bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability Control of Double Inverted Pendulum on a Cart Using Full State Feedback with H infinity and H 2 Controllers
Authors: Jibril Mustefa , Tadese Messay , Degefa Reta
Published: August 2020

In this paper a full state feedback control of a double inverted pendulum on a cart (DIPC) are designed and compared. Modeling is based on Euler-Lagrange equations derived by specifying a Lagrangian, difference between kinetic and potential energy of the DIPC system. A full state feedback control with H infinity and H 2 is addressed. Two approaches are tested: open loop impulse response and a double inverted pendulum on a cart with full state feedback H infinity and H 2 controllers. Simulations reveal superior performance of the double inverted pendulum on a cart with full state feedback H infinity controller.
The Effect of Organic Fertilisers on the Floristic Composition of Grassland, Herbage Yield and Quality
Authors: Mrázková Marie , Bilošová Hana , Látal Oldřich , Pozdíšek Jan
Published: August 2020

The aim of this study was to assess the effects of organic fertilisers (cow manure + dung water; cattle slurry) applied in different annual doses of nitrogen (54 kg ha-1; 84 kg ha-1; 120 kg ha-1) according to 3 different intensities of grassland utilisation (extensive – 2 cuts per year, medium intensive – 3 cuts per year, intensive – 4 cuts per year) on percentage of plant functional groups (grasses, legumes, forbs), dry matter yield, and forage quality. The study was performed as a small-plot trial over 7 years on moderately moist grassland in the Czech Republic. The proportion of legumes was significantly higher in the fertilisation treatments with cow manure + dung-water combined with medium intensive utilisation and intensive utilisation (10.2% and 10.3%, respectively). Fertilisation significantly increased dry matter yields by 51.9 % (cow manure + dung water) and 56% (cattle slurry) compared to unfertilised controls (4.81 t ha-1). Grasslands fertilised with cattle slurry showed significantly higher concentration of crude protein (142.9 g kg-1) than unfertilised (126.4 g kg-1). Extensive grassland utilisation significantly increased crude fibre concentration (up to 282.1 g kg-1), and decreased the energy value (up to 4.68 MJ kg-1 of NEL). Organic matter digestibility was negatively influenced by extensive grassland utilisation (61.0%, 65.42 % and 67.44% for the extensive, medium intensive and intensive utilisation, respectively). Our findings suggest that medium intensive and intensive grassland utilisation using organic fertilisation which correspond to annual doses of nitrogen of 84 kg ha-1 and 120 kg ha-1, are the most suitable for animal nutrition.
Evaluation of the School Water, Sanitation and Hygiene National Strategic Implementation Plan (2012 -2017) in Ukerewe District, North-Western Tanzania
Authors: Ngimbwa Joshua , Basinda Namanya , Kapesa Anthony , Ngallaba Sosprato
Published: August 2020

Background: Ongoing Primary and Secondary Education Development Program (PEDP & SEDP) has led to increase in enrollment of children in schools. This created a high demand for facilities such as classroom, chairs, laboratories, latrines and water supply. Water and latrines did not receive equal attention like others. National strategic plan for School Water Sanitation and Hygiene (SWASH) 2012-2017 was to address such challenges with objectives to improve SWASH by 2017. Hence this study aimed to evaluate the implementation of SWASH program in Ukerewe. Methodology: A cross sectional survey was done among 42 schools in the district with 40 schools being government owned. Systematic random sampling was used and data were collected using a structured interview which was pre-tested and amended prior to conducting fieldwork. UNICEF, WASH in Schools Monitoring Package observational check-list was used to assess sanitation facilities. Results: Findings from this study showed the latrine-hole to student ratio was 1:71 with only 31.3% of the latrines being in good clean condition and about half (59.5%) of the schools have no facilities for washing hands. For the schools with hand washing facilities only 21.4% have an effective hand washing practice (presence of soap and water). The most common source of water used was lake water (35.7%) with (42.9%) having water storage facilities. Conclusion: The study shows that most of the objectives of national strategic plan are yet to be implemented at Ukerewe. There is a need for minor repairs to complete new construction of SWASH facilities in Ukerewe.
SIKAP MASYARAKAT SEKITAR KAWASAN MARUNDA TERHADAP RESTORASI EKOLOGI HUTAN MANGROVE DI KELURAHAN MARUNDA, KECAMATAN CILINCING, JAKARTA UTARA
Authors: Puspitasari Nesmi , Lestari Eny , Widiyanti Emi
Published: August 2020

This research aims to determine the factors that shape the attitudes of the community, to know the attitude of the community, to analyze the relationship between the factors that shape the public attitudes, and to analyze the differences of people's attitudes toward the economic impacts of the people who live close to the restoration site with the people who live far from Location of restoration of ecological restoration of mangrove forest. The location of the study was determined purposively. The sampling method used is proportional random sampling, with sample number 60 Marunda Pulo community. The result of the research shows that: (1) There is a significant relationship between the attitude of the community with the influence of others who are considered important. While there is a non-significant relationship between the attitude of the community towards age, type of work, formal education, non-formal education, and mass media exposure. (2) There is a significant difference between the attitude of the people whose location is 400 meters away from the coast with the attitude of the people whose residence is more than 400 meters from the beach.
EFEKTIVITAS PENGGUNAAN METODE MIND MAP PADA PELATIHAN PENGEMBANGAN PENGUASAAN MATERI PEMBELAJARAN
Authors: Karim Abdul
Published: August 2020

Tujuan penelitian ini untuk membantu menyelesaikan
keterbatasan guru menemukan metode pembelajaran yang dapat
meningkatkan kreativitas belajar siswa. Penelitian menggunakan
pendekatan kualitatif dengan teknikParticipation Action Research.
Hasil penelitian menunjukkan bahwa metode pembelajaran yang
efektif dapat memberikan semangat belajar siswa memiliki kriteria:
metode itu mampu memberikan semangat siswa menggali hal-hal
baru, merangsang otak kiri dan otak kanan berkembang secara
proporsional, dapat menghasilkan ide-ide baru dan
mengembangkan keterampilan baru. Pelatihan metode
pembelajaran mind map, dapat membantu guru: lebih mudah
memahami materi pembelajaran, lebih mudah mengembangkan
2 Journal of Social Science Teaching
materi pembelajaran dan mengingat kembali, dapat
mengembangkan kreativitas dan menyenangkan. Disarankan
kepada para guru dapat mengembangkan penggunaan metode mind
map untuk mempermudah memahami dan mengembangkan materi
pembelajaran serta memperkuat dingatan.
INTEGRASI AL-QURAN, SAINS DAN ILMU SOSIAL SEBAGAI BASIS MODEL PENGEMBANGAN MATERI AJAR IPS DI MADRASAH
Authors: SANUSI SANUSI
Published: August 2020

Penelitian ini bertujuan untuk mendeskripsikan konsepsi
model pengembangan materi ajar IPS di madrasahmelalui pola dan
pendekatan integratif.Pola Integrasi sebagai sebuah model
pengembangan materi ajar IPS hadir sebagai upaya untuk
memberikan sejumlah alternatif yang berorientasi pada pencapaian
tujuan yang lebih holistik.Di samping itu model pengembaangan
dengan model pendekatan ini dilakukan sebagai kerangka dasar
untuk menempatkan identitas madrasah sesuai porsinya, sehingga
mata pelajaran IPS di madrasah memiliki corak dan karakteristik
berbasis nilai spiritualitas.Titik berangkat dari model
pengembangan integratif ini adalah dimana al-quran dansains
dapat menjadi sumber dari pembentukan elemen-elemen teoretis
untuk menjelaskan realitas, yang memperkuatkajian ilmu sosial
sebagai pengembangan materi ajar IPS yang di terapkan di
madrasah. Selain itu pendekatan ini juga mendorong
pengembangan ilmu-ilmu ke-Islam-an yang di dilakukan dengan
memperkuat dimensi empiris.
Penerapan Model Pembelajaran Index Card Match (ICM) Untuk Meningkatan Keaktifan Belajar Siswa Mata Pelajaran IPS Terpadu Kelas IX MTs Negeri Gemolong
Authors: H. F. Siti Azhariyah
Published: August 2020

The teaching and learning process is important in learning effective and efficient learning outcomes with the activities of students who are actively involved in learning. This study aims to improve student learning activeness in the Integrated Social Sciences learning process and improve students' understanding through Index Card Match learning in Class IX MTS Gemolong State. The method used in the study is Class room Action Research, the implementation of which is carried out in two cycles. Data collection uses Observation. The results of the study at MTS Gemolong State showed that student activity increased pre cycle 61.56%. In the first cycle the speed became 70.22%, and the second cycle became 96.57%. Increased learning outcomes of students who have fulfilled the completeness value that is pre cycle is 8.33%. Then in the first cycle increases, which is to 72.22% and increases again in the second cycle to 75%.

Keywords:

Learning Activity, Learning Model, Learning Outcomes
Closed Management of a Distal Radius Refracture Through a Bent Volar Plate: Can an Open Procedure be Avoided?
Authors: Hall Christopher , Lambers Anton , Gohil Satyen
Published: August 2020

Case:

A 55-year-old man sustained a distal radius fracture, which was fixed with a volar plate 20 years ago. He then fell from 2 m and sustained a refracture with a bent but intact volar plate. A manipulation under anaesthetic/anaesthesia was attempted. Satisfactory reduction was confirmed and maintained, with bony union confirmed at 6 months. Regular follow-up showed continuing functional improvement.

Conclusion:

This rare case avoided surgical intervention and its associated risks and costs. Attempted closed reduction can be considered a treatment option before open revision fixation, with demonstrated ability for fracture healing in an acceptable position.
Organization of management and structure in local networks internet of things
Authors: Vishniakou U. A. , Al-Masri A. H. , Al-Haji S. K.
Published: August 2020

Internet of Things (IoT) symbolic formula is given. The analysis of management technologies both in the network structures of infocommunications, based on the NSMP, and on local networks of the Io T. Two approaches for implementing the management process in infocommunication networks are shown: one is based on creating special software tools, the second is based on the working with data describing the network device. The basic operations of SNMP are given. Four levels of IoT in local network structure are described: smart sensors, network vehicles, services, and applications. Structure of local network of IoT which includes smart sensors, transport environment, services and applications information representation in network use semantic web are considered.

The structure of multi-agent system (MAS) of milk farms analyzing in Leban (MASMFA) for monitoring of production quality. MASMFA structure has many agents such as quality milk sensors, agents of communications, data base, analysis of the information received from sensor agents, decision-making. This system implements the functions to ensure the required class of milk quality and based on IoT local network construction. The information algorithm processing in such IoT is proposed. Milk sensor shell be periodically queried, their values will be recorded in the server database. The decisionmaking subsystem will issue data on milk quality to the farm administrator on a mobile device. The server structure will be implemented using a cloud service. Implementation this Internet of things network is being developed using LTE technology.
Identification of a simplified mathematical model of an unmanned aerial vehicle
Authors: Lobaty A. A. , Yatsyna Y. F. , Prohorovith S. S. , Hvitko Y. A.
Published: August 2020

The problem of determining the shape and parameters of a mathematical model in the form of a transfer function for the movement of an unmanned aerial vehicle (UAV) in the vertical plane of space is solved. The angle of deviation of the Elevator is considered as the input signal, and the pitch angle of the UAV is considered as the output signal. We use the results of experimental studies of UAV flight, which are considered as known values of input and output signals under specified flight conditions. The measured discrete values of the experimental results are approximated by a fourth-order polynomial based on regression analysis for ease of use in identification. The analytical substantiation of the need to apply the methods of linearization of the mathematical model of UAV movement and the accepted assumptions for obtaining differential equations of UAV movement relative to the center of mass, allowing to synthesize the required transfer function of the corresponding element of the UAV control system. The results of computer modeling confirmed the validity of the synthesized mathematical model obtained on the basis of structural and parametric identification. This approach can be used to obtain simplified mathematical models that are used to solve problems of synthesis and optimization of control systems not only for UAVS, but also for other dynamic objects.
Creating the Ideal Community as A Root of Fethullah Gulen’s View on Gender Equality
Authors: Khamami Akhmad Rizqon
Published: August 2020

Abstract: This article discusses the roots of Gulen's view on gender equality and its roles within the movement, which constitutes an example of an Islamic movement that can adapt in the contemporary era and becomes progressive Islam. Conversely, Gulen’s view on gender belongs to the conservative movement. By employing functionalism, this article tries to seek and delve into the theme. It further argues that the movements' mission to create “the ideal community” is the driving ideology on gender relations. Examining some important scholarly findings on the movement and works by its founder Fethullah Gulen, the women’s position is unequally subordinated to that of men, as their initial functions to obey their husbands and to maintain family’s honor. Importantly, their role is limited to educate their children to deliver "the next golden generation”. Thus, it is reasonably true that Gulen’s view on women’s rights and gender relations is envisioned along with the movement's mission to transform the society towards the ideal community that in turn sacrifices women’s freedom and liberty.الملخص: يناقش هذا المقال أفكار كولن حول العلاقات بين الجنسين. السؤال في هذا المقال ، ما هي جذور الفكرة بين الجنسين عند كولن؟ يفترض المؤلف أن فكرة كولن تم تطويرها من طموحات كولن لإنشاء مجتمع مثالي. أنطلاقا منها، يتم إعطاء المرأة وظيفة لتعليم الأطفال ، وطاعة لزوجها ، والحفاظ على الشرف ، وتكون على استعداد لتكون تابعة للرجال في الأسرة والمجتمع. يضع كولن النساء كأول معلمات لأطفالهنّ وتم تكليفهن بتربيتهم ليكونوا جيلا ذهبيّا في  المستقبل. أعرب كولن عن حقوق المرأة والعلاقات بين الجنسين من أجل التحول الاجتماعي إلى مجتمع مثالي. ومن أجل تكوين هذا المجتمع المثالي فتكاليفه هي تخضع النساء تحت الرجال.Abstrak: Artikel ini mengupas akar pemikiran Gulen tentang persamaan gender dan peran perempuan di tengah-tengah gerakan Gulen. Sejauh ini gerakan Gulen merupakan sebuah contoh gerakan Islam yang mampu beradaptasi dengan perkembangan dunia kontemporer dan dianggap sebagai gerakan Islam progresif. Akan tetapi, pandangan Gulen tentang gender justru merefleksikan warna konservatif. Dengan menggunakan pendekatan fungsionalisme, artikel ini berupaya menggali dan mengupas persoalan akademik tersebut. Artikel ini mengungkapkan bahwa misi gerakan Gulen dalam menciptakan “masyarakat ideal” merupakan ideologi pendorong atas warna pandangan Gulen tentang hubungan gender dan peran perempuan. Sejumlah temuan tentang gerakan dan dari karya-karya Gulen mengungkapkan bahwa di mata Gulen posisi perempuan berada di bawah laki-laki dengan fungsi untuk mematuhi suami dan menjaga kehormatan keluarga. Peran perempuan dibatasi pada mendidik anak-anak mereka agar menjadi “generasi emas”. Karena itu, pandangan Gulen tentang relasi gender dan hak perempuan memperoleh bentuk senada dengan misi gerakan ini yang ingin mengubah masyarakat menjadi sebuah masyarakat ideal meskipun pada gilirannya harus mengorbankan kebebasan perempuan.
Health Care of Refugees in Indonesia: A Case Study in Kupang City, Indonesia
Authors: Ayuningtyas Dumilah , Utami Raden Roro Mega
Published: August 2020

Backgrounds: This study analyzes Indonesia's readiness to balance its role in responding to its internal and external health system situations, including the capacity of health advocacy and diplomacy in providing health services to the refugees. The analysis aims to provide recommendations to the government from the perspective of human rights and health security. Methods: Triangulation through observations, interviews with experts, and related literature and news searches were carried out using a qualitative approach to obtain thematic phenomena to validate data. Interviews were conducted using content analysis to get thematic phenomena based on structured interview guidelines to obtain the expert judgment. The selected informants are the main stakeholders in the health sector who meet appropriateness and adequacy principles. They also meet Tremblay's ideal informants' criteria, namely, role in community, knowledge, willingness, communicability, and impartiality.Results: Stakeholders have inadequate lines of communication, resulting in a lack of proper coordination between agencies. The Port Health Office (PHO) in Kupang was not involved in handling refugees despite its crucial role in preventing the entry and exit of potential disease outbreaks. The government of Indonesia established Presidential Regulation No. 125 of 2016 to deal with refugees abroad. However, the law has not been appropriately implemented. The city government of Kupang has not maintained an optimal balance between human rights and health security. Conclusions: Health advocacy and diplomacy capacity are needed to strengthen health resilience in preventive measures while recognizing the refugees' right to health as part of human rights.
Predicting Neovascular Glaucoma Risk in a Chinese Proliferative Diabetic Retinopathy Population: Development and Assessment of a New Predictive Nomogram
Authors: Zhang Xinyue , Chen Xiaolong , Xu Li
Published: August 2020

Background: The aim of this study was to develop and internally validate a postoperative NVG risk nomogram in a Chinese population of patients with PDR.Methods: We developed a prediction model based on a training dataset of 107 PDR patients who underwent vitrectomy from March,2017 to March,2018 in Shenyang Fourth People’s Hospital, and they were followed up for at least 12 months. The presence or absence of NVG were observed. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for the postoperative NVG risk model. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation.Results: Predictors contained in the prediction nomogram included HbAlc level, presence of diabetic nephropathy and anti-VEGF therapy. The model displayed good discrimination with a C-index of 0.852 (95% CI: 0.740–0.964) and good calibration. High C-index value of 0.849 could still be reached in the interval validation. Decision curve analysis showed that the NVG nomogram was clinically useful when intervention was decided at the NVG possibility threshold of 2%.Conclusion: This novel NVG nomogram incorporating HbAlc level, presence of diabetic nephropathy and anti-VEGF therapy could be conveniently used to facilitate the postoperative NVG risk prediction in PDR patients.
The Value of Urinary RBP4 in The Diagnosis of FSGS and other Renal Diseases.
Authors: Marek-Bukowiec Karolina , Konieczny Andrzej , Ratajczyk Krzysztof , Macur Katarzyna , Czaplewska Paulina , Czyżewska-Buczyńska Agnieszka , Kowal Paweł , Witkiewicz Wojciech
Published: August 2020

BackgroundUnequivocal diagnosis of FSGS can only be made with a renal biopsy, which is an invasive, risk-associated medical procedure. The discovery of non-invasive molecular biomarkers for the diagnosis of FSGS remains an important scientific goal. This study examines the urinary proteome of FSGS patients and reference groups, in order to identify urinary protein expression alterations indicative of FSGS. Methods Urine samples were collected from subjects representing FSGS, IgA nephropathy (IgAN), clear cell renal cell carcinoma (ccRCC), chromophobe renal cell carcinoma (chRCC), and healthy control group, respectively. The samples were subjected to SWATH-MS proteomics analysis. ELISA was utilized to validate the expression level of Retinol-binding protein 4 (uRBP4) in FSGS and reference samples (IgAN, ccRCC, chRCC, prostate cancer and healthy subjects).ResultsThe MS study identified 194 (FSGS), 179 (IgAN), 271 (ccRCC), 255 (chRCC), and 275 (healthy controls) urinary proteins. The comparative proteomic analysis revealed that urinary Retinol-binding protein 4 (uRBP4) clearly discriminates FSGS from the rest of the groups. Increased levels of uRBP4 in FSGS urine specimens were also evidenced by ELISA. Significantly elevated levels of uRBP4 were also observed for IgAN, ccRCC and chRCC versus healthy individuals. ConclusionsDetermining FSGS diagnosis based on uRBP4 expression alone is not possible. Specific uRBP4 concentration cut-off can be applied to accurately distinguish individuals with renal disorder (in general) from healthy subjects. Possibly, urinary RBP4 could serve as a screening biomarker identifying people at risk of renal disorders, who should undergo more detailed diagnostics.
Dark Energy is a Phenomenal Effect of the Expanding Universe-Possibility for Experimental Verification.
Authors: Kodukula Siva Prasad
Published: August 2020

Vacuum energy density has been defined and mass formation from ‘space-time’ has been viewed in a different perspective. This explanation for vacuum energy is based on ‘space-time’ and conversion of space in to time keeping ‘space-time density’ as constant. Equations for ‘space-time’ and mutual conversion of space and time have been derived. As a result, new concept of mass creation has been explained. By postulating that space time density of universe is constant, low and high values of cosmological constants has been shown as the exchange of energy between space, time and energy. The concept has been used to explain dark energy concept of the universe. It concluded a result that velocity of light is changing with the apparent expansion of the universe. The derived equation is possible for experimental verification. Obviously it is a contradiction to Big bang model. So the derived equation with the help of quantum concepts explained the 2.7o K cosmic micro wave background radiation. Finally it proposed a relation between diameter of hydrogen atom and Hubble’s constant with another postulate that gives importance to the existence of positive and negative charges below atomic level that describe the basic facts of quantum physics.
Associations of Different Media Activities With Behavioral Strengths and Difficulties and School Performance in Adolescents: a Cross-Sectional Analysis
Authors: Poulain Tanja , Meigen Christof , Grafe Nico , Kiess Wieland
Published: August 2020

Background: This study investigates the times adolescents engage in different media activities (including entertaining and educational activities) and explores associations with behavioral strengths and difficulties and school grades. Methods: This cross-sectional study included 664 10- to 18-year-old adolescents (350 boys, 314 girls) participating in the LIFE Child study in Germany. Participants completed questionnaires on their media use, on strengths and difficulties (using the Strengths and Difficulties Questionnaire), and on their school grades in mathematics and first language. Associations of the times engaged in different media activities via mobile phone or computer (traditional communication, social media use, gaming, playing learning games, watching videos, and searching for information) with behavioral strengths/difficulties and school grades were assessed using linear regression analyses (adjusting for age, gender, and socioeconomic status). Results: With the exception of playing learning games, each media activity was followed for almost one hour per day, with high inter-relations between the single activities. Gaming, watching videos, social networking, traditional communication, and playing learning games were significantly associated with more behavioral difficulties in at least one domain (emotional problems, conduct problems, hyperactivity/inattention, peer-relationship problems, prosocial behavior) and with lower school grades. Searching for information showed the weakest associations with behavioral difficulties and no association with school grades. In a multivariate analysis, searching for information was associated with fewer behavioral difficulties. Conclusions: Using media to search for information might weaken the adverse effects of other media activities on school performance and behavioral adjustment.
Improving Diagnostic Ability and Confidence In Otoscopy Through A Web Based Learning Platform: A Prospective Interventional Study
Authors: Azman Mawaddah , Rajasingam Devyadarsshni , Mokhtar Rahmi Hidayati Mohammad Mursal , Hamzah Amir Thaqiff , Iskandarrani Izzatul Ismah , Roslan Ainur Atikah , Besar Mohd Nasri Awang
Published: August 2020

Background

Otoscopy is an important clinical skill to master in the undergraduate medical curriculum. This study investigated the effect of a new web-based learning platform in improving diagnostic ability and confidence in otoscopy among final year medical undergraduates in Universiti Kebangsaan Malaysia Medical Centre (UKMMC).
Methods

A new web-based learning platform for otoscopy was introduced to final year medical undergraduates who have completed a three-week posting in otorhinolaryngology. A total of 45 subjects who participated in the learning platform were included in this prospective interventional study. All of them answered questionnaires on level of confidence (LC) and completed online questions on diagnostic ability (DA) at three different timelines during the study: prior to intervention (T1), after intervention (T2) and 4 months following the intervention (T3).
Results

LC scores were significantly higher in between T1 and other timelines measured: T1 vs T2 and T1 vs T3 respectively (p < 0.05). DA scores were significantly higher in between T1 and other timelines measured: T1 vs T2 and T1 vs T3 respectively (p < 0.05). LC and DA scores continued to improve at T3 with scores significantly higher when compared with scores at T2 (p < 0.05).
Conclusion

Subjects’ level of confidence in performing otoscopy and diagnostic ability showed sustained improvements at 4 months with this intervention. We conclude that otoscopy web based learning platform complements the teaching and learning of otoscopy among final year medical undergraduates.
The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: assessment of the psychometric properties of the Greek version of the BSES-SF tool.
Authors: Economou Mary , Kolokotroni Ourania , Paphiti-Demetriou Irene , Kouta Christiana , Lambrinou Ekaterini , Hadjigeorgiou Eleni , Hadjiona Vasiliki , Middleton Nicos
Published: August 2020

Background: Breastfeeding self-efficacy (BSES) is an important modifiable determinant of BF initiation, duration and exclusivity. The use of valid measurement tools of BSES is important in clinical and community practice. Thus, we aimed to assess the properties of the Breastfeeding Self-Efficacy Scale (BSES-SF) to measure the self-efficacy of mothers in Cyprus and its association with BF and EBF up to the sixth month.Methods: A cross-sectional and longitudinal descriptive study with a nationwide consecutive sample of 586 mother-infant dyads, recruited from all state maternity wards and 24 (of 30) private clinics within 24-48 hours of birth and followed up by telephone up to the 6 th month postpartum. BSES was assessed at the clinic and at the first month with the Greek version of the 14-item 5-point Likert BSES-SF scale. Information on infant feeding practices was collected at all four time points. The association between self-efficacy and breastfeeding outcomes was estimated in logistic regression models. Results: With Mean=3.55 (SD=0.85), BSES was only moderate, and lower among Cypriot women, primiparas, those who delivered by C/S and did not intent to breastfeed exclusively. There was good internal consistency across the 14 items (alpha coefficient=0.94). While higherlevels of self-efficacy were not strongly associated with the likelihood of breastfeeding initiation, there was a stepwise association with exclusivity. The association between in-hospital assessment of self-efficacy and long-term EBF persisted in multivariable models adjusting for socio-demographic characteristics. Women in the upper quartile of BSES at 48 hours were more likely to breastfeed exclusively at the 1 stand at the 4 th month. Similar, if not stronger, associations were observed between self-efficacy at the 1 st month and BF outcomes at subsequent time-points. High BSES at the first month (>3.96) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months.Conclusions: The Greek version of the BSES-SF showed good metric properties. The generally low prevalence of breastfeeding among mothers in Cyprus, suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.
Association of Stress Management Skills and Stressful Life Events With Allergy Risk: a Case-control Study in Southern China
Authors: Cheng Jingru , Li Fei , Lai Yigui , Chen Jieyu , Sun Xiaomin , Xiang Lei , Jiang Pingping , Wu Shengwei , Xiao Ya , Zhou Lin , Luo Ren , Zhao Xiaoshan , Liu Yanyan
Published: August 2020

Background: Psychosocial stress and stressful life events are known to aggravate atopic diseases. Less is known about the impact of stress management skills on allergies. Here we sought to determine whether stress management skills are associated with the allergies and to assess the combined effects of stress management skills and stressful events on allergy risk. Methods: A survey on risk factors for self-reported allergic diseases was carried out among 28,144 southern Chinese people; 14 stressful life events and 8 stress management skills were retrospectively recorded in a case-control setting with multivariate logistic regression analysis. Multiplicative and additive interactions between stressful events and stress management skills were evaluated. Results: Stressful events significantly increased allergy risk. The odds ratio (OR) for allergies was 1.65 (95% confidence interval CI, 1.41–1.93) for those reporting one or two stressful events and 3.10 (95% CI, 2.55–3.79) for those reporting more than two stressful events. Stress management skills were adversely associated with allergic risk for people experiencing stressful events (OR, 0.71; 95% CI, 0.53–0.97) when adjusted demographically, particularly “concentrate on pleasant thoughts at bedtime” (OR, 0.67; 95% CI, 0.51–0.89), “pace myself to prevent tiredness” (OR, 0.67; 95% CI, 0.54–0.83), “get enough sleep” (OR, 0.48; 95% CI, 0.32–0.72) and “take some time for relaxation each day” (OR, 0.55; 95% CI, 0.37–0.80). There was a significant linear trend for allergy risk from good stress management skills with no stressful events to poor stress management skills with stressful events (P < 0.000), with significant interaction in additive models (P = 0.006). Conclusions: There are independent and antagonistic combined associations of stressful life events and stress management skills with allergy risk. This supports the use of stress management skills in managing allergic disease.
Beliefs and Barriers Associated with COVID-19 Vaccination Among the General Population in Saudi Arabia
Authors: Magadmi Rania M , Kamel Fatemah O.
Published: August 2020

Background: Developing a vaccine against COVID-19 is considered a key strategy to end the pandemic. However, public acceptance is reliant on beliefs and perception toward the vaccine. Therefore, the study aimed to assess the beliefs and barriers associated with COVID-19 vaccination among the Saudi population. Methods: An online self-administered questionnaire was distributed across the main regions of Saudi Arabia on May 2020. The questionnaire addressed the socio-demographic variables, beliefs toward COVID-19 vaccination, and potential barriers that may prevent participants from being vaccinated. The association between COVID-19 vaccine acceptance and sociodemographic variables were analyzed. Logistic regression analysis was used to identify the predicting variables of vaccine acceptance.Results: Out of 3,101 participants, 44.7% are accepting of COVID-19 vaccination if available, whereas 55.3% admitted hesitancy. Younger, male, with secondary education, history of taking previous seasonal influenza vaccine, and positive belief toward COVID-19 vaccination are more likely to accept. The study found that concerns about side effects were the key barrier for vaccine acceptance. Furthermore, the majority of refusers will accept the vaccine if additional studies confirmed safety and effectiveness. Conclusion: Results can be utilized in planning vaccination campaigns while waiting for vaccine development.
COVID-19 and Epilepsy
Authors: Sidig Amira , Alhusseini Radi Tofaha , Abbasher Khabab , Elsayed Mohamed , Abbasher Hussien , Abbasher Mohammed , N Sufian Khalid M. , Hajnoor Khalid , Malekaldar Mohammed , Hussien Abbasher , Hamid Omer Eladil A. , Digna Mutaz F.
Published: August 2020

Introduction: COVID-19 caused by SARS-CoV-2 acquired via respiratory droplets. It can present with many systemic disorders, includingA 45-year-old Sudanese male known to have well-controlled generalized tonic-clonic epilepsy, He presented to the Accident and Emergency (A&E) department complaining of refractory status epilepticus. Despite immediate initial stabilization, the seizure attacks were still refractory to intravenous loading doses of antiepileptic drugs AEDs. Hence the patient was intubated and mechanically ventilated. Brain MRI and EEG were normal. The chest X-ray was normal. The screening of COVID-19 was positive.Epilepsy is one of the most common neurological disorders. Since the beginning of the Coronavirus outbreak in December 2019, no available research data is suggesting that the patients with epilepsy are at more risk than others. As no available data relating epilepsy to severe COVID-19 infection (6). Moreover, no data studied COVID-19 and the sudden unexpected death among epileptic patients (SUDEP).Conclusion: This case might report the effect of SARS-CoV-2 on provoking the refractory seizures in a previously well-controlled patient with epilepsy. More researches are needed to explain the relation between COVID and seizure threshold.
An Interdisciplinary Oral Health Program for Children in Kindergartens of Northern Italy
Authors: Orlando Antonina , Arisido Maeregu Woldeyes , Brioschi Stefano , Maccà Luca , Graci Stephanie , Panzeri Maria Cristina , Mecatti Fulvia , Palestini Paola , Cazzaniga Emanuela
Published: August 2020

Background: The aim of the study was to investigate if a parents’ training program on nutritional and oral health behaviours held by health professionals can influence children habits in a sample of kindergartens in Northern Italy.Methods: The study designed was a longitudinal study. The study population were children aged 6–36 months attending four kindergartens. Parents were invited to participate filling out a self-administered questionnaire, and after having returned the informed consent form they were asked to participate to a training meeting. Parents had to fill out a questionnaire at baseline and after 3 months from the training meeting. The questionnaire included information on socio-demographics about parents, oral hygiene habits of parents and child, and eating habits of child. Wald test was used to analyse data collected. Results: After the training program, almost all children were able to use a toothbrush suitable for kids (from 91% at the baseline to 99% after the 3-months). The analysis shows that the given training significantly increased the number of children who use toothpaste from 86% at baseline (95%CI: 85%-88%) to 96% (95%CI: 94%-98%). The use of fluoride toothpaste significantly increased after the training intervention as the baseline measure of 59% proportion increased to 80%. The intervention study showed a positive impact on the number of pupils who wash their tooth more than twice per week and on the timing of oral hygiene as both night and morning time proportion increased after the 3-month. Regarding the feeding habits the given consultation resulted in a statistically significant increase regarding the importance of morning snack from 94% at baseline (95%CI: 92%-96%) to 97% after 3-month (95%CI: 94%-99%). Another promising effect of the education is the decrease from 47% at baseline (95%CI: 46%-49%) to 42% after the study (95%CI:41%-43%) of the bad habit of having a snack after dinner.Conclusions: Results of our study have shown that a parents training intervention can have good results on the oral hygiene and eating habits of children of this age group. To underline the importance of several professional figures who work together with a common purpose.
Association of HMGB1, S100A12 and IL-17A Expression with IVIG-Resistant Kawasaki Disease and Treatment Options
Authors: Liu Deying , Liu Pan , Liu Fan , Yin Wei , Ding Yan
Published: August 2020

Background: Kawasaki disease (KD) is a medium vessel vasculitis of unknown aetiology that predominantly affecting coronary arteries. The damage-associated molecular pattern molecules (DAMPs) such as HMGB1, S100A12 and IL-17A have been reported to predict poor response to IVIG. Here, we explored the the role of HMGB1, S100A12 and IL-17A in the detection of intravenous immunoglobulin (IVIG)-resistant in KD patients, and to investigate the value of different adjunctive therapy.Method: 126 KD patients and as well as age- and sex-matched 16 febrile control subjects were enrolled in our study. The fresh peripheral blood were collected from KD patients and febrile controls, analyzed the demographic or clinical data and various laboratory parameters. We also measured changes in serum levels of IL-17A and mRNA expression levels of HMGB1 and S100A12 were tested in IVIG-resistant KD patients. Further we explored the association between coronary arteries lesions and different treatment options about IVIG retreatment, methylprednisolone and infliximab for IVIG-resistant KD patients. Result: Regarding laboratory parameters, KD individuals were found to have lower levels of lymphocyte(L)%, prealbumin, CD4+, CD8+ and higher levels of WBC, neutrophil (N)%, CRP, ESR, NT-proBNP, ALT, CD4+/CD8+ (P<0.05 or P<0.01). For KD group, the 53 IVIG-resistant patients had significantly higher levels of S100A12, HMGB1, serum IL-17A, N%, CRP, NT-proBNP, TBIL, ALT, AST and lower levels of L%, PLT (P<0.05 or P<0.01) in comparison to the IVIG-responsive patients. For patients with IVIG-resistant, IVIG retreatment, methylprednisolone or infliximab were used. Methylprednisolone showed better in improving clinical symptoms and CRP than the IVIG retreatment and infliximab (P> 0.05).Conclusion: IVIG-resistant was associated with overreaction of inflammation.The levels of HMGB1,S100A12 and IL-17A suggested to be reliable predictors for IVIG-resistant in KD. In addition, the adjunctive therapy of methylprednisolone and infliximab showed more effective in relieving clinical symptoms than IVIG retreatment.
Evaluation of Biochemical, Hematological and Oxidative Parameters in Mice exposed to the Binapacryl
Authors: Sowunmi Kehinde , Adebayo Sofiyah Modupeola , Lawal Ayobami Adesiyan , Kade Ayomikun Emmanuel , Kaur Gurpreet
Published: August 2020

We evaluated the toxicity of hepatic, hematological, and oxidative effects of binapacryl on female albino mice. The animals were treated orally with 50, 100, 150 and 200 mg/kg body weight of the binapacryl, on a daily basis for a period of 15 days. Distilled water was used as control treatment. Samples of blood and hepatic tissue were collected at the end of the treatment. Hepatotoxicity was monitored by quantitative analysis of the serum enzymes ALT, AST, γ-GT, urea and creatinine. We also investigated liver tissues histopathologically. Alterations of hematological parameters were monitored by RBC, WBC, hemoglobin, hematocrit, MCV, MCH, and MCHC. Significant increases in the levels of hepatic enzymes (ALT, AST, and γ-GT) were observed for both binapacryl treatments, but no considerable differences were found by histological analysis. The hematological parameters showed significant alterations (200mg/kg body weight) with reductions of RBC, hematocrit, and hemoglobin, together with a significant increase of MCV. There was an important increase in lipid peroxidation at both dosage levels, together with an NPSH decrease in the hepatic tissue, and significant changes in these parameters were observed only at the higher dose rate. The results of this study indicate that binapacryl can promote hematological and hepatic alterations, even at subacute exposure, which could be related to the induction of reactive oxygen species.
An Observational Study of a National Referral System: An Analysis of 14,266 Referrals in Sierra Leone
Authors: Youkee Daniel , Bangura Thaimu , O’Neill Kwame , Hartshorn Lucy , Samura Sorie
Published: August 2020

Background Referral systems are critical to a well-functioning health system. In 2017, a special cadre of referral coordinators were trained and deployed at every district and tertiary hospital in Sierra Leone. We analyse the referrals coordinated by the network to understand health service utilisation, referral pathways and outcomes.Methods A retrospective observational study of incoming referrals to all district and tertiary hospitals in Sierra Leone from 1st November 2017 until 31st October 2018. Multivariate analysis was performed on all referrals and a subgroup analysis of urgent referrals (n=10,865). Hospital preparedness and readiness scores were sourced from the Service Availability and Readiness Assessment 2017.Results 14,266 referrals were captured over the 12 months. Referral indices ranged from 0·51-5·97, with the highest indices found in Freetown and Pujehun. Bed occupancy ranged from 36·8-83·3%. 606 deaths were recorded, mortality rate per referral was 4.25%, with the majority of deaths, 446 (73.60%) occurring in the U5 population. Higher OR for mortality are seen from referrals originating from higher levels of the health system. The OR for mortality for a referral from the lowest level, MCHP, was 0.77, whilst from tertiary level was 2.40 (MCHP 0·77, CHP 0·90, CHC 1·40, district 2·06 and tertiary 2·40). For urgent referrals, factors associated with mortality were U5s, adult non-maternity cases and being seen by a clinician within one hour. Referrals from district hospitals to tertiary hospitals only accounted for 0·5% of all referrals. No correlation was found between referral index, bed occupancy and hospital service availability and readiness scores. The study did not detect any difference in total number of national referrals during the rainy season.Conclusions Wide variations in bed occupancy and referrals by district highlight disparities in health service utilisation. Low rates of referral from district hospitals to tertiary care should be further investigated. Referral indices and referral mortality rates are useful to monitor over time and to make inter district comparisons. Referral systems and pathways are useful indicators of health service utilisation and further research should be undertaken to standardise definitions and identify performance indicators for referral systems in low resource settings.
Management of Masada type I/IIb forearm deformity by gradual ulnar lengthening in patients with hereditary multiple osteochondromas
Authors: Li Yuchan , Wang Zhigang , Chen Mu , Cai Haoqi
Published: August 2020

Background

Gradual ulnar lengthening is the most commonly used procedure in treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children and only slightly handicapped of daily life activities in untreated adult patients. The aim of this study was to evaluate mid-term clinical and radiological outcomes of ulnar gradual lengthening in our clinic.
Methods

We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. Patients with less than two years of follow-up were excluded. The surgical procedures consisted of ulnar lengthening by external fixator and/or excision of the osteochondroma at the distal ulna. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, two months after external frame removal, and at the last follow-up.
Results

The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37.3 ± 7.9° to 29.8 ± 6.5° initially (P = 0.003) and relapsed to 34.4 ± 7.6° at the last follow-up (p = 0.234). There was minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). The elbow flexion and forearm pronation were improved significantly at last follow-up (p < 0.001 and p = 0.024, respectively). The mean carrying angle improved significantly from − 6.3 ± 7.4 ° preoperatively to 7.4 ± 11.1° at last follow-up (p < 0.001).
Conclusions

Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function; it is recommended for patients with Masada type I/IIb deformity. Therefore, we advocated aggressive individual treatment protocol for patients with Masada type I/IIb deformities.