bluuebunny/crossref_metadata_2025 huggingface dataset:
Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study
Authors: Wallin Amanda Regodón , Tielsch James M , Khatry Subarna K , Mullany Luke C , Englund Janet A , Chu Helen , LeClerq Steven C , Katz Joanne
Published: October 2019

Background: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite (NVP) during pregnancy on birth outcomes in rural Nepal. Methods: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Symptoms of NVP were recorded monthly throughout pregnancy; exposure was defined as NVP at any point during pregnancy and by trimester. Adverse outcomes were low birth weight (LBW), preterm birth, and small for gestational age (SGA). Adjusted relative risk (RR) with 95% CIs is reported from Poisson regressions with robust variance. Results: Among 3,623 pregnant women, the prevalence of NVP was 49.5% (n=1793) any time during pregnancy and 60.6% (n=731) in the first trimester. Significantly higher RRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower RR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher RRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions: NVP during pregnancy is associated with birth outcomes in a setting with limited resources, especially beyond the first trimester. Trial registration: ClinicalTrials.gov number (NCT01034254) Keywords: Nausea and vomiting in pregnancy, adverse birth outcomes, pregnancy, birthweight, low birth weight, small for gestational age, preterm birth, Nepal
Identity Matters - Perceptions of Inter- and Intra-Professional Feedback in the Context of Workplace-based Assessment in Diabetology Training: A Qualitative Study
Authors: Feller Katrin , Berendonk Christoph
Published: October 2019

Background: Inter-professional collaboration is acknowledged as essential for quality patient-care. However, little is known about receptiveness to inter-professional feedback in the postgraduate training. This study explores, in light of social identity theory, the perceptions of residents, supervising physicians and allied health care professionals regarding inter- and intra-professional feedback in the context of workplace-based assessment. Methods: For six months, residents in diabetology at the University Hospital of Bern performed formative workplace-based assessments under direct observation of a supervising physician and an allied health care professional. Feedback from both observers was given to the resident after every assessment. Subsequently, focus group discussions were conducted to collect the participants’ perceptions of inter- and intra-professional feedback. Transcripts were analyzed qualitatively using a thematic analysis approach. Results: We identified four main themes: (1) Identity and hierarchy; (2) Interdependence of feedback source and feedback content; (3) Impact on collaboration and patient-care; (4) Logistical and organizational requirements. While different social identities are the source of inter-professional hierarchies, they did not impede the receptiveness to feedback. Perceived trustworthiness of the feedback was attributed with more importance than professional affiliations, whereas intra-professional hierarchies between physicians led to the perception of a more summative nature of the feedback and rather impeded receptiveness. According to the participants, inter-professional feedback raised awareness of the working reality of other team members and had a positive impact on communication between the different professional groups. Moreover, participants reported positive response from patients regarding the inter-professional collaboration they experienced. Considerable organizational effort is required to enable the parallel observation of a resident’s consultation by a supervising physician and an allied health care professional. Conclusions: Feedback from allied health care professionals can be a powerful learning resource for residents, given its role outside the sometimes conflicting area of intra-professional hierarchies. Inter-professional feedback in the context of workplace based assessment carries the potential to strengthen collaboration between the different professional groups and to improve patient care.
Integration of a Kalman filter in the geographically weighted regression for modeling the transmission of hand, foot and mouth disease
Authors: Hu Bisong , Qiu Wenqing , Xu Chengdong , Wang Jinfeng
Published: October 2019

Background: Hand, foot and mouth disease (HFMD) is a common infectious disease whose mechanism of transmission continues to remain a puzzle for researchers. The measurement and prediction of the HFMD incidence can be combined to improve the estimation accuracy, and provide a novel perspective to explore the spatiotemporal patterns and determinant factors of an HFMD epidemic. Methods: In this study, we collected weekly HFMD incidence reports for a total of 138 districts in Shandong province, China, from May 2008 to March 2009. A Kalman filter was integrated with geographically weighted regression (GWR) to estimate the HFMD incidence. Spatiotemporal variation characteristics were explored and potential risk regions were identified, along with quantitatively evaluating the influence of meteorological and socioeconomic factors on the HFMD incidence. Results: The results showed that the average error covariance of the estimated HFMD incidence by district was reduced from 0.3841 to 0.1846 compared to the measured incidence, indicating an overall improvement of over 50% in error reduction. Furthermore, three specific categories of potential risk regions of HFMD epidemics in Shandong were identified by the filter processing, with manifest filtering oscillations in the initial, local and long-term periods, respectively. Amongst meteorological and socioeconomic factors, the temperature and number of hospital beds per capita, respectively, were recognized as the dominant determinants that influence HFMD incidence variation. Conclusions: The estimation accuracy of the HFMD incidence can be significantly improved by integrating a Kalman filter with GWR and the integration is effective for exploring spatiotemporal patterns and determinants of an HFMD epidemic. Our findings could help establish more accurate HFMD prevention and control strategies in Shandong. The present study demonstrates a novel approach to exploring spatiotemporal patterns and determinant factors of HFMD epidemics, and it can be easily extended to other regions and other infectious diseases similar to HFMD.
Residential Radon Exposure and Cigarette Smoking in Association with Lung Cancer: a Matched Case-control Study in Korea
Authors: Park Eung Joo , Lee Hokyou , Kim Hyeon Chang , Sheen Seung soo , Koh Sang Baek , Park Ki Soo , Cho Nam Han , Lee Cheol-Min , Kang Dae Ryong
Published: October 2019

Background: Residential radon exposure and cigarette smoking are the two most important risk factors for lung cancer. The combined effects thereof were evaluated in a multi-center matched case-control study in South Korea.Methods: A total of 1,038 participants were included, comprising 519 non-small cell lung cancer cases and 519 age- and sex- matched community-based controls. Residential radon levels were measured for all participants. Multivariate logistic regression was used to calculate odds ratios (OR) for lung cancer according to radon exposure (high ≥100 Bq/m3 vs. low <100 Bq/m3), smoking status, and combinations of the two after adjusting for age, sex, indoor hours, and other housing information.Results: The median age of the participants was 64 years, and 51.3% were women. The adjusted ORs (95% confidence intervals [CIs]) for high radon and cigarette smoking were 1.56 (1.03-2.37) and 2.53 (1.60-3.99), respectively. When stratified according to combinations of radon exposure and smoking status, the adjusted ORs (95% CIs) for lung cancer in high-radon non-smokers, low-radon smokers, and high-radon smokers were 1.40 (0.81-2.43), 2.42 (1.49-3.92), and 4.27 (2.14-8.52), respectively, with reference to low-radon non-smokers.Conclusion: Both residential radon and cigarette smoking were associated with increased odds for lung cancer, and the difference in ORs according to radon exposure was much greater in smokers than in non-smokers.
A qualitative analysis of junior doctors’ journeys to preparedness in acute care
Authors: Burridge Samuel , Shanmugalingam Thurkaa , Nawrozzadeh Fatima , Leedham-Green Kathleen , Sharif Amar
Published: October 2019

Background New doctors are expected to assess and manage acutely deteriorating patients from their first days in the hospital. However, current evidence suggests that medical graduates are not prepared for this. We aimed to explore junior doctors’ first experiences with unwell patients and how they developed preparedness over time. Methods We conducted seven semi-structured interviews with doctors in their first postgraduate year. The interview transcripts underwent inductive thematic analysis using consensual qualitative research approaches. Themes identified were categorised into early experiences of unpreparedness and first experiences of genuine preparedness. Reflection on how participants progressed between the two was facilitated through a sorting and ranking exercise. Results Most participants initially felt unprepared when responding to acutely unwell patients. They described feeling overwhelmed, apprehensive and challenged. Two main challenges involved knowing when to escalate, and feeling expected to perform beyond their level of competency. A lack of acute care exposure at medical school was a common thread. All participants felt prepared to respond to unwell patients three to six months after starting work. Hands-on experience, reflection, simulation and multidisciplinary team-working were consistently ranked as the most useful learning experiences. Conclusions Starting work as a doctor is a challenging time and preparedness to manage an acutely deteriorating patient is a common area of concern. Given our findings and because preparedness in acute care ranks poorly compared to other outcomes, we see this as an important area for improvement. We suggest increasing the duration and intensity of shadowing in acute care, with opportunities for scaffolded clinical decision making.
Surgical site infection prevalence and associated factors in Hawassa University comprehensive specialized hospital, southern Ethiopia.
Authors: Deribe Bedilu , Jemebere Wegene , Bekele Gezahegn
Published: October 2019

Background Surgical site infections (SSIs) continue the main problem in health care facilities, causing the prolonged length of stay, considerable morbidity, mortality, and the extra cost to patients after surgery. The aim of this study was to determine the prevalence of SSIs and explore its associated factors among surgical patients at Hawassa university comprehensive specialized hospital, southern Ethiopia.Methods A hospital-based cross-sectional study design was conducted among post-operative patients on a sample of 281 who were admitted and have had surgery from 1 March – 1 April 2019. Purposive sampling technique and the structured questioner were selected to gather data from the patient's medical record, interview, and observation. EPI Info 3.5.4 was a data entry software and SPSS version 20.0 was selected for analysis. Associations among variables were assessed by binary logistic regression.Result A total of 281 patients have participated and the mean age was 30.3 (±18.9) years. The prevalence of SSIs was (24.6%) (95% CI 19.6 – 29.69). Age less than 15 years AOR = 0.131 (95% CI 0.020, 0.087), having clean surgical wound AOR = 0.006 (95% CI 0.002, 0.024) were significant protective associated factors to SSIs while having open surgical wound AOR =5.189 (95% CI 1.511, 17.821) and malnutrition AOR =29.351 (95% CI 5.711, 150.851) were significant risk associated factors to SSIs.Conclusion The prevalence of SSIs was bigger than the worldwide range between (1.2%) and (5.2%) even higher compared to reports from several developing countries. This needs exceptional attention to reduce the odds of surgical site infection by standardizing patient care and controlling of comorbidities.
Ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large accessory malleolar ossicles
Authors: Author) Yongxing Cao(Former Corresponding , Huang Qiang , Xu Yang , Hong Yuan , Author) Xiangyang Xu(New Corresponding
Published: October 2019

BackgroundAccessory malleolar ossicles are often found in patients with chronic ankle instability. For the large ossicles more than 10mm, there are still uncertainties about the suitable surgical option.This study was aimed at evaluating the clinical efficacy of ossicle resection and anatomic reconstruction of the lateral ligaments for chronic ankle instability with large accessory malleolar ossicles.MethodsSixteen chronic ankle instability patients with large accessory malleolar ossicles were treated with ossicle resection and anatomic reconstruction of lateral ligaments between December 2014 and February 2018. The clinical effects were evaluated with Visual Analogue Scale, Karlsson-Peterson ankle scoring system, and subjective satisfaction of patients. The varus talar tilt angle and anterior talar displacement between bony surfaces of the tibia and talus were included as radiographic parameters.ResultsThere were 11 males and 5 females in this study group. The average age at the time of surgery was 28.9 years old. The average final follow-up time was 26.9 months (range, 12 to 47). The average size of the ossicles was 11.7mm. The VAS score declined from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow up (p < 0.01). The Karlsson-Peterson score was significantly improved from 52.7 ± 15.1 before surgery to 86.4 ± 8.2 at the last follow up (p < 0.01). Radiologically, the average varus talar tilt angle was decreased from 15.4 ± 2.0 degrees preoperatively to 6.2 ± 1.6 degrees at the final follow up (p < 0.01), and the average anterior talar displacement was decreased from 14.3 ± 2.1 mm preoperatively to 6.3 ± 1.4 mm at final follow up (p < 0.01). Fourteen patients (87.5%) were satisfied (‘excellent’ or ’good’) with treatment outcome.ConclusionsOssicle resection and anatomic reconstruction of the lateral ligaments provided good clinical outcomes for chronic ankle instability with large accessory malleolar ossicles. This method appears to be one of the reliable and effective procedures for the treatment of chronic ankle instability with large accessory malleolar ossicles.
Cardiovascular magnetic resonance 4D flow analysis has a higher diagnostic yield than Doppler echocardiography for detecting increased pulmonary artery pressure
Authors: Ramos João G. , Fyrdahl Alexander , Wieslander Björn , Reiter Gert , Reiter Ursula , Jin Ning , Maret Eva , Eriksson Maria , Caidahl Kenneth , Sörensson Peder , Sigfridsson Andreas , Ugander Martin
Published: October 2019

Background: Pulmonary hypertension is definitively diagnosed by the measurement of mean pulmonary artery (PA) pressure (mPAP) using right heart catheterization. Cardiovascular magnetic resonance (CMR) four-dimensional (4D) flow analysis can estimate mPAP from blood flow vortex duration in the PA, with excellent results. Moreover, the peak systolic tricuspid regurgitation (TR) pressure gradient (TRPG) measured by Doppler echocardiography is commonly used in clinical routine to estimate systolic PA pressure. This study aimed to compare CMR and echocardiography with regards to quantitative and categorical agreement, and diagnostic yield for detecting increased PA pressure. Methods: Consecutive clinically referred patients (n=60, median [interquartile range] age 60 [48–68] years, 33% female) underwent echocardiography and CMR at 1.5T (n=43) or 3T (n=17). PA vortex duration was used to estimate mPAP using a commercially available time-resolved multiple 2D slice phase contrast three-directional velocity encoded sequence covering the main PA. Transthoracic Doppler echocardiography was performed to measure TR and derive TRPG. Diagnostic yield was defined as the fraction of cases in which CMR or echocardiography detected an increased PA pressure, defined as vortex duration ≥15% of the cardiac cycle (mPAP ≥25 mmHg) or TR velocity >2.8 m/s (TRPG >31 mmHg). Results: Both CMR and echocardiography showed normal PA pressure in 39/60 (65%) patients and increased PA pressure in 9/60 (15%) patients, overall agreement in 48/60 (80%) patients, kappa 0.49 (95% confidence interval 0.27-0.71). CMR had a higher diagnostic yield for detecting increased PA pressure compared to echocardiography (21/60 (35%) vs 9/60 (15%), p<0.001). In cases with both an observable PA vortex and measurable TR velocity (34/60, 56%), TRPG was correlated with mPAP (R 2 =0.65, p<0.001). Conclusions: There is good quantitative and fair categorical agreement between estimated mPAP from CMR and TRPG from echocardiography. CMR has higher diagnostic yield for detecting increased PA pressure compared to echocardiography, potentially due to a lower sensitivity of echocardiography in detecting increased PA pressure compared to CMR, related to limitations in the ability to adequately visualize and measure the TR jet by echocardiography. Future comparison between echocardiography, CMR and invasive measurements are justified to definitively confirm these findings.
Microscopic Ileitis in Clinically Suspected Inflammatory Bowel Disease Patients- Can It Predict the Future?
Authors: Baker Fadi Abu , Garza Jesus Alonso Z'cruz De La , Nafrin Smadar , Mari Amir , Suki Muhammed , Ovadia Baruch , Gal Oren , Kopelman Yael
Published: October 2019

Background: The implication of microscopic ileitis finding in patients referred for ileocolonoscopy for clinically suspected inflammatory bowel disease is not well defined and its correlation with clinical outcome has not been fully studied. The current study aims to determine the prognostic yield of biopsies in this setting, and to evaluate the correlation of microscopic ileitis with long-term clinical outcome. Methods: Endoscopic reports of patients referred to our department for ileocolonoscopy in the years 2010-2016, as part of a diagnostic work-up for suspected IBD were revised. Patients with normal ileocolonoscopy were included, provided that terminal ileum biopsies were performed. Accordingly, patients were divided into normal (normal or reactive changes) and microscopic ileitis (inflammation or ileitis of any severity) groups. Both groups were followed prospectively to determine clinical outcome. Results: 439 patients met the inclusion criteria. 64 (14.6%) had inflammation on biopsy and were included in the microscopic ileitis group. Age and gender didn't differ significantly between groups. Overall follow up period was 6.1±2.3 years. Patients in the microscopic ileitis group were significantly associated with Crohn's diagnosis during follow-up period compared to normal (19% vs 2%, OR=11.98, 95%CI=4.48-32.01; p<0.01). Patients with granuloma or moderate-severe ileitis on biopsy were significantly associated with Crohn's development (100% vs 11%; P<0.01) compared to mild or nonspecific inflammation. Conclusion: Microscopic ileitis finding in clinically suspected IBD is associated with increased risk of future diagnosis of crohn's disease.
What Explains the Regional Variation in the Use of General Practitioners in Australia?
Authors: Mu Chunzhou , Hall Jane
Published: October 2019

Background: Regional variation in the use of health care services is widespread. Identifying and understanding the sources of variation and how much variation is unwarranted can inform policy interventions to improve the efficiency and equity of health care delivery. Methods: We examined the regional variation in the use of general practitioners (GPs) using data from the Social Health Atlas of Australia by Statistical Local Area (SLAs). 756 SLAs were included in the analysis. The outcome variable of GP visits per capita by SLAs was regressed on a series of demand-side factors measuring population health status and demographic characteristics and supply-side factors measuring access to physicians. Each group of variables was entered into the model sequentially to assess their explanatory share on regional differences in GP usage. Results: Both demand-side and supply-side factors were found to influence the frequency of GP visits. Specifically, areas in urban regions, areas with a higher percentage of the population who are obese, who have profound or severe disability, and who hold concession cards, and areas with a smaller percentage of the population who reported difficulty in accessing services have higher GP usage. The availability of more GPs led to higher use of GP services while the supply of more specialists reduced use. 30.56% of the variation was explained by medical need. Together, both need-related and supply-side variables accounted for 32.24% of the regional differences as measured by the standard deviation of adjusted GP-consultation rate. Conclusions: There was substantial variation in GP use across Australian regions with only a small proportion of them being explained by population health needs, indicating a high level of unwarranted clinical variation. Supply factors did not add a lot to the explanatory power. There was a lot of variation that was not attributable to the factors we could observe. This could be due to more subtle aspects of population need or preferences and therefore warranted. However, it could be due to practice patterns or other aspects of supply and be unwarranted. Future work should try to explain the remaining unexplained variation.
Motivations, experiences and aspirations of Trainee Nursing Associates in England. A qualitative study
Authors: King Rachel Louise , Wood Emily , Robertson Steve , Ryan Tony , Tod Angela
Published: October 2019

Background The nursing associate role was developed in England in response to the ‘Shape of Caring’ review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of national workforce shortages. Other high income countries successfully deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who embark on the new nursing associate training course, or their perceptions of the experience.Methods An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations. Three focus groups (n=15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was managed using Quirkos software v 1.5.2 and analysed thematically.Findings This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity.Conclusion The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The findings increase our understanding of this emerging role, and inform the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role.
Knowledge Of Glaucoma And Associated Factors Among Adults In Gish Abay Town, Northwest Ethiopia
Authors: Bizuneh Zewdu Yenegeta , Tsega Ayanaw , Addis Yezinash , Admassu Fisseha
Published: October 2019

Introduction Glaucoma is a global public health problem and it is the leading cause of irreversible blindness worldwide and the fifth cause of blindness in Ethiopia. Even though public knowledge of glaucoma is a key for early case identification and prevention of blindness, it is unknown in the study area, making provision of interventions difficult. Objective: To assess knowledge of glaucoma and associated factors among adults in Gish Abay town, Northwest Ethiopia, 2018 Methods: A Community based cross - sectional study design with systematic random sampling technique was used to select 630 adults. The study was conducted from April 25-May 05, 2018. Data was entered into Epi Info version 7 and was analysed by Statistical Package for Social Sciences version 23. Binary logistic regression model and adjusted odds ratio with 95% confidence level was used to identify the significant factors associated with knowledge of glaucoma. P–value ≤ 0.05 was considered statistically significant. Results: About 594 adults were participated with a response rate of 94%. Nearly 52% of the participants were females with median age of 28 years. The proportion of good knowledge was demonstrated in 68.9% [95% CI; 61, 75.9]. Educational status: secondary education [AOR; 4.01: 1.15, 13.94], college and above [AOR; 4.49: 1.31, 15.32], history of eye examination [AOR; 2.86: 1.05, 7.79] and younger age (18-22) [6.39: 1.82, 22.41] were positively associated with good knowledge of glaucoma. Conclusion and recommendation: The proportion of good knowledge of glaucoma was high. Better educational status, younger age, eye examination at least once in life and higher income level were associated with better knowledge of glaucoma. Recognizing the severity of glaucoma, enhancing knowledge is paramount at the community.
Identifying appropriate outcomes to help evaluate the impact of the Canadian Guideline for Safe and Effective Use of Opioids for Non-Cancer Pain
Authors: Allen Michael , Sproule Beth , MacDougall Peter , Furlan Andrea , Murphy Laura , Debono Victoria Borg , Buckley Norman
Published: October 2019

Background: The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes .
Methods: A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes.
Results: Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient’s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient’s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases.

Conclusion: Measuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.
Effects of Different Doses of Magnesium Sulfate on Pneumoperitoneum-related Hemodynamic Changes in Patients Undergoing Gastrointestinal Laparoscopy
Authors: Tan Wei , Qian Dong-chen , Zheng Meng-meng , Lu Xuan , Han Yuan , Qi Dun yi
Published: October 2019

Background: The infusion of magnesium sulfate is well known to reduce arterial pressure and attenuate hemodynamic response to pneumoperitoneum. This study aimed to investigate whether different doses of magnesium sulfate can effectively attenuate the pneumoperitoneum-related hemodynamic changes and the release of vasopressin in patients undergoing laparoscopic gastrointestinal surgery.
Methods: Sixty-nine patients undergoing laparoscopic partial gastrectomy were randomized into three groups: group L received magnesium sulfate 30 mg/kg loading dose and 15 mg/kg/h continuous maintenance infusion for 1 h; group H received magnesium sulfate 50 mg/kg followed by 30 mg/kg/h for 1 h; and group S (control group) received same volume 0.9% saline infusion, immediately before the induction of pneumoperitoneum. Systemic vascular resistance (SVR), cardiac output (CO), mean arterial pressure (MAP), heart rate (HR), central venous pressure(CVP), serum vasopressin and magnesium concentrations were measured. The extubation time, visual analogue scale were also assessed. The primary outcome is the difference in SVR between different groups. The secondary outcome is the differences of other indicators between groups, such as CO, MAP, HR, CVP, vasopressin and postoperative pain score.
Results: Pneumoperitoneum instantly resulted in a significant reduction of cardiac output and an increase in mean arterial pressure, systemic vascular resistance, central venous pressure and heart rate in the control group (P < 0.01). The mean arterial pressure (T2 – T4), systemic vascular resistance (T2 – T3), central venous pressure(T3-T5) and the level of serum vasopressin were significantly lower (P < 0.05) and the cardiac output (T2 – T3) was significantly higher (P < 0.05) in group H than those in the control group. The mean arterial pressure (T4), systemic vascular resistance (T2), and central venous pressure(T3-T4) were significantly lower in group H than those in group L (P < 0.05). Furthermore, the visual analog scales at 5 min and 20 min, the level of vasopressin, and the dose of remifentanil were significantly decreased in group H compared to the control group and group L (P < 0.01).
Conclusion: Magnesium sulfate could safely and effectively attenuate the pneumoperitoneum-related hemodynamic instability during gastrointestinal laparoscopy and improve postoperative pain at serum magnesium concentrations above 2 mmol/L.
Comparison of marsupialization under nasal endoscopy versus lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases
Authors: Cui Yan-Hui , Sun Peng , Tang Li-Xing , Zhang Cheng-Yue , Wu Qian , Yu Gang , Li Li , Wei Wen-Bin
Published: October 2019

Background This study was performed to compare the efficacy of marsupialization under nasal endoscopy versus Lacrimal probing in the treatment of congenital dacryocystocele. Methods Forty neonates (43 eyes) diagnosed with congenital dacryocystoceles were divided into Group A (nasal endoscopic marsupialization) and Group B (Lacrimal probing). The patients were followed up for 1 year after surgery. The efficacy, incidence of complications, and reoperation rate were compared between the two groups. Results The male:female ratio was 25:15 patients (27:16 eyes). In Group A, the success rate was 100%, the incidence of complications was 5%, and the reoperation rate was 0%. In Group B, the success rate was 90%, the incidence of complications was 20%, and the reoperation rate was 30%. Conclusion Compared with Lacrimal probing, marsupialization under nasal endoscopy provides greater efficacy and safety for congenital dacryocystoceles.
Key words: Nasal endoscopy; Marsupialization; Lacrimal probing; Congenital dacryocystocele
The impact of sectorial and geographical segmentation on risk-based asset allocation techniques
Authors: Basile Ignazio , Ferrari Pierpaolo , Abate Guido
Published: October 2019

In the last decades, risk-based portfolio construction techniques have enjoyed a widespread diffusion in the financial community. This study aims at evaluating how these portfolio construction techniques produce different results depending on whether the segmentation of the stock market investment universe is based on sectorial or geographical criteria. An empirical analysis, applied on the global equity market, is carried out by making use of the typical and most advanced statistical and financial evaluation measures. Geographical segmentation is carried out in relation to the listing market, while sectorial segmentation is made in relation to the productive sectors to which individual companies belong. Our comparative analysis provides substantially coherent results, demonstrating a significant preference for the sectorial criterion compared to the geographic one. In conclusion, this result can be attributed to the subdivision of the investment universe into sectorial indices characterized by greater internal coherence and better external differentiation, in addition to the lower concentration of sectorial segmentation compared to the geographical one.
Financial instruments and innovations in business environment: European countries and Ukraine
Authors: Khalatur Svitlana , Stachowiak Zenon , Zhylenko Kateryna , Honcharenko Oksana , Khalatur Oleksandr
Published: October 2019

One of the most crucial tasks for the national economies development both in European countries and Ukraine is stimulating and ensuring sustainable economic growth. For this purpose, all states develop an innovative sphere and use financial different instruments. The aim of the article is determining the impact of financial instruments and innovations on business environment development of the national economy of Ukraine in comparison with European countries in order to create successful and effective business environment in Ukraine for foreign investments. The paper examines the impact of foreign direct investments and domestic loans on the Global Innovation Index 2018 using two-factor analysis of variance. The null hypothesis of an interaction effect (factor A (foreign direct investments, net inflows) and factor B (domestic loans of financial sector) doesn`t exert an interaction effect on result Y (Global Innovation Index)) was rejected. Also the combination of foreign indicators, direct investments and domestic loans has a significant impact on the Global Innovation Index. Practical recommendations should provide a comprehensive approach to assessing the use of financial instruments in order to encourage the investments. Thus, overcoming the uneven distribution of innovations and investments should provide using the global financial resources.
The relationship between sovereign credit rating and trends of macroeconomic indicators
Authors: Kotěšovcová Jana , Mihola Jiří , Budinský Petr
Published: October 2019

The sovereign credit rating provides information about the creditworthiness of a country and thereby serves as a tool for investors in order to make right decisions concerning financial assets worth investments. Thus, determination of a sovereign credit rating is a highly complex and challenging activity. Specialized agencies are involved in rating assessment. So, it’s essential to analyze the efficiency of their work and seek out easily accessible tools for generating assessments of such ratings. The objective of this article is to find out whether sovereign credit rating can be reliably estimated using trends of selected macroeconomic indicators, despite the fact that sovereign credit rating is most likely influenced by non-economic factors. This can be used for strategic considerations at national and multinational levels. The relationships between sovereign credit rating and the trends of macroeconomic indicators were examined using statistical methods, linear multiple regression analysis, cumulative correlation coefficient, and multicollinearity test. The data source used is comprised of selected World Bank indicators meeting the conditions of completeness and representativeness. The data set has shown a cumulative correlation coefficient value greater than 95%, however at 100% multicollinearity. This is followed by the gradual elimination of indicators, but even this did not allow achieving acceptable values. So, the conclusion is that rating levels are not explainable solely by the trends of economic indicators, but other influences, e.g. political. However, the fact that the statistical model yielded acceptable results for five and fewer indicators allowed a regression equation to be found that gives good estimates of a country’s rating. This allows, for example, predicting of ratings relatively easy by forecasting the development of selected macroeconomic indicators.
Analysis of spatial variability and temporal trends of rainfall in Amhara region, Ethiopia
Authors: Alemu Melkamu Meseret , Bawoke Getnet Taye
Published: October 2019

Understanding rainfall distribution in space and time is crucial for sustainable water resource management and agricultural productivity. This study investigated the spatial distribution and temporal trends of rainfall in Amhara region using time series rainfall data of Climate Hazards Group Infrared Precipitation with Stations (CHIRPS) for the period 1981–2017. Coefficient of variation, standardized anomaly index (SAI), precipitation concentration index (PCI) and seasonality index (SI) were used to evaluate rainfall variability and seasonality. Mann–Kendall's test was also employed for rainfall trend analysis. Results showed that the region has been experiencing variable rainfall events that cause droughts and floods over different years. SAI also witnessed the presence of inter-annual variability of rainfall with negative and positive anomalies in 59.46% and 40.54% of the analyzed years, respectively. PCI and SI results implied that the area had irregular and strong irregular rainfall distribution. Trend analysis results showed an overall increase in the annual and seasonal rainfall (except winter) during the study period. The information obtained from this study could serve as a proxy for rainfall variability and trend in the study area which might be used as input for decision-makers to take appropriate adaptive measures in various agricultural and water resources sectors.
Moda Tasarımcısı Issey Mıyake’nin Koleksiyonlarının Tasarım Ögeleri Bakımından İncelenmesi
Authors: Yıldız Şerife , Turunç Yasemen
Published: October 2019

Tasarım sözcüğü tasarı sözcüğünden türemiş olup bir konuda düşünme ve planlama
işinin ilk evresidir. Çevremizdeki her şeyde tasarım görmek mümkündür. Doğadaki
yaratılan her şeyde ya da insanoğlunun her ürettiğinde tasarım unsurunu görmek
mümkündür. Tasarım üretilen ürünün oluşumundaki ilk basamaklardan biri olup her
şeye derinden nüfus eder. Dolayısıyla tasarım üretilen her ürünün var olan her
şeyin ayrılmaz bir parçasıdır. Yıllar boyunca yaşam biçimleri ve teknolojiye göre
tasarlama işi değişmiş olsa da sürekliliğini her zaman korumuştur. Tasarım
yapabilmek bazı ilke ve ögeleri uygulamaktan geçmektedir. Tasarım ögeleri
tasarlama işinde kullanılan kuralları ifade etmektedir. Tasarım ögeleri tasarımda
dengeyi sağlamak için ortaya koyulmuş bir takım unsurları içerir. Bu unsurlar;
nokta, çizgi, form-biçim, doku, renk ve valör’dür. Bu unsurların dengeli kullanımı
tasarımı estetik ve işlevsel yapabilir. Tasarım ögeleri aslında tasarımda estetiği
yakalamak için oluşturulan bilgi aktarımıdır. Bu araştırmada tasarım ögelerinin giysi
tasarımlarında nasıl kullanıldığına ilişkin bir çalışma yapılmıştır. Araştırmanın
konusu Japon moda tasarımcı olan Issey Miyake’nin koleksiyonlarında yer alan
giysilerin tasarım öğeleri bakımından incelenmesi olarak planlanmıştır. Moda
dünyasında, Batı dışından kabul edilen ilk kimlik olarak Japon moda
tasarımcılarından biri olan Issey Miyake’nin, kendi bireyselliklerinden çok, ulusal
kültürlerini ve değerlerini bir bütün olarak sunmasıyla birlikte Paris’in moda
dünyasındaki uluslararası ününe kavuşmuştur. Araştırmada, Issey Miyake’nin 1980
– 1985 yılları arasında hazırlamış olduğu koleksiyonlarından yargısal örneklem
yöntemi ile her yıldan 1 giysi seçilmiş ve giysilerin tasarım ögeleri bakımından
incelenmesi yapılmıştır. Ayrıca o dönemlerde modayı şekillendiren faktörler ve
bahsedilen moda tasarımcısının tasarımlarına değinmek amaçlanmıştır. Bu
doğrultuda koleksiyondaki giysileri incelemek için inceleme formu oluşturulmuştur.
İnceleme formunda; çizgi, form-biçim, doku ve renk-valör tasarım öğelerine yer
verilmiş ve giysiler bu bağlamda incelenmiştir. Araştırmadan elde edilen bulgulara
göre Japon moda tasarımcısı Issey Miyake’nin giysiyi vücut formuna uydurma
çabası gütmeden tasarım yaptığı, rahat hareket etme imkanı sunan , genellikle tek
renkten oluşan ve asimetrik çizgiyi benimsemiş olduğu, ayrıca tasarımcının vücuda
göre değil, kumaş formuna göre şekillenen tasarım anlayışı ile giysilerini tasarladığı
görülmüştür.
Synthesis, Molecular Docking, and In Vitro Investigation of 1,1'-Diaryl- 3,3'-(p-phenylenedicarbonyl) dithioureas as Urease Inhibitors
Authors: Rafique Hummera , Tahira Fizza , Afshan Syeda Zar , Naseem Muhammad , Kausar Naghmana , Saeed Aamer , Sharif Muhammad
Published: October 2019

Synthesis of some 1,1'-diaryl-3,3'-(p-phenylenedicarbonyl)dithioureas was accomplished in two steps. Dithioureas were prepared under inert conditions with significantly high yields. Inhibitory activity of dithiourea compounds was investigated against urease enzyme. All the synthesized compounds were evaluated for their urease inhibitory activities, and molecular docking studies were carried out to ascertain the inhibitor binding mode with the enzyme. All the compounds displayed moderate to significant urease inhibitory activities.
Use of Web Conferencing Technology for Conducting Online Focus Groups Among Young People With Lived Experience of Suicidal Thoughts: Mixed Methods Research
Authors: Han Jin , Torok Michelle , Gale Nyree , Wong Quincy JJ , Werner-Seidler Aliza , Hetrick Sarah E , Christensen Helen
Published: October 2019

Background

There is an increasing interest in engaging people with lived experience in suicide prevention research. However, young people with suicidal thoughts have been described as a “hard-to-include” population due to time, distance, stigma, and social barriers.

Objective

This study aims to investigate whether conducting synchronous Web conferencing technology–based online focus groups (W-OFGs) is a feasible method to engage young people with lived experience of suicidal thoughts in suicide prevention research.

Methods

Young people aged between 16 and 25 years and living in Sydney, Australia, were recruited through flyers, emails, and social media advertisements. The W-OFGs were established using a Web conferencing technology called GoToMeeting. Participants’ response rate, attendance, and feedback of the W-OFGs were analyzed to determine whether the W-OFG system is feasible for suicide prevention research. Researchers’ reflections about how to effectively implement the W-OFGs were also reported as part of the results.

Results

In the pre–W-OFG survey, 39 (97.5%) young people (n=40) chose to attend the online focus group. Among the 22 participants who responded to the W-OFG invitations, 15 confirmed that they would attend the W-OFGs, of which 11 participants attended the W-OFGs. Feedback collected from the participants in the W-OFG and the post–W-OFG survey suggested that online focus groups are acceptable to young people in suicide prevention research. Considerations for selecting the Web conferencing platform, conducting the mock W-OFGs, implementing the risk management procedure, inviting participants to the W-OFGs, and hosting and moderating the W-OFGs as well as a few potential ethical and pragmatic challenges in using this method are discussed in this study.

Conclusions

The Web conferencing technology provides a feasible replacement for conventional methods, particularly for qualitative research involving vulnerable populations and stigmatized topics including suicide prevention. Our results indicate that this modality is an optimal alternative to engage young people in the focus group discussion. Future studies should compare the data collected from the Web conferencing technology and conventional face-to-face methods in suicide prevention research to determine if these two methods are equivalent in data quality from a quantitative approach.
Developing Effective Methods for Electronic Health Personalization: Protocol for Health Telescope, a Prospective Interventional Study (Preprint)
Authors: Willemse Bastiaan Johannes Paulus Cornelis , Kaptein Maurits Clemens , Hasaart Fleur
Published: October 2019

BACKGROUND

Existing evaluations of the effects of mobile apps to encourage physical activity have been criticized owing to their common lack of external validity, their short duration, and their inability to explain the drivers of the observed effects. This protocol describes the setup of Health Telescope, a longitudinal panel study in which the long-term effects of mobile electronic health (eHealth) apps are investigated. By setting up Health Telescope, we aim to (1) understand more about the long-term use of eHealth apps in an externally valid setting, (2) understand the relationships between short-term and long-term outcomes of the usage of eHealth apps, and (3) test different ways in which eHealth app allocation can be personalized.

OBJECTIVE

The objectives of this paper are to (1) demonstrate and motivate the validity of the many choices that we made in setting up an intensive longitudinal study, (2) provide a resource for researchers interested in using data generated by our study, and (3) act as a guideline for researchers interested in setting up their own longitudinal data collection using wearable devices. For the third objective, we explicitly discuss the General Data Protection Regulation and ethical requirements that need to be addressed.

METHODS

In this 4-month study, a group of approximately 450 participants will have their daily step count measured and will be asked daily about their mood using experience sampling. Once per month, participants will receive an intervention containing a recommendation to download an app that focuses on increasing physical activity. The mechanism for assigning recommendations to participants will be personalized over time, using contextual data obtained from previous interventions.

RESULTS

The data collection software has been developed, and all the legal and ethical checks are in place. Recruitment will start in Q4 of 2020. The initial results will be published in 2021.

CONCLUSIONS

The aim of Health Telescope is to investigate how different individuals respond to different ways of being encouraged to increase their physical activity. In this paper, we detail the setup, methods, and analysis plan that will enable us to reach this aim.

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/16471