bluuebunny/crossref_metadata_2025 huggingface dataset:
ESTABLISHMENT OF CHARITY LOBBYING IN THE CONTEXT OF PUBLIC AUTHORITY INTERACTION AND CIVIL SOCIETY IN UKRAINE
Authors: LOPUSHYNSKYI Ivan , OSTAPIAK Vasyl , KUSHNIRIUK Sergiy
Published: July 2024

The article examines the problems of the formation of honest lobbying in the context of interaction between public authorities and civil society in Ukraine; it has been proven that lobbying is an integral part of the political process in a democratic society, as it is a special system of realizing the interests of various groups of the public through its influence on legislative and executive bodies of public power; it is shown that lobbyists or groups of lobbyists perform an important function of mediators between civil society and public authorities, informing the latter about the interests of certain groups of citizens, the state of affairs in certain spheres of life; that the positive activity of the lobbying institute is beneficial to society, as it significantly complements the complex system of checks and balances, as it allows comparing group interests, opportunities and consequences of various actions and contributes to the reflection of these interests and opportunities in political decisions; the experience of the developed democratic countries of the world, primarily the USA, in lobbying over the past decades is described; analyzed the main principles of the Law of Ukraine dated February 23, 2024 «On Lobbying»; it has been proven that the adoption of this normative-legal act, according to the intention of the legislators, should ensure a reduction in the level of corruption-inducing factors in Ukraine in the processes of planning the development, development and adoption of normative-legal acts, will ensure the equal rights of citizens, civil society institutions and businesses regarding influence on public authorities, their officials and employees during their adoption of normative legal acts, will strengthen the transparency and efficiency of the activities of public authorities; it is shown that the adoption of this normative legal act will contribute to the acceleration of Ukraine's accession to the European Union.
EFFECTIVE PUBLIC ADMINISTRATION AND NATIONAL SECURITY IN THE CONTEXT OF THE DEEP STATE
Authors: OSTAPIAK Vasyl
Published: July 2024

The article explores the concept of the «deep state» as a key element of ensuring sustainable public administration and national security in war and peace. The author examines global and regional development trends that affect the formation of national security and analyses the mechanisms of power and governance in different countries. Particular attention is paid to the role of informal and closed networks in influencing official policy, which allows for a deeper understanding of the sources of information wars and manipulation of public opinion.
The relevance of the study is driven by the need to build a transparent, fair and democratic society, as well as to strengthen democratic institutions and protect the rights and freedoms of citizens. The analysis of the deep state allows us to identify the interconnections between state institutions, the military, intelligence services and big business, which often remain outside democratic control. The author notes that the study of the deep state is important for the protection of democratic values, increasing transparency, accountability and efficiency of governance. Particular attention is paid to the influence of the deep state on the information space and the mechanisms of manipulating public opinion through the media. Understanding these processes contributes to the development of critical thinking and the protection of citizens' rights and freedoms.
In the context of globalisation, the concept of the deep state is seen as an important factor influencing international relations, trade policies and economic alliances. The study of this phenomenon helps to predict changes in global politics and the economy, which is important for the development of long-term national security strategies. The term «deep state» is used to describe a network of influential individuals or organisations that can exert significant influence on public policy beyond democratic control. This concept is actively discussed in political debates, causing controversy over its role and influence on political processes.
Impact of a first-year medical student patient navigation initiative on healthcare access and students' skills
Authors: Morcate Lien , Masciarella Andrew , Dawra Emily , Legros Amy , Cho Courtney , Rasmussen Monica , Mascarenhas Kristen , Deshpande Amar R. , Taldone Sabrina
Published: July 2024

Background: Medical schools with complex patient populations, characterized by linguistic diversity and uncertain immigration status, face challenges in imparting essential skills in patient care, particularly in understanding healthcare barriers, building rapport, and fostering empathy. A South Florida medical school with a predominantly non-English-speaking and undocumented patient population piloted a Patient Navigation (PN) program within the first-year curriculum to address these challenges. We present the student feedback from the program’s first two years to guide medical schools in simultaneously caring for this unique patient population, with the aim of enhancing medical education. Methods: This program diverged from traditional Patient Navigation approaches by leveraging specialized hospital-associated translation services and collaborating with the Health System's Financial Assistance program. We performed a crosssectional study on student feedback surveys to identify program features significantly associated with a satisfying PN experience, and to provide insights to optimize and refine the program for future implementations. Results: The program engaged 245 out of 306 first-year medical students in PN for 118 patients. Successful contact was established with 55% of patients and 70% achieved their navigation objectives. Satisfaction metrics revealed that students given patients were nearly five times more satisfied than their counterparts. This positively impacts both student experience and patient outcomes, showcasing the program's effectiveness in bridging healthcare disparities. Discussion: The PN program proved successful in linking low-risk patients to follow-up care, offering medical students first-hand exposure to the challenges of care for primarily non-English-speaking and undocumented populations. The initiative aimed to enhance healthcare access for marginalized patients while providing medical students with an immersive understanding of patient-centric care beyond conventional curricular offerings. Key lessons learned include improving communication channels between students and patients, and optimizing community resources for streamlined patient support. Future iterations will prioritize these lessons, emphasizing cultural competence and patient advocacy to enhance both student education and patient care outcomes.
“It creates a divide”: minoritized medical students’ perceptions of professional identity formation
Authors: Volpe Rebecca L. , Geathers Jasmine , Loeffler Morgan , Costigan Heather , Smith Candis , Van Scoy Lauren J.
Published: July 2024

Background: If the task of professional identity formation (PIF) is for the trainee to become acculturated to a specific set of professional values, trainees whose individual identities are already closely aligned with the hegemonic values of medicine might be expected to have an easier PIF process than those trainees who begin their acculturation with individual values that are quite different than the prevailing values in medicine. Method: The present cross-sectional qualitative study examines the PIF experience of 15 medical students who face a range of structural inequalities and cultural constraints in a rural, predominately white medical school setting. Results: Five themes emerged from interviews: 1) participants’ decision to enroll in medical school was substantially influenced by family and broader community; 2) participants' expectations about starting medical school were not met; 3) participants perceived they were different from other medical students and also from the stereotypical physician; 4) participants felt pressure to adjust their personal identity; and 5) participants drew from personal identities to cope with stress. Discussion: These qualitative findings suggest that many participants felt their identity was often an asset in connecting with patients. Concurrently, participants felt a responsibility to return to practice in their home communities, which may represent a uniqueburden. Furthermore, some felt pressure to compromise or change their individual identity to be successful in medical culture. The task for medical schools may be to help students view their identities as a unique advantage, rather than something they need to quell or minimize to be successful.
Dasatinib-Induced Chylothorax- A Rare Case
Authors: Bhatia Ankit , Joshi Sharad , Tayal Nitesh
Published: July 2024

Dasatinib is an efficacious and highly potent second-generation oral tyrosine kinase inhibitor used in the therapy of Philadelphia chromosome-positive acute lymphoblastic leukaemia (ALL) or BCR-ABL-positive chronic myeloid leukaemia (CML). Pulmonary complications are commonly seen with Dasatinib therapy out of which pleural effusion is the most frequent finding. Pleural effusion in these cases is caused secondary to fluid retention, however, chylothorax causing pleural effusion is exceptionally rare. A 58-year-old man treated with second-line Dasatinib for CML presented to us with Empyema thoracis for a chest tube insertion. Thoracentesis showed thick dirty haemorrhagic aspirate, which was then inferred as chylothorax by cholesterol and triglyceride concentrations. After the exclusion of other common causes, drug-induced chylothorax was confirmed. Dasatinib was stopped, a short course of prednisolone was given and the chylothorax resolved. A substitute drug as suggested by the haematologist was started. There was no reoccurrence of pleural effusion.
Age-Defying Recovery from Severe Covid ARDS with Prolonged ECMO
Authors: Ansari Abdul Ansari , Gadekar Sushil
Published: July 2024

Historically, the survival of the elderly requiring ECMO support has been poor. Hence, there has been a reluctance to offer ECMO to patients above 65 years of age. Here, we have a case of an 80-year-old man with severe COVID-19 ARDS successfully treated with prolonged VV ECMO, which may perhaps encourage doctors to select the elderly for ECMO carefully.
Effect of COVID Vaccine on Long COVID: An Observational Study on Hospitalised Patients in North India
Authors: Budhiraja Sandeep , Indrayan Abhaya , Mahajan Monica
Published: July 2024

We know that vaccination reduces the risk of hospitalisation and death but how these vaccines impact long-COVID is under debate. The current study analyses the patterns of long-COVID amongst vaccinated and unvaccinated hospitalised patients during the three waves in India. From the computerised medical records of COVID patients admitted to a group of hospitals in and around Delhi every 3rd case of wave-1 and wave-2 and all cases of wave-3 were telephonically contacted in April 2022 for symptoms and their duration of long-COVID and their vaccination status. Of the 6676 contacted, 6056 (90.7%) responded. These were compared for two groups: fully vaccinated (913) and unvaccinated at the time of admission (4616). Others and deaths were excluded. “Symptom-weeks” was calculated as the sum of weeks of symptoms in case of two or more symptoms. The fully vaccinated cases had reduced length of stay in the hospital and had a milder disease. When all the cases are combined, almost three-fourths had symptoms lasting up to a month. In the first two waves, 15.6% (95% CI: 14.6%–16.7%) reported a duration of exceeding 4 weeks including 11.5% (95% CI: 10.6%–12.4%) even one year or more. During wave-3, more vaccinated patients reported short-term long-COVID than the unvaccinated group. The cases with diabetes (OR = 1.96, 95% CI: 1.45–2.66) and hypertension (OR = 1.60, 95% CI: 1.25–2.04) had higher odds of reporting at least one symptom when the effect of vaccination, age, sex, severity and length of stay was adjusted. Most common symptoms reported by both the groups were fatigue, insomnia and myalgia. There were differences in the duration and the type of long-COVID symptoms between the vaccinated and the unvaccinated groups but overall, no difference could be detected. Nearly 15% reported symptoms of duration at least 4 weeks including 11% at last one year. Some symptoms were more common in the vaccinated and some others more common in the unvaccinated but overall, the vaccination did not alter either the incidence or the duration of long-COVID.
Development and Implementation of Training Resource Package for School Heads
Authors: Madera Rolly Ben
Published: July 2024

This study aimed to develop a training resource package and implement and evaluate the training program for Western Visayas school heads based on their priority competency needs, according to the Philippine Professional Standards for School Heads (PPSSH). Using the Analysis, Design, Development, Implementation, Evaluation (ADDIE) model, this descriptive developmental study identified the priority competency needs of school heads, assessed the quality of the Training Resource Package, measured participants' learning before and after the program, and evaluated their satisfaction with the training sessions, venue and accommodation, program management, and resource persons. Statistical analyses included mean and Wilcoxon Signed Rank Test with a significance level 0.05. Results showed that school heads' needs covered learning assessment, teaching standards, school planning, professional development, learner discipline, school facilities, learning environment, teacher performance feedback, and learner achievement. A Training Design and Proposal encompassed program title, description, prerequisites, duration, management level, target participants, budget, activity requirements, funding sources, rationale, objectives, outputs, training methods, and action plan. The Training Resource Package was rated high quality (M=3.0). Among 104 randomly selected school heads from 21 School Divisions in Region VI, participants' competence increased from "highly competent" (M=66.99%) to "very highly competent" (M=96.19%) post-training, with a significant improvement (p=0.00 < α). Participants reported strong satisfaction with sessions (M=3.99), program management (M=3.99), venue (M=3.99), accommodation (M=3.98), and resource speakers (M=3.99). It is recommended that school heads should apply the competencies acquired from the training program to improve instructional supervision practices, enhance school leadership, and advocate for opportunities for teachers and staff to participate in similar training programs to foster continuous growth and improvement within the school community. Furthermore, as instructional leaders, school heads should design and implement relevant and needs-based professional development programs for teachers.
THE STATE POLICY OF THE USSR IN THE FIELD OF DEVELOPMENT OF THE OIL REFINING AND PETROCHEMICAL INDUSTRY IN THE 1960S: ACHIEVEMENTS AND REASONS FOR LAGGING BEHIND
Authors: БОДРОВА Е.В. , КАЛИНОВ В.В.
Published: July 2024

На основе к настоящему времени рассекреченных архивных документов исследуется актуальная проблема реализации государственной политики в сфере развития нефтепе- рерабатывающей и нефтехимической промышленности в СССР в 1960‑е гг. Осуществле- ние анализа сравнительных данных, заключений экспертов позволило сформулировать выводы о наличии факторов, определивших отставание в этой сфере от ведущих капиталистических стран и стран-союзников. В качестве причин торможения названы: дефицит современного оборудования; недостаточность выделяемых средств и просчеты планирования; отставание в развитии транспортных средств для вывоза нефтепродуктов; слабый уровень подготовки сырья на промыслах и др. Произведенная продукция не отличалась качеством, не была достаточно конкурентоспособной. Низкие цены на нефть и нефтепродукты сдерживали разработку и при- менение ресурсосберегающих технологий. Фактором торможения являлись и политические мотивы, форсированный экспорт нефти в социалистические страны.

Based on the currently declassified archival documents, the current problem of implementing state policy in the field of development of the oil refining and petrochemical industry in the USSR in the 1960s is being investigated. The analysis of comparative data and expert opinions made it possible to formulate conclusions about the presence of factors that determined the lag in this area from the leading capitalist countries and allied countries. The reasons for the slowdown are: a shortage of modern equipment; insufficient funds allocated and planning miscalculations; lagging in the development of vehicles for the export of petroleum products; a weak level of preparation of raw materials in the fields, etc. The products produced were not of high quality and were not competitive enough. Low prices for oil and petroleum products hindered the development and application of resource-saving technologies. Political motives and forced oil exports to socialist countries were also a factor in the slowdown.
THE FIRST OPTION FOR THE CONSTRUCTION OF A TRANSPOLAR RAILWAY (1943–1944)
Authors: КОЛЕВА Г.Ю. , КОЛЕВ Ж.М.
Published: July 2024

В истории Тюменской области, которой в этом году исполняется 80 лет, есть ряд нереализованных проектов. К их числу относится и строительство Трансполярной магистрали. Цель данной статьи — рассмотреть, что представлял начальный, первый из трех, вариант дороги, называемой «Трансполярная магистраль». Источниковая база про- блемы очень скудна, в силу засекреченности документов в период строительства, и скорей всего, сохраняющихся грифов секретности на значительную часть документов по сей день. В статье использованы общенаучные методы анализа, синтеза, обобщения, гипотез, аналогии, а также исторические методы исследования, среди них — историко-генетический метод, направленный на выявление происхождения изучаемого процесса, его причин; историко-диахронный метод, связанный с изучением динамики процесса в рамках более сложной системы, а также историко-сравнительный метод. Основной вывод авторов сводится к тому, что в условиях обострения военного противостояния в Арктике в 1943–1944 гг. на повестку был поставлен вопрос строительства дороги от Воркуты до Салехарда, а затем с ее продол- жением, как минимум, до Пуровского района, где находилась «бухта Находка». Проект отвечал военно-стратегическим целям, а также предусматривал обеспечение топливом, как территории ЯННО, так и объектов военного значения в заливах Карского моря. Снятие проекта с повестки в 1944 г. объяснялось установлением безопасности Арктики в результате проведенных советскими войсками операций.

In the history of the Tyumen region, which turns 80 this year, there are anumber of unrealized projects. These include the construction of a TranspolarRailway. The purpose of this article is to consider what the initial, first of threevariants of the road, called the " Transpolar Railway", represented. The source baseof the problem is very scarce, due to the secrecy of documents during the construction period, and most likely, the remaining secrecy stamps for a significantpart of the documents to this day. The article uses general scientific methods ofanalysis, synthesis, generalization, hypotheses, analogies, as well as historicalresearch methods, among them — the historical-genetic method aimed at identifyingthe origin of the process under study, its causes; the historical-diachronic methodassociated with the study of the dynamics of the process within a more complexsystem, as well as the historical-comparative method. The main conclusion of theauthors is that in the conditions of the aggravation of the military confrontation inthe Arctic in 1943–1944 the issue of building a road from Vorkuta to Salekhard, and then with its continuation, at least to the Purovsky district, where theNakhodka Bay was located, was put on the agenda. The project met militarystrategic goals, and also provided for the provision of fuel for both the territory of YANND and military facilities in the bays of the Kara Sea. The removal of theproject from the agenda in 1944 was explained by the establishment of Arctic security as a result of operations conducted by Soviet troops.
THE PLACE OF DISTILLING IN THE ECONOMIC DEVELOPMENT OF WESTERN SIBERIA IN THE SECOND HALF OF THE NINETEENTH CENTURY
Authors: СКУБНЕВСКИЙ В.А. , МАРИУПОЛЬСКИЙ А.М.
Published: July 2024

Данная статья посвящена собственно не самому винокурению как весьма успешно раз- вивавшейся отрасли обрабатывающей промышленности Западной Сибири во второй половине ХIХ в., а той роли, которую играло производство спирта в плане стимулиро- вания процесса развития экономики региона в целом. Винокурение наряду с виноторговлей создавало благоприятные условия для формирования и укрепления товарно-денежных отношений, ускоряло процесс первоначального накопления капиталов и способствовало социально-экономическому развитию Западной Сибири. Хронологические рамки статьи охватывают вторую половину ХIХ в. При работе над данной статьей авторы использовали как архивные данные, так и сведения, содержащиеся в опубликованных источниках, а также работах других исследователей.

This article is devoted not to distilling itself, as a very successfully developing branch of the manufacturing industry in Western Siberia in the second half of the nineteenth century, but to the role played by alcohol production in terms of the development of the region’s economy as a whole. Distillery production, along with wine trade, created favorable conditions for the formation and strengthening of commodity-money relations, accelerated the process of initial capital accumulation and contributed to the socio-economic development of Western Siberia. The chronological framework of the article covers the second half of the XIX century. When working on this article, the author used both archival data and information contained in published sources, as well as the works of other researchers.
«SOBREFEMINIZACIÓN» DE LOS CUIDADOS: EL TRABAJO CON ESCASOS DERECHOS
Authors: Rodríguez Escanciano Susana
Published: July 2024

Pese al tiempo transcurrido desde la consagración constitucional del derecho a la igualdad y no discriminación entre mujeres y hombres y sin dejar de reconocer los avances derivados de la regulación normativa, la realidad de las relaciones laborales está todavía lejos de ofrecer un panorama de verdadero equilibrio y de efectiva igualdad para las mujeres. Al tiempo, la reconversión productiva asociada a las ineludibles exigencias de lucha contra el cambio climático puede provocar nuevas brechas de género.  Ante este panorama, es necesario buscar las explicaciones concretas de esta preterición laboral en aras a corregir este abrupto devenir, adoptando una perspectiva propositiva capaz de introducir mejoras ad futurum.  A tal efecto, se ha llevado a cabo un análisis multifactorial de las circunstancias que inciden en las altas tasas de pobreza femenina y de precariedad laboral, el rostro femenino de los cuidados, la segregación ocupacional, el trabajo informal, el emprendimiento sin red, fórmulas de economía social, la parcialidad y la temporalidad, la siniestralidad laboral, la ordenación sexista de la clasificación profesional, la inexistente promoción vertical, las exigencias de constante disponibilidad, la mera formalidad en la corresponsabilidad, la particular problemática de los territorios rurales, el ecofeminismo o, entre otros, los dobles o triples estigmas que padecen las mujeres que acarrean una discriminación interseccional. Asimismo, se han propuesto vías de avance y buenas prácticas para la erradicación de las discriminaciones múltiples obrantes por razón de sexo y género en el contexto productivo actual apostando por el fomento del empleo de las mujeres en unas condiciones de trabajo dignas.
PREVALENCE OF EPISIOTOMY AND FACTORS ASSOCIATED WITH PRACTICE OF EPISIOTOMY AT SAINT PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE: A CROSS SECTIONAL STUDY
Authors: Tefera Tobiaw , Kebede Birhanu , Mekonen Tadios
Published: July 2024

ABSTRACTINTRODUCTION: Episiotomy is a surgical incision made on the perineum to widen the vaginal opening for delivery. Although rate of episiotomy decreased, it is still one of the most commonly performed procedures in obstetrics (1). OBJECTIVE: The objective of the study is to determine the prevalence of episiotomy and identify risk factors associated with the practice of episiotomy at (Saint Paul’s Hospital Millennium Medical College) SPHMMC. METHODOLOGY: Hospital-based cross-sectional study was conducted from February 1/2016 to July 1/2016. All mothers who gave birth vaginally were included in the study. Data was entered in to epi info version 7 and exported into SSPS statistical package version 16 and analyzed. Both bivariate and multivariate analysis were used to see the association of the dependent and independent variables with p-value <0.05 considered statistically significant. RESULT: A total of 405 participants were included in the study. The prevalence of episiotomy was 65.4%. Both Bivariate & Multivariate analysis showed that nulliparity, duration of second stage of labor more than 90-minute, instrumental delivery, assisted breech delivery & birth weigh more than 4,000 gm were strongly associated with episiotomy (p- value < 0.005). CONCLUSIONS AND RECOMMENDATIONS: The prevalence of episiotomy (65.4%) at SPHMMC is higher than the findings in other studies in Ethiopia & the WHO’s recommendation of 5- 10%. Nulliparity, duration of second stage of labour more than 90 minutes, instrumental & breech vaginal deliveries and birth weight of more than 4000 gm were independent risk factors for episiotomy. KEYWORDS: Episiotomy, prevalence, risk factors
Pedagogías de simulación médica y las competencias profesionales de la enfermería en la atención del parto humanizado
Authors: Hernández Baquero Deysi Marilú
Published: July 2024

El propósito del estudio es destacar la importancia de las pedagogías de simulación médica en el desarrollo de competencias profesionales en enfermería, específicamente en la atención del parto humanizado. Como metodología se adoptó un enfoque cualitativo, basado en la teoría fundamentada. Para el análisis, se revisaron 30 documentos clave, incluyendo artículos científicos, informes y estudios relevantes en el campo de la simulación médica y la atención humanizada del parto. Este enfoque permitió una interpretación profunda y detallada del objeto de estudio, destacando con ello que estas simulaciones no solo mejoran las habilidades técnicas y el conocimiento clínico, sino que también fomentan la capacidad de los enfermeros para proporcionar una atención humanizada durante el parto. La combinación de la simulación médica con un enfoque en la humanización del parto asegura una preparación más completa y efectiva para los profesionales de enfermería, permitiéndoles abordar de manera integral las necesidades de las pacientes durante el parto. La investigación concluye en que las pedagogías de simulación médica son de vital importancia para el fomento de competencias profesionales en el ámbito de la enfermería, con un enfoque particular en la atención del parto humanizado.
HUMANITARIZATION OF MATHEMATICAL EDUCATION THROUGH THE USE OF METHODOLOGICAL REALITY
Authors: Omorov Sh. D. , Asanova J. K.
Published: July 2024

The problem of humanization of mathematical education is an important pedagogical problem in our time, related to the upbringing of a comprehensively developed personality in the learning process. Study the global problems of the modern world–environmental, energy crises, etc. great hopes are pinned on a solution. In this regarded, it is important to know what the goals of science are, how it solves "human" problems, what role the concepts of morality, good and evil play in science, etc. It is important to know whether it becomes more humane. With the change in the social orientation of science, with the strengthening of its influence on the social world and man, its internal directions are also changing.
ECONOMIC ANALYSIS OF LIQUOR PROHIBITION IN BIHAR ON THE EFFICIENCY CRITERIA
Authors: Mohan Dr. Shivani
Published: July 2024

The State of Bihar implemented a State wise liquor ban on manufacturing, possession, sale and consumption of Indian Made Foreign Liquor (IMFL), Foreign Made Foreign Liquor (FMFL) and Beer on April 5, 2016, through the “Bihar Prohibition and Excise Act, 2016” to empower women and control domestic violence faced by them due to excessive drinking. The present study is based on a critical analysis of the abovementioned legislation and its potential impact on the economy of Bihar. The impact analysis shall be based on data collected from different sources. The study will analyse the State’s economic capacity and its resources used towards effective implementation of the alcohol ban in the last four years. The study’s findings can help decide whether the abovementioned law is an economically efficient solution or not for a resource starved State like Bihar. The study will also shed light on the unintended consequences of the Bihar alcohol prohibition policy on the socio-economic environment of the State. Consequently, based on the findings, the policymakers can understand the impact of the policy on revenue, social and other economic expenditures of the State government, employment and economic growth of Bihar. At this point, it is imperative to understand that the economic impact of prohibition policy cannot be undermined. In order to assess the full range of economic implications of the liquor ban policy, the government of Bihar needs to understand that the implementation should not evoke contradictory responses from policy targets. This will make the alcohol prohibition policy well-designed and help control spill-over effects and other externalities attached to it.
IDENTIFYING THE ‘PEOPLE’ IN ‘WHAT WILL PEOPLE SAY’: INCORPORATING SOCIAL IDENTITY WITHIN LAW AND NORMS DISCOURSE
Authors: Roy Shubhangi
Published: July 2024

identity has an immediate and profound impact on how the two motivations for adhering to social influences operate in real world. First, individuals not only are likely to believe but ‘need to’ believe members from within their identity group are ‘right’ (and those outside to their group ‘wrong’) for self-esteem maintenance. Expressive powers of law, therefore, will vary considerably depending on how it portrays behaviors of those within my group. Second, whose positive opinion we crave for is deeply rooted in our social identity. This has direct consequence on how individual respond to a law when offenders are likely to be part of one’s identity (such as men responding to the #metoo movement or white Americans responding to All Lives Matter). The discussion also helps identify the limits of reputational tools like shaming for enforcing laws. Finally, the article highlights an important epistemological lacuna in the law and norms discourse by incorporating social identity within it. Individuals, when influenced by those they identify with, have both informational and normative reasons to adhere to these influences. The article argues that while either of the two motivations can ex-post rationalize the phenomenon, neither capture the true motivations underlying adherence through identification. The motivational dichotomy is not as evident as the discourse presumes and there is a need to revisit the framework we use to understand social influences.
Noonan Syndrome in a 14-year-old Female with Heart Failure
Authors: Nugraheni Dian Aristi , Widjaja Sri Lilijanti , Nursidiq Alfa Alfin
Published: July 2024

Noonan syndrome is a genetic disorder leading to multiple congenital abnormalities and other  health complications, with an incidence of one in 1,000 to 2,500 live births. It is difficult to identify  because of its various clinical manifestations. This is the case of a 14-year old female admitted  for cardiac failure. The patient was born with normal birth weight but had stunted growth and  started walking at the age of five years old. She had speech as well as learning difficulties.  She had curly hair, deeply grooved philtrum, ptosis, hypertelorism, micrognathia, low set ears,  webbed neck, pectus carinatum, mild thoracic scoliosis and short stature. Her bone age was  in line with that of an 8–10 months old infant. Her luteinizing hormone level was below normal.  Echocardiography showed severe infundibular pulmonary stenosis, secundum atrial septal defect  (ASD), bidirectional shunt with a diameter of 2.1 cm, an anterior rim of 3.71 cm and a posterior  rim of 1.17 cm. She also had severe tricuspid regurgitation due to severe infundibular pulmonary  stenosis, and moderate mitral regurgitation due to posterior mitral leaflet prolapse. She received  hormonal therapy, an angiotensin-converting enzyme inhibitor, a beta-blocker, spironolactone and  furosemide. Resection of the infundibular muscle, ASD closure and repair mitral valve was planned.  

KEYWORDS: diagnosis, management, Noonan syndrome
A Comparison of the 6-Minute Walk Test to Treadmill Exercise Test as a Tool to Evaluate Functional Capacity in Healthy ManilaMed Employees: The CoST TET Study
Authors: Narvas Nicy F , Barcelon-Cruz Mariel , Puzalan Felix Eduardo
Published: July 2024

INTRODUCTION: Functional capacity is a strong predictor of mortality and nonfatal cardiovascular outcomes in both men and women with and without coronary artery disease. This study aimed to compare the distance traveled of the 6-minute walk test (6MWT) to the metabolic equivalent (MET) of the treadmill exercise test (TET) as a measure of functional capacity among healthy ManilaMed (Medical Center Manila) employees and to determine and compare the distance traveled in 6MWT and the MET of TET according to general characteristics such as age, sex, height, weight, and body mass index (BMI) as determinants of maximal walking distance and the cause of the early termination of the TET.

METHODS: This was a single-center prospective cross-sectional study done at a private tertiary hospital. All participants underwent TET and 6MWT. Metabolic equivalent of TET, distance traveled in 6MWT, and the computed MET of the distance traveled were recorded and analyzed.

RESULTS: Fifty healthy employees performed both the 6MWT and the TET to measure their functional capacity. Twenty-two were males, and 28 were females. The mean age was 31.80 ± 7.17 years, and the mean ± SD for BMI was 25.05 ± 4.32 kg/m2. Using 400 m as predictor of good functional capacity, the farther the distance traveled (>400 m), the higher the MET they achieved in the TET, and the lower the distance traveled (<400 m), the lower the MET achieved in the TET (t test P = 0.0125). This study also showed that more than or equal to 400- m distance traveled in the 6MWT can be used as a measure of good functional capacity in this population. However, there was a significant difference (t test P = 0.006) in the computed MET in the 6MWT in relation to the MET achieved in TET. In this study age, sex, and BMI were the predictors of the distance traveled in the 6MWT (P = 0.0049) and in the TET.

CONCLUSION: The distance traveled in meters in the 6MWT can be used as an objective measure of functional capacity in healthy population, and >400-m distance can be used as a parameter of good functional capacity. The formula used to compute MET in the 6MWT is not comparable with the MET achieved in TET. Age, sex, and BMI significantly influenced the performance in the 6MWT and TET.
Clinical Outcome and Predictors of In-Hospital Mortality Among Patients With Infective Endocarditis at the Philippine Heart Center
Authors: Yap Emily Mae L , Medrano Ana Beatriz D , Ecarma Raquel Victoria M
Published: July 2024

BACKGROUND: Infective endocarditis (IE) continues to be a fatal disease if inappropriately diagnosed or managed. This study aims to determine the clinical features, outcomes, and predictors of mortality among those with IE in our institution. 

METHODOLOGY: We retrospectively reviewed 283 patients in our institutional database for all cases of IE admitted and diagnosed as having definite and possible IE based on the modified Duke’s criteria between 2007 and 2016. Incidence, clinical course, and predictors of outcomes were analyzed.  

RESULTS: The 10-year prevalence rate of IE was 0.21%, with 21 cases of IE for every 10,000 person-days. The mean age was 40 ± 16.5 years, with a male predominance (59%). Fever (47%) and dyspnea (36%) were the most common clinical presentation. One-half of the patients received empiric antibiotics prior to admission. Blood cultures were negative in 62% of cases. Streptococcus species was the most common isolated organism. β-Lactams as monotherapy or in combination with aminoglycosides were the most common antibiotics given. Acute kidney injury (18%), septic shock (15%), and acute heart failure (12%) were the most common major adverse events during hospitalization. The in-hospital mortality rate was 30%. On multivariate analysis, positive blood culture (odds ratio [OR], 8.7; 95% confidence interval [CI], 1.68–45.26; p = 0.010), acute kidney injury (OR, 5.0; 95% CI, 1.04–24.15; p = 0.045), septic shock (OR, 2.58; 95% CI, 1.33–5.01; p = 0.005), and surgical management for an emergent or urgent indication (OR, 0.22; 95% CI, 0.05–0.90) were independent predictors of mortality. 

CONCLUSION: Infective endocarditis continues to be associated with significant morbidity and mortality. The results of this study underscore the need to identify patients who are at high risk of complications as well as more aggressive medical and surgical management to improve outcomes. 

KEYWORDS: infective endocarditis, native valve endocarditis, prosthetic valve endocarditis valves
The Epidemiologic Burden of Hospitalization for Coronary Artery Disease Among Adults Aged 19 years and above in the Philippines
Authors: Santos April Ann A. Bermudez-delos , Tumanan-Mendoza Bernadette A , Mendoza Victor L , Sison Eric Oliver D , Punzalan Felix Eduardo R , Pestano Noemi S , Reyes Eugene B , Leon Karen Amoloza-de
Published: July 2024

INTRODUCTION: Most deaths from cardiovascular disease result from coronary artery disease (CAD). In the country, it consistently has been the most common cause of overall mortality for the last 10 years.

OBJECTIVE AND METHODOLOGY: The study aimed to determine the prevalence of hospitalization due to CAD using data collected from PhilHealth hospitalization claims from January 1 to December 31, 2017. The data retrieved included the demographic profile, management done, duration of hospitalization, facility type, and condition on discharge. Data analysis was done using median and interquartile range for continuous data, and frequency and percent distribution for categorical data.

RESULTS: There were a total of 7,739,396 PhilHealth medical and procedural claims for adult Filipino patients in 2017. Of the total claims, 2,787,401 were for medical conditions, with 51,053 claims for CAD (42,866 claims for medically managed cases and 8,187 claims for those with invasive procedures). This translated to an estimated prevalence rate of 1.8% or 1,831 claims for CAD for every 100,000 PhilHealth hospitalization claims for a medical condition. The majority of patients were male (57.4%), with a median age of 63 years. There were 42,328 claims (82.9%) for acute coronary syndrome (ACS) among the claims for CAD. The median (quartile 1, quartile 3) length of hospitalization for CAD patients who received pharmacologic therapy alone was 4 (3, 6) days, whereas it was 3 (1, 5) days for those who underwent procedures. Only 162 admissions (0.4%) had invasive procedures done during the index hospitalization. The overall in-hospital mortality rate for CAD claims who received only pharmacologic therapy was 9.2%. For CAD patients who underwent invasive procedures, the in-hospital mortality rate was 1.7%. The in hospital mortality for ACS patients who received pharmacologic therapy alone was 9.2%. For ACS patients with an invasive procedure done during the index hospitalization, it was 5.6%.

CONCLUSION: In 2017, hospitalization claims for CAD were 1.8% or 1,831 claims for every 100,000 PhilHealth claims for a medical condition. The majority of CAD patients were admitted for an ACS. Most of the ACS patients were given pharmacologic therapy alone. Low revascularization rate on index admission was noted.

KEYWORDS: coronary artery disease, acute coronary syndrome, prevalence, mortality
Trimetazidine as Adjunctive Therapy for Decreasing Major Adverse Cardiac Events in Coronary Artery Disease Patients Undergoing Reperfusion Strategy: A Meta-analysis of Randomized Controlled Trials
Authors: Saroca Christdianzen Grace P , Tan John David S , Bailon Douglas P , Te-Rosano Abigail  Louise D , Tiongco Richard Henry P
Published: July 2024

Trimetazidine as adjunctive therapy in cardioischemic patients has shown improvement in angina and left ventricular ejection fraction, but with conflicting evidence on hard clinical outcomes. This  meta-analysis aims to compare the efficacy of trimetazidine versus placebo in reducing cardiac   mortality and major adverse cardiac events (MACEs) in coronary artery disease patients after reperfusion strategies, whether percutaneous coronary intervention or thrombolysis. The primary outcomes examined were cardiac mortality and combined MACEs; secondary outcomes were repeat revascularization, heart failure after reperfusion, stent restenosis, recurrence of angina, and reinfarction. Trimetazidine in comparison to placebo was associated with lower cardiac mortality and combined MACEs, but results were not significant. Among secondary outcomes, only stent restenosis was significantly reduced (risk ratio, 0.53; 95% confidence interval, 0.34–0.83; P = 0.006). Further trials should be conducted with more standard dosing regimens, duration of therapy, and similar severities of ischemic disease.
Sulodexide as an Adjunct for the Management of Venous Ulcers: A Meta-analysis
Authors: Seguban Joseph Marc , Uy-Reyes Michelle Andrea , Lim Allan , Alajar Elaine , Pestaño Noemi , Punzalan Felix Eduardo , Tumanan-Mendoza Bernadette
Published: July 2024

Background: Venous leg ulcer is a common, chronic recurring condition that causes pain and disability. If not treated, it can lead to severe infection and malignant transformation. Sulodexide is a highly purified glycosaminoglycan with anti-thrombotic, anti-fibrinolytic and anti-inflammatory properties that make it a suitable agent for the management of venous leg ulcers. At present, there is insufficient evidence to support the efficacy of the use of sulodexide in the management of venous leg ulcers and ulcer pain.

Objective: This meta-analysis aims to determine the efficacy of sulodexide in the treatment of venous leg ulcers in the promotion of complete ulcer healing and the reduction of pain.

Methods: We selected studies with the following inclusion criteria: randomized controlled trials comparing sulodexide with placebo in reducing pain and promoting complete ulcer healing among patients with venous leg ulcers. Both MESH and free text were used for searching text with the following terms: “sulodexide”, “venous ulcer”, “ulcer healing” and “ulcer pain”. The databases used were PubMed, MEDLINE and the Cochrane Central Register of Controlled Trials. Studies published in any language were eligible, without restrictions. The search was restricted to studies conducted with human participants. A review of all the included trials in recent meta-analyses that included sulodexide in the management of venous ulcers was also done. Full-text articles of the selected articles were obtained from websites of publications and collections of both local and international libraries. For articles not available online, correspondence with the author was done. Data on incomplete ulcer healing was extracted from each included trial to determine the reduction of incidences of incomplete ulcer healing among patients with venous leg ulcers, with the use of sulodexide for two and three months. Analysis was done using Review Manager software version 5.3, with heterogeneity measured using I2.

Results: Four RCTs (n = 482) were included. Sulodexide was associated with significant reduction of incomplete healing of venous leg ulcer. The pooled analysis at one month showed risk ratio of 0.77 (0.63 to 0.96) with p value of 0.06 and I2 = 71%. At two months, the data showed risk ratio of 0.71 (0.53 to 0.94) with p value of 0.15 and I2 = 47%. At three months, the data showed risk ratio of 0.66 (0.53 to 0.83) with p value of 0.04 and I2 = 77%.

Conclusion: The results showed that sulodexide is an effective adjunct to wound care and compression therapy in the management of venous ulcer within two months of use. The results also suggest a reduction in ulcer size as early as one month with further improvement in ulcer healing with continued use for three months.

Keywords: sulodexide, venous leg ulcers, ulcer healing, pain.
Dual Antiplatelet Versus Single Antiplatelet in Post– Transcatheter Aortic Valve Implantation/Transcatheter Aortic Valve Replacement for Stroke Prevention: A Systematic Review and Meta-analysis
Authors: Yap Ralph , Bailon Douglas , Te-Rosano Abigail Louise
Published: July 2024

BACKGROUND: There is ambiguity on antiplatelet therapy for post–transcatheter aortic  valve replacement (TAVR) patients for stroke prevention, but dual antiplatelet therapy (DAPT) is  routinely started despite lack of data on effectiveness and bleeding safety of DAPT versus single  antiplatelet therapy (SAPT). This study aims to determine the effectiveness of DAPT versus SAPT  in stroke prevention and assess bleeding safety. 

METHODS: A systematic search was done for randomized clinical trials involving DAPT and  SAPT in patients who underwent TAVR. The primary outcome was stroke after 1 year of either  DAPT and SAPT and life-threatening bleeding. Secondary end points included all-cause mortality.  Trials were identified through systematic searches on the following databases (November 2019):  Cochrane, MEDLINE, and Google Scholar and ClinicalTrials.gov and World Health Organization  International Clinical Trials Registry Platform. Risk ratio was used for dichotomous outcomes.  Heterogeneity among the studies for the meta-analysis was detected using a χ2 test (0.01 level of  significance). Risk-of-bias assessment was done. 

RESULTS: There is a lower incidence of stroke in patients on DAPT, but with a higher incidence  of life-threatening bleeding and major bleeding. There is also a lower incidence of all-cause  mortality in SAPT. The statistical power of this meta-analysis is low due to small population size. 

CONCLUSION: Single antiplatelet therapy is comparable to DAPT in preventing stroke with the  added benefit of a lower incidence of life-threatening and major bleeding and a lower incidence  of all-cause mortality. 

KEYWORDS: antiplatelet therapy, bleeding, dual antiplatelet therapy, single antiplatelet therapy,  mortality, myocardial infarction, stroke, transcatheter aortic valve replacement, transcatheter  aortic valve implantation