bluuebunny/crossref_metadata_2025 huggingface dataset:
The Efficacy of Epley Maneuvers in the Management of Subjective Benign Paroxysmal Positional Vertigo in Sulaimany Governorate
Authors:   MBChB, KBMS(ENT) trainee ENT, Head & Neck surgery., Mohammed Hemn Yaseen , Al Chalabi Yousif Ibrahim ,   Assist. Prof. Senior consultant surgeon F.I.C.M.S (ENT), C.A.B.S (ORL-Head and Neck surgery).
Published: July 2022

Background and objectives: Benign paroxysmal positional vertigo is vestibular disorder with most frequent episodes. It is mostly idiopathic. Epley maneuver gives good results in most patients. The aim of this study is to confirm the diagnoses of benign paroxysmal positional vertigo by Dix-Hall pike test. And to evaluate the effectiveness of Epley maneuver in treating patients with this disorder. Methods: A prospective study conducted on (100) patients with benign paroxysmal positional vertigo, in Sulaimany training Center for Otolaryngology-Head and Neck surgery, Kurdistan audiological centre from September 2018 to November 2019. Those with induced vertigo without nystagmus were included in the study. All patients had undergone complete ear nose and throat and audiological assessment, diagnoses were confirmed by Dix Hallpike test. The maneuver was performed weekly over 4 weeks and the results were recorded accordingly. Results: Twenty eight patients were males (28%), seventy two patients were females (72%). Age ranged between 18 and 72 years. Mean age (42.23). There was complete recovery in (82%), partial recovery in (13%), and resistance in (5%) these values were significant statistically. Conclusions: Epley maneuver gave good results in management of benign paroxysmal positional vertigo and is a safe procedure without complications. Dix hallpike test gave a definite diagnosis of benign paroxysmal positional vertigo particularly the posterior canal.
Hemşirelik Öğrencilerinin Toplumsal Cinsiyet Algısının Flört Şiddeti Tutumuna Etkisi
Authors: BALCI DEVRİM Sevgi , BEYDAĞ Kerime Derya
Published: July 2022

Bu çalışma, hemşirelik öğrencilerinin toplumsal cinsiyet algısı ve flört şiddeti tutumlarını belirlemek ve birbiri üzerinde etkisini incelemek amacıyla yapılmıştır. Tanımlayıcı ve kesitsel nitelikteki çalışmanın evrenini, İstanbul’un Anadolu yakasında eğitim veren bir vakıf üniversitesinin hemşirelik bölümüne 2017-2018 güz yarıyılında devam eden 192 öğrenci oluşturmuştur. Örneklem seçilmeden evrenin tamamına ulaşılmak hedeflenmiş, ancak katılmak istemeyen öğrenciler olması nedeniyle 175 (%61,1) öğrenci örneklemi oluşturmuştur. Veriler, tanımlayıcı veri toplama formu, Flört Şiddeti Tutum Ölçeği (FSTÖ) ve Toplumsal Cinsiyet Algısı Ölçeği (TCAÖ) ile elde edilmiştir. Verilerin değerlendirilmesinde, sayı-yüzdelik hesaplamaları Kruskal-wallis, Anova test, Independent t testi, Man Whitney U testi ve Pearson korelasyon testi kullanılmıştır. Çalışma kapsamındaki öğrencilerin %11,4’ü flört ilişkisi sırasında şiddete maruz kaldığını ve %6,3’ü flört ilişkisinde şiddet uyguladığını ifade etmiştir. Öğrencilerin %7,4’ü aile içi şiddete maruz kaldığını ve %8,6’sı ailesinde aile içi şiddete maruz kalan birey olduğunu belirtmiştir. Öğrencilerin FŞTÖ puan ortalaması 4,53±0,96 ve TCAÖ puan ortalaması 69,93±10,8 olarak hesaplanmıştır. Çalışma sonucunda öğrencilerin, FŞTÖ ve TCAÖ puan ortalamaları arasında pozitif yönde ve zayıf düzeyde ilişki olduğu belirlenmiştir. Öğrencilerin eğitimleri sırasında toplumsal cinsiyet algısı ve flört şiddetine yönelik farkındalık oluşturulması önerilmektedir.
The Gambaran Tingkat Distress Dan Faktor-Faktor Yang Memengaruhi Pada Perawat Di RSUD X Tembilahan Tahun 2022: Validasi Dan Reliabilitas Copenhagen Psychosocial Questionnaire Version III
Authors: Yussy Rha Warda , Tejamaya Mila
Published: July 2022

Nursing is one of the stressful professions. Stress emerged on nurses due to various factors, They have affected nurses in the form of tiredness, harsh behavior, anxiety, increase of blood pressure, lack of self-confidence, lack of job satisfaction, decrease in efficiency, etc. The Copenhagen Psychosocial Questionnaire (COPSOQ) is one of a few research-based instruments that have been developed for use at workplaces as well as for research purposes. The instrument is internationally recognized as a risk assessment tool by both the International Labour Organization and the World Health Organization and is used in workplace surveys worldwide for work environment development and follow-up of organizational changes. This study aims to analyze the validity and reliability of the Copenhagen Psychosocial Questionnaire (COPSOQ III) on Nurse at RSUD X. The study design is cross-sectional. Determination of the sample of this study using simple random sampling method of Nurse in RSUD X, The questionnaire was based on COPSOQ III scales, Validity and Reliability tests using Pearson Product Moment and Cronbach's alpha.
Impact of Population Growth on Forest Cover: A Case Study of Tawang District of Arunachal Pradesh
Authors: Tsering Gendan , Nimasow Gibji , Singh Nandini Chakrabarthy
Published: July 2022

The role of population growth on the forest degradation has been much debated worldwide. There is a reciprocal relationship between population growth and forest cover in large. In other words, population growth turns out to be the main cause of deforestation. Deforestation threatens the well-being and livelihoods of millions of people who largely depends on forest resources. Today deforestation is occurring at alarmingly rates, especially in the regions that are experiencing rapid population growth. Tawang district of Arunachal Pradesh has a population density of 22 persons per square kilometres which is higher than the state. The district is inhabited by the Monpa tribes who are living in close association to their forest resources and derive their daily requirements like fire woods, timber, medicinal plants, food and fodder for their animal. The fire wood extraction appears to be causing maximum impact on forest degradation as firewood forms the basic source of heating the houses in an area which is characterized by longer winter months. Every year each household burns at least two fully matured trees to keep their houses warm. But there is no denying the fact that the other form of extractions are also contributing in the deforestation. Earlier, man-nature interaction was quite sustainable when population was very low. But today due to rapid population growth interaction with forest is becoming more and more intense leading to loss of many important resources. Consequently, many important plant species like rhododendron, oak, juniper pines, etc. are largely threatened. The paper attempts to examine the population growth trend in the Tawang district and and its impact on the forest cover of the district. Both the primary and secondary data sources have been used to analyse the relationship between population growth and forest cover change in the district.
Pluralism and Identity Politics: A Look into the Indian Centre-State Scenario
Authors: Basistha Nandini
Published: July 2022

Constructed ideas of identity have been posing a threat to humanity in the pluralist notion of India. Shared concept of class, clan and culture get politicized by a small group of people, often driven by self-interest, and turmoil the democratic set up. Most of the time identity politics ends up with some patches on the minds and mentality of the commoners where the actual goal of the so-called identity-seekers catches veil of ignorance. How the demand to determine identity of a minority group threatens the broader concept of pluralism is the central theme of this paper. This paper also tries to underline the interwoven character of identity politics and pluralism in Centre – State relation of India. Starting with the theoretical genre, it will end with the practical hiccups and way-outs.
Voice of the Voiceless: An Analyses of the Poems of Nissim Ezekiel and Kamala Das
Authors: George Shiny
Published: July 2022

Literature is a mirror of the mind and society. Poems, novels, short-stories, dramas and sketches would give an image of an individual, society, country and the world at large of a particular century and beyond. A profound investigation into poems or novels would reveal the unfathomable mystery of human life, expressions, emotions, feelings and struggles. Poems are a vehicle to transport the milk and honey, fire and fury of an illumined mind. Hence, the present paper is an attempt to explore the poetic stance of Nissim Ezekiel and Kamala Das and their endeavours in giving voices to their embittered experiences of marginalization, double-marginalization, exploitation and identity quest.
Indigenous Healing and Treatment Practices among the Nyishis of Kurung Kumey and Kra Daadi Districts in Arunachal Pradesh
Authors: Chokio Toku
Published: July 2022

The use of plants and animal as a source of medicine is as old as humanity. Traditional medicine is widely used by the tribes of Arunachal Pradesh as well as North East India and India as a whole. The Nyishi tribe is an indigenous group of people living in some districts of Arunachal Pradesh. For this study, Kurung Kumey and Kra Daadi districts have been taken as the focus areas of study. The paper gives a brief overviews of the indigenous knowledge system of health and healthcare, people’s understanding of health and dieseases and how the people care and heal diseases & illness and drive away illness and sickness by traditional religious ritual and performances.
Inovasi Wisata: Upaya Pemerintah Kota Sawahlunto Dalam Pengembangan Daya Saing dan Destinasi Wisata baru
Authors: Suhendra Adi , Hartopo Agus
Published: July 2022

Penelitian ini adalah tentang kebijakan atau inovasi dalam bidang pariwisata yang dilakukan oleh Kota Sawahlunto. Penelitian ini relevan dan menarik untuk dibahas karena inovasi yang dilakukan Pemerintah Kota Sawahlunto dengan merubah Kawasan bekas penambagan batu bara (Kawasan Kandi) merupakan program yang bisa ditiru oleh Pemerintah Kabupaten/Kota lain yang lahan penambagannya sudah tidak berproduksi lagi. Populasi dalam penelitian ini yaitu pada daerah yang telah melakukan kebijakan atau inovasi dalam bidang pariwisata. Sedangkan sampel dalam penelitian ini adalah inovasi bernama Just Not Green sebagai inovasi dalam rangka menciptakan destinasi wisata dari lahan bekas tambang batu bara Kawasan Kandi Kota Sawahlunto. Hasil penelitian ini menunjukkan bahwa inovasi yang dilakukan Pemerintah Kota Sawahlunto dengan menjadikan kawasan kandi (lahan bekas penambangan batu bara) sebagai destinasi wisata memang telah berhasil meningkatkan perekonomian Kota Sawahlunto. Terhadap inovasi tersebut dapat disimpulkan bahwa pengaruh perkembangan pariwisata terhadap kondisi makro ekonomi Kota Sawahlunto dapat dilihat dari pengaruhnya terhadap pertumbuhan ekonomi, struktur ekonomi dan tenaga kerja. Pertumbuhan ekonomi Kota Sawahlunto tahun 2004-2013 untuk masing-masing sektor fluktuatif. Untuk sektor kepariwisataan seperti perhotelan dan restoran cenderung meningkat hingga tahun 2013 dan sudah mencapai 7,54 %. Untuk sektor jasa-jasa dengan peningkatan pada tahun 2004 sebesar 3,98 % menjadi 8,9 % pada tahun 2013.
Interrelationships between Blood Pressure and Lipid Profile Characteristics among Postmenopausal Women at Naxalbari in Darjeeling, West Bengal
Authors: Datta Banik Sudip
Published: July 2022

Objective of the present study was to find association between blood pressure and lipid profile characteristics in postmenopausal women. A cross-sectional study was done in 2015 at Naxalbari in Darjeeling district of West Bengal, India. The sample included 129 postmenopausal women aged between 40- and 55-years, representing Dhimal community. Blood pressure (systolic and diastolic) was recorded and levels of triglycerides (TG), high-density lipoprotein cholesterol (HDLC), and low-density lipoprotein cholesterol (LDL-C) were estimated. Derived lipid profile parameters were total cholesterol, non-HDL-C, Castelli Risk Index (CRI) I and II, atherogenic coefficient, and atherogenic index of plasma (AIP).Hypertension (systolic/diastolic 140/90 mmHg), hypertriglyceridemia (≥150 mg/dL), high LDL-C (≥130 mg/dL), and low HDL-C (<50 mg/dL) were diagnosed. Correlation and binomial logistic regression analyses were done to find the association between variables. Mean values of age and age at menopause were 50.34 years and 45.36 years, respectively. Prevalence of hypertension (65.89%), hypertriglyceridemia (21.71%), high LDL-C (43.41%), and low HDL-C (48.06%) were remarkable in the sample. Binomial logistic regression models after adjusting for age, showed that lipid parameters (TG, non-HDL-C, and AIP) significantly predicted hypertension. AIP was observed to be the best predictor of hypertension (Youden index = 0.52) and odds ratio showed that one unit increase in AIP had a chance of 24% rise in odds of having hypertension. Hypertensive postmenopausal women had higher mean values and prevalence of abnormal lipid profile characteristics. Age at menopause had significantly negative association with blood pressure and lipid profile parameters.
The Influence of Social Support on Life Satisfaction of Elderly People in Care Homes
Authors: Zoranić Sanja , Sajko Melita , Županić Mara , Knežević Goran
Published: July 2022

Social network of each individual plays a significant role in the aging process, while at the same time social support is considered as one of the major factors attributing to quality of life of the elderly. Insufficient social inclusion of an individual leads to loneliness as a consequence of the lack of social relations, which commonly occurs among older people and greatly affects their quality of life. The aim of this paper is to explore the perception of the social support for elderly and disabled people in care homes and its impact onto their life satisfaction, as well as correlation between social support and loneliness. The instruments used in the research were the Social Provisions Scale, a general measure to evaluate current relations with important people in a person’s life, and Socio-Demographic Data Questionnaire. The sample involved 113 people over 65 in care homes for elderly and disabled in Dubrovnik-Neretva County. The results have shown that there are differences in quality of life of the elderly in care homes as well as in their life satisfaction with regard to social sup¬port, and also that there is a correlation between the lack of support and loneliness. Furthermore, the research results have shown that there are no statistically significant gender differences in the quality of life of the elderly with social support.
“They Think We Have No Ears”
Authors: Mizel Omar
Published: July 2022

The continuous debate in the West about women wearing a hijab in the public sphere excludes the women themselves and does not enable a fair discussion of the topic. This study aims to benefit Muslim women by bringing their experiences to the forefront and providing them with an opportunity to voice their distress without concern. The study examines the experiences of Muslim women immigrants in three cities in Germany. These women experienced exclusion and felt marginalized, and believed they were unjustly treated in the public sphere, which purports to be liberal and enabling. Nevertheless, these women preserved their Muslim-Arab identity. The study recommends, among other suggestions, to display the Muslim women immigrants’ culture, showing where they live and establishing shared educational settings for German and Muslim girls and women.
Avaliação de Desempenho de Algoritmos de Balanceamento de Carga de Aplicações SPMD na Presença de Carga Externa
Authors: Costa Roberto , Vianna Daniela , Thomé Viviane , Plastino Alexandre
Published: July 2022

O desempenho de programas paralelos é frequentemente afetado por diferentes fatores dinâmicos de desequilíbrio de carga. Um fator de desequilíbrio muito comum, presente nos ambientes paralelos não dedicados, é a existência de outros processos concorrendo com a aplicação paralela pelos recursos computacionais. A heterogeneidade e variação desta carga externa impede que seja feita uma distribuição prévia e equilibrada das tarefas da aplicação paralela. O uso de uma estratégia de balanceamento de carga adequada é fundamemal para a redução dos efeitos causados por este fator de desequilíbrio. Neste trabalho, serão avaliadas oito estratégias de balanceamento de carga utilizadas em duas aplicações paralelas SPMD distintas, quando executadas na presença de carga externa. As aplicações SPMD implementadas calculam: (a) a multiplicação de matrizes quadradas e (b) a dispersão térmica em meios porosos. Neste trabalho, propõe-se também um índice de desbalanceamento de carga para aplicações SPMD.
Um Esquema para Distribuição de Carga em Ambientes Virtuais de Computação Maciçamente Paralela
Authors: Lucchese Fabiano de O. , Sambatti Francisco S. , Yero Eduardo J. Huerta , Henriques Marco A. A.
Published: July 2022

O recente desenvolvimento de infra-estruturas de telecomunicação, como as redes internacionais de computadores, capazes de interconectar milhões de computadores espalhados pelo mundo inteiro, tornou possível a utilização de extensos recursos computacionais a custos relativamente baixos. Desta nova realidade, surgiram as pesquisas de computadores virtuais maciçamente paralelos, que consistem em ambientes virtuais formados por um grande número de computadores que procuram trabalhar cooperativamente na busca de soluções para problemas até então impossíveis de serem tratados pelos sistemas computacionais disponíveis. Entretanto, como em todo novo domínio de pesquisa, existem também muitas questões ainda sem solução, especialmente em relação ao problema de gerenciamento da carga de processamento realizado nestes ambientes. Neste trabalho, será abordado o problema de balanceamento de carga em ambientes virtuais de computação maciçamente paralela introduzindo-se o algoritmo de Escalonamento Geracional com Replicação de Tarefas (GSTR).
Reconhecimento de Imagens em Aplicações Críticas
Authors: Moschetta Eduardo , Osório Fernando S. , Cavalheiro Gerson Geraldo H.
Published: July 2022

Muitas aplicações multimídia oferecem sistemas de consultas de imagens-exemplo em grandes bases de imagens. A maioria dessas aplicações são críticas, ou seja, requerem um tempo de resposta mínimo. Este artigo apresenta uma solução para esse problema através da programação concorrente. Proposta inicialmente com o objetivo de testar e validar o ambiente de programação Anahy, a implementação realizada tem como foco principal minimizar esse tempo de resposta. Para sua compreensão, são apresentados detalhes da implementação concorrente e métodos de escalonamento de tarefas aplicados, bem como conceitos básicos sobre busca de imagens. Ainda, para validar a solução proposta, é apresentada uma análise de desempenho feita para medir tanto a qualidade do matching quanto o tempo de resposta da aplicação no reconhecimento de imagens.
Reconhecimento Automático de Padrões Utilizando Redes Bayesianas: Uma Abordagem Paralela e Distribuída
Authors: Duarte Filho Nelson Lopes , Calheiros Rodrigo Neves
Published: July 2022

Reconhecimento automático de padrões é um problema que encontra inúmeras aplicações, como, por exemplo, em robótica. Visando a solução desse problema, e considerando os aspectos de incerteza a ele inerentes, descreve-se uma solução que utiliza aspectos da teoria das probabilidades, em especial redes bayesianas. São apresentados algoritmos, que, utilizando técnicas de processamento paralelo e distribuído, se propõem a resolver subproblemas relacionados à aquisição automática de conhecimento (como gerar automaticamente uma rede bayesiana a partir de um banco de casos exemplo) e ao raciocínio probabilístico (como reconhecer um novo padrão apresentado, à luz do conhecimento representado numa rede bayesiana). Relacionam-se alguns resultados sobre a eficiência, obtidos numa implementação sobre uma network of worstations (NOW), em termos de speedup, e sugerem-se melhorias a serem incorporadas às soluções propostas.
Análise Comparativa do Uso de Multi-Thread e OpenMP Aplicados a Operações de Convolução de Imagem
Authors: Penha Dulcinéia Oliveira da , Corrêa João Batista Torres , Martins Carlos Augusto Paiva S.
Published: July 2022

Este trabalho apresenta uma análise comparativa de diferentes métodos de implementações paralelas para sistemas de memória compartilhada, aplicados na operação de convoluçào de imagem. São analisadas implementações paralelas de convolução, usando os padrões WinThread e OpenMp, do ponto de vista de programabilidade e de desempenho. Este último é analisado em termos de tempo de resposta. Ao longo do desenvolvimento do trabalho, a implementação com o uso de OpenMp mostrou-se mais simples em relação à implementação com WinThread. Isto porque a segunda apresenta para o programador métodos de programação paralela mais explícitos do que a primeira. Em termos de desempenho, as implementações paralelas apresentaram um significativo ganho de desempenho em relação às implementações seqüenciais.
HoloVM: Uma máquina virtual com suporte à Concorrência, Mobilidade e Blackboards
Authors: Garzão Alex Sandro , Barbosa Jorge Luis Victória
Published: July 2022

Este artigo propõe uma máquina virtual com suporte à concorrência, mobilidade e blackboards, realizando processamento simbólico. Após explicações sobre o que é o Holoparadigma e a Hololinguagem, será demonstrada a estrutura desta máquina virtual, juntamente com o projeto de um compilador e um montador assembler que serão utilizados para auxiliar na validação e uso desta máquina.
Wie Wahlkommunikation mobilisiert: Einfluss-, Selektions- und Reziprozitätsbeziehungen bei der Bundestagswahl 2017
Authors: Schulz Winfried
Published: July 2022

Die Mobilisierung der Bürgerinnen und Bürger ist ein wichtiges Ziel jeder Wahlkampagne, auch weil die Höhe der Wahlbeteiligung mitentscheidend ist für das Abschneiden der einzelnen Parteien. Viele empirische Studien gehen daher der Frage nach, ob Wahlwerbung oder andere Kampagnenmaßnahmen zur Mobilisierung der Wahlberechtigten beitragen. Bisherige Untersuchungen konnten jedoch nicht aufklären, ob Zusammenhänge zwischen Wahlkommunikation und Mobilisierung tatsächlich auf einen Kommunikationseffekt zurückgehen oder doch eher auf selektive Kommunikationsnutzung der schon Mobilisierten. Diesen blinden Fleck der Forschung beseitigt dieser Beitrag exemplarisch mit einem statistischen Ansatz, der zwischen Effektbeziehungen und Selektionsbeziehungen unterscheidet. Anhand von Daten eines Panels zur Bundestagswahl 2017 lassen sich Mobilisierungseffekte sowohl für Wahlwerbung wie auch für politische Gespräche nachweisen, ebenso auch Selektionsbeziehungen - also Selektion von Wahlkommunikation, ausgehend von der Wahlabsicht. Darüber hinaus zeigt die Analyse dynamische Reziprozität über mehrere Wochen nach dem Muster einer Spiralbeziehung, und zwar für die Beziehungen zwischen Werbung und Wahlabsicht, wobei die Wahlabsicht in der frühen Phase des Wahlkampfs ein stärkerer Treiber der Dynamik ist als die Wahlwerbung. Die dynamische Reziprozität ist besonders ausgeprägt bei Personen, die zu Beginn der heißen Kampagnenphase parteipolitisch noch nicht entschieden sind.
Themen & Timing. Die Krisenkommunikation der deutschen Landesregierungen in der Corona-Pandemie – eine (teil-)automatisierte Inhaltsanalyse zentraler Kommunikationskanäle
Authors: Drerup Floriane , Birkner Thomas
Published: July 2022

In der Corona-Pandemie kommt der Krisenkommunikation der 16 deutschen Landesregierungen eine entscheidende Rolle zu. Der Beitrag untersucht diese Krisenkommunikation im ersten Jahr der weltumspannenden Gesundheitskrise und analysiert hierzu über 27000 Pressemitteilungen, Tweets und Facebook-Posts. Mittels der Methode der (teil-)automatisierten Inhaltsanalyse kann gezeigt werden, dass sich die Inhalte je nach Kommunikationskanal unterscheiden: Neue Infektionszahlen werden schnell über Social Media verbreitet, die wirtschaftlichen Folgen der Pandemie eher via Pressemitteilungen. Mittels Topic Modeling kann außerdem gezeigt werden, dass die Landesregierungen durchaus jeweils eigene thematische Schwerpunkte setzen. Über den gesamten Untersuchungszeitraum im Jahr 2020 hinweg zeigt sich, dass dabei einige Themen dem wellenförmigen Verlauf der Pandemie in Deutschland folgen, andere einen gegenteiligen Verlauf haben.
Improving Uptake of Emergency Department-initiated Buprenorphine: Barriers and Solutions
Authors: Kelly Timothy , Hawk Kathryn , Samuels Elizabeth , Strayer Reuben , Hoppe Jason
Published: July 2022

Emergency departments (ED) are increasingly providing buprenorphine to persons with opioid use disorder. Buprenorphine programs in the ED have strong support from public health leaders and emergency medicine specialty societies and have proven to be clinically effective, cost effective, and feasible. Even so, few ED buprenorphine programs currently exist. Given this imbalance between evidence-based practice and current practice, proven behavior change approaches can be used to guide local efforts to expand ED buprenorphine capacity. In this paper, we use the theory of planned behavior to identify and address the 1) clinician factors, 2) institutional factors, and 3) external factors surrounding ED buprenorphine implementation. By doing so, we seek to provide actionable and pragmatic recommendations to increase ED buprenorphine availability across different practice settings.
The Use of Non-physician Prescribed Medications in Patients Presenting to Two Emergency Departments in a Low/Middle-income Country
Authors: Venezia Donna , Cabble Alexandra , Lum Diane , Lim Kruy , Singer Adam
Published: July 2022

Introduction: With few trained healthcare practitioners and limited personal finances, many patients in low/middle income countries purchase prescription medications from non-physician prescribers (NPP). This study documents various aspects of this practice, including patterns of prescribing, and the patient’s understanding of medication risks.

Methods: From January to April 2017, 479 patients entering two hospitals in Phnom Penh, Cambodia, were surveyed. Demographics, medications, types of NPP who provided the medication, patients history and physicians’ chart data were documented. Information, including symptoms when the medication was purchased, possible side effects, hospital presenting symptoms, etc, was recorded. The patient’s understanding of medication allergies and risk of serious side effects was also documented.

Results: Of the 467 patients included, more than half (59%), reported buying medications from NPPs within the two weeks before presenting to the hospital. Nearly half of those patients, (42%), could not identify any of their medications. Of those 159 patients who could identify at least one drug, 79% bought at least one medication that would require a prescription in the United States. Only 8% of patients were aware that medications could cause serious harm. Twenty-three percent of the known medications were oral or injectable corticosteroids, and 56% of steroid users, typically chronic users, had evidence of possible side effects.

Conclusion: Many patients in one low/middle income country received prescription medications from various NPPs with little information concerning these medications. Efforts to educate the public about their medications and the potential risks of medications are needed.
Physician Pipeline and Pathway Programs: An Evidence-based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine
Authors: Parsons Melissa , Caldwell Martina , Alvarez Al'ai , Davenport Dayle , Gallegos Moises , Landry Adaira , Gottlieb Michael , Natesan Sreeja
Published: July 2022

Improving the diversity and representation in the medical workforce requires intentional and deliberate efforts to improve the pipeline and pathway for underrepresented in medicine (UIM) applicants. Diversity enhances educational experiences and improves patient care and outcomes. Through a critical review of the literature, in this article we offer evidence-based guidelines for physician pipeline and pathway programs (PP). Recommendations are provided regarding considerations on the types of programs and surrounding implementation to ensure a sound infrastructure and framework. We believe this guide will be valuable for all leaders and faculty members seeking to grow the UIM applicant pool in our efforts to advance diversity, equity, and inclusion within medicine.
Revisits After Emergency Department Discharge for Conditions with High Disposition-Decision Variability at Hospitals with High and Low Discharge Rates
Authors: Baehr Avi , Fought Angela , Hsia Renee , Wiler Jennifer , Ginde Adit
Published: July 2022

Introduction: The first proposed emergency care alternative payment model seeks to reduce avoidable admissions from the emergency department (ED), but this initiative may increase risk of adverse events after discharge. Our study objective was to describe variation in ED discharge rates and determine whether higher discharge rates were associated with more ED revisits.

Methods: Using all-payer inpatient and ED administrative data from the California Office of Statewide Health Planning and Development (OSHPD) 2017 database, we performed a retrospective cohort study of hospital-level ED discharge rates and ED revisits using conditions that have been previously described as having variability in discharge rates: abdominal pain; altered mental status; chest pain; chronic obstructive pulmonary disease exacerbation; skin and soft tissue infection; syncope; and urinary tract infection. We categorized hospitals into quartiles for each condition based on a covariate-adjusted discharge rate and compared the rate of ED revisits between hospitals in the highest and lowest quartiles.

Results: We found a greater than 10% difference in the between-quartile median adjusted discharge rate for each condition except for abdominal pain. There was no significant association between adjusted discharge rates and ED revisits. Altered mental status had the highest revisit rate, at 34% for hospitals in the quartile with the lowest and 30% in hospitals with the highest adjusted discharge rate, although this was not statistically significant. Syncope had the lowest rate of revisits at 16% for hospitals in both the lowest and highest adjusted discharge rate quartiles.

Conclusion: Our findings suggest that there may be opportunity to increase ED discharges for certain conditions without resulting in higher rates of ED revisits, which may be a surrogate for adverse events after discharge.
The Use of a Self-triage Tool to Predict COVID-19 Cases and Hospitalizations in the State of Georgia
Authors: Lee Yi-Ting Hana , Di Mengyu , Schrager Justin , Buckareff Zack , Patzer Rachel , Yaffee Anna
Published: July 2022

Introduction: The coronavirus 2019 (COVID-19) pandemic has created significant burden on healthcare systems throughout the world. Syndromic surveillance, which collects real-time data based on a range of symptoms rather than laboratory diagnoses, can help provide timely information in emergency response. We examined the effectiveness of a web-based COVID-19 symptom checking tool (C19Check) in the state of Georgia (GA) in predicting COVID-19 cases and hospitalizations.

Methods: We analyzed C19Check use data, COVID-19 cases, and hospitalizations from April 22– November 28, 2020. Cases and hospitalizations in GA were extracted from the Georgia Department of Public Health data repository. We used the Granger causality test to assess whether including C19Check data can improve predictions compared to using previous COVID-19 cases and hospitalizations data alone. Vector autoregression (VAR) models were fitted to forecast cases and hospitalizations from November 29 - December 12, 2020. We calculated mean absolute percentage error to estimate the errors in forecast of cases and hospitalizations.

Results: There were 25,861 C19Check uses in GA from April 22–November 28, 2020. Time-lags tested in Granger causality test for cases (6-8 days) and hospitalizations (10-12 days) were significant (P= <0.05); the mean absolute percentage error of fitted VAR models were 39.63% and 15.86%, respectively.

Conclusion: The C19Check tool was able to help predict COVID-19 cases and related hospitalizations in GA. In settings where laboratory tests are limited, a real-time, symptom-based assessment tool can provide timely and inexpensive data for syndromic surveillance to guide pandemic response. Findings from this study demonstrate that online symptom-checking tools can be a source of data for syndromic surveillance, and the data may help improve predictions of cases and hospitalizations.
A Qualitative Study of “What Matters” to Older Adults in the Emergency Department
Authors: Gettel Cameron , Venkatesh Arjun , Dowd Hollie , Hwang Ula , Ferrigno Rockman , Reid Eleanor , Tinetti Mary
Published: July 2022

Introduction: The “4Ms” model – What Matters, Medication, Mentation, and Mobility – is increasingly gaining attention in age-friendly health systems, yet a feasible approach to identifying what matters to older adults in the emergency department (ED) is lacking. Adapting the “What Matters” questions to the ED setting, we sought to describe the concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians.

Methods: We conducted 46 dyadic semi-structured interviews of cognitively intact older adults and their treating clinicians. We used the “What Matters” conversation guide to explore patients’ 1) concerns and 2) desired outcomes. We then asked analogous questions to each patient’s treating clinician regarding the patient’s priorities. Interviews were professionally transcribed and coded using an inductive approach of thematic analysis to identify emergent themes.

Results: Interviews with older adults lasted a mean of three minutes, with a range of 1–8 minutes. Regarding patients’ concerns, five themes emerged from older adults: 1) concern through a family member or outpatient clinician recommendation; 2) no concern, with a high degree of trust in the healthcare system; 3) concerns regarding symptom cause identification; 4) concerns regarding symptom resolution; and 5) concerns regarding preservation of their current status. Regarding desired outcomes, five priority themes emerged among older adults: 1) obtaining a diagnosis; 2) returning to their home environment; 3) reducing or resolving symptoms; 4) maintaining self-care and independence; and 5) gaining reassurance. Responding to what they believed mattered most to older adult patients, ED clinicians believed that older adults were concerned primarily about symptom cause identification and resolution and primarily desired a return to the home environment and symptom reduction.

Conclusion: This work identifies concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians as well as the feasibility of incorporating the “What Matters” questions within ED clinical practice.
Caregiver Perceptions Regarding Alternative Emergency Medical Services Dispositions for Children: A Cross-Sectional Survey Analysis
Authors: Ward Caleb , Gougelet Jonathan , Pearman Ryan , Badolato Gia , Simpson Joelle
Published: July 2022

Introduction: Emergency medical services (EMS) systems have developed alternative disposition processes for patients (including leaving the patient at the scene, using taxis, and transporting to clinics) vs taking patients directly to an emergency department (ED). Studies show that patients favorably support these alternative options but have not included the perspectives of caregivers of children. Our objective was to describe caregivers’ views about these alternative disposition processes and analyze whether caregiver support is associated with sociodemographic factors.

Methods: We surveyed a convenience sample of caregivers in a pediatric ED. We asked caregivers 15 questions based on a previously validated survey. We then conducted logistic regressions to determine whether sociodemographic factors were associated with levels of support.

Results: We enrolled 241 caregivers. The median age of their children was five years. The majority of respondents were non-Hispanic Black (57%) and had public insurance (65%). We found that a majority of respondents supported all alternative EMS disposition options. The overall level of agreement for survey questions ranged from 51-93%. We grouped questions by theme: non-transport; alternative destinations; communication with EMS physician; communication with primary care physician and sharing records; restricted EMS role; and shared decision-making. Regression analyses for each theme found that race/ethnicity, public insurance, and patient age were not significantly associated with the level of support.

Conclusion: Most caregivers were supportive of alternative EMS disposition options for children with low-acuity complaints. Support did not vary significantly by respondent race/ethnicity, public insurance status, or patient age.
United States Emergency Department Screening for Drug Use Among Assault-Injured Individuals: A Systematic Review
Authors: Coupet Jr. Edouard , Dodington James , Brackett Alexandria , Vaca Federico
Published: July 2022

Introduction: The clinical model of screening, providing a brief psychosocial and/or pharmacological intervention, and directly referring patients to treatment (SBIRT) is a compelling model to address drug use among assault-injured individuals in the busy emergency department (ED) setting. Our objective in this study was to examine the current literature and determine ED-based strategies that have been reported that screen, directly refer to drug mis-use/addiction specialized treatment services, or initiate addiction treatment among individuals injured by non-partner assault in the United States.

Methods: We conducted a systematic review of ED-based studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. OVID, MEDLINE, OVID Embase, OVID AMED, Web of Science-Core Collection, Cochrane CENTRAL, and CINAHL were systematically searched using keywords and Medical Subject Heading terms. Studies were excluded if they only involved intimate partner assault-injury, tobacco, or alcohol use. We categorized ED-based strategies as screening, direct referral, or treatment initiation.

Results: Of the 2,076 non-duplicated studies identified, we included 26 full-text articles in the final analysis. Fourteen studies were cross-sectional, 11 were cohort, and one was case-control in design. The most common drug use screening instrument used was the National Institute on Drug Abuse Quick Screen Question. Cannabis was the most common drug detected upon screening.

Conclusion: Drug use, while highly prevalent, is a modifiable risk factor for non-partner assault-injury. The paucity of scientific studies is evidence for the need to intentionally address this area that remains a major challenge for the public’s health. Future research is needed to evaluate ED-based interventions for drug use in this population.
Violence Against Frontline Emergency Nurses During COVID-19 Pandemic in Guilan: A Cross-sectional Study
Authors: Ghanbari Atefeh , Panahi Latif , Pouy Somaye
Published: July 2022

Background: Violence in the workplace is one of the most critical risk factors worldwide. Nurses are continuously exposed to violence in their workplace, primarily because of having contact with patients and their families. Objectives: The present study aimed to investigate the violence against nurses in Razi educational and remedial center in Rasht. Methods: In a cross-sectional study, we recruited 112 nurses working in Rasht's educational and remedial center by convenience sampling. The instrument included a questionnaire to assess workplace violence in medical settings, which had been used in several Iranian studies and was psychometrically assessed by Najafi in Iran. After collecting and entering the data into SPSS version 22 software, they were analyzed by independent t test, chi-square test, and Fisher's exact test. The significance level was set at a P value < 0.05. Results: The findings showed that 11.1% of nurses experienced physical violence, and 55.7% experienced verbal violence. We found a significant relationship between education level and verbal violence (P = 0.02) and between job (P = 0.02) and marital (P = 0.02) status and physical violence. Linear regression analysis showed that nurses with low experience were 1.01 times more likely to undergo violence (OR = 1.01; CI: 0.66 - 1.44). Conclusions: Verbal and physical violence frequently occurred against nurses during the COVID-19 pandemic. Thus, the authorities are required to take adequate measures to reduce the incidence of violence in hospitals.
Identification of Shared Gene Signatures in Different Stages of Nonalcoholic Fatty Liver Disease Using Integrated Microarray Datasets
Authors: Nobakht M. Gh B. Fatemeh , Hasani Nourian Yazdan , Arabfard Masoud
Published: July 2022

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease worldwide. Left untreated, it can be a risk factor for developing cirrhosis or hepatocellular carcinoma (HCC). Although experts have made many efforts to find the underlying mechanisms of NAFLD, they remain a mystery. Objectives: This study aimed to distinguish common gene signatures and pathways in the human liver during NAFLD progression through systems biology. Methods: In this study, the researchers selected three microarray datasets, GSE48452, GSE63067, and GSE89632, from the NCBI GEO database to explore differentially expressed genes (DEGs) among healthy controls, simple steatosis, and nonalcoholic steatohepatitis (NASH) patients. Furthermore, protein-protein interaction (PPI) networks and pathway enrichment analyses were used to detect common genes and biological pathways in different stages of NAFLD. Results: The current study included 45 healthy participants, 36 simple steatosis patients, and 46 NASH patients. Common genes for NAFLD progression were Chi3L1, ICAM1, MT1A, MT1H, ABCB11, ACOT1, CYP2C9, HSP90B1, and CPB2, which are involved in inflammation and oxidative stress pathways. Conclusions: The present study investigated the shared vital genes and pathways between different stages of NAFLD, which may facilitate understanding NAFLD mechanisms and identifying potential therapeutic targets in this disease.
Bilateral Lumbar Erector Spinae Plane Block for Pain Control in Open Ureteric Repair and Reimplant: A Case Report
Authors: Angeletti Chiara , De Martinis Giulia , D'Agostino Massimiliano Luca , Carrocci Chiara , Scimia Paolo , Marinangeli Franco
Published: July 2022

Introduction: Lower abdominal surgery often leads to severe postoperative pain and challenge for anesthetists regarding its management. A multimodal approach with regional anesthesia techniques might be an opportunity. Erector spinae plane block (ESPB) is usually used for pain management in thoracic and abdominal surgery. New surgical indications are increasingly suggested for lumbar ESPB (spine and urological surgery) both in pediatric and adult procedures. In this case report, we present the results of the fascial block at the lumbar spine in an adult patient for lower abdominal surgery. The purpose of this procedure is to offer the patient an alternative to neuraxial anesthesia/analgesia and opioid-sparing anesthesia. Case Presentation: Bilateral lumbar ESPB in a 46-year-old female patient scheduled for bilateral open ureteral reimplantation surgery after iatrogenic injury was performed at the Civil Hospital of Teramo in Italy (January 2022). Postoperative pain evaluation reported a substantial absence of pain. The patient was promptly mobilized, and the postoperative course was free of complications. There was no additional opioid administration. Conclusions: To the best of our knowledge, this has been the first described lumbar ESPB case for intraoperative and postoperative analgesia in adult bilateral ureters replacement and reimplantation after iatrogenic injury. We suggest bilateral lumbar ESPB, as already reported for numerous lower abdominal surgeries, as a valid alternative in perioperative pain management in adults’ ureteral reimplant.
Correlation Between Stress, Anxiety and Depression of Patients with Rheumatoid Arthritis During COVID-19 Pandemic and Their Non-compliance to Treatment: A Cross-sectional Study
Authors: Tasorian Baharak , Tabatabaei Mohsen , Shayganfard Mehran
Published: July 2022

Background: The prevalence of anxiety and depression is high in rheumatoid arthritis (RA) patients. As RA patients tend to be immunodeficient, they are at greater risk of coronavirus disease 2019 (COVID-19) infection due to their scheduled hospital appointments. Therefore, they have become more anxious and worried during COVID-19 pandemic, and some patients recently have canceled or postponed their treatment. Objectives: This study aimed to assess the effect of stress, anxiety, and depression due to COVID-19 outbreak on non-compliance to treatment among RA patients. Methods: In this cross-sectional study, we included 149 RA patients (male/female = 12: 137). Four questionnaires, including the 21-item Depression, Anxiety, and Stress Scale (DASS-21), 14-item Perceived Stress Scale (PSS-14), 18-item Health Anxiety Inventory (HAI-18), and 8-item Morisky Medication Adherence Scale (MMAS-8) were employed. The questionnaires were filled by the researchers on behalf of the participants using telephone interviews due to social distancing protocol. Results: There was a significant negative correlation between stress (P = 0.001), anxiety (P < 0.001), health anxiety (P = 0.014), and depression (P = 0.001) and compliance to treatment among RA patients. However, anxiety was the only predictor for non-compliance to treatment. Conclusions: Therapists should be aware of the symptoms of stress, anxiety, and depression among their RA patients, especially during stressful life events, and carefully monitor their compliance to treatment to prevent exacerbation of RA.