bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol
Authors: Evans Catrin , Poku Brenda , Pearce Ruth , Eldridge Jeanette , Hendrick Paul , Knaggs Roger , McLuskey John , Tomczak Philippa , Thow Ruaridh , Harris Peter , Conway Joy , Collier Richard 
Published: May 2020

IntroductionA global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective.Methods and analysisThis scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework).DisseminationThe review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.
Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study
Authors: Howard Ian , Cameron Peter , Wallis Lee , Castrén Maaret , Lindström Veronica 
Published: May 2020

IntroductionIn South Africa (SA), prehospital emergency care is delivered by emergency medical services (EMS) across the country. Within these services, quality systems are in their infancy, and issues regarding transparency, reliability and contextual relevance have been cited as common concerns, exacerbated by poor communication, and ineffective leadership. As a result, we undertook a study to assess the current state of quality systems in EMS in SA, so as to determine priorities for initial focus regarding their development.MethodsA multiple exploratory case study design was used that employed the Institute for Healthcare Improvement’s 18-point Quality Program Assessment Tool as both a formative assessment and semistructured interview guide using four provincial government EMS and one national private service.ResultsServices generally scored higher forstructureandplanning. Measurementandimprovementwere found to be more dependent on utilisation and perceived mandate. There was a relatively strong focus on clinical quality assessment within the private service, whereas in the provincial systems, measures were exclusively restricted to call times with little focus on clinical care.Staff engagementandprogramme evaluationwere generally among the lowest scores. A multitude of contextual factors were identified that affected the effectiveness of quality systems, centred around leadership, vision and mission, and quality system infrastructure and capacity, guided by the need for comprehensive yet pragmatic strategic policies and standards.ConclusionUnderstanding and accounting for these factors will be key to ensuring both successful implementation and ongoing utilisation of healthcare quality systems in emergency care. The result will not only provide a more efficient and effective service, but also positively impact patient safety and quality of care of the services delivered.
Mechanical ventilation withdrawal in motor neuron disease: an evaluation of practice
Authors: Faull Christina , Wenzel David 
Published: May 2020

ObjectivesClinicians report that withdrawal of mechanical ventilation in motor neuron disease is challenging. We report on the evaluation of the process and outcomes called for by the Association for Palliative Medicine of Great Britain and Ireland (APM) guidance.MethodsExcel analysis of a core data set, defined in the APM guidance, and thematic analysis of free-text comments, submitted by a UK clinician soon after withdrawal of mechanical ventilation in any care setting.ResultsThirty-seven professionals submitted 46 data sets from 4 patients with tracheostomy ventilation (TV) and 42 with non-invasive ventilation (NIV) in 35 months. These took place at home (43%), inpatient hospice (48%), hospital and care homes. Eighty-nine per cent received opioid and/or sedative medication at the initiation of withdrawal, majority of which were subcutaneous. A median of 2 doses (range 1–9) were used to manage symptoms before ventilation withdrawal. Subsequently 73% of patients required either none or one dose of medication. In addition to any background opioid, symptom management required a total parenteral morphine equivalent mean of 20.6 mg (range 0–60 mg) and midazolam mean of 25.8 mg (range 0–120 mg). The median time from first medication to removal of mechanical ventilation was 45 min. Patients with TV died within 30 min of withdrawal. The mode (14 of 42 patients) time to death after NIV withdrawal was 15 min, but ranged between <15 min and 54 hours.ConclusionsIndividualised, proportionate, titrated opioid and sedative medications were used to provide good symptom management, and provided new insight into the substantial variability in what patients require to manage their symptoms and how long the process takes. Most patients required lower doses than in previous literature.
PD-L1 targeting high-affinity NK (t-haNK) cells induce direct antitumor effects and target suppressive MDSC populations
Authors: Fabian Kellsye P , Padget Michelle R , Donahue Renee N. , Solocinski Kristen , Robbins Yvette , Allen Clint T. , Lee John H. , Rabizadeh Shahrooz , Soon-Shiong Patrick , Schlom Jeffrey , Hodge James W 
Published: May 2020

BackgroundAlthough immune checkpoint inhibitors have revolutionized cancer treatment, clinical benefit with this class of agents has been limited to a subset of patients. Hence, more effective means to target tumor cells that express immune checkpoint molecules should be developed. For the first time, we report a novel natural killer (NK) cell line, programmed death-ligand 1 (PD-L1) targeting high-affinity natural killer (t-haNK), which was derived from NK-92 and was engineered to express high-affinity CD16, endoplasmic reticulum-retained interleukin (IL)-2, and a PD-L1-specific chimeric antigen receptor (CAR). We show that PD-L1 t-haNK cells also retained the expression of native NK receptors and carried a high content of granzyme and perforin granules.MethodsNanoString, flow cytometry, and immunofluorescence analyses were performed to characterize the phenotype of irradiated PD-L1 t-haNK cells. In vitro PD-L1 t-haNK cell activity against cancer cell lines and human peripheral blood mononuclear cells (PBMCs) was determined via flow-based and111In-release killing assays. The antitumor effect of PD-L1 t-haNK cells in vivo was investigated using MDA-MB-231, H460, and HTB1 xenograft models in NOD-scid IL2Rgammanull(NSG) mice. Additionally, the antitumor effect of PD-L1 t-haNK cells, in combination with anti-PD-1 and N-803, an IL-15 superagonist, was evaluated using mouse oral cancer 1 syngeneic model in C57BL/6 mice.ResultsWe show that PD-L1 t-haNK cells expressed PD-L1-targeting CAR and CD16, retained the expression of native NK receptors, and carried a high content of granzyme and perforin granules. In vitro, we demonstrate the ability of irradiated PD-L1 t-haNK cells to lyse 20 of the 20 human cancer cell lines tested, including triple negative breast cancer (TNBC) and lung, urogenital, and gastric cancer cells. The cytotoxicity of PD-L1 t-haNK cells was correlated to the PD-L1 expression of the tumor targets and can be improved by pretreating the targets with interferon (IFN)-γ. In vivo, irradiated PD-L1 t-haNK cells inhibited the growth of engrafted TNBC and lung and bladder tumors in NSG mice. The combination of PD-L1 t-haNK cells with N-803 and anti-PD-1 antibody resulted in superior tumor growth control of engrafted oral cavity squamous carcinoma tumors in C57BL/6 mice. In addition, when cocultured with human PBMCs, PD-L1 t-haNK cells preferentially lysed the myeloid-derived suppressor cell population but not other immune cell types.ConclusionThese studies demonstrate the antitumor efficacy of PD-L1 t-haNK cells and provide a rationale for the potential use of these cells in clinical studies.
R&D Investments and Strategic Use of Financial Models
Authors: Harris Wesley L. , Wonglimpiyarat Jarunee 
Published: May 2020

Given that making research and development (R&D) investments has the potential to generate high profits in the future, this research aims to discuss the merits and demerits of using the major financial models — net present value (NPV), internal rate of return (IRR) and Black–Scholes — in assessing R&D investments. The study follows the appreciative theorizing to examine the strategic implications of financial models for managing R&D and building firm’s competitiveness. Conclusively, the analyses point out how conventional financial models fail to recognize the importance of strategic positioning as there are limits in terms of using the quantified approaches to measure the performance of R&D investments. The main contribution of this paper is the insights as well as the comprehensive and deeper understanding of using the financial models for evaluating investments in new technologies.
Digital control strategy for SPWM MPPT of PV system with three-phase NPC three-level converter
Authors: Aref Mahmoud , Ahmed Ismaiel , Oboskalov Vladislav 
Published: May 2020

<p><span>This paper is aimed at investigating MPPT of PV system controlled by SPWM which is generated by comparing sinusoidal wave with variable frequency sawtooth wave. Perturb and Observe (P&amp;O) method is used for MPPT control of PV system. NPC three-phase three-level converter with LCL filter is designed to produce output voltage with minimum Total Harmonic Distortion (THD) and high efficiency. The simple and fast method to get MPP of PV system with variable irradiation is digital control where the maximum power point is obtained from look-up table for the values of optimum voltage that achieve the maximum power for each irradiance value is used for digital control signal in microcontroller. The output voltage harmonic of multi-level three-phase inverter is controlled using SPWM control. THD of output voltage of multi-level three-phase inverter is 22% of stand-alone and grid-connected PV system. Small rate LCL filter is used to limit voltage harmonics within medium and low voltage limits (5%). THD output voltage of LCL filter is 4.9% and 3.51% of stand-alone and grid-connected PV system respectively. </span></p>
A Influência da Infraestrutura de Transporte na Mobilidade do Turista em Ambientes Insulares
Authors: Peixoto Nathane Eva Santos , Silva Elisangela Aparecida Machado da , Ribeiro Hugo Alves Silva 
Published: May 2020

A dispersão de atrativos pelo destino turístico prescinde a movimentação dos visitantes. Isso justifica a importância da infraestrutura de transporte disponível e dos mecanismos de promoção da mobilidade para os deslocamentos. Diante de tal importância, este artigo objetivou avaliar as infraestruturas de transporte que influenciam na mobilidade do turista na ilha de Fernando de Noronha, Brasil. Metodologicamente, foi realizado estudo de caso único, com coleta de dados advinda da observação in loco, complementada por análise de dados secundários. Dentre os principais achados, tem-se que o deslocamento a pé é a principal alternativa de mobilidade no ambiente analisado. Isso porque muitos atrativos não estão diretamente conectados com as infraestruturas que atendem ao transporte motorizado. Ante as características geográficas insulares que promove diferentes níveis de dificuldade, algumas caminhadas tornam-se demasiadamente longas o que exige capacidade física do visitante. A mobilidade turística em destinos insulares prescinde de maior apreensão técnica sobre o nível de caminhabilidade proporcionada aos visitantes. Isso requer estudos de soluções alinhadas às restrições normativas ambientais, ao interesse de promover inclusão e, sobretudo, de ofertar estruturas em conformidade ao perfil dos visitantes. Ao final, esta pesquisa auxilia a desenvolver soluções a partir da contribuição multidisciplinar dos campos de estudo do turismo e dos transportes.
Palavras-chave: infraestrutura de transporte, mobilidade, destino turístico.
Humanidade e crítica de Harun Farocki
Authors: Sant'Anna Antonio Carlos Vargas , Person Flávia 
Published: May 2020

Este artigo apresenta o resultado de uma investigação sobre o documentário do cineasta Harun Farocki, Imagens da prisão, e identifica seis conjuntos de imagens recorrentes que foram organizados em blocos temáticos: “Corpo disciplinado”, “Corpo oprimido”, “Corpo vigiado”, “A tecnologia como instrumento de dessubjetivação”, “Trabalho e prisão” e “O desejo”. Essa estruturação permitiu uma compreensão do seu pensamento poético e intelectual, evidenciando não apenas a sensibilidade e caráter inovador da estrutura formal de seu trabalho, mas, sobretudo, uma dimensão crítica e humana que adquire especial relevância nos dias atuais. O artigo evidencia o raciocínio do artista ao relacionar a produção das imagens na sociedade contemporânea e o processo de desumanização, que se encontra tanto nos meios de produção quanto no encarceramento.
Publicamos para encontrar camaradas
Authors: Cadôr Amir Brito 
Published: May 2020

Artigo a respeito das revistas de artista publicadas no Brasil no período de 1952 a 1988, no qual se mostra a formação de uma rede de colaboradores que perpassa a maioria das publicações, com destaque ao papel que tiveram as revistas para o surgimento dos livros de artista. O artigo é resultado de um mapeamento inédito das revistas, realizado com o objetivo de montar uma exposição dedicada ao tema. Esse tipo de produção, ignorado por boa parte da historiografia brasileira, até mesmo em estudos sobre os livros de artista, é fundamental para entender o fenômeno atual das publicações de artista.
Era uma vez em Westworld
Authors: Oliveira Junior Luiz Carlos 
Published: May 2020

Este artigo analisa a ficção televisiva Westworld buscando elucidar a inserção da série na onda distópica contemporânea e sua representação de uma crise do sujeito humanista moderno. Outros aspectos destacados são a relação entre humanos e máquinas, sua ressignificação dos códigos do western cinematográfico, sua complexidade narrativa e as alusões à iconografia da pintura de natureza morta.
Mudança no MoMA
Authors: Foster Hal 
Published: May 2020

Neste texto, Hal Foster examina a iniciativa do Museu de Arte Moderna de Nova York, historicamente reconhecido como bastião do modernismo, de confrontar as transformações no meio artístico global e as novas exigências de um ampliado público de arte. Foster comenta o que vê como os grandes acertos dessa iniciativa – dentre eles, a maior diversidade das obras em relação a gênero, raça e proveniência dos artistas –, mas também os seus problemas, como a desautorização de critérios baseados na história da arte em prol de arranjos meramente caprichosos ou fundados na semelhança morfólogica das obras. Foster nota que mudanças semelhantes vêm ocorrendo em outros grandes museus nos Estados Unidos e assinala a premissa populista que subjaz a muitas delas.
Real-Time Closed-Loop Suppression of Repolarization Alternans Reduces Arrhythmia Susceptibility In Vivo
Authors: Merchant Faisal M. , Sayadi Omid , Sohn Kwanghyun , Weiss Eric H. , Puppala Dheeraj , Doddamani Rajiv , Singh Jagmeet P. , Heist E. Kevin , Owen Chris , Kulkarni Kanchan , Armoundas Antonis A. 
Published: May 2020

Background:
Repolarization alternans (RA) has been implicated in the pathogenesis of ventricular arrhythmias and sudden cardiac death.

Methods:
We have developed a real-time, closed-loop system to record and analyze RA from multiple intracardiac leads, and deliver dynamically R-wave triggered pacing stimuli during the absolute refractory period. We have evaluated the ability of this system to control RA and reduce arrhythmia susceptibility, in vivo.

Results:

R-wave triggered pacing can induce RA, the magnitude of which can be modulated by varying the amplitude, pulse width, and size of the pacing vector. Using a swine model (n=9), we demonstrate that to induce a 1 µV change in the alternans voltage on the body surface, coronary sinus and left ventricle leads, requires a delivered charge of 0.04±0.02, 0.05±0.025, and 0.06±0.033 µC, respectively, while to induce a one unit change of the K
score
, requires a delivered charge of 0.93±0.73, 0.32±0.29, and 0.33±0.37 µC, respectively. For all body surface and intracardiac leads, both Δ(alternans voltage) and ΔK
score
between baseline and R-wave triggered paced beats increases consistently with an increase in the pacing pulse amplitude, pulse width, and vector spacing. Additionally, we show that the proposed method can be used to suppress spontaneously occurring alternans (n=7), in the presence of myocardial ischemia. Suppression of RA by pacing during the absolute refractory period results in a significant reduction in arrhythmia susceptibility, evidenced by a lower S
rank
score during programmed ventricular stimulation compared with baseline before ischemia.

Conclusions:
We have developed and evaluated a novel closed-loop method to dynamically modulate RA in a swine model. Our data suggest that suppression of RA directly reduces arrhythmia susceptibility and reinforces the concept that RA plays a critical role in the pathophysiology of arrhythmogenesis.
The COMPASS Trial
Authors: Steffel Jan , Eikelboom John W. , Anand Sonia S. , Shestakovska Olga , Yusuf Salim , Fox Keith A.A. 
Published: May 2020

Background:
Rivaroxaban 2.5 mg twice daily plus acetylsalicylic acid (aspirin; ASA) 100 mg reduced the risk of cardiovascular events as compared with ASA monotherapy in the COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) but increased the risk of major bleedings. Analysis of net clinical benefit (NCB) is of key clinical relevance and represents an integrated measure of overall patient outcome.

Methods:
The current prespecified analysis was performed to assess the NCB of adding rivaroxaban 2.5 mg twice daily to ASA monotherapy in patients with chronic vascular disease in the COMPASS study cohort (intention-to-treat study population), with a specific focus on high-risk subgroups. The predefined NCB outcome was the composite of cardiovascular death, stroke, myocardial infarction, fatal bleeding, or symptomatic bleeding into a critical organ.

Results:

A lower number of NCB adverse outcomes was observed with rivaroxaban 2.5 mg twice daily plus ASA versus ASA alone (hazard ratio, 0.80 [95% CI, 0.70–0.91],
P
=0.0005), which became increasingly favorable with longer treatment duration. The main drivers of NCB outcomes were “efficacy” events, in particular stroke (0.5%/y versus 0.8%/y; hazard ratio, 0.58 [95% CI, 0.44–0.76],
P
<0.0001) and cardiovascular death (0.9%/y versus 1.2%/y; hazard ratio, 0.78 [95% CI, 0.64–0.96],
P
=0.02), whereas the bleeding components of the NCB, in particular fatal bleeding (0.09%/y versus 0.06%/y; hazard ratio, 1.49 [95% CI 0.67–3.33],
P
=0.32), only represented a minority of NCB events. In selected high-risk subgroups, including patients with polyvascular disease (≥2 vascular beds affected with atherosclerosis), impaired renal function, heart failure, and/or diabetes mellitus, a larger absolute risk reduction for experiencing a NCB event was observed.

Conclusions:
Compared with ASA monotherapy, the combination of rivaroxaban 2.5 mg twice daily plus ASA resulted in fewer NCB events primarily by preventing adverse efficacy events, particularly stroke and cardiovascular mortality, whereas severe bleedings were less frequent and with less clinical impact. The NCB was particularly favorable in high-risk subgroups and those with multiple risk characteristics.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01776424.
Surgical outcomes of macular hole and epimacular membrane treatment in patients with intraoperative amaurosis under sub-Tenon’s anesthesia
Authors: Zhang Qi , Huang Zijing , Huang Dingguo , Chen Haoyu , Zheng Dezhi , Zheng Jianlong , Lin Peimin , Chen Weiqi 
Published: May 2020

Objective Some patients have been found to develop intraoperative amaurosis under sub-Tenon’s anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up. Methods In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon’s anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP). Results Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery. Conclusion Intraoperative amaurosis following sub-Tenon’s block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient’s anxiety.
TNFα inhibitor may be effective for severe COVID-19: learning from toxic epidermal necrolysis
Authors: Chen Xue-Yan , Yan Bing-Xi , Man Xiao-Yong 
Published: May 2020

Increased inflammatory cytokines [such as tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6)] are observed in COVID-19 patients, especially in the severe group. The phenomenon of a cytokine storm may be the central inducer of apoptosis of alveolar epithelial cells, which leads to rapid progression in severe group patients. Given the similarities of clinical features and pathogenesis between toxic epidermal necrolysis (TEN) and COVID-19, we hypothesize that the application of etanercept, an inhibitor of TNFα, could attenuate disease progression in severe group COVID-19 patients by suppressing systemic auto-inflammatory responses. The reviews of this paper are available via the supplemental material section.