exchange efficiency by increasing height. Additionally, the lateral position had a notable influence on the left wall surface of the heat source, and the optimum heat exchange efficiency of the heat source’s left wall existed in the condition of small lateral offset.
Cosmic evolution in the background of R (1 + αQ) gravity
Authors: Zubair M. , Zeeshan M. , Waheed Saira
Published: July 2019

In this paper, we discuss the cosmic evolution in a modified theory involving non-minimal interaction of geometry and matter, labeled as [Formula: see text] gravity, where [Formula: see text] is the non-minimal interaction term. First, we develop the dynamical [Formula: see text] field equations for Friedmann–Lemaitre–Robertson–Walker (FLRW) spacetime and then by using divergence of these equations, we explore its interesting outcome of non-conserved energy–momentum tensor (EMT). The presence of geometry matter coupling in such theories results in non-geodesic test particles motion and hence causes an additional force orthogonal to four-velocity of these particles. By taking these interesting features into account along with a particular choice of Lagrangian [Formula: see text], we explore the resulting expression of energy density. Further, the free model parameters are constrained using energy condition bounds where it is concluded that these values of free parameters are compatible with the recent data.
Dependence on well widths of total optical absorption coefficient of asymmetric triple GaAlAs/GaAs and GaInAs/GaAs quantum wells
Authors: Ozturk O. , Ozturk E. , Elagoz S.
Published: July 2019

Herein, the total optical absorption coefficient (TOAC) and the electronic characteristics of asymmetric triple Ga[Formula: see text]Al[Formula: see text]As/GaAs (A model) and Ga[Formula: see text]In[Formula: see text]As/GaAs (B model) quantum wells (QWs) have been examined related to the well widths (WWs). For TOAC, we first varied all WWs equally, and then we kept a WW constant and changed the other two WWs. The wavefunctions (WFs), the subband energies and the probability densities of asymmetric triple quantum wells (ATQW) with different QW shapes under effective mass approach were determined by the solution of Schrödinger equation. According to the results obtained, the major diversities of A and B models are the effective mass and the energy gap. The potential depth and the energy levels (ELs) of A model are continuously smaller than of B model. We see that WWs have a great influence on TOAC and the electronic features of ATQW. The inter-subband absorption spectrum designates blue/red shifts, when the energy spacing varies with WWs. These characteristics draw a convenient attention for the purpose of adjustable semiconductor devices. Hence, the alteration of this absorption spectrum, which could be fit for many optical modulators and infra-red optical device applications, may be efficiently realized by changing WWs.

Highlights

Energy spacing varies by increasing WWs. Due to the shape of the wells, the influence of each WW is quite different from the others. TOAC varies with rising WWs. The absorption spectrum illustrates red or blue shifts depending on WWs.
Luminescence studies of Eu3+ ions in tellurite glass ceramics
Authors: Hong Tran Thi , Dung Phan Tien , Quang Vu Xuan
Published: July 2019

The optical properties of Eu[Formula: see text] ions in tellurite glass ceramics with the chemical composition 50TeO2–29B2O3–10ZnO–10Na2O–1Eu2O3-based precursor glasses were presented. These precursor glasses have been prepared by melt quenching method in air, followed by thermal annealing at 550[Formula: see text]C for 12 h, 24 h and 36 h. After thermal annealing process, the micro–crystals appeared in host tellurite glasses. Judd–Ofelt (JO) parameters were calculated from the photoluminescence (PL) spectral measurements. The [Formula: see text], [Formula: see text] and [Formula: see text] parameters have been used to estimate the radiative properties of Eu[Formula: see text] ions in tellurite glass ceramics such as transition probabilities, branching ratio, radiative lifetimes and stimulated emission cross-section. The results of tellurite glass ceramic have been discussed and compared with the similar studies.
A novel 4D chaotic system with multistability: Dynamical analysis, circuit implementation, control design
Authors: He Jian-Jun , Lai Bang-Cheng
Published: July 2019

The purpose of this work is to introduce a novel 4D chaotic system and investigate its multistability. The novel system has an unstable origin and two stable symmetrical hyperbolic equilibria. When the parameter increases across a critical value, the equilibria lose their stability and double Hopf bifurcations occur with the appearance of limit cycles. A pair of point, periodic, chaotic attractors are observed in the system from different initial values for given parameters. The chaos of the system is yielded via period-doubling bifurcation. A double-scroll chaotic attractor is numerically observed as well. By using the electronic circuit, the chaotic attractor of the system is realized. The control problem of the system is reported. An effective controller is designed to stabilize the system.
A Single-Ended 28-nm CMOS 6T SRAM Design with Read-assist Path and PDP Reduction Circuitry
Authors: Wang Chua-Chin , Hou Zong-You , Wang Deng-Shian , Hsieh Chia-Lung
Published: July 2019

A single-ended six-transistor (6T) SRAM cell composed of a five-transistor (5T) cell and a read-assist low-[Formula: see text] PMOS as foot switch to prevent leakage damaging the data state is proposed in this work. Besides, a power–delay product (PDP) reduction circuitry design for nanoscale SRAMs is also proposed. The proposed PDP reduction circuitry design is composed of an adaptive voltage detection (AVD) circuit generating a boost-enable signal if the process variation is over a predefined range and a half-period word-line boosting (HWB) circuit responding to the enable signal. The proposed SRAM is implemented using TSMC 28-nm CMOS logic technology. PDP reduction is verified to be 41.73% according to the measurement results. The energy per access is 0.0206 pJ given the 800-mV power supply and 40-MHz system clock rate.