bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Review of Opioid Prescribing Practices for At-Risk Pediatric Populations Undergoing Ambulatory Surgery
Authors: Lee Sterling , Reid Ashley , Tong Suhong , Silveira Lori , Thomas James J. , Masaracchia Melissa M. 
Published: December 2021

OBJECTIVEPediatric patients with sleep-disordered breathing (SDB) and obesity are at risk for opioid-induced respiratory depression. Although monitoring in the inpatient setting allows for early recognition of opioid-related adverse events, there is far less vigilance after ambulatory surgery as patients are discharged home. Guidelines for proper opioid dosing in these pediatric subsets have not been established. We sought to determine if at-risk children were more likely to receive doses of opioids outside the recommended range.METHODSBaseline opioid prescribing data for all outpatient surgery patients receiving an opioid prescription between January 2019 and June 2020 were retrospectively reviewed. Patients with SDB or obesity were identified. To obtain more information about prescribing practices, we analyzed patient demographics, size descriptors used for calculations, and prescription characteristics (dose, duration, and prescribing surgical service).RESULTSA total of 4674 patients received an opioid prescription after outpatient surgery. Of those, 173 patients had SDB and 128 were obese. Surgical subspecialties rendering most of the opioid prescriptions included otolaryngology and orthopedics. Obese patients were more likely (64%) to be prescribed opioids using ideal weight at higher mg/kg doses (&gt;0.05 mg/kg; 83.3%; p &lt; 0.0001). When providers used actual body weight, lower mg/kg doses were more likely to be used (53.7%; p &lt; 0.0001). No prescriptions used lean body mass.CONCLUSIONSOverweight/obese children were more likely to receive opioid doses outside the recommended range. Variability in prescribing patterns demonstrates the need for more detailed guidelines to minimize the risk of opioid-induced respiratory complications in vulnerable pediatric populations.
Comparison of Timing to Develop Anti-Drug Antibodies to Infliximab and Adalimumab Between Adult and Pediatric Age Groups, Males and Females
Authors: Trotta Maria Consiglia , Alfano Roberto , Cuomo Giovanna , Romano Ciro , Gravina Antonietta Gerarda , Romano Marco , Galdiero Marilena , Montemurro Maria Vittoria , Giordano Antonio , D'Amico Michele 
Published: December 2021

OBJECTIVE
To compare the timing of serum anti-drug antibodies in adult and pediatric age groups, males and females, treated for inflammatory bowel disease or arthritis with adalimumab or infliximab by retrospectively combining data collected during a 2-year therapeutic drug monitoring period.

METHODS
Four hundred thirty sera were divided in groups collected at 0, 3, 6, 12, and 24 months (T0, T3, T6, T12, and T24) after initiation of therapy and assayed for drug and relative anti-drug antibodies levels. At each time point, the percentage of sera presenting anti-drug antibodies, as well as the drug concentrations, were calculated and correlated with patient age and sex.

RESULTS
Anti-drug antibodies were present in 31.5% of sera and were significantly higher in the pediatric age group than in the adult age group, through all time points. The percentages of sera showing anti-drug antibodies were significantly different as early as 3 months and were sera from pediatric female group. The percentages of sera showing anti-drug antibodies reached the highest value at 6 months in the pediatric age group and at 12 months in the adult age group.

CONCLUSIONS
Sera from pediatric had an earlier presence of anti-drug antibodies than adults. In particular, pediatric females sera showed the fastest anti-drug antibodies development.
Antimicrobial Prophylaxis and Anticoagulation Therapy in Pediatric ECMO: A Survey Study
Authors: Frazier Cierra A. , Scott Brittany M. , Johnson Peter N. , LaRochelle Joseph M. 
Published: December 2021

OBJECTIVE
The purpose was to characterize antimicrobial and anticoagulation therapies used in health systems with children receiving extracorporeal membrane oxygenation (ECMO).

METHODS
An anonymous electronic survey assessing health system demographics and antimicrobial and anticoagulation therapies during ECMO was distributed to the American College of Clinical Pharmacy Pediatric Practice and Research Network and the Pediatric Pharmacy Association Critical Care Special Interest Group. The primary objective was to identify the number of respondents using antimicrobial prophylaxis for ECMO cannulation and ECMO runs. Secondary objectives included the first- and second-line anticoagulants and anticoagulation laboratory parameters. Additionally, the antimicrobial regimens and the dosing and administration of antithrombin III (AT III) with systemic anticoagulation were collected. Descriptive statistics were employed.

RESULTS
The questionnaire was completed by 38 respondents from 33 health systems; respondents practiced in the pediatric ICU (n = 20; 52.6%), cardiovascular ICU (n = 14; 36.8%), and neonatal ICU (n = 4; 10.5%). Twenty-eight (73.6%) respondents use antimicrobial prophylaxis during ECMO cannulation or ECMO runs, with most units using cefazolin monotherapy. Thirty-five (92.1%) respondents use heparin as the first-line anticoagulant and used a variety of laboratory tests including anti-factor Xa, activated clotting time, and activated partial thromboplastin time. The most common second-line anticoagulant was bivalirudin (n = 24; 63.2%). Thirty-six (94.7%) respondents use AT III with heparin, with most patients receiving AT III dosing calculated based on a formula for the desired AT III concentration.

CONCLUSIONS
The majority of respondents use antimicrobial prophylaxis, but variations in the regimens were noted. Heparin was the most common anticoagulant, but variations in laboratory monitoring and concomitant use of AT III were found.
Caracterização morfofisiológica de isolados de rizóbios provenientes de solos ácidos da Amazônia Central
Authors: Souza Luiz Carlos Costa de , Hara Francisco Adilson dos Santos , Vendruscolo Jhony , Inácio Ariele Cristine Ferreira , Silva Milena Sousa 
Published: December 2021

Os rizóbios, além de fixarem o nitrogênio atmosférico, possuem capacidade de solubilizar fosfatos insolúveis e produzir o ácido indolacético (AIA). Esses microrganismos representam alternativas viáveis para a produção agrícola sustentável na Amazônia. Este trabalho teve como objetivo realizar a caracterização morfofisiológica de isolados de rizóbios proveniente de solos ácidos da região de Manaus. Foram obtidos 22 isolados provenientes de raízes de leguminosas tropicais, sendo que 100% dos isolados mostraram-se tolerantes à acidez, e a maioria (86%) cresceu satisfatoriamente em meio alcalino. Isso indica que os isolados são bastante versáteis com relação ao pH do solo. Todos os isolados foram sensíveis ao alumínio trocável (2 cmolc dm-3). Apenas nove isolados (41%) foram capazes de solubilizar o fosfato de cálcio e nenhum solubilizou o fosfato de alumínio. Em relação à produção de AIA, 52% foram capazes de sintetizar esse metabólito em meio com triptofano e tiveram a produção classificada entre baixa (38%) e média (52%). A partir da análise de cluster foi possível identificar 5 grupos distintos de rizóbios com 80% de grau de similaridade, evidenciando elevada diversidade morfofisiológica. Alguns isolados da mesma planta apresentam diferenças marcantes quanto às suas características.
Efeitos do clima e sazonalidade nos atropelamentos de Rhinella Jimi, em duas rodovias do Agreste de Pernambuco
Authors: Tenório José Cleiton Souza , Lopes Arthur Macário , Vilar Dayara Claudia Souto Maior de Moraes , Araújo Bianca Gonzaga de , Souza Werônica Meira de , Neves Rachel Maria de Lyra , Telino Júnior Wallace Rodrigues 
Published: December 2021

As mudanças climáticas podem gerar algumas transformações na biosfera como o aumento dos eventos extremos (secas e enchentes) e aumento das temperaturas. As estradas são ambientes de desenvolvimento econômico e estão vinculadas aos processos de projeção da interiorização de determinada região, com tais benefícios as estradas também causam alguns efeitos à biodiversidade, como a formação de subpopulações, processos de fragmentação dos ambientes, como também animais atropelados, que em alguns períodos do ano, algumas espécies são mais frequentemente observadas atropeladas que outras. Neste sentido, o intuito deste trabalho foi verificar a relação existente entre o clima e a frequência de atropelamentos da espécie Rhinella jimi em dois fragmentos de rodovias no Semiárido pernambucano. As coletas do material informacional biológico foram feitas a partir de observação de duas rodovias pernambucanas, a BR 232 e 423. Os dados de distribuição e sazonalidade foram comparados com o número de atropelamentos da espécie. Foram verificados alguns fatores relacionados ao crescimento de indivíduos atropelados depois do período chuvoso, além de uma relação de crescimento dos atropelamentos durante as chuvas, indicando que os atropelamentos estão vinculados às atividades metabólicas do animal e seu consequente desenvolvimento populacional depois dos períodos de chuva, uma vez que a característica de adaptabilidade dos anfíbios no semiárido é vinculada a sua maior atividade e rápida reprodução nos períodos chuvosos e redução metabólica nos períodos mais secos e escassos de alimento. Assim, as flutuações pluviométricas ao longo do ano, além de permitirem adaptabilidade aos organismos, possibilitam pontualmente o seu desenvolvimento populacional no ambiente.
Resgate, apreensão e destinação da herpetofauna pelos órgãos de fauna na região metropolitana do Recife, Pernambuco: contribuição para conservação
Authors: Negromonte Mayara Gabrielly , Mascarenhas Junior Paulo Braga , Santos Ednilza Maranhão dos , Correia Jozelia Maria de Sousa 
Published: December 2021

O tráfico de animais, a introdução de espécies exóticas e a destruição de hábitats são fatores que levam à distrurbios na biodiversidade, principalmente em grupos sinantrópicos, como vários répteis e anfíbios. Diante disto, este trabalho teve como objetivo realizar um diagnóstico da herpetofauna resgatada, apreendida, recebida e destinada pelos órgãos de fauna responsáveis em Pernambuco entre os anos de 2010 e 2014. Foram analisados 1369 boletins de ocorrência (B.O.), com um total de 1793 indivíduos, divididos em 24 taxóns (21,3% testudines, 16,2% crocodilianos, 11,6% lagartos, 50,6% serpentes e 0,1% anfisbenas). As principais espécies registradas foram a Boa constrictor (n=429), Caiman latirostris (n=295), Chelonoidis sp. (n=184), Iguana iguana (n=154) e Amphisbaena sp. (n=2). Entre as espécies consideradas com maior grau de ameaça, foram recebidos Eretmochelys imbricata e Podocdemis unifilis (espécie exótica para fauna da região). A maioria dos registros veio do município de Recife (24,1%). Foi observado um maior número de resgates na época chuvosa, principalmente para os crocodilianos e as serpentes. Testudines foi o grupo com maior número de apreensões e entregas voluntárias (n= 33 e 90, respectivamente), possivelmente por ser o mais associado a pets. De maneira geral, o tráfico de animais é um problema para os órgãos ambientais no estado de Pernambuco e as políticas publicas precisam ser mais eficientes. Há também necessidade de melhor aparato estrutural e de pessoal para tornar mais eficiente a identificação e o manejo (captura e sotura) dos animais resgatados, bem como o incentivo a ações educativas com a população.
Funerary heritage tourism: definitions and principles
Authors: Rugg Julie 
Published: December 2021

En muchas grandes ciudades, el ‘primer’ cementerio decimonónico es cada vez más el núcleo del turismo de cementerios. El texto considera el ‘patrimonio funerario’ como un desarrollo relacionado pero diferente. Señala la posible relación incómoda entre el turismo de cemen- terios y patrimonio funerario, en parte debido a la falta de voluntad de asociar directamente las visitas a los cementerios con la muerte. Un turismo de cementerios mal planteado puede socavar el patrimonio tangible e intangible de los cementerios. Muchos cementerios siguen en uso y, por lo tanto, deben considerase como ‘patrimonio vivo’. En estas circunstancias, la interpretación debe reconocer a los afectados como partes interesadas relevantes, mientras que los sistemas de interpretación deben comunicar con más firmeza los diversos aspectos de la mortalidad. Poner de relieve las dinámicas de ‘funcionamiento’ del cementerio es un marco narrativo poco explorado y es necesario ser consciente de que las formas de interpre- tación pueden sesgar el esfuerzo de conservación. Asimismo, se pueden plantear cuestiones éticas. En el texto sugerimos que, como mínimo, esa interpretación debería demostrar cómo la humanidad, en todas las épocas y culturas, se ha esforzado por aceptar la muerte.
In many major cities, the ‘first’ nineteenth-century cemetery is increasingly the focus of cemetery tourism. This paper recognises ‘funerary heritage’ as an associated but separate development. It indicates that there can be an uneasy relationship between cemetery tourism and funerary heritage, in part resting on unwillingness directly to associate cemetery visits with death. Poorly framed cemetery tourism can actively undermine both the tangible and intangible heritage of cemeteries. Many cemeteries are still in use, and this paper regards these sites as ‘living heritage’. In these circumstances, interpretation should acknowledge the bereaved as relevant stakeholders; interpretation needs to be more confident in the ways in which it talks about the various aspects of mortality; foregrounding how the cemetery ‘works’ presents an under-explored narrative frame; and there is a need to be aware of the ways that interpretation can skew conservation effort. Ethical issues also pertain. Here it is suggested that, at the very least, that interpretation should demonstrate how –across all times and cultures– humanity has striven to come to terms with mortality.
The Cost of Isolation
Authors: Boamah Sheila A. , Dal Bello-Haas Vanina , Weldrick Rachel 
Published: December 2021

Background: Recent research has found that family (e.g., informal, unpaid) caregivers to those in long-term care can experience significant risk of social isolation, a harmful social outcome linked to poor health and wellbeing. For many, the COVID-19 global pandemic has been a time marked by challenges that have exacerbated existing risk of social isolation and has likely impacted mental health and wellbeing among caregivers. As such, this paper outlines a protocol to investigate the extent to which the COVID-19 pandemic has impacted the psychological health and well-being of family caregivers of people living in residential long-term care.
Methods/Design: A descriptive phenomenological design and photovoice methodology will be used alongside focus groups to capture the perspectives and voices of 15-20 family caregivers. Data will be analyzed thematically, and themes will be developed collaboratively alongside participants. A secondary analysis will be guided by a cumulative inequality lens to consider how the COVID-19 pandemic has differentially affected caregivers.
Discussion: The results will fill a significant gap in the existing literature on caregiver isolation during this pandemic and inform the development and/or refinement of caregiver supports.
Electroencephalogram-derived pain index for evaluating pain during labor
Authors: Sun Liang , Zhang Hong , Han Qiaoyu , Feng Yi 
Published: December 2021

Background
The discriminative ability of a point-of-care electroencephalogram (EEG)-derived pain index (Pi) for objectively assessing pain has been validated in chronic pain patients. The current study aimed to determine its feasibility in assessing labor pain in an obstetric setting.

Methods
Parturients were enrolled from the delivery room at the department of obstetrics in a tertiary hospital between February and June of 2018. Pi values and relevant numerical rating scale (NRS) scores were collected at different stages of labor in the presence or absence of epidural analgesia. The correlation between Pi values and NRS scores was analyzed using the Pearson correlation analysis. The receiver operating characteristic (ROC) curve was plotted to estimate the discriminative capability of Pi to detect labor pain in parturients.

Results
Eighty paturients were eligible for inclusion. The Pearson correlation analysis exhibited a positive correlation between Pi values and NRS scores in parturients (r = 0.768, P < 0.001). The ROC analysis revealed a cut-off Pi value of 18.37 to discriminate between mild and moderate-to-severe labor pain in parturients. Further analysis indicated that Pi values had the best diagnostic accuracy reflected by the highest area under the curve (AUC) of 0.857, with a sensitivity and specificity of 0.767 and 0.833, respectively, and a Youden index of 0.6. Subgroup analyses further substantiated the correlations between Pi values and NRS scores, especially in parturients with higher pain intensity.

Conclusion
This study indicates that Pi values derived from EEGs significantly correlate with the NRS scores, and can serve as a way to quantitatively and objectively evaluate labor pain in parturients.
Reorganização Societária Atípica: Impactos Contábeis e Tributários do DROP DOWN no Brasil
Authors: Assumpção Debora Skibinski , Kronbauer Clovis Antonio , Alves Diego Saldo 
Published: December 2021

O presente estudo tem o objetivo de analisar os impactos contábeis e tributários de uma reorganização societária conhecida como DROP DOWN. Muito comum nos Estados Unidos no meio empresarial, ela é caracterizada pelo aumento de capital que uma empresa faz em outra, na qual transfere bens, direitos e/ou obrigações em troca da participação societária com controle acionário. Sem previsão legal no direito societário brasileiro, mas já sendo realizada em algumas empresas brasileiras como uma opção de reestruturação societária.
O DROP DOWN se assemelha a cisão em alguns aspectos, mas sem a redução do capital social ou extinção da empresa cindida, por isso alguns autores aqui no Brasil a denominaram de “cisão branca”.
A metodologia concentrou-se em bases documentais, e assim, o estudo foi realizado por meio de buscas em sites jurídicos, no site EBSCO, biblioteca do STF, artigos e livros jurídicos, onde constassem temas ligados à reestruturação ou reorganização societária por intermédio da combinação de negócio que envolvessem a operação de drop down . Os resultados obtidos foram satisfatórios, pois demonstram que mesmo não sendo divulgada e ou conhecida em nosso país, o drop down vem ocorrendo em muitas estratégias de negócios em empresas brasileiras; e, concluiu-se que por não haver previsão legal para esse modelo de reestruturação societária em nosso país, todas as suas causas e efeitos são discutíveis judicialmente, se por acaso as entidades federais ou estaduais sentirem-se prejudicadas.
Validation of automated complex head and neck treatment planning with pencil beam scanning proton therapy
Authors: Hedrick Samantha Grace , Petro Scott , Ward Alex , Morris Bart 
Published: December 2021

AbstractBackgroundPencil beam scanning (PBS) proton therapy offers dosimetric advantages for several treatment sites, including head and neck (H&N). However, to achieve the optimal target coverage and robustness, these plans can be complex and time consuming to develop and optimize. Automating the treatment planning process can ensure a high‐quality and standardized plan, reduce burden to the planner, and decrease time‐to‐treatment. We utilized in‐house scripting to automate a four‐field multi‐field optimization (MFO) H&N planning technique.Methods and materialsTen bilateral H&N patients were planned in RayStation v6 with a four‐field modified‐X beam configuration using MFO planning. Automation included creation of avoidance structures to control spot placement and development of standardized beams, PBS spot settings, robust optimization objectives, and patient‐specific predicted planning constraints. Each patient was planned both with and without automation to evaluate differences in planning time, perceived effort and plan quality, plan robustness, and OAR sparing.ResultsOn average, scripted plans required 3.2 h, compared to 4.3 h without the script. There was no difference in target coverage or plan robustness with or without automation. Automation significantly reduced mean dose to the oral cavity, parotids, esophagus, trachea, and larynx. Perceived effort was scaled from 1 (minimum effort) to 100 (maximum effort), and automation reduced perceived effort by 42% (p < 0.05). Two non‐scripted plans required re‐planning due to errors.ConclusionsAutomation of this multi‐beam, the MFO proton planning process reduced planning time and improved OAR sparing compared to the same planning process without scripting. Scripting generation of complex structures and planning objectives reduced burden on the planner. With most current treatment planning software, this automation is simple to implement and can standardize quality of care across all treatment planners.
Implication of the Nociplastic Features for Clinical Diagnosis of Fibromyalgia: Development of the Preliminary Nociplastic‐Based Fibromyalgia Features (NFF) Tool
Authors: Ghavidel‐Parsa Banafsheh , Bidari Ali , Atrkarroushan Zahra , Khosousi Mohammad‐Javad 
Published: December 2021

ObjectiveNociplastic concept incorporates a broad continuum of pain phenotypes shared with clinical peculiarity. This study aimed to develop and validate a diagnostic tool, the preliminary Nociplastic‐based Fibromyalgia Features (NFF), to detect fibromyalgia (FM) in patients with chronic pain.MethodsItems requiring yes or no responses and relating to the most relevant clinical nociplastic pain (NP) features of FM were compiled by a group of expert rheumatologists. The provisional list was tested in a prospective study on 185 consecutive patients with chronic pain (126 patients with FM and 59 patients with non‐FM non‐inflammatory chronic pain) diagnosed based on expert decision. Identification of the most discriminant combinations of items for FM and the calculation of their sensitivity and specificity were based on both univariate and multivariate (stepwise logistic regression) analyses. All participants were investigated through the final NFF, the 2011 American College of Rheumatology (ACR) criteria, and the 2016 ACR criteria. NFF performance was assessed with receiver operating characteristic curve analysis.ResultsBased on multivariate analyses, we retained only seven items in the final version of the NFF. A cut‐off score of 4 (corresponding to the number of positive items) gave the highest rate of correct identification of patients (85%), with a sensitivity of 82% and a specificity of 91%. The NFF showed the highest concordance rate with expert diagnosis (85%) and the lowest value (77%) with the ACR 2016 criteria.ConclusionThe preliminary NFF with respect to the various aspects of NP showed good performance for detection of the FM in the clinical setting. This tool may provide a more pragmatic approach to the timely diagnosis of FM.