bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Intranasal Fentanyl for the Palliation of Incident Dyspnea in Advanced Congestive Heart Failure: A Pilot Study
Authors: Pilkey Jana , Pedersen Allison , Tam James W. , Malik Amrit , Wong Jonathan 
Published: May 2018

Background: Dyspnea is distressing in palliative patients with end-stage heart failure and many are hospitalized to optimize this symptom. We hoped to conduct a pilot study to determine whether the administration of intranasal fentanyl would decrease activity-induced dyspnea in this patient population. Methods: Patients performed two 6-minute walk tests with and without the administration of 50 μg of intranasal fentanyl. Vital signs were recorded before and after each walk, as were participant reported dyspnea and adverse events scores. Results: Twenty-four patients were screened, 13 were deemed eligible, and 6 completed the study. Dyspnea scores changed from a mean of 6.00 immediately after the walk without fentanyl to a mean of 3.83 after the walk with fentanyl ( P = .048). Mean respiratory rate decreased from 21.0 to 18.7 ( P = .034) breaths per minute and was considered a favorable outcome by the participants. Distance walked did not significantly increase with the fentanyl pretreatment (136.0-144.2 m; P = .283), although the participants reported feeling better while walking a similar distance. Conclusions: In this pilot study, the preadministration of intranasal fentanyl prior to activity in palliative, end-stage hospitalized heart failure patients, safely reduced tachypnea, and the feeling of shortness of breath. This approach may help palliate advanced heart failure patients by alleviating symptoms brought on by exertional activities.
“You Know if You Quit, That’s Failure, Right?”: Barriers to Professional Lactation Certification
Authors: Thomas Erin V. 
Published: May 2018

Background: Researchers have confirmed that breastfeeding disparities persist and that International Board Certified Lactation Consultants (IBCLCs) play a key role in reducing them. However, there continues to be a limited availability of IBCLCs throughout the United States, with racial minorities facing persistent barriers during the certification process. Research aim: Using a critical race theory framework, the aim was to describe the barriers and supports that IBCLCs experience during the course of their certification. Methods: This study used a prospective, cross-sectional, qualitative design with semistructured interviews with IBCLCs ( N = 36) from across the United States. Interviews were audio-recorded and professionally transcribed. Results were analyzed using an in-depth thematic analysis from the perspective of critical race theory. Results: Women made up the majority ( n = 35; 97.22%) of the sample. People of color made up slightly less than half of the sample ( n = 16; 44.44%). Barriers were initially coded by the stages of the certification process. Existing healthcare providers experienced advantages in the certification process because of their connection to social networks and resources in their hospital or place of employment. Cost and racial discrimination were identified, using a structural racism lens, as primary barriers for certification. Race-related barriers were particularly pervasive and were detailed by each stage of the certification process. Conclusion: Lactation organizations and care providers need to consider ways to mitigate these perceived differences in support and infrastructure. These changes could help to ensure equity in the profession and may reduce racial discrimination in lactation care.
Optimization of acid pretreatment and enzymatic hydrolysis on the production of ethanol fuel from waste banana peels
Authors: Guo Jiaxin , Li Zhenchi , Su Lingcheng , Tsang Yiu-Fai , An AK , Yu Chun-Fai 
Published: May 2018

This study investigated the application of waste banana peels as feedstock for the production of ethanol fuel as a second-generation biofuel. First, acid pretreatment followed by enzymatic hydrolysis converted both the cellulosic and hemicellulosic biomass of the peels into fermentable sugars, which eventually produced ethanol by yeast fermentation. The optimal conditions for the production of ethanol fuel were determined by orthogonal experimental design method. The results showed that 100 g of fresh banana would produce 31.4 g of banana peel which could be turned into 2.8 g dried peel powder. Under optimal conditions of acid pretreatment with 0.2% tartaric acid, enzymatic hydrolysis by cellulase and yeast fermentation, 115 mg of ethanol (95% purity) could be recovered by distillation from the fermentation broth, which was approximately 4% by weight of the dried peel powder. This study concluded that banana fruit, after the removal of peels for consumption or food processing, the discarded peels will no longer pose an organic waste problem to the environment if they could be recollected and converted into value-added products like ethanol fuel. We also demonstrated that tartaric acid, an organic acid used in the acid pretreatment, for the first time to our knowledge, outperformed the traditional sulfuric acid used commonly in other studies.
Decreased T cell expression of H/ACA box small nucleolar RNA 12 promotes lupus pathogenesis in patients with systemic lupus erythematosus
Authors: Lai N-S , Yu H-C , Huang K-Y , Tung C-H , Huang H-B , Lu M-C 
Published: May 2018

Objective To investigate whether the aberrant expression of non-coding RNAs (ncRNAs) in T cells from patients with systemic lupus erythematosus (SLE) could contribute to the pathogenesis of lupus. Methods Expression profiles of RNA transcripts in T cells from three patients with SLE and three controls were analyzed by microarray analysis. Potentially aberrant-expressed ncRNAs were validated using T cell samples from 23 patients with SLE and 17 controls. Transfection studies and microarray analyses were conducted to search for any gene expression that is regulated by specific ncRNAs. Results Initial analysis revealed differential expression of 18 ncRNAs in SLE T cells. After validation, decreased expression of H/ACA box small nucleolar RNA 12 (SNORA12) was confirmed in SLE T cells (0.69-fold, P = 0.007) compared with normal T cells, and its expression level was inversely associated with higher SLE disease activity scores. Jurkat cells transfected with a plasmid encoding SNORA12 showed increased expression of two genes and decreased expression of 15 genes in Jurkat cells. These changes of gene expression were significantly associated with the SLE pathway in the Kyoto Encyclopedia of Genes and Genomes map using microarray analysis. Overexpression of SNORA12 altered the expression of CD69, decreased the expression of histone cluster 1 H4 family member k (HIST1H4K), inhibited the secretion of interferon gamma and the expression of HIST1H4K was increased in SLE T cells. Conclusion Among the ncRNAs, we found that the expression level of SNORA12, which belongs to the family of small nucleolar RNAs, was lower in SLE T cells and affected T cell function. This novel finding suggests that aberrant-expressed snoRNAs lead to dysfunction of T cells and may be involved in the immunopathogenesis of SLE.
Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness
Authors: Suzuki K , Miyamoto M , Miyamoto T , Matsubara T , Inoue Y , Iijima M , Mizuno S , Horie J , Hirata K , Shimizu T , Kanbayashi T 
Published: May 2018

Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92–180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.
Bank Runs in China: Evidence from a Dynamic Panel Model
Authors: Liu Xuefang , Alexander W. Robert J. , Anwar Sajid 
Published: May 2018

The rise of China as a global economic power has caused concern that a crisis in Chinese banking could lead to a worldwide downturn similar to the Global Financial Crisis. Early warning indicators, such as the credit-to-GDP gap and the debt service ratio, are worrying. It is, therefore, worthwhile to study the key factors affecting bank deposits in China. We estimate a dynamic panel model applied to a panel of 63 Chinese banks and find that bank-specific fundamentals, as opposed to macroeconomic factors, are the main drivers of changes in bank deposits. JEL: E44, G21, G28
Low frequency electromagnetic field decreases ischemia–reperfusion injury of human cardiomyocytes and supports their metabolic function
Authors: Biały Dariusz , Wawrzyńska Magdalena , Bil-Lula Iwona , Krzywonos-Zawadzka Anna , Sapa-Wojciechowska Agnieszka , Arkowski Jacek , Woźniak Mieczysław , Sawicki Grzegorz 
Published: May 2018

Electromagnetic field at extremely low frequencies plays a significant role in the physiological function of human tissues and systems. It is shown that electromagnetic field inhibits production of reactive oxygen species which are involved in heart injury triggered by oxidative stress. We hypothesize that low frequency electromagnetic field protects function of cardiac cells from ischemia–reperfusion injury. Human cardiac myocytes, endothelial cells, and cardiac fibroblast underwent ischemia–reperfusion conditions in the presence or in the absence of low frequency electromagnetic field. LDH and MMP-2 activities (as markers of cell injury), and cell metabolic activity (by fluorescein diacetate staining) were measured to determine the protective role of low frequency electromagnetic field. Our data showed that short courses of low frequency electromagnetic field protect cardiac cells from cellular damage and preserve their metabolic activity during ischemia–reperfusion. This study demonstrates the possibility to use of low frequency electromagnetic field as strategy for the prevention or therapy of ischemia–reperfusion injury. Impact statement In our study, we showed that LF-EMF may be protective for heart during ischemia–reperfusion (I/R). Following is the short description of the main findings: (a) the response to the I/R injury was different for endothelial cells, fibroblasts, and cardiomyocytes; (b) I/R decreases MMP-2 activity in cardiac myocytes and fibroblasts; (c) I/R increases MMP-2 activity in endothelial cells; (d) LF-EMF reverses these changes; (e) LF-EMF protects cells from injury and preserves their metabolic activity.
From a small local audit to a regional quality improvement project – Improving lung protective ventilation
Authors: Birkhoelzer Sarah , Taylor Matt , Harris Ben , Adeniji Kayode 
Published: May 2018

Background Lung protective ventilation with tidal volumes (VT) of 6–8 ml per kg ideal body weight have been shown to reduce mortality in patients with acute respiratory distress syndrome and reduce post-operative pulmonary complications in major abdominal surgery. Following a local audit on weight recording, the Southcoast Perioperative Audit and Research Collaboration (SPARC) conducted a regional multi-disciplinary survey on the current practice in lung protective ventilation in the Wessex region. This resulted in a quality improvement project improving lung protective ventilation across these intensive care units. Methods Over one-week period in January over two consecutive years, lung protective ventilation parameters of mandatory ventilated patients (above the age of 18 years) were audited in intensive care units in the Wessex region. Results A total 1843 hours of mandatory ventilation were audited. The quality improvement project led to an improvement of lung protective ventilation with an average of 30% higher duration of ventilation with VT < 8 ml/kg ideal body weight. There was a suggestion that documentation of height and weight on admission to intensive care units improved compliance with lung protective ventilation. Conclusions Adherence to lung protective ventilation is variable across intensive care units but can be improved by recording patient’s weight and height accurately and using simple chart to help calculate the appropriate tidal volume. Additionally, this project demonstrates how a regional audit and quality improvement network can help to facilitate regional quality improvement.
The Paradox of Community Participation in Primary Health Care in Zaire
Authors: Bebe D. Ngo , Dumbi T. , Bulemvo P. , Bakanseka I. 
Published: May 2018

Dr. Ngo Bebe, author of the preceding article, considers that the difficulty in achieving true community participation remains one of the main impediments to success in primary health care programmes (PHC). The classic approach fails from the very beginning when District Medical Officers and other health professionals are chosen to manage primary health care programmes. Their attempts to convince the communities of the necessity of following their advice are often far too overbearing, and thus reinforce the «expert to ignorant» situation to a point where maintaining a true partnership becomes difficult, even impossible. It often happens as well that the community representatives in PHC programmes adopt aspects of the overbearing, «expert-like» behaviour. When this happens, they alienate themselves from the community or, in the least, lose any influence toward initiating action. As for the health professionals, they most likely direct any influence they may have towards clinically-oriented health measures. The preceding tendencies result in programmes which are quite far from the community's true concerns for achieving well-being and development. The PHC's problems such as lack of medicine and care facilities are generally overtaken by the more pressing priorities such as lack of good roads, energy, safe water, diminishing crops, etc. Dr. Ngo Bebe's article describes an initiative wherein the traditional primary health care approach is replaced by an integrated, community - centered programme. The health center remains the physical point for coordination, and its personnel participates in a variety of activities already taking place in the community. A health aspect is included, but does not overpower the activity which was formerly underway. A community development worker is integrated into the health center team. This provides the opportunity for growth and exchange, thus rendering the various activities truly interdisciplinary. Although this community mobilisation process has been underway in certain villages in Zaire for the past two years, and seems to have a positive impact on community development and the health status of the villagers, it is still early to proclaim the initiative an entire success. Only an assessment of the long term benefits will indicate the strengths and weaknesses of the project.
Long-Term Effects of Fibrin Conduit with Human Mesenchymal Stem Cells and Immunosuppression after Peripheral Nerve Repair in a Xenogenic Model
Authors: McGrath Aleksandra M. , Brohlin Maria , Wiberg Rebecca , Kingham Paul J. , Novikov Lev N. , Wiberg Mikael , Novikova Liudmila N. 
Published: May 2018

Introduction: Previously we showed that a fibrin glue conduit with human mesenchymal stem cells (hMSCs) and cyclosporine A (CsA) enhanced early nerve regeneration. In this study long term effects of this conduit are investigated. Methods: In a rat model, the sciatic nerve was repaired with fibrin conduit containing fibrin matrix, fibrin conduit containing fibrin matrix with CsA treatment and fibrin conduit containing fibrin matrix with hMSCs and CsA treatment, and also with nerve graft as control. Results: At 12 weeks 34% of motoneurons of the control group regenerated axons through the fibrin conduit. CsA treatment alone or with hMSCs resulted in axon regeneration of 67% and 64% motoneurons respectively. The gastrocnemius muscle weight was reduced in the conduit with fibrin matrix. The treatment with CsA or CsA with hMSCs induced recovery of the muscle weight and size of fast type fibers towards the levels of the nerve graft group. Discussion: The transplantation of hMSCs for peripheral nerve injury should be optimized to demonstrate their beneficial effects. The CsA may have its own effect on nerve regeneration.
Biomechanical, histological, and radiological effects of different phosphodiesterase inhibitors on femoral fracture healing in rats
Authors: Dincel Yasar Mahsut , Alagoz Ender , Arikan Yavuz , Caglar Aysel Kara , Dogru Suzan Cansel , Ortes Faruk , Arslan Yunus Ziya 
Published: May 2018

Purpose: To investigate the biomechanical, histological, and radiological effects of sildenafil and pentoxifylline on femoral fracture healing in rats. Methods: Forty-eight Sprague-Dawley rats were divided into three groups equally according to the pharmacological agents to be investigated. Femoral shaft fractures were formed in the left side. Group 1 (control group), group 2, and group 3 were administered with saline, sildenafil, and pentoxifylline during the fracture healing process, respectively. Eight rats from each group were euthanized on days 15 and 30. X-ray images of the rats were taken after euthanasia for radiographical examination. Femur samples were subjected to histopathological and biomechanical (three-point bending) examinations. Results: Radiologically, no difference between the Goldberg scores of the groups was found for day 15 ( p > 0.05), while higher Goldberg scores were obtained from group 2 than that of group 1 ( p > 0.05) and group 3 ( p < 0.05) for day 30. In the biomechanical analysis, higher mean breaking forces were found both for day 15 and day 30 from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p > 0.05) and group 3 (for day 15 p < 0.05 and day 30 p < 0.01). Higher mean absorbed energy values were obtained from group 2 than those obtained from group 1 (for day 15 p > 0.05 and day 30 p < 0.05) and group 3 (for day 15 p < 0.01 and day 30 p < 0.01). A significant difference was not found between the histological scores of all groups ( p > 0.05) for day 15, while the histological score of group 1 on day 30 was found to be significantly lower than that of sildenafil and pentoxifylline groups ( p < 0.05). Conclusion: Sildenafil had a positive effect on fracture healing, while pentoxifylline did not provide consistent positive effect.
Validity of QuickDASH at day of surgery versus day of initial consultation: Does informed consent make a difference?
Authors: Ikpeze Tochukwu C , Childs Sean , Buckley Taylor , Elfar John C 
Published: May 2018

Introduction: The trend toward requiring explicit consent from patients participating in observational research increases time and resources required to perform such research. Informed consent introduces the potential for “consent bias”—either through selection bias or through the “Hawthorne effect,” where patients may alter responses based upon the awareness of participation in a study, thus potentially limiting its applicability to a generalized orthopedic practice. We hypothesized that administering Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) to patients on the day of surgery with informed consent would alter responses in a statistically and clinically meaningful way compared to patients who complete QuickDASH as a quality control measure. Methods: We previously instituted the QuickDASH questionnaire as the standard new patient intake and postoperative questionnaire for quality assurance purposes. We retrospectively reviewed data on a cohort of patients who underwent isolated carpal tunnel release (CTR) who had completed preoperative and postoperative QuickDASH forms without providing consent for study participation. Next, a cohort of patients scheduled to undergo isolated CTR who completed the intake questionnaire was approached on the day of surgery for consent to participate in the study. After obtaining consent but prior to surgery, these patients completed a second questionnaire and then completed a postoperative questionnaire on follow-up at a mean of 8 weeks postoperatively. Results: Thirty-nine patients and 35 patients were included in the retrospective and prospective cohorts, respectively. No significant differences were observed in age, gender, symptom duration, nerve conduction study/electromyography results, or disease severity between the two groups. We identified no statistically significant difference in preoperative or postoperative QuickDASH score between the retrospective and prospective cohorts (39.8 ± 22.7 vs. 39.7 ± 19.1 preoperatively; 27.3 ± 24.7 vs. 18.7 ± 13.3 postoperatively) or within the prospective cohort before and after obtaining informed consent. Conclusion: Informed consent did not significantly alter patient responses to the QuickDASH questionnaire. These results suggest that both “opt-in” and “opt-out” approaches to observational research in hand surgery provide results that may be applicable to a generalized orthopedic practice. Clinical Relevance: This study provides evidence that will inform the interpretation of observational research findings in hand surgery.
Feedback Quality Using an Observation Form
Authors: Beck Dallaghan Gary L , Higgins Joy , Reinhardt Adam 
Published: May 2018

Background: Direct observations with focused feedback are critical components for medical student education. Numerous challenges exist in providing useful comments to students during their clerkships. Students’ evaluations of the clerkship indicated they were not receiving feedback from preceptors or house officers. Objective: To encourage direct observation with feedback, Structured Patient Care Observation (SPCO) forms were used to evaluate third-year medical students during patient encounters. Design: In 2014-2015, third-year medical students at a Midwestern medical school completing an 8-week pediatrics clerkship provided experiences on inpatient wards and in ambulatory clinics. Students were expected to solicit feedback using the SPCO form. Results/Findings: A total of 121 third-year medical students completed the pediatrics clerkship. All of the students completed at least one SPCO form. Several students had more than one observation documented, resulting in 161 SPCOs submitted. Eight were excluded for missing data, leaving 153 observations for analysis. Encounter settings included hospital (70), well-child visits (34), sick visits (41), not identified (8). Observers included attending physicians (88) and residents (65). The SPCOs generated 769 points of feedback, comments coalesced into themes of patient interviews, physical examination, or communication with patients and family. Once themes were identified, comments within each theme were further categorized as either actionable or reinforcing feedback. Discussion: SPCOs provided a structure to receive formative feedback from clinical supervisors. Within each theme, reinforcing feedback and actionable comments specific enough to be useful in shaping future encounters were identified.