bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adiabatic Effectiveness and Thermal Field Measurements of a Shaped Hole in the Showerhead of a Model Turbine Blade
Authors: Moore Jacob D. , Horner Matthew J. , Bogard David G. 
Published: June 2021

Abstract
Few published studies incorporating shaped hole designs in the leading-edge region, or showerhead, of turbine airfoils have been performed; but among them is the indication that shaped holes may offer an improvement in coolant performance compared to cylindrical holes. A shaped hole was designed with the goal of high performance in the showerhead. The performance and physical behavior of this shaped hole design was studied in comparison to a traditional cylindrical hole design in a series of experiments. The geometries were built into the leading edge of a scaled-up turbine blade model for testing in a low-speed simulated linear cascade. To accomplish an engine-representative test environment, a nominally 5% approach turbulence level was used for this study. Adiabatic effectiveness as a function of coolant injection rate was measured for the two designs using infrared thermography. In addition, off-the-wall thermal field measurements were performed for each hole geometry in the leading-edge region. It was found that the shaped hole offered ∼20 − 100% higher performance in terms of adiabatic effectiveness depending on the coolant injection rate. The thermal field measurements suggested that this was due to the better attachment of the jets exiting the shaped holes, the momenta of which were effectively reduced by the diffusers.
Taxonomic Status of Four Rare Alien Fish Species of the Kapchagay Reservoir (Balkhash Basin, Central Asia)
Authors: Mamilov N. Sh. , Konysbaev T. G. , Magda I. N. , Vasil’eva E. D. 
Published: June 2021

Abstract—
Based on the morphological features, four rare alien species in the Kapchagai reservoir were identified: Coregonus peled, Parasalmo mykiss, Megalobrama mantschuricus, and Oreochromis niloticus. The latter two species were recorded for the ichthyofauna of Kazakhstan for the first time. Self-reproducing P. mykiss populations have been known in the Balkhash Basin since the late 1990s, whereas the introduction of C. peled into the Ili basin in 1968−1969 and 1971 did not lead to the naturalization of the species. The reasons for the great diversity of invasive fish species in the Kapchagai reservoir are overviewed.
Role of Semenov’s Theory of Chain Reactions in the Formation of Modern Concepts on the Processes of Combustion, Explosion, and Detonation of Gases
Authors: Azatyan V. V. 
Published: June 2021

Abstract
This paper presents the results of the theoretical and experimental studies of ignition, flame propagation, explosion, and detonation of gases, showing that, contrary to previous concepts, chain mechanisms in combustion reactions play a decisive role not only at pressures tens of times lower than atmospheric pressure in the absence of self-heating but also at higher pressures and any temperature conditions. Examples of the chemical control of all these processes are given. At the same time, the results show the outstanding role of N.N. Semenov’s theory of chain reactions in the development of the theory of the rates of chemical reactions and combustion processes.
‘I haven’t heard much about other methods’: quality of care and person-centredness in a programme to promote the postpartum intrauterine device in Tanzania
Authors: Senderowicz Leigh , Pearson Erin , Hackett Kristy , Huber-Krum Sarah , Francis Joel Msafiri , Ulenga Nzovu , Bärnighausen Till 
Published: June 2021

BackgroundProgrammes promoting the postpartum intrauterine device (PPIUD) have proliferated throughout South Asia and sub-Saharan Africa in recent years, with proponents touting this long-acting reversible contraceptive (LARC) method’s high efficacy and potential to meet contraceptive unmet need. While critiques of LARC-first programming abound in the Global North, there have been few studies of the impact of LARC-centric programmes on patient-centred outcomes in the Global South.MethodsHere, we explore the impact of a PPIUD intervention at five Tanzanian hospitals and their surrounding satellite clinics on quality of contraceptive counselling and person-centred care using 20 qualitative in-depth interviews with pregnant women seeking antenatal care at one of those clinics. Using a modified version of the contraceptive counselling quality framework elaborated by Holt and colleagues, we blend deductive analysis with an inductive approach based on open coding and thematic analysis.ResultsInterpersonal aspects of relationship building during counselling were strong, but a mix of PPIUD intervention-related factors and structural issues rendered most other aspects of counselling quality low. The intervention led providers to emphasise the advantages of the IUD through biased counselling, and to de-emphasise the suitability of other contraceptive methods. Respondents reported being counselled only about the IUD and no other methods, while other respondents reported that other methods were mentioned but disparaged by providers in relation to the IUD. A lack of trained providers meant that most counselling took place in large groups, resulting in providers’ inability to conduct needs assessments or tailor information to women’s individual situations.DiscussionAs implemented, LARC-centric programmes like this PPIUD intervention may decrease access to person-centred contraceptive counselling and to accurate information about a broad range of contraceptive methods. A shift away from emphasising LARC methods to more comprehensive, person-centred contraceptive counselling is critical to promote contraceptive autonomy.
Tailored mHealth intervention for improving treatment adherence for people living with HIV in Iran (HamRaah): protocol for a feasibility study and randomised pilot trial with a nested realist evaluation
Authors: Ameli Vira , Haberer Jessica , Sabin Lora , Meinck Franziska , Barlow Jane , Taj Leila , Mohraz Minoo 
Published: June 2021

IntroductionMiddle East and North Africa (MENA) has a rising rate of new HIV infections and AIDS-related mortality. Consistent adherence to antiretroviral therapy (ART) leads to viral suppression, preventing HIV transmission and treatment failure. mHealth interventions can improve ART adherence by providing tailored support and directing patients to existing healthcare services. HamRaah (Persian for ‘together-in-path’) is the first mHealth-based intervention in a MENA country and is designed to improve adherence through two-way mobile messaging for people recently diagnosed with HIV in Tehran, Iran. The objectives of this pilot randomised controlled trial (RCT) are to examine the feasibility, acceptability and preliminary effectiveness of HamRaah, and to develop an explanatory theory for any observed effects through a nested realist evaluation.MethodsA feasibility study and two-arm RCT of HamRaah, with an embedded realist evaluation will be conducted. Participants will be randomised 1:1 to HamRaah or routine care for a 6-month intervention. The initial effectiveness of HamRaah will be assessed through the primary outcome of self-reported ART adherence and several secondary outcomes: retention in care, CD4 count and viral suppression. A theory-driven realist evaluation framework will be used to develop an explanatory theory regarding what works, for whom, how and in what context.Ethics and disseminationThe study received ethical clearance from Tehran University of Medical Sciences Ethics Committee and Oxford Tropical Research Ethics Committee People living with HIV in Tehran and key country stakeholders in HIV policy and programming have been involved in the development of HamRaah and this pilot trial. Participants will provide informed consent prior to study enrolment. The results will be disseminated to all stakeholders and presented in peer-reviewed journal publications and conferences.Trial registration numberIRCT20100601004076N23; Pre-results.
Recompensation factors for patients with decompensated cirrhosis: a multicentre retrospective case–control study
Authors: Xu Xiaomei , Wang Haolin , Zhao Wenlong , Wang Yong , Wang Jiayue , Qin Bo 
Published: June 2021

ObjectivesWe aimed to evaluate recompensation factors among patients with decompensated cirrhosis.DesignA multicentre retrospective case–control study was conducted. Data were collected from and compared between groups of patients with recompensated and acute decompensated cirrhosis. Univariable and multivariable logistic regressions were used to select indicators associated with recompensation among patients with decompensated cirrhosis with different complications. A decision tree with 10-fold cross-validation was used to develop the model to identify patients with recompensation. We followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guideline for development and reporting of the new model.SettingThe study was conducted in six tertiary public hospitals in Chongqing, China.ParticipantsThis study included 3953 patients with decompensated cirrhosis.ResultsIn the total sample of included patients, there were 553 patients with recompensation and 3400 patients with acute decompensation, including 1158 patients with gastrointestinal bleeding, 1715 patients with a bacterial infection, 104 patients with hepatic encephalopathy and 423 patients with ascites. The most relevant indicator of recompensation selected by the decision tree model was albumin, with a threshold of 40 g/L. Total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes were also selected to subsequently distinguish patients. The terminal nodes with a probability of recompensation was 0.89. The overall accuracy rate of the model was 0.92 (0.91–0.93), and it exhibited high specificity (86.9%) and sensitivity (92.6%).ConclusionsThe occurrence of recompensated cirrhosis could be identified by albumin, total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes. These simple variables may help clinicians develop a treatment plan to encourage patients with decompensated cirrhosis to recompensate.
Parents, healthcare professionals and other stakeholders’ experiences of caring for babies born too soon in a low-resource setting: a qualitative study of essential newborn care for preterm infants in Kenya
Authors: Mitchell Eleanor J , Pallotti Phoebe , Qureshi Zahida P , Daniels Jane P , Oliver Mary , Were Fredrick , Osoti Alfred , Gwako George , Kimani Violet , Opira Jacqueline , Ojha Shalini 
Published: June 2021

ObjectivesPrematurity is the leading cause of global neonatal and infant mortality. Many babies could survive by the provision of essential newborn care. This qualitative study was conducted in order to understand, from a family and professional perspective, the barriers and facilitators to essential newborn care. The study will inform the development of an early warning score for preterm and low birthweight infants in low and middle income countries (LMICs).SettingSingle-centre, tertiary referral hospital in Nairobi, Kenya.ParticipantsNineteen mothers and family members participated in focus group discussions and 20 key-informant interviews with professionals (healthcare professionals and policy-makers) were conducted. Focus group participants were identified via postnatal wards, the newborn unit and Kangaroo Mother Care (KMC) unit. Convenience and purposive sampling was used to identify professionals.Outcome measuresUnderstanding facilitators and barriers to provision of essential newborn care in preterm infants.ResultsFrom 27 themes, three global themes emerged from the data: mothers’ physical and psychological needs, system pillars and KMC.ConclusionMeeting mothers’ needs in the care of their babies is important to mothers, family members and professionals, and deserves greater attention. Functioning system pillars depended on a standardised approach to care and low cost, universally applicable interventions are needed to support the existing care structure. KMC was effective in both meeting mothers’ needs, supporting existing care structures and also provided a space for the resolution of the dialectical relationship between families and hospital procedures. Lessons learnt from the implementation of KMC could be applied to the development of an early warning score in LMICs.
Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants
Authors: Kidman Anna Madeline , Manley Brett James , Boland Rosemarie Anne , Malhotra Atul , Donath Susan M , Davis Peter G , Bhatia Risha 
Published: June 2021

IntroductionRespiratory distress syndrome is a complication of prematurity and extremely preterm infants born before 28 weeks’ gestation often require endotracheal intubation and mechanical ventilation. In this high-risk population, mechanical ventilation is associated with lung injury and contributes to bronchopulmonary dysplasia. Therefore, clinicians attempt to extubate infants as quickly and use non-invasive respiratory support such as nasal continuous positive airway pressure (CPAP) to facilitate the transition. However, approximately 60% of extremely preterm infants experience ‘extubation failure’ and require reintubation. While CPAP pressures of 5–8 cm H2O are commonly used, the optimal CPAP pressure is unknown, and higher pressures may be beneficial in avoiding extubation failure. Our trial is the Extubation CPAP Level Assessment Trial (ÉCLAT). The aim of this trial is to compare higher CPAP pressures 9–11 cm H2O with a current standard pressures of 6–8 cmH2O on extubation failure in extremely preterm infants.Methods and analysis200 extremely preterm infants will be recruited prior to their first extubation from mechanical ventilation to CPAP. This is a parallel group randomised controlled trial. Infants will be randomised to one of two set CPAP pressures: CPAP 10 cmH2O (intervention) or CPAP 7 cmH2O (control). The primary outcome will be extubation failure (reintubation) within 7 days. Statistical analysis will follow standard methods for randomised trials on an intention to treat basis. For the primary outcome, this will be by intention to treat, adjusted for the prerandomisation strata (GA and centre). We will use the appropriate parametric and non-parametric statistical tests.Ethics and disseminationEthics approval has been granted by the Monash Health Human Research Ethics Committees. Amendments to the trial protocol will be submitted for approval. The findings of this study will be written into a clinical trial report manuscript and disseminated via peer-reviewed journals (on-line or in press) and presented at national and international conferences.Trial registration numberACTRN12618001638224; pre-results.
Birth control pills and risk of hypothyroidism: a cross-sectional study of the National Health and Nutrition Examination Survey, 2007–2012
Authors: Qiu Yuxuan , Hu Yuanyuan , Xing Zhichao , Fu Qingyu , Zhu Jingqiang , Su Anping 
Published: June 2021

ObjectiveThe association between use of birth control pills and thyroid function in women has not ever been well studied, but potential risk has been implicated by small sample-sized studies. We aimed to determine this association using a large epidemiological survey.DesignCross-sectional study.SettingNational Health and Nutrition Examination Survey conducted in the USA from 2007 to 2012.ParticipantsFemale respondents aged 18+ who had data on history of taking birth control pills and thyroid function were included. History of taking birth control pills was based on responses on the reproductive health questionnaire. Participants not on antithyroid medication with thyroid-stimulating hormone (TSH) >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorised as hypothyroid. Participants not on thyroid hormone replacement or antithyroid medication who had TSH between 0.34 mIU/L and 5.6 mIU/L were classified as euthyroid.Primary and secondary outcome measuresAssociation between use of birth control pills and hypothyroidism based on multivariate logistic regression analysis.ResultsA total of 5116 female adults with history of taking birth control pills (n=3034) and without (n=2082) were included. A higher prevalence of hypothyroidism was found in those who have ever taken birth control pills (17.7% vs 14.1%; p=0.003). Multivariate logistic regression adjusted for confounding covariables, including age, race, education, body mass index, smoking status, alcohol use, history of thyroid disease, current thyroid disease, first menstrual age, pregnancy history, menopause status and history of hormone replacement use, demonstrated a significant association between history of taking birth control pills for more than 10 years and hypothyroidism (OR, 3.837; 95% CI 1.402 to 10.500; p=0.009).ConclusionsLonger history of using birth control pills was strongly associated with hypothyroidism, especially for more than 10 years.
Association between comorbid sleep apnoea–hypopnoea syndrome and prognosis of intensive care patients: a retrospective cohort study
Authors: Wang Hongxia , Shao Guangqiang , Rong Lei , Ji Yang , Zhang Keke , Liu Min , Ma Ling 
Published: June 2021

ObjectiveIn this study, we investigated the association between comorbid sleep apnoea–hypopnoea syndrome (SAHS) and the prognosis of patients in an intensive care unit (ICU) to determine whether this relationship varies between different disease subgroups.MethodsWe conducted a retrospective cohort study using publicly available information from the critical care database Medical Information Mart for Intensive Care III. Adults (≥18 years of age) who attended the ICU for the first time were enrolled. Demographic information and clinical data were obtained from each patient. The primary outcome was 30-day mortality after ICU admission, and the secondary outcomes were in-hospital and ICU mortality. Multivariate logistic regression and Cox regression analyses were used to examine the associations between SAHS comorbidities and the research outcomes. Propensity score matching was used to adjust for potential confounding variables.ResultsOf the 32 989 patients enrolled, 1918 (5.81%) were diagnosed with SAHS as a comorbid condition. Patients with SAHS had a significantly lower 30-day mortality rate compared with those without SAHS (5.27% vs 13.65%, respectively; p<0.001). The frequency of chronic obstructive pulmonary disease, cerebral disease, cardiovascular disease, hypertension, diabetes mellitus and renal failure was significantly different between the two groups. Patients with SAHS demonstrated significantly longer survival compared with patients without SAHS. Multivariate Cox proportional hazards regression identified a significant relationship between SAHS and mortality within 30 days (adjusted HR=0.610, 95% CI 0.499 to 0.747, p<0.0001).ConclusionSAHS as a comorbid condition decreases the risk of 30-day mortality, in-hospital mortality and ICU mortality among ICU patients.
What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol
Authors: Rodrigues Luciana Pereira , Rezende Andréa Toledo de Oliveira , Moura Letícia de Almeida Nogueira e , Nunes Bruno Pereira , Noll Matias , de Oliveira Cesar , Silveira Erika Aparecida 
Published: June 2021

IntroductionThe development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission.Methods and analysisA systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case–control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems.Ethics and disseminationEthical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete.PROSPERO registration numberCRD42021229328.
Preliminary case report study of training and support needed to conduct bowtie analysis in healthcare
Authors: McLeod Ronald , Russell Wendy , Stewart Marjorie , Prentice Mark , Bowie Paul 
Published: June 2021

BackgroundThere is limited engagement in healthcare with the kinds of proactive approaches to risk assessment used in other industries. Bowtie analysis (BTA) has previously been shown to have potential as a straightforward approach to proactively assessing risk in healthcare. The visual nature of BTA diagrams can aid communication of the essential elements of a complex risk management system. The aim of this small case report study was to investigate the training and support likely to be needed for existing healthcare professionals to conduct BTA in compliance with recognised industry best-practice.MethodOf 17 volunteers who attended training, 3 completed an analysis of significant healthcare risks in the study period: misadministration of gentamicin; unknown development of acute kidney injury and disposal of medical devices containing patient identifiable information (PII). Subjective assessments of the quality of the analyses were made against indicators of BTA best-practice.ResultsUse of the BTA method led to a deeper understanding of the issues and a more thorough understanding of the risks and what was needed to control them than would have been the case if ‘normal practice’ had been followed. Classroom-based training supported by written guidance; however, do not appear adequate to support development of competence to carry out a quality BTA in a healthcare setting.ConclusionsBTA seems to have potential though further evaluation of its application and utility is necessary. The most cost-effective and productive approach is likely to be to train a small number of people to develop deeper skills and experience in BTA. In addition to training and user guidance, the opportunity to facilitate at least one analysis, with some specialist/trainer support, appears to be essential in developing BTA competence.