bluuebunny/crossref_metadata_2025 huggingface dataset:
Paroxetine Treatment of Problematic Pornography Use: A Case Series
Authors: Gola Mateusz , Potenza Marc N.
Published: July 2016

Background

How best to conceptualize problematic pornography use (PPU) and intervene most effectively remain debated, with obsessive–compulsive disorder (OCD) and addiction frameworks. We investigated the efficacy of the serotonin-reuptake inhibitor paroxetine in combination with cognitive-behavioral therapy in the treatment of problematic pornography use (PPU).

Case presentation

Three heterosexual males with PPU were treated with cognitive-behavioral therapy and paroxetine. Frequency of pornography use, other sexual behaviors, and anxiety were assessed during treatment.

Discussion

Paroxetine treatment, although seemingly initially effective in reducing pornography use and anxiety, appeared related to new compulsive sexual behaviors after 3 months.

Conclusions

Paroxetine may hold promise for short-term reduction of PPU and related anxiety, but new potentially distressing sexual behaviors may emerge. The cases suggest that PPU may arise from multiple domains. We propose an explanation of the effects based on recent neuroscientific research on sexual behaviors and alcohol use.
Reliability of the SWAG—The Standardized Way to Assess Grafts Method for Alveolar Bone Grafting in Patients with Cleft Lip and Palate
Authors: Russell Kathleen , Long Ross E. , Daskalogiannakis John , Mercado Ana , Hathaway Ronald , Semb Gunvor , Shaw William
Published: July 2016

Objective

The objective of this study was to test a new method, a Standardized Way to Assess Grafts (SWAG), to rate alveolar bone graft (ABG) outcomes for patients with cleft lip and palate.

Design

This was a retrospective comparison using the SWAG scale.

Setting

This study took place in four cleft palate centers with different treatment protocols.

Methods

A total of 160 maxillary occlusal radiographs taken 3 to 18 months post-ABG for sequentially treated patients with cleft lip and palate were assessed using the SWAG scale. Radiographs were scanned, standardized, blinded, and rated by 6 calibrated orthodontists to assess vertical thirds, bony root coverage, and complete bony fill. All radiographs were rated twice, 24 hours apart, by the same raters.

Main Outcomes

Intra- and interrater reliabilities were assessed.

Results

Intrarater reliability was good to very good (.760; .652–.834), and interrater reliability was moderate to good (.606; .569–.681), comparable to previously published methods.

Conclusions

Rater reliabilities were shown to be comparable to or better than existing methods. The SWAG method was validated for ABG assessments in the mixed and permanent dentitions based on reliabilities in an intercenter outcome comparison.
Evaluation of Ventilation Tube Placement and Long-term Audiologic Outcome in Children with Cleft Palate
Authors: Kim Elissa , Kanack Melissa D. , Dang-Vu Milan D. , Carvalho Daniela , Jones Marilyn C. , Gosman Amanda A.
Published: July 2016

Objective

The purpose of this study was to assess the effect of ventilation tube (VT) placement on long-term hearing outcomes in children with cleft palate.

Study Design

Case series with chart review.

Setting

Genetic and dysmorphology database at Rady Children's Hospital–San Diego (RCHSD).

Patients

Children with cleft palate diagnosis who underwent surgery at RCHSD between 1995 and 2002.

Main Outcome Measure

The primary outcome studied was hearing acuity at 10 years of age. Independent variables studied included gender, age at palate repair and first VT placement, total number of VTs, number of complications, and presence of tympanic membrane perforation.

Results

An increased number of tubes was associated with a greater incidence of hearing loss at age 10, even after adjusting for total number of otologic complications. The timing of initial tube placement did not have a significant effect on long-term hearing outcome in this study.

Conclusions

While children with worse middle ear disease are more likely to receive more tubes and have long-term conductive hearing loss as a result of ear disease, the results of this study suggest that multiple tube placements may not contribute to improved long-term hearing outcomes. Further research focusing on long-term outcomes is needed to establish patient-centered criteria guiding decision making for ventilation tube placement in children with cleft palate.
Antidrug Antibody Formation in Oncology: Clinical Relevance and Challenges
Authors: van Brummelen Emilie M.J. , Ros Willeke , Wolbink Gertjan , Beijnen Jos H. , Schellens Jan H.M.
Published: July 2016

In oncology, an increasing number of targeted anticancer agents and immunotherapies are of biological origin. These biological drugs may trigger immune responses that lead to the formation of antidrug antibodies (ADAs). ADAs are directed against immunogenic parts of the drug and may affect efficacy and safety. In other medical fields, such as rheumatology and hematology, the relevance of ADA formation is well established. However, the relevance of ADAs in oncology is just starting to be recognized, and literature on this topic is scarce. In an attempt to fill this gap in the literature, we provide an up-to-date status of ADA formation in oncology. In this focused review, data on ADAs was extracted from 81 clinical trials with biological anticancer agents. We found that most biological anticancer drugs in these trials are immunogenic and induce ADAs (63%). However, it is difficult to establish the clinical relevance of these ADAs. In order to determine this relevance, the possible effects of ADAs on pharmacokinetics, efficacy, and safety parameters need to be investigated. Our data show that this was done in fewer than 50% of the trials. In addition, we describe the incidence and consequences of ADAs for registered agents. We highlight the challenges in ADA detection and argue for the importance of validating, standardizing, and describing well the used assays. Finally, we discuss prevention strategies such as immunosuppression and regimen adaptations. We encourage the launch of clinical trials that explore these strategies in oncology.
Structural behaviour of reinforced concrete beams with high yield strength stirrups
Authors: Lee Jung-Yoon , Choi Seong-Ho , Lee Do Hyung
Published: July 2016

Primary national codes and standards for reinforced concrete (RC) members and structures specify a limit value of stirrup yield strength. The salient reason for this restriction is to control diagonal crack widths, which lead to shear tension failure. The influence of a high yield strength of stirrups on the failure mode of such members is thus of great concern. To investigate this issue, 12 RC beam specimens incorporating stirrups with high yield strength were tested. The test variables employed in the study were three levels of stirrup spacing and four levels of stirrup yield strength. Assessment of the test results was conducted by analysing the variation of both spacing and number of diagonal cracks due to an increment in the total amount of stirrups. An evaluation of diagonal crack width measured under the service load level was also performed. The test results showed that the diagonal crack width under the service load level is affected by the yield strength of the stirrups and the stirrup spacing. In addition, the number of diagonal cracks increased and the spacing of the cracks reduced as the amount of stirrups was increased. Overall, the average diagonal crack width of all the specimens incorporating high yield strength stirrups was less than the 0·41 mm recommended in ACI 224R-01.
Bangladeshi EFL Learners’ English Connectors: Overused or Underused?
Authors: Faruk Syed Md Golam , Barua Pulak
Published: July 2016

The paper investigates the answer scripts of an “English Writing” exam of 72 students in a Bangladeshi university in order to find out the nature and extent of the use of connectors in their second semester-final exam. It also tries to find out similarities and differences between the connector use of Bangladeshi non-native speakers (BNNS) and that of French, Japanese, Swedish, and Chinese non-native speakers on the one hand and between the connector use of BNNS and that of the native speakers of English (only British and American) on the other. To this end, the secondary data for other non-native and native speakers (NS) of almost the same age and level were collected from some published articles. The paper finds that in comparison to NS, BNNS, like most other non-native speakers, underuse most of the connectors.
An Investigation of Motivation in Children’s Foreign Language Learning Process — A Case Study on the Basis of Needs Analysis
Authors: Wei Na
Published: July 2016

Affective elements in foreign language teaching area involve motivation, anxiety, self-confidence, self-image, inhibition, empathy, etc., all of which lead to differential success among second language learners. However, among all of them, motivation is often recognized as the first major factor. This article makes an investigation of children’s learning motivation on the basis of Needs Analysis and the primary objective of this research is to find how the five needs (according to Maslow) are satisfied in child language learning process and how to stimulate and maintain their motivation to learn through needs satisfaction.
Absurdity and Postmodernism: An Analysis of Barthelme’s The Glass Mountain
Authors: Han Lingeng
Published: July 2016

Barthelme’s Glass Mountain is a masterpiece of postmodernism. As a leading author of his age, Barthelme makes use of techniques of postmodernism, such as parody, pastiche, fragments, and irony, to demonstrate a world of deconstruction and a theme of absurdity. However, the absurdity depicted by Barthelme actually has its profound social meaning, which reflects the author’s real understanding to the reality.
Draft Method for Determining the Number of Checking Devices Utilized within the Regional Passenger Transport
Authors:   Department of Transport and Logistics, Institute of Technology and Business České Budějovice, Czech Republic, Stopka Ondrej , Ponický Ján , Chovancová Mária , Zitrický Vladislav
Published: July 2016

The transportation purpose represents the most important objective of regional passenger transport. The decision on determining the way of the passengers checking is one of the attributes that needs to be considered in relation to the passengers transportation. This issue may be solved by utilizing the checking devices and their appropriate placement. Applying the checking devices inside the transport means represents the establishing the prerequisites for self-check-in method in terms of passengers checking. This article presents the overview of aspects affecting the number of checking devices utilized within the regional passenger transport. For instance: traveled distance, transport means velocity, transport means circuit period and other may be included among these aspects. In the particular article chapter, the method for determining the number of checking devices utilized within the regional passenger transport is outlined.
Perinatal Music Therapy and Antenatal Music Classes: Principles, Mechanisms, and Benefits
Authors: Mastnak Wolfgang
Published: July 2016

Antenatal music activities are in the ascendant. Regarding evidence-based research, the article advocates 5 main aims: music therapeutic control of pre- and perinatal stress, anxiety, and depression; music-related mental and physical birth preparation comprising cognitive adjustment, emotional regulation, physical activity, relaxation and pain management, and social inclusion; music-associated bonding and self-efficacy; prenatal sound stimulation to trigger learning processes, pedagogical priming and brain maturation; music activities to facilitate the child’s acculturation and adaptive self-regulation. Underlying mechanisms such as neuroplasticity help to understand the multifaceted effects of music in pre- and perinatal care. Individual conditions and features of the mother and her child have to be taken into account and music interventions to be harmonized with complementary perinatal programs.
Integrating animals in the classroom: The attitudes and experiences of Australian school teachers toward animal-assisted interventions for children with Autism Spectrum Disorder.
Authors: Smith Bradley P , Dale Ashley A
Published: July 2016

The introduction of animals into school classrooms has been posited as a beneficial intervention for individuals with Autism Spectrum Disorder (ASD).  Whilst evidence that animal-assisted interventions or activities can positively influence classroom behaviour and learning outcomes is emerging, little is known about the experiences and attitudes of those who implement it. We presented a series of open and close-ended questions via an online survey to Australian school teachers working with students on the autistic spectrum. Whether teachers had experienced companion animals in the classroom or not, companion animals were believed to provide a means for improving social skills and engagement within the classroom, as well as decreasing stress, anxiety, and the occurrence of problematic behaviours. Yet, despite an overall positive attitude, and 68% having had animals or pets in their classroom, only 16% of respondents had experience with ‘formal’ animal-assisted interventions. Explanations for why both formal and informal animal-assisted interventions were either not being adopted, or was not currently being considered, included a lack of knowledge, lack of support and resources, reactions of the student in relation to allergies and behaviour, and issues relating to animal welfare. It was also acknowledged that the evidence-base for animal-assisted interventions for students with ASD is currently lacking, and that such interventions were not suitable for all students, or all classroom situations. Moving forward, it is important that the inclusion of companion animals and more formal based animal intervention programs in classrooms be adequately designed and evaluated, because implementing or promoting time consuming and financially costly strategies without the evidence is problematic.
OFERTA DE VAGAS DE GRADUAÇÃO E RESIDÊNCIA MÉDICAS NO ESTADO DO RIO DE JANEIRO A PARTIR DO PROGRAMA MAIS MÉDICOS (2013-2015)
Authors: Da Silva Junior Aluisio Gomes , De Andrade Henrique Sater , Alexandre Gisele Caldas , Alves Márcia Guimarães de Mello , Costa Bruna Dos Reis
Published: July 2016

O Programa Mais Médicos (PMM) se apresenta como uma das principais políticas federais para o fortalecimento da Atenção Primária à Saúde (APS). Entretanto, a dimensão da formação profissional foi pouco avaliada pela literatura. Este artigo teve como objetivo descrever os resultados iniciais do PMM no Estado do Rio de Janeiro em relação ao eixo da formação médica, desde a implantação do PMM. Foi realizada uma análise descritiva a partir de dados coletados do Portal Mais Médicos; do E-MEC e do IBGE. Observamos a tendência crescente de privatização da graduação médica identificada também em outros estudos nacionais. O processo de interiorização das vagas de graduação no Estado é evidente, mas não está clara sua contribuição para a fixação dos médicos nos municípios. A expansão dos programas de residência médica no interior, em especial de MFC, pode diminuir a concentração de médicos na capital do Estado e facilitar a fixação no interior.
Alternativas Técnicas y de Gestión para el Saneamiento en Asentamientos Irregulares: El Caso de San Juan Tulcingo, Puebla
Authors: Flores Lucero María de Lourdes
Published: July 2016

Uno de los rezagos más fuertes en materia de servicios urbanos en los asentamientos irregulares (AI) en Puebla es la falta de la red de saneamiento. Para obtener este servicio suelen pasar muchos años, a veces más de 20, como en nuestro caso de estudio ubicado en San Juan Tulcingo, Puebla. El presente trabajo muestra una parte de los avances de nuestra investigación enfocada al mejoramiento urbano de los AI. En él planteamos la posibilidad de implementar tecnologías alternativas para el tratamiento de aguas residuales, basándonos en una gestión participativa entre gobierno, organizaciones no gubernamentales y la comunidad.
Estados electrónicos para un cascarón cuántico semiconductor de geometría cilíndrica
Authors: Betancourt-Riera Ri. , Betancourt-Riera Re. , Jordán Hernández R. , Riera R.
Published: July 2016

En este trabajo obtenemos los estados electrónicos para un cascarón cuántico semiconductor de geometría cilíndrica obtenido a partir de una matriz de . En este caso hemos asumido que el sistema solo tiene una banda la cual se desdobla en un sistema de sub-bandas debido al confinamiento. Utilizando el formalismo de la masa efectiva determinamos las funciones de onda y las energías de los estados.
El Hidróxido de Calcio y los bloques de tierra comprimida, alternativa sostenible de construcción
Authors: Roux Gutiérrez Rubén Salvador , Espuna Mujica José Adán
Published: July 2016

En la actualidad, en nuestro país se hace mención a que existen una serie de problemas con los programas de vivienda, aún cuando se ha reducido el déficit de vivienda o que se han construido cada año más viviendas en beneficio de las personas de bajos ingresos. Topelson (2011) el presente artículo describe un estudio sobre una alternativa sustentable de edificación y a la vez pretende demostrar las ventajas del uso del hidróxido de cal y los bloques de tierra comprimida (BTC), para la edificación de vivienda y así poder reducir las emisones de CO2 emitidas por los procesos constructivos convencionalesEl presente artículo trata dos materiales elementales en los procesos constructivos de las viviendas, por un lado se realizá el estudio químico de los morteros cal – arena que se utilizán para el pegado de los mampuestos y  los revoques,  con la finalidad de determinar la absorción de CO2 y por otra parte se hace el estudio mecánicos de un  material alternativo para el uso de muros de carga como son los Bloques de Tierra Comprimida estabilizados con cal, por último se hace un comparativo entre estos materiales alternativos y los convencionales con relación a las emisones de CO2.
Vinculación social de los prestadores de servicio social de odontología de la UAGRO en Guerrero
Authors: Beltrán Cuevas José , Quintero Romero Dulce María , González González Justiniano
Published: July 2016

Los padecimientos y el deterioro bucodental incrementan su presencia entre la población a todos los ámbitos: local, regional y nacional, con mayores afecciones en los más pobres, por lo que se han articulado esfuerzos entre instituciones educativas y del Sector Salud a fin de llevar a cabo estrategias, planes y programas enfocados a la salud bucodental. Uno de ellos ha sido el programa de Servicio Social al término de la formación académica  de los profesionales de la odontología como cierre de su etapa formadora. Sin embargo esta práctica profesional, requisito indispensable para su proceso de titulación, es sin duda un proceso que permite a los pasantes el enfrentarse a la realidad odontológica a fin de comprobar si se encuentran listos para el buen desempeño profesional de la odontología.Método: Desde esta perspectiva se realizó un seguimiento a los pasantes de la Escuela Superior de Odontología de Guerrero, de la generación 2005-2010 a quienes se les aplicaron encuestas y se les incorporó a un foro de discusión junto con otros implicados en su formación profesional a fin de discutir realmente la vinculación social de los profesionistas y su problemática, para analizar la pertinencia del Servicio Social en la atención de los problemas de salud de los habitantes  en zonas alejadas y la posibilidad de que a partir de la experiencia, los odontólogos consideren la posibilidad de ejercer profesionalmente en los ámbitos rurales.Resultados: Se encontró que en un principio los pasantes del Servicio Social mostraban una buena disposición para desarrollar sus prácticas profesionales en las comunidades apartadas, lo cual varió al término de su servicio debido a una serie de irregularidades que se presentaron durante el mismo con las que se redujo significativamente el interés de estos profesionistas por laborar profesionalmente fuera de las ciudades.Conclusión: Los resultados muestran la necesidad de revisar la formación y orientación de los profesionales de la odontología de la UAGro, pero sobre todo el que la universidad discuta y acuerde con las instituciones del Sector Salud de los ámbitos nacional, estatal y municipal la articulación de un programa efectivo para la atención de los problemas de salud bucodental en comunidades marginadas.
Talento verde: caracterización y búsqueda
Authors: Torres María Del Carmen
Published: July 2016

Introducción: Los impactos del calentamiento global y el cambio climático son una preocupación en prácticamente todos los sectores de la sociedad, debido a las consecuencias que ya se perciben y que afectarán cada día más a todos los sistemas naturales y creados por el hombre, generalmente de forma negativa. Para revertir estos efectos negativos y no continuar deteriorando el medio ambiente, es necesario un tipo especial de personas que sean capaces de tomar las decisiones adecuadas en los ámbitos en los que se desenvuelven. En esta investigación, estos seres humanos se denominan: personas con “talento verde”. El término talento verde no se ha sido caracterizado y su uso es aun restringido. Esta investigación hace una caracterización del talento verde y propone una encuesta para detectar a las personas que cuentan con estas características. Es importante hacer notar que este trabajo forma parte de una investigación más amplia que busca la relación entre directivos con talento verde y prácticas de cadena de suministro sustentable.Método: La caracterización del talento verde se realizó a través de la metodología de representaciones sociales, de la cual surgieron una serie de preguntas que buscan las características de talento verde en directivos de empresas y que forman parte de una encuesta de mayor cobertura que fue piloteada para su validación. La confiabilidad se midió a través del Alfa de Crombach y la validez por un Análisis Factorial.Resultados: Se encontraron nueve características para las personas con talento verde, de las cuales surgieron también nueve preguntas. Estas preguntas se hicieron a 25 directivos de empresas que participan en la Cámara de la Industria de la Transformación (CANACINTRA) con el objetivo de validar el instrumento. El alfa de Crombrach obtenido fue del 0.948 y el análisis factorial indica que no es necesario reducir la cantidad de preguntas para este bloque.Conclusión: La caracterización del talento verde por medio de representaciones sociales obtenida en este trabajo, esta teóricamente sustentada y es posible buscar estas características a través de preguntas de una encuesta validada estadísticamente. La continuación de este trabajo incluye la aplicación de la encuesta para encontrar directivos con características de talento verde y su relación con la aplicación de prácticas de cadena de suministro sustentable en las empresas donde laboran.
Phosphorus sorption kinetics and sorption capacity in agricultural drainage ditch sediments in reclaimed land, Kasaoka Bay, Japan
Authors: Nguyen H. V. , Maeda M.
Published: July 2016

Equilibrium analysis is essential to evaluate sorption capacity and to determine whether sediment acts as a source or sink of phosphorus (P). This study was carried out to determine whether or not the sediment in drainage ditches acts as a source or sink of P, evaluate phosphorus sorption kinetics, and determine the potential P sorption by using the Langmuir isotherm sorption model. Surface sediment (0–10 cm) and the overlying water were collected from three drainage ditches for the experiments. Results showed that the drainage ditch that was the most contaminated with P had the highest sediment zero-equilibrium phosphorus concentration (EPC0). Because sediment EPC0 of the three ditches was higher than water P concentration, they acted as a sink of P across the sediment interface. The kinetic sorption of sediments consisted of two stages that were quick and slow, regardless of the sampling sites. The amounts of P sorbed to sediments at equilibrium (Qe) ranged from 50.8 to 77.5 mg kg−1. Phosphorus sorption capacity (Qmax) of sediments ranged from 447.0–493.8 mg kg−1 with the constant related to binding energy (K) (0.140–0.171 L mg−1). The results from this study indicate the importance of ditch sediment in controlling P dynamics in discharge from agricultural farms.
Photocatalytic Degradation of NOM for Power Plant Feedwater using Coating and Suspension of TiO2
Authors: Emam Eman A.
Published: July 2016

This study investigated the effectiveness of coating and suspension of Degussa P25 TiO2 photocatalyst to remove natural organic matter (NOM) from surface water for use as power plant feedwater. The catalyst yield, transmittance intensity and X‐ray pattern as a function of the number of coatings were characterized. In addition, P25 coating photocatalytic activity was studied. The photocatalytic activity also of P25 suspension with different catalyst concentrations and the reusing of the catalyst without and with regeneration was investigated. Results obtained show that the P25 coatings were transparent with good adhesion to the glass substrate. P25 suspension was found to be more effective in the NOM photodegradation and gave a higher rate constant compared to P25 coating. The maximum rate constants were 0.028 and 0.015 min−1 at 0.7 g/L P25 suspension and 4 coatings, respectively. After four runs without regeneration and three runs with regeneration of P25 reusing, the photoactivity to remove NOM was still significant.
Spatial Variability of Anaerobic Processes and Wastewater pH in Force Mains
Authors: Rudelle Elice Alice , Nielsen Asbjørn Haaning , Hvitved‐Jacobsen Thorkild , Jensen Henriette Stokbro , Vollertsen Jes
Published: July 2016

The present study focuses on anaerobic organic matter transformation processes in force mains for the purpose of improving existing sewer process models. Wastewater samples were obtained at 100 m intervals from a 1 km long pilot scale force main and measured for several wastewater parameters. Transformation rates for selected parameters were calculated and their spatial variability analyzed. In terms of electron transfer, fermentation was the most significant process, resulting in a net volatile fatty acid formation of 0.83 mmol/L. Sulfate reduction resulted in a production of 0.73 mmol/L of inorganic sulfide. Methanogenesis was negligable in all experiments despite an anaerobic residence time of more than 30 hours. As a result of the anaerobic processes, the wastewater pH decreased by approximately one pH unit, resulting in a corresponding increase in the fraction of molecular hydrogen sulfide. A significant spatial variablilty was observed for the average transformation rates of all parameters.
„Vásárolj hazait(ól)”?!
Authors: Láng Edina , Láng László
Published: July 2016

A cikk egy 2011 nyarán elvégeztetett, reprezentatív kérdőíves felmérés (N=619) eredményein alapul. A megkérdezés célja azoknak az érzelmi és normatív attitűdöknek az azonosítása volt, amelyek befolyásolhatják a hazai élelmiszer- és napifogyasztásicikk-kiskereskedelem vásárlóit a hazai kontra külföldi üzletek, üzletláncok választását érintő döntéseikben. Erős, szignifikáns összefüggést mutattunk ki a gazdasági nacionalizmusnak elkeresztelt attitűd és a hazai üzletek preferenciája között, általában is, és különösen az üzletek hazai/külföldi háttere közötti különbségtételre hajlamos és képes vásárlók körében. Nem találtunk említésre méltó kapcsolatot más vásárlói ideológiák (nacionalizmus, patriotizmus, kozmopolitizmus vagy éppen a „tiszta” fogyasztói etnocentrizmus) és a hazai üzletek előnyben részesítése között. A gazdasági nacionalizmus faktora viszont kölcsönhatásba lép a kognitív, az észlelt üzletjellemzőkre épülő, hazai kontra külföldi láncokkal kapcsolatos preferenciaképzéssel, és javítja a csak az utóbbiakra mint független változókra épített regressziós modell magyarázó erejét.

Journal of Economic Literature (JEL) kód: M31, Z13, M39
A Miskolci Operafesztivál gazdasági és társadalmi-kulturális hatásainak elemző bemutatása
Authors: Kundi Viktória
Published: July 2016

Jelen tanulmány a Miskolci Operafesztivál gazdasági és társadalmi-kulturális hatásait vizsgálja, bemutatva, hogy egy stagnáló gazdasági helyzetben lévő, nagyipari múlttal rendelkező városban miként képes prosperálni egy kulturális attrakció, amely a tudatos, kulturális alapú városfejlesztés eredményeképpen jöttlétre. A módszertani felvezetést követően, rövid elméleti felvezető után, Miskolc turisztikai adottságainak elemző bemutatása olvasható. A tanulmány további részben a módszertani fejezetben ismertetett módon lebonyolított empirikus vizsgálatok eredményeit láthatjuk.

Journal of Economic Literature (JEL) kód: Z130
Politikai költségvetési ciklusok: fiskális ciklushatások az állami kiadásokban Lengyelországban
Authors: Halász Ágnes
Published: July 2016

A tanulmány a fiskális ciklusok jelenlétét vizsgálja az államháztartási egyenlegek alakulásában Lengyelországban, 1989 és 2011 között. Összességében a legutóbbi kutatások eredményei azt mutatják, hogy a politikai költségvetési ciklusok (PBC) jelensége inkább a kevés demokratikus tapasztalattal rendelkező új demokráciákra jellemző, mint amilyenek például a posztszocialista tranzíciós országok. Mindazonáltal,a ciklusok idővel eltűnnek, ahogy a választópolgárok kiismerik a demokratikus intézmények működését és a politikai manipulációt. Ezt az elméletet azonban Lengyelország mintáját vizsgálva nem tudtukempirikusan megerősíteni – sem a teljes államháztartási egyenlegben, sem az állami kiadásokban. Bár az 1997-es és a 2001-es választási mintában azonosítottunk fiskális ciklushatásokat a nyugdíjak és közszféra bérei terén, ezek átmeneti jellegűek voltak, s pozitív szavazatvásárlási hatásukat sokszor egyéb tényezők, intézkedések mérsékelték. Összességében a lengyel költségvetési egyenleg ciklikus mozgását – különösen a kilencvenes években – jellemzően nem a PBC okozta. Journal of Economic Literature (JEL) kódok: D72, E62, H3
A politikai vezetés és a gazdasági növekedés
Authors: Zolcsák Dóra
Published: July 2016

A cikk a politikai vezetés gazdasági növekedésben játszott szerepét foglalja össze, s áttekinti azokat az irodalmakat, amelyekben a vezető és maga a vezetés (leadership) válik hangsúlyossá a gazdasági teljesítmény egyik lehetséges magyarázataként. Az írás az intézményi közgazdaságtan főáramából indul ki, amely egyelőre mostohán kezeli az egyén szerepét, s leginkább az intézményrendszer fontosságára fókuszál. Az intézményi felfogással szembeni kritikák magva leginkább az, hogy az általuk használt mutatók endogének és a politikai kimenetre összpontosítanak. Hatékony gazdaságpolitikát viszont a vezetők is létrehozhatnak, ezért válhat fontossá, hogy magyarázó tényezőként bevonjuk őket az empirikus elemzésekbe. Journal of Economic Literature (JEL) kódok: B3, O4, P48
A Fisher ráta és a beruházások gazdaságossági rangsora
Authors: Illés Mária
Published: July 2016

A tanulmány a Fisher ráta és a Fisher metszéspont létrejöttének mechanizmusát, feltételeit, gazdasági összefüggéseit, valamint a beruházások gazdaságossági rangsorképzésében betölthető szerepét vizsgálja. A ráta azt mutatja meg, hogy két, egymással versengő beruházási projekt nettó jelenértéke milyen kamatláb mellett válik azonossá. Ez az információ elsősorban akkor jelentős, ha a rangsorképzés a nettó jelenérték alapján történik. A nettó jelenértékek azonban három fő torzító tényező miatt nem hasonlíthatók össze. A torzító hatásoktól megtisztított nettó jelenérték ráták (azonos kalkulatív kamatláb mellett) ugyanahhoz a rangsorhoz vezetnek, mint a belső kamatláb. Következőleg a Fisher ráta ismeretének nincs érdemleges gyakorlati jelentősége, alapvetően elvi-elméleti és tudománytörténeti jelentőséggel bír. A Fisher ráta oksági hátterének elemzése segítheti a nettó jelenérték tartalmi összefüggéseinek alaposabb megértését. Journal of Economic Literature (JEL) kód: M21
Cough Syrup Psychosis
Authors: Amaladoss Alfred , O'Brien Simon
Published: July 2016

Over-the-counter medications are widely accessible and used. Cough suppressant syrups contain dextromethorphan (DM), which has the potential to be abused, with resultant psychiatric symptoms. This case report describes a young woman presenting with psychotic mania secondary to DM abuse. We also describe the treatment of this toxidrome and include the results of a literature search on this topic. The recognition of cough syrup as an agent of abuse and its toxidrome is important. This will facilitate early diagnostic clarification and promote efficient treatment strategies.
Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients
Authors: Atzema Clare L. , Austin Peter C. , Tu Jack V. , Schull Michael J.
Published: July 2016

Objective:

The American Heart Association (AHA) recommends a benchmark door-to-electrocardiogram (ECG) time of 10 minutes for acute myocardial infarction patients, but this is based on expert opinion (level of evidence C). We sought to establish an evidence-based benchmark door-to-ECG time.

Methods:

This retrospective cohort study used a population-based sample of patients who suffered an ST elevation myocardial infarction (STEMI) in Ontario between 1999 and 2001. Using cubic smoothing splines, we described (1) the relationship between door-to-ECG time and ECG-to-needle time and (2) the proportion of STEMI patients who met the benchmark door-to-needle time of 30 minutes based on their door-to-ECG time. We hypothesized nonlinear relationships and sought to identify an inflection point in the latter curve that would define the most efficient (benefit the greatest number of patients) door-to-ECG time.

Results:

In 2,961 STEMI patients, the median door-to-ECG and ECG-to-needle times were 8.0 and 27.0 minutes, respectively. There was a linear increase in ECG-to-needle time as the door-to-ECG time increased, up to approximately 30 minutes, after which the ECG-to-needle time remained constant at 53 minutes. The inflection point in the probability of achieving the benchmark door-to-needle time occurred at 4 minutes, after which it decreased linearly, with every minute of door-to-ECG time decreasing the average probability of achievement by 2.2%.

Conclusions:

Hospitals that are not meeting benchmark reperfusion times may improve performance by decreasing door-to-ECG times, even if they are meeting the current AHA benchmark door-to-ECG time. The highest probability of meeting the reperfusion target time for fibrinolytic administration is associated with a door-to-ECG time of 4 minutes or less.
Application of Lean principles to improve early cardiac care in the emergency department
Authors: Piggott Zoë , Weldon Erin , Strome Trevor , Chochinov Alecs
Published: July 2016

Objective:

To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED).

Methods:

Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS. A chart review was also conducted. To evaluate our success, proportions of care milestones (first electrocardiogram [ECG], ECG interpretation, physician assessment, and acetylsalicylic acid [ASA] administration) meeting target times were chosen as outcome metrics in this before-and-after study.

Results:

The proportion of cases with 12-lead ECGs completed within 10 minutes of patient triage increased by 37.4% (p< 0.0001). The proportion of cases with physician assessment initiated within 60 minutes increased by 12.1% (p= 0.0251). Times to ECG, physician assessment, and ASA administration also continued to improve significantly over time (pvalues < 0.0001). Post-Lean, the median time from ECG performance to physician interpretation was 3 minutes. All of these improvements were achieved using existing staff and resources.

Conclusions:

The application of Lean principles can significantly improve attainment of early diagnostic and therapeutic milestones of emergency cardiac care in the ED.
Surfer's myelopathy: case report and review
Authors: Karabegovic Amna , Strachan-Jackman Shirley , Carr David
Published: July 2016

Nontraumatic spinal cord injury from surfing is a new entity first described in 2004 and likely of ischemic etiology. We report the case of a 25-year-old man who presented to the emergency department with a 2-week history of lower extremity weakness after surfing in Indonesia. The patient reported developing low back pain, lower extremity weakness, sensory changes, and urinary retention shortly after his first surfing lesson. The patient was subsequently diagnosed with surfer's myelopathy. The purpose of this report is to review the clinical presentation, etiology, risk factors, and management of this increasingly described entity.
Massive levothyroxine ingestion in a pediatric patient: case report and discussion
Authors: Ho Josephine , Jackson Renee , Johnson David
Published: July 2016

We describe the course of a toddler who ingested a massive amount of levothyroxine and review treatment options for such overdoses. A 2½-year-old boy presented shortly after an ingestion of up to 7.6 mg of levothyroxine (potentially as much as 700 µg/kg). He was initially asymptomatic, treated with oral charcoal 1 g/kg, and discharged home from the emergency department after a few hours. He returned approximately 24 hours later with a temperature of 38.5°C, heart rate of 163 beats per minute, respiratory rate of 30 breaths per minute, and blood pressure of 136/70 mm Hg. He had a slightly decreased appetite and no signs or symptoms of infection. He was admitted to hospital and treated with oral acetaminophen. The initial free thyroxine (T4) was > 100 pmol/L and free triiodothyronine (T3) was 35.3 pmol/L. The patient had desquamation of the palms and soles, hair loss, and irritability during the month following the ingestion. Resolution of the elevated free T4occurred by 12 days post-ingestion and normalization of the thyroid-stimulating hormone by 7 weeks post-ingestion. There were no longterm sequelae. Levothyroxine overdose can result in significant complications, including seizures and arrhythmias, both of which should be monitored for. However, as our case illustrates, massive ingestion of levothyroxine in children typically follows a benign course.
Carbon monoxide poisoning in narghile (water pipe) tobacco smokers
Authors: Fauci Giovanna La , Weiser Giora , Steiner Ivan P. , Shavit Itai
Published: July 2016

Narghile (water pipe, hookah, shisha, goza, hubble bubble, argeela) is a traditional method of tobacco use. In recent years, its use has increased worldwide, especially among young people. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide (CO). We present an acutely confused adolescent patient who had CO poisoning after narghile tobacco smoking. She presented with syncope and a carboxyhemoglobin level of 24% and was treated with hyperbaric oxygen. Five additional cases of CO poisoning after narghile smoking were identified during a literature search, with carboxyhemoglobin levels of 20 to 30%. Each patient was treated with oxygen supplementation and did well clinically. In light of the increasing popularity of narghile smoking, young patients presenting with unexplained confusion or nonspecific neurologic symptoms should be asked specifically about this exposure, followed by carboxyhemoglobin measurement.
How do we manage emergency department patients diagnosed with transient ischemic attack?
Authors: Perry Jeffrey J. , Kerr Jonathan , Symington Cheryl , Sutherland Jane
Published: July 2016

Introduction:

Multiple studies have demonstrated low rates of antithrombotic use, low neuroimaging rates, and high subsequent risk of stroke at 90 days following an emergency department (ED) diagnosis of transient ischemic attack (TIA). This study assessed the use of antithrombotic medications, neuroimaging, and subsequent 90-day stroke rate for patients in a more recent cohort of ED patients discharged home with TIA.

Methods:

We conducted a 1-year historical cohort study of all patients discharged with a TIA at a tertiary care ED (census 60,000 visits/year), which was one of the four sites participating in one of the aforementioned studies. Data were extracted from paper and electronic records onto standardized data extraction forms. Clinical findings, medications, and tests were recorded.

Results:

A total of 211 patients were enrolled in the study. The patients had the following characteristics: the mean age was 71.2 years (SD 13.8 years), 56.9% were female, 53.1% had a history of hypertension, 26.5% had a history of ischemic heart disease, and 17.1% had a previous stroke. The most frequent neurologic deficit was unilateral weakness (53.6%), and most deficits lasted for more than 60 minutes (71.6%). Antithrombotic medications were used for 96.7% of patients at ED discharge. Neuroimaging was conducted in 94.3% of patients while in the ED. Our cohort had a 90-day stroke rate of 1.9%.

Conclusions:

This study established that most TIA patients receive neuroimaging in the ED and are started on or maintained on antithrombotic agents. Clinicians are encouraged to ensure that electrocardiography is done routinely and to involve Neurology in follow-up care.
Development and evaluation of a simulation-based resuscitation scenario assessment tool for emergency medicine residents
Authors: Hall Andrew Koch , Pickett William , Dagnone Jeffrey Damon
Published: July 2016

Objective:

We sought to develop and validate a three-station simulation-based Objective Structured Clinical Examination (OSCE) tool to assess emergency medicine resident competency in resuscitation scenarios.

Methods:

An expert panel of emergency physicians developed three scenarios for use with high-fidelity mannequins. For each scenario, a corresponding assessment tool was developed with an essential actions (EA) checklist and a global assessment score (GAS). The scenarios were (1) unstable ventricular tachycardia, (2) respiratory failure, and (3) ST elevation myocardial infarction. Emergency medicine residents were videotaped completing the OSCE, and three clinician experts independently evaluated the videotapes using the assessment tool.

Results:

Twenty-one residents completed the OSCE (nine residents in the College of Family Physicians of Canada– Emergency Medicine [CCFP-EM] program, six junior residents in the Fellow of the Royal College of Physicians of Canada–Emergency Medicine [FRCP-EM] program, six senior residents in the FRCP-EM). Interrater reliability for the EA scores was good but varied between scenarios (Spearman rho 5 [1] 0.68, [2] 0.81, [3] 0.41). Interrater reliability for the GAS was also good, with less variability (rho 5 [1] 0.64, [2] 0.56, [3] 0.62). When comparing GAS scores, senior FRCP residents outperformed CCFP-EM residents in all scenarios and junior residents in two of three scenarios (p , 0.001 to 0.01). Based on EA scores, senior FRCP residents outperformed CCFP-EM residents, but junior residents outperformed senior FRCP residents in scenario 1 and CCFPEM residents in all scenarios (p 5 0.006 to 0.04).

Conclusions:

This study outlines the creation of a high-fidelity simulation assessment tool for trainees in emergency medicine. A single-point GAS demonstrated stronger relational validity and more consistent reliability in comparison with an EA checklist. This preliminary work will provide a foundation for ongoing future development of simulationbased assessment tools.
Prevalence of advance directives among elderly patients attending an urban Canadian emergency department
Authors: Gill Ginjeet Gina K. , Fukushima Erin , Abu-Laban Riyad B. , Sweet David D.
Published: July 2016

Introduction:

To date, there has been minimal research on advance directives (ADs) among elderly patients in Canadian emergency departments (EDs). The purpose of this study was to determine the prevalence of ADs among elderly patients visiting an urban ED. We also explored whether there were factors associated with the existence of an AD and possible barriers to having one.

Methods:

This prospective study ran between October and December 2008. Individuals over the age of 70 who presented to the ED between 7 am and 7 pm, 7 days a week, were considered for enrolment. Exclusion criteria included previous enrolment and inability to provide informed consent. A team of nurses who specialize in assessment of geriatric patients administered a study instrument consisting of 28 questions. Topics included demographics, level of education, medical information, and knowledge of and attitudes toward ADs.

Results:

The results from 280 participants, with an average age of 80.6 years, were analyzed. Thirty-five percent of participants reported that they knew what an AD was; 19.3% of participants said they had an AD, but only 5.6% brought it to the hospital; 50.7% were interested in further information regarding ADs; and 67.9% of participants felt that it was important for physicians to know their wishes about life support.

Conclusion:

Knowledge of ADs among elderly patients visiting an urban Canadian ED is limited and is likely a significant factor precluding wider prevalence of ADs. There is interest in further discussion about ADs in this population group.
Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents
Authors: Hicks Christopher M. , Kiss Alex , Bandiera Glen W. , Denny Christopher J.
Published: July 2016

Objectives:

Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviationbased crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of “Crisis Resources for Emergency Workers” (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents.

Methods:

Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS).

Results:

Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved teambased attitudes as assessed by the HFAS (p= 0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p= 0.16).

Conclusions:

EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.