bluuebunny/crossref_metadata_2025 huggingface dataset:
HOSPITAL UNIVERSITÁRIO JOÃO DE BARROS BARRETO
Authors: Miranda Cybelle , Moreira Paloma
Published: June 2024

Em 2009, a equipe do Laboratório de Memória e Patrimônio Cultural – LAMEMO integrou o Inventário Nacional do Patrimônio Cultural da Saúde, que produziu fichas de 23 instituições hospitalares consideradas como portadoras e constituintes da herança da saúde em Belém (PA), dentre elas o atual Hospital Universitário João de Barros Barreto – HUJBB, relevante à época devido ao quadro epistemológico nacional, e relevante na atualidade devido à pandemia da Covid-19. À vista disso, o presente artigo se propõe a avaliar aspectos físicos da edificação sob o prisma da teoria da Salutogênese, ato que pressupõe um enfoque em seus usuários e nas relações que esses cultivam com o local. Para a produção desse artigo, foram realizas pesquisas bibliográfica e documental, incursões a campo, observação empírica, registros fotográficos, diálogo com usuários e redesenho de plantas arquitetônicas. Da investigação, conclui-se que determinados detalhes da materialidade do HUJBB contribuem para o Senso de Coerência – SC dos usuários, para além de serem identitários da instituição e passíveis de preservação, algo possível apenas na ocasião da devida participação da comunidade junto às perspectivas das agências de saúde no momento de formular as intervenções para o complexo hospitalar.
An Analogy between Two Bio-Membranes (CGF-PRGF) Mixed with Xenogeneic Bone Graft to Achieve Frugal Management of Labial Dehiscence amidst Immediate Implantation in Esthetic Zone: A Randomized Clinical Trial
Authors: Fathy Abo-elkheir Hussein , Moustafa Ahmed Abdel Meguid , Khalil Ahmed Abdallah
Published: June 2024

Background

Labial dehiscence is a very prevalent esthetic concern among implantologists during immediate implantation in the esthetic zone since recent implant treatment and patient ambition are not only directed to function reestablishment, but esthetic superbness also holds immense consideration.

Objective

This study aimed to manage the labial dehiscence at the time of implantation and evaluate and compare the effects of two different autologous biomembranes, Concentrated Growth Factor (CGF) and Plasma Rich Growth Factors (PRGF), in combination with xenogeneic bone around the immediate implants in the esthetic zone.

Methods

Twenty patients indicated for immediate implant in the esthetic zone were randomly divided into two groups. The first group received CGF with xenograft, and the second group received PRGF mixed with xenograft. Cone Beam Computed Tomography (CBCT) radiographs and clinical periodontal parameters were evaluated, and all the results were tabulated and statistically analyzed.

Results

The two groups showed a statistically significant increase in bone density and inevitable crestal bone loss after 9 months, even though the CGF group comparably showed a statistically significant reduction in crestal bone loss.

Conclusion

Platelet concentrate derivatives, such as CGF and PRGF, are beneficial in the management of labial dehiscence around the immediate implants even though CGF offers a considerably and statistically significant decrease in crestal bone loss and more amelioration of bone density alongside its easier and faster preparation than PRGF.

Clinical Trial Registration

The study is registered at the U.S. National Library of Medicine website of clinical trials (clinicaltrials.gov) under ID: NCT05595772.
Prevalence of Dentin Hypersensitivity Among Dental Students and Effectiveness of Tooth Desensitizing Agents
Authors: Islam Md. Sofiqul , Padmanabhan Vivek , Al Abid Hanan Khalil , Khallaf Ebtessam Ahmad Abouelnaga , Rahman Muhammed Mustahsen , Aryal A C Smriti
Published: June 2024

Objectives

Dentin hypersensitivity (DH) is a growing concern in Dentistry. The objective of this study was to evaluate the prevalence and effectiveness of different desensitizing agents of (DH) among undergraduate dental students.

Materials and Methods

This cross-sectional clinical study was conducted with 161 undergraduate dental students. A self-reporting questionnaire along with a clinical examination was performed to diagnose DH and determine the severity. The effectiveness of home-based and in-office desensitizers was evaluated by comparing the combined DH scale in the pre- and post-treatment periods. The data were analyzed for frequency, correlation, and T-test.

Results

The prevalence of DH in the tested population was 19.3%, predominantly in females. The Chi-Square test showed significance in gender and oral hygiene practice by the participants (p<0.05). However, none of the tested factors strongly correlated with DH in this population. The post-treatment combined DH scale (5.48±3.1) was statistically significant (p=0.0001) compared to the pretreatment scale (11.29±3.5). The effectiveness of SRA was 87%, and the remaining 13% of DH recovered using GLUMA.

Conclusion

The prevalence of DH was 19.3% without any strongly correlated etiology. Home-based and in-office desensitizers were effective in reducing DH in the tested population.
K’abeena phonology
Authors: Girma Tadesse
Published: June 2024

The article provides descriptive analysis of the phonology of K'abeena, a language belonging to the Afro-Asian phylum, spoken in central Ethiopia. In this article, I identify 25 consonant phonemes and 3 loan phonemes. The loan phonemes are included as they are used in the current language's orthography. The language has five vowels. Vowel length and Gemination of consonants are phonemic in the language. With the exception of /h/ and /f/, which never geminate in the language, the rest of the consonant phonemes appear together to geminate. This only happens in the medial position of the words. Consonant clusters are allowed in word medial position with a maximum of two consonants. The phonological process identified in this article involves processes like assimilation, palatalization and deletion. Kabeena does not appear to be a pitch-accent language, but further research is needed to establish confirmed statements.
Performance of Dodging Channels and Cofferdams Against Flood Flows in the Construction of Bener Dams
Authors: Lestari Yuni , Istiarto Istiarto , Sujono Joko
Published: June 2024

Bener Dam is one of the new dams built in Bogowonto River, in Guntur Village, Bener District, Purworejo Regency. Bener Dam was constructed to fulfill the irrigation and raw water demand, and also as a flood control, and a micro-hydro power plant, conservation, and tourism that can improve the economy. The diversion works of the Dam consist of the construction of a cofferdam and a diversion tunnel. The cofferdam and diversion tunnel need to be planned well to prevent the river from overflowing through the main dam and causing material losses and casualties. Therefore it is necessary to study the performance of cofferdam and the diversion tunnel of Bener Dam against the flood discharge. In this study, the diversion tunnel flood routing was carried out by HEC-RAS software version 4.1.0. The design flood uses return periods of 25 and 50 years. The flood routing simulation is carried out by two scenarios: the flow simulation on the existing conditions and the flow simulation on the diversion tunnel. The research results show that the Bogowonto River still can accommodate 25-year, and 50-year floods along the river channel. The cofferdam with a peak elevation of +235 m which is designed with a discharge of 410 m3/s is also capable of diverting the flood discharge with a return period of 25 years and 50 years. The diversion tunnel of Bener dam is planned by a horseshoe shape F, with a 25-year flood design with 7m tunnel diameter Based on the flood routing analysis, it was found that the maximum water elevation in the diversion tunnel was +221 m, and with outflow of 332 m3/s. The 50-year flood routing in the diversion tunnel results maximum water elevation of +222 m with an outflow of 396 m3/s. The flood simulation shows the flow characteristics in the diversion tunnel in the form of open channel flow because the tunnel is not filled by water. Then, the maximum flow velocity on the diversion tunnel is ±14.3 m/s which exceeds the permissible velocity so it can cause damage due to erosion and affect the amount of sediment transport.
Wayfinding Analysis for Evacuation Optimization with Urban Network Analysis in Disaster Preparedness School KB TK Masjid Syuhada
Authors: Setyawan Siti Luzviminda Harum Pratiwi , Syafii Nedyomukti Imam
Published: June 2024

The existence of evacuation routes is one of the most important elements in disaster management because it will determine the smoothness of the rescue process during a disaster. An evacuation route is a route to an assembly point or exit that is assumed to be a safe space. Wayfinding is the process of moving from one point to another within the closest or fastest distance. In relation to the evacuation process, wayfinding will show the movement from a point, which in relation to buildings can be a specific space, to an exit or assembly point. As one of the disaster preparedness schools in Yogyakarta's Special Region, Masjid Syuhada Kindergarten was chosen as the site of the research. It is a complex of schools ranging from playgroup, kindergarten, elementary school, to junior high school, all of which are connected by the Syuhada Mosque.  The analysis of evacuation routes in the kindergarten was conducted using Urban Network Analysis (UNA). UNA is used as a method to determine the effectiveness of providing evacuation routes in a building area because it can analyze trips between points, called origin and destination. Of the various analyses that UNA can perform, this research uses the closest facility analysis. In this study, the origins were all the class in the kindergarten which placed at the door as the open access and in the middle of the class if the class have two doors; while the destinations were the stairs which heading to assembly point. The conclusion is reached after analyzing the network that connects the origin of the class to the destination of the stairs, which is connected to the assembly point.
Transmission Pipeline Planning from Kregan Water Treatment Plant to Watu Gadjah Tank by PERUMDA PDAM Sleman Using EPANET 2.2
Authors: Dewata Hendra , Faishal Faris Amir , Marleni Ni Nyoman Nepi
Published: June 2024

Clean water is vital as it directly impacts health and influences various aspects of life, including social, economic, and cultural activities. To address the clean water supply requirements in the area, PERUMDA PDAM Sleman, Yogyakarta, is currently planning for a transmission network linking the Kregan WTP to the Watu Gadjah Tank. The pipeline planning is carried out to ensure efficient and optimal network performance. The pipeline planning use both primary and secondary data. The primary data was obtained from surveys, while the secondary data was obtained though previous research and planning, regulation, and from the other sources. The pipeline network analysis carried out using EPANET 2.2. software. EPTANET was selected because of its cost-effectiveness and robust capabilities in modeling drinking water networks, with the advantage of being re-programmable. The results of the analysis are then adjusted to the planning standards that applicable in Indonesia. Risk analysis was carried out based on experience and expert opinion. The results of the planning showed that the maximum pressure on the transmission network was 84.21m on Pendowo Road. The velocity between 1.03 m/s and 1.63 m/ss with the highest headloss was 10.33 m/km. Based on the results of the planning, the entire parameter meets the standard of the applicable planning criteria. The results of the analysis indicate that the technical specifications of the pipe used must be able to withstand a pressure of 92,63m. There was a potential risk that network performance may be disrupted both in terms of network performance, implementation of development, and operational stages. The re-examination and the development of operational standard procedures is needed to ensure that planning has been in line with the expectations, can be implemented, and can be operated efficiently.
Hubungan antara Self-compassion dengan Burnout pada Guru Sekolah Dasar Inklusif
Authors: Hasyyati Bewizta Maurilla , Widyasari Pratiwi
Published: June 2024

Guru sekolah inklusif rentan mengalami stres terkait pekerjaan, yang dapat menimbulkan burnout. Burnout berdampak negatif pada performa guru maupun pencapaian akademis dan sosial siswa. Penelitian sebelumnya mengajukan self-compassion sebagai pencegah burnout. Penelitian ini menguji korelasi antara self-compassion dengan burnout pada guru SD inklusif menggunakan Self-Compassion Scale dan Maslach Burnout Inventory-Educators Survey. 170 guru kelas dan pendamping SD inklusif direkrut dengan metode purposive dan accidental sampling. Pengumpulan data dilakukan melalui google form dan kuesioner paper-and-pencil di SD inklusif di Jakarta, Depok, Bogor. Pearson correlation digunakan untuk menganalisis korelasi antara self-compassion dengan burnout. Sesuai hipotesis, self-compassion berhubungan signifikan dengan dimensi burnout, yaitu hubungan negatif dengan kelelahan emosional dan depersonalisasi, serta hubungan positif dengan pencapaian personal. Penemuan mengindikasikan self-compassion sebagai pelindung terhadap burnout pada guru SD inklusif. Dengan demikian, penting bagi guru sekolah inklusif untuk mengembangkan self-compassion untuk mengantisipasi burnout. Limitasi dan saran penelitian didiskusikan lebih lanjut.
Intervensi Picture Exchange Communication System untuk Meningkatkan Komunikasi Anak dengan Autism Spectrum Disorder - Non Verbal
Authors: Sukriananda Riskia Ramadhina , Mangunsong Frieda M
Published: June 2024

Penelitian sebelumnya menemukan bahwa kesulitan komunikasi pada anak dengan autism spectrum disorder non verbal, khususnya keengganan untuk memulai komunikasi, dapat ditangani dengan progam pelatihan komunikasi alternatif menggunakan kartu bergambar, atau disebut juga dengan picture exchange communication system (PECS). Walau demikian, belum ada pelatihan yang melibatkan orang tua di dalam prosesnya. Dengan demikian, penelitian ini bertujuan untuk melihat efektivitas intervensi PECS dalam meningkatkan komunikasi anak dengan orang tua sebagai pelatih. Keberhasilan intervensi ditandai dengan peningkatan persentase anak melakukan satu siklus penggunaan kartu (mengambil kartu, menjangkau pelatih, dan meletakkan kartu bergambar kepada pelatih) dalam mengkomunikasikan keinginannya, secara mandiri. Penelitian ini menggunakan metode reversal replication strategy (ABA design) dengan subjek tunggal, yang dilakukan pada anak lelaki usia 7 tahun 6 bulan, dengan diagnosis Autistism Syndrome Disorder - non verbal. Data dalam penelitian ini dikumpulkan dengan metode continuous recording. Pelatihan dilakukan selama delapan hari dengan rincian dua hari persiapan pelatihan mencakup workshop kepada orang tua sebagai pelatih, reinforcement assessment dan baseline, lima hari intervensi anak, serta satu hari evaluasi. Hasil penelitian menunjukkan peningkatan persentase keberhasilan anak untuk memulai komunikasi menggunakan kartu bergambar secara mandiri hingga empat puluh persen keberhasilan setelah intervensi.
Tantangan dan Kebutuhan Guru SDLB dalam Implementasi Kurikulum Merdeka Di Lampung
Authors: Wardany Ossy Firstanti , Sani Yulvia , Herlina Heni , Setyaningsih Septi
Published: June 2024

Transisi dari Kurikulum 2013 ke Kurikulum Merdeka bagi PDBK (Peserta Didik Berkebutuhan Khusus) diasumsikan menimbulkan tantangan baru bagi guru dalam mengimplementasikannya. Penelitian bertujuan menggali tantangan dan merumuskan kebutuhan guru Sekolah Dasar Luar Biasa (SLB) dalam implementasi Kurikulum Merdeka bagi PDBK di jenjang SD. Penelitian merupakan penelitian kuantitatif dengan menggunakan metode survei. Responden penelitian adalah 44 guru SLB tingkat Sekolah Dasar di Provinsi Lampung yang menerapkan Kurikulum Merdeka yang dipilih secara random sampling. Pengumpulan data menggunakan penyebaran kuesioner dengan Google Form. Hasil penelitian menunjukkan bahwa guru telah memiliki pemahaman yang baik, pandangan positif dan kesiapan yang cukup mengenai Kurikulum Merdeka yang didukung dari pengalaman belajar melalui berbagai kegiatan dari pemerintah, sekolah, dan pihak lain. Dari 44 guru tersebut,  55% guru merasa kekurangan waktu dalam merancang evaluasi yang sesuai dengan keragaman jenis dan fase peserta didik, 59% guru merasa pilihan keterampilan vokasional  yang ada di sekolah masih terbatas, 48% masih kesulitan dalam membuat instrumen asesmen awal, dan 45% mengalami masalah dalam melaksanakan pembelajaran yang mengakomodasi keberagaman. Tantangan ini selaras dengan kebutuhan yang diinginkan guru, di mana 3 kebutuhan teratas yakni 84% mengharapkan pelatihan mengenai metode dan media pembelajaran yang berdiferensiasi, 77% membuat asesmen dan rencana pembelajaran, 77% pelatihan program kebutuhan khusus.
Age as a determinant of emotional health problems among secondary school teachers in Ilorin Metropolis
Authors: Lasisi Adekola Kamil , Annor Patricia Omioguele
Published: June 2024

The study examined age as a determinant of emotional health problems among secondary school teachers in Ilorin Metropolis. The study adopted a descriptive survey of a correlation type. The researcher's instrument titled the Emotional Style Questionnaire from Kesebir et al. was used to collect the data for the study. The reliability coefficient of the questionnaire was reported to be 0.85. There was no significant relationship between ages and emotional health of secondary school teachers in Ilorin Metropolis; there was no significant relationship between ages and emotional health of younger secondary school teachers in Ilorin Metropolis; and there was no significant relationship between the ages and emotional health of older secondary school teachers in Ilorin Metropolis were postulated hypotheses of the study. These hypotheses were tested at a 0.05 level of significance. Pearson-Product Moment Correlation was the statistical method employed for this study. The finding of the hypotheses showed there were significant relationships between the ages and emotional health of secondary school teachers in Ilorin Metropolis. There was a significant relationship between the ages of young teachers and their emotional health in Ilorin Metropolis of Kwara State. It was also observed that there was a significant relationship between the ages of older teachers and their emotional health in the Ilorin Metropolis of Kwara State. The study recommended that counsellors should orientate teachers on how to maintain good emotional health irrespective of their age and gender.
Pengaruh Teman Sebaya, Minat Belajar, dan Kreativitas Siswa Terhadap Prestasi Belajar Akuntansi Keuangan
Authors: Siswanto Siswanto , Rosa Laksmita
Published: June 2024

Penelitian ini bertujuan untuk mengetahui Pengaruh Teman Sebaya, Minat Belajar, dan Kreativitas Siswa terhadap Prestasi Belajar Akuntansi Keuangan. Penelitian ini merupakan jenis penelitian ex-post facto. Objek penelitian adalah siswa kelas XI Akuntansi Keuangan Lembaga SMK Negeri 1 Batealit Jepara dengan jumlah 72 siswa. Metode pengumpulan data yang digunakan adalah kuesioner. Teknik analisis data yang digunakan ialah analisis regresi. Hasil penelitian menunjukkan bahwa: (1) Terdapat pengaruh positif  Teman Sebaya terhadap Prestasi Belajar Akuntansi Keuangan dengan koefisien regresi (r1x1)sebesar 0,386; dan : 3,505;  (2) Terdapat pengaruh positif Minat Belajar terhadap Prestasi Belajar Akuntansi Keuangan dengan nilai koefisien regresi (r2x2 ) sebesar 0,210; dan  : 2,093. (3) Terdapat pengaruh positif Kreativitas Siswa terhadap Prestasi Belajar Akuntansi Keuangan dengan nilai koefisien regresi (r3x3 ) sebesar 0,142; dan 417; (4) Terdapat pengaruh positif  Teman Sebaya, Minat Belajar, dan Kreativitas Siswa terhadap Prestasi Belajar Akuntansi Keuangan dengan koefisien korelasi (Ry123 ) sebesar 0,706; koefisien determinasi ( R2y123)sebesar 0,498.
Analisis Peluang Kerja Lulusan Pendidikan Administrasi Perkantoran dalam Rekrutmen Pegawai Pemerintah Kelompok Teknis 2022
Authors: Rusdiyanto Wahyu , Ismawati Junica , Zulkarnaen Zulkarnaen
Published: June 2024

Penelitian ini bertujuan untuk menganalisis peluang kerja lulusan pendidikan administrasi perkantoran pada rekrutmen Pegawai Pemerintah dengan Perjanjian Kerja (PPPK) Teknis Tahun 2022. Penelitian ini menggunakan metode analisis konten dengan pendekatan kualitatif. Pengumpulan data dalam penelitian ini menggunakan dokumentasi tentang informasi jenis pengadaan, instansi, serta tingkat pendidikan. Sumber data dalam penelitian ini yaitu website resmi rekrutmen PPPK (sscasn.bkn.go.id). Selanjutnya, data dianalisis untuk mendapatkan informasi jenis formasi jabatan dan instansi yang membuka lowongan.  Analisis deskriptif digunakan untuk mendapatkan informasi jenis lowongan pekerjaan dan kantor pemerintah penyedia lowongan pekerjaan. Hasil penelitian menunjukkan bahwa terdapat 1901 peluang kerja untuk lulusan Pendidikan Administrasi Perkantoran. Peluang kerja terbanyak berada di Kementerian Agama. Formasi pekerjaan yang tersedia yaitu arsiparis dan analis kebijakan. Namun, lulusan pendidikan administrasi perkantoran harus bersaing dengan lulusan program studi lain yang layak mengisi formasi tersebut.
Upaya Guru PPKn Dalam Mengembangkan Civic Responsibility Siswa Kelas XI Sma Negeri 2 Lolofitu Moi 2022/2023
Authors: Gulo Perdamaian , Hulu Syukur Kasieli
Published: June 2024

Tanggung jawab dalam kamus besar bahasa indonesia (KKBI, 2007:1139) memiliki keadaan wajib menanggung segala sesuatunya (kalau terjadi apa-apa boleh dituntut, dipersalahkan, diperkarakan, dan lain sebagainya) Sikap tanggung jawab adalah sikap sadar diri dalam melaksanakan kewajiban, amanah atau kepercayaan yang telah diberikan kepada seseorang, menanggung sebab ataupun akibat dari hal-hal yang dipertanggung jawabkan.Penelitian ini menggunakan metode kualitatif yang menggunakan analisis dengan pendekatan deskriptif. Dengan melakukan pengamatan langsung di sekolah SMA NEGERI 2 LOLOFITU MOI dan melakukan wawancara langsung kepada narasumber yang terdiri dari Guru mata pelajaran PPKn dan kepada siswa sebanyak 6 orang. Hasil penelitian yang dilakukan dilapangan upaya guru dalam mengembangngkan sifat tanggung jawab siswa ialah guru selalu berperan aktif dan menjadi fasilitator dan motivator kepada siswa untuk mengembangkan sifat tanggung jawab siswa tersebut. Berdasarkan hasil penelitian, dapat disimpulkan bahwa Peran guru dalam mengembangkan sifat tanggung jawabsiswa melalui pembelajaran Pendidikan Kewarganegaraan di kelas XI SMA Negeri 2 Lolofitu Moi sebagai berikut memberikan arahan dan bimbingan kepada siswa untuk memahami betapa pentignya perubahan perubahan sikap dan karakter kearah yang lebih baik seperti bertanggung jawab, kesungguhan belajar, dan menaati displin sekolah dan melakukan pendekatan kepada siswa seperti memanggil siswa ketika siswa dijalur yang salah untuk diarahkan kearah yang lebih baik tanpa menggunakan kekerasan ataupun tekanan kepada siswa sehingga siswa merasa nyaman.
Communicative products of social networks and the Internet as a social glue in times of social crises and disasters
Authors: Tymofieieva Halyna
Published: June 2024

The article presents the quantitative and qualitative impact of social networks and the Internet products on social bonding during crises and disasters. The study is based on the data of psychological experiments, the results of sociological research and various models of news broadcasting and presents consideration about the nature of this impact. In particular, it is shown that informal communication, being a "social glue", has been replenished with new powerful communication channels due to the development of Internet technologies. Despite such an important characteristic as unverified information and other features of counter-knowledge, these channels are massively used by people, thus, according to the author, their communicative and informational products can be studied regarding the possibilities and conditions their expansion and heuristic ability, so they can be analyzed as a factor of social bonding. It has been proven that informal communication in its massive forms are activated in situations of social crises and disasters, because the users are traumatized, often lose control, plunge into a state of social deprivation and need constant communication with like-minded people in similar circumstances. In this way, the community is bonding by social glue by overcoming common problems, and relevant information products and their rapid sharing by the Internet contribute to this. The very information content of for the informal communication through social networks and the Internet allows people to explain reality better and "modify" or alter its representation to a more comfortable one. It has been proven that such factors as "cognitive simplicity" of the information content, its myth-producing component and the high status of an addressee of a message contribute to this. The article also outlines considerations on how people could be taught to navigate the information and choose those products of social networks and the Internet that not only glue community together, but also unite it on the basis of real knowledge. People should be taught to approach information messages critically, to understand the nature and properties of media messages, their communicative and destructive influences. Media literacy and critical thinking could be very helpful in these situations as they facilitate informational culture, teach media literacy, increase personal self-confidence, help people shape their own view of reality and consciously choose partners for constructive communication.
Ceftazidim/avibaktam u liječenju intrahospitalnih pneumonija kod mehanički ventiliranih bolesnika s infekcijom COVID-19
Authors: Mandarić Anja , Šitum Ivan , Siroglavić Marko , Lovrić Daniel , Karmelić Dora , Erceg Ante , Mažar Mirabel , Mihaljević Slobodan
Published: June 2024

U razdoblju pandemije koronavirusne bolesti 2019. (COVID-19) mnogi bolesnici kojima je bila potrebna invazivna mehanička ventilacija, primljeni su u jedinice intenzivnog liječenja (JIL) zbog teškog respiratornog zatajenja povezanog s bolešću COVID-19. Prijam u JIL i invazivna mehanička ventilacija neovisni su rizici za pneumoniju povezanu s ventilatorom (engl. ventilator associated pneumonia; VAP), kod koje je zabilježena visoka stopa smrtnosti i dulji boravak u JIL-u te je produljeno bolničko liječenje. Ako govorimo o uzročnicima VAP-a, Pseudomonas aeruginosa bio je jedan od glavnih gram-negativnih nefermentirajućih uzročnika ove patologije, zajedno s Burkholderia cepacia i Stenotrophomonas maltophilia u manjoj mjeri. Protiv gram-negativnih mikroorganizama otpornih na karbapeneme, ceftazidim/avibaktam (CZA) jedan je od najčešće korištenih antimikrobnih lijekova. Cilj ovog preglednog članka bio je opisati korištenje CZA u liječenju bolesnika s infekcijom COVID-19 koji su razvili VAP uzrokovan P. aeruginosa, B. cepacia i S. maltophilia, usporediti to s podatcima objavljenim u literaturi te skrenuti pozornost na kontinuiranu primjenu lijeka kao drugačijeg modaliteta u odnosu na standardni način primjene u bolusu. Unatoč visokoj smrtnosti kritično oboljelih bolesnika s COVID-om, CZA predstavlja valjanu opciju liječenja VAP-a uzrokovanog nefermentirajućim gram-negativnim mikroorganizmima.
Assessment of Five Patellar Height Measurement Methods on Lateral Knee Radiograph
Authors: Šantić Marta , Perić Petar , Miletić Damir , Karić Maja , Šestan Branko , Legović Dalen
Published: June 2024

Cilj: Položaj patele ima značajan utjecaj na pojavu kliničkih simptoma boli i oticanja koljenog zgloba, kao i na pojavu nestabilnosti patele. Cilj ovog istraživanja bio je ispitati pouzdanost primjene metoda mjerenja visine patela po Insall-Salvatiju, modificiranom Insall-Salvatiju, Blackburn-Peelu, Caton-Deschampsu te metodom mjerenja kuta plato - patela. Ispitanici i metode: Ispitivanje je izvršeno na 100 profilnih radiograma koljena bolesnika prosječne dobi od 50,14 godina, koji su pregledani na Klinici za ortopediju Lovran u razdoblju od godine dana. Prosječna vrijednost fleksije koljena na analiziranim profilnim radiogramima ispitanika iznosila je 36,57°. Provedena mjerenja učinila su dva istraživača i ponovljena su u dva navrata u razmaku od mjesec dana. U radu su se koristile statističke metode za analizu preciznosti i točnosti dviju metoda, pri čemu je korišten koeficijent korelacije podudarnosti i modificirani Pearsonov koeficijent. Rezultati: Rezultati su pokazali da u broju klinički dijagnosticiranih patela alta ili infera nije postojala značajna razlika između dvaju istraživača kod svake od primijenjenih metoda mjerenja visine patele. Uspoređujući dobivene rezultate mjerenja na temelju izračuna koeficijenta korelacije podudarnosti, Insall-Salvatijeva metoda pokazala se kao najpouzdanija zbog najbolje preciznosti (p1 = 0,8431, p2 = 0,8337) i zadovoljavajuće točnosti (Cb1 = 0,9171, Cb2 = 0,9275). Kod drugih metoda mjerenja rezultati su pokazali da se postiže jako dobra točnost, no slabija preciznost. Zaključak: Metoda mjerenja visine patele po Insall-Salvatiju na profilnom radiogramu koljena mogla bi se preporučiti kao optimalna metoda za potrebe korištenja u svakodnevnoj kliničkoj praksi.
Hiperparatireoidizam
nakon transplantacije bubrega
Authors: Orlić Lidija
Published: June 2024

Nakon uspješne transplantacije bubrega dolazi do oporavka egzokrine i endokrine funkcije bubrega. Vrijednosti serumske koncentracije kalcija, fosfata, paraireoidnog hormona (PTH), čimbenika rasta fibroblasta 23 i vitamina D se normaliziraju. Zbog toga bi trebale uslijediti pozitivne promjene u koštanom metabolizmu. Kod dijela bolesnika, unatoč uspješnoj transplantaciji, ostaju poremećaji u koštanom metabolizmu. Učestalost hiperparatireoidizma (HPT) nakon prve godine od transplantacije bubrega kreće se od 10 do 50 %. Trajanje dijalize i stupanj hiperplazije paratireoidnih žlijezda čimbenici su rizika za razvoj poslijetransplantacijskog HPT-a. Liječenje poslijetransplantacijskog HPT-a uključuje terapiju vitaminom D, analozima vitamina D, kalcimemeticima i paratireidektomija.
Rijedak slučaj bolesnika s miotoničkom distrofijom tipa 1 i multiplom sklerozom
Authors: Prenc Matea , Janko Labinac Dolores , Radolović Prenc Lorena , Flegarić Bradić Mirjana
Published: June 2024

Cilj: Prikazati bolesnika s iznimno rijetkom združenom pojavnosti miotoničke distrofije tipa 1 i multiple skleroze. Miotonička distrofija tipa 1 najčešća je nasljedna mišićna distrofija u odraslih osoba, dok je multipla skleroza demijelinizacijska autoimuna bolest središnjeg živčanog sustava uzrokovana međudjelovanjem genetskih i okolišnih čimbenika. Istodobna pojavnost ovih dviju bolesti opisana je kod samo jednog slučaja u svjetskoj literaturi. Prikaz slučaja: 31-godišnji muškarac javlja se s ponavljajućim epizodama spastične ljevostrane hemipareze, ataksije, dizartrije i diplopije uz mentalno nazadovanje i napredovanje mišićne atrofije. DNA analiza, uz pozitivnu obiteljsku anamnezu i EMNG nalaz, potvrdila je da pacijent boluje od miotoničke distrofije tipa 1, no produljeni vidni evocirani potencijali, prisutnost oligoklonalnih traka imunoglobulina G u likvoru i MR nalaz mozga upućivali su na multiplu sklerozu. Primjenom kortikosteroidne terapije neki su se simptomi povukli te se stanje pacijenta poboljšalo. Zaključak: Svi klinički i laboratorijski nalazi upućuju na to da pacijent boluje od obiju navedenih bolesti. Ovaj izrazito rijedak slučaj zasigurno može pobuditi znanstveni i stručni interes.
Kirurško zbrinjavanje kasnih komplikacija nakon endovaskularnog liječenja aneurizme abdominalne aorte
Authors: Kovačević Miljenko , Kovač Lovro , Tkalčić Lovro
Published: June 2024

Aneurizma abdominalne aorte (AAA) čest je problem u starije populacije, a rizik rupture korelira s promjerom aneurizme. Tradicionalno su se bolesnici s aneurizmom abdominalne aorte većeg promjera liječili otvorenim kirurškim tehnikama, dok u posljednjih 20 godina pratimo porast korištenja tehnike endovaskularnog popravka aneurizme aorte (EVAR-a), koja uključuje postavljanje prostetskog nepropusnog grafta unutar lumena abdominalne aorte s ciljem isključenja aneurizme iz protoka i sprječavanja rupture. Sigurnosni profil i dugoročni podatci metode EVAR rezultirali su značajnim porastom korištenja EVAR-a, unatoč studijama koje dugoročnim praćenjem nisu pokazale bolje preživljavanje ili kvalitetu života. Zbog porasta broja bolesnika liječenih EVAR-om, očekujemo porast broja komplikacija i potrebu za sekundarnim intervencijama. U najčešće komplikacije nakon EVAR-a ubrajamo endoleak, migraciju stent-grafta, kinking-proteze, trombozu te infekciju grafta. Sekundarne komplikacije prvenstveno treba zbrinjavati endovaskularno, no kasne komplikacije koje zahtijevaju otvorenu kiruršku operaciju možemo očekivati u do 9 % bolesnika kojima je učinjen EVAR. Operacije aneurizme abdominalne aorte nakon nezadovoljavajućeg rezultata EVAR-a prati veći broj komplikacija, zbog atrofije zida aorte, periaortalne upale i fibroze te otežanog postizanja proksimalne i distalne vaskularne kontrole zbog pozicije stent-grafta, što često zahtijeva suprarenalno klemanje. Otvorena kirurgija gotovo je uvijek potrebna kod sekundarne rupture AAA, ako endovaskularne opcije odmah nisu dostupne ili tehnički moguće, kao i kod infekcije grafta, gdje je poželjna potpuna ekstrakcija protetskog materijala. Ključno je praćenje bolesnika nakon EVAR-a te pravovremeno i elektivno zbrinjavanje komplikacija.
The Effect of Artificial Intelligence on Patient-Physician Trust: Cross-Sectional Vignette Study
Authors: Zondag Anna G M , Rozestraten Raoul , Grimmelikhuijsen Stephan G , Jongsma Karin R , van Solinge Wouter W , Bots Michiel L , Vernooij Robin W M , Haitjema Saskia
Published: June 2024

Background

Clinical decision support systems (CDSSs) based on routine care data, using artificial intelligence (AI), are increasingly being developed. Previous studies focused largely on the technical aspects of using AI, but the acceptability of these technologies by patients remains unclear.

Objective

We aimed to investigate whether patient-physician trust is affected when medical decision-making is supported by a CDSS.

Methods

We conducted a vignette study among the patient panel (N=860) of the University Medical Center Utrecht, the Netherlands. Patients were randomly assigned into 4 groups—either the intervention or control groups of the high-risk or low-risk cases. In both the high-risk and low-risk case groups, a physician made a treatment decision with (intervention groups) or without (control groups) the support of a CDSS. Using a questionnaire with a 7-point Likert scale, with 1 indicating “strongly disagree” and 7 indicating “strongly agree,” we collected data on patient-physician trust in 3 dimensions: competence, integrity, and benevolence. We assessed differences in patient-physician trust between the control and intervention groups per case using Mann-Whitney U tests and potential effect modification by the participant’s sex, age, education level, general trust in health care, and general trust in technology using multivariate analyses of (co)variance.

Results

In total, 398 patients participated. In the high-risk case, median perceived competence and integrity were lower in the intervention group compared to the control group but not statistically significant (5.8 vs 5.6; P=.16 and 6.3 vs 6.0; P=.06, respectively). However, the effect of a CDSS application on the perceived competence of the physician depended on the participant’s sex (P=.03). Although no between-group differences were found in men, in women, the perception of the physician’s competence and integrity was significantly lower in the intervention compared to the control group (P=.009 and P=.01, respectively). In the low-risk case, no differences in trust between the groups were found. However, increased trust in technology positively influenced the perceived benevolence and integrity in the low-risk case (P=.009 and P=.04, respectively).

Conclusions

We found that, in general, patient-physician trust was high. However, our findings indicate a potentially negative effect of AI applications on the patient-physician relationship, especially among women and in high-risk situations. Trust in technology, in general, might increase the likelihood of embracing the use of CDSSs by treating professionals.
Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link
Authors: Avanceña Anton L V , Brody Carinne , Chhoun Pheak , Tuot Sovannary , Yi Siyan
Published: June 2024

Background

Mobile Link is a mobile phone–based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use.

Objective

This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability.

Methods

We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link’s messaging and outreach services to 70% of female entertainment workers in 5 years.

Results

The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval –0.088 to 0.126) DALYs averted, Mobile Link’s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year.

Conclusions

This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population.

Trial Registration

ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842
Trend of Mortality Due to Congenital Anomalies in Children Younger Than 5 Years in Eastern China, 2012-2021: Surveillance Data Analysis
Authors: Dong Wen-Hong , Guo Jun-Xia , Wang Lei , Zheng Shuang-Shuang , Zhu Bing-Quan , Shao Jie
Published: June 2024

Background

As one of the leading causes of child mortality, deaths due to congenital anomalies (CAs) have been a prominent obstacle to meet Sustainable Development Goal 3.2.

Objective

We conducted this study to understand the death burden and trend of under-5 CA mortality (CAMR) in Zhejiang, one of the provinces with the best medical services and public health foundations in Eastern China.

Methods

We used data retrieved from the under-5 mortality surveillance system in Zhejiang from 2012 to 2021. CAMR by sex, residence, and age group for each year was calculated and standardized according to 2020 National Population Census sex- and residence-specific live birth data in China. Poisson regression models were used to estimate the annual average change rate (AACR) of CAMR and to obtain the rate ratio between subgroups after adjusting for sex, residence, and age group when appropriate.

Results

From 2012 to 2021, a total of 1753 children died from CAs, and the standardized CAMR declined from 121.2 to 62.6 per 100,000 live births with an AACR of –9% (95% CI –10.7% to –7.2%; P<.001). The declining trend was also observed in female and male children, urban and rural children, and neonates and older infants, and the AACRs were –9.7%, –8.5%, –8.5%, –9.2%, –12%, and –6.3%, respectively (all P<.001). However, no significant reduction was observed in children aged 1-4 years (P=.22). Generally, the CAMR rate ratios for male versus female children, rural versus urban children, older infants versus neonates, and older children versus neonates were 1.18 (95% CI 1.08-1.30; P<.001), 1.20 (95% CI 1.08-1.32; P=.001), 0.66 (95% CI 0.59-0.73; P<.001), and 0.20 (95% CI 0.17-0.24; P<.001), respectively. Among all broad CA groups, circulatory system malformations, mainly deaths caused by congenital heart diseases, accounted for 49.4% (866/1753) of deaths and ranked first across all years, although it declined yearly with an AACR of –9.8% (P<.001). Deaths due to chromosomal abnormalities tended to grow in recent years, although the AACR was not significant (P=.90).

Conclusions

CAMR reduced annually, with cardiovascular malformations ranking first across all years in Zhejiang, China. Future research and practices should focus more on the prevention, early detection, long-term management of CAs and comprehensive support for families with children with CAs to improve their survival chances.
A Virtual Reality Serious Game for the Rehabilitation of Hand and Finger Function: Iterative Development and Suitability Study
Authors: Bressler Michael , Merk Joachim , Gohlke Tanja , Kayali Fares , Daigeler Adrien , Kolbenschlag Jonas , Prahm Cosima
Published: June 2024

Background

Restoring hand and finger function after a traumatic hand injury necessitates a regimen of consistent and conscientious exercise. However, motivation frequently wanes due to unchallenging repetitive tasks or discomfort, causing exercises to be performed carelessly or avoided completely. Introducing gamification to these repetitive tasks can make them more appealing to patients, ultimately increasing their motivation to exercise consistently.

Objective

This study aims to iteratively develop a serious virtual reality game for hand and finger rehabilitation within an appealing and engaging digital environment, encouraging patient motivation for at least 2 weeks of continuous therapy.

Methods

The development process comprised 3 distinct stages, each of which was subject to evaluation. Initially, a prototype was created to encompass the game’s core functionalities, which was assessed by 18 healthy participants and 7 patients with impaired hand function. Subsequently, version 1 of the game was developed and evaluated with 20 patients who were divided into an investigation group and a control group. On the basis of these findings, version 2 was developed and evaluated with 20 patients who were divided into an investigation group and a control group. Motivation was assessed using the Intrinsic Motivation Inventory (IMI), while the application’s quality was rated using the Mobile Application Rating Scale and the System Usability Scale. User feedback was gathered using semistructured interviews.

Results

The prototype evaluation confirmed the acceptance and feasibility of the game design. Version 1 significantly increased motivation in 2 IMI subscales, effort (P<.001) and usefulness (P=.02). In version 2, a significant increase in daily performed exercises was achieved (P=.008) compared to version 1, with significantly higher motivation in the IMI subscale effort (P=.02). High Mobile Application Rating Scale scores were obtained for both versions 1 and 2, with version 2 scoring 86.9 on the System Usability Scale, indicating excellent acceptability. User feedback provided by the semistructured interviews was instrumental in the iterative development regarding improvements and the expansion of the playable content.

Conclusions

This study presented a virtual reality serious game designed for hand and finger rehabilitation. The game was well received and provided an environment that effectively motivated the users. The iterative development process incorporated user feedback, confirming the game’s ease of use and feasibility even for patients with severely limited hand function.
Self-Explainable Graph Neural Network for Alzheimer Disease and Related Dementias Risk Prediction: Algorithm Development and Validation Study
Authors: Hu Xinyue , Sun Zenan , Nian Yi , Wang Yichen , Dang Yifang , Li Fang , Feng Jingna , Yu Evan , Tao Cui
Published: June 2024

Background

Alzheimer disease and related dementias (ADRD) rank as the sixth leading cause of death in the United States, underlining the importance of accurate ADRD risk prediction. While recent advancements in ADRD risk prediction have primarily relied on imaging analysis, not all patients undergo medical imaging before an ADRD diagnosis. Merging machine learning with claims data can reveal additional risk factors and uncover interconnections among diverse medical codes.

Objective

The study aims to use graph neural networks (GNNs) with claim data for ADRD risk prediction. Addressing the lack of human-interpretable reasons behind these predictions, we introduce an innovative, self-explainable method to evaluate relationship importance and its influence on ADRD risk prediction.

Methods

We used a variationally regularized encoder-decoder GNN (variational GNN [VGNN]) integrated with our proposed relation importance method for estimating ADRD likelihood. This self-explainable method can provide a feature-important explanation in the context of ADRD risk prediction, leveraging relational information within a graph. Three scenarios with 1-year, 2-year, and 3-year prediction windows were created to assess the model’s efficiency, respectively. Random forest (RF) and light gradient boost machine (LGBM) were used as baselines. By using this method, we further clarify the key relationships for ADRD risk prediction.

Results

In scenario 1, the VGNN model showed area under the receiver operating characteristic (AUROC) scores of 0.7272 and 0.7480 for the small subset and the matched cohort data set. It outperforms RF and LGBM by 10.6% and 9.1%, respectively, on average. In scenario 2, it achieved AUROC scores of 0.7125 and 0.7281, surpassing the other models by 10.5% and 8.9%, respectively. Similarly, in scenario 3, AUROC scores of 0.7001 and 0.7187 were obtained, exceeding 10.1% and 8.5% than the baseline models, respectively. These results clearly demonstrate the significant superiority of the graph-based approach over the tree-based models (RF and LGBM) in predicting ADRD. Furthermore, the integration of the VGNN model and our relation importance interpretation could provide valuable insight into paired factors that may contribute to or delay ADRD progression.

Conclusions

Using our innovative self-explainable method with claims data enhances ADRD risk prediction and provides insights into the impact of interconnected medical code relationships. This methodology not only enables ADRD risk modeling but also shows potential for other image analysis predictions using claims data.