bluuebunny/crossref_metadata_2025_split huggingface dataset:
Involvement of the extracellular matrix and integrin signalling proteins in skeletal muscle glucose uptake
Authors: Draicchio Fulvia , Behrends Volker , Tillin Neale A. , Hurren Nicholas M. , Sylow Lykke , Mackenzie Richard 
Published: September 2022

AbstractWhole‐body euglycaemia is partly maintained by two cellular processes that encourage glucose uptake in skeletal muscle, the insulin‐ and contraction‐stimulated pathways, with research suggesting convergence between these two processes. The normal structural integrity of the skeletal muscle requires an intact actin cytoskeleton as well as integrin‐associated proteins, and thus those structures are likely fundamental for effective glucose uptake in skeletal muscle. In contrast, excessive extracellular matrix (ECM) remodelling and integrin expression in skeletal muscle may contribute to insulin resistance owing to an increased physical barrier causing reduced nutrient and hormonal flux. This review explores the role of the ECM and the actin cytoskeleton in insulin‐ and contraction‐mediated glucose uptake in skeletal muscle. This is a clinically important area of research given that defects in the structural integrity of the ECM and integrin‐associated proteins may contribute to loss of muscle function and decreased glucose uptake in type 2 diabetes.
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Discrete Element Analysis on Mechanical Properties of Ballast Bed by Tamping in Railway Turnout Areas
Authors: Chi Yihao , Xiao Hong , Zhang Zhihai , Fang Shuwei , Wang Haoyu 
Published: September 2022

AbstractTurnout is the key component of the railway tracks for trains to change direction, which is vital to operational safety and passenger comfort. Therefore, it is of great importance to perform a scientific and reasonable tamping operation for turnout areas. In this paper, based on the commercial software edem and recurdyn, a coupled simulation model of the large machine tamping device-rail-sleeper-ballast bed in the turnout area is jointly established, and the correctness of the model is verified by the test results of the lateral resistance of the ballast bed. The influence of tamping operation on the macro-and micromechanical properties of ballast bed at the switching part of railway turnout areas is studied and recommendations for the optimization of tamping operation are proposed. The results show that in the squeezing stage, strong force chains are distributed concentrately under sleepers, where the distribution range is approximately elliptical with a depth of 150 mm. After tamping, only the 200-mm ballast under the sleepers is compacted, where the compactness is increased by 5.9%. On the contrary, the compactness of the ballast in the sleeper crib is reduced by 27.4%, which is the weakest part. To ensure favorable tamping quality, the tamping sequence at the switching part of railway turnout areas is suggested to be conducted in order of first through track and then diverging track.
Stratified and Buoyancy-Induced Flow in Closed Compressor Rotors
Authors: Lock Gary D. , Jackson Richard W. , Pernak Mikolaj , Pountney Oliver J. , Sangan Carl M. , Owen J. Michael , Tang Hui , Scobie James A. 
Published: September 2022

Abstract
The radial growth of compressor discs is strongly influenced by conjugate heat transfer between conduction in the co-rotating discs and buoyancy-driven convection in the rotating fluid core between the discs. An accurate prediction of metal temperatures of these discs is an important issue in thermo-mechanical design, where blade-tip clearances must be controlled carefully to ensure safety and efficiency under all operating conditions. This paper presents an experimental study of the fluid dynamics and heat transfer in a closed rotating cavity, comparing results with theoretical models and introducing a new compressibility parameter χ. At large values of χ, where compressibility effects are significant, the air temperature approaches that of the shroud; such conditions suppress buoyancy effects and the flow in the rotating cavity becomes stratified, with convection replaced by conduction inside the fluid core. There are important practical consequences of stratification with significant differences in temperature distributions and stresses inside compressor discs. The influence of χ is also shown on the radial temperature distributions for the discs and on the shroud heat transfer correlations, which are compared qualitatively with previously published data collected where the effects of compressibility are relatively small. The experiments reveal that there is a critical value of χ where the convective heat flux to the shroud is zero. The radial distribution of disc temperature was that expected from pure conduction in a cylinder. A new heat transfer correlation based on measured shroud heat flux and the theoretical core temperature is presented. The unsteady flow characteristics in the cavity were also investigated, identifying coherent rotating structures across a range of experimental conditions. These cyclonic/anti-cyclonic vortex pairs generate the nondimensional circumferential pressure difference necessary for the radial outflow (of cold fluid) and inflow (of hot fluid) through the rotating core. The experiments show that the magnitude of these pressure variations can be correlated against Grashof number and at high values of χ the structures do not exist. The combined experimental and theoretical results will be of practical interest to engine designers and for the validation of computational models.
The Inter-Bristle Pressure Field in a Large-Scale Brush Seal
Authors: Bowen Joshua P. , Jenkins Matthew R. , Bowsher Aaron A. , Crudgington Peter F. , Sangan Carl M. , Scobie James A. 
Published: September 2022

Abstract
Brush seals promise improvements to the widely used labyrinth seal in regulating turbomachinery leakages. Enhanced resistance to the flow is provided by a static ring of densely packed fine wire bristles that are angled in the direction of rotation and flex to accommodate rotor excursions. A large-scale brush seal was constructed to study the leakage characteristics in direct relation to the pressure field within and surrounding the bristle pack for multiple clearance conditions, therefore developing the understanding of brush seal fluid dynamic behavior. The governing parameter controlling leakage behavior transitioned from pressure ratio for a large clearance, to pressure load for a line-on-line configuration. In all cases, leakage flow converged to an asymptotic value once maximum levels of bristle blow-down and pack compaction were attained. For both clearance configurations, this occurred at a pressure ratio corresponding to that at which axial distributions of pressure converged; equivalent behavior was noted for the line-on-line configuration with pressure drop. Comparatively small changes were experienced in leakage behavior and in the interbristle pressure field with increasing pressure drop for the line-on-line brush seal. This indicated that brush seal performance is more influenced by changes in bristle blow-down than bristle pack compaction.
Effect of Strong Azimuthal Swirl on Ignition and Light-Around in an Annular Combustor
Authors: Kwah Yi Hao , Agostinelli Pasquale Walter , Richard Stephane , Exilard Gorka , Pascaud Stephane , Gicquel Laurent , Dawson James R. 
Published: September 2022

Abstract
In this paper, we investigate the effect of strong azimuthal swirl on ignition dynamics in a laboratory-scale annular combustor. Bulk azimuthal swirl was produced by a novel angled injector configuration, producing swirling jet flames oriented downwards toward the combustor backplane and in the azimuthal direction, replicating a simplified version of the SAFRAN spinning combustor concept. To provide more realistic flow conditions, the design included rich-quench-lean (RQL) staging via a circumferential distribution of dilution ports and an effusion cooled combustor backplane. High-speed imaging and an azimuthal array of photomultipliers to measure OH* chemiluminescence were used to characterize the ignition dynamics for different injector velocities and global equivalence ratios. The mass flows through the injectors, dilution ports, and effusion cooled backplane were independently metered so that the injector equivalence ratio and global equivalence ratio could be separately controlled. The light-around times were found to have no clear correlation with the injector velocity since the rich injector equivalence ratio meant the flame burned in a nonpremixed mode even though the global equivalence ratio was lean due to the RQL staging. However, it was found that lower injector velocities extended the lean ignition limit based on the global equivalence ratio. The ignition sequence during light-around (order in which the injectors are ignited) was found to be highly repeatable, igniting each consecutive injector in the anticlockwise direction (the direction of bulk swirl). In rare cases, the ignition sequence was observed to branch in both directions. Finally, in an effort to extend the lean ignition limit, the effect of azimuthal staging was investigated. Two configurations were tested. In the first configuration, the injectors on one half of the annulus were operated at a fixed equivalence ratio whereas the other half of the annulus was operated at a different equivalence ratio. In the second configuration, every second injector had the same equivalence ratio. Both configurations extended the lean extinction limit but the first configuration was the most effective.
Evaluating effects of the structural reform of outpatient psychotherapy for patients with mental disorders in Germany: comparing patients with and without comorbid chronic physical condition – rationale and study protocol of the ES-RiP project
Authors: Kampling Hanna , Kruse Johannes , Friederich Hans-Christoph , Heuft Gereon , Christoffer Andrea , Grobe Thomas G , Marschall Ursula , Szecsenyi Joachim , Wild Beate , Hartmann Mechthild 
Published: September 2022

IntroductionIn 2017, in Germany, a structural reform of the outpatient psychotherapy guideline took place, aiming to reduce waiting times, to facilitate flexible low-threshold access (eg, general reachability by phone) and to lower access barriers for specific patient groups. The reform included new service elements, such as the implementation of additional psychotherapeutic consultations, acute short-term psychotherapeutic interventions and relapse prophylaxis as well as the promotion of group therapies, the facilitation of psychotherapists’ availability, and the installation of appointment service centres. The ES-RiP project aims to thoroughly evaluate the effects of the reform with a special focus on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs) compared with patients with a mental disorder but no long-term physical condition (MnoP). The project aims to evaluate (a) the extent to which the reform goals were achieved in the large group of patients with cMPs compared with MnoP, (b) the barriers that might hinder the implementation of the new guideline and (c) the procedures required for further developing and improving outpatient psychotherapy.Methods and analysisA mixed-methods design (quantitative, qualitative) along with a multilevel approach (patients, service providers, payers) triangulating several data sources (primary and secondary data) will be applied to evaluate the reform from different perspectives.Ethics and disseminationEthical approval was obtained from the coordinating committee as well as one local ethics committee, Justus Liebig University Giessen and Marburg – Faculty of Medicine (approval number: AZ 107/20) and Heidelberg (approval number: S-466/2020). The results of this study will be disseminated through expert panels, conference presentations and publications in peer-reviewed journals.Trial registration numberDRKS00020344.
Timing of endoscopic intervention in patients with cirrhosis with acute variceal haemorrhage (TEACH trial): protocol for a randomised clinical trial (RCT)
Authors: Yang Zhuoxin , Xuan Ji , Yang Fengwu , Qi Ying , Yang Miaofang , Xu Huabing , Jiang Mingzuo , Shen Si , Lu Mengjie , Shi Hui , Jiang Kang , Tao Hui , Liu Yuxiu , Wang Fangyu 
Published: September 2022

IntroductionAcute variceal haemorrhage (AVH) in patients with cirrhosis remains a topic of great interest. Although several guidelines recommend endoscopy within 24 hours after AVH, there is no consensus on the most appropriate time to perform this intervention. The purpose of this study is to identify whether urgent endoscopy (within 6 hours after gastroenterological consultation) is superior to non-urgent endoscopy (between 6 hours and 24 hours after gastroenterological consultation) in reducing the rebleeding rate of these patients.Methods and analysisThis is a single-centred, prospective, randomised clinical trial. Between March 2021 and December 2023, an estimated 400 patients will be randomised in a 1:1 ratio to receive endoscopic intervention either within 6 hours or between 6 and 24 hours after gastroenterological consultation. Randomisation will be conducted by permuted block randomisation, with stratification by age, systolic blood pressure and pulse rate. The primary efficacy endpoint is rebleeding within 42 days after control of AVH. The secondary efficacy endpoints mainly include all-cause mortality within 42 days after randomisation, persistent bleeding, length of hospitalisation, etc.Ethics and disseminationThe study protocol was approved by the Ethical Committees of Jinling Hospital (authorised ethics no. DZQH-KYLL-21-01). This trial will provide valuable insights into the timing of endoscopic intervention for AVH in patients with cirrhosis. Furthermore, the trial results and conclusions could provide high-quality evidence to guide clinical research and treatment.Trial registration numberNCT04786743.
Developing an Australian Melanoma Clinical Outcomes Registry (MelCOR): a protocol paper
Authors: Jobson Dale , Roffey Benjamin , Best Renee , Button-Sloan Alison , Cossio Danica , Evans Sue , Shang Catherine , Moore Julie , Arnold Christopher , Mann Graham , Shackleton Mark , Soyer H Peter , Morton Rachel L , Zalcberg John , Mar Victoria 
Published: September 2022

IntroductionAustralia has the highest incidence of melanoma in the world with variable care provided by a diverse range of clinicians. Clinical quality registries aim to identify these variations in care and provide anonymised, benchmarked feedback to clinicians and institutions to improve patient outcomes. The Australian Melanoma Clinical Outcomes Registry (MelCOR) aims to collect population-wide, clinical-level data for the early management of cutaneous melanoma and provide anonymised feedback to healthcare providers.Methods and analysisA modified Delphi process will be undertaken to identify key clinical quality indicators for inclusion in the MelCOR pilot. MelCOR will prospectively collect data relevant to these quality indicators, initially for all people over the age of 18 years living in Victoria and Queensland with a melanoma diagnosis confirmed by histopathology, via a two-stage recruitment and consent process. In stage 1, existing State-based cancer registries contact the treating clinician and provide an opportunity for them to opt themselves or their patients out of direct contact with MelCOR. After stage 1, re-identifiable clinical data are provided to the MelCOR under a waiver of consent. In stage 2, the State-based cancer registry will approach the patient directly and invite them to opt in to MelCOR and share identifiable data. If a patient elects to opt in, MelCOR will be able to contact patients directly to collect patient-reported outcome measures. Aggregated data will be used to provide benchmarked, comparative feedback to participating institutions/clinicians.Ethics and disseminationFollowing the successful collection of pilot data, the feasibility of an Australia-wide roll out will be evaluated. Key quality indicator data will be the core of the MelCOR dataset, with additional data points added later. Annual reports will be issued, first to the relevant stakeholders followed by the public. MelCOR is approved by the Alfred Ethics Committee (58280/127/20).
Relationship between the red cell distribution width-to-platelet ratio and in-hospital mortality among critically ill patients with acute myocardial infarction: a retrospective analysis of the MIMIC-IV database
Authors: Tong li , Liu Yan-Qiong , Shen Jin Hua , B O Min , Zhou Quan , Duan Xiang-Jie , Guo Ya Fen , Zhang Xue Qing 
Published: September 2022

ObjectivesWe aimed to investigate the association between red cell distribution width-to-platelet ratio (RPR), and in-hospital mortality in critically ill patients with acute myocardial infarction (AMI).DesignA retrospective cohort study.SettingData were collected from the Medical Information Mart for Intensive Care database (MIMIC-IV) consisting of critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Centre in Boston.ParticipantsA total of 5067 patients with AMI were enrolled from the MIMIC-IV database.Primary and secondary outcomeIn-hospital mortality.ResultsA total of 4034 patients survived, while 1033 died. In a multiple regression analysis adjusted for age, weight and ethnicity, RPR also showed a positive correlation with in-hospital mortality (HR 1.91, 95% CI 1.42 to 2.56, p<0.0001). Moreover, after adjusting for additional confounding factors, obvious changes were observed (HR 1.63, 95% CI 1.03 to 2.57, p=0.0357). In model 2, the high ratio quartile remained positively associated with hospital mortality compared with the low ratio quartile (HR 1.20, 95% CI 1.01 to 1. 43), with a p-value trend of 0.0177. Subgroup analyses showed no significant effect modifications on the association between RPR and in-hospital mortality in the different AMI groups (p>0.05).ConclusionRPR is an independent predictor of in-hospital mortality in critically ill patients with AMI.
Systematic scoping review on moral distress among physicians
Authors: Quek Chrystie Wan Ning , Ong Ryan Rui Song , Wong Ruth Si Man , Chan Sarah Wye Kit , Chok Amanda Kay-Lyn , Shen Grace Shen , Teo Andrea York Tiang , Panda Aiswarya , Burla Neha , Wong Yu An , Chee Ryan Choon Hoe , Loh Caitlin Yuen Ling , Lee Kun Woo , Tan Gabrielle Hui Ning , Leong Ryan Emmanuel Jian , Koh Natalie Song Yi , Ong Yun Ting , Chin Annelissa Mien Chew , Chiam Min , Lim Crystal , Zhou Xuelian Jamie , Ong Simon Yew Kuang , Ong Eng Koon , Krishna Lalit Kumar Radha 
Published: September 2022

BackgroundConcepts of moral distress (MD) among physicians have evolved and extend beyond the notion of psychological distress caused by being in a situation in which one is constrained from acting on what one knows to be right. With many accounts involving complex personal, professional, legal, ethical and moral issues, we propose a review of current understanding of MD among physicians.MethodsA systematic evidence-based approach guided systematic scoping review is proposed to map the current concepts of MD among physicians published in PubMed, Embase, PsycINFO, Web of Science, SCOPUS, ERIC and Google Scholar databases. Concurrent and independent thematic and direct content analysis (split approach) was conducted on included articles to enhance the reliability and transparency of the process. The themes and categories identified were combined using the jigsaw perspective to create domains that form the framework of the discussion that follows.ResultsA total of 30 156 abstracts were identified, 2473 full-text articles were reviewed and 128 articles were included. The five domains identified were as follows: (1) current concepts, (2) risk factors, (3) impact, (4) tools and (5) interventions.ConclusionsInitial reviews suggest that MD involves conflicts within a physician’s personal beliefs, values and principles (personal constructs) caused by personal, ethical, moral, contextual, professional and sociocultural factors. How these experiences are processed and reflected on and then integrated into the physician’s personal constructs impacts their self-concepts of personhood and identity and can result in MD. The ring theory of personhood facilitates an appreciation of how new experiences create dissonance and resonance within personal constructs. These insights allow the forwarding of a new broader concept of MD and a personalised approach to assessing and treating MD. While further studies are required to test these findings, they offer a personalised means of supporting a physician’s MD and preventing burn-out.
Inpatient cardiovascular outcomes in patients with cancer affected by viral influenza infection
Authors: Sheth Aakash R , Grewal Udhayvir Singh , Patel Harsh P , Thotamgari Sahith Reddy , Patel Smit , Desai Rohan , Thakkar Samarthkumar , Papayannis Aristotelis 
Published: September 2022

Abstract

Background
Influenza disproportionately affects individuals with underlying comorbidities. Long-term follow-up studies have shown that patients with cancer with influenza have higher mortality. However, very little is known about the in-hospital mortality and cardiovascular outcomes of influenza infection in cancer hospitalisations.

Methods
We compared the in-hospital mortality and cardiovascular outcomes in patients with cancer with and without influenza by screening the National Inpatient Sample from 2015 to 2017. A total of 9 443 421 hospitalisations with any cancer were identified, out of which 14 634 had influenza while 9 252 007 did not. A two-level hierarchical multivariate logistic regression analysis adjusted for age, sex, race, hospital type and relevant comorbidities was performed.

Results
The group with cancer and influenza had higher in-hospital mortality (OR 1.08; 95% CI 1.003 to 1.16; p=0.04), acute coronary syndromes (OR 1.74; 95% CI 1.57 to 1.93; p&lt;0.0001), atrial fibrillation (OR 1.24; 95% CI 1.18 to 1.29; p&lt;0.0001) and acute heart failure (OR 1.41; 95% CI 1.32 to 1.51; p&lt;0.0001).

Conclusion
Patients with cancer affected by influenza have higher in-hospital mortality and a higher prevalence of acute coronary syndrome, atrial fibrillation and acute heart failure.
Comparison of sitting and prone positions for real-time ultrasound-guided thoracic epidural catheter placement: a randomized controlled trial
Authors: Shin Sojin , Lee Jong-Hyuk , Kwon Hyun-Jung , Lee Ingon , Kim Dongseok , Cho Hakmoo , Kim Doo-Hwan , Jeong Sung-Moon 
Published: September 2022

IntroductionReal-time ultrasound-guided thoracic epidural catheter placement (US-TECP) has been recently introduced. Patient’s position is associated with the success of spine interventions; however, the effects of position on the outcome of the procedure remain unknown. We aimed to assess the clinical usefulness of patient positioning during real-time US-TECP.MethodsPatients were randomly assigned to the prone position group (group P) and sitting position group (group S). The primary outcome was needling time during the procedure. The secondary outcomes were time to mark space, total number of needle passes, number of skin punctures, first-pass success, final success, crossover success, and visibility of ultrasound (US) views. Global Rating Scale (GRS) score, Patient Comfort Scale score, procedural pain intensity, patient satisfaction, and procedure-related complications were also determined.ResultsSixty-four patients were included in this study. The needling time was significantly shorter in group P than in group S (36.5 (26.5–51.0) vs 59.5 (34.5–152.0) s, p<0.01). The numbers of needle passes and skin punctures were significantly lesser in group P than in group S. First-pass success was higher in group P than in group S. Group P had higher GRS compared with group S. The time to mark space, final success, US visibility score, Patient Comfort Scale score, procedural pain intensity, and patient satisfaction did not differ between the groups. One patient in group S developed a vasovagal reaction.DiscussionThis study shows that prone position may be preferred for real-time US-TECP, considering its better clinical usefulness.Trial registration numberKCT0005757.