bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distribution of heating surface areas in sugar juice evaporation process for maximum energy efficiency
Authors: Chantasiriwan Somchart 
Published: January 2019

AbstractThe conversion of diluted sugar juice into raw sugar and molasses requires thermal energy for evaporating the water content in sugar juice. The supply of thermal energy is saturated steam at around 200 kPa. The efficiency of energy use by the process is determined from the amount of saturated steam to process a given amount of sugar juice. It depends on heating surfaces of the juice heater and the evaporator. This article investigates the improvement in energy efficiency of the sugar juice evaporation process that has five evaporator effects by distributing fixed heating surface areas of the evaporator and the juice heater optimally. It is shown that there exists the optimum distribution of heating surfaces that results in the maximum energy efficiency for a specified sugar juice flow rate.Practical applicationsA mathematical model of quintuple‐effect evaporator in sugar juice evaporation process is presented in this paper. The proposed model should be useful for the design and analysis of the process. The article also presents an example of the application of the proposed model in determining the optimum distribution of fixed total heating surface areas that results in the maximum energy efficiency. The method presented in this article can be used by a process designer to determine the optimum distributions of evaporator and juice heater surface areas when total heating surface areas and sugar juice flow rate are given.
The Effect of a Comprehensive Dementia Care Management Program on End‐of‐Life Care
Authors: Jennings Lee A. , Turner Maurice , Keebler Chandra , Burton Carl H. , Romero Tahmineh , Wenger Neil S. , Reuben David B. 
Published: January 2019

BACKGROUND/OBJECTIVESAlthough Alzheimer disease and other dementias are life limiting, only a minority of these patients or their proxy decision makers participate in advance care planning. We describe end‐of‐life care preferences and acute care and hospice use in the last 6 months of life for persons enrolled in a comprehensive dementia care management program.DESIGNObservational, retrospective cohort.SETTINGUrban, academic medical center.PARTICIPANTSA total of 322 persons enrolled in dementia care management after July 1, 2012, who died before July 1, 2016.INTERVENTIONDementia care comanagement model using nurse practitioners partnered with primary care providers and community organizations to provide comprehensive dementia care, including advance care planning.MEASUREMENTSAdvance care preferences, use of Physician Orders for Life Sustaining Treatment (POLST), hospice enrollment, and hospitalizations and emergency department (ED) visits in the last 6 months of life obtained from electronic health record data.RESULTSNearly all decedents (99.7%, N = 321) had a goals‐of‐care conversation documented (median = 3 conversations; interquartile range = 2‐4 conversations), and 64% had advance care preferences recorded. Among those with recorded preferences, 88% indicated do not resuscitate, 48% limited medical interventions, and 35% chose comfort‐focused care. Most patients (89%) specified limited artificial nutrition, including withholding feeding tubes. Over half (54%) had no hospitalizations or ED visits in the last 6 months of life, and intensive care unit stays were rare (5% of decedents). Overall, 69% died on hospice. Decedents who had completed a POLST were more likely to die in hospice care (74% vs 62%; P = .03) and die at home (70% vs 59%; P = .04).CONCLUSIONSEnrollees in a comprehensive dementia care comanagement program had high engagement in advance care planning, high rates of hospice use, and low acute care utilization near the end of life. Wider implementation of such programs may improve end‐of‐life care for persons with dementia. J Am Geriatr Soc 67:443–448, 2019.
Effects of the neuromuscular bandage as rehabilitative treatment of patients with drooling and intellectual disability: an interventional study
Authors: Lorca Larrosa M. , Ruiz Roca J. A. , Ruiz Roca M. I. , López‐Jornet P. 
Published: January 2019

AbstractBackgroundThe aim of this work was to assess the effect of neurological bandages (Kinesio Taping) for managing saliva flow in patients with drooling and intellectual disability.MethodsQuasi‐experimental study included 30 patients (20 male and 10 female participants) mean age of 15 years with intellectual disability and drooling [Public Special Education Centre in Cartagena (Murcia, Spain)]. Treatment consisted of the application of a strip of neuromuscular bandage applied in the suprahyoid area for a 3‐month period. Efficacy was assessed by means of three clinical scales: the Sialorrhea clinical scale, the drooling rating scale and the drooling impact scale. These evaluations were performed at baseline, after 1 and 3 months of intervention.ResultsClinical improvements were obtained, showing statistically significant reductions in drooling after 1 month (P < 0.001) and 3 months (P < 0.001).ConclusionsThe application of neuromuscular bandages in the suprahyoid muscle area can be a useful option for managing drooling in patients with intellectual disability.
From sensory circumventricular organs to cerebral cortex: Neural pathways controlling thirst and hunger
Authors: McKinley Michael J. , Denton Derek A. , Ryan Philip J. , Yao Song T. , Stefanidis Aneta , Oldfield Brian J. 
Published: January 2019

Much progress has been made during the past 30 years with respect to elucidating the neural and endocrine pathways by which bodily needs for water and energy are brought to conscious awareness through the generation of thirst and hunger. One way that circulating hormones influence thirst and hunger is by acting on neurones within sensory circumventricular organs (CVOs). This is possible because the subfornical organ and organum vasculosum of the lamina terminalis (OVLT), the sensory CVOs in the forebrain, and the area postrema in the hindbrain lack a normal blood‐brain barrier such that neurones within them are exposed to blood‐borne agents. The neural signals generated by hormonal action in these sensory CVOs are relayed to several sites in the cerebral cortex to stimulate or inhibit thirst or hunger. The subfornical organ and OVLT respond to circulating angiotensin II, relaxin and hypertonicity to drive thirst‐related neural pathways, whereas circulating amylin, leptin and possibly glucagon‐like peptide‐1 act at the area postrema to influence neural pathways inhibiting food intake. As a result of investigations using functional brain imaging techniques, the insula and anterior cingulate cortex, as well as several other cortical sites, have been implicated in the conscious perception of thirst and hunger in humans. Viral tracing techniques show that the anterior cingulate cortex and insula receive neural inputs from thirst‐related neurones in the subfornical organ and OVLT, with hunger‐related neurones in the area postrema having polysynaptic efferent connections to these cortical regions. For thirst, initially, the median preoptic nucleus and, subsequently, the thalamic paraventricular nucleus and lateral hypothalamus have been identified as likely sites of synaptic links in pathways from the subfornical organ and OVLT to the cortex. The challenge remains to identify the links in the neural pathways that relay signals originating in sensory CVOs to cortical sites subserving either thirst or hunger.
Does the intravascular volume status in haemodialysis patients measured by inferior vena cava ultrasound correlate with bioimpedance spectroscopy?
Authors: Steinwandel Ulrich , Gibson Nick , Towell‐Barnard Amanda , Parsons Richard , Rippey James , Rosman Johan 
Published: January 2019

AbstractAims and objectivesTo evaluate the accuracy of traditional clinical predialytic fluid assessment by renal nurses and the efficacy of 2 additional fluid assessment methods focussing on the potential preventative effect for intradialytic hypotension (IDH).BackgroundPredialytic fluid assessment remains a daily challenge for renal nurses, when aiming for adverse event free haemodialysis treatments. Adding further objective parameters obtained through noninvasive methods into pre‐ and intradialytic fluid assessment could potentially improve health outcomes for haemodialysis patients.DesignComparative, observational study of three fluid assessment methods on their reliability on volume status and correlation to clinical outcomes.MethodsClinical predialytic nursing fluid assessments in 30 haemodialysis patients were compared with additional initial bioimpedance spectroscopy (BIS) measurements, and 3 serial intradialytic ultrasound scans of the inferior vena cava (IVC‐US) performed by a second renal nurse concurrently during the same session. A retrospective data analysis compared all measurements in each individual for the predictive value for IDH. A STROBE checklist for observational cohort studies was used for the reporting of results.ResultsSeven subjects experienced episodes of symptomatic intradialytic hypotension (S‐IDH), which would have been anticipated by IVC‐US or by BIS in 5 patients (71%). Using an algorithm to predict IDH would have provided a sensitivity of 100% and specificity of 95%.ConclusionBoth additional fluid assessment methods would have provided critical information before and during each haemodialysis session. Therefore, we consider them as being potentially effective for the prevention of intradialytic hypotension, with IVC‐US being similar to BIS.Relevance to clinical practiceTraditional clinical nursing fluid assessment methods in haemodialysis patients do not provide sufficient information to prevent episodes of IDH. Additional objective fluid assessment methods are useful and likely to lead to improved health outcomes in HD patients when applied by renal nurses. A combination of IVC‐US, MAP and BIS has potential to reduce the risk of IDH events in HD patients significantly.
The practice of off label prescribing and associated adverse drug reactions in pediatric inpatients in a tertiary care hospital in India
Authors: Rajan Rebecca , Peter Sharlin M. , Kurian Vincey M. , Ansari Roohinaz , Pawar Sunita , Kalrao Vijay 
Published: January 2019

Abstract

Objectives
To assess the extent of use, patterns, variables and Adverse Drug Reactions associated with off label prescribing in Pediatrics.

Methods
A prospective observational study was conducted for a period of 6 months for children of the age group 0-17 years in a tertiary care Hospital in Maharashtra, India. Off label drug use was assessed using Micromedex and British National Formulary for Children (BNFC 2016–2017). Adverse Drug Reactions (ADRs) were assessed according to the physicians' notes, recorded during the patient's hospital stay. Pearson correlation coefficient was computed to assess the relationship between age and the number of off-label drugs. Odds ratio was calculated for the occurrence of ADRs in on-label prescriptions Vs off label-prescriptions. A P value of &lt;0.05 was considered as significant.

Key findings
A total of 1514 prescriptions were evaluated in 300 patients. Out of which 542 (35.79%) and 423 (27.9%) were off label according to Micromedex and BNFC respectively. The number of patients who received at least one off label was found to be 225 (75%) – Micromedex and 223 (74.3%) – BNFC Unspecified indication and use of drugs outside the specified age limit were identified as the main variables associated with off label prescribing. Highest proportion of off-label drugs was found in Alimentary system. A total of 35 ADRs (OR 6.92 CI 95%(OR 6.92, 95% CI, 3.13-15.27)) were identified in 31 patients.

Conclusions
Off-label drug use is prevalent in the pediatric population and warrants an evidence-based approach to improve prescribing practices in pediatrics.
Implementing MTSS in Beginning Reading: Tools and Systems to Support Schools and Teachers
Authors: Leonard Kaitlin M. , Coyne Michael D. , Oldham Ashley C. , Burns Darci , Gillis Margie B. 
Published: January 2019

AbstractMulti‐tiered Systems of Support (MTSS) frameworks are designed to directly support students with, and at risk for, disabilities by providing timely, aligned, and coordinated supports, with the goal of preventing or ameliorating the effects of early risk. Yet developing and implementing MTSS in beginning reading is a complex process. Many schools encounter common barriers to achieving full and sustained implementation of MTSS systems and practices. The purpose of this article is to describe a state K‐3 reading initiative that resulted in improved reading outcomes for K‐3 students, including students at risk for reading disabilities. Specifically, this article describes a series of tools (i.e., activity timeline, whole group and small group templates, data grouping workbook) that helped teachers in the initiative to overcome barriers in order to ensure that tiered instruction met the needs of all students, including students with, and at risk for, reading disabilities.
The modification of quantity and quality of muscle mass improves the cognitive impairment after TIPS
Authors: Gioia Stefania , Merli Manuela , Nardelli Silvia , Lattanzi Barbara , Pitocchi Francesca , Ridola Lorenzo , Riggio Oliviero 
Published: January 2019

AbstractBackgroundHepatic encephalopathy (HE) is the major complication of transjugular intrahepatic portosystemic shunt (TIPS). In cirrhotic patients, a correlation between sarcopenia and HE has been suggested.AimTo evaluate the evolution of the skeletal muscle quantity and quality at CT scan and of the patients' cognitive impairment (both overt and minimal HE) before and after TIPS.Patients and MethodsTwenty‐seven cirrhotic patients submitted to TIPS were studied. The modification of Skeletal Muscle Index (SMI), muscle attenuation, HE and plasma ammonia were evaluated before and after a mean follow‐up of 9.8 ± 4 months after TIPS.ResultsDuring the follow‐up, the mean SMI and muscle attenuation increased significantly, although not uniformly in all patients. Psychometric Hepatic Encephalopathy Score (PHES) and ammonia improved significantly in the patients with amelioration in SMI >10% (n = 16) and not in those without (n = 11) (PHES: −1.6 ± 2 vs −4.8 ± 2.1; P = 0.0005; ammonia: 48.5 ± 28.7 vs 96 ± 31.5 μg/dL; P = 0.0004). Moreover, the prevalence of minimal HE (12.5% vs 73%, P = 0.001) as well as the number of episodes of overt HE during the follow‐up were significantly reduced in the patients with improved SMI. Model for end‐stage liver disease remained stable or worsened after TIPS and was not significantly different between the groups with or without SMI improvement.ConclusionThe amelioration of muscle wasting and HE independent of liver function observed after TIPS supports the causal relationship between muscle wasting and HE.
Remnants of paleoflora in impact melt rocks of the El'gygytgyn crater (Chukotka, Russia)
Authors: Gurov E. P. , Permiakov V. V. , Koeberl C. 
Published: January 2019

AbstractRemnants of paleoflora were discovered in impact melt rocks from the El'gygytgyn crater, Chukotka, Russia. El'gygytgyn is a 3.58 Ma, 18 km diameter impact structure in Chukotka, northeastern Russia. A circular crater basin is surrounded by an uplifted rim. The crater floor is occupied by the El'gygytgyn Lake, 12 km in diameter, surrounded by lacustrine terraces up to 80 m in height. Impactites found at the El'gygytgyn crater include impact melt rocks, glass bombs, and shock metamorphosed volcanic rocks. Most impact melt rocks occur only in redeposited state in the terrace lake deposits. Floral remnants were discovered in impact melt rocks from various locations in the terrace deposits. The floral remnants include fragments of leaves, cell tissue, and undetermined organic matter that occur in vesicles within glassy melt rocks and impact melt breccias. After the discovery of floral remnants in impact melt breccias from upper Miocene strata in Argentina, and the description of floral imprints in the Dakhleh Glass of proposed impact origin in Egypt, the detection of paleoflora remnants in impact melt rocks of the El'gygytgyn structure is the first such occurrence in a confirmed impact crater on Earth.
Mechanistic insight into 3‐methylmercaptopropionate metabolism and kinetical regulation of demethylation pathway in marine dimethylsulfoniopropionate‐catabolizing bacteria
Authors: Shao Xuan , Cao Hai‐Yan , Zhao Fang , Peng Ming , Wang Peng , Li Chun‐Yang , Shi Wei‐Ling , Wei Tian‐Di , Yuan Zenglin , Zhang Xiao‐Hua , Chen Xiu‐Lan , Todd Jonathan D. , Zhang Yu‐Zhong 
Published: January 2019

SummaryThe vast majority of oceanic dimethylsulfoniopropionate (DMSP) is thought to be catabolized by bacteria via the DMSP demethylation pathway. This pathway contains four enzymes termed DmdA, DmdB, DmdC and DmdD/AcuH, which together catabolize DMSP to acetylaldehyde and methanethiol as carbon and sulfur sources respectively. While molecular mechanisms for DmdA and DmdD have been proposed, little is known of the catalytic mechanisms of DmdB and DmdC, which are central to this pathway. Here, we undertake physiological, structural and biochemical analyses to elucidate the catalytic mechanisms of DmdB and DmdC. DmdB, a 3‐methylmercaptopropionate (MMPA)‐coenzyme A (CoA) ligase, undergoes two sequential conformational changes to catalyze the ligation of MMPA and CoA. DmdC, a MMPA‐CoA dehydrogenase, catalyzes the dehydrogenation of MMPA‐CoA to generate MTA‐CoA with Glu435 as the catalytic base. Sequence alignment suggests that the proposed catalytic mechanisms of DmdB and DmdC are likely widely adopted by bacteria using the DMSP demethylation pathway. Analysis of the substrate affinities of involved enzymes indicates that Roseobacters kinetically regulate the DMSP demethylation pathway to ensure DMSP functioning and catabolism in their cells. Altogether, this study sheds novel lights on the catalytic and regulative mechanisms of bacterial DMSP demethylation, leading to a better understanding of bacterial DMSP catabolism.
Systemic comorbidities are associated with medication‐related osteonecrosis of the jaws: Case–control study
Authors: McGowan Kelly , Acton Caroline , Ivanovski Saso , Johnson Newell W. , Ware Robert S. 
Published: January 2019

AbstractObjectivesMedication‐related osteonecrosis of the jaws (MRONJ) is a serious condition developed in up to 15% of patients who take antiresorptive medications. Its underlying pathogenesis remains unclear. The association between systemic comorbidities and MRONJ was investigated.Subjects and MethodsA case–control study was conducted in Brisbane, Australia. Hospital records were used to identify 68 cases of MRONJ between January 2003 and March 2017. Each case was individually matched to three controls (204 in total) according to sex, age, primary disease, and type and duration of antiresorptive therapy. Data on patient demographic, social and clinical characteristics were collected. Systemic comorbidities and medications were quantified as a comorbidity–polypharmacy score (CPS). Associations were investigated using conditional logistic regression.ResultsThe CPS calculated for patients who developed MRONJ (mean ± SD = 20.2 ± 5.1) was significantly higher than for controls (12.9 ± 4.6). Multivariable analysis determined a significant relationship between CPS and the presence of MRONJ (OR = 1.5; 95% CI = 1.3, 1.8, p < 0.001).ConclusionsPatients with multiple systemic comorbidities and high levels of polypharmacy were more likely to develop MRONJ. The CPS is a simple and effective tool to quantify the risk of MRONJ attributed to a patient's systemic condition and should be considered in conjunction with the patient's oral health to assess the overall risk of MRONJ.
Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework
Authors: Xanidis Nikos , Gumley Andrew 
Published: January 2019

ObjectiveEvidence suggests that only a minority of service users experiencing psychosis have access to Cognitive Behavioural Therapy for psychosis (CBTp). Normalization Process Theory (NPT) is a theoretical framework which focuses on processes by which interventions are implemented and normalized in clinical practice. This study explored the views and experiences of mental health professionals regarding the implementation of CBTp. Barriers and facilitators to implementation were explored using the NPT framework.DesignA qualitative methodology was adopted involving semi‐structured focus groups and individual interviews.MethodsA total of 14 members of staff working in the community and crisis mental health teams were recruited. Thematic analysis was used to generate initial themes. The framework approach was utilized to map initial themes to the NPT framework.ResultsInductive coding generated five overarching themes consisting of 15 individual subthemes which captured the perceived barriers to engagement; contextual barriers to implementation; optimization of implementation; positive attitudes towards implementation; and expectations of implementing CBTp. All but two subthemes mapped on to the NPT framework. The deductive analysis suggested that difficulties in making sense of CBTp among professionals were reflected as service level barriers which impeded wider implementation.ConclusionThe results of this study suggested a mixture of barriers and facilitators to CBTp implementation. Interpreting our findings within an NPT framework indicates the importance of strong clinical leadership to address difficulties in sense‐making and service investment in CBTp.Practitioner points

Findings indicate a mixture of barriers and facilitators to CBTp implementation.

NPT analysis indicates difficulties in coherence among stakeholders regarding the purpose and value of CBTp.

Difficulties making sense of CBTp translates into service level barriers and impede the collective action of stakeholders.

The role of clinical leadership is crucial in increasing coherence and collective action in services.