bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trauma resource designation: an innovative approach to improving trauma system overtriage
Authors: Tominaga Gail T , Dandan Imad S , Schaffer Kathryn B , Nasrallah Fady , Gawlik R N Melanie , Kraus Jess F 
Published: September 2017

BackgroundEffective triage of injured patients is often a balancing act for trauma systems. As healthcare reimbursements continue to decline,1innovative programs to effectively use hospital resources are essential in maintaining a viable trauma system. The objective of this pilot intervention was to evaluate a new triage model using ‘trauma resource’ (TR) as a new category in our existing Tiered Trauma Team Activation (TA) approach with hopes of decreasing charges without adversely affecting patient outcome.MethodsPatients at one Level II Trauma Center (TC) over seven months were studied. Patients not meeting American College of Surgeons criteria for TA were assigned as TR and transported to a designated TC for expedited emergency department (ED) evaluation. Such patients were immediately assessed by a trauma nurse, ED nurse, and board-certified ED physician. Diagnostic studies were ordered, and the trauma surgeon (TS) was consulted as needed. Demographics, injury mechanism, time to physician evaluation, time to CT scan, time to disposition, hospital length of stay (LOS), and in-hospital mortality were analyzed.ResultsFifty-two of the 318 TR patients were admitted by the TS and were similar to TA patients (N=684) with regard to gender, mean Injury Severity Score, mean LOS and in-hospital mortality, but were older (60.4 vs 47.2 years, p<0.0001) and often involved in a fall injury (52% vs 35%, p=0.0170). TR patients had increased door to physician evaluation times (11.5 vs 0.4 minutes, p<0.0001) and increased door to CT times (76.2 vs 25.9 minutes, p<0.0001). Of the 313 TR patients, 52 incurred charges totaling US$253 708 compared with US$1 041 612 if patients had been classified as TA.ConclusionsDesignating patients as TR prehospital with expedited evaluation by an ED physician and early TS consultation resulted in reduced use of resources and lower hospital charges without increase in LOS, time to disposition or in-hospital mortality.Level of evidenceLevel II
Case report and literature review of the outcome following reimplantation of the arm
Authors: Fletcher Cary 
Published: September 2017

The following case report and literature review will detail the management of a traumatic amputation of the arm in a 12-year-old boy. Compared with lower limbs, upper limb prosthesis usually results in significant suboptimal function by any measure. While the literature lacks high-quality evidence with regard to functional outcomes following proximal amputations of the upper limb, especially in children, it is known that children generally have superior functional outcomes compared with their adult counterparts. The mechanism of injury, transportation of the amputated part, type of ischemia, timing of surgery, surgical techniques/factors and postoperative rehabilitation will be discussed as factors affecting outcome of reimplantation.Level of evidence: V
Research at VMware
Authors: Tennenhouse David 
Published: September 2017

VMware has its roots in the academic research community, starting with the commercialization of the work on x86 virtualization of Prof. Mendel Rosenblum and his team at Stanford University [1]. Developers embraced VMware's original workstation product and the ensuing work on server virtualization led to today's vSphere platform, which has enabled significant server consolidation, numerous operational benefits, and isolation-based security. In addition, the vast improvements in server utilization provide VMware's customers with significant cost savings and is a key contributor to the environmental sustainability of modern data centers [2].
VMware has remained true to its research roots, with a strong engineering culture that emphasizes grassroots innovation through hackathons, incubation projects, open source activities, seminars and RADIO, an annual R&D innovation offsite that brings together a substantial fraction of the company's developers. Just a few examples of current activities are open vSwitch (OVS), the virtualization and exploration of non-volatile memory (NVM), securing and managing the Internet of Things (IoT), and support for Containers.
Over time, there has been a dramatic increase in the scope for innovation at VMware. This paper provides an overview of how that scope has grown and how it has expanded the range of relevant research opportunities along with a description of VMware's recently formed research group, including its mission, composition and significant research thrusts.
Timing of Angiography and Outcomes in High-Risk Patients With Non–ST-Segment–Elevation Myocardial Infarction Managed Invasively
Authors: Deharo Pierre , Ducrocq Gregory , Bode Christoph , Cohen Marc , Cuisset Thomas , Mehta Shamir R. , Pollack Charles , Wiviott Stephen D. , Elbez Yedid , Sabatine Marc S. , Steg Philippe Gabriel 
Published: September 2017

Background:
In patients with non–ST-segment–elevation myocardial infarction (NSTEMI) and GRACE (Global Registry of Acute Coronary Events) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24 hours. We sought to study the association of very early (ie, ≤12 hours), early (12–24 hours), and delayed (>24 hours) CAG in patients with NSTEMI with GRACE score >140 with ischemic outcomes.

Methods:
The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with NSTEMI and CAG scheduled within 72 hours to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, patients with a GRACE score >140 were categorized into 3 groups according to timing of CAG from admission (<12, ≥12–<24, and ≥24 hours). The primary ischemic outcome was the composite of all-cause death and myocardial infarction within 180 days of randomization.

Results:

CAG was performed in 4071 patients (<12 hours, n=1648 [40.5%]; 12–24 hours, n=1420 [34.9%]; ≥24 hours, n=1003 [24.6%]). With CAG ≥24 hours as a reference, CAG from 12 to 24 hours was not associated with a lower risk of primary ischemic outcome at 180 days (odds ratio, 0.96; 95% confidence interval, 0.75–1.23), whereas CAG <12 hours was associated with a lower risk of death and myocardial infarction (odds ratio, 0.71; 95% confidence interval, 0.55–0.91). Performing CAG <12 hours was also associated with a lower risk of death and myocardial infarction (odds ratio, 0.76; 95% confidence interval, 0.61–0.94;
P
=0.01) compared with CAG performed at 12 to 24 hours. No difference was observed in bleeding complications.

Conclusions:
In patients with high-risk NSTEMI, undergoing CAG within the initial 12 hours after admission (as opposed to later, either 12–24 or ≥24 hours) was associated with lower risk of ischemic outcomes at 180 days.
Validation of the Full Outline of Unresponsiveness score coma scale in patients clinically suspected to have acute stroke in the emergency department
Authors: Lee Tommy Kwok Ping , Kitchell Abdul Karim Bin , Siu Axel Yuet Chung , Chen Ngan Kwan 
Published: September 2017

Introduction:The Full Outline of Unresponsiveness score coma scale is a recently introduced coma scale. The objectives of this study were to assess the interrater reliability of the Full Outline of Unresponsiveness score coma scale when physicians and nurses in the emergency department apply the Full Outline of Unresponsiveness score on patients clinically suspected to have acute stroke and to look for any association between Full Outline of Unresponsiveness score coma scale and in‐hospital mortality.Methods:Prospective study of 105 patients clinically suspected to have acute stroke recruited in an emergency department in a 4‐month period. The Full Outline of Unresponsiveness score coma scale and Glasgow Coma Scale of each patient were assessed by one doctor and one nurse independently. The interrater reliability between physicians and nurses using the Full Outline of Unresponsiveness score and Glasgow Coma Scale score was assessed. The association between the Full Outline of Unresponsiveness score coma scale and in‐hospital mortality was analysed using logistic regression, controlled for age, sex and diagnosis.Results:Full Outline of Unresponsiveness score had a good interrater reliability when applied to patients suspected to have acute stroke (kappa = 0.742, 95% confidence interval = 0.626–0.858). This was comparable to Glasgow Coma Scale score with a kappa = 0.796 (95% confidence interval = 0.694–0.898). For every 1‐point increase in Full Outline of Unresponsiveness score coma scale, a reduction in in‐hospital mortality was observed with an odds ratio of 0.76 (95% confidence interval = 0.63–0.91, p = 0.003), controlled for age, sex and diagnosis.Conclusion:The Full Outline of Unresponsiveness score may be a tool that can be used by emergency department doctors and nurses in assessing clinical stroke patients.
Comparison of Pentax‐AWS®, Glidescope®, and King Vision® for difficult‐airway intubation in manikins model by paramedics
Authors: Lee Sanghyun , Kang Hyunggoo , Oh Jaehoon , Lim Tae Ho , Lee Yoonjae , Kim Changsun 
Published: September 2017

Introduction:Prehospital tracheal intubation of a difficult airway is challenging for paramedics. Thus far, the potential role of video laryngoscopes for this purpose has not been confirmed. Therefore, this study aimed to determine the impact of different types of video laryngoscopes on the success rate and time to intubation by paramedics.Methods:This is a prospective, randomized, crossover manikin study involving 18 paramedics. Participants performed intubation on a difficult airway in a high‐fidelity manikin using Pentax‐AWS®, Glidescope®, and King Vision® (with two blade types). Time to intubation and success rate of intubation were determined. Participants also rated the best glottic view and reported their preferences of devices.Results:In a difficult‐airway scenario, the median time to intubation with Pentax‐AWS® was 22.9 s (interquartile range, 19.5–24.9 s), which was significantly shorter than using other devices. There were no significant differences in the time to maximal exposure of the vocal cords between four devices (p = 0.156). The time to insert the endotracheal tube with Pentax‐AWS® and King Vision® with a guide‐channel blade was significantly shorter than that with the other two devices (all, p < 0.05). Pentax‐AWS® and King Vision® with a guide‐channel blade showed higher success rates than the other two devices (p = 0.04). With regard to device preference, 14 participants preferred Pentax‐AWS® among all devices analyzed.Conclusion:Pentax‐AWS® could be an appropriate device for paramedics in cases of difficult airways, with high success rate.
Hong Kong Poison Information Centre: Annual report 2016
Authors: Chan Yiu Cheung , Chan Chi Keung , Ng Chun Ho , Ng Sze Hong , Lau Kai Kee , Tse Man Li 
Published: September 2017

Objective:To report and analyse the poisoning data of Hong Kong Poison Information Centre in 2016.Methods:In 2016, all poisoning cases received by Hong Kong Poison Information Centre were retrieved from its database (Poison Information and Clinical Management System) for analysis.Results:A total of 4096 poisoned cases were analysed. There were 1871 male patients (45.7%), 2203 female patients (53.8%) and 22 sex unspecified patients (0.5%). The majority of the cases (63.1%) were between 20 and 59 years old. Common causes for poisoning were suspected self‐harm/suicidal attempt (36.3%), unintentional exposure (18.4%) and abusive use (13.1%). Excluding the common co‐ingestant ethanol, the five commonest types of poisons were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 14.3% and 12.9% of them were treated by decontamination and antidotes, respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 3.9% had major outcomes. Six interesting cases and three poisoning outbreaks were discussed.Conclusion:This 11th annual report provided the updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports.
Normative values and affecting factors for the elbow range of motion
Authors: Zwerus Elisa L , Willigenburg Nienke W , Scholtes Vanessa A , Somford Matthijs P , Eygendaal Denise , van den Bekerom Michel PJ 
Published: September 2017

Introduction Abnormalities in the elbow range of motion (ROM) can be subtle; therefore, it is important that the examiner can compare findings with reliable reference values, matching the patients’ characteristics. Primarily, we aimed to provide normative values for the elbow ROM in subpopulations based on age, sex, dominance and body mass index (BMI). The secondary objective was to determine intra- and inter-rater reliability. Methods aROM (active range of motion) and pROM (passive range of motion) were measured bilaterally in healthy adults using a universal goniometer. The influence of factors affecting the ROM was calculated using Pearson’s correlation coefficient. In two samples of subjects, intra-rater and inter-rater reliability were determined. Results The study population ( n = 352) consisted of 47.2% male and 52.8% female subjects. For aROM (dominant hand), mean flexion was 146°, extension –2°, pronation 80° and supination 87°. Male subjects had smaller ROM compared to females ( p < 0.001). Differences between dominant and nondominant hand were less than one degree. pROMs were 3° to 5° larger than aROMs ( p < 0.001). Intra- and inter-rater reliability was good. Conclusions Elbow ROM is influenced by age, sex and BMI. In the general population, the ROM of the uninjured side can serve as a reference in case of an injured elbow.
Is inpatient bed number associated with the length of stay? A retrospective, single centre analysis
Authors: Cromb Daniel , Cheung Ronny , Blaker Paul 
Published: September 2017

Background: Hospital ward rounds often start at one end of the ward and progress in order of bed number. Anecdotal experience suggested that patients towards the end of a ward had longer stays. Methods: Data regarding hospital bed number and length of stay were collected retrospectively for all patients admitted to a single ward over a four month period and analysed to identify any correlation. Results: A significant positive correlation between bed number and length of stay was identified (N = 308; Rs = 0.143; p = 0.012). Patients in the second half of the ward had significantly longer stays than those in the first half (p = 0.019), as did those in the last third compared with the first (p = 0.025). Discussion: Patients in beds with higher bed numbers seem to have longer lengths of stay, and this effect is more pronounced in patients whose stays are longer than average. Further studies are needed to investigate whether this result is applicable in other settings.
Level of adherence to ICM global standards of midwifery education in Brunei: Survey results
Authors: Yusop Dyg Asnah Binti Haji , Musa Hjh Jainah Binti Hj , Elavally Sujitha , Bakar Arni Nur Aqilah Binti , Venkatasalu Munikumar Ramasamy 
Published: September 2017

Background The International Confederation of Midwives' (ICM) Global Standards of Midwifery Education aim to address dissimilarities in undergraduate midwifery education. Adherence to ICM standards is expected, in order to maintain high standards of midwifery education and yield high quality, competent midwives. Aim To explore levels of adherence to the ICM Global Standards of Midwifery Education in Brunei. Methods An online survey was developed, comprising 22 questions. Cross-sectional data were gathered among midwifery faculty members and students at one of Brunei's national universities. Data were analysed using descriptive and inferential statistics. Findings Although students perceived a few categories to be slightly less adherent to the ICM Global Standards than the faculty members, there was no significant difference between students and faculty members in terms of the ICM Global Standards score. Conclusions Adherence to the ICM Global Standards of Midwifery Education was found to be satisfactory, although there are some ways in which this could be improved.
Tongue-tie and breastfeeding: Identifying problems in the diagnostic and treatment journey
Authors: Wakelin Rachel , Howe Amanda , Fleetcroft Robert , Stöckl Andrea 
Published: September 2017

Background Tongue-tie is a common condition that often adversely affects breastfeeding. There is research that suggests that frenulotomy can improve breastfeeding but there is also evidence of lack of professional knowledge on tongue-tie. Methods This was a qualitative interview study with GPs, midwives, health visitors and nine mothers to explore facilitators and barriers to receiving a diagnosis of and treatment for tongue-tie. Findings Mothers told a common story of having to push for support, experiencing diagnostic and treatment delays and suffering ongoing distress, which threatened their ability to establish breastfeeding. Mothers also described feeling vulnerable in the neonatal period, and witnessing a variation in professional knowledge about tongue-tie. Conclusions Variable professional knowledge, conflicting advice, and a delayed diagnosis can lead to a difficult patient pathway. Assessment for tongue-tie should be considered when approaching infants with feeding difficulties. Frenulotomy should also be considered and services made available where findings suggest the cause is structural and breastfeeding support has not helped.
Reduction of a finger in the out-of-hospital arena?
Authors: Woodford Peter 
Published: September 2017

Introduction: Paramedics can find themselves called to digit dislocations. This is challenging as a dislocation can present in various ways, bringing residual damage to tissue and underlying structures from prolonged displacement. The aim is to limit impact on the welfare of the patient and the paramedic's objective is always to get the dislocation reduced as soon as a possible in a quick and safe manner. Dislocation: The most common dislocation of the digit is at the proximal interphalangeal joint (PIPJ), also known as the ‘coach's finger’. PIPJ injuries are commonly seen in ball sports; the dislocation is mainly dorsal in presentation, and normally closed and stable. It is vital that the paramedic undertakes an in-depth digit assessment in order to be equipped with an appropriate treatment plan for the presentation, which can manage the dislocated digit. Discussion—pain relief: While there has been extensive study of systemic analgesia in emergency medical services (EMS), there is little out-of-hospital research on digit ring blocks and the use of regional anesthetics by paramedics in the pre-hospital setting. X-ray: The evidence is contradictory as some insist that X-ray must be carried out pre-reduction, where other authors state that reduction first is acceptable, but only after a thorough assessment. Reduction: There is a distinct lack of evidence for out-of-hospital digit reduction, too sparse for any robust argument to be built. Conclusion: The suggestion is that reduction of the PIPJ dislocation in the out-of-hospital arena is not supported, owing to a lack of evidence. Until more studies are carried out and patient follow-up is proved to be negative with no ongoing digit impact, this skill needs to be undertaken in appropriate locations supported by X-ray.
Szkolnictwo wyższe – potrzeba całościowej reformy
Authors: Jajszczyk Andrzej 
Published: September 2017

W artykule przedstawiono propozycje kluczowych rozwiązań związanych z reformą szkolnictwa wyższego w Polsce. W obszarze kształcenia jest mowa o rezygnacji z wąsko zdefiniowanych kierunków studiów oraz konieczności utrzymania podziału toku studiów zgodnego z systemem bolońskim. Postuluje się uproszczenie ścieżki kariery akademickiej przez likwidację habilitacji na poziomie ogólnopolskim oraz rezygnację lub zmianę znaczenia tytułu profesora. W części dotyczącej ustroju i zarządzania uczelnią zaleca się zmianę sposobu wyboru rektora, a także wzmocnienie jego władzy. Proponuje się zróżnicowanie typów szkół wyższych, na uczelnie typu uniwersyteckiego, wyższe szkoły zawodowe i kolegia akademickie, a także wyłonienie dwóch bądź trzech uczelni badawczych. Osobną kategorię mogłyby stanowić uczelnie artystyczne. Podkreśla się znaczenie umiędzynarodowienia uczelni, a także ważną rolę mobilności akademickiej. W końcowej części artykułu poruszono zagadnienia finansowania szkolnictwa wyższego, omawiając m.in. znaczenie grantów, a także wskazano na zalety wprowadzenia opłat za studiowanie.
Szkoły doktorskie i ich rola w kształceniu doktorantów
Authors: Mikołajczyk Beata , Naskręcki Ryszard 
Published: September 2017

System kształcenia doktorantów w Polsce wymaga gruntownej przebudowy. Najbardziej efektywnym rozwiązaniem może być system oparty o tzw. szkoły doktorskie, prowadzone przez najlepsze uniwersytety. Szkoły takie mogłyby przyczynić się do poprawy jakości doktoratów i dzięki temu stać się istotnym elementem budowania reputacji i prestiżu uniwersytetu. Ich powstanie powinno przede wszystkim sprzyjać tworzeniu optymalnych warunków do prowadzenia badań naukowych przez doktorantów oraz ich wszechstronnego rozwoju. Szkoły doktorskie powinny mieć z jednej strony zapewnioną autonomię, z drugiej zaś – dobrze określony zakres odpowiedzialności. Zaproponowane tu rozwiązanie konfrontowane jest z różnymi modelami kształcenia doktorantów w Europie.
Ustawa 2.0: partycypacyjny model istotnej zmiany regulacyjnej
Authors: Górniak Jarosław 
Published: September 2017

W artykule przedstawione zostały podstawowe zasady, na których oparty został proces przygotowania nowej ustawy o szkolnictwie wyższym i nauce, która ma stanowić fundament reformy sektora akademickiego w Polsce. Ramą dla rozważań są wybrane zasady przygotowania istotnych zmian regulacyjnych, czy szerzej, instytucjonalnych. Należą do nich: celowość, trafne rozpoznanie mechanizmów przyczynowych, wariantowość, partycypacja, zaplanowanie oceny skutków wdrożenia i realizm. W świetle tych zasad został zaprezentowany toczący się od ponad roku proces prac nad nowymi rozwiązaniami dla nauki i szkolnictwa wyższego oraz kluczowe obszary wprowadzanych zmian, które mają służyć doskonałości naukowej, jakości kształcenia i pozycji nauki w społeczeństwie oraz jej odpowiedzialności względem społeczeństwa.
Cultural Flows and Pedagogical Dilemmas: Teaching with Collaborative Learning in the Chinese HE EFL Context
Authors: Lin Lin 
Published: September 2017

AbstractThis study makes a qualitative inquiry into the use of collaborative learning in Chinese higher education (HE) EFL classrooms with its focus on students’ experience. It seeks to reveal the dilemmas encountered by considering the cultural aspect of teaching and learning within the Chinese context. Drawing on data sources from 60 students’ written reflections, 2 groups of post-hoc interviews and the researcher’s field notes, the study reveals that: 1) the use of collaborative learning conflicts with students’ formed learning behaviors and grammar-oriented exams; 2)