bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduction of cardiac iron overload by optimising iron chelation therapy in transfusion dependent thalassaemia using cardiac T2* MRI: a quality improvement project from Pakistan
Authors: Hussain Shabneez , Hoodbhoy Zahra , Ali Fatima , Hasan Erum , Alvi Najveen , Hussain Aijaz , Ishrat Khajista , Ur Rahman Zia , Qamruddin Azizuddin , Parvin Azra , Hasan Babar S 
Published: September 2020

ObjectivesCardiac T2* MRI (T2*CMR), for accurate estimation of myocardial siderosis, was introduced as part of a QI collaborative to optimise chelation therapy in order to improve cardiac morbidity in transfusion dependent thalassaemia (TDT) patients. We report the impact of this QI initiative from two thalassaemia centres from this collaborative.Design and settingA key driver based quality initiative was implemented to improve chelation in TDT patients registered at these two centres in Karachi, Pakistan. Protocol optimisation and compliance to treatment through training, communication and feedback were used as the drivers for QI intervention. Preintervention variables (demographics, chelation history, T2*CMR, echocardiography and holters) were collected from January 2015 to December 2016) and compared with variables in the post implementation phase (January to December 2019). A standardised adverse event severity for chelators and its management was devised for safe drug therapy as well as ensuring compliance to the regimen. Preintervention and postintervention variables were compared using non-parametric test. P value<0.05 was statistically significant.Results100 patients with TDT, median age 17 (9–34) years, were included. An increase or stabilisation of T2*CMR was documented in 82% patients in the postintervention phase especially in patients with severe myocardial iron overload (5.5 vs 5.3 ms, p <0.01). Significantly fewer patients had abnormal echocardiographic findings (3.5% vs 26%, p <0.05) in the postintervention versus preintervention period.ConclusionThis QI initiative improved the chelation therapy leading to improved cardiac status in TDT patients at the participating centres.
Inhaled therapies for chronic obstructive pulmonary disease: a systematic review and meta-analysis
Authors: Axson Eleanor L , Lewis Adam , Potts James , Pang Marie , Dickinson Scott , Vioix Helene , Quint Jennifer K 
Published: September 2020

ObjectivesTo integrate evidence from randomised controlled trials (RCTs) and observational studies on the efficacy of inhaled treatments for chronic obstructive pulmonary disease using network meta-analyses.MethodsSystematic searches MEDLINE and Embase based on predetermined criteria. Network meta-analyses of RCTs investigated efficacy on exacerbations (long-term: ≥20 weeks of treatment; short-term: <20 weeks), lung function (≥12 weeks), health-related quality of life, mortality and adverse events. Qualitative comparisons of efficacies between RCTs and observational studies.Results212 RCTs and 19 observational studies were included. Compared with combined long-acting beta-adrenoceptor agonists and long-acting muscarinic antagonists (LABA+LAMA), triple therapy (LABA+LAMA+inhaled corticosteroid) was significantly more effective at reducing exacerbations (long-term 0.85 (95% CI: 0.78 to 0.94; short-term 0.67 (95% CI: 0.49 to 0.92)) and mortality (0.72 (95% CI: 0.59 to 0.89)) but was also associated with increased pneumonia (1.35 (95% CI: 1.10 to 1.67)). No differences in lung function (0.02 (95% CI: −0.10 to 0.14)), health-related quality of life (−1.12 (95% CI: −3.83 to 1.59)) or other adverse events (1.02 (95% CI: 0.96 to 1.08)) were found. Most of the observational evidence trended in the same direction as pooled RCT data.ConclusionFurther evidence, especially pragmatic trials, are needed to fully understand the characteristics of patient subgroups who may benefit from triple therapy and for those whom the extra risk of adverse events, such as pneumonia, may outweigh any benefits.PROSPERO registration numberCRD42018088013.
Thymosin alpha 1 in the prevention of infected pancreatic necrosis following acute necrotising pancreatitis (TRACE trial): protocol of a multicentre, randomised, double-blind, placebo-controlled, parallel-group trial
Authors: Zhou Jing , Mao Wenjian , Ke Lu , Chen Tao , He Wenhua , Pan Xinting , Chen Miao , He Chengjian , Gu Weili , Wu Jingyi , Song Jingchun , Ni Haibin , Tu Jianfeng , Sun Junli , Zhang Guoxiu , Chen Weiwei , Xue Bing , Zhao Xiangyang , Shao Min , Liu Yuxiu , Tong Zhihui , Li Weiqin 
Published: September 2020

IntroductionInfected pancreatic necrosis (IPN) and its related septic complications are the major causes of death in patients with acute necrotising pancreatitis (ANP). Therefore, the prevention of IPN is of great clinical value, and immunomodulatory therapy with thymosin alpha 1 may be beneficial. This study was designed to test the hypothesis that the administration of thymosin alpha 1 during the acute phase of ANP will result in a reduced incidence of IPN.Methods and analysisThis is a randomised, multicentre, double-blind, placebo-controlled study. 520 eligible patients with ANP will be randomised in a 1:1 ratio to receive either the thymosin alpha 1 or the placebo using the same mode of administration. The primary endpoint is the incidence of IPN during the index admission. Most of the secondary endpoints will be registered within the index admission including in-hospital mortality, the incidence of new-onset organ failure and new-onset persistent organ failure (respiration, cardiovascular and renal), receipt of new organ support therapy, requirement for drainage or necrosectomy, bleeding requiring intervention, human leucocyte antigens-DR(HLA-DR) on day 0, day 7, day 14, and so on and adverse events. Considering the possibility of readmission, an additional follow-up will be arranged 90 days after enrolment, and IPN and death at day 90 will also be served as secondary outcomes.Ethics and disseminationThis study was approved by the ethics committee of Jinling Hospital, Nanjing University (Number 2015NZKY-004-02). The thymosin alpha 1 in the prevention of infected pancreatic necrosis following acute necrotising pancreatitis(TRACE) trial was designed to test the effect of a new therapy focusing on the immune system in preventing secondary infection following ANP. The results of this trial will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberClinicalTrials.gov Registry (NCT02473406).
Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK
Authors: Garstang Joanna , Debelle Geoff , Anand Indu , Armstrong Jane , Botcher Emily , Chaplin Helen , Hallett Nutmeg , Morgans Clare , Price Malcolm , Tan Ern Ern Henna , Tudor Emily , Taylor Julie 
Published: September 2020

ObjectivesTo determine any change in referral patterns and outcomes in children (0–18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years.DesignRetrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.SettingBirmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.ParticipantsChildren aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.Main outcome measuresNumbers of referrals, source of disclosure and outcomes from CPME.ResultsThere were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.ConclusionsSchool closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.
Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey
Authors: Miller Connor R , Sutanto Edward , Smith Danielle M , Hitchman Sara C , Gravely Shannon , Yong Hua H , Borland Ron , O'Connor Richard J , Cummings K Michael , Fong Geoffrey T , Hyland Andrew , Quah Anne C K , Goniewicz Maciej L 
Published: September 2020

ObjectiveTo evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales.DesignData came from Wave 2 of the ITC Four Country Smoking and Vaping Survey, collected from February to July 2018. Respondents were current and former smokers and/or users of vaping products (18 years or older) from Canada (CA; n=3778), England (EN; n=4848), the USA (US; n=2846) and Australia (AU; n=1515). At the time of the survey, only Canada and England permitted the sale of contemporary HTPs (eg, IQOS).ResultsOverall, 30.2% of respondents reported being aware of HTPs (CA=30.4%; EN=31.0%; US=30.2%; AU=27.4%; p=0.346), 2.4% had ever tried HTPs (CA=3.3%; EN=2.4%; US=2.0%; AU=0.9%; p=0.001) and 0.9% currently used HTPs at least monthly (CA=0.8%; EN=1.2%; US=0.7%; AU=0.2%; p<0.001). Trial and current use were higher among those who concurrently smoked and vaped (at least monthly) versus other nicotine use categories (trial: 10.9% v. 1.2%–2.0%, p<0.001; current use: 8.4% v. 0.1%–1.0%, p<0.001). In multivariable analyses, HTP awareness did not differ across countries, whereas odds of trial and current use were lower where HTPs were unavailable. Odds of HTP trial did not differ by regulatory environment when restricting analysis to HTP-aware concurrent smokers–vapers.ConclusionApproximately one third of respondents were aware of HTPs, even in the USA and Australia, where contemporary HTPs were not yet on the market. Trial and use were uncommon, except among concurrent smokers–vapers. Restrictions on availability may have limited HTP use generally, but less so for concurrent smokers–vapers.
An alternative response to the off-shell quantum fluctuations: a step forward in resolution of the Casimir puzzle
Authors: Klimchitskaya G. L. , Mostepanenko V. M. 
Published: September 2020

AbstractThe spatially nonlocal response functions are proposed which nearly coincide with the commonly used local response for electromagnetic fields and fluctuations on the mass shell, but differ significantly for the off-shell fluctuating field. It is shown that the fundamental Lifshitz theory using the suggested response functions comes to an agreement with the measurement data for the Casimir force without neglecting the dissipation of free electrons. We demonstrate that reflectances of the on-shell electromagnetic waves calculated using the nonlocal and commonly employed local responses differ only slightly. The Kramers–Kronig relations for nonlocal response functions possessing the first- and second-order poles at zero frequency are derived, i.e., the proposed response satisfies the principle of causality. An application of these results to resolution of the Casimir puzzle, which lies in the fact that the Lifshitz theory is experimentally consistent only with discarded dissipation, is discussed.
Novel Neuromodulation Approach to Improve Left Ventricular Contractility in Heart Failure
Authors: Y. Reddy Vivek , Petrů Jan , Málek Filip , Stylos Lee , Goedeke Steve , Neužil Petr 
Published: September 2020

Background:
Morbidity and mortality outcomes for patients admitted for acute decompensated heart failure are poor and have not significantly changed in decades. Current therapies are focused on symptom relief by addressing signs and symptoms of congestion. The objective of this study was to test a novel neuromodulation therapy of stimulation of epicardial cardiac nerves passing along the posterior surface of the right pulmonary artery.

Methods:

Fifteen subjects admitted for defibrillator implantation and ejection fraction ≤35% on standard heart failure medications were enrolled. Through femoral arterial access, high fidelity pressure catheters were placed in the left ventricle and aortic root. After electro anatomic rendering of the pulmonary artery and branches, either a circular or basket electrophysiology catheter was placed in the right pulmonary artery to allow electrical intravascular stimulation at 20 Hz, 4 ms pulse width, and ≤20 mA. Changes in maximum positive dP/dt (dP/dt
Max
) indicated changes in ventricular contractility.

Results:

Of 15 enrolled subjects, 5 were not studied due to equipment failure or abnormal pulmonary arterial anatomy. In the remaining subjects, dP/dt
Max
increased significantly by 22.6%. There was also a significant increase in maximum negative dP/dt (dP/dt
Min
), mean arterial pressure, systolic pressure, diastolic pressure, and left ventricular systolic pressure. There was no significant change in heart rate or left ventricular diastolic pressure.

Conclusions:
In this first-in-human study, we demonstrated that in humans with stable heart failure, left ventricular contractility could be accentuated without an increase in heart rate or left ventricular filling pressures. This benign increase in contractility may benefit patients admitted for acute decompensated heart failure.
Between Times and Spaces
Authors: Heidel Andreas-Christian 
Published: September 2020

Abstract
The understanding of space and time and their relationship in the Epistle to the Hebrews is an essential key to the interpretation of this NT Scripture. In contrast to the too often one-sided interpretations of Hebrews throughout its history of research, Hebrews’ understanding of reality is characterized by an interplay of horizontal and vertical dimensions wherein, through God’s act of speaking in the Son, times and spaces overlap and form a paradoxical reality for the believers who seek their heavenly home.
Paul and Philo on the Psalms
Authors: Niehoff Maren R. 
Published: September 2020

Abstract
Philo of Alexandria shares Paul’s Jewish Diaspora background and his use of the LXX. He also addressed Roman audiences just a decade or two before Paul wrote his Letter to the Romans. He thus enables us to analyze Paul’s approach to Psalms from a rigorous historical perspective, which highlights both their phenomenological similarities and Paul’s innovations on the path to develop a spiritual notion of Scripture.
1 Cor 15:33
Authors: Cook John Granger 
Published: September 2020

Abstract
NA28 and UBS5 identify the source of Paul’s statement in 1 Cor 15:33 as Menander, Thais, although NA28 puts a question mark after “Thais.” One can, however, demonstrate that the proverb originally came from Euripides. Consequently, future critical editions of the New Testament should include Euripides in the margin along with Menander and should probably make reference also to the mass of proverbs that were shared orally or in writing in the culture of antiquity. One can read 1 Cor 15:33 as a text of Euripides, Menander, or as an expression of the common wisdom of antiquity.
Northern yellow-cheeked crested gibbons (Nomascus annamensis) travel and scan more at the cost of rest when in the presence of tourists
Authors: Williams Jessica L. , Behie Alison M. 
Published: September 2020

Abstract
The tourism sector is a fast-growing contributor to the global economy, and nature-based tourism (NBT), particularly in Asia and Africa, is booming. Through the creation of jobs and revenue NBT has the potential to combat deforestation in regions that are economically poor, but of high biodiversity value. Inspired by the success of gorilla tourism in Uganda and Rwanda, several gibbon tourism projects have been initiated in Southeast Asia and China. Despite the existence of these programmes, no research has been done to investigate the impact of tourism on the behaviour of gibbons. To address this, we collected observational data on a group of northern yellow-cheeked crested gibbons (Nomascus annamensis) at Veun Sai-Siem Pang National Park (VSSPNP), Cambodia, in the presence and absence of tourists. We found there was a significant increase in the amount of time individuals spent scanning their environment and travelling at the cost of rest when in the presence of tourists. We also found that individuals were significantly more likely to self-groom in the presence of tourists. These results highlight the importance of scientific research in implementing successful, low-impact NBT programmes that consider animal behavioural changes. We are continuing to collect data on gibbons at VSSPNP and at Mt. Gaoligong National Nature Reserve, China with the aim of extending the IUCN’s best-practice guidelines for great-ape tourism to include the small apes.
Plato’s Political Writings: a Utopia?
Authors: Brisson Luc 
Published: September 2020

Abstract
Thomas More’s 1516 Utopia describes a ‘fictitious’ republic on an imaginary island, and draws heavily on ancient political ideas. This paper explores the difficulties of applying the term ‘utopia’ to Plato’s political thinking, given that More’s term is anachronistically applied to ancient texts. The projects of the Republic and Laws should not be interpreted as ‘utopian’, but as blueprints for a foundation such as a new city, rather than as imagined ideal cities after More’s model. Support for Plato’s practical involvement in matters of political foundation is drawn from the Seventh Letter. The Republic and the Laws are discussed not as utopias, but political manifestos. The political context in which Plato lived, and his objectives, gives his political writings a wholly different dimension. The goal of the Republic and the Laws is not to describe unrealizable constitutions, but to exchange the Athenian constitution of Plato’s time for another.
Two Corrections for Turbulent Kinetic Energy Generated by Wind Farms in the WRF Model
Authors: Archer Cristina L. , Wu Sicheng , Ma Yulong , Jiménez Pedro A. 
Published: September 2020

AbstractAs wind farms grow in number and size worldwide, it is important that their potential impacts on the environment are studied and understood. The Fitch parameterization implemented in the Weather Research and Forecasting (WRF) Model since version 3.3 is a widely used tool today to study such impacts. We identified two important issues related to the way the added turbulent kinetic energy (TKE) generated by a wind farm is treated in the WRF Model with the Fitch parameterization. The first issue is a simple “bug” in the WRF code, and the second issue is the excessive value of a coefficient, called CTKE, that relates TKE to the turbine electromechanical losses. These two issues directly affect the way that a wind farm wake evolves, and they impact properties like near-surface temperature and wind speed at the wind farm as well as behind it in the wake. We provide a bug fix and a revised value of CTKE that is one-quarter of the original value. This 0.25 correction factor is empirical; future studies should examine its dependence on parameters such as atmospheric stability, grid resolution, and wind farm layout. We present the results obtained with the Fitch parameterization in the WRF Model for a single turbine with and without the bug fix and the corrected CTKE and compare them with high-fidelity large-eddy simulations. These two issues have not been discovered before because they interact with one another in such a way that their combined effect is a somewhat realistic vertical TKE profile at the wind farm and a realistic wind speed deficit in the wake. All WRF simulations that used the Fitch wind farm parameterization are affected, and their conclusions may need to be revisited.
Postural Control When Using an Industrial Lower Limb Exoskeleton: Impact of Reaching for a Working Tool and External Perturbation
Authors: Steinhilber Benjamin , Seibt Robert , Rieger Monika A. , Luger Tessy 
Published: September 2020

Objective To investigate postural control related to a lower limb exoskeleton (Chairless Chair) when (a) reaching for a working tool, and (b) an external perturbation occurs. Background Lower limb exoskeletons aiming to reduce physical load associated with prolonged standing may impair workers’ postural control and increase the risk of falling. Method Forty-five males were reaching for an object (3-kg dumbbell) at the lateral end of their reaching area without the exoskeleton in upright standing (STAND) and with the exoskeleton at a high (EXOHIGH.SEAT) and low sitting position (EXOLOW.SEAT). The task was performed with the object placed in three different angles (120°, 150°, and 180°) in the transversal plane. The minimum absolute static postural stability (SSABS.MIN) as the shortest distance (mm) of the center of pressure to the base of support border was measured (zero indicates risk of falling). Additionally, eight subjects were standing without the exoskeleton or sitting on it (EXOHIGH.SEAT and EXOLOW.SEAT) while being pulled backward. The tilting moment when subjects lost their balance was assessed. Results SSABS.MIN was lower when using the exoskeleton ( p < .05) but still about 17 mm. The location of the object to be reached had no influence. Tilting moments of less than 30 nm were sufficient to let people fall backward when sitting on the exoskeleton (50 nm for STAND). Conclusion Impairments in postural control by the exoskeleton may not be relevant when reaching laterally for objects up to 3 kg. When an external perturbation occurs, the risk of falling may be much higher; irrespective of factors like uneven or slippery flooring. Application The risk of falling using the exoskeleton seems to be low when reaching laterally for an object of up to 3 kg. In situations where, for example, a collision with coworkers is likely, this exoskeleton is not recommended.
A potential role for two brainstem nuclei in craniovascular nociception and the triggering of migraine headache
Authors: Zagami Alessandro S , Shaikh Sumaiya , Mahns David , Lambert Geoffrey A 
Published: September 2020

Aim To use an animal model of migraine to test whether migraine headache might arise from a brainstem-trigeminal nucleus pathway. Methods We measured evoked and spontaneous activity of second-order trigeminovascular neurons in rats to test whether the activity of these neurons increased following the induction of cortical spreading depression or the imposition of light flash – two potential migraine triggers, or headache provokers. We then tested whether drugs that could activate, or inactivate, neurons of the nucleus raphe magnus or the periaqueductal gray matter, would affect any such increases selectively for the dura mater. Results Injection of sodium glutamate (a neuronal excitant) into these two nuclei selectively inhibited the responses of trigeminovascular second-order neurons to dura mater, but not to facial skin, stimulation. Injection of lignocaine (a local anaesthetic) into these nuclei selectively potentiated the responses of these neurons to dura, but not to facial skin, stimulation. Furthermore, injections into either nucleus of glutamate inhibited the increase in the ongoing discharge rate of these neurons produced by cortical spreading depression and light flash. Conclusions These results provide indirect evidence that trigeminovascular nociception may be tightly controlled by these two nuclei, whereas cutaneous trigeminal sensation may be less so. These nuclei may be relays of one possible brainstem-trigeminal pathway that could mediate migraine headache. Modification of neuronal activity in these two nuclei produced by migraine (headache) triggers may lie behind the pain of a migraine attack, at least in some cases.