bluuebunny/crossref_metadata_2025_split huggingface dataset:
Os setores público e privado no processo de inovação no transporte de resíduos sólidos por intermédio do cavalo elétrico
Authors: Rosa Angelica Ferreira , Costaldello Angela Cassia 
Published: February 2020

O presente artigo tem como objetivo apresentar o projeto de vanguarda, o “cavalo elétrico”, como possível substituição das carroças, charretes e carrinhos para coleta e transporte de lixo reciclável no Município de Guarapuava, Paraná. A proposta foi desenvolvida por uma Empresa Júnior mediante parceria do setor público e a iniciativa privada, objetiva a construção de carros de coleta de tração elétrica como substituição para os profissionais de coleta e reciclagem de lixo e é objeto de projeto de lei municipal a ser apresentado ao Legislativo municipal, a fim de promover o bem estar animal ao substituir, de maneira sustentável, os veículos de tração animal. Essa iniciativa encontra respaldo nos objetivos da Organização das Nações Unidas que entende que o desenvolvimento sustentável está apoiado em três pilares, o econômico, o social e o ambiental, por isso, o mesmo tem o condão de atender de cada um desses setores, demonstrando a indispensabilidade do projeto de lei municipal que, depois de aprovado, deverá ser implantado pela Administração Pública de Guarapuava.
Improving pressure ulcer risk identification: a pilot project by ambulance staff
Authors: Mains Jacqueline , Graham Yitka , Hayes Catherine 
Published: February 2020

Background: A quality improvement initiative was designed to identify patients at risk of compromised tissue viability before they were admitted to hospital. Paramedics were educated to better identify patients with pressure ulcers or pressure damage, or those at risk of compromised tissue viability, and these patients were fitted with a pressure ulcer alert bracelet so that emergency department staff could identify them. Aims: The aims of the current initiative were to educate paramedics to better identify patients with pressure ulcers or those at risk of compromised tissue viability to emergency department staff, and fit them with a pressure ulcer alert bracelet to highlight them to emergency department staff so they would receive prompt intervention. Methods: A plan, do, study, act improvement methodology was used, and data from a 3-month period were retrospectively analysed. Patients identified as being at risk of compromised tissue viability were flagged as requiring assessment via a pressure ulcer risk assessment tool to enable prevention. Results: Paramedics identified 130 at-risk patients (aged 23–100 years), and data from 127 patients were analysed. Most at-risk patients fitted with pressure ulcer alert bracelets were aged 70 years or over, and there was an even female/male division. More than half (53%) of patients were found to have a pressure ulcer and alerted to emergency department staff. More than one in four (27%) patients who were identified as being at risk of pressure ulcers lived in nursing or residential homes, and 43% lived alone or in warden-controlled accommodation. Conclusions: Paramedics effectively identified potential risk factors for pressure ulcer development, indicating a need for immediate intervention. This study gives insight into how pressure ulcer risk assessment using an alert bracelet may be used in paramedic practice in emergency department handovers. Success depends on hospital staff acting upon paramedic recommendation.
Social Policies in Italian Fascism. Authoritarian Strategies and Social Integration
Authors: Giorgi Chiara 
Published: February 2020

El texto desarrolla algunos de los pasos fundamentales relacionados con el desarrollo del Welfare italiano durante los años del fascismo, enmarcándolos tanto en el debate historiográfico más reciente como en el contexto de algunos procesos nacionales e internacionales. Así, las políticas sociales fascistas se examinan tanto en el contexto general de extensión de los seguros sociales de la década de 1930, como en lo concerniente a la principal institución italiana responsable de la gestión de estos seguros sociales (el INFPS, -Instituto Nacional Fascista de Previsión Social-).
Fine needle aspiration adequacy in a one-stop neck lump clinic: 2nd cycle improvement
Authors: McNally George , Kamel Usama Fawzy , Hampal Sucha 
Published: February 2020

The one-stop neck lump clinic at Warrington Hospital was established in 2011 in line with NICE head and neck cancer guidelines.1 They recommend that fine needle aspiration (FNA) is performed under ultrasound guidance in the presence of an onsite cytopathologist. This enables an immediate assessment of adequacy and repeat sampling as required on the same day to prevent diagnostic delay.2 The Royal College of Radiologists recommend a minimum adequacy rate of 70% for thyroid lesions. In 2014, a systematic review of 78 papers found an average FNA adequacy rate for all head and neck lesions of 90.7%.3

Methods: This re-audit aimed to evaluate whether local recommendations for improving the performance of ultrasound. Data collected retrospectively between August 2017 and January 2018 were compared to the first cycle audit (December 2015 May 2016). The adequacy of initial FNA samples were recorded and whether repeat aspirations were required. Samples were considered inadequate if the cytology report stated insufficient material for adequate diagnosis.4 The reasons for diagnostically inconclusive reports were documented.
Results: FNA cytology reports for 62 patients (53% female) in the second cycle were compared to 56 patients (64% female) in the first cycle. All pathologies were included, except for patients with suspected lymphoma.The adequacy rate for initial FNA reports increased from 76% to 89%. The specific adequacy rates for thyroids, salivary glands and lymph nodes improved by 18%, 18% and 4% respectively
Conclusion: Discussion with the local pathology and radiology departments after the initial audit generated recommendations to improve adequacy rates. The introduction of CytoRich fluid for thyroid specimen preparation significantly increased adequacy. Narrower bore needles reduce the risk of haemorrhagic samples and were used for repeat FNA sampling to successfully decrease inadequate reports.
Genealogical Links in Samogitian Nobility Heraldry Sources in the Second Half of the 16th–18th Centuries
Authors: Jasiūnienė Gabrielė 
Published: February 2020

Heraldry and its research have deep traditions in Europe, making it a certain focus of attention among researchers. The interest in this field in Lithuania is a more recent phenomenon. The late beginning of heraldry research was partly influenced by Lithuania’s loss of independence. At present, researchers’ attention is focused mainly on the periods of the Grand Duchy of Lithuania and the Polish-Lithuanian Commonwealth, also looking at Lithuanian heraldry from the 20th–21st centuries, and conducting thorough research of the coats of arms of the state, cities, and towns. Research of the heraldry of the nobility is also being conducted, such as the heraldry of the political elite in the Grand Duchy of Lithuania – the Goštautas, Pacas, Radvila, Sapiega families, etc. The heraldry of representatives of the lower gentry, especially among the Samogitian families, has received less attention. Many unanswered questions and undeveloped themes remain in the field of the Samogitian nobility’s heraldry, overlooked in research for a long time. This article analyzes how genealogical links were reflected in Samogitian nobility heraldry sources in the second half of the 16th–18th centuries. Having analyzed the heraldic sources of the Samogitian nobility, it was found that these reflected not only information about a specific individual, but also their broader origins, family and marital lines. The coats of arms of the Samogitian nobility in time became a unique means of representation. The coats of arms of the Samogitian nobility were depicted in seals, literature, portraits, architecture, and elsewhere.
Beta-adrenergic reactivity of erythrocytes and the progression of heart failure in patients after myocardial infarction
Authors: Garganeeva A. A. , Aleksandrenko V. A. , Kuzheleva E. A. , Rebrova T. Yu. 
Published: February 2020

Aim. To identify the associations between beta-adrenergic reactivity of erythrocytes and the progression of heart failure (HF) in patients after myocardial infarction (MI).Material and methods. The study included 50 patients with HF and history of MI 6 months ago. To determine the level of sympathoadrenal system activity, we analyzed beta-adrenergic reactivity by changing the osmotic resistance of erythrocytes by use of adrenoceptor blocking agent.Results. The frequency of HF progression after index MI was 26% (n=13). All patients were divided into 2 groups depending on the presence/absence of HF progression in the postinfarction period. When determining beta-adrenergic reactivity, it was found that patients with HF progression compared with patients without it had the higher level of beta-adrenergic reactivity of membrane (β-ARM) of erythrocytes: 58,8 (50,9; 78,0) CU and 46,8 (38,0; 66,3) CU, p=0,025). A ROC analysis made it possible to establish the β-ARM level ≥49,53 CU a cut-off point, which can be considered as a marker of HF progression in patients after MI (sensitivity 92,3%, specificity 62,2%). This level of β-ARM is associated with a more than five-fold increase of HF progression risk in patients after MI (OR 5,48; 95% CI 1,28-23,37; p=0,024).Conclusion. In patients with HF and MI history, there is a decrease in the adrenergic reactivity of erythrocyte cell membrane, which is reflected by an increase of β-ARM above normal range of 20 CU. At the same time, β-ARM in patients with HF progression compared with patients without it is significantly increased. Established cut-off point of β-ARM (≥49,53 CU) allows predicting the HF progression with high sensitivity and specificity.
The effect of ivabradine as part of standard therapy on vascular endothelial function and cardiac electrical instability in patients with post-infarction cardiosclerosis and heart failure
Authors: Abdullaev A. A. , Mammaev S. N. , Anatova A. A. , Islamova U. A. , Makhacheva A. M. 
Published: February 2020

Aim. To reveal the equivalence of nebivolol replacement with ivabradine in the prevention of endothelial dysfunction and cardiac electrical instability in patients with heart failure with reduced ejection fraction (HFrEF).Material and methods. In current observational study, 126 patients with HFrEF in the postinfarction period were randomized into two groups for six-month treatment: group 1 (n=62) — standard therapy (acetylsalicylic acid 0,1 g/day, clopidogrel 75 mg/day, veroshpiron 50 mg/day, nebivolol 5 mg/day, perindopril 5 mg/day and rosuvastatin 20 mg/day; group 2 (n=66) — the same therapy with nebivolol replacement with ivabradine 10 mg/day. Initially and after 6 months, 24-hour Holter monitoring was performed, heart rate variability was determined. We also investigated endothelial dysfunction using the photoplethysmographic technique with post-occlusive reactive hyperemia (PORH) test.Results. The heart rate, the number of episodes and the duration of symptomatic and silent myocardial ischemia, total myocardial ischemia were significantly decreased in both groups (p<0,001). The decrease of supraventricular extrasystole frequency in both groups had not statistical significance (p>0,05). In both groups, after therapy, parameters of heart rate variability were improved with the parasympathetic predominance (p<0,01). In both groups, the PORH test revealed the increase of brachial artery diameter (group 1 — 5,90Ѓ}3,15% and group 2 — 5,88Ѓ}1,82%) and pulse wave amplitude (group 1 — 1,81Ѓ}0,78 and group 2 — 1,73Ѓ}0,90 times), which indicates a trend towards an improvement in endothelial function. Intergroup comparisons did not reveal significant differences.Conclusion. Ivabradine is equivalent to nebivolol in preventing ventricular extrasystole and reducing heart rate, number of episodes of symptomatic and silent ischemia and the duration of total myocardial ischemia in patients with HFrEF. Ivabradine equivalently to nebivolol improves endothelial function and heart rate variability with reducing the sympathetic activity.
Chronic heart failure and the frequency of taking nonsteroidal anti-inflammatory drugs: a register-based study on the possible risks
Authors: Tarlovskaya E. I. , Mikhailova Yu. V. 
Published: February 2020

Aim. To study the frequency of taking nonsteroidal anti-inflammatory drugs (NSAIDs) and possible adverse events in patients with cardiovascular diseases and heart failure (HF) hospitalized in the Heart Failure Therapy Center (Nizhny Novgorod).Material and methods. According to the local register, the study included 336 patients (men — 156 and women — 180, average age — 71 (63; 80)), hospitalized in Heart Failure Therapy Center in Nizhny Novgorod from February 1 to November 1, 2019. Examination and treatment of patients was performed based on current clinical practice guidelines and standards. According to the results of echocardiography, HF with preserved ejection fraction was diagnosed in 70% of patients, HF with mid-range ejection fraction — in 20%, and HF with reduced ejection fraction — in 10%. Based on data on the outpatient NSAIDs taking, all participants were divided into 2 groups: NSAID+ (n=63) and NSAID(n=273).Results. Among hospitalized patients, 18,7% of patients took NSAIDs on an outpatient basis, without a doctor’s prescription, more often non-selective, mainly by mouth, for stopping arthralgia. The frequency of emergency hospitalizations due to acute HF decompensation depending on the NSAIDs taking did not significantly differ. In the NSAID+ group, acute kidney injury was diagnosed 3 times more often and 10 times more often when NSAIDs were taken ≥1 times a week. Anemia was diagnosed more often in the NSAID+ group, when taking NSAIDs ≥1 times a week. In the NSAID+ group, grade 2-4 anemia was significantly more often diagnosed.Conclusion. None of the patients took the recommended NSAIDs with a low cardiovascular risk. Patients taking NSAIDs were more likely to have a history of atrial fibrillation and acute cerebrovascular accident. Patients from the NSAID+ group had the higher incidence of acute kidney injury and anemia.
The risk of venous thromboembolism in patients with heart failure
Authors: Vereina N. K. , Agasyan D. G. , Chulkov V. S. 
Published: February 2020

Aim. To quantify the risk of venous thromboembolism (VTE) in hospitalized patients, depending on the severity of heart failure (HF).Material and methods. Current cross-sectional study included 132 patients hospitalized in the cardiology department in 2019. All participants were divided into 2 groups: group 1 (n=48) — patients with class I-II HF; group 2 (n=84) — patients with class III-IV HF. A total quantitative assessment of the VTE risk was carried out according to the Caprini risk scoring method.Results. All patients hospitalized in the cardiology department, regardless of HF class, had a moderate and high risk of VTE and required prophylactic anticoagulation. High VTE risk had 85% of patients with class I-II HF; 97,6% — patients with a class III-IV HF. Mean score of ≥10 was observed in every fifth patient. Atrial fibrillation requiring long-term anticoagulant therapy was observed in 51,5% of patients. There were no absolute contraindications for parenteral prophylactic anticoagulation at the time of hospitalization in the study population.Conclusion. All patients admitted to the cardiology department had a moderate and high according to the Caprini risk score, regardless of HF class. More than half of the patients had indications for long-term anticoagulant therapy. The remaining patients required the parenteral prophylactic anticoagulation.
Comparative pharmacoeconomic analysis of medication for patients after acute decompensated heart failure
Authors: Zyryanov S. K. , Ushkalova E. A. 
Published: February 2020

Aim. Pharmacoeconomic comparison of medication management strategies (valsartan+ sacubitril) for patients with heart failure (HF), stabilized after an episode of acute decompensated heart failure (ADHF).Material and methods. “Cost — effectiveness analysis” and “Budget impact analysis” were used. The study is conducted in terms of the interests of Russian Federation health care system and budgets of individual regions.Results. The use of valsartan+sacubitril combination will require an increase in direct medical costs for 1 year by 38,5% compared with enalapril. The cost of one life year gained when using the valsartan+sacubitril combination was 307,294 rubles. When estimating data for the target ADHF population (n=200,769), valsartan+sacubitril will require additional 4,4 billion rubles per year. At the same time, this will save almost 17 thousand lives and prevent 126 thousand ambulance calls and 33,9 thousand rehospitalizations, including more than 6,5 thousand in the intensive care unit.Conclusion. The use of valsartan+sacubitril combination in HF patients hospitalized with ADHF is cost-effective management strategy that significantly improves the prognosis in this category of patients.
Evaluation of ST2 as an early marker of heart failure with a preserved left ventricular ejection fraction in patients with persistent atrial fibrillation
Authors: Polyanskaya E. A. , Koziolova N. A. , Mironova S. V. 
Published: February 2020

Aim. To assess the diagnostic value of soluble ST2 (sST2) for early detection of heart failure with a preserved ejection fraction (HFpEF) in patients with persistent atrial fibrillation (AF).Material and methods. A total of 165 patients hospitalized with AF paroxysm were examined. The inclusion criteria were the persistent AF and LVEF >50% according to echocardiography. A cohort of 60 patients with persistent AF and preserved LVEF was formed. Patients were divided into 2 equal groups of 30 people depending on the HF presence, assessed on the basis of LV diastolic dysfunction with or without left atrial enlargement >34 ml/m2 or left ventricular mass index >110 g/m2 in men and 95 g/m2 in women, as well as an increase in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) >125 pg/ml. LVEF was calculated using the Simpson method; assessment of LV diastolic function was carried out with determination of transmitral flow velocity characteristics and visualization of mitral annulus motion. The NT-proBNP concentration was determined in blood serum using the Biomedica Group reagent (Austria), sST2 — using Presage ST2 (Critical Diagnostics, USA) by enzyme-linked immunosorbent assay on an Immulite 1000 analyzer (DPC, USA).Results. In patients with HFpEF and persistent AF, the correlation analysis showed a direct strong relationship between NT-proBNP and sST2 (r=0,726; p<0,05). To assess sST2 as a diagnostic criterion for HF, ROC curve was constructed. It was shown that with sST2 ≥16 ng/ml (AUC=0,89), the sensitivity of the method was 80%, the specificity — 83%.Conclusion. In patients with a persistent AF, serum sST2 concentration ≥16 ng/ml can be used as an alternative to the NT-proBNP criterion for early diagnosis of HFpEF.
Guidelines for Hospitalization for Chemotherapy
Authors: Dollinger Malin 
Published: February 2020

Abstract
Administration of cancer chemotherapeutic agents has shifted from the hospital to outpatient settings, usually the oncologist's office. Hospitalization for chemotherapy is now limited to specific situations, reflecting the need for prolonged direct observation, prevention or treatment of anticipated or real side effects, the use of special facilities and the minimization of certain treatment risks which cannot be effectively dealt with in an outpatient setting. New financial guidelines also have a significant impact on the location of chemotherapy administration. Outpatient chemotherapy has the advantages of allowing safe, easy drug administration, respecting the patient's wish to avoid hospitalization and providing a familiar facility, which enhances the patient's physical comfort and psychological well-being. The oncologist has direct and immediate control of drug administration, assistance is immediately available if problems arise, care is less expensive than inpatient care and overnight stay can be avoided. It also facilitates monitoring and control of treatment costs and allows treatment to be administered at the patient's convenience. Specific circumstances which justify hospitalization for chemotherapy, as detailed in Table 1, include: higher dosage cisplatin, special procedure chemotherapy, induction therapy for acute leukemia, high-dosage chemotherapy with or without stem cell/bone marrow transplantation, severely emetogenic chemotherapy, ifosfamide therapy, combination radiation therapy plus chemotherapy programs, coexistent medical problems (comorbidities), complex chemotherapy programs, the initial dose of chemotherapy while hospitalized for diagnosis of cancer, a scheduled dose of chemotherapy occurring during hospitalization for an unrelated problem, special measures required to prevent significant side effects, high-dose methotrexate protocols, intraperitoneal chemotherapy, certain investigational treatment protocols, and if chemotherapy administration is mandatory despite comorbidities that would ordinarily delay or contraindicate chemotherapy.
New Antifolates: Pharmacology and Clinical Applications
Authors: Takimoto Chris H. 
Published: February 2020

Abstract
Many new antifolate compounds with unique clinical properties are currently in clinical development. Some of these agents have been rationally designed to circumvent known mechanisms of resistance to methotrexate, the most useful and extensively studied antifolate in clinical practice. Resistance to methotrexate can result from decreased active transport into cells, decreased polyglutamation resulting in enhanced drug efflux from cells, mutations in dihydrofolate reductase which reduce drug binding affinity, and increased expression of dihydrofolate reductase due to gene amplification or increased translational efficiency. As a consequence, the newer antifolates may differ from methotrexate because of increased lipid solubility, improved cellular uptake or increased ability to undergo polyglutamation. Several of these newer agents also uniquely target specific folate-dependent enzymes such as thymidylate synthase or glycinamide ribonucleotide transformylase. Antifolates currently in clinical development include trimetrexate, edatrexate, piritrexim, ZD1694, lometrexol, AG337, LY231514 and 1843U89. This report summarizes the basic pharmacology and potential clinical applications of these promising new agents.