bluuebunny/crossref_metadata_2025_split huggingface dataset:
Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support
Authors: Emple Artem , Fonseca Laura , Nakagawa Shunichi , Guevara Gina , Russell Cortessa , Hua May 
Published: September 2021

BackgroundAlthough use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians’ moral distress.ObjectiveTo measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support.MethodsIn this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one’s job. Clinicians’ likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed.ResultsThe sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P &lt; .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P &lt; .001).ConclusionMoral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.
Effect of Coconut (<em>Cocos nucifera</em>) Water Extract on the Development of Adventitious Roots in <em>Polyscias fillicifolia</em> Stem Cuttings
Authors: Jayawardena B. M. , Agampodi V. A. , Abeywickrama K. P. 
Published: September 2021

Purpose Vegetative propagation continues to be a popular method to propagate ornamental plant species. Coconut water (CW) can be considered as an abundant source of hormones and other plant growth regulators (PGRs). In this study, vegetative propagation of Polyscias fillicifolia was attempted using PGRs isolated from CW. Research method Stem cuttings were treated with varying concentrations (5, 10, 25, 50,100 μg mL-1) of PGR isolated from CW. The results were compared with a control set (treated with distilled water) and with those treated with solutions of pure synthetic indole acetic acid (IAA). Findings P. fillicifolia canes treated with a 25 μg mL-1 concentration of IAA, isolated from CW, showed the highest levels of root induction and development. Root development was more rapid (5 weeks) in the samples treated with PGRs isolated from CW compared to the canes propagated in the field by placing the canes on coir beds in plant nurseries. (6 weeks). Originality This is the first study to use PGRs isolated from CW extracts to improve lateral root proliferation, induce shoot development and leaf emergence in P. fillicifolia.
Magnetic resonance imaging in response assessment of mediastinal tuberculous lymphadenopathy
Authors: Singh Rashmi , Naranje Priyanka , Bhalla Ashu Seith , Pandey Shivam 
Published: September 2021

Background:
Assessment of response to antitubercular treatment (ATT) in mediastinal tuberculous lymph nodes (LNs) is challenging. Gold standard techniques such as biopsy and culture involve invasive procedures. Radiographic persistence of mediastinal LNs even after completion of ATT poses a treatment dilemma. In this study, we evaluated the changes in signal intensity (SI) and apparent diffusion coefficient (ADC) values of mediastinal LNs on magnetic resonance imaging (MRI), for response assessment to ATT.

Materials and Methods:
After institute ethics approval, a retrospective analysis of MRI images of 22 patients with 55 mediastinal tuberculous LNs was done. Clinically responsive patients of mediastinal tuberculous LNs who underwent chest MRI prior to ATT, or within 1 month of starting ATT, and second MRI performed at least after 2 months of start of the treatment were included. LN size, T1 and T2 signal characteristics (homogenously/heterogeneously and hyperintense or hypointense), T2 and T1 SI ratio, ADC values, and contrast enhancement characteristics were compared. Paired t-test and McNemar test were performed at a significance level of α =0.05.

Results:
Size of LN reduced, but 45 LNs measured >8 mm in second MRI. There was statistically significant decrease in the T2 and T1 SI ratios in second MRI, P = 0.026 and 0.008, respectively. No statistically significant difference was found in ADC values, P = 0.31.

Conclusions:
Decrease in T2 and T1 SI ratios of mediastinal tuberculous LNs can be used as a noninvasive imaging parameter to suggest response to ATT. However, ADC value is not a useful indicator of treatment response.
Is the SORT score reliable in predicting postoperative 30-day mortality after a nonemergency surgery in Saudi population?
Authors: Ul Huda Anwar , Khan Asad Z. , Memon Abdul S. , Sheikh Nasrullah , Anazi Abdullah A. 
Published: September 2021

Context:
The process of stratifying patient risk preoperatively helps in the decision about the best-possible postoperative care for patients. There have been many scoring systems that are used in anesthesia practice.

Aims:
To find out whether there is any difference between the mortality predicted from SORT scoring and the observed mortality among Saudi patients.

Settings and Design:
This was a prospective, observational study in which we included patients underoing nonemergency surgical procedures at the Security Forces Hospital, Riyadh.

Methods and Material:
We calculated the SORT scores for all the included patients. We then collected the 30-day mortality data of all the patients having nonemergency surgical procedures.

Statistical Analysis Used:
We calculated the expected mortality ratio. A P value of less than 0.05 was considered significant.

Results:
The mean SORT mortality risk score (%) for the whole sample was 0.30. The expected number of deaths was 1.638 while the observed deaths were 2, which yields an O/E ratio of 0.819 (p-value: 0.006). The O/E mortality ratios for patients in each individual ASA class were found to be statistically insignificant which means that SORT score can reliably predict mortality for each ASA class.

Conclusions:
SORT scores can be used to predict 30-day mortality after nonemergency surgeries in Saudi population.
Parental Awareness of Risks and Causes of Hearing Loss and the Acceptance of the Intervention in Taif City, Saudi Arabia
Authors: Aljuaid Sattam M. , Alotaibi Ghaida Hassan , Alsharif Maha Othman , Aljuaid Ahlam Mohammed , Alzahrani Waad Saeed , Alotaibi Ohoud Dhaifallah , Alharthi Rahaf Sifron 
Published: September 2021

Background and Objectives:
Pediatric hearing loss (HL) hinders or delays a child's auditory and speech development. This issue that results in anxiety and stress among parents affects the child's ability to engage in communication, participation in age-appropriate activities, and functional and language skills. This study aimed to assess parents' knowledge about risks and causes of HL and the acceptance of the intervention among Saudi parents living in Taif city.

Methodology:
A cross-sectional study was conducted between July 2020 and December 2020 through a pretested questionnaire that was published using an online-based (electronic) form. The questionnaire included items related to sensorineural HL, otitis media, conductive HL, and oto-acoustic emission. The total knowledge scores were calculated based on correct and wrong answers, and the relationship between knowledge level and other variables was determined.

Results:
In this study, the reported prevalence of HL among children was 5.6%. The knowledge related to various types of HL and their risk factors was determined to be good at only 4.5% of the participants. There was no statistically significant difference observed in knowledge between male and female parents (P = 0.620), different age groups (P = 0.591), and education levels of the participants (0.096).

Conclusion:
Parents need to be educated about conventional risk factors for HL because there was inadequate knowledge among our study population. In addition, it is necessary to increase awareness about various audiology services to facilitate early detection and intervention.
The unbounded Kasparov product by a differentiable module
Authors: Kaad Jens 
Published: September 2021

In this paper we investigate the unbounded Kasparov product between a differentiable module and an unbounded cycle of a very general kind that includes all unbounded Kasparov modules and hence also all spectral triples. Our assumptions on the differentiable module are weak and we do in particular not require that it satisfies any kind of smooth projectivity conditions. The algebras that we work with are furthermore not required to possess a smooth approximate identity. The lack of an adequate projectivity condition on our differentiable module entails that the usual class of unbounded Kasparov modules is not flexible enough to accommodate the unbounded Kasparov product and it becomes necessary to twist the commutator condition by an automorphism.
We show that the unbounded Kasparov product makes sense in this twisted setting and that it recovers the usual interior Kasparov product after taking bounded transforms. Since our unbounded cycles are twisted (or modular) we are not able to apply the work of Kucerovsky for recognizing unbounded representatives for the bounded Kasparov product, instead we rely directly on the connection criterion developed by Connes and Skandalis. In fact, since we do not impose any twisted Lipschitz regularity conditions on our unbounded cycles, even the passage from an unbounded cycle to a bounded Kasparov module requires a substantial amount of extra care.
Major trauma during COVID-19 in a level 1 trauma centre in Switzerland – a cohort study comparing the years 2020 and 2019
Authors: Anwander Helen , Klingberg Karsten , Gerber Joël , Bednarski Piotr , Exadaktylos Aristomenis , Müller Martin 
Published: September 2021

INTRODUCTION: The COVID-19 pandemic and the associated restrictions may have modified the activities of the Swiss population and thus altered trauma patterns.
MATERIALS AND PATIENTS: All adult patients with major trauma admitted to our institution in 2019 and 2020 were assessed using the Injury Severity Score (ISS), by body region involved, type of injury, age, admission to an intensive care unit and 30-day mortality.
RESULTS: In 2020, 454 patients with major trauma were admitted to our institution, 17% fewer than in the previous year. The drop in the number of major trauma patients proceeded with and overlapped both the first and second peaks in incidence of the pandemic and the associated restrictions. The median ISS was higher in 2020 (25, interquartile range [IQR] 17—26.5) than in 2019 (22, IQR 16—26, p = 0.04). There were no significant differences in body region involved, type of injury or age (p >0.05). In 2020, a higher percentage of patients were admitted to an intensive care unit (86.5% vs 77.7%, p <0.001) and died within 30 days (8.8% vs 5.0%, p = 0.015). The 30-day mortality was higher in 2020 than in 2019, with an odds ratio of 1.80 (95% confidence interval 1.04—3.10, p= 0.036) after adjustment for the following potential confounders: ISS, age, gender and type of injury.
CONCLUSION: In the first year of the COVID-19 pandemic, fewer patients with major trauma were admitted to our institution. However, the patients admitted were more severely injured and more often died within 30 days. Understanding the differences in injury patterns and admissions in major trauma patients under special conditions – such as a pandemic – could help to allocate rare resources adequately.
Surveillance of tuberculosis in Switzerland and the Principality of Liechtenstein, 2009 to 2019
Authors: Altpeter Ekkehardt S. , Schmidt Axel J. 
Published: September 2021

OBJECTIVE: To describe the epidemiology of tuberculosis in Switzerland from 2009 to 2019.
METHODS: Analysis of Swiss notification data.
RESULTS: Tuberculosis cases declined from 553 (7.1/100,000) in 2009 to 437 (5.1/100,000) in 2019. The male-to-female ratio was 3:2. Although the number of tuberculosis cases of Swiss origin has steadily declined, the number of tuberculosis cases of foreign origin was rather stable but peaked in 2016. Overall, three quarters of tuberculosis cases were among people of foreign origin; of these, around half were from East Africa, Southern East Europe, and Southern Asia. Forty-nine percent had extrapulmonary manifestations. Every year, with little variation, 7–16 cases with rifampicin resistance were reported (2.9% overall). Independent risk factors for rifampicin resistance were prior anti-tuberculosis treatment, with an adjusted odds ratio (aOR) of 5.5 and a 95% confidence interval (CI) from 3.7 to 8.1, and foreign origin (aOR 3.6, 95% CI 2.0–7.0), particularly Georgia (aOR 10.0, 95% CI 4.0–23.1), Ethiopia (aOR 9.4, 95% CI 3.5–24.2), Tibet (aOR 6.9; 95% CI 2.9–16.6) and Somalia (aOR 8.1, 95% CI 4.0–17.2), together with Eritrea (aOR 2.6, 95% CI 1.1–5.9), accounting for more than half of all 134 cases . From 2016 to 2018, applying the World Health Organization definitions, overall treatment success in culture-confirmed pulmonary cases was 78%, and thus below the target of 85%. Since most cases with unsuccessful outcome are due to missing information, the proportion of unsuccessful outcome are overestimated.
CONCLUSION: Autochthonous tuberculosis has become rare in Switzerland and the new diagnoses are increasingly attributable to immigration. Rifampicin resistance remains rare. Switzerland currently fails to achieve international targets for treatment success.
Applied Hydrothermal Carbonization
Authors: Zang Joachim Werner , Da Fonseca-Zang Warde Antonieta , Reis Stefan 
Published: September 2021

The technology of hydrothermal carbonization (HTC) is a thermal chemical conversion process of organic waste into products in a reactor at low and medium temperatures and pressures, with catalysts, using residual raw materials of diversified origin, such as domestic, industrial, or agricultural. The products from the process have several energies (renewable sources) and environmental applications, such as carbon sink, soil conditioners and nanostructured materials. Implications inherent to the process, such as the type of residual biomass, the carbon phases produced (products), and adaptation of the small-scale system, have been researched in the activities. Experiences show that a laboratory-scale system transforms wet biomass from industrial waste, such as septic tank sludge, into products with application potential. The septic tank effluent originating from the great region of Goiânia was treated through hydrothermal carbonization, generating products in nanometer scale to which value could be added (potential result), in case of application at an industrial scale.

A tecnologia de carbonização hidrotermal (HTC) trata de processo de conversão termoquímica de substâncias residuárias orgânicas em produtos em reator em baixas e médias temperaturas e pressões, com catalisadores, utilizando matérias-primas residuais de origem diversificada, tais como doméstica, indústria ou agrícola. Os produtos do processo apresentam diversas aplicações energéticas (fontes renováveis) e ambientais, tais como sumidouro de carbono, condicionadores de solo e materiais nanoestruturados. Implicações inerentes ao processo, tais como o tipo de biomassa residuária, as fases de carbono produzidas (produtos) e adaptação do sistema de pequena escala, têm sido pesquisadas nas atividades. Experiências mostram que sistema em escala laboratorial transforma biomassa úmida de resíduos industriais, como lodo de fossas sépticas, em produtos com potencial de aplicação. O efluente de fossa séptica originário da grande região de Goiânia foi tratado através da carbonização hidrotermal, gerando produtos na escala nanométrica, aos quais poderiam ser agregados valor (resultado potencial), em caso de aplicação na escala industrial.
Analysis of Gender Difference on Online Shopping Lifestyle at Padang City
Authors: Wiry Utami  , Linda Wati  , Listiana Sri Mulatsih  
Published: September 2021

This study aimed to examine the gender difference between men and women in online shopping lifestyle at Padang City. This type of research is comparative study, carried out to compare the similarities and differences of two or more the fact and object properties in the framework based on certain carefully. The technique of taking sample is by using purposive sampling. Total sample in this study is 100 consist of 50 men and 50 women. The samples in this study were men and women consumers who have shopped online for at least the last six month. Data collection uses questionnaire and analysis methods using independent sample t-test. The result of this study show that there are no differences between men and women in online shopping lifestyle at Padang City by t sig value ( 0,442 )> 0,05.
International Students’ Motivations and Decisions to do a PhD in Canada: Proposing a Three-Layer Push-Pull Framework
Authors: Zhang You , O'Shea Michael , Mou Leping 
Published: September 2021

The study aims to explore which factors influence international students’ decision to pursue doctoral studies in Canada. Drawing on the push-pull model and the mechanism of educational decision making, this study uses semi-structured interviews to gather data and explores themes such as political and economic forces, institutional factors, social background and experience, and individual motivation in students’ decision making. Our study identifies multiple factors at the individual, institutional, and country levels that influence students’ decision making, including students’ past experiences, funding, faculty members, and immigration policies. Moreover, it finds that the factors vary by students’ regions of origin and disciplines of study. Our findings, focused on international doctoral students in Canada, add to the ongoing conversation about student mobility and add nuances on international students’ decision-making process in times of shifting landscape of higher education internationalization.
ESTRATÉGIAS UTILIZADAS POR ENFERMEIRAS PARA ESTIMULAR A PARTICIPAÇÃO DO PAI/PARCEIRO NO PRÉ-NATAL
Authors: Comin Silva Almeida Denise , Almeida Fettermann Fernanda , Ferreira Cortes Laura , Dutra Sehnem Graciela , Saldanha da Silveira Donaduzzi Daiany 
Published: September 2021

Objetivo: identificar as estratégias utilizadas por enfermeiros para estimular a participação do pai/parceiro no pré-natal. Metodologia: Trata-se de um estudo descritivo, exploratório de abordagem qualitativa. Utilizou-se a entrevista semi-estruturada, um questionário sociodemográfico e Análise de Conteúdo. Resultados: Participaram do estudo 11 enfermeiros com média de tempo de formação de 15,36 anos e o tempo de atuação nas respectivas unidades de 3,96 anos. Os resultados demonstram que as estratégias utilizadas foram o acolhimento, o estímulo ao vínculo familiar, a realização de consultas mais dinâmicas, a realização de exames e testes rápidos, e o comprovante de comparecimento para aqueles homens que necessitam de comprovação para o seu trabalho. Conclusão: O modo como o enfermeiro oferta o pré-natal, fornece suporte técnico-científico e apoio emocional, demonstra empatia e solicitude em relação aos anseios do casal que passa pelo processo gestacional, interfere na satisfação e vinculação dos homens com o serviço de saúde.
Perfil clínico y análisis de sobrevida en pacientes con neoplasia mucinosa papilar intraductal diagnosticados por ecoendoscopía
Authors: Chacaltana Mendoza Alfonso , Abad Nuñez Jacqueline , Salvatierra Bruno Li , Arcana Lopez Ronald , Davalos Moscol Milagros , Vera Calderon Augusto 
Published: September 2021

Introducción. La neoplasia mucinosa papilar intraductal (IPMN) se diagnostica ahora con mayor frecuencia debido al mayor usode los métodos de imágenes, y conlleva un desafío clínico su manejo y seguimiento por su probable transformación maligna. Objetivos. Conocer las características por ecoendoscopía (USE), evolución clínica y sobrevida de los pacientes diagnosticados de IPMN por USE. Materiales y métodos. Estudio de cohorte retrospectivo con análisis de sobrevida en pacientes diagnosticados de IPMN por USE entre 2013 y 2018 en el Hospital Nacional Edgardo Rebagliati Martins (HNERM). Se analizaron variables demográficas y ecoendoscópicas, además de seguimiento hasta el fallecimiento o 6 meses después del término del estudio. Se realizó el análisis de sobrevida con los métodos de Kaplan-Meyer y de regresión de Cox. Resultados. Se incluyeron 133 pacientes con IPMN. Edad media fue 68,6 años, 80 (60,2%) fueron mujeres. Según subtipos, 89 (66,9%) fueron de rama secundaria, 23 (17,3%) de ducto principal y 21 (15,8%) de tipo mixto. La principal localización fue cabeza de páncreas (41,4%). En el seguimiento, 22 (16,5%) fueron a cirugía, 22 (16,5%) fallecieron después de una mediana de seguimiento de 522 días. En 8 pacientes (6%) se detectó neoplasia maligna. La tasa de sobrevida global fue 86.8% (IC 95%, 79,6-91,6) al año y de 81.9% (IC95%, 73,3-88,0) a los 3 años. En análisis univariado los factores asociados a la sobrevida fueron los subtipos de IPMN-DP (p=0,02) y mixto (p=0,005), sexo masculino (p=0,004), tamaño de lesión ≥30 mm (p=0,000), nódulos (p=0,014) y Wirsung≥10 mm (p=0,01). En el análisis multivariado, los factores predictores asociados con la sobrevida fueron: IPMN-DP (HR=6,3, p=0,005), IPMN mixto (HR=4,9, p=0,008) y tamaño de lesión ≥30 mm (HR=7,1, p=0,000). Conclusiones. El diagnostico de IPMN de ducto principal y mixto se asocian como factores predictores de sobrevida, al igual que el tamaño de la lesión ≥30 mm.
Síntomas digestivos en la enfermedad por coronavirus 2019 (COVID-19)
Authors: Cortés Manuel E. 
Published: September 2021

Actualmente vivimos una verdadera emergencia de salud pública internacional debido a la pandemia de COVID-19, causada por el coronavirus SARS-CoV-2 (1). A la fecha (finales de abril de 2020), esta enfermedad ha causado cerca de 180 mil muertos y más de 2,5 millones de contagiados en todo el mundo. Inicialmente se describieron como síntomas de COVID-19 la fiebre, tos seca, disnea, dolor de cabeza y neumonía con insuficiencia respiratoria progresiva, que puede provocar la muerte (2). Recientes estudios alertan que esta enfermedad también puede producir trastornos a nivel gastrointestinal (3-5). En virtud de lo anterior, esta Carta al Editor tiene por objetivo el destacar los síntomas digestivos de COVID-19.