bluuebunny/crossref_metadata_2025 huggingface dataset:
A „jó szegény legények” és a veszprémi cifraszűr
Authors: Földesi Ferenc
Published: February 2021

A 19. században Dunántúlon a „cifraszűr” viselése és készítésének mestersége – melynek „fővárosa” Veszprém volt – már nagyon régi idő óta virágzott. Ez a gazdagon díszített vastag gyapjú felöltő, amelyet parasztok, de mindenekelőtt pásztorok viseltek, használójának a mindene volt: derékalja, párnája, valamint oltalma a hideg, a szél, az eső, és árnyéka a nap heve ellen. A korabeli hatalom elítélte a köznép körében kibontakozó „luxust”, félve attól, hogy megrontja erkölcseiket. Rendeleteket hoztak a magyar cifraszűr eltiltására, mert azt gondolták, hogy a cifraszűr megkívánása még lopásra, rablásra is ráviszi majd a legényeket – amire volt is példa. A tiltásnak, a rendeleteknek nagy foganatja nem volt, a mesterség és a jellegzetesen magyar ruhadarab készítése, a vele való kereskedés töretlenül virágzott. A publikációban a különböző dunántúli megyék által kiadott tiltó rendeleteket mutatom be, röviden ismertetve az azokra adott reakciókat is.
Egyháziak, katonák, nemesek : Eszéki, károlyvárosi és selmecbányai szabadkőműves páholyok tagjai 1785-ben
Authors: Kökényesi Zsolt
Published: February 2021

A szabadkőművesség a 18. századi Európa egyik legmeghatározóbb és egyúttal legvitatottabb szellemi-kulturális és politikai mozgalma, közösségképző intézménye, amelynek nemzetközi és hazai kutatása az utóbbi években újabb lendületet vett. A tanulmány a Magyar Királyság 18. század végi szabadkőműves-hálózatának vizsgálatához kíván néhány újabb adalékkal és megközelítéssel hozzájárulni. A dolgozat három különböző földrajzi elhelyezkedésű város három különböző funkciójú és tagságú páholyának, az eszéki Zur Wachtsamkeit (Az éberséghez), a károlyvárosi Zur Tapferkeit (A vitézséghez), valamint a selmecbányai Zu den tugendhaften Menschenfreunden (Az erényes Emberbarátokhoz) páholy állománytörténetének a feltárását, ezáltal pedig a magyarországi szabadkőműves mozgalom személyi állományának pontosabb megismerését célozza. A tanulmány függelékében megtalálhatóak az említett három páholy 1785. évi tagnévsorai.
Párnahuzat és bor : Egy olasz rendőrnek és magyar feleségének hírszerzési megkörnyékezése
Authors: Neuspiller Ferenc
Published: February 2021

Az 1960-as években a magyar hírszerzés megpróbált beszervezni egy olasz rendőrt, Domenico Reitanót. Reitano a második világháború után először az olasz Idegeneket Ellenőrző Hivatalnál teljesített szolgálatot, majd innen átkerült a vasúti rendőrséghez. Utóbbinál az volt a feladata, hogy a Firenze és Róma között közlekedő vonatokon tartsa fenn a rendet. Reitano a világháború utolsó évében megismert egy magyar nőt, akit nem sokkal később feleségül vett. A feleségnek a Szovjetunióban és Magyarországon is éltek rokonai, utóbbiakat rendszeresen látogatta. A magyar hírszerzés ügynökei éveken keresztül igyekeztek megkörnyékezni az olasz rendőrt, feleségét és Magyarországon élő rokonaikat.
PENGARUH ATRIBUT-ATRIBUT KUALITAS AUDIT TERHADAP KEPUASAN KLIEN (Studi Empiris Pada Perusahaan Perbankan di Kota Medan)
Authors: Sijabat Jadongan
Published: February 2021

This research is a study about attributes of audit quality. The purpose of this research is to re-examine the effect of attributes of audit quality to client satisfaction as Bhen et al (1997).

This research conducted with survey on perception of financial managers or controller, that distributed by mail survey to 100 financial manager of banking in Medan City. Unit analysis are the financial managers or controller of banking. There are fifty five questionaires (55%) received and analyzed by Ordinari Least Square supported by SPSS 10.00 program.

The results showed that some of attributes of audit quality effected client satisfaction. The results showed that there were some different result between this study and Bhen et al. (1997).
Analisis Potensi Ekonomi Sektoral Kabupaten Humbang Hasundutan Tahun 2010-2018
Authors: Purba Elvis F.
Published: February 2021

This paper describes the economic potential of each industrial origin Humbang Hasundutan regency period 2010-2018. The analysis is based on: (1) location quotient (LQ), (2) sectoral contribution to GDRP, and (3) sectoral contribution to the regency's economic growth rate. Assuming that there is no a drastic change in the sectoral GDRP value in one or several industrial origin, the annual average value from the observation period is used. Furthermore, to determine the economic potential of each industrial origin based on established quantitative criteria. The results of data analysis indicate that only one industrial origin has high economic potential, namely agriculture, forestry and fisheries. Then there are two industrial origin with moderate potential, i.e.: (1) construction and (2) government administration, defense and campulsory social security. The remaining fourteen other industrial origin have low potential.

Over time, it is estimated that there will be changes in the contribution of each industrial origin to GDRP and the rate of regency economic growth. However, agriculture, forestry and fisheries are estimated to still have high potential in the next few decades, especially since Humbang Hasundutan regency has been designated as one of the food estate for Indonesia.
TINJAUAN YURIDIS PREDATORY PRICING OLEH PELAKU USAHA RESELLER KARTU PAKET INTERNET DITINJAU DARI UNDANG-UNDANG NO. 5 TAHUN 1999 (STUDI: DI KOMPLEK MMTC JALAN PANCING MEDAN)
Authors: Sihotang Lesson , Ricky Omega Yosua
Published: February 2021

Predatory Pricing is the act of a company setting prices below the cost of production in order to eliminate competitors. The study of the law is by predatory pricing by an Internet raffle card in the MMTC complex and section 5 and 8 links to pricing arranged in 1999's statute no. 5 on monopoly and improper business competition. The aim of the study is to find out the adverse effects of the reseller of Internet package Cards and to learn about the pricing of those governed in 1999's statute no. 5 regarding monopoly and unhealthy business competition. This legal research is taken from a normative-empirical legal approach. This approach will merge data that comes from library research and data obtained in the field. Normative data will be generated in legal literature, legal books, legal journals and other materials. While empirical data will be obtained from an interview with the perpetrators of an Internet package card. This legal study will address the indelicate effects of the Internet package card business and the relationships chapters 5 and 8 on pricing under 1999 law no.5. The end of this legal study will be to learn more about the cost of the undergraduate work.
EDITORIAL
Authors: Steven Un Antonius
Published: February 2021

EDITORIAL Antonius Steven Un?
Mobiliosios programėlės rinkiminėje komunikacijoje
Authors: Šuminas Andrius , Aleksandravičius Arnas
Published: February 2021

Kiekvienais metais sparčiai augant mobiliųjų įrenginių naudotojų skaičiui ir didėjant įrenginių techninėms galimybėms, mobiliosios programėlės tampa vis dažniau ir plačiau naudojamu politinės komunikacijos įrankiu, ypač rinkimų kampanijų laikotarpiu. Mobiliosios programėlės, kaip ir daugelis kitų informacinių ir komunikacinių technologijų inovacijų, politiniams tikslams pirmą kartą panaudotos JAV, tačiau netruko sparčiai išplisti ir į kitas pasaulio šalis, taip pat ir į Lietuvą. Šiame straipsnyje nagrinėjamos mobiliųjų programėlių taikymo galimybės politinės komunikacijos procesuose, analizuojami praktiniai jų išnaudojimo pavyzdžiai rinkimų kampanijose. Straipsnyje apibrėžiama mobiliųjų programėlių samprata ir jų pagrindinės savybės, aptariamos taikymo galimybės ir nauda politikoje ir rinkimuose. Taip pat detaliai aptariami pirmieji mobiliųjų programėlių panaudojimo rinkiminėje komunikacijoje pavyzdžiai anglakalbėse šalyse ir Lietuvoje.
Parlamentarų informacinės elgsenos ypatumai: Lietuvos Respublikos Seimo narių atvejis
Authors: Vernickaitė Aurelija
Published: February 2021

Informacijos vaidmuo ir įtaka politiniams sprendimams teoriniu požiūriu suvokiama ir interpretuojama gana skirtingai, tačiau jos reikalingumas ir svarba išlieka nepaneigiami. Parlamento narius galima vadinti vienais iš svarbiausių informacijos vartotojų, nes nei politiniai sprendimai, nei politinė veikla, nei politika iš esmės negali būti atskirti nuo informacijos, todėl politikų kaip informacijos vartotojų elgsena reikalauja išskirtinio tyrėjų dėmesio ir kruopščios analizės. Tokie tyrimai svarbūs ir aktualūs siekiant atskleisti ir suvokti parlamentarų informacinius poreikius, informacijos ieškos ir informacijos naudojimo priimant sprendimus ypatumus, taip pat tai leidžia numatyti praktines informacijos sklaidos ir aprūpinimo informacija tobulinimo galimybes parlamente, o tai yra ypač svarbu siekiant geresnio ir sklandesnio sprendimų priėmimo įstatymų leidybos institucijoje. Kol kas Lietuvoje galima pastebėti tik užuomazgas mokslinių bandymų tirti Seimo narių informacinę elgseną. Šiame straipsnyje pristatomi rezultatai atlikto kokybinio tyrimo, kuriuo siekiama atskleisti Lietuvos Respublikos Seimo narių informacinės elgsenos ypatumus. Siekta ištirti, kaip parlamentarai suvokia informacijos vaidmenį politiniuose sprendimuose, kokie motyvai skatina parlamento narius ieškoti informacijos, kaip ir kur informacijos ieškoma, kaip Seimo nariai vertina gaunamą informaciją ir kaip ją naudoja (nenaudoja) priimdami sprendimus. Pateikiamas parlamento narių požiūris į informacijos sklaidą parlamente ir sprendimų priėmimo proceso informacinį aprūpinimą, siekiant nurodyti galimas informacinio aprūpinimo tobulinimo galimybes.
Permąstant partinių sistemų įtaką rinkėjų elgsenos kaitumui: Lietuvos savivaldybių tarybų atvejis
Authors: Jastramskis Mažvydas
Published: February 2021

Pastaraisiais dešimtmečiais rinkėjų elgsenos kaitumo tyrimai politikos moksluose tapo aktualia tema. Tačiau vieno įtakingiausių šio reiškinio aiškinimų, partinės sistemos, teorinis ir empirinis pagrindimas yra gana komplikuotas dėl dviejų priežasčių: Giovannio Sartorio partinių sistemų klasifikacijos tiesioginio transplantavimo ir nacionalinio lyg­mens imčių naudojimo. Šiame straipsnyje, derinant G. Sartorio ir Peterio Mairo teorijas, pasiūloma inovatyvi partinių sistemų (apibrėžiamų kaip ilgojo laikotarpio koalicinių šablonų) tipologija ir iš jos išvedamas rinkėjų elgsenos kaitumo aiškinimas. Teorija tikrinama remiantis empiriniu tyrimu ir naudojant 1995–2011 m. duomenis iš Lietuvos savivaldybių tarybų. Atrandama, kad kuo mažiau partinėse sistemose, kurias apibrėžia konkretus koalicinio partijų elgesio šablonas, yra paskatų stabiliau balsuoti už tam tikras partijų blokų alternatyvas, tuo didesnė jose aukšto rinkėjų elgsenos kaitumo tikimybė.
Mažasis Seimas Lietuvos parlamento istorijoje
Authors: Maksimaitis Mindaugas
Published: February 2021

Straipsnyje aptariamos politinės ir teisinės Mažojo Seimo, tapusio ryškiu epizodu Lietuvos parlamentarizmo raidoje, atsiradimo prielaidos, analizuojamas jo sudarymas, veikla ir pasiekti rezultatai.

Mažojo Seimo įsteigimas ir veikla sudarė galimybę į Steigiamąjį Seimą išrinktiems autoritetingiausiems visuomenės nariams įsijungti į tiesioginę veiklą mobilizuojant krašto pajėgas kovai prieš lenkų agresiją. Tai padėjo išvengti Steigiamojo Seimo, didžiąją laiko dalį lygiagrečiai su pagrindinių valstybės įstatymų rengimu skyrusio einamiesiems parlamentinės veiklos klausimams spręsti, darbo trukdžių.
Kalbos vieta valstybių politikoje: standartinių kalbų susikūrimas
Authors: Smetonienė Irena
Published: February 2021

Straipsnyje siekiama parodyti, kada ir kaip Europoje atsiranda kalbos standartas, kokia jo prasmė, kuo šie procesai panašūs į procesus, vykusius Lietuvoje. Standartinės kalbos greičiau sukuriamos ir įtvirtinamos ten, kur jos suprantamos kaip valstybių vienijimo ir valdymo įrankis. O ten, kur standartinės kalbos idėja kyla pavergtoje tautoje, jai tenka nueiti ilgą ir sunkų kelią. Lietuvių standartinės kalbos istorija sudėtinga ir ilga. Iki XIX a. tarmė, nepaisant rašančiųjų polinkio į vakarų aukštaičių tarmę, nepasirenkama, rašyba nenusistovėjusi, su valstybės politika ji siejasi tik tiek, kiek lietuvių kalba yra reikalinga kaimiečiams ir smulkiajai bajorijai valdyti. XIX a. didžiulį vaidmenį suvaidina Žemaičių sąjūdis ir jo siekius tęsęs Motiejus Valančius. XIX a. pabaigoje tarmė jau pasirinkta, rašyba nusistovi. Apskritai visas XIX a. pažymėtas kalbos gryninimo žyme. Svarbiausiais standartinei kalbai laikytini 1922 metai, kai Konstitucijoje ji paskelbiama valstybine, Švietimo ministerija Jablonskio gramatiką pripažįsta gramatikos standartu, o Kaune įkuriamas universitetas.
Europos kalbų paveikslas: esminiai kalbos politikos klausimai ir kryptys
Authors: Vaišnienė Daiva
Published: February 2021

Lietuvių kalba gana sparčiai įsitvirtino šiuolaikinės daugiakalbės Europos kalbiniame kraštovaizdyje. Per labai trumpą laiką po Nepriklausomybės atkūrimo sukurta teisinė valstybinės kalbos politikos bazė, įsteigtos kalbos planavimu, tvarkyba ir priežiūra besirūpinančios institucijos. Dabartinė lietuvių kalbos politika yra daugiakryptė, sprendžianti valstybinės kalbos statuso įteisinimo ir įgyvendinimo, kalbos ir visuomenės santykių, mokslinės komunikacijos nacionalinėmis kalbomis ir pan. klausimus, aktualius ir kitose Europos valstybėse.

Skirtingų šalių kalbos politikos nuostatų ir vartosenos tradicijų įvairovė turi nemažai bendrų bruožų, kuriančių gana vientisą kalbinį Europos paveikslą, kurio ypatumai aptariami šiame straipsnyje. Pasirinktas apžvalgos pagrindas – kas keleri metai atliekamos apklausos, kurioje dalyvauja pagrindinės Europos valstybių kalbos institucijos, duomenys, parodantys nacionalinių kalbų teisinio reglamentavimo lygmenį ir kalbų vartojimo pokyčius svarbiose viešojo gyvenimo srityse. Pagrindinės tiriamosios sritys: bendroji kalbos būklė, teisinis reglamentavimas, kalbų vartojimas švietimo srityje, žiniasklaidoje, verslo reikmėms, kalbos sklaida.
Pemanfaatan Konsep Ekohidrologi (Penciptaan Air dan Sanitasi Bersih) Sebagai Upaya Mengatasi Stunting di Desa Bulang
Authors: Mubaroq Husni
Published: February 2021

Ecohydrology is an approach to integrated water resources management that offers a sustainable development approach in understanding the environment and water resources systems. In this case the conditions where clean water and food can be created to reduce the number of stunting in an area. The concept of ecohydrology can also prevent the spread of disease through water. The introduction of this concept is intended to reduce stunting and overcome the lack of clean water in the future. In this case the concept of Ecohydrology is offered with the existing water purification plan to produce clean water that is ready to use and utilizes materials that are easily available and have low prices.

Keywords: Stunting, ecohydrology concept
Edukasi Kesehatan Bagi Ibu Dan Calon Ibu Sebagai Upaya Pencegahan Masalah Stunting Di Desa Jatiadi Kecamatan Gending Kabupaten Probolinggo
Authors: Widayanto Mutinda Teguh
Published: February 2021

Government efforts to improve the level of public health need to be supported by all parties. The desire to create a superior generation can only be achieved if the community has a good degree of health. One of the problems in the health sector is still relatively high stunting in Indonesia. Stunting is the failure of a child to grow and develop optimally due to the impact of cumulative and ongoing nutritional deficiencies. Or chronic nutrition problems where families and the community do not feel that this is a problem, this is because not many people know the causes, impacts and prevention. The central and regional governments together are trying to overcome these problems. The Local Government of Probolinggo Regency also strives to solve this problem with various policies adopted. Panca Marga University Probolinggo Real Work Lecture (KKN) placed in Jatiadi Village, Gending District, Probolinggo Regency tried to participate in preventing stunting problems through Health Education activities for mothers and prospective mothers as an effort to prevent stunting problems in Teati Village, Gending District, Probolinggo Regency, which is intended for mothers who have toddlers and pregnant mothers. It is expected that with this activity the community's understanding of health can be increased and stunting sufferers can be reduced, so that the desire to realize a smart and superior healthy community can be achieved.

Keywords:  Stunting, Health Education, Pregnant Women, Toddler
Upaya Memberdayakan Warga Desa Karangpranti untuk Meningkatkan Produktifitas Abon Kluwih Padaumkm Abon Hj. Sun Dalam Rangka Pencegahan Stunting
Authors: Susilo Wawan
Published: February 2021

Karangpranti Village is a village located in Pajarakan District, Probolinggo Regency. The local advantage of the Karangpranti village is that there are several superior MSMEs that seek to empower the surrounding residents to build and help improve the economy of the surrounding residents. One of the MSMEs that is quite helpful in providing employment in the Karangpranti village is Abon Hj. Sun. However, the development of MSME Abon Hj. Sun is constrained by the lack of capital and public knowledge about the empowerment of its citizens. So that solutions can be done to overcome existing obstacles, for example, Students hold a Micro Small and Medium Enterprises (MSME) Socialization, Expanding production land, Assistance for capital submission. The method used is the preparation stage includes a survey or observation, evaluation of problems and preparation, then the implementation phase which includes approaches to the community and MSME socialization, then the evaluation stage is carried out to see the success rate of activities starting from the beginning, the process, to the achievement of the results of activities . If the productivity of MSME Abon Hj. Sun is increasingly being developed so that efforts to empower residents around Karangpranti village will be increasingly realized, so that the welfare of the people can be increasingly created. So that the increase in welfare can prevent stunting in the Karangpranti village community.

Keywords : Productivity, Community Health, Prevention of Stunting
Pencegahan Stunting dengan Memanfaatkan Garam Beryodium Ud. Sumber Rejeki Di Desa Pajurangan, Kecamatan Gending Kabupaten Probolinggo
Authors: Prihatiningsih Tri
Published: February 2021

Pajurangi Village is one of the 13 villages in Gending District, Probolinggo Regency. Pajurangi Village is an area close to the beach 250m above sea level, administratively, this village consists of 7 hamlets, 9 RW and 12 RT. The population of this village is approximately 6,987 people with an area of ​​363,363 km2. This village is located in the middle of Probolinggo Regency. One of the village's local potentials is the UMKM UD. Sumber Rejeki which produces iodized salt. Iodized salt is salt that has been enriched with iodine which is needed for growth and intelligence. Iodized salt has a fixed dose to be consumed in accordance with 2019 Ministry of Health standards. Iodine intake can be obtained by consuming iodized salt which is added to dishes or drinks. The use of iodized salt in accordance with the standard can help prevent the occurrence of stunting abnormal growth of children. With the production of iodized salt at UD. Sources of Sustenance can help overcome early stunting and can provide opportunities for unemployment in the village of Pajurangi. This MSME can be developed by promoting salt products to the surrounding community with brochure media.

Keywords: Stunting, Iodized Salt, Local Potential
Pencegahan Stunting Sejak Dini di Era Milenial Desa Sukokerto Kecamatan Pajarakan Kabupaten Probolinggo
Authors: Wicaksono Indro
Published: February 2021

Most people do not understand correctly about Stunting, and assume that Stunting or dwarf designation commonly used in society is heredity. This dedication activity is carried out to increase knowledge and understanding of stunting which is expected to directly motivate the community to participate in paying attention to the growth and development of their children so that their growth and development can be optimal. Factors causing stunting are low birth weight, not getting exclusive breastfeeding, lack of energy and protein intake, and not immunizing. Based on statistical data on the progress of the implementation of the acceleration of prevention of integrated stunting in East Java Province, the status of April 2019, Probolinggo district, showed that the prevalence of stunting reached 94%, the data of stunting children in 2018 reached 17.29%. Data from the analysis of the stunting prevention plan in Probolinggo Regency in 2020 through a source from Bappeda Sukokerto village, including villages with 90 children under five. Data stunting in the village of Sukokerto was 3.72%. The main target of the implementation of the socialization program on prevention of stunting is pregnant women and children under five in the Sukokerto village community by holding a Posyandu Outreach event with the theme "Prevention of Early Stunting in the Millennial Era" and pregnant women. Based on the above table it can be stated the results before the test participants who knew about the Stunting prevention program 14 people (40%) while the results based on after the test participants who knew about the stunting prevention program were 27 people (77%) seen from the results before the test that most parents did not know about how to prevent stunting. community empowerment in the form of Moringa plant-based food development, because Moringa has been proven to contain super nutrition and is easy to obtain. The method for community empowerment is carried out by organizing land use movements for Moringa plant cultivation and also counseling about the use of Moringa plants. Besides that, when the Moringa planting activities are carried out, the entire community can participate enthusiastically until all activities end.

Keywords: Stunting counseling and Moringa planting
América Latina hoy y el futuro de la educación, la política, lo social, lo económico, lo cultural, lo espiritual, y el humanismo
Authors: Bustamante Guerrero Carmen Helena
Published: February 2021

El presente artículo es una reflexión desde la perspectiva de la experiencia como doctora en Educación, desde hace diecinueve años. Lo que me permite realizar un análisis crítico de la Educación en América Latina y el estado juicioso de los procesos que de una u otra forma han sucedido, en el escenario de los países.
La educación es un fenómeno social de relevante importancia para la formación y el desarrollo del hombre. El destacado pedagogo catalán Octavi Fullat ha expresado: “el ser hombre es tener que educarse”, para significar que no se pueden separar: antropos y educación.
¿Enseñar la sensibilidad? Notas para una pedagogía de la esperanza
Authors: Madriz Ramírez Gladys
Published: February 2021

En este trabajo se aborda como objeto de estudio la enseñanza de la sensibilidad como posibilidad, desde una fenomenología hermenéutica. Así, la sensibilidad es entendida como opción y elección e inclinación estética (en tanto recepción), ética y política (en tanto recibimiento y donación) al amor, la empatía y la compasión. Su principal aporte puede definirse como el de unas notas introductorias a una pedagogía del amor, a través del recordatorio de una vida, de una acción pastoral y formativa, que hoy a la distancia todavía nos ofrece motivos para pensarla y reconocerla como excepcional y profundamente cristiana.
The Rules of Four: A Systematic Approach to Diagnosing Common Musculoskeletal Conditions of the Knee
Authors: Lerew Shawn , Stoker Steven , Nallamothu Shivajee
Published: February 2021

Musculoskeletal symptoms are consistently one of the most commonly cited reasons for visits to ambulatory care centers every year, with knee pain accounting for approximately one-third of the reported complaints. Previous studies have demonstrated that many non-orthopedic physicians report a lack of confidence in performing clinical musculoskeletal knee examinations. “The Rules of Four” approach presented in this paper is designed to present a systematic and concise method to musculoskeletal examination of the knee within a memorable format. The approach allows for the timely diagnosis of common musculoskeletal injuries while aiding in directing further treatment and diagnostic testing. This method will ideally allow medical students and non-orthopedic physicians alike to confidently and effectively evaluate patients with complaints of knee pain in ambulatory care settings.
The Efficacy of Subchondroplasty for the Treatment of Knee Pain Associated with Bone Marrow Lesions
Authors: Krebs Nathan M , Kehoe James L. , Van Wagner Michael J. , Rios-Bedoya Carlos
Published: February 2021

CONTEXT

Symptomatic bone marrow lesions on MRI in patients with knee osteoarthritis are strongly associated with progressive deterioration of the joint and an increased risk of progression requiring joint replacement surgery. This study evaluates the efficacy of knee arthroscopy with adjunctive subchondroplasty (i.e. cartilage stabilization) to improve self-rated visual analog scale (VAS) pain scores, rate of conversion to arthroplasty, and patient satisfaction levels.

METHODS

A retrospective chart review and phone survey was performed on 12 patients who had undergone knee arthroscopy with adjunctive subchondroplasty for knee pain associated with chronic subchondral bone marrow lesions on MRI. Follow-up for the 12 patients was 36 months on average (range of 12 to 51 months), self-reported paired preoperative and postoperative VAS scores were analyzed in addition to rate of conversion to arthroplasty and patient satisfaction.

RESULTS

The results demonstrated statistically significant reductions in mean preoperative VAS scores versus six-week postoperative VAS scores from 7.58 to 1.83 (p < 0.001) in addition to significant reductions in mean preoperative VAS scores to final postoperative VAS scores from 7.58 to 1.60 (p < 0.001). There was no statistically significant association (p > 0.05) with patients’ demographic and clinical data (e.g., age, height, weight, BMI, length of symptoms) and rate of revision to total arthroplasty after receiving the arthroscopic subchondroplasty procedure. Out of the 12 patients, two (16.7%) patients went on to conversion to total knee arthroplasty.

CONCLUSIONS

In this series, knee arthroscopy with adjunctive subchondroplasty for the treatment of osteoarthritis with symptomatic bone marrow lesions was associated with clinically significant improvements in VAS pain scores. Furthermore, patients who underwent subchondroplasty had a low rate (16.7%) of conversion to total knee arthroplasty at 36-month follow-up.
Myocardial Ischemia, a Rare Presentation of Meckel’s Diverticulum
Authors: Nessel Trevor A , Kerndt Connor C. , Shareef Zaid J. , Doig Christopher
Published: February 2021

CONTEXT

Meckel’s diverticulum is a rare congenital anomaly of the gastrointestinal tract. It is typically asymptomatic and found incidentally in the work-up of another medical complaint. However, it has been known to cause complications in a minority of cases.

METHODS

This case involves an elderly male in his early 80’s who presented to the emergency department with a 2-day history of emesis and hematochezia, in addition to sudden onset syncope and angina-like symptoms. Serial electrocardiograms demonstrated diffuse ST-segment depressions, consistent with myocardial ischemia. The patient underwent laboratory testing, imaging, endoscopy, and a subsequent exploratory laparotomy.

RESULTS

Laboratory results revealed lactic acidosis, anemia, and leukocytosis. Upper endoscopy resulted in negative findings. Imaging, including CT-scan and Technetium-99 RBC scan, visualized a gastrointestinal bleed. However, the arterial embolization procedure was unable to stop the bleeding diverticulum. Exploratory laparotomy revealed an infarcted Meckel’s diverticulum.

CONCLUSIONS

This case demonstrates the importance of clinicians generating a wide differential when evaluating a gastrointestinal bleed, and considering Meckel’s diverticulum as a potential cause of a bleed with an unknown source. The primary test to diagnose a Meckel’s diverticulum is a Technetium-99 RBC scan. However, visualization via exploratory laparotomy is the best test for definitive diagnosis. The decision to intervene surgically earlier can limit mortality with symptomatic Meckel’s diverticula.
Clinicopathological and Perioperative Outcome of Appendiceal Tumors: Case Review of 31 Patients
Authors: Boyajian Haroutioun , Majeski Vanessa , Flores Alicia , Sturtz David , Baidoun Fadi , Dughayli Mohammed
Published: February 2021

INTRODUCTION

Neoplasms of the appendix are quite rare and found in approximately 1% of appendectomy specimens. These neoplasms have been pathologically categorized into various subgroups depending on cell of origin, and surgical treatment varies according to histological subtype and disease stage.

PURPOSE

The purpose of this case series review was to evaluate the clinicopathological presentation and survival outcome of a sample of patients with appendiceal tumors.

METHODS

Before data collection, this project design was approved by the authors’ institutional review board. Pathology records at our institution were reviewed for cases of appendiceal tumors from January 2007 to December 2016. A total of 31 patients were identified over this 10-year period. Retrospective data collection included patient demographics, presenting symptoms, tumor size, histologic diagnosis, initial and secondary management, perioperative and postoperative outcome, and survival benefits.

RESULTS

Thirty one patients with four different appendiceal tumor subtypes were included in the study: Mucinous Cystadenoma, Mucinous Adenocarcinoma, Goblet Cell, and Carcinoid. The sample was comprised of 17 women (54.8%) and 14 men (45.2%) with an overall mean age of 50.1 (SD = 22.3). Subgroups of 13 (42%) patients had Carcinoid tumor, 12 (39%) had Mucinous Cystadenoma, four (13%) had Goblet cell tumor, and two (6%) had Mucinous Adenocarcinoma. The stage at presentation and tumor size also varied by histologic subtype. The most common presenting symptom was abdominal pain (64.5%), followed by a radiological identified mass (12.9%). Overall, 27 (87.1%) patients survived, and four (12.9%) were deceased.

CONCLUSIONS

The findings from this case series review provides a retrospective analysis of appendiceal tumor characteristics, follow up, and survival. Based on these results, the prognosis and management of patients with these tumors should be based on the histologic subtype and the extent of their disease.
Radiological Findings of COVID-19 Patients in Italy
Authors: Brennan Zachary , Guerra Samantha , Seman Susan
Published: February 2021

CONTEXT

The emergence of COVID-19/SARS-CoV2 (COVID-19) was an outbreak that began in December 2019 and rose to pandemic levels in 2020. One of the largest problems with COVID-19 is the typical delay in testing and diagnosis that can lead to additional transmission of the disease. Under consultation with a board-certified radiologist, the study team evaluated the common radiological findings of COVID-19 on computed tomography (CT) and compared the efficacy of chest radiographs (i.e., x-rays) to CT in diagnosing COVID-19.

METHODS

In 2020, the authors completed a retrospective review of radiologic imaging data (i.e., the original imaging report notes) from Italy performed on 47 patients who had tested positive for COVID-19 in Italy during the national outbreak from February to March 2020. Radiologic images were obtained from Società Italiana di Radiologia Medica e Interventistica radiological database of COVID-19 patients. Each case was analyzed for whether they had positive findings on either chest radiograph or CT or both among patients who had positive COVID-19 test results.

RESULTS

The authors found significant radiological finding similarities among the 47 COVID-19 positive case studies from Italy during the February to March 2020 time period. Ground glass opacities and crazy paving were the most significant findings, resembling the findings in China and other Coronavirus strains. The authors’ statistical analyses indicated that CT scans were more reliable by 30.7% than chest radiographs in identifying signs of COVID-19. In cases where either an initial negative swab for COVID-19 or providers lacked patient social histories, chest radiographs were used to show clinical findings consistent with COVID-19.

CONCLUSIONS

Based on these results, chest radiographs appear to be a consistent method to assist in the diagnosis of most COVID-19 cases. The authors discuss several scenarios in community-based and non-hospital US settings for COVID-19 diagnostic processes.
Lingual Osseous Choristoma: A Systematic Review of Lesion Presentation, Histology, and Morphology
Authors: Shareef Zaid J , Shareef Sarah J , Kerndt Connor C , Aughenbaugh Arielle , Di Ponio Anthony
Published: February 2021

INTRODUCTION

Osseous choristomas of the tongue are rare, benign tumor-like lesions composed of abnormally placed bone and cartilage tissue. The few publications to date concerning this condition have been primarily limited to case reports. This systematic review aimed to clarify the clinical presentations of osseous choristomas and how to delineate them from other oral pathologies.

METHODS

The authors utilized PubMed, Embase, and Cochrane Library reference databases from 1971 to mid-2020. Search terms were “osseous choristoma,” “oral cavity,” and “lingual.” Preferred Reporting Systems for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to aggregate relevant data from each study. The authors specifically collected data regarding patient demographics, clinical findings, symptoms, treatments, and subsequent outcomes relating to lingual osseous choristomas.

RESULTS

A total of 35 (14.6% of total identified) publications that met inclusion criteria were identified concerning a total of 69 lingual osseous choristoma cases. Results were compiled focusing on sex and age, presenting symptoms, histology, appearance of the lesion base being most commonly pedunculated (e.g., stalk or stem-like), the lesion’s location on the tongue, and subsequent treatments. Osseous choristomas had a higher rate of occurrence in females, 48 (70%) and those under the age of 40. Symptomatic presentations occurred in 38 (55%) patients, with the most common presenting symptoms being gagging/globus (i.e., lump or foreign body) sensation (n = 47, 68%) and dysphagia (n = 20, 29%). Identified masses were pedunculated in 33 (80%) of cases and eight (20%) were identified as sessile (i.e., immobile). A total of 41 (59%) lesions were more commonly located in the posterior one third of the tongue compared to 28 (41%) in the anterior two thirds of the tongue. Of those 49 (71%) cases requiring surgical mass excisions, recurrence was reported in 0% of cases.

CONCLUSIONS

Although osseous choristomas are benign processes that rarely arise from the tongue, providers should carefully inspect patients with a gagging/globus sensation and pedunculated mass toward the back of the tongue. Surgical resection remains the best treatment to prevent recurrence.
Multi-Specialty Care for Second-Degree Pressure Cooker Explosion Burn Injuries
Authors: Schukow Casey , Nordyke Billy R.
Published: February 2021

CONTEXT

Although pressure cookers are very common kitchen utensils used in the United States, only a few cases of serious injuries secondary to pressure cooker explosions have been reported in the medical literature. When second-degree (i.e., “partial-thickness”) burns result from pressure cooker explosions, wounds involving near to or greater than 10% of total body surface area typically require multidisciplinary treatment, with burn center referral for proper wound care, potential fluid resuscitation, and eventual scar management.

EXAMPLE CASE

The example patient described in this report was an African American female in her early 30s who presented during the summer of 2020 after suffering varying levels of second-degree burns to her bilateral upper torso and left wrist (i.e., approximately 10%, total body surface area). The authors first saw the patient during a primary care office visit a week after her initial injury when she first went to a local urgent care clinic. Upon her arrival to the second author’s family medicine clinic, a multi-specialty wound recovery plan was initiated since her first urgent care visit treatment had been minimal without prophylactic antibiotic therapy or placement of a burn center referral.

CONCLUSIONS

Partial and full-thickness burn injuries generally warrant immediate clinical (i.e., body surface area burn assessment, fluid resuscitation, empiric antibiotics) as well as ongoing (burn center referral, debridement procedures, active scar management, provision of psychological support) treatment needs. This paper discusses the critical opportunities posed for more extensive burn patients’ physicians to first categorize the extent of burn wounds and initiate subsequent specialty care in other settings.
Trauma Dictations in the Emergency Department: A Quality Improvement/Patient Safety Project
Authors: Toth Eric W. , Richardson Kristopher , Berry Courtney , Butki Nikolai
Published: February 2021

CONTEXT

Trauma patients frequently represent a unique and challenging patient population in emergency medicine care settings. The policy of the McLaren Oakland Emergency Department (ED) is to have the treatment of all Level 1 and Level 2 trauma activations dictated by the ED resident. This policy is intended to facilitate both patient safety through clear communication between multiple medical services and quality improvement through reporting trauma specific quality metrics to third party agencies. Despite this requirement, trauma dictations in this setting were often found to not be completed. The purpose of this quality improvement/patient safety project was to implement a trauma dictation template to increase the rate of completed ED trauma dictations to above 75% of all Level 1 and Level 2 trauma activations.

METHODS

A trauma dictation template was created to aid ED residents while completing trauma dictations. It was thought by the authors that the implementation of a standardized dictation template would help residents specify the necessary components needed to improve both patient safety and quality reporting. The development of the template was a collaborative effort between the emergency medicine residents and faculty, the trauma coordinator and trauma surgeons. The project was evaluated using two separate measures. A “process measure” was first used to determine if the addition of the trauma template made dictating less burdensome for ED residents, and an “outcomes measure” helped the authors examine whether template implementation actually led to an increased rate in completed trauma dictation.

RESULTS

Data were collected during a three-month period prior to template implementation and three months after implementation. From November, 2015 through April, 2016, a total of 132 Trauma Activations were reviewed. The rate of completed dictations on Level 1 trauma activations increased from 45.16% to 53.33%. However, the rate of dictations on Level 2 trauma activations decreased from 50% to 30.4%, suggesting that Level 1 trauma patient care may have derived greater improvements from the new dictation template.

CONCLUSIONS

The results of the ED residents’ evaluative survey responses were generally positive, indicating that the trauma template was perceived by most residents as a useful tool to complete dictations. Even though the outcome goal was not achieved, the project successfully achieved the goal of creating and implementing a usable trauma dictation template. Following the Plan-Do-Study-Act model for quality improvement/patient safety projects, the next project will examine additional barriers preventing users from utilizing this initial well-received tool.
Delayed Intracranial Hemorrhage in Patients Taking Warfarin with Head Trauma
Authors: Macedo Mark , Grima Jonathon , Yangouyian Michael , Kim Brian S.
Published: February 2021

CONTEXT

Patients presenting to the Emergency Department after a minor head injury have been shown to have a higher incidence of delayed spontaneous intracranial bleed, even with an initial negative CT. Some institutions have initiated a protocol of 24-hour observation followed by repeat head CT scan the next day. At the authors’ institution, a 24-hour observation protocol was adopted in January 2012. The authors sought to evaluate the utility of this protocol given the apparently limited amount of data to support such a practice.

METHODS

A 12-month prospective observational study conducted at a community hospital evaluating a 24-month observation protocol for patients presenting after a minor head injury. During this study period, a sample of minor head injury patients were identified and followed through their hospital course. CT scan results were also compiled, and patient charts were reviewed at 30 days for any return visits or post-injury complications.

RESULTS

A total of 51 patients were enrolled during the study period. Of those patients receiving a repeat head CT, none showed any evidence of a new or worsening intracranial bleed, with all patients discharged safely from the hospital. At 30 days, patients’ charts were reviewed to examine whether any patients had returned to the hospital for any reason. No sample patients returned to the hospital within the 30-day review period.

CONCLUSION

Similar to the results of the retrospective chart review, no sample patients with minor head injuries showed any evidence of a subsequent delayed intracranial bleed during the 12-month study period. Our study results suggest that 24-hour observation protocols with costly repeat CT head scans may not be useful in the management of most head trauma patients. Patients may be better served to be discharged home with education including signs of symptoms of a worsening bleed (i.e., confusion, worsening headaches and not feeling right) that actually warrant a return to the hospital.
A Rarer Case of Spontaneous Coronary Artery Dissection causing Acute Coronary Syndrome in a Puerperal Woman: Case Report
Authors: Asfar Milad
Published: February 2021

Chest pain is one of the most common complaints of patients presenting to the emergency room department. There are many causes of chest pain and providers must always consider acute coronary syndrome (ACS). Spontaneous coronary artery dissection is a very rare cause of ACS but providers must consider this possibility in younger patients without risk factors or a history of coronary artery disease. This rare phenomenon is commonly associated with pregnant women or those in the postpartum period. This is a case report study describing a classic scenario of a postpartum female in her early 30s who presented with spontaneous coronary artery dissection. Providers obtained the usual tests of an electrocardiogram (EKG) and blood work. She then had a heart catheterization performed. The patient was conservatively managed through use of medications without any use of invasive measures. The patient also had other images of the chest taken to rule out other causes of chest pain such as pneumothorax and pulmonary embolism. There were EKG changes noted, as well elevated troponin levels suggestive of heart damage. The heart catheterization results showed coronary artery dissection involving the artery that correlated with the EKG changes. Spontaneous coronary artery dissection is a rare phenomenon that can present as ACS. Pregnant and postpartum women are at higher risk to develop this condition. It is essential to consider this condition along with other causes of chest pain.
Utilizing PDSA Cycle in Implementing a Chest Pain Accelerated Diagnostic Protocol
Authors: Breckner Gretchen , Walker Jennifer , Hanley Karen , Butki Nikolai
Published: February 2021

CONTEXT

The authors in the Emergency Department (ED) at McLaren Oakland utilized the Plan-Do-Study-Act (PDSA) model to implement, evaluate and incrementally modify a Chest Pain Accelerated Diagnostic Protocol (CPADP) using the History, EKG, Age, Risk Factors, Troponin (HEART) Score at their institution. The objective of this study was to evaluate the ability of patients who presented to the ED with chest pain and fell into the low risk category based on their HEART Score to receive adequate outpatient follow-up for their chest pain.

METHODS

Modifying protocols implemented at other institutions, in 2016 the authors developed CP-ADP utilizing the HEART Score to risk-stratify patients presenting to the ED with chest pain as low, moderate or high risk for major adverse cardiac events (MACE). Patients identified as low risk were offered the options of hospital observation or being discharged home with outpatient follow-up within seven days. Patients who were risk-stratified into the medium or high risk for MACE were admitted into the in-patient setting for cardiac evaluation. Once implemented, the protocol was evaluated to measure patient follow-up within thirty days.

RESULTS

During a five-month period, 50 patients presenting to the ED with chest pain were risk-stratified as low risk for adverse cardiac events and opted for discharge from the ED to follow-up in the outpatient setting. A total of 18 patients were lost to follow up, and two patients subsequently returned to the ED for further evaluation of their chest pain and were admitted to the inpatient setting. These two patients were not included in the analysis. Thirty patients were successfully contacted by telephone 30 days postdischarge. Of those 30 patients contacted, none experienced any MACE events. However, only 14 (47%) low risk patients followed up with a primary care provider or cardiologist and only four (13%) received provocative cardiac testing (i.e., stress testing).

CONCLUSIONS

Only 47% of patients discharged from the ED received outpatient follow-up and only 13% received cardiac testing. As a result of the study, the multi-disciplinary Chest Pain Committee has progressed to the Act ‘A’ step of the PDSA cycle to modify the authors’ protocol to ensure more clinically appropriate outpatient follow-up for patients discharged under the CP-ADP.
Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak
Authors: Allen Aubrey , Wynberg Jason , Walton Eric
Published: February 2021

CONTEXT

Radical prostatectomy (RP) is a major oncologic urological surgery that can have high morbidity if complications arise. Bladder-urethral urine anastomotic leaks (AL) are one of the most common complications and can greatly increase morbidity. To date, there are few resources to manage AL. One management technique is using a Foley catheter with an additional auxiliary drainage port, also known as a fenestrated catheter. This type of auxiliary drainage port allows a low-pressure drainage source that is located near the anastomosis to increase urine drainage from catheter rather than from the AL site. The optimal size and location of this additional drainage port is currently unknown. This experiment evaluated the optimal auxiliary drainage port size and an inexpensive technique to easily construct such a catheter.

METHODS

Utilizing different size punch biopsies, auxiliary drainage ports were placed in different size Foley catheters and drainage rates and the structural integrity of the catheter was assessed.

RESULTS

A 3.0 mm punch biopsy located 1.0 cm proximal to the Foley balloon in an 18 French (Fr) catheter was determined to be the optimal size. A 2.0 mm punch biopsy provided significantly less drainage. The 4.0 mm punch biopsy compromised the structural integrity of the catheter.

CONCLUSIONS

Based on these experimental results, we recommend using a 3.0 mm punch biopsy in an 18 Fr catheter 1.0 cm. proximal to the balloon for an auxiliary drain site in Foley catheter when the anastomosis is not watertight or the surgeon has reason to believe the patient is at higher risk for an AL Factors such as history of pelvic radiation, abnormal anatomy, large prostate, post-surgical hematoma formation, obesity, previous prostatic surgery, difficult anastomosis, blood loss and postoperative urinary tract infection may make use of this type of device more attractive.