bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sequential Self-Folding of Shape Memory Polymer Sheets by Laser Rastering Toward Origami-Based Manufacturing
Authors: Abdulhafez Moataz , Line Joshua , Bedewy Mostafa 
Published: March 2021

Abstract
Origami-based fabrication strategies open the door for developing new manufacturing processes capable of producing complex three-dimensional (3D) geometries from two-dimensional (2D) sheets. Nevertheless, for these methods to translate into scalable manufacturing processes, rapid techniques for creating controlled folds are needed. In this work, we propose a new approach for controlled self-folding of shape memory polymer sheets based on direct laser rastering. We demonstrate that rapidly moving a CO2 laser over pre-strained polystyrene sheets results in creating controlled folds along the laser path. Laser interaction with the polymer induces localized heating above the glass transition temperature with a temperature gradient across the thickness of the thin sheets. This gradient of temperature results in a gradient of shrinkage owing to the viscoelastic relaxation of the polymer, favoring folding toward the hotter side (toward the laser source). We study the influence of laser power, rastering speed, fluence, and the number of passes on the fold angle. Moreover, we investigate process parameters that produce the highest quality folds with minimal undesired deformations. Our results show that we can create clean folds up to and exceeding 90 deg, which highlights the potential of our approach for creating lightweight 3D geometries with smooth surface finishes that are challenging to create using 3D printing methods. Hence, laser-induced self-folding of polymers is an inherently mass-customizable approach to manufacturing, especially when combined with cutting for integration of origami and kirigami.
A Computational Efficient Approach to Compute Temperature for Energy Beam Additive Manufacturing
Authors: Ou Chun-Yu , Richard Liu C. 
Published: March 2021

Abstract
Temperature history prediction is essential for a better understanding of the relationship between microstructural change and processing conditions for energy beam additive manufacturing fabricated components. Here, a new efficient approach combining a moving heat source analytical model with a melting and solidification model is presented. An innovative method is proposed to compute the “effective computation zone” as a boundary condition, which can save computation time significantly. Notably, the computational efficiency can improve by 104–105 compared with finite element models. With this range of improvement efficiency, the temperature predicted based on this method is consistent (around 9% of average deviation) with experimental measurements by the thermocouple. This model can be used as a reference to define the boundary condition for further complex numerical analysis with improved accuracy at a reduction of efficiency as desired. In addition, it can be used as a reference to determine processing conditions that would allow the efficient and effective control of the temperature history within a range for a certain microstructure design.
Temporal Location of High-Intensity Interval Training in Cycling Does Not Impact the Time Spent Near Maximal Oxygen Consumption
Authors: Mckee James R. , Wall Bradley A. , Peiffer Jeremiah J. 
Published: March 2021

Purpose: To examine the influence of temporal location of high-intensity interval training (HIIT) within a cycling session on the time spent ≥90% of maximal oxygen consumption and physiological and perceptual responses. Methods: In a randomized, crossover design, 16 trained cyclists (male, n = 13 and female, n = 3) completed three 90-minute cycling sessions with HIIT placed at the beginning, middle, or end of the session (13, 36, and 69 min, respectively). Intervals consisted of three 3-minute efforts at 90% of the power output associated with maximal oxygen consumption interspersed with 3 minutes of recovery. Oxygen consumption, minute ventilation, respiratory rate, and heart rate were recorded continuously during work intervals. Rate of perceived exertion was recorded at the end of work intervals, and sessional rate of perceived exertion was collected 20 minutes after session completion. Results: No differences were observed for mean oxygen consumption (P = .479) or time spent ≥90% maximal oxygen consumption (P = .753) between condition. The mean rate of perceived exertion of all intervals were greater in the Middle (P < .01, effect size = 0.83) and End (P < .05, effect size = 0.75) compared with Beginning conditions. Mean minute ventilation was greater in the End compared with Beginning condition (P = .015, effect size = 0.63). However, no differences in mean respiratory rate were observed between conditions (P = .297). Conclusions: Temporal location of HIIT has no impact on oxygen consumption or cardiovascular stress within a cycling session. However, HIIT performed later in the session resulted in higher ventilation, which may indicate the need for greater anaerobic contribution to these intervals.
‘Do I, don’t I?’ A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic
Authors: Watson Gabriella , Pickard Lucy , Williams Bhanu , Hargreaves Dougal , Blair Mitch 
Published: March 2021

BackgroundPaediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care.MethodsSemistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach.ResultsFrom interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them.ConclusionA pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.
Severe covid-19 pneumonia: pathogenesis and clinical management
Authors: Attaway Amy H , Scheraga Rachel G , Bhimraj Adarsh , Biehl Michelle , Hatipoğlu Umur 
Published: March 2021

AbstractSevere covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.
Patterns of age disparities in colon and lung cancer survival: a systematic narrative literature review
Authors: Pilleron Sophie , Gower Helen , Janssen-Heijnen Maryska , Signal Virginia Claire , Gurney Jason K , Morris Eva JA , Cunningham Ruth , Sarfati Diana 
Published: March 2021

ObjectivesTo identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars.DesignSystematic review of the literature.Data sourcesWe searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020.Eligibility criteriaWe retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment).Data extraction and synthesisTwo independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves.ResultsOut of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer.ConclusionsAlthough age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival.PROSPERO registration numberCRD42020151402.
Electromagnetic-guided versus endoscopic placement of nasoenteral feeding tubes: protocol for a systematic review and meta-analysis
Authors: Jin Zheng , Wei Yaping , Shen Guofan , Zhang Xiaofeng 
Published: March 2021

IntroductionCurrent evidence supporting the utility of electromagnetic (EM)-guided method as the preferred technique for nasoenteral feeding tube placement is limited. We plan to provide a meta-analysis to compare the performance of EM-guided versus endoscopic placement.Methods and analysisRandomised controlled trials evaluating EM-guided versus endoscopic placement will be searched in MEDLINE, EMBASE and CENTRAL from database inception to 30 September 2020. Data on study design, participant characteristics, intervention details and outcomes will be extracted. Primary outcomes to be assessed are complications. Secondary outcomes include procedure success rate, total procedure time, patient recommendation, length of hospital stay and mortality. Study quality will be assessed using the Cochrane risk of bias tool. Data will be combined with a random effects model. The results will be presented as a risk ratio for dichotomous data and weighted mean difference for continuous data. Publication bias will be visualised using funnel plots. We will quantify the effect of potential effect modifiers by meta-regression if appropriate. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework.Ethics and disseminationThis study will not use primary data, and therefore formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.PROSPERO registration numberCRD42020172427.
Strategy to reduce adverse health outcomes in subjects highly vulnerable to COVID-19: results from a population-based study in Northern Italy
Authors: Russo Antonio Giampiero , Faccini Marino , Bergamaschi Walter , Riussi Antonio 
Published: March 2021

ObjectivesThis study describes a new strategy to reduce the impact of COVID-19 on the elderly and other clinically vulnerable subjects, where general practitioners (GPs) play an active role in managing high-risk patients, reducing adverse health outcomes.DesignRetrospective cohort study.SettingPopulation-based study including subjects resident in the province of Milan and Lodi.Participants127 735 residents older than 70 years, with specific chronic conditions.InterventionsWe developed a predictive algorithm for overall mortality risk based on demographic and clinical characteristics. All residents older than 70 years were classified as being at low or high risk of death from COVID-19 infection according to the algorithm. The high-risk group was assigned to their GPs for telephone triage and consultation. The high-risk cohort was divided into two groups based on GP intervention: patients who were not contacted and patients who were contacted by their GPs.Outcome measuresOverall mortality, COVID-19 morbidity and hospitalisation.ResultsPatients with increased risk of death from COVID-19 were 127 735; 495 669 patients were not at high risk and were not included in the intervention. Out of the high-risk subjects, 79 110 were included but not contacted by their GPs, while 48 625 high-risk subjects were included and contacted. Overall mortality, morbidity and hospitalisation was higher in high-risk patients compared with low-risk populations. High-risk patients contacted by their GPs had a 50% risk reduction in COVID-19 mortality, and a 70% risk reduction in morbidity and hospitalisation for COVID-19 compared with non-contacted patients.ConclusionsThe study showed that, during the COVID-19 outbreak, involvement of GPs and changes in care management of high-risk groups produced a significant reduction in all adverse health outcomes.
Long COVID and the role of physical activity: a qualitative study
Authors: Humphreys Helen , Kilby Laura , Kudiersky Nik , Copeland Robert 
Published: March 2021

ObjectivesTo explore the lived experience of long COVID with particular focus on the role of physical activity.DesignQualitative study using semistructured interviews.Participants18 people living with long COVID (9 men, 9 women; aged between 18–74 years; 10 white British, 3 white Other, 3 Asian, 1 black, 1 mixed ethnicity) recruited via a UK-based research interest database for people with long COVID.SettingTelephone interviews with 17 participants living in the UK and 1 participant living in the USA.ResultsFour themes were generated. Theme 1 describes how participants struggled with drastically reduced physical function, compounded by the cognitive and psychological effects of long COVID. Theme 2 highlights challenges associated with finding and interpreting advice about physical activity that was appropriately tailored. Theme 3 describes individual approaches to managing symptoms including fatigue and ‘brain fog’ while trying to resume and maintain activities of daily living and other forms of exercise. Theme 4 illustrates the battle with self-concept to accept reduced function (even temporarily) and the fear of permanent reduction in physical and cognitive ability.ConclusionsThis study provides insight into the challenges of managing physical activity alongside the extended symptoms associated with long COVID. Findings highlight the need for greater clarity and tailoring of physical activity-related advice for people with long COVID and improved support to resume activities important to individual well-being.
Utility of bedside leucocyte esterase testing to rule out septic arthritis
Authors: Knapper Thomas , Murphy Richard J , Rocos Brett , Fagg James , Murray Nick , Whitehouse Michael Richard 
Published: March 2021

IntroductionSuspected septic arthritis is a common presentation to EDs. The underlying diagnosis is often non-infective pathology. Differentiating between aetiologies is difficult. A bedside test with high negative predictive value (NPV) may allow safe discharge of patients, reduce the time in the ED, hospital admission and associated costs. This study aims to evaluate the NPV of bedside leucocyte esterase (LE) in the assessment of these patients.MethodsA prospective multicentre observational study of ED adult patients referred to orthopaedics with suspected native joint septic arthritis between October 2015 and April 2016. At three hospital sites in the Bristol region, the results of the LE test exposed to aspirated synovial fluid were recorded along with Gram stain, culture, haematinics and length of stay. A positive LE test was considered 2+ or 3+ leucocytes based on the test strip colour. Data were analysed to establish sensitivity, specificity, NPV and positive predictive value (PPV) against the gold standard 48-hour culture. We determined the potential number of inpatient bed-days that might be avoided using this bedside test.ResultsEighty patients underwent joint aspiration. Five cases had positive 48-hour culture. All (5/5) infected cases showed ≥2+ LE, sensitivity of 100% (95% CI 47.8% to 100%) while the Gram stain was positive in only one case (sensitivity 20%, 95% CI 0.51% to 71.6%). Twenty-three LE were read negative or 1+, all with negative 48-hour culture results, resulting in an NPV of 100% (95% CI 82.1% to 1.00%) for a negative LE test. Specificity of a positive LE test was 30.7% (95% CI 20.5% to 42.45%) with PPV of 8.77% (95% CI 7.64% to 10.1%). It was calculated that 57 orthopaedic bed-days could have potentially been saved by immediately discharging those with a negative LE test.ConclusionsLE point-of-care testing for suspected septic arthritis of native joints has a high NPV. Implementation of LE may facilitate more rapid discharge of patients with negative results. This test has the potential to reduce diagnostic uncertainty and costs to the healthcare system.
Improving the diagnosis of heart failure in patients with atrial fibrillation
Authors: Bunting Karina V , Gill Simrat K , Sitch Alice , Mehta Samir , O'Connor Kieran , Lip Gregory YH , Kirchhof Paulus , Strauss Victoria Y , Rahimi Kazem , Camm A John , Stanbury Mary , Griffith Michael , Townend Jonathan N , Gkoutos Georgios V , Karwath Andreas , Steeds Richard P , Kotecha Dipak 
Published: March 2021

ObjectiveTo improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval.MethodsTransthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e’ (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides.Results160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69–82) and a median heart rate of 100 beats per minute (IQR 86–112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e’ (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (p<0.001): 35.4 s to measure E/e’ (95% CI 33.1 to 37.8) compared with 44.7 s for 5-beat (95% CI 41.8 to 47.5) and 98.1 s for 10-beat (95% CI 91.7 to 104.4) analyses. Using a single index-beat did not compromise the association of LVEF, GLS or E/e’ with natriuretic peptide levels.ConclusionsCompared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF.
Predicting drowning from sea and weather forecasts: development and validation of a model on surf beaches of southwestern France
Authors: Tellier Éric , Simonnet Bruno , Gil-Jardiné Cédric , Lerouge-Bailhache Marion , Castelle Bruno , Salmi Rachid 
Published: March 2021

ObjectiveTo predict the coast-wide risk of drowning along the surf beaches of Gironde, southwestern France.MethodsData on rescues and drownings were collected from the Medical Emergency Center of Gironde (SAMU 33). Seasonality, holidays, weekends, weather and metocean conditions were considered potentially predictive. Logistic regression models were fitted with data from 2011 to 2013 and used to predict 2015–2017 events employing weather and ocean forecasts.ResultsAir temperature, wave parameters, seasonality and holidays were associated with drownings. Prospective validation was performed on 617 days, covering 232 events (rescues and drownings) reported on 104 different days. The area under the curve (AUC) of the daily risk prediction model (combined with 3-day forecasts) was 0.82 (95% CI 0.79 to 0.86). The AUC of the 3-hour step model was 0.85 (95% CI 0.81 to 0.88).ConclusionsDrowning events along the Gironde surf coast can be anticipated up to 3 days in advance. Preventative messages and rescue preparations could be increased as the forecast risk increased, especially during the off-peak season, when the number of available rescuers is low.
Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes
Authors: Kumar Manoj , Arcot Thanjan Maasila , Gopalakrishnan Natarajan , Jeyachandran Dhanapriya , Thanigachalam Dineshkumar , Ramanathan Sakthirajan 
Published: March 2021

AbstractBackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR &lt;60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio &gt;0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.