bluuebunny/crossref_metadata_2025_split huggingface dataset:
Research and Development of Three-Dimensional Isolation System for Sodium-Cooled Fast Reactor: Part 1 — Proposal of Analytical Models Based on Loading Tests
Authors: Fukasawa Tsuyoshi , Okamura Shigeki , Somaki Takahiro , Miyagawa Takayuki , Uchita Masato , Yamamoto Tomohiko , Watakabe Tomoyoshi , Fujita Satoshi 
Published: November 2018

This paper describes that the analytical model for the three-dimensional isolation system [1], which consists of thick rubber bearings, disc springs and oil dampers, is created through loading tests. The new-type analytical models of each element are proposed to improve the prediction accuracy of the seismic response analysis.
The concept of the three-dimensional isolation system has been proposed to ensure the structural integrity for large reactor vessels. The primary specifications of the three-dimensional isolation system are a horizontal natural period of 3.4 s and a vertical natural period of 0.33 s. The investigations of horizontal isolation performances have been conducted for the various types of isolation devices, beginning with rubber bearings, whereas the previous studies focused on the vertical isolation performances are only a few. Hence, isolation characteristics, such as restoring force and damping force, should be clarified by loading tests using vertical seismic isolation elements, and analytical model to assess the seismic response should be identified on the basis of the loading test results.
This paper presents a new analytical model with providing of the differential equations to improve the prediction accuracy and demonstrates the seismic performance, including beyond-design-basis ground motion, for the three-dimensional isolation system by the seismic response analysis.
New Generation of Monitoring Systems: From Measurement to Numerical Simulation
Authors: Jouan Benoît , Heinz Benedikt , Pascan Oana Zenaida 
Published: November 2018

This paper presents a new method for monitoring systems with direct coupling of measurement data and a finite element model of a mechanical component. In the presented first case study the measurement data received from a monitoring system is coupled with a finite element model developed in Code_Aster, showing the possibility of minimizing the efforts of data-model coupling on complex components.
A thermo-mechanical calculation of a generic regenerative heat exchanger of a nuclear power plant will be used as an example to describe the opportunities and the limitations of the use of numerical simulation in modern monitoring systems. The experimental measurements and the thermo-mechanical numerical simulation process will be presented. The projection hypothesis that allows the transition from locally measured temperature to the numerical model will be described. The relation between computing time, sampling rate of the data acquisition system and refinement of the numerical mesh will be analyzed and discussed in terms of computation perspective.
The paper explains how the measurement data can be projected on the mesh of a mechanical component with Code_Aster and how the numerical simulation can be fed on the measurement data. In an outlook, the use of this method in future monitoring systems will be discussed under consideration of real world problems and applications in nuclear power stations.
Physical compatibility of pentoxifylline and intravenous medications
Authors: Senarathna S M D K Ganga , Strunk Tobias , Petrovski Michael , Batty Kevin T 
Published: November 2018

ObjectiveTo investigate the physical and chemical compatibility of pentoxifylline (PTX) with a wide range of parenteral medications used in the neonatal intensive care setting.DesignPTX and drug solutions were combined in glass phials and inspected visually for physical incompatibility. The chemical compatibility was evaluated on the basis of PTX concentrations.ResultsPrecipitation, colour change or turbidity was not visible in any of the test mixtures, indicating no observed physical incompatibility or apparent risk of blockage in narrow-bore intravenous tubing. The PTX concentration was approximately 2.5% and 4.5% lower when combined with dopamine and amoxicillin, respectively. The PTX concentration ratios for all other combinations were in the range of 99%–102%.ConclusionIn simulated Y-site conditions, physical compatibility testing of PTX and 30 parenteral medications revealed no evidence of precipitation. Based on PTX concentration tests, it could be prudent to avoid mixing PTX with dopamine or amoxicillin.
Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience
Authors: Rennie Janet M , de Vries Linda S , Blennow Mats , Foran Adrienne , Shah Divyen K , Livingstone Vicki , van Huffelen Alexander C , Mathieson Sean R , Pavlidis Elena , Weeke Lauren C , Toet Mona C , Finder Mikael , Pinnamaneni Raga Mallika , Murray Deirdre M , Ryan Anthony C , Marnane William P , Boylan Geraldine B 
Published: November 2018

ObjectiveThe aim of this multicentre study was to describe detailed characteristics of electrographic seizures in a cohort of neonates monitored with multichannel continuous electroencephalography (cEEG) in 6 European centres.MethodsNeonates of at least 36 weeks of gestation who required cEEG monitoring for clinical concerns were eligible, and were enrolled prospectively over 2 years from June 2013. Additional retrospective data were available from two centres for January 2011 to February 2014. Clinical data and EEGs were reviewed by expert neurophysiologists through a central server.ResultsOf 214 neonates who had recordings suitable for analysis, EEG seizures were confirmed in 75 (35%). The most common cause was hypoxic-ischaemic encephalopathy (44/75, 59%), followed by metabolic/genetic disorders (16/75, 21%) and stroke (10/75, 13%). The median number of seizures was 24 (IQR 9–51), and the median maximum hourly seizure burden in minutes per hour (MSB) was 21 min (IQR 11–32), with 21 (28%) having status epilepticus defined as MSB>30 min/hour. MSB developed later in neonates with a metabolic/genetic disorder. Over half (112/214, 52%) of the neonates were given at least one antiepileptic drug (AED) and both overtreatment and undertreatment was evident. When EEG monitoring was ongoing, 27 neonates (19%) with no electrographic seizures received AEDs. Fourteen neonates (19%) who did have electrographic seizures during cEEG monitoring did not receive an AED.ConclusionsOur results show that even with access to cEEG monitoring, neonatal seizures are frequent, difficult to recognise and difficult to treat.Oberservation study numberNCT02160171
Clinical relevance of protruded retinal layers in minimum rim width measurement of the optic nerve head
Authors: Torres Lucas A , Jarrar Faisal , Sharpe Glen P , Hutchison Donna M , Ferracioli-Oda Eduardo , Hatanaka Marcelo , Nicolela Marcelo T , Vianna Jayme R , Chauhan Balwantray C 
Published: November 2018

Background/aimsOptical coherence tomography (OCT) imaging of the optic nerve head minimum rim width (MRW) has recently been shown to sometimes contain components besides extended retinal nerve fibre layer (RNFL). This study was conducted to determine whether excluding these components, termed protruded retinal layers (PRLs), from MRW increases diagnostic accuracy for detecting glaucoma.MethodsIn this cross-sectional study, we included 123 patients with glaucoma and 123 normal age-similar controls with OCT imaging of the optic nerve head (24 radial scans) and RNFL (circle scan). When present, PRLs were manually segmented, and adjusted MRW measurements were computed. We compared diagnostic accuracy of adjusted versus unadjusted MRW measurement. We also determined whether adjusted MRW correlates better with RNFL thickness compared with unadjusted MRW.ResultsThe median (IQR) visual field mean deviation of patients and controls was −4.4 (−10.3 to −2.1) dB and 0.0 (−0.6 to 0.8) dB, respectively. In the 5904 individual B-scans, PRLs were identified less frequently in patients (448, 7.6%) compared with controls (728, 12.3%; p<0.01) and were present most frequently in the temporal sector of both groups. Areas under the receiver operating characteristic curves and sensitivity values at 95% specificity indicated that PRL adjustment did not improve diagnostic accuracy of MRW, globally or temporally. Furthermore, adjusting MRW for PRL did not improve its correlation with RNFL thickness in either group.ConclusionWhile layers besides the RNFL are sometimes included in OCT measurements of MRW, subtracting these layers does not impact clinical utility.
Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review
Authors: Ebben Remco H A , Siqeca Flaka , Madsen Ulla Riis , Vloet Lilian C M , van Achterberg Theo 
Published: November 2018

ObjectiveGuideline and protocol adherence in prehospital and in-hospital emergency departments (EDs) is suboptimal. Therefore, the objective of this systematic review was to identify effective strategies for improving guideline and protocol adherence in prehospital and ED settings.DesignSystematic review.Data sourcesPubMed (including MEDLINE), CINAHL, EMBASE and Cochrane.MethodsWe selected (quasi) experimental studies published between 2004 and 2018 that used strategies to increase guideline and protocol adherence in prehospital and in-hospital emergency care. Pairs of two independent reviewers performed the selection process, quality assessment and data extraction.ResultsEleven studies were included, nine of which were performed in the ED setting and two studies were performed in a combined prehospital and ED setting. For the ED setting, the studies indicated that educational strategies as sole intervention, and educational strategies in combination with audit and feedback, are probably effective in improving guideline adherence. Sole use of reminders in the ED setting also showed positive effects. The two studies in the combined prehospital and ED setting showed similar results for the sole use of educational interventions.ConclusionsOur review does not allow firm conclusion on how to promote guideline and protocol adherence in prehospital emergency care, or the combination of prehospital and ED care. For ED settings, the sole use of reminders or educational interventions and the use of multifaceted strategies of education combined with audit and feedback are all likely to be effective in improving guideline adherence.
Prognostic factors for recovery and non-recovery in patients with non-specific neck pain: a protocol for a systematic literature review
Authors: Domingues Lucia , Cruz Eduardo B , Pimentel-Santos Fernando M , Ramiro Sofia , Donato Helena , Manica Santiago Rodrigues , Hayden Jill Alison , Buchbinder Rachelle , Branco Jaime C 
Published: November 2018

IntroductionNeck pain is a common musculoskeletal disorder worldwide. It can result in significant disability and impaired quality of life. More than 50% of patients with neck pain still report symptoms 1 year later despite receiving different forms of non-pharmacological and pharmacological treatment. Identifying patient characteristics that are modifiable or predict recovery and non-recovery for an individual patient might identify ways of improving outcomes. This systematic review aims to comprehensively summarise the existing evidence regarding baseline patient characteristics associated with recovery and non-recovery, as defined by measures of pain intensity, disability and global perceived improvement.Methods and analysisSix electronic databases, PubMed, CINAHL, PEDro Database, EMBASE, Cochrane Library and Web of Science, will be searched, with terms related to the review question such as neck pain, prognostic or predictive research, from inception to 28 September of 2018. Studies will be included if they have investigated an association between patient characteristics and outcomes, with at least one follow-up time point. Two independent reviewers will screen the titles and abstracts followed by a full-text review to assess papers regarding their eligibility. Data from included papers will be extracted using standardised forms, including study and participants’ characteristics, outcomes, prognostic factors and effect size of the association. The risk of bias of each study will be assessed using the Quality in Prognostic Studies tool. A narrative synthesis will be conducted considering the strength, consistency of results and the methodological quality.Ethics and disseminationThis systematic review does not require ethical approval. The results will be disseminated through publication in a peer-review journal, as a chapter of a doctoral thesis and through presentations at national and international conferences.PROSPERO registration numberCRD42018091183.
‘Primary care sensitive’ situations that result in an ambulance attendance: a conversation analytic study of UK emergency ‘999’ call recordings
Authors: Booker Matthew James , Shaw Ali R G , Purdy Sarah , Barnes Rebecca 
Published: November 2018

ObjectivesTo explore common features of conversations occurring in a sample of emergency calls that result in an ambulance dispatch for a ‘primary care sensitive’ situation, and better understand the challenges of triaging this cohort.DesignA qualitative study, applying conversation analytic methods to routinely recorded telephone calls made through the ‘999’ system for an emergency ambulance. Cases were identified by a primary care clinician, observing front-line UK ambulance service shifts. A sample of 48 ‘999’ recordings were analysed, corresponding to situations potentially amenable to primary care management.ResultsThe analysis focuses on four recurring ways that speakers use talk in these calls. Progress can be impeded when call-taker’s questions appear to require callers to have access to knowledge that is not available to them. Accordingly, callers often provide personal accounts of observed events, which may be troublesome for call-takers to ‘code’ and triage. Certain question formats—notably ‘alternative question’ formats—appear particularly problematic. Callers deploy specific lexical, grammatical and prosodic resources to legitimise the contact as ‘urgent’, and ensure that their perception of risk is conveyed. Difficulties encountered in the triage exchange may be evidence of misalignment between organisational and caller perceptions of the ‘purpose’ of the questions.ConclusionsPrevious work has focused on exploring the presentation and triage of life-threatening medical emergencies. Meaningful insights into the challenges of EMS triage can also be gained by exploring calls for ‘primary care sensitive’ situations. The highly scripted triage process requires precise, ‘codeable’ responses to questions, which can create challenges when the exact urgency of the problem is unclear to both caller and call-taker. Calling on behalf of someone else may compound this complexity. The aetiology of some common interactional challenges may offer a useful frame for future comparison between calls for ‘primary care sensitive’ situations and life-threatening emergencies.
Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners
Authors: Glaudemans Jolien Jeltje , Moll van Charante Eric , Wind Jan , Oosterink John Jacob , Willems Dick Ludolf 
Published: November 2018

ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.ConclusionsAwareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients’ access to ACP.
How do palliative care doctors recognise imminently dying patients? A judgement analysis
Authors: White Nicola , Harries Priscilla , Harris Adam JL , Vickerstaff Victoria , Lodge Philip , McGowan Catherine , Minton Ollie , Tomlinson Christopher , Tookman Adrian , Reid Fiona , Stone Patrick 
Published: November 2018

ObjectivesTo identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.DesignProspective observational study and two cross-sectional online studies.SettingPhase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes.ParticipantsAll members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis.MeasuresPhase I: participants were asked to give a probability of death within 72 hours (0%–100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the ‘expert’ group (scale range: 0 (expert)–1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%–100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors.ResultsThe mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the ‘experts’ was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors’ prognostic decision making (β=0.48, p<0.001).ConclusionsThis study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.
Assessing photoreceptor structure in patients with traumatic head injury
Authors: Braza Matthew E , Young Jonathon , Hammeke Thomas A , Robison Scott E , Han Dennis P , Warren Clinton C , Carroll Joseph , Stepien Kimberly E 
Published: November 2018

ObjectivePrevious work using adaptive optics scanning light ophthalmoscopy (AOSLO) imaging has shown photoreceptor disruption to be a common finding in head and ocular trauma patients. Here an expanded trauma population was examined using a novel imaging technique, split-detector AOSLO, to assess remnant cone structure in areas with significant disruption on confocal AOSLO imaging and to follow photoreceptor changes longitudinally.Methods and AnalysisEight eyes from seven subjects with head and/or ocular trauma underwent imaging with spectral domain optical coherence tomography, confocal AOSLO and split-detector AOSLO to assess foveal and parafoveal photoreceptor structure.ResultsConfocal AOSLO imaging revealed hyporeflective foveal regions in two of eight eyes. Split-detector imaging within the hyporeflective confocal areas showed both remnant and absent inner-segment structure. Both of these eyes were imaged longitudinally and showed variation of the photoreceptor mosaic over time. Four other eyes demonstrated subclinical regions of abnormal waveguiding photoreceptors on multimodal AOSLO imagery but were otherwise normal. Two eyes demonstrated normal foveal cone packing without disruption.ConclusionMultimodal imaging can detect subtle photoreceptor abnormalities not necessarily detected by conventional clinical imaging. The addition of split-detector AOSLO revealed the variable condition of inner segments within confocal photoreceptor disruption, confirming the usefulness of dual-modality AOSLO imaging in assessing photoreceptor structure and integrity. Longitudinal imaging demonstrated the dynamic nature of the photoreceptor mosaic after trauma. Multimodal imaging with dual-modality AOSLO improves understanding of visual symptoms and photoreceptor structure changes in patients with head and ocular trauma.
Enteric fungal microbiota dysbiosis and ecological alterations in colorectal cancer
Authors: Coker Olabisi Oluwabukola , Nakatsu Geicho , Dai Rudin Zhenwei , Wu William Ka Kei , Wong Sunny Hei , Ng Siew Chien , Chan Francis Ka Leung , Sung Joseph Jao Yiu , Yu Jun 
Published: November 2018

ObjectivesBacteriome and virome alterations are associated with colorectal cancer (CRC). Nevertheless, the gut fungal microbiota in CRC remains largely unexplored. We aimed to characterise enteric mycobiome in CRC.DesignFaecal shotgun metagenomic sequences of 184 patients with CRC, 197 patients with adenoma and 204 control subjects from Hong Kong were analysed (discovery cohort: 73 patients with CRC and 92 control subjects; validation cohort: 111 patients with CRC, 197 patients with adenoma and 112 controls from Hong Kong). CRC-associated fungal markers and ecological changes were also validated in additional independent cohorts of 90 patients with CRC, 42 patients with adenoma and 66 control subjects of published repository sequences from Germany and France. Assignment of taxonomies was performed by exact k-mer alignment against an integrated microbial reference genome database.ResultsPrincipal component analysis revealed separate clusters for CRC and control (p<0.0001), with distinct mycobiomes in early-stage and late-stage CRC (p=0.0048). Basidiomycota:Ascomycota ratio was higher in CRC (p=0.0042), with increase in Malasseziomycetes (p<0.0001) and decrease in Saccharomycetes (p<0.0001) and Pneumocystidomycetes (p=0.0017). Abundances of 14 fungal biomarkers distinguished CRC from controls with an area under the receiver-operating characteristic curve (AUC) of 0.93 and validated AUCs of 0.82 and 0.74 in independent Chinese cohort V1 and European cohort V2, respectively. Further ecological analysis revealed higher numbers of co-occurring fungal intrakingdom and co-exclusive bacterial–fungal correlations in CRC (p<0.0001). Moreover, co-occurrence interactions between fungi and bacteria, mostly contributed by fungal Ascomycota and bacterial Proteobacteria in control, were reverted to co-exclusive interplay in CRC (p=0.00045).ConclusionsThis study revealed CRC-associated mycobiome dysbiosis characterised by altered fungal composition and ecology, signifying that the gut mycobiome might play a role in CRC.