bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Calculator Use on Arithmetic and Conceptual Skills of Nursing Students
Authors: Shockley Judith S , McGurn Wealtha C , Gunning Carolyn , Graveley Elaine , Tillotson Delight 
Published: May 2019

ABSTRACT
The purpose of this study was to determine the effect of the use of calculators on the responses of undergraduate nursing students to items on a dosage calculations examination. The study sought to determine if calculator use had any influence on both the arithmetic and conceptual skills associated with the solving of calculations problems. The population consisted of all students enrolled in a pharmacology course in a baccalaureate nursing program. An experimental repeated measures design was used in which all participants completed two parallel forms of a calculations examination, one form with a calculator and one form without a calculator.
Findings of the study revealed that there was significant difference in both arithmetic and conceptual skills ability using a calculator. Use of a calculator was associated with improved arithmetic skills performance and diminished conceptual skills performance. A major factor underlying both arithmetic skills and conceptual skills performance, independent of the calculator effect, was the pre-admission arithmetic skills ability of the subject.
Unplanned Removal of Medical Devices in Critical Care Units in North West England Between 2011 and 2016
Authors: Balmforth Joanna E. , Thomas Antony N. 
Published: May 2019

Background
The unplanned removal of medical devices poses a risk of harm to critically ill patients.

Objective
To determine rates, causes, and consequences of unplanned medical device removal, as well as factors mitigating harm to patients, in critical care units in the United Kingdom by reviewing patient safety incident reports.

Methods
Incidents of unplanned medical device removal in critical care units in North West England between 2011 and 2016 were retrospectively reviewed and classified. The incidents were classified by type of device displaced, staff and patient factors, causes and consequences of removal, and staff actions following removal. Displacement rates were calculated per 1000 patient days per unit.

Results
A total of 34 705 incident reports were reviewed, of which 1090 described unplanned device removal. The median rate of device removal was 0.7 (interquartile range, 0.4-2.2) per 1000 patient days per unit. Devices displaced most commonly included nasogastric tubes (317), central catheters (245), tracheostomy tubes (174), and endotracheal tubes (140). A total of 11 cardiac arrests were reported (8 associated with airway devices and 3 with central catheters). Factors contributing to displacement included initial placement (188), patient factors (563), and manual handling (238). Manual handling was cited in 49% of central catheter incidents and only 9% of nasogastric tube incidents. Patients’ organic confusion was a factor in 16% of endotracheal tube and 80% of nasogastric tube removals.

Conclusions
Unplanned device removal may cause patient harm and is often preventable. The causes and consequences depend on the type of device removed.
Low-Dose Maraviroc, an Antiretroviral Drug, Attenuates the Infiltration of T Cells into the Central Nervous System and Protects the Nigrostriatum in Hemiparkinsonian Monkeys
Authors: Mondal Susanta , Rangasamy Suresh B. , Roy Avik , Dasarathy Sridevi , Kordower Jeffrey H. , Pahan Kalipada 
Published: May 2019

Abstract
Parkinson's disease (PD) is the most common neurodegenerative movement disorder in humans. Despite intense investigation, no effective therapy is available to stop the progression of this disease. It is becoming clear that both innate and adaptive immune responses are active in PD. Accordingly, we have reported a marked increase in RANTES and eotaxin, chemokines that are involved in T cell trafficking, in vivo in the substantia nigra (SN) and the serum of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine–intoxicated hemiparkinsonian monkeys. Because RANTES and eotaxin share a common receptor, CCR5, we examined the efficacy of maraviroc, an inhibitor of CCR5 and a Food and Drug Administration–approved drug against HIV infection, in hemiparkinsonian rhesus monkeys. First, we found glial limitans injury, loss of GFAP immunostaining, and infiltration of T cells across the endothelial monolayer in SN of hemiparkinsonian monkeys. However, oral administration of a low dose of maraviroc protected glia limitans partially, maintained the integrity of endothelial monolayer, reduced the infiltration of T cells, attenuated neuroinflammation, and decreased α-synucleinopathy in the SN. Accordingly, maraviroc treatment also protected both the nigrostriatal axis and neurotransmitters and improved motor functions in hemiparkinsonian monkeys. These results suggest that low-dose maraviroc and other CCR5 antagonists may be helpful for PD patients.
Jesus as Mirrored in John
Authors: Charlesworth James H. 
Published: May 2019

In this volume James H. Charlesworth analyzes how John is a vital resource in understanding both the origin of Christianity and Jesus' position in history. Charlesworth begins from a burgeoning point of scholarly consensus – that more and more scholars are coming to recognize that John's gospel is much more historically complex and valuable than previously thought (even if this is itself complex and contested).
Charlesworth outlines the two historical horizons within John: on the one hand the Jewish background to the text (complete with extensive evidence of the evangelist's knowledge of Palestinian geography and Jewish customs) which Charlesworth sees as offering a window on pre-70 Palestinian Judaism; on the other hand a world post-70 in which non-believing Jews, with more unity, begin to part definitively with those who identified Jesus as the messiah. Charlesworth’s work is split into four areas. The first examines the origins of the gospel, its evolution in several editions, and its setting in Judea and Galilee. The second looks specifically at the figure of Jesus and issues of history. The third considers the gospel alongside contemporaneous Jewish literature, most notably the Dead Sea Scrolls. The final section engages with John’s symbolism and language, looking closely at key aspects in which John differs from the synoptic gospels, and also raising such provocative questions as whether or not it is possible that Jesus married Mary Magdalene.
Determinants of the Capital Adequacy of U.S Financial Institutions
Authors: Charitou Melita 
Published: May 2019

In this study we examine the determinants of the capital adequacy ratios of the US financial institutions over the period 2012-2017. Using a dataset of 2135 bank-year observations, results show that financial institutions with high operating expenses as a percentage of revenues have lower capital adequacy ratios. This is an indication that bank inefficiencies are an impediment to robust capital adequacy ratios. Moreover, results show that more profitable banks have higher CARs. Evidence shows that additional two risk related variables affect positively CARs, namely, earnings coverage of net charge off and loss allowance to loans. These results should be of great importance to bank executives, bank regulators and to major stakeholders such as investors and financial analysts, especially after the latest global financial crisis and the collapse of giant US financial institutions.
De kerk als werkgever
Authors: Zondag Wijnand 
Published: May 2019

The tensionful relationship between churchlaw and labour law in the Netherlands
As a special employer, the church has an interest in shaping its own personnel policy in order to achieve the mission and objective. In part, the legislator has met this need. After all, various laws in the field of appointment, terms of employment and dismissal take account of the specific interests of the church as described before. The external border consists of fundamental human rights that are included in the ECHR and the European Directive on equal treatment. It is not always clear where the external border is exactly. The Dutch legislation regarding the battle of ‘church law’ and fundamental rights is not consistent. Moreover, there we notice a tension between national law and the European directive.
Volumetric pulp chambers measurements in mandibular and maxillary permanent first molar using cone-beam computed tomography by age and gender
Authors: Açıklar Kavas Anıl , Tümen Emin Caner 
Published: May 2019

Aim: The aim of this study was to demonstrate the anatomical structure of pulp chamber, measure the volume of the total pulp chambers in mm3 and evaluate the pulp chamber volume changes by age and gender statistically in mandibular and maxillary first molars by means of CBCT.
Methodology: In our study, CBCT examinations of patients between the ages of 7-18 years, which were carried out due to different reasons were evaluated retrospectively. The CBCT images of healthy total of 160 lower and upper right permanent first molar teeth were selected randomly and the volumes of the total pulp chamber were measured in mm3 with the 3D Slicer software program. We analyzed the collected data with statistical analysis methods and we evaluated whether there was any difference between the patients grouped according to the age in respect of volume changes in the total pulp chamber and whether there was any difference between the mean volume values and gender of the patients within the same group.
Results: Comparison of the volume measurements of the lower and upper first permanent molar teeth between the groups showed that the volume values of the total pulp chamber decreased depending on the age (p<0.05). Regarding gender, volume decrease related to age was statistically more significant among females. We determined in all age groups except age 7-9 group that the volume value of the total pulp chamber of the upper permanent first molar teeth was statistically higher than the volume value of the total pulp chamber of the lower permanent first molar teeth (p<0,05).
Conclusion: We believe that CBCT is an easy and conservative method for the 3D-imaging of the pulp chamber, volume measurement and examination of the dimensional changes of the total pulp chamber depending on deposition of secondary dentin.

How to cite this article: Açıklar Kavas A, Tümen EC. Volumetric pulp chambers measurements in mandibular and maxillary permanent first molar using cone-beam computed tomography by age and gender. Int Dent Res 2019;9(1):30-40.

Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
Feasibility and acceptability of remote real-time ultrasound supervision
Authors: Jensen Stig Holm , Duvald Iben , Aagaard Rasmus , Primdahl Stine Catharina , Petersen Poul , Kirkegaard Hans , Weile Jesper 
Published: May 2019

Background: Minor emergency departments (ED) struggle to access sufficient expertise to supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using tele-ultrasound (tele-US) for remote supervision may remedy this situation. We aimed to evaluate the feasibility of real-time supervision via tele-US when applied to an everyday ED clinic.
Methods: We conducted a mixed-methods study that assessed practical feasibility, determined performance, and explored users’ acceptability of supervision via tele-US. A tele-US setup was established and temporarily implemented in the emergency department of the Regional Hospital West Jutland in the Central Denmark Region. We intended to expose 10 junior doctors to five tele-supervised lung and cardiac POCUS examinations. Qualitatively, exposed doctors’ and supervisors’ acceptability were unfolded by exploratory semi-structured interviews addressing their impression, satisfaction and perceived benefits. Technical performance was assessed quantitatively by the ratio in mean grey value (MGV) between images on site and as received by the supervisor, and by after-compression frame rate; MGV and frame rate were measured on five different days with alternating on-site laptops, software and internet connection.
Results: Remote supervision via tele-US was performed with 10 junior doctors scanning 45 included patients. Qualitatively, 12 exploratory semi-structured interviews were conducted with exposed junior doctors and supervisors. Supervisors stressed the importance of preserving frame rate, and junior doctors emphasized a need for shared ultrasound terminology. Overall, setup mobility, accessibility, and time consumption were emphasized as being of key importance for future clinical implementations. During performance assessment, neither alternating internet connection nor software significantly changed the mean grey value ratio. The lowest median frame rate of 4.6 (interquartile range [IQR]: 3.1–5.0) was found by using a 4G internet connection; the highest of 28.5 (IQR: 28.5–29.0) was found with alternative computer and local area network internet connection.
Conclusions: Remote supervision via a commercially available and low-cost tele-US setup is operational for both junior doctors and supervisors when applied to lung and cardiac POCUS scans of hospitalized patients.
The necessity of prehospital peripheral intravenous cannulation and its relation to triage category
Authors: Betzer Martin , Lyngby Rasmus 
Published: May 2019

Background: Prehospital peripheral intravenous cannulation (PPIC) is a procedure performed routinely and often precautionary despite evidence that it increases the risk of infection and phlebitis, prolongs scene time and increases mortality. The aim of this study was to identify to which extend PPIC was necessary before arrival to hospital, and to investigate whether the triage category of the patient had a role in the necessity of PPIC.
Methods: Prehospital providers from the Capital Region of Denmark were asked to collect data on all PPIC attempts in a course of two months, during summer 2018. The questions were related to the patients’ classification into one of four available triage categories and the providers’ assessment of the necessity of the PPIC for either prehospital medical treatment or the anticipation of such. Data was exported to statistical software for analysis and descriptive statistics was performed.
Results: From the available datasets (n=204) 52% (n=106) of PPIC attempts were considered necessary by the prehospital provider. In the red/immediate triage category, 37 PPIC attempts were performed, of these 70.2% (n=26) were considered necessary. In the amber/very urgent triage category, 20 PPIC attempts were performed, of these 85% (n=17) were considered necessary. In the yellow/urgent triage category, 40 PPIC attempts were performed, of these 65% (n=26) were considered necessary. In the green/non-urgent triage category, 107 PPIC attempts were performed, of these 34.6% (n=37) were considered necessary.
Conclusions: Based on the findings of this study, approximately half of PPIC’s are necessary for prehospital use, and the necessity tends to correspond with an increase in triage category. However, PPIC necessity for patients in the green/non-urgent triage category should be carefully evaluated, based on a patient risk/benefit analysis.
Clinical presentation of pulmonary embolism among patients in the emergency department
Authors: Nadim Giti 
Published: May 2019

Background: Pulmonary embolism (PE) is an important clinical entity known to cause a wide range of symptoms. Morbidity and mortality of PE are high. However, knowledge of symptomatology is sparse.
Aim: To elucidate the clinical presentation of emergency department (ED) patients diagnosed with PE.
Methods: We carried out a cross-sectional study of adult patients attending the EDs at Odense University Hospital and Hospital of Southwest Jutland. The main symptom at presentation was

prospectively registered. ED and hospital discharge diagnosis was sampled from the Danish national health registry. Patients with PE were identified based on discharge diagnoses (ICD-10 code I26.0 or I26.9) from the ED or following hospitalization.
Results: Among 24,124 contacts to the EDs, 322 (1.3%) were diagnosed with PE. The main presenting symptom was respiratory distress (31%; n=101), while 26% (n=85) had symptoms suspicious of heart disease such as dyspnea of cardiac cause, chest pain and palpitation, 8% (n=27) fainting / syncope or suspected neurological disorders, 8% (n=26) pain in the lower limb, and 6% (n=18) had fever as their main symptom.
Conclusion: PE patients have a wide variety of symptoms and most PE patients present with other symptoms than dyspnea.
Evaluation of dispatch outcomes and staffing of the Copenhagen mobile health and social care unit – Sociolancen
Authors: Østergaard Simon , Lyngby Rasmus 
Published: May 2019

Background: The mobile health and social care unit – Sociolancen (MHSCU) is a specialized unit within the Emergency Medical Services (EMS) of the Capital Region of Denmark. The unit provides acute social care for homeless and social deprived groups and is staffed with a social worker and a paramedic and available through the EMS dispatch during daytime. The MHSCU is dispatched to citizens where the need for acute social care is suspected, falling outside the normal scope of practice for emergency ambulances. The aim of this study was to evaluate the dispatch outcomes of the MHSCU and the constellation of paramedical and social effort.
Methods: Data on the total number of MHSCU dispatches and outcomes in 2016 and 2017 was retrieved from the dispatch system operated by EMS Copenhagen. Outcome data was grouped for descriptive statistics.
Results: During the data collection period the MHSCU was dispatched 2976 times. The outcome resulted in 384 (12.9%) citizens being brought to a somatic emergency department (ED) and 255 (8.6%) citizens being brought to a psychiatric ED. A total of 355 (11.9%) citizens were left to selfcare and 196 (6.6%) citizens were brought to a shelter. Number of citizens handed over from emergency ambulances was 41 (1.4%), number of citizens handed over to emergency ambulances was 4 (0.1%), number of citizens handed over to police was 13 (0.4%). In 1386 (46.6%) cases MHSCU were doing outreach work, citizen had left scene or MHSCU was cancelled. Number of dispatches labeled ‘unknown’ was 342 (11.5%).
Conclusions: The outcome of MHSCU dispatches indicate the need for both paramedical and social staffing when attending the homeless and social deprived citizens, as there is an approximately even distribution between health related and social related referral. Half of dispatches covers outreach work not within the normal scope of practice for emergency ambulances, enabling MHSCU to provide community service and security. Further, based on the low referral to emergency ambulances and police, the dispatch of MHSCU seems well-prioritized.
Acknowledgments: The authors wish to thank Paramedic Martin Betzer for assistance.
Early detection of delirium – using the CAM score
Authors: Rekvad Lise 
Published: May 2019

Background: Delirium is common in elderly patients and has been identified as an independent marker for increased mortality and hospital-acquired complications, yet it is poorly recognized by health care providers. The aim of this study was to investigate whether systematic use of the validated screening tool Confusion Assessment Method (CAM) would result in a higher recognizing of delirium in patients ≥ 65 years old admitted at Odense Emergency Department (FAM).
Methods: All caregivers in the Emergency department (ED) at Odense University Hospital received 2 hours of education in delirium and how to use the CAM score. They were asked to systematically perform CAM score in all patients ≥ 65 years at arrival to the ED and at least every 8 hours. During 2 periods of 5 days - one before the caregivers was educated (pre-CAM) and one 4 weeks after CAM scoring was started (during-CAM). A research team interviewed all ≥ 65 year old patients and their caregivers at the first and second day of admission. In relation to the interviews all patients underwent a cognitive assessment using the CAM by a trained investigator. These results were blinded to the clinical personal. After discharge patient files were screened with the aim to identify any delirium registered by the clinical personal.
Results: Out of 276 screened patients 192 where included in the project. 100 patients and were included in the pre-CAM group and 92 patients in the during-CAM group. According to the registrations by the research team 24 of 100 (24% 95%CI 16%-34%) patients experience delirium in the pre-CAM group and 18 of 92 (20% 95%CI 12%-29%) in the during-CAM group. Increasing age and comorbidity was related to delirium. Prevalence of the diagnoses delirium registered in the patient file increased from 1 of 24 (4% 95%CI 0%-21%) to 9 of 18 (50% 95%CI 26%-74%).
Conclusion: One out of four elderly acute patients has deliria symptoms during the first 2 days at hospital. Systematic CAM scoring does not change the prevalence but increase the awareness significantly. The high prevalence underlines the clinical importance of the problem.
Characteristic and help-seeking behavior of patients with infections who called the medical helpline 1813: a mixed methods study
Authors: Udesen Stine Emilie Junker , Kristiansen Maria , Lassen Annmarie , Folke Fredrik , Gamst-Jensen Hejdi 
Published: May 2019

Early identification of patients with serious infections is a clinical challenge for both medical helplines and emergency departments (ED). Serious infections might be difficult to identify as some patients present unspecific symptoms and a normal body temperature. It is therefore important to describe characteristics and help-seeking behaviour (HSB) with the aim to identify infections earlier.
The study population was part of a data collection carried out between 24.01-09.02 2017, at the Emergency Medical Services Copenhagen (Medical Helpline 1813). Among 11,340 patients in contact with the Medical Helpline, we identified adult patients seen in the EDs with a diagnosis of infection (ICD-10 classification). Quantitative and qualitative (recorded voicelogs) data were extracted and a mixed methods study (convergent design) was performed. Descriptive statistics and logistic regression was used for the quantitative data strand. Thematic analysis was used for the qualitative data strand. Both data strands were integrated to describe the characteristics of the HSB of patients with infections.
In total 3,614 adult patients were triaged to an ED, and 753 (20.8%) were diagnosed with infection of which 83 (11%) were hospitalized. ED patients with infection were younger (Median: 42 vs 47 years, p=<0.001), more often without comorbidity (68.5% vs 74.5%, p=0.006) and more often females (64.1% vs 53.2%, p=<0.001) compared to ED patients without infection. Hospitalized patients with infection were older (71 vs 40 years, p=<0.001), and had more comorbidity (60.2% vs 39.8%, p=<0.001) than those with infection who were not hospitalized. Fever was presented by 18 out of 32 hospitalized patients (56.3%) in the voicelogs. Some described that fever appeared with breathing difficulties, cough, and general weakness. Several patients had tried to self-manage their infection, but most calls (71.2%) were made by a close relative who was concerned. This illustrates that patients did not seek health professional help before their relatives were sufficiently concerned.
Hospitalized patients with infections were older and had more comorbidity compared to the non-hospitalized patients with infections. Among hospitalized patients with infections, fever was frequently presented in 1813-calls. Characteristic like self-management and concerned relatives are important to understand the HSB of hospitalized patients with infections.