bluuebunny/crossref_metadata_2025_split huggingface dataset:
Testing Placement of Gastric Feeding Tubes in Infants
Authors: Metheny Norma A. , Pawluszka Ann , Lulic Melanie , Hinyard Leslie J. , Meert Kathleen L. 
Published: November 2017

Background
Inadvertent positioning of a nasogastric tube in the lung can cause serious complications, so identifying methods to detect improperly inserted tubes is imperative.

Objectives
To compare the sensitivity, specificity, and negative and positive predictive values of 4 pH cut points (&lt; 4.0, &lt; 4.5, &lt; 5.0, and &lt; 5.5) in differentiating gastric and tracheal aspirates under various treatment conditions and to explore the utility of a pepsin assay for distinguishing between gastric and tracheal aspirates.

Methods
Gastric and tracheal aspirates were collected from critically ill infants undergoing mechanical ventilation who had nasogastric or orogastric feeding tubes. Aspirates were tested with colorimetric pH indicators and a rapid pepsin assay. Information about treatment conditions was obtained from medical records.

Results
Two hundred twelve gastric aspirates and 60 tracheal aspirates were collected from 212 patients. Sensitivity was highest and specificity was lowest at the gastric aspirate pH cut point of less than 5.5. Positive predictive values were 100% at all pH cut points less than 5.0. Negative predictive values were higher at the pH cut point of less than 5.0 than at cut points less than 4.5. A higher percentage of pepsin-positive readings was found in gastric aspirates (88.3%) than in tracheal aspirates (5.4%).

Conclusion
For a desired positive predictive value of 100%, a pH cut point of less than 5.0 provides the best negative predictive values, regardless of gastric acid inhibitor administration and feeding status. The pepsin assay is promising as an additional marker to distinguish gastric from tracheal aspirates.
B Cells Drive Autoimmunity in Mice with CD28-Deficient Regulatory T Cells
Authors: Zhang Ruan , Sage Peter T. , Finn Kelsey , Huynh Alexandria , Blazar Bruce R. , Marangoni Francesco , Mempel Thorsten R. , Sharpe Arlene H. , Turka Laurence A. 
Published: November 2017

Abstract
Follicular regulatory T (TFR) cells are a newly defined regulatory T cell (Treg) subset that suppresses follicular helper T cell–mediated B cell responses in the germinal center reaction. The precise costimulatory signal requirements for proper TFR cell differentiation and function are still not known. Using conditional knockout strategies of CD28, we previously demonstrated that loss of CD28 signaling in Tregs caused autoimmunity in mice (termed CD28-ΔTreg mice), characterized by lymphadenopathy, accumulation of activated T cells, and cell-mediated inflammation of the skin and lung. In this study, we show that CD28 signaling is required for TFR cell differentiation. Treg-specific deletion of CD28 caused a reduction in TFR cell numbers and function, which resulted in increased germinal center B cells and Ab production. Moreover, residual CD28-deficient TFR cells showed a diminished suppressive capacity as assessed by their ability to inhibit Ab responses in vitro. Surprisingly, genetic deletion of B cells in CD28-ΔTreg mice prevented the development of lymphadenopathy and CD4+ T cell activation, and autoimmunity that mainly targeted skin and lung tissues. Thus, autoimmunity occurring in mice with CD28-deficient Tregs appears to be driven primarily by loss of TFR cell differentiation and function with resulting B cell–driven inflammation.
Precipitable water characteristics during the 2013 Colorado flood using ground-based GPS measurements
Authors: Huelsing Hannah K. , Wang Junhong , Mears Carl , Braun John J. 
Published: November 2017

Abstract. During 9–16 September 2013, the Front Range region of Colorado experienced heavy rainfall that resulted in severe flooding. Precipitation totals for the event exceeded 450 mm, damages to public and private properties were estimated to be over USD 2 billion, and nine lives were lost. This study analyzes the characteristics of precipitable water (PW) surrounding the event using 10 years of high-resolution GPS PW data in Boulder, Colorado, which was located within the region of maximum rainfall. PW in Boulder is dominated by seasonal variability with an average summertime maximum of 36 mm. In 2013, the seasonal PW maximum extended into early September and the September monthly mean PW exceeded the 99th percentile of climatology with a value 25 % higher than the 40-year climatology. Prior to the flood, around 18:00 UTC on 8 September, PW rapidly increased from 22 to 32 mm and remained around 30 mm for the entire event as a result of the nearly saturated atmosphere. The frequency distribution of September PW for Boulder is typically normal, but in 2013 the distribution was bimodal due to a combination of above-average PW values from 1 to 15 September and much drier conditions from 16 to 30 September. The above-normal, near-saturation PW values during the flood were the result of large-scale moisture transport into Colorado from the Tropical Eastern Pacific and the Gulf of Mexico. This moisture transport was the product of a stagnating cutoff low over the southwestern United States working in conjunction with an anticyclone located over the southeastern United States. A blocking ridge located over the Canadian Rocky Mountains kept both of the synoptic features in place over the course of several days, which helped to provide continuous moisture to the storm, thus enhancing the accumulated precipitation totals.
Freudian Notion of Psychoanalysis: Its Implications in Contemporary Teaching Practices
Authors: Afzal Awan Muhammad 
Published: November 2017

The author has engaged in a critical review of Frued's notion of psychoanalysis and its vitality in teaching. Illustrating from Freud's own assertions and through the interpretations of the later critics, the author has pointed out certain noticeable pitfalls and, or incapacities of contemporary teaching practices. The forces of aggression and sex exert their influence through the unconscious drives to make teaching, holds Freud, one of the 'impossible' professions. Impossibility of teaching does not imply an absolute failure of all what education stands for, but it refers to the challenges of the problematic nature of the profession. Teaching a child entails a tug of war between 'conscious self' and 'unconscious drives'. This tug of war is organized by ill-conceived notions of love, kindness, motherhood associated with teachers. On the contrary, the contemporary teaching practices are guided by coercive methods of subjugation, standardized tests and institutional control. None but the leaner suffers in this predicament. This is how more damage than the benefit is suspected from education. The author concludes that a more liberal environment can create a space for the leaner to appease the vulnerable impulses of sex and aggression without affecting the natural creativity which is probably the greatest intrinsic capital to invest for great gains. Frued's notion of psychoanalysis can be a means to an end but not an end in itself. It can defend teaching from failing in its pursuits; if the failure is predetermined, teachers may fail honorably rather than miserably.
Complications of Translating the Meanings of the Holy Qur’an at Word Level in the English Language in Relation to Frame Semantic Theory
Authors: Ahmed Saeed Balla Asjad , Gumaa Siddiek Ahmed 
Published: November 2017

The present study is an attempt to investigate the problems resulting from the lexical choice in the translation of the Holy Qur’an to emphasize the importance of the theory of “Frame Semantics” in the translation process. It has been conducted with the aim of measuring the difference in concept between the two languages Arabic and English. In order to find out this difference two words have been chosen from the Qur’an to see how the different English frames can affect the translation of the Holy Qur’an. In addition to that the paper aims to reveal the strategies used by translators to avoid such effect. We also intended to see which factors that can mostly affect the translation of the Qur’an: the linguistic background or the cultural knowledge. Four hypotheses were coined to deal with the difference in frame knowledge (conception) between Arabic and English. The analysis of the data showed that the linguistic background contributed more to the translators’ ability than the cultural knowledge. A rank ordering for the five translations performed in the present study resulted in that the first rank (completely appropriate) was assigned to Yusuf Ali’s translation and the second position was booked by Pickhall’s translation.
Management of serious cardiac adverse effects of antipsychotic medications
Authors: Stoner Steven C. 
Published: November 2017

Abstract
The use of antipsychotic medications has now expanded to multiple mental health conditions beyond schizophrenia. This has increased the overall population exposure to these medications, which have been associated with both metabolic changes and adverse cardiovascular effects. QTc prolongation, torsades de pointes, sudden cardiac death, myocarditis, and cardiomyopathy are all very real concerns that clinicians face on a regular basis. One must take these risks into consideration when selecting antipsychotic therapy and also when determining whether therapeutic changes and adjustments are necessary. This review examines a number of cardiac-associated concerns, the role that antipsychotics may play in contributing to these adverse events, and suggested management interventions.
Medication management of bipolar disorder during the reproductive years
Authors: Kennedy Mary Lindsey Hedgepeth 
Published: November 2017

AbstractThe management of bipolar disorder during reproductive years is a challenge to both patient and clinician. The rapidly changing landscape of medical literature, newly available medications, and implementation of the Pregnancy and Lactation Labeling Final Rule by the Food and Drug Administration can be dizzying. This article serves as a brief, practical guide on the use of medications for the treatment of bipolar disorder before, during, and immediately after pregnancy. Special focus is devoted to the risk-benefit analysis of using potentially teratogenic medications during pregnancy. Availability and appropriateness of various contraceptive methods and folic acid supplementation in combination with mood stabilizers is also addressed. Every clinician managing bipolar disorder in adult women should be knowledgeable of family planning resources and what to do in the setting of unintended pregnancy.
Treatment of psychotic symptoms in patients with Parkinson disease
Authors: Chen Jack J. 
Published: November 2017

Abstract
Persistent psychotic symptoms will develop in up to 60% of patients with Parkinson disease (PD). The initial approach to the management of PD psychosis (PDP) begins with addressing concurrent systemic conditions associated with psychotic behavior, such as delirium, medical conditions (eg, infections), psychiatric disorders (eg, major depression with psychotic symptoms, mania, schizophrenia), and substance misuse or withdrawal. A review of current medications is recommended, and medications that may trigger psychotic symptoms should be eliminated. If possible, antiparkinson medications should be reduced to the minimum therapeutic dose or discontinued in a sequential manner. Generally, dose reduction or discontinuation of anticholinergics is attempted first, followed by that of monoamine oxidase B inhibitors, amantadine, dopamine agonists, catechol-O-methyltransferase inhibitors, and lastly carbidopa/levodopa. The aim of antiparkinson medication dose reduction is to achieve a balance between improving drug-related psychotic symptoms and not significantly worsening the motor symptoms of PD. If additional measures are needed for chronic PDP treatment, the use of second-generation antipsychotics, such as clozapine, pimavanserin, or quetiapine, must be considered. The first-generation antipsychotics (eg, fluphenazine, haloperidol) are not recommended. In the patient with comorbid dementia, the addition of a cholinesterase inhibitor might also be beneficial for PDP. The choice of agent is based on patient-specific parameters, potential benefit, and side effects.
Evaluation of buprenorphine/naloxone dose and use of sedating supportive medication on treatment outcomes in veterans with opioid use disorder
Authors: Kapuganti Amber , Turner Traci , Thomas Christopher J. 
Published: November 2017

Abstract

Introduction:
This retrospective cohort study evaluated effects of buprenorphine/naloxone dose and concomitant use of selected sedating medications on treatment outcomes in patients with opioid use disorder.

Methods:
Patients enrolled in the buprenorphine/naloxone clinic at the study institution from 2009 until April 2013 were included. There were no exclusion criteria. Part 1 assessed treatment failure within 6 months and time to treatment failure with buprenorphine doses &gt;8 mg and ≤8 mg. Part 2 assessed for treatment failure within 6 months and time to treatment failure with use of selected sedating medications. Sedating medications were cyproheptadine, hydroxyzine, quetiapine, and trazodone. Treatment failure was defined as documentation of illicit opioid use per patient report, urine drug screen showing opioid use, or patient lost to follow-up.

Results:
There were 132 patients included in this study, but 163 separate encounters due to multiple enrollments. Treatment failure was experienced within 6 months 51 times a patient was prescribed ≤8 mg (66.2%) and 26 times a patient was prescribed &gt;8 mg (33.8%) (P = .0005). Average time to treatment failure was 5.1 months with ≤8 mg and 8.4 months with &gt;8 mg. The 48% of patients who received sedating medications did not demonstrate any significant differences in treatment response at 6 months (P = .2746) or time to treatment failure (P = .2209).

Discussion:
Doses of buprenorphine/naloxone &gt;8 mg demonstrated better treatment response and prolonged time to treatment failure. Concomitant sedating medications did not have a statistically significant effect on treatment response or time to treatment failure.
Successful bystander-administered intranasal naloxone reversal of opioid overdose between two veterans: A case report
Authors: Ouyang Shuang , Moore Troy 
Published: November 2017

Abstract
Opioid overdose–related morbidity and mortality remain one of the most pressing public health crises. Overdose education and naloxone distribution have emerged as an effective initiative for mitigating overdose deaths. This case highlights areas of patient education essential to optimizing treatment outcome when using a naloxone reversal kit. The patient is a 46-year-old white male with a past medical history significant for opioid use disorder, alcohol use disorder, stimulant use disorder, sedative-hypnotic use disorder, and posttraumatic stress disorder. The patient received an intranasal naloxone kit during residential substance abuse treatment. Five months later, the patient requested a new kit and was asked about the disposition of his previous kit. The patient recounted how he was telephoned to pick up an unconscious friend (and fellow veteran) from a nonresidential location. Upon arrival, the patient recognized opioid products near his friend and took steps to reverse the suspected opioid overdose with his 2 mg/2 mL naloxone intranasal kit. The reversal was successful, but many critical rescue response steps were omitted. This case report may guide future changes to educating patients on appropriate responses to opioid overdoses with naloxone. A PubMed search located one other case report of successful naloxone reversal of opioid overdose in the veteran population, which involved fentanyl sold as heroin. In our case report, a veteran successfully used his naloxone kit to reverse a suspected opioid overdose in another veteran, but he incompletely provided the rescue response. This experience may influence content changes for future overdose education and naloxone distribution training.
The care of dependent elderly on the family context O cuidado do idoso dependente no contexto familiar
Authors: Silva Tatiana Gaffuri da , Mocelin Cheila - , De Souza Silvia Silva , Madureira Valeria Faganelo , Celich Katia Lilian Sedrez , Colliselli Liane - 
Published: November 2017

Objetivo: Compreender como ocorre a organização de famílias cuidadoras de idosos dependentes no contexto familiar. Método: Qualitativo, com 5 participantes e coleta de dados em duas etapas. A primeira com o propósito de identificar: idade, sexo, grau de instrução, estado marital e renda e a segunda com foco na organização familiar. O método de análise utilizado foi o Discurso do Sujeito Coletivo, CAAE: 33714314.4.0000.5564. Resultados: Os discursos revelaram necessidade das famílias adaptarem-se as rotinas impostas pela presença do idoso e cuidador principal como membro da família que mais altera seus hábitos, e sofre privação da liberdade. Conclusão: Famílias e cuidadores necessitam da vigilância, atenção à saúde e suporte contínuo das equipes que atuam nas programas da estratégia de saúde da família. Descritores: Assistência domiciliar a idosos, Cuidador familiar, Enfermagem.
Popular healing practices and medical plants use for riparian mothers in early childhood care Práticas populares de cura e o uso de plantas medicinais por mães ribeirinhas no cuidado infantil
Authors: Lima Raquel , Turrini Ruth , Silva Leila Rangel , Melo Lilian , Augusto Susie Imbiriba 
Published: November 2017

OBJETIVO: Analisar as práticas populares de cura com plantas medicinais pelas mães ribeirinhas durante o cuidado dos filhos. MÉTODOS: Trata-se de uma pesquisa qualitativa, de etnoenfermagem, com coleta de dados por meio de entrevista semiestruturada e observação participante. Participaram do estudo 15 mães da comunidade ribeirinha Vila Nova Maringá, Amazonas. Para análise dos dados foi utilizada a análise temática. Pesquisa aprovada pelo CEP EEAN/HESFA n°54/08. RESULTADOS: Constatou-se que as práticas populares de cura variam de acordo com a etiologia; que 17 problemas físicos de saúde infantis podem ser tratados com 37 plantas medicinais; e que grande parte das plantas utilizadas encontram respaldo no saber científico. CONCLUSÃO: Acredita-se que a pesquisa tenha relevância para a enfermagem e comunidade, pois permitiu o intercâmbio de saberes popular e científico, bem como apontou uma necessidade de investimentos que trabalhem com esta temática.
Dry eye in critically ill patients: integrative review Olho seco em pacientes críticos: revisão integrativa
Authors: De Araújo Diego Dias , Ribeiro Nayara Souza , Aleixo Silva Priscila Marinho , Rezende Macieira Tamara Gonçalves , Da Silva Patrick Leonardo Nogueira , Machado Chianca Tânia Couto 
Published: November 2017

Objetivo: Identificar na literatura publicações sobre os fatores de risco para o olho seco em pacientes internados em unidade de terapia intensiva de adultos. Método: Realizou-se busca nas bases de dados MedLine, CINAHL, Web of Knowledge, LILACS, Cochrane, IBECS e BDENF. Foram identificadas 620 publicações potencialmente elegíveis para inclusão nesta revisão, selecionando-se ao final vinte e sete publicações que atenderam aos critérios de inclusão. Essas foram analisadas por dois pesquisadores independentes, usando-se instrumento adaptado para verificar o nível de evidência. Resultado: Foram identificados 39 diferentes fatores de risco para olho seco, sendo que os apontados em 50% ou mais dos estudos, o lagoftalmo (85,18%), uso de sedativos (70,37%), ventilação mecânica (66.66%) e uso de bloqueadores musculares (55,55%). Conclusão: Foi encontrado somente um estudo que abordasse especificamente o problema do olho seco em pacientes críticos; estudos clínicos são necessários, a fim de se apresentar evidências científicas fortes ao problema.
Vulnerability of Coral Reefs to Bioerosion From Land‐Based Sources of Pollution
Authors: Prouty Nancy G. , Cohen Anne , Yates Kimberly K. , Storlazzi Curt D. , Swarzenski Peter W. , White Darla 
Published: November 2017

AbstractOcean acidification (OA), the gradual decline in ocean pH and [
] caused by rising levels of atmospheric CO2, poses a significant threat to coral reef ecosystems, depressing rates of calcium carbonate (CaCO3) production, and enhancing rates of bioerosion and dissolution. As ocean pH and [
] decline globally, there is increasing emphasis on managing local stressors that can exacerbate the vulnerability of coral reefs to the effects of OA. We show that sustained, nutrient rich, lower pH submarine groundwater discharging onto nearshore coral reefs off west Maui lowers the pH of seawater and exposes corals to nitrate concentrations 50 times higher than ambient. Rates of coral calcification are substantially decreased, and rates of bioerosion are orders of magnitude higher than those observed in coral cores collected in the Pacific under equivalent low pH conditions but living in oligotrophic waters. Heavier coral nitrogen isotope (δ15N) values pinpoint not only site‐specific eutrophication, but also a sewage nitrogen source enriched in 15N. Our results show that eutrophication of reef seawater by land‐based sources of pollution can magnify the effects of OA through nutrient driven‐bioerosion. These conditions could contribute to the collapse of coastal coral reef ecosystems sooner than current projections predict based only on ocean acidification.
Analysis of Thermal Structure of Arctic Lakes at Local and Regional Scales Using in Situ and Multidate Landsat‐8 Data
Authors: Huang Yan , Liu Hongxing , Hinkel Kenneth , Yu Bailang , Beck Richard , Wu Jianping 
Published: November 2017

AbstractThe Arctic coastal plain is covered with numerous thermokarst lakes. These lakes are closely linked to climate and environmental change through their heat and water budgets. We examined the intralake thermal structure at the local scale and investigated the water temperature pattern of lakes at the regional scale by utilizing extensive in situ measurements and multidate Landsat‐8 remote sensing data. Our analysis indicates that the lake skin temperatures derived from satellite thermal sensors during most of the ice‐free summer period effectively represent the lake bulk temperature because the lakes are typically well‐mixed and without significant vertical stratification. With the relatively high‐resolution Landsat‐8 thermal data, we were able to quantitatively examine intralake lateral temperature differences and gradients in relation to geographical location, topography, meteorological factors, and lake morphometry for the first time. Our results suggest that wind speed and direction not only control the vertical stratification but also influences lateral differences and gradients of lake surface temperature. Wind can considerably reduce the intralake temperature gradient. Interestingly, we found that geographical location (latitude, longitude, distance to the ocean) and lake morphometry (surface size, depth, volume) not only control lake temperature regionally but also affect the lateral temperature gradient and homogeneity level within each individual lake. For the Arctic coastal plain, at regional scales, inland and southern lakes tend to have larger horizontal temperature differences and gradients compared to coastal and northern lakes. At local scales, large and shallow lakes tend to have large lateral temperature differences relative to small and deep lakes.