bluuebunny/crossref_metadata_2025_split huggingface dataset:
Criteria for Eliminating Cyclic Limit for PVHO Flat Disc Windows
Authors: Kemper Bart 
Published: May 2019

Acrylics (Poly Methyl Methalcrylate, or PMMA) are a proven, reliable material for Pressure Vessel for Human Occupancy (PVHO) windows. The current codes and standards reflect a first-generation development of defining a nonmetallic for pressure vessel application. Subsequent investigations in material science as well as decades of operational experience indicates the code-specified 10,000 cycle limit for some flat disc acrylic ASME PVHO windows may be eliminated using criteria consistent with the ASME Boiler and Pressure Vessel Code
Paper published with permission.
Inservice Examination and Testing Issues for Dynamic Restraints (Snubbers) in Nuclear Power Plants
Authors: Bedi Gurjendra S. 
Published: May 2019

This paper discusses recent issues related to inservice examination and testing of dynamic restraints (snubbers) at U.S. nuclear power plants. These issues were identified during the U.S. Nuclear Regulatory Commission (NRC) staff review of snubber examination and testing programs, relief requests, and applicable operating experience. This discussion includes information that could have generic applicability in the implementation of effective snubber programs at U.S. nuclear power plants.
Paper published with permission.
The MOV Issue: Perspective From Consejo de Seguridad Nuclear (C.S.N.) / Spain
Authors: Pérez Alfonso 
Published: May 2019

The “Consejo de Seguridad Nuclear” (Nuclear Safety Council), or CSN, is the nuclear regulatory body of Spain.
U.S. Nuclear Regulatory Commission (NRC) regulations and standards have been primarily used in the past up to the present. However, there is a process such that regulations recently generated in Spain replace or complement regulations coming from other countries. This is not the case with the evaluation and control of motor-operated valves (MOVs), which are mainly monitored using the process described in Generic Letters 89-10 and 96-05.
During a nine-month assignment from April to December 1989 at NRC offices in King of Prussia, PA, the author gained knowledge of NRC Bulletin 85-03 and of Generic Letter 89-10, which was issued in June 1989. The author realized the importance of these communications for improving the safety of the plants in the future if the issues they describe are adequately managed and solved.
Paper published with permission.
Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline
Authors: Bekkering G E , Agoritsas T , Lytvyn L , Heen A F , Feller M , Moutzouri E , Abdulazeem H , Aertgeerts B , Beecher D , Brito J P , Farhoumand P D , Singh Ospina N , Rodondi N , van Driel M , Wallace E , Snel M , Okwen P M , Siemieniuk R , Vandvik P O , Kuijpers T , Vermandere M 
Published: May 2019

AbstractClinical questionWhat are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice.Current practiceCurrent guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing.RecommendationThe guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old).How this guideline was createdA guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach.The evidenceThe systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years’ follow-up.Understanding the recommendationThe panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.
Taking stock of cost-effectiveness analysis of healthcare in China
Authors: Butt Thomas , Liu Gordon G , Kim David D , Neumann Peter J 
Published: May 2019

IntroductionCost-effectiveness analysis (CEA) is playing an increasingly important role in informing healthcare decision-making in China. This study aims to review the published literature on CEA in mainland China and describe its characteristics and evolution. We provide recommendations on the future direction of CEA as a methodology and as a tool to support healthcare decision-making in China.MethodsEnglish-language cost-per-quality-adjusted life-year (QALY) and cost-per-disability-adjusted life-year (DALY) publications relating to mainland China were reviewed using the Tufts Medical Center Cost-Effectiveness Analysis Registry and Global Health Cost-Effectiveness Analysis Registry through 2017. Study features were summarised using descriptive statistics. Changes in study methodology over time were analysed by trend test, and study characteristics influencing the incremental cost-effectiveness ratio (ICER) of cost-per-QALY studies were investigated using logistic regression.Results170 studies were identified reporting CEA for mainland China (cost/QALY=125, cost/DALY=45) since 1998. The number and quality of studies has increased over the past two decades, with significantly more cost-per-QALY studies compared with cost-per-DALY studies (p<0.0001) and more studies with authors affiliated with Chinese institutions (p=0.0002). The average quality score was 5.04 out of 7 for cost-per-QALY and 4.70 for cost-per-DALY studies based on Registry reviewers’ subjective assessment of overall quality (methods, assumptions and reporting practices). The median ICER reported for interventions for oncology patients was higher (US$26 694 per QALY) than the median ICER reported for all interventions (US$11 503 per QALY). Oncology interventions were associated with the likelihood of reporting higher ICERs than the median ICER (p=0.003).ConclusionThe number of English-language published CEA studies relating to China has grown rapidly over the past 20 years. In terms of quality, the China studies compare favourably with international studies, although they remain a small proportion of studies globally.
Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study
Authors: Radulovic Nada , Mason Stephanie A , Rehou Sarah , Godleski Matthew , Jeschke Marc G 
Published: May 2019

ObjectiveTo determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae.DesignRetrospective cohort study evaluating EI admissions between 1998 and 2015.SettingProvincial burn centre and rehabilitation hospital specialising in EI management.ParticipantsAll EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68–766) and 980 (391–1409) days, respectively.Outcome measuresAcute and long-term clinical, neuropsychological and RTW sequelae.ResultsAcute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p<0.001). Rates of acute neuropsychological sequelae were similar between voltage groups. Long-term outcomes were dominated by insomnia (68%), anxiety (62%), post-traumatic stress disorder (33%) and major depressive disorder (25%). Sleep difficulties (67%) were common following HVIs, while the LVI group most frequently experienced sleep difficulties (70%) and anxiety (70%). Ninety work-related EIs were available for RTW analysis. Sixty-one per cent returned to their preinjury employment and 19% were unable to return to any form of work. RTW rates were similar when compared between voltage groups.ConclusionsThis is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.
Kanuka honey versus aciclovir for the topical treatment of herpes simplex labialis: a randomised controlled trial
Authors: Semprini Alex , Singer Joseph , Braithwaite Irene , Shortt Nick , Thayabaran Darmiga , McConnell Melanie , Weatherall Mark , Beasley Richard 
Published: May 2019

ObjectiveTo compare New Zealand medical grade kanuka honey with topical aciclovir for the treatment of herpes simplex labialis.DesignProspective parallel randomised controlled open-label superiority trial.Setting76 community pharmacies across New Zealand between 10 September 2015 and 13 December 2017.Participants952 adults randomised within the first 72 hours of a herpes simplex labialis episode.InterventionsRandom assignment 1:1 to either 5% aciclovir cream or medical grade kanuka honey (90%)/glycerine (10%) cream, both applied five times daily.Outcome measuresThe primary outcome was time from randomisation to return to normal skin (stage 7). Secondary outcomes included time from randomisation to stage 4 (open wound), time from stage 4 to 7, maximal pain, time to pain resolution and treatment acceptability.ResultsPrimary outcome variable: Kaplan-Meier-based estimates (95% CI) for the median time in days for return to normal skin were 8 (8 to 9) days for aciclovir and 9 (8 to 9) for honey; HR (95% CI) 1.06 (0.92 to 1.22), p=0.56. There were no statistically significant differences between treatments for all secondary outcome variables. No related serious adverse events were reported.ConclusionThere was no evidence of a difference in efficacy between topical medical grade kanuka honey and 5% aciclovir in the pharmacy-based treatment of herpes simplex labialis.Trial registration numberACTRN12615000648527;Post-results
Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission
Authors: Ireland Susan , Ray Robin A , Larkins Sarah , Woodward Lynn 
Published: May 2019

DesignA qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopmental or medical sequelae.SettingNorth Queensland is a large area in Eastern Australia of 500 000 km2, which is served by one tertiary neonatal unit.ParticipantsSeventeen families representing 21 extremely preterm babies and one baby with congenital malformations who was not expected to survive prior to delivery (but did) were interviewed using grounded theory principles. Interviews were coded and themes derived.ResultsParents who recollect their neonatal experiences from 3 to 7 years after the baby was cared for in the neonatal intensive care described negative themes of grief and loss, guilt and disempowerment. Positive enhancers of care included parental strengths, religion and culture, family supports and neonatal unit practices. Novel findings included that prior pregnancy loss and infertility formed part of the narrative for parents, and hope was engendered by religion for parents who did not usually have a religious faith.ConclusionsAn understanding of both the negative aspects of neonatal care and the positive enhancers is necessary to improve the neonatal experience for parents. Parents are able to contextualise their previous neonatal experiences within both the long-term outcome for the child and their own life history.
Adjuvant dendritic cell based immunotherapy (DCBI) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma, a phase II single centre open-label clinical trial: rationale and design of the MESOPEC trial
Authors: de Boer Nadine L , van Kooten Job P , Burger Jacobus W A , Verhoef Cornelis , Aerts Joachim G J V , Madsen Eva V E 
Published: May 2019

IntroductionMalignant peritoneal mesothelioma (MPM) is an uncommon but aggressive neoplasm and has a strong association with asbestos exposure. MPM has low survival rates of approximately 1 year even after (palliative) surgery and/or systemic chemotherapy. Recent advances in treatment strategies focusing on cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have resulted in improved median survival of 53 months and a 5 year survival of 47%. However, recurrence rates are high. Current systemic chemotherapy in the adjuvant setting is of limited efficacy, while immunotherapy with dendritic cell based immunotherapy (DCBI) has yielded promising results in murine models with peritoneal mesothelioma and in patients with pleural mesothelioma.Methods and analysisThe MESOPEC trial is an open-label single centre phase II study. The study population are adult patients with histological/cytological confirmed diagnosis of epithelioid malignant peritoneal mesothelioma. Intervention: 4 to 6 weeks before CRS-HIPEC a leukapheresis is performed of which the monocytes are used for differentiation to dendritic cells (DCs). Autologous DCs pulsed with allogeneic tumour associated antigens (MesoPher) are re-injected 8 to 10 weeks after surgery, three times biweekly. Additional booster vaccinations are given at 3 and 6 months.Primary objective is to determine the feasibility of administering DCBI after CRS-HIPEC in patients with malignant peritoneal mesothelioma. Secondary objectives are to assess safety of DCBI in patients with peritoneal mesothelioma and determine whether a specific immunological response against the tumour occurs as a result of this adjuvant immunotherapy.Ethics and disseminationPermission to carry out this study protocol has been granted by the Central Committee on Research Involving Human Subjects (CCMO in Dutch) and the Research Ethics Committee (METC in Dutch). The results of this trial will be submitted for publication in a peer-reviewed journal.Trial registration numberNTR7060. EudraCT: 2017-000897-12; Pre-Results.
Assessing the appropriateness of the management of upper respiratory tract infection in Australian children: a population-based sample survey
Authors: Long Janet C , Williams Helena M , Jani Shefali , Arnolda Gaston , Ting Hsuen P , Molloy Charlotte J , Hibbert Peter D , Churruca Kate , Ellis Louise A , Braithwaite Jeffrey 
Published: May 2019

ObjectiveTo assess the proportion of Australian children aged 0–15 years that received care in line with clinical practice guidelines (CPGs) for upper respiratory tract infections (URTIs).DesignRetrospective medical record review using a multistage sampling strategy.SettingGeneral practices, hospital emergency departments and hospital inpatient service providers in three Australian states.ParticipantsChildren aged up to 15 years who received care for URTI in 2012 and 2013.Primary and secondary outcome measuresThe primary assessment was estimated adherence with 14 indicators of appropriate care as documented in medical records. Indicators were extracted from national and international CPGs and ratified by experts. Secondary assessment was adherence to two bundles of indicators (diagnostic symptoms and medical history taking), where all indicators must be adherent for the bundle to be scored as adherent.ResultsThere were 1653 children with one or more assessments of URTI care to CPG adherence. Over half of the children were under 3 years of age, with roughly equal numbers of males and females. Three indicators had fewer than 25 visits so were not reported. Overall adherence ranged from 0.5% for ‘documented advice around antibiotics’ to 88.3% for ‘documentation of medical history’. Adherence with Bundle A (documentation of all three definitive symptoms) was 43.1% (95% CI 32.8% to 54.0%) and Bundle B (documentation of all four indicators of medical history) was 30.2% (95% CI 20.9% to 40.9%).ConclusionsURTIs in children are common, usually self-limiting, conditions that are allocated considerable resources. The results suggest that there may be a need for more thorough holistic assessment of the patient and improved documentation. Since inappropriate prescription of antibiotics for URTIs is still a known problem in Australia, there is a need for consistent, clear communication around antibiotics’ lack of impact on symptoms and a high association with undesirable side effects.
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA
Authors: Delling Francesca N , Vittinghoff Eric , Dewland Thomas A , Pletcher Mark J , Olgin Jeffrey E , Nah Gregory , Aschbacher Kirstin , Fang Christina D , Lee Emily S , Fan Shannon M , Kazi Dhruv S , Marcus Gregory M 
Published: May 2019

ObjectiveTo assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK).DesignWe used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK.SettingPopulation-based, inpatient.ParticipantsHCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states.Main outcome measuresWe used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states.ResultsIn CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95% CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95% CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state).ConclusionsRecreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.
Environmental correlates of sedentary time and physical activity in preschool children living in a relatively rural setting in the Netherlands: a cross-sectional analysis of the GECKO Drenthe cohort
Authors: Lu Congchao , Huang Guowei , Corpeleijn Eva 
Published: May 2019

ObjectivesThis study examined the relationship between environmental correlates and children’s sedentary time (ST), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) in preschool children.DesignCross-sectional studySettingA birth cohort in Drenthe, a northern province and relatively rural area of the Netherlands.ParticipantsValid data both for the ActiGraph and the questionnaire were obtained from 505 child–parent pairs.Primary and secondary outcome measuresST, LPA and MVPA of children were objectively measured by ActiGraph accelerometry (minimum three wearing days, more than 10 hours/day). Environmental correlates were collected using a questionnaire reported by parents that included household characteristics, parental and children’s PA behaviours and neighbourhood environment (eg, traffic safety, road network and presence of PA facilities). Potential correlates were identified using linear regression analysis, adjusted by age, gender, siblings, and maternal age and education level. Ordinary least square regression-based path analysis was used to estimate direct and indirect effects on activity outcomes in mediation models.ResultsLinear regression analysis showed that ‘parents taking children to play sports’ was related to less ST, more LPA and MVPA; more outdoor play was also related to less ST and more LPA, but not MVPA. Parents who perceived more PA facilities in their neighbourhood showed more support for ‘taking children to play sports’, and this was associated with less ST or more MVPA compared with children living with less PA facilities in their neighbourhood. No evidence was found for a relation between traffic safety or road network with ST, LPA and MVPA.ConclusionsThis study indicated that parental support and child outdoor play may influence children’s daily PA patterns. Convenient neighbourhood PA facilities, such as parks and playgrounds, had an indirect effect through parental support associated with lower children’s ST and higher MVPA, even in relatively rural areas.