bluuebunny/crossref_metadata_2025 huggingface dataset:
KEJADIAN ASFIKSIA PADA KETUBAN PECAH DINI DI RUANG NICU RSUD KABUPATEN BULELENG
Authors: Hartaningrum Putu Intan , Wulandari Ni Ketut Ayu
Published: June 2021

Pendahuluan: Beberapa faktor telah diteliti sebagai penyebab asfiksia pada bayi baru lahir diantaranya asfiksia yang disebabkan karena ketuban pecah dini. Hal ini tidak terlepas dari pemantauan apgar skor yang dilakukan di ruang NICU RSUD Kabupaten Buleleng. Setiap ibu yang melahirkan yang memiliki riwayat obetetri yang baik dan buruk saat bayinya lahir akan memiliki nilai apgar skor yang berbeda. Adapun tujuan dari penelitian ini adalah untuk mengetahuai kejadian asfiksia pada ketuban pecah dini di ruang NICU RSUD Kabupaten Buleleng.  Metode: Jenis penelitian ini retrospektif deskriptif. Hasil: Hasil penelitian menunjukkan bahwa 189 kejadian asfiksia yang disebabkan oleh ketuban pecah dini dengan tingkat asfiksia didapatkan bayi yang mengalami asfiksia  ringan sebanyak 43 (22,8) bayi dan pada asfiksia sedang sebanyak 134 (70,9) bayi. Dan bayi yang mengalami asfiksia berat sebanyak 12 (6,3) bayi. Kesimpulan dari penelitian yang dilakukan masih banyak kejadian asfiksi yang disebabkan oleh ketuban pecah dini di ruang NICU RSUD Kabupaten Buleleng tahun 2018
Vesti la Giubba! Indumentaria, apariencia y comhunicación en la entrada triunfal de Alfonso el Magnánimo en Nápoles (1443)
Authors: García Marsilla Juan Vicente
Published: June 2021

La entrada triunfal de Alfonso el Magnánimo en Nápoles el 26 de febrero de 1443 es uno de esos momentos de la Historia que quedaron marcados para la posteridad, no solo por la importancia del hecho en sí, sino por todo el despliegue de mensajes en clave simbólica que en ese acto se llegaron a emitir. Analizado por diversos autores desde diferentes puntos de vista, se ha abordado bastante menos hasta la fecha una interpretación de los códigos implícitos en la indumentaria de quienes participaron en la ceremonia, que aquí se ha tratado de realizar en base a las variadas fuentes que la describieron y de los nuevos conocimientos que la historia del vestido pone hoy a nuestra disposición.
Algunas reflexiones sobre los ordenamientos de moneda en Castilla (1296-1335). Beneficios y beneficiarios de su lectura interesada y del uso de información privilegiada
Authors: Oliva Manso Gonzalo
Published: June 2021

Desde la segunda mitad del siglo XIII, las cecas europeas estuvieron inmersas en una creciente actividad. Estas instituciones, hasta entonces fugaces, se convirtieron en establecimiento permanentes. Sus operarios alcanzaron un elevado nivel profesional mientras los maestros aprendieron a leer entre líneas los ordenamientos de moneda para incrementar sus beneficios. Con la expresión francesa chatouiller le remède se hace referencia a la acuñación por las cecas de series de monedas ajustadas a los valores más débiles permitidos por la ley. En este trabajo exploramos la posibilidad del uso de esta técnica en Castilla durante el siglo XIV. Paralelamente comprobamos como los arrendadores de las cecas supieron relacionar la información de las nuevas emisiones monetarias con otras actividades mercantiles, puramente especulativas, que resultaron muy lucrativas para ellos y perniciosas para la economía.
La capacidad bélica de las órdenes militares con implantación hispana. Valoración y matizaciones
Authors: Palacios Ontalva J. Santiago
Published: June 2021

Las órdenes militares hispanas, a pesar de su modesta contribución numérica, tuvieron un indudable protagonismo en la guerra fronteriza contra el islam, y cada vez son más los estudios dedicados exclusivamente a tratar esta función esencial. Sin embargo, existen algunos presupuestos sobre su capacidad militar que conviene matizar y complejizar. Este trabajo busca analizar la cualificación militar de los ejércitos de las órdenes, para determinar si tuvieron específicas capacidades operativas, cuál fue su eficacia real en el combate y qué imagen positiva proyectaron en torno a su papel en la materialización de la ideología de la reconquista.
Complexidade da cultura escolar: elementos dialogicos na prática educativa
Authors: Santos da Conceição Victor Julierme , Molina Neto Vicente , Krug Hugo Norberto
Published: June 2021

Objetivamos compreender os elementos produzidos nas relações entre as culturas escolares e o desenvolvimento docente dos professores de Educação Física iniciantes na carreira na Rede Municipal de Ensino de Porto Alegre- RS. Realizamos uma etnografia educacional crítica em duas escolas, onde emergiram duas grandes categorias analíticas: “Imprinting” cultural: choque cultural sobre realidades opostas no mundo da docência; Rotinização da vida cotidiana na escola: Debates sobre Perspectivas e compreensões sobre a escola e a educação. Concluímos que as marcas culturais, em diferentes situações de ensino, contribuem para os professores demarcarem condutas e rotinas no início da docência.
Relações entre gordofobia e teoria Histórico-Cultural
Authors: Cruz da Silva Souza Valdelice , Peres Gonçalves Josiane
Published: June 2021

Ao observar o desenvolvimento da humanidade, é possível notar as diferentes configurações atribuídas ao corpo humano que ocorreram de maneira contraditória, isso é, outrora o corpo gordo foi considerado sinônimo de riqueza e fartura, atualmente é tido como deformidade, feio e repugnante. Destarte, a partir dessa afirmativa, o objetivo desse escrito consiste em analisar criticamente o fenômeno gordofobia segundo a perspectiva da Teoria Histórico-Cutural, bem como destacar sua ação coerciva na vida dos indivíduos, principalmente entre os pré-adolescentes em âmbito escolar. Assim, a pesquisa se pauta numa perspectiva bibliográfica, norteada por autores que discutem o assunto. Os resultados evidenciam que a gordofobia é internalizada socialmente como signos e ocorre em vários campos sociais, como escolar, profissional e econômico, sendo divulgados constantemente pela mídia. Evidencia-se ainda que o preconceito seja maior em relação às mulheres, o que torna essencial as discussões de gênero relacionado à gordofobia.
Resolução de Problemas como metodologia para o ensino de Matemática nos anos iniciais
Authors: Cardoso Márcia Regina Gonçalves , De Oliveira Guilherme Saramago
Published: June 2021

A presente investigação é parte de uma pesquisa de doutoramento que buscou investigar a Resolução de Problemas como campo de pesquisa e sua aplicação ao ensino de Matemática. Esse estudo foi norteado pela busca de resposta ao seguinte questionamento: como é concebida a Resolução de Problemas nos documentos orientadores para o ensino de Matemática do MEC[1] e nos livros didáticos de Matemática utilizados pelas escolas públicas nos anos iniciais do Ensino Fundamental? A hipótese é a de que as orientações para o ensino de Matemática nos anos iniciais, através dos PCN[2], não sejam efetivamente observadas, na elaboração de livros didáticos. Diante dessa questão, buscou-se analisar se há uma discordância quanto ao tratamento dado à Resolução de Problemas nas orientações oficiais do MEC (através dos PCN) e a concepção efetivamente presente nos materiais didáticos distribuídos pelo FNDE[3]. De forma específica, buscou-se ainda: (1) Examinar as orientações metodológicas do MEC/PCN para o ensino de Matemática; (2) conhecer as diferentes perspectivas sobre Resolução de Problemas; (3) pesquisar as diferenças entre exercícios e problemas; (4) identificar os principais tipos de problemas; (5) identificar como a Resolução de Problemas é abordada nos livros didáticos de Matemática fornecidos pelo FNDE; (5) confrontar os dados resultantes da pesquisa. O estudo foi teórico-bibliográfico, de natureza qualitativa, com foco na Resolução de Problemas como metodologia de ensino de Matemática. A pesquisa demonstrou que a Resolução de Problemas como metodologia de ensino para o ensino de Matemática, oficialmente adotada pelo MEC/PCN, não é efetivamente compreendida e observada na elaboração dos livros didáticos.
Ensino da arquitetura funcional da memória, ilusões, mitos e técnicas para um aprendizado efetivo:
Authors: De Oliveira Thiago Borges
Published: June 2021

Apesar de passar-se grande parte da vida estudando, pouquíssima ou quase nenhuma parte dos anos de estudo é dedicada ao ensino do como estudar de forma eficaz. Espera-­se, por meio do ensino e avaliação dos vários outros conceitos e competências, que a prática constante de estudo, por si própria, seja capaz de habilitar o indivíduo a aprender de forma eficaz. Seria ‘saber aprender’ uma competência inata dos indivíduos? E a prática do estudo um processo capaz de desenvolvê-­la em seu completo potencial? Teriam os ingressantes da graduação maturado esta competência a ponto de não ser necessário avaliar o seu domínio? A avaliação do aprendizado das demais competências – línguas, matemática, ciência e suas tecnologias – seria suficiente para atestar a habilidade de aprender do estudante? Afinal, a graduação e, posteriormente, a pós­graduação, constituirão os anos de estudo mais intensos da vida e quando mais se necessitará de um domínio completo de técnicas eficazes de aprendizagem. Na direção das respostas para estas perguntas, apresenta­se aqui uma pesquisa de finalidade básica, com estudo exploratório, de natureza quasi­qualitativa e delineamento de pesquisa documental, com resultados científicos sobre as peculiaridades do aprendizado e memória humanos. Destaca-­se o quão iludidos estão os estudantes, em geral, em relação a sua habilidade de aprender e à eficácia das técnicas que usam durante o estudo. Esclarecendo alguns mitos e ilusões à luz de resultados científicos e apresentando técnicas mais efetivas – como o conceito de dificuldades desejadas, intercalação, testes distribuídos, aptidão e desenvolvimento da criatividade – tem-­se o objetivo de conscientizar os estudantes dos resultados da ciência a este respeito e fomentar a potencialização do aprendizado de longo prazo.
Palavra-chave: Autoaprendizagem. Ilusões e Mitos de Aprendizado. Técnicas de Aprendizado Eficazes.
Weder Attentat noch Zensur
Authors: Bertschi Manuel
Published: June 2021

Nach Ansicht des Autors hat die von der ständerätlichen Rechtskommission vorgeschlagene Änderung von Artikel 266 ZPO eine einseitige und unsachliche Debatte ausgelöst. Das von Schwaibold monierte «Attentat auf die Meinungsfreiheit» sei ebenso verfehlt wie der Vorwurf der «Zensur». Vorsorglichen Rechtsschutz gegen Medienberichte zu erhalten, sei in der Schweiz sehr schwierig. Der Autor hält den von der ständerätlichen Rechtskommission bezweckten Machtausgleich zwischen Medien und Medienbetroffenen grundsätzlich für begrüssenswert, schlägt aber andere Handlungsmöglichkeiten vor.
A Comparative study to observe the effect of Meditation in Hypertension
Authors: Kolarkar Rajesh , Kolarkar Rajashree
Published: June 2021

Primary objective was to evaluate and compare the change or reduction in systolic and diastolic blood pressure (BP) in sitting position from baseline (week 0) to the end point (Week 12) between two groups, to evaluate and compare the change or reduction in Stress value between two groups and Secondary Objective was to observe and compare change in lipid profiles between two groups. Methods: In a comparative interventional study Group A 30 patients of hypertension of male and female were given training in relaxation and meditation. Study was performed in YMT Ayurvedic Medical College and Smt. K.G. Mittal college and Sanjivani Ayurvedic centre Mumbai.The study was conducted on 30 patients including both male and female practicing daily meditation for 12 weeks to observe effect of meditation in hypertension. This showed an overall reduction of systolic and diastolic blood pressure.
THE ROLE OF GUGGUL DHUP IN THE MANAGEMENT OF OTITIS MEDIA ( KARNASTRAVA) A CASE REPORT
Authors: Dhate Rajendra Haribhau
Published: June 2021

There is availability of number of higher antibiotics, still there is challenge to treat middle ear infection and so its recurrence mostly occurs. Sushrut has already described the treatment of Karnastrava, Putikarna and Krimikarna.2Today every persons lifestyle is changed with food habbit, working hours, type of work & pollution etc., these factors are responsible forupper respiratory tract infections which leads to otitis media ( Karnastrava)1. Sushrut has described the treatment for Karnastrava is guggule dhupan 4. As the guggule is â€˜ushnaâ€™ acts â€˜vatshamak,â€™ due to â€˜tikshna, ushna gun, kaph shamak5. Guggule is also shothhar, Jantughna, Vranashodhan, vranaropan and vednasthapan5, it is used in kaph wat rogâ€™. Dhup of guggule can easily reaches at affected area. This properties of guggule is useful in the management karnastrava.So, here I present a case where a chronic otitis media (KARNASTRAVA) is treated withâ€™ guggule dhup.â€™
Inhibiting in function of Gene in sickle Cell Disease
Authors: Nandeshwar Ashay Harish
Published: June 2021

I was much struck with the fact that Sickle-Cell Disease and most of the genetic diseases are incurable. The knowledge I gained about base substitution mutation in DNA and the Human Genome Project, showed me light to the possibility of a cure to the disease. Stem Cell Therapy was the first thing that came into my mind, while thinking of a cure to SCD. Eventually I found that researches about using stem cell therapy for curing SCD were already being carried in various academic and research institutions across the globe. As a result, bone marrow transplant became a ray of hope for the sufferers of the disorder; but still, the scientists and doctors would assert the non-existence of a definite cure to the disease
The role of intellectual capital as a mediation of relationship between audit committee and real earnings management
Authors: Istanti Sri Layla Wahyu , Chariri Anis , Juliarto Agung
Published: June 2021

This study aims to examine the role of human capital, which is part of intellectual capital, as a mediator in the relationship between audit committee expertise and the number of audit committee meetings with real earnings management. This research is a quantitative study. The data source used is data from manufacturing companies in Indonesia. The sample selection technique used purposive sampling. The analysis technique uses path analysis. The results showed that the expertise of the audit committee had a significant effect on human capital, while the number of audit meetings had no effect on human capital. The results of this study also state that audit committee expertise, number of audit committee meetings and human capital performance have no effect on real earnings management actions. Furthermore, there is empirical evidence that shows that human capital has a mediating effect on the relationship between audit committee expertise and the number of audit committee meetings with real earnings management. The role of human capital in the relationship between the expertise of the audit committee and the number of audit committee meetings becomes originality, so it is the main contribution of research. The limitation of this research is that it only uses human capital as a mediating variable.
The role of corporate governance in earnings persistence: Audit committee as a moderation variable
Authors: Agustina Heni , Elfita Rizki Amalia , Soelistya Djoko , Muttaqiin Ninnasi , Mochklas Mochamad
Published: June 2021

During the current Covid-19 pandemic, it is undeniable that many companies are experiencing a decline in turnover, and some companies have even been forced to go out of business. Due to the many fraud incidents, corporate governance is vital in ensuring earnings persistence by considering many audit committee structures. Based on this phenomenon, the purpose of this study is to determine how significant the role of corporate governance is in overcoming earnings persistence moderated by the number of audit committees. This study is quantitative descriptive with a population of all companies listed on the Indonesia Stock Index (IDX), and the number of samples with several criteria found as many as six companies. This research period was conducted from 2011-2019. This result implies a positive influence on corporate governance moderated by the audit committee on earnings persistence. This led to point out that the power of corporate governance has a positive effect on earnings persistence.
Determinants of business performance of the firms: A case of the construction listed enterprises in Vietnam Stock Market
Authors: Xuan Vu Ngoc
Published: June 2021

This research aims to investigate the determinants of business performance in Vietnam small and medium sized firms. The study employs a sample of 100 construction-listed enterprises in the Vietnam Stock Market. The author collects data on time series of October 2020 based on the financial statement and annual reports of the Vietnam construction listed companies. The survey data are collected by email and internet sources. This study also identifies the factors that affect the business performance enterprises in Vietnam. The author processed data via STATA 14.0 and SPSS 20.0 software. The research results indicate that (1) government support policies, (2) education level of enterprises owner, (3) enterprises scale, (4) society relationships of enterprises and (5) revenue growth rate affect the business performance of construction- listed enterprises in Vietnam. In addition, the government support policies, education level of enterprises owner, enterprises scale, society relationships of enterprises and revenue growth rate have positive impact on business performance of the Vietnam Construction Listed Companies. In which, education level of enterprises owner and government support policies have mostly positive impacts on business performance. The findings of this study also suggest that the education level of enterprise owners is the highest impact to business performance of the construction- listed firm in Vietnam.
Can Islamic banking revive Somalia’s ailing economy?
Authors: Warsame Mohammed Hersi , Abdalla Yousif Abdelbagi , Lasyoud Alhashmi Aboubaker
Published: June 2021

The study aims to evaluate the Islamic banking prospects in Somalia and the role it can play in reviving the country’s ailing economy. Somalis were recruited through purposive sampling techniques. Structural equation modeling (SEM) has been adopted to analyze the data collected using SmartPLS. The findings have shown a negative and insignificant impact of absence of a functioning financial system, lack of funding and expertise, and effect of bank absence on businesses. Financial and political infrastructure significantly affected the Islamic banking system of Somalia. Law and order measures show a significant impact on suitability of banking and financial systems of Somalia. Sharia compliant finance shows a positive but insignificant impact on Islamic banking in Somalia. Standalone new banks in Somalia have fewer chances of success due to the absence of personnel with the necessary skills and qualifications.
Financial development in Jordan: Where do remittances play a role in bank credit?
Authors: Yaseen Hadeel , Omet Ghassan
Published: June 2021

The Jordanian economy has been a recipient of huge amounts of remittances. Indeed, for more than a decade now, the inflow of this capital has been fluctuating around 10 percent of Gross Domestic Product (GDP). Within this context, the subject matter of remittances has resulted in the development of a myriad of research issues. One of these issues is the impact of remittances on financial development or bank credit to the private sector. This paper looks at the relationship between financial development and remittances in the Jordanian context. Based on the time period 1992-2019, and time series econometric techniques (co-integration and vector auto-regression, among others), this paper examines the impact of remittances on bank credit to the private sector, and on its main sectoral distributions. The estimated results reveal some interesting findings. There is no long-run stable relationship between bank credit to the private sector and remittances. However, there is a stable long-run relationship between credit to individuals (households) and remittances, and between credit to the construction sector and remittances. These conclusions imply that remittances, on average, promote private consumption in general, and residential spending.
The role of logistics industry in the sustainable economic development of Southeast Asian countries
Authors: Nguyen Hong Anh Thi
Published: June 2021

The purpose of this study is to determine the role of the logistics industry in the sustainable economic development in the context of Southeast Asian countries. This study is quantitative in nature where the data are gathered from the secondary sources. The analysis is carried out with the help of correlation, feasible generalized least square model (FGLS). The outcome of this study confirms the significant impact of LPI on GDP growth, CO2 emission and current health expenditure. Similarly, the significant impact of FDI is found on all the dependent variables of this study. In contrast, the variable of TOP is found to have a significant impact on both CO2 emission and current health expenditure, whereas it makes an insignificant impact on GDP growth. The absence of qualitative data is one of the major limitations of this study. Apart from that, the limited scope of this research on Southeast Asian countries is another limitation.
Determinants of personal tax compliance
Authors: Subadriyah Subadriyah , Harto Puji
Published: June 2021

The largest state revenue comes from taxes. Even though the number of taxpayers is increasing from year to year, the tax revenue in Indonesia is still relatively low, since taxpayer compliance is still low. This study aims to determine the factors that influence individual taxpayer compliance in paying taxes at Jepara, Indonesia. The study uses a quantitative approach with a population of individual taxpayers who are registered at the tax office of Jepara, Indonesia. The number of samples is obtained by 100 respondents using the Slovin formula. The sampling technique was a convenience sampling technique. The data analysis method used is multiple regression analysis and Moderated Regression Analysis (MRA). Based on the test, it is found that the quality of tax authorities service, understanding and knowledge of taxation, tax sanctions, tax socialization, taxpayer awareness and perceptions of tax effectiveness have an influence on taxpayer compliance. In addition, the employment status of Civil Servants is more compliant in paying taxes since their income tax has been routinely deducted by the employer on the paid income.
ANALISIS FAKTOR – FAKTOR YANG MEMPENGARUHI HARGA SAHAM (STUDI EMPIRIS PADA PERUSAHAAN YANG TERDAFTAR DI LQ 45-BEI TAHUN 2016-2018)
Authors: Fathihani Fathihani
Published: June 2021

Penelitian ini bertujuan untuk menganalisis faktor-faktor yang mempengaruhi harga saham. Populasi dari penelitian ini adalah semua perusahaan yang pernah terdaftar di LQ-45 Bursa Efek Indonesia pada periode penelitian tahun 2016-2018. Indeks LQ45 sebagai salah satu indikator indeks saham di BEI dapat dijadikan acuan sebagai bahan untuk menilai kinerja perdagangan saham. Penelitian ini menggunakan data sekunder berupa laporan keuangan tahunan yang diperoleh dari Bursa Efek Indonesia. Teknik pengambilan sampel diambil dengan metode purposive sampling sebanyak 24 perusahaan. Analisis data yang digunakan yaitu regresi linier berganda. Target khusus yang ingin dicapai adalah pembuktian mengenai hipotesis dengan kesesuaian antara teori yang ada dengan fakta yang terjadi sesungguhnya. Menjadikan hasil penelitian sebagai kajian studi kasus perusahaan untuk diimplementasikan dalam mata kuliah dibidang ekonomi khususnya ilmu manajemen.
An unusual cause of psoas abscess
Authors:   Department of Surgery, Blackpool Victoria Hospital, Choudhury A K , Bhatia Praveen ,   Department of Respiratory Medicine, Blackpool Victoria Hospital
Published: June 2021

This case study reports an uncommon cause of psoas abscess, a complication of pancreatic pseudocyst in a 75 years old man. A few other causes of psoas abscess and some complications of pancreatic pseudocyst are touched upon in this report,and management options in the treatment of pancreatic pseudocysts have been enumerated.
Acute Medicine – a new era?
Authors:   Acute Medicine, Lothian University Hospitals NHS Trust / Society for Acute Medicine, Bell Derek
Published: June 2021

Acute Medicine is a hot topic which has been discussed extensively throughout the United Kingdom over the last decade. However, recent developments demonstrate a move from discussion to action, with an increasing number of Consultant appointments in Acute Medicine, the development of the Society for Acute Medicine (UK) and, more recently, discussions within the JCHMT to develop Acute Medicine as a subspecialty of General (Internal) Medicine. This latter step is very significant as we may soon be in the position to develop training programmes for Specialty Registrars in Acute Medicine which will ultimately ensure that they have the appropriate clinical and organisational skills to support the delivery of emergency care.
Delirium (acute toxic confusion) in the elderly
Authors:   Department of Medicine for Elderly People, Queen Alexandra Hospital, Portsmouth, Spice Claire , Bacon Michael ,   Department of Medicine for Elderly People, Queen Alexandra Hospital, Portsmouth
Published: June 2021

Delirium (also referred to as acute confusional state or toxic confusional state) is common in elderly patients admitted to hospital, and is usually secondary to an acute physical problem rather than being a primary abnormality. Physicians caring for acutely ill patients will frequently encounter those with delirium and need to be aware of the likely precipitants as well as the optimum management. We discuss the common precipitants, the clinical features, the differential diagnosis and the management of delirium.
Essential Guide to Acute Care
Authors: Cramp Paul , Cooper Nicola ,   Derby Hospitals NHS Foundation Trust, Division of Medical Sciences / Graduate Entry Medicine, University of Nottingham UK
Published: June 2021

At last! A book that addresses the needs of every junior doctor faced with the management of acutely sick patients. Concise and readable, its format allows the reader to absorb the principles of human physiology, and to apply them to everyday situations involving critically ill patients. With each chapter being dedicated to a separate physiological ‘insult’, Cooper and Cramp open with a brief outline of what happens under ‘normal’conditions. This is followed by a summary of how physiology adapts under disease conditions. In this way the authors cover oxygen therapy, acid base disturbance,fluid balance, circulatory failure, sepsis, acute renal failure and coma. There are also chapters on identifying the patient at risk, and optimising physiology in the preoperative patient. With a distinct ‘anaesthetic slant’, the layout and emphasis are different to that with which most physicians will be familiar. This is however to its advantage, as it effectively bridges the traditional gap between medicine and critical care. Unlike many texts, the authors have ignored the minutiae and have concentrated on the most relevant and applicable information. Well illustrated throughout, the reader is guided towards establishing a logical approach to the ill patient. With self-test questions relevant to each chapter, it becomes a valuable learning tool. ‘Mini- tutorials’ in each chapter highlight controversies, such as the relative merits of crystalloid versus colloid in f luid resuscitation, or the use of sodium bicarbonate in the treatment of metabolic acidosis. The size of the book lends itself well to being carried in the white coat pocket. However the layout of the text makes it more suited to evening reading, rather than as a bedside reference. Some algorithms summarising the key points of each chapter might have added to the practical uses of the text. Although this book will not help in passing the MRCP examination, it will hopefully make its readers into safer, better clinicians. If you ’ve ever been faced with a sick patient, a blank mind and a room full of expectant faces, then this is the book for you. Dr Stuart Henderson Specialist Registrar in Medicine Southampton University Hospitals NHS Trust
Management of Pleural Effusions in Acute Medical Settings: a practical guide
Authors:   Wellcome Trust Centre for Human Genetics, Oxford, U.K., Lee Y C Gary , Davies R J O ,   Oxford Pleural Disease Unit, Oxford Centre for Respiratory Medicine Oxford Radcliffe Hospital Oxford, U.K.
Published: June 2021

In the setting of acute medical care, pleural effusions are often overlooked. This article aims to provide a practical guide for the initial workup of pleural effusions and the management of common types of effusions.
The Dix-Hallpike and Modified Epley Manoeuvres in the diagnosis and management of Benign Paroxysmal Positional Vertigo (BPPV)
Authors:   Department of Medicine Southampton University Hospital NHS Trust Tremona Road Southampton SO16 6YD, Clarke Matthew , Stallworthy Liz ,   Department of Medicine Southampton University Hospital NHS Trust Tremona Road Southampton SO16 6YD, Dulay J ,   Southampton University Hospitals NHS Trust Tremona Road Southampton SO16 6YD
Published: June 2021

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common balance disorders and one of the easiest to diagnose and treat. It is characterised by short lived episodes of vertigo and geotropic rotatory nystagmus, which occur a few seconds after rapid changes in head position. The vertigo usually lasts no more than a minute and the symptoms reduce in severity with repetitions of the evoking movement.
Controversies in acute medicine: Oxygen therapy for exacerbations of chronic obstructive pulmonary disease (COPD)
Authors:   Acute Medicine, Leeds Teaching Hospitals, Cooper Nicola
Published: June 2021

Some patients with COPD ‘retain CO2’ when given high concentration or uncontrolled oxygen therapy. The mechanism for this, and why it occurs in only some patients, is unclear. The pathogenesis of chronic hypercapnia in COPD involves multiple, poorly understood mechanisms. During acute exacerbations ‘CO2 retention’ is thought to occur due to redistribution in ventilation-perfusion with oxygen therapy, although some studies suggest reduced ventilation also contributes. Problems arise when inexperienced staff extrapolate this teaching to include all patients with hypercapnia. The most common cause of hypercapnia is ventilatory failure. Teachers need to emphasise how to recognise ventilatory failure and the dangers of hypoxaemia in critically ill patients.
Conference Report: The Society for Acute Medicine Spring Meeting – April 22nd to 23rd 2004
Authors:   Department of Acute Medicine, Worthing Hospital, Worthing, UK, Duckitt Roger
Published: June 2021

For this year’s spring meeting, the Society for Acute Medicine took us to Bournemouth on the sunny south coast of England. The Marsham Court Hotel served as an excellent venue for this, the ninth meeting of the society, which ran for two days over the 22nd and 23rd of April. Sunshine, the grand Pier and long stretches of raked beach augmented a relaxed and friendly atmosphere and provided a spectacular backdrop for coffee breaks between sessions.
Editorial
Authors:   Southampton Foundation Trust, Roseveare Chris
Published: June 2021

While the profile of the subspecialty of Acute Medicine continues to rise, so does the burden of work under which we are continually placed. Changes in General Practice out-of-hours cover, reduced junior doctor hours, continued pressure to achieve four hour A&E wait targets along with the arrival of yet another winter will be familiar themes for many readers. There are times when it may seem difficult to stay positive in the face of such adversity. In these moments of despair, I have recently taken to reading our ward admissions list in search of light relief. This list, compiled by non-clinical staff, describes the problems which doctors referring patients to the AMU ascribe to their patients. ‘COPD Exasperation’ appears to be a common problem (not least amongst the junior medical staff), while I hope that the patient admitted with ‘aspirations of pneumonia’ wasn’t too disappointed by his final diagnosis. A patient with Wegener’s granulomatosis was admitted several times with ‘acute f lare-up of vagueness’, an aff liction with which many of us will be familiar. My favourite, however, remains the unfortunate patient described as ‘Bilateral amputee – off legs’; things clearly could not get much worse for this man! If your own search for light relief leads you to browse through the following pages you will find more useful reviews, case reports and the second in our ‘Controversies in acute medicine’ series. This time Guha and Sheron tackle the issue of f luid resuscitation in chronic liver disease, an area which is frequently a source of considerable confusion. I have only ever treated one patient with thyroid storm, sadly without a favourable outcome; Ben Turner’s overview of the management of this rare condition will hopefully equip readers to deal with the consequences, should you ever be faced with such a problem. At the other end of the pulse-rate spectrum, bradyarrhythmias are a more familiar on-take emergency. In part one of a series of reviews on arrhythmias to be published over the next few editions, this subject is tackled in some detail. Diarrhoea and Cardiac Arrest have both been areas traditionally avoided by consultant physicians. In these days of the ‘hands-on’ consultant (preferably gloved!), I would urge colleagues to be prepared for such eventualities by taking note of our final two reviews. I am pleased to report that my continued pleas for submissions has resulted in more than a trickle of case reports, which has enabled us to publish two ‘Cases to remember’ in this edition. More on a similar theme would be most welcome. Mike Jones, originally brought into the editorial board for his renal expertise, wears his hat as Secretary of the SAC in General Internal Medicine to give an insight into Training developments in Acute Medicine in Viewpoint. Submissions for this section would again be welcomed. I hope you enjoy this edition, and that you continue to find the journal helpful in your everyday practice and personal CPD into the New Year.
Acute Urinary Tract Infections
Authors:   Acute Medicine Ninewells Hospital 35 Listen Place Dundee DD2 1UX, Chaudhuri Arun
Published: June 2021

Urinary tract infections remain a significant cause of morbidity throughout the globe. Proper understanding of the disease is extremely important for appropriate management. Recent studies have helped to define the population groups at risk for these infections, as well as the most cost-effective management strategies. This article will discuss aspects of initial diagnosis and subsequent management of different high risk groups.
Picture Quiz: An unusual cause of headache
Authors:   Hull Royal Infirmary Anlaby Rd Hull, HU3 2JZ, Shukla Satyen , Anand V ,   Hull and East Yorkshire Hospitals NHS Trust
Published: June 2021

A sixty-six year old lady was admitted after describing two ‘vacant’ episodes with collapse. She had also complained of chronic fronto-occipital headache and more than 10kg weight loss over the preceding three month period. She denied any gastrointestinal, respiratory or cardiac symptoms. She was a non-smoker and did not drink alcohol regularly. She had a past history of hypertension and hypothyroidism for which she was taking ramipril and thyroxine. On examination she appeared cachexic, but no other abnormality was detected.
Acute Abdominal Pain for the General Physician – who, when and how to refer to the on-call surgeon
Authors:   Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2DR, Knight John S , Lamparelli Michael J ,   Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2DR
Published: June 2021

Patients with abdominal pain are most frequently referred to the on-call surgical team, but there are occasions when physicians may be required to assess, investigate or treat such patients. This article aims to equip non-surgeons with the skills to undertake an appropriate initial assessment and consider the most appropriate selection, timing and mode of referral to the surgical team.
Picture Quiz (Questions)
Authors:   Department of Medicine Mid Stafford General Hospital Stafford UK, Chatha Hamid Aizaz , Nakash Shaun ,   Department of Medicine Mid Stafford General Hospital Stafford UK
Published: June 2021

A 75-year- old man was referred to hospital with a 24 hour history of severe neck pain, associated with fever, rigors and mild confusion. The pain radiated into his arms and was exacerbated by neck movements. Eight days prior to admission he had developed loose stools for 3 days. There was no history of trauma, and no other features of meningism. He gave a past history of ischemic heart disease and atrial fibrillation for which he was taking warfarin. Examination revealed a pyrexia of 38.3c. There was tenderness over the cervical spine but no other positive findings. Neurological examination was unremarkable.
Cerebrospinal Fluid analysis in Suspected Subarachnoid Haemorrhage
Authors:   Portsmouth Hospitals, Hill Stephen , Pinto Ashwin ,   Portsmouth Hospitals
Published: June 2021

Aneurysmal subarachnoid haemorrhage (SAH) is an acute life-threatening neurological disorder. A delay in diagnosis can lead to substantial and avoidable morbidity and mortality. It is important to identify patients with SAH promptly, to enable specialist referral to neurosurgical centres. This review aims to provide an up-to-date practical guide concerning the interpretation of spinal fluid results in patients with suspected SAH.
A Challenging Case of Malignant Hypercalcaemia
Authors:   Torbay Hospital, Torquay, Evans Kate M , Chong Patric K ,   Derriford Hospital Plymouth
Published: June 2021

The investigation and management of patients presenting with hypercalcaemia is not always straightforward. We describe the case of a middleaged man presenting with severe symptomatic hypercalcaemia. The difficulties encountered here – in striving for biochemical and symptom control, and in establishing a definite diagnosis – are fortunately rare. The case illustrates the range of options in the treatment of severe hypercalcaemia, and highlights the use of haemodialysis in treatmentresistant cases.
Abstracts from the Society for Acute Medicine: Spring meeting
Authors:   Nottingham City Hospital NHS Trust, Sturrock NDC , Bowler SJ ,   Nottingham City Hospital NHS Trust, Sunman W ,   Nottingham City Hospital NHS Trust, Burns A ,   Nottingham City Hospital NHS Trust
Published: June 2021

We have successfully been running with a Consultant presence in day-time (0900-1700) in the admissions area for a number of years. The recent NCEPOD report – an Acute Problem, criticised the lack of Consultant input into care of patients being transferred to Critical care areas out of hours. The DoH Hospital at Night project has suggested extending the normal working day into the twilight shift.
How to Assess Patients Admitted with ‘Falls’
Authors:   Leeds Teaching Hospitals, Cooper Nicola
Published: June 2021

Many Medical Admission Units admit patients who have suffered a fall. Falls are incredibly common, yet often assessed and managed suboptimally in hospitals. Falls may be due to an acute illness, or due to a combination of factors which can be identified and managed in order to reduce the risk of falling in the future. A true ‘mechanical fall’ in an older person is rare.
The Role of Invasive Ventilation in Exacerbations of Chronic Obstructive Pulmonary Disease Causing Respiratory Failure.
Authors:   Brighton and Sussex University Hospital, Kosky Cristopher , Turton Charles ,   Brighton and Sussex University Hospital
Published: June 2021

Acute hypercapnic respiratory failure in chronic obstructive pulmonary disease can usually be managed initially with medical treatment and non- invasive ventilation. In circumstances where non- invasive ventilation cannot be used or has failed, intubation and invasive ventilation may be lifesaving. The outcome of patients with an exacerbation of COPD requiring invasive ventilation is better than often thought, with a hospital survival of 70-89%. Decisions regarding invasive ventilation made by physicians and patients with COPD are unpredictable and vary with the individual. This article reviews the role of invasive ventilation in exacerbations of COPD to assist decision making.
Ecstasy: An Important Cause of Acute Liver Failure
Authors:   Southampton General Hospital, Muddu Ajay Kiran , Wright Mark ,   Southampton General Hospital, Sheron Nick ,   Southampton General Hospital
Published: June 2021

A twenty year old female was referred to hospital by her GP, after he received the results of blood tests taken earlier in the day. She had presented to him complaining of malaise, nausea and anorexia over a 3 day period. On the day of referral she had also become jaundiced with dark urine, but normal stool colour. There was no abdominal pain. She had no significant past medical history with no history of jaundice, liver disease or autoimmune conditions, and no apparent risk factors for blood-borne hepatitis infection. There was no relevant family history. She was taking no prescribed medication, had not taken any over the counter medication or herbal remedies. She denied excessive alcohol use or use of intravenous drugs in the past, although she was not specifically questioned on the use of other recreational drugs. She was a single mother and admitted to being under considerable stress recently. On examination she appeared well, apart from marked jaundice. There were no signs of hepatic encephalopathy or chronic liver disease. Abdominal examination revealed mild left upper quadrant tenderness, but no significant hepatomegaly. Liver function tests (LFTs) taken by her GP are shown in Table 1, revealing marked elevation of the Alanine Transaminase (ALT) (Table 1), with a relatively preserved albumin. Unfortunately her International Normalised Ratio (INR) had not been measured. An Ultrasound of the abdomen demonstrated a normal size liver with normal contour and texture with no other abnormality.
Addison’s Disease Presenting with Abdominal Pain
Authors:   Royal Bournemouth Hospital, Dorset, Desai Tejal , Richardson Tristan ,   Royal Bournemouth Hospital, Dorset
Published: June 2021

Primary Adrenal Insufficiency is due to bilateral destruction of the adrenal cortex and has a prevalence of approximately 40-60 per million adults. 1 The commonest cause is autoimmune. 1 Prompt treatment not only restores quality of life but also a normal life expectancy. 2 Here we present an unusual case of primary adrenal insufficiency, which illustrates how such an important disease often provides a diagnostic conundrum.
Hospital Readmissions: Patient, Carer and Clinician Views
Authors:   Sheffield University, Kirk Elinor , Prasad M K ,   Rotherham General Hospital Moorgate, Abdelhafiz Ahmed H ,   Rotherham General Hospital Moorgate Road Rotherham
Published: June 2021

Aim: To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission. Methods: A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles. Results: Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged ≥75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients ≥ 75 years was noted (7.2% vs 5.1%, p=0.1). Conclusion: Although the majority of discharges are appropriate, up to a third of readmissions may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.
Management of Suspected Avian (H5N1) Influenza in a Non-pandemic Setting
Authors:   John Radcliffe Hospital, Headley Way Headington Oxford OX3 9DU, Esmail Hanif , Aarons Emma ,   Virology University College London Hospitals, London
Published: June 2021

Avian (H5N1) influenza has been responsible for millions of wild bird and poultry deaths throughout the world. Sporadic human cases with a high mortality have occurred, almost exclusively in association with very close contact with sick, dying or dead birds. Appropriate management of suspected cases requires their prompt recognition via attention to travel and bird-exposure history. The early isolation, diagnosis and treatment of suspected cases as well as prompt involvement of the health protection unit should enable patients to be optimally managed with minimum risk to health care staff.
The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide
Authors:   Chelsea & Westminster Hospital 369 Fulham Road London SW10 9NH, Proudfoot Alastair , Bell Derek ,   Northwest London Chelsea and Westminster Hospital Imperial College London Fulham Road London SW10 9NH
Published: June 2021

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.
Picture Quiz: A Case of Sudden Severe Chest Pain
Authors:   Hope Hospital Stott Lane. Salford Manchester M6 8HD, Rabia Mustafa Abu , Sullivan P ,   Hope Hospital. Salford, Stivaros. Stavros M ,   Hope Hospital. Salford
Published: June 2021

An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.
Jaundice, Renal Failure and Pulmonary Haemorrhage in a Canal Boat Owner
Authors:   Great Western Hospital, Swindon SN3 6BB, Lind A , Dawson S ,   Microbiology Department, Great Western Hospital, Swindon SN3 6BB, Cannon Charlotte ,   Swindon Great Western Hospital Swindon SN3 6BB
Published: June 2021

Leptospirosis is a rare notifiable disease with three major clinical manifestations: subclinical disease, a self limiting illness (90% cases) and Weil’s disease, a fulminant, life-threatening condition with renal and hepatic failure, haemorrhagic pneumonitis and cardiovascular collapse. Diagnosis is by the detection of IgM antibodies to leptospira produced 7 to 14 days after the onset of illness. It is important for acute physicians to consider this condition in their initial differential diagnosis since early treatment reduces the severity and duration of symptoms and hospital stay. A history of environmental or occupational exposure to animals or potentially infected water should raise suspicions of leptospirosis. This article aims to remind clinicians of the diagnosis and management of this condition. The typical symptoms and signs are illustrated by a recent case which presented to our department.