bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indoor Environmental Exposures Among Children With Asthma Seen in an Urban Emergency Department
Authors: Teach Stephen J. , Crain Ellen F. , Quint Deborah M. , Hylan Michelle L. , Joseph Jill G. 
Published: January 2017

BACKGROUND. Current guidelines for asthma management emphasize the control of environmental irritants and allergens within the home. Understanding the prevalence of indoor home exposures within such a population may be important for any emergency department (ED) program that seeks to improve the quality of its asthma care and patient education.OBJECTIVE. We sought to determine the prevalence of indoor home exposures in a cohort of children with moderate to severe asthma who were treated in an urban pediatric ED and to correlate these exposures with household income, prior asthma morbidity, health care utilization, and quality of life (QoL).METHODS. We enrolled a cohort of children with chronic asthma who were 12 months through 17 years of age and who had at least one other unscheduled visit for asthma within the previous 6 months. Trained research assistants interviewed the children’s parent or guardian regarding the prevalence of home exposures to environmental tobacco smoke (ETS) and common allergens. In addition, data were collected on each patient’s prior asthma history, morbidity, health care utilization, medication use, and QoL.RESULTS. Of the 488 eligible children enrolled, 60.0% were &lt;6 years of age, 63.9% were male, 85.9% were black, 68.4% were publicly insured, and 51.8% had &gt;3 ED visits in the previous 12 months. Home exposure to ETS and potential allergens was high. Exposure to cockroach allergen was significantly associated with household income. Coexistence of exposures was common: significantly more patients reporting ETS exposure also reported exposure to cockroach allergen and mold than those not reporting ETS exposure. Poorer QoL was significantly associated with cockroach exposure, although this effect was limited to those also exposed to ETS. Higher rates of unscheduled health care utilization and persistent asthma symptoms were not associated with exposures.CONCLUSION. Additional investigation is necessary to clarify the role of exposure-avoidance measures as a component of ED-based interventions for asthma care.
Financing State Newborn Screening Programs: Sources and Uses of Funds
Authors: Johnson Kay , Lloyd-Puryear Michele A. , Mann Marie Y. , Ramos Lauren Raskin , Therrell Bradford L. 
Published: January 2017

BACKGROUND. Financing for newborn screening is different from virtually all other public health programs. All except 5 screening programs collect fees as the primary source of program funding. A fee-based approach to financing newborn screening has been adopted by most states, to ensure consistent funding for this critical public health activity.METHODS. Two types of data are reported here, ie, primary data from a survey of 37 state public health agencies and findings from exploratory case studies from 7 states.RESULTS. Most of the programs that participated in this survey (73%) reported that their newborn screening funding increased between 2002 and 2005, typically through increased fees and to a lesser extent through Medicaid, Title V Maternal and Child Health Services Block Grant, and state general revenue funding. All of the responding states that collect fees (n = 31) use such funds to support laboratory expenses, and most (70%) finance short-term follow-up services and program management. Nearly one half (47%) finance longer-term follow-up services, case management, or family support beyond diagnosis. Other states (43%) finance genetic or nutritional counseling and formula foods or treatment.CONCLUSIONS. Regardless of the source of funds, the available evidence indicates that states are committed to maintaining their programs and securing the necessary financing for the initial screening through diagnosis. Use of federal funding is currently limited; however, pressure to provide dedicated federal funding would likely increase if national recommendations for a uniform newborn screening panel were issued.
Economic Evaluation of Tandem Mass Spectrometry Screening in California
Authors: Feuchtbaum Lisa , Cunningham George 
Published: January 2017

OBJECTIVE. On the basis of California’s experience implementing a pilot tandem mass spectrometry (MS/MS) screening program, an economic evaluation was conducted to determine the economic benefits and costs of a statewide MS/MS screening program.
METHODS. Cost-effectiveness, benefit/cost, and cost-utility analyses were conducted with a base-case set of assumptions. The base-case assumptions were varied by using a set of more-favorable and less-favorable assumptions to test the robustness of the analysis findings.
RESULTS. The total estimated, annualized, incremental costs of MS/MS screening of 540000 births in California were nearly $5.7 million; 83 affected newborns would be identified. Screening would reduce the expected lifetime costs of medical care for affected newborns by $7.2 million ($9.0 million in the best-case scenario and $1.8 million in the worst-case scenario). When all program costs and savings were considered, screening saved $1.5 million ($3.4 million saved in the best-case scenario and $3.8 million additional costs in the worst-case scenario). With only incremental program costs, the cost per life saved was $708000 and the cost per case detected was $68000. With consideration of the projected lifetime medical care costs, the total cost per case detected was $132000. MS/MS screening produced a benefit/cost ratio of $9.32 ($11.67 with the best-case set of assumptions and $4.34 with the worst-case set of assumptions). In this analysis, the benefits of screening exceeded total program costs by $47.1 million (the net incremental benefit). In the worst-case scenario, the net incremental benefit of screening was $18.9 million. Screening saved 949 quality-adjusted life-years (QALYs) and saved $1628 per QALY in the base case analysis. Under the worst-case scenario, the cost per QALY was $14922.
CONCLUSIONS. We found that the benefits of MS/MS screening outweighed the costs and that the net benefits were significant and robust in various scenarios with various conservative underlying assumptions.
Comprehensive Cost-Utility Analysis of Newborn Screening Strategies
Authors: Carroll Aaron E. , Downs Stephen M. 
Published: January 2017

BACKGROUND. Inborn errors of metabolism are a significant cause of morbidity and death among children. Inconsistencies in how individual states arrive at screening strategies, however, lead to marked variations in testing between states.OBJECTIVE. To determine the cost-effectiveness of each component test of a multitest newborn screening program, including screening for phenylketonuria, congenital adrenal hyperplasia, congenital hypothyroidism, biotinidase deficiency, maple syrup urine disease, galactosemia, homocystinuria, and medium-chain acyl-CoA dehydrogenase deficiency.METHODS. A decision model was used, with cohort studies, government reports, secondary analyses, and other sources. Discounted costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were measured.RESULTS. All except 2 screening tests dominated the “no-test” strategy. The 2 exceptions were screening for congenital adrenal hyperplasia, which cost slightly more than $20000 per QALY gained, and screening for galactosemia, which cost $94000 per QALY gained. The screening test with the lowest expected cost was tandem mass spectrometry. The results found in our base-case analysis were stable across variations in nearly all variables. In instances in which changes in risks, sequelae, costs, or utilities did affect our results, the variation from base-case estimates was quite large.CONCLUSIONS. Newborn screening seems to be one of the rare health care interventions that is beneficial to patients and, in many cases, cost saving. Over the long term, funding comprehensive newborn screening programs is likely to save money for society.
Assessment of Newborn Screening Parent Education Materials
Authors: Arnold Connie L. , Davis Terry C. , Frempong Janet Ohene , Humiston Sharon G. , Bocchini Anna , Kennen Estela M. , Lloyd-Puryear Michele 
Published: January 2017

OBJECTIVE. The purpose of this study was to measure the readability and user-friendliness (clarity, complexity, organization, appearance, and cultural appropriateness of materials) of parent education brochures on newborn screening.METHODS. We studied English-language versions of the brochures that state newborn screening programs prepare and distribute. We obtained brochures from 48 states and Puerto Rico. We evaluated each brochure for readability with the Flesch reading ease formula. User-friendliness of the brochures was assessed with an instrument we created that contained 22 specific criteria grouped into 5 categories, ie, layout, illustrations, message, manageable information, and cultural appropriateness.RESULTS. Most current newborn screening brochures should be revised to make them more readable and user-friendly for parents. Ninety-two percent of brochures were written at a reading level that is higher than the average reading level of US adults (eighth-grade level). In most brochures, the essential information for parents was buried. Although all brochures were brief and focused on the newborn screening tests being performed, 81% needed improvement in getting to the point quickly and making it easy for parents to identify what they needed to know or to do. None of the brochures scored high in all 22 criteria on the user-friendliness checklist.CONCLUSIONS. Parent education materials about newborn screening should be revised to be easier to read and more user-friendly, by lowering the reading difficulty to eighth-grade level and focusing on issues such as layout, illustrations, message, information, and cultural appropriateness. It is important that state newborn screening programs and organizations work with parents to develop and to evaluate materials to ensure that they are user-friendly.
Infant Hearing Screening: Stakeholder Recommendations for Parent-Centered Communication
Authors: Arnold Connie L. , Davis Terry C. , Humiston Sharon G. , Bocchini Joseph A. , Bass Pat F. , Bocchini Anna , Kennen Estela M. , White Karl , Forsman Irene 
Published: January 2017

OBJECTIVES. The purpose of this study was to identify what stakeholders considered best practices for parent-provider communication regarding newborn hearing screening and diagnosis. We used consensus data to develop educational materials for parents.
METHODS. We conducted 29 focus groups and 23 individual interviews between October 2003 and May 2004. Participants included (1) English- and Spanish-speaking parents of infants &lt;18 months of age who had experience with hospital-based newborn hearing screening; (2) parents of children with hearing loss; (3) primary care providers who provide prenatal care or care for newborns; and (4) audiologists, audiology technicians, and hospital nurses.
RESULTS. Communication to parents about hospital-based newborn hearing screening was limited. Most parents first learned about the screening in the hospital, but all stakeholders thought a more opportune time for education was before the birth. For parents of infants who did not pass the newborn hearing screening, stakeholders recommended direct communication about the urgency of diagnostic testing. They also indicated that primary care providers needed current information regarding hearing screening, diagnostic testing, and early intervention. All stakeholders thought that a brief brochure for parents to take home would be helpful for hospital-based screening and, if necessary, subsequent diagnostic testing. Primary care providers requested basic, to-the-point information.
CONCLUSIONS. The most opportune time to begin discussion of newborn hearing screening is before the birth. Providers need up-to-date information on current standards of hearing screening, diagnosis, and intervention. User-friendly patient education materials, such as those we developed, could assist providers in educating parents.
An Improvement Approach to Integrate Teaching Teams in the Reporting of Safety Events
Authors: Dunbar Alston E. , Cupit Marcie , Vath Richard J. , Pontiff Kyle , Evans Natalie , Roy Melissa , Bolton Michael 
Published: January 2017

BACKGROUND AND OBJECTIVE:
Patient safety events are underreported by physicians. Baseline data demonstrated that physicians submitted 3% of event reports at Our Lady of the Lake Children’s Hospital. Our aim was to increase the proportion of safety reports filed by residents and faculty to 6% of all reports within a 9-month period.

METHODS:
We used the Model for Improvement and serial Plan, Do, Study, Act cycles to test interventions we hypothesized would improve physician recognition and reporting of patient safety events. We tracked the percentage of Our Lady of the Lake Children’s Hospital event reports entered by residents or faculty over time as the primary outcome measure. Changes to teaching team processes included “patient safety rounds” prompted by text messages, an inpatient “superintendent” rotation with core patient safety responsibilities, and a “just-in-time” faculty development program called “QI on the Fly.”

RESULTS:
Physician-reported events increased to a monthly average of 24% of all events reported, an improvement that has been sustained over 17 months. Resident reporting accounted for most of the increase in physician reports. Increased physician reporting was temporally associated with implementation of the “superintendent” rotation. The total number of events reported increased as a result of increased physician reporting.

CONCLUSIONS:
Incorporating patient safety responsibilities into a teaching team’s workflow can increase physician safety event reporting. We plan additional Plan, Do, Study, Act cycles to spread this approach to other clinical settings and investigate the impact increased reporting might have on patient care.
Characterization of Inpatient Cystic Fibrosis Pulmonary Exacerbations
Authors: Cogen Jonathan D. , Oron Assaf P. , Gibson Ronald L. , Hoffman Lucas R. , Kronman Matthew P. , Ong Thida , Rosenfeld Margaret 
Published: January 2017

BACKGROUND AND OBJECTIVES:Pulmonary exacerbations lead to significant morbidity and mortality in patients with cystic fibrosis (CF). National consensus guidelines exist, but few studies report current practice in the treatment and monitoring of pulmonary exacerbations. The goal of this study was to characterize consistency and variability in the inpatient management of CF-related pulmonary exacerbations. We focused on the use of guideline-recommended maintenance therapies, antibiotic selection and treatment regimens, use of systemic corticosteroids, and frequency of lung function testing. We hypothesized that significant variability in these treatment practices exists nationally.METHODS:This trial was a retrospective cross-sectional study. It included patients with CF aged ≤18 years hospitalized for pulmonary exacerbations between July 1, 2010, and June 30, 2015, at hospitals within the US Pediatric Health Information System database that are also Cystic Fibrosis Foundation–accredited care centers. One exacerbation per patient was randomly selected over the 5-year study period.RESULTS:From 38 hospitals, 4827 individual pulmonary exacerbations were examined. Median length of stay was 10.0 days (interquartile range, 6–14.0 days). Significant variation was seen among centers in the use of hypertonic saline (11%–100%), azithromycin (5%–83%), and systemic corticosteroids (3%–61%) and in the frequency of lung function testing. Four different admission antibiotic regimens were used &gt;10% of the time, and the most commonly used admission antibiotic regimen comprised 2 intravenous antibiotics with no additional oral or inhaled antibiotics (29%).CONCLUSIONS:Significant variation exists in the treatment and monitoring of pulmonary exacerbations across Pediatric Health Information System–participating, Cystic Fibrosis Foundation–accredited care centers. Results from this study can inform future research working toward standardized inpatient pulmonary exacerbation management to improve CF care for children and adolescents.
Structure and Mechanical Properties of Functionally-Graded Nanostructured Metalloceramic Coatings
Authors: Catledge Shane A. , Vohra Yogesh K. , Woodard Shanna , Venugopalan Ramakrishna 
Published: January 2017

AbstractA functionally graded nanocrystalline metalloceramic coating on cobalt-chrome alloy was investigated using thin film x-ray diffraction (XRD), cross-sectional transmission electron microscopy (TEM), nanoindentation, and scratch adhesion testing. The gradual transition in bonding from metallic (Cr/CrTi) near the interface to predominantly covalent (CrTiN) near the surface provides a combination of high toughness and high surface hardness. XRD analysis of the (CrTiN) coating suggests a cubic sodium chloride type phase structure with lattice parameter a = 4.2169±0.0035 Å. The surface layer structure is described as a tertiary Ti-N-Cr disordered solid solution that is predominantly cubic TiN, but with some Cr atoms substituted for Ti. TEM shows a transition from equiaxed 20-40 nm-sized grains at the surface to larger, elongated columnar grains below the surface. Nanoindentation measurements of the coating result in a hardness of 27 GPa and Young's modulus of 320 GPa. In addition, the high plasticity of 55% observed for this coating represents an increase in toughness over other ceramic coatings having similar hardness. The unique, functionally graded, smooth nanocrystalline metalloceramic coating structure provides an opportunity to reduce wear and increase longevity of total hip joint replacements.
Food and feeding behaviour of Mozambique tilapia (Oreochromis mossambicus Peters) from Borna Reservoir of Maharashtra, India
Authors: Sakhare Vishwas Balasaheb , Jetithor Shivaji Gyanba 
Published: January 2017

The food analysis of 80 specimens of Oreochromis mossambicus collected from Borna Reservoir of Maharashtra, India revealed that the food of juveniles mainly consisted of rotifers (35%), followed by copepods (30%), Chlorophyceae (20%), Bacillariophyceae (10%) and aquatic insects (5%). While the food items recorded in the gut of adults were Chlorophyceae (40%), followed by Bacillariophyceae (30%), rotifers (15%), copepods (10%) and aquatic insects (5%). During present study it was found that the juveniles of O. mossamobicus mainly feed on zooplankton, and adults on phytoplankton. Intense feeding was noticed during summer season and juveniles were the active feeders.
Fault and load flows analysis of electricity transmission and distribution system in Casanare (Colombia)
Authors: Castro-Galeano Juan Carlos , Cabra-Sarmiento Wilson Javier , Ortiz-Portilla Jhony Fernando 
Published: January 2017

This article describes a simulation of the electrical local distribution and regional transmission system of Enerca S.A. E.S.P. at 34.5 kV and 115 kV, identifying the most critical circuits and substations. The company is located in one of the major petroleum production areas in Colombia, and because of a massive growth in this sector, the electrical company expanded its networks in a radial way. This expansion was improvised and poorly planned due to the accelerated need to meet the new demand, which resulted in stability, balance, voltage regulation, and system reliability problems. Load flow and fault analyses were carried out based on current load and demand predictions in the short and medium term. Twelve proposals were made for network and substation modernization that once implemented will significantly improve the service reliability.
Use of thermal water as a natural coagulant for domestic wastewater sustainable treatment
Authors: Quintero-Jaramillo Javier Andrés , Murillo-Arango Walter , Cerón-Salazar Ivonne Ximena 
Published: January 2017

In the last several years, the interest on domestic wastewater treatment has increased due to the rise of water consumption resulted from the world population growth. The excessive use of inorganic coagulants, such as aluminum sulphate, in domestic wastewater treatment processes contributes to generate high negative environmental impacts and risks to living organisms. Besides its low biodegradability, as aluminum sulphate increases metal content in discharged effluents rises, generating toxic sludge. Therefore, searching for clean and sustainable processes for domestic wastewater treatment is important in order to reduce the pollutant discharges into fresh water bodies. In this paper, the potential use of thermal water as a natural coagulant for the domestic wastewater treatment from Manizales city (department of Caldas, Colombia), was studied. The effect of coagulant dose was analyzed and compared with the results of the conventional coagulants. Applying different doses of coagulants in domestic wastewater showed that the best coagulation activity was achieved by adding 35 ml/l of thermal water, and 140 mg/l of aluminum sulphate. In both cases, high turbidity removal efficiency (98.1 %) was achieved. The removal efficiency of Chemical Oxygen Demand (COD) using aluminum sulphate was 81.5 %, and using thermal water was 75.4 %. In conclusion, thermal water has positive coagulation properties; therefore, it is a promising alternative to aluminum sulphate as a natural coagulant on the treatment of domestic wastewater.
Characterization of copper smelter slag and recovery of residual metals from these residues
Authors: Echeverry-Vargas Luver , Rojas-Reyes Néstor Ricardo , Estupiñán Edgar 
Published: January 2017

The pyrometallurgical copper extraction process generates 2.2 t of residues for each ton of produced metal. Initially, this paper shows the physical and chemical characterization of a copper processing residue, followed by the procedure to obtain the gold and silver that are contained in the copper residue. The characterization of a white metal oxidized calcine indicates a high content of copper as cupric ferrite, and important values of gold and silver. Gold and silver concentrations were 38.5 g t-1 and 1085 g t-1, respectively. The gold was found scattered in cupric ferrite grains, while the silver was dissolved in a matrix of Cu-S in amounts between 1 % and 50 %. Cyanidation tests showed that 95 % gold recovery could be obtained with a concentration of 0.06 g l-1 KCN, a pH of 10.5, room temperature, and a residence time of 80 h. When the temperature was increased to 75 °C, and the other cyanidation parameters were maintained intact, the same recovery was obtained but with a shorter residence time. Silver recovery was less than 30 % with a concentration of 1.2 g l-1 KCN, pH of 10.5, temperature of 45 °C, and a residence time longer than 72 h.