bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of hiatal hernias: comparison of high-resolution manometry and physician reported in an obese-predominant population
Authors: Shah-Khan Sardar Momin , Chaudhary Fahad , Abdelqader Abdelhai , Kupec Justin T. , Szoka Nova 
Published: May 2019

BackgroundThe diagnosis of a hiatal hernia (HH) can be made by barium oesophagram or upper endoscopy. Data regarding the ability of high-resolution manometry (HRM) with oesophageal pressure topography (OPT) to identify HH remains limited. We aim to assess the diagnostic accuracy of the automated localisation on high-resolution manometry compared with physician visual interpretation on the detection of HH.MethodsPatients (n=181) from West Virginia, Pennsylvania, Maryland, Virginia and Ohio, undergoing HRM with OPT from 1 January 2015 to 1 December 2017 were reviewed. The BMIs of this patient population are of the highest in the USA. Demographics, presenting symptoms, laboratory data, endoscopic findings, radiographic findings, and HRM findings were collected. Diagnosis of HH through HRM automated identification of oesophageal landmarks were compared with diagnosis by physician visual interpretation of OPT.ResultsAutomated identification of HH using HRM had high specificity (99.1%), but low sensitivity (11.4%). Physician visual interpretation of OPT similarly had high specificity (82.9%, 83.8%), but low sensitivity (30.0%, 28.6%). Automated identification of HH had a greater positive predictive value (88.9%) compared with physician visual interpretation (52.5%, 52.6%) but was found to have a similar negative predictive value (63.9%) as physician visual interpretation (65.3%, 65.0%).ConclusionCompared with physician visual interpretation of OPT, automated identification of HH was more specific, but less sensitive in the diagnosis of HH. Use of automated identification of HH using HRM alone may lead to an increased number of false negatives, and subsequent underdiagnosis of this condition.
Exploratory, cross-sectional social network study to assess the influence of social networks on the care-seeking behaviour, treatment adherence and outcomes of patients with tuberculosis in Chennai, India: a study protocol
Authors: Nagarajan Karikalan , Das Bagavan 
Published: May 2019

IntroductionPoor treatment adherence and outcomes among patients with tuberculosis (TB) lead to drug resistance, and increased risk of morbidity, mortality and transmission of the disease in the community. Individual patient-level psychological and behavioural risk factors and structural-level social and health system determinants of treatment adherence and outcomes had been studied widely in India and other countries. There is an evidence gap on how care-seeking behaviour, treatment adherence and outcomes of patients with TB are influenced by their social network structure and the different support they received from social network members.Methods and analysisWe propose an exploratory, cross-sectional social network study to assess the social network structure of patients with TB in Chennai who recently completed their treatment under the Revised National Tuberculosis Control Program in India. We will employ egocentric personal social network survey to 380 patients with TB to generate their social network relationships and will retrospectively assess the types of support they received from different network members. Support received will be categorised as emotional support, resources support, appraisal support, informational support, spiritual support, occupational support and practical support. Social network size, composition, density, centrality and cohesion for individual patients with TB will be calculated and sociograms will be developed. Multinomial logistic regressions will be used to assess the relationship between the ‘structure of social network members’ and ‘social network supports’ and the differential treatment-seeking behaviour, treatment adherence and outcomes among patients with TB.Ethics and human protectionThe proposal was approved by the Institutional Review Board and Ethics Committee of the School of Public Health, SRM University in Kancheepuram. Confidentiality and privacy of participants will be protected. Duty of care for patients who have not completed treatment will be ensured by taking all possible measures to bring them back for treatment.
Endovascular Stroke Therapy Trends From 2011 to 2017 Show Significant Improvement in Clinical and Economic Outcomes
Authors: Rai Ansaar T. , Crivera Concetta , Kalsekar Iftekhar , Kumari Rashmi , Patino Nataly , Chekani Farid , Khanna Rahul 
Published: May 2019

Background and Purpose—
The purpose of this study was to evaluate trends in length of stay, discharge status, and costs among patients with acute ischemic stroke who underwent endovascular therapy (ET) between 2011 and 2017.

Methods—
Using a retrospective observational study design, acute ischemic stroke patients undergoing ET from 2011 to 2017 were identified in the Premier Healthcare Database. The Mann-Kendall trend test was performed to examine clinical and economic outcomes trends.

Results—

Among the 505 824 acute ischemic stroke patients, 11 811(2.3%) were treated with ET. Patients receiving ET had a significant increase in home discharge and a significant decrease in mortality (17.7% to 29.6%,
P
<0.01; 21.6% to 12.8%,
P
<0.01). There was a significant decline in length of stay from 11.7 days to 8.7 days (
P
<0.01). Total index admission costs declined ≈17% from 2011 to 2017 ($50 516.5–$42 026.9,
P
<0.01).

Conclusions—
Clinical and economic indicators significantly improved for acute ischemic stroke patients undergoing ET from 2011 to 2017.
The effect of routine preoperative interruption of dabigatran therapy on coagulation parameters and dabigatran plasma levels in a mixed surgical population
Authors: Brett Oliver F , Brett Christian N , Chin Paul KL 
Published: May 2019

Summary Dabigatran is an oral anticoagulant used for atrial fibrillation and venous thromboembolism. While an effective antibody reversal agent is available, its cost precludes routine use and the mainstay of preoperative management is timely dabigatran interruption. Unlike warfarin, there are no universally accepted protocols for interruption of dabigatran in the preoperative period and there is uncertainty around the interpretation of standard coagulation tests in the presence of dabigatran. We performed a prospective, observational pilot study in patients presenting for elective surgery to examine: 1) the preoperative plasma dabigatran concentrations on day of surgery associated with the local dabigatran interruption protocol, 2) the potential utility of dabigatran concentrations on day of surgery, and 3) the utility of standard coagulation tests in determining whether dabigatran concentrations were below a ‘safe’ threshold for surgery. We recruited patients presenting to pre-admission clinics for elective surgery. Dabigatran concentrations below 30 µg/L were considered adequate for proceeding with surgery. Data were obtained and analysed from 21 patients with a median (range) age of 70 (20–86) years. Median (range) dabigatran concentrations on the day of surgery were 5 (0–59) µg/L. Two patients had day of surgery concentrations exceeding 30 µg/L. Of the standard coagulation tests examined, only the thrombin clotting time (TCT) was abnormal for these two patients. Our interruption protocol was associated with safe dabigatran concentrations in most patients on the day of surgery. A minority of patients had dabigatran concentrations above the safe threshold, which were detectable by abnormal TCT results.
Opioid Consumption Rate Following Foot and Ankle Surgery
Authors: Kvarda Peter , Hagemeijer Noortje Catharina , Waryasz Gregory , Guss Daniel , DiGiovanni Christopher W. , Johnson Anne H. 
Published: May 2019

Background: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economic, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among all operative specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopedic foot and ankle (F&A) procedures. The aim of this study was to determine the opioid consumption rate after foot and ankle procedures and identify risk factors associated with higher use. Methods: A total of 535 patients who underwent foot and/or ankle surgery between August 2016 and March 2018 were included in the study. Each patient received a preoperative discussion about postoperative pain and expectations alongside a standardized handout. At the 2-week postoperative visit, the patients self-reported the amount of consumed opioids. Prescription details, number of opioid pills consumed, refill requests, pain-issue-related telephone calls, and additional physician/emergency department visits were documented. Patient demographics, comorbidities, use of regional anesthesia, hospitalization, surgery type/severity, and preoperative opioid use were collected. A total of 244 patients had a sufficiently complete data set for inclusion in the final cohort. Subjects had a mean age of 50 years (±16.3) and a body mass index (BMI) of 29 (±6.1). Sixty-six (27%) patients underwent a soft tissue procedure alone and 178 (73%) underwent a bony procedure. Results: On average, patients consumed 46.6% of the prescribed pills following a bony procedure and 42.4% after a soft tissue procedure, which resulted in a total of 4496 leftover pills. BMI, procedure type (bony vs soft tissue)/severity, and number of opioids prescribed were positively correlated with elevated consumption rates ( P = .008, P < .001, P < .001, P < .001, respectively). Conclusion: BMI, procedure type, and higher initial pill dispensation correlated with a larger number of consumed pills during the postoperative period. On average, patients took 42.4% of the prescribed opioid after soft tissue procedures and 46.6% after bony procedures, resulting in a significant number of unused pills. Future guidelines are necessary to improve postoperative pain management to prevent narcotic overprescription and minimize the downstream potential for unprescribed community opioid access. Level of Evidence: Level III, retrospective case series, analytic.
Using Virtual Reality to Compare Design Alternatives Using Subjective and Objective Evaluation Methods
Authors: Wingler Deborah , Joseph Anjali , Bayramzadeh Sara , Robb Andrew 
Published: May 2019

Objective: This study sought to develop a method that supports a more evidence-based approach to evaluating multiple design options in virtual reality (VR), combining subjective insights gathered using traditional approaches and objective feedback gathered using the VR platform. Additionally, this study sought to understand how objective data garnered from the VR platform could be used to compliment traditional evaluation strategies. Background: VR can be a viable research platform for supporting evidence-based design practices. Prior studies have predominately utilized experiential user feedback. While able to provide valuable subjective insights, these approaches are less effective in making objective comparisons between multiple designs alternatives. Method: A repeated measures study was conducted with nursing faculty. User feedback was captured through surveys, interviews, and the VR platform. Results: The survey, interview, and the objective VR data converged in terms of identifying the highest performing design option. Survey data showed that Room 2 performed best in terms of perceived physical access to supplies, unobstructed movement, and availability of space to accommodate additional equipment. VR data showed that participants in Room 2 had significantly higher visibility to both patient and care partners throughout their simulated interaction. Conclusion: Simulation-based evaluations in VR that use a combination of users’ subjective insights and objective data obtained from VR can be an effective tool for helping designers evaluate multiple design options. The use of scenario-based simulations provided a structured and clinically relevant approach to comparing three preoperative rooms, supporting a more robust assessment of users’ physical response to a simulated healthcare environment.
Surgical/orthodontic management of a large mandibular odontogenic keratocyst (OKC)
Authors: Atwal Amarpreet , Cottom Hannah , Doyle Peter , Sandler Jonathan 
Published: May 2019

The odontogenic keratocyst (OKC) is the third most common cyst of the jaw. OKCs are benign developmental cysts that are often locally destructive and large at presentation. They are usually identified during radiographic examination and require appropriate treatment planning to ensure optimal care. We present a very challenging case of a 12-year-old boy with a large mandibular OKC. The roots of several teeth were displaced, with both LR3 and LR5 unerupted and severely malpositioned. A multidisciplinary approach was therefore essential in view of the complexity, with joint planning and close liaison of treatment between the surgeon, orthodontist and general dental practitioner (GDP). This was fundamental to ensure the best possible outcome was achieved for the patient. CPD/Clinical Relevance: This case report aims to increase awareness of OKCs to GDPs and outlines the surgical, orthodontic and restorative challenges faced in the management of such cases.
Cerebellar Stellate Cell Excitability Is Coordinated by Shifts in the Gating Behavior of Voltage-Gated Na+and A-Type K+Channels
Authors: Alexander Ryan P.D. , Mitry John , Sareen Vasu , Khadra Anmar , Bowie Derek 
Published: May 2019

AbstractNeuronal excitability in the vertebrate brain is governed by the coordinated activity of both ligand- and voltage-gated ion channels. In the cerebellum, spontaneous action potential (AP) firing of inhibitory stellate cells (SCs) is variable, typically operating within the 5- to 30-Hz frequency range. AP frequency is shaped by the activity of somatodendritic A-type K+channels and the inhibitory effect of GABAergic transmission. An added complication, however, is that whole-cell recording from SCs induces a time-dependent and sustained increase in membrane excitability making it difficult to define the full range of firing rates. Here, we show that whole-cell recording in cerebellar SCs of both male and female mice augments firing rates by reducing the membrane potential at which APs are initiated. AP threshold is lowered due to a hyperpolarizing shift in the gating behavior of voltage-gated Na+channels. Whole-cell recording also elicits a hyperpolarizing shift in the gating behavior of A-type K+channels which contributes to increased firing rates. Hodgkin–Huxley modeling and pharmacological experiments reveal that gating shifts in A-type K+channel activity do not impact AP threshold, but rather promote channel inactivation which removes restraint on the upper limit of firing rates. Taken together, our work reveals an unappreciated impact of voltage-gated Na+channels that work in coordination with A-type K+channels to regulate the firing frequency of cerebellar SCs.
TUGAS DAN FUNGSI PESANTREN DI ERA MODERN
Authors: Maesaroh Nenden , Achdiani Yani 
Published: May 2019

Penelitian ini dilatarbelakangi oleh terjadinya modernisasi yang dilakukan oleh Pondok Pesantren Najaahaan yang semula berkonsep pesantren tradisional, saat ini sedang mengalami perubahan secara bertahap menjadi pesantren modern. Penelitian ini bertujuan untuk mengetahui perubahan tugas dan fungsi pesantren di era modern. Penelitian ini dilakukan dengan menggunakan pendekatan penelitian kualitatif dan metode studi deskriptif. Pengumpulan data dilakukan dengan menggunakan teknik observasi, wawancara, studi literatur dan studi dokumentasi. Informan penelitian terdiri dari pihak pengelola pesantren, santri, dan masyarakat di sekitar pesantren. Hasil penelitian ini menunjukan bahwa tugas pesantren di era modern adalah mempertahankan eksistensi dan fungsinya saat ini selain sebagai lembaga pendidikan ilmu agama serta penjaga nilai-nilai dan norma keagamaan masyarakat, salah satu cara mempertahankan eksistensi pesantren saat ini juga dengan menyelenggarakan pendidikan formal. Sedangkan fungsi pesantren secara umum adalah menciptakan dan mengembangkan kepribadian muslim yang dapat berperan aktif di dalam lingkungan masyarakat modern saat ini melalui fungsi pendidikan, religi, sosial serta penambahan fungsi ekonomi pada pesantren.
Choroidal Structural Changes Correlate with Severity of Diabetic Retinopathy in Diabetes Mellitus
Authors: Wang Hui , Tao Yong 
Published: May 2019

Abstract
Background This study aims to investigate the choroidal thickness and choroidal vascular density parameters and their correlation with severity of diabetic retinopathy (DR) in diabetes mellitus (DM) patients. Methods An observational cross-sectional study was conducted of 104 eyes, which were divided into 4 groups: Healthy controls (n = 38), DM with no DR eyes (n = 22), non-proliferative DR (NPDR) eyes (n = 24), proliferative DR (PDR) eyes (n = 20). Optical coherence tomography (OCT) was performed. The total choroidal area (TCA), stromal area (SA), the luminal areas (LA) and the ratio of the luminal to choroidal area were compared. Results The ratio of the luminal to choroidal area values was 67.53 ± 6.20 in controls and 63.43 ± 4.47 in DM eyes (P < 0.001). But there were no statistically significant differences in retinal nerve fiber layer (RNFL), retinal thickness and subfoveal choroidal thickness (SCT) measurements between the two groups (P = 0.407, P = 0.654 and P = 0.849; respectively). The vessel density values were significantly different in DM with no DR eyes, NPDR eyes and PDR eyes. (P < 0.001 for SCT, TCA and SA). The ratio of the luminal to choroidal area in the three groups were significant different(P = 0.019). Conclusion Eyes of patients with DM showed decreased ratio of the luminal to choroidal area compared with normal controls. Choroidal thickness and the ratio of the luminal to choroidal area significantly increased with severity of DR eyes compared with DM eyes and normal. Changes in the ratio of the luminal to choroidal area may predict DR development or recurrence before they are otherwise evident clinically. Choroidal blood flow deficit can be an early pathologic change in DR.
Ketersediaan dan Kualitas Airtanah pada Akuifer Tidak Tertekan Di Kecamatan Jawilan dan Kopo, Kabupaten Serang
Authors: Purnama Setyawan 
Published: May 2019

Tujuan dari penelitian ini adalah (1) mengetahui sistem akuifer di daerah penelitian, (2) menghitung ketersediaan airtanah pada akuifer tidak tertekan dan (3) menganalisis kualitas airtanahnya. Sistem akuifer diketahui dengan melakukan interpretasi data geolistrik. Potensi akuifer tidak tertekan dihitung secara kualitatif melalui skoring dan tumpang susun antara Peta Kedalaman Muka Airtanah, Peta Fluktuasi Airtanah dan Peta Kualitas Airtanah. Volume akuifer ditentukan berdasarkan perkalian antara luas wilayah masing-masing potensi dan tebal akuifer. Ketersediaan airtanah dihitung berdasarkan asumsi aliran airtanah statik, sedangkan hasil aman pengambilan airtanah ditentukan berdasarkan parameter fluktuasi airtanah, luas akuifer dan spesifik yield. Kualitas air dianalisis berdasarkan pengambilan sampel air pada sumur gali. Hasil penelitian menunjukkan bahwa di daerah penelitian ditemukan adanya akuifer semi tertekan dan akuifer tidak tertekan. Ditinjau dari potensinya, ketersediaan airtanah pada akuifer tidak tertekan sebesar 1.205.967.345 m3, dengan hasil aman pengambilan airtanah sebesar 54.585.307 m3/tahun. Untuk kualitas air, secara umum baik, meskipun beberapa parameter seperti kalsium, magnesium, mangan dan COD kadarnya telah melampaui baku mutu di beberapa sampel.ABSTRACT The objectives of the research are (1) knowing the aquifer system in research area, (2) calculate groundwater availability in unconfined aquifer and (3) analysis the groundwater quality. Aquifer system is known by interpretation of geoelectric data. Groundwater potency is calculated qualitatively by scoring and overlay of Groundwater Depth Map, Groundwater Fluctuation Map and Groundwater Quality Map. Aquifer volume is calculated by multiplied area width of each potency and aquifer thickness. Amount of groundwater is calculated base on static groundwater flow assumption, whereas safe yield of groundwater exploitation is determined base on parametre groundwater fluctuation, aquifer width and specific yield. Groundwater quality are analized by groundwater samples that taken from dug well. Result of research show that there are two aquifer type in research area i.e. semi confined aquifer and unconfined aquifer. The potency of unconfined aquifer is 1.205.967.345 m3, with safe yield 54.585.307 m3/year. For groundwater quality, generally good, although some parameters have concentration exceeded the standard in some samples such as calcium, magnesium, manganese and COD.
Uma proposta de princípios para a construção de ambientes de aprendizagem com orientação construtivista para o ensino em Administração
Authors: Mondadori Mauricio Grazziotin , Santos Eduardo Ribas 
Published: May 2019

Diversas pesquisas sobre abordagens alternativas de ensino emAdministração, e que buscam resolver as limitações do método tradicional baseado emaulas expositivas, vêm sendo desenvolvidas. Entretanto, são poucos os estudosaprofundados sobre o desenvolvimento de ambientes de aprendizagem efetivos. Apesquisa, cujos resultados são apresentados neste artigo, compreende a elaboração deum framework composto de um conjunto de princípios para a construção de ambientesde aprendizagem com orientação construtivista, assim como uma ilustração de suaaplicabilidade para o ensino na área de Administração. Com base em uma revisão deestudos existentes, foi proposta uma síntese de princípios. A partir destes, foi construídoum protótipo de ambiente de aprendizagem aplicado à área de empreendedorismo
Desenvolvendo o cálculo mental e as 4 operações com o uso do software educativo Tux of the Math Comand.
Authors: Siqueira Claudiomir Feustler Rodrigues de 
Published: May 2019

Este artigo apresenta resultados de um projeto de ensino de matemática com o uso de software educativo, o qual visava motivar e reforçar o aprendizado de 96 alunos dos 6os anos de uma escola municipal na cidade de Novo HamburgoRS. No início do estudo o índice de rejeição à matemática estava muito alto e os alunos apresentavam diversas dificuldades na resolução das atividades. Também foi observado que o aprendizado estava muito abaixo do ano escolar em que se encontravam. Os resultados indicam uma significativa mudança de atitude dos alunos quanto à motivação demonstrada nas participações em aula e também na qualidade das resoluções das atividades.
Panorama do Ensino de Engenharia de Software em Cursos de Graduação Focado em Teste de Software: Uma Proposta de Aprendizagem Baseada em Jogos
Authors: Silva Tarcila Gesteira da , Müller Felipe Martins , Bernardi Giliane 
Published: May 2019

Este trabalho apresenta um panorama do ensino de engenharia de software em cursos de graduação na área de computação com base nos currículos de referência da Sociedade Brasileira de Computação (SBC) e da Association for Computing Machinery(ACM), focando no conteúdo referente ao tópico de teste de software. Com base neste panorama é apresentada uma proposta de aprendizagem baseada em jogos para apoio ao ensino-aprendizagem de estratégias de teste de software.