bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hand washing practice at critical times and its associated factors among mothers of under five children in Debark town, northwest Ethiopia, 2018
Authors: Dagne Henok , Bogale Laekemariam , Borcha Muluneh , Tesfaye Anley , Dagnew Baye 
Published: September 2019

Abstract

Background
The burden of communicable diseases within developing countries is mainly influenced by poor personal hygiene practices. Hand washing is considered as most cost effective intervention for reducing health problems such as diarrhoea and acute respiratory tract infections. This study aimed to assess hand washing practice at critical times and identify associated factors among mothers of under five children in Debark town.

Method
A community based cross-sectional study design was carried out from May 1–20, 2018 in Debark town. After selection of participants using simple random sampling, face to face interview was performed by using semi-structured pre-tested questionnaire. Data were entered into EPI Info 7 and exported into SPSS 21 for further analysis. Results were presented by simple frequency, percentage and mean for descriptive variables. Binary logistic regression analysis was used to test the association of dependent and independent factors. Variables with 95% confidence interval and p ≤ 0.2 during the univariable binary logistic regression analysis were included in the multivariate logistic regression analysis. At the final model variables with p ≤ 0.05 were treated as significantly associated factors of hand washing practice at critical times.

Results
Good hand washing practice at critical times was reported in 52.2% (95% CI: 47.5, 57.2%) of study participants. Desirable attitude [AOR = 3.37, 95% CI (2.03, 5.58)], presence of water for washing hands [AOR = 4.86, 95% CI (1.26, 18.69)] and a good knowledge [AOR = 2.98, 95% CI (1.92, 4.60)] were significantly associated factors with hand washing practice at critical times.

Conclusion
The hand washing practice at critical times of study participants was found to be low. A significant proportion of mothers of under five children have a poor hand washing practice at critical times. It is necessary to increase the access to water and to improve knowledge and attitude of mothers to improve their hand washing practice at critical times.
The pulsed ultrasound strategy effectively decreases the S. aureus population of chronic rhinosinusitis patients
Authors: Feizabadi Narjes , Sarrafzadeh Javad , Fathali Mojtaba , Vasaghi-Gharamaleki Behnoosh , Dadgoo Mahdi , Kardan-Yamchi Jalil , Kazemian Hossein , Hesam-Shariati Sonia , Feizabadi Mohammad Mehdi 
Published: September 2019

Abstract

Objective
Staphylococcus aureus with the ability of biofilm formation and the drug resistance acquisition is one of the most frequently isolated pathogens from chronic rhinosinusitis patients. Ultrasound as an alternative therapy is effectively able to kill the bacteria by cavitation in or on the bacterial cells and peroxide generation and hence improving antibiotic treatment efficacy.

Results
Staphylococcus aureus was detected in 4 and 6 out of 14 patients by phenotypic and qPCR assays, respectively. Four patients were completely resolved after pulsed ultrasound treatment. However, presence of the S. aureus was confirmed in three healthy controls by bacterial cultivation. Pulsed ultrasound have been quantitatively decreased the S. aureus population in chronic rhinosinusitis patients (p < 0.05). Further studies need to be investigated the effectiveness of pulsed ultrasound as an alternative course of CRS patient’s treatment.
Accuracy of P0.1 measurements performed by ICU ventilators: a bench study
Authors: Beloncle François , Piquilloud Lise , Olivier Pierre-Yves , Vuillermoz Alice , Yvin Elise , Mercat Alain , Richard Jean-Christophe 
Published: September 2019

Abstract

Background
Occlusion pressure at 100 ms (P0.1), defined as the negative pressure measured 100 ms after the initiation of an inspiratory effort performed against a closed respiratory circuit, has been shown to be well correlated with central respiratory drive and respiratory effort. Automated P0.1 measurement is available on modern ventilators. However, the reliability of this measurement has never been studied. This bench study aimed at assessing the accuracy of P0.1 measurements automatically performed by different ICU ventilators.

Methods
Five ventilators set in pressure support mode were tested using a two-chamber test lung model simulating spontaneous breathing. P0.1 automatically displayed on the ventilator screen (P0.1vent) was recorded at three levels of simulated inspiratory effort corresponding to P0.1 of 2.5, 5 and 10 cm H2O measured directly at the test lung and considered as the reference values of P0.1 (P0.1ref). The pressure drop after 100 ms was measured offline on the airway pressure–time curves recorded during the automated P0.1 measurements (P0.1aw). P0.1vent was compared to P0.1ref and to P0.1aw. To assess the potential impact of the circuit length, P0.1 were also measured with circuits of different lengths (P0.1circuit).

Results
Variations of P0.1vent correlated well with variations of P0.1ref. Overall, P0.1vent underestimated P0.1ref except for the Löwenstein® ventilator at P0.1ref 2.5 cm H2O and for the Getinge group® ventilator at P0.1ref 10 cm H2O. The agreement between P0.1vent and P0.1ref assessed with the Bland–Altman method gave a mean bias of − 1.3 cm H2O (limits of agreement: 1 and − 3.7 cm H2O). Analysis of airway pressure–time and flow–time curves showed that all the tested ventilators except the Getinge group® ventilator performed an occlusion of at least 100 ms to measure P0.1. The agreement between P0.1vent and P0.1aw assessed with the Bland–Altman method gave a mean bias of 0.5 cm H2O (limits of agreement: 2.4 and − 1.4 cm H2O). The circuit’s length impacted P0.1 measurements’ values. A longer circuit was associated with lower P0.1circuit values.

Conclusion
P0.1vent relative changes are well correlated to P0.1ref changes in all the tested ventilators. Accuracy of absolute values of P0.1vent varies according to the ventilator model. Overall, P0.1vent underestimates P0.1ref. The length of the circuit may partially explain P0.1vent underestimation.
Physicians Prescribe More Opioid Than Needed to Treat Pain in Children After Outpatient Urological Procedures: An Observational Cohort Study
Authors: Hunsberger Joann B. , Hsu Aaron , Yaster Myron , Vozzo Paul T. , Gao Shuna , White Elizabeth D. , Yenokyan Gayane , Vickers Barbara , Monitto Constance L. 
Published: September 2019

BACKGROUND:
The epidemic of nonmedical use of prescription opioids (NMUPOs) has been fueled in part by the availability of leftover, legitimately prescribed opioids. In children, outpatient urological procedures are among the most common surgeries performed, but data are lacking to guide appropriate postoperative opioid prescribing. The aim of this study was to compare the amount of prescribed opioid medication to the amount taken for acute pain after minor pediatric urological surgery and to determine the disposition of excess opioid. In addition, we explored whether distinct patient characteristics and procedure type influenced opioid prescribing and consumption.

METHODS:
Of the 139 families of pediatric patients enrolled, 115 were interviewed within 48 hours and/or 10–14 days of discharge to determine the amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid.

RESULTS:
The most common procedures performed were circumcision (n = 58) and orchiopexy (n = 40). Most patients (98%) were male, and 77% were <8 years of age. All opioid prescriptions were for oxycodone dosed every 4 hours as needed (PRN). Median number of doses prescribed was 30 (interquartile range [IQR], 23–31; n = 138) for both respondents who reported doses remaining (IQR, 29–31; n = 83) and those who did not (IQR, 22–32; n = 55). Among those reporting doses remaining, median number of doses consumed was 4.2 (IQR, 0–14). Multivariable linear regression showed no significant association between doses consumed and patient age, type of procedure, discharge pain score, or use of adjuvant analgesics. Median duration of opioid therapy was 2 days (IQR, 0–5; n = 83) with each additional day of opioid use corresponding to an average increase in consumption of 2.3 doses (95% confidence interval [CI], 1.8–2.8). An estimated 75% (95% CI, 69%–81%) of opioid dispensed was not consumed, and 86% (72/83) of patients took ≤18 doses. Forty-four of 65 (68%) families reported receiving no disposal instructions for leftover opioid, and only 7 families disposed of leftover medication.

CONCLUSIONS:
For minor pediatric urological surgeries in young boys, a 3-day supply (18 doses) of opioid was sufficient to adequately treat acute postoperative pain in most patients. Adjusting opioid dispensing to align with consumption and better educating patients and families on opioid disposal can be used to potentially decrease availability of leftover opioids in homes and communities.
Voluntary Exercise Rescues the Spatial Memory Deficit Associated With Early Life Isoflurane Exposure in Male Rats
Authors: Chinn Gregory A. , Sasaki Russell Jennifer M. , Banh Esther T. , Lee Saehee C. , Sall Jeffrey W. 
Published: September 2019

BACKGROUND:
Early life anesthesia exposure results in long-term cognitive deficits in rats. Environmental enrichment consisting of social housing, a stimulating environment, and voluntary exercise can rescue this deficit. We hypothesized that exercise alone is sufficient to rescue the cognitive deficit associated with perinatal anesthesia.

METHODS:
Postnatal day 7 male rats (P7) underwent isoflurane (Iso) or sham exposure and were subsequently weaned at P21. They were then singly housed in a cage with a running wheel or a fixed wheel. After 3 weeks of exercise, animals underwent behavioral testing for spatial and recognition memory assessments. Animals were killed at various time points to accomplish either bromodeoxyuridine (BrdU) labeling or quantitative real-time polymerase chain reaction (qRT-PCR) to quantify brain-derived neurotrophic factor (BDNF) messenger ribonucleic acid (mRNA) levels.

RESULTS:
Postweaning voluntary exercise rescued the long-term spatial memory deficit associated with perinatal Iso exposure. Iso-sedentary animals did not discriminate the goal quadrant, spending no more time than chance during the Barnes maze probe trial (1-sample t test, P = .524) while all other groups did (1-sample t test, P
Iso-exercise = .033; P
control [Con]-sedentary = .004). We did not find a deficit in recognition memory tasks after Iso exposure as we observed previously. BrdU incorporation in the adult hippocampus of Iso-sedentary animals was decreased compared to sedentary controls (Tukey P = .005). Exercise prevented this decrease, with Iso-exercise animals having more proliferation than Iso-sedentary (Tukey P < .001). There was no effect of exercise or Iso on BDNF mRNA in either the cortex or hippocampus (cortex: F
Exercise
[1,32
] = 0.236, P = .631; F
Iso [
1,32] = 0.038, P = .847; F
Interaction [
1,32] = 1.543, P = .223; and hippocampus: F
Exercise
[
1,33] = 1.186, P = .284; F
Iso [
1,33] = 1.46, P = .236; F
Interaction
[
1,33] = 1.78, P = .191).

CONCLUSIONS:
Exercise restores BrdU incorporation and rescues a spatial memory deficit after early life anesthesia exposure. This demonstrates sufficiency of exercise alone in the context of environmental enrichment to recover a behavioral phenotype after a perinatal insult.
Effect of Remote Ischemic Preconditioning in Patients Undergoing Hepatectomy With Portal Triad Clamping: A Randomized Controlled Trial
Authors: Liu Xiaoqing , Cao Longhui , Zhang Tianhua , Guo Rongping , Lin Wenqian 
Published: September 2019

BACKGROUND:
Remote ischemic preconditioning (RIPC) is reported to reduce liver injury in patients undergoing hepatectomy for colorectal liver metastasis, but its role is unclear in hepatocellular carcinoma patients with portal triad clamping during hepatectomy.

METHODS:
In this prospective, randomized trial, 140 patients with hepatocellular carcinoma undergoing liver resection requiring portal triad clamping were randomized to a RIPC group or a control group. Patients in the RIPC group received RIPC (3 cycles of 5-minute ischemia and 5-minute reperfusion in right upper limb with cuff pressure at 30 kPa [225 mm Hg]) approximately 10 minutes after induction of anesthesia. In the control group, patients received sham RIPC (the cuff was not inflated). The primary outcome was the postoperative peak level of total bilirubin (TBIL) and was analyzed with the independent t test. Secondary outcomes were liver function test at postoperative days 1, 3, and 5; postoperative morbidity and mortality during the first month; and the length of postoperative hospital stay.

RESULTS:
Data from 136 patients (69 in the RIPC group and 67 in the control group) were analyzed. The RIPC group had on average a 5.9 μmol lower peak level of TBIL than the control group; the mean difference is −5.9, and the 95% confidence interval (CI) reverses to −17.9 to 6.1. There were no significant differences between the 2 groups in liver function test at postoperative days 1, 3, and 5; postoperative morbidity and mortality during the first month; and the length of postoperative hospital stay.

CONCLUSIONS:
We found no evidence that RIPC can reduce postoperative liver injury after hepatectomy.
Optimal Arrangements of Tetracene Molecule Pairs for Fast Singlet Fission
Authors: Buchanan Eric A , Havlas Zdeněk , Michl Josef 
Published: September 2019

Abstract
In search for a qualitative understanding of the effects of molecular packing on singlet fission (SF) rate, a simplified version of the frontier orbital model is described and illustrated on a pair of tetracene molecules. To identify all favorable physically accessible pair geometries, all significant local maxima of the square of the electronic matrix element for SF have been located within the six-dimensional space of possible arrangements of two rigid bodies, using a grid of over 4.7 × 108 pair geometries. Those at which the molecules interpenetrate were excluded using a hard-sphere model. The effects of intermolecular interaction on the SF energy balance and thus its rate constant kSF were approximated using Marcus theory at each of the maxima using the same simplified version of the frontier orbital model. Starting at these local maxima, the pair geometries were optimized for maximum kSF and the 21 best are reported along with their computed Davydov splitting and triplet biexciton binding energies. The optimal pair structures at the resulting maxima follow qualitative rules published previously and further elaborated here.
Alcoholic Liver Disease Epidemiology in the United States: A Retrospective Analysis of 3 US Databases
Authors: Dang Katherine , Hirode Grishma , Singal Ashwani K. , Sundaram Vinay , Wong Robert J. 
Published: September 2019

OBJECTIVES:
Alcoholic liver disease (ALD) prevalence, particularly the subset with advanced liver disease, is not well defined. Herein, we aim to provide a comprehensive assessment of ALD epidemiology across the spectrum of disease severity and across different settings using 3 unique US databases.

METHODS:
We performed a retrospective, observational study of US adults with ALD using 2001–2016 National Health and Nutrition Examination Survey (NHANES), 2007–2014 Nationwide Inpatient Sample (NIS), and 2007–2017 United Network for Organ Sharing (UNOS) registry. ALD in the NHANES was defined using clinical laboratory data and self-reported alcohol use, among which fibrosis-4 score of >2.67 defined stage ≥3 fibrosis. Alcoholic cirrhosis (AC) in the NIS was identified using International Classification of Diseases, Ninth Revision codes. ALD in the UNOS was identified using UNOS coding.

RESULTS:
From 2001–2002 to 2015–2016, the overall weighted ALD prevalence was stable from 8.8% to 8.1% (P = 0.102), whereas the proportion of ALD with stage ≥3 fibrosis increased from 2.2% (95% CI: 0.4–4.0) to 6.6% (95% CI: 2.0–9.9; P = 0.007) (NHANES). From 2007 to 2014, the number of hospitalizations among patients with AC per 1,000 increased by 32.8%, and the proportion of hospitalizations among the patients with AC with ≥3 cirrhosis complications increased from 11.6% in 2007 to 25.8% in 2014 (P
trend < 0.0001) (NIS). From 2007 to 2017, the total number of adults with ALD listed for liver transplant increased by 63.4% and the proportion with concurrent hepatocellular carcinoma increased by 178% (UNOS).

DISCUSSION:
Among these 3 US databases, consistent observations of increasing ALD severity emphasize the urgent need for greater awareness about the consequences of unhealthy alcohol use and interventions aimed specifically at addressing alcohol use disorders.
Histologic Findings of Advanced Fibrosis and Cirrhosis in Patients With Nonalcoholic Fatty Liver Disease Who Have Normal Aminotransferase Levels
Authors: Gawrieh Samer , Wilson Laura A. , Cummings Oscar W. , Clark Jeanne M. , Loomba Rohit , Hameed Bilal , Abdelmalek Manal F. , Dasarathy Srinivasan , Neuschwander-Tetri Brent A. , Kowdley Kris , Kleiner David , Doo Edward , Tonascia James , Sanyal Arun , Chalasani Naga ,   and the NASH Clinical Research Network
Published: September 2019

OBJECTIVES:
Patients with nonalcoholic fatty liver disease (NAFLD) and normal aminotransferase levels may have advanced liver histology. We conducted a study to characterize the prevalence of and factors associated with advanced liver histology in patients with histologically characterized NAFLD and normal aminotransferase levels.

METHODS:
We evaluated 534 adults with biopsy-proven NAFLD and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <40U/L within 3 months of their liver biopsy. Histological phenotypes of primary interest were nonalcoholic steatohepatitis (NASH) with stage 2–3 fibrosis (NASH F2-3) and cirrhosis. Using multiple logistic regression models with Akaike's Information Criteria (AIC), we identified variables associated with these histological phenotypes. We developed and internally validated their clinical prediction models.

RESULTS:
The prevalence of NASH F2-F3 and cirrhosis was 19% and 7%, respectively. The best multiple regression AIC model for NASH F2-3 consisted of type 2 diabetes, white race, lower low-density lipoprotein, lower platelet count, higher AST/ALT ratio, higher serum triglycerides, and hypertension. The best AIC model for cirrhosis consisted of lower platelet count, lower AST/ALT ratio, higher body mass index, and female sex. The area under the receiver operator curves of the prediction models were 0.70 (95% confidence interval: 0.65–0.76) for detecting NASH-F2-3 and 0.85 (95% confidence interval: 0.77–0.92) for detecting cirrhosis. When models were fixed at maximum Youden's index, their positive and negative predictive values were 35% and 88% for NASH F2-F3 and 30% and 98% for cirrhosis, respectively.

DISCUSSION:
Clinically significant histological phenotypes are observed in patients with NAFLD and normal aminotransferase levels. Our models can assist the clinicians in excluding advanced liver histology in NAFLD patients with normal aminotransferase levels.
Graft-Versus-Host Disease After Pancreatic Transplantation
Authors: Saffo Saad , Peng Chengwei , Kibbi Nour , Patel Natalie , Robert Marie E. , Adekolu Evelyn , Asch William S. , Sanchez Mayra 
Published: September 2019

ABSTRACT
Graft-versus-host disease (GVHD) is a common complication of hematopoietic stem cell transplantation but can rarely occur after solid organ transplants. Small bowel and liver transplants are typically implicated, but solid organ transplant-associated GVHD has also been associated with other organs. We present a 40-year-old diabetic woman who underwent renal followed by pancreatic transplantation over a span of 21 months and ultimately developed acute classic GVHD. The diagnosis proved to be challenging in the context of confounding infections and inconclusive bone marrow and skin biopsy findings. She had multiorgan failure at the time of endoscopic confirmation and died after having minimal response to aggressive immunosuppression.
Isolated Intestinal Angioedema Secondary to a Food Allergen
Authors: Hassan Ammar , Weissman Simcha , Sciarra Michael A. , Sotiriadis John 
Published: September 2019

ABSTRACT
Intestinal angioedema is the dilatation or thickening, or both, of a segment of bowel. It is a diagnostic phenomenon that manifests itself clinically as acute abdominal pain, diarrhea, and emesis. Generally, this condition occurs in tandem with angioedema of the face and tongue and/or in association with the use of an angiotensin-converting enzyme inhibitor (ACE-I). We present a rare case of a 63-year-old woman who developed isolated intestinal angioedema due to the ingestion of a food allergen.
Factors That Affect Prevalence of Small Intestinal Bacterial Overgrowth in Chronic Pancreatitis: A Systematic Review, Meta-Analysis, and Meta-Regression
Authors: El Kurdi Bara , Babar Sumbal , El Iskandarani Mahmoud , Bataineh Adam , Lerch Markus M. , Young Mark , Singh Vijay P. 
Published: September 2019

OBJECTIVES:
Small intestinal bacterial overgrowth (SIBO) can complicate chronic pancreatitis (CP) and interfere with management. Its predisposing factors in CP and treatment response are unknown. In this review, we evaluated factors affecting disease burden.

METHODS:
A computerized search of PubMed and EMBASE databases from inception through May 2019 was done for studies correlating SIBO with CP. Studies were screened, and relevant data were extracted and analyzed. Pooled prevalence, odds ratio (OR), and meta-regression were performed using the random effects model as classically described by Borenstein et al. (2009). SIBO's relation to diabetes mellitus (DM), pancreatic exocrine insufficiency (PEI), narcotic use, and proton-pump inhibitor use was investigated. Treatment response was pooled across studies. P value < 0.05 was considered significant.

RESULTS:
In 13 studies containing 518 patients with CP, SIBO prevalence was 38.6% (95% confidence interval [CI] 25.5–53.5). OR for SIBO in CP vs controls was 5.58 (95% CI 2.26–13.75). Meta-regression showed that PEI and the diagnostic test used were able to explain 54% and 43% of the variance in SIBO prevalence across studies, respectively. DM and PEI were associated with increased SIBO in CP with OR (2.1, 95% CI 1.2–3.5) and OR (2.5, 95% CI 1.3–4.8), respectively. Symptomatic improvement was reported in 76% of patients after SIBO treatment.

DISCUSSION:
SIBO complicates 38% of CP with OR of 5.58 indicating a predisposition for this condition. PEI correlates with SIBO in CP and might play a role in pathophysiology. DM and PEI are associated with increased SIBO in CP. Treatment of SIBO may lead to symptomatic improvement.