bluuebunny/crossref_metadata_2025_split huggingface dataset:
Newborns With Neonatal Abstinence Syndrome Are Concentrated in Poorer-Quality Hospitals
Authors: Lake Eileen T. , French Rachel , Clark Rebecca R. S. , O’Rourke Kathleen , Lorch Scott 
Published: April 2021

OBJECTIVES:To determine the extent to which newborns with neonatal abstinence syndrome (NAS) are concentrated in some hospitals as compared with newborns without NAS and whether care quality and safety differed among these hospitals. We hypothesized that newborns with NAS would be cared for in poorer-quality hospitals.METHODS:Secondary analysis of 3 2016 data sets: (1) the panel study of effects of changes in nursing on patient outcomes-US survey of hospital registered nurses regarding work conditions and safety, (2) inpatient discharge abstracts, and (3) the American Hospital Association annual survey. Newborns in 266 hospitals from the 4 states where the panel study of effects of changes in nursing on patient outcomes was conducted were included. We used Lorenz curves to determine if newborns with NAS were concentrated in different hospitals than newborns without NAS and whether care quality and safety differed among those hospitals. Quality and safety were assessed by staff nurses by using standard survey questions.RESULTS:Of the 659 403 newborns in this study, 3130 were diagnosed with noniatrogenic NAS. We found that newborns with NAS were cared for in different hospitals compared with newborns without NAS (Gini coefficient 0.62, 95% confidence interval, 0.56–0.68) and that the hospitals in which they received care were rated as having poorer quality and safety (Gini coefficient 0.12, 95% confidence interval, 0.01–0.23).CONCLUSIONS:Newborns with NAS are cared for in poorer-quality hospitals than other newborns. Our findings are of concern because poorer-quality care is linked to patient outcomes. As stakeholders seek to address the opioid epidemic and improve outcomes of newborns with NAS, our findings suggest the importance of examining hospital factors.
Improving Isotonic Maintenance Intravenous Fluid Use at a Tertiary Children’s Hospital
Authors: Nordstrom Matthew , Landman Geri , Pfaff Nora , Kaiser Sunitha V. 
Published: April 2021

OBJECTIVES:Maintenance intravenous fluids (IVFs) are routinely used in the care of hospitalized children. The American Academy of Pediatrics (AAP) published clinical practice guidelines in November 2018 that recommended the use of isotonic maintenance IVF. Our primary aim was to increase the proportion of hospital days pediatric inpatients were exclusively administered isotonic maintenance IVF to ≥80% by May 2020 at our institution.METHODS:We conducted a single-center quality improvement (QI) study as part of an AAP collaborative. An interdisciplinary team led QI interventions including providing targeted education to clinicians, integrating guideline recommendations into the electronic medical record, engaging hospital leaders, and providing performance data to clinicians. Our study population included children ages 28 days to 18 years admitted to inpatient wards. Our primary outcome was the proportion of hospital days with exclusive isotonic maintenance IVF use. Balancing measures included transfers to the ICU, ordering of serum sodium laboratory tests, and adverse events. Data were analyzed by using statistical process control.RESULTS:We analyzed 500 hospital admissions and found a significant increase in exclusive isotonic IVF use (63% to 95%) within 9 months of starting our QI intervention. We found no significant changes in balancing measures (serum sodium laboratory tests [24% to 25%], ICU transfer [0.3% to 1%], adverse events [0.3% to 1%]).CONCLUSIONS:Our interdisciplinary QI team led interventions that were associated with significant improvements in isotonic IVF use, in accordance with AAP clinical practice guidelines. With our study, we provide detailed guidance on successful interventions for implementing this evidence-based guideline.
Metric Development for the Multicenter Improving Pediatric Sepsis Outcomes (IPSO) Collaborative
Authors: Paul Raina , Niedner Matthew , Brilli Richard , Macias Charles , Riggs Ruth , Balamuth Frances , Depinet Holly , Larsen Gitte , Huskins Charlie , Scott Halden , Lucasiewicz Gloria , Schaffer Melissa , DeSouza Heidi Gruhler , Silver Pete , Richardson Troy , Hueschen Leslie , Campbell Deborah , Wathen Beth , Auletta Jeffery J. ,   FOR THE IPSO COLLABORATIVE INVESTIGATORS
Published: April 2021

BACKGROUND:
A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)–based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites.

METHODS:
An expert panel developed metrics and corresponding variables to assess improvements across the care delivery spectrum, including the emergency department, acute care units, hematology and oncology, and the ICU. Outcome, process, and balancing measures were represented. Variables and statistical process control charts were mapped to each metric, elucidating progress over time and informing plan-do-study-act cycles. Electronic health record (EHR) abstraction feasibility was prioritized. Time 0 was defined as time of earliest sepsis recognition (determined electronically), or as a clinically derived time 0 (manually abstracted), identifying earliest physiologic onset of sepsis.

RESULTS:
Twenty-four evidence-based metrics reflected timely and appropriate interventions for a uniformly defined sepsis cohort. Metrics mapped to statistical process control charts with 44 final variables; 40 could be abstracted automatically from multiple EHRs. Variables, including high-risk conditions and bedside huddle time, were challenging to abstract (reported in &lt;80% of encounters). Size or type of hospital, method of data abstraction, and previous QI collaboration participation did not influence hospitals’ abilities to contribute data. To date, 90% of data have been submitted, representing 200 007 sepsis episodes.

CONCLUSIONS:
A comprehensive data dictionary was developed for the largest pediatric sepsis QI collaborative, optimizing automation and ensuring sustainable reporting. These approaches can be used in other large-scale sepsis QI projects in which researchers seek to leverage EHR data abstraction.
Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-based Severity at Admission
Authors: Fuad M. , Oehadian Amaylia , Prihatni Delita , Marthoenis Marthoenis 
Published: April 2021

Background: Increased Neutrophil-to-Lymphocyte Ratio (NLR) is an independent risk factor for mortality in Covid-19 patients and is considered as an early warning sign of Covid-19 severity. This study aimed to observe the differences in NLR at admission between patients with mild, moderate, and severe symptoms of Covid-19 treated in a referral hospital in Banda Aceh, Indonesia.Methods: A total of 114 patients with Covid-19 admitted to a referral hospital in Banda Aceh, Indonesia, during March–September 2020 were included in this study. Demographic information and baseline laboratory data, including the NLR, were collected. Descriptive and inferential statistics were used to analyze the data. Results: The median NLR at admission was higher among patients with moderate to severe symptoms than those with mild symptoms [6.54 (2.80–97.00, IQR 4.81–9.44) vs 2.27 (0.79–5.07, IQR 1.43-2.98), p <0.001]. Covid-19 patients who died had a higher NLR than those who survived [10.88 (4.17–47.50, IQR 7.00–15.17) vs 6.15 (2.80–97.00, IQR 4.63–8.50), p 0.02]. Patients with moderate-severe symptoms had an initial NLR of 4.63–8.50 and decreased to 2.75–5.43 at the end of the treatment had a greater chance of survival. There was an increased probability of death in patients with moderate-severe symptoms whose initial NLR was 7.00–15.17, which was then elevated to 14.33–23.25.Conclusion: Different NLR at admission is seen among Covid-19 patients with mild and moderate-severe symptoms, leading to significantly different outcomes. The NLR can be used as a simple parameter to determine the severity of the disease and predict the outcome of Covid-19 patients.
Impacto de la aplicación de vacunas contra COVID-19 sobre la incidencia de nuevas infecciones por SARS-COV-2 en PS de la Provincia de Buenos Aires
Authors: Luzuriaga Juan Pedro , Marsico Franco , Garcia Enio , González Verónica , Kreplak Nicolás , Pifano Marina , González Soledad 
Published: April 2021

Introducción. El plan de vacunación de la provincia de Buenos Aires ha priorizado los grupos de mayor riesgo epidemiológico, iniciando el proceso de inmunización sobre el Personal de Salud (PS).El presente trabajo tiene por objetivo evaluar el impacto de la vacunación sobre la evolución media de nuevos casos SARS-Cov-2 en PS comparada con la de la población general.
Metodología. La información de los casos confirmados se obtuvo del Sistema Nacional de Vigilancia de la Salud, período abril/2020 a marzo/2021. La cantidad de vacunados utilizó la base del sistema VacunatePBA.
Resultados. A partir de septiembre, el número de casos comienza a disminuir más pronunciadamente en PS que en la población general. Esta tendencia se consolida con el comienzo del plan de vacunación. Para febrero de 2021 se han inmunizado con la primera dosis el 42% del PS y con la segunda dosis el 24%. Se observa que, en marzo, mientras la cantidad de casos de la Población General aumenta un 10% respecto a febrero, PS disminuye un 35%. Esto indica un descenso significativamente más pronunciado en PS (p-valor < 0.00001).
Discusión. A partir de la introducción de la vacuna contra COVID-19 a finales de diciembre en distintos países, se ha comenzado a reportar una baja de la incidencia de nuevos casos de infección por SARS-CoV-2 en PS, coincidente con los hallazgos del presente estudio. Nuestro estudio aporta los primeros datos del país sobre el impacto de las vacunas COVID-19 en PS.
Vardiyalı Çalışanlarda Uykusuzluk ve Kalp Hastalıkları Riskleri: Sistematik Derleme
Authors: KOLAÇ Nurcan 
Published: April 2021

Gece vardiyasında çalışan bireylerde gündüz çalışanlara göre daha fazla metabolik risk faktörleri rastlanmaktadır. Bu çalışmanın amacı, literatürde vardiyalı çalışanlarda uykusuzluk ve kalp hastalıkları risklerini araştıran çalışmaları tanımlamaktır. Değerlendirmeye tanımlayıcı, kesitsel, kohort, sistematik derleme, ve meta-analiz, prospektif kohort ve ilişki arayıcı türde toplam 12 çalışma dahil edilmiştir.
Bulgular: Litaratürde vardiyalı çalışanlarda uykusuzluk ve kalp hastalıkları risklerini tanılamaya yönelik olarak yapılan çalışmalar değerlendirildiğinde, vardiyalı çalışanların uyku bozuklukları yaşadıkları ve sirkadiyen ritmin bozulduğu görülmüştür. Bunun sonucunda çalışanların, vardiyalı çalışmayanlara göre kardiyovasküler hastalık ve koroner kalp hastalığı riskinin yüksek olduğu; bu riskin çalışma yılı ile birlikte arttığı belirlenmiştir. Ayrıca kardiyovasküler hastalık mortalite riskinin çalışanlar için yüksek olduğu bulunmuştur.
Sonuç: Bu sistematik derleme sonucunda vardiya çalışmanın uykusuzluk ile kardiyovasküler hastalık arasında ilişkisi olduğu fakat vardiyalı çalışmanın kalp hastalıkları üzerindeki etkisini değerlendiren çalışmaların sayıca yetersizliği olmasının yanı sıra fiziki etmenlerden ve psikososyal faktörlerden bağımsız olarak vardiyalı çalışma ile kardiyovasküler hastalık riski arasındaki ilişkinin değerlendirilememiştir.
The Use of Accounting Information in Financing Decision: The Context of Bangladeshi Private Commercial Banks
Authors: Saha Sumi , Sil Subhash Chandra , Sayaduzzaman Md. 
Published: April 2021

Accounting information is essential to elucidate the financial scenario of any organization. The use of accounting information enhances the decision-making process that has a good role in managerial efficiency. This research study has attempted to know the use of accounting information contained in the annual reports in making a financing decision. Five components of financing decision like selecting the best source of financing, assessing the cash flows, preparing the budget and profit planning, valuation of bond and share as well as financial statement analysis have been considered for the purpose of the study and collected opinions from the selected respondents amounts to one hundred fifty with the use of structured questionnaire and the outcomes of this survey report that the most of the respondents strongly agreed that the accounting information has been used in making a financing decision. The study also reveals that there is a significant relationship among the opinions of the respondents regarding using accounting information in making decisions about the different components of financing decisions.
Prevalence of blaCTX-M, blaTEM, and blaSHV Genes among Extended-spectrum β-lactamases-producing Clinical Isolates of Enterobacteriaceae in Different Regions of Sudan
Authors: N Altayb Hisham , A M Siddig Mohamed , M El Amin Nagwa , M. Mukhtar Maowia 
Published: April 2021

Background: This study aimed to characterize blaCTX-M, blaTEM, and blaSHV genes among extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae species in different regions of Sudan.
Methods: In this cross-sectional study, different clinical samples (n = 985) were collected randomly from symptomatic patients from four geographical regions of Sudan and cultured on chromogenic media. Following bacterial identification, phenotypic screening of ESBLs was done according to CLSI guidelines using cefotaxime (30 μg), ceftazidime (30 μg), and cefepime (30 μg) discs with and without clavulanic acid. The DNA was extracted by guanidine hydrochloride protocol, and then conventional PCR was used to detect blaCTX-M, blaTEM, and blaSHV genes. The presence of genes’ subtypes was characterized by DNA Sanger sequencing for selected samples.
Results: Enterobacteriaceae represented 31% (305/985) of all isolates, 42 (128/305) of which were ESBLs producer, confirmed by phenotypic confirmatory test (75% [96/128] of them were positive for blaCTX-M genes, 61% [78/128] for blaTEM genes, and 38% [48/128] for blaSHV genes). Fourteen isolates (11%) were negative for all genes. Forty-eight percent (63/75) of Escherichia coli isolates were positive for blaCTX-M, while in Klebsiella pneumoniae, the dominant gene was blaTEM (82%) and had a low amount of blaSHV (59%). There was a significant association (P-value = 0.001 for all except for chloramphenicol, P = 0.014, and amikacin, P = 0.017) between resistance to third-generation cephalosporins and ciprofloxacin, nalidixic acid, meropenem, chloramphenicol, and amikacin. Forty-two percent (40/96) of CTX-M-positive isolates were in Gizera State, 33% (32.96) in Sinnar, 24% (23/96) in Khartoum, and 1% (1/96) in White Nile.
Conclusion: We conclude that blaCTX-M genes are the most dominant genes in ESBLs-producing isolates and are more prevalent in big cities than in rural areas.
Keywords: phenotypic, blaCTX-M, blaTEM, and blaSHV ESBLs genes, Enterobacteriaceae, Sudan
Iwaszkiewicz’s Venice
Authors: Pietrych Krystyna 
Published: April 2021

The article offers an overview of Iwaszkiewicz’s Venice works, starting with his early poems from his first visit in the city on a lagoon, and all the way to a work in his final poetry collection. This overview helps one realise that the writer’s autobiography is the key to all of them. Both poems and prose works followed the writer’s rhythm of existence. The presented images not so much extract the features of the city but rather refer to the author’s age, mood, and mental disposition. Another major factor that shaped the image of Venice in Iwaszkiewicz’s works were the conventional topoi consolidated in culture which build the artistic means of symbolising actual spaces. Iwaszkiewicz’s text, which developed for nearly sixty years is a praise of art understood, per modernist principles, in an absolutist manner.
Ischemia-modified albumin in migraine patients during interictal period
Authors: Michalak Slawomir , Osztynowicz Krystyna , Płóciniczak Alicja , Myszka Waldemar , Nowicki Marcin , Węgrzyn Danuta , Drzewiecka Małgorzata , Kapecka Kinga , Kozubski Wojciech 
Published: April 2021

Aim. Ischemia-modified albumin (IMA) is a marker of myocardial ischemia and may be affected by ischemia occurring in other tissues. Migraine has been reported as a risk factor of ischemic stroke or cardiovascular events. Dysfunction of endothelial cells, as well as association with arteriopathies was evidenced in migraine patients. The aim of this study was to evaluate interictal IMA in migraine patients.Material and Methods. Fifty migraineurs aged 38 ± 9 years were included in the study. The control group consisted of 25 healthy volunteers aged 37 ± 8 years. In all subjects neurological examination was carried on, as well as clinimetric evaluation with the use of: MIDAS, MIGSEV, QVM, VAS and VRS. Ischemia-modified albumin was evaluated by means of spectrophotometric method with the use of cobalt chloride. The concentrations of total cholesterol, HDL- and LDL-cholesterol, triglycerides, homocysteine, C-reactive protein and Lp(a) were analyzed with routine spectrophotometric methods.Results. IMA was significantly (P = 0.0108) higher in migraine patients (0.101; 0.00–0.327 O.D.) than in controls (0.00; 0.00–0.102 O.D.; median; interquartile range). Migraineurs with aura have also higher IMA than controls. IMA correlated (rS = 0.383, P = 0.0073) with VAS and with homocysteine concentration (rS = 0.430, P = 0.0026). Multiple regression analysis of IMA and atherosclerosis risk factors showed significant correlation (P = 0.0247) with HDL cholesterol (R = 0.2958) and triglycerides concentrations (R = 0.3285).Conclusions. IMA formation in migraine patients, as a marker of oxidative stress even during interictal period in patients with hyperhomocysteinemia and/or hypertriacylglyceridemia can reflect a milieu of factors which further increases the risk for cardiovascular complications.
A 10 year data analysis of lymphatic system metastasis and recurrence in individuals affected by malignant tumors within the oral cavity and maxillofacial region
Authors: Dreksler Adam , Lenkowski Marcin , Marcinkowski Michał , Nowaczyk Marian Tomasz , Osmola Krzysztof , Pełczyński Tomasz , Radzewicz Gleb , Rahma Samir 
Published: April 2021

Introduction. Tumors are only second to cardiovascular diseases as a cause of death. According to World Health Organization (WHO), these statistics will increase especially within aging and well-developed countries.Aim. The aim of the research was to analyze the frequency of recurrences and lymph node involvement in individuals affected by malignant tumor of head and neck region. Special attention was paid to tumor location, sex, age of the affected individuals as well as histological appearance of the tumor.Material and methods. The research team has analyzed medical data record base from 2002–2011 and selected a group of 1697 individuals treated for malignant tumors within the oral cavity and maxillofacial region.Results. Reoperation was carried out on 192 patients due to recurrences and lymph node involvement; (11.3%) of the study group. Patients were further subdivided into groups according to sex, age, histological appearance and anatomical location of tumor recurrence. Results were compared with the available literature.Conclusions. Our data confirms the findings of other research groups in terms of accuracy of early diagnostic screening and its effect on final tumor treatment. It is also essential to accentuate the importance of post-treatment monitoring within first five years after initiation of treatment, which allows for an early determination of local recurrences and/or lymph node involvement.
Effectiveness of regular physical activity on exercise tolerance and biochemical parameters in high-risk prostate cancer patients during radiotherapy
Authors: Hojan Katarzyna , Ozga-Majchrzak Owidia , Górecki Maciej , Leporowska Ewa , Milecki Piotr 
Published: April 2021

Introduction. Radiotherapy (RT) is an important modality for curative treatment in high-risk prostate cancer (PCa) patients that improves overall survival, however, it may cause unfavorable changes in physical fitness, increased risk factors for cardiovascular and metabolic complications. The effects of physical exercise on aerobic capacity and on serum levels of liver and renal function indices in PCa patients undergoing RT are still unknown. Aim. The purpose was to assess the impact of supervised physical activity on aerobic capacity, hemorheology and metabolic biomarker levels in high-risk PCa patients during RT. Material and methods. Seventy-two men were randomly allocated to two groups before RT for high-risk prostate carcinoma. Thirty-six men conducted physical exercise (EG) and the other 36 men were a control group (UC). Outcomes measured were 6-Minute Walk Test (6MWT), blood parameters, serum levels of hepatic and renal function biomarkers (urea, creatinine, alanine and aspartate aminotransferase, PSA) in a modified shuttle test before and after RT. Results. After RT, decreased diastolic blood pressure (before test p = 0.05) was observed in the EG and in the UG, there was an increase in resting heart rate (p = 0.017), a decrease in walking distance (p = 0.036), and an increase in Borg fatigue score during the 6MWT. There was no statistically significant change in renal biomarkers or PSA in the liver in either group. Conclusions. Physical activity in prostate carcinoma patients during RT improves capacity tolerance with a decrease in Borg fatigue score, but this activity did not influence on serology outcomes or other blood indicators during RT
The benefits and risks of short-term diet changes on the example of the use a 5-week long lactoovovegetarian diet. Analysis of 7-day nutritional surveys of women – preliminary study
Authors: Czyżewska-Majchrzak Łucja , Krzymińska-Siemaszko Roma , Pelczyńska Marta , Witmanowski Henryk 
Published: April 2021

Aim. Due to more frequent incidence of diet related diseases, alternative methods of nutrition become more popular. The aim of this paper is to determine the degree of balance of a short-term lactoovovegetarian diet followed by those who do not have any previous experience with such a diet. Moreover, the study aims at comparing its findings with results of a nutritional analysis carried out in the case of volunteers following a long-term lactoovovegetarian diet.Material and methods. The method chosen in this study is a nutritional analysis based on 7-day long nutritional surveys. Diet 5.0 software was used analyze this data. The tests were conducted among 9 lactoovovegetarians females (LVD – long-term vegetarian diet) and 9 females who decided to follow a lactoovovegetarian diet for the duration of 5 weeks (SVD – short-term vegetarian diet). In the latter case, nutritional surveys were performed in the week preceding the experiment (SVD1/control group) and the last week of the diet (SVD2).Results. In LVD group, when compared with SVD1, significant differences in average daily intake of vitamin E, fat and plant fiber have transpired. After analyzing data from nutritional surveys of SVD2 group, significant differences in the amount of basic nutritional elements (e.g. smaller amount of fat and fiber), microelements (e.g. lower supply of calcium, iron, magnesium) and vitamins (vitamin E, thiamine, niacin) have been noted, as compared to LVD group. When comparing data within SVD group, i.e. a traditional diet and a 5 week long lactoovovegetarian diet significantly lower supplies of vitamins B1, B3, B12 and D were observed than before starting the experiment. Conclusions. A short-term change of eating habits from a traditional diet into a lactoovovegetarian one may result in insufficient supply of numerous nutrients.