bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early and comprehensive care bundle in elderly for acute heart failure in the emergency department: study protocol of The ELISABETH stepped wedge cluster randomized trial
Authors: Freund Yonathan , Gorlick Judith , Cachanado Marine , Salhi Sarah , Lemaitre Vanessa , Simon Tabassome , Mebazaa Alexandre 
Published: December 2018

Abstract
Background: Acute heart failure (AHF) is one of the most common diagnoses for elderly patients in the emergency department (ED), with an admission rate higher than 80% and 1-month mortality around 10%. The European guidelines for the management of AHF are based on moderate levels of evidence, due to the lack of randomized controlled trials and the scarce evidence of any clinical added value of a specific treatment to improve outcomes. Recent reports suggest that the very early administration of full recommended therapy may decrease mortality. However, several studies highlighted that elderly patients often received suboptimal treatment. Our hypothesis is that an early care bundle that comprises early and comprehensive management of symptoms, along with prompt detection and treatment of precipitating factors should improve AHF outcome in elderly patients.
Method/design: ELISABETH is a stepped-wedge, controlled cluster randomized, clinical trial in 15 emergency departments in France recruiting all patients aged 75 years and older with a diagnosis of AHF. The tested intervention is a care bundle with a checklist that mandates detection and early treatment of AHF precipitating factors, early and intensive treatment of congestion with intravenous nitrates boluses, and application of other recommended treatment (low dose diuretics, non-invasive ventilation when indicated, and preventive low molecular weight heparin). Each centre are randomized to the order in which they will switch from “control period” to “intervention period”. All centers begin the trials with the control period for two weeks, then after each two-weeks step a new centre will be in the intervention period. At the end of the trial, all clusters will receive the intervention regimen. The primary outcome is the number of days alive and out of the hospital at 30 days.
Discussion: If our hypothesis is confirmed, this trial will strengthen the level of evidence of AHF guidelines and stress the importance of the associated early and comprehensive treatment of precipitating factors. This trial could be the first to report a reduction in short term morbidity and mortality in elderly AHF patients.
Registration: NCT03683212, prospectively registered on September 25th 2018
Keywords: Elderly, acute heart failure, emergency department
Comprehension of Feedback by Patients within a Delphi Survey
Authors: Fish Rebecca , Brookes Sara T , Sanders Caroline , Williamson Paula R 
Published: December 2018

Abstract
Background: Delphi studies, used to develop consensus, allow participants to change their responses to a questionnaire after reviewing the summarised responses of other participants. Different methods for presenting feedback within a Delphi are employed in core outcome set (COS) development, including a summary statistic (e.g. median) and histograms. It is not known how well these feedback methods are understood by patient participants. The aim of this study was to examine patient preferences for style of feedback and to determine whether different feedback methods could be accurately interpreted by patients.
Methods: Participants were patients who had been interviewed for development of the CORMAC COS for anal cancer. In a separate one-to-one interview, participants completed a simulated 2-round Delphi whilst being asked to ‘think out loud’. Feedback was presented first as a single summary statistic (a median) then simultaneously as two different forms of graph, a histogram and a pie chart. Participants were asked to explain their understanding of the terms used, e.g. “median” and “average” and give an overall preference.
Results: Eight patients were interviewed. No participant fully understood median; six described median average as the mean and two could not accurately explain any average. All participants understood both types of graph, although two required additional explanation of the graph axes. All valued seeing the spread of scores provided by the graphs and the concept of distribution was well understood. Seven out of eight participants preferred the histogram overall.
Discussion and conclusions: This small study provides the first evidence for patient understanding of feedback within a Delphi. Participants understood and valued seeing the spread of scores as a histogram. Median was not well understood and may be an inappropriate choice for Delphi surveys involving patients. Larger studies are needed to validate these findings.
Sustained mitochondrial damages in cardiomyocytes in a patient with severe propofol infusion syndrome (PRIS)
Authors: Karasawa Satoshi , Nakada Taka-aki , Mori Naoto , Daimon Michiko , Miyauchi Hideyuki , Kanai Tetsuya , Takano Hiroyuki , Kobayashi Yoshio , Oda Shigeto 
Published: December 2018

Abstract
Background: Propofol infusion syndrome (PRIS) is rare but possibly lethal. Mitochondrial damage is suggested as a potential pathogenesis. However, investigations on the mitochondrial damages in cardiomyocytes in patients with PRIS are insufficient.
Case presentation: A 20-year-old man with Guillain-Barré syndrome had propofol administration for sedation. On day 13, he had hypotension with ST elevation in electrocardiogram, acute kidney injury, hyperkalemia and severe rhabdomyolysis. He was transferred to our ICU on suspicion of PRIS. Administration of noradrenaline and hemodialysis were initiated, and fasciotomy was required for PRIS-rhabdomyolysis. He gradually recovered and was discharged from the ICU on day 30. On day 37, he repeatedly presented sinus bradycardia and conduction disturbance eventually requiring temporary pacing. Cardiac 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) on day 67 demonstrated heterogeneous 18F-FDG uptake in left ventricle. Electron microscopic investigation of the endomyocardial biopsy on day 75 revealed abnormal findings in the mitochondria of the cardiomyocytes including myelinization of the cristae. He was discharged with normal cardiac function without arrhythmia on day 192.
Conclusions: This is a case of PRIS with evidence of mitochondrial damage in both morphological and functional aspects. Sustained mitochondrial damage may be a therapeutic target beyond the initial therapy of discontinuing propofol administration.
Keywords: Mitochondria, arrhythmia, cardiac failure
Understanding Organic Nonpoint‐Source Pollution in Watersheds via Pollutant Indicators, Disinfection By‐Product Precursor Predictors, and Composition of Dissolved Organic Matter
Authors: Zhang Yixiang , Liang Xinqiang 
Published: December 2018

The analytical techniques and instrumentation used to assess agricultural and rural nonpoint‐source organic pollution loading are usually complex and expensive. There has been a strong demand for alternative methodologies to determine the presence and composition of organic pollutants and to predict their levels. In the current work, we investigated a simple and inexpensive approach combining excitation–emission matrix and support vector machine that measures pollution and predicts the levels of precursors to disinfection by‐products, which are organic pollutants derived from agricultural and rural nonpoint sources in small watersheds. Through parallel factor analysis, a four‐component model was developed to explain the composition of dissolved organic matter in water impacted by nonpoint‐source pollution. Support vector classification and support vector regression with model components can use fluorescence properties as proxy indicators for nonpoint‐source pollution. When the model components are used as input variables, formation potential of disinfection by‐products can be predicted. This method provides water utilities managers with tools to control pollution, supervise aquatic environments, and ensure the safety of drinking water.Core Ideas
Parallel factor (PARAFAC) components are indicators of nonpoint‐source pollution.
PARAFAC components can predict disinfection by‐product (DBP) formation potential (FP).
Correlation among DBP FPs and PARAFAC components was visualized by ordination diagram.
Effects on FPs across PARAFAC components were visualized by ordination diagram.
Humic‐ and protein‐like substances were origins of organic nonpoint‐source pollution.
Nutrient, Metal, and Organics Removal from Stormwater Using a Range of Bioretention Soil Mixtures
Authors: Jay Julia G. , Tyler‐Plog Megan , Brown Sally L. , Grothkopp Fritz 
Published: December 2018

A column study was conducted to test the ability of bioretention soil mixtures (BSMs) to remove nutrients, metals, and polyaromatic hydrocarbons (PAHs) from stormwater collected from an urban highway. Infiltration rate, plant growth response, and turbidity of the effluent were also measured. The BSMs were made from a range of types and rates of composts and additional materials such as water treatment residuals, sawdust, and oyster shells. Sand was used as a control. Total N and P in stormwater measured 1.8 ± 1 and 0.08 ± 0.03 mg L−1. All treatments were a source of these nutrients. Metal concentrations in the stormwater were low, with mean Cu and Zn concentrations of 39.8 ± 19.1 and 173 ± 113 μg L−1, and Cd and Pb close to detection limits. All treatments absorbed Cu and Zn from stormwater with varying levels of removal efficiency. The three treatments tested removed 84 to 100% of the PAHs from the stormwater. In general, contaminant removal (N, P, and Zn) efficiency was not related to infiltration rate, with a slight decrease in Cu removal efficiency observed with increased infiltration rate (R2 = 0.32). These results indicate that the BSMs tested were a source of nutrients but were generally effective at removing metals and PAHs from stormwater.Core Ideas
A wide range of bioretention soil mixtures were tested for their ability to remove contaminants from stormwater.
No single bioretention soil mixture outperformed others across all categories.
Retention time was generally not related to contaminant removal efficiency.
Gypsum Amendment Reduces Redox‐Induced Phosphorous Release from Freshly Manured, Flooded Soils to Floodwater
Authors: Dharmakeerthi Randombage S. , Kumaragamage Darshani , Indraratne Srimathie P. , Goltz Doug 
Published: December 2018

The effectiveness of gypsum in reducing runoff P losses from soils and the mechanisms responsible are well documented; however, gypsum amendment effects in reducing redox‐induced P losses from flooded soils are less researched and documented. We examined the effect of gypsum amendment on P release from freshly manured soils to pore water and floodwater with continuous flooding for 56 d in the laboratory. Three soils (Pembina, Denham, and Dencross series) collected from Manitoba, Canada, were preincubated with liquid swine manure. Each preincubated manured soil was packed into vessels with or without recycled wallboard gypsum in triplicates and flooded for 56 d, during which pore water and floodwater were sampled weekly and analyzed for pH and dissolved reactive P (DRP), Ca, Mg, Fe, and Mn concentrations. Change in soil redox potential (Eh) with flooding was also monitored. Wallboard gypsum amendment significantly decreased the pore water and surface floodwater DRP concentrations in all three soils for most days after flooding (DAF). The Dencross soil, which had Olsen P about fivefold greater than the other soils, showed the greatest magnitude decrease in DRP concentration with gypsum amendment, by 1.27 mg L−1 on 49 DAF and 0.99 mg L−1 on 21 DAF for pore water and floodwater, respectively. Gypsum amendment (i) delayed the Eh reduction with flooding beyond +200 mV, (ii) decreased pore water pH, and (iii) increased concentrations of Ca, Mg, and Mn in pore water favoring precipitation of P, all of which may have directly or indirectly reduced the P release from flooded soils to overlying floodwater.Core Ideas
Floodwater P concentration increased with flooding time in all soils and treatments.
Redox‐induced P release was less from gypsum‐amended than unamended soils.
Gypsum amendment reduced both pore water and floodwater P concentrations.
Adding gypsum reduced floodwater P concentration to a maximum of 57%.
The effectiveness of gypsum in reducing P release from flooded soils is soil dependent.
Evaluation of Nutrisphere‐N as an Inhibitor of Urease in Soils with pH Values Near Five
Authors: Goos R. Jay 
Published: December 2018

Core IdeasA recent paper showed that Nutrisphere‐N inhibits purified urease at pH 5.0.Nutrisphere‐N was tested as a urease inhibitor with soils near pH 5.0.Nutrisphere‐N did not inhibit urease activity in soils near pH 5.0.Nutrisphere‐N is a maleic‐itaconic polymer (MIP) marketed as a soil urease inhibitor. Recently, it was shown that the MIP in Nutrisphere‐N was able to inhibit purified urease at a pH of 5.0. Furthermore, Ni was removed from purified urease by MIP at a pH of 5.0. The objective of this study was to determine if these findings with purified urease at pH 5.0 could be replicated with soils with pH values near 5.0. Three soils with pH values of 4.5, 5.2, and 5.7 were incubated with 5 μg g–1ofN‐(n‐butyl) thiophosphoric triamide (NBPT) as Agrotain Ultra, and 5 and 50 μg g–1of MIP as Nutrisphere‐N. The inhibitors were allowed to react with the soil for 1 d before application of urea (sequential application) or applied at the same time as urea (simultaneous application). For the sequential application, 5 μg g–1of NBPT as Agrotain Ultra inhibited soil urease activity by 49%, versus –3 and –1% for 5 and 50 μg g–1of MIP as Nutrisphere‐N (average of three soils). For the simultaneous application, averaged across the three soils, 5 μg g–1of NBPT inhibited soil urease activity by 59%, versus –1 and −4% for 5 and 50 μg g–1of MIP. The observation that MIP inhibits purified urease at a pH of 5.0 could not be repeated with soils with pH values near 5.0. It remains to be demonstrated that Nutrisphere‐N functions as a soil urease inhibitor at the concentrations likely to be applied to soil.
Synthesis and SAR Study of Simple Aryl Oximes and Nitrofuranyl Derivatives with Potent Activity Against Mycobacterium tuberculosis
Authors: da Costa Cristiane França , de Souza Marcus Vinicius Nora , da Silva Lourenço Maria Cristina , Coimbra Elaine Soares , da Silva Lourenço Carvalho Guilherme , Wardell James , Calixto Stephane Lima , da Trindade Granato Juliana 
Published: December 2018

Background:
Oximes and nitrofuranyl derivatives are particularly important compounds
in medicinal chemistry. Thus, many researchers have been reported to possess antibacterial,
antiparasitic, insecticidal and fungicidal activities.

Methods:
In this work, we report the synthesis and the biological activity against Mycobacterium
tuberculosis H37RV of a series of fifty aryl oximes, ArCH=N-OH, I, and eight nitrofuranyl compounds,
2-nitrofuranyl-X, II.

Results:
Among the oximes, I: Ar = 2-OH-4-OH, 42, and I: Ar = 5-nitrofuranyl, 46, possessed the
best activity at 3.74 and 32.0 µM, respectively. Also, 46, the nitrofuran compounds, II; X = MeO,
55, and II: X = NHCH2Ph, 58, (14.6 and 12.6 µM, respectively), exhibited excellent biological activities
and were non-cytotoxic.

Conclusion:
The compound 55 showed a selectivity index of 9.85. Further antibacterial tests were
performed with compound 55 which was inactive against Enterococcus faecalis, Klebisiella
pneumonae, Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella typhymurium and Shigella
flexneri. This study adds important information to the rational design of new lead anti-TB drugs.
Structure-activity Relationship (SAR) is reported.
Age-related Trends in Adults with Urinary Tract Infections Presenting to the Emergency Department: A 5-Year Experience
Authors: Cardone Silvia , Petruzziello Carmine , Migneco Alessio , Fiori Barbara , Spanu Teresa , D'Inzeo Tiziana , Franceschi Francesco , Ojetti Veronica 
Published: December 2018

Introduction:
Urinary tract infections (UTIs) are among the most common bacterial infections,
affecting 150 million people worldwide each year. Importantly, the incidence of UTI increases
markedly with age. The increasing resistance to empirically prescribed antimicrobial agents complicates
the management of this disease. This makes UTI an important issue in increasingly aging population
and updated epidemiological investigation is advisable.

:
To understand the epidemiological variation in UTI resistance patterns among differently aged populations,
we conducted a retrospective study among patients presenting to the emergency department
(ED) of a large tertiary-care hospital in Italy during January 2013 and June 2017.

Methods:
1281 patients who presented with UTI symptoms to the ED, were stratified into four age
categories: young adults (18-44 years old;), adults (45-64), the elderly (65-84), and the oldest old (≥
85). Inclusion criteria were urine collected in ED patients with UTI symptoms and first positive culture
from one given patient in a given year.

Results:
362 (28.2%) patients had a urine culture with positive result, leading to a total of 459 germs
isolated, stratified into four categories: young adults (58 isolates, 12.6%), adults (98, 21.4%), the elderly
(174, 37.9%), and the oldest old (129, 28.1%).

:
Escherichia coli represents the 60% of all monomicrobial infections, followed in frequency by Klebsiella
pneumoniae (15%), and Enterococcus faecalis (5%). The other 20% of the infections are
caused by various germs.

:
The most common association of germs in polymicrobial is E. coli + E. faecalis, accounting for the
28% of all infections.

:
Overall, we found a peak of susceptibility to amoxicillin (AMX) in the oldest old ( 81%),
significantly higher compared to young adults (54%), adults (47%) and elderly (35%) (p<0,001).

:
For ciprofloxacin (CIP) there is a greater susceptibility in the young adult (55.5%), but not so marked
compared to the other three groups; for fosfomicin (FOS) the susceptibility was greater in the group
of adults (60%) compared to young adults, elderly and the oldest old. Also for trimethoprim/
sulfamethoxazole (TMP-SMX) we found greater susceptibility in the adult group (60%), followed by
the oldest old (57,6%), young adults (49%) and elderly (47%).

Conclusion:
Age-related differences in antimicrobial-resistant microorganisms were evident for
adults with UTI, and could potentially contribute to the risk of inappropriate empirical therapy in elderly
patients. Thus, different empirical antimicrobial regimens should be considered for distinct age
groups.
Detrimental Impact of Interferon-Based Regimens for Chronic Hepatitis C on Vitamin D/Parathyroid Hormone Homeostasis
Authors: Salmi Livia , Barbaglia Matteo Nazzareno , Smirne Carlo , Bianco Sara , Guaschino Giulia , Crobu Maria Grazia Stella , Minisini Rosalba , Pirisi Mario 
Published: December 2018

Background:
Both the anti-infective and anti-inflammatory properties of vitamin D, an essential hormone of calcium homeostasis, have ample support in the literature. The high rates of vitamin D deficiency among patients with chronic hepatitis C are also well known. That supplementation with vitamin D may boost sustained viral response rates in vitamin D deficient, hepatitis C virus (HCV) infected patients undergoing Interferon-alpha (IFN) treatment, on the other hand, is controversial. Surprisingly, studies considering in this latter setting what are the effects of IFN treatment (with or without vitamin D supplementation) on the other major regulator of mineral metabolism, i.e. the Parathyroid hormone (PTH), are lacking.

Aim:
Evaluate the impact of interferon-based treatment against HCV (±cholecalciferol supplementation) on vitamin D and PTH homeostasis.

Methods:
A series of 40 consecutive patients received pegylated IFN plus ribavirin to treat chronic hepatitis C. At the discretion of their physician, some of them (N. = 27) received vitamin D supplementation while others did not (N. = 13). All had measured plasma 25-hydroxycholecalciferol and PTH concentrations at baseline, at completion of the 4th (TW4) and 12th treatment week (TW12) and at 24 weeks after the end of therapy (SVR24).

Results:
Plasma PTH concentration increased significantly from baseline during treatment, raising to 44.8 [30.7-57.2] pg/mL at TW4 (p=0.01), 47.0 [37.1-63.2] pg/mL at TW12 (p=0.006) to return to baseline levels in the follow-up (34.5 [27.6-43.0]; p=0.16). The proportion of patients who satisfied criteria for hyperparathyroidism was higher at TW12 (N=10, 25%) than at TW4 (N=6, 15%). There was no statistical correlation between vitamin D and PTH blood levels (ρ=-0.07; p=0.65).

Conclusion:
An increase in plasma PTH occurs systematically during IFN treatment of HCV patients and cannot be prevented by vitamin D supplementation.
Efficient Micromixing for Continuous Biodiesel Production from Jatropha Oil
Authors: Mohammed Waleed S. , El-Shazly Ahmed H. , Elkady Marwa F. , Ohshima Masahiro 
Published: December 2018

Introduction:The utilization of biodiesel as an alternative fuel is turning out to be progressively famous these days because of worldwide energy deficiency. The enthusiasm for utilizing Jatropha as a non-edible oil feedstock is quickly developing. The performance of the base catalyzed methanolysis reaction could be improved by a continuous process through a microreactor in view of the high mass transfer coefficient of this technique.Materials & Methods:Nanozirconium tungstovanadate, which was synthetized using sol-gel preparation method, was utilized in a complementary step for biodiesel production process. The prepared material has an average diameter of 0.066 &µm.Results:First, the NaOH catalyzed methanolysis of Jatropha oil was investigated in a continuous microreactor, and the efficient mixing over different mixers and its impact on the biodiesel yield were studied under varied conditions. Second, the effect of adding the nanocatalyst as a second stage was investigated.Conclusion:The maximum percentage of produced methyl esters from Jatropha oil was 98.1% using a methanol/Jatropha oil molar ratio of 11 within 94 s using 1% NaOH at 60 &°C. The same maximum conversion ratio was recorded with the nanocatalyst via only 0.3% NaOH.