bluuebunny/crossref_metadata_2025_split huggingface dataset:
A long‐term study of stable isotopes as tracers of processes governing water flow and quality in a lowland river basin: the upper Thames, UK
Authors: Darling W. George , Bowes Michael J. 
Published: December 2015

AbstractA long‐term study of O, H and C stable isotopes has been undertaken on river waters across the 7000‐km2 upper Thames lowland river basin in the southern UK. During the period, flow conditions ranged from drought to flood. A 10‐year monthly record (2003–2012) of the main River Thames showed a maximum variation of 3‰ (δ18O) and 20‰ (δ2H), although interannual average values varied little around a mean of –6.5‰ (δ18O) and –44‰ (δ2H). A δ2H/δ18O slope of 5.3 suggested a degree of evaporative enrichment, consistent with derivation from local rainfall with a weighted mean of –7.2‰ (δ18O) and –48‰ (δ2H) for the period. A tendency towards isotopic depletion of the river with increasing flow rate was noted, but at very high flows (>100 m3/s), a reversion to the mean was interpreted as the displacement of bank storage by rising groundwater levels (corroborated by measurements of specific electrical conductivity). A shorter quarterly study (October 2011–April 2013) of isotope variations in 15 tributaries with varying geology revealed different responses to evaporation, with a well‐correlated inverse relationship between Δ18O and baseflow index for most of the rivers. A comparison with aquifer waters in the basin showed that even at low flow, rivers rarely consist solely of isotopically unmodified groundwater.Long‐term monitoring (2003–2007) of carbon stable isotopes in dissolved inorganic carbon (DIC) in the Thames revealed a complex interplay between respiration, photosynthesis and evasion, but with a mean interannual δ13C‐DIC value of –14.8 ± 0.5‰, exchange with atmospheric carbon could be ruled out. Quarterly monitoring of the tributaries (October 2011–April 2013) indicated that in addition to the aforementioned factors, river flow variations and catchment characteristics were likely to affect δ13C‐DIC. Comparison with basin groundwaters of different alkalinity and δ13C‐DIC values showed that the origin of river baseflow is usually obscured.The findings show that long‐term monitoring of environmental tracers can help to improve the understanding of how lowland river catchments function. Copyright © NERC 2015. Hydrological Processes © 2015 John Wiley & Sons, Ltd.
EARLY CHILDHOOD MENTAL HEALTH CONSULTATION: AN EVALUATION OF EFFECTIVENESS IN A RURAL COMMUNITY
Authors: Vuyk M. Alexandra , Sprague‐Jones Jessica , Reed Christie 
Published: December 2015

ABSTRACTLittle research has been done to evaluate the effectiveness of early childhood mental health consultation (ECMHC) in rural, applied settings. In this mixed‐methods study, we evaluated an approach to ECMHC used in rural Southwest Kansas with individualized services for childcare providers. Twenty‐nine home‐based and center‐based childcare providers completed measures on provider growth, perceptions of child outcomes, and satisfaction with sessions. In total, 162 data points were collected and analyzed using multilevel growth models. In addition, 16 providers participated in qualitative interviews. Both home‐based and center‐based providers reported very high satisfaction with consultation sessions which increased with time, although home‐based providers showed significantly higher satisfaction than did center‐based providers. Provider growth, encompassing personal well‐being, scheduling and transitions, connections with parents, and positive discipline strategies increased significantly over time. Child outcomes, encompassing prosocial behavior, resilience, and overall well‐being also improved significantly in providers’ perception. ECMHC as conducted in Southwest Kansas appears to have a positive effect on childcare providers and the children in their care.
Biological activity of selenium: Revisited
Authors: Wrobel Jagoda K. , Power Ronan , Toborek Michal 
Published: December 2015

AbstractSelenium (Se) is an essential micronutrient that exerts multiple and complex effects on human health. Se is essential for human well‐being largely due to its potent antioxidant, anti‐inflammatory, and antiviral properties. The physiological functions of Se are carried out by selenoproteins, in which Se is specifically incorporated as the amino acid, selenocysteine. Importantly, both beneficial and toxic effects of Se have been reported suggesting that the mode of action of Se is strictly chemical form and concentration dependent. Additionally, there is a relatively narrow window between Se deficiency and toxicity and growing evidence suggests that Se health effects depend greatly on the baseline level of this micronutrient. Thus, Se supplementation is not an easy task and requires an individualized approach. It is essential that we continue to explore and better characterize Se containing compounds and mechanisms of action, which could be crucial for disease prevention and treatment. © 2015 IUBMB Life, 68(2):97–105, 2016
Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies
Authors: Nesbitt‐Hawes Erin M , Tetstall Emma , Gee Kiera , Welsh Alec W 
Published: December 2015

AbstractIntroduction: Fetal abdominal circumference (AC) is utilised in calculations for the estimation of fetal weight (EFW) and has been proposed as a method of monitoring diabetic pregnancies. We evaluated true ultrasound accuracy by comparing fetal AC biometry with neonatal anthropometry and compared this with standard ultrasound estimations of fetal weight.Methods: A prospective observational study was performed at a tertiary referral centre. Women who were having their confinement of a term, singleton gestation either by induction of labour or elective caesarean section from 2009–2011 were approached to participate. An ultrasound was performed within 24 hours of delivery measuring the biometric parameters of AC, head circumference (HC), biparietal diameter and femur length. Following delivery the AC, HC and birthweight were measured on the neonate.Results: Fifty‐two patients were enrolled in the study with data collected from 50. Mean AC measurement was 35.1 ± 2.1 cm and birth weight was 3596 ± 517 g. A Bland‐Altman plot was used to compare the two AC measurements with the 95% limits of agreement ranging from −2.33–4.69 cm around a mean difference of 1.2 cm. Mean percentage error was 5.0% and 6.2% for the AC and HC measurements respectively, in comparison with percentage errors of 7.0–13.8% for estimation of fetal weight (EFW) from 27 formulae.Conclusions: Sonographic AC measurement is accurate in term pregnancies, with a percentage error less than HC or EFW. Perceptions of ultrasound inaccuracy may relate to the application of formulae rather than the ultrasound technique itself. Fetal surveillance using serial AC measurement has been proposed, in particular monitoring of diabetic pregnancies and in such a group AC may be easier and faster to obtain and more meaningful than EFW.
Three patients with signs of acute flail mitral leaflet seen on emergency department echo: a critical constellation within the focused cardiac exam
Authors: Bomann J Scott , Stephenson George , Wallace Craig , Mao Pras , Moore Chris 
Published: December 2015

AbstractAcute flail mitral leaflet is a time‐sensitive, reversible cause of cardiogenic shock. Transthoracic echocardiography (echo) is increasingly becoming a vital tool for non‐cardiologist physicians who treat patients with undifferentiated chest pain and dyspnoea. The sonographic abnormalities seen in acute flail mitral leaflet are within the boundaries of a focused echo. Individually, these findings are non‐specific. As a constellation, however, they are highly suggestive of this disease process. We present a case series of three patients with acute flail mitral leaflet seen on emergency department echo along with a discussion of the findings and the disease itself.
The association between discharge before noon and length of stay in medical and surgical patients
Authors: Rajkomar Alvin , Valencia Victoria , Novelero Maria , Mourad Michelle , Auerbach Andrew 
Published: December 2015

BACKGROUNDDischarging patients before noon is a key approach to improving bed utilization. Few data exist to describe whether patients are discharged earlier or their stay is extended to allow for an early discharge the next day.OBJECTIVETo determine if a discharge before noon (DCBN) is associated with length of stay (LOS).DESIGN/SETTINGS/PATIENTSRetrospective analysis of data from adult medical and surgical discharges from a single academic center from July 2012 through April 2015. We used a multivariable generalized linear model to evaluate the association between DCBN and LOS.RESULTSOf 38,365 hospitalizations, 6484 (16.9%) were discharged before noon, and the median LOS was 3.7 days. After adjustment, DCBN was associated with a longer LOS (adjusted odds ratio [OR]: 1.043, 95% confidence interval [CI]: 1.003‐1.086). The association between longer LOS and DCBN was more pronounced in patients admitted emergently (n = 14,192, 37%) (adjusted OR: 1.14, 95% CI: 1.033‐1.249).CONCLUSIONSAlthough we cannot discern whether discharges were delayed to achieve discharge before noon, earlier discharge was associated with a longer LOS, particularly among emergent admissions. Journal of Hospital Medicine 2015;11:859–861. © 2015 Society of Hospital Medicine
Gray and white matter alterations in early HIV‐infected patients: Combined voxel‐based morphometry and tract‐based spatial statistics
Authors: Wang Bo , Liu Zhenyu , Liu Jiaojiao , Tang Zhenchao , Li Hongjun , Tian Jie 
Published: December 2015

PurposeTo investigate both the gray matter (GM) and whiter matter (WM) alterations in a homogeneous cohort of early HIV‐infected patients by combining voxel‐based morphometry (VBM) and tract‐based spatial statistics (TBSS).Materials and MethodsTwenty‐six HIV and 26 control subjects enrolled in this study with 3D T1 and diffusion‐tensor imaging acquired on a 3.0T Siemens scanner. Group differences in regional GM were assessed using VBM analysis, while differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and relative anisotropy (RD) of WM were evaluated using TBSS analysis. After that, interactions between GM changes and white matter alterations were investigated by using a correlation analysis.ResultsThe HIV‐infected patients displayed decreased GM volume, mainly located in the bilateral frontal cortices, bilateral anterior cingulate cortex, and left supplementary motor area (P < 0.05, false discovery rate‐corrected). Meanwhile, the patient group showed decreased FA in the genu of capsule callosum, body of capsule callosum, and bilateral anterior corona radiate (P < 0.05, family wise error [FEW]‐corrected). Areas of increased MD, RD, and AD in HIV patients were more extensive and observed in most skeleton locations (P < 0.05, FEW‐corrected). The interaction analysis in the patient group revealed that there were no significant correlations between GM changes and WM alterations (P > 0.05).ConclusionOur results indicate that structural brain alterations occurred early in HIV‐infected patients. The current study may shed further light on the potential brain effects of HIV. J. Magn. Reson. Imaging 2016;43:1474–1483.
Polypharmacy: a risk factor to consider in valproate‐induced hyperammonaemic encephalopathy
Authors: Kowalski Melanie , Tong Erica Y. , Yip Gary S. , Dooley Michael J. 
Published: December 2015

AbstractBackgroundValproate is commonly prescribed as part of combination therapy in antiepileptic or mood stabilising regimens. Although generally well tolerated, valproate has potential to cause serious adverse effects, one of which is valproate‐induced hyperammonaemic encephalopathy (VHE). The risk of developing VHE is rare; however, this can increase when valproate is used in conjunction with other medications.AimThis report aims to highlight the importance of early diagnosis of VHE and emphasise the potential deleterious effects of polypharmacy and certain hazardous drug combinations.Clinical detailsA 58‐year‐old woman with a 1‐week history of increasing lethargy, confusion and drowsiness presented to the emergency department. Blood tests showed a raised ammonia level and liver function test (LFT) derangement. She had been on a long‐term antiepileptic regimen which included sodium valproate. The only recent change to her medications was the introduction of atorvastatin. A diagnosis of VHE was made and valproate was discontinued. Atorvastatin was also stopped on account of its likely role in LFT derangement.OutcomesAfter discontinuation of both agents attributed to her presentation, serum ammonia and LFTs returned to within normal range. The patient also gradually resumed her usual level of alertness and functional state.ConclusionThis report describes a case of VHE and emphasises the detrimental role of polypharmacy associated with this presentation. This illustrates the potentially complex pharmacy issues that must be considered in the management of a patient on chronic valproate therapy.
Atypical presentation of metoclopramide‐induced galactorrhea
Authors: Menon Parvathy , Thunga Girish , Nambiar Srikanth , Khera Kanav 
Published: December 2015

AbstractBackgroundMetoclopramide is commonly used for the management of nausea and vomiting, but is associated with a range of adverse effects, including galactorrhea.AimTo present a case of an atypical presentation of metoclopramide‐induced galactorrhea.Clinical detailsA previously asymptomatic 30‐year‐old woman was treated with metoclopramide for management of gastrointestinal symptoms. Five days after the initiation of treatment she developed pain in both breasts and whitish discharge from nipples of both breasts, which was subsequently identified as milk. Her last menstrual period was 4 days before admission to hospital, and had lasted only for a day. Four years prior to admission, she had undergone a tubectomy. Transvaginal ultrasound was used to rule out pregnancy. Thyroid, liver and kidney function were normal, and the serum concentration of prolactin at this time was 1.8 ng/mL (reference range 3.3–26 ng/mL), slightly below the normal level. Metoclopramide was discontinued and galactorrhea, mastalgia and fever subsided.OutcomesMetoclopramide was discontinued and galactorrhea, mastalgia and fever subsided.ConclusionAlthough previous reports have described metoclopramide‐induced galactorrhea in association with hyperprolactinaemia, this case appears to represent a probable atypical presentation of an adverse drug reaction.
Narrative review: status of key performance indicators in contemporary hospital pharmacy practice
Authors: Lloyd Georgia F. , Bajorek Beata , Barclay Peter , Goh Sue 
Published: December 2015

AbstractAimThe aim of this review was to explore the status of key performance indicators (KPIs) in Australian hospital pharmacy practice.Data sourcesFor this narrative review, databases (MEDLINE, PubMed and EBSCO) were searched for relevant publications within the period from April 1980 to April 2014 using the following search terms: hospital pharmacy, key performance indicators, performance measures, clinical indicators and benchmarking. The inclusion criteria were as follows: full text papers (papers only available as abstracts were discarded) and English language. Reference lists of selected papers were also searched to identify additional literature.ResultsWhile there are established competencies, standards and quality use of medicines (QUM) indicators for hospital pharmacy in Australia, there are no standardised KPIs relating to the performance and practice of hospital pharmacy. International research has demonstrated that KPIs are valuable tools for measuring pharmacy performance; the need for KPIs is highlighted in research from the UK, USA, Canada, New Zealand and Australia. Particular challenges associated with KPI implementation include: the need for relevance to all stakeholders; difficulties in measuring pharmacists’ activities due to the inherent nature of their work; lack of resources for data collection; limited understanding of KPIs; and negative attitudes toward KPIs by some pharmacists.ConclusionBefore nationally standardised KPIs are introduced into Australian hospital pharmacy practice, attention must be paid to developing relevant measures through careful consultation with all relevant stakeholders, including pharmacists themselves. KPIs should provide relevant results, be easy to measure and highlight the value of hospital pharmacy services in a resource‐friendly manner.
Chronic obstructive pulmonary disease exacerbations, ‘Sugar Sugar’, what are we monitoring?
Authors: M. del Campo Michaela , W. Roberts Greg , Cooter Anna 
Published: December 2015

AbstractBackgroundHigh‐dose prednisolone is the mainstay of treatment for chronic obstructive pulmonary disease (COPD) exacerbation and commonly causes hyperglycaemia that requires management. Routine blood glucose level (BGL) tests four times a day should be performed to monitor for hyperglycaemia in this group.ObjectiveTo investigate the impact of pharmacist intervention to improve BGL monitoring and recording for COPD inpatients treated with high‐dose prednisolone.DesignA pre‐ and post‐intervention design was used. Pre‐intervention data were collected retrospectively and post‐intervention data prospectively. The main endpoints were the proportion of patients with BGLs monitored at least three times a day (which was considered to be the minimum clinical requirement) and evaluation of the time period BGL monitoring occurred. Secondary assessments were to explore hyperglycaemia management and the use of HbA1c as a tool for detecting unknown diabetics.ResultsA greater proportion of post‐intervention patients achieved the minimum required monitoring on Day 1 compared to the pre‐intervention group (29 vs 7%, p = 0.043). An improvement in monitoring occurred on Day 2 (42 vs 17%, p = 0.048). The post‐intervention group had a higher mean number of BGL tests during all time periods of the day with a threefold increase between 1400 and 2400 hours (2.4 ± 1.9 vs 0.8 ± 1.2, p = 0.00).ConclusionPharmacist intervention can significantly improve BGL monitoring, including targeting of the time period crucial for detecting steroid‐induced hyperglycaemia.
Cysteamine eye drops in the treatment of cystinosis – an Australian perspective
Authors: Radojkovic Branko 
Published: December 2015

AbstractCystinosis is a rare but very serious genetic disorder. Advancements in medical science, in the past few decades, have transformed this previously terminal condition into a manageable disease. Ophthalmic sequelae of cystinosis are caused by accumulation of cystine crystals in ocular tissues and are very troublesome for most cystinosis patients. Accumulation of crystals in the cornea causes debilitating photophobia and pain that does not respond to systemic cysteamine therapy. If left untreated, this can lead to structural damage (corneal ulcers, scarring and band keratopathy) and eventually result in corneal blindness requiring corneal transplant. Topical ophthalmic application of cysteamine can alleviate the symptoms and, if instituted early, may prevent the damage. There is no commercially manufactured ophthalmic cysteamine product available in Australia and patients who receive treatment are usually supplied with extemporaneously prepared cysteamine eye drops or ointment. Stability issues, various factors influencing product effectiveness and patient adherence are only few of the problems that make formulation and compounding of cysteamine ophthalmic products a complex task.
Medication costs in an emergency department
Authors: Harding Andrew M. , Welton Caillan G. , Yeoh Michael J. 
Published: December 2015

AbstractObjectiveTo determine the average medication costs associated per emergency department (ED) presentation. To determine the top 10 medications by cost to the ED.MethodsRetrospective analysis of all pharmacy‐related medication costs and ED patient presentations from 1 January 2013 to 31 December 2013. Medication expenditure data were collected from the pharmacy software Merlin Hospital Drug Management System. Patient presentation data were collected from the hospital ED information system (MedTrak).ResultsThe average medication cost per patient per episode of care was AU$7.49. The top 10 medications by cost to the ED were alteplase, diphtheria and tetanus vaccine, Hartmann's intravenous fluid, sodium chloride 0.9% 10 mL ampoules, enbucrilate, digoxin immune Fab, acetylcysteine injection, icatibant injection, ondansetron wafers and metaraminol injection.ConclusionThe total cost of medication per patient presentation in the ED is small and represents limited opportunities for cost savings through changes to prescribing practices.
Hypoglycaemia in elderly patients with type 2 diabetes mellitus: a review of risk factors, consequences and prevention
Authors: Jafari Badieh , Britton Mary E. 
Published: December 2015

AbstractThe prevalence of diabetes in the elderly is high. Hypoglycaemia is a treatment‐related complication of diabetes. Owing to age‐related changes, decreased perception of hypoglycaemic symptoms, comorbidities and polypharmacy, elderly diabetic persons are at a greater risk of developing hypoglycaemia. Other risk factors include longer duration of diabetes, history of previous hypoglycaemic episodes, intensive glycaemic control, poor nutrition or missed meals and recent hospitalisation. Insulin and sulphonylureas are the medication classes most frequently associated with hypoglycaemia. Other antidiabetic medications typically cause hypoglycaemia only when used in combination with sulphonylureas or insulin. Hypoglycaemia in older people is associated with loss of independence, increased morbidity and mortality. Prevention of hypoglycaemia requires recognition of the risk, identification of precipitating factors, patient and caregiver education, appropriate prescribing and ongoing health professional support.
The generation of amplified spontaneous emission in high‐power CPA laser systems
Authors: Keppler Sebastian , Sävert Alexander , Körner Jörg , Hornung Marco , Liebetrau Hartmut , Hein Joachim , Kaluza Malte Christoph 
Published: December 2015

AbstractAn analytical model is presented describing the temporal intensity contrast determined by amplified spontaneous emission in high‐intensity laser systems which are based on the principle of chirped pulse amplification. The model describes both the generation and the amplification of the amplified spontaneous emission for each type of laser amplifier. This model is applied to different solid state laser materials which can support the amplification of pulse durations . The results are compared to intensity and fluence thresholds, e.g. determined by damage thresholds of a certain target material to be used in high‐intensity applications. This allows determining if additional means for contrast improvement, e.g. plasma mirrors, are required for a certain type of laser system and application. Using this model, the requirements for an optimized high‐contrast front‐end design are derived regarding the necessary contrast improvement and the amplified “clean” output energy for a desired focussed peak intensity. Finally, the model is compared to measurements at three different high‐intensity laser systems based on Ti:Sapphire and Yb:glass. These measurements show an excellent agreement with the model.
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