bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patientenzufriedenheit nach Anwendung eines standardisierten
Analgesieverfahrens durch Rettungsfachpersonal – eine
Beobachtungsstudie
Authors: Sander Henning , Matschuck Guido , Möckel Martin , Nübling Matthias , Gnirke André 
Published: October 2021

Zusammenfassung
Hintergrund Unzureichende präklinische Schmerzbehandlung führte 2015 zur
Einführung eines standardisierten Analgesiekonzeptes in der
Rettungsdienst-Kooperation in Schleswig-Holstein (RKiSH). Obwohl die
Verträglichkeit, Wirksamkeit und Sicherheit des Analgesiekonzeptes nachgewiesen
wurden, muss die Zufriedenheit der Patienten mit diesem neuen Ansatz noch durch
einen validierten Fragebogen ermittelt werden.
Zielsetzung Untersuchung und Analyse der Unterschiede in der
Patientenzufriedenheit zwischen den eingesetzten Schmerzmitteln.
Methodik Nach Durchsicht der vorhandenen validierten/getesteten
Instrumente zur Messung der Patientenzufriedenheit wurde ein Fragebogen
entwickelt. Nach psychometrischen Tests erhielten wir einen abschließenden
16-Punkte-Fragebogen, der 4 Dimensionen der Patientenzufriedenheit analysierte:
Schmerzbehandlung, Personal, Wartezeit und Medikamentenverträglichkeit. Die
Datenerhebung erfolgte mittels Fragebogen in 4 Kreisen des Landes
Schleswig-Holstein von Juni 2018 bis Juni 2019. Insgesamt wurden 820 Fragebögen
versandt und 363 anonymisierte gültige Antworten ausgewertet.
Ergebnisse Wir beobachteten sehr hohe Zufriedenheitswerte für alle Skalen.
Wir fanden keine Unterschiede in der Patientenzufriedenheit zwischen den
einzelnen Arzneimittelgruppen.
Diskussion Unsere Ergebnisse haben gezeigt, dass die Patienten mit der
derzeitigen Analgesiebehandlung durch das eingesetzte Rettungsdienstpersonal
sehr zufrieden sind und dass keine bestimmte Kombination aus Medikamenten für
die Patienten zufriedenstellender war.
Improving Consistency and Accuracy of Neonatal Amplitude-Integrated Electroencephalography
Authors: Tsoi Kathleen , Yam Karen K. M. , Cheung Hon M. , Ma Terence P.Y. , So King W. , Fung Eva L.W. , Lam Hugh S. 
Published: October 2021

Objective This study aimed to improve the utilization of amplitude-integrated electroencephalography (aEEG) in a neonatal unit by improving aEEG documentation, aEEG knowledge, and pattern recognition ability of neonatal staff.
Methods A quality improvement (QI) program comprising the two Plan-Do-Study-Act (PDSA) cycles was conducted in a level-3 neonatal intensive care unit. The first cycle was focused on improving aEEG documentation with the primary outcome indicator being compliance with aEEG documentation. The second cycle was focused on aEEG interpretation in a health care professional education program with the outcome indicators being accuracy of seizure identification on aEEG and change in conventional EEGs (cEEG) performed. Other outcome indicators included accuracy in identification of background pattern, sleep–wake cycles and artifacts. Process indicators included improvement in aEEG-related knowledge.
Results First PDSA cycle includes lectures on aEEG interpretation, a bedside key, and documentation form. Second PDSA cycle includes online aEEG education pack and detailed aEEG guideline. There was a significant improvement in aEEG documentation after the implementation of both PDSA cycles. Seven of the 46 patients (15.2%) had isolated electrographic seizures which would not have been identified in the pre-aEEG monitoring era. There was an increase in the number of patients with cEEGs done but a steady decrease in number of cEEGs per patient.
Conclusion With the successful application of standardized QI methods, improvements in outcome indicators, such as correct aEEG pattern recognition and improved coverage of at risk infants with cEEGs, were observed. Our QI measures were associated with improvement in aEEG pattern recognition.
Key Points
Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors
Authors: Pineda Roberta , Lisle Julia , Ferrara Louisa , Knudsen Kati , Kumar Ramya , Fernandez-Fernandez Alicia 
Published: October 2021

Objectives This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors.
Study Design This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States.
Results We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circumstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT).
Conclusion Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families.
Key Points
Artrodese tibiotalocalcaneana minimamente invasiva com haste intramedular retrógrada bloqueada – Relato de três casos
Authors: Moreira Fernando Delmonte , Jambeiro Jorge Eduardo de Schoucair , Cordeiro Antero Tavares , Oliveira José Augusto , Leão Felipe Fernandes , Guedes Alex 
Published: October 2021

ResumoA osteoartrite do tornozelo (OAT) está associada a quadro álgico e limitação funcional variável, demandando tratamento clínico e eventual indicação cirúrgica quando as medidas conservadoras são inefetivas – a artrodese tem sido o procedimento de escolha, por reduzir a dor, restaurar o alinhamento articular e tornar o segmento estável, preservando a marcha. O presente estudo relata 3 casos (3 tornozelos) de pacientes do sexo masculino, com entre 49 e 63 anos de idade, portadores de OAT secundária, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS, na sigla em inglês) pré-operatória de 27 a 39 pontos, tratados mediante artrodese tibiotalocalcaneana minimamente invasiva utilizando haste intramedular retrógrada bloqueada. A permanência hospitalar foi de 1 dia, e os pacientes foram autorizados para carga imediata com órteses removíveis para deambulação, conforme tolerado. O tratamento fisioterápico, introduzido desde o internamento, foi mantido, priorizando-se treino de marcha, ganho de força e propriocepção. Foi realizado acompanhamento clínico e radiográfico nas semanas 1, 2, 6, 12 e 24. Após evidências de consolidação (entre a 6ª e a 10ª semanas), as órteses foram retiradas. Um paciente queixou-se de dor no pós-operatório imediato e, ao final do 1° ano, apenas 1 paciente apresentou dor durante a reabilitação, resolvida completamente com analgésicos. Atualmente, os pacientes não apresentam queixas, retornando às atividades sem restrições – um deles, à prática de futebol e rapel. A AOFAS AHS pós-operatória foi de 68 a 86 pontos.
Limites da artroscopia na instabilidade anterior do ombro
Authors: Simmer Filho Jair , Kautsky Raul Meyer 
Published: October 2021

ResumoMuito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica.Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação.Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva.O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.
Análise comparativa de um protocolo de cicatrização secundária modificado para amputações das pontas dos dedos e técnicas de reconstrução não microcirúrgicas
Authors: Chavez-Galvan Carlos Rubén , Martínez-Pérez Ricardo , Flores-Alvarez Efrén , Martínez-Pérez Armando 
Published: October 2021

Resumo
Objetivo Descrever e comparar os resultados obtidos com um protocolo de cicatrização secundária para amputações das pontas dos dedos e sua relação com a gravidade da lesão de acordo com a classificação de Allen.
Métodos Foram revisados os prontuários clínicos de 127 lesões nas pontas dos dedos, e realizou-se um estudo retrospectivo, comparativo e analítico das amputações tratadas de forma conservadora. Foram descritas e analisadas as características da lesão, o tempo de cicatrização, e as complicações.
Resultados Entre abril de 2017 e maio de 2019, foram tratadas de forma conservadora 127 lesões nas pontas dos dedos. A idade média da amostra era de 28,33 anos. O tempo médio de cicatrização foi de 4,31 semanas. As complicações apresentadas durante o acompanhamento afetaram 18,9% (n = 24) dos casos, porém nenhum exigiu tratamento de revisão. Não foi encontrada relação estatisticamente significativa entre o desenvolvimento das complicações e a revisão do tratamento de acordo com a classificação de Allen (p ≥ 0,05).
Conclusão O protocolo de cicatrização secundária proposto mostrou-se seguro e eficaz nas amputações das pontas dos dedos conforme os tipos de 1 a 3 da classificação de Allen, e deve ser incluída como opção terapêutica mesmo em lesões de maior extensão do que aquelas tradicionalmente limitadas.
Efeito da COVID-19 na artroplastia de ombro em um centro médico terciário na cidade de Nova York
Authors: Wang Kevin C. , Patel Akshar V. , White Christopher A. , Gross Benjamin D. , Parsons Bradford O. , Cagle Paul J. 
Published: October 2021

Resumo
Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019).
Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados.
Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p = 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p = 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p = 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p = 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p = 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes.
Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019.
Nível de Evidência III.
Cerebral Venous Thrombosis Developing after COVID-19 Vaccination: VITT, VATT, TTS, and More
Authors: Lippi Giuseppe , Favaloro Emmanuel J. 
Published: October 2021

AbstractDespite the huge efforts globally underway for preventing or limiting the spread of severe acute respiratory coronavirus disease 2 (SARS-CoV-2), the coronavirus disease 2019 (COVID-19) pandemic outbreak appears still virtually unstoppable. As for many other infectious diseases, COVID-19 vaccination has now become crucial for limiting viral spread, especially for averting hospitalizations, need for intensive care, and fatal outcome. Nonetheless, as for other vaccines, COVID-19 vaccination is not completely free from side effects. Among the adverse events that have been reported after receiving COVID-19 vaccination, special emphasis has been given to an unexpected number of thrombocytopenic episodes with or without thrombotic complications, especially in recipients of adenovirus-based COVID-19 vaccines. Along with a specific clinical presentation, encompassing “atypical” thrombosis (especially cerebral venous [sinus] thrombosis, CVT) more prevalent in young female subjects, this new syndrome called vaccine-induced thrombocytopenia and thrombosis (VITT) is characterized by, and thereby diagnosed for, the presence of three paradigmatic laboratory abnormalities, i.e., low platelet count (<150 × 109/L), elevated plasma D-dimer levels (>0.5 mg/L), accompanied by a positive test for anti-PF4 (platelet factor 4) antibodies assayed with ELISA (enzyme-linked immunosorbent assay) techniques. Timely identification of these important abnormalities by both clinicians and laboratory professional is essential for early diagnosis and management of VITT, since the outcome of this condition may be fatal in half or even more of effected patients with severe disease. Therefore, this narrative review aims to review here the epidemiology, pathogenesis, clinical, and laboratory characteristics of VITT and other COVID-19 vaccine-associated thrombocytopenias.
Vitamin D-Dependent Rickets Type 1A in Two Siblings with a Hypomorphic CYP27B1 Variant Frequent in the African Population
Authors: de Brito Chagas Joana , Cordinhã Carolina , do Carmo Carmen , Alves Cristina , Heath Karen E. , Sousa Sérgio B. , Gomes Clara 
Published: October 2021

AbstractVitamin D-dependent type 1A rickets (VDDR-1A) is a rare autosomal recessive disease due to the inability to convert 25-hydroxyvitamin D [25(OH)D] to the active form 1.25-dihydroxyvitamin D [1.25(OH)2D] by the enzyme 25(OH)D-1α-hydroxylase leading to low or low-normal serum levels of [1.25(OH)2D].We report two sisters with rickets in whom the diagnosis of VDDR-1A was a challenge. They had normal 1.25(OH)2D levels, which are unusual with this condition but may be explained by the identified genotype. Both have compound heterozygous for two, most likely, hypomorphic CYP27B1 alleles: the novel p.(Arg117Gly) variant, and p.(Ala129Thr), which are present in 0.43% of the African population.This report illustrates the variability of clinical, laboratory, and radiological presentation between two sisters with the same genotype, during phases of faster or slower growth. Genetic testing was crucial for establishing the diagnosis that optimized the management and genetic counseling.
A unified and flexible formulation of molecular fragmentation schemes
Authors: Hellmers Janine , König Carolin 
Published: October 2021

We present a flexible formulation for energy-based molecular fragmentation schemes. This framework does not only incorporate the majority of existing fragmentation expansions but also allows for flexible formulation of novel schemes. We further illustrate its application in multi-level approaches and for electronic interaction energies. For the examples of small water clusters, a small protein, and protein–protein interaction energies, we show how this flexible setup can be exploited to generate a well-suited multi-level fragmentation expansion for the given case. With such a setup, we reproduce the electronic protein–protein interaction energy of ten different structures of a neurotensin and an extracellular loop of its receptor with a mean absolute deviation to the respective super-system calculations below 1 kJ/mol.
Experimental evidence for neonicotinoid driven decline in aquatic emerging insects
Authors: Barmentlo S. Henrik , Schrama Maarten , de Snoo Geert R. , van Bodegom Peter M. , van Nieuwenhuijzen André , Vijver Martina G. 
Published: October 2021

SignificanceSurvey data show a large-scale decline in insects. This global decline is often linked to human actions in intensive agricultural areas. To investigate whether this decline has a causal relationship with neonicotinoid insecticides, we performed an outdoor experiment with representative surface water concentrations of the neonicotinoid thiacloprid. We exposed naturally formed aquatic communities to increasing neonicotinoid concentrations and monitored insect emergence during a 3-mo period. We show that increasing neonicotinoid concentrations strongly decreased the abundance and biomass of five major insect orders that together comprised >99% of the 55,574 collected insects as well as the diversity of the most species-rich freshwater family, thus showing a causal relation between insect decline and neonicotinoids.
Estimating sexual size dimorphism in fossil species from posterior probability densities
Authors: Sasaki Tomohiko , Semaw Sileshi , Rogers Michael J. , Simpson Scott W. , Beyene Yonas , Asfaw Berhane , White Tim D. , Suwa Gen 
Published: October 2021

Significance
The evolutionary study of sexual dimorphism has been hampered by the general inability to accurately estimate low levels of dimorphism in fossil assemblages with no information on sex membership. In previous estimates, accuracy decreased with lower dimorphism levels because the hidden distributions of the two sexes embedded in the sample were not adequately modeled. The posterior density peak (pdPeak) method that we developed in part solves this problem by estimating dimorphism and within-sex variance simultaneously and provides unbiased estimates of dimorphism at levels lower than previously possible. Thus, this method has potential to better address the evolutionary history of weakly dimorphic structures, such as the human canine, enabling a better understanding of dimorphisms and adaptive strategies among primate taxa.
Organizing the “we” in interaction
Authors: Etelämäki Marja 
Published: October 2021

Abstract
In this paper, I analyse a piece of interaction during
which the participants seem to have trouble arriving at an agreement
in a series of affective evaluations. The sequence does not contain
other initiations of repair, third position repairs or fourth
position repairs, places in which problems of intersubjectivity
become visible in the conversation analytic tradition. I show that
these problems are due to the fact that the participants do not
share an understanding of the nature of the conversation, their
respective roles in it, or their mutual relationship. In the end, I
discuss my analysis in light of the Schuetzian (1953) understanding of
intersubjectivity and suggest that initiating and accomplishing
repair are not the only means for restoring intersubjectivity in
interaction.
Definitely indefinite
Authors: Laury Ritva 
Published: October 2021

Abstract
This chapter concerns expressions which seem internally
contradictory because they consist of both a recognitional and a
non-recognitional element. They contain both the Finnish
demonstrative se ‘that, the’, a recognitional, as
in se ihminen ‘that/the person’, and one of the
indefinite determiners yksi ‘one’,
semmonen ‘such’, and joku
‘some’, all of which are non-recognitionals, resulting in
expressions such as se joku ihminen ‘that/the some
person’. The chapter shows that each of these expressions has its
own home environment and expresses a distinct epistemic stance. The
main findings are that these expressions constitute a fine-grained
resource for the negotiation of relative epistemic status and are
tools for building intersubjective common ground in interaction.
Directive turn design and intersubjectivity
Authors: Couper-Kuhlen Elizabeth , Etelämäki Marja , Sorjonen Marja-Leena 
Published: October 2021

Abstract
In this paper, we discuss turn design as a locus of
intersubjectivity. We focus on two types of directives in Finnish
interactions, turns formatted with second-person imperative and
turns that contain zero person. Neither of these turn designs
contains a separate subject phrase explicating the person(s)
referred to, nor does either indicate when the action nominated is
to take place. We study the kinds of assumptions these two turn
designs make and present as shared, and the interplay of the
assumptions in relation to the sequential and activity context of
the turn. The design of turns and actions in sequences of
interaction thus allows us to see intersubjectivity at work, even
when repair does not take place.
Language performance of sequential bilinguals on an Irish and English sentence repetition task
Authors: Antonijević-Elliott Stanislava , Durham Ruth , Chonghaile Íde Ní 
Published: October 2021

Abstract
Currently there are no standardized language assessments for English-Irish bilingual school age children that would test languages in a comparable way. There are also no standardized language assessments of Irish for this age group. The current study aimed to design comparable language assessments in both languages targeting structures known to be challenging for children with language impairments. A sentence repetition (SRep) task equivalent to the English SRep task (Marinis, Chiat, Armon-Lotem, Piper, & Roy, 2011) was designed for Irish. Twenty-four typically developing, sequential bilingual children immersed in Irish in the educational setting performed better on the English SRep task than on the Irish SRep task. Different patterns were observed in language performance across sentence types with performance on relative clauses being particularly poor in Irish. Similarly, differences were observed in error patterns with the highest number of errors of omission in Irish, and the highest number of substitution errors in English.