bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency medical services (EMS) and waste: a review of the literature on sustainable EMS waste management
Authors: Nichols Andrew , Allum Pete 
Published: November 2015

Waste management contributes significantly to the financial costs and carbon footprints of healthcare organisations, thus contributing to climate change and subsequent harm to health. Increasing efficiencies and the introduction of sustainable waste management practice within healthcare organisations, including emergency medical services (EMS), could reduce associated CO2 and other greenhouse gas emissions while reducing costs, enabling funding to be reinvested in patient care. This article aims to contribute to the discussion of sustainable healthcare waste management, particularly within EMS, and provides a review of the literature on this topic. The literature suggests there is a growing interest among EMS in the efficient use of resources and there has been some gradual change in practice, including the introduction of sustainable waste management practices. The literature also reveals that empirical research discussing greenhouse gas emissions associated with EMS is limited, particularly in regard to waste management. The evidence indicates that there is scope for further research investigating the environmental impacts of EMS. Such research could specifically investigate the CO2 emissions associated with EMS waste management and interventions that might reduce these emissions, with the potential sequelae of cost savings or income generation.
The perceived concerns of newly qualified paramedics commencing their careers: a pilot study
Authors: Thompson Sally 
Published: November 2015

Objective: To identify the perceived concerns of newly qualified paramedics commencing their careers and how they may be subsequently supported both in university and practice. Methods: A pilot study using a focus group approach to collect qualitative data from a selection of newly qualified paramedics regarding their perceived concerns when first becoming clinical lead. Transcripts were analysed and themes generated. Results: Four paramedics attended the session. Themes emerged around confidence, defensive practice and theory to practice application. Confidence appeared to be a key topic and linked into all the other themes. Conclusions: Newly qualified paramedics have the clinical knowledge and application but lack confidence in their own abilities due to lack of exposure and experience. They rely on support given to them by colleagues, peers and preceptors in the early stage of their careers.
A retrospective observational study to explore the introduction of the National Early Warning Score in NEAS
Authors: McClelland Graham 
Published: November 2015

Background: The National Early Warning Score (NEWS) is a simple, rapid assessment tool compiled from respiratory rate, oxygen saturations, supplemental oxygen, temperature, systolic blood pressure, heart rate and level of consciousness developed by the Royal College of Physicians. NEWS was introduced into practice at North East Ambulance Service NHS Foundation Trust (NEAS) between April 2013 and March 2014. This paper will examine the use of NEWS in pre-hospital practice and seek to describe the patient population in terms of NEWS. Methods: Cross-sectional samples of patient records from NEAS attendances over two 24-hour periods were examined for NEWS usage, completeness of necessary observations and outcomes that may be linked to NEWS. A primary sample from 8 July 2013 included 100% of patients. A secondary sample of 10% of patients was taken from 1 April 2014. Results: Although 90% of all cases may be suitable for NEWS <1% (n=6) of patients attended had NEWS recorded. Of the NEWS elements only temperature was not consistently recorded. 95% of sets of observations included >4 NEWS elements. A consistent pattern emerged when the sample population was described according to NEWS using three methods of accounting for missing items of data. Pre-alerting based on NEWS was examined with little agreement between NEWS and current practice found, although this does not take into account practical reasons for pre-alerting such as underlying condition or local pathways. Conclusions: NEWS is not being documented by ambulance crews although the majority of the necessary elements are being recorded. This largely descriptive account of the use of NEWS within NEAS indicates that NEWS has not been adopted by ambulance crews.
Developing understanding and awareness of children's distress, distraction techniques and holding
Authors: Preston Christopher , Bray Lucy 
Published: November 2015

Purpose: This project aimed to evaluate the influence of an education session on ambulance clinicians' understanding and awareness of children's distress, distraction techniques and holding in the pre-hospital setting. Methods: An inter-professional education session that focused on raising awareness of children's distress, the use of distraction techniques and clinical holding during pre-hospital care was provided. A mixed methods approach was then used to evaluate both existing and newly acquired knowledge and opinion through the use of questionnaires (n=26) and focus group discussion (n=20). Results: Despite literature suggesting that ambulance clinicians may not use distraction techniques during pre-hospital care, data gained from this project indicates that use of distraction techniques is widespread (92%, n=24) and has been adapted to fit within pre-hospital care. The inter-professional education event was reported as being of value for ambulance clinicians. Conclusions: Ambulance clinicians endeavour to provide a positive experience for children undergoing procedures, despite reported limitations in education, exposure and equipment. By using a collaborative and consultative education event, it is possible to facilitate ambulance clinicians to challenge their practice and improve their reported knowledge of dealing with children during procedures in the pre-hospital setting. Additional work needs to be undertaken to further explore and improve pre-hospital practice in relation to children's distress and clinical procedures.
Prioritising the development of paramedic students' interpersonal skills
Authors: Lucas Peter V , McCall Michael J , Eccleston Claire , Lea Emma , Stratton Brigit , Annear Michael , Crisp Elaine , Elliott Kate-Ellen , Robinson Andrew 
Published: November 2015

Objective: This paper analyses residential-aged care clinical placements undertaken by undergraduate paramedic students participating in the Wicking Dementia Research and Education Centre's ‘Teaching Aged Care Facilities Program’. Benefits of the placement in facilitating the development of critical interpersonal skills are identified and discussed. Setting: A cohort of final year undergraduate students (n=31) completed a five-day clinical placement in four participating residential-aged care facilities in Tasmania, Australia. Method: The research involved the collection of qualitative data during student feedback meetings at the end of students' placements. The data were analysed using a thematic analysis approach. Additionally, quantitative data from pre- and post-placement surveys were collected and analysed using IBM SPSS Statistics 20.0.0. Results: The research found that students benefited from the placement in terms of developing their interpersonal skills. Students demonstrated an increased understanding of dementia and improved communication strategies for working with people with dementia. Conclusions: Paramedic clinical placements in residential-aged care facilities address two key issues identified by the Australian Learning and Teaching Council, these being a lack of interpersonal skills among graduate paramedics and a shortage of alternative learning sites.
Challenges of postpartum haemorrhage: a case study in the aeromedical retrieval environment
Authors: Proctor Jeffrey , Sinclair Neil 
Published: November 2015

Postpartum haemorrhage is one of the main causes of maternal deaths worldwide. The presentation of this aetiology in the remote and rural setting presents significant challenges to both referring and retrieval clinicians. A safe, timely and robust response to transferring these patients direct to definitive care is necessary. This article considers the case of a 36-year-old female who presented to the Emergency Medical Retrieval Service with a slow but worsening onset of abdominal pain and persistent vaginal bleeding. The patient was 16 days postpartum following the uncomplicated birth of her third child. Treatment delivered to the patient is included in the case example and discussion given to challenges faced in the areomedical retrieval environment. Considerations during treatment, such as communication, resuscitation, investigation and monitoring are also presented.
Infections of the heart and how they relate to the ambulance service
Authors: Savage Leon 
Published: November 2015

Background: In the pre-hospital environment, the treatment of acute coronary syndrome (ACS) is at the forefront of most clinicians’ priorities when symptoms include non-traumatic chest pain. As ACS is a leading cause of preventable deaths, less emphasis is placed on other potentially life-changing conditions that are associated with non-traumatic chest pain. Objectives: This article discusses the three main groups of cardiac infections (pericarditis, myocarditis, and endocarditis). It then discusses how they can be identified in the pre-hospital setting and how the ambulance service can contribute to the subsequent diagnosis of patients presenting with these conditions. Discussion: Pericarditis is a relatively common cause of non-traumatic chest pain. It has symptoms that can be found in the pre-hospital environment such as specific ECG changes and symptoms that can be identified during an initial consultation. Myocarditis has a low incidence rate as well as a wide variety of symptoms that can be associated with other common ailments. It is a very hard condition to determine in the pre-hospital environment. Endocarditis in the intravenous drug user population is a significant condition and has a high mortality rate.
A pilot study exploring the accuracy of pre-hospital sepsis recognition in the North East Ambulance Service
Authors: McClelland Graham , Jones Jacqui 
Published: November 2015

Background: Over the past decade there has been a focus on improving pre-hospital recognition and treatment of patients with sepsis. This pilot study investigates pre-hospital sepsis recognition, including the use of a Sepsis Screening Tool (SST), treatment and whether timely identification influenced the time to treatment and outcome at the receiving unit. Methods: A cross-sectional sample of patients with a documented suspicion of sepsis by North East Ambulance Service NHS Foundation Trust (NEAS) was combined and cross referenced with patients coded for sepsis at The James Cook University Hospital (JCUH) to generate a sample of sepsis patients seen within January 2014. NEAS sepsis recognition was compared with SST identification by retrospectively examining patients' medical records. Sensitivity and specificity for NEAS diagnosis were calculated by comparing NEAS identification with JCUH diagnosis using the hospital SST. Results: The sample included 49 patients from January 2014. NEAS correctly identified 18/42 patients with sepsis (43% sensitivity, 14% specificity). NEAS correctly identified 8/27 patients with severe sepsis (30% sensitivity, 77% specificity). Conclusions: It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Use of the SST would improve the ability of NEAS clinicians to identify patients with sepsis.
Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy
Authors: Waterford Stephen D. , Rastegar Michelle , Juan Viviana , Khoynezhad Ali 
Published: November 2015

Minimally invasive cardiac surgical techniques include the use of partial sternotomy for aortic valve and mitral valve replacement. Partial sternotomy is associated with less pain, better chest and upper-sternal stability, shorter hospital stays, and faster recoveries. However, aortic arch operations are still typically performed through median sternotomies.
We describe the case of a 77-year-old woman who underwent elective hemiarch replacement because of an asymptomatic ascending aortic aneurysm. She requested a minimal incision. Our J-shaped partial lower sternotomy adequately exposed the proximal aorta and enabled all cannulations to be performed through the sternotomy. The patient had an uncomplicated postoperative course. We think that a partial sternotomy for ascending aortic and hemiarch replacement can be considered in selected patients for whom the procedure's benefits are important.
The Mesozoic megafossil genus Linguifolium Arber 1917
Authors: Pattemore Gary A. , Rigby John F. , Playford Geoffrey 
Published: November 2015

Abstract
The plant megafossil genus Linguifolium Arber 1917 is chiefly known from the Middle and Upper Triassic of Gondwana. The range of Linguifolium extended beyond Gondwana by the Late Triassic, persisting there through the earliest Jurassic (Hettangian). The parent plants probably grew in a well-watered, canopied environment.
Diagnoses of the genus and four of its species - Linguifolium tenison-woodsii (Shirley 1898) Retallack 1980, L. waitakiense Bell in Bell et al. 1956, L. parvum Holmes & Anderson in Holmes et al. 2010, and L. steinmannii (Solms-Laubach 1899) Arber 1917 - are emended with particular reference to venation and leaf morphology; consequently, the stratigraphic ranges of the species have been more precisely defined.
Coalescent venation has previously been reported in some species of Linguifolium and is identified in new material described herein. Although the vast majority of specimens assigned to the genus are from the Upper Triassic, none shows coalescent venation. This character is entirely restricted to the Middle Triassic, in particular to two species: L. waitakiense and L. parvum.
Linguifolium tenison-woodsii is restricted to the Carnian-lowermost Norian of Australia and South Africa and is recorded here for the first time from the Tarong Basin (upper Carnian), Queensland. Confusion regarding assignment of specimens to this species from the Middle Jurassic of Queensland is resolved.
Effectiveness of Gaalas Phototherapy According to Diagnostic Criteria for Tемрoromandibular Disorders
Authors: Nencheva-Sveshtarova Savina , Sveshtarov V. , Uzunov Ts. , Prodanova K. 
Published: November 2015

Summary
The objective of this study was to test the clinical effectiveness of the combined gallium-aluminum-arsenide laser (GaAlAs; 785 nm) and superluminiscent diods (SLD; 633 nm) phototherapy (MedX 1100 device) for the treatment of 62 patients with 7 of the most common pain-related temporomandibular disorders with highest sensitivity and specificity according to diagnostic criteria DC/TMD. Using paired samples t-test a positive effect in the pain relief for all tested conditions was demonstrated. The most manifested and statistically significant reduction of pain was found in arthralgia attributed to osteoarthritis and systemic (rheumatoid) arthritis (p = 0.0000001), and disc displacement without reduction with limited opening (p = 0.0000002). Similar levels of pain reduction were found in arthralgia attributed to subluxation, myofascial pain with referral, local myalgia (p values vary between 0.000001 and 0.000284); the lowest values were recorded for myofascial pain (p = 0.001789) and hypermobility-related myalgia (p = 0.018443). The combined laser and SLD phototherapy can be defined as very effective treatment option particularly in pain reduction of internal derangement disorders as well as in some myogenic-related pain conditions affected by TMJ dysfunction.
Layered polymer GRIN lenses and their benefits to optical designs
Authors: Boyd Andrew , Ponting Michael , Fein Howard 
Published: November 2015

Abstract
We discuss the findings of a recent optical design study into layered polymeric gradient index lenses (known as L-GRIN). A range of GRIN singlet lenses were designed for various aperture and field-of-view configurations. Their optical performance was compared to polymer diffractive lenses and glass-cemented doublets (both spherical and aspheric) designed to the same specification. We find that diamond-turned polymer GRIN lenses offer comparable performance to achromatic doublets and polymer diffractive hybrid elements over a significant aperture and field-of-view range. We also find that the correction potential of GRIN solutions is substantially increased when the bulk GRIN Abbé value (V
10) is negative, the GRIN distribution is radial, or the index range (ΔN) of the GRIN is increased significantly.
A Generalized Multi Criteria Decision Making Method Based on Extension of ANP by Enhancing PAIR WISE Comparison Techniques
Authors: Barve Arpita , Deepa N. , Ravi Chandrasekar 
Published: November 2015

Abstract
A model of multi criteria decision making based on extended ANP has been provided and the existing AHP scale method is replaced by another method, in which the user has to provide fewer inputs. To check the validity of the proposed method, a sample data has been taken and an enhanced method is applied on it.
Improved Cross Entropy Measures of Single Valued Neutrosophic Sets and Interval Neutrosophic Sets and Their Multicriteria Decision Making Methods
Authors: Ye Jun 
Published: November 2015

Abstract
Due to some drawbacks of the cross entropy between Single Valued Neutrosophic Sets (SVNSs) in dealing with decision-making problems, the existing single valued neutrosophic cross entropy indicates an asymmetrical phenomenon or may produce an undefined (unmeaningful) phenomenon in some situations. In order to overcome these disadvantages, this paper proposes an improved cross entropy measure of SVNSs and investigates its properties, and then extends it to a cross entropy measure between interval neutrosophic sets (INSs). Furthermore, the cross entropy measures are applied to multicriteria decision making problems with single valued neutrosophic information and interval neutrosophic information. In decision making methods, through the weighted cross entropy measure between each alternative and the the ideal alternative, one can obtain the ranking order of all alternatives and the best one. The decision-making methods using the proposed cross entropy measures can efficiently deal with decision making problems with incomplete, indeterminate and inconsistent information which exist usually in real situations. Finally, two illustrative examples are provided to demonstrate the application and efficiency of the developed decision making approaches under single valued neutrosophic and interval neutrosophic environments.
Robust Stability Analysis for a Perturbed Single-Area Power System Model
Authors: Savov Svetoslav , Popchev Ivan 
Published: November 2015

Abstract
This research work investigates the derivation of a fixed upper matrix bound for the solution of one class of parameter-dependent Continuous Algebraic Lyapunov Equations (CALE). It is supposed that the nominal coefficient matrix is subjected to real structured parametric uncertainty belonging to a convex set. The bound is used to analyze the robust stability and the performance behavior of a load-frequency control system for a single area power system model. By means of the bound one can easily estimate the distance from instability of the uncertain system and the linear quadratic performance index associated with it. The applicability of the obtained results is illustrated by an example.
BRLO-Tree: A Data Structure Used for 3D GIS Dynamic Scene Rendering
Authors: Wang Wenju , Xuan Zhang , Sun Liujie , Jiang Zhongmin , Shang Jingjing 
Published: November 2015

Abstract
BRLO-Tree (Block-R-Tree-Loose-Octree) is presented in this paper based on the R-Tree and Loose-Octree. The aim of the structure is to visualize the large scale and complex dynamic scenes in a 3D (three-dimensional) GIS (Geographic Information System). A new method of clustering rectangles to construct R-tree based on an improved K-means algorithm is put forward. Landform in 3D GIS is organized by R-Tree. The block is used as the basic rendering unit. The 3D objects of each block are respectively organized by a Loose-Octree. A series of techniques, based on this data structure, such as LOD (Level of Detail), relief impostors are integrated. The results of the tests show that BRLO-Tree cannot only support the large scale 3D GIS scene exhibition with wandering and fighting, but it can also efficiently manage the models in a dynamic scene. At the same time, a set of integrated techniques based on BRLO-Tree can make the rendering pictures more fluence and the rendering time vastly improved.
Qualitative and quantitative analysis
of polyphenolic compounds in Ilex Sp.
Authors: Zwyrzykowska Anna , Kupczyński Robert , Jarosz Bogdan , Szumny Antoni , Kucharska Alicja Z. 
Published: November 2015

Abstract
Natural compounds are an important source of desired biological activity which help to improve nutritional status, enhance productivity and bring many health benefits. The leaves of the Ilex paraguariensis (Aquifoliaceae) are used for preparing a beverage known as yerba mate and represent a proven source of natural polyphenols which are known to foster biological activity with the emphasis on antioxidant properties. In present work we focused on the polyphenolic content of air-dried leaves of Ilex aquifolium L., Ilex aquifolium ‘Argentea Mariginata’, Ilex meserveae ‘Blue Angel’, and a commercially available mate as the reference product. Liquid chromatography combined with mass spectrometry (HPLC and LC-MS) and thin layer chromatography (TLC), were used to establish polyphenolic substances content in aqueous methanolic extracts obtained from the biological matter. Up to 20 polyphenolic compounds were identified in the extracts, including rutin, quinic acid and its caffeoyl esters, i.e. chlorogenic acid and its isomers as well as dicaffeoyl derivatives. We took chlorogenic acid and rutin as reference compounds to quantify their levels in the extracts. It was determined that in all tested plants, high levels of these antioxidants were present. This led us to the conclusion that their leaves might serve as valuable food additives.
Treatment of wastewater from production
of meat-bone meal
Authors: Makara Agnieszka , Kowalski Zygmunt , Saeid Agnieszka 
Published: November 2015

Abstract
The paper presents the results of the selection of the flocculent and coagulant types as well as the evaluation of the best parameters of treatment of wastewater deriving from meat-bone meal (MBM) production. The efficiency of purification depends on the composition of the coagulant and flocculent as well as the magnitude of the applied dose. The use of ferrous sulfate PIX 113 coagulant assured the highest reduction of the contamination content in filtrate, resulting in the reduction of color of wastewater by 96.8%, turbidity by 99.2%, and the phosphorus content by 99.9% and nitrogen by 92.4%, with the Chemical Oxygen Demand (COD) being reduced by 62.8%. The X-ray method proved the significant presence of phosphorus salts in the content of sediment. The moisture content in the sediment varied from 45 to 78.5%. The elaborated method of pretreatment of wastewater from meat-bone meal unit was verified on an industrial scale. A very high reduction of the phosphorus content in filtrate (> 99.9%), and a significant reduction of COD as well as nitrogen and suspended solid contents (90−95%) were presented. A high reduction of contamination in filtrate increases the production capacity of the existing biological treatment plant, in the next step of treatment of filtrate in the biological treatment unit.