bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decent work for sustainable development inpost‐crisisNepal: Social policy challenges and a way forward
Authors: Dhakal Subas P. , Burgess John 
Published: June 2020

AbstractAlthough the Decent Work agenda has received significant attention in the context of sustainable development, the formulation and implementation of appropriate social policies in developing countries remain an underexplored subject. This article responds to this gap and traces country‐specific Decent Work related policies and programs in Nepal—which is recovering from two major crises: a decade‐long armed conflict that ended in 2006 as well as the 2015 earthquake. Drawing on Critical Policy Analysis framework, this article examines how key tenets of the International Labour Organisation's Decent Work platform, namely creation and provision of employment, social protection, social dialogue and rights at work have manifested in Nepal. The findings indicate that while attempts have been made to embrace the Decent Work agenda into social policies and programs, structural instability of political processes means that there is a lack of strategic directions to address a capacity deficit specific to the informal sector and outbound labour migrants. The article makes broader analytical contributions towards evaluating the implementation of social policies driven by the global priority in the context of developing nations with weak governance settings. In countries like Nepal, where the majority of workers are located within the informal sector and as such the administrative reach and effectiveness of Decent Work related social policies designed for the formal sector are limited.
Public Views of the U.S. Supreme Court in the Aftermath of the Kavanaugh Confirmation
Authors: Krewson Christopher N. , Schroedel Jean R. 
Published: June 2020

ObjectiveWe analyze public views of the Supreme Court following the confirmation hearings of Brett M. Kavanaugh.MethodsWe distributed an online survey days after the Senate confirmed Kavanaugh's appointment.ResultsSupreme Court legitimacy was weak following the hearings and perceptions of legitimacy varied based on partisanship, gender, and race. However, legitimacy was not strongly related to support for Kavanaugh. Furthermore, respondents consistently ranked political characteristics as the least important attributes of a nominee. Still, those satisfied with the Senate confirmation process ranked political attributes as more important.ConclusionOur findings portend some challenges for the Court in the wake of the Kavanaugh confirmation. At the same time, Supreme Court legitimacy was only weakly tied to Kavanaugh, and legal qualities and moral character were more important to the public than a nominee's political attributes.
Universal molecular Clostridioides difficile screening and overtreatment in solid organ transplant recipients
Authors: McCort Margaret Newman , Oehler Cassandra , Enriquez Matthew , Landon Emily , Nguyen Cynthia T. , Pettit Natasha N. , Ridgway Jessica , Pisano Jennifer 
Published: June 2020

AbstractBackgroundScreening for Clostridioides difficile (CD) colonization can be performed using molecular testing to identify the presence of microbial DNA of the toxin gene. Colonization rates for hospitalized patients are as high as 20% and may be considerably higher in solid organ transplant (SOT) recipients. Treatment for CD should be based on clinical disease and not colonization, yet clinicians may misinterpret a positive CD screen resulting in overtreatment.ObjectivesThe objective of this analysis is to determine how often positive CD screens resulted in inappropriate treatment with oral vancomycin.MethodsClostridioides difficile screens were performed using the Xpert C difficile assay (Cepheid), a nucleic acid amplification testing method utilizing polymerase chain reaction (PCR), on peri‐rectal swabs for newly admitted patients. This was a single‐center cohort study of adult patients with CD screens hospitalized between July 2015 and November 2018. The primary outcome was the rate of inappropriate oral vancomycin treatment in all patients and in SOT recipients, defined as therapy in the absence of diarrhea.ResultsOf the 47 076 total CD screens reviewed, 1,921 were positive. In the SOT cohort, 58 of 329 screens were positive (4.1% vs 17.9%, P < .01). Of all patients with a positive CD screen, 20.1% (386/1921) were treated with oral vancomycin within 48 hours of swab collection. In the SOT cohort, 39.6% (23/58) with positive CD screens were treated with oral vancomycin within 48 hours. Of the SOT patients who received oral vancomycin, 39% (9/23) did not have true CD infection.ConclusionSolid organ transplant recipients were more likely to have CD colonization detected by peri‐rectal screening than the general inpatient population. SOT and non‐SOT patients were treated with oral vancomycin at similar rates in response to the positive screen. Nearly half of the oral vancomycin use in SOT recipients was likely overtreatment, but this finding is limited by the low number of patients in this cohort.
Developing a STEM+M Identity in Underrepresented Minority Youth Through Biomechanics and Sports-Based Education
Authors: Marshall Brittany , Loya Amy , Drazan John , Prato Anthony , Conley Nicole , Thomopoulos Stavros , E. Reuther Katherine 
Published: June 2020

Abstract
A Science, Technology, Engineering, Math, and Medicine (STEM+M) identity, a form of social identity, is the extent to which an individual feels accepted in the STEM+M career fields. The development of a strong STEM+M identity hinges largely on one's perceived self-efficacy in STEM+M and can be bolstered by associating STEM+M with other areas in which an individual already exhibits self-efficacy. In this study, a basketball camp served as a platform for STEM+M education in an effort to link participants' self-efficacy in basketball to STEM+M concepts where they may feel less self-efficacious. Over the first 2 years of the program, known as the Youth Sports Lab (YSL), two cohorts of underrepresented minority (URM) middle school students attended a 4-day long basketball camp hosted at Columbia University in partnership with Harlem- and Albany-based afterschool programs. The camp consisted of basketball training, jump plate fabrication, data collection, invited speakers, and group-based research projects. Our hypotheses were that participation in the program would lead to improved (1) familiarity, (2) perceived importance, and (3) interest in STEM+M. Participant responses, gathered from a 17-question Likert-scale survey administered before and after the camp, demonstrated 10 questions with significantly increased responses due to the program. The results support the conclusion that the sports-based engineering program increased STEM+M identity in the URM cohort. Future improvements to the program will include midyear student engagement and long-term follow-up.
The Doping Dependence of the Thermal Conductivity of Bulk Gallium Nitride Substrates
Authors: Song Yiwen , Lundh James Spencer , Wang Weijie , Leach Jacob H. , Eichfeld Devon , Krishnan Anusha , Perez Carlos , Ji Dong , Borman Trent , Ferri Kevin , Maria Jon-Paul , Chowdhury Srabanti , Ryou Jae-Hyun , Foley Brian M. , Choi Sukwon 
Published: June 2020

Abstract
Gallium nitride (GaN) has emerged as one of the most attractive base materials for next-generation high-power and high-frequency electronic devices. Recent efforts have focused on realizing vertical power device structures such as in situ oxide, GaN interlayer based vertical trench metal–oxide–semiconductor field-effect transistors (OG-FETs). Unfortunately, the higher-power density of GaN electronics inevitably leads to considerable device self-heating which impacts device performance and reliability. Halide vapor-phase epitaxy (HVPE) is currently the most common approach for manufacturing commercial GaN substrates used to build vertical GaN transistors. Vertical device structures consist of GaN layers of diverse doping levels. Hence, it is of crucial importance to measure and understand how the dopant type (Si, Fe, and Mg), doping level, and crystal quality alter the thermal conductivity of HVPE-grown bulk GaN. In this work, a steady-state thermoreflectance (SSTR) technique was used to measure the thermal conductivity of HVPE-grown GaN substrates employing different doping schemes and levels. Structural and electrical characterization methods including X-ray diffraction (XRD), secondary-ion mass spectrometry (SIMS), Raman spectroscopy, and Hall-effect measurements were used to determine and compare the GaN crystal quality, dislocation density, doping level, and carrier concentration. Using this comprehensive suite of characterization methods, the interrelation among structural/electrical parameters and the thermal conductivity of bulk GaN substrates was investigated. While doping is evidenced to reduce the GaN thermal conductivity, the highest thermal conductivity (201 W/mK) is observed in a heavily Si-doped (1–5.00 × 1018 cm−3) substrate with the highest crystalline quality. This suggests that phonon-dislocation scattering dominates over phonon-impurity scattering in the tested HVPE-grown bulk GaN substrates. The results provide useful information for designing thermal management solutions for vertical GaN power electronic devices.
Long-term reversal of diabetes by subcutaneous transplantation of pancreatic islet cells and adipose-derived stem cell sheet using surface-immobilized heparin and engineered collagen scaffold
Authors: Kim Yang Hee , Ko Jae Hyung , Lee Song , Oh Ju Yun , Jeong Gi Seok , Park Si-Nae , Shim In Kyong , Kim Song Cheol 
Published: June 2020

ObjectiveEsterified collagen (EC) can be functionalized with heparin to enhance islet graft stability. Growth factors secreted by human adipose-derived stem cells (hADSCs) can bind efficiently to EC-heparin (EC-Hep), which enhances revascularization and cell protection. We investigated the therapeutic potential of a combined heparin-esterified collagen-hADSC (HCA)-islet sheet to enhance islet engraftment.Research design and methodsThis study was designed to assess the efficiency of using EC-Hep as a scaffold for subcutaneous islet transplantation in diabetic athymic mice. After the hADSC-cocultured islets were seeded in the EC-Hep scaffold, islet function was measured by glucose-stimulated insulin secretion test and growth factors in the culture supernatants were detected by protein array. Islet transplantation was performed in mice, and graft function and survival were monitored by measuring the blood glucose levels. β-Cell mass and vascular densities were assessed by immunohistochemistry.ResultsThe EC-Hep composite allowed sustained release of growth factors. Secretion of growth factors and islet functionality in the HCA-islet sheet were significantly increased compared with the control groups of islets alone or combined with native collagen. In vivo, stable long-term glucose control by the graft was achieved after subcutaneous transplantation of HCA-islet sheet due to enhanced capillary network formation around the sheet.ConclusionsThe findings indicate the potential of the HCA-islet sheet to enhance islet revascularization and engraftment in a hADSC dose-dependent manner, following clinical islet transplantation for the treatment of diabetes mellitus.
The 6-star doctor? Physicians’ communication of poor prognosis to patients and their families in Cape Coast, Ghana
Authors: Caulfield Alexandra , Plymoth Amelie , Nartey Yvonne Ayerki , Mölsted-Alvesson Helle 
Published: June 2020

IntroductionCommunication is considered a key skill for physicians globally and has formed a central part of medical curricula since the WHO identified it as a key attribute of the ‘5-star doctor’. Communication of poor prognosis to patients and caregivers is particularly challenging, yet an important example of physicians’ clinical communication, and a priority within palliative care research. Knowledge is scarce regarding the different positions physicians adopt during poor prognosis communication, especially in sub-Saharan countries.MethodsThis qualitative study took place at the Cape Coast Teaching Hospital in Ghana’s Central Region. Physicians in the internal medicine department, with experience in communicating poor prognosis to patients and families on a weekly basis were purposively sampled. Based on the concept of information power, a maximum variation of participants, in terms of age, sex, seniority and experience was achieved after conducting 10 semistructured interviews in March 2019. Positioning theory was used as a theoretical lens to inform study design. The data were analysed through a constructivist thematic analysis approach.ResultsPhysicians adopted six positions, considered as six different themes, during their communication of poor prognosis: clinical expert, educator, counsellor, communicator, protector and mentor. Physicians’ choice of position was fluid, guided by local context and wider health system factors. Physicians’ desire to communicate with patients and families in a way that met their needs highlighted three key challenges for communication of poor prognosis: linguistic difficulties, pluralistic health beliefs and the role of family. These challenges presented ethical complexities in relation to autonomy and non-maleficence.ConclusionContext is key to physicians’ communication of poor prognosis. Communication of poor prognosis is multifaceted, complex and unpredictable. Physicians’ communication training should be developed to emphasise contextual circumstances and physician support, and international policy models on physicians’ roles developed to include a greater focus on social accountability.
Severe varicose veins and the risk of mortality: a nationwide population-based cohort study
Authors: Wu Nan-Chun , Chen Zhih-Cherng , Feng I-Jung , Ho Chung-Han , Chiang Chun-Yen , Wang Jhi-Joung , Chang Wei-Ting 
Published: June 2020

ObjectiveVaricose veins (VVs) are common and although considered benign may cause morbidity. However, the association between VV severity and cardiovascular and mortality risks remains unknown. The aim of this study was to investigate the factors associated with overall mortality in patients with VV.MethodsA total of 4644 patients with newly diagnosed VV between 1999 and 2013 were identified from Taiwan’s National Health Insurance Database. VV severity was classified from grade 1 to 3 according to the presentation of ulcers or inflammation. Moreover, 9497, 2541 and 5722 age-matched, sex-matched and chronic cardiovascular risk factor-matched controls, as assessed based on propensity score, were separately selected for three grading VV groups. Enrolled patients were analysed using conditional Cox proportional hazards regression analysis to estimate risk of mortality and major adverse cardiovascular events (MACEs) in the VV and control groups.ResultsMost patients with VV were free from systemic disease. However, compared with matched controls, patients with VV showed a 1.37 times increased risk of mortality (95% CI 1.19 to 1.57; p<0.0001). Compared with matched controls, older (age ≧65 years) (adjusted HR: 1.38; 95% CI 1.17 to 1.62; p=0.0001) and male patients with VV (adjusted HR 1.41; 95% CI 1.18 to 1.68; p=0.0001) showed increased risk of mortality. Furthermore, compared with controls, patients with VV showed 2.05 times greater risk of MACE. Compared with matched controls, population at grade 3 increased 1.83 times risk of mortality and 2.04 to 38.42 times risk of heart failure, acute coronary syndrome, ischaemic stroke and venous thromboembolism.ConclusionsThis nationwide cohort study demonstrated that patients with VV are at a risk of cardiovascular events and mortality. Our findings suggest that presence of VV warrants close attention in terms of prognosis and treatment.
Study protocol for two complementary trials of non-steroidal or opioid analgesia use for children aged 6 to 17 years with musculoskeletal injuries (the No OUCH study)
Authors: Ali Samina , Rajagopal Manasi , Klassen Terry , Richer Lawrence , McCabe Christopher , Willan Andy , Yaskina Maryna , Heath Anna , Drendel Amy L , Offringa Martin , Gouin Serge , Stang Antonia , Sawyer Scott , Bhatt Maala , Hickes Serena , Poonai Naveen 
Published: June 2020

IntroductionMusculoskeletal (MSK) injuries are a frequent cause for emergency department (ED) visits in children. MSK injuries are associated with moderate-to-severe pain in most children, yet recent research confirms that the management of children’s pain in the ED remains inadequate. Clinicians are seeking better oral analgesic options for MSK injury pain with demonstrated efficacy and an excellent safety profile. This study aims to determine the efficacy and safety of adding oral acetaminophen or oral hydromorphone to oral ibuprofen and interpret this information within the context of parent/caregiver preference.Methods and analysisUsing a novel preference-informed complementary trial design, two simultaneous trials are being conducted. Parents/caregivers of children presenting to the ED with acute limb injury will be approached and they will decide which trial they wish to participate in: an opioid-inclusive trial or a non-opioid trial. Both trials will follow randomised, double-blind, placebo-controlled, superiority-trial methodology and will enrol a minimum of 536 children across six Canadian paediatric EDs. Children will be eligible if they are 6 to 17 years of age and if they present to the ED with an acute limb injury and a self-reported verbal Numerical Rating Scale pain score ≥5. The primary objective is to determine the effectiveness of oral ibuprofen+oral hydromorphone versus oral ibuprofen+oral acetaminophen versus oral ibuprofen alone. Recruitment was launched in April 2019.Ethics and disseminationThis study has been approved by the Health Research Ethics Board (University of Alberta), and by appropriate ethics boards at all recruiting centres. Informed consent will be obtained from parents/guardians of all participants, in conjunction with assent from the participants themselves. Study data will be submitted for publication regardless of results. This study is funded through a Canadian Institutes of Health Research grant.Trial registration numberNCT03767933, first registered on 07 December 2018.
Conceptualisation and measurement of adaptation within the Roy adaptation model in chronic care: a scoping review protocol
Authors: Wang Xiyi , Zhang Qi , Shao Jing , Ye Zhihong 
Published: June 2020

IntroductionThe Roy adaptation model provides a basis for developing the science of nursing. Its theoretical assumptions have been tested in empirical studies. Although several works have historically reviewed the development of this model, a refinement of its key concepts is needed. The proposed scoping review aims to describe how the concept of adaptation was defined and measured in nursing studies related to chronic health conditions.Methods and analysisThis scoping review will adopt the methodology proposed by Arksey and O’Malley. Several databases, including MEDLINE (OVID), CINAHL, EMBASE, PsycINFO, PubMed, Wan Fang, China National Knowledge Infrastructure and VIP net, will be selected and used to mine literature published in English and Chinese languages, up to December 2019. Key terms related to ‘Roy adaptation model’ will be identified and used for developing tailored search strategies for each database. Articles will be included in the analysis if they are primary research reports explaining the concept of adaptation within the field of chronic care. All screening and extraction of literature will be independently performed and checked by two authors, according to the guideline of Preferred Reporting Items for Systematic Review and Meta-Analysis-Extension for Scoping Reviews. The findings will be organised and summarised into narratives in line with the construction of conceptual–theoretical–empirical system of knowledge for further consultation and translation.Ethics and disseminationThis scoping review does not require ethical approval. The findings are expected to be published in peer-reviewed English or Chinese journals as well as conference proceedings in the area of chronic care.
Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU
Authors: Keller Niklas , Bosse Götz , Memmert Belinda , Treskatsch Sascha , Spies Claudia 
Published: June 2020

PurposeStandardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the quality of postoperative handovers to the intensive care unit (ICU) and postoperative care unit.Materials and methodsThe VA was constructed and implemented via a brief (<1 min) training of anaesthesiologic staff during the operation. Ease of implementation was measured by amount of information transferred, handover duration and handover structure. 50 handovers were audio recorded before intervention and 50 after intervention. External validity was evaluated by blinded assessment of the recordings by experienced anaesthesiologists (n=10) on 10-point scales.ResultsThe brief intervention resulted in increased information transfer (9.0–14.8 items,t(98)=7.44, p<0.0001, Cohen’s d=1.59) and increased handover duration (81.3–192.8 s,t(98)=6.642, p=0.013, Cohen’s d=1.33) with no loss in structure (1.60–1.56,t(98)=0.173, p=0.43). Blinded assessment on 10-point scales by experienced anaesthesiologists showed improved overall handover quality from 7.1 to 7.8 (t(98)=1.89, p=0.031, Cohen’s d=0.21) and improved completeness of information (t(98)=2.42, p=0.009, Cohen’s d=0.28) from 7.3 to 8.3.ConclusionsAn intervention consisting of a simple VA and <1 min instructions significantly increased overall quality and amount of information transferred during ICU/postanaesthetic care unit handovers.