bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experimental Assessment of a Sliding-Blade Inside-Out Ceramic Turbine
Authors: Thibault D. , Dubois P. K. , Picard B. , Landry-Blais A. , Plante J.-S. , Picard M. 
Published: December 2020

Abstract
In order to reach 40% efficiency, sub-MW turbines must operate in a recuperated gas Brayton cycle at a turbine inlet temperature (TIT) above 1300 °C. Current sub-MW turbines have material-related operating temperature limits. Still to this day, there is no cost-effective rotor design which operates at such high temperatures. This paper introduces a novel, sliding-blade, inside-out ceramic turbine (ICT) wheel configuration, which could enable high-efficiency sub-MW recuperated engines to be achieved with cheap monolithic ceramic blades. The inside-out configuration uses a rotating structural hoop, or shroud, to convert centrifugal forces into compressive blade loading. The sliding-blade architecture uses a hub with angled planes on which ceramic blades slide up and down, allowing to match the radial expansion of the structural shroud. This configuration generates low stress values in both ceramic and metallic components and can achieve high tip speeds. A prototype is designed and its reliability is calculated using cares software. The result is a design which has a single blade probability of failure (Pf) of 0.1% for 1000 h of steady operation. Analyses also demonstrate that reliability is greatly dependent on friction at ceramic-to-metal interfaces. Low friction could lead to acceptable reliability levels for engine applications. The prototype was successfully tested in a laboratory turbine environment at a tip speed of 350 m/s and a TIT of 1100 °C without any damage. These achievements demonstrate the robustness of the sliding-blade ICT configuration. Further research and development will focus on increasing tip speed and TIT to higher values.
Optic nerve sheath diameter changes at high altitude and in acute mountain sickness: meta-regression analyses
Authors: Tsai Tou-Yuan , Gozari George , Su Yung-Cheng , Lee Yi-Kung , Tu Yu-Kang 
Published: December 2020

Background/aimsTo assess changes in optic nerve sheath diameter (ONSD) at high altitude and in acute mountain sickness (AMS).MethodsCochrane Library, EMBASE, Google Scholar and PubMed were searched for articles published from their inception to 31st of July 2020. Outcome measures were mean changes of ONSD at high altitude and difference in ONSD change between subjects with and without AMS. Meta-regressions were conducted to investigate the relation of ONSD change to altitude and time spent at that altitude.ResultsEight studies with 248 participants comparing ONSD from sea level to high altitude, and five studies with 454 participants comparing subjects with or without AMS, were included. ONSD increased by 0.14 mm per 1000 m after adjustment for time (95% CI: 0.10 to 0.18; p<0.01). Restricted cubic spline regression revealed an almost linear relation between ONSD change and time within 2 days. ONSD was greater in subjects with AMS (mean difference=0.47; 95% CI: 0.14 to 0.80; p=0.01; I2=89.4%).ConclusionOur analysis shows that ONSD changes correlate with altitude and tend to increase in subjects with AMS. Small study number and high heterogeneity are the limitations of our study. Further large prospective studies are required to verify our findings.
Inactivated trivalent influenza vaccination is associated with lower mortality among patients with COVID-19 in Brazil
Authors: Fink Günther , Orlova-Fink Nina , Schindler Tobias , Grisi Sandra , Ferrer Ana Paula S , Daubenberger Claudia , Brentani Alexandra 
Published: December 2020

Objective
To estimate associations between trivalent influenza vaccination and COVID-19 mortality as well as severe clinical outcomes among hospitalised patients.

Design
Retrospective observational study.

Setting
This study was conducted among hospitalised patients with COVID-19 in Brazil.

Participants
We analysed all hospitalised patients with COVID-19 with available vaccination information captured in Brazil’s national electronic respiratory infection data system between 1 January 2020 and 23 June 2020.

Main outcome measures
The primary outcomes were age-specific mortality rates of hospitalised patients with COVID-19 with and without recent inactivated trivalent influenza vaccination.

Results
A total of 53 752 clinically confirmed COVID-19 cases were analysed. Controlling for health facility of treatment, comorbidities as well as an extensive range of sociodemographic factors, patients who received a recent influenza vaccine experienced on average 7% lower odds of needing intensive care treatment (95% CI 0.87 to 0.98), 17% lower odds of requiring invasive respiratory support (95% CI 0.77 to 0.88) and 16% lower odds of death (95% CI 0.78 to 0.90). Protective effects were larger when the vaccine was administered after onset of symptoms as well as among younger patients.

Conclusion
Patients with COVID-19 with recent inactivated influenza vaccination experience significantly better health outcomes than non-vaccinated patients in Brazil. Beneficial off-target effects of influenza vaccination through trained innate immune responses seem plausible and need to be further explored. Large-scale promotion of influenza vaccines seems advisable, especially in populations at high risk for severe COVID-19 disease progression.
Comparison of health service use and costs in stroke with and without comorbidities: a cross-sectional analysis using China urban medical claims data
Authors: Ding Ruoxi , Zhu Dawei , Ma Yong , Shi Xuefeng , He Ping 
Published: December 2020

ObjectivesStroke is the leading cause of death and disability in China, but there is scare of evidence on whether and to what extent comorbidity affects the stroke-related costs in health system. We examined the association between comorbidity and stroke-related health service utilisation and costs in urban China.SettingsThe data used in this study were extracted by a 5% random sampling from claims data of China Urban Employees’ Basic Medical Insurance and Urban Residents’ Basic Medical Insurance from 2013 to 2016, which covered more than 93% of residents in urban China. The data included 89 cities and contained beneficiaries’ demographic information, medical diagnoses and expenditures of outpatient and inpatients services.Participants382 906 patients with stroke were identified as the study population in this study.Primary and secondary outcome measuresThe information on health service utilisation and cost was extracted based on the condition that stroke was claimed as the index disease.ResultsAmong 382 906 patients with stroke, 41.0% had a comorbidity. The estimated number of annual outpatient visits among patients with 0, 1, 2 and 3 or more comorbidities were 1.97, 2.30, 2.34 and 2.37, respectively. The annual outpatient expenditure increased from 762.4 (95% CI 746.9 to 777.8) RMB among patients without any comorbidities to 1156.4 (1132.7 to 1180.2) RMB among patients with three or more comorbidities. The increased utilisation and costs among patients with comorbidity were also observed for inpatient services. Stroke-related services utilisation and costs were significantly increased among patients who comorbid conditions like hypertension or chronic pulmonary diseases.ConclusionComorbidity among patients with stroke was associated with increased healthcare utilisation and cost. It poses an extra substantial healthcare burden in China. Our study provides information for both clinical management and health service planning and financing for patients with stroke.
Worried, weary and worn out: mixed-method study of stress and well-being in final-year medical students
Authors: Lane Abbie , McGrath Jack , Cleary Eimear , Guerandel Allys , Malone Kevin M 
Published: December 2020

ObjectiveAlthough there is much focus on burnout and psychological distress among doctors, studies about stress and well-being in medical students are limited but could inform early intervention and prevention strategies.DesignThe primary aim of this mixed-method, cross-sectional survey was to compare objective and subjective levels of stress in final-year medical students (2017) and to explore their perspectives on the factors they considered relevant to their well-being.SettingUniversity College Dublin, the largest university in Ireland.Participants161 of 235 medical students participated in this study (response rate 69%).Results65.2% of students scored over accepted norms for the Perceived Stress Scale (34.8% low, 55.9% moderate and 9.3% high). 35% scored low, 28.7% moderate and 36.3% high on the Subjective Stress Scale. Thematic analysis identified worry about exams, relationships, concern about the future, work–life balance and finance; one in three students reported worry, irritability and hostility; many felt worn out. Cognitive impacts included overthinking, poor concentration, sense of failure, hopelessness and procrastination. Almost a third reported sleep and appetite disturbance, fatigue and weariness. A quarter reported a ‘positive reaction’ to stress. Positive strategies to manage stress included connection and talking, exercise, non-study activity and meditation. Unhelpful strategies included isolation and substance use. No student reported using the college support services or sought professional help.ConclusionMedical students experience high levels of psychological distress, similar to their more senior doctor colleagues. They are disinclined to avail of traditional college help services. Toxic effects of stress may impact their cognition, learning, engagement and empathy and may increase patient risk and adverse outcomes. The focus of well-being in doctors should be extended upstream and embedded in the curriculum where it could prevent future burnout, improve retention to the profession and deliver better outcomes for patients.
Maintenance of professional competence in Ireland: a national survey of doctors’ attitudes and experiences
Authors: Galvin Emer , Wiese Anel , Dahly Darren , O'Farrell Janet , Cotter Jantze , Bennett Deirdre 
Published: December 2020

ObjectivesProgrammes to ensure doctors’ maintenance of professional competence (MPC) have been established in many countries. Since 2011, doctors in Ireland have been legally required to participate in MPC. A significant minority has been slow to engage with MPC, mirroring the contested nature of such programmes internationally. This study aimed to describe doctors’ attitudes and experiences of MPC in Ireland with a view to enhancing engagement.ParticipantsAll registered medical practitioners in Ireland required to undertake MPC in 2018 were surveyed using a 33-item cross-sectional mixed-methods survey designed to elicit attitudes, experiences and suggestions for improvement.ResultsThere were 5368 responses (response rate 42%). Attitudes to MPC were generally positive, but the time, effort and expense involved outweighed the benefit for half of doctors. Thirty-eight per cent agreed that MPC is a tick-box exercise. Heavy workload, travel, requirement to record continuing professional development activities and demands placed on personal time were difficulties cited. Additional support, as well as higher quality, more varied educational activities, were among suggested improvements. Thirteen per cent lacked confidence that they could meet requirements, citing employment status as the primary issue. MPC was particularly challenging for those working less than full-time, in locum or non-clinical roles, and taking maternity or sick leave. Seventy-seven per cent stated a definite intention to comply with MPC requirements. Being male, or having a basic medical qualification from outside Ireland, was associated with less firm intention to comply.ConclusionsDoctors need to be convinced of the benefits of MPC to them and their patients. A combination of clear communication and improved relevance to practice would help. Addition of a facilitated element, for example, appraisal, and varied ways to meet requirements, would support participation. MPC should be adequately resourced, including provision of high-quality free educational activities. Systems should be established to continually evaluate doctors’ perspectives.
Atypical lymphoid cells circulating in blood in COVID-19 infection: morphology, immunophenotype and prognosis value
Authors: Merino Anna , Vlagea Alexandru , Molina Angel , Egri Natalia , Laguna Javier , Barrera Kevin , Boldú Laura , Acevedo Andrea , Díaz-Pavón Mar , Sibina Francesc , Bascón Francisca , Sibila Oriol , Juan Manel , Rodellar José 
Published: December 2020

AimsAtypical lymphocytes circulating in blood have been reported in COVID-19 patients. This study aims to (1) analyse if patients with reactive lymphocytes (COVID-19 RL) show clinical or biological characteristics related to outcome; (2) develop an automatic system to recognise them in an objective way and (3) study their immunophenotype.MethodsClinical and laboratory findings in 36 COVID-19 patients were compared between those showing COVID-19 RL in blood (18) and those without (18). Blood samples were analysed in Advia2120i and stained with May Grünwald-Giemsa. Digital images were acquired in CellaVisionDM96. Convolutional neural networks (CNNs) were used to accurately recognise COVID-19 RL. Immunophenotypic study was performed throughflow cytometry.ResultsNeutrophils, D-dimer, procalcitonin, glomerular filtration rate and total protein values were higher in patients without COVID-19 RL (p<0.05) and four of these patients died. Haemoglobin and lymphocyte counts were higher (p<0.02) and no patients died in the group showing COVID-19 RL. COVID-19 RL showed a distinct deep blue cytoplasm with nucleus mostly in eccentric position. Through two sequential CNNs, they were automatically distinguished from normal lymphocytes and classical RL with sensitivity, specificity and overall accuracy values of 90.5%, 99.4% and 98.7%, respectively. Immunophenotypic analysis revealed COVID-19 RL are mostly activated effector memory CD4 and CD8 T cells.ConclusionWe found that COVID-19 RL are related to a better evolution and prognosis. They can be detected by morphology in the smear review, being the computerised approach proposed useful to enhance a more objective recognition. Their presence suggests an abundant production of virus-specific T cells, thus explaining the better outcome of patients showing these cells circulating in blood.
The critical temperature of the 2D-Ising model through deep learning autoencoders
Authors: Alexandrou Constantia , Athenodorou Andreas , Chrysostomou Charalambos , Paul Srijit 
Published: December 2020

AbstractWe investigate deep learning autoencoders for the unsupervised recognition of phase transitions in physical systems formulated on a lattice. We focus our investigation on the 2-dimensional ferromagnetic Ising model and then test the application of the autoencoder on the anti-ferromagnetic Ising model. We use spin configurations produced for the 2-dimensional ferromagnetic and anti-ferromagnetic Ising model in zero external magnetic field. For the ferromagnetic Ising model, we study numerically the relation between one latent variable extracted from the autoencoder to the critical temperatureTc. The proposed autoencoder reveals the two phases, one for which the spins are ordered and the other for which spins are disordered, reflecting the restoration of the ℤ2symmetry as the temperature increases. We provide a finite volume analysis for a sequence of increasing lattice sizes. For the largest volume studied, the transition between the two phases occurs very close to the theoretically extracted critical temperature. We define as a quasi-order parameter the absolute average latent variable z̃, which enables us to predict the critical temperature. One can define a latent susceptibility and use it to quantify the value of the critical temperatureTc(L) at different lattice sizes and that these values suffer from only small finite scaling effects. We demonstrate thatTc(L) extrapolates to the known theoretical value asL→∞suggesting that the autoencoder can also be used to extract the critical temperature of the phase transition to an adequate precision. Subsequently, we test the application of the autoencoder on the anti-ferromagnetic Ising model, demonstrating that the proposed network can detect the phase transition successfully in a similar way.Graphical abstract
Consistency conditions for p-form field localization on codimension two braneworlds
Authors: Freitas L. F. F. , Alencar G. , Landim R. R. 
Published: December 2020

AbstractIn a recent work (Eur. Phys. J. C 80(5), 432, 2020), the present authors obtained general stringent conditions on the localization of fields in braneworlds by imposing the requirement that its zero mode must satisfy Einstein’s equations (EEs). In this manuscript, we continue this study by considering freep-form fields. These fields present an on-shell equivalency relation between ap-form and a$$(D-p-2)$$(D-p-2)-form, provided by a Hodge duality (HD) transformation. This symmetry will impose a new consistency condition, namely, confinement of ap-form on the brane must imply the localization of its dual. We apply the above two conditions to 6D braneworld models. With this, we find that in global string-like defects, for example, the 1-form field has a normalizable zero mode. By using the HD as a guide, we show that its bulk dual 3-form field also has a normalizable zero mode, making the confinement consistent with HD. However, these solutions cannot be made consistent with EE, therefore, these fields must be ruled out. In fact, by imposing both conditions, only the scalar field and its dual can be consistently localized in codimension two braneworlds. In this way, all the literature so far in which the free vector field (1-form) is localized in codimension two models should be reviewed. These results also point to the fact that the symmetries of the fields can be used to verify the consistency of their localization and even prohibit it.
The Relationship Between Architectural Modularity and Platform Scale Up Performance: The Moderating Effects of Strategic Flexibility and Technology Turbulence
Authors: Padmanabhan Jaykumar , Raghunath S. 
Published: December 2020

The emergence of digital platforms has had a deep impact on the way firms design and position their products. An open architecture is a key to successfully scale up platforms in terms of usage. Architectural modularity is an important feature that facilitates openness of platforms. Successful scaling of platforms needs a digital infrastructure layer that facilitates collaboration and creation and hence the role of modular systems in the development of platform ecosystems has increased substantially. In this paper, we study the relationship between modular architectures and platform scale up performance from a survey data of managers in the semiconductor industry with 232 data points. The findings from our study show that the scale-up performance of platforms has an inverted U-shaped relationship with modularity. We also find that the strategic flexibility of firms positively moderates this relationship.The degree of flexibility that system architecture should have is not only an important technical decision but is important from a business perspective as well. Ambiguity in terms of interfaces and the functionality of modules reduces the possibility of ex-ante specification of contracting terms and incentives and monitoring of incentives. The link between architectural modularity and the relationship to performance is important as this enables us to examine questions related to the success of task partitioning at an industry level.
Newly comprehensive understanding of Li2S8 as additive in liquid electrolyte for lithium-sulfur battery through reconstructing the cathode and SEI
Authors: He Gangguo , Zhao Lei , Han Jiayue , Huang Yun , Li Xing , Wang Mingshan , Cao Haijun 
Published: December 2020

Adding Li2S8 as additive in liquid electrolyte (LE) for lithium-sulfur battery (LSB) is one of the most effective strategies which not only suppresses the shuffle effect of lithium polysulfide (LPS) through concentration difference but also maintains the excellent properties of ether-based electrolyte. However, previous researches on this strategy mostly focus on low-concentration Li2S8 additive (no more than 0.2 mol/L), which cannot provide comprehensive understanding of the special role of Li2S8. In this study, high-concentration Li2S8 is selected as the LE additive which is demonstrated inducing two marvelous reconstruction effects that have not been reported both for the cathode and solid electrolyte interphase (SEI). Through these two effects, the cathode and SEI are reconstructed to form denser and more stable structures, ensuring the battery to possess much higher discharge specific capacity and excellent cycle stability, with a Coulombic efficiency (CE) fade of only 0.091% per cycle. This exploration of Li2S8 additive helps to better understand the role of electrolyte additive and how the concentration of it influences the whole battery system.
Efficacy and Safety of Direct Oral Anticoagulants for Atrial Fibrillation Across Body Mass Index Categories
Authors: Kaplan Rachel M. , Tanaka Yoshihiro , Passman Rod S. , Fine Michelle , Rasmussen‐Torvik Laura J. , Vupputuri Suma , Martin Karlyn , Khan Sadiya S. 
Published: December 2020

Background
Direct‐acting oral anticoagulants are now the preferred method of anticoagulation in patients with atrial fibrillation. Limited data on efficacy and safety of these fixed‐dose regimens are available in severe obesity where drug pharmacokinetics and pharmacodynamics may be altered. The objectives of this study were to evaluate efficacy and safety in patients with atrial fibrillation taking direct‐acting oral anticoagulants across body mass index (BMI) categories in a contemporary, real‐world population.

Methods and Results

We performed a retrospective study of patients with atrial fibrillation at an integrated multisite healthcare system. Patients receiving a direct‐acting oral anticoagulant prescription and ≥12 months of follow‐up between 2010 and 2017 were included. The primary efficacy and safety outcomes were ischemic stroke or systemic embolism and intracranial hemorrhage. We performed Cox proportional hazards modeling to compute hazard ratios (HRs) adjusted for CHA
2
DS
2
‐VASc score to examine differences by excess BMI categories relative to normal BMI. Of 7642 patients, mean±SD age was 69±12 years with a median (interquartile range) follow‐up of 3.8 (2.2–6.0) years. Approximately 22% had class 1 obesity and 19% had class 2 or 3 obesity. Stroke risks were similar in patients with and without obesity (HR, 1.2; 95% CI, 0.5–2.9; and HR, 0.68; 95% CI, 0.23–2.0 for class 1 and class 2 or 3 obesity compared with normal BMI, respectively). Risk of intracranial hemorrhage was also similar in class 1 and class 2 or 3 obesity compared with normal BMI (HR, 0.64; 95% CI, 0.35–1.2; and HR, 0.66; 95% CI, 0.35–1.2, respectively).

Conclusions
Direct‐acting oral anticoagulants demonstrated similar efficacy and safety across all BMI categories, even at high weight values.
Delivering Education to the Underserved through a Public-Private Partnership Program in Pakistan
Authors: Barrera-Osorio Felipe , Blakeslee David S. , Hoover Matthew , Linden Leigh , Raju Dhushyanth , Ryan Stephen P. 
Published: December 2020

Abstract
We evaluate a program that recruited local entrepreneurs to open and operate new schools in 200 underserved villages in Sindh, Pakistan. School operators received a per student subsidy to provide tuition-free primary education, and half the villages received a higher subsidy for females. The program increased enrollment by 32 percentage points and test scores by 0.63 standard deviations, with no difference across the two subsidy schemes. Estimating a structural model of the demand and supply for school inputs, we find that program schools selected inputs similar to those of a social planner who internalizes all the education benefits to society.