bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real‐world estimate of the value of one metabolic equivalent in a population of patients planning major surgery
Authors: Douglas Ned , Andrews Grace , Altamimi Hassanain , Wang Andrew , Basto Jarrod , Smith Robert E. R. , Taylor Hugh E. 
Published: May 2021

AbstractBackgroundOne metabolic equivalent (MET) is equal to resting oxygen consumption. The average value for one MET in humans is widely quoted as 3.5 mL/kg/min. However, this value was derived from a single male participant at the end of the 19th century and has become canonical. Several small studies have identified varied estimates of one MET from widely varying populations. The ability of a patient to complete 4 MET (or 14 mL/kg/min) is considered an indicator of their fitness to proceed to surgery.AimsTo define a typical value of one MET from a real‐world patient population, as well as determine factors that influenced the value.MethodsA database of cardiopulmonary exercise testing (CPET) was interrogated to find a total of 1847 adult patients who had undergone CPET testing in the previous 10 years. From this database, estimates of oxygen consumption (VO2) at rest and at the anaerobic threshold and several other variables were obtained. The influence of age, body mass index (BMI), sex and the use of beta‐blockers was tested.ResultsThe median resting VO2 at rest was 3.6 mL/kg/min (interquartile range (IQR): 3.0–4.2). Neither sex, age >65 years or the use of beta‐blockers produced a significant difference in resting VO2, while those with a BMI >25 kg/m2 had a significantly lower VO2 at rest (3.4 mL/kg/min vs 4.0 mL/kg/min; P < 0.001).ConclusionsThe estimate of 3.6 mL/kg/min for resting VO2 presented here is consistent with the previous literature, despite this being the first large study of its kind. This estimate can be safely used for pre‐operative risk stratification.
Serum anion gap revisited: a verified reference interval for contemporary use
Authors: Chionh Chang Yin , Poh Cheng Boon , Roy Debajyoti M. , Koduri Sreekanth , Chow Bing Lun , Tan Pei Ting , Tin Aung Soe , Kam Jia Wen , Lau Chin Shern , Hoo See Ping , Phua Soon Kieng , Aw Tar Choon 
Published: May 2021

AbstractBackgroundThe anion gap (AG) is often used to evaluate acid–base disorders. The reference interval for normal AG is used to differentiate between raised (gap) or normal AG (non‐gap) acidosis. Historically accepted AG values may not be valid with the evolution of modern analytical techniques and the reference interval requires revalidation.AimsTo determine the reference interval for AG based on current laboratory techniques.MethodsDuring a health‐screening exercise, 284 participants with no major illnesses volunteered surplus blood for analysis. The samples were tested in an internationally accredited clinical laboratory. AG was calculated by [Na+] − [Cl−] − [HCO3−] and AGK by [Na+] + [K+] − [Cl−] − [HCO3−]. The reference interval was determined at 2.5th–97.5th percentiles. Analysis was further undertaken for a subcohort of 156 individuals with no suboptimal health indicators.ResultsMedian age was 35 years, body mass index 23.4 kg/m2 and the glomerular filtration rate was 106 mL/min/1.73 m2. Median AG was 13 mmol/L and the reference interval for normal AG is 10–18 mmol/L with a 99% level of confidence. Statistically significant differences in AG were detected for sex, race, obesity and serum albumin, but the difference was 1 mmol/L between subgroups. The reference interval was the same for the sub‐cohort of 156 individuals. Median AGK was 17.7 mmol/L and reference interval was 14.6–22.5 mmol/L.ConclusionsThe AG reference interval of 10–18 mmol/L is valid for laboratories with similar reference intervals for electrolytes. Lower values expected with current laboratory techniques were not observed. The median AG of 13 mmol/L may be used to differentiate gap acidosis, non‐gap acidosis or mixed acid–base disorders.
Clinical and financial burden of spinal infections in people who inject drugs
Authors: Ananda Roshan A. , Attwood Lucy O. , Lancaster Reece , Jacka David , Jhoomun Tanya , Danks Andrew , Woolley Ian 
Published: May 2021

AbstractBackgroundPeople who inject drugs (PWID) are known to be at increased risk of infectious diseases including bacterial and blood‐borne viral infections. However, there is limited literature surrounding the burden of spinal infections as a complication of injecting drug use (IDU).AimsTo quantify the clinical and financial burden of IDU‐related spinal infections.MethodsRetrospective chart review of adult PWID with spinal infections requiring hospital admission to a tertiary health service in Melbourne, Australia between 2011 and 2019.ResultsFifty‐seven PWID with 63 episodes of spinal infections were identified with a median hospital stay of 47 days (interquartile range (IQR) 16; range 4–243 days). One‐third of episodes required neurosurgical intervention and 11 (17%) episodes required intensive care unit admission (range 2–17 days). Staphylococcus aureus was the most common causative pathogen, present in three‐quarters of all episodes (n = 47). The median duration of antibiotic regime was 59 days (IQR 42) and longer courses were associated with known bacteraemia (P = 0.048), polymicrobial infections (P = 0.001) and active IDU (P = 0.066). Predictors of surgery include neurological symptoms at presentation (relative risk (RR) 2.6; P = 0.010), inactive IDU status (RR 3.0; P = 0.002), a diagnosis of epidural abscess (RR 4.1; P = 0.001) and spinal abscess (RR ∞; P < 0.001). Completion of planned antimicrobial therapy was reported in 51 (82%) episodes. Average expenditure per episode was A$61 577.ConclusionsSpinal infections in PWID are an underreported serious medical complication of IDU. Although mortality is low, there is significant morbidity with prolonged admissions, large antimicrobial requirements and surgical interventions generating a substantial cost to the health system.
Macrophage‐fibroblast circuits in the spleen
Authors: Bellomo Alicia , Gentek Rebecca , Golub Rachel , Bajénoff Marc 
Published: May 2021

AbstractMacrophages are an integral part of all organs in the body, where they contribute to immune surveillance, protection, and tissue‐specific homeostatic functions. This is facilitated by so‐called niches composed of macrophages and their surrounding stroma. These niches structurally anchor macrophages and provide them with survival factors and tissue‐specific signals that imprint their functional identity. In turn, macrophages ensure appropriate functioning of the niches they reside in. Macrophages thus form reciprocal, mutually beneficial circuits with their cellular niches. In this review, we explore how this concept applies to the spleen, a large secondary lymphoid organ whose primary functions are to filter the blood and regulate immunity. We first outline the splenic micro‐anatomy, the different populations of splenic fibroblasts and macrophages and their respective contribution to protection of and key physiological processes occurring in the spleen. We then discuss firmly established and potential cellular circuits formed by splenic macrophages and fibroblasts, with an emphasis on the molecular cues underlying their crosstalk and their relevance to splenic functionality. Lastly, we conclude by considering how these macrophage‐fibroblast circuits might be impaired by aging, and how understanding these changes might help identify novel therapeutic avenues with the potential of restoring splenic functions in the elderly.
Dread and solace: Talking about perinatal mental health
Authors: Law Susan , Ormel Ilja , Babinski Stephanie , Plett Donna , Dionne Emilie , Schwartz Hannah , Rozmovits Linda 
Published: May 2021

AbstractPerinatal mental health issues are a global public health challenge. Worldwide, it is estimated that 10% of pregnant women, and 13% of women who have just given birth, experience a mental disorder. Yet, for many reasons – including stigma, limited access to services, patients’ lack of awareness about symptoms, and inadequate professional intervention – actual rates of clinical and subclinical perinatal mental health issues are likely higher. Studies have explored experiences such as postpartum depression, but few involve a wider‐ranging exploration of a variety of self‐reported perinatal mental health issues through personal narrative. We conducted 21 narrative interviews with women, in two Canadian provinces, about their experiences of perinatal mental health issues. Our aim was to deepen understanding of how individual and cultural narratives of motherhood and perinatal mental health can be sources of shame, guilt, and suffering, but also spaces for healing and recovery. We identified four predominant themes in women’s narrative: feeling like a failed mother; societal silencing of negative experiences of motherhood; coming to terms with a new sense of self; and finding solace in shared experiences. These findings are consistent with other studies that highlight the personal challenges associated with perinatal mental health issues, particularly the dread of facing societal norms of the ‘good mother’. We also highlight the positive potential for healing and self‐care through sharing experiences, and the power of narratives to help shape feelings of self‐worth and a new identity. This study adheres to the expectations for conducting and reporting qualitative research.
Kotahitanga and koinonia in shalom as the objective of the mission of God
Authors: Matenga Jay 
Published: May 2021

AbstractEvangelical theology and the missions that flowed from it was born in an era of high colonialism, shaped by enlightenment dualism and scientific method, under the influence of industrialization. As evangelical Christianity’s centre of gravity shifted south, global North dominance over its theology and missiology persisted, translated into new tongues. This paper, sensing a tipping point in evangelical thought as we emerge out of global pandemic disruption, proposes an alternative framing of church and missions from the collectivist perspective shared by those less affected by the influence of Western industrialization and individualism. It proposes that both the means and the objective of the mission of God should be common unity in‐Christ. It shifts focus from the Great Commission to the Great Commitment, which emphasizes being one and holding fast to that unity for the joy that awaits those who persevere in mutuality. Along the way, the demonstration of whole‐of‐life covenantal community in‐Christ serves as our witness to the world, which provides those of us in‐Christ with an opportunity to explain the hope that we have and invite others to join us in the experience of God’s shalom goodness.
Coupling of diffusion and chemical stress: The case of ion exchange in glass
Authors: Macrelli Guglielmo , Mauro John C. , Varshneya Arun K. 
Published: May 2021

AbstractThe chemical strengthening of glass results from an ion exchange process in which smaller alkali ions in a glass are replaced with larger alkali ions from a molten salt bath. This interdiffusion process leads to a buildup of chemical stress in the glass. However, traditional modeling of the ion exchange process has not fully accounted for interaction effects between mass diffusion and the chemical stress developed during the process. In this study, we develop the general theory of coupling between diffusion and stress, resulting in a single flux equation with a concentration‐ and stress‐dependent interdiffusion coefficient. We apply the theory to the specific cases of chemically strengthened soda lime silicate and aluminosilicate glasses, demonstrating the impact of interaction terms on concentration profiles and interdiffusion coefficient. Following a phenomenological approach, this study demonstrates the effect of the interdiffusion on stress generation and vice versa to account for deviations from the simple expressions published hitherto in the literature.
Protocol for a mixed‐method systematic review on challenges perceived by final‐year undergraduate nursing students in a clinical learning environment
Authors: Ali Siti Hajar , Ahmad Rahman Nurul Husna , Mohd Shariff Noorsuzana , Karim Jalina , Chin Kok Yong 
Published: May 2021

AbstractAimsTo determine the challenges perceived by final‐year nursing students in the clinical learning environment.DesignData‐based convergent mixed‐method systematic review.MethodsThree electronic databases (Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature) will be used in the identification stage. The first search will use the search string for each database to identify relevant studies. The articles retrieved will be screened by year of publication, article type and language. Abstracts and full‐text of selected studies will be screened for eligibility independently by a minimum of two reviewers. The reference lists will be manually screened to identify additional publications. The quality assessment will be conducted by two reviewers using the Mixed Methods Appraisal Tools. Quantitative and mixed‐method studies will be transformed into qualitative. A thematic approach will be used to synthesize and report the data. Ethics approval and funding have been approved in April 2020.DiscussionThis study will synthesize the types of challenges perceived by final‐year undergraduate nursing students in different clinical learning environments across the country.ImpactThe proposed study findings will help nursing education stakeholders and faculty provide assistance to final‐year nursing students in their transition year to become registered nurses.
Effectiveness of ethanol infusion into the vein of Marshall combined with a fixed anatomical ablation strategy (the “upgraded 2C3L” approach) for catheter ablation of persistent atrial fibrillation
Authors: Lai Yiwei , Liu Xiaoxia , Sang Caihua , Long Deyong , Li Mengmeng , Ge Weili , Liu Xiangfei , Lu Zhibing , Guo Qi , Jiang Chao , Zuo Song , Jiang Chenxi , Bai Rong , Tang Ribo , Guo Xueyuan , Li Songnan , Liu Nian , Wang Wei , Zhao Xin , Li Changyi , Du Xin , Dong Jianzeng , Ma Changsheng 
Published: May 2021

AbstractIntroductionLinear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI).Methods and ResultsThe study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, ethanol infusion into the vein of Marshall was first performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63 (95.5%) and 101 (80.8%) patients in groups 1 and 2, respectively (p = .006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 vs. 12.59 min, p < .001) and MI (7.0 vs. 11.8 min, p < .001) and required less cardioversion (50 [78.5%] vs. 113 [90.4%], p = .007). During the 12‐month follow‐up, 58 (87.9%) patients were free from atrial fibrillation/atrial tachycardia in group 1 compared with 81 (64.8%) in group 2 (p < .001). In multivariate cox regression, the “upgraded 2C3L” procedure is associated with a lower recurrence rate (hazard ratio = 0.27, 95% confidence interval = 0.12–0.59).ConclusionCompared with the conventional “2C3L” approach, the “upgraded 2C3L” approach has higher effectiveness for ablation of PeAF.
Virulence and immunogenicity of blue catfish alloherpesvirus in channel, blue and blue × channel hybrid catfish
Authors: Venugopalan Arun , Griffin Matt J. , Wise David J. , White Danielle’ , Ford Lorelei , López‐Porras Adrián , Camus Alvin C. , Hanson Larry A. 
Published: May 2021

AbstractBlue catfish alloherpesvirus (BCAHV) is a novel virus isolated from the blue catfish (Ictalurus furcatus). To date, the ultrastructure, virulence and immunogenicity of BCAHV have not been reported. Given the importance of blue catfish in producing channel ♀ (I. punctatus) × ♂ blue (I. furcatus) catfish hybrids and the increasing demand for hybrid catfish in the US catfish industry, the susceptibility of blue, channel and hybrid catfish to BCAHV was assessed. Further, the cross‐protective potential of BCAHV against Ictalurid herpesvirus 1 (IcHV1) was investigated in channel and hybrid catfish that survive BCAHV exposure. Neutralization assays revealed BCAHV is refractive (neutralization index [NI] = 0) to anti‐IcHV1 monoclonal antibody Mab 95, compared to IcHV1 (NI = 1.8). Exposure of blue catfish fingerling to 1.3 × 105 TCID50/L BCAHV produced cumulative mortality of 51.67 ± 0.70% and pathologic changes similar to those of channel catfish virus disease. No mortality was observed in channel or hybrid catfish. Twenty‐eight days post‐challenge, surviving channel and hybrid catfish were exposed to 9.4 × 104 TCID50/L IcHV1 (LC50 dose), resulting in 100% relative per cent survival compared to naïve cohorts. These data provide baseline information for BCAHV and lay the groundwork for future studies. Data also identify BCAHV as a potential vaccine candidate against IcHV1. Based on host range and immunogenicity evaluations, in addition to genome sequence data from previous studies, BCAHV should be given consideration as a new species of Ictalurivirus.
A computational‐experimental investigation of thermal vapor compressor as an energy saving tool for the crystallization of sugar in a sugar processing plant
Authors: Rezvanivand Fanaei Adel , Nikbakht Ali M. , Hassanpour Ali 
Published: May 2021

AbstractEnergy saving in the food industry is of a great deal of importance. Thermal vapor compressors (TVCs) do not have moving parts which offer advantages including simplicity, low construction capital, and low maintenance costs. In this study, a TVC is designed, and simulated to recover waste vapor streams and reuse the recovered streams in the crystallization of sugar. Computational fluid dynamics is employed to simulate the flows. The effect of motive steam pressure on the entrainment ratio and compressor ratio is simulated. Thermodynamics parameters such as static pressure, temperature, velocity, Mach number, and mass ratios of motive steam and suction are assessed. As the flow is of jet flow type, the realizable k‐e turbulent model is used to model the turbulence. The results show that by applying the motive steam at a pressure of 28 bars (boiler outlet), the pressure and temperature of discharge vapor reach the values of 0.65 bar and 511 K, respectively. The average mass ratios of motive and suction flow at the output of the designed TVC diffuser are 0.59 and 0.41, respectively. As the crystallization pressure demand is 0.6 bar, the findings reveal that the discharged vapor from TVC has sufficient enthalpy to be consumed in the crystallization section, hence making the whole process more efficient.Practical applicationEquipping the crystallization section of the sugar factory with a thermal vapor compressor, beside the recovery of low‐pressure vapor with motive steam, can reduce energy consumption and play a key role in decreasing fossil pollution. Computational Fluid Dynamics is a validated tool in the simulation of the food processing phenomenon. In terms of TVC optimization, the results obtained from this research serve to designers and process managers to get a detailed perception of energy reduction scenarios and recovery of low enthalpy streams.
Osteoporosis, bisphosphonate use, and risk of moderate or worse hearing loss in women
Authors: Curhan Sharon G. , Stankovic Konstantina , Halpin Christopher , Wang Molin , Eavey Roland D. , Paik Julie M. , Curhan Gary C. 
Published: May 2021

AbstractBackgroundOsteoporosis and low bone density (LBD) may be associated with higher risk of hearing loss, but findings are inconsistent and longitudinal data are scarce. Bisphosphonates may influence risk, but the relation has not been studied in humans. We longitudinally investigated associations of osteoporosis and LBD, bisphosphonate use, vertebral fracture (VF), hip fracture (HF), and risk of self‐reported moderate or worse hearing loss.DesignLongitudinal cohort study.SettingThe Nurses' Health Study (NHS) (1982–2016) and Nurses' Health Study II (NHS II) (1995–2017).ParticipantsParticipants included 60,821 NHS women, aged 36–61 years at baseline, and 83,078 NHS II women, aged 31–48 years at baseline (total n = 143,899).MeasurementsInformation on osteoporosis, LBD, bisphosphonate use, VF, HF, and hearing status was obtained from validated biennial questionnaires. In a subcohort (n = 3749), objective hearing thresholds were obtained by audiometry. Multivariable‐adjusted Cox proportional hazards models were used to examine independent associations between osteoporosis (NHS), osteoporosis/LBD (NHS II), and risk of hearing loss.ResultsThe multivariable‐adjusted relative risk (MVRR, 95% confidence interval) of moderate or worse hearing loss was higher among women with osteoporosis or LBD in both cohorts. In NHS, compared with women without osteoporosis, the MVRR was 1.14 (1.09, 1.19) among women with osteoporosis; in NHS II, the MVRR was 1.30 (1.21, 1.40) among women with osteoporosis/LBD. The magnitude of the elevated risk was similar among women who did and did not use bisphosphonates. VF was associated with higher risk (NHS: 1.31 [1.16, 1.49]; NHS II: 1.39 [1.13, 1.71]), but HF was not (NHS: 1.00 [0.86, 1.16];NHS II: 1.15 [0.75,1.74]). Among participants with audiometric measurements, compared with women without osteoporosis/LBD, the mean multivariable‐adjusted hearing thresholds were higher (i.e., worse) among those with osteoporosis/LBD who used bisphosphonates.ConclusionOsteoporosis and LBD may be important contributors to aging‐related hearing loss. Among women with osteoporosis, the risk of hearing loss was not influenced by bisphosphonate use.
Closed‐loop sustainable product design for circular economy
Authors: Hapuwatte Buddhika M. , Jawahir I. S. 
Published: May 2021

AbstractIntensifying global consumption stipulates the use of sustainable manufacturing and circular economy concepts to make products while managing available finite resources. Designers must be equipped to design products considering the economic, environmental, and social impacts of the product life cycle. This paper explores product design in relation to sustainability and circularity principles, presents fundamental concepts, sets definitions, and proposes a new methodology to incorporate these two principles. This new methodology synthesizes elements of design for sustainability and circularity. The primary stakeholder categories are updated to explicitly include “society‐at‐large”—a neglected category in typical manufacturer‐focused sustainability evaluations. Sustainability elements based on the total life cycle approach, including triple bottom line, life cycle perspective, 6Rs, and perpetual resource flow, are integrated with the circular design elements of resource conservation, product‐life extension, and circularity compliance to create the novel closed‐loop sustainable product design methodology. The metrics‐based product evaluation framework presented compels designers to integrate sustainability and circularity elements in the designed products. Sustainability concerns of the product life cycle are evaluated for both negative and positive impacts to identify the value created for all primary stakeholders (i.e., manufacturers, users, and society‐at‐large). This methodology promotes a holistic view of the product life cycle, including end‐of‐life activity planning, leading to a perpetual resource flow. Performance influencing parameters available for designers are also examined, including the overlooked “dedicated” and “incidental” process‐induced types, providing a strong basis for future research on product sustainability predictive models.