bluuebunny/crossref_metadata_2025 huggingface dataset:
Tool Life Prediction of Ti [C,N] Mixed Alumina Ceramic Cutting Tool Using Gradient Descent Algorithm on Machining Martensitic Stainless Steel
Authors: A Senthil Kumar , S Joseph Daniel
Published: November 2020

In automated manufacturing systems, most of the manufacturing processes including machining are automated. Automatic tool change is one of the important parameters for reducing manufacturing lead time. Ceramic cutting tools are used to machine hard materials. Ti[C,N] mixed alumina ceramic cutting tools are widely used to machine hardened steel and Stainless Steel due to its superior mechanical properties. Martensitic stainless steel has wide applications in screws, bolts, nuts and other engineering applications. Machining studies on Martensitic Stainless Steel was conducted using Ti[C,N] mixed alumina ceramic cutting tool. Tool life was evaluated using flank wear criterion. The tool life obtained from experimental machining process was taken as training dataset and test dataset for machine learning. Using the dataset obtained from experimental machining tool life model has been developed using Gradient Descent algorithm. The model was validated using co-efficient of determination. The accuracy of the machine learning model was tested using the test data and 99.83% accuracy was obtained. Tool life model based on Gradient Descent Algorithm was successfully implemented for the tool life of Ti[C,N] mixed alumina ceramic cutting tool.Keywords: keyword 1; keyword 2; keyword 3 (List three to ten pertinent keywords specific to the article; yet reasonably common within the subject discipline.)
The Influence of the Environment on the Patient-Centered Therapeutic Relationship in Physical Therapy: A Qualitative Study
Authors: Morera-Balaguer Jaume , Martínez-González Mari Carmen , del Río-Medina Sonia , Zamora-Conesa Víctor , Leal-Clavel Marina , Botella-Rico José Martín , Rodríguez-Nogueira Óscar
Published: November 2020

Currently, in the scientific literature there is a great interest on the study of strategies to implement patient-centered care. One of the main tools for this is the therapeutic relationship. Some studies suggest that the perception of the environment in which the physical therapy treatment takes place can influence the perception of its quality. A qualitative study using focus groups was performed. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audio-recorded, transcribed verbatim and analyzed thematically using a modified grounded theory approach. The setting was three hospitals and six public health centers located in Spain. The inclusion criteria were patients who had received a minimum of 15 physical therapy sessions and with no communication impairments. Thirty-one participants in four focus groups. Participants described a series of specific experiences relating to the environment, which they felt were influential in the establishment of therapeutic patient-centered relationships, including eight physical factors and five organizational factors. The results of this study highlight environmental factors that affect the quality of the therapeutic patient-centered relationship in physical therapy and emphasize the need for physical therapists and administrators to rethink the situation and propose strategies for improvement.
Serious Games and Gamification: A Systematic Literature Review
Authors: Khan Akif Quddus , Khan Salman , Safaev Utkurbek
Published: November 2020

Keeping in mind the increasing trend and need for serious games in science education, we have done a systematic literature review. These papers show the trends and patterns of research carried out in this field from the year 2011 to 2020. Specifically, we investigated country-wise concentration and the most common evaluation methods. Literature is reviewed from IEEEexplore, Springer, and Scopus. Moreover, we discussed the role of Augmented Reality(AR) games in teaching physics. Lastly, we have discussed the positive and negative aspects of serious games in science education in particular, and the trend of using serious games in the past decade in education in general.
Distribution of the two-point product of complex amplitudes in the fully saturated scattering regime
Authors: Wilson D. , Ostashev Vladimir , Pettit Chris
Published: November 2020

This Letter considers probability density functions (pdfs) involving products of the complex amplitudes observed at two points (which may, in general, involve separations in space, time, or frequency) in conditions of fully saturated scattering. First, the pdf is derived for the product of the complex amplitude at one point with the conjugate of the complex amplitude at another point. It is shown that the real and imaginary parts of this product each have a variance gamma pdf. Second, expressions are derived for several joint pdfs involving complex amplitude products and powers at two points.
Pertinencia del marketing digital en las empresas de Aburrá Sur
Authors: Trejos-Gil Carlos Andrés
Published: November 2020

Rev.esc.adm.neg

Debido a las altas tasas de mortalidad de las pequeñas y medianas empresas –pymes– en Colombia, donde, en el 2016, se tuvieron cifras cercanas al 70 % de liquidación en el primer año y del 20 % en el segundo, existe la necesidad de crear mecanismos, herramientas y alternativas que ayuden a las pymes a no cerrar de forma prematura. Este trabajo propone analizar la actualidad del marketing digital en 13 pymes inscritas a la Cámara de Comercio Aburrá Sur (CCAS) de Antioquia, Colombia, escogidas de forma aleatoria. Se implementó una metodología de enfoque cuantitativo con análisis exploratorio, descriptivo y correlación de variables con el fin de validar la fiabilidad del instrumento. Los resultados indican que de las 13 pymes inscritas en la CCAS, el 23,1 % considera un gasto el marketing digital. A pesar de que el 46,2 % no lo considera costoso, el 53,8 % se encarga — por sí mismos— del marketing digital, apenas el 30,8 % miden sus actividades en marketing digital y el 100 % está interesado en recibir capacitaciones al respecto. Por tanto, se concluye que, si bien los empresarios conocen el marketing digital, no lo aplican de forma adecuada, lo hacen de manera empírica y no invierten en él.
Perfil psicosocial de la mujer emprendedora. Un análisis cualitativo y local
Authors: Silva-Peralta Yamila Fernanda , Rompato María Emilia
Published: November 2020

Rev.esc.adm.neg

Mediante la perspectiva de la motivación inicial, la teoría clásica de las necesidades y el modelo de valores individualistas y colectivistas, se analiza el perfil psicosocial de la mujer emprendedora de Mar del Plata, Argentina. Con una base etnometodológica, se administraron cuestionarios sociodemográficos y entrevistas en profundidad según muestreo intencional, con un N = 34. Se realizó análisis de contenido de las respuestas en conformidad con los mencionados modelos teóricos. Las recurrencias muestran que las mujeres desarrollan su emprendimiento con una marcada implicación personal y ante situaciones de criticidad personales o laborales. Así, emprenden tanto por necesidad como por oportunidad, e incorporan una mirada social de especial atención hacia el otro. Desarrollan una característica necesidad de logro, asociada a la superación de obstáculos y el alcance de metas propuestas, aunque también se encuentra necesidad de afiliación, la cual se relaciona con la mirada social antes nombrada. Por último, se han encontrado una conjunción de valores colectivistas asociados a la benevolencia, así como mixtos, asociados al universalismo. Los resultados encontrados, así como su discusión, abren un abanico de preguntas y, a su vez, de posibilidades. El análisis permite concluir que es necesario cuestionarse el espacio de la mujer en el ámbito emprendedor y su necesidad de visibilización.
Cohort Profile: The Nigerian HIV Geriatric Cohort Study
Authors: Dakum Patrick , Avong Yohanna Kambai , Odutola Michael Kolawole , Okuma James , Kayode Gbenga Ayodele , Nta Iboro Ekpo , Ndembi Nicaise , Mensah Charles , Khamofu Hadiza , Okonkwo Prosper , Okpanachi John Oko , Ezeanolue Echezona
Published: November 2020

Background: The Nigerian HIV Geriatric Cohort (NHGC) is a longitudinal cohort setup to learn how elderly people living with HIV (EPLHIV) in Nigeria fare, despite not being prioritized by the national treatment program, and to deepen knowledge for their differentiated care and achieve better outcomes. In this paper, we describe data collected on sociodemographic and clinical data from EPLHIV from the inception of Nigeria’s national HIV program to 2018. Methods: Patient-level data spanning the period 2004 to 2018, obtained from comprehensive HIV treatment hospitals, that are supported by four major PEPFAR-implementing partners in Nigeria were used. These 4 entities collaborated as member organizations of the Nigeria Implementation Science Alliance. We defined elderly as those aged 50 years and above. From deidentified treatment records, demographic and clinical data of EPLHIV ≥50-year-old at ART initiation during the review period was examined. Results: A total of 101,652 EPLHIV were analysed. Women accounted for 53,608(53%), 51,037(71%) of EPLHIV identified as married and 33,446(51%) unemployed. Median age was 57.1years (IQR 52–60 years) with a median duration on ART treatment of 4.1years (IQR 1.7–7.1years). ART profile showed that 97,586(96%) were on 1st-line and 66,125(65%) were on TDF-based regimens. Median body mass index (BMI) was 22.2 kg/m 2 (IQR 19.5–25.4kg/m 2 ) with 43,012(55%), 15,081(19%) and 6,803(9%) showing normal (18.5–<25kg/m 2 ), overweight (BMI 25–<30kg/m 2 ) and obese (BMI ≥30kg/m 2 ) ranges respectively. Prevalence of hypertension (systolic-BP >140mmHg or diastolic-BP >90mmHg) was 16,201(21%). EPLHIV Median CD4 count was 381cells/μL (IQR 212-577cells/μL) and 26,687(82%) had a viral load result showing <1000copies/ml within one year of their last visit. As for outcomes at their last visit, 62,821(62%) were on active-in-treatment, 28,463(28%) were lost-to-follow-up and 6,912(7%) died. Poor population death records and aversion to autopsies makes it almost impossible to estimate AIDS-related deaths. Conclusions: This cohort describes the clinical and non-clinical profile of EPLHIV in Nigeria. We are following up the cohort to design and implement intervention programs, develop prognostic models to achieve better care outcomes for EPLHIV. This cohort would provide vital information for stakeholders in HIV prevention, care and treatment to understand the characteristics of EPLHIV.
WITHDRAWN: Assessment of Suspected Breast Lesions in Early Stage Triple Negative Breast Cancer During Follow-up After Breast Conserving Surgery Using Multiparmetric MRI
Authors: sad Lamiss Mohamed abd el aziz , Dabees Naglaa Lofty , Mohamed Dareen Abd El- Aziz , Tageldin Amr , Younis Samar Galal
Published: November 2020

Background: The local recurrence rate in triple negative breast cancer (TNBC) can be as high as 12%.The standard treatment for early-stage TNBC is breast conserving surgery (BCS), followed by postoperative radiotherapy with or without chemotherapy. However, detection of the local recurrence of the disease after radiotherapy is a major issue.Objective: The aim of this study was to investigate the role of dynamic and functional magnetic resonance imaging (MRI) during follow-up after BCS and radiotherapy with/without chemotherapy to differentiate between loco regional recurrence and postoperative fibrosis.Patients and methods: This prospective study was conducted at Oncology, Radiology, and Pathology Departments, Tanta University. It involved 50 patients with early-stage TNBC who were treated with BCS, followed by radiotherapy with/without chemotherapy. The suspected lesions were evaluated during the follow-up period by sonomammography. All patients were subjected to MRI, including conventional sequences, diffusion-weighted imaging (DWI), and dynamic post-contrast study. Results: Ten cases were confirmed as recurrent malignant lesions. After contrast administration, they all exhibited irregular T1 hypodense lesions of variable morphology with diffusion restriction and positive enhancement. Eight cases displayed a type III curve, while two showed a type II curve. Histopathological assessment was consistent with the MRI findings in all eight cases. The combination of the data produced by DWI-MRI and dynamic contrast enhanced (DCE)-MRI resulted in 100%sensitivity, 92.5% specificity, 90.9% positive predictive value, 100% negative predictive value, and 98% accuracy. Conclusion: Combination of DWI-MRI and DCE-MRI could have high diagnostic value for evaluating postoperative changes in patients with TNBC after BCS, followed by radiotherapy with/without chemotherapy.Trial Registrations: not trial to be registered
Identification and Phylogenetic Analysis of Enterococcus Isolates Using MALDI-TOF MS, VITEK 2, and 16S rRNA Sequencing
Authors: Kim Se-Hyung , Chon Jung-Whan , Jeong Hyo-Won , Song Kwang-Young , Kim Dong-Hyeon , Bae Dongryeoul , Kim Hyunsook , Seo Kun-Ho
Published: November 2020

The bacterial genus Enterococcus encompasses 38 species. Two of the most common species are E. faecalis and E. faecium. Recently, however, there has been an increase in clinical reports concerning less prevalent Enterococcus species, such as E. durans, E. hirae, and E. gallinarum. Rapid and accurate laboratory methods are needed to facilitate the identification of all these bacterial species. In the present study, we compared the relative accuracy of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS), VITEK 2, and 16S rRNA gene sequencing using 39 enterococci isolates from dairy samples, and compared the resultant phylogenetic trees. We found that MALDI-TOF MS correctly identified all isolates at the species level except for one, whereas the VITEK 2 system, which is an automated identification system using biochemical characteristics of species, misidentified ten isolates. However, phylogenetic trees constructed from both methods showed all isolates in similar positions. Our results clearly showed that MALDI-TOF MS is a reliable and rapid tool for identifying Enterococcus species with greater discriminatory power than the biochemical assay method of VITEK 2.
African American Faith Communities and Public Health:Working at the Intersections of COVID-19
Authors: Goldblum PhD Peter , Thompkins  , Lai MBA Tammy , Brown
Published: November 2020

The unprecendented global disruption caused by COVID-19 has exacerbated systemic inequities in healthcare, public health, socioeconomic status, and structural racism. How systematic inequities that are expressed at the intersection of human activities are addressed will influence whether we can control or stop the pandemic. Priotizing collaboration, equity, and investing financial and social capitol into community leadership is an essential part of mitigating and addressing both the short- and long-term repercussions of COVID-19. Through analysis of and evidence from the lived experiences of a national network of African American pastors, the authors recommend four strategies to expedite recovery from the pandemic and to promote enduring beneficial societal change: (1) public health and faith communities should initiate and maintain ongoing relationships that are based on trust; (2) recognition and acknowledgement by agencies and organizations that faith community leaders possess unique knowledge of their communities; (3) inclusion of faith community leaders as full partners when strategizing, decision-making, problem-solving, and policy development sessions occur that affect community wellbeing; and, (4) use of an intersecting approach that recognizes the multifactorial realities of COVID-19 and uses remedies that effectively address existing and new problems in a comprehensive, long-term manner.
Clubfeet and Constriction Band Syndrome - Case Report
Authors: Shabani Bujar , Bytyqi Dafina , Bytyqi Cen
Published: November 2020

Background: Clubfeet and constriction band syndrome is very rare nonidiopathic condition. Treatment is often difficult and the recurrence deformity rate is high. The purpose of this study was to assess the effectiveness of Ponseti method in treatment of congenital constriction band syndrome accompanied clubfoot deformity and lymphedema.Case presentation: We are presenting an interesting case of bilateral clubfeet and congenital circumferential constriction band syndrome in lower limb. Ponseti method of correcting the congenital clubfoot deformity was applied. Constriction band release is accomplished by two stage completely excising the ﬁbrous band and multiple two stage Z-plasties on the right calf.Conclusion: The results of this study indicate that the Ponseti method of gentle, systematic manipulation and weekly cast changes is effective treatment of nonidiopathic clubfoot distal to congenital amniotic constriction band.
NYU-EDA in Modelling the Effect of COVID-19 on Patient Volumes in A Finnish Emergency Department
Authors: Tuominen Jalmari , Hällberg Ville , Oksala Niku , Palomäki Ari , Lukkarinen Timo , Roine Antti
Published: November 2020

Background: Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. Methods: We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified by New York University Emergency Department Algorithm (NYU-EDA) in order to evaluate changes in presentations with different acuity levels.Results: A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23 % (from 113 to 87, p<.001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42 % (from 18 to 10, p<.001). Emergent presentations were reduced by 19 to 28 % depending on the subgroup (p<.001). Number of injuries were reduced by 25 % (from 27 to 20, p<.001). The NYU-EDA distribution changed statistically significantly with 4 percent point reduction in Non-Emergent visits (from 16 % to 12 %, p<.001) and 0.9 percent point increase in Alcohol-related visits (from 1.6 % to 2.5 %, p<.001).Conclusions: We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.
Neutrophil-lymphocyte count ratio better predict prognosis than conventional markers in critical patients? A multiple-centered retrospective cohort study
Authors: Zhou Tao , Zheng Nan , Li Xiang , Zhu Dongmei , Han Yi
Published: November 2020

Background: Neutrophil-lymphocyte count ratio (NLCR) has been reported as better indicator of bacteremia than procalcitonin (PCT), and better predictor of mortality than C-reactive protein (CRP) in various medical conditions. However, large controversy remains upon this topic. We compared the efficiency of NLCR with conventional inflammatory markers in predicting the prognosis of critical illness. Methods: We performed a multiple-centered retrospective cohort study consisting of 536 ICU patients with outcomes of survival, 28- and 7-day mortality. NLCR was compared with conventional inflammatory markers such as PCT, C-reactive protein (CRP), serum lactate (LAC), white blood cell, neutrophil and severity score APACHE II (Acute Physiology and Chronic Health Evaluation II) to evaluate the predictive value on outcomes of critical illness. Then receiver operating characteristics (ROC) curves were constructed to assess and compare each marker’s sensitivity and specificity respectively. Results: NLCR values were not differential among survival and mortality groups. Meanwhile remarkable differences were observed upon APACHE II score, CRP, PCT and LAC levels among survival and death groups. ROC analysis revealed that NLCR was not competent to predict prognosis of critical illness. The AUROCs of conventional markers such as CRP, PCT, LAC and APACHE II score were more significant in predicting 28- and 7-day mortality. Conclusions: NLCR is not competent and less reliable than conventional markers CRP, PCT, LAC and APACHE II score in assessing severity and in predicting outcomes of critical illness.
Does the Screw Position in the ACDF Affect the Degeneration of Adjacent Segments? A Three-Dimensional Finite Element Analysis
Authors: Guo Kai , Lu Jiawei , Zhu Ziqi , Shen Beiduo , Wu Tongde , Huang Yufeng , Liu Xiaoming , Ba Zhaoyu , Wu Desheng , Li Haoxi
Published: November 2020

Background: ACDF is the main treatment of cervical disease. Adjacent Segment Degeneration (ASD) is the main complication of long-term follow-up of ACDF. we conduct a detailed study of ACDF by means of three-dimensional finite element analysis and find the effect of screw placement and location on the occurrence of ASD.Methods: The cervical computed tomography (CT) data (layer thickness of 0.625 mm) for a 30-year-old healthy male volunteer was collected. All the data were combined to create a C2-7 3D finite element model using Abaqus software. Based on the data and the actual surgical maneuver, a screw positioning model was established, in order to observe the cervical range of motion (ROM) with different positions of screw, as well as the pressure change of the adjacent segment intervertebral disc.Results: The proposed finite element model of cervical spine was effective, and ROM on all directions of C4-C6 segments changed after ACDF surgery. Under the same torque settings, compared with the control group, C2/3 segment rotational ROM increased; C2/3, C3/4 segments lateral flexion ROM also increased. Regarding the influence of screw positioning, it has limited influence on the ROM and The intervertebral disc pressure (IDP), and compared with different horizontal positions, different vertical positions imposed greater influence on the ROM and IDP. Conclusions: For ACDF surgery, positioning the screw at the anterior inferior part of the cervical vertebral body could provide more natural cervical ROM and the least IDP, while maintaining high biomechanical stability, and is more in line with human biomechanical requirements.
The Effectiveness of Decompression Surgery on Low Back Pain in Patients with Central Lumbar Spinal Stenosis
Authors: Ko Sangbong , Lee Jaejun , Nam Junho
Published: November 2020

Background: Patients with central lumbar spinal stenosis (CLSS) complain of not only the lower leg symptoms but also low back pain (LBP) simultaneously in many cases. Therefore, patients who undergo decompressive surgery expect recovery from LBP as well as lower leg symptoms, and surgeons who perform decompression surgery are making efforts to improve both symptoms. The objective of this study is to investigate whether decompression surgery can improve low back pain and symptoms of lower limb pain in patients with one level central lumbar spinal stenosis.Methods: The present study included 39 patients who had findings of central lumbar spinal stenosis and underwent decompression surgery due to its corresponding claudication and lower leg radiating pain complaints from 2013 to 2018. Their pain (lower leg radiating pain and low back pain) and functional outcomes (Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), and Short Form-36 (SF-36)) were evaluated before surgery and 6 and 12 months after surgery.Results: Mean lower leg radiating pain continuously showed statistically significant improvement (p < 0.05, p = 0.003); however, the clinical significance of differences above minimum clinically important difference (MCID) was up to 6 months. Mean low back pain was 4.72 ± 3.40 before surgery, 2.33 ± 2.27 at 6 months after surgery, and 2.21 ± 2.02 at 12 months after surgery, showing statistically and clinically significant improvement (p < 0.05) up to 6 months after surgery, after which there were no findings of improvement. Conclusion: Decompression surgery for patients with central lumbar spinal stenosis showed clinically significant improvements in lower leg radiating pain and low back pain up to 6 months after surgery and continuous improvements in lower leg radiating pain up to 12 months, but there was no continuous improvement in LBP.
WITHDRAWN: Effects of Different Fiber to Starch Ratios on Growth Performance, Nutrients Digestibility, and Ruminal Microbiota in Holstein Bulls
Authors: Wang Zenglin , Yan Hui , Shen Yizhao , Li Yan , Wang Meimei , Cao Yufeng , Zhang Xiujiang , Gao Yanxia , Li Jianguo , Li Yunqi , Li Qiufeng
Published: November 2020

Background: The objective of this study was to investigate the effects of dietary neutral detergent fiber (NDF) to starch ratios on growth performance, nutrient digestibility, ruminal fermentation, and microbial community patterns. Thirty-six healthy Holstein bulls at nine months of age (averaged 282±37 kg of body weight) were randomly allocated into three treatments: dietary NDF to starch ratio of 1.13, 1.38, and 1.63. Dry matter (DM) intake (DMI), body weight gain, serum biochemical characteristics, hormones, total-tract digestibility, ruminal enzyme activities, ruminal fermentation, and microbial communities were analyzed.Results: Though the DMI and feed efficiency were not affected, the average daily gain (ADG) increased linearly with a decreasing NDF to starch ratio. DM digestibility, ruminal microbial diversity, ruminal amylase activity, propionate and butyrate concentration, serum glucose, acetyl-CoA carboxylase increased linearly with decreasing dietary NDF:starch ratio. The abundance of the predominant ruminal genus, Prevotella 1 (19.00%~31.64%) linearly decreased, while the proportion of two dominant genera (Ruminococcaceae NK4A214 group/4.14%~6.66% and Rikenellaceae RC9 group/5.57%~7.76%) increased with the decreasing NDF:starch ratio. Dry matter intake, digestibility of crude protein, ether extract (EE), NDF and ADF, AST, BUN, TP, NEFA, GH, IGF-1, and insulin were not affected by the dietary NDF:starch ratio.Conclusions: In conclusion, the dietary NDF:starch ratio of 1.13 benefits the weight gain of Holstein bulls. A potential reason might be the regulation of propionate productivity, amylase activity, and physiological metabolism through the change of dominant ruminal microbiota (Prevotella 1, Ruminococcaceae NK4A214 group and Rikenellaceae RC9 group), which might have a beneficial effect on the lipogenesis and body weight gain of Holstein bulls during the fattening period.
The Impact of COVID-19 Pandemic on Colorectal Cancer Patients: A Single-Center Retrospective Study
Authors: Xu Yun , Huang Zong-Hao , Zheng Charlie Zhi-Lin , Li Cong , Zhang Yu-Qin , Guo Tian-An , Liu Fang-Qi , Xu Ye
Published: November 2020

Background: Since December 2019, China has experienced the public health emergency of coronavirus disease, which has expanded globally and is impacting the care of cancer patients. This study evaluated the impact of the pandemic on colorectal cancer (CRC) patients at our center and aimed to share lessons learned with clinics currently experiencing this impact. Methods: We retrospectively collected data on CRC patients admitted between January 1, 2020 and May 3, 2020; the control group comprised patients admitted between January 1, 2019 and May 3, 2019. Results: During the pandemic, outpatient volumes decreased significantly, especially among nonlocal and elderly patients, whereas the number of patients who received chemotherapy and surgery were maintained. During the pandemic, 710 CRC patients underwent curative enterectomy. The proportion of laparoscopic surgery was 49.4%, which was significantly higher than the 39.5% patients who received a laparoscopic surgery during the same period in 2019. The proportion of major complication during the pandemic was not significantly different from that of the control group. The mean hospital stay was significantly longer than that of the control group. Conclusions: CRC patients who are confirmed to be infection-free can receive routine treatment. Using online medical counseling and appropriate identification, treatment and follow-up was effectively maintained. Adjuvant and palliative chemotherapy should not be discontinued. Endoscopic polypectomy, elective, palliative, and multidisciplinary surgeries can be postponed, whereas curative surgery should be performed. For elderly CRC patients, endoscopic surgery and neoadjuvant radiotherapy are recommended.Trial registration: retrospectively registered
Ultrasound-Guided Hydrostatic Reduction Versus Fluoroscopy-Guided Air Reduction for Pediatric Intussusception: A Multi-Center, Prospective, Cohort Study
Authors: Liu Shu Ting , Tang Xiao Bing , Li Huan , Chen Dong , Lei Jun , Bai Yuzuo
Published: November 2020

Background：Intussusception is the most common abdominal emergency in children. The first line treatment of uncomplicated pediatric intussusception is enema reduction. Until now, there have been no multi-center studies comparing the effectiveness and safety of UGHR and FGAR in the treatment of pediatric intussusception. The aim of this study was to compare the effectiveness and safety of the two most commonly used enema methods of pediatric intussusception: Ultrasound-guided hydrostatic reduction (UGHR) and Fluoroscopy-guided air reduction (FGAR).Methods: From November 1, 2017 to October 31, 2018, we conducted a multi-center, prospective, cohort study. Children diagnosed with intussusception in four large Children’s Medical Centers in China were divided into UGHR and FGAR groups. Stratified analysis and subgroup analysis were used for further comparison. The success and recurrence rates were used to evaluate the effectiveness of enema reduction. The perforation rate was used to evaluate the safety of enema reduction.Results: A total of 2,124 cases met the inclusion criteria (UGHR group: 1119 cases; FGAR group: 1005 cases). The success and recurrence rates in the UGHR group were higher than in the FGAR group (95.80%, 9.28% vs. 93.13%, 10.65%) (P<0.05, P>0.05), respectively. The perforation rate in the UGHR group was 0.36% compared with 0.30% in the FGAR group (P>0.05). Subgroup analysis showed the success rates in the UGHR group were higher than in the FGAR group of patients with onset time between 12h and 24h (95.56% vs 90.57%) (P<0.05). Of patients aged 4 to 24 months, the success rates in the UGHR group were also higher than in the FGAR group (95.77% vs 91.60%) (P<0.05). Stratified analysis showed the success rates in the UGHR group were higher than in the FGAR group in patients with the symptom of bloody stool (91.91% vs 85.38%) (P<0.05).Conclusions: UGHR and FGAR are safe, nonsurgical treatment methods for acute pediatric intussusception. UGHR is superior to FGAR, no radiation risk, its success rate is higher, without a difference in perforation rate, especially for patients aged 4–24 months.Level of evidence: Level II.
Residential Green, Blue Spaces and type 2 Diabetes Mellitus: A Population-based Health Study in China
Authors: Li Ruijia , Chen Gongbo , Jiao Anqi , Lu Yuanan , Guo Yuming , Li Shanshan , Wang Chongjian , Xiang Hao
Published: November 2020

Background: Evidence on the health benefits of green space in residential environments is still limited, and few studies have investigated the potential association between blue space and type 2 diabetes mellitus (T2DM) prevalence. Methods: The study included 39,019 participants who had completed the baseline survey from Henan Rural Cohort, 2015–2017. The Normalized Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) were employed to characterize the residential green space, and the distance from the participant's residential address to the nearest water body was considered to represent the residential blue space. Mixed effect models were applied to evaluate the associations of the residential environment with T2DM and fasting blood glucose levels. Results: An interquartile range (IQR) increase in NDVI and EVI was significantly associated with a 13.4% (Odds ratio (OR):0.866, 95%Confidence interval (CI): 0.830, 0.903) and 14.2% (OR:0.858, 95%CI: 0.817,0.901) decreased risk of T2DM, respectively. The residential green space was associated with lower fasting blood glucose levels in men (%change, –2.060 in men vs. –0.972 in women) and the elderly (%change, –1.696 in elderly vs. –1.268 in young people). Additionally, people who lived more than 5 km from the water body had a 15.7% lower risk of T2DM (OR: 0.843, 95% CI: 0.770, 0.923) and 1.829% lower fasting blood glucose levels (95% CI: –2.335%,–1.320%) than those who lived closer to the blue space. Conclusion: Our findings suggest that residential green space was beneficially associated with T2DM and fasting blood glucose levels. However, further research is needed to explore more comprehensively the relationship between residential blue space and public health.
Mental Distress Among Young Adults – Gender Differences in the Role of Social Support
Authors: Johansen Rune , Espetvedt Mari Nicholls , Lyshol Heidi , Clench-Aas Jocelyne , Myklestad Ingri
Published: November 2020

Background: The aim of the present study was to examine to what extent observed gender differences in mental health are associated with the protective factors social support, sense of coherence and participation in regular physical activity and more generally, engagement in organized or unorganized activity with other people.Methods: This study was based upon a cross-sectional regional health survey in Norway, conducted during the winter 2015-2016, in three southern counties; Aust-Agder, Vest-Agder and Vestfold. The study focused on young adults, comparing three age groups; 18-24 years old (n=624), 25-31 (n=582), and 32-38 years old (n=795).Results: Sense of coherence was strongly associated with low mental distress in all age groups and for both genders, while the association with social support was highly significant for young women only. Regular physical activity was not positively associated with low mental distress when sense of coherence and social support were included in the analysis.Conclusion: Social support appears to have a stronger role as a protective factor for mental distress among young women, compared to young men and older persons. This has implications for health promoting activities that target young women. Sense of coherence showed a strong association with low mental distress scores for all ages studied.
Effect of Resilience on Stress, Anxiety and Depression in Grass-roots Civil Servants: The Mediating and Moderating Model
Authors: Song Huiling , Zhang Mengjie , Wang Yanjie , Yang Liying , Wang Yanyu , Li Yan
Published: November 2020

Background: Civil servants are a special group in China, and there is limited research on how their resilience affects mental health, such as depression and anxiety. Therefore, the aim of the paper is to explore the role of resilience through the relationship between stress, depression and anxiety, and to further provide an explanation for how resilience interacts with stress, depression and anxiety in civil servants.Method: In a cross-sectional survey, 302 civil servants completed a battery of questionnaires. The Civil Servants Stress Scale (CSSS) was used to assess the stress of civil servants. The depression and anxiety of participants were evaluated by the Self-rating Depression Scale (SDS) and the Self-rating Anxiety Scale (SAS), respectively. The Conner-Davidson Resilience Scale (CD-RISC) was used to assess the stress of civil servants as well. We conducted the moderating and mediating models to the resilience, depression and anxiety in gross-roots civil servants.Results: The results have shown that resilience was related to stress, depression, and anxiety in civil servants at the basic level. Stress was positively correlated with resilience. On the contrary, stress was negatively associated with depression and anxiety.Conclusion: Resilience played the moderating and mediating roles for stress,depression and anxiety. Resilience can moderate the relationship between stress and depression, anxiety as a dynamic moderate mode. Improving resilience and reducing stress play a vital role in preventing depression and anxiety in gross-roots civil servants.
Effectiveness of a Community-level Social Mobilization Intervention in Achieving the Outcomes of Polio Vaccination Campaigns During the Post-polio-endemic Period: Evidence from CORE Group Polio Project in Uttar Pradesh, India.
Authors: Choudhary Manojkumar , Solomon Roma , Awale Jitendra , Dey Rina , Singh Jagajeet Prasad , Weiss William
Published: November 2020

Background:A social mobilization (SM) initiative contributed to India’s success in polio elimination. This was the CORE Group Polio Project (CGPP), a partner of Uttar Pradesh (U.P.) SM Network and which continued its SM activities, even during the polio-free period through a network of multi-level social mobilizers. This paper assesses the effects of this community-level SM (CLSM) intervention on the extent of community engagement and performance of polio vaccination campaigns during the post-polio-endemic period (i.e., from March 2012 to September 2017). Methods:This study followed a quasi-experimental design. We used secondary, cluster-level data from CGPP India’s Management Information System, including 52 SIAs held from January 2008 to September 2017 in 56 blocks, covering 12 districts of U.P. We computed various indicators and performed Generalized Estimating Equations (GEE) based analysis to assess the statistical difference. We then estimated the effects of the SM intervention, using Interrupted time-series, Difference-in-Differences and Synthetic Control Methods. Also, estimated the population influenced by the intervention. Results:The performance of polio vaccination campaigns changed over time, with the intervention areas having better outcomes than non-intervention areas. The absence of community-level SM Net intervention during the post-polio-endemic period would have negatively impacted booth coverage, X-to-P conversion rate, Refusal-to-Acceptor conversion of intervention areas to 14.1 (range: 12.7 to 15.5), 6.3 (range: 5.2 to 7.3) and 7.4 percentage points, respectively. Community engagement would have reduced by 7.2 (range: 6.6 to 7.7) percentage points. The study guesstimated that the intervention averted at least 43 (range: 40 to 47) paralytic polio cases annually from the intervention areas, during the post-polio-endemic period. Conclusions:The absence of CLSM intervention would have significantly decreased the level of community engagement and negatively impacted the performance of polio SIAs of the post-polio-endemic period. The study provides evidence of an added-value of additional human resources dedicated to social mobilization to achieve desired vaccination outcomes in hard-to-reach or programmatically challenging areas.
Respectful maternity care: Disconnect between perspectives and practices of midwives from a referral hospital in Kampala, Uganda.
Authors: Andru Monicah , Olwit Connie , Osingada Charles Peter , Nabisere Allen , Ayebare Elizabeth , Mbalinda Scovia Nalugo
Published: November 2020

Introduction: Disrespectful and undignified care during childbirth is a global challenge, particularly in less developed countries. Despite the increase in health facility births, women continue to suffer from disrespect and abuse during childbirth. This practice counters the efforts to encourage women to deliver in health facilities by a skilled birth attendant as a strategy to reduce maternal and neonatal mortality. The purpose of the study was to explore midwives' understanding of respectful maternity care and observe how their practice conforms to this concept. Methods: We conducted a qualitative study combining one-on-one interviews and observation methods of data collection. In-depth interviews were conducted with 17 midwives and 20 observations were done. Audio-recorded data were later transcribed verbatim and analyzed using the content analysis method. Observation data was summarized into a table 2 below.Results: Midwives understood respectful maternity care (RMC) as treating women with respect, dignity, politeness, providing information to clients, and ensuring privacy and confidentiality. However, there was a discrepancy between their understanding of RMC and what they practiced. They also lacked an in-depth understanding of the domains of RMC. Conclusion: There is a need to strengthen midwife's knowledge and skills to enable them to provide respectful maternity services. We recommend in-service training and mentoring to equip midwives with knowledge and skills to offer RMC. Also, RMC should be integrated into pre-service curricula for midwifery and nursing training in Uganda. Furthermore, efforts should be put in to strengthen health systems, and support healthcare providers to provide RMC. More research is needed into locally relevant solutions to promote respectful maternity care.
Association of Coenzyme Q10 with Premature Ovarian Insufficiency
Authors: Ma Linjuan , Li Xiaojun , Li Chunming , Chen Peiqiong , Lan Yibing , Huang Yizhou , Xu Wenxian , Zhou Jianhong
Published: November 2020

ObjectiveThe aim of the study was to analyze the relationship between levels of coenzyme Q10 (CoQ10) and the risk of premature ovarian insufficiency (POI).MethodsIn this cross-sectional case-control study, 32 women with POI and 58 women with normal menstrual cycles were recruited. The serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), CoQ10 and total cholesterol were measured. The association of CoQ10 with POI was assessed using binary logistic regression analysis.ResultsThe CoQ10/total cholesterol ratio was significantly lower in the women with POI than in the women with normal menstrual cycles (120.94 ± 25.35 nmol/mmol vs 138.97 ± 39.19 nmol/mmol, P = 0.021). The serum CoQ10/total cholesterol ratio was inversely associated with POI (the unadjusted odds ratio (OR) = 0.984, 95% CI: 0.970 - 0.998, P = 0.027). The same trend was found after adjusting for confounding factors (such as age, body mass index, annual household income and education) (OR = 0.976, 95% CI: 0.956 - 0.996, P = 0.020).Conclusions﻿The serum CoQ10/total cholesterol ratio was inversely associated with POI, indicating that antioxidant deficiency may be a risk associated with the development of POI. CoQ10 may be a protective factor for ovarian tissue.
Conquering Hypertension in Vietnam- Solutions at Grassroots Level: Study Protocol of a Cluster Randomized Controlled Trial
Authors: Ha Duc , Tran Oanh , Nguyen Hoa , Goldberg Robert , Chiriboga German , Phan Van , Nguyen Cuc , Nguyen Giang , Pham Hien , Nguyen Thang , Le Thanh , Allison Jeroan
Published: November 2020

Background Vietnam has been experiencing an epidemiologic transition to that of a lower-middle income country with an increasing prevalence of non-communicable diseases. The key risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam, particularly hypertension (HTN). Inasmuch, the burden of CVD will continue to increase in the Vietnamese population unless effective prevention and control measures are put in place. The objectives of the proposed project are to evaluate the implementation and effectiveness of two multi-faceted community and clinic-based strategies on the control of elevated blood pressure (BP) among adults in Vietnam via a cluster-randomized trial design. MethodsSixteen communities will be randomized to either an intervention (8 communities) or comparison group (8 communities). Eligible and consenting adult study participants with HTN (n = 680) will be assigned to intervention/comparison status based on the community in which they reside. Both comparison and intervention groups will receive a multi-level intervention modeled after the Vietnam National Hypertension Program including education and practice change modules for health care providers, accessible reading materials for patients, and a multi-media community awareness program. In addition, the intervention group only will receive three carefully selected enhancements integrated into routine clinical care: (1) expanded community health worker services; (2) home BP self-monitoring; and (3) a “storytelling intervention”, which consists of interactive, literacy-appropriate, and culturally sensitive multimedia storytelling modules for motivating behavior change through the power of patients speaking in their own voices. The storytelling intervention will be delivered by DVDs with serial installments at baseline and at 3, 6, and 9 months after trial enrollment. Changes in BP will be assessed in both groups at several follow-up time points. Implementation outcomes will be assessed as well.DiscussionResults from this full-scale trial will provide health policy makers with practical evidence on how to combat a key risk factor for CVD using a feasible, sustainable, and cost-effective intervention that could be used as a national program for controlling HTN in Vietnam.Trial registration: ClinicalTrials.gov. Registration number: https://clinicaltrials.gov/ct2/show/NCT03590691 (registration date July 17, 2018).Protocol version: 6. Date: 08/15/2019
Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil
Authors: Magno Laio , Leal Andrea Fachel , Knauth Daniela , Dourado Ines , Guimarães Mark Guimarães Drew Crosland , Santana Elis Passos , Jordão Tiago , Rocha Gustavo Machado , Veras Maria Amélia , Kendall Carl , Pontes Alexandre Kerr , Brito Ana Maria , Kerr Ligia , Group The Brazilian HIV/MSM Surveillance
Published: November 2020

Background: Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result.Methods: Respondent-driven sampling (RDS) was used to recruit 4,176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times).Results: For this analysis, 3,605 MSM were included. The acceptability of HIVST was 49.1%, lower among those had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. Conclusions: The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.