bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thermodynamic Modeling of Heat Engines Including Heat Transfer and Compression–Expansion Irreversibilities
Authors: Osorio Julian D. , Rivera-Alvarez Alejandro , Abakporo Obie I. , Ordonez Juan C. , Hovsapian Rob 
Published: April 2021

Abstract
In this work, a thermodynamic model based on an endoreversible engine approach is developed to analyze the performance of heat engines operating under different thermodynamic cycles. The model considers finite heat transfer rate, variable heat source and sink temperatures, and irreversibilities associated with the expansion and compression. Expressions for the maximum power and efficiency at maximum power output are obtained as a function of hot and cold reservoir temperatures, the equivalent isentropic efficiency of compression and expansion components, and the effective conductance ratio between heat exchangers. In all cases, the Curzon–Ahlborn efficiency is retrieved at constant reservoir temperatures and neglected compression–expansion irreversibilities. The proposed model allows assessing the effect of isentropic efficiencies and heat exchanger design and operation characteristics for different thermodynamic cycles.
Agreement Between Different Days of activPAL and Actigraph GT3X Measurement of Sedentary Behavior and Physical Activity During the School Hours in Elementary Children
Authors: Barboza Luciana L.S. , Gandarela Larissa , Santana Josefa Graziele S. , Silva Ellen Caroline M. , Machado Elondark S. , Silva Roberto Jerônimo S. , Gomes Thayse N. , Silva Danilo R. 
Published: April 2021

Introduction: The authors’ objective was to identify the minimum number of days required to measure sedentary behavior and physical activity in children during school hours. Methods: Fifty-three children from four classes of the second year of elementary school in a public school in Brazil were selected. Sedentary behavior and physical activity were evaluated using activPAL in the thigh and ActiGraph GT3X on the hip. The devices were used for 4 days during the 4 hr of school. Intraclass correlation coefficient (ICC) and Bland–Altman plots were used for statistical analysis (p < .05). Results: For sedentary/stationary behavior indicators, 1 day showed good agreement with 4 days (sitting time, ICC = .89; bias [limits of agreement 95%, LA95%] = 1.6 [45.1 to −41.9], standing time, ICC = .93; bias [LA95%] 1.1 [30.2 to −28.0], and stationary behavior, ICC = .56; bias [LA95%] = 0.2 [37.2 to −36.7]). However, 2 days were necessary for good agreement, with 4 days for physical activity indicators (walking time, ICC = .91; bias [LA95%] = 1.1 [12.0 to −9.7], light physical activity, ICC = .97; bias [LA95%] = 0.3 [7.6 to −7.0], moderate physical activity, ICC = .93; bias [LA95%] = 0.3 [2.3 to −1.6], and vigorous physical activity, ICC = .93; bias [LA95%] = 0.3 [3.1 to −2.5]). Conclusion: Therefore, 1 evaluation day seems enough to obtain representative data of school sedentary/stationary behavior, while 2 days are necessary for the evaluation of physical activity indicators during school hours.
Impact of Flexible Work Arrangements, Self-Efficacy, and Barriers on Daily Physical Activity Among University Staff
Authors: Borowski Shelby , Savla Jyoti , Zvonkovic Anisa M. 
Published: April 2021

Background: Little is known about the link between flexible work arrangements and health behaviors, such as physical activity. This study aimed to explore how self-efficacy and daily barriers to physical activity influence daily levels of physical activity on workdays when university staff members used a flexible work arrangement (flextime or telework). Methods: Full-time university staff employees (N = 61, mean age = 41; 89% female) participated in this daily diary study. Participants completed an initial survey followed by daily surveys over the course of one workweek, resulting in 281 diary days. Results: The most frequently reported barriers to physical activity were as follows: lack of time, feeling tired, and not enough motivation. Multilevel models revealed that as the number of barriers increased, minutes of physical activity significantly decreased. Self-efficacy was not significantly related to daily physical activity. Participants reported fewer minutes of physical activity on flextime workdays compared to days when a flexible work arrangement was not used (ie, traditional workday). Daily use of a flexible work arrangement did not moderate the association between barriers and physical activity. Conclusions: This study illustrated the influence of daily barriers and flextime workdays on physical activity levels, which can inform workplace health programs for university staff.
Cross-sectional study evaluating the association between integrated care and health-related quality of life (HRQOL) in Dutch primary care
Authors: Valentijn Pim P , Kerkhoven Marcel , Heideman Jantien , Arends Rosa 
Published: April 2021

ObjectivesThe aim of this study was to evaluate the association between integrated care and health-related quality of life (HRQOL) in a primary care practice population.DesignA cross-sectional survey study.SettingPrimary care practice population.ParticipantsA sample (n=5562) of patients in two general practitioner practices in the Netherlands.Primary outcome measuresThe Rainbow Model of Integrated Care Measurement Tool patient version and EQ-5D was used to assess integrated service delivery and HRQOL. The association between integrated care and HRQOL groups was analysed using multivariate logistic regression.ResultsOverall, 933 respondents with a mean age of 62 participated (20% response rate) in this study. The multivariate analysis revealed that positive organisational coordination experiences were linked to better HRQOL (OR=1.87, 95% CI 1.18 to 2.95), and less anxiety and depression problems (OR=0.36, 95% CI 0.20 to 0.63). Unemployment was associated with a poor HRQOL (OR=0.15, 95% CI 0.08 to 0.28). Ageing was associated with more mobility (OR=1.06, 95% CI 1.04 to 1.09), self-care (OR=1.06, 95% CI 1.02 to 1.11), usual activity (OR=1.03, 95% CI 1.01 to 1.05) and pain problems (OR=1.02, 95% CI 1.01 to 1.04). Being married improved the overall HRQOL (OR=1.60, 95% CI 1.13 to 2.26) and decreased anxiety and depression (OR=0.47, 95% CI 0.31 to 0.72). Finally, females had a poor overall HRQOL (OR=1.67, 95% CI 0.48 to 0.93) and more pain and discomfort problems (OR=1.47, 95% CI 1.11 to 1.95).ConclusionThis study shows for the first time that organisational coordination activities are positively associated with HROQL of adult patients in a primary care context, adding to the evidence of an association between integrated care and HRQOL. Also, unemployment, ageing and being female are accumulating risk factors that should be considered when designing integrated primary care programmes. Further research is needed to explore how various integration types relate to HRQOL for people in local communities.
Study protocol for a multicentre, randomised controlled trial to compare the use of the decellularised dermis allograft in addition to standard care versus standard care alone for the treatment of venous leg ulceration: DAVE trial
Authors: Onida Sarah , Heatley Francine , Peerbux Sarrah , Bolton Layla , Lane Tristan , Epstein David , Gohel Manjit , Poskitt Keith , Cullum Nicky , Norrie John , Lee Robert J , Bradbury Andrew , Dhillon Karen , Chandrasekar Akila , Lomas Richard , Davies A H 
Published: April 2021

IntroductionVenous leg ulceration (VLU), the most common type of chronic ulcer, can be difficult to heal and is a major cause of morbidity and reduced quality of life. Although compression bandaging is the principal treatment, it is time-consuming and bandage application requires specific training. There is evidence that intervention on superficial venous incompetence can help ulcer healing and recurrence, but this is not accessible to all patients. Hence, new treatments are required to address these chronic wounds. One possible adjuvant treatment for VLU is human decellularised dermis (DCD), a type of skin graft derived from skin from deceased tissue donors. Although DCD has the potential to promote ulcer healing, there is a paucity of data for its use in patients with VLU.Methods and analysisThis is a multicentre, parallel group, pragmatic randomised controlled trial. One hundred and ninety-six patients with VLU will be randomly assigned to receive either the DCD allograft in addition to standard care or standard care alone. The primary outcome is the proportion of participants with a healed index ulcer at 12 weeks post-randomisation in each treatment arm. Secondary outcomes include the time to index ulcer healing and the proportion of participants with a healed index ulcer at 12 months. Changes in quality of life scores and cost-effectiveness will also be assessed. All analyses will be carried out on an intention-to-treat (ITT) basis. A mixed-effects, logistic regression on the outcome of the proportion of those with the index ulcer healed at 12 weeks will be performed. Secondary outcomes will be assessed using various statistical models appropriate to the distribution and nature of these outcomes.Ethics and disseminationEthical approval was granted by the Bloomsbury Research Ethics Committee (19/LO/1271). Findings will be published in a peer-reviewed journal and presented at national and international conferences.Trial registration numberISRCTN21541209.
Instruments measuring the quality of life among people living with type 2 diabetes mellitus in India: a systematic review protocol
Authors: Demla Chetna , Thomas Anns , Jose Jomol , Joshy Angela L , Hrishikesh M A , Rajendran Ambigai , Parsekar Shradha S 
Published: April 2021

IntroductionType 2 diabetes mellitus affects an individual’s quality of life (QoL); and there are multiple instruments that can be used to measure QoL. The purpose of this systematic review is to identify the existing instruments that have been used to measure QoL in people living with diabetes, and to enlist the major domains (such as physical and psychological components) available in the identified instruments. Additionally, we plan to determine the psychometric properties of the identified QoL instruments using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.Methods and analysisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guideline was followed to report this systematic review protocol. Searches will be conducted on MEDLINE (via PubMed, Web of Science), SCOPUS and CINAHL. Predetermined inclusion/exclusion criteria will be applied to the search results, to include studies with adult individuals diagnosed with type 2 diabetes mellitus, with and without complications, and exclude studies with type 1 diabetes or other clinical illness. Studies conducted outside India will be excluded. Five authors in pairs will independently screen the articles and extract the data that meets the inclusion criteria. The COSMIN criteria will be used to assess the risk of bias of included studies. Narrative synthesis will be performed to analyse the findings of the instruments.Ethics and disseminationEthical permission is not applicable, as this is a systematic review. We intend to disseminate the systematic review findings through a national or international conference and publish the findings in a peer-reviewed journal.PROSPERO registration numberCRD42020180432.
Loneliness among older adults in the community during COVID-19: a cross-sectional survey in Canada
Authors: Savage Rachel D , Wu Wei , Li Joyce , Lawson Andrea , Bronskill Susan E , Chamberlain Stephanie A , Grieve Jim , Gruneir Andrea , Reppas-Rindlisbacher Christina , Stall Nathan M , Rochon Paula A 
Published: April 2021

ObjectivePhysical distancing and stay-at-home measures implemented to slow transmission of novel coronavirus disease (COVID-19) may intensify feelings of loneliness in older adults, especially those living alone. Our aim was to characterise the extent of loneliness during the first wave in a sample of older adults living in the community and assess characteristics associated with loneliness.DesignOnline cross-sectional survey between 6 May and 19 May 2020.SettingOntario, Canada.ParticipantsConvenience sample of members of a national retired educators’ organisation.Primary outcome measuresSelf-reported loneliness, including differences between women and men.Results4879 respondents (71.0% women; 67.4% 65–79 years) reported that in the preceding week, 43.1% felt lonely at least some of the time, including 8.3% who felt lonely always or often. Women had increased odds of loneliness compared with men, whether living alone (adjusted OR (aOR) 1.52, 95% CI 1.13 to 2.04) or with others (2.44, 95% CI 2.04 to 2.92). Increasing age group decreased the odds of loneliness (aOR 0.69 (95% CI 0.59 to 0.81) 65–79 years and 0.50 (95% CI 0.39 to 0.65) 80+ years compared with <65 years). Living alone was associated with loneliness, with a greater association in men (aOR 4.26, 95% CI 3.15 to 5.76) than women (aOR 2.65, 95% CI 2.26 to 3.11). Other factors associated with loneliness included: fair or poor health (aOR 1.93, 95% CI 1.54 to 2.41), being a caregiver (aOR 1.18, 95% CI 1.02 to 1.37), receiving care (aOR 1.47, 95% CI 1.19 to 1.81), high concern for the pandemic (aOR 1.55, 95% CI 1.31 to 1.84), not experiencing positive effects of pandemic distancing measures (aOR 1.94, 95% CI 1.62 to 2.32) and changes to daily routine (aOR 2.81, 95% CI 1.96 to 4.03).ConclusionsWhile many older adults reported feeling lonely during COVID-19, several characteristics—such as being female and living alone—increased the odds of loneliness. These characteristics may help identify priorities for targeting interventions to reduce loneliness.
Erector spinae plane block for minimally invasive mitral valve surgery: a double-blind, prospective, randomised placebo-controlled trial—a study protocol
Authors: Hoogma Danny Feike , Rex Steffen , Tournoy Jos , Verbrugghe Peter , Fieuws Steffen , Al Tmimi Layth 
Published: April 2021

IntroductionIn the context of enhanced recovery after cardiac surgery, surgical techniques for mitral valve surgery have witnessed substantial modifications, from approaching the heart using open approaches with traditional sternotomy to thoracoscopic access via minithoracotomy. After cardiac surgery, acute postoperative pain is frequent and caused by surgical incision and retraction. Perioperative analgesia in cardiac surgery still relies mainly on opioids. Although neuraxial techniques could be a valuable non-opioid-based analgesia regimen, they can be associated with devastating complications in situations with (iatrogenic) coagulation abnormalities. Only two randomised clinical trials describe the erector spinae plane (ESP) block to provide sufficient postoperative analgesia following cardiac surgery with median sternotomy. Regarding postoperative analgesia after cardiac surgery with a minithoracotomy approach, adequately designed trials are still lacking. We, therefore, designed a double-blind, placebo-controlled trial to prove the hypothesis that the ESP block reduces opioid consumption in patients undergoing minimally invasive mitral valve surgery (MIMVS).Methods and analysisSixty-four patients undergoing MIMVS will be included in this double-blind, prospective, placebo-controlled trial. Patients will be randomised to receive an ESP block with a catheter with either intermittent ropivacaine 0.5% (ropi group) or normal saline 0.9% (placebo group). Both groups will receive patient-controlled intravenous analgesia with morphine following extubation. Primary endpoint is the 24-hour cumulative morphine consumption after extubation. Multiple secondary endpoints will be evaluated.Ethics and disseminationThe study is approved by the ethics committee of the University Hospitals Leuven, the Clinical Trials Centre of the University Hospitals Leuven and the ‘Federaal Agentschap voor Geneesmiddelen en Gezondheidsproducten’. Dissemination of the study results will be via scientific papers.Trial registration numberEudraCT identifier: 2019-001125-27.
Paediatric emergency department dog bite attendance during the COVID-19 pandemic: an audit at a tertiary children’s hospital
Authors: Tulloch John S P , Minford Simon , Pimblett Vicky , Rotheram Matt , Christley Robert M , Westgarth Carri 
Published: April 2021

BackgroundResponses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures.MethodsAn audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ2 tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years’ data.ResultsDog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7–12 year-olds, girls in 4–6 year-olds. Girls showed higher attendance rates in the summer, while boys’ attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls.ConclusionsCOVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via ‘stay at home’ orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.
Association of cardiovascular health and incident atrial fibrillation in elderly population
Authors: Lee Jae-Hyuk , Yang Pil-Sung , Yu Hee Tae , Kim Tae-Hoon , Jang Eunsun , Uhm Jae-Sun , Pak Hui-Nam , Lee Moon-Hyoung , Joung Boyoung 
Published: April 2021

ObjectiveTo evaluate whether baseline and changes in cardiovascular health (CVH) were related to incident atrial fibrillation (AF) risk in the elderly population.MethodsFrom the Korea National Health Insurance Service-Senior cohort, we included 208 598 participants without prior AF (median age: 70 (IQR 66–74) years; 90 916 (43.6%) men) who underwent national health check-ups between 1 January 2005 and 31 December 2012. Using the six metrics of the American Heart Association, participants were categorised as having low, moderate and high CVH.ResultsOver a median follow-up of 7.2 years, 7818 cases of incident AF occurred. In multivariable analysis, moderate (HR: 0.90; 95% CI: 0.86 to 0.94) and high (HR: 0.81; 95% CI: 0.73 to 0.91) CVH status at baseline were associated with a lower risk of incident AF. However, in 109 695 participants with changes in CVH between the first and second check-ups, the direction of change in CVH scores showed no consistent association with future AF incidence. In newly diagnosed participants with AF, the incidence of the composite outcome (stroke, major bleeding and all-cause death) decreased with every 1-point increase in the baseline CVH score (HR: 0.94; 95% CI: 0.89 to 0.99).ConclusionsIn the general elderly population, better baseline CVH metrics were associated with lower incident AF risk. In participants with newly diagnosed AF, better CVH was also associated with lower incidence of future composite outcomes. However, the direction of change in CVH status within 2 years showed an inconsistent influence on incident AF risk.
Characterisation of protein-truncating and missense variants in PALB2 in 15 768 women from Malaysia and Singapore
Authors: Ng Pei Sze , Boonen Rick ACM , Wijaya Eldarina , Chong Chan Eng , Sharma Milan , Knaup Sabine , Mariapun Shivaani , Ho Weang Kee , Lim Joanna , Yoon Sook-Yee , Mohd Taib Nur Aishah , See Mee Hoong , Li Jingmei , Lim Swee Ho , Tan Ern Yu , Tan Benita Kiat-Tee , Tan Su-Ming , Tan Veronique Kiat-Mien , van Dam Rob Martinus , Rahmat Kartini , Yip Cheng Har , Carvalho Sara , Luccarini Craig , Baynes Caroline , Dunning Alison M , Antoniou Antonis , van Attikum Haico , Easton Douglas F , Hartman Mikael , Teo Soo Hwang 
Published: April 2021

BackgroundRare protein-truncating variants (PTVs) in partner and localiser of BRCA2 (PALB2) confer increased risk to breast cancer, but relatively few studies have reported the prevalence in South-East Asian populations. Here, we describe the prevalence of rare variants in PALB2 in a population-based study of 7840 breast cancer cases and 7928 healthy Chinese, Malay and Indian women from Malaysia and Singapore, and describe the functional impact of germline missense variants identified in this population.MethodsMutation testing was performed on germline DNA (n=15 768) using targeted sequencing panels. The functional impact of missense variants was tested in mouse embryonic stem cell based functional assays.ResultsPTVs in PALB2 were found in 0.73% of breast cancer patients and 0.14% of healthy individuals (OR=5.44; 95% CI 2.85 to 10.39, p<0.0001). In contrast, rare missense variants in PALB2 were not associated with increased risk of breast cancer. Whereas PTVs were associated with later stage of presentation and higher-grade tumours, no significant association was observed with missense variants in PALB2. However, two novel rare missense variants (p.L1027R and p.G1043V) produced unstable proteins and resulted in a decrease in homologous recombination-mediated repair of DNA double-strand breaks.ConclusionDespite genetic and lifestyle differences between Asian and other populations, the population prevalence of PALB2 PTVs and associated relative risk of breast cancer, are similar to those reported in European populations.