bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimisation of photovoltaic and battery systems from the prosumer-oriented total cost of ownership perspective
Authors: Kappner Kai , Letmathe Peter , Weidinger Philipp 
Published: December 2019

Abstract
Background
In the context of the German energy transition, the number of domestic households covering part of their electricity consumption from their own photovoltaic system is constantly increasing. Some even use battery storage systems to store excess power for later use, which increases the degree of self-sufficiency and, according to the providers of such systems, should yield financial advantages for the so-called prosumer.

Methods
We used the Prosumer-Oriented Total Cost of Ownership method to analyse the financial possibilities for prosumers under German market conditions, and thus determined the economically optimal solution for different domestic household sizes. In order to obtain realistic results, we applied real data covering the weather (relevant for the generation of electricity), consumption patterns, investment and operating costs, prices and revenues. If behavioural aspects are set aside and pre-requirements (e.g. sufficient roof space) are met, our model provides guidance for investors and policy-makers alike.

Results and conclusions
Our research shows that it is financially advantageous for all household sizes to operate the largest photovoltaic system possible for them (up to 10 kWp). By contrast, our results show that the investment in a battery storage system does not pay off even when government subsidies are taken into account. Regardless of the size of the selected battery storage system and all other influencing variables, the financial advantages of such a system do not materialise, although a battery storage system does substantially increase the self-sufficiency rate.
Active involvement of patients and relatives improves subjective adherence to hygienic measures, especially selfreported hand hygiene: Results of the AHOI pilot study.
Authors: Görig Tillmann , Dittmann Kathleen , Kramer Axel , Heidecke Claus-Dieter , Diedrich Stephan , Hübner Nils-Olaf 
Published: December 2019

AbstractBackgroundThe prevention of nosocomial infections requires participation from the patients themselves. In the past, however, patients have been apprehensive to point out hygiene-relevant behaviour to the personnel.In the project AHOI, the possibilities of active patient involvement in infection prevention are identified, tested and realized. The goal is a prevention strategy based upon three dimensions: “adherence”, “empowerment” and “acceptance”. “AHOI” stands for the “Activation of patients, persons in need of care and care givers for aHygiene-conscious participatiOn inInfection control”. Results from the AHOI pilot study on the implementation of a multimodal intervention bundle are reported.MethodsIn 2017, a two-stage patient survey was conducted on two surgical wards for 14 weeks. In addition to the intervention bundle, acceptance, adherence and empowerment regarding individual hygiene behaviour and perception were evaluated. The bundle included an AHOI-welcome-box with an informational and entertaining brochure and supportive incentives. Furthermore, multiple visual materials like video presentations for patients’ bedside TV, posters and visual reminders in the patients’ bedrooms and sanitary facilities were installed.Results179 respondents were surveyed at admission, 139 at discharge and 133 at both time points. Almost all respondents wanted to contribute to infection control. The AHOI project was well accepted by patients. Two-thirds wanted to be more involved. More than a third expected a negative response from staff after pointing out hygiene deficiencies. Four respondents observed a deficiency in hygiene with healthcare personnel and reported a very positive reaction once this was communicated to the personnel. More than four-fifths of the respondents felt well integrated and adequately informed post intervention. The feeling of active involvement correlated significantly with subjective participation and adherence to hygienic measures, especially self-reported hand disinfection.ConclusionThe results demonstrated that the required inclusion of patients in infection control is possible with AHOI. Active involvement of patients and relatives is associated with improvements in adherence to infection prevention measures.
An effective snakebite first aid training method for medics in the Chinese troops: a RCT
Authors: Qiu Chen , Qiu Xiao-Feng , Liu Jing-Jing , Wang Yi-Xin , Gui Li 
Published: December 2019

Abstract
Background
Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide. However, few Chinese military medics know the proper first aid procedures for snakebites. Therefore, this study aimed to explore the impact of the Standard Operation Procedure (SOP) and checklist on Chinese military medics’ ability to manage snakebite first aid.

Methods
This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017. A questionnaire-based survey was performed to collect the participants’ socio-demographic profiles before the baseline measurement. During the baseline measurement, participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the SPs (standardized patients) and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table. After the baseline measurement, they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores: group A received a self-learning course with textbooks (n = 27), group B received a self-learning training on the SOP and checklist (n = 27) and group C was engaged in an interactive discussion panel regarding the SOP and checklist (n = 26). After the interventions, participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error. The reviewers were blinded about the grouping in the trial.

Results
The baseline measurement yielded no significant difference (H = 1.647, P = 0.439) among the three groups. The post-intervention scores were higher than the pre-intervention scores for all three (A, B and C) groups (P = 0.008, P < 0.001 and P < 0.001, respectively). There was significant difference of the post-intervention scores among the three groups (F = 8.841, P < 0.001). Both post-intervention scores of group B and group C were higher than that of group A (P < 0.001 and P = 0.001, respectively), but no difference was found between group B and C (P = 0.695). The acceptance questionnaire score of SOP and checklist was mostly very satisfied, as the final scores of group B and group C were 4.62 ± 0.61 and 4.82 ± 0.45, respectively.

Conclusions
In this study, the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics. These intervention methods played an important role in improving the medics’ cognition and understanding of snakebite first aid. Therefore, this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.
Comparison of montage with conventional stereoscopic seven-field photographs for assessment of ETDRS diabetic retinopathy severity
Authors: Nguyen Nam V. , Vigil Erin M. , Hassan Muhammad , Halim Muhammad S. , Baluyot Sean C. , Guzman Hugo A. , Afridi Rubbia , Do Diana V. , Sepah Yasir J. 
Published: December 2019

Abstract
Background
The ETDRS stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials. To the best of our knowledge, the comparison between montage and stereoscopic 7F has not been reported in the literature. Therefore, the main purpose of this study is to compare agreement between montage and stereoscopic seven-field (7F) photographs in the assessment of DR severity.

Methods
Stereoscopic 7F photographs were captured from subjects with DR. Montages of monoscopic 7F images were created using Adobe Photoshop CS6 Extended©. The best quality image of each stereo pair was selected and placed on a 150 × 125-inch canvas field according to the standard location from field 1 to 7. All the fields were aligned following the vessels and overlaid using the built-in blending tool. The resulting montage was utilized for grading and compared with grading on stereoscopic 7F photographs. Three independent graders were asked to assess DR severity on stereoscopic 7F photographs and montage. Severity level agreement between stereo 7F and montage was cross-tabulated and the agreement of DR severity levels between stereoscopic 7-field images and montage was analyzed using κ intergrader agreement; statistical significance was set at p < 0.05.

Results
A total of 50 eyes were included in the study. There was a substantial agreement between stereoscopic 7F and montage (κ = 0.745, κweighted = 0.867) in assessment of DR severity. Of 50 eyes, 80% of the cases showed complete agreement, and 100% of the cases had agreement within one-step. There was a moderate agreement among graders, and κ-value ranged from 0.4705 to 0.5803.

Conclusion
In this study, we found a substantial agreement in assessing DR severity score employing non-stereoscopic montage and stereoscopic 7F photographs.
Treatment of an external iliac artery chronic total occlusion using alternate access sites
Authors: Ratcliffe Justin , Gorenchtein Mike , Khullar Pankaj , Casso Dominguez Abel , Satish Mohan , Green Philip , Puma Joseph 
Published: December 2019

Abstract
Background
With the advent of endovascular techniques, alternate sites such as the pedal and radial arteries can now be accessed when treating peripheral arterial disease to reduce procedural complications, shorten recovery time, and improve patient comfort. However, a paucity of literature exists on the availability of support devices that can be utilized during challenging cases.

Case presentation
A 70 year-old female patient presented for evaluation of severe lifestyle-limiting left-sided claudication refractory to maximal medical therapy. Angiography revealed a chronic total occlusion of the left external iliac artery, which was treated successfully by percutaneous intervention via a primary transpedal approach and with the assistance of the Outback® Elite re-entry device. The patient was discharged 2 h after the procedure and reported significant symptom improvement at follow-up.

Conclusion
This case highlights a newly adopted endovascular approach through an alternate access site and illustrates how the Outback® Elite device can be used as an adjunctive tool in the treatment of complex lower-extremity vascular lesions.
Phytoremediation of some heavy metals in contaminated soil
Authors: Shehata Sherine M. , Badawy Reham K. , Aboulsoud Yasmin I. E. 
Published: December 2019

Abstract
Background
Several cultivated areas are irrigated with low-quality waters from the drainage system due to the shortage of suitable source of water for agricultural activities. Most of these drainage waters are contaminated with heavy metals which are concentrated in surface layer of the soil and translocated to plant and food chains. The region of Sahl El Husseiniya, Alsharqia government, is mainly irrigated with wastewater of Bahr El-Baqar drain.

Objective
Two types of hyperaccumulator plants represented by kenaf (Hibiscus cannabinus L.) and flax (Linum usitatissimum L.) were cultivated successively in the study area. Humic acid and gibberellin were used in this experiment as foliar sprayings to enhance the plant ability to absorb heavy metal ions from the soil. In addition, three soil additives represented by sulfur, vermiculite, and compost were also applied.

Results
Sulfur was the soil additive of the most pronounced effect on the uptake of Cr, Co, Cd, and Mn by the hyperaccumulator plants, while humic acid was of more favorable effect as a foliar treatment on Co and Cr uptake by flax and Cd and Mn uptake by kenaf. However, the foliar application of gibberellin enhanced plant growth and was of the best effect on both Co and Cr uptake by kenaf-cultivated soils and both Cd and Mn in flax-cultivated soils. In general, heavy metals were more concentrated in roots than in shoots. Comparing the efficiency of the two crops in cleaning soils, results implied that kenaf was of more favorable effect on the removal of Cr, Co, and Cd, while flax was of higher superiority in the removal of Mn. The efficiency of kenaf on removal of the studied metal ions followed the descending order of Cr > Co > Mn > Cd where their removal percentage values reached 50.71, 38.27, 33.98, and 14.43%, respectively. Flax phytoremediation efficiency followed the descending order of Mn > Cr > Co > Cd, where their removal percentage values reached 54.36, 36.95, 28.72, and 11.37%, respectively. Double season phytoremediation efficiency followed the order of Cr ≥ Mn > Co > Cd achieving 66.87, 65.63, 54.66, and 23.40%, respectively.
Signatures of immune reprogramming in anti-CD52 therapy of MS: markers for risk stratification and treatment response
Authors: Bierhansl Laura , Ruck Tobias , Pfeuffer Steffen , Gross Catharina C. , Wiendl Heinz , Meuth Sven G. 
Published: December 2019

Abstract
Background
Multiple sclerosis is one of the most prevalent neurological diseases in young adults affecting over 2 million people worldwide. Alemtuzumab is a highly effective therapy in relapsing remitting MS. Alemtuzumab is a monoclonal CD52 antibody that proved its efficacy against an active comparator (interferon [IFN]-β1a) in a phase II trial and two phase III trials regarding clinical and MRI outcomes. Nevertheless, the exact mode of action is still unknown. Alemtuzumab is commonly associated with secondary autoimmune disorders significantly affecting the risk-benefit ratio. Therefore, new biomarkers predicting treatment response and adverse events are urgently needed. This study aims to further elucidate the mechanism of action of the neuroprotective potential of alemtuzumab in relapsing-remitting multiple sclerosis (RRMS).

Methods/Design
This is a 3-year multicentre, explorative study including overall 150 patients comprising three different groups: (i) de novo patients prior and after alemtuzumab treatment initiation, (ii) patients under alemtuzumab treatment and (iii) patients requiring more than two alemtuzumab infusions. Peripheral blood and serum samples will be collected semi-annually for several in vitro/ex vivo assays to detect and characterize immune cells including their functional activity. Furthermore, data of MRI scans and disease-related impairment (using EDSS and MSFC), as well as the number and time of relapses, will be assessed. The clinical study is registered at clinicaltrials.gov (NCT04082260).

Perspective
Our study will provide deep insights into the underlying immunological changes in a longitudinal analysis of alemtuzumab treated RRMS patients. By combining clinical, radiological and functional immune-phenotype data, we will be able to identify biomarkers and/or immune signatures predicting treatment response and adverse events. Thereby, the understanding of the mechanisms of action of alemtuzumab will improve its efficacy and safety for present and future patients.
Continuous positive airway pressure in patients with rapid eye movement (REM)-specific obstructive sleep apnea, a retrospective match-controlled chart review
Authors: Soca Rodolfo , Buchner Erica , Attarian Hrayr 
Published: December 2019

Background: Rapid eye movement (REM) obstructive sleep apnea (OSA) represents 13 to 35% of all OSA cases and is more common in women. Continuous positive airway pressure (CPAP) is the gold standard for treatment of all forms of OSA but we do not know if patients with REM OSA have different pressure requirements than those with non-stage dependent OSA. Methods: This was a retrospective case control study. We first identified individuals with REM OSA and then tried to identify apnea hypopnea index (AHI), gender, and body mass index (BMI) matching controls that had non-stage specific OSA. Individuals were considered to have REM OSA if the REM AHI was greater than 5 events/hour, and the ratio of REM AHI / non-rapid eye movement (NREM) AHI was greater than 2. Demographic variables and the recommended CPAP pressure were analyzed using paired Student’s T-Tests. Results: Our study included a total of 16 individuals with REM OSA and equal number of AHI, gender, and BMI matching controls. Both groups had similar demographic and polysomnographic characteristics. Individuals with REM OSA required similar CPAP pressures as controls (7.5 cm H 2O vs 7.4 cm H 2O p=0.78). Conclusion: Individuals with REM might require similar CPAP pressures as their AHI, gender, and BMI matching controls.
Generation Scotland participant survey on data collection
Authors: Edwards Rachel , Campbell Archie , Porteous David 
Published: December 2019

Background: Generation Scotland (GS) is a population and family-based study of genetic and environmental health determinants. Recruitment to the Scottish Family Health Study component of GS took place between 2006-2011. Participants were aged 18 or over and consented to genetic studies, linkage to health records and recontact. Several recontact exercises have been successfully conducted aimed at a) recruitment to embedded or partner studies and b) the collection of additional data. As the cohort matures in age, we were interested in surveying attitudes to potential new approaches to data collection and recruitment. Methods: A ten-question online survey was sent to those participants who provided an email address. Results: We report a high level of positive responses to encouraging relatives to participate, to remote data and sample collection and for research access to stored newborn dried blood spots. Conclusions: The majority of current and prospective GS participants are likely to respond positively to future requests for remote data and sample collection.
Consensus-based statements for the management of mitochondrial stroke-like episodes
Authors: Ng Yi Shiau , Bindoff Laurence A. , Gorman Gráinne S. , Horvath Rita , Klopstock Thomas , Mancuso Michelangelo , Martikainen Mika H. , Mcfarland Robert , Nesbitt Victoria , Pitceathly Robert D. S. , Schaefer Andrew M. , Turnbull Doug M. 
Published: December 2019

Background: Focal-onset seizures and encephalopathy are prominent features of a stroke-like episode, which is a severe neurological manifestation associated with subtypes of mitochondrial disease. Despite more than 30 years of research, the acute treatment of stroke-like episodes remains controversial. Methods: We used the modified Delphi process to harness the clinical expertise of a group of mitochondrial disease specialists from five European countries to produce consensus guidance for the acute management of stroke-like episodes and commonly associated complications. Results: Consensus on a new definition of mitochondrial stroke-like episodes was achieved and enabled the group to develop diagnostic criteria based on clinical features, neuroimaging and/or electroencephalogram findings. Guidelines for the management of strokelike episodes were agreed with aggressive seizure management strongly recommended at the outset of stroke-like episodes. Conclusions: Our consensus statement defines stroke-like episodes in terms of an epileptic encephalopathy and we have used this to revise both diagnostic criteria and guidelines for management. A prospective, multi-centre, randomised controlled trial is required for evaluating the efficacy of any compound on modifying the trajectory of stroke-like episodes.
Student paramedics' views on placements in general practice as part of a degree
Authors: Proctor Alyesha 
Published: December 2019

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.
Application of pelvic binders by student paramedics: an observational cohort study
Authors: Magner Andre , Smith Neil , Douglin Troy 
Published: December 2019

Background: Pelvic fractures occur in approximately 20% of all multi-system traumas and can lead to loss of life through exsanguination. Advanced Trauma Life Support (ATLS) guidelines advocate application of a pelvic binder, which is most effective when placed at the level of the greater trochanters; however, multiple studies demonstrate a high degree of misplacement. Aims: The aim of the current study was to assess the ability of UK student paramedics to locate the greater trochanters and optimally apply pelvic binders. Methods: A total of 52 student paramedics from UK universities were asked to apply a pelvic binder to a healthy volunteer using a recognised technique. The primary outcome was the location of the pelvic binder compared with an optimally applied device. Findings: n=52 with 17/49 pelvic binders incorrectly located (34%); 18% were too low and 16% were too high. Conclusion: The results demonstrate a high degree of misplacement; this represents both a challenge and an opportunity for UK higher education institutions to review the manner in which pelvic binder application is taught to the next generation of prehospital practitioners.