bluuebunny/crossref_metadata_2025_split huggingface dataset:
Budget impact analysis of using procalcitonin to optimize antimicrobial treatment for patients with suspected sepsis in the intensive care unit and hospitalized lower respiratory tract infections in Argentina
Authors: Garay Osvaldo Ulises , Guiñazú Gonzalo , Cornistein Wanda , Farina Javier , Valentini Ricardo , Levy Hara Gabriel 
Published: April 2021

BackgroundInappropriate antibiotic use represents a major global threat. Sepsis and bacterial lower respiratory tract infections (LRTIs) have been linked to antimicrobial resistance, carrying important consequences for patients and health systems. Procalcitonin-guided algorithms may represent helpful tools to reduce antibiotic overuse but the financial burden is unclear. The aim of this study was to estimate the healthcare and budget impact in Argentina of using procalcitonin-guided algorithms to guide antibiotic prescription.MethodsA decision tree was used to model health and cost outcomes for the Argentinean health system, over a one-year duration. Patients with suspected sepsis in the intensive care unit and hospitalized patients with LRTI were included. Model parameters were obtained from a focused, non-systematic, local and international bibliographic search, and validated by a panel of local experts. Deterministic and probabilistic sensitivity analyses were performed to analyze the uncertainty of parameters.ResultsThe model predicted that using procalcitonin-guided algorithms would result in 734.5 [95% confidence interval (CI): 1,105.2;438.8] thousand fewer antibiotic treatment days, 7.9 [95% CI: 18.5;8.5] thousand antibiotic-resistant cases avoided, and 5.1 [95% CI: 6.7;4.2] thousand fewerClostridioides difficilecases. In total, this would save $422.4 US dollars (USD) [95% CI: $935;$267] per patient per year, meaning cost savings of $83.0 [95% CI: $183.6;$57.7] million USD for the entire health system and $0.4 [95% CI: $0.9;$0.3] million USD for a healthcare provider with 1,000 cases per year of sepsis and LRTI patients. The sensitivity analysis showed that the probability of cost-saving for the sepsis patient group was lower than for the LRTI patient group (85% vs. 100%).ConclusionsHealthcare and financial benefits can be obtained by implementing procalcitonin-guided algorithms in Argentina. Although we found results to be robust on an aggregate level, some caution must be used when focusing only on sepsis patients in the intensive care unit.
Frailty and length of stay in older adults with blunt injury in a national multicentre prospective cohort study
Authors: Tan Timothy Xin Zhong , Nadkarni Nivedita V. , Chua Wei Chong , Loo Lynette Ma , Iau Philip Tsau Choong , Ang Arron Seng Hock , Goo Jerry Tiong Thye , Chan Kim Chai , Malhotra Rahul , Ong Marcus Eng Hock , Matchar David Bruce , Seow Dennis Chuen Chai , Nguyen Hai V. , Ng Yee Sien , Chan Angelique , Wong Ting-Hway 
Published: April 2021

Background
Patients suffering moderate or severe injury after low falls have higher readmission and long-term mortality rates compared to patients injured by high-velocity mechanisms such as motor vehicle accidents. We hypothesize that this is due to higher pre-injury frailty in low-fall patients, and present baseline patient and frailty demographics of a prospective cohort of moderate and severely injured older patients. Our second hypothesis was that frailty was associated with longer length of stay (LOS) at index admission.

Methods
This is a prospective, nation-wide, multi-center cohort study of Singaporean residents aged ≥55 years admitted for ≥48 hours after blunt injury with an injury severity score or new injury severity score ≥10, or an Organ Injury Scale ≥3, in public hospitals from 2016–2018. Demographics, mechanism of injury and frailty were recorded and analysed by Chi-square, or Kruskal-Wallis as appropriate.

Results
218 participants met criteria and survived the index admission. Low fall patients had the highest proportion of frailty (44, 27.3%), followed by higher level fallers (3, 21.4%) and motor vehicle accidents (1, 2.3%) (p < .01). Injury severity, extreme age, and surgery were independently associated with longer LOS. Frail patients were paradoxically noted to have shorter LOS (p < .05).

Conclusion
Patients sustaining moderate or severe injury after low falls are more likely to be frail compared to patients injured after higher-velocity mechanisms. However, this did not translate into longer adjusted LOS in hospital at index admission.
Time distribution for pharmacists conducting a randomized controlled trial—An observational time and motion study
Authors: Havnes Kjerstin , Lehnbom Elin C. , Walter Scott R. , Garcia Beate H. , Halvorsen Kjell H. 
Published: April 2021

IntroductionAn expected future increase in older adults will demand changes in health care delivery, making development, implementation and evaluation of new health care models essential. The rationale for political decision-making concerning the implementation and application of interventions in health care should include cost estimations, specifically those involving clinical interventions. To provide such data knowledge of time spent on the intervention is imperative. Time and motion methodology is suitable to quantify health care personnel’s time distribution.AimTo investigate the time distribution for pharmacists conducting a randomized controlled trial (RCT) implementing a clinical intervention.Materials and methodsThe setting was an RCT with a 5-step pharmacist-intervention in collaboration with the interdisciplinary team in a geriatric ward. Two pharmacists were involved in the trial during the observation period. Pharmacist activities, classified as RCT-tasks (intervention or administrative), non-RCT tasks and social/breaks, were recorded applying the Work Observation Method By Activity Timing methodology, enabling recording of predefined work tasks as well as interruptions and multitasking. One observer collected data over eight weeks.ResultsIn total, 109.1 hours were observed resulting in 110.2 hours total task time, including multitasking. RCT tasks comprised 85.4% of the total observed time, and nearly 60% of the RCT time was spent on intervention tasks. Medication reviews was the most time consuming task, accounting for 32% of the observed time. The clinical pharmacists spent 14% of the intervention time communicating verbally, mainly with patients and healthcare professionals.ConclusionDuring the RCT, the clinical pharmacists spent about half their time performing the actual intervention. Consequently, costs for providing such a clinical pharmacist service should reflect actual time spent; otherwise, we may risk overestimating theoretical costs.
Characteristics and Outcomes of Children With Cystic Fibrosis Hospitalized With Cirrhosis in the United States
Authors: Thornton Christina , Somayaji Ranjani , Parkins Michael , Swain Mark G. , Ramos Kathleen J. , Goss Christopher H. , Shaheen Abdel A. 
Published: April 2021

INTRODUCTION:
To describe the characteristics and outcomes of children with cystic fibrosis (CF) hospitalized with cirrhosis in the United States.

METHODS:
We conducted a population-based cohort study of hospitalizations among children with CF using the 2016 Kid's Inpatient Database.

RESULTS:
In total, 9,615 admissions were analyzed. Diagnosis of cirrhosis was present in 509 (5.3%) and was significantly associated with increased mortality, length of stay, and hospital charges compared with those without cirrhosis. Hepatic encephalopathy was significantly associated with death in children with cirrhosis.

DISCUSSION:
Future interventions should be designed to support children with CF who have cirrhosis to improve clinical outcomes.
Histologic Study of the Esophagogastric Junction of Organ Donors Reveals Novel Glandular Structures in Normal Esophageal and Gastric Mucosae
Authors: Odze Robert , Spechler Stuart J. , Podgaetz Eitan , Nguyen Anh , Konda Vani , Souza Rhonda F. 
Published: April 2021

INTRODUCTION:
Whether cardiac mucosa at the esophagogastric junction is normal or metaplastic is controversial. Studies attempting to resolve this issue have been limited by the use of superficial pinch biopsies, abnormal esophagi resected typically because of cancer, or autopsy specimens in which tissue autolysis in the stomach obscures histologic findings.

METHODS:
We performed histologic and immunohistochemical studies of the freshly fixed esophagus and stomach resected from 7 heart-beating, deceased organ donors with no history of esophageal or gastric disease and with minimal or no histologic evidence of esophagitis and gastritis.

RESULTS:
All subjects had cardiac mucosa, consisting of a mixture of mucous and oxyntic glands with surface foveolar epithelium, at the esophagogastric junction. All also had unique structures we termed compact mucous glands (CMG), which were histologically and immunohistochemically identical to the mucous glands of cardiac mucosa, under esophageal squamous epithelium and, hitherto undescribed, in uninflamed oxyntic mucosa throughout the gastric fundus.

DISCUSSION:
These findings support cardiac mucosa as a normal anatomic structure and do not support the hypothesis that cardiac mucosa is always metaplastic. However, they do support our novel hypothesis that in the setting of reflux esophagitis, reflux-induced damage to squamous epithelium exposes underlying CMG (which are likely more resistant to acid-peptic damage than squamous epithelium), and proliferation of these CMG as part of a wound-healing process to repair the acid-peptic damage could result in their expansion to the mucosal surface to be recognized as cardiac mucosa of a columnar-lined esophagus.
Burden of Ionizing Radiation in the Diagnosis and Management of Necrotizing Pancreatitis
Authors: Thiruvengadam Nikhil R. , Miranda Janille , Kim Christopher , Behr Spencer , Corvera Carlos , Dai Sun-Chuan , Kirkwood Kimberly , Harris Hobart W. , Hirose Kenzo , Nakakura Eric , Ostroff James W. , Kochman Michael L. , Arain Mustafa A. 
Published: April 2021

INTRODUCTION:
A step-up endoscopic or percutaneous approach improves outcomes in necrotizing pancreatitis (NP). However, these require multiple radiographic studies and fluoroscopic procedures, which use low-dose ionizing radiation. The cumulative radiation exposure for treatment of NP has not been well defined.

METHODS:
We conducted a retrospective study of consecutive patients with NP admitted to University of California San Francisco Medical Center from January 2011 to June 2019. We calculated effective doses for fluoroscopic procedures using the dose area product and used the National Cancer Institute tool for computed tomography studies. The primary outcome was the cumulative effective dose (CED). Multivariable logistic regression was used to evaluate risk factors of high exposure (CED > 500 mSv).

RESULTS:
One hundred seventy-one patients with NP (mean follow-up 40 ± 18 months) underwent a median of 7 (interquartile range [IQR] 5–11) computed tomography scans and 7 (IQR 5–12) fluoroscopic procedures. The median CED was 274 mSv (IQR 177–245) and 30% (51) of patients received high exposure. Risk factors of high exposure include multiorgan failure (aOR 3.47, 95%-CI: 1.53–9.88, P = 0.003), infected necrosis (adjusted odds ratio [aOR] 3.89 95%-CI:1.53–9.88, P = 0.005), and step-up endoscopic approach (aOR 1.86, 95%-CI: 1.41–1.84, P = 0.001) when compared with step-up percutaneous approach.

DISCUSSION:
Patients with NP were exposed to a substantial amount of ionizing radiation (257 mSv) as a part of their treatment, and 30% received more than 500 mSv, which corresponds with a 5% increase in lifetime cancer risk. Severity of NP and a step-up endoscopic approach were associated with CED > 500 mSv. Further studies are needed to help develop low-radiation treatment protocols for NP, particularly in patients receiving endoscopic therapy.
STRATEGIC MODULATION OF THERMAL TO ELECTRICAL ENERGY RATIO PRODUCED FROM PV/T MODULE
Authors: Aminou Moussavou Anges A. , Raji Atanda K. , Adonis Marco 
Published: April 2021

Several strategies have been developed to enhance the performance of a solar photovoltaicthermal (PV/T) system in buildings. However, these systems are limited by the cost, complex structure and power consumed by the pump. This paper proposes an optimisation method conversion strategy that modulates the ratio of thermal to electrical energy from the photovoltaic (PV) cell, to increase the PV/T system’s performance. The design and modelling of a PV cell was developed in MATLAB/Simulink to validate the heat transfer occurring in the PV cell model, which converts the radiation (solar) into heat and electricity. A linear regression equation curve was used to define the ratio of thermal to electrical energy technique, and the behavioural patterns of various types of power (thermal and electrical) as a function of extrinsic cell resistance (Rse). The simulation results show an effective balance of the thermal and electrical power when adjusting the Rse. The strategy to modulate the ratio of thermal to electrical energy from the PV cell may optimise the PV/T system’s performance. A change of Rse might be an effective method of controlling the amount of thermal and electrical energy from the PV cell to support the PV/T system temporally, based on the energy need. The optimisation technique of the PV/T system using the PV cell is particularly useful for households since they require electricity, heating, and cooling. Applying this technique demonstrates the ability of the PV/T system to balance the energy ( thermal and electrical) produced based on the weather conditions and the user’s energy demands.
Pengaruh Kepemimpinan Demokratis Kepala Ruang Rawat Inap Terhadap Kepuasan Kerja Perawat di Rumah Sakit Umum Aro Pekalongan
Authors: Rahardjo Broto , Suryawati Chriswardani , Agushybana Farid 
Published: April 2021

Leadership styles that are less suitable can reduce employee motivation, performance and job satisfaction. 4 out of 10 nurses in the inpatient room of Aro Pekalongan General Hospital felt dissatisfied with the leadership of the head of the inpatient room. Therefore a study was conducted to analyze the influence of the democratic leadership style of the inpatient head on the job satisfaction of nurses in Aro Pekalongan General Hospital.The study design was cross sectional with an observational quantitative approach. The research subjects were 32 nurses in the inpatient room of Aro General Hospital who were selected by the total sampling method. Data was collected by questionnaire. Processing and analysis of data using multiple logistic regression analysis.The results showed the variables of democratic leadership style related to nurse job satisfaction in Aro Pekalongan Hospital were delegation of responsibility variables (p = 0.005) and headroom decision-making variables (p = 0.034), while other variables not related to nurse job satisfaction were variable of headroom activity (p = 0.077) and empathy variable (p = 0.075). The variable delegation of tagging answers to the head of the room has a 19 times better effect on influencing nurse job satisfaction compared to the head of the room with poor delegation of responsibilities (p = 0.011 Exp (B) = 19.826). It is recommended for management for periodic monitoring and evaluation, the selection of the head of the room is based on the length of work, competence and experience of advice for the head of the room to improve effective communication and hold regular meetings with nurses in the inpatient room of Aro Pekalongan General Hospital.
Studi Implementasi Sistem Rujukan Berjenjang Antar Fasilitas Kesehatan Tingkat Lanjut di Era JKN di Provinsi Sulawesi Selatan
Authors: Arifah Nur , Anggraeni Rini , Mangilep Adelia U. A. 
Published: April 2021

One of the determinants of achieving quality control and cost control is the implementation of tiered referral health. This research was motivated by the absence of research on the implementation of referrals from FKTP to FKTL. Data from RSUP Dr. Wahidin Sudirohusodo’s annual report showed in 2015 and first half of 2016, >60% cases in class A hospital were level 1 severity case which should still be handle in class D and C hospitals. This affects the accumulation of patiens in tertiary hospitals and inefficient use of resources. It is a qualitative research with phenomenology approach to determine the implementation of a tiered referral system between advanced health facilities in JKN era in South Sulawesi. The results shows most of referral were made due to facilities limitation and inavailability of specialist. There were referrals which made based on patients requests not based on clinical reasons. It is also found hospital staff who did not know about the existing of standard operational procedure of referral in the hospital. Some hospital staff has no knowledge on the referral regulation nor about hospital classification. This research is expected to be able to contribute to the development of science and can be used as input for hospitals and BPJS in an effort to improve the optimization of tiered referral services. Based on the results of the study it is recommended to improve facilities and infrastructure that can support the provision of referral services in hospitals.
p-harmonic functions by way of intrinsic mean value properties
Authors: Arroyo Ángel , Llorente José G. 
Published: April 2021

Abstract
Let Ω be a bounded domain in

ℝ
n

{\mathbb{R}^{n}}

. Under appropriate conditions on Ω, we prove existence and uniqueness of continuous functions solving the Dirichlet problem associated to certain nonlinear mean value properties in Ω with respect to balls of variable radius. We also show that, when properly normalized, such functions converge to the p-harmonic solution of the Dirichlet problem in Ω for

p
⩾
2

{p\geqslant 2}

. Existence is obtained via iteration, a fundamental tool being the construction of explicit universal barriers in Ω.
Bilateral estimates of solutions to quasilinear elliptic equations with sub-natural growth terms
Authors: Verbitsky Igor E. 
Published: April 2021

Abstract
We study
quasilinear elliptic equations of the type

-

Δ
p

⁢
u

=

σ
⁢

u
q

+
μ

{-\Delta_{p}u=\sigma u^{q}+\mu}

in

ℝ
n

{\mathbb{R}^{n}}

in the
case

0
<
q
<

p
-
1

{0<q<p-1}

, where μ and σ are nonnegative measurable functions, or locally finite measures, and

Δ
p

⁢
u

=

div
⁡

(

|

∇
⁡
u

|

p
-
2

⁢

∇
⁡
u

)

{\Delta_{p}u=\operatorname{div}(\lvert\nabla u\rvert^{p-2}\nabla u)}

is the p-Laplacian. Similar equations with
more general local and nonlocal operators in place of

Δ
p

{\Delta_{p}}

are treated as well.
We obtain existence criteria and global bilateral pointwise estimates for all positive solutions u:

u
⁢

(
x
)

≈

(

𝐖
p

⁢
σ
⁢

(
x
)

)

p
-
q

p
-
q
-
1

+

𝐊

p
,
q

⁢
σ
⁢

(
x
)

+

𝐖
p

⁢
μ
⁢

(
x
)

,

x
∈

ℝ
n

,

u(x)\approx({\mathbf{W}}_{p}\sigma(x))^{\frac{p-q}{p-q-1}}+{\mathbf{K}}_{p,q}%
\sigma(x)+{\mathbf{W}}_{p}\mu(x),\quad x\in\mathbb{R}^{n},

where

𝐖
p

{{\mathbf{W}}_{p}}

and

𝐊

p
,
q

{{\mathbf{K}}_{p,q}}

are, respectively, the Wolff potential and the intrinsic Wolff potential, with the constants of equivalence depending only on p, q, and n.
The contributions of μ and σ in these pointwise estimates
are totally separated, which
is a new phenomenon even when

p
=
2

{p=2}

.
M-projective curvature tensor on an (LCS)2n+1-manifold
Authors: Shanmukha B. , Venkatesha V. 
Published: April 2021

Abstract
In this paper, we study M-projective curvature tensors on an

(
LCS
)

2
⁢
n

+
1

{(\mathrm{LCS})_{2n+1}}

-manifold. Here we study M-projectively Ricci symmetric and M-projectively flat admitting spacetime.
The Super State: The Political Economy of Phosphate Fertilizer Use in South Australia, 1880–1940
Authors: Byerlee Derek 
Published: April 2021

Abstract
From 1882 to 1910 superphosphate was almost universally adopted by wheat farmers in South Australia. A supply chain perspective is used to link the mining of phosphate rock in distant Pacific islands to the final application of superphosphate in the fields of Australian wheat farmers. Farmers and private manufacturers led the adoption stage in the context of a liberal market regime and the role of the state at this stage was limited although strategic. After 1920, the role of the state in the industry sharply increased in all phases of the industry. A political economy perspective is used to analyse state-ownership of raw material supplies and protectionist policies to manufacturers that resulted in high prices in Australia by 1930. Numerous government reviews pitted the interests of farmers and manufacturers leading to a complex system of tariffs and subsidies in efforts to serve all interests. Overall, the adoption of superphosphate was a critical factor in developing productive and sustainable farming systems in Australia, although at the expense of Pacific Islanders who prior to WWII received token benefits and were ultimately left with a highly degraded landscape.
Phenomenological analysis of constrained in-plane compression of paperboard using micro-computed tomography Imaging
Authors: Wallmeier Malte , Barbier Christophe , Beckmann Felix , Brandberg August , Holmqvist Claes , Kulachenko Artem , Moosmann Julian , Östlund Sören , Pettersson Torbjörn 
Published: April 2021

Abstract
Large deformations under in-plane compression of paperboard appear in forming processes like hydroforming, pressforming and deep drawing, but the mechanisms of deformation have not been studied on a micromechanical level. A constrained in-plane compression test is presented. This test allows for in-plane compression, buckling, wrinkling and compaction. The constrained compression test is realized using a DEBEN CT-500 in-situ tester for laboratory microtomography and synchrotron microtomography. Experiments with five different materials spanning from laboratory handsheets to commercially available multi-layered paperboards are performed. Image processing is used to observe the local out-of-plane fiber orientation and compaction. A phenomenological investigation of the deformation behavior of these materials is presented. Delamination is found to be the primary mechanisms of failure in the multi-layered boards. Furthermore, a porous network structure, created by using long and minimally refined softwood fibers, is found to facilitate the formation of uniform wrinkles and compaction.
Die Zukunft der Schuldenbremse nach der Pandemie
Authors: Blesse Sebastian , Heinemann Friedrich , Janeba Eckhard , Nover Justus 
Published: April 2021

Abstract
The German constitutional fiscal rule (the „debt brake“) is increasingly subject to a reform debate that has intensified with the fiscal fallout from the Covid-19 pandemic. This article presents survey evidence from the German state parliaments on views and preferences for the future of Germany’s fiscal rule. The survey among all 16 state parliaments was conducted between May and July 2020 with a participation of almost 30 per cent of all state parliamentarians. The results indicate that the debt brake still enjoys a large general support from more than two thirds of the parliamentarians. However, a reform in the direction of an investment clause is increasingly popular, much more than a clause that would support debt-financed climate policy measures.
Die Corona-Schulden gehören ins Endlager
Authors: Südekum Jens 
Published: April 2021

Abstract
Germany and other European countries have piled up considerable public debt in response to the Corona crisis. But owing to the ultra-low interest rates, which are likely to remain for the foreseeable future, there are no concerns regarding debt sustainability. Quickly paying down this debt by imposing austerity would be the wrong strategy from an economic point of view, but it could nevertheless imposed by existing fiscal rules. Those rules should be reformed quickly. The right way to handle the Corona debts is to engage in debt rollover, that is, to essentially inflate them away in times of negative real interest rates.