bluuebunny/crossref_metadata_2025 huggingface dataset:
Una inspección sin resultados. La visita judicial y hacendística del Perú (1664-1696)
Authors: Jiménez Jiménez Ismael
Published: November 2020

A lo largo del último tercio del siglo XVII, la situación política y fiscal del distrito de la Audiencia de Lima hizo necesaria que el Consejo de Indias ordenase la puesta en marcha de un proceso de visita. Las autoridades metropolitanas acordaron la división de esta tarea en dos partes, una judicial y otra hacendística, pero los resultados positivos no se produjeron en ningún momento, ni tan siquiera en sus inicios. Así, ante la falta de conclusiones, el proceso se fue alargando, pasando de manos de unos visitadores a otros con idénticos rendimientos, sin que se produjesen modificaciones procesales para su mejora. De esta manera, cuando se dio por concluida la visita, el estado en que se encontraban las instituciones sujetas a la auditoría apenas se diferenciaba del detectado al inicio de la inspección.
El último fin y el quehacer teológico de acuerdo con santo Tomás: entre el intelectualismo y el voluntarismo
Authors: Yangali Núñez Oscar Edmundo
Published: November 2020

En este trabajo, desarrollo la importancia de la reflexión de Tomás de Aquino acerca de la relación entre el entendimiento y la voluntad con respecto al quehacer teológico. Examino primero el llamado intelectualismo de santo Tomás. Luego, procedo a discutir y resolver en qué consiste la concepción tomista de esencia. Y, finalmente, presento el aporte que representa el amor de caridad en el quehacer teológico. Concluyo que el pensamiento y la actualidad de santo Tomás para la teología reside en una unidad esencial, una base metafísica y antropológica, que establece una relación entre la comprensión de la doctrina y la vivencia del evangelio fundamentada en el amor de caridad.
Fuente de la cadena de suministro de café orgánico. Integración de Procesos: Un caso peruano
Authors:   ,   Universidad Peruana de Ciencias Aplicadas (UPC), Ruiz Alvarado Sara Yesenia , Matos Quintana Daniel Germán
Published: November 2020

Se realizó un proceso de diagnóstico en las organizaciones certificadas pertenecientes al mercado, a través de resultados obtenidos de encuestas y entrevistas que se aplicaron en el espacio muestral. Este diagnóstico indicó que no tienen un flujo correcto de información y materiales, y evidenció el bajo nivel de interacciones entre los miembros, todo esto relacionado con el SC. El objetivo final de esta investigación es mejorar la competitividad de las organizaciones a través del aumento en el desempeño del SC, para lo cual se propone un modelo de Integración adecuado a la realidad.
Arquitectura Tecnológica de un Chatbot para la Gestión de la Información en una entidad superior
Authors:   ,   Universidad Peruana de Ciencias Aplicadas (UPC), Ramirez Alamo Yelithza Janerth , Carrizales Mamani Jhon Rodrigo
Published: November 2020

La gestión de información de la calidad en las universidades del Perú es uno de los factores más importantes para el desarrollo académico; sin embargo, no todas las entidades de educación superior cumplen con los estándares de calidad y políticas. Además, el acceso a toda la información de la calidad es muy difícil de administrar, si la universidad cuenta con un sistema muy limitado, sin mantenimiento y actualizaciones. La Universidad Peruana de Ciencias Aplicadas posee el Sistema Integrado de la Calidad de UPC, en adelante SICA, en el cual se publican los diferentes documentos oficiales de la universidad, tales como reglamentos, políticas, manuales, rúbricas, entre otros. Sin embargo, el proceso de búsqueda del portal web es muy limitado y engorroso, lo que conlleva a experimentar dificultades en la búsqueda de información por parte de los usuarios. En este proyecto se propone un sistema cognitivo para mejorar la experiencia del usuario en la búsqueda de información académica con un chatbot. La diferencia entre los sistemas de búsqueda tradicionales y el sistema cognitivo propuesto es mejorar la experiencia del usuario (UX) a través de factores de optimización como el tiempo de respuesta, la facilidad de uso, la interfaz amigable y la interacción del usuario a través de los servicios cognitivos de computación en la nube. Esto puede ir más allá de la interacción entre un chatbot y un humano, ya que la experiencia del usuario es muy importante y puede definir el éxito o el fracaso de un sistema.
Estudio cuantitativo de los hábitos de consumo de series y películas de los Millennials en Lima Moderna
Authors:   ,   Universidad Peruana de Ciencias Aplicadas (UPC), Gil Rubio José , Rivera Núñez Flavia Ornella Rosa
Published: November 2020

En la actualidad, la globalización y los avances de la tecnología han permitido obtener un mayor alcance de contenido multimedia. Los consumidores ahora tienen a su disposición diversos servicios de streaming donde pueden ver lo que ellos quieren, en cualquier momento y lugar a un precio módico. Por ello, ya no dependen solo de la señal abierta, tv paga o compra de contenido en DVD o Blu-ray para acceder a series o películas. Por ello, la presente investigación busca determinar si el streaming es un factor determinante y si ha originado una variación en la forma de acceder a series y películas de los millennials en Lima Moderna. Para la elaboración del presente estudio, se recabó información relacionada al streaming y las diversas formas de acceder a contenido multimedia. Asimismo, se realizó un análisis cuantitativo mediante la aplicación de encuestas a millennials de Lima Moderna que acceden a series y/o películas mediante streaming con la finalidad de conocer frecuencias de consumo y diversos factores que se consideran al momento de acceder a material multimedia. Se realizaron procedimientos estadísticos para analizar los resultados obtenidos. Por último, se concluyó que, si bien el streaming ha sido un factor determinante para los cambios de formas de ver series y/o películas, los millennials siguen considerando las formas tradicionales de acceso a contenido multimedia. Aunque, en menor proporción que años anteriores. No obstante, el consumo de piratería se redujo considerablemente.
Impacto de la gestión del tiempo en el desempeño de las funciones del personal del área de operaciones de las líneas navieras que actúan en el puerto de apm terminals en el año 2019
Authors:   ,   Universidad Peruana de Ciencias Aplicadas (UPC), Bazalar Rojas Ricardo Andrés , Sedano Flórez Eduardo Enrique
Published: November 2020

El presente informe está dividido en 6 capítulos. El contenido del primer capítulo se centra en explicar conceptos teóricos claves, como el comercio internacional, logística, transporte marítimo y también las características del área de operaciones de una línea naviera: su estructura, funciones y los principales agentes dentro de su cadena de procesos. Por motivos de la investigación se tomaron como referencia cuatro líneas que operan actualmente en APM Terminals: ONE, MSC, HLC & HMM. Además, se tratará el tema de gestión del tiempo, detallando también técnicas y modelos (como la Matriz de Eisenhower) propuestos por expertos en los temas de eficiencia y productividad. En el segundo capítulo presentamos el objetivo principal y específicos que serán la base de nuestra investigación. Dentro de los objetivos secundarios buscamos identificar posibles causas de pérdida de tiempo que puedan afectar al área, en particular cuando se ejecuta su tarea más importante: el proceso de llenado del CAL (Lista de Embarque de Contenedores). En el tercer capítulo se explicará la metodología usada, detallando el tipo de estudio, técnica de muestreo y los métodos de recopilación de datos. En este caso, se optó por un estudio mixto. Finalmente, en el capítulo cuarto, quinto y sexto se presentan los formatos de las herramientas de investigación, los resultados obtenidos, y las conclusiones y recomendaciones, respectivamente. Se tiene la expectativa que los hallazgos obtenidos puedan servir de base para otras investigaciones, o incluso ayudar a las líneas navieras a identificar posibles deficiencias en sus políticas de manejos de tiempo para aumentar así su productividad.
FARKLI YAYINEVLERİNE AİT ORTAOKUL TÜRKÇE DERS KİTAPLARINDAKİ METİNLERİN KALIPLAŞMIŞ SÖZ VARLIĞI AÇISINDAN İNCELENMESİ
Authors: BULUT Kenan , TAÇYILDIZ Enver
Published: November 2020

Bu çalışmanın amacı, farklı yayınevlerine ait ortaokul Türkçe ders kitaplarında yer alan metinleri kalıplaşmış söz varlığı açısından incelemektir. Bu amaç çerçevesinde, 2018-2019 Eğitim ve Öğretim Yılı’ndan itibaren, 6 ve 7. sınıflarda okutulan, Türkçe ders kitaplarındaki 96 okuma metninde bulunan kalıplaşmış söz varlığı tespit edilmiş ve kitaplar bu yönüyle karşılaştırılmıştır. Kalıplaşmış söz varlığı unsurları olarak deyimler, atasözleri, ikilemeler ve kalıplaşmış sözler ele alınmıştır. Çalışma nitel araştırma yöntemlerinden ‘temel nitel araştırma’ desenine göre yürütülmüştür. Araştırmanın çalışma materyalini, 6 ve 7. sınıflarda okutulan, farklı yayınevlerine ait dört Türkçe ders kitabı oluşturmaktadır. Çalışmada veriler doküman incelemesine göre toplanmıştır. Elde edilen veriler betimsel analizle çözümlenmiş, tablolarla gösterilmiş ve yorumlanmıştır. Çalışmanın sonunda iki sınıf düzeyinde de özel yayınevlerine ait kitaplarda en fazla söz varlığının hikâye edici metinlerde, MEB Yayınları’na ait kitaplarda ise en fazla söz varlığının bilgilendirici metinlerde olduğu; 6. sınıf düzeyinde EKOYAY Yayıncılık’a ait kitabın, 7. sınıf düzeyinde ise MEB Yayınları’na ait kitabın söz varlığı konusunda daha zengin olduğu; dört ders kitabındaki metinlerde en çok deyimlerin, en az ise atasözlerinin olduğu görülmüştür. Çalışmanın sonunda çeşitli önerilere yer verilmiştir.
The Effect of Financial Compensation and Motivation on Performance with Gender Equality as The Moderating Variable in The Regional Secretariat of East Java Province: The Study of Non-Permanent Employees with Work Agreements
Authors: Rachma* Arum Dwi
Published: November 2020

The Role of Non-Permanent Employees with Work Agreements was very important to support the achievement of the vision and mission of an organization. Performance evaluation of Non- Permanent Employees with Work Agreements assessed by the direct supervisor consisted of several aspects, namely integrity, discipline. service orientation, cooperation, and coordination and the performance results of some employees were still relatively low. The low performance could be caused by several factors one of which was financial compensation and motivation owned by employees. Besides, to improved employee performance, gender equality in an organization also needs to be considered. This was because, in the absence of gender differences in an organization, it was easier to achieve high levels of performance. The purpose of this study was to identifying and analyzing the effect of financial compensation and motivation on the performance of Non-Permanent Employees with Work Agreements with gender equality as a moderating variable in the Regional Secretariat of East Java Province. This research used a quantitative approach combined with an explanatory method design. The results of this study concluded that: 1.) Financial compensation had a positive and significant effect on performance;2.) Motivation had a positive and significant effect on performance; 3.) Gender equality had a positive and significant effect on performance; 4.) Financial compensation and motivation had a positive and significant effect on the performance of Non-Permanent Employees with Work Agreements  with gender as  a moderating variable in the Regional Secretariat of East Java Province.
EDUKASI MANAJEMEN DIRI DALAM MENINGKATKAN EFIKASI DIRI, MENGENDALIKAN KADAR GULA DARAH DAN MENINGKATKAN KUALITAS HIDUP PADA PASIEN DIABETES MELLITUS
Authors: Gultom Agustina Boru , Indrawati Indrawati
Published: November 2020

Pendahuluan: Kecamatan Pancur Batu merupakan salah satu kecamatan di Kabupaten Deli Serdang yang memiliki kasus diabetes mellitus yang cukup banyak dan merupakan 10 penyakit terbanyak diwilayah kerjanya dimana 2  desa yang cukup tinggi kasus tersebut adalah desa tuntungan 1 dan desa tuntungan 2.  Kasus diabetes melitus erat kaitannya dengan kemampuan pasien dalam memanajemen dirinya dalam menghadapi penyakit yang berdampak pada  efikasi diri, pengelolaan gula darah dan kualitas hidup,Metode: Pemberian edukasi manajemen diri melalui ceramah dan tanya jawab mengenai manajemen diri diabetes mellitus, demonstrasi dan redemonstrasi mengenai senam kaki, pengukuran efikasi diri, pemeriksaan kadar gula darah dan pengkuran kualitas hidup.Hasil: Edukasi manajemen diri diabetes mellitus meningkatkan skor efikasi diri sebesar 6,23, dan menurunkan skor kadar gula darah sebesar 3,53 serta meningkatkan skor kualitas hidup sebesar 10,17.Kesimpulan: Edukasi manajemen diri diabetes mellitus dapat meningkatkan skor efikasi diri, dapat mengendalikan kadar gula darah dan dapat meningkatkan skor kualitas hidup
Komercijalni FM radio u kontekstu hrvatske medijske politike
Authors: Mučalo Marina
Published: November 2020

Komercijalni privatni radiji dominiraju hrvatskim radijskim krajolikom. Razvijali su se od sredine 90-ih godina, od čega se posljednjih 15 godina sustavno financiraju javnim sredstvima iz Fonda za poticanje pluralizma i raznovrsnosti elektroničkih medija. Rad problematizira hrvatsku medijsku politiku koja je proteklih godina u cijelosti zanemarila razvoj neprofitne i javne radiodifuzije, prepuštajući medijski razvoj zemlje tržišnim instrumentima i komercijalnim sadržajima. Recentna istraživanja pokazuju da se ta vrsta radijskih programa doživljava kao jednolična glazbena kulisa koja gubi povjerenje slušatelja. Rad otvara pitanje daljnjeg razvoja hrvatskoga medijskog sustava pri čemu istaknutu ulogu imaju institucije koje su odgovorne za njegovo oblikovanje.
Machiavelli
Authors: Žagar Davorin
Published: November 2020

Autor u članku ukazuje na suvremenu relevantnost Machiavellijeva nauka sadržanog u Vladaru i Raspravama. U dijalogu s Lefortom i njegovim epohalnim tumačenjem Firentinca (1972) članak nudi alternativno, subverzivno čitanje Machiavellijeve teorije političkog konflikta i pritom, u kritičkom odnosu spram Honnetha (1995), osvjetljuje elemente specifične, makijavelijevske teorije priznanja. Autor tvrdi da je fundamentalno demokratski karakter Machiavellijeva projekta izravno povezan sa sposobnošću plebsa da prepozna svoju novu funkciju u društvenom polju i da na sebe odvažno preuzme queer “identitet”. To je moguće samo uz pomoć i potporu vladara. Plebs u tekstu označava dinamičku koaliciju na različite načine potlačenih skupina. Uz pomoć političke instance pučani trebaju preobraziti svoju težnju da ne budu tlačeni od velikaša u pozitivno usmjerenu težnju da bivstvuju na način koji čuva razliku u odnosu na težnju velikaša za posjedovanjem. Otkrivajući sebstvo kao mjesto nesvodive drugosti, pučani neprestano izumljuju nove načine postojanja u razlici spram “režimā normalnosti” i na taj način postaju nepresušni izvor društvene inovacije koja stoji na dispoziciji čitavom društvu. Poqueeravanje plebsa omogućuje viši stupanj zajedničkog bivstvovanja. Snaga demokratskog društva izravno ovisi o vitalitetu težnje pučana i njihovoj sposobnosti da neprestano osmišljavaju i proizvode nove načine života.
Dundee Discoveries Past and Present
Authors:   University of Dundee, Jarron Matthew , Cameron Amy R. ,   University of Dundee, Gemmill James
Published: November 2020

A series of self-guided walking tours through pioneering scientific research in medicine, biology, forensics, nursing and dentistry from the past to the present. Dundee is now celebrated internationally for its pioneering work in medical sciences, in particular the University of Dundee’s ground-breaking research into cancer, diabetes, drug development and surgical techniques. But the city has many more amazing stories of innovation and discovery in medicine and biology, past and present, and the three walking tours presented here will introduce you to some of the most extraordinary. Basic information about each topic is presented on this map, but you will ­find more in-depth information, images and videos on the accompanying website at uod.ac.uk/DundeeDiscoveriesMap For younger explorers, we have also included a Scavenger Hunt – look out for the cancer cell symbols on the map and see if you can ­find the various features listed along the way!
Export Diversification and Financial Openness
Authors: Gnangnon Sena Kimm
Published: November 2020

This paper investigates empirically the effect of export diversification (i.e., both export product diversification and services export diversification) on financial openness, using a sample of 119 countries (including both developed and developing countries) over the period 1985-2014. Based on the Blundell and Bond's two-step system Generalized Methods of Moments, the analysis has revealed that both export product diversification and services export diversification influence positively financial openness. However, this outcome hides differentiated effects across countries in the full sample. Specially, countries with a very high real per capita income experience a positive effect of export concentration on financial openness, while for countries with a relatively lower per capita income, it is rather export diversification that drives positively financial openness. Interestingly, the effect of export diversification on financial openness depends on the size of external shocks that affect domestic economies, as well as countries' economic growth performance. Overall, these findings add to the empirical literature on the effect of international trade on financial openness by showing that both export product diversification and services export diversification matter for financial openness.
Environmental Impact of Subsidy Concepts to Stimulate Car Sales in Germany
Authors: Scharf Malte , Heide Ludger , Grahle Alexander , Syré Anne , Göhlich Dietmar
Published: November 2020

This paper establishes a prognosis of the long term environmental impact of various car subsidy concepts. The CO2 emissions of the German car fleet impacted by the purchase subsidies are determined. A balance model of the CO2 emissions of the whole car life cycle is developed. Consideration of production-, use- and End-of-Life processes are taken into account. The implementation of different subsidy scenarios directly affects the forecasted composition of the vehicle population and therefore the resulting life cycle assessment. All scenarios compensate the additional emissions required by the production pull-in within the considered period and hence reduce the accumulated CO2 emissions until 2030. The exclusive funding of BEVs is most effective with a break-even in 2025.
The Resumption of Sports Medicine During the COVID-19 Post-Epidemic Period
Authors: Jin Shengyang , He Yu , Yang Kai , Gan Qin , Huang Wei , Wang Xiaohong , Meng Chunqing , Wang Hong
Published: November 2020

Coronavirus disease 2019 (COVID-19) is spreading worldwide, with its outlook not looking optimistic. Simultaneously, the epidemic is currently under control in many areas. The resumption of work and production in areas that have achieved control of outbreaks is a problem. Considering the extremely transmissible nature of COVID-19, and the presence of asymptomatic infected people, avoiding nosocomial infection and protecting medical staff and patients during the post-epidemic period remain difficult problems that need to be solved. At present, few articles have examined relevant experiences in the field of sports medicine. Wuhan, the People’s Republic of China, was the original epicenter of COVID-19, with physicians as the initial frontline workers. Wuhan is now gradually returning to a more normal state after a series of urgent, strict, and effective measures were utilized to combat the epidemic. During this time, we collected first-hand experiences of sports medicine work resumption in the initial 2-month period, including preparations before resuming work, outpatient management methods, online outpatient services, inpatient ward management, principles for determination of the examination results, and preparations for operations. The strict and feasible management strategies that we conducted were useful in avoiding hospital-based infections. We intend to share our own experiences and thoughts in this area. We hope that this will be helpful and inspiring to our sports medicine colleagues around the world.
Digital Automated Mobile Pipeline Construction
Authors: Stevenson Andrew , Bobat Mehboob , Everard Doug
Published: November 2020

The paper describes a holistic approach to automating onshore pipeline construction that includes mobile automated on-site pipe manufacture, digitised quality control of key pipe fabrication parameters and the embedding of optical fibre in the pipe wall for lifetime performance integrity monitoring.

Current processes are very labour intensive, have a high carbon footprint, are fraught with health and safety hazards and are slow.

The new method (MASIP) builds on the recent availability of high strength steel strip with good ductility to develop an on-site pipe manufacturing process that has proven amenable to automation and digitised quality control procedures. A series of machine modules apply the layers of the pipe, including optical fibre, on site and lower it directly into a trench. Sensors embedded into the process enable 100% quality control records to be produced. Design analysis has been developed using 3D local and 2D global finite element analysis which interface with industry standards and methods. The first full scale machine has produced sections of 12inch diameter pipe which have been physically tested using liquid and gas tests (including hydrogen and methane) with pressures up to 120bar. FEA calculations were in close agreement with strain gauge and burst data from physical tests. Fibre optic trials have shown that the 360degree spiral winding of the fibre provides an intimate data stream which gives a high-resolution picture of stress changes in the pipe wall. It was concluded that these can be used in a new approach to lifetime digital monitoring of a pipeline to prevent leakage and allow pro-active inspection and early repair. In this way the effect of pressure cycling, ground movement and corrosion can be picked up sensitively before they become problematic. The mobile pipe machine has made pipe at a field trial site in the UK. Durability pressure cycling trials have included water, methane gas and 100% hydrogen gas. There is a drive in the UK to install a hydrogen-based energy network.

The novel features of this automated approach to construction are that (a) the construction process can be much faster (b) the labour requirements are reduced by an order of magnitude (c) the costs can be halved (d) real-time lifetime integrity monitoring systems can be included at the construction phase and ( e) the carbon footprint is very considerably reduced.
Use of online knowledge base in primary health care and correlation to health care quality: An observational study
Authors: Gerdeskold Christian , Toth-Pal Eva , Wårdh Inger , Nilsson Gunnar H. , Nager Anna
Published: November 2020

BackgroundEvidence-based information available at the point of care improves patient care outcomes. Online knowledge bases can increase the application of evidence-based medicine and influence patient outcome data which may be captured in quality registries. The aim of this study was to explore the effect of use of an online knowledge base on patient experiences and health care quality.MethodsThe study was conducted as a retrospective, observational study of 24 primary health care centers in Sweden exploring their use of an online knowledge base. Frequency of use was compared to patient outcomes in two national quality registries. A socio-economic Care Need Index was applied to assess whether the burden of care influenced the results from those quality registries. Non-parametric statistical methods and linear regression were used.ResultsFrequency of knowledge base use showed two groups: frequent and non-frequent users, with a significant use difference between the groups (p<.001). Outcome data showed significant higher values for all seven National Primary Care Patient Survey dimensions in the frequent compared to the non-frequent knowledge base users (p<.001), whereas 10 out of 11 parameters in the National Diabetes Register showed no differences between the groups (p>.05). Adjusting for Care Need Index had almost no effect on the outcomes for the groups.ConclusionsFrequent users of a national online knowledge base received higher ratings on patient experiences, but figures on health care quality in diabetes showed near to no correlation. The findings indicate that some effects may be attributed to the use of knowledge bases and requires a controlled evaluation.
TAVR and Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis in Over 30 Million Patients
Authors: Monlezun Dominique , Hostetter Logan , Balan Prakash , Palaskas Nicolas , Lopez-Mattei Juan , Cilingiroglu Mehmet , Iakobishvili Zaza , Ewer Michael , Marmagkiolis Konstantinos , Iliescu Cezar
Published: November 2020

Introduction: Cardiovascular disease (CVD) and cancer are the top mortality causes globally, yet little is known about how the diagnosis of cancer affects treatment options in patients with hemodynamically compromising aortic stenosis (AS). Patients with cancer often are excluded from aortic valve replacement (AVR) trials including both trials with transcatheter AVR (TAVR) and surgical AVR (SAVR). This study looks at how cancer may influence treatment options, and assess the outcome of cancer patients who undergo surgical or TAVR intervention. Additionally, we sought to quantitate and compare both clinical and cost outcomes for cancer and non-cancer patients. Methods: This population-based case-control study uses the most recent year available National Inpatient Sample (NIS (2016) from the United States Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). Machine learning augmented propensity score adjusted multivariable regression was conducted based on the likelihood of undergoing TAVR versus MM and TAVR versus SAVR with model optimization supported by backward propagation neural network machine learning.Results: Of the 30,195,722 total hospital admissions, 39,254 (0.13%) TAVRs were performed, with significantly fewer performed in cancer versus non-cancer patients even in those of comparable age and mortality risk (23.82% versus 76.18%, p<0.001) despite having similar mortality. Multivariable regression in cancer patients demonstrated that mortality was similar for TAVR, MM, and SAVR, though LOS and cost was significantly lower for TAVR versus MM and comparable for TAVR versus SAVR. Patients with prostate cancer constituted the largest primary malignancy among TAVR patients including those with metastatic disease. There were no significant race or geographic disparities for TAVR mortality.Discussion: Comparison of aortic valve intervention in cancer patients with those without co-existing malignancy suggests that intervention is underutilized in the cancer population. This study suggests that as cancer patients including those with metastasis have similar clinical outcomes, patients who are symptomatic and those with higher risk aortic valve lesions should be offered the benefit of intervention. Modern techniques have reduced intervention-related adverse events, provided improved quality of life, and appear to be cost effective; these advantages should not be denied to patients on the basis of co-existing malignancy.
Co-Designing Genomics Research With A Large Group of Donor-Conceived Siblings
Authors: Nunn Jack , Crawshaw Marilyn , Lacaze Paul
Published: November 2020

Background: Human genomics research is growing rapidly. More effective methods are required for co-design and involving people, especially those from vulnerable sub-populations of inherently high interest to medical research. This case study documents how we worked with a large group of donor-conceived siblings who share the same sperm donor father, to explore how they might want to engage with and influence any future genomic research. Method: A participatory action research process was used to explore the views of a group of 18 known donor-conceived siblings; who are part of a larger group of up to 1000 people who share the same biological father. The discussion explored views about how the group would like to be involved in future research. Five members participated in co-design; 12 completed a pre-discussion online survey; and six participated in an online discussion forum and evaluation survey. The online discussion was led by one facilitator, supported by the study team. Results: Co-design informed the research process. Participants reported enjoying the overall experience of the surveys and discussion forum, which were perceived as inclusive and flexible. Most participants’ views regarding the value of involvement in research changed during the process, and ‘widened’ about who should be involved. Participants were supportive of future research being done with the siblings group. All who completed the final survey requested to remain part of the co-design process. Other themes in the online discussion included concerns about conflicting interests and a desire for research participation to improve the situation for people affected by assisted conception. The process informed later discussions in the sibling group about participating in a self-managed biobank and informed decision making about participating in genomics research. Conclusion: Findings from this study help inform how people from certain sub-populations should be involved in planning and defining their participation in genomic research; particularly those from more vulnerable or high-interest populations. This process provides a replicable and practical method of involving potential participants in co-designing genomics research using online discussions, with reported positive outcomes. Reporting this study using ‘Standardised data on initiatives (STARDIT)’ to report the process allows comparison with other studies.
The COVID-19 Pandemic Impact on Pediatric Surgery Residency Programs
Authors: Gunadi  , Balela Naisya , Kalim Alvin Santoso , Widitjiarso William , Fahri Fadil , Tedja Audric Kenny , Purnomo Eko , Dwihantoro Andi , Agustriani Nunik , Makhmudi Akhmad
Published: November 2020

Objective: The COVID-19 pandemic has had an impact not only on clinical practices but also on residency programs as an important part of hospital medical services. We investigated the impact of the COVID-19 pandemic on the pediatric surgery residency program in our institution. Results: A questionnaire was developed, consisting of 24 questions: a) the perspectives of residents about COVID-19 infection during their residency program; b) the learning process; c) academic evaluations; and d) residents' suggestions to improve the quality of their residency program during the outbreak. Most (85.7%) pediatric surgery residents agreed that elective surgeries should be postponed during the pandemic. Before the outbreak, almost all (90.5%) residents used textbooks and journals as their primary sources of learning, while during the outbreak, 71.4% of residents shifted to use online lectures either from the school or Association of Pediatric Surgeons. Interestingly, 95.2% of participants agreed that they had more time to complete their academic assignments during the pandemic. In conclusions, the pandemic has had a significant impact on the development of pediatric surgery residency programs. A comprehensive approach is needed to maintain the high standard of competence of pediatric surgery without compromising our safety from the COVID-19 infection risk.
The Changing Health Convergence for Life Expectancy and Spatial Interactions
Authors: Rodríguez Irene González , Sáez Marta Pascual , Prieto David Cantarero
Published: November 2020

BackgroundHealth convergence between the European Union countries and Spanish provinces is studied considering the spatial interactions among several territories. Health status measured through life expectancy in four ways: life expectancy at birth, life expectancy at age 65, disability-adjusted life expectancy and healthy life expectancy based on self-perceived health. The period analyzed differs from one indicator to another, for the period 1998-2018.MethodsTwo kinds of convergence are studied: σ-convergence, through standard deviation, and absolute β-convergence, estimating a determined regression. Furthermore, the Moran Test is performed in order to know the degree of spatial dependencies and two models of spatial regression (Spatial Lag Model and Spatial Error Model) are used to include these dependencies in the absolute β-convergence estimation.ResultsOur findings suggest that there is a convergence process, both in σ and β, between the European Union countries and between the Spanish provinces. Therefore, dispersion is reduced, and growth rates have been higher where had lower life expectancy values at the beginning. On the other hand, β-convergence is higher in women among European countries and in men among Spanish provinces, whether we consider the model without spatial dependencies or the one which include them. ConclusionIn general, there have been convergence processes (both in sigma and beta) inside Europe and Spain. Otherwise, the rise of the dispersion means that there is not a clear evidence about the trend in the following period. This study has a double contribution. First, it provides an updated vision of the health convergence. Secondly, it contributes to consider spatial econometrics in Health Economics research. These insights can be considered to reduce health population inequalities.
Evaluation of SUVlean Consistency in FDG and PSMA PET/MR with Dixon, James and Janma Based Lean Body Mass Correction
Authors: Zhao Jun , Xue Qiaoyi , Chen Xing , You Zhiwen , Wang Zhe , Yuan Jianmin , Liu Hui , Hu Lingzhi
Published: November 2020

PurposeTo systematically evaluate the consistency of various standardized uptake value (SUV) lean body mass (LBM) normalization methods in a clinical positron emission tomography/magnetic resonance imaging (PET/MR) setting.MethodsSUV of brain, liver, prostate, parotid, blood and muscle were measured in 90 18F-FDG and 28 18F-PSMA PET/MR scans and corrected for LBM using the James, Janma (short for Janmahasatian) and Dixon models. 40 dual energy X-ray absorptiometry (DXA) measurements of non-fat mass were used as the reference standard. Agreement between different methods was assessed by linear regression and Bland-Altman statistics. ResultsLBM fraction measured by DXA, James, Janma and Dixon approaches was 68.19±6.43%, 66.95±6.71%, 76.20±5.41% and 71.56±7.97% respectively. Compared to DXA, the Dixon approach presented the minimal bias when compared to the James and Janma models (bias: 0.76±7.35, -8.01±9.36, -3.33±8.26 respectively). SUV normalized by bodyweight (SUVbw) was positively correlated with Body Mass Index (BMI) in both FDG (liver: r=0.454, p<0.001) and PSMA studies (r=0.197,p=0.31), while SUV normalized by lean body mass (SUVlean) revealed a decreased dependency on BMI (r=0.22,0.08,0.14, p=0.04,0.46,0.18 for Dixon, James and Janma models respectively). Paired T-test showed significant difference between SUVlean of major organs measured using Dixon method vs James and Janma models.ConclusionSignificant systematic variation was found among SUVlean calculated using different approaches. A consistent correction method should be applied in PET/MR serial scans.
Genome-Wide Analyses of the Relict Gull (Larus Relictus) Insights Into Evolutionary Implications
Authors: Yang Chao , Li Xuejuan , Wang Qingxiong , Yuan Hao , Huang Yuan , Xiao Hong
Published: November 2020

BackgroundThe relict gull (Larus relictus), one of the least known Aves, was classified as vulnerable on the IUCN Red List and is a first-class national protected bird in China. Genomic resources for L. relictus are lacking, which limits the study of its evolution and its conservation.ResultsIn this study, based on the Illumina and PacBio sequencing platforms, we successfully assembled the genome of L. relictus, the first reference genome of the genus Larus. The size of the final assembled genome was 1.21 Gb, with a contig N50 of 8.11 Mb. A total of 18,454 protein-coding genes were predicted from the assembly results, with 16,967 (91.94%) of these genes annotated. The genome contained 92.52 Mb of repeat sequence, accounting for 7.63% of the assembly. The phylogenetic tree was constructed using 7,339 single-copy orthologous genes, which showed Charadriiformes located at the basal position and Philomachus pugnax as the closest relative of L. relictus. The divergence time between L. relictus and P. pugnax was ~68.44 Mya. The population dynamics of the Ordos breeding subpopulation in Hongjian Nur is a good confirmation that these birds are suffering from habitat loss and fragmentation.ConclusionsThis assembled genome will be a valuable genomic resource for a range of genomic and conservation studies of L. relictus and helps to establish a foundation for further studies investigating whether the other three breeding subpopulations have combined with the Ordos breeding subpopulation. As the species is threatened by habitat loss and fragmentation, actions to protect L. relictus are suggested to improve the fragmentation of breeding populations.
Moral neutralization: Nurses' evolution in unethical climate workplaces
Authors: Hakimi Hamideh , Joolaee Soodabeh , Farahani Mansoureh Ashghali , Rodney Patricia , Ranjbar Hadi
Published: November 2020

Introduction: Good quality of care is dependent on nurses’ strong clinical skills and strong moral competencies, as well. However, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The aim of the study reported on in this paper was to explore the experiences of nurses regarding negative changes in their moral practice. Materials and Methods: This was a qualitative study utilizing a inductive thematic analysis approach, which was conducted from February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews. Results: The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: (1) feeling discouraged; (2) normalization; (3) giving up; (4) becoming a justifier; and (5) moral indifference. Conclusions: Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both pateints and health syetms. Some unethical behaviors in nurses can be explaiened by this process.
Professional Image of Nursing and Midwifery in East Africa: An Exploratory Analysis
Authors: Ndirangu Eunice Wambui , Sarki Ahmed , Mbekenga Columba , Edwards Grace
Published: November 2020

Background: Evidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa, and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda.Methods: An exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the image of nursing and midwifery professions. Descriptive statistics and Pearson’s Chi square tests were used to analyse the data. The semi-structured questions were analysed using content analysis. Results: A total of 551 participants took part in the study. The majority were females (61.8%), registered nurses/midwives (45.8%), and aged 30-39 years (34.2%). The majority of the respondents were from Kenya (39.7%) and Uganda (32.9%). About two-thirds of the nurses and midwives in this study perceived nursing/midwifery as both trusted and respected professions and expressed having a level of control over how their image was portrayed. Conversely, the nurses and midwives were conscious that the public had mixed responses about the nursing/midwifery professions specifically, some members of the public described nurses/midwives as professionals, knowledgeable and caring, others perceived nurses/midwives to be rude, cruel, unkind, lazy, unkempt, and maids.Conclusion: This study offers an interesting insight about the image of nursing/midwifery in East Africa. Findings from this study will inform policy makers and educators about key concepts that affect the image of nursing and midwifery in East Africa. The findings will be used to design marketing materials to help improve the image of nursing and midwifery in the region and other African countries.
Multi-locus sequence typing of Mycoplasma bovis to assess its genetic diversity from 2009-2018 in Ningxia Hui Autonomous Region, China
Authors: Guo Yanan , Luo Haifeng , Guo Shuqiang , Lei Yuanyuan , Li Yong , He Shenghu
Published: November 2020

Background: Mycoplasma bovis (M. bovis) is a highly contagious cattle pathogen spreading worldwide and especially in Ningxia Hui Autonomous Region in China.Results: Two types of ST, ST10and ST134, were identified in Ningxia Hui Autonomous Region. Thirty-seven strains belonged to ST10 and 28 strains belonged to ST134. ST134 was a new ST and first found in 2009 and was only widely distributed in Ningxia Hui Autonomous Region at present. The M. bovis ST10 was widely spread in many provinces in China and was widespread in Ningxia Hui Autonomous Region since 2010. It is speculated that the prevalence of M. bovis ST10 in Ningxia Hui Autonomous Region began in 2010.Conclusion: This study is the first report on the genetic diversity of M. bovis from 2009 to 2018 in Ningxia Hui Autonomous Region and provides the epidemiological information. These results may help further our understanding of the evolution of M. bovis and provide information that may be useful for the development of novel vaccines.
Comparative transcriptome analysis uncovers roles of hydrogen sulfide for alleviating cadmium toxicity in Tetrahymena thermophila
Authors: Lv Hongrui , Xu Jing , Bo Tao , Wang Wei
Published: November 2020

Background: Cadmium (Cd) is a nonessential heavy metal with potentially deleterious effects on different organisms. The organisms have evolved sophisticated defense system to alleviate heavy metal toxicity. Hydrogen sulfide (H2S) effectively alleviates heavy metal toxicity in plants and reduces oxidative stress in mammals. However, the function of H2S for alleviating heavy metal toxicity in aquatic organisms remains less clear. Tetrahymena thermophila is an important model organism to evaluate toxic contaminants in an aquatic environment. In this study, the molecular roles of exogenously H2S application were explored by RNA sequencing under Cd stress in T. thermophila.Results: The exposure of 30 µM Cd resulted in T. thermophila growth inhibition, cell nigrescence, and malondialdehyde (MDA) content considerably increase. However, exogenous NaHS (donor of H2S, 70 µM) significantly alleviated the Cd-induced toxicity by inhibiting Cd absorbtion, promoting CdS nanoparticles formation and improved antioxidant system. Comparative transcriptome analysis showed that the expression levels of 9152 genes changed under Cd stress (4658 upregulated and 4494 downregulated). However, only 1359 genes were differentially expressed with NaHStreatment under Cd stress (1087 upregulated and 272 downregulated). The functional categories of the differentially expressed genes (DEGs) by gene ontology (GO) revealed that the transcripts involved in the oxidation–reduction process, oxidoreductase activity, glutathione peroxidase activity, and cell redox homeostasis were the considerable enrichments between Cd stress and NaHS treatment under Cd stress. Kyoto Encyclopedia of Genes and Genomes (KEGG) indicated that the carbon metabolism, glutathione metabolism, metabolism of xenobiotics by cytochrome P450, and ABC transporters were significantly differentially expressed components between Cd stress and NaHS treatment under Cd stress in T. thermophila. The relative expression levels of six DEGs were further confirmed through quantitative real-time polymerase chain reaction (qRT-PCR). Conclusion: NaHS alleviated Cd stress mainly through inhibiting Cd absorbtion, promoting CdS nanoparticles formation, increasing oxidation resistance, enhancing detoxification, and regulation of transport in free-living unicellular T. thermophila. These findings will expand our understanding for H2S functions in the freshwater protozoa.
Why do pregnant women prefer cesarean birth? A qualitative study in a tertiary care center in Southern Thailand
Authors: Suwanrath Chitkasaem , Chunuan Sopen , Matemanosak Phawat , Pinjaroen Sutham
Published: November 2020

AbstractBackground: The increasing worldwide rates of cesarean section are of global concern. In recent years, cesarean births upon maternal request have become a hotly debated issue. Hence, this study aimed to explore maternal reasons for cesarean preference without medical indications.Methods: A descriptive qualitative study was conducted, using in-depth interviews with 27 pregnant women who preferred cesarean birth, attending antenatal care in Songklanagarind Hospital from September 2018 to June 2019. Data were analyzed using content analysis.Results: Maternal reasons for cesarean preference were classified into six main categories: fear of childbirth, safety concerns related to health risk perceptions, negative previous birth experiences, positive attitudes toward cesarean birth, access to biased information and superstitious beliefs in auspicious birth dates. Most women had more than one reason for opting cesarean birth. Conclusion: Several reasons for cesarean birth preference have been elucidated. One striking reason was superstitious beliefs in auspicious birth dates, which are challengable for obstetricians to deal with. Obstetricians should explore the exact reasons why women request cesarean birth, so as to prevent or diminish unnecessary cesarean births.
Anemia and associated factors among adolescent girls and boys at 10-14 years in rural western China
Authors: Zhu Zhonghai , Sudfeld Christopher R. , Cheng Yue , Qi Qi , Li Shaoru , Elhoumed Mohamed , Yang Wenfang , Chang Suying , Dibley Michael J , Zeng Lingxia , Fawzi Wafaie W.
Published: November 2020

Background: Evidence on the anemia and associated factors among young adolescent girls and boys in rural western China is limited.Methods: We used data from a follow-up study of adolescents (10-14 years) born to women who participated in a randomized trial of antenatal micronutrient supplementation in western China. Anemia was defined by World Health Organization standards. Logistic regression was used to examine the associated factors with anemia.Results: The overall prevalence of anemia was 11.7% (178/1517). Female adolescents were 1.73 (95% CI 1.21, 2.48) times more likely to have anemia as compared to males. Adolescents whose mothers had completed high school were 65% (95% CI 7%, 87%) less likely to be anemic, compared with those of whom had <3 years. Household wealth was also inversely associated with anemia. The association of puberty status with anemia was modified by adolescent sex (p-value for interaction was 0.04): males with greater than mild puberty development had 65% (95% CI 17%, 85%) reduced odds of anemia while there was no association among females (OR: 0.72, 95% CI 0.29, 1.78). Consumption of flesh foods, eggs, and having a meal frequency of three times or more per day were associated with 42% (95% CI 11%, 62%), 40% (95% CI 7%, 62%) and 32% (95% CI 4%, 52%) reduced odds of anemia, respectively.Conclusions: Anemia is a mild public health problem among young adolescents in rural western China. Nutritional and social determinants were identified as predictors, warranting interventions to reduce the risk of anemia among this critical age group.