bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pengaruh Pelatihan Toileting Terhadap Pengetahuan Ibu dalam Toilet Training Anak Toddler di Pendidikan Anak Usia Dini (PAUD) Arrahman dan Lare Angon Yogyakarta
Authors: Mendri Ni Ketut , Badi'ah Atik 
Published: August 2021

One of the nurse's functions is to provide toilet training to children. This study aims to analyze the effect of toileting training on mother's knowledge in toilet training for toddlers at PAUD Arrahman and Lare Angon Yogyakarta. This type of research is experimental with pretest - posttest design with control group. The sample was selected using a random sampling technique that met the criteria, namely mothers who have toddlers in PAUD in the Gamping District, Sleman, Yogyakarta. The first observation was carried out to measure the mother's knowledge about toilet training for toddlers before being given training and the second observation was carried out to measure knowledge after being given training. The difference in knowledge between before and after the intervention was analyzed using the Wilcoxon test, while the difference in knowledge between the intervention group and the control group was analyzed using the Mann Whitney-U test. The results showed that there was a difference in the increase in mother's knowledge about toilet training for toddlers between the experimental group and the control group (p = 0.000). Furthermore, it was concluded that toileting training using pocket books was effective for increasing mother's knowledge in toilet training for toddlers at PAUD Arrahman and Lare Angon Yogyakarta.
Keywords: toileting; toilet training; toddlers; mother's knowledge

ABSTRAK

Salah satu fungsi perawat adalah memberikan pembelajaran toilet training kepada anak. Penelitian ini bertujuan untuk menganalisis pengaruh pelatihan toileting terhadap pengetahuan ibu dalam toilet training anak toddler di PAUD Arrahman dan Lare Angon Yogyakarta. Jenis penelitian ini adalah eksperimental dengan rancangan pretest - posttest with control group. Sampel dipilih dengan teknik random sampling yang memenuhi kriteria yaitu ibu yang mempunyai anak toddler di PAUD di wilayah Kecamatan Gamping, Sleman, Yogyakarta. Observasi pertama dilakukan untuk mengukur pengetahuan ibu tentang toilet training anak toddler sebelum diberikan pelatihan dan observasi kedua dilakukan untuk mengukur pengetahuan sesudah diberikan pelatihan. Perbedaan pengetahuan antara sebelum dan sesudah intervensi dianalisis menggunakan Wilcoxon test, sedangkan perbedaan pengetahuan antara kelompok intervensi dan kelompok kontrol dianalisis menggunakan Mann Whitney-U test. Hasil penelitian menunjukkan bahwa ada perbedaan peningkatan pengetahuan ibu tentang toilet training anak toddler antara kelompok eksperimen dan kelompok kontrol (p = 0,000). Selanjutnya disimpulkan bahwa pelatihan toileting menggunakan buku saku efektif untuk meningkatkan pengetahuan ibu dalam toilet training anak toddler di PAUD Arrahman dan Lare Angon Yogyakarta.
Kata kunci: toileting; toilet training; anak toddler; pengetahuan ibu
Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma?
Authors: Ma Tengfei , Wang Haiyang , Liu Jifeng , Zou Jian , Liu Shixi 
Published: August 2021

ObjectiveTo determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe.MethodsAdult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group.Results370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16–85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%.ConclusionPTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.
Greenhouse Gas Emissions and Carbon Sinks of an Italian Natural Park
Authors: Grossi Giampiero , Vitali Andrea , Bernabucci Umberto , Lacetera Nicola , Nardone Alessandro 
Published: August 2021

Natural parks (NPs) have a primary role in supporting people’s welfare by maintaining natural and cultural resources. Various activities, such as those related to conservation of flora and fauna, forestry, agriculture and livestock, residential, and tourism, coexist within the boundaries of NPs. All these activities may contribute as a source or sink of carbon dioxide and, despite some NPs having started to promote their environmental services, there is currently a lack of information on their carbon footprint (CF). Although various international standards have provided guidelines to assess the CF of organizations, a lack of explicit formulation and procedure in these standards makes them difficult to apply, especially when the organizations to be evaluated embed a wide range of biological and anthropogenic activities. The framework proposed in this paper provides for the first time a holistic methodological approach to quantitatively and qualitatively estimate the annual greenhouse gas (GHG) emissions and removals occurring in NPs. The main data needed for the NP’s GHG inventory were directly collected on-site. The activity data and emissions factors as well as the methodologies involved were all referenced to their data sources, including the use of a biogeochemical model, IPCC equations, Ecoinvent database, and a literature review. This method highlighted that, by emitting 0.55 Mg CO2e ha−1 year−1, the NP generates an annual CF of about 3,300 Mg of CO2e. The agricultural activities with 43.4% of share showed the largest incidence, followed by wild fauna (17.8%), tourism (15.1%), and, to a lesser extent, all the other sectors considered in the assessment. On the other hand, when the annual soil and forest C sequestration rates were included in the balance, the NP contributes to sequester about 3.7 Mg CO2e ha−1 year−1, thus resulting in it being an important C-sink site (i.e., about 22,000 Mg CO2e year−1). By providing granular information on GHG emissions and carbon removals trend, the methodological approach involved in this study could help NPs in both planning effective mitigation strategies and supporting environmental certification processes. CF of NPs could increase tourists’ awareness of the important role that these protected natural areas have in climate change mitigation and adaptation.
The Immunological Factors Predisposing to Severe Covid-19 Are Already Present in Healthy Elderly and Men
Authors: Kilic Gizem , Bulut Ozlem , Jaeger Martin , ter Horst Rob , Koeken Valerie A. C. M. , Moorlag Simone J. C. F. M. , Mourits Vera P. , de Bree Charlotte , Domínguez-Andrés Jorge , Joosten Leo A. B. , Netea Mihai G. 
Published: August 2021

Male sex and old age are risk factors for COVID-19 severity, but the underlying causes are unknown. A possible explanation for this might be the differences in immunological profiles in males and the elderly before the infection. With this in mind, we analyzed the abundance of circulating proteins and immune populations associated with severe COVID-19 in 2 healthy cohorts. Besides, given the seasonal profile of COVID-19, the seasonal response against SARS-CoV-2 could also be different in the elderly and males. Therefore, PBMCs of female, male, young, and old subjects in different seasons of the year were stimulated with heat-inactivated SARS-CoV-2 to investigate the season-dependent anti-SARS-CoV-2 immune response. We found that several T cell subsets, which are known to be depleted in severe COVID-19 patients, were intrinsically less abundant in men and older individuals. Plasma proteins increasing with disease severity, including HGF, IL-8, and MCP-1, were more abundant in the elderly and males. Upon in vitro SARS-CoV-2 stimulation, the elderly produced significantly more IL-1RA and had a dysregulated IFNγ response with lower production in the fall compared with young individuals. Our results suggest that the immune characteristics of severe COVID-19, described by a differential abundance of immune cells and circulating inflammatory proteins, are intrinsically present in healthy men and the elderly. This might explain the susceptibility of men and the elderly to SARS-CoV-2 infection.
Deficit of Inhibition as a Marker of Neuroplasticity (DEFINE Study) in Rehabilitation: A Longitudinal Cohort Study Protocol
Authors: Simis Marcel , Imamura Marta , Sampaio de Melo Paulo , Marduy Anna , Battistella Linamara , Fregni Felipe 
Published: August 2021

Background: Brain plasticity is an intrinsic property of the nervous system, which is modified during its lifetime. This is one mechanism of recuperation after injuries with an important role in rehabilitation. Evidence suggests that injuries in the nervous system disturb the stability between inhibition and excitability essential for the recuperation process of neuroplasticity. However, the mechanisms involved in this balance are not completely understood and, besides the advancement in the field, the knowledge has had a low impact on the rehabilitation practice. Therefore, the understanding of the relationship between biomarkers and functional disability may help to optimize and individualize treatments and build consistent studies in the future.Methods: This cohort study, the deficit of inhibition as a marker of neuroplasticity study, will follow four groups (stroke, spinal cord injury, limb amputation, and osteoarthritis) to understand the neuroplasticity mechanisms involved in motor rehabilitation. We will recruit 500 subjects (including 100 age- and sex-matched controls). A battery of neurophysiological assessments, transcranial magnetic stimulation, electroencephalography, functional near-infrared spectroscopy, and magnetic resonance imaging, is going to be used to assess plasticity on the motor cortex before and after rehabilitation. One of the main hypotheses in this cohort is that the level of intracortical inhibition is related to functional deficits. We expect to develop a better understanding of the neuroplasticity mechanisms involved in the rehabilitation, and we expect to build neurophysiological “transdiagnostic” biomarkers, especially the markers of inhibition, which will have great relevance in the scientific and therapeutic improvement in rehabilitation. The relationship between neurophysiological and clinical outcomes will be analyzed using linear and logistic regression models.Discussion: By evaluating the reliability of electroencephalography, functional near-infrared spectroscopy, transcranial magnetic stimulation, and magnetic resonance imaging measures as possible biomarkers for neurologic rehabilitation in different neurologic disorders, this study will aid in the understanding of brain plasticity mechanisms in rehabilitation, allowing more effective approaches and screening methods to take place.
Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients
Authors: Müller-Jensen Leonie , Ploner Christoph Johannes , Kroneberg Daniel , Schmidt Wolf Ulrich 
Published: August 2021

Introduction:Diagnosing non-traumatic spinal cord injury (NTSCI) is often challenging. However, clear discrimination from non-spinal pathologies, e.g., “myelopathy-mimics” (MMs), is critical in preventing long-term disability and death. In this retrospective study we (1) investigated causes of NTSCI, (2) identified clinical markers associated with NTSCI and (3) discuss implications for NTSCI management.Methods:Our sample consisted of 5.913 consecutive neurological and neurosurgical patients who were treated in our emergency department during a one-year period. Patients with a new or worsened bilateral sensorimotor deficit were defined as possible NTSCI. We then compared clinical and imaging findings and allocated patients into NTSCIs and MMs.Results:Of ninety-three included cases, thirty-six (38.7%) were diagnosed with NTSCI. Fifty-two patients (55.9%) were classified as MMs. In five patients (5.4%) the underlying pathology remained unclear. Predominant causes of NTSCI were spinal metastases (33.3%), inflammatory disorders (22.2%) and degenerative pathologies (19.4%). 58.6% of NTSCI patients required emergency treatment. Presence of a sensory level (p= &lt;0.001) and sphincter dysfunction (p= 0.02) were the only significant discriminators between NTSCI and MMs.Conclusion:In our study, one-third of patients presenting with a new bilateral sensorimotor deficit had NTSCI. Of these, the majority required emergency treatment. Since there is a significant clinical overlap with non-spinal disorders, a standardized diagnostic work-up including routine spinal MRI is recommended for NTSCI management, rather than an approach that is mainly based on clinical findings.
Unilateral Subfrontal Approach for Giant Tuberculum Sellae Meningioma: Single Center Experience and Review of the Literature
Authors: Xiao Feng , Shen Jie , Zhang Luyuan , Yang Jiqi , Weng Yuxiang , Fang Zebin , Zhang Chao , Ye Hongxing , Zhan Renya , Zheng Xiujue 
Published: August 2021

BackgroundMicrosurgical Transcranial approach (mTCA) is the primary choice for the resection of giant Tuberculum Sellae Meningiomas (TSM). The objective of this study is to explore surgical details of unilateral subfrontal approach.MethodsTen patients with giant TSM treated by unilateral subfrontal approach were included from January 2018 to June 2021. Demographic characteristics, surgical data, post-procedure complications and outcomes of patients have been descriptive analyzed, combined with systematic literature review to explore the surgical details and the prognosis of unilateral subfrontal approach.ResultsTen patients include six male and four females, age range from 35 to 77 years, duration of visual impairment from 1 to 12 months, were all performed unilateral subfrontal approach. Nine patients achieved radical resection (Simpson grades I-II) through post-operative imaging confirmation, and Simpson IV resection was performed in the remaining one due to cavernous sinus invasion. The postoperative visual acuity was improved or maintained in 8 patients. Visual acuity decreased in 2 cases, including 1 case of optic nerve atrophy and the other case of optic canal not opening. Five cases with frontal sinus opened were repaired during the operation and there was no postoperative cerebrospinal fluid leakage or intracranial infection. One patient suffered from postoperative anosmia, one patient developed left limb weakness, but their symptoms have improved in the follow-up.ConclusionSummarize the experience of our center and previous literature, unilateral forehead bottom craniotomy is a feasible surgical approach for giant tuberculum sellae meningioma. Intraoperative application of EC glue and pedicled fascia flap to repair the frontal sinus can prevent complications associated with frontal sinus opening. Optic canal unroofing has huge advantage in visual improvement.
Acute Kidney Injury in Pediatric Acute SARS-CoV-2 Infection and Multisystem Inflammatory Syndrome in Children (MIS-C): Is There a Difference?
Authors: Grewal Manpreet K. , Gregory Melissa J. , Jain Amrish , Mohammad Dunya , Cashen Katherine , Ang Jocelyn Y. , Thomas Ronald L. , Valentini Rudolph P. 
Published: August 2021

Objective: To evaluate the prevalence and factors associated with the risk of acute kidney injury (AKI) in pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem inflammatory syndrome in children (MIS-C).Study Design: We performed a retrospective chart review of 113 patients with SARS-CoV-2 infection with or without MIS-C admitted at Children's Hospital of Michigan (CHM) from March to August 2020. Patient demographic details, laboratory data, imaging studies, echocardiography reports, and treatment data were collected.Results: Of the 92 patients included in the final analysis, 22 (24%) developed AKI with 8/22 (36%) developing stage 3 AKI. The prevalence of AKI was much higher in patients with MIS-C 15/28 (54%) vs. those with acute SARS-CoV-2 infection 7/64 (11%), (p &lt; 0.001). Overall, when compared to patients without AKI, patients with AKI were older in age (11 vs. 6.5 years, p = 0.007), African American (86 vs. 58%, p = 0.028), had MIS-C diagnosis (68 vs. 19%, p &lt; 0.001), required ICU admission (91 vs. 20%, p &lt; 0.001), had cardiac dysfunction (63 vs. 16%, p &lt; 0.001), required inotropic support (59 vs. 6%, p &lt; 0.001) and had a greater elevation in inflammatory markers. In a multivariate analysis, requirement of inotropes [Odds Ratio (OR)−22.8, p &lt; 0.001], African American race (OR-8.8, p = 0.023) and MIS-C diagnosis (OR-5.3, p = 0.013) were the most significant predictors for AKI. All patients had recovery of kidney function, and none required kidney replacement therapy.Conclusion: Children with acute SARS-CoV-2 infection and MIS-C are at risk for AKI, with the risk being significantly greater with MIS-C. The pathogenesis of AKI in acute SARS-CoV-2 infection appears to be a combination of both renal hypo-perfusion and direct renal parenchymal damage whereas in MIS-C, the renal injury appears to be predominantly pre-renal from cardiac dysfunction and capillary leak from a hyperinflammatory state. These factors should be considered by clinicians caring for these children with a special focus on renal protective strategies to aid in recovery and prevent additional injury to this high-risk subgroup.
Searching for the one(s): Using Probiotics as Anthelmintic Treatments
Authors: Saracino Maria Priscila , Vila Cecilia Celeste , Baldi Pablo César , González Maglio Daniel Horacio 
Published: August 2021

Helminths are a major health concern as over one billion people are infected worldwide and, despite the multiple efforts made, there is still no effective human vaccine against them. The most important drugs used nowadays to control helminth infections belong to the benzimidazoles, imidazothiazoles (levamisole) and macrocyclic lactones (avermectins and milbemycins) families. However, in the last 20 years, many publications have revealed increasing anthelmintic resistance in livestock which is both an economical and a potential health problem, even though very few have reported similar findings in human populations. To deal with this worrying limitation of anthelmintic drugs, alternative treatments based on plant extracts or probiotics have been developed. Probiotics are defined by the Food and Agriculture Organization as live microorganisms, which, when consumed in adequate amounts, confer a health benefit to the host. It has been proven that probiotic microbes have the ability to exert an immunomodulatory effect both at the mucosa and the systemic level. The immune response against gastrointestinal helminths is characterized as a type 2 response, with high IgE levels, increased numbers and/or activity of Th2 cells, type 2 innate lymphoid cells, eosinophils, basophils, mast cells, and alternatively activated macrophages. The oral administration of probiotics may contribute to controlling gastrointestinal helminth infections since it has been demonstrated that these microorganisms stimulate dendritic cells to elicit a type 2 or regulatory immune response, among other effects on the host immune system. Here we review the current knowledge about the use of probiotic bacteria as anthelmintic therapy or as a complement to traditional anthelmintic treatments. Considering all research papers reviewed, we may conclude that the effect generated by probiotics on helminth infection depends not only on the parasite species, their stage and localization but also on the administration scheme.
Differences in Fracture Healing Between Female and Male C57BL/6J Mice
Authors: Haffner-Luntzer Melanie , Fischer Verena , Ignatius Anita 
Published: August 2021

BackgroundMice are increasingly used in fracture healing research because of the opportunity to use transgenic animals. While both, male and female mice are employed, there is no consensus in the literature whether fracture healing differs between both sexes. Therefore, the aim of the present study was to analyze diaphyseal fracture healing in female and male C57BL/6J mice, a commonly used mouse strain in bone research.MethodsFor that purpose, 12-week-old Female (17–20 g) and Male mice (22–26 g) received a standardized femur midshaft osteotomy stabilized by an external fixator. Mice were euthanized 10 and 21 days after fracture and bone healing was analyzed by biomechanical testing, μCT, histology, immunohistochemistry and qPCR.ResultsTen days after fracture, Male mice displayed significantly more cartilage but less fibrous tissue in the fracture callus compared to Female mice, whereas the amount of bone did not differ. At day 21, Male mice showed a significantly larger fracture callus compared to Female mice. The relative amount of bone in the fracture callus did not significantly differ between both sexes, whereas its tissue mineral density was significantly higher in Male mice on day 21, indicating more mature bone and slightly more rapid fracture healing. These results were confirmed by a significantly greater absolute bending stiffness of the fractured femurs of Male mice on day 21. On the molecular level, Male mice displayed increased active β-catenin expression in the fracture callus, whereas estrogen receptor α (ERα) expression was lower.ConclusionThese results suggest that Male mice display more rapid fracture healing with more prominent cartilaginous callus formation. This might be due to the higher weight of Male mice, resulting in increased mechanical loading of the fracture. Furthermore, Male mice displayed significantly greater activation of osteoanabolic Wnt/β-catenin signaling, which might also contribute to more rapid bone regeneration.
Pragmatic Management of Drug-Resistant Tuberculosis: A Qualitative Analysis of Human Resource Constraints in a Resource-Limited Country context—Ethiopia
Authors: Mussie Kirubel Manyazewal , Gradmann Christoph , Yimer Solomon Abebe , Manyazewal Tsegahun 
Published: August 2021

Objectives: Existing evidence suggests that drug-resistant tuberculosis (DR-TB) remains a huge public health threat in high-burden TB countries such as Ethiopia. The purpose of this qualitative study was to explore the challenges of healthcare workers (HCWs) involved in providing DR-TB care in Addis Ababa, Ethiopia.Methods: We conducted in-depth interviews with 18 HCWs purposively selected from 10 healthcare facilities in Addis Ababa, Ethiopia. We then transcribed the audiotaped interviews, and thematically analysed the transcripts using Braun and Clark’s reflexive thematic analysis framework.Results: We identified five major themes: 1) inadequate training and provision of information on DR-TB to HCWs assigned to work in DR-TB services, 2) fear of DR-TB infection, 3) risk of contracting DR-TB, 4) a heavy workload, and 5) resource limitations.Conclusion: Our findings highlight major human resource constraints that current DR-TB care policies need to foresee and accommodate. New evidence and best practices on what works in DR-TB care in such resource-limited countries are needed in order to address implementation gaps and to meet global TB strategies.