bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accelerated Venovenous Hemofiltration as a Transitional Renal Replacement Therapy in the Intensive Care Unit
Authors: Allegretti Andrew S. , Endres Paul , Parris Tyler , Zhao Sophia , May Megan , Sylvia-Reardon Mary , Bezreh Nicole , Culbert-Costley Roberta , Ananian Lillian , Roberts Russel J. , Lopez Natasha , Charytan David M. , Tolkoff-Rubin Nina 
Published: February 2020

<b><i>Background:</i></b> Continuous renal replacement therapy (CRRT) is commonly employed in the intensive care unit (ICU), though there are no guidelines around the transition between CRRT and intermittent hemodialysis (iHD). Accelerated venovenous hemofiltration (AVVH) is a modality utilizing higher hemofiltration rates (4–5 L/h) with shorter session durations (8–10 h) to “accelerate” the clearance and volume removal that normally is spread out over a 24-h period in CRRT. We examined AVVH as a transition therapy between CRRT and iHD, with the aim of decreasing time on CRRT and providing a more graduated transition for hemodynamically unstable patients requiring RRT. <b><i>Methods:</i></b> Retrospective cohort study describing the clinical outcomes and quality initiative experience of the integration of AVVH into the CRRT program at an academic tertiary care center. Outcomes of interest included mortality, ICU length of stay and readmission rates, and technical characteristics of treatments. <b><i>Results:</i></b> In total, 97 patients received a total of 298 AVVH treatments (3.1 ± 3.3 treatments per patient). Totally, 271/298 (91%) treatments were completed successfully. During an average treatment time of 9.5 ± 1.6 h with 4.2 ± 0.5 L/h ­replacement fluid rate, urea reduction ratio was 23 ± 26% per 10-h treatment, and net ultrafiltration volume was 2.4 ± 1.3 L/treatment. Inpatient mortality was 32%, mean total hospital length of stay was 54 ± 47 days. Sixty-four out of 97 (66%) patients recovered renal function by discharge. Among those who transferred out of the ICU, 7/62 (11%) patients required readmission to the ICU after developing hypotension on iHD. <b><i>Conclusion:</i></b> AVVH can serve as a transition therapy between CRRT and iHD in the ICU and has the potential to decrease total time on CRRT, improve patient mobility, and sustain low ICU readmission rates. Future study is needed to analyze the implications on resource use and cost of this modality.
Thomas Jones’ Neapolitan Kitchen: The Material Cultures of Food on the Grand Tour
Authors: Calaresu Melissa 
Published: February 2020

Abstract
The Welsh painter, Thomas Jones, recorded in minute detail the prices, origin, and types of food and services for each day of his family’s stay in Naples from their arrival from Rome in 1780 to their departure for England in 1783. His “Italian account book” has not been studied before in any depth, except in relation to his activities as an artist. However, this “time-capsule” of a Grand Tour household provides an extraordinarily vivid entry into the material world of urban provisioning in one of the largest cities in eighteenth-century Europe, by linking the economy of the street to wider networks of provisioning from outside of the city. It also provides a better understanding of the extent of acculturation of British residents in Italy. Space, time, and the interconnectedness between the home and the street are central themes in this material culture analysis of food on the Grand Tour.
Introduction: The Material Worlds of Food in Early Modern Europe
Authors: Calaresu Melissa 
Published: February 2020

Abstract
All of the articles in this special issue show the necessity of having to combine different kinds of sources—texts with images, images with objects, and objects with absences—to build an integrated history of the material worlds of food in the early modern period. They also reflect newer approaches to materiality which are sensitive to the relationship between matter and the senses and consider the haptic, visual, olfactory, and even aural aspects of cooking and eating alongside taste. In turn, the tastes of collectors and the fragility and absence of source material also need to be taken into consideration in order to write a meaningful cultural and social history of food. Despite the ephemeral nature of eating and cooking, this special issue shows that the sources studied by historians of material culture of the early modern period are remarkably rich, and their analysis fruitful.
The Gulper and the Slurper: A Lexicon of Mistakes to Avoid While Eating with Ottoman Gentlemen
Authors: Pfeifer Helen 
Published: February 2020

Abstract
This article examines the material culture and social etiquette of elite dining in the early modern Ottoman Empire. The challenges of eating with others were numerous, as the sixteenth-century Damascene scholar Badr al-Din al-Ghazzi (d. 1577) showed in painful and hilarious ways in his treatise entitled Table Manners (Adab al-Muʾakala). One set of problems stemmed from the objects structuring the meal, especially the relative dearth of crockery and cutlery. Far from making dining experiences simpler and more straightforward, as scholars have sometimes suggested, this necessitated greater cooperation between diners and made them vulnerable to individual misbehavior. Another set of problems arose from the material qualities of food, where sources of pleasure, handled poorly, could easily trigger disgust. The self-discipline that Ghazzi promoted in his manual offered a partial solution to these difficulties, but not a solution equally available to all.
Theoretical Understanding of the Linear Relationship between Convective Updrafts and Cloud-Base Height for Shallow Cumulus Clouds. Part II: Continental Conditions
Authors: Zheng Youtong , Sakradzija Mirjana , Lee Seoung-Soo , Li Zhanqing 
Published: February 2020

AbstractsThis is the Part II of a two-part study that seeks a theoretical understanding of an empirical relationship for shallow cumulus clouds: subcloud updraft velocity covaries linearly with the cloud-base height. This work focuses on continental cumulus clouds that are more strongly forced by surface fluxes and more deviated from equilibrium than those over oceans (Part I). We use a simple analytical model for shallow cumulus that is well tested against a high-resolution (25 m in the horizontal) large-eddy simulation model. Consistent with a conventional idea, we find that surface Bowen ratio is the key variable that regulates the covariability of both parameters: under the same solar insolation, a drier surface allows for stronger buoyancy flux, triggering stronger convection that deepens the subcloud layer. We find that the slope of the Bowen-ratio-regulated relationship between the two parameters (defined as λ) is dependent on both the local time and the stability of the lower free atmosphere. The value of λ decreases with time exponentially from sunrise to early afternoon and linearly from early afternoon to sunset. The value of λ is larger in a more stable atmosphere. In addition, continental λ in the early afternoon more than doubles the oceanic λ. Validation of the theoretical results against ground observations over the Southern Great Plains shows a reasonable agreement. Physical mechanisms underlying the findings are explained from the perspective of different time scales at which updrafts and cloud-base height respond to a surface flux forcing.
High‐Frequency Conductive Hearing following Total Drum Replacement Tympanoplasty
Authors: Polanik Marc D. , Trakimas Danielle R. , Black Nicole L. , Cheng Jeffrey T. , Kozin Elliott D. , Remenschneider Aaron K. 
Published: February 2020

ObjectivesConventional reporting of posttympanoplasty hearing outcomes use a pure‐tone averaged air‐bone gap (ABG) largely representing a low‐frequency sound conduction. Few studies report high‐frequency conductive hearing outcomes. Herein, we evaluate high‐frequency ABG in patients following temporalis fascia total drum replacement.Study DesignCase series with chart review.SettingTertiary care center.Subjects and MethodsAll patients who underwent type 1 tympanoplasty using a lateral graft total drum replacement technique between August 2016 and February 2019 were identified. Patients with pre‐ and postoperative audiograms were included. Low‐frequency ABG was calculated as the mean ABG at 250, 500, and 1000 Hz. High‐frequency ABG was calculated at 4 KHz. Pre‐ and postoperative ABGs were compared.ResultsTwenty‐three patients were included, and the mean age at surgery was 44 years (range, 9‐68 years). Perforation etiology was from trauma (n = 14) or chronic otitis media (n = 9). Preoperative mean low‐frequency ABG was 27.8 ± 12.6 dB and mean high‐frequency ABG was 21.5 ± 15.1 dB (P =. 044). Postoperatively, the mean low‐frequency ABG was significantly reduced by 15.5 ± 13.3 dB (P <. 001) while the mean high‐frequency ABG insignificantly changed (reduced by 2.6 ± 16.2 dB, P =. 450).ConclusionIn a series of patients undergoing temporalis fascia total drum replacement, low‐frequency ABG improved; however, high‐frequency conductive hearing loss persists. Conventional methods of reporting ABG may not identify persistent high‐frequency ABG. These results merit further study across a range of tympanoplasty graft materials and surgical techniques.
A practical approach to evaluating postoperative thrombocytopenia
Authors: Skeith Leslie , Baumann Kreuziger Lisa , Crowther Mark A. , Warkentin Theodore E. 
Published: February 2020

Abstract
Identifying the cause(s) of postoperative thrombocytopenia is challenging. The postoperative period includes numerous interventions, including fluid administration and transfusion of blood products, medication use (including heparin), and increased risk of organ dysfunction and infection. Understanding normal thrombopoietin physiology and the associated expected postoperative platelet count changes is the crucial first step in evaluation. Timing of thrombocytopenia is the most important feature when differentiating causes of postoperative thrombocytopenia. Thrombocytopenia within 4 days of surgery is commonly caused by hemodilution and increased perioperative platelet consumption prior to thrombopoietin-induced platelet count recovery and transient platelet count overshoot. A much broader list of possible conditions that can cause late-onset thrombocytopenia (postoperative day 5 [POD5] or later) is generally divided into consumptive and destructive causes. The former includes common (eg, infection-associated disseminated intravascular coagulation) and rare (eg, postoperative thrombotic thrombocytopenic purpura) conditions, whereas the latter includes such entities as drug-induced immune thrombocytopenia or posttransfusion purpura. Heparin-induced thrombocytopenia is a unique entity associated with thrombosis that is typically related to intraoperative/perioperative heparin exposure, although it can develop following knee replacement surgery even in the absence of heparin exposure. Very late onset (POD10 or later) of thrombocytopenia can indicate bacterial or fungal infection. Lastly, thrombocytopenia after mechanical device implantation requires unique considerations. Understanding the timing and severity of postoperative thrombocytopenia provides a practical approach to a common and challenging consultation.
Accuracy of transition zone in contrast enema to predict intraoperative aganglionosis level in patients with Hirschsprung disease
Authors: Haikal Zikrul , Dwihantoro Andi , Gunarti Hesti , Gunadi  
Published: February 2020

Abstract
Objective
While frozen section methods have been widely conducted to determine aganglionosis segment during transanal endorectal pull-through (TEPT) for Hirschsprung disease (HSCR) patients in most institutions, some hospitals still rely on contrast enema to predict aganglionosis segments due to unavailability of frozen section facilities. We determined the accuracy of transition zone in contrast enema to predict aganglionosis segments during TEPT. We retrospectively reviewed all contrast enema and frozen sections for HSCR patients under 2 years of age who underwent TEPT at our institution.

Results
We recruited 36 HSCR patients: twenty-six patients (72.2%) had radiographic transition zones limited to rectum, while ten subjects (27.8%) were limited to rectosigmoid. The rectum subgroup of patients showed a concordance of 30.8%, whereas the rectosigmoid subgroup had a concordance of 100%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of contrast enema compared with intraoperative histopathological findings for aganglionosis level were 100% (95% CI 0.60–1.0), 35.7% (95% CI 0.19–0.56), 30.8% (95% CI 0.15–0.52), 100% (95% CI 0.66–1.0), and 50% (95% CI 0.33–0.67), respectively. In conclusions, contrast enema has low accuracy to predict intraoperative aganglionosis segments in HSCR patients, indicating that it might not be utilized to determine aganglionosis level during TEPT.
Microlaryngeal surgery, difficult airway and a missing throat pack: C Mac D-blade to the rescue!
Authors: Shah Shagun B. , Bhardwaj M. , Bhargava Ajay K. , Bhageria Vani 
Published: February 2020

AbstractSkilful use of the C Mac D-blade videolaryngoscope, with preservation of spontaneous respiration, can avert preoperative tracheostomy and guide microlaryngeal surgery (MLS) tube insertion in patients with large growths obliterating glottic view. The long narrow stylet accompanying double-lumen tubes can be used for D-Blade guided MLS tube orotracheal intubation. A definite protocol for safe insertion and removal of throat packs has been described here. Throat packs may go missing despite following protocols. Our algorithm includes visual and documentary precautions and means of exploration of missing throat packs. D-blade is invaluable in scanning the oropharynx in event of a lost throat pack.
Peer-led team learning for introductory biology: relationships between peer-leader relatability, perceived role model status, and the potential influences of these variables on student learning gains
Authors: Winterton Christina I. , Dunk Ryan D. P. , Wiles Jason R. 
Published: February 2020

AbstractStudent-instructor interactions have an influence on student achievement and perceptions of learning. In college and university settings, large introductory STEM courses are increasingly including Peer-Led Team Learning (PLTL), an evidence-based technique associated with improved student achievement, recruitment, and retention in STEM fields, especially for underserved populations. Within this technique, peer leaders hold a unique position in a student’s education. Peer leaders have relevant experience in that they have had recent success in the courses in which they facilitate student learning, yet, compared to student-faculty or student-teaching assistant relationships, there is minimal imbalance of authority or power. Students might find their peer leaders to be more relatable than faculty or graduate teaching assistants, and may even consider them to be role models. We explored students’ perceptions of peer leader relatability and role model status in relation to students’ achievement and their perceived learning gains in the context of an introductory biology course with an associated PLTL program. The final course grades and self-assessed learning gains of PLTL students who felt they related to their peer leader were compared to those who did not. We also compared final course grades and self-assessed learning gains between PLTL students who viewed their peer leader as a role model versus those who did not. Self-reported learning gains were significantly higher for students who relate to their peer leader, as well as for students who viewed their peer leaders as a role model. There is some support that this trend is stronger for STEM majors versus those who are not enrolled in a STEM program, though the interaction is not significant. Significant differences in overall course grade were only observed between students who reported that they related to their peer leader versus those who did not relate to their peer leader.
From novice to expert: a qualitative study of implementation facilitation skills
Authors: Ritchie Mona J. , Parker Louise E. , Kirchner JoAnn E. 
Published: February 2020

Abstract
Background
It is widely reported that facilitation can aid implementation of evidence-based practices. Although scholars agree that facilitators need a diverse range of skills, only a few retrospective studies have identified some of these. During the test of a facilitation strategy within the context of a VA initiative to implement evidence-based care delivery models, we documented the skills an expert external facilitator transferred to two initially novice internal regional facilitators. Ours is the first study to explore facilitation skills as they are being applied and transferred.

Methods
Facilitators applied the strategy at eight primary care clinics that lacked implementation capacity in two VA networks. We conducted monthly debriefing interviews over a 30-month period and documented these in detailed notes. External facilitator interviews focused specifically on training and mentoring internal facilitators and the skills that she transferred. We also conducted, recorded, and transcribed two qualitative interviews with each facilitator and queried them about training content and process. We conducted a content analysis of the data, using deductive and inductive methods, to identify skills the external facilitator helped internal facilitators learn. We also explored the complexity of facilitation skills and grouped them into overarching skillsets.

Results
The external facilitator helped internal facilitators learn 22 complex skills; with few exceptions, these skills were not unique but overlapped with one another. We clustered 21 of these into 5 groups of overarching skillsets: (1) building relationships and creating a supportive environment, (2) changing the system of care and the structure and processes that support it, (3) transferring knowledge and skills and creating infrastructure support for ongoing learning, (4) planning and leading change efforts, and (5) assessing people, processes, and outcomes and creating infrastructure for program monitoring.

Conclusions
This study documented a broad range of implementation facilitation skills that are complex and overlapping. Findings suggest that studies and initiatives planning or applying facilitation as an implementation strategy should ensure that facilitators have or have the opportunity to learn the skills they need. Because facilitation skills are complex, the use of didactic methods alone may not be sufficient for transferring skills; future work should explore other methods and techniques.
A behavioral economic intervention to increase psychiatrist adherence to tobacco treatment guidelines: a provider-randomized study protocol
Authors: Rogers Erin S. , Wysota Christina , Prochaska Judith J. , Tenner Craig , Dognin Joanna , Wang Binhuan , Sherman Scott E. 
Published: February 2020

Abstract
Background
People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a “no treatment” default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce the status quo to not treat tobacco use in psychiatry. We aim to conduct a pilot study testing an opt-out system for implementing a 3As (ask, advise, assist) tobacco treatment model in outpatient psychiatry.

Methods
We will use a mixed-methods, cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists at the VA New York Harbor Healthcare System. Psychiatrists (N = 20) will be randomized 1:1 to one of the two groups: (1) opt-in treatment approach—psychiatrists will receive a reminder that encourages them to offer cessation medications and referral to cessation counseling; (2) opt-out treatment approach—psychiatrists will receive a clinical reminder that includes a standing cessation medication order and a referral to cessation counseling that will automatically generate unless the provider cancels. Prior to implementation of the reminders, we will hold a 1-h training on tobacco treatment for psychiatrists in both arms. We will use VA administrative data to calculate the study’s primary outcomes: (1) the percent of smokers prescribed a cessation medication and (2) the percent of smokers referred to counseling. During the intervention period, we will also conduct post-visit surveys with a cluster sample of 400 patients (20 per psychiatrist) to assess psychiatrist fidelity to the 3As approach and patient perceptions of the opt-out system. At 6 months, we will survey the clustered patient sample again to evaluate the study’s secondary outcomes: (1) patient use of cessation treatment in the prior 6 months and (2) self-reported 7-day abstinence at 6 months. At the end of the intervention period, we will conduct semi-structured interviews with 12–14 psychiatrists asking about their perceptions of the opt-out approach.

Discussion
This study will produce important data on the potential of opt-out systems to overcome the barriers in implementing tobacco use treatment in outpatient psychiatry.

Trial registration
Clinicaltrials.gov NCT04071795 (registered on August 28, 2019)
Development, implementation, and evaluation of a novel guideline engine for pediatric patients with severe traumatic brain injury: a study protocol
Authors: Pilar Meagan R. , Proctor Enola K. , Pineda Jose A. 
Published: February 2020

Abstract
Background
Severe traumatic brain injury (TBI) is a leading cause of death and disability for children. The Brain Trauma Foundation released evidence-based guidelines, a series of recommendations regarding care for pediatric patients with severe TBI. Clinical evidence suggests that adoption of guideline-based care improves outcomes in patients with severe TBI. However, guideline implementation has not been systematic or consistent in clinical practice. There is also a lack of information about implementation strategies that are effective given the nature of severe TBI care and the complex environment in the intensive care unit (ICU). Novel technology-based strategies may be uniquely suited to the fast-paced, transdisciplinary care delivered in the ICU, but such strategies must be carefully developed and evaluated to prevent unintended consequences within the system of care. This challenge presents a unique opportunity for intervention to more appropriately implement guideline-based care for pediatric patients with severe TBI.

Methods
This mixed-method study will develop a novel technology-based bedside guideline engine (the implementation strategy) to facilitate uptake of evidence-based guidelines (the intervention) for management of severe TBI. Group model building and systems dynamics will inform the guideline engine design, and bedside functionality will be initially assessed through patient simulation. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework, we will determine the feasibility of incorporating the guideline engine in the ICU. Study participants will include pediatric patients with severe TBI and providers at three trauma centers. Quantitative data will include measures of guideline engine acceptance and organizational readiness for change. Qualitative data will include semi-structured interviews from clinicians. We will test the feasibility of incorporating the guideline engine in “real life practice” in preparation for a future clinical trial that will assess clinical and implementation outcomes, including feasibility, acceptability, and adoption of the guideline engine.

Discussion
This study will lead to the development and feasibility testing of an adaptable strategy for implementing guideline-based care for severe TBI, a strategy that meets the needs of individual critical care environments and patients. A future study will test the adaptability and impact of the bedside guideline engine in a randomized clinical trial.