bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presentation, Prescription Pattern and Time Taken To Discharge From An Emergency Department Of Eastern Nepal
Authors: Yadav A K , Bhandari R , Rai B , Giri S , Baral D D , Mandal M 
Published: July 2016

Background: It is a great challenge for a doctor to give proper care and discharge because of overcrowding in emergency units like ours. The clinical records in emergency are an essential document that reflects the quality of care which is given to the patient.Objectives: To find out the time taken for discharge from emergency and to find out the current trend of problems presenting to emergency and their prescription pattern.Methods: A retrospective descriptive hospital based study was carried out using all emergency discharged patients’ case sheet records from 14th April to 14th May 2013. A number of 1022 files were analyzed. Results: Out of 1022 discharge files, majority (72%) of the patients included Australian Triage Score (ATS) 3. Patients with ATS 5 had a mean duration of stay of 24 hours whereas ATS 2, 3, 4 patients had mean duration of stay of 10.10 hours, 8.75 hours and 5.48 hours respectively. Most common clinical presentation was trauma (31.3%). Out of 1022 patients, 504 (49%) were treated with antibiotics. Cefixime was the most frequently administered antibiotics (24.7%). Of all 506 patients received analgesic, mostly diclofenac (30.8%), 79 received antispasmodic drugs, mostly hyoscine butyl bromide (6.2%), and antipyretics mostly paracetamol. Proton pump inhibitors (PPI) were used in 594 (58.1%) patients mostly pantoprazole (47.2%). Conclusion: Sicker patients had longer duration of stay in the emergency unit. Trauma is the most common presentation, analysis, antibiotics and PPL are the most commonly prescribed which show in the emergency unit.Health Renaissance 2014;12(3): 209-214
Varenicline for Smoking Cessation: a Review
Authors: Rauniar G P , Mishra A , Sarraf D P 
Published: July 2016

Tobacco use is the leading cause of preventable death and disability in the world. Although gradually declining in most developed countries, the prevalence of tobacco use has increased among developing countries. Nicotine is an addictive chemical that is inhaled from the tobacco present in the cigarettes. It acts on neuronal nicotinic acetylcholine receptors within the ventral tegmental area of the brain, causing dopamine release in the nucleus accumbens which reinforces nicotine-seeking behavior. Reward through the dopaminergic system is a common thread among many drugs of addiction. According to the National Anti-Tobacco Communication Campaign Strategy for Nepal smoking prevalence in Nepal is higher (38.4%) than the smoking prevalence in the world (29%). Smoking attributable annual deaths in Nepal is estimated at nearly 14,000 (9,000 male deaths and 5,000 female deaths) for population aged 35 and over. First-line pharmacotherapies for smoking cessation are varenicline, sustained-release bupropion and various forms of nicotine replacement therapy (i.e., patch, gum, lozenge, inhaler, nasal spray). These drugs can be used as monotherapy or combination therapy for the treatment of smoking cessation. After studying the outcome of many clinical trials and meta-analysis, it is concluded that cigarette smokers taking varenicline have the most success quitting smoking as compared with those taking other first-line pharmacotherapies for treating smoking cessation. Health Renaissance 2014;12(3): 215-220
Laparoscopic antireflux surgery - our initial experience
Authors: Pradhan S , Ghimire Bikal , Kansakar P , Singh YP , Vaidya P , Sayami P 
Published: July 2016

Introduction: Laparoscopic antireflux surgery (LARS) currently represents the gold standard in the surgical management of gastrointestinal reflux disease (GERD) with minimal morbidity and mortality. Routine fundoplication following laparoscopic Heller’s cardiomyotomy is also being recommended to reduce the incidence of pathological gastro-oesophageal reflux after surgery. The aim of the current study was to evaluate patients receiving LARS and to assess their surgical outcomesMethods: Prospective data of all patients admitted in our department with these diseases and undergoing LARS, from May 2014 to November 2015 were reviewed. Patients with Achalasia cardia underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication and those with GERD with hiatus hernia underwent Laparoscopic Toupet’s fundoplication. Age, sex, duration of surgery, surgical morbidity and hospital stay were recorded. Results: Eleven patients underwent LARS. Females were 5(45.5%) and males were 6 (54.5%). Mean age of patients was 36.18 ± 15.79 years (range 18-68 years). 6 patients (54.5%) underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication for Achalasia cardia while 5 patients (45.5%) underwent Laparoscopic fundoplication. The median operating room time was 133.64 ± 15.66 minutes (range, 110–160). There were no conversions. The median hospital stay was 3.45±0.522 days (range, 3-4 days). No postoperative complications or preoperative deaths occurred. No patient had a perforation revealed on the postoperative contrast swallow when performed. Gastro esophageal reflux symptoms were significantly improved and severity of dysphagia was also reduced after surgery. The average follow-up period is 5.45 ± 2.67 months (range, 3- 12).Conclusion: LARS is well established technique and becoming more popular over conventional open surgery in view of its equal safety and efficacy with added advantage of less morbidity and mortality. However larger case series and long term follow up would be warranted.
Comparative study between 3-ports and 4-ports laparoscopic cholecystectomy for the cases of gall stone disease
Authors: Tamrakar KK , Khwaunju P , Sah K 
Published: July 2016

Laparoscopic cholecystectomy is currently accepted approach for the management of patients with cholelithiasis. The standard method for removal of gall bladder in laparoscopic cholecystectomy is by using four ports. Although other techniques such as by using 3 ports or only single port are being practiced, their safety and efficacy has not been established. This study was done to assess the efficacy and safety of the use of only three ports for laparoscopic cholecystectomy.Methods: Between August 2013 and February 2014, 78 patients with the diagnosis of cholelithiasis were operated. Patients were randomized into 3-ports group and 4-ports group using random number. Operative time taken for the procedure and operative findings were noted. Postoperative pain and complications were noted in both groups. The two groups were compared using student-T test and chi square test. Results: There was no significant difference in the operating time taken for the 3-ports laparoscopic cholecystectomy and 4-ports laparoscopic cholecystectomy. However operating time was significantly higher when the cases that had dense adhesions present were compared with those who did not have. Conversion from 3-ports technique to 4-ports technique was determined mainly by the degree of adhesions and to some degree by the BMI of the patient. Postoperative wound infection rate was similar among the two groups. There was no incidence of biliary injury in both the groups.Conclusion: 3-ports laparoscopic cholecystectomy is safe and efficient approach for the selected patients who seek for lesser invasive method of laparoscopic cholecystectomy.
Cancer of esophagus and GE junction– a long-term follow-up results
Authors: Thakur Binay , Yonghui Di , Devkota Mukti , Baral Paribartan , Shrestha Sudhir , Upreti Janaki , Kandel Nirmala 
Published: July 2016

Background: Esophageal and GE Junction malignancies are diagnosed late and the long-term outcome is still suboptimal. We present our experience.Methods: 421 patients with mean age of 57.6 years with cancer of esophagus and GE Junction were evaluated with physical examination, CT chest and abdomen, gastroduodenoscopy and bronchoscopy. 254 (60.4%) patients underwent surgical treatment only and 167 (39.6%) underwent multimodality treatment. 295 patients underwent transthoracic approach, 88 – transhiatal approach and 58 patients underwent – abdominal approach only.Results: Upper, middle, GEJ type – I, GEJ type – II, GEJ type – III tumors were present in 5.7, 28.5, 36.8 and 1.9% cases, respectively. Anastomosis was placed at neck in 73.2% and in chest in 26.8% cases. Final stages were 0 (0.2%), Ia (0.5%), Ib (1.9%), IIa (10%), IIb (8.8%), IIIa (15.7%), IIIb (14.3%), IIIc (41.6%) and IV (7.1%). R0 resection was achieved in 91.5% cases. Postoperative mortality, recurrent laryngeal nerve injury, anastomotic leak and pneumonia were observed in 4.8%, 5.7%, 11.6% and 22.1%, respectively. Median overall survival was 28 months with 5-year overall survival of 21%. A subgroup of 70 patients (16.6%) who were subjected to preoperative chemoradiation followed by surgery showed response in 64.3% cases with a median and 5-year survival of 49 months and 30% in responders, and 15 months and 15% in non-responders.Conclusion: Patients presented mostly in stage III (78.7%), therefore a multimodality approach should be considered as a standard practice in Nepalese context in order to achieve better survival results.
Management of gun shot injury in a tertiary hospital
Authors: Joshi A 
Published: July 2016

Introduction: Gun shot injury is an uncommon surgical emergency . A timely and multidisciplinary management by surgical team is an essential factor in decreasing mortality and morbidity . This study highlights the multidisciplinary management of gun shot injury.Methodology: Bir hospital is a postgraduate teaching hospital under National Academy of Medical Sciences and tertiary referral center in Kathmandu. A prospective cohort study of gunshot injury was conducted during Septemeber 2015 and early outcome analysis was done.Results: There were thirteen cases of gunshot wound. The mean age of casualty was 31 years and all were male.Injury Number (n) Intervention Outcome Large intestine 3 Laparotomy Ileostomy/wound infection Perineum 1 Exploration/Debridement Loop ileostomy Bone- fracture 3 Traction/Enternal fixation/ Open reduction Internal Fixation Vertebra 1 Right hip power 3/5 Vascular- AV fistula 1 stenting Referred Brachial plexus 1 Sensory/motor deficit Neck 2 Exploration Marginal mandibular nerve palsy Elbow 1 Debridement/Split thickness skin graftThere were no mortality and one case was referred.Discussion: With the multidisciplinary team approach, all the gunshot injury cases were managed with good outcome. The timely intervention by a surgical team is an essential factor for proper management of gun shot injury.
ACCRETION DISK SIGNATURES IN TYPE I X-RAY BURSTS: PROSPECTS FOR FUTURE MISSIONS
Authors: Keek L. , Wolf Z. , Ballantyne D. R. 
Published: July 2016

ABSTRACT
Type I X-ray bursts and superbursts from accreting neutron stars illuminate the accretion disk and produce a reflection signal that evolves as the burst fades. Examining the evolution of reflection features in the spectra will provide insight into the burst–disk interaction, a potentially powerful probe of accretion disk physics. At present, reflection has been observed during only two bursts of exceptional duration. We investigate the detectability of reflection signatures with four of the latest well-studied X-ray observatory concepts: Hitomi, Neutron Star Interior Composition Explorer (NICER), Athena, and Large Observatory For X-ray Timing (LOFT). Burst spectra are modeled for different values for the flux, temperature, and the disk ionization parameter, which are representative for most known bursts and sources. The effective area and throughput of a Hitomi-like telescope are insufficient for characterizing burst reflection features. NICER and Athena will detect reflection signatures in Type I bursts with peak fluxes ≳10−7.5 erg cm−2 s−1 and also effectively constrain the reflection parameters for bright bursts with fluxes of ∼10−7 erg cm−2 s−1 in exposures of several seconds. Thus, these observatories will provide crucial new insight into the interaction of accretion flows and X-ray bursts. For sources with low line-of-sight absorption, the wide bandpass of these instruments allows for the detection of soft X-ray reflection features, which are sensitive to the disk metallicity and density. The large collecting area that is part of the LOFT design would revolutionize the field by tracing the evolution of the accretion geometry in detail throughout short bursts.
CHANDRA AND XMM-NEWTON X-RAY OBSERVATIONS OF THE HYPERACTIVE T TAURI STAR RY TAU
Authors: Skinner Stephen L. , Audard Marc , Güdel Manuel 
Published: July 2016

ABSTRACT
We present results of pointed X-ray observations of the accreting jet-driving T Tauri star RY Tau using Chandra and XMM-Newton. We obtained high-resolution grating spectra and excellent-quality CCD spectra and light curves with the objective of identifying the physical mechanisms underlying RY Tau’s bright X-ray emission. Grating spectra reveal numerous emission lines spanning a broad range of temperature superimposed on a hot continuum. The X-ray emission measure distribution is dominated by very hot plasma at T
hot ∼ 50 MK, but higher temperatures were present during flares. A weaker cool plasma component is also present as revealed by low-temperature lines such as O viii. X-ray light curves show complex variability consisting of short-duration (∼hours) superhot flares accompanied by fluorescent Fe emission at 6.4 keV superimposed on a slowly varying (∼one day) component that may be tied to stellar rotation. The hot flaring component is undoubtedly of magnetic (e.g., coronal) origin. Soft- and hard-band light curves undergo similar slow variability implying that at least some of the cool plasma shares a common magnetic origin with the hot plasma. Any contribution to the X-ray emission from cool shocked plasma is small compared to the dominant hot component but production of individual low-temperature lines such as O viii in an accretion shock is not ruled out.
THREE-DIMENSIONAL GEOMETRY OF A CURRENT SHEET IN THE HIGH SOLAR CORONA: EVIDENCE FOR RECONNECTION IN THE LATE STAGE OF THE CORONAL MASS EJECTIONS
Authors: Kwon Ryun-Young , Vourlidas Angelos , Webb David 
Published: July 2016

ABSTRACT
Motivated by the standard flare model, ray-like structures in the wake of coronal mass ejections (CMEs) have been often interpreted as proxies of the reconnecting current sheet connecting the CME with the postflare arcade. We present the three-dimensional properties of a post-CME ray derived from white light images taken from three different viewing perspectives on 2013 September 21. By using a forward modeling method, the direction, cross section, and electron density are determined within the heliocentric distance range of 5–9 R
⊙. The width and depth of the ray are 0.42 ± 0.08 R
⊙ and 1.24 ± 0.35 R
⊙, respectively, and the electron density is (2.0 ± 0.5) × 104 cm−3, which seems to be constant with height. Successive blobs moving outward along the ray are observed around 13 hr after the parent CME onset. We model the three-dimensional geometry of the parent CME with the Gradual Cylindrical Shell model and find that the CME and ray are coaxial. We suggest that coaxial post-CME rays, seen in coronagraph images, with successive formation of blobs could be associated with current sheets undergoing magnetic reconnection in the late stage of CMEs.
Digital Skills in the Z Generation: Key Questions for a Curricular Introduction in Primary School
Authors: Pérez-Escoda Ana , Castro-Zubizarreta Ana , Fandos-Igado Manuel 
Published: July 2016

Media convergence and massive usage of Internet-connected devices, distinguishing features of our current society, cause changes in the way that new generations learn and access knowledge. In addition, emerging new digital skills are necessary for the Z generation to face the challenges of a digital society. This quantitative study, with a sample of 678 Primary School students, aims to provide empirical evidence about the level of digital skills of students belonging to this generation. The results show that the acquisition of digital competences is not inherent to use, but require specific instruction. Otherwise, there is a danger of creating a digital divide, not due to frequency of use or access to connected devices but to lack of instruction on how to use them. The absence of significant variance in the overall level of digital competence among Primary School students of different grades reflects, to some extent, that this level is largely acquired by informal activities with ICTs in an informal context, rather than by developing competences in a school context that affords gradual and progressive skills acquisition. The results show the need to address digital competence in schools, focusing on the systematic development and enhancement of its component areas to move beyond the informal level and reach the academic level, thus facilitating digital natives’ access to future employment.
La convergencia mediática y el uso masivo de dispositivos conectados a Internet, rasgos distintivos de la sociedad actual, provocan cambios en el modo en el que las nuevas generaciones aprenden y acceden al conocimiento. Además, emergen nuevas competencias, las digitales, que la Generación Z necesita para afrontar los retos de una sociedad digitalizada. El estudio presentado, de corte cuantitativo, con una muestra de 678 alumnos de Educación Primaria, pretende aportar evidencias empíricas sobre el nivel de competencia digital del alumnado perteneciente a dicha generación. Los resultados revelan que no adquieren habilidades digitales de forma inherente sino que precisan de educación al respecto, atisbándose el peligro de una brecha digital, no por uso o acceso a ellas, sino por falta de competencia. La ausencia de diferencia significativa en el nivel general de competencia digital entre el alumnado de diferentes cursos de la etapa de Educación Primaria refleja que, en cierta medida, ese nivel se adquiere más por convivencia con las TIC en contextos informales que por un adecuado desarrollo en el contexto escolar que potencie gradual y progresivamente su adquisición. De los resultados se desprende, por tanto, la necesidad de abordar la competencia digital en la escuela, incidiendo en el desarrollo de las áreas que la componen y potenciándola para superar el nivel de uso en la vida cotidiana y acercarla al nivel académico que facilitará su inclusión al mundo laboral.
Teachers' Perceptions of the Digital Transformation of the Classroom through the Use of Tablets: A Study in Spain
Authors: Suárez-Guerrero Cristóbal , Lloret-Catalá Carmen , Mengual-Andrés Santiago 
Published: July 2016

This study examines the transformation of classroom dynamics brought about by the use of tablets for educational purposes. The empirical bases of this study were defined by the “Samsung Smart School” project, which was developed by Samsung and Spain’s Ministry of Education during academic year 2014-15, in which teachers and 5th and 6th year students attending 15 primary schools across several Autonomous Communities in Spain were provided with tablets. The research sample comprised 166 teachers. A qualitative analysis strategy was applied by means of: a) non-participant observation, b) focus groups, c) semi-structured interviews with teachers, and d) content analysis of teaching units. These techniques enabled us to extract and examine six dimensions of teaching (educational objective, teaching approach, organization of content and activities, teaching resources, space and time, and learning assessment). Our findings show that teachers tend to apply a transversal approach when using tablets to work on different competencies, focusing more on activities than on content through the use of apps. They reclaim the act of play as part of the learning process, and tablet use encourages project-based learning. To sum up, this study shows that teachers view tablets not only as a technological challenge, but also as an opportunity to rethink their traditional teaching models.
El presente estudio examina la trasformación de la dinámica del aula a través del uso educativo de las tabletas. La base empírica de este estudio se enmarca en el proyecto «Samsung Smart School», desarrollado entre Samsung y el Ministerio de Educación de España en el curso 2014-15. Se dotó de tabletas a profesores y alumnos de aulas de 5º y 6º de primaria de 15 centros de Educación Primaria de distintas comunidades autónomas del territorio Español. En suma el estudio se llevó a cabo con una muestra comprendida por 166 docentes. Se empleó una estrategia analítica cualitativa mediante: a) observación no participante, b) grupos focales, c) entrevistas semiestructuradas al profesorado y d) análisis de contenido de unidades didácticas. Dichas técnicas permitieron abordar el estudio de seis dimensiones pedagógicas (finalidad educativa, enfoque pedagógico, organización de contenidos y actividades, recursos didácticos, espacio y tiempo y evaluación del aprendizaje). Los hallazgos evidencian la tendencia del profesorado a trabajar con tabletas de forma transversal distintas competencias, centrarse en las actividades más que el contenido a través de las apps, asumir el reto de recuperar el juego como parte del aprendizaje y poner en práctica el aprendizaje basado en proyectos. En suma, la principal evidencia es que los docentes entienden la tableta no solo como un reto tecnológico, sino como la oportunidad para repensar sus modelos pedagógicos tradicionales.