bluuebunny/crossref_metadata_2025_split huggingface dataset:
Canadian Paramedic Experience with Intramuscular Ketamine for Extreme Agitation: A Quality Improvement Initiative
Authors: Helmer Jennie , Acker Joe , Deakin Jon , Johnston Tania 
Published: April 2020

Background There are no published reports in Canada examining paramedic use of ketamine for highly agitated patients or excited delirium syndrome. We employed a Plan, Do, Study, Act (PDSA) quality improvement approach to evaluate the safety and effectiveness of advanced care paramedic administered intramuscular (IM) ketamine for patients with extreme agitation in the out-of-hospital setting. Methods Data were prospectively collected from July 2018 to January 2019 when advanced care paramedics with specific training administered IM ketamine as an alternative to midazolam. Paramedics used a clinical audit form to document the ketamine dose, patient response on the Richmond Agitation Sedation Scale (RASS) at time intervals, adverse effects, and any airway management interventions they performed. Results Thirty-three patients received either 4 mg/kg or 5 mg/kg of ketamine. Combining data for both doses, the median change in RASS score at 5 minutes post-ketamine was 3 (range 0 to 8) and statistically significant for each dose. There were seven cases (21%) with reported adverse effects including SpO2 <90% (3/7), hypersalivation (3/7), trismus or teeth grinding (2/7), muscular rigidity (1/7) and laryngospasm (1/7). Statistical analysis confirmed that the incidence of adverse events was not dose dependent. Basic airway management was performed in one-third of all cases. Conclusion We piloted the implementation of ketamine for sedation in our paramedic system by employing a PDSA cycle. Ketamine 5 mg/kg IM provided effective control of acutely agitated patients with adequate sedation at 5 minutes post-delivery. Any adverse events that occurred as a result of IM ketamine were readily managed with basic airway management interventions.
Effect of Work Safety and Work Healthy Towards Employee's Productivity in PT. Sisirau Aceh Tamiang
Authors: Mora Zulkarnen , Suharyanto Agung , Yahya M. 
Published: April 2020

This study aims to determine the effect of work safety and work healthy on employee productivity in the production department at PT. Sisirau Aceh Tamiang. This research is a type of quantitative research with a sample of 45 people. The data analysis method used is multiple linear regression analysis. Hypothesis testing is done through t test, F test, and the coefficient of determination (R2). Regression equation results obtained Y = 2.255 + 0.314X1 + 0.811X2 means that the constant value of 2.255 is the value of employee productivity before being influenced by work safety and health. The work safety regression coefficient is 0.314 and is positive, meaning that if work safety is increased the employee's work productivity will increase by 0.314 with a tcount> ttable (2.333> 1.68195) and significant (0.025 <0.05). The work health regression coefficient is 0.118 and is positive, meaning that if work health is improved the employee's work productivity will increase by 0.811 with a tcount> ttable (8.063> 1.68195) and significant (0.000 <0.05). The coefficient of determination (R2) of 0.614 or 61.4%, which means the work safety and health variables influence the work productivity of employees by 61.4% and the remaining 39.6% is influenced by other variables not examined in this study.
Value Added Tax and Fiscal Federalism in Ethiopia
Authors: Yesegat Wollela Abehodie , Krever Richard 
Published: April 2020

Crucial to the success of any federal state is the fiscal viability of the central government and component federal states. A feature common to most federal systems is the collection of greater revenues by the central government and reliance by states on transfers from the central government in addition to locally imposed taxes to fund budget expenditures. As is the case in many other federal jurisdictions, in Ethiopia the value added tax (VAT), a tax levied on business sales but ultimately borne by consumers, is an important source of central government revenue. As is also the case in many federal jurisdictions, an assignment of a portion of central government VAT revenues to states is one of the main sources of transfer payments by the central government to state governments in Ethiopia. However, the Ethiopian version of fiscal federalism differs significantly from that found in most other jurisdictions in three key design features – the division between the central and state governments of responsibilities to administer the VAT, the basis on which VAT revenues are divided between the central government and the state governments, and a peculiar design feature that results in tax collections by one state government to be offset by tax reductions suffered by another state government. All three features are cause for concern. The division of administrative responsibility undermines the goal of comprehensive uniform tax administration. The basis for division of tax revenues, a distinction built on the legal form of businesses, leads to assignments of VAT revenue unrelated to fiscal needs. And, most importantly, the odd design feature – the assignment of revenues from the VAT, intended to be a tax on consumers, to the state in which the seller is located rather than the state of the buyer – results in effective cross subsidies when businesses located in wealthier states sell goods and services to businesses operating in poorer states. This article provides a history of the Ethiopian regime and explores how the unique features of the Ethiopian fiscal federalism system arose. It suggests a system that divides revenue on the basis of a fiscal equalisation formula that divides VAT revenues on the basis of relative budget needs of states or a system that allocates revenue to the state in which the customer is located would yield a fairer outcome than the current system. It concludes with modernisation of the tax administration coupled with the adoption of a fiscal equalisation formula for distributing VAT revenues and a generous transitional system for transition to this regime would yield the optimal path going forward.
Lack of Histological and Molecular Signature Response to Tocilizumab in Kidney Transplants with Chronic Active Antibody Mediated Rejection: A Case Series
Authors: Kumar Dhiren , Yakubu Idris , Safavi Frough , Levy Marlon , Moinuddin Irfan , Kimball Pamela , Kamal Layla , King Anne , Massey Davis , Halloran Philip , Gupta Gaurav 
Published: April 2020

Background
Traditional therapies for caAbMR have unclear efficacy with significant side effects in recipients of kidney transplants (KTs). A recent single-center case series suggested tocilizumab (TCZ) could stabilize renal function and improve microvascular inflammation. Here we report our findings of the use of TCZ in patients with caAbMR.

Methods
Ten adult recipients of KTs with biopsy-proven caAbMR were treated with TCZ at 8 mg/kg per month. Patients were monitored for adverse events, and therapy was interrupted in the setting of serious infections. Six patients (60%) underwent post-treatment biopsies.

Results
Patients (mean age of 43 years) were initiated on TCZ at a median of 36 months post-KT. A majority of patients were black (70%), underwent regrafts (40%), and were sensitized (mean cPRA=41%). Patients received a median of six doses of TCZ (range=3–10). At a median follow-up of 12 months (range=8–24 months), renal function did not show improvement (mean eGFR, 42±18 ml/min per 1.73 m2 to 37±24 ml/min per 1.73 m2; P=0.27). The slope of decline in eGFR remained unchanged (−0.14±0.9 to −0.33±1.1; P=0.25). There was no improvement in mean MVI (g+ptc) (4.8±1.4 to 4.2±2.0; P=0.39) scores or Molecular Microscope Diagnostic System (MMDx) AbMR scores (0.79±0.17 to 0.78±0.26; P=0.86). There was a numeric worsening of chronicity (ci+ct) scores (2.5±0.8 to 3.3±1.7; P=0.38) and MMDx atrophy fibrosis scores (0.36±0.24 to 0.58±0.15; P=0.21). Patient survival was 90%, with one patient death due to complications from a hip infection. Overall death-censored graft survival was 80%, with two graft losses in patients who had recurrent infections requiring hospitalization.

Conclusions
In this early experience, we report a lack of efficacy and toxicity with the use of TCZ for caAbMR. Prospective clinical trials are needed to clarify the role of IL-6 blockade and the possibility of increased incidence of infections in patients with caAbMR who are treated with TCZ.
OS LABIRINTOS INEVITÁVEIS DE JOSÉ SARAMAGO
Authors: Tracera Amanda 
Published: April 2020

Este artigo busca apresentar uma leitura do Manual de Pintura e Caligrafia, de José Saramago, que dialoga com a releitura borgeana do mito do Minotauro. Publicado pela primeira vez em 1977, o primeiro romance de Saramago elabora já algumas das questões que serão recorrentes na sua obra a partir da publicação de um dos seus romances "clássicos", Levantado do Chão (1980). Interessaram a este artigo, principalmente, os debates empreendidos pelas relações entre o eu e a obra e arte e a memória e a História. Assim, a partir da leitura do romance, pretendeu-se investigar os labirintos metafóricos evocados pela narrativa e, dessa forma, discutir as reflexões empreendidas pelo narrador-personagem sobre a obra de arte, a sua produção e a sua relação com a matéria histórica. Com base nessa investigação, compreendeu-se que, embora a "marca" dos romances de Saramago seja uma ubversão do discurso histórico, em Manual de Pintura e Caligrafia se pretendeu, antes, uma análise do discurso artístico e das suas influências na elaboração de uma nova História.
Palavras-chave: Manual de Pintura e Caligrafia; José Saramago; Labirinto.
O PACTO NACIONAL PELA ALFABETIZAÇÃO NA IDADE CERTA (PNAIC) E SEUS VÍNCULOS COM AS POLÍTICAS DE FORMAÇÃO DE PROFESSORES ALFABETIZADORES NOS MUNICÍPIOS PAULISTAS
Authors: PARENTE Cláudia da Mota Darós 
Published: April 2020

Esta pesquisa situa-se no campo das políticas públicas e tem como objetivo analisar possíveis relações entre o Pacto Nacional pela Alfabetização na Idade Certa (PNAIC) e as políticas de formação de professores alfabetizadores nos municípios paulistas. O estudo analisa 264 municípios paulistas que participaram do PNAIC em 2013 e/ou 2014, articulando as abordagens quantitativa e qualitativa na análise dos resultados. Os municípios paulistas possuem uma trajetória no campo da formação de professores, principalmente, decorrente da colaboração com as esferas estadual e federal. O PNAIC é uma ação entre várias outras já desenvolvidas e em desenvolvimento nos municípios paulistas em termos de formação de professores alfabetizadores. No entanto, o estudo mostra a importância do PNAIC para o fortalecimento da política de formação de professores alfabetizadores no âmbito municipal e defende a efetivação do regime de colaboração entre os diferentes entes federativos.
O USO DE CANAIS DE INFORMAÇÃO NA IMPLEMENTAÇÃO DO PROGRAMA MAIS EDUCAÇÃO
Authors: SANTOS Diana Viturino , SCHMITZ Heike 
Published: April 2020

Este estudo trata da gestão da informação na implementação do Programa Mais Educação, que prevê no seu desenho administrativo uma cooperação entre diferentes entes federados. A gestão da informação se torna, desta forma, um fator crucial para sua implementação. São apresentados os resultados de uma análise da gestão da informação na Secretaria de Estado da Educação de Sergipe, alcançados numa pesquisa qualitativa, na qual foram realizadas análises de documentos, observações diretas e entrevistas semiestruturadas com os integrantes da equipe coordenadora do programa na rede estadual de ensino. Enfatizou-se os canais utilizados para disseminar as informações entre as diferentes instâncias responsáveis pela sua implementação, em especíico, entre o Ministério da Educação e a Secretaria de Estado da Educação e entre a Secretaria e as Escolas. Como resultados principais constataram-se a falta ou carência no funcionamento de instâncias previstas no desenho administrativo do programa e as dissonâncias na disseminação de informações relacionadas, principalmente, ao seu inanciamento. Também, chama a atenção o predomínio dos canais de comunicação oral. Pouco se utiliza das vantagens das tecnologias eletrônicas da comunicação, o que levou a recomendar o investimento na infraestrutura tecnológica administrativa, na capacitação das pessoas e na adaptação da linguagem da informação ao seu usuário.
A CONCEPÇÃO DOS PROFESSORES DOS ANOS INICIAIS DO ENSINO FUNDAMENTAL A RESPEITO DE CURRÍCULO ESCOLAR
Authors: FELÍCIO Helena Maria dos Santos , MAGALHÃES Amanda Chiaradia 
Published: April 2020

O texto tem por objetivo analisar as concepções acerca de “currículo escolar” dos professores dos anos iniciais do município de Machado (MG). A importância de se trabalhar com a concepção de currículo escolar reside na necessidade de uma tomada de consciência de que o êxito da docência no ambiente escolar está, em grande parte, no conhecimento e aprofundamento do que vem a ser currículo escolar e de suas implicações no processo de ensino e de aprendizagem. O trabalho foi desenvolvido a partir de uma abordagem qualitativa, utilizando a entrevista como instrumento de coleta de dados. A partir das análises dos dados percebemos que o currículo é concebido como mera transposição dos saberes/fazeres de referência para a sala de aula, que a construção coletiva do currículo é pouco experienciada, seja pela não consciência da amplitude e importância dessa atividade de organização ou pela falta de espaço que os professores encontraram para opinar nesta construção. O que acarreta situações onde o professor e alunos são meros executores do currículo, sem poder intervir/opinar na própria realidade. O resultado encontrado nos faz pensar que a formação inicial e continuada dos professores apresenta uma fragilidade, já que os professores não se percebem como o principal sujeito na construção do currículo. Deste modo, é necessário, ao professor, conhecer o currículo em todas as suas dimensões, principalmente, a que diz respeito aos processos de elaboração e implementação do mesmo no espaço escolar.
TÉCNICA E ENSINO: UM DILEMA EXISTENCIAL OU ÉTICO POLITICO?
Authors: ALMEIDA Jonas Rangel 
Published: April 2020

O objetivo deste texto é discutir quais os efeitos que a técnica e seus desdobramentos incidem sobre o ensino e as práticas educativas na escola contemporânea. Compreende-se que esse processo produz uma série de dilemas, cujos efeitos estão se tornando perceptíveis atualmente para a atuação dos educadores. Quais são as formas de tratamento, de atenção e de cuidados mais acertados nessa relação com a técnica em um mundo em que seus desdobramentos ameaçam diluir as fronteiras estabelecidas em torno da autoridade pedagógica e da disciplina escolar? Para pensar esse problema confrontam-se as diferentes interpretações dessa questão na obra de Heidegger e de Foucault. De um lado, Heidegger oferece um caminho pelo pensamento que necessariamente passa pelo cuidado ontológico, pela angústia de ser-no-mundo e de uma relação mais atenta com a técnica; e, de outro, Foucault ao problematizar a questão do cuidado com a verdade nos mostra como essa relação implica uma problematização das práticas de assujeitamento e dos modos de subjetivação na cultura ocidental. Dessa maneira, espera-se neste exercício pensar de que modo o problema da técnica estabelece relações com o desenvolvimento das formas de ensino clariicando os impasses colocados ao papel dos educadores auxiliandonos buscar formas alternativas de ação.
The relationship between early and recent life stress and emotional expression processing: A functional connectivity study
Authors: Sokołowski Andrzej , Folkierska-Żukowska Monika , Jednoróg Katarzyna , Moodie Craig A. , Dragan Wojciech Ł. 
Published: April 2020

AbstractThe aim of this study was to characterize neural activation during the processing of negative facial expressions in a non-clinical group of individuals characterized by two factors: the levels of stress experienced in early life and in adulthood. Two models of stress consequences were investigated: the match/mismatch and cumulative stress models. The match/mismatch model assumes that early adversities may promote optimal coping with similar events in the future through fostering the development of coping strategies. The cumulative stress model assumes that effects of stress are additive, regardless of the timing of the stressors. Previous studies suggested that stress can have both cumulative and match/mismatch effects on brain structure and functioning and, consequently, we hypothesized that effects on brain circuitry would be found for both models. We anticipated effects on the neural circuitry of structures engaged in face perception and emotional processing. Hence, the amygdala, fusiform face area, occipital face area, and posterior superior temporal sulcus were selected as seeds for seed-based functional connectivity analyses. The interaction between early and recent stress was related to alterations during the processing of emotional expressions mainly in to the cerebellum, middle temporal gyrus, and supramarginal gyrus. For cumulative stress levels, such alterations were observed in functional connectivity to the middle temporal gyrus, lateral occipital cortex, precuneus, precentral and postcentral gyri, anterior and posterior cingulate gyri, and Heschl’s gyrus. This study adds to the growing body of literature suggesting that both the cumulative and the match/mismatch hypotheses are useful in explaining the effects of stress.
Properties of F Stars with Stable Radial Velocity Timeseries: A Useful Metric for Selecting Low-jitter F Stars
Authors: Luhn Jacob K. , Wright Jason T. , Isaacson Howard 
Published: April 2020

Abstract
In a companion paper, we have conducted an in-depth analysis of radial velocity jitter of over 600 stars, examining the astrophysical origins including stellar granulation, oscillation, and magnetic activity. In this paper, we highlight a subsample of those stars, specifically the main sequence and “retired” F stars—which we refer to as “MSRF” stars—that show low levels of RV jitter (<10 m s−1). We describe the observational signatures of these stars that allow them to be identified in radial velocity planet programs, for instance, those performing follow-up of transiting planets discovered by TESS. We introduce a “jitter metric” that combines the two competing effects of RV jitter with age: activity and convection. Using thresholds in the jitter metric, we can select both “complete” and “pure” samples of low jitter F stars. We also provide recipes for identifying these stars using only Gaia colors and magnitudes. Finally, we describe a region in the Gaia color–magnitude diagram where low jitter F stars are most highly concentrated. By fitting a ninth-order polynomial to the Gaia main sequence, we use the height above the main sequence as a proxy for evolution, allowing for a crude selection of low jitter MSRF stars when activity measurements are otherwise unavailable.
Small-scale Structure Traced by Neutral Hydrogen Absorption in the Direction of Multiple-component Radio Continuum Sources
Authors: Rybarczyk Daniel R. , Stanimirović Snezana , Zweibel Ellen G. , Murray Claire E. , Dickey John M. , Babler Brian , Heiles Carl 
Published: April 2020

Abstract
We have studied the small-scale distribution of atomic hydrogen (H i) using 21 cm absorption spectra against multiple-component background radio continuum sources from the 21-SPONGE survey and the Millennium Arecibo Absorption-Line Survey. We have found >5σ optical depth variations at a level of ∼0.03–0.5 between 13 out of 14 adjacent sightlines separated by a few arcseconds to a few arcminutes, suggesting the presence of neutral structures on spatial scales from a few to thousands of au (which we refer to as tiny-scale atomic structure, TSAS). The optical depth variations are strongest in directions where the H i column density and the fraction of H i in the cold neutral medium (CNM) are highest, which tend to be at low Galactic latitudes. By measuring changes in the properties of Gaussian components fitted to the absorption spectra, we find that changes in both the peak optical depth and the linewidth of TSAS absorption features contribute to the observed optical depth variations, while changes in the central velocity do not appear to strongly impact the observed variations. Both thermal and turbulent motions contribute appreciably to the linewidths, but the turbulence does not appear strong enough to confine overpressured TSAS. In a majority of cases, the TSAS column densities are sufficiently high that these structures can radiatively cool fast enough to maintain thermal equilibrium with their surroundings, even if they are overpressured. We also find that a majority of TSAS is associated with the CNM. For TSAS in the direction of the Taurus molecular cloud and the local Leo cold cloud, we estimate densities over an order of magnitude higher than typical CNM densities.
Parker Solar Probe Observations of Proton Beams Simultaneous with Ion-scale Waves
Authors: Verniero J. L. , Larson D. E. , Livi R. , Rahmati A. , McManus M. D. , Pyakurel P. Sharma , Klein K. G. , Bowen T. A. , Bonnell J. W. , Alterman B. L. , Whittlesey P. L. , Malaspina David M. , Bale S. D. , Kasper J. C. , Case A. W. , Goetz K. , Harvey P. R. , Korreck K. E. , MacDowall R. J. , Pulupa M. , Stevens M. L. , de Wit T. Dudok 
Published: April 2020

Abstract
Parker Solar Probe (PSP), NASA’s latest and closest mission to the Sun, is on a journey to investigate fundamental enigmas of the inner heliosphere. This paper reports initial observations made by the Solar Probe Analyzer for Ions (SPAN-I), one of the instruments in the Solar Wind Electrons Alphas and Protons instrument suite. We address the presence of secondary proton beams in concert with ion-scale waves observed by FIELDS, the electromagnetic fields instrument suite. We show two events from PSP’s second orbit that demonstrate signatures consistent with wave–particle interactions. We showcase 3D velocity distribution functions (VDFs) measured by SPAN-I during times of strong wave power at ion scales. From an initial instability analysis, we infer that the VDFs departed far enough away from local thermodynamic equilibrium to provide sufficient free energy to locally generate waves. These events exemplify the types of instabilities that may be present and, as such, may guide future data analysis characterizing and distinguishing between different wave–particle interactions.