bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Asia in the Face of Intellectual Migration Challenges: Trends and Prospects
Authors: Bahriev B. , Rizoyon S.
Published: June 2022

Intellectual migration is a key element of migration processes in Central Asia, but this topic remains insufficiently studied. In this article, the authors undertake the first attempt to comprehensively analyze the challenges of “brain drain” for the region’s countries. Conceptually, the research is based on developments in the field of migration studies, in particular on the push–pull approach, as well as the idea of relational and aspirational factors of intellectual migration. Methodologically, the study relies on discourse and documentary analysis, systems approach, statistical and survey methods. The authors discover that the topic of intellectual migration in the regional research discourse is presented fragmentarily, as its attention is mainly concentrated on international students mobility trends in the region. It is argued that state regulation of the intellectual migration in Central Asian countries has its own specific features – some are trying to use intellectual migration to stabilize the situation on national labor markets, to contain domestic protest potential, others are looking for an adequate model for turning the “brain drain” trends into “brain gain”, especially through the use of their diaspora’s resources. At the same time, the scale of educational emigration from the region shows growth patterns, which generates serious challenges for the Central Asian states, since a large proportion of foreign universities graduates from the region do not want to return to their countries. Based on the analysis of current trends, it is concluded that Central Asian states have all the economic and socio-political motives for intellectual emigration. In this context, out of the three scenarios for the development of international migration processes in Central Asia presented by the authors – a favorable scenario, a status quo scenario and a negative scenario – the latter seems to be the most probable at this stage. Accordingly, without systematic reforms and a serious approach to the problem of intellectual migration, the prospects for the implementation of the development strategies of the region’s countries will become vague, which is a challenge for their societal stability and national security.
New Shape of Environmental Policy amid COVID-19 Pandemic
Authors: Rovinskaya T.
Published: June 2022

The article examines the connection between the environmental processes during the COVID‑19 pandemic (2019–2022) and the “greening” of the political sphere. A specific feature of environmental policy is its close linkage with the economy, since economic activity is the direct cause of anthropogenic pollution of natural environments. The environmental changes that have arisen in response to economic realities of the pandemic period have led to transformation of socio-political attitudes towards strengthening the “green” direction in the policies of the world’s leading states – the European Union member countries, the United States, Russia, China and other. The global “green agenda” was substantiated at the World Economic Forum in Davos in 2020 and 2021, as well as at the following 26th UN Climate Change Conference 2021 (COP26) in Glasgow, actually shaping a new world order based on the environmental goals and obligations. In West European countries, with prominent green parties’ political positions, the environmental policy is formed largely from grassroots. In the United States, it depends entirely on the political situation (mostly on the sitting president’s party affiliation). Whereas the European Union and the EU states (primarily Germany and France) have seized the initiative of directing the world environmental policy, striving to take the lead in this sphere (particularly, in climate protection), the new U.S. government is now seriously challenging the European leadership. Noteworthy is that the COVID‑19 crisis has updated the green political and economic agenda globally, regardless of differences between the states, which verifies the importance and necessity of agreeing a conceptually new common approach to interaction with the environment in the short and long term.
The Analyses of Forest Fire Vulnerability at Taman Hutan Raya (Tahura) Nipa-Nipa Kendari City1
Authors:   Universitas Halu Oleo, Bana Sahindomi
Published: June 2022

Forest fires are one of the environmental problems that recur almost every year in Indonesia. This problem if not handled properly will certainly cause various negative impacts such as the emergence of haze that can interfere with public health and reduced forest cover, in forest areas. Taman Hutan Raya Nipa-Nipa (Tahura) as one of the Natural Preservation areas of Southeast Sulawesi Province is also inseparable from the problem of forest fires. The aims of the study were to analyze the level of forest fire vulnerability in the Tahura Nipa-Nipa area, especially in Watu-Watu Village, West Kendari Subdistrict, and the variables that most affect the level of forest fire vulnerability. Data analysis based on the weighting of each element is then carried out the determination of the vulnerability class using equations: forest fire vulnerability = {30 % x (land cover)} + {(20 % x height of place)} + {(20 % x Rainfall)} + {(10 % x distance from road)} + {(10 % x distance from river)} + {(10 % x distance from settlement)}. Mapping the class of forest fire vulnerability areas using geoprocessing with input data on land cover, place height, rainfall, and distance from roads, rivers, and settlements. Then an analysis is carried out and will be selected data according to the score of the level of forest fire vulnerability, namely very low/not a vulnerability with a score of 5, low with a score of 4, medium with a score of 3, high with a score of 2, very high /very vulnerability with a score of 1. The results showed that the level of forest fire vulnerability in Tahura Nipa-Nipa has 3 levels, namely the level of high forest fire vulnerability with an area of 68.51 ha, the level of moderate forest fire vulnerability with an area of 62.29 ha, and the level of low fire vulnerability with an area of 143.35 ha. The variables that most affect the level of forest fire vulnerability at the research site are land cover and community accessibility distance in the form of distance from the road and distance from the settlement.
Sistem Monitoring Suhu Air Pada Aquascape Berbasis Internet of Things (IoT)
Authors: Indriyanto Slamet , Yuliantoro Prasetyo , Kusumawati Dinda
Published: June 2022

Aquascape merupakan seni menanam tanaman hias didalam air. Pada aquascape, biota yang hidup dalamnya lebih banyak jika dibandingkan dengan biota pada akuarium biasa, sehingga pemantauan suhu air didalamnya harus lebih diperhatikan karena perubahan suhu air yang terjadi secara tiba-tiba pada aquascape dapat menimbulkan resiko bagi ikan dan tanaman didalamnya. Biota lain yang berada pada aquascape tersebut seperti tanaman air, rumput-rumput, lumut dan tumbuhan karang juga perlu diperhatikan agar tetap tumbuh subur di dalam air. Banyak dari tanaman yang digunakan untuk aquascape berasal dari daerah tropis seperti Java Moss. Secara umum suhu air yang hangat dapat memperlambat dalam pertumbuhan tanaman ini. Dengan memanfaatkan beberapa sensor seperti Sensor suhu DS18B20 dan teknologi Internet of things (IoT), maka pemantauan suhu akan lebih efektif. Sistem ini dibuat menggunakan NodeMCU ESP8266 dengan komunikasi data menggunakan Wi-Fi, sensor suhu DS18B20 dan tampilan menggunakan LCD dan Website. Dari hasil pengujian sensor suhu DS18B20 didapatkan nilai rata-rata error 0,86% dengan akurasi 99,14%.
Improving Clinical Prediction of Later Occurrence of Breast Cancer Metastasis Using Deep Learning and Machine Learning with Grid Search
Authors: Jiang Xia , Xu Chuhan
Published: June 2022

ABSTRACT Background It is important to be able to predict, for each individual patient, the likelihood of later metastatic occurrence, because the prediction can guide treatment plans tailored to a specific patient to prevent metastasis and to help avoid under- or over-treatment. Deep Neural Network (DNN) learning, commonly referred to as deep learning, has become popular due to its success in image detection and prediction, but questions such as whether deep learning outperforms other machine learning methods when using non-image clinical data remain unanswered. Grid search has been introduced to deep learning hyperparameter tunning for the purpose of improving its prediction performance, but the effect of grid search on other machine learning methods are under-studied. In this research, we take the empirical approach to study the performance of deep learning and other machine learning methods when using non-image clinical data to predict the occurrence of breast cancer metastasis (BCM) 5, 10, or 15-years after the initial treatment. We developed DNN models as well as models using 9 other machine learning methods including Naive Bayes (NB), Logistic Regression (LR), Support Vector Machine (SVM), LASSO, Decision Tree (DT), k-Nearest Neighbors (KNN), Random Forrest (RF), AdaBoost (ADB), and XGBoost (XGB). We used grid search to tune hyperparameters for all methods. We then compared the deep learning models to the models trained using the 9 other machine learning methods. Results Based on the mean test AUC results, DNN ranks 6th, 4th, and 3rd when predicting 5-year, 10-year, and 15-year BCM respectively, out of 10 machine learning methods. The top performing methods in predicting 5-year BCM are XGB(1st), RF(2nd), and KNN(3rd). For predicting 10-year BCM the top performers are XGB (1st), RF(2nd), and NB(3rd) . Finally, for 15-year BCM the top performers are SVM (1st), LR and LASSO (tied for 2nd), and DNN (3rd). The ensemble methods RF and XGB outperform other methods when data are less balanced, while SVM, LR, LASSO, and DNN outperform other methods when data are more balanced. Our statistical testing results show that at a significance level of 0.05 DNN overall performs no worse than other machine learning methods when predicting 5-year, 10-year, and 15-year BCM. Conclusions Our results show that deep learning with grid search overall performs at least as well as other machine learning methods when using non-image clinical data. It is interesting to note that some of the other machine learning methods such as XGB, RF, and SVM are very strong competitors of DNN when incorporating grid search. It is also worth noting that the computation time required to do grid search with DNN is way more than that required to do grid search with the other 9 machine learning methods.
Prognostic value of angiogenic factors (sFlt-1/PlGF ratio) as a marker for pre-eclampsia in twin pregnancy
Authors:   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Kurtser M.A. , Sichinava L.G. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Alazhazhi A.O. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Normantovich T.O. ,   Clinical Hospital MD Group, Moscow, Russian Federation, Nikolaeva E.V. ,   Clinical Hospital MD Group, Moscow, Russian Federation
Published: June 2022

Objective. To develop reference values for the sFlt-1/PlGF ratio in twin pregnancy and to establish its significance as a marker for pre-eclampsia (PE). Patients and methods. Sixty-two women with a dichorionic diamniotic (DCDA) twin pregnancy were examined: 44 women without PE and 18 women with PE. Levels of sFlt-1 and PlGF and their ratio were studied at 15,0–19,6; 20–23,6; 24–28,6; 29–33,6; 34–36,6 weeks’ gestation. Serum sFlt-1 and PlGF concentrations were measured by the cobas e 411 immunochemical analyzer (Roche Diagnostics GmbH, Germany) that uses electrochemiluminescence technology. Results. In uncomplicated twin pregnancy, serum concentrations of sFlt-1 and PlGF and their ratio were significantly elevated, which were higher than those in singleton pregnancy (SP); the sFlt-1/PlGF ratio was 13.7 by the end of the 37th week of pregnancy versus 9.0 in SP. In patients with PE, the median sFlt-1/PlGF ratio was 66.56, which was 4.8 times higher than in uncomplicated twin pregnancy. Using ROC analysis, threshold values for the sFlt-1/PlGF ratio were determined, allowing us with a high level of significance to exclude (<20.06; 100% sensitivity and 90% specificity) and to diagnose PE (>50.07; 60% sensitivity and 100% specificity). Conclusion. The developed accurate reference values for the sFlt-1/PIGF ratio in twin pregnancy enable early diagnosis of PE and prediction of the course of the disease. Key words: angiogenic factors, twins, twin pregnancy, pre-eclampsia
The use of combined hormonal contraceptives containing drospirenone in real clinical practice
Authors:   A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation, Minkina G.N.
Published: June 2022

Objective. To analyze patient satisfaction and adherence to contraception with Delsia® (30 μg ethinylestradiol and 3 mg drospirenone). Patients and methods. This prospective observational study included 193 women from 12 Russian cities who used a combined oral hormonal contraceptive drug Delsia®. Results. No pregnancies were recorded in women taking Delsia® during the study. When included in the study, 34.2% of women had heavy menstrual bleeding and 39.9% of them had painful menstrual periods. By the end of the sixth month of using Delsia®, these rates decreased to 1.04% (p < 0.001) and 2.07% (p < 0.05), respectively. The percentage of patients who reported adverse reactions after 3 months of using Delsia® was 7.37% and it decreased to 3.83% by the sixth month. The mean BMI at the first visit was 22.75 ± 3.50 kg/m2 and 22.56 ± 3.29 kg/m2 by the end of the study (p < 0.05). Upon completion of the study, 99.47% of women were satisfied with the convenience of using Delsia® at 4–5 points on a Likert scale, 98.94% – with affordability, 97.88% – with tolerability, 99.47% – with skin and hair condition, 97.36% – with overall well-being, and 97.88% – with libido level. Conclusion. The data obtained allow us to highly evaluate the effect of the combined oral contraceptive drug Delsia® on the overall well-being of the observed patients and their satisfaction with therapy, which may ensure high adherence to this method of contraception. Key words: drospirenone, combined oral contraceptives, non-contraceptive benefits, adverse reactions
The Colorado Initiative to Reduce Unintended Pregnancy: Contraceptive Access and Impact on Reproductive Health
Authors: Romer Sarah E. , Kennedy Kathy I.
Published: June 2022

The Colorado Initiative to Reduce Unintended Pregnancy, including its largest subproject, the Colorado Family Planning Initiative, had a significant impact on contraceptive access during and after the project period. This coordinated and multilevel initiative improved reproductive health outcomes by driving change in public health systems, advancing statewide policies, building capacity through training and technical assistance, and increasing public awareness and education. Lessons learned from the implementation and outcomes of the Colorado Initiative to Reduce Unintended Pregnancy continue to inform contraceptive access efforts. (Am J Public Health. 2022;112(S5):S532–S536. https://doi.org/10.2105/AJPH.2022.306891 )
US “Safety Net” Clinics Provide Access to Effective Contraception for Adolescents and Young Women, 2017–2019
Authors: Darney Blair G. , Biel Frances M. , Oakley Jee , Rodriguez Maria I. , Cottrell Erika K.
Published: June 2022

Objectives. To describe patterns of providing moderately effective versus the most effective contraception and of providing implants versus intrauterine devices in US community health centers.

Methods. We conducted a historical cohort study (2017–2019). Outcomes were woman-level receipt of most effective contraception (long-acting reversible contraception; implants and intrauterine devices) or moderately effective contraception. We used logistic regression to identify patient and clinic factors associated with providing (1) most versus moderately effective methods, and (2) implants versus intrauterine devices. We calculated adjusted probabilities for both outcomes by age group.

Results. We included 199 652 events of providing contraception to 114 280 women in 410 community health centers. Adjusted probabilities were similar across age groups for moderately versus most effective methods. However, the adjusted marginal means for receiving an implant compared with an intrauterine device were highest for adolescents (15–17 years: 78.2% [95% confidence interval (CI) = 75.6%, 80.6%]; 18–19 years: 69.5% [95% CI = 66.7%, 72.3%]). Women’s health specialists were more likely to provide most versus moderately effective contraception.

Conclusions. Community health centers are an important access point for most effective contraception for women of all ages. Adolescents are more likely to use implants than intrauterine devices. (Am J Public Health. 2022;112(S5):S555–S562. https://doi.org/10.2105/AJPH.2022.306913 )
Implementation and Monitoring of the Family Planning Elevated Contraceptive Access Program, Utah, 2018‒2019
Authors: Simmons Rebecca G. , Baayd Jami , Gero Alexandra , Quade Caitlin , Mullholand Madeline , Torres Erica , Turok David K. , Sanders Jessica N.
Published: June 2022

Family Planning Elevated (FPE) is a contraceptive access initiative in Utah. FPE designed and utilized a comprehensive monitoring system to identify and respond to challenges implementing our initiative as they arose. Here, we describe the components of our monitoring system, and highlight how FPE’s monitoring system successfully identified that Utah’s Medicaid expansion was not widely adopted by eligible individuals. We then describe how FPE adapted to this challenge. (Am J Public Health. 2022;112(S5):S528–S531. https://doi.org/10.2105/AJPH.2022.306935 )
Trend Analysis of Climatic and Hydrological Parameters in Ajora-Woybo Watershed, Omo-Gibe River Basin, Ethiopia
Authors: Toma Meseret Bekele , Belete Mulugeta Dadi , Ulsido Mihret Dananto
Published: June 2022

The identification of hydro-meteorological trends is essential for analyzing climate change and river discharge at the watershed level. The Ajora-Woybo watershed in Ethiopia was studied for long-term trends in rainfall, temperature, and discharge at the annual, monthly, and seasonal time scales. The rainfall and temperature data extend 1990 to 2020, whereas the discharge data span 1990 to 2015. The Pettit and SNHT tests were used to determine homogeneity. The Mann-Kendall and Sen's slope tests, as well as several variability measures, were then employed for trend analysis. The degree of relationship between climate variables and river discharge was determined using Pearson correlation coefficients (r). Inhomogeneity was discovered in annual rainfall data from the Angacha and Areka stations. Rainfall and discharge showed insignificant trends over time, with increasing and decreasing variability across stations. Monthly rainfall trends were observed to be significantly falling in February and March. Rainfall and runoff increase just insignificantly during the Kiremt season. Maximum, minimum, and mean annual temperatures, on the other hand, showed significant trends with annual increases of 0.04oC, 0.01oC, and 0.025oC, respectively. In this study, the relationships between discharge and temperature and rainfall were found to be minimal. Overall, the results of the long-term examination of the factors in the watershed show that water resources vary throughout and over time. As a result, caution is essential in designing appropriate strategies for water resource planning and sustainable development in the watershed.
Effects of the ketogenic diet in mice with hind limb ischemia
Authors: Shalamu Adilan , Dong Zhen , Liu Bowen , Pan Lihong , Cai Yun , Liu Liwei , Ma Xiurui , Hu Kai , Sun Aijun , Ge Junbo
Published: June 2022

Background: The ketogenic diet (KD) has anti-tumor and anti-diabetic effects in addition to its anti-epileptic role. It could also improve cardiac function and attenuate neurological insult. However, the effect of the KD on blood flow or tissue recovery after ischemia remains largely unknown. Thus, we observed blood flow and ischemic tissue recovery following hind limb ischemia in mice. Methods: C57 mice were fed with either a KD or normal diet (ND) for 2 weeks, before inducing hind limb ischemia, blood perfusion of ischemic limb tissue was observed at 0, 7, and 21 days post operation. Results: KD not only decreased blood perfusion of ischemic limb tissue but also delayed muscle recovery after ischemia, induced muscle atrophy of non-ischemic tissue compared to mice fed with ND. Furthermore, KD delayed wound healing at the surgical site and aggravated inflammation of the ischemic tissue. At the cellular level, KD altered the metabolic status of limb tissue by decreasing glucose and ketone body utilization while increasing fatty acid oxidation. Following ischemia, glycolysis, ketolysis, and fatty acid utilization in limb tissue were all further reduced by KD, while ketogenesis was mildly increased post KD in this mice model.Conclusion: The KD may cause impaired tissue recovery after ischemia and possible muscle atrophy under a prolonged diet. Our results hint that patients with limb ischemia should avoid ketogenic diet.
Ant-Lion Optimizer-Based Load Frequency Controller for a Hybrid Power System with PV and Thermal Power Plant
Authors: Can Ozay , Ozturk Ali , Kotb Hossam
Published: June 2022

The process of damping frequency fluctuations in power systems, known as load frequency control (LFC), is an important issue that directly affects the balance between production and consumption for maintaining the stable operation of an interconnected power system. LFC is more complex in multi-area interconnected power systems due to the increasing penetration of renewable energy sources, such as wind turbines and photovoltaic (PV) panels. This study proposes to determine the proportional integral derivative (PID) controller parameters for LFC in a two-area reheat thermal power system, including the photovoltaic system, using ant-lion optimization (ALO). The two-area power system model, consisting of a thermal generator and a PV system, was modelled in MATLAB/SIMULINK. To analyse the effectiveness of the optimization method, the system behavior was examined by considering different case studies, such as the change in load demand and solar irradiation values. The simulation results were compared with the results of different heuristic algorithms, such as the firefly algorithm (FA), genetic algorithm (GA), and population extremal algorithm (PEO). The results revealed that the suggested ALO-PID controller provides about 60% improvement in overshoot/undershoot values and settling time compared to other heuristic optimization methods mentioned.
Indirect carbon emissions from household consumption of middle-income groups: evidence from Yangtze River Economic Belt in China
Authors: Pang Qinghua , xiang min , Zhang Lina
Published: June 2022

With the proposal of goals of peak carbon emissions and carbon neutrality, indirect carbon emissions from household consumption (ICEHCs) reduction have become the research focus. The size of China’s middle-income groups is growing, which has a considerable impact on carbon emissions from consumption. However, the amount of middle-income groups’ ICEHCs and the effects of their drivers have not been quantitatively assessed. This paper adopts input-output tables to calculate urban-rural middle-income groups’ ICEHCs from 2012–2018, and uses structural decomposition analysis to determine the effects of drivers and sectors. Results are as follows: (1) Urban-rural middle-income groups’ ICEHCs in the Yangtze River Economic Belt (YREB) are increasing and its differences are significant, and present a spatial pattern of high in the eastern region while low in the western region. (2) Urban-rural middle-income groups’ ICEHCs in the YREB are mainly generated in PSE (S22), WRT (S26), FFA (S1) sectors. (3) Consumption pattern is the predominant driver for promoting urban-rural middle-income groups’ ICEHCs, whereas production structure is the predominant restraining driver. Carbon intensity and population size play different effects in different periods. PSE (S22) is the main contributor to the changes of middle-income groups’ ICEHCs.
Investigating the Role of Internal Audit in Risk Management in Selected Public Institutions in Ghana
Authors: ninson patrick , Tetteh Bernice
Published: June 2022

Both public and private organisations are under pressure to identify, promptly assess, and adequately manage all risks. This study sought to investigate the contribution of internal audit to risk management in public institutions. It specifically examined the risk management practices of three selected public health institutions in Accra and Tema, ascertained the effectiveness of risk management practices in the selected institutions, and investigated the challenges to risk management and internal audit in the selected institutions. A mixed-method approach was used, it involved the use of questionnaires and interviews to gather data from administrative staff and management of the selected health institutions. The study revealed that selected health institutions (Achimota Hospital, Ridge Hospital, and Manhean Polyclinic) have in place various risk management practices, but they use a traditional approach and focused primarily on financial and operational risks. Internal auditing in health institutions helps to avoid financial loss and provides independent assurance that the risk management and governance structures function effectively in these organisations. The findings also revealed that risk management practices have so far not proven to be effective in driving organisational growth and sustainability. The main challenges are the weak implementation of audit recommendations, political interference, resource constraints, and poor reporting standards. This study concludes that the challenges to risk management and internal audit are systematic, hence, the Ministry of Health must institute reforms that would promote enterprise risk management as part of the organisational culture in health facilities.
Identifying disrupted biological factors and patient-tailored interventions for chronic fatigue in adolescents and young adults with Q-Fever Fatigue Syndrome, Chronic Fatigue Syndrome and Juvenile Idiopathic Arthritis (QFS-study): study protocol for a randomized controlled trial with single-subject experimental case series design
Authors: Vroegindeweij Anouk , Swart Joost F. , Houtveen Jan , Eijkelkamp Niels , De Putte Elise M. Van , Wulffraat Nico M. , Nijhof Sanne L.
Published: June 2022

Background
Chronic fatigue with a debilitating effect on daily life is a frequently reported symptom among adolescents and young adults with a history of Q-fever infection (QFS). Persisting fatigue after infection may have a biological origin with psychological and social factors contributing to the disease phenotype. This is consistent with the biopsychosocial framework, which considers fatigue to be the result of a complex interaction between biological, psychological and social factors. In line, similar manifestations of chronic fatigue are observed in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and Juvenile Idiopathic Arthritis (JIA). Cognitive behavioural therapy is often recommended as treatment for chronic fatigue, considering its’ effectiveness on the group-level. However, not everybody benefits on the individual level. More treatment success at the individual level might be achieved with patient-tailored treatments that incorporate the biopsychosocial framework.
Methods
In addition to biological assessments of blood, stool, saliva, and hair, the QFS-study consists of a randomized controlled trial (RCT) in which a single-subject experimental case series (N = 1) design will be implemented using Experience Sampling Methodology in fatigued adolescents and young adults with QFS, CFS/ME and JIA (aged 12–29). With the RCT design, the effectiveness of patient-tailored PROfeel lifestyle advices will be compared against generic dietary advices in reducing fatigue severity at the group-level. Pre-post analyses will be conducted to determine relevance of intervention order. By means of the N = 1 design, effectiveness of both advices will be measured at the individual level.
Discussion
The QFS-study is a comprehensive study exploring disrupted biological factors and patient-tailored lifestyle advices as intervention in adolescent and young adults with QFS and similar manifestations of chronic fatigue. Practical or operational issues are expected during the study, but can be overcome through innovative study design, statistical approaches, and recruitment strategies. Ultimately, the study aims to contribute to biological research and (personalized) treatment in QFS and similar manifestations of chronic fatigue.
Trial registration:
Trial NL8789 (www.trialregister.nl). Registered July 21, 2020.
Growth and Nutritional Status of Phenylketonuric Children and Adolescents
Authors: Ahmadzadeh Mina , Sohrab Golbon , Alaei Mohammadreza , Eini-Zinab Hassan , mohammadpour-Ahranjani Behzad , Rastgoo Samira , Namkhah Zahra
Published: June 2022

Background: The goal of this study was to assess the anthropometric and biochemical parameters of children and adolescents with phenylketonuria (PKU).Methods: The participants in this cross-sectional study ranged in age from 4 to 18. Biochemical markers such as blood vitamin B12, folic acid, iron, ferritin, calcium, 25-hydroxy vitamin D3, zinc, and plasma phenylalanine (phe) and tyrosine (Tyr) levels were evaluated, as well as demographics and anthropometric measurements. A 3-day dietary recall questionnaire was completed by all individuals.Results: Eighty percent (64) of the 80 patients (42 females, 52.5%) had typical PKU. Consanguineous marriages were found in 57.5% (46) of the patients' parents. According to the height for age index, 17.5% of the study group (n = 14) were short or very short. According to age-related weight and body mass index (BMI) indices, 37.5% (n = 30) and 43.8% (n = 35) of people are obese or overweight, respectively. Biochemical testing revealed raised vitamin B12 levels and 25-hydroxy vitamin D3 deficiency in 28 (35%) of the patients, insufficient folic acid in 10 (12.5%), and elevated phenylalanine levels in children under 12 years old 45 (70.3%) and adolescents 10 (62.5%). A high phe intake (OR = 4.44, CI %95 = 1.27-15.57) is one risk factor for obesity and overweight.Conclusion: Patients with phenylketonuria had a high rate of overweight and obesity, according to anthropometric measurements. PKU patients who are overweight or obese do not differ from normal-weight patients in terms of dietary intake or laboratory findings (except for serum iron levels).
Food budget in kindergarten- is there an association with diet quality?
Authors: Fjæra Kristin , Lekhal Ratib , Helseth Sølvi , Småstuen Milada , Lekhal Samira
Published: June 2022

BackgroundThere is good evidence that the early establishment of healthy habits seems to track over later in life, and kindergarten is a unique arena to promote a healthy diet. It is variable how kindergartens work with food and meals and what is served by food. Food budget is often seen as a barrier considering a healthy diet in kindergartens. The aim of the present study was therefore to explore if the food budget is associated with the diet quality in kindergartens and how low the budget might be before diet quality is changed. MethodThe present study collects data through Healthier kids, a free web-based program that aims to streamline work with food and meals in kindergartens. As a part of Healthier kids, the kindergartens answer a web-based questionnaire that assesses the monthly food budget per child, the frequency of meals kindergarten serves, and how often the kindergartens serve food according to nutrition guidelines. The food budget was categorized into five groups; very low to very high budget level, and we made a total diet sum score. Logistic regression was used to explore the associations between diet quality and food budget. ResultsBased on 324 kindergartens, the results showed that diet quality in kindergartens was lower when the food budget was very low (0-199 NOK) compared to higher budget levels (OR 3.8). There was no difference in diet quality between low budget (200-299 NOK) compared to medium (OR .77), high (OR 1.2) or very high (>500 NOK) (OR 1.1) food budgets. ConclusionThe results in the present study only show a difference in diet quality when the food budget was very low, but there was no difference in diet quality when the budget was low compared to medium, high and very high. This might indicate that other environmental factors in the kindergarten might be important related to high diet quality in kindergartens.
Plasma concentrations of short-chain fatty acids in active and recovered anorexia nervosa
Authors: Nilsson Ida , Xu Jingjing , Landberg Rikard , Lavebratt Catharina , Bulik Cynthia , Landén Mikael
Published: June 2022

Anorexia nervosa (AN) is one of the most lethal psychiatric disorders, and to date, we lack adequate knowledge about the (neuro)biological mechanisms of the disorder to inform evidence-based pharmacological treatment. Gut dysbiosis is a trending topic in mental health, including AN. Communication between the gut microbiota and the brain is partly mediated by metabolites produced by the gut microbiota such as short-chain fatty acids (SCFA). Previous research has suggested a role of SCFA in weight regulation, e.g., correlations between specific SCFA-producing bacteria and BMI have been demonstrated. Moreover, fecal SCFA concentrations are reported to be altered in active AN. However, data on SCFA concentrations in individuals who have recovered from AN are limited. In the present study, we analyzed and compared the plasma concentrations of seven SCFA (acetic-, butyric-, formic-, isobutyric-, isovaleric-, propionic- and succinic acid) in females with active AN (N = 109), recovered from AN (AN-REC, N = 108), and healthy-weight age-matched controls (CTRL, N = 110), and explored correlations between SCFA concentrations and BMI. Significantly lower plasma concentrations of butyric, isobutyric-, and isovaleric acid were detected in AN as well as AN-REC compared with CTRL. We also show significant correlations between plasma concentrations of SCFA and BMI. These results encourage studies evaluating whether interventions directed toward altering gut microbiota and SCFA could support weight restoration in AN.
Student and supervisor perceptions of undergraduate research in college of Medicine and Health Sciences, Sultan Qaboos University, Oman
Authors: Ajmi Zainab Al , Na’abi Aya Al , Rawahi Abdel-Hakeem Al , Saadoon Muna Al , Balushi Huriya Darwish Al , Alhabsi Fatema , Babiker Hamza
Published: June 2022

Undergraduate research (UGR) is a valuable experience, that can potentially enhance the quality of graduates, and raise the awareness of the importance of research and its impact on career development. These outcomes, however, depend on the environment under which students conduct research. We undertook a self-administered survey, to elucidate the experiences of both students and supervisors, in the College of Medicine and Health Sciences (COMHS), Sultan Qaboos University, Oman. The study examined supervisors (n = 90) and students’ (n = 314) perceptions to UGR and factors that hinder the research experience. The supervisors’ and students’ satisfaction towards UGR was good (mean = 72.4 ± 13.0) and moderate (mean = 57.8 ± 14.2), respectively. The students reported a good satisfaction towards the relevance of research (Mean = 71.34 ± 20.0) research learning skills acquired (63.43 ± 18.9), research supervisor (68.47 ± 23.5), with female students been more positive towards UGR than males. The students’ grade in UGR module was the only independent factor influencing the overall satisfaction. The supervisors were highly satisfied with the relevance of UGR (mean = 84.4% ±20.7), the module structure (mean = 73.3 ± 14.6), workload (mean = 73.3 ± 14.6) and the students’ performance (71.8%±18). However, supervisors were less positive towards the students’ acquired skills (mean = 69.0% ±12.8) and logistics for UGR (mean = 67.8%±16.3). In summary, supervisors and students in COMHS, Oman, regard UGR as valuable and recognize its relevance. Supervisors were more likely than students to report lack of resources to run UGR. Thus, resources should be maintained to inspire supervisors and sustain a research-oriented environment to inspire students.
Testicular salvage: Using Machine Learning Algorithm to Develop a Predictive Model in Testicular Torsion
Authors: Ekşi Mithat , Yavuzsan Abdullah Hızır , Evren İsmail , Ayten Ali , Fakir Ali Emre , Akkaş Fatih , Bursalı Kerem , Akdağ Azad , Şahin Selçuk , Taşçı Ali İhsan
Published: June 2022

Purpose: To compare the models developed with a classical statistics method and a Machine Learning model to predict the possibility of orchiectomy using preoperative parameters in patients who were admitted with testicular torsion.Materials Method: Patients who underwent scrotal exploration due to the testicular torsion between the years 2000 and 2020 were retrospectively reviewed. Demographic data, features of admission time, and other preoperative clinical findings were recorded. Cox Regression Analysis as a classical statistics method and Random Forest as a Machine Learning algorithm was used to create a prediction model. Results: Among patients, 215 (71,6%) were performed orchidopexy and 85 (28,3%) were performed orchiectomy. The multivariate analysis revealed that monocyte count, symptom duration, and the number of previous Doppler Ultrasonography were predictive of orchiectomy. Classical Cox Regression analysis had an area under the curve (AUC) 0,937 with a sensitivity and specificity of 88% and 87%. The AUC for the Random Forest model was 0,95 with a sensitivity and specificity of 92% and 89%. Conclusion: The ML model outperformed the conventional statistical regression model in the prediction of orchiectomy.The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.
The value of COPD Assessment Test in Screening Anxiety and Depression in stable COPD patients
Authors: Liu Meishan , Li Yuna , Yin Danfeng , Wang Ying , Fu Tingting , Zhu Zhaomeng , Zheng Chunming , Huang Kewu
Published: June 2022

Background
Anxiety and depression are common comorbidities in COPD patients but are often under-diagnosed. We aimed to assess the value of the COPD Assessment Test (CAT) in identifying anxiety and depression from patients with COPD.
Methods
Stable COPD patients were recruited in this cross-sectional observational study between December 2016 and January 2021. The demographic characteristics and the CAT score were recorded. Anxiety was measured using Generalized Anxiety Disorder Questionnaire (GAD)-7. Depression was measured by Patient Health Questionnaire (PHQ)-9. Logistic regression analysis and receiver operating characteristic curve analysis were performed to identify factors associated with anxiety or depression and to calculate the predictive values.
Results
A total of 530 stable COPD patients were enrolled and of those the proportion of anxiety and depression were 17.0% and 21.5%, respectively. The CAT score correlated well with the GAD-7 score (r = 0.339, P < 0.001) and PHQ-9 score (r = 0.435, P < 0.001). The adjusted odds ratios of the CAT for the presence of anxiety and depression were 1.094 (95% CI: 1.057–1.131) and 1.143 (95% CI: 1.104–1.183), respectively. The CAT score demonstrated a good performance in identifying anxiety and depression with area under curves (AUCs) of 0.709 and 0.791, respectively. Among CAT items, analysis further showed that non-respiratory CAT components were superior to respiratory components in identifying both anxiety and depression.
Conclusions
The CAT score might be valuable in screening anxiety and depression in stable COPD patients. However, the screening value should be further evaluated using the diagnostic criteria for anxiety and depression in the future.
Trial registration:
Clinicaltrials.gov (NCT03044847); 07/02/2017.
Fiscal autonomy of subnational governments and equity in healthcare resource allocation: evidence from China
Authors: Yang Ciran , Cui Dan , Yin Shicheng , liu Xiaojun , Yang Ying , Ke Xinfeng , Teng Caixia , Xu Luxinyi , Sun Yixuan
Published: June 2022

Background: Promoting equity in healthcare resource allocation (EHRA) has become a critical political agenda of governments at all levels since the ambitious Universal Health Coverage was launched in China in 2009, while the role of an important institutional variable -- fiscal autonomy of subnational governments -- is often overlooked. The present study was designed to determine the effect of FASG on EHRA and its potential mechanism of action and heterogeneity characteristics to provide empirical support for the research field expansion and relative policies making of EHRA.Methods: From the start, we utilized the Theil index and the entropy method to calculate the EHRA index of 22 provinces (2011-2020) based on the medical resource data of 287 prefecture-level cities. Furthermore, we used the two-way fixed effects model (FE) to identify and analyze the impact of FASG on EHRA and then used three robustness test strategies and two-stage least squares (2SLS) regression to verify the reliability of the conclusions and deal with potential endogeneity problems respectively. At last, we extend the baseline regression model and obtain the two-way FE threshold model for conducting heterogeneity analysis, which makes us verify whether the baseline model has nonlinear characteristics. Results: The static value and the trend of interannual changes in the EHRA values in different provinces are both very different. The regression results of the two-way FE model show that FASG has a significant positive impact on EHRA, and the corresponding estimated coefficient is -0.0849 (P < 0.01). Moreover, this promotion effect can be reflected through two channels: enhancing the intensity of government health expenditure (IGHE) and optimizing the allocation of human resources for health (AHRH). At last, under the different economic and demographic constraints, the impact of FASG on EHRA has nonlinear characteristics, i.e., after crossing a specific threshold of per capita DGP (PGDP) and population density (PD), the promotion effect is reduced until it is not statistically significant, while after crossing a particular threshold of dependency ratio (DR), the promotion effect is further strengthened and still statistically significant.Conclusions: FASG plays an essential role in promoting EHRA, which shows that subnational governments need to attach great importance to the construction of fiscal capability in the allocation of health care resources, effectively improve the equity of medical and health fiscal expenditures, and promote the sustainable improvement of the level of EHRA.
Validation of a novel iPhone application for evaluating near functional visual acuity
Authors: Hanyuda Akiko , Kubota Miyuki , Kubota Shunsuke , Masui Sachiko , Yuki Kenya , Tsubota Kazuo , Negishi Kazuno
Published: June 2022

Monitoring dynamic changes in near vision is important for early detection of presbyopia. This study assessed the accuracy and reliability of a new smartphone-based application, the Smart Vision Check (SVC), compared with those of a conventional device (AS-28; Kowa, Aichi, Japan), for measuring near functional visual acuity (NFVA). We enrolled 115 healthy volunteers aged ≥ 20 years with bilateral best-corrected visual acuity of ≥ 20/25. The SVC was designed for use on an Apple iPhone SE2 to measure NFVA by tapping on the orientation icon manually. Conventional FVA testing was measured by the AS-28 with − 2.50 D added to the best distance correction at baseline. There was no significant difference of NFVA-related measurements between the AS-28 and the SVC (P > 0.05). The Spearman correlation coefficients of NFVA measurements between the two devices were over 0.60 (P < 0.001). The Bland-Altman plot indicated minimal bias with limits of agreements of ± 0.34 logMAR for NFVA with habitual correction when comparing the AS-28 and the SVC. The intraclass correlation coefficients of the repeated SVC-measured NFVA was 0.915 (95% CI, 0.800–0.969). In summary, the SVC has sufficient validity and reproducibility for evaluating NFVA and may improve early detection and management of presbyopia in an affordable and accessible manner.
Trends of inequalities of avoidable mortality among children in Colombia: A group-based trajectory analysis
Authors: Rojas-Botero Maylen Liseth , Fernández Julián Alfredo , Borrero-Martinez Yadira Eugenia
Published: June 2022

Background
In the last years, Colombia has improved most of the mayor health indicators, however, some inequalities –as those related with child health– remain over time; understanding the historical behavior of health inequalities, allows to evidence structural and persistent social inequalities that explain these trends. This study aims to describe territorial inequalities in child health among departments and municipalities of Colombia between 2000 and 2018, throughout the analysis of trajectories of under-five avoidable mortality rate.
Methods
We carried out a longitudinal and multi-group ecological study. We analyzed the longitudinal dynamics of avoidable mortality of Colombian under-five children by applying group-based trajectory approach and taking the Colombian departments and municipalities over time as analysis units.
Results
We included all the 33 departments and 1 118 municipalities in 19 years. The avoidable mortality rate in under-five children (AMRC) in the first and last year of follow-up was 23.3 and 12.2 deaths per thousand live births (lb), respectively. We identified three different trajectories of avoidable mortality at the department level: a best (57.6%; AMRC: 20.7–10.5 per thousand lb), moderate (30.3%; AMRC: 31.9–15.9) and worst trajectory (12.1%; AMRC: 56.4 − 26.9). We described the common characteristics of the departments within each identified group. At the municipality level we found five different trajectories, the worst had the greater reduction, but it was not enough to close the gap. We also found different trajectories when amenable, preventable, and mixed avoidable under-five mortality were analyzed among departments and municipalities.
Conclusions
The gaps in avoidable child mortality among departments and municipalities in Colombia have been reduced, however, territorial disparities persist over time, mainly in amenable mortality through timely and quality medical care. Those trajectories express inequities in child survival originated from the socioeconomic, political and health system determinants in Colombian territories.