bluuebunny/crossref_metadata_2025 huggingface dataset:
Point de vue dialectique sur le modèle du traitement adaptatif de l'information et sur la thérapie EMDR
Authors: Laub Brurit , Weiner Nomi , Bender Sheila S.
Published: February 2020

Cet article propose un point de vue dialectique sur le modèle du traitement adaptatif de l'information (TAI) de Shapiro (1995, 2001), avec une application à la thérapie EMDR (désensibilisation et retraitement par les mouvements oculaires). Les principes dialectiques peuvent contribuer à une compréhension plus détaillée de la manière dont le système TAI fonctionne et offrir de nouvelles lignes directrices thérapeutiques. Notre perspective dialectique est fondée sur deux propositions: La première dit que le mouvement du système TAI vers l'intégration se compose de deux mouvements dialectiques, l'un horizontal et l'autre vertical. Le mouvement horizontal a lieu entre divers opposés, comme le danger par rapport à la sécurité, la dépendance par rapport à l'indépendance, une mauvaise opinion de soi par rapport à une bonne opinion de soi. Le mouvement vertical, lui, concerne les mouvements tout/partie, dans lesquels un tout devient une partie du tout supérieur suivant. Le flux synergique de ces deux mouvements dialectiques est représenté sous la forme d'une spirale du système TAI. La deuxième proposition suggère que le système TAI fonctionne par cycles de différenciation et de liaison. Ces cycles découpent en morceaux le réseau mnésique condensé et fragmenté, ce qui permet l'apparition de nouveaux liens. Nous évoquons également les rapports de la différenciation et de la liaison avec l'accordage dialectique et avec l'attention double en pleine conscience. À l'aide de vignettes cliniques, nous montrons comment cette perspective peut fournir au thérapeute EMDR une carte du traitement associatif du patient, améliorer son accordage thérapeutique et favoriser des tissages cognitifs dialectiques efficaces lorsque le traitement se bloque.
Improving Engagement In A Lecture Course By Increasing Relevance To Student Needs And Interests
Authors: Arnold William W.
Published: February 2020

A modification in emphasis in an upper business course from a professor-centered approach to a student-centered focus demonstrated the use of possibilities to enrich a lecture course format to increase student engagement while also facilitating student readiness to enter the workforce. A proliferation of college teaching formats has emerged, including online learning, video teaching alternatives, and interactive learning outside the classroom. These rival formats offer new ways to engage students and ease them into future positions in organizations, yet the lecture format continues to be a choice preferred by many educational institutions. The transition to a course aligned with student needs and interests entailed numerous modifications in classroom conduct, curriculum, and student learning experiences. Certain changes appeared obvious along with other adjustments that, although profound, were subtle. This study identified factors associated with this transition along with their effects on students. Findings were based on input and evaluations by students. Three main factors were prominent in implementing the modifications: (a) augmenting the positioning of the professor as the unilateral classroom authority by adding the role of professor as agent of service to the students; (b) enriching content and assignments that immersed students in the course subjects, but often focused on the workplace environment; and (c) collecting initial input about student learning goals and requiring student feedback from each class meeting. Pre-post surveys completed by students assessed changes in their confidence on factors they associated with effectiveness in their careers.
Crises politico-militaires et dynamique de la végétation du Parc national du Mont Péko en Côte d’Ivoire
Authors: Ousmane Sidibé , N’da Dibi Hyppolite , Kouassi Kouadio Henri , Kouassi Konan Édouard , Ouattara Kpolo
Published: February 2020

Depuis sa création, le Parc national du Mont Péko est sujet à diverses pressions anthropiques. Ces pressions ont été accentuées durant les conflits armés en Côte d’Ivoire entre 2002 et 2011. L’intensification des pressions aurait entraîné une augmentation du taux de déforestation dans le parc. Pour vérifier cette hypothèse, la présente étude visait à déterminer l’effet des conflits sur la dynamique forestière du parc. À cet effet, quatre images satellitaires Landsat ont été analysées pour examiner les changements d’occupation des sols avant, pendant et après les conflits. Les résultats de ces travaux révèlent une forte réduction des surfaces forestières durant les conflits, qui s'est accentuée pendant la période post-conflit. En effet, 5,65 % de pertes se sont produites avant les conflits à un taux annuel de 0,42 %, contre 28,03 % pendant les conflits à un taux annuel de 3,92 %, et 34,02 % après les conflits à un taux annuel de 14,41 %. Cette aggravation de la déforestation dans le parc est liée à la culture illégale du cacao. L’infiltration massive des populations paysannes dans cette aire protégée pendant les conflits a entraîné une exacerbation des pressions. Une surveillance constante et un aménagement des zones converties en plantation de cacao afin d’accélérer la régénération dans le parc s’avèrent donc nécessaires. En outre, les résultats soulignent la vulnérabilité des aires protégées lors des conflits et l’urgence de la prise de mesures de sécurisation de celles-ci pour prévenir les risques de dégradation.
Viejas drogas, nuevos fármacos
Authors: Jiménez Treviño Luis , Velasco Ángela , Rodríguez-Revuelta Julia , A. Sáiz Pilar
Published: February 2020

Editorial del vol 32(1).
COMPUTER AIDED INSTRUCTIONAL MATERIALS IN TEACHING COOKERY IN GRADE 10: IT’S EFFECTIVENESS
Authors: Nicolas Sharon
Published: February 2020

Today's world is known as the globalization era and is marked by rapid and complex changes both in social and values and learning structures. As such, it is natural for the education sector to review, update and orient their programs to the paradigm of these developments because education is crucial to global competitiveness and total human development. The main purpose/aim of this research is to determine the effectiveness of computer aided instructional materials in teaching cookery to grade 10 students. In this study, experimental method of research was used, the pretest and posttest design. The control group and the experimental group were both given a pretest, then exposed to different teaching methods. The experimental group was exposed to computer aided instructional materials while the control group was taught using the traditional approach. Both groups were given a posttest. The researcher used Mean, Percentage and T-test for the statistical treatment. Comparing the results of the pretest and posttest in the control and experimental group, it shows that students who used computer aided instructional materials performed well in class. The result of the experimental group increases in the post test. Therefore, computer aided instruction enhances the learning abilities of the students.
Arthroplasty Roundtable: Pain Management with Knee Arthroplasty
Authors: Creamer Samantha , Davis Christopher , Johnson Joshua R. , Pape Randall , Cloutier Dagan
Published: February 2020

The purpose of the JOPA Roundtable discussion is to give orthopaedic physician assistants (PAs) insight on how each participating editorial board member treats certain clinical scenarios in their current practice. For this Arthroplasty Roundtable, editorial board members with expertise in joint reconstruction will discuss pain management with knee arthroplasty. Participants will share their knowledge and experience on the topic.
Pengukuran Kinerja Karyawan Dengan Metode Human Resources Scorecard Dan AHP (Studi Kasus : PT. Bella Citra Mandiri Sidoarjo)
Authors: Sahaya Abdul Rosyid , Wahyuni Hana Catur
Published: February 2020

PT. Bella Citra Mandiri Sidoarjo merupakan perusahaan yang bergerak dibidang pembuatan tempat tidur springbed. PT. Bella Citra Mandiri Sidoarjo saat ini menata diri menjadi perusahaan yang lebih maju, sedang berusaha mengembangkan dan meningkatkan dari segi kualitas sumber daya manusianya.Dengan metode Human Resource Scorecard dan AHP (Analytic Hierarchy Process) akan didapatkan pengukuran kinerja karyawan yang belum pernah dilakukan pada perusahaan ini. Metode Human Resources Scorecard sendiri merupakan suatu sistem pengukuran yang mengaitkan antara sumber daya manusia dengan strategi. Kemudian metode AHP digunakan dalam pengambilan keputusan kinerja karyawannya.Tujuan dari penelitian ini adalah mencari indikator kinerja karyawan serta mencari bobot dari masing – masing perspektif. Serta diberikan usulan kepada perusahaan yang dapat digunakan sebagai perbaikan kedepannya.Dari hasil penelitian didapatkan 18 KPI dari 4 perspektif yang terdiri dari perspektif finansial 4 KPI, pelanggan atau konsumen 3 KPI, proses bisnis internal 7 KPI, dan pertumbuhan dan pembelajaran 4 KPI. Kemudian dihasilkan skor terbobot dari perspektif finansial 3,341 (Sedang), pelanggan atau konsumen 3,524 (baik), proses bisnis internal 3,357 (sedang), pertumbuhan dan pembelajaran 3,38 (sedang).
PERANAN RELATIONAL BENEFITS DALAM PENINGKATAN KEPUASAN DAN LOYALITAS PELANGGAN MEBEL LAMONGAN
Authors: Yaskun Mohammad
Published: February 2020

Memberikan kepuasan secara konsisten kepada pelanggan dapat membuat pelanggan menjadi loyal kepada perusahaan. Sikap loyal pelanggan kepada perusahaan akan sangat membantu perusahaan untuk dapat bertahan dalam persaingan bisnis karena pelanggan merupakan sumber pendapatan dari perusahaan. Relationship marketing adalah salah satu strategi pemasaran yang bisa digunakan untuk mencapai tujuan tersebut. Melalui strategi relational benefits perusahaan dapat memberikan manfaat atas hubungan antara perusahaan dan pelanggan. Penelitian ini dilakukan di perusahaan mebel di Lamongan dengan responden sebanyak 202 orang. Hasil penelitian menunjukkan bahwa confidence benefits dan social benefits berpengaruh positif dan signifikan terhadap kepuasan pelanggan dan loyalitas pelanggan mebel. Special treatment benefits berpengaruh positif dan signifikan terhadap kepuasan pelanggan akan tetapi tidak berpengaruh signifikan terhadap loyalitas pelanggan mebel. Selanjutnya, kepuasan pelanggan berpengaruh positif dan signifikan terhadap loyalitas pelanggan mebel.
PENGUKURAN KINERJA KARYAWAN DENGAN HUMAN RESOURCES SCORECARD DI PONDOK PESANTREN ASSYAFIIYAH TAMBERU BATUMARMAR PAMEKASAN
Authors: Lailatus Siyami Faiqoh Bahjah , Dasyanti Terisa Sapta
Published: February 2020

Pondok Pesantren  (Islamic Boarding School) is one of the oldest pedagogical institutions in Indonesia. Pondok Pesantren Assyafiiyah is one of Islamic BoardingSchools located in the area of Madura. To be a productive Islamic Boarding School (i.e.a boarding school which fits the need of pesantren), Assyafiiyah Islamic Boarding School needs to measure the performance of the employee. In this case, it is known as Board Performance which involves human resources, strategy, and performance. To produce a superior educational institution, the implementation of Human Resource Scorecard method that has a positive and significant effect on the institution of Assyafiiyah Islamic Boarding School is very necessary. It is used as an analysis of human resource performance. It is expected that this kind performance measurement system (i.e. Human Resource Scorecard) is able to provide the best solution in improving employee performance. Try Out is given and conducted on the institution to measure the performance system achievemet of its human resources. Therefore, the Key Performance Indicators which does not reach the target can be discovered. In other words, such kind of Try Out can be used to analyze the necessary refinement and improvement of the Key Performance Indicators previously mentioned. Based on the status quo, there are two major problems in this research: 1) how is the mapping of Human Resourse Scorecard?; and 2) what are the factors influencing the optimalization of Board Performance in Assyafiiyah Islamic Boarding School through Human Resource Scorecard?
Keberagaman Dewan Direksi terhadap Struktur Modal
Authors: Fitri Lailatul , Erlita Vera Noviana
Published: February 2020

The characteristics of the board in a company affect the company's capital structure because of the relationship between the monitoring mechanism which is a function of the board of directors on the company's capital structure. The purpose of this study was to determine the effect of the board of directors' diversity which is proxied on the variables of female presence, foreign citizenship, board size, sales growth, profitability and firm size on capital structure. This study uses quantitative methods using multiple linear regression methods. The sample of this study is a manufacturing company listing on the Indonesia Stock Exchange for the period of 2016 - 2017. The method used to determine the sample is purposive sampling. This research data can be obtained from secondary data, namely the company's annual report. The results of hypothesis testing using multiple linear regression showed that the presence of women and foreign citizenship had an effect while the variable board size, sales growth, profitability and firm size did not affect the capital structure.
Pengaruh Profitabilitas Terhadap Struktur Keuangan
Authors: Rahayu Monica Budi
Published: February 2020

Dalam penulisan artikel ilmiah ini ditujukan untuk mengetahui apa yang menjadi pengaruh pertumbuhan penjualan serta profitabilitas terhadap strukutur keuangan. Teknik analisis data yang digunakan oleh peneliti adalah studi literatur yang didapat dari berbagai jurnal. Didalam penulisan artikel ilmiah  ini,  alat  ukur dalam  mengukur  rasio  profitabilitas  adalah  dengan menggunakan return  on equity (ROE).  ROE  adalah  rasio  laba bersih  terhadap  ekuitas  saham  biasa, yang   mengukur   tingkat   pengembalian   atas investasi dari pemegang saham biasa. Naiknya   ROE   dari   tahun   ke   tahun   pada perusahaan berarti terjadi adanya kenaikan laba bersih dari perusahaan yang bersangkutan. profitabilitas merupakan  salah  satu  variabel  yang  berpengaruh  terhadap  struktur keuangan. Dalam   studi literatur   ini   kemampulabaan   diwakili   oleh Return   On   Assets (ROA), yaitu   dengan   membandingkan   laba   bersih   dengan   total   aktiva perusahaan.
Pengaruh Nilai Tukar, Suku Bunga, Dan Inflasi Terhadap Harga Saham Di Suatu Perusahaan
Authors: Umami Risa
Published: February 2020

Artikel  ini  bertujuan  untuk  mengetahui  pengaruh  nilai  tukar,  suku bunga, dan inflasi baik secara simultan maupun secara parsial terhadap harga saham disuatu perusahaan. Teknik analisis yang digunakan analisis regresi nilai berganda yang diuji dengan uji F dan uji T. Berdasarkan hasil uji F diketahui bahwa nilai tukar, suku bunga, dan inflasi secara simultan berpengaruh terhadap harga saham. Berdasarkan hasil uji t diketahui bahwa suku bunga secara parsial berpengaruh terhadap harga saham, sedangkan nilai tukar dan inflasi secara parsial tidak berpengaruh terhadap harga saham. Dari hasil uji t juga dapat diketahui bahwa pengaruh dominan terhadap harga saham ditunjukkan oleh variabel suku bunga.
Religiusitas dan Kewirausahaan; Faktor Kritis dalam Mencapai Kinerja Bisnis pada UKM di Kabupaten Malang
Authors: Mustikowati Rita Indah , Wilujeng Sri
Published: February 2020

Religiosity are extremely abstract and subjective.From this perspective, the extent to which the level of religiosity that is owned by a person will affect the achievement of the firm performance, including SME’s. Thus, the purpose of this research is to examine some of the factors that affect the achievement of the performance based on the perspective of religiosity.The research population is all of SME’s In Malang, with a total sample of 100 SMEs. Sampling method that used to collecting data is probability sampling method, with Proportional Random Sampling techniques. Methods of data analysis used is Multiple Regression. Based on the results of hypothesis testing showed that all the factors that exist on the concept of religiosity, including honesty, ethics, moral and mutual value the influence on business performance improvements. Thus, in order to the business performance increased, the entrepreneurs SMEs in Malang should increase the level of religiosity.
Perancangan Perbaikan Proses Produksi Komponen Bodi Mobil Daihatsu dengan Lean Manufacturing di PT. “XYZ”
Authors: Isnain Satria Khalif , Karningsih Putu Dana
Published: February 2020

Astra Daihatsu Motor Company. Potential market for automotive is continuously growing which is positive signal for automotive businesses. However nowadays competition is also getting stronger. Therefore PT Inti Pantja Press Industri should efficiently manage their production. One way is by reducing and eliminating waste in its production. Production process in PT. Inti Pantja Press Industri is still having several problems. Based on early observation there are bottleneck in subassy processes and also defective product. Reffering to these problems, it can be indicated that there are several waste in production process of PT. Inti Pantja Press Industri.Therefore, Lean Manufacturing  approach  is  utilized  to  reduce  or  eliminate  waste  in  production processes. First,   various waste are identified using Value Stream Mapping. Borda Count Method is used for determining critical waste that occur, they are as follow: waste waiting, defect, and overproduction that cause over inventory finish product. Then, 5 Whys Analysis specifies root causes of waste waiting and waste defect. By using Failure Mode and Effect Analysis, highest priority of root causescan be selected, which are  operator  do  not  clean  dies  before  press  process,  operator  do  not  replace components that has already over its lifetime (wear) and rust on finish product part. Recommendations for improvements are conducted by implementating Poka Yoke method,  they  are:  installation  of  sensors  and  equipment  in  Press  machines  and wrapping finish part product.
Taksiran Zakat di Malaysia: Isu dan Cadangan Solusi
Authors: Awang Norafzan , Bakar Mohd Rizal Abu , Drani Wan Syukry Wan , Hamat Zahri
Published: February 2020

Di Malaysia, segala urusan yang berkaitan dengan zakat adalah di bawah bidang kuasa Majlis Agama Islam Negeri (MAIN) masing-masing. Oleh sebab itu, kepelbagaian kaedah taksiran zakat kekayaan yang diamalkan di negeri-negeri di Malaysia sukar dielakkan. Kertas ini bertujuan untuk membincangkan dua perkara. Pertama, membahaskan tentang isu-isu yang berkaitan dengan taksiran zakat pendapatan dan zakat saham. Kedua, mencadangkan solusi terhadap isu-isu yang terdapat dalam taksiran zakat kekayaan tersebut. Dengan menggunakan analisis kandungan terhadap data sekunder, dapatan kajian mempamerkan bahawa setelah mengambil kira faktor semasa dan setempat, maka manfaat berupa barangan adalah sebahagian daripada pendapatan yang diwajibkan zakat. Sementara bagi zakat saham, kaedah taksiran zakatnya adalah ditentukan oleh niat dan tindakan seseorang sama ada sebagai pelabur ataupun sebagai pedagang.
Mechanics of Foamy Oil during Methane-Based Cyclic Solvent Injection Process for Enhanced Heavy Oil Recovery: A Comprehensive Review
Authors: Basilio Enoc , Babadagli Tayfun
Published: February 2020

Foamy oil flow is a commonly encountered drive mechanism in the primary production (depletion of naturally methane-saturated heavy oil) and secondary stage (cyclic gas—mostly methane—injection after primary production). In the former, among other important parameters, pressure depletion rate has been reported to be the most crucial parameter to control the process. In the latter, type and amount of the gas (also described as “solvent”) and application conditions such as soaking time durations and depletion rates are critical. The cornerstone of the foamy oil behavior relies on its stability, which depends on parameters such as oil viscosity, temperature, dissolved gas ratio, pressure decline rate, and dissolved gas (solvent) composition. Although the process has been investigated and analyzed for different parameters in the literature, the optimal conditions for an efficient process (mainly foamy oil stability) has not been thoroughly understood, especially for the secondary recovery conditions (cyclic solvent injection, CSI). In this paper, internal and external gas drive mechanisms for foamy oil performance are reviewed in detail. The optimal conditions of the applications were compiled and listed for different primary production and secondary recovery stages. Combination of methane with other gases as a CSI practice was also discussed to accelerate the process and reduce cost in an effort to improve efficiency. It is reported that combining methane injection with air as a secondary recovery method can save up to 51% of solvent gas.
Epidemiology, vaccine effectiveness, and risk factors for mortality for pneumococcal disease among hospitalised adults in Singapore: a retrospective case-cohort study
Authors: Chan Tyson , Tay Min Zhi , Kyaw Win Mar , Chow Angela , Ho Hanley J
Published: February 2020

Background: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for mortality among hospitalised adults with pneumococcal disease in Singapore. Methods: Retrospective case-cohort study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015-2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. Results: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1±15.4yrs, and 65.5% were male. Compared with controls (N=9,181), IPD patients were younger (mean age 61.5±16.3yrs, vs 72.2±16.1yrs in controls; p<0.001) and with less co-morbidities [median Charlson’s score 1 (IQR 0-4), vs 3 (1-5) in controls; p<0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (relative risk ratio=0.20, 95%CI 0.06–0.69; p=0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥85yrs and Charlson’s score >3.Conclusion: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination was negatively associated with IPD and should be encouraged among high-risk patients.
Metabolic alterations provide insights into Stylosanthes roots responding to phosphorus deficiency
Authors: Luo Jiajia , Liu Yunxi , Zhang Huikai , Wang Jinpeng , Chen Zhijian , Luo Lijuan , Liu Guodao , Liu Pandao
Published: February 2020

Background: Phosphorus (P) deficiency is one of the major constraints limiting plant growth, especially in acid soils. Stylosanthes (stylo) is a pioneer tropical legume with excellent adaptability to low P stress, but its underlying mechanisms remain largely unknown.
Results: In this study, the physiological, molecular and metabolic changes in stylo responding to phosphate (Pi) starvation were investigated. Under low P condition, the root growth in stylo was significantly enhanced, which was accompanied with up-regulation of expansin genes participating in cell wall loosening. Metabolic profiling analysis showed that a total of 256 metabolites with differential accumulation were identified in stylo roots responding to P deficiency, which mainly include flavonoids, sugars, nucleotides, amino acids, phenylpropanoids and phenylamides. P deficiency led to significant reduction in the accumulation of phosphorylated metabolites (e.g., P-containing sugars, nucleotides and cholines), suggesting that internal P utilization was enhanced in stylo roots. However, flavonoid metabolites, such as kaempferol, daidzein and their glycoside derivatives, were significantly increased in P-deficient stylo roots. Furthermore, the transcripts of various genes involved in flavonoids synthesis were found to be up-regulated by Pi starvation in stylo roots. In addition, the abundance of phenolic acids and phenylamides was significantly increased in stylo roots during P deficiency. The enhanced accumulation of the metabolites in stylo roots, such as flavonoids, phenolic acids and phenylamides, might facilitate P solubilization and cooperate with beneficial microorganisms in rhizosphere, and thus contributing to P acquisition and utilization in stylo.
Conclusions: These results suggest that stylo plants cope with P deficiency by modulating root morphology, scavenging internal Pi from phosphorylated metabolites and enhancing accumulation of flavonoids, phenolic acids and phenylamides. This study provides valuable insights into the complex responses and adaptive mechanisms of stylo to P deficiency.
Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn’s disease
Authors: Huang Zihan , Liu Xiang , Yang Fei , Wang Guoxin , Ge Nan , Wang Sheng , Guo Jintao , Sun Siyu
Published: February 2020

Background : Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the nonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohn’s disease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel CD in situations where routine tests cannot confirm the diagnosis. Methods : This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients presenting with chronic diarrhea, abdominal pain, abdominal mass, perianal lesions, and systemic symptoms including weight loss, fever, and anemia after excluding infection factors. Patients with purely colonic CD were excluded from this cohort. Patients with suspected isolated small bowel CD underwent DBE. Results: In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was confirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum inflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by taking into account the clinical presentation, endoscopic and histological results as well as the experimental treatment. DBE assisted in the diagnosis in 86% (12/14) of the patients. Conclusions : In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical features, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT, we chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and pathological results of DBE to confirm the diagnosis.
The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia
Authors: Tao Kun-ming , Sokha Sann , Yuan Hong-bin
Published: February 2020

Background : The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA.
Methods : We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA.
Results: A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients’ mean age was 45.0 ± 16.6 years (range, 17–87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3–54.7), orthopedic (27.6%; CI, 25.2–29.9), and urological surgery (14.7%; CI, 12.8–16.6). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7–56.8), 28.2% (CI, 25.9–30.5), and 9.4% (CI, 7.9–10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations.
Conclusions : This study adds to the scarce literature on anesthesia practice in low- and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries’ inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.
Practice, Perceived Barriers and Motivating factors to medical-incident reporting: A cross-section survey of health care providers at Mbarara Regional Referral Hospital, Southwestern Uganda.
Authors: Turyahabwe Naome , Mwesigwa James , Atuhairwe Christine , Taremwa Ivan Mugisha
Published: February 2020

Background : Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH). Methods : We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH. Results : The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p value 0.669). Conclusion : Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.
Relationship of lymphovascular invasion with lymph node metastasis and prognosis in superficial esophageal carcinoma: Systematic review and meta-analysis
Authors: Yang Jinxin , Lu Zhouyi , Li Lintao , Li Yong , Tan Yulong , Zhang Dekang , Wang An
Published: February 2020

Background: The development of tumor cells inside the lymphatics or blood vessels is known as lymphovascular invasion (LVI). The correlation between LVI, lymph node metastasis (LNM), and the diagnosis of superficial esophageal carcinoma (SEC) remains unclear. Methods: We searched Embase, PubMed, Web of Science, and Cochrane Library databases for prospective articles to better understand the relationship between LVI, LNM, and SEC diagnosis. Results: We included 23 articles containing data for 4749 patients (range: 54-598) in our meta-analysis. The hazard ratio between LVI and overall survival (OS) was 1.85 with 95% confidence interval (CI) (1.10-3.11, P = 0.02). LNM rate was higher in SEC patients with LVI than SEC patients without LVI (univariate: OR = 4.94, 95% CI: 3.74-6.53, P < 0.0001; multivariate: OR = 5.72, 95%CI: 4.38-7.4, P < 0.0001). No obvious publication was found. Conclusions: The results indicate that LVI plays a dominant role in the prognosis of LNM in SEC and in the prognostic prediction for SEC.
Prognostic Significance of Stem Cell/ Epithelial-Mesenchymal Transition Markers in Periampullary/Pancreatic Cancers: FGFR1 Is A Promising Marker.
Authors: Chong Yosep , Thakur Nishant , Paik Kwang Yeol , Lee Eun Jung , Kang Chang Suk
Published: February 2020

Background: Periampullary cancers (PAC) including pancreatic, ampulla of Vater (AOV), and common bile duct (CBD) cancers are highly aggressive with a lack of useful prognostic markers beyond T stage. However, T staging can be biased due to the anatomic complexity of this region. Recently, several markers related to cancer stem cells and epithelial-mesenchymal transition (EMT) such as octamer transcription factor-4 (Oct4) and fibroblast growth factor receptor 1 (FGFR1) respectively, have been proposed as new promising markers in other solid cancers. The aim of this study was to assess the expression and prognostic significance of stem cell/EMT markers in PACs. Methods : Formalin-fixed, paraffin-embedded tissues of surgically excised PACs from the laboratory archives from 1998 to 2014 were evaluated by immunohistochemical staining for stem cell/EMT markers using tissue microarray. The clinicopathologic parameters were documented and statistically analyzed with the immunohistochemical findings. Survival and recurrence data were collected and analyzed. Results: A total of 126 PAC cases were evaluated. The average age was 63 years, with 76 male and 50 female patient samples. Age less than 74 years, AOV cancers, lower T & N stage, lower tumor size, no lymphatic, vascular, perineural invasion and histologic well differentiation, intestinal type, no fibrosis, severe inflammation were significantly associated with the better overall survival High expression levels of FGFR1 as well as CK20, CDX2, and VEGF were significantly related to better overall survival, while other stem cell markers were not related. Similar findings were observed for tumor recurrence using disease-free survival. Conclusions: In addition to other clinicopathologic parameters, severe fibrosis was related to frequent tumor recurrence, and high FGFR1 expression was associated with better overall survival. Histologic changes such as extensive fibrosis need to be investigated further in relation to EMT of PACs.
Emergence of human avian influenza A(H7N9) virus infections in Wenshan City in Southwest China, 2017
Authors: Jiang Li , Zhao Xiaonan , Xu Wen , Zhou Xuehua , Luo Chunrui , Zhou Jiunan , Fu Xiaoqing , Chen Yaoyao , Li Duo
Published: February 2020

Background: The emergence of human infection with avian influenza A(H7N9) virus was reported in Wenshan City, southwestern China in 2017. The study describes the epidemiological and virological features of the outbreak and discusses the origin of the infection.

Methods: Poultry exposure and timelines of key events for each patient were collected. Samples derived from the patients, their close contacts, and environments were tested for influenza A(H7N9) virus by real-time reverse transcription polymerase chain reaction. Genetic sequencing and phylogenetic analysis were also conducted.

Results: Five patients were reported in the outbreak. An epidemiological investigation showed that all patients had been exposed at live poultry markets. The A(H7N9) isolates from these patients had low pathogenicity in avian species. Both epidemiological investigations of chicken sources and phylogenetic analysis of viral gene sequences indicated that the source of infection was from Guangxi Province, which lies 100 km to the east of Wenshan City.

Conclusions: In the study, a sudden emergence of human cases of H7N9 was documented in urban area of Wenshan City. Chickens were an important carrier in the H7N9 virus spreading from Guangxi to Wenshan. Hygienic management of live poultry markets and virological screening of chickens transported across regions should be reinforced to limit the spread of H7N9 virus.
Two novel protein chips for the detection of antibodies against porcine parvovirus
Authors: Wu Yue , Wu Xudan , Hou Jinxiu , Chen Xiongnan , Huang Xiaobo , Zhou Bin
Published: February 2020

Background : PPV is one of the most important pathogens causing porcine reproductive disorder. It has been shown in clinical cases to be a commonly mixed infection with other important swine diseases which can aggravate the severity of the disease and bring serious economic losses to the pig industry. Serological methods, such as hemagglutination inhibition assays (HAI), serum neutralization (SN), and the modified direct complement-fixation (MDCF) test were utilized earlier, whereas the enzyme-linked immunosorbent assay (ELISA) is the most frequently applied assay to detect PPV-specific antibodies Results: We establish the visible protein chip and the cyanine dye 3 (Cy3)-labeled protein chip to detect the clinical serum from pigs. In this study, the recombinant protein VP2 of PPV was expressed in E.coli , purified with nickel magnetic beads, and then printed onto epoxy-coated glass slides for preparation of the protein chip. After a series of experiments, the conditions of antigen protein concentration, incubation time of primary antibody or secondary antibody, and optimal serum dilution fold were optimized, resulting in a successful visible protein chip and Cy3-labeled protein chip. The results showed that the positive serum, diluted up to 6000-fold, can be detected by the visible protein chip, and the positive serum, diluted up to 12,800-fold, can be detected by the Cy3-labeled protein chip, suggesting the high sensitivity of these protein chips. Moreover, the positive detection ratio, sensitivity, and specificity of these two kinds of protein chips were higher than those of commercial ELISA antibody detection kits. Conclusion: Overall, these two protein chips can be used to rapidly diagnose clinical samples with high throughput. Key words: Protein chip; Porcine parvovirus (PPV); Antibody detection; Clinical serum
Ada-WHIPS: Explaining AdaBoost Classification with Applications in the Health Sciences
Authors: Hatwell Julian , Gaber Mohamed Medhat , Azad R.M. Atif
Published: February 2020

Background

Computer Aided Diagnostics (CAD) can support medical practitioners to make critical decisions about their patients' disease conditions. Practitioners require access to the chain of reasoning behind CAD to build trust in the CAD advice and to supplement their own expertise. Yet, CAD systems might be based on black box machine learning (ML) models and high dimensional data sources (electronic health records, MRI scans, cardiotocograms, etc). These foundations make interpretation and explanation of the CAD advice very challenging. This challenge is recognised throughout the machine learning research community. eXplainable Artificial Intelligence (XAI) is emerging as one of the most important research areas of recent years, because it addresses the interpretability and trust concerns of medical practitioners and other critical decision makers. Method

In this work, we focus on AdaBoost, a black box model that has been widely adopted in the CAD literature. We address the challenge -- to explain AdaBoost classification -- with a novel algorithm that extracts simple, logical rules from AdaBoost models. Our algorithm, \textit{Adaptive-Weighted High Importance Path Snippets} (Ada-WHIPS), makes use of AdaBoost's adaptive classifier weights; using a novel formulation, Ada-WHIPS uniquely redistributes the weights among individual decision nodes at the internals of the AdaBoost model. Then, a simple heuristic search of the weighted nodes finds a single rule that dominated the model's decision. We compare the explanations generated by our novel approach with the state of the art in an experimental study. We evaluate the derived explanations with simple statistical tests of well-known quality measures, precision and coverage, and a novel measure \textit{stability} that is better suited to the XAI setting. Results

In this paper, our experimental results demonstrate the benefits of using our novel algorithm for explaining AdaBoost classification. The simple rule-based explanations have better generalisation (mean coverage 15\%-68\%) while remaining competitive for specificity (mean precision 80\%-99\%). A very small trade-off in specificity is shown to guard against over-fitting. Conclusions

This research demonstrates that interpretable, classification rule-based explanations can be generated for computer aided diagnostic tools based on AdaBoost, and that a tightly coupled, AdaBoost-specific approach can outperform model-agnostic methods.
Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present
Authors: Hao Lu , Li Shengwen , Liu Junhui , Shan Zhi , Fan Shunwu , Zhao Fengdong
Published: February 2020

Objective: To investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH), and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD).
Methods: We included 102 (65 males, 37 females, aged 20–66 yrs) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: nucleus pulposus group, hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of recurrent disc herniation was assessed based on more than 2-year follow-up.
Results: In total, 11 patients were lost to follow up; the other 91 were followed up during 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05).
Conclusions: MCs were associated with the herniated cartilage disc component. rLDH following PELD preferentially occurs when MCs or the herniated cartilage are present. Patients with MCs following PELD might require a second operation.
FHIR PIT: an open software application for spatiotemporal integration of clinical data and environmental exposures data
Authors: Xu Hao , Cox Steven , Stillwell Lisa , Pfaff Emily , Champion James , Ahalt Stanley C. , Fecho Karamarie
Published: February 2020

Background: Informatics tools to support the integration and subsequent interrogation of spatiotemporal data such as clinical data and environmental exposures data are lacking. Such tools are needed to support research in environmental health and any biomedical field that is challenged by the need for integrated spatiotemporal data to examine individual-level determinants of health and disease. Results: We have developed an open-source software application—FHIR PIT (Health Level 7 Fast Healthcare Interoperability Resources Patient data Integration Tool)—to enable studies on the impact of individual-level environmental exposures on health and disease. FHIR PIT was motivated by the need to integrate patient data derived from our institution’s clinical warehouse with a variety of public data sources on environmental exposures and then openly expose the data via ICEES (Integrated Clinical and Environmental Exposures Service). FHIR PIT consists of transformation steps or building blocks that can be chained together to form a transformation and integration workflow. Several transformation steps are generic and thus can be reused. As such, new types of data can be incorporated into the modular FHIR PIT pipeline by simply reusing generic steps or adding new ones. We have validated FHIR PIT in the context of a driving use case designed to investigate the impact of airborne pollutant exposures on asthma. Specifically, we replicated published findings demonstrating racial disparities in the impact of airborne pollutants on asthma exacerbations.Conclusions: While FHIR PIT was developed to support our driving use case, the software can be used to integrate any type and number of spatiotemporal data sources at a level of granularity that enables individual-level study. We expect FHIR PIT to facilitate research in environmental health and numerous other biomedical disciplines.
Newborn feeding recommendations and practices increase the risk of development of overweight and obesity
Authors: Watchmaker Brittany , Boyd Bridget , Dugas Lara
Published: February 2020

Background: The prevalence of obesity among infants less than 2 years of age has increased by more than 60 percent over the last three decades. Obese infants and toddlers are at an increased risk for staying overweight into adolescence and adulthood. Metabolic programming has been demonstrated in animal models whereby early life feeding habits result in life-long changes in hormone balance and metabolism. Our study explores if newborn over-nutrition on the first day of life (DOL1) is associated with risk for future overweight and obesity in childhood.

Methods: Retrospective chart data was collected for full-term formula-fed infants born between January 2008 and December 2012 who continued care at the same institution. Data included the volume of formula (ml) consumed on DOL1 as well as subsequent yearly BMI measures from well child check-ups. (WCC). Overfeeding was categorized as any feed greater than or equal to 30 ml on any of the first seven feeds while controlling for birth weight.

Results: The final data set included 1106 infants (547 male; 559 female). 1023 of the 1106 newborns (93%) were overfed at least once during DOL1, while 789 of 1106 (71%) were overfed 3 or more times during their first 7 feeds. After adjusting for birth weight, infants who were overfed 5 of the first 7 feeds were 5 times as likely to be overweight or obese at their 4th year well child check-up (p<0.05) compared to children not overfed. Infants who were overfed on all 7 of their first 7 feeds were 7 times more likely to be overweight or obese at their 4th year WCC (p=0.017).

Conclusions: Infants overfed on DOL1 were significantly more likely to be overweight or obese at their 4 th year WCC, compared to infants not overfed on their first day of life. Newborn families may benefit from counseling regarding age-appropriate volumes of formula during this early critical and impressionable time period. Future studies will aim to look at effect of smaller feeding bottle size on DOL1 on reducing overfeeding practices and future overweight and obesity.