bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug-Induced Hospital-Acquired Acute Kidney Injury in China: A Multicenter Cross-Sectional Survey
Authors: Liu Chen , Yan Suying , Wang Yuqin , Wang Jinwei , Fu Xiujuan , Song Hongtao , Tong Rongsheng , Dong Mei , Ge Weihong , Wang Jiawei , Yang Hui , Wang Changlian , Xia Peiyuan , Zhao Limei , Shen Sijing , Xie Juan , Xu Yangui , Ma Peizhi , Li Hongjian , Lu Shegui , Ding Yufeng , Jiang Ling , Lin Yang , Wang Maoyi , Qiu Feng , Feng Wanyu , Yang Li
Published: September 2020

Introduction: Drug-induced acute kidney injury (D-AKI) is one of the important types of AKI. The incidence of D-AKI in China has rarely been studied. Objective: This study aims to explore the disease burden, related drugs, and risk factors of D-AKI. Methods: A nationwide cross-sectional survey was conducted in adult patients from 23 academic hospitals in 17 provinces in China. Suspected AKI was screened based on serum creatinine changes in accordance with the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI, patients who met the diagnosis of hospital-acquired AKI in January and July of 2014 were defined. Suspected AKI was firstly evaluated for the possibility of D-AKI by pharmacists using the Naranjo Scale and finally defined as D-AKI by nephrologists through reviewing AKI clinical features. Results: Altogether 280,255 hospitalized patients were screened and 1,960 cases were diagnosed as hospital-acquired AKI, among which 735 cases were defined as having D-AKI (37.50%, 735/1,960) with an in-hospital mortality rate of 13.88% and 54.34% of the survivors did not achieve full renal recovery. 1,642 drugs were related to AKI in these patients. Anti-infectives, diuretics, and proton pump inhibitors were the top 3 types of drugs relevant to D-AKI, accounting for 66.63% cumulatively. Besides age, AKI staging, severe disease, hypoalbuminemia, plasma substitute, and carbapenem related D-AKI were independent risk factors for in-hospital mortality of D-AKI patients. Conclusion: In China, D-AKI has caused a substantial medical burden. Efforts should be made to pursue nephrotoxic drug stewardship to minimize attributable risk and improve the prevention, diagnosis, and treatment of D-AKI.
Successful Use of Denosumab for Life-Threatening Hypercalcemia in a Pediatric Patient with Primary Hyperparathyroidism
Authors: Mamedova Elizaveta , Kolodkina Anna , Vasilyev Evgeny V. , Petrov Vasiliy , Belaya Zhanna , Tiulpakov Anatoly
Published: September 2020

Introduction: Primary hyperparathyroidism (PHPT) is rare and usually symptomatic in children. There is no approved medication to lower serum calcium levels in this patient group. Denosumab is used in adult patients with osteoporosis and hyperparathyroidism. To our knowledge, only 1 case of denosumab treatment in a child with severe PHPT has been reported to date. Case Presentation: A 16-year-old female was referred to our clinic with symptoms including pathologic fractures, nausea, emesis, and progressive weight loss. At admission, her serum total calcium was 4.17 mmol/L (reference range 2.15–2.55), parathyroid hormone 2,151 pg/mL (15–65), and phosphate 1.07 mmol/L (1.45–1.78). Due to potentially life-threatening hypercalcemia, denosumab 60 mg subcutaneously was administered after obtaining informed consent. Serum calcium levels were reduced within 12 h of injection and the patient’s condition rapidly improved, which allowed genetic testing to be done prior to surgery. A heterozygous mutation in the CDC73 gene was revealed, and a parathyroidectomy was performed on day 22 after denosumab administration. Morphological examination revealed solitary parathyroid adenoma. After surgery, hypocalcemia developed requiring high doses of alfacalcidol and calcium supplements. Conclusion: Our case supports the previous observations in adults that denosumab can be safely and effectively used as a preoperative treatment in patients with PHPT and severe hypercalcemia and shows that it may be used in pediatric patients.
Validation of a New Transcutaneous tcPO2/tcPCO2 Sensor with an Optical Oxygen Measurement in Preterm Neonates
Authors: van Weteringen Willem , van Essen Tanja , Gangaram-Panday Norani H. , Goos Tom G. , de Jonge Rogier C.J. , Reiss Irwin K.M.
Published: September 2020

Introduction: Traditional transcutaneous oxygen (tcPO2) measurements are affected by measurement drift, limiting accuracy and usability. The new potentially drift-free oxygen fluorescence quenching technique has been combined in a single sensor with conventional transcutaneous carbon dioxide (tcPCO2) monitoring. This study aimed to validate optical tcPO2 and conventional tcPCO2 against arterial blood gas samples in preterm neonates and determine measurement drift. Methods: In this prospective observational study, during regular care, transcutaneous measurements were paired to arterial blood gases from preterm neonates aged 24–31 weeks of gestational age (GA) with an arterial catheter. Samples were included based on stability criteria and stratified for sepsis status. Agreement was assessed using the Bland-Altman analysis. Measurement drift per hour was calculated. Results: Sixty-eight premature neonates were included {median (interquartile range [IQR]) GA of 26 4/7 [25 3/7–27 5/7] weeks}, resulting in 216 stable paired samples. Agreement of stable samples in neonates without sepsis (n = 38) and with suspected sepsis (n = 112) was acceptable for tcPO2 and good for tcPCO2. However, in stable samples of neonates with sepsis (n = 66), tcPO2 agreement (bias and 95% limits of agreement) was −32.6 (−97.0 to 31.8) mm Hg and tcPCO2 agreement was 4.2 (−10.5 to 18.9) mm Hg. The median (IQR) absolute drift values were 0.058 (0.0231–0.1013) mm Hg/h for tcPO2 and 0.30 (0.11–0.64) mm Hg/h for tcPCO2. Conclusion: The accuracy of optical tcPO2 in premature neonates was acceptable without sepsis, while electrochemically measured tcPCO2 remained accurate under all circumstances. Measurement drift was negligible for tcPO2 and highly acceptable for tcPCO2.
Longitudinal Assessment of Rotation Angles after Implantation of Directional Deep Brain Stimulation Leads
Authors: Lange Florian , Steigerwald Frank , Engel Doortje , Malzacher Tobias , Neun Tilmann , Fricke Patrick , Volkmann Jens , Matthies Cordula , Capetian Philipp
Published: September 2020

Purpose: The risk/benefit-ratio of deep brain stimulation (DBS) depends on focusing the electrical field onto the target volume, excluding side-effect eliciting structures. Directional leads limiting radial current diffusion can target stimulation but add a spatial degree of freedom that requires control to align multimodal imaging datasets and for anatomical interpretation of stimulation. Unpredictable postoperative lead rotations have been reported. The extent and timing of rotation from the surgically intended alignment remain uncertain, as does the time point at which directional stimulation can be safely initiated without risking unexpected shifts in stimulation volume. We present a retrospective analysis of clinically indicated, repeated neuroimaging controls postimplantation in patients with directional DBS systems, which allow estimation of the amount and timing of postoperative lead rotation. Methods: Data from 67 patients with directional leads and multiple cranial computer tomographies (CCT) and/or rotation fluoroscopies at different postoperative time points were included. Rotation angles were detected based on CCT artifacts (n = 56) or direct visualization of lead segments on rotation fluoroscopies (n = 52). Cross-validation of both methods was conducted in patients who received both imaging modalities (n = 51). Results: Rotation angles deviated significantly (∼30°) from their intended 0° anterior/posterior orientation. Rotation was firmly established within the first postoperative day, with no additional torque in subsequent scans. The two methods highly correlated (right hemisphere: R2 = 0.94, left hemisphere: R2 = 0.91). Conclusion: Both methods for measuring rotation angles led to comparable results and can be used interchangeably. Directional stimulation settings can safely be initiated after the first postoperative day, without risking subsequent lead rotation-related anatomical shifts.
Uso de Dados de Telefonia Móvel para Obtenção de Informações Turísticas
Authors: Oliveira Rafael Granvilla , Brasil Gutemberg Hespanha , O’Keefe David Theodore
Published: September 2020

Este artigo apresenta a experiência do Estado do Espírito Santo na obtenção de dados turísticos a partir de informações de uso de telefonia móvel. O avanço tecnológico do setor de comunicação móvel, o aumento nas taxas de penetração nos mercados, sejam estes desenvolvidos ou em desenvolvimento, tornaram os telefones móveis parte da vida cotidiana. Em todo mundo é crescente o número de pesquisas relacionadas ao turismo em que são utilizados dados de telefonia móvel. Neste sentido, o objetivo principal deste estudo é apresentar a metodologia utilizada para a obtenção e análise de dados turísticos, de viagens domésticas, por meio de Big Data através de registros de telefonia móvel no Estado do Espírito Santo, sudeste do Brasil. Para tal, a Secretaria de Estado do Turismo do Espírito Santo firmou um contrato com a empresa Telefônica Data S.A., utilizando a tecnologia denominada “Smart Steps”, para a realização de pesquisas turísticas em 20 municípios e uma análise de todo o estado. Os dados utilizados correspondem a temporada de verão (janeiro) dos anos de 2016 e 2017. Com os resultados será possível auxiliar e orientar a gestão do turismo.
Tongoloa tagongensis (Apiaceae), a new species from the Hengduan Mountains, China

Authors: GUI LING-JIAN , JIA SHENG-BIN , GUO XIAN-LIN , PRICE MEGAN , ZHOU SONG-DONG , HE XING-JIN
Published: September 2020

Tongoloa tagongensis (Apiaceae), is proposed as a new species from the Hengduan Mountains in Sichuan, western China. It is most similar to T. elata, but the new species’ roots are short conic to tuberous, lower leaves 2–3-ternate/pinnate, rays 4–11, and ribs more obvious. Description and illustrations are provided.
Outcomes in Renal Cell Carcinoma With IVC Thrombectomy: A Multiteam Analysis Between an NCI-Designated Cancer Center and a Quaternary Care Teaching Hospital
Authors: Alsina Angel E. , Wind Daniel , Kumar Ambuj , Rogers Ebonie , Buggs Jacentha , Bukkapatnam Raviender , Sexton Wade J.
Published: September 2020

Introduction

Interteam performance and Clavien-Dindo (C-D) complications in renal cell carcinoma with inferior vena cava thrombectomy (RCC-IVCT) have not been reported. We aimed to describe complications by the degree of complexity and surgical teams in a collaborative effort between a National Cancer Institute-designated Comprehensive Cancer Center and a Quaternary Care Teaching Hospital.

Methods

Between January 2011 and May 2019, 73 consecutive RCC-IVCT were included. C-D grades III or higher were captured. Teams involved were urologic-oncology, vascular, hepatobiliary/transplant, and cardiothoracic. The Mayo Clinic tumor thrombus classification was used.

Results

Overall complication rate was 42% (n = 31). Nineteen percent had grade III, 18% had grade IV, and 6% had grade V complications. Patients with level IV thrombus had the highest in-hospital mortality rate (75%). Thrombus level did not show a correlation to complication rates (14% level I, 45% level II, 32% level III, 42% level IV). A positive correlation found between the number of teams involved and complication rates (35% with 2-team, 59% with 3-team, P = .059). Thromboembolic events (6% vs 24%, P = .02) and disposition other than home (22% vs 48%, P = .01) were statistically lower for the 2-team groups. Two-team in-hospital mortality was 1/51 (2%) versus 3-team (3/22,14%, ( P = .07). No statistical differences were found in infections, thromboembolic events, and grades of complications between surgical teams.

Conclusions

Despite similar interteam performance, the consistency of surgeons in high complexity cases could improve outcomes further. Complexity was higher for hepatobiliary/transplant and cardiothoracic teams. A combination of intraoperative events and patient selection (comorbidities and age) contributed to death. Overall, in-hospital mortality was lower than in most reported series.
Coalitional Resistance: Challenging Racialized and Gendered Oppression in Teacher Education
Authors: Hsieh Betina , Nguyen Huong Tran
Published: September 2020

In this article, the authors push back against “unnatural invisibility” and stereotypes of Asian American women by introducing a culturally informed coalitional resistance framework. Drawing from elements of Community Cultural Wealth (CCW) and AsianCrit, we use the framework to discuss the evolving microaggressions we have faced in teacher education spaces and how we have survived through them. We examine marginalizing experiences each of us has faced along multiple axes of oppression across our careers, the forms of resistance we could (or chose not to) enact in specific contexts and moments, and how, through coalitional resistance, we are reclaiming our collective right to thrive and be recognized for our contributions as teacher educators. We conclude by offering implications of coalitional resistance for fellow teacher educators of color and those who wish to support them.
Shaping Music Education Policy through Insight, Collaborating, Deliberating, and Strategizing
Authors: Hellman Daniel S.
Published: September 2020

Policy capacity in music education can be enhanced through understanding the policy-making process and state governmental policy. Three examples of engagement in state-level policy action are used to explore agency, negotiation, and visioning as important dispositions for advancing music education policy goals. First, influencing state-level policy necessitates knowledge of how state government informs policy action, and this knowledge can be used to advance policy thinking. Second, policies change through both incremental and dramatic processes, often requiring different policy strategies. Third, policy is influenced by random and unpredictable factors. State associations can enhance agency and policy capacity through timely and informed communication and provide meaningful opportunities for music educators to deliberate problems and possibilities as a means to move music education policy forward.
Spontaneous colonic perforation in adults: Evaluation of a pooled case series
Authors: Chongxi Ren , Jinggang Ji , Yan Shi , Hongqiao Wang , Yan Liu , Fengshuo Yang
Published: September 2020

Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann’s operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features ( p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication ( p = 0.012, p = 0.044) and mortality ( p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication ( p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.
Surgical repair for post-tuberculosis tracheobronchial stenosis
Authors: Vinh Vu Huu , Khoi Nguyen Van , Quang Nguyen Viet Dang , Khanh Huynh Quang
Published: September 2020

Aim

Post-tuberculosis tracheobronchial stenosis is rare but one of the most dangerous complications of tracheobronchial tuberculosis. Balloon dilatation, stent insertion, laser photoresection, argon plasma coagulation, and cryotherapy are some of the initial treatments recommended for mild to moderate cases. Here, we report a case series of patients who underwent segmental resection and end-to-end anastomosis for bronchial stenosis and a sliding technique for severe and long-segment tracheal stenosis.

Methods

We retrospectively reviewed the medical records of patients with post-tuberculosis tracheobronchial stenosis operated on in our thoracic surgery department. Of the 7 cases that were treated, two had severe tracheal stenosis stretching over 50% of the tracheal length, one was operated on using resection and end-to-end anastomosis, and the other had sliding tracheoplasty. The other 5 cases of bronchial stem stenosis were treated with segmental resection and end-to-end anastomosis.

Results

All five patients with bronchial stenosis had a good outcome; the ipsilateral lung was well ventilated and respiratory function was good. One patient with tracheal stenosis, treated with segmental resection and end-to-end anastomosis, died after the surgery, and the other patient, treated with slide tracheoplasty, had a good recovery.

Conclusion

The treatment plan for patients with post-tuberculosis tracheobronchial stenosis should be on a patient-by-patient basis. Sliding tracheoplasty can be a treatment option in patients with long-segment tracheal stenosis.
Influence of physicians’ seniority on head computed tomography use for patients with isolated vertigo/dizziness
Authors: Tsai Ming-Ta , Chang Kung-Pin , Huang Jyun-Bin , Cheng Shih-Yu , Chiang Charng-Yen , Cheng Fu-Jen
Published: September 2020

Objective

Vertigo/dizziness is a common reason for emergency department (ED) visits. Emergency physicians (EPs) must distinguish patients with dizziness/vertigo owing to serious central nervous system (CNS) disorders. We aimed to evaluate the association between physician seniority and use of head computed tomography (CT) and ED length of stay (LOS) in patients presenting to the ED with isolated dizziness/vertigo.

Methods

This retrospective cohort study included adult patients with non-traumatic dizziness/vertigo in the ED. EPs were categorized according to seniority: junior (less than 6 years’ clinical experience), intermediate (7–12 years), and senior (≥12 years).

Results

Among 2589 patients with isolated dizziness/vertigo, 460 (17.8%) received brain CT; 46 (1.78%) had CNS disorder as a final diagnosis. Junior and intermediate EPs ordered more CT examinations than senior EPs: (odds ratio [OR] = 1.329, 95% confidence interval [CI]: 1.002–1.769 and OR = 1.531, 95% CI: 1.178–2.001, respectively). Patients treated by junior and intermediate EPs had lower patient ED LOS (OR = −0.432, 95% CI: −0.887 to 0.024 and OR = −0.436, 95% CI: −0.862 to −0.011).

Conclusions

We revealed different judgment strategies among senior, intermediate, and junior EPs. Senior EPs ordered fewer CT examinations for patients with isolated vertigo/dizziness but had longer patient LOS.
CEACAM5 stimulates the progression of non-small-cell lung cancer by promoting cell proliferation and migration
Authors: Zhang Xinwen , Han Xingbao , Zuo Pengli , Zhang Xiuying , Xu Hongbang
Published: September 2020

Objective

To detect the expression of CEA-related cell adhesion molecule 5 (CEACAM5) in non-small-cell lung cancer (NSCLC) and explore its function in the progression and development of NSCLC.

Methods

qRT-PCR and immunohistochemistry were performed to detect CEACAM5 expression in human NSCLC tissues and cell lines. The correlation between CEACAM5 expression and the clinicopathological features of patients with NSCLC was also investigated. MTT, colony formation, wound healing, and immunoblot assays were performed to detect the functions of CEACAM5 in NSCLC cells in vitro, and immunoblotting was used to detect the effects of CEACAM5 on p38–Smad2/3 signaling.

Results

CEACAM5 expression was elevated in human NSCLC tissues and cells. We further found that CEACAM expression was correlated with clinicopathological features including T division, lymph invasion, and histological grade in patients with NSCLC. The in vitro assays confirmed that CEACAM5 depletion inhibited the proliferation and migration of NSCLC cells by activating p38–Smad2/3 signaling. We verified the involvement of CEACAM5 in the suppression of NSCLC tumor growth in mice.

Conclusion

CEACAM5 stimulated the progression of NSCLC by promoting cell proliferation and migration in vitro and in vivo. CEACAM5 may serve as a potential therapeutic target for the treatment of NSCLC.
New Registered Nurse Transition to the Workforce and Intention to Leave: Testing a Theoretical Model
Authors: Hallaran Amy J. , Edge Dana S. , Almost Joan , Tregunno Deborah
Published: September 2020

Background

The transition of new nurses into practice has been identified as challenging, and new nurses report having intentions to leave (ITL) jobs. Concerns of ITL are worrisome for the nursing profession, especially when faced with the need to replace an aging nursing workforce and to maintain quality patient care.

Purpose

Guided by components of Meleis et al.’s mid-range transition theory, the purpose of this study was to test a theoretical model linking transition and ITL, as well as the personal, community and societal conditions of transition.

Methods

A predictive, non-experimental design using cross-sectional data was employed. Ontario registered nurses, who had graduated within two years, were randomly selected to complete a mailed questionnaire in 2015 ( N = 217). Structural equation modeling was undertaken to test the model.

Results

The new nurses reported a relatively positive transition; yet, 44% of the respondents indicated leaving their first job, and 1% departed the nursing profession. A revised model of the constructs showed a more adequate fit with the data, but overall, the hypothesized model was not supported and methodological validity of tools questioned. From the modeling, lower role stress led to a positive transition.

Conclusions

Given organizational and governmental investments in orientation and transition programs, challenges in measuring transition and ITL requires additional research. Our findings highlight the value of organizations supporting new nurses by reducing role stress through reasonable workloads and expectations, which in turn contributes to a positive transition.
Evaluation of Oxygenation in 129 Proning Sessions in 34 Mechanically Ventilated COVID-19 Patients
Authors: Berrill Max
Published: September 2020

A minority of patients with Severe Acutre Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) disease-2019 (Covid-19) develop pulmonary features consistent with the Acute Respiratory Distress Syndrome (ARDS). Prone positioning (PP) is an intervention with proven survival benefits in moderate-to-severe and severe ARDS. It is advocated in international guidelines as an intervention in mechanically ventilated Covid-19 patients, despite very few published trials investigating its efficacy in Covid-19. There is an ongoing debate regarding the prevalence of reported mismatches between the severity of hypoxaemia and the preservation of pulmonary compliance in some patients, in the early stages of SARS-CoV-2 infection. This has led some to question its utility within this context. 129 proning sessions were identified in 34 consecutively prone patients admitted to the intensive care unit at a single center in the United Kingdom. Baseline characteristics of patients were consistent with previously published national and international reports and patients were ventilated in general concordance with the ARDSnet ventilation protocol. Paired analysis of the partial pressure of arterial oxygen(PaO2): fraction of inspired oxygen(FiO2) ratio (PF ratio) (n = 89) and FiO2 (n = 129) was recorded within 3 hours of both the initiation and termination of PP and differences were assessed with the paired Student’s t-test and Wilcoxon Signed-Rank test. Proning improved the PF ratio by 43.5 ± 54.9 from 99.8 ± 37.5 to 151.9 ± 58.9 (43.6% increase) [ p < 0.0001] and reduced FiO2 by 0.17 ± 0.2 from 0.68 ± 0.2 to 0.51 ± 0.2 (25% decrease) [ p < 0.0001]. 82% of proning maneouveres resulted in an improvement in the PF ratio. In summary, PP improved arterial oxygenation and reduced oxygen requirements in most Covid-19 patients in this single- center, retrospective analysis.
3D printed high-resolution scaffold with hydrogel microfibers for providing excellent biocompatibility
Authors: Ye Wenjie , Xie Chaoqi , Liu Yande , He Yong , Gao Qing , Ouyang Aiguo
Published: September 2020

Melt electrowriting (MEW) can print high-resolution scaffolds with the ultrafine fibers from 800 nm to 20 µm. However, the cell seeding efficiency relatively low due to the large pore size of the MEW scaffold. Here, we reported a method to solve this dilemma by electrospinning a gelatin methacrylate (GelMA) hydrogel fibers membrane (HFM) on the MEW scaffold. This composite scaffold can own the controlled structures and porosity and excellent cell seeding performance. We systematically investigate the fabrication, morphology, and biocompatibility of composite scaffolds. The implanting of human umbilical vein endothelial cells(HUVES) showed excellent adhesion and biocompatibility on the composite scaffold. Moreover, the cells migrated gradually into the MEW scaffold along the GelMA HFM to form the cell sheet. We hold the opinion that the composite scaffolds have potential applications in the field of tissue engineering repair.
Ethical considerations regarding the inclusion of children in nursing research
Authors: Damsma Bakker Aliza , van Leeuwen René , Roodbol Petrie
Published: September 2020

Evidence-based nursing practice is based on three pillars: the available research, known preferences of the patient or patient group and the professional experience of the nurse. For all pillars, research is the tool to expand the evidence we have, but when implementing evidence-based practice in paediatric nursing two of the pillars demand that children are included as respondents: practice research on the nursing interventions in paediatrics and the preferences of patients, something recognized by scholars and practitioners. But including a vulnerable group as children in nursing research raises specific ethical issues that need to be considered by researchers. What are ethical considerations that are currently raised about doing research with children and what do we learn by synthesizing the narrative of these studies of why the issues are raised and which solutions can be offered for these issues? In this article, considerations on three ethical principles according to the Belmont report are described by examining recent research. Twenty-one studies were found addressing relevant ethical aspects including vulnerability, gaining consent, designing quantitative or qualitative research methods and considerations regarding the execution of the study. Ethical considerations should be much more a case of continuous awareness and attitude, then box-ticking exercise, although there are sufficient international guidelines available specifically for research that includes children to aid researchers.
Managing ethical aspects of advance directives in emergency care services
Authors: Poveda-Moral Silvia , Rodríguez-Martín Dolors , Codern-Bové Núria , José-María Pilar , Sánchez-Valero Pere , Pomares-Quintana Núria , Vicente-García Mireia , Falcó-Pegueroles Anna
Published: September 2020

Background:

In Hospital Emergency Department and Emergency Medical Services professionals experience situations in which they face difficulties or barriers to know patient’s advance directives and implement them.

Objectives:

To analyse the barriers, facilitators, and ethical conflicts perceived by health professionals derived from the management of advance directives in emergency services.

Research design, participants, and context:

This is a qualitative phenomenological study conducted with purposive sampling including a population of nursing and medical professionals linked to Hospital Emergency Department and Emergency Medical Services. Three focus groups were formed, totalling 24 participants. We performed an inductive-type thematic discourse analysis.

Ethical considerations:

This study was approved by ethical committees of Ethical Commitee of Clínic Hospital (Barcelona) and Comittee of Emergency Medical Services (Barcelona). The participants received information about the purpose of the study. Patients’ anonymity and willingness to participate in the study were guaranteed.

Findings:

There were four types of barriers that hindered the proper management of patients’ advance directives in Hospital Emergency Department and Emergency Medical Services: personal and professional, family members, organisational and structural, and those derived from the health system. These barriers caused ethical conflicts and hindered professionals’ decision-making.

Discussion:

These results are in line with those of previous studies and indicate that factors such as gender, professional category, and years of experience, in addition to professionals’ beliefs and the opinions of colleagues and family members, can also influence the professionals’ final decisions.

Conclusion:

The different strategies described in this study can contribute to the development of health policies and action protocols to help reduce both the barriers that hinder the correct management and implementation of advance directives and the ethical conflicts generated.
Migration, Urbanization, and Adolescent Prostitution in Nigeria
Authors: Olofinbiyi Sogo Angel , Singh Shanta Balgobind
Published: September 2020

The article begins with a brief discussion of migration and urbanization and its attendant problems in propagating prostitution among adolescent girls in Nigeria. It argues that the combined effects of urbanization, as well as people’s increasing agitation to secure greener pastures in cities, have made a large number of adolescent girls migrate to cities in the hope of meeting some basic needs of life—an adventure that turns out contrary to their expectations and predisposes some of them into the act of prostitution. Due to excruciating poverty within various families and the impacts of this awkward situation on most adolescent girls, delivery of quality social support services and care to the adolescent girls has been undermined over time, and their life chances have been affected, thereby making them most vulnerable to prostitution as a means of livelihood. The article concludes on socioeconomic constraints as the primary factors that push adolescent girls into prostitution in Nigeria, and these same factors are seen to influence their migration from one geographical location to another. The article recommends programs that will reduce the poverty level and unemployment trends among adolescent girls across a wide range of Nigerian societies. Drawing upon lessons learnt from the existing literature, there is an urgent need for collective social action through which more resources must be put in place to ameliorate the conditions of young girls at the interface of migration for greener pastures.
Cyberbullying—A Shrouded Crime: Experiences of South African Undergraduate Students
Authors: Pillay Roshini , Sacks Glenda
Published: September 2020

Crimes in the 21st century using technology as a medium are complex and evolving rapidly. One such crime that is difficult to define is cyberbullying, which extorts an emotional impact on the victim. This qualitative, descriptive case study considers the experiences of 10 undergraduate students regarding what they self-disclosed as cyberbullying. Snowball sampling was used, and the data collected using face-to-face interviews were analyzed using content analysis. The research instrument used was a semi-structured interview schedule. Findings revealed that nine of the participants knew the identity of the bully. Some of the social media platforms used for the cyberbullying included Facebook, Mxit, and WhatsApp, whereby the types of bullying included harassment, flaming, and denigration. Some gender differences were evident in the verbalized emotions of the sample and the support systems the female participants used. This study can serve as a catalyst for further research and interventions for the development of strategies and educational programs to manage this type of bullying.
Red blood cell osmotic fragility in healthy loggerhead and green sea turtles
Authors: Radisic Rebecca , Owens Sean D. , Manire Charles A. , Montgomery Nicole , Mader Doug , Zirkelbach Bette , Stacy Nicole I.
Published: September 2020

Loggerhead ( Caretta caretta; Cc) and green sea ( Chelonia mydas; Cm) turtles admitted to rehabilitation facilities may require blood transfusions for supportive treatment of disorders resulting in life-threatening anemia, but, considering the unique erythrocyte chemistry of sea turtles, standardized donor red blood cell (RBC) storage protocols have not been established. Prolonged cold storage and the effects of various anticoagulant-preservative solutions have been associated with increased RBC osmotic fragility across a broad range of species. Increased RBC fragility in stored RBC products has been associated with acute transfusion reactions. The osmotic fragility test is used to measure erythrocyte resistance to hemolysis while being exposed to a series of dilutions of a saline solution. We obtained baseline measurements for osmotic fragility in healthy Cc and Cm. Osmotic fragility testing was performed on samples from 10 Cc to 10 Cm. Fifty percent (50%) RBC hemolysis was identified at a mean NaCl concentration of 0.38% in both species. Results of our study will help guide future studies evaluating optimal storage solutions for sea turtle blood products.
Detection of canine parvovirus and feline panleukopenia virus in fecal samples by strand exchange amplification
Authors: Liu Mengmeng , Li Mengzhe , Ma Cuiping , Shi Chao
Published: September 2020

Canine parvovirus 2 (CPV-2) and feline panleukopenia virus (FPLV) often cause acute enteric disease in their hosts. A simple, rapid, and effective method for the on-site detection of these viruses would be useful. We used a denaturation bubble-mediated strand exchange amplification (SEA) method to successfully detect CPV-2 and FPLV in fecal samples. SEA could detect as little as 3.6 pg/μL of CPV-2 and 6.6 pg/μL of FPLV genomic DNA following a 40-min incubation at an isothermal temperature of 61°C. Unlike PCR, SEA does not require complicated equipment, and positive samples produce a color change that can be visualized by the naked eye. Additionally, SEA is simpler than PCR because no extraction is needed, and heating of the fecal sample at 98°C can be performed with a heating block or water bath. This rapid and effective nucleic acid detection platform could be used as a point-of-care test for the detection of CPV-2 and FPLV.
“Our Beauty Is in Our Breasts”: A Culture-Centered Approach to Understanding Cancer Perceptions in Kwa Zulu Natal, South Africa
Authors: Zwane Duduzile
Published: September 2020

Breast cancer is an incapacitating physical illness. It was once reported predominantly by patients in developed countries. With the advent of globalization, it is increasingly becoming a major health concern in developing countries such as South Africa. Breast cancer researchers have continuously advocated for original studies that address this condition from a sociocultural perspective. Consequently, in this article I examine the perceptions of breast cancer patients from underprivileged parts of Kwa Zulu Natal (KZN). Thirty semi-structured interviews were conducted with Zulu women at a tertiary hospital in the region. A culture-centered approach was utilized to gauge their perceptions of life as breast cancer patients within the conservative Zulu community. The findings revealed that this ailment is generally misunderstood, which has adverse implications for the patients. Furthermore, there is a dire need for breast cancer communication interventions that can acquaint the Zulu community with this condition.
A Theory on the Components of Depression Self-Management in Older Adults
Authors: Polacsek Meg , Boardman Gayelene H. , McCann Terence V.
Published: September 2020

Depression is the most prevalent mental illness in older adults and is expected to increase with population aging. Health care policy in higher income countries increasingly promotes the self-management of long-term conditions, including depression. Scant research has considered how older adults understand and practice self-management. In this article, we present the findings of a grounded theory study which sought to explain how older community-based adults experience and self-manage depression. Interviews and observations were conducted with 32 older adults with a formal diagnosis of moderate depression. Participants responded to a diagnosis of depression by Taking stock, Accessing support, and Reclaiming self-identity. Their efforts were influenced by perspectives on age and depression, access to the health care system, and individual capacity for self-management. Improved understanding of how to facilitate self-management strategies may enable older adults to remain independent and healthier for longer, while moderating the risk of a chronic condition worsening.
Social Status Equalization and Outdoor Orientation Programs: An Exploratory Study
Authors: Bell Brent J. , Trumble Mason , Morrissette Renee’
Published: September 2020

Background: Research results indicate outdoor orientation programs (OOPs) successfully help students transition to college and increase student retention, but an understanding of all the key variables involved in creating those positive transitions is unknown. Purpose: The aim of this study is to explore the role of subjective social status as a variable that may be important to the curricular design of OOPs. Methodology/Approach: Surveys asking questions about status were sent to students from 31 college OOPs between 2013 and 2017. Responses ( N = 4,484) were reviewed to understand students’ perceptions of within-group social status. Findings/Conclusions: OOP participants most often reported perceiving their social status as equal among group members. Equality perception was associated with traits such as vocality (defined as being able to verbalize ideas and be listened to in the group) and certain aspects of the trip structure (e.g., shared living conditions). Respondents who reported social status equality also reported positive experiences. Implications: Subjective perceptions of within-group status may have important implications for OOPs and may be an important consideration for program planning and curriculum.
Situated Cognition: Implications for Visitor Studies
Authors: Koran Mary Lou , Willems Patricia Pulido , Camp Betty Dunckel
Published: September 2020

The development of visitor studies can benefit from the growing bodies of research in cognitive and social science. Recent perspectives in learning assume that thinking and learning occur as individuals interact in specific contexts. This emphasis contrasts with traditional information-processing models that highlight the processing and movement of information through mental structures, deemphasizing the importance of context.

The situated perspective can inform us about the ways in which the organization of classrooms as well as informal learning environments—such as museums, zoos, parks, and nature centers—may affect opportunities for productive learning. This offers new opportunities for exploring situational effects in informal learning settings and incorporating them within a larger psychological context. This article discusses illustrative ongoing research and its implications for visitor studies in general.
Using Interpretive Animals to Deliver Affective Messages in Zoos
Authors: Povey Karen D. , Rios José
Published: September 2020

The Point Defiance Zoo & Aquarium in Tacoma, Washington, served as the setting for a study to compare visitor responses to traditional and interpretive presentation of a clouded leopard. The primary research goal was to determine how well these two types of presentations achieved the zoo's educational goals of affective message delivery. Researchers made observations of the amount of time visitors spent viewing the clouded leopard and the effort spent seeking information (either reading signs or asking questions). In addition visitors to the traditional exhibit and the interpretive presentation were surveyed about their attitudes about zoo animals and wildlife conservation. Results indicated that visitors viewing the interpretive presentation demonstrated significantly longer viewing time and increased information-seeking as compared to visitors to the traditional exhibit. Additionally, survey results showed that visitors to the interpretive presentation demonstrated more positive feelings about the animal's care and quality of life than those observing the animal in the traditional exhibit.
The Effects of a National Wildlife Refuge's EE Programs on Elementary School Classes’ Knowledge and Attitudes
Authors: O'Brien Jason P. , Pease James L.
Published: September 2020

In 1997, the Neal Smith National Wildlife Refuge-Prairie Learning Center began offering on-site environmental education (EE) to school groups visiting their reconstructed tallgrass prairie. To evaluate the EE program, fourth-, fifth- and sixth-grade classes from central Iowa completed a pre- and post-visit knowledge and attitudes survey and results were compared with similar classes that did not visit the refuge. Results indicate a significant increase in knowledge and a positive change in attitudes in the treatment group two weeks after visiting the refuge compared with the control group. This research also tested the effectiveness of hands-on stewardship activities in changing knowledge and attitudes. No differences were detected in either knowledge or attitudes between treatment classes that participated in stewardship activities and treatment classes that did not.
Nontraditional Activities and Interpretation at National Parks: Conflict or Coexistence?
Authors: Morgan Mark
Published: September 2020

This study examined some nontraditional uses of a national park. During 2003, a survey was conducted to determine the activities and motives of visitors at Cowpens National Battlefield (CNB) in South Carolina. A total of 301 visitor groups completed questionnaires (77.4 percent response rate). A majority of visitors (53 percent) had been to the park two or more times in the past 12 months. About 87 percent stayed one to two hours per visit. Slightly over 40 percent of respondents said that exercise was their primary reason for visitation and nearly 60 percent had participated in fitness activities on previous trips. In contrast, interpretation was mentioned only 18 percent of the time when visitors were asked what they “liked most” about CNB. Although fitness is not resource-dependent, it is consistent with “healthy” activities promoted at national parks. Perhaps interpretation can be used to merge exercise with education, thus broadening the base of support for public lands.
The Concept of Authenticity: Implications for Interpretation
Authors: Hill Steve , Cable Ted T.
Published: September 2020

Although the concept of authenticity has received considerable attention in tourism literature, it has received little in interpretation literature despite its importance to practitioners and administrators involved in planning, marketing, and managing interpretive sites. Interpreters may seek to provide authentic experiences at their sites regardless of whether they are interpreting natural resources or cultural heritage. However, many interpreters may not realize that what constitutes an authentic experience for visitors is difficult to define and that authenticity is a complex concept. A framework showing three key types of authenticity—the objective, the constructed, and the personal—can be applied to interpretive sites. Doing so can help interpretation researchers and practitioners understand the indicators of authentic experiences and to provide authentic interpretive experiences to visitors. In exploring the varying meanings of authenticity for interpretation, we also expand prior analyses of such variation to little-examined issues such as birding, hiking, or other outdoor recreation.
Teacher Persistence in Implementing EE: Implications for the Interpretive Community
Authors: Ernst Julie Athman
Published: September 2020

There are a variety of barriers that deter teachers from using environmental education (EE), including state curriculum standards and testing, lack of funding and transportation, lack of training, and misconceptions about what EE is. Despite these barriers, some teachers persist in using EE. Because teachers and students in the formal educational setting often are a key audience for interpretive centers, it would be useful to understand teachers’ motivations for using EE and what helps them overcome barriers to integrating EE into their curriculum. Survey research was conducted with 70 K–12 teachers to investigate what they perceive as the strongest influences on their decisions to implement EE and their abilities to do so. Results indicated personal environmental literacy knowledge and skills, environmental sensitivity, and teaching context as key influences on teachers’ use of EE. Implications for the interpretive community related to providing teacher training and marketing school-based programs are discussed.
Interpretation and Place Attachment: Implications for Cognitive Map Theory
Authors: Morgan Mark
Published: September 2020

Place attachment is a common expression used by individuals to identify with natural settings. Although resource meanings are hard for some people to describe, intangible values can play an important role in site visitation. The purpose of this study was to measure the effect of interpretation on place attachment; a relationship that has been speculated, but not tested. A questionnaire was administered to nearly 200 visitors who attended a wild cave tour at a state park in mid-Missouri. Results indicated that the naturalist-led program was successful, but the place attachment scores were similar before and after the tour. However, visitors who attended cave tours frequently scored higher on place attachment than first-timers. Results of this study are discussed in relation to cognitive map theory.
How National Park Service Operations Relate to Law and Policy
Authors: Wade John W. (Bill)
Published: September 2020

We take for granted many of the programs and activities that have become a part of the national park experience, both for visitors and for employees. But what are the legal authorities for carrying out these park management operations? What permission do we have to protect natural or cultural resources; or to insist that visitors behave in certain ways; or to provide interpretation and education programs; or to provide and maintain facilities? In truth, the answer is a complex bundle of authorities, some of which are ambiguous and some are obscure. Fortunately, the guidance needed for carrying out most of the traditional, routine responsibilities that we've become accustomed to has been condensed into a relatively straight-forward set of policies and guidelines. Even so, we are seeing a disturbing trend of decisions being made at the park level that are inconsistent with law or policy.