bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upgrading municipal lagoons in temperate and cold climates: Total nitrogen removal and phosphorus assimilation at ultra‐low temperatures
Authors: D’Aoust Patrick M. , Vincent Simon , LeBlond Guillaume , Arabgol Raheleh , Hérard Richard , Ahmed Warsama , Guilherme Stéphanie , Kinsley Chris , Delatolla Robert 
Published: May 2021

AbstractIn this study, a municipal lagoon with high wintertime effluent total ammonia nitrogen (TAN) concentrations was upgraded with a pilot‐scale nitrifying‐nitrifying‐denitrifying (NIT‐NIT‐DENIT) moving bed biofilm reactor (MBBR) treatment train to characterize its effluent over wintertime operation, investigate the feasibility of upgrading lagoons to achieve substantial biological total nitrogen removal across ultra‐low temperatures (0.6–3.0) and to investigate nitrification inhibition pathways in facultative lagoon systems at ultra‐low temperatures. Throughout the study, it was observed that the system substantially reduced total nitrogen (TN) and total phosphorus (TP) effluent concentrations by an average of 69.8 ± 24.5% and 74.7 ± 20.1%, respectively. Furthermore, it was observed that sulfide toxicity may play an important role in the inhibition of nitrifying organisms in lagoons. Finally, the MBBR treatment technology has emerged as a suitable and sustainable upgrade technology for existing lagoon and waste stabilization pond facilities operating in temperate, northern and cold climate countries.
COVID‐19 and the UK water sector: Exploring organizational responses through a resilience framework
Authors: Lawson Elizabeth , Bunney Sarah , Cotterill Sarah , Farmani Raziyeh , Melville‐Shreeve Peter , Butler David 
Published: May 2021

AbstractThe unprecedented scale and impact of the COVID‐19 pandemic have required organizations to adapt all facets of their operations. The impact on the UK water sector extends beyond engineering and treatment processes, with social, economic and environmental consequences. Semi‐structured interviews were conducted with executives from 10 UK water companies to investigate the organizational response to the pandemic, and how their response impacted operational delivery. The Safe and SuRe framework was used to structure interview questions and analysis. Emergent themes of changes to customer behaviour, changes to operational practices and industry collaboration were mapped onto the framework and a ripple effect map developed. Lessons learnt highlight a failure to adequately prepare for the scale of the threat, the success of sector‐level collaboration and a need to embrace new ways of working.
Dietary Intake and Gastrointestinal Integrity in Runners Undertaking High-Intensity Exercise in the Heat
Authors: Etxebarria Naroa , Beard Nicole A. , Gleeson Maree , Wallett Alice , McDonald Warren A. , Pumpa Kate L. , Pyne David B. 
Published: May 2021

Gastrointestinal disturbances are one of the most common issues for endurance athletes during training and competition in the heat. The relationship between typical dietary intake or nutritional interventions and perturbations in or maintenance of gut integrity is unclear. Twelve well-trained male endurance athletes (peak oxygen consumption = 61.4 ± 7.0 ml·kg−1·min−1) completed two trials in a randomized order in 35 °C (heat) and 21 °C (thermoneutral) conditions and kept a detailed nutritional diary for eight consecutive days between the two trials. The treadmill running trials consisted of 15 min at 60% peak oxygen consumption, 15 min at 75% peak oxygen consumption, followed by 8 × 1-min high-intensity efforts. Venous blood samples were taken at the baseline, at the end of each of the three exercise stages, and 1 hr postexercise to measure gut integrity and the permeability biomarker concentration for intestinal fatty-acid-binding protein, lipopolysaccharide, and lipopolysaccharide-binding protein. The runners self-reported gut symptoms 1 hr postexercise and 3 days postexercise. The heat condition induced large (45–370%) increases in intestinal fatty-acid-binding protein, lipopolysaccharide-binding protein, and lipopolysaccharide concentrations compared with the baseline, but induced mild gastrointestinal symptoms. Carbohydrate and polyunsaturated fat intake 24 hr preexercise were associated with less lipopolysaccharide translocation. Protein, carbohydrate, total fat, and polyunsaturated fat intake (8 days) were positively associated with the percentage increase of intestinal fatty-acid-binding protein in both conditions (range of correlations, 95% confidence interval = .62–.93 [.02, .98]). Typical nutrition intake partly explained increases in biomarkers and the attenuation of symptoms induced by moderate- and high-intensity exercise under both heat and thermoneutral conditions.
Test–Retest Reliability of Single-Leg Time to Stabilization Following a Drop-Landing Task in Healthy Individuals
Authors: Byrne Aaron , Lodge Clare , Wallace Jennifer 
Published: May 2021

Context: Single-leg stability has been associated with injury risk and is a key component of many injury prevention interventions. Methods of measuring single-leg stability are varied yet often unreliable. Objective: To establish within- and between-day test–retest reliability for single-leg time to stabilization (SL-TTS) following a drop-landing maneuver of 20 cm in height among a healthy cohort. Design: Test–retest reliability study. Setting: Healthy cohort from a third-level educational institution. Participants: Nineteen (11 females and 8 males) healthy individuals. Main Outcome Measures: The SL-TTS in the vertical plane. Results: The SL-TTS showed good within-day (intraclass correlation coefficient = .715) and excellent between-day (intraclass correlation coefficient = .83) test–retest reliability. The minimal detectable change was calculated as 171.6 ms for within-day contexts and 123.8 ms for between-day contexts. Conclusions: This method of measuring SL-TTS is reliable and could be used to detect changes over time in a healthy cohort. This could be of value to clinicians in injury risk factor identification or assessing the effectiveness of single-leg stability training. However, further research is needed to investigate its reliability in pathological populations.
Oxygen saturation reference ranges and factors affecting SpO2 among children living at altitude
Authors: Binene Vanessa , Panauwe Doreen , Kauna Rhondi , Vince John D , Duke Trevor 
Published: May 2021

AimsTo determine reference values for oxygen saturation (SpO2) among healthy children younger than 5 years living at moderately high altitude in Papua New Guinea and to determine other factors that influence oxygen saturation levels.Methods266 well children living at 1810–2630 m above sea level were examined during immunisation clinic visits, and SpO2 was measured by pulse oximetry. Potential risk factors for hypoxaemia were recorded and analysed by multivariable analysis.ResultsThe median SpO2 was 95% (IQR 93%–97%), with a normal range of 89%–99% (2.5–97.5 centiles). On multivariable analysis, younger children, children of parents who smoked, those asleep and babies carried in bilums, a traditional carry bag made of wool or string, had significantly lower SpO2.ConclusionThe reference range for healthy children living in the highlands of Papua New Guinea was established. Besides altitude, other factors are associated with lower SpO2. Some higher-risk infants (preterm, very low birth weight, recurrent acute lower respiratory infection or chronic respiratory problem) may be more prone to hypoxaemia if they have additive risk factors: if parents smoke or they are allowed to sleep a bilum, as their baseline oxygen saturation may be significantly lower, or their respiratory drive or respiratory function is impaired. These findings need further research to determine the clinical importance.
Primary leptomeningeal melanoma: the prognostic significance of its genetic signature and embryological origin
Authors: Buckland Ali , Green Celia , Kho Lay Kun , Prentice David 
Published: May 2021

Primary leptomeningeal melanomas are rare, comprising less than one percent of all brain tumours. They are aggressive and radioresistant tumours, with a poor prognosis. The mainstay of treatment is complete surgical resection and chemotherapy with limited success. Distinguishing a primary leptomeningeal melanoma from the more common metastatic disease can be difficult, and often requires the use of ancillary molecular testing. Primary central nervous system melanomas, including uveal melanomas, frequently exhibit mutations in GNAQ and GNA11, rare in the cutaneous and mucosal counterparts.A case of a primary leptomeningeal melanoma of the cerebellopontine angle is described. Molecular studies identified a GNA11 p.Q209L and a KIT p.M541L missense variant, with losses of chromosomes 1p and 3p demonstrated with cytogenetic studies. Complete surgical resection was not possible and leptomeningeal metastatic disease rapidly ensued despite immunotherapy. Further understanding of the molecular signature may translate to improved diagnosis, prognostication and development of targeted therapies.
Higher contrast thresholds for vanishing optotype recognition in macular visual fields among glaucoma patients: a structure–function analysis
Authors: Wen Yun , Chen Zidong , Chen Shuo , Tan Kaixin , Kong Yang , Cheng Hui , Yu Minbin 
Published: May 2021

Background/aimsWe aimed to explore the impact of glaucomatous macular damage, specifically retinal ganglion cell (RGC) loss, on macular pattern vision measured by the vanishing optotype (VO) recognition contrast threshold.MethodsSeventy-two patients (mean age, 33.51±7.05 years) with primary open-angle glaucoma and 36 healthy controls (mean age, 30.25±6.70 years) were enrolled. VO recognition contrast thresholds of each participant were measured at the 16 preset test locations covering the central 5° visual field (VF). Macular sensitivity (MS) was tested by macular threshold test of Humphrey Field Analyzer. Macular RGC plus inner plexiform layer (GCIPL) thickness was also measured by spectral domain optical coherence tomography.ResultsThe VO contrast threshold demonstrated weak-to-moderate correlations (rho=−0.275 to −0.653) with MS (p<0.001). There was a significantly higher VO contrast threshold in glaucoma group (p<0.0001). At similar levels of MS, patients with glaucoma with GCIPL damage showed remarkably higher VO contrast thresholds than those with preserved GCIPL (p=0.0079). The structure–function relationships between VO contrast threshold and GCIPL thickness (rho=−0.725 to −0.802) were remarkably stronger than those between MS and GCIPL thickness (rho=0.210 to 0.448). VO contrast threshold showed stronger correlation with average GCIPL thickness (rho=−0.362 to −0.778) than MS (rho=0.238 to 0.398) at multiple test locations in glaucoma group.ConclusionsGlaucomatous eyes have higher contrast thresholds for VO recognition in fovea-around VF. Stronger structure–function relationships indicate that VO contrast threshold is more vulnerable to RGC damage.
Fit and filter integrity of a respirator mask after multiple cycles of autoclave
Authors: Desai Nidhi , Naveed Hasan , Koenig Michael , Huber Jörg , Kapur Nikil , Bhutta Mahmood F , Rajak Saul 
Published: May 2021

BackgroundThe COVID-19 pandemic has led to profound shortages in personal protective equipment worldwide. The availability of filtering facepiece class 3 (FFP3) respirators could be greatly increased if they could be reused after sterilisation.AimsTo determine the effects of repeated autoclave cycles on the fit and filter function of the 3M 1863 FFP3 disposable respirator.MethodsParticipants underwent fit tests with 3M 1863 FFP3 respirators. Respirators were subjected to autoclave cycles and a repeat fit test was conducted after each cycle until failure. The filter function of both unused and autoclaved respirators was determined by quantitatively assessing the differential pressures and filter penetration of aerosolised sodium chloride particles. Mask structural inspection was also carried out by light microscopy.ResultsA total of 38 participants were recruited. Repeat fit testing with a new respirator was passed by 30 of 38 (79%) participants in comparison with 31 of 38 (82%) of participants after the respirator had undergone one autoclave cycle. There was fit test failure with further rounds of autoclave. There was no evidence of structural changes after one autoclave cycle, but the nose foam began to separate from the mask following further cycles. Filter efficiency of all 15 autoclaved respirators that underwent filter testing was 97.40% or more. Differential pressure (breathability) of respirators was unaffected by autoclaving.Conclusions3M 1863 FFP3 respirator retains good fit and filter function after a single autoclave cycle. Addressing nose foam separation and further testing to EN149 standards would be required before respirators could be considered for reuse.
Toxicoepidemiology of poisoning exhibited in Indian population from 2010 to 2020: a systematic review and meta-analysis
Authors: Mittal Chaitanya , Singh Surjit , Kumar-M Praveen , Varthya Shoban Babu 
Published: May 2021

ObjectiveTo determine the prevalence of pesticide, corrosive, drugs, venom and miscellaneous poisoning in India.SettingSystematic literature search was done in PubMed Central, Cochrane and Google Scholar databases for studies that satisfied the inclusion criteria. Systematic review and meta-analyses of all observational studies published in the English language from January 2010 to May 2020 were included in this review.ParticipantsPatients exposed to poisoning reported to hospitals were included.Primary and secondary outcome measuresThe prevalence of pesticide poisoning was analysed. The prevalence of poisoning due to corrosives, venom, drugs and miscellaneous agents, along with subgroup analysis based on age and region, was also determined. The percentage of persons with poisoning along with 95% CI was analysed.ResultsPooled analysis of studies revealed that pesticides were the main cause of poisoning in adults, with an incidence of 63% (95% CI 63% to 64%), while miscellaneous agents were the main cause of poisoning in children, with an incidence of 45.0% (95% CI 43.1% to 46.9%), among those presenting to hospitals. Pesticide poisoning was the most prevalent in North India (79.1%, 95% CI 78.4% to 79.9%), followed by South (65.9%, 95% CI 65.3% to 66.6%), Central (59.2%, 95% CI 57.9% to 60.4%), West (53.1%, 95% CI 51.9% to 54.2%), North East (46.9%, 95% CI 41.5% to 52.4%) and East (38.5%, 95% CI 37.3% to 39.7%). The second most common cause of poisoning was miscellaneous agents (18%, 95% CI 18% to 19%), followed by drugs (10%, 95% CI 10% to 10%), venoms (6%, 95% CI 6% to 6%) and corrosives (2%, 95% CI 1% to 2%).ConclusionsPesticide poisoning is the most common type of poisoning in adults, while miscellaneous agents remain the main cause of poisoning in children.PROSPERO registration numberCRD42020199427.
Preconsultation compassion intervention to reduce anxiety among patients referred to a cancer center: protocol for a randomised control trial
Authors: Winn Christine , Generosa Grana , Mazzarelli Anthony , Trzeciak Stephen , Roberts Brian W 
Published: May 2021

IntroductionPatients diagnosed with cancer commonly have a high degree of anxiety during an initial oncology consultation, which may interfere with a patient’s ability to retain information required to make informed treatment decisions. A previous study randomised breast cancer survivors (volunteers) to view either (a) a brief video depicting a standard initial consultation from an oncologist or (b) an identical consultation with the addition of compassionate statements from the oncologist, and found the compassionate statements reduced anxiety among the volunteers. However, while compassionate statements reduced anxiety during simulation, it is currently unknown whether watching a video containing compassionate statements from an oncologist prior to an initial oncology consultation will reduce anxiety among patients referred to a cancer centre. The aim of this randomised control trial is to test whether watching a brief video containing compassionate statements from an oncologist, compared with watching a standard introduction video, prior to an initial oncology consultation will reduce the degree of anxiety among patients referred to a cancer centre.Methods and analysisThis is a prospective, randomised controlled clinical trial at an academic cancer centre. We will enrol adult patients scheduled for an initial oncology consultation. Subjects will be randomly assigned to receive a standard introduction video or enhanced compassion video for viewing prior to the initial oncology consultation. On arrival to the cancer centre, we will measure anxiety severity using the Hospital Anxiety and Depression Scale (HADS). The HADS has two 7-item subscales (HADS anxiety and HADS depression) and is well-validated among oncology patients. We will use Wilcoxon rank-sum test to test for a difference in the HADS subscales between the two video groups.Ethics and disseminationThe Cooper University Hospital Institutional Review Board approved this study. The results from this randomised control trial will be submitted for publication to a peer-reviewed journal.Trial registration numberNCT04503681.
Incidence, risk factors and prognostic effect of imaging right ventricular involvement in patients with COVID-19: a dose–response analysis protocol for systematic review
Authors: Zhou Chenghui , Lou Baohui , Li Hui , Wang Xin , Ao Hushan , Duan Fujian 
Published: May 2021

IntroductionEmerging evidence has shown that COVID-19 infection may result in right ventricular (RV) disturbance and be associated with adverse clinical outcomes. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging RV involvement in adult patients with COVID-19.MethodsA systematical search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (until October 2021) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of RV involvement (dysfunction and/or dilation) assessed by echocardiography, CT or MRI. Secondary outcomes will include the risk factors for RV involvement and their association with all-cause mortality during hospitalisation. Additional outcomes will include the RV global or free wall longitudinal strain (RV-GLS or RV-FWLS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and RV diameter. Univariable or multivariable meta-regression and subgroup analyses will be performed for the study design and patient characteristics (especially acute or chronic pulmonary embolism and pulmonary hypertension). Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of RV involvement incidence and related risk factors, association with all-cause mortality, and other RV parameters (RV-GLS or RV-FWLS, TAPSE, S’, FAC and RV diameter). Both linear and cubic spline regression models will be used to explore the dose–response relationship between different categories (>2) of RV involvement and the risk of mortality (OR or HR).Ethics and disseminationThere was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.PROSPERO registration numberCRD42021231689.
Cultural considerations in debriefing: a systematic review of the literature
Authors: Palaganas Janice C , Charnetski Matthew , Dowell Sharon , Chan Albert Kam Ming , Leighton Kim 
Published: May 2021

BackgroundConversations are influenced by cultural perceptions, beliefs and values. Debriefing is a learning conversation. Without cross-cultural engagement or culturally relevant teaching, learning may be compromised and may result in an outcome opposite of that intended.ObjectiveThis systematic review explores cultural considerations in healthcare simulation debriefing. We sought to explore findings that could help debriefers create culturally responsive and inclusive debriefings.Study selectionStudies were included if they were peer-reviewed articles in any language and focused on healthcare simulation debriefing and global cultural considerations. Research study methods included qualitative, quantitative or both. The review included any health-related profession and level of learner.FindingsThree studies met the criteria. The purposes of the three studies were significantly different and did not directly study cultural considerations in debriefing.ConclusionsThe learner–educator relationship is at risk and learning may be negatively impacted without addressing cultural awareness. More studies are needed to fully describe the effect of culture on successful debriefing.
Survival of people with valvular heart disease in a large, English community-based cohort study
Authors: Taylor Clare J , Ordóñez-Mena José M , Jones Nicholas R , Roalfe Andrea K , Myerson Saul G , Prendergast Bernard D , Hobbs FD Richard 
Published: May 2021

ObjectiveValvular heart disease (VHD) is present in half the population aged >65 years but is usually mild and of uncertain importance. We investigated the association between VHD and its phenotypes with all-cause and cause-specific mortality.MethodsThe OxVALVE (Oxford Valvular Heart Disease) population cohort study screened 4009 participants aged >65 years to establish the presence and severity of VHD. We linked data to a national mortality registry and undertook detailed outcome analysis.ResultsMortality data were available for 3511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Most had some form of valve abnormality (n=2645, 70.2%). In adjusted analyses, neither mild VHD (prevalence 44.9%) nor clinically significant VHD (moderate or severe stenosis or regurgitation; 5.2%) was associated with increased all-cause mortality (HR 1.20, 95% CI 0.96 to 1.51 and HR 1.47, 95% CI 0.94 to 2.31, respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and advanced mitral annular calcification (MAC, 1.31%) were associated with an increased risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively). Mortality was highest for people with both clinically significant VHD and advanced aortic sclerosis or MAC (HR 4.38, 95% CI 1.99 to 9.67).ConclusionsAdvanced aortic sclerosis or MAC is associated with a worse outcome, particularly for patients with significant VHD, but also in the absence of other VHD. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect its relatively low prevalence in our cohort.