bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health risks of exposure to air pollutants among students in schools in the vicinities of coal mines
Authors: Olufemi Adejoke C , Mji Andile , Mukhola Murembiwa S 
Published: March 2018

Air pollution poses a serious threat to human health and the general ecosystem both in South Africa and globally. This is mostly caused by the mining and combustion of fossil fuels, such as coal. There are some known pollutants associated with coal mining and combustion that are emitted into the air, resulting in various health implications that affect children the most as they are the most vulnerable. In this study, the levels of certain air pollutants in schools in the vicinities of coal mines were assessed. A cross-sectional study design was adopted. Five schools were purposively selected for this study. Air samples were collected inside and outside the classrooms of each school. Radiello® passive air samplers were used to measure the levels of sulphur dioxide, nitrogen dioxide and ozone while filter pumps were employed for lead (Pb). Standard laboratory analytical methods were employed for the analysis. Estimates of the possible health risks resulting from exposure to airborne sulphur dioxide, nitrogen dioxide and ozone were performed using the United States Environmental Protection Agency Human Health Risk Assessment framework. The non-cancer risk of sulphur dioxide, nitrogen dioxide and ozone was determined using the hazard quotient. The results of this study revealed that sulphur dioxide, nitrogen dioxide and ozone were detected within and outside the classrooms at various levels. For example, the concentration of sulphur dioxide within the classroom ranged from 3.0 to 38 µg/m3. Outside the classroom, sulphur dioxide levels detected were much higher ranging from 17 to 84 µg/m3. The results of the non-carcinogenic risks from exposure to nitrogen dioxide, sulphur dioxide and ozone via inhalation route were less than 1.0. The elevated levels of these pollutants in the vicinity of schools investigated should be a cause for concern for all the stakeholders in the education sector. Therefore, appropriate measures need to be taken urgently to safeguard the health of the concerned community.
Language Processing in Children with Emotional Disorders
Authors: Rogers-Adkinson Diana L. 
Published: March 2018

The author explores the language processing ability of children with emotional disorders who have preexisting language delays (ED/LA) to determine whether language difficulties in this population are internal biological features rather than due to environmental variables such as lack of language stimulation in the home. A comparison group consisting of children with ED but without language delays was used to determine whether language processing may be a critical factor in the occurrence of language delays in children with ED. Language competence was determined using the Test of Language Development/Intermediate. Language processing skills were then compared in the typical versus delay language groups using the Language Processing Test-R. Children with ED and language delays presented concerns in areas of language processing difficulty suggestive of underlying neurological pathology.
Assessment of electrocardiographic criteria of left atrial enlargement
Authors: Batra Mahesh Kumar , Khan Atif , Farooq Fawad , Masood Tariq , Karim Musa 
Published: March 2018

Background Left atrial enlargement is considered to be a robust, strong, and widely acceptable indicator of cardiovascular outcomes. Echocardiography is the gold standard for measurement of left atrial size, but electrocardiography can be simple, cost-effective, and noninvasive in clinical practice. This study was undertaken to assess the diagnostic accuracy of an established electrocardiographic criterion for left atrial enlargement, taking 2-dimensional echocardiography as the gold-standard technique. Methods A cross-sectional study was conducted on 146 consecutively selected patients with the complaints of dyspnea and palpitation and with a murmur detected on clinical examination, from September 10, 2016 to February 10, 2017. Electrocardiography and echocardiography were performed in all patients. Patients with a negative P wave terminal force in lead V1 > 40 ms·mm on electrocardiography or left atrial dimension > 40 mm on echocardiography were classified as having left atrial enlargement. Sensitivity and specificity were calculated to assess the diagnostic accuracy. Results Taking 2-dimensional echocardiography as the gold-standard technique, electrocardiography correctly diagnosed 68 patients as positive for left atrial enlargement and 12 as negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of electrocardiography for left atrial enlargement were 54.4%, 57.1%, 88.3%, 17.4%, and 54.8%, respectively. Conclusion The electrocardiogram appears to be a reasonable indicator of left atrial enlargement. In case of nonavailability of echocardiography, electrocardiography can be used for diagnosis of left atrial enlargement.
What influences decisions about ongoing stroke rehabilitation for patients with pre-existing dementia or cognitive impairment: a qualitative study?
Authors: Longley Verity , Peters Sarah , Swarbrick Caroline , Bowen Audrey 
Published: March 2018

Objective: To identify factors influencing clinicians decision-making about ongoing stroke rehabilitation for people with pre-existing dementia/cognitive impairment and the impact on clinical practice. Design: Qualitative semi-structured interviews with stroke specialist healthcare professionals analysed using thematic analysis. Setting: Acute stroke unit, inpatient stroke rehabilitation units, and community stroke services. Participants: Twenty three professionals from six multidisciplinary stroke teams involved in decision-making about stroke patients’ rehabilitation potential and clinical pathways. Results: Factors influencing decision-making about ongoing rehabilitation were (1) gaining understanding of the individual patient, (2) clinician’s knowledge of dementia/cognitive impairment, (3) predicting rehabilitation potential, (4) organizational constraints, and (5) clinician’s perceptions of their role within the team. Decision-making led to two outcomes, either accommodating the pre-existing dementia/cognitive impairment within delivery of rehabilitation or ending rehabilitation for that patient to allocate limited resources where they were perceived more likely to be effective. Participants felt that patients with pre-existing dementia/cognitive impairment had difficulty demonstrating the required rehabilitation potential within the short timescales available in the current model of service delivery. Participants identified a need for training to improve their knowledge and confidence for decision-making and delivery of rehabilitation for this growing population. Conclusion: Clinicians’ decision-making about ongoing rehabilitation for patients with prestroke dementia/cognitive impairments is influenced by gaps in their knowledge and by service constraints. Increased training and more flexible, patient-centred services would enable clinicians to better accommodate these patients in rehabilitation.
Mirtazapine attenuates nicotine-seeking behavior in rats
Authors: Barbosa-Méndez Susana , Salazar-Juárez Alberto 
Published: March 2018

Background: Nicotine is the major psychoactive component of tobacco. A number of pharmacological therapies have been evaluated, with poor results. Given the lack of success of these therapies, several authors have proposed alternative therapeutic strategies. One of these is the use of antidepressant drugs that may have a specific effect on the neural pathways or receptors underlying nicotine addiction. Mirtazapine is an antagonist of α2 NE receptors (noradrenergic receptor), 5-HT2A/C and 5-HT3 receptors and has demonstrated efficacy in reducing behavioral effects induced by drugs of abuse in human and animal models. Aims: In this study, we evaluated the effect of chronic dosing of mirtazapine during extinction on the re-acquisition of nicotine-seeking in rodents. Methods: We used the nicotine self-administration paradigm to assess the effects of mirtazapine on rats trained to self-administer nicotine under a pharmacological fixed-ratio schedule. Mirtazapine (30 mg/kg, i.p.) was administered during extinction. Results: In this work, we found that mirtazapine attenuates the re-acquisition of nicotine-seeking responses. Conclusions: These results support the use of mirtazapine in clinical controlled trials as a useful therapy that prolongs and increases rates of preventing relapse into nicotine intake in humans.
Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment
Authors: Schuster Philipp , Geßlein Markus , Schlumberger Michael , Mayer Philipp , Mayr Raul , Oremek Damian , Frank Sebastian , Schulz-Jahrsdörfer Martin , Richter Jörg 
Published: March 2018

Background: High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants. Purpose: To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed. Study Design: Case series; Level of evidence, 4. Methods: From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result. Results: Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (<40) were associated with decreased survival. High preoperative TBVA was associated with better and an overcorrected MPTA (>95°) with inferior functional outcome at final follow-up, respectively. Conclusion: Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.
Validation of an MRI Protocol for Routine Quantitative Assessment of Tunnel Position in Anterior Cruciate Ligament Reconstruction
Authors: Grasso Samuel , Linklater James , Li Qing , Parker David A. 
Published: March 2018

Background: No standardized methodology and objective criteria currently exist to accurately and objectively assess tunnel placement and consequent graft orientation in anterior cruciate ligament (ACL) reconstruction (ACLR) through a single imaging modality. Advances in magnetic resonance imaging (MRI) technology have enabled the use of volumetric high spatial and contrast resolution proton density–weighted sequencing, which allows precise delineation of graft orientation, tunnel position, and quantitative assessment of tunnel position relationship to adjacent reproducible anatomic landmarks. Purpose: To establish an MRI protocol that would provide an accurate alternative to 3-dimensional computed tomography (3D-CT) for standardized assessment of bone tunnel placement in ACLR, as a component of assessing ACLR outcomes and to assist in presurgical planning for revision ACLR. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Twenty-four participants diagnosed with a failed ACLR underwent MRI and 3D-CT per the imaging protocols of the Sydney Orthopaedic Research Institute, in which the acquired data were converted to 3D models. The bone tunnels of the previous ACLR were then intraoperatively digitized at the tunnel aperture and along the length of the tunnel (barrel) and used as the reference standard to evaluate the accuracy of high-resolution MRI and 3D-CT. Differences in geometry between the image-based model and the reference point cloud were calculated through point-to-point comparison. Results: At the tunnel apertures, no significant differences were detected between the MRI and 3D-CT models versus the reference models for the femur ( P = .9472) and tibia ( P = .5779). Mean ± SD tunnel barrel deviations between MRI and 3D-CT were 0.48 ± 0.28 mm (femur) and 0.46 ± 0.27 mm (tibia). No significant differences were detected between the MRI and 3D-CT models versus the reference models for the femoral ( P = .5730) and tibial ( P = .3002) tunnel barrels. Conclusion: This study demonstrated that, in addition to being the optimum modality for assessment of soft tissue injury of the knee, a high-resolution 3D turbo spin echo proton density sequence can provide an accurate assessment of tunnel placement, without the use of ionizing radiation. Therefore, this protocol provides the foundation for an objective standardized platform to quantitatively evaluate the location of ACL bone tunnels and graft orientation for routine postoperative assessment, presurgical planning, and evaluation of clinical outcomes.
Impact of Orofacial Dysfunction on the Quality of Life of Adult Patients With Cleft Lip and Palate
Authors: Mariano Natalia Cristina Reinaldo , Sano Mariana Naomi , Curvêllo Victor Prado , de Almeida Ana Lúcia Pompéia Fraga , Neppelenbroek Karin Hermana , Oliveira Thais Marchini , Soares Simone 
Published: March 2018

Objective: This study assessed the prevalence of orofacial dysfunctions (ODs) and quality of life (QoL) in adults with and without a cleft lip and palate. Design: Cross sectional. Setting: Craniofacial Center, Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil. Methods: The study was composed of a sample of 120 patients: 60 adults in the cleft lip and palate group (CLPG) and 60 adults in the control group with no craniofacial anomalies. Each patient underwent an interview and clinical examination, using the Nordic Orofacial Test-Screening (NOT-S) and the 36-Item Short Form Survey. Data were analyzed using Mann-Whitney U test, χ2, and the Spearman correlation coefficients. Results: There was a higher prevalence of OD in CLPG ( P < .001) on the NOT-S. The adults in the CLPG had higher QoL in the areas of general health ( P = .003), physical function ( P = .014), social function ( P < .001), and vitality ( P = .006). The CLPG had significant associations between higher OD and lower QoL for general health ( P = .004), emotional role function ( P = .028), and vitality ( P = .05). Conclusion: Orofacial dysfunctions were more prevalent in adults with a cleft, negatively impacting their QoL in general health, emotional role function, and vitality. However, adults with a cleft also had significantly higher QoL, reflecting possible resiliency when compared to adults without a cleft.
A Quality Improvement Initiative to Improve Feeding and Growth of Infants With Cleft Lip and/or Palate
Authors: Baylis Adriane L. , Pearson Gregory D. , Hall Courtney , Madhoun Lauren L. , Cummings Caitlin , Neal Nancy , Smith Amanda , Eastman Katherine , Stocker Christina , Kirschner Richard E. 
Published: March 2018

Objective: The purpose of this quality improvement initiative was to improve feeding and growth outcomes in infants with cleft lip and/or palate (CL/P). Design: Institute for Healthcare Improvement quality improvement model. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: One hundred forty-five infants with nonsyndromic CL/P ages 0 to 12 months. Interventions: Key drivers included (1) caregiver education and resources, (2) care coordination and flow, and (3) provider education and training. Interventions were designed around these themes and included targeting improved team communication, increased social work consultations, patient tracking, staff education, improved access to feeding equipment, and the launch of a new cleft palate feeding team. Main Outcome Measure(s): The primary outcome measure was the percentage of new patients with CL/P who met criteria for failure to thrive (FTT) per month. The secondary outcome measure was the frequency of hospitalization for infants with CL/P with a primary reason for admission of feeding difficulties or FTT. Results: The institutional FTT rate for infants with CL/P decreased from 17% to 7% ( P < .003). The frequency of hospitalization for FTT improved from once every 30 days to once every 118 days. Conclusions: Targeted interventions aimed at improving feeding efficiency and effectiveness, as well as changes in care delivery models, can reliably promote improvements in feeding and growth outcomes for infants with CL/P, even with psychosocial risk factors present.
Location and structure of fibrous sheath formed after placing a tunneled hemodialysis catheter in a large pig model
Authors: Florescu Marius C , Runge Joseph , Flora Maurino , Nio George , Lof John , Stolze Elizabeth , Fry Gretchen , Radio Stanley J , Foster Kirk W 
Published: March 2018

Background and objectives: We evaluated the location and structure of the fibrous sheath formed after the placement of tunneled, cuffed hemodialysis catheters in large animals, 70 kg pigs. We focused on describing the location of the fibrous sheath in relation to the catheter. Its location explains the fibrous sheath’s ability to cause catheter dysfunction by covering the catheter exit ports located at the catheter’s tip. Design: We used three animals. Each animal had a tunneled, cuffed, 15-French diameter hemodialysis catheter placed in the external jugular vein, with the tip at the junction of the superior vena cava and the right atrium. Two animals were sacrificed at 5 weeks and one animal at 17 weeks after catheter placement. The catheter and surrounding tissues were removed in one block. The fibrous sheath was dissected and longitudinally cut along the catheter to evaluate its extension in relation to the catheter. Relevant portions of the fibrous sheath were sent for pathology examination. Results: The fibrous sheath covered the catheter in its entire length and circumference. It started at the entry site and continued without any interruption along the entire length of the catheter, including the tip. Its average thickness is 1 mm and has an inner cellular/inflammatory layer comprising lymphocytes, plasma cells, neutrophils, macrophages, multinucleated giant cells, and spindled cells and an outer layer comprising a mixture of collagen and fibroblasts. Conclusion: Our model showed that the fibrous sheath forms around all catheters and covers them in their entire length and circumference without any gaps.
The forearm basilic vein looped transposition fistula as a tertiary option for upper limb vascular access
Authors: Zielinski Maciej , Inston Nicholas , Krasinski Zbigniew , Gabriel Marcin , Oszkinis Grzegorz 
Published: March 2018

Introduction: The forearm basilic vein can serve as an option for haemodialysis access but may not be possible in cases where the wrist arteries are unsuitable. In this setting, the forearm basilic vein can be used in a looped transposition with a brachial artery anastomosis. Aims: The aims of this study were to assess the outcome of forearm basilic vein looped transposition as an option for vascular access. Material and methods: Data from January 2007 to December 2010 were prospectively collected and analysed. Outcome measures were operative success, complications, maturation and primary and secondary patency following 5 years of follow-up. Results: From a total of 583 patients receiving autologous vascular access for haemodialysis, 24 (4.1%) underwent a forearm basilic vein looped transposition. The median age was 60 years (range, 27–80 years), with a slight male predominance (13 male:11 female). Mean follow-up was 34 months (1–60 months). Two patients died and other three were transplanted with subsequent fistula closure. All procedures were successful (100%); however, maturation failure occurred in one case (4.2%). No serious perioperative complications were observed. In two cases, we observed late false aneurysm formation requiring intervention. Primary patency at 1, 2, 3 and 5 years was the following: 77%, 62%, 21% and 10%, whereas secondary patency was the following: 81%, 71%, 61% and 32%, respectively. Conclusion: Autologous forearm basilic vein looped transposition is an effective surgical procedure for the creation of access for haemodialysis. This may be a useful option in patients with compromised peripheral arterial diameter or flow and should be considered in patients with a suitable forearm basilic vein.
A Meta-analysis of Preoperative Duplex Ultrasound Vessel Diameters for Successful Radiocephalic Fistula Placement
Authors: Glass Carolyn , Johansson Marcia , DiGragio William , Illig Karl A. 
Published: March 2018

Background The Kidney Dialysis Outcomes Quality Initiative (K/DOQI) guidelines for vascular access recommend the use of radiocephalic wrist arteriovenous fistulas (RCAVFs) as the initial option for dialysis access. The survival rate of a successfully placed fistula is excellent. However, 10–24% of RCAVFs fail to reach functional status as the result of early thrombosis or maturation failure. Many authors have investigated the utility of preoperative vascular mapping by Duplex ultrasound to predict adequate vessel size for successful fistula placement. This meta-analysis is the first in which preoperative radial arterial (RAD) and cephalic venous diameters (CVD) required for favorable fistula outcomes are reviewed. Methods A literature search was performed by use of the MEDLINE electronic base for “arteriovenous, fistula, ultrasound, and hemodialysis.” The analysis yielded 166 studies, of which 20 studies included preoperative duplex data. Meta-analysis was performed by applying the statistical test of comparing two proportions, assuming equal variances. Results A total of 433 patients were duplexed for preoperative evaluation of the RAD and 386 for CVD. The total number of subjects ranged from 21 to 91, mean age 58.7 years. The subjects were 55.5% male, 39.0% with diabetes mellitus. Meta-analysis yielded 2.0 mm for RAD and 2.0 mm for CVD as designated cutoff vessel diameters. Our study showed the mean fistula success rate was significantly different between RAD >2.0 mm (59%) and RAD >2.0 mm (40%). The mean fistula success rate was also significantly different between CVD > 2.0 mm (71%) and >2.0 mm (29%). Successful fistula placement was defined as a functional fistula at least 4–6 weeks after creation. Conclusion On the basis of our study, the use of Duplex ultrasound is important in determining preoperative vessel diameter size, and subsequent functional success rate of fistula placement.