bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heparin resistance in severe thermal injury: a prospective cohort study
Authors: Cato Liam D , Bailiff Benjamin , Price Joshua , Ermogeneous Christos , Hazeldine Jon , Lester William , Lowe Gillian , Wearn Christopher , Bishop Jonathan R B , Lord Janet M , Moiemen Naiem , Harrison Paul 
Published: July 2021

Abstract

Background
Low molecular-weight heparin (LMWH) is routinely administered to burn patients for thromboprophylaxis. Some studies have reported heparin resistance, yet the mechanism(s) and prevalence have not been systematically studied. We hypothesized that nucleosomes, composed of histone structures with associated DNA released from injured tissue and activated immune cells in the form of neutrophil extracellular traps (NETs or NETosis), neutralize LMWH resulting in suboptimal anticoagulation, assessed by reduction in anti-factor Xa activity.

Methods
Blood was sampled from &gt;15% total body surface area (TBSA) burn patients receiving LMWH on days 5, 10 and 14. Peak anti-factor Xa (AFXa) activity, anti-thrombin (ATIII) activity, cell-free DNA (cfDNA) levels and nucleosome levels were measured. Mixed effects regression was adjusted for multiple confounders, including injury severity and ATIII activity, and was used to test the association between nucleosomes and AFXa.

Results
A total of 30 patients with severe burns were included. Mean TBSA 43% (SD 17). Twenty-three (77%) patients were affected by heparin resistance (defined by AFXa activity &lt;0.2 IU/mL). Mean peak AFXa activity across samples was 0.18 IU/mL (SD 0.11). Mean ATIII was 81.9% activity (SD 20.4). Samples taken at higher LWMH doses were found to have significantly increased AFXa activity, though the effect was not observed at all doses, at 8000 IU no samples were heparin resistant. Nucleosome levels were negatively correlated with AFXa (r = −0.29, p = 0.050) consistent with the hypothesis. The final model, with peak AFXa as the response variable, was adjusted for nucleosome levels (p = 0.0453), ATIII activity (p = 0.0053), LMWH dose pre-sample (p = 0.0049), drug given (enoxaparin or tinzaparin) (p = 0.03), and other confounders including severity of injury, age, gender, time point of sample.

Conclusions
Heparin resistance is a prevalent issue in severe burns. Nucleosome levels were increased post-burn, and showed an inverse association with AFXa consistent with the hypothesis that they may interfere with the anticoagulant effect of heparin in vivo and contribute to heparin resistance. Accurate monitoring of AFXa activity with appropriate therapy escalation plans are recommended with dose adjustment following severe burn injury.
Evaluation of Radioactivity in Patient Specimens Received in the Core Laboratory at a National Cancer Institute (NCI) Designated Cancer Center
Authors: Suciu Christopher G , Amurao Max , Luechtefeld David , Marko Areti , Ashby Lori , Gronowski Ann M 
Published: July 2021

Abstract

Background
Biological specimens from patients who have received radiopharmaceuticals are often collected for diagnostic testing and sent to clinical laboratories. Residual radiation has long been assumed to be minimal. However, literature is sparse and may not represent the specimen volumes or spectrum of radionuclides currently seen at National Cancer Institute (NCI)–designated cancer centers. This study examined the radiopharmaceuticals associated with patient specimens received in the hospital core laboratory and assessed the potential risk of external radiation exposure to laboratory personnel.

Methods
The types and amounts of radiopharmaceuticals administered in a large metropolitan hospital system were retrospectively examined over a 20-month study period. The associated biological specimens sent to the largest core laboratory in the system for testing were evaluated. In addition, manual survey meter assessment of random clinical specimens and weekly wipe tests were performed for 44 weeks, and wearable and environmental dosimeters were placed for 6 months.

Results
Over 11 000 specimens, collected within 5 physical half-lives of radiopharmaceutical administration, were processed by our laboratory. Manual survey meter assessment of random clinical specimens routinely identified radioactive specimens. If held in a closed palm for &gt;2 min, many samples could potentially deliver a 0.02 mSv effective dose of radiation.

Conclusions
The laboratory regularly receives radioactive patient specimens without radioactive labels. Although the vast majority of these are blood specimens associated with low-dose diagnostic radiopharmaceuticals, some samples may be capable of delivering a significant amount of radiation. Recommendations for laboratories associated with NCI cancer centers are given.
The discerning ear: cardiac auscultation in the era of artificial intelligence and telemedicine
Authors: Jani Vivek , Danford David A , Thompson W Reid , Schuster Andreas , Manlhiot Cedric , Kutty Shelby 
Published: July 2021

Abstract
Heart murmur, a thoracic auscultatory finding of cardiovascular origin, is extremely common in childhood and can appear at any age from premature newborn to late adolescence. The objective of this review is to provide a modern examination and update of cardiac murmur auscultation in this new era of artificial intelligence (AI) and telemedicine. First, we provide a comprehensive review of the causes and differential diagnosis, clinical features, evaluation, and long-term management of paediatric heart murmurs. Next, we provide a brief history of computer-assisted auscultation and murmur analysis, along with insight into the engineering design of the digital stethoscope. We conclude with a discussion of the paradigm shifting impact of deep learning on murmur analysis, AI-assisted auscultation, and the implications of these technologies on telemedicine in paediatric cardiology. It is our hope that this article provides an updated perspective on the impact of AI on cardiac auscultation for the modern paediatric cardiologist.
Sporulation environment drives phenotypic variation in the pathogen Aspergillus fumigatus
Authors: Earl Kang S , Celia Brandi N , Bensasson Douda , Momany Michelle 
Published: July 2021

Abstract
Aspergillus fumigatus causes more than 300,000 life-threatening infections annually and is widespread across varied environments with a single colony producing thousands of conidia, genetically identical dormant spores. Conidia are easily wind-dispersed to new environments where they can germinate and, if inhaled by susceptible hosts, cause disease. Using high-throughput single-cell analysis via flow cytometry we analyzed conidia produced and germinated in nine environmentally and medically relevant conditions (complete medium, minimal medium, high temperature, excess copper, excess iron, limited iron, excess salt, excess reactive oxygen species, and limited zinc). We found that germination phenotypes vary among genetically identical individuals, that the environment of spore production determines the size of spores and the degree of germination heterogeneity, and that the environment of spore production impacts virulence in a Galleria mellonella host.
Testing the Feasibility of Virtual Reality With Older Adults With Cognitive Impairments and Their Family Members Who Live at a Distance
Authors: Afifi Tamara , Collins Nancy L , Rand Kyle , Fujiwara Ken , Mazur Allison , Otmar Chris , Dunbar Norah E , Harrison Kathryn , Logsdon Rebecca 
Published: July 2021

Abstract

Background and Objectives
This study tests the feasibility of using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild-to-moderate dementia with a family member who lives at a distance.

Research Design and Methods
21 residents in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by 3 weekly VR sessions.

Results
Residents and family members alike found the VR safe, extremely enjoyable, and easy to use. The VR was also acceptable and highly satisfying for residents with MCI and dementia. Human and automated coding revealed that residents were more conversationally and behaviorally engaged with their family member in the VR sessions compared to the baseline telephone call and in the VR sessions that used reminiscence therapy. The results also illustrate the importance of using multiple methods to assess engagement. Residents with dementia reported greater immersion in the VR than residents with MCI. However, the automated coding indicated that residents with MCI were more kinesically engaged while using the VR than residents with dementia.

Discussion and Implications
Combining networking and livestreaming features in a single VR platform can allow older adults in senior living communities to still travel, relive their past, and engage fully with life with their family members, despite geographical separation and physical and cognitive challenges.
Protection of Personal Rights in Poland on the Basis of the Judgment of the Polish Supreme Court – The Tiger Case
Authors: Buchalska Joanna 
Published: July 2021

Abstract
The protection of personal rights in Poland is currently one of the fastest developing areas of law. Each year it is noted that the number of cases in this area is growing, mostly because people are looking to protect their rights, such as freedom, name, pseudonym, image, health or another right on the basis of the Polish Civil Code. It allows them to receive financial compensation where their, mostly, immaterial rights were infringed or when they feel injured. This is also why the open catalogue of the values protected by personal rights is increasing rapidly, and now one can observe that such values as national identity, a sense of belonging to a gender or dignity are protected by these rights. The subject matter of this article is an opinion on the Polish Supreme Court case where the Court decided that the nickname ‘Tiger’ used by a Polish boxer cannot be protected as a personal right on the bases of the Civil Code. This article presents basic information about protecting personal rights in Polish law and sets out the author’s opinion on this case.**
Environmental effects onCalanus finmarchicusabundance and depth distribution in the Barents Sea
Authors: Kvile Kristina Ø , Prokopchuk Irina P , Stige Leif C 
Published: July 2021

AbstractThe vertical migrations performed by zooplankton at daily and seasonal scales are important for marine ecosystem dynamics and biogeochemical cycles. We analysed associations between seasonal variation in abundance and depth distribution of the copepod Calanus finmarchicus and temperature and predation pressure from visual (capelin and herring) and non-visual (ctenophores) predators, using data from a &gt; 30-year survey in the southwestern Barents Sea. Calanus finmarchicus abundances were significantly reduced in upper waters with increased capelin biomass, possibly due to a combination of predation mortality and active avoidance of the upper layer. The weighted mean depth of Calanus finmarchicus tended to become shallower, and abundances in deeper layers lower, with a high probability of ctenophore occurrence, possibly due to a predation effect at depth. Temperature influenced the seasonal timing of Calanus finmarchicus, but appeared less important for depth distribution. This study illustrates how climate-driven changes in the physical and biological environment can influence the seasonal and vertical distribution of zooplankton, which has major implications for the flow of energy and nutrients in marine ecosystems.
Shifting meanings of fazhi and China’s journey toward socialist rule of law
Authors: Ye Ruiping 
Published: July 2021

Abstract
Scholars disagree over the nature, extent, and direction of the rule of law in China. Unlike researchers who see China’s rule of law situation as either static or steadily improving, this article traces the use, meaning, and implementation of fazhi (法治, literally “law governs,” usually translated as “rule of law”) at different stages in China since 1978. It argues that the real meaning of fazhi has changed over the past forty years. Correspondingly, China’s journey towards the socialist rule of law experienced some turns. China went from laying down a foundation for the rule of law in the late 1970s and 1980s, to turning to rule by law in the 1990s and 2000s, and then to using law to legitimize the rule of the Communist Party in the 2010s as the legal system became more mature and more sophisticated. This article further argues that, despite significant improvements in the legal system, socialist rule of law turns out to be the rule of man, with tightened legal institutions and sharpened legal tools, although it is also hoped that the key principles laid down in the 1980s and increased awareness of rights may bring about transformation in the future.
Knowledge and perceptions about antibiotic resistance and prudent antibiotic prescribing among final year medical students in two African countries
Authors: Augie Bashar M , van Zyl Robyn L , McInerney Patricia A , Miot Jacqui 
Published: July 2021

AbstractObjectivesThe objectives of this study were to assess the knowledge and perceptions of final year medical students about antibiotic resistance and antibiotic use to assist in the development of an antibiotic stewardship curriculum for teaching medical students in South Africa and Nigeria and the principles of prudent antibiotic prescribing.MethodsA cross-sectional study was conducted to determine the knowledge and perceptions of final year medical students in one South African and three Nigerian universities about prudent antibiotic use, antibiotic resistance and antibiotic stewardship. A 26-item questionnaire was administered electronically to students in three medical schools and a paper-based copy in the fourth.Key findingsA difference in the gap in knowledge between the two countries was identified; however, respondents from both countries had a similar understanding of antibiotic use and antibiotic resistance. Most respondents in South Africa (94.8%) and Nigeria (91.4%) agreed that antibiotics are overused in their countries. There was a significant difference between the number of respondents in the two countries who thought that there are new antibiotics available to treat resistant pathogens; 45.4% of Nigerian respondents agreed with the statement as compared to 9.6% of the South African respondents. Of the 10 vignettes answered correctly, South African respondents scored an average of 62.4% in the knowledge segment compared to 31.9% scored by the Nigerian respondents (P = 0.001). All of the South African (100%) and 98.3% of the Nigerian respondents indicated their desire for more education on appropriate antibiotic use.ConclusionsAlthough students from both countries had the same perception of antibiotic resistance, there was, however, a difference in their level of knowledge, which could have been improved in both countries. This should be addressed at an undergraduate curriculum level; as well as with continued education to reinforce antibiotic knowledge.
Determinants of the choice of provisionally registered pharmacist (PRP) training in Malaysia: a qualitative insight
Authors: Ooi Guat See , Ong Siew Chin , Kwan Shin May 
Published: July 2021

Abstract

Objective
In Malaysia, due to provisional registered pharmacist (PRP) training places in government hospitals being oversubscribed, pharmacy graduates wait for about a year before starting their training. Therefore, a policy was implemented to allow pharmacy graduates to select their preferred areas of PRP training. This study was conducted to explore the perception and preferences of final year pharmacy students on the current PRP training system.

Methods
This qualitative interview study was conducted among final year pharmacy students. Participants were recruited using convenience sampling until data saturation (i.e., when additional interviews didn’t lead to any new themes). All interviews were audio-recorded, transcribed verbatim, and evaluated by thematic analysis.

Key findings
Twenty-two final year pharmacy students were interviewed. Fifteen of them preferred the government sector as their choice training, three chose the community sector, two preferred private hospitals and another two preferred the pharmaceutical industry. The majority of the students gave positive feedback towards the liberalization of PRP training sites. Most of them chose clinical pharmacy as their preferred training site despite knowing of the saturation issue in government hospitals. This was mainly due to the opportunity to gain clinical experience and knowledge from the government sector. A small number of students preferred the pharmaceutical industry based on their personal interests and opportunities for career advancement.

Conclusion
Pharmacy students generally chose their PRP training site based on personal interest, future career advancement and working environment. A better understanding of career pathways and opportunities in the pharmaceutical industry by the students is required.
Clinical pharmacy services provided in public sector hospitals in Nigeria: a national survey
Authors: Udoh Arit , Akpan Mary , Ibrahim Umar Idris , Lawal Basira Kankia , Labaran Kamilu Sarki , Ndem Ekpedeme , Amorha Kosisochi , Matuluko Ayodeji , Tikare Olubukola , Ohabunwa Unoma , Kpokiri Eneyi 
Published: July 2021

AbstractObjectivesStudies show that clinical pharmacy services are effective in optimizing medicines use and patients' outcomes. This study aimed to determine the clinical pharmacy services provided in public sector hospitals in Nigeria.MethodsThis was an online survey of 296 primary, secondary and tertiary care hospitals sampled purposively across the 36 States and Federal Capital Territory in Nigeria. Data analysis was conducted descriptively via χ 2 test and multivariate analysis of variance (MANOVA).Key findingsResponses were obtained from 272 hospitals in the country with a survey completion rate of 88%. This included 55 tertiary, 72 secondary and 145 primary healthcare centres (PHCs). Pharmacists provided pharmaceutical care services in all the tertiary care hospitals, 94% of the secondary and in only 6% of the PHCs surveyed. Most of the secondary and tertiary care hospitals provided medicines information, patient education and counselling, and in-patient dispensing services [n = 97 (79%), 116 (94%), 88 (72%)], respectively. However, fewer than a third reported involvement in multidisciplinary ward rounds, medication chart review and antibiotic stewardship programmes [n = 18 (15%), 33 (27%), 22 (18%), respectively]. Furthermore, medication error reporting and pharmacovigilance services were each routinely provided in only about half of the secondary and tertiary care hospitals [n = 62 (50%)], and this was not associated with the level of care (P &gt; 0.05).ConclusionsThe findings of this study demonstrate disparity in clinical pharmacy service availability across the various levels of care in Nigeria and emphasize the need to prioritize their integration within the primary care sector.
Competitive balance measures and the uncertainty of outcome hypothesis in European football
Authors: Manasis V , Ntzoufras I , Reade J J 
Published: July 2021

AbstractCompetitive balance is an important issue in professional sport in general and European football in particular. However, competitive balance is difficult to quantify because competitiveness is multi-dimensional and particular sports are distinctive. We aim to identify the most appropriate index for a holistic view of competitive balance in European football. We use data from eight domestic European football leagues over a time span of 60 years. The indices we consider are specifically designed to capture competitiveness at different levels of performance and in this way reflect the peculiarities of European football leagues. Our findings support the longstanding uncertainty of outcome hypothesis. A bivariate index that captures competitiveness in the top K places is shown to have the highest association with attendance. A seasonal index of champions’ domination is also found to have a large association with attendance. Finally, ranking mobility is found to have a slightly higher association with attendance than seasonal performance. These results imply that sports policy makers should use these indices to assess strategic decisions that may influence competitive balance.
Antibiotic stewardship in French nursing homes: a 2019 regional survey
Authors: Belan Martin , Agrinier Nelly , Gonthier Damien , Boivin Jean-Marc , Charmillon Alexandre , Chopard Virginie , Dif Claudine , Hansmann Véronique , Pereira Ouarda , Thilly Nathalie , Pulcini Céline 
Published: July 2021

Abstract

Background
Antibiotic resistance is a growing issue in nursing homes (NHs). Antibiotic stewardship (ABS) programmes can reduce antibiotic use in NHs, but few studies have assessed to what extent they are implemented in NHs.

Objectives
To describe ABS current practices and describe the opinion of NH stakeholders regarding ABS and opportunities for improvement in one French region.

Methods
We invited by e-mail the medical and nurse coordinators of all NHs of the Grand Est region, France, to participate in our survey in 2019. The online questionnaire included 35 questions covering four topics: NH characteristics, current ABS practices, attitudes towards ABS and opinions on strategies to promote ABS. A score evaluating implementation of core ABS elements was calculated using the current ABS practice responses.

Results
Out of 417 NHs, 75 (18%) participated in our survey. The three most implemented ABS activities were antibiotic consumption monitoring (65%), antibiotic plan documentation (56%) and antibiotic prescription guide distribution (54%). Audit and feedback, training sessions or identification of a local ABS leader ranged from 13% to 29%. Participants positively perceived ABS and most suggestions to improve ABS programmes in NH, with maximal interest in training, audit and feedback interventions. The median score for implementation of core ABS elements was 3.3 (IQR = 2.3–5.4; theoretical range 0–11), and the score distribution was not associated with any NH characteristic.

Conclusions
While there is still room for improvement, NHs had a positive attitude towards ABS strategies. Some regional and national initiatives to promote ABS in NHs exist and should be actively promoted.
Falling through the cracks no more? Article 102 TFEU and sustainability: the relation between dominance, environmental degradation, and social injustice
Authors: Iacovides Marios C , Vrettos Christos 
Published: July 2021

Abstract
EU competition law has a sustainability gap, particularly when it comes to enforcing Article 102 TFEU as a ‘sword’ to prohibit dominant undertakings’ unsustainable conduct. In this article, we ask whether EU competition law can and should be part of a holistic EU solution to the climate crisis and how it can contribute to ensuring that our social, economic, and ecological systems are not entrenched into further perpetuating and mutually reinforcing crises. By using EU constitutional theories of ‘mainstreaming’, we argue for the inclusion of environmental and social sustainability goals in those that are pursued by EU competition law. With research that cuts across law and socioecological studies, we offer an original and unique perspective that identifies a relation between market power and business practices that harm people and planet. We do this by demonstrating empirically that undertakings that have in the past been found to be dominant, also engage in unsustainable business practices. This relation is significant, as it demonstrates that addressing unsustainable business practices through Article 102 TFEU is not only a theoretical possibility mandated by EU constitutional law. It is a real opportunity to address environmental and social injustices and thereby contribute to tackling the most important existential threat facing humanity, climate change.