bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foreign language production and avoidance in US university Spanish‐language education
Authors: Hubert Michael D. 
Published: July 2011

Uno de los componentes principales de la gran mayoría de los cursos de lengua extranjera (LE) ofrecidos en las universidades estadounidenses es un enfoque explícito en la gramática de la lengua, y muchos de estos cursos enseñan un gran número de conceptos gramaticales durante el progreso del semestre universitario. Sin embargo, puede ser que los estudiantes de la LE no estén utilizando toda esta gramática nueva para cumplir con las metas comunicativas centrales de las tareas de sus cursos de español. Para investigar esta cuestión, se recolectaron muestras de habla y de escritura de 32 estudiantes universitarios que estudiaban el español en cada uno de los cuatro niveles de instrucción universitaria. Estas muestras se analizaron en términos de uso de gramática, de exactitud, y de complejidad. Los resultados indicaron que estos estudiantes están utilizando muy pocos de los conceptos gramaticales presentados en sus cursos universitarios de lengua española.Although the communicative language teaching (CLT) approach continues to enjoy the status of dominant orthodoxy in second language teaching, CLT is not without its drawbacks. As learners are encouraged to communicate in the target language despite a lack of necessary linguistic resources, they engage in a large amount of linguistic avoidance in order to meet their communicative goals. In order to describe how grammar is being employed in US university course assignments, speaking and writing samples were collected from 32 US university students studying Spanish at all four major levels of instruction. Samples were analyzed in terms of grammar usage and accuracy. Results indicate that these learners are using almost none of the more difficult grammatical structures presented to them in their Spanish‐language university courses.
Variation in Hospital Costs, Payments, and Profitabilty for Cardiac Valve Replacement Surgery
Authors: Robinson James C. 
Published: July 2011

Objective. Examine the variation for Medicare and privately insured patients in hospital costs, payments, and contribution margins and their association with characteristics of the patients, hospitals, and hospital markets.
Data Sources. Administrative records for 1,858 patients undergoing cardiac valve replacement surgery were obtained from 37 hospitals in 7 states for 2008.
Study Design. Bivariate and multivariate statistical analyses of costs, payments, and profitability (contribution margin) for Medicare and privately insured patients, adjusting for patient, hospital, and market characteristics.
Data Collection. Integrated Health Care Association, Aspen Health Metrics, American Hospital Association Annual Survey of Hospitals.
Principal Findings. Cardiac valve replacement surgery is an expensive but profitable procedure, with average cost and contribution margin per case of U.S.$38,667 and U.S.$21,967, respectively. Average costs per case for Medicare patients are 16.1 percent higher in concentrated than in competitive local markets after adjusting for patient comorbidities, complications, and other relevant factors (p<.01). Payments per case were 33.2 percent (p<.01) lower from Medicare than from private insurers. The average contribution margin earned by hospitals from Medicare was U.S.$30,986 lower than the margin earned from private insurers (p<.01), after adjusting for patient, hospital, and market characteristics.
Conclusions. Hospitals charge significantly higher prices and earn significantly higher contribution margins from private insurers than from Medicare for patients undergoing cardiac valve replacement.
International Comparability of Patient Safety Indicators in 15 OECD Member Countries: A Methodological Approach of Adjustment by Secondary Diagnoses
Authors: Drösler Saskia E. , Romano Patrick S. , Tancredi Daniel J. , Klazinga Niek S. 
Published: July 2011

Objective. To improve the international comparability of patient safety indicators based on administrative hospital data, adjustment of country‐specific rates by a proxy measure of diagnostic coding intensity was tested.
Data Sources. Secondary data (numerator and denominator counts of patient safety indicators) based on adults discharged from acute care hospitals between 2006 and 2008 was used.
Study Design. A retrospective cross‐sectional study using hospital administrative data was performed.
Data Collection. Belgium, Canada, Denmark, Germany, Italy, Ireland, New Zealand, Norway, Portugal, Singapore, Spain, Sweden, Switzerland, the United Kingdom, and the United States provided data according to detailed instructions.
Principal Findings. Age‐ and sex‐standardized rates varied across countries. An ordinary least squares regression model was estimated for each Patient Safety Indicator (PSI) using the mean number of secondary diagnoses among denominator cases as the predictor (R2=23 percent to 56 percent). Estimated country‐specific residuals were linearly transformed into adjusted PSI rates. Variation among age–sex standardized PSI rates decreased substantially after this adjustment.
Conclusions. International comparisons of health system performance based on unadjusted patient safety indicators are problematic due to suspected coding or ascertainment bias. The model could be an interim approach to provide comparable information on hospital quality, with a long‐term goal of improving international consistency in diagnostic reporting in administrative data.
Association of Experiences of Medical Home Quality with Health‐Related Quality of Life and School Engagement among Latino Children in Low‐Income Families
Authors: Stevens Gregory D. , Vane Christina , Cousineau Michael R. 
Published: July 2011

Objective. This study examines whether patient‐reported indicators of a quality medical home are associated with measures of health among Latino children in low‐income families.
Data Sources. Data on 3,258 children ages 2–18 years are from a cross‐sectional survey of parents of children affiliated with California's Healthy Kids insurance.
Study Design. Medical home quality was assessed using the Parents' Perception of Primary Care and was associated with health‐related quality of life (HRQOL) overall and in four domains (physical, emotional, social, and school/daycare) and four measures of school engagement.
Principal Findings. A higher total medical home score was associated with a higher total Pediatric Quality of Life Inventory score and scores in four subdomains (total beta [B]=1.77, physical B=1.71, social B=1.36, emotional B=2.22, and school/daycare B=1.69, all p<0.001). It was also associated with missing fewer than three school days due to illness (odds ratio [OR]=1.12, 95 percent confidence intervals [CI]: 1.05, 1.19), excellent/above average school performance overall (OR=1.10, 95 percent CI: 1.03, 1.17) and performance in reading (OR=1.13, 95 percent CI: 1.06, 1.20) and math (OR=1.10, 95 percent CI: 1.03, 1.16).
Conclusions. Patient‐reported medical home quality indicators are favorably associated with HRQOL and measures of school engagement among Latino children in low‐income families.
A novel allocation strategy for blood transfusions: investigating the tradeoff between the age and availability of transfused blood
Authors: Atkinson Michael P. , Fontaine Magali J. , Goodnough Lawrence T. , Wein Lawrence M. 
Published: July 2011

BACKGROUND: Recent studies show that transfusing older blood may lead to increased mortality. This raises the issue of whether transfusing fresher blood can be achieved without jeopardizing blood availability.STUDY DESIGN AND METHODS: We propose a simple family of policies that is defined by a single threshold: rather than transfusing the oldest available blood that is younger than 42 days, we transfuse the oldest blood that is younger than the threshold, and if there is no blood younger than the threshold then we transfuse the youngest blood that is older than the threshold. To assess this policy, we build a simulation model using data from Stanford University Medical Center. We focus on the tradeoff between the mean age of transfused blood and the fraction of transfused blood that is imported.RESULTS: For hospitals in which the local supply is greater than demand, our policy with a threshold of 14 days leads to a decrease of 10 to 20 days in the mean age of transfused blood while increasing the fraction of imported blood to less than 0.005 (i.e., 0.5%). If the health benefits from transfusing fresher blood can be confirmed by randomized clinical trials, then conservative assumptions suggest that this policy could reduce the annual number of transfused patients who die within 1 year by 20,000.CONCLUSION: The proposed allocation policy with a threshold of 14 days could allow many US hospitals to significantly reduce the age of transfused blood, thereby possibly reducing morbidity and mortality, while having a negligible impact on supply chain operations.
Home therapy with intravenous human C1‐inhibitor in children and adolescents with hereditary angioedema
Authors: Kreuz Wolfhart , Rusicke Eva , Martinez‐Saguer Inmaculada , Aygören‐Pürsün Emel , Heller Christine , Klingebiel Thomas 
Published: July 2011

BACKGROUND: C1‐esterase inhibitor (C1‐INH) replacement therapy is the treatment of choice for acute edema attacks in patients with hereditary angioedema (HAE).STUDY DESIGN AND METHODS: Our retrospective, observational study assessed the efficacy and safety of home therapy with a human plasma‐derived C1‐INH concentrate (pC1‐INH) in 20 pediatric patients with HAE who had previously been treated with physician‐based therapy. While on home therapy, 15 patients received on‐demand treatment and five received individual replacement treatment (IRT).RESULTS: The switch to home therapy did not involve a significant increase in the dose of pC1‐INH administered, but there was a significant increase in dosing frequency. Although only two patients were affected, the frequency of laryngeal attacks appeared to decrease on home therapy. All attacks, including laryngeal edema, were treated successfully during home therapy with pC1‐INH. The mean annual number of days hospitalized was reduced from 3.8 during physician‐based therapy to 0.11 during home therapy. No side effects or injection site complications were reported. The median time from onset of attack to administration of pC1‐INH was reduced from 67.5 minutes during physician‐based therapy to 15 minutes after switching to home therapy. The corresponding median time to initial symptom relief for all types of attack was reduced from 60 to 40 minutes.CONCLUSION: As in adults, home therapy with pC1‐INH is effective and safe in the treatment of HAE attacks in pediatric patients; a larger, randomized study should ideally confirm our findings before this approach can be considered the standard of care for pediatric patients.
Coxiella burnetii infection among blood donors during the 2009 Q‐fever outbreak in the Netherlands
Authors: Hogema Boris M. , Slot Ed , Molier Michel , Schneeberger Peter M. , Hermans Mirjam H. , van Hannen Erik J. , van der Hoek Wim , Cuijpers H. Theo , Zaaijer Hans L. 
Published: July 2011

BACKGROUND: In 2007, 2008, and 2009 outbreaks of Q‐fever occurred in the Netherlands with increasing magnitude. The 2009 outbreak with 2354 reported cases is the largest human Q‐fever outbreak ever recorded. To assess the extent of infection and the safety of donated blood, we tested local blood donations for presence of Coxiella burnetii antibodies and DNA.STUDY DESIGN AND METHODS: Starting May 2009, more than 40,000 serum samples were collected from all consenting blood donors in the areas with high Q‐fever incidence. The 1004 samples from the areas with the highest number of reported cases were tested for C. burnetii DNA by polymerase chain reaction; seroprevalence and incidence were determined using enzyme‐linked immunosorbent assay and immunofluorescence assays (IFAs) in the subset of 543 donors of whom a follow‐up sample was available.RESULTS: A total of 6 of 1004 donor samples tested reactive for C. burnetii DNA. Confirmatory testing (IFA) on the index and follow‐up samples demonstrated seroconversion in two donors, high‐level preexisting antibodies in one donor, and no seroconversion in three donors. Immunoglobulin (Ig)G testing of the 543 serum pairs showed that 66 were reactive in the latest sample, of which 10 represented seroconversions.CONCLUSION: In the area with highest incidence during a large Q‐fever outbreak, 3 of 1004 blood donations contained C. burnetii DNA (0.3%; 95% confidence interval, 0.1%‐1.0%). A total of 66 of 543 (12.2%) donors tested positive for anti‐Coxiella IgG. Ten seroconversions were detected, resulting in an incidence of 5.7% per year, which is more than 10‐fold higher than the local number of reported clinical cases (0.47% per year).[Correction added after online publication 14‐Jul‐11: high‐level existing antibodies has been updated to highlevel preexisting antibodies.]
Enhanced Sensitivity and Reduced Noise Floor in Magnetoelectric Laminate Sensors by an Improved Lamination Process
Authors: Li Menghui , Berry David , Das Jaydip , Gray David , Li Jiefang , Viehland Dwight 
Published: July 2011

The effect of lamination process on the performance of Metglas/Pb(Zr,Ti)O3‐based composite magnetoelectric (ME) sensors has been studied. Improved sensor processing can lead to higher coupling between the magnetostrictive and piezoelectric phases. A higher coupling factor results in higher magnetic field sensitivity and lower equivalent magnetic noise floors. Spin‐coat/vacuum‐bag application and cure of interfacial epoxy, in addition to the use of Metglas foils with enhanced magnetostriction (λ = 42 ppm), has led to an increase in the ME coefficient from 6 to 21.6 V/cm·Oe, and a decrease in the 1 Hz equivalent magnetic noise from 2 × 10−10 to 4 × 10−11 T/√Hz.
Fast Sol–Gel Preparation of Silicon Carbide–Silicon Oxycarbide Nanocomposites
Authors: Clark Michael D. , Walker Luke S. , Hadjiev Viktor G. , Khabashesku Valery , Corral Erica L. , Krishnamoorti Ramanan 
Published: July 2011

Silicon carbide nanofiber dispersion within a silicon oxycarbide glassy ceramic was achieved through a combination of a fast sol–gel procedure for in situ ceramic matrix synthesis and nanofiber conversion from sacrificial multiwalled carbon nanotube templates. Nanotubes were dispersed using both surfactant adsorption and a covalent sidewall modification scheme with gel‐grafting capabilities. The combination of high temperature processing and silicon monoxide precursor concentrations allowed substantial carbothermal reduction of the nanotube templates, yielding silicon carbide nanofibers. The resulting nanocomposites were examined for density, Vickers microhardness, Young's modulus, and fracture toughness. The surfactant‐assisted route inhibited ceramic densification, offering virtually no mechanical property enhancement. In contrast, the covalently functionalized nanotube templates at 0.8 wt% loading enhanced tensile modulus of 77% while simultaneously maintaining both Vickers microhardness and fracture toughness. These results indicate strong interfacial adhesion between the nanofiber surface and host matrix despite the abrupt chemical changes experienced during the high temperature processing.
Normal to Relaxor Ferroelectric Transition and Domain Morphology Evolution in (K,Na)(Nb,Sb)O3–LiTaO3–BaZrO3 Lead‐Free Ceramics
Authors: Zuo Ruzhong , Fu Jian , Lu Shengbo , Xu Zhengkui 
Published: July 2011

A normal to relaxor ferroelectric transition was induced by the substitution of BaZrO3 for LiTaO3 in a typical lead‐free (K,Na)(Nb,Sb)O3–LiTaO3–BaZrO3 system and this was found to accompany a tetragonal to rhombohedral phase structural transformation. The typical relaxor behavior characterized by diffuse phase transition and frequency dispersion was identified by the measurement of frequency‐dependent dielectric permittivity. The transmission electron microscopy studies demonstrated that the above phenomenon would be closely related to the domain morphology evolution from normal micron‐sized lamellar domains, to tweed‐like domains and finally to polar nanodomains. Selected area and convergent beam electron diffraction patterns further confirmed that the composition (2.5 mol% BaZrO3) exhibited rhombohedral and tetragonal phase coexistence. The evolution of domain morphology with temperature also disclosed the diffuseness of ferroelectric phase transition.
Radiological Imaging of Patients With Suspected Urinary Tract Stones: National Trends, Diagnoses, and Predictors
Authors: Westphalen Antonio C. , Hsia Renee Y. , Maselli Judith H. , Wang Ralph , Gonzales Ralph 
Published: July 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:700–707 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  Overutilization of computed tomography (CT) is a growing public health concern due to increasing health care costs and exposure to radiation; these must be weighed against the potential benefits of CT for improving diagnoses and treatment plans. The objective of this study was to determine the national trends of CT and ultrasound (US) utilization for assessment of suspected urolithiasis in emergency departments (EDs) and if these trends are accompanied by changes in diagnosis rates for urolithiasis or other significant disorders and hospitalization rates.Methods:  This was a retrospective cross‐sectional analysis of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 1996 and 2007. The authors determined the proportion of patient visits for flank or kidney pain receiving CT or US testing and calculated the diagnosis and hospitalization rates for urolithiasis and other significant disorders. Patient‐specific and hospital‐level variables associated with the use of CT were examined.Results:  Utilization of CT to assess patients with suspected urolithiasis increased from 4.0% to 42.5% over the study period (p < 0.001). In contrast, the use of US remained low, at about 5%, until it decreased beginning in 2005 to 2007 to 2.4% (p = 0.01). The proportion of patients diagnosed with urolithiasis (approximately 18%, p = 0.55), with other significant diagnoses (p > 0.05), and admitted to the hospital (approximately 11%, p = 0.49) did not change significantly. The following characteristics were associated with a higher likelihood of receiving a CT scan: male sex (odd ratio [OR] = 1.83, 95% confidence interval [CI] = 1.22 to 2.77), patients presenting with severe pain (OR = 2.96, 95% CI = 1.14 to 7.65), and those triaged in 15 minutes or less (OR = 2.41, 95% CI = 1.08 to 5.37). CT utilization was lower for patients presenting to rural hospitals (vs. urban areas; OR = 0.34, 95% CI = 0.19 to 0.61) and those managed by a nonphysician health care provider (OR = 0.19, 95% CI = 0.07 to 0.53).Conclusions:  From 1996 to 2007, there was a 10‐fold increase in the utilization of CT scan for patients with suspected kidney stone without an associated change in the proportion of diagnosis of kidney stone, diagnosis of significant alternate diagnoses, or admission to the hospital.
Nebulized Budesonide Added to Standard Pediatric Emergency Department Treatment of Acute Asthma: A Randomized, Double‐blind Trial
Authors: Upham Bryan D. , Mollen Cynthia J. , Scarfone Richard J. , Seiden Jeffrey , Chew Amber , Zorc Joseph J. 
Published: July 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:665–673 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The goal was to determine if adding inhaled budesonide to standard asthma therapy improves outcomes of pediatric patients presenting to the emergency department (ED) with acute asthma.Methods:  The authors conducted a randomized, double‐blind, placebo‐controlled trial in a tertiary care, urban pediatric ED. Patients 2 to 18 years of age with moderate to severe acute asthma were randomized to receive either a single 2‐mg dose of budesonide inhalation suspension (BUD) or normal sterile saline (NSS) placebo, added to albuterol, ipratropium bromide (IB), and systemic corticosteroids (SCS). The primary outcome was the difference in median asthma scores between treatment groups at 2 hours. Secondary outcomes included differences in vital signs and hospitalization rates.Results:  A total of 180 patients were enrolled. Treatment groups had similar baseline demographics, asthma scores, and vital signs. A total of 169 patients (88 BUD, 81 NSS) were assessed for the primary outcome. No significant difference was found between groups in the change in median asthma score at 2 hours (BUD –3, NSS –3, p = 0.64). Vital signs at 2 hours were also similar between groups. Fifty‐six children (62%) were admitted to the hospital in the BUD group and 55 (62%) in the NSS group (difference 0%, 95% confidence interval [CI] = –14% to 14%). Neither multivariate adjustment nor planned subgroup analysis by inhaled corticosteroids (ICS) use prior to the ED significantly altered the results.Conclusions:  For children 2 to 18 years of age treated in the ED for acute asthma, a single 2‐mg dose of budesonide added to standard therapy did not improve asthma severity scores or other short‐term ED‐based outcomes.
Paramedic Laryngoscopy in the Simulated Difficult Airway: Comparison of the Venner A.P. Advance and GlideScope Ranger Video Laryngoscopes
Authors: Butchart Angus G. , Tjen Christine , Garg Atul , Young Peter 
Published: July 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:692–698 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  This study assesses intubation times and potential trauma with two new portable video laryngoscopes, the GlideScope Ranger (GSR) and the Venner A.P. Advance (APA), in a simulated difficult prehospital airway. The GSR has a hockey stick shape and is inserted by a different (midline) technique compared with direct laryngoscopy and requires the use of a stylet. The APA has a handle similar to a direct laryngoscope, but with an angulated difficult airway blade. The APA is designed to have an intuitive insertion technique somewhat similar to that of direct laryngoscopy (lateral tongue displacement) and has a guiding mechanism that foregoes the need for a stylet.Methods:  Thirty qualified paramedics received a short demonstration of each device and were asked to intubate a modified Grade III difficult laryngoscopy mannequin in a random order (closed envelope technique). Optimal view and tracheal intubation times were recorded, and potential trauma assessed by the number of additional discrete forward advances and by visual analog scale (VAS). Direct laryngoscopy was used as a comparator. The Wilcoxon rank sum test was used for intubation times, optimal view times, percentage of glottis opening (POGO) seen, and objective trauma assessment. Student’s paired t‐test was used for subjective trauma assessment and a Bonferroni correction was used for the primary outcome measures.Results:  Participants declared a median of 60 (range 20 to 300) previous intubations. Time to achieve optimal view between APA and GSR was not different (20 seconds vs. 19 seconds; p = 0.19), but tracheal intubation was significantly faster with the APA (25 seconds vs. 46 seconds; p < 0.0001). Intubation success was ultimately 97% in both groups. Participants judged subjective trauma to be less for the APA than GSR on a VAS (1.6 cm vs. 3.3 cm; p < 0.001). More than three additional forward advances were required in 43% of GSR and 0% of APA intubations.Conclusions:  Following a brief demonstration to paramedics naïve to video laryngoscopy, the APA demonstrated earlier intubation, fewer additional discrete forward advances of the tube, and less participant‐judged subjective trauma when compared to the GSR in this simulation model.