bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of a Solar-Aided Natural Gas Cogeneration Plant Applied to the Textile Sector
Authors: Zuleta Marín Juan Sebastián , Konrad Burin Eduardo , Bazzo Edson 
Published: July 2019

Abstract
Two combined cooling heating power (CCHP) plant layouts are proposed to supply the electricity, heat, and cooling energy demands of textile industries. In the first scenario, natural gas fueled internal combustion engines are integrated with a heat recovery steam generator (HRSG) and a hot water absorption chiller to produce electricity, saturated steam, and chilled water for air conditioning purposes. In the second concept, a linear Fresnel solar field is integrated with the same CCHP to provide fuel economy during the sunny hours. The proposed plants were compared with a base case scenario in which electricity is imported from the grid, saturated steam is provided by a natural gas steam generator (NGSG), and chilled water is provided by electric chillers. Simulations were performed considering mass and energy conservation equations, information provided by equipment manufacturers and typical meteorological year (TMY) data sets for three different locations. The economic performance of plants was evaluated by calculating the net present value (NPV), the internal rate of return (IRR), and the discounted payback period (DPP) of investments. As an important result, a great potential for reducing the fuel consumption and CO2 emissions of hybrid concept was identified. However, the high investment of Fresnel collectors coupled with low natural gas prices showed the proposed hybrid concept as economically unfeasible. Nevertheless, it is expected that hybrid systems will have an important role once Fresnel technology costs are continuously declining and solar energy appears as a promising alternative for the sustainable transition to a low carbon future.
Program Reach and Implementation Feasibility of a Physical Activity School Health Program: A Qualitative Study of Teachers’ Perception
Authors: Guldager Julie D. , Leppin Anja , von Seelen Jesper , Andersen Pernille T. 
Published: July 2019

Background: The reasons for the mixed evidence of the effectiveness of school-based physical activity programs can be many, including implementation challenges. Studying program implementation can potentially contribute to enhancing effectiveness, the design of future interventions, improved implementation, and the interpretation of outcomes. Methods: For this process evaluation, individual interviews were conducted with 16 teachers who had implemented the program “Active All Year Round” in a fifth-grade school class (students aged 9–11 y) in 2017. Through systematic text condensation feasibility and barriers of program implementation, perceived program reach and the programs’ influence on social cohesion were identified and discussed. Results: Teachers described the program as very feasible to implement and identified very few implementation barriers, the most prominent being time constrains. Perceived program reach was very high, and teachers reported that those students who are less confident when it comes to physical activity did not have differential participation than those feeling more confident about physical activity. Finally, the program was perceived to positively affect social cohesion in class. Conclusions: Active All Year Round is a standardized, flexible, and easily implemented program in Danish schools. Future studies are needed to study implementation from a student’s perspective and/or students’ role in and experiences with competition-based health programs.
Late Quaternary slip rates for faults of the central Walker Lane (Nevada, USA): Spatiotemporal strain release in a strike-slip fault system
Authors: Angster Stephen J. , Wesnousky Steven G. , Figueiredo Paula M. , Owen Lewis A. , Hammer Sarah J. 
Published: July 2019

AbstractThe Walker Lane is a broad shear zone that accommodates a significant portion of North American–Pacific plate relative transform motion through a complex of fault systems and block rotations. Analysis of digital elevation models, constructed from both lidar data and structure-from-motion modeling of unmanned aerial vehicle photography, in conjunction with 10Be and 36Cl cosmogenic and optically stimulated luminescence dating define new Late Pleistocene to Holocene minimum strike-slip rates for the Benton Springs (1.5 ± 0.2 mm/yr), Petrified Springs (0.7 ± 0.1 mm/yr), Gumdrop Hills (0.9 +0.3/−0.2 mm/yr), and Indian Head (0.8 ± 0.1 mm/yr) faults of the central Walker Lane (Nevada, USA). Regional mapping of the fault traces within Quaternary deposits further show that the Indian Head and southern Benton Springs faults have had multiple Holocene ruptures, with inferred coseismic displacements of ∼3 m, while absence of displaced Holocene deposits along the Agai Pah, Gumdrop Hills, northern Benton Springs, and Petrified Springs faults suggest they have not. Combining these observations and comparing them with geodetic estimates of deformation across the central Walker Lane, indicates that at least one-third of the ∼8 mm/yr geodetic deformation budget has been focused across strike-slip faults, accommodated by only two of the five faults discussed here, during the Holocene, and possibly half from all the strike-slip faults during the Late Pleistocene. These results indicate secular variations of slip distribution and irregular recurrence intervals amongst the system of strike-slip faults. This makes the geodetic assessment of fault slip rates and return times of earthquakes on closely spaced strike-slip fault systems challenging. Moreover, it highlights the importance of understanding temporal variations of slip distribution within fault systems when comparing geologic and geodetic rates. Finally, the study provides examples of the importance and value in using observations of soil development in assessing the veracity of surface exposure ages determined with terrestrial cosmogenic nuclide analysis.
Indocyanine green angiography for identifying telangiectatic capillaries in diabetic macular oedema
Authors: Castro Farías Daniela , Matsui Serrano Rodrigo , Bianchi Gancharov Juan , de Dios Cuadras Ulises , Sahel José , Graue Wiechers Federico , Dupas Benedicte , Paques Michel 
Published: July 2019

AimsDuring diabetic macular oedema (DME), a spectrum of capillary abnormalities is commonly observed, ranging from microaneurysms to large microvascular abnormalities. Clinical evidence suggests that targeted photocoagulation of large microvascular abnormalities may be beneficial, but their detection is not done in a routine fashion. It was reported that they are better identified by indocyanine green angiography (ICGA) than by fluorescein angiography. Here, we investigated the prevalence and ICGA and optical coherence tomography (OCT) features of retinal microvascular abnormalities in a group of patients with DME.MethodsObservational study. The fundus photographs, ICGA and structural and angiographic OCT charts of 35 eyes from 25 consecutive patients with DME were reviewed.Results22 eyes (63%) had at least one focal area of microvascular abnormalities showing prolonged indocyanine green (ICG) staining (ie, beyond 10 mins after injection). In particular, all eyes (n=9) with circinate hard exudates showed foci of late ICG staining. These areas were either isolated globular capillary ecstasies or a cluster of ill-defined capillary abnormalities. They were located at a median distance of 2708 µm from the fovea (range: 1064–4583 µm). Their diameter ranged from 153 to 307 µm. During ICGA, 91% showed increased their contrast and apparent size in late frames, whereas 79% of microaneurysms showed reduced contrast on late frames. OCT angiography was not contributive for the detection of these lesions.ConclusionLate ICG staining revealing large microvascular abnormalities is commonly observed during DME. Because of their specific angiographic and OCT features relative to microaneurysms, we propose to name them telangiectatic capillaries (TelCaps).
How do stakeholders experience the adoption of electronic prescribing systems in hospitals? A systematic review and thematic synthesis of qualitative studies
Authors: Farre Albert , Heath Gemma , Shaw Karen , Bem Danai , Cummins Carole 
Published: July 2019

BackgroundElectronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of health services, but the translation of this into reduced harm for patients remains unclear. This review aimed to synthesise primary qualitative research relating to how stakeholders experience the adoption of ePrescribing/CPOE systems in hospitals, to help better understand why and how healthcare organisations have not yet realised the full potential of such systems and to inform future implementations and research.MethodsWe systematically searched 10 bibliographic databases and additional sources for citation searching and grey literature, with no restriction on date or publication language. Qualitative studies exploring the perspectives/experiences of stakeholders with the implementation, management, use and/or optimisation of ePrescribing/CPOE systems in hospitals were included. Quality assessment combined criteria from the Critical Appraisal Skills Programme Qualitative Checklist and the Standards for Reporting Qualitative Research guidelines. Data were synthesised thematically.Results79 articles were included. Stakeholders’ perspectives reflected a mixed set of positive and negative implications of engaging in ePrescribing/CPOE as part of their work. These were underpinned by further-reaching change processes. Impacts reported were largely practice related rather than at the organisational level. Factors affecting the implementation process and actions undertaken prior to implementation were perceived as important in understanding ePrescribing/CPOE adoption and impact.ConclusionsImplementing organisations and teams should consider the breadth and depth of changes that ePrescribing/CPOE adoption can trigger rather than focus on discrete benefits/problems and favour implementation strategies that: consider the preimplementation context, are responsive to (and transparent about) organisational and stakeholder needs and agendas and which can be sustained effectively over time as implementations develop and gradually transition to routine use and system optimisation.
Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals
Authors: Robert Glenn , Sarre Sophie , Maben Jill , Griffiths Peter , Chable Rosemary 
Published: July 2019

BackgroundThe ‘Productive Ward: Releasing Time to Care’ programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: (1) Increase time nurses spend in direct patient care. (2) Improve safety and reliability of care. (3) Improve experience for staff and patients. (4) Make changes to physical environments to improve efficiency.ObjectiveTo explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.DesignMultiple methods within six hospitals including 88 interviews (with Productive Ward leads, ward staff, Patient and Public Involvement representatives and senior managers), 10 ward manager questionnaires and structured observations on 12 randomly selected wards.ResultsResource constraints and a managerial desire for standardisation meant that, over time, there was a shift away from the original vision of empowering ward staff to take ownership of Productive Ward towards a range of implementation ‘short cuts’. Nonetheless, material legacies (eg, displaying metrics data; storage systems) have remained in place for up to a decade after initial implementation as have some specific practices (eg, protected mealtimes). Variations in timing of adoption, local implementation strategies and contextual changes influenced assimilation into routine practice and subsequent legacies. Productive Ward has informed wider organisational QI strategies that remain in place today and developed lasting QI capabilities among those meaningfully involved in its implementation.ConclusionsAs an ongoing QI approach Productive Ward has not been sustained but has informed contemporary organisational QI practices and strategies. Judgements about the long-term sustainability of QI interventions should consider the evolutionary and adaptive nature of change processes.
115 Is MBS restriction on EEGs truly beneficial? Retrospective observational analysis of EEG referral patterns
Authors: Ratnayake Chathri , Kokulan Ramja , Carney Patrick 
Published: July 2019

IntroductionThe November 2018 Medicare Benefits Schedule (MBS) Taskforce draft report recommends standardised national referral form for routine electroencephalogram (EEG) requests to prevent low value clinician referrals. MBS defines twelve clinical presentations where routine EEG is of relatively low diagnostic value. We aim to identify proportion of MBS defined low diagnostic value EEGs and likely referral patterns.MethodsRetrospective single centre observational study was conducted from January to December 2018. All EEG referrals to a tertiary hospital neurodiagnostic unit were categorised as low or high yield based on MBS recommendation. Sub-group analysis of the low yield group was carried out.ResultsTotal of 1210 EEG referrals were analysed and 5 were excluded from analysis due to insufficient clinical data. Of these referrals 1114 (92.4%) were for high yield indications, 77 (6.4%) for low yield and 14 (1.2%) were indeterminate as to low or high value. Of low yield referrals, 70% were referred for syncope or presyncope and 18.2% for psychogenic nonepileptic seizures. Low yield EEGs were referred by hospital doctors, neurologists and general partitioners by proportions of 37.7%, 33.7% and 28.6% respectively. Four (5.2%) low diagnostic value EEGs were abnormal.ConclusionCurrent clinical practice for EEG referrals is in line with MBS draft review recommendations. We believe addition of a standardised referral form and restricting referrals will have minimal impact on referral quality.
116 Altered peripheral axonal properties in fibromyalgia
Authors: Lin Cindy (Shin-YI) , Teng Hao-Wen , Tani Jowy , Chen Hung-Ju , Lin Yi-Chen , Chang Tsui-San , Sung Jia-Ying 
Published: July 2019

IntroductionFibromyalgia (FM), a common chronic widespread pain syndrome with neurological symptoms affecting ∼10% of the population worldwide. Whereas small fibre neuropathy is a recognized part of FM, surprisingly little is known about large fibre neuropathy. The present study investigates the sensory and motor axonal properties using novel nerve excitability testing (NET) to seek a better understanding of the pathogenesis of this painful disorder.Methods25 FM patients were recruited from the Wan Fang Hospital in Taiwan who fulfilled the American College of Rheumatology diagnostic criteria.1 NCS, pain scores, blood tests and NET were performed in all patients and patients with factors that may confound the results of NET were excluded. Control data were obtained from age and gender-matched healthy controls (HC) who had no neurological deficits or known pain disorders.ResultsThe FM group showed an increase in superexcitability (p<0.05), subexcitability (p<0.05) and over-shoot during hyperpolarizing threshold electrotonus (p<0.05) in the sensory excitability profiles in contrast to HC. However, motor nerve excitability profiles showed no significant difference.ConclusionsAlterations in the sensory axonal parameters can be detected while NCS is normal, these findings are compatible with the concept that the sensory system is mainly involved in the pathogenesis of FM. Results implied probable hypofunction of the paranodal fast K+ channel in the sensory axons, known to be associated with the generation of pain.2 Our study highlights the advantage of NET over NCS, in the early detection of axonal dysfunction and may provide further understandings of future therapeutic treatment.ReferencesWolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 2011;38(6):1113–1122.Kuwabara S, Misawa S. Pharmacologic intervention in axonal excitability: in vivo assessment of nodal persistent sodium currents in human neuropathies. Curr Mol Pharmacol 2008;1(1):61–67.
128 Late-onset pompe disease (LOPD) presenting with fulminant hypercapnic respiratory failure
Authors: Edwards Leon S , Tchan Michel , Crossley Kate M , Yee Brendon , Spies Judith M 
Published: July 2019

IntroductionWe report a case of LOPD with acute-on-chronic respiratory failure.CaseA 57 year-old retired farmer presented with obtundation requiring intubation. He reported a 4 month history of hypophonia, intermittent diplopia, lethargy and orthopnea.Initial arterial blood gas measurement displayed acute-on-chronic hypercapnic respiratory failure (pH 7.19, pO2 98 mmHg, pCO2 112 mmHg, HCO3 43 mmol/L). Muscle biopsy was suggestive of LOPD with myofibres demonstrating acid phosphatase and periodic acid-schiff positive vacuoles. Diagnosis was confirmed with low α-glucosidase activity on dried blood spot (0.4umol/h/L) and elevated urinary tetrasaccharide level (5 mmol/mol creatinine). Mutation analysis of the GAA gene demonstrated two known pathogenic mutations (c.-32–13T>G and c.1075+1G>T). With improved ventilation, he was able to be extubated. The only respiratory support on discharge was overnight bilevel positive airway pressure ventilation.ConclusionLOPD is a rare autosomal recessive metabolic disorder caused by a deficiency in acid α-glucosidase. This leads to intra-lysomal accumulation of glycogen in tissues. Particularly in the late form, there is significant phenotypic variability.1 Diagnosis remains challenging. Cases have been reported with a range of initial symptoms including stroke,2 syncope3 and chronic respiratory failure.4 Acute on chronic respiratory failure at presentation is rare.Enzyme replacement therapy has been shown to improve both morbidity and mortality in LOPD.5 Earlier treatment is associated with better outcomes.6 Prompt recognition of cases is paramount. Unexplained acute-on-chronic respiratory failure should raise the possibility of this condition. In such cases, management of ventilation is vital.ReferencesChan J, et al. The emerging phenotype of late-onset Pompe disease: A systematic literature review. Mol Genet Metab 2017;120(3):163–172.Hossain MA, et al. A Case of Adult-onset Pompe Disease with Cerebral Stroke and Left Ventricular Hypertrophy. J Stroke Cerebrovasc Dis 2018;27(11):3046–3052.Walczak-Galezewska M, et al, Late-onset Pompe disease in a 54 year-old sportsman with an episode of syncope: a case report. Eur Rev Med Pharmacol Sci 2017;21(16):3665–3667.O’Callaghan C, et al, Adult-onset Pompe disease presenting with insidious hypercapnic respiratory failure. Respirol Case Rep 2016;4(5):e00178.Schoser B, S A, Kanters S, Hamed A, Jansen J, Chan K, Karamouzian M, Toscano A. Survival and long-term outcomes in late-onset Pompe disease following alglucosidase alfa treatment: a systematic review and meta-analysis. J Neurol 2017;264(4):621–630.Chien YH, HW, Lee NC. Pompe disease: early diagnosis and early treatment make a difference. Pediatr Neonatol 2013;54(4):219–227.
131 CLADIN: CLADribine and INnate immune responses
Authors: Monif Mastura , Abdollahi Shokoufeh , Stankovich Jim , Maltby Vicki , Lechner-Scott Jeannette , Kalincik Tomas , Hamilton John , O’Brien Terence , Butzkueven Helmut 
Published: July 2019

IntroductionCladribine Tablets (Mavenclad®) is nucleoside analogue of deoxyadenosine, and an oral treatment for relapsing remitting MS (RRMS). In RRMS clinical trials, Cladribine has been shown to reduce brain atrophy, relapse rates, and new lesions on brain MRI. P2X7R is a purinergic receptor expressed in innate immune cells, and is thought to play a critical role in neuroinflammation. The mechanism of action of Cladribine on peripheral innate immune cells (monocytes), and its effect on P2X7R, is unclear, and forms the basis of this study.MethodsThis will be a Phase IV, multi-centre, 3 year, translational trial. Patients who are starting Cladribine as part of their routine clinical care will consent to take part in the study. Monocyte numbers and activation states will be measured at various times prior and after commencement of therapy. In addition, and in an in vitro setting the effect of Cladribine on P2X7R expression and function will be assessed, as well as measuring various cytokines/chemokines in serum. The laboratory data will also be correlated with clinical data from another long-term Cladribine study, CLOBAS.ResultsThis study has been approved by Alfred Health Human Research Ethics Committee. The study is to commence in April 2019.ConclusionThis study will shed light on whether Cladribine is exerting its beneficial effects via action on peripheral monocytes and alterations of their P2X7Rs. The laboratory and clinical data will be analysed to understand the relationship between innate immune parameters and patient outcome.
015 Unravelling psychosis in motor neurone disease – a study of clinical features, cognition, and survival
Authors: Devenney Emma M , Ahmed Rebekah M , Caga Jashelle , Highton-Williamson Elizabeth , Ramsey Eleanor , Zoing Margaret , Hodges John , Kiernan Matthew 
Published: July 2019

IntroductionPsychotic symptoms are now recognised to occur in patients with MND, often in association with FTD, and particularly in C9orf72 expansion carriers. As yet the impact of these symptoms on the clinical disease state is unknown and the relationship between severity and nature of these symptoms is not well understood. This study aimed to comprehensively explore the relationship between psychotic symptoms, clinical features, cognitive status and survival.MethodsIn total 148 participants; MND (n=100) and MND-FTD (n=48), were enrolled in the study. A detailed clinical interview in addition to a neurological, neuropsychological and behavioural assessment, genetic testing and brain MRI was undertaken in each participantResultsPsychotic symptoms were present in 25% of the cohort. The majority of participants in the psychosis cohort were male (83%) and were negative for the C9orf72 expansion (70%). Psychotic symptoms in younger patients were more likely to be florid, require medication and delay diagnosis. Within the MND subgroup, patients with psychotic symptoms were more impaired in the cognitive subdomains of attention, memory and executive functioning and exhibited more disinhibition, apathy and stereotypy, than patients without psychotic symptoms (all p<0.01), but no differences were identified for the MND-FTD subgroup (all p>0.2). Symptoms of depression were more common in those without psychotic symptoms (p>0.1). Survival was prolonged for patients with psychotic symptoms (HR=4.7, 95% CI: 2.1–10, p<0.001)ConclusionMND with psychosis represents a distinct clinical, cognitive and behavioural phenotype that has a positive impact on survival and may represent an overlap with psychiatric disorders.