bluuebunny/crossref_metadata_2025_split huggingface dataset:
Demographics, clinical characteristics, and recurrence rate of patients with primary spontaneous pneumothorax at a tertiary care center in Qatar
Authors: Ahmad Khan Adeel , Zahid Muhammad , Ahmad Alhiyari Mousa , Ahmad Al-Andulmalek Abdulrahman , Ekpuk Jumbo Unwam , Naser Kloub Mohammad , Muslim Muhammad , Naeem Muhammad , Yousaf Zohaib , Mazhar Rashid , Sharif Muhammad 
Published: November 2022

Introduction: Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation, needle thoracentesis, pleural catheter, video-assisted thoracoscopy (VATS), and open surgery. We aimed to establish the demographic, clinical characteristics, and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation, Qatar.
Materials and methods: We conducted a retrospective analysis of patients >14 years old who were admitted with PSP from January 1, 2017 to December 31, 2019. The patients were followed up for 12 months for the recurrence of PSP.
Results: Out of 246 patients enrolled in this study, 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/m2. Of these, 123 (51.2%) patients were smokers. Chest pain was the most common presenting complaint (82.5%). A total of 59 (23.98%) patients had a small pneumothorax, whereas 187 (76.01%) patients had a large pneumothorax.
Among the patients with small pneumothorax, 16 (28.33%) were managed through observation alone, 2 (3.33%) required needle aspiration, 15 (25%) required pleural catheter insertion, and 26 (44.06%) underwent surgical intervention for management. Out of 187 patients with large pneumothorax, 16 (8.6%) were managed through observation, 7 (3.76%) required needle aspiration, 73 (38.1%) required pleural catheter insertion, and 91 (48.6%) underwent surgery.
During the 12-month follow-up, 58 patients were lost to follow-up and 5 patients (5/188; 2.66%) presented with a recurrence of PSP. Out of 108 patients who underwent VATS, 2 (1.85%) had a recurrence of PSP.
Conclusion: PSP is more common in males than in females, with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore, the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.
Médicos de la independencia
Authors: Cuellar Montoya Zoilo 
Published: November 2022

Fragmento
La Independencia de nuestra Patria, como tal, no se limita ni al grito de independencia del 20 de julio de 1810, ni a la gesta libertadora, ni a la gloriosa vitoria del Puente de Boyacá. Es en realidad un extenso período de tiempo que parte de la Revolución de Los Comuneros en el Nuevo Reino de Granada, que tuvo su iniciación en la población del Socorro, Santander, el día 16 del mes de marzo de 1781, cuando Manuela Beltrán rompió el edicto virreinal referente a las nuevas contribuciones al grito de “viva el Rey y muera el mal gobierno”. La Independencia pasa también por la publicación de los “Derechos del Hombre” por don Antonio Nariño y Álvarez del Casal a comienzos del año de 1794, quien fue inmensamente ilustrado en las ciencias médicas de la época -prácticamente un galeno-, lo que puso en aprietos al Doctor Juan Gualberto Gutiérrez, su médico tratante durante sus últimos 5 días de vida en la Villa de Leyva. Siguiendo con las enseñanzas del Sabio gaditano don José Celestino Mutis, médico, cirujano, botánico y Sacerdote, llegado en 1761 a la Ciudad de Santa Fe de Bogotá quien, paradójicamente, a pesar de ser totalmente fiel al Soberano español, sembró, con sus enseñanzas de matemáticas, de botánica, la llama de la libertad en las mentes brillantes de don Francisco José de Caldas y sus compañeros en el seno de la Expedición Botánica del Nuevo Reino de Granada. Es así como, de las enseñanzas de un gran médico gaditano, español hasta la médula de los huesos, surge la llama de la libertad en estas tierras.
Pengaruh Metode Pengeringan Daun Karika (Vasconcellea pubescens A.DC) Terhadap Kadar Total Flavonoid
Authors: Ningsih Riska Fitria , Prabandari Rani , Samodra Galih 
Published: November 2022

Pendahuluan: Tanaman karika ( Vasconcellea pubescens A.DC) merupakan salah satu tanaman yang tumbuh di kawasan dataran tinggi Dieng yang berada di Kabupaten Wonosobo. Tanaman ini satu genus dengan pepaya. Pada salah satu bagian tanaman karika yaitu pada daun memiliki kandungan senyawa flavonoid yang berfungsi sebagai penangkal radikal bebas. Ada beberapa faktor yang dapat mempengaruhi kadar total flavonoid salah satunya adalah metode pengeringan.
Tujuan: Penelitian ini dilakukan dengan tujuan untuk mengetahui pengaruh kadar total flavonoid daun karika dengan menggunakan metode pengeringan yang berbeda.
Metode: Pada penelitian ini metoda pengeringan yang digunakan yaitu sinar matahari langsung, diangin-anginkan dan oven pada suhu 45 ºC, kemudian hasil yang didapatkan dianalisis menggunakan SPPS uji ANOVA untuk melihat adanya pengaruh yang signifikan atau tidak pada metode pengeringan yang digunakan.
Hasil: Hasil penelitian bahwa kadar total flavonoid pada ekstrak daun karika dengan metode pengeringan sinar matahari langsung diangin-anginkan dan oven pada suhu 45 ºC secara bertutut-turut sebesar 5,91 mgQE/g ekstrak, 7,85±0,053 mgQE/g ekstrak dan 7,15 mgQE/g ekstrak. Dari hasil analisis data oneway ANOVA didapatkan nilai sig sebesar 0,00 (<0,05) artinya metode pengeringan sangat mempengaruhi kadar total flavonoid
Kesimpulan: berdasarkan latar belakang tersebut dapat disimpulkan bahwa kadar total flavonoid tertinggi didapatkan pada metode pengeringan diangin-anginkan
Peluang Pasar Digital Untuk Pemasaran Sapi Potong
Authors: Gemuh Rasa Astiti Ni Made Ayu 
Published: November 2022

Digital marketing merupakan sebuah program yang menawarkan tempat untuk promosi dan pencarian peluang pasar melalui media digital secara online. Digital marketing ini dapat memberikan kemudahan bagi pelaku usaha untuk mengidentifikasi segala kebutuhan dan keinginan konsumen, baik untuk usaha besar maupun usaha kecil dan menengah. Tujuan dari penelitian ini adalah untuk analisis apa saja peluang usaha pasar digital pemasaran sapi potong. Metode yang digunakan dalam penelitian ini adalah metode deskriptif kualitatif. Hasil analisis Strengths, Weaknesses, Opportunities dan Threats (SWOT), diperoleh rumusan strategi berikut: kebutuhan untuk pelaksanaan kombinasi dari empat aspek pemasaran (4P): produk, harga, tempat dan promosi). Implikasi manajerial dari aspek-aspek yang diteliti dapat dikelompokkan menjadi empat: (1) pemasaran, (2) pembiayaan, (3) produksi, dan (4) sumber daya manusia. Berdasarkan perhitungan matriks Quantitative Strategic Planning (QSP), strategi yang paling menarik untuk diterapkan adalah untuk memperluas jaringan pemasaran dengan menembus pasar dengan nilai tertinggi dari daya tarik
ISOLASI DAN IDENTIFIKASI CENDAWAN PADA ROTI YANG DIJUAL DI PASAR PORTAL RAWA BUAYA
Authors: Djasfar Seftiwan Pratami , Pradika Yuri 
Published: November 2022

Roti merupakan salah satu contoh pangan yang sering dikonsumsi oleh masyarakat. Mikroorganisme utama yang berperan penting dalam proses pembusukan roti adalah cendawan. Cendawan tersebut dapat menimbulkan keracunan bila dikonsumsi dan sangat berbahaya untuk tubuh. Penelitian ini bertujuan untuk mengisolasi dan mengidentifikasi adanya cendawan pada roti. Penelitian dilakukan dengan menggunakan metode deskriptif yaitu dengan isolasi cendawan pada media Potato Dextrose Agar (PDA) kemudian disimpan selama 5-7 hari di inkubator pada suhu 27°C, setelah itu di periksa di bawah mikroskop dengan penambahan larutan LPCB (Lactophenol Cotton Blue). Variabel penelitian adalah cendawan pada roti yang dijual di Pasar Portal Rawa Buaya. Populasi dalam penelitian ini adalah toko yang menjual roti dengan merek yang berbeda yang dijual di Pasar Portal Rawa Buaya. Teknik penelitian menggunakan metode tuang dan sampel diuji dengan penanaman pada media Potato Dextrose Agar (PDA) dan diamati menggunakan mikroskop perbesaran 40x. Hasil penelitian didapatkan dari 10 sampel roti, 2 sampel positif terkontaminasi cendawan Rhizopus sp., 1 sampel positif terkontaminasi cendawan Aspergillus sp., dan 1 sampel terkontaminasi Penicillium sp.
Kata Kunci: Roti, Cendawan, Potato Dextrose Agar (PDA)
The 536 Dust Veil Event and the long 6th century
Authors: Gjerpe Lars Erik 
Published: November 2022

When Bo Gräslund (2008) argued that two years without summer in the late 530s was the reality behind the Fimbulwinter myth, it became acceptable once again to blame the climate and weather for radical societal changes. In the years since the 2008 article, the Dust Veil Event seems to have caused every 6th century change, even though a few critics have raised their voices against these interpretations. Recently, several authors have highlighted datasets that do not work with monocausal interpretation, and this critique has gained support. This leads to the fundamental question: how – if at all – did the Dust Veil Event affect Scandinavian societies? And following this: what methodology can we use to explore such an intricate problem? As disasters are inherently social phenomena, climatic change results in disaster only if societal circumstances allow. I will argue that resilience theory stands out as a promising approach, as it inherently considers the impact of nature as well as human agency, making the characteristics of the society stricken by disaster is as important as the disaster itself. Moreover, as the dating of the archaeological inventory is not accurate enough to relate material change to a single calendar year (such as AD 536), investigators need a long-term view. It is also necessary to consider circumstances such as long-term societal change and the geopolitical situation in Europe, and its impact on Scandinavia.
Ear your heart: transcutaneous auricular vagus nerve stimulation on heart rate variability in healthy young participants
Authors: Forte Giuseppe , Favieri Francesca , Leemhuis Erik , De Martino Maria Luisa , Giannini Anna Maria , De Gennaro Luigi , Casagrande Maria , Pazzaglia Mariella 
Published: November 2022

Background
Transcutaneous auricular vagus nerve stimulation (taVNS) stimulating the auricular branch of the vagus nerve along a well-defined neuroanatomical pathway, has promising therapeutic efficacy. Potentially, taVNS can modulate autonomic responses. Specifically, taVNS can induce more consistent parasympathetic activation and may lead to increased heart rate variability (HRV). However, the effects of taVNS on HRV remain inconclusive. Here, we investigated changes in HRV due to brief alteration periods of parasympathetic-vagal cardiac activity produced by taVNS on the cymba as opposed to control administration via the helix.

Materials and Methods
We compared the effect of 10 min of active stimulation (i.e., cymba conchae) to sham stimulation (i.e., helix) on peripheral cardiovascular response, in 28 healthy young adults. HRV was estimated in the time domain and frequency domain during the overall stimulation.

Results
Although active-taVNS and sham-taVNS stimulation did not differ in subjective intensity ratings, the active stimulation of the cymba led to vagally mediated HRV increases in both the time and frequency domains. Differences were significant between active-taVNS and both sham-taVNS and resting conditions in the absence of stimulation for various HRV parameters, but not for the low-frequency index of HRV, where no differences were found between active-taVNS and sham-taVNS conditions.

Conclusion
This work supports the hypothesis that taVNS reliably induces a rapid increase in HRV parameters when auricular stimulation is used to recruit fibers in the cymba compared to stimulation at another site. The results suggest that HRV can be used as a physiological indicator of autonomic tone in taVNS for research and potential therapeutic applications, in line with the established effects of invasive VNS. Knowledge of the physiological effect of taVNS short sessions in modulating cardiovagal processing is essential for enhancing its clinical use.
Increased vitamin D intake may reduce psychological anxiety and the incidence of menstrual irregularities in female athletes
Authors: Miyamoto Mana , Hanatani Yuko , Shibuya Kenichi 
Published: November 2022

BackgroundVitamin D deficiency has been associated with major depression and premenstrual mood symptoms, and menstrual irregularity has been correlated with mental anxiety. However, the potential effect of increased vitamin D intake on reducing the risk of menstrual irregularities by decreasing psychological anxiety is yet to be fully elucidated. The existence of such a relationship in athletes with high levels of psychological anxiety and adequate dietary intake remains unknown. Therefore, this study aimed to examine the effects of vitamin D intake on psychological anxiety levels and the risk of menstrual irregularities in healthy college-and international-level female athletes.MethodsFemale intercollege-level track and field and international-level rowing athletes (n= 107) aged 15–24 years were included in this study. Their nutritional intake, body mass, body fat, mental anxiety, and menstrual irregularities were investigated. A generalized linear mixed model (GLMM) was used to examine the effects of several parameters on menstrual irregularities. The independent variables introduced into the GLMM were determined based on Akaike’s information criterion.ResultsThe GLMM identified a significant interaction effect of vitamin D intake and state anxiety on menstrual irregularities, with ap-value of 0.049 and an odds ratio of 0.423. The study results suggest that increased vitamin D intake in relatively young endurance athletes may reduce mental anxiety, consequently decreasing menstrual irregularities.
Gender Differences in Emergency Medicine Attending Physician Comments to Residents: A Qualitative Analysis
Authors: Mamtani Mira , Shofer Frances , Scott Kevin , Kaminstein Dana , Eriksen Whitney , Takacs Michael , Hall Andrew K. , Weiss Anna , Walter Lauren A. , Gallahue Fiona , Yarris Lainie , Abbuhl Stephanie B. , Aysola Jaya 
Published: November 2022

ImportancePrior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents.ObjectiveTo explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents.Design, Setting, and ParticipantsThis multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021.Main Outcomes and MeasuresDifferences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident.ResultsIn this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P &amp;lt; .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills.Conclusions and RelevanceIn this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.
Association of Youth Suicides and County-Level Mental Health Professional Shortage Areas in the US
Authors: Hoffmann Jennifer A. , Attridge Megan M. , Carroll Michael S. , Simon Norma-Jean E. , Beck Andrew F. , Alpern Elizabeth R. 
Published: November 2022

ImportanceSuicide is the second leading cause of death among US adolescents. Workforce shortages of mental health professionals in the US are widespread, but the association between mental health workforce shortages and youth suicides is not well understood.ObjectiveTo assess the association between youth suicide rates and mental health professional workforce shortages at the county level, adjusting for county demographic and socioeconomic characteristics.Design, Setting, and ParticipantsThis retrospective cross-sectional study included all US counties and used data of all US youlth suicides from January 2015, through December 31, 2016. Data were analyzed from July 1, 2021, through December 20, 2021.ExposuresCounty health-professional shortage area designation for mental health, assigned by the US Health Resources and Services Administration based on mental health professionals relative to the population, level of need for mental health services, and service availability in contiguous areas. Designated shortage areas receive a score from 0 to 25, with higher scores indicating greater workforce shortages.Main Outcomes and MeasuresSuicides by youth aged 5 to 19 years from 2015 to 2016 were identified from the US Centers for Disease Control and Prevention’s Compressed Mortality File. A multivariable negative binomial regression model was used to analyze the association between youth suicide rates and mental health workforce shortage designation, adjusting for the presence of a children’s mental health hospital and county-level markers of health insurance coverage, education, unemployment, income, poverty, urbanicity, racial and ethnic composition, and year. Similar models were performed for the subgroups of (1) firearm suicides and (2) counties assigned a numeric shortage score.ResultsDuring the study period, there were 5034 youth suicides (72.8% male and 68.2% non-Hispanic White) with an annual suicide rate of 3.99 per 100 000 youths. Of 3133 US counties, 2117 (67.6%) were designated as mental health workforce shortage areas. After adjusting for county characteristics, mental health workforce shortage designation was associated with an increased youth suicide rate (adjusted incidence rate ratio [aIRR], 1.16; 95% CI, 1.07-1.26) and an increased youth firearm suicide rate (aIRR, 1.27; 95% CI, 1.13-1.42). For counties with an assigned numeric workforce shortage score, the adjusted youth suicide rate increased 4% for every 1-point increase in the score (aIRR, 1.04; 95% CI, 1.02-1.06).Conclusions and RelevanceIn this cross-sectional study, US county mental health professional workforce shortages were associated with increased youth suicide rates. These findings may inform suicide prevention efforts.
Effect of a Virtual Reality Environment Using a Domed Ceiling Screen on Procedural Pain During Intravenous Placement in Young Children
Authors: Lee Ha Ni , Park Joong Wan , Hwang Soyun , Jung Jae Yun , Kim Do Kyun , Kwak Young Ho , Lee Eui Jun 
Published: November 2022

ImportanceDistraction using virtual reality (VR) has been found to provide a clinically significant reduction in the experience of pain during various painful procedures. Commercially available VR systems usually require the user to wear a head-mounted display helmet, which can be challenging for young children, and whether VR can reduce pain during intravenous (IV) placement in young children is currently unknown.ObjectiveTo determine whether a VR environment using a novel domed ceiling screen reduces distress among children over the course of IV placement compared with standard care in a pediatric emergency department.Design, Setting, and ParticipantsThis randomized clinical trial was conducted from June 3, 2020, to February 8, 2021, at an urban tertiary academic children’s hospital. Included were children aged 6 months to 4 years undergoing IV placement in the pediatric emergency department.InterventionChildren in the intervention group lay on a bed to experience a VR animation using a domed ceiling screen during the IV placement procedure, which was performed as usual. Children in the control group also lay on a bed during the procedure but did not view a VR animation.Main Outcomes and MeasuresThe primary outcome was pain scores measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 4 time points during IV placement: immediately after the child lay down on the bed (T1), the moment the tourniquet was applied (T2), the moment a sterile alcohol swab was applied (T3), and the moment the needle penetrated the skin (T4).ResultsOf the 88 children included in the final analysis, 44 received VR distraction (median [IQR] age, 24.0 [14.5-44.0] months; 27 boys [61.4%]), and 44 received standard care (median [IQR] age, 23.0 [15.0-40.0] months; 26 boys [59.1%]). The median [IQR] FLACC scores at T4 were 6.0 (1.8-7.5) in the intervention group and 7.0 (5.5-7.8) in the control group. The ordinal logistic regression model showed that children in the VR intervention group vs the control group had a lower probability of higher FLACC scores (odds ratio, 0.53; 95% CI, 0.28-0.99; P = .046).Conclusions and RelevanceThe findings of this trial indicate that displaying VR using a domed ceiling screen may be an effective distraction method that reduces distress in young children undergoing IV placement.Trial Registrationisrctn.org Identifier: KCT0005122
Development and Validation of an Emergency Department Electronic Medical Record Gout Flare Alert
Authors: Jackson Lesley E. , Annapureddy Narender , Hansen Megan E. , Saag Kenneth G. , Booth James , Rosas Giovanna , Foster Phillip J. , Mudano Amy , Sun Dongmei , Osborne John D. , Bongartz Tim , Hess Erik , Lawrence Colleen , Dunkel Leah , Danila Maria I. 
Published: November 2022

ObjectivePatients with acute gout are frequently treated in the emergency department (ED) and represent a typically underresourced and understudied population. A key limitation for gout research in the ED is the timely ability to identify acute gout patients. Our goal was to refine a multicriteria, electronic medical record alert for gout flares and to determine its diagnostic characteristics in the ED.MethodsThe gout flare alert used electronic medical record data from ED nursing notes and was triggered by the term ‘gout’ preceding past medical history in the chief complaint, the term ‘gout’ and a musculoskeletal problem in the chief complaint, or the term ‘gout’ in the problem list and a musculoskeletal chief complaint. We validated its diagnostic properties to assess presence/absence of gout through manual medical record review using adjudicated expert consensus as the gold standard.ResultsIn January 2020, we analyzed 202 patient records from 2 university‐based EDs; from these records, 57 patients were identified by our gout flare alert, and 145 were identified by other means as potentially having an acute gout flare. The gout flare alert's positive predictive value was 47% (95% confidence interval [95% CI] 34–60%), negative predictive value was 94% (95% CI 90–98%), sensitivity was 75% (95% CI 61–89%), and specificity was 82% (95% CI 76–88%). The diagnostic properties were similar at both institutions.ConclusionOur multicomponent gout flare alert had reasonable sensitivity and specificity, albeit a modest positive predictive value. An electronic gout flare alert may help enable the conduct of gout research in the ED setting.