Miracle-dz/UniFAR-FTUs huggingface dataset:
Improving trauma tertiary survey performance and missed injury identification using an education-based quality improvement initiative

BACKGROUND Performance of a trauma tertiary survey (TTS) reduces rates of missed injuries, but performance has been inconsistent at trauma centers. The objectives of this study were to assess whether quality improvement (QI) efforts would increase the frequency of TTS documentation and determine if TTS documentation would increase identification of traumatic injuries. Our hypothesis was that QI efforts would improve documentation of the TTS. METHODS Before-and-after analysis of QI interventions at a level 1 trauma center was performed. The interventions included an electronic template for TTS documentation, customized educational sessions, and emphasis from trauma leadership on TTS performance. The primary outcome was documentation of the TTS. Detection of additional injuries based on tertiary evaluation was a secondary outcome. Associations between outcomes and categorical patient and encounter characteristics were assessed using χ2 tests. RESULTS Overall, 592 trauma encounters were reviewed (296 preimplementation and 296 postimplementation). Trauma tertiary survey documentation was significantly higher after implementation of the interventions (30.1% preimplementation vs. 85.1% postimplementation, p < 0.001). Preimplementation documentation of the TTS was less likely earlier in the academic year (14.3% first academic quarter vs. 46.5% last academic quarter, p < 0.001), but this temporal pattern was no longer evident postimplementation (88.5% first academic quarter vs. 77.9% last academic quarter, p = 0.126). Patients were more likely to have a missed traumatic injury diagnosed on TTS postimplementation (1.7% in preimplementation vs. 5.7% postimplementation, p = 0.009). CONCLUSION Documentation of the TTS and missed injury detection rates were significantly increased following implementation of a bundle of QI interventions. The association between time of year and documentation of the TTS was also attenuated, likely through reduction of the resident learning curve. Targeted efforts to improve TTS performance may improve outcomes for trauma patients at teaching hospitals. LEVEL OF EVIDENCE Care management, Level IV.
Patterns of diabetes management in South Africa: baseline and 24-month data from the South African cohort of the DISCOVER study

Objectives: To describe disease management patterns and associated outcomes in patients with type 2 diabetes initiating a second-line glucose-lowering therapy in routine clinical practice in South Africa. Design: Non-interventional observational study. Setting: General and specialist private practices. Subjects Patients with diabetes initiating second-line glucose-lowering therapy. Outcome measures: Variables collected at baseline and at 6-, 12- and 24-month follow-up visits included sociodemographics, first- and second-line glucose-lowering treatments and other medications, reasons for change in diabetes therapy, HbA1c target set by the attending clinician at the time of change, comorbidities and health-related quality of life (HRQoL). Results: Baseline data were collected for 519 patients (69% female). Mean age was 54.6 years and mean time since initial diagnosis was 7.5 years. Mean HbA1c at baseline was 9.0% and the most common second-line treatment approach was to combine metformin with a sulphonylurea. Median HbA1c and median fasting glucose measurements were marginally lower at 24 months than at baseline (8.0% vs. 8.4%, and 8.5 mmol/l vs. 8.8 mmol/l, respectively). Only approximately 5% of patients had had their diabetes medication changed at any time after the baseline visit. Conclusions: Management of type 2 diabetes mellitus in private practice in South Africa is suboptimal.
SCHOOL LEADERSHIP, INSPECTION AND VISIBILITY: PANOPTICISM AND POST-PANOPTICISM IN AN ENGLISH COASTAL AREA OF DEPRIVATION

ABSTRACT This paper contributes to recent debates pertaining to neoliberal technologies of performativity including fabrication, panopticism and post-panopticism. These terms are discussed here in relation to constant visibility from recent school inspection arrangements in England and the impact of this on school leadership. Case study research within one seaside town was drawn from two schools, one, a state primary school and the other, a state secondary school, located within an area of deprivation. Both schools had been judged as requires improvement by Ofsted, but immediately before the fieldwork commenced, the secondary school received a judgment of good. Fourteen semi-structured interviews with thirteen leaders in a range of roles were undertaken to examine the conditions created by school inspection. Data is considered in relation to the features of panopticism and post-panopticism and shows leaders experience constant visibility, the pressures of performing to shifting expectations, and resultant staffing instability. This is not conducive to leaders working to improve schools, particularly those serving areas of deprivation.
Prevalence and determinants of secondary posttraumatic growth following trauma work among medical personnel: a cross sectional study

ABSTRACT Background: People helping trauma victims as a part of their work may experience positive results, known as Secondary Posttraumatic Growth (SPTG). Aim: The present study aimed to determine the prevalence and determinants of SPTG among medical personnel, considering occupational load, job satisfaction, social support, and cognitive processing of trauma, understood as cognitive coping strategies. Methods: Subjects comprised 419 representatives of the medical profession, including paramedics and nurses. The age of the subjects varied from 19 to 65 (M = 39.60; SD = 11.03). Four standard measurement tools were utilized: the Secondary Posttraumatic Growth Inventory, the Job Satisfaction Scale, the Social Support Scale, which measured four support sources, and the Cognitive Processing of Trauma Scale to assess five cognitive coping strategies. Pearson’s correlation coefficients were applied to analyse the connections between the variables. A linear stepwise regression analysis was used to identify the determinants of SPTG. Pearson’s correlation coefficients with confidence intervals were applied to analyse the connections between the variables. Results: As many as 40% of participants experienced high levels of growth, with only 27.4% indicating a low level. The obtained results showed positive links between job satisfaction, all social support dimensions (from supervisors, co-workers, family, friends), all cognitive coping strategies (positive cognitive restructuring, downward comparison, resolution/acceptance, denial, regret), and SPTG. No significant connection between workload and SPTG total was discovered. The primary determinant of SPTG in the examined group of medical personnel is the cognitive processing of trauma, chiefly the strategy of positive cognitive restructuring. Conclusions: Paramedics and nurses, despite their exposure to secondary trauma, experience positive posttraumatic consequences of the profession that entails helping the injured parties. It is advisable to encourage the medical personnel to apply positive coping strategies, find satisfaction in their work, and benefit from social support to promote posttraumatic growth. HIGHLIGHTS Paramedics and nurses experience the positive aspects of the occupation that involves helping the injured; as many as 40% of those surveyed experienced high levels of growth. SPTG correlates with job satisfaction, social support and cognitive coping strategies. The main factor conditioning the occurrence of SPTG proved to be cognitive processing of trauma in the form of positive cognitive restructuring strategy. The results obtained confirm an assumption which indicates the importance of cognitive activity undertaken by an individual when faced with trauma.
Synthesis and Characterization of Zinc Oxide and Iron Oxide Nanoparticles Using Sesbania grandiflora Leaf Extract as Reducing Agent

The objectives of this present study are to synthesize iron oxide and zinc oxide nanoparticles from different concentrations of Sesbania grandiflora leaf extract (5–20%) using zinc nitrate and ferrous chloride as precursor materials and synthesized nanoparticles were characterized using UV-visible spectrometer, FTIR, X-ray diffraction, and SEM. The results showed that synthesized zinc oxide and iron oxide nanoparticles exhibited UV-visible absorption peaks at 235 nm and 220 nm, respectively, which indicated that both nanoparticles were photosensitive and the XRD study confirmed that both nanoparticles were crystalline in nature. In addition, FTIR was also used to analyze the various functional groups present in the synthesized nanoparticles. The SEM results reveal that zinc oxide nanoparticles were spherical in shape and having the particle size range of 15 to 35 nm whereas the iron oxide nanoparticles were nonspherical in shape with the size range of 25 to 60 nm. Application of synthesized nanoparticle on seafood effluent treatment was studied.
English fever and coffee: Transient cosmopolitanism and the rising cost of distinction

This article examines the intersection of English and coffee in Seoul, South Korea, in order to document how distinction (ala Bourdieu, 1984/2008) functions under the prevailing conditions of neoliberalism. A mere two decades after Starbucks first opened in Korea, high-end specialty coffee shops proliferate. Drawing on photographs of the exteriors, interiors, and menus from 89 coffee shops in the trendy Seongsu-dong neighborhood in Seoul, we examine how coffee shops deploy English (in addition to or instead of Korean) in their signage, and how this deployment differs by type of coffee shop. We argue that English and coffee interact in a complex process of dual distinction. The coffee shops brand themselves as cosmopolitan and simultaneously offer the customers the distinction of demonstrating themselves knowledgeable about/proficient in both coffee and English. We explain this dual distinction in terms of the extreme competitiveness occasioned by neoliberalism in the aftermath of the 1997 Asian Financial Crisis. We conclude by suggesting the notion of “transient cosmopolitanism” as a way to understand specialty coffee shops, which we argue are crucial sites for understanding the contemporary subjectivities occasioned by the dominance of neoliberalism.
Novel Two-Slope Equations to Predict Amino Acid Concentrations Using Crude Protein Concentration in Soybean Meal

Amino acid (AA)-to-crude protein (CP) ratios in soybean meal (SBM) may be different for different sources of SBM depending on the presence of additional hulls. Therefore, this study was conducted to develop novel two-slope equations to predict the concentrations of AAs in SBM using CP as an independent variable. Regression analyses were performed with each AA in SBM as the dependent variable and the CP as the independent variable. Among all AAs, the predicted Lys in SBM (% dry matter (DM)) was: Lys = 3.19 − 0.026 × (51.88 − CP) where CP < 51.88% DM and Lys = 3.19 + 0.072 × (CP − 51.88) where CP > 51.88% DM with R2 = 0.51 and p < 0.001. In conclusion, the novel equations provided reasonable estimates of the AA concentrations from different ranges of CP in SBM.
Body size, habitat quality, and territory defense in Bachman’s sparrow

Many wild populations of animals conform to the ideal despotic distribution (IDD) in which more competitive individuals exclude less competitive individuals from high quality resources. Body size and aggressiveness are two important traits for resource defense, and they positively covary so that larger individuals are usually more aggressive. Using Bachman’s sparrows, we tested the hypothesis that larger birds are more aggressive and are thus able to compete for the best quality territories. We found that larger males were more aggressive, and more aggressive birds fledged at least one young. However, we did not find consistent relationships between aggressiveness and habitat characteristics. Our results suggest that Bachman’s sparrows meet most of the predictions of the IDD. Frequent ecological disturbances, such as fires, might disrupt the IDD or make it difficult to detect. Additional studies are needed to test for relationships between ecological disturbances and territorial behaviour.
Longitudinal Association of a Medication Risk Score With Mortality Among Ambulatory Patients Acquired Through Electronic Health Record Data

Supplemental digital content is available in the text. The use of electronic health records allows for the application of a novel medication risk score for the rapid identification of ambulatory patients at risk of adverse drug events. We sought to examine the longitudinal association of medication risk score with mortality. This retrospective cohort study included patients whose data were available through electronic health records from multiple health care organizations in the United States that provided data as part of a Patient Safety Organization. Patients were included if they had ≥1 visit and ≥1 medication in their record between January 1, 2011, to June 30, 2017. Cox proportional hazards regression was used to examine the association between continuous and categorized medication risk score with all-cause mortality. Among 427,103 patients, the median age was 50 years (interquartile range, 29–64 years); 61% were female; 50% were White, 11% were Black, and 38% were Hispanic; and 6873 had a death date recorded. Patients 30 to 49 years old had the highest hazard ratios (HRs), followed by the 50- to 64-year-olds and lastly those 65 years or older. Controlling for all covariates, 30- to 49-year-olds with a score of 20 to 30 (versus <10) had a 604% increase in the hazard of death (HR, 7.04; 95% confidence interval [CI], 3.86–12.85), 50- to 64-year-olds had a 254% increase (HR, 3.54; 95% CI, 2.71–4.63), and ≥65-year-olds had an 87% increase (HR, 1.87; 95% CI, 1.67–2.09). The medication risk score was independently associated with death, adjusting for multimorbidities and other conditions. Risk was found to vary by age group and score. Results suggest that pharmaceutical interventions among those with elevated scores could improve medication safety for patients taking multiple medications.
Effect of dietary poppy (Papaver somniferum L.) seed meal supplementation on growth performance, nutrient digestibility, faecal microbiota, and blood profile in growing-finishing pigs

The global expansion of animal production has driven the increase in the demand for animal feed proteins. Nowadays, plant-derived proteins are considered the most dominant protein source in animal feeding (Patsios et al., 2020). It has been reported that up to 70% of these proteins are based on soyabean meal (SBM) (Kim et al., 2019). Unfortunately, the SBM has become an unreliable source because of the high demand for such a protein source and consequently, its continuously increasing price (FAS, 2021). This is possibly due to an active competition between human food and animal feed consumptions, especially pig feed, since needs for amino acids in pigs and humans are similar. Therefore, it has become necessary to explore alternatives in protein-rich sources at lower costs. This provoked the nutritionist to put interest in the use of home-grown sources of proteins. Nowadays, several feedstuffs have been explored, such as poppy (Papaver somniferum L.) seed meal (PSM), sunflower meal (SFM), rapeseed meal (RSM), cottonseed meal (CSM), flaxseed meal (FSM), peas, beans and some algae. ABSTRACT. Growth performance, nutrient digestibility, faecal microbiota and blood profile response in growing-finishing pigs fed diet supplemented with poppy (Papaver somniferum L.) seed meal (PSM) were investigated. Sixty crossbred [(Landrace × Yorkshire) × Duroc] pigs weighing 25.2 ± 0.50 kg were used in the 84-day feeding trial and assigned to two groups: CON – basal diet; and PSM – basal diet + 2% PSM. Using a randomized complete block design, six replications were arranged according to sex and body weight (BW). The PSM diet significantly increased the average daily feed intake and BW (P = 0.052 and P = 0.053, respectively) of pigs during days 57–84 of trial in comparison to CON diet. In addition, the average daily gain was significantly greater during the last phase and overall experiment (P = 0.045 and P = 0.042, respectively) in pigs receiving PSM diet than in those receiving CON diet. Besides, PSM supplementation significantly reduced (P = 0.007) feed conversion ratio during the first 28 days in comparison to the CON diet. Also, the digestibility of dry matter in pigs fed the PSM diet was significantly greater at days 56 and 84 (P = 0.037 and P = 0.048, respectively), whereas nitrogen digestibility was unaffected during the whole experiment. However, no significant differences were observed in the faecal microbiota count and blood profile throughout the whole experiment. So, it can be concluded that the PSM can be used in the swine nutrition to improve growth performance and nutrient digestibility. Received: 18 January 2021 Revised: 2 March 2021 Accepted: 4 March 2021
Combined Iron-Loaded Zeolites and Ozone-Based Process for the Purification of Drinking Water in a Novel Hybrid Reactor: Removal of Faecal Coliforms and Arsenic

This study was carried out to provide a novel solution to treat drinking water at household levels, specifically removing arsenic (As) and faecal coliforms (microbes). In the current investigation, a synergistic iron-loaded zeolites and ozonation process (O3/Fe-ZA) was used for the first time in a modified batch reactor to remove coliform bacteria and arsenic in tap water. Moreover, the study utilizes the human health risk assessment model to confirm the health risk due to As intake in drinking water. The risk assessment study revealed a health risk threat among the residents suffering from the adverse effects of As through its intake in drinking water. Furthermore, the results also suggested that the O3/Fe-ZA process significantly removes faecal coliforms and As, when compared with single ozonation processes. Additionally, the ozone dose 0.2 mg/min and Fe-ZA dose of 10 g (in the O3/Fe-ZA process) gives the maximum removal efficiency of 100% within 15 min for faecal coliform removal. In 30 min, the removal efficiency of 88.4% was achieved at the ozone dose of 0.5 mg/min and 93% removal efficiency was achieved using 10 g Fe-ZA for the removal of As in the O3/Fe-ZA process. Hence, it was concluded that the O3/Fe-ZA process may be regarded as an effective method for removing faecal coliforms and As from drinking water compared to the single ozonation processes.
Experimental study correlating damage and permeability in concrete using confined, flattened Brazilian disks

This research experimentally studies coupled hydro-mechanical relationships using flattened Brazilian disks under confinement, with concurrent permeability measurements and acoustic emission monitoring. A series of tests are performed on concrete, as representative samples of brittle geo-materials, under a range of confining stresses between 2.76 and 13.79 MPa. Acoustic emission data is used to quantify damage and identify damage thresholds. Damage is then correlated to pre-peak changes in permeability. The advancement of models that couple transport properties to mechanical responses are of interest in the fields of carbon sequestration, hydrofracking, production of geothermal energy, induced seismicity, and underground nuclear waste storage, and these experiments validate a novel experimental approach towards investigating hydro-mechanical relationships.
A review of trends and drivers of greenhouse gas emissions by sector from 1990 to 2018

Global greenhouse gas (GHG) emissions can be traced to five economic sectors: energy, industry, buildings, transport and AFOLU (agriculture, forestry and other land uses). In this topical review, we synthesise the literature to explain recent trends in global and regional emissions in each of these sectors. To contextualise our review, we present estimates of GHG emissions trends by sector from 1990 to 2018, describing the major sources of emissions growth, stability and decline across ten global regions. Overall, the literature and data emphasise that progress towards reducing GHG emissions has been limited. The prominent global pattern is a continuation of underlying drivers with few signs of emerging limits to demand, nor of a deep shift towards the delivery of low and zero carbon services across sectors. We observe a moderate decarbonisation of energy systems in Europe and North America, driven by fuel switching and the increasing penetration of renewables. By contrast, in rapidly industrialising regions, fossil-based energy systems have continuously expanded, only very recently slowing down in their growth. Strong demand for materials, floor area, energy services and travel have driven emissions growth in the industry, buildings and transport sectors, particularly in Eastern Asia, Southern Asia and South-East Asia. An expansion of agriculture into carbon-dense tropical forest areas has driven recent increases in AFOLU emissions in Latin America, South-East Asia and Africa. Identifying, understanding, and tackling the most persistent and climate-damaging trends across sectors is a fundamental concern for research and policy as humanity treads deeper into the Anthropocene.
Reform at the Intersection of Loose Coupling and Pedagogic Modalities: The Case of Hong Kong

This paper contributes to our understanding of the micro-policy experience of an implemented curriculum from the perspective of students, in addition to teachers, as the key coupling agents in the schools of a Chinese global city. Although the phenomenon of decoupling in educational policy is widely recognized, much less attention has been paid to the micro-dynamics involved in implementing education reform policy from the perspective of students and teachers. It is argued that these local actors’ experiences are best captured by the bi-dimensional framework of loose coupling and pedagogic modalities. This argument is illustrated through a case study of the implementation of the Liberal Studies reform under Senior Secondary Curriculum in Hong Kong since 2009. The study demonstrates how students and teachers interpret and make sense of policy, strategic, and practical needs manifested in the microprocesses of policy coupling and decoupling.
Chronotypes and circadian rhythms in university students

ABSTRACT Inter-individual differences have been described in circadian timing organization, including the characteristics of phase preferences known as chronotypes. Social, biological and geophysical factors can influence the characteristics of morning-evening preference. Although morning individuals report inability to return to sleep after waking up and difficulties in maintaining nocturnal sleep most complaints are reported by evening individuals. The objective of the present study was to analyze the temporal organization of chronotypes at different phases. We measured the rhythms of activity/rest, sleep/wake, wrist temperature, attention and cycles of exposure to light of 32 university volunteers over 21 consecutive days of data collection. The acrophases of the analyzed rhythms correlate with the score of Horne & Östberg Questionnaire, but not the parameters of the cycle of exposure to light. The evening type volunteers who have morning classes showed no corresponding phase advanced of the rhythms, social jet lag and disruption in the rhythm of attention, suggesting difficulty to entrainment by the university schedules.