bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frontline over ivory tower: key competencies in community-based curricula
Authors: Millar Adam , Malcolm Janine , Cheng Alice , Fine Rebecca , Wong Rene 
Published: April 2020

Background: The Royal College of Physicians and Surgeons of Canada mandates that community experiences be incorporated into medicine-based specialties. Presently there is wide variability in community endocrine experiences across Canadian training programs. This is complicated by the paucity of literature providing guidance on what constitutes a ‘community’ rotation.Method: A modified Delphi technique was used to determine the CanMEDS competencies best taught in a community endocrinology curriculum. The Delphi technique is a qualitative-research method that uses a series of questionnaires sent to a group of experts with controlled feedback provided by the researchers after each survey round. The experts in this study included endocrinology program directors, community endocrinologists, endocrinology residents and recent endocrinology graduates.Results: Thirty four out of 44 competencies rated by the panel were deemed suitable for a community curriculum. The experts considered the “Manager” role best taught in the community, while they considered the community least suitable to learn the “Medical Expert” competency.Conclusions: To our knowledge, this is the first time the content of a community-based subspecialty curriculum was determined using the Delphi process in Canada. These findings suggest that community settings have potential to fill in gaps in residency training in regards to the CanMEDS Manager role. The results will aid program directors in designing competency-based community endocrinology rotations and competency-based community rotations in other medical subspecialty programs.
Using visual art and collaborative reflection to explore medical attitudes toward vulnerable persons
Authors: Kidd Monica , Nixon Lara , Rosenal Tom , Jackson Roberta , Pereles Laurie , Mitchell Ian , Bendiak Glenda , Hughes Lisa 
Published: April 2020

Background: Vulnerable persons often face stigma-related barriers while seeking health care. Innovative education and professional development methods are needed to help change this.Method: We describe an interdisciplinary group workshop designed around a discomfiting oil portrait, intended to trigger provocative conversations among health care students and practitioners, and we present our mixed methods analysis of participant reflections.Results: After the workshop, participants were significantly more likely to endorse the statements that the observation and interpretive skills involved in viewing visual art are relevant to patient care and that visual art should be used in medical education to improve students’ observational skills, narrative skills, and empathy with their patients. Subsequent to the workshop, significantly more participants agreed that art interpretation should be required curriculum for health care students. Qualitative comments from two groups from two different education and professional contexts were examined for themes; conversations focused on issues of power, body image/self-esteem, and lessons for clinical practice. Conclusions: We argue that difficult conversations about affective responses to vulnerable persons are possible in a collaborative context using well-chosen works of visual art that can stand in for a patient.
Procedural skills training for Canadian medical students participating in international electives
Authors: Margolick Joseph , Kanters David , Cameron Brian 
Published: April 2020

Background: International medical electives (IMEs) are unique learning opportunities; however, trainees can risk patient safety. Returning medical students often express concern about doing procedures beyond their level of training. The Canadian Federation of Medical Students has developed guidelines for pre-departure training (PDT), which do not address procedural skills. The purpose of this research is to determine which procedural skills to include in future PDT.Methods: Twenty-six medical students who returned from IMEs completed surveys to assess PDT. Using a Likert scale, we compared procedures performed by students before departing on IME to those performed while abroad. We used a similar scale to assess which procedures students feel ought to be included in future PDT.Results: There was no significant increase in number of procedures performed while on IME. Skills deemed most important to include in future PDT were intravenous line insertion, suturing of lacerations, surgical assisting and post-operative wound care.Conclusions: Pre-departure training is new and lacks instruction in procedural skills. Over half the students rated several procedural skills such as IV line insertion, suturing, assisting in surgery, post operative wound management and foley catheterization as important assets for future PDT.
KEPATUHAN WAJIB PAJAK: KEADILAN DAN PENGETAHUAN PAJAK KPP MALANG SELATAN
Authors: Perdana Sukma , Arifin Rosyid 
Published: April 2020

The purpose of this study was to determine the effect of fairness and tax knowledge on compliance of individual taxpayers in Malang. The analytical method used in this study is multiple regression. Based on the results of the analysis found evidence that simultaneously or partially justice and tax knowledge affect the compliance of Individual Taxpayers in Malang. In order to improve taxpayer compliance, the KPP Pratama office in Malang provides taxation knowledge to the public through intensive, consistent and sustainable tax education. In addition, it is necessary to increase the quantity and quality of tax education counseling so that the public's tax knowledge increases and become more aware and compliant in carrying out their tax obligations. In addition, taxpayers to learn more and understand the regulations regarding taxation so that they can improve their compliance as taxpayers
Keywords: Justice, tax knowledge and taxpayer compliance
SISTEM PENGGAJIAN TERHADAP PENGENDALIAN INTERN DI RUMAH SAKIT PANTI NIRMALA MALANG
Authors: Putri Ayu Kemala , Hendrawaty Rina 
Published: April 2020

Accurate information is a major requirement for management in carrying out all activities related to achieving the stated goals. This information has an important role in the process of controlling and making decisions on the company's operations that have been and will be carried out, so that it can be said that the success of management depends on the information and whether information is owned accurately. Internal payroll system for good payroll is expected later ease the burden of payroll, so that it can be used as a monitoring tool for the company. Therefore, in a company there needs to be an adequate payroll system and procedure which includes recording time attendance, recording working time, making payroll, making procedures for proof of cash out, salary distribution procedures and procedures for payment of wages in which the implementation is an internal control. The results of the study explained that payroll accounting systems, payroll systems, payroll procedures and organizational structure simultaneously affect internal control of the Pirm Nirmala Hospital and partially each payroll accounting system, payroll system, payroll procedure, and organizational structure also very influential for control intern of Panti Nirmala Hospital Malang.
Keywords: Payroll accounting system, Payroll system, Payroll procedure Organizational structure and Internal control
Preliminary study for the adaptation of the »Heaven's Cave« for tourist purposes (Phong Nha-Ke Bang national park, Vietnam)
Authors: Debevec Bogdan , Knez Martin , Kranjc Andrej , Pahor Marko , Prelovšek Mitja , Slabe Tadej 
Published: April 2020

Heaven’s Cave is located in the centre of the Phong Nha-Ke Bang national park, about 500 km southern from the Vietnamese capital and 40 km from the city of Dong Hoi. Phong Nha-Ke Bang national park is protected also as a UNESCO world heritage site. Due to weak economic situation in this region as a result of lack of natural resources, karst tourism represents an important opportunity for raising the quality of live in the province. A proposal to adapt non-touristic Heaven’s Cave for tourism was presented to Karst Research Institute ZRC SAZU in 2006. Because the caves are sensitive ecosystems and all activities in them should be carefully implemented, our task was to make basic survey and map the cave, to perform a speleological and touristic research, to propose possible interventions for adapting the cave for tourism and to prepare a strategy for tourism development in this area. The latter should also show us if some interest is present among tourists for new show cave in this region. From this point of view this study does not represent systematic long-term approach for adapting a cave for tourism but rather a short study of a cave with potential to be show cave in remote area of Central Vietnam. Approach used in this study should be used in similar environments as a first step to estimate if weakly known cave is environmentally and economically suitable for development for touristic purposes.Keywords: Heaven’s Cave, Thien Duong Cave, Phong Nha-Ke Bang, Vietnam, show cave.
Reimški evangelij – jezik glagolskega dela
Authors: Perdih Andrej 
Published: April 2020

Glagolski del Reimškega evangelija je cerkvenoslovansko besedilo hrvaške
redakcije, napisano v samostanu Na Slovanech v Pragi leta 1395. V literaturi se večinoma navaja, da se v besedilu pojavljajo vplivi češkega jezika, pisec Reimškega evangelija pa naj bi bil po rodu Čeh, Slovak ali Hrvat. Z analizo fonetične in morfološke ravnine jezika želim preveriti, ali in v kolikšni meri lahko sprejmemo katero od teh možnosti.
Activities of Home-Based Heart Failure Nurse Specialists: A Modified Narrative Analysis
Authors: Davidson Patricia , Paull Glenn , Rees David , Daly John , Cockburn Jill 
Published: April 2020

• Background Heart failure nurse specialists strive to optimize patients’ outcomes in home-based settings.
• Objective To document the activities of home-based heart failure nurse specialists.
• Method A modified narrative analysis of clinical notes of home-based heart failure nurse specialists during a 12-month period was used.
• Results Data analysis revealed 7 key activities of home-based heart failure nurse specialists: (1) monitoring signs and symptoms and reinforcing patients’ self-management: identifying trends and appropriate action; (2) organization, liaison, and consultation with other health professionals to deal with changes in clinical status; (3) clarifying and reinforcing patients’ self-care strategies; (4) assisting patients in their desire to avoid institutionalized care; (5) identifying patients’ psychosocial issues: dealing with social isolation; (6) providing support: journeying with patients and patients’ families; and (7) helping patients and patients’ families deal with death and dying.
• Conclusions A major proportion of the activities of home-based heart failure nurse specialists are related to facilitating communication between health professionals and providing information and support to patients and patients’ families.
Critical Care Providers’ Perceptions of the Use of Vasopressin in Cardiac Arrest
Authors: Heath Janie , Hanson Dave , Long Rebecca , Crowell Nancy A. 
Published: April 2020

• Background Although published algorithms and guidelines list epinephrine and vasopressin as either/or choices for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, little is known about how critical care providers respond to this recommendation.
• Objectives To assess the use of vasopressin as a first-line drug of choice for ventricular fibrillation and/or pulseless ventricular tachycardia and describe factors that may influence decision making for using vasopressin.
• Methods A convenience sample from 4 academic medical centers in the United States was recruited to complete a 20-item survey on demographic factors such as year of last Advanced Cardiac Life Support (ACLS) provider course, specialty certification, predominant practice responsibility, and beliefs related to the use of vasopressin for cardiac arrest. Descriptive statistics, Pearson correlation analysis, and logistic regression were used to analyze the data.
• Results A total of 214 critical care providers (80% registered nurses) completed the survey. Year of last ACLS course (r = −0.188, P = .006) was a significant demographic factor, and behavioral beliefs (attitude about using vasopressin) had the strongest relationship (r = 0.687, P &lt; .001) and were the best predictor for intentions to use or recommend the use of vasopressin (beta=0.589, P&lt;.001).
• Conclusions Despite the recommendation for vasopressin as an agent equivalent to epinephrine for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, 63% of respondents used epinephrine as a first-line drug of choice. More research is needed to address the classification system for interpreting the quality of evidence that may influence practice.
Providing a “Good Death”: Critical Care Nurses’ Suggestions for Improving End-of-Life Care
Authors: Beckstrand Renea L. , Callister Lynn Clark , Kirchhoff Karin T. 
Published: April 2020

• Background Providing appropriate end-of-life care has become a primary concern of nurses and the public. The highly technological critical care environment may not facilitate such care.
• Objective To collect suggestions from critical care nurses for improving end-of-life care in intensive care units.
• Methods A geographically dispersed, random sample of 1409 members of the American Association of Critical-Care Nurses was sent a 72-item survey on perceptions of end-of life care. The survey included a request for suggestions on ways to improve end-of life care.
• Results Of the 861 critical care nurses who responded to the survey, 485 offered 530 suggestions for improving end-of-life care. Providing a “good death” was the major theme; specific suggestions included ways to help ensure death with dignity and peace. Barriers to providing good deaths included nursing time constraints, staffing patterns, communication challenges, and treatment decisions that were based on physicians’ rather than patients’ needs. Suggestions for providing a good death included facilitating dying with dignity; not allowing patients to be alone while dying; managing patients’ pain and discomfort; knowing, and then following, patients’ wishes for end-of-life care; promoting earlier cessation of treatment or not initiating aggressive treatment at all; and communicating effectively as a health-care team. Educational initiatives for professionals and the public were also suggested.
• Conclusions Implementation of specific suggestions provided by experienced critical care nurses might increase the quality of end-of-life care, facilitating a good death for intensive care patients.
Improving Adherence to a Mechanical Ventilation Weaning Protocol for Critically Ill Adults: Outcomes After an Implementation Program
Authors: McLean Suzanne E. , Jensen Louise A. , Schroeder Dallas G. , Gibney Noel R. T. , Skjodt Neil M. 
Published: April 2020

• Background Despite multiple reminders, education sessions, and multidisciplinary team involvement, adherence to an evidence-based mechanical ventilation weaning protocol had been less than 1% in a general systems intensive care unit since implementation.
• Objective To assess the effectiveness of using an implementation program, the Model for Accelerating Improvement, to improve adherence and clinical outcomes after restarting a mechanical ventilation weaning protocol in an adult general systems intensive care unit.
• Methods A prospective comparative design, before and after implementation of the Model for Accelerating Improvement, was used with a consecutive sample of 129 patients and 112 multidisciplinary team members. Clinical outcomes were rate of unsuccessful extubations, rate of ventilator-associated pneumonia, and duration of mechanical ventilation; practice outcomes were staff’s understanding of the mechanical ventilation weaning protocol, perceptions of the practice safety climate, and adherence to the weaning protocol.
• Results After the intervention, the rate of unsuccessful extubations decreased, and staff’s understanding of and adherence to the weaning protocol increased significantly. The rate of ventilator-associated pneumonia, duration of mechanical ventilation, and staff’s perceptions of the practice safety climate did not change significantly.
• Conclusion Implementing the Model for Accelerating Improvement improved understanding of and adherence to protocol-directed weaning and reduced the rate of unsuccessful extubations.
Factors Influencing Length of Stay in the Intensive Care Unit
Authors: Gruenberg David A. , Shelton Wayne , Rose Susannah L. , Rutter Ann E. , Socaris Sophia , McGee Glenn 
Published: April 2020

• Background Long stays in the intensive care unit are associated with high costs and burdens on patients and patients’ families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit.
• Objective To identify and categorize the factors associated with prolonged stays in the intensive care unit and to describe briefly the nonmedical interventions to date designed to reduce length of stay.
• Methods Articles published between January 1990 and March 2005 in English-language journals indexed by MEDLINE were searched for studies on outcomes and costs of care in the intensive care unit and on care at the end of life.
• Results The emerging consensus is that length of stay in the intensive care unit is exacerbated by several increasingly discernible medical, social, psychological, and institutional factors. At the same time, several nonmedical, experimental interventions have been designed to reduce length of stay.
• Conclusions Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients’ families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.
Long-term changes in central European river discharge for 1869–2016: impact of changing snow covers, reservoir constructions and an intensified hydrological cycle
Authors: Rottler Erwin , Francke Till , Bürger Gerd , Bronstert Axel 
Published: April 2020

Abstract. Recent climatic changes have the potential to severely alter river runoff, particularly in snow-dominated river basins. Effects of changing snow
covers superimpose with changes in precipitation and anthropogenic modifications of the watershed and river network. In the attempt to identify and
disentangle long-term effects of different mechanisms, we employ a set of analytical tools to extract long-term changes in river runoff at high
resolution. We combine quantile sampling with moving average trend statistics and empirical mode decomposition and apply these tools to discharge
data recorded along rivers with nival, pluvial and mixed flow regimes as well as temperature and precipitation data covering the time frame
1869–2016. With a focus on central Europe, we analyse the long-term impact of snow cover and precipitation changes along with their interaction
with reservoir constructions. Our results show that runoff seasonality of snow-dominated rivers decreases. Runoff increases in winter and spring, while discharge decreases in
summer and at the beginning of autumn. We attribute this redistribution of annual flow mainly to reservoir constructions in the Alpine ridge. During the
course of the last century, large fractions of the Alpine rivers were dammed to produce hydropower. In recent decades, runoff changes induced
by reservoir constructions seem to overlap with changes in snow cover. We suggest that Alpine signals propagate downstream and affect runoff far
outside the Alpine area in river segments with mixed flow regimes. Furthermore, our results hint at more (intense) rainfall in recent
decades. Detected increases in high discharge can be traced back to corresponding changes in precipitation.
FATORES DE RISCO ASSOCIADOS À INFECÇÃO POR Toxoplasma gondii EM GESTANTES ATENDIDAS EM UMA UNIDADE DE SAÚDE ESPECIALIZADA NO MUNICÍPIO DE CURITIBA - PARANÁ
Authors: Brito Junior Pedro De Alcântara , Poleto Ana Paula Coninck Mafra , Bontorin Viviani , Morikawa Vivien Midori 
Published: April 2020

O objetivo do presente estudo foi estimar a prevalência e identificar os fatores de risco associados à infecção por Toxoplasma gondii em 103 gestantes atendidas pelo Sistema Único de Saúde, em uma unidade de saúde especializada no município de Curitiba, Paraná. Para isso, foi realizado um estudo epidemiológico transversal quantitativo a partir da realização de entrevistas utilizando um questionário estruturado. As informações referentes à triagem sorológica foram obtidas a partir das cadernetas das gestantes durante a entrevista. O teste do Qui Quadrado e Exato de Fischer foram utilizados para análise dos dados, e o odds ratio (OR) para estimar a chance de associação entre variáveis de exposição e desfecho. Das 103 gestantes avaliadas, 59 (57,28%) apresentaram anticorpos anti-Toxoplasma gondii e 42,72% eram soronegativas. Houve associação estatisticamente significativa entre as variáveis renda familiar (P = 0,03), tipo de moradia (P = 0,005), consumo de carne crua ou mal cozida e ingestão de frutas e vegetais mal higienizados (p = 0,045). Deste modo, a identificação dos fatores de risco se faz necessária para implantação de medidas de prevenção e controle da toxoplasmose materna e congênita.
The Use of Debates as an Approach to Deliver the Course Entitled “The Impact of US Policy on Integration Processes in Europe in the Post-Bipolar Era”
Authors: Korniienko Alina Yu. 
Published: April 2020

The purpose of this research was to identify how the use of a debate-based course delivery approach merged with a flipped classroom model influenced the students’ academic outcomes and motivation in relation to their intelligence type and how the sampled students perceived the course delivery approach and certain debate-related activities. Sampled students’ academic performance records, an evaluation survey to obtain students’ feedback on both the course delivery approach and the effectiveness of the activities like ‘Think-Pair-Share’, ‘Write-Pair-Share’, ‘Illogical story-telling’, ‘Treasure Hunt’, case-study, ‘One Minute Paper’, ‘Attitude/motivation test battery’ as intelligence type-based diagnostics of learners’ motivation, and a focus-group semi-structured interview were used as the instruments. SPSS 10.0.5 computer statistical package was used to process data. The use of debates to deliver the instructional content to the tertiary students can be considered a three-vector approach capable to bring a positive change to learning motivation, cognitive (intellectual) activity, self-esteem (self-efﬁcacy) of a student and the overall quality of the vocational training system of the historians and lawyers-to-be. This study boosts the methodology of vocational training of the students majoring in humanities like History/Law in terms of fostering the 21st century-competencies and it adds a different perspective to the theory on relation between the type of intelligence and skills. This approach fosters learner autonomy and positive perception of challenging educational activities. It was found that it was prerequisite for the success of the above approach that there was a well-trained debate moderator, and debate-procedure-aware and trained students. The further research is needed in purposeful introduction of NLP training into the above model and examination its impacts.