bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of quality indexes of the provided health services in public and private services of Angola
Authors: Vicente Maria Teresa Conceição , Raimundo Rodrigo Daminello , Azalis Ligia Ajaime , Junqueira Virginia Berlanga Campos , Fonseca Fernando Luiz Affonso 
Published: August 2016

Introduction: Quality indices are being increasingly used by leaders, managers and health professionals as operational tools to improve processes and reduce costs. Noting that there is a greater tendency of private hospitals operating in the regulatory model for market mechanisms, it is expected that the quality indicators that serve as a reference for monitoring the health management are more critical in public hospitals. Objective: Evaluate the quality of health services provided in public and private service in Angola. Methods: We analyzed 142 patients of a public and a private institutions in Angola in a structured interview on health indicators. The indices were collected according to the process structure components and results. Results: There are 51,453 calls in the public institution, remaining hospitalized a day, an average of 184 patients, with an annual rate of bed occupancy of 90.84%. 50% of respondents praised the services and 22% complained about the quality of services. He was appointed as the main grounds for complaint the slow service (17%). The private institution received 2,222 patients, with an average of 570 patients. The mean hospital stay was 4.5 days. The average monthly rate of bed occupancy was 59.9%. In assessing the degree of satisfaction of care, regular or bad satisfaction obtained a rate of 60% in the private institution. Conclusion: There was no favorable results for quality in health management both in public service and in private.
Education and Communication in an Interprofessional Antimicrobial Stewardship Program
Authors: Foral Pamela A. , Anthone Jennifer M. , Destache Christopher J. , Vivekanandan Renuga , Preheim Laurel C. , Gorby Gary L. , Horne John M. , Dobronski Leo A. , Syed Javeria J. , Mindru Cezarina , Ali Mir A. , Ali Karim F. , Neemann Kari A. , Bittner Marvin J. 
Published: August 2016

Abstract

Context: Interprofessional education/interprofessional practice (IPE/IPP) is an essential component in medical education and training. A collaborative interprofessional team environment ensures optimal patient-centered care.

Objective: To describe the implementation of 2 interprofessional antimicrobial stewardship program (ASP) teams using IPE/IPP and to assess the acceptance rate by the primary medical and surgical teams of ASP recommendations for antimicrobial interventions.

Methods: A business plan for the ASP was approved at 2 academic medical centers used for the present study. During a 3-year study period, 2 interprofessional ASP teams included an attending physician specializing in infectious disease (ID), an ID physician fellow, an ASP pharmacist, physician residents, medical students, pharmacy residents, and pharmacy students. Educational seminars were presented for all adult-admitting physicians to discuss the need for the ASP and the prospective audit and feedback process. Cases were presented for discussion during ASP/ID rounds and recommendations were agreed upon by the ASP team. A motivational interviewing face-to-face technique was frequently used to convey the ASP team recommendation to the primary medical or surgical team in a noncoercive and educational manner. The ASP team recommendations for ASP interventions were documented in the medical records.

Results: The overall acceptance rate of recommendations by the primary medical and surgical teams were greater than 90% (2051 of 2266). The most frequent interventions provided were streamline therapy (601), route of administration change (452), bug-drug mismatch (190), and discontinuation of therapy (179). Route of administration change was also the most frequently accepted intervention (96%).

Conclusions: The motivational face-to-face communication technique was particularly useful in conveying ASP team member recommendations to the primary medical or surgical teams. Communicating recommendations as a multidisciplinary team in an educational manner seems to have resulted in to greater acceptance of recommendations.
Multicenter Osteopathic Pneumonia Study in the Elderly: Subgroup Analysis on Hospital Length of Stay, Ventilator-Dependent Respiratory Failure Rate, and In-hospital Mortality Rate
Authors: Noll Donald R. , Degenhardt Brian F. , Johnson Jane C. 
Published: August 2016

Abstract

Context: Osteopathic manipulative treatment (OMT) is a promising adjunctive treatment for older adults hospitalized for pneumonia.

Objective: To report subgroup analyses from the Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) relating to hospital length of stay (LOS), ventilator-dependent respiratory failure rate, and in-hospital mortality rate.

Design: Multicenter randomized controlled trial.

Setting: Seven community hospitals.

Participants: Three hundred eighty-seven patients aged 50 years or older who met specific criteria for pneumonia on hospital admission.

Interventions: Participants were randomly assigned to 1 of 3 groups that received an adjunctive OMT protocol (n=130), a light touch (LT) protocol (n=124), or conventional care only (CCO) (n=133).

Main Outcome Measures: Outcomes for subgroup analyses were LOS, ventilator-dependent respiratory failure rate, and in-hospital mortality rate. Subgroups were age (50-74 years or ≥75 years), Pneumonia Severity Index (PSI) class (I-II, III, IV, or V), and type of pneumonia (community-acquired or nursing–home acquired). Data were analyzed by intention-to-treat and per-protocol analyses using stratified Cox proportional hazards models and Cochran-Mantel-Haenszel tests for general association.

Results: By per-protocol analysis of the younger age subgroup, LOS was shorter for the OMT group (median, 2.9 days; n=43) than the LT (median, 3.7 days; n=45) and CCO (median, 4.0 days; n=65) groups (P=.006). By intention-to-treat analysis of the older age subgroup, in-hospital mortality rates were lower for the OMT (1 of 66 [2%]) and LT (2 of 68 [3%]) groups than the CCO group (9 of 67 [13%]) (P=.005). By per-protocol analysis of the PSI class IV subgroup, the OMT group had a shorter LOS than the CCO group (median, 3.8 days [n=40] vs 5.0 days [n=50]; P=.01) and a lower ventilator-dependent respiratory failure rate than the CCO group (0 of 40 [0%] vs 5 of 50 [10%]; P=.05). By intention-to-treat analysis, in-hospital mortality rates in the PSI class V subgroup were lower (P=.05) for the OMT group (1 of 22 [5%]) than the CCO group (6 of 19 [32%]) but not the LT group (2 of 15 [13%]).

Conclusion: Subgroup analyses suggested adjunctive OMT for pneumonia reduced LOS in adults aged 50 to 74 years and lowered in-hospital mortality rates in adults aged 75 years or older. Adjunctive OMT may also reduce LOS and in-hospital mortality rates in older adults with more severe pneumonia. Interestingly, LT also reduced in-hospital mortality rates in adults aged 75 years or older relative to CCO. (ClinicalTrials.gov number NCT00258661)
Teaching and Assessment of High-Velocity, Low-Amplitude Techniques for the Spine in Predoctoral Medical Education
Authors: Channell Millicent King 
Published: August 2016

Abstract
Although national didactic criteria have been set for predoctoral education and assessment in osteopathic manipulative treatment, there is no criterion standard for teaching methods and assessments of osteopathic manipulative treatment competence in colleges of osteopathic medicine. This issue is more pressing with the creation of the single graduate medical education accreditation system by the American Osteopathic Association and Accreditation Council for Graduate Medical Education, which introduced the creation of “osteopathic recognition” for residencies that want to incorporate osteopathic principles and practice into their programs. Residencies with osteopathic recognition may include both osteopathic and allopathic graduates. Increased standardization at the predoctoral level, however, is recommended as osteopathic principles and practice training applications are expanded. The objectives of this article are to review the standards for teaching osteopathic medical students high-velocity, low-amplitude (HVLA) techniques for the spine; to review and discuss the methods used to assess medical students’ proficiency in using HVLA; and to propose baseline standards for teaching and assessing HVLA techniques among medical students.
Nonprofit Board Membership for Health Care Professionals: Honor or Responsibility?
Authors: Johnson Joyce M. , Calderwood James A. 
Published: August 2016

Abstract
Physicians and other health care professionals are often invited to serve on nonprofit boards. Although service on a nonprofit board is an honor, it carries a large responsibility. Many health care professionals are unaware of the level of commitment and involvement board service requires, particularly fiduciary boards, which have accompanying risks and legal functions. In the present article, the authors describe the activities and responsibilities of a fiduciary board member. They also provide a checklist of questions to ask before agreeing to serve on a board and discuss how to decide whether one is the right fit for a specific board position.
The outflow of ionospheric nitrogen ions: A possible tracer for the altitude‐dependent transport and energization processes of ionospheric plasma
Authors: Ilie Raluca , Liemohn Michael W. 
Published: August 2016

AbstractThough limited, the existing observational data set indicates that N+ is a significant ion in the ionosphere, and its concentration varies with season, time of day, solar cycle, latitude, and geomagnetic conditions. Knowledge of the differential transport of heavy versus light ionospheric species can provide the connection between the macroscale dynamics and microscale processes that govern the near‐Earth space. The mass distribution of accelerated ionospheric ions reflects the source region of the low‐altitude ion composition, and the minor ion component can serve as a tracer of ionospheric processes since they can have a significant influence on the local plasma dynamics.
An improved method for interpretation of riverine concentration‐discharge relationships indicates long‐term shifts in reservoir sediment trapping
Authors: Zhang Qian , Harman Ciaran J. , Ball William P. 
Published: August 2016

AbstractDerived from river monitoring data, concentration‐discharge (C‐Q) relationships are powerful indicators of export dynamics. Proper interpretation of such relationships can be made complex, however, if the ln(C)‐ln(Q) relationships are nonlinear or if the relationships change over time, season, or discharge. Methods of addressing these issues by “binning” data can introduce artifacts that obscure underlying interactions among time, discharge, and season. Here we illustrate these issues and propose an alternative method that uses the regression coefficients of the recently developed “Weighted Regressions on Time, Discharge, and Season” model for examining C‐Q relationships in long‐term, discretely sampled data for various water‐quality constituents, including their uncertainties. The method is applied to sediment concentration data from Susquehanna River at Conowingo Dam, Maryland, to illustrate how the coefficients can be accessed and presented in ways that provide additional insights toward the interpretation of river water‐quality data, which reaffirms the recently documented decadal‐scale decline in reservoir trapping performance.
Using a large ensemble of simulations to assess the Northern Hemisphere stratospheric dynamical response to tropical volcanic eruptions and its uncertainty
Authors: Bittner Matthias , Schmidt Hauke , Timmreck Claudia , Sienz Frank 
Published: August 2016

AbstractThe observed strengthening of the Northern Hemisphere (NH) polar vortex after tropical volcanic eruptions appears to be underestimated by coupled climate models. However, there are only a limited number of observed eruptions, which makes the attribution of volcanic signals difficult, because the polar vortex is also influenced by other external forcing factors as well as internal variability. We show with a 100‐member ensemble of historical (1850–2005) simulations with the Max Planck Institute Earth System Model that an ensemble larger than what is provided by the Coupled Model Intercomparison Project Phase 5 (CMIP5) models is needed to detect a statistically significant NH polar vortex strengthening. The most robust signal can be found when only the two strongest eruptions (Krakatau and Pinatubo) are considered in contrast to including smaller eruptions to increase the sample size. For these two strongest eruptions, the mean of 15 CMIP5 models shows a statistically significant strengthening of the NH polar vortex as well.
Ionospheric electron number densities from CUTLASS dual‐frequency velocity measurements using artificial backscatter over EISCAT
Authors: Sarno‐Smith Lois K. , Kosch Michael J. , Yeoman Timothy , Rietveld Michael , Nel Amore' , Liemohn Michael W. 
Published: August 2016

AbstractUsing quasi‐simultaneous line‐of‐sight velocity measurements at multiple frequencies from the Hankasalmi Cooperative UK Twin Auroral Sounding System (CUTLASS) on the Super Dual Auroral Radar Network (SuperDARN), we calculate electron number densities using a derivation outlined in Gillies et al. (2010, 2012). Backscatter targets were generated using the European Incoherent Scatter (EISCAT) ionospheric modification facility at Tromsø, Norway. We use two methods on two case studies. The first approach is to use the dual‐frequency capability on CUTLASS and compare line‐of‐sight velocities between frequencies with a MHz or greater difference. The other method used the kHz frequency shifts automatically made by the SuperDARN radar during routine operations. Using ray tracing to obtain the approximate altitude of the backscatter, we demonstrate that for both methods, SuperDARN significantly overestimates Ne compared to those obtained from the EISCAT incoherent scatter radar over the same time period. The discrepancy between the Ne measurements of both radars may be largely due to SuperDARN sensitivity to backscatter produced by localized density irregularities which obscure the background levels.
Velocity‐weakening behavior of Westerly granite at temperature up to 600°C
Authors: Mitchell E. K. , Fialko Y. , Brown K. M. 
Published: August 2016

AbstractThe deep limit to seismicity in continental crust is believed to be controlled by a transition from velocity‐weakening to velocity‐strengthening friction based on experimental measurements of the rate dependence of friction at different temperatures. Available experimental data on granite suggest a transition to stable creep at about 350°C (∼15 km depth). Here we present results from unconfined experiments on Westerly granite at both dry and hydrated conditions that show increasingly unstable slip (velocity‐weakening behavior) at temperature up to 600°C. A comparison of previously published experimental results with those presented in this study suggests that the rate and state friction parameters strongly depend on normal stress and pore pressure at high (>400°C) temperature, which may help explain regional variations in the depth distribution of earthquakes in continental crust. Temperature dependence of the rate and state friction parameters may also contribute to strong dynamic weakening observed in high‐speed friction experiments on crystalline rocks such as granite and gabbro.
Evidence of reduced mid‐Holocene ENSO variance on the Great Barrier Reef, Australia
Authors: Leonard N. D. , Welsh K. J. , Lough J. M. , Feng Y.‐x. , Pandolfi J. M. , Clark T. R. , Zhao J.‐x. 
Published: August 2016

AbstractGlobally, coral reefs are under increasing pressure both through direct anthropogenic influence and increases in climate extremes. Understanding past climate dynamics that negatively affected coral reef growth is imperative for both improving management strategies and for modeling coral reef responses to a changing climate. The El Niño–Southern Oscillation (ENSO) is the primary source of climate variability at interannual timescales on the Great Barrier Reef (GBR), northeastern Australia. Applying continuous wavelet transforms to visually assessed coral luminescence intensity in massive Porites corals from the central GBR we demonstrate that these records reliably reproduce ENSO variance patterns for the period 1880–1985. We then applied this method to three subfossil corals from the same reef to reconstruct ENSO variance from ~5200 to 4300 years before present (yBP). We show that ENSO events were less extreme and less frequent after ~5200 yBP on the GBR compared to modern records. Growth characteristics of the corals are consistent with cooler sea surface temperatures (SSTs) between 5200 and 4300 yBP compared to both the millennia prior (~6000 yBP) and modern records. Understanding ENSO dynamics in response to SST variability at geological timescales will be important for improving predictions of future ENSO response to a rapidly warming climate.
RaD‐X: Complementary measurements of dose rates at aviation altitudes
Authors: Meier Matthias M. , Matthiä Daniel , Forkert Tomas , Wirtz Michael , Scheibinger Markus , Hübel Robert , Mertens Christopher J. 
Published: August 2016

AbstractThe RaD‐X stratospheric balloon flight organized by the National Aeronautics and Space Administration was launched from Fort Sumner on 25 September 2015 and carried several instruments to measure the radiation field in the upper atmosphere at the average vertical cutoff rigidity Rc of 4.1 GV. The German Aerospace Center (Deutsches Zentrum für Luft‐ und Raumfahrt) in cooperation with Lufthansa German Airlines supported this campaign with an independent measuring flight at the altitudes of civil aviation on a round trip from Germany to Japan. The goal was to measure dose rates under similar space weather conditions over an area on the Northern Hemisphere opposite to the RaD‐X flight. Dose rates were measured in the target areas, i.e., around vertical cutoff rigidity Rc of 4.1 GV, at two flight altitudes for about 1 h at each position with acceptable counting statistics. The analysis of the space weather situation during the flights shows that measuring data were acquired under stable and moderate space weather conditions with a virtually undisturbed magnetosphere. The measured rates of absorbed dose in silicon and ambient dose equivalent complement the data recorded during the balloon flight. The combined measurements provide a set of experimental data suitable for validating and improving numerical models for the calculation of radiation exposure at aviation altitudes.
Impact of dose, route, and composition on the immunogenicity of immune polyelectrolyte multilayers delivered on gold templates
Authors: Zhang Peipei , Andorko James I. , Jewell Christopher M. 
Published: August 2016

ABSTRACTBiomaterial vaccines offer new capabilities that can be exploited for both infectious disease and cancer. We recently developed a novel vaccine platform based on self‐assembly of immune signals into immune polyelectrolyte multilayers (iPEMs). These iPEM vaccines are electrostatically assembled from peptide antigens and nucleic acid‐based toll‐like receptor agonists (TLRas) that serve as molecular adjuvants. Gold nanoparticles (AuNPs) coated with iPEMs stimulate effector cytokine secretion in vitro and expand antigen‐specific T cells in mice. Here we investigated how the dose, injection route, and choice of molecular adjuvant impacts the ability of iPEMs to generate T cell immunity and anti‐tumor response in mice. Three injection routes—intradermal, subcutaneous, and intramuscular—and three iPEM dosing levels were employed. Intradermal injection induced the most potent antigen‐specific T cell responses and, for all routes, the level of response was dose‐dependent. We further discovered that these vaccines generate durable memory, indicated by potent, antigen‐specific CD8+ T cell recall responses in mice challenged with vaccine 49 days after a prime‐boost immunization regimen. In a common exogenous antigen melanoma model, iPEM vaccines slowed or stopped tumor growth more effectively than equivalent ad‐mixed formulations. Further, iPEMs containing CpG—a TLR9a—were more potent compared with iPEMs containing polyIC, a TLR3a. These findings demonstrate the ability of iPEMs to enhance response to several different classes of vaccine cargos, supporting iPEMs as a simple vaccine platform that mimics attractive features of other nanoparticles using immune signals that can be self‐assembled or coated on substrates. Biotechnol. Bioeng. 2017;114: 423–431. © 2016 The Authors. Biotechnology and Bioengineering Published by Wiley Periodicals, Inc.
Significance of delayed primary excision in localized nonmetastatic adult head and neck rhabdomyosarcoma
Authors: Kobayashi Kenya , Matsumoto Fumihiko , Kodaira Makoto , Mori Taisuke , Murakami Naoya , Yoshida Akihiko , Maki Daisuke , Teshima Masanori , Fukasawa Masahiko , Itami Jun , Asai Masahiro , Yoshimoto Seiichi 
Published: August 2016

AbstractAdult rhabdomyosarcoma (RMS) is a highly aggressive tumor. Multidisciplinary treatment is important. However, the role of surgery is controversial. The purpose of this study was to reveal the role of a delayed primary excision (DPE) after induction chemotherapy (IC) in localized nonmetastatic adult head and neck RMS. We retrospectively reviewed 24 adult head and neck RMS. Treatment was classified into the following two groups: the DPE group, who received IC followed by surgery, postoperative radiotherapy, and adjuvant chemotherapy (17 patients); the chemoradiotherapy (CRT) group, who received IC followed by chemoradiotherapy (seven patients). We analyzed the efficacy of IC, local control rate (LCR), and overall survival (OS). In the DPE group, 10 patients (59%) underwent complete surgical resection. In the evaluation of the surgical specimens, 14 patients (82%) had residual viable tumors after IC. The response to IC was significantly associated with the 3‐year LCR (CR/PR vs. SD/PD: 100% vs. 33%, P = 0.0014). In patients with good response to chemotherapy, the DPE group had a significantly better 3‐year LCR compared with that of the CRT group (DPE group vs. CRT group, 100% vs. 44%, P = 0.018). However, the treatment modalities were not associated with OS (DPE group vs. CRT group, 65% vs. 57%: P = 0.98). The recurrence patterns differed according to treatments, and distant metastases were more frequent in the DPE group. DPE may impact local control of localized nonmetastatic adult head and neck RMS. Poor response to IC is a risk factor for local recurrence.