bluuebunny/crossref_metadata_2025 huggingface dataset:
Sacubitril/valsartan na insuficiência cardíaca: Impacto na mortalidade e hospitalização
Authors: Oliveira Paes Landim Pacheco Luyla , Sarah Cutrim Nunes Costa  , Diego Araújo Diniz  , Gabriella Rodrigues Araujo  , Dariany Ribeiro Meireles  , Kaline dos Santos Kishishita Castro  , Juliana Pessoa Ferreira  , Danielle Brena Dantas Targino  , Amanda Henrique Santana  , Laura Cajubá Vieira de Britto  , Camila Souza Maluf  , Ana Rosa Bittencourt Beckman Ribeiro  , João de Brito Raposo Neto  , Luciana Núbia Alvim de Oliveira  , Gabriel Costa Falcao de Macedo  , Isabella Moreira Henriques  , Fernanda Moreira Henriques  , Petrônio Alves Macedo Filho  , Misael de Holanda Macedo  , João Gabriel Gomes Araújo
Published: August 2024

A insuficiência cardíaca (IC) é uma condição prevalente e de alta morbimortalidade, demandando terapias eficazes que possam melhorar os desfechos clínicos dos pacientes. Este estudo tem como objetivo avaliar o impacto do sacubitril/valsartan na mortalidade e hospitalização de pacientes com IC, explorando sua eficácia em diferentes subgrupos de fração de ejeção do ventrículo esquerdo (FE). A revisão sistemática de artigos publicados entre 2015 e 2024 nas bases de dados PubMed, MEDLINE, Cochrane Library e EMBASE revelou que o sacubitril/valsartan reduz significativamente os níveis de NT-proBNP e a taxa de mortalidade cardiovascular e hospitalizações em pacientes com IC e FE reduzida. Embora os resultados mostrem uma tendência positiva em subgrupos com FE intermediária e preservada, as evidências ainda são insuficientes para recomendações definitivas. A análise dos estudos destaca a superioridade do sacubitril/valsartan sobre as terapias convencionais, mas também sublinha a necessidade de mais pesquisas para compreender plenamente seu papel em diferentes contextos clínicos. Conclui-se que o sacubitril/valsartan representa uma intervenção terapêutica robusta para pacientes com IC, mas a prática clínica deve continuar a evoluir com base em evidências mais abrangentes.
Estenose mitral durante a gestação: Desafios clínicos e resultados perinatais
Authors: Da Silva Souza Marcos Vijano , Gabriela de Paula Cardoso  , Bruna Martins de Resende  , Breno Lucas Lima Gomes  , Ubiratan Rodrigues de Godoy Neto  , Igor Matheus Lima Cruz Fortaleza  , Aline Santos Soares de Paula  , Daniel Vinícius Olenski  , Lucas Resende de Vilhena  , Arildo Antonio de Campos Junior  , Brenda Flores de Campos  , Emanueli Ferreira Rubio Darini  , Amanda Lunardi Zvicker  , Giovanna Arissa Troleis Aoki  , Gabriel Rodrigues Ayalla Cassiano  , Dayane Bazilio Borin  , Ali Gassan Bhay
Published: August 2024

A estenose mitral (EM) durante a gestação é uma condição de alta complexidade que impõe desafios clínicos significativos, exacerbados pelas alterações hemodinâmicas associadas ao período gestacional. Este estudo tem como objetivo avaliar os desafios clínicos e os resultados perinatais associados à estenose mitral em gestantes, com ênfase na eficácia da comissurotomia mitral transvenosa percutânea (PTMC) como intervenção terapêutica. A revisão sistemática de artigos publicados entre 2015 e 2024 nas bases de dados PubMed, MEDLINE, Cochrane Library e EMBASE revelou que a PTMC melhora significativamente os sintomas clínicos e os parâmetros ecocardiográficos, como a área da valva mitral e os gradientes de pressão, em gestantes com EM. Além disso, o procedimento foi associado a uma redução nas taxas de insuficiência cardíaca, fibrilação atrial, parto prematuro e restrição de crescimento fetal, especialmente quando realizado no segundo trimestre. Apesar dos benefícios, a gravidade da estenose mitral continua sendo um fator determinante dos resultados maternos e fetais, sugerindo a necessidade de intervenções personalizadas e uma abordagem multidisciplinar no manejo dessas gestações de alto risco. Conclui-se que a PTMC é uma intervenção crucial para melhorar os desfechos maternos e fetais em gestantes com EM, mas a prática clínica deve continuar a evoluir com base em evidências robustas e individualizadas.
Carcinoma espinocelular cutâneo: Características clínicas e diagnóstico
Authors: Maganhin Luquetti Camilla , Daniel Zanoni Rodrigo , Locks Amanda , Francisco Ribeiro Leonardo , Maria Neves Silva Souza Elizabeth , Ribeiro de Souza Ricardo , Mendes Santos João Marcos , Dos Santos Barros Poliana , de Fátima Soares Nunes Heliomara , Guenes Barbosa Kamilla , Correia Lima Delza , Duarte da Silva Layane , Assunção de Andrade Lima Júnior Elson
Published: August 2024

Introdução: Carcinoma espinocelular é a neoplasia dos queratinócitos epidérmicos, em áreas de pele fotodanificada e com variedade de lesões cutâneas, incluindo pápulas, placas ou nódulos (lisos, hiperqueratóticos ou ulcerados). O diagnóstico é por meio da biópsia da pele. A aparência clínica reflete o grau de diferenciação tumoral, geralmente com 0,5-1,5 cm de diâmetro, mas podendo ser mais invasivas. Tumores mal diferenciados podem ter ulceração, hemorragia ou áreas de necrose. Objetivo: discutir a clínica do carcinoma espinocelular e o seu diagnóstico. Metodologia: Revisão de literatura a partir de bases de dados da Scielo, da PubMed e da BVS, de março a abril de 2024, com descritores “squamous cell carcinoma”, “clinical features” e “diagnosis”. Incluíram-se artigos de 2019-2024 (total 35), com exclusão de outros critérios e escolha de 05 artigos na íntegra. Resultados e Discussão: O carcinoma espinocelular ocorre em qualquer superfície, sendo mais comum em locais fotoexpostos. Quando em áreas anogenitais, há correlação com o HPV. Lesões de CCS invasivo são frequentemente assintomáticas. Os sintomas neurológicos locais (dormência, queimação, parestesias, paralisia ou alterações visuais) ocorrem em 1/3 dos pacientes de alto risco. Em particular, o carcinoma basocelular superficial e o CCS situ se parecem clínico e dermatoscopicamente. Assim, o exame histopatológico determina o diagnóstico. Além disso, é útil na invasão perineural, diferenciação e profundidade tumoral, importantes no estadiamento e prognóstico do tumor. Independentemente da técnica selecionada, as biópsias que se estendem pelo menos até a derme reticular média são preferenciais. Biópsias mais superficiais podem ser realizadas em pacientes com lesões sugestivas in situ. Conclusão: Há necessidade de diagnóstico precoce para manejo adequado, acompanhamento e estadiamento, para menor morbidade.
Integration of Chatting Technology in the Tandem Language Exchange Learning Process
Authors: Ambas Jamin , Touwe Yohana S. , Wenny J Syilvia , Abdullah Dahlan
Published: August 2024

Background. 21st century learning demands the integration of technology to meet the demands of current developments. In the context of language learning, Tandem Language Exchange is a modern method that stands out by utilizing chat technology.
Purpose. The main aim of this research is to evaluate the impact of tandem chat integration in Tandem Language Exchange on students' language skills. In addition, this research aims to provide practical guidance for the development of innovative language learning approaches using chat technology, by contributing to understanding the potential of chat technology in language learning.
Method. This research uses a quantitative approach with a survey model. Respondents consisted of English and Arabic primary language students at various universities in Indonesia. The survey results were analyzed using the Miles Huberman model and presented in chart form.
Results. Of the 30 respondents, the majority of students felt significant benefits from integrating chat technology in language learning. The frequency of use of Tandem Language Exchange is quite high, reflecting students' active interest and involvement. Apart from that, the survey results also show that students' comfort level in using chat technology is generally positive, with the majority feeling comfortable or very comfortable.  
Conclusion. The integration of chat technology in Tandem Language Exchange has an overall positive impact, supporting the development of language skills and motivating students to be actively involved in the learning process. Despite some reported obstacles, high acceptance shows the great potential of using chat technology in language learning contexts in this digital era. Future recommendations could focus on improving guidance and support to ensure the use of chat technology is more effective and satisfying for students.
Increasing understanding of foreign language vocabulary through technology-based educational games
Authors: Pertiwi Anggun , Danial Haris , Maharani Asnur Sardian , Abdullah Dahlan
Published: August 2024

Background. In the 21st century learning era, innovation in learning methods is crucial. Educational games stand out as an interesting and effective solution to improve the quality of learning. In particular, foreign language learning requires a more interactive and fun approach to motivate students.
Purpose. The main aim of this research is to measure the extent to which technology-based educational games can improve understanding of foreign language vocabulary. In addition, this research evaluates the level of satisfaction and motivation of students in using educational games as a means of learning vocabulary.
Method. With a quantitative approach and survey design, this research involved 30 language students. The use of the method of drawing student numbers for sample selection and distributing the questionnaire link via the WhatsApp group with a random technique ensures representativeness and voluntary participation of respondents. The research instrument was a structured questionnaire.
Results. The results of the questionnaire showed that 70% of respondents expressed satisfaction with the use of educational games, with 30% of them feeling 'Very Satisfied.' In terms of motivation, 87% of respondents reported increased motivation after using educational games, where 30% said 'Very Improved' and 56.7% said 'Improved.' Even though 13.3% of respondents felt 'Neutral' regarding increasing motivation, this does not reduce the positive impact felt by the majority of participants.
Conclusion. The use of educational games is effective in increasing student satisfaction and motivation in learning foreign language vocabulary. The game's attractiveness factors, reward system, and level achievement are the main contributors to a positive experience. Variations in levels of satisfaction and motivation can be used as a basis for further development and optimization of educational game designs according to student preferences and expectations. This conclusion provides a basis for improving the quality of foreign language learning at the tertiary level.
Analyzing the Impact of Social Media on Humanities and Social Sciences Research Dissemination
Authors: Astawa I Putu , Ulwi Krim
Published: August 2024

Background. The development of digital technology, especially social media, has changed how information is disseminated and accessed. Social media is essential in communicating the results of humanities and social sciences research. However, the impact of social media on the effectiveness and reach of research dissemination in this area has yet to be studied.
Purpose. This study aims to analyze the impact of social media on disseminating research in the humanities and social sciences. The focus is to evaluate how social media affects public reach, interaction, and acceptance of research results.
Method. This study uses a mixed methods approach that combines quantitative and qualitative analysis. The quantitative data was collected through an online survey involving 300 humanities and social sciences researchers. Qualitative data were obtained through in-depth interviews with 20 selected researchers. Descriptive statistical analysis is used to identify patterns and trends, while thematic analysis is used to explore insights from interviews.
Results. The results showed that social media significantly increased public reach and interaction with humanities and social sciences research. Researchers reported increased visibility and public engagement of their work through Twitter, Facebook, and LinkedIn platforms. However, there are also concerns about the quality of interactions and the risk of spreading inaccurate information.
Conclusion. This study concludes that social media significantly impacts the dissemination of research in the humanities and social sciences, especially in increasing public reach and interaction. However, to maximize the benefits, appropriate strategies are needed to manage risks and ensure the quality of interactions. The study recommends developing guidelines and training for researchers to utilize social media effectively in disseminating their research results.
Use of ARIAS Model (Assurance, Relevance, Interest, Assessment, Satisfaction) on Speech Learning
Authors: Ziliwu Bonafetura Niamonio , Gea Wecan Kartika Hidayati , Bawamenewi Arozatulo , Harefa Agung Harapan
Published: August 2024

Background. The effectiveness of oral corrective feedback (OCF) in language learning is influenced by learners’ comprehension and response to various OCF techniques. Therefore, it is essential for teachers to consider learners’ preferences for OCF strategies.
Purpose. this study aims to investigate the use of ARIAS Model on speech learning. This research will explore the effectiveness of this approach in helping learners overcome challenges in public speaking and improve their speaking skills with more confidence and conviction.
Method. This research used a qualitative method with a descriptive approach. Data collection techniques included interviews, observations, and questionnaires filled out by 21 students.
Results. The results showed that the use of the ARIAS model significantly improved students’ clarity (85%), intonation (80%), and expression (90%) in speech. In addition, 95% of students gave positive responses to the ARIAS model, indicating its acceptance and effectiveness in speech learning.
Conclusion. This study concludes that the ARIAS model is a comprehensive and effective approach to develop public speaking skills, help students overcome psychological barriers, and improve their speech skills with more confidence and convincing. However, technical challenges such as technological infrastructure must be overcome to ensure optimal implementation. The findings support the importance of integrating the ARIAS model in the Indonesian language learning curriculum to improve students’ communication skills.
LA MOTIVACIÓN UN PROCESO PSICOLÓGICO
Authors: Alá Miranda Paz Gastón
Published: August 2024

En la actualidad, mejorar el rendimiento académico en la labor educativa, es un objetivo fundamental en el proceso docente educativo, en el cual influyen las condiciones en el que se desarrolla este proceso, caracterizada por ciertos factores que condicionan el aprendizaje. Siendo uno de los factores principales, la motivación, con que éste proceso se afronta. Por lo que para facilitar que los estudiantes se interesen y se esfuercen por comprender y aprender los contenidos impartidos en la clase, es preciso conocer qué factores personales condicionan la motivación a la hora de enfrentarse con las tareas académicas. Solo conociendo tales factores y sus efectos es posible determinar los modos de actuación de los estudiantes, en la clase.
La Culinaria del Café
Authors: Cartay Rafael
Published: August 2024

Este artículo ofrece una visión exhaustiva de la relación entre el café y la culinaria, destacando su papel en tres áreas principales: infusiones y bebidas, helados y repostería. Aunque la literatura académica sobre el tema es limitada, se destaca la importancia del café en la cultura culinaria, especialmente en la creación de una amplia gama de bebidas, desde espresso hasta cafés fríos, así como su uso en la repostería y pastelería, como el tiramisú. Además, se explora el café como un elemento socializador, destacando su papel en la socialización primaria y secundaria, así como su valor simbólico en la literatura y la sociología. Se analizan los efectos de la cafeína, principal compuesto activo del café, en la salud y el rendimiento humano, particularmente en el contexto deportivo. Se enfatiza que más allá de su función culinaria, el café es un elemento fundamental en la sociedad contemporánea, tanto como activador cognitivo como facilitador de la interacción social.
METHODS OF CORROSION PROTECTION OF EQUIPMENT AND PIPELINES IN THE OIL AND GAS INDUSTRY
Authors: S.K. SHERYAZOV  , ZH.S. SARKULOVA  , A.M. BALGYNOVA  , S.S. SHUKIROVA  , TURYSBEKOVA A.ZH.
Published: August 2024

Мұнай-газ саласында жабдықтар мен құбырлардың коррозиясы инфрақұрылымның қауіпсіздігіне, сенімділігіне және беріктігіне елеулі қауіп төндіреді. Техникалық жүйелердің тұрақты жұмысын қамтамасыз етудің кілті болып табылатын коррозиядан қорғаудың әртүрлі әдістері әзірленді. Бұл мақалада коррозияның алдын алудың негізгі әдістері, соның ішінде катодты Қорғаныс, Қорғаныс жабындарын пайдалану, коррозия ингибиторларын пайдалану және тұрақты техникалық қызмет көрсету қарастырылады. Әр әдісті қолданудың артықшылықтары, шектеулері және оңтайлы шарттары талқыланады, сондай-ақ мұнай-газ саласындағы коррозиядан қорғаудың ең тиімді стратегияларын таңдау бойынша ұсыныстар ұсынылады.Мақалада коррозияның негізгі түрлері, олардың себептері мен салдары қарастырылады. Содан кейін әртүрлі қорғаныс стратегиялары, соның ішінде катодты және анодты қорғау әдістері, қорғаныс жабындарын пайдалану, коррозия ингибиторларын пайдалану және жабдықтың күйін бақылау мен бақылаудың техникалық әдістері ерекшеленеді.Осы әдістердің әрқайсысының артықшылықтары мен шектеулері, олардың тиімділігі, енгізу және техникалық қызмет көрсету шығындары талданады. Сондай-ақ, мұнай-газ жабдықтарының беріктігі мен сенімділігін арттыруы мүмкін коррозиядан қорғау саласындағы инновациялық технологиялар мен жаңа әзірлемелерге ерекше назар аударылады.Зерттеу әртүрлі қорғаныс әдістерінің комбинациясын пайдаланудың маңыздылығын, сондай-ақ мұнайгаз саласындағы коррозиялық процестерді азайту үшін технологияларды үнемі жетілдіру қажеттілігін көрсетеді.
БУЛЛИНГ КАК ЯВЛЕНИЕ СОЦИАЛЬНОЙ СРЕДЫ КАЗАХСТАНСКОГО ОБЩЕСТВА
Authors: КАРИМОВА А.Т.  , ЖОЛМУРЗАЕВА А.А.
Published: August 2024

The scientific article is devoted to the study of the actual problem of domestic (family) violence in modern Kazakhstan society. This article considers the causes, types, statistical data, consequences of domestic violence and methods of prevention of abuse in the family. Four forms of abusive relationships are singled out: physical abuses, psychological abuses, sexual abuses and economic abuses. The article also presents the consequences of domestic violence. Victims of domestic violence are usually women, children, the elderly and the disabled, i.e. socially vulnerable groups of the population. It should be noted that domestic violence is not segregated. Victims of domesticviolence can be of any age, race, religion, regardless of their socio-economic status or level of education. Domestic violence is a worldwide problem that affects not only the individual unit of society, but also society as a whole. The author points out that this problem is an inter-agency problem that needs to be solved using both psychological mechanisms and legal regulation mechanisms. The problem of domestic violence in many countries remains topical to this day.
ПРОБЛЕМЫ ИНТЕЛЛЕКТУАЛЬНОГО РАЗВИТИЯ УЧАЩИХСЯ МЛАДШИХ КЛАССОВ В ПРОЦЕССЕ ИЗУЧЕНИЯ АНГЛИЙСКОГО ЯЗЫКА
Authors: Н.А. КАРГАПОЛЬЦЕВА  , М.К. ЖАЗЫКОВА  , Г.К. САХИПОВА
Published: August 2024

Мақала ағылшын тілін оқыту үдерісінде бастауыш сынып оқушыларының зияткерлігін дамытумәселесіне арналған. Авторлар ағылшын тілі ресурсының объективті және субъективті құрамдас бөлігініңбастауыш сынып оқушыларының зияткерлігін дамуытуға әсерін талдайды, жұмыс барысында олар жетекшіпедагогтар мен психологтардың тілдік құрылымдарға негізделген ақыл-ой қызметінің рөлі туралы жұмыстарынзерттеген. Мақалада авторлар Қазақстан жағдайында ағылшын тілін бастауыш сыныптың білім беру үдерісінеықпалдастырудың әсерін бағалауға талпынған.Оқу іс-әрекетінде оқушының зияткерлігін дамыту проблемасы қоғам қалыптасуының әртүрлікезеңдерінде әрқашан болған және мектепте бұл міндетті іс жүзінде жүзеге асыру ешқашан толастаған емес.Мақалада авторлар психолог-ғалымдардың зерттеулеріне сүйеніп, зияттың дамуының адам ағзасы менпсихикасындағы сапалы өзгерістерге әкелетінін ескертеді және бастауыш сынып оқушыларының табыстыинтеллектуалды дамуы үшін ағылшын тілі мұғалімінің кәсіби дайындығының маңыздылығын атап көрсетеді.Сондай-ақ зерттеушілер ағылшын тілі сабағында бастауыш сынып оқушыларын интеллектуалды дамытудаолардың жеке ерекшеліктері мен шығармашылық әлеуеті ескеріліп, танымдық мотивтерінің өсуі қамтамасызетілетінін атап өтеді.Көптілділік Қазақстанның мемлекеттік білім беру саясаты стратегияларының бірі болып табылады. Бұлөз кезегінде бастауыш сынып оқушыларының шет тілін меңгеруге деген ынтасын арттырады. Мұғалімдербалаларды интеллектуалдық дамыту үшін оқытудың дәстүрлі әдістері мен білім берудің жаңа технологияларынбіріктіруге тырысады. Осыған байланысты мақала авторлары ағылшын тілі сабақтарында қолданылатынинтеллектуалдық тренингтердің бастауыш сынып оқушыларының интеллектуалдық дамуына, үлгерімініңартуына, тұлғалық және интеллектуалдық өсуіне ықпал ететінін атап көрсетеді.
Barriers into Higher Education for disabled students
Authors: Claricoats Liam
Published: August 2024

According to Sheffield Hallam University’s Access and Participation Plan (20/21-24/25), there has been an increased number of disabled students entering Higher Education (HE), with 14.6% of students declaring a disability in the sector. Therefore, this review of the literature explored potential barriers into Higher Education for students with disabilities. Within Higher Education institutions, disabled students may be categorised into having ‘mental health’, ‘cognitive and learning’, ‘sensory, medical and physical’ or ‘multiple impairment’ related disabilities. This review was commissioned in collaboration with the Higher Education Progression Partnership (South Yorkshire), with the aim of identifying barriers into Higher Education institutions for disabled students. Evidence provided from this literature review is intended to assist in developing a rationale for an intervention design and delivery that alleviates the barriers into Higher Education for disabled students. From examining the literature, a prominent barrier that emerged was a lack of accessibility at university. For instance, an inconsistent willingness from tutors to make reasonable adjustments to assessments, a lack of understanding of autism spectrum disorder (ASD) characteristics and spread-out university campus buildings that were inaccessible for students with Cerebral Palsy/walking disabilities. The research findings also revealed that there was a lack of accessible spaces on campus for disabled students, especially for students with ASD to interact. Furthermore, disabled students’ perceptions of stigmatisation and discrimination of disclosing their disability was another key barrier into Higher Education. For instance, during the application process to university, students believed that it would jeopardise their opportunity to be accepted into their chosen Higher Education institution if they were to disclose their disability.
Ditch the Doubt: Headline Project Evaluation Report 2022/23 (HeppSY)
Authors: Whitby Jessica
Published: August 2024

To determine whether this novel approach to targeted activity could help mitigate additional barriers faced by specific groups of students, Higher Education Progression Partnership South Yorkshire (HeppSY) adopted a mixed-method triangulation approach consisting of pre and post questionnaires, focus groups, rating scale activities and teacher observation forms. Such an approach allowed the evaluators to identify cognitive change before and after the project and to effectively locate the association with the specific interventions. The data collected throughout the project was used to explore the impact of the programme in five key areas: HE knowledge, career knowledge, seeing your future self, academic confidence, and likelihood to apply for HE at age 18/19. Ditch the Doubt had a clear impact on the students who participated. Students were equipped with greater knowledge of pathways, which will support them in making an informed choice about HE. Students developed an increased understanding student life and a greater sense of fit within HE. An increase in personal and academic confidence also emerged through survey and focus group data, as well as via the embedded coaching rating scales. The rating scales indicated that the coaching is a key component of Ditch the Doubt, highlighting its positive impact on the students’ confidence, trust in their own judgement and perception of their future. Confidence was further impacted by the programme’s oracy workshop, which was frequently referenced in the focus groups in the context of reducing anxiety prior to giving presentations.
Review of Radiation Dose Metric Tracking for Patients: Ethical Implications of the “Do Not Disclose” Standard
Authors: Brunger Fern , Kendall Edward
Published: August 2024

Medical diagnostic imaging tests that produce ionizing radiation now deploy technology that captures an individual patient’s cumulative radiation dose. This raises the question of whether there is an imperative for regional health authorities to disclose this information to physicians who may then engage their patients in decisions about whether the potential harms are worth the benefits of subsequent diagnostic imaging. Currently, the advice of the professional bodies providing standards of practice for medical diagnostic imaging is to withhold this information from physicians. Their concern is that cumulative dose information is difficult to evaluate in terms of risk to individual patients; it is not easily applicable to clinical decision making about the appropriateness of a subsequent imaging exam; and referring clinicians will feel compelled to offer a patient a less efficacious non-ionizing test, which could negatively affect patient care. We present a critical analysis of several assumptions underlying the stance of non-disclosure. Working at the intersection of medical physics, medical anthropology, and clinical ethics, we offer an alternative framing of the discourse of risk that has shaped the recent scholarly debate on disclosure of individual cumulative radiation dose. We posit that a persuasive argument can be made against the stance of the professional bodies and for a policy of disclosure – provided that such a policy prioritizes patient-centred shared decision making, radiologists as risk-interpretation experts, and the authority of the prescribing physician.
Research Ethics Oversight for Multi-jurisdictional Clinical Trials in Canada: A
Historical Perspective to Inform Future Direction
Authors: Lucas Brenda , Flamenbaum Jaime , Longstaff Holly , Murthy Srinivas , Schichter Brittney
Published: August 2024

As a condition of funding from the Canadian Tri-Agencies, researchers and
institutions are expected to adhere to the Tri-Council Policy Statement: Ethical Conduct
for Research Involving Humans (TCPS) and research projects must obtain approval from a
Research Ethics Board (REB). Yet there are a limited number of frameworks and standards to
guide the conduct and decisions of REBs in Canada and these are most often voluntary. Delays
and increased costs resulting from the lack of a common or coordinated approach to REB
review for multi-jurisdictional clinical trials is a long-standing issue in the Canadian
research environment. Formal reviews and recommendations as early as 2006 call for
accreditation or qualification for REBs, use of common forms and templates, and federal
leadership to harmonize processes.
La remobilisation des capabilités du soignant : une réponse à sa vulnérabilité
Authors: Kamgue Ericbert Tambou
Published: August 2024

Aborder la question de la vulnérabilité du soignant dans la relation de soin peut
paraître déplacé voire illusoire. En effet, la figure commune du soignant est celle d’une
personne forte, qui n’est pas affectée par la maladie et la souffrance du malade; une
personne qui ne laisse pas transparaître le malaise et le mal-être liés à son activité. La
pandémie de la Covid-19, qui a marqué notre monde ces dernières années, nous a révélé à
suffisance que le soignant n’est pas un dieu vêtu en blouse blanche/bleue/rose/violette.
L’expérience du quotidien nous montre que le soignant, tout comme le malade, peut être en
situation de vulnérabilité. Quand le soignant est abandonné à sa souffrance et que sa
vulnérabilité est ignorée, l’impact d’une telle expérience peut être néfaste pour les soins
prodigués. Il s’agit dans cet article de considérer la notion de capabilité comme paradigme
de compréhension de la prise en charge de la vulnérabilité du soignant. Suivant cette
logique, répondre à la vulnérabilité du soignant revient à promouvoir un environnement de
soin capacitant qui puisse lui permettre de développer ses capabilités. L’approche par les
capabilités nous rappelle ainsi la nécessité de prendre en compte les aspirations morales et
humaines des soignants dans la pratique médicale.
Including Organizational Ethics in the Risk Management Process: Towards Improved
Practices and Analysis
Authors: Bouchard Laurie , Dion-Labrie Marianne
Published: August 2024

Risk management has played an important role in Quebec’s health and social services
organizations for several years. This process is based on two guiding principles: the just
culture and the no-blame concept and is an integral part of the Act respecting
healthcare and social services. However, for all its usefulness, the current risk
management process has certain limitations and criticisms. To overcome these weaknesses, the
association of organizational ethics with the risk management process represents an
interesting option. The use of organizational ethics concepts and tools overcomes the
limitations of risk management and even optimizes it. Both are organizational processes with
many common objectives and links, and both provide tools for decision-making. The
combination of organizational ethics and risk management broadens the scope of risk
management. To enable the best possible optimization, an analysis grid is proposed, and
recommendations are made for the inclusion of ethics in risk management.
Aging Meaningfully: The Ethics of Existential Suffering for Older Adults in
Healthcare
Authors: Tsai Gabrielle
Published: August 2024

Existential suffering (ES) can be particularly prevalent among older adults, and
with Canada’s growing aging population, addressing ES in senior care will be a pressing
concern in coming years. ES is a side effect of aging that involves losing meaning,
self-identity, autonomy, and hope. This paper focuses on one cause of ES among older adults,
namely, the loss of meaning (LoM). Meaning becomes increasingly necessary for well-being at
later stages in life, due to the positive effects it confers on mood, health, and longevity.
I argue that when ES arises in healthcare settings, healthcare providers (HCPs) have a duty
to 1) understand ES and LoM and 2) respond to older adults who experience ES because of LoM.
HCPs may not be able to alleviate ES or LoM, but they are obliged to make a reasonable
attempt. To justify this, I draw upon three fundamental values in healthcare:
trust, compassion, and beneficence. By reflecting on each of
these values, it becomes clear that ES and LoM deserve attention from HCPs. In addition to
making this argument, I recognize that ES is not only limited to old age nor solely
incumbent on HCPs to address. Broader social factors and public health initiatives can help
people at all life stages to preserve meaning. In raising awareness in HCPs about ES due to
LoM, this paper also provides a non-exhaustive list of three psychotherapies that deserve
exploration and/or implementation for patients suffering from ES due to LoM, namely:
Palliative Care Psychotherapy, Meaning-Centred Group Psychotherapy, and Dignity
Therapy.
Assisted Suicide and Euthanasia: Language Lost in MAiD
Authors: Gromadzki Rafal , Christie Timothy
Published: August 2024

For most of Canada’s approximately 40-year debate on medically assisted death, euthanasia and assisted suicide were considered distinct issues. Yet in 2016 their ethical, psychological, and practical differences were effectively disregarded when the two acts were grouped together in the legislation under the umbrella term “Medical Assistance in Dying” (MAiD). The lack of distinction under the law of the two terms ignores important ethical considerations from the MAiD practitioners’ perspective. Although the principle of respect for autonomy must remain central to the assessments of MAiD eligibility, it cannot be the only consideration. This paper examines the ethical considerations and principles that underlie decisions to provide MAiD through an analysis of the progress, and results, of the 40-year debate on assisted suicide and euthanasia.
New Developments and Old Dilemmas in Ontario’s Resuscitation Policy at the End of Life
Authors: Apramian Tavis , Szego Michael , Langlois Dave
Published: August 2024

This paper deals with changes in code status policy in Ontario and endorses a new College of Physicians and Surgeons of Ontario (CPSO) policy. We argue that the recent policy changes in this area necessitate an active educational strategy around end-of-life care to prevent harm to dying patients.
Ethical Implications of End-Of-Life Decisions
Authors: Nemetz Elisheva , Huang Ryan  S.
Published: August 2024

This paper examines the recent policy update by the College of Physicians and
Surgeons of Ontario (CPSO), which allows physicians to override patient wishes for
cardiopulmonary resuscitation (CPR) without consent. It critically analyzes the ethical
implications of this shift, emphasizing the juxtaposition between the legal protections for
patient’s Last Wills and the relatively diminished safeguarding of their end-of-life care
preferences. The paper highlights the potential for bias in physician decision-making, the
risk of reverting to a more paternalistic healthcare model, and the challenge of balancing
patient autonomy with medical authority. The study underscores the need for a nuanced
approach to healthcare policy that respects patient autonomy while addressing the
complexities of end-of-life decisions.
Culturally Informed Care: Solidarity, Cultural Humility, and Medical Ethics
Authors: Hawkins Hailey G. , Nortjé Nico , Palmer Amitabha
Published: August 2024

This case study explores the ethical complexities surrounding the treatment of Mrs. H, an elderly woman with multiple myeloma. Divergent goals between her family, rooted in cultural and religious values, and the medical team prompted ethical deliberation. The divergent goals centered around the family’s desire for aggressive cancer treatment, driven by their Ubuntu and Christian beliefs in the sanctity of life and hope for divine intervention, contrasted with the medical team’s focus on palliative care, prioritizing comfort over aggressive medical interventions with unlikely benefits. Faced with this tension, the care team, guided by principles of solidarity and cultural humility, engaged in meaningful dialogue facilitated by an experienced ethicist. The resolution respects the family’s cultural and religious beliefs while adhering to medical ethics. This case highlights the importance of understanding and integrating cultural values in healthcare decision-making, ultimately achieving a patient-centered approach that respects the diversity of perspectives.
Chronique du cinéma 4 : Pauvres créatures - la transformation humaine
Authors: Quintin Jacques , Plaat-Gasdoue Nathalie
Published: August 2024

Analyse du film Pauvres créatures du cinéaste Yorgos Lanthimos. Une femme enceinte, Bella, se jette en bas d’un pont pour se donner la mort. Un médecin fou récupère le cadavre pour remplacer le cerveau de la mère par celui du foetus qu’elle porte. Nous voyons, dans un corps d’adulte, un enfant qui se développe à travers les âges jusqu’à la maturité. Bella découvre les comportements à adopter et à éviter en société, la sexualité et finalement la liberté de penser en explorant le monde et en lisant. Elle deviendra à son tour médecin pour s’adonner à des transformations sur le corps des êtres vivants, animaux et humains. Le film inspire plusieurs réflexions philosophiques et éthiques et illustre l’émancipation féminine.
Key Insights and Priorities for Evaluating the Effectiveness of Clinical Ethics
Consultation
Authors: Honan Lauren , Heesters Ann M. , Bianchi Andria , Salis Marina , Bell Jennifer A. H.
Published: August 2024

During the 2023 Canadian Bioethics Society forum, 28 practicing healthcare
ethicists (PHEs) and other attendees from across Canada, including bioethics students and
fellows, gathered virtually for a collaborative workshop entitled “Towards Evaluating
Clinical Ethics Consultation Effectiveness: Engagement in a Scoping Review of Reported
Outcomes”. The workshop was open to all members of the bioethics community who registered
for the forum but was designed primarily for PHEs.
Do Clinical Ethicists Improve with Experience? And, If So, How Would We Know?
Authors: Seavilleklein Victoria , Flynn Jennifer , Frolic Andrea , Wagner Frank , Lee-Ameduri Katarina
Published: August 2024

During our workshop at the 2023 CBS-SCB Workshop and Community Forum, we explored
and problematized the concept of “improvement” of clinical ethicists, situated within the
larger context of discussions about the professionalization of clinical ethics. This summary
provides key insights on this topic by clinical ethicists from across Canada and includes
suggestions for steps that we might want to take in the field to enable and support the
improvement of clinical ethicists going forward.
Heavy Burdens of Family Caregivers Caring for Persons with Severe Mental Disorders
Authors: Bahari Kissa , Bachtiar Arief , Pertiwi Gracia Herni , Syahlani Ahmad
Published: August 2024

Family caregivers who live with and care for individuals with severe mental disorders face serious issues. This study aimed to investigate the burdens of these family caregivers. This descriptive phenomenological study involved 15 family caregivers who looked after persons with mental disorders in Malang City, Indonesia; the participants were selected using a purposive sampling technique. Data were gathered using individual in-depth interviews and observations, and then analyzed inductively. Based on the findings, the burdens of family caregivers can be grouped into four main themes: 1) families encountered challenges and stigma in caring for persons with severe mental disorders, 2) there was a lack of support from the community and healthcare providers, 3) family caregivers reported experiencing various negative emotions and interpreting negative implications from their caregiving experiences, and 4) family caregivers employed coping strategies to alleviate their burdens. The researchers conclude that family caregivers experience complex burdens when caring for persons with severe mental disorders; hence, family caregivers need the support of healthcare personnel and community presence in situations of caring for persons with chronic mental disorders.
Keywords: burden of disease, caregiver, family, Indonesia, severe mental disorders
 
Abstrak
Beban Berat Caregiver Keluarga dalam Merawat Orang dengan Gangguan Jiwa Berat. Caregiver keluarga yang hidup bersama orang dengan gangguan jiwa berat menghadapi masalah yang serius. Penelitian ini bertujuan untuk mengetahui secara mendalam beban para caregiver keluarga. Penelitian fenomenologi deskriptif ini melibatkan 15 caregiver keluarga yang merawat orang dengan gangguan jiwa di Kota Malang, Indonesia; partisipan dipilih dengan teknik purposive sampling. Pengumpulan data menggunakan metode wawancara mendalam secara individual dan observasi, serta selanjutnya dianalisis secara induktif. Hasil penelitian menunjukkan bahwa beban caregiver keluarga dapat dikelompokkan ke dalam empat tema utama: 1) keluarga menghadapi tantangan dan stigma dalam merawat orang dengan gangguan jiwa berat, 2) kurangnya dukungan masyarakat dan penyedia layanan kesehatan keluarga, 3) caregiver keluarga mengalami berbagai perasaan negatif dan memaknai secara negatif pengalamannya, dan 4) caregiver keluarga menggunakan strategi koping untuk meringankan beban keluarga. Peneliti menyimpulkan bahwa caregiver keluarga mengalami beban yang kompleks saat merawat orang dengan gangguan jiwa berat; oleh karena itu, caregiver keluarga sangat membutuhkan dukungan dari tenaga kesehatan dan kehadiran masyarakat sekitar dalam menghadapi situasi perawatan kronis bagi orang-orang dengan gangguan jiwa berat.
Kata Kunci: beban penyakit, caregiver, gangguan jiwa berat, Indonesia, keluarga
Tailoring group delay dispersion of surface plasmon polaritons propagating on thin gold film by chirped femtosecond laser pulses
Authors: Song Han-Bing , Lang Peng , Ji Bo-Yu , Xu Yang , Song Xiao-Wei , Lin Jing-Quan ,   Key Laboratory of Ultrafast and Extreme Ultraviolet Optics, School of Physics, Changchun University of Science and Technology, Changchun 130022, China,   Chongqing Research Institute, Changchun University of Science and Technology, Chongqing 401135, China,   Zhongshan Institute of Changchun University of Science and Technology, Zhongshan 528400, China
Published: August 2024

Understanding the propagation characteristics of surface plasmon polaritons (SPPs) is of great significance in designing and constructing on-chip integrated systems utilizing plasmonic effect. Accurately characterizing and flexibly controlling SPP on thin metal film are indispensable. Here, we theoretically derive the group velocity dispersion of SPP propagation on the surface of Au films with various thicknesses. The results obtained in this work indicate that when the thickness of the Au film is less than 40 nm, group velocity dispersion of SPP decreases significantly as the film thickness increases. The decrease of group velocity dispersion becomes mild with the thickness increasing from 40 nm to 60 nm, then the dispersion keeps a very low constant value for the film thicker than 60 nm. Using the finite-difference time-domain method, temporal evolution of localized electric field of SPP is numerically simulated for various propagation distances. By comparing the field amplitudes and the dispersions of SPP which are excited by incident light pulses with different dispersions, group velocity dispersions of SPP on the Au films are obtained, showing a good consistence with the theoretical results. Moreover, we demonstrate that by utilizing the tailored SPP to excite metal nanoantenna, selective excitations at different frequencies on a femtosecond temporal scale can be achieved through localized surface plasmonic resonant effect. Manipulating the sign and amount of the dispersion from the incident pulse, the active control of the switching sequence and switching time of electric field between the Au cylinders can be achieved. Manipulating the propagation distance of SPP, the active control of the switching time of electric field between the Au cylinders can be achieved. Therefore, those results provide a promising avenue for realizing functions such as signal propagation, reception, adjustment, and encoding in on-chip interconnect circuit systems based on SPP. This work shows that the dispersion can be used as degree of freedom for controlling the amplitude, phase and pulse width of SPP propagating on thin film, and it is of great importance in designing and controlling on-chip integrated systems through utilizing plasmonic effect, such as ultrafast frequency demodulators and nanoantennas in on-chip interconnect optical circuits.
Stochastic tug-of-war among sarcomeres mediates cardiomyocyte response to environmental stiffness
Authors: Haertter Daniel , Hauke Lara , Driehorst Til , Nishi Kengo , Zimmermann Wolfram-Hubertus , Schmidt Christoph F
Published: August 2024

Cardiac muscle function emerges from the coordinated contraction of sarcomeres in cardiomyocytes. Sarcomere dynamics are usually inferred from whole-cell or myofibril observations, assuming synchronized, uniform behavior. Here, we investigated how different mechanical properties of the cell environment affect contraction at both the sarcomere and cell level. Human induced pluripotent stem cell-derived cardiomyocytes with fluorescently labeled Z-bands were cultured individually on patterned elastic substrates (5 - 85 kPa). Sarcomere dynamics were precisely tracked and analyzed using SarcAsM, a machine learning algorithm we developed. Increasingly stiff substrates inhibited overall cardiomyocyte contraction, but, surprisingly, did not diminish individual sarcomere dynamics. Instead, sarcomeres competed in a tug-of-war with increasing heterogeneity, exhibiting rich dynamic phenomena such as rapid length oscillations and overextensions (popping). Statistical analysis showed that the heterogeneous dynamics were not caused by static structural differences, but were largely stochastic. This stochastic heterogeneity is thus an intrinsic property of cardiac sarcomere dynamics and is likely to be crucial for the adaptation of emergent cardiomyocyte contractility to mechanical constraints from its environment.
Cartografiando afectos docentes en relación con la narcocultura
Authors:   , Baeza Castillo Daniela
Published: August 2024

La siguiente investigación propone cartografiar los afectos que circulan en siete docentes de escuelas públicas de Santiago en relación con la participación de sus estudiantes en la narcocultura. Utiliza un enfoque metodológico cualitativo posthumanista y hace un ensamblaje entre la teoría de afectos, biopoder, biopedagogía y subjetivación, utilizando como técnica de elicitación de datos la narración y la conversación informal. Como resultado se identificaron cinco temas principales emergentes: la narcocultura como concepto de opción rentable que da poder y estatus cuyo final es la muerte, los afectos del odio y el miedo generados por los medios de comunicación y redes sociales, el papel del biopoder y la verdad en la legitimación de roles sociales, el rol formativo de la escuela como alternativa frente a la narcocultura y la importancia de los docentes que marcan y dejan huella. Los hallazgos destacan la complejidad de los afectos que movilizan las representaciones que hacen los y las docentes respecto de la narcocultura, subrayando tanto la resistencia como las limitaciones del sistema educativo en contextos de alta vulnerabilidad social.