bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Electronic Health Record Tools to Facilitate and Audit Infliximab Prescribing
Authors: Sharpless Bethany R. , del Rosario Fernando , Molle-Rios Zarela , Hilmas Elora 
Published: February 2018

OBJECTIVES The objective of this project was to assess a pediatric institution's use of infliximab and develop and evaluate electronic health record tools to improve safety and efficiency of infliximab ordering through auditing and improved communication.
METHODS Best use of infliximab was defined through a literature review, analysis of baseline use of infliximab at our institution, and distribution and analysis of a national survey. Auditing and order communication were optimized through implementation of mandatory indications in the infliximab orderable and creation of an interactive flowsheet that collects discrete and free-text data. The value of the implemented electronic health record tools was assessed at the conclusion of the project.
RESULTS Baseline analysis determined that 93.8% of orders were dosed appropriately according to the findings of a literature review. After implementation of the flowsheet and indications, the time to perform an audit of use was reduced from 60 minutes to 5 minutes per month. Four months post implementation, data were entered by 60% of the pediatric gastroenterologists at our institution on 15.3% of all encounters for infliximab. Users were surveyed on the value of the tools, with 100% planning to continue using the workflow, and 82% stating the tools frequently improve the efficiency and safety of infliximab prescribing.
CONCLUSIONS Creation of a standard workflow by using an interactive flowsheet has improved auditing ability and facilitated the communication of important order information surrounding infliximab. Providers and pharmacists feel these tools improve the safety and efficiency of infliximab ordering, and auditing data reveal that the tools are being used.
Impact of Early Versus Late Diuretic Exposure on Metabolic Bone Disease and Growth in Premature Neonates
Authors: Orth Lucas E. , O'Mara Keliana L. 
Published: February 2018

OBJECTIVES This study aimed to determine whether there are differences in the incidence of metabolic bone disease (MBD) between preterm neonates first exposed to diuretics prior to 2 weeks of life versus those exposed after 2 weeks.
METHODS This study was a retrospective analysis of premature neonates born at a tertiary care center between 2011 and 2015 who received either furosemide or chlorothiazide. The primary outcome was incidence of MBD. Secondary outcomes included growth, electrolyte disturbances, oxygen requirement, and length of stay.
RESULTS A total of 147 patients were included. Early initiation (n = 90) and late initiation (n = 57) arms were balanced with respect to birth weight and gestational age. There was no difference in incidence of MBD in the early group (76%) versus the late group (65%; p = 0.164). Stratification by cumulative dose showed incidence of 85% in patients receiving ≥8 mg/kg of furosemide, compared with 68% and 64% of those in the &lt;4 mg/kg and 4 to 7.9 mg/kg strata, respectively (p = 0.06). The early group experienced greater reductions in length-for-age growth during diuretic therapy (−70% versus −40%; p = 0.009). Electrolyte abnormalities were more prevalent in the early group. Although there was no difference in duration of mechanical ventilation, duration of supplemental oxygen requirement was reduced in the late group (75 versus 89 days; p = 0.003).
CONCLUSIONS Timing of diuretic initiation did not affect incidence of MBD. Increased cumulative furosemide exposure may be associated with higher incidence. Patients first exposed to diuretics within 2 weeks of life are at higher risk for electrolyte abnormalities and reduced growth velocity.
Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity
Authors: Miller Jamie L. , Johnson Peter N. , Harkey Kari , Siatkowski R. Michael 
Published: February 2018

OBJECTIVES This study describes outcomes of intravenous (IV) analgesics and sedatives for bedside intravitreal bevacizumab injections for retinopathy of prematurity.
METHODS This retrospective study included infants receiving intravitreal bevacizumab injections between January 2012 and May 2016. Infants were excluded if bevacizumab was administered under general anesthesia or for incomplete records. Data collection included demographics, sedation and analgesia regimen, and cardiopulmonary adverse events (AEs). The primary objective was to identify the median doses of the IV analgesics and sedatives. The secondary objectives included the number of patients with cardiopulmonary AEs and those with procedure success, defined as procedure completion without interruption and absence of interventions.
RESULTS Fifteen infants were included. Fourteen (93.3%) were initiated on a fentanyl infusion at a median of 2 mcg/kg/hr (IQR, 2–3.6), and 12 (80%) received midazolam infusions at a median of 0.06 mg/kg/hr. All patients received at least 1 IV neuromuscular blocker dose just prior to the procedure. Only 2 patients (13.3%) required an increase in their fentanyl or midazolam infusions. Procedure success was achieved in 13 patients (86.7%). Five patients (33.3%) experienced 1 cardiopulmonary AE. One patient (6.7%) had a delay in the procedure, and 1 patient (6.7%) required naloxone. Despite this, the procedure was completed in all patients.
CONCLUSIONS Most received fentanyl and midazolam infusions with a dose of vecuronium just prior to the procedure. Thirteen (86.7%) met the criteria for procedure success. One-third experienced a cardiopulmonary AE. Future studies are needed to identify the optimal agents and route of administration for this procedure.
Infantile Gastroesophageal Reflux: Adherence to Treatment Guidelines in the Hospital Setting
Authors: Long Heather A. , Solski Lauren , Rebuck Jill A. , Bridgeman Colin 
Published: February 2018

OBJECTIVES Recent guidelines defined and differentiated the management of gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). The guidelines recommend against using empiric acid suppression therapy for infantile GER. The primary objective of this study was to assess inpatient guideline adherence regarding management of infantile GER through the perspective of pharmacists. Secondary objectives included assessing pharmacist comfort level with differentiation between GER and GERD, observing current trends in practice relating to the primary objective, and determining the availability of institution-specific guidelines that address the management of infantile GER.
METHODS An institutional review board-approved, national, online survey of pharmacists with inpatient pediatric experience was conducted. Pediatric pharmacy membership directories were used to create the listserv of eligible pharmacists. The 2009 NASPGHAN/ESPGHAN (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Gastroenterology, Hepatology, and Nutrition) Pediatric Gastroesophageal Reflux Clinical Practice Guideline was used to develop the survey and to define both GER and GERD. Demographic data was also collected regarding the institutional setting and pharmacists responding.
RESULTS The overall response rate was 14.8% (n = 149). Although 29.7% of pharmacists stated empiric acid suppression trials were not used for infantile GER at their institution, 44.6% responded that these trials are initiated 1 to 2 times per week in their hospitals. In addition, 19.6% responded that these empiric trials were initiated 3 to 5 times per week. A smaller percentage of responders reported even higher frequencies per week at their institutions.
CONCLUSIONS From the results of the survey, infants continue to receive empiric acid suppression trials for GER in the inpatient setting, which is not adherent to the current guideline recommendation.
Preliminary Indications for the Use of Sugammadex After Its Addition to a Formulary at a Tertiary Care Children's Hospital
Authors: Barry N'Diris , Uffman Joshua C. , Tumin Dmitry , Tobias Joseph D. 
Published: February 2018

OBJECTIVES Neuromuscular blocking agents (NMBAs) are administered to facilitate endotracheal intubation and provide skeletal muscle relaxation in surgical procedures. Sugammadex (Bridion) recently received approval by the United States Food and Drug Administration for reversal of rocuronium and vecuronium-induced neuromuscular blockade thereby providing an alternative to acetylcholinesterase inhibitors such as neostigmine. This quality improvement analysis sought to investigate the clinical reasons and common clinical perceptions for choosing sugammadex over neostigmine to reverse NMBAs.METHODS One hundred cases were reviewed where sugammadex was used for neuromuscular blockade reversal in the operating room. Cases were identified from electronic medical record reports. Anesthesia providers responsible for administering sugammadex were interviewed to obtain rationales for sugammadex use in the perioperative setting. Responses were reviewed to identify distinct reasons for using sugammadex. Two independent raters ranked the reasons according to prevalence. The study was exempt from Institutional Review Board approval as a quality improvement (QI) project.RESULTS Forty-two anesthesia providers (15 Certified Registered Nurse Anesthetists, 5 anesthesiology trainees, and 22 attending anesthesiologists) were interviewed to identify reasons why sugammadex was administered intraoperatively in 100 surgical cases (69/31 male/female patients, age 9.4 ± 6.5 years). The author identified the top 19 common reasons respondents chose to use sugammadex for each case, and independent raters reviewed the response summaries for those 19 primary reasons sugammadex was used. The most common reasons for choosing sugammadex were: 1) beneficial pharmacokinetics of the agent; 2) sugammadex's perceived superior efficacy over neostigmine; and 3) concerns regarding adverse effects of neostigmine and/or the anticholinergic agent.CONCLUSIONS Sugammadex has recently been introduced for clinical use to reverse NMBAs at our institution. Primary reasons and perceptions for its use over neostigmine included a limited adverse effect profile, a greater sense of control and predictability of patients' response, and a limited incidence of residual neuromuscular blockade.
Deficit irrigation and fertilization strategies to improve soil quality and alfalfa yield in arid and semi-arid areas of northern China
Authors: Jia Qianmin , Kamran Muhammad , Ali Shahzad , Sun Lefeng , Zhang Peng , Ren Xiaolong , Jia Zhikuan 
Published: February 2018

Background
In the arid and semi-arid areas of northern China, overexploitation of fertilizers and extensive irrigation with brackish groundwater have led to soil degradation and large areas of farmland have been abandoned. In order to improve the soil quality of abandoned farmland and make reasonable use of brackish groundwater, we conducted field trials in 2013 and 2014.

Methods
In our study, we used three fertilization modes (CF, chemical fertilizer; OM, organic manure and chemical fertilizer; NF, no fertilizer) and three deficit irrigation levels (I0: 0 mm; I75: 75 mm; I150: 150 mm).

Results
The results showed that the activities of soil urease, alkaline phosphatase, invertase, catalase, and dehydrogenase in the OM treatment were significantly improved compared with those in the CF and NF treatments under the three deficit irrigation levels. Compared with NF, the OM treatment significantly increased soil organic carbon (SOC), water-soluble carbon (WSC), total nitrogen, microbial biomass carbon and nitrogen (MBC and MBN), and soil respiration rate, and significantly decreased soil C:N and MBC:MBN ratios and the metabolic quotient, thus improving the soil quality of abandoned farmland. Furthermore, the OM treatment increased alfalfa plant height, leaf area index, leaf chlorophyll content, and biomass yield. Under the CF and OM fertilization modes, the activities of urease and catalase in I150 were significantly higher than those in I0, whereas irrigating without fertilizer did not significantly increase the activity of these two enzymes. Regardless of fertilization, alkaline phosphatase activity increased with an increase in irrigation amount, whereas invertase activity decreased.

Discussion
The results showed that deficit irrigation with brackish groundwater under the OM treatment can improve soil quality. Over the two years of the study, maximum SOC, total nitrogen, WSC, MBC, and MBN were observed under the OM-I150 treatment, and the alfalfa biomass yield of this treatment was also significantly higher than that of the OM-I0 treatment. Therefore, the OM-I150 treatment could be used as a suitable measure not only to improve the quality of abandoned farmland soil but also to increase the alfalfa biomass yield in arid and semi-arid areas of northern China.
Fruit and vegetable consumption and anemia among adult non-pregnant women: Ghana Demographic and Health Survey
Authors: Ghose Bishwajit , Yaya Sanni 
Published: February 2018

Background
Anemia is the most widely prevalent form of micronutrient deficiency that affects over a quarter of the global population. Evidence suggests that the burden of anemia is higher in the developing countries with women of reproductive age and children being the most at-risk groups. The most common causes are believed to be malnutrition and low bioavailability of micronutrients, which usually result from poor dietary habits and inadequate intake of food rich in micronutrients such as fresh fruits and vegetables. Regular consumption of F&V was shown to have protective effect against NCDs; however, evidence on this protective effect against micronutrient deficiency diseases are limited.

Objectives
(1) To measure the prevalence of anemia among adult non-pregnant women in Ghana, and (2) to investigate if there is any cross-sectional relationship between F&V consumption and anemia.

Methods
This is a cross-sectional study based on data extracted from the Ghana Demographic and Health Survey, 2008. Subjects were 4,290 non-pregnant women aged between 15 and 49 years. Hemoglobin levels were measured by HemoCue® hemoglobin-meter. Association between anemia and F&V consumption was assessed by multivariable regression methods.

Results
Findings indicate that well over half (57.9%) of the women were suffering from anemia of some level. The percentage of women consuming at least five servings of fruits and vegetables a day were 5.4% and 2.5% respectively. Results of multivariable analysis indicated that among urban women, consumption of <5 servings fruits/day was associated with significantly higher odds of severe [AOR = 9.27; 95% CI [5.15–16.70]] and moderate anemia [AOR = 6.63; 95% CI [4.21–10.44]], and consumption of <5 servings of vegetables/day was associated with higher odds of moderate anemia [AOR = 2.39; 95% CI [1.14–5.02]] compared with those who consumed >5 servings/day.

Conclusion
The findings indicate that urban women who did not maintain WHO recommended level of F&V consumption bear a significantly higher likelihood of being moderate to severely anemic.
Contribution of Hydrologic Opportunity and Biogeochemical Reactivity to the Variability of Nutrient Retention in River Networks
Authors: Marcé Rafael , von Schiller Daniel , Aguilera Rosana , Martí Eugènia , Bernal Susana 
Published: February 2018

AbstractIn‐stream nutrient retention results from the interaction between hydrological and biogeochemical processes involved in downstream transport. While hydrological processes set the opportunity for nutrient retention to occur, metabolic activity and abiotic processes determine the potential biogeochemical reactivity of streams. Yet, a comprehensive assessment of the relevance of hydrological opportunity versus biogeochemical reactivity on the variability of nutrient retention across streams is still missing. We compiled an extensive data set of existing studies on nutrient retention for ammonium, nitrate, and soluble reactive phosphorus to explore how variability in hydrological opportunity and biogeochemical reactivity explain nutrient retention. We quantified the relative contribution of hydrological opportunity and biogeochemical reactivity to the observed variability in stream nutrient retention using a linearization of the retention equation, which allows for an exact partitioning of the variance associated with residence time and nutrient uptake rate. Finally, we explored potential patterns of nutrient retention along the river network resulting from the interaction between hydrological opportunity and biogeochemical reactivity. Our results show that biogeochemical reactivity has a more relevant role on nutrient retention variability than previously thought, explaining over 66% of the variability in nutrient retention. Among the studied nutrients, retention variability of ammonium was the most subjected to biogeochemical reactivity controls. Furthermore, our results provide insights on controls of longitudinal patterns of nutrient retention along river networks, indicating that retention per unit length for the three nutrients will most likely decrease from headwaters to river mouth because of a decrease in water residence time.
Carbon Budget of Tidal Wetlands, Estuaries, and Shelf Waters of Eastern North America
Authors: Najjar R. G. , Herrmann M. , Alexander R. , Boyer E. W. , Burdige D. J. , Butman D. , Cai W.‐J. , Canuel E. A. , Chen R. F. , Friedrichs M. A. M. , Feagin R. A. , Griffith P. C. , Hinson A. L. , Holmquist J. R. , Hu X. , Kemp W. M. , Kroeger K. D. , Mannino A. , McCallister S. L. , McGillis W. R. , Mulholland M. R. , Pilskaln C. H. , Salisbury J. , Signorini S. R. , St‐Laurent P. , Tian H. , Tzortziou M. , Vlahos P. , Wang Z. A. , Zimmerman R. C. 
Published: February 2018

AbstractCarbon cycling in the coastal zone affects global carbon budgets and is critical for understanding the urgent issues of hypoxia, acidification, and tidal wetland loss. However, there are no regional carbon budgets spanning the three main ecosystems in coastal waters: tidal wetlands, estuaries, and shelf waters. Here we construct such a budget for eastern North America using historical data, empirical models, remote sensing algorithms, and process‐based models. Considering the net fluxes of total carbon at the domain boundaries, 59 ± 12% (± 2 standard errors) of the carbon entering is from rivers and 41 ± 12% is from the atmosphere, while 80 ± 9% of the carbon leaving is exported to the open ocean and 20 ± 9% is buried. Net lateral carbon transfers between the three main ecosystem types are comparable to fluxes at the domain boundaries. Each ecosystem type contributes substantially to exchange with the atmosphere, with CO2 uptake split evenly between tidal wetlands and shelf waters, and estuarine CO2 outgassing offsetting half of the uptake. Similarly, burial is about equal in tidal wetlands and shelf waters, while estuaries play a smaller but still substantial role. The importance of tidal wetlands and estuaries in the overall budget is remarkable given that they, respectively, make up only 2.4 and 8.9% of the study domain area. This study shows that coastal carbon budgets should explicitly include tidal wetlands, estuaries, shelf waters, and the linkages between them; ignoring any of them may produce a biased picture of coastal carbon cycling.
Terrestrial Sediments of the Earth: Development of a Global Unconsolidated Sediments Map Database (GUM)
Authors: Börker J. , Hartmann J. , Amann T. , Romero‐Mujalli G. 
Published: February 2018

AbstractMapped unconsolidated sediments cover half of the global land surface. They are of considerable importance for many Earth surface processes like weathering, hydrological fluxes or biogeochemical cycles. Ignoring their characteristics or spatial extent may lead to misinterpretations in Earth System studies. Therefore, a new Global Unconsolidated Sediments Map database (GUM) was compiled, using regional maps specifically representing unconsolidated and quaternary sediments. The new GUM database provides insights into the regional distribution of unconsolidated sediments and their properties. The GUM comprises 911,551 polygons and describes not only sediment types and subtypes, but also parameters like grain size, mineralogy, age and thickness where available. Previous global lithological maps or databases lacked detail for reported unconsolidated sediment areas or missed large areas, and reported a global coverage of 25 to 30%, considering the ice‐free land area. Here, alluvial sediments cover about 23% of the mapped total ice‐free area, followed by aeolian sediments (∼21%), glacial sediments (∼20%), and colluvial sediments (∼16%). A specific focus during the creation of the database was on the distribution of loess deposits, since loess is highly reactive and relevant to understand geochemical cycles related to dust deposition and weathering processes. An additional layer compiling pyroclastic sediment is added, which merges consolidated and unconsolidated pyroclastic sediments. The compilation shows latitudinal abundances of sediment types related to climate of the past. The GUM database is available at the PANGAEA database (https://doi.org/10.1594/PANGAEA.884822).
Northern Galápagos Corals Reveal Twentieth Century Warming in the Eastern Tropical Pacific
Authors: Jimenez Gloria , Cole Julia E. , Thompson Diane M. , Tudhope Alexander W. 
Published: February 2018

AbstractModels and observations disagree regarding sea surface temperature (SST) trends in the eastern tropical Pacific. We present a new Sr/Ca‐SST record that spans 1940–2010 from two Wolf Island corals (northern Galápagos). Trend analysis of the Wolf record shows significant warming on multiple timescales, which is also present in several other records and gridded instrumental products. Together, these data sets suggest that most of the eastern tropical Pacific has warmed over the twentieth century. In contrast, recent decades have been characterized by warming during boreal spring and summer (especially north of the equator), and subtropical cooling during boreal fall and winter (especially south of the equator). These SST trends are consistent with the effects of radiative forcing, mitigated by cooling due to wind forcing during boreal winter, as well as intensified upwelling and a strengthened Equatorial Undercurrent.
Abyssal Upwelling in Mid‐Ocean Ridge Fracture Zones
Authors: Clément Louis , Thurnherr Andreas M. 
Published: February 2018

AbstractTurbulence in the abyssal ocean plays a fundamental role in the climate system by sustaining the deepest branch of the overturning circulation. Over the western flank of the Mid‐Atlantic Ridge in the South Atlantic, previously observed bottom‐intensified and tidally modulated mixing of abyssal waters appears to imply a counterintuitive densification of deep and bottom waters. Here we show that inside fracture zones, however, turbulence is elevated away from the seafloor because of intensified downward propagating near‐inertial wave energy, which decays below a subinertial shear maximum. Ray‐tracing simulations predict a decay of wave energy subsequent to wave‐mean flow interactions. The hypothesized wave‐mean flow interactions drive a deep flow toward lighter densities of up to 0.6 Sv over the mid‐ocean ridge flank in the Brazil Basin, and the same process may also cause upwelling of abyssal waters in other ocean basins with mid‐ocean ridges with fracture zones.