bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of Ablation Thresholds for 3D-Cultured Patient-Derived Glioma Stem Cells in Response to High-Frequency Irreversible Electroporation
Authors: Ivey J. W. , Wasson E. M. , Alinezhadbalalami N. , Kanitkar A. , Debinski W. , Sheng Z. , Davalos R. V. , Verbridge S. S.
Published: April 2019

High-frequency irreversible electroporation (H-FIRE) is a technique that uses pulsed electric fields that have been shown to ablate malignant cells. In order to evaluate the clinical potential of H-FIRE to treat glioblastoma (GBM), a primary brain tumor, we have studied the effects of high-frequency waveforms on therapy-resistant glioma stem-like cell (GSC) populations. We demonstrate that patient-derived GSCs are more susceptible to H-FIRE damage than primary normal astrocytes. This selectivity presents an opportunity for a degree of malignant cell targeting as bulk tumor cells and tumor stem cells are seen to exhibit similar lethal electric field thresholds, significantly lower than that of healthy astrocytes. However, neural stem cell (NSC) populations also exhibit a similar sensitivity to these pulses. This observation may suggest that different considerations be taken when applying these therapies in younger versus older patients, where the importance of preserving NSC populations may impose different restrictions on use. We also demonstrate variability in threshold among the three patient-derived GSC lines studied, suggesting the need for personalized cell-specific characterization in the development of potential clinical procedures. Future work may provide further useful insights regarding this patient-dependent variability observed that could inform targeted and personalized treatment.
Incentivos fiscais estaduais: estudo em empresa beneficiada na região metropolitana do Cariri (RMC)
Authors: Félix Marduquel Bezerra , Correia José Jonas Alves , Andrade Juliana Coelho
Published: May 2019

Este estudo tem como objetivo demonstrar por meio de um estudo de caso, a capacidade de os incentivos fiscais concedidos pelo governo estadual intuírem na promoção do desenvolvimento e alavancagem da economia regional. Para o alcance desta proposta, realizou-se uma pesquisa de cunho exploratório-descritiva no que concerne aos objetivos. A abordagem empregada na pesquisa é a quantitativa. Na execução da pesquisa foram consultados os relatórios financeiros (fiscais e contábeis) de uma organização, classificando a pesquisa quanto aos procedimentos e delineamento, como documental e estudo de caso, respectivamente. Os principais achados apontam que a concessão de incentivos fiscais à empresa estudada, tem conseguido ampará-la no que diz respeito ao cumprimento das metas estabelecidas pelo FDI, bem como tem dado subsídio para a empresa se manter ativa no mercado e fomentar o crescimento econômico local.
Identification et changements d’identification des Autochtones en Australie : nouveaux résultats issus de l’appariement de microdonnées
Authors: Campbell Paul , Biddle Nicholas , Paradies Yin , Guerrouche Karine
Published: May 2019

Les Australiens autochtones représentent une faible part de la population, mais leurs caractéristiques démographiques sont spécifiques. Pour cette raison, le Bureau australien de statistiques (ABS) et les chercheurs en calculent régulièrement des estimations de cette population. Les changements d’identification (d’autochtone à non autochtone, ou l’inverse) contribuent à la dynamique de cette population. Jusqu’à présent, on ne disposait pas de données individuelles sur la population australienne qui permettent d’analyser les caractéristiques des personnes changeant d’identification. À partir d’une nouvelle source de données contenant le plus vaste échantillon longitudinal d’Australiens autochtones (Australian Census Longitudinal Dataset, ACLD), nous montrons que sur le plan quantitatif, se déclarer autochtone n’est pas stable dans le temps. Les nouvelles identifications représentent une proportion considérable de l’augmentation de cette population observée entre 2006 et 2011. En outre, les autochtones nouvellement identifiés ne présentent pas les mêmes caractéristiques que les personnes identifiées comme autochtones aux deux dates. Ils vivent plus souvent dans les villes (et peu dans les zones les plus reculées) et ont une situation socioéconomique plus favorable, ce qui n’est pas sans conséquences pour le choix et la mise en œuvre des politiques à mener.
Du pont au seuil : Un autre espace de la traduction
Authors: Sofo Giuseppe
Published: April 2019

Le discours sur la traduction regorge de métaphores censées décrire la nature de ce processus linguistique et culturel, mais qui risquent souvent d’enfermer ses finalités dans des limites figées, qui ne nous permettent pas d’en saisir jusqu’au fond les possibilités multiples. Parmi ces métaphores, l’image de la traduction comme pont nous permet de passer d’une langue à l’autre et d’une culture à l’autre. L’image des deux rives a sûrement été fructueuse dans la traductologie, mais voir la traduction comme un pont risque de nous donner une fausse image du rôle joué par cette pratique linguistique et culturelle. Cette image présuppose des rives distinctes et distantes, et un voyage d’aller simple qui ne prévoit pas de vrai échange entre les deux espaces, alors qu’il faudrait imaginer la traduction comme un espace fluide, dans lequel ce qui compte n’est plus l’opposition entre les deux rives, que le pont permet, au lieu de l’effacer, mais plutôt l’échange, le contact direct et non médié, l’espace de fluidité construit par l’« entre-deux », ce qui nous renvoie aux concepts de ‘in-between’, de ‘troisième espace’ si chers aux études sur la traduction, surtout dans les contextes postcoloniaux. Utiliser l’image du pont en tant que représentation du rôle de la traduction n’est donc pas seulement erroné, mais potentiellement dangereux, parce que cette image va contre le refus des dichotomies binaires et des identités uniformes qui est à la base d’une vision de la traduction en tant que pratique essentiellement interlinguistique et interculturelle, plurilingue et qui se construit à travers le partage. Plutôt qu’un pont, la traduction est un seuil, un espace liminaire, un contre-point qui offre la possibilité de découvrir le texte depuis des perspectives différentes, et de plonger dans le flux en mouvement éternel des mots, dans une tentative de traduire l’indicible, cette partie non-exprimée, non-traduite de tout texte et de toute langue qui peut se lire seulement à travers ce jeu de travestissements, de fluidité et de rencontres de soi et de l’autre qu’est la traduction.
Les ponts du désastre. Le motif du pont et la révolution dans Pétersbourg d'Andreï Biély
Authors: Dyachenko-Escalle Liliya
Published: April 2019

Cet article étudie le motif du pont dans Pétersbourg (1913), roman moderniste russe d'Andreï Biély. L'action se déroule dans Saint-Pétersbourg à l'époque de la première révolution russe, en 1905. Ces événements historiques ne font toutefois pas directement l'objet du récit, mais fournissent le cadre spatio-temporel d'un drame personnel aux éléments étranges, voire fantastiques. Dans cet article, il s'agira donc pour nous de mettre en parallèle les ponts en tant que motif incontournable dans l'univers de fiction symboliste construit par Biely avec leurs homologues réels de Saint-Pétersbourg, qui ont historiquement joué un rôle important pendant les révolutions russes de 1905 et 1917. Sous le régime tsariste, les ponts petersbourgeois relient en effet le riche quartier central de la capitale, avec ses palais et ses institutions gouvernementales, aux îles réservées à la population ouvrière. Cette division est au cœur du mythe littéraire de Saint-Pétersbourg, ville maudite, poussé à son paroxysme dans le roman de Biély. Nous examinerons comment les ponts jouent un rôle de premier plan dans cette mise en scène du destin tragique de la ville. Lors de la révolution, c'est en effet par les ponts, depuis les îles, que surgissent les masses révoltées à l'action décisive pour la chute de l'Empire russe.
La Passion christique au théâtre : réinterprétations des symboles sacrés dans le Mystère de la Passion d’Arnoul Gréban et Partage de midi de Paul Claudel
Authors: Averseng Hélène
Published: April 2019

Cet article propose une mise en regard de deux œuvres déterminantes du théâtre français, le Mystère de la Passion d’Arnoul Gréban et Partage de midi de Paul Claudel, autour de la notion de réécriture de la Passion christique. De la poétique du mystère médiéval à la relecture intimiste claudélienne, sont observées les intertextualités thématiques qui se jouent dans la construction d’un imaginaire sacré, au sein d’une évolution générique. Nous souhaitons ainsi définir les traits symboliques de la Passion théâtrale, par la transmission des symboles « Passionnels ». À travers les deux grands groupes thématiques pris en considération, l’espace-temps et les personnages, nous proposons de définir les intérêts – génériques, poétiques, métaphysiques – que présentent les réécritures des symboles sacrés.
Quand « la ligne part en queue de poisson ». Paradoxes des figures de pont dans les œuvres de Francis Alÿs, Bridge / Puente (2006) et Don’t cross the bridge before you get to the river (2008)
Authors: Ducoux Antoine
Published: April 2019

Le rôle de l’artiste est-il de bâtir des ponts et de combler les fossés entre les peuples ? Les figures de la traversée et du passage dans les œuvres de l’artiste belge Francis Alÿs sont des édifices inachevés, autour desquels l’artiste construit une dramaturgie symbolique instable, qui déroute le spectateur en multipliant les paradoxes et les impasses logiques. Cet article propose une étude des œuvres Bridge/Puente (2006) et Don’t cross the bridge before you get to the river (2008). Son objectif est d’explorer les ambivalences d’une démarche « bizarre » qui s’est confrontée à de véritables contraintes d’ordre politique. En bâtissant des ponts à la fois réels et imaginaires, Francis Alÿs fait signe vers l’horizon utopique d’un lien entre les peuples, tout en refusant de l’actualiser. Au cœur de ce système symbolique, l’idée de « jeu » est primordiale car elle oppose à l’idée de clôture, de comblement, une économie du manque, qui permet de susciter la rêverie du spectateur.
Les origines du dispositif photo-littéraire : 1840-1903
Authors: Carrara Giuseppe
Published: April 2019

Le photo-texte, qui peut être défini synthétiquement comme une structure rhétorique dans laquelle l’écriture et l’élément photographique se donnent comme une totalité insécable, s’est surtout répandu depuis la fin du vingtième siècle, mais des exemples de dispositif photo-littéraire se retrouvent tout au long de l’histoire de la photographie. Dans cet article, on essayera de reconstruire les origines du photo-texte narratif à travers l’analyse de Autoportrait en noyé (1840) de Hyppolyte Bayard, Pencil of Nature (1844) de W. H. F. Talbot, Street Life in London (1877) de John Thomson et Adolphe Smith, Bruges-la-Morte (1892) de Georges Rodenbach et People of the Abyss (1903) de Jack London.
Il kitsch e il vuoto di valori tra romanzo e saggio.
Authors: Borys Carola
Published: April 2019

Il problema del kitsch accompagna l’opera di Hermann Broch dagli anni Trenta alla sua morte nel 1951 e influenza l’intera sua pratica del romanzo. In questo testo, cercherò in un primo momento di estrarre una definizionedas welt di kitsch a partire da alcuni saggi di Broch ; in un secondo momento, la metterò in relazione con la scrittura romanzesca, concentrandomi sull’esempio de I sonnambuli.
Le dérèglement poétique à l’âge des Lumières
Authors: Capriotti Marco
Published: April 2019

Cette étude vise à analyser le concept d’ « enthousiasme » tel qu’il fut pensé en Angleterre et en France aux XVIIe et XVIIIe siècles. . Il s’agit d’abord de décrire comment le terme a été utilisé pour indiquer certains mouvements protestants radicaux pendant les Guerres de Religion. Ensuite, nous nous appuierons sur les catégories philosophiques employées par les intellectuels de l’époque pour considérer un phénomène, celui des « inspirations privées », qu’on jugeait presque comme pathologique. À travers Locke et Shaftesbury, qui envisagèrent une notion d’ « enthousiasme » positive et limitée au domaine esthétique, nous montrerons la façon dont cette notion fut conçue dans les traités d’esthétique français et par Voltaire : une théorie classiciste du dérèglement poétique, aux traits pareils à ceux d’un ravissement rituel.
ERKINIO ENCEFALITO KINTANČIO SERGAMUMO ĮTAKA KLINIKINEI FORMAI
Authors: Kalvelytė Gabrielė , Žibūdaitė Austėja , Radzišauskienė Daiva
Published: April 2019

Darbo tikslas. Įvertinti sirgusiųjų erkiniu encefalitu (EE) 2011-2014 m. ir 2005-2008 m.epidemiologiją ir klinikinį pasireiškimą.

Darbo objektas. Atliktas retrospektyvinis erkinio encefalito tyrimas Vilniaus rajone 2011-2014 m., kai sergamumas buvo didelis (13,1 atvejai 100 000 gyventojų) ir 2005-2008 m., kai sergamumas buvo mažas (3,7 atvejai 100 000 gyventojų). Ištirti Vilniaus rajono suaugę pacientai, sirgę erkiniu encefalitu ir gydyti Vilniaus universiteto Santaros klinikų Infekcinių ligų ir Neurologijos centruose 2005-2014 m.

Metodas. Į tyrimą buvo įtraukti tik laboratoriškai patvirtinti atvejai: nustačius EEV IgM ir IgG kraujyje arba EEV IgM likvore. Pacientai buvo suskirstyti į dvi grupes pagal sergamumo lygio laikotarpius, tai 2011-2014 m. (n=417) ir 2005-2008 m. (n=130). Grupės lyginamos pagal epidemiologiją, kliniką ir liekamuosius reiškinius. Statistinė analizė atlikta naudojant R statistinį paketą, chi-kvadrato, Fišerio (Fisher) testus; α=0,05.

Rezultatai. 2011-2014 m., kai sergamumas Vilniaus rajone didėjo, palyginus su 2005-2008 m. nustatyta, kad sumažėjo meningitinių ligos formų – 33/417 (7,91%) palyginus su 19/130 (14,62%), (p=0,023), taip pat sumažėjo ir encefalitinių formų – 12/417 (2,88%) lyginant su 9/130 (6,92%) (p=0,023). Meningoencefalomielitinių ligos formų padaugėjo – 18/417 (4,32%) palyginus su 1/130 (1,32%) (p=0,054). Meninginių simptomų pasireiškimo dažnis sumažėjo – 255/417 (61%) lyginant su 100/130 (76,92%) (p=0,001). Padidėjo šių simptomų/sindromų pasireiškimo dažnis: ataksijos 146/416 (35,1%) palyginus su 32/130 (24,63%) (p=0,026), tremoro 229/417 (54,78%) palyginus su 49/130 (37,69%) (p=0,001), galvinių nervų pažeidimo 188/417 (44,98%) palyginus su 44/130 (33,85%) (p=0,025) ir galvos skausmo 385/416 (92,55%) palyginus su 112/130 (86,15%) (p=0,026). Padažnėjo liekamieji reiškiniai: galvos svaigimas (p=0,028), ataksijos (p<0,05) bei tremoras (p<0,01). 2011-2014 metais buvo 4 mirtys (0,96%) palyginus su 2005-2008 metais, kai nebuvo nei vienos mirties (p=0,264).

Išvados. Vilniaus rajone nustatytas tiesioginis didėjančio erkinio encefalitu sergamumo ir kintančių ligos formų ryšys. Didėjant erkinio encefalito sergamumui Vilniaus rajone daugėja meningoencefalitinių, mažėja meningitinių ir encefalitinių ligos formų, dažnesni liekamieji reiškiniai, didėja mirštamumas.
PERFORATED PEPTIC ULCERS: 3 YEAR EXPERIENCE IN KLAIPEDA UNIVERSITY HOSPITAL
Authors: Dailidėnas Šarūnas , Garčauskis Martynas , Srėbaliūtė Gintarė , Jurgaitis Jonas , Žeromskas Paulius , Šimčikas Dainius
Published: April 2019

Perforation is second most common complication of peptic ulcers with mortality rate ranging from 3 to 30 %. For best outcomes this condition must be diagnosed and managed as soon as possible.

Objectives and methods. The aim of this study was to present our clinical experience in managing perforated peptic ulcers. Retrospective data analysis of patients treated for perforated peptic ulcers from year 2015 to 2017 was performed. Statistical data analysis was carried out using the SPSS 20.0 software.

Results. 90 patients were treated for perforated peptic ulcers. The female and male ratio was 1:1.25 with the mean patient age of 61.60±19.42 years. There were no more data from 16 patients. The average hospital stay was 12.89±13.31 days. 11% of the patients had type I, 49% – type II, 24% – type III, 5%- type IV, 11% – type V ulcer according to modified Johnson classification. 91% underwent ulcerorrhaphy, 4% -Billroth type I surgery, 2% – Billroth type II surgery and 1% had atypic resection. 84% of surgeries were performed with laparotomic approach, 12% – laparos-copically, 4% had a conversion. The mean duration of the operation was 85.2±4.64 minutes. The average Mannheim Peritonitis Index between the patients was 17.135±7.36. 24% of patients with perforated peptic ulcer died. Statistically significant correlation was observed between the Mannheim Peritonitis Index and mortality (r=0.640; p<0.05), age and mortality (r=0.459; p<0.05) and between age and Mannheim Peritonitis Index (r=0.740; p<0.05).

Conclusion. During the period from 2015 to 2017 90 patients were treated for PPU. Half of the patients had type II ulcer localization according to modified Johnson classification. Simple closure was performed for 91% of the patients, 84% of all surgeries were performed with an open approach. Statistically significant correlation was found between Mannheim Peritonitis Index and mortality, age and mortality and between age and Mannheim Peritonitis Index. No significant correlation was observed between the approach and the outcome. There could be a bigger role in laparascopic surgery treating PPU. It is important for clinicists to consider about PPI for treatment when prescribing NSAIDs, especially in elderly and hospitalized patients in order to avoid peptic ulcers and its complications.
PAAUGLIŲ SOCIALINIO NERIMO SĄSAJOS SU MENTALIZACIJA IR TRAUMINE PATIRTIMI
Authors: Skabeikytė Gabrielė , Barkauskienė Rasa , Gervinskaitė-Paulaitienė Lina
Published: April 2019

Tyrimo tikslas buvo įvertinti paauglių socialinio nerimo, mentalizacijos ir trauminės patirties sąsajas. Socialinis nerimas – aktuali problema, paprastai prasidedanti jau ankstyvoje paauglystėje ir įvairiapusiškai trikdanti asmens funkcionavimą. Analizuojant nerimo raidai svarbius veiksnius, tyrimai atskleidžia ryšį tarp vaikystės trauminių patirčių bei socialinio nerimo vėlesniame amžiuje. Socialiniam nerimui būdingos klaidingos kitų asmenų elgesio interpretacijos, tad tai gali būti susiję su paauglio gebėjimu interpretuoti savo ir kitų poelgius. Visgi atlikti tyrimai paliečia bendrą socialinio nerimo patyrimą arba atskirus mentalizacijos aspektus, nejungiant jų į visumą, o trauminės patirties vaidmuo šioje sąveikoje neaiški. Lietuvoje tokie tyrimai tik įsibėgėja, trūksta metodų įvertinti paauglių patiriamam socialiniam nerimui. Tyrimo dalyviai buvo 680 11–14 m. paaugliai (331 vaikinas ir 349 merginos) iš skirtingų Lietuvos mokyklų bei globos namų. Instrumentai. Liebowitz socialinio nerimo skalė vaikams ir paaugliams (LSAS-CA), Reflektyviosios funkcijos klausimynas (RFQY) bei Vaikystės patirčių klausimynas (VPK). Rezultatai. Trauminė patirtis yra susijusi su prastesne mentalizacija, vertinta kaip reflektyvioji funkcija, bei aukštesniais socialinio nerimo įverčiais. Aukštesni socialinio nerimo įverčiai yra susiję su prastesne reflektyviąja funkcija. Nustatyta, jog trauminės patirties ir socialinio nerimo sąsaja kinta esant skirtingam paauglio mentalizacijos lygiui: kuo geresnė mentalizacija, tuo silpnesnis ryšys tarp smurto patyrimo ir socialinio nerimo paauglystėje. Tai reiškia, kad aukšta mentalizacija atlieka apsauginio veiksnio funkciją.
ODONTOLOGINĖS PRIEŽIŪROS IR BURNOS HIGIENOS STUDIJŲ PROGRAMŲ ABSOLVENTŲ KOMPETENCIJŲ ATITIKTIS DARBO RINKOS POREIKIAMS
Authors: Spiriajevienė Irma , Albrechtienė Kristina , Andruškienė Jurgita
Published: April 2019

Tyrinėjamai temai analizuoti buvo atlikta literatūros ir dokumentų analizė bei focus grupės tyrimas. Tikslas – išanalizuoti darbdavių / socialinių partnerių požiūrį į Odontologinės priežiūros ir Burnos higienos studijų programų absolventų kompetencijų atitiktį darbo rinkos poreikiams. Empiriniai duomenys rinkti darbdavių / socialinių partnerių apskritojo stalo diskusijos metu, taikant focus grupės interviu metodiką. Tyrime dalyvavo 11 odontologijos srities specialistų – ekspertų. Empiriniams duomenims analizuoti atlikta kokybinė kontentinė analizė.

Rezultatai. Išanalizavus kokybinio tyrimo duomenis, išskirtos šios kategorijos: „Aukštojoje mokykloje įgyti profesinės kompetencijos pradmenys ugdomi ir tobulinami bedirbant“ (19 teiginių), „Socialinė kompetencija koncentruojasi profesinio bendravimo su klientais ir kolegomis segmente“ (19 teiginių), „Bendrųjų kompetencijų tobulinimo perspektyvos“ (6 teiginiai), „Absolventų motyvacijos svarba jų kompetencijų plėtotei – prioritetinė vertybė“ (6 teiginiai), „Emocinio intelekto kompetencija orientuota į lankstumą ir prisitaikymą prie gydytojo“ (6 teiginiai), „Bendravimas ir kitos kompetencijos priskiriamos tęstinėms gyvenimo bei darbo kompetencijoms, nesikoncentruojant į konkrečią ugdymosi instituciją“ (5 teiginiai), „Burnos higienos ir odontologinės priežiūros profesijų poliariškumas ir kompetencijų subalansavimo perspektyvos“ (5 teiginiai), „Naujų, progresyvių edukacinių sričių plėtotė ir atitinkamų kompetencijų stiprinimas“ (4 teiginiai), „Diskusijos apie absolventų kompetencijų atitiktį darbo rinkai poerikis” (7 teiginiai).

Tyrimo dalyvių diskusija koncentruojasi iš kategorijų sudarytose šiose pagrindinėse subkategorijose: „Prioritetas profesinio bendravimo kompetencijai” (9 teiginiai), „Praktinių įgūdžių poreikis ir praktikos galimybės“ (6 teiginiai), „Tobulinimosi motyvacijos siekiamybė – nuolat besimokančios visuomenės poreikis“ (4 teiginiai), „Darbo komandoje kompetencijos svarba ir plėtotė“ (4 teiginiai). Visos kitos 23 subkategorijos sudarytos iš mažesnės koncentracijos diskusijoje teiginių (kiekvienai subkategorijai skirti 2–3 teiginiai).
The Effect of Accounting Conservatism on Investment Efficiency and Debt Financing: Evidence From Egyptian Listed Companies
Authors: Abd-Elnaby Hala , Aref Ola
Published: April 2019

This paper examines the effect of accounting conservatism on investment efficiency by examining whether conservatism reduces overinvestment and underinvestment problems. Additionally, examining whether conservatism mitigates underinvestment problem by raising debt financing. The paper sample covers a period of five years from 2012 to 2016, including 57 Egyptian firms. The results show a negative relationship between conservatism and over (under)investment, implying that there is a positive association between conservatism and investment efficiency. Furthermore, there is a positive relationship between conservatism and debt financing in firms suffering from underinvestment problems. Hence, accounting conservatism is crucial for improving the quality of financial information.
The effect of career commitment on academic success among undergraduate baccalaureate nursing students
Authors: Kennel Kimberly D.
Published: April 2019

Background: The ability of students, specifically in higher education environments, to persist is a critical determinant of academic success. Student success is especially precarious within programs of nursing, where curricula include clinical, laboratory, and didactic content. Identifying and describing the barriers and facilitators to nursing student persistence provides a blueprint to appropriately use financial and human resources as well as determine the effect student demographic variables has on desiring, attending, or benefiting from academic interventions.Methods: A descriptive study was used to examine the relationship between the independent variable of self-assessed career commitment, and the dependent variable of academic success among undergraduate nursing students enrolled in a required blended course.Results: Despite no statistical significance between career commitment and academic success, it should be noted that the failing population had a higher mean score of TTF (Tendency to Foreclose) M = 32.75 than the passing population M = 31.54, which may that those students who failed may tend to prematurely commit to nursing as a career choice without a true exploration of possible career choices. The VEC (Vocational Exploration Commitment) M = 41.59 was higher in the passing population than the failures with a M = 37.50, which may indicate those that passed had explored all career options before committing to nursing as a career choice.Conclusions: The outcome of this study can guide further research concerning career commitment and career exploration interventions since the process of career commitment is a task for all college students, including those who choose nursing as they identify how they will meet their career goals. Framed by Tinto’s Theory of Student Departure, this study assessed the effect of career commitment on academic success among undergraduate baccalaureate nursing students.
Integrating a learning outcomes assessment rubric into a deteriorating patient simulation for undergraduate nursing students
Authors: Luctkar-Flude Marian , Tregunno Deborah , Egan Rylan , Sears Kim , Tyerman Jane
Published: April 2019

Background: Few studies have examined effective methods to prepare learners to participate in simulation-based learning experiences. Similarly, there is limited literature on valid, reliable assessment methods to determine whether clinical simulation learning outcomes have been met. We developed a learning outcomes assessment rubric to support self-regulated learning and assessment during presimulation preparation and debriefing.Methods: Fourth-year undergraduate nursing students enrolled in a critical care nursing course participated in two deteriorating patient simulations, one delivered in a traditional format, and the other using a new format incorporating a learning outcomes assessment rubric into presimulation preparation and debriefing. A descriptive survey evaluated learner perceived competence with deteriorating patients and satisfaction with the two simulations formats. Learner self-assessment data using the rubric was collected pre and post simulation.Results: Learner satisfaction with the deteriorating patient scenario and accompanying assessment rubric was very high. Learners were significantly more satisfied with the simulation scenario delivered using the new format which included the assessment rubric than with the standard format without the assessment rubric (p < .001). Learners valued the opportunity to identify their own learning needs, and reported increased competence in management of a deteriorating patient following the simulation (p < .001).Conclusions: Senior nursing students perceived that integration of learning outcomes assessment rubrics into simulation design enhanced their self-regulated learning and presimulation preparation. Further research is needed to explore presimulation preparation strategies and to validate rubrics used for summative assessment.
Awareness during CPR on cardiac arrest due to aortic dissection
Authors: Lundsgaard Rune Sarauw
Published: May 2019

Awareness during CPR is formerly reported in the literature but only in rare cases and it is still not clear whether these cases have anything in common.

A case report regarding a 69-year old male patient.

The patient was admitted to the hospital due to 3 days dyspeptic symptoms and sudden onset of dyspnoea a few hours before arriva. During admission a short period of tachycardia (250/min) is followed by asystolic cardiac arrest. CPR is immediately initiated. By the arrival of the cardio-resuscitation-team, the patient has a peripheral hemoglobin saturation of 100% and a high level of awareness with open eyes and movement of the head and both arms and legs. Re-evaluation of the hearts rhythm after 3 minutes still shows asystoli.  A total of 10 mg of Epinephrine is administered in boluses of 1 mg every 3-5 minutes. By the 3ed hand-off for rhythm evaluation, the patient is orally intubated. A total of 5 arterial gas samples are done during the 90 minute CPR, and despite a decrease in pH to 7,11 and lactate of 18 after 90 minutes all other markers remain within the normal range, and both the arterial and peripheral hemoglobin saturation remains 100%.  The level of awareness does not decrease notably during the 90 minutes. Echocardiography shows a heart with no noticeable ultrasonic movement. A projection visualizing the aortic arch raises suspicion of an aortic dissection. The autopsy shows he has have suffered a complete aortic dissection

High level of awareness plus saturation and arterial gas almost within the normal range through all 90 minutes indicate very effective chest compressions and peripheral and cerebral blood flow. Even though the patient had a poor prognosis (complete aortic dissection and refractory asystole), termination of CPR raised ethical questions in the team as the patient was still conscious once the resuscitation was terminated by 90 minutes. Awareness during CPR also raises the question of proper sedation doing resuscitation, which is currently not part of the guidelines. Further research regarding pain relief during CPR as well as increased focus on communicative and ethical aspects during CPR is needed.
Pediatric Early Warning Score Systems, nurse’s perspective – a focus group study
Authors: Jensen Claus Sixtus
Published: May 2019

Background: Pediatric early warning score (PEWS) systems are used to monitor pediatric patients’ vital signs and facilitate the treatment of patients at risk of deteriorating. The aim of this study was to gain knowledge about nurses’ experiences with PEWS and to highlight factors facilitating and impeding the use of PEWS tools in clinical practice we aim to obtain knowledge about nurses’ experiences with PEWS.

Methods: An exploratory qualitative design was chosen using focus group discussions to gain a deeper understanding of nurses’ experiences with PEWS. A total of five focus group discussions were conducted at three hospitals, and the analyses performed were inspired by Kvale and Brinckman.

Results: Seven themes were identified, including i) lack of interdisciplinary awareness, ii) clinical judgment and PEWS—a multi-faceted approach, iii) PEWS supports a professional language, iv) monitoring equipment—a challenge, v) PEWS helps to visualize the need for escalating care, vi) an inflexible and challenging tool, and vii) supportive tools enhance the nurses’ experiences of PEWS positively.

Conclusions: Our findings suggest that attention should be given to nurses’ perceptions of how both clinical judgment and PEWS should be seen as essential in providing nurses with information about the patients’ conditions. If not, the risk of failing to recognize patients’ deteriorating conditions will remain. From the nurses’ perspective, medical doctors seemed unaware of their role in using PEWS.
Transition to adulthood: Dynamics of disability, food security, and SNAP participation
Authors: Guo Baorong , Huang Jin , Porterfield Shirley L.
Published: April 2019

Introduction

This study examines how the transition to adulthood may affect food security for individuals with disabilities and estimates the effects of SNAP participation on their food security during the transition.

Methods

The study uses a repeated cross‐sectional design with five years of data (2011–2015) from the National Health Interview Survey (NHIS) in the US. The difference‐in‐difference approach is applied to compare individuals with and without disabilities regarding their food security status in adolescence and young adulthood. Instrumental Variable analyses are conducted using state SNAP policy rules as exogenous instruments to estimate the effects of SNAP participation on food security status for youth and young adults with disabilities.

Results

Results indicate that transition into adulthood results in greater food security for individuals without disabilities but an increased risk of low food security for individuals with disabilities. The increased risk for young adults with disabilities may well put them at very low food security, the most severe category on the food security scale. SNAP participation appears to have greater impacts for youth than for young adults.

Conclusions

Since food security likely has a profound impact on the long‐term development, economic independence, and self‐sufficiency, we discuss a few policy strategies that may help individuals with disabilities in their transition to adulthood.
Predicting the incidence of non-suicidal self-injury in college students
Authors: Kiekens G. , Hasking P. , Claes L. , Boyes M. , Mortier P. , Auerbach R.P. , Cuijpers P. , Demyttenaere K. , Green J.G. , Kessler R.C. , Myin-Germeys I. , Nock M.K. , Bruffaerts R.
Published: April 2019

Background:

Despite increased awareness that non-suicidal self-injury (NSSI) poses a significant public health concern on college campuses worldwide, few studies have prospectively investigated the incidence of NSSI in college and considered targeting college entrants at high risk for onset of NSSI.

Methods:

Using data from the Leuven College Surveys (n = 4,565; 56.8%female, Mage = 18.3, SD = 1.1), students provided data on NSSI, sociodemographics, traumatic experiences, stressful events, perceived social support, and mental disorders. A total of 2,163 baseline responders provided data at a two-year annual follow-up assessment (63.2% conditional response rate).

Results:

One-year incidence of first onset NSSI was 10.3% in year 1 and 6.0% in year 2, with a total of 8.6% reporting sporadic NSSI (1–4 times per year) and 7.0% reporting repetitive NSSI (≥ 5 times per year) during the first two years of college. Many hypothesized proximal and distal risk factors were associated with the subsequent onset of NSSI (ORs = 1.5–18.2). Dating violence prior to age 17 and severe role impairment in daily life were the strongest predictors. Multivariate prediction suggests that an intervention focused on the 10% at highest risk would reach 23.9% of students who report sporadic, and 36.1% of students who report repetitive NSSI during college (cross-validated AUCs =.70–.75).

Discussion:

The college period carries high risk for the onset of NSSI. Individualized web-based screening may be a promising approach for detecting young adults at high risk for self-injury and offering timely intervention.
What is a clinical trial protocol?
Authors: Cipriani Andrea , Barbui Corrado
Published: April 2019

Trial protocols are documents that describe the objectives, design, methodology, statistical considerations and aspects related to the organization of clinical trials. Trial protocols provide the background and rationale for conducting a study, highlighting specific research questions that are addressed, and taking into consideration ethical issues. Trial protocols must meet a standard that adheres to the principles of Good Clinical Practice, and are used to obtain ethics approval by local Ethics Committees or Institutional Review Boards.
The potential role of the parietal lobe in schizophrenia
Authors: Bellani Marcella , Ferro Adele , Brambilla Paolo
Published: April 2019

Although the anatomy of the parietal lobe has been under-investigated in schizophrenia, some magnetic resonance imaging studies have shown decreased volumes, suggesting its possible implication for the pathophysiology of the disease.
Mechanisms of impulsivity in bipolar disorder and related illness
Authors: Swann Alan C.
Published: April 2019

Aims– Impulsivity is a multifaceted aspect of behavior that is prominent in psychiatric disorders and has serious behavioral consequences. This paper reviews studies integrating behavioral and physiological mechanisms in impulsivity and their role in severity and course of bipolar and related disorders.Methods– This is a review of work that used questionnaire, human behavioral laboratory, and neurophysiological measurements of impulsivity or related aspects of behavior. Subjects included individuals with bipolar disorder, substance-use disorders, antisocial personality disorder, and healthy controls.Results– Models of impulsivity include rapid-response impulsivity, with inability to reflect or to evaluate a stimulus adequately before responding, and reward-based impulsivity, with inability to delay response for a reward. In normal subjects, rapid-response impulsivity is increased by yohimbine, which increases norepinephrine release. Impulsivity is increased in bipolar disorder, whether measured by questionnaire, by measures of rapid-response impulsivity, or by measures of ability to delay reward. While affective state has differential effects on impulsivity, impulsivity is increased in bipolar disorder regardless of affective state or treatment. Impulsivity, especially rapid-response, is more severe with a highly recurrent course of illness or with comorbid substance-use disorder, and with history of medically severe suicide attempt. In antisocial personality disorder, rapid-response impulsivity is increased, but rewardbased impulsivity is not. In general, impulsivity is increased more in bipolar disorder than in antisocial personality disorder. In combined bipolar disorder and antisocial personality disorder, increased impulsivity is associated with substance-use disorders and suicide attempts.Conclusions– Impulsivity is associated with severe behavioral complications of bipolar disorder, antisocial personality disorder, and substance-use disorders.
Mortality among people with mental disorders
Authors: Amaddeo Francesco , Tansella Michele
Published: April 2019

Mortality among psychiatric patients has been found to be higher than the general population, not only in those long-term residents in old-fashioned psychiatric hospitals or attending hospital-based psychiatric services (Harris & Barraclough, 1998) but also in those treated in modern community-based systems of care (Amaddeo et al., 1995; Grigoletti et al., 2009).
Suicides in psychiatric in-patients: what are we doing wrong?
Authors: Leo Diego De , Sveticic Jerneja
Published: April 2019

Given the uncontested role of psychiatric illnesses in both fatal and non-fatal suicidal behaviours, efforts are continuously made in improving mental health care provision. In cases of severe mental disorder, when intensified treatment protocols and continuous supervision are required due to individual's impaired emotional, cognitive and social functioning (including danger to self and others), psychiatric hospitalisation is warranted. However, to date there is no convincing evidence that in-patient care prevents suicide. In fact, quite paradoxically, both admissions to a psychiatric ward and recent discharge from it have been found to increase risk for suicidal behaviours. What elements in the chain of well-intentioned approaches to treating psychiatric illness and suicidality fail to protect this vulnerable population is still unclear. The same holds true for the identifications of factors that may increase the risk for suicide. This editorial discusses current knowledge on this subject, proposing strategies that might improve prevention.
What is a run-in phase?
Authors: Cipriani Andrea , Geddes John R.
Published: April 2019

Run-in periods are frequently used when designing a clinical trial. In this paper we analysed the implications of runin periods for interpreting the results of clinical trials and applying these results in clinical practice. Study reports should indicate in details how run-in periods were carried out.
Diagnosing psychotic disorders: validity, reliability and applications of the Diagnostic Interview for Psychosis (DIP). Italian version
Authors: Rossi Alberto , Morgan Vera , Amaddeo Francesco , Sandri Marco , Grigoletti Laura , Maggioni Francesca , Ferro Adele , Rigon Elena , Donisi Valeria , Venturi Valeria Vailati , Goria Fabrizio , Skre Ingunn , Tansella Michele , Jablensky Assen
Published: April 2019

Aims – The Diagnostic Interview for Psychoses (DIP) is a comprehensive interview schedule for psychotic disorders, linked to the OPCRIT diagnostic algorithm, bridging the gap between fully structured, lay-administered schedules and semistructured, psychiatrist-administered interviews. Here we describe the validity, reliability and applications of the Italian version of the DIP. Methods – The interview was translated into Italian and its content validity tested by back translation. Sixty patients, drawn from among those who contacted the South-Verona Community Mental Health Service, were included in the study. Each patient was first assessed independently by two raters, one of whom conducted the interview, while the other assumed the role of observer. Subsequently (median: 89 days), 44 of these patients were re-interviewed by a third rater, who made an independent assessment. Diagnostic validity was assessed in 18 cases, interviewed with the DIP and using the SCAN as ‘gold standard. Results – The mean duration of the interview was 37 minutes for the inter-rater interviews and 39 minutes for the retest interviews. Good to excellent inter-rater reliability was demonstrated for both ICD-10 and DSM-IV diagnoses, while in the test-retest reliability pairwise agreement was high for half of the items. Diagnostic validity was good, with twelve out of the 18 DIP-OPCRIT diagnoses (67%) matching the SCAN diagnosis. Conclusions – Overall, the results support the reliability and validity of the Italian translation of the DIP. The Italian version will be useful both in routine practice to establish standard reference diagnoses of psychosis and in the research field, where it can be used by academic researchers in clinical trials and epidemiological studies.
Development and validation of the RQC: a daily contact log for ACT and ICM teams
Authors: Lesage Alain D. , Gélinas Daniel , Bisson Jocelyn , Dion Éric , Ricard Nicole
Published: April 2019

Aim– Instruments to measure the process - the daily activities of home care workers - have received little attention and may impede research in refining the active ingredients, the clientele best served and continuous quality improvement. We developed a decade ago in Quebec, Canada, a new daily contact log (relevé quotidien des contacts or RQC) that has now reached in practice 1 million entries.Methods– Three features distinguish the RQC development, namely, practical ergonomics, a clear logic, and response categories easy to understand and retain. The instrument is filled following any 10-minute or more contact with or about the client, and covers the location, time and actors of the episode of care, and the nature of the intervention (crisis, representing, accompanying, discussing) in 10 areas (i.e. medication, daily living activities, housing, relationships, substance abuse, legal, etc.). Inter-rater agreement for eachRQCresponse category and rater agreement with a criterion measure (coded vignettes) were evaluated.Results– Kappa coefficients and intra-class correlation coefficients yielded results ranging from at least moderate to generally substantial agreement for all 77 response categories.Conclusions– The newRQCmay support international studies of the implementation and application of various forms of intensive home care, refining its indications, and serves as a clinical and managerial tool to ensure quality of the interventions.Declaration of Interest:The study was financed by funds from the Fonds de la recherche en santé du Québec (FRSQ) and the Canadian Institutes of Health Research (CIHR). The authors have not been involved with any other forms of financing that might be considered a conflict of interest in connection with the submitted article.

Declaration of Interest:The study was financed by funds from the Fonds de la recherche en santé du Québec (FRSQ) and the Canadian Institutes of Health Research (CIHR). The authors have not been involved with any other forms of financing that might be considered a conflict of interest in connection with the submitted article.
The beliefs about drug treatments. The Italian version of the BMQ (The Beliefs about Medicines Questionnaire): its validity and applicability
Authors: Argentero Piergiorgio , Torchio Elisabetta , Tibaldi Giuseppe , Horne Robert , Clatworthy Jane , Munizza Carmine
Published: April 2019

L'adesione al trattamento è stata definita come la consonanza del comportamento di una persona alle indicazioni mediche (Fawcett, 1995; Myers & Nidence, 1998). Le revisioni della letteratura orientate ad analizzare questo argomento rilevano che, nei Paesi sviluppati, solo il 50% dei pazienti affetti da patologie croniche aderisce al trattamento, mentre nei Paesi in via di sviluppo si riscontrano tassi ancora più bassi. Per esempio, negli Stati Uniti, circa 50 milioni di adulti sono affetti da ipertensione, ma solo il 50% di essi sono stati diagnosticati e trattati adeguatamente; tra i pazienti trattati soltanto il 51% aderisce al trattamento. Analogamente, in Australia, solo il 43% dei pazienti affetti da asma assume i farmaci prescritti per l 'intera durata del trattamento e solo il 27.8% usa i farmaci prescritti come preventer (World Health Organization, 2001). Sul piano della frequenza, l 'analisi della letteratura indica che tra il 20% e il 90% dei pazienti affetti da disturbi psichici abbandona il trattamento, con un 'ampia variabilità di incidenza dovuta alle differenze nella definizione di mancata adesione e alla diversità dei campioni studiati.
The Principle of Unity under Article 10 EC and the International Representation of the Union and its Member States
Authors: Zeben Josephine van
Published: April 2019

Case C-246/07 Commission v. Sweden nyr

1.

Unilateral proposals in the context of an international legal framework regarding alterations of that framework may be interpreted as dissociation from the common strategy within the Council (author’s headnote).

2.

If such dissociation has (legal) consequences for the Union, it compromises the principle of unity in the international representation of the Union and its Member States and weakens their negotiating power with regard to other parties to the Convention concerned. In such a case, there is a breach of the duty of cooperation in good faith under Article 10 EC (author’s headnote).

3.

By unilaterally proposing that a substance be listed in Annex A to the Stockholm Convention on Persistent Organic Pollutants, the Kingdom of Sweden failed to fulfil its obligations under Article 10 EC** (official headnote).
Processes and mechanisms of photosynthesis augmented by engineered nanomaterials
Authors: Liu Yinglin , Yue Le , Wang Zhenyu , Xing Baoshan
Published: April 2019

Environmental contextNanotechnology has great potential to provide a wide variety of benefits in food production, especially for plant-derived foods. We present an overview of augmented photosynthesis and its underlying mechanisms in plants in response to engineered nanomaterials. The goal of the review is to promote the development and application of nanotechnology in sustainable agriculture to increase crop productivity while minimising environmental impact.
AbstractWith their unique physicochemical properties, engineered nanomaterials (NMs) have been suggested to be regulators of the physiological and biochemical processes in terrestrial plants. Engineered nanoparticles (NPs) can be absorbed and stored in plant tissues, which lead to beneficial effects on their photosynthetic performance. However, to date, there has not been a comprehensive overview on the processes and underlying mechanisms of augmented photosynthesis by NMs. For this review, we examine enhanced plant photosynthesis by NMs through both light and dark reactions, and we herein discuss the potential mechanisms involved. Precautions are also presented for applying NMs in agriculture. A foliar spray of NMs is able to improve the photosynthetic efficiency better than their application to soil. In addition, coatings with negative charges and greater biocompatibility are able to facilitate the uptake of NMs by plants. As a foundational and pivotal physiological process, the promoted photosynthesis induced by NMs will likely increase crop yields and potentially further benefit sustainable agriculture. Hence, the underlying mechanisms of NM-enhanced photosynthetic efficiency need to be better understood to increase crop productivity and to minimise the environmental impact when applying agricultural nanotechnology.