bluuebunny/crossref_metadata_2025_split huggingface dataset:
Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial
Authors: Jabbour Mona , Curran Janet , Scott Shannon D , Guttman Astrid , Rotter Thomas , Ducharme Francine M , Lougheed M Diane , McNaughton-Filion M Louise , Newton Amanda , Shafir Mark , Paprica Alison , Klassen Terry , Taljaard Monica , Grimshaw Jeremy , Johnson David W 
Published: May 2013

Abstract

Background
The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways.

Design/methods
We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits.

Discussion
This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways.

Trial registration
ClinicalTrials.gov:NCT01815710
Ionic liquids as a tool for lignocellulosic biomass fractionation
Authors: da Costa Lopes Andre M , João Karen G , Morais Ana Rita C , Bogel-Łukasik Ewa , Bogel-Łukasik Rafał 
Published: May 2013

AbstractLignocellulosic biomass composes a diversity of feedstock raw materials representing an abundant and renewable carbon source. In majority lignocellulose is constituted by carbohydrate macromolecules, namely cellulose and hemicellulose, and by lignin, a polyphenilpropanoid macromolecule. Between these biomacromolecules, there are several covalent and non-covalent interactions defining an intricate, complex and rigid structure of lignocellulose. The deconstruction of the lignocellulosic biomass makes these fractions susceptible for easier transformation to large number of commodities including energy, chemicals and material within the concept of biorefinery. Generally, the biomass pre-treatment depends on the final goal in the biomass processing. The recalcitrance of lignocellulose materials is the main limitation of its processing once the inherent costs are excessively high for the conventional pre-treatments. Furthermore, none of the currently known processes is highly selective and efficient for the satisfactory and versatile use, thus, new methodologies are still studied broadly. The ionic liquid technology on biomass processing is relatively recent and first studies were focused on the lignocellulosic biomass dissolution in different ionic liquids (ILs). The dissolution in IL drives to the structural changes in the regenerated biomass by reduction of cellulose crystallinity and lignin content contrasting to the original biomass. These findings provided ILs as tools to perform biomass pre-treatment and the advantageous use of their specific properties over the conventional pre-treatment processes. This review shows the critical outlook on the study of biomass dissolution and changes occurred in the biomass during this process as well as on the influence of several crucial parameters that govern the dissolution and further pre-treatment process. The review of currently known methods of biomass fractionation in IL and aqueous-IL mixtures is also discussed here and perspectives regarding these topics are given as well.
Changes in Thyroid Status During Perinatal Development of MCT8-Deficient Male Mice
Authors: Ferrara Alfonso Massimiliano , Liao Xiao-Hui , Gil-Ibáñez Pilar , Marcinkowski Teresa , Bernal Juan , Weiss Roy E. , Dumitrescu Alexandra M. , Refetoff Samuel 
Published: May 2013

Abstract
Patients with the monocarboxylate transporter 8 (MCT8) deficiency syndrome present with a severe psychomotor retardation and abnormal serum thyroid hormone (TH) levels, consisting of high T3 and low T4 and rT3. Mice deficient in Mct8 replicate the thyroid phenotype of patients with the MCT8 gene mutations. We analyzed the serum TH levels and action in the cerebral cortex and in the liver during the perinatal period of mice deficient in Mct8 to assess how the thyroid abnormalities of Mct8 deficiency develop and to study the thyroidal status of specific tissues. During perinatal life, the thyroid phenotype of Mct8-deficient mice is different from that of adult mice. They manifest hyperthyroxinemia at embryonic day 18 and postnatal day 0. This perinatal hyperthyroxinemia is accompanied by manifestations of TH excess as evidenced by a relative increase in the expression of genes positively regulated by T3 in both the cerebral cortex and liver. An increased tissue accumulation of T4 and T3 and the expression of TH alternative transporters, including Lat1, Lat2, Oatp1c1, and Oatp3a1 in the cortex and Lat2 and Oatp1b2 in the liver, suggested that Mct8 deficiency either directly interferes with tissue efflux of TH or indirectly activates other transporters to increase TH uptake. This report is the first to identify that the ontogenesis of TH abnormalities in Mct8-deficient mice manifests with TH excess in the perinatal period.
Endogenous Somatostatin Is Critical in Regulating the Acute Effects of l-Arginine on Growth Hormone and Insulin Release in Mice
Authors: Córdoba-Chacón Jose , Gahete Manuel D. , Pozo-Salas Ana I. , Castaño Justo P. , Kineman Rhonda D. , Luque Raul M. 
Published: May 2013

Abstract
l-arginine (l-Arg) rapidly stimulates GH and insulin release in vivo. It has been hypothesized that l-Arg stimulates GH release by lowering hypothalamic somatostatin (SST) tone. l-Arg may also act directly at the pituitary to stimulate GH release. Moreover, l-Arg has a direct stimulatory effect on β-cells, which is thought to be blunted by the release of SST from pancreatic δ-cells. To confirm the role of endogenous SST on l-Arg-induced GH and insulin release, wild-type (WT) and SST-knockout (SST-KO) mice were injected with l-Arg (ip; 0.8 g/kg), and pre-/post-injection GH, insulin, and glucose levels were measured. In WT mice, l-Arg evoked a 6-fold increase in circulating GH. However, there was only a modest increase in GH levels in WT pituitary cell cultures treated with l-Arg. In contrast, l-Arg failed to increase GH in SST-KO beyond their already elevated levels. These results further support the hypothesis that the primary mechanism by which l-Arg acutely increases GH in vivo is by lowering hypothalamic SST input to the pituitary and not via direct pituitary effects. Additionally, l-Arg induced a clear first-phase insulin secretion in WT mice, but not in SST-KO. However, SST-KO, but not WT mice, displayed a robust and sustained second-phase insulin release. These results further support a role for endogenous SST in regulating l-Arg-mediated insulin release.
Sex, drugs and sexually transmitted infections in British university students
Authors: Vivancos R , Abubakar I , Hunter P R 
Published: May 2013

Summary: Understanding predisposing factors for sexually transmitted infections (STIs) in young adults may identify targets for public health interventions. We conducted a cross-sectional web-based survey of university students’ sexual attitudes, behaviours and lifestyles and self-reported rates of STI. A total of 827 students responded, 22.4% had two or more sexual partners in the previous year with inconsistent condom use and the lifetime prevalence of STIs was 9.6%. Factors associated with a diagnosis of STI were increasing age and number of sexual partners ever, female gender (adjusted odds ratio [AOR] 2.70, 95% confidence interval [CI] 1.31, 5.56) and use of crack (AOR 10.45, 95% CI 1.46, 75.16). For female students, these were increasing age and number of partners ever, whereas for male students having sex with other men (bisexual AOR 4.8, 95% CI 1.02, 22.595, homosexual AOR 17.66, 95% CI 3.03, 103.04) and use of crack (AOR 32.24, 95% CI 3.33, 312.08). Multiple partners and recreational drug use may predict incidence of STI. Prevention strategies need to aim at reducing risk behaviour across various activities.
Antimicrobial resistance pattern of Neisseria gonorrhoeae isolates from peripheral health centres and STD clinic attendees of a tertiary care centre in India
Authors: Bala M , Ray K , Gupta S M 
Published: May 2013

Summary: The aim of the study was to compare the antimicrobial resistance pattern of Neisseria gonorrhoeae isolates from urban and rural peripheral health centres and from sexually transmitted disease (STD) clinic attendees. Antimicrobial susceptibility testing of 191 N. gonorrhoeae isolates (165 isolates from STD clinic attendees and 26 from peripheral health centres) was carried out in Delhi, India, using the calibrated dichotomous sensitivity technique for penicillin, tetracycline, ceftriaxone, ciprofloxacin, spectinomycin and nalidixic acid, and minimum inhibitory concentrations were determined using E-test. Penicillin-resistant, ciprofloxacin-resistant, penicillinase-producing N. gonorrhoeae and tetracycline-resistant N. gonorrhoeae strains were higher in STD clinic attendees than in peripheral health centres, probably because of less antibiotic pressure in the peripheral areas. High-level resistance to ciprofloxacin and multiresistant strains were also higher in STD clinic attendees. The present study emphasizes the importance of surveillance of antimicrobial resistance of N. gonorrhoeae in different population subgroups in order to monitor the spread of multiresistant strains and to update the national treatment recommendations.
Audit of the management of antiretroviral treatment-naïve HIV patients in Greater Manchester, UK
Authors: Ratcliffe Libuše , Mcquillan Orla , Higgins Stephen P , Wilkins Edmund G L , Vilar F J 
Published: May 2013

Summary: We evaluated the management of antiretroviral treatment (ART)-naïve HIV-positive patients in Greater Manchester against the 2005 British HIV association (BHIVA) guidelines. Fifty-seven HIV patients (median age 36 years, 61% males, 53% black Africans) commenced their first ART regimen between 1 October and 31 December 2005. Most of them presented with advanced HIV disease (74% had CD4 lymphocytes <200 and 33% were Centers for Disease Control and Prevention stage C) and 51% commenced ART within three months of their HIV diagnosis. Ninety-six percent had baseline laboratory investigations performed but only 53% had baseline blood pressure estimation. Only 25% had urinalysis performed. A combination of two nucleoside reverse transcriptase inhibitors (NRTI) and one non-NRTI was chosen in 76% of patients. Eighty-two percent of patients had a clinical review and blood tests within five weeks of starting treatment.
Characteristics of HIV-1-associated Kaposi's sarcoma among women and men in South Africa
Authors: Mosam A , Hurkchand H P , Cassol E , Page T , Cassol S , Bodasing U , Aboobaker J , Dawood H , Friedland G H , Coovadia H M 
Published: May 2013

Summary: Despite the increase of HIV-1-associated Kaposi's sarcoma (KS), little is known about HIV-associated KS in the African setting, particularly among women. A descriptive study of the demographic, clinical, immunological and virological features of AIDS-associated KS from KwaZulu-Natal, South Africa was undertaken. Consecutively, recruited patients were clinically staged; CD4/CD8 cell counts, HIV-1 viral loads and clinical parameters were evaluated. Of the 152 patients (77 male and 75 female) 99% were black. Females were significantly younger (P = 0.02) and had poorer disease prognosis (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4, P = 0.003) and were more likely to have extensive cutaneous KS when compared with males (OR = 3.1, 95% CI = 1.4-6.7, P = 0.003). One-third of patients had coexisting HIV-related disease, most commonly tuberculosis, and these were more frequent in females (56.7 vs. 43.3%). In conclusion, HIV-associated KS in South Africans has an equal female-to-male ratio. Females are younger and have more severe disease than males.
The Somatic Double—A Key Role in Psychodramatic Bodywork®
Authors: Aaron Susan G. 
Published: May 2013

This article explores the role of somatic double as an innovation developed from Psychodramatic Bodywork®. Unlike other forms of doubling, a major component of the role of somatic double is the use of informed touch, which is based on some aspects of traditional Chinese medicine, meridians, and somatically based intuition. The somatic double is consistently used for auxiliary egos as well as protagonists.
The ability to sense information through the body is a common and pervasive experience but often exists below the level of consciousness. By making this experience conscious, many people discover they can be more effective in their lives and in the role of somatic double during a psychodrama.
The Aging Motor System as a Model for Plastic Changes of GABA-Mediated Intracortical Inhibition and Their Behavioral Relevance
Authors: Heise Kirstin-F. , Zimerman Maximo , Hoppe Julia , Gerloff Christian , Wegscheider Karl , Hummel Friedhelm C. 
Published: May 2013

Since GABAA-mediated intracortical inhibition has been shown to underlie plastic changes throughout the lifespan from development to aging, here, the aging motor system was used as a model to analyze the interdependence of plastic alterations within the inhibitory motorcortical network and level of behavioral performance. Double-pulse transcranial magnetic stimulation (dpTMS) was used to examine inhibition by means of short-interval intracortical inhibition (SICI) of the contralateral primary motor cortex in a sample of 64 healthy right-handed human subjects covering a wide range of the adult lifespan (age range 20–88 years, mean 47.6 ± 20.7, 34 female). SICI was evaluated during resting state and in an event-related condition during movement preparation in a visually triggered simple reaction time task. In a subgroup (N= 23), manual motor performance was tested with tasks of graded dexterous demand.Weak resting-state inhibition was associated with an overall lower manual motor performance. Better event-related modulation of inhibition correlated with better performance in more demanding tasks, in which fast alternating activation of cortical representations are necessary. Declining resting-state inhibition was associated with weakened event-related modulation of inhibition. Therefore, reduced resting-state inhibition might lead to a subsequent loss of modulatory capacity, possibly reflecting malfunctioning precision in GABAAergic neurotransmission; the consequence is an inevitable decline in motor function.
Synthesis of porous Li2MnO3-LiNi1/3Co1/3Mn1/3O2 nanoplates via colloidal crystal template
Authors: Jiang Yong , Zhuang Hua , Ma Qiliang , Jiao Zheng , Zhang Haijiao , Liu Ruizhe , Chu Yuliang , Zhao Bing 
Published: May 2013

Abstract
The impact of subglacial hydrology on the force balance of a physically modelled ice stream
Authors: Wagman Benjamin M. , Catania Ginny A. 
Published: May 2013

AbstractWe use a physical model to investigate how changes in subglacial hydrology affect ice motion of Antarctic ice streams. Ice streams are modelled using silicone polymer placed over a thin water layer to mimic ice flow dominated by basal sliding. The model ice-stream force balance is calculated and compared directly to the observed force balance of Whillans Ice Stream (WIS). Dynamic similarity between the model and WIS is achieved when their force balances are equivalent. The WIS force balance has evolved over time owing to increased basal resistance. We test two hypotheses: (1) the subglacial water distribution influences the ice-flow speed and thus the force balance; (2) shear margins are locations where transitions in water layer thickness occur. We find that the velocity and force balance are sensitive to pulsed water discharge events and changes in lubrication that result in sticky spots, and that model shear margins tend to overlie water lubrication boundaries. We conclude that local changes in basal lubrication near margins (possibly as a result of the presence of sticky spots or subglacial lakes) influence the stability of ice-stream margin position and may be responsible for large and rapid shifts in margin location.
Surgical Management of Parapharyngeal Abscess
Authors: Tubachi Jagadish , Hakeem Arsheed , Pradeep DC , Nayak Puneeth 
Published: May 2013

ABSTRACT
Parapharyngeal abscess is a life-threatening infection. It occurs due to spread of infection form anatomical locations in the vicinity of the space. Management of the deep neck infection is governed by the general condition of the patient, the extent of disease and patency of airway. In treatment of deep neck infections intensive antibiotic therapy and surgical drainage are complementary to each other.

How to cite this article
Tubachi J, Hakeem A, Pradeep DC, Nayak P. Surgical Management of Parapharyngeal Abscess. Int J Otorhinolaryngol Clin 2012;4(3):122-124.
Infratemporal Fossa, Masticator Space and Parapharyngeal Space: Can the Radiologist and Surgeon speak the Same Language?
Authors: Arya Supreeta , Rane Pawan , D'Cruz Anil 
Published: May 2013

ABSTRACT
Imaging is an integral part of head and neck cancer staging and assessing resectability. Accurate perception of imaging information by the clinician is possible only by effective communication between radiologist and surgeon. Traditionally, the radiologist studies the head neck region with two dimensional cross-sectional imaging. The surgeon perceives the head and neck region by real-time experience at surgery as a threedimensional (3D) space. Advances in computed tomography (multidetector CT) provide multiplanar and 3D reformations as added tools to facilitate understanding the complex anatomy and pathology and improve accuracy in staging. Despite these aids, accurate information requires a precise understanding of the different nomenclature of suprahyoid spaces used by the radiologist and clinician. While clinicians are familiar with infratemporal fossa (ITF), radiologists are familiar with masticator space (MS). Although these have been used interchangeably in the staging systems, the subtle difference needs to be understood. Literature also has differing definitions of the parapharyngeal space (PPS). This article describes these spaces, the varied definitions of PPS and the implications of involvement of structures of the ITF and MS on T staging of head neck cancers. A practical approach to the differential diagnoses of parapharyngeal lesions is also described.

How to cite this article
Arya S, Rane P, D'Cruz A. Infratemporal Fossa, Masticator Space and Parapharyngeal Space: Can the Radiologist and Surgeon speak the Same Language? Int J Otorhinolaryngol Clin 2012;4(3):125-135
Schwannoma of Descendence Hypoglossi Nerve
Authors: Ghorpade Chetan V , Deo Ravi P , Thorat Raghuji D , Watve Jayant K 
Published: May 2013

ABSTRACTWe are reporting a case of 30-year-old female with asymptomatic left sided neck mass who underwent surgical excision. She was diagnosed as having a neurilemmoma of left descendence hypoglossi nerve on histopathological examination. The review of available literature has shown it is a rare occurrence.How to cite this articleGhorpade CV, Deo RP, Thorat RD, Watve JK. Schwannoma of Descendence Hypoglossi Nerve. Int J Otorhinolaryngol Clin 2012;4(3):144-146.
Juvenile Aggressive Cemento-ossifying Fibroma of the Maxilla
Authors: Mishra Sarita , Bist Sampan Singh , Aggarwal Vinish 
Published: May 2013

ABSTRACTFibro-osseous lesions of the face and paranasal sinuses are relatively uncommon. The biological characteristics of fibroosseous lesions range from indolent to aggressive and from inflammatory to neoplastic. Cemento-ossifying fibroma is a rare, benign fibro-osseous lesion composed of lamellar bone, fibrous tissue and cementum. It is usually found in the jaw bone and presents in several variant pathological subtypes. The overlapping clinical, radiologic and histomorphologic features of these subtypes have led to diagnostic dilemma for the clinician, radiologist and the histopathologist. Clinically, the lesions are usually asymptomatic, slow-growing and wellcircumscribed. However, in very few cases, these tumors have demonstrated an aggressive course of development. Lesions that involve the midface and paranasal sinuses and presenting in earlier age tend to demonstrate aggressive behavior and rapid growth. We describe a case of a 13 years old young boy with aggressively behaving cemento-ossifying fibroma of the maxilla presenting acutely as right cheek swelling with gingival growth.How to cite this articleBist SS, Varshney S, Bhagat S, Mishra S, Aggarwal V. Juvenile Aggressive Cemento-ossifying Fibroma of the Maxilla. Int J Otorhinolaryngol Clin 2012;4(3):156-159.
Wage-Productivity Gap in OECD Economies
Authors: Elgin Ceyhun , Kuzubas Tolga Umut 
Published: May 2013

AbstractThe Walrasian theory of labor market equilibrium predicts that in the absence of any market frictions, workers earn a wage rate equal to their marginal productivity. In this paper, based on the neoclassical tradition, the authors define the ratio of the marginal product of labor to real wages as the Pigouvian exploitation rate and then construct a panel dataset of this specific wage-productivity gap for the manufacturing sector in OECD economies. Next, they investigate its relationship with the unemployment rate along with various other variables such as the government taxation, capital expansion, unionization, inflation. Their findings suggest that the wage-productivity gap gives a robust and significantly positive response to shocks to unemployment rate and a negative response to shocks to unionization.