bluuebunny/crossref_metadata_2025 huggingface dataset:
Production and Characterisation of Cork Pellets: An Alternative for Sustainable Energy Recovery
Authors: L.J.R. Nunes  , J.C.O. Matias  , J.P.S. Catalão
Published: May 2017

The cork industry presents itself as one of the most entrepreneurial in the Portuguese industrial sector, contributing significantly to the increase of exports. However, it is an industry in which the use of raw materials is maximised leaving a large volume of waste. The cork industry has tried to take advantage of these residues, mainly through direct energy recovery, despite the technical and safety difficulties presented by the use of such low density material, which complicates and hinders its transportation for industrial uses outside the area in which it is produced. The densification process opens new doors for such use and also for its storage, because it produces better results when compared with other more common products, such as wood sawdust or even forest and agricultural waste. Thus, cork pellets emerge as a safer and more easily transportable alternative for energy recovery from cork dust and other granulated types of cork waste, which offer the prospects for wider use. The results demonstrate that cork pellets have higher calorific value when compared with other biomass pellets; typically, approximately 19 MJ/kg with 2% volume of ashes, which is equivalent to that obtained from the combustion of pellets produced from combined forest and agricultural waste with a bulk density of 640 kg/m3, which offers real advantages in terms of logistics.
Prueba piloto de implementación del estándar de catalogación RDA en Colombia
Authors: Tuso González Fabio Ernesto
Published: May 2017

La Biblioteca Nacional de Colombia, como ente rector en la formulación, coordinación y ejecución de políticas, planes y programas relacionados con el procesamiento técnico del patrimonio bibliográfico y documental colombiano, lideró la prueba piloto de implementación del estándar de catalogación RDA en Colombia. Esta prueba piloto, cuenta actualmente con la participación de diferentes unidades de información del país como la Biblioteca Luis Ángel Arango, la Biblioteca Pública Piloto de Medellín, el Instituto Caro y Cuervo, el SENA, Corpoica, la Corporación Biblioteca Rafael Carrillo Luquez, la Fundación Universitaria de Ciencias de la Salud FUCS (Fundación Universitaria Ciencias de la Salud, la Universidad de Antioquia, la Universidad de “ El Bosque”, la Universidad del Valle, la Universidad Javeriana, la Universidad Nacional de Colombia (Manizales), la Universidad Pontificia Bolivariana y la Universidad Santo Tomás, todas ellas interesadas en estudiar la norma y establecer políticas de aplicación de forma consensuada, además de reconocer los cambios e impactos de su implementación. En este sentido, para la prueba piloto RDA se han efectuado reuniones periódicas, tanto presenciales como virtuales, con el objetivo de trabajar en la creación de registros RDA, los cuales son aplicables a todo tipo de recursos y contenidos, en especial a los del entorno digital. La experiencia de esta prueba piloto representa un referente para la implementación de la norma RDA en América Latina, dado que ha generado diversos productos: adaptación de software libre y configuración de los SIB (Sistema Integrado de Bibliotecas) de las entidades participantes para el modelo de metadatos, etiquetas y campos fijos MARC21 necesarios para la elaboración de registros RDA, elaboración de registros (obra, expresión, manifestación, autoridad: personal, corporativo y de familia), creación de un foro especializado para intercambiar, publicar, poner al servicio avances y, finalmente, elaborar manuales relacionados con la creación de registros. Considerando la importancia de esta prueba piloto para América Latina, este artículo presenta todos los aspectos relevantes de su desarrollo, los resultados obtenidos y los pasos a seguir en el futuro.
“Antojolías”: los modos de consagración en el campo de la bibliotecología y ciencia de la información internacionales
Authors: Urbizagástegui-Alvarado Rubén
Published: May 2017

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Aplicabilidade de indicadores agrometeorológicos para análise do incremento de água por irrigação em sistemas de produção da palma forrageira, cv. Miúda
Authors: Cruz Neto José Francisco Da , Morais José Edson Florentino de , Souza Carlos André Alves de , Carvalho Herica Fernanda De Sousa , Rodrigues Carlos Tiago Amâncio , Silva Thieres George Freire da
Published: May 2017

Objetivou-se avaliar a aplicação de indicadores agrometeorológicos de eficiência do uso da água para a palma forrageira, clone “Miúda”, visando à análise da contribuição do incremento de água em sistemas de produção da cultura. O experimento foi conduzido no município de Serra Talhada, PE. O delineamento foi em blocos ao acaso, com três repetições, e os tratamentos compostos por dois regimes hídricos, o primeiro equivalente a 756 mm ano-1 e outro de 493 mm ano-1. Na ocasião da colheita foram obtidas as variáveis biométricas e de biomassa. Por meio desses últimos dados e das lâminas de água recebidas pela cultura foram calculados a eficiência no uso da água (WUE), a produtividade econômica da água (EWP) e a produtividade da água de irrigação (IWP). A EWP foi avaliada assumindo a venda dos cladódios para alimentação animal e como “semente”. Não houve efeito da redução da disponibilidade de água sobre o crescimento, a produtividade e os indicadores agrometeorológicos (p > 0,05). Porém, percebeu-se um aumento em 42% e 22% na matéria verde e seca da cultura, respectivamente. Em termos de eficiência do uso da água, a Miúda apresentou valores de 59,27 kg MV ha-1 mm-1 e 7,25 kg MS ha-1 mm-1, resultando retorno econômico maior na produção de cladódios para “semente” (85,73 R$ ha-1 mm-1). A IWP foi de 50,64 kg MV ha-1 mm-1 e de 2,29 kg MS ha-1 mm-1. Conclui-se que, os indicadores agrometeorológicos de eficiência do uso da água podem ser utilizados na avaliação do desempenho da cultura da palma forrageira.
Uma abordagem etnobotânica acerca das plantas úteis cultivadas em quintais em uma comunidade rural do semiárido piauiense, Nordeste do Brasil
Authors: Silva Paulo Henrique da , Oliveira Ykaro Richard , Abreu Maria Carolina de
Published: May 2017

Este estudo direcionou-se a inventariar as plantas úteis cultivadas em quintais na comunidade rural de Aroeiras, município de Monsenhor Hipólito-PI, alocar as espécies citadas em categorias de uso, bem como delinear o perfil socioeconômico dos envolvidos na pesquisa, para assim conhecer e registrar o conhecimento tradicional local. O trabalho de campo foi realizado de fevereiro a maio de 2014, mediante entrevistas semi-estruturadas, fazendo uso do método bola-de-neve para a seleção dos participantes. Utilizou-se também a técnica da turnê-guiada pelos quintais e, simultâneo ao levantamento de dados, foram coletadas amostras das plantas citadas, as quais foram herborizadas segundo técnicas usuais em taxonomia vegetal, onde o sistema de classificação APG III foi o adotado. Dos 71 indivíduos entrevistados, 87,32% pertencem ao sexo feminino. Foram levantadas 188 espécies, pertencentes a 68 famílias, onde as mais representativas foram a Fabaceae e Lamiaceae. Quanto às categorias de uso, a ornamental, medicinal e alimentar foram as mais representativas. Chenopodium ambrosioides, Aloe vera e Ruta graveolens foram as espécies em que se encontrou os maiores valores de uso para a localidade estudada
Metabolism and physiology of Lactobacilli: a review
Authors: Mesquita Amanda Rafaela Carneiro de , Silveira Lucas Pacheco da Mota , Cruz Filho Iranildo José Da , Lima Valmir Felix de , Silveira Filho Vladimir Da Mota , Araujo Ana Albertina , Silva Tacilene Luzia Da , Araújo Klewdma De Freitas , Macedo Luciana Da Silva
Published: May 2017

The consumption of probiotic microorganisms in fermented products has been used for centuries. Lactobacillus spp. is one of the main species studied due to its various beneficial effects on health. This species has a great ability to adapt to hostile environments, produces antimicrobial substances capable of destroying or inhibiting the growth of pathogenic bacteria, and is involved in the digestion of complex carbohydrates not digested by the host. However, there are still some uncertainties and disagreements about the precise biochemical metabolism of lactobacilli. The aim of this article is to review the metabolism and physiological characteristics of lactobacilli for a better understanding of the benefits that these bacteria promote in the host and for the development of strains and probiotic products with higher health benefits.
MEGALITH AND JAR BURIAL OF THE JAMBI HIGHLAND IN ARCHAEOLOGY AND ETHNOHISTORY
Authors: S. Budisantosa Tri Marhaeni
Published: May 2017

One aspect of archaeological studies in highland of Jambi is ideology or belief existing within human mind. The ideology of the past society is not appeared directly through material culture.The ideological research, therefore, could approach closer to cultural system of the past with the supported by the endorsement of historical and ethnographical data of local community. This writingdiscusses development of such model to disclose the beliefs that playing a part in the construction of megaliths and burial jars in highland of Jambi. The problem is answered by relate the results of the discussion of archaeological data and ehtnohistorical data. Results of the discussion revealed that the archaeological data interpretation is supported by the etnhohistorical data.
SHORT INSCRIPTION FROM SANGGAR TEMPLE A HOMAGE TO BRAHMA
Authors: Istari T.M. Rita
Published: May 2017

Sanggar temple is located on Penanjakan slope.. The hill is part of Wonogriyo of Pusungmalang village, Puspo regency, Pasuruan district. Sanggar temple suspected as place of worship to the God Brahma who dwells in Mount Bromo. On a series of research carried out in 2005-2008 by Yogyakarta Centre of Archaeology were found several short inscriptions around the temple to be praises used in religious rituals it is allegedly the people in the region. The tradition to sing praises by until the spread of Islam in Java. The adoption of Islam influence changes lasted praises. The contents of such literatur review espeally ancient writings are used to prove the assumptin.
LOCATIONAL PATTERN OF INDIES BUILDINGS IN GORONTALO
Authors: Marzuki Irfanuddin Wahid
Published: May 2017

Indies buildings in Gorontalo are spread within several areas, namely Ipilo, Biawao, and Tenda. These buildings serve as offices, houses, schools, hotels, religious building, and shop. Research on indies buildings in Gorontalo aims to find its locational pattern and to determine the relationship among those buildings. This research uses descriptive method with an inductive approach. Analysis of the data using the nearest neighbour analysis. The results showed a locational pattern of Indies buildings are clustered around the square. Based on their function, houses, and hotel are clustered, while school and office buildings are randomly located. The relationship between the building relates to the function of each building. Residential and office buildings are located adjacent to the effectiveness. School buildings are spread to facilitate access to people living in all parts of the town. Religious building is located in the center to facilitate access from every direction, and shops are clustered adjacent to the market as the economic center.
MATERIAL CULTURE BIOGRAPHY: DIASPHORA OF BRONZE KETTLEDRUMS IN THE MOLUCCAS ARCHIPELAGO
Authors: Ririmasse Marlon
Published: May 2017

This article discusses the diaspora and biography of the Dong Son Kettledrums in the Moluccas Archipelago. This research found that the cultural historical setting behind the existence of these objects is related to the diaspora that corresponds with the trade dynamics in theMoluccas archipelago as a source region for the exotic commodities. Shifted from the original context of the production center origin culture di the Mainland Asia to the Insular Southeast Asia, new values had been attached to these bronze kettledrums that related with the local culturalidentity aspect.
Old Manuscript and Spreading of Islam in Moluccas: a case Study from Hitu Monarchy, Central Mollucas
Authors: Handoko Wuri
Published: May 2017

This study uses data codex to see the process of Islamization in the former Kingdom of Hitu . This study aimed to identify the forms of Islamization and the development of Islamic teachings and sects. Research methods with quantitative and qualitative approaches codex of data based identification and classification of the type and content of the manuscript. Methods of emphasizes quantitative comparison of the quantity and percentage of types of texts, while the qualitative approach to identify the contents of the script to see the development of the Islamic streams in the region. The results showed that the shape and model of Islamization propaganda approach and Sufism is the most dominant in addition to education and literacy teaching the Koran and Islamic law (fiqh). Additionally Islamization in the region of the Kingdom Hitu also growing recognition institutes, as well as the influence of the Shia tradition. Thus , the process ofIslamization from the Quran literacy education, the introduction of Islamic Sufism and the congregation as well as the development of Islamic schools into the factors of growth and development of Islam in the region since the Kingdom Hitu in 16 th -19 th century AD.
THE RELIEF OF CANDI AS AN EFFECTIVE MEDIA TO DELIVER MORAL-DIDACTIC MESSAGE IN ANCIENT JAVA
Authors: Lelono Hari
Published: May 2017

ABSTRACTThe establishment of temple as sacred buildings of Shivaism/Buddhism in AncientJavanese Period aimed to worship gods. Temples are, decorated by reliefs contain moraleducationalmessage to support their aim. Stories or non stories depicted on the relief functionedas information/publication medium for adult as well as children. This article examines why reliefwas used in Hinduism-Buddhism Period to deliver moral-educational message to them. Methodsused is observation on the relief stories carved on temples in Central and East Jav, analysis, andinterpretation based on literature study.
GIANT PRIMATE OF JAVA: A NEW GIGANTOPITHECUS SPECIMEN FROM SEMEDO
Authors: Noerwidi Sofwan , Siswanto Siswanto , Widianto Harry
Published: May 2017

In 2014 there was found two "enigmatic" specimens of mandible, which named as Semedo 3417 and 3418. Both mandibles are morphologically similar but twice bigger than common primate’s jaw. In this research, we use morphology and morphometric analysis to determine the species identity and taxonomic position of those specimens. For comparison study we use some samples from Homo erectus (Java and China), Gigantopithecus (blacki and bilaspurensis), Australopithecines (robust and gracile). Based on morphology and morphometric characters on the mandible and teeth, it is concluded that Semedo specimen tends to be close to Gigantopithecus blacki. The discoveries of Gigantopithecus fossil in Java has implication on some research problem, especially regarding the adaptation pattern of this species which known only found at high latitudes environment. Furthermore this discovery has reinforced the perspective that tropical environment has a very high biodiversity, particularly on primate fossils.
Jiwa Kewirausahaan dan Nilai Kewirausahaan Meningkatkan Kemandirian Usaha melalui Perilaku Kewirausahaan
Authors: Sukirman Sukirman
Published: May 2017

It is necessary to anticipate small businesses’ difficulties by conducting an empirical study on the entrepreneurial spirit, entrepreneurial values, and assessment of entrepreneurial behavior that may affect the realization of independence efforts. This study aims to analyze the influence of entrepreneurial spirit and entrepreneurial values on entrepreneurial behavior to create business independence. Our sample of 125 small business owners consist of 45 Pekalongan batik business owners, 42 small producers of typical Malang (Batu) food, and 38 ceramics business owners from Kasongan Bantul Yogyakarta. We use path analysis of Structural Equation Modelling (SEM) to analyze our date. The findings show that the entrepreneurial spirit has a direct positive influence on entrepreneurial behavior and positive indirect effect on the business independence. Further, entrepreneurial values have a direct impact on entrepreneurial behavior and also a positive indirect effect on the independence of the business. Meanwhile, entrepreneurial behavior has a positive effect on independence of business.

Abstrak

 

Kesulitan usaha kecil perlu diantisipasi dengan melakukan tindakan pengujian empirik melalui kajian terhadap jiwa kewirausahaan, nilai kewirausahaan, dan kajian perilaku kewirausahaan yang dapat mempengaruhi proses terwujudnya kemandirian usaha. Penelitian ini bertujuan untuk menganalisis pengaruh jiwa kewiruasahaan dan nilai kewirausahaan terhadap perilaku kewirausahaan untuk menciptakan kemandirian usaha. Metode yang digunakan dalam menganalisis data menggunakan Analisis Jalur (Path Analysis). Sampel dalam penelitian ini 125 pelaku usaha kecil yang terdiri dari 45 pelaku usaha kecil batik Pekalongan, 42 usaha kecil makanan khas Batu Malang dan 38 usaha kecil keramik Kasongan Bantul Yogyakarta. Analisis data menggunakan Structural Equation Modelling (SEM). Hasil pengujian menunjukkan bahwa jiwa kewirausahaan mempunyai pengaruh secara langsung terhadap perilaku kewirausahaan dan pengaruh tidak langsung terhadap kemandirian usaha. Nilai kewirausahaan mempunyai pengaruh langsung terhadap perilaku kewirausahaan dan juga berpengaruh tidak langsung terhadap kemandirian usaha. Sedangkan perilaku kewirausahaan berpengaruh positif terhadap kemandirian usaha.
Determinan dan Stabilitas Ekspor Crude Palm Oil Indonesia
Authors: Huda Eva Nurul , Widodo Arif
Published: May 2017

We analyze the influence of CPO production, exchange rate, international CPO price and the terms of trade on Indonesian CPO exports in October 2011-December 2015. In doing so, we use the Autoregressive Distributed Lag (ARDL) approach to analyze the monthly time-series data for the periods of 2011:M10-2015:M12. Our findings suggest that both in the short- and long-term, the international CPO price has a significantly negative impact on Indonesia's CPO exports. Meanwhile, the CPO production and exchange rate have negative and significant effects on Indonesia's CPO exports both in short- and long-term. Taken together, all the independent variables have significant effects on Indonesia’s CPO export. Finally, based on CUSUM and CUSUMQ test, it shows that the long-term coefficient of the CPO exports model is stable.

Abstrak

 

Tujuan dari studi ini adalah untuk menganalisis seberapa besar pengaruh dari produksi kelapa sawit, nilai tukar rupiah terhadap dollar AS, harga CPO internasional dan Term of Trade terhadap ekspor CPO Indonesia pada periode Oktober 2011 sampai dengan Desember 2015. Penelitian ini menggunakan pendekatan Autoregressive Distributed Lag (ARDL) dengan data sekunder runtut waktu bulanan untuk periode 2011:M10-2015:M12. Hasil dari penelitian ini menunjukkan bahwa harga CPO internasional mempunyai efek negatif dan signifikan, baik dalam jangka pendek maupun jangka panjang terhadap ekspor CPO Indonesia. Variable Term of Trade dalam jangka pendek maupun panjang mempunyai efek positif dan signifikan terhadap ekspor CPO, sedangkan variabel produksi kelapa sawit dan nilai tukar rupiah terhadap dolar Amerika mempunyai pengaruh negatif dan signifikan terhadap ekspor dalam jangka pendek maupun panjang. Lebih lanjut, semua variabel independen secara bersama-sama mempengaruhi ekspor CPO di Indonesia, sehingga hipotesis yang menunjukkan tidak ada hubungan antara variabel independen dan dependen ditolak. Terakhir, berdasarkan pada uji CUSUM dan CUSUMQ dapat disimpulkan bahwa model ekspor CPO stabil dalam jangka panjang.
THE EFFECT OF THE ATTITUDE TOWARD BREASTFEEDING CONCEPT BASED COMIC ON THE ADOLESCENCE'S ATTITUDE TOWARD EXCLUSIVE BREASTFEEDING
Authors: Anggraeni Mekar Dwi , Latifah Lutfatul , Kartikasari Aprilia , Rismawati Ima
Published: May 2017

Background and purpose: The earlier development of the attitude toward exclusive breastfeeding produces the longer exclusive breastfeeding duration. Considering the first marriage age among Indonesian, the attitude toward exclusive breastfeeding should be developed at the adolescence age. The purpose of this study was to examine the effect of the attitude toward breastfeeding concept based comic on the adolescent's attitude toward exclusive breastfeeding. Method: This was a quasy experimental posttest only with control group study. The respondents were provided an comic. The respondent's attitude toward exclusive breastfeeding was measured using The Breastfeeding Attitude Questionnaire. Data were analyzed using independent and dependent t test. Results: The majority of respondents were aged 17 years old in both intervention (70%) and control grup (63%), first child in both intervention (23,3%) and control grup (26,7%), and had a nuclear family in both intervention (80%) and control grup (90%). The independent t test showed that there was a significant difference between post-test scores among the intervention and control groups (t = 5,602, p < 0,01). Conclusion and recommendation: Nurses may use the Attitude Toward Breastfeeding based comic to increase the Adolescence's attitude toward breastfeeding.Keywords: Comic, Attitudes Toward Exclusive Breastfeeding, Adolescence
C.I.M. On-Line
Authors: Bevan David
Published: May 2017

C.I.M is on-line. This issue marks the beginning of a new phase of publication for the journal: CIM is now available only on-line. Over its 30 year existence, CIM has been published in several formats and by different agencies. In recent years, CIM was owned and published by CMA as one of its associate journals. In 2004, CSCI purchased CIM and ownership reverted to the society. Since then, CIM has been type-set and formatted in-house and printed and distributed by University of Toronto Press (UTP) and, as in interim measure, the journal was available on the CSCI web-site. This process was threatened by the sale of UTP's off-set Printing Division. Links have now been established between CSCI, CIM and the University of Toronto Library to make use of the U of T Open Journal Access initiative to develop sophisticated on-line distribution. The Library supports journals via the Open Journal System (OJS) management software as well as providing archiving facilities. CIM will remain a subscription journal but, in the spirit of open access, all content will be freely available after a six month publication delay. Access will also be made available to all Canadian Universities via their library websites and authors will have immediate access for submitted articles.
Lung hyperinflation, perception of bronchoconstriction and airway hyperresponsiveness
Authors: Boulet Louis-Philippe , Turcotte Helene
Published: May 2017

Purpose: To compare the influence of underlying airway inflammation and lung hyperinflation on dyspnea during induced bronchoconstriction in subjects with mild asthma (or asymptomatic airway hyperresponsiveness (AAHR).

Methods: Fourteen mild asthmatic and 14 AAHR subjects had methacholine and 5'-adenosine monophosphate (AMP) challenges, and induced sputum analysis. Changes in inspiratory capacity (IC) and respiratory symptom scores were measured after challenges. Perception of respiratory symptoms was recorded on a modified Borg scale.

Results: The mean baseline FEV1, IC, mean provocative concentration of methacholine inducing a 20% decrease in FEV1 (PC20), the mean PC20 AMP and median inflammatory cell counts were similar in both groups. After methacholine, mean (±SD) reductions in FEV1 were 24.7±10.3% in mild asthma and 35.6±19.1% in AAHR (P>0.05); reductions in IC were, respectively, 10±12% and 24±20% (P>0.05); mean breathlessness scores at PC20 were 1.1 in mild asthma and 0 in AAHR P=0.003), and mean chest tightness scores were 1.2 in mild asthma and 0.8 in AAHR (P>0.05). Maximum chest tightness scores following MC correlated with the maximum decrease in IC in mild asthma (rs=0.75,P=0.009) and with the maximum decrease in FEV1 in AAHR (rs=0.60,P=0.04). After AMP, symptom scores were not significantly correlated with decreases in FEV1 or IC. The number of inflammatory cells was not correlated with decreases in IC after methacholine, AMP or with their PC20s, although inflammation was minimal in both groups.

Conclusion: Lower breathlessness scores in AAHR compared to mild asthma were not explained by differences in lung hyperinflation nor in airway inflammation.
The CAGE Questionnaire for Alcohol Misuse: A Review of Reliability and Validity Studies
Authors: Dhalla Shayesta , Kopec Jacek A.
Published: May 2017

Purpose: To review the reliability and validity of the CAGE questionnaire across different patient populations and discuss its role in the detection of alcohol-related problems.

Methods: The Cochrane Database for Systematic Reviews, Medline, Embase, and Psychinfo were searched. No systematic reviews were found on the Cochrane Database. Search of the other databases yielded one systematic review and one meta-analysis, on different aspects of CAGE. Three articles on reliability and 16 on validity of CAGE were found and used. Studies generally yielded Level II evidence.

Results: CAGE has demonstrated high test-retest reliability (0.80-0.95), and adequate correlations (0.48-0.70) with other screening instruments. The questionnaire is a valid tool for detecting alcohol abuse and dependence in medical and surgical inpatients, ambulatory medical patients, and psychiatric inpatients (average sensitivity 0.71, specificity 0.90). Its performance in primary care patients has been varied, while it has not performed well in white women, prenatal women, and college students. Furthermore, it is not an appropriate screening test for less severe forms of drinking.

Conclusions: CAGE is short, feasible to use, and easily applied in clinical practice. However, users should be aware of its limitations when interpreting the results. A positive screen should be followed by a proper diagnostic evaluation using standard clinical criteria.
Impact of physician income source on productivity
Authors: Baerlocher Mark Otto , Noble Jason , Detsky Allan S.
Published: May 2017

Based on data from the 2004 National Physician Survey, physicians whose primary payment method was fee-for-service saw more patients per week than physicians remunerated by other methods, including salary or blended payments. This result did not change when examined according to specialty or specialty grouping (Table 1), physician age (Table 2) Family physicians versus specialists, type of practice (office-based versus hospital-based; data not shown), or practice setting (urban versus rural; data not shown). Overall, fee-for-service (FFS) physicians saw approximately twice the number of patients per week as salaried physicians. These data provide convincing evidence that FFS physicians see substantially more patients.
Exploring patient demographic and clinical characteristics associated with lipid-lowering pharmacotherapy use in primary care
Authors: Farahani Pendar , Levine Mitchell , Gaebel Kathryn , LeLorier Jacques , Perrault Sylvie , Gillis Jane , Soon Judith
Published: May 2017

Background: Lipid-lowering therapeutics, particularly HMG Co-A reductase inhibitors, can be beneficial in primary and secondary cardiovascular prevention. The Canadian population frequently uses these medications but the manner in which they are used in community-based practice is unknown.

Objectives: To assess the patient characteristics associated with lipid lowering drug use in community-based clinical practice across four geographic regions in Canada. To assess amongst lipid-lowering drugs users the proportion of patients that would meet accepted dyslipidemia management guidelines. To assess the community-based effectiveness of anti-hyperlipidemic drugs.

Methods: Patients filling a prescription for any anti-hyperlipidemia therapy in selected pharmacies in Ontario (ON), Quebec (PQ), British Columbia (BC) and Nova Scotia (NS). All eligible patients were interviewed over the telephone. Physicians who were providing healthcare to the participating patients were requested to provide information from the patient’s medical record.

Results: The mean patient age was > 60 yr in all four provinces. There were some differences amongst the four provinces pertaining to patient characteristics, prescription patterns and therapeutic indicators, but not to outcomes. Anti-hyperlipidemia therapy was associated with a 1.81 mmol/L decrease in LDL-Cholesterol (P < 0.001); however only 73% of patients achieved target LDL-Cholesterol concentrations. A lag time of 1.96 yr (P < 0.0001) was observed from the diagnosis of dyslipidemia until the drug treatment was initiated. Patients had an average of 2.8 cardiovascular (CV) risk factors and 86% of patients had at two or more CV risk factors. Thirty-nine percent (95% CI, 36% - 42%) of the patients were being treated for secondary prevention. Thirteen percent (11% - 16%) of patients who were being treated for primary prevention had diabetes. Metabolic syndrome was observed in 32% (29% - 35%) of patients.

Conclusion: Almost all patients fulfilled guideline requirements for the use of anti-hyperlipidemic therapy. Although the use of pharmacotherapy was associated with a lowering of LDL cholesterol more aggressive management is required to attain target LDL cholesterol concentrations.
Serial procalcitonin responses in infection of children with secondary immunodeficiency
Authors: Hatzistilianou M. , Rekleity A. , Athanassiadou F. , DeLutiis M. A. , Conti P. , Catriu D.
Published: May 2017

Purpose: Procalcitonin has proven to be a sensitive inflammatory marker in non-neutropenic patients. The aim of this study was to determine and compare Procalcitonin with other inflammatory markers in the serum of immunosuppressed children with haematological malignancies; and to assess the predictive value of these mediators in distinguishing between bacterial and non-bacterial infection.

Methods & Results: The study included 37 children with acute lymphoblastic leukaemia undergoing intensive chemotherapy. They were divided into 3 groups, A, B and C. Group A consisted of 29 neutropenic children with 94 febrile episodes, group B of 20 neutropenic children with 56 afebrile episodes and group C of 13 non-neutropenic children with 58 afebrile episodes. Serial serum levels of PCT, C-Reactive Protein, Neopterin, Interleukin-6 and NO2/NO3 were all determined on a day-to-day basis for 7 consecutive days. In serum the concentrations of CRP was determined by nephelometry, of PCT by immunoluminescence and of Neopterin, IL-6 and NO2/NO3 by ELISA method.

Conclusions: According to our results the Procalcitonin concentration increased rapidly in patients with microbial infection; the response was detectable within 24 hs of the onset of fever due to microbial infections. Procalcitonin is a spesific and sensitive marker of microbial infection in patients with neutropenic fever. The markers, C-Reactive Protein, Interleukin-6 and NO2/NO3 may not help to identify infections and distinguishe the etiology of infection in neutropenic febrile children with acute lymphoblastic leukaemia.
Bleeding during critical illness: A prospective cohort study using a new measurement tool
Authors: Arnold Donald M. , Donahoe Laura , Clarke France J. , Tkaczyk Andrea J. , Heels-Ansdell Diane , Zytaruk Nicole , Cook Richard , Webert Kathryn E. , McDonald Ellen , Cook Deborah J.
Published: May 2017

Purpose: To estimate the incidence, severity, duration and consequences of bleeding during critical illness, and to test the performance characteristics of a new bleeding assessment tool.

Methods: Clinical bleeding assessments were performed prospectively on 100 consecutive patients admitted to a medical-surgical intensive care unit (ICU) using a novel bleeding measurement tool called HEmorrhage MEasurement (HEME). Bleeding assessments were done daily in duplicate and independently by blinded, trained assessors. Inter-rater agreement and construct validity of the HEME tool were calculated using φ. Risk factors for major bleeding were identified using a multivariable Cox proportional hazards model.

Results: Overall, 90% of patients experienced a total of 480 bleeds of which 94.8% were minor and 5.2% were major. Inter-rater reliability of the HEME tool was excellent (φ = 0.98, 95% CI: 0.96 to 0.99). A decrease in platelet count and a prolongation of partial thromboplastin time were independent risk factors for major bleeding but neither were renal failure nor prophylactic anticoagulation. Patients with major bleeding received more blood transfusions and had longer ICU stays compared to patients with minor or no bleeding.

Conclusions: Bleeding, although primarily minor, occurred in the majority of ICU patients. One of five patients experienced a major bleed which was associated with abnormal coagulation tests but not with prophylactic anticoagulants. These baseline bleeding rates can inform the design of future clinical trials in critical care that use bleeding as an outcome and HEME is a useful tool to measure bleeding in critically ill patients.
The relationship between stress and hair cortisol in healthy pregnant women
Authors: Kalra Sanjog , Einarson Adrienne , Karaskov Tatyana , Van Uum Stan , Koren Gideon
Published: May 2017

Purpose: Stress has been shown to cause a large range of adverse fetal effects. This pilot study is the first attempt to examine cortisol level in the hair of pregnant women and assess its potential as a biomarker of gestational stress.

Patients and Methods: Twenty-five healthy pregnant women, in whom hair cortisol levels and the Perceived Stress Scale (PSS) were measured and correlated.

Results: Maternal hair cortisol levels, ranging between 0.06 and 0.23 nmol/g of hair correlated positively and significantly with measures of perceived stress (ranging between 2-22); (Rs=0.47) (P < 0.05).

Conclusions: Our findings corroborate recent primate studies with induced stress, and suggest that hair cortisol is a potential biomarker of chronic stress in pregnancy. This new long term biological marker may have important implications in research and clinical practice.
Achieving the daily step goal of 10,000 steps: The experience of a Canadian family attached to pedometers
Authors: Choi Bernard C. K. , Pak Anita W. P. , Choi Jerome C. L. , Choi Elaine C. L.
Published: May 2017

Background: Health experts recommend daily step goals of 10,000 steps for adults and 12,000 steps for youths to achieve a healthy active living. This article reports the findings of a Canadian family project to investigate whether the recommended daily step goals are achievable in a real life setting, and suggests ways to increase the daily steps to meet the goal. The family project also provides an example to encourage more Canadians to conduct family projects on healthy living.

Methods: This is a pilot feasibility study. A Canadian family was recruited for the study, with 4 volunteers (father, mother, son and daughter). Each volunteer was asked to wear a pedometer and to record daily steps for three time periods of each day during a 2-month period. Both minimal routine steps, and additional steps from special non-routine activities, were recorded at work, school and home.

Results: The mean number of daily steps from routine minimal daily activities for the family was 6685 steps in a day (16 hr, approx 400 steps/hr). There was thus a mean deficit of 4315 steps per day, or approximately 30,000 steps per week, from the goal (10,000 steps for adults; 12,000 steps for youths). Special activities that were found to effectively increase the steps above the routine level include: walking at brisk pace, grocery shopping, window shopping in a mall, going to an entertainment centre, and attending parties (such as to celebrate the holiday season and birthdays).

Discussion: To increase our daily steps to meet the daily step goal, a new culture is recommended: “get off the chair”. By definition, sitting on a chair precludes the opportunity to walk. We encourage people to get off the chair, to go shopping, and to go partying, as a practical and fun way to increase the daily steps. This paper is a call for increased physical activity to meet the daily step goal.
Aerobic Training with Hyperoxia in Patients with Mild/Severe Brain Injury
Authors: Busilacchi Élise , Cadoret Geneviève , Comtois Alain S.
Published: May 2017

Background: Previous studies have shown that aerobic training can induce physiological benefits for brain injured patients. However these benefits seem to be limited. Compared with untrained subjects who follow the same training program, patients with brain injury have a reduced exercise capacity and have difficulty in reaching a high intensity exercise level. A possible alternative to help these patients is to conduct the training in hyperoxia (O2 supply). Studies with untrained subjects have shown that training in hyperoxia enhances the fitness performance. Thus, the purpose of this study was to measure the effects of an aerobic training in hyperoxia with brain-injured patients.

Methods: Twelve patients were randomly assigned to either one of two aerobic training protocols: A) 100% O2; B) 20.9% O2 (room air). In both protocols training was on stationary bicycle, 2 sessions per week over 10 weeks. Each session lasted 25 min and was composed of 6 intervals with intensity ranging from 60 to 85% of the max HR. The first interesting result is that all patients were able to reach and sustain the 80-85% level of exercise. To measure the working capacity during the training, we recorded the workload (watts) reached at the third interval (80-85% of the HRmax) of each session.

Results: A difference (P < 0.05) in the power output on the ergocycle was observed between the pre test (measured on the first week) and the post test (measured on the 6th week) for subjects trained in hyperoxia but no difference was observed for subjects trained in normoxia. However, no difference was observed in the 6 min walk test for all subjects before and after the aerobic training. There was no difference in oxygen consumption (submaximal test 85% HRmax) between the pre and post tests in both groups of subjects (P=0.18). Nonetheless, subjects trained in hyperoxia showed a 16% average increase in their VO2 (85% HRmax) compared with subjects in normoxia who had a 4% average decrease.

Conclusion: Our results show that oxygen supply seems to accelerate the benefits of the aerobic training with brain injured patients. We believe that it is the combination of the training protocol (i.e. intervals) and the oxygen addition that induced the early benefits observed.
Chronic Obstructive Pulmonary Disease (COPD) as a Risk Factor for Glucose Metabolism Perturbation and Insulin Resistance
Authors: Doucet M. , Laviolette L. , Gagné-Belley D. , Maltais F.
Published: May 2017

Background: High body mass index (BMI) is associated with better survival in COPD. However, increased BMI and especially waist circumference is associated with elevated pro-inflammatory systemic markers that might contribute to glucose intolerance. On the other hand, COPD is a chronic inflammatory disease that could be a risk factor for impaired glucose metabolism. The objective of this study was to compare the prevalence of glucose intolerance in COPD patients and control subjects with high waist circumference.

Methods: Eleven patients with COPD (age:68±8 yr mean±SD; FEV1:49±17% pred) and 10 control subjects (C) (age:63±6 yr) underwent a 75g oral glucose tolerance test (OGTT). All subjects had a waist circumference >102cm and no previous history of diabetes. Height and weight were measured and each subject underwent dual-energy X-ray absorptiometry (DEXA) to evaluate fat-free mass (FFM) and fat mass (FM) and abdominal tomography to evaluate visceral fat (VF). Blood samples were taken to measure inflammatory markers (C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin (IL)-6). Venous blood samples of glucose and insulin were taken while fasting and during OGTT. Insulin resistance was estimated with the fasting homeostasis model assessment (HOMA) index.

Results: FM, FFM and VF were not different between groups. Diabetes was diagnosed in two subjects in both groups (2hr post OGTT glucose ≥11.1 mmol/l). Four COPD and 1 C had impaired fasting glucose (fasting glucose 5.6–6.9 mmol/l) while 1 COPD and 2 C had impaired glucose tolerance (2hr post OGTT glucose 7.8–11.1 mmol/l). In COPD patients a negative correlation was found between the HOMA index and FEV1 (r2:0.52, P < 0.05).

Conclusions: COPD subjects with high waist circumference are similar to control subjects in term of FFM and FM, level of systemic inflammation and response to OGTT. In COPD, the severity of the disease is associated with an insulin resistance that may potentiate the risk for the development of type 2 diabetes in these patients.
Assessment of Two Training Modalities Effects on Exercise Tolerance after a Cardiac Rehabilitation Program and 3 Months Later in Off-Pump Coronary Artery Bypass Patients
Authors: Kervio G. , Ville N. S. , Bourdet S. , Le Breton C. , Carré F.
Published: May 2017

Background. Physical training is recommended as an efficient therapy in patients with coronary disease. However its effects should depend on its modalities. The aim of this study was to compare the effects of continuous and interval training after off-pump coronary artery bypass surgery (CABG).

Methods. Twenty-three male patients (59.5 ± 1.2 yr) underwent a randomized physical training using continuous (C, n=10) or interval (IT, n=13) modalities, over 3 weeks (5 h. a week). All patients performed a symptom-limited exercise test with measurements of ventilatory threshold (VT) and peak workload (WL), oxygen uptake (VO2) and heart rate (HR), before, at the end and 3 months after the training period. They also completed the SF-36 questionnaire to assess their quality of life.

Results. Both C and IT improved WL and VO2 at VT (P < 0.05) and at peak exercise (P < 0.05). Only IT increased peak HR and HR reserve (P < 0.01). In both groups quality of life was improved (P < 0.05). In both groups, compared to after training, the 3-months assessment showed an increase in peak and ventilatory threshold WL, and in peak HR (P < 0.05) without any change in peak VO2 and VT HR. No difference was observed between groups whatever the period studied. Back to home, in accordance with the given recommendations, most of the patients carried on their physical training over 3 months. They performed either outside walking (n=9) or cycling sessions (n=1) or both activities (n=11). No difference concerning the global training schedule was noted regardless their group (5.4 ± 1.2 vs. 6.0 ± 1.1 h.week-1 for C and IT, respectively).

Conclusions. In off-pump CABG patients, similar improvements of exercise capacity and quality of life perception were observed after both C and IT programs. Only peak HR was increased after interval training. Thus, IT is a good alternative to C training in this population. Aerobic fitness still remained stable or increased after 3 months of individual practice which duration exceeded the minimal values recommended.
The Effect of Pulmonary Rehabilitation on Pedometer-Measured Physical Activity
Authors: McCusker Corliss , ZuWallack Richard
Published: May 2017

Background: Pulmonary rehabilitation results in favorable outcomes across multiple areas, including exercise capacity, dyspnea, and health status. The effectiveness of this intervention on increasing physical activity levels, however, has received less attention. Accordingly, we tested the potential usefulness of a commercially-available pedometer (NL-2000) as an outcome measure for pulmonary rehabilitation. This instrument, which is a uniaxial accelerometer, accurately detects walking activity in healthy adults.

Methods: Fifty-five patients with COPD who were referred to participating centers in the Northeast Pulmonary Rehabilitation Consortium (mean age 69 yr, FEV1 45%) were studied after informed consent was obtained. All were given usual outpatient pulmonary rehabilitation, with pre- to post-rehabilitation assessments of the six minute walk distance (6MWD), MRC dyspnea, and health status, using a self-administered version of the Chronic Respiratory Disease Questionnaire (CRQ). Pedometer activity was measured over a ~ one-week period early in rehabilitation and again for ~ 1 week at the end of rehabilitation. The device was not worn during rehabilitation sessions. Patients recorded in a diary the exact times they wore the device. Pre- to post-rehabilitation changes in NL-2000 counts per hour worn (NL·hr-1) were evaluated, as well as the standard outcome variables (6 MWD, MRC, and CRQ).

Results: Improvements were observed in the 6MWD (45 m.), MRC dyspnea (- 0.54 units) and the CRQ total score (10 units) (all, P < 0.001). However, there was no change in NL·hr-1 (30 counts, IP. = 0.11). NL·hr-1 were lower on rehabilitation days than on non-rehabilitation days; after adding this as a covariate, changes in activity became statistically significant.

Conclusion: These results suggest that either pedometer activity assessment is relatively insensitive to detecting activity in slow-moving patients with COPD and/or pulmonary rehabilitation has less effect on increasing activity than in improving exercise performance, dyspnea, or health status.
Taking the Stress Out of Stress Testing
Authors: Hohenleitner Miller Rosemary
Published: May 2017

Background: Stress testing is a widely used screening tool for finding coronary artery disease, the leading killer of men and women in the United States. Stress tests are a safe noninvasive way to detect coronary ischemia and sift out which patients may benefit from percutaneous coronary intervention or coronary artery bypass graft. This presentation is an overview of the factors to be considered when Stress Testing.

Methods: Many factors must be considered before deciding which type of stress test best suits the patient. Time, cost and patient compliance as well as preexisting factors in their medical history such as their electrocardiogram, pacemaker or internal defibrillator, and medications. Keep in mind the following conditions make the EKG portion uninterpretable: LBBB, LVH with strain, repolarization abnormalities secondary to digitalis, baseline abnormalities, and ventricular pacing. If patients are not fit enough to perform an adequate amount of time on a treadmill due to deconditioning or musculoskeletal problems such as arthritis, a pharmacologic stress test should be performed such as a Persantine or Adenosine stress test. When patients are taking heart lowering medication like beta blockers, non-hydropyridine calcium channel blockers, digitalis, or amiodarone, they may have a blunted heart rate response making the EKG portion of the test non-diagnostic. Such patients can be instructed not to take their medication that morning or may consider having a pharmacalogic test instead.

Results: Viability studies are sometimes coupled with pharmacalogic stress tests to see if the cardiac muscle is viable and would benefit from perfusion by percutaneous intervention or bypass. These tests are performed by giving the patient sublingual nitroglycerin prior to performing the resting images in a nuclear stress test.

Conclusion: Many factors must be taken into consideration before ordering a stress test to see which one would benefit the patient the most. Keep in mind the patients physical condition, medications, and baseline EKG before choosing which one to order.