bluuebunny/crossref_metadata_2025_split huggingface dataset:
Auto-organização na aprendizagem de conceito científico em espaço organizado na perspectiva da História da Ciência
Authors: Kamioji Marly Iyo 
Published: September 2017

Definimos e realizamos entrevistas pedagógicas com alunos da 7a e 8a série do ensino fundamental de escolas da rede pública que acabavam de visitar uma exposição científica onde eram expostos às teorias clássicas da física. Analisamos, através de registro em vídeo, a dinâmica das interações desenvolvidas durante a entrevista, aluno-aluno, aluno-grupo, aluno-entrevistador, aluno-exposição, em termos das expressões de linguagem e das correlações estabelecidas na direção de configurações científicas de significado. Chamamos dialógicas potenciais, de forma genérica, às interações em que há regulação da postura dos alunos na direção da aprendizagem, e de dialógicas efetivas às interações em que são desenvolvidas correlações que levam, através da permanência de significado, a configurações de aprendizado. Essa distinção surgiu na análise de duas situações que revelaram processos reguladores na interação, mas não com resultado final semelhantes: na primeira emergiu situação de aprendizagem enquanto que na outra não foi obtida nenhuma organização científica de significado. Os dados são analisados em termos de processos de auto-organização de sistemas dinâmicos aplicados à aprendizagem. A interação dialógica efetiva onde se desenvolveu a configuração de aprendizado do conceito científico de energia ocorreu num espaço de exposição científica organizado com coerência cognitiva onde a perspectiva histórica da construção dos conceitos científicos foi levada em conta. Concluímos que esse tipo de entrevista pode se constituir em instrumento eficiente para propostas e avaliação de metodologias, em sala de aula e em exposições científicas, que visem a aprendizagem conceitual.
Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients
Authors: Hansson Nils Henrik , Sörensen Jens , Harms Hendrik Johannes , Kim Won Yong , Nielsen Roni , Tolbod Lars Poulsen , Frøkiær Jørgen , Bouchelouche Kirsten , Dodt Karen Kaae , Sihm Inger , Poulsen Steen Hvitfeldt , Wiggers Henrik 
Published: September 2017

Background—
Currently, no pharmacological treatment can modify the natural history of aortic valve stenosis (AS). This underlines the critical need to explore novel treatment strategies, which could postpone or prevent the need for aortic valve replacement in patients with asymptomatic AS. The objectives of this study were to investigate whether metoprolol reduce the hemodynamic and metabolic burden imposed by AS.

Methods and Results—

In a double-blinded design, 40 patients with moderate-severe asymptomatic AS (aortic valve area, 0.5±0.1 cm
2
/m
2
; peak gradient, 53±19 mm Hg) were randomized to placebo or metoprolol treatment for 22 weeks. Patients were evaluated by echocardiography, cardiovascular magnetic resonance, and
11
C-acetate positron emission tomography. Compared with placebo, metoprolol (100±53 mg/d) decreased heart rate; mean difference (95% confidence interval) −8 minute
−
1
(−13, −3;
P
=0.003) and increased ejection time 26 ms (2, 50;
P
=0.03). Furthermore, metoprolol reduced aortic valve peak −7 mm Hg (−13, 0;
P
=0.05) and mean −4 mm Hg (−7, −1;
P
=0.03) gradients, without affecting stroke volume 3 mL/m
2
(−2, 8;
P
=0.16). Valvuloarterial impedance (ie, global afterload) and myocardial oxygen consumption were reduced by −11% and −12% (
P
=0.03 and 0.01), respectively; and decreased heart rate correlated with lower valvuloarterial impedance, myocardial oxygen consumption, and improved myocardial efficiency defined as stroke work/myocardial oxygen consumption (
r
=0.63–0.65; all
P
<0.01). There were 2 adverse cardiovascular events in the metoprolol group and none in the placebo group.

Conclusions—
In patients with asymptomatic AS, metoprolol increases systolic ejection time and reduces aortic valve gradients, global afterload, and myocardial oxygen requirements. Thus, metoprolol displays favorable hemodynamic and metabolic effects and could improve outcome in patients with asymptomatic AS.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02076711.
Temporal Trends in Use of Composite End Points in Major Cardiovascular Randomized Clinical Trials in Prominent Medical Journals
Authors: Tan Nigel S. , Ali Sammy H. , Lebovic Gerald , Mamdani Muhammad , Laupacis Andreas , Yan Andrew T. 
Published: September 2017

Background—
Cardiovascular mortality has decreased over the past 5 decades, making it increasingly difficult to demonstrate significant benefits of new therapies in randomized clinical trials. We sought to determine whether the use of composite end points in major cardiovascular trials has changed over time and examine temporal trends in the clinical importance of individual components of these composite end points.

Methods and Results—

Using a validated search strategy, we searched MEDLINE for randomized trials of therapies for primary or secondary cardiovascular prevention published in
New England Journal of Medicine
,
The Lancet
, and the
Journal of the American Medical Association
between 1986 and 2015. We abstracted and categorized study population demographics, type of intervention, and primary and secondary outcomes. Composite end point components were ranked according to importance (minor, moderate, major, critical, and death) and temporal trends analyzed. In total, 604 of 2607 trials retrieved met inclusion criteria. Use of composite end points increased significantly over time from 18.8% between 1986 and 1990 to 83.0% between 2011 and 2015 (
P
<0.001). The number of components in the primary end point also increased significantly (median 1 in 1986–1990, median 3 in 2011–2015;
P
<0.001). Contemporary trials were more likely to include end points of lesser importance to patients (minor 3.1% and moderate 6.3% in 1986–1990, minor 4.5% and moderate 44.6% in 2011–2015;
P
<0.001). Use of death as the sole primary end point declined significantly over time (53.1% in 1986–1990, 17.9% in 2011–2015;
P
<0.001).

Conclusions—
Contemporary cardiovascular randomized clinical trials are more likely to use primary composite end points that contain a larger number of components. Furthermore, these composite end points have increasingly incorporated components of lesser clinical importance. Clinicians and policymakers interpreting results of randomized trials should recognize that the significance of individual components in a composite end point is often heterogeneous.
Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization
Authors: Schwartz Jennifer , Wang Yongfei , Qin Li , Schwamm Lee H. , Fonarow Gregg C. , Cormier Nicole , Dorsey Karen , McNamara Robert L. , Suter Lisa G. , Krumholz Harlan M. , Bernheim Susannah M. 
Published: September 2017

Background and Purpose—
The Centers for Medicare & Medicaid Services publicly reports a hospital-level stroke mortality measure that lacks stroke severity risk adjustment. Our objective was to describe novel measures of stroke mortality suitable for public reporting that incorporate stroke severity into risk adjustment.

Methods—
We linked data from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke registry with Medicare fee-for-service claims data to develop the measures. We used logistic regression for variable selection in risk model development. We developed 3 risk-standardized mortality models for patients with acute ischemic stroke, all of which include the National Institutes of Health Stroke Scale score: one that includes other risk variables derived only from claims data (claims model); one that includes other risk variables derived from claims and clinical variables that could be obtained from electronic health record data (hybrid model); and one that includes other risk variables that could be derived only from electronic health record data (electronic health record model).

Results—
The cohort used to develop and validate the risk models consisted of 188 975 hospital admissions at 1511 hospitals. The claims, hybrid, and electronic health record risk models included 20, 21, and 9 risk-adjustment variables, respectively; the C statistics were 0.81, 0.82, and 0.79, respectively (as compared with the current publicly reported model C statistic of 0.75); the risk-standardized mortality rates ranged from 10.7% to 19.0%, 10.7% to 19.1%, and 10.8% to 20.3%, respectively; the median risk-standardized mortality rate was 14.5% for all measures; and the odds of mortality for a high-mortality hospital (+1 SD) were 1.51, 1.52, and 1.52 times those for a low-mortality hospital (−1 SD), respectively.

Conclusions—
We developed 3 quality measures that demonstrate better discrimination than the Centers for Medicare & Medicaid Services’ existing stroke mortality measure, adjust for stroke severity, and could be implemented in a variety of settings.
A new Australian species of Eotetranychus (Acari: Tetranychidae) from buck spinifex Triodia mitchelli (Poaceae), intraspecific variation in Eotetranychus, and the synonymy of Platytetranychus with Eotetranychus
Authors: SEEMAN OWEN D. , BEARD JENNIFER J. , ZHANG LANNI 
Published: September 2017

Eotetranychus spinophilus sp. nov. is described from adults and deutonymphs collected from the spinifex grass Triodia mitchelli (Poaceae) in Queensland, Australia. The species Eotetranychus sexmaculatus (Riley, 1890) is considered absent from Australia; all previous records are instead Eotetranychus queenslandicus Manson, 1967. A key to the six Australian species of Eotetranychus Oudemans, 1931 is provided. Although our new species is classified in Eotetranychus, it also resembles some species of Schizotetranychus Trägårdh, 1915. We reaffirm previous suggestions of polyphyly within Schizotetranychus and observed that the patterns of leg striae (e.g. longitudinal striae on tibiae and tarsi III–IV) may have taxonomic value within Schizotetranychus, but that such patterns are rarely included in descriptions of spider mites. We also discuss the relationships between Eotetranychus and the closely related genera Mononychellus Wainstein, 1971, Palmanychus Baker & Tuttle, 1972 and Platytetranychus Oudemans, 1931. We show that the type species of Platytetranychus, P. gibbosus Canestrini, 1889, is an incertae sedis taxon that is not a member of the Tetranychini, and for this and other reasons, we synonymise Platytetranychus with Eotetranychus. Leg setation is reported for all six Australian species and three European species of Eotetranychus. Although each species has a characteristic leg setation, variation is common, with 51% of specimens having at least one anomaly. Asymmetrical setal losses accounted for most variation (43% of specimens), but in five specimens (9%) the loss was symmetrical. Variation in the expression of setae was found mostly in setae added in the adult (21/27 variable setae), representing about two-thirds of the total 33 adult leg setae added in Eotetranychus. We therefore stress the need for multiple specimens when describing a new species, especially if species are being separated using differences in leg setation, and particularly those setae that are added in the adult life stage.
Fast and Slow Components of the Extratropical Atmospheric Circulation Response to CO2 Forcing
Authors: Ceppi Paulo , Zappa Giuseppe , Shepherd Theodore G. , Gregory Jonathan M. 
Published: September 2017

Abstract
Poleward shifts of the extratropical atmospheric circulation are a common response to CO2 forcing in global climate models (GCMs), but little is known about the time dependence of this response. Here it is shown that in coupled climate models, the long-term evolution of sea surface temperatures (SSTs) induces two distinct time scales of circulation response to steplike CO2 forcing. In most GCMs from phase 5 of the Coupled Model Intercomparison Project as well as in the multimodel mean, all of the poleward shift of the midlatitude jets and Hadley cell edge occurs in a fast response within 5–10 years of the forcing, during which less than half of the expected equilibrium warming is realized. Compared with this fast response, the slow response over subsequent decades to centuries features stronger polar amplification (especially in the Antarctic), enhanced warming in the Southern Ocean, an El Niño–like pattern of tropical Pacific warming, and weaker land–sea contrast. Atmosphere-only GCM experiments demonstrate that the SST evolution drives the difference between the fast and slow circulation responses, although the direct radiative effect of CO2 also contributes to the fast response. It is further shown that the fast and slow responses determine the long-term evolution of the circulation response to warming in the representative concentration pathway 4.5 (RCP4.5) scenario. The results imply that shifts in midlatitude circulation generally scale with the radiative forcing, rather than with global-mean temperature change. A corollary is that time slices taken from a transient simulation at a given level of warming will considerably overestimate the extratropical circulation response in a stabilized climate.
Awareness and use of electronic cigarettes: Perceptions of health science programme students in Malaysia
Authors: Goh Yin Hoong , Dujaili Juman Abdulelah , Blebil Ali Qais , Ahmed Syed Imran 
Published: September 2017

Objectives: In recent years, electronic nicotine delivery systems (ENDS) or e-cigarettes appear to be gaining in popularity despite controversy over their health effects and public health impacts. This paper is the first in Malaysia to assess sociodemographic and behavioural characteristics associated with ENDS awareness, perceptions and use among students enrolled in health science programmes. Design: Online self-reported use and perceptions of ENDS were assessed using a cross-sectional design. Setting: The study was conducted at the International Medical University, Malaysia. Method: An anonymous Internet-based, cross-sectional survey was conducted among a cohort of 404 undergraduate students at International Medical University, Malaysia, in September 2016. Data were collected over a period of 6 weeks. A 31-question web-based survey was developed to assess sociodemographic and behavioural characteristics associated with ENDS awareness, perceptions and use. Logistic regression analysis was performed to assess the impact of a set of predictors on e-cigarette use. Results: Almost 95% of respondents were aware of e-cigarettes, 13.8% reported ever-use and students had varied perceptions towards e-cigarettes. Characteristics associated with greater likelihood of ever-use included gender, ethnicity and parents educational level. Other correlates included prior conventional cigarette smoking, prior hookah smoking, parents’ tobacco use and higher sensation-seeking behaviour total score. Conclusion: In this sample of young adults, e-cigarette awareness was high and ever-use was evident especially among ever cigarette smokers. Nearly half of ever-users had not used an e-cigarette in the past 30 days of the survey and mostly reported flavoured over unflavoured e-cigarette use. These findings highlight the importance of e-cigarette surveillance and health promotion interventions targeting young adults.
A validation study of the Caregiver Mastery Scale for partners of patients with acquired brain injury
Authors: Cox Vincent CM , Schepers Vera PM , Ketelaar Marjolijn , Kruithof Willeke J , van Heugten Caroline M , Visser-Meily Johanna MA 
Published: September 2017

Objective: To validate the Caregiver Mastery Scale for partners of patients with acquired brain injury. Design: The score distributions, internal consistency and convergent validity of the Caregiver Mastery Scale were determined. Subjects: A total of 92 partners (53% male, age 62 years) of patients with acquired brain injury (91% stroke) discharged from inpatient rehabilitation (time since injury 32 months). Main measures: Outcome measure: Caregiver Mastery Scale. Reference measures: Caregiver Strain Index, Hospital Anxiety and Depression Scale and CarerQoL. Results: The Caregiver Mastery Scale has a normal distribution, with no floor or ceiling effects. Its internal consistency is acceptable (Cronbach’s alpha: 0.75). The convergent validity analyses confirmed our hypothesis that higher scores on the Caregiver Mastery Scale correlate with less burden, lower levels of anxiety and depression and greater well-being. Furthermore, partners scoring high on the Caregiver Mastery Scale mostly scored below the clinical cut-off scores on the Caregiver Strain Index and the anxiety and depression subscales of the Hospital Anxiety and Depression Scale, whereas partners scoring low on the Caregiver Mastery Scale were more likely to score above the cut-off points. Conclusion: The Caregiver Mastery Scale is a valid instrument to assess the caregiver mastery of partners of patients with acquired brain injury.
Confirmatory Testing Prior to Initiating Onychomycosis Therapy Is Cost-Effective
Authors: Gupta Aditya K. , Versteeg Sarah G. , Shear Neil H. 
Published: September 2017

Background: Onychomycosis can be investigated by sampling. Information gleaned includes nail bed involvement, nail plate penetration, fungal viability, and species identification. Testing samples can confirm a diagnosis. While diagnostic testing is considered useful in directing therapy, a substantial number of clinicians do not confirm diagnosis prior to treatment. Objectives: The aim of this study is to quantify the benefit of confirmatory testing prior to treating toenail onychomycosis. Methods: The cost of mycological cure (negative potassium hydroxide and negative culture) and the cost-effectiveness of confirmatory testing were determined using the average cost of potassium hydroxide (KOH), culture, periodic acid–Schiff (PAS), efinaconazole, ciclopirox, terbinafine, and itraconazole. Costs were obtained through literature searches, public domain websites, and telephone surveys to local pharmacies and laboratories. To represent the potential risks of prescribing onychomycosis treatment, the costs associated with liver monitoring, potential life-threatening adverse events, and drug-drug interactions were obtained through public domain websites, published studies, and product inserts. Results: PAS was determined to be the most sensitive confirmatory test and KOH the least expensive. The overall cost of an incorrect diagnosis (no confirmatory test used) ranged between $350 and $1175 CAD per patient for treatment of 3 infected toenails. Comparatively, performing confirmatory testing prior to treatment decreases the overall cost to $320 to $930, depending on the therapy, physician, and test. Conclusions: It is preferred to diagnose onychomycosis prior to treatment. Furthermore, there are cost savings when confirmatory testing is performed before initiating treatment with both topical and oral antifungals in Canada.
Analysis of live interactive teledermatologic consultations for prisoners in Korea for 3 years
Authors: Seol Jung Eun , Park So Hee , Kim Hyojin 
Published: September 2017

Introduction Teledermatology has contributed to the enhanced accessibility of underserved populations. This study investigated the prevalence and clinical outcomes of dermatologic diseases in prisoners in Korea through live interactive teledermatology (LITD) Method The medical records of patients in a Busan prison, who interacted with a dermatologist using LITD from July 2013 to August 2016, were reviewed retrospectively. Results The mean age of the 406 patients enrolled in the study was 39.0 years and 91.4% were male. Infectious disease (42.8%) was the most common type of disease, followed by eczematous disease (29.4%) and diseases of the skin appendages (14.5%). Among the 187 (38.2%) patients who had a follow-up consultation, 162 (86.7%) showed clinical improvement, whereas 21 showed either no change or a worse clinical outcome. Twenty patients were diagnosed with different types of dermatologic disease at follow-up consultations. Discussion LITD can contribute to a favourable clinical outcome and may thus be an effective alternative to face-to-face consultation in prisoners and other underserved populations.
Higher dose intra-arterial milrinone and intra-arterial combined milrinone-nimodipine infusion as a rescue therapy for refractory cerebral vasospasm
Authors: Duman Enes , Karakoç Fatma , Pinar H Ulas , Dogan Rafi , Fırat Ali , Yıldırım Erkan 
Published: September 2017

Background Cerebral vasospasm (CV) is a major cause of delayed morbidity and mortality in patients with subarachnoid hemorrhage (SAH). Various cerebral protectants have been tested in patients with aneurysmal SAH. We aimed to research the success rate of treatment of CV via intra-arterial milrinone injection and aggressive pharmacological therapy for refractory CV. Methods A total of 25 consecutive patients who received intra-arterial milrinone and nimodipine treatment for CV following SAH between 2014 and 2017 were included in the study. Patients who underwent surgical clipping were excluded. Refractory vasospasm was defined as patients with CV refractory to therapies requiring ≥3 endovascular interventions. Overall, six patients had refractory CV. Long-term neurological outcome was assessed 6–18 months after SAH using a modified Rankin score and Barthel index. Results The median modified Rankin scores were 1 (min: 0, max: 3) and Barthel index scores were 85 (min: 70, max: 100) From each vasospastic territory maximal 10–16 mg milrinone was given to patients; a maximum of 24 mg milrinone was given to each patient in a session and a maximum of 42 mg milrinone was given to a patient in a day. Both milrinone and nimodipine were given to three patients. There was a large vessel diameter increase after milrinone and nimodipine injections. No patient died due to CV; only one patient had motor dysfunction on the right lower extremity. Conclusion Higher doses of milrinone can be used effectively to control refractory CV. For exceptional patients with refractory CV, high dose intra-arterial nimodipine and milrinone infusion can be used as a rescue therapy.