bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Zigzag-Based Thickness-Accommodating Foldable Prismatic Structure With a Single-Degree-of-Freedom
Authors: Li Jihui , Yu Zhenyuan , Zhu Zhiwei , Deng Zichen 
Published: November 2022

Abstract
Origami inspires various designs of foldable prismatic structures with zero-thickness facets. However, there is a difficulty in directly applying them to thick materials. This paper presents a novel design of the foldable prismatic structure inspired by the zigzag pattern, which can accommodate the thickness of materials easily by placing hinges on the top or bottom surfaces of panels. The foldable prismatic structures are constructed by connecting multiple zigzag strips, in which each strip is made up of uniform-thickness hexagonal panels. By identifying the relationship between the foldable structure and spatial linkages, we analyze the mobility of the assembly based on the matrix method with DH notations. The result reveals that the foldable prismatic structure is equivalent to a network of spherical 4R linkages and Bennett linkages, and its motion has a single-degree-of-freedom. Based on the proposed foldable prismatic structure, a foldable manipulator is developed to demonstrate its potential engineering applications. The actuation strategy is designed by employing a motor-cable-driven system and torsional spring hinges. The physical prototype of the foldable manipulator is fabricated, and experimental results prove that our designs are feasible and effective.
Wire-Arc Directed Energy Deposition of Aluminum Alloy 7075 With Dispersed Nanoparticles
Authors: Chi Yitian , Pan Shauihang , Liese Maximillian , Liu Jingke , Murali Narayanan , Soemardy Ebryanto , Li Xiaochun 
Published: November 2022

Abstract
High-strength Al-Zn-Mg-Cu alloys such as AA7075 have drawn considerable attention and interest from both industry and academia owing to their high-specific strengths and good fatigue resistance. Wire-arc directed energy deposition, an emerging near-net-shape manufacturing technology, faces significant challenges in printing AA7075 due to its hot cracking susceptibility. In this study, we use nano-treated AA7075 wire as feedstock to additively manufacture a crack-free deposition of the high-performance alloy. After T6 heat treatment, the nano-treated AA7075 achieves exceptional yield strength (510.3 MPa), ultimate tensile strength (606.0 MPa), and elongation (12.6%). In addition, nanoparticles homogenize the microstructure upon solidification and inhibit grain growth from cyclic thermal exposure, yielding refined, equiaxed grains throughout the deposition and enabling isotropic mechanical properties in both as-built and T6-treated conditions. Thus, this study highlights a promising intersection of nano-treatment and wire-arc directed energy deposition for printing traditionally unprintable materials.
Reducing Carbon Intensity of Production & Improving Uptime by Use of an Electric Adaptive Gas Lift Compressor
Authors: Rathore Devvrat , Snow John , Snow Paul 
Published: November 2022

Abstract
This paper details the framework and operation of a wellsite facility that utilizes a wellsite gas lift compressor that implements “adaptive flow control” to minimize manual intervention and carbon intensity of oil and gas production. The adaptive operation of the compression package is detailed, along with the metrics quantifying the reduction in carbon intensity. The basis for the reduction in carbon intensity is achieved by reduction in scope-1 emissions, instrumentation exhaust, minimizing the intervention by operations teams, and operating in “adaptive” mode to minimize trips and maximize production.
Unconventional wells on gas lift are sensitive to surface compressors trips, and in most cases required to be shut in a few hours due to liquid loading. Given the remoteness of well facilities, there may not be enough time for a lease operator or compressor technician to arrive at the compressor before the well is shut-in. Tracking the data on the majority causes of failures, it is observed that about half of the compressor trips were caused due to fluctuation in process gas pressure — this can be suction side, discharge side or due to gas conditions causing sudden fluctuation between stages of compression. Additionally, these dynamic conditions of operation are protected by static equipment protection alarms. The adaptive compressor operates with the ability to adjust to fluctuating process conditions, including floating shutdown limits using real-time calculation of mechanical loads on key components to ensure the dynamic nature of the shutdown limits does not impact equipment integrity. In case of a trip, the compressor additionally goes through a series of tests and attempts to restart itself. First trials of this project have shown high uptime of the facility and gas lift compressor and provide a model for collaborative R&D towards achieving a producers goals.
Refractory paraneoplastic hypercalcaemia responding to cinacalcet
Authors: Shah Preet Mukesh , Rasool Irum , Maguire Deirdre 
Published: November 2022

A woman in her late 70s presented with an increased frequency of micturition, suprapubic pain and weight loss. She was found to be having advanced cancer of the urinary bladder, coupled with bilateral hydronephrosis.Whilst undergoing surgical intervention for the latter, she was incidentally found to be having hypercalcaemia. This was found to be paraneoplastic in nature, possibly due to elevated parathyroid hormone related peptide with no evidence of bone metastasis. The histology of the resected tumour revealed squamous and sarcomatoid differentiation. Her hypercalcaemia initially responded to intravenous fluids, and later on zolendronate,but the problem recurred again, with the response to a repeat dose of zolendronate and even denosumab being unsatisfactory. As a last resort cinacalcet was started, and although there was a good response to it, our patient sadly died a few weeks later.We believe our case to be the first case of hypercalcaemia associated with isolated bladder cancer which showed a successful response to cinacalcet.
Add-on imeglimin versus metformin dose escalation regarding glycemic control in patients with type 2 diabetes treated with a dipeptidyl peptidase-4 inhibitor plus low-dose metformin: study protocol for a multicenter, prospective, randomized, open-label, parallel-group comparison study (MEGMI study)
Authors: Nomoto Hiroshi , Takahashi Akihiro , Nakamura Akinobu , Kurihara Hiroyoshi , Takeuchi Jun , Nagai So , Taneda Shinji , Miya Aika , Kameda Hiraku , Cho Kyu Yong , Miyoshi Hideaki , Atsumi Tatsuya 
Published: November 2022

IntroductionImeglimin is a novel anti-hyperglycemic drug that improves both insulin resistance and insulin secretion. The effects of imeglimin on glycemic control were confirmed in phase III clinical trials, but little is known about its effectiveness in daily clinical practice settings, especially compared with metformin. Therefore, we aim to clarify the efficacy of imeglimin in patients with type 2 diabetes (T2D) being treated with a dipeptidyl peptidase-4 (DPP-4) inhibitor plus low-dose metformin.Research design and methodsThis is a multicenter, randomized, prospective, open-label, parallel-group trial. Seventy participants with T2D treated with a DPP-4 inhibitor plus metformin (500–1000 mg/day) for more than 12 weeks and a glycated hemoglobin (HbA1c) level of 52–85 mmol/mol (7.0%–9.9%) will be randomized to receive add-on imeglimin 1000 mg two times per day or metformin dose escalation for 24 weeks. Biochemical analyses and physical assessments will be performed at baseline and at the end of the study, and adverse events will be recorded. The primary endpoint is the change in HbA1c after 24 weeks. The secondary endpoints comprise the changes in blood pressure, pulse rate, body weight, abdominal circumference, and other laboratory parameters; the relationship between improvements of biological parameters including glycemic control and patient background characteristics; and side effects.ResultsThis study will reveal new insights into the incorporation of imeglimin into the diabetes treatment strategy.ConclusionsThis will be the first randomized controlled trial to compare the efficacy of adding imeglimin versus metformin dose escalation on glycemic control in patients with T2D.Trial registration numberjRCT1011220005.
Challenges of epidemiological investigation work in the COVID-19 pandemic: a qualitative study of the epidemiology workforce in Guangdong Province, China
Authors: Zheng Peng , Li Cuizhi , Zhang Hongyue , Huang Bing , Zhang Yue , Feng Huiyao , Jiang Diwei , Chen Xiongfei , Dong Xiaomei 
Published: November 2022

ObjectivesThis study sought to identify the epidemiological investigation challenges of the COVID-19 pandemic and offer insights into the underlying issues.DesignAn exploratory qualitative study used thematic analysis of semistructured and in-depth individual interviews.SettingThis study was conducted in Centers for Disease Control and Prevention in Guangdong Province.ParticipantsTwenty-four participants consented to participate in an in-depth interview. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.ResultsThe qualitative analysis revealed five key themes: high-intensity epidemiological investigation task, emergency management requiring improvement in the early stage, respondent uncertainty, impact on work and social life and inadequate early-stage Joint Prevention and Control Mechanism.ConclusionThis survey focuses on the epidemiology workforce at the forefront of the COVID-19 pandemic and qualitatively describes their experiences, vocational issues and psychological stressors. We found that the problems of epidemiological investigation posed intense challenges to the epidemiology workforce. These findings highlight the epidemiological investigation challenges associated with this pandemic. We have provided some suggestions that may help improve the efficiency and quality of the epidemiology workforce in China.
Patients’ experience of and participation in a stroke self-management programme, My Life After Stroke (MLAS): a multimethod study
Authors: Blatchford Emily Grace , Aquino Maria Raisa Jessica , Grant Julie , Johnson Vicki , Mullis Ricky , Lim Lisa , Mant Jonathan 
Published: November 2022

ObjectiveA self-management programme, My Life After Stroke (MLAS), was developed to support stroke survivors. This evaluation reports patients’ experience.DesignMultimethod, involving interviews and questionnaires.Setting23 general practices in the intervention arm of a cluster randomised controlled trial in East of England and East Midlands, UK.ParticipantsPeople on the stroke registers of participating general practices were invited to attend an MLAS programme.InterventionsMLAS comprises one-to-one and group-based sessions to promote independence, confidence and hope.Primary and secondary outcome measuresThe primary outcome was uptake of the programme. Participants who declined MLAS were sent a questionnaire to ascertain why. Attendees of four programmes completed evaluation forms. Attendees and non-attendees of MLAS were interviewed. Ad-hoc email conversations with the lead author were reviewed. Thematic analysis was used for qualitative data.Results141/420 (34%) participants (mean age 71) attended an MLAS programme and 103 (73%) completed 1. 64/228 (28%) participants who declined MLAS gave reasons as: good recovery, ongoing health issues, logistical issues and inappropriate. Nearly all attendees who completed questionnaires felt that process criteria such as talking about their stroke and outcomes such as developing a strong understanding of stroke had been achieved.ConclusionsMLAS was a positive experience for participants but many stroke survivors did not feel it was appropriate for them. Participation in self-management programmes after stroke might be improved by offering them sooner after the stroke and providing a range of delivery options beyond group-based, face-to-face learning.Trial registration numberNCT03353519, NIH.
Antenatal depression and its associated factors among women of Godawari Municipality, Lalitpur, Nepal: a cross-sectional study
Authors: Chalise Anisha , Shrestha Gambhir , Paudel Shishir , Poudyal Amod Kumar 
Published: November 2022

ObjectivesTo estimate the prevalence of antenatal depression and identify its associated factors among pregnant women of Godawari Municipality, Lalitpur, Nepal.DesignCommunity-based cross-sectional study.SettingGodawari Municipality, Lalitpur, Nepal, between September and November 2021.Participants250 randomly selected pregnant women of Godawari Municipality, Lalitpur, Nepal.Main outcome measuresThe level of antenatal depression was assessed using Edinburgh Postnatal Depression Scale. χ2test and multivariate logistic regression analysis were applied to determine the association between antenatal depression and related variables at 95% level of confidence.ResultsThe prevalence of antenatal depression was found to be 24.8% (95% CI: 19.2 to 30.7). Multigravida (AOR: 2.219, 95% CI: 1.113 to 4.423), unintended pregnancy (AOR: 2.547, 95% CI: 1.204 to 5.388), male sex preference of child by family (AOR: 2.531, 95% CI: 1.204 to 5.321) and intimate partner violence (AOR: 2.276, 95% CI: 1.116 to 4.640) were found to be the positive predictors of antenatal depression.ConclusionThis study showed a high prevalence of depression among pregnant women. The results suggest a need for mental health assessment during pregnancy. Screening for depression should be part of routine antenatal checkups for early detection and management of mental health concerns during this vulnerable period.
Paediatric dengue shock syndrome and acute respiratory failure: a single-centre retrospective study
Authors: Preeprem Nutnicha , Phumeetham Suwannee 
Published: November 2022

ObjectiveDengue shock syndrome (DSS) is a serious health condition leading to paediatric intensive care unit (PICU) admissions and deaths in tropical countries. Acute respiratory failure (ARF) is associated with DSS and is a major cause of dengue deaths. We aimed to identify risk factors associated with ARF in children with DSS.MethodsWe retrospectively reviewed children with DSS admitted to a PICU from 2010 to 2020 at a tertiary level hospital in Bangkok, Thailand. Patient characteristics, clinical parameters and laboratory data were collected. Multivariable logistic regression analysis was used to identify factors associated with ARF.ResultsTwenty-six (43.3%) of 60 children with DSS developed ARF and 6 did not survive to day 28. The median (IQR) age was 8.1 years (IQR 4.0–11.0). Fluid accumulation during the first 72 hours of PICU admission was greater in the ARF group compared with the non-ARF group (12.2% (IQR 7.6–21.7) vs 8.3% (IQR 4.4–13.3), p=0.009). In a multivariate analysis at 72 hours post PICU admission, the presence of ˃15% fluid accumulation was independently associated with ARF (adjusted OR 5.67, 95% CI 1.24 to 25.89, p=0.025).ConclusionARF is an important complication in children with DSS. A close assessment of patient fluid status is essential to identify patients at risk of ARF. Once the patient is haemodynamically stable and leakage slows, judicious fluid management is required to prevent ARF.
Towards NHS Zero: greener gastroenterology and the impact of virtual clinics on carbon emissions and patient outcomes. A multisite, observational, cross-sectional study.
Authors: King Jonathan , Poo Stephanie X , El-Sayed Ahmed , Kabir Misha , Hiner George , Olabinan Olaolu , Colwill Michael , Ayubi Homira ,   GLINT Research Network, Shakweh Eathar , Kronsten Victoria T , Kader Rawen , Hayee Bu'Hussain 
Published: November 2022

ObjectiveThe National Health Service (NHS) produces more carbon emissions than any public sector organisation in England. In 2020, it became the first health service worldwide to commit to becoming carbon net zero, the same year as the COVID-19 pandemic forced healthcare systems globally to rapidly adapt service delivery. As part of this, outpatient appointments became largely remote. Although the environmental benefit of this change may seem intuitive the impact on patient outcomes must remain a priority. Previous studies have evaluated the impact of telemedicine on emission reduction and patient outcomes but never before in the gastroenterology outpatient setting.Method2140 appointments from general gastroenterology clinics across 11 Trusts were retrospectively analysed prior to and during the pandemic. 100 consecutive appointments during two periods of time, from 1 June 2019 (prepandemic) to 1 June 2020 (during the pandemic), were used. Patients were telephoned to confirm the mode of transport used to attend their appointment and electronic patient records reviewed to assess did-not-attend (DNA) rates, 90-day admission rates and 90-day mortality rates.ResultsRemote consultations greatly reduced the carbon emissions associated with each appointment. Although more patients DNA their remote consultations and doctors more frequently requested follow-up blood tests when reviewing patients face-to-face, there was no significant difference in patient 90-day admissions or mortality when consultations were remote.ConclusionTeleconsultations can provide patients with a flexible and safe means of being reviewed in outpatient clinics while simultaneously having a major impact on the reduction of carbon emissions created by the NHS.
BSG cross-sectional survey on impact of COVID-19 recovery on workforce, workload and well-being
Authors: Kabir Misha , Matharoo Manmeet , Dhar Anjan , Gordon Harriet , King Jonathan , Lockett Melanie , Morris Danielle , Moroni Francesca , Patel Nisha , Verma Ajay Mark , Samji Shairoz 
Published: November 2022

ObjectiveThe aim of this survey was to understand the impact of the COVID-19 pandemic and recovery phase on workload, well-being and workforce attrition in UK gastroenterology and hepatology.Design/methodA cross-sectional survey of British Society of Gastroenterology physician and trainee members was conducted between August and October 2021. Multivariable binary logistic regression and qualitative analyses were performed.ResultsThe response rate was 28.8% (180/624 of opened email invites). 38.2% (n=21/55) of those who contracted COVID-19 felt pressured to return to work before they felt ready. 43.8% (71/162) had a regular increase in out-of-hours working. This disproportionately affected newly appointed consultants (OR 5.8), those working full-time (OR 11.6), those who developed COVID-19 (OR 4.1) and those planning early retirement (OR 4.0). 92% (150/164) believe the workforce is inadequate to manage the service backlog with new consultants expressing the highest levels of anxiety over this. 49.1% (80/163) felt isolated due to remote working and 65.9% (108/164) felt reduced face-to-face patient contact made their job less fulfilling. 34.0% (55/162) planned to work more flexibly and 54.3% (75/138) of consultants planned to retire early in the aftermath of the pandemic. Early retirement was independently associated with male gender (OR 2.5), feeling isolated from the department (OR 2.3) and increased anxiety over service backlog (OR 1.02).ConclusionThe pandemic has placed an additional burden on work-life balance, well-being and workforce retention within gastroenterology and hepatology. Increased aspirations for early retirement and flexible working need to be explicitly addressed in future workforce planning.
Sex differences in onset to hospital arrival time, prestroke disability, and clinical symptoms in patients with a large vessel occlusion: a MR CLEAN Registry substudy
Authors: Ali Mariam , van der Meij Anne , van Os Hendrikus J A , Ali Mahsoem , Van Zwet Erik W , Spaander Fianne H M , Hofmeijer Jeanette , Nederkoorn Paul J , van den Wijngaard Ido R , Majoie Charles B L M , van Es Adriaan C G M , Schonewille Wouter J , van Walderveen Marianne A A , Dippel Diederik W J , Visser Marieke C , Kruyt Nyika D , Wermer Marieke J H 
Published: November 2022

BackgroundWomen have been reported to have worse outcomes after endovascular treatment (EVT), despite a similar treatment effect in non-clinical trial populations. We aimed to assess sex differences at hospital presentation with respect to workflow metrics, prestroke disability, and presenting clinical symptoms.MethodsWe included consecutive patients from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in The Netherlands (MR CLEAN) Registry (2014–2018) who received EVT for anterior circulation large vessel occlusion (LVO). We assessed sex differences in workflow metrics, prestroke disability (modified Rankin Scale (mRS) score ≥1), and stroke severity and symptoms according to the National Institutes of Health Stroke Scale (NIHSS) score on hospital admission with logistic and linear regression analyses and calculated the adjusted OR (aOR).ResultsWe included 4872 patients (47.6% women). Compared with men, women were older (median age 76 vs 70 years) and less often achieved good functional outcome at 90 days (mRS ≤2: 35.2% vs 46.4%, aOR 0.70, 95% CI 0.60 to 0.82). Mean onset-to-door time was longer in women (2 hours 16 min vs 2 hours 7 min, adjusted delay 9 min, 95% CI 4 to 13). This delay contributed to longer onset-to-groin times (3 hours 26 min in women vs 3 hours 13 min in men, adjusted delay 13 min, 95% CI 9 to 17). Women more often had prestroke disability (mRS ≥1: 41.1% vs 29.1%, aOR 1.57, 95% CI 1.36 to 1.82). NIHSS on admission was essentially similar in men and women (mean 15±6 vs 15±6, NIHSS <10 vs ≥10, aOR 0.91, 95% CI 0.78 to 1.06). There were no clear sex differences in the occurrence of specific stroke symptoms.ConclusionWomen with LVO had longer onset-to-door times and more often prestroke disability than men. Raising awareness of these differences at hospital presentation and investigating underlying causes may help to improve outcome after EVT in women.
Parkinson’s disease and palliative care: a quality of care Delphi study
Authors: Rogers Alice , Richfield Edward William , Thomas Sue , Wee Bee , Trotter Sophie Anne 
Published: November 2022

ObjectivesExtending palliative care services to those with long-term neurological conditions is a current aim of UK health policy. Lack of holistic guidelines for palliative and end-of-life care, and differing models of service provision, has resulted in heterogeneity in care access and quality. There is a need for evidence-based standards of care to audit Parkinson’s services and drive improvements.MethodsA two-stage Delphi process was used to achieve consensus on statements that define quality standards in palliative care for patients with Parkinson’s disease (PD). An expert panel was selected to comprise healthcare professionals, patients and carers based in the UK; this panel evaluated the statements via a Delphi survey. Quantitative and qualitative analysis of the results informed modifications between the Delphi rounds.ResultsA final set of 16 statements was produced, reflecting aspirational standards of palliative care in PD. These statements, split into four domains (‘Structures and processes of care’, ‘Preparing for the end of life’, ‘ Care in the last weeks of life’ and ‘Care in the last days of life’) underline the importance of joint working between generalist and specialist services, individualised care and early and regular advance care planning.ConclusionsThe Delphi process has established a set of standards which can be integrated within and guide services, helping to improve the quality and equality of care. Further work remains to establish the effectiveness of different models of service provision, including the implementation of keyworkers and telemedicine.