bluuebunny/crossref_metadata_2025 huggingface dataset:
Analyzing ICU Patient Room Environmental Quality Through Unoccupied, Normal, and Emergency Procedure Modes: An EQI Evaluation
Authors: Wagner Jennifer A. , Greeley Damon G. , Gormley Thomas C. , Markel Troy A.
Published: June 2019

Background:

There is increasing need to perform invasive surgical procedures in intensive care units (ICUs). Traditional ICUs differ from operating rooms (ORs) in several ways including air changes per hour (ACH) and pressurization. Increased ACH and positive pressurization of ORs intend to provide more aseptic environments for surgery. Development of procedure ready ICUs that transition through unoccupied, occupied, and procedure modes is one solution to improve environmental quality when performing surgery in ICUs. This study assessed the efficacy of two airflow control systems, variable air volume (VAV) and Venturi control, in preventing contaminants from entering ICU from adjacent corridors.

Study Design:

Controlled contaminants, sulfur hexafluoride (SF6) and baker’s yeast (CFU/m3), were released in the corridor adjacent to the ICU. SF6 and CFU/m3 were detected inside the ICU at the patient bed during a dynamic simulation of code blue event. VAV and Venturi were compared as they cycled the room through unoccupied, occupied, and procedure modes.

Results:

VAV and Venturi showed significantly fewer CFU/m3 at the patient bed than corridor point of release ( p < .05). Although not significant, Venturi cultured 14% fewer CFU/m3 than VAV at the patient bed. There was less SF6 detected at the patient bed with VAV and Venturi ( p < .05). There was less SF6 detected at the patient bed with Venturi compared to VAV ( p < .05). Venturi transitioned between modes faster than VAV ( p < .05).

Conclusion:

Using efficient mode transitioning systems in ICUs may be effective in creating a more aseptic environment that mimics that of the OR.
Throw me a lifeline: Articulating mobile social network dispersion and the social construction of risk in rescue communication
Authors: Stephens Keri K. , Robertson Brett W. , Murthy Dhiraj
Published: June 2019

This research develops a model of mobile social network dispersion in rescue communication, and illustrates how people use a combination of mobile and social media, along with real-time communication, in their decision-making process. Guided by established research on smartphones, social media, and affordances, we used a qualitative approach and conducted field interviews that included photo-elicitation interview (PEI) techniques to examine participants’ private social media data. Our analysis of these rescue decisions reveals why so few people used the official 9-1-1 system. We show how rescue communication often occurs through a socially constructed assessment of risk that involves persuasion by trusted others in their network, regardless of professional qualifications. Furthermore, trusted others can function as proxies and can draw upon mobile social network affordances, helping to compensate for material limitations. The affordances people drew from can be organized into two sets: foundational and amplification. Hierarchical relationships exist among these sets of affordances, and materiality plays a pivotal role in rescue communication. Ultimately, our analysis uncovers the multimodality around people’s decisions to ask for help.
STandard versus Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury: Study Protocol for a Multi-National, Multi-Center, Randomized Controlled Trial
Authors:   The STARRT-AKI Investigators
Published: June 2019

Background:

The optimal timing of renal replacement therapy (RRT) initiation in critically ill patients with acute kidney injury (AKI) remains controversial.

Objective:

In critically ill patients with AKI, to determine whether the accelerated initiation of RRT reduces mortality compared to a strategy of standard RRT initiation whereby RRT is initiated if urgent complications of AKI arise or based on clinician judgment.

Design:

Pragmatic allocation-concealed open-label randomized controlled trial.

Setting:

Up to 170 centers in Australia, Austria, Belgium, Brazil, Canada, China, France, Germany, Ireland, Italy, Finland, New Zealand, Switzerland, the United Kingdom, and the United States.

Patients:

We will enroll at least 2,866 critically ill patients with AKI stages 2 or 3 (defined as doubling of serum creatinine from baseline or serum creatinine ≥354 µmol/L with increase of ≥27 µmol/L from baseline or urine output <6 mL/kg in preceding 12 hours). Patients will be excluded if 1 or more of the following is/are present: potassium >5.5 mmol/L; bicarbonate <15 mmol/L; concomitant intoxication necessitating RRT; philosophy of care precluding escalation to RRT; any RRT in preceding 2 months; kidney transplant within the past year; preexisting estimated glomerular filtration rate <20 mL/min/1.73 m2; AKI etiology attributable to obstruction, glomerulonephritis, vasculitis, microangiopathy, or acute interstitial nephritis; clinician opinion that urgent RRT is mandated; or clinician opinion that RRT must be deferred.

Methods:

Participants will be randomized to one of two strategies: accelerated RRT initiation, which entails the initiation of RRT within 12 hours of the patient fulfilling all eligibility criteria, or standard RRT initiation, whereby clinicians would be discouraged from initiating RRT unless a conventional trigger for RRT initiation arises or if AKI persists for ≥72 hours.

Measurements:

The primary outcome is all-cause mortality at 90 days following randomization. Key secondary outcomes include RRT dependence, residual kidney function, health services use, and health-related quality of life, all assessed at 90 days after randomization. In jurisdictions where it is feasible, participants will be followed through day 365 using linked administrative data.

Results:

Through March 18, 2019, we have recruited 2623 (92% of target) participants.

Limitations:

Reliance on physician declaration of equipoise may create heterogeneity across the trial population; open-label design may introduce bias and uneven postrandomization cointerventions; variations in practice (eg, choice of RRT modality and RRT prescription) likely exist across sites.

Conclusions:

Once complete, the STARRT-AKI trial will provide the most robust evidence to date to guide clinical practice on the optimal timing of RRT initiation among critically ill patients with AKI.

Trial registration:

Clinicaltrials.gov NCT02568722.
Islamic State in Iraq and Syria’s standardized media and jihadist nation-state building efforts
Authors: Al-Rawi Ahmed
Published: June 2019

In its efforts to establish order and legitimacy among the people it once controlled, Islamic State in Iraq and Syria followed standardized and systematic nation-state building policies. The terrorist group attempted to establish an imagined jihadist nation-state with the assistance of standardized media productions and practices. These media productions that are examined in this article reflect Islamic State in Iraq and Syria’s unified vision of the ultra-conservative society that it once intended to form in its different territories. I argue here that Islamic State in Iraq and Syria used standardized media productions to promote strict sharia laws including emphasis on men and women’s garments, distrust in secular rule, and calls for jihad in the different cities that it controlled. For Islamic State in Iraq and Syria, media is jihad and journalists are Mujahideen whose main purpose is to mobilize the masses and assist in creating a jihadist nation-state.
Hepatitis C Competency and Outreach of Occupational Health Nurses
Authors: Surjadi Miranda , Nuchols Beverly , Souza Denise , Wolfe Lori , Burgel Barbara
Published: June 2019

In the United States, approximately one half of individuals with chronic hepatitis C virus (HCV) are not aware of their status. Current HCV treatment is highly successful and is associated with a decrease in all-cause mortality. Occupational health nurses (OHNs) are often the sole health care providers at worksites and have a unique opportunity to provide HCV education, screening, and linkage to care. This project measured changes in OHN HCV competency and outreach, and identified barriers to screening. In June 2017, Survey 1 was emailed to 3,414 American Association of Occupational Health Nurse (AAOHN) members. For HCV competence, HCV knowledge and confidence in educating and counseling employees regarding HCV were assessed. HCV outreach and barriers to screening were identified. The HCV educational campaign launched in October 2017 with a webinar, a webpage/toolkit, and educational emails. Survey 2 was emailed in January 2018 to assess for changes in HCV competency and outreach. A total of 445 OHNs responded to Survey 1, and 111 completed both surveys, and participant demographics represented AAOHN membership base (95% female, mean age 56.4). The average HCV knowledge pretest score was 76% and posttest score was 77%. Confidence in educating/counseling employees about HCV increased from 2.6 to 2.9 (on a 1-5 scale; p = .052). Higher pretest scores were associated with bachelor’s degree (BS/BA) education or above, greater confidence in HCV education/counseling of employees, and HCV education participation within the prior 12 months. There are ongoing HCV learning needs for OHNs and greater opportunities for HCV outreach in worksites.
Chlamydia Infections
Authors: Phillips Jennan A.
Published: June 2019

Increasing rates for chlamydia and other sexually transmitted infections pose a global public health issue. Untreated chlamydia infections create an economic burden on the health care system, employers, and society. Occupational and environmental health nurses can help promote health awareness about chlamydia, teach prevention strategies, and encourage routine screening to slow its spread.
The Power of Replicated Measures to Increase Statistical Power
Authors: Goulet Marc-André , Cousineau Denis
Published: June 2019

When running statistical tests, researchers can commit a Type II error, that is, fail to reject the null hypothesis when it is false. To diminish the probability of committing a Type II error (β), statistical power must be augmented. Typically, this is done by increasing sample size, as more participants provide more power. When the estimated effect size is small, however, the sample size required to achieve sufficient statistical power can be prohibitive. To alleviate this lack of power, a common practice is to measure participants multiple times under the same condition. Here, we show how to estimate statistical power by taking into account the benefit of such replicated measures. To that end, two additional parameters are required: the correlation between the multiple measures within a given condition and the number of times the measure is replicated. An analysis of a sample of 15 studies (total of 298 participants and 38,404 measurements) suggests that in simple cognitive tasks, the correlation between multiple measures is approximately .14. Although multiple measurements increase statistical power, this effect is not linear, but reaches a plateau past 20 to 50 replications (depending on the correlation). Hence, multiple measurements do not replace the added population representativeness provided by additional participants.
Confounding of linkage disequilibrium patterns in large scale DNA based gene-gene interaction studies
Authors: Joiret Marc , Mahachie John Jestinah M. , Gusareva Elena S. , Van Steen Kristel
Published: June 2019

Background

In Genome-Wide Association Studies (GWAS), the concept of linkage disequilibrium is important as it allows identifying genetic markers that tag the actual causal variants. In Genome-Wide Association Interaction Studies (GWAIS), similar principles hold for pairs of causal variants. However, Linkage Disequilibrium (LD) may also interfere with the detection of genuine epistasis signals in that there may be complete confounding between Gametic Phase Disequilibrium (GPD) and interaction. GPD may involve unlinked genetic markers, even residing on different chromosomes. Often GPD is eliminated in GWAIS, via feature selection schemes or so-called pruning algorithms, to obtain unconfounded epistasis results. However, little is known about the optimal degree of GPD/LD-pruning that gives a balance between false positive control and sufficient power of epistasis detection statistics. Here, we focus on Model-Based Multifactor Dimensionality Reduction as one large-scale epistasis detection tool. Its performance has been thoroughly investigated in terms of false positive control and power, under a variety of scenarios involving different trait types and study designs, as well as error-free and noisy data, but never with respect to multicollinear SNPs.

Results

Using real-life human LD patterns from a homogeneous subpopulation of British ancestry, we investigated the impact of LD-pruning on the statistical sensitivity of MB-MDR. We considered three different non-fully penetrant epistasis models with varying effect sizes. There is a clear advantage in pre-analysis pruning using sliding windows atr2of 0.75 or lower, but using a threshold of 0.20 has a detrimental effect on the power to detect a functional interactive SNP pair (power < 25%). Signal sensitivity, directly using LD-block information to determine whether an epistasis signal is present or not, benefits from LD-pruning as well (average power across scenarios: 87%), but is largely hampered by functional loci residing at the boundaries of an LD-block.

Conclusions

Our results confirm that LD patterns and the position of causal variants in LD blocks do have an impact on epistasis detection, and that pruning strategies and LD-blocks definitions combined need careful attention, if we wish to maximize the power of large-scale epistasis screenings.
Gait-based age estimation using multi-stage convolutional neural network
Authors: Sakata Atsuya , Takemura Noriko , Yagi Yasushi
Published: June 2019

Gait-based age estimation has been extensively studied for various applications because of its high practicality. In this paper, we propose a gait-based age estimation method using convolutional neural networks (CNNs). Because gait features vary depending on a subject’s attributes, i.e., gender and generation, we propose the following three CNN stages: (1) a CNN for gender estimation, (2) a CNN for age-group estimation, and (3) a CNN for age regression. We conducted experiments using a large population gait database and confirm that the proposed method outperforms state-of-the-art benchmarks.
The Use and Abuse of Growth Hormone in Sports
Authors: Holt Richard I G , Ho Ken K Y
Published: June 2019

GH is banned by the World Anti-Doping Agency as a performance-enhancing anabolic agent. Doping with GH likely began in the early 1980s and became more prevalent with the advent of recombinant technology well before any scientific evidence of benefit. The expectation that GH improves physical function stems from its anabolic and lipolytic properties. Athletic performance depends on muscle strength and the energy required to power muscle function. In recreational athletes, GH selectively improves anaerobic sprint capacity but has not been proven to significantly enhance muscle strength, power, or maximum rate of oxygen consumption. GH is secreted as a family of isoform peptides in a pulsatile manner reflecting intermittent secretion and rapid clearance. Its anabolic actions are largely mediated by IGF-I, which stimulates whole-body protein synthesis, including skeletal muscle and collagen proteins. Two methods have been validated for detecting GH abuse in athletes. The first (the isoform method) is based on distinguishing pure recombinant 22-kDa GH from the heterogeneous isoforms secreted from the pituitary. The second (the marker method) is based on measuring blood levels of GH-responsive proteins, specifically IGF-I and the N-terminal propeptide of type III collagen (P-III-NP). Only a handful of athletes have been caught since the implementation of GH doping tests in 2004. The low rate likely reflects the limitation of in-competition testing using current methods. Improved detection rates may be achieved by more out-of-competition testing, introducing athletes’ biological passports, and the development of novel methods. Governance, operational, technical, and political factors influence the effectiveness of an anti-doping program.
A trap mutant reveals the physiological client spectrum of TRC40
Authors: Coy-Vergara Javier , Rivera-Monroy Jhon , Urlaub Henning , Lenz Christof , Schwappach Blanche
Published: June 2019

The transmembrane recognition complex (TRC) pathway targets tail-anchored (TA) proteins to the membrane of the endoplasmic reticulum (ER). While many TA proteins are known to be able to use this pathway, it is essential for the targeting of only a few. Here, we uncover a large number of TA proteins that engage with TRC40 when other targeting machineries are fully operational. We use a dominant-negative ATPase-impaired mutant of TRC40 in which aspartate 74 was replaced by a glutamate residue to trap TA proteins in the cytoplasm. Manipulation of the hydrophobic TA-binding groove in TRC40 (also known as ASNA1) reduces interaction with most, but not all, substrates suggesting that co-purification may also reflect interactions unrelated to precursor protein targeting. We confirm known TRC40 substrates and identify many additional TA proteins interacting with TRC40. By using the trap approach in combination with quantitative mass spectrometry, we show that Golgi-resident TA proteins such as the golgins golgin-84, CASP and giantin as well as the vesicle-associated membrane-protein-associated proteins VAPA and VAPB interact with TRC40. Thus, our results provide new avenues to assess the essential role of TRC40 in metazoan organisms.

This article has an associated First Person interview with the first author of the paper.
The Principle of Least Action As Universal Principle of Productive Housekeeping
Authors: Бабанов В. , Babanov V. , Хомяков В. , Homyakov V.
Published: June 2019

Any economic system is based on the analysis of the alternative development options existing in these conditions and the choice of the optimal one. In this case, the following question is fundamental: what principle of optimality should one be guided in when deciding on the choice of the option of carrying out economic activity. In this paper, it is proposed to use the Principle of Least Action (PLA) as such a principle. When applying this principle in practice, the goals of economic activity are achieved and the available resources are rationally used: the total costs of living and past (materialized) labor are minimized. The implementation of the PLA contributes to an increase in both the productivity of living labor and the productivity of aggregate labor. When used in practice PLA solves the problem of replacing manual labor machine. In this case, first of all, the release of heavy physical labor from economic activity takes place.
The Effectiveness of Fixed Assets in the Economy of the Regions of Modern Russia
Authors: Басовский Леонид , Basovskiy Leonid , Басовская Елена , Basovskaya Elena
Published: June 2019

The aim of the work was to study the dynamics of the influence of the main capital on labor productivity in the economy of modern Russia. To identify the effect of capital-labor ratio on labor productivity production function models were used. To obtain the models, Rosstat cross-section data were used for 80 regions of Russia for the period 2010–2017 except for the autonomous districts that are part of individual regions). In addition, for the period 2014–2017 cross section data were used for 82 regions of Russia, including the Republic of Crimea and the city of Sevastopol. The results of the simulation allowed us to determine that the capital productivity of labor in 2010–2017 explained from 75% to 81% of labor productivity in the regions of the country. In the period under review, there is a general tendency to reduce the impact of the capital-labor ratio, reflecting a decrease in the efficiency of using fixed capital in the country. The decline in the efficiency of using fixed capital in the economy may be a consequence of the formation of an institutional environment unfavorable to the economic development.
Uwięziona ambicja. Starania Jana Szczęsnego Herburta o uwolnienie z krakowskiego więzienia po rokoszu Zebrzydowskiego
Authors: Gałuszka Justyna
Published: June 2019

Ambition Imprisoned: Jan Szczesny Herburt's Attempts to Be Released from Prison in Krakow Following the Zebrzydowski Rokosz The article presents the endeavors of Jan Szczęsny Herburt (1567-1616) to leave the Kraków prison where he was placed after the Battle of Guzów in 1607. These were closely connected with contemporary domestic policy, which was dominated by a conflict between the monarch Zygmunt III Wasa and the Polish-Lithuanian nobility. Herburt was one of the few rokosz leaders to be imprisoned, and the monarch’s actions indicated that he wanted to punish the insubordinate noble firebrand.
Corrección de las dificultades psicopedagógicas de la lectura en español
Authors: Cadavid Ruiz Natalia , Jiménez Jiménez Sebastián , Quijano Martínez María Cristina , Solovieva Yulia
Published: June 2019

Hoy en día, se considera que la mayor parte de las dificultades en el desarrollo de la lectura se relacionan con deficiencias psicopedagógicas, y no precisamente con las alteraciones neurológicas propias de la dislexia. No obstante, pocos estudios exploran cuáles son los mejores métodos para apoyar el aprendizaje de la lectura ante estas deficiencias. Por ello, el presente estudio tuvo por objetivo evaluar la eficacia de un programa de intervención para mejorar el desarrollo inicial de la lectura en niños con estas dificultades. Para ello se evaluaron 54 niños entre los 7 y 8 años de edad, que cursaban primero y segundo de primaria en un colegio público de la ciudad de Cali: 26 niños con dificultades de la lectura y 28 con un apropiado aprendizaje. El programa de intervención se aplicó durante cuatro meses con una intensidad semanal de cuatro sesiones. Todas las tareas se centraron en evidenciar a los aprendices la relación entre el lenguaje oral y escrito. Los resultados mostraron que los niños con dificultades psicopedagógicas mejoraron su conciencia fonológica y su precisión de lectura inmediatamente después de la intervención, así como cuatro meses después; sin embargo, mantuvieron un rendimiento lector inferior al de sus pares. Se concluye que el programa mejora la conciencia y codificación de la palabra como unidad de análisis, pero se requieren intervenciones complementarias para mejorar la comprensión y velocidad lectora.Palabras clave: lectura, intervención, alfabetismo emergente, dificultad en el aprendizaje.
Correlatos valorativos de crenças em teorias da conspiração
Authors: Teixeira Rezende Alessandro , Veloso Gouveia Valdiney , Mesquita do Nascimento Anderson , Vilar Roosevelt , Guedes Oliveira Karen
Published: June 2019

As teorias da conspiração podem ser conceituadas como crenças que servem para explicar comportamentos e ações de grupos ou organizações secretas. O presente estudo buscou investigar a relação entre valores e teorias da conspiração. Contou-se com a participação de 205 estudantes universitários (Midade = 21.7; 56.6% do sexo feminino), os quais responderam a Escala de Crenças Gerais Conspiratórias, o Questionário dos Valores Básicos e perguntas demográficas. Os resultados indicaram que tais crenças estão associadas, principalmente, com os valores humanitários como representados por aqueles de experimentação, suprapessoais e interativos, mas também com os valores de realização. Concluiu-se que os valores podem ser uma variável importante para explicar o endosso à crenças em teorias da conspiração, sobretudo valores que promovem maior abertura à mudança e justiça social, não se limitando a fontes e explicações convencionais de fatos complexos. Finalmente, limitações e potenciais aplicações são discutidas.
Total hip arthroplasty in obesity: separating ‘fat’ from fiction
Authors: Pietrzak JRT , Maharaj Z , Mokete L , Sikhauli N , van der Jagt DR
Published: June 2019

Obesity is a modern-day epidemic with increasing prevalence that is directly impacting the global burden of primary total hip arthroplasty. The risk of requiring total hip arthroplasty for osteoarthritis increases incrementally with increasing obesity class. Surgical intervention in obese patients presents a set of unique challenges that should be recognized by the treating medical team. Although predominantly satisfactory outcomes have been reported, perioperative anaesthetic and surgical concerns require thorough patient assessment. There is an increased potential risk of thrombogenic and septic complications, but the body mass index cutoff level beyond which total hip arthroplasty should not be offered in the obese patient remains controversial. Preoperative medical optimization of the patient and appropriate intraoperative interventions are essential to mitigate the risk of complications.
Data centres as logistical facilities: Singapore and the emergence of production topologies
Authors: Neilson Brett , Notley Tanya
Published: June 2019

Data centres mobilise server-client architectures to disperse and draw in labour from across industries and nations. In doing so, they provide an infrastructural fix for capitalist actors seeking to bypass traditional labour actions, by designing logistical routes around which to redirect production processes. In this article, we build on research that investigates the data centre industry in Singapore to consider how these facilities drive processes of global circulation and establish new kinds of labour relations and processes. We point to limits in conceptualising these relations according to dominant models of the supply chain or the production network. We argue that understanding the client footprint enabled by data centres as a form of territory allows us to approach these facilities as political institutions that influence the operations of power across wide geographical vistas.
O mototurismo e a sua relação com o turismo de aventura e o ecoturismo
Authors: Ramoa Carlos Eduardo de Almeida , Pires Paulo Dos Santos
Published: June 2019

O estudo da relação do motociclista com a viagem e seu destino, portanto com enfoque turístico, pode ser considerado ainda recente e em expansão no meio acadêmico, mesmo em nível mundial. Neste sentido, esta pesquisa teve como objetivo revelar o universo do comportamento, as atividades e a percepção do mototurista sob a perspectiva do turismo de aventura e do ecoturismo. Metodologicamente adotou-se uma orientação indutiva com abordagem qualitativa em nível exploratório a partir do estado da arte, seguida de uma abordagem quantitativa em nível descritivo, a partir de dados primários obtidos por amostra não probabilística intencional junto a mototuristas de vários países. Os resultados apresentam, primeiramente, uma discussão bibliográfica de fundo conceitual sobre a relação motociclismo e mototurismo, seguido da análise descritiva do perfil, motivações, atividades e comportamento de 428 mototuristas nas viagens e nos destinos. A adoção do turismo de aventura e do ecoturismo enquanto modelos de referência para as análises permitiu inserir o mototurismo, de forma inédita, no âmbito da pesquisa em turismo no Brasil, além de oferecer uma primeira aproximação para a sua oportuna inserção na segmentação turística.
O Exame Nacional e Desempenho dos Estudantes – ENADE – como instrumento sinalizador para avaliação e qualificação de cursos presenciais de graduação em turismo sob a ótica de coordenadores de curso
Authors: Marcelino Thays De Oliveira , Santos Marcia Maria Cappellano dos
Published: June 2019

Este trabalho, de caráter qualitativo e exploratório, objetiva analisar processos de mudança e qualificação, conduzidos por coordenações de curso, de projetos pedagógicos e de práticas pedagógicas e avaliativas resultantes de estudo analítico-interpretativo da prova do Enade para os cursos de graduação em Turismo e do respectivo relatório. Optou-se, como recorte temporal e espacial pela prova de 2012 e por cursos presenciais oferecidos no RS por instituições de diferentes naturezas jurídicas que haviam participado das edições anteriores. Entrevistas semiestruturadas versaram sobre quatro eixos: (a) organização do processo operacional de análise, (b) concepções de turismo subjacentes às questões, (c) avaliação das questões de cunho geral e (d) concepções pedagógicas e metodológicas igualmente subjacentes às questões. As teorias que estariam na base das questões não são explicitadas, mesmo sendo apontados, prioritariamente de modo positivo, alguns elementos/aspectos conceituais e pragmáticos a elas vinculados. Associado a isso, referentemente às repercussões na avaliação e qualificação dos cursos, os resultados ainda apontam que as análises realizadas e as medidas decorrentes empreendidas não refletem a percepção da potencialidade do Enade como instrumento avaliativo complementar para identificação, compreensão e desenvolvimento de de operações cognitivas e matacognitivas, a sua vez, relevantes ao desenvolvimento das competências próprias ao processo de formação do licenciado em turismo.
Cirrhosis as a Comorbidity in Conditions Subject to the Hospital Readmissions Reduction Program
Authors: Rosenblatt Russell , Cohen-Mekelburg Shirley , Shen Nicole , Tafesh Zaid , Lucero Catherine , Kumar Sonal , Fortune Brett , Liu Sze Yan , Brown Robert , Jesudian Arun
Published: June 2019

INTRODUCTION:

Although the Hospital Readmissions Reduction Program (HRRP) has decreased readmissions in targeted conditions, outcomes in high-risk subgroups are unknown. This study analyzed the impact of cirrhosis as a comorbidity on readmissions in conditions subjected to the HRRP.

METHODS:

Using a longitudinal analysis of the New York, Florida, and Washington State inpatient databases from 2009 to 2013, adult Medicare beneficiaries with a diagnosis-related group of targeted conditions by the HRRP—pneumonia, congestive heart failure (CHF), and myocardial infarction (MI)—were included. Exclusion criteria included inability to assess for readmission, previous liver transplant, or having a readmission not subject to penalty under the HRRP. A sensitivity analysis used the International Classification of Diseases, 9th Revision, Clinical Modification codes to identify pneumonia, CHF, and MI hospitalizations. The primary outcome was 30-day readmission, with secondary outcomes including 90-day readmission, trends, and cirrhosis-specific risk factors for readmission.

RESULTS:

Of the 797,432 patients included, 8,964 (1.1%) had cirrhosis. Patients with cirrhosis had significantly higher 30-day readmissions overall (29.3% vs 23.8%, P < 0.001) and specifically for pneumonia and CHF, but not for MI. Thirty-day readmission rates significantly decreased in patients without cirrhosis (annual percent change −1.8%, P < 0.001), but not in patients with cirrhosis (P = 0.39). Similar findings were present for 90-day readmissions. A sensitivity analysis confirmed these findings. On multivariable analysis, cirrhosis was associated with significantly higher 30-day readmissions (odds ratio 1.13, P < 0.001).

DISCUSSION:

When cirrhosis is comorbid in patients with conditions subjected to the HRRP, readmissions are higher and have not improved. Focused efforts are needed to improve outcomes in cirrhosis and other high-risk comorbidities within the HRRP cohort.
Endoscopic Sinusotomy Using Needle Knife Technique for Treatment of H-Pouch With Leak and Sinus
Authors: Khoudari George , Singh Amandeep , Shen Bo
Published: June 2019

A 62-year-old patient with a history of ulcerative colitis and total colectomy with ileal pouch-anal anastomosis was referred to our pouch center for rectal pain, loose stool, and perianal swelling. He was diagnosed with chronic fistula and anastomotic stricture for which he had excision of J-pouch and creation of H-pouch. Surveillance workup after surgery revealed pouch sinus, which was treated with needle-knife sinusotomy (NKSi). This is the first case in the literature of an H-pouch complicated with anastomotic sinus successfully treated with NKSi. We propose using NKSi as the preferred technique for pouch sinuses.
LA FORMACIÓN INICIAL DEL BIÓLOGO. PRESCRIPCIONES Y SUPUESTOS DADOS EN EL PLAN DE ESTUDIOS
Authors: Flores Miriam Liset , Bar Aníbal Roque
Published: June 2019

El presente trabajo tiene como objetivo reconocer las prescripciones y supuestos que orientan la formación de los futuros biólogos en una universidad de gestión pública de la República Argentina. La técnica seleccionada para la recolección y tratamiento de la información es la de análisis de contenido de su Plan de Estudios y del sitio web de la facultad donde se inserta la carrera. Los resultados muestran que la formación está orientada en un sentido fuertemente técnico, aunque con un anclaje importante en la actividad de investigación. Se advierte la promoción de estrategias pedagógicas definidas en torno del pensamiento crítico y reflexivo, lo cual tendría ciertas dificultades de implementación en tanto se identifica un plan de estudios atomizado en subdisciplinas que interfieren en la integración del saber biológico. No obstante la actualización y ampliación conceptual referida en los contenidos, éstas se hallan enmarcadas en perspectivas que no logran desanclarse de la vieja tradición mecanicista, encuadre todavía imperante en grandes sectores de formación en la disciplina.
Efek Pemberian Pre-emptive Fentanyl 25 μg terhadap Kejadian Batuk Setelah Bolus Fentanyl 2 μg/kg IV (Fentanyl Induced Cough)
Authors: Siswagama Taufiq Agus , Bagianto Hari , Laksono Ristiawan Muji
Published: June 2019

Latar belakang: Fentanyl merupakan opioid sintetik yang poten, dengan berbagai kelebihannya sehingga fentanyl dijadikan pilihan utama agen premedikasi dan induksi anestesi umum. Kejadian batuk setelah pemberian bolus fentanyl intravena/ fentanyl induce cough (FIC) merupakan sesuatu yang tidak diharapkan pada kasus pembedahan tertentu sehingga pencegahan FIC haruslah dilakukan. Beberapa penelitian telah dilakukan namun kurang efisien, oleh karenanya pada penelitian ini dilakukan pemberian pre-emptive fentanyl dosis 25 μg untuk menurunkan FIC.Tujuan: Mengetahui efek pemberian pre-emptive fentanyl 25 μg intravena terhadap insiden batuk setelah bolus fentanyl 2 μg/kgBB intravena.Metode: Empat puluh pasien yang menjalani operasi dengan anestesi umum dipilih secara acak untuk diikutkan dalam penelitian. Dibagi menjadi dua kelompok, kelompok pertama (20 pasien) mendapat injeksi intravena normal salin 0,5 ml dan diikuti fentanyl 2 μg/kgBB dalam 2 detik, dan kelompok sisanya mendapatkan injeksi intravena fentanyl 25 μg sebelum fentanyl induksi. Digunakan tes Mann-Whitney dan uji korelasi Spearman untuk membandingkan dan menilai hubungan variabel.Hasil: Pemberian pre-emptive fentanyl menunjukkan nilai signifikansi 0.183 pada timbulnya batuk dibandingkan kelompok yang mendapat normal saline namun berkorelasi negatif. Hubungan insiden batuk diantara kedua kelompok bernilai tidak signifikan (p=0,08). Dari derajat batuknya, berbeda signifikan (p=0,043), dengan nilai koefisien korelasi negatif (-0,326) dan nilai yang signifikan (p=0,04).Simpulan: Pemberian pre-emptive fentanyl 25 μg dapat menurunkan insiden FIC namun secara statistik tidak bermakna.Perlu penelitian selanjutnya untuk mengetahui rentang dosis pre-emptive fentanyl yang tepat serta teknik lainnya sebagai alternative untuk menurunkan insiden FIC
Pengawasan Curah Jantung
Authors: Helmi Mochamat
Published: June 2019

Sebagai faktor penentu dari hantaran oksigen ke jariangan dan juga tekanan darah,curah jantung menjadi komponen penilaian hemodinamik yang penting.Penggunaanteknik thermodilusi yang menjadi standar baku, telah banyak diketahui mempunyairesiko karena teknik invasifnya. Sehingga teknik pengawasan CO yang kurang invasif,aman,akurat dan mudah digunakan, terus mengalami perkembangan. Tinjauanpustaka ini akan mamaparkan mengenai beberapa macam metode pengawasan CO.
Manajemen Anestesi pada Pasien dengan Kistoma Ovarii Permagna
Authors: Sinantyanta Hadyan , Gde Sujana Ida Bagus
Published: June 2019

Pendahuluan: Manajemen anestesi pada pasien dengan kistoma ovarium permagna merupakan tantangan karena memerlukan persiapan yang cermat dan memiliki risiko tinggi selama periode perioperatif . Seorang wanita 25 tahun dengan keluhan perut kembung mengganggu aktivitas karena sesak nafas .Tujuan:Melaporkan pengelolaan anestesi pada wanita dengan kistoma ovarium permagna.Metode: Seorang wanita berusia 25 tahun datang dengan keluhan perut membesar sejak 15 bulan sebelum masuk rumah sakit, pasien mengeluhkan kesulitan bernapas. Aktivitas mulai berkurang, terdapat kesulitan berjalan. Pasien memiliki lingkar perut 109 cm. Pemeriksaan USG menunjukkan kistoma besar dengan ascites. CT scan abdomen menunjukkan massa kistik besar dengan ukuran 30,3 x 34,9 x42 ,1 cm dengan komponen padat mendesak usus dan adanya hidronefrosis derajat IV dan III di kiri-kanan, cairan asites minimal intraperitoneal.Hasil: Operasi berlangsung selama 2 jam, kistoma berhasil diangkat secara utuh. Dengan berat massa saat ditimbang 23 kg. Perdarahan intraoperatif sekitar 500 ml, dan produksi urin 1600 ml. Setelah 19 jam pengawasan di unit perawatan intensif, pasien diekstubasi. Setelah hari ketiga pasien dirawat di ruangan. Berat pasien 30 kg diruangan. Aktivitas fisik normal dan tanpa keluhan nyeri dengan skala VAS ( skor analog visual) saat diam dan saat bergerak 2 cm 0 cm. Pasien diijinkan pulang ke rumah setelah hari ke-8 pasca operasi untuk rawat jalan.Ringkasan: Manajemen anestesi telah dilakukan pada wanita dengan kistoma ovarium permagna.Operasi berjalan sukses dan pasien diperbolehkan pulang ke rumah setelah hari ke-8 pasca operasi untuk rawat jalan
Efek Blok Transversus Abdominis Plane Teknik Landmark Terhadap Kebutuhan Analgetik Pascabedah Herniorafi
Authors: Asdarina Nur , Salam Syamsul Hilal , Tanra Husni
Published: June 2019

Latar Belakang : Blok transversus abdominis plane (TAP) adalah teknik yang aman, mudah, dan efektif untuk memberikan analgesia pascabedah pada operasi yang melibatkan dinding anterior abdomen.Obyektif : Menilai  efek blok TAP teknik landmark terhadap kebutuhan analgetik pascabedah herniorafi.Metode : Penelitian ini merupakan uji klinik tersamar tunggal. Penelitian dilakukan pada 44 pasien laki-laki, usia 18-60 tahun, status fisik ASA I-II, dan IMT 18-24 yang menjalani operasi herniorafi elektif dengan anestesi spinal. Pasien dibagi menjadi kelompok TAP  (n=22) yang mendapatkan blok TAP dengan bupivakain 0,25% 20 ml ditambahkan epinefrin 1:200.000  setelah operasi selesai; dan kelompok kontrol (n=22) yang tidak mendapatkan blok TAP. Semua pasien diberikan  meloksikam suppositoria 15 mg dan tramadol 0,1 mg/kgBB/infus kontinyu pada akhir operasi. Penilaian skala nyeri menggunakan Numeric Rating Scale (NRS), bila NRS mencapai 4 diberikan rescue fentanil 0,5 mcg/kgBB; waktu rescue pertama dan kebutuhan total fentanil selama 24 jam pascabedah dicatat.Hasil : Waktu rescue pertama lebih panjang pada kelompok TAP  dibandingkan dengan kelompok kontrol (17,81 ± 7,62 berbanding 9,15 ± 8,12 jam; p<0,001). Kebutuhan total fentanil dalam 24 jam lebih sedikit pada kelompok TAP  dibandingkan dengan kelompok kontrol (9,21 ± 13,59 berbanding 30,88 ± 20,39 mcg; p=0,02).Simpulan : Sehingga dari penelitian ini disimpulkan bahwa blok TAP sebagai komponen rejimen analgesia multimodal memberikan analgesia yang efektif  dengan durasi analgesia lebih panjang dibanding kontrol dan memiliki opioid sparing effect yang tinggi.
Pengaruh Lidokain Intravena Terhadap Kadar Superoxide Dismutase 1 (Sod-1) Paru Kelinci Dengan Lung Ischemic Reperfusion Injury Model
Authors: Kurniawan Mohammad Arief , Arifin Johan , Nugroho Taufik Eko
Published: June 2019

Latar belakang : Angka kejadian komplikasi paru paska operasi non jantung dibandingkan dengan komplikasi jantung yaitu 2,7% dan 2,5%. Penyebab hal ini adalah stres oksidatif, ketidakseimbangan radikal oksigen dan endogenous scavenging system.Lidokain  menghambat saluran natrium dan, mengurangi masukan kalsium intraseluler, mengurangi produksi Reactive Oxygen Species (ROS) dan modulasi bioenergetika mitokondria, sehingga diharapkan lidokain mampu meningkatkan kadar antioksidan alami di dalam sel.Superoxide Dismutase-1 (SOD-1) adalah salah satu antioksidan alami didalam sel yang berperan dalam melindungi organ dari anion superoksida yang berbahaya dengan mengubah anion yang dihasilkan dari cedera setelah ischaemia-reperfusion.Tujuan : Mengetahui efek lidokain intravena terhadap kadar Superoxide Dismutase 1 (SOD-1) paru kelinci dengan lung ischemic reperfusion injury model.Metode : Desain eksperimental laboratorik, 16 kelinci dibagi menjadi dua kelompok secara acak. Kelompok kontrol mendapat perlakuan lung ischemic reperfusion injury dan kelompok perlakuan dilakukan lung ischemic reperfusion injurydan mendapat injeksi lidokain 1,5mg/kgBB/jam intravena secara kontinyu kemudian diukur kadar SOD-1 jaringan paru kedua kelompok. Uji normalitas menggunakan uji Shapiro Wilk dilanjutkan uji beda Independent T-test.Hasil : Kadar SOD-1 paru kelinci dengan lung ischemic reperfusion injurydan mendapat lidokain lebih tinggi secara signifikan (p=0,01) dibandingkan dengan kadar SOD-1 paru kelinci dengan lung ischemic reperfusion injuryKesimpulan : Pemberian lidokain kontinyu intravena dapat meningkatkan kadar SOD-1 paru kelinci dengan lung ischemic reperfusion injury.
Is There Truth in Pain?
Authors: Rejali Darius
Published: June 2019

This essay explores four ways in which we believe truth can be found in painful experiences, even among those people who doubt that torture “works.” These endoxa, or commonplace beliefs, tap into deep human anxieties—about manhood, the maintenance of a just world, the meaning of suffering, and the possibility of transcending injustice. As such, they make it difficult for people to hear arguments against torture, including coerced interrogation. The essay suggests alternative ways of engaging these beliefs while acknowledging the challenge of dislodging them.
Molecular prognostic factors in small-intestinal neuroendocrine tumours
Authors: Samsom K G , van Veenendaal L M , Valk G D , Vriens M R , Tesselaar M E T , van den Berg J G
Published: June 2019

Background

Small-intestinal neuroendocrine tumours (SI-NETs) represent a heterogeneous group of rare tumours. In recent years, basic research in SI-NETs has attempted to unravel the molecular events underlying SI-NET tumorigenesis.

Aim

We aim to provide an overview of the current literature regarding prognostic and predictive molecular factors in patients with SI-NETs.

Method

A PubMed search was conducted on (epi)genetic prognostic factors in SI-NETs from 2000 until 2019.

Results

The search yielded 1522 articles of which 20 reviews and 35 original studies were selected for further evaluation. SI-NETs are mutationally quiet tumours with a different genetic make-up compared to pancreatic NETs. Loss of heterozygosity at chromosome 18 is the most frequent genomic aberration (44–100%) followed by mutations of CDKN1B in 8%. Prognostic analyses were performed in 16 studies, of which 8 found a significant (epi)genetic association for survival or progression. Loss of heterozygosity at chromosome 18, gains of chromosome 4, 5, 7, 14 and 20p, copy gain of the SRC gene and low expression of RASSF1A and P16 were associated with poorer survival. In comparison with genetic mutations, epigenetic alterations are significantly more common in SI-NETs and may represent more promising targets in the treatment of SI-NETs.

Conclusion

SI-NETs are mutationally silent tumours. No biomarkers have been identified yet that can easily be adopted into current clinical decision making. SI-NETs may represent a heterogeneous disease and larger international studies are warranted to translate molecular findings into precision oncology.
Adrenalectomy impairs insulin-induced hypophagia and related hypothalamic changes
Authors: Uchoa Ernane Torres , Marangon Paula Beatriz , Rorato Rodrigo , Ruginsk Silvia Graciela , Debarba Lucas Kniess , Antunes-Rodrigues Jose , Elias Lucila L K
Published: June 2019

Adrenalectomy (ADX) induces hypophagia and glucocorticoids counter-regulate the peripheral metabolic effects of insulin. This study evaluated the effects of ADX on ICV (lateral ventricle) injection of insulin-induced changes on food intake, mRNA expression of hypothalamic neuropeptides (insulin receptor (InsR), proopiomelanocortin, cocaine and amphetamine-regulated transcript (Cart), agouti-related protein, neuropeptide Y (Npy) in the arcuate nucleus of the hypothalamus (ARC), corticotrophin-releasing factor in the paraventricular nucleus of the hypothalamus) and hypothalamic protein content of insulin signaling-related molecules (insulin receptor substrate (IRS) 1, protein kinase B (AKT), extracellular-signal-regulated kinase (ERK1/2), c-Jun N-terminal kinase (JNK), protein tyrosine phosphatase-1B (PTP1B) and T cell protein tyrosine phosphatase (TCPTP)) Compared with sham animals, ADX increased the hypothalamic content of pJNK/JNK, PTP1B and TCPTP, as well as decreased mRNA expression of InsR, and corticosterone (B) treatment reversed these effects. Insulin central injection enhanced hypothalamic content of pAKT/AKT and Cart mRNA expression, decreased Npy mRNA expression and food intake only in sham rats, without effects in ADX and ADX + B rats. Insulin did not alter the hypothalamic phosphorylation of IRS1 and ERK1/2 in the three experimental groups. These data demonstrate that ADX reduces the expression of InsR and increases insulin counter-regulators in the hypothalamus, as well as ADX abolishes hypophagia, activation of hypothalamic AKT pathway and changes in Cart and Npy mRNA expression in the ARC induced by insulin. Thus, the higher levels of insulin counter-regulatory proteins and lower expression of InsR in the hypothalamus are likely to underlie impaired insulin-induced hypophagia and responses in the hypothalamus after ADX.
BIOÉTICA DE LA LIBERACIÓN: JUSTIFICACIÓN A PARTIR DE UNA CRÍTICA A LA BIOÉTICA POTTERIANA
Authors: Espericueta José Luis
Published: June 2019

En este trabajo se defiende la pertinencia de elaborar una bioética desde la corriente del pensamiento de liberación. Para lo anterior, se analiza el núcleo de la bioética pionera estadounidense de Van Rensselaer Potter en relación con tres puntos: su concepción antropológica, su objetivo y su fundamentación teórica. Posteriormente, y a modo de contraste, se retoman los mismos tres conceptos analizados, pero desarrollados ahora desde la perspectiva del movimiento de liberación. Una vez hecho esto se evidenciará la necesidad de invertir esfuerzos en reivindicar una función liberadora en esta disciplina.
ENTREVISTA CON JORGE IVÁN ARANGO, MÉDICO DEL MODELO DE MEDICINA SINTERGÉTICA
Authors: Rodríguez Allen Ana Cecilia , Castro Anabelle Contreras
Published: June 2019

El médico colombiano Jorge Iván Arango visitó Costa Rica, en el mes de noviembre de 2018, con motivo de la apertura del primer grupo de formación en Medicina Sintergética, e impartió el primer módulo. Esta es una propuesta nacida en Colombia y liderada por el Dr. Jorge Carvajal, que implica una concepción de vida y un replanteamiento de conceptos como: paciente, enfermedad, salud, terapeuta, curar, sanar, para ver al ser humano de forma integral. Para ello, reúne varios paradigmas y tradiciones, tanto de modelos de medicinas antiguas de otros países, como China e India, así como de aquellos ancestrales de nuestro continente, sin por ello querer competir o rechazar la medicina hegemónica. Antes bien, propone la integración, el estudio de los mínimos comunes de varios modelos y la enseñanza de la autogestión de la salud. El médico Jorge Iván Arango es un gran conocedor de las medicinas complementarias y un activo promotor de la salud auto- gestionada en las comunidades de bajos recursos.