bluuebunny/crossref_metadata_2025_split huggingface dataset:
De winsten van zorginstellingen
Authors: Suijs Jeroen , Verbon Harrie 
Published: May 2018

Profits obtained by health organizations
In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.We calculate and describe profits obtained by health organizations in The Netherlands in the years 2014 and 2015. We distinguish between profit and not-for-profit organizations. We find that on average net profits amount to about 2 percent on turnover with a peak of more than 3 percent for mental-healthcare organizations. If we take the size of organizations into account, we find that for-profit organizations with a turnover of less than 1 million euro tend to have on average net profit rates of 4 percent to more than 5 percent with peaks amounting to more than 50 percent. We are not yet able to come up with explanations for these excessively high profit rates in parts of the Dutch health care sector. On the other hand, the highest losses can be found in small-sized organizations as well. We delved deeper into the financial accounts of a few for-profit organizations and found indications of misreporting of turnover or number of treatments. On the other hand, bad management and unhealthy cost structures might explain why some organizations incur excessive big losses. The sector does not appear to be well monitored by the government.
Pyriform Widening with Concurrent Z-Plasty for Nasal Valve Surgery: Revisiting a Time-Tested Technique
Authors: Gilde Jason E. , Handler Ethan B. , Shih Charles W. 
Published: May 2018

Introduction: Nasal obstruction may originate from the nasal valve. Many surgical techniques to improve the nasal valve are available but may fail to correct obstruction originating from a narrow pyriform aperture. We present a technique to widen the narrow pyriform aperture and review the literature. Materials and Methods: The article highlights a retrospective case series of patients who underwent pyriform widening with concurrent Z-plasty (PWZ) for nasal obstruction. Subjective measures of nasal obstruction were analyzed using the Nasal Obstruction Symptom Evaluation (NOSE) scale. The procedure consists of an incision made anterior to the inferior turbinate along the inferior aspect of the lateral bony pyriform. The periosteum is elevated, and a rongeur is used to widen the exposed bone. After oblique incisions are made, soft tissue flaps are elevated and transposed. The literature is reviewed. Results: Six adults underwent PWZ for nasal obstruction from 2011 through 2014. Three patients had prior nasal surgery. All patients reported subjective improvement, with mean NOSE scale scores of 15.7 preoperatively and 9.7 postoperatively. In the literature, all prior articles on pyriform aperture widening report positive outcomes. Conclusions: The surgical correction of nasal obstruction is challenging, given the complexity of the nasal valve. Upon review of the literature and analysis of our experience, we advocate consideration of PWZ in patients with anatomic obstruction at the level of the pyriform rim who have failed previous procedures or as an adjunct to primary nasal valve surgery. Further research is needed to examine the effects of pyriform widening on nasal obstruction.
Le développement local par la culture : cinq propositions pour des villes culturelles
Authors: Leclerc Yvon 
Published: May 2018

Les recherches menées par l’auteur durant plus de vingt ans sur l’évolution des territoires l’ont conduit à présenter la culture comme le premier élément à considérer dans le développement urbain ou rural, car elle intègre le respect de l’histoire, le sens du lieu, le patrimoine sous toutes ses formes et les pratiques des habitants. Il a observé que les projets de nature culturelle provoquent des réactions intangibles qui ne sont pas toujours prises en compte dans le développement des territoires. À une époque où les villes et les régions sont en concurrence, la beauté d’un lieu, la fierté et le sentiment d’appartenance qui en découlent sont des facteurs de développement. L’auteur démontre, à partir d’études de cas, la pertinence du recours à une stratégie culturelle, car elle stimule la créativité, l’innovation et la mobilisation des acteurs locaux.
Adult and Lifelong Learning as Tools for Organisational Adaptation and Change Management
Authors: Laitinen Ilpo 
Published: May 2018

Significant structural reforms of public administration are commencing in Finland from 2017. Firstly, municipalities and cities are being combined into larger entities. Secondly, five social-welfare and healthcare regions are to be created, with that level being responsible for arranging services in this field. Thirdly, the City of Helsinki is outsourcing service provision. This study shows that in current thinking on services, the foundations of reform rest with customers and new service models. Little consideration has been given to the needs of clients or the potential that technology offers for the rationalisation of service practices. I consider the key change to involve a transition from closed systems to open ones. Open systems are core elements in the theory of complex adaptive systems, as discussed below. Public organisations are becoming less hierarchical and status-centred; they can be seen as relationships that lead to networks, interaction and understanding. The way public organisations are developing shows they are moving away from hierarchical bureaucracy towards more open, network-based and self-directed practices. Information, its accessibility and interpretation and the organisation's ability to use it have been internal drivers for change within organisations, and these are linked to continuous learning. The lower the predictability of organisational activities and the greater the uncertainty about everything continuing unchanged, the more important it becomes to enhance continuous learning, i.e. lifelong learning as an adaptation.
Effectiveness of a direct-to-consumer written health education program in the reduction of benzodiazepine and sedative-hypnotic use in an elderly population at a single Veterans Affairs medical center
Authors: Erwin William J. , Goodman Courtney , Smith Tammy 
Published: May 2018

Abstract

Introduction:
The use of benzodiazepines and sedative-hypnotics in the elderly is associated with a significant risk of delirium, falls, fractures, cognitive impairment, and motor vehicle accidents. This quality improvement project applies a direct-to-consumer intervention to an elderly veteran population to reduce the use of these medications.

Methods:
Patients aged 75 and older currently taking a benzodiazepine and/or a sedative-hypnotic were included in the project. Direct-to-consumer education intervention letters were mailed to patients within 30 days of their next appointment. Their providers were emailed a questionnaire after the patient's appointment. Providers were asked if the letter prompted a conversation regarding medication use, whether the provider initiated discussion regarding a taper, and whether a specific taper plan was developed. Medical records were reviewed to determine if a reduction in dose or discontinuation occurred.

Results:
Fifty-nine direct-to-consumer education letters were mailed to the patients. Follow-up questionnaires were e-mailed to 44 providers, and 27 providers responded. Twenty-two percent of patients had their benzodiazepine and/or sedative hypnotic dose reduced or discontinued after their follow-up appointment. Sixty-seven percent of veterans initiated a conversation with their provider regarding their medication with 74% of providers discussing dose reduction. Fifty-six percent of recipients developed a specific taper plan with their provider.

Discussion:
The data from this project suggests that direct-to-consumer patient education can reduce the exposure to benzodiazepines and sedative-hypnotics in an elderly veteran population. More data is needed on larger populations to further explore the benefit of direct-to-consumer interventions.
Role of antidepressants in the treatment of adults with anorexia nervosa
Authors: Marvanova Marketa , Gramith Kirstin 
Published: May 2018

Abstract

Introduction:
Anorexia nervosa (AN) is a severe psychiatric disorder that is difficult to treat and is associated with frequent relapses and high mortality rates. Psychiatric symptomatology (eg, depression, anxiety, obsessive-compulsive disorder/behaviors) are common comorbidities. This review provides current information about safety and efficacy of antidepressant therapy for management of AN in adults.

Methods:
A literature review of randomized controlled trials, open-label studies, and case reports with adults or adults/adolescents was conducted. PubMed and Medline were searched using anorexia management and treatment, antidepressants, selective serotonin reuptake inhibitors (SSRIs), fluoxetine, sertraline, citalopram, and mirtazapine in AN, relapse prevention in AN, and psychotropic medications in AN.

Results:
The role and utility of antidepressants in AN were published in double-blind, placebo-controlled studies; open-label trials; and a retrospective study. Antidepressants should not be used as sole therapy for AN although their use for confounding symptomatology makes discerning efficacy difficult as they are given together with other therapies. Neurobiological changes due to starvation and AN itself complicate results interpretation. For safety, tricyclic antidepressants and monoamine oxidase inhibitors are not recommended, and bupropion is contraindicated. Use of SSRIs during acute treatment lacks efficacy. Use of SSRIs—primarily fluoxetine and to some extent citalopram, sertraline, or mirtazapine—may aid in relapse prevention and improvement of psychiatric symptomatology in weight-restored anorexic patients.

Discussion:
Health care professionals should use clinical judgment regarding fluoxetine or possibly citalopram, sertraline or mirtazapine as adjunctive treatment to psychotherapy for relapse prevention, improvement of depressive and anxiety symptoms, and/or obsessive-compulsive behaviors unresolved with nutritional rehabilitation and psychotherapy.
Antiepileptic drugs and suicide-related outcomes in bipolar disorder: A descriptive review of published data
Authors: Caley Charles F. , Perriello Emily , Golden Julia 
Published: May 2018

Abstract

Introduction:
In January 2008 the US Food and Drug Administration issued a warning to healthcare professionals about the potential for an increased risk of suicidal thinking and behavior associated with antiepileptic drugs (AEDs). Given that AEDs are important for treating bipolar disorder (BD), a better understanding of suicide-related events is necessary.

Methods:
A PubMed search was performed using the following search terms: anticonvulsant OR valpro* OR carbamazepine OR lamotrigine OR oxcarbazepine OR topiramate AND bipolar AND suicid*. The objective was to identify published investigations reporting rate and/or risk data of suicide-related outcomes in BD patients treated with AED monotherapy.

Results:
The search identified 323 reviewable citations, with 13 of these studies (4.0%) being reviewed. Valproate was studied most often, and lithium treatment was frequently used as a reference group. Carbamazepine and lamotrigine had small treatment exposure durations. Suicide attempts and suicide deaths were studied the most; a few trials investigated suicidal thinking and/or hospitalizations for suicidal behavior. Suicide attempt rates occurred in the following order: no treatment &gt; carbamazepine &gt; valproate &gt; lithium, while suicide death rates were: no treatment &gt; valproate &gt; lithium &gt; carbamazepine. For valproate, the risk of suicide attempts and suicide death appeared higher than lithium, but lower than no treatment.

Discussion:
Investigating suicide-related events for AEDs in BD is difficult; more data are necessary for valproate, carbamazepine, and lamotrigine. An improved understanding of AED treatment and suicide-related events in BD may help pharmacists become more effective at supporting their patients with BD.
Implementation and evaluation of Parkinson disease management in an outpatient clinical pharmacist–run neurology telephone clinic
Authors: Stefan Teodora Cristina , Elharar Nicole , Garcia Guadalupe 
Published: May 2018

Abstract
Parkinson disease (PD) is a progressive, debilitating neurodegenerative disease that often requires complex pharmacologic treatment regimens. Prior to this clinic, there was no involvement of a clinical pharmacy specialist (CPS) in the outpatient neurology clinic at the West Palm Beach Veterans Affairs Medical Center. This was a prospective, quality-improvement project to develop a clinical pharmacist–run neurology telephone clinic and evaluate pharmacologic and nonpharmacologic interventions in an effort to improve the quality of care for patients with PD. Additionally, the CPS conducted medication education groups to 24 patients with PD and their caregivers, if applicable, at this medical center with the purpose of promoting patient knowledge and medication awareness. Medication management was performed via telephone rather than face to face. Only patients with a concomitant mental health diagnosis for which they were receiving at least one psychotropic medication were included for individual visits due to the established scope of practice of the CPS being limited to mental health and primary care medications. Data collection included patient and clinic demographics as well as pharmacologic and nonpharmacologic interventions made for patients enrolled from January 6, 2017, through March 31, 2017. A total of 49 pharmacologic and nonpharmacologic interventions were made for 10 patients. We successfully implemented and evaluated a clinical pharmacist–run neurology telephone clinic for patients with PD. Expansion of this clinic to patients with various neurological disorders may improve access to care using an innovative method of medication management expertise by a CPS.
Distribution and Prevalence of Myxobolus cerebralis in Postfire Areas of Plumas National Forest: Utility of Environmental DNA Sampling
Authors: Richey Christine A. , Kenelty Kirsten V. , Van Stone Hopkins Kristina , Stevens Brittany N. , Martínez-López Beatriz , Barnum Samantha M. , Hallett Sascha L. , Atkinson Stephen D. , Bartholomew Jerri L. , Soto Esteban 
Published: May 2018

Abstract
Myxobolus cerebralis is a myxozoan parasite and the etiological agent of whirling disease in salmonids. The parasite's life cycle involves waterborne spores and requires both a salmonid fish and the benthic freshwater oligochaete worm Tubifex tubifex (Oligochaeta: Tubificidae). Wildfires can lead to the erosion of fine sediments into stream channels and have been implicated as promoting environmental conditions that are suitable for the survival and success of T. tubifex, whose presence in turn can affect the prevalence of M. cerebralis. Analysis of environmental DNA (eDNA) has the potential to be a powerful tool for evaluating the presence of microorganisms, for which direct observation is impossible. We investigated the presence of M. cerebraliseDNA in river water and river sediment samples collected from areas affected by recent fire activity in Plumas National Forest, California. We compared eDNA loads in the environment to M. cerebralis infection in T. tubifex and sentinel-exposed Rainbow Trout Oncorhynchus mykiss and the presence of T. tubifex lineages in the same environment. For the latter, we developed a multiplex quantitative PCR assay for detection of T. tubifex lineages I, III, and V. Lineage IIIT. tubifex and M. cerebralis (eDNA as well as DNA extracted from fish and worm tissues) were detected only in samples obtained from areas affected by the Moonlight wildfire. The association between M. cerebralis infection in sentinel-exposed fish and eDNA detection in environmental samples only approached significance at a P-value of 0.056. However, given the difference in relative effort between the two sampling methods (host versus nonhost environment), our data suggest that eDNA sampling of water and substrate is a promising approach for surveillance of myxozoan fish parasites.
Histopathological Alterations in the Gonad of Megapitaria squalida (Mollusca: Bivalvia) Inhabiting a Heavy Metals Polluted Environment
Authors: Yee-Duarte Josué Alonso , Ceballos-Vázquez Bertha Patricia , Arellano-Martínez Marcial , Camacho-Mondragón Marian Alejandra , Uría-Galicia Esther 
Published: May 2018

Abstract
The gonadal health status of the chocolate clam Megapitaria squalida collected from the Santa Rosalía mining port and San Lucas beach (reference site), Gulf of California, Mexico, was assessed through histological analysis of the reproductive tissue, from which the histopathological alteration index (HAI) was determined. In addition, copper and iron accumulation in tissue was revealed using histochemical techniques. Our results showed a large presence of copper (30%) and iron (45%) only in the gonad tissue of clams from Santa Rosalía, in which histopathological alterations observed were inflammatory responses, degenerative–progressive processes, cell death, and response to infectious agents. The HAI was significantly higher in Santa Rosalía specimens (mean ± SE, 72.18 ± 6.12) than in San Lucas clams (4.60 ± 1.07). At San Lucas beach, a higher prevalence of histopathological alterations occurred in clams in the spent stage (43.2%) and in autumn (18.4%) and winter (17.8%) in concordance with the normal reproductive rest period, whereas at Santa Rosalía a higher prevalence occurred in clams at the ripe stage (76.9%) and in spring (83.7%). In conclusion, our results showed the deteriorated health condition of gonads in M. squalida from the Santa Rosalía mining port, which suggests there is a relationship with chronic exposure to local high levels of heavy metals. The high prevalence and intensity of histopathological alterations in the gonad suggest a strong adverse effect on gametogenesis, gamete quality, and, ultimately, in the reproductive potential of M. squalida at this site.
RhIII‐Catalyzed C−H Activation: Mizoroki–Heck‐Type Reaction of Maleimides
Authors: Bettadapur Kiran R. , Sherikar Mahadev Sharanappa , Lanke Veeranjaneyulu , Prabhu Kandikere Ramaiah 
Published: May 2018

AbstractMaleimides are not known to undergo oxidative‐Heck reaction because they lack a syn‐periplanar β‐hydrogen atom. Herein, we report a C−H activation‐based Mizoroki–Heck‐type reaction of maleimides using ketone as the directing group. The reaction utilizes a RhIII‐catalyst along with Ag2CO3 as the oxidant to carry out a base‐mediated formal β‐hydride elimination.
Kontrolle der Selbstmetallierungsrate von Tetraphenylporphyrinen auf Cu(111) durch Funktionalisierung mit Cyangruppen
Authors: Lepper Michael , Köbl Julia , Zhang Liang , Meusel Manuel , Hölzel Helen , Lungerich Dominik , Jux Norbert , de Siervo Abner , Meyer Bernd , Steinrück Hans‐Peter , Marbach Hubertus 
Published: May 2018

AbstractDie Reaktionsgeschwindigkeit der Selbstmetallierung von Freie‐Base‐Tetraphenylporphyrinen (TPPs) auf Cu(111) nimmt mit zunehmender Zahl der Cyangruppen in para‐Position der Phenylringe (n=0, 1, 2, 4) systematisch ab. Die Ergebnisse basieren auf Messungen mit isothermer Rastertunnelmikroskopie. Bei Raumtemperatur adsorbieren alle untersuchten Freie‐Base‐TPP‐Derivate als individuelle Moleküle mit klar definierter Orientierung entlang den dichtest gepackten Cu‐Substratreihen. Durch Heizen auf 400 K bilden sich durch intermolekulare CN‐Cu‐CN‐Bindungen lineare Dimere und/oder Multimere. Parallel dazu kann die Selbstmetallierung der Freie‐Base‐Porphyrine nach einer Reaktion 1. Ordnung stattfinden. Für Tetracyan‐funktionalisierte Moleküle nimmt die Reaktionsgeschwindigkeit um einen Faktor von >20 gegenüber der von nicht‐funktionalisierten Molekülen ab. Dies entspricht einer Zunahme der Aktivierungsenergie von 1.48 auf 1.59 eV. DFT‐Rechnungen geben einen tieferen Einblick in die Rolle der elektronenziehenden Cyangruppen.
A thermodynamic framework for modeling semiclathrate hydrate phase stability conditions in gas + tetra‐n‐butyl ammonium halide aqueous solution system
Authors: Parhizgar Hossein , Javanmardi Jafar , Mohammadi Amir H. , Moshfeghian Mahmood , Parvasi Payam 
Published: May 2018

AbstractTo estimate the dissociation conditions of semiclathrate hydrates in gas + tetra‐n‐butyl ammonium halide aqueous solution systems, we introduce an extended thermodynamic framework, which was originally proposed by Javanmardi and colleagues for modeling of gas hydrate dissociation conditions in aqueous solutions of electrolytes (12 [1998] 219–222, Energy and Fuels). For evaluating the hydrate dissociation conditions, we apply the van der Waals–Platteuw theory. In addition, we incorporate the Peng–Robinson equation of state and the activity coefficient model of Pitzer and Mayorga to respectively calculate gas/vapor fugacity and tetra‐n‐butyl ammonium halide activity coefficient. Using this model, we have estimated the semiclathrate hydrate dissociation conditions in the systems of CH4, N2, or CO2 + tetra‐n‐butylammonium bromide + water; CO2 + tetra‐n‐butylammonium fluoride + water; and CH4 or CO2 + tetra‐n‐butylammonium chloride + water systems. The model results are found in satisfactory agreement with the selected experimental data collected from literature. Also, the average absolute temperature deviations for the studied systems are about 0.3 K.
Severity of congenital heart defects associated with assisted reproductive technologies: Case series and review of the literature
Authors: Patil Avinash S. , Nguyen Cynthia , Groff Katie , Wu Jonathan , Elliott John , Gunatilake Ravindu P. 
Published: May 2018

ObjectiveAssisted reproductive technology (ART) has been associated with a higher incidence of congenital anomalies, including a specific increase in the rate of congenital heart defects (CHD). In this study, the rate of CHD in pregnancies resulting from ART at a single high‐risk pregnancy referral center are compared to the published literature.MethodsPregnancies were screened by fetal echocardiography for the indication of ART over a 2‐year period. CHD were classified as either mild or severe based on the need for postnatal surgical intervention. Results were compared to findings from a literature review of studies examining CHD in pregnancies resulting from ART since 1980.ResultsOver the course of two years, 363 fetuses in 264 pregnancies from our cohort were screened for CHD. The incidence of mild CHD in fetuses from ART pregnancies was 2.75% (10 out of 363 fetuses). None of the affected fetuses had severe CHD. Review of the literature yielded 20 studies since 1980 that examined CHD in pregnancies resulting from ART. Composite data from the studies was described based on characterization of severity of the CHD anomalies. The incidence of mild CHD in ART pregnancies was 2.2%, compared to 1% in non‐ART pregnancies (out of 332,157 infants). The incidence of severe CHD in ART pregnancies and naturally conceived pregnancies was 1.4% and 1.2%, respectively (out of 661,455 infants). The incidence of unspecified CHD in ART pregnancies was 1.8%, compared to 1% in naturally conceived pregnancies (out of 1,593,277 infants).ConclusionThe greatest increase in risk appears to be for mild CHD (nonsurgical), which may inform counseling of patients prior to use of assisted reproductive technologies.