bluuebunny/crossref_metadata_2025 huggingface dataset:
Fenugreek Anaphylaxis in a Pediatric Patient
Authors: Joseph Nancy I. , Slavin Eileen , Peppers Brian P. , Hostoffer Robert W.
Published: June 2018

Fenugreek ( Trigonella foenum-graecum) is a food product that belongs to the Leguminosae family along with other legumes. It has been used in India, Greece, and Egypt for culinary and medical purposes since ancient times, and today, fenugreek is used for flavoring foods, dyes, and drugs throughout the world. Many members of the Leguminosae family have been associated with allergies including soybean, green pea, and peanut. Fenugreek is also included in this family and may result in allergic reactions. Two cases of anaphylaxis have been described in children after ingestion of curry and pastes that contain fenugreek, although the true nature of the causative agent was unclear. We report the first case of fenugreek anaphylaxis in a pediatric patient defined by skin testing, immunoglobulin E ImmunoCAP assays, and clear ingestion.
Catalysts but Not Magicians: Role of NGOs in the Tribal Development
Authors: Thamminaina Apparao
Published: June 2018

The territories inhabited by the tribal communities of India often attract a wide variety of external agents and agencies for variety of reasons. One very important segment of such agencies often cites development and transformation of tribal communities as the prime objective. The “official” category is the agency of planned change, and its responsibility is to work in accordance with the profile of the job or institution. Besides this, there is another important category, “social worker,” whose presence is voluntary, at least in theory. The dominant section of the later is popular as nongovernmental organizations (NGOs). In recent years, efforts are made to bring together the activities of government and NGOs to maximize the benefit to tribal communities and to speed up the process of social and economic transformation. The idea of government organization and nongovernmental organization (GO-NGO) partnership gained momentum. The results of these partnerships proved positive when compared with the programs implemented by the government organization alone. Several NGOs are successful because they train local youth as resource persons according to the needs of development initiatives. However, it is not necessary that every development activity implemented by them would be successful. In this context, the article examines the role of NGOs in the process of tribal development by analyzing their activities and the results.
Perceptions of a Peer Modeling Workplace Physical Activity Intervention for Women
Authors: Rowland Sheri A. , Cohen Marlene Z. , Pullen Carol H. , Schulz Paula S. , Berg Kris E. , Yates Bernice C.
Published: June 2018

A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants’ perceptions of the peer modeling intervention. Nine women from the intervention group ( n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were “I am left wanting more” and “focus on food.” Two themes about the peer models were “real people” and “it is doable.” Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.
Beyond comanaged inpatient care to community integration: Factors leading to surgical delay in hip fractures and their associated outcomes
Authors: Declarador Nathalie , Ramason Rani , Tay Laura , Chan Wai Lim William , Kwek Ernest Beng Kee
Published: June 2018

Purpose:

Early surgery for older adults with hip fracture has been shown to improve outcomes. We aim to study the factors contributing to delay in surgery (defined as surgery performed more than 48 h after admission) and its associated outcomes in a tertiary hospital in Singapore with an integrated hip fracture program.

Methods:

This is a prospective cohort study of hip fracture patients aged more than 60 years over 1 year. We collected data on demographics, premorbid mobility and functional status, time to surgery, postoperative complications, and inhospital mortality. Mortality data and functional performance were reviewed at 1 year.

Results:

High American Society of Anaesthesiologists score independently predicted delay in surgery (odd ratio (OR) = 9.52, 95% confidence interval (CI): 1.69–53.68). Delayed surgery was significantly associated with longer length of stay (median 12.8 days with interquartile range (IQR) 9.7–17.6 days vs. 8.35 days with IQR 5.9–10.9 days, p < 0.01). Surgery within 48 h significantly reduced functional decline (Modified Barthel Index change −3.89 ± 17.23 vs. −9.29 ± 20.30, p = 0.01) and 1-year mortality (3.5% vs. 9.3%, p = 0.03). Surgical delay was an independent risk factor for early postoperative complications (OR = 3.21, 95% CI: 1.21–8.49), and patients were significantly less likely to return to premorbid mobility at 1 year (OR = 0.62, 95% CI: 0.39–0.97).

Conclusions:

Delayed hip fracture surgery in older adults is associated with worse short- and long-term outcomes, including early postoperative complications and poorer functional recovery.
Accuracy of thoracic pedicle screw placement using freehand technique and triggered EMG in adolescent idiopathic scoliosis: Is it different between concave and convex side?
Authors: Min Woo-Kie , Na Sang-bong , Jang Jin-An
Published: June 2018

Purpose:

To evaluate and compare the accuracy of the placement of thoracic pedicle screws between concave and convex side curve using freehand technique and triggered electromyogram (EMG).

Methods:

Three-hundred sixty eight thoracic pedicle screws were included for the evaluation of accuracy from postoperative computed tomography (CT) scans in 24 patients with adolescent idiopathic scoliosis with a mean follow-up of 27 months (range 24–58 months). All screws had stimulation thresholds greater than 6 mA. We divided the screws into two groups: (1) group A: concave side curve—254 screws (2) group B: convex side curve—114 screws.

Results:

The mean age at surgery was 12.8 years (range 11–17 years). The preoperative Cobb angle was 57.5° (range 50–75°). There were 41 total breaches (medial = 21, lateral = 20, p = 0.66) with an overall incidence of 11.1%. The overall breach rate did not attain statistically significant difference (group A = 11.8%, group B = 9.6%, p = 0.59). The rate of medial breaches was also similar for both concave and convex side (group A = 6.1%, group B = 5.9%, p > 0.05). No postoperative neurological or vascular complications were noted in both groups.

Conclusion:

Thoracic pedicle screw placement using both freehand technique and triggered EMG for adolescent idiopathic scoliosis surgery is safe and reliable. The overall accuracy rate is 88.9% with similar breaches on the concave and convex side on postoperative CT scans.
Nursing Student Remote Performance Assessment using a Novel Smartphone Application
Authors: Reischl Uwe , Salinas Olga , Oberleitner Ron , Mijovic Budimir
Published: June 2018

Smartphone technologies have transformed the way people interact with each other around the world. The technology offers new approaches and opportunities for collecting, storing and sharing information. A novel smartphone technology application (app) originally developed for Patient Behavior Health applications was tested to determine if the proficiency of nursing students demonstrating a standardized seasonal influenza immunization protocol could be accurately recorded and subsequently evaluated remotely. The student performance was rated by four university instructors independently of each other. Each instructor used a standardized competency check-list to score these students. The study showed that by using the new smart-phone application, the remote evaluation of clinical nursing student proficiencies could be accomplished quickly and easily. However, the inter-rater agreement indicated that training of the evaluators in the use of the new app prior to scoring student performances will be needed. While the new smartphone application proved to be effective in documenting student performance, the technology promises to have practical uses in additional fields such as the secure monitoring of specialized training for paramedics, firefighters, police, skilled tradesmen, aircraft crews, etc.
Participatory Bullseye Toolkit Interview: Identifying Physicians’ Relative Prioritization of Decision Factors When Ordering Radiologic Imaging in a Hospital Setting
Authors: Rayo Michael F. , Pawar Chandni , Sanders Elizabeth B.-N. , Liston Beth W. , Patterson Emily S.
Published: June 2018

Critical Decision Method (CDM), a popular cognitive task analysis (CTA) method, is an in-depth retrospective interview that uses a historical non-routine incident to identify experts’ decision-making factors in complex socio-technical settings with high consequences for failure. However, it is challenging to use CDM to make comparisons, including those between experts and trainees. We describe an alternative CTA method used to study physicians’ decision making for ordering diagnostic imaging. After being primed with 11 simulated patient scenarios, nine attending and 11 resident physicians were asked to map out and present their decision-making process with a bullseye participatory design toolkit. Interviews were analyzed qualitatively, revealing four common decision factors: diagnostic efficacy, patient safety, organizational constraints, and patient comfort. The bullseye maps were used to quantitatively measure priority differences between these decision factors. Attending and resident physicians both prioritized diagnostic efficacy over the other factors (2.38 vs. 3.71, p <.01, and 2.59 vs. 3.52, p<.01, respectively), but attending physicians’ decisions had a higher proportion of non-diagnostic items (65% vs. 50%, p = .008). Our results demonstrate the usefulness of this method in eliciting decision factors for a complex, face-valid task and for identifying differences due to levels of expertise and training.
Personal Health Records Buck Traditional Medical Culture
Authors: Jenkins Melinda L.
Published: June 2018

New financial incentives from the Centers for Medicare and Medicaid Services, along with new user-friendly technology, may be the impetus for a significant shift in ownership of health records from providers to patients. An evaluation of an early patient portal implementation, including a usability study with potential patients, a mapping of technical workflow for implementation, and a survey of physician users is presented. The results from the 2008 survey are compared with current studies, showing that, despite advances in technology and patient attitudes, until now patient portal utilization has barely grown, due in part to stagnant opinions and work routines among the clinician user community.
Perioperative Medication Management: Reconciling Differences across Clinical Sites
Authors: Duncan Benjamin J. , Zheng Lu , Furniss Stephanie K. , Doebbeling Bradley N. , Grando Adela , Solomon Andrew J. , Burton Matthew M. , Poterack Karl A. , Miksch Timothy A. , Helmers Richard A. , Kaufman David R.
Published: June 2018

Medication reconciliation (MedRec) is a mission-critical process which can serve to reduce adverse drug events (ADEs) in surgical settings. However, providing quality care is limited by current health information technology (IT), which is often inefficient and unintuitive due to poor usability, resulting in high cognitive burden. We have been characterizing EHR mediated workflow in the Mayo Clinic enterprise prior to a system-wide electronic health records (EHR) conversion in order to harmonize workflows. We compared and evaluated MedRec processes in pre-operative nursing assessments across two different EHRs in place in different locales at baseline. The interfaces differed both in their modes of interaction and cognitive support. Analyses surfaced interface elements that were unintuitive and inefficient, creating unnecessary complexities in clinicians’ interactive behavior. Keystroke level models (KLM), a modeling tool for predicting task completion time, showed that to access medication lists required a different series of operations across the two systems. Different designs can differentially mediate task performance, which can aid in the mitigation of errors for complex cognitive tasks. Identification of barriers in EHR-mediated workflow and barriers to interface usability could lead to system redesigns that minimize cognitive load while improving patient safety and efficiency.
Neurodynamic and Communication Analysis of Healthcare Teams During Simulation Debriefings
Authors: Stevens Ron , Willemsen-Dunlap Ann , Gorman Jamie , Galloway Trysha , Grimm David , Halpin Donald
Published: June 2018

Objective:

To determine whether a dynamical analysis of neural and communication data streams provide fine-grained insights into healthcare team debriefings.

Background:

Debriefing plays a key role in experiential learning activities such as healthcare simulation because it bolsters the transfer of experience into learning through a process of reflection. There have been few studies examining the neural and communication dynamics of teams as team members are supported by trained facilitators in making better sense of their performance.

Method:

Electroencephalographic (EEG)–derived brain waves and speech were recorded from experienced and medical student healthcare teams during post-simulation debriefings. Quantitative estimates of the neurodynamic organizations of individual team members and the team were modeled from the EEG data streams at different scalp locations and at frequencies from 1-40 Hz. In parallel the dynamics of speech turn taking were quantified by recurrence frequency analysis.

Results:

Neurodynamic organizations were preferentially detected from sensors over the parietal lobes with activities present in the alpha, beta and gamma frequency bands. Rhythmic structures emerged as correlations between speech, discussion blocks and team & team member neurodynamic organizations.

Conclusion:

Organizational representations help reveal the neurodynamic, communication, and cognitive structures of debriefing.

Application:

The quantitative neurodynamic and communication measures will allow direct comparisons of debriefing structures across teams and debriefing protocols.
These Aren’t the Triads You’re Looking For: Updating Clinical Mental Models of Acute Spinal Cord Compression
Authors: Weldon Danielle , Kowalski Rebecca , Blumenthal Joseph , Fong Allan , O’Mara Susan , Fairbanks Rollin J , Miller Kristen
Published: June 2018

Acute spinal cord compression (SCC) is rare, difficult to diagnose, and likely to result in devastating, irreversible neurological outcomes if not treated in a timely manner. This project aimed to 1) identify clinician perceptions and impressions of SCC diagnostic indicators and risk factors; 2) coalesce SCC diagnostic indicators and risk factors described in the literature; and 3) compare the above elements. The goal of this project is to optimize the SCC alert within the electronic health record system and to update the emergency department’s protocol.
Qualitative Review of Wrong-Site Surgeries: What Side Will My Surgery Take Place?
Authors: Moturu Anoosha , Howe Jessica , Tran Grace
Published: June 2018

Wrong site surgeries (WSS) are classified as “never events” and signify adverse events that are preventable. The prevalence of procedures in the wrong location is up to 50 WSS per week in the United States. Informed consent (IC) related contributing factors include communication breakdowns between staff and across units, lack of cross-checking documents, equipment-related issues, and lack of automation in document coordination. As part of a patient safety initiative, a qualitative review of IC and WSS-related factors was conducted using patient safety event (PSE) data within a large healthcare system in the mid-Atlantic region. A word search query of the PSE database containing 132,683 PSEs from 2009 to 2017 was performed using a comprehensive codebook, and inter-rater reliability was established. Qualitative analysis of the PSE data indicated highest frequencies of the following codes: mAbsence of consent for treatment (25.7%), Incorrect or missing information recorded in the IC form (15.5%), and Ambiguity in laterality of the procedure on IC form/other medical documentation (12.5%). These contributing factors often lead to Late procedure start times (6.6%) and New consent document procurement (6.42%). These findings inform the need for system-based interventions to reduce risk. A targeted intervention focused on improving the design of IC forms and other medical documents could address some of these vulnerabilities. Developing a system-based approach to cross check procedure information could increase the reliability of system safeguards to reduce the risk of potential patient harm.
Efficacy of a Hearing Aid Noise Reduction Function
Authors: Wong Lena L. N. , Chen Yuan , Wang Qianran , Kuehnel Volker
Published: June 2018

Noise reduction systems have been implemented in hearing aids to improve signal-to-noise ratio and listening comfort. The aim of this study was to evaluate the efficacy of hearing aid noise reduction for Mandarin speakers. The results showed a significant improvement in acceptable noise levels and speech reception thresholds with noise reduction turned on. Sound quality ratings also suggested that most listeners preferred having noise reduction turned on for listening effort, listening comfort, speech clarity, and overall sound quality. These results suggest that the noise reduction system used in this study might improve sentence perception in steady-state noise, noise tolerance, and sound quality, although not all listeners preferred aggressive noise reduction. However, due to large interindividual variation, clinical application of the results should be on an individual basis.
Venipuncture-Induced Hematomas Alter Skin Barrier Function in the Elderly Patients
Authors: Kimori Keiko , Konya Chizuko , Matsumoto Masaru
Published: June 2018

We aimed to compare the barrier function of the skin site with the color of hematoma induced by venipuncture and the area surrounding the skin site to help improve skin care for hospitalized elderly patients. There were 50 patients with a median age of 84 years who were included in the analysis. There was no significant difference between the hematoma site-induced venipuncture and the area surrounding the hematoma site in terms of transepidermal water loss and skin sebum level. The status of stratum corneum hydration and skin elasticity on the hematoma sites was significantly lower than that on nonhematoma sites. The median skin pH was significantly higher on hematoma sites than that on nonhematoma sites. The study variables did not reveal any significant correlation with the intensity of skin erythema. These findings showed that hematoma formation in the subcutaneous tissue affected the skin barrier function and that these sites need moisturizing skin care regardless of the intensity of skin erythema.
Dalit Capital and Markets: A Case of Unfavourable Inclusion
Authors: Prakash Aseem
Published: June 2018

The nature of our constitutional order is changing from a nation-state into a market-state. The market-state seeks to acquire legitimacy not as a provider or distributor of welfare goods and economic resources but strives to provide an enabling framework for the society to secure opportunities and better goods and services. As markets have acquired a pre-eminent institutional space, this article seeks to understand the aspirations of Dalits to enter markets as owners of capital and trade in diverse goods and services. The article examines the relationship between caste and capitalism, and argues that the current relationship of caste and capitalism does not operate on the notions of merit and efficiency. Markets are embedded in social relationships and, therefore, are more prone to be influenced by social customs rather than ideas of modern contracts, merit and efficiency. Drawing upon interviews with several successful Dalit entrepreneurs and their experiences, the article finds ‘unfavoured’ or ‘adverse’ inclusion of Dalits in the markets caused by social networks populated and controlled by upper-caste business peers.
Electrically stimulated cell migration and its contribution to wound healing
Authors: Tai Guangping , Tai Michael , Zhao Min
Published: June 2018

Naturally occurring electric fields are known to be morphogenetic cues and associated with growth and healing throughout mammalian and amphibian animals and the plant kingdom. Electricity in animals was discovered in the eighteenth century. Electric fields activate multiple cellular signaling pathways such as PI3K/PTEN, the membrane channel of KCNJ15/Kir4.2 and intracellular polyamines. These pathways are involved in the sensing of physiological electric fields, directional cell migration (galvanotaxis, also known as electrotaxis), and possibly other cellular responses. Importantly, electric fields provide a dominant and over-riding signal that directs cell migration. Electrical stimulation could be a promising therapeutic method in promoting wound healing and activating regeneration of chronic and non-healing wounds. This review provides an update of the physiological role of electric fields, its cellular and molecular mechanisms, its potential therapeutic value, and questions that still await answers.
Digital Health Interventions for Adolescent and Young Adult Cancer Survivors
Authors: Devine Katie A. , Viola Adrienne S. , Coups Elliot J. , Wu Yelena P.
Published: June 2018

This narrative review describes the evidence regarding digital health interventions targeting adolescent and young adult (AYA) cancer survivors. We reviewed the published literature for studies involving Internet, mHealth, social media, telehealth, and other digital interventions for AYA survivors. We highlight selected studies to illustrate the state of the research in this unique patient population. Interventions have used various digital modalities to improve health behaviors (eg, physical activity, nutrition, tobacco cessation), enhance emotional well-being, track and intervene on cancer-related symptoms, and improve survivorship care delivery. The majority of studies have demonstrated feasibility and acceptability of digital health interventions for AYA survivors, but few efficacy studies have been conducted. Digital health interventions are promising to address unmet psychosocial and health information needs of AYA survivors. Researchers should use rigorous development and evaluation methods to demonstrate the efficacy of these approaches to improve health outcomes for AYA survivors.
The HOPE Pilot Study: Harnessing Patient-Reported Outcomes and Biometric Data to Enhance Cancer Care
Authors: Wright Alexi A. , Raman Nikita , Staples Patrick , Schonholz Stephanie , Cronin Angel , Carlson Kenzie , Keating Nancy L. , Onnela Jukka-Pekka
Published: June 2018

Purpose

Integrating patient-reported outcomes (PROs) into clinical practice is an increasingly promising strategy for improving patients’ symptoms, communication, and clinical outcomes. The objective of the current study was to assess the feasibility, acceptability, and perceived effectiveness of a mobile health intervention that was designed to collect PROs and activity data as a measure of health status.

Patients and Methods

This work was a pilot intervention with 10 patients with gynecologic cancers who received palliative chemotherapy. The HOPE (Helping Our Patients Excel) study used wearable accelerometers to assess physical activity and the Beiwe research platform to collect PROs, stratify patient responses by risk, provide tailored symptom management, and notify patients and clinicians of high-risk symptoms. Feasibility and acceptability were assessed through enrollment and adherence rates, and perceived effectiveness was evaluated by patients and oncologists at study completion.

Results

The approach-to-consent rate was 100%, and participants were 90% and 70% adherent to the wearable accelerometers and smartphone surveys, respectively. Participants’ mean daily step count was 3,973 (standard deviation [SD], 2,305 steps) and increased from week 1 (mean, 3,520 steps; SD, 1,937 steps) to week 3 (mean, 4,136 steps; SD, 1,578 steps). Active monitoring of participants’ heart rates, daily steps, and PROs throughout the study identified anomalies in participants’ behavior patterns that suggested poor health for two patients (20%). Patients and clinicians indicated that the intervention improved physical activity, communication, and symptom management.

Conclusion

A mobile health intervention that collects PROs and activity data as a measure of health status is feasible, acceptable, and was perceived to be effective in improving symptom management in patients with advanced gynecologic cancers. A larger, multisite, randomized clinical trial to assess the efficacy of the HOPE intervention on patients’ symptoms, health-related quality of life, clinical outcomes, and health care use is warranted.
Framework to Advance Oncology-Related Telehealth
Authors: Rising Kristin L. , Ward Marcia M. , Goldwater Jason C. , Bhagianadh Divya , Hollander Judd E.
Published: June 2018

Purpose

As telehealth is increasingly used across the clinical care spectrum to provide patient-centered care, it is important to have robust measures to assess its impact on patient outcomes and care processes. The National Quality Forum (NQF) developed a Telehealth Framework to organize measures and inform target areas for measure development that includes the following four domains: access to care, financial impact or cost, experience, and effectiveness. Our goal is to identify and categorize within the NQF domains currently existing measures of telehealth applicable to oncology to detect priority areas for future research and measure development.

Methods

We reviewed telehealth-related measures applied to oncology care reported in systematic reviews and identified NQF-endorsed quality measures related to oncology care potentially amenable to telehealth. We organized identified measures by the NQF domains to inform suggestions for advancing the care of patients with cancer through telehealth.

Results

We identified 12 systematic reviews representing 183 studies reporting telehealth-related oncology research. Most studied outcomes related to diagnosis and treatment or user experience and symptom monitoring. Clinical effectiveness measures were most frequently reported (38%), and most were psychosocial. Patient, family, and/or caregiver experience was the next most frequently reported measure. There were only a few other cancer-related clinical effectiveness measures (eg, morbidity). Most NQF-endorsed oncology measures amenable to telehealth applied to the domains of access to care and effectiveness, with a lack of measures informing financial impact or cost and experience.

Conclusion

Overall, there has been a lack of quality measures to assess use of telehealth for the care of oncology patients. Future work should focus on developing measures within each of the NQF-identified domains, with special attention to the financial impact or cost domain.
Impact of Regional Anesthesia on Gastroesophageal Cancer Surgery Outcomes: A Systematic Review of the Literature
Authors: Pérez-González Oscar , Cuéllar-Guzmán Luis F. , Navarrete-Pacheco Mayra , Ortiz-Martínez Jorge J. , Williams Wendell H. , Cata Juan P.
Published: June 2018

Regional anesthesia may play a beneficial role in long-term oncological outcomes. Specifically, it has been suggested that it can prolong recurrence-free survival and overall survival after gastrointestinal cancer surgery, including gastric and esophageal cancer, by modulating the immune and inflammatory response. However, the results from human studies are conflicting. The goal of this systematic review was to summarize the evidence on the impact of regional anesthesia on immunomodulation and cancer recurrence after gastric and esophageal surgery. We conducted a literature search of 5 different databases. Two independent reviewers analyzed the quality of the selected manuscripts according to prespecified inclusion and exclusion criteria. Randomized controlled trials were assessed for potential sources of bias by using the Cochrane Risk of Bias tool. A total of 6 studies were included in the quality analysis and systematic review. A meta-analysis was not conducted for several reasons, including high heterogeneity among studies, low quality of the reports, and lack of standardized outcomes definitions. Although the literature suggests that regional anesthesia has some modulatory effects on the inflammatory and immunological response in the studied patient population, our systematic review indicates that there is no evidence to support or refute the use of epidural anesthesia or analgesia with the goal of reducing cancer recurrence after gastroesophageal cancer surgery.
Epidural Analgesia and Subcutaneous Heparin 3 Times Daily in Cancer Patients With Acute Postoperative Pain
Authors: Su Jackson , Soliz Jose M. , Popat Keyuri U. , Gebhardt Rodolfo
Published: June 2018

The use of epidural analgesia in conjunction with subcutaneous administration of unfractionated heparin 3 times per day could increase the risk of spinal epidural hematoma, but insufficient patient experience data exist to determine this. We retrospectively reviewed the incidence of spinal epidural hematoma in 3705 cases at our institution over a 7-year period of patients receiving acute postoperative epidural analgesia and heparin 3 times per day. No cases of spinal epidural hematoma were reported (95% CI, 0–0.0009952).
Can STOP-Bang and Pulse Oximetry Detect and Exclude Obstructive Sleep Apnea?
Authors: Christensson Eva , Franklin Karl A. , Sahlin Carin , Palm Andreas , Ulfberg Jan , Eriksson Lars I. , Lindberg Eva , Hagel Eva , Jonsson Fagerlund Malin
Published: June 2018

BACKGROUND:

Obstructive sleep apnea (OSA) is related to postoperative complications and is a common disorder. Most patients with sleep apnea are, however, undiagnosed, and there is a need for simple screening tools. We aimed to investigate whether STOP-Bang and oxygen desaturation index can identify subjects with OSA.

METHODS:

In this prospective, observational multicenter trial, 449 adult patients referred to a sleep clinic for evaluation of OSA were investigated with ambulatory polygraphy, including pulse oximetry and the STOP-Bang questionnaire in 4 Swedish centers. The STOP-Bang score is the sum of 8 positive answers to Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index >35 kg/m2, Age >50 years, Neck circumference >40 cm, and male Gender.

RESULTS:

The optimal STOP-Bang cutoff score was 6 for moderate and severe sleep apnea, defined as apnea-hypopnea index (AHI) ≥15, and the sensitivity and specificity for this score were 63% (95% CI, 0.55–0.70) and 69% (95% CI, 0.64–0.75), respectively. A STOP-Bang score of <2 had a probability of 95% (95% CI, 0.92–0.98) to exclude an AHI >15 and a STOP-Bang score of ≥6 had a specificity of 91% (95% CI, 0.87–0.94) for an AHI >15. The items contributing most to the STOP-Bang were the Bang items. There was a positive correlation between AHI versus STOP-Bang and between AHI versus oxygen desaturation index, Spearman ρ 0.50 (95% CI, 0.43–0.58) and 0.96 (95% CI, 0.94–0.97), respectively.

CONCLUSIONS:

STOP-Bang and pulse oximetry can be used to screen for sleep apnea. A STOP-Bang score of <2 almost excludes moderate and severe OSA, whereas nearly all the patients with a STOP-Bang score ≥6 have OSA. We suggest the addition of nightly pulse oximetry in patients with a STOP-Bang score of 2–5 when there is a need for screening for sleep apnea (ie, before surgery).
Dexmedetomidine Versus Remifentanil for Monitored Anesthesia Care During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Trial
Authors: St-Pierre Patrick , Tanoubi Issam , Verdonck Olivier , Fortier Louis-Philippe , Richebé Philippe , Côté Isabelle , Loubert Christian , Drolet Pierre
Published: June 2018

BACKGROUND:

We hypothesized that, compared to remifentanil, dexmedetomidine used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) performed under monitored anesthesia care (MAC) in nonintubated patients would result in fewer episodes of major respiratory adverse events (number of episodes of bradypnea, apnea or desaturation) but no difference in satisfaction with perioperative conditions.

METHODS:

Sixty (American Society of Anesthesiologists physical status I–III) patients scheduled to undergo EBUS-TBNA under MAC were randomized to receive either remifentanil (0.5 µg/kg IV bolus) in 10 minutes, followed by 0.05–0.25 µg/kg/min, or dexmedetomidine (0.4 µg/kg IV bolus) in 10 minutes, followed by 0.5–1.0 µg/kg/h. The primary outcome was the number of major respiratory adverse events (bradypnea, apnea, or hypoxia). The secondary outcomes included hemodynamic variables, discharge time from the postanesthesia care unit, endotracheal lidocaine use, patient’s sedation using the Observer Assessment of Alertness/Sedation Scale, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting.

RESULTS:

Dexmedetomidine produced significantly fewer episodes of major respiratory events (bradypnea, apnea, or desaturation), with 0 [0–0.5] episodes versus 2 [0–5] (median [interquartile range]) (P = .001), than did remifentanil. Fewer episodes of bradypnea or apnea (dexmedetomidine: 0 [0–0] versus remifentanil: 0 [0–0.5]; P = .031), and fewer episodes of desaturation (dexmedetomidine: 0 [0–0.5] versus remifentanil: 1 [0–4]; P = .039) were recorded in the dexmedetomidine group. The time needed for patients to meet postanesthesia care unit discharge criteria (Aldrete score: 9) after EBUS-TBNA was longer in the dexmedetomidine group (10 [3–37.5] minutes) versus the remifentanil group (3 [3–5] minutes) (P < .001). No differences were observed in the 2 groups for sedation depth (Observer Assessment of Alertness/Sedation Scale), endotracheal lidocaine use, operative conditions, operator and patient satisfaction, pain, coughing, vocal cord mobility, recall, and nausea/vomiting episodes.

CONCLUSIONS:

Dexmedetomidine resulted in fewer respiratory adverse events during EBUS-TBNA under MAC, when compared to remifentanil, with no difference in overall operative conditions. However, dexmedetomidine use was associated with delayed postoperative discharge.
A RELAÇÃO ENTRE PERCEPÇÃO DE QUALIDADE NA EDUCAÇÃO SUPERIOR E MOTIVAÇÃO DE DISCENTES UNIVERSITÁRIOS
Authors: Silva Joelma Soares da , Quezado Izabelle , Sousa Ellen Campos , Rocha Estevão Lima de Carvalho , Peñaloza Verónica
Published: June 2018

Mediante o crescimento do mercado universitário brasileiro, o objetivo deste trabalho é identificar a existência de relação entre a percepção de qualidade e a motivação de discentes universitários em relação à IES. Saber a opinião dos clientes/alunos é importante para que seja possível oferecer serviços mais adequados, mantendo-se no competitivo mercado. Neste trabalho, realizou-se uma pesquisa quantitativa, de campo, com 179 discentes de Administração de duas IES, uma pública e outra privada. Os resultados apontaram que existe relação entre os constructos motivação e qualidade.
OS NÚCLEOS DE INOVAÇÃO TECNOLÓGICA (NITS) E AS SPIN-OFFS ACADÊMICAS
Authors: Câmara Samuel Façanha
Published: June 2018

Os NITs têm como missão fazer chegar à sociedade brasileira, principalmente ao setor produtivo, os conhecimentos aplicados em forma de tecnologia produzidos pelas Instituições de Ciência e Tecnologia (ICTs). Complementarmente, as spin-offs acadêmicas, empresas que surgem a partir de projetos de pesquisa e desenvolvimento em ICTs, são um dos mais importantes mecanismos para a transferência de tecnologia (TT) no mundo dos NITs. No entanto, não há estatísticas sobre a quantidade e os impactos das spin-offs acadêmicas nem de sua evolução ao longo do tempo. Assim, é difícil afirmar que este processo está crescendo nas ICTs brasileiras e resultando em práticas de TT. Nesse sentido, os NITs precisam se envolver com as incubadoras de empresas em suas ICTs, em programas de estímulo e evolução de spin-offs. Essa discussão merece ser aprofundada, principalmente, considerando a definição mais clara de como  integração entre os NITs e as incubadoras de suas ICTs deve se realizar. Assim, precisamos continuar falando a respeito, apresentando casos e propostas metodológicas adequadas.
MARCO LEGAL DE CT&I EM CONSTRUÇÃO, POR VOCÊ
Authors: Amarante Segundo Gesil Sampaio
Published: June 2018

O recente Marco Legal de Inovação (Lei 13.243/2016) ainda não está completamente em vigor, demandando, no âmbito federal, regulamentação. No âmbito dos estados (e também o DF e municípios) serão necessárias a elaboração e a promulgação de leis e decretos locais coerentes com a norma nacional. Para além das normas e para facilitar o entendimento delas, será muito importante o esforço da construção de textos de referência para a correta interpretação de órgãos de assessoramento e fiscalização. Finalmente, as próprias Instituições de Ciência, Tecnologia e Inovação (ICTs, conceito criado na Lei para incluir as várias modalidades institucionais ocupadas da construção do conhecimento e da tecnologia) foi garantido espaço para complementar a norma, estabelecendo suas políticas de Inovação que definirão como elas próprias se posicionarão frente ao tema, de acordo com oito itens bastante abrangentes estabelecidos no art. 15-A da Lei de Inovação (Lei 10.973/2004), uma das 9 leis alteradas pelo Marco. Há, portanto, muito a ser feito no sentido do efetivo estabelecimento de um conjunto normativo completo para o Sistema Nacional de CT&I, pois todos nós devemos participar da construção deste conjunto.
AS INOVAÇÕES SOCIAIS NOS ECOSSISTEMAS
Authors: Matos Laércio Ferreira
Published: June 2018

A inovação é um fenômeno interativo e não linear, que modifica, em determinada intensidade, o cotidiano de uma parte da sociedade. Logo, podemos afirmar que toda inovação tem impacto social, em maior ou menor intensidade. Por outro lado, sabemos que o desenvolvimento de novos produtos, processos, metodologias ou estruturas tem o objetivo de gerar renda para seus criadores. Esta constatação denota dois elementos fundamentais para o processo inovador que, infelizmente, são, às vezes, erroneamente considerados antagônicos: lucratividade e bem-estar social. Este breve ensaio se baseia na analogia que normalmente ocorre entre as inovações sociais e as economias de baixo custo, o que tem levado os programas de apoio às inovações sociais a serem confundidos com assistencialistas, e mesmo os editais formulados, dirigidos a inovações sociais, têm restringido seus apoios às organizações sociais, quando se sabe que uma grande empresa, dotada de laboratório de equipamento de ponta, quando desenvolve um novo medicamento, por exemplo, realiza uma inovação social. O texto defende que a inovação social deve ser vista como parte do Ecossistema Inovador e, por isso, deve ser analisada de forma sistêmica, como fenômenos interativos, e não de forma isolada, o que tende ao viés assistencialista na formulação de políticas de apoio.
ANÁLISE E CATEGORIZAÇÃO DE ECOSSISTEMAS EMPREENDEDORES: UM ESTUDO EM DISTINTAS ESPACIALIDADES NA CIDADE DE SETE LAGOAS (MG)
Authors: Jelihovschi Paulo Henrique Gomes , Martins Henrique Cordeiro , Sant’Anna Anderson De Souza
Published: June 2018

Este artigo objetiva investigar ecossistemas empreendedores, por meio de análise de interações entre empreendedores em distintas espacialidades da cidade de Sete Lagoas (MG). Os espaços estudados foram o Centro, rua da periferia e o principal shopping center. Como marcos teóricos, foi utilizada a abordagem de Jacobs (2011) para análise das características dos espaços pesquisados; a Teoria da Ação Prática, elaborada por Bourdieu (2010), para análise dos capitais mobilizados pelos diferentes empreendedores investigados; e a Teoria das Relações Ecológicas Interespecíficas, desenvolvida por Lopes e Rosso (2010), para investigação das características dos ecossistemas alvos do estudo. Em termos metodológicos, a pesquisas pode ser caracterizada como estudos de caso, de abordagem qualitativa, realizada por meio de entrevistas semiestruturadas junto a empreendedores locais. Os dados obtidos foram submetidos a análise de conteúdo, permitindo a categorização dos espaços estudados em três tipos de ecossistemas: mutualismo (comércio de rua), protocooperação (Centro) e inquilinismo (Shopping center).
ANÁLISE DE VIABILIDADE DO MERCADO: IMPLANTAÇÃO DE UMA FÁBRICA DE LATICÍNIOS EM MOÇAMBIQUE
Authors: Mahomed Nadir Aboobacar , Nunes Rogerio Da Silva
Published: June 2018

O presente artigo procura responder sobre a viabilidade mercadológica de implantar uma fábrica de laticínios em Moçambique – África. Com onze províncias, superfície de 801.590 Km², 29 milhões de habitantes, o país não possui laticínios relevantes e depende da importação de produtos essenciais à nutrição, como os derivados do leite. A pesquisa contou com procedimentos de amostragem não probabilística junto às pessoas das classes A, B e C das três principais cidades do país, Maputo, Beira e Nampula. Assim, apresentam-se resultados relativos à percepção ao preço do litro, hábito de compra, padrão de compra, tipo e principais substitutos utilizados do leite longa vida e, hábitos de compra dos demais derivados, iogurte, queijo e manteiga. Por fim, exibe-se uma projeção de demanda agregada para os anos de 2018, 2019 e 2020 dos produtos. Na conclusão, aprova-se a viabilidade mercadológica do negócio, pela confirmação da demanda em quantidades substanciais dos produtos.
ΑΝΑΓΚΗ ΔΗΜΙΟΥΡΓΙΑΣ ΕΝΤΟΣ ΤΩΝ ΚΟΛΠΩΝ ΤΟΥ ΚΤΗΝΙΑΤΡΙΚΟΥ ΣΩΜΑΤΟΣ ΕΙΔΙΚΗΣ ΥΠΗΡΕΣΙΑΣ ΕΠΙΘΕΩΡΗΣΕΩΣ ΤΡΟΦΙΜΩΝ
Authors: ΧΡΙΣΤΟΦΟΡΟΥ Δ. Χ.
Published: June 2018

NO ABSTRACT AVAILABLE
ΠΕΡΙ ΤΩΝ ΑΠΟΤΕΛΕΣΜΑΤΩΝ ΤΟΥ ΑΝΤΙΛΥΣΣΙΚΟΥ ΕΜΒΟΛΙΑΣΜΟΥ
Authors: ΓΟΡΔΑΤΟΣ Σ.
Published: June 2018

NO ABSTRACT AVAILABLE
EFFICIENCY OF GRAIN FORMATION PRODUCTIVITY USE OF PISUM SATIVUM L. SELECTION
Authors: Фадеева Александра , Fadeeva Aleksandra , Шурхаева Ксения , Shurhaeva Kseniya
Published: June 2018

The results of investigations on revealing the features of the structure formation of seed productivity in new genotypes of peas with non-permeable beans are presented. Selection of Kaban, Fregat, Veles varieties and sample KT-6489 with a new trait was aimed at increasing the number of beans and seeds per plant. The increase in seed productivity was accompanied by a decrease in the mass of 1000 seeds and an increase in the performance of beans. Differences in the variability of the examined signs of seed productivity testify to the genotypic characteristics of the reaction to the effect of environmental conditions. The selection value of the “productivity of seed formation” and its hereditary character is grounded. The use of sources with a high seed-forming ability in breeding has contributed to an increase in the proportion of seeds from planted ovules on the plant. In the varieties with soft beans, the values of this feature, depending on environmental conditions, varied within the range 54.4-70.9%. In new breeding developments, these figures were significantly increased to 81.8-91.0%. Statistical analysis proved the reliability and significance of genotypic differentiation of the trait in changing environmental conditions. A high significant effect of the genotype with a share of 83.7% on the variability of seed production was established. The influence of the environment and the interaction of the factors “genotype x environment” on the trait was assessed by a weak impact (3.61 and 3.94%). The presence of stable genotypes in the study group results from the revealed advantage of variance of genotypes over the variance of the “genotype-environment” interaction. A sample of KT-6489 with a weak variability in seed production (1.6%) with variations by years 84.0-86.7% was isolated.
TO THE DEVELOPMENT OF SOIL TILLAGE WORKING UNITS ON THE BASIS OF FIELDS SOLIDGRAMS
Authors: Казаков Юрий , Kazakov Yuriy , Медведев Владимир , Medvedev Vladimir , Терентьев Алексей , Terent'ev Aleksey , Павлов Владимир , Pavlov Vladimir , Смирнов Анатолий , Smirnov Anatoliy , Акимов Александр , Akimov Aleksandr
Published: June 2018

When solving engineering problems in soil cultivation, soil resistivity is applied. The use of solidograms is more preferable in the construction of soil-working tools and the operation of agricultural machinery. The developed technologies and instruments for continuous layerwise determination of the longitudinal hardness of the arable layer make it possible to obtain soil maps by hardness, to create a database. Factors affecting hardness variability include crop cultivation technology, row spacing, parameters, number and gauge of movers of mobile power tools and agricultural tools, the width of the technological track. The influence of the degrees of freedom of the working units on the intensity of loosening of the soil, the magnitude and nature of the change in the traction resistance, both as a separate working unit and the entire implement, is considered. A combined working unit consisting of a cutaway knife, a built-in drainer, a spring bender on a spring-loaded draft, which creates conditions for the realization of low-intensity types of deformation, the Baushinger effect is proposed. The advantage of the working unit is the continuous automatic adaptation of geometric parameters. For design and strength calculation of such working units, synthesis of elastic characteristics, it is recommended to use methods of the theory of random oscillations. The force and kinematic perturbation of the oscillations is caused by the variability of the hardness of the arable layer, the speed of movement of the working organ, the vibrorheological properties of the soil, and the parameters of the elastic characteristics of the system of springs. The rationale for the smoothing capability of the dynamical system being designed is substantiated by justifying rational design parameters, selecting the material, determining the system parameters by known characteristics at the input and output.
MICROWAVE INSTALLATIONS WITH NON-TRADITIONAL RESONATORS FOR COLLECTING FUR FROM RABBITS’ SKIN
Authors: Шамин Евгений , Shamin Evgeniy , Новикова Галина , Novikova Galina , Михайлова Ольга , Mihaylova Ol'ga , Зайцев Петр , Zaycev Petr , Овчукова Светлана , Ovchukova Svetlana , Кириллов Николай , Kirillov Nikolay , Белов Евгений , Belov Evgeniy
Published: June 2018

The paper describes the developed ultrahigh-frequency installations with toroidal and conical resonators used for separating rabbits’ fur from hides providing high electric field strength, continuity of the technological process while observing radio-tightness and improving the quality of fluff by improving microwave technology and ultra-high-frequency installations. The technological process of collecting hair from rabbits’ skins in a microwave device with toroidal resonators is due to the weakening of the retention of the hair cover in hair follicles during the selective dielectric heating of the components of the skin and the spraying of the brine. In a biconical resonator, it is possible to obtain the highest possible high quality factor due to small longitudinal currents in the walls. The presence of gaps in the outermost regions provides the ability to move the skin through the internal cavity of the biconical resonator, where the emitters are located in the region of its maximum diameter.