bluuebunny/crossref_metadata_2025 huggingface dataset:
The Charlie Gard Case, and the Ethics of Obstructing International Transfer of Seriously Ill Children
Authors: Wilkinson Dominic
Published: July 2020

In 2017, the court case over medical treatment of UK infant, Charlie Gard, reached global attention. In this article, I will analyze one of the more distinctive elements of the case. The UK courts concluded that treatment of Charlie Gard was not in his best interests and that it would be permissible to withdraw life-sustaining treatment. However, in addition, the court ruled that Charlie should not be transferred overseas for the treatment that his parents sought, even though specialists in Italy and the US were willing to provide that treatment. Is it ethical to prevent parents from pursuing life-prolonging treatment overseas for their children? If so, when is it ethical to do this? I will outline arguments in defense of obstructing transfer in some situations. I will argue, however, that this is only justified if there is good reason to think that the proposed treatment would cause harm.
Reflections on Charlie Gard and the Best Interests Standard From Both Sides of the Atlantic Ocean
Authors: Ross Lainie Friedman
Published: July 2020

Charlie Gard (August 4, 2016, to July 28, 2017) was an infant in the United Kingdom who was diagnosed with an encephalopathic form of mitochondrial DNA depletion syndrome caused by a mutation in the RRM2B gene. Charlie’s parents raised £1.3 million (∼$1.6 million US) on a crowdfunding platform to travel to New York to pursue experimental nucleoside bypass treatment, which was being used to treat a myopathic form of mitochondrial DNA depletion syndrome caused by mutations in a different gene (TK2). The case made international headlines about what was in Charlie’s best interest. In the medical ethics community, it raised the question of whether best interest serves as a guidance principle (a principle that provides substantive directions as to how decisions are to be made), an intervention principle (a principle specifying the conditions under which third parties are to intervene), both guidance and intervention, or neither. I show that the United Kingdom uses best interest as both guidance and intervention, and the United States uses best interest for neither. This explains why the decision to withdraw the ventilator without attempting nucleoside bypass treatment was the correct decision in the United Kingdom and why the opposite conclusion would have been reached in the United States.
Acute Fulminant Myocarditis in a Pediatric Patient With COVID-19 Infection
Authors: Lara Diego , Young Thomas , Del Toro Kamill , Chan Victor , Ianiro Cora , Hunt Kenneth , Kleinmahon Jake
Published: July 2020

The majority of patients with coronavirus disease 2019 (COVID-19) display pulmonary disease; however, a significant portion of patients have cardiac injury as well, with a high incidence of myocarditis documented in the adult population. Pediatric disease from COVID-19 has been relatively rare, and no cases of virus-related cardiac disease have been published. We present a case of an adolescent girl with fulminant myocarditis with complete heart block, elevated troponin I levels, and severely depressed systolic function in the setting of COVID-19 infection.
Constipation
Authors: LeLeiko Neal S. , Mayer-Brown Sarah , Cerezo Carolina , Plante Wendy
Published: July 2020

Constipation in otherwise healthy infants and children is a common problem despite confusion about how to precisely define constipation and constipation-related disorders. Constipation may, rarely, be a sign or symptom of a more serious disease or a diagnosis defined only by its symptoms and without any structural or biochemical findings. In the latter case it is classified as a functional gastrointestinal disorder (FGID). FGIDs are defined as disorders that cannot be explained by structural or biochemical findings. The Rome Foundation has standardized diagnostic criteria for all FGIDs. The Rome criteria are based on the available research as well as the clinical experience of the Foundation’s assembled experts. The most recent report, Rome IV, described clinical criteria and diagnostic tools and encouraged more rigorous research in the area of FGIDs. The true incidence and prevalence of constipation is difficult to know because it may be treated at home using home remedies or diagnosed at a visit to a primary care provider or to a subspecialist pediatric gastroenterologist. The most recent attempts to define the prevalence of all pediatric FGIDs have been made using the Rome IV criteria. The defined FGID entities that may be associated with the complaint of constipation are infant dyschezia, functional constipation, and nonretentive fecal incontinence. The term encopresis, omitted from Rome IV, is defined by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The 3 Rome-defined (constipation-related) entities and the APA entity of encopresis are the focus of this review.
Hyperlipidemia
Authors: Stewart Jeremy , McCallin Tracy , Martinez Julian , Chacko Sheebu , Yusuf Shabana
Published: July 2020

Cardiovascular disease remains the top cause of morbidity and mortality in the United States. Atherosclerotic plaques are known to start in adolescence, and, therefore, young adults can be affected by coronary artery disease. Children with known risk factors, such as genetic predisposition, including familial hyperlipidemias, diabetes, and renal diseases, are at higher risk. With childhood obesity becoming an epidemic in certain parts of the United States, this problem is further highlighted as an important issue affecting children’s health. There are unclear recommendations for pediatricians regarding cholesterol screening of pediatric populations, when to initiate hyperlipidemia treatment with statin therapy, and when to refer to a specialist for further management. This article reviews the epidemiology and pathophysiology of hyperlipidemia, recommendations for screening and types of screening, management (including pharmacology), prognosis, and prevention.
Applying plant disturbance indicators to reveal the hemeroby of soil macrofauna species
Authors: Yorkina N. V. , Podorozhniy S. M. , Velcheva L. G. , Honcharenko Y. V. , Zhukov O. V.
Published: July 2020

Hemeroby is an integrated indicator for measuring human impacts on environmental systems. Hemeroby has a complex nature and a variety of mechanisms to affect ecosystems. Hemeroby is often used to assess disturbances in different vegetation types but this concept has seldom been evaluated for animals. The role of the hemeroby gradient in structuring the soil macrofauna community was investigated. The experimental polygon was located in Botanical Garden of the Oles Honchar Dnipro National University (Dnipro City, Ukraine). There were 20 sites within the polygon. On each of them at 105 points samples of soil macrofauna were taken, soil penetration resistance, electrical conductivity of soil, depth of litter, height of grasses were measured. Within each site, a description of the vegetation cover was made. Based on the description of the vegetation, an indication of the level of ecosystem hemeroby within the polygons was conducted. In total, 48,457 invertebrate (Annelida, Arthropoda, and Mollusca) individuals of 6 classes, 13 orders, 50 families and 83 species or parataxonomic units were recorded. Phytoindication reveals that the level of hemeroby within the studied polygons varies from 34.9 to 67.2. The model V and VI from the HOFJO-list were the most optimal model of the species response to hemeroby gradient. The weighted average factor value was used to assess the optimal factor level for the species in a symmetrical bell-shaped response model. The optimal factor level of the hemeroby for the soil macrofauna species ranges from 34.9 to 66.0. Species also differ in degree of specialization to the factor of hemeroby. There was a regular change in the soil macrofauna community size and diversity in the hemeroby gradient. The limiting influence of anthropogenic transformation of the environment on the abundance of soil macrofauna community is clearly marked at the level of hemeroby above average. Species diversity of the community is greatest at moderate hemeroby level. Both relatively little transformed habitats and strongly transformed ones are characterized by lower species richness of the soil macrofauna community. The Shannon index shows a clear upward trend with increasing hemeroby. The Pielou index indicates that the main reason for this trend is an increase in community evenness with increasing hemeroby. The intermediate disturbance hypothesis was fully supported with respect to species richness. For the number of species, there is indeed a certain level of heterogeneity at which the number of species is highest. For another aspect of diversity, evenness, this pattern is not true. The evenness increases with increasing habitat disturbance. This result is due to a decrease in the abundance of dominant species.
Modeling the processes of atom structure formation of a superconducting spin valve
Authors: Vakhrushev A. V , Fedotov A. Yu , Savva Yu. B , Sidorenko A. S
Published: July 2020

The paper considers the modeling of a multilayer nanocomposite, the combination of elements of which gives rise to a spin valve effect. The relevance and importance of effects in the field of spintronics and related materials and devices are described. We study the composition and atomic structure of individual layers of a multilayer nanocomposite, as well as the composition and morphology of the interface of nanocomposite layers. We analyzed a sample with a periodic superconductor-ferromagnet structure consisting of more than 20 alternating layers of niobium and cobalt. The deposition process took place in a deep vacuum. The simulation was carried out by the molecular dynamics method using the potential of the modified immersed atom method. The formation of layers was carried out in a stationary mode. The temperature was adjusted using the Nose-Hoover thermostat. The deposition of each nanofilm ended with a relaxation stage for the necessary stabilization and restructuring of the formed nanocomposite. Three deposition temperature regimes were considered: 300 K, 500 K, and 800 K. For these modes, we analysed the atomic structure of nanofilms and transition regions (interface) formed between the layers. A study of the atomic structure of nanofilms showed that niobium is formed by crystalline regions of different orientations. A cobalt nanofilm is characterized by a structure close to amorphous. The structural features of the interface between the superconductor-ferromagnet layers largely depend on a relief of the surface onto which the deposition is made. The smallest variation in atomic composition is observed in the first niobium-cobalt contact zone, since the formation of the first nanofilm occurs on an even plane of the substrate. An analysis of the influence of the temperature regime during the formation of the nanosystem shows the dependence of the processes of formation of multilayer nanofilm formation, the interface of nanolayers, as well as the composition and morphology of heterostructures on the temperature at which a nanocomposite is manufactured. An increased temperature leads to the formation of a more rarefied structure of nanolayers and an increase in the zones of the interface of nanolayers due to the diffusion of atoms of the sprayed materials.
The effect of replacing non-analytic trajectories with break points on smooth paths to the complexity of deformation and loading processes of materials
Authors: Zubchaninov V. G , Alekseev A. A , Gultiaev V. I
Published: July 2020

This article is devoted to an experimental study of the effect of rounding off corner points of two-link strain trajectories on complex loading processes during elastoplastic deformation of materials. Replacing corner points in their vicinity with local sections of circles allows a nonanalytic trajectory to be replaced with a smooth trajectory. Experimental studies were performed on thin-walled tubular specimens of the low-carbon steel St3 on an SN-EVM automated testing system. The loading programs for tubular specimens were set in the Ilyushin's deviatoric strain space. The rounding of the corner point of a two-link strain trajectory with an angle of 90° between the branches by arcs of circles with curvatures of 200, 400, as well as the rounding of the corner point of a two-link strain trajectory with an angle of 135° between the branches by arcs with curvatures of 400, 800 are considered. The experimental data characterizing the vector and scalar properties of the material are presented. The experimental data show that the effect of complex loading on the relationship between stresses and strains in a curved section is not immediately apparent. In the curved section, the magnitude of the stress vector modulus first increases, and then decreases with the formation of stress dives. The minimum point of the stress dive is located on the next straight branch of the strain trajectory. In the curvilinear section, the angle of delay increases, and in the next straight branch it decreases, and with the increase of the strain it tends to be zero. The rate of decrease of the angle of delay depends little on the differences in the geometry of the previous history of strain trajectory. In the second straight branch, the experimental results for a smooth and original two-link strain trajectories become little distinguishable from each other. Thus, replacing the original non-analytical strain trajectory to a smooth trajectory affects the complexity of the process of deformation and loading of the materials only in the vicinity of the corner point. This circumstance can be taken into account when numerically modeling the processes of elastoplastic deformation of materials and integrating the defining relations, replacing nonanalytic trajectories with smooth ones. This can be taken into account in the numerical calculation of elastic-plastic deformation and integration of constitutive relations, replacing non-analytical strain trajectories by smooth ones.
Numerical Modeling of Electroelastic Fields in the Surface Piezoelectric Luminescent Optical Fiber Sensor to Diagnose Deformation of Composite Plates
Authors: Pan’kov A. A , Pisarev P. V
Published: July 2020

We developed a three-dimensional numerical model of a piezoelectric luminescent optical fiber sensor fixed on a composite’s plate. The computational region of the sensor is the optical fiber with two concentric (with 6 sectors) shells of electroluminescent and piezoelectric materials, two control electrodes on interface surfaces, such as optical fiber-electroluminophore and piezoelectric-cover. The external sensor’s cover is made in the form of a semi-elliptic cylindrical polymer shell, which rectangular base is fixed on the surface of the fiberglass plate. In the piezoelectric shell sectors, the polarization directions of the PVDF transversal-isotropic polymer piezoelectric are different and non-planar for any three sectors. Deformation of the plate causes deformation of the sensor fixed on its surface, as well as the occurrence of informative piezoelectric fields in it, thus the occurrence of informative glows of electroluminescent elements. As a result, we find the requested information about the combined deformed state of the composite plate along the length of the sensor based on the digital processing of the integral intensities of the polychrome light signals at the output of the optical fiber. In simple cases of electric and mechanical loads, we present new numerical results of simulating the distribution of non-uniform electroelastic fields in the sensor multiphase volume, the sensor’s external cover and inside fragment of the composite plate. Loading of the sensor-covering-plate system is performed by controlling electric voltage on the sensor’s electrodes and the plate’s mechanical deformation by stretching along the transverse and longitudinal axes, as well as by twisting around these axes and bending in transverse and longitudinal planes. Numerical values of the control and informative transfer coefficients of the piezoelectric luminescent optical fiber sensor are determined, which makes it possible to perform a reliable and high-precision diagnostics of complex deformations of the composite plates and design sensors of this type.
Nonlinear dynamics and stages of damage of Ti6Al4V and Ti45Nb titanium alloys in very high cycle fatigue
Authors: Bannikov M. V , Oborin V. A , Bilalov D. A , Naimark O. B
Published: July 2020

The paper presents an experimental methodology aimed at evaluating a very-high cycle resource for aviation titanium alloys Vt-6 (Ti6Al4V) and Ti45Nb for medical applications with different microstructures (large-crystal and submicrocrystalline ones). The submicrocrystalline (SMC) state was obtained by an intensive plastic deformation realized in two ways: the three-dimensional forging for Ti45Nb and radial-shear rolling for Ti6Al4V. The experimental program tests high-cycle and very-high-cycle loading (number of cycles 107-109) realized using the in situ determination method of the accumulation of the irreversible fatigue damage by analyzing nonlinear forms of feedback in a closed system ultrasonic fatigue setup. This makes it possible to establish the connection of the microscopic fatigue mechanisms with the model views and consider the stages of the damage development based on the nonlinear kinetics of the defect accumulation under cyclic loading in high- and gigacycle fatigue modes. We established various relations between changes in the amplitude of the second harmonic of vibrations of the free end of the samples with different internal structures, which are associated with the mechanisms of stress relaxation and damage accumulation. The grain size reduction in Ti45Nb alloy by the three-dimensional forging improved the fatigue properties by 1.3-1.5 times, whereas for VT-6 alloy, the radial-shear rolling method could not increase the fatigue properties in the very high cycle fatigue range, which may be caused by the presence of large residual internal stresses. Based on the scale parameters obtained earlier from the fracture surface morphology and the relations established in this work, the kinetic equations for the origin and growth of fatigue cracks in the gigacycle loading range will be constructed. This equation, based on the empirical power parameters related to the structure of the material, will allow us to determine the number of cycles for the origin of an internal crack and its growth to the surface.
Teoretyczny i praktyczny wymiar międzynarodowej konkurencyjności gospodarki
Authors: Rubaj Piotr
Published: July 2020

Objective: To link scientific information on international competitiveness with its potential application in economic policy.Research Design & Methods: The article presents an analysis of theoretical and practical aspects of international competitiveness, a presentation of ways of measuring this phenomenon and description of factors determining it. It discusses and presents key information on selected international competitiveness rankings.Findings: The analysis of information contained in international competitiveness rankings can be of key importance for improving the efficiency of state structures.Implications / Recommendations: International economic competitiveness is among the most important issues in economics due to the key importance of foreign trade for a nation’s development and the living standards of its inhabitants.Contribution: The article justifies the conducting and analysing of international competitiveness rankings. The resulting practical guidelines can indicate the directions reforms should take and how to improve the quality of a nation’s decision-making processes.
The Right of Reflection and Comparison in Mortgage Loan Agreements according to Directive 2014/17/UE and Its Recent Implementation in Spanish Legislation
Authors: Hernández Sainz Esther
Published: July 2020

Objective: This article analyses and critically assesses the new Spanish rules regarding the consumer’s right of reflection previous to concluding a credit agreement for residential immovable property. It also looks at how it makes consumer protection more effective.Research Design & Methods: The article is based on, first, a critical analysis of the Spanish regulation and the existing literature and, second, on a comparison between the European and the Spanish regulation of this institution.Findings: Directive 2014/17/EU of the European Parliament and of the Council of 4 February 2014 on credit agreements for consumers relating to residential immovable property obliges Member States to specify a time period of at least seven days during which the consumer will have sufficient time to compare offers, assess their implications and make an informed decision before entering into a credit agreement. Following a lengthy delay, the Directive was implemented in Spanish legislation on 15 March, through Law 5/2019 on credit agreements relating to residential immovable property. The Directive admits the right of reflection to be articulated as a period of reflection before a credit agreement is concluded, as a period of withdrawal after the conclusion of the credit agreement or a combination of the two. Spanish legislation has chosen the first option but it does not fully respect all the requirements of the Directive.Implications / Recommendations: A period of reflection prior to the conclusion of a mortgage loan agreement is an essential instrument for consumer self-protection because it allows consumers to analyse pre-contractual information in depth, to compare offers, to assess the implications of each offer, and to make an informed decision. It likewise benefits banks and other lenders because it reduces consumer claims, and even benefits the mortgage loan market itself as it increases overall competence. Adequate regulation of this right is essential to sufficiently protect borrowers.Contribution: This article analyses the deficiencies of the Spanish regulation on the right of reflection and formulates proposals for reform.
Kierunki i metody badawcze w rachunkowości behawioralnej i neurorachunkowości
Authors: Gos Waldemar
Published: July 2020

Objective: The study provides an overview of directions in research and selected methods which can be used in neuroaccounting, a branch of behavioural accountancy.Research Design & Methods: The study employs content analysis and deductive and inductive reasoning.Findings: This overview introduces the author’s research on the subject of biological determinants of neuroaccounting.Implications / Recommendations: Behavioural economics is a newer fields of economics, explaining phenomena through the prisms of sociology and psychology. Neuroeconomics, on the other hand, uses research methods typically applied in biology, chemistry and medicine to describe processes that take place in the human brain. Ongoing changes in economics also affect accounting.Contribution: The article examines the notion that behavioural accounting and neuroaccounting are interdisciplinary fields of knowledge where various research methods can be used.
Practical Considerations for Online Open Book Examinations in Remote Settings
Authors: Er Hui Meng , Nadarajah Vishna Devi , Wong Pei Se , Mitra Nilesh Kumar , Ibrahim Zabibah
Published: July 2020

This article was migrated. The article was not marked as recommended. The COVID-19 outbreak has led to lockdown of cities and restricted access to university campuses, and hence face-to-face delivery of education has been disrupted worldwide. In order to continue teaching, learning and assessment activities, academic institutions have embarked on online delivery and assessments using technology. Online open book examination is one of the tools considered during the crisis period to ensure that students' progression in the academic programmes and graduation are not delayed. Its use is supported by literature evidences that show promotion of critical thinking and problem solving skills amongst students. The positive findings from our previous study on the impact of open book examinations on student performance and learning approach have encouraged us to implement online open book examinations in various health professional programmes in our institution during the COVID-19 pandemic. The objective of this paper is to share the practical tips for implementing online open book examinations remotely, in order to ensure the validity, reliability and fairness of the examinations.
Mixed Reality Technology Influences Motivation for Learning in Medical Students
Authors: Michalski Connor , Cowan Melissa , Bohinsky Jonathan , Dickerson Ryan , Plochocki Jeffrey
Published: July 2020

This article was migrated. The article was not marked as recommended. Introduction: Motivation plays an important role in the learning process and strongly influences learning outcomes. However, it remains unclear how the use of technologies like mixed reality (MR) affect student motivation for learning. Our study aims to assess differences in student motivation for learning using MR technology in comparison to large group, didactic learning. Methods: First-year medical students (n = 18) were given a survey to measure three components of motivation: attention, relevance, and confidence. The survey was given after classroom learning on cardiovascular anatomy and physiology was completed, and again after completing a learning activity on the same topic using MR technology. Results: The analysis showed overall student motivation to learn in the classroom and from the MR activity were similar (p > 0.05). However, the specific motivating factors differed between the two instructional methods. Students were motivated to learn using the MR activity because it better held their attention (p < 0.05). In contrast, classroom instruction motivated students to learn primarily because students viewed it as more worthwhile and useful (p < 0.05). There was no difference in student confidence as a motivating factor to learn. Conclusions: These findings suggest MR instructional activities may be designed to motivate student learning by holding their attention because of the variety of interactive learning options it is capable of presenting. However, instructional activities using MR technology may not be perceived by students as being as worthwhile and useful as formal classroom instruction.
High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening
Authors: Clarke Candice , Prendecki Maria , Dhutia Amrita , Ali Mahrukh A. , Sajjad Hira , Shivakumar Oshini , Lightstone Liz , Kelleher Peter , Pickering Matthew C. , Thomas David , Charif Rawya , Griffith Megan , McAdoo Stephen P. , Willicombe Michelle
Published: July 2020

Significance Statement

Strategies to limit acquisition and transmission of SARS-CoV-2 infection in patients with ESKD receiving in-center hemodialysis have been implemented globally. Despite these measures, acute SARS-CoV-2 infection rates confirmed by RT-PCR testing have been high in the United Kingdom. The seroprevalence rate in an in-center hemodialysis adult population has not been reported previously. In a study of 356 patients receiving in-center hemodialysis, the authors report a 36.3% seroprevalence rate. They also found that 40.3% of patients with IgG SARS-CoV-2 antibodies had either asymptomatic infection or undetected disease by PCR testing alone. These findings reveal limitations of current diagnostic screening strategies for active SARS-CoV-2 infection using PCR testing of individuals screened for symptoms prior to dialysis sessions. Effective screening is likely to require a hybrid strategy of PCR and serologic testing.

Background

Strategies to minimize the risk of transmission and acquisition of COVID-19 infection in patients with ESKD receiving in-center hemodialysis have been rapidly implemented across the globe. Despite these interventions, confirmed COVID-19 infection rates have been high in the United Kingdom. Prevalence of asymptomatic disease in an adult hemodialysis population has not been reported. Also, to our knowledge, the development of humoral response to SARS-CoV-2 has not been previously reported in this population. Although serologic testing does not provide information on the infectivity of patients, seroprevalence studies may enable investigation of exposure within dialysis units and hence, assessment of current screening strategies.

Methods

To investigate the seroprevalence of SARS-CoV-2 antibodies in a hemodialysis population, we used the Abbott IgG assay with the Architect system to test serum samples from 356 patients receiving in-center hemodialysis for SARS-CoV-2 antibodies.

Results

Of 356 patients, 121 had been symptomatic when screened before a dialysis session and received an RT-PCR test; 79 (22.2% of the total study population) tested positive for COVID-19. Serologic testing of all 356 patients found 129 (36.2%) who tested positive for SARS-CoV-2 antibodies. Only two patients with PCR-confirmed infection did not seroconvert. Of the 129 patients with SARS-CoV-2 antibodies, 52 (40.3%) had asymptomatic disease or undetected disease by PCR testing alone.

Conclusions

We found a high seroprevalence of SARS-CoV-2 antibodies in patients receiving in-center hemodialysis. Serologic evidence of previous infection in asymptomatic or PCR-negative patients suggests that current diagnostic screening strategies may be limited in their ability to detect acute infection.
Analysis of perioperative cardiac arrest in a rural hospital in Korea
Authors: Kim Young-Mu , Lee Jae-Ho , Kim Hyun-Soo , Kim Jin Sun , Yang Hong-Seuk
Published: July 2020

Background: Perioperative cardiac arrest has been studied in many countries but few related studies have been conducted in Korea. Previous studies were not applicable to rural hospitals due to differences in the demographics between the regions. In the present study, the incidence, mortality, and related factors of perioperative cardiac arrest in a hospital in Youngdong province were analyzed and compared with previous research.Methods: A retrospective study was conducted from the January 1, 2012, to December 31, 2018, on patients who underwent both anesthesia and surgery in our hospital. Patients who received local anesthesia were not included in the study. The collected data included the patient characteristics, anesthesia methods, the American Society of Anesthesiologists physical status, surgical department, emergency status, traumatic status, pre- and post-cardiac arrest medical records, and patient outcomes.Results: A total of 57,746 patients received anesthesia and underwent surgery during the study period, and 28 patients (4.85 per 10,000 anesthesia cases) received cardiopulmonary cerebral resuscitation (CPCR) during or within 24 hours of surgery. Eight patients survived and twenty patients died (3.46 per 10,000 anesthesia cases). There were three anesthesia-related arrests and all of these patients survived. When limiting the analysis to patients with intraoperative CPCR, the incidence and mortality were 1.56, and 1.39 per 10,000 anesthesia cases, respectively.Conclusions: The incidence and mortality of perioperative cardiac arrest in our hospital were higher than those in a recent study in Seoul, demonstrating a regional gap in Korea.
Effects of tranexamic acid on the activity of glutamate transporter EAAT3
Authors: Shin Hyun-Jung , Lee Soo-Young , Na Hyo-Seok , Koo Bon-Wook , Ryu Jung-Hee , Do Sang-Hwan
Published: July 2020

Background: Tranexamic acid (TXA) is the most widely used hemostatic agent in surgical patients. However, when used in a high dose, it could cause a seizure in the postoperative period. The exact effector mechanism behind the seizure triggering remains unknown. Therefore, the authors investigated the effects of TXA on the activity of glutamate transporter type 3 (excitatory amino acid transporter 3; EAAT3), which is the main neuronal glutamate transporter type. Methods: EAAT3 was expressed in Xenopus laevis oocytes through mRNA injection. Oocytes were incubated with diluted tranexamic acid for 72 h. Two-electrode voltage clamping was used to measure membrane currents before, during, and after applying 30 M L-glutamate. Responses were quantified by integrating the current traces and reported in microcoulombs (C). Results were presented as mean  SEM.Results: TXA (30 to 1,000 M) significantly decreased EAAT3 activity. Our kinetic study showed that Vmax was significantly decreased in the TXA group compared with the control group (1.1  0.1 vs. 1.4  0.1 C, n = 18–23, P = 0.043), but the Km did not significantly change (12.7  3.9 M for TXA vs. 12.8  3.8 for control, n = 18–23, P = 0.986).Conclusions: Our results suggest that TXA attenuates EAAT3 activity, which may explain its proconvulsant effect.
Effects of 10-min prewarming on core body temperature during gynecologic laparoscopic surgery under general anesthesia: a randomized controlled trial
Authors: Lee So Young , Kim Soo Jin , Jung Jin-Yong
Published: July 2020

Background: Previous research has shown a beneficial effect of prewarming for preventing inadvertent perioperative hypothermia. However, there are few studies of the effects of a short prewarming period, especially in gynecologic laparoscopic surgery. Methods: Fifty-four patients were randomly assigned to 2 groups. Patients in the non-prewarming group were only warmed intraoperatively with a forced air warming device, while those in the prewarming group were warmed for 10 min before anesthetic induction and during the surgery. The primary outcome was incidence of intraoperative hypothermia.Results: Intraoperative hypothermia was observed in 73.1% of the patients in the non-prewarming group and 24% of the patients in the prewarming group (P < 0.001). There were significant differences in core temperature changes between the groups (P < 0.001). Postoperative shivering occurred in 8 of the 26 (30.8%) patients in the non-prewarming group and in 1 of the 25 (4.0%) patients in the prewarming group (P = 0.024).Conclusions: Forced air warming for 10 min before induction on the operating table combined with intraoperative warming was an effective method to prevent hypothermia in patients undergoing gynecologic laparoscopic surgery.
Effects of various methods of dexmedetomidine administration for sedation in elderly patients undergoing spinal anesthesia: a randomized controlled study
Authors: Jeong Jeong , Jin So Hee , Kim Dong Yeon , Cho Sooyoung , Lee Heeseung , Han Jong In
Published: July 2020

Background: The purpose of this study was to investigate the degree of sedation and the incidence of adverse effects resulting from various methods of administering the initial dose followed by continuous infusion of dexmedetomidine (DEX) for sedation in elderly patients undergoing spinal anesthesia.Methods: In total, 72 patients aged over 65 years who were to be administered spinal anesthesia were randomly allocated into three groups. The initial doses were injected to the groups as follows: group DD, DEX 0.5 μg/kg for 10 min; group MD, midazolam 0.02 mg/kg; and group D, no initial dose. This was followed immediately by infusing a maintenance dose of DEX 0.5 μg/kg/h to all groups.Results: The Bispectral index (BIS) in the D group was significantly higher than in the other two groups. There were no significant differences in the Ramsay sedation scale (RSS) among the groups. The RSS 3 level was reached in 10 min from the start of sedation in MD and DD groups and in 20 min from the start of sedation in D group. Neither bradycardia nor hypotension was observed in any of the groups.Conclusions: Patients in all three groups reached the RSS 3 sedating-effect level. However, the group that received continuous infusion only without the initial dose showed higher BIS than the other two groups and reached the RSS 3 later. No adverse events were observed in any of the groups.
Bleeding properties according to surgical sites during pediatric craniotomy: a retrospective study comparing the two stages of epilepsy surgery
Authors: Lee Bora , Bae Myung Il , Eum Darhae , Ntungi Abel Mussa , Jun Byongnam , Min Kyeong Tae
Published: July 2020

Background: During pediatric epilepsy surgery, due to low circulating blood volume, intraoperative bleeding can result in significant hemodynamic instability, thereby requiring meticulous hemodynamic and transfusion strategies. Knowing the source of bleeding during the procedure would allow medical staff to better prepare the perioperative protocols for these patients. We compared intraoperative bleeding between the first (involving skin to meninges) and second (involving brain parenchyma) stages of epilepsy surgery to investigate the differences between various anatomical sites.Methods: We reviewed the electronic medical records of 102 pediatric patients < 14 years old who underwent two-stage epilepsy surgeries during January 2012–2016. Invasive subdural grids were placed via craniotomy during Stage 1 and the epileptogenic zone was removed during Stage 2 of the surgery. We compared the volume of intraoperative bleeding between these two surgeries and identified variables associated with bleeding using multivariate regression analysis.Results: Both surgeries resulted in similar intraoperative bleeding (24 vs. 26 ml/kg, P = 0.835), but Stage 2 required greater volumes of blood transfusion than Stage 1 (18.4 vs. 14.8 ml/kg, P = 0.011). Massive bleeding was associated with patients < 7 years old in Stage 1 and weighing < 18 kg in Stage 2.Conclusions: The volume of intraoperative bleeding was similar between the two stages of pediatric epilepsy surgery and was large enough to require blood transfusions. Thus, blood loss during pediatric epilepsy surgery occurred at both anatomic sites. This indicates the necessity of early preparation for blood transfusion in both stages of pediatric epilepsy surgery.
Does the minimal occlusive volume technique provide adequate endotracheal tube cuff pressure to prevent air leakage?: a prospective, randomized, crossover clinical study
Authors: Park Ha Yeon , Kim Mina , In Junyong
Published: July 2020

Background: Methods of determining proper endotracheal tube (ETT) cuff pressure to prevent air leakage include the minimal occlusive volume (MOV) technique, which uses auscultation, and the spirometer technique, which directly measures inspiratory and expiratory breathing volumes. Spirometers may measure even small air leakage, therefore, the spirometer technique requires a higher cuff pressure than the MOV technique to completely seal the airway. This study aimed to evaluate the difference in cuff pressure between the two techniques used to seal the airway.Methods: Thirty-five female patients were intubated using an ETT with a cuff, and cuff inflation was performed with both techniques at a 10-min interval in random order—the MOV technique and then the spirometer technique or vice versa. The cuff pressure was measured at each period.Results: The cuff pressures were 16.7 ± 1.2 cm H2O and 18.7 ± 1.3 cm H2O for the MOV and spirometer techniques, respectively. The cuff pressure for the spirometer technique was 2 cm H2O higher than that for the MOV technique and this difference was statistically significant (95% confidence interval, 0.7–3.3; P = 0.003). Considering the upper end (3.3 cm H2O) of the 95% confidence interval and the size of one scale unit (2 cm H2O) of a manometer, the difference in cuff pressure was up to 4 cm H2O in practice.Conclusions: Even though the air leakage sound disappears on auscultation, unlike the previous recommendation, the airway sealing would be completed only by increasing the cuff pressure by approximately 4 cm H2O.
Effects of 10-min of pre-warming on inadvertent perioperative hypothermia in intraoperative warming patients: a randomized controlled trial
Authors: Yoo Jae Hwa , Ok Si Young , Kim Sang Ho , Chung Ji Won , Park Sun Young , Kim Mun Gyu , Cho Ho Bum , You Gyu Wan
Published: July 2020

Background: This study aimed to evaluate the efficacy of 10-min pre-warming in preventing inadvertent perioperative hypothermia, which is defined as a reduction in body temperature to less than 36.0℃ during the perioperative period in intraoperative warming patients. Methods: In this prospective randomized study, 60 patients scheduled for elective surgery under general anesthesia lasting less than 120 min were divided into two groups: the 10-min pre-warming group (n = 30) and the control group (n = 30). Patients in the 10-min pre-warming group were pre-warmed for 10 min in the pre-anesthetic area using a forced-air warmer set at 47ºC. Intraoperatively, we warmed all patients with a forced-air warmer. Body temperature was measured using a tympanic membrane thermometer pre- or postoperatively and a nasopharyngeal temperature probe intraoperatively. Patients were evaluated on the shivering and thermal comfort scale in the pre-anesthetic area and post-anesthesia care unit. Results: The incidences of intraoperative hypothermia and postoperative hypothermia were similar in both groups (10.7% vs. 28.6%, P = 0.177; 10.7% vs. 10.7%, P = 1.000 respectively). Body temperature was higher in the 10-min pre-warming group (P = 0.003). Thermal comfort during the pre-warming period was higher in the 10-min pre-warming group (P < 0.001). However, postoperative thermal comfort and shivering grades of both groups were similar.Conclusions: Ten minutes of pre-warming has no additional effect on the prevention of inadvertent perioperative hypothermia in intraoperative warming patients.
Anesthetic considerations for awake craniotomy
Authors: Kim Seung Hyun , Choi Seung Ho
Published: July 2020

Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.
Quando o emissor é a mensagem: a comunicação de Marcelo Rebelo de Sousa nos incêndios de 2017
Authors: Toniolo Bianca Persici , Gonçalves Gisela
Published: July 2020

Este artigo tem como tema a comunicação oficial de crise da Presidência da República Portuguesa (PRP) durante os incêndios florestais que aconteceram nos meses de junho e de outubro de 2017, conhecidos, respetivamente, como “tragédia de Pedrógão Grande” e “incêndios de outubro”. Os incêndios de 2017 foram os mais nefastos da história de Portugal e receberam uma grande cobertura dos média internacionais. Naquele ano, Portugal foi o país que mais sofreu com os fogos, de acordo com o relatório da União Europeia (2018), tendo sido responsável por, aproximadamente, 90% das mortes causadas por incêndios. O principal fundamento teórico do estudo é a teoria situacional de comunicação de crise (TSCC) (Coombs, 2007). Na TSCC, Coombs (2007) identificou as variáveis envolvidas numa crise e apresentou as estratégias de resposta mais adequadas a serem aplicadas a cada tipo de crise. Por meio do método da análise do discurso, descrevemos e comparamos a comunicação da Presidência da República Portuguesa na gestão dessas duas crises de origens semelhantes (incêndios florestais) separadas por apenas quatro meses (junho e outubro de 2017). A nossa intenção é contribuir para a compreensão das estratégias de resposta propostas por Coombs (2007) quando aplicadas a uma comunicação exclusivamente baseada no modelo de informação pública (Grunig & Hunt, 1984). A investigação concluiu que a PRP optou pela estratégia de gestão do significado (Coombs, 2015) com informações de ajuste e predominância das respostas reparativas primárias da categoria “reconstrução” e subcategoria “compensação”, produzindo a resposta adequada segundo a TSCC (Coombs, 2007). No entanto, observamos que a comunicação de crise da PRP para os incêndios de 2017 é um caso em que as características pessoais do emissor e as variáveis – responsabilidade pela crise, histórico da crise e reputação relacional anterior – foram mais relevantes para a comunicação de crise do que as mensagens propriamente ditas.
A comunicação dos conservatórios superiores de música da Andaluzia
Authors: Haro-Almansa Rosario , Zummeren-Moreno Guillermo van
Published: July 2020

A presente investigação centra-se no estudo das relações públicas nos cinco conservatórios superiores de música da Andaluzia (Espanha), que representam 16% dos centros de educação musical do país: o Real Conservatório Superior de Música Victoria Eugenia de Granada; o Conservatorio Superior de Música Andrés Vandelvira de Jaén; o Conservatorio Superior de Música de Málaga; o Conservatorio Superior de Música Rafael Orozco de Córdoba; e o Conservatorio Superior de Música Manuel Castillo de Sevilha. Neste contexto, realizou-se um estudo sobre a sua comunicação, centrado em dois aspetos: na contextualização dos conservatórios no panorama histórico-nacional (já que são instituições que datam do século XVII) e na análise das suas relações e interações no âmbito interno e externo. A temática foi abordada na perspetiva da comunicação educacional e institucional, através da realização de entrevistas semiestruturadas com membros das equipas de gestão de cada um dos centros; mediante a análise bibliográfica e documental; e recorrendo à análise do conteúdo nas redes sociais (Facebook, Twitter, Instagram e YouTube) e dos sites oficiais de cada instituição. Como resultados, este estudo mostra que as relações públicas dos conservatórios superiores da música, para com os seus públicos, vão para além do campo educacional e permitem definir os conservatórios como geradores e disseminadores de paradigmas do património da sua cidade e da sua comunidade como um todo.
Ensaio sobre o livro “Admirável Mundo Novo” de Aldous Huxley: uma proposta crítica contemporânea
Authors: Silva Ricardo Marinho
Published: July 2020

Em tempos de grande avanço tecnológico e retrocessos no que se refere a aspectos humanos, o “Homo” descrito pela Biologia como “Sapiens” evolui para “Homo Maquinizado”. Essa nova configuração do homem regida pela Ciência, Tecnologia, Capitalismo e Globalização se reflete num novo paradoxo humano: a supervalorização da economia em detrimento da vida, impactando nas relações/configurações do viver. Dessa forma, o presente ensaio tem como objetivo fazer uma análise crítica do livro “Admirável Mundo Novo” de Aldous Huxley, que discute a relação homem que cria um sistema, e, que, quando atravessado pela sua criação, torna-se seu próprio produto no ciclo de se produzir. O livro “Admirável Mundo Novo” trata-se de uma parábola que romantiza a desumanização dos seres humanos. Identifica-se que, desde a sua primeira publicação em 1932, o mundo afundou-se a passos tão largos em direção errada semeando o mercantilismo da vida e a cultura da competitividade que corrói a sociabilidade e destrói os sentimentos intrínsecos da sociedade humana que, se o autor escrevesse hoje a mesma obra, a ficção não estaria a seiscentos anos do presente. E a consequência da liberdade, ou melhor, da simples humanidade, teria se revelado desumana.
Informações pedagógicas de cursos de psicologia em sites de instituições de ensino superior
Authors: Da Silva Gabriela Andrade , Rudá Caio , Martins Victória Dourado , Borges João Paulo Leal , Alves João Pedro Rodrigues , Soares Tárcila Lorrane Fernandes de Sousa
Published: July 2020

Nos últimos 30 anos, o ensino superior brasileiro cresceu vertiginosamente, e cursos de Psicologia apresentaram um dos maiores crescimentos de matrículas. Este artigo objetivou analisar a disponibilidade on-line de informações pedagógicas sobre cursos de Psicologia. Trata-se de estudo exploratório, documental, que analisou estatisticamente as taxas de disponibilidade das informações pesquisadas nos sites das respectivas Instituições de Ensino Superior. Os resultados apontam que cursos públicos e privados incorreram em omissão na publicização de informações relevantes, em desacordo com as noções de transparência e accountability e contrariando disposições legais.