bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Clinical Utility of Routine Daily Chest Radiography in Intensive Care Unit Patients With Tracheostomy Tubes
Authors: Cruz Jeffrey , Ferra Michael , Kasarabada Aditya , Gasperino James , Zigmund Beth 
Published: June 2014

Background: The utilization of imaging procedures is under scrutiny due to high costs and radiation exposure to patients and staff associated with some radiologic procedures. Within our institution’s intensive care unit (ICU), it is common for patients to undergo chest radiography (CR) not only immediately following tracheostomy tube placement but also on a daily basis, irrespective of the patient’s clinical status. We hypothesize that the clinical utility of performing routine daily CR on patients with tracheostomy tubes is low and leads to unnecessary financial cost. Methods: A retrospective medical chart review was done on 761 CRs performed on 79 ICU patients with tracheostomy from April 2010 to July 2011. We searched the radiology reports of the 761 CRs for the presence of new radiographically detected complications and reviewed medical records to determine which complications were clinically suspected and which radiology reports led to changes in patient management. Results: Of the 761 CRs, only 18 (2.3%) radiographs revealed new complications. All complications were clinically suspected prior to imaging. Only 5 (0.7%) complications resulted in a management change. The most common management changes were a change in antibiotic regimen (0.3%) and ordering of diuretics (0.3%). Conclusions: Routine daily imaging of patients with tracheostomy in an ICU provides little clinical utility, and CR in this population should be performed selectively based on the patient’s clinical status.
Ethical challenges when caring for dying children
Authors: Furingsten Lovisa , Sjögren Reet , Forsner Maria 
Published: June 2014

Background: Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals. Objective: The aim of this study was to describe caring as represented in healthcare workers’ experiences of caring for dying children. Method: A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence. Ethical considerations: Four nurses in a general acute paediatric care setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved. Findings: The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice. Discussion: Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient’s needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge. Conclusion: Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying.
Developing nursing ethical competences online versus in the traditional classroom
Authors: Trobec Irena , Starcic Andreja Istenic 
Published: June 2014

Background: The development of society and science, especially medical science, gives rise to new moral and ethical challenges in healthcare. Research question/objectives/hypothesis: In order to respond to the contemporary challenges that require autonomous decision-making in different work contexts, a pedagogical experiment was conducted to identify the readiness and responsiveness of current organisation of nursing higher education in Slovenia. It compared the successfulness of active learning methods online (experimental group) and in the traditional classroom (control group) and their impact on the ethical competences of nursing students. The hypothesis set in the experiment, hypothesis 1 (the experimental group will be successful and will have good achievements in comprehension and application of ethical principles) was confirmed based on pre-tests and post-tests. The hypothesis tested by the questionnaire, hypothesis 2 (according to the students, the active learning methods online in the experimental group have a positive impact on the development of ethical competences) was confirmed. Research design: The pedagogical experiment was supported by a multiple-case study that enabled the in-depth analysis of the students’ attitudes towards the active learning methods in both settings. Participants and research context: The study included Slovenian first-year nursing students (N = 211) of all the enrolled students (N = 225) at the University of Ljubljana and University of Primorska in the academic year 2010/2011. Ethical considerations: Before the study ethical permission was obtained from the managements of both participating faculties. The students were given all the necessary information of the experiment before the tutorials. Findings: No significant difference was found between the two learning settings and both had a positive impact upon learning. The results of the content analysis show that the students’ active engagement with the active learning methods in the group enables the development of ethical competences and the related communicative competences, interpersonal skills, collaboration and critical thinking. Discussion: Active learning methods in the settings compared, online and the traditional classroom, enabled the development of a higher level of knowledge defined by the ability of critical thinking and reflective response, the core of ethical competences. Students develop ethical competence through active engagement in a group work, role play and discussion, and there is no difference between online or traditional learning settings. Conclusion: In the healthcare, it is crucial for providers to be capable of making autonomous decisions and managing various communication situations and contexts in which the moral attitudes and ethical sensibility are essential.
Moral distress in nurses at an acute care hospital in Switzerland
Authors: Kleinknecht-Dolf Michael , Frei Irena Anna , Spichiger Elisabeth , Müller Marianne , Martin Jacqueline S , Spirig Rebecca 
Published: June 2014

Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial indications of the instrument’s validity. Method: The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. Ethical considerations: The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. Results: The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. Conclusion: The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups.
Claiming an Ethic of Care for midwifery
Authors: MacLellan Jennifer 
Published: June 2014

Background: The public domain of midwifery practice, represented by the educational and hospital institutions could be blamed for a subconscious ethical dilemma for midwifery practitioners. The result of such tension can be seen in complaints from maternity service users of dehumanised care. When expectations are not met, women report dehumanising experiences that carry long term consequences to both them and their child. Objectives: To revisit the ethical foundation of midwifery practice to reflect the feminist Ethic of Care and reframe what is valuable to women and midwives during the childbirth experience. Research Design: A comprehensive literature review is presented from the midwifery and feminist ethics discourse. Ethical Considerations: Nil to report. Findings: Women are vulnerable during childbirth as they need care, yet they prioritise elements of relationship in their experience. The Ethic of Care approach equalises the relationship between the midwife and the woman, providing the space for relationship building and allowing midwives to meet the expectations of their accepted responsibility. Discussion: Some midwives manage to balance the demands of the institution with the needs of the woman. This is described as both an emotional and professionally challenging balancing act. Conclusion: Until there is a formal acknowledgement of the different ethical approach to midwifery practice from within the profession and the Institution, midwifery identity and practice will continue to be compromised.
Windlass Mechanism in Individuals With Diabetes Mellitus, Peripheral Neuropathy, and Low Medial Longitudinal Arch Height
Authors: Gelber Judith R. , Sinacore David R. , Strube Michael J. , Mueller Michael J. , Johnson Jeffrey E. , Prior Fred W. , Hastings Mary K. 
Published: June 2014

Background: The windlass mechanism, acting through the plantar fascia, stabilizes the arches of the foot during stance phase of gait. The purpose of this study was to compare changes in radiographic measurements of the medial longitudinal arch (MLA) between toe-flat and -extended positions in participants with and without diabetes mellitus (DM), peripheral neuropathy (PN), and a low MLA. Methods: Twelve participants with DMPN and low MLA and 12 controls received weightbearing radiographs in a toe-flat and toe-extended position. DMPN participants were subcategorized from radiographs into DMPN severe, evidence of severe joint changes, and DMPN low, absence of joint changes. Primary measurements of MLA were determined in each position and included Meary’s angle, talar declination angle, first metatarsal declination angle, and navicular height. Results: The DMPN severe group had no difference between toe-flat and -extended positions for Meary’s, talar declination, and first metatarsal declination angles ( P > .35) while navicular height elevated ( P < .05). The DMPN low group had no difference between toe-flat and -extended positions for talar declination angle ( P = .38), while Meary’s angle, first metatarsal declination angle, and navicular height elevated ( P < .05). All measurements in the control group changed, consistent with arch height elevation, when toes were extended ( P < .05). Conclusion: The DMPN severe and low groups showed impaired ability to raise the arch from the toe-flat to -extended position. Further research is needed to examine the contribution of specific windlass mechanism components (ie, plantar fascia, ligament, foot joint integrity, and mobility) as they relate to progressive foot deformity in adults with DMPN. Level of Evidence: Level III, comparative series.
PTK2 expression and immunochemotherapy outcome in chronic lymphocytic leukemia
Authors: Weisser Martin , Yeh Ru-Fang , Duchateau-Nguyen Guillemette , Palermo Giuseppe , Nguyen Tri Quang , Shi Xiaoyan , Stinson Susanna Y. , Yu Nancy , Dufour Annika , Robak Tadeusz , Salogub Galina N. , Dmoszynska Anna , Solal-Celigny Philippe , Warzocha Krzysztof , Loscertales Javier , Catalano John , Larratt Loree , Rossiev Viktor A. , Bence-Bruckler Isabelle , Geisler Christian H. , Montillo Marco , Fischer Kirsten , Fink Anna-Maria , Hallek Michael , Bloehdorn Johannes , Busch Raymonde , Benner Axel , Döhner Hartmut , Valente Nancy , Wenger Michael K. , Stilgenbauer Stephan , Dornan David 
Published: June 2014

Key Points
Increased PTK2 expression is associated with improved outcomes in patients with CLL treated with R-FC immunochemotherapy. PTK2 expression represents a useful, novel biomarker for selection of patients who will benefit from R-FC immunochemotherapy.
Facile fabrication of high-efficiency near-infrared absorption film with tungsten bronze nanoparticle dense layer
Authors: Lee Seong Yun , Kim Jae Young , Lee Jun Young , Song Ho Jun , Lee Sangkug , Choi Kyung Ho , Shin Gyojic 
Published: June 2014

AbstractAn excellent transparent film with effective absorption property in near-infrared (NIR) region based on cesium-doped tungsten oxide nanoparticles was fabricated using a facile double layer coating method via the theoretical considerations. The optical performance was evaluated; the double layer-coated film exhibited 10% transmittance at 1,000 nm in the NIR region and over 80% transmittance at 550 nm in the visible region. To optimize the selectivity, the optical spectrum of this film was correlated with a theoretical model by combining the contributions of the Mie-Gans absorption-based localized surface plasmon resonance and reflections by the interfaces of the heterogeneous layers and the nanoparticles in the film. Through comparison of the composite and double layer coating method, the difference of the nanoscale distances between nanoparticles in each layer was significantly revealed. It is worth noting that the nanodistance between the nanoparticles decreased in the double layer film, which enhanced the optical properties of the film, yielding a haze value of 1% or less without any additional process. These results are very attractive for the nanocomposite coating process, which would lead to industrial fields of NIR shielding and thermo-medical applications.PACS78.67.Sc; 78.67.Bf; 81.15.-z
Effect of some operational parameters on the arsenic removal by electrocoagulation using iron electrodes
Authors: Can Berrin Zeliha , Boncukcuoglu Recep , Yilmaz Alper Erdem , Fil Baybars Ali 
Published: June 2014

Abstract
Arsenic contamination of drinking water is a global problem that will likely become more apparent in future years as scientists and engineers measure the true extent of the problem. Arsenic poisoning is preventable though as there are several methods for easily removing even trace amounts of arsenic from drinking water. In the present study, electrocoagulation was evaluated as a treatment technology for arsenic removal from aqueous solutions. The effects of parameters such as initial pH, current density, initial concentration, supporting electrolyte type and stirring speed on removal efficiency were investigated. It has been observed that initial pH was highly effective on the arsenic removal efficiency. The highest removal efficiency was observed at initial pH = 4. The obtained experimental results showed that the efficiency of arsenic removal increased with increasing current density and decreased with increasing arsenic concentration in the solution. Supporting electrolyte had not significant effects on removal, adding supporting electrolyte decreased energy consumption. The effect of stirring speed on removal efficiency was investigated and the best removal efficiency was at the 150 rpm. Under the optimum conditions of initial pH 4, current density of 0.54 mA/cm2, stirring speed of 150 rpm, electrolysis time of 30 minutes, removal was obtained as 99.50%. Energy consumption in the above conditions was calculated as 0.33 kWh/m3. Electrocoagulation with iron electrodes was able to bring down 50 mg/L arsenic concentration to less than 10 μg/L at the end of electrolysis time of 45 minutes with low electrical energy consumption as 0.52 kWh/m3.
Cerebral microbleeds: overview and implications in cognitive impairment
Authors: Martinez-Ramirez Sergi , Greenberg Steven M , Viswanathan Anand 
Published: June 2014

AbstractCerebral microbleeds (MBs) are small chronic brain hemorrhages which are likely caused by structural abnormalities of the small vessels of the brain. Owing to the paramagnetic properties of blood degradation products, MBs can be detected in vivo by using specific magnetic resonance imaging (MRI) sequences. Over the last decades, the implementation of these MRI sequences in both epidemiological and clinical studies has revealed MBs as a common finding in many different populations, including healthy individuals. Also, the topographic distribution of these MBs has been shown to be potentially associated with specific underlying vasculopathies. However, the clinical and prognostic significance of these small hemorrhages is still a matter of debate as well as a focus of extensive research. In this article, we aim to review the current knowledge on the pathophysiology and clinical implications of MBs, with special emphasis on the links between lobar MBs, cerebral amyloid angiopathy, and Alzheimer’s disease.
Higher brain extracellular potassium is associated with brain metabolic distress and poor outcome after aneurysmal subarachnoid hemorrhage
Authors: Antunes Ana Patrícia , Schiefecker Alois Josef , Beer Ronny , Pfausler Bettina , Sohm Florian , Fischer Marlene , Dietmann Anelia , Lackner Peter , Hackl Werner Oskar , Ndayisaba Jean-Pierre , Thomé Claudius , Schmutzhard Erich , Helbok Raimund 
Published: June 2014

Abstract
Introduction
Elevated brain potassium levels ([K+]) are associated with neuronal damage in experimental models. The role of brain extracellular [K+] in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) and its association with hemorrhage load, metabolic dysfunction and outcome has not been studied so far.

Methods
Cerebral microdialysis (CMD) samples from 28 poor grade aSAH patients were analyzed for CMD [K+] for 12 consecutive days after ictus, and time-matched to brain metabolic and hemodynamic parameters as well as corresponding plasma [K+]. Statistical analysis was performed using a generalized estimating equation with an autoregressive function to handle repeated observations of an individual patient.

Results
CMD [K+] did not correlate with plasma [K+] (Spearman’s ρ = 0.114, P = 0.109). Higher CMD [K+] was associated with the presence of intracerebral hematoma on admission head computed tomography, CMD lactate/pyruvate ratio >40 and CMD lactate >4 mmol/L (P < 0.05). In vitro retrodialysis data suggest that high CMD [K+] was of brain cellular origin. Higher CMD [K+] was significantly associated with poor 3-month outcome, even after adjusting for age and disease severity (P < 0.01).

Conclusions
The results of this pilot study suggest that brain extracellular [K+] may serve as a biomarker for brain tissue injury in poor-grade aSAH patients. Further studies are needed to elucidate the relevance of brain interstitial K+ levels in the pathophysiology of secondary brain injury after aSAH.
The use of Surgihoney to prevent or eradicate bacterial colonisation in dressing oncology long vascular lines
Authors: Dryden M. , Tawse C. , Adams J. , Howard A. , Saeed K. , Cooke J. 
Published: June 2014

Objective: A pilot evaluation was performed to assess the effects of Surgihoney, an engineered honey with highly active antimicrobial activity, on bacterial colonisation in long lines in oncology patients. Method: This prospective service evaluation was conducted at Hampshire Hospitals NHS Foundation Trust (HHFT) in England, UK, between 2012 and 2013. The study population consisted of oncology patients with central intravenous lines who were receiving outpatient chemotherapy. All patients were offered line dressing with or without Surgihoney, applied to the line exit site. Results: The primary outcome measure of the study was the presence or absence of bacterial colonisation of the line site. There were 30 patients in each arm – with or without Surgihoney. In the Surgihoney arm, 2 patients with existing line site colonisation were cleared of bacterial colonisation and none acquired colonisation during the study period. In the non-treatment arm, 6 patients were colonised at the line site prior to screening or during the evaluation. Bacterial colonisation was maintained throughout the period. Conclusion: Surgihoney is an effective antimicrobial line-site dressing, significantly reducing line site colonisation and eradicating existing colonisation. It was well tolerated by the patients. Declaration of interest: Surgihoney supplies were donated by Healing Honey International (HHI) who also provided some funding to Hampshire Hospitals Foundation Trust for microbiological investigation. MD and JC have provided clinical advice in an advisory capacity to HHI.
Liquid Chromatography High-Resolution TOF Analysis: Investigation of MSE for Broad-Spectrum Drug Screening
Authors: Chindarkar Nandkishor S , Wakefield Michael R , Stone Judith A , Fitzgerald Robert L 
Published: June 2014

Abstract

BACKGROUND
High-resolution mass spectrometry (HRMS) has the potential to supplement other drug screening platforms used in toxicology laboratories. HRMS offers high analytical specificity, which can be further enhanced by incorporating a fragment ion for each analyte. The ability to obtain precursor ions and fragment ions using elevated collision energies (MSE) can help improve the specificity of HRMS methods.

METHODS
We developed a broad-spectrum screening method on an ultraperformance liquid chromatography TOF mass spectrometer (UPLC-TOF-MS) using the MSE mode. A diverse set of patient samples were subjected to a simple dilute, hydrolyze, and shoot protocol and analyzed in a blind manner. Data were processed with 3 sets of criteria with increasing stringency, and the results were compared with the reference laboratory results.

RESULTS
A combination of retention time match (±0.2 min), a protonated analyte, and fragment ion mass accuracy of ±5 ppm produced zero false-positive results. Using these criteria, we confirmed 92% (253/275) of true positives. The positive confirmation rate increased to 98% (270/275) when the requirement for a fragment ion was dropped, but also produced 53 false positives. A total of 136 additional positive drug findings not identified by the reference methods were identified with the UPLC-TOF-MS.

CONCLUSIONS
MSE provides a unique way to incorporate fragment ion information without the need of precursor ion selection. A primary limitation of requiring a fragment ion for positive identification was that certain drug classes required high-energy collisions, which formed many fragment ions of low abundance that were not readily detected.