bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Emergency Department Care to Sexual Assault Survivors Using a Risk Stratification Tool
Authors: Sheridan Trisha G. , Callaway Todd R. 
Published: November 2016

Background:
Sexual assault survivors who present to emergency departments are not consistently offerered prophylaxis for HIV prevention because there are currently no national evidence-based practice protocols.

Purpose:
The project aim was to improve the provision rate of (N) PEP to SA survivors by providing a decision guideline risk stratification tool and appropriate training to forensic nurses who treated SA survivors who presented within 72-hours following an assault on how to use the risk assessment and stratification tool.

Methods:
A risk stratification tool provided HIV (N) PEP clinical decision guidelines and framework for use with adult survivors. Forensic and emergency department nurses (n=20 total) were given a pre-training knowledge assessment. Forensic nurses (n = 6) were given specific training in HIV risk stratification and use of the (N) PEP decision guideline tool. Knowledge scores were assessed immediately following training and three months after implementation of the risk stratification tool.

Results:
The average knowledge score of forensic and emergency department nurses increased following training, and remained higher after three months of implementation.

Conclusion:
The implementation of a locally-specific risk stratification decision guideline tool improved both provider knowledge and patient care as measured by an increase in appropriate (N) PEP treatment rates.

Recommendations:
Further research is needed to determine if risk stratification decision tools and standardized protocols improve provider knowledge across settings such as communities with different rates of SA, HIV prevalence, and socio-economic levels.
The Deconstruction of a Complex Case of Medical Child Abuse
Authors: Isaac Reena , Creamer Lisa , Trent Mike 
Published: November 2016

Background:Medical child abuse (MCA) is a serious and potentially fatal form of child abuse. The condition of medical child abuse has historically been regarded as a “rare” entity. However, the lack of a standardized definition of medical child abuse may have limited our understanding of the true scope of the problem. Cases may straddle the elements of physical abuse, medical neglect, and psychological abuse. Many cases may have been overlooked as medical child abuse or categorized under another form of child maltreatment, when identified as abuse or neglect. There is no one typical presentation. Medical investigations into suspected cases must be carefully and conservatively conducted.Method and Result:An illustrative case is described involving three young chronically-ill siblings with various degrees of medical dependencies, medical and surgical interventions, and multiple subspecialists and is deconstructed with the final outcome of three physically healthy children and a criminal conviction of the perpetrating caregiver.Conclusion:Cases of child medical abuse can be complex and challenging. Potential complications and sequelae of unidentified cases are vast, including: pain and suffering from multiple, unnecessary procedures, diminished quality of life and life potential, and ultimately risk of death. Challenges to medical and social investigations can hinder early identification and protection of the children at risk.
Effects of Modification of Pain Protocol on Incidence of Post Operative Nausea and Vomiting
Authors: Schwarzkopf Ran , Snir Nimrod , Sharfman Zachary T. , Rinehart Joseph B. , Calderon Michael-David , Bahn Esther , Harrington Brian , Ahn Kyle 
Published: November 2016

Background:
A Perioperative Surgical Home (PSH) care model applies a standardized multidisciplinary approach to patient care using evidence-based medicine to modify and improve protocols. Analysis of patient outcome measures, such as postoperative nausea and vomiting (PONV), allows for refinement of existing protocols to improve patient care. We aim to compare the incidence of PONV in patients who underwent primary total joint arthroplasty before and after modification of our PSH pain protocol.

Methods:
All total joint replacement PSH (TJR-PSH) patients who underwent primary THA (n=149) or TKA (n=212) in the study period were included. The modified protocol added a single dose of intravenous (IV) ketorolac given in the operating room and oxycodone immediate release orally instead of IV Hydromorphone in the Post Anesthesia Care Unit (PACU). The outcomes were (1) incidence of PONV and (2) average pain score in the PACU. We also examined the effect of primary anesthetic (spinal vs. GA) on these outcomes. The groups were compared using chi-square tests of proportions.

Results:
The incidence of post-operative nausea in the PACU decreased significantly with the modified protocol (27.4% vs. 38.1%, p=0.0442). There was no difference in PONV based on choice of anesthetic or procedure. Average PACU pain scores did not differ significantly between the two protocols.

Conclusion:
Simple modifications to TJR-PSH multimodal pain management protocol, with decrease in IV narcotic use, resulted in a lower incidence of postoperative nausea, without compromising average PACU pain scores. This report demonstrates the need for continuous monitoring of PSH pathways and implementation of revisions as needed.
Levels of Physical Activity among Kuwaiti Adults and Perceived Barriers
Authors: Al-Baho Abeer Khaled , Al-Naar Ashraaf , Al-Shuaib Hadwa , Panicker Jibu K , Gaber Sherine 
Published: November 2016

Background:
Regular Physical activity is associated with many positive health outcomes related to prevention and control of obesity and non-communicable diseases which have a high prevalence in Kuwait. The aim of our study was to investigate the level of physical activity among Kuwaiti adults and interfering barriers.

Methods:
A cross sectional randomized study was used to collect data about physical activity level among 858 Kuwaiti adults using the International Physical Activity Questionnaire, Arabic version and perceived barriers to physical activity were investigated using an ecological framework. Regression analysis was used to determine the predictors of physical activity among participants.

Results:
The results revealed that 19.13% of the sample did not perform any physical activity and 38.1% had low physical activity level, with no significant difference between males and females. The most common perceived barriers were hot weather (75.9%), work duties (71.21%), laziness (44.3%), lack of time (38.6%), family responsibilities (36.1%) and chronic diseases (33.33%).

Conclusion:
The level of physical activity among Kuwaiti adults was found to be low. This could be a reason for high levels of obesity in Kuwait. A comprehensive health promotion program including environmental and social modifications in addition to health education is suggested to improve physical activity among Kuwaiti adults.
Порушення травлення у дітей з антибіотик-асоційованою діареєю
Authors: Radutna O.A. , Kysyma N.V. 
Published: November 2016

Актуальність. Найбільш відчутною проблемою широкого використання антибіотиків є зміни мікробної екології, порушення рівноваги біоценозу кишечника, поява антибіотикорезистентних штамів мікроорганізмів з патогенними властивостями та виникнення у зв’язку з цим патологічних змін в кишечнику, що й обумовлюють симптоми порушення травлення у хворих з антибіотик-асоційованою діареєю. Мета дослідження. Визначення проявів синдрому мальабсорбції для удосконалення діагностики антибіотик-асоційованої діареї в дітей. Матеріали й методи. Об’єкт дослідження становили 116 хворих, які отримували антибіотики, віком від 6 місяців до 18 років. Обстеження дітей включало загальноклінічні, біохімічні, бактеріологічні, імуноферментні, імунохроматографічні, інструментальні, математичні методи дослідження. Результати. При розвитку діареї у хворих за умов негативних тестів на клостридіальні токсини кваліфікували ці випадки як ідіопатичну антибіотик-асоційовану діарею, при позитивних — як кишкову інфекцію Clostridium difficilе. У ході дослідження були виявлені вірогідні відмінності за копрологічними показниками між дітьми з гострою ідіопатичною й обумовленою клостридіальною інфекцією антибіотик-асоційованою діареєю. При мікроскопічному та біохімічному дослідженні випорожнень виявлено маніфестні ознаки порушення травлення та всмоктування жирів і вуглеводів, які проявляються клінічними симптомами мальабсорбції. Усім дітям з антибіотик-асоційованою діареєю притаманні підвищені концентрації вуглеводів у випорожненнях. Виявлені ознаки порушення травлення з розвитком мальабсорбції ліпідів у дітей з антибіотик-асоційованою діареєю, і в першу чергу обумовленою інфекцією Clostridium difficile. Висновки. Порушення травлення та всмоктування вуглеводів та ліпідів, а також показники запальної реакції кишечника (лейкоцити, прихована кров, слиз) є маркерами антибіотик-асоційованої діареї та можуть використовуватися для її ранньої діагностики, у тому числі в разі інфекції Clostridium difficile.
До питання відведення сечі при вродженому гідронефрозі в дітей
Authors: Shevchuk D.V. , Voloshyn P.I. 
Published: November 2016

Вступ. Гідронефроз у дітей — це обструкція пієлоуретрального сегмента, який, як правило, діагностується антенатально при ультразвуковому скринінгу близько в 1,5 % випадків вагітностей. Патофізіологія гідронефрозу все ще невідома. Найбільш патогенетично обґрунтованим та поширеним методом лікування вродженої обструкції пієлоуретрального сегмента (гідронефрозу) у дітей є хірургічне лікування. Як правило, використовуються відкриті методи (пластика пієлоуретрального сегмента за Хайнсом — Андерсеном та інші способи пластики). Останнім часом обговорюються ендоскопічні методи лікування. Усе частіше з’являються повідомлення про застосування роботизованого обладнання. Частота успішного застосування методики пластики пієлоуретрального сегмента за Хайнсом — Андерсеном досягає, за даними різних авторів, 95 %. Дискутабельним залишається питання дренування верхніх сечових шляхів. Вибір на користь установлення стента, як правило, залежить від хірурга, хоча аналіз літературних даних свідчить про зниження процента ускладнень після пієлопластики з використанням стентування сечоводу. Мета дослідження. Проаналізувати методи та способи відведення сечі при хірургічному лікуванні вродженого гідронефрозу в дітей. Матеріали і методи. На базі хірургічного відділення № 2 Житомирської обласної дитячої клінічної лікарні (ЖОДКЛ) за період із 2000 по 2015 р. прооперовано 108 дітей. Середній вік хворого становив 3,8 року. Хлопчиків було 38 (35,2 %), дівчаток 70 (64,8 %). У клініці за золотий стандарт прийняте виконання пластики пієлоуретрального сегмента за Хайнсом — Андерсеном. До 2006 року застосовувалось в основному зовнішнє дренування сечових шляхів при операції (переважно пієлостомія з інтубуванням сечоводу, рідше нефростомія), тоді як із 2006 року впроваджено пластику пієлоуретрального сегмента закритим способом, а із 2009 року — застосування внутрішнього стентування (JJ-стент) сечоводу. Із 2010 року впроваджено відеоасистовану пластику пієлоуретрального сегмента (лапароскопічний етап — мобілізація пієлоуретрального сегмента із подальшим накладанням анастомозу через міні-лапаротомний доступ). У 2016 р. вперше на базі ЖОДКЛ виконано лапароскопічну пластику пієлоуретрального сегмента у хлопчика 6 років. Середня тривалість операцій — 106 ± 32 хв. Висновки. Питання дренування сечовидільних шляхів після пластики пієлоуретрального сегмента в дітей з приводу вродженого гідронефрозу повинно розглядатись строго індивідуально. Дискутабельним залишається питання способу встановлення стента. При визначенні показань до хірургічного лікування вродженого гідронефрозу в дітей необхідно враховувати функцію нижніх сечових шляхів для забезпечення ефективної деривації сечі в післяопераційному періоді (наявність супутньої нервово-м’язової дисфункції сечового міхура).
Correlation of Lipoprotein (a) Level with Complexity of Coronary Lesion in Coronary Heart Disease Patient at RSUP Dr. Sardjito Yogyakarta
Authors: Mahmuda Iin Novita Nurhidayati , Dinarti Lucia Kris , Taufiq Nahar 
Published: November 2016

Background: In 2020 there were estimated to be 25 million deaths each year from cardiovascular disease; most of them being coronary heart disease. Traditional risk factors such as smoking, hypertension, diabetes, dyslipidemia reported to affect only 50% of the prevalence and degree of coronary heart disease. It pushes a lot of research on non-traditional risk factors one of which is lipoprotein (a). Levels of Lp (a) also reflects the degree of severity and is associated with the number of coronary arteries involved. The purpose of this study was to determine the relationship of Lp (a) level with the complexity of coronary artery lesion.Methods: This was a cross-sectional study. Subjects were male and women patients aged between 20 to 60 years who underwent coronary angiography for theirs STEMI, NSTEMI, unstable angina pectoris, and stable angina pectoris. Correlation between elevated Lp (a) with the complexity of coronary artery lesion was performed by Pearson test. If the distribution was abnormal we used Spearman test.Result: Number of samples was 64 subjects (49 men and 15 women). The result showed a significant positive correlation between Lp (a) level and complexity of coronary vessel lesion that counted by SYNTAX score (p 0,004) even though the coefficient correlation is weak (r 0, 33).Conclusion: The higher Lp (a) level shows bigger SYNTAX score which means the coronary vessel lesion more complex.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.362-367
Cost Analysis of Combination Diuretic Therapy with Ace-Inhibitors to Diuretic Therapy without Ace-Inhibitors in Heart Failure Patients
Authors: Pribadi Fajar Wahyu , Dwiprahasto Iwan , Thobari Jarir At 
Published: November 2016

Background: Heart failure is the final stage of the entire heart disease and become a major health problem because of the high morbidity and mortality. Diuretic combination therapy with ACE inhibitors compared to diuretic therapy without ACE inhibitors will affect the costs and hospitalization for heart failure patients; so it can be used to study Pharmacoeconomics.Method and Design: This study is an analytic observational retrospective cohort study design. Researchers compared the cost analysis between groups having diuretic combination therapy with an ACE inhibitor and diuretic therapy without ACE inhibitors. Data taken with a total sampling of heart failure databases claimed prescribing health insurance PT. ASKES Persero between January 1, 2010 until December 31, 2011.Results: Out of the 377 patients of the study population, 64 patients received combination therapy with ACE inhibitors and diuretics, and 60 patients received diuretic therapy without ACE inhibitors. The analysis showed that the total cost was Rp. 4.96 million and Rp. 5.14 million; the average total inpatient days a year was 10.67 days and 7.00 days.Conclusion: This study showed that the diuretic combination therapy with an ACE inhibitor is more cost-effective. Further research is needed to assess the total costs and effectiveness of therapy with more number of subjects and longer periods.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.368-375
NEUTRAL ATOM PROPERTIES IN THE DIRECTION OF THE IBEX RIBBON
Authors: Heerikhuisen Jacob , Gamayunov Konstantin V. , Zirnstein Eric J. , Pogorelov Nikolai V. 
Published: November 2016

ABSTRACT
In this paper, we present results from our three-dimensional (3D) simulations of the interaction between the solar wind and local interstellar medium with an emphasis on the phase-space properties of energetic neutral atoms (ENAs) along a sight line that intersects the ribbon of enhanced ENA flux seen by NASA’s Interstellar Boundary EXplorer spacecraft. The majority of these ENAs have velocities directed away from the heliosphere, but it is believed that interactions between heliospheric ENAs and ions outside the heliosphere may result in a population of secondary ENAs that return to the heliosphere and generate the ribbon. While we do not consider the ion dynamics that result in secondary ENAs, our analysis is of key importance to the process since the heliospheric ENAs we consider form the source population for those ions. We present the moments of the hydrogen distribution, along with moments parallel and perpendicular to the local magnetic field for the pick-up ions (PUIs) that these neutrals generate. Finally, we present gyro-averaged velocity distributions relative to the local magnetic field for the PUIs created from our simulated H-atoms, along with analytic fits to these distributions in the secondary ENA source region just beyond the heliopause.
RADIO CONSTRAINTS ON LONG-LIVED MAGNETAR REMNANTS IN SHORT GAMMA-RAY BURSTS
Authors: Fong W. , Metzger B. D. , Berger E. , Özel F. 
Published: November 2016

ABSTRACT
The merger of a neutron star (NS) binary may result in the formation of a rapidly spinning magnetar. The magnetar can potentially survive for seconds or longer as a supramassive NS before collapsing to a black hole if, indeed, it collapses at all. During this process, a fraction of the magnetar’s rotational energy of ∼1053 erg is transferred via magnetic spin-down to the surrounding ejecta. The resulting interaction between the ejecta and the surrounding circumburst medium powers a year-long or greater synchrotron radio transient. We present a search for radio emission with the Very Large Array following nine short-duration gamma-ray bursts (GRBs) at rest-frame times of ≈1.3–7.6 yr after the bursts, focusing on those events that exhibit early-time excess X-ray emission that may signify the presence of magnetars. We place upper limits of ≲18–32 μJy on the 6.0 GHz radio emission, corresponding to spectral luminosities of ≲(0.05–8.3) × 1039 erg s−1. Comparing these limits to the predicted radio emission from a long-lived remnant and incorporating measurements of the circumburst densities from broadband modeling of short GRB afterglows, we rule out a stable magnetar with an energy of 1053 erg for half of the events in our sample. A supramassive remnant that injects a lower rotational energy of 1052 erg is ruled out for a single event, GRB 050724A. This study represents the deepest and most extensive search for long-term radio emission following short GRBs to date, and thus the most stringent limits placed on the physical properties of magnetars associated with short GRBs from radio observations.
FERMI STUDY OF γ-RAY MILLISECOND PULSARS: THE SPECTRAL SHAPE AND PULSED EMISSION FROM J0614–3329 UP TO 60 GeV
Authors: Xing Yi , Wang Zhongxiang 
Published: November 2016

ABSTRACT
We report our analysis of the Fermi Large Area Telescope data for 39 millisecond pulsars (MSPs) listed in the second γ-ray pulsar catalog. Spectra of the pulsars are obtained. We fit the spectra with a function of a power law with exponential cutoff, and find the best-fit parameters of photon index

and cutoff energy

GeV. This spectral shape, which includes the intrinsic differences in the spectra of the MSPs, can be used for finding candidate MSPs and unidentified types of sources detected by Fermi at high Galactic latitudes. In one of the MSPs, PSR J0614−3329, we find significant pulsed emission up to 60 GeV. The result has thus added this MSP to the group of pulsars that have been detected with pulsed emission at energies of tens of GeV. Comparing the γ-ray spectrum of PSR J0614−3329 with those of the Crab and Vela pulsars, we discuss possible emission mechanisms for the very high-energy component.
LONG-TERM X-RAY VARIABILITY OF TYPICAL ACTIVE GALACTIC NUCLEI IN THE DISTANT UNIVERSE
Authors: Yang G. , Brandt W. N. , Luo B. , Xue Y. Q. , Bauer F. E. , Sun M. Y. , Kim S. , Schulze S. , Zheng X. C. , Paolillo M. , Shemmer O. , Liu T. , Schneider D. P. , Vignali C. , Vito F. , Wang J.-X. 
Published: November 2016

ABSTRACT
We perform long-term (≈15 years, observed-frame) X-ray variability analyses of the 68 brightest radio-quiet active galactic nuclei (AGNs) in the 6 Ms Chandra Deep Field-South survey; the majority are in the redshift range of 0.6–3.1, providing access to penetrating rest-frame X-rays up to ≈10–30 keV. Of the 68 sources, 24 are optical spectral type I AGNs, and the rest (44) are type II AGNs. The timescales probed in this work are among the longest for X-ray variability studies of distant AGNs. Photometric analyses reveal widespread photon flux variability: 90% of AGNs are variable above a 95% confidence level, including many X-ray obscured AGNs and several optically classified type II quasars. We characterize the intrinsic X-ray luminosity (

) and absorption (

) variability via spectral fitting. Most (74%) sources show

variability; the variability amplitudes are generally smaller for quasars. A Compton-thick candidate AGN shows variability of its high-energy X-ray flux, indicating the size of reflecting material to be ≲0.3 pc.

variability is also detected in a broad absorption line quasar. The

variability amplitude for our sample appears to rise as time separation increases. About 16% of sources show

variability. One source transitions from an X-ray unobscured to obscured state, while its optical classification remains type I; this behavior indicates the X-ray eclipsing material is not large enough to obscure the whole broad-line region.
COMPACT E+A GALAXIES AS A PROGENITOR OF MASSIVE COMPACT QUIESCENT GALAXIES AT 0.2 < z < 0.8
Authors: Zahid H. Jabran , Hochmuth Nicholas Baeza , Geller Margaret J. , Damjanov Ivana , Chilingarian Igor V. , Sohn Jubee , Salmi Fadia , Hwang Ho Seong 
Published: November 2016

ABSTRACT
We search the Sloan Digital Sky Survey and the Baryon Oscillation Sky Survey to identify ∼5500 massive compact quiescent galaxy candidates at 0.2 < z < 0.8. We robustly classify a subsample of 438 E+A galaxies based on their spectral properties and make this catalog publicly available. We examine sizes, stellar population ages, and kinematics of galaxies in the sample and show that the physical properties of compact E+A galaxies suggest that they are a progenitor of massive compact quiescent galaxies. Thus, two classes of objects—compact E+A and compact quiescent galaxies—may be linked by a common formation scenario. The typical stellar population age of compact E+A galaxies is <1 Gyr. The existence of compact E+A galaxies with young stellar populations at 0.2 < z < 0.8 means that some compact quiescent galaxies first appear at intermediate redshifts. We derive a lower limit for the number density of compact E+A galaxies. Assuming passive evolution, we convert this number density into an appearance rate of new compact quiescent galaxies at 0.2 < z < 0.8. The lower limit number density of compact quiescent galaxies that may appear at z < 0.8 is comparable to the lower limit of the total number density of compact quiescent galaxies at these intermediate redshifts. Thus, a substantial fraction of the z < 0.8 massive compact quiescent galaxy population may descend from compact E+A galaxies at intermediate redshifts.