bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accessing simply-substituted 4-hydroxytetrahydroisoquinolines via Pomeranz–Fritsch–Bobbitt reaction with non-activated and moderately-activated systems
Authors: Mottinelli Marco , Leese Mathew P , Potter Barry V L 
Published: September 2017

Background: 1,2,3,4-Tetrahydroisoquinolines (THIQs) are common motifs in alkaloids and in medicinal chemistry. Synthetic access to THIQs via the Pomeranz–Fritsch–Bobbit (PFB) methodology using mineral acids for deactivated, electron-poor aromatic systems, is scarcely represented in the literature. Here, the factors controlling the regiochemical outcome of cyclization are evaluated.Results: A double reductive alkylation was telescoped into a one-pot reaction delivering good to excellent yields of desired aminoacetals for cyclization. Cyclization of activated systems proceeded smoothly under standard PFB conditions, but for non-activated systems the use of HClO4 alone was effective. When cyclization was possible in both para- and ortho-positions to the substituent, 7-substituted derivatives were formed with significant amounts of 5-substituted byproduct. The formation of the 4-hydroxy-THIQs vs the 4-methoxy-THIQ products could be controlled through modification of the reaction concentration. In addition, while a highly-activated system exclusively cyclized to the indole, this seems generally highly disfavored. When competition between 6- and 7-ring formation was investigated in non-activated systems, 5,7,8,13-tetrahydro-6,13-methanodibenzo[c,f]azonine was exclusively obtained. Furthermore, selective ring closure in the para-position could be achieved under standard PFB conditions, while a double ring closure could be obtained utilizing HClO4.Conclusion: Reactivity differences in aminoacetal precursors can be employed to control cyclization using the PFB methodology. It is now possible to select confidently the right conditions for the synthesis of N-aryl-4-hydroxy-1,2,3,4-tetrahydroisoquinolines.
Bartonella spp. and hematological changes in privately owned domestic cats from Rio de Janeiro, Brazil
Authors: Souza Aline Moreira , Almosny Nadia Regina Pereira , Favacho Alexsandra Rodrigues Mendonça , Almeida Daniele Nunes Pereira , Ferreira Renata Fernandes , Ferreira Eliane Oliveira , Moreira Namir Santos , Lemos Elba Regina Sampaio 
Published: September 2017

Introduction: Bartonella infection in cats can represent a risk to owners, particularly today when considering the increase in cat populations and their role in human bartonellosis epidemiology. In the present study, we aimed to detect Bartonella spp. in blood samples from 163 asymptomatic privately-owned cats from the metropolitan area of Rio de Janeiro State, Brazil by using a conventional PCR test and also to evaluate the association between Bartonella spp. and hematological changes in positive cats.
Methodology: PCR assays were performed targeting the Bartonella spp heat shock protein (htrA) gene and complete blood counts were also performed in all samples. Positive PCR samples were confirmed by the presence of two genes, citrate synthase (gltA) and RNA polymerase beta-subunit-encoding (rpoB).
Results: A total of 74.85% (122/163) of the tested cats were positive for Bartonella spp and partial sequencing confirmed to be B. henselae. All hematological findings from the 163 cats tested (PCR-positive and negative), presented normal limits.
Conclusions: This study demonstrates that B. henselae is present in almost 75% asymptomatic privately-owned domestic cats in the metropolitan region of Rio de Janeiro State, Brazil. Our results also show that hematological findings in Bartonella spp. infected cats are uncommon. In this scenario, the use of PCR as a diagnostic tool in feline Bartonella infections should be considered. Finally, these results also demonstrate the potential risk of Bartonella spp. infection in the human population of the metropolitan area of Rio de Janeiro State, Brazil.
Predictors of Persistence and Success in an Accelerated Online RN-to-BSN Program
Authors: Cipher Daisha Jane , Mancini Mary E. , Shrestha Sachin 
Published: September 2017

Background:
To meet the increasing demand for RNs to further their education, many colleges of nursing have developed RN-to-baccalaureate nursing (BSN) programs, many of which are delivered online. A better understanding of the demographic and academic characteristics and outcomes of individuals enrolled in online RN-to-BSN programs is needed.

Method:
This article reports a retrospective predictive analysis of 9,567 students enrolled in an online RN-to-BSN program. Outcome variables examined were graduation, timely graduation, and discontinuation.

Results:
Younger students who received financial aid and had a previous baccalaureate degree reflected the demographic profile associated with the highest likelihood of graduating and graduating sooner. Fewer failed and withdrawn courses also predicted graduation and retention.

Conclusion:

Implications of these findings are that when online programs are designed with persistence in mind, progression to graduation in such programs can be consistent with national benchmarks. The creation of an early identification process for at-risk students would have the potential to enhance educational outcomes even further. [
J Nurs Educ.
2017;56(9):522–526.]
Evidence-Based Practice in Clinical Nursing Education: A Scoping Review
Authors: Fiset Valerie J. , Graham Ian D. , Davies Barbara L. 
Published: September 2017

Background:
Nursing students require education that integrates evidence-based practice (EBP) knowledge across classroom and clinical settings. This study was conducted to identify and examine the literature related to nursing students' use of evidence in clinical education and to identify associated research gaps.

Method:
A scoping review describing the extent, range, and nature of the research activity focused on students' use of evidence in clinical education.

Results:

Included studies (
N
= 37) describe the barriers and facilitators to nursing students' EBP and describe the evaluation of strategies that support nursing students' engagement in EBP. Most commonly identified barriers include a lack of knowledge and skills for EBP; negative attitudes toward EBP in students, faculty, and nurses; and lack of support in the clinical setting. Evaluated strategies included educational sessions and EBP projects, either alone or in combination, as well as other stand-alone interventions. All but two of the intervention studies reported positive subjective or objective outcomes.

Conclusion:

On the basis of these results, educators can engage in combined educational strategies that focus on addressing described barriers. [
J Nurs Educ.
2017;56(9):534–541.]
Clinical decisions support malfunctions in a commercial electronic health record
Authors: Yackel Thomas R. , Gorman Paul N. , Dorr David A. , Kassakian Steven Z. 
Published: September 2017

Summary
Objectives: Determine if clinical decision support (CDS) malfunctions occur in a commercial electronic health record (EHR) system, characterize their pathways and describe methods of detection.
Methods: We retrospectively examined the firing rate for 226 alert type CDS rules for detection of anomalies using both expert visualization and statistical process control (SPC) methods over a five year period. Candidate anomalies were investigated and validated.
Results: Twenty-one candidate CDS anomalies were identified from 8,300 alert-months. Of these candidate anomalies, four were confirmed as CDS malfunctions, eight as false-positives, and nine could not be classified. The four CDS malfunctions were a result of errors in knowledge management: 1) inadvertent addition and removal of a medication code to the electronic formulary list; 2) a seasonal alert which was not activated; 3) a change in the base data structures; and 4) direct editing of an alert related to its medications. 154 CDS rules (68%) were amenable to SPC methods and the test characteristics were calculated as a sensitivity of 95%, positive predictive value of 29% and F-measure 0.44.
Discussion: CDS malfunctions were found to occur in our EHR. All of the pathways for these malfunctions can be described as knowledge management errors. Expert visualization is a robust method of detection, but is resource intensive. SPC-based methods, when applicable, perform reasonably well retrospectively.
Conclusion: CDS anomalies were found to occur in a commercial EHR and visual detection along with SPC analysis represents promising methods of malfunction detection.Citation: Kassakian SZ, Yackel TR, Gorman PN, Dorr DA. Clinical decisions support malfunctions in a commercial electronic health record. Appl Clin Inform 2017; 8: 910–923 https://doi.org/10.4338/ACI-2017-01-RA-0006
Vrijheid van religie op de werkplaats en het Hof van Justitie: terug naar cuius regio, illius religio?
Authors: Dorssemont Filip 
Published: September 2017

Vrijheid van religie op de werkplaats en het Hof van Justitie: terug naar cuius regio, illius religio?
In deze bijdrage worden twee mijlpaalarresten de dato 14 maart 2017 van het Hof van Justitie die betrekking hebben op discriminatie op basis van religie kritisch geanalyseerd. In beide gevallen gaf het dragen van een hoofddoek aanleiding tot het ontslag van een werkneemster. De auteur stelt dat het ontslag van een werkneemster wegens het dragen van een hoofddoek op basis van een algemene regel die uitingen van religieuze, politieke en filosofische overtuigingen verbiedt wel degelijk een directe vorm van discriminatie betreft. Hij betwist dat een beleid van neutraliteit in de onderneming een afdoende legitieme doelstelling vormt die indirecte discriminatie zou rechtvaardigen. De grondslag voor een dergelijke benadering, de in het Handvest van de grondrechten van de Europese Unie opgenomen vrijheid van ondernemerschap, is niet dienstig om een richtlijn die het burgerschap binnen de Europese Unie beschermt, beperkend te interpreteren. Hij bepleit dat rechtvaardigingsgronden voor discriminatie op basis van religie voorzienbaar en kenbaar moeten zijn. Tot slot wordt het gebruik van de redelijke aanpassingen door het Hof van Justitie beschouwd. De auteur meent dat de analyse van het Hof op gespannen voet staat met de rechtspraak van het Hof voor de Rechten van de Mens en een risico in zich draagt van ‘harassment’ van werknemers die naar een plek in ‘backoffice’ worden verbannen.
Analysis of Hydrometeorological Conditions in the South Baltic Sea During the Stormy Weather on 27th November, 2016
Authors: Dyrcz Czesław 
Published: September 2017

Abstract
The paper presents results of research concerning hydrological and meteorological conditions during the stormy weather on 27th November, 2016 in the South Baltic Sea and over the Polish coast. The wind which occurred the South Baltic Sea at that time reached the force of 7 Beaufort degree and in gusts 8 to 9 Beaufort degree. The south part of the Baltic Sea was affected by the low pressure system (981 hPa) which the centre was situated in South Finland and Northwest Russia. Some destroys were observed on the Polish coast line and in ports of the Gdansk Bay. The analysis is concerned on the wind force, the wind direction, the atmospheric pressure and the sea water level in some places of the Polish coast line and especially in the Gdansk Bay.
Les enfants terribles de Cocteau et l’Ancien Testament
Authors: Bénard Johanne 
Published: September 2017

Je propose dans cet article de relire une scène canonique des Enfants terribles de Jean Cocteau, un roman au riche réseau intertextuel dont on a reconnu déjà (depuis sa parution, chez Grasset, en 1929) les nombreux emprunts au mythe, à la tragédie et à la poésie. Je montre ainsi que la scène où Élisabeth gave son frère endormi avec des écrevisses n’est pas à interpréter seulement par rapport à une symbolique du rêve, mais également par rapport aux interdictions du Lévitique, qui circonscrivent de manière très imagée les oppositions du pur et de l’impur. En faisant intervenir la théorie de Julia Kristeva sur l’abject, qui se réfère aux travaux anthropologiques de Mary Douglas sur la souillure, je suggère que cette scène centrale des Enfants terribles plonge au coeur de l’inceste dans sa version la plus archaïque. L’intertexte biblique de l’Ancien Testament révélerait donc chez Cocteau le sens caché de l’inceste, qui concerne tout autant la relation impure du frère et de la soeur que l’inceste avec la mère, « mythème originaire du texte biblique » selon Kristeva. De même, l’interdit alimentaire biblique mis au premier plan dans cette scène ne serait pas là seulement pour signaler l’inceste, mais la différenciation même du pur et de l’impur à la base de la « cohérence de la structure culturelle », qui a été démontrée par Mary Douglas. Alors que dans l’édition critique de ce roman dans la Pléiade (en 2006), Serge Linares cherche à atténuer le rapport du roman à la perversion (qui serait selon lui contrebalancé par son rapport à la poésie), je montre quant à moi que si nous sommes dans l’impur chez Cocteau, c’est d’abord parce que nous sommes dans l’ordre de l’hybride, de l’inclassable, de l’indifférencié.
Esquives, pièges et désaveux
Authors: Killeen Marie-Chantal 
Published: September 2017

« [O]n va leur montrer nos sextes ! » Depuis quarante ans déjà, les écrivaines et réalisatrices de langue française ont répondu en grand nombre à ce cri de ralliement lancé naguère par Hélène Cixous dans son essai « Le rire de la Méduse ». Dans des oeuvres bien souvent provocatrices – où il est question, entre autres, de pratiques sadomasochistes, d’échangisme, de prostitution, de viol, d’inceste –, il importe manifestement d’arracher au silence les expériences les plus diverses de la sexualité féminine. Malgré les accusations de nombrilisme et d’exhibitionnisme que la critique dirige parfois contre ces récits d’aveu, il est d’usage d’interpréter ceux-ci comme signes d’une audacieuse expression de soi et d’une émancipation collective toujours croissante. C’est dans la transgression des tabous, aussi bien que dans l’affranchissement des carcans patriarcaux et hétéronormatifs, que cette entreprise puiserait à la fois sa force personnelle et sa légitimité politique. Les deux oeuvres autofictionnelles sur lesquelles je me concentre ici s’inscrivent toutefois en faux contre cette tendance dominante. Car si Nelly Arcan et Anne F. Garréta se prêtent à des confidences intimes dans Putain (2001) et Pas un jour (2002), c’est pour mieux désavouer la littérature d’aveu. Toutes deux reprennent à leur compte la thèse de Michel Foucault selon laquelle la sexualité, loin d’être sujette à la répression et à la censure, représente à l’âge moderne une source intarissable du discours. Nous serions en définitive constamment adjurés de parler du désir et du plaisir sexuels, l’« ironie de ce dispositif », notait Foucault, étant de « nous fai[re] croire qu’il y va de notre “libération” ». Arcan et Garréta engagent dès lors à se demander si l’injonction actuelle au dévoilement ne relève pas d’une forme insoupçonnée de coercition. En traquant deux des motifs qui animent leurs textes – le scandale dans Putain, la déprise dans Pas un jour –, cette étude s’attache à montrer comment ces oeuvres se constituent en anti-confessions.
Car Equivalents Dependence on the Longitudinal Road Gradient on Two-lane Roads in Bosnia and Herzegovina
Authors: Subotić Marko Miladin , Tubić Vladan Jevđen 
Published: September 2017

The main objective of this paper, based upon the extensive empirical research of free flow in local conditions, is to quantify the unfavourable impact of the flow structure on the road capacity using PCE (Passenger Car Equivalent) values as a function of longitudinal grade. Based on literature reviews and empirical research, it has been proved that the PCE value for all vehicle classes is directly correlated with the road gradient. The PCE values in free flow conditions have been determined for the approved vehicle classes. Based on the measured values, models for determining the average PCE value depending on the upward grade on two-lane roads have been developed. Comparison of the developed models in conditions of free traffic flow with the Highway Capacity Manual (HCM) models has shown lower PCE values in this research. Models for the percentage of PCE values PCE15%, PCE50% and PCE85% have also been established.
Trends in Transcatheter Aortic Valve Replacement Outcomes
Authors: Arnold Suzanne V. , Manandhar Pratik , Vemulapalli Sreekanth , Kosinski Andrzej S. , Batchelor Wayne B. , Thourani Vinod H. , Mack Michael J. , Cohen David J. 
Published: October 2024

ImportanceAlthough transcatheter aortic valve replacement (TAVR) outcomes in the US have improved substantially since 2011, it is unknown whether these trends have continued since 2019.ObjectiveTo examine changes in risk-adjusted TAVR outcomes from 2019 to 2022 and to examine any noteworthy trends over time.Design, Setting, and ParticipantsThis cohort study examined data from patients with severe aortic stenosis treated with TAVR at 786 US hospitals between January 1, 2019, and March 31, 2022, included in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry.ExposurePatients who underwent TAVR.Main Outcomes and MeasuresThe primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality and 30-day composite adverse events. To understand factors explaining these trends, a series of logistic regression models was constructed for each outcome, with time as the primary explanatory variable. After adjusting for changing patent characteristics and procedural factors, a series of exploratory analyses was performed to examine the extent to which these findings could be explained by several plausible hypotheses.ResultsThis study’s analytic cohort included a total of 210 495 patients. Median (IQR) patient age was 79 (73-85) years, and 91 313 patients (43.4%) were female. Median (IQR) STS predicted risk of mortality (PROM) was 3.3% (2.0%-5.3%). There were no significant changes in unadjusted 30-day mortality from quarter 1 of 2019 (2.4%) to the end of quarter 1 of 2022 (2.2%) (P for trend = .10), with an unadjusted odds ratio (OR) for time of 0.98 per year (95% CI, 0.94-1.01). After adjusting for patient characteristics, the OR increased to 1.05 per year (95% CI, 1.02-1.08), which increased further after adjusting for procedural characteristics to 1.09 per year (95% CI, 1.05-1.13). In exploratory analyses, there were no meaningful changes in the adjusted odds of death after excluding sites that entered the STS/ACC TVT Registry in 2019 or later (OR, 1.09; 95% CI, 1.05-1.13), low-volume sites (OR, 1.09; 95% CI, 1.06-1.13), low-risk patients (OR, 1.11; 95% CI, 1.07-1.15), patients with a bicuspid aortic valve (OR, 1.09; 95% CI, 1.05-1.13), in-hospital deaths (OR, 1.08; 95% CI, 1.03-1.14), or patients who experienced a major vascular complication (OR, 1.09; 95% CI, 1.05-1.12).Conclusions and RelevanceIn this observational cohort study performing a national analysis of outcomes after TAVR, it was found that risk-adjusted 30-day mortality increased modestly from January 2019 to March 2022. However, no site-level, patient-related, or process-related factors were identified that could explain these findings. Although the absolute increase in risk-adjusted mortality during the study period was relatively small, these findings warrant continued surveillance.
Aortic Stenosis, Heart Failure, and Aortic Valve Replacement
Authors: Mengi Siddhartha , Januzzi James L. , Cavalcante João L. , Avvedimento Marisa , Galhardo Attilio , Bernier Mathieu , Rodés-Cabau Josep 
Published: October 2024

ImportanceHeart failure (HF) and aortic stenosis (AS) frequently coexist, presenting a complex clinical challenge due to their intertwined pathophysiology and associated high morbidity and mortality. Despite numerous advancements in transcatheter and surgical aortic valve replacement (AVR), HF decompensation remains the leading cause of cardiac rehospitalization and a major predictor of mortality in patients with AS, before or after AVR. This review aims to provide a comprehensive analysis of the interplay between AS and HF, delving into myocardial changes caused by stenotic insult, the impact of AVR on these changes, and the prevalence and contributing elements of HF before and after AVR.ObservationsThe prevalence of HF remains high before and after AVR, particularly among patients with left ventricular dysfunction. Increased afterload from AS causes cardiac remodeling, which is initially benign but over time these changes become maladaptive, contributing to HF and increased mortality. The progression of HF is influenced by the degree of reverse cardiac remodeling, which can be affected by comorbid conditions, the hemodynamic performance of the valve prosthesis, and vascular stiffness. Several blood and imaging biomarkers offer insights into underlying AS pathophysiology, serving as mortality predictors and predicting HF in this patient population.Conclusions and RelevanceHF development in AS is multifactorial and its link to left ventricular dysfunction is a complex process. Delineating the determinants of HF admissions in AS is crucial for identifying individuals at high risk. Identifying the early signs of left ventricular decompensation by using surrogate markers may be the key, even before left ventricular function becomes impaired. Translating multimodality imaging techniques and biomarkers into routine clinical practice for evaluating cardiac damage and integrating these markers with patient and procedural factors that affect HF before and after AVR can facilitate timely intervention, minimizing the likelihood of HF progression and influencing future guidelines.