bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ammonia Levels Do Not Guide Clinical Management of Patients With Hepatic Encephalopathy Caused by Cirrhosis
Authors: Haj Mona , Rockey Don C. 
Published: October 2019

Introduction:
Ammonia appears to play a major role in the pathophysiology of hepatic encephalopathy (HE), but its role in guiding management is unclear. We aimed to understand the impact of ammonia levels on inpatient HE management, hypothesizing that patients with elevated ammonia levels would receive more aggressive lactulose therapy than patients with normal ammonia or no ammonia level drawn.

METHODS:
We examined patients with cirrhosis older than 18 years admitted for management of HE from 2005 to 2015. We additionally used propensity matching to control for confounding by the severity of underlying disease. Patients with an ammonia level taken at time of HE diagnosis were further separated into those with normal or elevated ammonia levels. The primary endpoint was the total lactulose (mL) amount (or dose) given in the first 48 hours of HE management.

RESULTS:
One thousand two hundred two admissions with HE were identified. Ammonia levels were drawn in 551 (46%) patients; 328 patients (60%) had an abnormal ammonia level (>72 μmol/L). There were no significant differences in the Child-Pugh score, MELD, or Charlson Comorbidity Index in those with and without ammonia levels drawn. The average total lactulose dose over 48 hours was 167 and 171 mL in the no ammonia vs ammonia groups, respectively (P = 0.42). The average lactulose dose in patients with an elevated ammonia level was 161 mL, identical to the lactulose dose in patients with a normal ammonia level. There was no correlation between lactulose dose and ammonia level (R
2 = 0.0026).

DISCUSSION:
Inpatient management of HE with lactulose was not influenced by either the presence or level of ammonia level, suggesting that ammonia levels do not guide therapy in clinical practice.
Increasing Burden of Acute-On-Chronic Liver Failure Among Alcohol-Associated Liver Disease in the Young Population in the United States
Authors: Singal Ashwani K. , Arora Sumant , Wong Robert J. , Satapathy Sanjaya K. , Shah Vijay H. , Kuo Yong-Fang , Kamath Patrick S. 
Published: October 2019

OBJECTIVES:
Alcohol-associated liver disease is increasing, especially hospitalizations with acute on chronic liver failure and need for liver transplant. We examined trends in prevalence, inhospital mortality, and resource utilization associated with AALD and ACLF in the young.

METHODS:
The National Inpatient Sample (2006–2014) was queried for hospitalizations with a discharge diagnosis of cirrhosis using the International Classification of Diseases, Ninth Edition, codes. ACLF hospitalization was defined as ≥2 organ failures and stratified by age: young (≤35 years) and older (>35 years).

RESULTS:
Of 447,090 AALD admissions (16,126 in young) between 2006 and 2014, ACLF occurred in 29,599 (6.6%), of which 1,143 (7.1%) were in young. Compared with older, admissions in young had more women (35% vs 29%), were obese (11% vs 7.6%), were Hispanics (29% vs 18%), have alcoholic hepatitis (AH) (41% vs 17%), and have ACLF grades 2 or 3 (34% vs 25%), P < 0.001 for all. Between 2006 and 2014, ACLF in AALD among young increased from 2.8% to 5.2%, with an AH proportion from 24% to 42%, P < 0.0001 for both. Young had more complications requiring ventilation (79% vs 76%) and dialysis (32% vs 28%), P < 0.001 for both. Compared with older, ACLF admission in young had longer hospitalization (12 vs 10 days) with higher hospital charges ($127,915 vs $97,511), P < 0.0001 for both, with 20% reduced inhospital mortality (54%–45%), P < 0.001.

DISCUSSION:
AALD-related hospitalizations are increasing in young in the United States, mainly because of the increasing frequency of AH. Furthermore, this disease burden in young is increasing with a higher frequency of admissions with more severe ACLF and consumption of hospital resources. Studies are needed to develop preventive strategies to reduce burden related to AALD and ACLF in young.
Colonic Polypoid Arteriovenous Malformation Causing Symptomatic Anemia
Authors: Rzepczynski Allison , Kramer Jason , Jakate Shriram , Cheng Lin , Singh Ajaypal 
Published: October 2019

ABSTRACT
Vascular ectasias, which can be classified as angiodysplasias and arteriovenous malformations (AVMs), accounts for approximately 3% of lower gastrointestinal bleeding. Typically, colonic AVMs are solitary, large, and flat or elevated red lesions on endoscopy. We present an interesting case of a polypoid ulcerated AVM in the transverse colon causing symptomatic anemia, which was resected endoscopically with a resolution of symptoms. Polypoid colonic AVMs are rather rare with only 15 other cases described in the literature. This case highlights the approach to endoscopic management of these lesions.
Mirtazapine for Refractory Gastroparesis
Authors: Marella Hemnishil K. , Saleem Nasir , Olden Kevin 
Published: October 2019

ABSTRACT
Gastroparesis is a chronic condition of delayed gastric emptying in the absence of mechanical outlet obstruction. We report a 47-year-old African American woman with diabetic gastroparesis who presented with intractable nausea, vomiting, and decreased oral intake with electrolyte disturbances. The patient's symptoms were difficult to control with antiemetic and conventional prokinetic agents, and she was started on mirtazapine 15 mg nightly. She experienced an almost complete symptom relief and was able to tolerate solid food within 24–48 hours. We highlight the role of mirtazapine, a 5-HT1a agonist, as an effective therapy for refractory gastroparesis.
Influence of Gender and Reproductive Factors on Liver Fibrosis in Patients With Chronic Hepatitis B Infection
Authors: Xiong Ming , Li Junying , Yang Shuling , Zeng Fansen , Ji Yali , Liu Jiang , Wu Qiaoping , He Qingjun , Jiang Ronglong , Zhou Fuyuan , Wen Weiqun , Chen Jinjun , Hou Jinlin 
Published: October 2019

INTRODUCTION:
The role of reproductive factors in the development of chronic hepatitis B (CHB) remains unknown. We assessed the potential contributions of gender, menopausal status, and menarche age to liver fibrosis in CHB.

METHODS:
A cross-sectional prospective study included 716 women and 716 age-matched men with CHB who were not currently receiving antiviral therapy. Liver stiffness measurement using transient elastography was used to stage liver fibrosis as F0–F1 (<7.2 kPa), F ≥ 2 (7.2 kPa), F ≥ 3 (9.4 kPa), and F = 4 (12.2 kPa). Female patients were asked regarding their age at menarche and menopausal status using a questionnaire.

RESULTS:
Of the 716 women, 121 (16.9%) were postmenopausal, and 80 (11.2%) had advanced liver fibrosis. Multivariate logistic regression analysis showed that the postmenopausal status compared with the premenopausal status (odds ratio [OR] = 3.65–8.83; P < 0.05) and age at menarche of >14 years compared with <13 years (OR = 2.85–3.95; P < 0.05) were significantly associated with advanced fibrosis. Compared with premenopausal women, age-matched men had a higher OR for advanced fibrosis (P < 0.05). Compared with postmenopausal women, age-matched men did not show a significant difference in the degree of liver fibrosis (P > 0.05). Longitudinal data analysis showed that postmenopausal women (n = 31) were significantly less likely to undergo regression of liver fibrosis after antiviral treatment vs premenopausal women (n = 19) (26.3% vs 74.2%, respectively; P < 0.001).

DISCUSSION:
Menopause and late menarche aggravated liver fibrosis in untreated CHB, besides menopause delayed fibrosis regression under antiviral therapy. The protective effect of female gender against fibrosis was lost for postmenopausal women.

TRANSLATIONAL IMPACT:
It is important to consider menopausal status and age at menarche in establishing surveillance strategies among CHB females. Postmenopausal estrogen therapy may be considered for the prevention or treatment of liver fibrosis.
Successes and Limitations of Inquiry-Based Laboratories on Affective Learning Outcomes for Deaf, Hard-of-Hearing, and Hearing Signing Students
Authors: Marchut Amber Elizabeth , Gormally Cara 
Published: October 2019

Active learning pedagogies such as inquiry-based learning have the potential not only to improve students’ science literacy but also promote affective learning and interest in science, technology, engineering, and mathematics (STEM) careers. Moreover, a focus on affective learning may be key to improve recruitment in STEM. Yet, we know little about how participation in inquiry-based courses can impact college students’ affective learning. Here, we present results from a comparative analysis of two affective learning outcomes, attitudes toward science and science identity, after participation in inquiry-based laboratory courses. Then, we synthesize what we have learned about successes and limitations to promoting growth in positive attitudes toward science and science identity after participation in these courses. Our work focuses on non-science majors who are deaf, hard-of-hearing and hearing signers in bilingual (American Sign Language and written English) inquiry-based biology laboratory courses. We concentrate on the Deaf Community because deaf individuals often face challenges regarding access in STEM education. Our results indicate that participation in inquiry-based laboratory courses has the potential to positively influence students’ attitudes toward science via repeated engagement with hands-on, student-driven experimentation, peer collaboration, and a welcoming classroom environment. However, participation in these classes had a limited impact on students’ science identities. Some students saw themselves as scientists during laboratory classes, however, their science identities beyond the classroom remained unchanged. While inquiry-based laboratories successfully promote one aspect of affective learning, work is needed to improve students’ science identities and increase interest in STEM careers to more effectively recruit students in these courses.
Construcción y evaluación de un divisor de alto voltaje para pruebas de impulso tipo rayo
Authors: Mina Casaran Juan David , García Diego Fernando , Echeverry Diego Fernando 
Published: October 2019

Contexto: La medición segura y efectiva de señales de alto voltaje se ha convertido, desde hace años, en una de las mayores preocupaciones por parte de quienes realizan ensayos en alta tensión. En ese sentido, el divisor de tensión representa uno de los dispositivos de mayor importancia para la medición en laboratorio de señales como las generadas por los rayos. Sin embargo, el divisor debe contar con características adecuadas de voltaje nominal, factor de escala y respuesta en frecuencia, para que la señal registrada sea un reflejo de la señal aplicada al equipo bajo prueba. Muestra de ello son los tipos más comunes de divisores de tensión desarrollados (divisor resistivo, divisor capacitivo y divisor capacitivo amortiguado), cada uno con características propias que permiten un buen desempeño del sistema de medición y registro en alta tensión. Con el propósito de evaluar el desempeño del sistema de medición y registro, en lo referente a la etapa de conversión, en este trabajo se presentan los aspectos teóricos y prácticos relacionados con el diseño, construcción y evaluación de un divisor capacitivo amortiguado de 300 kV, usado para la medición de señales de impulso de tensión tipo rayo.
Método: Para el diseño y evaluación del divisor de voltaje, se utilizaron herramientas computacionales de simulación, como Mathematica® y Pspice®, las cuales ayudaron a estimar el comportamiento de los componentes del divisor: resistor de amortiguamiento y ramas de bajo voltaje. Del mismo modo, se utilizaron equipos de laboratorio (medidor de respuesta en frecuencia y generador de impulsos de voltaje de 300 kV), para verificar el desempeño de los componentes del divisor. Los ensayos se basaron en pruebas de respuesta en frecuencia, capacidad de aislamiento y obtención de los factores de escala del divisor, de acuerdo con estándares nacionales e internacionales.
Resultados: En la prueba de respuesta en frecuencia realizada al resistor de amortiguamiento, desde 20 Hz hasta aproximadamente 1 MHz, los efectos parásitos son despreciables y la impedancia del resistor se puede considerar puramente resistiva. Por su parte, en la prueba de capacidad de aislamiento, se observó que el resistor puede soportar impulsos de tensión de hasta 10 kV, sin que se produzca ruptura del aislamiento del resistor. Respecto a la verificación de los factores de escala, las diferencias porcentuales no superaron el límite de variación de voltaje pico establecido por norma.
Conclusiones: Los resultados muestran que la metodología desarrollada fue adecuada para el diseño, construcción y simulación del divisor de tensión. Los modelos eléctricos propuestos en la metodología fueron suficientes para obtener resultados confiables en las simulaciones. Finalmente, las contribuciones más importantes del trabajo fueron la construcción de un resistor de amortiguamiento no inductivo y la construcción de una rama adicional de bajo voltaje.
Control Directo al Par y Control de Campo Orientado para un Motor Síncrono de Imanes Permanentes
Authors: Cuji William David , Arcos Avilés Diego 
Published: October 2019

Contexto: Los motores síncronos de imanes permanentes o Permanent Magnet Synchronous Motor (PMSM, por sus siglas en inglés) han mejorado rápidamente su rendimiento en cuanto a la densidad de potencia, eficiencia y mejor dinámica, gracias a los procesos de tecnologías empleadas en ellos tales como: la técnica de control y la tecnología de circuitos de accionamiento. Un PMSM puede operar tanto como motor y como generador, además se destacan por tener un reducido mantenimiento, ya que a diferencia de otro tipo de motores los PMSM no presentan anillos colectores ni escobillas. El algoritmo de control que se emplea generalmente en este tipo de motores es un control vectorial, divido en Control Directo del Par (DTC) y Control de Campo Orientado (FOC).
Método: La plataforma computacional donde se realizan las simulaciones es en el software Matlab (R2017a) Simulink 8.9, donde se utilizan bloques predeterminados y funciones programas para los diagramas de control vectorial DTC y FOC.
Resultados: En cuanto al control del par electromagnético, FOC presenta mayor rizado que el DTC, por lo que se determina que el DTC tiene mayor control de par en relación al FOC. Para el control del flujo magnético, de acuerdo con los valores obtenidos, el DTC tiene un mejor control que el FOC. Para el control de velocidad, tanto el control DTC como FOC tienen una rápida respuesta ante perturbaciones, sin embargo el DTC tiene un tiempo de respuesta menor cuando el PMSM se pone en movimiento desde el reposo, es decir que el DTC tiene una respuesta rápida en el estado transitorio y una vez que el motor se encuentra en movimiento, ante perturbaciones como la disminución de velocidad el FOC tiene mejor control.
Conclusiones: Al analizar los aspectos más importantes para determinar cuál técnica de control es efectiva, se concluye que la técnica de control DTC tiene mayor efectividad de acuerdo con la técnica de control FOC, sin embargo, cabe mencionar que las dos técnicas de control son ampliamente utilizadas en el sector industrial en el accionamiento de motores eléctricos por lo que la selección de dichas técnicas dependerá del proceso a realizar.
Stratigraphy of Architectural Elements of a Buried Monogenetic Volcanic System
Authors: Bischoff Alan , Nicol Andrew , Cole Jim , Gravley Darren 
Published: October 2019

AbstractLarge volumes of magma emplaced and deposited within sedimentary basins can have an impact on the architecture and geological evolution of these basins. Over the last decade, continuous improvement in techniques such as seismic volcano-stratigraphy and 3D visualisation of igneous bodies has helped increase knowledge about the architecture of volcanic systems buried in sedimentary basins. Here, we present the complete architecture of the Maahunui Volcanic System (MVS), a middle Miocene monogenetic volcanic field now buried in the offshore Canterbury Basin, South Island of New Zealand. We show the location, geometry, size, and stratigraphic relationships between 25 main intrusive, extrusive and sedimentary architectural elements, in a comprehensive volcano-stratigraphic framework that explains the evolution of the MVS from emplacement to complete burial in the host sedimentary basin. Understanding the relationships between these diverse architectural elements allows us to reconstruct the complete architecture of the MVS, including its shallow (<3 km) plumbing system, the morphology of the volcanoes, and their impact in the host sedimentary basin during their burial. The plumbing system of the MVS comprises saucer-shaped sills, dikes and sill swarms, minor stocks and laccoliths, and pre-eruptive strata deformed by intrusions. The eruptive and associated sedimentary architectural elements define the morphology of volcanoes in the MVS, which comprise deep-water equivalents of crater and cone-type volcanoes. After volcanism ceased, the process of degradation and burial of volcanic edifices formed sedimentary architectural elements such as inter-cone plains, epiclastic plumes, and canyons. Insights from the architecture of the MVS can be used to explore for natural resources such as hydrocarbons, geothermal energy and minerals in buried and active volcanic systems elsewhere.
Traditional versus modern settlement on torrential alluvial fans considering the danger of debris flows: a case study of the Upper Sava Valley (NW Slovenia)
Authors: Valjavec Mateja Breg , Komac Blaž 
Published: October 2019

AbstractWe analysed spatial development of traditional and modern settlements on active alluvial fans in the Upper Sava Valley (NW Slovenia), by using old cadastral data from the beginning of the 19th century, time series of aerial photographs from the middle of the 20th century and recent building cadastre. The valley is surrounded by the mountainous Julian Alps in the south and the Karavanke Mountains in the north where there is a lack of space for settlements due to steep slopes that are increasing the danger of slope processes, torrential processes and floods. By using a very high-resolution 1m LiDAR digital elevation model, we defined the morphometry of alluvial fans and the characteristics of the drainage system of contributing tributaries. We classified the areas according to the threat posed by the modelled torrents and debris flows. We analysed the resilience of settlement in different periods from this perspective and evaluated the integration of natural processes effects in modern spatial planning projects. We found that geomorphic processes threaten a relatively large proportion of some new and old settlements on alluvial fans and that safe planning of areas of settlement has been successful neither in the past nor in recent decades.
Transport mechanism of Mycobacterium tuberculosis MmpL/S family proteins and implications in pharmaceutical targeting
Authors: Ma Shuang , Huang Yu , Xie Fuling , Gong Zhen , Zhang Yuan , Stojkoska Andrea , Xie Jianping 
Published: October 2019

Abstract
Tuberculosis caused by Mycobacterium tuberculosis remains a serious threat to public health. The M. tuberculosis cell envelope is closely related to its virulence and drug resistance. Mycobacterial membrane large proteins (MmpL) are lipid-transporting proteins of the efflux pump resistance nodulation cell division (RND) superfamily with lipid substrate specificity and non-transport lipid function. Mycobacterial membrane small proteins (MmpS) are small regulatory proteins, and they are also responsible for some virulence-related effects as accessory proteins of MmpL. The MmpL transporters are the candidate targets for the development of anti-tuberculosis drugs. This article summarizes the structure, function, phylogenetics of M. tuberculosis MmpL/S proteins and their roles in host immune response, inhibitors and regulatory system.
Risk factors and drug resistance of the MDR Acinetobacter baumannii in pneumonia patients in ICU
Authors: Ren Jichen , Li Xiaomeng , Wang Libo , Liu Mingzhu , Zheng Ke , Wang Yanrong 
Published: October 2019

Abstract

Objective
To investigate the risk factors and drug resistance of MDR Acinetobacter baumannii in pneumonia patients.

Methods
From January 2013 to February 2016, 98 pneumonia patients with MDR Acinetobacter baumannii in our hospital ICU were selected as the observation group, and 49 pneumonia patients with not-MDR Acinetobacter baumannii in our hospital ICU were selected as the control group in accordance with the proportion of 2:1. Sputum samples were collected from the two groups for drug resistance, and the risk factors and prognosis of MDR Acinetobacter baumannii in pneumonia patients were given survey analysis.

Results
The observation group was highly resistant to cefotaxime, piperacillin, imipenem, levofloxacin, gentamicin, tetracycline and ceftazidime, and was only sensitive to polymyxin. In addition to piperacillin, polymyxin B, the other antimicrobial drug resistance rates in the control group was significantly lower than in the observation group (P<0.05). Univariate analysis showed that diabetes, infection before hospitalization, admission 24h score of APACHE II and GCS scores, deep venous catheterization, and mechanical ventilation were related to the MDR Acinetobacter baumannii in pneumonia patients(P<0.05). Non conditional logistic regression analysis showed that diabetes mellitus, infection before hospitalization, admission 24h score of APACHE II and GCS scores were the independent risk factors for the MDR Acinetobacter baumannii in pneumonia patients(P<0.05).

Conclusion
MDR Acinetobacter baumannii in pneumonia patients in ICU is common, where diabetes infection before hospitalization, admission 24h score of APACHE II and GCS scores are the main risk factors, and the vast majority of the antibiotics are resistant to the MDR Acinetobacter baumannii that can lead to poorer prognosis and followed-up of patients with increased mortality.
Effect of the paper surface properties on the ink transfer parameters in offset printing
Authors: Cigula Tomislav , Tomašegović Tamara , Hudika Tomislav 
Published: October 2019

Abstract
Paper has a crucial impact on the qualitative properties of printed product as properties of the paper’s surface directly impact the ink transfer, consequently, basic optical properties of the print. Although same ISO paper type, papers possess variable surface properties leading to different influence on the ink transfer. The aim of this research was to analyse influence of the surface properties of the paper, including surface free energy, smoothness and gloss of some standard papers used in lithography on the ink transfer while matching the colorimetric values defined by ISO 12647-2:2013. Determination of amount of the ink transfer, optical density, mottling and colour difference of prints were performed to evaluate paper-ink interactions. Results have shown that produced prints differ in the investigated properties. Furthermore, there are significant correlations between the surface free energy of the paper and paper smoothness and the ink transfer. In addition, amount of ink used to produce a standardized print varies for different paper types (even in the same ISO paper classification), meaning difference in ink costs. This research proved the high influence of paper’s certain parameters on the ink transfer by strong correlation coefficients. This enables better process control and optimization of the printing.