bluuebunny/crossref_metadata_2025 huggingface dataset:
GAMBARAN POLA TIDUR IBU YANG MENERAPKAN CO-SLEEPING & NON CO-SLEEPING
Authors: Pristinella Debri
Published: February 2021

The role of a mother in a family is very complicated. To be able to perform these roles optimally,the mother needs physical and mental (psychic) energy management. Sleep is one of the mostimportant but often neglected as a physical and mental management. The problem of sleep inwomen is not a popular topic regarding the physical and mental well-being of womencomparing to other issues such as self-esteem. This study aims to explore the co-sleeping andnon-co-sleeping arrangements among mothers and the reasons behind the sleep settingscurrently apply. This study also aims to explore the sleep patterns and the correlation betweenthe reasons for sleep arrangements and their sleep patterns.Participants were 115 mothers with children age 6 months until 10 years old who live inJogjakarta. The survey was the data collection method. The research instrument was aquestionnaire on Sleep arrangements and Sleep Patterns, analyzed using descriptive analysisand Spearman correlation analysis.The results showed that 49.1% of mothers applied co-sleeping arrangements every day, while15.8% of mothers applied non-co-sleeping (sleeping separately with their children). The age ofthe subject's children ranged from 6 months to 10 years. The main reason for their sleeparrangement was “best for children's sleep quality” (61.4%). As many as 62.2% of mothershave poor and very poor sleep patterns. And this poor sleep pattern has a negative andsignificant correlation (-0.028) with the reason that sleep settings are “best for children's sleepquality”. It means that mothers arguing that the sleeping arrangements are best for theirchildren, tend to have a poor sleep pattern.
GAMBARAN FAKTOR- FAKTOR RESILIENSI PADA REMAJA PEREMPUAN YANG TINGGAL DI PANTI ASUHAN
Authors: Shintaningtyas Akasya , Wibawa Dhevy Setya
Published: February 2021

Teenagers have various problems including those who live in orphanages for various reasons.This situation can cause them to encounter various problems from their inner side and theenvironment such as, resignation due to lack of attention from their closest person,withdrawing from the society, facing the challenges feels heavy, difficult to be open with thesurrounding community especially after they leave the orphanage and this often happens toadolescents women. However, there are young women who are able to turn these negativeconsequences into challenges to get up and develop themselves in a positive direction. Thisqualitative study uses a semi-structured interview which aims to look at the factors of resilienceof adolescent girls living in orphanages in terms of Grotberg's theory, among others, thefactors I Am, I Can and I Have with three female teenage participants who have a minimum ofone year of living in orphanage. The results of this study indicate that the factors I Have(environmental support), I Am (self-strength) and I Can (social and interpersonal) are relatedto each other, although in factor I Can there are some young women who still have highemotions but they has been able to control his emotions thanks to the support and assistancefrom the surrounding environment which can be the strength of self to determine future lifegoals.
GAMBARAN ACCEPTANCE OF DATING VIOLENCE PADA DEWASA AWAL YANG MENJADI KORBAN KEKERASAN DALAM PACARAN
Authors: Pratiwi Ari , P Ayu Septi
Published: February 2021

This study aims to determine how the description of acceptance of dating violence in victims ofdating violence. The description described concerns how the attitude and behavior of the victimin acceptance of dating violence and the factors that influence it. The method used in thisresearch is a qualitative method with a phenomenological approach. The technique of selectingparticipants using purposive sampling technique. Participants in this study were 4 people, aged20-25 years and currently experiencing dating violence. The data collection technique usedwas the interview technique, while the analysis technique used to process the data was theMiles and Huberman analysis technique. The results of the study reveal that Acceptance ofdating violence occurs through 2 different processes. The first process involves putting up afight before giving rise to acceptance of dating violence. The second process is to do nothingor surrender and immediately generate acceptance of dating violence. This process is basedon factors, namely shackling affections, feelings of helplessness, limitations in understandingproblems, expectations of protective figures, pre-married sex, views of family and other people,and views of relationships (commitment, duration of relationship, and sense of responsibility)
Description of two new species of Cerambycidae (Coleoptera) from Northwestern Yunnan (China)
Authors:   Technical University of Ostrava, Sokolska trida 33, Ostrava, 702 00, Czech Republic, Tichý T. , Lin M.-Y. ,   Key Laboratory of Zoological Systematics and Evolution, Institute of Zoology, Chinese Academy of Sciences, 1-5 Beichen West Road, Chaoyang Dist., Beijing, 100101, China
Published: February 2021

Two new species of Cerambycidae, Ischnostrangalis ohbayashii Tichý et Lin, sp. n. (Lepturinae: Lepturini) and Anaglyptus miroshnikovi Tichý et Lin, sp. n. (Cerambycinae: Anaglyptini), are described from Yunnan province of China. The new species are compared with closely related congeners.
Fração prevenível na associação entre a atividade física e doença cardiovascular: uma revisão narrativa
Authors: Bomfim Vitoria Vilas Boas da Silva , Aleluia Emilie dos Santos , De Jesus Heloisa Ferreira , De Almeida Amanda Larissa de Souza Matos , Costa Gislana de Souza , Brito Adriele da Silva , Silva Tainara Regina Castro , Oliveira Leidiane Araújo , Almeida Hytirsia Santos , Barreto Naiara Caroline da Silva
Published: February 2021

Objetivo: Revisar na literatura o papel da atividade física na prevenção de eventos cardiovasculares. Revisão Bibliográfica: Os fatores modificáveis ou controláveis são aqueles que podem ser revertidos a partir de uma mudança nos hábitos de vida do paciente. São eles: tabagismo, hipertensão arterial, diabetes mellitus, dislipidemia, obesidade e sedentarismo. O tabagismo é fator de risco que pode ser totalmente eliminado, apesar de ser difícil. Estudos mostram que a redução do nível pressórico traz benefícios diretos na redução da morbimortalidade por DCV. Evidências mostram que o risco de DCV está aumentando em pacientes com DM, sendo que a DM 2 apresenta um risco duas vezes maior para homens e quatro vezes maior para mulheres. A prática regular de exercícios físicos está diretamente relacionada com a prevenção e o controle das doenças cardiovasculares (DCV), uma vez que ela exerce influência nos fatores de risco modificáveis para cada tipo de artigo usar o subtítulo pertinente. Considerações Finais: O estudo demonstrou então que pacientes mais ativos têm um risco de DCV reduzido em aproximadamente 30% a 40%, quando comparado com aqueles menos ativos, evidenciando uma relação inversa entre atividade física e risco de DCV.
A enfermagem frente às manifestações clínicas da depressão em idosos que sofreram abandono: revisão integrativa da literatura
Authors: Lima Yasmin Beatriz Reis da Silva , De Miranda Ayanne Castro , Jucá Eduardo Soares , Dias Stéphanie Caroline Vaz , Pinheiro Suellen Karoline de Lima , Silva Sara do Socorro da Silva , Viana Ana Paula Moia Rodrigues , Portilho Paulo Gabriel Moreira , Martins Melissa Barbosa , De Aguiar Viviane Ferraz Ferreira
Published: February 2021

Objetivo: Mapear o processo de enfermagem, com ênfase nas intervenções de enfermagem, do cuidado ao idoso em contexto de abandono e acometido a depressão. Métodos: Este estudo consiste numa Revisão Integrativa da Literatura. Foi realizada pesquisa nas bases de dados Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), utilizando-se a combinação de descritores em idioma português segundo consulta aos Descritores em Ciências da Saúde (DeCS). Para apoiar a análise dos dados, foi utilizado o software IRAMUTEQ e para o processamento de dados utilizou-se a Classificação Hierárquica Descendente (CHD). Resultados: A qualidade de vida não está restrita somente ao físico, mas também ao social. Verificou-se a prevalência de sintomas depressivos em idosos que foram institucionalizados e com isso perderam a convivência com a comunidade. Dessa forma o abandono favorece a aquisição de sintomas depressivos no idoso, por conta do sentimento de solidão. Considerações finais: Há poucas referências correlacionando o processo de enfermagem com a população idosa acometida de quadros de transtorno psicológico. Sendo necessário o desenvolvimento de estudos visando promover intervenções de enfermagem ao cuidado do idoso.
Perfil dos recém-nascidos prematuros atendidos no seguimento ambulatorial em uma cidade do sul do Brasil
Authors: Fontana Fernanda , Vieira Igor Soares , Souza Luciano Dias de Mattos
Published: February 2021

Objetivo: Analisar o perfil de recém-nascidos prematuros atendidos em um seguimento ambulatorial em uma cidade do sul do Brasil. Métodos: Estudo observacional, retrospectivo, através de análise de prontuários. Foram incluídos todos os pré-termos com idade gestacional inferior a 35 semanas e após alta, tiveram acompanhamento regular até completar doze meses de idade corrigida, no período de janeiro de 2010 a dezembro de 2017. Resultados: Um total de 9419 prontuários foram revisados, entretanto apenas 397 preencheram os critérios de inclusão. Os prematuros acompanhados no ambulatório de pediatria tiveram um crescimento adequado e compatível com as curvas do Intergrowth-21. Na triagem neonatal, o teste da orelhinha apresentou maior alteração (10,3%), seguido do teste do pezinho (3,4%). As comorbidades mais prevalentes foram as alterações cardiológicas (51,1%), alterações no desenvolvimento neuropsicomotor (35,1%) e anemia (30,5%). Prematuridade extrema, baixo peso ao nascer e apgar abaixo de 7 no quinto minuto foram os fatores de risco mais associados as comorbidades encontradas. Conclusão: Os resultados sugerem que os prematuros acompanhados no ambulatório de pediatria da universidade têm um crescimento compatível com as curvas do Intergrowth-21, entretanto, é imprescindível o acompanhamento a médio e longo prazo, especialmente nos casos de prematuridade extrema, baixo peso ao nascer e apgar baixo para diagnóstico e intervenção precoce das morbidades.
O cuidado em saúde mental centrado na pessoa: uma experiência na atenção primária à saúde
Authors: Moraes Leidiely Gomes , Rézio Larissa de Almeida , Marcon Samira Reschetti
Published: February 2021

Objetivo: Relatar a experiência de uma discente do curso de graduação em enfermagem quanto ao desenvolvimento de intervenções em saúde mental direcionadas a uma adolescente no âmbito da Atenção Primária à Saúde. Relato de Experiência: Trata-se de um relato de experiência desenvolvido a partir de vivências em uma Estratégia de Saúde da Família de uma capital brasileira. Os cuidados direcionaram-se a uma adolescente acompanhada pela enfermagem. Durante cinco encontros, entre atendimentos na unidade, visita domiciliária e discussão interprofissional, foram realizadas intervenções centradas nas suas demandas, utilizando o referencial da Atenção Centrada na Pessoa e modelo de atenção psicossocial. A partir disso, o cuidado foi construído de modo dialogado, resultando em melhorias na adolescente referentes à afetividade, humor e, maior empenho em interagir com a acadêmica. Considerações Finais: Analisar esse processo, como discente, permitiu uma reflexão acerca da possibilidade de atuação do enfermeiro referente aos cuidados com a saúde mental na Atenção Primária à Saúde, à luz do modelo de atenção psicossocial e Atenção Centrada na Pessoa.
Aparelho celular: risco de infecções hospitalares durante jornada de trabalho de profissionais da saúde
Authors: De Oliveira Darline Dantas , Martins Moisés de Oliveira , Maia João Pedro Pontes , Hanemann Larissa Dias , Araújo Verônica Lima , Da Costa Taline Soares , Mafra Lorena dos Santos , Da Rocha Eduarda Rubem , Moura Heriederson Sávio Dias , Lopes Graciana de Sousa
Published: February 2021

Objetivo: Discutir medidas de prevenção de antissepsia em aparelhos celulares constantemente utilizados em blocos cirúrgicos e associar a adesão de protocolos rígidos de higienização das mãos em ambientes hospitalares restritos. Métodos: Trata-se de um estudo exploratório, descritivo, do tipo revisão narrativa da literatura, para coleta de dados, foram utilizadas as bibliotecas virtuais de pesquisa: Google Acadêmico, Advensad Biomedical Research, Saber digital, Hospital Santa Cruz (HSC). Resultados: Nos resultados desta pesquisa foram usados 12 artigos científicos, 2 revistas eletrônicas e 1 decreto de lei, que apontaram que o aparelho telefônico é um recurso utilizado habitualmente e diariamente por todos, pode ainda apresentar-se como ponte que liga a transmissão de bactérias as infecções nos ambientes hospitalares. Além disso, esta tecnologia torna-se um veículo para microrganismos infecciosos, e sua utilização durante a prestação do serviço de saúde pode elevar a taxa de incidência de infecções hospitalares. Considerações finais: Portanto, implementar protocolos de higienização dos parelhos celulares e seguir medidas de educação continuada adotando novas metodologias de trabalho, assim assegurando a segurança do paciente.
A amamentação e o risco de transmissão de COVID-19
Authors: Godoi Bruna de Oliveira , Alvino Camylla Cristina de Melo , Dos Santos Evelyn Caldas , Da Silva Karen Iulianne Machado , Teixeira Jackson Gois , Vieira Brenda Christina , França Silvana Dias de Macedo , De Oliveira Gabriela Ataides , Nascente Flávia Miquetichuc Nogueira , Bontempo Albênica Paulino dos Santos
Published: February 2021

Objetivo: Observar o risco de transmissão da COVID-19 durante a amamentação e os principais cuidados necessários em sua execução. Métodos: Revisão sistemática, realizada em julho de 2020, na Biblioteca Virtual em Saúde, com os descritores “Lactante”, “Recém-Nascido” e “COVID-19”, disponíveis na íntegra. Assunto principal: infecção por coronavírus, publicados em 2020. Resultados: Foram localizados 172 artigos; após remoção dos duplicados, indisponíveis, uso dos filtros e critérios de elegibilidade, restaram 9 para análise. Observou-se que o leite materno é o melhor alimento para o neonato, sendo importante também para o desenvolvimento do seu sistema imunológico. Quanto à COVID-19, as evidências foram insuficientes para afirmar a transmissão do vírus, embora não tenha sido encontrado nas amostras de leite analisadas. Há controvérsias nos textos quanto aos riscos e benefícios da amamentação no contexto pandêmico. No entanto, muitos autores recomendam o alojamento conjunto e a prática da amamentação. Considerações Finais: Não há evidências robustas da presença do vírus no leite materno ou do risco de transmissão durante a amamentação. Recomenda-se que as puérperas infectadas sejam orientadas quanto aos cuidados para prevenir que gotículas com vírus cheguem ao neonato por vias aéreas. As informações encontradas na literatura são limitadas, é necessário que mais estudos sejam realizados.
Our experience in the surgical treatment of congenital cataract
Authors:   S. N. Fyodorov Eye Microsurgery Federal State Institution Orenburg branch of the Russian Federation Ministry of Health, Orenburg, Kuznetsov I. V. , Pasikova N. V. ,   S. N. Fyodorov Eye Microsurgery Federal State Institution Orenburg branch of the Russian Federation Ministry of Health, Orenburg
Published: February 2021

Aim. To present our experience and evaluate the results of surgical treatment of congenital cataracts. Methods. A clinical analysis of the results of congenital cataract aspiration in 16 children (22 eyes) aged 2 months to 5 years is performed. Bilateral cataract was determined in 6 children, unilateral – in 10. Preoperative examination of children aged 3–5 years was carried out in a standard way. Children younger than 3 years of age at the initial appointment underwent non-contact examination methods, the remaining studies were performed under general anesthesia in the operating room immediately before surgery. Congenital cataract phacoaspiration was performed under general anesthesia using the Stellaris microsurgical system (Bausch and Lomb, USA) through a 1.2-mm paracentesis in the lens irrigation-aspiration regime. Hydrophobic IOL models were implanted. The posterior lens capsule was preserved in all cases. Mandatory was the appointment of cycloplegics in drops in the early postoperative period. Results. An increase in visual acuity (from 0.03 to 0.7) occurred in all cases. However, presence of obscuration amblyopia of varying degrees required regular courses of pleoptic treatment. Conclusions. The effectiveness of congenital cataracts phacoaspiration is ensured by the fulfillment of federal clinical recommendations, however, sutureless surgery allows achieving high functional results in the treatment of this pathology. Key words: congenital cataract; phacoaspiration; intraocular lens.
A clinical case of newly detected far-advanced primary open-angle glaucoma against the background of optic disc drusen
Authors:   Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Khabarovsk, Burya R.A. , Sorokin E.L. ,   Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Khabarovsk,   Far Eastern State Medical University, Khabarovsk
Published: February 2021

Aim. To present a clinical case of glaucoma development against the background of optic disc drusen (ODD), demonstrating the difficulties of differential diagnosis between such nosologies as glaucomatous optic neuropathy, optic disc swelling, and chronic optic neuropathy caused by ODD. Methods. Patient S., 72 years old, was referred to clinic with suspected optic disc swelling, initial senile cataract of both eyes. The patient underwent additional investigations: Maklakov tonometry registered an increase of intraocular pressure level exceeding permissible norm; perimetry which has revealed narrowing of visual field boundaries in both eyes; ß-scan ultrasonography has visualized morphological changes with highly reflective drusen in both eyes; optical coherence tomography of optic nerve and ganglion cell layer revealed decrease in nerve fiber layer thickness on nasal side. For differential diagnosis, the patient underwent magnetic resonance imaging (MRI) of the brain, according to which intracranial pathology was excluded. Results. Using modern diagnostic methods it was possible to establish clinical diagnosis: newly detected primary open-angle glaucoma (POAG) III b, explicit ODD, initial senile cataract, pseudoexfoliation syndrome grade 2. Hypotensive regimen did not result in target pressure; therefore, the patient was prescribed surgical treatment (microinvasive non-penetrating deep sclerectomy on both eyes). Conclusion. The presented clinical case showed that against the background of ODD creating the picture of pseudo-swelling and masking the changes in optic nerve because of glaucoma process, the patient had POAG in far-advanced stage. MRI of the brain, as well as additional ophthalmological investigations using modern technologies, made it possible to establish correct diagnosis and prescribe the necessary therapy for this nosology. Key words: optic disc drusen; primary open-angle glaucoma; perimetry; optical coherence tomography.
Unassisted Noise-Reduction of Chemical Reactions Data Sets
Authors: Toniato Alessandra , Schwaller Philippe , Cardinale Antonio , Geluykens Joppe , Laino Teodoro
Published: February 2021

Existing deep learning models applied to reaction prediction in organic chemistry can reach high levels of accuracy (> 90% for Natural Language Processing-based ones).With no chemical knowledge embedded than the information learnt from reaction data, the quality of the data sets plays a crucial role in the performance of the prediction models. While human curation is prohibitively expensive, the need for unaided approaches to remove chemically incorrect entries from existing data sets is essential to improve artificial intelligence models' performance in synthetic chemistry tasks. Here we propose a machine learning-based, unassisted approach to remove chemically wrong entries from chemical reaction collections. We applied this method to the collection of chemical reactions Pistachio and to an open data set, both extracted from USPTO (United States Patent Office) patents. Our results show an improved prediction quality for models trained on the cleaned and balanced data sets. For the retrosynthetic models, the round-trip accuracy metric grows by 13 percentage points and the value ofthe cumulative Jensen Shannon divergence decreases by 30% compared to its original record. The coverage remains high with 97%, and the value of the class-diversity is not affected by the cleaning. The proposed strategy is the first unassisted rule-free technique to address automatic noise reduction in chemical data sets.
Seeding the Multi-dimensional Nonequilibrium Pulling for Hamiltonian Variation: Indirect QM/MM Free Energy Simulations
Authors: Sun Zhaoxi , He Qiaole
Published: February 2021

The combination of free energy simulations in the alchemical and configurational spaces provides a feasible route to access the thermodynamic profiles under a computationally demanding target Hamiltonian. Normally, due to the significant differences between the computational cost of ab initio quantum mechanics (QM) calculations and those of semi-empirical quantum mechanics (SQM) and molecular mechanics (MM), this indirect method is often applied to obtain the QM thermodynamics by combining the SQM or MM thermodynamics and the SQM-to-QM or MM-to-QM corrections. In our previous works, a multi-dimensional nonequilibrium pulling framework for Hamiltonian variations has been introduced based on bidirectional pulling and bidirectional reweighting. The method performs nonequilibrium free energy simulations in the configurational space to obtain the thermodynamic profile along the conformational change pathway under a selected computationally efficient Hamiltonian, and uses the nonequilibrium alchemical method to correct or perturb the thermodynamic profile to that under the target Hamiltonian. The BAR-based method is designed to achieve the best generality and transferability and thus leads to modest (~20 fold) speedup. In this work, we explore the possibility of further accelerating the nonequilibrium free energy simulation by employing unidirectional pulling and using the selection criterion to obtain the initial configurations used to initiate nonequilibrium trajectories following the idea of adaptive steered molecular dynamics (ASMD). A single initial condition is used to seed the whole multi-dimensional nonequilibrium free energy simulation and the sampling is performed fully in the nonequilibrium ensemble. The ASMD scheme estimates the free energy difference with the unidirectional exponential average (EXP), but it does not follow exactly the requirements of the EXP estimator. Another consequence of the seeding simulation is the inherently sequential or serial pulling due to the inter-segment dependency, which triggers some problems in the parallelizability of the simulation. Therefore, some tests are required to grasp some insights and guidelines for using this selection-criterion-based ASMD scheme. The ASMD method is tested thoroughly on a dihedral flipping model system and encouraging numerical results are obtained. The selection-criterion-based multi-dimensional ASMD framework follows the same perturbation framework of the BAR-based method, and thus could be used in various Hamiltonian-variation cases.
A Mechanistic Analysis of Trimethylanilinium Salt Degradation: Implications for Methylation and Cross-coupling Applications
Authors: Washington Jack B. , Assante Michele , Yan Chunhui , McKinney David , Juba Vanessa , Leach Andrew , Baillie Sharon E. , Reid Marc
Published: February 2021

N,N,N-trimethylanilinium salts are known to display dual reactivity through both the aryl group and the N-methyl groups. These salts have thus been widely applied in cross-coupling, aryl etherification, fluorine radiolabelling, phase-transfer catalysis, supramolecular recognition, polymer design, and (more recently) methylation. However, their application as electrophilic methylating reagents remains somewhat underexplored, and an understanding of their arylation versus methylation reactivities is lacking. This study presents a mechanistic degradation analysis of N,N,N-trimethylanilinium salts and highlights the implications for synthetic applications of this important class of salts. Kinetic degradation studies, in both solid state and solution phases, have delivered insights into the physical and chemical parameters affecting anilinium salt stability. 1H NMR kinetic analysis of salt degradation has evidenced thermal degradation to methyl iodide and the parent aniline, consistent with a closed-shell SN2-centred degradative pathway, and methyl iodide being the key reactive species in applied methylation procedures. Furthermore, the effect of halide and non-nucleophilic counterions on salt degradation has been investigated, along with deuterium isotope and solvent effects. Finally, new mechanistic insights have enabled the investigation of the use of trimethylanilinium salts in O-methylation and in improved cross-coupling strategies.
Enantioselective Hydroalkylation of α,β-Unsaturated Amides through Reversed syn-Hydrometallation of NiH
Authors: Zhou Fang , Zhu Shaolin
Published: February 2021

Enantioselective synthesis of a wide range of structurally diverse β-chiral amides has been achieved through nickel-catalyzed regio-reversed hydroalkylation of α,β-unsaturated amides with alkyl iodides in the presence of a hydrosilane. Different from the classical homolysis/enantioconvergent recombination process of Ni(III) intermediates as the enantio-determining step, chiral induction in this reductive hydroalkylation was achieved through an enantiodifferentiating regio-reversed syn-hydrometallation process of α,β-unsaturated amides.
From the Editor’s Desk: The emergence of "personalized medicine" in medical care
Authors: Lawler Patrick , Miao Wenya , Williams Patrick
Published: February 2021

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Reperfusion times for ST elevation myocardial infarction: a prospective audit
Authors: Kaila Kendeep S , Bhagirath Kapil M , Kass Malek , Avery Lorraine , Hall Lillian , Chochinov Alex H , Tam James W
Published: February 2021

Background: New published guidelines recommend treatment of ST elevation myocardial infarction (STEMI) within 30 minutes of first medical contact to thrombolysis and 90 minutes to primary percutaneous coronary intervention (PCI). Objectives: To determine how a tertiary care center compares to these new guidelines and to evaluate the success of measures directed to shorten delays. Methods: This was a prospectively designed audit loop using retrospective chart review. Specific time intervals were evaluated: 1) T2 (ER presentation to diagnostic EKG; 2) T ER (ER presentation to reperfusion); and 3) T AHA (first medical contact to reperfusion). Results of the initial 12-month data were conveyed to Emergency Room staff and a dedicated EKG machine was placed in the ER for the subsequent 12 months, and the results were then re-analyzed. Results: In 2003-4, 58 patients with STEMI were identified, with 41 (70.7%) receiving reperfusion. Of those receiving thrombolysis, median T AHA was 54 [37-72] minutes, with 12.0% <30 minutes, while those receiving PCI, median T AHA was 58 [43-78] minutes, with 25.0% <90 minutes. In 2004-5, 52 patients had STEMI, with 40 (76.9%) receiving reperfusion. The percentage of patients meeting the guidelines was 14.3% for the thrombolysis group and 11.1% for the PCI group. Introduction of a dedicated EKG machine led to a strong trend towards improvement in median T2 (22 vs 10 minutes; P=0.07), but other treatment times remained unchanged. Conclusions: Treatment times are longer than recommended guidelines. More comprehensive strategies and improved coordination of medical services are required to shorten pre-contact and post-contact response times.
Teaching technical skills using medical simulation: a new frontier
Authors: Lachapelle Kevin
Published: February 2021

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"Last supper with mushroom soup": a case report of amatoxin poisoning
Authors: Das Rabindra Nath , Parajuli S , Jayakumar J
Published: February 2021

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Letters to the MJM
Authors: Giri Bishnu Rath , Shankar P. Ravi
Published: February 2021

In response to "TRIPS agreement and public health" by Junaid Subhan.
Asian wasp envenomation and acute renal failure: a report of two cases
Authors: Das Rabindra , Mukherjee Keka
Published: February 2021

Acute renal failure is an unusual complication of wasp stings. We report two cases of renal failure after multiple wasp stings (Vespa affinis). Both patients had evidence of intravascular haemolysis, hepatic dysfunction, oligo-anuria and azotaemia and required dialysis. The first patient had severe hemolysis, rhabdomyolysis, pigment and venom nephropathy and died on the 8th day in hospital. The second patient, who recovered completely in 3 weeks time with steroid and antihistaminic therapy, had interstitial nephritis. Although acute renal failure after wasp stings is typically caused by acute tubular necrosis (ATN) in the setting of haemolysis or rhabdomyolysis, in some patients, acute renal failure may result from a direct nephrotoxic effect or acute interstitial nephritis from a hypersensitivity reaction.
Placebos and Medical Education
Authors: Raz Amir , Guindi Daniella
Published: February 2021

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Study of prescription of injectable drugs and intravenous fluids to inpatients in a teaching hospital in Western Nepal
Authors: Gyawali Sudesh , Shankar P Ravi , Saha Archana , Mohan Lalit
Published: February 2021

Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teaching hospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal Teaching Hospital during 1st January to 30th June 2006 was studied. The mean number of drugs, IDs and IVFs administered, median cost of drugs and of IDs/IVFs per prescription calculated. Comparison of ID/IVF use in the four major hospital departments (Medicine, Obstetrics and Gynecology, Pediatrics and Surgery) was done. The administration of IDs/IVFs and injectable antimicrobials were measured in Defined Daily Dose (DDD)/100 bed-days and of Intravenous fluid in Liters (L)/100 bed-days. Of the 1131 patients discharged, 938 (82.94%) patients received one or more IDs/IVFs. The mean number of drugs, IDs and IVFs prescribed were 8.75, 4.72 and 1.42. Median cost of drugs and IDs/IVFs per prescription were 8.26US$ and 5.12US$ respectively. IDs/IVFs accounted for 81.37% of total drug cost. The most commonly used ID, injectable antimicrobial and IVF were Diclofenac (19.3 DDD/100 bed-days), Metronidazole (7.68 DDD/100 bed-days) and Dextrose normal saline (8.56 L/100 bed-days), respectively. The total IVF consumption was 24.25 L/100 bed-days. Significant differences between departments were observed (p<0.05). In conclusion, the use of IDs/IVFs was higher compared to other studies. Interventions to improve IDs/IVFs prescribing practices may be required.
Ethical Issues in the Emergency Department: Consent for Procedure Training on Newly Deceased Patients
Authors: Karczewska Marta
Published: February 2021

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The Potential Implementation of Radio-Frequency Identification Technology for Personal Health Examination and Monitoring
Authors: Nguyen Andrew
Published: February 2021

This paper presents several possible applications of the radio-frequency identification (RFID) technology for personal health examination and monitoring. One application involves using RFID sensors external to the human body, while another one uses both internal and external RFID sensors. Another application involves simultaneous assessment and monitoring of many patients in a hospital setting using networks of RFID sensors. All the assessment and monitoring are done wirelessly, either continuously or periodically in any interval, in which the sensors collect information on human parts such as the lungs or heart and transmit this information to a router, PC or PDA device connected to the internet, from which patient’s condition can be diagnosed and viewed by authorized medical professionals in remote locations. Instantaneous information allows medical professionals to intervene properly and in a timely fashion to prevent possible catastrophic effects to patients. The continuously assessed and monitored information provides medical professionals with more complete and long-term studies of patients. The proposed ideas promise to result in not only enhancement of the health treatment quality but also in significant reduction of medical expenditure.
Postpartum Haemorrhage in the Developing World A Review of Clinical Management Strategies
Authors: Snelgrove John W
Published: February 2021

The developing world is disproportionately burdened with high rates of maternal mortality. Despite widespread reduction in maternal deaths due to improved antepartum, intrapartum, and postpartum care in developed nations, mortality rates are persistently high in many countries unable to provide advanced medical care. Postpartum haemorrhage accounts for a substantial proportion of maternal deaths in developing countries. This review addresses the clinical management  strategies aimed at the prevention and treatment of postpartum haemorrhage that are effective in low- resource settings. The review was conducted by searching the English-language medical literature  using MEDlINE (1950 - Feb 2009) and the online search engine Google Scholar. Four relevant strategies were identified in the literature: active management of the third stage of labour (AMSTl), the use of uterotonic agents including misoprostol, accurate measurement of blood loss, and internal and external compression techniques. Despite known intervention options, additional research on effective management strategies and their implementation is needed to address postpartum haemorrhage in countries of the developing world.
27th annual Montreal Regional Science and Technology Fair (MRSTF) Abstracts
Authors: Med MJM
Published: February 2021

In our true scholarly spirit, the MJM remains committed to supporting budding scientist at all stages of their careers. This year we are pleased to provide you with a unique collection of abstracts outlining the high caliber projects that were undertaken by the most recent winners of the 27th annual Montreal Regional Science and Technology Fair (MRSTF) that was held at Marianopolis College from March 22-24th 2009. This unique event not only invites hundreds of students from greater Montreal area high schools and CEGEPs to present their projects to their peers, but also permits them with a unique opportunity to interact with leading researchers and university professors from top academic institutions. By supporting such initiatives the MJM hopes to further encourage young scientists and engineers to pursue their interests in the sciences so that they may excel and can become tomorrow’s leaders.
ICA Occlusion by an ACTH- secreting pituitary adenoma post-TSS and irradiation
Authors: El-Zammar Diala , Akagami Ryojo
Published: February 2021

Occlusion of intracranial arteries by a pituitary adenoma with ensuing infarction is a rare occurrence. In this case study, we show the instance of a pituitary  macroadenoma and apoplexy causing mechanical obstruction of the internal carot- id artery with consequent infarction following transphenoidal surgery (TSS) and ra- diation therapy in a patient with Cushing’s disease. we report a 44-year-old woman  presented with amenorrhea and headaches. Necessary investigations, resection by  TSS, and microscopic examination revealed an adenocorticotropin (ACTH)-secret- ing pituitary macroadenoma. The pituitary tumour recurred in subsequent years,  resulting in the development of Cushing’s disease and syndrome. despite two more  transphenoidal surgeries, radiotherapy, and medical suppressive therapy, the pi- tuitary adenoma continued to enlarge, and the hypercortisolemia and Cushingoid  symptoms persisted. A craniotomy was arranged as the next step in the treatment strategy. Only hours prior to the scheduled surgery, the patient developed left-sided hemiplegia, was diagnosed with acute occlusion of the right ICA and underwent an emergency bifrontal craniotomy with evacuation of the tumour and decompression.  Pathological examination revealed evidence of apoplexy in the ACTH-secreting pi- tuitary adenoma. This case demonstrates the vast scope of complications that can  arise from pituitary adenomas despite combination therapy and forewarns clinicians to be prepared to manage these infrequent but conceivable occurrences.
Maternal Hemoglobin Concentration and Pregnancy Outcome: A Study of the Effects of Elevation in El Alto, Bolivia
Authors: Laflamme Elise M
Published: February 2021

Iron-defciency anemia is often under-diagnosed in developing coun- tries, specifcally in pregnant populations in regions of high altitude. Hemoglobin  levels are not consistently adjusted for elevation, and therefore many anemic pa- tients are left undiagnosed. The purpose of this study was to incorporate current  parameters for diagnosing anemia in pregnancy at high altitudes, and to evaluate  the effects of appropriately adjusted hemoglobin concentrations on pregnancy out- come. A few studies have examined the effect of elevation on hemoglobin status,  and other studies have considered the effects of anemia of pregnancy; however,  there is a lack of data demonstrating that altitude-adjusted hemoglobin levels ac- curately predict pregnancy outcome. Using the Student t-Test, multiple linear re- gression, and ANOVA statistical analyses, various factors of pregnancy outcome  were compared between anemic and non-anemic groups, as defned by hemoglobin cut-off levels adjusted for trimester of pregnancy and altitude. when appropriate adjustments were used, maternal anemia was associated with lower infant Apgar scores at both one minute and fve minutes after birth, as well as complication of labor, lower gestational age at birth, and higher parity. This study demonstrates the importance of altitude and trimester specifc adjustments to maternal hemoglobin  levels in order to accurately diagnose anemia in pregnancy. In addition, a clear cor- relation is seen between maternal hemoglobin level and pregnancy outcome.
14,000 Volt Electrical Injury to Bilateral Upper Extremities: A Case Report
Authors: Lee J , Sinno H , Perkins A , Tahiri Y , Luc M
Published: February 2021

Electrical burns are among the most devastating of burn injuries. High  voltage electrical injuries result in extensive deep tissue damage and are associ- ated with multiple complications, long term morbidity, and a high mortality rate. we  describe the case of a 47 year-old electric company linesman who suffered a high voltage electrical injury (HVEI) of 14,000 volts to bilateral hands and wrists managed by the division of Plastic and Reconstructive Surgery at the Mcgill University Health Center in Montreal, Quebec, Canada. His management included multiple operative  procedures, including escharotomies, fasciotomies, serial debridements, and bilat- eral pedicle groin faps, and amputation of his left hand.
The Osler Library of the History of Medicine: Mcgill’s Medical Memory
Authors: Lyons Christopher , Crawford David
Published: February 2021

Sir william Osler bequeathed his library to Mcgill University in 1919; a decade later, the 8000 volumes arrived in Montreal. Then, as now, the collection consisted of primary works (“rare books”), secondary commentaries, and current works on the history of the health sciences. In the last 80 years the collection has grown considerably and the library now adds about 1,000 books to its collection yearly (mainly current publications) and receives 200 current serial titles. The Osler Library is one of the largest “history of medicine” libraries in the world and the largest of its kind in Canada. The library tries to collect current material on the history of the health sciences from all over the world and attempts to collect all medical history published in Canada. The Osler offers its resources to researchers and students through its website, publications and Research Travel grant programme.
The United States’ Health Care Reform Bill – A Translation
Authors: Quenell Gregory
Published: February 2021

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Medical Care in the Arctic and on orbit
Authors: Saint-Jacques David
Published: February 2021

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Physicians as Astronauts
Authors: Thirsk Robert
Published: February 2021

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Cultural Competency in Haitian-Serving Community Health Centers in South Florida
Authors: Campbell David
Published: February 2021

The purpose of this research was to explore the perspectives of health care administrators, practitioners and patients regarding the role and operationalization of cultural competency in their organizations. This work was conducted in three Haitian-serving Community Health Centers (CHCs) in South Florida. CHCs were established in the United States to provide services to underinsured individu- als. In recent years cultural competency discourse has become prominent in these institutions through the establishment of federal regulations mandating these pro- grams. The data was collected primarily through ethnographic methods: interviews and participant observation. Conversational interviews were held with the following groups of informants: staff, patients and members of the community at large. Semi-structured interviews were held with 15 physicians and administrators of the cen-ters. Unexpectedly, institutions largely devalued cultural competency and were able to sidestep federal regulations by hiring Haitian staff. However, through interactions with patients, it was discovered that aspects of cultural competency were in fact important to them. The qualities they most desire in physicians are: accessibility, linguistic profciency, and the ability to treat them as individuals within their cultural context.“Cultural humility” is proposed as the resolution to this dilemma. Cultural humility involves a redefning of medicine’s understanding of culture. It does not involve complex training programs or the hiring of physicians who are similar to the patient population, but is patient-centered medicine, practiced refexively. This approach is proposed to improve communication without the undesirable assump-tions and effects of the cultural competency paradigm.
An Atypical Case of Myasthenia Gravis: Purely Bulbar in a Young Male
Authors: Saleem Muhammad Amer , Pervaiz Faizan , Yousaf Anum , Saleem Muhammad Amer
Published: February 2021

Myasthenia Gravis (MG), an uncommon autoimmune syndrome caused by the failure of neuromuscular transmission, results from bind- ing of autoantibodies to proteins that are involved in signaling at the neuromuscular junction (1). Ac- quired myasthenia gravis (MG) is an uncommon disorder (occurring in 200–400 cases per million people) (2). Its symptoms are caused by a character- istic muscle weakness that worsens after repeated use. In most cases of MG, the initial sign is ocular weakness of any sort. The next most common sign is bulbar weakness (5) . In about two-thirds of pa- tients, the extrinsic ocular muscles (EOMs) present with the initial symptoms. These symptoms usually progress to other bulbar muscles and limb muscles, resulting in generalized MG (gMG). In about 10% of MG patients, symptoms remain limited to the EOM, and this condition is termed ocular MG (oMG)(3,4). However in cases where weakening of other stri- ated skeletal muscles occurs, this is referred to as generalized MG. We present a rare case of early onset Myasthenia Gravis affecting a young male with only and purely bulbar involvement.
2016 Nobel Prize Winner Yoshinori Ohsumi; Solving the Mystery of Autophagy
Authors: Dan Andrei
Published: February 2021

In 2016, Dr. Yoshinori Ohsumi accomplished an incredible feat: he received the Nobel Prize in medicine or physiology as a single recipient. Awarded once a year to up to 3 individuals who made a significant contribution to the scientific community, this Nobel Prize is the most well known, and arguably the most prestigious prize for those studying the human body.
Is My Blood Pressure OK?
Authors: Raj Anita
Published: February 2021

Before I entered medical school, I knew little about what family doctors did. I had one as a child, but he soon retired and I remember very little of him. However, during my medical training several years later, I had the opportunity to work with many family doctors. I learned just how important a role they could play in patients’ lives, providing continuous care and support. The doctor-patient relationship is a unique one, one that inspired me as I now start a residency in Family Medicine. This connection is not only adapted to each patient’s health status, but also their personality and other needs. One aspect of this relationship that stood out to me was the reassurance and support that family doctors can provide, no matter what a patient presents with. In this artwork, I hoped to elicit how the physical exam not only gives us physicians information, can also reassure the patient in different ways.
Small Town, Big Picture: Scope of Practice of Rural Family Medicine, the Shawville Experience
Authors: Gorsky Kevin , Safran Tyler
Published: February 2021

Living in the countryside, time moves a little bit slower. The people are friendly, neighbours look out for one another and denizens are grateful for the miles that separate them from the high-octane hustle of city life. When a city-slicker tries to integrate into this new world, certain dichotomies quickly emerge. For those that call small-town Canada their home, the start of hunting season is a far more prescient date than the start of the new fiscal quarter. These remarks are not a condemnation, far from it, but rather an attempt to illuminate a culture and perspective that many metropolitans have lost, if ever grasped at all. These comments certainly hold water when discussing the town of Shawville, Quebec. Though the overall ethos may be a bit humbler throughout the expansive planes of the Pontiac, the practice of medicine is anything but.
Family physician hospitalists: the good and the bad
Authors: Khare Satya Rashi
Published: February 2021

A hospitalist is the most responsible physician for inpatient care without the responsibility for care post discharge. In Canada, the majority of hospitalists are family physicians which raises concerns in the context of a shortage of family physicians in the community. In this commentary, advantages and disadvantages of the hospitalist model are discussed, with a focus on the necessity of family physician hospitalists. Finally, some challenges for maintaining the family physician hospitalist model going forward are presented.