bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome after Robotic-Assisted Thymectomy in Children and Adolescents with Acetylcholine Receptor Antibody-Positive Juvenile Myasthenia Gravis
Authors: Kölbel Heike , Müllers Maximilian , Kaiser Olaf , Ismail Mahmoud , Swierzy Marc , Rueckert Jens-Carsten , Schara Ulrike , Della Marina Adela 
Published: June 2017

AbstractThe aim of our study was to describe the long-term outcomes after robotic-assisted thymectomy in a cohort of acetylcholine receptor (AChR)-antibody (Ab)–positive, generalized juvenile myasthenia gravis (JMG). We retrospectively analyzed a cohort of 18 patients (15 females and 3 males) who underwent robotic-assisted thymectomy. At the time of diagnosis, 12/18 patients were prepubertal; the mean age was 9.8 years at the onset of the disease. All patients received therapy with pyridostigmine; additional immunotherapy included: corticosteroid therapy in 18/18, azathioprine in 14/18 patients, mycophenolate mofetil in 4/18, and cyclosporine in 1/18 patients. Eight patients received intravenous immunoglobulin and four plasma exchange. The mean age of patients at thymectomy was 11.7 years (range: 4.2–16 years). The mean duration of postoperative stay was 2.9 days. Thymectomy was followed by gradual clinical improvement (39% patients achieved clinical remission) and dose reduction in steroid therapy in all patients during the follow-up period (mean: 27.4 months). In children and adolescents with AChR-Ab–positive JMG, thymectomy has a beneficial effect on the weaning off immunosuppressive therapy in patients with generalized symptoms and should be considered as a part of multimodal therapy. Robotic-assisted thymectomy is a safe procedure with low morbidity and a comparable clinical outcome compared with the open sternal procedure.
Das Krankenhausstrukturgesetz: Hehre Ziele – Ernüchternde Umsetzung
Authors: Dittmann Heidi 
Published: June 2017

ZusammenfassungMit dem Krankenhausstrukturgesetz sollen Strukturen geschaffen werden, die auch in Zukunft eine qualitativ hochwertige Gesundheitsversorgung
der Bevölkerung ermöglichen. Ein wesentliches Element der Reform besteht im Einbezug der Qualität in die Krankenhausvergütung. Bei
andauernden Qualitätsdefiziten ist ein Ausschluss aus der Landesbedarfsplanung vorgesehen. Im Beitrag wird dem hehren Ziel der
Qualitätsverbesserung die ernüchternde Umsetzung auf Landesebene am Beispiel Thüringens gegenübergestellt. Anstatt eine Marktbereinigung um
qualitativ ineffiziente Anbieter zu begrüßen, bekennen sich die Fraktionen des Thüringer Landtags zu allen Standorten und nehmen per
Rechtsverordnung alle an der Notfallversorgung teilnehmenden Kliniken von der Möglichkeit des Ausschlusses aus. Etwaige strukturelle
Änderungen werden konterkariert.
Implementing marine ecosystem-based management: lessons from Australia
Authors: Smith David C. , Fulton Elizabeth A. , Apfel Petrina , Cresswell Ian D. , Gillanders Bronwyn M. , Haward Marcus , Sainsbury Keith J. , Smith Anthony D. M. , Vince Joanna , Ward Tim M. 
Published: June 2017

AbstractEcosystem-based management (EBM) is now widely accepted as the best means of managing the complex interactions in marine systems. However, progress towards implementing and operationalizing it has been slow. We take a pragmatic approach to EBM. Our simple definition is balancing human activities and environmental stewardship in a multiple-use context. In this paper, we present case studies on the development and implementation of EBM in Australia. The case studies (Australia’s Ocean Policy, the Great Barrier Reef, New South Wales (NSW) marine estate, Gladstone Harbour, and South Australia and Spencer Gulf) span different spatial scales, from national to regional to local. They also cover different levels of governance or legislated mandate. We identify the key learnings, necessary components and future needs to support better implementation. These include requirements for clearly identified needs and objectives, stakeholder ownership, well defined governance frameworks, and scientific tools to deal with conflicts and trade-offs. Without all these components, multi-sector management will be difficult and there will be a tendency to maintain a focus on single sectors. While the need to manage individual sectors remains important and is often challenging, this alone will not necessarily ensure sustainable management of marine systems confronted by increasing cumulative impacts.
Abilities of a Densitometric Analysis of Computed Tomography Images and Hemorrhagic Parameters to Predict Outcome Favorability in Patients With Intracerebral Hemorrhage
Authors: Kim Hakseung , Yang Xiaoke , Choi Young Hun , Yoon Byung C , Kim Keewon , Kim Dong-Joo 
Published: June 2017

Abstract

BACKGROUND
Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability.

OBJECTIVE
To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes.

METHODS
Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted.

RESULTS
The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes.

CONCLUSION
Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.
“Bringing heaven down to earth”: the purpose and place of religion in UK food aid
Authors: Power Madeleine , Small Neil , Doherty Bob , Stewart-Knox Barbara , Pickett Kate E. 
Published: June 2017

Purpose
This paper uses data from a city with a multi-ethnic, multi-faith population to better understand faith-based food aid. The paper aims to understand what constitutes faith-based responses to food insecurity, compare the prevalence and nature of faith-based food aid across different religions and explore how community food aid meets the needs of a multi-ethnic, multi-faith population.

Design/methodology/approach
The study involved two phases of primary research. In Phase 1, desk-based research and dialogue with stakeholders in local food security programmes were used to identify faith-based responses to food insecurity. Phase 2 consisted of 18 semi-structured interviews involving faith-based and secular charitable food aid organizations.

Findings
The paper illustrates the internal heterogeneity of faith-based food aid. Faith-based food aid is highly prevalent and the vast majority is Christian. Doctrine is a key motivation among Christian organizations for their provision of food. The fact that the clients at faith-based, particularly Christian, food aid did not reflect the local religious demographic is a cause for concern in light of the entry-barriers identified. This concern is heightened by the co-option of faith-based organizations by the state as part of the “Big Society” agenda.

Originality/value
This is the first academic study in the UK to look at the faith-based arrangements of Christian and Muslim food aid providers, to set out what it means to provide faith-based food aid in the UK and to explore how faith-based food aid interacts with people of other religions and no religion.
Addressing food insecurity: a systemic innovation approach
Authors: Zivkovic Sharon 
Published: June 2017

Purpose
This paper aims to question the utility of addressing food insecurity through food assistance programmes and by separating food security into pillars, and it argues for a systemic innovation and complexity approach. This is achieved by demonstrating that food insecurity is a wicked problem and therefore needs to be addressed holistically.

Design/methodology/approach
To establish that food insecurity is a wicked problem, characteristics of food insecurity are aligned to characteristics of wicked problems. The need to address wicked problems holistically through a systemic innovation approach and an understanding of complexity theory is discussed by referring to the literature. How to take such an approach for addressing food insecurity is illustrated by describing the use of an online tool that takes a systemic innovation and complexity approach.

Findings
Given food insecurity is a wicked problem and needs to be addressed holistically, the focus when addressing food insecurity should not be on programmes or pillars. Instead, it needs to be on increasing the coherence and building the adaptive capacity of food insecurity solution ecosystems.

Practical implications
This paper provides insights into the nature of food insecurity and how to address food insecurity.

Originality/value
For the first time, this paper aligns characteristics of food insecurity to characteristics of wicked problems and demonstrates how an online tool for systemic innovation can assist food insecurity solution ecosystems to address food insecurity.
Working separately but together: appraising virtual project team challenges
Authors: Zuofa Tarila , Ochieng Edward G. 
Published: June 2017

Purpose
This paper aims to extend the extant knowledge on virtual teams by examining the challenges of virtual project teams in organisations in Nigeria.

Design/methodology/approach
Data were collected through semi-structured interviews. Totally, 20 interviews were recorded, transcribed and analysed. Validity and reliability were achieved by first assessing the plausibility in terms of already existing knowledge on some of the virtual project team issues identified by participants.

Findings
The findings from this study confirmed the growing relevance of virtual project teams in highly competitive global business environments. It emerged that some of the challenges identified in the study had some level of congruence with those previously identified from similar studies from other geographical locations. The findings also suggested that challenges in virtual project teams can be linked to the organisation, the project team and the virtual environment or even a combination of all.

Practical implications
The present study corroborates the position that managing virtual project teams requires additional efforts to attain their objectives through effective communications and the adoption of appropriate technology.

Originality/value
The originality of this study lies in its exploration of virtual project team challenges in a sub-Saharan Africa country (Nigeria). By identifying the challenges associated with virtual project teams, stakeholders will be better able to successfully establish and manage virtual project teams better.
Consensus‐building on developing dysphagia competence: a North West of England perspective
Authors: Guthrie Susan , Lancaster John , Stansfield Jois 
Published: June 2017

AbstractBackgroundDysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings.AimTo explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England.Methods & ProceduresA four‐phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two‐round Delphi process.Outcomes & ResultsFive themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus.Conclusions & ImplicationsThere are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings.
National Museum of African American History and Culture: A New Integration?
Authors: Rice Faun 
Published: June 2017

AbstractThe National Museum of African American History and Culture (NMAAHC) marks a milestone moment in American history; the project has taken almost a century to come to fruition. Beginning with the first glimpse of the new monumental building on the National Mall, a NMAAHC visitor encounters complex symbols and histories. This review explores NMAAHC's historical context alongside its symbolic capital and its inaugural exhibitions, focusing on the central topic of the museum's efforts to embody “a new integration,” a space wherein all Americans can see their country through the lens of the African American experience.
Children's Museums: A Look Back at the Literature
Authors: Herz Rebecca Shulman 
Published: June 2017

AbstractThis article examines nine articles from the Curator archive, from 1960–2017, on the topic of children's museums. It concludes that despite enormous changes in these museums over the 60‐year span, there are a number of trends consistent in the literature. The article concludes with a call to museums to invest in research in order to understand the impact of our work, and to help us ensure we are really achieving what we claim to.
Museums and the Future of a Healthy World: “Just, Verdant and Peaceful”
Authors: Sutton Sarah W. , Wylie Elizabeth , Economopoulos Beka , O'Brien Carter , Shapiro Stephanie , Xu Shengyin 
Published: June 2017

AbstractMuseums hold the physical and intellectual resources, abilities, creativity, freedom, and authority to foster the changes the world needs most. The authors offer a mantra for the field's role in creating a world where people and cultures flourish as the environment thrives. The text includes a variety of international calls‐to‐action, and provides example institutional responses. The authors are all members of PIC Green, the American Alliance of Museums’ professional network on environmental sustainability.
No Such Thing as Killer Robots
Authors: Robillard Michael 
Published: June 2017

AbstractThere have been two recent strands of argument (one offered by Rob Sparrow and the other offered by Duncan Purves, Ryan Jenkins, and Bradley Strawser) arguing for the pro tanto impermissibility of fully autonomous weapon systems (AWS). On Sparrow's view, AWS are impermissible because they generate a morally problematic ‘responsibility gap’. According to Purves et al., AWS are impermissible because moral reasoning is not codifiable and because AWS are incapable of acting for the ‘right’ reasons. I contend that these arguments are flawed and that AWS are not morally problematic in principle. Specifically, I contend that these arguments presuppose an incoherent conception of an AWS as somehow making genuine decisions but not being morally responsible for those very same decisions. Rather than conceiving of AWS in this way, I argue that an AWS is either a socially‐constructed institution that has been physically instantiated or it is a genuine agent. If it is the former, then we should treat AWS as we do any other collective action problem. If it is the latter, then we should treat AWS as responsibility‐bearers, but also as bearers of rights and/or interests. To reject this disjunction is not only conceptually incoherent but also potentially morally dangerous.
Cholelithiasis in adult bearded dragons: retrospective study of nine adult bearded dragons (Pogona vitticeps) with cholelithiasis between 2013 and 2015 in southern Germany
Authors: Gimmel A. , Kempf H. , Öfner S. , Müller D. , Liesegang A. 
Published: June 2017

SummaryWith an increased number of pet reptiles, many diseases occur due to nutritional disorders. Between 2013 and 2015, irregular gallbladder contents (sludge/choleliths) in adult bearded dragons (Pogona vitticeps) were recorded in many of the routinely conducted necropsies at the reptile rescue station in Munich (Auffangstation für Reptilien, München e.V., Munich, Germany). Nine animals, six from the rescue station and three from an associated veterinary practice (Tierärztliche Praxis für Exoten, Augsburg, Germany), were studied. Gallbladder contents from all animals were analysed at the Institute for Clinical Chemistry in Zurich, Switzerland. In three of nine animals, one cholelith composed of 100% calcium carbonate (CaCO3) was detected and it precipitated either as pure calcite or as a calcite:vaterite combination. In the remaining six animals, analyses suggested a protein‐based material. The detection of choleliths/sludge was not anticipated at necropsy or surgery in eight of nine animals. The diet of the six animals from the rescue station was retrospectively described as mainly insects, whereas the diet of the three animals from the veterinary practice also contained little plant matter. Fed insect species were mealworm larva (Tenebrio molitor), house cricket (Acheta domestica), migratory locust (Locusta migratoria) and zophobas larva (Zophobas morio), all high in protein and fat. In other species, a nidus must be present for CaCO3 to precipitate. As a protein‐based sludge was detected in six gallbladders, it is possible that a high‐protein diet could lead to such a nidus and subsequently to cholelith formation. Cholelithiasis seems to be a rising problem in adult bearded dragons and is likely underdiagnosed, as many choleliths were found at necropsy. This rise in cholelithiasis may correlate with an unnatural high‐protein, high‐fat insect‐based diet instead of a balanced plant‐based diet.
Evaluation of an in vitro system to simulate equine foregut digestion and the influence of acidity on protein and fructan degradation in the horse′s stomach
Authors: Strauch S. , Wichert B. , Greef J. M. , Hillegeist D. , Zeyner A. , Liesegang A. 
Published: June 2017

SummaryThe aim of this study was to improve an in vitro system in order to gather optimized information on the digestion of different forages in the horse′s upper gastrointestinal tract. Therefore, foregut digestion of several forages was simulated in vitro (Part 1). The effect of different pH values on in vitro fructan degradation of two selected grasses (Part 2) was tested subsequently. Part 1: We hypothesized that our system produces representative results simulating digestive processes in the upper alimentary tract, but neglects microbial fermentation. In vitro digestion of six forages (grass mixture for horses, grass mixture for cows (GMC), tall fescue, English perennial ryegrass (ER), white clover, lucerne) was performed in two phases with pepsin and pancreatin. The results are consistent with current data from in vivo studies, including a degradation of crude protein and monosaccharides as well as a relative increase in fibres. Interestingly, a loss of fructan was measured in two feedstuffs (ER/GMC: 4.1/4.4% DM fructan before and 0.59/0.00% DM after simulated foregut digestion). Part 2: As fructans are thought not to be fragmented by digestive enzymes, another hypothesis was developed: acidic hydrolysis leads to a degradation of fructans. To evaluate the influence of gastric pH on the digestion of fructan and protein, different pH values (2, 3 and 4) were adjusted in a second series of in vitro foregut digestion trials with ER and GMC. As expected, the highest degradation of protein was seen at the lowest pH (protein in ER/GMC at pH 2: 6.11/8.28% DM and at pH 4: 7.73/10.64% DM), whereas fructan degradation was highest at pH 4 (fructan in ER/GMC at pH 2: 1.63/1.95% DM and at pH 4: 1.31/0.91% DM). We presume that not only acidic hydrolysis but also plant enzymes cause the loss of fructans in an acidic environment.
Beet pulp intake and hairball faecal excretion in mixed‐breed shorthaired cats
Authors: Loureiro B. A. , Monti M. , Pedreira R. S. , Vitta A. , Pacheco P. D. G. , Putarov T. C. , Carciofi A. C. 
Published: June 2017

SummaryHairball formation may induce vomiting and intestinal obstruction in predisposed cats. Some insoluble fibres as sugarcane fibre and cellulose can prevent hairball formation. The aim of this study was to evaluate the effect of beet pulp consumption, a moderate soluble and fermentable fibre source, on faecal trichobezoars excretion in adult shorthaired cats fed kibble diets. Eighteen mixed‐breed shorthaired cats and three extruded diets were used as follows: a basal diet without added fibre source (PB0–8.8% dietary fibre); BP8–8% inclusion of beet pulp (17.5% of dietary fibre); BP16–16% inclusion of beet pulp (23.8% of dietary fibre). The cats were fed during 31 days and faeces quantitatively collected during three periods of 3 days each (from days 3–5; 15–17; 26–28). Gastrointestinal transit time was determined in the last 3 days of study (from days 29–31). The trichobezoars were separated from faeces, collected, dried and washed in ether for complete removal of all faecal material. The results were submitted to repeated‐measure analysis of variance and means evaluated by polynomial contrast (p < 0.05). Beet pulp increased faecal production (p < 0.001) and reduced gastrointestinal transit time (p = 0.003). No alterations were found on trichobezoar faecal excretion, both as considered in number per cat per day of mg per cat per day (p > 0.05). Beet pulp intake did not reduce the number or the size of hairballs eliminated via faeces of shorthaired cats.