bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Close Binary Evolution on the Main-sequence Morphology of Young Star Clusters
Authors: Wang Chen , Langer Norbert , Schootemeijer Abel , Castro Norberto , Adscheid Sylvia , Marchant Pablo , Hastings Ben
Published: January 2020

Star clusters are the building blocks of galaxies. They are composed of stars of nearly equal age and chemical composition, allowing us to use them as chronometers and as testbeds for gauging stellar evolution. It has become clear recently that massive stars are formed preferentially in close binaries, in which mass transfer will drastically change the evolution of the stars. This is expected to leave a significant imprint in the distribution of cluster stars in the Hertzsprung–Russell diagram. Our results, based on a dense model grid of more than 50,000 detailed binary-evolution calculations, show several distinct, coeval main-sequence (MS) components, most notably an extended MS turnoff region, and a group of near-critical rotating stars that is spread over a large luminosity range on the red side of the classical MS. We comprehensively demonstrate the time evolution of the features in an animation, and we derive analytic expressions to describe these features. We find quantitative agreement with results based on recent photometric and spectroscopic observations. We conclude that while other factors may also be at play, binary evolution has a major impact on the MS morphology of young star clusters.
Optimizing Antiplatelet and Anticoagulant Agents in the Perioperative Orthopedic Surgery Patient
Authors: Oh Jennifer J , Robon Matthew J , Akers Wendell S
Published: January 2020

This month's Pharmacology Update addresses advantages, disadvantages and updated recommendations on anticoagulant agents.
Treatment of Foot Drop Using a Dynamic, Non-Rigid Dorsiflexion Foot Litter
Authors: Brumett David , Rouhe Stanley A , Struven James B , Trindade Carmo
Published: January 2020

Various neurologic, muscular, and anatomic disorders may cause a weakness in the dorsiflexion muscle group that often results in the development of foot drop. Evaluation of the Walk Easy Assistor demonstrated the efficacy and therapeutic value of using a dynamic support system to perform the functions of an ankle-foot orthotic for select patients.
Do Team Dynamics Influence the Organizations to Be Innovative?
Authors: Hasan Ikramul , Islam MD. Nazmul , Chowdhury Mohammad Ashraful Ferdous
Published: January 2020

Innovating products or services are not an emerging issue rather a reality in today's marketplace. Organizations are relentlessly chasing innovation to compete with their rivals. Considering these phenomena, literature from the different management studies suggest that to being mechanistic it would better to become organic in its operation. The organic structure of the firm also highlights teamwork as a priority to become successful. This study illustrates the effects of team dynamics and mediating effects of organizational learning on organizational innovativeness. By proposing the conceptual model, the chapter presents different practical implications to the practitioners, researchers, and academicians connected to the industry and can be a source for future research Bangladesh and other developing economies to develop different insights.
Open Innovation Challenges and Coopetition-Based Open-Innovation Empirical Evidence From Malaysia
Authors: Iqbal Jawad , Hameed Waseem Ul
Published: January 2020

Innovation trends are a highly competitive environment, and have been changed and companies are moving towards the open innovation model rather than to follow close or in a traditional innovation model. Therefore, this chapter demonstrated various determinants of open innovation. For this purpose, a survey was carried out among Malaysian small and medium-sized enterprises (SMEs). The outcomes of the survey highlighted that, the success of open innovation model is based on five major elements, namely, 1) motivating spillovers, 2) incorporation of external knowledge, 3) intellectual property management, 4) maximization of internal innovation, and 5) financial constraints. These five elements are the major challenges for companies while adopting open innovation model. More specifically, the phenomenon of coopetition-based open-innovation is emerging rapidly among the companies. Nowadays, by following the open innovation activities, competitors are collaborating with each other rather than to compete.
The Role of Narrative Elements in Gamification Towards Value Co-Creation
Authors: Kit Cheah Wen , Zolkepli Izzal Asnira
Published: January 2020

This article discusses the role of narrative element in gamification towards value co-creation in a crowdsourcing application system. The discourse addresses the gap of knowledge to understand the user motivation and experience to co-create value in a gamified system. Value co-creation is an interactive engagement process that refers to the act of collaborating with a group of intended consumers through a crowdsourcing approach. As the decentralisation of the web enables participation of people to shape the future based on their contributions, understanding Internet users' motivation and experience to co-create value is crucial in ensuring that the initiatives are reciprocated by the intended parties. As gamification has been widely utilised in numerous contexts in order to encourage users to contribute their resources of knowledge and skills, the effectiveness of its elements, namely narrative, remains questionable.
A Hybrid Analysis Method for Train Driver Errors in Railway Systems
Authors: Rekabi Mohammed Manar , Liu Yiliu
Published: January 2020

The main objective of this chapter is to analyze safety in railway systems through studying and understanding the train drivers' tasks and their common errors. Different approaches to classifying and analyzing driver errors are reviewed, as well the factors that affect driver performance. A comprehensive overview of the systems theoretic process analysis (STPA) method is presented, along with how it could be applied for controllers and humans. Quantitative risk assessment, along with some methods for quantifying human errors, are overviewed, and a Bayesian network is selected to study the effects of the identified driver errors. A case study aims to present a detailed quantitative safety analysis at European Train Control System (ETCS) system Levels 1 and Level 2, including driver errors. The STPA and Bayesian methods are combined to identify the hazards and quantify the probabilities of hazards when trains fail to stop at red signals.
The Roles and Challenges of Micro and Small Enterprises in Urban Employment Creation in Ethiopia
Authors: Belay Degwale Gebeyehu , Kifle Moges Yirgabelew
Published: January 2020

This study had the objective of assessing the roles and challenges of micro and small enterprises (MSEs) in urban employment creation in Debre Berhan Town, Amhara Regional State of Ethiopia. Mixed research approach was adopted and both primary and secondary data was collected. The study had a total of 352 respondents who were selected using systematic sampling technique. Tools of data collection were questionnaire, interviews, and focus group discussions (FGDs). The findings of the study revealed that MSEs have indeed contributed significantly in creating urban employment, and in generating income of employees. However, the capacity of creating employment and generating income varies among MSE. While the construction and manufacturing sectors had better employment creation and income generation capacity, trade sector was the least in creating such opportunities. The challenges of MSEs in employment creation include lack of adequate finances, inputs, poor organizational structure and management, poor government support and regulations, and technological challenges.
CANDIDEMIA IN PATIENTS WITH ACUTE LEUKEMIA: ANALYSIS OF SEVEN YEARS’ EXPERIENCE AT A SINGLE CENTER IN CHINA
Authors: Gong Xiaoyuan , Yang Mianzeng , Lin Dong , Wei Hui , Wang Ying , Liu Bingchen , Zhou Chunlin , Liu Kaiqi , Wei Shuning , Gong Benfa , Zhang Guancji , Liu Yuntao , Li Yan , Zao Xingli , Qiu Shaowei , Gu Ruxia , Mi Yingchang , Wang Jianxiang
Published: January 2020

The study of candidemia in Chinese leukemia patients has been limited. This retrospective study aims to investigate the characteristics and prognostic factors of candidemia among leukemia patients in a Chinese chemotherapy center.

From 2009 to 2015, 30 isolates of candidemia were detected in 19 patients with acute leukemia after chemotherapy. The overall incidence of candidemia was 2.12 episode per 1000 admissions. Candida tropicalis was the most common Candida species (n = 17; 89.5%), followed by Candida albicans (n = 2; 10.5%). The most common underlying disease was acute myeloid leukemia (94.7%) and induction chemotherapy phase was the most susceptible stage. The vast majority of candidal infections are endogenous rather than central venous catheter-related. The overall 30-day crude mortality rate was 31.6%. Neutrophil recovery (P = 0.000) and initiation of empiric antifungal treatment before first positive blood culture (P = 0.041) were associated with a significant improvement in overall survival.

Although the incidence of candidaemia appears to be quite low in patients with leukemia submitted to intensive chemotherapy, its high mortality rate continues to be a crucial problem despite the availability of new effective antifungal drugs. Early diagnosis followed by rapid antifungal treatment remains the cornerstone of successful management. Catheter removal should be considered on an individual basis. The widespread use of newer antifungal agents as prophylaxis among patients with acute leukemia may result in a decreased candidemia incidence.
FEBRILE NEUTROPENIA IN ACUTE LEUKEMIA. EPIDEMIOLOGY, ETIOLOGY, PATHOPHYSIOLOGY AND TREATMENT
Authors: Hansen Bent-Are , Wendelbo Øystein , Bruserud Øyvind , Hemsing Anette Lodvir , Mosevoll Knut Anders , Reikvam Håkon
Published: January 2020

Acute leukemias are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient. Patients with chemotherapy-induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular, this applies to extended-spectrum beta-lactamase resistance (ESBL), Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and even carbapenemase-producing Enterobacteriaceae (CPE). International guidelines for the treatment of sepsis in leukemia patients include the use of broad-spectrum Pseudomonas-acting antibiotics. However, one should implant the knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. Here, we discuss infectious diseases in acute leukemia with a major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group. Meticulously and thorough clinical and radiological examination combined with adequate microbiology samples are cornerstones of the examination. Diagnostic and prognostic evaluation includes patient review according to the multinational association for supportive care in cancer (MASCC) and sequential organ failure assessment (SOFA) scoring system. Antimicrobial treatments for important etiological agents are presented. The main challenge for reducing the spread of resistant microbes is to avoid unnecessary antibiotic treatment, but without giving to narrow treatment to the febrile neutropenic patient that reduce the prognosis.
Imaging diagnosis of Crouzon syndrome in two cases confirmed on genetic studies - with a brief review
Authors: Grover Shabnam Bhandari , Bhayana Aanchal , Grover Hemal , Kapoor Seema , Chellani Harish
Published: January 2020

Crouzon syndrome is the most common form of craniofacial dysostosis, characterised by a classical triad of abnormal skull shape, abnormal facies, and exophthalmos. The clinically overt dental abnormalities in these patients, distracts clinicians from the developmental neurological defects and therefore this entity remains relatively under - highlighted in radiology literature. We report and highlight the role of imaging in diagnosis of Crouzon syndrome in two patients, and discuss the relevant differential diagnosis. Moreover, our report is among the few Indian studies in which Crouzon syndrome was confirmed by genetic studies. The classical clinical triad of Crouzon syndrome was observed in both patients. The skull radiographs and cranial CT with 3D reconstruction VRT (Volume rendered technique), revealed characteristic radiological features. Genetic studies reconfirmed the clinical and radiological diagnosis of Crouzon syndrome, in both patients.
Statistical downscaling of water vapour satellite measurements from profiles of tropical ice clouds
Authors: Carella Giulia , Vrac Mathieu , Brogniez Hélène , Yiou Pascal , Chepfer Hélène
Published: January 2020

Abstract. Multi-scale interactions between the main players of the atmospheric water cycle are poorly understood, even in the present-day climate, and represent one of the main sources of uncertainty among future climate projections. Here, we present a method to downscale observations of relative humidity available from the Sondeur Atmosphérique du Profil d'Humidité Intertropical par Radiométrie (SAPHIR) passive microwave sounder at a nominal horizontal resolution of 10 km to the finer resolution of 90 m using scattering ratio profiles from the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) lidar. With the scattering ratio profiles as covariates, an iterative approach applied to a non-parametric regression model based on a quantile random forest is used. This allows us to effectively incorporate into the predicted relative humidity structure the high-resolution variability from cloud profiles. The finer-scale water vapour structure is hereby deduced from the indirect physical correlation between relative humidity and the lidar observations. Results are presented for tropical ice clouds over the ocean: based on the coefficient of determination (with respect to the observed relative humidity) and the continuous rank probability skill score (with respect to the climatology), we conclude that we are able to successfully predict, at the resolution of cloud measurements, the relative humidity along the whole troposphere, yet ensure the best possible coherence with the values observed by SAPHIR. By providing a method to generate pseudo-observations of relative humidity (at high spatial resolution) from simultaneous co-located cloud profiles, this work will help revisit some of the current key barriers in atmospheric science. A sample dataset of simultaneous co-located scattering ratio profiles of tropical ice clouds and observations of relative humidity downscaled at the resolution of cloud measurements is available at https://doi.org/10.14768/20181022001.1 (Carella et al., 2019).
Exploration of Migrants’ Social Life: A Case Study on Bangladeshi Temporary Contract Worker’s in Malaysia
Authors: Uddin Md. Sayed , Mohammed Adam Andani
Published: January 2020

Migrant workers are a different community as they have leave their origin country and entered to a new nation where the social life they had to dealt with differently. Because social life is very important as an individual has hold an ideology, special socio-cultural background and religious affiliation. It is, thus, an important phenomena to assess the perception of migrants about social life, the nature of their involvement in the social setting, the meaning they attach to it and their priorities and preferences in interacting with others. The study is based on the face-to-face interview of 100 Bangladeshis migrant workers who were selected according to two stage sampling procedure. On one stage, an area where Bangladeshi workers reside was selected through random sampling procedure. On the second stage, 100 respondents were selected from the area according to purposive and snowball sampling procedures. The study suggested that adequate measures should be taken to provide pre-departure training on job and Host County’s culture to the expected migrant workers.
Aqueous Extracts of Plants on the Physiological and Sanitary Quality of Chenopodium Quinoa Seeds as an Alternative to Conventional Seed Treatment
Authors: Lidório Henrique Fernando , Sobrinho José Cardoso , Menegaes Janine Farias , Leão José Domingos Jacques , Nunes Ubirajara Russi , Munareto Janete Denardi , Barbieri Geovana Facco , Leivas Angelo Lorensi
Published: January 2020

This work evaluated the effect of aqueous plant extracts from chrysanthemum (Dendranthema grandiflora Tzvelev), cinnamon (Melia azedarach L.) and clove (Syzygium aromaticum L.) in the physiological and sanitary quality of germinating Chenopodium quinoa Willd (quinoa) seeds, as an alternative to seed treatment. The experiment was carried out under laboratory conditions in the year 2018. The experimental design was completely randomized in a 2×10 factorial scheme (two lots of quinoa seeds × ten doses of concentrated plant extracts), with four replicates each. The quinoa seeds were exposed to the plant extracts separately for ten minutes by submersion at the concentrations of 0, 1, 5 and 10%. The variables evaluated were germination, first germination count, field emergence, germination and emergence speed index, seedling length and sanity. The aqueous plant extracts of Dendranthema grandiflora Tzvelev, Melia azadarach L. and Syzygium aromaticum L. used in the quinoa seed treatment raised the emergence speed and the fungi control of these seeds within the variations and situations of each batch. The D. grandiflora extract, in all concentrations used, improved seed germination index, obtaining the highest rate of 70% in seeds treated with 5% concentration compared to the control treatment, which obtained 59%. M. azedarach (10% concentration) is the best treatment for emergence speed improvement, while S. aromaticum (10% concentration) provides the highest control of pathogens: 28% in relation to the control treatment that obtained 75%. These results highlighted the viability of the use of these species with low toxicity to man and the environment as treatment of quinoa seeds.
Category-specific effects in Welsh mutation
Authors: Hammond Michael , Bell Elise , Anderson Skye , Webb-Davies Peredur , Ohala. Diane , Carnie Andrew , Brooks Heddwen
Published: January 2020

In this paper we investigate category-specific effects through the lens of Welsh mutation. Smith (2011) and Moreton et al. (2017) show that English distinguishes nouns and proper nouns in an experimental blending task. Here we show that Welsh distinguishes nouns, verbs, personal names, and place names in the mutation system. We demonstrate these effects experimentally in a translation task designed to elicit mutation intuitions and in several corpus studies. In addition, we show that these effects correlate with lexical frequency. Deeper statistical analysis and a review of the English data suggests that frequency is a more explanatory factor than part of speech in both languages. We therefore argue that these category-specific effects can be reduced to lexical frequency effects.
Transitcriminaliteit en logistieke knooppunten in Nederland
Authors: Madarie Renushka , Kruisbergen Edwin
Published: January 2020

Organized crime at logistical nodes in the Netherlands. Empirical results of the Dutch Organized Crime Monitor

The Netherlands functions as an important source and transit country for international organized drug trafficking. This is in part due to its large logistical nodes in the world economy, like the airport and the seaport. Based on in-depth analyses of sixteen cases of the Dutch Organized Crime Monitor, this article explores how drug traffickers operate at logistical nodes, in particular airports. The results demonstrate that organized crime groups deploy mainly three types of tactics to traffic drugs, namely defying, avoiding, and neutralizing security checks. Occupational embeddedness is manifested through several job-related factors. Autonomy, mobility, and the similarity between legitimate duties and criminal activities facilitate discrete engagement in organized crime activities during work time. Port employees are also attractive to organized crime groups because of their job-related social capital and knowledge.
Hygienic quality, milk yield and basic composition of sheep milk depending on the stage of lactation
Authors: Bielińska-Nowak Sylwia , Czyżak-Runowska Grażyna
Published: January 2020

The aim of the study was to determine the influence of the stage of lactation on the yield and quality of sheep milk. The material for the investigation was milk from morning milking of 30 East Friesian sheep in their third to fifth lactation. Milking began after the lambs were weaned and continued for about 120 days. Milk samples were collected individually from the sheep in three stages of lactation: at its peak, during the stabilized stage and at the end (late) lactation. Daily milk yield, total bacterial count, somatic cell count and the basic composition of the milk were determined. The microbiological quality of the milk was very high and the somatic cell count was favourable. As lactation progressed the somatic cell count increased while microbiological quality remained stable. At the end of lactation a significant increase was noted in the concentration of dry matter, protein and fat, accompanied by a decrease in lactose concentration, in comparison with the peak of lactation. Yield was shown to be negatively correlated with fat (–0.63; p≤0.01) and dry matter (–0.53; p≤0.01) and positively correlated with lactose (0.61; p≤0.01).
The concentration of lead in muscle tissue of wild boars (Sus scrofa) in selected voivodeships in Poland
Authors: Zowczak Michalina , Niedziałek Grażyna , Miler Roman , Salamończyk Ewa
Published: January 2020

The aim of the study was to assess the degree of bioaccumulation of lead in the muscle tissue of wild boars harvested in Poland in six selected voivodeships. The presence of chemical contaminants is one of the criteria for assessing the safety of food products for human consumption. The material consisted of samples taken from wild boars in peak condition during the 2013/2014 season. The animals were shot down in six voivodeships: Lower Silesian, Lubusz, Kuyavian-Pomeranian, Warmian-Masurian, Greater Poland and West Pomeranian. The analysis showed that the acceptable concentration of lead was exceeded in only five cases, which was about 4.5% of the samples. Excessive concentrations occurred in the Greater Poland (1 sample), West Pomeranian (2 samples) and Kuyavian-Pomeranian (2 samples) voivodeships.
A Multimodal Curriculum With Patient Feedback to Improve Medical Student Communication: Pilot Study
Authors: Dubosh Nicole , Hall Matthew , Novack Victor , Shafat Tali , Shapiro Nathan , Ullman Edward
Published: January 2020

Introduction: Despite the extraordinary amount of time physicians spend communicating with patients, dedicated education strategies on this topic are lacking. The objective of this study was to develop a multimodal curriculum including direct patient feedback and assess whether it improves communication skills as measured by the Communication Assessment Tool (CAT) in fourth-year medical students during an emergency medicine (EM) clerkship.

Methods: This was a prospective, randomized trial of fourth-year students in an EM clerkship at an academic medical center from 2016-2017. We developed a multimodal curriculum to teach communication skills consisting of 1) an asynchronous video on communication skills, and 2) direct patient feedback from the CAT, a 15-question tool with validity evidence in the emergency department setting. The intervention group received the curriculum at the clerkship midpoint. The control group received the curriculum at the clerkship’s end. We calculated proportions and odds ratios (OR) of students achieving maximum CAT score in the first and second half of the clerkship.

Results: A total of 64 students were enrolled: 37 in the control group and 27 in the intervention group. The percentage of students achieving the maximum CAT score was similar between groups during the first half (OR 0.70, p = 0.15). Following the intervention, students in the intervention group achieved a maximum score more often than the control group (OR 1.65, p = 0.008).

Conclusion: Students exposed to the curriculum early had higher patient ratings on communication compared to the control group. A multimodal curriculum involving direct patient feedback may be an effective means of teaching communication skills.
Early Impact of the Western Journal of Emergency Medicine CDEM/CORD Special Issue in Educational Research & Practice
Authors: Love Jeffrey , Santen Sally , Way David , Munzer Brendan , Merritt Chris , Ander Douglas , Cyrus John
Published: January 2020

Introduction: In 2015, with a stated goal of disseminating best teaching practices and developing a community of educational scholars, the Council of Emergency Medicine Directors (CORD) and the Clerkship Directors of Emergency Medicine (CDEM) created an annual Special Issue in Educational Research and Practice (Special Issue) in cooperation with the Western Journal of Emergency Medicine. The intention of this study was to analyze the impact of this effort to date.

Methods: Bibliometric data was gathered on all four special issues, 2015-2019, from the Web of Science and then verified with the eScholarship website. Authorship, academic affiliation, date published, article type, and format were tabulated for descriptive analysis. Using metrics from Google Scholar, alternative scholarly impact metrics (altmetrics), and the eScholarship website, the authors identified top articles and grouped them into themes.

Results: Of the 136 articles included in the first four years of the Special Issue, 126 represented peer-reviewed publications with an overall acceptance rate of 25.0% (126/505). Authors from this cohort represented 103 of the 182 (56.6%) Accreditation Council for Graduate Medical Education (ACGME) programs in existence at the time of the inaugural issue. Multi-institutional studies represented 34.9% (44/126) of the peer-reviewed publications. Traditional and alternative publication metrics are reported to assess the impact of articles from the Special Issues.

Conclusion: The Special Issue is a proven outlet to share best practices, innovations, and research related to education. Additionally, the infrastructure of this process promotes the development of individual faculty and a community of teaching scholars.
Teaching Endotracheal Intubation Using a Cadaver Versus a Manikin-based Model: a Randomized Controlled Trial
Authors: Pedigo Ryan , Tolles Juliana , Watcha Daena , Kaji Amy , Lewis Roger , Stark Elena , Jordan Jaime
Published: January 2020

Introduction: The optimal method to train novice learners to perform endotracheal intubation (ETI) is unknown. The study objective was to compare two models: unembalmed cadaver vs simulation manikin.

Methods: Fourth-year medical students, stratified by baseline ETI experience, were randomized 1:1 to train on a cadaver or simulation manikin. Students were tested and video recorded on a separate cadaver; two reviewers, blinded to the intervention, assessed the videos. Primary outcome was time to successful ETI, analyzed with a Cox proportional hazards model. Authors also compared percentage of glottic opening (POGO), number of ETI attempts, learner confidence, and satisfaction.

Results: Of 97 students randomized, 78 were included in the final analysis. Median time to ETI did not differ significantly (hazard ratio [HR] 1.1; 95% CI [confidence interval], 0.7-1.8): cadaver group = 34.5 seconds (interquartile ratio [IQR]: 23.3-55.8) vs manikin group = 35.5 seconds (IQR: 23.8-80.5), with no difference in first-pass success (odds ratio [OR] = 1; 95% CI, 0.1-7.5) or median POGO: 80% cadaver vs 90% manikin (95% CI, -14-34%). Satisfaction was higher for cadavers (median difference = 0.5; p = 0.002; 95% CI, 0-1) as was change in student confidence (median difference = 0.5; p = 0.03; 95% CI, 0-1). Students rating their confidence a 5 (“extremely confident”) demonstrated decreased time to ETI (HR = 4.2; 95% CI, 1.0-17.2).

Conclusion: Manikin and cadaver training models for ETI produced similar time to ETI, POGO, and first-pass success. Cadaver training was associated with increased student satisfaction and confidence; subjects with the highest confidence level demonstrated decreased time to ETI.
Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital
Authors: Chen Carol , Werne Alexander , Osborn Katharine , Vo Holly , George Upendo , Sawe Hendry , Addo Newton , Cruz Andrea
Published: January 2020

Introduction: The World Health Organization recently recognized the importance of emergency and trauma care in reducing morbidity and mortality. Training programs are essential to improving emergency care in low-resource settings; however, a paucity of comprehensive curricula focusing specifically on pediatric emergency medicine (PEM) currently exists. The African Federation for Emergency Medicine (AFEM) developed a PEM curriculum that was pilot-tested in a non-randomized, controlled study to evaluate its effectiveness in nurses working in a public Tanzanian referral hospital. Methods: Fifteen nurses were recruited to participate in a two-and-a-half-day curriculum of lectures, skill sessions, and simulation scenarios covering nine topics; they were matched with controls. Both groups completed pre- and post-training assessments of their knowledge (multiple-choice test), self-efficacy (Likert surveys), and behavior. Changes in behavior were assessed using a binary checklist of critical actions during observations of live pediatric resuscitations. Results: Participant-rated pre-training self-efficacy and knowledge test scores were similar in both control and intervention groups. However, post-training, self-efficacy ratings in the intervention group increased by a median of 11.5 points (interquartile range [IQR]: 6-16) while unchanged in the control group. Knowledge test scores also increased by a median of three points (IQR: 0-4) in the nurses who received the training while the control group’s results did not differ in the two periods. A total of 1192 pediatric resuscitation cases were observed post-training, with the intervention group demonstrating higher rates of performance of three of 27 critical actions. Conclusion: This pilot study of the AFEM PEM curriculum for nurses has shown it to be an effective tool in knowledge acquisition and improved self-efficacy of pediatric emergencies. Further evaluation will be needed to assess whether it is currently effective in changing nurse behavior and patient outcomes or whether curricular modifications are needed.
Women’s Night in Emergency Medicine Mentorship Program: A SWOT Analysis
Authors: Marshall Alison , Sista Priyanka , Colton Katie , Fant Abra , Kim Howard , Lank Patrick , McCarthy Danielle
Published: January 2020

Introduction: Women in emergency medicine (EM) at all career stages report gender-specific obstacles to satisfaction and advancement. Programs that facilitate longitudinal mentoring, professional development, and networking may ameliorate these barriers.

Methods: We designed and implemented a program for female residents, faculty, and alumnae from our EM training program to enhance social support, leadership training and professional mentorship opportunities. An anonymous, online survey was sent to participants at the end of the academic year, using a SWOT (strengths, weaknesses, opportunities, and threats) format. The survey collected free-text responses designed to evaluate the program.

Results: Of 43 invited participants, 32 responded (74.4%). Eight themes emerged from the free-text responses and were grouped by SWOT domain. We identified four themes relating to the “strength” domain: 1) creating a dedicated space; 2) networking community; 3) building solidarity; and 4) providing forward guidance. Responses to the “weaknesses” and “threats” questions were combined due to overlapping codes and resulted in three themes: 5) barriers to participation; 6) the threat of poorly structured events lapsing into negativity; and 7) concerns about external optics. A final theme: 8) expansion of program scope was noted in the “opportunity” domain.

Conclusion: This program evaluation of the Women’s Night curriculum demonstrates it was a positive addition to the formal curriculum, providing longitudinal professional development opportunities. Sharing the strengths of the program, along with identified weaknesses, threats, and opportunities for advancement allows other departments to learn from this experience and implement similar models that use existing intellectual and social capital.
When the Learner Is the Expert: A Simulation-Based Curriculum for Emergency Medicine Faculty
Authors: Binstadt Emily , Dahms Rachel , Carlson Amanda , Hegarty Cullen , Nelson Jessie
Published: January 2020

Emergency physicians supervise residents performing rare clinical procedures, but they infrequently perform those procedures independently. Simulation offers a forum to practice procedural skills, but simulation labs often target resident learners, and barriers exist to faculty as learners in simulation-based training. Simulation-based curricula focused on improving emergency medicine (EM) faculty’s rare procedure skills were not discovered on review of published literature. Our objective was to create a sustainable, simulation-based faculty education curriculum for rare procedural skills in EM. Between 2012 and 2019, most EM teaching faculty at a single, urban, Level 1 trauma center completed an annual two-hour simulation-based rare procedure lab with small-group learning and guided hands-on instruction, covering 30 different procedural education sessions for faculty learners. A questionnaire administered before and after each session assessed EM faculty physicians’ self-perceived ability to perform these rare procedures. Participants’ self-reported confidence in their performance improved for all procedures, regardless of prior procedural experience. Faculty participation was initially mandatory, but is now voluntary. Diverse strategies were used to address barriers in this learner group including eliciting learner feedback, offering continuing medical education credits, gradual roll-out of checklist assessments, and welcoming expertise of faculty leaders from EM and other specialties and professions. Participants perceived training to be most helpful for the most rarely-encountered clinical procedures. Similar curricula could be implemented with minimal risk at other institutions.
Usability of Learning Moment: Features of an E-learning Tool That Maximize Adoption by Students
Authors: Chu Andrew , Biancarelli Dea , Drainoni Mari-Lynn , Liu James , Schneider Jeffrey , Sullivan Ryan , Sheng Alexander
Published: January 2020

Introduction: E-learning is widely used in medical education. To maximize the potential of E-learning tools, every effort should be made to encourage adoption by optimizing usability. We created Learning Moment (LM), a web-based application that integrates principles of asynchronous learning and learning portfolios into a platform on which students can document and share learning experiences that occur during clinical work. We sought to evaluate the usability of LM and identify features that optimize adoption by users. Methods: We implemented LM in August 2016 at a busy, urban, tertiary care emergency department that hosts an emergency medicine residency, robust third and fourth year medical student clerkships as well as a physician assistant student rotation. We conducted a single-center, mix-methods study using the System Usability Scale (SUS) questionnaire and qualitative interviews. We sent e-mail invitations with subsequent reminders to all students who rotated in our emergency medicine clerkship from August 2016 to April 2017 to complete the SUS questionnaire anonymously and to participate in qualitative interviews. We employed purposive sampling to recruit students who used LM during their rotation to participate in our qualitative interviews. We conducted semi-structured interviews with 13 participants (10 individual interviews and one 3-person group interview) between January and March 2017 using an ethnographic approach and utilized a general inductive method to analyze and code for potential themes. Results: Thirty of the seventy students invited to participate completed the SUS questionnaire (Response rate of 42.8%). The mean SUS score is 80.9 (SD 18.2, 80% CI 76.5 – 85.3). The internal consistency of the responses achieved the Cronbach’s Alpha of 0.95. The participants stressed the importance of the following in the adoption of LM: maximal simplicity and usability, compatibility with learning preferences, and department-wide acceptance and integration. Conclusion: The overall perceived usability of LM was high. Our qualitative data revealed important implications for future designers to maximize adoption: include target users in every step of the design and development process to maximize simplicity and usability; build features that cater to a diversity of learning preferences; involve the entire department and find ways to incorporate the tool into the educational infrastructure and daily workflow.
Synchronous Online Journal Club to Connect Subspecialty Trainees across Geographic Barriers
Authors: Musits Andrew , Mannix Alexandra
Published: January 2020

Introduction: Journal club holds a well-respected place in medical education by promoting critical review of the literature and fostering scholarly discussions. Journal clubs are often not available to trainees with niche interests due to the geographic limitations of subspecialty programs such as simulation, medical education, disaster medicine, ultrasound, global health, and women’s health.

Methods: A recurring online journal club was held on a quarterly basis to connect simulation fellows. An online conferencing program with screen-sharing capabilities served as the platform for this scholarly exchange. Articles were presented by fellows supported by more seasoned mentors. We surveyed participants to evaluate the program and provide feedback to the presenter.

Results: The first eight sessions drew participants from across the United States and Canada. The program was highly rated by participants who commented specifically on its value. Presenters were also highly rated, suggesting that fellows, with online support and mentoring, were effective in providing a quality program.

Conclusion: Online synchronous journal clubs can fill an educational niche for subspecialists and their trainees, as demonstrated with this curriculum piloted with simulation fellows. Challenges of scheduling across time zones, distribution of materials, and recruitment of participants can be overcome by a dedicated team of facilitators aided by readily accessible technology.
Maggots, Mucous and Monkey Meat: Does Disgust Sensitivity Affect Case Mix Seen During Residency?
Authors: Schnapp Benjamin , Fleming Emily , Kraut Aaron , Westergaard Mary , Batt Robert , Patterson Brian
Published: January 2020

Introduction: Emergency physicians encounter scenarios daily that many would consider “disgusting,” including exposure to blood, pus, and stool. Physicians in procedural specialties such as surgery and emergency medicine (EM) have lower disgust sensitivity overall, but the role this plays in clinical practice is unclear. The objective of this study was to determine whether emergency physicians with higher disgust sensitivity see fewer “disgusting” cases during training. Methods: All EM residents at a midsize urban EM program were eligible to complete the Disgust Scale Revised (DS-R). We preidentified cases as “disgust elicitors” based on diagnoses likely to induce disgust due to physician exposure to bodily fluids, anogenital anatomy, or gross deformity. The “disgust elicitor” case percent was determined by “disgust elicitor” cases seen as the primary resident divided by the number of cases seen thus far in residency. We calculated Pearson’s r, t-tests and descriptive statistics on resident and population DS-R scores and “disgust elicitor” cases per month. Results: Mean DS-R for EM residents (n = 40) was 1.20 (standard deviation [SD] 1.24), significantly less than the population mean of 1.67 (SD 0.61, p<0.05). There was no correlation (r = -0.04) between “disgust elicitor” case (n = 2191) percent and DS-R scores. There was no significant difference between DS-R scores for junior residents (31.1, 95% confidence interval [CI], 26.8-35.4) and for senior residents (29.0, 95%CI, 23.4-34.6). Conclusion: Higher disgust sensitivity does not appear to be correlated with a lower percentage of “disgust elicitor” cases seen during EM residency.
Amb b de Benjamí
Authors: Vilardell Benjamí
Published: January 2020

Benjamí Vilardell nos deleita en esta experiencia con una redacción poética y sutilmente irónica sobre su ejercicio para la asignatura “Imagen y lenguaje visual”. En la práctica usará la letra que precede su nombre, la “b”, para el diseño de una imagen.
EVOLUHCION
Authors: Senabre Enric , Mayoral Daniel
Published: January 2020

Este trabajo muestra con detalle técnico y conceptual un ejemplo real y próximo de adaptación a los nuevos medios por parte de una redacción y un equipo humanos que han dado el salto de lo analógico a lo digital. Pero más que analizar esa transición del papel a la pantalla, el trabajo se centra en la edición digital actual y su estrategia interactiva en Internet.
Javier Fernández Rivera
Authors: Casado Martínez Carlos , Giménez Ferran
Published: January 2020

Javier Fernández Rivera está convencido que el mundo está en manos de aquellos que tienen el coraje de soñar y de vivir sus sueños. Así pues, no nos extrañará que Coca-Cola acudiera a él para crear Almacén de la ilusión, la campaña de trueque por Internet que la empresa ha impulsado para estas Navidades.
Self-Care Management Behavior of Type 2 Diabetes Mellitus Patients in Indonesian Diabetes Association (Persadia) Depok City
Authors: Setyamarta Natasya , Aryani Denissa Faradita
Published: January 2020

Objective: Type 2 diabetes mellitus (type 2 diabetes) is a chronic disease that requires long-term management throughout the life to prevent acute and chronic complications. Self-care is a fundamental and integral part of diabetes management. Social support obtained from family, health professionals, friends, or diabetic peers may predict good self-care behavior. The purpose of this study was to evaluate the self-care behavior of adult with type 2 DM in Persadia Depok.

Methods: This quantitative study used a cross-sectional design. A consecutive sample of 52 subjects with type 2 DM who joined in Persadia Depok was included. The instrument used to measure self-care behavior is The Summary of Diabetes Self-Care Activities questionnaire

Results: The results showed that self-care behavior of participants in the last seven days is 4,4 days (Median 4.4, Minimal-Maximum 2.6-5.4, 95% CI 4.1-4.5). Self-care was described as “good” in only half of the participant (50%). Self-care behavior was reported good in diet, physical exercise, and taking medication, but it was poor in self-monitoring of blood glucose (SMBG) and foot care.

Conclusion: This study recommended that nurses should enhance education and support to improve patient self-care behaviors especially SMBG and foot care.

 

Keywords: Colon cancer, deep breathing, early mobilization, effective coughing, preoperative education.
A terminal selector prevents a Hox transcriptional switch to safeguard motor neuron identity throughout life
Authors: Feng Weidong , Li Yinan , Dao Pauline , Aburas Jihad , Islam Priota , Elbaz Benayahu , Kolarzyk Anna , Brown André EX , Kratsios Paschalis
Published: January 2020

To become and remain functional, individual neuron types must select during development and maintain throughout life their distinct terminal identity features, such as expression of specific neurotransmitter receptors, ion channels and neuropeptides. Here, we report a molecular mechanism that enables cholinergic motor neurons (MNs) in the C. elegans ventral nerve cord to select and maintain their unique terminal identity. This mechanism relies on the dual function of the conserved terminal selector UNC-3 (Collier/Ebf). UNC-3 synergizes with LIN-39 (Scr/Dfd/Hox4-5) to directly co-activate multiple terminal identity traits specific to cholinergic MNs, but also antagonizes LIN-39’s ability to activate terminal features of alternative neuronal identities. Loss of unc-3 causes a switch in the transcriptional targets of LIN-39, thereby alternative, not cholinergic MN-specific, terminal features become activated and locomotion defects occur. The strategy of a terminal selector preventing a transcriptional switch may constitute a general principle for safeguarding neuronal identity throughout life.
Hair follicle stem cells regulate retinoid metabolism to maintain the self-renewal niche for melanocyte stem cells
Authors: Lu Zhiwei , Xie Yuhua , Huang Huanwei , Jiang Kaiju , Zhou Bin , Wang Fengchao , Chen Ting
Published: January 2020

Metabolites are major biological parameters sensed by many cell types in vivo, whether they function as signaling mediators of SC and niche cross talk to regulate tissue regeneration is largely unknown. We show here that deletion of the Notch pathway co-factor RBP-J specifically in mouse HFSCs triggers adjacent McSCs to precociously differentiate in their shared niche. Transcriptome screen and in vivo functional studies revealed that the elevated level of retinoic acid (RA) caused by de-repression of RA metabolic process genes as a result of RBP-J deletion in HFSCs triggers ectopic McSCs differentiation in the niche. Mechanistically the increased level of RA sensitizes McSCs to differentiation signal KIT-ligand by increasing its c-Kit receptor protein level in vivo. Using genetic approach, we further pinpointed HFSCs as the source of KIT-ligand in the niche. We discover that HFSCs regulate the metabolite RA level in vivo to allow self-renewal of neighboring McSCs.