bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical tourism in Poland: the perspective and experience of the physicians
Authors: Jankowski Mateusz , Zgliczyński Wojciech Stefan , Kobuszewski Bartosz , Sytnik-Czetwertyński Janusz , Skowron Adam , Pinkas Jarosław 
Published: March 2020

Introduction: Medical tourism is gaining popularity all over the world. This term in this paper refers to patients of Polish nationality living abroad but using health services in Poland as well as foreign patients who use health services in Poland.
Objective of the paper: The objective of this study was to investigate the magnitude and characteristics of medical tourism in Poland from the perspective of the physicians.
Material and methods: a questionnaire-based survey was conducted among 700 physicians in Poland. The questionnaire included 29 questions regarding healthcare services in Poland.
Results: Completed questionnaires were obtained from 498 physicians (67.9% females; average age 41.8±10.5 years), with a response rate of 71.1%. Clinical encounter with a Polish patient who resides on permanent basis outside the country was declared by 67.5% of respondents. There were significant differences (p<0.05) in the frequency of domestic medical tourism depending on the medical education level as well as practice type. Most of the participants (72.3%) declared an encounter with a foreign patient who has used health services in Poland. Except the urgent health need, as factors determining domestic or international medical tourism, the doctors mentioned: quality of healthcare services, price competitiveness as well as the possibility of combining treatment with a visit to the family.
Conclusions: Most physicians in Poland have had the opportunity to consult a patient who has used health services as part of national or international medical tourism.
KOMPETENSI MANAJERIAL KEPALA SMP ISLAM AL AZHAR 15 CILACAP
Authors: Wardjono  
Published: March 2020

The problem in this research is the head of the school can manage all the components or resources that exist in the school environment with good so thatstudent achievement continues to rise in academic and non academic. The purpose of this study is: (1) Describe and analyze so that the head of school in implementing managerial competencies in SMP Islam Al Azhar 15 Cilacap. (2) Describe and analyze the response of the teachers and education personnel of the competence of the managerial head of school in SMP Islam Al Azhar 15 Cilacap. (3) Describe and analyze the contraints of the head of school in implementing mangerial competencies in SMP Islam Al Azhar 15 Cilacap. The results of this study are: (1) The head of the SMP Islam Al Azhar 15 Cilacap has been making efforts to utilize existing resources in the school environment both from human resources, school facilities and infrastructure, financial resources of the school, and the advancement of technology in the field of information and communication, which includes 16 type of competence; (2) support of personal is realized by setting up the school adminstration well in order to improve the quality of education, as for the support of educators is realized with: create lesson plans, implement learning process and assesment and evaluation; The head of SMP Islam Al Azhar 15 Cilacap get the constrains in implementing managerial competencies, namely limitations in manging the school’s finances.
PENGARUH LABEL HALAL DAN CELEBRITY ENDORSER TERHADAP KEPUTUSAN PEMBELIAN (Studi Kasus pada Pelanggan Kosmetik Wardah di Kota Sumbawa )
Authors: Afriliantini Indri , Salam Abdul , Abdurrahman  
Published: March 2020

The purpose this study is to determine : 1) Effect of halal labels on wardah cosmetic purchasing decision. 2) Effect of celebrity endorser on purcahasing decisions. The model used in data analysis is the research instrumens, classic assumption test, multiple linear analysis, and test the hypothesis. The analytical tool used in this study is SPSS Data used is primary data and secondary data with sampling purposive sampling. The result of this study show 1) label halal label has a positive and significant what is indicated by the value for the halal label variabel is equal to 0.000 where is this value < 0,5. 2) celebrity endorser have a positive and significant shown by the value for the celebrity endorser variable value is equal to 0.014 where is this value > dari 0,5.
PENGARUH HARGA DAN KUALITAS INFORMASI TERHADAP PEMBELIAN IMPULSIF SECARA ONLINE
Authors: Indarsih Puput , Sudodo Yandri , Sri Nuryani Hanifa 
Published: March 2020

Penelitian ini bertujuan untuk mengetahui : I) Pengaruh Harga terhadap pembelian Impulsif secara Online II) Pengaruh Kualitas informasi terhadap pembelian Impulsif secara Online III) Pengaruh Harga dan Kualitas informasi terhadap pembelian Impulsif secara Online. Model yang digunakan dalam analisis data yang di gunakan adalah uji instrumen penelitian, uji asumsi klasik, analisis regresi berganda, dan uji hipotesis. Alat analisis yang digunakan dalam penelitian ini adalah SPSS 16. Data yang digunakan yaitu data primer dan data sekunder dengan pengambilan sampel secara purposive sampling. Hasil penelitian menunjukkan bahwa I) Harga berpengaruh positif tetapi tidak signifikan yang ditunjukkan dengan nilai signifikansi sebesar 0,533 dimana nilai ini > 0,05. II) Kualitas informasi berpengaruh positif dan signifikan yang ditunjukkan dengan nilai signifikan sebesar 0,003 dimana nilai ini < 0,05. III) Harga dan Kualitas informasi secara simultan mempengaruhi pembelian impulsif sebesar 11,460.
Plasma Emission Induced by Electron Cyclotron Maser Instability in Solar Plasmas with a Large Ratio of Plasma Frequency to Gyrofrequency
Authors: Ni Sulan , Chen Yao , Li Chuanyang , Zhang Zilong , Ning Hao , Kong Xiangliang , Wang Bing , Hosseinpour M. 
Published: March 2020

Abstract
In plasmas with a large ratio of plasma frequency to gyrofrequency (ω
pe/Ωce), energetic electrons characterized by

can excite electron cyclotron maser instability (ECMI), generating waves of upper hybrid (UH), Z, and W modes. It has been presumed that these ECMI waves can somehow convert to escaping X–O modes as fundamental (F) or harmonic (H) plasma emission. Here we perform a fully kinetic, electromagnetic particle-in-cell simulation to investigate the proposed radiation process. ECMI is driven by energetic electrons with a Dory–Guest–Harris distribution representative of a double-sided loss cone, and ω
pe/Ωce is set to be 10. We find that the electrostatic UH mode is the fastest-growing mode. Around the time when its energy starts to decline, the W mode grows to be dominant. During this stage, we observe significant F and H plasma emission. The F emission is in the O mode with a bandwidth around 0.1–0.2 Ωce, and the H emission is contributed by both X and O modes with a narrower bandwidth. We suggest that the O–F emission is caused by coalescence of almost counterpropagating Z and W modes, while the H emission arises from coalescence of an almost counterpropagating UH mode at relatively large wave number. Thus the plasma emission investigated here is induced by a combination of wave growth due to ECMI and further nonlinear wave-coupling processes. The result is relevant to understanding solar radio bursts as well as other astronomical radio sources that are excited by energetic electrons trapped within certain magnetic structures.
Direct Measurements of Activation Energies for Surface Diffusion of CO and CO2 on Amorphous Solid Water Using In Situ Transmission Electron Microscopy
Authors: Kouchi Akira , Furuya Kenji , Hama Tetsuya , Chigai Takeshi , Kozasa Takashi , Watanabe Naoki 
Published: March 2020

Abstract
The importance of the activation energy of surface diffusion (E
sd) of adsorbed molecules on amorphous solid water (ASW) has been widely discussed in terms of chemical reactions on ASW at low temperatures. However, in previous work, E
sd has not been measured directly but estimated from indirect experiments. It has been assumed in chemical network calculations that E
sd is between 0.3 and 0.8 of the desorption energies of a molecule. It remains important to obtain direct measurements of E
sd. We performed in situ observations of the deposition process of CO and CO2 on ASW using transmission electron microscopy (TEM) and deduced the E
sd of CO and CO2 on ASW to be 350 ± 50 and 1500 ± 100 K, respectively. The value of E
sd of CO is approximately 0.3 of the total adsorption energy of CO on ASW, i.e., much smaller than assumed in chemical network calculations, where the corresponding figure is 575 K, assuming approximately 0.5 of the desorption energy. We demonstrated that TEM is very useful not only for the observation of ices but also for the measurement of some physical properties that are relevant in astrochemistry and astrophysics. Using the E
sd of CO measured in the present study (350 K), we have updated the chemical network model of Furuya et al., confirming that CO2 could be efficiently formed by the reaction CO + OH → CO2 + H in the initial stages of the evolution of molecular clouds.
Sunward-propagating Whistler Waves Collocated with Localized Magnetic Field Holes in the Solar Wind: Parker Solar Probe Observations at 35.7 R⊙ Radii
Authors: Agapitov O. V. , Wit T. Dudok de , Mozer F. S. , Bonnell J. W. , Drake J. F. , Malaspina D. , Krasnoselskikh V. , Bale S. , Whittlesey P. L. , Case A. W. , Chaston C. , Froment C. , Goetz K. , Goodrich K. A. , Harvey P. R. , Kasper J. C. , Korreck K. E. , Larson D. E. , Livi R. , MacDowall R. J. , Pulupa M. , Revillet C. , Stevens M. , Wygant J. R. 
Published: March 2020

Abstract
Observations by the Parker Solar Probe mission of the solar wind at ∼35.7 solar radii reveal the existence of whistler wave packets with frequencies below 0.1 f
ce (20–80 Hz in the spacecraft frame). These waves often coincide with local minima of the magnetic field magnitude or with sudden deflections of the magnetic field that are called switchbacks. Their sunward propagation leads to a significant Doppler frequency downshift from 200–300 to 20–80 Hz (from 0.2 to 0.5 f
ce). The polarization of these waves varies from quasi-parallel to significantly oblique with wave normal angles that are close to the resonance cone. Their peak amplitude can be as large as 2–4 nT. Such values represent approximately 10% of the background magnetic field, which is considerably more than what is observed at 1 au. Recent numerical studies show that such waves may potentially play a key role in breaking the heat flux and scattering the Strahl population of suprathermal electrons into a halo population.
Serum MicroRNA Signature as a Diagnostic and Therapeutic Marker in Patients with Psoriatic Arthritis
Authors: Wade Sarah M. , McGarry Trudy , Wade Siobhan C. , Fearon Ursula , Veale Douglas J. 
Published: March 2020

ObjectiveMicroRNA (miRNA) are small endogenous regulatory RNA molecules that have emerged as potential therapeutic targets and biomarkers in autoimmunity. Here, we investigated serum miRNA levels in patients with psoriatic arthritis (PsA) and further assessed a serum miRNA signature in therapeutic responder versus nonresponder PsA patients.MethodsSerum samples were collected from healthy controls (HC; n = 20) and PsA patients (n = 31), and clinical demographics were obtained. To examine circulatory miRNA in serum from HC and PsA patients, a focused immunology miRNA panel was analyzed utilizing a miRNA Fireplex assay (FirePlex Bioworks Inc.). MiRNA expression was further assessed in responders versus nonresponders according to the European League Against Rheumatism response criteria.ResultsSix miRNA (miR-221-3p, miR-130a-3p, miR-146a-5p, miR-151-5p, miR-26a-5p, and miR-21-5p) were significantly higher in PsA compared to HC (all P < 0.05), with high specificity and sensitivity determined by receiver-operating characteristic curve analysis. Analysis of responder versus nonresponders demonstrated higher baseline levels of miR-221-3p, miR-130a-3p, miR-146a-5p, miR-151-5p, and miR-26a-5p were associated with therapeutic response.ConclusionThis study identified a 6-serum microRNA signature that could be attractive candidates as noninvasive markers for PsA and may help to elucidate the disease pathogenesis.
Association of Poverty Income Ratio with Physical Functioning in a Cohort of Patients with Systemic Lupus Erythematosus
Authors: Hoge Courtney , Bowling C. Barrett , Lim S. Sam , Drenkard Cristina , Plantinga Laura C. 
Published: March 2020

Objective.To examine the association of income relative to the poverty threshold [poverty income ratio (PIR)] with self-reported physical functioning (PF) in a cohort of patients with systemic lupus erythematosus.Methods.We used cross-sectional data on 744 participants from Georgians Organized Against Lupus (GOAL), and secondary analyses used data on 56 participants from a nested pilot study. Primary analyses used multivariable linear regression to estimate the association between PIR (categorized as < 1.00, 1.00–1.99, 2.00–3.99, and ≥ 4.00; lower PIR indicate higher poverty) and PF (scaled subscore from the Medical Outcomes Study Short Form–12 survey; range 0–100, higher scores indicate better functioning). Secondary analyses summarized complementary measures of PF as means or percentages by PIR (categorized as < 1.00, 1.00–1.99, and ≥ 2.00).Results.The mean age of participants was 48.0 years; 6.7% were male; 80.9% were black; and 37.5%, 21.0%, 29.6%, and 12.0% had PIR of < 1.00, 1.00–1.99, 2.00–3.99, and ≥ 4.00, respectively. The overall mean PF score was 45.8 (36.2, 40.7, 55.5, and 61.2 for PIR of < 1.00, 1.00–1.99, 2.00–3.99, and ≥ 4.00). With adjustment, higher PIR remained associated with higher PF scores [2.00–3.99 vs 1.00–1.99: β = 10.9 (95% CI 3.3–18.6); ≥ 4.00 vs 1.00–1.99: β = 16.2 (95% CI 6.4–26.0)]. In secondary analyses, higher PIR was also associated with higher scores for objective physical performance.Conclusion.Our results show that higher income relative to the poverty threshold is associated with better PF across multiple domains, warranting further research into multicomponent functional assessments to develop individual treatment plans and potentially improve socioeconomic disparities in outcomes.
Decreasing Delirium Through Music: A Randomized Pilot Trial
Authors: Khan Sikandar H. , Xu Chenjia , Purpura Russell , Durrani Sana , Lindroth Heidi , Wang Sophia , Gao Sujuan , Heiderscheit Annie , Chlan Linda , Boustani Malaz , Khan Babar A. 
Published: March 2020

Background
Management of delirium in intensive care units is challenging because effective therapies are lacking. Music is a promising nonpharmacological intervention.

Objectives
To determine the feasibility and acceptability of personalized music (PM), slow-tempo music (STM), and attention control (AC) in patients receiving mechanical ventilation in an intensive care unit, and to estimate the effect of music on delirium.

Methods
A randomized controlled trial was performed in an academic medical-surgical intensive care unit. After particular inclusion and exclusion criteria were applied, patients were randomized to groups listening to PM, relaxing STM, or an audiobook (AC group). Sessions lasted 1 hour and were given twice daily for up to 7 days. Patients wore noise-canceling headphones and used mp3 players to listen to their music/audiobook. Delirium and delirium severity were assessed twice daily by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the CAM-ICU-7, respectively.

Results
Of the 1589 patients screened, 117 (7.4%) were eligible. Of those, 52 (44.4%) were randomized, with a recruitment rate of 5 patients per month. Adherence was higher in the groups listening to music (80% in the PM and STM groups vs 30% in the AC group; P = .01), and 80% of patients surveyed rated the music as enjoyable. The median number (interquartile range) of delirium/coma-free days by day 7 was 2 (1-6) for PM, 3 (1-6) for STM, and 2 (0-3) for AC (P = .32). Median delirium severity was 5.5 (1-7) for PM, 3.5 (0-7) for STM, and 4 (1-6.5) for AC (P = .78).

Conclusions
Music delivery is acceptable to patients and is feasible in intensive care units. Further research testing use of this promising intervention to reduce delirium is warranted.
Prevalence of Coping Strategy Training in Nursing School Curricula
Authors: Cochran Kathryn L. , Moss Marc , Mealer Meredith 
Published: March 2020

BackgroundStress and burnout are plaguing critical care nurses across the globe and leading to high levels of turnover. Resilience-building strategies such as mindfulness, self-care, and well-being can help shield nurses from the negative effects of workplace stress. As the first line of defense, nursing schools could provide students with strategies that build resilience; however, little is known about the availability of such resources in nursing education.ObjectivesTo determine the prevalence of resources and curricula targeting resilience training and stress reduction at nursing schools across the United States.MethodsRaters analyzed publicly available college/ university websites and course catalogs of a sample of nursing schools in the United States to determine the availability of resilience resources and curricula.ResultsNone of the schools surveyed regularly screened their students for burnout syndrome, and only 9% of schools had a formal curriculum that included resilience training.ConclusionsTraining in practices to build resilience and prevent burnout is essentially absent from accredited nursing schools. This highlights an important opportunity to modify existing curricula to include preventative strategies—such as developing positive coping skills— that could mitigate symptoms of workplace stress in future generations of nurses.
Effect of Delirium on Physical Function in Noncardiac Thoracic Surgery Patients
Authors: Khan Sikandar H. , Xu Chenjia , Wang Sophia , Gao Sujuan , Lasiter Sue , Kesler Kenneth , Khan Babar A. 
Published: March 2020

BackgroundThe effect of delirium on physical function in patients undergoing noncardiac thoracic surgery has not been well described and may differ from that in other surgical populations.ObjectiveTo determine the effects of delirium on muscle strength and functional independence. The primary end point was change in Medical Research Council sum score (MRC-SS) by delirium status.MethodsA secondary analysis of data from a clinical trial involving English-speaking adults aged 18 years or older who were undergoing major noncardiac thoracic surgery. Exclusion criteria were history of schizophrenia, Parkinson disease, dementia, alcohol abuse, or neuroleptic malignant syndrome; haloperidol allergy; being pregnant or nursing; QT prolongation; and taking levodopa or cholinesterase inhibitors. Delirium was assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit. Preoperatively and postoperatively, muscle strength was assessed using the modified MRC-SS and functional independence was assessed using the Katz scale of activities of daily living. Changes in MRC-SS and Katz score by delirium status were analyzed using the Fisher exact test.ResultsSeventy-three patients were included in the analysis. Median (interquartile range) MRC-SS and Katz score before surgery did not differ significantly between patients without and with delirium (MRC-SS: 30 [30-30] vs 30 [30-30], P &gt; .99; Katz score: 6 [6-6] vs 6 [6-6], P = .63). The percentage of patients with a change in MRC-SS was similar in patients without and with delirium (17% vs 13%, respectively; P &gt; .99). More patients in the delirium group had a change in Katz score (13% vs 0%, P = .04).ConclusionsPostoperative delirium was not associated with change in muscle strength. Follow-up studies using other muscle measures may be needed.
Patient-Reported Outcomes Associated With Sedation and Agitation Intensity in the Critically Ill
Authors: Malinowski Ashleigh , Benedict Neal J. , Ho Meng-Ni , Kirisci Levent , Kane-Gill Sandra L. 
Published: March 2020

Background
Patient-reported outcomes are essential to understand the relationship between patients’ perception of sedation and clinicians’ assessments of sedation.

Objectives
To evaluate the association between sedation and agitation indexes and patient-reported outcomes of sedation and analgesia.

Methods
This prospective, single-center, observational study included adult patients who were continuously sedated for at least 24 hours in a medical or surgical/ trauma intensive care unit. Patients were interviewed after sedation was discontinued regarding their satisfaction with the quality of sedation and potentially related factors. The primary outcome was the correlation between sedation and agitation indexes and patient-reported outcomes.

Results
A total of 68 patients were interviewed after sedation. Of these, 29 (42.6%) described their overall feelings about their experience while receiving mechanical ventilation in the intensive care unit as "pleasant". When asked about their desires if they were to experience the situation again, 29 patients (42.6%) reported that they would want more sedation. Agitation index was statistically significantly correlated with several patient-reported outcomes. Receiving mechanical ventilation (r = 0.41, P = .002), the amount of noise (r = 0.34, P = .01), suctioning (r = 0.32, P = .02), difficulty resting or sleeping (r = 0.39, P = .003), inability to communicate by talking (r = 0.36, P = .008), anxiety (r = 0.29, P = .03), panic (r = 0.3, P = .02), and frustration (r = 0.47, P &lt; .001) were associated with a higher agitation index.

Conclusion
Agitation index was significantly associated with several patient-reported outcomes and thus seems to be a promising descriptor of patients’ experience.
Intensive Care Nurses’ Perceptions of Routine Dyspnea Assessment
Authors: Baker Kathy M. , Vragovic Natalia Sullivan , Banzett Robert B. 
Published: March 2020

Background
Dyspnea (breathing discomfort) is commonly experienced by critically ill patients and at this time is not routinely assessed and documented. Intensive care unit nurses at the study institution recently instituted routine assessment and documentation of dyspnea in all patients able to report using a numeric scale ranging from 0 to 10.

Objective
To assess nurses’ perceptions of the utility of routine dyspnea measurement, patients’ comprehension of assessment questions, and the impact on nursing practice and to gather nurses’ suggestions for improvement.

Methods
Data were obtained from interviews with intensive care unit nurses in small focus groups and an anonymous online survey randomly distributed to nurses representing all intensive care units.

Results
Intensive care unit nurses affirmed the importance of routine dyspnea assessment and documentation. Before implementing the measurement tool, nurses often assessed for breathing discomfort in patients by using observed signs. Most nurses agreed that routine assessment can be used to predict patients’ outcomes and improve patient-centered care. Nurses found the assessment tool easy to use and reported that it did not interfere with workflow. Nurses felt that patients were able to provide meaningful ratings of dyspnea, similar to ratings of pain, and often used patients’ ratings in conjunction with observed physical signs to optimize patient care.

Conclusion
Our study shows that nurses understand the importance of routine dyspnea assessment and that the addition of a simple patient report scale can improve care delivery and does not add to the burden of work-flow.