bluuebunny/crossref_metadata_2025 huggingface dataset:
The Implementation of 21st Century Skills as the New Learning Paradigm to the Result of Student’s Career and Life Skills
Authors: Sulistyaningsih Sulistyaningsih , Rahmawati Vebriary Eka
Published: February 2021

Teaching students to learn and to work well with 21st century skills is not only the domain of vocational school (SMK), but also general senior high school (SMA/MA) as well. It is not enough for students to have only core skills in literacy and numeracy in order to succeed as individuals, citizen, or workers. This article deliberates how to implement the 21st century skills as the new learning paradigm for senior high school students. Furthermore, how is the result of those implementations to the student’s career and life skills based on its five elements as the indicators. For the first research question, the study was descriptive and qualitative. For the second research question, the study was descriptive and quantitative. The writer did an observation, which is workplace action research. There is a Career and Life Skills Program for the twelfth grade students of MA NU Walisongo Sidoarjo. The indicator of the scoring result sheet consists of the five elements of skills that comprise the Career and Life Skills (CLS) domain. They are (1) Flexibility and adaptability skills; (2) Initiative and self-direction skills; (3) Social and cross-cultural skills; (4) Productivity and accountability skills; and (5) Leadership and responsibility skills. The result of those implementations to the student’s career and life skills based on its five elements is quite good. At the end, they are expected will be job-ready with the skills most in demand in the 21st century.
Measurement report: An assessment of the impact of a nationwide
lockdown on air pollution – a remote sensing perspective over India
Authors: Pathakoti Mahesh , Muppalla Aarathi , Hazra Sayan , D. Venkata Mahalakshmi , A. Lakshmi Kanchana , K. Sagar Vijay , Shekhar Raja , Jella Srinivasulu , M. V. Rama Sesha Sai , Vijayasundaram Uma
Published: February 2021

Abstract. The nationwide lockdown was imposed over India from 25th March to 31st May 2020 with varied relaxations from phase-I to phase-IV to contain the spread of COVID-19. Thus emissions from industrial and transport sectors were halted during lockdown (LD) which resulted in a significant reduction of anthropogenic pollutants. The first two lockdown phases were strictly followed (phase-I and phase-II) and hence are considered as total lockdown (TLD) in this study. Satellite-based tropospheric columnar nitrogen dioxide (TCN) from the years 2015 to 2020, tropospheric columnar carbon monoxide (TCC) during 2019–2020 and aerosol optical depth (AOD550) from the years 2014 to 2020 during phase-I and phase-II LD and pre-LD periods were investigated with observations from Aura/OMI, Sentinel-5P/TROPOMI, and Aqua-Terra/ MODIS satellite sensors. To quantify lockdown induced changes in TCN, TCC, and AOD550, detailed statistical analysis was performed on de-trended data using student’s paired statistical t-test. Results indicate that mean TCN levels over India showed a dip of 18 % compared to the previous year and also against the 5-year mean TCN levels during the phase-I lockdown, which was found statistically significant (p-value <0.05) against the respective period. Furthermore, drastic changes in TCN levels were observed over hotspots namely the eastern region and urban cities. For example, there was a sharp decrease of 62 % and 54 % in TCN levels as compared to 2019 and against 5-years mean TCN levels over New Delhi with a p-value of 0.0002 (which is statistically significant) during total LD. The TCC levels were high in the North East (NE) region during the phase-I LD period, which is mainly attributed to the active fire counts in this region. However, lower TCC levels are observed in the same region due to the diminished fire counts during phase-II. Further, AOD550 is reduced over the country by ~16 % (Aqua and Terra) from the 6-years (2014–2019) mean AOD550 levels, with a significant reduction (Aqua/MODIS 28 %) observed over the Indo-Gangetic plains (IGP) region with a p-value of
Measurement report: Sulfuric acid nucleation and experimental conditions in a photolytic flow reactor
Authors: Hanson David R. , Menheer Seakh , Wentzel Michael , Kunz Joan
Published: February 2021

Abstract. Nucleation rates involving sulfuric acid and water
measured in a photolytic flow reactor have decreased considerably over a
time period of several years. Results show that the system – flow reactor,
gas supplies and lines, flow meters, valves, H2SO4 photo-oxidant
sources – has reached a baseline stability that yields nucleation
information such as cluster free energies. The baseline nucleation rate is
punctuated by temporary bursts that in many instances are linked to cylinder
changes, delineating this source of potential contaminants. Diagnostics were
performed to better understand the system, including growth studies to assess
H2SO4 levels, chemiluminescent NO and NOx detection to
assess the HONO source, and deployment of a second particle detector to
assess the nanoparticle detection system. The growth of seed particles shows
trends consistent with the sizes of nucleated particles and provides an
anchor for calculated H2SO4 concentrations. The chemiluminescent
detector revealed that small amounts of NO are present in the HONO source,
∼ 10 % of HONO. The second condensation-type particle
counter indicates that the nanoparticle mobility sizing system has a bias at
low sulfuric acid levels. The measured and modeled nucleation rates
represent upper limits to nucleation in the binary homogeneous system,
H2SO4-H2O, as contaminants might act to enhance nucleation
rates and ion-mediated nucleation may contribute. Nonetheless, the
experimental nucleation rates, which have decreased by an order of magnitude
or larger since our first publication, extrapolate to some of the lowest rates
reported in experiments with photolytic H2SO4. Results from
experiments with varying water content and with ammonia addition are also
presented and have also decreased by an order of magnitude from our previous
work; revised energetics of clusters in this three-component system are
derived which differ from our previous energetics mainly in the five-acid and
larger clusters.
Evaluation of satellite retrievals of liquid clouds from the GOES-13
Imager and MODIS over the midlatitude North Atlantic during
NAAMES campaign
Authors: Painemal David , Spangenberg Douglas , Smith Jr. William L. , Minnis Patrick , Cairns Brian , Moore Richard H. , Crosbie Ewan , Robinson Claire , Thornhill Kenneth L. , Winstead Edward L. , Ziemba Luke
Published: February 2021

Abstract. Satellite retrievals of cloud droplet effective radius (re) and optical depth (t) from the Thirteenth Geostationary Operational Environmental Satellite (GOES-13), and the MOderate resolution Imaging Spectroradiometer (MODIS) onboard Aqua and Terra are evaluated with airborne data collected over the midlatitude boundary layer during the North Atlantic Aerosols and Marine Ecosystems Study (NAAMES). The airborne dataset comprises in-situ re from the Cloud Droplet Probe (CDP) and remotely sensed re and t from the airborne Research Scanning Polarimeter (RSP). GOES-13 and MODIS (Aqua and Terra) re values are systematically greater than those from the CDP and RSP by at least 4.8 um (GOES-13) and 1.7 um (MODIS) despite relatively high linear correlations coefficients (r = 0.52–0.68). In contrast, the satellite t underestimates its RSP counterpart by −3.0, with r = 0.76–077. Overall, MODIS yields better agreement with airborne data than GOES-13, with biases consistent with those reported for subtropical stratocumulus clouds. While the negative bias in satellite t is mostly due to the retrievals having been collected in highly heterogeneous cloud scenes, the causes for the positive bias in satellite re, especially for GOES-13, are more complex. Although the high viewing zenith angle (~65°) and coarser pixel resolution for GOES-13 could explain a re bias of at least 0.7 um, the higher GOES-13 re bias relative to that from MODIS is likely rooted in other factors. In this regard, a near monotonic increase was also observed in GOES-13 re up to 1.0 um with satellite scattering angle (ϴ) over the angular range 116°–165°, that is, re increases toward the backscattering direction. Understanding the variations of re with ϴ will require the combined use of theoretical computations along with inter-comparisons of satellite retrievals derived from sensors with dissimilar viewing geometry.
Oxygen budget of the north-western Mediterranean deep- convection region
Authors: Ulses Caroline , Estournel Claude , Fourrier Marine , Coppola Laurent , Kessouri Fayçal , Lefèvre Dominique , Marsaleix Patrick
Published: February 2021

Abstract. The north-western Mediterranean deep convection plays a crucial role in the general circulation and biogeochemical cycles of the Mediterranean Sea. The DEWEX (DEnse Water EXperiment) project aimed to better understand this role through an intensive observation platform combined with a modelling framework. We developed a three-dimensional coupled physical and biogeochemical model to estimate the cycling and budget of dissolved oxygen in the entire north-western Mediterranean deep-convection area over the period September 2012 to September 2013. After showing that the simulated dissolved oxygen concentrations are in a good agreement with the in situ data collected from research cruises and Argo floats, we analyse the seasonal cycle of the air–sea oxygen exchanges, as well as physical and biogeochemical oxygen fluxes, and we estimate an annual oxygen budget. Our study indicates that the annual air-to-sea fluxes in the deep-convection area amounted to 20 molm-2yr-1. A total of 88 % of the annual uptake of atmospheric oxygen, i.e. 18 mol m−2, occurred during the intense vertical mixing period. The model shows that an amount of 27 mol m−2 of oxygen, injected at the sea surface and produced through photosynthesis, was transferred under the euphotic layer, mainly during deep convection. An amount of 20 mol m−2 of oxygen was then gradually exported in the aphotic layers to the south and west of the western basin, notably, through the spreading of dense waters recently formed. The decline in the deep-convection intensity in this region predicted by the end of the century in recent projections may have important consequences on the overall uptake of atmospheric oxygen in the Mediterranean Sea and on the oxygen exchanges with the Atlantic Ocean, which appear necessary to better quantify in the context of the expansion of low-oxygen zones.
Vertical distribution of planktic foraminifera through an oxygen minimum zone: how assemblages and test morphology reflect oxygen concentrations
Authors: Davis Catherine V. , Wishner Karen , Renema Willem , Hull Pincelli M.
Published: February 2021

Abstract. Oxygen-depleted regions of the global ocean are rapidly expanding, with
important implications for global biogeochemical cycles. However, our
ability to make projections about the future of oxygen in the ocean is
limited by a lack of empirical data with which to test and constrain the
behavior of global climatic and oceanographic models. We use
depth-stratified plankton tows to demonstrate that some species of planktic
foraminifera are adapted to life in the heart of the pelagic oxygen minimum
zone (OMZ). In particular, we identify two species, Globorotaloides hexagonus and Hastigerina parapelagica, living within the
eastern tropical North Pacific OMZ. The tests of the former are preserved in
marine sediments and could be used to trace the extent and intensity of
low-oxygen pelagic habitats in the fossil record. Additional morphometric
analyses of G. hexagonus show that tests found in the lowest oxygen environments are
larger, more porous, less dense, and have more chambers in the final whorl.
The association of this species with the OMZ and the apparent plasticity of
its test in response to ambient oxygenation invites the use of G. hexagonus tests in
sediment cores as potential proxies for both the presence and intensity of
overlying OMZs.
The value of short Earth science continuing professional development for trainee primary school teachers
Authors: Balmer Denise
Published: February 2021

Abstract. The paper investigates the potential of Earth science for the development of
primary school science. The evaluation from workshops run by the Earth
Science Education Unit for trainee primary teachers was appraised to assess
the effectiveness of the short continuing professional development (CPD)
programmes over the period 2009–2015. Trainee teacher comments are analysed using thematic analysis, which identified points recognised by Guskey (2000) as being the most important ideas for effective CPD programmes. Despite these workshops being short, lasting generally less than 2 h each, the conclusion reached was that they offered useful teaching ideas, resources and background information which the trainees could and would apply in the classroom.
Global ground strike point characteristics in negative downward
lightning flashes – part 2: Algorithm validation
Authors: Poelman Dieter R. , Schulz Wolfgang , Pedeboy Stephane , Campos Leandro Z. S. , Matsui Michihiro , Hill Dustin , Saba Marcelo , Hunt Hugh
Published: February 2021

Abstract. At present the lightning flash density is a key input parameter to assess the risk of occurrence of a lightning strike in a particular region of interest. Since it is known that flashes tend to have more than one ground termination point on average, the use of ground strike point densities as opposed to flash densities is more appropriate. Lightning location systems (LLSs) do not directly provide ground strike point densities. However, ingesting their observations into an algorithm that groups strokes in respective ground strike points results in the sought after density value. The aim of this study is to assess the ability of three distinct ground strike point algorithms to correctly determine the observed ground-truth strike points. The output of the algorithms is tested against a large set of ground-truth observations taken from different regions around the world, including Austria, Brazil, France, Spain, South Africa and the United States of America. These observations are linked to the observations made by local LLSs in order to retrieve the necessary parameters of each lightning discharge and serves as inputs for the algorithms. It follows that all three of the algorithms perform well, with success rates up to about 90 % to retrieve the correct type of the strokes in the flash, i.e., whether the stroke creates a new termination point or follows a pre-existing channel. The most important factor that influences the algorithms' performance is the accuracy by which the strokes are located by the LLS. Additionally, it is shown that the strokes' peak current plays an important role, whereby strokes with a larger absolute peak current have a higher probability of being correctly classified compared to the weaker strokes.
Plastics in the Indian Ocean – sources, fate, distribution and impacts
Authors: Pattiaratchi Charitha , van der Mheen Mirjam , Schlundt Cathleen , Narayanaswamy Bhavani E. , Sura Appalanaidu , Hajbane Sara , White Rachel , Kumar Nimit , Fernandes Michelle , Wijeratne Sarath
Published: February 2021

Abstract. Plastic debris are the most common and exponentially increasing human pollutant in the world's oceans. The distribution and impact of plastics in the Pacific and Atlantic Oceans have been the subject of many studies but not so for the Indian Ocean (IO). Some of the IO rim countries have the highest population densities in the world and mis-management of plastic waste is of concern in many of these IO rim states. Some of the highest plastic-polluted rivers end up in the IO with all this suggesting that the IO receives a tremendous amount of plastic debris each year. However, the concentration, distribution and impacts of plastics in the IO are poorly understood as the region is under-sampled compared to other oceans. In this review, we discuss sources and sinks, which are specific for the IO as well as unique atmospheric, oceanographic and topographic features of the IO such as reversing wind directions due to the monsoon, fronts and upwelling regions that control plastic distribution. We identified hotspots of possible plastic accumulation in the IO, which were different in the two hemispheres. In the northern Indian Ocean, the majority of the plastic material will most likely end up being beached due to the absence of a sub-tropical gyre, whereas in the southern Indian Ocean, the garbage patch is not well defined and there may be leakage of plastics into the southern Atlantic Ocean. Hotspots of predicted plastic accumulations are identified here as well as the vast knowledge gaps about the plastic issue of the IO and point to the most striking future investigation topics.
An overlooked freshwater source contributed to the extreme freshening
event in the eastern subpolar North Atlantic after 2014
Authors: Hansen Bogi , Larsen Karin Margretha Húsgarð , Hátún Hjálmar , Jónsson Steingrímur , Ólafsdóttir Sólveig Rósa , Macrander Andreas , Johns William , Holliday N. Penny , Olsen Steffen Malskær
Published: February 2021

Abstract. Outflows of low-salinity waters from the Arctic to the upper layers of the subpolar North Atlantic (SPNA) are central in redistributing freshwater from river runoff, melting sea ice, and precipitation. They act to reduce shallow, as well as deep, convection; thereby affecting both biological production and the Atlantic Meridional Overturning Circulation. The two main sources of low-salinity water to the SPNA are the flows through the Canadian Arctic Archipelago and through the Denmark Strait. A potential additional source of low-salinity water is the shelf/slope region south of Iceland, mainly fed by Icelandic runoff. Normally this water passes into the Nordic Seas, but in some periods, it may instead flow into the upper layers of the central parts of the Iceland Basin in the eastern SPNA. This low-salinity water has previously been overlooked as a freshwater supply to the SPNA. Using a range of observational data sets, we show that the conditions for a diversion of this water mass from the south Iceland shelf into the Iceland Basin were favourable during the 2014–2018 period. In those years the Iceland Basin became extraordinarily fresh, characterized by surface salinity lower than previously seen in a 120-year long time series. The event is thought to have been mainly caused by unusual winter wind stress patterns that diverted freshwater from the western SPNA to the eastern basin and caused a zonal shift of the subpolar front. Here, we show that the low-salinity signal near the surface was locally reinforced in the central Iceland Basin by anomalous diversion of low-salinity water originating in the shallow shelf areas south of Iceland and that this can help explain why the surface salinity of the Iceland Basin became so exceptionally low. The diversion was generated by anomalous wind conditions over the Iceland Basin and caused slightly enhanced freshening of the warm waters crossing the Greenland-Scotland Ridge from the SPNA into the Nordic Seas. The low-salinity Icelandic-source water also increased the near-surface stratification and reduced the depth of convection in the Iceland Basin during two consecutive winters with reduced nutrient renewal of near-surface waters as a consequence. Although especially pronounced after 2014, this extra freshwater input probably occurs more generally, which may help explain why the central Iceland Basin may be an oligotrophic region, as has previously been suggested.
The role of religiosity in moderating the influence of servant leadership on job satisfaction
Authors: Jamal Abdul , Budiyanto Budiyanto , Agustedi Agustedi
Published: February 2021

This research aims to analyze the role of religiosity in moderating the influence of servant leadership and job satisfaction on the education office employees’ performances of Pekanbaru City. The sample of the research includes 121 employees and the sampling used a simple random sampling method. This research used closed questionnaires and the results of data are processed using SmartPLS 3.0. The result of the research is: (1) Variable of servant leadership has a significant effect on the employees’ performances, (2) Variable of job satisfaction has a significant effect on the employees’ performances, (3) Variable of religiosity moderating the influences of servant leadership (has a negative significant effect) on the employees’ performance, and (4) Variable of religiosity does not play any moderating role between job satisfaction and employees’ performances.
The moderating role of director’s financial expertise in political connections and corporate financial performance in Pakistan
Authors: Niazi Murtaza Masud , Othman Zaleha , Chandren Sitraselvi
Published: February 2021

Prior theoretical and empirical studies have suggested that political influence affects the application of corporate governance and firm performance enormously. However, several fundamental questions remain to be answered. To fill this knowledge gap,the study's main objectives are examining the direct impact of political connection on firm financial performance in Pakistani non-financial listed companies and the moderating effect of director's financial expertise on political connections and firm financial performance. The study utilised panel data of 220 firms from 2008 to 2017 and used panel corrected standard error regression analysis. The results show that political connection negatively impacted firm financial performance, and director financial expertise as a moderator strengthened the relationship between political connections and firm financial performance. This study's results supported political economy theory in that weak judicial systems and unstable political systems have immense effects on investor’s rights. The study contributes to extending the existing literature on political connection by providing evidence of the impact of politically connected firms on firm performance in an emerging market. The study also deliberates on how the director’s financial expertise contributes towards the relationship. The findings could be generalised to other countries with similar degrees of development and culture.
Decentralization of local self-government under the conditions of administrative-territorial reform in Ukraine
Authors: Siryk Zinoviy , Popadynets Nazariy , Pityulych Mykhaylo , Chakii Olha , Irtyshcheva Inna , Panukhnyk Olena , Hyk Vasyl , Fedotova Yana , Rohozian Yuliia , Lysyak Nataliia
Published: February 2021

The essence of administrative and territorial reform and decentralization reform in Ukraine is to move away from a centralized model of government in the state, ensure the ability of local self-government and build an effective system of territorial power organization in Ukraine based on the principles of subsidiarity, omnipresence and financial self-sufficiency of local self-government. The purpose of the article is to identify areas for improving the effectiveness of the administrative-territorial reform in Ukraine based on assessing the results of its financial decentralization component. Peculiarities of changing the territorial basis of local self-government in Ukraine investigate the necessity of moving from a voluntary amalgamation of territorial communities to the stage of their formation according to clearly defined criteria and providing opportunities for the development of such communities in the future. It focuses on the need to consolidate areas and change the system of interaction of the subregional level with the amalgamated territorial communities at a basic level.
Profitability and value of firm: An evidence from manufacturing industry in Indonesia
Authors: Aryantini Siwi , Jumono Sapto
Published: February 2021

The purposes of this research were to understand the profitability performance and its influencing factors based on DuPont Analysis and the effect toward the value of the firm. As a causality research, the sample data involved were 20 non-banking and finance companies as listed on LQ-45 of Indonesian Stock Exchange (IDX) years of 2014-2018, which could be classified into two types of industry; manufacture and non-manufacture sectors. The research’s quantitative design as a systematic approach of the relation among the variables focusing on the hypothesis testing done by data analysis tools using GLS Regression test of panel data. Profitability determinants of net profit margin, total assets turnover and financial leverage multiplier showed the result of positive and significant effect toward ROE (return on equity), while growth sales ratio showed the negative and significant effect. In terms of the relationship toward value of firm, the ROE and industry types were proven to have significant positive contributions. This implied that the management must be more efficient and effective in managing the company operational activities and minimizing the operational costs and other costs, both in the assets and debt usage to have maximal product results, to increase sales, net income, profit rate and return of equity where they will affect the increasing of investors’ and the market’s trust toward the firms since the increasing of return on equity for the owners and the shareholders. The different characteristics, traits and features of the industry’s types resulted in the different use of strategies in managing the firms’ operational activities. These all affected the increasing value of the firm.
Accounting conservatism: Does business strategy and investment level matter?
Authors: Hassan Nasr Taha
Published: February 2021

This study aims to contribute to the ongoing debate over accounting conservatism through examining whether the corporate strategy can provide a logical justification for the conservatism, and whether this justification is consistent with or contradicts the contractual justification. In this context, the study examines the impact of corporate strategy on the level of conservatism in financial statements, and the impact of the level of conservatism on corporate investment level. Using data from a sample of non-financial Saudi listed companies, the results show that prospector companies are more likely to provide more conservative financial statements, and the level of conservatism influences investment level. The results also show that the integration between corporate strategy and the level of conservatism influence the level of investment. These results suggest that accounting conservatism can be explained in the context of both business strategy and contractual benefits. Also, the results imply that adopting business strategy could influence the financial reporting process.
Cambridge, Carnaval, and the ‘Actually Existing Circularity’ of Plastics
Authors: O'Hare Patrick
Published: February 2021

This article draws on comparative ethnographic research on plastic consumption, (re)use, and disposal in households and collective spaces in Cambridge (England) and Montevideo (Uruguay). Focusing on practices of re-use by individuals and collectives, it argues that these constitute forms of ‘actually existing circularity’ that provide an alternative to circular economy schemes premised on retained corporate ownership. In the context of discussions of the circular economy that are often limited to the macro policy level, this article thus provides a degree of granularity and a focus on everyday practices. Connecting with debates around materiality, it argues both that we must play close attention to the synthetic materials that surround us in everyday life, and that a focus on materials can help demonstrate the way that commodity status can be undone through projects of collective, inventive re-use that spill out beyond the household. Finally, it points to the potentially disenfranchising elements of dominant business-friendly circular economy visions and the way that these might disrupt complex materials pathways and cultures of re-use and repair rather than straight-forward linear economies.
Editorial (4-7)
Authors: Klein Luciana
Published: February 2021

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Coronavirus (Covid-19) and Stock Market: Empirical Analysis with Panel Data Approach
Authors: Topaloglu Emre Esat , Ege Ilhan , Koycu Erol
Published: February 2021

In this study, the relationship between the pandemic and the stock market range of the dates 17-03-2020 and 14-04-2020, when the COVID-19 pandemic was most intense, was examined by panel data analysis method. In this study conducted for Turkey and Belgium, Germany, France, Italy, Spain, United Kingdom, United States, China and Netherland countries where the COVID-19 pandemic is most common, COVID-19 data is based on the total number of cases and the total number of deaths, while stock market data is based on important stock indexes of countries. The results of the study, while a negative relationship was found between total number of cases and the stock market, a positive relationship was found between total number of death and the stock market. This is an indication that market investors are closely monitoring the number of COVID-19 cases, and that the number of cases described significantly affects stock market investments.
De juridisering van goed bestuur
Authors: Kahn Ph.S. , Meersma K.D.
Published: February 2021

De juridisering van goed bestuur. De onstuitbare regelzucht over good governance in de zorg

Er is bij de overheid en het veld veel aandacht voor goed bestuur of good governance. Daarbij bestaat de drang om dit onderwerp zo veel mogelijk in regels te vatten. In dit artikel wordt deze juridisering van het bestuur van zorgorganisaties besproken aan de hand van vier manifestaties daarvan: (aankomende) wetgeving over goed bestuur in de zorg, de Governancecode, de recent veranderde eisen die de IGJ/NZa stellen aan het intern toezicht in hun nieuwe toezichtkader en recente uitspraken van de Governancecommissie over goed bestuur. Bij de auteurs bestaat op zich geen bezwaar tegen regelgeving omtrent governance, maar zij hebben grote moeite met de eindeloze regelzucht omtrent het onderwerp goed bestuur in de zorg.
Kroniek rechtspraak Scheidsgerecht Gezondheidszorg
Authors: van den Ende T.A.M.
Published: February 2021

Kroniek rechtspraak Scheidsgerecht gezondheidszorg. Van medisch specialisten, ziekenhuis en governance

Sinds 1998 zijn in deze kroniek steeds de belangrijkste uitspraken van het Scheidsgerecht Gezondheidszorg behandeld. In de laatste twee kronieken is die focus verschoven naar zowel uitspraken van het Scheidsgerecht Gezondheidszorg als uitspraken van de civiele rechter. De vorming van de medisch-specialistische bedrijven heeft gezorgd voor een andere dynamiek binnen het ziekenhuis. Meer dan voorheen zien we in de jurisprudentie van de civiele rechter maatschapsgeschillen, opzeggingen, toegangsontzeggingen en geschillen die de governance van het ziekenhuis raken.
Opportunities of Circular Economy in a Complex System of Woody Biomass and Municipal Sewage Plants
Authors: Bai Attila , Gabnai Zoltán
Published: February 2021

In this chapter, we present the opportunities and general importance of woody biomass production (forests and short-rotation coppices) and waste management in a common system. Wastewater and different forms of sewage sludge, as energy- and nutrient-rich materials, can contribute to reaching resource efficiency, savings in energy, and reduction of CO2 emissions. Within certain limits, these woody plantations are suitable options for the environmentally sound disposal of wastewater and/or sewage sludge; in addition, they can facilitate the realization of full or partial energy self-sufficiency of the wastewater plant through bioenergy production. Focusing on circular economy, we introduce the aspects of the treatment process and the sizing issues regarding the municipal wastewater treatment and the woody biomass in a complex system. Based on a specific case study, approximately 826 ha of short-rotation coppices (with a 2-year rotation) are required for the disposal of sewage sludge generated by a 250,000 population equivalent wastewater treatment plant. If we look at the self-sufficiency of its energy output, 120–150 ha of short-rotation coppices may be adequate. This complex system can replace the emissions of around 5650 t of CO2 through electricity generation alone and another 1490 t of CO2 by utilizing the waste heat.
Contraversy in the Nursery; or, A Brace of Basterds
Authors: Clemens Justin ,   Philosophy Documentation Center
Published: February 2021

The controversies unleashed by psychoanalysis never seem to stop repeating themselves. If what psychoanalysis has to say is true, then, by its own lights, it has to be controversial. Controversies are thus a privileged place to see this truth and this resistance in violent and lurid action. Take infant experience and bastardry. Every kid is a bit of a bastard, and the establishment of this infantile bastardry conditions subsequent repetitions of the organism: that breast is persecuting me, these are not my real parents, I did not borrow your kettle. Just how much of a bastard is this baby? The answers psychoanalysis comes up with depend on how it formulates the vicissitudes of differential repetitions, formations of the unconscious. Yet there remains something puzzling about repetition: if eros is constantly getting itself into nasty situations as a matter of course, are there still other factors (perhaps even more sinister) at work? Because of his refusal to dismiss his own puzzlement, Jacques Lacan persistently returned to the relation between desire and drive, reformulating his own theory as he went. At one moment, as we shall see, he comes to discriminate between a surprising number of (at least 3!) kinds of death.
Variant Chromophobe Renal Cell Carcinoma
Authors: Cohen Ronald J. , Weinstein Sydney , Robertson Terry , Sellner Loryn N. , Dawkins Hugh J. S. , McNeal John E.
Published: February 2021

Separation of renal cell tumors into different prognostic groups is an imperative function of the diagnostic pathologist. Recently, chromophobe renal carcinoma has been described as a tumor that is morphologically distinct from conventional “clear cell” carcinoma and that has a low metastatic potential. Identification is based on routine light microscopic features and is confirmed by special stains, immunohistochemistry, and electron microscopy. We present a variant of chromophobe renal carcinoma that did not show the typical cytomorphologic features on light microscopy after formaldehyde fixation. After fixation in Solufix (a commercial fixative), these features were recognized and the diagnosis was confirmed. The tumor also showed an unusual form of calcification and psammoma body formation not previously recognized in chromophobe tumors. Molecular biological assessment was inconclusive, but excluded a chromosome 3p deletion usually found in conventional renal carcinoma. The use of a different primary fixative may provide a cost-effective screening tool to detect variant renal tumors and may have important prognostic implications.
Sclerosing Mucoepidermoid Carcinoma of the Parotid Gland
Authors: Fadare Oluwole , Hileeto Denise , Gruddin Yves L. , Mariappan M. Rajan
Published: February 2021

Although mucoepidermoid carcinoma is the most common primary malignancy of the salivary glands, the sclerosing morphologic variant of this tumor is extremely rare, with only 6 reported cases. As its name suggests, sclerosing mucoepidermoid carcinoma is characterized by an intense central sclerosis that occupies the entirety of an otherwise typical tumor, frequently with an inflammatory infiltrate of plasma cells, eosinophils, and/or lymphocytes at its peripheral regions. The sclerosis associated with these tumors may obscure their typical morphologic features and result in diagnostic difficulties. Tumor infarction and extravasation of mucin eventuating in reactive fibrosis are 2 mechanisms of formation that have been suggested as underlying this morphologic variant. We describe herein another case of sclerosing mucoepidermoid carcinoma that was diagnosed in a 44-year-old woman and review the relevant literature. Morphologic evidence in support of the mucin extravasation hypothesis was identified, as small pools of mucin were present throughout the tumor. However, there was no concentration of the mucin pools near the areas with the most viable tumor cells, which would have provided evidence for a temporal sequence that eventuates in lack of mucin in the most sclerotic regions.
Bethesda 2001 Implementation and Reporting Rates: 2003 Practices of Participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology
Authors: Davey Diane D. , Neal Margaret H. , Wilbur David C. , Colgan Terence J. , Styer Patricia E. , Mody Dina R.
Published: February 2021

Context.—The 2001 Bethesda System for the reporting of cervical cytology specimens and the use of new liquid-based and human papillomavirus testing technologies have led to changes in cervical cytology reporting practices.

Objectives.—To analyze current laboratory reporting practices using Bethesda 2001 terminology and to compare results with previous survey data from 1996.

Design.—Questionnaire survey mailed to 1751 laboratories in mid-2003.

Participants.—Laboratories enrolled in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.

Results.—Of the 759 responding laboratories, most (85.5%) had implemented Bethesda 2001 terminology, and the majority had adopted major changes, such as elimination of the benign cellular changes category and the satisfactory but limited category. The median reporting rate for low-grade squamous intraepithelial lesion was 2.1%, compared to a 1996 median rate of 1.6%, but the increase was confined to liquid-based preparations. Reporting rates for high-grade squamous intraepithelial lesion (median, 0.5%) and atypical squamous cells (ASC) had changed little. Most ASC cases were subclassified as “undetermined significance” (median, 3.9%) with ASC, cannot exclude high-grade SIL accounting for a minority (median, 0.2%). The median ratio of ASC to squamous intraepithelial lesions and carcinomas (SIL+) was 1.4 and was lower than the 1996 median ratio of 2.0. Median reporting rates for squamous abnormalities for 2002 were noted to be significantly higher for liquid-based preparations than for conventional smears, while median ASC/SIL+ ratios were lower. Most laboratories offer human papillomavirus testing, but almost half (47%) of laboratories do not know the percentage of positive testing results in patients with ASC.

Conclusions.—Most laboratories have implemented Bethesda 2001 terminology. New criteria and liquid-based methods have led to an increase in low-grade squamous intraepithelial lesion reporting rates and a decrease in ASC/ SIL+ ratios when compared with 1996 data. Liquid-based preparations have higher median squamous intraepithelial lesion rates and lower ASC/SIL+ ratios than conventional smears.
Use of Physician Extenders in Surgical Pathology Practice
Authors: Grzybicki Dana Marie , Vrbin Colleen M. , Reilly Thomas L. , Zarbo Richard J. , Raab Stephen S.
Published: February 2021

Context.—Use of a variety of nonphysician personnel for surgical pathology gross examination is generally known to be increasing, although detailed information regarding nonphysician use is currently unavailable.

Objective.—To measure and describe the use of nonphysician personnel for surgical pathology gross examination in order to gain a better understanding of the current surgical pathology workforce.

Design.—A voluntary, mailed questionnaire containing items related to the use of multiple nonphysician personnel types in surgical pathology was distributed to (1) a cross-sectional sample (n = 968) of US pathologists and (2) a purposive sample of pathologist directors of surgical and/or anatomic pathology (n = 77) located at teaching institutions. Responses were analyzed using descriptive statistics, correlation analyses, the χ2 test, and 1-way analysis of variance. Staffing ratios were calculated for multiple nonphysician personnel types.

Results.—The overall response rate was 22% (n = 225). Of the US sample, 56% of respondents reported using nonphysician laboratory personnel to perform gross examinations, compared with 91% of the directors' sample. The most frequently reported personnel type for both samples was pathologists' assistants, but multiple other personnel types were used as well. Significant associations existed between certain practice types and personnel types used, as well as differences in the scope of responsibilities between personnel types. Calculated staffing ratios were variable across personnel types and were highest for pathologists' assistants.

Conclusions.—The use of a variety of nonphysician laboratory personnel for surgical pathology gross examination is common, particularly in academic pathology practice. Further studies are needed to examine the impact of physician extenders on laboratory efficiency and quality of care.
Use of Polymerase Chain Reaction to Diagnose Tuberculous Arthritis From Joint Tissues and Synovial Fluid
Authors: Titov Alexei G. , Vyshnevskaya Elena B. , Mazurenko Sergei I. , Santavirta Seppo , Konttinen YrjöT.
Published: February 2021

Context.—Tuberculosis of the joints and bones is a significant worldwide problem, often leading to joint and bone destruction. The diagnosis of this disease manifestation is difficult.

Objective.—To assess the role of conventional diagnostics compared to polymerase chain reaction applied to samples obtained at arthroscopy.

Design.—This was an open observational study that was blinded to the microbiologist, histopathologist, and molecular biologist responsible for assessing the main outcome measures.

Patients.—Seven patients (8 samples) with joint and bone tuberculosis and 14 patients (16 samples) with nontuberculous joint and bone disease.

Intervention.—Arthroscopic examination and tissue sample collection.

Main Outcome Measures.—Mycobacterium tuberculosis staining, culture, and histopathologic assessment of caseating granulomas vs polymerase chain reaction.

Results.—Polymerase chain reaction was positive in all cases of true tuberculosis and falsely identified 2 samples as positive, both however, in patients who had lung tuberculosis in the past.

Conclusions.—Conventional bacteriological methods for demonstration of M tuberculosis are not very sensitive and can be time-consuming. Polymerase chain reaction of arthroscopically obtained joint tissue biopsies appears promising in the early diagnosis of tuberculous arthritis.
Correlation of Plasma Coagulation Parameters With Thromboprophylaxis, Patient Characteristics, and Outcome in the MEDENOX Study
Authors: Desjardins Louis , Bara Lucienne , Boutitie Florent , Michel Samama Meyer , Cohen Alexander T. , Combe Sophie , Janbon Charles , Leizorovicz Alain , Olsson Carl-Gustav , Turpie Alexander G. G.
Published: February 2021

Context.—Plasma anti-Xa and anti-IIa activities correlate with the dose of low-molecular-weight heparin, and D-dimer and thrombin-antithrombin complexes are markers of procoagulant activity.

Objective.—To investigate the relationship between plasma coagulation parameters and patient characteristics, including renal function, thromboprophylaxis, and incidence of venous thromboembolism (VTE) in the MEDENOX study population.

Design.—Controlled, multicenter, double-blind, randomized study.

Patients.—Two hundred twenty-four acutely ill medical patients.

Interventions.—Either 20 or 40 mg of enoxaparin administered subcutaneously or a placebo once daily for 10 (±4) days.

Main Outcome Measures.—VTE and plasma anti-Xa and anti-IIa activities, D-dimer, and thrombin-antithrombin levels in blood collected before prophylaxis was given (day 0) and after the last injection of the study drug.

Results and Conclusions.—Anti-Xa activity correlated with the dose of enoxaparin. In patients with mild or moderate renal impairment, there was no significant relationship between anti-Xa activity and the creatinine clearance rate. D-dimer concentrations were lower at day 10 (±4) in the 40-mg group, which had a 63% lower VTE incidence, than at day 0. No venographically confirmed thromboses were found in patients with a normal D-dimer concentration (<0.5 μg/mL [0.5 mg/L]). D-dimer levels were higher in patients with VTE than in those without VTE, but no predictive value could be demonstrated for individual patients.
Clostridium botulinumand the Clinical Laboratorian: A Detailed Review of Botulism, Including Biological Warfare Ramifications of Botulinum Toxin
Authors: Caya James G. , Agni Rashmi , Miller Joan E.
Published: February 2021

Objective.—This review article is designed to thoroughly familiarize all health care professionals with the history, classification, epidemiology, clinical characteristics, differential diagnosis, diagnostic evaluation (including laboratory-based testing), treatment, and prognosis of botulism. It is especially targeted toward clinical laboratorians and includes a detailed enumeration of the important clinical laboratory contributions to the diagnosis, treatment, and monitoring of patients with botulism. Finally, the bioterrorism potential for botulism is discussed, with an emphasis on the clinical laboratory ramifications of this possibility.

Data Sources.—Included medical periodicals and textbooks accessioned from computerized and manual medical literature searches. More than 1000 medical works published from the 1800s through 2003 were retrieved and reviewed in this process.

Data Synthesis.—Pertinent data are presented in textual and tabular formats, the latter including 6 tables presenting detailed information regarding the clinical parameters, differential diagnosis, diagnostic studies, laboratory testing, and therapeutic approaches to botulism.

Conclusions.—Because botulism is such a rare disease, a keen awareness of its manifestations and prompt diagnosis are absolutely crucial for its successful treatment. The bioterrorism potential of botulism adds further urgency to the need for all health care professionals to be familiar with this disease, its proper evaluation, and timely treatment; the need for such urgency clearly includes the clinical laboratory.