bluuebunny/crossref_metadata_2025_split huggingface dataset:
The combined effect of probiotic cultures and incubation final pH on the quality of buffalo milk yogurt during cold storage
Authors: Akgun Abdullah , Yazici Fehmi , Gulec Haci Ali 
Published: March 2018

AbstractThe combined effects of starter culture type (SCT) and incubation final pH (IFpH) on the physicochemical and organoleptic properties of buffalo milk yogurt containing 3 g·100 g−1 milk fat were investigated throughout 20 days of storage at 4°C. The postacidification kinetics fitted to zero‐order reaction for all buffalo milk yogurt samples. The reaction rate constants of the buffalo milk yogurt samples containing YC‐X11, ABY‐2, and ABT‐4 cultures were 0.010, 0.007, and 0.004 g·100 g−1·day−1, respectively. Regardless of the IFpH, the absence of Lactobacillus delbrueckii subsp. bulgaricus in the starter culture increased the syneresis. L*, a*, and b* values were not affected by the IFpH and the SCT. ABY‐2 culture increased the amount of organic acids during cold storage in comparison with the YC‐X11, while its effect on the proportions of saturated and unsaturated fatty acids was not significant. The results of sensory evaluation revealed that a more acceptable buffalo milk yogurt can be manufactured by using probiotic ABY‐2 culture.
A pragmatic approach to monitor and evaluate implementation and impact of differentiated ART delivery for global and national stakeholders
Authors: Ehrenkranz Peter D , Calleja Jesus MG , El‐Sadr Wafaa , Fakoya Ade O , Ford Nathan , Grimsrud Anna , Harris Kate L , Jed Suzanne L , Low‐Beer Daniel , Patel Sadhna V , Rabkin Miriam , Reidy William John , Reinisch Annette , Siberry George K , Tally Leigh A , Zulu Isaac , Zaidi Irum 
Published: March 2018

AbstractIntroductionThe World Health Organization's (WHO) recommendation of “Treat All” has accelerated the call for differentiated antiretroviral therapy (ART) delivery, a method of care that efficiently uses limited resources to increase access to HIV treatment. WHO has further recommended that stable individuals on ART receive refills every 3 to 6 months and attend clinical visits every 3 to 6 months. However, there is not yet consensus on how to ensure that the quality of services is maintained as countries strive to meet these standards. This commentary responds to this gap by defining a pragmatic approach to the monitoring and evaluation (M&E) of the scale up of differentiated ART delivery for global and national stakeholders.DiscussionProgramme managers need to demonstrate that the scale up of differentiated ART delivery is achieving the desired effectiveness and efficiency outcomes to justify continued support by national and global stakeholders. To achieve this goal, the two existing global WHO HIV treatment indicators of ART retention and viral suppression should be augmented with two broad aggregate measures. The addition of indicators measuring the frequency of (1) clinical and (2) refill visits by PLHIV per year will allow evaluation of the pace of scale up while monitoring its overall effect on the quality and efficiency of services. The combination of these four routinely collected aggregate indicators will also facilitate the comparison of outcomes among facilities, regions or countries implementing different models of ART delivery. Enhanced monitoring or additional assessments will be required to answer other critical questions on the process of implementation, acceptability, effectiveness and efficiency.ConclusionsThese proposed outcomes are useful markers for the effectiveness and efficiency of the health system's attempts to deliver quality treatment to those who need it—and still reserve as much of the available resource pool as possible for other key elements of the HIV response.
Anatomic Location and Mechanism of Injury Correlating with Prehospital Deaths in Sub‐Saharan Africa
Authors: Reid T. D. , Strassle P. D. , Gallaher J. , Grudziak J. , Mabedi C. , Charles A. G. 
Published: March 2018

AbstractIntroductionTrauma is a large contributor to morbidity and mortality in developing countries. We sought to determine which anatomic injury locations and mechanisms of injury predispose to prehospital mortality in Malawi to help target preventive and therapeutic interventions. We hypothesized that head injury would result in the highest prehospital mortality.MethodsThis was a retrospective analysis of all trauma patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, from 2008 to 2015. Independent variables included baseline characteristics, anatomic location of primary injury, mechanism of injury, and severity of secondary injuries. Multivariable logistic regression was used to assess the effect of primary injury location and injury mechanism on prehospital death, after adjusting for confounders. Effect measure modification of the primary injury site/prehospital death relationship by injury mechanism (stratified into intentional and unintentional injury) was assessed.ResultsOf 85,806 patients, 701 died in transit (0.8%). Five hundred and five (72%) of these patients sustained a primary head injury. After adjustment, head injury was the anatomic location most associated with prehospital death (OR 11.81 (95% CI 6.96–20.06, p < 0.0001). The mechanisms of injury most associated with prehospital death were gunshot wounds (OR 38.23, 95% CI 17.66–87.78, p < 0.0001) and pedestrian hit by vehicle (OR 2.62, 95% CI 1.92–3.55, p < 0.0001). Among head injury patients, the odds of prehospital mortality were higher with unintentional injuries.ConclusionsHead injuries are the most common causes of prehospital death in Malawi, while pedestrians hit by vehicles are the most common mechanisms. In a resource‐poor setting, preventive measures are critical in averting mortality.
Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a “Damage Control Strategy”
Authors: Sohn Maximilian , Iesalnieks I. , Agha A. , Steiner P. , Hochrein A. , Pratschke J. , Ritschl P. , Aigner F. 
Published: March 2018

AbstractPurposeOptimal surgical management of perforated diverticulitis of the sigmoid colon has yet to be clearly defined. The purpose of this study was to evaluate efficacy of a “Damage Control Strategy” (DCS).Materials and methodsPatients with perforated diverticulitis of the sigmoid colon complicated by generalized peritonitis (Hinchey III and IV) surgically treated according to a damage control strategy between May 2011 and February 2017 were enrolled in the present multicenter retrospective cohort study. Data were collected at three surgical centers. DCS comprises a two‐stage concept: [1] limited resection of the perforated colon segment with oral and aboral blind closure during the emergency procedure and [2] definitive reconstruction at scheduled second laparotomy (anastomosis ∓ loop ileostomy or a Hartmann’s procedure) after 24–48 h.ResultsFifty‐eight patients were included into the analysis [W:M 28:30, median age 70.1 years (30–92)]. Eleven patients (19%) initially presented with fecal peritonitis (Hinchey IV) and 47 patients with purulent peritonitis (Hinchey III). An anastomosis could be created during the second procedure in 48 patients (83%), 14 of those received an additional loop ileostomy. In the remaining ten patients (n = 17%), an end colostomy was created at second laparotomy. A fecal diversion was performed in five patients to treat anastomotic complications. Thus, altogether, 29 patients (50%) had stoma at the end of the hospital stay. The postoperative mortality was 9% (n = 5), and median postoperative hospital stay was 18.5 days (3–66). At the end of the follow‐up, 44 of 53 surviving patients were stoma free (83%).ConclusionThe use of the Damage Control strategy leads to a comparatively low stoma rate in patients suffering from perforated diverticulitis with generalized peritonitis.
Impact of Jaundice on Outcomes Following Emergency Laparoscopic Cholecystectomy in Patients with Choledocholithiasis
Authors: Poh Benjamin R. , Cashin Paul A. , Croagh Daniel G. 
Published: March 2018

AbstractIntroductionTraditional teaching dictates that it may not be prudent to take the jaundiced patient to theatre for emergency laparoscopic cholecystectomy as they may experience worse outcomes following surgery.MethodsA prospective cohort of 104 patients undergoing emergency laparoscopic cholecystectomy was stratified into two groups using a serum total bilirubin of above 50 μmol/L (2.9 mg/dL) to define the jaundiced group. Primary outcomes were morbidity and mortality rate. The Clavien–Dindo classification and the novel Comprehensive Complication Index (CCI) were applied to the grading of surgical complications. Multivariate analysis to identify possible predictors of morbidity and length of stay was also performed.ResultsOverall morbidity rate in the jaundiced group was 28 versus 36% (control), p = 0.405. Mean CCI in the jaundiced group was 5.28 versus 8.00 in the control group, p = 0.229. Mean length of stay was shorter in the jaundiced group, 4.65 versus 6.51 days, p = 0.036. There were no peri‐operative mortalities or conversions to open surgery. Only male gender and the presence of retained stones were found to be associated with morbidity. Serum total bilirubin was not associated with increased morbidity.ConclusionAmongst patients undergoing laparoscopic cholecystectomy who are found to have choledocholithiasis on IOC, the presence of jaundice does not appear to contribute towards increased morbidity.
Overweight and diabetes prevention: is a low-carbohydrate–high-fat diet recommendable?
Authors: Brouns Fred 
Published: March 2018

Abstract
In the past, different types of diet with a generally low-carbohydrate content (< 50–< 20 g/day) have been promoted, for weight loss and diabetes, and the effectiveness of a very low dietary carbohydrate content has always been a matter of debate. A significant reduction in the amount of carbohydrates in the diet is usually accompanied by an increase in the amount of fat and to a lesser extent, also protein. Accordingly, using the term “low carb–high fat” (LCHF) diet is most appropriate. Low/very low intakes of carbohydrate food sources may impact on overall diet quality and long-term effects of such drastic diet changes remain at present unknown. This narrative review highlights recent metabolic and clinical outcomes of studies as well as practical feasibility of low LCHF diets. A few relevant observations are as follows: (1) any diet type resulting in reduced energy intake will result in weight loss and related favorable metabolic and functional changes; (2) short-term LCHF studies show both favorable and less desirable effects; (3) sustained adherence to a ketogenic LCHF diet appears to be difficult. A non-ketogenic diet supplying 100–150 g carbohydrate/day, under good control, may be more practical. (4) There is lack of data supporting long-term efficacy, safety and health benefits of LCHF diets. Any recommendation should be judged in this light. (5) Lifestyle intervention in people at high risk of developing type 2 diabetes, while maintaining a relative carbohydrate-rich diet, results in long-term prevention of progression to type 2 diabetes and is generally seen as safe.
Is Less Noise, Light and Parental/Caregiver Stress in the Neonatal Intensive Care Unit Better for Neonates?
Authors: Venkataraman Rohini , Kamaluddeen Majeeda , Amin Harish , Lodha Abhay 
Published: March 2018

Abstract

In utero sensory stimuli and interaction with the environment strongly influence early phases of fetal and infant development. Extremely premature infants are subjected to noxious procedures and routine monitoring, in addition to exposure to excessive light and noise, which disturb the natural sleep cycle and induce stress. Non-invasive ventilation, measures to prevent sepsis, and human milk feeding improve short-term and long-term neurodevelopmental outcomes in premature infants. To preserve brain function, and to improve quality of life and long-term neurodevelopmental outcomes, the focus now is on the neonatal intensive care unit (NICU) environment and its impact on the infant during hospital stay. The objectives of this write-up are to understand the effects of environmental factors, including lighting and noise in the NICU, on sensory development of the infant, the need to decrease parental and caregiver stress, and to review existing literature, local policies and recommendations.
Impact of physician payment mechanism on emergency department operational performance
Authors: Innes Grant D. , Scheuermeyer Frank X. , Marsden Julian , Sing Chad Kim , Kalla Dan , Stenstrom Rob , Law Michael , Grafstein Eric 
Published: March 2018

ABSTRACTObjectiveFee-for-service payment may motivate physicians to see more patients and achieve higher productivity. In 2015, emergency physicians at one Vancouver hospital switched to fee-for-service payment, while those at a sister hospital remained on contract, creating a natural experiment where the compensation method changed, but other factors remained constant. Our hypothesis was that fee-for-service payment would increase physician efficiency and reduce patient wait times.MethodsThis interrupted time series with concurrent control analysed emergency department (ED) performance during a 42-week period, encompassing the intervention (fee for service). Data were aggregated by week and plotted in a time series fashion. We adjusted for autocorrelation and developed general linear regression models to assess level and trend changes. Our primary outcome was the wait time to physician.ResultsData from 142,361 ED visits were analysed. Baseline wait times rose at both sites during the pre-intervention phase. Immediately post-intervention, the median wait time increased by 2.4 minutes at the control site and fell by 7.2 minutes at the intervention site (difference=9.6 minutes; 95% confidence interval, 2.9-16.4;p=0.007). The wait time trend (slope) subsequently deteriorated by 0.5 minutes per week at the intervention site relative to the expected counterfactual (pfor the trend difference=0.07). By the end of the study, cross-site differences had not changed significantly from baseline.ConclusionFee-for-service payment was associated with a 9.6-minute (24%) reduction in wait time, compatible with an extrinsic motivational effect; however, this was not sustained, and the intervention had no impact on other operational parameters studied. Physician compensation is an important policy issue but may not be a primary determinant of ED operational efficiency.
Coherent structures in wall-bounded turbulence
Authors: Jiménez Javier 
Published: March 2018

This article discusses the description of wall-bounded turbulence as a deterministic high-dimensional dynamical system of interacting coherent structures, defined as eddies with enough internal dynamics to behave relatively autonomously from any remaining incoherent part of the flow. The guiding principle is that randomness is not a property, but a methodological choice of what to ignore in the flow, and that a complete understanding of turbulence, including the possibility of control, requires that it be kept to a minimum. After briefly reviewing the underlying low-order statistics of flows at moderate Reynolds numbers, the article examines what two-point statistics imply for the decomposition of the flow into individual eddies. Intense eddies are examined next, including their temporal evolution, and shown to satisfy many of the properties required for coherence. In particular, it is shown that coherent structures larger than the Corrsin scale are a natural consequence of the shear. In wall-bounded turbulence, they can be classified into coherent dispersive waves and transient bursts. The former are found in the viscous layer near the wall, and as very large structures spanning the entire boundary layer. Although they are shear-driven, these waves have enough internal structure to maintain a uniform advection velocity. Conversely, bursts exist at all scales, are characteristic of the logarithmic layer, and interact almost linearly with the shear. While the waves require a wall to determine their length scale, the bursts are essentially independent from it. The article concludes with a brief review of our present theoretical understanding of turbulent structures, and with a list of open problems and future perspectives.‘Chance is the name we give to what we choose to ignore (Voltaire)’
Hindfins ofIchthyosaurus: effects of large sample size on ‘distinct’ morphological characters
Authors: MASSARE JUDY A. , LOMAX DEAN R. 
Published: March 2018

AbstractThe abundance of specimens ofIchthyosaurusprovides an opportunity to assess morphological variation without the limits of a small sample size. This research evaluates the variation and taxonomic utility of hindfin morphology. Two seemingly distinct morphotypes of the mesopodium occur in the genus. Morphotype 1 has three elements in the third row: metatarsal two, distal tarsal three and distal tarsal four. This is the common morphology inIchthyosaurus breviceps,I. conybeariandI. somersetensis. Morphotype 2 has four elements in the third row, owing to a bifurcation. This morphotype occurs in at least some specimens of each species, but it has several variations distinguished by the extent of contact of elements in the third row with the astragalus. Two specimens display a different morphotype in each fin, suggesting that the difference reflects individual variation. InIchthyosaurus, the hindfin is taxonomically useful at the genus level, but species cannot be identified unequivocally from a well-preserved hindfin, although certain morphologies are more common in certain species than others. The large sample size filled in morphological gaps between what initially appeared to be taxonomically distinct characters. The full picture of variation would have been obscured with a small sample size. Furthermore, we have found several unusual morphologies which, in isolation, could have been mistaken for new taxa. Thus, one must be cautious when describing new species or genera on the basis of limited material, such as isolated fins and fragmentary specimens.
Some limits and political implications of participation within health and social care for older adults
Authors: CAREY MALCOLM 
Published: March 2018

ABSTRACTThis paper critically examines service user participation and involvement for older adults. It concentrates on research and community-led engagement for older people, and maintains that despite extensive support and expansion, participation offers a complex form of governance and ideological control, as well as a means by which local governments and some welfare professions seek to legitimise or extend their activities. Some of the paradoxes of participation are discussed, including tensions that persist between rhetorical claims of empowerment, active citizenship and democratic engagement, on one hand, despite tendencies towards risk-aversion, welfare retrenchment and participant ambivalence, on the other. The paper also highlights practical problems in relation to participative research and community involvement, and questions arguments that participation may challenge the authority of welfare professionals. Critical theory is drawn upon to contextualise the role of participative narratives within wider welfare, including its role in moving debate away from ownership or redistribution while masking and validating policy-related goals which can counter many older people's needs. Tension is also noted between participation projects represented as resources to support ageing identities as opposed to those representing technologies for social regulation and conformity.
The Rotation of the Be Star γ Cas
Authors: Hutchings J. B. 
Published: March 2018

AbstractA period of 0.7 days has been found in the peak separation and VIR ratio of the double emission profiles of Hγ and Hβ in this star. The phenomenon is believed to arise from short lived condensations near the base of an equatorially extended atmosphere, and the period to be that of rotation of the star. The deduced stellar diameter is 7 R⊙. Further considerations on the emission line profiles lead to a model of an equatorial ring extending 1-2 stellar radii with angular velocity decreasing outwards, and viewed at an axial inclination of some 60°.
Genetic diversity of norovirus in children under 5 years of age with acute gastroenteritis from Angola
Authors: Esteves A. , Nordgren J. , Tavares C. , Fortes F. , Dimbu R. , Saraiva N. , Istrate C. 
Published: March 2018

AbstractNorovirus (NoV) is a major cause of acute gastroenteritis (AGE). In this study, we investigated the genetic diversity of NoV strains identified in children under 5 years of age with AGE in four provinces of Angola. Faecal samples from 343 children were screened for NoV by an in house real-time PCR assay and genotyping was performed by partial capsid gene sequencing. NoV was detected in 17.4% (58/334) of the samples, with high detection rates in children <6 months old (19%) and in children aged 12–24 months (23%). Genotype diversity was large, as demonstrated by the 11 identified genotypes. GII.4 was the predominant genotype (20% of all NoV-positive samples), followed by GII.6 (15%), GI.3 (12%), GII.7 (10%) and by other genotypes to a lesser extent. Two GII.4 variants, New Orleans 2009 and Sydney 2012, were detected and several genetic clusters were observed for genotypes GI.3, GII.6 and GII.7. The present study shows high detection rates and genetic diversity of circulating NoV genotypes in paediatric AGE samples from Angola. This information emphasises the importance of continuous assessment of NoV burden and evolution in the target population.
Unmasking the borderline coarctation: the utility of isoproterenol in the paediatric cardiac catheterisation laboratory
Authors: Patel Neil D. , Sullivan Patrick M. , Takao Cheryl M. , Badran Sarah , Ahdoot Joseph , Ing Frank F. 
Published: March 2018

AbstractBackgroundOne indication for intervention in coarctation of the aorta is a peak-to-peak gradient >20 mmHg. Gradients may be masked in patients under general anaesthesia and may be higher during exercise. Isoproterenol was given during cardiac catheterisation to simulate a more active physiologic state.ObjectivesWe aimed to describe the haemodynamic effects of isoproterenol in patients with coarctation and the impact of intervention on the elicited gradients.MethodsA retrospective study was performed on two-ventricle patients who underwent cardiac catheterisation for coarctation with isoproterenol testing.Results25 patients received isoproterenol before and after intervention. With isoproterenol, the mean diastolic (p=0.0015) and mean arterial (p=0.0065) blood pressures proximal to the coarctation decreased significantly. The mean systolic, diastolic, and mean arterial blood pressures distal to the coarctation decreased significantly (p<0.0001). In patients with a baseline gradient ⩽20 mmHg (n=17) at catheterisation, the median gradient increased from 10 (0–20) to 30 (15–50) mmHg (p<0.0001) with isoproterenol. Of these, 15 patients developed a gradient >20 mmHg. Post intervention, the median gradient decreased to 2 (0–29) mmHg, versus baseline, p=0.005, and with isoproterenol it decreased to 8 (0–27) mmHg, versus pre-intervention isoproterenol, p<0.0001. There were significant improvements in the gradients by Doppler (<0.0001) and by blood pressure cuff (p=0.0313). The gradients on isoproterenol best correlated with gradients by blood pressure cuff in the awake state (R2=0.76, p<0.0001).ConclusionsIsoproterenol can be a useful tool to assess the significance of a coarctation and the effectiveness of an intervention. Percutaneous interventions can effectively reduce the gradients elicited by isoproterenol.