bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smoking Cessation and the Risk of Hyperactive Delirium in Hospitalized Patients: A Retrospective Study
Authors: Park HyeYoun , Kim Ki Woong , Yoon In-Young 
Published: May 2016

Objectives: The acute cessation of smoking often induces symptoms that are similar to those associated with delirium. We aimed to evaluate effects of sudden nicotine abstinence on the development of delirium and its motoric subtypes in hospitalized patients. Methods: The present study included patients who were referred to psychiatrists by ward physicians due to confusion. The presence of delirium was defined using the Confusion Assessment Method and the Delirium Rating Scale Revised–98, which was also used to assess the severity of delirium. Outcome variables, including the length of hospital stay and 3-month mortality rate, were collected by a retrospective chart review. Results: Delirium was confirmed in 210 of the 293 referred patients. Of the motoric subtypes of delirium, the hyperactive subtype was more common (68.1%) and was related to higher 3-month mortality (odds ratio [OR], 2.189; 95% confidence interval [CI], 1.07 to 4.49; P = 0.033) compared with hypoactive delirium. Patients undergoing sudden cessation of smoking ( n = 55) were more likely to exhibit hyperactive delirium than were nonsmokers ( P = 0.001). A multivariate analysis revealed that smoking cessation was an independent risk factor for hyperactive delirium (OR, 10.33; 95% CI, 2.31 to 46.09; P = 0.002). In addition, the amount of smoking was positively correlated with the severity of hyperactivity ( r = 0.421, P = 0.003). Smoking status did not significantly influence overall delirium incidence. Conclusions: The present findings demonstrated that nicotine withdrawal was associated with hyperactive delirium, which suggests that they share common pathophysiologies that involve the dopamine, opioid, and cholinergic systems.
Corporate Governance Determinants of FII in Indian IT Firms
Authors: Panicker Vidya Sukumara , Mitra Sumit , Sensarma Rudra 
Published: May 2016

The objective of this study is to investigate the impact of corporate governance characteristics on foreign ownership in the Indian information technology industry. The ownership pattern of a firm and board characteristics are analysed to understand their impact on inflow of foreign institutional investors to the firms. Panel data for 9 years from 113 Indian IT firms, which are publicly listed, have been used. The results show that firms with more concentrated promoter holdings have lesser foreign investments. Apart from the total number of board members, measures of corporate governance including the number of independent members on board and an independent board chairman have been found to be insignificant. The outcomes point to the need of a strong performance before relying on international investments for fundraising.
Preclinical Medical Students’ Diverse Educational and Emotional Responses to a Required Hospice Experience
Authors: Tse Chung Sang , Morrison Laura J. , Ellman Matthew S. 
Published: May 2016

Background: Physicians’ lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students’ knowledge and comfort with hospice care. Objective: To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE). Design: Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts. Setting/patients: Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites. Measurements: Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded. Results: Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers’ attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported “no specified emotional reaction,” “sad/depressed,” “difficult /challenging,” “heartened/encouraged,” and “mixed emotions.” Conclusion: In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.
Interaction of CYP2C19, P2Y12, and GPIIIa Variants Associates With Efficacy of Clopidogrel and Adverse Events on Patients With Ischemic Stroke
Authors: Yi Xingyang , Wang Yanfen , Lin Jing , Cheng Wen , Zhou Qiang , Wang Chun 
Published: May 2016

Objective: Clopidogrel is a clinically important oral antiplatelet agent for the treatment or prevention of cerebrovascular disease. However, different individuals have different sensitivities to clopidogrel. This study assessed variants of different genes for association with response to clopidogrel, clinical outcome, and side effects in patients with ischemic stroke (IS). Methods: We consecutively enrolled 375 patients with IS after they received clopidogrel therapy, and venous blood samples were subjected to genotyping allelic variants of genes modulating clopidogrel absorption (ATP binding cassette subfamily B1, ABCB1), metabolic activation (cytochrome P450[CYP] 3A and CYP2C19), and biologic activity (platelet membrane receptor [ P2Y12, P2Y1)], and glycoprotein IIIa [ GPIIIa]) and statistically analyzing their interactions with clopidogrel sensitivity (CS) and adverse events, risk of IS recurrence, myocardial infarction, and death during 6 months of follow-up. Results: Adverse events occurred in 37 patients (31 had IS recurrence, 4 died, and 2 had myocardial infarction) during the first 6 months of follow-up. Single locus analysis showed that only the CYP2C19*2(rs4244285) variant was independently associated with CS and risk of adverse events after adjusting covariates. However, there was significant gene–gene interaction among CYP2C19*2(rs4244285), P2Y12(rs16863323), and GPIIIa (rs2317676) analyzed by generalized multifactor dimensionality reduction methods. The rate of adverse events among patients with the 3-loci interaction was 2.82 times the rate among those with no interaction (95% confidence interval: 2.04-8.63). Conclusion: Sensitivity of patients with IS to clopidogrel and clopidogrel-induced adverse clinical events may be multifactorial but is not determined by single gene polymorphisms.
Evaluation of a New Sonoclot Device for Heparin Management in Cardiac Surgery
Authors: Dzemali Omer , Ganter Michael T. , Zientara Alicja , Graves Kirk , Behr Renate , Genoni Michele , Hofer Christoph K. 
Published: May 2016

Background: Sonoclot is used to measure kaolin-based activated clotting time (kACT) for heparin management. Apart from measuring kACT, the device assesses the patient’s coagulation status by glass bead–activated tests (gbACTs; measuring also clot rate [CR] and platelet function [PF]). Recently, a new version of the Sonoclot has been released, and the redesign may result in performance changes. The aim of this study was to evaluate and compare the performance of the new (S2) and the previous (S1) Sonoclot. Methods: The S1 was used in the routine management of 30 patients undergoing elective cardiac surgery. Blood samples were taken at baseline (T1), after heparin administration (200 U/kg, 100 U/kg; T2 and T3), during cardiopulmonary bypass (T4), after protamine infusion (T5), and before intensive care unit transfer (T6). Kaolin-based activated clotting time and gbACTs were measured in duplicate by both the old and the new device and performance compared by Bland-Altman analysis and percentage error calculation. Results: A total of 300 kACT and 180 gbACTs were available. Bland-Altman analysis for kACT revealed that S2 consistently reported results in shorter time compared to S1 (overall = −14.7%). Comparing S2 and S1, the glass bead–activated tests showed mean percentage differences of −18.9% (gbACTs), +37.4% (CR), and −3.7% (PF). Conclusion: Since clotting is faster in the new S2 compared to S1, shorter clotting times have to be considered in clinical practice. The use of S2 kACT in heparin management will result in higher heparin and protamine dosing unless heparin kACT target values are adjusted to correct for the differences in results between S1 and S2.
Duration of Venodilation for Peripheral Intravenous Cannulation, as Induced by a Thermal Stimulus on the Forearm
Authors: Tokizawa Yuki , Tsujimoto Tomomi , Inoue Tomoko 
Published: May 2016

Background: Application of a thermal stimulus is a common procedure used to promote venodilation for peripheral intravenous cannulation (PIVC); however, the effects of thermal stimulation on the duration of venodilation and skin temperature of the forearm are unclear. Aim: To investigate the duration of venodilation induced by a thermal stimulus on the forearm. Method: Healthy female adults ( N = 40) from Japan participated in this study from November to December 2013. A heat pack was warmed to 40°C ± 2°C and placed over the forearm for 15 min. Vein diameter was measured via ultrasound and skin temperature via temperature sensor at six time points: before application of the thermal stimulus and at 1-min intervals for 5 min upon removal of the thermal stimulus. The main outcomes were vein diameter, proportional change in vein diameter, and skin temperature. We calculated proportional change in vein diameter after application of the thermal stimulus using vein diameter before the thermal stimulus to represent 100%. Results: Compared with vein diameter before thermal stimulus, the diameter at each time point after thermal stimulus was significantly increased ( p < .05) as were proportional change in vein diameter ( p < .05) and skin temperature. Conclusion: A thermal stimulus of 40°C ± 2°C on the forearm dilated veins significantly for PIVC, and the effect persisted for at least 5 min.
Disorderly conduct: Feminist nudity in Chinese protest movements
Authors: Jacobs Katrien 
Published: May 2016

The essay contributes to Cultural Studies as an evaluation of changing practices of media and social activism while highlighting theories of feminism and dialogic aesthetics. More specifically, it discusses women’s use of online self-photography as a protest medium and a platform for feminist activism within two distinctive protest movements, the Umbrella Movement of Fall 2014 and the mainland Chinese feminist movement of 2012–2013. Forerunners of these movements in mainland China can be found in the work of performance artists and sex bloggers such as Ye Haiyan and Muzimei, who have used bulletin board systems and blogs to lay bare their sex lives and the cultural mechanisms of misogyny. Their performances in public spaces and their online postings have also elicited public brawls and significant responses within governmental agencies (Farrer, 2007; Tong, 2011). The article posits that these discourses also have a historical lineage in the ‘light’ or ‘fleeting’ dissident writings of the Cultural Revolution that generated large-scale responses but did not aim at becoming earnest or solidified works of art (Voci, 2010). In this vein, nudity is employed to titillate and stir fellow netizens rather than offering a coherent and embodied stance. It offers flippant gestures and statements that come to signify ideology within online social movements.
Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses
Authors: de Bruijn Menno T , Tournoij Erik , van den Heuvel Daniel AF , de Vries-Werson Debbie , Wille Jan , de Vries Jean-Paul PM 
Published: May 2016

Purpose To describe an off-the-shelf method for the treatment of abdominal aortic aneurysms with hostile (large, >30 mm) neck and/or small (<20 mm) aortic bifurcation. Case report We describe five patients with large aortic necks and/or small aortic bifurcations, which were treated by combining an AFX endoprosthesis with a Valiant Captiva endograft, and additional proximal endoanchors when deemed necessary. Initial technical success was 100%. Follow-up ranged from 228 to 875 days. One patient suffered a type 1A and 1B endoleak at 446 days follow-up, which were successfully treated by endovascular means. Conclusion Combining the AFX and Valiant Captiva endografts is an off-the-shelf solution for treatment of large diameter aortic necks and small aortic bifurcations in patients deemed unfit for open repair or declined for fenestrated endografts. Longer follow-up is required to assess the long-term safety with special focus on aortic neck dilation.
Protecting our patients by protecting ourselves
Authors: Ziegler Blake , Alsabbagh Wasem , Houle Sherilyn , Wenger Lisa , Church Dana , Waite Nancy 
Published: May 2016

Background: With recent expansions to scope of practice that have allowed Canadian pharmacists to play a larger role in administering influenza vaccinations to the public, it is important that pharmacists themselves meet Canadian guidelines recommending that 80% of health care professionals and 100% of vaccinators receive an annual influenza vaccination. Unvaccinated health care professionals pose an infection risk to patients they serve and are at an increased risk of infection themselves. Methods: An online, anonymous survey was sent to Ontario community pharmacists to determine whether they had received the influenza vaccination during the 2013–2014 influenza season. All significant univariate chi-square analysis respondent characteristics were included in a multivariate regression analysis model to determine predictors of vaccination status. Results: A total of 780 pharmacists completed the survey (18.1% response rate), which showed that 7 in 10 Ontario community pharmacists received the influenza vaccine. Those certified to immunize were nearly 3 times more likely to have received the influenza vaccine than those not certified (81.6% versus 61.2%, respectively). Discussion: Having 70% of Ontario community pharmacists vaccinated against influenza is both an accomplishment and an opportunity to improve vaccination rates. While similar to the influenza immunization rates of other health care professions, Ontario community pharmacists did not meet Public Health Canada’s recommendations. Comprehensive worksite programs, including promotion, education and convenient access to influenza vaccination at no cost, could increase community pharmacist influenza vaccination rates. Conclusion: The authors issue a call to arms to encourage all pharmacists to receive the influenza vaccine to protect the public and themselves.
Use of proton-pump inhibitors among adults: a Danish nationwide drug utilization study
Authors: Pottegård Anton , Broe Anne , Hallas Jesper , de Muckadell Ove B. Schaffalitzky , Lassen Annmarie T. , Lødrup Anders B. 
Published: May 2016

Background: The use of proton-pump inhibitors (PPIs) has increased over the last decade. The objective of this study was to provide detailed utilization data on PPI use over time, with special emphasis on duration of PPI use and concomitant use of ulcerogenic drugs. Methods: Using the nationwide Danish Prescription Registry, we identified all Danish adults filling a PPI between 2002 and 2014. Using descriptive statistics, we reported (i) the distribution of use between single PPI entities, (ii) the development in incidence and prevalence of use over time, (iii) measures of duration and intensity of treatment, and (iv) the prevalence of use of ulcerogenic drugs among users of PPIs. Results: We identified 1,617,614 adults using PPIs during the study period. The prevalence of PPI use increased fourfold during the study period to 7.4% of all Danish adults in 2014. PPI use showed strong age dependency, reaching more than 20% among those aged at least 80 years. The proportion of users maintaining treatment over time increased with increasing age, with less than10% of those aged 18–39 years using PPIs 2 years after their first prescription, compared with about 40% among those aged at least 80 years. The overall use of ulcerogenic drugs among PPI users increased moderately, from 35% of users of PPI in 2002 to 45% in 2014. Conclusions: The use of PPIs is extensive and increasing rapidly, especially among the elderly.
Fear of an HIV positive test result: an exploration of the low uptake of couples HIV counselling and testing (CHCT) in a rural setting in Mukono district, Uganda
Authors: Nannozi Victoria , Wobudeya Eric , Gahagan Jacqueline 
Published: May 2016

Background: Couples HIV counselling and testing (CHCT) is a key preventive strategy used to reduce the spread of HIV. In Uganda, HIV prevalence among married or cohabiting couples is 5.6%, compared to 2.2% among those never married. CHCT can help ease disclosure of HIV positive status, which in turn may help increase opportunities to obtain social supports and reduce new infections. The purpose of this study was aimed at exploring the possible reasons for the low uptake of CHCT in Mukono district, a rural in setting in Uganda. Methods: The study was conducted in two sub-counties in a rural district (Mukono district) using a descriptive qualitative research design. Specifically, we conducted four focus group discussions and 10 key informant interviews. We also interviewed 53 individuals in couple relationships. Data were collected mainly in the local language Luganda and English, all data were transcribed into English and coded for emergent themes. Ethical clearance for this study was obtained from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. Results: Fear of a positive HIV test result emerged strongly as the most significant barrier to CHCT. To a lesser extent, perceptions and knowledge of CHCT, mistrust in marriages and culture were also noted by participants as important barriers to the uptake of CHCT among couples. Participants offered suggestions on ways to overcome these barriers, including peer couple counselling, offering incentives to couples that test together and door-to-door CHCT testing. Conclusion: In an effort to improve the uptake of CHCT, it is crucial to involve both females and males in the planning and implementation of CHCT, as well as to address the misconceptions about CHCT and to prioritise CHCT within health care systems management.
Gender Differences in Concussion Reporting Among High School Athletes
Authors: Miyashita Theresa L. , Diakogeorgiou Eleni , VanderVegt Christina 
Published: May 2016

Background: An athlete’s lack of concussion knowledge could lead to significant underreporting and injury mismanagement. To provide more effective management strategies of concussions in adolescent athletes, further examination of reporting behaviors is of critical importance. Hypothesis: The hypotheses for this study were as follows: (1) Girls are more likely to report concussion, (2) girls are more likely to report future concussions after an educational intervention, and (3) a difference in rationale for not reporting concussion will be found between sexes. Study Design: Cross-sectional, cohort design. Level of Evidence: Level 3. Methods: Survey answers were collected on 454 high school athletes (212 girls, 242 boys; mean age, 15.7 ± 1.15 years). Individual team meetings lasting approximately 30 minutes were held to collect data and provide an educational lecture. Participants were randomly provided an iClicker to submit a response to questions asked. Results: Girls were more likely to report a concussion (χ2 = 8.32, df = 3, N = 454, P = 0.040) and more likely to report future concussions after educational intervention (χ2 = 8.54, df = 2, N = 454, P = 0.014). There were no differences between sexes regarding rationale for not reporting a concussion (χ2 = 6.42, df = 4, N = 454, P = 0.170). Conclusion: There is concern these athletes still fail to understand the severity and potential sequelae of concussion injury. Both sexes cited that concussion is not a serious enough injury to warrant reporting to a medical professional. Clinical Relevance: High school athletes recover more slowly from concussions compared with college athletes; therefore, educating this population and promoting the importance of being knowledgeable regarding concussion recognition may increase reporting prevalence.
Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans
Authors: Ishikawa Masakazu , Adachi Nobuo , Yoshikawa Masahiro , Nakamae Atsuo , Nakasa Tomoyuki , Ikuta Yasunari , Hayashi Seiju , Deie Masataka , Ochi Mitsuo 
Published: May 2016

Background: Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy. Purpose: To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 39 patients (46 knees) with OCD lesions who had undergone surgical treatment. Using magnetic resonance imaging (MRI) scans, the PCL attachment at the lateral wall of the MFC was measured on the coronal sections, and the knee flexion angle was also measured on the sagittal sections. As with non-OCD knees, we reviewed and analyzed 25 knees with anterior cruciate ligament (ACL) injuries and 16 knees with meniscal injuries. Results: MRIs revealed that the femoral PCL footprint was located in a significantly more distal position in the patients with MFC OCD compared with patients with LFC OCD and ACL and meniscal injuries. There was no significant difference in knee flexion angle among the 4 groups. Conclusion: The PCL in patients with MFC OCD attached more distally at the lateral aspect of the MFC compared with knees with LFC OCD and ACL and meniscal injuries.
Factors Associated With Emergency Department Visits
Authors: Agarwal Parul , Bias Thomas K. , Madhavan Suresh , Sambamoorthi Nethra , Frisbee Stephanie , Sambamoorthi Usha 
Published: May 2016

Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.