bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective change management within an Australian community palliative care service
Authors: Dredge Angie , Oates Lyle , Gregory Heidi , King Scott 
Published: November 2017

This article attempts to examine and explore the change management process that was undertaken by the community palliative care service at Calvary Health Care Bethlehem, Australia, to challenge the historical practice of prescribing ‘emergency subcutaneous medications’ for all patients admitted to the service. It discusses how, using a team approach, change management was effectively facilitated to ultimately enhance service provision and consumer satisfaction. Literature (both national and international) was examined to identify the use of emergency medications in the community palliative care setting. The historical practice of all community palliative care patients being prescribed this medication within the Victoria region of Australia was tested, and concerns and misconceptions of staff and referrers were challenged in regards to this practice. Through working parties, descriptive surveys and staff evaluations, the use of the term ‘emergency medication’ was changed to ‘anticipatory medication’ with clear criteria for usage. Change was undertaken slowly and with continued collaboration of staff to ensure effectiveness. Staff survey results identified that the majority were satisfied with the change, and they considered there to be no impact on the quality of care that their patients were receiving. The natural progression of the project, which resulted in positive quantitative and qualitative results, was the facilitation of an education package for carers to educate them on giving subcutaneous medications to the patient. By undertaking change that was slow and methodical with clear communication to all, the community palliative care service was able to embed the changes into everyday practice, and the use of anticipatory medications within the Calvary Health Care Bethlehem community palliative care service is now understood, acknowledged, and adhered to by all staff.
PROSES GLISEROLISIS MINYAK KELAPA SAWIT MENJADI MONO DAN DIACYL GLISEROL DENGAN PELARUT N-BUTANOL DAN KATALIS MgO
Authors: Anggoro Didi Dwi , Budi Faleh Setia 
Published: November 2017

Indonesia merupakan salah satu negara penghasil minyak sawit terbesar di dunia. Lebih dari setengah produksinya digunakan untuk kebutuhan dalam negeri dan sisanya diekspor. Produk turunan minyak sawit seperti Mono-Di Acyl Gliserol (MAG-DAG) mempunyai nilai ekonomi yang tingg dan selama ini Indonesia masih mengimpornya. MAG- DAG dibuat dari senyawa gliserida yang banyak terdapat dalam bahan minyak atau lemak, seperti minyak kelapa sawit, dengan gliserol. Tujuan dari penelitian ini adalah Studi eksperimen produksi MAG-DAG dari minyak kelapa sawit pada suhu rendah (2000C) dengan reaktor batch skala laboratorium, dan mengetahui pengaruh variabel-variabel proses. Variabel berubah yang digunakan adalah suhu (70 oC, 90 oC, dan 110 oC), rasio gliserol/CPO (3, 4, dan 5), dan jumlah katalis (2% w, 3% w, dan 4% w). Sedangkan variabel tetapnya adalah berat total campuran reaksi 300 gram, kecepatan pengadukan 400 rpm, waktu 4 jam dan jumlah pelarut 20 ml/10 gram CPO. Dari hasil pengolahan data menggunakan program STATISTICA 6 diperoleh kondisi operasi optimum dicapai pada suhu sekitar 70-1000C, rasio gliserol/CPO sekitar 3,5-4,5 serta katalis pada kisaran 2,5-4% dengan konversi yang diperoleh sekitar 93-98%. Dengan adanya penambahan pelarut n-Butanol, reaksi dapat dijalankan pada suhu yang lebih rendah (di bawah 2000C) tanpa menurunkan konversi yang diperoleh.
Optimasi Proses Ozonasi pada Depolimerisasi κ-Karagenan dengan Metode Respon Permukaan
Authors: Prasetyaningrum Aji , Ratnawati Ratnawati , Jos Bakti 
Published: November 2017

Abstract OPTIMIZATION OF OZONATION PROCESS FOR κ-CARRAGEENAN DEPOLYMERIZATION USING RESPONSE SURFACE METHODOLOGY. The objective of this research is to optimize the operating parameters in depolymerization of κ-carrageenan by ozone treatment. The optimization is done by using Box-Bhenken Design (BBD) model with ozonation time (5-15 minute), pH (3-11) and temperature (20-40oC) as the independent variables.The response of ozonation process is the degree of depolymerization of κ-carrageenan (DP). The initial molecular weight of refined κ-karagenan was 271 kDa. The κ-carrageenans powder was completely dissolved in distilled water to form 1% (weight/volume). The experiments were carried out in a 2000 ml of a glass reactor with an ozone gas sparger. The inlet ozone concentration was 80±2 ppm. The result shows that ozonation time, pH and temperature have significant effects during ozonation process (p< 0.05). Analysis of variance shows that the experimental data fit the model very well with the R2 value of 0.98. The optimum conditions during ozonation process are achieved at the reaction time of 15 min, ozonation pH of 3 and reaction temperature of 25oC. Under these optimum conditions the DP of κ-carrageenan is 91.513%. Keywords: depolymerization; κ-carrageenan;optimization; ozonation process Abstrak Tujuan penelitian ini adalah menentukan kondisi optimum parameter operasi depolimerisasi κ-karagenan dengan perlakuan ozonasi. Optimasi dilakukan dengan menggunakan model statistika Box-Bhenken Design (BBD) dengan variabel yang digunakan yaitu waktu ozonasi (5-15 menit), pH (3-11), dan suhu (20-40oC). Respon dari proses ozonasi adalah derajat depolimerisasi κ-karagenan (DP). Berat molekul awal refined κ-karagenan adalah 271 kDa. Sampel κ-karagenan dilarutkan secara sempurna dalam air distilasi dan konsentrasi diatur 1% (berat/volume). Percobaan dilakukan dalam reaktor gelas volume 2000 ml yang dilengkapi dengan sparger gas ozon. Konsentrasi gas ozon yang masuk adalah 80±2 ppm. Hasil penelitian menunjukkan bahwa waktu ozonasi, pH, dan suhu berpengaruh secara signifikan terhadap proses ozonasi (p<0,05). Analisis varian menghasilkan ketelitian yang tinggi antara data eksperimen dan prediksi, dengan nilai koefisien R2 = 0,98. Kondisi optimum diperoleh pada waktu ozonasi 15 menit, pH ozonasi 3 dan temperatur reaksi 25oC. Pada kondisi optimum ini diperoleh DP κ-karagenan sebesar 91,513%. Kata kunci:depolimerisasi; κ-carrageenan;optimasi; proses ozonasi
Uji Kinerja Burner dan Tabung Reaktor Flame Untuk Proses Spray Pyrolysis
Authors: Hidayat Darmawan , Nurohman Ganjar , Setianto S , Mukti Wibawa Bambang , Suhendi Nendi 
Published: November 2017

Abstract PERFORMANCE EVALUATION OF BURNER AND THE REACTOR TUBE OF FLAME FOR A SPRAY PYROLYSIS PROCESS. Flame spray pyrolysis is a versatile process in the syntheses of various functional materials. This work reports the performance of a diffusion flame built from a coaxial burner and a Pyrex-glass tube reactor with respect to the relatively low propane flow rates (0.1-0.8 L/min). The burner comprised of three cylindrically tubes with three inlets for fuel (propane), oxidant (oxygen) and precursor aerosol. Three flame parameters were measured, i.e. the flame height, flame temperature and reactor temperature profile, respectively. The test results showed the increase of the flame height and temperature with increasing of propane flow rate. The temperature profile measurements showed the decreasing as the height above burner increased; and temperature profile increased at the increasing propane flow rate. The reactor temperature was in the range of 36-190°C at low propane flow rates of 0.1-0.8 L/min. In conclusion, control of flame process parameters could be conducted by controlling of propane flow rate. Keywords: diffusion flame burner; spray pyrolysis; flame reactor; electronic material syntheses Abstrak Pirolisis flame spray merupakan proses yang banyak digunakan untuk keperluan sintesis bahan-bahan fungsional. Makalah ini melaporkan kinerja sebuah reaktor flame difusi yang dibangun dari sebuah pembakar (burner) dan tabung reaktor silinder. Pembakar dibangun dari tiga buah silinder stainless steel yang dipasang koaksial sebagai saluran bahan bakar propana, oksidator oksigen dan aerosol prekursor. Tiga parameter proses flame yang diuji adalah tinggi flame, temperatur flame dan profil temperatur tabung reaktor. Hasil pengujian menunjukkan bahwa seiring kenaikan laju alir propana, tinggi dan temperatur flame meningkat. Pengukuran profil temperatur menunjukkan penurunan seiring kenaikan posisi dari ujung-atas pembakar; dan temperatur profil reaktor meningkat seiring dengan kenaikan laju alir propana. Temperatur reaktor berkisar 36-190°C pada laju alir propana rendah 0,1-0,8 L/min. Dapat disimpulkan bahwa pengontrolan parameter-parameter proses flame dapat dilakukan dengan pengaturan laju alir propana. Kata kunci: diffusion flame burner; proses spray pyrolysis; reaktor flame; sintesis bahan elektronik
Dynamics of GnRH Neuron Ionotropic GABA and Glutamate Synaptic Receptors Are Unchanged during Estrogen Positive and Negative Feedback in Female Mice
Authors: Liu Xinhuai , Porteous Robert , Herbison Allan E. 
Published: November 2017

AbstractInputs from GABAergic and glutamatergic neurons are suspected to play an important role in regulating the activity of the gonadotropin-releasing hormone (GnRH) neurons. The GnRH neurons exhibit marked plasticity to control the ovarian cycle with circulating estradiol concentrations having profound “feedback” effects on their activity. This includes “negative feedback” responsible for suppressing GnRH neuron activity and “positive feedback” that occurs at mid-cycle to activate the GnRH neurons to generate the preovulatory luteinizing hormone surge. In the present study, we employed brain slice electrophysiology to question whether synaptic ionotropic GABA and glutamate receptor signaling at the GnRH neuron changed at times of negative and positive feedback. We used a well characterized estradiol (E)–treated ovariectomized (OVX) mouse model to replicate negative and positive feedback. Miniature and spontaneous postsynaptic currents (mPSCs and sPSCs) attributable to GABAAand glutamatergic receptor signaling were recorded from GnRH neurons obtained from intact diestrous, OVX, OVX + E (negative feedback), and OVX + E+E (positive feedback) female mice. Approximately 90% of GnRH neurons exhibited spontaneous GABAA-mPSCs in all groups but no significant differences in the frequency or kinetics of mPSCs were found at the times of negative or positive feedback. Approximately 50% of GnRH neurons exhibited spontaneous glutamate mPSCs but again no differences were detected. The same was true for spontaneous PSCs in all cases. These observations indicate that the kinetics of ionotropic GABA and glutamate receptor synaptic transmission to GnRH neurons remain stable across the different estrogen feedback states.
Improving Communication Through Resident-Nurse Shadowing
Authors: Walsh Heather A. , Jolly Inouye Adriane A. , Goldman Ellen F. 
Published: November 2017

BACKGROUND:
Previously, reduced resident hours, multiple ways to communicate (text paging, calling), and fewer opportunities for face-to-face communication had led to increased frustration from residents and nurses in our institution about communicating and prioritizing patient care needs. It was thought that a shared understanding and improved teamwork and communication between residents and nurses might be achieved if the residents could watch the nurses’ workflow and observe their care priorities.

OBJECTIVES:
To understand the experience of residents and nurses who had participated in a novel 4-hour nurse shadowing experience conducted during the first year of pediatric medical residency in a children’s hospital.

METHODS:
We undertook a basic interpretive qualitative study by using semistructured interviews to formally evaluate the shadowing program by examining the experiences of both the first-year residents and the nurses being shadowed. Residents and nurses who had participated in the past 3 years were eligible for inclusion in the study.

RESULTS:
Seven themes emerged that supported the overarching theme of improving communication between residents and nurses. Shadowing led to improved resident understanding and appreciation of nurses’ work. Both residents and nurses experienced enhanced relationships as they discussed opportunities to improve care delivery. Residents reported practice changes after shadowing a nurse. Peer relationships formed among the dyads that extended beyond the shadowing experience.

CONCLUSIONS:
Shadowing a nurse proved to be a valuable experience that had an impact on participants and potentially a positive impact on patient care.
The Involvement of Adolescents With Chronic Health Conditions in Medical Education: An Exploratory Qualitative Study
Authors: Moreau Katherine A. , Eady Kaylee 
Published: November 2017

OBJECTIVES:In this study, we explored the involvement of adolescents with chronic health conditions in medical education. We focused specifically on adolescents’ desired level of involvement in the education of medical students and residents, strategies for involving them in it, and topics on which they would feel comfortable educating these learners.METHODS:We used a community-based participatory research approach and qualitative one-on-one semistructured interviews. Adolescents (ages 13–18) with chronic health conditions lasting &gt;3 months who were admitted on inpatient wards and were well enough to participate in an interview were eligible. Two investigators analyzed the interview transcripts to identify common categories across the interview data.RESULTS:A total of 17 adolescents participated. Data analysis revealed that adolescents want to be regularly involved in medical education, compensated in some way for their time and effort, and receive support and oversight in their activities. Adolescents discussed the following 5 strategies for involving them in the education of medical students and residents: face-to-face presentations, shadowing and mentoring, videos, handouts and books, and assessment feedback. Adolescents want to educate learners on their experiences and coping strategies as well as on how to interact and develop rapport with adolescents.CONCLUSIONS:The adolescents with chronic health conditions who participated in this study want to be actively involved in medical education and can provide innovative insights and strategies for doing so. However, future researchers need to explore the benefits and limitations of such involvement.
Admissions to Acute Care Within 30 and 90 Days of Discharge Home From a Pediatric Post-acute Care Hospital
Authors: O’Brien Jane E. , Dumas Helene M. , Fragala-Pinkham Maria A. , Berry Jay G. 
Published: November 2017

OBJECTIVES:
Of all hospitalized children, those with medical complexity have the highest likelihood of hospital readmission. Post-acute hospital care could potentially help stabilize the health of these children. We examined the frequency of acute care hospital admissions after discharge home from a post-acute care hospital (PACH).

METHODS:
A retrospective cohort analysis of 448 children with medical complexity discharged from a PACH from January 1, 2010, to December 31, 2015, with the main outcomes of acute care hospital readmissions 0 to 30 and 31 to 90 days after discharge home from a PACH. Demographic and clinical characteristics were compared between children with and without acute care readmission and between the 2 readmission groups.

RESULTS:
Ninety-nine children (22%) had a readmission to the acute care hospital. Of these readmissions, 61 (62%) occurred between 0 and 30 days and 38 (38%) between 31 and 90 days after PACH discharge. A higher percentage of children readmitted had high medical severity (&gt;3 systems involved or ventilator dependent) compared with children not readmitted (68% vs 31%, P = .04). No differences were found between children who were readmitted and those who were not by sex, race, payer, length of stay, or age at PACH discharge. Additionally, no differences were found between children readmitted within 30 days and children readmitted 31 to 90 days after PACH discharge.

CONCLUSIONS:
The majority of children discharged home from a PACH do not require an acute care hospitalization within the first 3 months. Children with greater medical severity are readmitted more often than others.
Educational Added Value Unit: Development and Testing of a Measure for Educational Activities
Authors: Guiot Amy B. , Kirkendall Eric S. , Gosdin Craig H. , Shah Samir S. , DeBlasio Dominick J. , Meier Katie A. , O’Toole Jennifer K. 
Published: November 2017

OBJECTIVES:
University-based hospitalists educate health care professionals as an expectation, often lacking time and support for these activities. The purpose of this study was to (1) develop a tracking tool to record educational activities, (2) demonstrate its applicability and ease of completion for faculty members in different divisions, and (3) compare educational efforts of individuals from different professional pathways and divisions by using the educational added value unit (EAVU).

METHODS:
Educational activities were selected and ranked according to preparation effort, presentation time, and impact to calculate the EAVU. Faculty participants from 5 divisions at 1 institution (hospital medicine, general and community pediatrics, emergency medicine, behavior medicine and clinical psychology, and biostatistics and epidemiology) completed the retrospective, self-report tracking tool.

RESULTS:
A total of 62% (74 of 119) of invited faculty members participated. All faculty earned some EAVUs; however, there was a wide distribution range. The median EAVU varied by division (hospital medicine [21.7], general and community pediatrics [20.6], emergency medicine [26.1], behavior medicine and clinical psychology [18.3], and biostatistics and epidemiology [8.2]). Faculty on the educator pathway had a higher median EAVU compared with clinical or research pathways.

CONCLUSIONS:
The EAVU tracking tool holds promise as a mechanism to track educational activities of different faculty pathways. EAVU collection could be of particular benefit to hospitalists, who often perform unsupported teaching activities. Additional studies are needed to determine how to apply a similar process in different institutions and to determine how EAVUs could be used for additional support for teaching, curriculum development, and educational scholarship.
Tobacco's Toll: Implications for the Pediatrician
Authors:   Committee on Substance Abuse
Published: November 2017

This Policy Statement was retired September 2013.
The disease of tobacco addiction, which is pervasive in the United States, begins in childhood and adolescence. Twenty-five percent of the population regularly uses tobacco, despite evidence that such use is the leading preventable cause of death in the United States. Tobacco use reportedly kills 2.5 times as many people each year as alcohol and drug abuse combined. According to 1998 data from the World Health Organization, there were 1.1 billion smokers worldwide and 10 000 tobacco-related deaths per day. Furthermore, in the United States, 43% of children aged 2 to 11 years are exposed to environmental tobacco smoke, which has been implicated in sudden infant death syndrome, low birth weight, asthma, middle ear disease, pneumonia, cough, and upper respiratory infection. Pediatricians play a crucial role in reducing both tobacco use (by children, adolescents, and their parents) and exposure to tobacco smoke and should rank this among their highest health prevention priorities.
Rendering Beyond_words in Transitioning to Motherhood Through Visual and Dramatic Arts
Authors: Scotti Victoria , Gerber Nancy 
Published: November 2017

The purpose of this doctoral dissertation research study was to use arts-based research methods to explore the beyond_words phenomena of first-time mothers who were in the process of transitioning to motherhood. The multidimensional embodied, emotional, and sensory experiences that accompany new motherhood can be overwhelming, be difficult to articulate verbally, and impact the perceptions of the new mother’s relationship to herself and her child (Crossley, 2009; Lintott & Sander-Staudt, 2011; Prinds et al., 2014).In order to honor and capture the emergent, vital, and multi-dimensional nature of beyond_words in transitioning to motherhood, in this study, arts-based research methods were used to explore and represent these phenomena, otherwise inexpressible in words. The arts-based results are presented as five portrait syntheses and a final synthesis play in four acts that bring to life and invite the viewer to live the mothers’ beyond_words experiences, while simultaneously positioning them within the wider context of current medical and health sciences research perspectives. The final synthesis, which is the featured dramatic play, aspires to give voice and aesthetic power to these mothers’ beyond_words transitioning to motherhood experiences. In the philosophical tradition of ABR (Leavy, 2009, 2015), this study marries the rigor of research with the aesthetic power of the visual and dramatic arts challenging existing assumptions, beliefs, and cultural stereotypes about motherhood and disseminating the results to relevant stakeholders.
El dictamen pericial contable, medio de prueba y criterios de valoración
Authors: Caro Espitia Néstor Raúl , Hernández Aros Ludivia , Gallego Cossio Laura Constanza , Flórez Guzmán Mario Heimer 
Published: November 2017

El presente artículo establece desde una perspectiva teórica, los deberes del contador público en cuanto al manejo contable y financiero de las organizaciones, y en su labor como perito; a su vez, la responsabilidad de emitir conceptos en las controversias técnico-contables; desde el punto de vista procesal como testigo técnico, debido a que percibe de manera especial los hechos económicos, y emite conceptos sustentados en evidencia que le sirven al juez para adoptar su decisión, previa contradicción y valoración. Bajo esta premisa, la investigación indagó sobre los criterios que influyen al momento de presentar el dictamen pericial, ante un juez o tribunal. Para ello se propone utilizar el método cualitativo, descriptivo, exploratorio y documental. Los resultados se obtuvieron a partir de la revisión bibliográfica, normativa, y del análisis y síntesis de la información obtenida. Las conclusiones reflejan que el dictamen pericial constituye un instrumento fundamental para dirimir las controversias técnico-contables, razón por la cual, se exige una preparación exigente -con evidencia amplia y suficiente- que contenga los requisitos mínimos de existencia, validez y eficacia, aspectos que, desde el punto de vista probatorio, le darán solidez a su conocimiento.
La reivindicación de derechos y garantías de los movimientos sociales (LGBTI – Desplazados) a través del activismo y progresismo de la Corte Constitucional colombiana
Authors: Malagón Rubio Laura Milena 
Published: November 2017

Resulta imperioso demostrar por qué en un contexto como el colombiano, ante las dificultades del reconocimiento social, económico, político, cultural y los fuertes patrones de discriminación histórica contra la población minoritaria LGBTI y el desplazamiento forzado, el activismo y progresismo judicial de la Corte Constitucional colombiana, ha sido decisivamente significativo en el reconocimiento de sus derechos y garantías con respuestas efectivas a sus necesidades; esto frente a un Legislativo y Ejecutivo que minimiza los derechos y garantías, en contraste con un Tribunal Constitucional que los maximiza. En ese sentido, a pesar de las limitaciones y algunas decisiones controversiales del tribunal, se reivindica y defiende el trabajo de la Corte Constitucional colombiana como un actor institucional, a partir del debate contemporáneo que plantea dos respuestas: los defensores del constitucionalismo democrático y los defensores del constitucionalismo popular; en el cuál se defenderá el primero de ellos por los cambios e incidencia social a partir de sus decisiones en el reconocimiento y transformación real de las demandas sociales de dichos movimientos sociales.