bluuebunny/crossref_metadata_2025_split huggingface dataset:
The safety and efficacy of bariatric surgery for obese, wheelchair bound patients
Authors: Williams GJ , Georgiou PA , Cocker DM , Bonanomi G , Smellie J , Efthimiou E 
Published: July 2014

Introduction The aim of this study was to evaluate outcomes of bariatric surgery performed in order to improve mobility in patients with severe mobility limitations. Methods Patients with severe mobility impairment (wheelchair bound) who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic adjustable gastric banding (LAGB) surgery to improve their mobility were included in this study. Patients were identified between July 2009 and October 2011 using an electronic prospective bariatric database. Mobility was assessed by questionnaire during clinic follow-up appointments. Results Fifteen patients (11 female, 4 male) with a mean age of 48 years (range: 26–71 years) and a mean body mass index of 46kg/m2 (range: 33–54kg/m2) were included. Seven patients (47%) underwent LAGB and eight (53%) LRYGB. The aetiologies of mobility impairment included advanced osteoarthritis (n=6), spinal conditions (n=4), severe bilateral leg oedema and ulceration (n=2), advanced rheumatoid arthritis (n=2) and traumatic paraplegia (n=1). The mean length of hospital stay was 3.8 days. There was no mortality. One patient was lost to follow-up. Of the remaining 14 patients, the mean excess weight loss percentage at a mean of 18.5 months postoperatively was 48% (68% for LRYGB, 20 months; 29% for LAGB, 17 months). Ten patients reported improved mobility. Reduced pain, improved independence and ability to transfer were most commonly cited. Four patients reported no improvement in mobility (three LAGB patients, one LRYGB patient). Conclusions Bariatric surgery can safely improve mobility and quality of life in obese patients with severe mobility impairment. Our paper supports the idea that severe mobility impairment should be considered an indication for bariatric surgery in selected patients. LRYGB demonstrated better weight loss and mobility improvement than LAGB. Larger studies are required to establish robust selection criteria for surgery in this group.
Sair da clausura: único remédio para a salvação.
Authors: Silva Ana Margarida Dias da 
Published: July 2014

Os Processos de saída de clausura (1694-1834) relativos a conventos femininos do bispado de Coimbra servem de base a este estudo que procura dar a conhecer os motivos que levam as religiosas a sair dos conventos: a saúde, ou melhor, a doença; os remédios que as religiosas experimentam dentro da clausura; os remédios impraticáveis intra claustra (banhos de rio, mar e o uso das caldas, a mudança de ares, e os passeios a pé ou a cavalo); bem como o destino das religiosas quando a saída de clausura se torna inevitável. The Processos de saída de clausura (1694-1834) from de female convents of the Bispado de Coimbra allow us to know the reasons why religious could go out and break the vows of perpetual closure. We studied the motives, mainly due to health problems, the medicines that they tried in the monastery and those that could only be taken outside like baths in the river or in the sea, thermal waters, exercise, walks and horse rides, and we also looked at the places that religious went when they got out and the cure was only possible outside the monastery.
Faculdade de Letras da Universidade de Coimbra e Conimbriga (1911-1962)
Authors: Gomes Liliana Isabel Esteves 
Published: July 2014

Conimbriga´s roman city ruins opened to the public in 1930. This year also marked an intervention of the official services and the beginning the systematic archaeological excavations which drove to the progressive valorisation of the ruins. The main purpose of this paper is to unveil the results of the work in archival research carried out in the Archive of the University of Coimbra (AUC). The research done has permitted to reconstruct the historical connection of the Faculty of Humanities of the University of Coimbra (FLUC) to the roman city of Conimbriga. As ruínas de cidade romana de Conimbriga abriram ao público em 1930. Este ano também marcou uma intervenção dos serviços oficiais e o início das escavações arqueológicas sistemáticas que levaram à progressiva valorização das ruínas. O principal objectivo deste trabalho é apresentar os resultados da pesquisa arquivística efectuada no Arquivo da Universidade de Coimbra (AUC). A investigação realizada permitiu reconstruir a ligação histórica da Faculdade de Letras da Universidade de Coimbra (FLUC) à cidade romana de Conímbriga.
O Convento de Santa Teresa de Jesus de Coimbra: inventário do acervo documental
Authors: Guedes Gracinda 
Published: July 2014

No Arquivo da Universidade de Coimbra (AUC) existe um pequeno acervo documental pertencente ao Convento de Santa Teresa de Jesus de Coimbra que, após a extinção das ordens religiosas, integrou o Arquivo dos Próprios Nacionais e deu entrada nesta instituição a 28 de dezembro de 1937. O presente trabalho pretende dar a conhecer o referido arquivo, devidamente classificado e ordenado, com o intuito de agilizar o acesso a esta fonte documental, testemunha da história e da vida quotidiana desta comunidade de Carmelitas Descalças de Coimbra. Trata-se, pois, do tratamento arquivístico da documentação – com base na norma internacional ISAD(G) e na nacional ODA – com a consequente elaboração de inventário, complementado com a apresentação do recenseamento das unidades de instalação. Abstract In the Archive of the University of Coimbra (AUC) there is a small archive of documents belonging to the Convent of Saint Teresa of Jesus of Coimbra which, after the extinction of the religious orders, joined the Archive of Próprios Nationais and was received into this institution in 28 December 1937.This paper intends to make known the above archive, properly classified and orderly to quick access to this documental source, witness of history and everyday life of this community of Discalced Carmelite nuns of Coimbra.It is therefore an archival processing of documentation – based on the international standard ISAD (G) and the national ODA – with the consequent development of inventory, complemented with the presentation of registration of the units of installation.
A justiça eclesiástica e os mecanismos de busca de infratores: as queixas, as querelas e as denúncias no século XVIII
Authors: Silveira Patricia Ferreira dos Santos 
Published: July 2014

A justiça eclesiástica perseguiu e puniu centenas de infratores nos domínios lusitanos coloniais. Em busca dos leigos e sacerdotes em desvio, os juízes eclesiásticos empregaram, principalmente, três mecanismos de procura: queixas, querelas e denúncias. Por meio de uma análise comparativa com a norma oficial, e denúncias das dioceses de Mariana e de Coimbra, evidencia-se que a ação pastoral de orientação tridentina era indissociável da ação da justiça eclesiástica. Abstract: The ecclesiastical justice pursued and punished hundreds of offenders in the areas Lusitanian colony. In search of the laity and priests misuse, ecclesiastical judges employed mainly three search engines: complaints, disputes and denunciations. These testimonies show, through a comparison with standard ecclesiastical, that the evangelization guidance Tridentine, was inseparable from the action of ecclesiastical justice.
Creating a Safe Place for Pediatric Care: A No Hit Zone
Authors: Frazier Erin R. , Liu Gilbert C. , Dauk Kelly L. 
Published: July 2014

Objectives:
Our goal was to create and implement a program, Kosair Children’s Hospital’s No Hit Zone, which trains health care workers in de-escalation techniques to address parental disruptive behaviors and physical discipline of children commonly encountered in the hospital environment.

Methods:
The Child Abuse Task Force, a multidisciplinary group, along with key hospital administrators developed specific content for the policy, as well as marketing and educational materials. The No Hit Zone policy designates Kosair Children’s Hospital as “an environment in which no adult shall hit a child, no adult shall hit another adult, no child shall hit an adult, and no child shall hit another child. When hitting is observed, it is everyone’s responsibility to interrupt the behavior as well as communicate system policy to those present.”

Results:
Via a multidisciplinary, collaborative approach, the No Hit Zone was successfully implemented at Kosair Children’s Hospital in 2012. Cost was nominal, and the support of key hospital administrators was critical to the program’s success. Education of health professionals on de-escalation techniques and intervention with families at the early signs of parental stress occurred via live sessions and online training via case-based scenarios.

Conclusions:
The No Hit Zone is an important program used to provide a safe and caring environment for all families and staff of Kosair Children’s Hospital. Demand for the program continues, demonstrated by the establishment of No Hit Zones at other local hospitals and multiple outpatient clinics. This article offers information for other organizations planning to conduct similar initiatives.
Effects of the 2011 Duty Hour Restrictions on Resident Education and Learning From Patient Admissions
Authors: Auger Katherine A. , Jerardi Karen E. , Sucharew Heidi J. , Yau Connie , Unaka Ndidi , Simmons Jeffrey M. 
Published: July 2014

Objective:
In July 2011, new duty hour limits for resident physicians were instituted to address concerns about the effects of sleep deprivation on patient care and trainee experience. We sought to evaluate potential educational impacts of these duty hour changes with regard to learning and frequency of attending interactions during patient admissions.

Methods:
Forty-nine residents on general pediatric teams participated in a prospective observational cohort study. Intervention residents (n = 23) worked a shift-based schedule compliant with new requirements. Control residents (n = 26) were on call every fourth night and compliant with 2003 work hour limits. Faculty members were present 16 hours daily. Resident surveys assessed learning from admissions (frequency of attending interaction and perceived learning during admissions). Data were analyzed with generalized linear mixed models to account for multiple responses from each resident.

Results:
Intervention interns and seniors were less likely to present admissions to faculty during morning rounds, but there were no differences between intervention and control groups in percentage of admissions discussed with faculty at any time. Perceived learning from admissions was not different between the 2 groups.

Conclusions:
Faculty-resident interaction decreased during morning rounds; however, overall attending contact did not, suggesting inpatient teaching approaches must adapt to meet learners’ needs throughout the workday.
The Harada Score in the US Population of Children With Kawasaki Disease
Authors: Tewelde Helen , Yoon Jeein , Van Ittersum Wendy , Worley Sarah , Preminger Tamar , Goldfarb Johanna 
Published: July 2014

Objective:To describe and quantify the presentations of Kawasaki disease (KD) in a children’s hospital over 10 years to assess the Harada score in a US population.Methods:A retrospective chart review from 2001 to 2011 of children discharged from Cleveland Clinic with the diagnosis of KD. Demographic and clinical data were collected and Harada scores were derived to evaluate efficacy in predicting risk for coronary artery aneurysms (CAAs).Results:A total of 105 children met diagnostic criteria for KD, and 97 of 105 had long-term follow-up. Full criteria for KD were found in 67 of 105 (64%); 38 had incomplete presentations. CAA developed in 10 children, 5 during follow-up despite treatment with intravenous immunoglobulin (IVIG.) Children with incomplete presentations had a higher risk of developing CAA (20% vs 5%, P = .03) and a delayed diagnosis (median days from fever to diagnosis 8.0 vs 5.0 days, P &lt; .001). Of children who developed CAA, 9 of 10 had a positive Harada score (sensitivity of 90%). All children who developed CAA after IVIG were in the high-risk group, but 1 child with an incomplete presentation who had a CAA at presentation was missed by the score. Overall, the negative predictive value was 98%.Conclusions:As in Japanese studies, a positive Harada score in a US population could be used to identify a high-risk population for CAA development. All children who developed CAA after treatment with IVIG would have been assigned to a high-risk category. Though not specific enough to select initial therapy, the score might be useful in identifying high-risk children for evaluation of new therapies and more frequent follow-up.
Medical Students’ Experiences Working With Frequently Rotating Pediatric Inpatient Attending Physicians
Authors: Seltz L. Barry , Montgomery Alison , Lane J. Lindsey , Soep Jennifer , Hanson Janice L. 
Published: July 2014

Objective:
To explore medical students’ experiences working with frequently rotating pediatric inpatient attending physicians.

Methods:
We performed a qualitative study using focus groups and individual interviews of medical students who rotated on the general pediatric inpatient service at Children’s Hospital Colorado. The majority of inpatient pediatric attending physicians worked 1-week blocks. We used a semistructured interview guide and analyzed data using the constant comparative method. In accordance with the grounded theory method, codes were developed using an iterative approach, and major themes were identified. Analysis indicated theoretical saturation was achieved. We created a theory that arose from analysis of the data.

Results:
Twenty-seven medical students participated. Data analysis yielded 6 themes: learning climate, continuity, student resilience, opportunity to progress, growth into a physician, and evaluation. In the learning climate, the emotional environment was often stressful, although students valued exposure to different patient care and teaching styles. Senior resident continuity promoted student function; lack of continuity with attending physicians inhibited relationship development. Students were resilient in adjusting to changing faculty with different expectations. In the context of frequently rotating faculty, students had difficulty showing improvement to a single attending physician after feedback, which limited students’ opportunities to progress. Students perceived summative evaluation as less meaningful in the absence of having a relationship with their attending physicians.

Conclusions:
Medical students valued exposure to different patient care and teaching styles. However, frequently changing attending physicians caused students stress and limited students’ perceived ability to achieve and show professional growth.
Age at Referral and Mortality From Critical Congenital Heart Disease
Authors: Fixler David E. , Xu Ping , Nembhard Wendy N. , Ethen Mary K. , Canfield Mark A. 
Published: July 2014

BACKGROUND AND OBJECTIVE:
Newborn pulse oximetry screening is recommended to promote early referral of neonates with critical congenital heart disease (CCHD) and reduce mortality; however, the impact of late referral on mortality is not well defined. The purpose of this population-based study was to describe the association between timing of referral to a cardiac center and mortality in 2360 liveborn neonates with CCHD.

METHODS:
Neonates with CCHD born before pulse oximetry screening (1996–2007) were selected from the Texas Birth Defects Registry and linked to state birth and death records. Age at referral was ascertained from date of first cardiac procedure at a cardiac center. Logistic and Cox proportional hazards regression models were used to estimate factors associated with late referral and mortality; the Kaplan-Meier method was used to estimate 3-month survival.

RESULTS:
Median age at referral was 1 day (25th–75th percentile: 0–6 days). Overall, 27.5% (649 of 2360) were referred after age 4 days and 7.5% (178 of 2360) had no record of referral. Neonatal mortality was 18.1% (277 of 1533) for those referred at 0 to 4 days of age, 9.0% (34 of 379) for those referred at 5 to 27 days of age, and 38.8% (69 of 178) for those with no referral. No improvement in age at referral was found across the 2 eras within 1996–2007.

CONCLUSIONS:
A significant proportion of neonates with CCHD experienced late or no referral to cardiac specialty centers, accounting for a significant number of the deaths. Future population-based studies are needed to determine the benefit of pulse oximetry screening on mortality and morbidity.
Attention-Deficit/Hyperactivity Disorder and Substance Abuse
Authors: Harstad Elizabeth , Levy Sharon ,   COMMITTEE ON SUBSTANCE ABUSE, Levy Sharon , Ammerman Seth D. , Gonzalez Pamela K. , Ryan Sheryl A. , Siqueira Lorena M. , Smith Vincent C. 
Published: July 2014

This Clinical Report was reaffirmed October 2020.
Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders are inextricably intertwined. Children with ADHD are more likely than peers to develop substance use disorders. Treatment with stimulants may reduce the risk of substance use disorders, but stimulants are a class of medication with significant abuse and diversion potential. The objectives of this clinical report were to present practical strategies for reducing the risk of substance use disorders in patients with ADHD and suggestions for safe stimulant prescribing.
Traumatic thoracolumbar spinal injury: an algorithm for minimally invasive surgical management
Authors: Dhall Sanjay S. , Wadhwa Rishi , Wang Michael Y. , Tien-Smith Alexandra , Mummaneni Praveen V. 
Published: July 2014

Object
Minimally invasive spinal (MIS) surgery techniques have been used sporadically in thoracolumbar junction trauma cases in the past 5 years. A review of the literature on the treatment of thoracolumbar trauma treated with MIS surgery revealed no unifying algorithm to assist with treatment planning. Therefore, the authors formulated a treatment algorithm.

Methods
The authors reviewed the current literature on MIS treatment of thoracolumbar trauma. Based on the literature review, they then created an algorithm for the treatment of thoracolumbar trauma utilizing MIS techniques. This MIS trauma treatment algorithm incorporates concepts form the Thoracolumbar Injury Classification System (TLICS).

Results
The authors provide representative cases of patients with thoracolumbar trauma who underwent MIS surgery utilizing the MIS trauma treatment algorithm. The cases involve the use of mini-open lateral approaches and/or minimally invasive posterior decompression with or without fusion.

Conclusions
Cases involving thoracolumbar trauma can safely be treated with MIS surgery in select cases of burst fractures. The role of percutaneous nonfusion techniques remains very limited (primarily to treat thoracolumbar trauma in patients with a propensity for autofusion [for example, those with ankylosing spondylitis]).
Endovascular transarterial embolization of cerebral arteriovenous malformation with ethylene-vinyl alcohol copolymer
Authors: Tan Lee A. , Johnson Andrew K. , Keigher Kiffon M. , Moftakhar Roham , Lopes Demetrius K. 
Published: July 2014

Cerebral arteriovenous malformations (AVMs) have an estimated 2–4% annual risk of hemorrhage. Treatment options for AVMs include microsurgical resection, stereotactic radiosurgery, and endovascular embolization. As endovascular technology and techniques continue to advance and mature, endovascular embolization is becoming an increasingly vital component of AVM treatment not only as a presurgical treatment to reduce microsurgical risks, but also as a stand-alone curative method in some cases. This case illustrates the successful and curative transarterial embolization of a right frontal AVM in a 17-year-old boy with ethylene-vinyl alcohol copolymer (Onyx).The video can be found here: http://youtu.be/L4hE1MvCZCY.
Endovascular management of cerebral vasospasm
Authors: Kelman Craig , Reavey-Cantwell John 
Published: July 2014

Cerebral vasospasm remains a feared complication from subarachnoid hemorrhage. Vasospasm typically occurs from three to fourteen days post–aneurysm rupture, with peak risk on Day 7. Up to 50% of patients with angiographic vasospasm will subsequently develop delayed cerebral ischemia; 15–20% of this subset will develop stroke or death despite maximal medical therapy. We define symptomatic vasospasm as the presence of neurological worsening after exclusion of other identifiable causes, such as seizure, hydrocephalus, intracerebral hemorrhage, or metabolic dysfunction. This video demonstrates the set-up and treatment protocol for endovascular intervention of symptomatic vasospasm not responsive to maximal medical management.The video can be found here: http://youtu.be/q7YvxLzIDnU.
Transarterial embolization of an anterior fossa cranial base dural arteriovenous fistula
Authors: Lee Brian , Mehta Vivek A. , Amar Arun P. , Tenser Matthew S. , Mack William J. 
Published: July 2014

Open surgical disconnection has long been the treatment of choice for dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa. However, advanced patient age and the presence of medical comorbidities can substantially increase the risk of craniotomy and favor a less invasive endovascular approach. Optimal positioning within the distal ophthalmic artery, beyond the origin of the central retinal branch, is achievable using current microcatheter technology and embolic materials. Here we present the case of an 88-year-old female with an incidentally discovered dAVF of the anterior cranial fossa. Angiographic cure was achieved with one-stage Onyx embolization.The video can be found here: http://youtu.be/KVE0fUIECQM.
Endovascular coil embolization of unruptured posterior communicating artery aneurysm
Authors: Binning Mandy , Hakma Zakaria , Veznedaroglu Erol 
Published: July 2014

The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1.The video can be found here: http://youtu.be/MjOc3Zpv2K8.
Transcirculation balloon-assisted stent-supported coil embolization of a basilar tip aneurysm
Authors: Agarwal Vijay , Zomorodi Ali , Mcdougal Cameron , Babu Ranjith , Back Adam , Gonzalez L. Fernando 
Published: July 2014

We present the case of a balloon-assisted, stent-supported coil embolization of a basilar tip aneurysm. Initially, a balloon extending from the basilar artery into the right PCA was placed.3 However, even with a more proximal purchase, coils were found to impinge on the left PCA. Subsequently, a transcirculation approach was performed, where the left posterior communicating artery was utilized as a conduit for balloon support and the coils were embolized from the ipsilateral vertebral artery.1 However, after this transcirculation approach was completed, there was a coil tail extruding from the aneurysm. The balloon was then removed over an exchange wire and a horizontal stent advanced, spanning the entire neck of the aneurysm, eliminating the extruded coil.2The video can be found here: http://youtu.be/bMbtZoPnYvo.