bluuebunny/crossref_metadata_2025 huggingface dataset:
Stacks of Azobenzene Stars: Self-Assembly Scenario and Stabilising Forces Quantified in Computer Modelling
Authors: Savchenko Vladyslav , Koch Markus , Pavlov Aleksander S. , Saphiannikova Marina , Guskova Olga
Published: November 2019

In this paper, the columnar supramolecular aggregates of photosensitive star-shaped azobenzenes with benzene-1,3,5-tricarboxamide core and azobenzene arms are analysed theoretically applying a combination of computer simulation techniques. Without a light stimulus, the trans-stars build one-dimensional columns of stacked molecules during the first stage of the noncovalent association. These columnar aggregates represent the structural elements of more complex experimentally observed morphologies -- fibers, spheres, gels and others. Upon UV light exposure, the azobenzene arms isomerise from thermodynamically stable planar trans- to a metastable kinked cis-state influencing the aggregate morphology. Here, we determine the most favourable mutual orientations of the \textit{trans}-stars in the stack in terms of (i) the pi-pi distance between the cores lengthwise the aggregate, (ii) the star slipped displacements and (iii) the rotation promoting the helical twist and chirality of the aggregate by calculating the binding energy diagrams using density functional theory. The model predictions are further compared with available experimental data. The intermolecular forces responsible for the stability of the stacks made of trans-azobenzene stars in crystals are quantified using Hirshfeld surface analysis. Finally, to characterize the self-assembly mechanism of such stars in solution, we calculate the hydrogen bond lengths, the normalized dipole moment and the binding energies as the functions of the columnar length using molecular dynamics trajectories, and conclude about the cooperative nature of this process.
EXPERIMENTAL STUDY THE EFFECT ANGLE OF BLADE ON THE ELECTRICAL POWER OUTPUT OF PROPELLER PICOHYDRO TURBINE
Authors: Shalih Abdullah , Widodo Purwadi Joko , Himawanto Dwi Aries
Published: November 2019

This study aimed to analyze the effect of angle of blade on the horizontal flow to the performance of the propeller water turbine. The experiments were performed using several test parameters including the angle of blade on the variation mass flow rate of water. With potential head 2 meters and variated turbine blade angle to achieved optimal power generated.  The result showed that the variation of angle of blade with 300 angles and 11.6 l/s mass flow rate of water was the best variation to improve the performance of the propeller water turbine. The best variation can generated 32 Watt of electric power.
Pengaruh Kualitas Produk dan Kualitas Layanan terhadap Loyalitas Pelanggan PT. Roman Ceramic International di Mojokerto
Authors: Prastyo Habib Eko , Oetarjo Mas
Published: November 2019

This study aims to determine the effect of product quality and service quality to customer loyalty either partially or simultaneously, and to know the quality of product and service quality that has the most significant effect on customer loyalty at PT. Roman Ceramic International in Mojokerto. This research is done by quantitative method. The technique data used is questionnaires with a sample of 100 respondents. Data analysis technique used in this research is multiple linear regression using SPSS version 17 for windows. The results obtained based on the validity test show all existing questions are valid. This is done r count> r table. For reliability test can be concluded. The results of the research based on F test show the quality of the product and the quality simultaneous or together with customer loyalty. Test quality, product quality. Quality of service has the most significant influence on customer loyalty due to having the largest t arithmetic compared with product quality variables.
Need Analysis on The Inclusive English Materials for The Primary Graders: Voices from Practitioners
Authors: Mu'alimin Mu'alimin , Khoiriyah Khoiriyah , Qiptiah Devi Mariatul
Published: November 2019

This study is aimed at conducting a need analysis on the existence of English materials for the students of elementary level in an inclusive classroom. The data is obtained from inclusive teacher who has ELT undergraduate educational background and the students of pre-service training of PGMI at IAIN Jember. The result shows that teacher takes a very important role in conducting an inclusive classroom in primary level due to the fact that they have to prepare materials and activities specifically for the students who have social, emotional, and behavioral difficulties (SEBD). Listening and speaking skill (oracy cycle) are considered as the first skills to be taught and introduced to the students of primary level in order to be able to make interrelationship with others more easily. English materials that compatible with the students of primary level in an inclusive classroom are the materials that encourage their multiple intelligences and recognize their learning style. The teaching procedure is emphasized on the role play in the form of guided instruction flowing from fully guided, partly guided, to fully free learning so the scaffolding of presenting materials which emphasized on touching their feeling can improve their sense of empathy and sense of taking care of others as well as building their social skill.
Supervisi Akademik Pada Guru Sebagai Langkah Peningkatan Mutu Madrasah
Authors: Mu'alimin Mu'alimin , Sarwan Sarwan , Rosady Imron
Published: November 2019

This paper aims to examine the academic supervision of teachers as a step to improve the quality of madrasas. The teacher has an essential role in improving the quality of learning. Teacher quality will significantly affect the quality of knowledge and the resulting output. However, teachers must have capable abilities based on pedagogical, professional, social, and personality competencies. Academic supervision is a routine activity that must be carried out by supervisors and madrasa heads, so the role of supervisors to supervise and foster is very much needed. The part of supervisors is still not maximized in conducting supervision and coaching. This situation has an impact on the quality of teachers in the teaching and learning process, not only that it will affect the quality of madrasas.
Transient Wellbore-Pressure-Buildup Correlation Helps Engineers To Ensure HIPPS Safe Operation
Authors: Homoud Ahmed , Gajbhiye Rahul , Al-Shehri Dhafer
Published: November 2019

The objective of this study is to develop a correlation for transient wellbore-pressure buildup and relate it to the high-integrity pressure-protection system (HIPPS) response time in multiphase flow. The developed correlation gives an accurate estimate of the pressure buildup with time under shut-in conditions. It provides guidelines to set the HIPPS activation pressure considering different reservoir and wellbore parameters to ensure the safety and timely response of HIPPS.

The correlation was developed by performing transient simulations to calculate the wellbore-pressure-buildup time under shut-in conditions accounting for different reservoir and wellbore parameters. The input data were gathered from three oil fields with various fluid properties, reservoir pressures, productivity indices (PIs), depths, and shut-in wellhead pressures (SIWHPs). Before feeding the data to the dynamic flow simulator, the reservoir data were tuned to match the well-flow conditions. After completing the transient simulation for every well, the pressure-buildup data as a function of time were collected and used as input to develop a correlation using the nonlinear-regression method.

The results of this study show that the most influential parameters on the pressure-buildup behaviors are fluid compressibility, PI, flowing wellhead pressure (FWHP), and well measured depth (MD). In addition, we observed that there is a strong relationship between the fluid compressibility at FWHP condition and the time it takes to pressurize the wellbore to maximum pressure. The higher the fluid compressibility, the longer it takes the system to pressurize. The newly developed correlation provides a guideline for setting the HIPPS activation pressure and ensuring the wells’ safe operation.
Evaluation of venous pathology of the lower extremities with triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI)
Authors: Huang Yao-Kuang , Tseng Yuan-Hsi , Lin Chih-Hung , Tsai Yuan-Hsiung , Hsu Yin-Chen , Wang Shih-Chung , Chen Chien-Wei
Published: November 2019

Background: To explore the diagnostic performance of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) for the evaluation of venous pathology of the lower extremity.
Methods: This was a single-centre prospective cohort study of 25 patients with suspected venous disease in the lower extremities. Each patient received Doppler ultrasonography (for venous evaluation) before the scheduled TRANCE-MRI (for venous and arterial evaluations) on a 1.5T MR scanner (Philips Ingenia, Philips Healthcare, Best, the Netherlands), followed by lymphography and computed tomography angiography that were arranged according to the diagnostic indications.
Results: The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9% and 88%, respectively. The inter-rater agreement for deep vein thrombosis (DVT) of the thigh between the ultrasonography and TRANCE-MRI results was substantial agreement (Cohen's kappa κ, 0.72). In ultrasonography-negative cases, TRANCE-MRI detected four additional cases (16%, 4/25) of DVT; three cases (12%, 3/25) of venous compression caused by pelvic lymphadenopathy, hip prosthesis or knee joint effusion; one case (4%, 1/25) of vena cava anomaly; two cases (8%, 2/25) of occult peripheral artery disease (PAD); and one case (4%, 1/25) of an occluded bypass graft.
Conclusion : TRANCE-MRI can be used as an alternative and objective tool for assessing lower extremity diseases, especially suspected venous pathology. Compared with ultrasonography, TRANCE-MRI plays a better role in assessing varicose veins of the lower extremities and deep veins of the pelvis and abdomen. However, false-positive results may occur in the left common iliac vein of elderly patients. Finally, occult PAD rarely occurs in patients with suspected lower extremity venous disease. Therefore, we recommend performing the TRANCE-MRV protocol instead of the full protocol (MRV+MRA) in the clinical setting in patients with venous scenarios.
The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: A randomized clinical trial
Authors: Bajracharya Joshan Lal , Subedi Asish , Pokharel Krishna , Bhattarai Balkrishna
Published: November 2019

Background: As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy.
Methods: In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/hour) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5-15 µg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤ 3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 hours postoperatively.
Results: Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0-1.5) mg compared to 1.5 (1-2) mg in lidocaine group ( p =0.27). The median pain scores at various time points were similar between the two groups ( p >0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p<0.05); however, no difference was detected later.
Conclusion: Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 hours after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.
Transcriptomic and proteomic analysis reveals mechanisms of low pollen-pistil compatibility during water lily cross breeding
Authors: Sun Chun-Qing , Chen Fa-Di , Teng Nian-Jun , Yao Yue-Mei , Shan Xi , Dai Zhong-liang
Published: November 2019

Background: In water lily (Nymphaea) hybrid breeding, breeders often encounter non-viable seeds, which make it difficult to transfer desired or targeted genes of different Nymphaea germplasm. We found that pre-fertilization barriers were the main factor in the failure of the hybridization of Nymphaea. The mechanism of low compatibility between the pollen and stigma remains unclear; therefore, we studied the differences of stigma transcripts and proteomes at 0, 2, and 6 hours after pollination (HAP). Moreover, some regulatory genes and functional proteins that may cause low pollen-pistil compatibility in Nymphaea were identified. Results: RNA-seq was performed for three comparisons (2 vs 0 HAP, 6 vs 2 HAP, 6 vs 0 HAP), and the number of differentially expressed genes (DEGs) was 8,789 (4,680 were up-regulated), 6,401 (3,020 were up-regulated), and 11,284 (6,148 were up-regulated), respectively. Using label-free analysis, 75 (2 vs 0 HAP) proteins (43 increased and 32 decreased), nine (6 vs 2 HAP) proteins (three increased and six decreased), and 90 (6 vs 0 HAP) proteins (52 increased and 38 decreased) were defined as differentially expressed proteins (DEPs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses revealed that the DEGs and DEPs were mainly involved in cell wall organization or biogenesis, S-adenosylmethionine (SAM) metabolism , hydrogen peroxide decomposition and metabolism, reactive oxygen species (ROS) metabolism, secondary metabolism, secondary metabolite biosynthesis, and phenylpropanoid biosynthesis. Conclusions: Our transcriptomic and proteomic analysis highlighted specific genes, incuding those in ROS metabolism, biosynthesis of flavonoids, SAM metabolism, cell wall organization or biogenesis and phenylpropanoid biosynthesis that warrant further study in investigations of the pollen-stigma interaction of water lily. This study strengthens our understanding of the mechanism of low pollen-pistil compatibility in Nymphaea at the molecular level, and provides a theoretical basis for overcoming the pre-fertilization barriers in Nymphaea in the future.
Simulation and minimization: Technical advances for factorial experiments designed to optimize clinical interventions
Authors: Kuhn Jocelyn Lara , Sheldrick Radley Christopher , Broder-Fingert Sarabeth , Chu Andrea , Fortuna Lisa , Jordan Megan , Rubin Dana , Feinberg Emily
Published: November 2019

Background: The Multiphase Optimization Strategy (MOST) is designed to maximize the impact of clinical healthcare interventions, which are typically multicomponent and increasingly complex. MOST often relies on factorial experiments to identify which components of an intervention are most effective, efficient, and scalable. When assigning participants to conditions in factorial experiments, researchers must be careful to select the assignment procedure that will result in balanced sample sizes and equivalence of covariates across conditions while maintaining unpredictability.
Methods: In the context of a MOST optimization trial with a 2x2x2x2 factorial design, we used computer simulation to empirically test five subject allocation procedures: simple randomization, stratified randomization with permuted blocks, maximum tolerated imbalance (MTI), minimal sufficient balance (MSB), and minimization. We compared these methods across the 16 study cells with respect to sample size balance, equivalence on key covariates, and unpredictability. Leveraging an existing dataset to compare these procedures, we conducted 250 computerized simulations using bootstrap samples of 304 participants.
Results: Simple randomization, the most unpredictable procedure, generated poor sample balance and equivalence of covariates across the 16 study cells. Stratified randomization with permuted blocks performed well on stratified variables but resulted in poor equivalence on other covariates and poor balance. MTI, MSB, and minimization had higher complexity and cost. MTI resulted in balance close to pre-specified thresholds and a higher degree of unpredictability, but poor equivalence of covariates. MSB had 19.7% deterministic allocations, poor sample balance and improved equivalence on only a few covariates. Minimization was most successful in achieving balanced sample sizes and equivalence across a large number of covariates, but resulted in 34% deterministic allocations. Small differences in proportion of correct guesses were found across the procedures.
Conclusions: Computer simulation was highly useful for evaluating tradeoffs among randomization procedures. Based on the computer simulation results and priorities within the study context, minimization with a random element was selected for the planned research study. Minimization with a random element, as well as computer simulation to make an informed randomization procedure choice, are utilized infrequently in randomized experiments but represent important technical advances that researchers implementing multi-arm and factorial studies should consider.
Measles Outbreak Investigation in Artuma Fursi Woreda, Oromia Zone, Amhara Region, Ethiopia, 2018: A case control study
Authors: Tariku Mengistie Kassahun , Misikir Sewnet Wongiel
Published: November 2019

Objective: To confirm the existence of Outbreak, describe cases in person, place and time, and identify determinants of the outbreak. Unmatched case control study in the ratio of 1:4 (38 cases and 152 controls) was conducted in Artuma fursi woreda from July 13- August 1 /2018. Data were collected with standard questionnaires. Collected data were entered into Epi Info version 7 and exported to Statistical package for social science (SPSS) version 23 for analysis. Results: A total of 38 cases and 1 death with attack rate and case fatality rate 11.8/100,000 and 2.6% respectively. All study participants had not vaccination history. Females and age group 5-14 were more affected. Being 5-14 years old versus (vs) 15 years [adjusted odd ratio (AOR) =3.53; 95% CI; 1.52-8.45)], contact with cases vs no contact with cases [AOR=2.78; 95% CI; 1.23-8.67] and travel history 7-18 days prior onset of illness vs no travel history [AOR= 2.53; 95% CI; 1.31-7.24] were significantly associated with contracting measles. Routine and supplement immunization should be strengthened to reduce future occurrence of outbreak. Keywords: Measles, outbreak, Artuma fursi woreda
Tobacco Use and Associated Risk Factors in Burkina Faso: Results from a Population-Based Cross-Sectional Survey.
Authors: Bonnechère Bruno , Kadari Cissé , Tiéba Millogo , Gautier Ouédraogo H. , Franck Garanet , Mariam Ouedraogo A. , Gabriela Boyle , Sékou Samadoulougou , Seni Kouanda , Fati Kirakoya-Samadoulougou
Published: November 2019

Background: Tobacco is a leading preventable cause of non-communicable diseases (NCDs). Studies characterizing the prevalence of tobacco use in low-income countries are lacking. This study describes the prevalence of tobacco use in Burkina Faso and its associated factors.
Methods : Data from the 2013 Burkina Faso World Health Organization (WHO) Stepwise approach to Surveillance (STEPS) were analyzed. The prevalence of any tobacco product use, cigarette smoking, and other tobacco use was calculated. Logistic regression analyses identified factors associated with tobacco use. Overall, 4,691 people were included in this analysis.
Results: The prevalence of any tobacco use was 19.8% (95% CI: 18.4–21.2). Tobacco use was higher for men (29.2% [27.0–31.5]) than women (11.8% [10.3–13.4]). The prevalence of smoked tobacco was 11.3% (10.3–12.4), with a significantly higher prevalence among men (24.5% [22.1–27.0]) than women (0.1% [0.01–0.3]). The overall prevalence of other tobacco use was 8.9% (7.4–10.7), with lower values for men (5.6% [4.1–7.2]) compared to women (11.7% [9.4–14.1]). Tobacco smoking among men was significantly associated with an increased age and alcohol consumption. The analysis of risk factors for other tobacco use stratified by gender showed that age, education, residence, and alcohol consumption were significantly associated with consumption for women, and age and alcohol consumption for men.
Conclusion: Tobacco use is common in Burkina Faso. To effectively reduce tobacco use in Burkina Faso, a comprehensive tobacco control program should consider associated factors, such as gender, age, and alcohol consumption.
Treating periodontitis-A systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths.
Authors: Zhang Xin , Hu Zixuan , Zhu Xuesong , Li Wenjie , Chen Jun
Published: November 2019

Background: Mechanical plaque removal has been commonly accepted to be the basis for periodontal treatment. This study aims to compare the effectiveness of ultrasonic and manual subgingival scaling at different initial probing pocket depths (PPD) in periodontal treatment. Methods: Public databases were searched. Weighted mean differences in PPD and clinical attachment loss (CAL) reduction were estimated by random effects model. Bleeding on probing (BOP), gingival recession (GR), and post-scaling residual dental calculus were analyzed by comparing the results of each study. Results: Ten randomized controlled trials were included out of 1,434 identified. Selected outcomes were PPD and CAL. Initial PPD and follow-up periods formed subgroups. For 3-month follow-up: (1) too few shallow initial pocket studies available to draw a conclusion; (2) the heterogeneity of medium depth studies was so high that could not be merged to draw a conclusion; (3) deep pocket studies showed no statistical differences in PPD and CAL reduction between ultrasonic and manual groups. For 6-month follow-up: (1) too few shallow initial PPD studies to draw a conclusion; (2) at medium pocket depth, PPD reduction showed manual subgingival scaling better than ultrasound. No statistical differences were observed in CAL reduction between the two approaches; (3) for deep initial PPD studies, both PPD and CAL reduction showed manual subgingival scaling better. GR results indicated no statistical differences at medium and deep initial pocket studies between the two methods. BOP results showed more reduction at deep pocket depths with manual subgingival scaling. No conclusion could be drawn about residual dental calculus. Conclusion: When initial probing pocket depth was 4-6mm, PPD reduction proved manual scaling superior to ultrasonic subgingival scaling, but CAL and GR results showed no statistical differences between the two means. When initial probing pocket depth was ≥6mm, PPD, CAL and BOP reductions suggested that manual subgingival scaling was superior to ultrasonic subgingival scaling, but GR results showed no statistical differences. No conclusion could be drawn about residual dental calculus.
Surgical treatment to multiple primary lung cancer patients: A systematic review and meta-analysis
Authors: Author) Ting-Fei Chen(Former Corresponding , Xie Chun-Ying , Rao Bing-Yu , Shan Shi-Chao , Zhang Xin , Zeng Bo , Lei Yi-Yan , Author) Hong-He Luo(New Corresponding
Published: November 2019

Background As there is no consensus on the optimal surgery strategy for multiple primary lung cancer (MPLC), we conducted this study to address this issue by comparing the prognosis of MPLC patients underwent different surgical strategies including sublobar resection and the standard resection through a systemic review and meta-analysis. Methods Relevant literature was obtained from three databases including PubMed, Embase and Web of Science. Inclusion and exclusion criteria were set for the screening of articles to be selected for further conduction of systemic review and meta-analysis. The HRs of OS of the sublobar group compared with standard resection group were extracted directly or calculated indirectly from included researches. ResultsTen researches published from 2000 to 2017 were included in this study, with 468 and 445 MPLC cases for the standard resection group and sublobar resection group respectively. The result suggested that OS of MPLC patients underwent sublobar resection (segmentectomy or wedge resection for at least one lesion) was comparable with those underwent standard resection approach (lobectomy or pneumonectomy for all lesions), with HR 1.07, 95% CI 0.67 - 1.71, p = 0.784. Further analysis found no difference in subgroups of synchronous and metachronous (from second metachronous lesion), different population region and dominant sex type. Conclusions This study may reveal that sublobar resection is acceptable for patients with MPLC at an early stage, because of the equivalent prognosis to the standard resection and better pulmonary function preservation. Further research is needed to validate these findings.
Physical, Behavioral and Sociodemographic determinants of hypertension among adult population in Nekemte town, western Ethiopia: Community based study.
Authors: Geleta Gemechis Teshome , Cheme Melese Chego , Roro Elias Merdassa
Published: November 2019

Objectives: Hypertension is a growing public health problem in many developing countries. However, there is an insufficiency of scientific evidence on the prevalence of hypertension (HTN) at a community level in the study area. The aim of the study was exploring the prevalence and associated factors of hypertension among adults in Nekemte town, Ethiopia. A community-based cross-sectional study was conducted on 711 adults who were selected by the multistage sampling procedure. Height, weight, blood pressure and waist circumference were measured with standard procedures. Data were analyzed by statistical package for social sciences (SPSS) version 20, and multiple logistic regression model was used to determine the independent risk factors for hypertension. Result: The overall prevalence of hypertension was 34.9% among the adult population. Of them, only 52.7% know their status, and 22.4% were on antihypertensive medication. The prevalence of hypertension was higher among the older aged; AOR 5.85 (95% CI=1.74-20), Obese and over-weighted; (AOR 1.71 (95% CI=1.09-2.67), Khat chewers in the past year; AOR 2.44 (95% CI=1.05-5.68), and with higher formal education (college and above); AOR 2.75 (95% CI=1.26-6.03) than their respective counterparts. Community-level prevention and treatment of hypertension should get due attention. Keywords: Hypertension, Nekemte, Ethiopia.
True and False Positive Rates for Different Criteria of Evaluating Statistical Evidence from Clinical Trials
Authors: Ravenzwaaij Don van , Ioannidis John P A
Published: November 2019

Background: Until recently a typical rule that has often been used for the endorsement of new medications by the Food and Drug Administration has been the existence of at least two statistically significant clinical trials favoring the new medication. This rule has consequences for the true positive (endorsement of an effective treatment) and false positive rates (endorsement of an ineffective treatment). Methods: In this paper, we compare true positive and false positive rates for different evaluation criteria through simulations that rely on (1) conventional p-values; (2) confidence intervals based on meta-analyses assuming fixed or random effects; and (3) Bayes factors. We varied threshold levels for statistical evidence, thresholds for what constitutes a clinically meaningful treatment effect, and number of trials conducted. Results: Our results show that Bayes factors, meta-analytic confidence intervals, and p-values often have similar performance. Bayes factors may perform better when the number of trials conducted is high and when trials have small sample sizes and clinically meaningful effects are not small, particularly in fields where the number of non-zero effects is relatively large. Conclusions: Thinking about realistic effect sizes in conjunction with desirable levels of statistical evidence, as well as quantifying statistical evidence with Bayes factors may help improve decision-making in some circumstances.
Biological-guided Metronomic Chemotherapy as Maintenance Strategy in Responders After Induction Therapy in Metastatic Colorectal Cancer
Authors: Shi Min , Ma Tao , Xi Wenqi , Jiang Jingling , Wu Junwei , Zhou Chenfei , Yang Chen , Zhu Zhenggang , Zhang Jun
Published: November 2019

Background The aim of this study is to demonstrate that capecitabine metronomic chemotherapy is non-inferior to capecitabine conventional chemotherapy as maintenance treatment, who have responded to 16-18 weeks first-line chemotherapy in metastatic colorectal cancer.Methods The study design is a prospective, randomized, open label, phase II clinical trial. Those mCRC patients who respond well after 16-18 weeks of standard doublet chemotherapy as induction may enrolled into this study, randomly divided into capecitabine metronomic group or standard dosage group. The duration of disease control after randomization and progression free survival from enrollment are primary endpoints. Meanwhile, the overall survival, safety and quality of life are secondary endpoints. The sample size required to achieve the research objectives of this project is 79 cases in each group. The study recently started on 29-01-2018, and will last for 36 months.Discussion This project intends to study the efficacy and safety of capecitabine metronomic chemotherapy in the maintenance treatment of advanced colorectal cancer, and to explore the strategy of "low toxicity, high efficiency, economy and individualization" which is suitable for China's national conditions and pharmacoeconomics. It has great clinical application prospects and clear socio-economic value.
The EMPOWER-SUSTAIN e-Health Intervention to improve patient activation and self-management behaviours among individuals with Metabolic Syndrome in primary care: study protocol for a pilot randomised controlled trial
Authors: Daud Maryam Hannah , Ramli Anis Safura , Abdul-Razak Suraya , Isa Mohamad Rodi , Baharudin Noorhida , Mohamed-Yassin Mohamed Syarif , Badlishah-Sham Siti Fatimah , Nikmat Azlina Wati
Published: November 2019

Background: Epidemiological studies from various parts of the world have clearly demonstrated that metabolic syndrome (MetS) is an increasing global health problem, not only in the western societies but also in the Asian populations. Web-based and mobile phone-based self-management applications have been proven to be effective in improving self-management behaviour in patients with MetS components i.e. diabetes or hypertension. However, evidence is lacking in terms of its effectiveness specifically for patients with MetS. The aim of this pilot study is to evaluate the feasibility and potential effectiveness of the EMPOWER-SUSTAIN Self-Management e-Health Intervention in improving patient activation and self-management behaviours among patients with MetS. This paper presents the study protocol. Methods: A pilot randomised controlled trial will be conducted in a university primary care clinic. A total of 232 patients with MetS will be recruited; 116 will be randomised to receive the EMPOWER-SUSTAIN intervention for 6 months and another 116 patients will continue with usual care. The EMPOWER-SUSTAIN intervention is a multifaceted chronic disease management strategy based on the Chronic Care Model (CCM) and persuasive technology (PT) theory. It consists of training physicians and patients to use the EMPOWER-SUSTAIN web-based self-management intervention mobile apps, strengthening patient-physician relationship and reinforcing the use of relevant clinical practice guidelines (CPG) to guide management and prescribing. The primary outcome is the mean change in patient activation score using the Patient Activation Measure short form Malay version (PAM-13-M) questionnaire. The secondary outcomes include the change in patients’ physical activity level, eating behavior, patients’ perception on chronic illness care, satisfaction in patient-physician interaction and perceived absolute 10-year cardiovascular disease (CVD) risk. Feasibility of implementing the intervention will be evaluated. These include acceptability of the intervention, estimating the likely rate of participant recruitment and retention, appropriateness of the outcome measures, calculation of sample size, and its potential effectiveness. Conclusion: To our knowledge, this is the first study in Malaysia that aims to determine the feasibility of a multifaceted e-health intervention, as well as to indicate more useful aspects of this intervention for further exploration in a larger trial.
Pelvic and Bladder Catecholamine-Producing Tumors A Review of the Literature
Authors: Petramala Luigi , Bisogni Valeria , Olmati Federica , Concistrè Antonio , Celi Monia , Saracino Vincenza , Iannucci Gino , Toma Giorgio De , Tarallo Maria Rita , Ciardi Antonio , Letizia Claudio
Published: November 2019

Background Although PGLs may arise at any site where physiologic paraganglionic tissue exists, pelvic origins are not frequent (about 2%), and the most common localization is the retroperitoneal space, whereas bladder PGLs account for less than 0.06% of all bladder neoplasms and less than 1% of all PGLs. Starting from the description of two interesting our cases, we wondered to review the literature on pelvic and bladder paragangliomas (PGLs) with the aim of illustrating clinical characteristics and current management, and enlightening the needed of a prompt diagnosis to avoid the onset of several complications.Methods We herein performed a brief review of the literature about pelvic PGLs in the PubMed library, conducted according to the PRISMA statement, including studies published from 1954 to 2019. We also discuss clinical presentation, morphologic appearance, and management of two cases of pelvic PGL, both of them characterized by a history of paroxysmal high blood pressure episodes uncontrolled by antihypertensive therapy associated with disabling symptoms, misdiagnosed for many years.Results Overall, we evaluated 108 case reports. The majority were females, presenting typical signs and symptoms, such as arterial hypertension (54.2%), hematuria (35.1%), and headache (33.6%). After treatment, the clinical and biochemical remission was showed in only 55% of analyzed cases.Conclusions For their singular localization, pelvic and bladder PGLs often might be misdiagnosed. The resulting delay in the proper treatment could be responsible for the relative low percentage of complete clinical and biochemical remission.
The expressions of tooth eruption relevant genes are different in incisors and molars dental follicle cells in rat: an in vitro study
Authors: He Mengting , Dong Xiaomeng , Wang Peiqi , Xiang Zichao , Wang Jiangyue , Wang Xinghai , Chen Jiajun , Bai Ding
Published: November 2019

Background The incisors and molars showed different patterns of tooth eruption in rodents and the dental follicle cells play key roles in tooth eruption. Little is known about the differences in incisors and molars dental follicle cells during tooth eruption in rodents. The purpose of this study was to investigate the differences between incisor dental follicle cells and molar dental follicle cells during tooth eruption in rat.Methods Incisor dental follicle cells and molar dental follicle cells were obtained as previously described. Immunofluorescence was used to identify the cells. Gene expression was measured by real-time qPCR and western blot.Results Compared with molar dental follicle cells, the incisor dental follicle cells showed higher expression of OPG, BMP-2 and BMP-3. The molar dental follicle cells showed higher expression of MCP-1 and RANKL.Conclusions The expression patterns of genes related to tooth eruption were different in incisors and molars dental follicle cells in rat.
Transcriptome analysis of the sex pheromone gland and pheromone biosynthetic pathway in Eogystia hippophaecolus
Authors: Hu Ping , Wang Dongbai , Gao Chenglong , Lu Pengfei , Tao Jing , Luo Youqing
Published: November 2019

The moth Eogystia hippophaecolus (Hua et al.) is a major threat to sea buckthorn plantations in China. Specific and highly efficient artificial sex pheromone traps have been developed and used to control this pest species. However, the biosynthesis of sex pheromones Z7-14:Ac and E3-14:Ac remains poorly understood.Results We investigated the female pheromone gland transcriptome of E. hippophaecolus and identified two pheromone biosynthesis-activating neuropeptides (PBANs), two pheromone biosynthesis-activating neuropeptide receptors (PBANrs), five acetyl-CoA carboxylases (ACCs), six fatty acid synthases (FASs), 16 Acyl-CoA desaturases (DESs), 26 reductases (REDs), 13 acetyltransferases (ACTs), one fatty acid transport protein (FATP), one acyl-CoA-binding protein (ACBP), and five elongation of very long-chain fatty acid proteins (ELOs) in pheromone biosynthesis pathways. Additionally, we identified 11 odorant-degrading enzymes (ODEs) and 16 odorant-binding proteins (OBPs), 14 chemosensory proteins (CSPs), two sensory neuron membrane proteins (SNMPs), three odorant receptors (ORs), seven ionotropic receptors (IRs), and six gustatory receptors (GRs).Conclusions 77 unigenes involved in female pheromone biosynthesis, 31 chemoreception proteins and 11 odorant degradation enzymes were identified, which provided insight into the regulation of the pheromone components and pheromone recognition in the sex gland, and knowledge pertinent to new integrated pest management strategy of interference pheromone biosynthesis and recognition.
Twenty-five Years On: Revisiting Bosnia and Herzegovina after Implementation of a Family Medicine Development Program.
Authors: Hodgetts Geoffrey , Brown Glenn , Batić-Mujanović Olivera , Gavran Larisa , Jatić Zaim , Račić Maja , Tešanović Gordana , Zahilić Amra , Martin Mary Imelda , Birtwhistle Richard
Published: November 2019

Background: The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen-years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina (B-H) played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were imbedded in new laws and regulations to insure sustainability. This study revisited B-H 8-years after the end of the program to evaluate the outcome of initiatives through exploring the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, representatives from the Ministry of Health, Health Centre Directors and Association Leaders. Methods: Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes analyzed using an interpretative phenomenological approach to identify major themes and subthemes. Results: Overall, 122 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources). Conclusions: Despite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in BH to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.
The Informal Curriculum of Family Medicine – what does it entail and how is it taught to residents? A systematic review.
Authors: Rothlind Erica , Fors Uno , Salminen Helena , Wandell Per , Ekblad Solvig
Published: November 2019

Background The informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term “the hidden curriculum” is often used interchangeably. In short, they both refer to the implicit learning taking place outside the formal curriculum, encompassing both a trickling down effect of organizational values and attitudes passed on by a mentor or colleague. While the informal curriculum is a recurrent theme in medical education literature; it is seldom discussed in Family Medicine. As the informal curriculum is likely to be highly influential in the forming of future family practitioners our aim was to explore the area further with respect to the following: which elements of the informal curriculum are applicable in a Family Medicine context and what educational interventions for Family Medicine residents, visualizing the various educational elements of it, have been performed?Methods We conducted a systematic review comprising iterative literature searches and a narrative synthesis of the results.Results 20 articles, published between 2000 and 2019, were included in the analysis which resulted in three partly interrelated themes comprising the informal curriculum in Family Medicine: gaining cultural competence, achieving medical professionalism and dealing with uncertainty. The themes on cultural competence and uncertainty seemed to be more contextual than professionalism, the latter being discussed in relation to the informal curriculum across various medical disciplines. Formalized training for Family Medicine residents in aspects of the informal curriculum appeared to be lacking, and in general the quality of the few interventional studies found was low.Conclusions Important aspects of being a family practitioner, such as cultural competence and dealing with uncertainty, are learned through a context-dependent informal curriculum. In order to ensure a more uniform base for all residents and to reduce the impact of the individual supervisor’s preferences, complementary formalized training would be beneficial. However, to date there are too few studies published to conclude how to best teach the informal curriculum.
Application of MALDI-TOF MS to rapid identification of anaerobic bacteria
Authors: Li Ying , Shan Mingzhu , Zhu Zuobin , Mao Xuhua , Yan Mingju , Chen Ying , Zhu Qiuju , Li Hongchun , Gu Bing
Published: November 2019

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been rapidly developed and widely used as an analytical technique in clinical laboratories with high accuracy in microorganism identification. OBJECTIVE: To validate the efficacy of MALDI-TOF MS in identification of clinical pathogenic anaerobes. METHODS: Twenty-eight studies covering 6685 strains of anaerobic bacteria were included in this meta-analysis. Fixed-effects models based on the P -value and the I-squared were used for meta-analysis to consider the possibility of heterogeneity between studies. Statistical analyses were performed by using STATA 12.0. RESULTS : The identification accuracy of MALDI-TOF MS was 84% for species (I 2 = 98.0%, P < 0.1), and 92% for genus (I 2 = 96.6%, P < 0.1). Thereinto, the identification accuracy of Bacteroides was the highest at 96% with a 95% CI of 95-97%, followed by Lactobacillus spp., Parabacteroides spp., Clostridium spp., Propionibacterium spp., Prevotella spp., Veillonella spp. and Peptostreptococcus spp., and their correct identification rates were all above 90%, while the accuracy of rare anaerobic bacteria was relatively low. Meanwhile, the overall capabilities of two MALDI-TOF MS systems were different. The identification accuracy rate was 90% for VITEK MS vs . 86% for MALDI biotyper system. CONCLUSIONS: Our research showed that MALDI-TOF-MS was satisfactory in genus identification of clinical pathogenic anaerobic bacteria. However, this method still suffers from different drawbacks in precise identification of rare anaerobe and species levels of common anaerobic bacteria. Key words : MALDI-TOF MS , anaerobec, bacteria identification
DNA methylation and miRNA-1296 act in concert to mediate spatiotemporal expression of KPNA7 during bovine oocyte and early embryonic development
Authors: Wang Lei , Hand Jacqelyn M. , Fu Liyuan , Smith George W. , Yao Jianbo
Published: November 2019

Epigenetic regulation of oocyte-specific maternal factors is essential for oocyte and early embryonic development. KPNA7 is an oocyte-specific maternal factor, which controls transportation of nuclear proteins important for early embryonic development. To elucidate the epigenetic mechanisms involved in the controlled expression of KPNA7, both DNA methylation associated transcriptional silencing and miRNA-mediated mRNA degradation of KPNA7 were examined. Results Comparison of DNA methylation profiles at the proximal promoter of KPNA7 gene between oocyte and 6 different somatic tissues identified 3 oocyte-specific differentially methylated CpG sites. Expression of KPNA7 mRNA was reintroduced in bovine kidney-derived CCL2 cells after treatment with the methylation inhibitor, 5-aza-2-deoxycytidine (5-Aza). Analysis of the promoter region of KPNA7 gene in CCL2 cells treated with 5-Aza showed a lighter methylation rate in all the CpG sites. Bioinformatic analysis predicted 4 miRNA-1296 binding sites in the coding region of KPNA7 mRNA. Ectopic co-expression of miRNA-1296 and KPNA7 in HEK293 cells led to reduced expression of KPNA7 protein. Quantitative real time PCR analysis revealed that miRNA-1296 is expressed in oocytes and early stage embryos, and the expression reaches a peak level in 8-cell stage embryos, coincident with the time of embryonic genome activation and the start of declining of KPNA7 expression. Conclusions These results suggest that DNA methylation may account for oocyte-specific expression of KPNA7, and miRNA-1296 targeting the coding region of KPNA7 is a potential mechanism for KPNA7 transcript degradation during the maternal-to-zygotic transition.