bluuebunny/crossref_metadata_2025_split huggingface dataset:
General Corrosion of Chromium-Coated Zirconium- and Titanium-Based Alloys in Supercritical Water at 500 °C
Authors: Khumsa-Ang K. , Edwards M. , Rousseau S. 
Published: November 2019

Abstract
The 300 MWel small Canadian supercritical water-cooled reactor (SCWR), which is a scaled-down version of the original 1200 MWel concept, has a smaller core, uses low enriched uranium fuel instead of a plutonium–thorium fuel, and features a lower (maximum) cladding temperature of 500 °C. The lower cladding temperature may permit the use of different alloys, including zirconium alloys, which had been ruled out as candidates for the Canadian SCWR, whose cladding temperature may reach 850 °C. The potential to use zirconium alloys is exciting because they have a low neutron cross section, which in turn means that fewer neutrons are lost, and the fuel can be used more efficiently. One advantage, for example,, is that the fuel cycle can be lengthened. In this paper, we report on the results of corrosion experiments used to screen zirconium- and titanium-based alloys as well as corrosion-resistant coating materials such as Cr and Al as potential candidates for fuel cladding in the small Canadian SCWR. These experiments were conducted in a refreshed autoclave in deaerated supercritical water at 500 °C and 23.5 MPa. After exposure, the weight gain was measured, and the oxide thickness and the oxide phases were examined. Of all materials, the coated and uncoated Ti-grade 2 and Ti-grade 5 alloys met our screening qualification criteria, however, Al/Cr-coated zirconium coupons showed notable improvement and will be explored further in future testing.
Retinopathy progression and the risk of end-stage kidney disease: results from a longitudinal Japanese cohort of 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease
Authors: Yamanouchi Masayuki , Mori Mikiro , Hoshino Junichi , Kinowaki Keiichi , Fujii Takeshi , Ohashi Kenichi , Furuichi Kengo , Wada Takashi , Ubara Yoshifumi 
Published: November 2019

ObjectiveThe predictive value of diabetic retinopathy on end-stage kidney disease (ESKD) has not been fully addressed in patients with type 2 diabetes and diabetic kidney disease.Research design and methodsWe studied 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease who were screened for diabetic retinopathy during the 1 month of kidney biopsy. We examined the association between retinopathy progression and renal lesions. We used Cox regression analyses to explore the risk of ESKD adjusting for known risk demographic and clinical variables. We assessed the incremental prognostic value of ESKD by adding diabetic retinopathy to the clinical variables.ResultsThe diabetic retinopathy progression positively correlated with all scores of renal lesions, especially with the glomerular-based classification (r=0.41), scores of interstitial fibrosis (r=0.41) and diffuse lesion (r=0.48). During a median follow-up of 5.7 years, 114 patients developed ESKD. Adjusting for known risk factors of ESKD, the HR for ESKD (patients with no apparent retinopathy as a reference) were 1.96 (95% CI 0.62 to 6.17) for patients with mild non-proliferative diabetic retinopathy (NPDR), 3.10 (95% CI 1.45 to 6.65) for patients with moderate NPDR, 3.03 (95% CI 1.44 to 6.37) for patients with severe NPDR, and 3.43 (95% CI 1.68 to 7.03) for patients with proliferative diabetic retinopathy, respectively. Addition of the retinopathy grading to the clinical model alone improved the prognostic value (the global χ2statistic increased from 155.2 to 164.5; p<0.001), which is an improvement equivalent to the addition of the renal lesion grading to the clinical model.ConclusionsRetinopathy progression appeared to be associated with renal lesions and the development of ESKD. Our findings suggest that diabetic retinopathy and kidney disease share the same magnitude of disease progression, and therefore diabetic retinopathy may be useful for prognosticating the clinical course for diabetic kidney disease.
Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017
Authors: Wu Xiaobing , Guan Yang , Ye Jianbin , Fu Hanlin , Zhang Chunlai , Lan Lina , Wu Fengxin , Tang Fen , Wang Feng , Cai Yumao , Yu Weiye , Feng Tiejian 
Published: November 2019

ObjectiveThis study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults.MethodsData were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014–2017. Blood samples were screened using the ELISAs, and confirmed using theTreponema pallidumparticle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST).ResultsAmong 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged <25 years, respectively. The prevalence of syphilis seropositivity (χ2trend=311.9, ptrend<0.001) and active infection (χ2trend=72.1, ptrend<0.001) increased significantly with age. After stratification by gender and year of donation, the increasing trend of prevalence with age remained (ptrend<0.05), except for the prevalence of active infection in males and females in 2014. About 16.3% of donors with active infection and aged ≥45 years had a TRUST titre of ≥1∶8, lower than that of patients aged <25 years (51.3%) and 25–34 years (34.1%).ConclusionsThe findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.
The structure and predictive value of intrinsic capacity in a longitudinal study of ageing
Authors: Beard John R , Jotheeswaran A T , Cesari Matteo , Araujo de Carvalho Islene 
Published: November 2019

ObjectivesTo assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.DesignStructural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.SettingsCommunity, United Kingdom.Participants2560 eligible participants aged over 60 years.Main outcome measuresActivities of daily living (ADL) and instrumental activities of daily living (IADL).ResultsOne general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.ConclusionsThe WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis
Authors: KhalafAllah Mahmoud Tawfik , Basiony Ahmed , Salama Ahmed 
Published: November 2019

ObjectiveTopical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.DesignSystematic review and meta-analysis.Data sourcesMedline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references’ lists of the relevant articles.Eligibility criteriaRandomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.Data extraction and synthesisTwo independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.ResultsWe included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1 week (OR=2.5, p>0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1 day (OR=2.6, p=0.02) and 1 week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1 month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).ConclusionWith low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively.
Relationships between dipstick proteinuria and risk of hearing impairment among Japanese workers: a prospective cohort study
Authors: Umesawa Mitsumasa , Hara Mikako , Sairenchi Toshimi , Nagao Masanori , Haruyama Yasuo , Kobashi Gen 
Published: November 2019

ObjectivesHearing impairment is among the most significant health problems, and the number of adults with hearing impairment is increasing worldwide. Therefore, the prevention of hearing impairment is important. Proteinuria appears to be a risk factor for hearing impairment, but no prospective studies have examined the association between proteinuria and hearing impairment risk. This prospective study aimed to clarify the association between dipstick proteinuria and risk of hearing impairment.DesignThis was a prospective cohort study based on annual health check-up data, 2008–2016.SettingData were collected on 7005 employees of a single company who worked in offices and factories throughout Japan.ParticipantsWe analysed data from 5699 subjects (88.6% men) who underwent annual health check-ups twice or more from 2008 to 2016, had no missing data, and were free from hearing impairment at baseline. We regarded the first health check-up as the baseline examination.Primary and secondary outcome measuresHearing tests were performed using audiometry at two frequencies (1 and 4 kHz) during the health check-ups. Defining total moderate hearing impairment as the inability to respond to 30 dB at 1 kHz and/or 40 dB at 4 kHz, we examined the association between dipstick proteinuria at baseline and risk of hearing impairment at final examination.ResultsTotal moderate hearing impairment was noted in 162 (2.8%) subjects. Compared with subjects without proteinuria at baseline, the multivariable adjusted OR (95% CI) was 5.35 (1.87–15.25) for subjects with proteinuria ≥2+, 0.92 (0.40–2.13) for those with proteinuria +/−, and 1.33 (0.63–2.80) for those with proteinuria+ at baseline.ConclusionsSevere dipstick proteinuria was positively associated with risk of hearing impairment in the future. Our results suggest that medical examinations including urine testing are effective for detecting subjects with high risk of hearing impairment.
Pharmaceutical use and costs in patients with coronary artery disease, using Australian observational data
Authors: McCreanor Victoria , Parsonage William A , Whiteman David C , Olsen Catherine , Barnett Adrian G , Graves Nicholas 
Published: November 2019

ObjectivesWe aimed to estimate the annual pharmaceutical costs for patients with stable coronary artery disease, using Australian administrative data, comparing patients who had undergone interventional treatment with those had not. We also aimed to compare the duration of dual antiplatelet therapy (DAPT) prescription in the real-world, with recommended guidelines.DesignAn observational study using administrative data.ParticipantsWe used data from theQSkinstudy, a population-based prospective study assessing skin cancer risk. Participants were invited from the Queensland population, not based on perceived skin cancer risk, and had consented to future use of their data for approved research projects.Main outcome measuresWe calculated 12-month costs of pharmaceutical therapy for coronary artery disease for patients in each of three clinically relevant groups: medical therapy only, following coronary stent implantation and following coronary artery bypass graft surgery. We measured the duration of DAPT following stent implantation and total duration of DAPT, where it was prescribed, in the medical therapy only group.ResultsEstimated mean annual pharmaceutical costs were highest in the stent group at AUD$1920, compared with AUD$1481 in the medical therapy group, and AUD$881 in the coronary artery bypass group. There were similar rates of prescriptions of symptom relief drugs following stent insertion, compared with the medical therapy only group. The median duration of DAPT in the stent group was 16, and 31 months in the medical therapy group.ConclusionsOur results suggest that despite the common expectation that the burden of medical therapy is reduced following coronary stent insertion for stable coronary artery disease, this does not occur in practice. Many patients also appear to continue DAPT longer than guidelines recommend, which may put them at unnecessarily elevated risk of bleeding events.
Fostering humanism: a mixed methods evaluation of the Footprints Project in critical care
Authors: Hoad Neala , Swinton Marilyn , Takaoka Alyson , Tam Benjamin , Shears Melissa , Waugh Lily , Toledo Feli , Clarke France J , Duan Erick Huaileigh , Soth Mark , Cook Deborah J 
Published: November 2019

ObjectivesThe objectives of this mixed-methods study were to assess the uptake, sustainability and influence of the Footprints Project.SettingTwenty-two-bed university-affiliated ICU in Hamilton, Canada.ParticipantsICU patients admitted and their families, as well as clinicians.InterventionsWe developed a personalised patient Footprints Form and Whiteboard to facilitate holistic, patient-centred care, to inform clinical encounters, and to create deeper connections among patients, families and clinicians.Outcome measuresWe conducted 3 audits to examine uptake and sustainability. We conducted semi-structured interviews with 10 clinicians, and held 5 focus groups with 25 clinicians; and we interviewed 5 patients and 13 family representatives of 5 patients who survived and 5 who died in the ICU. Transcripts were analysed using qualitative content analysis.ResultsThe Footprints Project facilitated holistic, patient-centred care by setting the stage for patient and family experience, motivating the patient and humanising the patient for clinicians. Through informing clinical encounters, Footprints helped clinicians initiate more personal conversations, foster deeper connections and guide treatment. Professional practice influences included more focused attention on the patient, enhanced interdisciplinary communication and changes in community culture. Initially used in 15.8% of patients (audit A), uptake increased to 51.4% in audit B, and was sustained at 57.8% in audit C.ConclusionsBy sharing valuable personal information about patients before and beyond their illness on individualised whiteboards at each bedside, the Footprints Project fosters humanism in critical care practice.
Animal-related injuries and fatalities: evidence from a large-scale population-based cross-sectional survey in rural Bangladesh
Authors: Bhuiyan Md Al Amin , Agrawal Priyanka , Wadhwaniya Shirin , Li Qingfeng , Alonge O , Rahman AKM Fazlur , Rahman Aminur 
Published: November 2019

ObjectiveThis study determines the magnitude and pattern of animal-related injury mortalities and morbidities in rural Bangladesh.Design and settingA cross-sectional survey was conducted in 51 Unions of 7 subdistricts of Bangladesh from June 2013 to September 2013.ParticipantsA total of approximately 1.17 million individuals across all age and gender profiles were included in the survey. The participants had to be residents of the seven subdistricts and have provided consent to participate in the study.Primary and secondary outcome measuresAnimal-related injury characteristics and demographic information was collected in the study. Frequency, proportion and 95% CIs of variables such as type of animal, type of animal attack, activity of the person prior to attack and the seasonality of the injury were reported. Data was then statistically analysed for associations between injury and sociodemographic characteristics.ResultsThe incidence rate of fatal and non-fatal animal-related injuries across all ages were 0.7 (95% CI 0.4 to 1.4) and 1635.3 (95% CI 1612.0 to 1658.0) per 100 000 populations, respectively. Non-fatal animal-related injury rates were highest among adults 18 years and older (1820.6 per 100 000 population (1777.2 to 1865.1)), and in males across all age groups. The most common animal injury was wasp/hornet/bee sting (49%), followed by cow/buffalo (25%), dog bite (9%) and snake bites (9%).ConclusionsAnimal-related injuries are an important public health issue in rural Bangladesh. The incidence of animal-related morbidities was found high in the study area. Males, school-going and productive age groups were at high risk. Immediate attention should be given to prevent these events.
Using the General Social Survey – National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA
Authors: Grinshteyn Erin , Muennig Peter , Pabayo Roman 
Published: November 2019

ObjectivesFear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death.Setting and participantsData from the 1978–2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297).MethodsGSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex.ResultsAmong those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14).ConclusionsResearch has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully.
Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review
Authors: Sempé Lucas , Billings Jenny , Lloyd-Sherlock Peter 
Published: November 2019

ObjectivesTo synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy.DesignA systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach.ResultsThe search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines.ConclusionsThe review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.PROSPERO registration numberCRD42018108116.