bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-of-Life Communication in the Emergency Department
Authors: Zhang Yuan Helen , De Silva Muthuwadura Waruni Subashini , Allen John Carson , Lateef Fatimah , Omar Eunizar Binte 
Published: April 2022

Introduction:
End-of-life (EOL) conditions are commonly encountered by emergency physicians (EP). We aim to explore EPs’ experience and perspectives toward EOL discussions in acute settings.

Methods:
A qualitative survey was conducted among EPs in three tertiary institutions. Data on demographics, EOL knowledge, conflict management strategies, comfort level, and perceived barriers to EOL discussions were collected. Data analysis was performed using SPSS and SAS.

Results:
Of 63 respondents, 40 (63.5%) were male. Respondents comprised 22 senior residents/registrars, 9 associate consultants, 22 consultants, and 10 senior consultants. The median duration of emergency department practice was 8 (interquartile range: 6–10) years. A majority (79.3%) reported conducting EOL discussions daily to weekly, with most (90.5%) able to obtain general agreement with families and patients regarding goals of care. Top barriers were communications with family/clinicians, lack of understanding of palliative care, and lack of rapport with patients. 38 (60.3%) deferred discussions to other colleagues (e.g., intensivists), 10 (15.9%) involved more family members, and 13 (20.6%) employed a combination of approaches. Physician's comfort level in discussing EOL issues also differed with physician seniority and patient type. There was a positive correlation between the mean general comfort level when discussing EOL and the seniority of the EPs up till consultancy. However, the comfort level dropped among senior consultants as compared to consultants. EPs were most comfortable discussing EOL of patients with a known terminal illness and least comfortable in cases of sudden death.

Conclusions:
Formal training and standardized framework would be useful to enhance the competency of EPs in conducting EOL discussions.
Facilitators and Barriers to Infant Immunization during COVID-19 Pandemic
Authors: Tawar Shabeena , Yadav Arun Kumar , Garg Swati , Bhaskar Vijay , Swain Santosh Kumar 
Published: April 2022

Introduction:
The world is enveloped with the coronavirus disease 2019 (COVID-19) Pandemic with modern medicine and public health facing their most significant challenges ever posed. As the number of COVID-19 cases increased worldwide, an important issue of concern was the continuation of routine immunization services for children. This study has been conceptualized to assess the effect of the COVID-19 pandemic on infant Immunization.

Materials and Methods:
This study was a descriptive study conducted in an urban community amongst healthy children <1-year-old from January 2018 to September 2021. Immunization records of infants were obtained from data generated during each immunization session and strength, weakness, opportunity, and threat analysis was done using a questionnaire.

Results:
During the study, a total of 3518 vaccinations were done, a total of 3010 vaccinations (85.5%) were done on time, and the total delayed vaccinations were 508 (14.5%). The difference among the years was statistically significant, with the highest delay in the year 2020 (P < 0.001). However, in the year 2021, the number of vaccinations carried out from April to September was 568, with delayed vaccination of only 10.9%.

Conclusion:
The Armed Forces childhood immunization program could be sustained during the COVID-19 pandemic due to a multitude of contributing factors such as adherence to national guidelines that prioritized vaccination, infrastructure, and availability of trained workforce and most importantly commitment to strict COVID appropriate behavior.
Malnutrition in Elderly Pilgrims Attending Kumbh Festival 2019
Authors: Aggarwal Vivek , Sashindran V. K. , Dudeja Puja , Prashant P. , Sarkar Nandini , Vasdev Vivek , Singhal Anuj 
Published: April 2022

Background and Objectives:
Geriatric population is at increased risk of malnutrition which in turn leads to decreased immunity, sarcopenia, frailty and poor clinical outcomes. This study was planned to study the prevalence of malnutrition in the elderly people (>60 yrs) attending Kumbh Mahotsava. The objectives of the study were to see the association of malnutrition with socioeconomic status, gender, age and geriatric syndromes.

Methods:
Cross sectional observational study in elderly more than 60 years attending Kumbh Festival. Nutritional assessment was done using Mini Nutritional Assessment (MNA) questionnaire. Socioeconomic status was assessed using the modified Kuppuswamy score. Anthropometric data like body mass index (BMI), calf circumference, and upper mid-arm circumference were measured. All the above data points were integrated into a web application and the socioeconomic and nutritional score were calculated automatically. Based on nutritional assessment nutritional advice was given by a short message service and verbal counseling. Prevalence of malnutrition and its association with socioeconomic status, gender, age and geriatric syndromes were analysed.

Results:
Total 219 elderly were included in the study. Mean age was 68.5 years. Around 70% (152/219) were either malnourished or at risk of malnutrition. Nutritional status was significantly associated with modified Kuppuswamy socioeconomic status (P = < 0.001). There was a significant association between nutritional status and presence of geriatric syndromes in form of having a falls (P= 0.010), leaking of urine (P= <0.001) and forgetfulness (P < 0.01).

Conclusion:
Around 70% (152/219) of the elderly were either malnourished or at risk of malnutrition with significant ssociation with socioeconomic status and geriatric syndromes. This study shows the importance of screening our geriatric population for malnutrition.
Short-term Evaluation of Renal Transplantation Complications
Authors: Aggarwal Puneet , Talwar Raghav , Karan S. C. 
Published: April 2022

Introduction:
Renal Transplant remains one of the pioneer branches of solid organ transplant and surgical complications can affect the outcome.

Material and Methods:
Present study was done to find out the incidence of surgical complications in Renal Transplant Recipients, their outcome, to compare it with contemporary studies and suggest remedial measures. It was Prospective non-randomized observational study conducted at tertiary centre. All patients who underwent live related or deceased donor transplant over two yrs were recruited. All relevant data was collected. Data were collected and put in a master chart in Microsoft Excel© format and statistical analysis was done using SPSS 17 software®. Student t test was used to compare data with published contemporary series and p value was calculated.

Results:
one hundred and forty-five cases including 31 (21%) deceased donor recipients were studied. Eleven (7.58%) had surgical complications. Two with arterial complications required graft nephrectomies and one with renal artery stenosis stented successfully. Higher incidence of arterial complications (2.06%) was noted as compared to contemporary studies (0.69%-1.3%) (p>.05) with higher incidence (3.2%) in deceased Donor recipients. No venous complications recorded (contemporary studies 0.15% - 0.55% incidence). One (0.68%) Ureteric stricture was reported, comparable to contemporary studies (0.27%-0.54%) (p>.05) and managed endoscopically. No uretric-vesical anastamosis leak recorded (contemporary studies 0% - 0.97% incidence). Four (2.75%) had Lymphorea, (Three deceased, one live donor) requiring Betadine instillation, significantly lower than contemporary studies (7.14%- 23%) (p<.05). Two (1.4%) had surgical site infection requiring secondary suturing, significantly lower than contemporary studies (3.2%- 15%) (<.05). One (0.68%) had stricture urethra managed conservatively, comparable to contemporary studies (0.83%-1.18%).

Conclusion:
Overall incidence of surgical complications is reducing. Complication rates are higher in Deceased Donor recipients.
Cesarean Sections Conducted in a Tertiary Care Hospital – An Analysis as per Robson's Ten Group Classification System
Authors: Asthana Shilpa , Lele P. R. , Pitale Devdatt , Sandeep G. 
Published: April 2022

Background:
Over a past few decades, there has been an increase in cesarean section (CS) rates globally. The exponential rise in CS is a major contributory factor in both maternal and fetal morbidities. It is important to assess, analyze, and audit cesarean section rate and its indications, in obstetric care delivery units existing in every health-care system. This study was conducted to audit the rate of CS in our institute with a focus to optimize the indications of CS with an aim to help in reduction in cesarean deliveries in future.

Materials and Methods:
This retrospective observational study was conducted over a period of 1 year in a large tertiary care hospital. All patients who underwent cesarean section were categorized according to Robson Ten group Classification system.

Results:
In this study, a total number of deliveries in the given time period were 1062, of which 455 (42.84%) underwent CS. Among the total CS, n = 237 (52.08%) were elective and n = 218 (47.91%) were emergency CS. The highest contribution to the CS, according to Robson's TGCS, was Group 5 and Group 2 in this study. Group 9 had the lowest contribution to CS rate. The most common indication for emergency CS was nonreassuring fetal heart rate (n = 76, 34.86%); however, post-LSCS pregnancy attributed (n = 132, 55.70%) to elective CS. A total number of CS performed at term were 402 (88.35%) and preterm CS conferred to 53 (11.65%).

Conclusion:
There exists a significant concern toward the overuse of CS. A definitive protocol and optimization of indications for primary CS along with clinical and administrative efforts would aid in minimizing the CS rate. Furthermore, it must be noted that every effort should be made toward provision of CS in women warranting it, rather than achieving specific target goal.
Outcomes in HIV Patients on Two Different Protease Inhibitors on Second-Line Antiretroviral Therapy
Authors: Ashta Kuldeep Kumar , Arora Sumit , Verma Niket 
Published: April 2022

Introduction:
There were 38 million people living with HIV in the world in 2019, out of which 5.8 million were living within the Asia-Pacific region. Globally, 67% (25.4 million) and within the Asia-Pacific region, 60% (3.5 million) of the individuals living with HIV were accessing anti-retroviral therapy (ART) respectively. Approximately 4% of the patients on ART are on second-line therapy. The aim of this research was to analyze the difference in efficacy and tolerance of boosted lopinavir and boosted atazanavir as part of second-line ART regimens and factors associated with the difference.

Materials and Methods:
The observational study was conducted at a referral ART clinic of a tertiary care hospital in North India. This was an ambispective study on patients under evaluation for first-line treatment failure. One hundred and fifteen and sixty patients were recruited to lopinavir and atazanavir study groups, respectively. Efficacy was assessed by adequate suppression of plasma viral loads 12 months after starting therapy with protease inhibitors.

Results:
Both the regimens are highly effective in reducing viral loads. Regarding adverse drug reactions (ADRs), hyperlipidemia and abnormal liver function test (transaminitis) were the most common ADRs in the lopinavir study group, whereas nausea, fever, and indirect hyperbilirubinemia were the most common ADRs in the atazanavir study group.

Conclusions:
Lopinavir and atazanavir are both highly effective in reducing viral loads and produced comparable CD4 levels post 1-year follow-up.
Stone Clearance Rate and Postoperative Recovery of Mini Percutaneous Nephrolithotomy: A Single-Institute Study
Authors: Shah Amit Kumar , Upadhye Manoj A , Deepak H , Goud Naveen Kumar , Shah Akshat 
Published: April 2022

Introduction:
During the last two decades, the evaluation and management of renal and upper ureteric stones has vastly altered. The era of endoscopic surgery replaced open pyelolithotomy or nephrolithotomy which caused a significant morbidity. During this decade we saw evolution of endoscopic surgery where Mini PCNL (Mini Perc) , Ultra Mini and Micro Perc have further achieved stone clearance with better outcomes pertaining to reduced morbidity because of reduction in caliber of tract dilatation, even avoiding a nephrostomy post procedure in select cases. Aim of this study summarizes the outcome of patients undergoing Mini Perc. The primary objective of the study was to get Post-Operative evaluation of complications associated with Mini Perc by Modified Clavien Dindo Grading and secondary objectives were to see Post-Operative pain assessment by Visual Analogue scale and to see Stone clearance rate of the surgical procedure.

Materials and Methods:
Research was carried out in the form of a Hospital-based prospective observational study as per the guidelines shared by the Prospective Observational Clinical Studies Good Research Practices Task Force (formed May 16, 2010). Hospital-based prospective observational study of 78 consecutive patients who underwent Mini Perc between Aug 2018 and May 2020 at tertiary care centre were vetted against the criteria for inclusion and exclusion. The management policy for pelvicalyceal calculi at the study centre has closely followed those of the American Urological Association (AUA) guidelines for managing renal stones.

Results:
The mean age of the group was 43.3 years (range 16–84) with 47 males and 38 females. Mean stone size was 20.11 mm (range 11–38 mm) and mean operative time was 44.5 min (range 29–98 min). Double J (DJ) stent was placed in all patients as a prophylaxis to prevent obstructive uropathy / post op urinary leak. Postoperatively, the most commonly noted complication was fever recorded in 12 (15.38%) patients followed by bleeding at the surgical site in 03 (3.84%) patients. Sepsis was noted in 02 (2.56%) patients, pleural injury in 01(1.28) patient. Haemorrhage requiring intervention was recorded in 01 (1.28%) of patients. Pain assessment done at specified interval showed progressive decreasing trend in intensity as evaluated by visual analogue scale. The stone clearance rate in our study was 96.15% at the end of one month following post op period.

Conclusion:
The study shows that Mini Perc remains standard of care for management of Renal and upper ureteric stone. The technique beyond doubt is safe, efficient, feasible and economical in achieving excellent stone clearance rates. The Modified Clavien-Dindo system of grading for perioperative complications is easy to use and reproducible. It can be used as an objective and reliable method for describing the complications of the surgical procedure.
Preliminary Analysis of Excess Mortality in India During the COVID-19 Pandemic
Authors: Leffler Christopher T. , Lykins V Joseph D. , Das Saurav , Yang Edward , Konda Sneha 
Published: April 2022

ABSTRACT.
We studied all-cause mortality during the COVID-19 pandemic in 19 Indian states (population 1.27 billion). Excess mortality was calculated by comparison with years 2015 to 2019. The known COVID-19 deaths reported for a state were assumed to be accurate, unless excess mortality data suggested a higher toll. Data from one state were excluded due to anomalies. In several regions, fewer deaths were reported in 2020 than expected. Areas in Andhra Pradesh, Delhi, Haryana, Karnataka, Madhya Pradesh, Tamil Nadu, and West Bengal saw spikes in mortality in Spring 2021. The pandemic-related mortality through August 31, 2021, in 18 Indian states was estimated to be 198.7 per 100,000 population (range 146.1–263.8 per 100,000). If these rates apply nationally, then 2.69 million people (range 1.98 to 3.57 million) may have perished in India as a result of the pandemic by August 31, 2021.
Exposición química y síntomas dérmicos y respiratorios en estilistas del sector informal de Palmira 2020
Authors: Motato-Carvajal Maryury , Osorio-Torres Carlos Alfonso 
Published: April 2022

Introducción: Los productos cosméticos utilizados en los tratamientos de belleza contienen diferentes sustancias químicas toxicas irritantes y cancerígenas como el formaldehido, clasificado por la Agencia Internacional de Investigación sobre el Cáncer IARC (siglas en inglés) como tipo 2, probablemente cancerígeno en humanos(1) ; y el amoniaco también clasificado como cancerígeno por el Instituto Nacional para la Seguridad y Salud Ocupacional NIOSH(2) (siglas en inglés) , los cuales pueden ingresar al organismo por inhalación, vía oral, contacto en globo ocular y contacto con la piel produciendo diferentes síntomas clínicos en los estilistas. Objetivo: Identificar la exposición química y los síntomas relacionados en estilistas del sector informal del municipio de Palmira Colombia.
Método: Se evaluaron las características de la población con una encuesta sociodemográfica de elaboración propia, las características de exposición química en los salones de belleza con el cuestionario de evaluación cualitativa Stoffenmanager, y los síntomas en la piel, mucosa ocular y vía aérea superior de los estilistas con el cuestionario nórdico de enfermedades cutáneas de origen profesional NOSQ-2002/SHORT. Las peluquerías fueron seleccionadas al azar de un universo de 35 peluquerías clasificadas según el número de trabajadores.
Resultados: Las condiciones de exposición a químicos se evaluaron en 12 peluquerías, la exposición por inhalación fue alta en el proceso de alisado; la exposición dérmica por contacto fue alta en el alisado y en la coloración , y fue muy alta en la decoloración; la exposición dérmica por absorción fue alta en la coloración y muy alta en el alisado y la decoloración. Los síntomas dérmicos y respiratorios se evaluaron en 64 estilistas, encontrando síntomas dérmicos en el 51,6 % , y síntomas respiratorios en el 60,9 %.
Conclusiones: El mayor peligro por exposición químico estaba en el proceso de alisado. Los síntomas de los estilistas se relacionan con la frecuencia de exposición a estos químicos.
Akıt Hacı Oğulları’nın Kazakça Meali
Authors: Aitbayev Zhandos 
Published: April 2022

Kur’anı Keri’in Kazakça ilk meallerden birisi olan Kazakistan topraklarından Doğu Türkistan bölgesine hicret eden Akıt hacı Ülimci oğlunun kaybolup günümüze kadar ulaşılamayan mealini oğulları babalarinin vefatından yarım asır sonra oğulları Aziz (d.1924) ve Makaş (d.1931-2003) Akıtulu onun arzusunu yerine getirip bir meal yazarak 1990 yılında Sincanda basmıştır.
Makalede Aziz ve Makaş Akıt oğullarının “Kuran Karim’nin Kazakşa Audarması” adlı mealinin tanıtımı işlenmiştir.
Birinci bölimde Kazakça meallerin doğuşu ve gelişiminden söz edilmektedir.
İkinci bölümde ise mütercimlerin hayatları ve eserlerine yer verilmektedir.
Üçüncü ana bölümde ise “Kuran Karim’nin Kazakşa Audarması” adli mealinin tanıtımını işlemiştir. Mealin teknik özelliklerine değinerek meal’in orjinal ve kiril baskılarını karşılaştırarak bazı örnekler getirilmiştir. Aynı zamanda mealin orjinal ve kiril nüshaları arasındakı farkları dile getirerek iki baskı arasında mukayese de yapılmıştır. Belli başlıklı kavramların tercüme edilişine ve mealde’ki eksik ve yanlış tercüme edilmiş ayetleri tespit ederek örneklerle makalenin içeriğindeki zenginliğini artırmıştır.
Makale’nin sonuç bölümünde tercüme’nin özelliklerini anlatarak meal hakkında değerlendirmelerde bulunmuştur.
Effect of Proportion of Sorbitol and Sucrose with Pectin Concentration to Physicochemical and Sensoric Characteristics of Pedada Jam Gelato (Sonneratia caseolaris)
Authors: Sukma Salsabila Ayu , Jariyah Jariyah 
Published: April 2022

Gelato is a frozen dessert that has lower fat and overrun content and higher sugar content than ice cream. Sorbitol can affect the texture of gelato and has lower glycemic index and calories than sucrose. Sucrose provides sweetness without cooling effect therefore it can balance the sweetness of gelato. Pectin can affect the melting speed and produce better stability of product. The addition of pedada fruit jam was to improve aroma, taste and nutrition. This study aimed to determine the effect of proportion of sorbitol and sucrose with the concentration of pectin on the physicochemical and sensoric properties of pedada jam gelato. The experimental design used was completely randomized design with two factors. Factor I was the proportion of sorbitol and sucrose (13:2, 12:3, 11:4%) and factor II was the addition of pectin (0.3, 0.5, 0.7%). The analysis parametes were fat content, overrun, melting time, viscosity, total solids, total sugar, soluble fiber, reducing sugar and organoleptic scale scoring test (taste, color, aroma, texture). The best treatment was the proportion of sorbitol and sucrose 11:4% with pectin 0.5% which had fat content 1.77%, overrun 26.97%, melting time 18.07 minutes, total solids 43.19%, viscosity 1577 cP, total sugar 16.68%, soluble fiber 2.16% and reducing sugar 3.63%. The result of the organoleptic scale scoring test showed a taste of 4.32 (sweet), color 3.56 (moderate dark brown), texture 4 (soft), and aroma 3 (moderate pedada fruit aroma).
Pandangan Orang Tua dan Lingkungan Sekitar Terhadap Pendidikan di Kelurahan Bantan Kota Pematangsiantar
Authors: Pratama Janri Lendha , Maulina Intan 
Published: April 2022

Pendidikan sangat penting bagi kehidupan manusia. Pertama, pendidikan dapat menghasilkan insan yg terdidik, cerdas serta terampil. Kedua, pendidikan mempunyai peranan krusial pada kehidupan perseorangan, rakyat, bangsa dan negara. Maju mundurnya negara dipengaruhi pendidikan pada negara itu sendiri. Ketiga, manusia akan berkembang maju jika dapat menunjukkan potensinya. Taraf perkembangan tadi dilakukan melalui pendidikan yg diharapkan mencapai tingkat yang setinggi-tingginya, karena insan yang terdidik menjadi kunci perkembangan warga.
Metode penelitian ini merupakan penelitian analisis deskeriptif dengan jenis penelitian studi perkara. Adapun jenis penelitian naratif yg dipergunakan pada penelitian ini artinya jenis studi masalah sebab penelitian ini bermaksud buat meneliti realitas secara mendalam wacana pandangan orangtua serta lingkungan terhadap pendidikan.
Haisl dalam penelitian ini menunjukkan ada beberapa orang tua yg memiliki pemahaman yang rupawan ihwal pendidikan, dengan menyekolahkan anaknya ke jenjang yang lebih tinggi walaupun ekonomi mereka masih pas-pasan. Terdapat pula beberapa anak yg lebih memilih untuk bekerja tamat sekolah untuk membantu perekonomian keluarganya.
Pandangan orang tua terhadap pendidikan anak adalah sesuatu yang penting dan seharusnya tetap dilanjutkan ke jenjang yang lebih tinggi jika ekonomi keluarga mendukung. Sikap kepedulian yang dimiliki orang tua pada pendidikan anak cukup baik, hal ini terbukti adanya fasilitas pendidikan anak yang selalu diupayakan orang tua dan tanggapan/respon orang tua terhadap pendidikan anak yang pada umumnya baik, karena orang tuan selalu memberikan nasehat pada anaknya terkait betapa pentingnya pendidikan untuk masa depan juga dorongan secara moril