bluuebunny/crossref_metadata_2025_split huggingface dataset:
SCIENTIFIC UNIFORMITY OR “NATURAL” DIVINE ACTION: SHIFTING THE BOUNDARIES OF LAW IN THE NINETEENTH CENTURY
Authors: Bossoh Nathan K. C. 
Published: February 2021

AbstractIn October 1862, the Duke of Argyll published an article in the Edinburgh Review entitled “The Supernatural.” In it, Argyll argued that contrary to the prevailing assumption, miracles were “natural” rather than “supernatural” acts of God. This reconceptualization was a response to the controversial publication Essays and Reviews (1860), which challenged orthodox Biblical doctrine. Argyll's characterization of a miracle was not novel; a number of early modern Newtonian thinkers had advanced the same argument for similar reasons. New in this nineteenth‐century reconceptualization, however, were (1) the recent geological, physical, and evolutionary developments and (2) the introduction of German higher criticism. Argyll and the neo‐Newtonians thus attempted to construct a philosophico‐theological alternative, which would constitute a middle‐position between the traditional acceptance and liberal rejection of miracles. I argue finally that 21st‐century debates on divine action in fact exist as part of a longer historical tradition that dates back to Augustine.
Critical appraisal and issues regarding generalisability of comparative effectiveness studies of NOACs in atrial fibrillation and their relation to clinical trial data: a systematic review
Authors: Bunge Eveline M , van Hout Ben , Haas Sylvia , Spentzouris Georgios , Cohen Alexander 
Published: February 2021

ObjectiveTo critically appraise the published comparative effectiveness studies on non-vitamin K antagonist oral anticoagulants (NOACs) in non-valvular atrial fibrillation (NVAF). Results were compared with expectations formulated on the basis of trial results with specific attention to the patient years in each study.MethodsAll studies that compared the effectiveness or safety between at least two NOACs in patients with NVAF were eligible. We performed a systematic literature review in Medline and EMbase to investigate the way comparisons between NOACs were made, search date 23 April 2019. Critical appraisal of the studies was done using among others ISPOR Good Research Practices for comparative effectiveness research.ResultsWe included 39 studies in which direct comparison between at least two NOACs were made. Almost all studies concerned patient registries, pharmacy or prescription databases and/or health insurance database studies using a cohort design. Corrections for differences in patient characteristics was applied in all but two studies. Eighteen studies matched using propensity scores (PS), 8 studies weighted patients based on the inverse probability of treatment, 1 study used PS stratification and 10 studies applied a proportional hazards model. These studies have some important limitations regarding unmeasured confounders and channelling bias, even though the larger part of the studies were well conducted technically. On the basis of trial results, expected differences are small and a naïve analysis suggests trials with between 7200 and 56 500 patients are needed to confirm the observed differences in bleedings and between 51 800 and 7 994 300 to confirm differences in efficacy.DiscussionComparisons regarding effectiveness and safety between NOACs on the basis of observational data, even after correction for baseline characteristics, may not be reliable due to unmeasured confounders, channelling bias and insufficient sample size. These limitations should be kept in mind when results of these studies are used to decide on ranking NOAC treatment options.
Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial
Authors: Saredakis Dimitrios , Keage Hannah A D , Corlis Megan , Loetscher Tobias 
Published: February 2021

IntroductionApathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).Methods and analysisParticipants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.Ethics and disseminationEthics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.Trial registration numberACTRN12619001510134.
Publishing at any cost: a cross-sectional study of the amount that medical researchers spend on open access publishing each year
Authors: Ellingson Mallory K. , Shi Xiaoting , Skydel Joshua J. , Nyhan Kate , Lehman Richard , Ross Joseph S. , Wallach Joshua D. 
Published: February 2021

ObjectiveTo estimate the financial costs paid by individual medical researchers from meeting the article processing charges (APCs) levied by open access journals in 2019.DesignCross-sectional analysis.Data sourcesScopus was used to generate two random samples of researchers, the first with a senior author article indexed in the ‘Medicine’ subject area (general researchers) and the second with an article published in the ten highest-impact factor general clinical medicine journals (high-impact researchers) in 2019. For each researcher, Scopus was used to identify all first and senior author original research or review articles published in 2019. Data were obtained from Scopus, institutional profiles, Journal Citation Reports, publisher databases, the Directory of Open Access Journals, and individual journal websites.Main outcome measuresMedian APCs paid by general and high-impact researchers for all first and senior author research and review articles published in 2019.ResultsThere were 241 general and 246 high-impact researchers identified as eligible for our study. In 2019, the general and high-impact researchers published a total of 914 (median 2, IQR 1–5) and 1471 (4, 2–8) first or senior author research or review articles, respectively. 42% (384/914) of the articles from the general researchers and 29% (428/1471) of the articles from the high-impact medical researchers were published in fully open access journals. The median total APCs paid by general researchers in 2019 was US$191 (US$0–US$2500) and the median total paid by high-impact researchers was US$2900 (US$0–US$5465); the maximum paid by a single researcher in total APCs was US$30115 and US$34676, respectively.ConclusionsMedical researchers in 2019 were found to have paid between US$0 and US$34676 in total APCs. As journals with APCs become more common, it is important to continue to evaluate the potential cost to researchers, especially on individuals who may not have the funding or institutional resources to cover these costs.
Status and disparities of diabetes among urban and rural residents aged 40 years and older: insight from a population-based study in northeast China, 2017–2019
Authors: Xing Liying , Tian Yuanmeng , Jing Li , Lin Min , Du Zhi , Sun Qun , Dai Dong , Shi Lei , Yang Zuosen , Liu Shuang 
Published: February 2021

ObjectivesTo evaluate the up-to-date epidemiology of diabetes in northeast China.MethodsThe cross-sectional study was conducted between September 2017 and March 2019 using a multistage, stratified and cluster random sampling method. 18 796 participants (28.9% urban and 71.1% rural) aged ≥40 years were enrolled. Diabetes and pre-diabetes were diagnosed according to the history, fasting plasma glucose (FPG) and glycosylated haemoglobin A1c (HbA1c) levels.ResultsThe prevalence of diabetes was 17.1%, higher in urban than in rural residents (20.2% vs 15.8%, p<0.001). Meanwhile, the prevalence of pre-diabetes was 44.3%, higher in rural than in urban areas (49.4% vs 31.8%, p<0.001). The overall FPG and HbA1c were 6.10±1.94 mmol/L and 5.59%±1.08%. The FPG level was higher in rural area than in urban areas (6.15±1.83 mmol/L vs 5.97±2.18 mmol/L, p<0.001). Among participants with diabetes, 47.5% were aware of their diabetes condition; 39.5% were taking antidiabetic medications and 36.8% of people had their diabetes controlled. The awareness and treatment rates in rural areas were lower than those in urban areas (47.3% vs 57.5%, 34.4% vs 49.5%, p<0.001). Patients with diabetic, especially those in rural areas, tended to have multiple risk factors including hypertension (71.7%), overweight or obesity (69.6%) and dyslipidaemia (52.8%).ConclusionA considerable burden of diabetes was observed in northeast China, with high percentage of untreated diabetes, high prevalence of pre-diabetes, high overall FPG level and multiple uncontrolled risk factors in patients with diabetics. Therefore, region-specific strategies on prevention and management of diabetes should be emphasised.
Audit of prescription of anti-malarial prophylaxis to patients admitted to Royal Centre for Defence Medicine (RCDM following evacuation from Afghanistan
Authors: Penn-Barwell J , Pengelly S 
Published: February 2021

AbstractIntroductionFor most of the year Military personnel deployed to Afghanistan are required to take anti-malarial chemoprophylaxis (AMC). This audit aims to quantify how many personnel taking AMC in theatre have it continued at RCDM.MethodA database kept at RCDM was searched for details of all evacuated patients. Records of these patients were then searched to find out which had been admitted, how many had been taking AMC prior to admission and how many were prescribed it in hospital.ResultsDuring the study period 40 patients were evacuated to RCDM. 26 of these were admitted and had notes available and were therefore included in the study. 9 of these had been taking AMC prior to admission; of them, only 4 had been continued on AMC by the time they were admitted to RCDM.ConclusionInsufficient numbers of patients taking AMC prior to admission have it continued as an inpatient. Awareness of this issue needs to be raised at all points of the medical evacuation chain.
Naval Service Cohort Study of Occupational Stress: Background to the research and a review of the latest findings
Authors: Bridger R S 
Published: February 2021

AbstractThe Naval Service has been actively involved in research on occupational stress for almost 10 years. Three cross-sectional studies have been completed during this time period. It has been shown that the prevalence rate of psychological strain amongst personnel is relatively constant at 31-34%. Several smaller studies, of personnel at sea and of the availability of support services have also been completed. In general, the research has shown that the prevalence rate of strain is higher in the NS than in the general population and is comparable to that found in similar uniformed service organisations, such as the Police.Recognising the limitations of crosssectional research methods, the decision was made, in 2006, to follow a cohort of personnel over a 6-year period in order to gain better understanding of the processes by which work demands impact on psychological health and to determine whether psychological ill-health has an adverse impact on factors such as premature voluntary retirement and medical downgrading.The paper presents the history of the research and some of the work in progress.‘Disease is a pathological process that, at least in theory, is amenable to objective, external verification. Illness, on the other hand, is by definition, a subjective state’. D. Coggan 2006(1).
Asbestos – a legacy and a persistent problem
Authors: Brims F J H 
Published: February 2021

AbstractAsbestos has been utilised by industrialised nations for over a century and its deleterious health effects have been reported for an almost equal length of time. Whilst developed countries have now reduced their asbestos use, developing nations are increasing their asbestos imports and consumption. Because of this, there is now a perceived risk to Non Government Organisation and military personnel involved in aid operations or conflict areas, where asbestos containing materials and buildings may have been disrupted.With significant asbestos exposures to UK military and dockyard personnel in the past, the health consequences are continuing to increase, with the incidence of malignant mesothelioma expected to continue to rise until between 2012-2020. There is no effective cure or treatment for any of the lung or pleural asbestos related diseases; malignant mesothelioma has a median survival of just 6-12 months. Misconceptions about asbestos are widespread, contributed in part by a long latency between exposure and disease. Following diagnosis of an asbestos related disease, financial recompense for exservice personnel is limited, and the civilian legal implications continue to change. This review will encompass the historical usage of asbestos, its biological effects, the legal and financial implications of exposure, and establish that there may be a continuing threat of exposure to deployed military personnel
Lost Days – Diaries for Military Intensive Care Patients
Authors: Thomas J , Bell E 
Published: February 2021

AbstractThere is a real possibility of critically injured service personnel suffering from psychological disturbance as a result of not being able to recall traumatic events. Many patients report symptoms of depression, anxiety and other psychological disturbances such as hallucinations, delusional memories and nightmares after discharge from an Intensive Care Unit (ICU). Patients who have memories of ICU, sometimes unpleasant ones, as opposed to those who have no memories of their stay in ICU, suffer less anxiety, panic attacks and other PTSD-related symptoms. The impact for clinical practice is that, whilst health care professionals cannot remove all of the stressors of treatment in ICU for service personnel, we must try to minimise their impact by providing continued patient information and reassurance. The introduction of patient diaries has helped this vulnerable group of patients and the feedback from patients and their relatives validates this. Patient diaries have been developed and introduced for use by military patients and further exploration of their impact expected.
Case report – Carcinoid Syndrome: Two case reports from Reserve Unit
Authors: Smith D Fitzroy 
Published: February 2021

AbstractCarcinoid tumours are uncommon and carcinoid syndrome is likely to be encountered only occasionally during a clinical career outside the Neuro-endocrine and related specialties. Two cases of carcinoid syndrome are described in Royal Naval Reserve (RNR) personnel presenting simultaneously in the same unit. Both had long histories and, despite early contact with medical staff, had for some time been dismissed as having trivial complaints. Both have responded well to treatment, though neither has been able to have curative surgery. The current methods of diagnosis which allow much earlier identification and localisation of these tumours are discussed. We also review the management options now available which will control disease and allow the patient to pursue their chosen career, be it military or civil.
Investigating hormonal adaptations to high altitude: five years of Defence Medical Services expeditions
Authors: Rowland C 
Published: February 2021

AbstractThe military has a tradition of supporting and promoting scientific expeditions. The past five years have witnessed a series of Defence Medical Service (DMS) expeditions to mountainous areas of the world, which set out with the dual purpose of researching high altitude human physiology and promoting the uptake of adventurous pursuits within the military. Beginning with exercise Medical Sentinel to Aconcagua, Argentina, in 2007, members of the DMS have since conducted two expeditions to the Himalayas (expedition Imja Tse, 2009 and expedition Khumbu Ramble, 2011) before returning to South America, to the Cordillera Real mountain range in Bolivia, on expedition Bolivian Venture, in late May 2012. This article aims to provide a brief background to the rationale behind these expeditions, a brief description of our understanding of altitude sickness and a history of the adventures that members of the Defence Medical Services have been having contributing to that understanding.
Anaesthesia and critical care aspects of Role 2 Afloat
Authors: Mercer S J , Heames R M 
Published: February 2021

AbstractThe equipment and procedures for providing anaesthesia and critical care within the Role 2 Afloat team are described. In particular the lessons learned from a recent exercise onboard RFA CARDIGAN BAY are outlined with emphasis on the constraints of the unique maritime environment and the essential differences between the level of care at Role 2 and Role 3.
Panton-Valentine Leukocidin Staphylococcus Aureus (PVL-SA) – an uninvited stowaway aboard a Royal Navy submarine
Authors: Bourn SJN , Evans G , O’Shea MK 
Published: February 2021

AbstractThe toxin Panton-Valentine Leukocidin (PVL) is a virulence factor produced by some strains of Staphylococcus aureus (S. aureus, SA) that destroys leucocytes. PVL-SA predominantly results in skin and soft tissue infections (SSTIs) but may also cause invasive disease, including necrotising pneumonia, which may affect healthy young individuals and has a high mortality. We describe a case of PVL-SA in a submariner who presented at sea and which resulted in a requirement to both alter the submarine’s programme and undertake population screening. The case highlights many important issues pertinent to military populations including clinical and public health considerations.
Anterior chamber gas bubbles in open globe injury
Authors: Barnard EBG , Baxter D , Blanch R 
Published: February 2021

AbstractWe present a case of a 40-year-old soldier who was in close proximity to the detonation of an improvised explosive device (IED). Bubbles of gas were visible within the anterior chamber of his left eye. The authors propose that intraocular gas, present acutely after trauma, is diagnostic of open globe injury and is of particular importance in remote military environments.
Culture obtained from urethral swab of asymptomatic men who screen positive forNeisseria gonorrhoeaeby urine nucleic acid amplification testing
Authors: Ratnappuli Ayoma , Bissessor Melanie , Arumugam Shehara , Williamson Deborah A , Chow Eric P F , Fairley Christopher K , Ong Jason J , De Petra Vesna , Chen Marcus Y 
Published: February 2021

BackgroundIn a previous study of men attending Melbourne Sexual Health Centre who hadNeisseria gonorrhoeaedetected by urine Aptima Combo 2 (AC2) testing, 11% were asymptomatic. This study aimed to determine whetherN. gonorrhoeaecan be cultured from asymptomatic men screening positive forN. gonorrhoeaeby nucleic acid amplification testing (NAAT) of urine.MethodsBetween 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested forN. gonorrhoeaeby AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution.ResultsThere were 1001 cases (860 individuals) positive forN. gonorrhoeaeby urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive forN. gonorrhoeae. Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates.ConclusionsGonorrhoea was isolated in most but not all asymptomatic men screening positive forN. gonorrhoeaeby urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation ofN. gonorrhoeaeby culture in men without discharge indicates these are true infections with viable organisms.
Development of a large animal model of lethal polytrauma and intra-abdominal sepsis with bacteremia
Authors: O'Connell Rachel L , Wakam Glenn K , Siddiqui Ali , Williams Aaron M , Graham Nathan , Kemp Michael T , Chtraklin Kiril , Bhatti Umar F , Shamshad Alizeh , Li Yongqing , Alam Hasan B , Biesterveld Ben E 
Published: February 2021

BackgroundTrauma and sepsis are individually two of the leading causes of death worldwide. When combined, the mortality is greater than 50%. Thus, it is imperative to have a reproducible and reliable animal model to study the effects of polytrauma and sepsis and test novel treatment options. Porcine models are more translatable to humans than rodent models due to the similarities in anatomy and physiological response. We embarked on a study to develop a reproducible model of lethal polytrauma and intra-abdominal sepsis, which was lethal, though potentially salvageable with treatment.MethodsOur laboratory has a well-established porcine model that was used as the foundation. Animals were subjected to a rectus crush injury, long bone fracture, liver and spleen laceration, traumatic brain injury and hemorrhage that was used as a foundation. We tested various colon injuries to create intra-abdominal sepsis. All animals underwent injuries followed by a period of shock, then subsequent resuscitation.ResultsAll animals had blood culture-proven sepsis. Attempts at long-term survival of animals after injury were ceased because of poor appetite and energy. We shifted to an 8-hour endpoint. The polytrauma injury pattern remained constant and the colon injury pattern changed with the intention of creating a model that was ultimately lethal but potentially salvageable with a therapeutic drug. An uncontrolled cecal injury (n=4) group resulted in very early deaths. A controlled cecal injury (CCI; n=4) group had prolonged time prior to mortality with one surviving to the endpoint. The sigmoid injury (n=5) produced a similar survival curve to CCI but no animals surviving to the endpoint.ConclusionWe have described a porcine model of polytrauma and sepsis that is reproducible and may be used to investigate novel treatments for trauma and sepsis.Level of evidenceNot applicable. Animal study.