bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Documentation of Penicillin Allergy Labels Among Pediatric Inpatients
Authors: Hampton Laura L. , DeBoy Jason T. , Gunaratne Aruni , Stallings Amy P. , Bell Tara , Phillips Michael A. , Kamath Sameer S. , Sterrett Emily C. , Nazareth-Pidgeon Kristina M. 
Published: August 2023

BACKGROUND AND OBJECTIVES
Penicillin allergy is the most common medication allergy, and the penicillin allergy label is commonly over-applied without adequate reaction history inquiry or documentation. Because penicillin allergy labels are often applied in childhood and carried into adulthood, we sought to increase the completeness of reaction history documentation from 20% to 70% for pediatric hospital medicine patients and from 20% to 50% for all other pediatric inpatients within 12 months. As a secondary outcome, we also aimed to increase the proportion of delabeling unnecessary penicillin labels to 20% for all pediatric inpatients.

METHODS
To address our aims, our quality improvement initiative included education for pediatric faculty and staff, development and implementation of a clinical pathway for allergy risk stratification, and electronic health record optimizations. Statistical process control charts were used to track the impact of the interventions facilitated by an automated dashboard.

RESULTS
Within 12 months of interventions, the completeness of allergy labels improved from 20% to 64% among patients admitted to the pediatric hospital medicine service and improved from 20% to 45% for all other pediatric inpatients. The frequency of penicillin allergy delabeling remained unchanged; however, 98 patients were risk stratified and 34 received outpatient allergy referrals for further testing. The number of adverse drug reactions to penicillin, a balancing measure, did not change during the study period.

CONCLUSIONS
We increased the completeness of penicillin allergy documentation using a standardized workflow facilitated by a multidisciplinary clinical pathway. With ongoing efforts, more penicillin delabeling in low-risk patients is anticipated.
Quality Improvement to Reduce High-Flow Nasal Cannula Overuse in Children With Bronchiolitis
Authors: Treasure Jennifer D. , Lipshaw Matthew J. , Dean Preston , Paff Zachary , Arnsperger Anita , Meyer Justin , Gillen Matthew , Segev Natalie , Woeste Laura , Mullaney Randi , O’Neill William , Fallon Anne , Gildner Candace , Brady Patrick W. , Statile Angela M. 
Published: August 2023

BACKGROUND
High-flow nasal cannula oxygen therapy (HFNC) is increasingly used to treat bronchiolitis. However, HFNC has not reduced time on supplemental oxygen, length of stay (LOS), or ICU admission. Our objective was to reduce HFNC use in children admitted for bronchiolitis from 41% to 20% over 2 years.

METHODS
Using quality improvement methods, our multidisciplinary team formulated key drivers, including standardization of HFNC use, effective communication, knowledgeable staff, engaged providers and families, data transparency, and high-value care focus. Interventions included: (1) standardized HFNC initiation criteria, (2) staff education, (3) real-time feedback to providers, (4) a script for providers to use with families about expectations during admission, (5) team huddle for patients admitted on HFNC to discuss necessity, and (6) distribution of a bronchiolitis toolkit. We used statistical process control charts to track the percentage of children with bronchiolitis who received HFNC. Data were compared with a comparison institution not actively involved in quality improvement work around HFNC use to ensure improvements were not secondary to the COVID-19 pandemic alone.

RESULTS
Over 10 months of interventions, we saw a decrease in HFNC use for patients admitted with bronchiolitis from 41% to 22%, which was sustained for &gt;12 months. There was no change in HFNC use at the comparison institution. The overall mean LOS for children with bronchiolitis decreased from 60 to 45 hours.

CONCLUSIONS
We successfully reduced HFNC use in children with bronchiolitis, improving delivery of high-value and evidence-based care. This reduction was associated with a 25% decrease in LOS.
Characteristics and Results of Pediatric Medical Device Studies: 2017–2022
Authors: Quazi Sabrina , Narang Claire , Espinoza Juan C. , Bourgeois Florence T. 
Published: August 2023

OBJECTIVES
The development of medical devices for children faces unique challenges that have contributed to a paucity of devices specifically designed and tested for children. Increased knowledge on research activities for pediatric devices can guide optimal study design and ensure timely dissemination of clinical findings.

METHODS
We performed a cross-sectional analysis of interventional studies registered on ClinicalTrials.gov, initiated January 1, 2017, through December 12, 2022, evaluating a Food and Drug Administration–regulated class II or III device, and enrolling any pediatric patients (aged ≤17 years). Data were extracted from ClinicalTrials.gov on study characteristics and from Devices@FDA on device features. For completed studies, we determined whether results were reported in a peer-reviewed publication as of December 27, 2022.

RESULTS
Among 482 studies, 406 (84.2%) examined a class II device and 76 (15.8%) a class III device. The most common device types were diabetes-related devices (N = 57, 11.8%) and monitors and measurement devices (N = 39, 8.1%). Most studies were single-center (N = 326, 67.6%), used a nonrandomized (N = 255, 52.9%), open label (N = 350, 72.6%) design, and were funded by academic institutions (N = 278, 57.7%) or industry (N = 142, 29.5%). A total of 291 (60.4%) studies included a primary outcome of only efficacy without safety endpoints. Among completed studies, more than half (N = 64, 51.6%) enrolled &lt;50 participants and 71.0% (N = 88) &lt;100. After median follow-up of 3.0 years, results were available in publications for 27 (21.8%) completed studies.

CONCLUSIONS
Our findings serve to inform programs and initiatives seeking to increase pediatric-specific device development. In addition to considerations on ensuring rigorous trial design, greater focus is needed on timely dissemination of results generated in pediatric device studies.
Percepción del personal operativo sobre la implementación del Sistema de Gestión de Calidad ISO 9001
Authors: Moncaleano Maquilón Jorge Andrés , Candelo Viáfara Juan Manuel , Rivera Díaz María del Pilar 
Published: August 2023

Objetivo: Analizar la percepción del personal involucrado en los procesos operativos sobre la implementación del Sistema de Gestión de la Calidad ISO 9001 en una empresa de servicios públicos para determinar el impacto que esta genera en el desempeño laboral. Método: Investigación mixta que combinó la recolección y análisis de datos cualitativos y cuantitativos, sustentada en entrevistas y encuestas aplicadas al personal con una antigüedad superior a cinco años en la organización. Resultados: Se encontró que el 100% del personal involucrado en el proceso seleccionado, percibe que la implementación del sistema de gestión de calidad, ha generado efectos positivos en ellos como dinamizadores del proceso, siendo la capacitación y la orientación al cliente, los aspectos con mayor impacto, lo que permite inferir que la implementación de los sistemas de gestión, se relacionan positivamente con el desempeño laboral en las organizaciones. Conclusiones: La percepción del personal operativo con respecto a la implementación de la norma ISO 9001, apoyada en los principios de la gestión de calidad establecidos en ISO 9001, ha generado conciencia sobre el desarrollo adecuado de sus actividades operativas y la orientación al cliente, no obstante, su implementación no es sencilla debido a deficiencia en el liderazgo, la falta de personal capacitado, la baja atención a los riesgos y poco compromiso de la alta dirección para fortalecer el SGC
A Macroscopic and Microscopic Study of Liver in Female Iraqi Green Freshwater Turtle (Chelonia mydas) Linnaeus,1758 during the Active Period
Authors: Al-Alwany Ekhlas Abid Hamza , Al-Khakani Salim Salih Ali , Al-Khamas Ahlam J. H. , Al-Janabi Sabreen M. , Zabiba Isam M J , AL-Khafaji Siraj M. 
Published: August 2023

The study aims to provide anatomical and histological information about the liver in female Iraqi green freshwater turtles. Ten female green freshwater turtles (Chelonia mydas) were collected from Shatt Al-Hilla and used in this study. They were anesthetized by chloroform in closed chambers. The anatomical information was recorded and the histological sections of the liver were stained by using hematoxylin and Eosin stains. The result showed that the liver of a female green freshwater turtle (Chelonia mydas) is a large elongated organ. The mean weight of turtles is 735±0.04 gm, and the mean weight of the liver is 28±0.02 gm. The ratio between the weight of the liver to the weight of the body was 3.809 %. The liver of (Chelonia mydas) is formed from three lobes right, left and middle (central) lobes. The right lobe is the large one with an average weight of 13 ±0.022 gm. It looks like a square and has two surfaces ventral and dorsal (visceral) surface. The left lobe is smaller than the right with an average weight of 9±0.05gm, and its shape is rectangular. The middle lobe is rounded and small. Its mean weight is 7±0.01gm. Histologically, the liver is covered by mesothelium under its connective tissue layer as a hepatic capsule which divided the liver into lobules in the shape of hexagons with portal spaces, from the central to the walls of the hepatocyte.
Physico-Chemical and Bacteriological Qualities of Raw Milk from Collection Centers and Hawking Activity in the Rabat-Salé-Kenitra Region (Morocco)
Authors: Tanjaoui Yousra , Dahani Said , Rachid Khatouf , Hakim Karib 
Published: August 2023

The study aims to analyze the two circuits of the dairy chain: authorized and unauthorized, by studying the parameters influencing the physico-chemical and bacteriological quality of milk in both networks. Samples of raw milk (n=22), collected from nine collection centers (CCL): four authorized and five unauthorized in the region of Kenitra, and four hawking points in the region of Rabat, during a period between March and May 2022, were analyzed to evaluate their physicochemical and bacteriological qualities. The physicochemical quality of the milk included the measurement of chlorides, lactose and fat content, and the determination of titratable acidity and freezing point. The bacteriological quality was assessed by counting the total aerobic mesophilic flora (TAMF), total and fecal coliforms, presumed pathogenic staphylococci and searching for Salmonella. The fat content varies considerably depending on where the milk samples are collected; the average is 4.13% for licensed collection centers, versus 2.94% for unlicensed collection centers and 2.82% for hawking activity. In terms of hygienic quality, the average bacterial load of TAMF in milk from the authorized collection centers is 3.8×108 CFU/ml. Total coliforms (TC) are present with an average rate of 9.37 ×105 CFU/ml with an average portion of 7.87 ×103 CFU/ml in fecal coliforms (FC), and 1.03 ×106 CFU/ml for presumed pathogenic staphylococci. On the other hand, milk samples from unauthorized collection centers and hawking activity showed higher levels of microbial contamination than those from licensed collection centers. Salmonella was not detected in any of the samples analyzed. The non-compliance with hygiene practices and the late application of cold during the milking, the collection, and the transportation of raw milk, partly explain the origin of this finding.
Outcomes of endoscopic guided adenoidectomy versus conventional adenoidectomy
Authors: Rinshin T  , Bhandary Rukma 
Published: August 2023

: Adenoidectomy is one of the most common surgical procedures performed on children. Conventional curettage adenoidectomy is a low-cost procedure that is still widely practised, particularly in developing nations. To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider. Consecutive cases for Conventional Adenoidectomy (Group I) and Endoscopic Assisted Adenoidectomy (Group II) were taken from cases undergoing adenoidectomy, with each group consisting of 20 patients. The operating time and postoperative pain score were measured and compared between the two groups. Patients were evaluated at the first and sixth weeks to measure subjective improvement of symptoms , DNE was performed to evaluate remaining adenoid tissue and scarring of adjacent structures. The total operating time in groups I and II was 13 minutes (range: 10-15 minutes) and 21 minutes (range: 15-25 minutes), respectively. In 12 cases, remnent adenoid tissue ranged from 25 to 50%. Ten of them received conventional adenoidectomy. Group I experienced significantly higher postoperative pain than group II. Endoscopic adenoidectomy is a safe and effective alternative to conventional curettage. It favours consistent restoration of nasopharyngeal patency, improved haemostasis, and reduced postoperative pain.
Impacted ear drop dispenser cap: A rare cause of recurrent otitis externa
Authors: Jangra Parmod , Gulia Joginder Singh , Saini Nishant 
Published: August 2023

: To report a case of an elderly male with aural foreign body presenting as recurrent otitis externa and to highlight the fact that aural foreign bodies may be an underlying cause in such recurrent cases.: Case report: Aural foreign body with recurrent otitis externa.: Tertiary care center.: Surgical removal of foreign body. : The granulations and recurrent otitis externa resolved after removal of foreign body.: Suspicion of an aural foreign body should be maintained in a child or even adult presenting with recurrent otitis externa.
Performance of Spouted bed on drying of Foliar fertilizer: Analysis of yield and powder retention
Authors: Stoppe Ana Carolina Ribeiro , Luz Mário Sérgio da , Vieira Neto José Luiz , Santos Kassia Graciele dos 
Published: August 2023

Foliar fertilization is one of the most important management techniques used to improve crop productivity and quality. To increase the efficiency of fertilization, the fertilizer must be highly soluble. The drying of paste and solutions in spouted bed can change the powder structure, making it more soluble. However, depending on the operational conditions, the powder yield produced in this operation may be low. As such, the goal of this research was to investigate the impact of operational conditions on powder yield and powder losses caused by adhesion on the walls of the bed and cyclone, on the particle surface, on the exhaust tube, filter, and filter overflow. To accomplish this, a 23 factorial design was used. The results of powder yield (between 2.3 and 26.6%.) were like those obtained in other spouted bed applications, but lower when compared to spray-dryer. The higher powder retention occurred on the surface of the inert particles and at the bed wall. A high level of instability was observed during spouting, which may have increased the powder adherence at the equipment's walls. The powder obtained after drying was solubilized about 5.9 times fast than the original fertilizer, demonstrating that the technique is promising if the bed stability is maintained.
The Myth of the 50-Minute Epiphany: #MeToo and Implications for Teaching
Authors: Russell Emily , Kline Nolan , McClure Amy , Schoen Steven , Chick Nancy 
Published: August 2023

Because university campuses are microcosms of broader political and social climates, the increasingly polarized climates outside universities can permeate the classroom, challenging faculty who teach topics characterized by controversy and discomfort. We conducted a lesson study project at a college in the southeastern United States in three first-year courses from different disciplines to examine how the broader tensions of the #MeToo movement emerged and affected a class activity focused on gender. We sought to understand our students’ responses to a moment of discomfort generated by discussions of sexual roles, consent, and assault—issues that are relevant in both this cultural moment and in the lives of many first-year college students. We observed responses ranging from affirmation to resistance in what felt at times like our own failure. Without this collaboration, each of us may have been left with a narrower view of what the students learned and an incomplete sense of our own work. What began as an investigation into students’ transformative learning experiences ended as a transformative experience in our own understanding of the acts of teaching and the complexities of student learning.
Nurses' experiences of critical care in the COVID-19 Intensive nursing unit
Authors: Mirjalili Alirez , Mirzaei Samaneh , Nasiriani Khadijeh 
Published: August 2023

Background: The intensive care unit is one of the essential and vital departments of hospitals that accommodate patients in critical condition. Intensive care nurses play an important role in the evaluation, treatment, and management of these patients. The outbreak of the COVID-19 (Coronavirus disease ) pandemic, followed by severe respiratory involvement, highlighted the importance of nurses' performance in the intensive care unit. The aim of this study was to explain the nurses' experiences of nursing care in the COVID-19 intensive care unit.Methods: This study was qualitative content analysis. Participants were 12 nurses who were selected based on purposive sampling. Data collected by semi and unstructured interview. Data analysis was performed based on Graneheim and Lundman (2004) at three-phase. Research trustworthiness was confirmed by four criteria of credibility, transferability, dependability, and conformability.Results: In this study, a total of 1311 meaning units were extracted; after condensation and abstraction, 257 codes were obtained, which were extracted into 32 primary subcategories, eight secondary subcategories, and two themes. The first theme was nursing care inhibitors in the COVID-19 (Coronavirus disease) Intensive Care Unit included five categories: "Problems with personal protective equipment, lack of care supplies, Insufficient preparation of intensive care nurses, burnout of nurses, and care burden." The second theme was the strengths of nursing care in the intensive care unit in the COVID-19 included three categories: "Acquiring new knowledge and experience of intensive care, upgrading and developing the intensive care system and improving the image of nursing in the community."Conclusion: The COVID-19 pandemic was associated with challenges and problems for nursing and nursing care, the identification of which can help prepare for future crises. Also, due to its positive achievements for nursing, it can be used to improve the position of nursing and its care.
The Influence of Aerobic and Ergonomic Combination Gymnastics in Blood Pressure in Adult Age Patients
Authors: Agitiyo Fadli Maulana , Bakar Abu , Hidayati Laily 
Published: August 2023

Introduction: Hypertension is a disease characterized by increased blood pressure in the body. One of the non-pharmacological management of hypertension is to do a combination of aerobic and ergonomic exercises to optimize the heart and blood vessels. This study describes the effect of a combination of aerobic and ergonomic gymnastics on blood pressure in adult sufferers in Kepuh Village, Palimanan District, Cirebon.

Methods: The research design used in this study was a pre-experimental design with a pretest–posttest one-group design and using a probability sampling technique with a purposive sampling type of 25 respondents which included patients aged 25-45 years who suffered from hypertension. This study used observation sheets and blood pressure measurements using a sphygmomanometer, and data analysis using the Wilcoxon test with a significance value of 5% (0.05).

Results: Research results in the Wilcoxon test for the pre and post-systolic blood pressure showed a value of p = 0.000, while for pre and post-diastolic blood pressure the value was p = 0.001 which indicates that there is an effect of combined aerobic and ergonomic exercise on blood pressure in adult patients in Kepuh Village, Palimanan District, Cirebon Regency.

Conclusion: The combination of aerobic and ergonomic exercise has an effect on systolic and diastolic blood pressure in adult hypertensive patients in Kepuh Village, Cirebon. Therefore, a combination of aerobic and ergonomic exercise can be an alternative to regulating blood pressure in adult hypertensive patients.
Shoulder and neck pain in swimmers: front crawl stroke analysis, correlation with the symptomatology in 61 masters athletes and short literature review.
Authors: Rinonapoli Giuseppe , Ceccarini Paolo , Manfreda Francesco , Talesa Giuseppe Rocco , Simonetti Simonetta , Caraffa Auro 
Published: August 2023

Background: Swimming and, specifically, front crawl, can be included among the &quot;overhead&quot; sports. Overhead sports are a risk factor for some problems of the musculoskeletal system, especially the shoulder. The aim of the study was assessing the incidence of shoulder and neck pain in a Masters Swimming Team and its correlation with the crawl stroke.
Methods: It is an observational study through video-analysis of the stroke and a questionnaire. The participants are 61 athletes of a Master team, whose prevailing training stroke was the front crawl were selected for the present study. Their stroke was analyzed during training by a go-pro camera mounted on a sliding trolley on a track, evaluating with their trainer their technical defects. A questionnaire about frequency of shoulder and neck pain during the last five years was administered to all the participants at the study.
Results: From the questionnaire, 45 and 55 out of 61 athletes had suffered from shoulder pain and cervical pain, respectively. Both types of pain were correlated with the weekly swimming volume. The swimmers with hyperflexion of the wrist and prolonged internal rotation in the pulling phase had shoulder problems. Those who suffered from current shoulder pain reduced the underwater time. The four swimmers with an excessive body roll during breathing and those who kept their heads extended, reported cervical pain.
Conclusions: Shoulder and neck pain could be prevented with the correction of specific technical errors in crawl stroke.