bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study on Gas-Liquid Two-Phase Flow Distribution Inside a Flute Header
Authors: Pang Liping , Li Shangmin , Yuan Hu , Duan Liqiang 
Published: October 2020

Abstract
When the supercritical boiler is working at low load during flexible operation, the uneven distribution of the gas-liquid flow at the intermediate header may affect the safety of the water-cooled wall at the vertical parallel panels. In order to improve the uniformity of gas-liquid flow distribution in the water-cooled wall of intermediate header and study the internal flow mechanism, a flute inside the header is applied with parallel vertical parallel channels and experiments under different operating conditions are conducted to verify the effectiveness of this geometrical structure. The flow pattern in the experiment belongs to stratified and wavy flow. Computational fluid dynamic (CFD) simulation is conducted in order to investigate two-phase flow distribution behavior inside a flute header. It was found that the radial gas phase distribution in the flute tube shows a symmetrical relationship, and there are two vortexes in opposite directions. With the increasing distance from the inlet, the uniformity of the gas phase distribution becomes even. The gravity is greater than the drag force, which has effect on the two-phase flow distribution. The gas phase velocity has been improved inside flute section and liquid phase flow has more even flow distribution along annular section. It makes liquid phase sent to far end of flute header. That benefits two-phase flow distribution along 10 parallel channels equally.
Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial
Authors: Hamilton David F , Beard David J , Barker Karen L , Macfarlane Gary J , Tuck Christopher E , Stoddart Andrew , Wilton Timothy , Hutchinson James D , Murray Gordon D , Simpson A Hamish R W 
Published: October 2020

Abstract

Objective
To evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty.

Design
Parallel group randomised controlled trial.

Setting
13 secondary and tertiary care centres in the UK providing postoperative physiotherapy.

Participants
334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol.

Interventions
All participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist).

Main outcome measures
Primary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery.

Results
334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval −0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, −0.78 to 0.28, P=0.36) or worst pain (0.22 points, −0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval −14.25 to 4.96, P=0.34).

Conclusions
Outpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures.

Trials registration

Current Controlled Trials
ISRCTN23357609
and ClinicalTrials.gov
NCT01849445
.
Prescribing trends over time by non-medical independent prescribers in primary care settings across Wales (2011–2018): a secondary database analysis
Authors: Alghamdi Saeed Saad A , Hodson Karen , Deslandes Paul , Gillespie David , Haines Kath , Hulme Elliott , Courtenay Molly , Deslandes Rhian 
Published: October 2020

IntroductionAs of 2015, as part of the implementation of the Welsh Government primary care plan and primary care clusters, the Welsh Government has encouraged non-medical healthcare professionals working in primary care to train as independent prescribers (IPs).ObjectivesThis research aimed to identify the number of NMIPs in primary care in Wales and describe their prescribing trend of items between 2011 and 2018, in order to compare their prescribing pattern before and after the implementation of primary care clusters for Wales.DesignRetrospective secondary data analysis and interrupted time series analysis in order to compare prescribing by non-medical independent prescribers (NMIPs) preimplementation and postimplementation of primary care clusters across Wales.ResultsOver the study period, 600 NMIPs (nurses n=474 and pharmacists n=104) had prescribed at least one item. The number of nurse IPs increased by 108% and pharmacists by 325% (pharmacists had the largest increase between July 2015 and March 2018). The number of items prescribed by NMIPs increased over time by an average of 1380 per month (95% CI 904 to 1855, p<0.001) after the implementation of primary care clusters compared with 496 (95% CI 445 to 548, p<0.001) prior its implementation. Approximately one-third of the items prescribed by NMIPs was within Betsi Cadwaladr University Health Board (HB) with only 4% in Powys Teaching HB.ConclusionThe number of NMIPs and their volume of prescribing in primary care in Wales has increased following the implementation of primary care clusters in 2015. This suggests that the Government’s recommendations of using NMIPs in primary care have been implemented. Future studies should focus on efficiency and quality of prescribing by NMIPs in primary care.
Patient-reported experiences with general practitioners: a randomised study of mail and web-based approaches following a national survey
Authors: Iversen Hilde Hestad , Holmboe Olaf , Bjertnaes Oyvind 
Published: October 2020

ObjectiveThe standard data-collection procedure in the Norwegian national patient experience survey programme is post-discharge mail surveys, which include a pen-and-paper questionnaire with the option to answer electronically. A purely electronic protocol has not previously been explored in Norway. The aim of this study was to compare response rates, background characteristics, data quality and main study results for a survey of patient experiences with general practitioners (GPs) administered by the standard mail data-collection procedure and a web-based approach.DesignCross-sectional survey.SettingGP offices in Norway.ParticipantsThe sample consisted of 6999 patients aged 16 years and older registered with a GP in November 2018.InterventionBased on a three-stage sampling design, 6999 patients of GPs aged 16 or older were randomised to one of two survey administration protocols: Group A, who were mailed an invitation with both a pen-and-paper including an electronic response option (n=4999) and Group B, who received an email invitation with electronic response option (n=2000).Main outcome measuresResponse rates, background characteristics, data quality and main study results.ResultsThe response rate was markedly higher for the mail survey (42.6%) than for the web-based survey (18.3%). A few of the background variables differed significantly between the two groups, but the data quality and patient-reported experiences were similar.ConclusionsWeb-based surveys are faster and less expensive than standard mail surveys, but their low response rates and coverage problems threaten their usefulness and legitimacy. Initiatives to increase response rates for web-based data collection and strategies for tailoring data collection to different groups should be key elements in future research.
Effect of mHealth tool on knowledge regarding reproductive health of school going adolescent girls: a before-after quasi-experimental study
Authors: Ahmed Tanima 
Published: October 2020

ObjectiveThis study was executed to (1) assess the effect of mHealth (mobile health) tool on knowledge regarding reproductive health (RH) of adolescent girls and (2) determine the utilisation of mHealth tool among school girls.DesignBefore-after type of quasi-experimental study.SettingDhaka North City Corporation in Bangladesh.Participants400 adolescent girls aged 14–19 years were selected based on defined criteria.InterventionsShort message service (SMS) intervention on RH was delivered through a mobile phone.Primary and secondary outcome measures8 schools out of 61 were randomly selected in the study area. A total of 400 girls were selected randomly on permission from those schools and parents. SMS interventions were delivered for 8 weeks. The data were collected using a self-administered questionnaire before and after SMS intervention to evaluate the effect. The number of responses to weekly SMS determined mHealth usage or practice.ResultsPostintervention knowledge score (mean 70.8%±9.7%) on RH was significantly higher (paired t=69.721, p<0.001) than preintervention knowledge score (mean 44.71%±9.13%) with a large effect size (cohen’s d=3.6). The knowledge score on RH was (p<0.001) correlated (+0.636) with SMS response. Multiple linear regression indicated that increase response to one SMS intervention there was an increase of knowledge score by 2.661% (linear slope 2.66, at 95% CI, p<0.001) after controlling the confounder. The mean knowledge score in all five knowledge segments of RH increased significantly (p<0.001) after SMS intervention.ConclusionThe result indicated that the SMS tool of the mHealth approach is an easy and effective way to improve RH knowledge for adolescent girls. SMS intervention was well accepted by the girls. Thereby this mHealth tool can be chosen to provide health information for a mass approach.
Perioperative intravenous lignocaine infusion for postoperative pain control in patients undergoing surgery of the spine: protocol for a systematic review and meta-analysis
Authors: Licina Ana , Silvers Andrew 
Published: October 2020

IntroductionIntravenous lignocaine is an amide local anaesthetic known for its analgesic, antihyperalgesic and anti-inflammatory properties. Administration of intravenous lignocaine has been shown to enhance perioperative recovery parameters. This is the protocol for a systematic review which intends to summarise the evidence base for perioperative intravenous lignocaine administration in patients undergoing spinal surgery.Methods and analysisOur primary outcomes include: postoperative pain scores at rest and movement at predefined early, intermediate and late time points and adverse events. Other outcomes of interest include perioperative opioid consumption, composite morbidity, surgical complications and hospital length of stay. We will include randomised controlled trials, which compared intravenous lignocaine infusion vs standard treatment for perioperative analgesia. We will search electronic databases from inception to present; MEDLINE, EMBASE and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two team members will independently screen all citations, full-text articles and abstract data. The individual study risk of bias will be appraised using the Cochrane risk of bias tool. We will obtain a risk ratio or mean difference (MD) from the intervention and control group event rates based on the nature of data. We will correct for the variable measurement tools by using the standardised MD (SMD). We will use a random-effects model to synthesise data. We will conduct five subgroup analysis: major versus minor surgery, emergency versus elective surgery, patients with chronic pain conditions versus patients without, duration of lignocaine infusion and adult versus paediatric. Confidence in cumulative evidence for will be classified according to the Grading of Recommendations, Assessment, Development and Evaluation system. We will construct summary of findings tables supported detailed evidence profile tables for predefined outcomes.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.PROSPERO registration numberCRD420201963314
Factors contributing to the patient safety culture in Saudi Arabia: a systematic review
Authors: Albalawi Abdulmajeed , Kidd Lisa , Cowey Eileen 
Published: October 2020

BackgroundPatient safety, concerned with the prevention of harm to patients, has become a fundamental component of the global healthcare system. The evidence regarding the status of the patient safety culture in Arab countries in general shows that it is at a suboptimal level due to a punitive approach to errors and deficits in the openness of communications.ObjectivesTo identify factors contributing to the patient safety culture in Saudi Arabia.DesignSystematic review.MethodsA systematic search was carried out in May 2018 in five electronic databases and updated in July 2020—MEDLINE, CINAHL, Embase, PsycINFO and the Cochrane Database of Systematic Reviews. Relevant journals and reference lists of included studies were also hand-searched. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of studies and extracted their relevant characteristics. The Yorkshire Contributory Factors Framework (YCFF) was used to categorise factors affecting safety culture in the included papers.Results14 papers were included and the majority of studies were appraised as being of good quality. Strength and weakness factors that contribute to patient safety culture were identified. Ineffective leadership, a blame culture, workload/inadequate staffing and poor communication are reported as the main factors hindering a positive patient safety culture in Saudi Arabia. Conversely, ‘strength’ factors contributing to a positive patient safety culture included supportive organisational attitudes to learning/continuous improvement, good teamwork within units and support from hospital management for patient safety. There is an absence of patient perspectives regarding patient safety culture in Saudi Arabia.ConclusionPolicymakers in the Saudi healthcare system should pay attention to the factors that may contribute to a positive patient safety culture, especially establishing a blame-free culture, improving communications and leadership capacity, learning from errors and involving patient perspectives in safety initiatives. Further research is required to understand in depth the barriers and facilitators to the implementation of a positive patient safety culture in Saudi Arabia.
Rehabilitative management of back pain in children: protocol for a mixed studies systematic review
Authors: Cancelliere Carol , Wong Jessica J , Yu Hainan , Mior Silvano , Brunton Ginny , Shearer Heather M , Rudoler David , Hestbæk Lise , Papaconstantinou Efrosini , Cedraschi Christine , Swain Michael , Connell Gaelan , Verville Leslie , Taylor-Vaisey Anne , Côté Pierre 
Published: October 2020

IntroductionLittle is known about effective, efficient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice.ObjectiveTo inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost–effective and safe rehabilitation interventions for children with back pain to improve their functioning and other health outcomes.Methods and analysisWe will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and EconLit for primary studies published from inception in all languages. We will include quantitative studies (randomised controlled trials, cohort and case–control studies), qualitative studies, mixed-methods studies and full economic evaluations. To augment our search of the bibliographic electronic databases, we will search reference lists of included studies and relevant systematic reviews, the WHO International Clinical Trials Registry Platform and consult with content experts. We will assess the risk of bias using appropriate critical appraisal tools. We will extract data about study and participant characteristics, intervention type and comparators, context and setting, outcomes, themes and methodological quality assessment. We will use a sequential approach at the review level to integrate data from the quantitative, qualitative and economic evidence syntheses.Ethics and disseminationEthics approval is not required. We will disseminate findings through activities, including (1) presentations in national and international conferences; (2) meetings with national and international decision makers; (3) publications in peer-reviewed journals and (4) posts on organisational websites and social media.PROSPERO registration numberCRD42019135009.
Troponin T but not C reactive protein is associated with future surgery for aortic stenosis: a population-based nested case-referent study
Authors: Holmgren Anders , Ljungberg Johan , Hultdin Johan , Johansson Bengt , Bergdahl Ingvar A , Näslund Ulf , Söderberg Stefan 
Published: October 2020

AimsHigh-sensitivity troponin T (hs-TnT) and high-sensitivity C reactive protein (hs-CRP) may convey prognostic information in patients with aortic stenosis (AS). This study evaluated if hs-TnT and hs-CRP associate with myocardial mass, and risk of future surgery for AS.MethodsIn total, 336 patients (48% women) with surgery for AS with previous participation in large population surveys were identified. Preoperatively, myocardial mass and the presence of coronary artery disease (CAD) were assessed. Two matched referents were allocated for each case, and hs-TnT and hs-CRP were determined in stored plasma from the baseline survey. Conditional logistic regression analysis was used to estimate the risk (OR (95% CI)) related to one (natural logarithm) SD increase in hs-TnT and hs-CRP. Kaplan-Mayer and Cox regression analyses were used to evaluate time to surgery.ResultsMedian age (IQR) was 59.8 (10.3) years at survey, and median time between survey and surgery was 10.9 (9.3) years. Hs-TnT was independently associated with surgery for AS (1.24 (1.06–1.44)) irrespective of CAD, whereas Hs-CRP was not (1.05 (0.90–1.22)). Elevated hs-TnT levels at survey associated with shorter time to surgery (p<0.001), and with increased myocardial mass (p=0.002). Hs-CRP did not associate with time to surgery or with myocardial mass.ConclusionsHs-TnT—but not hs-CRP—was associated with increased risk of—and shorter time to—future surgery for AS. Hs-TnT associated with myocardial mass at surgery which indicates that hs-TnT could be a potential biomarker for determining intervention.
Factors associated with treatment satisfaction in patients with rheumatoid arthritis: data from the biological register RABBIT
Authors: Schäfer Martin , Albrecht Katinka , Kekow Jörn , Rockwitz Karin , Liebhaber Anke , Zink Angela , Strangfeld Anja 
Published: October 2020

ObjectiveTo assess satisfaction with the effectiveness and tolerability of treatments in patients with rheumatoid arthritis (RA).MethodsPatients from the RABBIT register, starting a biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drug (DMARD), or a conventional synthetic (cs)DMARD treatment after ≥1 csDMARD failure, were included. Treatment satisfaction was measured after 1 year of treatment in four categories and binarised for analysis. Logistic regression models were performed to calculate ORs for factors associated with treatment satisfaction.ResultsData of 10 646 patients (74% women, mean 58 years) were analysed. At baseline, 55% of the patients were satisfied with the efficacy and 68% with the tolerability of their previously given treatments. After 1 year, 85% of the patients were satisfied with treatment effectiveness and 90% with tolerability. Baseline satisfaction (OR 2.98, 95% CI 2.58 to 3.44), seropositivity (OR 1.36, 95% CI 1.17 to 1.57), reduction of DAS28 (OR 1.38, 95% CI 1.31 to 1.46) and pain (OR 1.26, 95% CI 1.22 to 1.31), and the improvement of physical capacity (OR 1.22, 95% CI 1.17 to 1.29) were positively associated with treatment satisfaction at follow-up while glucocorticoids (GCs) >5 mg/day, depression, fibromyalgia, obesity, prior bDMARDs and therapy changes were negatively associated. The impact of GC on satisfaction was dose-dependent, becoming strongest for GC >15 mg (OR 0.24, 95% CI 0.16 to 0.34). A 5 mg/day reduction within 12 months was positively associated with satisfaction regarding efficacy (OR 1.19, 95% CI 1.11 to 1.27) and tolerability (OR 1.11, 95% CI 1.03 to 1.21).ConclusionMost patients were satisfied with their treatment’s effectiveness and tolerability after 1 year of treatment. Tapering GCs was positively associated with the improvement of patients’ satisfaction.
The relationship between altitudinal gradients, diversity, and body size in a dung beetle (Coleoptera: Scarabaeinae: Onthophagus) model system
Authors: Salomão R.P. , Arriaga-Jiménez A. , Kohlmann B. 
Published: October 2020

Mountainous regions represent an excellent model to test ecological hypotheses encompassing assemblage diversity and body traits of species. Among insects, there is no uniform body size pattern across temperature gradients, suggesting that processes controlling body size may differ among species. The aim of this study was to explore diversity and body size patterns of dung beetle species of the genus Onthophagus Latreille, 1802 across altitudinal gradients at two mountains in Mexico. Tropical mountain species were sampled from 2200 to 3400 m a.s.l. In both mountains, there was a decrease of richness and abundance of Onthophagus with increasing altitude. There were contrasting relationships between beetle body size and altitude, which varied depending on the data set analyzed. Furthermore, interspecific variations of body size were not related to the number of altitudinal bands recorded by each species. Species from high altitudes were also recorded at lower mountain altitudes, suggesting that diversity at the highest altitudes represents a subgroup of lowland diversity. This may indicate that the fauna inhabiting higher elevations could be the most eurytopic one. Here we present an example of an assemblage that partially contradicts Bergmann’s rule, with contrasting effects of altitude on dung beetle body size.
Apocalypse Now?
Authors: Liu Hin-Yan , Lauta Kristian , Maas Matthijs 
Published: October 2020

Abstract
This paper explores the ongoing Covid-19 pandemic through the framework of existential risks – a class of extreme risks that threaten the entire future of humanity. In doing so, we tease out three lessons: (1) possible reasons underlying the limits and shortfalls of international law, international institutions and other actors which Covid-19 has revealed, and what they reveal about the resilience or fragility of institutional frameworks in the face of existential risks; (2) using Covid-19 to test and refine our prior ‘Boring Apocalypses’ model for understanding the interplay of hazards, vulnerabilities and exposures in facilitating a particular disaster, or magnifying its effects; and (3) to extrapolate some possible futures for existential risk scholarship and governance.