bluuebunny/crossref_metadata_2025 huggingface dataset:
PEMANFAATAN BUAH TIN UNTUK PEREKONOMIAN DAN KESEHATAN
Authors: Enjang Suherman
Published: November 2019

The natural wealth of Medalsari is mostly plantations. Many extensive plantation areas at the south of Karawang are shady forests. Not comparable with less than optimal yields due because low prices, marketing and other problems. The purpose of this service is "going forward with figs" is “to utilize figs in improving people's welfare, economy and environment”. The training method delivered is in the form of contextual intruction and question and answer method. Providing training material is associated with everyday life. Presentation of material is done comfortably, cooperation and participation. This training resulted in an understanding of the benefits of fig trees and their fruits that are used for health, environment and people's economy. Participant participation was enthusiastic with the many questions that were conveyed. Keys : Figs

 

Kekayaan alam yang dimiliki oleh Desa Medalsari sebagian besar merupakan perkebunan. Banyak area perkebunan luas di ujung kabupaten Karawang berupa hutan yang rindang. Tidak sebanding dengan hasil panen yang kurang optimal karena harga murah, pemasaran dan permasalah lainnya. Tujuan dari pengabdian maju bersama buah tin yaitu “ untuk memanfaatkan buah tin dalam meningkatkan kesejahteraan masyarakat meliputi kesehatan, ekonomi dan lingkungan”. Metode pelatihan yang disampaikan berupa contextual intruction dan tanya jawab. Pemberian materi pelatihan dikaitkan dengan kehidupan sehari-hari. Penyajian materi dilakukan secara nyaman, kerjasama dan partisipasi. Pelatihan ini menghasilkan pemahaman akan manfaat pohon tin beserta buahnya yang digunakan untuk kesehatan, lingkungan maupun ekonomi kerakyatan. Partisipasi peserta antusias dengan banyaknya pertanyaan-pertanyaan yang disampaikan. Key: Buah Tin
Qualifier la qualité des données localisées numériques des réseaux d’eau et d’assainissement
Authors: LE MOAL M.
Published: November 2019

Les systèmes d’information géographique (SIG) sont devenus incontournables dans la gestion des réseaux d’eau et d’assainissement et leur efficacité repose en très grande partie sur la qualité des données exploitées. Parallèlement, les évolutions réglementaires et les pratiques des utilisateurs augmentant notamment les échanges d’informations renforcent le rôle central des données et de leur qualité. Si la plupart des solutions SIG du marché disposent de fonctions dédiées à la qualification de la qualité des données, elles procèdent de la traduction préalable de spécifications des données en règles informatiques avant de procéder aux tests qualitatifs. Cette approche chronophage requiert des compétences métier. Pour éviter ces contraintes, Axes Conseil a élaboré un procédé de contrôle des données SIG rapide et accessible à des acteurs métier de l’eau et de l’assainissement. Plutôt qu’une lourde approche de modélisation a priori, le principe est de générer un ensemble d’indicateurs explicites facilement exploitables a posteriori par les acteurs du métier. Cette approche offre une grande souplesse d’analyse et ne nécessite pas de compétences informatiques avancées.
IMPLEMENTASI GUGATAN SEDERHANA DALAM LITIGASI DI PASAR MODAL SEBAGAI UPAYA PERLINDUNGAN KONSUMEN (INVESTOR) PASAR MODAL INDONESIA
Authors: Rahmawat Ema
Published: November 2019

Capital market sector is one of the ﬁnancial services which quite dynamic in progress. Capital market transactions have varied characteristics and complexity. In its practices, many factors may motivate legal dispute in capital market in which mostly not settled in litigation way. The investors avoid settle their dispute through litigation mostly because of its formalistic procedure, time consume, and uncertainty of the result because of distrust against court system. The Indonesian Supreme Court has enacted Supreme Court Regulation No. 5 of 2015 concerning Small Claims Procedure as an effort to reform civil justice system which is simplify and expedite. The small claim procedure may offer dispute settlement which simple and quick, however it is limited with the claim value up to Rp200 millions, while mostly capital market transaction has greater value than Rp200 millions. This article will discuss the implementation of the small claims procedure in investor dispute settlement in the capital market. Moreover, this article also elaborates the advantages and disadvantages of small claims procedure in settling investor dispute as a protection to the consumer in capital market.
Pernikahan Lintas Iman Dalam Konteks Masyarakat Majemuk
Authors: Borrong Robert Patannang
Published: November 2019

meninjau persoalan perkawinan campur beda agama yang diistilahkan perkawinan lintas iman, dalam konteks Negara majemuk, terutama dari sudut pandang etika/moral yang dikaitkan dengan sudut pandang hukum dan teologi. Dengan sengaja menggunakan istilah perkawinan lintas iman karena iman adalah sesuatu yang mencerminkan hubungan seseorang dengan Tuhan, apapun agamanya, sedangkan agama adalah institusi yang memfasilitasi iman. Orang yang mau menikah dengan orang yang berbeda agama tetapi suka mempertahankan agama masing-masing seharusnya dilandaskan pada keyakinan iman dan bukan sekedar agama
KETERLIBATAN KAUM INJILI DALAM DIALOG ANTAR UMAT BERAGAMA: SUATU REFLEKSI TEOLOGIS-PEDAGOGIS ATAS METODE DIALOG “PASSING OVER”
Authors: Sianipar Desi
Published: November 2019

Penulisan makalah ini dilatarbelakangi oleh pengamatan penulis mengenai kurangnya keterlibatan kaum Injili dalam dialog antar umat beragama, yang justru banyak dilakukan oleh kalangan Kristen lainnya. Hal ini disebabkan kaum Injili memiliki pemahaman teologis yang berbeda mengenai perjumpaan dengan agama-agama lain, dan kekuatiran mengenai akibat dari perjumpaan tersebut.Berdasarkan pembahasan teoritis, tampak bahwa ada beberapa penyebab kaum Injili kurang terlibat dalam dialog antar umat beragama, yaitu: kekuatiran terjadinya sinkretisme melalui dialog; kekuatiran akan disalahmengerti mengenai keterlibatan dalam dialog; dialog tidak dibutuhkan dalam penginjilan, yang dibutuhkan adalah pendampingan pastoral Kristen; kekuatiran akan terjadinya kemunduran dalam penginjilan; dan sikap eksklusivisme dalammemandang agama-agama lain. Meski dalam posisi demikian, menurut penulis, sebenarnya keterlibatan kaum Injili dalam dialog antar umat beragama masih bisa dimungkinkan kalau mereka memahami dan menghayati keteladan Kristus dalam hal mengosongkan diri (kenosis) untuk mampu membuka diri terhadap orang lain. Metode yang digunakan dalam penulisan makalah ini adalah metode kepustakaan di mana penulis menggunakan sejumlah literatur berbahasa Indonesia dan Inggris, yang membahas tentang dialog antar umat beragama dan keterlibatan kaum Injili dalam dialog antar umat beragama. Selanjutnya, pembahasan dilakukan menurut tinjauan secara teologis pedagogis.Orang Kristen semestinya mampu terlibat dalam dialog antar umat beragama. Penulis mengusulkan suatu metode dialog “melintas batas” atau “passing over”, yang kalau menerapkan prinsip kenosis, kaum Injili dapat melakukannya. Metode ini akan memampukan setiap orang mengalami pengenalan yang mendalam mengenai para penganut agama lain dimana orang tidak pindah agama atau keyakinan, dan bukan sedang dalam pencarian jati diri,juga bukan sedang mencoba-coba mencicipi rasa keagamaan yang lain. Dia melakukan dialog ini untuk memiliki pemahaman yang lebih dalam lagi tentang keyakinan orang-orang dalam agama lain, dan dengan itu justru akan memperkuat keyakinannya sendiri.
MERETAS RANCANG BANGUN TEOLOGI MULTIKULTURAL
Authors: Sudarmanto Gunaryo
Published: November 2019

Hubungan budaya dan teologi dipahami secara beragam. Deskripsi budaya secara sempit telah membedakan dan memisahkannya dari teologi. Sebaliknya deskripsi teologi yang sempit juga mengesampingkan budaya. Tulisan ini bermaksud mendeskripsikan budaya dan teologi secara proporsional baik secara umum maupun alkitabiah. Kemudian mendeskripsikan korelasi antara budaya dan teologi serta menetapkan apa peran teologi terhadap budaya. Khususnya dalam konteks paradigma ’multikultur’ yang sarat dengan konflik antar etnis dan religi di dunia pada umumnya dan Indonesia pada khususnya, bagaimana teologi berperan memberi alternatif solusi. Untuk itu diusulkan terbentuknya rancang bangun ’Teologi Multikultur’ yaitu suatu teologi yang didisain berbasis prinsipprinsip alkitab yang menjadi pedoman bagi orang kristen dalam membangun hubungan dengan orang lain yang berbeda etnis dan religi. Prinisp-prinsip tersebut bermaksud untukmempertemukan segala perbedaan dalam masyarakat pada tataran etis, yang didasarkan pada prinsip teologis.
Role of Real-World Evidence in Informing Cancer Care: Lessons from Colorectal Cancer
Authors: Batra A. , Cheung W.Y.
Published: November 2019

The term “real-world evidence” (rwe) describes the analysis of data that are collected beyond the context of clinical trials. The use and application of rwe have become increasingly common and relevant, especially in oncology, because there is growing recognition that randomized controlled trials (rcts) might not be sufficiently representative of the entire patient population that is affected by cancer, and that specific clinical research questions might be best addressed by real-world data. In this brief review, our main aim is to highlight the role of rwe in informing cancer care, particularly focusing on specific examples from colorectal cancer. Our hope is to illustrate the ways in which rwe can complement rcts in improving the understanding of cancer management and how rwe can facilitate cancer treatment decisions for real-world patients encountered in routine clinical care.
Diferentes 'guerras', preconceitos iguais: questões de gênero nas trajetórias das pioneiras de um Instituto de Matemática e de suas sucessoras
Authors: Menezes Márcia Barbosa de
Published: November 2019

Neste artigo, que apresenta um recorte da pesquisa de Doutorado, será discutido o pioneirismo de mulheres no Instituto de Matemática (IM) da Universidade Federal da Bahia e as percepções de duas gerações de docentes deste Instituto em relação ao “Caleidoscópio de Gênero” que revela as “guerras” enfrentadas ao longo de suas trajetórias profissionais, em cada época.  Na consecução desta pesquisa foram utilizadas entrevistas semi-estruturadas e análise documental nos arquivos do IM, Instituto de Física (IF) e Faculdade de Filosofia (FF), utilizando elementos da análise do discurso.  Resultados do estudo na perspectiva de gênero possibilitaram visualizar que as duas gerações enfrentaram assimetrias de gênero.  Suas capacidades intelectuais e seus desempenhos cognitivos foram subvalorizados em associação ao seu pertencimento biológico.  Revelar o exemplo de luta e de crescimento destas mulheres poderá contribuir na inserção de futuras gerações de mulheres nas áreas da Ciência e Tecnologia.
Gênero e diversidade para além da escola: avanços e desafios da política pública
Authors: Tozetti Renata De Fátima , Signorelli Marcos Claudio , Oliveira Daniel Canavese de
Published: November 2019

As políticas públicas educacionais em gênero e diversidade estão cada vez mais alinhadas à seara dos direitos humanos. O curso Gênero e Diversidade na Escola (GDE) é uma dessas políticas que preparam profissionais de educação nas temáticas de gênero, sexualidade, orientação sexual e relações étnico-raciais. Este artigo objetivou analisar como essa política pública impactou nas atividades, na profissão e na vida dos egressos do curso ofertado pela Universidade Federal do Paraná entre os anos de 2013-2014. Utilizou-se a abordagem quantitativa como método, por meio de formulário eletrônico aplicado com 69 participantes, envolvendo a Escala de Likert e estudo temporal follow-up de dois anos após a conclusão do curso. Os resultados apontaram que: a) 72,4% (n=50) tiveram a oportunidade de abordar a temática em círculos de amigos e conhecidos; b) 56,5% (n=39) voltaram a trabalhar o conteúdo do GDE no cotidiano escolar ou no local de trabalho; c) 49,3% (n=34) não sentiram constrangimento ao tratar sobre o tema em diferentes espaços da sociedade; d); 49,3% (n=34) acreditam que sua constituição enquanto ser humano recebeu impactos do GDE; e) 43,5% (n=30) sentiram-se preparados para falar sobre o tema após dois anos. A importância da manutenção de políticas públicas como essa é um passo decisivo para sua potencialização, evitando o desmonte político desta estratégia.
Editorial
Authors: Casagrande Lindamir Salete
Published: November 2019

Editorial do número 38 dos Cadernos de Gênero e Tecnologia.
Constituição da identidade de mulher/professora/diretora a partir das concepções de gênero e sexualidade
Authors: Silva Gabriela Da , Bobek João Vinicius
Published: November 2019

Apresentamos elementos da pesquisa de mestrado, (2015) no PPPGE/Unisul, na linha de pesquisa Relações Culturais e História da Educação. Trata-se de um recorte da investigação em que se busca compreender, a partir das falas das diretoras entrevistadas: “qual a concepção delas sobre gênero e sexualidade”. Para assim, buscar reconstruir suas histórias de vidas, experiências e subjetividades na constituição de suas identidades. Utilizamos como instrumento metodológico, as narrativas orais e transcritas das diretoras, a partir dos enfoques teóricos de gênero e sexualidade. Compreendemos que pensar a construção dessas identidades não se trata apenas de pensar uma questão de concepção teórica, mas também como ato político e formativo. Por isto, as temáticas em torno de gênero e da sexualidade não envolvem apenas pensar o processo ensino e aprendizagem, mas conformam valores, normas, e posicionamentos que também são políticos diante da multiplicidade de viver e de ser. Ouvir as diretoras/mulheres/professoras na construção de suas histórias de vida na docência, no contexto do cotidiano da escola e da educação formal nos trouxe elementos para reafirmar o quanto as suas concepções de gênero e sexualidade é constituidora de suas identidades na docência, e de como elas organizam as suas práticas pedagógicas para dar resposta a uma situação considerada um problema a ser resolvido.
Entre vozes e silêncios: representações de um professor gay sobre sua sexualidade em sala de aula
Authors: Pellim Tiago
Published: November 2019

A escola, assim como outras instituições sociais como a mídia, a família e a religião, atua na produção de discursos que sustentam normas e crenças e que, por sua vez, orientam o processo de criação das identidades sociais (incluindo o gênero e a sexualidade). Este trabalho tem como objetivo analisar as representações de um professor homossexual acerca da construção de sua sexualidade em sala de aula. Foram realizadas entrevistas com o professor participante que posteriormente passaram por uma análise temática que revelou três grandes unidades significativas, a saber: o dualismo “naturalidade” x “intencionalidade”; a preocupação com os/as alunos/as; e a ênfase no conteúdo curricular. Tal análise nos permite aprofundar a compreensão acerca dos sentidos que estão disponíveis na escola acerca das identidades de gênero e sexualidade, além de vislumbrar a produção de outros sentidos possíveis. PALAVRAS-CHAVE: Escola. Identidades. Discurso. Gênero. Sexualidade.
Conflitos e intenções narrativas entre ficção e realidade: reflexões sobre concepções sociais e de gênero em "o que é isso companheiro?"
Authors: Do Socorro Gomes de Araújo Maria , Leite Lima Filho Domingos
Published: November 2019

Algumas características do filme "O que é isso companheiro?" são analisadas no presente texto. Dado o seu caráter sintétíco, não se pretende aqui uma discussão exaustiva e aprofundada. Nossos objetivos são o de fazer uma contextualização da época, bem como o de situar algumas questões para a reflexão e o debate acerca das concepções sociais e de gênero presentes na obra.
Educação para todas e todos: em busca da equidade de gênero e da diversidade sexual no ambiente escolar
Authors: Salete Casagrande Lindamir , De Souza Batista Tortato Cíntia , Gomes de Carvalho Marilia
Published: November 2019

A necessidade de reflexão sobre as relações de gênero e diversidade sexual no ambiente escolar e a importância de se minimizar desigualdades e preconceitos nos levou a propor e realizar o curso de extensão universitária “Refletindo gênero na escola: a importância de repensar conceitos e preconceitos” cujos objetivos foram: 1- sensibilizar as/os profissionais da educação sobre a importância de se abordar as questões de gênero e diversidade sexual no ambiente escolar, e 2- produzir conhecimento a partir desta experiência. O curso foi ofertado a profissionais do Município de Matinhos no Estado do Paraná – Brasil. O objetivo desta comunicação é apresentar os resultados de uma das atividades realizadas neste curso. Na referida atividade propôs-se às/aos participantes que fizessem uma pintura na qual fosse representada uma síntese dos conceitos e temas abordados no curso em questão. Elas e eles se reuniram em grupos e produziram obras que trataram sobre os mais variados temas como: a importância de se respeitar a diversidade de raça, classe, gênero e sexo; a necessidade de romper com estereótipos e preconceitos; a importância de se reconhecer e respeitar os diversos tipos de família existentes na sociedade brasileira; a necessidade de se oferecer uma educação democrática que busque a eqüidade de gênero, dentre outros. Nesta comunicação apresentar-se-á algumas obras produzidas juntamente com a explicação que as autoras deram e a interpretação que nós fizemos sobre as mesmas. Por meio desta atividade pôde-se perceber que as participantes assimilaram os conceitos e temas abordados no curso. Percebeu-se também a necessidade de se proporcionar outros momentos como este, visando minimizar os preconceitos e discriminações e evitar que diferenças de gênero se transformem em desigualdades sociais. Acreditamos assim, que a educação em todos os seus aspectos, inclusive no aspecto da inclusão e eqüidade de gênero é um direito de todos e todas e não um luxo.
Contribuições dos estudos cts para a educação superior no Brasil: uma perspectiva de gênero
Authors: Luciane Correia Muzi Joyce , Stancki da Luz Nanci
Published: November 2019

Este artigo tem por objetivo entender como os estudos sociais da Ciência e Tecnologia (CTS) possibilitaram discussões em torno da condição das “excluídas” do fazer Ciência e Tecnologia (C&T), com foco numa instituição de ensino superior – a Universidade Tecnológica Federal do Paraná (UTFPR). Nesse sentido, considerando a universidade como espaço em que se faz C&T e do qual as mulheres ficaram durante muito tempo excluídas, faz-se necessário recuperar de que maneira elas conseguiram entrar em redutos antes reservados aos homens. Apresentamos uma breve revisão bibliográfica a respeito do campo CTS na América Latina, bem como da perspectiva de feministas a respeito desse campo de estudos. A seguir apresentamos alguns dados levantados durante a pesquisa para a elaboração de minha dissertação para o Programa de Pós-graduação em Tecnologia especialmente sobre a história da UTFPR e sobre a participação das mulheres nesta história. Como resultado, podemos dizer que, graças à interferência do movimento feminista e dos questionamentos em torno dos chamados ideais da Ciência – neutralidade e objetividade – a situação das mulheres em áreas antes inacessíveis foi modificada, permitindo especialmente que elas ingressassem como alunas e como profissionais nas instituições de ensino superior (IES), atuando inclusive na pesquisa científico-tecnológica.
Uma história toda sua: trajetórias de historiadoras brasileiras, 1940 – 1990
Authors: Silvia da Fonseca Kummer Liblik Carmem
Published: November 2019

Mapear, investigar e analisar as trajetórias intelectuais e pro ssionais, bem como explorar a riqueza das narrativas biográ cas que expressam as experiências pessoais, interpessoais e de vida das historiadoras brasileiras, constituem a natureza essencial da problemática deste artigo. Para tanto, delimitaremos duas gerações de historiadoras pro ssionais que se sobrepõem, as quais estiveram vinculadas às universidades públicas brasileiras conforme suas produções acadêmicas e prática docente: 1ª geração (1940- 1970), responsável pela iniciação dos estudos historiográ cos, escolha de objetos e procedimentos vinculados à História cientí ca, ao lado da consolidação das cátedras; e 2ª geração (1971-1990), responsável pelo início dos primeiros cursos de pós-graduação no país, os quais voltaram-se para novos temas, propostas metodológicas, extinção evolutiva das cátedras e, sobretudo, para pesquisas regularmente organizadas. Tal problemática será analisada mediante o questionamento se o gênero se constitui, ou não, como elemento estruturante na diferenciação e pro ssionalização dos(as) historiadores(as) no campo disciplinar histórico. Espera-se, com isso, compreender inicialmente os papéis assumidos e a maneira como as historiadoras brasileiras se inseriram no âmbito universitário e contribuíram para a consolidação das pesquisas historiográ cas, constituindo assim, suas trajetórias intelectuais e pro ssionais.
Taxonomy on Ambient Computing
Authors: Sengupta Diganta
Published: November 2019

The rise of Internet-of-Things, Cloud infrastructure, and intelligent home solutions has resulted in the growth of Ambient Computing over the past decade. This article is an attempt to cluster the multi-dimensional research in ambient computing into relevant nodes. The author proposes a taxonomy in ambient computing, creating a logical arrangement of such nodes. An algorithm based on the cosine similarity function for calculating the distance between two ‘author keywords' has been used to spawn the inter-nodal relationships. The vocabulary for the research has been generated from IEEE Xplore taking into consideration the relevant journal publications. The taxonomy will guide researchers to the relevant published literature about a certain area of interest instead of exhaustive search into a plethora of published research in ambient computing. The taxonomy exhibits exponential growth of research in ambient computing over the last three years.
An Enhanced Facial Expression Recognition Model Using Local Feature Fusion of Gabor Wavelets and Local Directionality Patterns
Authors: Bellamkonda Sivaiah , Gopalan N.P
Published: November 2019

Facial expression analysis and recognition has gained popularity in the last few years for its challenging nature and broad area of applications like HCI, pain detection, operator fatigue detection, surveillance, etc. The key of real-time FER system is exploiting its variety of features extracted from the source image. In this article, three different features viz. local binary pattern, Gabor, and local directionality pattern were exploited to perform feature fusion and two classification algorithms viz. support vector machines and artificial neural networks were used to validate the proposed model on benchmark datasets. The classification accuracy has been improved in the proposed feature fusion of Gabor and LDP features with SVM classifier, recorded an average accuracy of 93.83% on JAFFE, 95.83% on CK and 96.50% on MMI. The recognition rates were compared with the existing studies in the literature and found that the proposed feature fusion model has improved the performance.
Dynamic Search Fireworks Algorithm with Adaptive Parameters
Authors: Gong Chibing
Published: November 2019

As a comparatively new algorithm of swarm intelligence, the dynamic search fireworks algorithm (dynFWA) imitates the explosion procedure of fireworks. With the goal of achieving global optimization and further boosting performance of dynFWA, adaptive parameters are added in this present study, called dynamic search fireworks algorithm with adaptive parameters (dynFWAAP). In this novel dynFWAAP, a self-adaptive method is used to tune the amplification coefficient Ca and the reduction coefficient Cr for fast convergence. To balance exploration and exploitation, the coefficient of amplitude α and the coefficient of sparks β are also adapted, and a new selection operator is proposed. Evaluated on twelve benchmark functions, it is evident from the experimental results that the dynFWAAP significantly outperformed the three variants of fireworks algorithms (FWA) based on solution accuracy and performed best in other four algorithms of swarm intelligence in terms of time cost and solution accuracy.
Mining Partners in Trajectories
Authors: Monteiro Diego Vilela , Coelho dos Santos Rafael Duarte , Ferreira Karine Reis
Published: November 2019

Spatiotemporal data is everywhere, being gathered from different devices such as Earth Observation and GPS satellites, sensor networks and mobile gadgets. Spatiotemporal data collected from moving objects is of particular interest for a broad range of applications. In the last years, such applications have motivated many pieces of research on moving object trajectory data mining. In this article, it is proposed an efficient method to discover partners in moving object trajectories. Such a method identifies pairs of trajectories whose objects stay together during certain periods, based on distance time series analysis. It presents two case studies using the proposed algorithm. This article also describes an R package, called TrajDataMining, that contains algorithms for trajectory data preparation, such as filtering, compressing and clustering, as well as the proposed method Partner.
The Impact of Psychological Empowerment on the Effectiveness of Performance
Authors: Abu Warda Mona Hamid
Published: November 2019

This study aims to identify the concept of psychological empowerment and clarify its various dimensions and their impact on the effectiveness of performance in the higher education sector. The study has been applied to a sample of 185 staff members working at 3 universities in Saudi Arabia. This study found that the degree of practice of staff members to the dimensions of psychological empowerment exceeds the middle degree, while the level of performance in these universities was high, it showed the existence of a significant effect of the dimensions of psychological empowerment (competence, impact) on the effectiveness in performance. This is while the other two dimensions (self-determination, meaning) do not significantly affect the effectiveness of performance. The study also pointed to the existence of significant differences between the practice of faculty members to psychological empowerment according to the variables (experience, scientific rank, college), and also indicates there are significant differences in the levels of effectiveness performance, according to the variables (marital status, college).
Effects of patient-controlled analgesia on postoperative anxiety in elderly men
Authors: Egbert AM , Lampros LL , Parks LL
Published: November 2019

OBJECTIVE: To determine whether the use of patient-controlled analgesia vs intramuscular injections improves postoperative psychological parameters, particularly anxiety. DESIGN: Randomized, controlled trial of patient-controlled analgesia vs as-needed intramuscular morphine with pre- and postoperative assessments of pain, mental status, narcotic use, anxiety and mood states. SETTING: General surgical wards and surgical intensive care unit at a Veterans Administration hospital. PATIENTS: Eighty-three elderly, chronically ill males undergoing major elective surgery. INTERVENTION: Subjects randomized to receive postoperative patient-controlled analgesia vs as-needed intramuscular morphine. Pre- and postoperative assessments of State-Trait Anxiety Inventory, McGill-Dartmouth Part IV and Short Portable Mental Status Questionnaire. Pain (using linear analog scale), sedation score and narcotic use assessed every 4 hours for 72 hours. RESULTS: No differences were found in state anxiety or self-perceived mood states. Postoperative state anxiety was found to relate most closely to preoperative anxiety and postoperative complications, rather than method of analgesia or severity of pain. However, patient-controlled analgesia subjects had significantly improved analgesia and increased satisfaction. CONCLUSION: The use of patient-controlled analgesia does not significantly alter the measured psychological parameters, compared with intramuscular injections. Improved analgesia is the result of pharmacologic effects, independent of psychological factors.
Pilot study of the relationship between heart rate and ectopy and unrestricted vs restricted visiting hours in the coronary care unit
Authors: Schulte DA , Burrell LO , Gueldner SH , Bramlett MH , Fuszard B , Stone SK , Dudley WN
Published: November 2019

OBJECTIVE: To determine the relationship between cardiac performance (as measured by heart rate and ectopy) and unrestricted vs restricted visiting hours in the coronary care unit. DESIGN: Patients were from two coronary care units. Group A had unrestricted visiting hours, and group B had restricted visiting hours. Heart rate and ectopy were measured three times both in patients with unrestricted visiting hours and in those with restricted visiting hours: (1) before visitors arrived, (2) 5 minutes after visitors arrived and (3) 1 to 5 minutes after the visitors left. A total of 25 visits were analyzed. FINDINGS: There were no significant differences in rates of premature ventricular contractions and premature atrial contractions between the two groups. Patients with unrestricted visiting hours had a significantly lower heart rate after visits than patients with restricted visits. CONCLUSION: Consideration should be given to development of unrestricted visiting policies that promote the continuing presence and natural support of the family and significant others for patients in coronary care units.
Comparative study of bedside and laboratory measurements of hemoglobin
Authors: Krenzischek DA , Tanseco FV
Published: November 2019

OBJECTIVE: The purpose of this study was to examine the effects of variations in technique on measurements of hemoglobin level done at the bedside and to compare these results with laboratory measurements of hemoglobin. DESIGN: In accordance with hospital policy, procedure, and protocol, various techniques were used to obtain samples of capillary and venous blood and of blood from arterial and central venous catheters. Levels of hemoglobin were measured at the bedside and in the laboratory, and the results were compared. SETTING: The Johns Hopkins Hospital adult postanesthesia care unit. SAMPLE: A total of 187 blood samples were obtained from 62 adults who had undergone general surgery. Group I comprised 20 subjects with capillary and venous blood samples. Group II comprised 21 subjects with arterial blood samples. Group III comprised 21 subjects with central venous blood samples. RESULTS: The results showed that the amount of blood to be discarded before obtaining samples of arterial and central venous blood need not be any larger than double the dead space of the catheter, and that shaking the blood sample for 10 seconds was sufficient to mix the sample before measurement of hemoglobin levels. Results of bedside and laboratory measurements of hemoglobin level were comparable. CONCLUSION: Bedside measurement of hemoglobin increases efficiency in patient care, decreases risk of blood-transmitted infection for staff, and decreases cost to the patient. However, the persons who perform the assay must be responsible in adhering to the standard of practice to minimize errors in the measurements.
Use of backrest elevation in critical care: a pilot study
Authors: Grap MJ , Cantley M , Munro CL , Corley MC
Published: November 2019

BACKGROUND: Use of lower backrest positions occurs frequently and is a factor in the development of ventilator-associated pneumonia. OBJECTIVES: To determine the usual bed elevation and backrest position in a medical intensive care unit and their relationship to hemodynamic status and enteral feeding. METHODS: Data were collected in a 12-bed medical respiratory intensive care unit for 2 months. A protractor was used to measure the elevation of the head of the bed. Hemodynamic status was defined by systolic, diastolic, and mean arterial blood pressure measurements retrieved from each patient's flow sheet. RESULTS: The sample included 347 measurements of 52 patients. Mean backrest elevation was 22.9 degrees, and 86% of patients were supine. Backrest position differed significantly (P = .005) among nursing shifts (days, evenings, nights) but not for systolic (r = -0.04, P = .49), diastolic (r = 0.01, P = .83), or mean arterial blood pressure (r = -0.01, P = .84). Backrest elevation did not differ significantly between patients who were receiving enteral feedings and patients who were not (P = .23) or between patients receiving intermittent versus continuous nutrition (P = .22). CONCLUSIONS: Use of higher levels of backrest elevation (> or = 30 degrees) is minimal and is not related to use of enteral feeding or to hemodynamic status. The rationale for using lower backrest positions for critically ill patients may be based on convenience, the patient's comfort, or usual patterns in the unit. However, the dangers of supine positioning and its relationship to aspiration and ventilator-associated pneumonia should not be minimized.
Evidence-based practice: fever-related interventions
Authors: Henker R
Published: November 2019

Fever is a common phenomenon in critically ill patients. Ideally, all decisions about treatment of fever would be based on results of well-developed research studies. Instead, some research questions related to treatment of fever have been studied more extensively than others. This article is an evaluation of the usefulness of the research studies related to treatment of fever in the critically ill. Two questions are addressed: when is treatment of fever most beneficial to a critically ill patient, and how is fever most effectively treated in the critically ill? Evidence related to the treatment of fever is evaluated by using the recommendation levels of the research-based practice protocols of the American Association of Critical-Care Nurses.
A post hoc descriptive study of patients receiving propofol
Authors: Kowalski SD , Rayfield CA
Published: November 2019

BACKGROUND: Use of propofol has recently gained popularity in intensive care settings for patients receiving mechanical ventilation. This newer intravenous sedative is often preferred over other sedatives because of a rapid onset of action, easy titration that allows neurological assessment during administration, and quick arousability of patients after the drug is discontinued. OBJECTIVES: To determine the time to awakening after discontinuance of propofol in a sample of 100 patients receiving mechanical ventilation who had received propofol for at least 12 hours. In addition, demographics, primary and secondary diagnoses, clinical signs and symptoms, propofol dosage and duration, and concomitant use of analgesics and sedatives were determined. METHODS: A descriptive post hoc design was used. Patients' medical records for an 18-month period in an urban hospital in the southwestern United States were reviewed. Sections used for data collection included each patient's admission sheet, the findings of the history and physical examination done by a physician, physicians' progress notes, nursing notes, critical care flow sheets, and records of medications administered. RESULTS: Although nursing documentation indicated 2 common side effects, decreases in heart rate (18%) and decreases in systolic blood pressure (17%), within the first hour of treatment with propofol, immediate arousability after the drug was discontinued was not observed. Mean Glasgow Coma Scale scores took longer than 30 minutes to return to baseline. CONCLUSIONS: The awakening time of patients receiving propofol for a protracted period, usually in conjunction with other potentiating drugs, may be longer than is commonly cited in the literature.
Update on management of acute myocardial infarction: facilitated percutaneous coronary intervention
Authors: Futterman LG , Lemberg L
Published: November 2019

Combination therapy with abciximab and reteplase and heparin allows high rates of patency 60 minutes after therapy. PTCA is facilitated by these adjunctive therapies to improve procedural outcomes. Stent implantation and blockade of the platelet GP IIb/IIIa receptor with abciximab provide potent complementary benefits allowing PTCA to be performed at a new standard of safety and efficacy. Thus the acronym FPCI stands for the use of drugs, angioplasty and stenting. Time and experience will determine the efficacy of the combined pharmacological-mechanical bridge. We believe that FPCI is the wave of the future and that in skilled hands this emergent coordinated care of acute MI has lowered and will continue to lower morbidity and mortality in acute coronary events.
Evaluating the efficiency and effectiveness of approaches to nasogastric tube insertion during trauma care
Authors: Morse JM , Penrod J , Kassab C , Dellasega C
Published: November 2019

BACKGROUND: Numerous invasive, uncomfortable, and discomforting procedures are implemented almost routinely during trauma care. Previous research has shown that trauma care practitioners use comforting strategies during this care. Yet little is known of the effect of these comforting strategies on the effectiveness and efficiency of treatment. OBJECTIVES: To evaluate the effect of the caregiver's approach on the efficient and effective completion of a discomforting procedure (nasogastric tube insertion) on conscious patients during trauma care. METHODS: Ethology was used to analyze 32 attempts at nasogastric tube insertion from 193 videotaped trauma cases from 3 level I trauma centers in North America. Both qualitative and quantitative analytic techniques were used. RESULTS: The practitioner's approach was associated with the outcome of the treatment. Overall, practitioners who balanced the technical aspects of the procedure with use of comforting strategies to minimize the patient's discomfort (the blended approach) were most efficient and most effective in completing this procedure. Practitioners who were most attentive to procedural technique (with little respect to patients' discomfort) or who were overly attentive to comforting strategies (termed the technical and affective approaches, respectively) took longer and/or were less successful at completing the procedure. CONCLUSIONS: Four patterned, standardized approaches to care were found: technical, affective, blended, and mixed. This study has implications for further research into the effect of the practitioner's approach on the patient's behavioral state in trauma care.
Cooling by convection vs cooling by conduction for treatment of fever in critically ill adults
Authors: Creechan T , Vollman K , Kravutske ME
Published: November 2019

BACKGROUND: Cooling with water-flow blankets, which are difficult to manipulate and interfere with patients' care, may be ineffective in controlling fever. OBJECTIVE: To compare the effectiveness of cooling via convective airflow blankets with cooling via conductive water-flow blankets for treatment of fever in critically ill adults. METHOD: A 2-group experimental design was used to compare cooling via convection (n = 20) with cooling via conduction (n = 17) in critically ill adults with an infection-related fever of 38.5 degrees C or greater. Esophageal temperature was measured every 15 minutes until a temperature of 38.0 degrees C was reached or 8 hours had elapsed. Alternative cooling measures were withheld unless the temperature increased to more than 40.0 degrees C. Data on nurses' satisfaction were collected, and complications related to each cooling method were examined. RESULTS: Temperatures decreased more rapidly in the airflow group (mean decrease, 0.377 degree C/h) than in the water-flow group (mean decrease, 0.163 degree C/h). A temperature of 38.0 degrees C was achieved more often in the airflow group (75% vs 47.1%). Fever (temperature > 38.5 degrees C) recurred sooner in the water-flow group (6.6 hours) than in the airflow group (22.2 hours). Both methods were easy to use. Compared with the water-flow blanket, the airflow blanket was recommended for future use twice as often and interfered less with patients' care. CONCLUSIONS: In critically ill adults with an infection or a suspected infection, cooling with an airflow blanket is more effective and more preferred for cooling than is cooling with a water-flow blanket.
Evaluation of nursing care after diagnostic coronary angiography
Authors: McCabe PJ , McPherson LA , Lohse CM , Weaver AL
Published: November 2019

BACKGROUND: Restricting inpatients who have undergone a cardiac catheterization to 6 hours of flat bed rest to reduce the potential for bleeding from the femoral arteriotomy site is based on tradition rather than on research and is associated with discomfort for the patients. OBJECTIVES: To (1) determine the prevalence of femoral arteriotomy complications after diagnostic coronary angiography among inpatients after implementation of a guideline that included reduced duration of bed rest, elimination of sandbags at the arteriotomy site, and 30 degrees elevation of the head of the bed; (2) compare complication rates in this study with rates in previous studies; and (3) determine patient- or practice-related characteristics associated with complications. METHODS: Records of 306 inpatients were reviewed retrospectively to determine the prevalence of femoral arteriotomy complications and the presence of patient- or practice-related characteristics potentially associated with complications. Associations between each characteristic and the presence of a complication were evaluated by using the Wilcoxon rank sum test for continuous data and the chi 2 or Fisher exact test for nominal data. RESULTS: Prevalences of complications were hematoma, 8.8%; bleeding, 4.5%; pseudoaneurysm, 1%; arteriovenous fistula, 0%; and thrombosis, 0%. No evidence indicated that the occurrence of a complication was related to any patient- or practice-related characteristic. Complication rates were comparable to those of previous studies. CONCLUSIONS: The findings support continuation of the current guideline for patients' care after diagnostic coronary angiography. However, further prospective studies with larger samples of inpatients are warranted.
Predictors and outcomes associated with early extubation in older adults undergoing coronary artery bypass surgery
Authors: Bezanson JL , Deaton C , Craver J , Jones E , Guyton RA , Weintraub WS
Published: November 2019

BACKGROUND: Older age has been associated with prolonged mechanical ventilation after coronary artery bypass surgery. Prolonged mechanical ventilation contributes to increased morbidity and mortality and to use of limited financial resources among older adults. OBJECTIVES: To examine selected physiological and pathophysiological variables ofpresurgicalpatients to predict duration of mechanical ventilation in older adults after coronary artery bypass surgery. METHODS: Nonrandomized study of a clinical database of 919 patients (> or =65 years old) who had coronary artery bypass surgery between October 1996 and December 1997. RESULTS: Median elapsed time after coronary artery bypass surgery until extubation was used to sort patients into 2 groups: group 1, 6 hours or fewer (n = 464); and group 2, more than 6 hours (n = 455). With stepwise logistic regression, the physiological model included age (odds ratio, 1.05; P<.001) and female sex (odds ratio, 1.48; P = .005) with weak discrimination by group (concordance statistic = 0.5880). The pathophysiological model, which included renal insufficiency (odds ratio, 3.28; P = .01), previous peripheral vascular surgery (odds ratio, 2.87; P = .03), nonelective preoperative clinical status (odds ratio, 2.8; P = .006), congestive heartfailure (odds ratio, 2.6; P<.001), and reoperation (odds ratio, 2.34; P = .007), showed moderate discrimination bygroup (concordance statistic =0.6755). CONCLUSION: Many older adults were easily extubated and had good outcomes. The variables comorbid conditions and severity of illness provided better discrimination between extubation groups than a physiological model provided. Both predictive models allowed limited discrimination between groups.
Subjective Perceptions and Physiological Variables During Weaning From Mechanical Ventilation
Authors: Twibell Renee , Siela Debra , Mahmoodi Mahnaz
Published: November 2019

• Background As costs related to mechanical ventilation increase, clear indicators of patients’ readiness to be weaned are needed. Research has not yet yielded a consensus on physiological variables that are consistent correlates of weaning outcomes. Subjective perceptions rarely have been examined for their contribution to successful weaning.

• Objective To explore the subjective perceptions of dyspnea, fatigue, and self-efficacy and selected physiological variables in patients being weaned from mechanical ventilation.

• Methods Data were collected prospectively on 68 patients being weaned from mechanical ventilation. Subjective perceptions were measured by using 3 visual analog scales; physiological variables were measured by using the Burns Weaning Assessment Program and a patient profile. Weaning outcomes were recorded 24 hours after data collection.

• Results Participants were primarily white women and required mechanical ventilation for a mean of less than 4 days. Participants reported mild dyspnea, moderate fatigue, and high weaning self-efficacy. High Pao2, low Paco2, stable hemodynamic status, adequate cough and swallow reflexes, no metabolic changes, and no abdominal problems were associated with complete weaning (P = .05). Subjective perceptions were associated with physiological variables but not with weaning outcomes.

• Conclusions Multidimensional assessment of both primary and secondary indicators of readiness to be weaned is necessary for timely, efficient weaning from mechanical ventilation. Primary assessments include physiological variables related to gas exchange, hemodynamic status, diaphragmatic expansion, and airway clearance. Secondary assessments include perceptions related to key physiological variables. Additional research is needed to determine the predictive value of physiological variables and perceptions of dyspnea, fatigue, and self-efficacy.
Oral Care Interventions in Critical Care: Frequency and Documentation
Authors: Grap Mary Jo , Munro Cindy L. , Ashtiani Brooke , Bryant Sandra
Published: November 2019

• Background No data have been collected to describe the products, methods, and frequency of oral care needed to reduce dental plaque, oral colonization, and ventilator-associated pneumonia in critically ill patients.

• Objectives To describe the frequency of use of oral care interventions reported by nurses in several intensive care units in a large southeastern medical center.

• Methods Staff members completed a written survey describing their oral care practices, and oral care interventions were recorded from the unit’s flow sheet for the previous 24 hours for all patients at 5 randomly selected times during 1 month.

• Results Most respondents (75%) reported providing oral care 2 or 3 times daily for nonintubated patients, and 72% reported providing care 5 times daily or more for intubated patients. However, oral care was documented on the unit’s flow sheet a mean of 1.2 times per patient. Reported use of toothpaste and a toothbrush was significantly greater in nonintubated patients (P < .001), and use of a sponge toothette was significantly greater in intubated patients (P < .001). Nurses’ mean rating of oral care priority was 53.9 on a 100-point scale.

• Conclusions Despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required; nursing research to delineate the best procedure for all patients in intensive care units is needed.