bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient assessment and selection for pulmonary rehabilitation
Authors: Rochester Carolyn L.
Published: June 2019

Pulmonary rehabilitation (PR) is beneficial for people with several forms of chronic respiratory disease. Given the existing limitations on availability of PR services, it is important to identify participants who are most likely to benefit from it. Identification of criteria for patient referral to PR is challenging, as chronic respiratory diseases and their medical and psychosocial co‐morbidities place a complex and multifaceted burden on patients. Although research studies have attempted to identify key parameters predictive of ‘responsiveness to PR’, to date no firm physiological, psychosocial or other criteria exist by which optimal patient candidacy can be determined. Moreover, individual factors do not reliably predict successful multidimensional PR outcomes. In general, individuals who remain symptomatic with dyspnoea, fatigue and exercise intolerance; who have difficulty performing activities of daily living (ADL); and who are having difficulty coping with or managing their disease despite optimized pharmacological therapy are potential candidates for PR. Patient assessment and outcome measurement are core essential features of PR. To be considered as a PR programme, rehabilitation programmes must demonstrate, at a minimum, assessment and outcome measurement in regard to exercise capacity, dyspnoea and health‐related quality of life. Additional parameters, including physical activity, nutritional status, tobacco use status, patient knowledge and self‐efficacy, performance of ADL, fatigue, disease exacerbations, hospitalizations and other urgent healthcare utilization, and behavioural outcomes, including coping styles, patient satisfaction and programme metrics, are other relevant and important aspects of patient assessment and outcome measurement that should be considered and undertaken in PR, where feasible.
Health Risk Assessment of Photoresists Used in an Optoelectronic Semiconductor Factory
Authors: Huang Shao‐Zu , Wu Kuen‐Yuh
Published: June 2019

Photoresist materials are indispensable in photolithography, a process used in semiconductor fabrication. The work process and potential hazards in semiconductor production have raised concerns as to adverse health effects. We therefore performed a health risk assessment of occupational exposure to positive photoresists in a single optoelectronic semiconductor factory in Taiwan. Positive photoresists are widely used in the optoelectronic semiconductor industry for photolithography. Occupational exposure was estimated using the Stoffenmanager® model. Bayesian modeling incorporated available personal air sampling data. We examined the composition and by‐products of the photoresists according to descriptions published in the literature and patents; the main compositions assessed were propylene glycol methyl ether acetate (PGMEA), novolac resin, photoactive compound, phenol, cresol, benzene, toluene, and xylene. Reference concentrations for each compound were reassessed and updated if necessary. Calculated hazard quotients were greater than 1 for benzene, phenol, xylene, and PGMEA, indicating that they have the potential for exposures that exceed reference levels. The information from our health risk assessment suggests that benzene and phenol have a higher level of risk than is currently acknowledged. Undertaking our form of risk assessment in the workplace design phase could identify compounds of major concern, allow for the early implementation of control measures and monitoring strategies, and thereby reduce the level of exposure to health risks that workers face throughout their career.
Fluvial shoal water deltas: pre‐vegetation sedimentation through the fluvial–marine transition, Lower Cambrian, English Channel region
Authors: Went David J.
Published: June 2019

Lower Palaeozoic fluvial systems tend to be more sand‐prone than those of later eras and the nature of coastal environments less certain. Field studies are presented that characterize the fluvial to marine transition over a distance of 80 km, in the Lower Cambrian of the Cotentin Peninsula, northern France. The sedimentary rocks are divided into six facies associations which represent deposition in proximal fluvial, distal fluvial, delta plain, delta front, pro‐delta and offshore carbonate bank environments. The basin fill is sandstone‐dominated and subdivided into three stratigraphic intervals. A 200 to 300 m thick basal interval contains very coarse‐grained fluvial sandstones deposited during a relative sea level lowstand. An overlying interval, 250 to 1500 m thick, is a facies mosaic. Fluvial strata in the north‐west pass laterally south‐east into deltaic and shallow marine pro‐delta sediments. The delta front deposits show repetitively stacked, upward‐coarsening parasequences, 8 to 10 m thick, which reflect the repeated progradation of lobate, fluvially‐dominated deltas onto a shallow marine shelf. The deltas formed following marine transgression and accumulated during a period of gradually rising relative sea level. An upper unit, 130 m thick, containing offshore stromatolitic and oolitic limestones, caps the study interval and represents deposition during a relative sea level highstand. The fluvial and delta distributary channel sandstones of the middle unit contain <1% mudstone. The cohesionless substrate determined that deltaic distributaries were predominantly braided in character and subject to common bifurcations which resulted in an ordered diminution of channel size and competence in a seaward direction. Terminal distributary channels show evidence of migratory levées and mouth‐bars and consistently delivered fine to medium‐grained sand to the delta front. The study highlights an example of pre‐vegetation deltaic sedimentation that was hydraulically organized and predictable, despite being fed by braided fluvial systems with high levels of peak discharge.
A novel HLA‐A*24:460 allele identified in a hematopoietic stem cell transplantation donor and recipient
Authors: Shin Kyung‐Hwa , Lee Hyun‐Ji , Lee Junghoon , Choi So‐Jung , Kim Hyung Hoi
Published: June 2019

HLA‐A*24:460 differs from HLA‐A*24:02 by one nucleotide in codon 285.
Ethnic/Immigrant Entrepreneurship Through the Yellow Pages in Berlin
Authors: Ülker Barış
Published: June 2019

Space is not an ontologically given entity; following this line of reasoning, the paper explores the concept of ethnic/immigrant entrepreneurship in Berlin relying on the yellow pages directoryGelbe Seiten – İş Rehberi(IR, published in German and Turkish). This particular yellow pages directory has become a spatial reflection of migrant entrepreneurial activities since 1996. It has also been playing a crucial role in the self‐representation of migrants after the fall of the Wall. In this context, the paper explores how individuals construct themselves as ethnic/immigrant entrepreneurs by using the IR, which serves as a networking tool for them. To achieve this goal, it looks at three advertisement strategies of entrepreneurs in the IR between 1996 and 2016.
Identification and characterization of permissive cells to dengue virus infection in human hematopoietic stem and progenitor cells
Authors: Hsu Alan Y. , Ho Tzu‐Chuan , Lai Mei‐Ling , Tan Sia Seng , Chen Tsai‐Yun , Lee Meed , Chien Yu‐Wen , Chen Ya‐Ping , Perng Guey Chuen
Published: June 2019

BACKGROUND

Dengue virus (DENV) is a significant threat to public health in tropical and subtropical regions, where the frequency of human migration is increasing. Transmission of DENV from donors to recipients after hematopoietic stem cell transplantation has been steadily described. However, the underlying mechanisms remain unclear.

STUDY DESIGN AND METHODS

Freshly isolated bone marrow (BM) was subjected to DENV infection, followed by multicolor fluorescence‐activated cell sorting (FACS) analysis. Virus in supernatants was collected and analyzed by plaque assay.

RESULTS

DENV‐1 to DENV‐4 could effectively infect freshly obtained BM and produced infectious virus. DENV infection did not change the quantitative population of hematopoietic stem and progenitor cells (HSPCs), megakaryocytic progenitor cells (MkPs) and megakaryocytes. Additionally, DENV antigen, nonstructural protein 1, was enriched in HSPCs and MkPs of DENV infected marrow cells. CD34+, CD133+, or CD61+ cells sorted out from BM were not only the major contributing targets facilitating the DENV infection directly but also facilitated the spread of DENV into other cells when cocultured.

CONCLUSION

Results suggest that DENV can efficiently infect HSPCs, which might jeopardize the recipients if DENV‐infected cells were subsequently used. We therefore raise the need for DENV screening for both the donors and recipients of hematopoietic stem cell transplantation, especially for donors exposed to endemic areas, to mitigate DENV infection in immunocompromised recipients.
Changes in target volume during irradiation of canine intranasal tumors can significantly impact radiation dosimetry
Authors: Yoshikawa Hiroto , Nolan Michael W.
Published: June 2019

Nasal tumor size can change during radiation therapy (RT). The amount of peritumoral fluid (eg, mucohemorrhagic effusions) can also fluctuate. How often this occurs and the magnitude of change are unknown. Likewise, there are no data which describe dosimetric effects of these changing volumes during a course of RT in veterinary medicine. This study addresses that gap in knowledge. Using pet dogs with nasal tumors, three CT image sets were created. Different Hounsfield units were applied to the gross tumor volume (GTV) of each image set: unchanged, –1000 (AIR), –1000 (to the portion of the GTV that actually underwent volume reduction during clinical RT; REAL). Two plans were created: 18‐fraction three‐dimensional conformal RT (3DCRT) and three‐fraction intensity‐modulated stereotactic RT (IM‐SRT). For nearby normal tissues and GTV, near‐maximum doses (D2% and D5%) and volumes receiving clinically significant doses were recorded. To verify “AIR” results, thermoluminescent dosimeters recorded dose in cadavers that were irradiated using both 3DCRT and IM‐SRT plans. “AIR” scenario had ≤1.5 Gray (Gy) increases in D2% and ≤3.2 cc increases of volume. “REAL” scenario had ≤0.97 Gy increases in D5% and ≤0.55 cc increases of volume at clinically relevant doses. Both were statistical significant. Results suggest that near‐complete resolution of GTV warrants plan revision.
Prácticas poéticas y micropolítica: “Mi Casa Mi Cuerpo”, “La Casa de la Frontera” y “Radio Conversa”
Authors: Moreno Escárraga Oscar Mauricio
Published: June 2019

“Mi Casa Mi Cuerpo”, “La Casa de la Frontera” y “Radio Conversa” son propuestas de creación artística que ponen en primer plano la voz poética y política de diversas comunida- des en Colombia, a través de dispositivos estéticos y afectivos abiertos al encuentro y a la elaboración de distintas miradas y sentidos de realidad, en el contexto del conflicto armado interno que ha vivido el país en las últimas décadas, caracterizado por la complejidad de acontecimientos y formas de violencia. Estas propuestas acogen estrategias de las artes plásticas contem- poráneas y las ponen en relación con algunas prácticas prove- nientes de otras disciplinas académicas y de otras expresiones culturales. En este caso, los conceptos de cuerpo vibrátil, ar- chivo e imagen poética —principalmente— se vinculan con la autobiografía, los relatos de vida, las experiencias domésticas y barriales, los conocimientos ancestrales, entre otros. A partir de este soporte fundamental, “Mi Casa Mi Cuerpo”, “La Casa de la Frontera” y “Radio Conversa” pretenden apreciar los pro- cesos de memoria y los imaginarios de comunidades que han atravesado por situaciones de migración forzosa, desarraigo o exilio, en contraste con los mecanismos de control social que se implementan con la guerra y la inserción de políticas de exis- tencia vinculadas con las lógicas de un mundo consumido por el capital y el poder. Finalmente, el viaje emprendido tras la rea- lización de estas propuestas artísticas devuelve la mirada sobre el propio universo personal, devela la necesidad apremiante de una subjetividad activa, permeable a los encuentros, las conver- saciones y las sensibilidades colectivas como premisa para el advenimiento de los “mundos por venir”.
Open Data, Models, and Codes for Vanadium Redox Batch Cell Systems: A Systems Approach Using Zero-Dimensional Models
Authors: Lee Seong Beom , Mitra Kishalay , Pratt Harry D. , Anderson Travis M. , Ramadesigan Venkatasailanathan , Chalamala Babu R. , Subramanian Venkat R.
Published: June 2019

In this paper, we study, analyze, and validate some important zero-dimensional physics-based models for vanadium redox batch cell (VRBC) systems and formulate an adequate physics-based model that can predict the battery performance accurately. In the model formulation process, a systems approach to multiple parameters estimation has been conducted using VRBC systems at low C-rates (∼C/30). In this batch cell system, the effect of ions' crossover through the membrane is dominant, and therefore, the capacity loss phenomena can be explicitly observed. Paradoxically, this means that using the batch system might be a better approach for identifying a more suitable model describing the effect of ions transport. Next, we propose an efficient systems approach, which enables to help understand the battery performance quickly by estimating all parameters of the battery system. Finally, open source codes, executable files, and experimental data are provided to enable people's access to robust and accurate models and optimizers. In battery simulations, different models and optimizers describing the same systems produce different values of the estimated parameters. Providing an open access platform can accelerate the process to arrive at robust models and optimizers by continuous modification from the users' side.
Glues Make Gummy Metals Easy To Cut
Authors: Udupa Anirudh , Sugihara Tatsuya , Mann James B.
Published: June 2019

Metals such as Cu, Al, Ni, Ta, and stainless steels, despite their softness and ductility, are considered difficult to machine. This is due to large cutting forces and corresponding formation of a very thick chip during cutting, and hence, these metals are referred to as “gummy.” Their poor machinability of these materials arises because of an unsteady and highly redundant mode of plastic deformation referred to as sinuous flow. The prevailing plastic deformation mode during machining can be overcome by the application of certain coatings and chemical media on the undeformed free surface of the workpiece ahead of the cutting process. Using in situ imaging and concurrent force measurements, we present two different mechanochemical routes through which these media can improve machinability. The first route, which requires chemicals that adhere to the metal surface, such as glues and inks, improves cutting by inducing a change in the local plastic deformation mode—from sinuous flow to one characterized by periodic fracture or segmented flow. The second route, which requires chemicals that can react with the workpiece to form a low-friction layer, changes the sinuous flow mode to a smooth, laminar one. Both routes decrease cutting forces by more than 50% with order of magnitude improvement in surface texture as characterized by measured roughness and defect density. The results suggest a broad range of opportunities for improving the performance of machining processes for many difficult-to-cut gummy metals.
Design Heuristics: Extraction and Classification Methods With Jet Propulsion Laboratory's Architecture Team
Authors: Fillingim Kenton B. , Nwaeri Richard O. , Borja Felipe , Fu Katherine , Paredis Christiaan J. J.
Published: June 2019

This study offers insight into the processes of expert designers at the Jet Propulsion Laboratory (JPL) and how they use heuristics in the design process. A methodology for the extraction, classification, and characterization of heuristics is presented. Ten expert participants were interviewed to identify design heuristics used during early stage space mission design at JPL. In total, 101 heuristics were obtained, classified, and characterized. The use of interviews to extract heuristics allowed for researchers to confirm that those heuristics were indeed used by designers. Through the use of post-interview surveys, participants characterized heuristics based on attributes including source/origin, applicability based on concept maturity, frequency of use, reliability, and tendency to evolve. These findings are presented, and statistically significant correlations were found between the participant perceptions of frequency of use, reliability, and evolution of a heuristic. A positive correlation was found between frequency of use and reliability while negative correlations were found between frequency of use and evolution, and reliability and evolution. Survey results and analysis aim to identify valid attributes for assessing the applicability and value of multiple heuristics for design practice in early space mission formulation.
The Application of Evolutionary Algorithms in Multi-Objective Design and Optimization of Air Cooled Heatsinks
Authors: Abdelsalam Younis Osama , Alimohammadi Sajad , Persoons Tim
Published: June 2019

Genetic algorithms (GAs) are considered to be one of the main types of evolutionary algorithms (EAs) and are being increasingly used in various engineering design applications. To a large extent, plate-fin heatsinks are used in the thermal management of compact electronic equipment and data centers. The shape optimization of the heatsinks is not rigorously investigated during the design process of high power electronics. Any improvements in the effectiveness of the heatsinks impact the energy consumed by large-scale information communication technology (ICT) facilities including data centers and telecommunication systems and promote a more sustainable use of raw materials. This paper investigates the optimization of plate-fin heatsinks by modifying the fin layout in a forced crossflow using a multi-objective genetic algorithm (MOGA) combined with computational fluid dynamics (CFD) simulations. The main objective is to improve the heat dissipation rate by modifying geometric parameters, i.e., the number, arrangement, and orientation of fins. For a generic heatsink test case, the optimized performance is examined in terms of thermal resistance, turbulence intensity, pumping power, coefficient of performance, and Chilton–Colburn j-factors. Among all of the cases investigated, the input parameter optimization configurations which coupled and rotated fins in groups of ten proved to be the most successful. For one case, an 18% increase in the effectiveness of heat dissipation is reported. However, when weight reduction was considered by dividing by the unit mass, the designs in one of the investigated families which remove a number of fins from the heatsink outperformed the rest, achieving improvements of 65% over the baseline.
Effects of Pulsation Intensities on Flame Characteristics of a Small Backward-Inclined Jet Flame in Crossflow
Authors: Hsu Ching Min , Khan Farha , Mosiria Dickson Bwana
Published: June 2019

The effects of pulsation intensities on the flame characteristics of a 10 deg-backward-inclined jet flame in the crossflow were investigated in a wind tunnel. The jet and the crossflow Reynolds numbers were 1527 and 2165, respectively. The jet-to-crossflow momentum flux ratio was 0.10. A loudspeaker was used to acoustically excite the jet flame. The excitation Strouhal number was 0.73, while the jet pulsation intensities varied from 0 to 1.26. The flame behaviors were studied through photography techniques. The flame temperatures were measured using a fine-wire R-type thermocouple. The combustion-induced emissions were probed by a commercial multi-gas analyzer. The jet flames were categorized into five characteristic modes with increasing pulsation intensities. Mode I was characterized by a yellowish down-washed recirculation flame, a blue neck flame, and a yellow tail flame. Modes II and III featured a split yellow tail flame, a yellowish recirculation flame, and a blue neck flame. Mode IV was characterized by a blue down-washed recirculation flame and neck flame, as well as a split yellow tail flame. Mode V was identified by a single yellow tail flame and the absence of the down-washed recirculation flame. When the jet flames were excited beyond mode I, the combustion-induced pollutants of carbon monoxide and nitric oxide were significantly reduced. However, the excited jet flame in mode V displayed low temperatures in the near-tube region.
Numerical Survey of the Melting Driven Natural Convection Using Generation Heat Source: Application to the Passive Cooling of Electronics Using Nano-Enhanced Phase Change Material
Authors: Faraji Hamza , Faraji Mustapha , El Alami Mustapha
Published: June 2019

The present paper reports numerical results of the melting driven natural convection in an inclined rectangular enclosure filled with nano-enhanced phase change material (NePCM). The enclosure is heated from the bottom side by a flush-mounted heat source (microprocessor) that generates heat at a constant and uniform volumetric rate and mounted on a substrate (motherboard). All the walls are considered adiabatic. The purpose of the investigation is analyzing the effect of nanoparticles insertion by quantifying their contribution to the overall heat transfer. Combined effects of the PCM type, the inclination angle and the nanoparticles fraction on the structure of the fluid flow and heat transfer are investigated. A 2D mathematical model based on the conservation equations of mass, momentum, and energy was developed. The governing equations were integrated and discretized using the finite volume method. The SIMPLE algorithm was adopted for velocity–pressure coupling. The obtained results show that the nanoparticles insertion has an important quantitative effect on the overall heat transfer. The insertion of metallic nanoparticles with different concentrations affects the thermal behavior of the heat sink. They contribute to an efficient cooling of the heat source. The effect of nanoparticles insertion is also shown at the temperature distribution along the substrate.
Infrasonic source altitude localization based on an infrasound ray tracing propagation model
Authors: Shang Chuxiang , Teng Pengxiao , Lyu Jun , Yang Jun , Sun Hongling
Published: June 2019

Based on a three-dimensional Hamiltonian ray tracing program in spherical coordinates, the effective sound speed is confirmed as the determining factor that influences the infrasound propagation path, and a theoretical model for the back-projected infrasound propagation trajectory is established. In this paper, the mass spectrometer incoherent scatter radar model (MSISE00) and horizontal wind model (HWM93) are first used to obtain the effective sound speed at different altitudes in summer and winter in Beijing. Then, the propagation paths generated by an infrasound source in Beijing are simulated with a conventional model. Some of the simulated rays are used to verify the back-projection model, and the verification has a high degree of coincidence with the simulation. Finally, using an experiment to validate the back-projection model, the altitude localization essentially conforms to the true value, proving the feasibility of the ray tracing back-projection algorithm.
Sound simulation-based design optimization of brass wind instruments
Authors: Tournemenne Robin , Petiot Jean-François , Talgorn Bastien , Gilbert Joël , Kokkolaras Michael
Published: June 2019

A method for optimizing the inner shape of brass instruments using sound simulations is presented. This study considers different objective functions and constraints (representative of both the intonation and the spectrum of the instrument) for a relatively large number of design variables. A complete physics-based model, taking into account the instrument and the musician's embouchure, is used to simulate steady regimes of sounds by means of the harmonic balance technique, the instrument being represented by its input impedance. The design optimization variables are related to the geometrical dimensions of the resonator. The embouchure's parameters are varied during the optimization procedure to obtain an average behavior of the instrument. The objective and constraint functions of the optimization problem are evaluated using the physics-based simulation model, which is computationally expensive. Moreover, the gradients of the objective and constraint functions can be discontinuous, unavailable, or hard to approximate reliably. Therefore, a surrogate-assisted derivative-free optimization strategy using the mesh adaptive direct search algorithm was employed. One example of a B♭ trumpet's bore is used to demonstrate the effectiveness of the design optimization approach: the obtained results improve previously reported objective function values significantly.
Autofocals: Evaluating gaze-contingent eyeglasses for presbyopes
Authors: Padmanaban Nitish , Konrad Robert , Wetzstein Gordon
Published: June 2019

Modern presbyopia corrections exhibit unnatural refocusing behavior; we build and evaluate autofocal eyeglasses to improve them.
Emission of circularly polarized light by a linear dipole
Authors: Neugebauer Martin , Banzer Peter , Nechayev Sergey
Published: June 2019

We show that an individual linear dipole emitter—contrary to common belief—can also radiate circularly polarized light.
Ni-catalyzed deaminative cross-electrophile coupling of Katritzky salts with halides via C─N bond activation
Authors: Ni Shengyang , Li Chun-Xiao , Mao Yu , Han Jianlin , Wang Yi , Yan Hong , Pan Yi
Published: June 2019

Reductive cross-coupling of primary amines and alkyl halides goes through a radical change.
Creation of two-dimensional layered Zintl phase by dimensional manipulation of crystal structure
Authors: Song Junseong , Song Hyun Yong , Wang Zhen , Lee Seokhee , Hwang Jae-Yeol , Lee Seung Youb , Lee Jouhahn , Kim Dongwook , Lee Kyu Hyong , Kim Youngkuk , Oh Sang Ho , Kim Sung Wng
Published: June 2019

A 3D crystal structure can be transformed into a layered structure by dimensional manipulation, expanding the 2D material library.
Solvent-dependent segmental dynamics in intrinsically disordered proteins
Authors: Salvi Nicola , Abyzov Anton , Blackledge Martin
Published: June 2019

Molecular simulation and NMR reveal how intrinsically disordered proteins move in synergy with their surrounding environment.
Polar Effects of Transposon Insertion into a Minimal Bacterial Genome
Authors: Hutchison Clyde A. , Merryman Chuck , Sun Lijie , Assad-Garcia Nacyra , Richter R. Alexander , Smith Hamilton O. , Glass John I.
Published: June 2019

In studies of the minimal genetic requirements for life, we used global transposon mutagenesis to identify genes needed for a minimal bacterial genome. Transposon insertion can disrupt the function of a gene but can also have polar effects on the expression of adjacent genes. In the Tn
5
-Puro
r
construct used in our studies, read-through transcription from Tn
5
-Puro
r
can drive expression of downstream genes. This results in a preference for Tn
5
-Puro
r
insertions transcribed toward a downstream essential or quasi-essential gene within the same operon. Such polar effects can have an impact on the classification of genes as essential, quasi-essential, or nonessential, but this has been observed in only a few cases. Also, polar effects of Tn
5
-Puro
r
insertion can sometimes give clues to gene function.
Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis
Authors: Yin Shang-He-Lin , Xu Peng , Wang Bian , Lu Yao , Wu Qiao-Yu , Zhou Meng-Li , Wu Jun-Ru , Cai Jing-Jing , Sun Xin , Yuan Hong
Published: June 2019

Objective

To evaluate the efficacy and safety of standard term (12 months) or long term (>12 months) dual antiplatelet therapy (DAPT) versus short term (<6 months) DAPT after percutaneous coronary intervention (PCI) with drug-eluting stent (DES).

Design

Systematic review and network meta-analysis.

Data sources

Relevant studies published between June 1983 and April 2018 from Medline, Embase, Cochrane Library for clinical trials, PubMed, Web of Science, ClinicalTrials.gov, and Clinicaltrialsregister.eu.

Review methods

Randomised controlled trials comparing two of the three durations of DAPT (short term, standard term, and long term) after PCI with DES were included. The primary study outcomes were cardiac or non-cardiac death, all cause mortality, myocardial infarction, stent thrombosis, and all bleeding events.

Results

17 studies (n=46 864) were included. Compared with short term DAPT, network meta-analysis showed that long term DAPT resulted in higher rates of major bleeding (odds ratio 1.78, 95% confidence interval 1.27 to 2.49) and non-cardiac death (1.63, 1.03 to 2.59); standard term DAPT was associated with higher rates of any bleeding (1.39, 1.01 to 1.92). No noticeable difference was observed in other primary endpoints. The sensitivity analysis revealed that the risks of non-cardiac death and bleeding were further increased for ≥18 months of DAPT compared with short term or standard term DAPT. In the subgroup analysis, long term DAPT led to higher all cause mortality than short term DAPT in patients implanted with newer-generation DES (1.99, 1.04 to 3.81); short term DAPT presented similar efficacy and safety to standard term DAPT with acute coronary syndrome (ACS) presentation and newer-generation DES placement. The heterogeneity of pooled trials was low, providing more confidence in the interpretation of results.

Conclusions

In patients with all clinical presentations, compared with short term DAPT (clopidogrel), long term DAPT led to higher rates of major bleeding and non-cardiac death, and standard term DAPT was associated with an increased risk of any bleeding. For patients with ACS, short term DAPT presented similar efficacy and safety with standard term DAPT. For patients implanted with newer-generation DES, long term DAPT resulted in more all cause mortality than short term DAPT. Although the optimal duration of DAPT should take personal ischaemic and bleeding risks into account, this study suggested short term DAPT could be considered for most patients after PCI with DES, combining evidence from both direct and indirect comparisons.

Systematic review registration

PROSPERO CRD42018099519.
Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women
Authors: Schoep Mark E , Adang Eddy M M , Maas Jacques W M , De Bie Bianca , Aarts Johanna W M , Nieboer Theodoor E
Published: June 2019

Objective

To evaluate age-dependent productivity loss caused by menstruation-related symptoms, measured in absenteeism (time away from work or school) and presenteeism (productivity loss while present at work or school).

Methods

Design/setting: internet-based, cross-sectional survey conducted in the Netherlands from July to October 2017.

Participants: 32 748 women aged 15–45 years, recruited through social media.

Outcome measures: self-reported lost productivity in days, divided into absenteeism and presenteeism; impact of menstrual symptoms; reasons women give when calling in sick; and women’s preferences regarding the implications of menstruation-related symptoms for schools and workplaces.

Results

A total of 13.8% (n=4514) of all women reported absenteeism during their menstrual periods with 3.4% (n=1108) reporting absenteeism every or almost every menstrual cycle. The mean absenteeism related to a woman’s period was 1.3 days per year. A total of 80.7% (n=26 438) of the respondents reported presenteeism and decreased productivity a mean of 23.2 days per year. An average productivity loss of 33% resulted in a mean of 8.9 days of total lost productivity per year due to presenteeism. Women under 21 years were more likely to report absenteeism due to menstruation-related symptoms (OR 3.3, 95% CI 3.1 to 3.6). When women called in sick due to their periods, only 20.1% (n=908) told their employer or school that their absence was due to menstrual complaints. Notably, 67.7% (n=22 154) of the participants wished they had greater flexibility in their tasks and working hours at work or school during their periods.

Conclusions

Menstruation-related symptoms cause a great deal of lost productivity, and presenteeism is a bigger contributor to this than absenteeism. There is an urgent need for more focus on the impact of these symptoms, especially in women aged under 21 years, for discussions of treatment options with women of all ages and, ideally, more flexibility for women who work or go to school.
Prevalence and socioeconomic impact of depressive disorders in India: multisite population-based cross-sectional study
Authors: Arvind Banavaram Anniappan , Gururaj Gopalkrishna , Loganathan Santosh , Amudhan Senthil , Varghese Mathew , Benegal Vivek , Rao Girish N , Kokane Arun Mahadeo , B S Chavan , P K Dalal , Ram Daya , Pathak Kangkan , R K Lenin Singh , Singh Lokesh Kumar , Sharma Pradeep , Saha Pradeep Kumar , C Ramasubramanian , Mehta Ritambhara Y , T M Shibukumar
Published: June 2019

Objectives

The National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS.

Design

Multisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage.

Setting

Conducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology.

Participants

A total of 34 802 adults (>18 years) were interviewed.

Main outcome measure

Prevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0.

Results

The weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40–59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD.

Conclusion

Around 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.
The effect of dose on the antimalarial efficacy of artesunate-mefloquine againstPlasmodium falciparummalaria: a protocol for systematic review and individual patient data (IPD) meta-analysis
Authors: Mansoor Rashid , Dahal Prabin , Humphreys Georgina S , Guerin Philippe , Ashley Elizabeth A , Stepniewska Kasia
Published: June 2019

Introduction

Antimalarial posology based on weight bands leaves patients at the margins vulnerable to receiving either lower or higher weight-adjusted (mg/kg) dosages. This article aims to describe the protocol for systematic review and individual patient meta-analysis (MA) for a study of the distribution of artesunate and mefloquine dosage administered in patients with uncomplicatedPlasmodium falciparummalaria treated with an artesunate-mefloquine (AS-MQ) regimen. Relationship between mg/kg dose and therapeutic outcomes will be assessed through a one-stage individual participant data (IPD) MA.

Methods and analysis

Therapeutic efficacy studies with the AS-MQ regimen will be identified by searching the following databases: PUBMED, EMBASE and Web of Science. The corresponding authors of the relevant studies will be requested to share the IPD for the purpose of this MA to a secured repository. All available studies will be standardised using a common data management protocol and pooled into a single database. The relationship between mg/kg dosage and treatment failures will be assessed using a Cox regression model with study sites considered as a shared frailty term. Safety parameters will be explored where available.

Ethics and dissemination

This IPD MA met the criteria for waiver of ethical review as defined by the Oxford Tropical Research Ethics Committee as the research consisted of secondary analysis of existing anonymous data. The results of this analysis will be disseminated at conferences, WorldWide Antimalarial Resistance Network website and any peer-reviewed publication arising will be made open source.

PROSPERO registration number

CRD42018103776.
Relationship of different domains of physical activity practice with health-related quality of life among community-dwelling older people: a cross-sectional study
Authors: Scarabottolo Catarina Covolo , Cyrino Edilson Serpeloni , Nakamura Priscila Missaki , Tebar William Rodrigues , Canhin Daniel da Silva , Gobbo Luis Alberto , Christofaro Diego Giulliano Destro
Published: June 2019

Objective

To analyse the association between different domains of physical activity (PA) and health-related domains of health-related quality of life (HRQoL) in older adults, independent of confounding variables.

Design

Cross-sectional study.

Participants

In total, 400 individuals 60 years or above were randomly selected to participate in the study.

Primary and secondary outcome measures

PA was assessed by a questionnaire in three different domains (work/occupational, sports/gym and leisure time) and total PA. The 36-Item Short Form Health Survey was used to evaluate HRQoL. The variables socioeconomic condition, marital status and presence of health professional-diagnosed comorbidities were self-reported.

Results

The mean age of the sample was 71.5 (±8.4) years, of whom 58% (n=232) were female. Male older adults showed higher scores of PA in sports, leisure time and in total PA than female adults. Older adults who were more physically active in the work/occupational domain were associated with better scores in functional capacity (OR=1.73, 95% CI 1.02 to 2.93) and general health perception (OR=1.61, 95% CI 1.02 to 2.56). Those who presented a higher score in the sports/gym domain had better scores in functional capacity, even after adjustment for comorbidities (OR=1.72, 95% CI 1.01 to 2.96). Individuals with higher activity in leisure time were more likely to have better scores in functional capacity (OR=1.75, 95% CI 1.03 to 2.98), body pain (OR=1.74, 95% CI 1.09 to 2.78) and mental health (OR=1.67, 95% CI 1.03 to 2.69). Older adults who were more active in total PA were 77% more likely to have better scores in functional capacity (OR=1.77, 95% CI 1.04 to 3.02).

Conclusion

Physically active older adults in the different domains of PA presented better HRQoL parameters, reinforcing the importance of studies analysing PA in different contexts and in countries with low and medium socioeconomic conditions.
Diversity in the emergency care for febrile children in Europe: a questionnaire study
Authors: Borensztajn Dorine , Yeung Shunmay , Hagedoorn Nienke N , Balode Anda , von Both Ulrich , Carrol Enitan D , Dewez Juan Emmanuel , Eleftheriou Irini , Emonts Marieke , van der Flier Michiel , de Groot Ronald , Herberg Jethro Adam , Kohlmaier Benno , Lim Emma , Maconochie Ian , Martinón-Torres Federico , Nijman Ruud , Pokorn Marko , Strle Franc , Tsolia Maria , Wendelin Gerald , Zavadska Dace , Zenz Werner , Levin Michael , Moll Henriette A
Published: June 2019

Objective

To provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children.

Design and setting

An electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), www.perform2020.eu) in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK.

Outcome measures

The questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates).

Results

Reported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries.

Conclusion

Differences in local, regional and national aspects of care exist in the management of febrile children across Europe. This variability has to be considered when trying to interpret differences in the use of diagnostic tools, antibiotics and admission rates. Any future implementation of interventions or diagnostic tests will need to be aware of this European diversity.
mHOMR: a feasibility study of an automated system for identifying inpatients having an elevated risk of 1-year mortality
Authors: Wegier Pete , Koo Ellen , Ansari Shahin , Kobewka Daniel , O'Connor Erin , Wu Peter , Steinberg Leah , Bell Chaim , Walton Tara , van Walraven Carl , Embuldeniya Gayathri , Costello Judy , Downar James
Published: June 2019

Objective

The need for clinical staff to reliably identify patients with a shortened life expectancy is an obstacle to improving palliative and end-of-life care. We developed and evaluated the feasibility of an automated tool to identify patients with a high risk of death in the next year to prompt treating physicians to consider a palliative approach and reduce the identification burden faced by clinical staff.

Methods

Two-phase feasibility study conducted at two quaternary healthcare facilities in Toronto, Canada. We modified the Hospitalised-patient One-year Mortality Risk (HOMR) score, which identifies patients having an elevated 1-year mortality risk, to use only data available at the time of admission. An application prompted the admitting team when patients had an elevated mortality risk and suggested a palliative approach. The incidences of goals of care discussions and/or palliative care consultation were abstracted from medical records.

Results

Our model (C-statistic=0.89) was found to be similarly accurate to the original HOMR score and identified 15.8% and 12.2% of admitted patients at Sites 1 and 2, respectively. Of 400 patients included, the most common indications for admission included a frailty condition (219, 55%), chronic organ failure (91, 23%) and cancer (78, 20%). At Site 1 (integrated notification), patients with the notification were significantly more likely to have a discussion about goals of care and/or palliative care consultation (35% vs 20%, p = 0.016). At Site 2 (electronic mail), there was no significant difference (45% vs 53%, p = 0.322).

Conclusions

Our application is an accurate, feasible and timely identification tool for patients at elevated risk of death in the next year and may be effective for improving palliative and end-of-life care.
Physical activity and health-related quality of life in multiple myeloma survivors: the PROFILES registry
Authors: Servadio Michela , Cottone Francesco , Sommer Kathrin , Oerlemans Simone , van de Poll-Franse Lonneke , Efficace Fabio
Published: June 2019

Objectives

To investigate whether physical activity (PA) is associated with health-related quality of life (HRQOL) outcomes in multiple myeloma (MM) survivors up to 11 years after diagnosis.

Methods

We used data from the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry. We included 175 MM survivors diagnosed between 1999 and 2009 as registered by the Netherlands Cancer Registry. Sixty-four per cent (n=112/175) of patients who received the questionnaires, completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-MY20. Patients were classified into two groups: physically active and not physically active patients. Univariable and multivariable linear regression models were used to evaluate associations between PA and HRQOL outcomes.

Results

Physically active patients reported a statistically significant higher global health status/HRQOL (p=0.001), lower fatigue (p=0.002) and fewer side effects of treatments (p=0.001), than not physically active patients. PA was not associated with psychological symptoms (ie, anxiety and depressive symptoms) (anxiety: p=0.139; depressive symptoms: p=0.073). Exploratory analyses performed on the other scales of the EORTC QLQ-C30 indicated statistically significant better outcomes in several functional and symptom subscales for physically active patients.

Conclusions

These findings might contribute to a better understanding of the relationship between PA and disease specific HRQOL aspects in MM survivors. Prospective studies are warranted to further elucidate on the beneficial effects of PA on HRQOL outcomes of MM survivors.