bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Influencing Interoperability Level Required for the Implementation of T-Government in Saudi Arabia
Authors: Alshetewi Sameer , Alturise Fahad , Karim Faten
Published: April 2018

Governments around the world have invested significant sums of money on Information and Communication Technology (ICT) to improve the efficiency and effectiveness of services being provided to their citizens. However, they have not achieved the desired results because of the lack of interoperability between different government entities. Therefore, many governments have started shifting away from the original concept of e-Government towards a much more transformational approach that encompasses the entire relationship between different government departments and users of public services, which can be termed as transformational government (t-Government). This implementation of t-Government requires a high level of interoperability between government organisations. In this paper, a model is proposed to explore and investigates the key factors that influence interoperability required for the implementation of t-Government in Saudi Arabian context from four key areas, namely, organisational, technological, political and social using institutional theory as a lens. This model was developed comprising the effect of six main constructs: technological compatibility, organizational compatibility, governance readiness, citizen centricity and e-Government program on interoperability required for the implementation of t-Government. The model factors, relationships, and hypotheses stemmed from the literature on Information Sharing, Information Integration, G2G, interoperability and t-Government models.The results show that technological compatibility, organizational compatibility, and governance readiness have a positive impact on the interoperability required for the implementation of t-Government in this particular context. Unexpectedly, it indicates that citizen centricity has negative impact on the interoperability required for the implementation of t-Government. It also shows that there is a direct and positive impact from e-Government program (Yesser) to technological compatibility and governance readiness. Moreover, it shows that there is a direct and positive impact from citizen centricity to e-Government program (Yesser). Unexpectedly, the results indicate that e-Government program (Yesser) has no impact on the interoperability required for the implementation of t-Government. It also indicates that the e-Government program (Yesser) doesn’t affect organizational compatibility.This paper provides a model for creating interoperability between government organisations to help e-Government officials and policy makers to identify the key factors that can affect the interoperability level required for the implementation of t-Government, and examines how these issues could be treated in practice. It also provides a guideline to researchers with regard to the impact of these identified factors on interoperability required for t-Government implementation.
An Improved Comparison of Chemometric Analyses for the Identification of Acids and Bases With Colorimetric Sensor Arrays
Authors: Kangas Michael James , Wilson Christina L , Burks Raychelle M , Atwater Jordyn , Lukowicz Rachel M , Garver Billy , Mayer Miles , Havenridge Shana , Holmes Andrea E
Published: April 2018

Colorimetric sensor arrays incorporating red, green, and blue (RGB) image analysis use value changes from multiple sensors for the identification and quantification of various analytes. RGB data can be easily obtained using image analysis software such as ImageJ. Subsequent chemometric analysis is becoming a key component of colorimetric array RGB data analysis, though literature contains mainly principal component analysis (PCA) and hierarchical cluster analysis (HCA). Seeking to expand the chemometric methods toolkit for array analysis, we explored the performance of nine chemometric methods were compared for the task of classifying 631 solutions (0.1 to 3 M) of acetic acid, malonic acid, lysine, and ammonia using an eight sensor colorimetric array. PCA and LDA (linear discriminant analysis) were effective for visualizing the dataset. For classification, linear discriminant analysis (LDA), (k nearest neighbors) KNN, (soft independent modelling by class analogy) SIMCA, recursive partitioning and regression trees (RPART), and hit quality index (HQI) were very effective with each method classifying compounds with over 90% correct assignments. Support vector machines (SVM) and partial least squares – discriminant analysis (PLS-DA) struggled with ~85 and 39% correct assignments, respectively. Additional mathematical treatments of the data set, such as incrementally increasing the exponents, did not improve the performance of LDA and KNN. The literature precedence indicates that the most common methods for analyzing colorimetric arrays are PCA, LDA, HCA, and KNN. To our knowledge, this is the first report of comparing and contrasting several more diverse chemometric methods to analyze the same colorimetric array data.
The Equivalence and Nonequivalence of Proverbs Across Cultures (Indonesian and English)
Authors: Lubis Syahron
Published: April 2018

The aim of the present study is to examine whether or not proverbs, culturally-related medium of communication, are equivalent across cultures. The proverbs compared are derived from Indonesian and English cultures, as two distinct cultures. Fifteen Indonesian proverbs and fifteen English proverbs have been compared to find out whether or not they are equivalent in terms of meaning, linguistic structure and culture. The proverbs are collected from a list of well-known Indonesian and English proverbs. Since almost the thirty proverbs are expressed in metaphorical meaning and since Indonesian is still foreign to many international readers the literal meaning of lexical items found in the proverbs have been glossed in brackets followed by the explanation of the metaphorical meaning of the thirty proverbs. Ten Indonesian proverbs are found to be equivalent in terms of meaning to ten English proverbs. In terms of linguistic structure they are almost equivalent that is they are expressed mostly in the form of sentence. But they are different in the use of lexical items that constitute the proverbs. Five Indonesian proverbs are found to be nonequivalent to five of English in terms of meaning and the lexical items used to build the metaphor. Thus it is found out that fifteen Indonesian proverbs are equivalent to fifteen English proverbs and five Indonesian proverbs are found to be nonequivalent to five English proverbs.
Identity Formation and Discourse of Power: A Study of Us, Them and Othering in Nervous Conditions
Authors: Manzoor Fehmida , Khan Fouzia Rehman
Published: April 2018

This study was designed to trace the deconstruction of authoritative officialized history in fiction through Postmodern Historigraphic Metafiction. Historiographic Metafiction dismantles the metanarrative of official history and raises the voice of silenced subaltern thus generates mininarratives. The study is thus grounded in Postmodern Historiographic Metafictional theory of Linda Hutcheon for investigation of the “subversive strategies” of officialized history and deconstruction of positively accentuated binary of “us” and negatively accentuated binary of “them” in the backdrop of postcolonial literary text Nervous Conditions. Norman Fairclough’s model of Critical Discourse Analysis is taken up as a research method for the analysis of fictionalized historical work under study. Finally, text is analyzed leading to the conclusion of the study. The study shows that fiction unveils the official overriding history and provides new perspectives of untold historical events.
Policy Based Approach for Information Transfer over Mobile ad hoc Network using Messages Privacy Control
Authors: Hamad Faten , Adwan Omar
Published: April 2018

Ad Hoc networks are a set of wireless mobile communication nodes (stations, users) that exchange information between different nodes in a dynamic environment. The mobile infrastructure help to form the dynamic network structure. Nodes communicate and send information between each other and with the centralized access points without interference. Each node acts both as a router to information or as an end user node that receive the sent information. Information dissemination between different nodes may face lake of security due to accidental or unauthorized message forward to illegal third party. This paper proposes a policy based approach for information transfer over Mobile ad hoc network (MANET) using messages privacy control where the creator of the message determines the nodes that should receive the message and deny sending the message to other nodes. Each message is sent in combination with a policy which controls its sending behavior at the receiver side. The policy is applied at the application level. A simulation of the proposed approach has been programmed to perform experimental case studies. The results have proven the efficiency of the proposed approach in securing the privacy of information transfer.
Innovation and Perception of Selected New Food Products
and Unusual Marketing Solutions in the Food Market
Authors: Białoskurski Sebastian , Janulewicz Paweł
Published: April 2018

This article concerns issues of innovation management, especially product
innovations (new products) and marketing innovations in context of shaping
a positive image of the offer and in that way achieving a competitive advantage.
The purpose of this article is to determine the effect of the degree of innovation
of food products on their perception. Furthermore, in this article there were
verified opinions of respondents about perception of new products and marketing
innovations (unusual promotion and distribution solutions) used in the food
market which are the result of the creative technique of combination.
Persuasiveness of Human Resources Management – Metaphors in Coaching
Authors: Bielenia-Grajewska Magdalena
Published: April 2018

The important role of communication in human resources leads to the growing interest in the discurse aspect of HRM. The aim of this article is to draw attention to the metaphorical dimension of human resources management, reflected in particular the persuasive character of metaphors and their role in coaching communication. The key features of this discourse have been illustrated by examples from books targeted at people who want to deepen their knowledge about coaching. The main domains used in coaching discourse such as sports, biology, medicine, travel, fairytale and cuisine have been selected on the basis of gathered examples.
Cultural Diversity and Its Implications in Human Resources Management Practice
Authors: Gadomska-Lila Katarzyna
Published: April 2018

The article concerns the problem of human resources management in organizations diversified by national culture. It presents advantages and disadvantages of multicultural organizations, main problems connected with cultural differences as well as strategies for solving them. It points out the important role of the human resources department and of managers of every level in the process of cultural diversity management. The main thesis is presented by describing cases related to a multinational company where the national culture strongly influences human resources practices.
Third Mission of Higher Education Institutions (HEIs) in Poland in the Context of Their Role in Regional Development
Authors: Piotrowska‑Piątek Agnieszka
Published: April 2018

The article concerns the role of HEIs in regional development, with particular emphasis on the concept of the third mission. The aim of the article is to answer the question whether HEIs, while formulating and carrying out their missions and strategies, are oriented to support the process of regional development. The research problem was analyzed in accordance with the principle of methodological triangulation, based on literature review and the results of the author’s own study: the content analysis of the missions and strategies of HEIs, and a survey conducted among rectors of HEIs. The article discusses the concept of the third mission of HEIs as the view reflecting the growing importance of their activities for the benefit of regional communities.  The analysis of HEIs` missions and strategies shows that regional orientation in these documents is articulated in a positive way. The results of the content analysis correspond to the survey results, which show that the activities in the field of third mission are distinctive in the management concepts at the level of HEIs’ missions and development strategies.
Perception of Generation Differences – Interpretations and Conclusions for Leaders of Creative Teams
Authors: Lipka Anna
Published: April 2018

The objective of the article is to prove that there is no justification for attributing particular characteristics to generation Y and Z(C). Taking them for granted (and discarding any thought of possible perceptual distortions or even stereotypes) may result in negative implications for the functioning of creative multigenerational teams, such as research teams.
Intergenerational Diversity Management – Terminal and Instrumental Values in the Opinion of Future Employees of Generation Y Entering the European Labour Market
Authors: Łużniak‑Piecha Magdalena , Kaczkowska‑Serafińska Magdalena
Published: April 2018

The presented article is an analysis of the study on the structure of terminal and instrumental values in the opinion of future employees of Generation Y who in the next few years will enter the European labour market. The presented results show the impact of cultural differences (Poland, Italy, Ukraine, Russia, Belarus) on the above mentioned issues. The results of the research were compared with the results of the research conducted by the authors in previous years, and hence, has shown the optimum direction to shape the intergenerational diversity management system. The aim of the analysis was to identify strategies for managing employees of Generation Y coming from different European countries.
Antinomian Diversity of Organizational Behavior – Selected Aspects of Primary Identity in Empirical Researches
Authors: Januszkiewicz Katarzyna , Bednarska‑Wnuk Izabela
Published: April 2018

The aim of the article in the theoretical layer based on the analysis of the literature on the subject is a description of the concept of diversity and identification of the main indicators of behavioral differentiation in selected aspects of primary identity (gender and age). On the other hand, the empirical goal, the explanation of the gender and age, differentiates the character of the employee‑organization relationship (in four distinct components: location of responsibility for tasks, location of sources of knowledge, location of development responsibility and localization of identification). The article presents the results of empirical research in 2015, on a sample, randomly selected population of 2,274 employees from 40 Polish companies.
Provided Leadership and Selected Outcomes of Trainings in Public Organizations
Authors: Strużyna Janusz , Marzec Izabela
Published: April 2018

Trainings as well as their impact on employability and employees’ performance have been the subject of interest of theoreticians and practitioners of management for a long time. However, according to the literature study, the outcomes of employees’ trainings also depend on the applied style of leadership as well as on the quality of relationships between supervisors and subordinates. This paper tries to answer the question: what are the relationships between transformational leadership, the quality of supervisors’ relationships with subordinates, employees’ trainings and employability, employees’ quality and effort of work in public organizations? This aim will be achieved by presenting the results of literature study and empirical research carried out in public organizations. 1The research project has been financed with the funds of the National Centre for Science granted under the Decision No. DEC‑2013/11/B/HS4/00561.
До питання синонімії назв медичних інструментів і приладів (на матеріалі української і польської термінології акушерства та гінекології)
Authors: Borys Oksana
Published: April 2018

The article presents the analysis of synonymic terms in Polish and Ukrainian terminology. The study was conducted on the names of instruments and equipment used in gynecology and obstetrics in both above mentioned languages. The research results show that synonymy is presented in both terminological systems. Taking into consideration the quantity of synonymic terms in the fi eld of gynecological and obstetric instruments this phenomenon occurs more often in Ukrainian than in the Polish language. The possible reasons of that are considered as well as the solutions for the abovementioned issue. The collected data is an integral part of further substantial case study.
Слово у вимірах історичної пам’яті українців
Authors: Hnatiuk Lidia
Published: April 2018

The article shows that archaic language is one of the components and methods of the
detection of historical memory of Ukrainians. The analysis of the use of such elements in
Old Ukrainian literary language of the 14-18th centuries., in Ukrainian literary language
of the 19-20th centuries and in modern Ukrainian dialects has proved “Ukrainianness” of
some archaic elements of the Ukrainian language, which are perceived by the language
awareness of the modern Ukrainian as elements of the Russian language rather than the
elements of its national identity in the diachronic dimension, as these words do exist in
the modern Russian literary language, while in the New Ukrainian literary language they
are replaced by other lexemes. It is shown that such archaisms in the language awareness
of educated Ukrainians, including writers, acquire additional connotations and update their
historical memory.
Терміни з міжнародними компонентами в сучасній українській мові (лексеми на фоно-….-фон(ія))
Authors: Koczan Iryna
Published: April 2018

Words with international components that serve as terms are concerned in the article. International components may be used both at the beginning of the words and in the end or have binary position in diff erent words. The collected material shows that the function of pre positive and postpositive term elements is diff erent. At the beginning of the word, a component may defi ne the sphere of its application or a certain branch of science, so the postpositive component clearly points out the specifi c group of terms. The words with such international components came into Ukrainian language by different ways: borrowed from Romance and Germanic languages, west slavonic particularly from Polish and could get into our language through Polish or Russian. Today Greek-Latin elements have become building blocks for creating new words in these languages that never happened before. The article deals with the terms including pre positive and postpositive –fon - component. The written out words from explanatory dictionaries edited in diff erent years and published in Ukraine since 1906 made it possible to trace the dynamics of appearance such words in Ukrainian language, identify effi ciency / ineffi ciency of term elements.
Назви релігійних свят як невід’ємний складник української
народнопісенної онімії
Authors: Kolesnyk Natalija
Published: April 2018

The article is one of the series of author’s publications dedicated to sacral space in
Ukrainian song folklore. An analysis of names of religious holidays used in Ukrainian
popular poetic creative works was carried out in the present paper. Despite the fact that
the names are Christian onyms and a part of them is Biblical names, both semantically and
structurally, another part is the names that reveal in their Christianized sound form pagan images, preserving their Pre-Christian symbolism and functional characteristics, and according
to their semantic meaning, connotations quite often correlate with ancient cultural senses.
The composition and inner form of folklore heortonyms (names of holidays) reveal the
peculiarities of Ukrainian Christianity, which is the evidence of dualism characteristic of
popular faith for over centuries. It is evident that Pre-Christian cultural tradition dominates:
symbiosis of two religious paradigms in popular song onymy occured with the prevalence
of pagan traditions.
Паризька школа неовізантизму Михайла Бойчука у творчості Софії
Бодуен де Куртене (до 130- ліття від дня народження)
Authors: Krawczenko Jaroslaw
Published: April 2018

The article considers art of Sofi a Baudouin de Courtenay, Mykhailo Boychuk’s student
during his Parisian period. Over the years of her life in art she decorated with frescoes
and stained glass more than 24 cathedrals and churches all around Poland ”from Yaroslav
to Western borders”. Reff ering to Bizantine artistic tradition and using theoretical and
methodical principles of early Boychuk’s school, she worked at the same time with modern
expressive plastic forms and brought to new life sophisticated colorism of Old-Polish
Gothic. Nevertheless, authentic and self-suffi cient artistic approach, developed by Sofi a
Baudouin de Courtenay, until recently was left behind the offi cial art historical knowledge
in Polish humanities.
„Матуся мала секретарку, котра писала і радо, і скоро”. Роль Юлії
Нєментовської у збереженні творчої спадщини Уляни Кравченко
Authors: Kramar Rusłana
Published: April 2018

Julia-Valerie Niementowska (1899-1982), a daughter of the classic author of Ukrainian
literature Ulyana Kravchenko (1860-1947) devoted her life to ordering and preservation
of her mother’s creativity and her archive. Thanks to her activities, modern scholars can
use valuable documents that relate not only to the life and work of Ulyana Kravchenko,
but also to many fi gures of Ukrainian culture at the end of the 19th and fi rst half of the
20th century. The materials from her mother’s personal archive were located in Kyiv and
Warsaw. On the verge of 1950-1960 a part of the most valuable manuscripts Julia Niementowska
was transferred from the mother’s archive to the Institute of Literature at the
Academy of Sciences of Ukraine. Instead, the bulk of Ulyana Kravchenko’s archive after
the death of Julia Niementowska were moved into the monastic archive of the Basilian
Fathers in Warsaw.
Viscosity and surface tension in the biological microparticle filtration process
Authors: Górka Andrzej
Published: April 2018

The paper uses a simple model to present the effects of viscosity and surface tension on the basic parameters of the biological microparticle filtration process. A single filtration membrane with a uniform transmission structure in 2D space was used for the purposes of this analysis. The filtration system relations are described for the threshold filtration force, maximum and minimum height of the filtered liquid to guarantee stable filtration in a gravity field, and the duration of the process and forces affecting the microparticles during filtration. Based on these relations, the summary shows sample calculations for the base model of negative filtration of biological particles. Keywords: microparticle filtration, filtration screens, biological particle filtration, filtration membranes, sedimentation, kinematic viscosity, dynamic viscosity, liquid surface tension
Зоряна Купчинська, Стратиграфія архаїчної ойконімії України,
Львів 2016, 1278 с.
Authors: Mytnik Irena
Published: April 2018

-
Low cost GNSS receivers in time synchronization systems
Authors: Czopik Grzegorz , Kraszewski Tomasz
Published: April 2018

The GNSS (GNSS — Global Navigation Satellite Systems) receivers can be utilized to obtain accurate time markers. The preliminary results of the cheap GNSS receivers’ tests are presented
in the paper. The one receiver’s price (including antenna) does not exceed 30 $. The studies on the use of receivers in the time synchronization systems were executed. Three identical models of receiver modules were used. The 1PPS (1PPS — 1 Pulse Per Second) signals available on the receiver’s output were used. The 1PPS’s main time characteristics were described. Delay times between different receivers 1PPS signals were measured. Measurements were taken using 1 GHz oscilloscope and precise time/frequency counter T3200U.
Keywords: time synchronization, 1PPS, GNSS, GPS time
Stability analysis of steel compression members under shock loads
Authors: Brzuzy Aneta , Bąk Grzegorz
Published: April 2018

This paper presents the results of a numerical analysis of the elastic-plastic behaviour of steel compression members subjected to compression with a permanent pre-deformation in the longitudinal axis by a longitudinal indispensable shock load. A differential load intensity was considered up to the loss of stability. A finite difference method was applied, with an explicit integration schema for the time of the dynamic stability equations. It was assumed that the precursor to the unstable behaviour of a steel compression member was a continuous deformation of the rod axis, which was defined according to current industry-standard design procedures. Cases of flexible and stiff rods, varying in slenderness, were considered. It was demonstrated that a significant load on the performance of the steel compression members and their buckling mechanisms is attributable to longitudinal wave effects. These longitudinal wave effects cause high-frequency changes in the axial forces with a significant stress concentration due to the effect of reflection from a pinned support. This is critical for the dissipation of internal energy by plastic deformation. The applied research method facilitated an estimation of the dynamic critical forces and their relationships with static values.
Keywords: steel rods with pre-deformation of axis, elastic-plastic behaviour, dynamic stability of rods, differential approximation, effects of axial wave response
A Retrospective Review of Infants Receiving Sildenafil
Authors: De Aliva , Shah Payal , Szmuszkovicz Jacqueline , Bhombal Shazia , Azen Stanley , Kato Roberta M.
Published: April 2018

OBJECTIVE The purpose of the study was to assess mortality in an infant population receiving sildenafil.

METHODS A retrospective review of hospitalized infants at Children's Hospital Los Angeles who received sildenafil between 2008 and 2012 was conducted. Patient characteristics, comorbidities, and treatment characteristics were analyzed. Primary outcome was mortality at discharge. Sildenafil dosage ranges were based on the Sildenafil in Treatment-Naïve Children, Aged 1–17 Years, With Pulmonary Arterial Hypertension trial and were categorized as small (<1.5 mg/kg/day), medium (1.5–3.75 mg/kg/day), large (3.76–7.5 mg/kg/day), and very large (>7.5 mg/kg/day).

RESULTS A total of 147 infants were studied. A total of 82% of patients had severe pulmonary hypertension. Our data revealed 29% mortality at discharge. Mortality increased with increasing sildenafil dosage: 14% (small), 19% (medium), 49% (large), and 90% (very large). On multivariate analysis of sildenafil dosage, other pulmonary hypertension therapies, presence of persistent cardiac shunts, and duration of sildenafil, odds of dying were significantly higher with combined high and very high sildenafil dosage groups compared with combined low and medium dosage groups (OR, 13.2; CI, 4.4–39.5; p < 0.0001).

CONCLUSION Sildenafil was given to critically ill infants with multiple risk factors for mortality. Although higher doses cannot be causally related to mortality, there appears to be no added benefit by escalating the sildenafil dose.
Resource Use Evaluation of Tobramycin Formulations in a State Medicaid Program
Authors: Keast Shellie L.
Published: April 2018

OBJECTIVE Patients with cystic fibrosis (CF) often suffer from chronic infection with Pseudomonas aeruginosa. For patients with CF, 6 years of age and older, with P aeruginosa persistently present in cultures of the airways, the Cystic Fibrosis Foundation recommends the chronic use of inhaled tobramycin to reduce exacerbations. To ease treatment burden, a new dry powder formulation was developed. The objective of this research was to compare resource utilization between tobramycin inhaled solution (TIS) and a new tobramycin dry powder (TIP) formulation in a state Medicaid program.

METHODS Members that switched from TIS to TIP were matched to TIS-only beneficiaries via propensity score based on age, sex, race, and residence location. The outcomes (tobramycin reimbursement, inpatient hospital reimbursement, additional antibiotic therapy reimbursement, length of inpatient stays, odds of adherence, odds of inpatient hospital stay, and additional mean days of antibiotic therapy) were assessed by using multivariable regression and included baseline clinical surrogates.

RESULTS No difference was found between 54 matched members for tobramycin reimbursement, length of inpatient stays, odds of adherence, or odds of hospital stay. Cost of additional antibiotic therapy was higher for TIP (+$518, p < 0.001) and inpatient reimbursement was higher for TIS (+$503, p = 0.031). Additional mean days of antibiotic therapy were lower for TIP (8.6 vs. 10.1, p = 0.374), but was not statistically significant.

CONCLUSIONS In patients that switched from TIS to TIP, an increase in cost of additional antibiotic therapy was observed, while inpatient costs were lower. Research should be considered in larger populations to fully determine the impact of the new dry powder formulation on overall resource use and outcomes.
Comparison of the Pharmacoeconomics of Calfactant and Poractant Alfa in Surfactant Replacement Therapy
Authors: Zayek Michael M. , Eyal Fabien G. , Smith Robert C.
Published: April 2018

OBJECTIVE To compare the pharmacy costs of calfactant (Infasurf, ONY, Inc.) and poractant alfa (Curosurf, Chiesi USA, Inc., Cary, NC).

METHODS The University of South Alabama Children's and Women's Hospital switched from calfactant to poractant alfa in 2013 and back to calfactant in 2015. Retrospectively, we used deidentified data from pharmacy records that provided type of surfactant administered, gestational age, birth weight, and number of doses on each patient. We examined differences in the number of doses by gestational ages and the differences in costs by birth weight cohorts because cost per dose is based on weight.

RESULTS There were 762 patients who received calfactant and 432 patients who received poractant alfa. The average number of doses required per patient was 1.6 administrations for calfactant-treated patients and 1.7 administrations for poractant alfa-treated patients, p = 0.03. A higher percentage of calfactant patients needed only 1 dose (53%) than poractant alfa patients (47%). The distribution of the number of doses for calfactant-treated patients was significantly lower than for the poractant alfa-patients, p < 0.001. Gestational age had no consistent effect on the number of doses required for either calfactant or poractant alfa. Per patient cost was higher for poractant alfa than for calfactant in all birth weight cohorts. Average per patient cost was $1160.62 for poractant alfa, 38% higher than the average per patient cost for calfactant ($838.34). Using poractant alfa for 22 months is estimated to have cost $202,732.75 more than it would have cost if the hospital had continued using calfactant.

CONCLUSION Our experience showed a strong pharmacoeconomic advantage for the use of calfactant compared to the use of poractant alfa because of similar average dosing and lower per patient drug costs.
Extended Interval Tobramycin Pharmacokinetics in a Pediatric Patient With Primary Ciliary Dyskinesia Presenting With an Acute Respiratory Exacerbation
Authors: Higgins Kristi L. , Noda Cady , Stultz Jeremy S.
Published: April 2018

The pharmacokinetics of tobramycin in patients with ciliary dyskinesia have not been previously reported. A 10-year-old female patient with primary ciliary dyskinesia was admitted to the general pediatrics floor with an acute respiratory exacerbation after several months of worsening lung function that was unresponsive to oral antibiotics. Extrapolating from cystic fibrosis dosing regimens, she was given intravenous tobramycin 320 mg (10.3 mg/kg/day) on admission as a result of concern for a Pseudomonas aeruginosa infection. Two-point pharmacokinetic monitoring revealed a maximum serum concentration (Cmax) of 18.9 mg/L and a 24-hour area under the curve (AUC0–24hr) of 58.8 (mg × hr)/L, as well as a volume of distribution (Vd) of 0.5 L/kg and an elimination rate (Ke) of 0.34 hr−1. After a dosage increase to tobramycin 400 mg (12.8 mg/kg/day), pharmacokinetic parameters on 2 assessments were as follows: Vd 0.37 to 0.39 L/kg, Ke 0.33 to 0.39 hr−1, Cmax 27.8 to 28.7 mg/L, and AUC0–24h 78.4 to 89.4 (mg × hr)/L. This was the first case report of aminoglycoside pharmacokinetics in a patient with ciliary dyskinesia. The administration of larger doses (up to 12.8 mg/kg/day) of extended-interval tobramycin, similar to the treatment recommendation of at least 10 mg/kg/day for cystic fibrosis patients, was necessary in this patient to achieve serum concentrations that were appropriate for treatment.
Disulfiram-like Reaction Involving Ceftriaxone in a Pediatric Patient
Authors: Small Stephen M. , Bacher Rachel S. , Jost Sheridan A.
Published: April 2018

Several medications have been shown to cause disulfiram-like reactions in patients concomitantly exposed to ethanol, including specific cephalosporin antibiotics that possess a methylthiotetrazole substituent. Within the cephalosporin class, there are few reports of disulfiram-like reactions with ceftriaxone. This case report is the first to involve a pediatric patient, and it describes a mild but likely disulfiram-like reaction manifesting as facial flushing in an 8-year-old male upon receiving a ceftriaxone infusion preceded by a dose of prednisolone elixir (5% ethanol by volume) for presumed community-acquired pneumonia thought to be complicated by an asthma exacerbation. The patient's flushing resolved with intravenous diphenhydramine, did not reappear, and was diagnosed as an allergy to ceftriaxone. Upon further evaluation, a hypersensitivity reaction was considered unlikely, and the allergy history was revised. The patient's antibiotic treatment was switched to azithromycin without steroids, and he had no further issues. This case suggests there is benefit in increased monitoring of pediatric patients receiving certain cephalosporins along with alcohol-containing medications, and it demonstrates how disulfiram reactions can easily be misinterpreted as hypersensitivity reactions. Aside from just alcohol-cephalosporin interactions, this case underscores the need for general vigilance when using alcohol-containing drug preparations in pediatric patients in an effort to prevent adverse effects and potential drug interactions.
Sedation and Analgesia Using Medications Delivered via the Extravascular Route in Children Undergoing Laceration Repair
Authors: Miller Jamie L. , Capino Amanda C. , Thomas Amber , Couloures Kevin , Johnson Peter N.
Published: April 2018

OBJECTIVES To describe the method of delivery, dosage regimens, and outcomes of sedatives and analgesics administered via the extravascular route for laceration repair in children

METHODS Medline, Embase, and International Pharmaceutical Abstracts were searched using the keywords “child,” “midazolam,” “ketamine,” dexmedetomidine,” “fentanyl,” “nitrous oxide” (N2O), and “laceration repair.” Articles evaluating the use of extravascular sedation in children for laceration repair published in the English language between 1946 and June 2017 were included. Two authors independently screened each article for inclusion. Reports were excluded if they did not contain sufficient details on dosage regimen and outcomes.

RESULTS A total of 16 reports representing 953 children receiving sedatives and analgesics via the extravascular route were included for analyses. A statistical analysis was not performed because of heterogeneity in dosing and types of analyses conducted. Midazolam and N2O were the most common agents, with oral (PO) midazolam being the most common agent. Other agents that have supporting data were intranasal (IN) dexmedetomidine, IN ketamine, IN midazolam, PO diazepam, PO ketamine, transmucosal (TM) midazolam, and TM fentanyl.

CONCLUSIONS Most of the agents administered through the extravascular route were efficacious. Selection of the agents should be based on perceived need for analgesia versus sedation, patient accessibility, and adverse drug events. Future research is needed to determine the optimal agent and route for laceration repair.
Implementation and Impact of an Antimicrobial Stewardship Program at a Non-freestanding Children's Hospital
Authors: Klatte J. Michael , Kopcza Kathleen , Knee Alexander , Horton Evan R. , Housman Erica , Fisher Donna J.
Published: April 2018

OBJECTIVES Pediatric Antimicrobial Stewardship Programs (ASP) have been associated with improvements in antibiotic utilization and patient outcomes; however, ASP studies originating from non-freestanding children's hospitals are lacking. In this study, we present the implementation and impact of a multidisciplinary ASP that employs a collaborative physician and pharmacist driven thrice-weekly prospective audit-with-feedback approach at a non-freestanding children's hospital.

METHODS Implementation was assessed via descriptive design. Pediatric inpatients maintained on predefined targeted antibiotics of interest for 48 to 72 hours preceding ASP review were eligible for inclusion. Outcomes evaluated included ASP recommendation and provider acceptance rates (overall and by antibiotic and provider specialty). Impact was examined using an interrupted time series design (with a preimplementation period of August 1, 2013, to July 31, 2014 and postimplementation period of December 1, 2014 to May 31, 2016). Eligibility included all targeted antibiotic usage among pediatric inpatients, with a control group comprising those who received antibiotics requiring preauthorization. Outcomes analyzed included days of antibiotic therapy per 1000 patient days (DOT/1000 PD) and 30-day hospital readmission rates over time.

RESULTS Postimplementation, 882 antibiotic reviews were performed on 637 patients, with 327 recommendations generated. Reviews of patients maintained on vancomycin and clindamycin, and of those under care of intensivist and hospitalist physicians, were most likely to prompt recommendations. A mean targeted antibiotic usage decrease of 24.8 DOT/1000 PD (95% confidence interval, −62 to 14) was observed postimplementation, with no change in 30-day readmissions (0.64% during both periods).

CONCLUSIONS ASP implementation at a non-freestanding children's hospital was feasible and allowed for identification of areas for targeted quality improvement, while demonstrating modest antibiotic use reduction without adversely impacting patient care.
Use of Individual Pharmacokinetics to Improve Time to Therapeutic Vancomycin Trough in Pediatric Oncology Patients
Authors: Miller Calvin L. , Winans S. Alexander , Veillette John J. , Forland Steven C.
Published: April 2018

OBJECTIVE Optimization of vancomycin dosing is difficult in children, given rapid drug clearance and patient heterogeneity. We sought to evaluate the impact of dosing using individual pharmacokinetic parameters on time to goal trough concentration in pediatric oncology patients.

METHODS A retrospective review was conducted to assess vancomycin dosing in the pediatric oncology unit at Loma Linda University Children's Hospital between January 2013 and August 2013 (standard dosing group [SDG]). These patients were compared to those in a prospective arm that used pharmacokinetic dosing (pharmacokinetic dosing group [PKG]) between March 2014 and May 2015. Outcomes included percent of patients reaching a target trough by the specified time points, number of dose adjustments, number of serum concentrations drawn, and number of patients with supratherapeutic troughs.

RESULTS Of 35 patients meeting inclusion criteria for the SDG, 2 (5.7%) reached goal trough concentration by 48 hours, compared with 14 of 16 patients (87%) in the PKG (p = 0.0001). Significantly more patients reached their goal trough at each time point in the PKG. There was no difference in number of dose adjustments, but significantly more concentrations were drawn on average in the PKG (mean, 4.6 versus 3.1, p = 0.02). In the SDG and PKG, respectively, 1 patient and 3 patients had supratherapeutic trough concentrations (p = 0.09).

CONCLUSIONS Dosing using individual pharmacokinetic parameters led to a significant reduction in time to attain the desired vancomycin trough concentration in our pediatric oncology patients. Given the wide variation in dose requirements in this and other studies, application of patient-specific pharmacokinetics is essential to optimize vancomycin dosing in pediatric patients.
Trauma por acidentes de trânsito após implantação da lei Nº 11.705 - "LEI SECA"
Authors: Geiger Layssa Silva Cardoso , Chavaglia Suzel Regina Ribeiro , Ohl Rosali Isabel Barduchi , Barbosa Maria Helena , Tavares Jordânia Lumênia , Oliveira Ana Carolina D'Arelli de
Published: April 2018

Objetivo: caracterizar la incidencia de traumas por accidentes de tránsito en un municipio del estado de Minas Gerais, un año antes de la implementación de la Ley 11.705 "Ley Seca" y después de la misma. Método: estudio transversal retrospectivo. Se utilizaron los registros de accidentes de tránsito atendidos por el 8º Batallón del Cuerpo de Bomberos y el Servicio de Atención Móvil de Urgencias. Las variables eran: edad y sexo, tipo de accidente, día de la semana, horario, lugar y muertes. Resultados: Hubo 5.904 accidentes: 48,2% antes de la "Ley Seca" y 51,8% después. Fueron socorridas 6.581 víctimas, con predominio del grupo de edad entre 18 y 29 años y del sexo masculino (86,8%). Se observó una reducción significativa del número de muertes (35,7%), predominio de accidentes de motocicleta, en calles y avenidas, los sábados, entre las 17h y las 19h59min. Conclusión: a pesar de la pequeña elevación en el número de accidentes de tránsito después de la implementación de la "Ley Seca", en este estudio se constató una importante reducción del número de muertes, lo cual permite deducir que la ley redujo la gravedad de los accidentes en el municipio estudiado.
Motivo da realização de cesárea segundo relato das mães e registros de prontuários em maternidades de belo horizonte
Authors: Viana Thamara Gabriela Fernandes , Martins Eunice Francisca , Sousa Ana Maria Magalhães , Souza Kleyde Ventura de , Rezende Edna Maria , Matozinhos Fernanda Penido
Published: April 2018

La alta prevalencia del parto por cesárea es un problema de salud pública porque se la asocia al aumento de la mortalidad materna y neonatal, especialmente cuando se realiza sin justificación clínica. El objeto del presente estudio fue evaluar el motivo de realización de cesáreas según los relatos de las parturientas y la información que consta en los expedientes médicos. Se trata de un estudio de cohorte basado en el hospital y desarrollado con datos de la encuesta "Nacer en Belo Horizonte: encuesta sobre el parto y el nacimiento." Se compararon los motivos de la cesárea según los relatos de las madres y la información de los expedientes con las complicaciones clínicas u obstétricas durante el embarazo, el parto, el trabajo de parto y la forma de pago del parto. Del total de 1.088 madres evaluadas, 465 habían realizado el parto por cesárea y fueron incluidas en este estudio. Hubo una diferencia estadísticamente significativa entre los motivos relatados por las madres y aquéllos en los expedientes médicos, lo cual indica la necesidad de rever la formación profesional y el modelo de atención, además de la necesidad de perfeccionar el proceso laboral y las prácticas asistenciales y de fortalecer la autonomía de las mujeres para que tomen decisiones informadas.
Vítimas de acidente motociclístico atendidas em hospital público de ensino
Authors: Silva Amanda Diniz , Alves Gabrielly Cristina Quintiliano , Amaral Eliana Maria Scarelli , Ferreira Lúcia Aparecida , Dutra Cintia Machado , Ohl Rosali Isabel Barduchi , Chavaglia Suzel Regina Ribeiro
Published: April 2018

Los traumatismos, lesiones o cualesquiera otros agravios a la salud, intencionales o no, son considerados causas externas. El objeto de este estudio fue caracterizar el perfil demográfico de las víctimas de traumatismos por accidente de motocicleta e identificar la frecuencia de dichos eventos. Se trata de un estudio retrospectivo, cuantitativo y exploratorio descriptivo, desarrollado en el hospital de clínicas de una universidad pública del estado de Minas Gerais. La muestra estaba compuesta por 64 registros de accidentes de motocicleta. Los pacientes eran mayores de 14 años, permanecieron internados hasta el alta hospitalaria, su transferencia o su deceso. Se utilizó un instrumento adaptado de variables sociodemográficas y aspectos vinculados al evento traumático. Se evidenció que la mayoría de los pacientes era de Uberaba, con enseñanza primaria completa, varones, entre 20 y 29 años y de tez blanca. El principal diagnóstico médico era fractura de diáfisis de la tibia. La mayoría de las lesiones anatómicas era en las extremidades inferiores y el promedio de permanencia en el hospital de 7 días. Los accidentes ocurrían principalmente de noche y durante los domingos. Hubo más internaciones en los meses de marzo y julio. Según la escala de Rankin, las víctimas fueron dadas de alta con incapacidad moderada. Se puede concluir que los accidentes de motocicleta son frecuentes en nuestro medio y que constituyen un problema de salud pública, con riesgo de muerte o de secuelas discapacitantes. Estudios como éste pueden contribuir a elaborar políticas públicas con miras a la implementación de medidas preventivas y de promoción de la salud.
Associação entre o acolhimento com classificação de risco, desfecho clínico e o escore mews
Authors: Mendes Tatiane de Jesus Martins , Silveira Laura Menezes , Silva Lilian Puglas da , Stabile Angelita Maria
Published: April 2018

Objetivo: verificar la asociación entre la clasificación de riesgo, la puntuación de MEWS y el desenlace clínico del paciente atendido en el servicio de urgencias y emergencias. Método: se trata de un estudio transversal de investigación cuantitativa realizado en el servicio de urgencias y emergencias médicas de un hospital privado del interior de São Paulo. Los datos se recogieron entre julio 2014 y junio 2015, con una muestra de 1.674 expedientes médicos de pacientes que buscaron atención clínica. Resultados: entre los expedientes médicos evaluados, el 65% pertenecía a pacientes del sexo femenino, edad promedio de 42 años y queja más frecuente relacionada con el tracto digestivo (el 14,8%). La mayoría de los pacientes atendidos (91,2%) fue clasificada como poco urgente (verde). En el análisis de los desenlaces, el 98,7% fue dado de alta después de la atención médica, con prevalencia de clasificación no urgente. Entre los pacientes remitidos para internación el 59,1% fue clasificado como emergente/urgente. Al comparar la clasificación de riesgo con la puntuación de alerta temprana (MEWS), se observa que la puntuación es superior en los pacientes clasificados como emergentes/urgentes y que los pacientes internados obtuvieron puntuación más elevada que aquéllos dados de alta. CONSIDERACIONES FINALES: los resultados demuestran que la clasificación de riesgo se muestra eficaz en definir la prioridad de atención y en prever el desenlace en un servicio de urgencias y emergencias.