bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metal ion levels from well-functioning Birmingham Hip Resurfacings decline significantly at ten years
Authors: Van Der Straeten C. , Van Quickenborne D. , De Roest B. , Calistri A. , Victor J. , De Smet K. 
Published: September 2013

A retrospective study was conducted to investigate the changes in metal ion levels in a consecutive series of Birmingham Hip Resurfacings (BHRs) at a minimum ten-year follow-up. We reviewed 250 BHRs implanted in 232 patients between 1998 and 2001. Implant survival, clinical outcome (Harris hip score), radiographs and serum chromium (Cr) and cobalt (Co) ion levels were assessed. Of 232 patients, 18 were dead (five bilateral BHRs), 15 lost to follow-up and ten had been revised. The remaining 202 BHRs in 190 patients (136 men and 54 women; mean age at surgery 50.5 years (17 to 76)) were evaluated at a minimum follow-up of ten years (mean 10.8 years (10 to 13.6)). The overall implant survival at 13.2 years was 92.4% (95% confidence interval 90.8 to 94.0). The mean Harris hip score was 97.7 (median 100; 65 to 100). Median and mean ion levels were low for unilateral resurfacings (Cr: median 1.3 µg/l, mean 1.95 µg/l (< 0.5 to 16.2); Co: median 1.0 µg/l, mean 1.62 µg/l (< 0.5 to 17.3)) and bilateral resurfacings (Cr: median 3.2 µg/l, mean 3.46 µg/l (< 0.5 to 10.0); Co: median 2.3 µg/l, mean 2.66 µg/l (< 0.5 to 9.5)). In 80 unilateral BHRs with sequential ion measurements, Cr and Co levels were found to decrease significantly (p < 0.001) from the initial assessment at a median of six years (4 to 8) to the last assessment at a median of 11 years (9 to 13), with a mean reduction of 1.24 µg/l for Cr and 0.88 µg/l for Co. Three female patients had a > 2.5 µg/l increase of Co ions, associated with head sizes ≤ 50 mm, clinical symptoms and osteolysis. Overall, there was no significant difference in change of ion levels between genders (Cr, p = 0.845; Co, p = 0.310) or component sizes (Cr, p = 0.505; Co, p = 0.370). Higher acetabular component inclination angles correlated with greater change in ion levels (Cr, p = 0.013; Co, p = 0.002). Patients with increased ion levels had lower Harris hip scores (p = 0.038). In conclusion, in well-functioning BHRs the metal ion levels decreased significantly at ten years. An increase > 2.5 µg/l was associated with poor function. Cite this article: Bone Joint J 2013;95-B:1332–8.
Analysis of Robust Parameter-Free Multilevel Methods for Neumann Boundary Control Problems
Authors: Gonçalves Etereldes , Sarkis Marcus 
Published: September 2013

Abstract.
We consider a linear-quadratic elliptic control problem (LQECP)
where the control
variable corresponds to the Neumann data on the boundary of a convex
polygonal domain. The optimal control unknown is the
one for which the harmonic extension approximates best a
specified target in the interior of the domain. We propose multilevel
preconditioners for the reduced system (the discrete Hessian system)
resulting from the application
of the Schur complement method to the discrete LQECP. In order to
derive robust preconditioners with respect to stabilization parameters,
we first show that the continuous reduced Hessian operator and the
corresponding discrete Hessian matrix are associated to a
linear combination of fractional negative Sobolev norms. Then we propose a
preconditioner based on multilevel methods, including cases
where the stabilization parameters are set equal to zero.
We also present numerical experiments
which agree with the theoretical results.
Fast Domain Decomposition Type Solver for Stiffness Matrices of Reference p-Elements
Authors: Korneev Vadim 
Published: September 2013

Abstract.
A key component of domain decomposition solvers for hp discretizations of elliptic equations
is the solver for internal stiffness matrices of p-elements.
We consider an
algorithm which belongs to the family of secondary domain
decomposition solvers, based on the finite-difference like preconditioning of p-elements,
and was outlined by the author earlier. We remove the
uncertainty in the choice of the coarse (decomposition) grid
solver and suggest the new interface Schur complement
preconditioner. The latter essentially uses the boundary norm for discrete harmonic functions
induced by orthotropic discretizations on slim rectangles,
which was derived recently.
We prove that the algorithm has linear arithmetical complexity.
Comparison of Split Step Solvers for Multidimensional Schrödinger Problems
Authors: Čiegis Raimondas , Mirinavičius Aleksas , Radziunas Mindaugas 
Published: September 2013

Abstract.
This paper presents the analysis of the split step solvers
for multidimensional Schrödinger problems.
The second-order symmetrical splitting
techniques are applied. The standard operator splitting is used
to split the linear diffraction and reaction/potential processes.
The dimension splitting exploits
the commuting property of one-dimensional discrete diffraction operators.
Alternating Direction Implicit (ADI) and Locally One-Dimensional (LOD)
algorithms are constructed and stability is investigated for
two- and three-dimensional problems. Compact
high-order approximations are applied to discretize diffraction operators.
Results of numerical experiments are presented and convergence
of finite difference schemes is investigated.
A Family of Finite-Difference Schemes with Discrete Transparent Boundary Conditions for a Parabolic Equation on the Half-Axis
Authors: Zlotnik Alexander , Koltsova Natalya 
Published: September 2013

Abstract.
An initial-boundary value problem for the 1D self-adjoint parabolic equation on the half-axis is solved.
We study a broad family of two-level finite-difference schemes with two parameters
related to averages both in time and space.
Stability in two norms is proved by the energy method.
Also discrete transparent boundary conditions are rigorously derived for schemes by applying the method of reproducing functions.
Results of numerical experiments are included as well.
A Posteriori Error Estimation for Highly Indefinite Helmholtz Problems
Authors: Dörfler Willy , Sauter Stefan 
Published: September 2013

Abstract.
We develop a new analysis for residual-type a posteriori error estimation for
a class of highly indefinite elliptic boundary value problems by considering
the Helmholtz equation at high wavenumber as our model problem. We
employ a classical conforming Galerkin discretization by using hp-finite elements.
In [Convergence analysis for finite element discretizations of the Helmholtz equation with
Dirichlet-to-Neumann boundary conditions, Math. Comp., 79 (2010), pp. 1871–1914], Melenk and Sauter introduced an hp-finite element discretization which leads to a stable
and pollution-free discretization of the Helmholtz equation under a mild
resolution condition which requires only
degrees of freedom, where denotes the spatial dimension.
In the present paper, we will introduce an a posteriori error estimator for this
problem and prove its reliability and efficiency. The constants in these
estimates become independent of the, possibly, high wavenumber
provided the aforementioned resolution condition for stability is satisfied.
We emphasize that, by using the classical theory, the constants in the a posteriori estimates would be amplified by a factor k.
On Finite Difference Schemes for Elliptic Equations with Discontinuous Coefficients
Authors: Dobrowolski Manfred 
Published: September 2013

Abstract.
We study the convergence of finite difference schemes for approximating
elliptic equations of second order with discontinuous coefficients.
Two of these finite difference schemes arise from the discretization
by the finite element method using bilinear shape functions.
We prove
an convergence for the gradient, if the solution is locally in H3. Thus, in contrast to the first order convergence
for the gradient obtained by the finite element theory we show that the gradient is superclose.
From the Bramble–Hilbert Lemma we derive a higher order compact (HOC) difference scheme
that gives an approximation error of order four for the gradient.
A numerical example is given.
The covert language in Kenyan hip hop lyrics
Authors: Ochoki, Beatrice , Schroeder, Helga 
Published: September 2013

Abstract
This article discusses the covert language of Kenyan hip hop lyrics. It will show that it has two interacting factors for its covertness, one is the uniqueness of Sheng and the other is the lexical adjustment processes that involve the construction of ad hoc concepts based on the interrelation between the encoded concepts, contextual information and the pragmatic processes of narrowing and broadening. This article will also show that Kenyan hip hop lyrics are prone to misinterpretation as a result of the lexical manipulation processes and the figurative language used. It will also prove that the misunderstanding of Kenyan hip hop lyrics is triggered intentionally by the speakers� abilities and preferences to exploit covert language, which is intended to lock out outsiders and create a new identity for the Kenyan urban youth. Hidden in the figurative language is a demeaning understanding of women as sex objects.
Effect of Focused Debriefing on Team Communication Skills
Authors: Nwokorie Ndidi , Svoboda Deborah , Rovito Debra K. , Krugman Scott D. 
Published: September 2013

Background and Objective:
Community hospitals often lack tertiary care support such as pediatric intensivists and anesthesiologists. Resuscitation of critically ill and injured children in community hospitals requires a well-coordinated team effort, because good team performance improves quality of care. The lack of subspecialty support makes team coordination and communication more imperative yet much more challenging. This study sought to determine if the addition of a defined focused post-mock code debriefing session improved communication skills among team members in a community pediatric emergency department.

Methods:
Twenty-two volunteer members of the pediatric emergency and respiratory therapy departments at Medstar Franklin Square Medical Center took part in monthly simulated resuscitations for 3 consecutive months. After each simulation, participants answered an 18-item survey on observed communication among their team members. Members then participated in a 30-minute debriefing session in which they reflected on their own communication skills. A video taping of the resuscitation was later scored by one of the investigators by using a rubric designed by the investigators. Descriptive statistics were calculated for both the participant survey and the team communication indicator scores. Paired-sample Wilcoxon signed rank test examined the difference in the scores between each of 3 sessions.

Results:
The mean scores by investigator-scored video recordings of the teams’ mock resuscitation by session showed overall team communication improved between sessions 1 and 3 for all communication areas (P = .03), with significant improvement in 4 of 9 communication areas by the third session. All team members improved communication skills as well, with the greatest improvement by the clinical multifunctional technicians.

Conclusions:
Communication skills improve with the addition of focused debriefing sessions after mock codes as perceived by participants during debriefing sessions and evidenced by investigator-scored video recordings of resuscitations.
Traditional Measures of Hospital Utilization May Not Accurately Reflect Dynamic Patient Demand: Findings From a Children’s Hospital
Authors: Fieldston Evan , Ragavan Meera , Jayaraman Bhuvaneswari , Metlay Joshua , Pati Susmita 
Published: September 2013

Objectives:
Hospital crowding adversely affects access to emergent and elective care, quality and safety, patient and staff satisfaction, and trainee education. Reliable and valid measurements are crucial to operational planning and improvement, but traditional measures of hospital utilization may not accurately describe dynamic demand at hospitals. The goal of this study was to determine how effectively traditional measures express demand for hospital services and to describe the dynamic nature of patient flow in children’s hospitals compared with alternative measures.

Methods:
This was a retrospective administrative data review conducted at an urban, tertiary care children’s hospital. A total of 28 045 inpatients (22 310 from fiscal year 2008 and 5735 from 2 months in the fall of 2009 during the H1N1 influenza surge [October 16, 2009–November 18, 2009]) were reviewed. Admission-discharge-transfer data were abstracted from a total of 14 months (1 fiscal year and a separate 2 months including an influenza surge). Hourly hospital census and occupancy were determined. Measures of mean and median length of stay (LOS) were compared. Turnover was calculated by summing admissions, discharges, and interunit transfers. Coefficient of variation (SD/mean) was used to describe variation.

Results:
Midnight occupancy was generally closer to minimum occupancy than peak. Peak was usually between 10 AM and 12 PM and was a mean of 4% points higher than midnight (but as large as 13% points). Median LOS was 58% shorter than average LOS. There was a high level of turnover, and patient-days did not express the wide variation in how demand was generated by day of week.

Conclusions:
Traditional metrics for hospital utilization do not accurately express the true extent and dynamic nature of patient flow and inpatient demand at a children’s hospital. Hospitals and government regulatory agencies should consider additional means of measuring utilization to accurately determine demand, including its variation, and thus assist in budgeting, staffing, and capacity planning.
Neonatal Bilirubin Triage With Transcutaneous Meters: When is a Blood Draw Necessary?
Authors: Hoppenot Claire , Emmett Gary A. 
Published: September 2013

Objective:
To find the optimal transcutaneous bilirubin (TcB) screening level in term neonates that minimizes the discomfort of phlebotomy, while protecting the child from harm and controlling costs.

Methods:
All available TcB and total serum bilirubin (TSB) measurements taken between 27 and 51 hours of life from a cohort of term newborns were analyzed in a retrospective chart review. TcB cutoffs between 6 and 12 mg/dL were evaluated for their negative predictive values (NPVs) for high risk (HR) and for the combination of high-intermediate risk and HR on the Bhutani TSB risk nomogram.

Results:
One thousand seventy-one full-term newborns were entered into the study. Of 601 newborns with TcB &lt;7 mg/dL, none were HR by TSB. Of newborns with a TcB of &lt;8 mg/dL, 1 in 759 was HR. The NPVs for screening levels of 7 and 8 mg/dL were of 100% and 99.9%, respectively, for HR and 99% and 97.6%, respectively, for high-intermediate/HR. A cutoff at 12 mg/dL had NPVs of 99.3% for HR, with 7 neonates, and 92.7% for high-intermediate/HR, with 76 infants of 1041.

Conclusions:
In our center, term infants with a TcB of &lt;8 mg/dL may be safely discharged without a follow-up TSB, with the understanding that ~1/1000 infants may be at HR for developing severe hyperbilirubinemia. Practices with universal follow-up may safely choose cutoffs up to 12 mg/dL. An institution’s degree of comfort and confidence in follow-up of the newborn cohort will guide the choice of an appropriate TcB cutoff requiring a TSB.
A Qualitative Description of the Development and Evaluation of Our Voice, a Health Promotion Magazine Created by Pediatric Patients for Hospitalized Pediatric Patients
Authors: Luca Paola D. , Chan Melissa , Basak Sanjukta , Segal Audrey O. , Porepa Michelle , Pinard Marie , Au Hosanna , Birken Catherine S. 
Published: September 2013

Objectives:
To facilitate a peer-developed health promotion magazine that provides health education and engages hospitalized pediatric patients during a hospital admission. To evaluate patient satisfaction with the content and layout of the magazine and its impact on patients’ attitudes toward healthy living.

Methods:
A pediatric resident–led multidisciplinary team collaborated with the Children’s Council at The Hospital for Sick Children to create a health promotion magazine for inpatients. Articles included a scavenger hunt, healthy recipes, physical activities, hospital staff interviews, and patient stories. Patients 7 to 18 years of age admitted to Pediatric Medicine or Respirology were invited to read the magazine and complete a questionnaire 24 hours later on their satisfaction with the magazine and their attitudes regarding healthy living.

Results:
Thirty-seven patients received a copy of the magazine, and 24 patients completed the questionnaire (mean 13.4 years, 54% female, 25% overweight/obese). Eleven of 24 (46%) read the entire magazine, and 19 of 23 (83%) reported learning. The exercises, recipes, and patient stories were most liked. Ten of 24 (42%) participants performed the exercises; the most common reason for not trying an exercise was pain. After reading the magazine, 15 of 24 (65%) patients reported that they will try to be more active, and 11 of 23 (48%) reported that they will try to eat more fruits and vegetables. Eighty-three percent were interested in a future edition.

Conclusions:
A health promotion magazine created by patients for patients changed patient-reported attitudes about healthy living. Peer-led interventions in the inpatient setting may be an important opportunity to promote healthy lifestyles and require further study.
Successful Implementation of a Referral-based Academic Pediatric Hospitalist Service
Authors: Hrach Christine M. , Smith Carolyn A. , Shah Purvi P. , Guth Rebecca M. , Lashly Dana , Carlson Douglas W. 
Published: September 2013

Objective:
St Louis Children’s Hospital (SLCH) developed Service for Hospital Admissions by Referring Physicians (SHARP) in January 2008 as an inpatient referral service for pediatricians who previously admitted their own patients. We hypothesized that use of SHARP would make hospitalization more efficient and cost-effective compared with the general pediatric medicine (GM) service.

Methods:
Admission volumes, diagnoses, length of stay (LOS), costs, and physician billing data were abstracted from SLCH information systems and the Pediatric Health Information System database. We compared admissions for SHARP and GM from January 2008 through June 2010.

Results:
SHARP had lower LOS and costs versus GM, with no change in 7-day readmission rate. Median LOS was 2 days for SHARP and 3 days for GM (P &lt; .001). Median hospital cost per patient was $2719 for SHARP and $3062 for GM (P &lt; .001). Over the study period, the admission rate increased 37% and daily patient encounters increased 39%. Physician billing revenue increased 25% in the first 6 months, then continued to increase steadily. Total physicians and geographic referral area using SHARP increased, and referring physician satisfaction was high.

Conclusions:
SHARP approaches financial independence and provides a cost savings to SLCH. LOS decreased by a statistically significant amount compared with GM with no change in readmission rate. Referring physician satisfaction was high, likely allowing for growth in referrals to SLCH. SHARP hospitalists’ collaboration with referring physicians, ensuring excellent follow-up, provides decreased duration of hospitalization and resource utilization. Our availability throughout the day to reassess patients increases efficiency. We project that we must average 12.6 daily encounters to be financially independent.
The Prevalence of Bacteremia in Pediatric Patients With Community-Acquired Pneumonia: Guidelines to Reduce the Frequency of Obtaining Blood Cultures
Authors: Heine Daniel , Cochran Christina , Moore Melissa , Titus M. Olivia , Andrews Annie Lintzenich 
Published: September 2013

Objective:
The goal of this study was to determine the prevalence of bacteremia in pediatric patients with community-acquired pneumonia (CAP) at our institution and to test the effectiveness of newly developed guidelines for obtaining blood cultures.

Methods:
Using recent literature and local expert opinion, institutional guidelines for obtaining blood cultures in pediatric patients with CAP were developed. A retrospective chart review of children treated in the emergency department or admitted for CAP from January 2010 through June 2011 was conducted. Demographic and clinical data were collected, including results of blood cultures. χ2 tests assessed for variables associated with bacteremia, whether a blood culture was obtained, and if the decision to obtain a culture was appropriate based on our guidelines.

Results:
The study included 330 patients; 155 (47%) blood cultures were obtained in our patient population. Five cultures were true-positive findings, making the prevalence of bacteremia 3.2% in patients with blood cultures and 1.5% in all patients. All 5 true positive results met criteria for blood culture based on our guidelines. Applying our guidelines retrospectively, the decision to obtain a blood culture met criteria in 55% of the cases. Bivariate analysis showed that patients discharged from the emergency department had higher rates of guideline-appropriate decisions than patients admitted. Radiographic findings were associated with making a guideline-appropriate decision regarding blood culture.

Conclusions:
Instituting local guidelines that limit the frequency of obtaining blood cultures in pediatric patients with CAP is likely to capture any patient with bacteremia. This study suggests that blood cultures may not need to be routinely obtained in all patients admitted to the hospital with CAP.
Development of Performance Tracking for a Pediatric Hospitalist Division
Authors: Paciorkowski Natalia , Pruitt Cassandra , Lashly Dana , Hrach Chrissy , Harrison Elizabeth , Srinivasan Mythili , Turmelle Michael , Carlson Douglas 
Published: September 2013

OBJECTIVES:
Our goal was to develop a comprehensive performance tracking process for a large pediatric hospitalist division. We aimed to use established dimensions and theory of health care quality to identify measures relevant to common inpatient diagnoses, reflective of current standards of clinical care, and applicable to individual physician performance. We also sought to implement a reproducible data collection strategy that minimizes manual data collection and measurement bias.

METHODS:
Washington University Division of Pediatric Hospital Medicine provides clinical care in 17 units within 3 different hospitals. Hospitalist services were grouped into 5 areas, and a task group was created of divisional leaders representing clinical services. The group was educated on the health care quality theory and tasked to search clinical practice standards and quality resources. The groups proposed a broad spectrum of performance questions that were screened for electronic data availability and modified into measurable formulas.

RESULTS:
Eighty-seven performance questions were identified and analyzed for their alignment with known clinical guidelines and value in measuring performance. Questions were distributed across quality domains, with most addressing safety. They reflected structure, outcome, and, most commonly, process. Forty-seven questions were disease specific, and 79 questions reflected individual physician performance; 52 questions had electronically available data.

CONCLUSIONS:
We describe a systematic approach to the development of performance indicators for a pediatric hospitalist division that can be used to measure performance on a division and physician level. We outline steps to develop a broad-spectrum quality tracking process to standardize clinical care and build invaluable resources for quality improvement research.