bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is een ‘akkoorden-democratie’ wel een democratie?
Authors: Koole R.A. 
Published: May 2019

Is een ‘akkoorden-democratie’ wel een democratie?
De toename en verbreding van politiek-maatschappelijke akkoorden (tussen politici en belangenorganisaties) en parlementaire akkoorden (tussen fracties in de Tweede Kamer) roept de vraag op of de parlementaire democratie hiermee gediend is. Internationale literatuur wijst op de ontwikkeling naar een verzwakking van de positie van parlementen. De Nederlandse praktijk van ‘regeren bij akkoord’ versterkt deze trend, met name in het geval van politiek-maatschappelijke akkoorden (waaronder klimaatakkoorden). Het eventuele gebruik van dergelijke akkoorden zou zo moeten worden vormgegeven dat het parlement voldoende tijd en ruimte heeft om de resultaten ervan te doorgronden en eventueel te wijzigen.
Kolencentrales in de polder: private en publieke belangen in het Energieakkoord
Authors: Mulder M. 
Published: May 2019

Kolencentrales in de polder: private en publieke belangen in het Energieakkoord
In 2013 sloten meer dan veertig organisaties, waaronder de rijksoverheid, een akkoord om de Nederlandse energievoorziening duurzamer te maken. Een belangrijk onderdeel van dit Energieakkoord was het voornemen om vijf oude kolencentrales vervroegd te sluiten. Na een negatief oordeel van de Autoriteit Consument & Markt (ACM) besloot de overheid de sluiting alsnog zelf via regelgeving af te dwingen. Dit artikel gaat in op de vraag in hoeverre het sluiten van een akkoord nuttig is om publieke doelen op het gebied van energie en klimaat te bereiken. Na een beschrijving van het proces en de inhoud van het Energieakkoord wordt dieper ingegaan op de discussie in Nederland over de positie van kolencentrales. Geconcludeerd wordt dat de overheid in het Energieakkoord concessies aan de energiebedrijven heeft gedaan, die niet nodig zouden zijn als ze direct via regelgeving of belastingheffing haar doel had nagestreefd. Akkoorden op het gebied van energie en klimaat moeten vooral worden gebruikt om coördinatieproblemen op te lossen, zoals bij de aanleg van nieuwe infrastructuur.
The effects of different irrigation agents on root canal dentine micro-hardness and surface roughness
Authors: Öztekin Faruk , Adıgüzel Özkan 
Published: May 2019

Aim: Successful endodontic treatments rely on sufficient mechanical preparation and irrigation of the root canal followed by an adequate three-dimensional filling. This study investigated the changes in root dentine micro-hardness and surface roughness upon treatment with different irrigating agents.
Methodology: A total of 60 human maxillary incisors and canine teeth were used in this study. The crowns of all teeth were decoronated and roots were divided longitudinally. The samples were separated into three groups prior to irrigation. A 5% NaOCl irrigation agent was applied to the first group, a QMix agent was used for the second group, and a 2% CHX agent was used for the third group. All irrigations were performed for 15 minutes. Following irrigation, microstructural and surface-roughness measurements were taken again from all samples.
Results: Micro-hardness was not significantly different between QMix or 5% NaOCl (p>0.05). A significant difference was observed between the QMix- and 2% CHX-treated groups, and between the 5% NaOCl- and QMix-treated groups (p<0.05). A significant difference in surface roughness was observed between the QMix and 2% CHX, and between the 5% NaOCl and QMix (p<0.05). No difference in surface roughness was observed between 5% NaOCl or 2% CHX. The 5% NaOCl and QMix agents reduced the dentine micro-hardness equal to or more than that of the 2% CHX agent. The QMix agent also increased the dentine surface roughness significantly more than the other agents. The 5% NaOCl and 2% CHX agents increased surface roughness equally.
Conclusions: It was seen that all of the irrigation agents used in our study affected dentin microhardness and surface roughness at different rates.

How to cite this article: Öztekin F, Adıgüzel Ö. The effects of different irrigation agents on root canal dentine micro-hardness and surface roughness. Int Dent Res 2019;9(1):16-21.

Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
Investigation of the effects of different chelating solutions on the microhardness and surface roughness of root canal dentin
Authors: Topbaş Celalettin , Adıgüzel Özkan , Çölgeçen Özlem 
Published: May 2019

Introduction: The purpose of this study is to examine the effect of different chelating solutions on microhardness and surface roughness of root canal dentin.
Methodology: The crowns of sixty recently extracted maxillary central incisors were separated by diamond burs from the cemento-enamel junction. Roots are divided longitudinally into two pieces with diamond saw. The obtained samples were embedded in autopolymeric-acrylic and the dentin-surfaces of the teeth were grounded. Micro-hardness and surface-roughness measurements were carried out before the chelating processes. First group, the specimens were treated with gel-formed 17% Ethylenediaminetetraacetic acid [EDTA] (JE), second group, specimens were treated with 17% Liquid-formed EDTA (LE), third group, specimens were treated with 20% Citric acid (CA), and the last group specimens were treated with 7% Maleic acid (MA) for 120 seconds. After application of the chelating agents, micro-hardness and surface-roughness measurements of all samples were performed again. The difference between the initial and final measurements was calculated and statistically analyzed. One Way Analysis of Variance ANOVA was used for statistical-analysis and statistically significant difference was observed between the groups (p <0.05).
Results: According to the test results, the microhardness of LE was statistically equal to that of JE and caused the least decrease in micro-hardness, SA decreased micro-hardness more than LE and JE, and MA decreased dentin micro-hardness more than all other solutions. And surface-roughness results are: MA increased surface-roughness more than other groups, SA and JE less roughened the dentin surface than MA, and there was no significant difference between the two solutions, LE caused less increase in dentin surface roughness compared to all solutions.
Conclusions: Besides the use of EDTA and SA, the clinical use of MA can be considered, and it should also be noted that EDTA differs in terms of surface roughness between liquid and gel forms.

How to cite this article: Topbaş C, Adıgüzel Ö, Çölgeçen Ö. Investigation of the effects of different chelating solutions on the microhardness and surface roughness of root canal dentin. Int Dent Res 2019;9(1):22-9.

Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.
Editorial: Dossiê História e Historiadores
Authors: Mata Sérgio Da , Rocha Sabrina Magalhães 
Published: May 2019

O editorial do Dossiê História e Historiadores traz os pesquisadores Sérgio da Mata e Sabrina Magalhães Rocha para apresentar o campo da História como disciplina a partir dos seus exercícios epistemológicos e interpretativos.
Resíduos sólidos e meio ambiente: Prevenção e punição de lesões e ameaças de lesão ao meio ambiente ecologicamente equilibrado / Solid waste and environment: Prevention and punishment of injuries and injuries of injury to the ecologically balanced environment
Authors: Varela Isabela Dalle , Zini Júlio César Faria 
Published: May 2019

Por meio de uma análise compreensiva e contextual das principais concepções ambientais e jurídicas afeitas à poluição por resíduos sólidos, será realizada uma análise das medidas de prevenção e punição de lesões ou ameaças de lesão ao meio ambiente ecologicamente equilibrado.Palavras-chave: Resíduo sólido; meio ambiente ecologicamente equilibrado; poluição; prevenção; puniçãoAbstractBy means of a comprehensive and contextual analysis of the main environmental and legal concepts related to solid waste pollution, an analysis of measures to prevent and punish injuries or threats of injury to the ecologically balanced environment will be carried out.Keywords: Solid waste; ecologically balanced environment; pollution; prevention; punishment
New-onset atrial fibrillation is associated with 28-day mortality among patients with sepsis
Authors: Nielsen Finn Erland 
Published: May 2019

Background: New-onset atrial fibrillation (NO-AF) has been associated with adverse outcomes in sepsis. The definition of sepsis is based on organ dysfunction by use of the Sequential Organ Failure Assessment (SOFA) score. However, adult patients with suspected infection can be identified as being more likely to have poor outcomes typical of sepsis if they have at least two qSOFA criteria. We have analyzed the occurrence of NO-AF on admission and 28-day mortality among infected patients with two or more qSOFA criteria on admission.
Methods: A prospective cohort study of infected patients aged 18 years or older admitted to the emergency department (ED) of Slagelse Hospital during 01.10.2017 – 31.03.2018 (171 days). The population in the area was 198.000. All patients with suspected or documented infection on arrival, and treated with antibiotics, were included. NO-AF was defined as episodes of atrial fibrillation (AF) within 4 hours from admission documented on a 12-lead electrocardiogram and without a history of prior AF. We used a logistic regression analysis to adjust for the potential confounding of the association between NO-AF and 28-day mortality. Survival status was obtained from the Danish Civil Registration System.
Results: A total of 2.168 infected patients with median age of 73.1 years were included, and 181 (8.3%; 95% CI 4.7-13.3) fulfilled at least two qSOFA criteria on admission. The incidence of sepsis based on qSOFA criteria was estimated to 194/100,000. A total of 15 (8.3%, 95% CI 4.7-13.3) qSOFA patients developed NO-AF. The 28-day mortality among all qSOFA patients was 17.1% (95% CI 11.9-23.4), 40.0% (95 % 16.3-67.7) among patients with NO-AF and 15.1% (95% CI 10.0-21.4) among patients without NO-AF). Unadjusted odds ratio for 28-day mortality among NO-AF patients was 3.8 (95% CI 1.2-11.50) and 4.6 (95% CI 1.4-15.3) after adjustment for several potential confounders.
Conclusion: New-onset atrial fibrillation is independently associated with 28-day mortality among patients with qSOFA defined sepsis.
Triage response by two different out-of-hours healthcare services: an observational cohort study
Authors: Søvsø Morten Breinholt , Gamst-Jensen Hejdi , Christensen Morten Bondo , Huibers Linda , Lippert Freddy , Christensen Erika Frischknecht 
Published: May 2019

Background: The entry points to Danish acute care are the out-of-hours health care services (OOH) and emergency medical services (EMS). Where EMS is organized in a similar manner throughout Denmark, the OOH is not. Four regions (including the North Denmark Region) have a general practitioner operated service (OOH-GP), whereas the Capital Region of Copenhagen, (Copenhagen) Denmark has the Medical Helpline 1813, (OOH-1813) which is staffed by nurses and physicians. Nationally, access to out-of-hours healthcare and emergency departments requires referral by one of the healthcare services. The OOH services in the North Denmark Region and Copenhagen handle similar patients and health problems; however, no published research has compared the type of actions performed in response to patient calls. We investigated and compared the type of triage response given by OOH-GP and OOH-1813 to patient contacts in the study period and the proportion of subsequent hospitalization.
Methods: Observational cohort study of patients contacting OOH-GP and OOH-1813 from January 24th to February 9th, 2017. Patients with valid personal identification numbers were included. Primary outcomes were action performed by the call-handler i.e. telephone consultation, face-to-face consultation, home visit and hospitalization within 24 hours. Hospitalization was defined as a hospital stay of ≥24 hours.
Results: We included 32,489 contacts (OOH-GP: 21,149 and OOH-1813: 11,340 (representative sample)). Calls to the OOH-GP were handled as follows: 67.2% (n=14,214) telephone consultation only, 32.8% (n=6,935) face-to-face consultations including 1,089 home visits (5.1%). In comparison, at OOH-1813, 51% (n=5,763) were handled by telephone consultation only, 49% (n=5,575) were triaged to face-to-face consultation including 38 home visits (0.44%). The differences in triage were statistically significant (p<0.05). Subsequent admissions occurred after 524 (4.6%) OOH-1813 contacts and 798 (3.8%) OOH-GP contacts (OR = 1.22 (1.01;1.27)).
Conclusions: This comparison of OOH-1813 and OOH-GP shows significant differences in the triage responses, among these, notably more face-to-face consultations at OOH-1813. Subsequent hospitalizations were comparable with a small, but statistically significant, overrepresentation among the OOH-1813 cohort. These results could be due to the differences in organizational structure of the OOH or demographics in the two regions (capital vs city-rural), however further research is needed to determine this.
Prehospital dyspnoea patients in the North Denmark Region
Authors: Lindskou Tim Alex , Pilgaard Laura , Søvsø Morten Breinholt , Kløjgård Torben Anders , Larsen Thomas Mulvad , Jensen Flemming Bøgh , Weinrich Ulla Møller , Christensen Erika Frischknecht 
Published: May 2019

Background: Prehospital dyspnoea patients are a frequent group with a high mortality. However, there is limited knowledge about their characteristics. We aimed to investigate causes for dispatched ambulances to patients diagnosed with dyspnoea, and diagnoses given to patients to whom an ambulance was dispatched due to dyspnoea.
Method: Retrospective cohort study in the North Denmark region in the period 2012-2015. We included all emergency ambulance patients where the main cause for a dispatched ambulance was “Breathing difficulty”, and all emergency ambulance patients who were diagnosed within the ICD-10 chapter “Diseases of the respiratory system” at hospital.
Results: 4933 patients had an ambulance dispatched due to “Breathing difficulty”. Their most frequent diagnoses at hospital were ICD-10 chapter “Diseases of the respiratory system” (49.45%), “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” (18.56%), “Diseases of the circulatory system” (9.20%), and “Factors influencing health status and contact with health services” (5.71%). Contrariwise, 5163 emergency ambulance patients received a diagnosis within ICD-10 chapter “Diseases of the respiratory system” at hospital. The most frequent causes for dispatched ambulances to these patients were “Breathing difficulty” (49.45%), “Unclarified problem” (11.16%), and “Chest pain - heart disease” (9.55%). 16.00% of dispatches were without cause.
Conclusion: Only half of the patients had both ambulance dispatch and hospital diagnose related to breathing difficulties. The variation and distribution of causes for ambulance dispatch and diagnoses given at hospital, suggests that dyspnoea is a symptom present in many conditions and the patient group is complex.
Clinical and environmental factors are not associated with establishment of pre-hospital intravenous access.
Authors: Lyngby Rasmus 
Published: May 2019

Background: Establishing intravenous (IV) access is part of the paramedic scope of practice and in critically ill patients the procedure is essential to administer fluids and/or drugs. However, in the unique pre-hospital setting clinical and environmental factors may challenge the procedure. Previous studies have investigated IV procedure time and overall success-rates with little or no attention to the impact of challenging factors. The aim of this study was to investigate clinical and environmental factors associated with the first attempt of IV access establishment.
Methods: Data containing information on IV procedure characteristics, patient condition and environmental factors were obtained by paramedics operating in the Capital Region of Denmark. Data was collected during three non-consecutive months in 2017 and 2018. Data was exported to IBM’s Statistical Package for the Social Sciences (SPSS) for analysis. A chi-square test for independence (with Yates’ Continuity Correction for 2x2 tables and likelihood ratio for expected count violations) was applied to test for association between first attempt of IV access establishment, patient condition and environmental factors.
Results: A total of 259 datasets were available. Statistical analysis revealed a significant association between first attempt of IV access establishment and assessed level of difficulty (p=0.00). No significant association was found between first attempt of IV access establishment and presence of radial pulse (p=0.21), patient triage category (p=0.35), size of catheter (p=0.80), site of catheter insertion (p=0.11), light conditions (p=0.26) and procedure location (p=0.31).
Conclusion: This study concludes that first-attempt IV access establishment was significantly associated with assessed level of difficulty, and non-significantly associated with the investigated clinical end environmental factors. Based on the findings, paramedics should reconsider IV access for patients where the procedure is considered difficult, and consider other available administration options. On the contrary, paramedics should not refrain from attempting IV access establishment based on present clinical and environmental factors thought to challenge the procedure.
Is video communication technology building bridges between the primary health care and the emergency department in the Region of Southern Denmark?
Authors: Paulsen Gitte Højsgaard , Fredskild Trine Ungermann 
Published: May 2019

Background: In 2017, 2523 patients above the age of 64 were admitted from the community of Aabenraa to the Emergency Department (ED). Around 54% of them discharged from the ED within 48 hours. The aim of the CoLab project is to explore the information barriers in the transition of elder patients between primary health care (PHC) and the ED and back. Furthermore, to investigate whether a standardized communication tool combined with video communication technology improves the cross-sectoral communication and collaboration between nurses in the ED and PHC.
Methods: This was an exploratory and qualitative study. Data was generated from semi-structured group interviews with seven PHC nurses and two ED nurses. The standardized communication tool was developed from both a similar tool constructed by the Danish society for patient safety: ISBAR MED SALSA and the results from the interviews. Video communication via iPad was used between the acute care nurses in PHC and ED and a stationary video communication tool was installed between the ED and the two call centers in PHC.
Results: The interim analysis of the study so far suggests that is it not possible to establish a scheduled time for communication between ED and the PHC because of the established fast track patient pathways. Using a communication tool as guide for information sharing led to a higher quality exchange of information between PHC and ED. Both the PHC and ED nurses saw improvement in exchanging information by combining the standardized communication tool with video conferencing. This has raised the understanding of each other’s work areas and the need for sharing information about the transition of the elder patients between the PHC and ED.
Conclusion: The project is still in progress. However, the midterm analysis has shown evidence that a standardized communication tool combined with video communication would improve the quality of cross-sectoral communication and collaboration between nurses in the ED and PHC. We believe that communication barriers should be reduced or eliminated in order to improve cross-sectoral collaboration and the continuity of care for the elder patient during the transition between PHC and ED.
Registration of Prehospital Vital Parameters
Authors: Poulsen Ninna Rysholt 
Published: May 2019

Background: The North Denmark Region implemented an electronic Prehospital Patient medical Record (PPR) in 2006. In 2015 a new version of the PPR was implemented. Implementation of new technologies can be challenging, including structurally and organizational obstacles, which causes difficulty in achieving data completeness. The aim was to examine completeness of registrations of vital parameters in PPR before and after the new version, and examine the distribution of the registrations.
Method: The cohort includes all patients to whom an ambulance was dispatched after an emergency 112-call in the North Denmark Region from 2007-2014 and 2016. We examined the registration and distribution of six vital parameters, and included the first measurement. A trend analysis was used to assess the change in registration from 2007-2014, 2016. To exclude outliers in registrations we defined cut-points for systolic blood pressure (BP) (250mmHG), heart rate (HR) (250 beats per minute), and Respiratory Rate (RR) (100 breaths per minute), based on clinical relevance and their natural distributions. The other vital parameters had well-defined cut-points. We examined the distributions with and without outliers.
Results: We identified 220,173 patients. Percentage of registrations without outliers from 2007 to 2014 vs. 2016: BP 73% to 86% vs. 81%, HR 76% to 88% vs. 81%, blood oxygenation (SpO2) 72% to 85% vs. 81%, RR 34% to 82% vs. 77%, Glasgow-Coma-Scale-score (GCS) 54% to 92% vs. 81%, Numeric Rating Scale for pain (NRS) 0% to 16% vs. 24%. Data from all years showed normal distributions for systolic BP and HR with mean (95% confidence interval): 141.8 (141.7; 142), 91.9 (91.8; 92.1), respectively. For RR, SpO2 and NRS; median (interquartile range) was: 18 (16; 20), 98 (95; 99), 6 (3; 8). From 2007-2014, 82% of the GCS-scores were on 15; in 2016 85% were on 15. There was 51% of the patients who had five vital parameters measured from 2007-2014 and 47% in 2016.
Conclusion: Registration increased significantly from 2007 to 2014, with a significant decrease in 2016, except for the NRS-score. The decrease in 2016 is probably attributed the implementation process. Overall vital parameters were within normal ranges, despite outliers in registration.