bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program in Pediatric Units in Tertiary Care Teaching Hospital in Thailand
Authors: Chautrakarn Sineenart , Anugulruengkitt Suvaporn , Puthanakit Thanyawee , Rattananupong Thanapoom , Hiransuthikul Narin 
Published: November 2019

BACKGROUND:
Antimicrobial stewardship programs (ASPs) have been proven to be beneficial in reducing the use of antimicrobial agents, antibiotic resistance, and health care costs. The data supporting the utility of ASPs has come largely from adult hospital units, but few pediatric hospital units have implemented ASPs. Our objective for this study was to assess the impact of ASPs in pediatric units in tertiary care teaching hospitals.

METHODS:
We conducted a retrospective chart review to compare antimicrobial use pre- and post-ASP over a 6-month period in a tertiary care hospital in which an ASP had been in use since July 2017. Meropenem, vancomycin, and colistin were selected to be monitored. ASP rounds were conducted twice a week to assess and provide feedback on antimicrobial prescriptions. Antimicrobial use was measured as days of therapy (DOTs) per 1000 patient-days and was compared pre- and post-ASP by using independent t tests.

RESULTS:
Charts of children hospitalized who were in antimicrobial treatment pre-ASP (44.3%) and post-ASP (41.7%) were reviewed. The percentages of children who received selected antimicrobial agents did not differ between pre- and post-ASP. During the post-ASP period, a significant reduction in DOT with vancomycin and colistin was observed. Vancomycin use decreased from 58.5 to 40.2 DOTs per 1000 patient-days (P = .038), and colistin decreased from 36.3 to 13.8 DOTs per 1000 patient-days (P = .026). Meropenem use decreased from 126.8 to 111.2 DOTs per 1000 patient-days (P = .467). Between the 2 periods, there was no effect on length of stay and mortality.

CONCLUSIONS:
ASPs can lead to a significant reduction in selected antimicrobial use in children who are hospitalized, with no effect on length of stay or mortality rate.
Prevalence and Trends in Obesity Among Hospitalized Children
Authors: Kyler Kathryn E. , Bettenhausen Jessica L. , Hall Matthew , Hampl Sarah 
Published: November 2019

OBJECTIVES:
As obesity rates rise in children, it is likely that the number of hospitalized children with obesity is also increasing. However, characterization of the inpatient population with obesity as a whole has not been reported. We aimed to examine trends in the annual prevalence of obesity in hospitalized children and to identify demographic and clinical characteristics associated with higher obesity prevalence in children who are hospitalized.

METHODS:
We completed a retrospective cohort analysis of children aged 2 to 19 years admitted to a single tertiary children’s hospital system for any reason in 2009–2016. Body mass index was calculated from documented height and weight. Children with obesity were defined by using age- and sex-specific body mass index percentile guidelines established by the Centers for Disease Control and Prevention. Annual obesity prevalence was calculated on the encounter level for service line and All Patients Refined Diagnosis-Related Groups (diagnosis groups). χ2 tests were used to determine statistical differences between groups, and the Cochran-Armitage test of trend was used to describe changes in obesity over time.

RESULTS:
Of 83 329 children who were hospitalized, 17.0% had obesity, increasing from 16.5% of hospitalizations in 2009–2010 to 17.3% in 2015–2016 (P = .002). Service lines with the highest obesity prevalence included orthopedics (22.1%), infectious disease (20.6%), and neuroscience (18.7%). Diagnosis groups with the highest obesity prevalence included cellulitis (22.5%), tonsil/adenoid procedures (22.0%), and some orthopedic procedures (28.7%).

CONCLUSIONS:
Some groups of children who were hospitalized experience higher obesity prevalence, including children hospitalized with orthopedic, infectious disease, and neurologic problems. In future research, investigators should target disproportionately affected groups by examining health outcomes, patient safety, and satisfaction issues.
Improving Efficiency of Pediatric Hospital Medicine Team Daily Workflow
Authors: Unaka Ndidi I. , Herrmann Lisa E. , Parker Michelle W. , Jerardi Karen E. , Brady Patrick W. , Demeritt Brenda , Lichner Kelli , Carlisle Michael , Treasure Jennifer D. , Hickey Erin , Statile Angela M. 
Published: November 2019

BACKGROUND AND OBJECTIVES:
Workflow inefficiencies by medical teams caring for hospitalized patients may affect patient care and team experience. At our institution, complexity and clinical volume of the pediatric hospital medicine (HM) service have increased over time; however, efficient workflow expectations were lacking. We aimed to increase the percentage of HM teams meeting 3 efficiency criteria (70% nurses present for rounds, rounds completed by 11:30 am, and HM attending notes completed by 5 pm) from 28% to 80% within 1 year.

METHODS:
Improvement efforts targeted 5 HM teams at a large academic hospital. Our multidisciplinary team, including HM attending physicians, pediatric residents, and nurses, focused on several key drivers: shared expectations, enhanced physician and nursing buy-in and communication, streamlined rounding process, and data transparency. Interventions included (1) daily rounding expectations with prerounds huddle, (2) visible reminders, (3) complex care team scheduled rounds, (4) real-time nurse notification of rounds via electronic platform, (5) workflow redesign, (6) attending feedback and data transparency, and (7) resource attending implementation. Attending physicians entered efficiency data each day through a Research Electronic Data Capture survey. Annotated control charts were used to assess the impact of interventions over time.

RESULTS:
Through sequential interventions, the percentage of HM teams meeting all 3 efficiency criteria increased from 28% to 61%. Nursing presence on rounds improved, and rounds end time compliance remained high, whereas attending note completion time remained variable.

CONCLUSIONS:
Inpatient workflow for pediatric providers was improved by setting clear expectations and enhancing team communication; competing demands while on service contributed to difficulty in improving timely attending note completion.
Risk factors for cardiovascular disease in patients with non-alcoholic fatty liver disease with polymorbidity
Authors: Sevostyanova E. V. , Nikolaev Yu. A. , Mitrofanov I. M. , Polyakov V. Ya. 
Published: November 2019

Aim.To study the associations of the frequency and values of parameters of the main risk factors (RF) of cardiovascular diseases (CVD) and the degree of transnosological polymorbidity (PM) in patients with nonalcoholic fatty liver disease (NAFLD).Material and methods. The analysis of 3667 medical records (men, women) treated in the clinic of Research Institute of Experimental and Clinical Medicine (Novosibirsk) was carried out. Index of polymorbidity was evaluated by the number of nosological forms in accordance with the International Classification of Diseases, 10th revision (ICD-10). The following risk factors were assessed according to clinical and laboratory tests: arterial hypertension, dyslipidemia, hyperglycemia, obesity.Results.Both among men and women with increasing index of PM there was identified growth of the parameters that determine the main RF: systolic BP, diastolic BP, obesity (both in men and women), atherogenicity index (in women), glucose concentration in the blood serum (in women). Frequency of AH occurrence in persons with a high degree of PM among men was 49%, and among women — 69% higher, compared with persons with a low degree of PM. Among men, there was an increase in the incidence of AH (by 9%) and obesity (by 9%) in individuals with a high degree of PM, compared with individuals with an average degree of PM. Among women, there was an increase in the incidence of AH (by 15%), obesity (by 9%), hyperglycemia (by 11%) in persons with a high degree of PM, compared with individuals with an average degree of PM.Conclusion.There was established the role of risk factors for cardiovascular diseases, arterial hypertension mainly, in the development of polymorbidity in patients with NAFLD. The findings indicate the need for personified prevention and treatment of such patients with mandatory identification and correction of modifiable CVD RF.
Queer as a Bell: Music and the Psychotherapeutic Relationship
Authors: Harris Brian 
Published: November 2019

Musical co-creation between the client and the therapist can be used as a means of skewing the dominant paradigms of the historically hierarchal psychotherapeutic relationship. This process, known as queering, opens the possibility for new ways of being in therapy space that may support empowerment of both the client and the therapist. Music engagement contributes to an intersubjective dynamic where the therapist's material may enter the session space more vulnerably and authentically than through a purely verbal process. When viewed critically through a queered perspective, this intersubjectivity may allow for a decrease in the power differential traditionally associated with the client–therapist dyad. In this article, a queer theoretical perspective is used to examine the unique role music and creativity play in this therapeutic relationship. Current queer, linguistic, and creative arts therapy theory are examined to support the hypothesis.
Farklı fizyografya ünitelerinde gelişen yayla seracılığının zamansal ve mekansal değişiminin uzaktan algılama ve CBS teknikleri ile belirlenmesi: Elmalı/Antalya örneği
Authors: BUYURGAN Kadir , ALTUNBAŞ Sevda , GÖZÜKARA Gafur 
Published: November 2019

Son yıllarda kontrolsüz ve çok hızlı yayla
seracılık faaliyetlerinin arttığı yerlerden biri de Antalya-Elmalı ilçesindeki
tektonik-karstik kökenli olan Elmalı Depresyonu’dur. Çalışma alanı olarak
seçilen bu depresyondaki üç farklı fizyografya ünitesi üzerinde zamansal ve
mekânsal değişimin belirlenmesi hedeflenmiştir. Eskihisar bölgesinde, Pansharp
yapılmış 2009 ve 2016 yıllarına ait sırasıyla 0.4 m yersel çözünürlüklü
GeoEye-1 ve 0.5 m WorldView-3 uydu görüntüleri, Gölova-Çukurelma
bölgesinde 2008 ve 2016 yıllarına ait sırasıyla 0.6 m yersel çözünürlüklü
QuickBird-2, 0.5 m yersel çözünürlüklü GeoEye-1 uydu görüntüleri, son
olarak Beyler bölgesinde 2011 ve 2016 yıllarına ait 0.5 m yersel çözünürlüklü
WorldView-2 ve 1.5 m yersel çözünürlüklü Spot-7 uydu görüntüleri
kullanılmıştır. Kontrollü sınıflama tekniklerinden biri olan Maksimum
Likelihood tekniği ile yapılan sınıflandırma sonucunda raster veriden
hesaplanan toplam sera varlığı, yersel olarak ölçümler ile oluşturulmuş
hâlihazır vektör verilerden hesaplanan toplam sera varlığı ile kıyaslanarak,
çalışmanın doğruluğu hesaplanmıştır. Fizyografya üniteleri ve sera üretim
alanları sırasıyla, alüvyal araziler üzerindeki Eskihisar bölgesinde
126.19 ha, eski göl tabanı ve alüvyal yelpazeyi içerisine alan
Gölova-Çukurelma bölgesinde 104.41 ha ve eski göl tabanı arazileri üzerindeki
Beyler bölgesinde 38.23 ha tespit edilmiştir. Seracılık faaliyetlerinin
yapıldığı alanların yüzdesel olarak artışı zamana bağlı olarak
değerlendirildiğinde, en yüksek artışın Gölova-Çukurelma bölgesinde (%313.51),
ikinci olarak Eskihisar bölgesinde (%166.27) ve en az artışın ise yine eski bir
göl tabanı fizyografyası olan Beyler bölgesinde (%61.35) olduğu tespit
edilmiştir. Çalışmanın doğruluk oranları incelendiğinde, en yüksek doğruluk
Eskihisar bölgesine ait 2009 yılı görüntüsünden (%94.83), 2016 yılında (92.04),
Gölova-Çukurlema 2008 yılı (89.33), 2016 yılı en düşük doğruluk (83.52), Beyler
bölgesine ait 2011 yılı (87.72), 2016 yılı (83.95) olarak elde edilmiştir.
Contexto de la edificación de un recinto para la memoria.
Authors: Suaste Lugo María del Rosario 
Published: November 2019

En enero de 1979 el entonces rector de la Universidad Guillermo Soberón, daba a conocer el programa de celebraciones en conmemoración del Cincuentenario de la Autonomía universitaria. Cada mes del año tendría un evento de celebración, culminando en diciembre con la inauguración del edificio de la Biblioteca y la Hemeroteca Nacionales. El contexto en el que se da tal evento permitirá observar cómo la influencia de los acontecimientos políticos y económicos y las redes de poder de los años setenta promovieron y orientaron una política de gasto social que favoreció la construcción de infraestructura educativa y cultural, lo que hizo posible, entre otras, la construcción del Centro Cultural Universitario. Dentro de tal proyecto se consideró la edificación de la Unidad Bibliográfica, con lo que se darían las condiciones para instalar a la Hemeroteca y Biblioteca Nacionales de México, en los umbrales de la modernidad bibliotecaria.
Asimetrías y diversidad en las relaciones naturaleza-cultura: una reflexión en torno a la modernidad occidental
Authors: Piñeiro Aguiar Eleder 
Published: November 2019

En este texto de carácter exploratorio desarrollamos una genealogía acerca de la visión que diferentes autores y teorías occidentales han desarrollado en torno a la idea de naturaleza y su relación con el progreso, desde la fiolosofía clásica hasta la modernidad eurocéntrica. A continuación, contraponemos lo que consideramos un imaginario universal en torno a las relaciones naturaleza-cultura con otras investigaciones procedentes del Sur global y en particular de diversas teorizaciones indigenistas, latinoamericanas y decoloniales. Para todo ello se ha desarrollado una revisión documental en torno a textos “clásicos” y actuales, concluyendo que el individualismo y desarrollismo emanados de la tradición occidental encuentran fracturas, resistencias y puntos de fuga planteados desde perspectivas académicas y activistas que articulan un discurso contrario al extractivismo epistémico y materialista eurocéntricos.
Ultrasound diagnosis of oropharyngeal squamous cell carcinoma and ultrasound evaluation of treatment efficacy (changes in tumor volume)
Authors: Allakhverdieva G. F. , Sinyukova G. Т. , Sholokhov V. N. , Danzanova Т. Yu. , Saprina О. А. , Gudilina Е. А. 
Published: November 2019

The study objectiveis to assess the capabilities of ultrasonography in the diagnosis of oropharyngeal squamous cell carcinomas and in the evaluation of treatment efficacy (changes in tumor volume).Materials and methods.This study included 98 patients (27 (27.5 %) females and 71 (72.5 %) males aged between 20 and 78 years with oropharyngeal tumors; of them, 12 (12.2 %) patients had recurrent tumors. Sixty-seven (68.4 %) participants had their tumors located in the tonsils; 31 (31.6 %) patients had tumors of the root of the tongue; 47 (48.0 %) patients presented with tumors invading adjacent tissues; 57 (58.2 %) patients had their lymph nodes involved. Thirty-two patients were operated at the first stage of treatment, whereas 66 (67.3 %) individuals received induction chemotherapy followed by sequential chemoradiotherapy. Treatment efficacy was evaluated 2 weeks following the completion of the second course of induction chemotherapy. We assessed tumor volume, its structure, type and intensity of vascularization, and the number and size of lymph nodes affected by metastasis. Ultrasonography findings were compared with the results of fibroscopy, X-ray computed tomography (CT) and magnetic resonance imaging (MRI) performed 2 weeks following the completion of the second course of induction chemotherapy (no later than 7–10 days).Results.The disagreement between histology and ultrasonography findings reflecting tumor volume (of either newly diagnosed or recurrent tumor) was statistically insignificant. The results of X-ray CT were more likely to be in agreement with histology than the ultrasonography results (85.0 % vs 70.0 %); however, this difference was not statistically significant. Data of X-ray CT and ultrasonography on the tumor volume demonstrated no significant difference between them. MRI and ultrasonography findings on the tumor volume were consistent in 50 % of cases. We identified the most common changes in the structure of the oropharyngeal tumors typical of positive and negative dynamics after 2 courses of induction chemotherapy. Patients with positive dynamics demonstrated a significant decrease in tumor volume detected by all diagnostic methods used (ultrasonography, X-ray CT, and MRI). There was a significant negative correlation between the efficacy of treatment assessed by ultrasonography and the grade of therapeutic pathomorphosis assessed by histology (r = –0.69; р = 0.0014).Conclusion.The accuracy of ultrasonography for the estimation of oropharyngeal tumor volume and its spread is comparable with that of X-ray CT and MRI. The disagreement between these methods was statistically insignificant. Ultrasonography is a more sensitive method for the evaluation of patient response to treatment than clinical data.
Mucoepidermoid carcinoma of the hard palate in a 9-year-old girl (clinical case)
Authors: Zolotarev К. А. , Mudunov A. М. , Shishkov R. V. , Polyakov V. G. , Alymov Yu. V. , Ivashkov V. Yu. , Babkin N. S. 
Published: November 2019

The objective of the work is to demonstrate the signs of mucoepidermoid carcinoma of the minor salivary glands in pediatric patients on a clinical example.Clinical case. In August 2017, a girl of 9 years old appeared in the area of the right half of the hard palate. The dentist at the place of residence diagnosed an abscess in the area of the hard palate, performed the lancing and drainage of the “abscess”, prescribed antibiotic therapy. After 3.5 months (in December 2017), hyperemia and an increase in the volume of the mucous membrane reappeared in the same zone. Reapplied to the dentist. The girl was sent to the Oral and Maxillofacial Surgery Department, where the hard palate formation was removed on 23.01.2018; according to histological examination a highly differentiated tumor of the hard palate was diagnosed. The girl was sent for a consultation to the N. N. Blokhin National Medical Research Center of Oncology, where histological preparations were reviewed: a fragment of the mucous membrane of the hard palate covered with squamous epithelium, with the growth of low-grade mucoepidermoid cancer (from the minor salivary glands of the hard palate). A biopsy of the postoperative scar 3 mm long and of the formation of a hard palate 1 mm in diameter was performed; during histological examination of the biopsy material tumor cells were not detected (the material was represented by fibrous tissue). Despite the biopsy results, taking into account the medical history, the results of a review of histological preparations, the rarity and high aggressiveness of the tumor, poor prognosis for relapse, lack of data for regional and distant metastases, at the concilium it was accepted the decision to conduct repeated surgery. In the Surgical Department No. 1 of the Research Institute of Pediatric Oncology and Hematology, N. N. Blokhin National Medical Research Center of Oncology on 13.03.2018 a resection of the hard palate was performed with plastic surgery of the defect with a mixed skin-muscle flap on the vascular pedicle.Conclusion. Mucoepidermoid cancer of the minor salivary glands of the hard palate in children and adolescents can be manifested by the presence of a slowly growing, painless, pale blue tumor. For a correct clinical and morphological diagnosis, a biopsy of the tumor is necessary, further the removal of the tumor is recommended with resection of the hard palate, in view of the high risk of tumor spreading in the thickness of the bone.
Diagnosed laryngeal cancer relapse using harpoon biopsy under ultrasound guidance (clinical case)
Authors: Gafurova А. I. , Vinogradov V. V. , Korobkin А. S. , Reshulsky S. S. 
Published: November 2019

The objective is to demonstrate possibilities of a harpoon biopsy under ultrasound guidance for malignant neoplasms early detection using a clinical example.Clinical case. A 65-year-old patient with morphologically verified laryngeal cancer (stage II, T2N0M0) underwent radiation therapy, which resulted in a complete tumor resorption. Subsequent ultrasound detected a neoplasm in the projection of the folding section. Percutaneous harpoon biopsy was performed under ultrasound guidance because standard clinical and instrumental studies were unable to confirm the diagnosis. Histological study of the biopsy material confirmed the “relapse of larynx squamous cell carcinoma”.Conclusion. A transdermal harpoon biopsy under ultrasound guidance followed by morphological biopsy study makes it possible to diagnose the disease and determine therapeutic approach as soon as possible.
Siirt İli Mercimek (Lens culinaris medic.) Ekim Alanlarında Sorun Oluşturan Yabancı Ot Türlerinin Yoğunluk ve Rastlanma Sıklıklarının Belirlenmesi
Authors: SIRRI Mesut 
Published: November 2019

Mercimek
(Lens culinaris Medic.) insanlar için
bitkisel protein, hayvanlar için yem, toprak için ise önemli bir azot
kaynağıdır. Yabancı otlar mercimek tarımını sınırlandıran unsurların başında
gelmektedir. Bu çalışmada, Siirt ili mercimek ekili alanlarda, 2018 yılı
vejetasyon döneminde sürvey çalışmaları gerçekleştirilmiştir. Araştırma alanını
temsil edecek şekilde rastgele toplam 40 mercimek tarlasında örnekleme
yapılmıştır. Her örnekleme noktasında yabancı otların tür, rastlanma sıklığı ve
yoğunlukları belirlenmiştir. Sürvey sonucunda 2’si parazit, 3’ü
monocotyledoneae (tek çenekli), 24’ü de dicotyledoneae (çift çenekli) olmak üzere toplam 29 familyaya ait 101
yabancı ot türü tespit edilmiştir. İncelenen tarlalarda rastlanma sıklığına
göre en yaygın türlerin; Sinapis arvensis L. (%97.5), Vicia sativa L. (%75), Papaver rhoeas L. (%75), Avena sterilis subsp. ludoviciana (%72.5), Vaccaria
pyramidata Medik (%62.5), Silene conica L. (%55), Vicia narbonensis L. (%57.5) ve (Silybum
marianum (L.) Gaertner (%52.5) olduğu tespit edilmiştir. Çalışma sonuçlarına göre
bölgede mercimek ekim alanlarında yabancı ot tür ve yoğunlukları dikkate alınarak
mücadele yapılması önerilmiştir.
La resiliation unilaterale du contrat administratif en france
Authors: GÜECHÁ TORRES JESSICA TATIANA , GÜECHÁ MEDINA CIRO NOLBERTO 
Published: November 2019

La résiliation unilatérale du contrat administratif implique que l’administration en tant que partie dans un contrat puisse cesser ses effets avant la date prévue sans avoir besoin de saisir le juge du contrat; dans ces conditions les parties se trouvent dans une situation d’inégalité, puisque cette prérogative ne favorise que á un des parties à le convention.
La résiliation unilatérale découle en principe d’une faute du cocontractant, cependant, il est posible que l’administration prenne la décision de mettre fin au contrat sans aucune faute, et bien que dans le deux cas certains principes tels que la sécurité juridique et l’égalité soient méconnus, leur exercice est justifié par l’intérêt général et compensée en raison de certains garanties économiques (le droit de rétablissement de l’équilibre économique du contrat a travers une indemnisation intégrale) et contentieuses (le recours de plein contentieux).
En tentant compte que dans les cas énoncés, il faut qu’il existe une imputation de l’Administration, c’est-à-dire qu’ la responsabilité de l’état pour faute ou sans faute joue un rôle indispensable pour donner une application effective des garanties accordées par la loi et la jurisprudence.