bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost of Intravenous Analgesia for the Management of Acute Pain in the Emergency Department is Substantial in the United States
Authors: Palmer Pamela P. , Walker Judith A. , Patanwala Asad E. , Hagberg Carin A. , House John A.
Published: October 2019

Background: Pain is a leading cause of admission to the emergency department (ED) and moderate-to-severe acute pain in medically supervised settings is often treated with intravenous (IV) opioids. With novel noninvasive analgesic products in development for this indication, it is important to assess the costs associated with IV administration of opioids.

Materials and Methods: A retrospective observational study of data derived from the Premier database was conducted. All ED encounters of adult patients treated with IV opioids during a 2-year time period, who were charged for at least one IV opioid administration in the ED were included. Hospital reported costs were used to estimate the costs to administer IV opioids.

Results: Over a 24 month-period, 7.3 million encounters, which included the administration of IV opioids took place in 614 US EDs. The mean cost per encounter of IV administration of an initial dose of the three most frequently prescribed opioids were: morphine $145, hydromorphone $146, and fentanyl $147. The main driver of the total costs is the cost of nursing time and equipment cost to set up and maintain an IV infusion ($140 ± 60). Adding a second dose of opioid, brings the average costs to $151-$154. If costs associated with the management of opioid-related adverse events and IV-related complications are also added, the total costs can amount to $269-$273. Of these 7.3 million encounters, 4.3 million (58%) did not lead to hospital admission of the patient and, therefore, the patient may have only required an IV catheter for opioid administration.

Conclusions: IV opioid use in the ED is indicated for moderate-to-severe pain but is associated with significant costs. In subjects who are discharged from the ED and may not have required an IV for reasons other than opioid administration, rapid-onset analgesics for moderate-to-severe pain that do not require IV administration could lead to direct cost reductions and improved care.
Secondary Use of Data: Non-Interventional Study Best Practices in Planning and Protocol Development
Authors: Fang Juanzhi , Bruce Wirta Sara , Kahler Kristijan
Published: October 2019

Well established guidelines already exist that address best practices for Non-Interventional Study (NIS) design and methods. These guidelines provide advice on things to consider while designing a study and developing a protocol, but do not necessarily capture specific details related to the implementation of NIS. The intent of this paper is to propose a best practice for conducting secondary use of data NIS. We propose that the ideal implementation of a NIS should include the development of a strong Study Concept, followed by a detailed Protocol, Analysis Plan, Report, and considerations for Dissemination.

We review and discuss common mistakes/pitfalls and key considerations at each step from concept to publication. In many cases in this review, we have also provided suggestions or accessible resources that researchers can apply as a “best practices” guide when planning, conducting, or reviewing this investigative method.
New Oral Anaticoagulant Prescribing Decisions amongst General Practitioners: Handle with Care
Authors: Kirby Ann , Murphy Aileen , Bradley Colin
Published: October 2019

Background: Prescribing oral anticoagulants for atrial fibrillation patients is becoming more challenging as more alternatives enter the market. While warfarin has dominated the market it is a challenging medicine to use owing to its narrow therapeutic range, increased bleeding risk and requirement for continuous monitoring. The introduction of new oral anticoagulants (NOACs) offers a wider choice but they are more costly and their use also brings additional pharmacological considerations.

Objective: This paper investigates if the identified risk factors (renal impairment, hepatic impairment, other co-morbidities & drug interactions) influence GPs’ NOAC prescribing decisions, using a multivariate probit model, while controlling for other GP characteristics.

Methods: Employing primary data, collected using a dedicated survey of Irish GPs in November 2015, a multivariate probit is employed. This measures the joint decision making process of prescribing a NOAC based on four risk factors - renal impairment, hepatic impairment, other comorbidities and drug interactions.

Results: Younger GPs are more likely to consider ‘other co-morbidities’ and ‘renal impairment’ as important when making NOAC prescribing decisions. Male GPs are more likely to consider ‘other co-morbidities’ and ‘drug interactions’ as important when prescribing NOACs compared to female GPs. Prescribers who have initiated NOACs are more likely to consider ‘renal impairment’ as important compared with non-initiators.

Conclusions: Our study highlights the importance for general practitioners prescribing NOACs and caring for patients on oral anticoagulants, of adequate education, of appropriate patient selection and of appropriate monitoring of such patients. While warfarin prescribing remains predominant, NOAC prescribing is increasing. Incorporating the risk factors into prescribing decisions signals responsible prescribing for atrial fibrillation patients. Existing prescribing guidelines/toolkits need to be used in an effective manner.
Impact of Oxycodone HCl Extended-release Formulary Restrictions on Extended-release Opioid Market Share, Healthcare Resource Utilization and Costs in Commercial and Medicare Plans
Authors: Wade Rolin L. , Chen Chi-Chang , De Ajita P. , Howard Jaren C.
Published: October 2019

Background: Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans.

Objective: This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States.

Methods: This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs.

Results: The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05).

Conclusions: This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.
Translation of the UK Pediatric Influenza Vaccination Programme in Primary Schools to 13 European Countries Using a Dynamic Transmission Model
Authors: Gerlier Laetitia , Hackett Judith , Lawson Richard , Dos Santos Mendes Sofia , Eichner Martin
Published: October 2019

Objectives: To simulate the impact of a pediatric influenza vaccination programme using quadrivalent live attenuated influenza vaccine (QLAIV) in Europe by applying coverage rates achieved in the United Kingdom during the 2014–2015 season and to compare the model outcomes to the UK results.

Methods: We used a deterministic, age-structured, dynamic transmission model adapted to the demography, contact patterns and influenza incidence of 13 European countries, with a 10-year horizon. The reference strategy was the unchanged country-specific coverage rate, using quadrivalent inactivated vaccine (assumed efficacy against infection from 45% in 1-year-old children to 60% in healthy adults). In the evaluated strategy, 56.8% of 5–10-year-old children were additionally vaccinated with QLAIV (assumed efficacy 80%), as was the case in 2014–2015 in the United Kingdom’s primary school pilot areas. Symptomatic influenza cases and associated medical resources (primary care consultations [PCC], hospitalization, intensive care unit [ICU] admissions) were calculated. The evaluated versus reference strategies were compared using odds ratios (ORs) for PCC in the target (aged 5–10-years) and non-target adult (aged >17 years) populations as well as number needed to vaccinate (NNV) with QLAIV to avert one PCC, hospitalization or ICU admission. Model outcomes, averaged over 10 seasons, were compared with published real-life data from the United Kingdom for the 2014–2015 season.

Results: Over 13 countries and 10 years, the evaluated strategy prevented 32.8 million of symptomatic influenza cases (172.3 vs 205.2 million). The resulting range of ORs for PCC was 0.18–0.48 among children aged 5–10-years, and the published OR in the United Kingdom was 0.06 (95% confidence interval [0.01; 0.62]). In adults, the range of ORs for PCC was 0.60–0.91 (UK OR=0.41 [0.19; 0.86]). NNV ranges were 6–19 per averted PCC (UK NNV=16), 530–1524 per averted hospitalization (UK NNV=317) and 5298–15 241 per averted ICU admission (UK NNV=2205).

Conclusions: Across a range of European countries, our model shows the beneficial direct and indirect impact of a paediatric vaccination programme using QLAIV in primary school-aged children, consistent with what was observed during a single season in the United Kingdom. Recommendations for the implementation of pediatric vaccination programmes are, therefore, supported in Europe.
Real-world Bleeding Outcomes and Costs Following Vascular Graft Anastomosis Using PROLENE Sutures with HEMO-SEAL Technology in Patients Undergoing Abdominal Aortic Aneurysm Repair
Authors: Sutton Nadia Y. , Schmitz Niels-Derrek
Published: October 2019

Background: Suture hole bleeding is a common complication of vascular graft anastomosis that has potential to prolong vascular procedures, increase costs, and compromise patient outcomes.

Objectives: Compare real-world bleeding-related outcomes and costs following vascular anastomosis using PROLENE sutures with HEMO-SEAL technology (HEMO-SEAL sutures) compared with standard PROLENE sutures in patients receiving abdominal aortic aneurysm (AAA) repair in the United States.

Methods: AAA repair procedures using hemostats and either HEMO-SEAL sutures or standard PROLENE sutures were identified from 2009 to 2013 using the Premier Healthcare Database. The primary outcome was the number and cost of hemostat units. Secondary outcomes were number and cost of sutures, bleeding complications, and transfusions.

Results: A total of 5082 discharges for AAA repairs using hemostats and HEMO-SEAL sutures or standard PROLENE sutures were identified. HEMO-SEAL sutures were used in 79 (1.6%) discharges, standard PROLENE sutures were used in 4946 (97.3%); both sutures (excluded from the analysis) were used in 57 (1.1%). Discharge demographics were similar across suture groups, with the exception of disease severity; the HEMO-SEAL suture group had a higher proportion of minor discharges and a lower proportion of extreme discharges compared with the standard PROLENE suture group. Mean number of hemostat units used per discharge (2.34 vs 3.30; median = 2.0 in both groups; p=0.026) and median hemostat costs per discharge ($111 vs $186; p<0.01) were significantly lower in the HEMO-SEAL suture group compared with the standard PROLENE suture group. Fewer sutures per discharge (p<0.0001), lower mean costs of sutures per discharge, higher median costs of sutures per discharge (p=0.0045), and fewer transfusions (0.0019) were also seen in the HEMO-SEAL suture group compared with the standard PROLENE suture group. No statistically significant difference in bleeding complications was observed between suture groups.

Conclusion: The results indicate that real-world use of HEMO-SEAL sutures may be associated with reduced hemostat usage and costs, and reduced bleeding that requires additional hemostats and/or transfusions.
Clinical and Cost Burden of Primary Sjögren’s Syndrome: Descriptive Analysis Using a US Administrative Claims Database
Authors: Perera Sue , Ma Liyuan , Punwaney Raj , Ramachandran Sulabha
Published: October 2019

Background: Current knowledge of the disease burden of primary Sjögren’s syndrome (pSS) is limited.

Objectives: The primary objective of this study was to describe the demographic and clinical characteristics of patients with pSS. The secondary objective was to describe the treatment patterns and healthcare resource utilization of patients with pSS. Furthermore, clinical characteristics of interest were described and the proportions of patients with glandular versus extra-glandular disease were reported.

Methods: This was a retrospective cohort study (HO-15-16077) conducted in the US Truven MarketScan Commercial database. We report descriptive data from employees and their families, as covered by employer-sponsored medical insurance. The primary cohort comprised patients with pSS (with ≥1 diagnosis of sicca syndrome prior to January 1, 2013), with continuous enrollment for ≥24 months (January 1, 2012–December 31, 2013). Patients with conditions mimicking sicca symptoms not due to SS were excluded, as were those with connective tissue disease that may have suggested secondary SS. To compare the healthcare burden of patients with and without sicca symptoms, a 1:1 matched comparator population comprising subjects without a previous diagnosis of sicca syndrome (sicca-free) was also identified.

Results: There were 12 717 eligible patients in the primary cohort. The majority (86%) was female and the mean age was 51 years. Overall, 60.7% of patients had claims associated with pSS extra glandular disease manifestations. These patients experienced a higher disease burden, and more commonly reported pain, fatigue or insomnia and any combination of pain, fatigue or insomnia (41.3%) compared with patients with glandular disease only (12.4%). Patients in the primary cohort incurred greater annual healthcare service costs (1.6 times greater, all causes) and healthcare resource utilization compared with the sicca-free comparator cohort. Patients with extra glandular disease also incurred greater average annual costs (2.9 times) contributing to ≥2 times/year more resource use for outpatient services than patients with glandular disease only.

Conclusion: Patients with pSS experience a high disease burden despite treatment. This study provides novel insights in to the extent of the burden on healthcare resources among patients with pSS, in particular for patients with extra-glandular disease manifestations, when compared with sicca-free subjects.
La Unidad Norte de la Cordillera Blanca y el Cambio Climático
Authors: Morales Arnao Benjamín , Santiago Martel Alexzander
Published: October 2019

La Cordillera Blanca del Perú es la cadena de montañas glaciares más extensa y alta del planeta en la zona intertropical. Tiene 180 km de largo y una superficie de
470 km² de glaciares. Su constitución geomorfológica la individualiza en varios sectores divididos por profundos valles glaciares o quebradas.

El sector más importante de la Cordillera Blanca está ubicado en la parte norte, entre la quebrada de Santa Cruz en su flanco sur y la quebrada Quitaracsa en su flanco norte, que drenan sus aguas al río Santa, teniendo como quebrada intermedia a Los Cedros. Esta gran superficie de territorio de montañas tiene cumbres glaciares entre los 4800 hasta los 6241 msnm, cinco cumbres superiores a los 6000 m, y encierra al famoso nevado Alpamayo, considerado la montaña más bella del planeta.
Por efecto de los cambios climáticos, con elevación de temperatura promedio mayor a 0.5 °C entre 1962 y 2016, se ha reducido el área de la superficie glaciar de 105.22 km², calculados con fotografías aéreas de los años 1962-1965, a 71.06 km² al año 2016, estimados en base a imágenes ópticas SPOT, reduciéndose a la vez las reservas hídricas en 34.16 km², con un aporte descendente de agua para los fines de la generación de energía, la agricultura y la industria, afectando el desarrollo futuro de las regiones de Ancash y la Libertad.
Las líneas que siguen en el presente artículo se refieren a las principales manifestaciones que se advierten en los glaciares por efecto de los impactos negativos del cambio climático y las correspondientes acciones de adaptación que se vienen dando.
Explorando Patrones y Controles en la Hidroquímica de Corrientes Proglaciales en el Alto Río Santa, Perú
Authors: M. Eddy Alex , G. Mark Bryan , Baraër Michel , McKenzie Jeffrey , Fernández Alfonso , Welch Susan , Fortner Sarah
Published: October 2019

La dramática pérdida de glaciares en la cuenca alta del río Santa en Ancash, Perú, tiene un impacto significativo en los sistemas hidrológicos proglaciales, con implicaciones para los factores estresantes aguas abajo en las actividades de uso humano del agua. Este estudio integra el análisis hidroquímico y la exploración espacial en múltiples escalas con el objetivo de explorar patrones y controles de la calidad del agua inorgánica en la región. La química de las aguas superficiales proglaciales está determinada principalmente por la intemperie en las áreas de contacto agua-roca, y el agua de deshielo glacial hereda las propiedades químicas de la litología superficial a lo largo de un camino de flujo. Los métodos de análisis hidroquímico identifican características elementales que son exclusivas de la región de estudio. Los procesos hidroquímicos dominantes incluyen la meteorización del silicato, la oxidación de pirita acoplada con el desgaste del silicato y, en menor medida, la meteorización del carbonato. El constituyente de sulfato es inusualmente alto para partes de la región de estudio y se atribuye a aguas altamente acidificadas inmediatamente aguas abajo de fuentes puntuales glaciales. La geovisualización amplía los resultados del análisis hidroquímico al mostrar cambios temporales y sugerir conexiones entre áreas de litologías superficiales recién expuestas, altas tasas de erosión y meteorización, y concentraciones elevadas de sulfato.
Pasantías Formativas del Instituto de Montaña: Generación de Información y Capacidades
Authors: Menéndez Isabel , Recharte Bullard Jorge
Published: October 2019

La región andina se enfrenta al reto inminente que supone la generación de acciones que favorezcan la adaptación y mitigación de los efectos originados por el cambio climático. Los ecosistemas andinos y las poblaciones humanas que de ellos forman parte son altamente vulnerables a la variabilidad climática que estamos enfrentando. Para desarrollar estas herramientas de adaptación, es crucial el impulso de la investigación científica de calidad, así como la recuperación y puesta en práctica de los conocimientos ancestrales desarrollados a lo largo de miles de años por las poblaciones humanas que habitan este territorio cambiante.

A fin de llevar a cabo estos propósitos a escala local en el entorno de la Cordillera Blanca, se detectaron una serie de brechas de información a ser cerradas, priorizando la falta y la dispersión de información de base ambiental a escala local que sirva para la realización de estudios e investigaciones que redunden en una mejora de las condiciones de vida de las poblaciones altoandinas.

Asimismo, desde el Instituto de Montaña (TMI) se detectó la necesidad de poner en alza y apoyar el talento y motivación de los jóvenes egresados de la Universidad Nacional Santiago Antúnez de Mayolo (UNASAM). Estas pasantías universitarias tienen una duración de entre seis y ocho meses, y constituyen un primer acercamiento laboral, una experiencia de trabajo junto a las comunidades rurales, la posibilidad de formar parte de un equipo interdisciplinario, así como la oportunidad de recibir capacitación especializada en los temas de trabajo desarrollados.
En el marco del programa, los y las pasantes han realizado hasta la fecha estudios base a nivel ecológico e hidrológico, tratamiento y sistematización de información hidrometeorológica recogida por el Centro de Investigación Ambiental para el Desarrollo (CIAD) de la UNASAM, levantamientos y tratamiento de información socioeconómica y modelamientos y evaluación del peligro proveniente de avalanchas glaciares. Los resultados y la información recabada han servido de base para estudios más específicos en torno a la implementación de Mecanismos de Retribución por Servicios Ecosistémicos (MRSE) y para la redacción de varios perfiles de proyectos de desarrollo como los Proyectos de Inversión Pública (PIP), entre otros.
Variación del pH en Aguas Superficiales Debido a Drenajes Ácidos de Roca en la Subcuenca Quillcay, Huaraz, Ancash
Authors: Martel Valverde Gabriel , C. Torres Lázaro Juan , Jara Infantes W. Harrinson
Published: October 2019

El objetivo de esta investigación es caracterizar la variabilidad del pH en la subcuenca Quillcay, basada en mediciones puntuales directas. Con este fin, se realizó la recolección de datos en diferentes puntos de la subcuenca dentro de tres microcuencas en 2016 y 2017. En total se midieron treinta y siete puntos dentro de la subcuenca Quillcay: diez en la microcuenca Cojup, diecisiete en la microcuenca Quillcayhuanca y diez en la microcuenca Shallap.
Las mediciones en las microcuencas y sus aportantes fueron analizadas con la finalidad de determinar tendencias que muestren si los valores exceden los Estándares de Calidad Ambiental para Agua (ECA de Agua). Además, se realizó un levantamiento geológico en las cabeceras de la subcuenca Quillcay para poder identificar las formaciones geológicas, con lo cual se pudo determinar zonas de alteración y afloramiento de un pórfido andesítico en la quebrada Cayesh, que contiene minerales generadores de acidez.
Para mostrar el retroceso glaciar, se analizó las cabeceras de las microcuencas mediante la comparación de imágenes satelitales recuperadas de Google Earth Pro el 7 de setiembre de 2018. Las imágenes a comparar fueron obtenidas mediante la herramienta de Google Earth Pro (Historial de Imágenes) que permitió obtener imágenes de octubre 2013 y julio 2017.
الضغوط النفسية لدى عينة من أمهات أطفال متلازمة داون
Authors: سلطان عادل مصطفي , التائب كوثر عبدالرحيم
Published: October 2019

يهدف هذا البحث إلى التعرف على مستوى الضغوط النفسية لدى عينة من أمهات أطفال متلازمة داون .وتكونت عينة البحث من (10) أمهات أطفال متلازمة داون واستخدم الباحثان المنهج الوصفي لملاءمته لطبيعة البحث،ولتحقيق أهداف البحث والإجابة على تساؤلاته قام الباحثان باستخدم مقياس الضغوط النفسية لأولياء أمور الأطفال المعاقين. إعداد (زيدان السرطاوي و عبدالعزيزالسيد الشخص) كما تم استخدام استمارة البيانات الشخصية إعداد الباحثين . والتى تحتوي على بيانات أولية تتعلق بجنس طفل متلازمة داون والمستوى الاقتصادي للأسرة والمستوى التعليمي للأم . الهدف منها معرفة تأتير هذة المتغيرات على مستوى الضغط النفسي لدى أمهات أطفال متلازمة داون . وتوصل البحث إلى أن أمهات متلازمة ذوَات المستوى التعليمي والاقتصادي المنخفض أكثر ارتفاعا لمستوى الضغط النفسي . وأن أمهات الأطفال الذكور أكثر ارتفاعا في مستوى الضغوط النفسية مقارنة بأمهات الأطفال الإنات .
Uniting to Move Forward: Native Hawaiian and Pacific Islanders in 2040
Authors: Chang Richard
Published: October 2019

This essay examines the importance of disaggregating Native Hawaiian and Pacific Islander data, issues currently faced by NHPI communities, and where NHPI communities could be in 2040. Projected demographic trends may exacerbate challenges faced by NHPIs in areas such as health, education, income, incarceration, housing, and immigration. The impact of climate change, technological innovations, and the United States’ shift towards a majority-minority status on NHPI communities are also analyzed. Three recommendations for improving the position of NHPIs in 2040 are provided: (1) Address the needs of an increasingly diverse NHPI community; (2) develop community capacity for civic engagement; and (3) invest in leadership development and NHPI youth.
Revisiting Works on Asian American Wealth and Inequality through Graphics
Authors: Cheng Alycia , Ong Paul , De La Cruz-Viesca Melany
Published: October 2019

The following text visually represent some of the major findings relating to the theme of wealth and financial security -- defined as having enough assets to address short-term needs (unemployment spells, health and other emergencies) and long-term investments (education, retirement).
Asian Americans and Pacific Islanders and Philanthropy in 2040
Authors: Ho Andrew
Published: October 2019

The trends we see in today’s philanthropy will have significant effects on the philanthropy of 2040, especially for Asian Americans and Pacific Islanders. As the blended, multiracial Asian American population continues to increase, the very definition of Asian American philanthropy is up for grabs. Add in the trend of giving while living, the increase in the blurring of philanthropic forms and structures, and the ubiquity of technology, social media, and connectedness, and you have a future of philanthropy in 2040 that is more diverse, global, and participatory than the present day.
Serve the People! Asian American Studies at Fifty: Empowerment and Critical Community Service Learning at San Francisco State University
Authors: Mar Eric , Carreon Jensine , Dariotis Wei Ming , Jeung Russell , Nguyen Philip , Pelaud Isabelle
Published: October 2019

This essay reflects on five decades of growth of the nation’s first Asian American Studies Department at San Francisco State University (SFSU AAS), focusing on its primary commitment to community empowerment and critical “community service learning” (CSL) and also highlighting past and present struggles, challenges, and innovations. This collectively written analysis summarizes SFSU AAS departmental approaches to CSL and community-based participatory research and highlights two case studies: (1) refugees from Burma community health needs research and advocacy in Oakland and (2) the Diasporic Vietnamese Artists Network. We conclude by describing how we are applying our model and building support for critical CSL and argue that AAS and ethnic studies must reclaim CSL from the dominant “charity-based” model or risk losing our social justice orientation and commitment to empowerment and self-determination for our communities.
Building Gardens: Food Justice, Community Engagement, and Gardens for the Asian Pacific Islander Community in the San Gabriel Valley
Authors: Phun Juily , Dang Elise
Published: October 2019

Culturally relevant gardens can significantly benefit regions like the San Gabriel Valley, which contain nearly a third of Asian Americans who are low income, by providing organically grown produce for students (Asian Americans Advancing Justice, 2018). This article focuses on one service-learning program: Asian/Asian American Studies 3510 Food Justice, the Body, and the Environment in the API Community at Cal State LA that works with schools throughout the San Gabriel Valley to build culturally relevant produce gardens. While our work focuses on building gardens and considerations of food justice, one of the greatest barriers to community-university partnerships is the lack of procedural transparency embedded within the university structure and culture. The heart of this essay is this process.
Retention and Matriculation Obstacles and Opportunities for Southeast Asian Community College Transfer Students
Authors: Wagoner Richard , Lin Anthony
Published: October 2019

This qualitative case study of twenty Southeast Asian students at a flagship public research university suggests that it is illogical to view them as the “model minority” so often described in the literature. Their experience is not the same as that of students from other Asian ethnicities. They struggle with similar issues that challenge other students who come from lower socioeconomic backgrounds. However, the students in this study did discuss two issues that might be more unique to them: immigrant status and the importance of the ethnically based student organization as a means of support and belonging.
RECURSOS HÍDRICOS EN EL PERÚ
Authors: Mayorca Baldoceda Eduardo
Published: October 2019

El presente artículo de carácter técnico pedagógico, trata de dos aspectos importantes de los recursos hídricos en nuestro país referidos; primero, a la gestión de los recursos naturales en áreas naturales protegidas por medio de la captación y beneﬁcio de los embalses del agua y el segundo, el agua en la evaluación del impacto ambiental en los proyectos minero metalúrgico.

La relevancia de los aspectos mencionados se da respectivamente en los siguientes propósitos:

 Una de las alternativas para contribuir a dar solución a la escasez de agua en nuestra costa peruana, es el aprovechamiento de los beneﬁcios de los embalses del agua.

La información periodística actual señala que las cuencas del Pacíﬁco de nuestro país pierden en el mar en cada verano grandes masas de agua que serían valiosas para extender la frontera agrícola y cubrir otras necesidades en nuestra árida costa por falta de embalses de regulación.

 Conscientes de la importancia que tiene el agua como un elemento fundamental que tiene toda actividad humana, así como para el desarrollo sostenible de las operaciones, las empresas de los sectores mineros energéticos deben implementar mayores acciones y mecanismos para hacer un uso cada vez más eﬁciente de este importante recurso natural. Más aun cuando se trata de proyectos nuevos, el agua en la evaluación del impacto ambiental en los proyectos mineros constituye un procedimiento muy responsable para el otorgamiento de derechos de uso y el manejo de conﬂictos vinculados al uso del agua.
LA GESTIÓN DEL CONOCIMIENTO Y LOS CÍRCULOS DE MEJORA CONTINUA PARA LA ACREDITACIÓN EN LA UNIVERSIDAD NACIONAL HERMILIO VALDIZÁN, HUÁNUCO
Authors: Bustamante Paulino Nicéforo
Published: October 2019

La gestión del conocimiento es una poderosa herramienta humana que, a través de los Círculos de Mejora Continua (CMC) en la Universidad Nacional Hermilio Valdizán de Huánuco se han constituido en medios eﬁcaces de acreditación, de las carreras profesionales, teniendo como pilares: el trabajo colaborativo, las experiencias personales, la cultura e identidad institucional, el talento de sus integrantes, la decisión política de sus autoridades quienes, con una permanente autoevaluación y autorregulación en base a los principio del “Aseguramiento de Calidad” se viene logrando un excelente servicio en función a los estándares del modelo de calidad para universidades.
ESTUDIO DEL APRENDIZAJE MOTOR EN EL DEPORTE BAJO EL MODELO DE KURT MEINEL
Authors: Tapia Camargo Jorge Luis
Published: October 2019

El objeto de trabajo de investigación fue estudiar el aprendizaje motor en el deporte bajo el modelo de Kurt Meinel. Teniendo como problema a investigar ¿Cuál es la teoría del aprendizaje motor en el deporte que presenta Kurt Meinel? Los métodos a utilizar son: El método científico como general y el descriptivo como método específico. Se usó las técnicas de fichaje y cuaderno de gabinete. Siendo una investigación de nivel descriptivo y de tipo básico, se utilizó un diseño descriptivo simple. El primer capítulo trata sobre la caracterización del estudio, prosiguiendo con el segundo capítulo en relación a las teorías que sustentan la presente investigación, el tercer capítulo trata sobre la metodología del estudio finalizando con la discusión de los resultados.
Hukum Islam dan Perubahan Sosial: Telaah atas Ijtihâd Fardi dan Jamâ’i
Authors: Bisri Hasan
Published: October 2019

Scientific and technological development creates so many kinds of new products concerning the telecommunication, automotive industry as well as medicine, technology of food and beverage and cosmetics, that this can cause the changes of social interaction among the society, and consequently, response is needed to face a challenging time and the changes of social life. Meanwhile, the number of texts (nash) of Alquran and hadis (prophetic saying) are limited to give the solution the new problems that appear. Based upon a reality, so this will encourage the attempt to grow and develop the Islamic law through Ijtihad (exerting individual as well as collective effort) being is more dynamic for the sake of the people welfare, fair human right protection, and improvement of the people’s standard of living. The writing tries to describe many kinds of factors of social changes responding to the law needed immediately, and are then followed by a great effort to reform the Islamic law suitable for all the time through ijtihad being more accurate and responsible.
MEMBANGUN ETOS KERJA GURU
Authors: Syarifuddin Syarifuddin
Published: October 2019

In trying to develop teacher work ethos is feeling getting fair treatment: honest, healthy, just and etc. Teachers have to be aware that they are competent people. It means that they have to give big contribution for certain activity till the progress in teaching happens.
PENGARUH KEPEMIMPINAN KEPALA SEKOLAH DAN KOMPETENSI GURU TERHADAP DISIPLIN BELAJAR SISWA DI SEKOLAH
Authors: Hasibuan Abdul Aziz
Published: October 2019

Kedisiplinan menjadi salah satu perhatian serius dalam lembaga pendidikan, dalam sekolah masih ada ketidakdisiplinan yang terjadi, sehingga dibutuhkan penanganan yang tepat dalam mengurangi dan mencegah terjadinya ketidakdisiplinan di sekolah. Kedisiplinan sangat dibutuhkan baik oleh guru maupun siswa dalam proses pembelajaran, tanpa adanya kedisiplinan proses pembelajaran tidak akan berhasil secara maksimal. Oleh sebab itu dalam penelitian ini peneliti ingin mengkaji dan menganalisis tentang disiplin belajar siswa yang dikaitkan dengan kepemimpinan kepala sekolah serta kompetensi guru. Penelitian dilakukan terhadap guru Sekolah Menengah Pertama (SMP) di Ciputat, Tangerang Selatan, dengan menggunakan metode kuantitatif yang dianalisis menggunakan analisis deskriptif dan inferensial. Dari penelitian ini didapati bahwa kedisiplinan belajar siswa dapat dipengaruhi oleh kepemimpinan kepala sekolah dan kompetensi guru, kepemimpinan kepala sekolah dan kompetensi guru memiliki pengaruh yang positif dan signifikan terhadap kedisiplinan belajar siswa, adanya kepemimpinan kepala sekolah yang mengedepankan kualitas proses pembelajaran serta adanya guru yang memiliki kompetensi baik akan memberikan perubahan yang berarti pada kedisiplinan belajar siswa di sekolah
ANÁLISE E AVALIAÇÃO DA TEORIA DE GERENCIAMENTO DE FILAS COM COLETA DE TEMPO EM UM LABORATÓRIO HOSPITALAR
Authors: Lima Ana Carolina Nogueira , Carvalho Jaqueline Bispo , Costa Juliana Evangelista , Medeiros Juliana Silva , Oliveira Vinicius de Assis
Published: October 2019

O presente trabalho foi realizado com objetivo de analisar como funciona o sistema de atendimento do laboratório Labclin no Hospital de Cataguases-MG, com ferramentas da disciplina de Pesquisa Operacional. A pesquisa se baseia em avaliar o método do gerenciamento de fila do sistema FIFO e implantar o SJF – NP com o objetivo de melhorar o processo. Os resultados mostraram que, no dia 23 de novembro de 2018, durante 3 horas de atendimento, a diferença do tempo de atendimento do FIFO para o SJF-NP reduziu em cerca de 39 minutos
KNOWLEDGE ABOUT PREGNANCY DANGER SIGNS AMONG MOTHERS ATTENDING ANTENATAL CARE IN JUGAL HOSPITAL, HARARI REGIONAL STATE, ETHIOPIA, 2019
Authors: Hussen Arif
Published: October 2019

Background: Every pregnant woman faces the risk of sudden, unpredictable complication that could end in death or injury to mother or infant. Each year, approximately 287,000 women die from complications related to pregnancy and childbirth in developing countries. Maternal mortality ratio (MMR) in developing regions is 15 times (240/100,000 live births) higher than in developed regions (16/100,000live births)  Objective: The aim of this study was to determine the knowledge about pregnancy danger signs among mothers attending antenatal care in Jugal Hospital, Harari Regional State, Ethiopia.Methods: Institution based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants from pregnant mothers attending antenatal care during the time of data collection. Data were collected using a structured questionnaire and it was entered in to EPI Data version 3.1 software program and exported to SPSS version 20 software for analysis.Results: A total of 316 pregnant women were included in the study with a response rate of 86%. The study indicated that 44.67% of the respondents had knowledge on danger signs of pregnancy, and there was a significant association with the knowledge on danger signs of pregnancy and the age of the respondent and educational status of the respondent (P 0.05).Conclusion: The study finding shows that poor awareness about danger signs of pregnancy among antenatal care attendants in Jugal hospital, Harari Regional State. There was a significant association between educational status, the age of the mother and knowledge about pregnancy danger signs among mothers attending antenatal care.
Cannabis Use in Cancer: A Survey of the Current State at BC Cancer before Recreational Legalization in Canada
Authors: Hawley P. , Gobbo M.
Published: October 2019

Background: Cancer patients experience multiple symptoms throughout their illness, and some report benefit from the use of cannabis. There are concerns that many patients are accessing products inappropriate for their situation and potentially putting themselves at risk. In the present study, we aimed to capture the prevalence of cannabis use among cancer patients at BC Cancer before recreational legalization in Canada and to identify the reasons that patients take cannabis, the various routes of administration they use, and the reasons that prior users stopped. Methods: Patients were eligible if, on the selected study day (15 August 2018), they were scheduled for an appointment at any of the 6 BC Cancer sites. Eligible patients were mailed a survey. Results: Of surveys sent to 2998 patients, 821 (27.4%) were returned and included in analysis. Of those respondents, 23% were currently using cannabis-based products, almost exclusively for medical purposes, and an additional 28% had been users in the past (most often recreationally). Of the patients currently using cannabis, 31% had medical authorization. The most common symptoms that the current users were targeting were pain, insomnia, nausea, and anxiety; many were also hoping for anticancer effects. Conclusions: More than half the respondents had tried cannabis at some time, and almost one quarter of respondents were currently taking cannabis to help manage their symptoms or treat their cancer, or both. Many more patients would consider use with appropriate guidance from a health care professional. More research is needed to inform physicians and patients about safe uses and doses and about the potential adverse effects of cannabis use.
Pembrolizumab-Induced Obstructive Bronchiolitis in a Patient With Stage IV Non-Small-Cell Lung Cancer
Authors: Blanchard A. , Bouchard N.
Published: October 2019

Objective: Immune checkpoint inhibitors are now a standard of care for the management of many metastatic cancers, including non-small-cell lung cancer. Pembrolizumab, a selective anti–PD-1 monoclonal antibody, augments the host antitumoural response. This hyperactivation of the immune system has side effects, the so-called immune-related adverse effects. The objective of this case report was to review and point out a new pattern of immune checkpoint inhibitor–associated pneumonitis. Case Description: A 69-year-old woman with stage iv non-small-cell lung cancer receiving pembrolizumab presented for increased dyspnea. Pembrolizumab-related obstructive bronchiolitis was diagnosed based on a new severe obstructive disorder, without bronchodilator reversibility, and mosaic attenuation on angiography, without other identifiable causes. Summary: To our knowledge, this is the first description of a case of pembrolizumab-induced obstructive bronchiolitis. Various patterns of immune checkpoint inhibitor–associated lung disease have been described, and bronchiolitis should be included in the differential diagnosis.
Patient-Reported Outcomes in Alberta: Rationale, Scope, and Design of a Database Initiative
Authors: Cuthbert C.A. , Watson L. , Xu Y. , Boyne D.J. , Hemmelgarn B.R. , Cheung W.Y.
Published: October 2019

Background: The collection of patient reported outcomes (PROS) is a standard of care in many cancer organizations. In Alberta, pros have been integrated into routine clinical practice since 2012. This longitudinal collection of pros provides a wealth of data and a unique research opportunity to improve cancer care. The goal of this pro data initiative is to establish a robust repository of information for ongoing clinical care and research focused on pros. In this paper, we describe the rationale, scope, and design of this initiative. Implementation: The initiative consists of pros and other administrative health data from the province of Alberta. Retrieval of health data from a variety of provincially governed sources will create a platform of information on pros, health outcomes, cancer data, other health conditions, and demographics. The aims of the initiative are to use the data to inform best practices at the point of care; to conduct health services research, particularly clinical epidemiology studies; and to evaluate a variety of pro-related outcomes. Discussion: Because this effort represents our first to integrate routinely collected pros with other administrative health data, a unique and robust data repository will be created. The ability to integrate various types of data will provide a comprehensive mechanism to evaluate a variety of outcomes. Because cancer care in Alberta is governed by a single health care system, the data linkages will include population health and psychosocial cancer data. We anticipate that research related to this initiative will ultimately help to inform more patient-centred care.
Primary Ewing Sarcoma of the Larynx with Distant Metastasis: A Case Report and Review of the Literature
Authors: Maroun C.A. , Khalifeh I. , Tfayli A. , Moukarbel R.V.
Published: October 2019

Extraosseous Ewing sarcoma is a rare, poorly differentiated round-cell tumour that is part of the Ewing sarcoma family of tumours. Here, we present an extremely rare case of primary extraosseous Ewing sarcoma arising in the larynx, with distant metastases. A 53-year-old man with a history of Hodgkin lymphoma treated 4 years earlier with 8 cycles of chemotherapy presented to our medical centre with a 2-week history of hoarseness. On physical examination, he was found to have a right supraglottic mass together with a fixed right vocal cord. Computed tomography imaging of the patient’s neck showed a heterogeneously enhancing lesion measuring 5.0×3.8×3.8 cm, centred on the right thyroid cartilage and invading the right true vocal cord. Imaging by integrated fluorodeoxyglucose positron-emission tomography and computed tomography showed active subcarinal and axillary lymph nodes, multiple scattered lung nodules, and multiple bony metastases. Needle core biopsy of the laryngeal mass was diagnostic for Ewing sarcoma. The patient received radiation to the laryngeal area and then alternating cycles of vincristine–actinomycin-D–cyclophosphamide and etoposide–ifosfamide. The patient remains in remission 1 year after completing therapy. As demonstrated in the present report, these tumours can behave very aggressively both locally and by metastasizing to distant organs. Our treatment approach provided favourable results for the patient; however, future reports are needed to further elucidate optimal management.
Crizotinib Inhibition of ROS1-Positive Tumours in Advanced Non-Small-Cell Lung Cancer: A Canadian Perspective
Authors: Bebb D.G. , Agulnik J. , Albadine R. , Banerji S. , Bigras G. , Butts C. , Couture C. , Cutz J.C. , Desmeules P. , Ionescu D.N. , Leighl N.B. , Melosky B. , Morzycki W. , Rashid-Kolvear F. , Sekhon H.S. , Smith A.C. , Stockley T.L. , Torlakovic E. , Xu Z. , Tsao M.S.
Published: October 2019

The ROS1 kinase is an oncogenic driver in non-small-cell lung cancer (NSCLC). Fusion events involving the ROS1 gene are found in 1%–2% of NSCLC patients and lead to deregulation of a tyrosine kinase–mediated multi-use intracellular signalling pathway, which then promotes the growth, proliferation, and progression of tumour cells. ROS1 fusion is a distinct molecular subtype of NSCLC, found independently of other recognized driver mutations, and it is predominantly identified in younger patients (<50 years of age), women, never-smokers, and patients with adenocarcinoma histology. Targeted inhibition of the aberrant ROS1 kinase with crizotinib is associated with increased progression-free survival (PFS) and improved quality-of-life measures. As the sole approved treatment for ROS1-rearranged NSCLC, crizotinib has been demonstrated, through a variety of clinical trials and retrospective analyses, to be a safe, effective, well-tolerated, and appropriate treatment for patients having the ROS1 rearrangement. Canadian physicians endorse current guidelines which recommend that all patients with nonsquamous advanced NSCLC, regardless of clinical characteristics, be tested for ROS1 rearrangement. Future integration of multigene testing panels into the standard of care could allow for efficient and cost-effective comprehensive testing of all patients with advanced nsclc. If a ROS1 rearrangement is found, treatment with crizotinib, preferably in the first-line setting, constitutes the standard of care, with other treatment options being investigated, as appropriate, should resistance to crizotinib develop.