bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expediting Discharges on the Inpatient Medicine Teaching Services
Authors: Khan Misha , Daniel Emmanuel , Janardan Veena , Al-Sous Ola 
Published: August 2024

Introduction: Delayed discharges can adversely affect patient flow throughout the hospital. Late afternoon discharges may lead to high hospital occupancy, admission bottlenecks, ER overcrowding, and disrupted ICU transfers. Discharge by noon (DBN) is key to enhancing hospital capacity, bed utilization, and patient satisfaction and outcomes. Last year, DBN for patients returning home with or without home care services (HHC) was chosen as one of three annual priorities for our hospital medicine division. This was implemented in October 2023 but did not gain momentum among the medical resident teaching services (MTS), paving the way for our QI project. Model for Improvement: Baseline data on the percentage of MTS DBN to home and HHC were available from November 2023 to January 2024. We surveyed our residents/faculty and conducted a root-cause analysis. The main barriers to DBN included a lack of planning and motivation, delayed communication with case management, and prolonged rounding. Aims Statement: Our goal was to increase the median percentage of MTS discharge orders placed by noon to home and HHC from 22% to 35% within 3 months. Measures: Our primary outcome measure was the percentage of MTS DBN to home and HHC. Weekly EMR-generated reports were collected. The outcome measure was then calculated and uploaded weekly on a run chart for analysis. Qualitative process measures included assessing if residents were planning discharges and documenting the number of discharges completed before noon. Changes: Our interventions targeted the lack of planning and motivation. These included introducing the expedited initiative and its importance to residents/faculty through conferences. In addition, a process was created where potential next-day discharges were discussed at afternoon sign-out and a tracking chart of DBN orders was designed for each team room. Tests of Change: Our pre-intervention median percentage of MTS DMB to home and HHC was 22% and improved to 40% post-intervention. While we observed a variation in discharge practice based on the rounding attending, we had notably sustained an upward shift in practice from our baseline when data was plotted on a run chart. We are currently continuing data collection to track sustainability and variability among rounding physicians. Conclusion: We attained an upward shift in the percentage of MTS DBN to home and HHC post-intervention. Although an upward shift has been achieved, we are looking to sustain and further improve it. In future PDSA cycles, we will look at individualizing feedback and optimizing interdisciplinary rounds. We plan on further investigating balancing measures such as bed availability, discharge timing for rehabilitation destinations, and patient and staff satisfaction.
Quality Initiative to Improve Emergency Department Sepsis Bundle Compliance Through Resident Education and Awareness
Authors: Basal Yasmeen , Ruedisueli Maria , Farooqui Zainab , Ghiardi Martina , Santiago-Rivera Olga , Butki Nikolai , Gotlib Ari 
Published: August 2024

Introduction: Timely recognition of sepsis is important for physicians as each hour of delay before sepsis is treated is associated with a 4-9% increase in mortality. In order to monitor the care provided in critically ill patients, the Centers for Medicare & Medicaid Services (CzMS) designed Hospital Quality Initiatives which include The Severe Sepsis and Septic Shock Management Bundle (SEP-1). A prior study conducted by Alexander et al at McLaren Oakland Hospital’s Emergency Department (ED) demonstrated improvement in bundle compliance with standardization in documentation and order entry in EMR in the form of Sepsis Macros. Subsequently, the compliance rates with the SEP-1 bundle at McLaren Oakland were found to have fluctuated monthly. This fluctuation affects both patient outcomes and reimbursement for the care provided. Therefore, we hypothesized further education needed to be provided to ensure quality care of septic patients. Objectives: Our project aimed to improve sepsis bundle compliance at McLaren Oakland by providing education to the PGY-1 class and off-service residents on how to accurately utilize the pre-populated sepsis macro and order sets in EMR in order to recognize and treat sepsis in a timely manner. Methods: We developed a Sepsis Education sheet sent in the form of a monthly educational email. This initiative targeted PGY-1s, instructing them on how to appropriately use the new sepsis macro to have timely recognition of sepsis and appropriate orders placed to meet compliance guidelines. Our monthly educational email was sent from August 2022 to February 2023. Results: Sepsis Compliance data was analyzed from August 2022 to February 2023 and compared to August 2021 to February 2022. After implementation of the Sepsis Education sheet, the mean of compliance rates actually decreased from 64% (SD= 0.101 95% CI: 0.575 to 0.719) to 47% (SD= 0.116 95% CI: 0.388 to 0.560) during intervention (p-value = 0.0101). Conclusion: Our intervention was not successful in increasing compliance with SEP-1 bundle requirements. We therefore determined that PGY-1 awareness of sepsis and use of macros is not the limiting factor in sepsis compliance for McLaren Oakland Hospital’s ED. Further investigation regarding limiting factors in sepsis bundle compliance at our institution will need to be conducted.
Reducing Stool Ova and Parasite Testing in Patients Admitted to the Hospital with Acute Diarrhea
Authors: Jha Prekchha , Townsend Mary , Workman Lauren , Patel Fatima , Aguinaga Sarah , Halalau Alexandra , Maddens Nicholas 
Published: August 2024

Introduction & Background: A significant number of patients are either admitted to the hospital for acute diarrhea or develop diarrhea during their admission. Frequently stool O&P testing is ordered as part of the workup for acute diarrhea when it is not clinically indicated, leading to an increased financial burden on both the patient and the hospital. Aim & Significance: To reduce the overuse of inpatient stool O&P testing by instructing residents on the appropriate criteria for ordering this test in patients with acute diarrhea. Methods & Design: Infectious Disease Society of America and American College of Gastroenterology guidelines for acute diarrheal infections in adults were reviewed and a simplified flowsheet was created based upon their recommendations for indications for Stool O&P testing. The flowsheets were then placed in easy to view locations in the resident work rooms. Baseline data was collected by pulling the number of stool O&P tests ordered by the resident teaching service for the 3 months leading up to the intervention. Data from the same teaching services were pulled once again 3 months after the intervention had been performed. Results: After the intervention, there was an 18% decrease in stool O&P orders placed by the resident teaching services. Discussion: Overutilization of stool O&P testing and the associated financial burden can be reduced by providing education regarding the appropriate indications for ordering this test in patients with acute diarrhea.
Improving Completion Rates for Autism Screening - A Quality Improvement Project
Authors: Roberts Andrew , Petroff Christy , Szpunar Susan , Anne Premchand 
Published: August 2024

Introduction: Autism spectrum disorder (ASD) may be the most well-known and most studied neurocognitive disorder responsible for developmental delay. The medical community, in response to the noted increase in prevalence, emphasized the importance of routine screenings at 18 months and 24 to 30 months of age. Ascension St. John Children’s Hospital Resident Clinic utilizes the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) or MCHAT for short, validated for ages 16 through 30 months. It was noted that screening is frequently missed or undocumented. Because of the need for timely diagnosis and intervention, these missed opportunities can be costly for children and their families. Purpose: To improve compliance with the American Academy of Pediatrics’ (AAP) recommendation to screen all children for ASD at 18 and 24 months of age. Methods: An educational lecture was provided to the pediatric residents to screen all children in the above age group being seen for a well-child visit. A visual reminder red pen mark was also applied to eligible patient charts as they were checked in. Baseline completion rates in two three month periods, one year before and three months after the intervention, were compared. Results: A total of 337 charts were reviewed with similar baseline characteristics between pre- and post-intervention groups. Overall MCHAT completion rates were lower after the intervention: 64% pre- vs. 49% post-intervention (p <0.05). Subgroup analysis of visits where screening was directly indicated (excluding ages 16-17 months, >24 month olds where a screen was already passed at a 24 month well visit, or children already diagnosed with autism, n = 281), had similar completion rates (67.5% and 64.5% respectively, p = 0.59). Conclusion: MCHAT completion did not improve after the combined intervention of a single, in-person lecture and visual reminder chart marking.
Integrating Residents – Organizational Quality Metric of reducing 30-day readmission of patients with acute decompensated heart failure (Interdisciplinary QI project)
Authors: Talaei Fahimeh , Ibrahim Mahmoud , Mikhail Elizabeth , Alexander Dheeraj , Almorsy Khaled , Moudgal Varsha , Kesari Kavitha 
Published: August 2024

Introduction: Hospital readmissions post-discharge for congestive heart failure (CHF) pose a significant burden on patients and healthcare systems, indicating potential gaps in care quality. The 2022 heart failure guidelines advocate for structured workflows to address this issue. Despite this, McLaren Flint Hospital witnessed a rise in 30-day readmissions for CHF exacerbation, highlighting the need for intervention. To tackle this challenge, our resident-faculty Quality Improvement (QI) team has partnered with institutional QI/Patient Safety (PS) initiatives. Our goal is to establish a coordinated approach involving various healthcare professionals to optimize the discharge process and transition of care for CHF patients at McLaren Flint Hospital. Methods and Materials: Our intervention comprises two crucial tools: a CHF workflow sheet and a CHF medication sheet. The workflow begins with patient identification through daily census reports. Upon discharge, nurses implement the CHF medication sheet, with medications prescribed by medical floor doctors. Pharmacists and dietitians review and educate patients about medications and dietary considerations, respectively. Additionally, case managers organize post-discharge phone calls and appointments with primary care physicians within 48 to 72 hours and 7 days, respectively. Weekly reports on patients requiring cardiac rehabilitation are also dispatched. Plan-Do-Study-Act (PDSA) Toolkit guides our implementation, allowing for continuous improvement and adaptation. Results: The initial implementation phase commenced on March 6th, 2024. Nursing staff are well-versed in the workflow, and CHF medication forms are readily accessible in patient charts. However, challenges in timely medication reconciliation and orders pose operational hurdles, necessitating resolution. Ongoing evaluation will provide more comprehensive results approximately two months post-completion of the first PDSA cycle. Conclusion: Our initiative aims to address areas for improvement in reducing 30-day readmission rates post-CHF exacerbation at McLaren Flint Hospital. Utilizing the PDSA cycle toolkit, we will monitor outcomes and refine our process accordingly.
The Impact of Cloud Computing on System Lifecycle Methodologies: an Innovative Approach to Scalability Flexibility
Authors: Sarpudin Sarpudin , Rahmadeli Fajri , Supratikta Hadi 
Published: August 2024

This research analyzes the impact of cloud computing on traditional system lifecycle methodologies and offers an innovative approach that leverages the advantages of cloud computing. Qualitative research was conducted with a literature study on conventional system lifecycle methodologies and cloud computing. The results show that cloud computing enables increased scalability and flexibility through a service-based approach, automation, and elastic management of resources. This research provides recommendations for implementing a hybrid lifecycle methodology that leverages the advantages of both cloud and traditional systems.This paper discusses the impact of cloud computing on system lifecycle methodologies. Cloud computing offers an innovative approach to system scalability and flexibility by allowing computing and storage resources to scale dynamically according to demand. Traditional system lifecycle methodologies are becoming less relevant for rapidly changing cloud environments, so they need to be adapted to respond to the scalability and flexibility capabilities offered by cloud computing.This paper evaluates the impact of the shift towards cloud computing on the methodologies used in the system development lifecycle. Cloud computing offers the ability to scale elastically according to demand, which opens up opportunities to adopt a more adaptable and flexible approach to system development. This paper discusses how traditional system lifecycle methodologies can be adapted to accommodate key cloud computing characteristics such as scalability, flexibility, and virtualization of computing resources. This paper reviews the implications of the move towards a cloud computing paradigm on the methodologies used in developing and maintaining software systems. The shift towards cloud-based environments offers the advantages of scalability and flexibility in dynamically managing system resources. However, these key characteristics of cloud computing pose challenges to traditional system lifecycle methodologies designed for on-premise environments. This paper discusses how system lifecycle methodologies can be adapted to better support system development in cloud computing environments.
Diagnóstico de Sífilis Latente no Brasil: Uma Revisão Sistemática
Authors: Oliveira Aneliza Mota Barbosa de , Fonseca Emily Freitas , Delvaux Lorena Horta Barbosa , Hespanhol Gustavo Morandi Costa Xavier , Braga Lucas Moreira , Silva Daniel Fedrigo Rodrigues da , Anna Cecília Soares Antônio  , Humberto Pereira Azzi  , Vu John 
Published: August 2024

A sífilis latente é uma infecção sexualmente transmissível que apresenta desafios significativos para o diagnóstico, especialmente devido à sua natureza assintomática. Este estudo tem como objetivo revisar e analisar os métodos diagnósticos utilizados para identificar a sífilis latente no Brasil, avaliando suas eficácias e limitações. Foi realizada uma revisão sistemática da literatura, com pesquisa em bases de dados como SciELO, PubMed e LILACS, considerando artigos publicados entre 2010 e 2023. A metodologia incluiu a aplicação do sistema PICO para estruturar a pesquisa e a análise dos dados. Os resultados revelam uma diversidade de métodos diagnósticos, com a combinação de testes treponêmicos e não treponêmicos mostrando maior precisão na detecção. Além disso, a prevalência da sífilis latente varia entre diferentes regiões do Brasil, e fatores socioeconômicos e demográficos influenciam o acesso ao diagnóstico. A conclusão enfatiza a necessidade de estratégias de saúde pública que promovam a conscientização e o acesso a testes diagnósticos, visando reduzir a incidência da sífilis latente e suas complicações associadas. Este estudo contribui para a compreensão dos desafios e avanços no diagnóstico da sífilis latente, sugerindo direções para futuras pesquisas e práticas clínicas.
The Impact of Quizlet Learning Media in Increasing Student Interest and Motivation in Junior High School
Authors: Siswandi Siswandi , Abdullah Hazlina , Solisa Windy Zeanly , Danial Haris , Winarti Sri 
Published: August 2024

Background. Lately, the influence on student learning motivation has begun to decline due to the lack of teacher mastery of learning media, even though at this time there are many references that can be used as guidelines or references in the process of introducing learning materials, for example by using online application-based learning media.
Purpose. The purpose of this study was to determine the impact of quizlet learning media in increasing students' interest and motivation to learn in junior high school. This learning media can develop skills in reading and writing vocabulary.
Method. This research method uses quantitative methods, data obtained through interviews and distributing questionnaires using Google Form.
Results. The results of this study indicate that the implementation of the quizlet application can help millions of junior high school students in learning online, so that it can increase the value in the learning process to the maximum.
Conclusion. The conclusion of the study can be concluded that students' understanding in the addition of vocabulary increased from before the application of learning with the quizlet application.
Video Utilization in Improving Student Achievement in Early Childhood Education
Authors: Sappaile Baso Intang , Abidin Jenal , Aisyah Siti 
Published: August 2024

Background. Video media in learning can have an impact in the field of education, especially in early childhood to help children's growth and development, video as a three-dimensional system that has an important role.
Purpose. The study aims to determine the utilization of video in improving early childhood achievement.
Method. The method used is quantitative method, the research format is Survey Study. The data collection technique used is communication technique. Data tools are collected in the form of questionnaires and documents. In-depth data analysis This research uses percentage analysis. The sample in this study was 50 people.
Results. The results of this study indicate that learning videos can improve student achievement in learning in early childhood education.
Conclusion. The conclusion of this study is that with learning video media, children become more confident and make it easier for early childhood to absorb material delivered by educators, and can assess children's activeness directly.
Development of Time Passage Media to Stimulate Symbolic Thinking and Problem Solving in 5-6 Years Old Children
Authors: Mimah Mimah , Tabroni Imam , Barroso Uwe , Intes Amina 
Published: August 2024

Learning media is only a tool for the success of the teaching and learning process, as a component of the success of the teaching and learning process, the provision of learning media is a must. The purpose of the time passage is to introduce the concept of time, introduce the count of 1-10, and how to turn the hands of the clock. Research using research and development models from Borg & Gall. Research location at RA Ibnu Zain Respondents 4 students of Ra Ibnu Zain. The overall results of this study state that the Time Aisle Media can be used as learning media referring to the results of the validation test, the first trial pre-test 31.25% and the second trial post-test 72.5% showed there was development as expected in the time aisle media in problem solving and symbolic thinking at Ra Ibnu Zain.
Van Allen probes, NOAA, GOES, and ground observations of an intense EMIC wave event extending over 12 h in magnetic local time
Authors: Engebretson M. J. , Posch J. L. , Wygant J. R. , Kletzing C. A. , Lessard M. R. , Huang C.‐L. , Spence H. E. , Smith C. W. , Singer H. J. , Omura Y. , Horne R. B. , Reeves G. D. , Baker D. N. , Gkioulidou M. , Oksavik K. , Mann I. R. , Raita T . , Shiokawa K. 
Published: June 2015

AbstractAlthough most studies of the effects of electromagnetic ion cyclotron (EMIC) waves on Earth's outer radiation belt have focused on events in the afternoon sector in the outer plasmasphere or plume region, strong magnetospheric compressions provide an additional stimulus for EMIC wave generation across a large range of local times and L shells. We present here observations of the effects of a wave event on 23 February 2014 that extended over 8 h in UT and over 12 h in local time, stimulated by a gradual 4 h rise and subsequent sharp increases in solar wind pressure. Large‐amplitude linearly polarized hydrogen band EMIC waves (up to 25 nT p‐p) appeared for over 4 h at both Van Allen Probes, from late morning through local noon, when these spacecraft were outside the plasmapause, with densities ~5–20 cm−3. Waves were also observed by ground‐based induction magnetometers in Antarctica (near dawn), Finland (near local noon), Russia (in the afternoon), and in Canada (from dusk to midnight). Ten passes of NOAA‐POES and METOP satellites near the northern foot point of the Van Allen Probes observed 30–80 keV subauroral proton precipitation, often over extended L shell ranges; other passes identified a narrow L shell region of precipitation over Canada. Observations of relativistic electrons by the Van Allen Probes showed that the fluxes of more field‐aligned and more energetic radiation belt electrons were reduced in response to both the emission over Canada and the more spatially extended emission associated with the compression, confirming the effectiveness of EMIC‐induced loss processes for this event.
Electrical properties of methane hydrate + sediment mixtures
Authors: Du Frane Wyatt L. , Stern Laura A. , Constable Steven , Weitemeyer Karen A. , Smith Megan M. , Roberts Jeffery J. 
Published: June 2015

AbstractKnowledge of the electrical properties of multicomponent systems with gas hydrate, sediments, and pore water is needed to help relate electromagnetic (EM) measurements to specific gas hydrate concentration and distribution patterns in nature. Toward this goal, we built a pressure cell capable of measuring in situ electrical properties of multicomponent systems such that the effects of individual components and mixing relations can be assessed. We first established the temperature‐dependent electrical conductivity (σ) of pure, single‐phase methane hydrate to be ~5 orders of magnitude lower than seawater, a substantial contrast that can help differentiate hydrate deposits from significantly more conductive water‐saturated sediments in EM field surveys. Here we report σ measurements of two‐component systems in which methane hydrate is mixed with variable amounts of quartz sand or glass beads. Sand by itself has low σ but is found to increase the overall σ of mixtures with well‐connected methane hydrate. Alternatively, the overall σ decreases when sand concentrations are high enough to cause gas hydrate to be poorly connected, indicating that hydrate grains provide the primary conduction path. Our measurements suggest that impurities from sand induce chemical interactions and/or doping effects that result in higher electrical conductivity with lower temperature dependence. These results can be used in the modeling of massive or two‐phase gas‐hydrate‐bearing systems devoid of conductive pore water. Further experiments that include a free water phase are the necessary next steps toward developing complex models relevant to most natural systems.