bluuebunny/crossref_metadata_2025 huggingface dataset:
PENERAPAN BUDAYA KARO “ARON DAN RUNGGU” OLEH KEPALA RUANGAN DALAM MENINGKATKAN KINERJA DI TIM KEPERAWATAN
Authors: Sari Kartika
Published: October 2019

Abstrak - Peran kepala ruangan dalam meningkatkan kinerja di tim keperawatan sangat menentukan keberhasilan tim dalam memberikan asuhan keperawatan yang berkualitas. Dalam pelaksanaannya di tim keperawatan pasti ada ditemukan masalah baik dari antar perawat,dalam menghadapi pasien dan profesi lain,karena setiap orang mempunyai sifat yang berbeda-beda,cara pandang yang berbeda dan sikap menghadapi masalahpasti berbeda,ada yang emosional,panik,diam,dan lain sebagainya. Disinilah peran kepala ruangan untuk mempengaruhi dan sebagai role model yang patut dicontoh oleh staf perawat dalam tim keperawatan. Kearifan lokal dari Suku Karo dapat diambil yaitu budaya aron dan runggu yang dapat diadopsi dalam pelaksanaannya. Budaya aron yaitu budaya tolong menolong,saling membantu. Kepala ruangan harus dapat membujuk dan mempengaruhi anggota perawatnya dengan sikap role model yang ditunjukkannya,kepala ruangan melibatkan diri dalam pelaksanaan asuhan keperawatan sehingga budaya aron secara otomatis dapat masuk dan diterapkan dalam tim keperawatan. Dalam pengambilan keputusan,peran kepala ruangan juga sangat menentukan keberhasilan dalam pemberian asuhan keperawatan. Kearifan lokal yang dapat diambil adalah runggu. Budaya runggu adalah gaya kepemimpinan demokratis,dimana kepala ruangan selalu memberi kebebasan mengeluarkan pendapat,selalu melibatkan anggota perawat dalam pemecahan masalah,tetapi akhir keputusan selalu berada ditangan kepala ruangan dengan mempertimbangkan segala aspek baik dan buruk. Peran kepala ruangan dan staf perawat membutuhkan sikap profesional yang dapat dilihat dari kemampuannya dalam menerapkan karakteristik sikap CIH’HUY yaitu: Memiliki daya kreatifitas(Creative),Penuh Wawasan (Insight),Kerendahan Hati(Humble),Ramah Tamah(Hospitality),Kesatuan perasaan sebagai kesatuan tim kesehatan(Unity),dan Kebanggaan Akan Layanan Asuhan Keperawatan ( Yes I’m a Nurse). Tujuan dari kajian adalah untuk meningkatkan kinerja dalam tim keperawatan. Metode yang digunakan dengan deskriptif kualitatif untuk mendeskripsikan dan menganalisa bagaimana perubahan yang terjadi dengan menerapkan budaya aron dan runggu dalam meningkatkan kinerja di tim keperawatan. Rekomendasi yang dapat disarankan kearifan lokal Suku Karo Aron dan Runggu dapat diadopsi oleh pemimpin tim keperawatan dalam menjalankan perannya sehingga hal positif yang bisa diterima adalah tim menjadi solid dan tercipta kekeluargaan dan keikhlasan dalam menjalan tugas serta semangat kerja tercipta sehingga mutu layanan dapat terwujud dari kinerja yang ditampilkan dari tim keperawatan.
GAYA PEMECAHAN KONFLIK PEMIMPIN KEPERAWATAN BERLANDASKAN KODE ETIK
Authors: Silalahi Rini Debora
Published: October 2019

AbstrakKonflik adalah ketidaksesuaian antara dua angota atau lebih yang timbul karena adanya perbedan tujuan, nilai, dan cara pandang. Dalam lingkungan perawat erat kaitannya dengan adanya konflik. Seorang manajer perawat harus memiliki kemampuan strategi manajemen konflik yang baik untuk menciptakan keharmonisan lingkungan kerja, kepuasan kerja dan menurunkan intensitas pergantian perawat. Penelitian ini bertujuan untuk menentukan gaya manajemen konflik utama dari perawat manajer dari sudut panang perawat dan pengaruhnya terhadap intensitas perpindahan perawat. Jenis penelitian kuantitatif, deskriptif korelatif dengan sampel 30 manajer perawat dan 150 staff perawat. Alat pengumpulan data dengan kuesioner dan analisa data menggunakan uji statistik chi square. Hasil penelitian gaya pemecahan konflik yang paling banyak digunakan dari persepsi perawat adalah menghindar, sedangkan dari persepsi perawat manajer adalah kolaborasi. Terdapat perbedan yang signifikan antara intensitas pergantian perawat dan tiga gaya manajemen konflik (kolaborasi, kompromi, dan menghindar). Saran bagi peneliti selanjutnya agar menggunkan sampel yang lebih besar di berbagai instansi pemerintah dan swasta untuk menambah pengetahuan kita tentang apa penyebab konflik dan bagaimana mengatasinya. Kata Kunci : Gaya Manajemen Konflik, Perawat Manajer, Kode Etik
KEARIFAN LOKAL BUDAYA MANDAILING SEBAGAI BASIS MODEL KEPEMIMPINAN KEPERAWATAN
Authors: Siregar Rafika Nur
Published: October 2019

Kearifan lokal merupakan tata nilai atau perilaku hidup masyarakat lokal dalam berinteraksi dengan lingkungan tempat hidupnya secara arif. Masyarakat yang ideal menurut mandailing adalah masyarakat yang didalam interaksi sosialnya ditemukan holong (kasih sayang). Tujuan untuk memecahkan masalah yang didapatkan pada kearifan lokal budaya mandailing sebagai basis model kepemimpinan keperawatan. Metode yaitu literatur review dengan mencari semua jurnal (compresehensive literatur search). dilakukan dengan membandingkan literatur. Dilakukan dengan menganalisis, mensintesis, meringkas. Dengan formulasi permasalah yakni kearifan lokal budaya mandailing sebagai basis model kepemimpinan keperawatan. Dilakukan evaluasi data yakni mencari beberapa referensi yang mendukung. Selanujtnyamelakukan analisa terhadap data, referensi yang didapatkan dan mengipretasikannya. Hasil Dalam kepemimpinan keperawatan memiliki sebagian besar interaksi dengan pasien. Banyaknya keluhan pasien terhadap pelayanan keperawatan akibat kendala interferensi bahasa mandailing kedalam bahasa indonesia. Pembahasan menurut tatanan adat setempat seorang raja tidak boleh membiarkan seorang pun dari rakyatnya kelaparan. Hal ini sejalan dengan kepemimpinan keperawatan, dimana seorang pemimpin mampu menggerakkan, mempengaruhi, mengajak, mengarahkan, menasehati, membimbing, memerintah, melarang dan serta membina bawahannya dengan tujuan untuk mencapai tujuan bersama Begitu juga dengan kepemimpinan keperawatan, dengan kearifan lokal budaya mandailing dengan bersama-sama akan tercapai tujuan yang telah ditetapkan. Rekomendasi dalam kepemimpinan keperawatan harusnya dalam pelayanan tetap diterapkan bahasa daerah untuk menjalin komunikasi terapeutik.
CARTOGRAFIA SOCIAL DAS MULHERES DA COMUNIDADE RAPOSA/RIBEIRÃO RIBEIRÃO D’ANTA
Authors: Santos Valéria Pereira
Published: October 2019

Este cartograma é um dos resultados da pesquisa “Mulheres e conflitos socioambientais: saberes e olhares da camponesas” sobre os impactos da soja na Serra do Centro, Campos Lindos/TO, defendia em 2019 no Programa de Pós-Graduação em Demandas Populares e Dinâmicas Regionais (PPGdire/UFT). O estudo buscou dar visibilidade às mulheres camponesas e seus modos de vida nas áreas de conflitos socioambientais. Além das violências intrínsecas ao modelo de sociedade patriarcal, as mulheres com liderança sofrem violências extremas, como assassinatos e a perda dos bens comuns, que são fontes de sustentação dos seus modos de vida. Na Serra do Centro, o conflito socioambiental chegou juntamente com os sojicultores do Projeto Agrícola Campos Lindos, em 1997; um grande projeto de interesses econômicos e políticos privado, com dimensão regional e nacional. Já são mais de vinte anos de conflito, e o território tradicional e os modos de vida das mulheres camponesas sofreram grandes transformações. Por isso, o objetivo do estudo foi identificar e refletir sobre os impactos socioambientais gerados pelo Projeto à vida das mulheres camponesas a partir dos seus olhares e compreensões. Para construir o enredo dessa história, foi realizado um mapeamento social dos saberes e olhares das camponesas da Raposa/Ribeirão D’anta, refletindo sobre as histórias de vida das mulheres, as relações de convivência com o ambiente, a inserção na organização política, social e familiar e o que essas mulheres defendem como desenvolvimento. Para compreender o espaço vivido pelas camponesas e as mudanças deste mesmo espaço, frente às transformações socioambientais ocorridas na Raposa/Ribeirão D’anta após a implantação das lavouras de soja, foi reproduzida cartograficamente a dinâmica do território, identificando as relações cotidianas das mulheres no espaço vivido.
PELAYANAN ASUHAN KEPERAWATAN SARAK OPAT GAYO
Authors: Nilawati
Published: October 2019

Latar Belakang: Manajemen asuhan keperawatan merupakan pengaturan sumber daya dalam menjalankan kegiatan keperawatan dengan menggunakan metoda proses keperawatan untuk memenuhi kebutuhan klien atau menyelesaikan masalah klienTujuan: Tujuan dari kajian ilmiah ini adalah untuk penerapan atau melaksanakan layanan asuhan keperawatan sesuai kearifan local daerah gayo sarak opat.Metode: Penelitian ini merupakan penelitian kualitatifHasil: Dalam layanan asuhan keperawatan, manajer perawat di rumah sakit menggunakan gaya kemimpinan sarak opat. Untuk melakukan tindakan asuhan keperawatan dengan memandang kebudayaan pasien, agama, social dan psikologis.Pembahasan: Dalam membangun masyarakan dan pimpinan yang demokratis dengan baik, harus ada pola pikir yang perlu dikembangkan, terutama sarakopatnya yaitu nilai budaya, nilai agama, nilai politis dan lain- lain.Saran: Diharapkan kepada peneliti selanjutnya dapat melakukan kajian ilmiahdengan mengevaluasi penerapan gaya kepemimpinan Sarakopak.
KONTRIBUSI KEPALA RUANGAN DALAM PENERAPAN KODE ETIK KEPERAWATAN UNTUK MENCIPTAKAN BUDAYA KESELAMATAN PASIEN DI RUMAH SAKIT
Authors: Zega Petra Diansari
Published: October 2019

Keselamatan pasien di rumah sakit merupakan hal utama dan sudah menjadi kewajiban rumah sakit dalam memberikan pelayanan kesehatan. Keselamatan pasien berkaitan dengan aspek etika yang harus dilakasanakan. Pada pelaksanaannya diharapkan kepala ruangan mampu menggerakkan anggotanya dalam menciptakan keselamatan pasien sehingga terciptalah budaya keselamatan pasien. Kajian ini bertujuan untuk mengidentifikasi kontribusi kepala ruangan dalam penerapan kode etik keperawatan dengan menciptakan budaya keselamatan pasien di rumah sakit. Metode yang digunakan kajian ini dilakukan dengan mencari sumber data baik dari jurnal maupun buku-buku yang berhubungan dengan kontribusi kepala ruangan dalam penerapan kode etik keperawatan untuk menciptakan budaya keselamatan pasien. Artikel penelitian yang digunakan bersumber dari Repository USU, Scholar Google. Budaya keselamatan pasien merupakan penerapan kode etik keperawatan beneficence dan nonmaleficience dan penerapannya dibutuhkan kontribusi kepala ruangan yang memiliki dedikasi yang tinggi. Diharapkan Kepala Ruangan mampu menggerakkan perawat di ruangan untuk menciptakan budaya keselamatan pasien sebagai penerapan kode etik keperawatan untuk asuhan keperawatan yang berkualitas.
KAJIAN ILMIAH Kepemimpinan Keperawatan Berbasis Kearifan Lokal Pepatah-Petitih Minangkabau
Authors: telaumbanua Hariesty talenta narwastu
Published: October 2019

Latarbelakang: Mingkabau adalah salah satu budaya yang memiliki kearifan lokal yang unik yang tertuang dalam petatah – petitih dan menjadi pegangan hidup orang Minangkabau. Begitu pula dalam hal mempimpin suatu organisasi masyarakat, petatah – petitih Minangkabau adalah salah satu sumber pembelajaran yang dapat diterapkan dalam proses kepemimpinan yang dapat diterapakan seorang pemimpin keperawatan dalam pelayanan kesehatan Tujuan: untuk mengindetifikasi dan menganalisis penerapan kearifan lokal petatah – petitih Minangkabau sebagai konsep dalam kepemimpinan keperawatan. Metode: menggunakan metode penelitian kualitatif dengan analisis deskriptif kualitatif yang diharapkan dapat mendeskripsikan mengenai konsep kepemimpinan dalam petatah – petitih. Hasil: Pada hasil penelitian didapat berbagai petatah – petitih Minangkabau yang dapat diaplikasikan seorang pemimpin keperawatan dalam mengarahkan peran dan fungsi anggota tim keperawatan. Kesimpulan dan Saran: Petatah – petitih Minangkabau merupakan salah satu kearifan lokal yang memiliki nilai yang sangat baik untuk dijadikan sebagai pedoman hidup terutama dalam kepemimpinan keperawatan. Sebab dalam ungkapan masyrakat Minangkabau bahwa adat dan kearifan lokal “adat nan indak lapuk dek hujan nan indak langkang dek panah” yang berarti adat tidak akan hancur karna hujan, dan tidak akan rusak terkena panas
misi
Authors: park james
Published: October 2019

misi kristen masa kini
INFLUENCE OF LACTATION ON COMPOSITION OF MARE'S MILK. Scientific Bulletin. Series F. Biotechnologies, Vol. XXIII, 2019 ISSN 2285-1364, CD-ROM ISSN 2285-5521, ISSN Online 2285-1372, ISSN-L 2285-1364
Authors: Marchis Zamfir , Longodor Adina Lia , Balta Igori , Coroian Aurelia
Published: October 2019

Mare's milk is valuable because of its nutritional properties. It is used in human food and tartamente for variousdiseases. Mare milk changes its composition depending on the lactation. It has the lowest values in first and secondlactation in lactating 3, the highest values. The fat content varies between 1.88 g/100 g (lactation 1) and 2.17 g/100 g(lactation 3). Milk protein varies between 1.74 g/100g (lactation 1) and 1.92 g/100 g (lactation 3). For colostrum,affecting all day postpartum physico-chemical parameters. The highest values for these parameters are within 3 dayspostpartum. On day 5, the low values are observed. The fat content of the colostrum varies between 2.85 g/100 g, onday 1, and 2.13 g/100 g, on day 5.
mesias yahudi
Authors: nurjaman boby
Published: October 2019

mesias yahudi dalam konteks
keadilan retributif PL
Authors: nurjaman boby
Published: October 2019

keadilan dari perspektif PL
pernikahan
Authors: nurjaman boby
Published: October 2019

keluarga dalam perjanjian lama
A Rationale for Backprojection in Spotlight Synthetic Aperture Radar Image Formation
Authors: Bauck Jerald
Published: October 2019

This note on backprojection for spotlight synthetic aperture radar image formation is mainly pedagogic in purpose and is intended to be accessible. The presentation from first principles is elementary and detailed, beginning with the wave equation and melding wave notions with signal processing notions using a compact and consistent notation throughout. A reflection model is developed including a general expression for the receiver signal which does not depend on a particular transmitted waveform. Then the signal is specialized to monochromatic waves to show how waves and the Fourier transform fit together. In the end the signal is once again generalized so that the theory works for any signal type. Backprojection is shown to reconstruct the wave field that was lost by sampling it at only one point, the receiving antenna. After specializing some details to the synthetic aperture radar geometry, the Projection Slice Theorem is introduced late, after an understanding of the underlying principles is obtained. Computational aspects are considered and it is seen that backprojection and direct Fourier inversion, also known as the polar format algorithm, are fundamentally the same, differing only in some implementation details, albeit significant ones, thus overturning the notion that backprojection is not a Fourier process. Those who might benefit from this paper include people who have worked in this field and who seek a somewhat different point of view from the usual presentation, people in other fields who are unfamiliar with some of the engineering concepts involved, and signal processing engineers who appreciate a bit of wave theory.
Advancements in mechanical engineering spell hopeful development of autonomous biobots
Authors: Triwiyatno Aris , Sumardi Sumardi
Published: October 2019

In the case of injection gasoline engine, or better known as spark ignition engines, an effort to improve engine performance as well as to reduce fuel consumption is a fairly complex problem. Generally, engine performance improvement efforts will lead to increase in fuel consumption. However, this problem can be solved by implementing engine torque control based on intelligent regulation such as the fuzzy logic inference system. In this study, fuzzy logic engine torque regulation is used to control the throttle position entered by the driver to achieve optimal engine torque. An engine torque vs. throttle position and engine speed mapping for vehicles with economical function is used to build this control process regulation. From the simulation result, it can be concluded that this control strategy is very effective to reduce fuel consumption and simultaneously to optimize the engine performance.
Pentingnya Materi Lingkungan dalam Pembelajaran Bahasa Indonesia di Sekolah
Authors: M Willa Sisti
Published: October 2019

Lingkungan hidup sangat erat kaitannya dengan keberlangsungan kehidupan manusia, artinya baik atau sehat tidaknya lingkungan di sekitar kita ditentukan dari bagaimana cara kita menjaga alam supaya permasalahan lingkungan tidak mengancam kehidupan manusia. Kerusakan lingkungan hidup memberikan dampak langsung untuk kehidupan manusia. Keadaan seperti ini dapat disebabkan oleh dua faktor yaitu akibat peristiwa alam dan akibat ulah manusia. Penyebab kerusakan lingkungan yang dilakukan oleh manusia ini lebih besar dampaknya dibandingkan dengan peristiwa alam, karena kerusakan yang dilakukan bisa terjadi secara terus menerus dan cenderung meningkat. Kerusakan seperti ini biasanya dilakukan oleh aktivitas manusia yang tidak ramah lingkungan.
Legal Politics of Simplifying Political Parties in Indonesia (Case Study of 2004 – 2014 Election)
Authors: Mamonto Moch. Andry WW
Published: October 2019

Combination of presidential government systems and multi-party systems as a system of Indonesian state has led to a government that does not effective and stable. The formulation of the problem which is the focus of the study in this paper, namely how is the legal politics of simplification of political parties in Indonesia for the period 2004 – 2014. The research method used in this study is normative. Based on the results of the study, the authors obtained answers to the existing problems, that the legal politics of simplifying political parties in Indonesia is democratic legal politics, but the legal politics of simplifying political parties in Indonesia should not only be directed at simplifying political parties in parliament, but also simplifying political parties in political parties participating in the general election.
Ekonometrika Terapan
Authors: Grace Karania Melody
Published: October 2019

This study aims to understand the complex relationship between religiosity and citizenshipbehaviour by examining the role of materialism attitude and empathy.
PENGARUH KUALITAS JASA, NILAI PELANGGAN DAN CITRA MEREK TERHADAP KEPUASAN PELANGGAN (Pengguna Jasa Kurir Kantor Pos cabang Bogor)
Authors: Rusliansyah
Published: October 2019

Pada era informasi sekarang ini, alat komunikasi semakin berkembang dengan pesat dan memunculkan banyak inovasi baru dalam penggunaannya. Memasuki banyak perubahan pada era digital sekarang ini membuat perusahaan berlomba-lomba untuk meningkatkan layanan dan memenangkan hati pelanggan. Pos merupakan salah satu sarana komunikasi dan infomasi yang mempunyai suatu peran penting dan strategis dalam mendukung pelaksanaan pembangunan, serta meningkatkan hubungan antar bangsa dalam bentuk layanan pengiriman surat dan paket, logistik dan jasa keuangan.Tujuan dari penelitian ini adalah (1) untuk mengetahui dan menganalisis pengaruh Kualitas Jasa terhadap Kepuasan Pelanggan, (2) untuk mengetahui dan menganalisis pengaruh Nilai Pelanggan terhadap Kepuasan Pelanggan, dan (3) untuk mengatahui dan menganalisis pengaruh Citra Merek terhadap Kepuasan Pelanggan. Jumlah responden dalam penelitian ini berjumlah 100 responden yang diambil dari orang-orang yang sudah pernah menggunakan layanan jasa Pos. Data penelitian diolah menggunakan SPSS versi 22.Hasil dari penelitian ini sebagai berikut : (1) Kualitas Jasa berpengaruh negatif dan tidak signifikan terhadap Kepuasan Pelanggan dengan nilai t-hitung sebesar 0,937, lebih kecil dari t-tabel sebesar 1,984. (2) Nilai Pelanggan berpengaruh positif dan signifikan terhadap Kepuasan Pelanggan dengan nilai t-hitung sebesar 2,513 lebih besar dari t-tabel sebesar 1,984 dan, (3) Citra Merek berpengaruh positif dan signifikan terhadap Kepuasan Pelanggan dengan nilai t-hitung sebesar 4,775 lebih besar dari t-tabel sebesar 1,984.Kata Kunci : Kualitas Jasa, Nilai Pelanggan, Citra Merek, dan Layanan Jasa PT. Pos di Kota Bogor.
Kepemimpinan dan Kualitas Pendidikan Daerah
Authors: SUARTI NI WAYAN
Published: October 2019

Faktor-faktor yang dapat mempengaruhi kualitas pendidikan di suatu daerah antara lain:1.Rendahnya Kualitas Sarana Fisik2.Rendahnya Kualitas Guru3.Rendahnya Kesejahteraan Guru4.Rendahnya Prestasi Siswa5.Kurangnya Pemerataan Kesempatan Pendidikan6.Rendahnya Relevansi Pendidikan dengan Kebutuhan7.Mahalnya Biaya Pendidikan
Ekonometrika Trerapan (Review Artikel)
Authors: Hernando Jovan
Published: October 2019

The purpose of this study is to develop a structural equation model to explain the complexrelationship between social network and firm performance by introducing the mediating role of trust, sellingcapability and pricing capability.
Pentingnya Materi Lingkungan dalam Pembelajaran Bahasa di Sekolah Menengah Pertama (SMP)
Authors: Putri Lasri Maisa
Published: October 2019

Tujuan penelitian ini adalah untuk mengetahui respon guru terhadap materi lingkungan dalam pembelajaran bahasa di sekolah, khususnya di sekolah menengah pertama (SMP). Penelitian ini dilakukan menggunakan angket yang disebar melalui google form. Angket tersebut berisi sepuluh pertanyaan yang berhubungan dengan materi lingkungan. Penulis berharap hasil penelitian ini dapat menjadi referensi bagi para guru untuk memberikan materi lingkungan dalam pembelajaran bahasa. Penulis juga berharap berdasarkan materi yang telah disampaikan oleh guru siswa dapat memahaminya dengan baik.
A 16-week aerobic exercise and mindfulness-based intervention on chronic psychosocial stress: a pilot and feasibility study
Authors: Prochilo Guy A , Costa Ricardo J.S. , Hassed Craig , Chambers Richard , Molenberghs Pascal
Published: October 2019

ObjectivesResearchers have begun delivering mindfulness and aerobic exercise training concurrently on the premise that a combination intervention will yield salutary outcomes over and above each intervention alone. An estimate of the effect of combination training on chronic psychosocial stress in a nonclinical population has not been established. The objective of this study was to establish protocol feasibility in preparation of a definitive RCT targeting healthy individuals, and to explore the preliminary effect of combination training on reducing chronic psychosocial stress in this population.MethodsTwenty-four participants were allocated to a single-arm pre-post study and subjected to 16 weeks of concurrent mindfulness psychoeducation and aerobic exercise training. Feasibility criteria were collected and evaluated. Within-group changes in chronic psychosocial stress, mindfulness, emotion regulation, and cardiorespiratory fitness were also assessed. Primary analyses were based on 17 participants.ResultsRetention rate, response rate, recruitment rate, and sample size analyses indicate a definitive trial is feasible for detecting most effects with precision. There was also a decline in our primary dependent measure of chronic psychosocial stress (dpretest = −0.56, 95% CI [ −1.14,−0.06]). With regard to secondary measures, there was an increase in the use of cognitive reappraisal, and a reduction in use of maladaptive emotion regulation strategies. We are insufficiently confident to comment on changes in mindfulness and aerobic capacity (𝑉˙𝑂2𝑚𝑎𝑥). However, there were subgroup improvements in aerobic economy at submaximal exercise intensities.ConclusionsWe recommend a definitive trial is feasible and should proceed.
Edgcumbe. 2019 - The relationship between cognitive reflection and morality judgments are mediated by thinking dispositions.
Authors: Edgcumbe Daniel
Published: October 2019

Abstract:Performance on Cognitive Reflection Test (CRT) is thought to predict moral judgments concerning the Moral Foundations Questionnaire (MFQ). This relationship is hypothesised to be mediated by the tendency toward thinking dispositions such as actively open-minded thinking (AOT), rational (REI-R) and experiential thinking (REI-E), and religiosity. The relationship between cognitive reflection, intuitive thinking and moral judgments with thinking dispositions are examined. As the MFQ measures five types of moral judgments which include ‘individualising values’ – harm and fairness, and ‘binding values’ - loyalty, authority and purity it was hypothesised that performance on these moral foundations would be influenced by thinking dispositions and cognitive reflection. Results indicate that the relationship between cognitive reflection and moral judgments were mediated differently by thinking dispositions. Religious participants and intuitive thinkers alike scored highly on binding moral values. Analytic thinkers and non-religious participants scored highly on individualising moral values. The data is consistent with religiosity and intuition being inherently linked and suggests that moral values are influenced by individual differences in thinking dispositions and cognitive style.
A retrospective review of Chinese translated name of schizophrenia (in Chinese)
Authors: Chen Jian Saturn
Published: October 2019

Schizophrenia is a mental disorder that affects a person’s ability to feel, think, and behave clearly. Since 1935, schizophrenia was translated into Chinese as Jing Shen Fen Lie Zheng, which literally explained as “mind splitting disease”. However, such a translation fails to reflect the truth of this mental disorder, and it has evident stigma. It is argued in this article that a new Chinese name is required for Schizophrenia in mainland China. In fact, in recent years, some countries and regions have already changed the translation name for schizophrenia. For instance, Japan has changed the name from “Seishin-Bunretsu-Byo” (Mind-split-disease) to “Togo-Shitcho-Sho” (Integration disorder); South Korea has changed the name from “Jeongshin-bunyeol-byung”(Mind-split-disorder) to “Johyun-byung” (attunement disorder). In Hong Kong and Taiwan, this name has been changed from “Jing Shen Fen Lie Zheng”to “Si Jue Shi Tiao Zheng” (dysfunction of thought and perception). Studies have demonstrated that such a change brought many benefits. It is suggested that the psychiatrists in the mainland China can learn from others’ experiences and promote the name change of schizophrenia. It is argued in this article that the name of “Si Jue Shi Tiao Zheng” is a proper option.
The Pigovian tax on capital-intensive industries
Authors: Maruyama Yuuki
Published: October 2019

Government intervention in the market and industrial policy tend not to be considered good. However, as can be seen from the Cobb-Douglas production function, capital has the effect of increasing the marginal productivity of labor, and the effect is greater in industries with high labor share (labor-intensive industries). For this reason, if a Pigovian tax is imposed on capital-intensive industries, some capital will move to labor-intensive industries and workers' wages will increase. This paper uses a two-sector model to analyze the optimal Pigovian tax rate that will maximize the income of workers. It shows that the optimal Pigovian tax rate is higher in countries with higher productivity in capital-intensive industries and have more capital and less population.
Recessions in a two-sector model: Capitalists’ risk preferences determine workers' real wages
Authors: Maruyama Yuuki
Published: October 2019

With a two-sector model of the consumer goods sector and the capital goods sector, this paper analyzes workers’ real wages. The higher the risk preference of capitalists, the greater the ratio of capital goods to safe assets in savings, the labor demand in the capital goods sector will increase, some workers will move from the consumer goods sector to the capital goods sector, the marginal product of labor will rise in both sectors, and workers’ real wages will increase. In this model, a sudden increase in capitalists’ risk aversion can cause a recession. In addition, this model is used to analyze monetary policy, suppression of an overheating economy, and two positive externalities from capitalists to workers.
Pediatric nonoperative skull fractures: delayed complications and factors associated with clinic and imaging utilization
Authors: Northam Weston , Chandran Avinash , Quinsey Carolyn , Abumoussa Andrew , Flores Alex , Elton Scott
Published: October 2019

OBJECTIVE

Skull fractures represent a common source of morbidity in the pediatric trauma population. This study characterizes the type of follow-up that these patients receive and discusses predictive factors for follow-up.

METHODS

The authors reviewed cases of nonoperative pediatric skull fractures at a single academic hospital between 2007 and 2017. Clinical patient and radiological fractures were recorded. Recommended neurosurgical follow-up, follow-up appointments, imaging studies, and fracture-related complications were recorded. Statistical analyses were performed to identify predictors for outpatient follow-up and imaging.

RESULTS

The study included 414 patients, whose mean age was 5.2 years; 37.2% were female, and the median length of stay was 1 day (IQR 0.9–4 days). During 438 clinic visits and a median follow-up period of 8 weeks (IQR 4–12, range 1–144 weeks), 231 imaging studies were obtained, mostly head CT scans (55%). A total of 283 patients were given recommendations to attend follow-up in the clinic, and 86% were seen. Only 12 complications were detected, including 7 growing skull fractures, 2 traumatic encephaloceles, and 3 cases of hearing loss. Primary care physician (PCP) status and insurance status were associated with a recommendation of follow-up, actual follow-up compliance, and the decision to order outpatient imaging in patients both with and without intracranial hemorrhage. PCP status remained an independent predictor in each of these analyses. Follow-up compliance was not associated with a patient’s distance from home. Among patients without intracranial hemorrhage, a follow-up recommendation and actual follow-up compliance were associated with pneumocephalus and other polytraumatic injuries, and outpatient imaging was associated with a bilateral fracture. No complications were found in patients with linear fractures above the skull base in those without an intracranial hemorrhage.

CONCLUSIONS

Pediatric nonoperative skull fractures drive a large expenditure of clinic and imaging resources to detect a relatively small profile of complications. Understanding the factors underlying the decision for clinic follow-up and additional imaging can decrease future costs, resource utilization, and radiation exposure. Factors related to injury severity and socioeconomic indicators were associated with outpatient imaging, the decision to follow up patients in the clinic, and patients’ subsequent attendance. Socioeconomic status (PCP and insurance) may affect access to appropriate neurosurgical follow-up and deserves future research attention. Patients with no intracranial hemorrhage and with a linear fracture above the skull base do not appear to be at risk for delayed complications and could be candidates for reduced follow-up and imaging.
Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series
Authors: Bhatia Kartik , Kortman Hans , Blair Christopher , Parker Geoffrey , Brunacci David , Ang Timothy , Worthington John , Muthusami Prakash , Shoirah Hazem , Mocco J , Krings Timo
Published: October 2019

OBJECTIVE

The role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.

METHODS

Using PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).

RESULTS

The authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.

CONCLUSIONS

Mechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.
Perioperative acute neurological deficits in instrumented pediatric cervical spine fusions
Authors: Verhofste Bram P. , Glotzbecker Michael P. , Hresko Michael T. , Miller Patricia E. , Birch Craig M. , Troy Michael J. , Karlin Lawrence I. , Emans John B. , Proctor Mark R. , Hedequist Daniel J.
Published: October 2019

OBJECTIVE

Pediatric cervical deformity is a complex disorder often associated with neurological deterioration requiring cervical spine fusion. However, limited literature exists on new perioperative neurological deficits in children. This study describes new perioperative neurological deficits in pediatric cervical spine instrumentation and fusion.

METHODS

A single-center review of pediatric cervical spine instrumentation and fusion during 2002–2018 was performed. Demographics, surgical characteristics, and neurological complications were recorded. Perioperative neurological deficits were defined as the deterioration of preexisting neurological function or the appearance of new neurological symptoms.

RESULTS

A total of 184 cases (160 patients, 57% male) with an average age of 12.6 ± 5.30 years (range 0.2–24.9 years) were included. Deformity (n = 39) and instability (n = 36) were the most frequent indications. Syndromes were present in 39% (n = 71), with Down syndrome (n = 20) and neurofibromatosis (n = 12) the most prevalent. Eighty-seven (48%) children presented with preoperative neurological deficits (16 sensory, 16 motor, and 55 combined deficits).

A total of 178 (96.7%) cases improved or remained neurologically stable. New neurological deficits occurred in 6 (3.3%) cases: 3 hemiparesis, 1 hemiplegia, 1 quadriplegia, and 1 quadriparesis. Preoperative neurological compromise was seen in 4 (67%) of these new deficits (3 myelopathy, 1 sensory deficit) and 5 had complex syndromes. Three new deficits were anticipated with intraoperative neuromonitoring changes (p = 0.025).

Three (50.0%) patients with new neurological deficits recovered within 6 months and the child with quadriparesis was regaining neurological function at the latest follow-up. Hemiplegia persisted in 1 patient, and 1 child died due a complication related to the tracheostomy. No association was found between neurological deficits and indication (p = 0.96), etiology (p = 0.46), preoperative neurological symptoms (p = 0.65), age (p = 0.56), use of halo vest (p = 0.41), estimated blood loss (p = 0.09), levels fused (p = 0.09), approach (p = 0.07), or fusion location (p = 0.07).

CONCLUSIONS

An improvement of the preexisting neurological deficit or stabilization of neurological function was seen in 96.7% of children after cervical spine fusion. New or progressive neurological deficits occurred in 3.3% of the patients and occurred more frequently in children with preoperative neurological symptoms. Patients with syndromic diagnoses are at higher risk to develop a deficit, probably due to the severity of deformity and the degree of cervical instability. Long-term outcomes of new neurological deficits are favorable, and 50% of patients experienced complete neurological recovery within 6 months.
Endovascular stenting for rescue of a failed donor graft during superficial temporal artery to middle cerebral artery bypass surgery: case report
Authors: LoPresti Melissa A. , Srinivasan Visish M. , North Robert Y. , Ravindra Vijay M. , Johnson Jeremiah , Burkhardt Jan-Karl , Lam Sandi K. , Kan Peter
Published: October 2019

Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.

The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.

This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.
Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series
Authors: McAvoy Malia , McCrea Heather J. , Chavakula Vamsidhar , Choi Hoon , Bi Wenya Linda , Mekary Rania A. , Stone Scellig , Proctor Mark R.
Published: October 2019

OBJECTIVE

Few studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.

METHODS

A retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.

RESULTS

Over the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).

CONCLUSIONS

Microdiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.
Developing a 3D composite training model for cranial remodeling
Authors: Cheng Du , Yuan Melissa , Perera Imali , O’Connor Ashley , Evins Alexander I. , Imahiyerobo Thomas , Souweidane Mark , Hoffman Caitlin
Published: October 2019

OBJECTIVE

Craniosynostosis correction, including cranial vault remodeling, fronto-orbital advancement (FOA), and endoscopic suturectomy, requires practical experience with complex anatomy and tools. The infrequent exposure to complex neurosurgical procedures such as these during residency limits extraoperative training. Lack of cadaveric teaching tools given the pediatric nature of synostosis compounds this challenge. The authors sought to create lifelike 3D printed models based on actual cases of craniosynostosis in infants and incorporate them into a practical course for endoscopic and open correction. The authors hypothesized that this training tool would increase extraoperative facility and familiarity with cranial vault reconstruction to better prepare surgeons for in vivo procedures.

METHODS

The authors utilized representative craniosynostosis patient scans to create 3D printed models of the calvaria, soft tissues, and cranial contents. Two annual courses implementing these models were held, and surveys were completed by participants (n = 18, 5 attending physicians, 4 fellows, 9 residents) on the day of the course. These participants were surveyed during the course and 1 year later to assess the impact of this training tool. A comparable cohort of trainees who did not participate in the course (n = 11) was also surveyed at the time of the 1-year follow-up to assess their preparation and confidence with performing craniosynostosis surgeries.

RESULTS

An iterative process using multiple materials and the various printing parameters was used to create representative models. Participants performed all major surgical steps, and we quantified the fidelity and utility of the model through surveys. All attendees reported that the model was a valuable training tool for open reconstruction (n = 18/18 [100%]) and endoscopic suturectomy (n = 17/18 [94%]). In the first year, 83% of course participants (n = 14/17) agreed or strongly agreed that the skin and bone materials were realistic and appropriately detailed; the second year, 100% (n = 16/16) agreed or strongly agreed that the skin material was realistic and appropriately detailed, and 88% (n = 14/16) agreed or strongly agreed that the bone material was realistic and appropriately detailed. All participants responded that they would use the models for their own personal training and the training of residents and fellows in their programs.

CONCLUSIONS

The authors have developed realistic 3D printed models of craniosynostosis including soft tissues that allow for surgical practice simulation. The use of these models in surgical simulation provides a level of preparedness that exceeds what currently exists through traditional resident training experience. Employing practical modules using such models as part of a standardized resident curriculum is a logical evolution in neurosurgical education and training.
Liquid biopsy for diffuse intrinsic pontine glioma: an update
Authors: Lu Victor M. , Power Erica A. , Zhang Liang , Daniels David J.
Published: October 2019

Diffuse intrinsic pontine glioma (DIPG), otherwise known as diffuse midline glioma with H3K27M mutation, is a devastating brainstem glioma without a cure. Efforts are currently underway to better optimize molecular diagnoses through biological sampling, which today remains largely limited to surgical biopsy sampling. Surgical intervention is not without its risks, and therefore a preference remains for a less invasive modality that can provide biological information about the tumor. There is emerging evidence to suggest that a liquid biopsy, targeting biofluids such as CSF and blood plasma, presents an attractive alternative for brain tumors in general. In this update, the authors provide a summary of the progress made to date regarding the use of liquid biopsy to diagnose and monitor DIPG, and they also propose future development and applications of this technique moving forward, given its unique histone biology.
Recurrent Langerhans cell histiocytosis at the site of prior craniotomy: case report
Authors: Iqbal M. Omar , Merve Ashirwad , Galea Nathalie , Aquilina Kristian
Published: October 2019

Tumors of the CNS represent the largest group of solid tumors found in the pediatric patient population. Langerhans cell histiocytosis (LCH) is an inflammatory lesion that may present in bone and/or soft tissue, including the CNS. Management depends on the extent of multisystem involvement, which determines resection with or without systemic chemotherapy. The authors report on the case of a child who underwent an open craniotomy for biopsy of a pituitary stalk lesion followed by neuropathological assessment, procedures used to diagnose LCH. The patient then underwent 12 months of systemic chemotherapy with subsequent resolution of the pituitary stalk lesion. Two years following pathological diagnosis, the patient presented with frontal orbital pain at the site of the prior craniotomy. Advanced imaging revealed MRI enhancement and radiotracer uptake of a soft-tissue growth at the frontal burr-hole site and MRI enhancement at a posterior burr-hole site without soft-tissue growth. The patient then underwent open biopsy and curettage that revealed LCH recurrence at the site of prior craniotomy. This case demonstrates that LCH may represent an abnormal reactive clonal proliferation of dendritic cells, rather than a de novo malignant neoplasm that can occur at sites of prior craniotomy despite systemic chemotherapy. The authors advocate close follow-up with contrast-enhanced imaging. Special attention should be given to sites of prior surgical manipulation to avoid missing distant sites of recurrence.
Management of NF2-associated vestibular schwannomas in children and young adults: influence of surgery and clinical factors on tumor volume and growth rate
Authors: Gugel Isabel , Grimm Florian , Teuber Christian , Kluwe Lan , Mautner Victor-Felix , Tatagiba Marcos , Schuhmann Martin Ulrich
Published: October 2019

OBJECTIVE

The authors’ aim was to evaluate the tumor volume and growth rate of neurofibromatosis type 2 (NF2)–associated vestibular schwannomas (VSs) and the clinical factors or type of mutations before and after surgery in children and adults younger than 25 years at the time of diagnosis.

METHODS

A total of 579 volumetric measurements were performed in 46 operated tumors in 28 NF2 patients, using thin-slice (< 3 mm) T1-weighted contrast-enhanced MRI. The follow-up period ranged from 21 to 167 months (mean 75 months). Growth rate was calculated using a multilinear regression model. Mutation analysis of the NF2 gene was performed in 25 patients.

RESULTS

Surgery significantly (p = 0.013) slowed the VS growth rate from 0.69 ± 1.30 cm3/yr to 0.23 ± 0.42 cm3/yr. Factors significantly associated with a higher growth rate of VSs were increasing patient age (p < 0.0005), tumor volume (p = 0.006), tumor size (p = 0.001), and constitutional truncating mutations in the NF2 gene (p = 0.018). VS growth rates tended to be higher in patients with spinal ependymomas and in right-sided tumors and lower in the presence of peripheral schwannomas; however, no statistical significance was achieved.

CONCLUSIONS

Decompression of the internal auditory canal with various degrees of tumor resection decreases the postoperative tumor growth rate in children and young adults with NF2-associated VS. Patients with potential risk factors for accelerated growth (e.g., large volume, truncating mutations) and with increasing age should be monitored more closely before and after surgery.