bluuebunny/crossref_metadata_2025_split huggingface dataset:
The establishment of a micro-scale heat market using a biomass-fired district heating system
Authors: Sebestyén Tihamér Tibor , Pavičević Matija , Dorotić Hrvoje , Krajačić Goran 
Published: June 2020

Abstract
Background
Local biomass potential in Southeastern European countries is relatively high. Nevertheless, biomass residues such as wood leftovers, straw and energy crops are often not properly managed or inefficiently utilised for energy purposes in individual house heating or domestic hot water preparation. This is more relevant in rural areas, where the utilisation of biomass resources is mainly based upon traditional technologies, has low efficiency or is carried out by using individual bases without local energy supply management. Usage of biomass residues in combination with other renewable energy sources is in agreement with the targets of the EU’s Energy and Climate Goals and promotes rural development and a circular economy.

Methods
For this purpose, local heating and domestic hot water preparation demands, as well as the available biomass potentials, were analysed and mapped by using a geographic information system (GIS). A model for analysing the optimal operation of the district heating boiler with a relatively high share of solar energy, which is backed up by either a short- or long-term heat storage, was developed. The model takes the supply and the return temperatures from the DH network into account and decides whether the excess of solar heat produced by the prosumers can be delivered into the network. This reduces heat overproduction and enables a smooth and uninterrupted operation of the system. Such configuration would benefit both the DH Company and the prosumers. The DH Company would have the opportunity to buy cheaper excess heat from the prosumers rather than to start its own and relatively slow biomass boiler.

Results
In this paper, several scenarios are proposed for the Romanian village Ghelinta. The target village is characterised by a small-scale biomass district heating boiler with thermal storage and prosumers with either solar thermal collectors or locally installed heat pumps. Integration of seasonal thermal storage and local prosumers can smooth out the biomass district heating boiler operation and bring additional socio-economic benefits for the bioenergy village communities. This could be the first step towards the establishment of a micro-scale thermal energy market.

Conclusions
Analysis has proven that the proposed system configuration is socio-technically feasible, even for micro-scale systems, as apparent in the Romanian target village Ghelinta. The main objective of this research is to analyse the implementation of a small-scale biomass and renewable energy-based district heating system and to prove the concept of bioenergy villages from a technical and economical perspective. Furthermore, the role of residential household prosumers has been analysed. Based on outcomes, the transferability of the results is also discussed, while several suggestions for stakeholders who implement such projects were formulated for future research as well.
Smartphone applications targeting borderline personality disorder symptoms: a systematic review and meta-analysis
Authors: Ilagan Gabrielle S. , Iliakis Evan A. , Wilks Chelsey R. , Vahia Ipsit V. , Choi-Kain Lois W. 
Published: June 2020

Abstract
Background
Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care.

Objective
This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD.

Data sources
Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019.

Study selection
Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included.

Study appraisal and synthesis methods
Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search.

Results
Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges’ g = − 0.066, 95% CI [−.257, .125]), nor on general psychopathology (Hedges’ g = 0.305, 95% CI [− 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available.

Conclusions
The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.
Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital cardiac arrest
Authors: Higashi Akiko , Nakada Taka-aki , Imaeda Taro , Abe Ryuzo , Shinozaki Koichiro , Oda Shigeto 
Published: June 2020

Abstract
Introduction
Quality improvement in the administration of extracorporeal cardiopulmonary resuscitation (ECPR) over time and its association with low-flow duration (LFD) and outcomes of cardiac arrest (CA) have been insufficiently investigated. In this study, we hypothesized that quality improvement in efforts to shorten the duration of initiating ECPR had decreased LFD over the last 15 years of experience at an academic tertiary care hospital, which in turn improved the outcomes of in-hospital CA (IHCA).

Methods
This was a single-center retrospective observational study of ECPR patients between January 2003 and December 2017. A rapid response system (RRS) and an extracorporeal membrane oxygenation (ECMO) program were initiated in 2011 and 2013. First, the association of LFD per minute with the 90-day mortality and neurological outcome was analyzed using multiple logistic regression analysis. Then, the temporal changes in LFD were investigated.

Results
Of 175 study subjects who received ECPR, 117 had IHCA. In the multivariate logistic regression, IHCA patients with shorter LFD experienced significantly increased 90-day survival and favorable neurological outcomes (LFD per minute, 90-day survival: odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.94–1.00, P = 0.032; 90-day favorable neurological outcome: OR = 0.97, 95% CI = 0.94–1.00, P = 0.049). In the study period, LFD significantly decreased over time (slope − 5.39 [min/3 years], P < 0.0001).

Conclusion
A shorter LFD was associated with increased 90-day survival and favorable neurological outcomes of IHCA patients who received ECPR. The quality improvement in administering ECPR over time, including the RRS program and the ECMO program, appeared to ameliorate clinical outcomes.
Incidence, casualties and risk characteristics of civilian explosion blast injury in China: 2000—2017 data from the state Administration of Work Safety
Authors: Wang Xu , Du Juan , Zhuang Zhuo , Wang Zheng-Guo , Jiang Jian-Xin , Yang Ce 
Published: June 2020

Abstract
Background
Civilian explosion blast injury is more frequent in developing countries, including China. However, the incidence, casualties, and characteristics of such incidents in China are unknown.

Methods
This is a retrospective analysis of the State Administration of Work Safety database. Incidents during a period from January 1, 2000 to April 30, 2017 were included in the analysis. The explosions were classified based on the number of deaths into extraordinarily major, major, serious and ordinary type. Descriptive statistics was used to analyze the incidence and characteristics of the explosions. Correlation analysis was performed to examine the potential correlations among various variables.

Results
Data base search identified a total of 2098 explosions from 2000 to 2017, with 29,579 casualties: 15,788 deaths (53.4%), 12,637 injured (42.7%) and 1154 missing (3.9%). Majority of the explosions were serious type (65.4%). The number of deaths (39.5%) was also highest with the serious type (P = 0.006). The highest incidence was observed in the fourth quarter of the year (October to December), and at 9:00–11:00 am and 4:00–6:00 pm of the day. The explosions were most frequent in coal-producing provinces (Guizhou and Shanxi Province). Coal mine gas explosions resulted majority of the deaths (9620, 60.9%). The number of explosion accidents closely correlated with economic output (regional economy and national GDP growth rate) (r = − 0.372, P = 0.040; r = 0.629, P = 0.028).

Conclusions
The incidence and civilian casualties due to explosions remain unacceptabe in developing China. Measures that mitigate the risk factors are of urgently required.
Uric acid and cardiometabolic diseases
Authors: Lee Seung Jae , Oh Byeong Kil , Sung Ki-Chul 
Published: June 2020

AbstractHyperuricemia, which has been considered as a cause of gout and nephrolithiasis has recently been suggested to be associated with hypertension, coronary heart disease, heart failure, atrial fibrillation, insulin resistance, and nonalcoholic fatty liver disease. Several clinical and experimental studies have supported uric acid (UA) as an independent risk factor for predicting disease development along with the traditional risk factors. The mechanism by which UA causes cardiometabolic disease has not been fully elucidated to date; however, it has been explained by several hypotheses such as oxidative stress, reduced nitric oxide bioavailability, inflammation, endothelial dysfunction, and so on. Although evidence of the preventive and therapeutic effects of UA lowering therapy on cardiometabolic diseases is still insufficient, it is expected to be considered as a new treatment strategy for such diseases through additional, carefully designed, large-scale clinical studies.
In situ simulation training in helicopter emergency medical services: feasible for on-call crews?
Authors: Bredmose Per P. , Hagemo Jostein , Røislien Jo , Østergaard Doris , Sollid Stephen 
Published: June 2020

AbstractSimulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base.We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adults, children, and neonates. All scenarios included learning objectives for non-technical skills. A total of 44 simulations were carried out. Total median (quartiles) time consumption for on-call HEMS crew was 65 (59-73) min. Time for preparation of scenarios was 10 (5-11) min, time for simulations was 20 (19-26) min, cleaning up 7 (6-10) min, and debrief 35 (30-40) min. For all items on the questionnaire, the majority of respondents replied with the two most positive categories on the Likert scale. Our results demonstrate that in situ simulation training for on-call crews on a busy HEMS base is feasible with judicious investment of time and money. The participants were very positive about their experience and the impact of this type of training.
Benin responds to covid-19: sanitary cordon without generalized containment or lockdown?
Authors: Osseni Issideen Ayinla 
Published: June 2020

AbstractSince the novel coronavirus disease 2019 (COVID-19) has been identified in Wuhan, China, in the last week of December, the virus has spread across nations and continents affecting over 3 million people and putting the whole world to a halt. Nations across the globe went on lockdown in an attempt to contain the spread of the virus and curb its propagation curve. Affected African countries did the same except for Benin, which opted for a sanitary cordon around the affected regions with free movement of people. The biggest challenge is the effectiveness of this measure.
Chemical profiling of Thevetia peruviana leaves cytotoxic active extracts enhanced by microemulsion formulation
Authors: El-Sawi Salma A. , Maamoun Amal A. , Salama Alaa H. , Farghaly Ayman A. 
Published: June 2020

Abstract
Background
Natural products played an essential role as a complementary cytotoxic agent avoiding complications of other therapies. In phytoformulation research, herbal drugs of nano-size have attracted more attention for more bioavailability and less active dose. We aim in this work to introduce new non-mutagenic cytotoxic agent from Thevetia peruviana leaves extracts and potentiate the activity by loading upon microemulsion formulations as an advanced mode of drug delivery system.

Results
Thevetia peruviana toxicity test revealed its safety (LD50 = 3.083 g/kg). In vivo genotoxicity tests measuring chromosomal aberrations were done to prove non-mutagenicity of the plant for both somatic and germ cells. The plant showed antioxidant activity with 121.215, 128.925, and 120.098 mg/g extract, calculated as Trolox equivalent (TE/g) for DPPH, ABTS, and FRAP assays, respectively. Successive extracts of the plant were incorporated in microemulsion formulations (MEF) and characterized for their electrical conductivity, poly-dispersity index, and in vitro drug release action. Cytotoxic activity of successive extracts was investigated against breast MCF7 and liver HEPG2 carcinoma cell lines before and after loading upon MEs. Enhancement in activity was detected for both pet. ether and ethanol MEFs, as IC50 of pet. ether extract decreased from 25 to 6.5 μg/ml against MCF7 cell line, while ethanol formulation recorded IC50 = 3.58 μg/ml against HEPG2 cell line after showing no activity of the extract at the tested concentrations.
Regarding metabolites of polar fraction, total ethanol extract was estimated for total phenolic and flavonoid contents to record 47.7941 mg GAE/g calculated as gallic acid equivalent and 32.7667 mg CE/g measured as catechin equivalent, respectively. HPLC analysis for polar fraction recorded twelve compounds identified according to the available authentics with rutin the major flavonoid (7.33 mg/g) and rosmarinic acid (13.48 mg/g) the most abundant phenolic acid. Phytoconstituents of non-polar fraction were investigated after saponification of pet. ether extract using GC/MS analysis revealed the identification of 88.02% of the total unsaponifiable matter and 89.17 % of the total saponifiable matter.

Conclusion
Thevetia peruviana is a safe cytotoxic agent. Microemulsion formulations of active extracts potentiate the cytotoxic actions against HEPG2 and MCF7 cell lines with better bioavailability and less medicinal doses.
Resource recovery and waste-to-energy from wastewater sludge via thermochemical conversion technologies in support of circular economy: a comprehensive review
Authors: Bora Raaj R. , Richardson Ruth E. , You Fengqi 
Published: June 2020

AbstractWith the rapid rise in global population over the past decades, there has been a corresponding surge in demand for resources such as food and energy. As a consequence, the rate of waste generation and resultant pollution levels have risen drastically. Currently, most organic solid wastes are either land applied or sent to landfills, with the remaining fraction incinerated or anaerobically digested. However, with the current emphasis on the reduction of emissions, nutrient recovery, clean energy production and circular economy, it is important to revisit some of the conventional methods of treating these wastes and tap into their largely unrealized potential in terms of environmental and economic benefits. Wastewater sludge, with its high organic content and fairly constant supply, provides a great opportunity to implement some of these strategies using thermochemical conversion technologies, which are considered as one of the alternatives for upcycling such waste streams. This paper summarizes the results of prominent studies for valorizing wastewater sludge through thermochemical conversion technologies while drawing inferences and identifying relationships between different technical and operating parameters involved. This is followed by sections emphasizing the environmental and economic implications of these technologies, and their corresponding products in context of the broader fields of waste-to-energy, nutrient recycling and the progress towards a circular economy.
Dot product graphs and domination number
Authors: Saleh Dina , Megahed Nefertiti 
Published: June 2020

AbstractLet A be a commutative ring with 1≠0 and R=A×A. The unit dot product graph of R is defined to be the undirected graph UD(R) with the multiplicative group of units in R, denoted by U(R), as its vertex set. Two distinct vertices x and y are adjacent if and only if x·y=0∈A, where x·y denotes the normal dot product of x and y. In 2016, Abdulla studied this graph when $A=\mathbb {Z}_{n}$
A
=

ℤ

n

, $n \in \mathbb {N}$
n
∈
ℕ
, n≥2. Inspired by this idea, we study this graph when A has a finite multiplicative group of units. We define the congruence unit dot product graph of R to be the undirected graph CUD(R) with the congruent classes of the relation $\thicksim $
∽
defined on R as its vertices. Also, we study the domination number of the total dot product graph of the ring $R=\mathbb {Z}_{n}\times... \times \mathbb {Z}_{n}$
R
=

ℤ

n

×
...
×

ℤ

n

, k times and k<∞, where all elements of the ring are vertices and adjacency of two distinct vertices is the same as in UD(R). We find an upper bound of the domination number of this graph improving that found by Abdulla.
Reduced dose iterative reconstruction versus standard dose filtered back projection in detection of bladder tumors
Authors: Sharafeldeen Mohamed , Shaaban Mohamed , Ramadan Asmaa Mahmoud , Rashad Tarek , Elsaqa Mohamed 
Published: June 2020

Abstract
Background
The purpose was to assess radiation dose, image quality, and diagnostic performance of reduced-dose scanning with iterative reconstruction (IR) compared with standard-dose with filtered back projection (FBP) with CT urography for detection of bladder tumor. This study was prospectively conducted on 21 patients with bladder masses. All patients were subjected to two scanning protocols: protocol A (standard dose with FBP) and protocol B (additional limited scan to the pelvis at delayed phase with low dose with IR). Based on body weight (< or > 80 kg), each protocol was subdivided into 2 protocols A1 (130 kVp) and A2 (130 kVp) and protocols B1 (80 kVp) and B2 (110 kVp). Radiation dose was assessed in terms of mean CT dose index (CTDI), Dose-length product (DLP) and effective dose (ED). Image quality and diagnostic accuracy were compared in both groups.

Results
Mean CTDI, DLP and ED were reduced by average 72.3 % in the 80 kVp protocol (B1) and by 36.3% in 110 kVp (B2) protocol compared to standard-dose protocols. There were significantly lower SNR (signal to noise ratio) between protocol A1 and B1 at aorta and psoas muscles. Subjective image quality analysis revealed no statistically significant differences between the protocol A2 and B2 whereas there were significant differences between protocol A1and B1 as regards to visual image noise and overall image quality. Diagnostic accuracy was identical among different protocols.

Conclusion
CT urography with IR scanning showed reduced radiation dose and no difference in detection of urothelial carcinomas from standard dose with FBP despite of degraded image quality in 80 kVp scanning.
Nonfunctional distractor analysis: An indicator for quality of Multiple choice questions
Authors: Sajjad Madiha , Iltaf Samina , Khan Rehan Ahmed 
Published: June 2020

Objectives: To analyze the low to medium distractor efficiency items in a multiple-choice question (MCQ) paper for item writing flaws.
Methods: This qualitative study was conducted at Islamic International Medical College Rawalpindi, in October 2019. Archived item- analysis report from a midyear medium stakes MCQ paper of 2nd year MBBS class, was analyzed to determine the non-functional distractors (NFDs) and distractor efficiency (DE) of items, in a total of 181 MCQs. DE was categorized as low (3-4 NFDs), medium (1-2 NFDs) and high (0 NFD). Subsequently, qualitative document analysis of the MCQ paper whose item analysis report was assessed was conducted to investigate the item flaws in the low to medium DE items. The flaws identified were coded and grouped as, within option flaws, alignment flaws between options and stem/ lead-in and other flaws.
Results: Distractor efficiency was high in 69 items (38%), moderate in 75 items (42%) and low in 37 items (20%). The item-writing flaws identified in low to moderate DE items within distractors included, non-homogenous length (1.8%), non-homogenous content (8%) and repeat in distractor (1.7%). Alignment flaws between distractors and stem/ lead-in identified were linguistic cues (10%), logic cues (12.5%) and irrelevant distractors (16%). Flaws unrelated to distractors were low cognitive level items (40%) and unnecessarily complicated stems (11.6%).
Conclusions: Analyzing the low to medium DE items for item writing flaws, provides valuable information about item writing errors which negatively impact the distractor efficiency.
doi: https://doi.org/10.12669/pjms.36.5.2439
How to cite this:Sajjad M, Iltaf S, Khan RA. Nonfunctional distractor analysis: An indicator for quality of Multiple choice questions. Pak J Med Sci. 2020;36(5):982-986. doi: https://doi.org/10.12669/pjms.36.5.2439
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Outside: Let’s Promote Biodiversity
Authors: Soares M. F. , Liz R. , Ganço I. 
Published: June 2020

The school Santa Marta do Pinhal opened in the academic year 2017/2018 with many expectations, but the reality caused some disappointment. The playground was small for so many children, and everything seemed impersonal, lifeless. It was necessary to act and the whole school community got involved. Class assemblies were held within all school groups, where problems were discussed and suggestions were made. This was followed by meetings of delegates, teachers, parents and local authorities, which led to new partnerships. Thanks to the enormous willingness, determination, commitment and resilience of all stakeholders, our school are now very different. The pond enchants kids and grownups, the flowerbeds, the aromatic spiral and the vegetable garden give life to the playground. Many of the classes are now OUTSIDE, willing to learn and where discoveries are made every moment.